In light of recent advances in HIV prevention and treatment, we reviewed the literature to understand how different types of stigma impact HIV risk; access to HIV prevention, care, and treatment services; and related health outcomes among men who have sex with men (MSM) in the US. We conducted a scoping literature review of observational and qualitative studies that examined stigma and HIV-related outcomes among MSM. Our search identified 5794 studies, of which 47 met the eligibility criteria and were included in the final analysis. The review suggests that stigma remains a formidable barrier to engaging in HIV prevention and treatment among both HIV-negative and HIV-positive MSM. Among the studies of HIV-positive MSM, internalized stigma was related to lower levels of treatment engagement. HIV-positive MSM in the Southern part of the US were also more likely to engage in risky sexual behavior. Perceived health care discrimination was negatively associated with PrEP awareness, particularly among HIV-negative Black MSM. Among young MSM of color, intersectional stigma compounded the social structural barriers to PrEP adherence. Findings indicate that stigma reduction interventions should be implemented in diverse MSM communities to address the disproportionate burden of HIV along with critical gap in the care continuum. Further research should examine how individual types of stigma, including intersectional stigma, affect viral suppression and PrEP uptake and adherence, especially among MSM of color. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-021-03262-4.
Background: The disproportionate burden of more aggressive breast cancer subtypes among African American/Black women may stem from multilevel determinants. However, data are limited regarding the impacts of neighborhood social environmental characteristics among Black women. Methods: We evaluated the association between neighborhood-level socioeconomic status (nSES) and breast cancer subtypes in the Women's Circle of Health and Women's Circle of Health Follow-up Study, which included 1,220 Black women diagnosed from 2005 to 2017 with invasive breast cancer. nSES at diagnosis was measured using NCI's census tract-level SES index. We used multilevel multinomial logistic regression models to estimate the association of nSES with breast cancer subtypes [triple-negative breast cancer (TNBC), HER2-positive vs. luminal A], adjusting for individual-level SES, body mass index, and reproductive factors. We tested for interactions by neighborhood racial composition. Results: Compared with census tracts characterized as high nSES, the relative risk ratios (RRR) for TNBC were 1.81 [95% confidence interval (CI): 1.20–2.71] and 1.95 (95% CI: 1.27–2.99) for women residing in areas with intermediate and low nSES, respectively (Ptrend = 0.002). Neighborhood racial composition modified the association between nSES and TNBC; the highest relative risk of TNBC was among women residing in low nSES areas with low proportions of Black residents. Conclusions: Black women residing in socioeconomically disadvantaged neighborhoods may have an increased risk of TNBC, particularly in areas with lower proportions of Black residents. Impact: Places people live may influence breast tumor biology. A deeper understanding of multilevel pathways contributing to tumor biology is needed.
Introduction:Various built environment factors might influence certain health behaviors and outcomes. Reliable, resource-efficient methods that are feasible for assessing built environment characteristics across large geographies are needed for larger, more-robust studies. This paper reports the item response prevalence, reliability, and rating time of a new virtual neighborhood audit protocol, drop-and-spin auditing, developed for assessment of walkability and physical disorder characteristics across large geographic areas.Methods: Drop-and-spin auditing, a method where a Google Street View (GSV) scene was rated by spinning 360° around a point location, was developed using a modified version of the virtual audit tool CANVAS. Approximately 8,000 locations within Essex County, New Jersey were assessed by 11 trained auditors. Thirty-two built environment items per a location within GSV were audited using a standardized protocol. Test-retest and inter-rater κ statistics were from a 5% subsample of locations. Data were collected in 2017-2018 and analyzed in 2018.Results: Roughly 70% of GSV scenes had sidewalks. Among those, two thirds were in good condition. At least five obvious items of garbage or litter were present in 41% of GSV scenes.
Background: Studies have been conducted to assess the prevalence of undiagnosed HIV infections however, at present, there is no study that compares and evaluates the association of perceived HIV stigma, gay related enacted stigma, and undiagnosed HIV infections among MSM by geographic region in the United States (U.S). This ecological study identifies clusters of cities with similar stigma measures in the U.S. Methods: We conducted the analysis using data from National HIV Behavioral Surveillance (NHBS) collected during the 2017 MSM cycle. We used unsupervised machine learning procedure known as k-means clustering to identify clusters of cities with similar stigma measures. We also examined correlations between percentages of undiagnosed HIV infections both with perceived HIV stigma and gay related enacted stigma. In addition, we used American Community Survey (ACS), 2013-2017, data to characterize each city in terms of key population level characteristics. Results: Cities were grouped in two distinct clusters after the implementation of the clustering technique; each cluster was different in terms of their racial makeup. There was a moderate correlation (0.50) between percentage of perceived HIV stigma and undiagnosed HIV infections and a low correlation (0.23) between percentage of gay related enacted stigma and undiagnosed HIV infections among MSM. Conclusion: Stigma reduction interventions should be tailored by city to address the underlying HIV burden among MSM communities. This will not only improve the health of the MSM communities but the larger community as a whole. Future studies should include more cities from the Southern U.S and examine how stigma affects MSM populations, especially of color.
Background: Compared to White women, African American/Black women are more likely to develop triple-negative breast cancer (TNBC), an aggressive breast cancer subtype. While many studies have examined individual-level socioeconomic status (SES) as a major social determinant of more aggressive breast tumor phenotypes, the impact of neighborhood-level SES (nSES) on breast cancer is not well understood, particularly among Blacks. Objective: To evaluate the impact of nSES on breast cancer subtypes among Black women with breast cancer. Methods: We evaluated the association of interest among 1,220 Black women with invasive breast cancer from 2006 to 2018 enrolled from 10 counties of New Jersey in the Women’s Circle of Health Study (WCHS). Residential address at diagnosis was geocoded to the census tract-level. Neighborhood SES was measured using the NCI’s census tract-level SES index, a time-dependent score constructed by a factor analysis of seven variables measuring different aspects of census tract SES (education index, percent unemployed, percent working class, median household income, percent below 150% of poverty line, median house value, and median rent). In a case-only analysis, we used multilevel multinomial logistic regressions to estimate nSES in relation to breast cancer subtype (TNBC, HER2-enriched, Luminal B vs. Luminal A). Models were adjusted for individual-level SES variables, body mass index and reproductive factors, and census tract-level percentage of Black residents. We tested whether the associations were modified by percentage of Black residents and participant’s education. Results: Higher nSES was found to predict a lower risk of TNBC. Compared to tertile 1 (lowest nSES score), the odds ratio (OR) was 0.91 (95% CI: 0.65, 1.29) for tertile 2 and 0.52 (95% CI: 0.34, 0.79) for tertile 3 (highest nSES score; p-trend: 0.001). Higher nSES was borderline significantly associated with a lower risk of Luminal B (OR: 0.61 comparing highest vs. lowest nSES tertile; 95% CI: 0.36, 1.03; p-trend: 0.055). The inverse association between nSES and TNBC was observed only among Black women living in census tracts with lower proportion of Black residents (p-for-interaction=0.08). Compared to the lowest nSES tertile, OR was 0.38 (95% CI: 0.21, 0.68) for the highest tertile (p-trend: <0.001). There was a suggestion that the inverse relationship of nSES with TNBC was also more pronounced among women who had relatively lower levels of education. Conclusion: Neighborhood socioeconomic environment may influence the development of TNBC among Black women, which might be buffered by some contextual factors in areas with more Black residents. Further investigation to elucidate these factors is needed. Citation Format: Bo Qin, Adana A.M. Llanos, Riddhi Babel, Jesse J. Plascak, Karen Pawlish, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Impact of neighborhood socioeconomic status on breast cancer subtypes among Black women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C063.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.