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Dive into the research topics where Anthony J. Silvestre is active.

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Featured researches published by Anthony J. Silvestre.


Journal of Acquired Immune Deficiency Syndromes | 2009

Evaluation of Adherence and Factors Affecting Adherence to Combination Antiretroviral Therapy among White, Hispanic, and Black Men in the MACS Cohort

Debora Lee Oh; Farjad Sarafian; Anthony J. Silvestre; Todd T. Brown; Lisa P. Jacobson; Sheila Badri; Roger Detels

Objectives:This study investigated levels of adherence to antiretroviral therapy in white, Hispanic, and black men and isolated factors associated with adherence among each racial group. Methods:Data were collected from 1102 men enrolled in the Multicenter AIDS Cohort Study followed between April 2002 and October 2006. Self-reported 100% adherence was defined as taking all doses and pills over the previous 4-day period, reporting not typically skipping any medications, and reporting always following the medication schedule. Variables associated with adherence were determined by multilevel logistic regression for each racial group. Adherence was also analyzed by ethnicity within racial groups. Results:After controlling for confounders, we found that Hispanics were 2.16 times and blacks were 1.37 times more likely than whites to not report 100% adherence (95% confidence interval 1.47 to 3.18 and 1.05 to 1.79, respectively). Hispanics with ethnic backgrounds from Central and South America and the Caribbean had lower rates of adherence. Blacks with ethnic backgrounds from the Caribbean had lower rates of adherence than those from other regions.


PLOS ONE | 2014

HIV Infection and Sexual Risk among Men Who Have Sex with Men and Women (MSMW): A Systematic Review and Meta-Analysis

M. Reuel Friedman; Chongyi Wei; Mary Lou Klem; Anthony J. Silvestre; Nina Markovic; Ron Stall

Objectives To estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses. Results We estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples. Conclusions This represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population’s HIV burden.


American Journal of Public Health | 2006

Recruiting Minority Men Who Have Sex With Men for HIV Research: Results From a 4-City Campaign

Anthony J. Silvestre; John B. Hylton; Lisette Johnson; Carmoncelia Houston; Mallory D. Witt; Lisa P. Jacobson; David G. Ostrow

We describe the efforts of a 4-city campaign to recruit Black and Hispanic men who have sex with men into an established HIV epidemiological study. The campaign used community organizing principles and a social marketing model that focused on personnel, location, product, costs and benefits, and promotion. The campaign was developed at the community, group, and individual levels to both increase trust and reduce barriers.The proportion of Hispanic men recruited during the 2002-2003 campaign doubled compared with the 1987 campaign, and the proportion and number of White men decreased by 20%. The proportion of Black men decreased because of the large increase in Hispanic men, although the number of Black men increased by 56%. Successful recruitment included training recruitment specialists, involving knowledgeable minority community members during planning, and having an accessible site with convenient hours.


AIDS | 2015

Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study.

M. Reuel Friedman; Ron Stall; Anthony J. Silvestre; Chongyi Wei; Steve Shoptaw; Amy L. Herrick; Pamela J. Surkan; Linda A. Teplin; Michael Plankey

Objectives:The objective of this study is to determine associations between intertwining epidemics (syndemics) and HIV medication adherence and viral load levels among HIV-positive MSM and to test whether adherence mediates the relationship between syndemics and viral load. Design:We analysed participant data collected between 2003 and 2009 from the Multicenter AIDS Cohort Study, a prospective HIV/AIDS cohort study in four U.S. cities. Methods:We conducted longitudinal analyses (repeated measures mixed models) to assess whether differences in viral load levels, undetectable viral load and self-reported HIV medication adherence were associated with count of syndemic conditions (substance use, depression symptoms and sexual risk behaviour, range 0–3), adjusting for race/ethnicity, age and income. Mediation analyses were conducted using structural equation modelling and the SAS %mediate macro. Results:Syndemics count was associated with higher viral loads (P < 0.0001) and lower adherence (P < 0.0001). Increased counts of concomitant syndemics were associated with viral load (P < 0.01), detectable viral load (P < 0.05) and adherence (P < 0.001). Black MSM experienced worse outcomes across domains than white MSM (P < 0.0001) and experienced higher overall rates of syndemics (P < 0.01). Adherence significantly mediated the relationship between syndemics and viral load, accounting for an estimated 32.3% of the effect (P < 0.05). Conclusion:Effectively lowering viral load levels among MSM has implications for both HIV/AIDS prevention and care. Our findings suggest that integrating substance use interventions, mental healthcare and sexual risk prevention into standard HIV care may be necessary to optimize treatment and Treatment as Prevention (TasP) models.


AIDS | 1989

Factors related to seroconversion among homo- and bisexual men after attending a risk-reduction educational session.

Anthony J. Silvestre; David W. Lyter; Ronald O. Valdiserri; James Huggins; Charles R. Rinaldo

Thirteen homosexual men, volunteers in a study of the natural history of HIV, who seroconverted to HIV after participating in an educational program on HIV prevention, were interviewed about the circumstances leading to their seroconversion. Six men had participated in unprotected anal intercourse with at least one partner whom they believed was HIV-negative. Four men attributed their conversion to mental health problems or to drug and alcohol use. Two mens seroconversions could not be ascertained and one man attributed seroconversion to a condom break. Most men who had learned how to avoid infection, and had successfully done so for a time, had knowingly engaged in unsafe behaviors because of strong emotional responses to certain partners or because of mental health or drug and alcohol-related problems. Skills training for dealing with partners who pressure men to behave unsafely is needed, as is mental health and drug and alcohol counseling for men at risk for HIV infection.


Aids Care-psychological and Socio-medical Aspects of Aids\/hiv | 2010

Intimate partner violence among HIV-positive persons in an urban clinic

Michael A. Yonas; Anthony J. Silvestre; Jessica G. Burke

Abstract While the intersection of HIV/AIDS and intimate partner violence (IPV) has gained increased attention, little focus has been given to the relationship among minority men and men who have sex with men (MSM). This pilot study, conducted at an urban clinic, explores the IPV experiences of HIV-positive persons involved in both heterosexual and homosexual relationships. Fifty-six HIV-positive individuals were interviewed to assess for verbal, physical, and sexual IPV, and for HIV-related abuse and attitudes regarding routine IPV screening. Approximately three quarters (73%) of the sample reported lifetime IPV and 20% reported current abuse. Physical IPV (85%) was cited the most by abused participants. IPV rates were highest among African-Americans and MSM. More than one-fourth (29%) of those abused felt the abuse was related to their HIV status. A majority of participants favored IPV screening by providers, but felt it might increase risk of IPV. IPV and its association to HIV are significant issues among this sample. Findings support the need for developing new programs that address these epidemics simultaneously.


Sexually Transmitted Infections | 2002

Prevalence of chlamydia and gonorrhoea among a population of men who have sex with men

Robert L. Cook; K St George; Anthony J. Silvestre; S A Riddler; Maryann Lassak; Charles R. Rinaldo

Objectives: Few data are available on the prevalence of sexually transmitted diseases (STDs) in men who have sex with men (MSM), making it difficult to develop STD screening guidelines for this population. The objective of the study was to determine the prevalence of urethral infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae within a large, community based population of MSM, and to assess the feasibility of rectal screening in this population. Methods: This was a cross sectional study of 566 MSM, who were predominantly middle aged, white, asymptomatic, and engaged in sex with multiple partners. All provided a urine sample to screen for chlamydial and gonorrhoea infections using a PCR assay; rectal screening was performed on 48 participants. Results: Urethral C trachomatis infections were detected in 1/566 participants (prevalence 0.2%, 95% CI 0.004% to 1.0%), and rectal C trachomatis infections were detected in 2/48 men (prevalence 4.2%, 95% CI 0.5% to 14.2%). No gonorrhoea infections were detected, and none of the 117 HIV positive men had either infection. Conclusions: Chlamydial and gonorrhoea infections were uncommon in this sample of MSM, even among those with multiple sexual partners or HIV infection. These data call into question recommendations to screen all MSM based on their individual sexual behaviours or HIV. Additional data are needed on the prevalence of these infections in MSM from different settings.


Journal of Acquired Immune Deficiency Syndromes | 2014

Stuck in the middle: longitudinal HIV-related health disparities among men who have sex with men and women.

M. Reuel Friedman; Ron Stall; Anthony J. Silvestre; Brian Mustanski; Steve Shoptaw; Pamela J. Surkan; Charles R. Rinaldo; Michael Plankey

Introduction:Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO. Methods:Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion. Results:MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01). Discussion:Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.


Journal of Community Health | 1986

Marketing strategies for recruiting gay men into AIDS research and education projects

Anthony J. Silvestre; David W. Lyter; R Charles RinaldoJr.; Lawrence A. Kingsley; Randall Forrester; James Huggins

Recruiting gay and bisexual men into AIDS-related research and education programs will become increasingly common as federal, state and local funds become available. The Pitt Mens Study, a study of the natural history of Human Immunodeficiency Virus (HIV) infection, developed a recruitment strategy based on marketing principles. These techniques allowed the study to target particular gay and bisexual groups for inclusion. 1718 gay and bisexual men were recruited. Non-whites and unemployed men were targeted and recruited in numbers comparable to their representation in the larger community.


Archives of Sexual Behavior | 2012

Sexual, Behavioral, and Quality of Life Characteristics of Healthy Weight, Overweight, and Obese Gay and Bisexual Men: Findings from a Prospective Cohort Study

Thomas E. Guadamuz; Sin How Lim; Michael P. Marshal; Mark S. Friedman; Ron Stall; Anthony J. Silvestre

While there have been attempts to explore the association of obesity and risky sexual behaviors among gay men, findings have been conflicting. Using a prospective cohort of gay and bisexual men residing in Pittsburgh, we performed a semi-parametric, group-based analysis to identify distinct groups of trajectories in body mass index slopes over time from 1999 to 2007 and then correlated these trajectories with a number of psychosocial and behavioral factors, including sexual behaviors. We found many men were either overweight (41.2%) or obese (10.9%) in 1999 and remained stable at these levels over time, in contrast to recent increasing trends in the general population. Correlates of obesity in our study replicated findings from the general population. However, we found no significant association between obesity and sexual risk-taking behaviors, as suggested from several cross-sectional studies of gay men. While there was not a significant association between obesity and sexual risk-taking behaviors, we found high prevalence of overweight and obesity in this population. Gay and bisexual men’s health researchers and practitioners need to look beyond HIV and STI prevention and also address a broader range of health concerns important to this population.

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Ron Stall

University of Pittsburgh

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David W. Lyter

University of Pittsburgh

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Chongyi Wei

University of California

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