Daniel E. Siconolfi

Individual, psychosocial, and social correlates of unprotected anal intercourse in a new generation of young men who have sex with men in New York City.

OBJECTIVES We examined associations of individual, psychosocial, and social factors with unprotected anal intercourse (UAI) among young men who have sex with men in New York City. METHODS Using baseline assessment data from 592 young men who have sex with men participating in an ongoing prospective cohort study, we conducted multivariable logistic regression analyses to examine the associations between covariates and likelihood of recently engaging in UAI with same-sex partners. RESULTS Nineteen percent reported recent UAI with a same-sex partner. In multivariable models, being in a current relationship with another man (adjusted odds ratio [AOR] = 4.87), an arrest history (AOR = 2.01), greater residential instability (AOR = 1.75), and unstable housing or homelessness (AOR = 3.10) was associated with recent UAI. Although high levels of gay community affinity and low internalized homophobia were associated with engaging in UAI in bivariate analyses, these associations did not persist in multivariable analyses. CONCLUSIONS Associations of psychosocial and socially produced conditions with UAI among a new generation of young men who have sex with men warrant that HIV prevention programs and policies address structural factors that predispose sexual risk behaviors.

Substance Use in the MSM Population of New York City during the Era of HIV/AIDS

This literature review considers the historical significance, emergence of, and interplay between the HIV and illicit drug use epidemics among gay, bisexual, and other men who have sex with men (MSM) in New York City (NYC). The continual rise in HIV infections in recent years among MSM, particularly among young MSM (YMSM), commands a need for the examination of the effectiveness of current HIV prevention strategies and a more comprehensive understanding of the complex biopsychosocial influences that place YMSM at risk. A chronological perspective of both the HIV and illicit drug use epidemics affecting NYC MSM is presented, followed by a review of the existing research on the synergistic relation between the two. Special consideration is given to the patterns and interconnectivity between HIV, substance use, and housing instability specific to YMSM, as they represent the demographic currently at greatest risk for HIV transmission in NYC. Thereafter, an overview of treatment research is provided. We conclude by offering recommendations for future research and best practices as we move forward in an attempt to reduce the incidence of HIV transmission.

Sexual Behaviors of Adolescent Emerging and Young Adult Men Who Have Sex With Men Ages 13-29 in New York City

Content: HIV infections among young men who have sex with men (YMSM), ages 13-29 in New York City have been steadily increasing over the last decade. Objective: To document the sexual onset and behavior of YMSM as a means for informing the development of new HIV prevention messaging. Design: Cross-sectional study. Participants: Five hundred fifty-eight YMSM, with more than 60% racial/ethnic minorities. Results: Young adults (25-29 years) reported a greater number of lifetime sexual partners, but the adolescents (13-17 years) and emerging adults (18-24 years) reported having their first sexual encounter with another man at a younger age. Black and Latino men first engaged in various sexual behaviors, including receptive anal intercourse, at a younger age than either Asian/Pacific Islander or white men, and were more likely to report an HIV-seropositive status. Across race/ethnicity, YMSM reported an equivalent number of recent male sex partners and selected both main and casual partners who were age and race/ethnicity matches. During the most recent sexual encounter with a casual male partner, black men were more likely than white men to have had unprotected receptive anal intercourse, whereas white men were more likely to report unprotected oral sex. Black YMSM reported more recent female partners than all other groups. Conclusions: Black and Latino YMSM may be at increased risk for seroconversion because they tend to start having sex with other men at a younger age than their white and Asian/Pacific Islander peers and because they engage in unprotected sexual behaviors with men of concordant race/ethnicity and of a similar age where levels of viremia may be more elevated but not because of the sheer number of sexual partners.

Sexual Risk Taking in Relation to Sexual Identification, Age, and Education in a Diverse Sample of African American Men Who Have Sex with Men (MSM) in New York City

HIV disproportionately affects African American men who have sex with men (MSM) in the United States. To inform this epidemiological pattern, we examined cross-sectional sexual behavior data in 509 African American MSM. Bivariate logistic regression analyses were conducted to examine the extent to which age, education, and sexual identity explain the likelihood of engaging in sex with a partner of a specific gender and the likelihood of engaging in unprotected sexual behaviors based on partner gender. Across all partner gender types, unprotected sexual behaviors were more likely to be reported by men with lower education. Younger, non-gay identified men were more likely to engage in unprotected sexual behaviors with transgender partners, while older, non-gay identified men were more likely to engage in unprotected sexual behaviors with women. African American MSM do not represent a monolithic group in their sexual behaviors, highlighting the need to target HIV prevention efforts to different subsets of African American MSM communities as appropriate.ResumenEn los Estados Unidos el VIH afecta desproporcionadamente a los hombres Afroamericanos que tienen sexo con otros hombres. Para explorar este patrón epidemiológico, examinamos transversalmente la conducta sexual de 509 hombres Afroamericanos que tienen sexo con otros hombres. Se realizó un análisis de regresión logística binaria para examinar en qué medida la edad, la educación, y la identidad sexual explicarían la probabilidad de tener relaciones sexuales con una pareja de un género específico y la probabilidad de tener relaciones sexuales sin protección basada en el género de la pareja. Independientemente del genero de la pareja (hombres, mujeres, y transgénero), el tener relaciones sexuales sin protección fue reportado más frecuentemente por hombres con menor educación formal. Los hombres más jóvenes y que no se identifican como gay tuvieron una mayor probabilidad de reportar relaciones sexuales sin protección con parejas transgénero. Mientras que los hombres más viejos y que no se identifican como gay tuvieron una mayor probabilidad de reportar relaciones sexuales sin protección con mujeres. Los hombres Afroamericanos que tienen sexo con otros hombres no representan un grupo monolítico en sus relaciones sexuales, destacando la necesidad de dirigir los esfuerzos de prevención del VIH en modo específico a diferentes subgrupos de estas comunidades.

Club Drug Use, Sexual Behavior, and HIV Seroconversion: A Qualitative Study of Motivations

This qualitative study funded by the National Institute on Drug Abuse examines phenomenological meanings surrounding motivations for club drug use in a sample of HIV seroconverted and seronegative gay and bisexual men. Grounded in the cognitive escape model (CEM), this study sought to clarify the synergistic relationship between club drug use, risky sexual behavior, and seroconversion. Sixteen seropositive participants were drawn from a large-scale (n = 450), longitudinal, mixed-method investigation of club drug use among gay and bisexual men in New York City from 2001–2004 and matched with 16 seronegative participants for race/ethnicity, most-frequently used substance, and educational level. Total sample size consisted of 32 participants. Sample size consisted of 13 (41%) Black/African-American, 12 (37.5%) White/Caucasian, 5 (15.5%) Hispanic/Latino, and 2 (6%) mixed/other race/ethnicity participants. Findings suggest behavioral outcomes of club drug use and HIV seroconversion result from complex interactions between physical, emotional, and social motivations.

Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore

Background Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations. Objective We describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore. Methods Participants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants’ location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants’ self-reported episodes of drinking. Results A total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score ≥16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable. Conclusions This study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings.

Alcohol Use Among Young Men Who Have Sex With Men

This study reveals associations between alcohol use and demographic variables, as well as the relation between alcohol use and sexual activity, using episodic data. Data were obtained during summer and fall from a sample of 558 gay, bisexual, and other young men who have sex with men (YMSM), ages of 13–29 years in New York City. Recruitment strategies targeted potential participants at gay-related venues and public spaces often frequented by YMSM. Alcohol use varied by race/ethnicity, with White YMSM consuming significantly more alcohol than other races/ethnicities. Participants over the age of 21 drank significantly more alcohol than participants ages 13–20. Alcohol use was not found to be associated with sexual risk-taking activity. Our findings are enriched by a large, diverse sample of urban YMSM. Study limitations are noted.

Methamphetamine Use among Gay, Bisexual and Non-identified Men-Who-Have-Sex-with-Men An Analysis of Daily Patterns

This study sought to understand the patterns, methods of administration and contexts for methamphetamine use (MA) in a sample of racially diverse men who have sex with men (MSM). Inclusion into the study required participants to be classified as clinically dependent on MA, but indicate no other illicit substance use. Use was assessed using Timeline Followback for a period of 30 days. Of the 900 assessed days, MA use was reported on 217. Participants reported an average of seven days of use, with the majority of use occurring on the weekend. The weekend usage pattern suggests an incorporation of drugs into the lives of gay men as a means of socialization and recreation.

Cigarette Smoking as Part of a Syndemic among Young Men Who Have Sex with Men Ages 13–29 in New York City

The prevalence of cigarette smoking among young men who have sex with men (YMSM) is significantly higher than among their heterosexual peers. We undertook an analysis to examine cigarette smoking in relation to demographic factors and other risk behaviors among 580 YMSM, ages 13–29, in New York City. Cross-sectional data were collected as part of larger study of risk behaviors using palm devices and targeted active recruitment strategies across all five boroughs of the city. Multivariate modeling suggests that Asian or Pacific Islander and White YMSM are more likely to report cigarette smoking than other racial and ethnic groups, as are men reporting a middle class socioeconomic status. In addition, smoking was related to the likelihood of using a variety of illicit substances, as well as alcohol and pharmaceuticals without a prescription, during the period of assessment. YMSM who smoke cigarettes reported a greater number of casual sex partners and a greater number of transactional sex partners than non-smokers. Episodic analysis of sexual behaviors with casual partners indicated that smokers were more likely to engage in illicit drug and alcohol use immediately before or during sex than did non-smokers. These findings are understood as part of a larger syndemic among YMSM, and suggest that smoking prevention and cessation programs should be embedded as part of larger more holistic health and wellness programs targeting YMSM.

Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults

BACKGROUND Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED). METHODS Cross-sectional surveys were completed by 75,192 students aged 18-29 years attending 120 post-secondary educational institutions in the United States from 2011 to 2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females. RESULTS Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28 to 0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24 to 0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization. CONCLUSIONS Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.