Errol L. Fields

Masculine Socialization and sexual risk behaviors among Black men who have sex with men: A qualitative exploration

Aspects of masculine socialization among Black men who have sex with men (MSM) and potential corresponding influences on high-risk sexual behaviors are explored in this study. Individual interviews were conducted with 29 Black MSM in Atlanta, Georgia. Findings included (1) formative masculine socialization experiences marked by an absence of biological fathers and Black male role models, (2) negative perceptions of “gay” identities and communities, (3) race and racial identification as intersecting influences on masculine and sexual identities, (4) the influences of masculine socialization and beliefs on partner selection and sexual behaviors, and (5) general themes of trust, control, “heat of the moment” sex, and low self-love as primary factors influencing condom use. Implications for future research and HIV prevention efforts targeting Black MSM are discussed.

The Intersection of Sociocultural Factors and Health-Related Behavior in Lesbian, Gay, Bisexual, and Transgender Youth: Experiences Among Young Black Gay Males as an Example

Intersectionality suggests that multiple social identities intersect at the individual or micro level of experience and reflects larger social structural inequities experienced on the macro level. This article uses intersectionality to describe how multiple stigmatized social identities can create unique challenges for young black gay and bisexual men (YBGBM). YBGBM exist at the intersection of multiple stigmatized identities compared with their majority peers. This article examines key intersecting identities and cultural expectations that exist in YBGBM and how those factors may predispose young men to adverse health outcomes and health inequality.

Qualitative Comparison of Barriers to Antiretroviral Medication Adherence Among Perinatally and Behaviorally HIV-Infected Youth

Medication adherence among youth living with HIV (28%–69%) is often insufficient for viral suppression. The psychosocial context of adherence barriers is complex. We sought to qualitatively understand adherence barriers among behaviorally infected and perinatally infected youth and develop an intervention specific to their needs. We conducted in-depth interviews with 30 youth living with HIV (aged 14–24 years) and analyzed transcripts using the constant comparative method. Barriers were influenced by clinical and psychosocial factors. Perinatally infected youth barriers included reactance, complicated regimens, HIV fatigue, and difficulty transitioning to autonomous care. Behaviorally infected youth barriers included HIV-related shame and difficulty initiating medication. Both groups reported low risk perception, medication as a reminder of HIV, and nondisclosure, but described different contexts to these common barriers. Common and unique barriers emerged for behaviorally infected and perinatally infected youth reflecting varying HIV experiences and psychosocial contexts. We developed a customizable intervention addressing identified barriers and their psychosocial antecedents.

Sex Partner Meeting Places Over Time Among Newly HIV-Diagnosed Men Who Have Sex With Men in Baltimore, Maryland.

Background Sex partner meeting places may be important locales to access men who have sex with men (MSM) and implement targeted HIV control strategies. These locales may change over time, but temporal evaluations have not been performed. Methods The objectives of this study were to describe the frequency of report of MSM sex partner meeting places over time and to compare frequently reported meeting places in the past 5 years and past year among newly HIV-diagnosed MSM in Baltimore City, Maryland. Public health HIV surveillance data including partner services information were obtained for this study from the Baltimore City Health Department from May 2009 to June 2014. Results A total of 869 sex partner meeting places were reported, including 306 unique places. Bars/clubs (31%) and Internet-based sites (38%) were the most frequently reported meeting place types. Over the 5-year period, the percentage of bars/clubs decreased over time and the percentage of Internet-based sites increased over time. Among bars/clubs, 4 of 5 of those most frequently reported in the past 5 years were also most frequently reported in the most recent year. Among Internet-based sites, 3 of 5 of those most frequently reported in the past 5 years were also in the top 5 most frequently reported in the past year. Conclusion This study provides a richer understanding of sex partner meeting places reported by MSM over time and information to health departments on types of places to access a population at high risk for HIV transmission.

Introductory Learning of Inclusive Sexual History Taking: An E-Lecture, Standardized Patient Case, and Facilitated Debrief

Introduction This student-driven curriculum intervention, implemented with first-year medical students, was guided by the Association of American Medical Colleges’ standards for medical education on health care for sexual and gender minorities. Its goals are to describe the spectrum of sexual orientation and gender identity and sensitively and effectively elicit relevant information from patients about their sexual orientation and gender identity through inclusive sexual history taking. Methods Developed through student-faculty collaboration, this three-part module includes a 14-minute e-lecture on taking an inclusive sexual history, a 35-minute formative standardized patient encounter in which students take a sexual history and receive feedback, and a 20-minute facilitated group debrief on the standardized patient activity. Results Students completed a postmodule evaluation anonymously; the majority of respondents (92%) agreed that they felt more prepared to take a sexual history inclusive of sexual and gender minority patients. Most were more comfortable discussing sexual orientation (91%) and gender identity (83%) with patients after the module. Content analysis revealed an improved confidence in creating a safe space for sexual and gender minority patients and an increased awareness of biases about sexual and gender minority patients. Discussion This curriculum serves as an early foundation for students to understand sexual and gender minority identities and develop confidence in their inclusive sexual history taking skills before they provide care for patients. In addition, the student-driven curriculum development process used can serve as a template for students at other institutions hoping to collaborate with faculty to develop comprehensive sexual and gender minority curricula.

Treatment Considerations for the Cardiometabolic Signs of Polycystic Ovary Syndrome: A Review of the Literature Since the 2013 Endocrine Society Clinical Practice Guidelines

IMPORTANCE Polycystic ovary syndrome is characterized by an excess in androgen levels, ovarian dysfunction, and polycystic ovarian morphology but is also associated with metabolic dysfunction and risk factors for cardiovascular disease. To our knowledge, there are few therapeutic recommendations for these cardiometabolic risk factors and little evidence of their long-term clinical relevance to cardiovascular health. OBJECTIVE To determine metabolic and/or cardiovascular outcomes in polycystic ovary syndrome treatment literature since the publication of the most recent Endocrine Society clinical practice guidelines in 2013. EVIDENCE REVIEW We searched PubMed using a string of variations of polycystic ovary syndrome, therapy/treatment, and adolescence, and we included English-language original research articles published while the 2013 clinical practice guidelines were disseminated (ie, articles published from January 1, 2011, to June 1, 2015). Articles that appeared relevant based on a review of titles and abstracts were read in full to determine relevancy. References from relevant articles were reviewed for additional studies. FINDINGS Four topic areas emerged: (1) lifestyle modification, (2) metformin vs placebo or estrogen-progestin oral contraceptives, (3) insulin-sensitizing agents, and (4) estrogen-progestin formulations. Most studies assessed the role of metformin as a monotherapy or dual therapy supplement and found significant benefit when including metformin in polycystic ovary syndrome treatment regimens. Studies showed improvements in cardiometabolic risk factors and, in several, androgen excess and cutaneous and menstrual symptoms. Studies were limited by sample size (range, 22-171), few adolescent participants, and short-term outcomes. CONCLUSIONS AND RELEVANCE Findings show potential for metformin and estrogen-progestin dual therapy but warrant longitudinal studies examining outcomes from adolescence through middle age to determine the effect on long-term cardiovascular health.

Investigation of Early Syphilis Trends Among Men Who Have Sex With Men to Identify Gaps in Screening and Case-finding in Baltimore City, Maryland

BackgroundSyphilis incidence is increasing across the United States among men who have sex with men (MSM). Early latent (EL) versus primary and secondary (P&S) syphilis may be an indicator of delayed diagnosis and increased opportunity for transmission. To inform syphilis control strategies and identify potential gaps in case finding, we described recent syphilis trends among MSM and compared characteristics of syphilis cases by diagnosis stage. MethodsWe used public health surveillance data on P&S and EL syphilis diagnoses reported to the Baltimore City Health Department between 2009 and 2015. Differences across diagnosis stage were assessed using Cochran-Armitage and &khgr;2 tests. ResultsBetween 2009 and 2015, Baltimore City Health Department received 2436 reports of P&S and EL diagnoses. The majority (61%) of reports were among MSM, among whom 86% were black and 67% were human immunodeficiency virus (HIV)-infected. During this period, P&S and EL syphilis increased by 85% and 245%, respectively (P < 0.0001). MSM with EL versus P&S syphilis were similarly likely to be Black, more likely to be older (P < 0.05), HIV coinfected (P < 0.001), and diagnosed in private health care settings (P < 0.0001), but less likely to report multiple (P < 0.001) and anonymous sex partners (P < 0.001). ConclusionsIn Baltimore City, syphilis diagnoses, particularly EL diagnoses, are increasing rapidly and are concentrated among Black HIV-infected MSM. Significant gaps in identifying MSM with P&S syphilis may exist, specifically among HIV-infected MSM, and those diagnosed in private health care settings. Strategies to address these gaps may include local guidelines and provider education to screen MSM more frequently than CDC currently recommends and regardless of HIV status or risk.

O09.6 Integration of prep in an academic adolescent clinic & impact of prep use on sexually transmitted infection (STI) rates

Introduction US youth are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) significantly reduces the risk of HIV infection and may impact sexual risk. Clinics that serve adolescents are one site proposed in reaching sexually active youth. We sought to: 1) describe the integration of PrEP into an adolescent clinic; and 2) examine impact of PrEP use on sexually transmitted infection (STI) rates. Methods Over 6 months, we integrated PrEP program into current family planning (FP) and HIV testing programs in an urban adolescent clinic. Patient lists were reviewed daily to identify those eligible for HIV testing/FP. Each eligible youth was asked about awareness of and interest in PrEP. We reviewed each chart to examine the PrEP cascade including: awareness, receipt of information, referral and referral acceptance, and PrEP use. We then examined whether PrEP use impacted rates of STI, comparing proportion of youth on PrEP with an STI in the 6 months before and after PrEP. Results 234 youth were approached as part of the the HIV/FP program. The mean age was 17.7 (S.D. 3.0), 232 were black (99%), 101 were males (43%), 133 were females (57%), 2 transgender (1%), and 24 self-identified as lesbian, gay, or bisexual (LGB) (10%). Among the 234 youth seen, 17 (7.2%) were aware of PrEP, 49 (21%) received information, and 33 (14%) were referred for PrEP. Among those referred, 24 (73%) accepted referral and 15 (45%) initiated PrEP. Rates of STI decreased from 60% (n=9) at baseline/6 months prior to 13% in the 6 months after PrEP (p=0.02). Conclusions Few sexually active youth in this setting were aware of PrEP. Coupling HIV testing/FP with an assessment of interest in PrEP and referral to PrEP services may be one access point in increasing knowledge and use of PrEP.

P3.45 Identifying health care settings for prep delivery to msm at high risk for hiv acquisition

Introduction Syphilis rates among MSM are increasing sharply in urban areas across the U.S. MSM with syphilis are at high risk for acquiring HIV, and may be an important subgroup to increase awareness and delivery of pre-exposure prophylaxis (PrEP). Key, however, is identifying access points to this population. Our objective was to determine health care settings where syphilis positive and HIV negative (vs. HIV positive) MSM were diagnosed to prioritise and tailor to settings for PrEP delivery. Setting: A mid-Atlantic U.S. city which has seen a 102% increase in early (primary, secondary and early latent) syphilis among MSM from 2009–2015. Methods We analysed routinely collected public health surveillance data on MSM diagnosed with early syphilis reported to a city health department between 2009–2015. We compared diagnosing provider information by HIV status overall and in 2015 using Chi-squared tests. Results Of the 1,495 MSM diagnosed with early syphilis between 2009–2015, the majority was aged ≥ 25 years (73%), African American (86%) and HIV co-infected (67%). Overall, 52% were diagnosed in private health care settings, and 25% were diagnosed in publically funded sexually transmitted infection (STI) clinics. Early syphilis positive/HIV negative MSM were more likely than HIV positive MSM to receive a syphilis diagnosis in STI clinics (38% vs. 19% p=<0.0001) and Emergency Departments (EDs) or Urgent Care Centres (UCC) (12% vs. 8% p<0.0001) and less likely to be diagnosed by private providers (33% vs. 61%, p<0.0001). Among the 268 MSM diagnosed with early syphilis in 2015, HIV negative MSM (n=44) were as likely as HIV positive MSM (n=224) to receive a syphilis diagnosis in STI clinics (27% vs. 16%, p=0.06), more likely to be diagnosed in EDs/UCCs (20% vs. 10%, p=0.03) and less likely to be diagnosed by private providers (36% vs. 66%, p<0.0001). Conclusions EDs/UCCs and are important access points for MSM at high risk for HIV but sites may change over time. Efforts by the city health department to increase PrEP delivery at these sites are being initiated.

P3.126 Sex Partner Meeting Place Typologies Reported by Newly Diagnosed HIV-Infected MSM

Background Men who have sex with men (MSM) are affected by HIV more than any other group in the US, accounting for more than half of all new HIV infections annually. Within this group, young Black MSM (13–24) have had the highest increase in new infections. Characterizing sex partner meeting places of newly diagnosed HIV-infected MSM by race and age may help to identify locations for targeted control strategies in the populations most at risk. Targeted HIV control strategies seek to prevent HIV transmission by focusing specifically on those most likely to transmit, i.e. those with new infections or high viral loads. The objective of this study was to describe sex partner meeting place typologies and their distribution by age and race among newly diagnosed HIV-infected MSM in Baltimore, Maryland. Methods Using retrospective surveillance data of newly diagnosed HIV-infected MSM reported to the Baltimore City Health Department from 2009–2011, we identified the most frequently reported sex partner meeting place typologies and characterised their distribution by age and race. Results Among 243 reports of newly diagnosed HIV-infected MSM, 91% (220) were interviewed, and 64% (141) of those interviewed provided information on their sex partner meeting places in the past 12 months. Among the 141, 45% reported a bar or club, 41% reported using the internet, and 20% reported other places such as street corner or school. Meeting sex partners via the internet was more frequently reported by younger (≤ 24 years) compared to older MSM (49% vs. 34%, respectively) and Black compared to white MSM (43% vs. 28%, respectively). Conclusion Among those who reported sex partner meeting places, young (vs. older) and Black (vs. white) MSM more frequently reported meeting sex partners via the internet. The internet may be an important location for targeted HIV control strategies especially among young Black MSM.