Ian W. Holloway

Sex risk among young men who have sex with men who use Grindr, a smartphone geosocial networking application.

Objectives: Smartphone geosocial networking applications, like Grindr, have become a new context through which young men who have sex with men (YMSM) can meet potential sex partners. Geosocial networking applications move beyond online social networking websites like Facebook by utilizing smartphones’ geo-location functions to facilitate connections with other users based on their current physical location. This study presents data on HIV risk-taking behaviors of YMSM who use Grindr, comparing the sex behaviors with partners met via the application to behaviors with partners met via other means (e.g., a bar, through friends, online). Methods: Utilizing the geo-locating feature of Grindr, 195 YMSM, aged 18 to 24, were randomly recruited based on their location within West Hollywood and Long Beach, CA between August and October, 2011. Participants completed an online survey. Results: YMSM reported using Grindr for entertainment, socializing, partner seeking, and gay community connection. Seventy-five percent of users reported sexual encounters with partners met on Grindr. YMSM reported significantly higher rates of condom use with partners met on Grindr (59.8%) relative to those partners met elsewhere (41.9%). Only 14.7% reported unprotected anal intercourse (UAI) with their last Grindr partner. YMSM who reported UAI with their last partners from Grindr reported significantly more recent male anal sex partners than YMSM who reported no UAI with their last Grindr-met partners. Conclusions: Grindr was used by YMSM for a variety of reasons, and not exclusively for the purpose of sex partner seeking. Overall YMSM who use Grindr practice safer sex with partners met via the application than with partners met elsewhere. YMSM engaging in UAI with partners on Grindr are an especially high-risk group and should be targeted by prevention efforts. Sexual risk behavior with geosocial networking-located partners could be addressed with mobile HIV prevention applications, or within Grindr and other similar applications.

Associations of unprotected anal intercourse with Grindr-met partners among Grindr-using young men who have sex with men in Los Angeles.

Grindr, a geosocial smartphone application, is a networking medium for men who have sex with men. Although three quarters of young men who have sex with men (YMSM) Grindr users report having sex with a Grindr-met partner, the correlates of risky sexual behavior with Grindr-met partners are unknown. A randomly selected sample of 18- to 24-year-old, Grindr-using YMSM completed an anonymous online questionnaire assessing patterns of Grindr use and sexual behavior with their last Grindr-met partners. Of the 146 YMSM who reported having sex with Grindr-met partners, 20% had unprotected anal intercourse (UAI) at last sex with their Grindr-met partner. In the multivariable model, YMSM who used Grindr for at least one year showed naked chest/abs in their profile photo, and reported more past month Grindr-met partners were more likely to report UAI. These findings suggest that familiarity with the app was associated with YMSMs UAI with Grindr-met partners. Moreover, sexualized profile photos (i.e., naked chest/abs) may be associated with sexual risk-taking behaviors. HIV prevention interventions delivered or linked through such apps should target individuals who are longer/frequent users and who present sexualized profiles.

Minority Stress Experiences and Psychological Well-Being: The Impact of Support from and Connection to Social Networks Within the Los Angeles House and Ball Communities

African American young men who have sex with men (AAYMSM) from the House and Ball communities are at high risk for HIV infection. Because these communities are not only sources of risk but also support for AAYMSM, researchers must also consider the resources these communities possess. This knowledge will assist in the formulation of more effective prevention strategies and intervention approaches. Using minority stress theory as a framework, the current study illustrates the impact minority stress has on the psychological well-being of a sample of MSM from the Los Angeles House and Ball communities and investigates how these factors affect the relationship between minority stress and psychological well-being. Surveys were administered to participants over the course of a year. Structural equation modeling was used to estimate a model of the associations between minority stressors, support, connection to social network, and psychological well-being/distress (N = 233). The results indicated significant associations between different sources of minority stress, including distal minority stress (e.g., racism, homophobia), gay identification, and internalized homophobia. Minority stressors were in turn significantly associated with greater distress. However, greater instrumental support significantly reduced the effects of distal minority stress on distress. Greater connection to social network also significantly reduced stress associated with gay identification on distress. The findings captured the diverse sources of minority stress faced by this population and how these stressors are interrelated to impact mental health. The results also illustrate how support from and connection to social networks can reduce the negative impact of minority stress experiences.

Social Networks of Homeless Youth in Emerging Adulthood

Little is known about the social networks of homeless youth in emerging adulthood despite the importance of this information for interventions to reduce health risks. This study examined the composition of social networks, and the risks and supports present within them, in a random sample of 349 homeless youth (33.4% female, 23.9% African American, 17.7% Hispanic) between the ages of 18 and 24. Social network members who were met on the street were among the most likely to be perceived as engaging in risky sex, as well as to engage in substance use with the youth. Youth were more likely to count on relatives and sex partners for support compared to other network members, but they also were more likely to use substances with sex partners and perceived them as engaging in risky sex. Interventions may need to recognize the importance of intimate relationships during the developmental stage of emerging adulthood by enhancing supportive bonds and reducing substance use and risky sex in these relationships.

Inter-Organizational Collaboration in the Implementation of Evidence-based Practices Among Public Agencies Serving Abused and Neglected Youth

This study examined the role of inter-organizational collaboration in implementing new evidence-based practices for addressing problem behaviors in at-risk youth. Semi-structured interviews were conducted with 38 systems leaders of probation, mental health, and child welfare departments of 12 California counties participating in a large randomized controlled trial to scale-up the use of Multidimensional Treatment Foster Care. Three sets of collaboration characteristics were identified: (1) characteristics of collaboration process, (2) characteristics of the external environment, and (3) characteristics of participating organizations and individuals. Inter-organizational collaboration enables an exchange of information and advice and a pooling of resources individual agencies may require for successful implementation.

Understanding the influence of depression on self-efficacy, work status and condom use among HIV clients in Uganda

OBJECTIVES Depression is common among persons living with HIV/AIDS in sub-Saharan Africa, yet few studies in the region have assessed the relationship of depression to economic well-being and risk-reduction behavior. Among HIV clients in Uganda, we examined whether depression is directly related to self-efficacy, work status, and condom use, as well as indirectly through its interaction with physical health functioning. METHODS Baseline data from a prospective longitudinal cohort of 602 clients entering HIV care were examined. In separate multivariate analyses, we examined whether depression [both depressive severity and clinical depression, as measured by the nine-item Patient Health Questionnaire (PHQ-9)], physical health functioning, and their interaction were predictors of current work status, consistent condom use, and general self-efficacy, controlling for measures of social support, stigma, and demographics. RESULTS Mean PHQ-9 score was 5.2 (S.D.=3.9; range=0-24) and 13% had scores ≥10 (indicator of clinical depression). Not being depressed, better physical health, and their interaction were predictors of working, while lower depressive severity, lower physical health, and their interaction were associated with always using condoms. Better physical health was predictive of greater self-efficacy, but not depression; general self-efficacy was predictive of both work status and condom use. CONCLUSIONS Effective diagnosis and treatment of depression may be critical to maximizing the benefits of HIV treatment with regard to both HIV prevention and restoring the social and economic health of persons living with HIV.

Online Social Networking, Sexual Risk and Protective Behaviors: Considerations for Clinicians and Researchers

Online social networking refers to the use of internet-based technologies that facilitate connection and communication between users. These platforms may be accessed via computer or mobile device (e.g., tablet, smartphone); communication between users may include linking of profiles, posting of text, photo and video content, instant messaging, and email. This review provides an overview of recent research on the relationship between online social networking and sexual risk and protective behaviors, with a focus on use of social networking sites (SNS) among young people and populations at high risk for sexually transmitted infections (STIs). While findings are mixed, the widespread use of SNS for sexual communication and partner seeking presents opportunities for the delivery and evaluation of public health interventions. Results of SNS-based interventions to reduce sexual risk are synthesized in order to offer hands-on advice for clinicians and researchers interested in engaging patients and study participants via online social networking.

Theory development for HIV behavioral health: empirical validation of behavior health models specific to HIV risk.

Abstract In the presence of numerous health behavior theories, it is difficult to determine which of the many theories is most precise in explaining health-related behavior. New models continue to be introduced to the field, despite already existing disparity, overlap, and lack of unification among health promotion theories. This paper will provide an overview of current arguments and frameworks for testing and developing a comprehensive set of health behavior theories. In addition, the authors make a unique contribution to the HIV health behavior theory literature by moving beyond current health behavior theory critiques to argue that one of the fields preexisting, but less popular theories, Social Action Theory (SAT), offers a pragmatic and broad framework to address many of the accuracy issues within HIV health behavior theory. The authors conclude this article by offering a comprehensive plan for validating model accuracy, variable influence, and behavioral applicability of SAT.

Brief Report: PrEP Uptake, Adherence, and Discontinuation Among California YMSM Using Geosocial Networking Applications.

Abstract: We investigated pre-exposure prophylaxis (PrEP) uptake, adherence, and discontinuation among young app-using men who have sex with men in California (N = 761). Approximately, 9.7% of participants had ever used PrEP; 87% of those deemed good candidates for screening (indicated by a Centers for Disease Control and Prevention risk index score ≥10) were not current or past users. PrEP use was associated with higher income [adjusted odds ratio (aOR): 4.13; confidence interval (CI): 1.87 to 9.12], receptive condomless anal sex (aOR: 3.41; CI: 1.71 to 6.78), HIV-positive sex partners (aOR: 2.87; CI: 1.53 to 5.38), popper use (aOR: 3.47; CI: 1.96 to 6.13), and recent sexually transmitted infection diagnosis (aOR: 2.90; CI: 1.64 to 5.13). Some users (41.5%) wanted help remembering to take PrEP. The top reason for discontinuation was concern about long-term side effects (33.0%). Young men who have sex with men app users are prime candidates for PrEP, despite low uptake. Apps may be useful tools for PrEP information dissemination, adherence monitoring, and support.

Environmental risk, social cognition, and drug use among young men who have sex with men: longitudinal effects of minority status on health processes and outcomes.

BACKGROUND Young men who have sex with men (YMSM) continue to be at elevated risk for substance use; however, models explaining this phenomenon have often focused on a limited array of explanatory constructs. This study examined the longitudinal relationship of contextual risk factors, social cognitive processes, mental health, and health protective behavior to identify key mechanisms of illicit drug use of YMSM as they aged through emerging adulthood. METHODS Our sample included an ethnically diverse cohort of 487 YMSM recruited through venue based probability sampling in Los Angeles. We used latent growth curve modeling to understand relationships between environmental risk factors, changing individual and social process variables, health protective behavior, psychological distress, and illicit drug use outcomes among YMSM. RESULTS Age, ethnicity, violence and discrimination, depression, and previous histories of illicit drug use were key elements of risk for future illicit drug use among YMSM. During this theoretically distinct time period, health as a value, self-efficacy, and social support are vital social cognitive processes for promoting self-change among YMSM, and YMSM have independent growth within each process. Health as a value, self-efficacy, and social support were dynamic social cognitive processes, which served as key mechanisms by which risk factors were converted into health promotion strategies or psychological distress, and ultimately illicit drug use. CONCLUSIONS The efficacy of prevention interventions aimed at reducing illicit drug use among YMSM can be enhanced by addressing social cognitive processes for this underserved portion of the male population.