Jacob J. van den Berg

Race, social support, and coping strategies among HIV‐positive gay and bisexual men

Few studies have examined the relation between race, social support, and coping, particularly among HIV‐infected individuals. We examined the relation of race and social support to coping with HIV infection in a sample of 121 gay and bisexual men (64 African American, 57 White). Compared to White participants, African Americans reported higher use of multiple coping strategies. High levels of perceived social support were related to greater use of positive coping and seeking support; lower levels of social support were related to greater use of self‐destructive coping. There were no race‐related differences in social support, and no race by social support interactions. Possible explanations for observed cultural differences and coping challenges of African American gay and bisexual men with HIV are discussed.

The Roles of Counseling Psychologists in Reducing Health Disparities

This article presents an overview of the health disparities problem that exists among individuals from ethnic minority and low-income backgrounds and their majority counterparts. The argument is made that the involvement of counseling psychologists in addressing this health disparities problem presents an opportunity for the field to remain true to its commitment to prevention, multiculturalism, and social justice while becoming more competitive in the health care and health promotion fields. This article highlights the prevalence of health disparities and identifies the primary factors contributing to these disparities. In addition, the roles and approaches that counseling psychologists can adopt to help alleviate this problem are specified.

Sexual Minority Health Disparities in Adult Men and Women in the United States: National Health and Nutrition Examination Survey, 2001–2010

OBJECTIVES We used nationally representative data to investigate health disparities associated with sexual minority status among adults in the United States. METHODS We analyzed data from 11,114 adults who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey. Using multiple logistic regressions, we examined the prevalence of HIV, sexually transmitted infections, mental health problems, cigarette smoking, and alcohol and illicit drug use in sexual minorities and heterosexual adults. RESULTS After adjusting for sociodemographic characteristics, sexual minority men had greater odds of mental health problems, testing positive for HIV and herpes simplex virus type 2 and self-reported gonorrhea and chlamydia. Sexual minority women had greater odds of mental health problems, testing positive for hepatitis C, smoking, heavy drinking, and illicit drug use. CONCLUSIONS Numerous health disparities continue to face sexual minority men and women in the United States. Notably, health disparities persisted beyond the role of sociodemographic factors, including access to insurance and primary care, suggesting that further research is warranted to identify the determinants of health inequity for sexual minorities.

Intrapersonal and Interpersonal Manifestations of Antilesbian and Gay Prejudice: An Application of Personal Construct Theory.

This study extended research on prejudice against lesbian and gay (LG) persons by examining theoretically grounded links between intrapersonal and interpersonal manifestations of such prejudice. On the basis of G. A. Kelly’s (1955/1991a, 1955/1991b) conceptualization of threat, the authors operationalized intrapersonal homophobia, or LG threat, as the extent to which the notion of being LG was perceived to cause undesirable change in the construal of self. Consistent with hypotheses, results with 175 participants indicated that level of LG threat was correlated positively with anti-LG attitudes. Furthermore, LG threat moderated the link of anti-LG attitudes with positive self-perception and self-presentation such that for persons with high levels of LG threat, anti-LG attitudes were related positively, whereas for persons with low levels of LG threat, anti-LG attitudes were related negatively to positive self-perception and self-presentation. Implications for prevention and intervention efforts to reduce anti-LG prejudice are explored, and directions for future research are discussed.

Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care

Less than half of the 1.2 million HIV-infected individuals in the United States are in consistent medical care, with only a third receiving treatment resulting in viral suppression. Novel interventions to improve engagement are necessary to ensure medical adherence, improve long-term outcomes, and reduce HIV transmission. Mobile health (mHealth) strategies including cell phone and text messaging have shown success in the developing world for medical adherence, yet mHealth interventions have not been developed and evaluated to improve retention in HIV care in the United States. We conducted a 6-month pilot study investigating the use of a clinic-based bi-directional texting intervention to enhance engagement in HIV care among those with higher risk of loss to follow up, including those with a recent HIV diagnosis or those re-engaging in HIV care at a large urban clinic in New England.

Set it and forget it: women's perceptions and opinions of long-acting topical vaginal gels.

Women’s initial understandings and anticipated acceptability of long-acting vaginal gels as potential anti-HIV microbicides was investigated by exploring the perceptibility variables associated with prototype formulations. Four focus groups with 29 women, aged 18–45, were conducted to consider gel prototypes with varied physicochemical and rheological properties. Participants responded favorably to the concept of long-acting vaginal gels as microbicides. Distinctions in understandings and stated needs regarding product dosing, characteristics, and effectiveness offer valuable insights into product design. Long-acting vaginal gels capable of protecting against HIV/STIs will be a viable option among potential users, with dosing frequency being an important factor in willingness to use.ResumenEl entendimiento inicial y la aceptabilidad anticipada de geles vaginales de acción prolongada como potenciales anti-VIH microbicidas por parte de las mujeres, fueron investigados explorando variables de perceptibilidad asociadas a formulaciones prototípicas. Para examinar los prototipos de geles con diferentes propiedades fisicoquímicas y reológicas, se realizaron cuatro grupos focales con 29 mujeres entre las edades de 18–45 años. Las participantes respondieron favorablemente al concepto de geles vaginales de acción prolongada como microbicidas. Distinciones en el entendimiento y las necesidades expresadas en cuanto a dosificación, características, y eficacia del producto ofrecen conocimiento de valor para el diseño del mismo. Los geles vaginales de acción prolongada capaces de proteger contra el VIH/ITS serán una opción viable entre consumidoras potenciales, siendo la frecuencia de dosificación un factor importante en la disposición al uso.

Drinking trajectories among HIV-infected men who have sex with men: a cohort study of United States veterans.

BACKGROUND Although high rates of alcohol consumption and related problems have been observed among HIV-infected men who have sex with men (MSM), little is known about the long-term patterns of and factors associated with hazardous alcohol use in this population. We sought to identify alcohol use trajectories and correlates of hazardous alcohol use among HIV-infected MSM. METHODS Sexually active, HIV-infected MSM participating in the Veterans Aging Cohort Study were eligible for inclusion. Participants were recruited from VA infectious disease clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh, and Washington, DC. Data from annual self-reported assessments and group-based trajectory models were used to identify distinct alcohol use trajectories over an eight-year study period (2002-2010). We then used generalized estimate equations (GEE) to examine longitudinal correlates of hazardous alcohol use (defined as an AUDIT-C score ≥4). RESULTS Among 1065 participants, the mean age was 45.5 (SD=9.2) and 606 (58.2%) were African American. Baseline hazardous alcohol use was reported by 309 (29.3%). Group-based trajectory modeling revealed a distinct group (12.5% of the sample) with consistently hazardous alcohol use, characterized by a mean AUDIT-C score of >5 at every time point. In a GEE-based multivariable model, hazardous alcohol use was associated with earning <

Systematic Review of Interventions to Reduce Problematic Alcohol Use in Men who have Sex with Men

6000 annually, having an alcohol-related diagnosis, using cannabis, and using cocaine. CONCLUSIONS More than 1 in 10 HIV-infected MSM US veterans reported consistent, long-term hazardous alcohol use. Financial insecurity and concurrent substance use were predictors of consistently hazardous alcohol use, and may be modifiable targets for intervention.

The promise of intravaginal rings for prevention: User perceptions of biomechanical properties and implications for prevention product development

ISSUES Rates of heavy drinking, alcohol problems and alcohol-related disorders are high among men who have sex with men (MSM) and are an important public health issue. Associations between heavy drinking and human immunodeficiency virus (HIV) acquisition among MSM also suggest that drinking may have more severe and chronic consequences for this population relative to others. Consequently, effective interventions to reduce heavy drinking and alcohol-related risk factors among MSM are needed. APPROACH We conducted a systematic review of randomised controlled trials of interventions to reduce heavy drinking and/or alcohol-related problems among MSM. We searched five electronic databases, screened 3722 records and identified 5 studies involving 1022 participants that satisfied inclusion criteria, which included having: (i) incorporated a comparison condition; (ii) randomised participants to groups; and (iii) reported quantitative outcomes. KEY FINDINGS The methodological quality of studies varied, and meta-analysis was not conducted because of heterogeneity in intervention approaches and outcomes. Studies provided preliminary support for the use of motivational interviewing/motivational enhancement-based interventions (MI) and hybrid MI and cognitive behavioural therapy treatments for heavy drinking among MSM over no treatment. Perhaps the most important conclusion of this review, however, is that well-designed, theoretically informed research focused on establishing the efficacy of interventions for hazardous drinking and alcohol use disorders among MSM is alarmingly scarce. CONCLUSIONS Effective interventions to reduce hazardous drinking among MSM and prevent key alcohol-related outcomes, including risk for HIV transmission and health problems among HIV-positive MSM, are needed to mitigate health disparities in this population.

Co-occurring psychiatric and drug use disorders among sexual minority men with lifetime alcohol use disorders

Intravaginal rings (IVRs) are currently under investigation as devices for the delivery of agents to protect against the sexual transmission of HIV and STIs, as well as pregnancy. To assist product developers in creating highly acceptable rings, we sought to identify characteristics that intravaginal ring users consider when making decisions about ring use or non-use. We conducted four semi-structured focus groups with 21 women (aged 18–45) who reported using an IVR in the past 12 months. Participants manipulated four prototype rings in their hands, discussed ring materials, dimensionality, and “behavior,” and shared perceptions and appraisals. Five salient ring characteristics were identified: 1) appearance of the rings’ surfaces, 2) tactile sensations of the cylinder material, 3) materials properties, 4) diameter of the cylinder, and 5) ring circumference. Pliability (or flexibility) was generally considered the most important mechanical property. Several ring properties (e.g., porousness, dimensionality) were associated with perceptions of efficacy. Women also revealed user behaviors that may impact the effectiveness of certain drugs, such as removing, rinsing and re-inserting the ring while bathing, and removing the ring during sexual encounters. As product developers explore IVRs as prevention delivery systems, it is critical to balance product materials and dimensions with use parameters to optimize drug delivery and the user experience. It is also critical to consider how user behaviors (e.g., removing the ring) might impact drug delivery.