Rafael Perez-Figueroa

Acceptability of PrEP Uptake Among Racially/Ethnically Diverse Young Men Who Have Sex With Men: The P18 Study

Pre-exposure prophylaxis (PrEP) is considered an effective biomedical approach for HIV prevention. However, there is limited understanding of PrEP uptake among racially/ethnically and socioeconomically diverse young men who have sex with men (YMSM). This study examined attitudes and perceptions toward PrEP uptake among YMSM by conducting semistructured interviews with a sample (N = 100) of YMSM in New York City. Thematic analysis was employed to explore key issues related to attitudes and perceptions toward PrEP utilization. Findings suggest that self-perceived risk for HIV transmission, enjoying unprotected sex, and being in a romantic relationship were associated with PrEP uptake. The most prominent barriers to PrEP uptake included costs, adherence regimen, and access. In summary, these findings underscore the importance of addressing behavioral and structural factors in maximizing the effectiveness of PrEP. In addition, PrEP implementation programs ought to consider the role of social and structural challenges to PrEP uptake and adherence among YMSM.

Psychosocial burdens negatively impact HIV antiretroviral adherence in gay, bisexual, and other men who have sex with men aged 50 and older.

We sought to characterize HIV antiretroviral therapy (ART) adherence and psychosocial correlates of adherence in a sample of gay, bisexual, and other non-gay or -bisexual identified men who have sex with men aged 50 and over. As part of a cross-sectional study we recruited a community-based sample of 199 men and assessed adherence to current ART medications along four domains: (1) missing doses in the past 4 days, (2) taking doses on the specified schedule in the past 4 days, (3) following instructions about how to take the medications (e.g., to take medications with food), and (4) missing doses in the last weekend. A total adherence score was also computed. Bivariable analyses indicated negative associations between depression, sexual compulsivity, and HIV-related stigma with each of the individual adherence variables and the composite adherence score, while an older age was found to be protective. In multivariable analyses, controlling for age and educational attainment, a higher likelihood of missing doses and failing to follow instructions were related to higher levels of HIV-related stigma, while dosing off-schedule and missing doses on weekends was associated with higher levels of sexual compulsivity. These results indicate that psychosocial burdens undermine the adherence behaviors of older HIV-positive sexual minority men. Programming and services to address this compromising health behavior must embrace a holistic approach to health as informed by syndemics theory, while attending to the developmental and age-specific needs of older men.

Psychosocial and Demographic Correlates of Drug Use in a Sample of HIV-Positive Adults Ages 50 and Older

The prevalence of HIV among adults 50 and older in the USA is increasing as a result of improvements in treatment and detection of HIV infection. Substance use by this population has implications for physical and mental health outcomes. We examined patterns of demographics, mental health, and recent substance use in a diverse sample of heterosexual, bisexual, and gay adults 50 and older living with HIV/AIDS (PLWHA) in New York City. The most commonly used substances were cigarettes or alcohol; however, the majority of the sample did not report recent use of marijuana, poppers, or hard drugs (crystal methamphetamine, cocaine, crack, heroin, ecstasy, GHB, ketamine, and LSD or PCP). Statistically significant associations between substance use and psychological states (well-being and loneliness) were generally weak, and depression scores were not significantly related to use; instead, drug use was associated with gender/sexual orientation. The study observations support addressing substance use specific to subpopulations within PLWHA.

Moving Toward a Holistic Conceptual Framework for Understanding Healthy Aging Among Gay Men

In the last four decades, we have witnessed vast and important transitions in the social, economic, political, and health contexts of the lived experiences of gay men in the United States. This dynamic period, as evidenced most prominently by the transition of the gay rights movement to a civil rights movement, has shifted the exploration of gay men’s health from one focusing primarily on HIV/AIDS into a mainstream consideration of the overall health and wellbeing of gay men. Against this backdrop, aging gay men in the United States constitute a growing population, for whom further investigations of health states and health-related disparities are warranted. In order to advance our understanding of the health and wellbeing of aging gay men, we outline here a multilevel, ecosocial conceptual framework that integrates salient environmental, social, psychosocial, and sociodeomgraphic factors into sets of macro-, meso-, and micro-level constructs that can be applied to comprehensively study health states and health care utilization in older gay men.

Toward a Typology of Acculturative Stress Results Among Hispanic Immigrants in the United States

The objective of this study is to identify latent classes of Hispanic immigrants on the basis of acculturative stress and, in turn, examine the links between membership in acculturative stress classes and the prevalence of mental disorders. We use latent class analysis (LCA) and multinomial logistic regression with data from a population-based study of Hispanic immigrants in the United States (n = 1,630). Classes were identified as “Low Acculturative Stress” (38.40%); “Social and Linguistic Stress” (32.27%); “Acculturative Stress, No Fear of Deportation” (20.06%); and “Acculturative Stress, Fear of Deportation” (9.26%). Members of the “Acculturative Stress, Fear of Deportation” class were significantly more likely than members of the “Low Acculturative Stress” class to meet criteria for generalized anxiety disorder (risk ratios [RR] = 3.55, 95% confidence interval [CI] [1.00, 12.56]). The present study represents an important step in the development of a typology of acculturative stress among Hispanic immigrants in the United States.

Religiousness, Spirituality, and Existential Well-being Among HIV-Positive Gay, Bisexual, and Other MSM Age 50 and Over

The religious and spiritual experiences of HIV-positive gay, bisexual, and other men who have sex with men (MSM) are severely understudied, especially among those over 50. However, literature supports that religious/spiritual experiences are related to both physical and mental health among older adults. In this exploratory analysis we assessed the relations that exist among a sample of HIV-positive gay, bisexual, and other MSM over 50 in regard to sociodemographic factors and two established measures of religiosity/spirituality. Differences emerged in relation to both race/ethnicity and age for the Ironson-Woods Spirituality/Religiousness (SR) Index, while, for the Existential Well-being subscale, differences emerged in relation to race/ethnicity and perceived socioeconomic status.

Age- and education-matched comparison of aging HIV+ men who have sex with men to general population on common neuropsychological assessments

Little is known about the impact of HIV and aging on cognitive functioning. This New York City cross-sectional study of aging HIV-positive gay and bisexual men assessed their neuropsychological state. Working memory and verbal abstract reasoning were relatively intact. After 55 years of age, attention abilities were impaired. Executive function impairment was present regardless of age and education. Results suggest the need for HIV-specific norms, and the use of neuropsychological assessments (i.e. baseline and over time) as a cost-effective way to assess HIV-related cognitive decline in developed and under-developed countries.