Wilson Vincent

Resilience, stress, and life quality in older adults living with HIV/AIDS

Objectives: This study tested the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in older people, 50 years of age and older, living with HIV/AIDS (OPLWHA). Method: Data from 299 OPLWHA were analyzed using structural equation modeling (SEM) to define a novel resilience construct (represented by coping self-efficacy, active coping, hope/optimism, and social support) and to assess mediating effects of resilience on the association between life stress and HRQoL (physical, emotional, and functional/global well-being). Results: SEM analyses showed satisfactory model fit for both resilience and mediational models, with resilience mediating the associations between life stress and physical, emotional, and functional/global well-being. Conclusion: Resilience may reduce the negative influence of life stress on physical, emotional, and functional/global well-being in OPLWHA. Interventions that build personal capacity, coping skills, and social support may contribute to better management of HIV/AIDS and increase HRQoL.

The link between alcohol use and aggression toward sexual minorities: An event-based analysis

The current study used an event-based assessment approach to examine the day-to-day relationship between heterosexual mens alcohol consumption and perpetration of aggression toward sexual minorities. Participants were 199 heterosexual drinking men between the ages of 18-30 who completed (1) separate timeline followback interviews to assess alcohol use and aggression toward sexual minorities during the past year, and (2) written self-report measures of risk factors for aggression toward sexual minorities. Results indicated that aggression toward sexual minorities was twice as likely on a day when drinking was reported than on nondrinking days, with over 80% of alcohol-related aggressive acts perpetrated within the group context. Patterns of alcohol use (i.e., number of drinking days, mean drinks per drinking day, number of heavy drinking days) were not associated with perpetration after controlling for demographic variables and pertinent risk factors. Results suggest that it is the acute effects of alcohol, and not mens patterns of alcohol consumption, that facilitate aggression toward sexual minorities. More importantly, these data are the first to support an event-based link between alcohol use and aggression toward sexual minorities (or any minority group), and provide the impetus for future research to examine risk factors and mechanisms for intoxicated aggression toward sexual minorities and other stigmatized groups.

What Factors Are Associated With Receiving a Recommendation to Get Tested for HIV by Health Care Providers Among Men Who Have Sex With Men

Background: The approach of treatment as prevention for reducing HIV incidence and prevalence hinges on early detection of HIV infection and treatment to achieve viral suppression and, thus, to reduce HIV transmissibility. However, men who have sex with men (MSM), who are at greater risk of HIV infection than the average adult in the United States, are often not tested because many providers do not provide routine opt-out testing or even recommend HIV testing. Methods: In a sample of 244 MSM in San Francisco, CA, this study examined whether (1) sociodemographic characteristics (ie, youth, education, employment status, being African American, being Latino), (2) health care access and utilization, and (3) participants disclosing their sexual orientation to their health care providers were associated with their odds of having received a recommendation from a health care provider for HIV testing. Results: Results showed that none of the sociodemographic or health care–related factors were associated with whether a health care provider recommended HIV testing, but MSM disclosing their sexual orientation to their health care providers was associated with an over 8 times greater odds of MSM receiving a recommendation for HIV testing. Conclusion: The study findings underscore the need for routine opt-out HIV testing to screen members of high-risk populations who may not enter the HIV continuum of care and for health care providers to be able to ask patients about HIV risk behavior and sexual orientation and behavior.

A Closer Look at Racism and Heterosexism in Medical Students’ Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education

Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.

Intimate Partner Violence Among Low-Income Fathers: Testing a Stress-Coping Model

This research used a stress-coping conceptual framework to examine intimate partner violence (IPV) among men who are fathers. The current study examined how perceived stress explained associations between stressors (e.g., employment status, psychological and physical female-to-male partner violence [FMPV], substance use, criminal justice system involvement) and male-perpetrated physical and psychological IPV. Participants were 1,971 low-income, ethnically diverse fathers involved in a statewide fatherhood program. Findings indicated that, across African American, White, and Hispanic/Latino men, male-reported FMPV and criminal justice involvement were associated with psychological and/or physical IPV via perceived stress. Employment status and alcohol use were associated with psychological IPV via perceived stress among African American men only. Implications for community-based fatherhood programs are discussed.

HIV risk and multiple sources of heterosexism among young Black men who have sex with men. - eScholarship

Objective: This study examined whether the association between social support and condom self-efficacy would be moderated by (a) internalized heterosexism among and (b) enacted heterosexism experienced by young Black men who have sex with men (YBMSM), who contend with high HIV incidence, heterosexism, and low uptake of preexposure prophylaxis. Method: Participants were 1,210 YBMSM (ages 18–29) who completed measures of social support, internalized and enacted heterosexism, and condom self-efficacy in 2 large cities in the southern United States as part of a community-level HIV-prevention study. Results: A significant 3-way interaction between social support and both hypothesized moderators, internalized and enacted heterosexism, showed that social support was positively associated with condom self-efficacy when both internalized and enacted heterosexism were high (1 SD above the mean; b = .177, 95% confidence interval [CI: .088, .266]). However, social support was not associated with condom self-efficacy when scores were low (1 SD below the mean) on both internalized and enacted heterosexism (b = .024, 95% CI [−.054, .101]), low on internalized and high on enacted heterosexism (b = .058, 95% CI [−.061, .117]), or high on internalized and low on enacted heterosexism (b = .039, 95% CI [−.083, .161]). Conclusions: YBMSM who are high in both internalized and enacted heterosexism may see greater benefits from social support on condom self-efficacy than would YBMSM who grapple with less heterosexism. In addition to promoting social support, interventions should aim to assess and reduce multiple forms of stigma.

The association between AIDS‐related stigma and aggression toward gay men and lesbians

This study examined whether self-identified race and prior contact with a gay man or lesbian moderate the association between AIDS-related stigma and aggression toward gay men and lesbians when controlling for sexual prejudice. A regional, community-recruited sample of 194 heterosexual men (50% Black, 50% White) completed measures of AIDS-related stigma, sexual prejudice, and prior contact with gay men and lesbians. Regression analyses showed that AIDS-related stigma was positively associated with aggression toward gay men and lesbians among White men who reported no prior contact, but not among White men who endorsed prior contact and Black men regardless of prior contact. Findings suggest that intergroup contact may be a key component to reducing the effects of AIDS-related stigma towards stigmatized groups. Implications for aggression theory and intervention are discussed. Aggr. Behav. 42:542-554, 2016.