Esben Strodl 1 , Lauren Stewart 1 , Amy B Mullens 2 and Sibnath Deb 3
The study examined whether the relationships between HIVstigma and depression and anxiety would be mediated by metacognitive beliefs and thought control strategies in menwhohavesex with menliving with HIV. Menwhohavesex with menliving with HIV completed an online survey that measured 30-item Metacognitions Questionnaire, thought control strategies (Thought Control Questionnaire), as well as symptoms of depression (Patient Health Questionnaire-9) and anxiety (generalized anxiety disorder-7). The relationships between internalised and anticipated HIVstigma with depressive symptoms were mediated by Negative Metacognitive Beliefs and the use of Worry and Social thought control strategies. Negative Metacognitive Beliefs mediated the association between internalised HIVstigma and anxiety symptoms.
Previous research in Western countries examining the nature of thoughts with regard to UAI suggested that HIV-positive MSM focused on themes regarding the deferral of responsibility, the assumption that the partner is positive, or that sex without a condom fulfills emotional needs . Our results targeting Japa- nese HIV-positive MSM are generally similar to Western research, apart from the aspect of “Concern about Relationships,” which reflects anxiety about the mood of the sex partner or being suspected serostatus by the sex partner and may be unique among HIV-positive Japanese MSM.
Participants explained how maintaining a secondary identity has direct negative implications for physical and mental health. For example, the inability of MSM to reveal their sexual lives with health care providers was related to misdiagnosis, delayed diagnosis, and delayed treatment, leading to poor health prognosis and higher risk of HIV and STI transmission to sexual partners. In addition, being forced to hide their sexuality from family, friends, coworkers, and broader society can lead to internalized shame and poor self-worth, often manifesting in depression and anxiety. Although some men did not name their pain as a form of poor mental health, when other men described feelings of depression, all the men recognized and endorsed an urgent need to address this phenomenon.
Stigma is defined as “typically a social process, experienced or anticipated, characterized by exclusion, rejection, blame or devaluation that results from experience, perception or reasonable anticipation of an adverse social judgment about a person or group” (Weiss, Ramakrishna, & Somma, 2006). Evidence has shown that stigma has negative effects on people living with HIV and AIDS, such as depression, anxiety and low-self esteem, and even lower medication adherence (Lee, Kochman, & Sikkema, 2002; Dowshen, Binns, & Garofalo, 2009; Rintamaki, Davis, Skripkauskas , Bennett, &
Data for this study derives from the baseline, an online survey of a randomized controlled trial (RCT). The aim of the RCT was to investigate the effect of a comprehen- sive crowdsourced intervention to increase HIV testing uptake among Chinese MSM. A detailed description of the study design was provided in the published protocol [ 26 ]. This baseline survey was conducted between June and August 2016 in eight cities in China (Guangzhou, Shenzhen, Zhuhai, Jiangmen, Jinan, Qingdao, Jining, and Yantai). Participants were recruited through banner ad- vertisements on Blued (Blue Brother, Beijing, China), the largest mobile phone application for MSM social net- working in China, with over 40 million users worldwide [ 27 ]. MSM, who clicked the survey link was directed to the information page and survey, hosted by SoJump (Sojump, Shanghai, China). Before commencing the sur- vey, we obtained online consent from each participant. Eligibility criteria for the study included being born bio- logically male, age 16-years or older, currently living in one of the eight study cities, never being diagnosed with HIV infection, and ever had oral or anal sex with a man. Participants’ mobile phone numbers were verified by the survey platform to avoid multiple answers by the same participant. After finishing the survey, each participant received 50 Chinese Yuan (approximately 8 USD) as a mobile phone credit.
In this study, external experiences of discrimination were used as an observable measure that explains only one aspect of a stigmatized identity (e.g., sexuality). Although the experiences of discrimination were prevalent in our sam- ple, our measurement of experiences of discrimination was limited in determining an association with HIV testing. Examining the frequency and intensity of experiences of discrimination, in addition to the presence of discrimina- tion, might produce different results. Moreover, it is possible that HIV-related discrimination (e.g., HIV criminalization laws; absence of legal protections for people living with HIV) might be more closely linked to HIV testing behavior than sexuality-related discrimination. Previous literature supports this notion, as researchers have noted that experi- ences and/or anticipation of HIV-related discrimination or HIVstigma may also be an important indicator of HIV testing behaviors (Arnold et al., 2014; Brooks et al., 2005; Golub & Gamarel, 2013). Future research should consider how dis- crimination is measured and defined and consider the context of HIVstigma when measuring the relationship between experiences of discrimination and HIV testing.
Chairperson: Dr. Annie Sondag
The purpose of this study was to collect information about the HIV prevention needs of menwhohavesex with men (MSM) living in Montana. Prevention needs were explored by identifying the environmental factors and behaviors that put MSM at risk for HIV infection, describing the demographic and contextual factors that influence those behaviors, and comparing current prevention needs to existing resources and services. To evaluate the prevention needs, primary qualitative data was collected in the form of four focus groups and nine key informant interviews. Supporting secondary quantitative and qualitative data in the form of an online survey and interviews with men on the “down low” were also assessed. The results of this assessment identified behaviors that contribute to HIV infection including unprotected anal intercourse, alcohol and drug use, using the Internet to find sexual partners, and hiding one‟s sexuality. Aspects of the environment that increase risk of HIV infection were also identified including geographic and social isolation, and communal hostility towards MSM. Factors contributing to HIV risk behaviors include depression and poor mental health, HIV testing issues, misperceptions about HIV and HIV medications, lack of social support, skills, younger age, and lack of comprehensive sex education. Finally, a number of HIV prevention needs were identified including needed resources such as more gay community centers, outreach efforts such as publicizing HIV rates in Montana and its communities, and health-related interventions such as comprehensive sex education, more support groups, and anonymous HIV testing. Other needed resources include cultural changes such as cultural competency training for individuals working with the public and greater acceptance of individuals who are two-spirit; social changes such as more MSM community and socializing events and greater political clout of the MSM community;
Most countries in the EU/EEA ensure that their national HIV prevention policies and plans have some specific focus on MSM. Across the EU/EEA, MSM are identified as a priority group for the promotion of HIV testing, condoms and targeted information on risk reduction . Stigma reduction and STI testing and treatment among MSM are also common national priorities. However, implementation and coverage of programme services often do not meet policy aspirations. Some countries continue to have legislation that hampers HIV prevention planning and programming. Protective laws that ensure MSM are not subject to discrimination are also often absent . While HIV and STI programmes across Europe include MSM to varying extents, very few settings provide services tailored to the needs of MSM, particularly MSM who are living with HIV. Fewer still comprehensively address men’s needs for health promotion to empower sexual health decision-making, HIV and STI testing, treatment, and prevention. More challenging is that due to stigma and fear of discrimination, significant numbers of men in parts of Europe do not disclose their sexual orientation to others. A recent survey conducted by the EU Fundamental Rights Agency found that 38% of gay male respondents said that none of their healthcare providers were aware of their sexual orientation . The European MSM Internet Survey showed that lack of ‘being out’ was associated with sexual unhappiness, not being tested for HIV, lack of coverage by HIV prevention programmes, lack of knowledge about HIV and STIs, and internalised homonegativity i [28, 35].
The researcher utilized purposive sampling strat- egies (Padgett, 2004 ) to recruit participants who met the requirements for inclusion which were: (a) age 50 and older; (b) self-identified as Black or African American; (c) living with HIV; (d) in treat- ment for the past 12 months; (e) man whohavesex with men; (f) spoke and read English; (g) absent of having any severe mental and/or cognitive chal- lenges; and (h) identify having experiences with HIVstigma and use of spirituality. Participants learned of the study through advertisements at the sole AIDS service organization. The potential par- ticipants were invited to contact the researcher dir- ectly through a private Google voice number and e-mail. A total of ten men were selected to partici- pate in the study. Participants received a $30 gift card for reimbursement for their time and resour- ces used to participate.
HIV incidence among Black menwhohavesex with men (BMSM) is extremely high in contrast to their estimated population size and compared to other racial groups.
Researchers have established that a significant proportion of these new cases annually originate from HIV transmission by BMSM who are unaware of their HIV status. The purpose of the study was to assess the relationship between age, sexual behavior, social support, substance use, internalized homophobia, depression, and HIV test history in BMSM. Guided by the social ecological model (SEM) as the conceptual framework, a quantitative cross-sectional study was designed to analyze secondary data from the HIV Prevention Trials Network Study 061. Bivariate and multivariate logistic regression was used to estimate the association. The research goal was to identify strategies to engage BMSM with infrequent/nonexistent HIV testing history into testing services. While there was very little difference between the bivariate and multivariate models, the results indicated that BMSM who were younger in age, had lower levels of internalized
Discussions about sex and sexuality are taboo in Lesotho, which complicates an already delicate situation given that the HIV pandemic feeds off this conservatism and the lack of education around prevention. According to Populations Services International, an organization working on the social marketing of condoms, many Basotho would rather support HIV positive people than talk to them about safe sex as a means of HIV prevention (Population Services International - Lesotho, 2012). Many HIV/AIDS education programs are not as effective as they could be because of the difficulty in discussing culturally-taboo subjects. (UNAIDS; UNESCO, 2002) According to Asthana, an African man‟s success was defined by how many women he could sleep with, and the more powerful you became, the more wives and children you should have (Asthana, 2005). As in India, (Thomas, Mimiaga, Mayer, Perry, Swaminathan, & Safren, 2013) cultural expectations of the Basotho are that each man will marry a woman, placing future female partners at an increased risk of acquiring HIV. Not surprisingly, menwho choose to follow a path that differs from this traditional expectation are often shunned from society. Men in this predicament have two logical choices: 1) Stay true to their identity without regard to
Our 2016 sample is younger than the 2009 sample. 
Although HIV prevalence increases with increasing age due to cumulative incidence and improved survival, the much higher prevalence in 2016 is particularly notable. The trend toward rising new infections among youth is not isolated to Brazil. The US Centers for Disease Control report that in the US youth aged 13 to 24 account for 20% of all new HIV diagnoses, 81% of those occurring among self-reporting gay and bisexual males. Youth presents a special problem, reports CDC: they are the least likely to test or to use a condom, are more likely to drink or use drugs during sex, and have 4 or more partners during their incipient sexual careers.  Other studies con ﬁrm these differences between younger and older MSM. Analyzing from a generational perspective, Méthy et al 
HIV-positive individuals had significantly higher weighted but not unweighted beta diversity across time points compared to the seronegative controls, suggesting ART initiation results in significant alter- ation of the community proportions (UniFrac, Kruskal-Wallis test, p < 0.05 (weighted), p = 0.11 (unweighted); Fig. 6a). This result is also mirrored in abundance and binary Jaccard (Additional file 4: Figure S1D). There was no significant difference in the change in alpha diversity between the two time points when comparing HIV-positive individuals and HIV-negative controls (Fig. 6b). However, two subjects had a significant reduction in observed OTUs and one subject had significant reduction in Shannon di- versity as defined by being significant outliers from the rest of the data (Tietjen-Moore test, p < 0.05). While there was a 3-month antibiotic exclusion cri- teria for initial enrollment, subjects may have taken antibiotics between the two collected time points. However, there was no significant association between beta diversity or change in alpha diversity and anti- biotic usage in the 6 months prior to the second sample collection (p > 0.05; Kruskal-Wallis test; Fig. 6a, b). We also specifically tested whether the OTUs that had a significant reduction in relative abundance in ART-treated compared to untreated HIV infection in the cross-sectional analysis of MSM (Table 3) also were significantly reduced longitudinally after ART initiation. We found a significant reduction in the OTUs identified as Turicibacter sanguinis and Strepto- coccus sp. (S. mitis group) (Wilcoxon signed-rank test, p < 0.05; Fig. 6c).
The US Preventive Services Task Force recommends screening for HIV in individuals aged 15 to 65 years and younger adolescents at increased risk, such as AMSM. 12 The CDC further recommends that sexually active MSM be screened at least annually and may bene ﬁ t from even more frequent screening. 13 Bright Futures guidelines, 14 published by the American Academy of Pediatrics, recommend similar HIV screening practices for adolescents. However, nationally representative studies suggest that only ∼10% of all high school students have ever been tested for HIV, with rates being higher among AMSM (20.6%) than among
1 Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America, 2 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America, 3 Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, United States of America, 4 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America, 5 Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America, 6 Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America, 7 Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America, 8 Department of Family Medicine, University of California Los Angeles, Los Angeles, California, United States of America, 9 Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America, 10 Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at The George Washington University, Washington, District of Columbia, United States of America, 11 Department of Medicine, Harlem Hospital, Columbia University, Mailman School of Public Health, New York, New York, United States of America, 12 Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, United States of America, 13 School of Social Welfare, University at Albany, State University of New York, Albany, New York, United States of America, 14 The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America, 15 Infectious Disease Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America, 16 Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
ASTRA is the largest questionnaire study of HIV-diagnosed individuals in the UK to date; the study population can be considered representative of HIV-diagnosed MSM in the UK, as access to healthcare is universal and over 95% of HIV-diagnosed people access specialist HIV services. The response rate (64%) is satisfactory and comparable to earlier similar studies. 22 23 25 There were no significant differences in VL or CD4 cell count between responders and those who did not respond but consented to participate. 2 Our study does have some limitations. Self-reported sexual behaviour may be subject to error and bias; underreporting of CLS is possible and may have led to underestimation of prev- alence. A single clinic-recorded plasma VL measure was used in the definition of higher HIV risk CLS-D. Although this measure was the latest VL result available to the participant, it occurred at a variable time in relation to the 3-month recall period for sexual behaviour; VL status may have changed over this period for some participants. The length of time with viral suppression specifically could not be incorporated. Among HIV-diagnosed MSM who had CLS with other HIV-positive partners only, it was not possible to ascertain whether a partner’s HIV-positive serostatus was assumed or known with confidence.
forgotten when educating MSM adolescents. Future EE intervention studies should include a larger sample size as well as a control group. Implementing another time point in later months after the study may be useful in determining the long-term effects of this kind of intervention. The relationship between other HIV factors, such as HIV knowledge, and H/A stigma would be interesting to investigate. For example, does higher HIV knowledge correlate with lower H/A stigma? These relationships could be researched in future studies to further understand H/A stigma. In this study, reducing only two of the four dimensions of H/A stigma were investigated. Future studies should research the effects of EE interventions on the other two dimensions: enacted stigma and compounded/layered stigma.
in the community, become a legal liability, and ultimately decrease shareholder value for financial stakeholders.
One participant stated that his physician, upon receiving his HIV test results, did not call to give him the results of his HIV antibody test. The doctor instead contacted the patient’s mother and disclosed his HIV status to her. The doctor felt she had a right to know. Moreover, his mother contacted other members of the family and shared this information with them. So, before he was aware that he was HIV positive, his mother and extended family were aware of his infection. The doctor acted out of a sense of paternalism. That is, he believed that it was his duty to disclose to others regardless of HIPAA guidelines. He acted as though he was operating in his patients’ best interest (Moyer et al., 2013). The results for the patient were devastating. Not only did he have to initially process that he was HIV positive, he also had to act upon the fact that his family knew. His doctor exposed his patient to stigmatization and discrimination from his own family. Newly diagnosed patients need time to process the implications of their health condition; they need time to initially come to terms with this new reality. Various protective and coping mechanisms are adapted in these early months as the patient tries to make sense of everything and find solid ground to stand upon. This participant never had the opportunity to do this.
While the MSM2013 had the strengths of a large sample size, stratified random sampling and a wide range of respondents in terms of age and place of residence, a higher response rate would have been desirable. This is a challenge that many public health researchers face nowadays. Limitations of the MSM2013 survey have been described in detail elsewhere (Persson et al. 2015). Future survey questions focusing on motivators and barriers for HIV testing could preferably be constructed somewhat differently to increase analysis possibilities. The questions in MSM2013 on reasons for being tested and not being tested had binary response options. Response options allowing for greater variability have also been recommended by Awad et al. (2004), and these should be developed in future surveys in order to capture nuances to a greater extent. Instead of letting participants specify as many responses as they want to, one could let them specify a given number of their most important reasons. Many participants chose to formulate motivators for being tested themselves rather than specifying reasons on the list that was provides. Depending on future study aims, there could also be advantages in letting participants themselves formulate reasons for and for not being tested. However, this would require different methods for statistical analysis.
“…for the LGBT youth out there who are struggling, who are made to feel inferior, let me say this: God loves you as you are. He wants you to live and to thrive. So please take care of yourself, educate yourself about HIV, protect your partners, honor and cherish them. And