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Psychosocial associations of biobehavioral HIV prevention among Black men who have sex with men in the United States

Chandler, Cristian (2018) Psychosocial associations of biobehavioral HIV prevention among Black men who have sex with men in the United States. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Black men who have sex with men (BMSM) experience the highest HIV incidence among at-risk groups; therefore, understanding the unique circumstances of BMSM is essential to addressing this significant public health issue. The theory of syndemic production, or the effect of co-occurring epidemics, was used to explore the result of psychosocial issues (substance use, intimate partner violence, sexual risk and depression) on HIV prevention and care outcomes. This dissertation analyzed data from the Promoting Our Worth, Equality and Resilience (POWER) study to explore the impact of individual-level syndemics on past six-month screening behavior, PrEP use and HIV care continuum outcomes among BMSM. In the first analysis, BMSM under 30 were more likely to have been screened than BMSM aged 40 and older (AOR = 2.18, 95% CI: 1.74, 2.72). Further, despite the presence of a syndemic, men with two psychosocial issues were significantly more likely to report being screened for HIV compared to men who reported no psychosocial issues (AOR = 1.37, 95% CI: 1.04, 1.80). The second analysis explored differences among BMSM who reported PrEP-eligible HIV risk and BMSM who reported using PrEP. The analysis found that those with a college education (AOR = 0.39, 95% CI: 0.28 – 0.55) and graduate education (AOR = 0.50, 95% CI: 0.32, 0.79) were significantly less likely than men with a high school or less education to report PrEP use. Additionally, compared to men who reported no psychosocial issues, BMSM were significantly more likely to report PrEP use when experiencing three (AOR = 5.65, 95% CI: 3.17, 10.08) or four psychosocial issues (AOR = 18.34, 95% CI: 5.01, 67.20). The third analysis focused on HIV-positive BMSM found that BMSM without insurance were less likely to report being in HIV care (AOR = 0.13, 95% CI: 0.05, 0.36) or using ART (AOR = 0.33, 95% CI: 0.20, 0.54). There were no significant associations between syndemic variables and HIV care outcomes. The results of these analyses suggest that individual factors cannot entirely explain disparities in HIV incidence and demonstrate the need to model the social and structural ecology of BMSM contributing to excess disease burden.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Chandler, CristianCJC143@pitt.eduCJC1430000-0003-1770-4357
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairStall, Ronaldrstall@pitt.edurstall
Committee MemberMatthews, Derrickderrick.matthews@pitt.eduddm17
Committee MemberEgan, Jamesjee48@pitt.edujee48
Committee MemberHawk, MaryMary.Hawk@pitt.edumeh96
Committee MemberMarkovik, NinaNinam@pitt.eduninam
Date: 28 June 2018
Date Type: Publication
Defense Date: 6 April 2018
Approval Date: 28 June 2018
Submission Date: 29 March 2018
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 116
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: HIV, men who have sex with men, syndemic, psychosocial, PrEP, pre-exposure prophylaxis
Date Deposited: 28 Jun 2018 20:30
Last Modified: 01 May 2023 05:15


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