Identifying Factors Related to HIV Infection and Transmission Risk among Young, Black Men who have Sex with Men Open Access
Kim, Min (Fall 2018)
Abstract
In the United States, young, Black men who have sex with men (YBMSM) are disproportionately impacted by HIV. In 2015, YBMSM accounted for more HIV diagnoses than any other race, gender, or age subgroup. Once diagnosed, YBMSM are more likely to experience negative health outcomes, including low rates of linkage to care, retention in care, and viral suppression. This dissertation seeks to identify multi-level factors facilitating HIV infection and transmission risk among HIV-negative and HIV-positive YBMSM.
In Aim 1, I utilized latent class analysis to construct a measure of perceived HIV risk in a sample of young, HIV-negative Black and White MSM residing in Atlanta, GA. The 4-class latent model provided both clear definitions of each class, and yielded the best statistical fit. This latent measure of perceived risk was validated against 11 sexual and non-sexual measures, providing evidence supporting two perceived risk typologies.
In Aim 2, I used the same sample of young MSM in Aim 1 to examine the associations between the latent typologies of perceived risk and both past and future sexual behaviors. Participants with a low risk perception were less likely to report sex with HIV status unknown partners at baseline, and were less likely to report condomless anal intercourse (CAI) at follow-up. Participants whose perceived risk was largely dependent on their partner’s HIV status were less likely to report sex with HIV-positive partners at baseline, and were less likely to report CAI with HIV-positive partners at follow-up.
In Aim 3, qualitative timeline interviews were used to identify individual-level, dyadic, and structural factors related to antiretroviral therapy access and adherence among a sample of seropositive YBMSM engaged in HIV care in Atlanta, GA. A high proportion of YBMSM experienced secondary drug resistance and health care coverage losses during the timeline period. HIV-related stigma was a central theme that impacted YBMSM’s treatment access and adherence through multiple pathways involving other multi-level domains of influence.
Findings from this dissertation can be used to inform the development of multi-level HIV prevention interventions that decrease the susceptibility among uninfected YBMSM, and reduce the transmissibility of YBMSM living with HIV/AIDS.
Table of Contents
Chapter 1. Background and Significance.................................................................................................................................................1
Chapter 2. Evaluating the Construct Validity of a Latent Measure of HIV Risk Perception among Young, HIV-Negative MSM in Atlanta, GA..19
Introduction.............................................................................................................................................................................................................................19
Methods...................................................................................................................................................................................................................................23
Results.....................................................................................................................................................................................................................................34
Discussion................................................................................................................................................................................................................................44
Chapter 3. Evaluating the Relationship between a Latent Measure of HIV Risk Perception and Sexual Behaviors among Young, HIV-Negative MSM in Atlanta, GA..50
Introduction.............................................................................................................................................................................................................................50
Methods...................................................................................................................................................................................................................................58
Results.....................................................................................................................................................................................................................................70
Discussion................................................................................................................................................................................................................................84
Chapter 4. Identifying Multi-Level Domains Related to Antiretroviral Therapy Access and Adherence among Young, HIV-Positive Black MSM in Atlanta, GA...97
Introduction.............................................................................................................................................................................................................................97
Methods...................................................................................................................................................................................................................................103
Results.....................................................................................................................................................................................................................................112
Discussion...............................................................................................................................................................................................................................142
Chapter 5. Conclusions and Public Health Implications.....................................................................................................................................157
References..............................................................................................................................................................................................172
Appendices...........................................................................................................................................................................................213
Appendix A. InvolveMENt Survey Questions..............................................................................................................................................................213
Appendix B. Additional Analyses................................................................................................................................................................................218
Appendix C. Previous Literature on Aims 1 and 2.......................................................................................................................................................224
Appendix D. Aim 3 Quantitative Survey......................................................................................................................................................................231
About this Dissertation
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