Understanding structural factors of place for HIV prevention among adolescent and young men who have sex with men in the U.S. Pubblico
Lee, Veronica (Summer 2020)
Abstract
Adolescent and young gay, bisexual, and other men who have sex with men (AYMSM) are at high risk for HIV. Understanding the role of structural place-based factors in AYMSM’s access and utilization of HIV prevention and testing services may help with informing effective HIV prevention interventions for this population. This dissertation utilized online-based HIV behavioral surveillance data from an age- and geographically-diverse sample of AYMSM to investigate the following multilevel relationships:
In Aim 1, we examined the relationship between urban-rural residence and sexual identity disclosure, to anyone and to health care providers, by perceptions of neighborhood tolerance of gay and bisexual individuals. Among AYMSM who perceived their neighborhoods to be tolerant, we observed a consistent pattern of less disclosure to anyone for AYMSM residing in suburban, small and medium metropolitan, and rural areas compared to AYMSM residing in urban areas. Regardless of neighborhood tolerance perception, AYMSM in non-urban areas were less likely to disclose to providers compared to their urban counterparts.
In Aim 2, we explored the relationships between two place-based factors, area disadvantage and local racial/ethnic spatial concentration, and receipt of free condoms by AYMSM’s race/ethnicity. Overall, free condom receipt was low. We observed different relationships by race/ethnicity. Receipt was associated with residing in the high disadvantaged areas compared to the less disadvantaged areas among White and Hispanic AYMSM, adjusting for individual- and area-level covariates. Among White AYMSM, those residing in areas with high concentrations of racial/ethnic minorities, compared to those in areas with high concentrations of White residents, were more likely to have received free condoms. No meaningful associations were observed among Black AYMSM.
In Aim 3, we explored the relationships between the same structural place-based factors from Aim 2 and having ever tested for HIV by race/ethnicity. Overall, only half of AYMSM reported ever testing for HIV. Different patterns by race/ethnicity were observed. Residing in high disadvantaged areas was associated with increased HIV testing for White and Hispanic AYMSM. Residing in areas with highest concentrations of racial/ethnic minorities was associated with increased HIV testing for White AYMSM and decreased testing for Hispanic AYMSM. No meaningful associations were observed among Black AYMSM.
Taken together, these findings suggest that contextual factors within AYMSM’s residential environments may a play a role in their HIV prevention access and utilization. Understanding how these contextual features affect AYMSM, and how these relationships may differ based on sexual identity-related stigma and race/ethnicity, is critical to effective HIV prevention for AYMSM.
Table of Contents
Chapter 1 Background and significance 1
Chapter 2 Urban-rural residence and sexual identity disclosure among adolescent and young adult men who have sex with men 7
Chapter 3 Area disadvantage and local racial/ethnic concentration and receipt of free condoms among adolescent and young men who have sex with men 41
Chapter 4 Area disadvantage and local racial/ethnic spatial concentration and HIV testing among adolescent and young men who have sex with men 77
Chapter 5 Conclusions and public health implications 111
Chapter 6 References 118
About this Dissertation
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Understanding structural factors of place for HIV prevention among adolescent and young men who have sex with men in the U.S. () | 2020-07-09 16:00:34 -0400 |
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