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"Halkitis, Perry N"
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High Interest in a Long-Acting Injectable Formulation of Pre-Exposure Prophylaxis for HIV in Young Men Who Have Sex with Men in NYC: A P18 Cohort Substudy
In the context of continued high rates of condomless anal intercourse and HIV-1 infection, young men who have sex with men (YMSM) need additional effective and desirable HIV prevention tools. This study reports on the willingness of a racially-ethnically diverse cohort of YMSM to use a new biomedical prevention approach, a long-acting injectable pre-exposure prophylaxis (LAI-PrEP) agent.
A cross-sectional study conducted between June-August 2013 recruited participants from an ongoing cohort study of YMSM in NYC. Participants included 197 YMSM, of whom 72.6% (n = 143) identified as men of color. Two outcomes were measured through computer-assisted self-interviews: 1) willingness to use long-acting injectable PrEP and 2) preference for route of administration of PrEP. In addition, concerns about perceived impacts of PrEP on health and risk behavior, access to health services, and stigma were investigated.
Over 80% (n = 159/197, p<0.001) of participants stated they would be willing to use LAI-PrEP. With regards to preference for mode of delivery 79.2% (n = 156/197, p<0.001) stated they would prefer an injection administered every three months over a daily pill or neither one.
This study is the first to explore acceptability of LAI-PrEP in the US. A significant majority of participants expressed willingness to use LAI and the majority preferred LAI-PrEP. LAI-PrEP holds great promise in that it could circumvent the adherence challenges associated with daily dosing, especially if nested within appropriate psycho-behavioral support. Medical providers whose patients include YMSM at high risk for HIV infection should note the positive attitudes toward PrEP, and specifically LAI-PrEP.
Journal Article
Prevalence of HHV-6 Detection Among People Living with HIV: A Systematic Review and Meta-Analysis
Human herpesvirus 6 (HHV-6) is a ubiquitous virus with significant implications for immunocompromised individuals, particularly people living with HIV (PLWH). This study aimed to estimate the prevalence of HHV-6 detection in blood samples among PLWH using molecular diagnostic techniques. A systematic literature search was conducted across multiple databases until September 2024, including studies that reported HHV-6 detection in blood samples of PLWH through molecular methods. The meta-analysis calculated pooled prevalence rates using a random-effects model and assessed study quality, with additional analyses for outlier identification and influential study effects. Twelve studies met the inclusion criteria, and the random-effects model estimated the prevalence of HHV-6 detection at 11.7% (95% CI: 4.3–21.8%), with considerable heterogeneity. Influence diagnostics identified one study as influential, and after its exclusion, the recalculated pooled prevalence was 8% (95% CI: 4.4–12.4%), with reduced but still considerable heterogeneity. This meta-analysis highlights the prevalence of HHV-6 detection in PLWH, emphasizing the need for ongoing research to explore the clinical implications and factors influencing viral detection as well as the implications of this coinfection on the treatment and overall health of PLWH.
Journal Article
Racial and ethnic disparities in “stop-and-frisk” experience among young sexual minority men in New York City
Although racial/ethnic disparities in police contact are well documented, less is known about other dimensions of inequity in policing. Sexual minority groups may face disproportionate police contact. We used data from the P18 Cohort Study (Version 2), a study conducted to measure determinants of inequity in STI/HIV risk among young sexual minority men (YSMM) in New York City, to measure across-time trends, racial/ethnic disparities, and correlates of self-reported stop-and-frisk experience over the cohort follow-up (2014–2019). Over the study period, 43% reported stop-and-frisk with higher levels reported among Black (47%) and Hispanic/Latinx (45%) than White (38%) participants. Stop-and-frisk levels declined over follow-up for each racial/ethnic group. The per capita rates among P18 participants calculated based on self-reported stop-and-frisk were much higher than rates calculated based on New York City Police Department official counts. We stratified respondents’ ZIP codes of residence into tertiles of per capita stop rates and observed pronounced disparities in Black versus White stop-and-frisk rates, particularly in neighborhoods with low or moderate levels of stop-and-frisk activity. YSMM facing the greatest economic vulnerability and mental disorder symptoms were most likely to report stop-and-frisk. Among White respondents levels of past year stop-and-frisk were markedly higher among those who reported past 30 day marijuana use (41%) versus those reporting no use (17%) while among Black and Hispanic/Latinx respondents stop-and-frisk levels were comparable among those reporting marijuana use (38%) versus those reporting no use (31%). These findings suggest inequity in policing is observed not only among racial/ethnic but also sexual minority groups and that racial/ethnic YSMM, who are at the intersection of multiple minority statuses, face disproportionate risk. Because the most socially vulnerable experience disproportionate stop-and-frisk risk, we need to reach YSMM with community resources to promote health and wellbeing as an alternative to targeting this group with stressful and stigmatizing police exposure.
Journal Article
Feasibility and Acceptability of Global Positioning System (GPS) Methods to Study the Spatial Contexts of Substance Use and Sexual Risk Behaviors among Young Men Who Have Sex with Men in New York City: A P18 Cohort Sub-Study
No global positioning system (GPS) technology study has been conducted among a sample of young gay, bisexual, and other men who have sex with men (YMSM). As such, the purpose of this study was to evaluate the feasibility and acceptability of using GPS methods to understand the spatial context of substance use and sexual risk behaviors among a sample of YMSM in New York City, a high-risk population.
Data came from a subsample of the ongoing P18 Cohort Study (n = 75). GPS feasibility and acceptability among participants was measured with: 1) a pre- and post-survey and 2) adherence to the GPS protocol which included returning the GPS device, self-report of charging and carrying the GPS device as well as objective data analyzed from the GPS devices. Analyses of the feasibility surveys were treated as repeated measures as each participant had a pre- and post-feasibility survey. When comparing the similar GPS survey items asked at baseline and at follow-up, we present percentages and associated p-values based on chi-square statistics.
Participants reported high ratings of pre-GPS acceptability, ease of use, and low levels of wear-related concerns in addition to few concerns related to safety, loss, or appearance, which were maintained after baseline GPS feasibility data collection. The GPS return rate was 100%. Most participants charged and carried the GPS device on most days. Of the total of 75 participants with GPS data, 75 (100%) have at least one hour of GPS data for one day and 63 (84%) had at least one hour on all 7 days.
Results from this pilot study demonstrate that utilizing GPS methods among YMSM is feasible and acceptable. GPS devices may be used in spatial epidemiology research in YMSM populations to understand place-based determinants of health such as substance use and sexual risk behaviors.
Journal Article
The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective
The emergence of the novel coronavirus disease known as COVID-19 creates another health burden for people living with HIV (PLWH) who face multiple morbidities and may be at heightened risk for severe physical health illness from COVID-19. Our abilities to address these morbidities in PLWH must be considered alongside the socially-produced burdens that both place this population at risk for COVID-19 and heighten the likelihood of adverse outcomes. These burdens can affect the physical, emotional, and social well-being of PLWH and interfere with the delivery of effective healthcare and access to HIV treatment. We posit that a syndemic framework can be used to conceptualize the potential impact of COVID-19 among PLWH to inform the development of health programming services.
Journal Article
The Stonewall Riots, the AIDS Epidemic, and the Public’s Health
Conventional wisdom suggests that the Stonewall Riots of 1969 precipitated the HIV epidemic in our country. This remains an unsubstantiated fact borne on undocumented notions that the majority of gay men began to engage in more promiscuous sexual behaviors after this social revolution. There is no doubt that sexual liberation empowered individuals, including heterosexuals, to love more freely and to experiment with their sexuality and partners. However, this does not fully support the assertion that a sudden rush to promiscuity after Stonewall initiated the ravages of AIDS on the gay community. In fact, gay men were very sexually active before Stonewall, albeit less openly in fear of prosecution. Still, after Stonewall, the ease of engaging with multiple sexual partners at bathhouses by a small subset of gay men may have been one of a multitude of factors that accelerated transmission. Even with this knowledge, the impact of HIV would have been very difficult to predict.The challenge in foreseeing the AIDS crisis was attributable in part to a health care system that was ill equipped and unwillingto meet the needs of the lesbian, gay, bisexual, transgender, and queer or questioning iLGBTQ) population. The health burdens faced by LGBTQ people were very much present before and after the Stonewall Riots and before the first indication of AIDS in 1981, but services were scarce and underfunded. These disparities in care were predicated in the invisibility of the population by most health care professionals at the time, a phenomenon that has only begun to improve in the past two decades.
Journal Article
Undetectable = Untransmittable: A Cross-Population Systematic Review and Meta-Analysis on Awareness and Acceptance
The Undetectable = Untransmittable (U=U) message is a cornerstone of HIV-related public health communication, yet global levels of awareness and acceptance remain unclear across key populations. This study aimed to assess the global prevalence of awareness and acceptance of the U=U message among men who have sex with men (MSM), people living with HIV (PLWH), healthcare professionals, and the general population. A systematic review and meta-analysis was conducted using data from PubMed, Embase, and Google Scholar without language restrictions through 31 October 2023. Eligible studies included prospective cohort studies, randomized clinical trials, and cross-sectional studies reporting numerical data on U=U awareness and acceptance. From 1171 screened records, 43 studies were included. Data were analyzed using a random effects model. The findings showed that U=U awareness was high among PLWH, moderate among MSM and healthcare professionals, and low in the general population. Complete acceptance of U=U was low in MSM and the general population, and moderate in PLWH and healthcare professionals. Any acceptance was moderate among MSM and the general population, and high among PLWH and healthcare professionals. These results highlight the need for targeted education strategies to enhance understanding and reduce HIV-related stigma, particularly in populations with lower awareness and acceptance.
Journal Article
Ensuring survey research data integrity in the era of internet bots
We used an internet-based survey platform to conduct a cross-sectional survey regarding the impact of COVID-19 on the LGBTQ + population in the United States. While this method of data collection was quick and inexpensive, the data collected required extensive cleaning due to the infiltration of bots. Based on this experience, we provide recommendations for ensuring data integrity. Recruitment conducted between May 7 and 8, 2020 resulted in an initial sample of 1251 responses. The Qualtrics survey was disseminated via social media and professional association listservs. After noticing data discrepancies, research staff developed a rigorous data cleaning protocol. A second wave of recruitment was conducted on June 11–12, 2020 using the original recruitment methods. The five-step data cleaning protocol led to the removal of 773 (61.8%) surveys from the initial dataset, resulting in a sample of 478 participants in the first wave of data collection. The protocol led to the removal of 46 (31.9%) surveys from the second two-day wave of data collection, resulting in a sample of 98 participants in the second wave of data collection. After verifying the two-day pilot process was effective at screening for bots, the survey was reopened for a third wave of data collection resulting in a total of 709 responses, which were identified as an additional 514 (72.5%) valid participants and led to the removal of an additional 194 (27.4%) possible bots. The final analytic sample consists of 1090 participants. Although a useful and efficient research tool, especially among hard-to-reach populations, internet-based research is vulnerable to bots and mischievous responders, despite survey platforms’ built-in protections. Beyond the depletion of research funds, bot infiltration threatens data integrity and may disproportionately harm research with marginalized populations. Based on our experience, we recommend the use of strategies such as qualitative questions, duplicate demographic questions, and incentive raffles to reduce likelihood of mischievous respondents. These protections can be undertaken to ensure data integrity and facilitate research on vulnerable populations.
Journal Article
Depression Severity among a Sample of LGBTQ+ Individuals during the COVID-19 Pandemic
Background: The global pandemic of coronavirus disease 2019 (COVID-19) has led to immense impacts on global community health, the public perception of healthcare, and attitudes surrounding mental health during widespread quarantine. Methods: This analysis examines the rates of depressive symptomology among a sample of LGBTQ+-identifying individuals in the United States (n = 1090). The variables examined included socio-demographic factors, the use of mental health medication, access to mental health medication, and experiences of depression symptomology. Results: The findings indicate that depressive symptoms were less severe for older adults, as they reported higher levels of minimal to moderately severe depressive symptoms. Participants who were not working and those who were using substances were less likely to report depressive symptoms. Participants who were employed full-time reported higher levels of depression compared to those who were unemployed. Conclusions: Understanding the mental health of marginalized populations such as the LGBTQ+ community is critical to providing more nuanced preventative healthcare for unique populations, as members of the LGBTQ+ community are non-monolithic and require more personalized approaches to their healthcare needs.
Journal Article