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Factors associated with barriers to engagement in HIV-prevention care among sexual minority men

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Abstract

Engagement with HIV-prevention services varies among sexual minority men (SMM). 183 HIV-negative SMM completed a baseline assessment including sociodemographic, psychosocial, identity and stigma, and sexuality measures, as well as HIV-prevention behaviors: (1) date of most recent HIV test, (2) whether they discussed HIV or (3) sexual behavior with their provider, and (4) disclosure to provider about engaging in condomless anal sex (CAS). Factor analysis of these four items yielded an HIV-prevention engagement factor score. Stochastic search variable selection (SSVS) followed by multiple linear regression identified variables associated with HIV-prevention engagement. SSVS identified three variables for inclusion in a multiple linear regression model. Not disclosing sexual orientation to one’s provider (p < 0.001), discomfort discussing sex with provider (p < 0.001) and lower education (p = 0.007) were associated with less HIV-prevention engagement. Findings suggest the importance of training providers in culturally competent care to mitigate observed barriers.

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Notes

  1. We refer to gay, bisexual, and other men who have sex with men collectively as “sexual minority men,” however, when referencing sources that specifically refer to men who have sex with men (MSM) we use the matching terminology.

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Funding

Data collection for this study was supported by P01AI074415 (Altfeld) and P30AI060354 (Walker). Additional support was provided by K24DA040489 and P30MH116867 (Safren) and K23MD015690 (Harkness). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any other funders.

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Authors and Affiliations

  1. Clinical Research Building, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA

    Audrey Harkness, Noelle A. Mendez, Daniel Hernandez Altamirano & Steven A. Safren

  2. University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33146, USA

    Sierra A. Bainter

  3. Harvard Medical School, Massachusetts General Hospital, Boston, USA

    Conall O’Cleirigh

  4. University of California Los Angeles, Los Angeles, USA

    Matthew J. Mimiaga

  5. Harvard School of Public Health, Boston, USA

    Kenneth H. Mayer

  6. The Fenway Institute, Boston, MA, USA

    Kenneth H. Mayer

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  1. Audrey Harkness
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  2. Sierra A. Bainter
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  8. Steven A. Safren
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Contributions

Conceptualization and Methodology: Audrey Harkness, Sierra A. Bainter, Steven A. Safren; Methodology: Audrey Harkness, Sierra A. Bainter, Steven A. Safren; Formal analysis: Audrey Harkness and Sierra A. Bainter; Writing—original draft preparation: Audrey Harkness, Noelle A. Mendez, Daniel Hernandez Altamirano; Writing—review and editing: Sierra A. Bainter, Noelle A. Mendez, Daniel Hernandez Altamirano, Conall O’Cleirigh, Matthew J. Mimiaga, Kenneth H. Mayer, Steven A. Safren; Supervision: Sierra A. Bainter, Conall O’Cleirigh, Matthew J. Mimiaga, Kenneth H. Mayer, Steven A. Safren.

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Correspondence to Audrey Harkness.

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Conflicts of Interest

Dr. Safren receives royalties from Oxford University Press, Guilford Publications, and Springer/Humana press for books on cognitive behavioral therapy. The authors have no relevant financial or non-financial competing interests to report.

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Study procedures were reviewed and approved by the Fenway Health Institutional Review Board, which included obtaining written informed consent from all participants.

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Harkness, A., Bainter, S.A., Mendez, N.A. et al. Factors associated with barriers to engagement in HIV-prevention care among sexual minority men. J Behav Med 44, 784–793 (2021). https://doi.org/10.1007/s10865-021-00230-0

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