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Open Access Publications from the University of California

Scholarly Works (59 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2025)

In the highly-active antiretroviral therapy (HAART) era, sexual minority men (SMM) have achieved high life expectancies. However, they continue to be disproportionately affected by aging-related outcomes (e.g., lung cancer) and low quality of life (e.g., high rates of hospitalization and mortality). Previous literature has shown that overlapping behavioral and psychosocial factors predict HIV infection, low HAART use, and sexual risk behaviors among SMM but whether these factors are linked to adverse health outcomes including hospitalization, lung cancer, and mortality remains unknown. In this dissertation, we used data from the Multicenter AIDS Cohort Study (MACS). The first study included men having sex with men (MSM) who completed at least two assessments between 2004 and 2019 in the Methamphetamine Substudy of the MACS, and we used generalized estimating equation (GEE) models to examine the synergistic effects of psychosocial factors on incident all-cause hospitalization. Our second study involved SMM who underwent at least two assessments in the MACS between 1996 and 2022, and we conducted survival analyses to examine the additive effects of behavioral and psychosocial factors on incident lung cancer. In the third study, we included SMM living with HIV who completed two or more assessments and initiated HAART for at least one year between 1996 and 2022. We examined the predictive capabilities of behavioral and psychosocial factors on all-cause mortality when these factors were added to the Veteran Aging Cohort Study (VACS) Index 2.0, which is a commonly used clinical tool to predict mortality among people living with HIV (PLWH). In our first study, we found synergistic effects of depression, stimulant use, smoking, heroin use, childhood sexual abuse, and intimate partner violence on hospitalization. In our second study, we found a dose-response relationship between the number of behavioral and psychosocial factors (depression, cigarette smoking, heavy alcohol use, and polydrug use) and lung cancer incidence. Our findings from the third study indicated that including depression enhanced the accuracy of the VACS Index 2.0 in predicting mortality. Future interventions should target behavioral and psychosocial factors to reduce healthcare costs and improve the quality of life and overall health among SMM in the US.

    • Thesis
    • Peer Reviewed
    UCLA Electronic Theses and Dissertations (2025)

    Background: Sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis are a significant public health concern in the United States, particularly among young adult sexual and gender minority (SGM) populations who use substances. While prior research links specific substances to HIV and STI risk in men who have sex with men (MSM), less has been studied on how different types of substance use relate to STI outcomes in gender-diverse young adults who use substances in the context of sexual behavior.

    Methods: Cross-sectional data was analyzed from 420 SGM young adults who reported using substances in the context of sexual behavior in the past 3 months were recruited nationally to examine associations between recent substance use (prior 6 months) and STI outcomes. Participants completed a quantitative survey on sociodemographics, PrEP status, and substance use, and a subset (n=233, 55.5%) submitted laboratory-confirmed STI test results through at-home kits or provider documentation. Firth Multivariable logistic regression models were used to assess associations between self-reported and laboratory-confirmed STIs and recent use of substances, adjusting for age, gender, race/ethnicity, educational attainment, and HIV pre-exposure prophylaxis (PrEP) use.

    Results: Poppers use was consistently associated with increased odds of STI positivity across both self-report and lab-confirmed outcomes. In self-report data, poppers use was associated with gonorrhea (aOR = 3.89, 95% CI: 1.64–11.04) and any STI (aOR = 2.93, 95% CI: 1.55–5.96). Polydrug use was linked to syphilis (aOR = 8.52, 95% CI: 1.01–1112.53) and any STI (aOR = 1.85, 95% CI: 1.07–3.30). In lab-confirmed results, poppers use remained significantly associated with any STI (aOR = 3.98, 95% CI: 1.42–15.08) and syphilis via kit testing (aOR = 4.55, 95% CI: 1.11–41.35). Stimulant use was also associated with syphilis (aOR = 3.07, 95% CI: 1.12–9.55), and opioid use showed strong associations with syphilis (aOR = 25.67, 95% CI: 2.83–381.96) and any STI (aOR = 15.92, 95% CI: 1.66–249.23), though estimates were imprecise. Cannabis use was associated with lower odds of gonorrhea (aOR = 0.18, 95% CI: 0.04–0.76).

    Conclusion: Use of poppers, stimulants, opioids, as well as use of three or more drugs concurrently and prescription drug misuse was associated with increased odds of both self-reported and laboratory-confirmed STIs among SGM young adults. Findings suggest substance use is a behavioral marker of heightened sexual health risk. Interpretation should be cautious given the study’s cross-sectional design, missing data, and potential biases. Longitudinal research is needed to clarify pathways and inform targeted interventions.

      Cover page: Substance Use and STI Positivity Among Sexual and Gender Minority Young Adults Who Use Substances in the Context of Sexual Behavior: Associations with Self-Reported and Laboratory-Confirmed Outcomes
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2010)
      Non-occupational post-exposure prophylaxis (nPEP) use is an HIV prevention strategy that has been recommended by the CDC to prevent HIV infection after a high risk sexual exposure since 1997. In a behavioral intervention trial of 4,295 MSM we assessed perceptions and use of nPEP over 4 years in six cities across the United States. Overall, 1.9% of MSM reported use of nPEP prior to enrollment, and 6.3% at least once during the trial. Awareness of nPEP was reported by 47.5%, with higher awareness in two sites with funded nPEP programs. Three seroconversions occurred in the 384 visits where nPEP courses were reported, with no effect of nPEP on risk of HIV acquisition in this cohort (hazard ratio = 0.91, 95% confidence interval [0.29, 2.86]). NPEP users were a riskier group: increased odds of nPEP use were observed in association with multiple partners and unprotected receptive and insertive anal sex with HIV infected partners and partners with unknown HIV status. NPEP use was also associated with use of illicit drugs (injection drugs, crack cocaine, hallucinogens, and amphetamines). Importantly, willingness to use nPEP after high risk sex was associated with lower odds of high risk sex. After an episode of nPEP use, nPEP users remained more likely to report high risk sex than those in this cohort who had not previously used nPEP. However, within the subset of people who had previously reported high risk sex, previous nPEP use was not associated with higher odds of high risk sex, thus allaying fears that availability of nPEP would lead to an increase in high risk sex.
        Cover page: Use of Non-Occupational Post-Exposure Prophylaxis does not Lead to an Increase in High Risk Sex Behaviors in Men Who have Sex with Men Participating in the EXPLORE Trial
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2022)

        Background & objectives

        Transgender women (TGW) in India are at high risk of HIV infection. Despite behavioural interventions aimed at reducing HIV risk, no literature synthesis exists so far to evaluate their potential for reducing HIV incidence in India This review was aimed to identify and evaluate HIV-focussed behaviour change interventions for TGW in India.

        Methods

        Literature from three databases were reviewed up to June 2, 2021, for studies describing behavioural interventions for HIV prevention among TGW in India. The inclusion criteria were studies that included TGW and reported intervention effects on HIV prevention-related behaviour. Data were analyzed descriptively.

        Results

        Of the 146 articles screened, only three met the inclusion criteria. All three interventions were at the open pilot trial stage and included other high-risk groups (e.g. men who have sex with men). The interventions used behavioural counselling, increased sexually transmitted infection screening and sexual healthcare visits and leveraged community-based organizations to improve the outcomes. All these interventions showed modest improvements in health-seeking behaviour and access to services. However, none specifically targeted TGW.

        Interpretation & conclusions

        The scoping review highlights the need for behavioural interventions for HIV prevention tailored to TGW in India. This study emphasizes the need for research to move to the next stage of intervention development and testing utilizing more rigorous evaluation methods, such as a randomized controlled trial.
          Cover page: The need for targeted behavioural HIV-related interventions for transgender women in India: A scoping review.Creative Commons 'BY-NC-SA' version 4.0 license
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2021)

          Purpose of review

          Recent HIV outbreaks among people who use drugs (PWUD) necessitate additional HIV prevention tools. Pre-exposure prophylaxis (PrEP) is highly efficacious yet uptake among PWUD remains exceedingly low. To address multilevel, complex barriers to PrEP use among PWUD, a range of intervention strategies are needed.

          Recent findings

          The literature on interventions to optimize PrEP use among PWUD is nascent, comprising small pilots and demonstration projects in early phases of intervention development. Initial studies suggest that structural, healthcare, interpersonal, and individual-level interventions can improve PrEP use for PWUD, and a number of efficacy trials are underway. Future studies are needed to optimize the use of new PrEP modalities (e.g., injectable PrEP), simultaneously target multilevel challenges to PrEP use, and evaluate the integration of PrEP into other service settings and substance use treatment modalities.
            Cover page: The Past, Present, and Future of PrEP implementation Among People Who Use Drugs
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2021)

            Background

            Men who have sex with men are disproportionately burdened by HIV/AIDS, and the advent of pre-exposure prophylaxis (PrEP) has provided an effective strategy to reduce the risk of HIV transmission. Research has shown that improving one partner's health-promoting behaviors increases the likelihood that their partner adopts healthier behaviors. We examined the longitudinal relationship between favorable HIV treatment outcomes with current PrEP use among HIV serodiscordant male partners.

            Setting

            Data are from Project Stronger Together, a randomized controlled trial that recruited serodiscordant male couples from Atlanta, GA; Boston, MA; and Chicago, IL.

            Methods

            Serodiscordant couples completed assessments at baseline, 6, 12, 18, and 24 months. We analyzed longitudinal data from 120 HIV serodiscordant male partners to assess the relationship between the HIV-negative partner's current PrEP use and their HIV-positive partner's current ART use, ART adherence, and viral load using generalized estimating equation models.

            Results

            Fewer than half of the HIV-negative partners were on PrEP at baseline and nearly two-thirds of their HIV-positive partners were virally suppressed. HIV-negative male partners who had partners with an undetectable viral load had greater odds of being a current PrEP user than HIV-negative partners with partners with a detectable viral load.

            Conclusion

            Our study highlights the need to develop dyad-level interventions to improve HIV medication use/adherence by HIV serodiscordant male couples. Our findings also suggest that dyad-level interventions may be able to leverage our understanding of how partners can influence each other's health-promoting behaviors to develop programs that improve health outcomes for both partners.
              Cover page: Examining the Longitudinal Predictive Relationship Between HIV Treatment Outcomes and Pre-exposure Prophylaxis Use by Serodiscordant Male Couples.
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2022)
              Introduction: Coronavirus disease 2019 (COVID-19) has impacted researchers' ability to continue to deliver HIV prevention and treatment interventions face to face. Although telehealth has been an important strategy to maintain research operations during the current pandemic, participants at increased risk of or living with HIV are often at higher risk of also experiencing poverty, housing instability, and other challenges that may present obstacles to successful remote delivery. Methods: We provide descriptions of remote adaptations to two randomized controlled efficacy trials of behavioral interventions for primary and secondary HIV prevention with descriptive enrollment and retention data. Results and Conclusions: Best practices for implementing telemedicine and e-health procedures are discussed, including procedures for addressing remote participation barriers (economic, health literacy, etc.) and other challenges, such as building rapport and staff support (NCT03092531 and NCT03175159).
                Cover page: Transitioning from Face to Face to the Digital Space: Best Practices and Lessons Learned Leveraging Technology to Conduct HIV-Focused Interventions
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2021)
                Gay and bisexual men (GBM) who report engagement in transactional sex are at increased risk for HIV acquisition. The current study aimed to assess the prevalence of transactional sex and its association with demographic characteristics, social marginalization, HIV sexual risk behaviors, psychosocial health problems, and access to healthcare services among a multi-site sample of GBM in Nigeria. Bivariate and multivariable logistic regression were used to examine factors associated with engagement in transactional sex in the previous 3 months. More than a third (39.6%) of the participants reported engagement in transactional sex in the previous 3 months. In the multivariable model, factors associated with engagement in transactional sex included: reporting a monthly income of 30,000 Naira [adjusted odds ratio (aOR) 1.98; 95% CI: 1.12 to 3.35], compared to 30,000 or more Naira monthly income, reporting 4 or more receptive anal sex acts in the previous 30 days (aOR 2.45; 95% CI: 1.31 to 4.57) compared to reporting none, and having depressive symptoms (aOR 1.82; 95% CI: 1.06 to 3.14). There is an urgent need for interventions that address the economic disenfranchisement and psychosocial problems experienced by GBM in Nigeria, which has implications for sexual health.
                  Cover page: Transactional Sex Is Associated with Income Level and Psychosocial Health Problems among Gay and Bisexual Men (GBM) in Nigeria, Africa
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2021)
                  Multilevel barriers to pre-exposure prophylaxis (PrEP) care among male sex workers (MSW) include aspects of interactions with health services and providers. We examined relationships between health service- and provider-level factors and PrEP care among MSW. Between 2017 and 2019, we enrolled 111 MSW in the Northeast United States who were not on PrEP, but expressed interest in potentially using PrEP, in a behavioral intervention to promote PrEP uptake and adherence. Using baseline data, we examined whether having a primary care provider, past year frequency of medical visits, comfort discussing sexual practices with providers, and transportation difficulties to accessing general health care were associated with PrEP use self-efficacy, anticipated barriers to PrEP uptake, adherence, and retention (linear regression), and intention to initiate PrEP (logistic regression). Models adjusted for age, race/ethnicity, sexual identity, education, and income. Participants' mean age was 34.2 [standard deviation (SD) = 8.5], and 47% were non-White. Three-quarters (76%) intended to initiate PrEP within the next month. Comfort discussing sexual practices with providers was associated with PrEP use self-efficacy (b = 0.41, p = 0.008). Comfort discussing sexual practices with providers was negatively associated with anticipated barriers to PrEP uptake (b = -0.29, p = 0.006). Transportation difficulties to accessing general health care were associated with barriers to PrEP uptake (b = 0.30, p = 0.007) and barriers to PrEP adherence and retention (b = 0.57, p < 0.001). No health service- and provider-level characteristics were associated with intention to initiate PrEP. PrEP programs targeting MSW may benefit from interventions to foster communication between MSW and providers about sexual practices and should consider structural barriers to accessing care, including lack of access to transportation.
                    Cover page: Health Service- and Provider-Level Factors Influencing Engagement in HIV Pre-Exposure Prophylaxis Care Among Male Sex Workers
                    • Article
                    • Peer Reviewed
                    UCLA Previously Published Works (2021)
                    Purpose: The purpose of this study was to examine the extent to which transgender people have observed negative transgender-related messages in the media and the relationship between negative media message exposure and the mental health of transgender people. Methods: In 2019, 545 transgender adults completed an online survey assessing demographics, negative transgender-related media messages, violence, and mental health. Separate multivariable logistic regression models examined the association of frequency of negative media exposure and clinically significant symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and global psychological distress. Results: Mean age of the sample was 31.2 years (standard deviation [SD] = 11.2). Nearly half identified as nonbinary (42.2%), 82.0% were White, non-Hispanic, 56.9% had a college degree, and 67.0% were financially insecure. The majority reported experiencing childhood abuse (60.6%) and abuse in adulthood (58.0%). The mean frequency of exposure to negative transgender-related media was 6.41 (SD = 2.9) with 97.6% of the sample reporting exposure to negative media depictions of transgender people across a range of mediums. In separate multivariable models adjusted for age, gender identity, race, education, income, and childhood/adult abuse, more frequent exposure to negative depictions of transgender people in the media was significantly associated with clinically significant symptoms of depression (adjusted odds ratio [aOR] = 1.18; 95% confidence interval [CI] = 1.08-1.29; p = 0.0003); anxiety (aOR = 1.26; 95% CI = 1.14-1.40; p < 0.0001); PTSD (aOR = 1.25; 95% CI = 1.16-1.34; p < 0.0001); and global psychological distress (aOR = 1.28; 95% CI = 1.15-1.42; p < 0.0001). Conclusion: Exposure to negative media messages from multiple sources necessitates multilevel interventions to improve the mental health of transgender people and curb stigma at its source.
                      Cover page: Negative Transgender-Related Media Messages Are Associated with Adverse Mental Health Outcomes in a Multistate Study of Transgender Adults
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