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Article ; Online: Pilot Trial Results of Mlambe: An Economic and Relationship-Strengthening Intervention to Address Heavy Drinking and Adherence to Antiretroviral Therapy in Malawi.

Conroy, Amy A / Hahn, Judith A / Neilands, Torsten B / Darbes, Lynae A / Tebbetts, Scott / Mulauzi, Nancy / Mkandawire, James / Ssewamala, Fred M

AIDS and behavior

2024

Abstract: We evaluated the feasibility, acceptability, and preliminary efficacy of an economic and relationship-strengthening intervention to reduce heavy alcohol use among couples living with HIV in Malawi (Mlambe). Mlambe consisted of training on financial ... ...

Abstract	We evaluated the feasibility, acceptability, and preliminary efficacy of an economic and relationship-strengthening intervention to reduce heavy alcohol use among couples living with HIV in Malawi (Mlambe). Mlambe consisted of training on financial literacy and relationship skills, combined with 1:1 matched savings accounts to invest in an income-generating activity. In a randomized controlled trial, we compared Mlambe to enhanced usual care (EUC). We enrolled 78 married couples having a partner on antiretroviral therapy (ART) who reported heavy alcohol use based on the AUDIT-C. Using targets of 75%, primary outcomes included retention rates at 10 and 15-months, session attendance rates, and satisfaction with Mlambe. Exploratory outcomes were heavy alcohol use (AUDIT-C and/or PEth positive), number of drinking days in the past month, AUDIT-C score, optimal adherence to ART (95% or higher), and viral suppression. We exceeded our targets for feasibility and acceptability metrics. Retention rates were 96% at 15-months. Session attendance and satisfaction levels were both 100%. From baseline to 15-months, Mlambe participants reported decreases in mean number of drinking days (from 6.8 to 2.1) and AUDIT-C scores (from 7.5 to 3.1); while ART adherence rates improved across the same period (from 63.2 to 73.9%). Participants in Mlambe, as compared to those in EUC, had lower rates of heavy alcohol use (89.5% vs. 97.2%) and higher rates of viral suppression (100% vs. 91.9%) at 10-months. Differences between arms were not statistically significant in this small pilot study. Mlambe was highly feasible and acceptable, and shows promise for reducing heavy alcohol use and viral non-suppression among couples with HIV in a larger efficacy study.
Language	English
Publishing date	2024-03-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-024-04326-x
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Article ; Online: Communal or Autonomous? Coping Experiences of Chinese Serodiscordant Male Couples to HIV Care: A Dyadic Qualitative Analysis.

Fu, Rong / Chen, Chen / Gu, Yuzhou / Wu, Dan / Darbes, Lynae A / Yu, Nancy Xiaonan

Archives of sexual behavior

2023 Volume 52, Issue 8, Page(s) 3553–3564

Abstract: Limited empirical evidence exists on the interpersonal challenges faced by Chinese serodiscordant male couples in HIV care. This study aimed to explore their coping experiences in HIV care by applying the communal coping process theoretical framework. A ... ...

Abstract	Limited empirical evidence exists on the interpersonal challenges faced by Chinese serodiscordant male couples in HIV care. This study aimed to explore their coping experiences in HIV care by applying the communal coping process theoretical framework. A dyadic qualitative study using face-to-face interviews with 20 serodiscordant male couples (n = 40) was conducted between July and September 2021 in two Chinese metropolitan areas through purposive sampling. Eligibility included one partner living with HIV and the other being HIV-negative, both aged 18 or older, born male, gay or bisexual, and in a relationship together for at least 3 months. A hybrid deductive-inductive approach integrated with dyadic interview analysis and framework method was used for data analysis. We identified three themes in the coping process in HIV care: (1) coping as an autonomous process, (2) coping as a dissonant process, and (3) coping as a contextualized communal process. Concerning autonomous coping, most couples adopted either disengaged avoidance or mutual noninvolvement as negative coping strategies. We also identified potential risk factors for dissonant coping, which are a partner living with internalized HIV stigma and the couple's asymmetric relationship goals. Our results indicate the communal coping process of HIV care is contextual, and our expansion of the communal coping theory sheds light on how serodiscordant male couples cope with stressors connected to HIV care. Our findings provide theoretical insights for the development of dyadic interventions based on health psychology for Chinese serodiscordant male couples to engage in HIV care.
MeSH term(s)	Humans ; Male ; HIV Infections/psychology ; Risk Factors ; Social Stigma ; Sexual Partners/psychology ; China
Language	English
Publishing date	2023-06-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	184221-3
ISSN	1573-2800 ; 0004-0002
ISSN (online)	1573-2800
ISSN	0004-0002
DOI	10.1007/s10508-023-02643-1
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Article ; Online: Sexual Relationship Violence Among Young, Partnered Sexual Minority Men in the United States.

Stephenson, Rob / Washington, Catherine / Darbes, Lynae A / Hightow-Weidman, Lisa / Sullivan, Patrick / Gamarel, Kristi E

Journal of interpersonal violence

2023 Volume 38, Issue 11-12, Page(s) 7804–7823

Abstract: While there has been a growth in studies examining sexual violence among sexual minority men, little research attention has been paid to the experience of sexual violence among young sexual minority men (YSMM). In this article we analyze secondary data ... ...

Abstract	While there has been a growth in studies examining sexual violence among sexual minority men, little research attention has been paid to the experience of sexual violence among young sexual minority men (YSMM). In this article we analyze secondary data from the baseline of a pilot randomized control trial with 318 YSMM aged 15 to 24 years in the United States who were in relationships with other males to examine the associations between sexual minority-specific stigma and sociodemographic and relationship characteristics and experiences of intimate partner violence (IPV) and sexual IPV in their relationships. Approximately one-in-five participants reported experiencing any form of IPV and 6% reported sexual IPV in their current relationship. Participants who reported sexual minority-specific familial rejection (Adjusted Odds Rato (aOR) = 2.33, 95% confidence interval [CI] [1.03, 5.26],
MeSH term(s)	Male ; Humans ; United States ; Sex Offenses ; Men ; Sexual Partners ; Intimate Partner Violence/prevention & control ; Violence ; Sexual and Gender Minorities ; Risk Factors
Language	English
Publishing date	2023-01-13
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2028900-5
ISSN	1552-6518 ; 0886-2605
ISSN (online)	1552-6518
ISSN	0886-2605
DOI	10.1177/08862605221149091
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Article ; Online: Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence.

Gutin, Sarah A / Ruark, Allison / Darbes, Lynae A / Neilands, Torsten B / Mkandawire, James / Conroy, Amy A

BMC public health

2023 Volume 23, Issue 1, Page(s) 1878

Abstract: Introduction: HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health ... ...

Abstract	Introduction: HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the potential link between HIV stigma, relationship dynamics, and antiretroviral therapy (ART) adherence. Using dyadic data from a cross-sectional study of Malawian couples living with HIV, we tested associations between anticipated stigma and: 1) relationship dynamics (e.g., trust, sexual satisfaction, communication) and partner support; and 2) self-reported ART adherence. Methods: Heterosexual couples (211 couples, 422 individuals) with at least one partner on ART were recruited from clinics in Zomba, Malawi. Partners completed separate surveys on anticipated stigma, relationship dynamics, and ART adherence. Linear mixed models evaluated associations between anticipated stigma and relationship dynamics, and whether associations varied by gender. Generalized estimating equation models tested for associations between anticipated stigma and high ART adherence (90-100% vs. < 90%) at the individual level, and whether they were moderated by relationship dynamics at the couple level. Results: Couples' relationship length averaged 12.5 years, 66.8% were HIV sero-concordant, and 95.6% reported high ART adherence. In multivariable models, sexual satisfaction (β = -0.22, 95%CI = -0.41;-0.03, p = 0.020) and partner social support (β = -0.02, 95%CI = -0.04;-0.01, p < 0.01) were negatively associated with anticipated stigma. Significant interaction effects showed that adherence is moderated in couples with higher partner support and sexual satisfaction such that adherence is lowest when anticipated stigma is high and social support is low, and that adherence is lowest when anticipated stigma is high and sexual satisfaction is low. Conclusions: Increased anticipated stigma is most associated with lower ART non-adherence at lower levels of social support and sexual satisfaction. Conversely, supportive and fulfilling relationships may buffer the negative association between stigma and ART adherence. Couples' interventions that focus on improving communication and support systems within couples could reduce the negative impacts of anticipated stigma on couples living with HIV.
MeSH term(s)	Humans ; Sexual Partners ; Cross-Sectional Studies ; HIV Infections/drug therapy ; Anti-Retroviral Agents/therapeutic use ; Treatment Adherence and Compliance ; Medication Adherence ; Social Stigma
Chemical Substances	Anti-Retroviral Agents
Language	English
Publishing date	2023-09-28
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-023-16762-w
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Article ; Online: Day-level associations between drug use and sexual behavior in male couples: Actor partner interdependence modeling of timeline follow-back data.

Starks, Tyrel J / Sauermilch, Daniel / Adebayo, Trinae / Kyre, Kory D / Stratton, Mark J / Darbes, Lynae A

Drug and alcohol dependence

2021 Volume 225, Page(s) 108758

Abstract: Background: Both marijuana and other illicit drugs (e.g., cocaine/crack, methamphetamines, ecstasy, gamma-hydroxybuterate, and ketamine) have been linked to the occurrence of condomless anal sex (CAS) with casual partners among sexual minority men (SMM) ...

Abstract	Background: Both marijuana and other illicit drugs (e.g., cocaine/crack, methamphetamines, ecstasy, gamma-hydroxybuterate, and ketamine) have been linked to the occurrence of condomless anal sex (CAS) with casual partners among sexual minority men (SMM) and these associations largely generalize to partnered SMM. Software advances now permit testing the day-level correspondence between participants' sexual behavior and their own drug use (actor effects) as well as their partners' (partner-effects). Methods: Participants comprised 50 couples (100 individuals) recruited in the New York City metro area. All were 18 or older and identified as cis male. In each couple, at least one partner was 18-29 years old, HIV-negative, reported recent (past 30 day) drug use and recent (past 30 day) CAS with a casual partner or CAS with a non-monogamous or sero-discordant main partner at screening. Results: Marijuana was associated with CAS between main partners on days both partners reported its use. A similar pattern was observed for other illicit drugs. Respondents were more likely to report CAS with casual partners on days CAS between main partners occurred. Both marijuana and other illicit drugs were associated with increased likelihood of CAS with casual partners on days a main partner did not use drugs. These associations were attenuated on days where partners reported the use of different drugs. Conclusions: The co-occurrence of CAS with main and casual partners maximizes shared sexual risk. Results support the continued emphasis on dyadic HIV prevention interventions and the development of theoretically-based interventions that may address drug use by both partners in the relationship.
MeSH term(s)	Adolescent ; Adult ; HIV Infections ; Homosexuality, Male ; Humans ; Illicit Drugs ; Male ; Risk-Taking ; Sexual Behavior ; Sexual Partners ; Unsafe Sex ; Young Adult
Chemical Substances	Illicit Drugs
Language	English
Publishing date	2021-05-21
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2021.108758
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Article ; Online: HIV Testing, Knowledge and Willingness to Use PrEP Among Partnered Men Who Have Sex With Men in South Africa and Namibia.

Stephenson, Rob / Darbes, Lynae A / Chavanduka, Tanaka / Essack, Zaynab / van Rooyen, Heidi

AIDS and behavior

2021 Volume 25, Issue 7, Page(s) 1993–2004

Abstract: There is strong evidence that gay, bisexual and other men who have sex with men (GBMSM) in African countries experience high prevalence of HIV. However, missing from the literature is an understanding of the HIV risk behaviors and prevention needs of ... ...

Abstract	There is strong evidence that gay, bisexual and other men who have sex with men (GBMSM) in African countries experience high prevalence of HIV. However, missing from the literature is an understanding of the HIV risk behaviors and prevention needs of partnered GBMSM in African countries. The Together Tomorrow project sampled 440 partnered GBMSM (220 couples) in South Africa and Namibia. Prevalence of HIV was high at 42%, with 33% of men in sero-discordant relationships. Despite high levels of HIV testing in the past 6 months (65%), condom use with main and outside sex partners was low. Men reported low levels of willingness to use pre-exposure prophylaxis (PrEP) (16%). HIV testing in the past 12 months and willingness to use PrEP were significantly associated with recent binge drinking and substance use. Men in sero-discordant relationships, those with sexual agreements and those who had experienced any form of IPV were all less likely to report that they had recently tested for HIV. There is a need to develop interventions that meet the unique needs of African partnered GBMSM and tackle stigma and discrimination as drivers of HIV risk in these settings.
MeSH term(s)	HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; HIV Testing ; Homosexuality, Male ; Humans ; Male ; Namibia/epidemiology ; Pre-Exposure Prophylaxis ; Sexual Partners ; Sexual and Gender Minorities ; South Africa/epidemiology
Language	English
Publishing date	2021-01-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-020-03129-0
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Article ; Online: Correlates of Substance Misuse, Transactional Sex, and Depressive Symptomatology Among Partnered Gay, Bisexual and Other Men Who Have Sex with Men in South Africa and Namibia.

Metheny, Nicholas / Stephenson, Rob / Darbes, Lynae A / Chavanduka, Tanaka M D / Essack, Zaynab / van Rooyen, Heidi

AIDS and behavior

2022 Volume 26, Issue 6, Page(s) 2003–2014

Abstract: Despite having some of the world's highest rates of HIV, there is a lack of knowledge on correlates of transmission risk among gay, bisexual and other men who have sex with men in Southern Africa. There is even less known about the factors that shape HIV ...

Abstract	Despite having some of the world's highest rates of HIV, there is a lack of knowledge on correlates of transmission risk among gay, bisexual and other men who have sex with men in Southern Africa. There is even less known about the factors that shape HIV risk in male-male couples. Using data from Together Tomorrow, a study of partnered GBMSM in South Africa and Namibia, this study assessed the individual and dyadic correlates of three major HIV risk factors in this population: substance misuse, transactional sex, and depressive symptomatology. Data were collected during November 2016-March 2017 via a quantitative survey conducted with 140 partnered MSM (70 couples) in Windohoek, Keetmanshoop, Walvis Bay, and Swakopmund, Namibia and 300 partnered MSM (150 couples) in Pietermaritzburg and Durban, KwaZulu-Natal, South Africa for a total sample size of 440 partnered MSM (220 couples). Results of multilevel modeling analyses show several significant factors present in partnered GBMSM that differ from studies of single GBMSM, with intimate partner violence being a significant correlate across all three risk factors. Future interventions should consider dyadic approaches and integrate IPV prevention and mitigation efforts to reduce HIV in this population as part of a multisectoral approach. To reduce rates of HIV in partnered GBMSM in Namibia and South Africa multilevel, multisectoral work is needed in policy, social norms change, and relationship-focused dyadic interventions to reduce the social and structural stigma facing male couples.
MeSH term(s)	HIV Infections/epidemiology ; HIV Infections/prevention & control ; Homosexuality, Male ; Humans ; Male ; Namibia/epidemiology ; Sexual and Gender Minorities ; South Africa/epidemiology ; Substance-Related Disorders/epidemiology
Language	English
Publishing date	2022-01-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-021-03549-6
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Article ; Online: Perceptions of Relationship Quality Before and During COVID-19 Pandemic Among Young Sexual Minority Men in Romantic Relationships.

Gamarel, Kristi E / Washington, Catherine / Rosso, Matthew T / Darbes, Lynae A / Claude, Kristina Felder / Hightow-Weidman, Lisa / Sullivan, Patrick / Stephenson, Rob

Archives of sexual behavior

2022 Volume 51, Issue 4, Page(s) 2261–2268

Abstract: The COVID-19 pandemic has impacted the well-being of people worldwide; however, there has been limited research examining ways in which the pandemic has created changes in relationship quality among young sexual minority men. We analyzed data from a ... ...

Abstract	The COVID-19 pandemic has impacted the well-being of people worldwide; however, there has been limited research examining ways in which the pandemic has created changes in relationship quality among young sexual minority men. We analyzed data from a sample of 150 young sexual minority men, aged 15-24 years. In total, 25% reported their relationship quality decreased during the pandemic, 47% reported no change, and 28% reported increased relationship quality due to COVID-19. In multinomial models, intimate partner violence, lower commitment, and spending less time with a partner due to COVID-19 were associated with decreased relationship quality during the pandemic compared to those who reported no change or increased relationship quality due to the pandemic. More efforts are needed to understand and address the impact of COVID-19 on the romantic relationships of young sexual minority men.
MeSH term(s)	COVID-19/epidemiology ; Humans ; Intimate Partner Violence ; Male ; Pandemics ; Sexual Behavior ; Sexual and Gender Minorities
Language	English
Publishing date	2022-06-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	184221-3
ISSN	1573-2800 ; 0004-0002
ISSN (online)	1573-2800
ISSN	0004-0002
DOI	10.1007/s10508-021-02254-8
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Article ; Online: Analysis of emergency department visits for all reasons by adults with depression in the United States.

Hill, Tyler / Jiang, Yun / Friese, Christopher R / Darbes, Lynae A / Blazes, Christopher K / Zhang, Xingyu

BMC emergency medicine

2020 Volume 20, Issue 1, Page(s) 51

Abstract: Background: We aimed to characterize Emergency Department (ED) utilization and outcomes of patients with depression seeking emergency care for all reasons.: Methods: Using 2014-2016 ED data from the National Hospital Ambulatory Medical Care Survey, ... ...

Abstract	Background: We aimed to characterize Emergency Department (ED) utilization and outcomes of patients with depression seeking emergency care for all reasons. Methods: Using 2014-2016 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, clinical characteristics, and disposition of patients with depression versus those without depression. Results: Approximately 10,626,184 (11.4%) out of 92,899,685 annual ED visits were by patients with depression. ED patients with depression were mostly non-Hispanic White (74.0%) and were less likely to be male than patients without depression (aOR: 0.62; [95%] CI: 0.57-0.68). ED patients with depression were more likely to be admitted to the hospital (aOR: 1.50; CI: 1.38-1.63) than patients without depression. Among ED patients with depression, males were more likely than females to be seeking emergency care for psychiatric reasons (OR: 2.45; 95% CI: 2.10-2.87)) and to present with overdose/poisoning (OR: 1.46; CI: 1.03-2.05). Conclusions: We described the unique demographic, socioeconomic, and clinical characteristics of ED patients with depression, using the most comprehensive, nationally representative study to date. We revealed notable gender disparities in rates and reasons for admissions. The higher hospital and ICU admission rates of ED patients with depression suggests this population requires a higher level of emergency care, for reasons that remain poorly understood.
MeSH term(s)	Adult ; Cross-Sectional Studies ; Depression/epidemiology ; Drug Overdose/epidemiology ; Emergency Service, Hospital/statistics & numerical data ; Female ; Health Care Surveys ; Humans ; Male ; Patient Admission/statistics & numerical data ; Poisoning/epidemiology ; Sex Factors ; United States/epidemiology
Language	English
Publishing date	2020-06-22
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1471-227X
ISSN (online)	1471-227X
DOI	10.1186/s12873-020-00347-6
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Article ; Online: Bidirectional Violence Is Associated with Poor Engagement in HIV Care and Treatment in Malawian Couples.

Conroy, Amy A / Leddy, Anna M / Darbes, Lynae A / Neilands, Torsten B / Mkandawire, James / Stephenson, Rob

Journal of interpersonal violence

2020 Volume 37, Issue 7-8, Page(s) NP4258–NP4277

Abstract: Growing evidence suggests that intimate partner violence (IPV) is a barrier to engagement in HIV care. Bidirectional IPV-being both a perpetrator and victim-may be the most common pattern of IPV, yet no research has examined its effect on engagement in ... ...

Abstract	Growing evidence suggests that intimate partner violence (IPV) is a barrier to engagement in HIV care. Bidirectional IPV-being both a perpetrator and victim-may be the most common pattern of IPV, yet no research has examined its effect on engagement in care, which could identify couples in most need of interventions. Married couples (
MeSH term(s)	HIV Infections/drug therapy ; Humans ; Intimate Partner Violence/psychology ; Prevalence ; Risk Factors ; Sexual Partners/psychology ; Violence
Language	English
Publishing date	2020-09-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2028900-5
ISSN	1552-6518 ; 0886-2605
ISSN (online)	1552-6518
ISSN	0886-2605
DOI	10.1177/0886260520959632
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