Purpose We sought to describe the prevalence of food insecurity and its relationship with mental ... more Purpose We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S. Design and Setting We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia. Sample The study sample was restricted to LGB adults ≥18 years (N = 1178) from the 2021 NHIS survey. Measures Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence. Analysis Descriptive statistics and linear and generalized linear regressions. Results The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as ...
Lesbian, gay, bisexual, and transgender (LGBT) individuals have a high prevalence of substance us... more Lesbian, gay, bisexual, and transgender (LGBT) individuals have a high prevalence of substance use disorders (SUDs) and experience unique barriers to treatment. Little is known about the characteristics of SUD treatment facilities providing LGBT-tailored programs at the outpatient and residential levels of care. The purpose of this study is to examine the availability of LGBT-tailored programs in outpatient and residential SUD treatment facilities. Using the National Survey of Substance Abuse Treatment Services 2020, we conducted logistic regression to examine facility characteristics, including ownership, pay assistance, region, outreach, and telehealth services, associated with having an LGBT-tailored program among SUD treatment facilities. Outpatient facilities that were for-profit, had pay assistance, had community outreach services, and provided telemedicine/telehealth were more likely to have an LGBT-tailored program. Those that were government-owned, in the Midwest, and that ...
Background Studies show that stressful life events (SLE) (e.g., discrimination, financial problem... more Background Studies show that stressful life events (SLE) (e.g., discrimination, financial problems) can lead to psychosocial problems and exacerbate condomless anal sex (CAS) without protection via pre-exposure prophylaxis (PrEP) among men who have sex with men. However, few studies have examined this relationship among men who have sex with men in India, and none have examined this longitudinally. Methods As a part of an HIV-prevention intervention, 608 MSM from Chennai and Mumbai, India, completed behavioral surveys at baseline, 4, 8, and 12 months. We used longitudinal generalized estimating equations (GEE) modeling to examine the relationship between SLE and its severity and subsequent psychosocial problems, CAS, and history of diagnosed sexually transmitted infection (STI). All models are adjusted for age, sexual identity, intervention arm, human immunodeficiency virus status, and recruitment city. Results The number of SLE and their corresponding perceived impact score remaine...
ABSTRACTAmid incremental progress in establishing an enabling legal and policy environment for le... more ABSTRACTAmid incremental progress in establishing an enabling legal and policy environment for lesbian, gay, bisexual, transgender and queer-identified people, and people with intersex variations (LGBTQI+) in India, evidence gaps on LGBTQI+ health are of increasing concern. To that end, we conducted a scoping review to map and synthesize the current evidence base, identify research gaps, and provide recommendations for future research. We conducted a scoping review using the Joanna Briggs Institute methodology. We systematically searched 14 databases to identify peer-reviewed journal articles published in English language between January 1, 2010 and November 20, 2021, that reported empirical qualitative, quantitative or mixed methods data on LGBTQI+ people’s health in India. Out of 3,003 results in total, we identified 177 eligible articles; 62% used quantitative, 31% qualitative, and 7% mixed methods. The majority (55%) focused on gay and other men who have sex with men (MSM), 16% ...
India has one of the largest numbers of men who have sex with men (MSM) globally; however, geogra... more India has one of the largest numbers of men who have sex with men (MSM) globally; however, geographic data on sexually transmitted infection (STI) prevalence and associations with sexual behavior are limited. Six-hundred and eight MSM in Chennai and Mumbai underwent screening for a behavioral trial and were assessed for bacterial STIs (syphilis, chlamydia, gonorrhea), HIV, and past-month self-reported condomless anal sex (CAS). Mumbai (37.8%) had a greater prevalence of any STI than Chennai (27.6%) (prevalence ratio [PR] = 1.37, 95% CI: 1.09, 1.73). This pattern also emerged for gonorrhea and chlamydia separately but not syphilis. Conversely, Mumbai MSM reported lower rates of CAS (mean = 2.2) compared to Chennai MSM (mean = 14.0) (mean difference = −11.8, 95% CI: −14.6, −9.1). The interaction of city by CAS on any STI prevalence (PR = 2.09, 95% CI: 1.45, 3.01, p < .0001) revealed that in Chennai, higher rates of CAS were not associated with STI prevalence, but in Mumbai they wer...
With PrEP demonstration projects planned for MSM in India, we assessed: 1) associations between g... more With PrEP demonstration projects planned for MSM in India, we assessed: 1) associations between guideline-informed PrEP eligibility, HIV risk perception (Health Belief Model), and perceived PrEP benefits and costs (Rational Choice Theory), with willingness to use PrEP (WTUP); and 2) correlates of non-willingness to use PrEP among PrEP-eligible MSM. From December 2016 to March 2017, we conducted an interviewer-administered survey among MSM recruited from "cruising" sites in Mumbai and Chennai. PrEP eligibility criteria included condomless anal sex, sex work, >1 male partner (all past month), physician-diagnosed sexually transmitted infection (past-year), or alcohol use before last anal sex. Perceived benefits and costs of PrEP were assessed with Likert-type scales (Cronbach's alphas >.85). Participants' (n=197) mean age was 26.6 (SD 6.6); 34% completed college-degree education and 49% engaged in sex work. Three-fourths (77%) reported they would "definitely use" PrEP. Among the 93% who met ≥1 PrEP-eligibility criterion, 79% (n=145/183) reported WTUP. In logistic regression analyses, PrEP eligibility (aOR=5.31, 95% CI 1.11, 25.45), medium (aOR = 2.41, 95% CI 1.03, 5.63) or high (aOR =13.08, 95% CI 1.29, 132.27) perceived HIV risk, and greater perceived benefits (aOR=1.13, 95% CI 1.03, 1.24) were associated with higher odds of WTUP. Among PrEP-eligible MSM, non-willingness to use PrEP was associated with low HIV risk perception (aOR=2.77, 95% CI 1.15 to 6.69, p=.02) and lower perceived benefits (aOR=.85, 95% CI .77, .95, p=.005).
Background Men who have sex with men (MSM) in India are extremely marginalised and stigmatised, a... more Background Men who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention. Methods We did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resiliencerelated mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294.
Research on transmasculine people's health is scant globally, including in India. We explored tra... more Research on transmasculine people's health is scant globally, including in India. We explored transmasculine people's experiences in affirming their gender in family and social spaces, and how those experiences impact mental health. In 2019, we conducted four focus groups (n=17 participants) and 10 in-depth interviews with transmasculine people in Mumbai and Chennai. Data analyses were guided by minority stress theory and the gender affirmation model. Within family, the pressure to conform to assigned gender roles and gender policing usually began in adolescence and increased over time. Some participants left parental homes due to violence. In educational settings, participants described the enforcement of gender-normative dress codes, lack of faculty support, and bullying victimisation, which led some to quit schooling. In the workplace, experiences varied depending on whether participants were visibly trans or had an incongruence between their identity documents and gender identity. Everyday discrimination experiences in diverse settings contributed to psychological distress. Amidst these challenges, participants reported resilience strategies, including self-acceptance, connecting with peers, strategic (non)disclosure, and circumventing gendered restrictions on dress and behaviour. Interventions at social-structural, institutional, family and individual levels are needed to reduce stigma and discrimination faced by transmasculine people in India and to promote their mental health.
Some social technologies can reduce marginality by enabling access to individuals and resources t... more Some social technologies can reduce marginality by enabling access to individuals and resources through increased visibility and opportunities for social connection, but visibility carries risks that may be outsized for some marginalized populations. This article reports on a study of location-based social apps (LBSA) used by men who have sex with men (MSM) in Mumbai, India, a legally and socially marginalized population. LBSAs, which facilitate interaction and social connection between physically proximate individuals would seem at first to be a valuable resource in reducing marginality for MSM by connecting otherwise isolated individuals with each other. We explored this from a socio-technical perspective through a qualitative study of MSM in Mumbai, India, who use LBSAs. Results suggest that, as in other contexts, using LBSAs presented formidable risks and challenges such as information security and identification by others, but also could serve as a valuable resource for connect...
Purpose We sought to describe the prevalence of food insecurity and its relationship with mental ... more Purpose We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S. Design and Setting We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia. Sample The study sample was restricted to LGB adults ≥18 years (N = 1178) from the 2021 NHIS survey. Measures Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence. Analysis Descriptive statistics and linear and generalized linear regressions. Results The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as ...
Lesbian, gay, bisexual, and transgender (LGBT) individuals have a high prevalence of substance us... more Lesbian, gay, bisexual, and transgender (LGBT) individuals have a high prevalence of substance use disorders (SUDs) and experience unique barriers to treatment. Little is known about the characteristics of SUD treatment facilities providing LGBT-tailored programs at the outpatient and residential levels of care. The purpose of this study is to examine the availability of LGBT-tailored programs in outpatient and residential SUD treatment facilities. Using the National Survey of Substance Abuse Treatment Services 2020, we conducted logistic regression to examine facility characteristics, including ownership, pay assistance, region, outreach, and telehealth services, associated with having an LGBT-tailored program among SUD treatment facilities. Outpatient facilities that were for-profit, had pay assistance, had community outreach services, and provided telemedicine/telehealth were more likely to have an LGBT-tailored program. Those that were government-owned, in the Midwest, and that ...
Background Studies show that stressful life events (SLE) (e.g., discrimination, financial problem... more Background Studies show that stressful life events (SLE) (e.g., discrimination, financial problems) can lead to psychosocial problems and exacerbate condomless anal sex (CAS) without protection via pre-exposure prophylaxis (PrEP) among men who have sex with men. However, few studies have examined this relationship among men who have sex with men in India, and none have examined this longitudinally. Methods As a part of an HIV-prevention intervention, 608 MSM from Chennai and Mumbai, India, completed behavioral surveys at baseline, 4, 8, and 12 months. We used longitudinal generalized estimating equations (GEE) modeling to examine the relationship between SLE and its severity and subsequent psychosocial problems, CAS, and history of diagnosed sexually transmitted infection (STI). All models are adjusted for age, sexual identity, intervention arm, human immunodeficiency virus status, and recruitment city. Results The number of SLE and their corresponding perceived impact score remaine...
ABSTRACTAmid incremental progress in establishing an enabling legal and policy environment for le... more ABSTRACTAmid incremental progress in establishing an enabling legal and policy environment for lesbian, gay, bisexual, transgender and queer-identified people, and people with intersex variations (LGBTQI+) in India, evidence gaps on LGBTQI+ health are of increasing concern. To that end, we conducted a scoping review to map and synthesize the current evidence base, identify research gaps, and provide recommendations for future research. We conducted a scoping review using the Joanna Briggs Institute methodology. We systematically searched 14 databases to identify peer-reviewed journal articles published in English language between January 1, 2010 and November 20, 2021, that reported empirical qualitative, quantitative or mixed methods data on LGBTQI+ people’s health in India. Out of 3,003 results in total, we identified 177 eligible articles; 62% used quantitative, 31% qualitative, and 7% mixed methods. The majority (55%) focused on gay and other men who have sex with men (MSM), 16% ...
India has one of the largest numbers of men who have sex with men (MSM) globally; however, geogra... more India has one of the largest numbers of men who have sex with men (MSM) globally; however, geographic data on sexually transmitted infection (STI) prevalence and associations with sexual behavior are limited. Six-hundred and eight MSM in Chennai and Mumbai underwent screening for a behavioral trial and were assessed for bacterial STIs (syphilis, chlamydia, gonorrhea), HIV, and past-month self-reported condomless anal sex (CAS). Mumbai (37.8%) had a greater prevalence of any STI than Chennai (27.6%) (prevalence ratio [PR] = 1.37, 95% CI: 1.09, 1.73). This pattern also emerged for gonorrhea and chlamydia separately but not syphilis. Conversely, Mumbai MSM reported lower rates of CAS (mean = 2.2) compared to Chennai MSM (mean = 14.0) (mean difference = −11.8, 95% CI: −14.6, −9.1). The interaction of city by CAS on any STI prevalence (PR = 2.09, 95% CI: 1.45, 3.01, p < .0001) revealed that in Chennai, higher rates of CAS were not associated with STI prevalence, but in Mumbai they wer...
With PrEP demonstration projects planned for MSM in India, we assessed: 1) associations between g... more With PrEP demonstration projects planned for MSM in India, we assessed: 1) associations between guideline-informed PrEP eligibility, HIV risk perception (Health Belief Model), and perceived PrEP benefits and costs (Rational Choice Theory), with willingness to use PrEP (WTUP); and 2) correlates of non-willingness to use PrEP among PrEP-eligible MSM. From December 2016 to March 2017, we conducted an interviewer-administered survey among MSM recruited from "cruising" sites in Mumbai and Chennai. PrEP eligibility criteria included condomless anal sex, sex work, >1 male partner (all past month), physician-diagnosed sexually transmitted infection (past-year), or alcohol use before last anal sex. Perceived benefits and costs of PrEP were assessed with Likert-type scales (Cronbach's alphas >.85). Participants' (n=197) mean age was 26.6 (SD 6.6); 34% completed college-degree education and 49% engaged in sex work. Three-fourths (77%) reported they would "definitely use" PrEP. Among the 93% who met ≥1 PrEP-eligibility criterion, 79% (n=145/183) reported WTUP. In logistic regression analyses, PrEP eligibility (aOR=5.31, 95% CI 1.11, 25.45), medium (aOR = 2.41, 95% CI 1.03, 5.63) or high (aOR =13.08, 95% CI 1.29, 132.27) perceived HIV risk, and greater perceived benefits (aOR=1.13, 95% CI 1.03, 1.24) were associated with higher odds of WTUP. Among PrEP-eligible MSM, non-willingness to use PrEP was associated with low HIV risk perception (aOR=2.77, 95% CI 1.15 to 6.69, p=.02) and lower perceived benefits (aOR=.85, 95% CI .77, .95, p=.005).
Background Men who have sex with men (MSM) in India are extremely marginalised and stigmatised, a... more Background Men who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention. Methods We did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resiliencerelated mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294.
Research on transmasculine people's health is scant globally, including in India. We explored tra... more Research on transmasculine people's health is scant globally, including in India. We explored transmasculine people's experiences in affirming their gender in family and social spaces, and how those experiences impact mental health. In 2019, we conducted four focus groups (n=17 participants) and 10 in-depth interviews with transmasculine people in Mumbai and Chennai. Data analyses were guided by minority stress theory and the gender affirmation model. Within family, the pressure to conform to assigned gender roles and gender policing usually began in adolescence and increased over time. Some participants left parental homes due to violence. In educational settings, participants described the enforcement of gender-normative dress codes, lack of faculty support, and bullying victimisation, which led some to quit schooling. In the workplace, experiences varied depending on whether participants were visibly trans or had an incongruence between their identity documents and gender identity. Everyday discrimination experiences in diverse settings contributed to psychological distress. Amidst these challenges, participants reported resilience strategies, including self-acceptance, connecting with peers, strategic (non)disclosure, and circumventing gendered restrictions on dress and behaviour. Interventions at social-structural, institutional, family and individual levels are needed to reduce stigma and discrimination faced by transmasculine people in India and to promote their mental health.
Some social technologies can reduce marginality by enabling access to individuals and resources t... more Some social technologies can reduce marginality by enabling access to individuals and resources through increased visibility and opportunities for social connection, but visibility carries risks that may be outsized for some marginalized populations. This article reports on a study of location-based social apps (LBSA) used by men who have sex with men (MSM) in Mumbai, India, a legally and socially marginalized population. LBSAs, which facilitate interaction and social connection between physically proximate individuals would seem at first to be a valuable resource in reducing marginality for MSM by connecting otherwise isolated individuals with each other. We explored this from a socio-technical perspective through a qualitative study of MSM in Mumbai, India, who use LBSAs. Results suggest that, as in other contexts, using LBSAs presented formidable risks and challenges such as information security and identification by others, but also could serve as a valuable resource for connect...
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Papers by Dicky Baruah