Papers by Sabina Hirshfield
mHealth
Background: Gay, bisexual, and other men who have sex with men (GBMSM) continue to be overreprese... more Background: Gay, bisexual, and other men who have sex with men (GBMSM) continue to be overrepresented in human immunodeficiency virus (HIV) infection in the United States. HIV prevention and care interventions that are tailored to an individual's serostatus have the potential to lower the rate of new infections among GBMSM. Mobile technology is a critical tool for disseminating targeted messaging and increasing uptake of basic prevention services including HIV testing, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Mobile Messaging for Men (M-Cubed) is a mobile health HIV prevention intervention designed to deliver video-and text-based prevention messages, provide STI and HIV information, and link GBMSM to prevention and healthcare resources. The current report describes an iterative process of identifying and selecting publicly available videos to be used as part of the M-Cubed intervention. We also conducted interviews with GBMSM to assess the acceptability, comprehension, and potential audience reach of the selected video messages. Methods: The selection of videos included balancing of specific criteria [e.g., accuracy of scientific information, video length, prevention domains: HIV/STI testing, antiretroviral therapy (ART), PrEP, engagement in care, and condom use] to ensure that they were intended for our GBMSM audiences: HIVnegative men who engage in condomless anal sex, HIV-negative men who do not engage in condomless anal sex, and men living with HIV. This formative study included in-person interviews with 26 GBMSM from three U.S. cities heavily impacted by the HIV epidemic-New York City, Detroit, and Atlanta.
JAMA Network Open
ImportanceHIV transmission rates in the United States have increased among men who have sex with ... more ImportanceHIV transmission rates in the United States have increased among men who have sex with men. However, there are no published randomized trials examining interventions to reduce sexual risk for HIV acquisition in males younger than 18 years.ObjectiveTo determine the efficacy of MyPEEPS Mobile, a mobile-delivered HIV prevention intervention, to reduce sexual risk behavior in same-sex attracted young males.Design, Setting, and ParticipantsThis was a national randomized clinical trial of the efficacy MyPEEPS Mobile vs a delayed intervention among males aged 13 to 18 years to prevent or reduce sexual risk for HIV acquisition. Study activities were completed through 4 study sites in Birmingham, Alabama; New York, New York; Seattle, Washington; and Chicago, Illinois. Study staff at each site met with participants in person or via video conferencing. Data were collected from June 1, 2018, to April 7, 2020, and analyzed from July to October 2021.InterventionsThe MyPEEPS Mobile inter...
Journal of Adolescent Health
PURPOSE The objective of this study was to determine whether state-level policies that restrict m... more PURPOSE The objective of this study was to determine whether state-level policies that restrict minors' access to confidential HIV testing without parental consent may suppress HIV testing in young men who have sex with men (YMSM) in the United States. METHODS Secondary data from a national HIV prevention trial among YMSM aged 13-17 years (N= 612) were analyzed to evaluate the association between living in a state with restrictive HIV testing policies for minors and HIV testing behavior, awareness of home-based HIV testing, and confidential interactions with a physician. Multilevel logistic regression models were adjusted for age, parents' education level, race, ethnicity, sexual orientation, being sexually experienced, and health literacy of medical forms and controlled for clustering by state. Age-stratified models by state-level age of consent for HIV testing and a subanalysis (including only sexually experienced participants) were also conducted. RESULTS Residing in a state with restrictive HIV testing policies was associated with the lack of awareness of home-based HIV testing (adjusted odds ratio [aOR]: 3.06; 95% confidence intervals [CI]: 1.49, 6.28). No significant associations were found for HIV testing behavior (aOR: 1.81; 95% CI: 0.85, 3.84), speaking privately with a physician (aOR: 1.00; 95% CI: 0.56, 1.79), or discussing confidentiality with a physician (aOR: 0.95; 95% CI: 0.52, 1.71) and HIV testing policies for minors. These results were consistent in both the age-stratified models and subanalysis. DISCUSSION HIV testing proportions among YMSM did not differ by state-level minor consent laws. However, YMSM living in states with restrictive policies on HIV testing for minors were less likely to be aware of home-based HIV testing.
Studies in health technology and informatics, 2018
The MyPEEPS Mobile intervention is a novel evidence-driven intervention using mobile technology t... more The MyPEEPS Mobile intervention is a novel evidence-driven intervention using mobile technology to deliver HIV prevention information. This is the first study to test the efficacy of a scaled-up, mobile version of an existing HIV prevention intervention originally developed, designed, and piloted for, a diverse group of YMSM. We used an iterative design process incorporating feedback from experts and end-users to update the user-interface and content of the MyPEEPS Mobile Intervention.
Objectives: Get It & Forget It, an educational video about intrauterine devices (IUDs), was devel... more Objectives: Get It & Forget It, an educational video about intrauterine devices (IUDs), was developed and evaluated. Study design: Afeasibilitystudyandapre/postevaluationnestedwithinarandomizedtrialwereconductedtotestchangeinknowledgeaboutIUDs andintentiontogetanIUDafterviewingatheory-drivendramaticvideo.Participants(n=315)completedsurveysbeforeandafterwatchingthevideo. Results: Knowledge about IUD effectiveness increased significantly (33% to 64%, pb.001), as did intention to use an IUD (18% to 36%, pb.001) postvideo. Conclusion: An online theory-driven video intervention can reach young women seeking information about long-acting contraception.
Journal of the International AIDS Society, 2021
BackgroundDaily oral pre‐exposure prophylaxis (PrEP) is available and recommended for men who hav... more BackgroundDaily oral pre‐exposure prophylaxis (PrEP) is available and recommended for men who have sex with men (MSM) at risk for HIV infection. Other HIV prevention products are being developed, including long‐acting injectable (LAI) and event‐based oral and topical formulations. Understanding preferences for potential products by MSM can help direct further development of prevention messaging.MethodsWe present baseline data from HIV‐negative participants enrolled in the US Mobile Messaging for Men (M‐cubed) Study. Participants were asked their likelihood of and rank order preference for using daily oral PrEP and various potential prevention products (one‐ to ‐three‐month injections, 2‐1‐1 sexual event oral dosing, anal or penile gel, or anal suppository), and their sociodemographic characteristics. Bivariate and multivariable logistics regression assessed demographic associations with likelihood of use and rank order preference.ResultsOverall, most MSM reported a likelihood of usi...
Journal of Black Psychology, 2018
This study examined characteristics and correlates of lifetime suicidal thoughts and suicide atte... more This study examined characteristics and correlates of lifetime suicidal thoughts and suicide attempts among HIV-negative young Black men who have sex with men (MSM) and transgender women (transwomen) between 16 and 29 years of age ( N = 161). In our sample, 36.6% of young Black MSM and transwomen reported a history of lifetime suicidal thoughts, while 16.1% reported prior suicide attempts. Using multivariable analysis, a history of intimate partner violence, greater psychological distress, and higher perceived sexuality discrimination were significantly associated with lifetime suicidal thoughts. Childhood sexual abuse history, greater psychological distress, lower score for outness, and higher perceived sexuality discrimination were significantly related to suicide attempts among young Black MSM and transwomen. Efforts to identify and understand factors associated with lifetime suicidal thoughts and attempts are urgently needed to inform the development and implementation of cultur...
Archives of Sexual Behavior, 2020
Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men ... more Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men (MSM). Few studies have examined exchange sex among HIV-positive MSM. We utilize a syndemic framework to account for co-occurring psychosocial problems that suggest the presence of intertwining epidemics (i.e., syndemics), which have not been examined within the context of exchange sex among HIV-positive MSM. In 2015, MSM were recruited via online sexual networking Web site and app advertisements for Sex Positive! [+] , a video-based online intervention that aimed to improve health outcomes for men living with HIV. Participants completed surveys every three months for a year. Surveys covered demographics, drug use, exchange sex, intimate partner violence (IPV), and past 2-week depressive symptoms. We conducted three logistic regression models to assess syndemic factors associated with exchange
AIDS and Behavior, 2019
This study describes a sample of HIV+ young transgender women of color aged 18–24 and their exper... more This study describes a sample of HIV+ young transgender women of color aged 18–24 and their experience with homelessness as part of a demonstration project of engagement and retention in HIV medical care funded by Health Resources and Services Administration. The study engaged transgender women of color in HIV care in nine sites across the US between 2012 and 2017. This analysis describes and compares transwomen who had been homeless in the last 6 months to those not homeless. We hypothesized that homelessness would compete with HIV care, food, shelter, and be associated with poverty. Variable domains included sociodemographic, mental health and substance use, HIV care, sexual risk behavior, social support from transgender and other friends, and childhood sexual abuse. There were 102 youth enrolled, 77 (75.5%) who had been homeless, and 25 (24.5%) who had not been homeless. Bivariate analyses showed that low income, sex work as source of income, inability to afford food, lack of viral load (VL) suppression, childhood sexual abuse, lower levels of social support, and higher levels of depression were associated with homelessness. A logistic regression model showed that being unable to afford food (AOR = 9.24, 95% CI 2.13–40.16), lack of VL suppression in last 6 months (AOR = 0.10, 95% CI .02–.57), and lack of transgender friend support (AOR = 0.09, 95% CI .02–.53) was associated with homelessness. Programs that place basic needs first—food and shelter—may be able to engage and assist young transgender women of color with HIV to survive and live healthier lives.
Annals of Epidemiology, 2019
Purpose: Non-Hispanic black communities in the US experience belowaverage life expectancy (LE). H... more Purpose: Non-Hispanic black communities in the US experience belowaverage life expectancy (LE). However, little is known about how the magnitude of these inequities vary between major US cities. We sought to understand variability in the relationship between percent of census tract residents who were non-Hispanic black and tract-level LE. Methods: We obtained census tract-level estimates of LE in 492 large US cities from the US Small Area Life Expectancy Estimates Project and combined them with socio-demographic data from the American Community Survey. We fit a multilevel linear null model to partition the variance in LE between the tract, city, and state levels. We estimated a random slope model to quantify the degree to which the association between percent non-Hispanic black and LE in census tracts varied between cities. Results: In a null model, 10% of LE variation was at the state level, 21% at the city level, and 69% was within cities at the tract level. Detroit and Flint, Michigan, both majority-black cities, had the lowest city-level average LE estimates (>5 years below average), and Chicago had the widest range for tract LEs (30.1 years). Nationally, a 10-point increase in tract percent non-Hispanic black was associated with 1.1 years shorter LE (95% CI: 1.0, 1.1). However, there was considerable variation in this association (standard deviation for random slope ¼ 0.29). Conclusions: The magnitude of inequalities in LE by tract racial composition varied considerably between cities. Further research to understand this variability can inform efforts to address urban health inequities.
AIDS and Behavior, 2019
Transgender women (TW) have higher HIV prevalence rates than cisgender (i.e., non-transgender) wo... more Transgender women (TW) have higher HIV prevalence rates than cisgender (i.e., non-transgender) women. However, utilization of healthcare for transgender people in the U.S. is low. As part of a multisite initiative to facilitate entry and retention in HIV care for TW of color, we compared health outcomes between participants who became Peer Leaders and those who did not. From 2013-2016, 163 New York City, mostly Latina, TW enrolled in the Transgender Women Engagement and Entry to Care Project (TWEET). The TWEET intervention included peer-led, group-based educational sessions called Transgender Leader (TL)-Teach Back; 39% completed Peer Leadership requirements. Comparing pre-post change by Peer Leader status, Peer Leaders had a significant decrease in viral load and significant increase in CD4 at the last HIV care visit compared to the first. In multivariable logistic regression, predictors associated with Peer Leadership included having at least some college education, being in a relationship, stable housing, receiving legal assistance for political asylum, and having two or more HIV care visits during the intervention. Findings suggest that, for trans women who have completed at least secondary school education, participating in a peer-led intervention can lead to improved HIV care engagement. Understanding which program components lead to becoming a Peer Leader, and how to better engage non-Peer Leaders, are important next steps.
AIDS and Behavior, 2019
Sex Positive! [+] is a two-arm, video-based web intervention aimed at reducing condomless anal se... more Sex Positive! [+] is a two-arm, video-based web intervention aimed at reducing condomless anal sex (CAS) with partners of known and unknown serostatus that was delivered online to a racially and ethnically diverse sample of 830 gay, bisexual, and other men who have sex with men living with HIV. Men in each arm received 6 weekly videos after completing a baseline assessment and 4 weekly booster videos following a 6-month assessment. Follow-up assessments were conducted every 3 months for 1 year. At 3-month follow-up, men in the intervention arm reported significantly reduced risk of having unknown serodiscordant CAS partners than men in the control arm (RR 0.60, 95% CI 0.39-0.92), partially supporting study hypotheses. Aside from this finding, similar reductions in sexual risk behaviors were observed in both arms over the study period. There is much to be learned about video-based web interventions in terms of methodological development and intervention delivery, including frequency and duration of intervention components.
Archives of sexual behavior, Jan 5, 2016
Advances in production and distribution of sexually explicit media (SEM) online have resulted in ... more Advances in production and distribution of sexually explicit media (SEM) online have resulted in widespread use among men. Limited research has compared contexts of use and behaviors viewed in Internet SEM by sexual identity. The current study examined differences in recent SEM use (past 6 months) by sexual identity among an ethnically diverse sample of 821 men who completed an online survey in 2015. Both gay and bisexual men reported significantly more frequent use of Internet SEM compared to heterosexual men. Although most participants reported viewing SEM at home (on a computer, tablet, or smartphone), significantly more gay men reported SEM use at a sex party or commercial sex venue than either heterosexual or bisexual men. Sexual identity predicted viewing of high-risk and protective behaviors in separate logistic regression models. Specifically, compared to heterosexual men, gay and bisexual men had increased odds of viewing condomless anal sex (gay OR 5.20, 95 % CI 3.35-8.09;...
Current Addiction Reports, 2016
Purpose of Review The current literature consistently links compulsive sexual behavior (CSB) to s... more Purpose of Review The current literature consistently links compulsive sexual behavior (CSB) to sexual risk behaviors among diverse populations. Controversy over the conceptualization of CSB has led to challenges in formulating standardized treatment options and health promotion/prevention strategies. However, the increase in empirical research on this topic has led to a greater understanding of CSB and evidence for subtypes including the consumption of sexually explicit media (SEM) via the Internet. Recent Findings While the etiology of CSB is under debate, the absence of standard criteria and measures supports the heterogeneity of the condition and emphasizes the importance of other factors (e.g., developmental stage, personality characteristics, cultural background, and gender concepts) in making a comprehensive clinical assessment. Moreover, there is growing empirical support that CSB contributes to a syndemics model of HIV risk, which suggests the importance of additive and complex effects of co-occurring factors in sexual risk taking. While much scientific progress has been made on CSB in the past few years, it remains a pliable topic. Summary Further exploration on varying levels of CSB severity and the determination of clinically and contextually appropriate cutoff points using existing measures of CSB could provide a greater understanding of this condition, leading to more effective treatment and prevention options. Keywords Compulsive sexual behavior. Hypersexuality. HIV. Sexually transmitted infections This article is part of the Topical Collection on Sex Addiction
Background: Smartphone applications (apps) designed to locate sexual partners among men who have ... more Background: Smartphone applications (apps) designed to locate sexual partners among men who have sex with men (MSM) may enable men to meet more partners more quickly. Yet, little is known about men’s use of these apps and whether sexual risks taken with partners met through them differ from risks taken with partners met in other ways. Method: In 2013, street-intercept surveys were conducted with 617 MSM in New York City. Results: In the past 3 months, 44% of MSM had used a sexual partnering app and 25% of MSM reported sex with a man met through these apps. However, apps did not replace other venues for meeting sexual partners, as men also reported partners from bars/clubs (34%) and websites (23%) in the past 3 months. Likewise, there were no differences in the number of sexual partners met in each venue or the prevalence of condomless anal sex with partners met through smartphone apps, websites, or bars/clubs. However, there were significant demographic differences in the types of m...
Sexually transmitted diseases, 2014
The changing landscape of HIV prevention in the United States underscores the need to improve our... more The changing landscape of HIV prevention in the United States underscores the need to improve our ability to efficiently reach HIV-positive men who have sex with men (MSM) who engage in behaviors that could transmit HIV. We examined the prevalence of anal intercourse (AI) without condoms with HIV-negative or unknown serostatus partners ("at-risk partners") among 1319 HIV-positive adult male members of a sexual networking Web site for MSM. Sexual behaviors and substance use were measured over a 60-day recall period. Logistic regression was used to identify correlates of insertive and receptive AI without condoms with at-risk partners. Approximately 25% of the men had been diagnosed as having HIV 12 months or less before study enrollment. Overall, 32% of men engaged in AI without condoms with at-risk partners. Multiple logistic regression identified behavioral predictors of insertive AI without condoms with at-risk partners, including HIV diagnosis within the last 12 months,...
Contraception, 2015
Objectives: Get It & Forget It, an educational video about intrauterine devices (IUDs), was devel... more Objectives: Get It & Forget It, an educational video about intrauterine devices (IUDs), was developed and evaluated. Study design: A feasibility study and a pre/post evaluation nested within a randomized trial were conducted to test change in knowledge about IUDs and intention to get an IUD after viewing a theory-driven dramatic video. Participants (n=315) completed surveys before and after watching the video. Results: Knowledge about IUD effectiveness increased significantly (33% to 64%, pb.001), as did intention to use an IUD (18% to 36%, pb.001) postvideo. Conclusion: An online theory-driven video intervention can reach young women seeking information about long-acting contraception.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2007
To assess whether men who have sex with men (MSM) are more likely to report unprotected anal inte... more To assess whether men who have sex with men (MSM) are more likely to report unprotected anal intercourse (UAI) with partners met on-line compared with those met off-line. A total of 6122 individuals consented to participate in an anonymous behavioral survey on-line. This event-based analysis is limited to the 1683 men from the United States and Canada who had sex in the 3 months before the study and reported that their last sexual encounter included a new or casual male partner or partners. Prevalence and predictors of UAI were analyzed separately for the 386 men reporting more than 1 partner (multiple) and the 1297 men reporting only 1 (single) partner in their last encounter. Of the 1683 MSM recruited on-line, 51% met their partner(s) in their last sexual encounter on-line and 23% reported UAI. No difference in risk for UAI was found for partners met on-line versus off-line in the bivariate or multivariate analyses. In a multivariate analysis of men with multiple-partner encounters, UAI was significantly associated with being HIV-seropositive (adjusted odds ratio [OR] = 2.87; P = 0.02) in a model that included age; education; whether partners were met on-line or off-line; and use of crystal methamphetamine, sildenafil, or alcohol before sex. Using the same model, significant predictors of UAI in men reporting a single-partner encounter were use of crystal methamphetamine (adjusted OR = 5.67; P = 0.001) and no college degree (adjusted OR = 1.63; P = 0.01). MSM recruited on-line who reported a new or casual sex partner(s) in the prior 3 months are at considerable risk of HIV or other sexually transmitted infections, but they are equally likely to report UAI whether sex partners were met on-line or off-line. The Internet may be an ideal venue for reaching high-risk MSM.
Archives of Sexual Behavior, 2005
Numerous studies on the mental health effects of terrorist attacks have been published, with some... more Numerous studies on the mental health effects of terrorist attacks have been published, with some reporting increases in smoking and drug and alcohol use. None have reported on changes in sexual behavior. To investigate the impact of the September 11 attacks on sexual and drug- and alcohol-using behaviors of men who have sex with men (MSM), an anonymous Internet survey was conducted to obtain information retrospectively on behavior during three month periods before and after the attacks. A total of 2,915 MSM from all 50 U.S. states completed the survey. Men who were exposed to the attacks were not differentially targeted for the survey since the online banner ad used to recruit did not mention September 11. Exposure to the attacks varied: 11.4% lost a friend or relative; 5% witnessed the attacks in person; and nearly all saw the attacks on television within one hour of their occurrence. Nearly equal proportions of men reported increases and decreases in the number of sex partners following September 11. Small, statistically significant increases in unprotected anal intercourse and alcohol use, but not illicit drug use, were found when behavior after September 11 was compared to that before the attacks. Men who lost a friend or relative in the attacks were significantly more likely to report unprotected anal intercourse, an increased number of sex partners, and increased alcohol use after September 11 than those who did not. Counseling about substance abuse and risky sexual behavior should be incorporated into trauma-related programs for adolescents and adults.
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Papers by Sabina Hirshfield