articles by Sean Howell
Researchsquare, 2020
There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have s... more There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n= 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether subgroups of our study population are disproportionately impacted by COVID-19. Many men not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. Consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. Findings underscore the crucial need to mitigate the multifaceted impacts of COVID-19 among gay men and other MSM, especially for those with intersecting vulnerabilities.
Authors: Glenn-Milo Santos, Benjamin Ackerman, Amrita Rao, Sara Wallach, George Ayala, Erik Lamontage, Alex Garner, Ian Holloway, Sonya Arreola, Vince Silenzio, Susanne Strömdahl, Louis Yu, Carol Strong, Tyler Adamson, Anna Yakusik, Tran Doan, Poyao Huang, Damiano Cerasuolo, Amie Bishop, Teymur Noori, Anastasia Pharris, Max Aung, Masoud Dara, Ssu Yu Chung, Marguerite Hanley, Stefan Baral, Chris Beyrer, Sean Howell
Covid19 Disparities Working Group: Glenn-Milo Santos, Benjamin Ackerman, Amrita Rao, Sara Wallach, George Ayala, Erik Lamontage, Alex Garner, Ian Holloway, Sonya Arreola, Vince Silenzio, Susanne Strömdahl, Louis Yu, Carol Strong, Tyler Adamson, Anna Yakusik, Tran Doan, Poyao Huang, Damiano Cerasuolo, Amie Bishop, Teymur Noori, Anastasia Pharris, Max Aung, Masoud Dara, Ssu Yu Chung, Marguerite Hanley, Stefan Baral, Chris Beyrer, Sean Howell
Newsweek, 2017
LGBT in Egypt face entrapment.
Indian Journal of Health, Sexuality and Culture, 2019
Implications of disparities on happiness and wellness from the first global LGBTQ+ survey
Journal: Sociology: Theory, Methods and Marketing, 2019
Journal: Sociology: Theory, Methods and Marketing (2019, №1) Ukranian: оціологія: теорія, методи,... more Journal: Sociology: Theory, Methods and Marketing (2019, №1) Ukranian: оціологія: теорія, методи, маркетинг (СТММ) The paper studies internalized homonegativity (IH) and its predictors among men who have sex with men (MSM) in 12 countries of Eastern Europe and Central Asia (EECA). Internalized homonegativity (sometimes called internal homophobia) is a negative attitude to own same-sex attractions. It arises when gays and other people with homosexual attractions interiorize predominant negative attitudes and assumptions about homosexuals and homosexuality. Internalized homonegativity is a significant factor of poorer health (including vulnerability to HIV infection), and lower inclusion in the community in Western countries. It remains highly understudied in post-Soviet countries, although there is a sufficient ground to suppose its higher prevalence here. Cross-sectional online survey of MSM was conducted in August–October, 2017. Convenience sample was recruited via dating apps and websites, other partner sites, and MSM-service organizations. Analytical sample size was 8239 respondents from Russia, Ukraine, Belarus, Kazakhstan, Kyrgyzstan, Estonia and Lithuania (which were merged), Armenia, Georgia, Azerbaijan, Macedonia, and Moldova. IH was measured by the 8-item Short Internalized Homonegativity Scale (SIHS) in all main languages of the countries. According to results of Cronbach’s a test and multi-group confirmatory factor analysis, adaptation of SIHS showed satisfactory to good reliability, and partial scalar invariance across EECA. IH was not predominant in all countries’ samples. However, average IH was significantly different by countries. That could be attributed to both sampling design and differences in societal homophobia. Results of structural equation modeling of SIHS predictors also varied between countries. However, in most countries IH was lower among self-identified gays, those who were more open about own homosexual attractions, and was less religious. The unexpected findings included negative associations between IH and higher education, and contradictory associations with age in some countries. Results showed that internalized homonegativity is a common and comparable phenomenon among MSM in Eastern Europe and Central Asia. Its prevalence is presumably different across the countries. IH relates, first of all, to own sexual orientation (gay, bi- etc.), and acknowledgement of own same-sex attractions. Also, the SIHS measure is good enough for use in further studies of male health and possibilities for LGBTIQ mobilization in the region. Keywords: internalized homonegativity, homosexuality, MSM, EECA, homophobia, measurement invariance, structural equation modeling
Taiwan Aids Society 2020 Conference, 2020
SocArXiv , 2020
The term “conversion therapy” is most widely used to describe practices attempting to change, sup... more The term “conversion therapy” is most widely used to describe practices attempting to change, suppress, or divert one’s sexual orientation, gender identity, or gender expression. Such practices are also called: reorientation therapy, reparative therapy, sexual orientation change efforts, ex-gay/ex-trans therapy, gay cure therapy, or more recently, support for unwanted same-sex attraction or transgender identities. To discover global prevalence of both conversion therapy and various methods of practicing attempted therapy a survey was distributed online. The survey was developed by combining existing measurement tools with newly designed questions to gauge experiences with conversion therapy. The survey consisted of a series of 44 questions covering a range of topics, including personal experience with conversion therapy, types of therapy experienced, long-term impacts, mental health, human rights, faith, and others. The survey was provided in several languages, including English, Arabic, Traditional and Simplified Chinese, and others. Any Hornet user was able to voluntarily participate in the survey. 8092 individuals from over 100 countries participated in the survey, ranging in age from under 18 to 85+. 8092 individuals from over 100 countries participated in the survey, ranging in age from under 18 to 85+. Of the 5820 individuals who responded to the question “Does conversion therapy happen in your country?”, 1851 participants responded “yes,” that they were aware conversion therapy occurs in the country where they live, and 1227 (21.08%) and 1263 (21.70%) responding that they were unsure or maybe, respectively. 1627 (20.09%) of respondents indicated that either they or someone they know (family member, friend, etc.) have been in conversion therapy. The majority of practitioners who led conversion therapy were mental health providers, followed by religious authorities or their associates. These findings with a large global sample reveal that the practice of conversion therapy continues to be utilized around the world despite broad consensus on its harmful effects and lack of scientific justification.
Journal: Sociology: Theory, Methods and Marketing , 2019
Journal: Sociology: Theory, Methods and Marketing (2019, №1) Ukranian: оціологія: теорія, методи,... more Journal: Sociology: Theory, Methods and Marketing (2019, №1) Ukranian: оціологія: теорія, методи, маркетинг (СТММ) The paper studies internalized homonegativity (IH) and its predictors among men who have sex with men (MSM) in 12 countries of Eastern Europe and Central Asia (EECA). Internalized homonegativity (sometimes called internal homophobia) is a negative attitude to own same-sex attractions. It arises when gays and other people with homosexual attractions interiorize predominant negative attitudes and assumptions about homosexuals and homosexuality. Internalized homonegativity is a significant factor of poorer health (including vulnerability to HIV infection), and lower inclusion in the community in Western countries. It remains highly understudied in post-Soviet countries, although there is a sufficient ground to suppose its higher prevalence here. Cross-sectional online survey of MSM was conducted in August–October, 2017. Convenience sample was recruited via dating apps and websites, other partner sites, and MSM-service organizations. Analytical sample size was 8239 respondents from Russia, Ukraine, Belarus, Kazakhstan, Kyrgyzstan, Estonia and Lithuania (which were merged), Armenia, Georgia, Azerbaijan, Macedonia, and Moldova. IH was measured by the 8-item Short Internalized Homonegativity Scale (SIHS) in all main languages of the countries. According to results of Cronbach’s a test and multi-group confirmatory factor analysis, adaptation of SIHS showed satisfactory to good reliability, and partial scalar invariance across EECA. IH was not predominant in all countries’ samples. However, average IH was significantly different by countries. That could be attributed to both sampling design and differences in societal homophobia. Results of structural equation modeling of SIHS predictors also varied between countries. However, in most countries IH was lower among self-identified gays, those who were more open about own homosexual attractions, and was less religious. The unexpected findings included negative associations between IH and higher education, and contradictory associations with age in some countries. Results showed that internalized homonegativity is a common and comparable phenomenon among MSM in Eastern Europe and Central Asia. Its prevalence is presumably different across the countries. IH relates, first of all, to own sexual orientation (gay, bi- etc.), and acknowledgement of own same-sex attractions. Also, the SIHS measure is good enough for use in further studies of male health and possibilities for LGBTIQ mobilization in the region. Keywords: internalized homonegativity, homosexuality, MSM, EECA, homophobia, measurement invariance, structural equation modeling
JMIR Public Health and Surveillance: JPH, 2018
Background: Gay, bisexual, and other cisgender men who have sex with men (GBMSM) are disproportio... more Background: Gay, bisexual, and other cisgender men who have sex with men (GBMSM) are disproportionately affected by the HIV pandemic. Traditionally, GBMSM have been deemed less relevant in HIV epidemics in low- and middle-income settings where HIV epidemics are more generalized. This is due (in part) to how important population size estimates regarding the number of individuals who identify as GBMSM are to informing the development and monitoring of HIV prevention, treatment, and care programs and coverage. However, pervasive stigma and criminalization of same-sex practices and relationships provide a challenging environment for population enumeration, and these factors have been associated with implausibly low or absent size estimates of GBMSM, thereby limiting knowledge about the dynamics of HIV transmission and the implementation of programs addressing GBMSM.
Objective: This study leverages estimates of the number of members of a social app geared towards gay men (Hornet) and members of Facebook using self-reported relationship interests in men, men and women, and those with at least one reported same-sex interest. Results were categorized by country of residence to validate official size estimates of GBMSM in 13 countries across five continents.
Methods: Data were collected through the Hornet Gay Social Network and by using an a priori determined framework to estimate the numbers of Facebook members with interests associated with GBMSM in South Africa, Ghana, Nigeria, Senegal, Côte d'Ivoire, Mauritania, The Gambia, Lebanon, Thailand, Malaysia, Brazil, Ukraine, and the United States. These estimates were compared with the most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) and national estimates across 143 countries.
Results: The estimates that leveraged social media apps for the number of GBMSM across countries are consistently far higher than official UNAIDS estimates. Using Facebook, it is also feasible to assess the numbers of GBMSM aged 13-17 years, which demonstrate similar proportions to those of older men. There is greater consistency in Facebook estimates of GBMSM compared to UNAIDS-reported estimates across countries.
Conclusions: The ability to use social media for epidemiologic and HIV prevention, treatment, and care needs continues to improve. Here, a method leveraging different categories of same-sex interests on Facebook, combined with a specific gay-oriented app (Hornet), demonstrated significantly higher estimates than those officially reported. While there are biases in this approach, these data reinforce the need for multiple methods to be used to count the number of GBMSM (especially in more stigmatizing settings) to better inform mathematical models and the scale of HIV program coverage. Moreover, these estimates can inform programs for those aged 13-17 years; a group for which HIV incidence is the highest and HIV prevention program coverage, including the availability of pre-exposure prophylaxis (PrEP), is lowest. Taken together, these results highlight the potential for social media to provide comparable estimates of the number of GBMSM across a large range of countries, including some with no reported estimates.
Biorxiv, 2017
Background: Achieving the 90-90-90 is essential to keep people alive and to end AIDS. Men who hav... more Background: Achieving the 90-90-90 is essential to keep people alive and to end AIDS. Men who have sex with men (MSM) often have the least access to HIV services.
Purpose: Estimates for key populations are often unavailable, dated or have very wide confidence intervals and more accurate estimates are required.
Methods: We compared registered users from a major gay dating application (2016) from 29 countries with the latest available (2013-2016) UNAIDS estimates by country. We searched the Internet, PubMed, national surveillance reports, UNAIDS country reports, President’s Emergency Plan for AIDS Relief (PEPFAR) 2016 and 2017 operational plans, and conference abstracts for the latest nationally representative continua for MSM.
Results: Of comparison countries, only 18 countries had UNAIDS or other MSM population estimates in the public domain. UNAIDS estimates were larger than the gay dating application users in 9 countries, perhaps reflecting incomplete market penetration for the application. The gay dating application users in 9 countries were above the UNAIDS estimates; 8 were over 30% higher and three more than double the reported estimate. Seven partial or complete nationally representative care continua for MSM were published between 2010 and 2016. Among estimated MSM living with HIV, viral suppression varied between 42% (United States) to 99% (Denmark). The quality of the continua methods varied (quality data not shown).
Conclusion: “What is not monitored is not done” and social media has significant promise to improve estimates to ensure that MSM and other vulnerable people living with HIV and their communities are not left behind on the way to ending AIDS.
Conference Presentations by Sean Howell
International AIDS Society Conference (IAS), Mexico, 2019
Presentation of the LGBTI Happiness Survey for Mexico AIDS conference
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articles by Sean Howell
Authors: Glenn-Milo Santos, Benjamin Ackerman, Amrita Rao, Sara Wallach, George Ayala, Erik Lamontage, Alex Garner, Ian Holloway, Sonya Arreola, Vince Silenzio, Susanne Strömdahl, Louis Yu, Carol Strong, Tyler Adamson, Anna Yakusik, Tran Doan, Poyao Huang, Damiano Cerasuolo, Amie Bishop, Teymur Noori, Anastasia Pharris, Max Aung, Masoud Dara, Ssu Yu Chung, Marguerite Hanley, Stefan Baral, Chris Beyrer, Sean Howell
Covid19 Disparities Working Group: Glenn-Milo Santos, Benjamin Ackerman, Amrita Rao, Sara Wallach, George Ayala, Erik Lamontage, Alex Garner, Ian Holloway, Sonya Arreola, Vince Silenzio, Susanne Strömdahl, Louis Yu, Carol Strong, Tyler Adamson, Anna Yakusik, Tran Doan, Poyao Huang, Damiano Cerasuolo, Amie Bishop, Teymur Noori, Anastasia Pharris, Max Aung, Masoud Dara, Ssu Yu Chung, Marguerite Hanley, Stefan Baral, Chris Beyrer, Sean Howell
Objective: This study leverages estimates of the number of members of a social app geared towards gay men (Hornet) and members of Facebook using self-reported relationship interests in men, men and women, and those with at least one reported same-sex interest. Results were categorized by country of residence to validate official size estimates of GBMSM in 13 countries across five continents.
Methods: Data were collected through the Hornet Gay Social Network and by using an a priori determined framework to estimate the numbers of Facebook members with interests associated with GBMSM in South Africa, Ghana, Nigeria, Senegal, Côte d'Ivoire, Mauritania, The Gambia, Lebanon, Thailand, Malaysia, Brazil, Ukraine, and the United States. These estimates were compared with the most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) and national estimates across 143 countries.
Results: The estimates that leveraged social media apps for the number of GBMSM across countries are consistently far higher than official UNAIDS estimates. Using Facebook, it is also feasible to assess the numbers of GBMSM aged 13-17 years, which demonstrate similar proportions to those of older men. There is greater consistency in Facebook estimates of GBMSM compared to UNAIDS-reported estimates across countries.
Conclusions: The ability to use social media for epidemiologic and HIV prevention, treatment, and care needs continues to improve. Here, a method leveraging different categories of same-sex interests on Facebook, combined with a specific gay-oriented app (Hornet), demonstrated significantly higher estimates than those officially reported. While there are biases in this approach, these data reinforce the need for multiple methods to be used to count the number of GBMSM (especially in more stigmatizing settings) to better inform mathematical models and the scale of HIV program coverage. Moreover, these estimates can inform programs for those aged 13-17 years; a group for which HIV incidence is the highest and HIV prevention program coverage, including the availability of pre-exposure prophylaxis (PrEP), is lowest. Taken together, these results highlight the potential for social media to provide comparable estimates of the number of GBMSM across a large range of countries, including some with no reported estimates.
Purpose: Estimates for key populations are often unavailable, dated or have very wide confidence intervals and more accurate estimates are required.
Methods: We compared registered users from a major gay dating application (2016) from 29 countries with the latest available (2013-2016) UNAIDS estimates by country. We searched the Internet, PubMed, national surveillance reports, UNAIDS country reports, President’s Emergency Plan for AIDS Relief (PEPFAR) 2016 and 2017 operational plans, and conference abstracts for the latest nationally representative continua for MSM.
Results: Of comparison countries, only 18 countries had UNAIDS or other MSM population estimates in the public domain. UNAIDS estimates were larger than the gay dating application users in 9 countries, perhaps reflecting incomplete market penetration for the application. The gay dating application users in 9 countries were above the UNAIDS estimates; 8 were over 30% higher and three more than double the reported estimate. Seven partial or complete nationally representative care continua for MSM were published between 2010 and 2016. Among estimated MSM living with HIV, viral suppression varied between 42% (United States) to 99% (Denmark). The quality of the continua methods varied (quality data not shown).
Conclusion: “What is not monitored is not done” and social media has significant promise to improve estimates to ensure that MSM and other vulnerable people living with HIV and their communities are not left behind on the way to ending AIDS.
Conference Presentations by Sean Howell
Authors: Glenn-Milo Santos, Benjamin Ackerman, Amrita Rao, Sara Wallach, George Ayala, Erik Lamontage, Alex Garner, Ian Holloway, Sonya Arreola, Vince Silenzio, Susanne Strömdahl, Louis Yu, Carol Strong, Tyler Adamson, Anna Yakusik, Tran Doan, Poyao Huang, Damiano Cerasuolo, Amie Bishop, Teymur Noori, Anastasia Pharris, Max Aung, Masoud Dara, Ssu Yu Chung, Marguerite Hanley, Stefan Baral, Chris Beyrer, Sean Howell
Covid19 Disparities Working Group: Glenn-Milo Santos, Benjamin Ackerman, Amrita Rao, Sara Wallach, George Ayala, Erik Lamontage, Alex Garner, Ian Holloway, Sonya Arreola, Vince Silenzio, Susanne Strömdahl, Louis Yu, Carol Strong, Tyler Adamson, Anna Yakusik, Tran Doan, Poyao Huang, Damiano Cerasuolo, Amie Bishop, Teymur Noori, Anastasia Pharris, Max Aung, Masoud Dara, Ssu Yu Chung, Marguerite Hanley, Stefan Baral, Chris Beyrer, Sean Howell
Objective: This study leverages estimates of the number of members of a social app geared towards gay men (Hornet) and members of Facebook using self-reported relationship interests in men, men and women, and those with at least one reported same-sex interest. Results were categorized by country of residence to validate official size estimates of GBMSM in 13 countries across five continents.
Methods: Data were collected through the Hornet Gay Social Network and by using an a priori determined framework to estimate the numbers of Facebook members with interests associated with GBMSM in South Africa, Ghana, Nigeria, Senegal, Côte d'Ivoire, Mauritania, The Gambia, Lebanon, Thailand, Malaysia, Brazil, Ukraine, and the United States. These estimates were compared with the most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) and national estimates across 143 countries.
Results: The estimates that leveraged social media apps for the number of GBMSM across countries are consistently far higher than official UNAIDS estimates. Using Facebook, it is also feasible to assess the numbers of GBMSM aged 13-17 years, which demonstrate similar proportions to those of older men. There is greater consistency in Facebook estimates of GBMSM compared to UNAIDS-reported estimates across countries.
Conclusions: The ability to use social media for epidemiologic and HIV prevention, treatment, and care needs continues to improve. Here, a method leveraging different categories of same-sex interests on Facebook, combined with a specific gay-oriented app (Hornet), demonstrated significantly higher estimates than those officially reported. While there are biases in this approach, these data reinforce the need for multiple methods to be used to count the number of GBMSM (especially in more stigmatizing settings) to better inform mathematical models and the scale of HIV program coverage. Moreover, these estimates can inform programs for those aged 13-17 years; a group for which HIV incidence is the highest and HIV prevention program coverage, including the availability of pre-exposure prophylaxis (PrEP), is lowest. Taken together, these results highlight the potential for social media to provide comparable estimates of the number of GBMSM across a large range of countries, including some with no reported estimates.
Purpose: Estimates for key populations are often unavailable, dated or have very wide confidence intervals and more accurate estimates are required.
Methods: We compared registered users from a major gay dating application (2016) from 29 countries with the latest available (2013-2016) UNAIDS estimates by country. We searched the Internet, PubMed, national surveillance reports, UNAIDS country reports, President’s Emergency Plan for AIDS Relief (PEPFAR) 2016 and 2017 operational plans, and conference abstracts for the latest nationally representative continua for MSM.
Results: Of comparison countries, only 18 countries had UNAIDS or other MSM population estimates in the public domain. UNAIDS estimates were larger than the gay dating application users in 9 countries, perhaps reflecting incomplete market penetration for the application. The gay dating application users in 9 countries were above the UNAIDS estimates; 8 were over 30% higher and three more than double the reported estimate. Seven partial or complete nationally representative care continua for MSM were published between 2010 and 2016. Among estimated MSM living with HIV, viral suppression varied between 42% (United States) to 99% (Denmark). The quality of the continua methods varied (quality data not shown).
Conclusion: “What is not monitored is not done” and social media has significant promise to improve estimates to ensure that MSM and other vulnerable people living with HIV and their communities are not left behind on the way to ending AIDS.