Papers by Molly J Kingdon
ABSTRACT ABSTRACT Background: The Centers for Disease Control and Prevention recommend annual scr... more ABSTRACT ABSTRACT Background: The Centers for Disease Control and Prevention recommend annual screening for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) in all sexually active MSM. However, uptake of screening strategies in clinical practice remains poor. This study aimed to evaluate the rate at which asymptomatic HIV-positive MSM ages 50 and older test positive for pharyngeal, rectal, and urethral GC/CT infections, and to characterize the STI-positive participants. Methods: This cross-sectional pilot study screened 99 HIV-positive MSM age 50 and over for asymptomatic sexually transmitted infections (STI). STI testing included GC cultures from oropharyngeal and rectal swabs, nucleic acid amplification testing (NAAT) for GC and CT from urine, and NAAT for CT from a rectal swab. A computer-administered survey and a calendar-based assessment were used to assess known predictors for HIV transmission. Results: Four percent of the participants tested positive for an STI. Two percent tested positive for urine CT and an additional 2% for rectal CT. The STI-infected men engaged in equal proportion (50%) in unprotected anal intercourse with seroconcordant partners and unprotected anal intercourse with serodiscordant partners. Three men reported using marijuana and other illicit drugs (i.e. powder cocaine, crack cocaine, ecstasy). Conclusions: Extra-genital sites are substantial reservoirs of undetected GC and CT infections. Efforts should be directed to increase the uptake of STI screening guidelines in clinical practice. Furthermore, our findings support the importance of exploring the impact and interplay of HIV, sexual risk-taking, and substance use among aging MSM.
Journal of Health Communication, 2013
HIV prevention messaging has been shown to reduce or delay high-risk sexual behaviors in young me... more HIV prevention messaging has been shown to reduce or delay high-risk sexual behaviors in young men who have sex with men (YMSM). Since the onset of the HIV/AIDS epidemic, a new generation of YMSM has come of age during an evolution in communication modalities. Because both these communication technologies and this new generation remain understudied, the authors investigated the manner in which YMSM interact with HIV prevention messaging. In particular, the authors examined 6 venues in which YMSM are exposed to, pay attention to, and access HIV prevention information: the Internet, bars/dance clubs, print media, clinics/doctors' offices, community centers/agencies, and educational classes. Data were drawn from a community-based sample of 481 racially and ethnically diverse YMSM from New York City. Significant differences in exposure to HIV prevention messaging venues emerged with respect to age, race/ethnicity, and sexual orientation. Attention paid to HIV prevention messages in various venues differed by age and sexual orientation. Across all venues, multivariate modeling indicated YMSM were more likely to access HIV messaging from the same venues at which they paid attention, with some variability explained by person characteristics (age and perceived family socioeconomic status). This suggests that the one-size-fits-all approach does not hold true, and both the venue and person characteristics must be considered when generating and disseminating HIV prevention messaging.
Journal of Health Communication, 2013
HIV prevention messaging has been shown to reduce or delay high-risk sexual behaviors in young me... more HIV prevention messaging has been shown to reduce or delay high-risk sexual behaviors in young men who have sex with men (YMSM). Since the onset of the HIV/AIDS epidemic, a new generation of YMSM has come of age during an evolution in communication modalities. Because both these communication technologies and this new generation remain understudied, the authors investigated the manner in which YMSM interact with HIV prevention messaging. In particular, the authors examined 6 venues in which YMSM are exposed to, pay attention to, and access HIV prevention information: the Internet, bars/dance clubs, print media, clinics/doctors' offices, community centers/agencies, and educational classes. Data were drawn from a community-based sample of 481 racially and ethnically diverse YMSM from New York City. Significant differences in exposure to HIV prevention messaging venues emerged with respect to age, race/ethnicity, and sexual orientation. Attention paid to HIV prevention messages in various venues differed by age and sexual orientation. Across all venues, multivariate modeling indicated YMSM were more likely to access HIV messaging from the same venues at which they paid attention, with some variability explained by person characteristics (age and perceived family socioeconomic status). This suggests that the one-size-fits-all approach does not hold true, and both the venue and person characteristics must be considered when generating and disseminating HIV prevention messaging.
Journal of Health Communication, 2013
HIV prevention messaging has been shown to reduce or delay high-risk sexual behaviors in young me... more HIV prevention messaging has been shown to reduce or delay high-risk sexual behaviors in young men who have sex with men (YMSM). Since the onset of the HIV/AIDS epidemic, a new generation of YMSM has come of age during an evolution in communication modalities. Because both these communication technologies and this new generation remain understudied, the authors investigated the manner in which YMSM interact with HIV prevention messaging. In particular, the authors examined 6 venues in which YMSM are exposed to, pay attention to, and access HIV prevention information: the Internet, bars/dance clubs, print media, clinics/doctors' offices, community centers/agencies, and educational classes. Data were drawn from a community-based sample of 481 racially and ethnically diverse YMSM from New York City. Significant differences in exposure to HIV prevention messaging venues emerged with respect to age, race/ethnicity, and sexual orientation. Attention paid to HIV prevention messages in various venues differed by age and sexual orientation. Across all venues, multivariate modeling indicated YMSM were more likely to access HIV messaging from the same venues at which they paid attention, with some variability explained by person characteristics (age and perceived family socioeconomic status). This suggests that the one-size-fits-all approach does not hold true, and both the venue and person characteristics must be considered when generating and disseminating HIV prevention messaging.
Archives of Sexual Behavior, 2015
Prevention Science, Feb 14, 2013
Journal of Health Communication, Jan 15, 2013
Behavioral Medicine, 2014
The prevalence of cigarette smoking and the relations between smoking and HIV clinical markers, H... more The prevalence of cigarette smoking and the relations between smoking and HIV clinical markers, HIV medication adherence, and opportunistic infections (OIs) were examined in a sample of 199 HIV-positive, gay, bisexual, and other men who have sex with men (MSM) aged 50 and older. Overall, 35.7% were current smokers, 35.7% were former smokers, and 28.6% were never smokers. In the final multivariable polytomous logistic regression model controlling for age, income, and illicit drug use, current smokers were less likely to report an undetectable viral load as compared to never and former smokers. Relative to never smokers, former smokers were more likely to report respiratory OIs, and current smokers were more likely to report gastrointestinal OIs. This study demonstrates high prevalence of cigarette smoking among aging, HIV-positive MSM and provides additional evidence for a relationship between smoking and poorer HIV clinical markers. Targeted and tailored smoking cessation programs within the context of HIV care services are warranted.
Journal of Gay & Lesbian Mental Health, 2015
AIDS Care, 2014
We sought to characterize HIV antiretroviral therapy (ART) adherence and psychosocial correlates ... more We sought to characterize HIV antiretroviral therapy (ART) adherence and psychosocial correlates of adherence in a sample of gay, bisexual, and other non-gay or -bisexual identified men who have sex with men aged 50 and over. As part of a cross-sectional study we recruited a community-based sample of 199 men and assessed adherence to current ART medications along four domains: (1) missing doses in the past 4 days, (2) taking doses on the specified schedule in the past 4 days, (3) following instructions about how to take the medications (e.g., to take medications with food), and (4) missing doses in the last weekend. A total adherence score was also computed. Bivariable analyses indicated negative associations between depression, sexual compulsivity, and HIV-related stigma with each of the individual adherence variables and the composite adherence score, while an older age was found to be protective. In multivariable analyses, controlling for age and educational attainment, a higher likelihood of missing doses and failing to follow instructions were related to higher levels of HIV-related stigma, while dosing off-schedule and missing doses on weekends was associated with higher levels of sexual compulsivity. These results indicate that psychosocial burdens undermine the adherence behaviors of older HIV-positive sexual minority men. Programming and services to address this compromising health behavior must embrace a holistic approach to health as informed by syndemics theory, while attending to the developmental and age-specific needs of older men.
Annals of Anthropological Practice, 2012
The theory of syndemics has been widely applied in HIV-prevention studies of gay, bisexual, and o... more The theory of syndemics has been widely applied in HIV-prevention studies of gay, bisexual, and other MSM (men who have sex with men) over the last decade. Our investigation is the first to consider the applicability of the theory in a sample of aging (ages 50 and over) HIV-positive MSM, which is a growing population in the United States. A sample of 199 men were actively recruited and assessed in terms of mental health and drug-use burden, as well as sexual risk behaviors. Bivariate and multivariable analyses indicate a high level of association between psychosocial burdens (i.e., drug use and mental health) and same-sex unprotected sexual behaviors, providing initial support for the applicability of the theory of syndemics to this population. Further support can be seen in participants' narratives. Findings suggest the mutually reinforcing nature of drug use, psychiatric disorders, and unprotected sexual behavior in older, HIV-positive, gay, bisexual, and other MSM, highlighting the need for holistic strategies to prevention and care among this population of older and sexually active individuals. In short, the generation of gay men who came of age in the late 1970s and 1980s, "the AIDS Generation," are continuing to mature such that further efforts must be enacted to meet the multidimensional nature of these men's physical, mental, and sexual health needs.
Substance Use & Misuse, 2011
This literature review considers the historical significance, emergence of, and interplay between... more This literature review considers the historical significance, emergence of, and interplay between the HIV and illicit drug use epidemics among gay, bisexual, and other men who have sex with men (MSM) in New York City (NYC). The continual rise in HIV infections in recent years among MSM, particularly among young MSM (YMSM), commands a need for the examination of the effectiveness of current HIV prevention strategies and a more comprehensive understanding of the complex biopsychosocial influences that place YMSM at risk. A chronological perspective of both the HIV and illicit drug use epidemics affecting NYC MSM is presented, followed by a review of the existing research on the synergistic relation between the two. Special consideration is given to the patterns and interconnectivity between HIV, substance use, and housing instability specific to YMSM, as they represent the demographic currently at greatest risk for HIV transmission in NYC. Thereafter, an overview of treatment research is provided. We conclude by offering recommendations for future research and best practices as we move forward in an attempt to reduce the incidence of HIV transmission.
AIDS Care, 2011
This study examined club drug use (i.e., cocaine, ecstasy, ketamine, gamma-hydroxybutyrate [GHB],... more This study examined club drug use (i.e., cocaine, ecstasy, ketamine, gamma-hydroxybutyrate [GHB], and methamphetamine) and unprotected anal intercourse (UAI) in an ethnically and racially diverse sample of 166 New York City-based seropositive, club drug-using, gay and bisexual men, ages 19-61, and considered these behaviors in relation to age category (20s, 30s, and 40 +) and number of years living with HIV. Club drug use was common across all age categories, with differences arising only in the type of club drug used. Multivariate logistic regression modeling indicated older participants (30s and 40 +) were more likely to use cocaine and methamphetamine and less likely to use GHB and ketamine than those in their 20s. We examined UAI with casual partners in relation to age category, the number of years living with HIV, and club drug use. The likelihood of engaging in UAI with seronegative casual partners was greater among those in their 20s than those in their 30s or 40+. Further, participants were equally likely to engage in unprotected receptive anal intercourse and unprotected insertive anal intercourse with each casual partner serostatus type. With regard to number of years living with HIV, those living longer with the disease were more likely to report UAI with casual partners with a seropositive status than with a negative or unknown serostatus. Our findings suggest that UAI and club drug use is common among seropositive gay and bisexual men regardless of age category, but that differential patterns of risk emerge in relation to the number of years one has been living with HIV and age. These findings are of significance as both the aging population of seropositive gay and bisexual men and HIV infection rates continue to grow, and demonstrate a need for differentiated and tailored prevention strategies across the age continuum.
Addictive Behaviors, 2010
This analysis considers the relation between personality traits, mental health states and methamp... more This analysis considers the relation between personality traits, mental health states and methamphetamine (MA) use in 60 men who have sex with men (MSM). Thirty MA-dependent and 30 MA non-using MSM were assessed on the Neo Five Factor Inventory, the Brief Symptom Inventory, the Perceived Stress Scale, and the Posttraumatic Stress Disorder Checklist -Civilian Version tests. Our results indicate differences between groups on a variety of measures of personality traits and mental states. Specifically, MA-dependent participants were found to be more Neurotic, less Open, less Agreeable, and less Conscientious. Further, MA-dependent participants were found to have higher levels of Paranoid Ideation and lower levels of Interpersonal Sensitivity. Given the high prevalence of MA use in the MSM community and the association between MA use and sexual risk taking, our findings provided a clearer understanding of how individual personality traits may be a factor in the continued use of this drug among MSM. Further research should seek to incorporate individual personality traits into the development of efficacious MA-specific treatment interventions.
Addiction Research & Theory, 2012
... Todd M. Solomon 1 * , Perry N. Halkitis 1 , Robert W. Moeller 1 , Molly K. Pappas 1 ... Sempl... more ... Todd M. Solomon 1 * , Perry N. Halkitis 1 , Robert W. Moeller 1 , Molly K. Pappas 1 ... Semple, Zians, & Strathdee, 2005), where use is typified by the ingestion of multiple substances simultaneously or within a more extensive period of time (Halkitis & Jerome, 2008; Halkitis et al ...
Journal of Health Psychology, 2013
Little is known about the impact of HIV and aging on cognitive functioning. This New York City cr... more Little is known about the impact of HIV and aging on cognitive functioning. This New York City crosssectional study of aging HIV-positive gay and bisexual men assessed their neuropsychological state. Working memory and verbal abstract reasoning were relatively intact. After 55 years of age, attention abilities were impaired. Executive function impairment was present regardless of age and education. Results suggest the need for HIV-specific norms, and the use of neuropsychological assessments (i.e. baseline and over time) as a cost-effective way to assess HIV-related cognitive decline in developed and under-developed countries.
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Papers by Molly J Kingdon