%0 Journal Article %J AIDS Behav %D 2014 %T Place and sexual partnership transition among young American Indian and Alaska native women. %A Pearson, Cynthia R %A Cassels, Susan %K Adolescent %K Adult %K Alaska %K Condoms %K Cross-Sectional Studies %K Female %K Health Knowledge, Attitudes, Practice %K Humans %K Indians, North American %K Interpersonal Relations %K Life Style %K Population Surveillance %K Psychosexual Development %K Risk-Taking %K Self Efficacy %K Sexual Behavior %K Sexual Partners %K Social Behavior %K Social Class %K Social Environment %K Socioeconomic Factors %K Substance-Related Disorders %X

Multiple challenges expose American Indian and Alaska Native (AIAN) women to high-risk sexual partnerships and increased risk for HIV/STI. Using a unique sample of sexually-active young AIAN women (n = 129), we examined characteristics of last three partners and whether transitional partnerships were associated with different risk profiles, including where partners met, lived, and had sex. Respondents were more likely to have met their previous or current secondary partner (P2) at a friend's or family setting (versus work or social setting) (AOR = 3.92; 95 % CI 1.31, 11.70). Condom use was less likely when meeting a partner at friend's or family settings (AOR = 0.17; 95 % CI 0.05, 0.59). Sexual intercourse with P2 (compared to P1) usually took place in "riskier" settings such as a car, bar, or outside (AOR = 4.15; 95 % CI 1.59, 10.68). Perceived "safe" places, e.g., friend's or family's house, were identified with risky behaviors; thus, homogeneous messaging campaigns may promote a false sense of safety.

%B AIDS Behav %V 18 %P 1443-53 %8 2014 Aug %G eng %N 8 %R 10.1007/s10461-013-0667-x %0 Journal Article %J AIDS Behav %D 2014 %T Prospective predictors of unprotected anal intercourse among HIV-seropositive men who have sex with men initiating antiretroviral therapy. %A Pantalone, David W %A Huh, David %A Nelson, Kimberly M %A Pearson, Cynthia R %A Simoni, Jane M %K Adult %K Anti-HIV Agents %K Drug Administration Schedule %K Health Knowledge, Attitudes, Practice %K HIV Infections %K HIV Seropositivity %K Homosexuality, Male %K Humans %K Interviews as Topic %K Latin America %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K Sexual Behavior %K Socioeconomic Factors %K Stress, Psychological %K Substance-Related Disorders %K Surveys and Questionnaires %K Unsafe Sex %K Vulnerable Populations %K Washington %K Young Adult %X

Contemporary HIV prevention efforts are increasingly focused on those already living with HIV/AIDS (i.e., "prevention with positives"). Key to these initiatives is research identifying the most risky behavioral targets. Using a longitudinal design, we examined socio-demographic and psychosocial factors that prospectively predicted unprotected anal intercourse (UAI) in a sample of 134 HIV-seropositive men who have sex with men (MSM) initiating, changing, or re-starting an antiretroviral therapy regimen as part of a behavioral intervention study. Computer-based questionnaires were given at baseline and 6 months. In a sequential logistic regression, baseline measures of UAI (step 1), socio-demographic factors such as Latino ethnicity (step 2), and psychosocial factors such as crystal methamphetamine use, greater life stress, and lower trait anxiety (step 3) were predictors of UAI at 6 months. Problem drinking was not a significant predictor. Prevention efforts among MSM living with HIV/AIDS might focus on multiple psychosocial targets, like decreasing their crystal methamphetamine use and teaching coping skills to deal with life stress.

%B AIDS Behav %V 18 %P 78-87 %8 2014 Jan %G eng %N 1 %R 10.1007/s10461-013-0477-1 %0 Journal Article %J AIDS Educ Prev %D 2013 %T A cautionary tale: risk reduction strategies among urban American Indian/Alaska Native men who have sex with men. %A Pearson, Cynthia R %A Walters, Karina L %A Simoni, Jane M %A Beltran, Ramona %A Nelson, Kimberly M %K Adolescent %K Adult %K Alaska %K Condoms %K Cross-Sectional Studies %K Health Knowledge, Attitudes, Practice %K HIV Infections %K HIV Seronegativity %K Homosexuality, Male %K Humans %K Indians, North American %K Male %K Middle Aged %K Risk Factors %K Risk Reduction Behavior %K Risk-Taking %K Sexual Partners %K Socioeconomic Factors %K Surveys and Questionnaires %K Truth Disclosure %K Unsafe Sex %K Urban Population %K Young Adult %X

American Indian and Alaska Native (AIAN) men who have sex with men (MSM) are considered particularly high risk for HIV transmission and acquisition. In a multi-site cross-sectional survey, 174 AIAN men reported having sex with a man in the past 12 months. We describe harm reduction strategies and sexual behavior by HIV serostatus and seroconcordant partnerships. About half (51.3%) of the respondents reported no anal sex or 100% condom use and 8% were in seroconcordant monogamous partnership. Of the 65 men who reported any sero-adaptive strategy (e.g., 100% seroconcordant partnership, strategic positioning or engaging in any strategy half or most of the time), only 35 (54.7%) disclosed their serostatus to their partners and 27 (41.5%) tested for HIV in the past 3 months. Public health messages directed towards AIAN MSM should continue to encourage risk reduction practices, including condom use and sero-adaptive behaviors. However, messages should emphasize the importance of HIV testing and HIV serostatus disclosure when relying solely on sero-adaptive practices.

%B AIDS Educ Prev %V 25 %P 25-37 %8 2013 Feb %G eng %N 1 %R 10.1521/aeap.2013.25.1.25 %0 Journal Article %J Am J Drug Alcohol Abuse %D 2012 %T Indian boarding school experience, substance use, and mental health among urban two-spirit American Indian/Alaska natives. %A Evans-Campbell, Teresa %A Walters, Karina L %A Pearson, Cynthia R %A Campbell, Christopher D %K Acculturation %K Adult %K Alaska %K Alcohol-Related Disorders %K Anxiety Disorders %K Cross-Sectional Studies %K Female %K Health Surveys %K Humans %K Indians, North American %K Inuits %K Male %K Mental Disorders %K Middle Aged %K Schools %K Stress Disorders, Post-Traumatic %K Substance-Related Disorders %K Suicidal Ideation %K Suicide, Attempted %K United States %K Urban Population %X

BACKGROUND: Systematic efforts of assimilation removed many Native children from their tribal communities and placed in non-Indian-run residential schools.

OBJECTIVES: To explore substance use and mental health concerns among a community-based sample of 447 urban two-spirit American Indian/Alaska Native adults who had attended boarding school as children and/or who were raised by someone who attended boarding school.

METHOD: Eighty-two respondents who had attended Indian boarding school as children were compared to respondents with no history of boarding school with respect to mental health and substance use.

RESULTS: Former boarding school attendees reported higher rates of current illicit drug use and living with alcohol use disorder, and were significantly more likely to have attempted suicide and experienced suicidal thoughts in their lifetime compared to non-attendees. About 39% of the sample had been raised by someone who attended boarding school. People raised by boarding school attendees were significantly more likely to have a general anxiety disorder, experience posttraumatic stress disorder symptoms, and have suicidal thoughts in their lifetime compared to others.

%B Am J Drug Alcohol Abuse %V 38 %P 421-7 %8 2012 Sep %G eng %N 5 %R 10.3109/00952990.2012.701358 %0 Journal Article %J Ann Behav Med %D 2011 %T 'I've had unsafe sex so many times why bother being safe now?': the role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men. %A Nelson, Kimberly M %A Simoni, Jane M %A Pearson, Cynthia R %A Walters, Karina L %K Adult %K Alaska %K Attitude to Health %K Cognition %K Condoms %K Cross-Sectional Studies %K HIV Infections %K Homosexuality, Male %K Humans %K Indians, North American %K Male %K Middle Aged %K Multivariate Analysis %K Risk Factors %K Risk-Taking %K Sexual Partners %K Socioeconomic Factors %K Stress Disorders, Post-Traumatic %K Surveys and Questionnaires %K Unsafe Sex %K Young Adult %X

BACKGROUND: American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission.

PURPOSE: This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM.

METHODS: AI/AN MSM (Nā€‰=ā€‰173) from a national cross-sectional survey were analyzed.

RESULTS: Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both.

CONCLUSIONS: Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.

%B Ann Behav Med %V 42 %P 370-80 %8 2011 Dec %G eng %N 3 %R 10.1007/s12160-011-9302-0 %0 Journal Article %J Public Health Rep %D 2010 %T Risk factors for HIV disease progression in a rural southwest American Indian population. %A Iralu, Jonathan %A Duran, Bonnie %A Pearson, Cynthia R %A Jiang, Yizhou %A Foley, Kevin %A Harrison, Melvin %K Alcoholism %K CD4 Lymphocyte Count %K Disease Progression %K Female %K HIV Infections %K Humans %K Indians, North American %K Male %K Medication Adherence %K Medicine, Traditional %K Prisoners %K Risk Factors %K Rural Population %K Southwestern United States %K Viral Load %X

OBJECTIVES: Risk factors for human immunodeficiency virus (HIV) disease progression among American Indians (AIs) have been poorly characterized. We assessed the impact of socioeconomic factors and use of traditional healing on HIV disease progression in a rural AI community.

METHODS: From January 2004 through December 2006, we interviewed 36 HIV-positive AIs regarding their socioeconomic status, incarceration, and use of traditional healing. We also collected chart-abstracted adherence and substance-abuse data. Through bivariate analysis, we compared these factors with the CD4-cell counts and log HIV-1 viral loads (VLs). Using a simple regression model, we assessed interactions between the significant associations and the outcome.

RESULTS: Participant characteristics included being male (58.3%), being transgender (13.9%), having ever been incarcerated (63.9%), having a household income of < $1,000/month (41.7%), being unemployed (61.1%), being diagnosed with alcohol abuse (50.0%), and using traditional medicine (27.8%) in the last 12 months. Higher VLs were associated with recent incarceration (p < 0.05), household income of < $1,000/month (p < 0.05), and provider-assessed alcohol abuse (p < 0.05). We found an interaction between incarceration and alcohol abuse, and alcohol abuse was the factor more strongly associated with higher VLs. A lower CD4 count was associated with recent incarceration (p < 0.05) and use of traditional medicine (p < 0.05).

CONCLUSIONS: Alcohol abuse is an important contributor to HIV disease progression, and participants with lower CD4 counts were more likely to use traditional medicine. HIV care among this rural AI population should focus on addressing alcohol abuse and other socioeconomic risk factors and promote collaboration between Western medical and Navajo traditional practitioners.

%B Public Health Rep %V 125 Suppl 4 %P 43-50 %8 2010 Jul-Aug %G eng %0 Journal Article %J Sex Transm Dis %D 2010 %T Sexual partner concurrency and sexual risk among gay, lesbian, bisexual, and transgender American Indian/Alaska natives. %A Cassels, Susan %A Pearson, Cynthia R %A Walters, Karina %A Simoni, Jane M %A Morris, Martina %K Adolescent %K Adult %K Aged %K Alaska %K Bisexuality %K Female %K Health Knowledge, Attitudes, Practice %K Healthcare Disparities %K HIV Infections %K Homosexuality, Female %K Homosexuality, Male %K Humans %K Indians, North American %K Male %K Middle Aged %K Prevalence %K Risk-Taking %K Sexual Behavior %K Sexual Partners %K Socioeconomic Factors %K Surveys and Questionnaires %K Transgender Persons %X

BACKGROUND: American Indian and Alaska Natives suffer pervasive health disparities, including disproportionately high rates of HIV. Sexual network dynamics, including concurrency and sexual mixing patterns, are key determinants of HIV disparities.

METHODS: We analyzed data from the first national study of gay, lesbian, bisexual, and transgender American Indian and Alaska Natives to examine the prevalence of concurrency, sex and race of partners, and level of risk across different partnership patterns. Egocentric network data were analyzed at the level of the respondents, who were grouped according to the sex of their last 3 partners.

RESULTS: Overall rates of HIV and concurrency were high in this population. HIV prevalence (34%) and cumulative prevalence of concurrency (55%) were highest among men who had sex with only men, while women who had sex with only women reported lower concurrency and HIV. Women who had sex with women and men also had high HIV prevalence (15%) and reported slightly higher concurrency risk and low condom use, making them effective bridge populations.

CONCLUSIONS: The uniformly high rates of Native partner selection creates the potential for amplification of disease spread within this small community, while the high rates of selecting partners of other races creates the potential for bridging to other groups in the transmission network. These findings provide some of the first insights into sexual networks and concurrency among Native gay, lesbian, bisexual, and transgender populations and suggest that both men and women deserve attention in HIV prevention efforts at individual, dyadic and population levels.

%B Sex Transm Dis %V 37 %P 272-8 %8 2010 Apr %G eng %N 4 %R 10.1097/OLQ.0b013e3181c37e3e