1. Brian Dodge, PhD7; Alex Carballo-Diéguez, PhD1 CONCLUSIONS/DISCUSSION
Sexual Health, Alcohol Use, Childhood Sexual Abuse, and Mental Health Outcomes Among Latino MSM in the Northeastern United States
Omar Martinez, JD, MPH, MS1; Elwin Wu, PhD2; Joseph Spadafino, MPH3; Theo Sandfort, PhD1; Andrew Z. Shultz, MA1
Javier López Rios1; Hugo Ovejero, JD4; Scott D Rhodes, PhD5; Eva Moya, PhD6; Silvia Chavez Baray, PhD6
Brian Dodge, PhD7; Alex Carballo-Diéguez, PhD1
1HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, USA
2Social Intervention Group, Columbia University, USA; 3Arizona State University, USA; 4Latino Commission on AIDS, USA
5Wake Forest University School of Medicine, USA; 6University of Texas at El Paso, USA; 7Indiana University Bloomington, USA
HIV CENTER
for Clinical and
Behavioral Studies
INTRODUCTION
Latinos represent approximately 16% of the US population but accounted for 22% of new HIV infections and 21% of new AIDS diagnoses in In 2011, Latino men who have sex with men (MSM) represented 72% (7,266) of all new HIV infections among Latinos.
Substance use has been identified as a coping mechanism used by Latino men to mitigate the depression, migration experiences, and discrimination. Elevated rates of problematic alcohol use have been observed among Latino MSM, between 8 and 40% report harmful alcohol consumption.
Although research has documented childhood sexual abuse among Latino gay men, there is a need for current research that explores and addresses the gaps in childhood sexual abuse prevention and treatment interventions and programs.
Overall prevalence of depression among Latinos in the United States has been estimated to be as high as 20% among Latino men and 50% among Latina women. However, little is known about the mental health status of Latino gay men, MSM, and male-to-female transgender individuals.
The purpose of this study was to: (1) provide a description of the demographic characteristics of a cohort of Latino MSM in New York City; (2) evaluate the prevalence estimates of problematic alcohol consumption, depression, and childhood sexual abuse; and (3) examine predictors of problematic alcohol consumption.
RESULTS
Table 1. Demographic characteristics (N=176)
Characteristics
M ± SD or n (%)
Age (years; n= 176)
33.37 (9.10)
Country of Origin (n=176)
Mexico
34 (18)
Central America
28 (15)
South America
37 (21.5)
Caribbean
77 (44.5)
Sexual Identity (n=175)
Gay
148 (85)
Bisexual
20 (10)
Transgender or Transexual
4 (3)
Other
3 (2)
Language spoken, written, and read (n=176)
Only Spanish
66 (38)
Spanish better than English
33 (19)
Both equally
50 (28)
English better than Spanish
10 (6)
Only English
17 (9)
Time in the United States (n=176)
Less than 12 months
62 (35)
More than 12 months
114 (65)
Employment Status (n=176)
Employed full-time
Employed part-time
29 (16)
Unemployed
76 (43)
Disabled
5 (3)
Education (175)
No formal education
Less than a high school diploma
14 (8)
High school diploma or GED
53 (30)
Some college
46 (27)
Two-year college degree
13 (7)
Four-year college degree
32 (18)
Graduate or professional degree
7 (4)
Medical Insurance (n=176) No
72 (41)
Yes
104 (59)
Table 2.Statistics on other covariates
Covariates
M ± SD or n (%)
Problematic Alcohol Consumption (n=176)
None
93 (53)
Binge
36 (21)
Heavy
47 (26)
Depressive Symptoms (n=176)
56 (32)
Clinically significant depressive symptoms
120 (68)
Number of sexual partners in the past 3 mos (n=174)
7.59 (19.33)
No sexual partner
12 (7)
1 partner
70 (40)
More than 1 partner
92 (53)
Number of anal intercourse acts in the past 3 mos (n=175)
26.41 (34.64)
Risky Sexual Behavior in the past 3 mo (n=176)
Reported at least one act of unprotected anal intercourse
97 (55)
Did not report unprotected anal intercourse
79 (45)
Relationship Status (n=175)
Reported having a relationship with another man
118 (67)
Single/Not being in a relationship
57 (33)
Length of relationship (n=118)
1-12 mos
47 (40)
More than 12 mos
71 (60)
Intimate Partner Violence (n=176)
Reported intimate partner violence at least one time
13 (7)
Did not report intimate partner violence
163 (93)
Self-reported HIV Status (n=175)
Positive
60 (34)
Negative
103 (59)
Never been tested
Childhood sexual abuse (n=130)
Yes
39 (30) No
91 (70)
METHODS
Between January and March of 2014 a cohort of Latino MSM in New York City (N=176) completed phone screenings to determine eligibility to participate in Latinos en Pareja, a couple-based HIV/STI prevention intervention adaptation study.
A multinomial logistic regression model predicting problematic alcohol consumption was carried out; demographic characteristics, sexual risk factors, childhood sexual abuse experiences, and mental health outcomes were included in the model.
Problematic alcohol consumption was categorized as: binge drinking (more than 4 alcoholic drinks on the same occasion on at least 1 day in the past 30 days) and heavy drinking (more than 4 alcoholic drinks on the same occasion on each of 5 or more days in the past 30 days). Clinically significant depressive symptoms were measured using the short 10-item Center for Epidemiological Studies Depression (CES-D) scale. Childhood sexual abuse was operationalized as having disclosed forced or coerced sexual activity before the age of 17.
CONCLUSIONS/DISCUSSION
Prevalence estimates of problematic alcohol consumption in the past 30 days and clinically significant depressive symptoms (CES-D score ≥ 10) were 47% and 68%, respectively. Internal consistency reliability coefficients of the CES-D scale were satisfactory (Cronbach α=0.86). Among participants who reported sexual activity before the age of 17 (n=130, 74%), 39 participants (30%) reported childhood sexual abuse.
The results of the study provide additional relevant and up-to-date evidence linking problematic alcohol consumption with having multiple sexual partners, engaging in unprotected anal intercourse, being in a relationship, and reporting intimate partner violence. In addition, our study highlights the importance of serving Latino MSM and their needs, while considering the diversity of the community regarding childhood sexual abuse, relationship status, and depressive symptoms.
Several limitations should be acknowledged when interpreting the results of this study. First, the cross-sectional design of our survey precludes making any definitive causal claims about the direction of the relationship we observed. A second limitation is the concern of the study’s modest sample size and demographic distribution that could be unrepresentative of gay and other Latino MSM in New York City. Another study limitation is that, due to the scope of this small intervention adaptation pilot grant, we could not pair all individuals that reported being in a relationship. Analyses of data from couples require special adjustments because the assumption of independent observations is not met. The generalized estimating equation (GEE) can be used as a tool to adjust for paired data.
Future research considering associations with problematic alcohol consumption should further examine the role of childhood sexual abuse on health outcomes. Additionally, given the high prevalence estimate of childhood sexual abuse and the potential negative impact of intimate partner violence on health outcomes, interventions designed to prevent and reduce harmful alcohol consumption should include empowerment tools, including social support and self-efficacy to cope with these potentially traumatic experiences.
Given the fact that being in a relationship was associated with problematic alcohol consumption, future wellness programs for couples and couple-based HIV prevention interventions should incorporate mediators and couple-focused activities, such as sexual communication skills, sexual decision-making power for couples, social support for risk reduction, social and self-regulatory skills to cope with problematic alcohol consumption, along with other related health concerns pertinent to same-sex couples, including risky sexual behaviors, intimate partner violence, and childhood sexual abuse.
Table 3. Covariates included in the final model – multinomial logistic regression
Characteristics and other covariates
Binge Drinking
Heavy Drinking
OR (95% CI)
Number of sexual partners in the past 3 mos
More than one partner
2.53 (1.07, 5.99)*
4.23 (1.73, 10.37)**
One partner or none 1
Risky sexual behavior in the past 3 mos
Risky
0.89 (0.38, 2.07)
2.52 (1.05, 6.10)*
None
Relationship status
Being in a relationship with another man
4.42 (1.56, 12.50)**
1.75 (0.69, 4.45)
Single
Intimate Partner Violence
Violence
0.70 (0.07, 7.27)
6.16 (1.31, 29.02)*
Depressive symptoms
Clinically significant depressive symptoms
0.89 (0.38, 6.44)
2.36 (0.86, 6.44)
Childhood sexual abuse
Yes
0.94 (0.33, 2.66)
1.53 (0.61, 3.87) No
OR = odds ratio; CI = confidence interval
**p < .01. *p < .05.
PUBLICATIONS
Martinez, O., Wu, E., Shultz, A., Capote, J., López Rios, J., Sandfort, T., & ... Rhodes, S. (2014). Still a hard-to-reach population? Using social media to recruit Latino gay couples for an HIV intervention adaptation study. Journal Of Medical Internet Research, 16(4), e113.
Martinez, O., Wu, E., Sandfort, T., Shultz, A., Dodge, B. Chavez-Baray, S., & …Ovejero, H. (2014). A Couple-Based Approach: An Innovative Effort to Tackle HIV Infection Among Latino MSM. Ehquidad, 1(1),
ACKNOWLEDGMENTS
This research was supported by a center grant from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University (P30-MH43520; Principal Investigator: Robert H. Remien, Ph.D.). Mr. Omar Martinez was supported by a training grant from the National Institute of Mental Health (T32 MH19139, Behavioral Sciences Research in HIV Infection; Principal Investigator: Theo Sandfort, Ph.D.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the NIH.
Omar Martinez, JD, MPH, MS