Who Aren’t We Reaching? Young Sexual Minority Men’s Non-participation in an HIV-Prevention and Mental Health Clinical Trial

Abstract

Despite many successful clinical trials to test HIV-prevention interventions for sexual minority men (SMM), not all SMM are reached by these trials. Identifying factors associated with non-participation in these trials could help to ensure the benefits of research extend to all SMM. Prospective participants in New York City and Miami were screened to determine eligibility for a baseline assessment for a mental health/HIV-prevention trial (N = 633 eligible on screen). Logistic regression and classification and regression tree (CART) analysis identified predictors of non-participation in the baseline, among those who were screened as eligible and invited to participate. Individuals who reported unknown HIV status were more likely to be non-participators than those who reported being HIV-negative (OR = 2.39; 95% CI 1.41, 4.04). In New York City, Latinx SMM were more likely to be non-participators than non-Latinx white SMM (OR = 1.81; 95% CI, 1.09, 2.98). A CART model pruned two predictors of non-participation: knowledge of HIV status and age, such that SMM with unknown HIV status and SMM ages 18–19 were less likely to participate. Young SMM who did not know their HIV status, and thus are more likely to acquire and transmit HIV, were less likely to participate. Additionally, younger SMM (18–19 years) and Latinx SMM in New York City were less likely to participate. The findings suggest the importance of tailored recruitment to ensure HIV-prevention/mental health trials reach all SMM.

Resumen

A pesar de muchos ensayos clínicos exitosos para probar intervenciones de prevención del VIH para hombres de minorías sexuales (HMS), no todos los HMS son alcanzados por estos ensayos. La identificación de factores asociados con la no participación en estos ensayos podría ayudar a asegurar que los beneficios de la investigación se extiendan a todos los HMS. Se realizaron evaluaciones de teléfono para determinar la elegibilidad para la visita inicial para un ensayo de salud mental/prevención del VIH (N = 633 elegibles en las evaluaciones). La regresión logística y el análisis de arboles de regresión y clasificación (ARC) identificaron predictores de no participación en la visita inicial, entre aquellos que fueron evaluados como elegibles e invitados a participar. Los individuos que reportaron estado desconocido de VIH fueron más probables a ser no participantes que aquellos que reportaron ser VIH negativos (RP = 2.39; IC 95% 1.41, 4.04). En la ciudad de Nueva York, HMS latinx eran más probable a no participar que los HMS blancos no latinx (RP = 1.81; IC 95%, 1.09, 2.98). Un modelo de ARC podó dos predictores de no participación: el conocimiento del estado de VIH y la edad, tal que los HMS con estado desconocido del VIH y las HMS de 18–19 años eran menos probables a participar. Los HMS jóvenes que no conocían su estado de VIH, y por lo tanto eran más probables a adquirir y transmitir el VIH, tenían menos probabilidades de participar. Además, las HMS más jóvenes (18–19 años) y los HMS latinx en la ciudad de Nueva York eran menos probables a participar. Los resultados sugieren la importancia de un reclutamiento personalizado para garantizar que los ensayos de prevención del VIH y salud mental lleguen a todos los SMM.

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Notes

  1. 1.

    We use the term “sexual minority men” to refer to men who identify as gay, bisexual, or another non-heterosexual identity. Some sources referenced use the term “men who have sex with men” (MSM) to refer to men who engage in sexual behavior with men, regardless of their sexual orientation identity; therefore, we use the term MSM to describe these groups, consistent with the cited research.

References

  1. 1.

    Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States 2010–2016. 2019. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-24-1.pdf.

  2. 2.

    Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2014–2018. 2020. Report No.: 25. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-25-1.pdf?deliveryName=FCP_2_USCDCNPIN_162-DM27706&deliveryName=USCDC_1046-DM27774.

  3. 3.

    Cochran SD, Sullivan JG, Mays VM. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 2003;71(1):53–61.

    PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008. https://doi.org/10.1186/1471-244X-8-70.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Marshal MP, Dietz LJ, Friedman MS, Stall R, Smith HA, McGinley J, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health. 2011;49(2):115–23.

    PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Bränström R, Hatzenbuehler ML, Pachankis JE. Sexual orientation disparities in physical health: age and gender effects in a population-based study. Soc Psychiatry Psychiatr Epidemiol. 2016;51(2):289–301.

    PubMed  Article  Google Scholar 

  7. 7.

    Rice CE, Vasilenko SA, Fish JN, Lanza ST. Sexual minority health disparities: an examination of age-related trends across adulthood in a national cross-sectional sample. Ann Epidemiol. 2019;39:20–5.

    Article  Google Scholar 

  8. 8.

    Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. 2011 [cited 2020 Oct 8]. https://www.nap.edu/catalog/13128/the-health-of-lesbian-gay-bisexual-and-transgender-people-building.

  9. 9.

    Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009;123(1):346–52.

    PubMed  Article  Google Scholar 

  10. 10.

    Pachankis JE, Cochran SD, Mays VM. The mental health of sexual minority adults in and out of the closet: a population-based study. J Consult Clin Psychol. 2015;83(5):890–901.

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Ragins BR, Singh R, Cornwell JM. Making the invisible visible: fear and disclosure of sexual orientation at work. J Appl Psychol. 2007;92(4):1103–18.

    PubMed  Article  Google Scholar 

  12. 12.

    Lee JH, Gamarel KE, Bryant KJ, Zaller ND, Operario D. Discrimination, mental health, and substance use disorders among sexual minority populations. LGBT Health. 2016;3(4):258–65.

    PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    McCabe SE, Bostwick WB, Hughes TL, West BT, Boyd CJ. The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. Am J Public Health. 2010;100(10):1946–52.

    PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Meyer IH, Frost DM. Minority stress and the health of sexual minorities. In: Patterson CJ, D’Augelli AR, editors. Handbook of psychology and sexual orientation. Oxford: Oxford University Press; 2012.

    Google Scholar 

  16. 16.

    Dyer TP, Shoptaw S, Guadamuz TE, Plankey M, Kao U, Ostrow D, et al. Application of syndemic theory to Black men who have sex with men in the Multicenter AIDS Cohort Study. J Urban Health. 2012;89(4):697–708.

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Ferlatte O, Hottes TS, Trussler T, Marchand R. Evidence of a syndemic among young Canadian gay and bisexual men: uncovering the associations between anti-gay experiences, psychosocial issues, and HIV risk. AIDS Behav. 2014;18(7):1256–63.

    PubMed  Article  Google Scholar 

  18. 18.

    Mimiaga MJ, Biello KB, Robertson AM, Oldenburg CE, Rosenberger JG, O’Cleirigh C, et al. High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish- and Portuguese-speaking men who have sex with men in Latin America. Arch Sex Behav. 2015;44(7):1869–78.

    PubMed  Article  Google Scholar 

  19. 19.

    Mustanski B, Garofalo R, Herrick A, Donenberg G. Psychosocial health problems increase risk for HIV among urban young men who have sex with men: preliminary evidence of a syndemic in need of attention. Ann Behav Med. 2007;34(1):37–45.

    PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Parsons JT, Grov C, Golub SA. Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic. Am J Public Health. 2012;102(1):156–62.

    PubMed  PubMed Central  Article  Google Scholar 

  21. 21.

    Parsons JT, Millar BM, Moody RL, Starks TJ, Rendina HJ, Grov C. Syndemic conditions and HIV transmission risk behavior among HIV-negative gay and bisexual men in a U.S. national sample. Health Psychol. 2017;36(7):695–703.

    PubMed  PubMed Central  Article  Google Scholar 

  22. 22.

    Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42.

    PubMed  PubMed Central  Article  Google Scholar 

  23. 23.

    Singer MC, Erickson PI, Badiane L, Diaz R, Ortiz D, Abraham T, et al. Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context. Soc Sci Med. 2006;63(8):2010–21.

    PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Singer MC, Clair S. Syndemics and public health: reconceptualizing disease in bio-social context. Med Anthropol Q. 2003;17(4):423–41.

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25.

    Fitzpatrick LK, Sutton M, Greenberg AE. Toward eliminating health disparities in HIV/AIDS: the importance of the minority investigator in addressing scientific gaps in Black and Latino communities. J Natl Med Assoc. 2006;98(12):1906–11.

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Ellard-Gray A, Jeffrey NK, Choubak M, Crann SE. Finding the hidden participant: solutions for recruiting hidden, hard-to-reach, and vulnerable populations. Int J Qual Methods. 2015;14(5):160940691562142.

    Article  Google Scholar 

  27. 27.

    Fernández MI, Warren JC, Varga LM, Prado G, Hernandez N, Bowen GS. Cruising in cyber space: comparing Internet chat room versus community venues for recruiting Hispanic men who have sex with men to participate in prevention studies. J Ethn Subst Abuse. 2007;6(2):143–62.

    PubMed  Article  Google Scholar 

  28. 28.

    Holloway IW, Cederbaum JA, Ajayi A, Shoptaw S. Where are the young men in HIV prevention efforts? Comments on HIV prevention programs and research from young men who sex with men in Los Angeles County. J Prim Prev. 2012;33(5–6):271–8.

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Richardson S, Seekaew P, Koblin B, Vazquez T, Nandi V, Tieu H-V. Barriers and facilitators of HIV vaccine and prevention study participation among Young Black MSM and transwomen in New York City. PLoS ONE. 2017;12(7):e0181702.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  30. 30.

    Arnold MP, Andrasik M, Landers S, Karuna S, Mimiaga MJ, Wakefield S, et al. Sources of racial/ethnic differences in awareness of HIV vaccine trials. Am J Public Health. 2014;104(8):e112–8.

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Connochie D, Tingler RC, Bauermeister JA. Young men who have sex with men’s awareness, acceptability, and willingness to participate in HIV vaccine trials: results from a nationwide online pilot study. Vaccine. 2019;37(43):6494–9.

    PubMed  PubMed Central  Article  Google Scholar 

  32. 32.

    Castillo-Mancilla JR, Cohn SE, Krishnan S, Cespedes M, Floris-Moore M, Schulte G, et al. Minorities remain underrepresented in HIV/AIDS research despite access to clinical trials. HIV Clin Trials. 2014;15(1):14–26.

    PubMed  PubMed Central  Article  Google Scholar 

  33. 33.

    Sullivan PS, McNaghten AD, Begley E, Hutchinson A, Cargill VA. Enrollment of racial/ethnic minorities and women with HIV in clinical research studies of HIV medicines. J Natl Med Assoc. 2007;99(3):242–50.

    PubMed  PubMed Central  Google Scholar 

  34. 34.

    Andrasik MP, Chandler C, Powell B, Humes D, Wakefield S, Kripke K, et al. Bridging the divide: HIV prevention research and Black men who have sex with men. Am J Public Health. 2014;104(4):708–14.

    PubMed  PubMed Central  Article  Google Scholar 

  35. 35.

    George S, Duran N, Norris K. A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders. Am J Public Health. 2014;104(2):e16-31.

    PubMed  PubMed Central  Article  Google Scholar 

  36. 36.

    Grov C, Cain D, Whitfield THF, Rendina HJ, Pawson M, Ventuneac A, et al. Recruiting a US national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: challenges and opportunities. Sex Res Soc Policy. 2016;13(1):1–21.

    Article  Google Scholar 

  37. 37.

    Hoyt MA, Rubin LR, Nemeroff CJ, Lee J, Huebner DM, Proeschold-Bell RJ. HIV/AIDS-related institutional mistrust among multiethnic men who have sex with men: effects on HIV testing and risk behaviors. Health Psychol. 2012;31(3):269–77.

    PubMed  Article  Google Scholar 

  38. 38.

    Martinez O, Wu E, Shultz AZ, Capote J, López Rios J, Sandfort T, et al. Still a hard-to-reach population? Using social media to recruit Latino gay couples for an HIV intervention adaptation study. J Med Internet Res. 2014;16(4):e113.

    PubMed  PubMed Central  Article  Google Scholar 

  39. 39.

    Westergaard RP, Beach MC, Saha S, Jacobs EA. Racial/ethnic differences in trust in health care: HIV conspiracy beliefs and vaccine research participation. J Gen Intern Med. 2014;29(1):140–6.

    PubMed  Article  Google Scholar 

  40. 40.

    Harkness A, Rogers BG, Mayo D, Smith-Alvarez R, Pachankis JE, Safren SA. A relational framework for engaging Latinx sexual minority men in sexual and behavioral health research. Manuscript Under Review

  41. 41.

    Dhalla S, Poole G. Effect of race/ethnicity on participation in HIV vaccine trials and comparison to other trials of biomedical prevention. Hum Vaccines Immunother. 2014;10(7):1974–84.

    Article  Google Scholar 

  42. 42.

    Guo Y, Li X, Fang X, Lin X, Song Y, Jiang S, et al. A comparison of four sampling methods among men having sex with men in China: implications for HIV/STD surveillance and prevention. AIDS Care. 2011;23(11):1400–9.

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Balsam KF, Beauchaine TP, Mickey RM, Rothblum ED. Mental health of lesbian, gay, bisexual, and heterosexual siblings: effects of gender, sexual orientation, and family. J Abnorm Psychol. 2005;114(3):471–6.

    PubMed  Article  Google Scholar 

  44. 44.

    Kerr DL, Santurri L, Peters P. A comparison of lesbian, bisexual, and heterosexual college undergraduate women on selected mental health issues. J Am Coll Health. 2013;61(4):185–94.

    PubMed  Article  Google Scholar 

  45. 45.

    Platt LF, Wolf JK, Scheitle CP. Patterns of mental health care utilization among sexual orientation minority groups. J Homosex. 2018;65(2):135–53.

    PubMed  Article  Google Scholar 

  46. 46.

    Raifman J, Dean LT, Montgomery MC, Almonte A, Arrington-Sanders R, Stein MD, et al. Racial and ethnic disparities in HIV pre-exposure prophylaxis awareness among men who have sex with men. AIDS Behav. 2019;23(10):2706–9.

    PubMed  PubMed Central  Article  Google Scholar 

  47. 47.

    Centers for Disease Control and Prevention. HIV infection risk, prevention, and testing behaviors among men who have sex with men national HIV behavioral surveillance 23 U.S. cities, 2017. 2019. Report No.: 22. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-22.pdf.

  48. 48.

    Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health. 2015;105(2):e75-82.

    PubMed  PubMed Central  Article  Google Scholar 

  49. 49.

    Rhodes SD, Martinez O, Song E-Y, Daniel J, Alonzo J, Eng E, et al. Depressive symptoms among immigrant Latino sexual minorities. Am J Health Behav. 2013;37(3):404–13.

    PubMed  PubMed Central  Article  Google Scholar 

  50. 50.

    Pachankis JE, McConocha EM, Reynolds JS, Winston R, Adeyinka O, Harkness A, et al. Project ESTEEM protocol: a randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men’s mental and sexual health. BMC Public Health. 2019;19(1):1086.

    PubMed  PubMed Central  Article  Google Scholar 

  51. 51.

    Lang AJ, Norman SB, Means-Christensen A, Stein MB. Abbreviated brief symptom inventory for use as an anxiety and depression screening instrument in primary care. Depress Anxiety. 2008;26:537–43.

    Google Scholar 

  52. 52.

    Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med. 1983;13(3):595–605.

    CAS  PubMed  Article  Google Scholar 

  53. 53.

    Orellana ER, El-Bassel N, Gilbert L, Miller KM, Catania J, Epperson M, et al. Sex trading and other HIV risks among drug-involved men: differential associations with childhood sexual abuse. Soc Work Res. 2014;38(2):117–26.

    Article  Google Scholar 

  54. 54.

    AIDSVu. Emory University, Rollins School of Public Health; aidsvu.org

  55. 55.

    Center for Disease Control and Prevention. NCHHSTP AtlasPlus. cdc.gov. 2019 [cited 2020 Feb 5]. https://www.cdc.gov/NCHHSTP/Atlas/.

  56. 56.

    New Jersey Department of Health. County and municipal HIV/AIDS statistics, 2018. state.nj.us. 2018 [cited 2020 Feb 5]. https://www.state.nj.us/health/hivstdtb/hiv-aids/statmap.shtml.

  57. 57.

    Kuhn M, Johnson K. Applied Predictive Modeling. 1st ed. 2013, Corr. 2nd printing 2018 edition. New York: Springer; 2013.

  58. 58.

    Caetano SJ, Sonpavde G, Pond GR. C-statistic: a brief explanation of its construction, interpretation and limitations. Eur J Cancer Oxf Engl. 1990;2018(90):130–2.

    Google Scholar 

  59. 59.

    Therneau TM, Atkinson EJ. An introduction to recursive partitioning using the RPART routines. 2019 Apr. https://cran.r-project.org/web/packages/rpart/vignettes/longintro.pdf.

  60. 60.

    Huamani KF, Metch B, Broder G, Andrasik M. A demographic analysis of racial/ethnic minority enrollment into HVTN preventive early phase HIV vaccine clinical tials conducted in the United States, 2002–2016. Public Health Rep. 2019;134(1):72–80.

    PubMed  Article  PubMed Central  Google Scholar 

  61. 61.

    Orellana ER, Picciano JF, Roffman RA, Swanson F, Kalichman SC. Correlates of nonparticipation in an HIV prevention program for MSM. AIDS Educ Prev. 2006;18(4):348–61.

    PubMed  Article  PubMed Central  Google Scholar 

  62. 62.

    Joseph HA, Belcher L, O’Donnell L, Fernandez MI, Spikes PS, Flores SA. HIV testing among sexually active Hispanic/Latino MSM in Miami-Dade County and New York City: opportunities for increasing acceptance and frequency of testing. Health Promot Pract. 2014;15(6):867–80.

    PubMed  Article  PubMed Central  Google Scholar 

  63. 63.

    Mackellar DA, Hou S-I, Whalen CC, Samuelsen K, Sanchez T, Smith A, et al. Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV. Sex Transm Dis. 2011;38(5):419–28.

    PubMed  Article  PubMed Central  Google Scholar 

  64. 64.

    Evangeli M, Kafaar Z, Kagee A, Swartz L, Bullemor-Day P. Does message framing predict willingness to participate in a hypothetical HIV vaccine trial: an application of Prospect Theory. AIDS Care. 2013;25(7):910–4.

    PubMed  Article  PubMed Central  Google Scholar 

  65. 65.

    Mavandadi S, Wright E, Klaus J, Oslin D. Message framing and engagement in specialty mental health care. Psychiatr Serv. 2017;69(3):308–14.

    PubMed  Article  PubMed Central  Google Scholar 

  66. 66.

    Pew Research Center. Chapter 3: The coming out experience. 2013 Jun [cited 2020 Oct 8]. (A survey of LGBT Americans attitudes, experiences and values in changing times). https://www.pewsocialtrends.org/2013/06/13/chapter-3-the-coming-out-experience/.

  67. 67.

    Wejnert C, Hess KL, Rose CE, Balaji A, Smith JC, Paz-Bailey G. Age-specific race and ethnicity disparities in HIV infection and awareness among men who have sex with men–20 US cities, 2008–2014. J Infect Dis. 2016;213(5):776–83.

    PubMed  Article  PubMed Central  Google Scholar 

  68. 68.

    Dowshen N, Lee S, Matty Lehman B, Castillo M, Mollen C. Iknowushould2: feasibility of a youth-driven social media campaign to promote STI and HIV testing among adolescents in Philadelphia. AIDS Behav. 2015;19(S2):106–11.

    PubMed  PubMed Central  Article  Google Scholar 

  69. 69.

    Rice E, Tulbert E, Cederbaum J, Barman Adhikari A, Milburn NG. Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention. Health Educ Res. 2012;27(2):226–36.

    PubMed  PubMed Central  Article  Google Scholar 

  70. 70.

    Ybarra ML, Liu W, Prescott TL, Phillips G, Mustanski B. The effect of a text messaging based HIV prevention program on sexual minority male youths: A national evaluation of information, motivation and behavioral skills in a randomized controlled trial of Guy2Guy. AIDS Behav. 2018;22(10):3335–44.

    PubMed  PubMed Central  Article  Google Scholar 

  71. 71.

    Lucassen MFG, Fleming TM, Merry SN. Tips for research recruitment: the views of sexual minority youth. J LGBT Youth. 2017;14(1):16–30.

    Article  Google Scholar 

  72. 72.

    Bermúdez MJ, Kirkpatrick DR, Hecker L, Torres-Robles C. Describing Latinos families and their help-seeking attitudes: challenging the family therapy literature. Contemp Fam Ther. 2010;32(2):155–72.

    Article  Google Scholar 

  73. 73.

    Mendoza H, Masuda A, Swartout KM. Mental health stigma and self-concealment as predictors of help-seeking attitudes among Latina/o college students in the United States. Int J Adv Couns. 2015;37(3):207–22.

    Article  Google Scholar 

  74. 74.

    United States Census Bureau. 2019 national and state population estimates. United States Census Bureau. 2019 [cited 2020 Oct 8]. https://www.census.gov/newsroom/press-kits/2019/national-state-estimates.html.

  75. 75.

    Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2018. Centers for Disease Control and Prevention; 2020 [cited 2020 May 7]. Report No.: 31. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-31.pdf.

  76. 76.

    Martinez O. A review of current strategies to improve HIV prevention and treatment in sexual and gender minority Latinx (SGML) communities. Expert Rev Anti Infect Ther. 2020;17:1–7.

    Article  Google Scholar 

  77. 77.

    Israel BA, Schulz AJ, Parker EA, Becker AB. Community-based participatory research: policy recommendations for promoting a partnership approach in health research. Educ Health Change Learn Pract. 2001;14(2):182–97.

    CAS  Google Scholar 

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Acknowledgements

Data collection for this study was supported by R01MH109413 (Pachankis). Additional support came from P30MH116867 and K24DA040489 (Safren) and K23MD015690 (Harkness). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

Data collection for this study was supported by R01MH109413 (Pachankis). Additional support came from P30MH116867 and K24DA040489 (Safren) and K23MD015690 (Harkness).

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Dr. Pachankis receives royalties from Oxford University Press for books related to LGBTQ-affirmative mental health treatments. Dr. Safren receives royalties from Oxford University Press, Guilford Publications, and Springer/Humana press for books on cognitive behavioral therapy. The authors have no other relevant financial or non-financial interests to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Boards at Yale University and University of Miami.

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Harkness, A., Rogers, B.G., Balise, R. et al. Who Aren’t We Reaching? Young Sexual Minority Men’s Non-participation in an HIV-Prevention and Mental Health Clinical Trial. AIDS Behav (2021). https://doi.org/10.1007/s10461-020-03148-x

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Keywords

  • HIV prevention
  • Sexual minority men
  • Mental health
  • Recruitment and outreach