Addressing Health Disparities Among Young Men Who Have Sex With Men (YMSM) in Los Angeles County By Craig Pulsipher

Background YMSM (young men who have sex with men) have higher rates of HIV infection than young men who have sex with only women Most recent CDC study found that 14% of YMSM 18 to 24- years old were HIV-positive; 79% of those who were HIV- positive were unaware of their positive serostatus Why do young men with a better social demographic profile (education, income, etc.) have such a disadvantaged health profile?

Theory of Syndemic Production (Stall, Friedman, & Catania, 2008) Syndemic is “a set of mutually reinforcing epidemics that are functioning to make each other worse” (Stall et al., 2008, p. 251) High levels of substance use, sexual risk behaviors, and depression are mutually reinforcing and function together May be result of difficult experiences during childhood and adolescence as well as added stresses associated with migration to large cities that contain “gay ghettos”

Popular Venues for YMSM in Los Angeles County Skills: clipping

Popular Venues for YMSM in West Hollywood Skills: inset map, clipping, select by location (“LA_Venues_Zoom” was derived by selecting venues from “WeHo_Community”)

Advantages Positive social identity Protection from homophobic assaults More romantic partners Disadvantages High prevalence rates of substance abuse, violence, depression, STDs, and HIV infection “The ability of gay men to maintain good health in large gay ghettos relies on their ability to balance the stresses and advantages of connecting to gay community and the larger community” (Stall et al., 2008, p. 260).

Rates of Males Living with an HIV or AIDS Diagnosis, by ZIP Code, Los Angeles County, 2009 Skills: graduated colors, clipping, joining

Rates of Males Living with an HIV or AIDS Diagnosis, by Community, Los Angeles County, 2009 Skills: inset map, graduated colors, clipping, joining

Rates of Males Living with an HIV or AIDS Diagnosis, by Community, Los Angeles County, 2009 Skills: inset map, graduated colors, clipping, joining

HIV Testing Locations in Areas with a High Concentration of Males Living with an HIV or AIDS Diagnosis Skills: inset map, graduated colors, clipping, geocoding, select by attributes (“HIV_high” was derived by querying “LA_HIV_prev” for male_rate>1500 and exporting data to a new layer), select by location (“HIV_testing_high” was derived by selecting HIV testing sites from “HIV_high”)

Healthy Young Men (HYM) Study (Kipke et al., 2007) 526 young men who have sex with men (YMSM) Recruited between February 2005 and January 2006 One survey every 6 months for 2 years Explore the individual, familial, interpersonal, and community factors that may influence drug use, HIV risk, and mental health Demographic variables, sexual orientation, perceived health status, personal satisfaction, health behaviors, access to care, history of STIs and HIV, depression, suicidality

Healthy Young Men (HYM) Study (Kipke et al., 2007)

HYM Study Participants by Zip Code Skills: graduated colors, clipping, joining

HYM Study Participants Favorite “Gay Places” Skills: point graduated symbols, joining, clipping, aggregating attribute fields (FAV1+FAV2+FAV3=FAVSUM)

HYM Study Participants Top 5 Most Popular Venues Skills: point graduated symbols, aggregating attribute fields (FAV1+FAV2+FAV3=FAVSUM)

Next Steps What do we know about the young men who attend these venues? – Demographic variables – Alcohol and drug use – Sexual behavior (condom use, number of partners, etc.) – STD history – HIV testing behavior How can we use this information to develop more effective interventions for this population?

References Centers for Disease Control and Prevention. HIV Prevalence, Unrecognized Infection, and HIV Testing Among Men Who Have Sex With Men—Five U.S. Cities, June 2004–April ;54:597– 624. Kipke, M. D., Kubicek, K., Weiss, G., Wong, C., Lopez, D., Iverson, E., & Ford, W. (2007). The health and health behaviors of young men who have sex with men. The Journal of adolescent health: official publication of the Society for Adolescent Medicine. 40(4): Stall, R., Friedman, M., & Catania, J. A. (2008). Interacting epidemics and gay men’s health: A theory of syndemic production among urban gay men. Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States.