Gay and bisexual men (GBM) and other men who have sex with men (MSM) accounted for 63% of all new HIV diagnoses in 2010 -they are among the only population in which infections are actually rising. The syndemics model has been applied to MSM finding considerable empirical support for a model in which several specific co-occurring psychosocial health problems (e.g., depression, substance use, trauma from childhood sexual abuse, intimate partner violence) compound risk for HIV. Yet this model does not account for resilience in the face of syndemic factors-there are GBM who experience syndemics and yet do not engage in hazardous (i.e., HIV risk) behavior. Yet, resilience too is not well understood among GBM. The proposed study builds from the syndemics framework by investigating patterns of resilience in a national US sample of GBM. We have partnered with Harris Interactive, Inc., a research firm that maintains the largest and most comprehensive database of GBM, to identify a national sample of 1,000 GBM to participate in a 3- year longitudinal study (Baseline, 12-, 24-, 36-months) investigating patterns and correlates of syndemic, protective, and resilient factors. We propose to collect behavioral and biological outcomes (at-home HIV and STI testing). We will: (1) Determine patterns and prevalence of syndemic factors and risk behavior in a national sample of GBM;(2) Conduct qualitative interviews with a subsample of participants to identify new/unmeasured mechanisms of resilience and to contextualize our quantitative data (Baseline and 36- months);and (3) Longitudinally track trajectories in resilience, syndemics, and HIV and STI incidence to identify psychosocial and behavioral factors associated with these changing trajectories. Our methodological design-including the use of a national sample, longitudinal assessments, biological testing for HIV and STIs-enhances this study's external validity and thus the impact of our findings. And by tracking patterns in syndemics and resilience, this study will inform (1) the development of the next generation of HIV prevention methods and (2) potential ways to improve established CDC DEBIs. Our application addresses an important problem and barrier to progress in the field (a strengths-based approach to HIV prevention among GBM that goes above and beyond general protective factors to examine resilient factors among men with high risk for hazardous behavior). It has potential to improve scientific knowledge regarding HIV prevention efforts with GBM. And understanding resilience in the face of syndemics can change the conceptual approach, treatments, services, and interventions for a population that remains in critical need.

Public Health Relevance

Gay and bisexual men are disproportionally impacted by HIV and STIs. Our investigation of factors that are associated with resilience, HIV risk behavior, and HIV/STI incidence over time will inform (1) the development of the next generation of HIV prevention methods and (2) potential ways to improve established CDC DEBIs. By design, our findings will be generalizable such to inform HIV prevention for gay and bisexual men on a national scale.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Schulden, Jeffrey D
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Hunter College
Schools of Arts and Sciences
New York
United States
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Grov, Christian; Jonathan Rendina, H; Patel, Viraj V et al. (2018) Prevalence of and Factors Associated with the Use of HIV Serosorting and Other Biomedical Prevention Strategies Among Men Who Have Sex with Men in a US Nationwide Survey. AIDS Behav 22:2743-2755
Whitfield, Thomas H F; Rendina, H Jonathon; Grov, Christian et al. (2018) Viewing Sexually Explicit Media and Its Association with Mental Health Among Gay and Bisexual Men Across the U.S. Arch Sex Behav 47:1163-1172
Moody, Raymond L; Starks, Tyrel J; Grov, Christian et al. (2018) Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors. Arch Sex Behav 47:1133-1144
Whitfield, Thomas H F; John, Steven A; Rendina, H Jonathon et al. (2018) Why I Quit Pre-Exposure Prophylaxis (PrEP)? A Mixed-Method Study Exploring Reasons for PrEP Discontinuation and Potential Re-initiation Among Gay and Bisexual Men. AIDS Behav 22:3566-3575
Millar, Brett M; Starks, Tyrel J; Rendina, H Jonathon et al. (2018) Three Reasons to Consider the Role of Tiredness in Sexual Risk-Taking Among Gay and Bisexual Men. Arch Sex Behav :
Grov, Christian; Rendina, H Jonathon; Parsons, Jeffrey T (2018) Birth Cohort Differences in Sexual Identity Development Milestones Among HIV-Negative Gay and Bisexual Men in the United States. J Sex Res 55:984-994
Starks, Tyrel J; Robles, Gabriel; Bosco, Stephen C et al. (2018) The Prevalence and Correlates of Sexual Arrangements in a National Cohort of HIV-Negative Gay and Bisexual Men in the United States. Arch Sex Behav :
John, Steven A; Walsh, Jennifer L; Cho, Young Ik et al. (2018) Perceived Risk of Intimate Partner Violence Among STI Clinic Patients: Implications for Partner Notification and Patient-Delivered Partner Therapy. Arch Sex Behav 47:481-492
Whitfield, Thomas H F; Rendina, H Jonathon; Grov, Christian et al. (2018) Sexually Explicit Media and Condomless Anal Sex Among Gay and Bisexual Men. AIDS Behav 22:681-689
John, Steven A; Starks, Tyrel J; Rendina, H Jonathon et al. (2018) Should I Convince My Partner to Go on Pre-Exposure Prophylaxis (PrEP)? The Role of Personal and Relationship Factors on PrEP-Related Social Control among Gay and Bisexual Men. AIDS Behav 22:1239-1252

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