Associate Professor of Epidemiology
Dr. Farzana Kapadia is an epidemiologist interested in understanding the distribution, determinants, and consequences of HIV/AIDS across the lifespan. In adolescents and younger adults, Dr. Kapadia is interested in studying contextual factors that influence HIV/AIDS related health behaviors and outcomes. Given the increasingly chronic nature of HIV/AIDS, she also studies the impact of HIV/AIDS on the physical, mental, and behavioral health of older HIV+ adults.
Dr. Kapadia is co-Director of the Center for Health, Identity, Behavior, and Prevention Studies and is affiliated with the Institute of Human Development and Social Change and the NYU Population Center. She has taught courses in Introductory Epidemiology (graduate- and undergraduate-level), Intermediate Epidemiology, and Research Methods in Public Health, and History & Principles of Public Health.
BS, Biology and History, SUNY Binghamton, Binghamton, NYMPH, Community Public Health, New York University, New York, NYPhD, Epidemiology, Columbia University, New York, NY
Excellence in Public Health Faculty Award, New York University (2012)Steinhardt Goddard Award (2011)Community Collaborative Award, Steinhardt School of Culture, Education and Human Development (2009)Elected Member, American College of Epidemiology (2007)
Behavioral Determinants of HealthBehavioral ScienceEpidemiologyHIV/AIDSReproductive HealthSocial BehaviorsSocial Determinants of HealthSocial epidemiologySubstance Abuse
Healthcare experiences of urban young adult lesbiansGriffin, M., Jaiswal, J., Krytusa, D., Krause, K. D., Kapadia, F., & Halkitis, P. N.
Journal titleWomen's Health
Volume16Purpose: This cross-sectional study of young adult lesbians explores their healthcare experiences including having a primary care provider, forgone care, knowledge of where to obtain Pap testing, and sexually transmitted infection testing. Methods: Quantitative surveys were conducted at lesbian, gay, bisexual, and transgender venues and events with a sample of 100 young adult lesbians in New York City between June and October 2016. Using the Andersen model of healthcare access, this study examined associations between sociodemographic characteristics and healthcare experiences using multivariable logistic regression models. Results: Having a primary care provider was associated with having health insurance (adjusted odds ratio (AOR) = 4.9, p < 0.05). Both insurance (AOR = 0.2, p < 0.05) and employment (AOR = 0.2, p < 0.05) status were protective against foregone care among young adult lesbians. Disclosure of sexual orientation to a provider improved knowledge of where to access Pap testing (AOR = 7.5, p < 0.05). Disclosure of sexual orientation to friends and family improved knowledge of where to access sexually transmitted infection testing (AOR = 3.6, p < 0.05). Conclusion: Socioeconomic factors are significantly associated with healthcare access among young adult lesbians in New York City. Maintaining non-discrimination protections for both healthcare services and insurance coverage are important for this population. In addition, financial subsidies that lower the cost of health insurance coverage may also help improve healthcare access among young adult lesbians.
Misinformation, Gendered Perceptions, and Low Healthcare Provider Communication Around HPV and the HPV Vaccine Among Young Sexual Minority Men in New York City: The P18 Cohort StudyJaiswal, J., LoSchiavo, C., Maiolatesi, A., Kapadia, F., & Halkitis, P. N.
Journal titleJournal of Community HealthHuman papillomavirus (HPV) is the most common sexually transmitted infection among adults in the United States, and can cause several types of cancer. This is of particular concern for sexual minority men, as their increased risk of HIV acquisition increases risk for HPV and HPV-associated cancers, particularly when coupled with low rates of HPV vaccination. As part of a larger study of the syndemic of HIV, substance use, and mental health among young sexual minority men in New York City, we sought to explore what sexual minority men know about HPV and the HPV vaccine, along with their experiences have been communicating about the virus and vaccine. We interviewed 38 young sexual minority men with diverse sociodemographic characteristics and identified three main themes: low knowledge about HPV infection and vaccination, highly gendered misconceptions about HPV only affecting women, and lack of communication from healthcare providers about HPV. The prevalence of incorrect HPV knowledge, coupled with inadequate education and vaccination in healthcare settings, indicates a missed opportunity for HPV prevention in a high-risk and high-need population.
50 years after stonewall, the LGBTQ health movement embodies empowerment, expertise, and energyLanders, S., & Kapadia, F.
Journal titleAmerican journal of public health
Access to Health Services Among Young Adult Gay Men in New York CityGriffin-Tomas, M., Cahill, S., Kapadia, F., & Halkitis, P. N.
Journal titleAmerican Journal of Men's Health
Issue1This research is a cross-sectional study of young adult gay men (YAGM), ages 18 to 29, that aims to understand their health-care access including: having a primary care provider (PCP), frequency of health-care visits, and instances of foregone health care. Surveys were conducted with a modified time-space sample of 800 YAGM in New York City (NYC). Surveys were conducted between November 2015 and June 2016. This study examined associations between sociodemographic characteristics and health-care access using multivariable logistic regression models. In multivariable logistic regression models, there were higher odds of having a PCP among participants enrolled in school (Adjusted Odds Ratio [AOR] = 1.85, 95% CI [1.18, 2.91], p <.01) and covered by insurance (AOR = 21.29, 95% CI [11.77, 38.53], p <.001). Modeling indicated higher odds of more than one health visit in the past 12 months for non-White participants (AOR = 2.27, 95% CI [1.43, 3.63], p <.001), those covered by insurance (AOR = 3.10, 95% CI [1.06, 9.04], p <.05), and those who disclosed their sexual orientation to their PCP (AOR = 2.99, 95% CI [1.58, 5.69], p <.001). Participants with insurance were less likely to report instances of foregone care (AOR = 0.21, 95% CI [0.21, 0.13], p <.001). Understanding the facilitators and barriers to health-care access among YAGM populations is of critical importance, as many YAGM between the ages of 18 and 29 are establishing their access to health care without parental guidance. Health-care access, including the decision to forego care, can represent a missed opportunity for primary prevention and early diagnosis of health issues, as well as more effective, less invasive, and less costly treatments.
Determinants of Intimate Partner Violence Among Young Men Who Have Sex With Men: The P18 Cohort StudyStults, C. B., Javdani, S., Kapadia, F., & Halkitis, P. N.
Journal titleJournal of Interpersonal Violence
Page(s)886260519831374Intimate Partner Violence (IPV) is an understudied health problem among young gay, bisexual, and other non-identified young men who have sex with men (YMSM). According to cross-sectional studies, IPV is associated with psychosocial and mental health problems, such as stigma and depression, among YMSM. IPV is also associated with health-risk behaviors, such as substance use, among this population. Yet, to date, no studies have used longitudinal data to examine determinants of IPV among YMSM. This gap in the extant literature is problematic, as it limits our understanding of how to intervene to interrupt cycles of violence. The aim of the present study was to examine longitudinal determinants of IPV among a sample of (N = 526) YMSM living in the New York City area. Longitudinal analyses using Generalized Estimating Equations (GEE) were used to examine individual, relationship, mental health, psychosocial, and substance use factors in relation to IPV victimization and perpetration. Most notably, early experiences of IPV were a robust predictor of later experiences of IPV victimization and perpetration. Relationship status, depression, public gay-related stigma, and illicit substance use were associated with IPV victimization over time. Similarly, relationship status, depression, public gay-related stigma, marijuana, and other illicit substance were associated with IPV perpetration. These findings suggest that prevention programs and awareness campaigns should aim to reach YMSM before their first experiences of relationship violence, as these early experiences of violence are strongly linked to later experiences of violence. Also, IPV interventions should be tailored to the needs of YMSM and should target depressive symptoms, gay-related stigma, and substance use behaviors. Additionally, substance use interventions may be improved by addressing IPV. Finally, policymakers should support policies that improve the social climate for LGBTQ people, thereby reducing gay-related stigma, and potentially stemming violence against and among YMSM.
Human Papillomavirus Vaccination and Infection in Young Sexual Minority Men: The P18 Cohort StudyHalkitis, P. N., Valera, P., Loschiavo, C. E., Goldstone, S. E., Kanztanou, M., Maiolatesi, A. J., Ompad, D. C., Greene, R. E., & Kapadia, F.
Journal titleAIDS patient care and STDs
Page(s)149-156We examined the prevalence of infection with human papillomavirus (HPV) and HIV in a cohort of young gay, bisexual, and other men who have sex with men [sexual minority men (SMM)]. HPV vaccination uptake was assessed; HIV antibody testing was performed and genetic testing for oral and anal HPV infection was undertaken. We examined both HPV vaccination and infection in relation to key demographic and structural variables. Participants (n = 486) were on average 23 years old; 70% identified as a member of a racial/ethnic minority group, and 7% identified as transgender females. Only 18.1% of the participants indicated having received the full dosage of HPV vaccination and 45.1% were unvaccinated. Slightly over half the participants (58.6%) were infected with HPV, with 58.1% testing positive for anal infection and 8.8% for oral infection. HIV seropositivity was associated with infection to oral HPV [adjusted odds ratio (AOR) = 4.03] and vaccine-preventable HPV, whereas both neighborhood-level poverty (AOR = 1.68) and HIV infection (AOR = 31.13) were associated with anal infection to HPV (AOR = 1.68). Prevalence of HPV infection is high among unvaccinated young SMM, despite the availability and eligibility for vaccination. HPV infection adds further health burden to these populations and is particularly concerning for those who are HIV positive as HIV infection increases the risk of developing HPV-related cancers. These findings underscore a missed prevention opportunity for an at-risk and underserved population and suggest the need for active strategies to increase HPV vaccination uptake in young SMM before the onset of sexual behavior.
Motivations for alcohol use to intoxication among young adult gay, bisexual, and other MSM in New York City: The P18 Cohort StudyRistuccia, A., LoSchiavo, C., Kapadia, F., & Halkitis, P. N.
Journal titleAddictive Behaviors
Page(s)44-50Introduction: Motivations for alcohol use to intoxication vary among young adults depending on social setting and other contextual factors. However, there is limited research exploring the role of different drinking motivations among young men who have sex with men (YMSM). Methods: Data from a racially/ethnically and socioeconomically diverse sample of YMSM (n = 426) were used to examine associations between recent (last 30 days) alcohol use to intoxication and scores on three distinct drinking motivation subscales: convivial, intimate, and negative coping drinking. Multinomial logistic regression models were constructed to examine associations between drinking motivations and days of alcohol use to intoxication, controlling for sociodemographic characteristics. Results: YMSM who scored higher on all three drinking motivation subscales were more likely to engage in recent alcohol use to intoxication compared to those who reported no alcohol use to intoxication. In multivariable models, Black and Hispanic YMSM had lower odds of intoxication compared to White YMSM, and those reporting lower perceived familial SES had lower odds compared to higher SES. In a final model including all three motivations, only convivial drinking was significantly associated with days of intoxication (1–2 days: AOR = 1.22; 3+ days: AOR = 1.45). Conclusions: This study identifies distinct associations between different motivations for drinking and alcohol use to intoxication in a sample of YMSM. These findings highlight a need to incorporate an understanding of motivations for alcohol use to intoxication into research and clinical practice with YMSM, as different reasons for drinking carry respective potential health risks.
Positive Development and Changes in Self-Rated Health Among Young Sexual Minority Males: The P18 Cohort StudyKapadia, F., D’Avanzo, P. A., Cook, S. H., Barton, S., Halkitis, S. N., & Halkitis, P. N.
Journal titleBehavioral Medicine
Page(s)304-313We seek to move beyond a deficits-based approach, which has dominated our understanding of health and wellbeing in in young sexual minority males (YSMM), by examining how indicators of positive development are associated with development of positive self-rated health in YSMM. Using data from a prospective cohort study of YSMM (n = 514; 18–22 years old; 36.9% Hispanic/Latino, 15.6% non-Hispanic Black, 30.2% White, 16.9% other/multi-racial), we examined how three measures of positive development–the Life Orientation Test, the Satisfaction with Life Scale (SWLS) and the Social Responsibility Scale (SRS) were associated with self-rated health (SRH), a valid and reliable measure of self-assessed general health status. Findings suggest that YSMM who self-identified as homosexual reported higher SRH while those who reported higher levels of substance use and mental health burdens reported lower SRH. Second, in linear growth models controlling for mental health burdens and substance use, higher scores on all measures of positive development were associated with higher ratings of SRH over time. In conclusion, the presence of positive development characteristics, specifically generalized optimism, life satisfaction and social responsibility, may buffer against negative SRH assessments. Health promotion programs focusing on positive development may more effectively promote health and well-being among YSMM.
Sexual orientation and gender identity victimization among young adults in the New York City metropolitan area: The P18 cohort studyLoSchiavo, C., Halkitis, P. N., & Kapadia, F.
Journal titlePsychology of Sexual Orientation and Gender Diversity
Page(s)399-407Sexual and gender minority populations are significantly more likely to experience verbal and physical victimization in young adulthood. These analyses examine the types, contexts, and sources of lifetime sexual orientation and gender identity victimization (SGV) in a diverse sample of sexual minority men (SMM) and transgender women as well as the extent to which experiences of SGV vary among subgroups of the population. Cross-sectional data were collected as part of a study of sexual health, mental health, and HIV examined through the lens of syndemic production in young SMM. Measures assessed sociodemographic characteristics as well as the types, sources, and contexts of physical assault and verbal harassment due to actual or perceived gender or sexuality. Verbal harassment was more prevalent in the sample than physical assault (44.5% vs. 11.6%). Schools or sports teams and neighborhoods were the most common contexts for verbal and physical SGV. Strangers were the most frequent perpetrators of SGV, followed by family and peers. Bivariate analyses showed significant differences in SGV based on race, education, perceived familial SES, sexual identity, and borough of residence. In multivariate analyses, race, SES, sexual identity, and borough of residence were significant predictors of verbal SGV. Findings suggest that SGV experiences are not uniform in sexual minority young adults, and thus prevention and care must be targeted. Understanding the multiple identities of sexual minority young adults who experience greater levels of victimization can allow for policy and interventions to best support those at risk.
A qualitative investigation of healthcare engagement among young adult gay men in New York City: A P18 cohort substudyGriffin, M., Krause, K. D., Kapadia, F., & Halkitis, P. N.
Journal titleLGBT health
Page(s)368-374Purpose: We used in-depth interviews with a cohort of young adult gay men (YAGM) to provide a more detailed understanding of their current healthcare engagement, including experiences with the healthcare system, provider knowledge of healthcare needs, and desired provider characteristics. Methods: Qualitative interviews were conducted with a sample of 40 YAGM in New York City. The interview guide examined healthcare engagement across key developmental stages: Childhood (birth-12), adolescence (13-18), young adulthood (19-22), and the present (23-26). All transcripts were coded using a consensual qualitative research approach to identify crosscutting topics. The interviews were conducted between September and October 2015. Results: The following topics were identified: Experiences with the healthcare system, provider knowledge of healthcare needs, and desired provider characteristics. Common barriers to healthcare access were financial concerns, lack of insurance, and dissatisfaction with the care provided. Reasons for dissatisfaction with care were based on perceptions of providers' anti-gay attitudes, judgment of same-sex sexual behavior, and lack of provider knowledge about YAGM's health needs. This often led men in this study to seek sexual healthcare from providers other than their primary care provider. When asked about desired provider characteristics, participants noted that basic demographics were of less importance than skills-based characteristics such as rapport, comfort discussing sexual health issues, and knowledge of YAGM's health. Conclusion: YAGM have unique challenges to engaging in healthcare, including provider stigma and lack of provider knowledge of YAGM's health needs, which are not faced by other young adult populations. The results from this study highlight the need for more extensive and standardized training in medical school and as part of continuing medical education for healthcare providers.
Access to and experiences with healthcare in urban-dwelling young adult lesbian women in the United StatesGriffin-Tomas, M., Jaiswal, J., Krause, K. D., Kapadia, F., & Halkitis, P. N.
Journal titleCulture, Health and Sexuality
Assessing Gaps in the HIV Care Continuum in Young Men Who Have Sex With Men: The P18 Cohort StudyGreene, R. E., Luong, A., Barton, S. C., Kapadia, F., & Halkitis, P. N.
Journal titleJournal of the Association of Nurses in AIDS Care
Beliefs About the End of AIDS, Concerns About PrEP Functionality, and Perceptions of HIV Risk as Drivers of PrEP Use in Urban Sexual Minority Men: The P18 Cohort StudyHalkitis, P. N., Jaiswal, J., Griffin-Tomas, M., Krause, K. D., D’Avanzo, P., & Kapadia, F.
Journal titleAIDS and Behavior
Page(s)3705-3717Using cross-sectional data from an ongoing cohort study of young gay, bisexual, and other men who have sex with men (N = 492), we examined the extent to which cognitive factors such as beliefs about the end of AIDS, concerns about the manner in which PrEP works, and perceptions about risk of contracting HIV, are related to PrEP uptake and use. While almost all participants indicted awareness of PrEP, a mere 14% had ever used PrEP. Those with lower concerns about the side effects of PrEP and greater belief that treatment and PrEP would eliminate AIDS were also more likely to have ever used PrEP. Our findings support the ongoing challenges of PrEP uptake as means of curtailing HIV in young sexual minority men, and suggest that beyond the structural factors, consideration must be given to further educating the population as a means of adjusting potentially faulty beliefs, concerns, and perceptions which may influence PrEP utilization.
Latent Growth Curve Modeling of Non-Injection Drug Use and Condomless Sexual Behavior from Ages 18 to 21 in Gay, Bisexual, and Other YMSM: The P18 Cohort StudyHalkitis, P. N., Bub, K., Stults, C. B., Bates, F. C., & Kapadia, F.
Journal titleSubstance Use and Misuse
Page(s)101-113Background: HIV/AIDS continues to be a health disparity faced by sexual minority men, and is exacerbated by non-injection drug use. Objectives: We sought to delineate growth in non-injection drug use and condomless sex in a sample of racially and economically diverse of gay, bisexual, and other young men who have sex with men (YMSM) as they emerged into adulthood between the ages of 18 and 21 and who came of age in the post-HAART era. Methods: Behavioral data on drug use and condomless sex, collected via a calendar based technique over 7 waves of a cohort study of 600 YMSM, were analyzed using latent growth curve modeling to document patterns of growth in these behaviors, their associations, and the extent to which patterns and associations are moderated by race/ethnicity and socioeconomic status. Results: Significant growth was noted in the frequencies of condomless oral and anal intercourse, alcohol to intoxication, marijuana use, and inhalant nitrate use. High levels of association were noted between all behaviors across time but associations did not differ by either race/ethnicity or socioeconomic status. The link between drug use and risky sexual behavior continue to be evident in YMSM with significant increases in these behaviors demonstrated as YMSM transition between adolescence and young adulthood. Conclusions/Importance: Healthcare for a new generation of sexual minority males must address the synergy of these behaviors and also nest HIV prevention and care within a larger context of sexual minority health that acknowledges the advances made in the last three decades.
Psychometric analysis of the life worries scale for a new generation of sexual minority men: The P18 cohort studyHalkitis, P. N., Cook, S. H., Ristuccia, A., Despotoulis, J., Levy, M. D., Bates, F. C., & Kapadia, F.
Journal titleHealth Psychology
Page(s)89-101Objective: Sexual minority men (SMM) in the United States continue to experience adverse health problems and psychosocial burdens. However, there is limited psychometric research seeking to quantify the life worries of this population. Informed by syndemic theory, the Life Worries Scale (LWS) was developed to measure the concerns of young SMM. Method: Analyses of the scale were undertaken using baseline data (n = 665) from an ongoing cohort study of emerging adult, SMM. Results: Exploratory factor analyses (EFA) of an initial set of 24 Likert-type items, followed by confirmatory factor analysis (CFA) and an exploratory structural equation model (ESEM), indicated a structure consisting of 6 domains of worries: financial stability, social stability, self esteem, loneliness, physical appearance, and physical health. These 6 subscales were highly correlated and also demonstrated high levels of internal consistency. Differences in life worries were noted across demographic states, specifically HIV serostatus, sexual attraction, housing status, and self-rated health. High levels of association were also detected between all 6 subscales with both depression and PTSD, while significant correlations were detected between suicidality and both self esteem and loneliness related worries. Conclusions: The results of our analyses provide evidence for the strong psychometric characteristics of the LWS. This newly developed instrument should be utilized in research to examine the extent to which life worries explain health outcomes and risk behaviors in sexual minority males, and may be potentially extended for use in other populations.
Relationship cognitions and longitudinal trajectories of sexual risk behavior among young gay and bisexual men: The P18 cohort studyCook, S. H., Halkitis, P. N., & Kapadia, F.
Journal titleJournal of health psychology
Page(s)1884-1894This study examines how romantic relationship cognitions are associated with changes of condomless anal sex among emerging adult gay and bisexual men. The sample was drawn from four waves of a prospective cohort study (N = 598; M age = 18.2). Results suggest that condomless anal sex increased over the emerging adulthood period. Romantic relationship fear was associated with increased receptive condomless anal sex. Perceptions of greater romantic relationship control increased the likelihood of having insertive and receptive condomless anal sex. Findings suggest that romantic relationship cognitions are important to consider when understanding longitudinal changes in condomless anal sex in this population.
Reliability and Validity of a Material Resources Scale and Its Association With Depression Among Young Men Who Have Sex With Men: The P18 Cohort StudyOmpad, D. C., Palamar, J. J., Krause, K. D., Kapadia, F., & Halkitis, P. N.
Journal titleAmerican Journal of Men's Health
Page(s)1384-1397Socioeconomic status (SES) is a fundamental cause of ill health, but an understudied determinant of health for gay, bisexual, and other men who have sex with men (MSM). Surprisingly, few studies have examined the relations between poverty and depression among young MSM. The aims of this study were to determine the reliability and validity of an 18-item Family Resource Scale (FRS) as a measure of SES among YMSM and examine the relations between SES and depression, while taking into account factors associated with resilience or risk for poor mental health. Reliability of the SES scale was determined with Cronbach’s alpha. Validity was assessed with factor analysis and bivariable comparisons with other SES measures. Multiple logistic regression was used to determine the relations between depressive symptomology (via the Beck Depression Inventory–II), SES, and gay-related psychosocial variables. In this racially/ethnically diverse sample (mean age = 21.8 years, 37.3% Hispanic/Latino, 30.5% White, 14.9% Black, and 17.0% other race/ethnicity), 70.8% reported incomes ≤ $10,000 and the mean FRS score was 4.1 (SD = 0.9, range 0-5). The FRS demonstrated reliability (α =.91) and criterion and construct validity. The Beck Depression Inventory–II rated 17.6% with depressive symptomology. Higher FRS scores were associated with a lower odds of depression (adjusted odds ratio = 0.58; 95% confidence interval = 0.46-0.74) in logistic regression models controlling for gay community affinity and internalized homophobia. This diverse sample of YMSM in New York City reported substantial financial hardship and those who were more gay-identified had fewer material resources. Fewer material resources and internalized homophobia were both associated with higher odds of depression.
Sexualised drug use among sexual minority young adults in the United States: The P18 cohort studyRistuccia, A., LoSchiavo, C., Halkitis, P. N., & Kapadia, F.
Journal titleInternational Journal of Drug Policy
Page(s)207-214Background: Substance use and condomless sexual behaviours are both well studied in sexual minority men, but few researchers have used event-level data collection to examine sexualised drug use in sexual and gender minority young adults. The aim of this study is to describe the co-occurrence of sex under the influence of substances and condomless sexual behaviours, using nuanced event-level data, in a racially/ethnically and socioeconomically diverse sample in New York City. Methods: Data from one wave of a cohort of sexual and gender minority young adults who were assigned male at birth (n = 500) were used to characterise co-occurrence of sex under the influence of drugs and condomless sexual behaviours (oral receptive, anal insertive, and anal receptive sex), in the last 30 days. Logistic regression models were constructed to assess associations between sex while high and condomless sexual behaviours, controlling for sociodemographic factors. Results: Preliminary analyses indicated significant associations between engaging in sex while high and condomless sexual behaviours. In unadjusted regression models, sexualised and non-sexualised drug use were both significantly associated with increased odds of condomless sexual behaviours. In adjusted models, sexualised drug use remained significantly associated with condomless anal insertive sex (AOR = 3.57) and condomless anal receptive sex (AOR = 4.98). Having multiple sexual partners was also significantly associated with greater odds of condomless sexual activity in all three adjusted models. Conclusion: Multivariable analyses indicated that engaging in sex while high on any drug was associated with increased condomless sexual behaviour, but that sexualised drug use was associated with particularly elevated condomless anal sex. These findings provide insight for understanding the co-occurrence of substance use and condomless sex, and suggest a need for HIV/STI risk reduction strategies that address the role of sexualised drug use.
Structural barriers to pre-exposure prophylaxis use among young sexual minority men: The P18 cohort studyJaiswal, J., Griffin, M., Singer, S. N., Greene, R. E., Acosta, I. L. Z., Kaudeyr, S. K., Kapadia, F., & Halkitis, P. N.
Journal titleCurrent HIV Research
Page(s)237-249Background: Despite decreasing rates of HIV among many populations, HIV-related health disparities among gay, bisexual and other men who have sex with men persist, with disproportional percentages of new HIV diagnoses among racial and ethnic minority men. Despite increasing awareness of HIV pre-exposure prophylaxis (PrEP), PrEP use remains low. In addition to exploring individual-level factors for this slow uptake, structural drivers of PrEP use must also be identified in order to maximize the effectiveness of biomedical HIV prevention strategies. Method: Using cross-sectional data from an ongoing cohort study of young sexual minority men (N=492), we examine the extent to which structural-level barriers, including access to health care, medication logistics, counseling support, and stigma are related to PrEP use. Results: While almost all participants indicated awareness of PrEP, only 14% had ever used PrEP. PrEP use was associated with lower concerns about health care access, particularly paying for PrEP. Those with greater concerns talking with their provider about their sexual behaviors were less likely to use PrEP. Conclusion: Paying for PrEP and talking to one’s provider about sexual behaviors are concerns for young sexual minority men. In particular, stigma from healthcare providers poses a significant barrier to PrEP use in this population. Providers need not only to increase their own awareness of and advocacy for PrEP as an effective risk-management strategy for HIV prevention, but also must work to create open and non-judgmental spaces in which patients can discuss sexual behaviors without the fear of stigma.
Structural divers of PrEP use in urban sexual minority men: the P18 cohort studyJaiswal, J., Griffin-Tomas, M., Singer, S. N., Greene, R., Zambrano, I., Kaudeyr, S., Kapadia, F., & Halkitis, P. N.
Journal titleCurrent HIV Research
The 10 000 Paper BenchmarkMorabia, A., Costanza, M. C., & Kapadia, F.
Journal titleAmerican journal of public health
A Case of Rectal Ureaplasma Infection and Implications for Testing in Young Men Who Have Sex with Men: The P18 Cohort StudyAbbott, C. E., Greene, R. E., Kapadia, F., & Halkitis, P. N.
Journal titleLGBT health
Page(s)161-163Ureaplasma is a significant cause of nongonococcal urethritis. This is a case of rectal Ureaplasma found on culture in a young man who has sex with men not previously reported in the literature. Nucleic acid amplification tests are now standard of care for sexually transmitted infection testing, but they do not test for Ureaplasma and, therefore, may be missing important infections. Ureaplasma could have important implications in urethritis and rectal HIV transmission among men who have sex with men engaging in condomless anal intercourse. Further study of Ureaplasma's role as a rectal pathogen may be warranted.
Acceptability of ecological momentary assessment among young men who have sex with menDuncan, D. T., Kapadia, F., Kirchner, T. R., Goedel, W. C., Brady, W. J., & Halkitis, P. N.
Journal titleJournal of LGBT Youth
Page(s)436-444The study evaluated the acceptability of text message– and voice-based ecological momentary assessment (EMA) methods among a sample (N = 74) of young men who have sex with men (MSM). We assessed the acceptability of text message– and voice-based EMA methods. Almost all participants (96%) reported that they would be willing to accept texts on their smartphone to answer questions about their current mood, surroundings, or feelings. A large majority (89%) also reported being willing to accept phone calls to answer these questions. This work suggests that different EMA methods are acceptable for use among young MSM.
Associations Between Neurocognitive Impairment and Biomarkers of Poor Physiologic Reserve in a Clinic-Based Sample of Older Adults Living with HIVYu, K. C., D’Avanzo, P. A., Nesheiwat, L., Greene, R. E., Urbina, A., Halkitis, P. N., & Kapadia, F.
Journal titleJournal of the Association of Nurses in AIDS Care
Page(s)55-66Data from a cross-sectional study of a clinic-based sample of older people living with HIV (PLWH; n = 100) were used to examine associations between biomarkers of physical health and neurocognitive impairment (NCI). In this sample, anemia, chronic kidney disease (CKD) stages 4-5, and hypocalcemia were associated with impairment in executive functioning or processing speed. Furthermore, participants with anemia were more likely to have CD4+ T cell counts <200 cells/mm3 (χ2  = 19.57, p < .001); hypocalcemia (χ2  = 17.55, p < .001); and CKD 4-5 (χ2  = 10.12, p = .006). Black and Hispanic participants were more likely to be anemic compared to other races and ethnicities (χ2  = 12.76, p = .005). Common medical conditions (e.g., anemia, hypocalcemia, CKD) should be investigated as potential contributors to NCI in older PLWH. Additionally, laboratory testing in racial/ethnic minority PLWH may help inform NCI screening.
Associations of Perceived Parental Psychopathology with Mental Health Burden and Lifetime Drug Use in Gay, Bisexual, and other YMSM: The P18 Cohort StudyHalkitis, P. N., Griffin-Tomas, M., Levy, M. D., Greene, R. E., & Kapadia, F.
Journal titleJournal of Homosexuality
Page(s)1596-1616Parental mental health may be a critical component in understanding the overlapping health burdens of mental health symptomatology and drug use in young men who have sex with men (YMSM), yet studies of YMSM have not fully examined these associations. To understand these relationships, data drawn from a study of gay, bisexual, and other YMSM were used to examine associations between perceived parental psychopathology and the health of YMSM. Findings suggest that YMSM reporting at least one parent with perceived depression, manic depression, schizophrenia, or antisocial behavior anytime during their childhoods were more likely to report higher levels of both depressive symptomatology and post-traumatic stress disorder (PTSD) than those reporting no perception of any of these psychopathologies in their parents. Number of different drugs used in one’s life were higher among participants who perceived at least one parent as depressed. Mediation analyses indicated that the relationship between perceived parental depression and lifetime drug use of YMSM was mediated both by YMSM depression and YMSM PTSD. These results suggest that parental psychopathology plays an important role in the health of sexual minority men, a population with elevated levels of mental health burden and drug use across the lifespan.