Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
REVIEW (Open Access)

Mental health in 2020 for men who have sex with men in the United States

Abigail W. Batchelder A B E , Steven Safren C , Avery D. Mitchell B D , Ivan Ivardic C and Conall O’Cleirigh A B

A Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th floor, Boston, MA 02114, USA.

B The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.

C Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA.

D Department of Psychology and Neuroscience, University of North Carolina, 235 E. Cameron Avenue, Chapel Hill, NC 27599, USA.

E Corresponding author. Email: abatchelder@mgh.harvard.edu

Sexual Health 14(1) 59-71 http://dx.doi.org/10.1071/SH16083
Submitted: 13 May 2016  Accepted: 26 September 16   Published: 6 January 2017

Abstract

Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.


References

[1]  Centers for Disease Control and Prevention. HIV among gay and bisexual men. 2015. Available online at: http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf [verified 24 March 2016].

[2]  Frieden TR, Foti KE, Mermin J. Applying public health principles to the HIV epidemic – how are we doing? N Engl J Med 2015; 373 2281–7.
Applying public health principles to the HIV epidemic – how are we doing?CrossRef | 1:CAS:528:DC%2BC28XntFSnsb4%3D&md5=65cee6204346d5126b41b6998d77ca82CAS | open url image1

[3]  Asch SM, et al Underdiagnosis of depression in HIV. J Gen Intern Med 2003; 18 450–60.
Underdiagnosis of depression in HIV.CrossRef | open url image1

[4]  Cochran SD, Mays VM. Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey. J Abnorm Psychol 2009; 118 647–58.
Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey.CrossRef | open url image1

[5]  King M, et al A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 2008; 8 70
A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people.CrossRef | open url image1

[6]  O’Cleirigh C, Magidson JF, Skeer MR, Mayer KH, Safren SA. Prevalence of psychiatric and substance abuse symptomatology among HIV-infected gay and bisexual men in HIV primary care. Psychosomatics 2015; 56 470–8.
Prevalence of psychiatric and substance abuse symptomatology among HIV-infected gay and bisexual men in HIV primary care.CrossRef | open url image1

[7]  Mills TC, et al Distress and depression in men who have sex with men: the Urban Men’s Health Study. Am J Psychiatry 2004; 161 278–85.
Distress and depression in men who have sex with men: the Urban Men’s Health Study.CrossRef | open url image1

[8]  Roberts AL, Austin SB, Corliss HL, Vandermorris AK, Koenen KC. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. Am J Public Health 2010; 100 2433–41.
Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder.CrossRef | open url image1

[9]  McCabe SE, Hughes T, Bostwick WB, West BT, Boyd, CJ. Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction 2009; 8 1333–45.
Sexual orientation, substance use behaviors and substance dependence in the United States.CrossRef | open url image1

[10]  Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav 1995; 36 38–56.
Minority stress and mental health in gay men.CrossRef | 1:STN:280:DyaK2M3ls1KjsQ%3D%3D&md5=45e48440be1e3e0921f838cb389cc7bcCAS | open url image1

[11]  Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003; 129 674–97.
Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.CrossRef | open url image1

[12]  Hatzenbuehler ML. How does sexual minority stigma ‘get under the skin’? A psychological mediation framework. Psychol Bull 2009; 135 707–30.
How does sexual minority stigma ‘get under the skin’? A psychological mediation framework.CrossRef | open url image1

[13]  Singer M. A dose of drugs, a touch of violence, a case of aids: conceptualizing the sava syndemic. Free Inq Creat Sociol 1996; 24 99–110. open url image1

[14]  Stall R, 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; 93 939–42.
Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men.CrossRef | open url image1

[15]  Biello KB, et al Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America. AIDS Care 2016; 28 84–91.
Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America.CrossRef | open url image1

[16]  Guadamuz TE, et al Psychosocial health conditions and HIV prevalence and incidence in a cohort of men who have sex with men in Bangkok, Thailand: evidence of a syndemic effect. AIDS Behav 2014; 18 2089–96.
Psychosocial health conditions and HIV prevalence and incidence in a cohort of men who have sex with men in Bangkok, Thailand: evidence of a syndemic effect.CrossRef | 1:STN:280:DC%2BC2cfpt1Ojug%3D%3D&md5=f50e72ad0bbf7ec72451862b98415674CAS | open url image1

[17]  Halkitis PN, Kapadia F, Ompad DC, Perez-Figueroa R. Moving toward a holistic conceptual framework for understanding healthy aging among gay men. J Homosex 2015; 62 571–87.
Moving toward a holistic conceptual framework for understanding healthy aging among gay men.CrossRef | open url image1

[18]  Mimiaga MJ, et al The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. J Acquir Immune Defic Syndr 2015; 68 329–36.
The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men.CrossRef | open url image1

[19]  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; 102 156–62.
Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: further evidence of a syndemic.CrossRef | open url image1

[20]  Mustanski B, Andrews R, Herrick A, Stall R, Schnarrs PW. A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. Am J Public Health 2014; 104 287–94.
A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men.CrossRef | open url image1

[21]  Crepaz N, et al Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS 2006; 20 143–57.
Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials.CrossRef | open url image1

[22]  Herbst JH, et al A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. J Acquir Immune Defic Syndr 2005; 1999 228–41. open url image1

[23]  Lyles CM, et al Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004. Am J Public Health 2007; 97 133–43.
Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004.CrossRef | open url image1

[24]  O’Cleirigh, C, et al. Integrated sexual risk/trauma symptom reduction in MSM with childhood sexual abuse: pilot randomized trial outcomes. Presented at: The Centers for Disease Control National HIV Prevention Conference (2011).

[25]  Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers. J Acquir Immune Defic Syndr 2007; 46 443–50.
Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers.CrossRef | open url image1

[26]  Safren SA, et al A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol 2009; 28 1–10.
A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals.CrossRef | open url image1

[27]  Pachankis JE. A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions. Arch Sex Behav 2015; 44 1843–60.
A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions.CrossRef | open url image1

[28]  Crepaz N, Marks G. Are negative affective states associated with HIV sexual risk behaviors? A meta-analytic review. Health Psychol 2001; 20 291–9.
Are negative affective states associated with HIV sexual risk behaviors? A meta-analytic review.CrossRef | 1:STN:280:DC%2BD3MvntFemtw%3D%3D&md5=3d2f8d33eebd6e73779809d07ffd87ddCAS | open url image1

[29]  Kalichman SC, Weinhardt L. Negative affect and sexual risk behavior: comment on Crepaz and Marks (2001). Health Psychol 2001; 20 300–1.
Negative affect and sexual risk behavior: comment on Crepaz and Marks (2001).CrossRef | 1:STN:280:DC%2BD3MvntFemtA%3D%3D&md5=988a780f386c2d24f8c335846c84dea6CAS | open url image1

[30]  Pines HA, et al Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery. J Acquir Immune Defic Syndr 2014; 65 579–86.
Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery.CrossRef | open url image1

[31]  Allgöwer A, Wardle J, Steptoe A. Depressive symptoms, social support, and personal health behaviors in young men and women. Health Psychol 2001; 20 223–7.
Depressive symptoms, social support, and personal health behaviors in young men and women.CrossRef | open url image1

[32]  O’Cleirigh C, et al Moderate levels of depression predict sexual transmission risk in HIV-infected MSM: a longitudinal analysis of data from six sites involved in a ‘prevention for positives’ study. AIDS Behav 2013; 17 1764–9.
Moderate levels of depression predict sexual transmission risk in HIV-infected MSM: a longitudinal analysis of data from six sites involved in a ‘prevention for positives’ study.CrossRef | open url image1

[33]  Mimiaga MJ, et al Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE Study. J Acquir Immune Defic Syndr 2009; 51 340–8.
Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE Study.CrossRef | open url image1

[34]  O’leary A, Purcell D, Remien RH, Gomez C. Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men. AIDS Care 2003; 15 17–26.
Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men.CrossRef | 1:STN:280:DC%2BD3s7ktFeltw%3D%3D&md5=3adb1104488de36bde26a8edb6e21620CAS | open url image1

[35]  Paul JP, Catania J, Pollack L, Stall R. Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men’s Health Study 1. Child Abuse Negl 2001; 25 557–84.
Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men’s Health Study 1.CrossRef | 1:CAS:528:DC%2BD38XmtlyqsrY%3D&md5=25c27f252ba0668bdd80b8ac6368ffe2CAS | open url image1

[36]  Radcliffe J, Beidas R, Hawkins L, Doty N. Trauma and sexual risk among sexual minority African American HIV-positive young adults. Traumatology 2011; 17 24–33.
Trauma and sexual risk among sexual minority African American HIV-positive young adults.CrossRef | open url image1

[37]  Carballo-Diéguez A, Dolezal C. Association between history of childhood sexual abuse and adult HIV-risk sexual behavior in Puerto Rican men who have sex with men. Child Abuse Negl 1995; 19 595–605.
Association between history of childhood sexual abuse and adult HIV-risk sexual behavior in Puerto Rican men who have sex with men.CrossRef | open url image1

[38]  Lenderking WR, et al Childhood sexual abuse among homosexual men. J Gen Intern Med 1997; 12 250–3.
| 1:STN:280:DyaK2s3nt1Ghtw%3D%3D&md5=e39bfa9bc4ca0c1f06cf7627c1b5ddb3CAS | open url image1

[39]  Sikkema KJ, Hansen NB, Meade CS, Kochman A, Fox AM. Psychosocial predictors of sexual HIV transmission risk behavior among HIV-positive adults with a sexual abuse history in childhood. Arch Sex Behav 2009; 38 121–34.
Psychosocial predictors of sexual HIV transmission risk behavior among HIV-positive adults with a sexual abuse history in childhood.CrossRef | open url image1

[40]  Burnham KE, et al Trauma symptoms, internalized stigma, social support, and sexual risk behavior among HIV-positive gay and bisexual MSM who have sought sex partners online. AIDS Care 2016; 28 347–53.
Trauma symptoms, internalized stigma, social support, and sexual risk behavior among HIV-positive gay and bisexual MSM who have sought sex partners online.CrossRef | open url image1

[41]  Mayer KH, et al Which HIV-infected men who have sex with men in care are engaging in risky sex and acquiring sexually transmitted infections: findings from a Boston community health centre. Sex Transm Infect 2010; 86 66–70.
Which HIV-infected men who have sex with men in care are engaging in risky sex and acquiring sexually transmitted infections: findings from a Boston community health centre.CrossRef | 1:STN:280:DC%2BC3c7gs1WmtQ%3D%3D&md5=a18977e88c246ae7be782d14340141e2CAS | open url image1

[42]  Morin SF, et al Predicting HIV transmission risk among HIV-infected men who have sex with men: findings from the healthy living project. J Acquir Immune Defic Syndr 2005; 40 226–35.
Predicting HIV transmission risk among HIV-infected men who have sex with men: findings from the healthy living project.CrossRef | open url image1

[43]  Vaudrey J, et al Indicators of use of methamphetamine and other substances among men who have sex with men, San Francisco, 2003–2006. Drug Alcohol Depend 2007; 90 97–100.
Indicators of use of methamphetamine and other substances among men who have sex with men, San Francisco, 2003–2006.CrossRef | open url image1

[44]  Boone MR, Cook SH, Wilson P. Substance use and sexual risk behavior in HIV-positive men who have sex with men: an episode-level analysis. AIDS Behav 2013; 17 1883–7.
Substance use and sexual risk behavior in HIV-positive men who have sex with men: an episode-level analysis.CrossRef | open url image1

[45]  Peck JA, Shoptaw S, Rotheram-Fuller E, Reback CJ, Bierman B. HIV-associated medical, behavioral, and psychiatric characteristics of treatment-seeking, methamphetamine-dependent men who have sex with men. J Addict Dis 2005; 24 115–32.
HIV-associated medical, behavioral, and psychiatric characteristics of treatment-seeking, methamphetamine-dependent men who have sex with men.CrossRef | open url image1

[46]  Skeer MR, et al Patterns of substance use among a large urban cohort of HIV-infected men who have sex with men in primary care. AIDS Behav 2012; 16 676–89.
Patterns of substance use among a large urban cohort of HIV-infected men who have sex with men in primary care.CrossRef | open url image1

[47]  Mimiaga MJ, et al Polysubstance use and HIV/STD risk behavior among Massachusetts men who have sex with men accessing department of public health mobile van services: implications for intervention development. AIDS Patient Care STDS 2008; 22 745–51.
Polysubstance use and HIV/STD risk behavior among Massachusetts men who have sex with men accessing department of public health mobile van services: implications for intervention development.CrossRef | open url image1

[48]  Mimiaga MJ, et al Latent class profiles of internalizing and externalizing psychosocial health indicators are differentially associated with sexual transmission risk: findings from the CFAR network of integrated clinical systems (CNICS) cohort study of HIV-infected men engaged in primary care in the United States. Health Psychol 2015; 34 951–9.
Latent class profiles of internalizing and externalizing psychosocial health indicators are differentially associated with sexual transmission risk: findings from the CFAR network of integrated clinical systems (CNICS) cohort study of HIV-infected men engaged in primary care in the United States.CrossRef | open url image1

[49]  Santos G-M, et al Dose-response associations between number and frequency of substance use and high-risk sexual behaviors among HIV-negative substance-using men who have sex with men (SUMSM) in San Francisco. J Acquir Immune Defic Syndr 2013; 63 540–4.
Dose-response associations between number and frequency of substance use and high-risk sexual behaviors among HIV-negative substance-using men who have sex with men (SUMSM) in San Francisco.CrossRef | open url image1

[50]  Halkitis PN, Levy MD, Solomon TM. Temporal relations between methamphetamine use and HIV seroconversion in gay, bisexual, and other men who have sex with men. J Health Psychol 2016; 21 93–9.
Temporal relations between methamphetamine use and HIV seroconversion in gay, bisexual, and other men who have sex with men.CrossRef | open url image1

[51]  Buchbinder SP, Liu AY. CROI 2015: advances in HIV testing and prevention strategies. Top Antivir Med 2015; 23 8–27. open url image1

[52]  Haire BG. Preexposure prophylaxis-related stigma: strategies to improve uptake and adherence – a narrative review. HIV AIDS (Auckl) 2015; 7 241–9.
Preexposure prophylaxis-related stigma: strategies to improve uptake and adherence – a narrative review.CrossRef | open url image1

[53]  Hood JE, et al Dramatic increase in preexposure prophylaxis use among MSM in Washington state. AIDS 2016; 30 515–9. open url image1

[54]  Kelley CF, et al Applying a PrEP continuum of care for men who have sex with men in Atlanta, GA. Clin Infect Dis 2015; 61 1590–7.
Applying a PrEP continuum of care for men who have sex with men in Atlanta, GA.CrossRef | open url image1

[55]  Oldenburg CE, et al State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States. AIDS 2015; 29 837–45.
State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States.CrossRef | open url image1

[56]  Wade Taylor S, et al Optimizing content for pre-exposure prophylaxis (PrEP) counseling for men who have sex with men: perspectives of PrEP users and high-risk PrEP naïve men. AIDS Behav 2014; 18 871–9.
Optimizing content for pre-exposure prophylaxis (PrEP) counseling for men who have sex with men: perspectives of PrEP users and high-risk PrEP naïve men.CrossRef | 1:STN:280:DC%2BC2c%2FitFCluw%3D%3D&md5=3bb5badc3890f358b6ace938acd800a4CAS | open url image1

[57]  Calabrese SK, Underhill K. How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize ‘Truvada whores’. Am J Public Health 2015; 105 1960–4.
How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize ‘Truvada whores’.CrossRef | open url image1

[58]  Van der Elst EM, et al High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav 2013; 17 2162–72.
High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya.CrossRef | open url image1

[59]  Oldenburg CE, et al Differences in attitudes about HIV pre-exposure prophylaxis use among stimulant versus alcohol using men who have sex with men. AIDS Behav 2016; 20 1451–60.
Differences in attitudes about HIV pre-exposure prophylaxis use among stimulant versus alcohol using men who have sex with men.CrossRef | open url image1

[60]  Eaton LA, Kalichman SC. Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep 2007; 4 165–72.
Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies.CrossRef | open url image1

[61]  Chen Y-H, Snowden JM, McFarland W, Raymond HF. Pre-exposure prophylaxis (PrEP) use, seroadaptation, and sexual behavior among men who have sex with men, San Francisco, 2004–2014. AIDS Behav 2016;
Pre-exposure prophylaxis (PrEP) use, seroadaptation, and sexual behavior among men who have sex with men, San Francisco, 2004–2014.CrossRef | open url image1

[62]  Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveilance 2015, HIV/AIDS, CDC. Available online at: http://www.cdc.gov/std/stats15/std-surveillance-2015-print.pdf [verified 15 November 2016].

[63]  Scott HM, Klausner JD. Sexually transmitted infections and pre-exposure prophylaxis: challenges and opportunities among men who have sex with men in the US. AIDS Res Ther 2016; 13 5
Sexually transmitted infections and pre-exposure prophylaxis: challenges and opportunities among men who have sex with men in the US.CrossRef | open url image1

[64]  Golub SA, Kowalczyk W, Weinberger CL, Parsons JT. Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men. J Acquir Immune Defic Syndr 2010; 54 548–55.
Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men.CrossRef | open url image1

[65]  Marcus JL, et al No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis. PLoS One 2013; 8 e81997
No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis.CrossRef | open url image1

[66]  Volk JE, et al No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clin Infect Dis 2015; 61 1601–3.
No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting.CrossRef | open url image1

[67]  UNAIDS. 2014 progress report on the Global Plan. 2014. Available online at: http://www.unaids.org/en/resources/documents/2014/JC2681_2014-Global-Plan-progress [verified 24 March 2016].

[68]  Centers for Disease Control and Prevention. HIV among gay and bisexual men. 2016. Available online at: https://www.cdc.gov/hiv/group/msm/ [verified 15 November 2016].

[69]  Deblonde J, et al Barriers to HIV testing in Europe: a systematic review. Eur J Public Health 2010; 20 422–32.
Barriers to HIV testing in Europe: a systematic review.CrossRef | open url image1

[70]  Centers for Disease Control and Prevention. HIV testing among men who have sex with men—21 cities, United States, 2008. Available online at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6021a3. htm [verified 24 March 2016].

[71]  Ross MW, et al Internalised homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country cross-sectional study: some public health implications of homophobia. BMJ Open 2013; 3 e001928
Internalised homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country cross-sectional study: some public health implications of homophobia.CrossRef | open url image1

[72]  Andrinopoulos K, et al Evidence of the negative effect of sexual minority stigma on HIV testing among MSM and transgender women in San Salvador, El Salvador. AIDS Behav 2015; 19 60–71.
Evidence of the negative effect of sexual minority stigma on HIV testing among MSM and transgender women in San Salvador, El Salvador.CrossRef | open url image1

[73]  Pachankis JE, et al Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS 2015; 29 1239–46.
Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey.CrossRef | open url image1

[74]  den Daas C, Doppen M, Schmidt AJ, de Coul EO. Determinants of never having tested for HIV among MSM in the Netherlands. BMJ Open 2016; 6 e009480
Determinants of never having tested for HIV among MSM in the Netherlands.CrossRef | open url image1

[75]  Mikolajczak J, Hospers HJ, Kok G. Reasons for not taking an HIV-test among untested men who have sex with men: an internet study. AIDS Behav 2006; 10 431–5.
Reasons for not taking an HIV-test among untested men who have sex with men: an internet study.CrossRef | open url image1

[76]  Knussen C, Flowers P, Church S. The intentions of gay men in taking an HIV test. Cult Health Sex 2004; 6 45–59.
The intentions of gay men in taking an HIV test.CrossRef | open url image1

[77]  Mugavero M, et al Barriers to antiretroviral adherence: the importance of depression, abuse, and other traumatic events. AIDS Patient Care STDS 2006; 20 418–28.
Barriers to antiretroviral adherence: the importance of depression, abuse, and other traumatic events.CrossRef | open url image1

[78]  Remien RH, et al Barriers and facilitators to engagement of vulnerable populations in HIV primary care in New York City. J Acquir Immune Defic Syndr 2015; 69 S16–24.
Barriers and facilitators to engagement of vulnerable populations in HIV primary care in New York City.CrossRef | open url image1

[79]  Klinkenberg WD, Sacks S, HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Group Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care 2004; 16 22–42.
Mental disorders and drug abuse in persons living with HIV/AIDS.CrossRef | open url image1

[80]  O’Cleirigh C, Skeer M, Mayer KH, Safren SA. Functional impairment and health care utilization among HIV-infected men who have sex with men: the relationship with depression and post-traumatic stress. J Behav Med 2009; 32 466–77.
Functional impairment and health care utilization among HIV-infected men who have sex with men: the relationship with depression and post-traumatic stress.CrossRef | open url image1

[81]  Magnus M, et al Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of national significance initiative. J Acquir Immune Defic Syndr 2010; 53 529–36.
Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of national significance initiative.CrossRef | open url image1

[82]  Eaton LA, 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 e75–82.
The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men.CrossRef | open url image1

[83]  Dale SK, Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV. J Health Psychol 2016; 21 1311–21.
Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV.CrossRef | open url image1

[84]  Hussen SA, Harper GW, Bauermeister JA, Hightow-Weidman LB. Psychosocial influences on engagement in care among HIV-positive young black gay/bisexual and other men who have sex with men. AIDS Patient Care STDS 2015; 29 77–85.
Psychosocial influences on engagement in care among HIV-positive young black gay/bisexual and other men who have sex with men.CrossRef | open url image1

[85]  Harper GW, et al The role of multiple identities in adherence to medical appointments among gay/bisexual male adolescents living with HIV. AIDS Behav 2013; 17 213–23.
The role of multiple identities in adherence to medical appointments among gay/bisexual male adolescents living with HIV.CrossRef | open url image1

[86]  Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry 2001; 158 725–30.
Meta-analysis of the relationship between HIV infection and risk for depressive disorders.CrossRef | 1:STN:280:DC%2BD3M3ovVGntA%3D%3D&md5=bb7b9a5670a779ac9390a539b6124cf0CAS | open url image1

[87]  Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr 2011; 58 181–7.
Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis.CrossRef | open url image1

[88]  Rabkin JG. HIV and depression: 2008 review and update. Curr HIV/AIDS Rep 2008; 5 163–71.
HIV and depression: 2008 review and update.CrossRef | open url image1

[89]  Vranceanu AM, et al The relationship of post-traumatic stress disorder and depression to antiretroviral medication adherence in persons with HIV. AIDS Patient Care STDS 2008; 22 313–21.
The relationship of post-traumatic stress disorder and depression to antiretroviral medication adherence in persons with HIV.CrossRef | open url image1

[90]  Carrico AW, et al Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of anti-retroviral therapy utilization. J Acquir Immune Defic Syndr 2011; 56 146–50.
Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of anti-retroviral therapy utilization.CrossRef | open url image1

[91]  Pence BW, et al Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. J Acquir Immune Defic Syndr 2012; 59 409–16.
Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways.CrossRef | open url image1

[92]  Markowitz SM, et al Childhood sexual abuse and health risk behaviors in patients with HIV and a history of injection drug use. AIDS Behav 2011; 15 1554–60.
Childhood sexual abuse and health risk behaviors in patients with HIV and a history of injection drug use.CrossRef | open url image1

[93]  Blashill AJ, Gordon JR, Safren SA. Depression longitudinally mediates the association of appearance concerns to ART non-adherence in HIV-infected individuals with a history of injection drug use. J Behav Med 2014; 37 166–72.
Depression longitudinally mediates the association of appearance concerns to ART non-adherence in HIV-infected individuals with a history of injection drug use.CrossRef | open url image1

[94]  Blashill AJ, Gordon JR, Safren SA. Appearance concerns and psychological distress among HIV-infected individuals with injection drug use histories: prospective analyses. AIDS Patient Care STDS 2012; 26 557–61.
Appearance concerns and psychological distress among HIV-infected individuals with injection drug use histories: prospective analyses.CrossRef | open url image1

[95]  Huang JS, et al Body image in men with HIV. AIDS Patient Care STDS 2006; 20 668–77.
Body image in men with HIV.CrossRef | open url image1

[96]  Shacham E, Morgan JC, Önen NF, Taniguchi T, Overton ET. Screening anxiety in the HIV clinic. AIDS Behav 2012; 16 2407–13.
Screening anxiety in the HIV clinic.CrossRef | open url image1

[97]  Halkitis PN, Kutnick AH, Slater S. The social realities of adherence to protease inhibitor regimens: substance use, health care and psychological states. J Health Psychol 2005; 10 545–58.
The social realities of adherence to protease inhibitor regimens: substance use, health care and psychological states.CrossRef | open url image1

[98]  Carrico AW, Woolf-King SE, Neilands TB, Dilworth SE, Johnson MO. Stimulant use and HIV disease management among men in same-sex relationships. Drug Alcohol Depend 2014; 139 174–7.
Stimulant use and HIV disease management among men in same-sex relationships.CrossRef | open url image1

[99]  Friedman MR, et al Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study. AIDS 2015; 29 1087–96.
Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study.CrossRef | open url image1

[100]  Pantalone DW, Hessler DM, Simoni JM. Mental health pathways from interpersonal violence to health-related outcomes in HIV-positive sexual minority men. J Consult Clin Psychol 2010; 78 387–97.
Mental health pathways from interpersonal violence to health-related outcomes in HIV-positive sexual minority men.CrossRef | open url image1

[101]  Maulsby C, et al HIV among black men who have sex with men (MSM) in the United States: a review of the literature. AIDS Behav 2014; 18 10–25.
HIV among black men who have sex with men (MSM) in the United States: a review of the literature.CrossRef | open url image1

[102]  Hess K, Amy L, Jonathan M, Irene H. Estimating the lifetime risk of a diagnosis of HIV infection in the United States. Presented at: Conference on Retrovirus and Opportunistic Infections. (2016).

[103]  Hallfors DD, Iritani BJ, Miller WC, Bauer DJ. Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions. Am J Public Health 2007; 97 125–32.
Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions.CrossRef | open url image1

[104]  Sullivan PS, et al Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann Epidemiol 2015; 25 445–54.
Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study.CrossRef | open url image1

[105]  Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health 2006; 96 1007–19.
Greater risk for HIV infection of black men who have sex with men: a critical literature review.CrossRef | open url image1

[106]  Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 2007; 21 2083–91.
Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors.CrossRef | open url image1

[107]  Millett GA, et al Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet 2012; 380 341–8.
Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis.CrossRef | open url image1

[108]  Reisner SL, et al Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts. AIDS Behav 2009; 13 798–810.
Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts.CrossRef | open url image1

[109]  Glick SN, Cleary SD, Golden MR. Brief report: increasing acceptance of homosexuality in the United States across racial and ethnic subgroups. J Acquir Immune Defic Syndr 2015; 70 319–22.
Brief report: increasing acceptance of homosexuality in the United States across racial and ethnic subgroups.CrossRef | open url image1

[110]  Choi K-H, Paul J, Ayala G, Boylan R, Gregorich SE. Experiences of discrimination and their impact on the mental health among African American, Asian and Pacific Islander, and Latino men who have sex with men. Am J Public Health 2013; 103 868–74.
Experiences of discrimination and their impact on the mental health among African American, Asian and Pacific Islander, and Latino men who have sex with men.CrossRef | open url image1

[111]  Goldstein ND, Burstyn I, LeVasseur MT, Welles SL. Drug use among men by sexual behavior, race and ethnicity: prevalence estimates from a nationally representative US sample. Int J Drug Policy 2016; 36 148–50.
Drug use among men by sexual behavior, race and ethnicity: prevalence estimates from a nationally representative US sample.CrossRef | open url image1

[112]  Strathdee SA, Stockman JK. Epidemiology of HIV among injecting and non-injecting drug users: current trends and implications for interventions. Curr HIV/AIDS Rep 2010; 7 99–106.
Epidemiology of HIV among injecting and non-injecting drug users: current trends and implications for interventions.CrossRef | open url image1

[113]  Broz D, Ouellet LJ. Racial and ethnic changes in heroin injection in the United States: implications for the HIV/AIDS epidemic. Drug Alcohol Depend 2008; 94 221–33.
Racial and ethnic changes in heroin injection in the United States: implications for the HIV/AIDS epidemic.CrossRef | open url image1

[114]  Mizuno Y, et al Homophobia and racism experienced by Latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors. AIDS Behav 2012; 16 724–35.
Homophobia and racism experienced by Latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors.CrossRef | open url image1

[115]  Frye V, et al Sexual orientation- and race-based discrimination and sexual HIV risk behavior among urban MSM. AIDS Behav 2015; 19 257–69.
Sexual orientation- and race-based discrimination and sexual HIV risk behavior among urban MSM.CrossRef | open url image1

[116]  Chae DH, et al Implications of discrimination based on sexuality, gender, and race/ethnicity for psychological distress among working-class sexual minorities: the United for Health Study, 2003–2004. Int J Health Serv 2010; 40 589–608.
Implications of discrimination based on sexuality, gender, and race/ethnicity for psychological distress among working-class sexual minorities: the United for Health Study, 2003–2004.CrossRef | open url image1

[117]  Fields EL, et al ‘I always felt I had to prove my manhood’: homosexuality, masculinity, gender role strain, and HIV risk among young black men who have sex with men. Am J Public Health 2015; 105 122–31.
‘I always felt I had to prove my manhood’: homosexuality, masculinity, gender role strain, and HIV risk among young black men who have sex with men.CrossRef | open url image1

[118]  Murray JM, McDonald AM, Law MG. Rapidly ageing HIV epidemic among men who have sex with men in Australia. Sex Health 2009; 6 83–6.
Rapidly ageing HIV epidemic among men who have sex with men in Australia.CrossRef | open url image1

[119]  Emlet CA, Fredriksen-Goldsen KI, Kim H-J, Hoy-Ellis C. The relationship between sexual minority stigma and sexual health risk behaviors among HIV-positive older gay and bisexual men. J Appl Gerontol 2015;
The relationship between sexual minority stigma and sexual health risk behaviors among HIV-positive older gay and bisexual men.CrossRef | open url image1

[120]  Halkitis PN, et al Evidence for a syndemic in aging HIV-positive gay, bisexual, and other MSM: implications for a holistic approach to prevention and health care. Ann Anthropol Pract 2012; 36 365–86.
Evidence for a syndemic in aging HIV-positive gay, bisexual, and other MSM: implications for a holistic approach to prevention and health care.CrossRef | open url image1

[121]  Wight RG, LeBlanc AJ, Meyer IH, Harig FA. Internalized gay ageism, mattering, and depressive symptoms among midlife and older gay-identified men. Soc Sci Med 2015; 147 200–8.
Internalized gay ageism, mattering, and depressive symptoms among midlife and older gay-identified men.CrossRef | open url image1

[122]  Wight RG, Harig F, Aneshensel CS, Detels R. Depressive symptom trajectories, aging-related stress, and sexual minority stress among midlife and older gay men: linking past and present. Res Aging 2016; 38 427–52.
Depressive symptom trajectories, aging-related stress, and sexual minority stress among midlife and older gay men: linking past and present.CrossRef | open url image1

[123]  Halkitis PN, et al Psychosocial burdens negatively impact HIV antiretroviral adherence in gay, bisexual, and other men who have sex with men aged 50 and older. AIDS Care 2014; 26 1426–34.
Psychosocial burdens negatively impact HIV antiretroviral adherence in gay, bisexual, and other men who have sex with men aged 50 and older.CrossRef | open url image1

[124]  Ompad DC, et al Smoking and HIV-related health issues among older HIV-positive gay, bisexual, and other men who have sex with men. Behav Med 2014; 40 99–107.
Smoking and HIV-related health issues among older HIV-positive gay, bisexual, and other men who have sex with men.CrossRef | open url image1

[125]  Brennan-Ing M, Seidel L, Larson B, Karpiak SE. Social care networks and older LGBT adults: challenges for the future. J Homosex 2014; 61 21–52.
Social care networks and older LGBT adults: challenges for the future.CrossRef | open url image1

[126]  Centers for Disease Control and Prevention. HIV and young men who have sex with men. (2014). Available online at: http://www.cdc.gov/healthyyouth/sexualbehaviors/pdf/hiv_factsheet_ymsm.pdf [verified 24 March 2016].

[127]  Fergusson DM, Horwood LJ, Beautrais AL. Is sexual orientation related to mental health problems and suicidality in young people? Arch Gen Psychiatry 1999; 56 876–80.
Is sexual orientation related to mental health problems and suicidality in young people?CrossRef | 1:STN:280:DyaK1MvlvVajuw%3D%3D&md5=dabafc53a3b8f01f4f748a743839d281CAS | open url image1

[128]  Mustanski BS, Newcomb ME, Du Bois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res 2011; 48 218–53.
HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions.CrossRef | open url image1

[129]  Marshal MP, et al Sexual orientation and adolescent substance use: a meta-analysis and methodological review*. Addiction 2008; 103 546–56.
Sexual orientation and adolescent substance use: a meta-analysis and methodological review*.CrossRef | open url image1

[130]  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 37–45.
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.CrossRef | open url image1

[131]  Parsons JT, Lelutiu-Weinberger C, Botsko M, Golub SA. Predictors of day-level sexual risk for young gay and bisexual men. AIDS Behav 2013; 17 1465–77.
Predictors of day-level sexual risk for young gay and bisexual men.CrossRef | open url image1

[132]  Wilson PA, et al Using syndemic theory to understand vulnerability to HIV infection among Black and Latino men in New York City. J Urban Health 2014; 91 983–98.
Using syndemic theory to understand vulnerability to HIV infection among Black and Latino men in New York City.CrossRef | open url image1

[133]  Fletcher JB, Reback CJ. Mental health disorders among homeless, substance-dependent men who have sex with men. Drug Alcohol Rev 2016;
Mental health disorders among homeless, substance-dependent men who have sex with men.CrossRef | open url image1

[134]  Neaigus A, et al Multilevel risk factors for greater HIV infection of black men who have sex with men in New York City. Sex Transm Dis 2014; 41 433–9.
Multilevel risk factors for greater HIV infection of black men who have sex with men in New York City.CrossRef | open url image1

[135]  Seth P, Figueroa A, Wang G, Reid L, Belcher L. HIV testing, HIV positivity, and linkage and referral services in correctional facilities in the United States, 2009–2013. Sex Transm Dis 2015; 42 643–9.
HIV testing, HIV positivity, and linkage and referral services in correctional facilities in the United States, 2009–2013.CrossRef | open url image1

[136]  McGuire TG, Miranda J. New evidence regarding racial and ethnic disparities in mental health: policy implications. Health Aff 2008; 27 393–403.
New evidence regarding racial and ethnic disparities in mental health: policy implications.CrossRef | open url image1

[137]  Ayala G, Bingham T, Kim J, Wheeler DP, Millett GA. Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men. Am J Public Health 2012; 102 S242–9.
Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men.CrossRef | open url image1

[138]  Raymond HF, et al The role of individual and neighborhood factors: HIV acquisition risk among high-risk populations in San Francisco. AIDS Behav 2014; 18 346–56.
The role of individual and neighborhood factors: HIV acquisition risk among high-risk populations in San Francisco.CrossRef | 1:STN:280:DC%2BC3sjitlSrsg%3D%3D&md5=989006da1e735052b8260035df7ce6baCAS | open url image1

[139]  Mayer KH, et al Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among Black men who have sex with men in 6 U.S. cities. PLoS One 2014; 9 e87298
Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among Black men who have sex with men in 6 U.S. cities.CrossRef | open url image1

[140]  Aidala AA, et al Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health 2016; 106 e1–23.
Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review.CrossRef | open url image1

[141]  Stein MS, et al HIV-positive and in jail: race, risk factors, and prior access to care. AIDS Behav 2013; 17 108–17.
HIV-positive and in jail: race, risk factors, and prior access to care.CrossRef | open url image1

[142]  Vagenas P, et al HIV-infected men who have sex with men, before and after release from jail: the impact of age and race, results from a multi-site study. AIDS Care 2016; 28 22–31.
HIV-infected men who have sex with men, before and after release from jail: the impact of age and race, results from a multi-site study.CrossRef | open url image1

[143]  Safren SA, Reisner SL, Herrick A, Mimiaga MJ, Stall R. Mental health and HIV risk in men who have sex with men. J Acquir Immune Defic Syndr 2010; 55 S74–7.
Mental health and HIV risk in men who have sex with men.CrossRef | open url image1

[144]  O’Cleirigh C, Safren SA, Mayer KH. The pervasive effects of childhood sexual abuse: challenges for improving HIV prevention and treatment interventions. J Acquir Immune Defic Syndr 2012; 59 331–4.
The pervasive effects of childhood sexual abuse: challenges for improving HIV prevention and treatment interventions.CrossRef | open url image1

[145]  Boroughs MS, et al Complexity of childhood sexual abuse: predictors of current post-traumatic stress disorder, mood disorders, substance use, and sexual risk behavior among adult men who have sex with men. Arch Sex Behav 2015; 44 1891–902.
Complexity of childhood sexual abuse: predictors of current post-traumatic stress disorder, mood disorders, substance use, and sexual risk behavior among adult men who have sex with men.CrossRef | open url image1

[146]  Mimiaga MJ, et al A pilot trial of integrated behavioral activation and sexual risk reduction counseling for HIV-uninfected men who have sex with men abusing crystal methamphetamine. AIDS Patient Care STDS 2012; 26 681–93.
A pilot trial of integrated behavioral activation and sexual risk reduction counseling for HIV-uninfected men who have sex with men abusing crystal methamphetamine.CrossRef | open url image1

[147]  Daughters SB, Magidson JF, Schuster RM, Safren SA. ACT HEALTHY: a combined cognitive-behavioral depression and medication adherence treatment for HIV-infected substance users. Cognit Behav Pract 2010; 17 309–21.
ACT HEALTHY: a combined cognitive-behavioral depression and medication adherence treatment for HIV-infected substance users.CrossRef | open url image1

[148]  Safren SA, et al Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol 2012; 80 404–15.
Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial.CrossRef | open url image1

[149]  Barlow DH, et al. Unified protocol for transdiagnostic treatment of emotional disorders: therapist guide. New York: Oxford University Press; 2010.

[150]  Pachankis JE, Hatzenbuehler ML, Jonathon H, Safren SA, Parsons JT. LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach. J Consult Clin Psychol 2015; 83 875–89.
LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach.CrossRef | open url image1

[151]  Pachankis JE, et al A minority stress–emotion regulation model of sexual compulsivity among highly sexually active gay and bisexual men. Health Psychol. 2015; 34 829–40. open url image1

[152]  Schnall R, Travers J, Rojas M, Carballo-Diéguez A. eHealth interventions for HIV prevention in high-risk men who have sex with men: a systematic review. J Med Internet Res 2014; 16 e134
eHealth interventions for HIV prevention in high-risk men who have sex with men: a systematic review.CrossRef | open url image1


Full Text PDF (255 KB) Export Citation Cited By (1)