Skip to main content

Advertisement

SpringerLink
Log in

A Multi-Group Latent Class Analysis of Chronic Medical Conditions Among Men Who Have Sex with Men

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Until recently, research on the health of gay and other men who have sex with men (MSM) has focused on risk for and the health consequences of HIV and other sexually transmitted infections. A multigroup latent class analysis examined a range of lifetime chronic medical conditions (CMCs) among MSM. Covariates included sociodemographics, substance use, psychological distress, and HIV serostatus. A two-class model best fit the medical condition data: a low probabilities class for most CMCs and a moderate to high probabilities (MHP) class. HIV serostatus was associated with increased within-class probabilities for some CMCs, particularly gastrointestinal and skin disorders. Only increasing age and use of erectile dysfunction drugs were directly associated with increased odds of being in the MHP class whereas methamphetamine use, identifying as gay, and lower alcohol use were indirectly associated. Implications of the findings for future research and the health care needs of MSM are discussed.

Resumen

Hasta hace poco, la investigación sobre la salud de los hombres gay y otros hombres que tienen relaciones sexuales con hombres (HSH) se ha centrado en el riesgo y las consecuencias de salud del VIH y otras infecciones sexualmente transmisibles. Un análisis de grupos multiples de variables de clase latente examinó una amplia gama de condiciones médicas crónicas que se presentan en el curso de la vida (CMC) entre los HSH. Los factores de covarianza incluyeron datos sociodemográficos, el abuso de sustancias, trastornos psicológicos y el estado serológico respecto al VIH. Un modelo de dos clases se adaptó mejor a los datos de la condición médica: una clase con probabilidad baja para la mayoría de las CMC y una clase con probabilidad moderada a alta (MHP). El estado serológico respecto al VIH se asoció con mayor probabilidad dentro de la clase para algunas CMC, especialmente trastornos gastrointestinales y de la piel. Sólo el aumento de edad y el uso de medicamentos para la disfunción eréctil estaban directamente relacionados con el aumento de las probabilidades de estar en la clase de MHP, mientras que el uso de la metanfetamina, identificando como gay, y el bajo consumo de alcohol se asocian de manera indirecta. Las implicaciones de los hallazgos para investigaciones futuras y las necesidades de cuidado de la salud de los HSH son discutidos.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Makadon HJ, Mayer KH, Garofalo R. Optimizing primary care for men who have sex with men. J Am Med Assoc. 2006;296(19):2362–5.

    Article  CAS  Google Scholar 

  2. Snyder JE. Trend analysis of medical publications about LGBT persons: 1950–2007. J Homosex. 2011;58(2):164–88.

    Article  PubMed  Google Scholar 

  3. Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: The National Academics Press; 2011.

    Google Scholar 

  4. Wolitski RJ, Fenton KA. Sexual health, HIV, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the United States. AIDS Behav. 2011;15(1):9–17.

    Article  Google Scholar 

  5. Carrico AW. Substance use and HIV disease progression in the HAART era: implications for the primary prevention of HIV. Life Sci. 2011;88(21–22):940–7.

    Article  CAS  PubMed  Google Scholar 

  6. Ostrow DG, Plankey MW, Cox C, Li X, Shoptaw S, Jacobson LP, et al. Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. J Acquir Immune Defic Syndr. 2009;51(3):349–55.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Plankey MW, Ostrow DG, Stall R, Cox C, Li X, Peck JA, et al. The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr. 2007;45(1):85–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Santos GM, Do T, Beck J, Makofane K, Arreola S, Pyun T, et al. Syndemic conditions associated with increased HIV risk in a global sample of men who have sex with men. Sex Transm Infect. 2014;90:250.

    Article  PubMed  Google Scholar 

  9. Nakagawa F, Lodwick RK, Smith CJ, Smith R, Cambiano V, Lundgren JD, et al. Projected life expectancy of people with HIV according to timing of diagnosis. AIDS. 2012;26(3):335–43.

    Article  PubMed  Google Scholar 

  10. Mirani G, Williams PL, Chernoff M, Abzug MJ, Levin MJ, Seage GR, et al.: Changing trends in complications and mortality rates among US youth and young adults with HIV infection in the era of combination antiretroviral therapy. Clin Infect Dis. http://www.ncbi.nlm.nih.gov/pubmed/26270680 (2015). Accessed 13 Sept 2015.

  11. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the united states and dependent areas. 2013. 2015. http://www.cdc.gov/hiv/library/reports/surveillance/.

  12. Addis S, Davies M, Greene G, Macbride-Stewart S, Shepherd M. The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature. Health Soc Care Community. 2009;17(6):647–58.

    Article  PubMed  Google Scholar 

  13. Gee R. Primary care health issues among men who have sex with men. J Am Acad Nurse Pract. 2006;18(4):144–53.

    Article  PubMed  Google Scholar 

  14. Hirshfield S, Downing Jr. MJ, Horvath KJ, Swartz JA, Chiasson MA.: Risk factors for hypertension in a sample of MSM: adapting Andersen’s behavioral model of healthcare utilization. (In press) 2015.

  15. Sandfort TG, Bakker F, Schellevis FG, Vanwesenbeeck I. Sexual orientation and mental and physical health status: findings from a Dutch population survey. Am J Public Health. 2006;96(6):1119–25.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Clark CJ, Borowsky IW, Salisbury J, Usher J, Spencer RA, Przedworski JM, et al. Disparities in long-term cardiovascular disease risk by sexual identity: the national longitudinal study of adolescent to adult health. Prev Med. 2015;76:26–30.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Conron KJ, Mimiaga MJ, Landers SJ. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health. 2010;100(10):1953–60.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hatzenbuehler ML, McLaughlin KA, Slopen N. Sexual orientation disparities in cardiovascular biomarkers among young adults. Am J Prev Med. 2013;44(6):612–21.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cochran SD, Mays VM. Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: results from the California quality of life survey. Am J Public Health. 2007;97(11):2048–55.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Garland-Forshee RY, Fiala SC, Ngo DL, Moseley K. Sexual orientation and sex differences in adult chronic conditions, health risk factors, and protective health practices, Oregon, 2005–2008. Prev Chronic Dis. 2014;11:E136.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Swartz JA. The relative odds of lifetime health conditions and infectious diseases among men who have sex with men compared with a matched general population sample. Am J Mens Health. 2015;9(2):150–62.

    Article  PubMed  Google Scholar 

  22. Swartz JA, Berkey B, Gratzer B, Koelinger S, Merrell J, Pickett J, et al. Chicago crystal prevention project needs assessment report. Chicago: Chicago Department of Public Health; 2008.

    Google Scholar 

  23. Bolton S-L, Sareen J. Sexual orientation and its relation to mental disorders and suicide attempts: findings from a nationally representative sample. Can J Psychiatry. 2011;56(1):35–43.

    PubMed  Google Scholar 

  24. Cochran SD, Ackerman D, Mays VM, Ross MW. Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population. Addiction. 2004;99(8):989–98.

    Article  PubMed  PubMed Central  Google Scholar 

  25. McCarty-Caplan D, Jantz I, Swartz J. MSM and drug use: a latent class analysis of drug use and related sexual risk behaviors. AIDS Behav. 2014;18(7):1339–51.

    Article  PubMed  Google Scholar 

  26. Kessler RC, Ustun TB. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13(2):93–121.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  28. Stall R, Purcell DW. Intertwining epidemics: a review of research on substance use among men who have sex with men and its connection to the AIDS epidemic. AIDS Behav. 2000;4(2):181–92.

    Article  Google Scholar 

  29. Viron MJ, Stern TA. The impact of serious mental illness on health and healthcare. Psychosomatics. 2010;51(6):458–65.

    Article  PubMed  Google Scholar 

  30. Collins E, Tranter S, Irvine F. The physical health of the seriously mentally ill: an overview of the literature. J Psychiatr Ment Health Nurs. 2012;19(7):638–46.

    Article  CAS  PubMed  Google Scholar 

  31. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT, Walters EE, Zaslavsky A. Short screening scales to monitor population prevalences and trends in nonspecific psychological distress. Psychol Med. 2002;32(6):959–76.

    Article  CAS  PubMed  Google Scholar 

  32. American Psychiatric Association, editor. Diagnostic and statistical manual of mental disorders, text-revision. Washington: American Psychiatric Association; 2002.

    Google Scholar 

  33. Andrews G, Slade T. Interpreting scores on the Kessler psychological distress scale (K10). Aust N Z J Public Health. 2001;25(6):494–7.

    Article  CAS  PubMed  Google Scholar 

  34. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184–9.

    Article  PubMed  Google Scholar 

  35. Prochaska JJ, Sung HY, Max W, Shi Y, Ong M. Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. Int J Methods Psychiatr Res. 2012;21(2):88–97.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Fisher DG, Reynolds GL, Napper LE. Use of crystal methamphetamine, Viagra, and sexual behavior. Curr Opin Infect Dis. 2010;23(1):53–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. StataCorp. Stata 14.0 for Macintosh. College Station: StataCorp; 2015.

    Google Scholar 

  38. Muthén B, Muthén LK. Mplus. Los Angeles: Muthén & Muthén; 2015.

    Google Scholar 

  39. McCutcheon AL. Basic concepts and procedures in single- and multiple-group latent class analysis. In: Hagenaars JA, McCutcheon AL, editors. Applied latent class analysis. Cambridge: Cambridge University Press; 2002. p. 56–88.

    Chapter  Google Scholar 

  40. Nylund KL, Asparouhov T, Muthén BO. Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model. 2007;14(4):535–69.

    Article  Google Scholar 

  41. King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008;8:70.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Weissman J, Pratt LA, Miller EA, Parker JD. Serious psychological distress among adults: United States, 2009–2013. Atlanta: National Center for Health Statistics; 2015. p. 1–8.

    Google Scholar 

  43. Wilcox CM, Saag MS. Gastrointestinal complications of HIV infection: changing priorities in the HAART era. Gut. 2008;57(6):861–70.

    Article  CAS  PubMed  Google Scholar 

  44. Rigopoulos D, Paparizos V, Katsambas A. Cutaneous markers of HIV infection. Clin Dermatol. 2004;22(6):487–98.

    Article  PubMed  Google Scholar 

  45. Khambaty MM, Hsu SS. Dermatology of the patient with HIV. Emerg Med Clin N Am. 2010;28(2):355–68 (Table of contents).

    Article  Google Scholar 

  46. Panel on antiretroviral guidelines for adults and adolescents. Guidelines for the use of antiretroviral agents. Washington, DC: Department of Health and Human Services; 2015.

    Google Scholar 

  47. Zhang D, Bi P, Hiller JE, Lv F. Web-based HIV/AIDS behavioral surveillance among men who have sex with men: potential and challenges. Int J Infect Dis. 2008;12(2):126–31.

    Article  PubMed  Google Scholar 

  48. Jenkins RA. Recruiting substance-using men who have sex with men into HIV prevention research: current status and future directions. AIDS Behav. 2012;16:1411–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The author would like to acknowledge the contributions and support of the following project team members and their organizational affiliations at the time of the project: Jim Picket, Jim Merrell, and Pete Subkoviak (AIDS Foundation of Chicago); Beau Gratzer and Jeff Glotfelty (Howard Brown Health Center); Matthew Sharp and Anthony Galloway (Test Positive Awareness Network); Braden Berkey, John Garver, and Courtney Reid (Center on Halsted); and Simone Koehlinger (Office of LGBT Health, Chicago Department of Public Health).

Funding

Funding for the Crystal Prevention Project and corresponding Internet survey of MSM was provided through a grant from the Chicago Department of Public Health (Grant #14357) as part of a Special Projects of National Significance award to CDPH from the Centers for Disease Control.

Author information

Authors and Affiliations

  1. Jane Addams College of Social Work, University of Illinois at Chicago, 1040 W. Harrison Street, (M/C 309), Chicago, IL, 60607, USA

    James A. Swartz

Authors
  1. James A. Swartz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James A. Swartz.

Ethics declarations

Conflict of interest

The author has no conflict of interest to report.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Swartz, J.A. A Multi-Group Latent Class Analysis of Chronic Medical Conditions Among Men Who Have Sex with Men. AIDS Behav 20, 2418–2432 (2016). https://doi.org/10.1007/s10461-016-1381-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-016-1381-2

Keywords

Search

Navigation