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Cited by 81HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskLGBTQ Health, Identity, and Policy

A systematic review and meta-analysis of combination behavioral interventions Co-targeting psychosocial syndemics and HIV-related health behaviors for sexual minority men

Open access
Pantalone, David W., Nelson, Kimberly M., Batchelder, Abigail W., Chiu, Christopher, Gunn, Hamish A., Horvath, Keith J.·2020·The Journal of Sex Research
DOI 10.1080/00224499.2020.1728514PMC PMC7457381
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Abstract

In the U.S., sexual minority men (SMM) are disproportionately affected by HIV. Interventions are needed to increase HIV prevention and treatment behaviors, especially among syndemically exposed SMM. In recent years, researchers have created and tested combination behavioral interventions co-targeting syndemics and HIV-related health behaviors. We evaluated that literature via systematic review and meta-analysis, identifying 44 trials targeting mental health symptoms, alcohol use, and drug use, as well as sexual risk behavior, antiretroviral adherence, and healthcare engagement. For the randomized controlled trials, we computed between-group, pre-post effect sizes and tested them via random-effects models. Results supported the efficacy of combined interventions with significant, small, positive effects for improving mental health and reducing substance use (d = .20, CIs: 0.12, .29), and reducing sexual risk behavior and improving antiretroviral adherence (d = .16, CIs: .03, .30). Stratification analyses indicate that longer (9+ sessions) and individual (vs. group) interventions resulted in stronger effects on syndemic but not health behavior outcomes. Intervention developers should attend to intervention intensity and format. More evidence is needed about the importance of additional factors, such as novel intervention targets and cultural tailoring, as well as broadening the focus to multi-level interventions to address both interpersonal and structural mechanisms of change.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis pooled 44 behavioral intervention trials that simultaneously addressed psychosocial syndemics and HIV-related health behaviors among sexual minority men. Randomized trials showed small positive effects on both syndemic and health behavior outcomes, with stronger syndemic effects for individual and longer interventions.

Key findings

  • Across 44 trials reported in 43 articles and covering 7,156 participants, randomized controlled trials produced small significant improvements in syndemic outcomes, \(d = .20\) (95% CI .12–.29), and health behavior outcomes, \(d = .16\) (95% CI .03–.30).
  • Subcategory meta-analyses found significant effects for mental health, \(d = .23\) (95% CI .12–.34), substance use, \(d = .17\) (95% CI .05–.30), and sexual risk behavior in the .17–.23 range, while the antiretroviral adherence meta-analysis was non-significant.
  • For syndemic outcomes, stronger effects appeared for individual versus group interventions (\(Q_b = 5.431\), \(p = .02\)), interventions with nine or more sessions versus eight or fewer (\(Q_b = 9.771\), \(p = .002\)), and follow-up of six months or less versus longer (\(Q_b = 5.381\), \(p = .02\)); no stratification variable was significant for health behavior outcomes.
  • Publication bias checks showed asymmetry (Egger’s test \(p < .001\) for syndemics and \(p = .017\) for health behaviors); trim-and-fill reduced the syndemic effect to \(d = .09\) (95% CI .0036–.18) and the health behavior effect to \(d = .033\) (95% CI −.12–.18), with fail-safe \(N\) values of 361 and 52, respectively.

Methods

  • The authors followed PRISMA guidance and searched databases for English-language peer-reviewed articles published from 2000 through May 2019, focusing on North America and Western Europe and including controlled or uncontrolled behavioral intervention trials that targeted at least one syndemic indicator plus at least one HIV-related health behavior in sexual minority men or samples at least 50% sexual minority men.
  • From 1,621 electronic records plus 22 additional records, screening left 97 full-text articles and ultimately 43 articles representing 44 trials; data extraction covered design, demographics, recruitment, intervention content, retention, and outcomes, with risk of bias assessed using the Cochrane tool.
  • Between-group Cohen’s \(d\) values were calculated from the most distal assessment, odds ratios were converted to \(d\), and random-effects models were used for six meta-analyses covering syndemics, health behaviors, mental health, substance use, antiretroviral adherence, and sexual risk; moderator analyses and publication bias tests were also conducted.

Limitations

  • The authors state that the review may have missed relevant trials, that the strict inclusion rule requiring more than 50% sexual minority men excluded some studies, that the geographic focus was limited to North America and Western Europe, that most samples were urban, that provider- and structural-level interventions were not reviewed, and that significant heterogeneity raised concerns about the reliability of the pooled estimates.
  • The authors also note that many included trials were uncontrolled pilots, that cultural tailoring was often underreported, that only one study reported transgender or gender diverse participants (\(n = 4\)), that few interventions were delivered online, that no published pre-exposure prophylaxis adherence trials were found, and that risk-of-bias concerns were common, including high performance bias in 83% of randomized trials and frequent unclear reporting for selective outcome reporting and attrition.
  • Evident from the text: publication bias analyses indicated asymmetry and trim-and-fill attenuated the health behavior effect to non-significance, and several outcome categories had too few trials for separate alcohol and drug meta-analyses, limiting precision and generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1080/00224499.2020.1728514

Cites

121 of 121 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 81 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    The share of tailored interventions is between 34% and 68%, depending on how tailoring is defined.

    “Thus, depending on whether tailoring only includes explicit mention of being tailored to SMM or also may include tailoring to an individual without explicit mention of being tailored to SMM, the proportion of tailored interventions ranges from 34–68%.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The 44 trials collectively enrolled 7,156 participants.

    “The trials, which report collectively on the results of interventions with 7,156 participants, are described in Table 1.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Of 54 excluded publications, about half (n=26, 48%) lacked data on the SMM proportion of the sample.

    “Of the 54 excluded publications, approximately half (n = 26, 48%) were excluded due to not reporting the proportion of the sample who were SMM.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Most trials were limited to SMM (n=36, 82%).

    “The majority of the trials were limited to SMM (n = 36, 82%), whereas the remaining one-fifth also included members of other HIV risk populations (e.g., women, heterosexual men; n = 8, 18%).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Seventeen interventions were described by their authors as culturally tailored for SMM.

    “In 17 interventions, authors described the content as culturally tailored for SMM in a number of ways, primarily through developing psychoeducational content, strategies, and examples that specifically referenced and reflected the experiences of SMM.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 93
  • Classified as probably not a substantial claim. 67

  • May combine two claims.

    Findingown data

    The most common syndemic-health behavior pairings were drug use with sexual risk (n=23, 52%), alcohol use with sexual risk (n=15, 34%), and mental health with sexual risk (n=16, 36%).

    “When syndemic factors and health behaviors were paired together, the most common pairings were drug use and sexual risk behavior (n = 23, 52%), alcohol use and sexual risk behavior (n = 15, 34%), and mental health and sexual risk behavior (n = 16, 36%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The review included 43 articles covering 44 intervention trials; one article by Carrico et al. (2014) contained two trials.

    “This process resulted in the inclusion of 43 articles, which represent 44 intervention trials; the paper by Carrico et al. (2014) presented two trials in a single article.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Carrico et al. (2014)

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The majority (57%; n=25) reported incentivizing assessments, and thirteen incentivized session attendance.

    “The majority of interventions (57%; n = 25) reported incentivizing completion of assessments and thirteen incentivized session attendance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The trials assessed three health behavior outcomes: sexual behavior (n=34, 77%), ARV adherence (n=17, 39%), and missed healthcare visits (n=1, 2%).

    “There were three health behavior outcomes in the trials: (1) sexual behavior (n = 34, 77%), (2) ARV adherence (n = 17, 39%), and (3) missed healthcare visits (n = 1, 2%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Trials had a mean sample size of 166, with a range of 8 to 1,686.

    “The average N among trials was 166, ranging from 8 to 1,686.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For studies with one recruitment method, the most frequent was medical/HIV clinic recruitment or provider referral (n=8).

    “Among those using a single recruitment method, the most common was recruitment within a medical setting/HIV clinic or through referrals from healthcare providers (n = 8).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 33 controlled studies, seven had attention-matched controls and seven had treatment-as-usual or enhanced treatment-as-usual.

    “Among the studies whose design included a control condition (n = 33), seven used attention-matched controls and seven were treatment-as-usual or enhanced treatment-as-usual arm.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most trials were based in the U.S. (n=41, 93%).

    “Most of the intervention trials were based in the U.S. (n = 41, 93%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most interventions (n=27) were delivered individually, while one-quarter (n=11) were group-based.

    “Most (n = 27) interventions were individually delivered, while one-quarter (n = 11) were delivered in a group format.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Only two studies were not delivered in person.

    “All but two studies, one delivered through a Facebook chat and the other using a tablet-based app, were delivered in-person.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Stratification analyses found that interventions with 9+ sessions and individual (vs. group) format had stronger effects on syndemic outcomes, but not on health behavior outcomes.

    “Stratification analyses indicate that longer (9+ sessions) and individual (vs. group) interventions resulted in stronger effects on syndemic but not health behavior outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Twenty-one interventions were pilot trials, most of which (n=13) were single-arm.

    “Twenty-one of the interventions were described as pilot trials, the majority of which (n = 13) were single-arm designs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Alcohol (n=5) and drug use (n=8) had too few trials for separate quantitative analysis.

    “However, there were too few trials for alcohol (n = 5) and drug use (n = 8) to evaluate them separately in quantitative analyses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Pilot trials had a mean of 46.9 participants and 8.4 sessions (SD=5.5).

    “The average number of participants in the pilot trials (all but two reported these data) was 46.9, with an average of 8.4 intervention sessions (SD = 5.5).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The included trials were published between 2001 and 2019.

    “The 44 included trials were published between 2001–2019.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    On average, 54% of each sample were people of color, with a range from 3.7% to 100%.

    “An average of 54% across samples were people of color, with a range of 3.7% to 100%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Thirty-three studies used more than one recruitment method, with two to five unique strategies.

    “Thirty-three studies used more than one recruitment method, with a range from two to five unique strategies employed.”
    Quote in the paperNot a substantial claim

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    Findingown data

    Nearly all studies took place in the U.S., except three.

    “All but three studies were conducted in the U.S.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Interventions targeted three syndemic indicators: mental health (n=24, 55%), alcohol use (n=19, 43%), and drug use (n=24, 55%).

    “Within the included trials, interventions targeted three syndemic indicators: (1) mental health (n = 24, 55%), (2) alcohol use (n = 19, 43%), and (3) drug use (n = 24, 55%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Non-pilot studies (n=23) had a mean of 274 participants and 12.4 sessions (SD=12.3).

    “The average number of participants across the 23 non-pilot studies was 274, with an average of 12.4 (SD = 12.3) intervention sessions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Average retention at the final follow-up assessment was 81.2%, ranging from 58% to 100%.

    “The average percent retention at the final follow-up assessment was 81.2%, with a range of 58% to 100%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Five (63%) of those trials were RCTs.

    “Five (63%) of these trials were RCTs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For the remaining RCT, authors did not report enough information to calculate effect sizes but reported a significant difference between intervention and control for sexual behavior outcomes.

    “For the remaining RCT, although the authors did not report enough information to calculate effect sizes, they did report a significant difference between the intervention and control conditions for sexual behavior outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The remaining two (29%) were open pilots.

    “The remaining two (29%) were open pilots (Hart et al., 2016; Reisner et al., 2011).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hart et al., 2016

      Not checked in the free run.

    • cites Reisner et al., 2011

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Six (75%) were individual interventions and two (25%) were group-based.

    “Six (75%) trials were individual interventions and two (25%) trials were group-based interventions.”
    Quote in the paperNot a substantial claim

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    Findingcitation

    Self-efficacy was targeted in one (14%) trial.

    “Mental health symptoms targeted included depression (n = 5, 71%), anxiety and stress (n = 5, 71%), traumatic stress and PTSD (n = 3, 43%), loneliness (n = 2, 29%), self-efficacy (n = 1, 14%) (Carrico et al., 2009; Hart et al., 2016), and sexual compulsivity (n = 1, 14%; Hart et al., 2016).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Carrico et al., 2009

      Not checked in the free run.

    • cites Hart et al., 2016

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    Findingown data

    Two (25%) trials explicitly noted problem solving.

    “Psychoeducation (n = 3, 38%), relaxation (n = 3, 38%), MI (n = 2, 25%), problem solving (n = 2, 25%), and supportive therapy (n = 1, 13%) techniques were also explicitly noted as intervention components for some trials.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Three (43%) trials explicitly noted using problem solving.

    “A few trials noted explicitly using psychoeducation (n = 4, 57%), motivational interviewing (MI; n = 4, 57%), or problem solving (n = 3, 43%) techniques as well.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Five (71%) were group-based interventions.

    “Five (71%) were group-based interventions (Hart et al., 2016; Reisner et al., 2011; Williams et al., 2008; 2013).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Hart et al., 2016

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    • cites Reisner et al., 2011

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    • cites Williams et al., 2008; 2013

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    Findingown data

    One (13%) trial explicitly noted supportive therapy.

    “Psychoeducation (n = 3, 38%), relaxation (n = 3, 38%), MI (n = 2, 25%), problem solving (n = 2, 25%), and supportive therapy (n = 1, 13%) techniques were also explicitly noted as intervention components for some trials.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Three (38%) trials explicitly noted psychoeducation as an intervention component.

    “Psychoeducation (n = 3, 38%), relaxation (n = 3, 38%), MI (n = 2, 25%), problem solving (n = 2, 25%), and supportive therapy (n = 1, 13%) techniques were also explicitly noted as intervention components for some trials.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The remaining trial (12%) was a one-arm feasibility study.

    “The remaining trial (12%) was a one-arm feasibility study (Kennard et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kennard et al., 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Two (25%) were pilot RCTs.

    “Two (25%) trials were pilot RCTs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Four (57%) trials explicitly noted using psychoeducation.

    “A few trials noted explicitly using psychoeducation (n = 4, 57%), motivational interviewing (MI; n = 4, 57%), or problem solving (n = 3, 43%) techniques as well.”
    Quote in the paperNot a substantial claim

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    Findingown data

    Three (38%) trials explicitly noted relaxation.

    “Psychoeducation (n = 3, 38%), relaxation (n = 3, 38%), MI (n = 2, 25%), problem solving (n = 2, 25%), and supportive therapy (n = 1, 13%) techniques were also explicitly noted as intervention components for some trials.”
    Quote in the paperNot a substantial claim

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    Findingown data

    Five (71%) of those seven trials were RCTs.

    “Five (71%) of these trials were RCTs.”
    Quote in the paperNot a substantial claim

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    Findingown data

    All seven (100%) assessed in-person interventions.

    “All seven (100%) assessed in-person interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Across all interventions, follow-up assessments averaged 33.5 weeks, with a range of 6 to 64 weeks.

    “The average number of weeks of follow-up assessments across all interventions was 33.5 (range = 6–64 weeks).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One (20%) trial noted using psychoeducation to address sexual risk behavior.

    “Additional techniques specifically noted to address sexual risk behavior included MI (n = 3, 43%), problem solving (n = 3, 43%), and psychoeducation (n = 1, 20%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Four (57%) trials explicitly noted using motivational interviewing.

    “A few trials noted explicitly using psychoeducation (n = 4, 57%), motivational interviewing (MI; n = 4, 57%), or problem solving (n = 3, 43%) techniques as well.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Two (25%) trials explicitly noted motivational interviewing.

    “Psychoeducation (n = 3, 38%), relaxation (n = 3, 38%), MI (n = 2, 25%), problem solving (n = 2, 25%), and supportive therapy (n = 1, 13%) techniques were also explicitly noted as intervention components for some trials.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All eight (100%) assessed in-person interventions.

    “All eight (100%) trials assessed in-person interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Four (80%) of the five studies exclusively recruited sexual minority men, and one identified SMM as just over half (53.1%) of the sample.

    “Four (80%) of the five studies exclusively recruited SMM and one identified SMM as just over half (53.1%) of the sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Both fully powered RCTs reported significant between-group differences, indicating that the interventions had performed favorably.

    “Both fully powered RCTs reported significant between-group differences, indicating that the interventions had performed favorably.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Wray et al. (2019) showed treatment condition reported fewer total drinking days and fewer alcohol-related problems over the three-month follow-up compared to control.

    “The results of the study by Wray and his colleagues (2019) showed that those in the treatment condition reported fewer total drinking days and fewer alcohol-related problems over the three-month follow-up period compared to those in the control condition.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wray and his colleagues (2019)

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Two (50%) were individual interventions, one (25%) was a couples intervention, and one (25%) involved four randomization assignments comparing group-based CBT, SMM-specific CBT, contingency management, and CBT plus contingency management.

    “Two (50%) were individual interventions, one (25%) was a couples intervention, and one (25%) intervention involved four randomization assignments, comparing (1) group-based CBT to (2) SMM-specific CBT, (3) contingency management, and (4) CBT plus contingency management.”
    Quote in the paperNot a substantial claim

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    Findingcitation

    Wu and colleagues (2011) described providing psychoeducation and technical skills related to HIV and other STI transmission and condom use.

    “Wu and colleagues (2011) described providing psychoeducation and technical skills related to HIV and other STI transmission and condom use.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wu and colleagues (2011)

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In a trial of 67 SMM, the ESTEEM intervention was individually delivered over 10 sessions.

    “In a trial of 67 SMM, the ESTEEM (Effective Skills to Empower Effective Men) intervention was individually delivered over 10 sessions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Three (60%) of these studies were RCTs to assess efficacy, one was a pilot study, and the fifth appeared to be a pilot trial though not explicitly stated.

    “Three (60%) of these studies were RCTs to assess efficacy, one was a pilot study, and the fifth study appeared to be, although not explicitly stated as, a pilot trial as well.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    To decrease sexual risk behavior, two (50%) of the trials reported using MI techniques.

    “To decrease sexual risk behavior, two (50%) of the trials reported using MI techniques.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Two (25%) trials noted psychoeducation to address ARV adherence.

    “Additional techniques specifically noted to address ARV adherence included problem solving (n = 3, 38%), psychoeducation (n = 2, 25%), and MI (n = 1, 13%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One (13%) trial noted motivational interviewing to address ARV adherence.

    “Additional techniques specifically noted to address ARV adherence included problem solving (n = 3, 38%), psychoeducation (n = 2, 25%), and MI (n = 1, 13%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Seven of these focused on drug use only (29%), eight studies (7 published papers) on drug and alcohol use (33%), four on drug and alcohol use as well as mental health (17%), and five on drug use and mental health (20%).

    “Seven of these focused on drug use only (29%), eight studies (7 published papers) on drug and alcohol use (33%), four on drug and alcohol use as well as mental health (17%), and five on drug use and mental health (20%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Shoptaw and colleagues (2005) did not provide enough information to compute effect sizes.

    “However, Shoptaw and colleagues (2005) did not provide enough information to compute effect sizes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shoptaw and colleagues (2005)

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  • May combine two claims.

    Findingown data

    Of four studies co-targeting drug use and sexual risk behavior, two (50%) were fully powered RCTs and two (50%) were uncontrolled pilot studies.

    “Of the four studies that co-targeted drug use and sexual risk behavior, two (50%) were fully powered RCTs and two (50%) were uncontrolled pilot studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Four interventions were delivered in-person and were either exclusively individually delivered or had both an individual and a peer group education/support component.

    “Four interventions were delivered in-person and were either exclusively individually delivered or had both an individual and a peer group education/support component.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Wu and colleagues (2011) aimed to address knowledge and technical skills related to drug use and sexual risk reduction, in addition to expectancies of methamphetamine use.

    “Wu and colleagues (2011) aimed to address knowledge and technical skills related to drug use and sexual risk reduction, in addition to expectancies of methamphetamine use.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wu and colleagues (2011)

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  • May combine two claims.

    Findingcitation

    Velasquez et al. (2009) showed no between-group intervention effects on sexual risk behavior in intent-to-treat analysis, but found significant improvements in reduction of sexual risk behavior for intervention group when restricted to men who reported heavy-drinking and unprotected-sex days at baseline (d = 0.59, 95% CI: 0.31, 0.86).

    “Similarly, the trial by Velasquez and colleagues (2009) showed no between-group intervention effects on sexual risk behavior in an intent-to-treat analysis, but did find significant improvements in the reduction of sexual risk behavior for the intervention group when the sample was restricted to those men who reported heavy-drinking and unprotected-sex days at baseline (d = 0.59, 95% CI: 0.31, 0.8”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Velasquez and colleagues (2009)

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Both studies showed treatment condition participants reported fewer heavy drinking days in the previous 30 days (Kahler d = −0.40, 95% CI: −0.71, −0.09; Velasquez d = .22, 95% CI: −0.05, .49).

    “Both of these studies showed that treatment condition participants reported fewer heavy drinking days in the previous 30 days (d for Kahler et al. = −0.40, 95% CI: −0.71, −0.09; d for Velasquez et al. = .22, 95% CI: −0.05, .49).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kahler et al.

      Not checked in the free run.

    • cites Velasquez et al.

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    That pilot RCT did not find significant group differences on ARV adherence measures, but results trended positive (d range 0.38 to 0.57).

    “That trial did not find significant group differences on ARV adherence measures, but results trended in a positive direction (d range = 0.38 to 0.57).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Two (50%) of the trials tested interventions of MI techniques and one (25%) compared general versus SMM-specific CBT focused approaches.

    “Two (50%) of the trials tested interventions of MI techniques and one (25%) compared general versus SMM-specific CBT focused approaches.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of seven trials targeting drug use, four (57%) co-targeted sexual risk and three (43%) co-targeted both sexual risk and ARV adherence.

    “Of the seven trials that targeted drug use, four (57%) co-targeted sexual risk and three (43%) co-targeted both sexual risk and ARV adherence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When intervention and waitlist groups were pooled, significant within-group effects were found in each of these factors, except number of days of heavy drinking in the previous 90 days, which showed non-significant improvement (p < .10).

    “When results from the intervention and waitlist groups were pooled, significant within-group effects were found in each of these factors, with the exception of the number of days of heavy drinking in the previous 90 days, which showed non-significant improvement (p < .10).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One intervention was a tablet-based app delivered in the clinic during an HIV testing visit.

    “One intervention was a tablet-based app that was delivered in the clinic during an HIV testing visit (Wray et al., 2019).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wray et al., 2019

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The percentage of persons of color across the four trials ranged from 94% to 30%, with authors separately reporting four Latinx participants.

    “The percentage of persons of color across the four trials ranged from 94% to 30% (with the authors seperately reporting that four participants were Latinx).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Both groups reported significant decreases in number of standard drinks consumed in the previous 14 days and in number of drinks consumed during drinking days in the previous 14 days at both 3- and 6-month assessments.

    “However, both groups reported significant decreases in the number of standard drinks consumed in the previous 14 days, and in the number of drinks consumed during drinking days in the previous 14 days, at both the 3- and 6-month assessments (see below for effects on alcohol use in the trial by Kahler et al., 2018).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All four (100%) studies only included SMM and assessed in-person interventions.

    “All four (100%) studies only included SMM and assessed in-person interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No between-group differences were detected for condomless anal sex or condomless anal sex with new or casual partners or partners with unknown HIV status.

    “No between group differences were detected for CAS or CAS with new or casual partners or partners with an unknown HIV status.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In the same study, men in both conditions showed decreases in number of drinks, drinking days, and heavy drinking days over the study period.

    “In the same study, men in both conditions showed decreases in the number of drinks, drinking days, and heavy drinking days over the study period.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One pilot RCT provided enough information to calculate effect sizes.

    “One of the pilot RCTs also provided enough information to calculate effect sizes (Blashill et al., 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Blashill et al., 2017

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Only one intervention focused on improving ARV adherence was successful at changing that behavior and associated clinical indicators of HIV viral load, although it did not observe between-group differences in reducing alcohol use compared to control.

    “there was only one intervention focused on improving ARV adherence that was successful at changing that behavior as well as the associated clinical indicators of HIV viral load—although that study did not observe between-group differences in reducing alcohol use in comparison to the control condition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of three studies triply targeting drug use, sexual behavior, and ARV adherence, two (67%) were RCTs and one (33%) was an uncontrolled pilot feasibility study.

    “Of the three studies that triply targeted drug use, sexual behavior, and ARV adherence, two (67%) were RCTs and one (33%) was an uncontrolled pilot feasibility study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The majority of these trials reported within-group improvements in mental health symptoms and sexual risk behaviors, but few found significant between-group differences.

    “The majority of these trials reported within-group improvements in mental health symptoms and sexual risk behaviors, but few found significant between-group differences.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Shoptaw et al. (2005) reported a significant difference in condomless receptive anal intercourse after the first four weeks of treatment, but the difference attenuated over follow-up.

    “In the trial by Shoptaw and colleagues (2005), they reported a significant difference in reports of condomless receptive anal intercourse after the first four weeks of treatment, although that difference attenuated over the follow-up period.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shoptaw and colleagues (2005)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The second RCT was an individually delivered weekly intervention involving motivational interviewing and CBT focused on reducing methamphetamine use.

    “The second RCT was an individually delivered weekly intervention involving motivational interviewing and CBT focused on reducing methamphetamine use.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Although some RCTs demonstrated success in reducing drug use and some showed benefits for reducing mental health symptoms, the majority did not significantly and consistently reduce HIV sexual risk behavior.

    “Although some of these RCTs demonstrated success in reducing drug use, with some showing benefits for reducing mental health symptoms as well, the majority did not significantly and consistently reduce HIV sexual risk behavior.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Although Parsons and colleagues (2018) did not provide overall means by condition, men in both conditions reported significant reductions in days of methamphetamine use at three-month follow-up, and days of methamphetamine use did not differ between groups (d = 0.07, 95% CI: −0.20, 0.34).

    “Although Parsons and colleagues (2018) did not provide overall means by condition, men in both conditions reported significant reductions in days of methamphetamine use at the three-month follow-up visit, and days of methamphetamine use did not differ between groups (d = 0.07, 95% CI: −0.20, 0.34.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Parsons and colleagues (2018)

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Five of the 24 drug-use trials also targeted ARV adherence, and one of those co-targeted ARV adherence and missed healthcare appointments.

    “Five of the 24 trials also targeted ARV adherence, one of which co-targeted ARV adherence as well as missed healthcare appointments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Many studies did not report on sexual minority-specific cultural tailoring in their intervention development.

    “although many studies did not report on that element of their intervention development efforts.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    These mental health trials were primarily group-based and enrolled SMM exclusively.

    “These interventions were primarily group-based and enrolled SMM exclusively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Some RCTs found non-significant between-group differences in drug use, while others found significantly greater reductions in drug use in the intervention group compared to control.

    “Although the results of some RCTs were non-significant between-group differences in drug use, the results of other trials did include significantly greater reductions in drug use in the intervention group compared to the control group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Nearly all trials reviewed were conducted in the U.S., despite the search strategy attempting to identify similar trials throughout North America and Western Europe.

    “Nearly all of the trials we reviewed were conducted in the U.S., despite our search strategy attempting to identify similar trials throughout North America and Western Europe”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Approximately one-third of studies in the review reported explicitly tailoring intervention content to SMM; an additional one-third provided individually tailored content that may have been tailored to SMM participants but not in a standardized way.

    “Approximately one-third of studies in our review reported explicitly having tailored intervention content to apply to SMM; an additional one-third of studies provided intervention content that was tailored to the individual and, therefore, may have been tailored to their SMM participants although not in a standardized (or measurable) way.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Across these alcohol-focused studies, interventions additionally addressed mental health symptoms and HIV care outcomes and sexual risk behavior.

    “Across these studies, interventions aimed additionally to address mental health symptoms from the syndemic category, and HIV care outcomes and sexual risk behavior from the health behavior category.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Eleven of the 24 drug-use trials were uncontrolled pilot studies and two were controlled pilot studies aimed at determining feasibility and acceptability.

    “Eleven of the 24 trials were uncontrolled pilot studies and two were controlled pilot studies, with the aim to determine feasibility and acceptability of the intervention procedures.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Meta-analyses of RCT effects on mental health, substance use, and sexual risk behaviors showed small, positive, significant improvements with effect sizes in the .17 to .23 range.

    “Effect sizes for meta-analyses examining RCT effects on mental health, substance use (alcohol and drug use), and sexual risk behaviors also showed small, positive, significant improvements in the .17 to .23 range of ds.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Four intervention trials showed greater improvement on one or more alcohol use measures for the intervention group compared to control; the fifth showed improvement in both study arms.

    “Four intervention trials showed greater improvement on one or more alcohol use measures for the intervention group compared to the control group; the fifth intervention showed improvement in alcohol use measures in both study arms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Trials targeting mental health and ARV adherence primarily tested individual, in-person CBT interventions and enrolled both SMM and other populations.

    “These trials primarily tested individual, in-person interventions utilizing CBT techniques and enrolled both SMM and other populations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Other potential sources of bias were either not described at all or poorly described, or reported procedures indicated a strong possibility for bias.

    “other potential sources of bias were either not described at all or poorly described (e.g., procedures to blind outcome assessors from intervention allocation; methods for handling missing outcome data), or the reported procedures indicated a strong possibility for bias to be introduced”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Investigators found no significant differences at the final assessment visits for either of the two fully powered RCTs.

    “Investigators found no significant differences at the final assessment visits for either of the two fully powered RCTs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The uncontrolled pilot and one RCT were contingency management interventions involving vouchers in exchange for drug-free urine samples.

    “The uncontrolled pilot and one of the RCTs were contingency management interventions that involved providing vouchers to participants in exchange for drug-free urine samples.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All three included SMM and were conducted in-person.

    “All three included SMM and were conducted in-person.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Across the RCTs examined, effect sizes were modest but indicated favorable intervention effects, with substantial heterogeneity across studies and outcome categories.

    “Across the RCTs we examined, we observed modest effect sizes that indicated favorable intervention effects, with substantial heterogeneity across studies and outcome categories.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    One (25%) trial identified a significant reduction in unprotected receptive anal sex in the first four weeks of treatment in the SMM-specific CBT group, but at six- and twelve-month follow-up there were no significant differences across groups.

    “One (25%) trial identified a significant reduction in unprotected receptive anal sex in the first four weeks of treatment in the SMM-specific CBT group (Shoptaw et al., 2005); however, at the six- and twelve-month follow-up visits, there were no significant differences across groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shoptaw et al., 2005

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Excluding outliers, the average number of intervention sessions for pilot trials and non-pilot trials was approximately eight and nine, respectively.

    “Excluding outliers, the average number of intervention sessions for pilot trials and non-pilot (primarily efficacy) trials was approximately eight and nine, respectively.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    An important gap in the reviewed studies is the lack of attention on multi-level predictors of HIV risk.

    “An important gap in the reviewed studies is the lack of attention on multi-level predictors of HIV risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Existing interventions in this area show positive effects on mental health and sexual risk behavior outcomes.

    “Existing interventions in this area show positive effects on mental health and sexual risk behavior outcomes”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Relatively few of the reviewed trials identified their intervention content as uniquely culturally tailored to SMM, and even fewer explicated the tailoring process.

    “Relatively few of the trials we reviewed identified their intervention content as uniquely culturally tailored to SMM, and even fewer explicated the process for how they conducted the tailoring.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was a lack of published trials on PrEP adherence interventions and on interventions focused on addressing traumatic sequelae of victimization experiences like CSA and partner abuse tailored to SMM.

    “there was a disappointing (but perhaps not surprising given the time lag from intervention development to testing to publication) lack of published trials on PrEP adherence interventions—as well as interventions focused on addressing the traumatic sequelae of victimization experiences like CSA and partner abuse tailored to SMM.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Among HIV-positive SMM, syndemics are associated with poorer ARV adherence and medical hospitalization.

    “Indeed, in samples of HIV-positive SMM, syndemics have been associated with ARV non-adherence and medical hospitalization, among other outcomes (e.g., Pantalone, Valentine, Woodward, & O’Cleirigh, 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Pantalone, Valentine, Woodward, & O’Cleirigh, 2018

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sexual minority people are more likely to experience mental health problems, probably because of stress from living in a disapproving or hostile society.

    “Epidemiologic studies have demonstrated that sexual minority individuals are at increased risk for mental health problems, likely due to the added stress experienced by living in a society that is disapproving and sometimes hostile about their identities (Pachankis, Cochran, & Mays, 2015; Plöderl & Tremblay, 2015; Meyer, 2003).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Pachankis, Cochran, & Mays, 2015

      Not checked in the free run.

    • cites Plöderl & Tremblay, 2015

      Not checked in the free run.

    • cites Meyer, 2003

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The four syndemic categories-CSA, partner abuse, mental health symptoms, and substance use-are strongly associated with HIV risk behaviors, HIV serostatus, and higher healthcare utilization and medical costs in HIV-negative SMM subgroups.

    “Thus, these four categories of individual-level health problems—childhood sexual abuse, partner abuse, mental health symptoms, and drug and alcohol use—have been vigorously investigated in SMM, and have been shown to have strong associations with HIV risk behaviors, HIV serostatus, and higher healthcare utilization and medical costs in a variety of HIV-negative SMM subgroups (e.g., O’Cleirigh et a”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites O’Cleirigh et al., 2018

      Not checked in the free run.

    • cites Tsai & Burns, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Keeping intervention development siloed impedes rather than advances progress.

    “This siloed approach to intervention development, although understandable given the organization of the field, hinders rather than facilitates progress.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Interventions for HIV-related health behaviors and those for mental health symptoms have traditionally been created separately by different researchers and in different settings.

  • May combine two claims.

    Premisecitation

    Because HIV epidemics in North America and Western Europe are similar, the search was limited to trials from those regions.

    “Given the transmission dynamics and cultural mores related to sexual minority men vary widely (e.g., Beyrer et al., 2010), we focused our search on trials conducted in North America (Canada, U.S., Mexico) and Western Europe (Belgium, France, Ireland, Luxembourg, Netherlands, Portugal, Spain, United Kingdom) because of similarities in the epidemic in those areas.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Beyrer et al., 2010

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Over the past decade, scholars have increasingly urged merging HIV-related health behavior and mental health intervention targets into one program.

    “Indeed, in the past decade especially, more and more scholars have highlighted the need to marry those categories of intervention targets into a single package (e.g., Carrico et al., 2016; Mimiaga et al., 2015; Sikkema et al., 2010).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Carrico et al., 2016

      Not checked in the free run.

    • cites Mimiaga et al., 2015

      Not checked in the free run.

    • cites Sikkema et al., 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Since 1981, MSM in the U.S. have had the highest HIV incidence and prevalence, accounting for 68% of new infections and 71% of total infections.

    “Men who have sex with men (MSM) have had the highest HIV incidence (68% of new infections) and prevalence (71% of total infections) since HIV was identified in 1981 (CDC, 1981; CDC, 2018b).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites CDC, 1981

      Not checked in the free run.

    • cites CDC, 2018b

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Psychosocial challenges often co-occur and interact, affecting SMM's HIV-related health behaviors; this is termed syndemics.

    “These psychosocial challenges co-occur and interact to impact SMM’s HIV-related health behaviors and have been termed syndemics in the literature—referring to the synergy created by multiple epidemics.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Stigma and social/structural determinants are central to HIV burden among SMM, alongside high per-act transmission probability of receptive anal intercourse and clustering within social-sexual networks.

    “Stigma, as well as social and structural determinants of health, play central roles in the burden of HIV in SMM, in addition to the high per-act transmission probability of receptive anal intercourse and strong clustering of HIV within SMM social-sexual networks (Beyrer et al., 2013; Earnshaw, Bogart, Dovidio, & Williams, 2013).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Beyrer et al., 2013

      Not checked in the free run.

    • cites Earnshaw, Bogart, Dovidio, & Williams, 2013

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    O'Cleirigh et al. (2019) found that THRIVE, which targets post-trauma cognitions and sexual risk reduction, improved mental health symptoms and sexual risk behavior more than sexual risk reduction counseling alone.

    “Results indicate significant improvements in both mental health symptoms and sexual risk behavior over and above sexual risk reduction counseling alone.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites O’Cleirigh et al., 2019

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Risk of bias was evaluated with the Cochrane Collaboration's tool.

    “Additionally, to evaluate methodological rigor, we assessed each articles’ risk of bias using the Cochrane Collaboration’s tool (Higgins & Green, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Higgins & Green, 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    In the United States, sexual minority men bear a disproportionate HIV burden.

    “In the U.S., sexual minority men (SMM) are disproportionately affected by HIV.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the EXPLORE study, among participants reporting childhood sexual abuse, the intervention did not reduce HIV infection rates, whereas the overall sample showed modest reductions.

    “Further, among participants reporting CSA, the intervention showed no effect in reducing HIV infection rates compared to modest reductions in HIV risk in the sample overall.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mimiaga et al., 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A single author independently reviewed every full-text article to verify eligibility reliability; kappa was 0.89 (95% CI 0.80-0.98).

    “During a second round of review, one author independently reviewed each full-text article to determine the reliability of our eligibility assessment procedures (kappa = 0.89, CIs: 0.80, 0.98).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Effect sizes were recalculated from available data and checked against reported values; no discrepancies emerged.

    “If authors presented effect sizes as part of their results, for consistency, we re-calculated them from the available data and compared our calculation to their reports (note that we identified no discrepancies).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Pooled estimates were computed with random effects models.

    “We conducted meta-analyses using random effects models to compute the pooled estimates for the trials, given the high degree of heterogeneity between studies (Viechtbauer, 2007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Viechtbauer, 2007

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Publication bias was assessed with funnel plots, Egger's test, Trim and Fill, and Orwin's fail-safe N.

    “However, because graphical evaluation can be subjective, we also calculated Egger’s test (Egger, Smith, Schneider, & Minder, 1997), Duval and Tweedie’s (2000) “Trim and Fill,” and Orwin’s (1983) fail-safe N for both primary analyses—grouping together all of the syndemic outcomes and then grouping together all of the health behavior outcomes.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Egger, Smith, Schneider, & Minder, 1997

      Not checked in the free run.

    • cites Duval and Tweedie’s (2000)

      Not checked in the free run.

    • cites Orwin’s (1983)

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The studies aiming to address substance use, alone and with other syndemic indicators, were diverse, making generalizations challenging.

    “The studies aiming to address substance use, both alone and in conjunction with other syndemic indicators, were diverse, making generalizations challenging”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Combination behavioral interventions may be critical for reducing HIV disease burden among SMM, but their full potential has not yet been realized.

    “Combination behavioral interventions may be critical for reducing the HIV disease burden among SMM, yet this review indicates that their full potential has yet to be realized.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Brief interventions have demonstrated efficacy across a number of behaviors, including reducing HIV risk behavior of people with HIV.

    “Although brief interventions have demonstrated efficacy across a number of behaviors (e.g., Dunn, Deroo, & Rivara, 2001), including reducing HIV risk behavior of people with HIV (Crepaz et al., 2014)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Dunn, Deroo, & Rivara, 2001

      Not checked in the free run.

    • cites Crepaz et al., 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A common limitation of syndemic framework operationalization is that typical analytic approaches weigh syndemic indicators equally and examine associations additively rather than multiplicatively.

    “one of which is that the typical analytic approach involves weighing equally each of the syndemic indicators and then investigating their associations with health behaviors or health status additively and not multiplicatively”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tsai & Burns, 2015

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Culturally tailoring intervention content and other factors (e.g., using similar peers for intervention delivery) appears to be associated with higher perceived intervention acceptability and more effective interventions among SMM.

    “Culturally tailoring intervention content and other factors (e.g., using similar peers for intervention delivery) appears to be associated with higher perceived intervention acceptability and more effective interventions among SMM (e.g., Horvath & Bauermeister, 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Horvath & Bauermeister, 2017

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Group-based interventions for SMM that co-target mental health and sexual risk behaviors may produce favorable within-person change over time but may not be more effective than a standard health-focused group.

    “it could be the case that group-based interventions for SMM that co-target mental health and sexual risk behaviors may produce favorable change over time within individuals, but that they are not necessarily more effective than a standard health-focused group”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Most interventions targeting combined syndemic and HIV prevention and care outcomes are necessarily more intensive than brief interventions and may need to be even more intensive to improve outcomes.

    “the results of our review showed that most interventions targeting combined syndemic and HIV prevention and care outcomes are necessarily more intensive in comparison and, yet, may need to be even more intensive to further improve intervention outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sex between men is the primary mode of HIV transmission in North America and Western Europe.

    “where sex between men is the primary mode of HIV transmission (UNAIDS, 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites UNAIDS, 2017

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The substance use component of combination interventions is promising but could be bolstered to be more efficacious.

    “suggesting that the substance use component of the combination interventions is promising and, yet, could be bolstered to be more efficacious in the future.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The syndemics framework holds that multiple co-occurring psychosocial epidemics are inextricably intertwined and interact synergistically to increase disease burden among vulnerable populations.

    “The syndemics framework is based on the premise that multiple, co-occurring psychosocial epidemics are inextricably intertwined and, as such, are thought to interact synergistically to increase the burden of disease among vulnerable populations (Singer, 1996).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Singer, 1996

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The range of effect sizes suggests that combination prevention efforts must be strengthened to substantially impact the HIV epidemic among SMM.

    “In aggregate, the range of effect sizes suggest that combination prevention efforts must be strengthened to substantially impact the HIV epidemic among SMM.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    It is straightforward to generate a proper randomization sequence and blind all parties prior to group assignment, but considerably more challenging to keep participants from knowing their behavioral trial arm, especially if one arm includes more sessions or a different format.

    “Specifically, it is straightforward to /generate a proper randomization sequence and enact procedures to blind to allocation all parties prior to group assignment, but it is considerably more challenging to keep participants from knowing which arm of a behavioral trial they are assigned to, especially if one arm includes more sessions or a different format than the others.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The pattern of variable methodologic rigor is unlikely unique to the interventions meeting inclusion criteria and likely reflects difficulties in sustaining methodologic rigor in behavioral RCTs generally.

    “This pattern of results is unlikely unique to interventions that met our inclusion criteria. Instead, our findings in this category likely reflect the difficulties in sustaining methodologic rigor in behavioral RCTs generally.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the U.S., Black and Latino SMM, especially youth, are at highest risk for acquiring HIV and have poorer HIV care outcomes than White peers after diagnosis.

    “In the U.S., Black and Latino SMM, especially youth, are at the highest risk for acquiring HIV and, after an HIV diagnosis, have poorer HIV care outcomes than their White peers (CDC, 2017e, 2017b, 2018d).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites CDC, 2017e, 2017b, 2018d

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationown data

    More work is needed to improve the efficacy of ARV adherence interventions, given the null findings in that domain.

    “More work is needed to improve the efficacy of ARV adherence interventions, given the null findings we observed in that domain”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The cultural tailoring analysis had relatively few studies contributing (13 not tailored, 6 tailored), and a large proportion of published articles did not report on this variable.

    “However, there were relatively few studies contributing to that analysis (13 not tailored, 6 tailored), although a large proportion of the published articles did not report on this variable.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Current estimates hold that one-quarter of transgender women live with HIV, and over half of Black transgender women have been diagnosed with HIV.

    “Current estimates hold that one-quarter of transgender women live with HIV, and over half of Black transgender women have been diagnosed with HIV (CDC, 2018c).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites CDC, 2018c

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    When effect sizes are examined in aggregate, more work is needed.

    “Nevertheless, when we examine the effect sizes in aggregate, it is clear that more work is needed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Numerous recently completed and ongoing technology-based interventions address substance use and mental health to improve HIV prevention and care outcomes.

    “despite numerous recently completed and ongoing technology-based interventions addressing substance use and mental health to improve individuals’ HIV prevention and care outcomes (Muessig, LeGrand, Horvath, Bauermeister, & Hightow-Weidman, 2017; Tso, Tang, Li, Yan, & Tucker, 2016).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Muessig, LeGrand, Horvath, Bauermeister, & Hightow-Weidman, 2017

      Not checked in the free run.

    • cites Tso, Tang, Li, Yan, & Tucker, 2016

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The review found stronger intervention effects for individual versus group intervention formats, supporting the notion that more intensive interventions are needed for syndemic-exposed SMM.

    “We found stronger intervention effects for individual versus group intervention formats, lending support to the notion that more intensive interventions are needed for syndemic-exposed SMM.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The effectiveness and eventual implementation of technology-based studies has not been fully determined.

    “the effectiveness and eventual implementation of technology-based studies has not been fully determined.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The review followed PRISMA guidelines closely and made the most conservative methodologic decisions to reflect the state of the field without overstating successes.

    “We followed the PRISMA guidelines closely and made the most conservative methodologic decisions in an effort to reflect the state of the field as accurately as possible without overstating successes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The review included trials focused on North American or Western European SMM and did not specifically search for other geographic regions, so it might have missed interventions from other regions.

    “Similarly, we included trials that focused on North American or Western European SMM and, although we did not come across trials from other geographic regions, we did not specifically search for them and so might have missed an opportunity to review a greater number of interventions.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The review's findings point to the potential utility of adding substance use treatment services to primary care integration.

    “Our findings point to the potential utility of adding substance use treatment services to that integration as well.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many SMM use social media and other electronic venues for connecting with dating and sex partners.

    “which we see as recognizing that many SMM use social media and other electronic venues for connecting with dating and sex partners (Grov, Rendina, & Parsons, 2014; Prescott et al., 2016).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Grov, Rendina, & Parsons, 2014

      Not checked in the free run.

    • cites Prescott et al., 2016

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    New HIV diagnoses among Black SMM increased 4% and among Hispanic/Latino SMM increased 14% from 2011 to 2015, while new HIV diagnoses decreased by 10% among white SMM in the same period.

    “New HIV diagnoses among Black SMM increased 4% and among Hispanic/Latino SMM increased 14% from 2011 to 2015; in contrast, new HIV diagnoses decreased by 10% among white SMM in the same time period (CDC, 2018e).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites CDC, 2018e

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Given historical and logistical barriers to research participation, the reviewed trials may not have reached the SMM most in need of intervention.

    “Given historical and logistical barriers to research participation, the reviewed trials may not have reached the SMM who are most in need of intervention.”
    Quote in the paperNot a substantial claim
143 of 143

  • The paper relies on this without support.

    HIV-related health behavior interventions are usually brief and target the behavior alone, not the syndemic barriers such as mental health and substance use.

    “Typically, HIV-related health behavior interventions are short and focused on improving the behavior without addressing syndemic factors that serve as barriers to behavior change, such as mental health and substance use.”

  • The paper relies on this without support.

    Interventions for HIV-related health behaviors and those for mental health symptoms have traditionally been created separately by different researchers and in different settings.

    “Historically, behavioral interventions to address HIV-related health behaviors and those to address mental health symptoms typically have been developed separately, by different groups of investigators, and in different settings.”

  • The paper relies on this without support.

    Effect sizes derived from different outcome measures are comparable enough to combine in meta-analysis.

    “Using Microsoft Excel, we calculated effect sizes as Cohen’s d, the standardized mean difference between the intervention and control groups for each outcome variable, regardless of how it was measured (Cohen, 1988).”

  • The paper relies on this without support.

    The included trials provide independent effect estimates.

    “we developed a number of decision-rules such that each trial contributed only one effect size per outcome variable within each of the five categories”

  • The paper relies on this without support.

    The level of risk of bias in the included trials does not undermine the pooled effect estimates.

    “Additionally, to evaluate methodological rigor, we assessed each articles’ risk of bias using the Cochrane Collaboration’s tool (Higgins & Green, 2011).”

  • The paper relies on this without support.

    Many mental health providers do not focus on changing health behaviors, and many physical health providers do not focus on improving mental health symptoms.

    “Many mental health providers do not focus on working to change health behaviors, and many healthcare providers focused on physical health do not focus on working to improve mental health symptoms.”

  • The paper relies on this without support.

    SMM have unique syndemic and HIV-related health behavior patterns and needs that may not be addressed sufficiently in interventions developed for heterosexual individuals.

    “SMM have unique syndemic and HIV-related health behavior patterns and needs that may not be addressed sufficiently in interventions developed and tested for heterosexual individuals with, or at high risk for acquiring, HIV.”

  • The paper relies on this without support.

    SMM often present clinically with many multifaceted psychosocial needs.

    “SMM often present clinically with many, multifaceted psychosocial needs”

  • The paper relies on this without support.

    Shorter and more focused interventions do work for some people but not for everyone, especially those with significant mental health burden.

    “Shorter and more focused interventions do work for some people but not for everyone, especially the segment of the population dealing with a significant mental health burden.”

  • The paper relies on this without support.

    There is a significant movement towards incorporating mental health service delivery into primary care settings.

    “There is a significant movement towards incorporating mental health service delivery into primary care settings.”

  • The paper relies on this without support.

    Historically, it has been standard to assess only two options for gender (or sex), male and female, which likely fails to capture gender identities of transgender, non-binary, and other gender diverse individuals.

    “historically, it has been standard to assess only two options for gender (or sex, depending on the context), male and female, which likely fails to capture the gender identities of transgender, non-binary, and other gender diverse individuals.”

  • The paper relies on this without support.

    There is ample evidence that institutional and structural factors strongly impact the health of stigmatized populations, such as SMM.

    “there is ample evidence that institutional and structural factors strongly impact the health of stigmatized populations, such as SMM.”

  • The paper relies on this without support.

    For the past 20 years, behavioral interventions have increasingly attempted to address combinations of mental health, substance use, and HIV risk behaviors.

    “For the past 20 years, behavioral interventions have increasingly attempted to address combinations of mental health, substance use, and HIV risk behaviors.”

  • The paper relies on this without support.

    The improvements observed in the meta-analysis are clinically significant.

    “to bring about clinically significant changes”
14 of 14

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The effect sizes for HIV-transmission risk behavior were in the small-to-medium range, consistent with previous trials of psychosocial interventions for this population.

    “effect sizes for this outcome were in the small-to-medium range consistent with previous trials of psychosocial interventions for this population (Pantalone et al., 2020).”

    From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Pantalone et al., 2020

    The Results (Meta-Analytic Results; page unavailable) report modest effects for sexual risk behavior, with category-level effect sizes in the d = .17–.23 range; the paper calls the overall pooled effects small. The Results (Summary of Intervention Results; page unavailable) also report a medium-sized effect for one condomless-sex outcome (d = 0.59), but the paper does not characterize HIV-transmission risk effects overall as small-to-medium or explicitly make the claimed comparison with previous trials. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • In the US, the median age of initiation of cocaine and methamphetamine use is approximately 20 years.

    “the median age of initiation of cocaine and methamphetamine use is approximately 20 years.164,165”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [165]

    The Results passages discuss changes in methamphetamine use during interventions, not the age at which use began. Searches for the claimed median age and for age of first cocaine or methamphetamine use found no passage in our copy reporting an initiation age of approximately 20 years in the US. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

  • In the US, the peak age for initiating nonmedical use of prescription stimulants is 16 to 19 years.

    “the peak age for initiating nonmedical use of prescription stimulants is 16 to 19 years”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [165]

    The Results and Discussion passages concern interventions targeting drug use among sexual minority men, including methamphetamine use; they do not report the age at which nonmedical prescription-stimulant use begins in the US. Searches for the claimed 16-to-19-year peak and for age of onset found no passage addressing it. Page numbers were not provided in our copy. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Project PLUS effects are called significant despite intervals crossing zero

    Major

    The reported 95% confidence intervals for the described significant six-month effects include zero, so they do not support significance at the corresponding two-sided level.

  • One of seven trials is not 20%

    Minor

    One trial out of seven is approximately 14%, rather than 20%.

    Reported 20 · recomputed 14.285714

  • Listed control types account for only 29 studies

    Minor

    The counts for the seven control-condition types add to 29, not the stated 33 studies with controls.

    Reported 33 · recomputed 29

  • Mental-health-only trial count changes between subsections

    Minor

    One subsection says 15 trials solely targeted mental health, while the next says there were 13 such studies.

  • Reasons for exclusion account for only 52 publications

    Minor

    The counts given for the exclusion reasons sum to 52, leaving two of the stated 54 excluded publications unaccounted for.

    Reported 54 · recomputed 52

  • An alcohol-use effect is called significant despite its interval crossing zero

    Minor

    The paragraph says all the studies showed significant between-group alcohol-use improvements, but the reported interval for the Velasquez drinks measure includes zero.

  • Syndemic-target combinations total 45 rather than 44 trials

    Minor

    The seven mutually exclusive combinations listed for syndemic targets add to 45 trials, although the review reports 44 included trials.

    Reported 44 · recomputed 45

  • Alcohol-use combination counts disagree with the stated total

    Minor

    The listed combinations that include alcohol use add to 18 trials rather than 19.

    Reported 19 · recomputed 18

  • Three of five trials is not 75%

    Minor

    The stated fraction is 60%, not 75%.

    Reported 75 · recomputed 60

  • Detection-bias percentage does not match the RCT count

    Minor

    The section assesses 30 RCTs; 12 of 30 is 40%, not 44%.

    Reported 44 · recomputed 40

  • Mental-health combination counts disagree with the stated total

    Minor

    Adding the listed combinations that include mental health gives 25 trials, not the stated 24.

    Reported 24 · recomputed 25

  • Attrition-bias percentage and majority claim do not match the count

    Minor

    Fourteen of the 30 assessed RCTs is about 47%, not 52% or more than half.

    Reported 52 · recomputed 46.666667

12 of 12

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. 10.1080/09652140120089481 · DOI
  2. Hedges L. V., 2014, Statistical methods for meta-analysis

Cited by

Sorted by citations

Related

Authors
Pantalone, D. W., Nelson, K. M., Batchelder, A. W., Chiu, C., Gunn, H. A., & Horvath, K. J.
Affiliations
  • University of Massachusetts Boston (US)
  • Boston University (US)
  • Harvard University (US)
  • San Diego State University (US)
Corresponding author
Pantalone, David W.
ORCID
Venue
The Journal of Sex Research
Publisher
Informa UK Limited
Published
2020-02-20
Volume
57
Issue
6
Pages
681-708
ISSN
  • 0022-4499 (ISSN-L)
  • 1559-8519
DOI
10.1080/00224499.2020.1728514
PMC
PMC7457381
OpenAlex
W3008522523
Semantic Scholar
c71b7d21e4ca5e6658f8c28d0021c665502fdfaa
Cited by
81
References
121
Citations by year
2026: 8 · 2025: 9 · 2024: 16 · 2023: 7 · 2022: 30 · 2021: 8 · 2020: 3
FWCI
0.57
Type
journal article
Language
en
Open access
Locations
  • The Journal of Sex Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (K23MH109346)
  • National Institute on Drug Abuse (K23DA043418)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
Keywords
sexual minority men, HIV prevention, mental health, substance use, alcohol consumption, drug use, sexual risk behavior, antiretroviral therapy adherence, healthcare engagement, intervention intensity
MeSH terms
Sexual and Gender Minorities, Treatment Adherence and Compliance, Syndemic, Alcohol Drinking, Behavior Therapy, Clinical Trials as Topic, Humans, Male, Mental Health, Sexual Behavior, Health Behavior, HIV Infections, Substance-Related Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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