Biopsychosocial Intervention Paper Example

1.0 Introduction

The P18 articles suggest that bioecological factors may negatively influence the overall health and wellbeing of the participants that took part in distinct studies. Consequently, an effective HIV/AIDS prevention intervention ought to be composed of multiple components, encompassing these factors. The components include (1) an app-based mindfulness training section, (2) a short-message service (SMS)-based text piece, (3) a health care advocacy module, and (4) a patient-navigator component. The app-based mindfulness section will target loneliness and stress mindsets with the goal of mitigating the degree of perceived social isolation, enhancing overall self-esteem, and attenuating maladaptive stress responses. The SMS piece will be educational in nature and target common stressors faced by queer men and trans women with the goal of increasing knowledge spanning across multiple domains (e.g., health, financial, social, etc.). The health care advocacy module will target health awareness and agency by increasing health-specific knowledge, pushing the individual to take an active role in his/her healthcare. The patient-navigator component will be used to maximize access to resources and the continuation of care. Each component mentioned above is included in the P18 articles as a standalone model or as a combination approach. While the intervention contains various elements, there exists a hierarchy to these parts. The prioritization of each component will be represented in the charts below. In the first chart, the application of each article to an appropriate intervention component is depicted by checking an X on the applicable box. The second chart depicts the intervention components that are most represented across all P18 articles.

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2.0 Critical Article Review: Key Literature Perspectives

D'Avanzo et al. (2017), "Personality and it's Relation to Mental and Psychosocial Health in Emerging in Adult Sexual Minority Men: The P18 Cohort Study," investigated several variables such as personality, psychosocial factors, and mental health concerns afflicting young sexual minority men (YSMM). The contributing factors presented in the study were:

In light of very few studies on personality-related pathology, Personality Disorder (PD) is often overlooked. Furthermore, Personality Disorder is comorbid with depression and generalized anxiety.

Young sexual minority men (YSMM) who participated in this study (18 to 25 years of age) are representative of a critical stage of development often referred to as "emerging adulthood" which coincides with the developmental stage considered to be the peak age of onset for Personality Disorder.

Personality Disorder is considered to be relatively enduring and pervasive, and it influences behavior and interpersonal functioning.

Contextual factors relevant to gay men and other sexual minority men include perfectionist tendencies towards self-criticism, rigidity, feelings of intense anxiety often related to HIV, and experiences of harassment based on sexual identity, which gives rise to social avoidance and distrust (e.g., self-stigma due to chronic exposure to stigma-related stress).

D'Avanzo et al. (2016), "Demographic, Mental Health, Behavioral, and Psychosocial Factors, Associated with Cigarette Smoking Status Among Young Men Who Have Sex with Men: The P18 Cohort Study," recruited 598 participants between June 2009 and May 2011. The scholars indicated that the following maladaptive behaviors or social stressors might diminish the health and wellbeing of young sexual minority men (YSMM) and men who have sex with other men (MSM):

• Psychosocial factors such as gay community affinity, mental health stressors associated with Post Traumatic Stress Disorder and depression, and behavioral elements such as recent alcohol and drug use were convincingly related to current and former smoking (e.g., syndemic theory).
• Prior studies have noted an absence of relations between internalized homophobia and substance abuse including cigarette smoking, especially among males. However, Pachankis et al, indicates that smoking provides a means of enhancing their masculinity image as to conform to gender role norms or to conceal one's sexual orientation.
• The relationship of gay community acculturation may be more permissive toward substance abuse including cigarettes; however, it requires further examination.

The articles suggest that an approach that is not monolithic be used since different social stressors along with the phenomenon of polysubstance use is more common among sexual minority male substance users.

Greene et al. (2018), "Assessing Gaps in the HIV Care Continuum in Young Men Who Have Sex with Men: The P18 Cohort Study," conducted a P18 study that examined various gaps that contributed to the "drop-offs," which limits progress in improving health outcomes among people living with HIV between the ages of 18 to 24 years of age.

The 2011 report by the Center for Disease Control and Prevention reported that approximately 1.2 million people living with HIV presented the following statistics: 86% were aware of their diagnosis, 40% were engaged in care, 37% were prescribed antiretroviral therapy (ART), and 30% were virally suppressed.

Conversely, people living with HIV between the ages of 18 to 24 years of age had a much more pronounced "drop-off" rates with 49% of those infected with HIV were diagnosed, 22% were engaged in care, 18% were prescribed ART, and 13% were virally suppressed. However, New York State outperformed on all measures.

Disparities in HIV diagnosis have continued to worsen, specifically among gay and bisexual men. The findings from the study suggest that gaps in the HIV continuum may be linked to lack of comprehensive risk reduction-based pre and posttest counseling by trained study staff, failure to link participants to HIV care facilities, inability to adhere to ART resulting from deficits in insurance coverage that can facilitate retention into care.

Halkitis and Perez Figueroa (2013), "Sociodemographic Characteristics Explains Differences in Unprotected Sexual Behavior Among Young HIV-Negative Gay, Bisexual, and Other YMSM in New York City," examined four demographic states (race/ethnicity, socioeconomic status, foreign-born status, sexual orientation) that engender social conditions; therefore, accentuating risk behaviors in the young gay, bisexual and other men who have sex with men (YMSM) population. Some associations that heighten sexual risks include:

• Findings concerning race and ethnicity are associated with sexual risks behaviors and HIV prevalence amongst YMSM was not robust in the multivariable models. However, foreign-born status and perceived socioeconomic status were found to be reliable indicators of unprotected sexual behaviors.
• Foreign-born YMSM who reside within their ethnic community are subject to discrimination and stigma. Nonetheless, the role of foreign-born status and migration progress, specifically, are poorly understood.
• An inadequacy in socioeconomic resources is linked with early initiation of sexual activity and fewer instances of condom use that can result in HIV infection. Furthermore, SES could have a twofold effect by determining the quality of life and health outcomes for HIV-positive individuals.
• Adolescents are least likely to have access to healthcare; therefore, YMSM of color with limited access to public health care are more likely to engage in sexual risk-taking and to be unvaccinated for viral pathogens.
• Future interventions must consider more than race/ethnicity and include foreign-born and low SES young gay and bisexual men. Hence, the interactive effects of race, culture, sexual orientation, SES, and foreign-born status must be considered in tandem when designing an intervention.

Halkitis et al. (2013), "Individual, Psychosocial, and Social Correlates of Unprotected Anal Intercourse in a New Generation of Young Men Who Have Sex with Men in New York City," examined individual-level characteristics (MSM aged 18 to 19 years of age) by taking into account both protective and harmful psychosocial states that may either safeguard against or exacerbate susceptibilities that function as drivers of HIV-related sexual risk behaviors.

For young men who have sex with other men (MSM), transitional periods, especially, around the formation of sexual identity as well as coming out to family members and peers may increase exposure to HIV.

Previous research suggests that individuals with a history of arrest or incarceration are more likely to engage in greater sexual risk behaviors. In addition, a twofold effect influenced by a lack of availability of condoms in prison settings and consensual and nonconsensual sex may increase the risk of unprotected anal intercourse (UAI).

Likewise, a cofactor association consisting of unstable housing, homelessness, and arrest history may limit employment opportunities that could lead to sexual victimization, sex work, sexual risk behaviors, and substance abuse.

The baseline date for this cohort of MSM suggested that individual factors such as being in a relationship with another man were the sturdiest predictor of engaging in (UAI).

Moreover, a subset of young MSM engage in UAI only with a primary partner or only with HIV-seroconcordant mates, thus negotiating safer sexual practices. However, partners who engage in UAI with other individuals outside the primary relationship may increase exposure to HIV.

The article recommends that a broader more comprehensive approach that entails an individual and dyad-level component in HIV prevention interventions must be developed for young MSM.

Halkitis et al. (2014), "Modeling Substance Use in Emerging Adult Gay, Bisexual, and Other YMSM Across Time: The P18 Cohort Study," analyzed patterns of substance use over a period in a new generation of emerging adult gay, bisexual, and other young men who have sex with men (YMSM). Some aspects that increased the risk for substance use involve:

• The unique challenges of emerging adulthood (e.g., leaving their families and home and pronounced engagement in their gay community) faced by YMSM, coupled with the experimentation that often accompanies this stage of life suggests greater susceptibility to substance use in YMSM. Furthermore, a symbiotic relationship between substance use, HIV, and sexually transmitted infections (STI) is prevalent among emerging adult sexual minority men.
• An increase in substance use may be attributable to the development of men's sexual identities over time. As young men develop their sexual identities, they may progressively engage with gay and sexual minority cultures and venues where substance use tends to be normative.
• The study indicated high levels of marijuana and alcohol use as the primary substances affecting YMSM.

The article suggests that an intervention program must be specific to the conditions of this developmental stage as young men form their identities as gay and bisexual men. Also, the development of drug and alcohol prevention programming at both the structural and behavioral level could prove effective in restructuring the trajectories into substance use.

Halkitis et al. (2015), "Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM: The P18 Cohort Study," evaluated the incidence of HIV among a cohort of racially/ethnically and socioeconomically diverse YMSM and the demographic, behavioral, a...