Browsing by Author "Kongjareon Y."

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    A Syndemic Clustering of Adversities on Suicide Risk among YMSM Living with HIV in Bangkok: A Causal Latent Class Analysis
    (2025-01-01) Cheung D.H.; Waratworawan W.; Kongjareon Y.; Jonas K.J.; Lim S.H.; Reeves A.N.; Guadamuz T.E.; Cheung D.H.; Mahidol University
    This study investigated the clustering of psychosocial adversities and their synergistic effect with depression on suicidality in a 12-month prospective cohort (N = 214) of YMSM living with HIV in Bangkok, Thailand. Latent class analysis identified subgroups with distinct combinations of adversities, including bullying, intimate partner violence, substance use, HIV stigma, low social support, histories of sex work, and below-income status. Significant interactive synergism were found as hypothesized, supporting a syndemic effect with qualitatively increasing levels of adversities on suicidality (score range: 3–17) over the 12 months. The interaction between moderate adversity clustering and depression (βow = 2.50, 95% CI: 1.12–3.88) and high adversity clustering and depression (βow = 3.61, 95% CI: 1.12–6.09) indicated that the impact of depression on suicidality was modified by pre-existing adversities. The findings suggest that, while a multi-component intervention addressing psychosocial problems is ideal, effective depression treatment alone could significantly reduce suicidality among YMSM living with HIV.
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    Effects of intimate partner violence and homophobic bullying on ART adherence among young Thai men who have sex with men: a causal mediation analysis
    (2025-12-01) Cheung D.H.; Reeves A.N.; Waratworawan W.; Kongjareon Y.; Guadamuz T.E.; Cheung D.H.; Mahidol University
    Background: Adherence to antiretroviral therapy is crucial for determining health outcomes and secondary HIV transmission among people living with HIV/AIDS. Young men who have sex with men (YMSM) living with HIV are often challenged by the prevailing experiences of psychosocial stressors such as intimate partner violence and homophobic bullying, which may negatively affect their HIV care engagement. Methods: This study is the first to utilize a prospective cohort design (N = 185) involving YMSM living with HIV in Thailand. We examined the effects of intimate partner violence and homophobic bullying on ART adherence. We also tested the mediating effect of depression on the relationship between intimate partner violence and homophobic bullying and ART adherence. Results: We found that intimate partner violence (AOR: 2.58, 95% CI: 1.13, 5.42) and homophobic bullying (AOR: 2.40, 95% CI: 1.26, 4.48) were associated with subsequent ART nonadherence. Moreover, depression partially mediated 17.4% (95% CI: 0.75%–56%) of the effect of homophobic bullying on ART nonadherence. Conclusions: The results suggest that tailored interventions to optimize ART adherence should address the impact of intimate partner violence and homophobic bullying among YMSM living with HIV. Screening and subsequent treatment of depression alone may not be sufficient to address the effects of intimate partner violence, homophobic bullying, and possibly other MSM-specific psychosocial stressors on ART adherence.
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    Partying in Thailand: Never Testing Among Men Who Have Sex With Men Who Attend Sexualized (Drug) Parties
    (2024-05-01) Cheung D.H.; Samoh N.; Jonas K.; Lim S.H.; Kongjareon Y.; Guadamuz T.E.; Cheung D.H.; Mahidol University
    BACKGROUND: Human immunodeficiency virus (HIV) testing for Thai men who have sex with men (MSM) is suboptimal, which undermines their linkage to care and subsequent HIV preexposure prophylaxis (PrEP) uptake. METHODS: We analyzed a cross-sectional survey conducted in 2021 among Thai MSM who attended any private sex parties or circuit parties in the past 3 years ("sexualized parties"). RESULTS: Of the 424 men included in our analysis, 47.6% had been recently tested for HIV in the past 1 year, 30.2% had not recently been tested, and 22.2% had never been tested. In our multivariable analysis, relative to participants who had recently tested for HIV, those who have never tested were more likely to have lower education or to live outside of Bangkok, and to have attended both circuit and private sex parties (vs. private sex party only) but were less likely to report any sexually transmitted infection diagnosis or to have heard of PrEP. Participants who had an HIV test more than a year ago were more likely to have attended both circuit and private sex parties (vs. private sex parties only) but were less likely to have any sexually transmitted infection diagnosis, meet sexual partners online, or have heard of PrEP. Rates of condomless anal sex and willingness to use PrEP were similar across groups. CONCLUSIONS: Despite the high rates of sexual risk-taking, sexualized party attendees reported suboptimal HIV testing uptake. The joint promotion of HIV testing and PrEP is warranted-especially on-premise HIV testing at circuit parties and outreach at online platforms to reach sexualized party attendees.
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    Patterns of Chemsex Substance Use and Its Association with HIV Transmission Risk Among Men Who Have Sex with Men in Thailand: A Latent Class Analysis
    (2024-01-01) Cheung D.H.; Samoh N.; Jonas K.J.; Lim S.H.; Kongjareon Y.; Guadamuz T.E.; Cheung D.H.; Mahidol University
    Sexualized substance use or “chemsex” may contribute to the HIV epidemic among men who have sex with men (MSM) in Thailand. Specific patterns of chemsex use may be associated with different HIV/STI transmission risks. We examined typologies and correlates of sexualized substance use among a sample of high-risk MSM (n = 532) who had attended a private sex party or circuit party in the past three years using latent class analysis. Multinomial regression was used to adjust for variables associated with the 3-class latent class model. We identified a 3-class model as the best fitting model, which included: (1) “negligible sexualized substance users” (36.7%), who had never engaged in chemsex in the past six months; (2) “sexualized substance users” (13.9%), who had a high level of sexualized alcohol use and a wide range of other substances before or during sex in the past six months; and (3) “exclusive chemsex users” (49.4%), who predominantly used crystal methamphetamine, amyl nitrite, and erectile dysfunctional drugs before or during sex in the past six months. Compared to negligible sexualized substance users, exclusive chemsex users were more likely to be HIV-positive, more likely to have six or more sexual partners in the past six months, less likely to have condom use at last anal intercourse, and more likely to have provided sex work. Relative to negligible sexualized substance users, sexualized substance users reported more frequent online sex-seeking behaviors. These subgroups of Thai MSM have unique substance use patterns and HIV-related risk profiles, underscoring the importance of targeted HIV prevention strategies.
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    Pride-based violence, intoxicated sex and poly-drug use: a vocational school-based study of heterosexual and LGBT students in Bangkok
    (2022-12-01) Kongjareon Y.; Samoh N.; Peerawaranun P.; Guadamuz T.E.; Mahidol University
    Background: In Thailand, drug use is widely observed, especially among vocational-school students, who are more inclined to use various types of drugs and to experience pride-based violence (violence based on institutional pride, honor, or on seniority status) than any other groups of students. Drug use contexts differ based on sexual orientation and gender identity (e.g., clubs). This study aims to examine the prevalence and correlates of poly-drug use (the use of at least three types of drugs) among vocational-school students, with a focus on sexual orientation and gender identity. Methods: In this study, 638 vocational school students living in Bangkok metropolitan area participated in a three-year longitudinal survey of four vocational schools. Experiences of violence, sexual behaviours, and poly-drug use were assessed and analyzed using multivariable logistic regression. Results: About one tenth of all students (11.3%) reported poly-drug use, a fifth among Lesbian, Gay, Bisexual and Transgender (LGBT) students (20.2%) and almost a tenth of heterosexual students (9.8%). In the multivariable logistic model of LGBT students, GPA, pride-based violence, intoxicated sex, and counseling needs were significantly associated with poly-drug use (AOR = 4.62; 95% CI 1.17–18.29, AOR = 6.01; 95% CI 1.31–27.32, AOR = 5.17; 95% CI 1.10–24.28, AOR = 4.64; 95% CI 1.16–18.54, respectively). Likewise, among heterosexual students, GPA and intoxicated sex were significantly associated with poly-drug use (AOR = 2.02; 95% CI 1.09–3.75, AOR = 5.31; 95% CI 2.81–10.04, respectively). Conclusions: LGBT vocational-school students have significantly higher prevalence of poly-drug use than their heterosexual peers. Correlates include lower GPA, having experienced pride-based violence and intoxicated sex. School-based intervention programs should also address pride-based violence and intoxicated sex in their harm reduction programs.
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    Sexual and Psychosocial Risk Burdens Associated With Online Sex Seeking Among Young Men Who Have Sex With Men: Cross-Sectional Study
    (2025-01-01) Cheung D.H.; Waratworawan W.; Clatts M.C.; Colby D.; Le G.M.; Kongjareon Y.; Do L.A.T.; Guadamuz T.E.; Cheung D.H.; Mahidol University
    Background: The heightened HIV vulnerability associated with men who have sex with men (MSM) who find sex online in Western and East Asian countries may pose similar concerns for MSM in Southeast Asia. However, this line of research is underexamined among Southeast Asian MSM, especially in Southeast Asian cities with a high HIV prevalence among young MSM, such as Ho Chi Minh City, Vietnam. Objective: This study aimed to characterize the sexual behavioral and psychosocial correlates of online sex seeking in a sample of largely gay-identified young MSM in Ho Chi Minh City, Vietnam, and examine the relationships among social support, outness, and last instance of condomless anal sex while not on preexposure prophylaxis (PrEP) for HIV or antiretroviral therapy (ART). The analysis included specific attention paid to the use of different types of online sex platforms, which may contribute to the understanding of online sex seeking. Methods: Patterns of online sex seeking in a cross-sectional sample of young MSM (N=1005) were identified using latent class analysis. Multinomial logistic regressions and Poisson regressions with robust variance were used to estimate the associations between patterns of online sex seeking and other participant characteristics. Results: We found four latent classes of MSM with distinct profiles of online platform use for sex seeking: (1) negligible app users, (2) gay app users, (3) poly app users, and (4) low-cost app users. Patterns of online sex seeking moderated the protective effects of social support and outness on last instance of condomless anal sex while not on PrEP or ART. When stratified by level of social support and outness, only gay app users were associated with a protective effect on last instance of condomless anal sex while not on PrEP or ART when social support and outness were high, respectively. Low-cost app users were marginally associated with a higher prevalence of condomless anal sex while not on PrEP or ART when the level of outness was low. Conclusions: Young Vietnamese MSM who find sex partners online have distinct patterns of app use, with contrasting sexual and psychosocial health burdens that indicate that online sex seeking is a socially patterned behavior. HIV prevention programs and tailored digital interventions should consider the different exposures to social influences associated with patterns of social networking app use as they could moderate the effectiveness of the delivered programs and interventions for reducing HIV vulnerability in young MSM.
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    Sexual orientation disclosure and depression among Thai gay, bisexual, and other men who have sex with men: The roles of social support and intimate partner violence
    (2023-01-01) Encina E.; Waratworawan W.; Kongjareon Y.; Desai M.M.; Guadamuz T.E.; Mahidol University
    BACKGROUND: Among gay, bisexual, and other men who have sex with men (GBM), sexual orientation disclosure to social groups can act as a significant risk for depression. The primary goal of this research is to understand the association between disclosure and depression, the association of social support and intimate partner violence (IPV) experiences, depression, and disclosure. METHODS: This project uses a secondary dataset of Thailand from a larger cross-sectional study distributed in the Greater Mekong Sub-Region. This study utilized web-based answers from 1468 Thai GBM respondents between the ages of 15-24 years. RESULTS: Prevalence of depression was over 50%. Across the social groups of interest, those who disclosed to everyone had the lowest depression prevalence. This association was statistically significant for all groups (p<0.050) except for "Family members" (p = 0.052). There was a statistically significant association illustrated between full disclosure to social groups and increased social support. Most respondents (43.9%) had low social support, and additionally this group had the highest level of depression, compared to those with high social support. There was a statistically significant association for lowered depression outcomes and increased social support. IPV experiences that occurred within the last six months had a statistically significant relationship with depression (p = 0.002). There was a notable association between those with experiences of being a victim of IPV, alone and in conjunction with experience of being a perpetrator of IPV, which was associated with increased odds of depression. However, the type of IPV experiences an individual had did not differ based on disclosure status. DISCUSSION: This study provides strengthened evidence of the impact that differences in supportive networks can have on mental health outcomes. In addition, they provided a wider consideration for how people may have different IPV experiences, either as a perpetrator, victim, or both, and how those shapes health outcomes of depression. GBM communities still face adversity and challenges that affect their long-term health outcomes, even if they do live in what is considered an accepting country.
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    The Moderating Role of Social Support and HIV Stigma on the Association Between Depression and ART Adherence Among Young Thai Men Who Have Sex with Men
    (2023-01-01) Mireles L.; Horvath K.J.; Guadamuz T.E.; Waratworawan W.; Kongjareon Y.; Meyers-Pantele S.A.; Mahidol University
    In Thailand, antiretroviral therapy (ART) programs still have difficulties reaching and promoting adherence among a key population - young men who have sex with men (YMSM) living with HIV. As such, we sought to examine potential psychosocial barriers that may contribute to suboptimal levels of ART adherence for this population. Data were drawn from a study of 214 YMSM living with HIV from Bangkok, Thailand. Linear regression models tested the association between depression and ART adherence, and whether social support and HIV-related stigma moderated that relationship. Multivariable models demonstrated social support was significantly associated with higher levels of ART adherence, and that there was a three-way interaction between depression, social support, and HIV-related stigma on ART adherence. These results further our understanding of the role of depression, stigma, and social support in ART adherence among Thai YMSM living with HIV, and that additional supports for YMSM with depression and HIV-related stigma are needed.