Scholars@Duke
Ashleigh Rich

Ashleigh Rich

Adjunct Associate in the School of Nursing
School of Nursing

Selected Publications

Trends in mental health and smoking disparities between sexual minority and heterosexual adults in Canada, 2003–2020

Journal Article SSM - Population Health · September 1, 2024 Sexual minority populations experience a higher burden of mental health and substance use/misuse conditions than heterosexual comparators—a health inequality that has predominantly been attributed to forms of minority stress experienced by the former group ... Full text Cite

The forecasted prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030: A modeling study.

Journal Article PLoS medicine · January 2024 BackgroundEstimating the medical complexity of people aging with HIV can inform clinical programs and policy to meet future healthcare needs. The objective of our study was to forecast the prevalence of comorbidities and multimorbidity among peopl ... Full text Cite

Health status of transgender people globally: A systematic review of research on disease burden and correlates.

Journal Article PloS one · January 2024 Background and objectivesTransgender and gender diverse (trans) health research has grown rapidly, highlighting the need to characterize the scientific evidence base. We conducted a systematic review of peer-reviewed research on disease burden and ... Full text Cite

Impact of subgroup-specific heterogeneities and dynamic changes in mortality rates on forecasted population size, deaths, and age distribution of persons receiving antiretroviral treatment in the United States: a computer simulation study.

Journal Article Annals of epidemiology · November 2023 PurposeModel-based forecasts of population size, deaths, and age distribution of people with HIV (PWH) are helpful for public health and clinical services planning but are influenced by subgroup-specific heterogeneities and changes in mortality ra ... Full text Cite

Cardiovascular Disease Risk Estimation for Transgender and Gender-Diverse Patients: Cross-Sectional Analysis of Baseline Data From the LITE Plus Cohort Study

Journal Article AJPM Focus · September 1, 2023 Introduction: Approximately 2% of the U.S. population identifies as transgender, and transgender people experience disproportionate rates of cardiovascular disease mortality. However, widely used cardiovascular disease risk estimators have not been validat ... Full text Cite

Brief Report: Interruptions in HIV Prevention and Treatment During the COVID-19 Pandemic: A Cross-Sectional Study of Transgender and Gender Nonbinary Adults in the United States.

Journal Article Journal of acquired immune deficiency syndromes (1999) · July 2023 BackgroundTransgender and gender nonbinary (TNB) people have been disproportionately affected by HIV and the COVID-19 pandemic. This study explored the prevalence of HIV prevention and treatment (HPT) interruptions during the pandemic and identifi ... Full text Cite

Access to and quality of care for sexual and gender minority women living with HIV in Metro Vancouver, Canada: Results from a longitudinal cohort study.

Journal Article Women's health (London, England) · January 2023 BackgroundWhile scarce, literature suggests that women at the intersection of HIV status and gender and/or sexual minority identities experience heightened social and health disparities within health care systems.ObjectivesThis study exam ... Full text Cite

Effects of Race and Gender Classifications on Atherosclerotic Cardiovascular Disease Risk Estimates for Clinical Decision-Making in a Cohort of Black Transgender Women.

Journal Article Health equity · January 2023 IntroductionDespite their dynamic, socially constructed, and imprecise nature, both race and gender are included in common risk calculators used for clinical decision-making about statin therapy for atherosclerotic cardiovascular disease (ASCVD) p ... Full text Cite

Preventable mortality among sexual minority Canadians

Journal Article SSM - Population Health · December 1, 2022 Background: Epidemiologic studies point to multiple health inequities among sexual minority people, but few studies have examined mortality. Some causes of death are more preventable than others, and access to prevention is theorized to follow patterns of ... Full text Cite

Longitudinal HIV care outcomes by gender identity in the United States.

Journal Article AIDS (London, England) · November 2022 ObjectiveDescribe engagement in HIV care over time after initial engagement in HIV care, by gender identity.DesignObservational, clinical cohort study of people with HIV engaged in routine HIV care across the United States.Methods Full text Cite

Hosts as Gatekeepers for North American Gay and Bisexual Men's Private Group Sex Parties.

Journal Article Journal of homosexuality · July 2022 Gay and bisexual men's (GBM) group sex parties are considered HIV risk environments due to their association with concurrent sexual partners, condomless anal sex, and polysubstance use. The possibility of group sex party hosts acting as gatekeepers to mini ... Full text Cite

Health of two-spirit, lesbian, gay, bisexual and transgender people experiencing poverty in Canada: a review.

Journal Article Health promotion international · February 2022 Two-spirit, lesbian, gay, bisexual and transgender (2SLGBTQ+) people are disproportionately represented among those experiencing poverty. Both 2SLGBTQ+ people and people experiencing poverty face poorer health outcomes and greater difficulty accessing heal ... Full text Cite

Development of a computable phenotype to identify a transgender sample for health research purposes: a feasibility study in a large linked provincial healthcare administrative cohort in British Columbia, Canada.

Journal Article BMJ open · March 2021 ObjectivesInnovative methods are needed for identification of transgender people in administrative records for health research purposes. This study investigated the feasibility of using transgender-specific healthcare utilisation in a Canadian pop ... Full text Cite

Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood.

Journal Article Social psychiatry and psychiatric epidemiology · February 2021 PurposeSexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orie ... Full text Cite

Longitudinal Analysis of HIV Risk and Substance Use Patterns for Men Who Have Sex With Men and Women and Men Who Have Sex With Men Only

Journal Article Journal of Bisexuality · January 1, 2021 Men who have sex with men and women (MSMW) experience discrimination from same-sex and heterosexual communities partially because of perceptions that they engage in high-risk sexual behavior, have elevated polysubstance use levels, and constitute an HIV br ... Full text Cite

Non-HIV chronic disease burden among transgender populations globally: A systematic review and narrative synthesis

Journal Article Preventive Medicine Reports · December 1, 2020 Chronic disease is a growing concern for research, policy and clinical care. While the global burden of HIV for transgender populations has been comprehensively covered in recent systematic reviews, the same is not true for the burden of other chronic dise ... Full text Cite

Identifying Health Differences Between Transgender and Cisgender Gay, Bisexual and Other Men Who Have Sex With Men Using a Community-Based Approach.

Journal Article Journal of sex research · October 2020 In this article, we describe a community-based research (CBR) approach to making a national online survey of gay, bisexual, and other men who have sex with men (GBMSM) inclusive of transgender GBMSM by working with members of the transgender community at a ... Full text Cite

Biopsychosocial Mechanisms Linking Gender Minority Stress to HIV Comorbidities Among Black and Latina Transgender Women (LITE Plus): Protocol for a Mixed Methods Longitudinal Study.

Journal Article JMIR research protocols · April 2020 BackgroundBlack and Latina transgender women (TW) experience a disparate burden of HIV and related comorbidities, including poor mental health and cardiovascular disease (CVD) risks. Pervasive multilevel stigma and discrimination operate as psycho ... Full text Cite

Characterizing the Human Immunodeficiency Virus Care Continuum Among Transgender Women and Cisgender Women and Men in Clinical Care: A Retrospective Time-series Analysis.

Journal Article Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · March 2020 BackgroundPrior studies suggest that transgender women (TW) with human immunodeficiency virus (HIV) are less likely to be virally suppressed than cisgender women (CW) and cisgender men (CM). However, prior data are limited by small sample sizes an ... Full text Cite

Cardiovascular disease risk among transgender women living with HIV in the United States.

Journal Article PloS one · January 2020 BackgroundTransgender women (TW) are disproportionately affected by both HIV and cardiovascular disease (CVD).ObjectivesWe aim to quantify prevalence of elevated predicted CVD risk for TW compared to cisgender women (CW) and cisgender men ... Full text Cite

A Computable Phenotype Model for Classification of Men Who Have Sex With Men Within a Large Linked Database of Laboratory, Surveillance, and Administrative Healthcare Records

Journal Article Frontiers in Digital Health · January 1, 2020 Background: Most public health datasets do not include sexual orientation measures, thereby limiting the availability of data to monitor health disparities, and evaluate tailored interventions. We therefore developed, validated, and applied a novel computa ... Full text Cite

Longitudinal Event-Level Analysis of Gay and Bisexual Men's Anal Sex Versatility: Behavior, Roles, and Substance Use.

Journal Article Journal of sex research · November 2019 Gay and bisexual Men Who Have Sex with Men (GBM) are sexually unique in that they can practice penile-anal sex versatility, i.e. engage in insertive and receptive anal sex. Individual-level versatility is extensively researched both as a sexual behavior li ... Full text Cite

Perceived Barriers to Mental Health Services Among Canadian Sexual and Gender Minorities with Depression and at Risk of Suicide.

Journal Article Community mental health journal · November 2019 This study examines barriers to mental health services among sexual and gender minorities (SGM) who screened positive for depression and risk of suicide. Data from an online survey of SGM (N = 2778) are analyzed. 37.5% met criteria for depression and 73.6% ... Full text Cite

The Need and Desire for Mental Health and Substance Use-Related Services Among Clients of Publicly Funded Sexually Transmitted Infection Clinics in Vancouver, Canada.

Journal Article Journal of public health management and practice : JPHMP · May 2019 ContextSexually transmitted infections (STI) and mental health and substance use (MHSU) disorders all occur at elevated rates in sexual and gender minorities. These overlapping epidemics, or syndemics, are exacerbated by challenges these same popu ... Full text Cite

Substance Use as a Mechanism for Social Inclusion among Gay, Bisexual, and Other Men Who Have Sex with Men in Vancouver, Canada.

Journal Article Substance use & misuse · January 2019 Background: Previous research demonstrates that substance use preferences and social-sexual environments are highly interrelated for gay, bisexual, and other men who have sex with men (gbMSM). Objective: We conducted a qualitative study to ex ... Full text Cite

Associations between sexual partner number and HIV risk behaviors: implications for HIV prevention efforts in a Treatment as Prevention (TasP) environment.

Journal Article AIDS care · October 2018 Previous research indicates that gay and bisexual men (GBM) have significantly more sexual partners than same-aged heterosexual men and women. As a result, some HIV intervention programs have focused on partner reduction. However, new research findings que ... Full text Cite

Substance Use Patterns of Gay and Bisexual Men in the Momentum Health Study.

Journal Article American journal of men's health · September 2018 Research with male sexual minorities frequently combines gay and bisexual men as Men Who Have Sex with Men or Gay and Bisexual Men. When analyzed separately, bisexual men consistently feature negative health differentials, exemplified by higher substance u ... Full text Cite

Sexual Orientation Measurement, Bisexuality, and Mental Health in a Sample of Men Who Have Sex with Men in Vancouver, Canada

Journal Article Journal of Bisexuality · July 3, 2018 This cross-sectional study used a validated index (i.e., Hospital Anxiety and Depression Scale) to measure anxiety and depression (caseness score: ≥8) among men who have sex with men recruited via respondent-driven sampling in Vancouver, Canada (N = 774) a ... Full text Cite

Repeated Measures Analysis of Alcohol Patterns among Gay and Bisexual Men in the Momentum Health Study.

Journal Article Substance use & misuse · April 2018 BackgroundThis study analyzed repeated study visits (n = 2,624) of 693 gay and bisexual men (GBM) in the Momentum Health Study from July, 2012 to June, 2015. Based on recent cross-sectional analyses, we hypothesized that over the study period: (1) ... Full text Cite

Estimating the Size of the MSM Population in Metro Vancouver, Canada, Using Multiple Methods and Diverse Data Sources.

Journal Article Journal of urban health : bulletin of the New York Academy of Medicine · April 2018 Men who have sex with men (MSM) are disproportionately affected by HIV globally, regionally in Canada, and locally in Vancouver. Lack of reliable population size estimates of MSM impedes effective implementation of health care services and limits our under ... Full text Cite

Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment.

Journal Article Journal of homosexuality · January 2018 British Columbia's treatment as prevention policy has provided free access to highly active antiretroviral therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppr ... Full text Cite

Sexual HIV risk among gay, bisexual and queer transgender men: findings from interviews in Vancouver, Canada.

Journal Article Culture, health & sexuality · November 2017 Gay, bisexual, queer and other men who have sex with men are disproportionately affected by HIV in Canada. While up to 63% of transgender men identify as gay, bisexual or queer and report a variety of HIV sexual risk behaviours, transgender men are often o ... Full text Cite

Does age matter? Sexual event-level analysis of age-disparate sexual partners among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada.

Journal Article Sexually transmitted infections · August 2017 BackgroundTo determine factors associated with age-disparate sexual partners among Vancouver gay, bisexual and other men who have sex with men (GBM).MethodsSexually active GBM aged ≥16 years were recruited from February 2012 to February 2 ... Full text Cite

Exploring the role of sex-seeking apps and websites in the social and sexual lives of gay, bisexual and other men who have sex with men: a cross-sectional study.

Journal Article Sexual health · June 2017 Background The objective of this study was to explore the relationship between online sex-seeking, community/social attachment and sexual behaviour.MethodsRespondent-driven sampling was used to recruit 774 sexually active gay and bisexual men in V ... Full text Cite

Lifetime Doctor-Diagnosed Mental Health Conditions and Current Substance Use Among Gay and Bisexual Men Living in Vancouver, Canada.

Journal Article Substance use & misuse · May 2017 BackgroundStudies have found that gay, bisexual, and other men who have sex with men (GBM) have higher rates of mental health conditions and substance use than heterosexual men, but are limited by issues of representativeness.ObjectivesTo ... Full text Cite

Seroadaptive Strategies of Gay & Bisexual Men (GBM) with the Highest Quartile Number of Sexual Partners in Vancouver, Canada.

Journal Article AIDS and behavior · May 2017 Despite continued research among men with more sexual partners, little information exists on their seroadaptive behavior. Therefore, we examined seroadaptive anal sex strategies among 719 Vancouver gay and bisexual men (GBM) recruited using respondent-driv ... Full text Cite

An Event-Level Analysis of the Interpersonal Factors Associated With Condomless Anal Sex Among Gay, Bisexual, and Other Men Who Have Sex With Men (MSM) With Online-Met Partners.

Journal Article AIDS education and prevention : official publication of the International Society for AIDS Education · April 2017 The interpersonal determinants of condomless anal sex (CAS) within online-initiated sexual relationships remain poorly understood. Therefore, respondent-driven sampling was used to recruit a prospective cohort of sexually active gay, bisexual, and other me ... Full text Cite

An Event-Level Analysis of Condom Use During Anal Intercourse Among Self-Reported Human Immunodeficiency Virus-Negative Gay and Bisexual Men in a Treatment as Prevention Environment.

Journal Article Sexually transmitted diseases · December 2016 BackgroundWe sought to identify factors associated with condom use during anal intercourse among self-identified human immunodeficiency virus-negative gay, bisexual, and other men who have sex with men (GBM) in Vancouver, Canada following "treatme ... Full text Cite

Does size really matter? A sensitivity analysis of number of seeds in a respondent-driven sampling study of gay, bisexual and other men who have sex with men in Vancouver, Canada.

Journal Article BMC medical research methodology · November 2016 BackgroundRespondent-driven sampling (RDS) is an increasingly used peer chain-recruitment method to sample "hard-to-reach" populations for whom there are no reliable sampling frames. Implementation success of RDS varies; one potential negative fac ... Full text Cite

Awareness and use of nonoccupational post-exposure prophylaxis among men who have sex with men in Vancouver, Canada.

Journal Article HIV medicine · October 2016 ObjectivesNonoccupational post-exposure prophylaxis (nPEP) is a strategy to reduce the risk of HIV infection in those with high-risk exposure. This study characterized nPEP awareness among gay, bisexual and other men who have sex with men (MSM) in ... Full text Cite

Event-Level Analysis of Anal Sex Roles and Sex Drug Use Among Gay and Bisexual Men in Vancouver, British Columbia, Canada.

Journal Article Archives of sexual behavior · August 2016 This study analyzed event-level partnership data from a computer-assisted survey of 719 gay and bisexual men (GBM) enrolled in the Momentum Health Study to delineate potential linkages between anal sex roles and the so-called "sex drugs," i.e., erectile dy ... Full text Cite

Pre-exposure Prophylaxis Awareness Among Gay and Other Men who have Sex with Men in Vancouver, British Columbia, Canada.

Journal Article AIDS and behavior · July 2016 Men who have sex with men (MSM) account for approximately half of Canada's new HIV infections. Pre-exposure prophylaxis (PrEP), a recently established and effective HIV prevention tool for MSM is currently not approved nor publicly funded. We recruited MSM ... Full text Cite

HIV Community Viral Load and Factors Associated With Elevated Viremia Among a Community-Based Sample of Men Who Have Sex With Men in Vancouver, Canada.

Journal Article Journal of acquired immune deficiency syndromes (1999) · May 2016 BackgroundWe developed estimates of community viral load (VL) and risk factors for unsuppressed VL from a cross-sectional study of men who have sex with men (MSM) in Vancouver, Canada.MethodsMSM were recruited from February 25, 2012 to Fe ... Full text Cite

Including Online-Recruited Seeds: A Respondent-Driven Sample of Men Who Have Sex With Men.

Journal Article Journal of medical Internet research · March 2016 BackgroundTechnology has changed the way men who have sex with men (MSM) seek sex and socialize, which may impact the implementation of respondent-driven sampling (RDS) among this population. Initial participants (also known as seeds) are a critic ... Full text Cite

Substance use, sexual behaviour and prevention strategies of Vancouver gay and bisexual men who recently attended group sex events.

Journal Article Culture, health & sexuality · January 2016 Group sex events are an epidemiologically important part of some gay and bisexual men's sexual culture in Canada. Associated with condomless anal intercourse and polysubstance use, such events have been cited as disproportionally contributing to HIV infect ... Full text Cite

Gay and bisexual men's awareness and knowledge of treatment as prevention: findings from the Momentum Health Study in Vancouver, Canada.

Journal Article Journal of the International AIDS Society · January 2015 IntroductionAwareness and knowledge of treatment as prevention (TasP) was assessed among HIV-positive and HIV-negative gay, bisexual and other men who have sex with men (GBMSM) in Vancouver, Canada.MethodsBaseline cross-sectional survey d ... Full text Cite

Association between childhood physical abuse, unprotected receptive anal intercourse and HIV infection among young men who have sex with men in Vancouver, Canada.

Journal Article PloS one · January 2014 IntroductionThe association between childhood sexual abuse and HIV risk among men who have sex with men (MSM) is well established. However, no studies have examined the potential impact of other forms of childhood maltreatment on HIV incidence in ... Full text Cite

Community mapping and respondent-driven sampling of gay and bisexual men's communities in Vancouver, Canada

Journal Article Culture, Health and Sexuality · January 1, 2014 Literature suggests formative research is vital for those using respondent-driven sampling (RDS) to study hidden populations of interest. However, few authors have described in detail how different qualitative methodologies can address the objectives of fo ... Full text Cite