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Shrader CH, Stephenson R, Moody R, Knox J. Binge Drinking Moderates Unprotected Sex Among HIV Sero-Similar Same Sex Male Couples: An Actor-Partner Interdependence Model. AIDS Behav 2023; 27:1824-1835. [PMID: 36441407 PMCID: PMC10149586 DOI: 10.1007/s10461-022-03914-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/29/2022]
Abstract
Most new HIV diagnoses in the US occur among sexual minority men (SMM). The majority (69%) of new HIV diagnoses among US SMM are due to transmission from main sex partners. We identified multilevel correlates of unprotected anal intercourse (UAI; condomless anal intercourse while not using a biomedical strategy) among SMM couples using the Actor Partner Interdependence Model (APIM). Participants were US SMM over 18 years, with a primary male partner > 6 months. Couples were recruited online from April 2016 until June 2017 and interviewed using self-administered computer-assisted surveys. We used a series of APIM regressions to assess multilevel associations with UAI. We also tested the moderating role of an individual's binge drinking on the relationship between HIV status similarity and UAI. Among 798 participants (n = 411 couples), 61% reported UAI in the past 6 months. Binge drinking (52%) and physical intimate partner violence (IPV; 34%) were considerably high within our sample. Actor's binge drinking, reporting experiencing and/or perpetrating physical IPV, and partner's trust were positively associated with UAI. Actor having other sexual partner(s), using illegal drugs (not marijuana), and length of relationship were negatively associated with UAI. Binge drinking positively moderated UAI among HIV serostatus similar partners. HIV prevention programming should integrate components on IPV and binge drinking reduction- especially among HIV serostatus similar couples.
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Affiliation(s)
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Raymond Moody
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA.
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA.
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
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Aridoss S, David JK, Jaganathasamy N, Mathiyazhakan M, Balasubramanian G, Natesan M, V.M. P, Kumar P, Rajan S, Arumugam E. Spatial heterogeneity of risk factors associated with HIV prevalence among men who inject drugs in India: An analysis of the data from the integrated bio-behavioral surveillance, India. Medicine (Baltimore) 2022; 101:e31688. [PMID: 36482574 PMCID: PMC9726355 DOI: 10.1097/md.0000000000031688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
People who inject drugs (PWID) are India's third-largest vulnerable population to human immunodeficiency virus (HIV) infection. PWID in India are confined to certain geographic locations and exhibit varying injecting and sexual risk behaviors, contributing considerably to increasing HIV trends in specific regions. Spatial heterogeneity in risk factors among vulnerable PWID influences HIV prevalence, transmission dynamics, and disease management. Stratified analysis of HIV prevalence based on risk behaviors and geographic locations of PWID will be instrumental in strategic interventions. To stratify the male PWID based on their risk behaviors in each state and determine the HIV prevalence for each stratum. The behavioral data and HIV prevalence of the national integrated biological and behavioural surveillance (IBBS), a nationwide cross-sectional community-based study conducted in 2014 to 2015, was analyzed. Data from 19,902 men who inject drugs across 53 domains in 29 states of India were included. Women who inject drugs were excluded at the time of IBBS, and hence PWID in this study refers to only men who inject drugs. PWID were categorized based on their risk profile, and the corresponding HIV prevalence for each state was determined. HIV prevalence was the highest (29.6%) in Uttar Pradesh, with a high prevalence of risk behaviors among PWID. High HIV prevalence ranging between 12.1% and 22.4% was observed in a few states in East and North-East India and most states in central and North India. Unsafe injecting and sexual practices were significantly (P < .05) associated with higher HIV prevalence and more significantly in National Capital Territory of Delhi (P < .001). Unsafe injecting practices among PWID were proportionally higher in Western and Central India, whereas unsafe sexual behaviors were widespread among most states. Unsafe sexual practices among male PWID were common. The high prevalence of unsafe injecting had significant HIV infection and transmission risks in Western and Central India. The results emphasize the need for stratified, region-specific interventions and combination approaches for harm reduction among PWID. Strengthening the measures that facilitate the reduction of high-risk behaviors, adoption of safe practices, and utilization of HIV services will positively impact HIV prevention measures among PWID.
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Affiliation(s)
- Santhakumar Aridoss
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Nagaraj Jaganathasamy
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Malathi Mathiyazhakan
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Ganesh Balasubramanian
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Manikandan Natesan
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Padmapriya V.M.
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Pradeep Kumar
- National AIDS Control Organisation, Department of Health & Family Welfare, Government of India, New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organisation, Department of Health & Family Welfare, Government of India, New Delhi, India
| | - Elangovan Arumugam
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
- * Correspondence: Elangovan Arumugam, Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, R-127, 2nd Main Road, TNHB, Ayapakkam, Chennai 600 077, Tamil Nadu, India (e-mail: )
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Vasilenko SA. More than the sum of their parts: A dyad-centered approach to understanding adolescent sexual behavior. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:105-118. [PMID: 35990880 PMCID: PMC9390880 DOI: 10.1007/s13178-020-00528-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 06/03/2023]
Abstract
BACKGROUND Research has documented multiple levels of influences on adolescent sexual behavior, but has generally focused less on the relational nature of this behavior. Studies with dyadic data have provided important findings on relationship process, including the role of gender in different-sex dyads. However, both of these bodies of literature typically utilize a variable-centered approach, which examines average influences of particular variables on sexual behavior. This study expands upon this research by presenting a dyad-centered approach to adolescent sexual behavior that can identify types of couples based on patterns of multidimensional risk and protective factors. METHODS I demonstrate the dyad-centered approach using data from different-sex dyads in the National Longitudinal Study of Adolescent to Adult Health to uncover profiles marked by individual, parent, peer, and religion predictors for both male and female partners. RESULTS Analyses uncovered five classes of dyadic influences, four of which were marked by relative similarity between partners and one marked by lesser approval of sex for women compared to men. Dyads marked by both partners intending to have sex and being in a context that is more approving of sex were more likely to engage in sexual intercourse. CONCLUSIONS Findings demonstrate the heterogeneity of influences and intentions to have sex among adolescent couples, and identify profiles of dyads who are more likely to engage in sexual intercourse. This approach can explicate dyadic processes involved in sexual behavior and the types of couples that exist in a population, leading to more tailored and efficacious interventions.
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Walsh AR, Sullivan S, Stephenson R. Inter-partner Agreement of Condom Use and Sexual Positioning in Male Couples. JOURNAL OF SEX RESEARCH 2022; 59:212-223. [PMID: 33983091 DOI: 10.1080/00224499.2021.1924606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Accurate, reliable self-reports of sexual behavior are a crucial component of valid HIV risk-estimation and behavioral intervention evaluation, yet this data's reliability remains understudied. The goal of this study was to describe interpartner agreement on recent receptive anal intercourse (AI) and condomless receptive AI frequencies, among a sample of male couples. We quantified interpartner agreement on self-reported receptive AI and condomless receptive AI (absolute and relative to AI frequency), and position and condom use during a couple's most recent AI, using cross-sectional data from male partners (US, 2016-2017; N = 718 individuals). Proportional and statistical agreement (intraclass correlation coefficients (ICC), kappa (k)) were assessed. Observed agreement for receptive AI frequency was 49.44% (ICC (95% CI): 0.82(0.79, 0.84)) and for relative receptive frequency, 59.05% (ICC: 0.96 (0.85, 0.96). Agreement on condomless receptive AI was 90.21% (ICC: 0.78 (0.75, 0.82), and for relative condomless receptive AI, 91.15% (ICC: 0.80 (0.77, 0.83). Most recent AI position agreement was 89.42% (k (95% CI): 0.84 (0.80, 0.88)), and condom use, 98.89% (k: 0.82 (0.87, 0.98)). Observed agreement was higher among those who reported consistent positioning and condom use. Further research on self-reported sexual behavior data is needed to improve research validity and intervention effectiveness.
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Affiliation(s)
- Alison R Walsh
- Center for Sexuality and Health Disparities, University of Michigan
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing
| | - Stephen Sullivan
- Center for Sexuality and Health Disparities, University of Michigan
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing
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Firkey M, Sheinfil A, Ramos J, Woolf-King SE. Cannabis and Alcohol Co-Use and Condomless Anal Sex Among Men Who have Sex with Men Living with HIV: An Event-Level Analysis. AIDS Behav 2021; 25:3770-3781. [PMID: 33733310 DOI: 10.1007/s10461-021-03228-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Men who have sex with men (MSM) account for more than two thirds of new HIV diagnoses annually. Sexual behavior that increases risk for onward transmission of HIV is associated with both alcohol and cannabis use. However, little is known about the influence of cannabis and alcohol co-use on engagement in condomless anal sex (CAS). The current study explored daily associations between substance use and CAS among HIV-positive MSM using a 42-day timeline followback interview (N = 101). Generalized estimating equation (GEE) logistic regression models were used to examine the association between cannabis and alcohol co-use and CAS at the sexual event while controlling for study site, condition, adherence to antiretroviral therapy, sex-related alcohol expectancies, and partner type. Participants provided data for 1052 sexual activity days, 60.7% of which involved CAS. Of 638 CAS days, 9.1% involved no substances, 72.0% involved either cannabis or alcohol use, and 18.9% involved cannabis and alcohol co-use. Results indicated that the odds of engaging in CAS were higher for sexual events in which cannabis and alcohol co-use occurred (aOR 2.98; 95% CI 1.27, 6.97) compared to events in which no substance use occurred (p = 0.012), but this relationship was no longer significant when cannabis and alcohol co-use was compared to single substance use (aOR 1.57; 95% CI 0.85, 2.90; p = 0.15). Future research should identify specific substance use (e.g., quantity) and partner characteristics (e.g., level of intoxication) that may uniquely influence the relationship between cannabis and alcohol co-use and condomless sex.
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Jin H, Biello K, Garofalo R, Lurie M, Sullivan PS, Stephenson R, Mimiaga MJ. Better Communication Regarding Sexual Agreements Within Serodiscordant Male Couples Leads to Improved Antiretroviral Therapy Adherence Among the HIV-Positive Partner. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1771-1779. [PMID: 34021459 DOI: 10.1007/s10508-021-01954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
Sexual agreements (SAs)-guidelines that outline what type of sexual behaviors are permissible with sexual partners outside of their primary relationship-are often negotiated within same-sex male relationships to reduce their risk for HIV infection. However, HIV risk is not only a function of sexual behavior, but is also affected by factors such as antiretroviral therapy (ART) adherence. We examined whether HIV-positive partners in serodiscordant male couples who have better communication about SAs and report concordant SAs with their partners have greater odds of being adherent to ART to not only improve their health, but to also reduce the risk of transmitting HIV to partners. We analyzed longitudinal data from 135 HIV-positive partners in serodiscordant male couples recruited from Atlanta, GA, Boston, MA, and Chicago, IL to examine the relationship between optimal ART adherence and two independent variables: communication about SAs and if the couples have discrepant SAs. HIV-positive male partners who reported high levels of communication regarding SAs had nearly three times the odds of optimal adherence to ART compared to those who reported lower levels. The HIV-positive partners with discrepant SAs with their male partner had approximately half the odds of optimal adherence to ART compared to those with concordant SAs. Our findings suggest that integrating communication skills training into dyad-level HIV interventions to improve communication regarding HIV may provide more opportunities for couples to discuss ways of reducing the risk of HIV transmission. Couples may benefit from interventions that assist them in composing SAs.
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Affiliation(s)
- Harry Jin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Johns Hopkins Bloomberg School of Public Health, 615 S Wolfe St., Baltimore, 21205, USA.
| | - Katie Biello
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Robert Garofalo
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Population and Leadership and The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
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Maksut JL, Eaton LA, Driver R, Knowles CM, Watson. RJ. Factors associated with awareness and use of pre-exposure prophylaxis (PrEP) among Black men who have sex with men with a recent STI diagnosis. Behav Med 2021; 47:161-169. [PMID: 34048328 PMCID: PMC8163996 DOI: 10.1080/08964289.2019.1692776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 10/24/2019] [Accepted: 11/09/2019] [Indexed: 01/04/2023]
Abstract
Black men who have sex with men (BMSM) with a recent STI diagnosis are at particularly high risk for HIV infection and, as such, are a population for whom we must focus our antiretroviral pre-exposure prophylaxis (PrEP) implementation efforts. Understanding the factors that are associated with awareness and use of PrEP among BMSM with a recent STI diagnosis is a critical component of meeting our HIV prevention goals. For the current study, BMSM (N = 209) diagnosed with a STI in the past year residing in the Atlanta, Georgia metropolitan and surrounding areas were assessed on PrEP awareness and use, HIV risk behaviors (e.g., condomless anal intercourse) HIV risk perceptions, HIV treatment optimism, and HIV status communication self-efficacy. BMSM aware of PrEP (n = 152, 72.7%) were younger in age (OR = 0.96, 95% CI: 0.93-0.98, p = 0.030) and had significantly higher educational attainment (OR = 1.96, 95% CI: 1.28-3.02, p = 0.027) than PrEP unaware participants. In addition, participants who were aware of PrEP had significantly higher levels of HIV risk perceptions (OR = 1.27, 95% CI: 1.04-1.56, p = 0.019) than PrEP unaware participants. Finally, participants who had ever used PrEP (n = 15, 7.1%) had significantly higher HIV treatment optimism (OR = 1.55, 95% CI: 1.05-2.96, p = 0.034) than PrEP non-users. The present study showed that, while nearly three-fourths of the sample were PrEP aware, PrEP use among BMSM with STI diagnoses was limited and that PrEP is utilized less often by individuals who have less HIV treatment optimism. These findings call attention to the need to better understand how to effectively target PrEP uptake strategies for key populations.
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Affiliation(s)
- Jessica L. Maksut
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT
| | - Lisa A. Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs Mansfield, CT
| | - Redd Driver
- Department of Psychological Sciences, University of Connecticut, Storrs Mansfield, CT
| | - Cristina M. Knowles
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT
| | - Ryan J. Watson.
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT
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Marotta PL, Gilbert L, Goddard-Eckrich D, Hunt T, Metsch L, Davis A, Feaster D, Wu E, El-Bassel N. A Dyadic Analysis of Criminal Justice Involvement and Sexual HIV Risk Behaviors Among Drug-Involved Men in Community Corrections and Their Intimate Partners in New York City: Implications for Prevention, Treatment and Policies. AIDS Behav 2021; 25:1047-1062. [PMID: 33057892 PMCID: PMC8570384 DOI: 10.1007/s10461-020-03019-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Indexed: 10/23/2022]
Abstract
People in community corrections have rates of HIV and sexual risk behaviors that are much higher than the general population. Prior literature suggests that criminal justice involvement is associated with increased sexual risk behaviors, yet these studies focus on incarceration and use one-sided study designs that only collect data from one partner. To address gaps in the literature, this study used the Actor Partner-Interdependence Model with Structural Equation Modeling (SEM), to perform a dyadic analysis estimating individual (actor-only) partner-only, and dyadic patterns (actor-partner) of criminal justice involvement and greater sexual risks in a sample of 227 men on probation and their intimate partners in New York City, United States. Standard errors were bootstrapped with 10,000 replications to reduce bias in the significance tests. Goodness of fit indices suggested adequate or better model fit for all the models. Significant actor-only relationships included associations between exposures to arrest, misdemeanor convictions, time spent in jail or prison, felony convictions, lifetime number of incarceration events, prior conviction for disorderly conduct and increased sexual risk behaviors. Partner only effects included significant associations between male partners conviction for a violent crime and their female partners' sexual risk behaviors. Men's encounters with police and number of prior misdemeanors were associated with their own and intimate partners' sexual risk behaviors. Women's prior arrest was associated with their own and intimate partners' sexual risk behaviors. The results from the present study suggest that men on probation and their intimate partners' criminal justice involvement are associated with increased engagement in sexual risk behaviors. It is necessary to conduct greater research into developing dyadic sexual risk reduction and HIV/STI prevention interventions for people who are involved in the criminal justice system.
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Affiliation(s)
- Phillip L Marotta
- Division of Prevention and Community Psychology, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT, USA.
- The Consultation Center, Yale University, New Haven, CT, USA.
| | - Louisa Gilbert
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Dawn Goddard-Eckrich
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Tim Hunt
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Lisa Metsch
- School of General Studies, Columbia University, New York City, NY, USA
- Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alissa Davis
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Daniel Feaster
- Department of Biostatistics, School of Public Health, University of Miami, Miami, FL, USA
| | - Elwin Wu
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
| | - Nabila El-Bassel
- School of Social Work, Columbia University, New York City, NY, USA
- Social Intervention Group, Columbia University, New York City, NY, USA
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Bavinton BR, Prestage GP, Jin F, Phanuphak N, Grinsztejn B, Fairley CK, Baker D, Hoy J, Templeton DJ, Tee BK, Kelleher A, Grulich AE. Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries. J Int AIDS Soc 2020; 22:e25277. [PMID: 30983155 PMCID: PMC6462805 DOI: 10.1002/jia2.25277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/15/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. METHODS Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV-positive partners had viral load (VL) tested; HIV-negative partners reported sexual behaviour and perceptions of their HIV-positive partner's VL results. Within-couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom-protected, biomedically protected (undetectable VL and/or pre-exposure prophylaxis [PrEP]), or not protected by either (HIV-negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). RESULTS A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three-quarters of HIV-positive partners were consistently virally suppressed (<200 copies/mL) during follow-up, and HIV-negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One-third of HIV-negative partners used daily PrEP during follow-up. Over follow-up, 73.8% of couples had CLAI. HIV-negative partners reported 31,532 acts of anal intercourse with their HIV-positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom-protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two-thirds (n = 983) were when the HIV-negative partner was insertive (strategic positioning). Of the 490 acts when the HIV-negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. CONCLUSIONS Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.
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Affiliation(s)
| | | | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Beatriz Grinsztejn
- Evandro Chagas Institute of Clinical Research (IPEC), FIOCRUZ, Rio de Janeiro, Brazil
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia.,Monash University, Melbourne, Australia
| | | | - Jennifer Hoy
- Monash University, Melbourne, Australia.,The Alfred Hospital, Melbourne, Australia
| | - David J Templeton
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,RPA Sexual Health, Sydney, Australia
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10
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Kim H, Harling G, Vandormael A, Tomita A, Cuadros DF, Bärnighausen T, Tanser F. HIV seroconcordance among heterosexual couples in rural KwaZulu-Natal, South Africa: a population-based analysis. J Int AIDS Soc 2020; 23:e25432. [PMID: 31916420 PMCID: PMC6949466 DOI: 10.1002/jia2.25432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/08/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION High levels of HIV seroconcordance at the population level reduce the potential for effective HIV transmission. However, the level of HIV seroconcordance is largely unknown among heterosexual couples in sub-Saharan Africa. We aimed to quantify the population level HIV seroconcordance in stable heterosexual couples in rural South Africa. METHODS We followed adults (≥15 years old) using a population-based, longitudinal and open surveillance system in KwaZulu-Natal, South Africa, from 2003 to 2016. Sexual partnerships and HIV status were confirmed via household surveys and annual HIV surveillance. We calculated the proportions of HIV seroconcordance and serodiscordance in stable sexual partnerships and compared them to the expected proportions under the assumption of random mixing using individual-based microsimulation models. Among unpartnered individuals, we estimated the incidence rates and hazard of sexual partnership formation with HIV-positive or HIV-negative partners by participants' own time-varying HIV status. Competing risks survival regressions were fitted adjusting for sociodemographic and clinical factors. We also calculated Newman's assortativity coefficients. RESULTS A total of 18,341 HIV-negative and 11,361 HIV-positive individuals contributed 154,469 person-years (PY) of follow-up. Overall, 28% of the participants were in stable sexual partnerships. Of the 677 newly formed stable sexual partnerships, 7.7% (95% CI: 5.8 to 10.0) were HIV-positive seroconcordant (i.e. both individuals in the partnership were HIV-positive), which was three times higher than the expected proportion (2.3%) in microsimulation models based on random mixing. The incidence rates of sexual partnership formation were 0.54/1000PY with HIV-positive, 1.12/1000PY with HIV-negative and 2.65/1000PY with unknown serostatus partners. HIV-positive individuals had 2.39 (95% CI: 1.43 to 3.99) times higher hazard of forming a sexual partnership with an HIV-positive partner than did HIV-negative individuals after adjusting for age, opposite-sex HIV prevalence (by 5-years age groups), HIV prevalence in the surrounding community, ART coverage and other sociodemographic factors. Similarly, forming a sexual partnership with an HIV-negative partner was 1.47 (95% CI: 1.01 to 2.14) times higher in HIV-negative individuals in the adjusted model. Newman's coefficient also showed that assortativity by participant and partner HIV status was moderate (r = 0.35). CONCLUSIONS A high degree of population level HIV seroconcordance (both positive and negative) was observed at the time of forming new sexual partnerships. Understanding factors driving these patterns may help the development of strategies to bring the HIV epidemic under control.
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Affiliation(s)
- Hae‐Young Kim
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNYUSA
| | - Guy Harling
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Institute for Global HealthUniversity College LondonLondonUK
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMAUSA
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt)University of the WitwatersrandJohannesburgSouth Africa
| | - Alain Vandormael
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- School of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
- Heidelberg Institute of Global HealthFaculty of MedicineUniversity of HeidelbergHeidelbergGermany
| | - Andrew Tomita
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- Centre for Rural HealthSchool of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Diego F Cuadros
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Department of Geography and Geographic Information ScienceUniversity of CincinnatiCincinnatiOHUSA
| | - Till Bärnighausen
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Heidelberg Institute of Global HealthFaculty of MedicineUniversity of HeidelbergHeidelbergGermany
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Frank Tanser
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMAUSA
- Lincoln Institute for HealthUniversity of LincolnLincolnUK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
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11
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Robles G, Dellucci TV, Stratton MJ, Jimenez RH, Starks TJ. The Utility of Index Case Recruitment for Establishing Couples' Eligibility: An Examination of Consistency in Reporting the Drug Use of a Primary Partner Among Sexual Minority Male Couples. ACTA ACUST UNITED AC 2019; 8:221-232. [PMID: 32395393 DOI: 10.1037/cfp0000128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sexual minority men are disproportionately impacted by substance use, which is associated with greater HIV transmission behaviors. Novel approaches to drug use prevention and treatment are needed. Couple-based approaches have garnered significant attention. The recruitment of couples into substance use interventions has proven challenging. We evaluate an index-case approach to screening participants in couples' research. Seventy index cases, aged 18-29, and their main partner (140 individuals), were recruited. At screening, index participants reported their drug use and their partners' drug use for the previous 30 days. At baseline, both partners reported their drug use over the past 30 days. Individuals' self-reports and perceptions of their partner's concurrency were compared within couples using the κ (Kappa) coefficient. We found high levels of personal predictive accuracy from screening to baseline for cannabis (κ = .81, p < .01) and cocaine/crack (κ = .70, p < .01). Predictive accuracy of index case reporting of their partner's drug use behavior were moderately high among cocaine/crack use (κ = .68, p < .01) and MDMA/GHB/Ketamine (κ = .56, p < .01). Perceived partner similarity for recent drug use was also high for all drugs, with the highest levels among cocaine/crack (κ =.82) and prescription drugs (κ =.81). This study demonstrates that index partners report drug use with differing levels of agreement between drug types. Index recruitment has advantages in determining drug use-related eligibility requirements. Discrepancies in reporting were more frequently false positives, which reduces the risk of screening out potentially eligible couples.
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Affiliation(s)
- Gabriel Robles
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA
| | - Trey V Dellucci
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of City University of New York, New York, NY. USA
| | - Mark J Stratton
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA
| | - Ruben H Jimenez
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA.,Health Psychology and Clinical Science Doctoral Program, Graduate Center of City University of New York, New York, NY. USA
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12
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Henderson NJ. 'Top, bottom, versatile': narratives of sexual practices in gay relationships in the Cape Metropole, South Africa. CULTURE, HEALTH & SEXUALITY 2018; 20:1145-1156. [PMID: 28704135 DOI: 10.1080/13691058.2017.1347715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sexual practices among gay and other men who have sex with men are evolving in South Africa and heteronormative stereotypes are being contested. This paper draws from a larger qualitative study on how men construct a gay identity and negotiate their relationships within contemporary South African contexts, following constitutional and legal changes, in this respect. A feminist, social constructionist approach was used to collect and analyse data from in-depth interviews with 15 self-identified gay men, aged 20 to 46 years, drawn from a university in the larger Cape Metropole, South Africa. Interviews were audio-recorded, transcribed verbatim and analysed using thematic and narrative analysis. 'Bottoms' revealed being powerful in receptive sex. Other men deconstructed the binaries of masculine/feminine and resisted heteronormativity by engaging in fluid constructions in their relationships, whereby participants 'switched' or 'flipped' or did not recognise stereotypical roles when practising sex. There may be value in making these flexible and reciprocal sexual practices better known about and promoted as non-normative African models of sexual practice.
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Affiliation(s)
- Neil John Henderson
- a Department of Social Work, Faculty of Community and Health Sciences , University of the Western Cape , Cape Town , South Africa
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13
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Kim HY, Hanrahan CF, Dowdy DW, Martinson N, Golub J, Bridges JFP. The effect of partner HIV status on motivation to take antiretroviral and isoniazid preventive therapies: a conjoint analysis. AIDS Care 2018; 30:1298-1305. [PMID: 29595060 DOI: 10.1080/09540121.2018.1455958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are important to reduce morbidity and mortality among people newly diagnosed of HIV. The successful uptake of ART and IPT requires a comprehensive understanding of patients' motivation to take such therapies. Partners also play an important role in the decision to be initiated and retained in care. We quantified patients' motivation to take preventive therapies (ART and IPT) and compared by partner HIV status among people newly diagnosed of HIV. We enrolled and surveyed adults (≥18 years) with a recent HIV diagnosis (<6 months) from 14 public primary care clinics in Matlosana, South Africa. Participants received eight forced-choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapies. A linear probability model was fitted to estimate the probability of prioritizing each benefit. Tests of concordance were conducted across partner HIV status (no partner, HIV- or unknown, or HIV+). A total of 424 people completed surveys. At the time of interview, 272 (64%) were on ART and 334 (79%) had a partner or spouse. Keeping themselves healthy for their family was the most important motivator to take preventive therapies (p < 0.001). Preventing HIV transmission to partners was also highly prioritized among participants with current partners independent of partner's HIV status (p < 0.001), but it was least prioritized among those without current partners (p = 0.72). Keeping themselves healthy was less prioritized. We demonstrate that social responsibility such as supporting family and preventing HIV transmission to partners may pose greater motivation for ART and IPT initiation and adherence compared to individual health benefits. These messages should be emphasized to provide effective patient-centered care and counseling.
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Affiliation(s)
- Hae-Young Kim
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Colleen F Hanrahan
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - David W Dowdy
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Neil Martinson
- c Perinatal HIV Research Unit , University of Witwatersrand , Johannesburg , South Africa.,d Center for Tuberculosis Research , Johns Hopkins University , Baltimore , MD , USA
| | - Jonathan Golub
- a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,d Center for Tuberculosis Research , Johns Hopkins University , Baltimore , MD , USA
| | - John F P Bridges
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,e Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,f Department of Health Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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14
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Mor Z, Turner D, Livnat Y, Levy I. HIV infected men who have sex with men in Israel: knowledge, attitudes and sexual behavior. BMC Infect Dis 2017; 17:679. [PMID: 29025414 PMCID: PMC5639789 DOI: 10.1186/s12879-017-2782-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 10/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-infected (HIVI) men who have sex with men (MSM) may transmit HIV to their sero-discordant sex partner/s. This study assesses the knowledge, attitudes and sex-practices of Israeli HIVI-MSM. METHODS This cross-sectional study compared HIVI-MSM to self-reported HIV-uninfected (HIVU) MSM by using anonymous questionnaires that were distributed in AIDS-treatment centers and gay-related internet-sites in 2015. Unprotected anal intercourse (UAI) in the last 6 months was the outcome variable. RESULTS Of 300 HIVI-MSM and 1299 HIVU-MSM, UAI with sero-discordant/unknown-status partner/s was performed by 12.1% and 17.9%, respectively, p=0.02. UAI with sero-discordant/unknown-status among HIVI-MSM and HIVU-MSM was associated with the type of partnership: 37.7% vs. 52.4% for steady partner/s, 19.0% vs. 39.9% for sex-buddies and 23.5% vs. 24.0% for casual partner/s (p<0.001, p=0.01, p=0.6), respectively. On these occasions, HIVI-MSM were more likely to be receptive during UAI: 92.3%, 87.5% and 83.3% for steady partner/s, sex buddies and casual partner/s, respectively. In cases HIVI-MSM performed UAI, 31.3% expected their partner/s to share responsibility for condom-use vs. 9.7% of HIVU-MSM. HIVI-MSM were involved in risky sexual-behaviors, such as substances-use, earlier sexual debut and sex for money. HIVI-MSM were more likely to disclose their HIV-status with their partner before sex and demonstrated better knowledge about HIV-transmission than HIVU-MSM. CONCLUSION HIVI-MSM performed UAI with sero-discordant/unknown-status partner/s less frequently than HIVU-MSM. Their condom-use practices were associated with the type of partner, and were lower for casual vs. steady partners or sex-buddies. HIVI-MSM tended to use sero-adaptive strategies to reduce the potential risk of HIV-transmission to their sero-discordant/unknown-status partner/s.
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Affiliation(s)
- Zohar Mor
- Tel Aviv Department of Health, 12 Ha'arba'a St, 6473912, Tel Aviv, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Turner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,AIDS Treatment Center, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Itzchak Levy
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,AIDS Treatment Center, Sheba Medical Center, Ramat Gan, Israel
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15
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Surkan PJ, Li Y, Jacobson LP, Cox C, Silvestre A, Gorbach P, Teplin L, Plankey M. Unsafe Sexual Behavior Among Gay/Bisexual Men in the Era of Combination Antiretroviral Therapy (cART). AIDS Behav 2017; 21:2874-2885. [PMID: 27990578 DOI: 10.1007/s10461-016-1614-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this study was to determine the association between psychosocial determinants of unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI). Data from 417 HIV positive men who have sex with men (MSM) in the Multicenter AIDS Cohort Study from April 1999 to March 2012 were analyzed and adjusted odds were calculated. It was found that 66% (n = 277) and 72% (n = 299) reported any UIAI or URAI over follow-up, respectively. Cumulative cART-years (median = 5.30 years) was associated with 33 and 47% increases in UIAI and URAI, respectively. Not having reduced concern about HIV transmission (UIAI: OR 0.37, p-value = 0.0004; URAI: OR 0.57, p-value = 0.04), increased safe sex fatigue (UIAI: OR 2.32, 95% p-value = 0.0002; URAI: OR 1.94, p-value = 0.003), and sexual sensation seeking (UIAI: OR 1.76, p-value = 0.002; URAI: OR 1.56, p-value = 0.02) were associated with UIAI and URAI. Serosorting was associated with UIAI (OR 6.11, p-value < 0.0001) and URAI (OR 6.80, p-value < 0.0001). Findings suggest that negative attitudes about HIV transmission are sustained among older men who have sex with men.
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Affiliation(s)
- Pamela J Surkan
- Social and Behavioral Intervention Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E5523, Baltimore, MD, 21205-2179, USA.
| | - Ying Li
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anthony Silvestre
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pamina Gorbach
- Division of Infectious Diseases, Department of Epidemiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Linda Teplin
- Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
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16
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Skalski LM, Gunn RL, Caswell A, Maisto S, Metrik J. Sex-related marijuana expectancies as predictors of sexual risk behavior following smoked marijuana challenge. Exp Clin Psychopharmacol 2017; 25:402-411. [PMID: 29048189 PMCID: PMC5657572 DOI: 10.1037/pha0000138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Marijuana use has been associated with sexual risk behavior, but the mechanisms that underlie this relationship are not well understood. The present study examined whether marijuana acutely increased sexual risk on a behavioral decision-making task and whether sex-related marijuana outcome expectancies influenced sexual risk decisions after marijuana administration. Participants were heterosexual marijuana users (n = 126) who were randomly assigned to 1 of 4 study conditions using a 2 × 2 factorial design crossing drug administration (received 2.8% delta-9-tetrahydrocannabinol [THC] or 0% THC) with instructional set (told THC or told placebo). Participants completed a self-report measure of sex-related marijuana outcome expectancies at baseline and estimated likelihood of using condoms with a new and a steady partner in an interactive sexual role-play task (SRT) after smoking. In gender-specific analyses, there was a significant interaction of drug administration by sex-related outcome expectancies, such that for men in the received-placebo conditions, more salient sex-related marijuana outcome expectancies were associated with increased likelihood for sex without a condom with a new partner. Among women, there was no interaction or main effect of drug administration but more salient sex-related marijuana outcome expectancies were associated with increased likelihood of sex without a condom with a steady but not new partner. Findings suggest marijuana does not acutely increase risk for engaging in sexual risk behaviors. By contrast, sex-related marijuana outcome expectancies may play a more significant role in sexual decision-making process among marijuana users. (PsycINFO Database Record
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Affiliation(s)
- Linda M. Skalski
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912
- Providence VA Medical Center, Providence, RI, 02908
| | - Rachel L. Gunn
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912
| | - Amy Caswell
- Department of Psychology, University of Bath, UK BA2 7AY
| | - Stephen Maisto
- Department of Psychology, Syracuse University, Syracuse, NY 13244
| | - Jane Metrik
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912
- Providence VA Medical Center, Providence, RI, 02908
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903
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17
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Brenick A, Romano K, Kegler C, Eaton LA. Understanding the Influence of Stigma and Medical Mistrust on Engagement in Routine Healthcare Among Black Women Who Have Sex with Women. LGBT Health 2017; 4:4-10. [PMID: 28113005 PMCID: PMC5278794 DOI: 10.1089/lgbt.2016.0083] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE For Black women who have sex with women (BWSW), obtaining routine healthcare can be obstructed by a number of psychosocial barriers, including experiences of stigma, related to both sexual orientation and race, and medical mistrust, both race-based and global. Previous research demonstrates that sexual orientation and race-based stigma, as well as global and race-based medical mistrust, each have a negative impact on health outcomes and engagement in care (EIC) independently. This study addresses gaps in the literature by examining the impact of these psychosocial barriers and their interactions among BWSW, an understudied population. METHODS Participants (256 BWSW) were surveyed at a Black Gay Pride festival. Separate generalized linear models assessed the independent and multiplicative effects of participants' self-reported sexual orientation stigma, race-based stigma, race-based medical mistrust, and global medical mistrust related to their engagement in routine physical exams and blood pressure screenings. RESULTS Prevalence rates of both stigma measures were low, but prevalence rates of global and race-based medical mistrust were high. The results show that experiencing sexual orientation stigma or having race-based medical mistrust predicts significantly lower EIC. Furthermore, the frequencies of obtaining recent physical examinations and blood pressure screenings were significantly related to three- and two-way interactions between stigma and medical mistrust, respectively. CONCLUSION There is an urgent need to address the intersectionality of these psychosocial barriers in an effort to increase BWSW's EIC.
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Affiliation(s)
- Alaina Brenick
- Department of Human Development and Family Studies and the Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
| | - Kelly Romano
- Mental Health Counseling, Florida State University, Tallahassee, Florida
| | | | - Lisa A. Eaton
- Department of Human Development and Family Studies and the Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut
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18
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Hoff CC, Campbell CK, Chakravarty D, Darbes LA. Relationship-Based Predictors of Sexual Risk for HIV Among MSM Couples: A Systematic Review of the Literature. AIDS Behav 2016; 20:2873-2892. [PMID: 27048237 DOI: 10.1007/s10461-016-1350-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Behavioral and epidemiological studies report high risk for HIV among MSM couples. Over the last decade, studies have examined relationship dynamics associated with sexual risk for HIV. It is important to examine the impact this research has had on HIV prevention and what is still needed. We conducted a review of the literature focusing on relationship dynamics associated with sexual risk for HIV among MSM couples. Procedures used for this review were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses established to provide a framework for collecting, reviewing and reporting studies systematically (Mohler et al. in Ann Intern Med 151(4):264-269, 2009). We found that positive relationship dynamics are associated with less risk with partners outside the relationship, but were associated with greater odds of unprotected anal intercourse with primary partners. We also discuss other factors including sexual agreements about outside partners and make recommendations for next steps in HIV prevention research among MSM couples.
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Affiliation(s)
- Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street Suite 523, San Francisco, CA, 94103, USA.
| | - Chadwick K Campbell
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street Suite 523, San Francisco, CA, 94103, USA
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Deepalika Chakravarty
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street Suite 523, San Francisco, CA, 94103, USA
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Lynae A Darbes
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
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19
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Kiene SM, Simbayi LC, Abrams A, Cloete A. Alcohol Expectancies and Inhibition Conflict as Moderators of the Alcohol-Unprotected Sex Relationship: Event-Level Findings from a Daily Diary Study Among Individuals Living with HIV in Cape Town, South Africa. AIDS Behav 2016; 20 Suppl 1:S60-73. [PMID: 26280530 DOI: 10.1007/s10461-015-1157-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Literature from sub-Saharan Africa and elsewhere supports a global association between alcohol and HIV risk. However, more rigorous studies using multiple event-level methods find mixed support for this association, suggesting the importance of examining potential moderators of this relationship. The present study explores the assumptions of alcohol expectancy theory and alcohol myopia theory as possible moderators that help elucidate the circumstances under which alcohol may affect individuals' ability to use a condom. Participants were 82 individuals (58 women, 24 men) living with HIV who completed daily phone interviews for 42 days which assessed daily sexual behavior and alcohol consumption. Logistic generalized estimating equation models were used to examine the potential moderating effects of inhibition conflict and sex-related alcohol outcome expectancies. The data provided some support for both theories and in some cases the moderation effects were stronger when both partners consumed alcohol.
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20
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Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, Cherry C. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health 2015; 105:e75-82. [PMID: 25521875 DOI: 10.2105/ajph.2014.302322] [Citation(s) in RCA: 307] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
UNLABELLED Objectives: We assessed how health care-related stigma, global medical mistrust, and personal trust in one's health care provider relate to engaging in medical care among Black men who have sex with men (MSM). METHODS In 2012, we surveyed 544 Black MSM attending a community event. We completed generalized linear modeling and mediation analyses in 2013. RESULTS Twenty-nine percent of participants reported experiencing racial and sexual orientation stigma from heath care providers and 48% reported mistrust of medical establishments. We found that, among HIV-negative Black MSM, those who experienced greater stigma and global medical mistrust had longer gaps in time since their last medical exam. Furthermore, global medical mistrust mediated the relationship between stigma and engagement in care. Among HIV-positive Black MSM, experiencing stigma from health care providers was associated with longer gaps in time since last HIV care appointment. CONCLUSIONS Interventions focusing on health care settings that support the development of greater awareness of stigma and mistrust are urgently needed. Failure to address psychosocial deterrents will stymie progress in biomedical prevention and cripple the ability to implement effective prevention and treatment strategies.
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Affiliation(s)
- Lisa A Eaton
- Lisa A. Eaton is with Human Development and Family Studies, University of Connecticut, Storrs. Daniel D. Driffin, Christopher Kegler, Harlan Smith, Christopher Conway-Washington, Denise White, and Chauncey Cherry are with the SHARE Project, University of Connecticut
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21
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Stimulant use patterns and HIV transmission risk among HIV-serodiscordant male couples. J Acquir Immune Defic Syndr 2015; 68:147-51. [PMID: 25590269 DOI: 10.1097/qai.0000000000000418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Substance use is strongly linked to HIV risk, and members of couples can have a powerful influence on each other's health behaviors. We examined whether couple-level patterns of stimulant use were differentially associated with engaging in condomless anal intercourse with primary partners and outside partners. METHODS Members of HIV serodiscordant male couples (N = 117 couples, 232 men) completed surveys, and HIV-positive men had blood drawn for viral load. RESULTS Results revealed that stimulant use by only one partner in the couple was associated with a decrease in the odds of engaging in condomless anal sex with one's primary partner (AOR = 0.09, 95% CI: 0.01, 0.89). When both partners reported stimulant use, the HIV-negative partner had an increase in the odds of condomless sex with outside partners (AOR = 6.68, 95% CI: 1.09, 8.01). CONCLUSIONS Understanding the role of couples' stimulant use patterns in HIV transmission risk is an important area for future research and intervention.
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22
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Mendelsohn JB, Calzavara L, Daftary A, Mitra S, Pidutti J, Allman D, Bourne A, Loutfy M, Myers T. A scoping review and thematic analysis of social and behavioural research among HIV-serodiscordant couples in high-income settings. BMC Public Health 2015; 15:241. [PMID: 25885027 PMCID: PMC4365541 DOI: 10.1186/s12889-015-1488-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/28/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND While HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs. METHODS Ten electronic databases were searched. Studies were included if they were reported in English, used primary data, were from the combination antiretroviral (cART) era (>1996), reported on social or behavioural aspects, included any fraction of primary (i.e., stable) relationships, and were conducted in high-income settings. Studies that identified their unit of analysis as either the dyad or individual member of the couple were included. Studies were coded according to a thematic framework. RESULTS Included studies (n = 154) clustered into eight themes: risk behaviours (29%), risk management (26%), reproductive issues (12%), relationship quality (9%), serostatus disclosure (7%), adherence to antiretroviral therapy (7%), vulnerability (5%), and social support (3%). The proportion of studies conducted among heterosexual couples, same-sex male couples, and mixed cohorts were 42%, 34%, and 24%, respectively. Most studies (70%) were conducted in the United States, 70% of all studies were quantitative (including interventions), but only one-third were focused on couples (dyads) where both partners are recruited to a study. Over 25% of studies focused on sexual risk among same-sex male couples. CONCLUSIONS Future research efforts should focus on the interrelationship of risk management strategies and relationship quality, social determinants of health and wellbeing, HIV testing, vulnerable populations, reproductive issues among same-sex couples, disclosure of serodiscordant status to social networks, dyadic studies, population-based studies, and interventions to support risk management within couples. Additional population-based studies and studies among marginalized groups would be helpful for targeting research and interventions to couples that are most in need. As HIV-positive partners are typically the link to services and research, innovative ways are needed for reaching out to HIV-negative partners. Our review suggests that significantly more research is needed to understand the social and behavioural contexts of HIV-serodiscordant relationships.
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Affiliation(s)
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Amrita Daftary
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu Natal, Durban, South Africa.
| | - Sanjana Mitra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Joel Pidutti
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Dan Allman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Adam Bourne
- Sigma Research Group, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Blackwell CW. Serosorting Sexual Partners by Gay and Bisexual Men to Prevent HIV Infection: Implications for Public Health Clinicians. Public Health Nurs 2015; 32:555-64. [PMID: 25655303 DOI: 10.1111/phn.12181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The most recent Centers for Disease Control and Prevention epidemiological statistics in the United States demonstrate that gay and bisexual men are at most risk for acquiring new HIV infections. While public health campaigns aimed at gay and bisexual males have resulted in improved HIV screening and greater awareness of the need for safer sex practices, barebacking has become a practice of increasing incidence. This act carries the highest risk of HIV transmission and acquisition; and data suggest HIV disease burden is higher among ethnic minorities. Serosorting-purposely seeking HIV serocordant partners--to help lower risk of HIV infection is common. While this can be a positive step in preventing the spread of HIV, it carries serious threats that must be acknowledged. The purpose of this article was to explore the positive and negative aspects of serosorting in the prevention of HIV, describe ways in which health care providers can approach the topic with clients, provide clinical practice implications, and suggest some direction for future research.
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Beougher SC, Bircher AE, Chakravarty D, Darbes LA, Gómez Mandic C, Neilands TB, Garcia CC, Hoff CC. Motivations to test for HIV among partners in concordant HIV-negative and HIV-discordant gay male couples. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:499-508. [PMID: 25550145 PMCID: PMC4323847 DOI: 10.1007/s10508-014-0403-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/08/2014] [Accepted: 09/13/2014] [Indexed: 05/23/2023]
Abstract
Previous studies of HIV testing among gay men describe the motivations, facilitators and barriers, behaviors, and demographic characteristics of individuals who test. What little research focuses on HIV testing among gay men in relationships shows that they do not test regularly or, in some cases, at all-their motivations to test have not been investigated. With so little data on HIV testing for this population, and the continued privileging of individually focused approaches, gay men in relationships fall into a blind spot of research and prevention efforts. This study examined motivations to test for HIV using qualitative data from both partners in 20 gay male couples. Analysis revealed that the partners' motivations were either event-related (e.g., participants testing at the beginning of their relationship or HIV-negative participants in an HIV-discordant relationship testing after risky episode with their discordant primary partner) or partner-related (e.g., participants testing in response to a request or suggestion to test from their primary partner or participants testing out of concern for their primary partner's health and well-being). These data provide insight into relationship-oriented motivations to test for HIV for gay men in relationships and, in doing so, evidence their commitment to their primary partner and relationship. These motivations can be leveraged to increase HIV testing among gay men in relationships, a population that tests less often than single gay men, yet, until recently, has been underserved by prevention efforts.
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Affiliation(s)
- Sean C. Beougher
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
| | - Anja E. Bircher
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
| | - Deepalika Chakravarty
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, USA
| | - Lynae A. Darbes
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, USA
| | - Carmen Gómez Mandic
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, USA
| | - Carla C. Garcia
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
| | - Colleen C. Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
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Eaton LA, Driffin DD, Smith H, Conway-Washington C, White D, Cherry C. Black men who have sex with men, sexual risk-taking, and willingness to use rapid home HIV tests. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:321-9. [PMID: 24906999 PMCID: PMC4258525 DOI: 10.1007/s11121-014-0496-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The availability of rapid home-based HIV testing (RHT) in the USA has provided us with a valuable, new option in our efforts to identify more people living with HIV and to do so sooner. Furthermore, it is possible that RHT will be or is currently being used as a means of learning one's own and one's partner's HIV status prior to engaging in condomless intercourse. Data regarding knowledge and willingness to use RHT, however, is very limited. In particular, no studies have investigated RHT use among Black men who have sex with men (BMSM). Understanding RHT use among BMSM is critical as we have observed alarming rates of HIV prevalence among this group, and RHT may provide an opportunity to slow HIV transmission among BMSM. In order to better understand RHT, we assessed knowledge, willingness to use and actual use of RHT, HIV testing history, substance use, and sexual risk-taking among 387 HIV-negative BMSM and 157 HIV-positive BMSM attending a community event in the southeastern USA. We used generalized linear modeling to assess factors associated with their willingness to use RHT. Although familiarity with the availability of RHT was somewhat limited among these men, a substantial portion of BMSM did report an interest in using RHT, including with their sex partners. Among HIV-negative BMSM, however, we found a negative relationship between willingness to use RHT and sexual risk-taking, i.e., higher numbers of condomless anal sex acts were associated with a reduction in willingness to use RHT. It appears that men who report the greatest risk-taking for HIV are least interested in RHT. Future research should focus on better understanding concerns regarding RHT among at-risk HIV-negative men and should investigate the usefulness of using RHT as a HIV prevention method.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Studies, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269-1058, USA,
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Cardoso LD, Malbergier A. Who is not using condoms among HIV-positive patients in treatment in the largest city in Brazil? AIDS Care 2014; 27:629-36. [PMID: 25495898 DOI: 10.1080/09540121.2014.986047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Data on risky sexual behaviors in people living with HIV/AIDS (PLWHA) is still scarce in some populations around the world. The purpose of this study was to assess the factors associated with the use of condoms in a representative sample of PLWHA in outpatient treatment in the city of São Paulo. Six hundred and sixty-seven HIV-positive patients (383 men and 284 women) who were being treated at eight centers participated in this study. Data were collected using a sociodemographic survey, the Beck depression and anxiety inventories, a survey of alcohol and other drugs use, the Alcohol Use Disorders Identification Test, a sexual behavior survey, and the Sexual Risk Behavior Assessment Schedule. The majority of study participants were sexually active (almost 62% of the sample had at least one sexual partner in the last three months), and at least one-fourth engaged in unsafe sex (25.3% did not use condoms during at least one instance of anal and/or vaginal intercourse in the past three months). Multivariate logistic regression showed that engaging in unprotected sex was more likely among females (p < .001), persons with an HIV-positive partner (p < .001), and people using cannabis before sex (p = .002). These findings should stimulate health-care workers to create specific groups for women, seroconcordant couples, and cannabis users to discuss condom use, as they seem to be vulnerable groups.
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Matser A, Heijman T, Geskus R, de Vries H, Kretzschmar M, Speksnijder A, Xiridou M, Fennema H, Schim van der Loeff M. Perceived HIV status is a key determinant of unprotected anal intercourse within partnerships of men who have sex with men in Amsterdam. AIDS Behav 2014; 18:2442-56. [PMID: 24920343 DOI: 10.1007/s10461-014-0819-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The practice of unprotected anal intercourse (UAI) involves at least two partners. We examined the associations between insertive or receptive UAI and perceived HIV seroconcordance and partnership type in self-perceived HIV-negative and self-perceived HIV-positive men who have sex with men (MSM). MSM (age ≥ 18 years) were recruited for a cross-sectional survey at the sexually transmitted infections clinic in Amsterdam, the Netherlands, in 2008-2009. Participants completed a questionnaire concerning partnerships in the preceding 6 months. Associations were quantified via multinomial logistic regression models using generalized estimating equations. The outcomes were 'no, or safe anal intercourse', 'insertive UAI', and 'receptive UAI'. We included 5,456 partnerships from 1,890 self-perceived HIV-negative men and 1,861 partnerships from 558 self-perceived HIV-positive men. Within the partnerships, perceived HIV status of the partner was an important determinant of UAI (p < 0.001). Among HIV-negative men, perceived HIV discordance was negatively associated with receptive UAI compared with no or safe UAI (OR 0.57; 95 % CI 0.36-0.92); when the partners were more familiar with each other, the risk of receptive UAI was increased relative to no or safe anal intercourse. Among HIV-positive men, perceived HIV discordance was negatively associated with insertive UAI (OR 0.05; 95 % CI 0.03-0.08). Within partnerships, perceived HIV status of the partner was one of the strongest determinants of UAI among self-perceived HIV-negative and HIV-positive MSM, and discordant serostatus was negatively associated with UAI. The findings suggest that serosorting is one of the main strategies when engaging in UAI.
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Affiliation(s)
- Amy Matser
- Department of Research, Cluster of Infectious Diseases, Public Health Service of Amsterdam, Postbox 2200, 1000 CE, Amsterdam, The Netherlands,
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28
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Jones D, Bagga R, Nehra R, Deepika, Sethi S, Walia K, Kumar M, Villar-Loubet O, Lopez M, Weiss SM. Reducing sexual risk behavior among high-risk couples in Northern India. Int J Behav Med 2014; 20:344-54. [PMID: 22648338 DOI: 10.1007/s12529-012-9235-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND With a population of 1.1 billion, India is considered to be a country in which effective prevention interventions could contain the development of a human immunodeficiency virus (HIV) epidemic. Heterosexual transmission accounts for 85 % of the extant HIV infections. PURPOSE This study sought to assess the feasibility of conducting a group, culturally tailored behavioral intervention and its impact on sexual barrier use, self-efficacy, knowledge, conflict resolution, and coping among high-risk heterosexual couples in Northern India. METHOD This pilot study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India from February 2008 to January 2009. Thirty sexually active high-risk couples were drawn from a convenience sample of PGIMER patients attending infectious disease and family planning clinics. Couples participated in 1 month of three weekly gender-concordant behavioral intervention groups and were individually administered assessments preintervention and post-intervention. The intervention was tailored to the Northern Indian context and addressed sexual barrier use, human immunodeficiency virus (HIV)/sexually transmitted infection transmission, and cognitive behavioral skill building focusing on sexual negotiation and communication. RESULTS The participants had a mean age of 32 years (men) and 29 years (women), and the majority had at least 10 years of education. At baseline, the majority reported inconsistent condom use (<100 % of the time; 64 % of women, 59 % of men). Post-intervention, nearly all participants reported consistent condom use (100 % of the time; 100 % of men, 97 % of women). Participants also reported decreased verbal aggression, increased self-efficacy, and increased HIV-related knowledge, and women increased their use of positive coping tactics. CONCLUSIONS The results highlight the potential to successfully utilize a group intervention to discuss sensitive issues such as sexual risk behavior among both men and women. Strategies to improve condom use and communication without increasing intimate partner violence in high-risk couples may be an important adjunct to preventing the development of a generalized epidemic in India.
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Affiliation(s)
- Deborah Jones
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA,
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Wall KM, Sullivan PS, Kleinbaum D, Stephenson R. Actor-partner effects associated with experiencing intimate partner violence or coercion among male couples enrolled in an HIV prevention trial. BMC Public Health 2014; 14:209. [PMID: 24580732 PMCID: PMC3942775 DOI: 10.1186/1471-2458-14-209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 02/17/2014] [Indexed: 12/01/2022] Open
Abstract
Background Intimate partner violence (IPV) and coercion have been associated with negative health outcomes, including increased HIV risk behaviors, among men who have sex with men (MSM). This is the first study to describe the prevalence and factors associated with experiencing IPV or coercion among US MSM dyads using the actor-partner interdependence model (APIM), an analytic framework to describe interdependent outcomes within dyads. Methods Among MSM couples enrolled as dyads in an HIV prevention randomized controlled trial (RCT), two outcomes are examined in this cross-sectional analysis: 1) the actor experiencing physical or sexual IPV from the study partner in the past 3-months and 2) the actor feeling coerced to participate in the RCT by the study partner. Two multilevel APIM logistic regression models evaluated the association between each outcome and actor, partner, and dyad-level factors. Results Of 190 individuals (95 MSM couples), 14 reported experiencing physical or sexual IPV from their study partner in the past 3 months (7.3%) and 12 reported feeling coerced to participate in the RCT by their study partner (6.3%). Results of multivariate APIM analyses indicated that reporting experienced IPV was associated (p < 0.1) with non-Black/African American actor race, lower actor education, and lower partner education. Reporting experienced coercion was associated (p < 0.1) with younger actor age and lower partner education. Conclusions These findings from an HIV prevention RCT for MSM show considerable levels of IPV experienced in the past 3-months and coercion to participate in the research study, indicating the need for screening tools and support services for these behaviors. The identification of factors associated with IPV and coercion demonstrate the importance of considering actor and partner effects, as well as dyadic-level effects, to improve development of screening tools and support services for these outcomes.
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Affiliation(s)
- Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, 1518 Clifton Road NE, 4th Floor, Atlanta, GA 30322, Georgia.
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Eaton LA, Driffin DD, Smith H, Conway-Washington C, White D, Cherry C. Psychosocial factors related to willingness to use pre-exposure prophylaxis for HIV prevention among Black men who have sex with men attending a community event. Sex Health 2014; 11:244-51. [PMID: 25001553 DOI: 10.1071/sh14022] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 03/04/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Objectives In the US, Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS. Pre-exposure prophylaxis (PrEP) holds tremendous promise for curbing the HIV/AIDS epidemic among these men. However, many psychosocial components must be addressed in order to implement this prevention tool effectively among BMSM. METHODS We assessed PrEP knowledge and use, health care access experiences, race-based medical mistrust, sexual partners and behaviours, and drug and alcohol use among 699 men attending a community event in the south-eastern United States. We used generalised linear modelling to assess factors associated with their willingness to use PrEP. RESULTS Three hundred and ninety-eight men reported being BMSM and having HIV-negative status. Among these men, 60% reported being willing to use PrEP. Lack of being comfortable with talking to a health care provider about having sex with men, not having discussed having sex with a man with a health care provider, race-based medical mistrust, and alcohol consumption and substance use were all identified as barriers to willingness to use PrEP. Sexual risk-taking, number of sex partners and STI diagnosis were not associated with willingness to use PrEP. CONCLUSIONS Findings from the current paper demonstrate the importance of acknowledging the role of various psychosocial factors in the uptake of PrEP. It is imperative that we prioritise research into understanding these barriers better, as the failure to do so will impede the tremendous potential of this prevention technology.
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Affiliation(s)
- Lisa A Eaton
- University of Connecticut, Storrs, CT 06269, USA
| | | | - Harlan Smith
- University of Connecticut, Storrs, CT 06269, USA
| | | | - Denise White
- University of Connecticut, Storrs, CT 06269, USA
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Darbes LA, Chakravarty D, Neilands TB, Beougher SC, Hoff CC. Sexual risk for HIV among gay male couples: a longitudinal study of the impact of relationship dynamics. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:47-60. [PMID: 24233329 PMCID: PMC4425439 DOI: 10.1007/s10508-013-0206-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
While the relationship context itself is increasingly being examined to understand sexual risk behavior among gay male couples, few studies have examined relationship dynamics and HIV risk longitudinally. We aimed to investigate relationship dynamics and psychosocial predictors of unprotected anal intercourse (UAI) with outside partners of serodiscordant or unknown HIV serostatus (UAIOUT) over time as well as UAI with primary partner in serodiscordant couples (UAIPP). We recruited a sample of 566 ethnically diverse, seroconcordant and serodiscordant couples and interviewed them six times over the course of 3 years. The surveys encompassed relationship dynamics between the partners and sexual behavior with primary and outside partners. We fit generalized linear mixed models for both the UAI outcomes with time and relationship dynamics as predictors while controlling for relationship length. Analyses of the longitudinal data revealed that, in both categories of couples, those with higher levels of positive relationship dynamics (e.g., commitment, satisfaction) were less likely to engage in UAIOUT. Higher investment in sexual agreement and communication were among the factors that significantly predicted less UAIOUT for seroconcordant couples, but not for the serodiscordant couples. For serodiscordant couples, greater levels of attachment and intimacy were associated with greater odds of UAIPP while increased HIV-specific social support was associated with lower odds of UAIPP. These results underscore the importance of creating and tailoring interventions for gay couples that help maintain and strengthen positive relationship dynamics as they have the potential to produce significant changes in HIV risk behavior and thereby in HIV transmission.
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Affiliation(s)
- Lynae A. Darbes
- Center for AIDS Prevention Studies, 50 Beale St., Suite 1300, San Francisco, CA 94105
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, 50 Beale St., Suite 1300, San Francisco, CA 94105
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, 50 Beale St., Suite 1300, San Francisco, CA 94105
| | - Sean C. Beougher
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA
| | - Colleen C. Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA
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Safika I, Johnson TP, Cho YI, Praptoraharjo I. Condom Use Among Men Who Have Sex With Men and Male-to-Female Transgenders in Jakarta, Indonesia. Am J Mens Health 2013; 8:278-88. [PMID: 24203992 DOI: 10.1177/1557988313508430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article examined differences in condom use during anal intercourse among men who have sex with men (MSM) and male-to-female transgender women in Jakarta, Indonesia. A cross-sectional design, structured interviews, and hierarchical linear modeling were used to examine condom use among MSM recruited from entertainment places (EPs; e.g., discotheques/dance clubs/karaoke bars), massage parlors (MPs), and among transgender women who congregated and/or sought sexual partners on streets/parks (S/P). The sample consisted of 91, 97, and 114 of MSM-EP, MSM-MP, and transgender-S/P, respectively. Respondents reported on 641 unique sexual partner encounters, which were "nested" within 302 respondents. Reported condom use was high, 66%, 84%, and 83% for MSM-EP, MSM-MP, and transgender-S/P, respectively, and varied across type of respondent. At the individual level, depressive symptoms and history of physical abuse during childhood and adulthood were associated with lower condom use (p < .05). By contrast, having a higher level of education was associated with more condom use (p < .05). At the partner level, condom use was associated with type of partners and the use of club drugs before sex. HIV-prevention efforts should take into account the multilevel determinants of condom use within these populations.
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Affiliation(s)
- Iko Safika
- University of Illinois at Chicago, Chicago, IL, USA
| | | | - Young Ik Cho
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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The impact of substance use, sexual trauma, and intimate partner violence on sexual risk intervention outcomes in couples: a randomized trial. Ann Behav Med 2013. [PMID: 23208648 DOI: 10.1007/s12160-012-9455-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Few HIV prevention interventions focus on sexual risk reduction as mutual process determined by couple members, though risk behaviors are inter-dependent. PURPOSE This trial examined the impact of substance use, history of sexual trauma, and intimate partner violence on sexual risk associated with participation in a risk reduction intervention. METHODS HIV seroconcordant and serodiscordant multicultural couples in Miami, Florida (n = 216) were randomized to group (n = 112) or individual (n = 104) couple-based interventions. RESULTS Group intervention participants increased condom use in couples in which women had a history of sexual trauma [F(2,221) = 3.39, p = 0.036] and by partners of alcohol users. History of sexual trauma was a determinant of conflict resolution, predicting negative communication and intimate partner violence. CONCLUSIONS Results emphasize the need for group sexual risk reduction interventions targeting sexual trauma, partner violence, and substance use among HIV seroconcordant and serodiscordant couples.
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Mitchell JW, Champeau D, Harvey SM. Actor-partner effects of demographic and relationship factors associated with HIV risk within gay male couples. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1337-45. [PMID: 22875716 PMCID: PMC4388025 DOI: 10.1007/s10508-012-9985-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 01/13/2012] [Accepted: 01/31/2012] [Indexed: 05/22/2023]
Abstract
Recent research has investigated the association of relationship factors and dynamics with sexual behaviors and HIV risk among gay male couples. However, few studies with gay male couples have used the Actor-Partner Interdependence Model framework to examine whether factors influence an individual and his partner's sexual risk behaviors. None of these studies analyzed whether relationship factors had influenced the sexual risk behaviors of both partners within the couple. Our cross-sectional study used dyadic data from 142 gay male couples to assess actor-partner effects of relationship commitment, trust, and investment in one's sexual agreement for HIV risk. Multilevel modeling was used to examine which actor-partner effects of these factors were predictive of individuals and their partners having had UAI within and outside the relationship. Results indicated that participants' likelihood of having had UAI within and outside of the relationship significantly decreased with: (1) actor effects of value in and commitment to a sexual agreement, and quality of alternatives to the relationship and (2) partner effects of participant's age, dependability of trust, quality of alternatives to the relationship, and investment of relationship commitment. No significant actor-partner effects were detected for having had UAI within the relationship. Our findings suggest that future HIV prevention strategies should take into account how relationship factors influence an individual and his main partners' sexual risk behaviors and in turn, the couple's risk for HIV. However, more research is needed to examine how actor-partner effects of relationship factors influence a variety of sexual risk behaviors within gay male couples.
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Affiliation(s)
- Jason W Mitchell
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, 53202, USA,
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35
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Jones D, Kashy D, Villar-Loubet O, Weiss S. Enhancing acceptability and use of sexual barrier products among HIV concordant and discordant couples. AIDS Behav 2013; 17:2185-93. [PMID: 23494224 DOI: 10.1007/s10461-013-0449-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Strategies to prevent HIV transmission may benefit from addressing both individual and dyadic factors. This study compared the impact of group and individual interventions on the acceptability of sexual barrier products among HIV sero-concordant and discordant couples, and evaluated the contribution of couple members' perceived product acceptability to their sexual barrier use. Participants (n = 216 couples) were multicultural couples in Miami, Florida. Longitudinal multilevel modeling and the actor-partner interdependence model were used for analyses. Product acceptability increased more among female group participants, and acceptability of male condoms increased more among sero-discordant couples in the group. Additionally, acceptability of products associated with prevention of STDS/HIV and pregnancy increased more among sero-concordant couples in the group condition. Both actor and partner product acceptability predicted use. Results support the use of group interventions targeting both partners in relationships in prevention programs designed to enhance sexual barrier use.
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Dual Protection and Dual Methods in Women Living with HIV: The Brazilian Context. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2013; 2013:540789. [PMID: 26316959 PMCID: PMC4437424 DOI: 10.1155/2013/540789] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/09/2013] [Accepted: 05/28/2013] [Indexed: 11/26/2022]
Abstract
The cooccurrence of HIV and unintended pregnancy has prompted a body of work on dual protection, the simultaneous protection against HIV and unintended pregnancy. This study examines dual protection and dual methods as a risk-reduction strategy for women living with HIV. Data are from a cross-sectional sample of HIV-positive women attended in Specialized STI/AIDS Public Health Service Clinics in 13 municipalities from all five regions of Brazil 2003-2004 (N = 834). Descriptive techniques and logistic regression were used to examine dual protection among women living with HIV. We expand the definition of dual protection to include consistent condom use and reversible/irreversible contraceptive methods, we test the dual methods hypothesis that women who use dual methods will use condoms less consistently than women who use only condoms, and we identify predictors of dual protection. Dual protection is common in our sample. Women who use dual methods have lower odds of consistent condom use than women who only use condoms. Among dual method users, we find that women who use an irreversible method use condoms more consistently than women who use a reversible method. Women on ART and with an HIV-serodiscordant partner have greater odds of consistent condom use than their counterparts.
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Mitchell JW, Petroll AE. Factors associated with men in HIV-negative gay couples who practiced UAI within and outside of their relationship. AIDS Behav 2013; 17:1329-37. [PMID: 22790903 PMCID: PMC4101801 DOI: 10.1007/s10461-012-0255-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite recent advances in research with gay male couples, less data exists about men who have had UAI within and outside of their HIV-negative seroconcordant relationship. Multilevel modeling with dyadic data from 142 couples was used to identify the characteristics associated with men who have had UAI with both their main partner and a casual MSM partner within the same timeframe. Analyses revealed that men were more likely to have had UAI within and outside of their relationship if they perceived their main partner has had a recent HIV test. Men were less likely to have had UAI within and outside of their relationship if they valued their sexual agreement and reported having a sexual agreement that does not allow sex outside of their relationship. Research with a more diverse sample of couples is warranted. Future interventions must consider the complexity of relationships and sexual behaviors among gay male couples.
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Affiliation(s)
- Jason W Mitchell
- Health Promotion and Risk Reduction Programs, School of Nursing, University of Michigan, 400 N. Ingalls, Room 3343, Ann Arbor, MI 48109-5482, USA.
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Sexual risk behavior and risk reduction beliefs among HIV-positive young men who have sex with men. AIDS Behav 2013; 17:1515-23. [PMID: 22350830 DOI: 10.1007/s10461-012-0155-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With young men who have sex with men (YMSM) continuing to be disproportionately affected by the HIV/AIDS epidemic in the U.S., secondary prevention efforts with this population take on increasing significance. We surveyed 200 HIV-positive YMSM (ages 16-24, 66% Black, 18% Latino, 7% White, 7% Multiracial/Other) recruited from 14 HIV primary care sites to examine associations of unprotected anal intercourse (UAI) and partner HIV status with endorsement of serosorting, sexual positioning, and viral load beliefs. Proportions of participants engaging in UAI one or more times during the past three months were consistent across type of UAI (insertive or receptive) and partner status. Belief that an undetectable viral load reduces infectiousness was significantly associated with insertive UAI (p < .05) and receptive UAI (p < .05) with HIV-negative or unknown status partners and receptive UAI with HIV-positive partners (p < .01). Endorsement of belief in serosorting was significantly associated with receptive UAI (p < .01) and insertive UAI (p < .05) with HIV-positive male partners. Implications for sexual behavior and risk reduction beliefs in this population are discussed.
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Mitchell JW. Characteristics and allowed behaviors of gay male couples' sexual agreements. JOURNAL OF SEX RESEARCH 2013; 51:316-28. [PMID: 23514544 PMCID: PMC4322899 DOI: 10.1080/00224499.2012.727915] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Research has shown that gay male couples' sexual agreements may affect their risk for HIV. Few U.S. studies have collected dyadic data nationally from gay male couples to assess what sexual behaviors they allow to occur by agreement type and the sequence of when certain behaviors occur within their relationships. In our cross-sectional study, dyadic data from a convenience sample of 361 male couples were collected electronically throughout the United States by using paid Facebook ads. Findings revealed that couples discussed their HIV status before having unprotected anal intercourse (UAI) but established their agreement some time after having UAI. About half of the couples (N = 207) concurred about having an agreement. Among these couples, 58% concurred about explicitly discussing their agreement, 84% concurred about having the same type of agreement, and 54% had both men adhering to it. A variety of sexual behaviors were endorsed and varied by agreement type. Concordance about aspects of couples' agreements varied, suggesting the need to engage couples to be more explicit and detailed when establishing and communicating about their agreements. The allowed behaviors and primary reasons for establishing and breaking sexual agreements further highlight the need to bolster HIV prevention for gay male couples.
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Affiliation(s)
- Jason W. Mitchell
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
- School of Nursing, University of Michigan, Ann Arbor, MI
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Pearson CR, Walters KL, Simoni JM, Beltran R, Nelson KM. A cautionary tale: risk reduction strategies among urban American Indian/Alaska Native men who have sex with men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:25-37. [PMID: 23387949 PMCID: PMC3951888 DOI: 10.1521/aeap.2013.25.1.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
American Indian and Alaska Native (AIAN) men who have sex with men (MSM) are considered particularly high risk for HIV transmission and acquisition. In a multi-site cross-sectional survey, 174 AIAN men reported having sex with a man in the past 12 months. We describe harm reduction strategies and sexual behavior by HIV serostatus and seroconcordant partnerships. About half (51.3%) of the respondents reported no anal sex or 100% condom use and 8% were in seroconcordant monogamous partnership. Of the 65 men who reported any sero-adaptive strategy (e.g., 100% seroconcordant partnership, strategic positioning or engaging in any strategy half or most of the time), only 35 (54.7%) disclosed their serostatus to their partners and 27 (41.5%) tested for HIV in the past 3 months. Public health messages directed towards AIAN MSM should continue to encourage risk reduction practices, including condom use and sero-adaptive behaviors. However, messages should emphasize the importance of HIV testing and HIV serostatus disclosure when relying solely on sero-adaptive practices.
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Affiliation(s)
- Cynthia R Pearson
- Indigenous Wellness Research Institute, University of Washington, Seattle, WA 98105, USA.
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Vamos S, Cook R, Chitalu N, Mumbi M, Weiss SM, Jones D. Quality of relationship and sexual risk behaviors among HIV couples in Lusaka, Zambia. AIDS Care 2013; 25:1102-8. [PMID: 23336258 PMCID: PMC3636183 DOI: 10.1080/09540121.2012.749339] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Relationship quality and partner dynamics provide important insights into understanding sexual behavior within HIV sero-positive and sero-discordant couples. Individuals in long-term partnerships may be vulnerable to HIV/sexually transmitted infections (STI) within their relationships due to misperceptions of their partners risk behaviors and potential concurrent (e.g., extramarital, nonprimary) sexual partnerships. This study sought to examine relationship quality among HIV sero-positive and sero-discordant couples in Zambia, and its association with safer sex behavior. This study utilized data drawn from an ongoing translational study, The Partnership II Project - a couples-based sexual risk reduction intervention in Lusaka, Zambia. Couples (n=240) were assessed on demographics, relationship quality, and sexual risk behavior. Overall, couples perceiving their relationships more positively engaged in less risky sexual behavior (i.e., more condom use (b=0.011, t=3.14, p=0.002) and fewer partners (χ(2)=11.4, p=0.003). Within the dyad, condom use was "actor driven," indicating that the association between relationship quality and condom use did not depend on the partner's evaluation of the relationship. Safer sex behavior was positively influenced by communication about condoms. Results support the paradigm shift from prevention strategies with HIV-positive and at-risk individuals to concentrated efforts addressing male-female dyads, and suggest that interventions to address the role of couples' relationship quality, a modifiable target for decreasing sexual risk behavior, are needed.
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Affiliation(s)
- Szonja Vamos
- University of Miami Miller School of Medicine, Dept. of Psychiatry and Behavioral Sciences, Miami, USA
| | - Ryan Cook
- University of Miami Miller School of Medicine, Dept. of Psychiatry and Behavioral Sciences, Miami, USA
| | - Ndashi Chitalu
- University of Zambia, University Teaching Hosptial, Lusaka, Zambia
| | - Miriam Mumbi
- University of Zambia, University Teaching Hosptial, Lusaka, Zambia
| | - Stephen M. Weiss
- University of Miami Miller School of Medicine, Dept. of Psychiatry and Behavioral Sciences, Miami, USA
| | - Deborah Jones
- University of Miami Miller School of Medicine, Dept. of Psychiatry and Behavioral Sciences, Miami, USA
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Hoff CC, Chakravarty D, Beougher SC, Neilands TB, Darbes LA. Relationship characteristics associated with sexual risk behavior among MSM in committed relationships. AIDS Patient Care STDS 2012; 26:738-45. [PMID: 23199191 PMCID: PMC3513980 DOI: 10.1089/apc.2012.0198] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Understanding situations that increase HIV risk among men who have sex with men (MSM) requires consideration of the context in which risky behaviors occur. Relationships are one such context. This study examines the presence and predictors of unprotected anal intercourse (UAI) in the past 3 months among 566 MSM couples. A majority of couples allowed sex with outside partners. Overall, 65% of the sample engaged in UAI with primary partner, including nearly half of discordant couples. Positive relationship factors, such as attachment and intimacy, were associated with an increased likelihood of UAI with primary partner. Meanwhile, 22% of the sample engaged in at least one episode of UAI with an outside partner, half of whom were discordant or unknown HIV status outside partners. Higher levels of HIV-specific social support, equality, and sexual agreement investment were significantly associated with a decreased likelihood of engaging in UAI with a discordant or unknown HIV status outside partner. HIV-positive men in discordant relationships had two and one half times the odds of having UAI with a discordant or unknown HIV status outside partner as their HIV-negative partners. Many MSM in relationships, including some in serodiscordant ones, engage in UAI with primary partners. Potential explanations include relationship closeness, relationship length, and agreement type. In addition, relationship context appears to have a differential impact upon UAI with primary and outside partners, implying that prevention messages may need to be tailored for different types of couples. Prevention efforts involving MSM couples must take into account relationship characteristics as couples balance safer sex and HIV risk with intimacy and pleasure.
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Affiliation(s)
- Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA 94103, USA.
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43
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Persson A. Notes on the concepts of 'serodiscordance' and 'risk' in couples with mixed HIV status. Glob Public Health 2012; 8:209-20. [PMID: 23043414 DOI: 10.1080/17441692.2012.729219] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Serodiscordant primary relationships, in which one partner is HIV-positive and the other is HIV-negative, are increasingly recognised as a key context for the transmission of HIV globally. Yet insights into the dynamics of serodiscordance remain relatively limited. I argue that to understand what makes serodiscordant couples engage in sexual practices that increase the chance of transmission, we need to examine what HIV 'risk' actually means in different cultures and contexts. A 'socially situated' approach to HIV risk moves beyond its scientific conceptualisation as an objective 'fact', revealing a diversity of perceptions and competing risks. It also reveals that couples do not necessarily perceive their mixed HIV status in terms of 'difference', a common assumption that predetermines serodiscordance and thereby obscures its many and complex enactments. I draw on examples from the social research literature to illustrate how serodiscordance is shaped in different ways by local practices, priorities, and meanings. I argue that it is within these lived contexts that perceptions and negotiations of 'risk' arise and, thus, where couples' sexual practices need to be situated and understood. Such insights are timely as HIV research and prevention grapple with emerging scientific data that challenge traditional understandings about HIV transmission risk.
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Affiliation(s)
- Asha Persson
- National Centre in HIV Social Research, University of New South Wales, Sydney, NSW, Australia.
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Li L, Liang LJ, Lee SJ, Farmer SC. HIV status and gender: a brief report from heterosexual couples in Thailand. Women Health 2012; 52:472-84. [PMID: 22747184 DOI: 10.1080/03630242.2012.687442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although the impact of HIV falls on both partners of a married couple, the burden of stress may not be necessarily shared evenly. The researchers in this study examined the relations among HIV status, gender, and depressive symptoms among 152 married or cohabitating couples living with HIV in the northern and northeastern regions of Thailand. Depressive symptoms were assessed using a 15-item depressive symptom screening test that was developed and used previously in Thailand. Among the 152 couples, 59% were couples in which both members were people living with HIV (seroconcordant; both people living with HIV couples), 28% had only female members with HIV (serodiscordant; females living with HIV couples), and 13% had only male members with HIV (serodiscordant; males living with HIV couples). The prevalence of depressive symptoms between seroconcordant and serodiscordant groups was similar. However, females living with HIV reported significantly higher levels of depressive symptoms, regardless of their partners' HIV status. Future prevention programs focusing on serodiscordant couples should be planned to target HIV risk, as well as emphasis on mental health, with a particular focus on women's increased susceptibility to negative mental health outcomes.
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Affiliation(s)
- Li Li
- Semel Institute–Center for Community Health, 10920 Wilshire Blvd., Los Angeles, CA 90024, USA.
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Mitchell JW, Harvey SM, Champeau D, Moskowitz DA, Seal DW. Relationship factors associated with gay male couples' concordance on aspects of their sexual agreements: establishment, type, and adherence. AIDS Behav 2012; 16:1560-9. [PMID: 22012148 PMCID: PMC4096805 DOI: 10.1007/s10461-011-0064-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Factors associated with gay male couples' concordance on aspects of sexual agreements remain understudied. The present study examined which relationship factors, self-reports of UAI, and patterns of HIV testing may be associated with men who were concordant about having a sexual agreement, the same type of sexual agreement, and adhering to their sexual agreement with their main partner. Various recruitment strategies were used to collect dyadic data from 142 gay male couples. Concordance on aspects of sexual agreements varied within the sample. Results indicated that relationship satisfaction was significantly associated with couples who were concordant about having and adhering to their sexual agreement. Predictability and faith of trusting a partner, and value in one's sexual agreement were also positively associated with couples' adhering to their sexual agreement. More research is needed to better understand how relationship dynamics, including sexual agreements, affect HIV risk among gay male couples in the U.S.
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Affiliation(s)
- Jason W Mitchell
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, 53202, USA.
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De Santis JP, Vasquez EP, Deleon DA, Gonzalez-Guarda RM. Relationships as Risk: High risk sex, Substance Abuse, and Violence among Hispanic Men who have Sex with Men. HORIZONTE DE ENFERMERIA 2012; 23:27-39. [PMID: 25242861 PMCID: PMC4167401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Men who have sex with men (MSM) experience a number of health disparities including high rates of HIV from high risk sex. High rates of HIV infection are related to high risk sexual behaviors and multiple sexual partners. High rates of HIV infection in this population also may be related to high risk sexual behaviors that occur within the context of primary relationships. However, relatively little is know about about relationships among Hispanic MSM. In addition, little is known about the factors that contribute to risk within these primary relationships. AIMS The purpose of this study is to use qualitative methods to explore the factors responsible for high risk sexual behavior within primary relationships among Hispanic MSM. METHODS Twenty Hispanic MSM were recruited from various community sites in South Florida to participate in auditotaped focus groups. Data from the focus groups were transcribed and analyzed using content analysis. Data were collected until saturation was achieved. RESULTS Participants identified a number of topics that contribute to risk: drugs/alcohol as risk, outside sex as risk, concealment of HIV infection, violence as risk, consensual and non-consensual sexual violence, and absent family support. Participants also described the relationship of sexual risk, substance abuse, and violence in the context of Hispanic MSM relationships. CONCLUSIONS The results of the study provided some important clinical implications for clinicians providing care to Hispanic MSM. From the results of this study, directions for future research focused on the relationships of Hispanic MSM are evident.
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Affiliation(s)
| | | | - Diego A Deleon
- University of Miami School of Nursing & Health Studies Coral Gable, FL
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Sarna A, Luchters S, Pickett M, Chersich M, Okal J, Geibel S, Kingola N, Temmerman M. Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs. AIDS Res Ther 2012; 9:9. [PMID: 22429560 PMCID: PMC3342087 DOI: 10.1186/1742-6405-9-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 03/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment. RESULTS Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma (AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91, p < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive methods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75, p < 0.001), compared to condom users. CONCLUSIONS High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviors.
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48
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Mitchell JW, Harvey SM, Champeau D, Seal DW. Relationship factors associated with HIV risk among a sample of gay male couples. AIDS Behav 2012; 16:404-11. [PMID: 21614560 PMCID: PMC4096799 DOI: 10.1007/s10461-011-9976-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
More HIV prevention research is needed to better understand how relationship factors may affect sexual risk behaviors among gay male couples. Our cross-sectional study collected dyadic data from 144 gay male couples to examine which relationship factors and characteristics were associated with men having UAI with a secondary sex partner. We targeted male couples by using a variety of recruitment strategies. Multilevel random-effects logistic regression modeling was used to examine which factors were predictive of men in gay couples who had UAI with a secondary sex partner. Analyses revealed that men were less likely to have had UAI with a secondary sex partner if they reported being in a strictly monogamous relationship, receiving an HIV test within the previous 3 months, and being committed to their sexual agreement. Future HIV prevention interventions must consider how relationship factors may influence sexual risk behaviors among gay male couples.
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Affiliation(s)
- Jason W Mitchell
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, 53202, USA.
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49
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Beougher SC, Chakravarty D, Garcia CC, Darbes LA, Neilands TB, Hoff CC. Risks worth taking: safety agreements among discordant gay couples. AIDS Care 2012; 24:1071-7. [PMID: 22292838 DOI: 10.1080/09540121.2011.648603] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
As HIV research and prevention efforts increasingly target gay men in relationships, situational factors such as couple serostatus and agreements about sex become central to examinations of risk. Discordant gay couples are of particular interest because the risk of HIV infection is seemingly near-at-hand. Yet, little is known about their sexual behaviors, agreements about sex, and safer sex efforts. The present study utilized longitudinal semi-structured, qualitative interviews to explore these issues among 12 discordant couples. Findings show that nearly every couple had agreements about reducing the likelihood of HIV transmission from one partner to the other. Negotiating these agreements involved establishing a level of acceptable risk, determining condom use, and employing other risk-reduction techniques, such as seropositioning and withdrawal. For half of the couples, these agreements did not involve using condoms; only two couples reported consistent condom use. Despite forgoing condoms, however, none reported seroconversion over the course of data collection. Additional issues are raised where long-term HIV prevention is concerned. Future prevention efforts with discordant couples should work with, rather than fight against, the couple's decision to use condoms and endeavor to complement and accentuate their other safer sex efforts.
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Affiliation(s)
- Sean C Beougher
- Center for Research on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA.
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50
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Wu E, El-Bassel N, McVinney LD, Hess L, Remien RH, Charania M, Mansergh G. Feasibility and promise of a couple-based HIV/STI preventive intervention for methamphetamine-using, black men who have sex with men. AIDS Behav 2011; 15:1745-54. [PMID: 21766193 PMCID: PMC6292195 DOI: 10.1007/s10461-011-9997-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Accumulating evidence supports couple-based approaches for HIV/STI preventive interventions. Yet, to date, no studies have examined couple-based sexual risk reductions intervention specifically for men who have sex with men (MSM) from populations with elevated rates of HIV/STI transmission, such as black MSM and methamphetamine-involved MSM. We pilot tested-using a pre-/post-test design-a seven-session couple-based intervention for black, methamphetamine-using, black MSM couples engaging in sexual risk. Feasibility was assessed via recruitment and retention rates; potential efficacy relied on self-reported sexual risk and drug use prior to and two months following intervention delivery. We enrolled 34 couples (N = 68 men). Over 80% attended all seven intervention sessions, and retention exceeded 95% at two-month follow-up. At follow-up, participants reported significantly fewer sexual partners, fewer episodes of unprotected anal sex, and greater condom use with their main partner; participants also reported significantly less methamphetamine use, any illicit drug use, and number of illicit drugs used. These findings indicate that couple-based HIV/STI intervention is feasible and promising for at-risk black MSM couples.
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Affiliation(s)
- Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA.
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