Reciprocal sex partner concurrency and STDs among heterosexuals at high-risk of HIV infection

How black heterosexual men's narratives about sexual partner type and condom use disrupt the main and casual partner dichotomy: 'we still get down, but we not together'

Sexual partner types and partnership dynamics have important implications for condom use. Yet most HIV prevention research conceptualises condom use as individual-level rather than dyadic-level behaviour. Evidence of a generalised HIV epidemic in urban predominantly low-income US Black heterosexual communities highlights the need for a culturally and contextually-grounded understanding of partner types, partnership dynamics and condom use from the perspective of Black heterosexual men. We conducted individual interviews with 30 self-identified men between the ages of 18 and 44, 18 (60%) of whom reported at least two partner types in the last 6 months. Key findings include: (1) 'main and casual' partner types per the HIV prevention literature; (2) three casual-partner subtypes: primary, recurrent, and one-time casuals; (3) overlapping partnership dynamics between main partners, primary-casual partners and recurrent-casual partners, but not one-time casual partners; and (4) consistent condom use reported for one-time casual partners only. The study underscores the critical need for more condom promotion messages and interventions that reflect the dyadic and culturally-grounded realities of US Black heterosexual men's sexual partner types and partnership dynamics.

Syndemic effects of HIV risk behaviours: results from the NHANES study

The aim of the present study is to use the syndemic framework to investigate the risk of contracting HIV in the US population. Cross-sectional analyses are from The National Health and Nutrition Examination Survey. We extracted and aggregated data on HIV antibody test, socio-demographic characteristics, alcohol use, drug use, depression, sexual behaviours and sexually transmitted diseases from cycle 2009-2010 to 2015-2016. We carried out weighted regression among young adults (20-39 years) and adults (40-59 years) separately. In total, 5230 men and 5794 women aged 20-59 years were included in the present analyses. In total, 0.8% men and 0.2% women were tested HIV-positive. Each increasing HIV risk behaviour was associated with elevated odds of being tested HIV-positive (1.15, 95% CI 1.15-1.15) among young adults and adults (1.61, 95% CI 1.61-1.61). Multi-faceted, community-based interventions are urgently required to reduce the incidence of HIV in the USA.

Sexual Risk and Protective Behaviors Among Reproductive-Aged Women in the United States

BACKGROUND

In 2014, women represented 19% of HIV diagnoses in the United States. Of these, 78% were among black women and Latinas. Sexual risk behaviors-for example concurrent sex partnerships, nonmonogamous sex partners, and inconsistent condom use-are associated with increased HIV transmission and prevalence; these behaviors have been understudied, collectively, in women.

METHODS

To examine HIV-related sexual risk behaviors among sexually active women aged 18-44 years by race/ethnicity and over time, we used data from the 2006-2008, 2008-2010, and 2011-2013 cycles of the National Survey of Family Growth. We estimated weighted percentages and performed logistic regression to measure adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between selected behaviors and sociodemographic covariates.

RESULTS

Among 13,588 women, 1.1% reported concurrent sex partnerships, 10.3% reported male partners whom they perceived were nonmonogamous, and 21.1% reported using a condom at either last vaginal or anal sex. Black women (aPR = 1.52; CI = 1.36-1.71) and Latinas (aPR = 1.29; CI = 1.14-1.47) were more likely to report condom use at either last vaginal or anal sex compared with white women. However, black women were also more likely to report concurrent opposite-sex partnerships (aPR = 2.44; CI = 1.57-3.78) and perceived nonmonogamous sex partners (aPR = 1.33; CI = 1.14-1.56) compared with white women.

CONCLUSIONS

Improved HIV behavioral risk-reduction strategies are needed for women. Black women could benefit from interventions that address partnership concurrency. For black women and Latinas, who are more likely to use condoms, further examination of broader social and structural factors as contributors to racial/ethnic gaps are warranted and vital for understanding and decreasing HIV-related disparities.

Prevalence of sexually transmitted infections among Tanzanian migrants: a cross-sectional study

For the many millions of migrants, mobility creates vulnerabilities and elevates risk for sexually transmitted infections (STIs). We document, among Tanzanian agricultural plantation residents, migrant characteristics and test associations between migrant status and prevalent STI (HSV-2, syphilis, and HIV). From 623 plantation resident participants, we limit this analysis to participants about whom we know migration status (migrants n = 242, non-migrants n = 291). We collected behavioral data via audio-computer assisted self-interview survey, and clinical data via STI testing. We used multivariate Poisson regression models, stratified by gender and controlling for behavioral risk factors, to measure associations between migrant status and STI. In men, HIV prevalence was 9% for migrants, and 6% for non-migrants. HSV-2 prevalence was 57% for migrants, and 32% for non-migrants. Syphilis prevalence was 12% for migrants, and 3% for non-migrants. Among women, there were few differences in STI prevalence by migrant status: prevalence of HIV was 6% vs. 5% (migrants vs. non-migrants); HSV-2 prevalence was 68% vs. 65%; and syphilis prevalence was 11% vs. 8%. Being a male migrant was significantly associated with increased prevalence of any STI after controlling for sociodemographic and behavioral characteristics (APR = 1.53, 95% CI 1.23-5.25). Migrant women did not have increased prevalence of STI as compared to non-migrant women (APR = 1.03, 95% CI 0.85-1.24). Amongst Tanzanian agricultural workers, male migrants experienced elevated risk for prevalent STI as compared to male non-migrants. We suggest structural interventions to reduce risks associated with migration, especially in male migrants, including workplace-based STI prevention programs, and connecting migrants to resources and support within new communities. The key messages are: migrant men experience significantly elevated risk for prevalent STI, above and beyond sociodemographic and behavioral risk factors, as compared to their non-migrant peers; women in this Tanzanian agricultural plantation community overall had higher prevalence of some STIs than men, migrant women had similar STI risk as non-migrant women; and migration for work, an economic strategy for millions, also creates vulnerabilities, so workplace-based STI prevention programs and connecting migrants to community resources are essential.

Concurrency and Other Sexual Risk Behaviors Among Black Young Adults in a Southeastern City

Black Americans continue to have higher rates of HIV disease than other races/ethnicities. Conventional individual-level risk behaviors do not fully account for these racial/ethnic disparities. Sexual concurrency may help explain them. Respondent-driven sampling (RDS) was used to enroll 508 sexually active 18- to 30-year-old Black men and women in Durham, North Carolina in a cross-sectional survey on HIV-related topics. Consistent condom use was low for all participants, especially with steady partners. Concurrent partnerships in the past 6 months were relatively common for both men (38%) and women (25%). In general, men involved in concurrent relationships engaged in more risk behaviors than other men (e.g., inconsistent condom use and alcohol and drug use). A majority of concurrent partnerships involved steady partners. HIV-prevention programs should address the risks of concurrency and factors that discourage condom use, especially with steady partners with whom condom use is particularly low.

Attitudes Towards Power in Relationships and Sexual Concurrency Within Heterosexual Youth Partnerships in Baltimore, MD

Sexual concurrency may increase risk for HIV/STIs among youth. Attitudes about gender roles, including power balances within sexual partnerships, could be a driver. We examined this association among Baltimore youth (N = 352), aged 15-24. Data were collected from February, 2011 to May, 2013. We examined whether index concurrency in male-reported partnerships (N = 221) and sex partner's concurrency in female-reported partnerships (N = 241) were associated with youth's attitudes towards relationship power. Males with more equitable beliefs about power were less likely to report index concurrency. Females with more equitable beliefs were more likely to report sex partner's concurrency. The relationship was significant in main and casual partnerships among females and main partnerships among males. The strongest associations were detected among middle-socioeconomic status (SES) males and low-SES and African American females. Implementing interventions that recognize the complex relationship between socioeconomic context, partner dynamics, gender, and sexual behavior is an important step towards reducing HIV/STI risk among youth.

Impact of Intimate Partner Forced Sex on HIV Risk Factors in Physically Abused African American and African Caribbean Women

We examined associations between intimate partner forced sex (IPFS) and HIV sexual risk behaviors among physically abused Black women. Women aged 18-55 in intimate relationships were interviewed in health clinics in Baltimore, MD and St. Thomas and St. Croix, US Virgin Islands (USVI). Of 426 physically abused women, 38% experienced IPFS; (Baltimore = 44 and USVI = 116). USVI women experiencing IPFS were more likely to have 3+ past-year sex partners (AOR 2.06, 95% CI 1.03-4.14), casual sex partners (AOR 2.71, 95% CI 1.42-5.17), and concurrent sex partners (AOR 1.94, 95% CI 1.01-3.73) compared to their counterparts. Baltimore women reporting IPFS were more likely to have exchanged sex (AOR 3.57, 95% CI 1.19-10.75). Women experiencing IPFS were more likely to report their abuser having other sexual partners in Baltimore (AOR 3.30, 95% CI 1.22-8.88) and USVI (AOR 2.03, 95% CI 1.20-3.44). Clinicians should consider the influence of IPFS on individual and partnership HIV sexual risk behaviors.

Correlates of Concurrent Sexual Partnerships Among Young, Rural African American Men

OBJECTIVE

We investigated the social, behavioral, and psychological factors associated with concurrent (i.e., overlapping in time) sexual partnerships among rural African American young men with a primary female partner.

METHODS

We recruited 505 men in rural areas of southern Georgia from January 2012 to August 2013 using respondent-driven sampling; 361 reported having a primary female partner and participating only in heterosexual sexual activity. Men provided data on their demographic characteristics and HIV-related risk behaviors, as well as social, behavioral, and psychological risk factors.

RESULTS

Of the 361 men with a primary female partner, 164 (45.4%) reported concurrent sexual partners during the past three months. Among the 164 men with a concurrent sexual partner, 144 (92.9%) reported inconsistent condom use with their primary partners, and 68 (41.5%) reported using condoms inconsistently with their concurrent partners. Having concurrent sexual partnerships was associated with inconsistent condom use, substance use before sex, and self-reported sexually transmitted infections (STIs). Bivariate correlates of concurrent sexual partnerships included incarceration, substance use, early onset of sexual activity, impulsive decision-making, and masculinity attitudes (i.e., men's adherence to culturally defined standards for male behavior). In a multivariate model, both masculinity ideology and impulsive decision-making independently predicted concurrent sexual partnerships independent of other risk factors.

CONCLUSION

Masculinity attitudes and impulsive decision-making are independent predictors of concurrent sexual partnerships among rural African American men and, consequently, the spread of HIV and other STIs. Developing programs that target masculinity attitudes and self-regulatory skills may help to reduce concurrent sexual partnerships.

Substance use patterns and factors associated with changes over time in a cohort of heterosexual women at risk for HIV acquisition in the United States

BACKGROUND

Substance use is associated with HIV sexual risk behaviors, yet few studies have examined substance use patterns longitudinally. We evaluated the types and frequency of substances used over a six-month period among U.S. women at risk for HIV acquisition.

METHODS

Women reporting unprotected sex with a man in the previous six months and at least one other personal or partner HIV risk characteristic enrolled in a multisite cohort study and completed interviews about substance use at study visits. Prevalence and frequency of substance use at the baseline and six-month visits were compared and correlates of decreased substance use at the six-month visit were assessed.

RESULTS

Of 2099 women enrolled, 1882 had substance use data at baseline and six-months. Of these, 76.1% reported using at least one drug or binge drinking in the previous six months; 37.5% were frequent and 38.6% non-frequent substance users. Binge drinking was most frequently reported (63.3%), followed by cocaine (25.0%) and opioids (16.5%). Fifty-five percent of opiate users and 30% of cocaine users reported daily/almost daily use. At the six-month visit, 40.5% reported a decrease in frequency of use. Adjusting for income and type of drug used, poly-substance users were less likely to decrease frequency of use compared to those who only used one substance.

CONCLUSION

A substantial decrease in frequency of substance use over time was observed in this cohort. Poly-substance users were less likely to reduce frequency of use over time, suggesting that specific substance use interventions targeting these users are warranted.