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Skakoon-Sparling S, Card KG, Novick JR, Berlin GW, Lachowsky NJ, Adam B, Brennan DJ, Sang JM, Noor SW, Cox J, Moore DM, Grace D, Grey C, Daroya E, Hart TA. The relevance of communal altruism for sexual minority men in contemporary contexts. J Community Psychol 2023; 51:1461-1478. [PMID: 35932490 DOI: 10.1002/jcop.22923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/17/2022] [Accepted: 07/24/2022] [Indexed: 05/23/2023]
Abstract
There are many reasons why individuals engage in prosocial behavior; communal sexual altruism is based on the notion that some practice safer sex in the interest of promoting the well-being of their community/in-group. Given that definitions of what constitutes "safer sex" have changed with advances in human immunodeficiency virus (HIV) prevention, we investigated the importance of communal sexual altruism (herein "altruism") among urban gay, bisexual, and other sexual minority men (GBM) in the contemporary context. Using a sample of 2449 GBM we examined the association of both safer-sex-related attitudes (e.g., HIV treatment optimism-skepticism) and behaviors (e.g., condomless anal sex [CAS]) with altruism scores. Higher altruism scores were associated with a lower likelihood of CAS and a greater frequency of discussing HIV status with new partners. These findings demonstrate that many GBM are motivated to engage in several kinds of behaviors that improve the well-being of their in-group (i.e., the GBM community).
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Affiliation(s)
- Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jake R Novick
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Graham W Berlin
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Barry Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Windsor, Ontario, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Syed W Noor
- Department of Kinesiology & Health Science, Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Joseph Cox
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- Direction régionale de santé publique de Montréal, Montreal, Quebec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cornel Grey
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Emerich Daroya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trevor A Hart
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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2
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Roth EA, Cui Z, Armstrong HL, Rich AJ, Lachowsky NJ, Sereda P, Card KG, Bacani N, Moore D, Hogg R. Longitudinal Analysis of HIV Risk and Substance Use Patterns for Men Who Have Sex with Men and Women and Men Who Have Sex with Men Only. J Bisex 2021; 21:405-423. [PMID: 35935471 PMCID: PMC9355115 DOI: 10.1080/15299716.2021.1982102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Men Who Have Sex with Men and Women (MSMW) experience discrimination from same-sex and heterosexual communities partially because of perceptions they feature high-risk sexual behavior, elevated polysubstance use levels, and constitute an HIV bridge population. We used a longitudinal multivariate generalized linear mixed model comparing sexual risk and substance use patterns for Men Who Have Sex with Men Only (MSMO) with MSMW in the same cohort study. Data consisted of 771 men reporting 3,705 sexual partnerships from 2012-2017. For high-risk sexual behavior multivariate results showed non-significant (p>0.05) differences for partner number and commercial sex work, and significantly less (p<0.05) HIV prevalence and condomless anal sex. However, MSMW had significantly higher levels of hallucinogen and prescription opioid use, and substance treatment histories. Only one HIV-positive MSMW had a transmittable viral load, negating the concept of an HIV bridge population. Results indicate the need for additional longitudinal studies comparing MSMO and MSMW.
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Affiliation(s)
- Eric Abella Roth
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Heather L Armstrong
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, University of Southampton, Southampton, United Kingdom
| | - Ashleigh J Rich
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - David Moore
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Robert Hogg
- Faculty of Health Sciences, Simon Fraser University, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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Khosropour CM, Dombrowski JC, Barbee LA, Kerani RP, Berzkalns A, Golden MR. Changing Patterns of Sexual Behavior and HIV/STI Among Men Who Have Sex With Men in Seattle, 2002 to 2018. J Acquir Immune Defic Syndr 2021; 87:1032-1039. [PMID: 33770066 PMCID: PMC8458506 DOI: 10.1097/qai.0000000000002686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The extent to which uptake of biomedical HIV prevention strategies have affected population-level sexual behavior and sexually transmitted infections (STIs) among men who have sex with men (MSM) is not well understood. METHODS We collected data as part of routine care from MSM attending the municipal STI clinic in Seattle, Washington, 2002-2018. MSM were asked about condom use in the previous 12 months. We classified behaviors into 4 mutually exclusive categories: no anal sex; consistent condom use for anal sex; serosorting [condomless anal sex (CAS) only with HIV-concordant partners]; and CAS with serodiscordant/unknown-status partners. STI/HIV testing was performed per routine clinic protocol. RESULTS There were 45,656 and 6987 visits by MSM without HIV and MSM with HIV, respectively. The use of antiretroviral therapy and preexposure prophylaxis increased substantially during the study period to 94% and 50%, respectively, by 2018. CAS with serodiscordant/unknown-status partners decreased through 2013 but increased thereafter (to 40% among MSM without HIV; 68% among MSM with HIV). Serosorting increased among MSM without HIV but declined after 2013 among MSM with HIV. Consistent condom use declined for all MSM (from 35% to 11% among MSM without HIV; from 20% to 5% among MSM with HIV). HIV test positivity declined substantially (3.5%-0.5%), whereas STI test positivity increased over time. CONCLUSIONS Since 2013, CAS with HIV-discordant/unknown-status partners increased substantially concurrent with declining HIV test positivity and increasing STI test positivity. This highlights the success of biomedical HIV prevention strategies to reduce HIV incidence while affirming the need for new approaches to STI prevention.
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Affiliation(s)
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Lindley A. Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Roxanne P. Kerani
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Anna Berzkalns
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
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Janulis P, Goodreau SM, Birkett M, Phillips G, Morris M, Mustanski B, Jenness SM. Temporal Variation in One-Time Partnership Rates Among Young Men Who Have Sex With Men and Transgender Women. J Acquir Immune Defic Syndr 2021; 87:e214-e221. [PMID: 33675616 PMCID: PMC8192435 DOI: 10.1097/qai.0000000000002679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Volatility in sexual contact rates has been recognized as an important factor influencing HIV transmission dynamics. One-time partnerships may be particularly important given the potential to quickly accumulate large number of contacts. Yet, empirical data documenting individual variation in contact rates remain rare. This study provides much needed data on temporal variation in one-time partners to better understand behavioral dynamics and improve the accuracy of transmission models. METHODS Data for this study were obtained from a longitudinal cohort study of young men who have sex with men and transgender women in Chicago. Participants provided sexual network data every 6 months for 2 years. A series of random effects models examined variation in one-time partnership rates and disaggregated within and between associations of exposure variables. Exposure variables included prior number of one-time partners, number of casual partners, and having a main partner. RESULTS Results indicated substantial between-person and within-person variation in one-time partners. Casual partnerships were positively associated and main partnerships negatively associated with one-time partnership rates. There remained a small positive association between prior one-time partnerships and the current number of one-time partnerships. CONCLUSIONS Despite the preponderance of a low number of one-time partners, substantial variation in one-time partnership rates exists among young men who have sex with men and transgender women. Accordingly, focusing on high contact rate individuals alone may be insufficient to identify periods of highest risk. Future studies should use these estimates to more accurately model how volatility impacts HIV transmission and better understand how this variation influences intervention effectiveness.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Steven M Goodreau
- Departments of Anthropology and Epidemiology, University of Washington
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
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Rowlinson E, Golden MR, Berzkalns A, Thibault C, Barbee LA. Epidemiologic Treatment for Contacts to Neisseria gonorrhoeae and Chlamydia trachomatis Infection in Sexually Transmitted Disease Clinic Patients in Seattle, WA; 1994 to 2018. Sex Transm Dis 2020; 47:665-671. [PMID: 32649579 PMCID: PMC8549494 DOI: 10.1097/olq.0000000000001234] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Current Centers for Disease Control and Prevention guidelines recommend that clinicians empirically treat the sex partners of persons with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) infection before confirming that they are infected. It is possible that this practice, known as epidemiologic treatment, results in overtreatment for uninfected persons and may contribute to development of antimicrobial resistance. We sought to quantify the number of patients who received epidemiologic treatment and the proportion of those who were overtreated. METHODS We reviewed records from a municipal sexually transmitted disease clinic in Seattle, WA, from 1994 to 2018 to identify visits by asymptomatic patients seeking care because of sexual contact to a partner with GC and/or CT. We defined overtreatment as receipt of antibiotic(s) in the absence of a positive GC/CT test result and calculated the proportions of contacts epidemiologically treated and tested positive for GC/CT and overtreated in five 5-year periods stratified by sex and gender of sex partner. We used the Cochran-Armitage test to assess for temporal trends. RESULTS The number of asymptomatic contacts epidemiologically treated for GC/CT increased from 949 to 3159 between the 1994-1998 and 2014-2018 periods. In 2014-2018, 55% of persons were overtreated, most (82.1%) of these were men who have sex with men (MSM). The proportion of MSM overtreated decreased from 74% to 65% (P < 0.01), but the total number of overtreated MSM increased from 172 to 1428. DISCUSSION A high proportion of persons receiving epidemiologic treatment of GC/CT are uninfected. The current practice of routinely treating all sex partners of persons with GC/CT merits reconsideration in light of growing antimicrobial resistance.
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Affiliation(s)
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington
- Department of Medicine, Division of Infectious Diseases, University of Washington
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
| | - Anna Berzkalns
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
| | | | - Lindley A. Barbee
- Department of Medicine, Division of Infectious Diseases, University of Washington
- HIV/STD Program, Public Health—Seattle & King County, Seattle, WA
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Meanley S, Connochie D, Bonett S, Flores DD, Bauermeister JA. Awareness and Perceived Accuracy of Undetectable = Untransmittable: A Cross-Sectional Analysis With Implications for Treatment as Prevention Among Young Men Who Have Sex With Men. Sex Transm Dis 2019; 46:733-6. [PMID: 31644502 DOI: 10.1097/OLQ.0000000000001048] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Undetectable = Untransmittable (U=U) campaign was launched in 2016 to simultaneously reduce human immunodeficiency virus (HIV) stigma and raise awareness about treatment as prevention. This research note assesses HIV-negative young men who have sex with men's U=U awareness and perceived accuracy to inform this population's combination HIV prevention strategies.
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7
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Abstract
PURPOSE OF REVIEW This study aims to review the epidemiology of sexually transmitted infections (STIs) among men who have sex with men (MSM) and suggest control measures. RECENT FINDINGS Despite declines in new HIV diagnosis, bacterial STIs among MSM have dramatically risen since the late 1990s. This increase occurred concurrent with introduction of effective antiretroviral therapy, the advent of electronic mechanisms for meeting sex partners and population-level changes in sexual behavior, including decreased condom use. HIV pre-exposure prophylaxis (PrEP) is now further diminishing condom use, though its impact on STIs is uncertain. A plan to confront the MSM STI epidemic should include increased HIV/STI testing promoted through expanded public health clinical infrastructure, health care system reform to improve the care of gender and sexual minorities and promote low-barrier care, re-invigorated condom promotion, and scientific innovation. There is an urgent need to implement new STI control measures while continuing to expand PrEP use.
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8
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Colyer SP, Moore DM, Cui Z, Zhu J, Armstrong HL, Taylor M, Edward J, Howard T, Dickie C, Olarewaju G, Montaner JSG, Hogg RS, Roth EA, Lachowsky NJ. Crystal Methamphetamine Use and Initiation among Gay, Bisexual, and Other Men Who Have Sex with Men Living with HIV in a Treatment as Prevention Environment. Subst Use Misuse 2020; 55:2428-2437. [PMID: 33059493 PMCID: PMC7657389 DOI: 10.1080/10826084.2020.1833925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Risk compensation in an HIV Treatment as Prevention (TasP) environment may increase high-risk sexual and substance use behaviors among people living with HIV. Objective: To examine recent crystal methamphetamine (CM) use/initiation in a longitudinal cohort of gay, bisexual, and other men who have sex with men (GBMSM) living with HIV in Metro Vancouver, Canada. Methods: Eligible participants were GBMSM aged >15 years who reported sex with another man in the past six months. Participants were recruited using respondent-driven sampling and self-completed a computer questionnaire every six months. We used multi-level generalized mixed-effect models to evaluate trends in recent CM use (past six months), multivariable logistic regression to identify covariates of recent CM use, and multivariable survival analysis to identify predictors of CM initiation. Results: Of 207 GBMSM living with HIV at enrollment, 44.3% reported recent CM use; there was a statistically non-significant decrease over the study period (41% in first period to 25% in final period, p = 0.087). HIV treatment optimism was not associated with CM use/initiation. CM use was positively associated with depressive symptomology, sexual escape motivation, transactional sex, number of anal sex partners, condomless anal sex with seroconcordant partners, STIs, and other substance use. Recent CM use was negatively associated with viral load sorting. CM initiation was predicted by escape motivation, transactional sex, and group sex participation. Conclusion: Results suggest that CM use among GBMSM living with HIV is prevalent and increased CM use/initiation is not a consequence of TasP public policy.
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Affiliation(s)
- Sean P Colyer
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - David M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Zishan Cui
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julia Zhu
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Heather L Armstrong
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada.,Department of Psychology, University of Southampton, Southampton, UK
| | | | - Joshua Edward
- Health Initiative for Men Society, Vancouver, Canada
| | - Terry Howard
- Community Advisory Board, Momentum Health Study, Vancouver, Canada
| | - Chad Dickie
- Community Advisory Board, Momentum Health Study, Vancouver, Canada
| | - Gbolahan Olarewaju
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio S G Montaner
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
| | - Nathan J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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9
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Shaw L, Wang L, Cui Z, Rich AJ, Armstrong HL, Lachowsky NJ, Sereda P, Card KG, Olarewaju G, Moore D, Hogg R, Roth EA. Longitudinal Event-Level Analysis of Gay and Bisexual Men's Anal Sex Versatility: Behavior, Roles, and Substance Use. J Sex Res 2019; 56:1136-1146. [PMID: 31461383 PMCID: PMC6791743 DOI: 10.1080/00224499.2019.1652238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Gay and bisexual Men Who Have Sex with Men (GBM) are sexually unique in that they can practice penile-anal sex versatility, i.e. engage in insertive and receptive anal sex. Individual-level versatility is extensively researched both as a sexual behavior linked to HIV/STI transmission, and as a GBM identity that can change over time. However, there is a dearth of research on event-level versatility (ELV), defined as taking the receptive and insertive role in the same sexual encounter. We analyzed event-level data from 644 GBM in the Momentum Health Study from February 2012-February 2017 to identify factors associated with ELV prevalence, the relationship between ELV and anal sex role preference, and sero-adaptive and sexualized drug use strategies. Univariate analysis revealed ELV prevalence rates between 15% and 20%. A multivariate generalized linear mixed model indicated ELV significantly (p < .05) associated with versatile role preference and condomless sex. However, the majority of ELV came from GBM reporting insertive or receptive role preferences, and there was significantly higher condom use among sero-discordant partners, indicating sero-adaptation. Multivariate log-linear modeling identified multiple polysubstance combinations significantly associated with ELV. Results provide insights into GBM sexual behavior and constitute empirical data useful for future HIV/STI transmission pattern modeling.
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Affiliation(s)
- Lindsay Shaw
- Canadian Institute for Substance Use Research, University of Victoria
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS
| | - Ashleigh J Rich
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Medicine, University of British Columbia
| | - Heather L Armstrong
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Medicine, University of British Columbia
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS
- School of Public Health and Social Policy, University of Victoria
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS
| | | | | | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Medicine, University of British Columbia
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Health Sciences, Simon Fraser University
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10
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Abstract
HIV is transmitted in social and sexual relationships, and HIV transmission risks, as well as protective actions, are evolving as HIV epidemics unfold. The current focus of HIV prevention is centered on antiretroviral medications used to reduce HIV infectiousness in persons already infected with HIV [treatment as prevention (TasP)]. The same medications used to treat infected persons can also be used by uninfected persons as pre-exposure prophylaxis (PrEP) to reduce the infectivity of HIV. Both PrEP and TasP are effective when adherence is high and individuals do not have co-occurring sexually transmitted infections. HIV prevention is most effective and efficient when delivered within sexual networks with high HIV prevalence. Specific network characteristics are recognized as important facilitators of HIV transmission; these characteristics include the degree of similarity among network members (homophily), gender role norms, and belief systems. Since 2011, HIV risk has been redefined based on infectiousness and infectivity, ushering in a new era of HIV prevention with the potential to end HIV epidemics.
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Affiliation(s)
- Andrew C Cortopassi
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Redd Driver
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut 06269, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA;
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11
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Roth EA, Cui Z, Wang L, Armstrong HL, Rich AJ, Lachowsky NJ, Sereda P, Card KG, Jollimore J, Howard T, Olarewaju G, Moore DM, Hogg RS. Substance Use Patterns of Gay and Bisexual Men in the Momentum Health Study. Am J Mens Health 2018; 12:1759-1773. [PMID: 30024296 PMCID: PMC6142133 DOI: 10.1177/1557988318786872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/23/2018] [Accepted: 06/07/2018] [Indexed: 01/25/2023] Open
Abstract
Research with male sexual minorities frequently combines gay and bisexual men as Men Who Have Sex with Men or Gay and Bisexual Men. When analyzed separately, bisexual men consistently feature negative health differentials, exemplified by higher substance use levels. This interpretation is not clear-cut because studies may combine bisexual men and women, use different dimensions of sexual orientation to define bisexuality, and/or not consider number of sexual partners as a possible confounding factor. This study conducted separate bivariate and multivariate analyses comparing gay to bisexual Momentum Study participants based on self-identity, sexual attraction, and sexual behavior, while controlling for number of sexual partners and sociodemographic, psychosocial, and sexual behavior measures. The study hypothesized that, regardless of definition, bisexual men feature higher substance use levels compared to gay men. Bivariate analyses revealed significantly higher ( p < .05) use among bisexual men for multiple substances in all samples. Nonprescription stimulants and heroin were significant in all multivariate logistic regression models. In contrast, all bisexual samples reported lower use of erectile dysfunction drugs and poppers, substances associated with anal sex among gay men. Subsequent analysis linked these results to lower levels of anal sex in all bisexual samples. Bivariate analyses also revealed that bisexual men featured significantly lower educational levels, annual incomes, and Social Support Scales scores and higher Anxiety and Depression Sub-Scale Scores. In summary, findings revealed bisexual men's distinctive substance use, sexual behavior, psychosocial, and sociodemographic profiles, and are important for tailoring specific health programs for bisexual men.
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Affiliation(s)
- Eric Abella Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Heather L. Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ashleigh J. Rich
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kiffer G. Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Jody Jollimore
- Executive Director, Community Based Research Centre for Gay Men’s Health, Vancouver, BC, Canada
| | - Terry Howard
- Community Advisory Board, Momentum Health Study, Vancouver, BC, Canada
| | - Gbolahan Olarewaju
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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12
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Colyer SP, Lachowsky NJ, Cui Z, Zhu J, Armstrong HL, Taylor M, Edward J, Olarewaju G, Hogg RS, Roth EA, Moore DM. HIV treatment optimism and crystal methamphetamine use and initiation among HIV-negative men who have sex with men in Vancouver, Canada: A longitudinal analysis. Drug Alcohol Depend 2018; 185:67-74. [PMID: 29427917 PMCID: PMC5889742 DOI: 10.1016/j.drugalcdep.2017.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment as Prevention (TasP) leading to increased HIV treatment optimism among men who have sex with men (MSM) has been previously associated with behavioural risk compensation, though not yet via crystal methamphetamine (CM) use. Among HIV-negative MSM in a TasP environment, this study aimed to investigate the prevalence of recent CM use over time, examine the association between HIV treatment optimism and CM use and initiation, and identify correlates of recent CM use and predictors of CM initiation. METHODS Using data from a prospective behavioural cohort study of sexually active MSM in the Vancouver area, we used multi-level generalized mixed effect models to evaluate temporal trends in CM use, univariable and multivariable logistic regression to identify covariates of recent CM use, and univariable and multivariable survival analysis to identify predictors of CM initiation. RESULTS Of 497 HIV-negative cohort participants, 10.3% reported any recent CM use at enrollment. From 2012-2016, there were no statistically significant temporal trends in overall CM use or with routes of administration. In multivariable logistic regression analyses, HIV treatment optimism was not associated with recent CM use (not retained in final model) or CM initiation (aHR = 1.06, 95% CI:0.98-1.15). Significant correlates of CM use include recent gamma-hydroxybutyrate (GHB) and ecstasy use, and having received/given drugs for sex. CONCLUSIONS Among HIV-negative MSM in Vancouver, HIV treatment optimism does not appear to be independently associated with CM use or initiation of use, though use of CM was both prevalent and stable over time.
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Affiliation(s)
- Sean P. Colyer
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julia Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Heather L. Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | | | | | | | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A. Roth
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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