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Kimberley ML, Jones SA, Elliott JM. A Content Analysis of Reasons for Disclosing Sexual Fantasies and Partner Responses. JOURNAL OF SEX RESEARCH 2024:1-12. [PMID: 38315824 DOI: 10.1080/00224499.2024.2310085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
This study aimed to identify some of the reasons held by participants for either disclosing or concealing a sexual fantasy. Participants were asked to describe either how their partner responded to a disclosure or (for those reporting on an undisclosed sexual fantasy) how they anticipated that their partner was likely to respond. A mixed-methods approach was employed. Two hundred and eighty-seven participants were surveyed about their reasons for disclosing/concealing fantasies and either their actual or anticipated disclosure experiences. The majority of participants (69.3%) indicated having disclosed a sexual fantasy at some point in their relationship. Five categories of reasons for disclosing/not disclosing a sexual fantasy were generated through descriptive content analysis. These categories were sexual gratification, relationship-motivated, partner traits or characteristics, communication patterns, and specific fantasy content. Participant descriptions of their partner's response to the disclosure of their sexual fantasy were frequently coded as positive. For those describing how they believed their partner would be likely to respond to the disclosure of reported sexual fantasy, these anticipated responses were often coded as negative. The findings of the current study deepen our understanding of sexual fantasy disclosure and highlight some of the reasons held for either disclosing or concealing sexual fantasies. More widely, these findings may have implications for sex education, furthering our understanding of sexual dysfunction and sex/relationship therapy.
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Affiliation(s)
- Matthew L Kimberley
- Department of Psychology, Staffordshire University
- Department of Psychology, Birmingham City University
| | - Samuel A Jones
- Department of Psychology, Staffordshire University
- Department of Psychology, Nottingham Trent University
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2
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Woerner J, Chadwick SB, Antebi-Gruszka N, Siegel K, Schrimshaw EW. Negative Sexual Experiences Among Gay, Bisexual, and Other Men Who Have Sex with Men Using GPS-Enabled Hook-Up Apps and Websites. JOURNAL OF SEX RESEARCH 2023:1-16. [PMID: 38016029 PMCID: PMC11130079 DOI: 10.1080/00224499.2023.2269930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) often use GPS-enabled dating apps and websites to facilitate in-person sexual encounters. Many of these encounters are positive and enjoyable. However, there is limited research on GBMSM's negative experiences with partners from hookup and dating apps/websites, especially those characterized by threats to GBMSM's sexual, physical, and/or psychological safety. In this report, we investigated this matter. We analyzed data from interviews with GBMSM (N = 60) and identified four categories of negative sexual experiences, each of which were comprised by sub-categories: 1) sexual violence (physical sexual assault, verbal sexual coercion, intoxicated assault/coercion), 2) sexual health risk behaviors (condom use resistance and coercion, deception related to HIV/STI status), 3) non-negotiated behaviors (undiscussed/unexpected sex acts, rough sex, sexualized racism, undesired substance use by the partner), and 4) threats to physical safety beyond sexual violence (being blocked from leaving, stalked, robbed, drugged). These results can inform future research and interventions that aim to promote safety on dating apps/websites within the GBMSM community.
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Affiliation(s)
- Jacqueline Woerner
- Departments of Sociology and Psychology, University of Central Florida, Orlando, FL
| | - Sara B. Chadwick
- Department of Gender & Women’s Studies, University of Wisconsin-Madison, Madison, WI
| | | | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Eric W. Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL
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3
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Pralat R, Anderson J, Burns F, Barber TJ. Asked to be a sperm donor: disclosure dilemmas of gay men living with HIV. CULTURE, HEALTH & SEXUALITY 2023:1-15. [PMID: 37982670 DOI: 10.1080/13691058.2023.2276804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023]
Abstract
Previous research has documented the various challenges people living with HIV face as they navigate intimate relationships, including what is often referred to as disclosure. In studies of gay, bisexual and other men who have sex with men, the issue of telling or not telling others about an HIV-positive status has been examined primarily in relation to communication with sexual partners, with few studies focusing on other aspects of intimacy. Drawing on interviews with gay men living with HIV, conducted in four clinics in London, this article explores the narratives of men who have been asked by female friends about the possibility of being a sperm donor. The narratives highlight layers of complexity which have received little attention, not only in research on HIV but also in studies of sperm donation and co-parenting. The article advances dialogue between these two largely separate bodies of work. Our data suggest that reluctance to share an HIV-positive status with others can be an important factor in deciding how to answer the 'sperm donor question'. Examining reproductive relationships of a specific kind - those based on friendships between women and gay men - the article develops the understanding of how secrecy about HIV shapes intimate lives.
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Affiliation(s)
- Robert Pralat
- Department of Sociology, University of Cambridge, Cambridge, UK
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jane Anderson
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Tristan J Barber
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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4
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Wells N, Murphy D, Ellard J, Philpot S, Prestage G. Experiences of, and motivations for, disclosing HIV to social and familial networks: considering the social and relational domains of HIV disclosure. CULTURE, HEALTH & SEXUALITY 2023; 25:1483-1497. [PMID: 36639148 DOI: 10.1080/13691058.2022.2161638] [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: 05/26/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
For people living with HIV, decisions about when, how and who to tell about their HIV status can involve navigating complex social, legal and health domains. With a focus on disclosure to broader social and familial networks, we explored the experiences of, and motivations for, HIV (non-)disclosure among recently diagnosed people living with HIV in Australia. Semi-structured interviews were conducted with 35 people diagnosed with HIV from 2016 onwards, of whom 25 completed follow-up interviews. Participants commonly reported anticipating negative responses and rejection from others when considering whether to disclose their HIV status. Some participants also took on the role of ensuring others' wellbeing when disclosing (or not), even as they themselves needed emotional support. Finally, some participants felt it important to be open about their HIV status to raise awareness of HIV and challenge HIV-related stigma. Our findings highlight the complex relational and social contexts that shape HIV disclosure. In addition to supporting individual people living with HIV when disclosing, we argue that educational programmes that target the broader, HIV-negative population are needed to shift the social landscape in which people living with HIV disclose.
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Affiliation(s)
- Nathanael Wells
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Dean Murphy
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Steven Philpot
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Garrett Prestage
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
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5
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Roth GH, Walker ER, Talley CL, Hussen SA. 'It's a very grey, very messy area': a qualitative examination of factors influencing undetectable gay men's HIV status disclosure to sexual partners. CULTURE, HEALTH & SEXUALITY 2023; 25:664-679. [PMID: 35697340 DOI: 10.1080/13691058.2022.2086708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
HIV disclosure to sexual partners remains a multifaceted yet stigmatised process. The 'undetectable equals untransmittable' (U = U) concept has raised ethical and moral concerns about the obligation and need to disclose, and using Internet applications to seek sex partners has modified disclosure practices. While previous qualitative literature has examined the HIV disclosure process, there is a dearth of information on this topic among gay men in the USA who have an undetectable viral load. Using thematic analysis of data collected during a period of expanded U = U knowledge, this study explores the cognitive, contextual, interpersonal and structural factors impacting undetectable gay men's HIV status disclosure decisions to sexual partners. In-depth interviews were conducted in August 2020 over Zoom with 20 gay men with undetectable viral loads. The main themes included 'sense of obligation,' 'situational disclosure' and 'partners' responsibility in the disclosure process.' Participants balanced the aforementioned factors to inform their disclosure decisions, and disclosure patterns varied across participants dependent upon thoughts regarding ethics and morality of (non-)disclosure. The findings provide new insights to how participants navigate disclosure while considering U = U, HIV criminalisation laws, and finding partners through Internet applications while providing direction for future studies and support for decriminalising HIV and expanding HIV education.
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Affiliation(s)
- Grant H Roth
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Colin L Talley
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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6
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Campbell CK. The Ongoing Process of HIV-Stigma (Re)Production. SOCIOLOGICAL PERSPECTIVES : SP : OFFICIAL PUBLICATION OF THE PACIFIC SOCIOLOGICAL ASSOCIATION 2023; 66:355-374. [PMID: 38516303 PMCID: PMC10956429 DOI: 10.1177/07311214221117294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
HIV stigma negatively affects the social experiences of people living with HIV (PLWH) and remains a challenge to HIV prevention, treatment, and care. Research has overwhelmingly focused on individual cognitive measures of HIV stigma (e.g., internalized, anticipated, and experienced). However, little research explores the interactions and societal structures through which HIV stigma is produced. Data from qualitative interviews with 30 black gay and bisexual men living with HIV in the U.S. Deep South revealed an interconnected and interdependent set of processes that produce and reproduce HIV stigma. These included social interactions (silence, euphemism, and gossip), witnessed acts of marginalization, word-of-mouth transmission of HIV misinformation, and laws and policies carried out within the education and criminal justice systems. Efforts to reduce stigma that focus on individual beliefs and attitudes are critical to improving the well-being of PLWH. However, reducing HIV stigma requires intervening on the social interactions and structures through which HIV stigma is produced and reproduced.
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Affiliation(s)
- Chadwick K. Campbell
- Herbert Wertheim School of Public Health and Human Longevity, University of California, San Diego, La Jolla, CA, USA
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7
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Kolstee J, Prestage G, Philpot S, Bavinton B, Hammoud M, Keen P, Holt M. The effect of pre-exposure prophylaxis (PrEP) on negotiating casual sex between gay men: disclosure, assumptions, and communication. Sex Health 2023; 20:64-70. [PMID: 36508715 DOI: 10.1071/sh22095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The disclosure of HIV status and pre-exposure prophylaxis (PrEP) use can be important in the negotiation of safe sex. With the rapid uptake of PrEP in Australia, norms and expectations about discussion and disclosure may have changed. METHODS We explored the disclosure of PrEP use, HIV status and communication with sex partners by HIV-negative gay men in Sydney, Australia. We conducted semi-structured interviews from October 2017 to May 2018 and analysed data using a codebook thematic analysis approach. RESULTS Participants had a variety of expectations of what they should tell their partners and what they expected in return. For some participants, PrEP had negated the need for any discussion about HIV. Many participants assumed their partners would find information about their HIV status or PrEP use on their online profiles or that partners would ask, if necessary. CONCLUSIONS Building a stronger, shared understanding among gay men that disclosure and discussion no longer automatically occur before sexual encounters may be useful.
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Affiliation(s)
- Johann Kolstee
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Garrett Prestage
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Steven Philpot
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Benjamin Bavinton
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Mohamed Hammoud
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Phillip Keen
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW, Australia
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8
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Jansson M, Smith M, Benoit C, Magnuson D, Healey P. Challenges and Benefits of Disclosure of Sex Work to Intimate Partners. JOURNAL OF SEX RESEARCH 2022:1-13. [PMID: 35877549 DOI: 10.1080/00224499.2022.2092587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex workers' noncommercial intimate partnerships are marginalized on two counts - they are non-monogamous and at least one partner is in sex work, an occupation with much stigma. We asked a heterogeneous sample of Canadian sex workers (N = 218) about their decisions to reveal/not reveal their sex work to intimate partners, and the resulting challenges and benefits. A minority (58/183) of participants who had been or were currently involved in an intimate relationship kept their work secret from at least one partner or disclosed limited information, shielding them from stigma but resulting in a burden of secrecy. The majority of participants (151/183) who had been/were currently involved in an intimate relationship chose to disclose their sex work to at least one partner, which for most, had one or more negative consequences. A small group of participants related that disclosure resulted in acceptance, support, and understanding from their intimate partner. Some participants avoided the disclosure dilemma by forming intimate relationships from social connections where sex work status was already known. These relationships were generally supportive. We conclude that intimate relationships provide positive experiences for many people who sell sexual services and that these relationships could be stronger if societal stigma was reduced.
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Affiliation(s)
- Mikael Jansson
- Canadian Institute for Substance Use Research & Department of Sociology, University of Victoria
| | - Michaela Smith
- Canadian Institute for Substance Use Research, University of Victoria
| | - Cecilia Benoit
- Canadian Institute for Substance Use Research & Department of Sociology, University of Victoria
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9
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Rushmore J, Copen CE, Schneider J, Lamuda PSM, Taylor BG, Kirkcaldy RD, Bernstein KT. Partner Seeking and Sexual Behavior in the United States During the COVID-19 Pandemic, March 2020 to March 2021. Sex Transm Dis 2022; 49:e57-e60. [PMID: 34772895 PMCID: PMC8940666 DOI: 10.1097/olq.0000000000001582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We examined partner seeking and sexual behaviors among a representative sample of US adults (n = 1161) during the first year of the COVID-19 pandemic. Approximately 10% of survey respondents sought a new partner, with age and sexual identity being associated with partner seeking behavior. Approximately 7% of respondents had sex with a new partner, which marks a decrease as compared with a prepandemic estimate from 2015 to 2016 in which 16% of US adults reported having sex with a new partner during the past year. Among respondents who had in-person sex with a new partner during the first year of the pandemic, public health guidelines for in-person sexual activity were infrequently followed.
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Affiliation(s)
- Julie Rushmore
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Casey E Copen
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - John Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago
| | | | | | - Robert D Kirkcaldy
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kyle T Bernstein
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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10
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Dong W, Muessig KE, Knudtson KA, Gilbertson A, Rennie S, Soni K, Hightow-Weidman LB. Moral practices shaping HIV disclosure among young gay and bisexual men living with HIV in the context of biomedical advance. CULTURE, HEALTH & SEXUALITY 2021; 23:1641-1655. [PMID: 32748729 PMCID: PMC9426661 DOI: 10.1080/13691058.2020.1790039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/28/2020] [Indexed: 05/25/2023]
Abstract
Biomedical advances in diagnostics, treatment and prevention increase the means available to reduce HIV transmission risk. Subsequent shifts in HIV status disclosure obligation and ethics may impact how those living with HIV view, enact and experience disclosure. We analysed focus group and interview data to explore how these changes are reflected in disclosure decision-making to sexual partners among young gay and bisexual men living with HIV in the USA. Three interrelated themes were identified: engaging with partners' varying HIV knowledge; attribution of blame; and negotiating disclosure-related harms. Participants experienced blame from partners that questioned the timing of HIV testing, status disclosure and sex events without regards for viral suppression or use of pre-exposure prophylaxis. Substantial HIV stigma was described in response to disclosure, mitigated in some cases by partners' higher HIV knowledge. Overall, an uneven diffusion of HIV treatment and prevention knowledge and continuing HIV stigma seemed to limit the translation of biomedical advances into improved disclosure experiences. Our findings suggest that young gay and bisexual men living with HIV may continue to perform much of the moral labour involved in disclosure by managing others' reactions, correcting inaccurate sexual health information, and negotiating the risks of disclosure-related harm.
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Affiliation(s)
- Willa Dong
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kelly A. Knudtson
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Adam Gilbertson
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Center for Bioethics, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stuart Rennie
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Center for Bioethics, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Karina Soni
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Lisa B. Hightow-Weidman
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, USA
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11
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Musiimenta A, Campbell JI, Tumuhimbise W, Burns B, Atukunda EC, Eyal N, Haberer JE. Electronic Adherence Monitoring May Facilitate Intentional HIV Status Disclosure Among People Living with HIV in Rural Southwestern Uganda. AIDS Behav 2021; 25:2131-2138. [PMID: 33389324 DOI: 10.1007/s10461-020-03143-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
HIV status disclosure remains one of the major challenges to effective HIV prevention. Given the complexities and low rates of disclosure, new innovative strategies are needed. Since electronic adherence monitoring (EAM) are unique mobile devices that light up when transmitting data, those who see them often want to know more about them, which can potentially result in HIV status disclosure. We conducted a qualitative study to explore patient experiences with EAM for antiretroviral therapy (ART) in Uganda with a goal of understanding potential ethical concerns, including disclosure. Unexpectedly, several participants reported intentionally using EAM to facilitate HIV status disclosure to others in order to get social support, encourage HIV testing, and create awareness about HIV. Although researchers and clinicians need to be mindful of the potential for unintended HIV status disclosure through the use of EAM, they should also recognize the potential of this approach to support intended disclosure.
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Affiliation(s)
- Angella Musiimenta
- Mbarara University of Science and Technology, P.O. Box 653, Mbarara, Uganda.
- Angels Compassion Organisation (ACO), Mbarara, Uganda.
| | | | - Wilson Tumuhimbise
- Mbarara University of Science and Technology, P.O. Box 653, Mbarara, Uganda
| | - Bridget Burns
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Esther C Atukunda
- Mbarara University of Science and Technology, P.O. Box 653, Mbarara, Uganda
| | - Nir Eyal
- School of Public Health and Philosophy, Rutgers University, New Brunswick, NJ, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
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12
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Behavioral Intentions to Use Patient Portals to Disclose HIV and Other Sexually Transmitted Infection Testing Histories with Sexual Partners Among U.S. Sexual Minority Men. AIDS Behav 2021; 25:1199-1209. [PMID: 33185776 DOI: 10.1007/s10461-020-03092-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
Disclosure of HIV and other sexually transmitted infection (HIV/STI) testing history to sexual partners is low among gay, bisexual, and other U.S. sexual minority men (SMM). Patient portals (PP) could increase HIV/STI testing history disclosure. This study estimated the predictive validity of the Enhancing Dyadic Communication (EDC) latent construct for perceived behavioral intentions to use PP for HIV/STI test disclosures. A randomized subset of SMM completed the Patient Portal Sexual Health Instrument as part of the 2018 American Men's Internet Survey. Multivariable logistic regression models estimated associations between EDC and intentions to use PP for test disclosures. Among a sample of 1,509 SMM aged 15 to 77 years, EDC was associated with intentions to use PP to disclose test history with main partners (aOR 2.17; 95% CI 1.90 to 2.47) and non-main partners (aOR 2.39; 95%CI 2.07 to 2.76). Assessing EDC could be useful in clinical settings for interventions encouraging patients to communicate with partners about testing.
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13
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Haas SM, Perazzo JD, Ruffner AH, Lyons MS. Exploring Current Stereotypes and Norms Impacting Sexual Partner HIV-Status Communication. HEALTH COMMUNICATION 2020; 35:1376-1385. [PMID: 31257927 DOI: 10.1080/10410236.2019.1636340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study sought to explore HIV-related stereotypes and norms that impact HIV-status communication with potential sexual partners. A series of focus groups and in-depth interviews were conducted (N = 59) with HIV-positive and HIV-negative MSM (75%) and Heterosexuals (25%). Findings indicate that HIV stereotypes and stigma remain as barriers to HIV-status discussion. Differences also emerged across groups: 1) HIV-negative MSM were more likely to report engaging in HIV-status communication, 2) HIV-positive MSM described inconsistent HIV-status communication and reported concealing their status at times, and 3) Heterosexuals reported being least likely to engage in HIV-status communication; often using the blanket question "Are you clean?" to encompass all STIs and avoiding direct HIV-status discussion. Overall, findings indicate that many HIV stereotypes and stigma-related communication norms persist that discourage discussion of sexual partners' HIV-status prior to sexual activity.
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14
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Sullivan MC, Cruess DG, Huedo-Medina TB, Kalichman SC. Substance Use, HIV Serostatus Disclosure, and Sexual Risk Behavior in People Living with HIV: An Event-Level Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2005-2018. [PMID: 31863314 DOI: 10.1007/s10508-019-01531-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/21/2019] [Accepted: 07/31/2019] [Indexed: 05/22/2023]
Abstract
People living with HIV (PLWH) face difficult decisions about disclosing their HIV status to new sexual partners. Alcohol and other drug use could impact these decision-making processes and subsequent sexual risk behavior. We sought to examine the event-level relationships between substance use, HIV disclosure, and condom use in PLWH and their first-time HIV-negative or unknown status sexual partners. Adult PLWH were recruited from care settings in a southeastern U.S. city. Participants reported their sexual behavior for 28 consecutive days via text message prompts. We employed multilevel covariation in a causal system to examine the event-level relations between substance use and condom use. We proposed that this relationship would be mediated by HIV disclosure and moderated by viral suppression status. A total of 243 participants (83% male, 93% Black) reported 509 sexual events with first-time HIV-negative/unknown status sexual partners. Substance use at the time of sex was negatively associated with disclosure in PLWH with suppressed viral load (OR 0.29, β = - 1.22, 95% CI [- 2.42, - 0.03], p = .045), but differentially associated with condom use in PLWH with detectable versus undetectable viral load. In PLWH with viral suppression, participants who always disclosed versus who never disclosed their HIV status were more likely to use condoms (β = 1.84, 95% CI [0.35, 3.53], p = .017), but inconsistent disclosers were less likely to use a condom after disclosing (OR 0.22, 95% CI [0.07, 0.68], p = .008). Event-level analysis offers a more nuanced understanding of the proximal (substance use, HIV disclosure) and person-level (substance use, viral load) determinants of HIV transmission risk behavior in PLWH.
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Affiliation(s)
- Matthew C Sullivan
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA.
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA.
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
| | - Tania B Huedo-Medina
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
- Allied Health Sciences Department, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
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15
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Ion A. Keeping secrets, disclosing health information: an institutional ethnography of the social organisation of perinatal care for women living with HIV in Canada. CULTURE, HEALTH & SEXUALITY 2020; 22:429-443. [PMID: 31032702 DOI: 10.1080/13691058.2019.1604996] [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: 12/23/2018] [Accepted: 04/03/2019] [Indexed: 06/09/2023]
Abstract
This paper describes findings from an institutional ethnography that arose out of the concerns of women living with HIV in Ontario, Canada, regarding the disclosure of their HIV status while accessing perinatal care. The enquiry traces the connections between women's experiences of perinatal care, the activities of healthcare providers delivering such care and the ruling relations that organise women's experiences and healthcare providers' activities. Focusing on HIV disclosure as a concern expressed by women, the findings make visible the day-to-day, routinised practices of healthcare providers working in perinatal care for women living with HIV, as well as the ideological discourses of 'fear of contagion' and 'AIDS hysteria' that contributed to producing the kinds of care experiences that were articulated by women. Opportunities to strengthen perinatal care policies and practices for women living with HIV are discussed.
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Affiliation(s)
- Allyson Ion
- School of Social Work, McMaster University, Hamilton, ON, Canada
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Ferraz D, Couto MT, Zucchi EM, Calazans GJ, dos Santos LA, Mathias A, Grangeiro A. AIDS- and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study. Sex Reprod Health Matters 2019; 27:1650587. [PMID: 31533555 PMCID: PMC7888039 DOI: 10.1080/26410397.2019.1650587] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIDS-related stigma is a major hurdle to care and it hinders people from accessing HIV prevention methods, such as post-exposure prophylaxis. This study was designed to explore how AIDS-related stigma impacts the experience of using non-occupational post-exposure prophylaxis (nPEP) for HIV after sexual contact. Data were gathered in in-depth interviews with 59 people who voluntarily sought out nPEP in five public healthcare facilities in Brazil between 2015 and 2016. Data were analysed into three thematic categories: fear of being mistaken for a person living with HIV and AIDS (PLWHA); desire to hide particular features of one's sexual life; and experiences of stigmatising behaviour due to nPEP use. Based on the Health Stigma and Discrimination Framework, predominant manifestations of AIDS-related stigma in each category were analysed, as well as their intersections with gender- and sexuality-related stigmas. Results show that experiences of using nPEP are permeated by AIDS-related stigma, intersecting with sexuality- and gender-related stigmas. Stigma experiences are mainly perceived, anticipated and internalised; stigma practices include prejudice and stigmatising behaviours. Taking antiretrovirals (ARVs) led participants to the fear of being discriminated against as a PLWHA and having particular features of their sexual identities disclosed. Thus, hiding nPEP was strategic to protect from stigmatising behaviour. As ARV-based prevention technologies are scaled-up, interventions designed to tackle AIDS- and sexuality-related stigmas must be expanded in Brazil. Required interventions include public campaigns about nPEP, educational programmes in healthcare settings to offer adequate support to nPEP users and investments in stigma research and monitoring.
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Affiliation(s)
- Dulce Ferraz
- Public Health Analyst, Escola de Governo em Saúde, Fundação Oswaldo Cruz, Brasília, Brazil
- PhD Candidate, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Eliana Miura Zucchi
- Assistant Professor at Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brazil
| | | | | | - Augusto Mathias
- PhD Candidate, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Grangeiro
- Researcher, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Fortenberry JD. Trust, Sexual Trust, and Sexual Health: An Interrogative Review. JOURNAL OF SEX RESEARCH 2019; 56:425-439. [PMID: 30289286 DOI: 10.1080/00224499.2018.1523999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Trust is experienced almost constantly in all forms of social and interpersonal relationships, including sexual relationships, and may contribute both directly and indirectly to sexual health. The purpose of this review is to link three aspects of trust to sexual health: (1) the role of trust in sexual relationships; (2) the role of trust in sexually transmitted infection (STI) prevention, particularly condom use; and (3) the relevance of trust in sexual relationships outside of the traditional model of monogamy. The review ends with consideration of perspectives that could guide new research toward understanding the enigmas of trust in partnered sexual relations in the context of sexual and public health.
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Muessig KE, Knudtson KA, Soni K, Larsen MA, Traum D, Dong W, Conserve DF, Leuski A, Artstein R, Hightow-Weidman LB. "I DIDN'T TELL YOU SOONER BECAUSE I DIDN'T KNOW HOW TO HANDLE IT MYSELF." DEVELOPING A VIRTUAL REALITY PROGRAM TO SUPPORT HIV-STATUS DISCLOSURE DECISIONS. DIGITAL CULTURE & EDUCATION 2018; 10:22-48. [PMID: 30123342 PMCID: PMC6097708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
HIV status disclosure is associated with increased sorcial support and protective behaviors against HIV transmission. Yet disclosure poses significant challenges in the face of persistent societal stigma. Few interventions focus on decision-making self-efficacy, and communication skills to support disclosing HIV status to an intimate partner. Virtual reality (VR) and artifcial intelligence (AI) technologies offer poweful tools to address this gap. Informed by Social Cognitive Theory, we created the Tough Talks VR program for HIV-positive young men who have sex with men (YMSM) to practice status disclosure safely and confidentially. Fifty-eight YMSM (ages 18 - 30, 88% HIV-positive) contributed 132 disclosure dialogues to develop the prototype through focus groups, usability testing, and a technical pilot. The prototype includes three disclosure scenarios (neutral, sympathetic, and negative response) and a database of 125 virtual character utterances. Participants select a VR scenario and realistic virtual character with whom to practice. In a pilot test of the fully automated neutral response scenario, the AI system responded appropriately to 71% of participant utterances. Most pilot study participants agreed Tough Talks was easy to use (9/11) and that they would like to use the system frequently (9/11). Tough Talks demonstrates that VR can be used to practice HIV status disclosure and lessons learned from program development offer insights for the use of AI systems for other areas of health and education.
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Affiliation(s)
- Kathryn E Muessig
- Department of Health Behavior, CB #7440, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7440
| | - Kelly A Knudtson
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Karina Soni
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Margo Adams Larsen
- Virtually Better Inc., 2440 Lawrenceville Hwy, Suite 200, Decatur, Georgia 30033
| | - David Traum
- USC Viterbi School of Engineering Computer Science Department, University of Southern California (USC), Director for Natural Language Research, USC Institute for Creative Technologies (ICT), 12015 Waterfront Drive, Playa Vista, CA 90094-2536
| | - Willa Dong
- Department of Health Behavior, Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC 29208
| | - Anton Leuski
- USC Viterbi School of Engineering Computer Science Department, University of Southern California (USC), USC Institute for Creative Technologies (ICT), 12015 Waterfront Drive, Playa Vista, CA 90094-2536
| | - Ron Artstein
- USC Viterbi School of Engineering Computer Science Department, University of Southern California (USC), USC Institute for Creative Technologies (ICT), 12015 Waterfront Drive, Playa Vista, CA 90094-2536
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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Gause NK, Brown JL, Welge J, Northern N. Meta-analyses of HIV prevention interventions targeting improved partner communication: effects on partner communication and condom use frequency outcomes. J Behav Med 2018; 41:423-440. [PMID: 29468532 DOI: 10.1007/s10865-018-9916-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 02/12/2018] [Indexed: 01/02/2023]
Abstract
Behavioral HIV prevention interventions designed to improve safer-sex communication skills with sexual partners may enhance engagement in protective behaviors and reduce HIV/STI risk. The current meta-analyses examined the efficacy of individual-based (i.e., not couples-based) HIV prevention interventions with a partner communication skills building component to increase frequency of: (a) safer-sex communication and (b) condom use with sexual partners among HIV at-risk groups (e.g., heterosexual African American females). Studies were retrieved from online bibliographic databases, a database of effective behavioral HIV prevention interventions, and an existing review of effective interventions. Eight manuscripts (k = 10 intervention vs. control comparisons) met inclusion criteria. Results indicated that compared to control conditions, at post-intervention follow-up, participants who were exposed to individual-based HIV prevention interventions with safer-sex communication skills training components had safer sex discussions with partners more frequently [drandom = 0.35 ± 0.10, p < .001, 95% CI (0.16, 0.55)], and used condoms more frequently [drandom = 0.39 ± 0.07, p < .001, 95% CI (0.25, 0.54)]. Including partner communication skills training in individual-based HIV prevention interventions may increase the frequency of both partner communication and condom use among the at-risk populations represented in the meta-analyses.
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Affiliation(s)
- Nicole K Gause
- Department of Psychology, University of Cincinnati, 3131 Harvey Ave, Suite 104, Cincinnati, OH, 45229, USA.
| | - Jennifer L Brown
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey Welge
- Division of Epidemiology and Biostatistics, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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