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McLean SA, Galea JT, Prudden HJ, Calvo G, Sánchez H, Brown B. Association between sexual role and HIV status among Peruvian men who have sex with men seeking an HIV test: a cross-sectional analysis. Int J STD AIDS 2015; 27:783-9. [PMID: 26187903 DOI: 10.1177/0956462415596300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/18/2015] [Indexed: 11/15/2022]
Abstract
In Latin America, sexual role, sexual identity and sexual practices are intricately related; the roles activo, pasivo and moderno often encompass sexual identity and sexual practices. We aimed to understand the association between sexual role and HIV status in Peruvian men who have sex with men. HIV-testing services at Epicentro Salud, a Peruvian gay men's health centre, were paired with clinic data on demographics and sexual behaviour. Bidirectional stepwise logistic regression was conducted to determine associations between sexual role and HIV status. Of 366 clients who underwent HIV testing, 86 (23.5%) tested positive. There was a strong association between sexual role ('activo' or typically insertive, 'pasivo' or typically receptive, 'moderno' or typically versatile) and a positive HIV test (p = 0.002). Compared to clients with an activo role, those who reported a pasivo (OR = 6.14) and moderno (OR = 6.26) role were more likely to test positive for HIV. Sexual role was associated with sexual identity (gay, straight and bisexual) and gender of partners in the past six months. Self-reported pasivo and moderno sexual roles were strongly associated with a positive HIV test result. Further research should examine differences in sexual practices between sexual role groups.
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Affiliation(s)
- Sarah A McLean
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Holly J Prudden
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Brandon Brown
- University of California Riverside, Riverside, CA, USA
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Semple SJ, Strathdee SA, Pitpitan EV, Chavarin C, Patterson TL. Behavioral and psychosocial correlates of anal sex among male clients of female sex workers in Tijuana, Mexico. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1025-1033. [PMID: 25795530 DOI: 10.1007/s10508-015-0514-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 06/04/2023]
Abstract
Most studies of heterosexual sex risk practices have focused on condomless vaginal sex despite evidence that condomless anal sex has a significantly higher risk of HIV transmission. The present study focused on male clients' anal sex practices with female sex workers (FSWs) in Tijuana, Mexico, where an HIV epidemic is growing among high-risk groups. Logistic regression analyses were used to identify psychosocial and behavioral correlates of anal sex among male clients. Our sample of HIV-negative men (N = 400) was predominantly Latino (87.5 %), born in Mexico (78.8 %), never married (36.8 %) or in a regular or common-law marriage (31.5 %), and employed (62.8 %), with an average age and education of 37.8 and 9.2 years, respectively. Eighty-nine percent identified as heterosexual and 11 % as bisexual. By design, 50 % of the sample resided in Tijuana and the other 50 % in San Diego County. Nearly half (49 %) reported at least one incident of anal sex with a FSW in Tijuana in the past 4 months; of those participants, 85 % reported that one or more of their anal sex acts with FSWs had been without a condom. In a multivariate model, anal sex with a FSW in the past 4 months was associated with bisexual identification, methamphetamine use with FSWs, repeat visits to the same FSW, higher scores on perceived stigma about being a client of FSWs, and sexual compulsivity. Prevention programs are needed that address the behavioral and psychosocial correlates of heterosexual anal sex in order to reduce HIV/STI transmission risk among male clients, FSWs, and their sexual network members.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 0680, La Jolla, CA, 92093-0680, USA
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Meng X, Zou H, Fan S, Zheng B, Zhang L, Dai X, Deng M, Zhang X, Lu B. Relative Risk for HIV Infection Among Men Who Have Sex with Men Engaging in Different Roles in Anal Sex: A Systematic Review and Meta-analysis on Global Data. AIDS Behav 2015; 19:882-9. [PMID: 25319954 DOI: 10.1007/s10461-014-0921-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We systematically reviewed and meta-analyzed global data on the relative risk for HIV infection among men who have sex with men (MSM) engaging in different roles in anal sex. MSM engaging in receptive anal sex only (MRAI) and MSM engaging in both insertive and receptive anal sex (MIRAI) were 6.9 (95 % CI 5.5-8.6) and 4.3 (95 % CI 3.6-5.3) times more likely to have prevalent HIV compared to MSM engaging in insertive anal sex only (MIAI) in 1981-1985. These figures were 1.8 (95 % CI 1.6-2.0) and 2.2 (95 % CI 2.0-2.4) in 1986-2010. Overall, MRAI and MIRAI were 6.2 (95 % CI 3.3-11.8) and 6.6 (95 % CI 3.8-11.7) times more likely to develop incident HIV infection compared to MIAI. MRAI are at higher risk for HIV infection compared to MIAI. HIV prevalence among men engaging in all roles in anal sex is high enough that all MSM should be aware of potential risk.
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Affiliation(s)
- Xiaojun Meng
- Wuxi Center for Disease Control and Prevention, Wuxi, Jiangsu, People's Republic of China
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Anal sex role segregation and versatility among men who have sex with men: EXPLORE Study. J Acquir Immune Defic Syndr 2013; 64:121-5. [PMID: 23945255 DOI: 10.1097/qai.0b013e318299cede] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anal sex role patterns and correlates during unprotected anal sex were examined longitudinally among HIV-negative men who have sex with men. Nearly 9.6% were exclusively receptive, 16.7% exclusively insertive, and 63.0% versatile. Versatility was more likely with primary and HIV-negative/unknown status partners and among younger men and substance users but less likely among Blacks and with higher number of partners. Exclusively receptive role was more likely with HIV-negative/unknown status partners and among younger men and substance users but less likely with higher number of partners. Examining anal sex role patterns helps understand the factors that drive the epidemic among men who have sex with men.
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Understanding the HIV Epidemic in the Dominican Republic: A Prevention Success Story in the Caribbean? J Acquir Immune Defic Syndr 2009; 51 Suppl 1:S52-9. [DOI: 10.1097/qai.0b013e3181a267e4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sentinel Surveillance of Sexually Transmitted Infections/HIV and Risk Behaviors in Vulnerable Populations in 5 Central American Countries. J Acquir Immune Defic Syndr 2007. [DOI: 10.1097/qai.0b013e318141f913] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Philen RC. A social geography of sex: men who have sex with men (MSMs) and gay bars on the U.S./Mexican border. JOURNAL OF HOMOSEXUALITY 2006; 50:31-48. [PMID: 16723339 DOI: 10.1300/j082v50n04_02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
In discussions of male homosexuality in Hispanic/Latin American and Anglo/North American contexts, ethnicity is often afforded a key role in structuring sexual identity, with a distinction being made between sexual role patterning (Hispanic, Latin American) and sexual object choice patterning (Anglo, North American). I argue instead that the key factor in shaping distinct patterns of sexual identity among Men who have Sex with Men (MSMs), within the broad though still circumscribed comparative context of Latin American and North America, is the role of particular sites, especially gay bars, in producing gay identity and community.
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Affiliation(s)
- Robert C Philen
- Department of Anthropology, University of West Florida, 11000 University Parkway, Pensacola, 32514, USA
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Goodreau SM, Goicochea LP, Sanchez J. Sexual role and transmission of HIV Type 1 among men who have sex with men, in Peru. J Infect Dis 2005; 191 Suppl 1:S147-58. [PMID: 15627225 PMCID: PMC4063354 DOI: 10.1086/425268] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In Latin America, men who have sex with men (MSM) have traditionally practiced role segregation--that is, the adoption of a fixed role (insertive or receptive) rather than a versatile role (both practices) during anal sex. Previous modeling has shown that role segregation may yield a lower incidence of human immunodeficiency virus (HIV) type 1 infection, compared with role versatility; however, the modeling assumed no risk of acquiring HIV-1 during insertive sex, which is now recognized as unlikely. We reexamine the issue by use of a deterministic model incorporating bidirectional transmission and data from a cohort study of MSM in Lima, Peru, to demonstrate the potential effects of role segregation on the trajectory of the HIV-1 epidemic. In Lima, 67% of MSM reported segregated roles in their recent male partnerships. A population of MSM with identical contact rates but complete role versatility would have twice the prevalence of HIV-1 infection throughout the epidemic's first 3 decades. Preferential mixing among versatile MSM does not change overall prevalence but affects which individuals become infected.
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Affiliation(s)
- Steven M Goodreau
- Center for AIDS and STD and Center for Statistics and the Social Sciences, University of Washington, Seattle, WA 98195, USA.
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Carrillo H. Another Crack in the Mirror: The Politics of AIDS Prevention in Mexico. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2004; 14:129-52. [DOI: 10.2190/jkyx-k9h8-1bly-c6kn] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Beginning in the mid-1980s, nongovernmental groups and the government in Mexico launched efforts to combat AIDS by addressing the population openly and directly. The content and tone of AIDS prevention messages in Mexico have been strongly influenced by models developed in the United States, even when the social conditions of Mexico are strikingly different. However, the local organization of AIDS prevention efforts in Mexico has differed sharply from efforts in large U.S. cities in terms of the distribution of funds and the role played by civil society in the creation of programs. Based on the premise that social and political forces may strongly influence the success, or failure, of health education interventions, this article analyzes the emergence of AIDS prevention in the Mexican context. The epidemiological characteristics of AIDS in Mexico, the governmental response to the epidemic, the role of nongovernmental groups, the availability of funds, the opposition of the political right, and the adoption of models imported from the United States are all considered to be important factors that shape current efforts. The article highlights possible directions for future development of AIDS prevention in Mexico.
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Halperin DT. Heterosexual anal intercourse: prevalence, cultural factors, and HIV infection and other health risks, Part I. AIDS Patient Care STDS 1999; 13:717-30. [PMID: 10743535 DOI: 10.1089/apc.1999.13.717] [Citation(s) in RCA: 168] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Studies of heterosexual HIV transmission have consistently found anal intercourse to be a highly predictive risk factor for seroconversion. Yet most AIDS prevention messages targeted at heterosexuals, presumably influenced by cultural taboos against acknowledging this sexual practice, continue to emphasize vaginal and, increasingly, oral sex transmission. The health risks of anal sex appear to be severely underestimated by a substantial proportion of sexually active women and men in North and Latin America as well as parts of South Asia, Africa, and other regions. Among heterosexuals reported rates of condom use are nearly universally lower for anal than for vaginal intercourse. This review examines anal sex among the general population, including its prevalence in various world regions, related sociocultural factors, and other associated health problems including anorectal STDs, Hepatitis B infection, and HPV-related anal cancer in women. U.S. survey and other data suggest that, in terms of absolute numbers, approximately seven times more women than homosexual men engage in unprotected receptive anal intercourse. Research among higher risk subpopulations, including bisexual men, injecting drug users, female sex workers, inner-city adolescents, and serodiscordant heterosexual couples, indicates that persons particularly at risk of being infected by or transmitting HIV are also more likely to practice anal sex. Considering this finding, along with the much greater efficiency for HIV infection as well as lower rates of condom usage, a significant proportion of heterosexual transmission in some populations is due to anal intercourse. This typically stigmatized and hidden sexual practice must be given greater emphasis in AIDS/STD prevention, women's care, and other health promotion programs.
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Affiliation(s)
- D T Halperin
- International Center for HIV/AIDS Research and Clinical Training in Nursing, University of California, San Francisco, USA.
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Wiessing LG, Houweling H, Sandfort TG, Schop W, van den Akker R, Hoogenveen RT. Reaching homosexual men for HIV surveillance through a gay magazine. Eur J Epidemiol 1999; 15:429-37. [PMID: 10442468 DOI: 10.1023/a:1007548810129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
HIV surveillance in homosexual men is poor in most countries, as this risk group is difficult to sample. The aim of this study is to test the feasibility of reaching homosexual men for national HIV surveillance using gay community media. In 1989, a questionnaire on general gay issues, with a section on AIDS, was included in a widely sold gay magazine in the Netherlands. Among 17,700 sold copies, 1134 responses were obtained from males (6%). Of these, 669 men (59%) gave their address, of which in turn 84% responded to a questionnaire on risk behaviour in 1990. In 1991/1992, the 669 men were asked to participate in an HIV serosurvey, in which eventually 308 participated with a blood test (46%) and 147 without (total 68%). Participation in the serosurvey with blood test was associated with reporting multiple partners in 1989. Twenty participants were infected (6.5%). In logistic regression analysis, risk factors for infection were recent unprotected receptive anal intercourse with multiple partners (odds ratio (OR): 10.7; 95% confidence interval (CI): (2.18-52.2); one partner 1.17 (0.31-4.48); none 1) and living in Amsterdam (OR: 3.92; 95% CI: (0.99-15.5); urbanised western Netherlands 2.15 (0.57-8.03); elsewhere 1), while a high educational level was protective (OR: 0.29 (0.08-0.96); middle 0.41 (0.11-1.54); low 1). Among those who participated in 1991/1992, risk behaviour increased between 1989 and 1991/1992 (reporting multiple casual partners rose from 55% to 64%; reporting inconsistent condom use with receptive anal sex from 58% to 71%). Using a predictive model which included self-reported serostatus in 1989, the HIV prevalence rate in 1991/1992 among all male responders to the 1989 questionnaire was estimated to be 5.3% (95% CI: 3.1 7.7%). In conclusion, unless initial response is improved, recruitment through a gay magazine may not allow reliable estimates of HIV prevalence in homosexual men. However, it can be useful at the national level for monitoring changes in prevalence and risk behaviour over time, geographical differences and risk factors for infection.
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Affiliation(s)
- L G Wiessing
- Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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Juárez-Figueroa LA, Uribe-Salas FJ, Conde-Glez CJ, Hernández-Avila M, Hernández-Nevárez P, Uribe-Zúñiga P, del Río-Chiriboga C. Hepatitis B markers in men seeking human immunodeficiency virus antibody testing in Mexico City. Sex Transm Dis 1997; 24:211-7. [PMID: 9101632 DOI: 10.1097/00007435-199704000-00005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To estimate the prevalence and associated risk factors of hepatitis B virus (HBV) serologic markers in 1,377 men with high-risk sexual behavior attending a center for human immunodeficiency virus (HIV) detection in Mexico City. METHODS The study population consisted of all men who were tested for HIV from March to September, 1992. Study participants responded to a standardized questionnaire and provided a blood sample for serology. RESULTS A total of 1.9% of the population were hepatitis B surface antigen (HBsAg) carriers, and there was a significant difference in HBsAg prevalence between HIV-negative (0.8%) and HIV-positive individuals (7.9%). Sexual preference was associated with HBsAg prevalence; only 0.3% of men who had female sexual partners exclusively were HBsAg carriers, compared with 4.8% of men who had male sexual partners exclusively. Prevalence of antibodies to hepatitis B core antigen (anti-HBc) was 15.4%. However, men who reported only female partners had a 4.6% prevalence, whereas men who had only male partners had a 30.4% prevalence. Logistic regression analysis demonstrated an association of anti-HBc prevalence with age, marital status, sexual preference, seropositivity for HIV, and antibodies to herpes simplex virus type 2. CONCLUSIONS These data demonstrate that coinfection with HBV is common in the HIV-positive men studied. The highest prevalences of HBsAg and anti-HBc were observed among homosexual men. These results highlight the need to intensify safe-sex education campaigns and to promote hepatitis B vaccination especially among this population group.
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Rodés A, Wang J, Blanch G, Tort X, Casabona J. [Transverse study on sex behavior associated with HIV transmission among homosexual men in Catalonia]. GACETA SANITARIA 1997; 11:16-23. [PMID: 9289481 DOI: 10.1016/s0213-9111(97)71267-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In 1993, a cross sectional study was carried out on the sexual behaviour of a sample of homosexual men recruited in saunas, sex shops and a gay community-beased organisation of Catalonia. A total of 551 men with an average age of 34 years and a high educational level sent in an anonymous questionnaire. In the previous 6 months the mean number of male sexual partners was 6 and for penetrative partners 3. In the previous month, 94% had had oral sex (22% with ejaculation) and 76% anal intercourse (38% without a condom and 21% with ejaculation). During sex, 51% used alcohol, 34% nitrite inhalants, 20% hashish and 10% cocaine, 61% had had the HIV test, with a self-reported HIV prevalence of 21%. 86% stated that they knew of one or more people infected by HIV or with AIDS. The high percentage of men who had unprotected anal intercourse and the high self-reported HIV prevalence highlights the need to increase efforts in AIDS prevention and research in this group. Monitoring HIV associated sexual behaviours provides valuable indicators of the evolution of the epidemic, useful for designing and evaluating preventive interventions.
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Affiliation(s)
- A Rodés
- Programa per a la Prevenció i el Control de la Sida. Departament de Sanitat i Seguretal Social, Badalona
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d'Oro LC, Parazzini F, Naldi L, La Vecchia C. Barrier methods of contraception, spermicides, and sexually transmitted diseases: a review. Genitourin Med 1994; 70:410-7. [PMID: 7705860 PMCID: PMC1195309 DOI: 10.1136/sti.70.6.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To understand whether barrier methods of contraception (BMC) and/or spermicides lower the risk of acquiring sexually transmitted disease (STD) and to quantify the protection. DESIGN Review of published experimental studies, in vitro and in vivo evidence on the issue. SUBJECTS We reviewed 22 papers that examined the impermeability of BMC in vitro against STD agents or the effect of spermicides, and 60 papers reporting results of epidemiological studies on the risk of STD in users of BMC. RESULTS There was in vitro evidence that both BMC and spermicides were effective against most sexually transmissible agents. Doubts remain on the effectiveness of BMC and spermicides in normal conditions of use, particularly against human papilloma virus. Natural membrane condoms are not impermeable and pores are seen by electron microscopy. Epidemiological studies show a consistent reduction in the risk for use of condoms against gonococcal (most studies giving relative risk, RR, estimates around 0.4 to 0.6) and HIV infection (RRs between 0.3 and 0.6 in most studies). Spermicides protect women against gonorrhoea and trichomoniasis; their role against other STDs is less clear and there is some indication of an irritative effect on the vaginal mucosa that is likely to be dose-dependent. CONCLUSIONS A large amount of evidence indicates that BMC reduce the risk of gonorrhoea and HIV transmission, but the results are--at least in quantitative terms--less consistent for other diseases. Implications for individual choices and public health approaches should relate to frequency of exposure and severity of the disease too.
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Affiliation(s)
- L C d'Oro
- Istituto di Richerche Farmacologiche Mario Negri, Milan, Italy
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