1
|
Gowda C, Coppock D, Brickman C, Shaw PA, Gross R. Determinants of HIV Transmission Risk Among HIV-Infected Persons Engaged in Care. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:440-452. [PMID: 27710086 DOI: 10.1521/aeap.2016.28.5.440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
People living with HIV (PLWH) engaged in medical care represent an accessible group to focus HIV prevention efforts. In an analysis of 1,883 PLWH from 2007 and 2015, we determined the proportion at risk of HIV transmission and identified factors associated with HIV transmission risk using multivariable mixed effects logistic regression models with random intercepts. HIV transmission risk was defined by an HIV viral load > 1,500 copies/mL and self-reported unprotected sex. We found that 174 (9.2%) individuals were at risk for HIV transmission at least once. Factors associated with HIV transmission risk included younger age (adjusted OR [95% CI] per decade decrease = 2.30 [1.84, 2.89]), illicit drug use (adjusted OR = 5.36 [3.02, 9.56]), depression (adjusted OR = 1.88 [1.10, 3.21]), and education <12th grade (adjusted OR = 2.05 [1.15, 3.67]). Thus, nearly 1 in 10 HIV-infected individuals engaged in care between 2007 and 2015 were potentially at risk of transmitting HIV. Behavioral interventions to decrease HIV transmission should focus on younger, less educated patients who are depressed and actively using illicit drugs.
Collapse
Affiliation(s)
- Charitha Gowda
- Division of Infectious Diseases, Nationwide Children's Hospital and the Department of Pediatrics, the Ohio State University College of Medicine, Columbus, Ohio
| | - Dagan Coppock
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Cristina Brickman
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco School of Medicine, San Francisco
| | - Pamela A Shaw
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
2
|
DíAz RM, Morales ES, Bein E, DiláN E, RodríGuez RA. Predictors of Sexual Risk in Latino Gay/Bisexual Men: The Role of Demographic, Developmental, Social Cognitive, and Behavioral Variables. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986399214007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined four types of predictors of sexual risk within a sample of 110 predominantly English-speaking Latino gay/bisexual men residing in the city of San Francisco. More than one fourth of the sample reported at least one instance of unprotected anal intercourse in the last 30 days; one fifth of the sample reported unprotected anal intercourse with a nonmonogamous sexual partner within the same time period. Findings suggest that weak personal intentions for safer sex and low levels of perceived self-efficacy are associated with risky sexual practices. In addition, a history of sexual abuse in childhood, drug use during sexual activity, and frequency of sex in public cruising environments emerged as significant predictors of sexual risk. Multivariate analyses indicated that a four-predictor model (including a young age, low levels of intention/self-efficacy, a high frequency of sex under the influence of drugs, and a high frequency of sex with nonmonogamous partners) is the most parsimonious model to predict sexual risk in this population. A history of childhood sexual abuse correlated positively with all predictors of risk in the model, except age.
Collapse
Affiliation(s)
| | | | | | - Eugene DiláN
- California School of Professional Psychology, Alameda
| | | |
Collapse
|
3
|
Fergus S, Lewis MA, Darbes LA, Butterfield RM. HIV Risk and Protection Among Gay Male Couples: The Role of Gay Community Integration. HEALTH EDUCATION & BEHAVIOR 2016; 32:151-71. [PMID: 15856614 DOI: 10.1177/1090198104271964] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the association between different types of integration in the gay community and HIV risk among gay male couples. Previous research linking gay community integration and involvement among couples to HIV risk has been equivocal. Each partner in 59 gay couples completed a separate anonymous questionnaire that assessed two types of social involvement in the gay community, assimilation into the gay community, and sexual HIV risk behaviors. We used the actor-partner interdependence analysis approach, which maintains the couple as the unit of analysis while allowing for tests of within-couple, between-couple, actor, and partner effects. Analyses revealed that, controlling for symptoms of alcohol problems, going to gay bars and clubs independently predicted more HIV risk.
Collapse
Affiliation(s)
- Stevenson Fergus
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor 48109, USA.
| | | | | | | |
Collapse
|
4
|
Martinez O, Wu E, Sandfort T, Shultz AZ, Capote J, Chávez S, Moya E, Dodge B, Morales G, Porras A, Ovejero H. [A couple-based approach: An innovative effort to tackle HIV infection among Latino gay men.]. EHQUIDAD 2014; 1:15-32. [PMID: 25580466 PMCID: PMC4286892 DOI: 10.15257/ehquidad.2014.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The HIV epidemic is a serious and pervasive health issue in the Latino community. While prevention efforts have helped maintain stability in the overall number of infections among Latinos for more than a decade, this population continues to be affected by HIV at high levels. In particular, Predominantly Spanish-speaking Latino men who have sex with men (MSM) are disproportionately impacted by HIV. Several factors contribute to the HIV epidemic among Predominantly Spanish-speaking Latino MSM including substance use; intimate partner violence; the presence of certain STIs; same-sex relationship dynamics; avoidance of seeking testing counseling and treatment out of fear of discrimination and immigration status; and poverty, migration patterns, and language barriers. In particular, epidemiological behavioral research has identified how relationship dynamics in male couples are associated with sexual risk behavior. Consequently, further research is needed to identify and deliver interventions geared toward couple-based risk reduction among men in same-sex relationships. This paper describes the potential significance that innovative couple-based approaches can have on reducing HIV and AIDS cases among Predominantly Spanish-speaking Latino MSM and their same-sex partners.
Collapse
Affiliation(s)
- Omar Martinez
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University
| | - Elwin Wu
- School of Social Work at Columbia University
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University
| | - Andrew Z. Shultz
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University
| | - Jonathan Capote
- Communications and Development Assistant at AID for AIDS International
| | | | | | | | | | | | | |
Collapse
|
5
|
Tucker JS, Hu J, Golinelli D, Kennedy DP, Green HD, Wenzel SL. Social network and individual correlates of sexual risk behavior among homeless young men who have sex with men. J Adolesc Health 2012; 51:386-92. [PMID: 22999840 PMCID: PMC3531968 DOI: 10.1016/j.jadohealth.2012.01.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE There is growing interest in network-based interventions to reduce HIV sexual risk behavior among both homeless youth and men who have sex with men. The goal of this study was to better understand the social network and individual correlates of sexual risk behavior among homeless young men who have sex with men (YMSM) to inform these HIV prevention efforts. METHODS A multistage sampling design was used to recruit a probability sample of 121 homeless YMSM (ages: 16-24 years) from shelters, drop-in centers, and street venues in Los Angeles County. Face-to-face interviews were conducted. Because of the different distributions of the three outcome variables, three distinct regression models were needed: ordinal logistic regression for unprotected sex, zero-truncated Poisson regression for number of sex partners, and logistic regression for any sex trade. RESULTS Homeless YMSM were less likely to engage in unprotected sex and had fewer sex partners if their networks included platonic ties to peers who regularly attended school, and had fewer sex partners if most of their network members were not heavy drinkers. Most other aspects of network composition were unrelated to sexual risk behavior. Individual predictors of sexual risk behavior included older age, Hispanic ethnicity, lower education, depressive symptoms, less positive condom attitudes, and sleeping outdoors because of nowhere else to stay. CONCLUSIONS HIV prevention programs for homeless YMSM may warrant a multipronged approach that helps these youth strengthen their ties to prosocial peers, develop more positive condom attitudes, and access needed mental health and housing services.
Collapse
Affiliation(s)
- Joan S Tucker
- RAND Health, RAND Corporation, Santa Monica, California 90407-2138, USA.
| | | | | | | | | | | |
Collapse
|
6
|
Drug use, interpersonal attraction, and communication: situational factors as predictors of episodes of unprotected anal intercourse among Latino gay men. AIDS Behav 2009; 13:691-9. [PMID: 18985447 DOI: 10.1007/s10461-008-9479-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
Abstract
It is important to understand situational factors linked to episodes of unprotected sexual intercourse among Latino gay men (LGM), who are disproportionately affected by HIV/AIDS in the U.S. Past research has suggested that participation in difficult sexual situations mediates the relationship between socio-cultural factors and sexual risk behaviors among LGM. This study examined drug use by self and sex partners, interpersonal factors, and other key variables, each examined at the situation-level of analysis, as predictors of episodes of unprotected anal intercourse (UAI) among LGM. Study participants included 270 LGM living in New York City, Miami, and Los Angeles who reported inconsistent condom use during anal intercourse in the last year. Men participated in structured interviews in which they were asked sets of detailed questions about their most recent episode of anal intercourse in which they used condoms, and their most recent anal intercourse episode in which they did not use condoms. Conditional logistic regression was used to compare the relevance of specific situational factors to participants' episodes of UAI and protected anal intercourse. We found that drug use by a sex partner and lacks of discussions about condom use with partners, among other situational factors, were significantly related to episodes of UAI. The findings highlight the importance of considering the impact of sexual situations and interactions with sex partners when studying HIV risk among LGM and when designing interventions.
Collapse
|
7
|
Brendan Flanagan M. The Medical Abnormality of Homosexuality. Linacre Q 2003. [DOI: 10.1080/20508549.2003.11877682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
8
|
Fernández MI, Perrino T, Bowen GS, Royal S, Varga L. Repeat HIV testing among Hispanic men who have sex with men--a sign of risk, prevention, or reassurance? AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2003; 15:105-116. [PMID: 12630603 DOI: 10.1521/aeap.15.1.5.105.23608] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study examined factors associated with repeat (n > or = 3 lifetime) and regular (n > or = 2 times per year, for a minimum of 1 year) HIV testing among a community sample of 538 seronegative Hispanic men who have sex with men (MSM). Bilingual staff interviewed respondents anonymously at public venues in South Florida. We compared (a) repeat testers with nonrepeat testers and (b) regular testers with nonregular testers. Results of logistic regression analyses indicated that repeat testers were more likely to be older, more educated, have a history of sexually transmitted disease, and have more sex partners than nonrepeat testers. Regular testers were more likely to be younger, have lower HIV risk perceptions, and have intentionally taken their first HIV test than were nonregular testers. They were also more likely to engage in oral sex and to only engage in 100% protected insertive anal sex. These findings suggest the importance of studying both the frequency and regularity of HIV testing behaviors, and using them to design interventions to promote testing among Hispanic MSM who are most at risk.
Collapse
Affiliation(s)
- M Isabel Fernández
- Behavioral Health Promotion Program, University of Miami School of Medicine, Department of Epidemiology and Public Health, Miami, FL 33101, USA.
| | | | | | | | | |
Collapse
|
9
|
Factors Associated with HIV Sexual Risk Behavior in Male Couples of Mixed HIV Status. ACTA ACUST UNITED AC 2002. [DOI: 10.1300/j056v13n02_03] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
10
|
Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. AIDS 2002; 16:135-49. [PMID: 11807297 DOI: 10.1097/00002030-200201250-00002] [Citation(s) in RCA: 271] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Palmer R, Bor R. The challenges to intimacy and sexual relationships for gay men in HIV serodiscordant relationships: a pilot study. JOURNAL OF MARITAL AND FAMILY THERAPY 2001; 27:419-431. [PMID: 11594011 DOI: 10.1111/j.1752-0606.2001.tb00337.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Human Immunodeficiency Virus (HIV) infection and disease progression create imbalance in long-term, HIV-serodiscordant, gay male relationships, particularly in sexual relations and issues of physical and emotional intimacy. Stage of disease progression and worldview of the couple both affect the relationship and its survival. To redress imbalance, partners employ a range of coping strategies and techniques. This article explores these issues in the context of HIV serodiscordant gay couples and how they preserve their relationships in the face of these unique challenges. For workers who provide psychotherapeutic and community support for people with HIV and for their partners, the results of this study may be helpful in recognizing stress factors for couples, and tailoring support services to the needs of both partners. Overall, this study provides a basis for further work examining the dynamics of serodiscordant relationships.
Collapse
Affiliation(s)
- R Palmer
- Greenway Centre, Newham General Hospital, Glen Road, London, E13 8SL, United Kingdom.
| | | |
Collapse
|
12
|
Moreau-Gruet F, Jeannin A, Dubois-Arber F, Spencer B. Management of the risk of HIV infection in male homosexual couples. AIDS 2001; 15:1025-35. [PMID: 11399985 DOI: 10.1097/00002030-200105250-00011] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To study the ways of managing HIV risk within male homosexual steady relationships (gay couples), including factors associated with consistent condom use during anal sex with the steady partner. METHOD An anonymous and standardized questionnaire completed by a convenience sample of homosexuals in Switzerland in 1997 (n = 1097). Information on the couple was provided by the 74% (n = 786) of male respondents who reported having a steady partner in the past 12 months. Data were analysed by contingency tables and logistic regression. RESULTS Different ways of managing HIV risk were reported: negotiated safety (both HIV negative, condoms abandoned) was chosen by one quarter of the couples, but the most frequent solution was reliance on condoms for anal sex, chosen by more than four in 10. Altogether 84% of couples exhibited safe management of HIV risk within their partnership. The 16% of couples showing inadequate management of HIV risk within the couple mostly relied on questionable assumptions about past or present risks. A total of 74% of couples had spoken about managing HIV risk with possible casual partners. Reported behaviour with the steady partner and with casual partners was highly consistent with claimed strategies chosen to manage HIV risk. Consistent condom use with the steady partner was mostly associated with variables characterizing the relationship: initial 2 years of the relationship, discordant or unknown serological HIV status, non-exclusivity. CONCLUSION Gay couples manage HIV risk in a variety of ways. Most strategies provide adequate protection with casual partners, but leave gaps in protection between the steady partners themselves.
Collapse
Affiliation(s)
- F Moreau-Gruet
- University Institute of Social and Preventive Medicine, Lausanne, Switzerland.
| | | | | | | |
Collapse
|
13
|
Halkitis PN, Parsons JT, Stirratt MJ. A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men. JOURNAL OF HOMOSEXUALITY 2001; 41:17-35. [PMID: 11482426 DOI: 10.1300/j082v41n02_02] [Citation(s) in RCA: 273] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Emerging research on methamphetamine use among gay men suggests that growth in the use of this drug could present serious problems for HIV/AIDS prevention within the gay community. This article summarizes current studies on the extent, role, and context of methamphetamine use among gay men and its relationship to high risk sexual behaviors related to HIV transmission. Methamphetamine is often used by gay men to initiate, enhance, and prolong sexual encounters. Use of the drug is, therefore, associated with particular environments where sexual contact among gay men is promoted, such as sex clubs and large "circuit" parties. Research with gay and bisexual men indicates that methamphetamine use is strongly associated with risky sexual behaviors that may transmit HIV. This relationship, coupled with emerging evidence that methamphetamine use is on the rise among gay men, suggests that the drug could exacerbate the HIV/AIDS epidemic among this community. The article offers recommendations for further research and suggestions for prevention programs regarding methamphetamine use by gay men.
Collapse
Affiliation(s)
- P N Halkitis
- Department of Applied Psychology, New York University, NY 10003, USA.
| | | | | |
Collapse
|
14
|
Carballo-Diéguez A, Stein Z, Sáez H, Dolezal C, Nieves-Rosa L, Díaz F. Frequent use of lubricants for anal sex among men who have sex with men: the HIV prevention potential of a microbicidal gel. Am J Public Health 2000; 90:1117-21. [PMID: 10897191 PMCID: PMC1446289 DOI: 10.2105/ajph.90.7.1117] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed frequency of rectal lubricant use, opinions about rectal microbicidal gels, and willingness to participate in acceptability trials of rectal microbicides among Latino men who have sex with men (MSM). METHODS Latino MSM (N = 307) living in New York City were surveyed from October 1995 through November 1996. Eleven Latino MSM participated in a focus group. RESULTS Among those having anal sex during the prior year, 93% used lubricants (59% always and 74% in at least 80% of sexual encounters) regardless of condom use. Of the 29 men who practiced anal sed but did not use condoms, 90% used lubricants with similar frequency. Of those using lubricants, 94% used at least 1 teaspoon per occasion. A transparent product, free of smell and taste, was favored. Of the MSM in the sample, 92% said that they would use a lubricant with an anti-HIV microbicidal agent, and 87% expressed interest in participating in an acceptability trial. Product and dispenser preferences also were discussed. CONCLUSIONS A rectal lubricant with microbicidal properties appears acceptable and desirable to Latino men who have anal sex with other men.
Collapse
Affiliation(s)
- A Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Affiliation(s)
- B Tüzün
- Department of Dermatology, Trakya University, Medical Faculty, Edirne, Turkey
| | | | | |
Collapse
|
16
|
|
17
|
Sullivan PS, Chu SY, Fleming PL, Ward JW. Changes in AIDS incidence for men who have sex with men, United States 1990-1995. AIDS 1997; 11:1641-6. [PMID: 9365770 DOI: 10.1097/00002030-199713000-00014] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To describe changes in AIDS incidence for men who have sex with men (MSM) from 1990 to 1995, by demographic and geographic groups. METHODS We examined national AIDS surveillance data reported up to 30 September 1996, for men who received AIDS diagnoses in the years 1990-1995 and whose only reported risk behavior was sex with men. We evaluated trends in AIDS rates by estimating the incidence of clinical AIDS (AIDS defined by opportunistic illnesses), and report clinical AIDS incidence rates for MSM (AIDS rates) and proportional change in rates from 1990 to 1995. RESULTS Clinical AIDS rates (MSM per 100,000 men per year) increased by 12% from 25.5% in 1990 to 28.5% in 1995. Significant variations in AIDS rates and 5-year changes in AIDS rates were observed in various subgroups of MSM. Five-year increases in AIDS rates were highest for American-Indian/Alaskan native (53%), black (45%), and Hispanic (23%) MSM; the only decrease occurred for white MSM (-2%). Incidence for black MSM increased from twofold (in 1990) to threefold (in 1995) the rate for white MSM. Large increases in AIDS rates were observed for MSM in rural areas (34%) and areas with 50,000 to 249,999 residents (34%) and for MSM aged over 60 years (32%). CONCLUSIONS The high national AIDS rate for MSM continued to rise, but more slowly than earlier in the epidemic. Racial/ethnic minority MSM had consistently large increases in AIDS rates; AIDS rates decreased only slightly for white MSM. The AIDS epidemic among MSM is not homogenous, and AIDS rates continue to increase for minority MSM, and MSM living in rural areas. HIV prevention remains a high priority for all MSM, especially black and Hispanic MSM.
Collapse
Affiliation(s)
- P S Sullivan
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | | | | | | |
Collapse
|
18
|
Fenton KA, Power R. Why do homosexual men continue to practise unsafe sex? A critical review of a qualitative research paper. Genitourin Med 1997; 73:404-9. [PMID: 9534756 PMCID: PMC1195905 DOI: 10.1136/sti.73.5.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- K A Fenton
- Department of Sexually Transmitted Diseases, UCL Medical School, London
| | | |
Collapse
|
19
|
Myers HF, Satz P, Miller BE, Bing EG, Evans G, Richardson MA, Forney D, Morgenstern H, Saxton E, D'Elia L, Longshore D, Mena I. The African-American Health Project (AAHP): study overview and select findings on high risk behaviors and psychiatric disorders in African American men. ETHNICITY & HEALTH 1997; 2:183-96. [PMID: 9426983 DOI: 10.1080/13557858.1997.9961827] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The AAHP investigated the neurobehavioral and psychosocial sequelae of HIV-1 and substance use in urban African American men. A community resident sample of 502 African American men stratified by HIV-1 serostatus, drug use and sexual orientation were recruited. A comprehensive battery of measures of neurobehavioral and health status, lifestyle and psychosocial characteristics were administered to all participants, and a stratified sub-sample of 120 participants were tested using state of the art brain imaging techniques to investigate differences in the functional and neurophysiologic effects of HIV-1 and substance use. An overview of the methodology of the AAHP and results on high risk sexual and substance use behaviors, and psychiatric disorders are presented and discussed. The sample was primarily HIV-negative (63%), heterosexual (49% gay or bisexual) and a high percentage used substances during the past year (56% used drugs and 30% moderate/heavy drinkers). High-risk sexual practices were relatively prevalent, and a high percentage reported a history of STDs and other infections. Finally, 25% had a current psychiatric disorder, with gays/bisexuals and HIV-seropositives evidencing greater psychiatric vulnerability. More research is needed to further explore the apparent greater risk for psychiatric disorders among gay and bisexual men, and to determine whether being African American and lower social class exacerbate this risk.
Collapse
Affiliation(s)
- H F Myers
- Department of Psychology, University of California 90095-1563, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Zimmerman MA, Ramirez-Valles J, Suarez E, de la Rosa G, Castro MA. An HIV/AIDS prevention project for Mexican homosexual men: an empowerment approach. HEALTH EDUCATION & BEHAVIOR 1997; 24:177-90. [PMID: 9079577 DOI: 10.1177/109019819702400206] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In this intervention, participants design and implement an HIV/AIDS prevention project for Mexican homosexual men. The intervention is consistent with, and contributes to, empowerment theory because it enhances collective action, provides opportunities to develop knowledge and skills, creates needed resources, and includes shared control with professional and among participants. The intervention described provides an illustration of an empowering process and distinguishes itself from empowerment outcomes. An evaluation of the project is also described, but the outcomes were HIV/AIDS-related behaviors rather than psychological empowerment of the participants. The results suggest that the participants' HIV/AIDS knowledge and preventive behavior improved when compared to individuals who did not participate in the intervention. In addition, the intervention generated community change initiated by participants. Implications for designing interventions using an empowerment approach are discussed.
Collapse
Affiliation(s)
- M A Zimmerman
- University of Michigan School of Public Health, Ann Arbor 48109-2029, USA.
| | | | | | | | | |
Collapse
|
21
|
Misovich SJ, Fisher JD, Fisher WA. Close Relationships and Elevated HIV Risk Behavior: Evidence and Possible Underlying Psychological Processes. REVIEW OF GENERAL PSYCHOLOGY 1997. [DOI: 10.1037/1089-2680.1.1.72] [Citation(s) in RCA: 271] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A review of research on AIDS preventive behavior indicates that minority and nonminority heterosexual adolescents and adults, gay men, injection drug users, and commercial sex workers are all less likely to practice safer sex with close relationship partners, compared with partners they perceive to be “casual” sexual partners. Because many individuals in close relationships have engaged in HIV risk behavior over extended periods of time and are unaware of their actual HIV status, practicing unprotected sexual intercourse with a committed relationship partner who is not tested for HIV appears to be a major and unrecognized source of HIV risk. This article reviews the evidence for higher levels of HIV risk behavior in close relationships and then presents relevant conceptual and empirical work to explore the psychological processes that may underlie risky sexual behavior in close relationships, using as a framework the information–motivation–behavioral skills model of preventive behavior.
Collapse
Affiliation(s)
| | | | - William A. Fisher
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
22
|
Flowers P, Sheeran P, Beail N, Smith JA. The role of psychosocial factors in hiv risk-reduction among gay and bisexual men: A quantitative review. Psychol Health 1997. [DOI: 10.1080/08870449708407400] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
23
|
Moreau-Gruet F, Dubois-Arber F. [AIDS prevention in homosexuals in Switzerland: adaptation to risks according to type of partner]. SOZIAL- UND PRAVENTIVMEDIZIN 1996; 41:1-10. [PMID: 8701614 DOI: 10.1007/bf01358841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of AIDS prevention and modes of adaptation to risk among gay men. Swiss results are presented from an international study conducted in 8 European countries. METHOD A self-administered questionnaire was published in gay magazines and distributed by gay organizations and clubs. 934 questionnaires were returned in Switzerland. RESULTS More than 80% of the respondents report no risk behaviours in the last 12 months. Among all respondents three main modes of adaptation to risk were found: avoidance (no partner, no penetration), protection (condom use), non-use of condoms by stable couples (this assumes an agreement between partners). With casual partners 39% avoid penetration, 49% use condoms and 12% do not use them consistently. With stable partners penetration is more frequent; protection and non use of condoms are found with equal frequency. Nevertheless, 10% of those who report always using condoms say that they have been exposed to a risk, while a third of those who do not always use condoms admitted having taken such a risk. CONCLUSIONS Prevention campaigns must continue and focus especially on factors linked to the non use of condoms in couples in stable relationships (poor communication, exaggerated trust).
Collapse
Affiliation(s)
- F Moreau-Gruet
- Institut universitaire de médecine sociale et préventive, Lausanne
| | | |
Collapse
|
24
|
Barrett DC, Bolan G, Joy D, Counts K, Doll L, Harrison J. Coping Strategies, Substance Use, Sexual Activity, and HIV Sexual Risks in a Sample of Gay Male STD Patients1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 1995. [DOI: 10.1111/j.1559-1816.1995.tb00617.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Kippax S, Crawford J, Rodden P, Noble J. Predictors of unprotected male-to-male anal intercourse with casual partners in a national sample. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1995; 19:132-8. [PMID: 7786937 DOI: 10.1111/j.1753-6405.1995.tb00362.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The focus of the paper is the predictors of unprotected anal intercourse with casual partners among a national Australian sample of homosexually active men. We interviewed by telephone 2583 homosexually active men (sex with a man within the last five years) about their sexual practice, type of sexual partners, human immunodeficiency virus (HIV) test status, attachment to the gay community, knowledge of HIV and acquired immune deficiency syndrome (AIDS) and a range of demographic variables. Logistic regression analyses were used to distinguish men who practised unprotected anal intercourse with casual partners from those who practised safe sex with casual partners. Men who practised unprotected anal intercourse with casual partners were less likely to have a regular male sexual partner than men who practised safe sex with their casual partners. They were less likely to be tertiary educated, more likely to be employed in trade and manual occupations and to live in Tasmania and the Northern Territory. They were less likely to be culturally or politically attached to the gay community. Knowledge of HIV/AIDS also distinguished the men: men with an accurate knowledge of HIV transmission were less likely to engage in unprotected anal intercourse with their casual partners. Several other variables, including age and HIV test status, did not distinguish those who practised safe sex with casual partners from those who practised unprotected anal intercourse with casual partners.
Collapse
Affiliation(s)
- S Kippax
- National Centre in HIV Social Research, Macquarie University, Sydney
| | | | | | | |
Collapse
|
26
|
Cameron P, Playfair WL, Wellum S. The Longevity of Homosexuals: Before and after the Aids Epidemic. OMEGA-JOURNAL OF DEATH AND DYING 1995. [DOI: 10.2190/g94q-xmfy-3g33-0xre] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although the U.S. Surgeon General characterized homosexual sex as “normal” and “healthy,” homosexuals and IV drug abusers have suffered disproportionately from the AIDS epidemic. Longevity is often utilized as a measure of health. How long did homosexuals live before the AIDS epidemic and how long do they live today? We examined 6,737 obituaries/death notices from eighteen U.S. homosexual journals over the past thirteen years and compared them to obituaries from two conventional newspapers. The obituaries from the non-homosexual newspapers were similar to U.S. averages for longevity: the median age of death of married men was seventy-five, 80 percent died old (65 or older); for unmarried men it was fifty-seven, 32 percent died old; for married women it was seventy-nine, 85 percent died old; for unmarried women it was seventy-one, 60 percent died old. For the 6,574 homosexual deaths, the median age of death if AIDS was the cause was thirty-nine irrespective of whether or not the individual had a Long Time Sexual Partner [LTSP], 1 percent died old. For those 829 who died of non-AIDS causes the median age of death was forty-two (41 for those 315 with a LTSP and 43 for those 514 without) and <9 percent died old. Homosexuals more frequently met a violent end from accidental death, traffic death, suicide, and murder than men in general. The 163 lesbians registered a median age of death of forty-four (20% died old) and exhibited high rates of violent death and cancer as compared to women in general. Old homosexuals appear to have been proportionately less numerous than their non-homosexual counterparts in the scientific literature from 1858 to 1993. The pattern of early death evident in the homosexual obituaries is consistent with the pattern exhibited in the published surveys of homosexuals and intravenous drug abusers. Homosexuals may have experienced a short lifespan for the last 140 years; AIDS has apparently reduced it about 10 percent. Such an abbreviated lifespan puts the healthfulness of homosexuality in question.
Collapse
Affiliation(s)
- Paul Cameron
- Family Research Institute, Inc., Washington, D.C
| | | | | |
Collapse
|
27
|
Abstract
PURPOSE To examine short-term changes in HIV knowledge, beliefs, and behaviors among gay and bisexual adolescents, 139 gay and bisexual male adolescents (13-21 years of age) completed interviews and self-administered surveys of HIV-related knowledge, attitudes, and behaviors during an initial assessment (Time 1) and 3-6 months after intervention (Time 2). METHODS The intervention included individualized HIV/AIDS risk assessment and risk reduction counseling, peer education, and referrals to needed services. Cross-sectional (group) and individual cognitive and behavioral changes were examined; adolescents who reported unprotected anal intercourse and/or injecting drug use after interventions were compared to those who did not. RESULTS Compared to Time 1, 60% fewer subjects at Time 2 reported unprotected anal intercourse with recent partners. Subjects also reported less frequent anal intercourse and more consistent use of condoms during follow-up. Substance abuse severity scores and use of amphetamines and amyl nitrite declined. One-quarter of subjects reported ongoing high-risk behaviors associated with multiple partners, frequent anal intercourse, completion of education, and relative numbers of gay friends. CONCLUSIONS Compliance with HIV risk reduction improved over time. Constructive change most often involved the practices of anal intercourse and, to a lesser extent, oral sex. Ongoing risk-taking behavior may reflect serious psychosocial problems.
Collapse
Affiliation(s)
- G Remafedi
- Department of Pediatrics, University of Minnesota, Minneapolis 55455
| |
Collapse
|
28
|
|
29
|
Leigh BC, Stall R. Substance use and risky sexual behavior for exposure to HIV. Issues in methodology, interpretation, and prevention. THE AMERICAN PSYCHOLOGIST 1993. [PMID: 8256876 DOI: 10.1037//0003-066x.48.10.1035] [Citation(s) in RCA: 186] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent reports have suggested that the use of alcohol or drugs is related to sexual behavior that is high risk for HIV infection. If substance use leads to unsafe sexual activity, understanding the dynamics of this relationship can contribute to research and preventive and educational efforts to contain the spread of AIDS. In this article, we review research on the relationship between substance use and high-risk sexual behavior. We then consider the inherent limitations of the research designs used to study this relationship, outline some methodological concerns including measurement and sampling issues, and comment on causal interpretations of correlational research findings. We end with a consideration of potential avenues for future research and a discussion of implications of these findings for current AIDS prevention policies.
Collapse
Affiliation(s)
- B C Leigh
- Alcohol and Drug Abuse Institute, University of Washington, Seattle 98105
| | | |
Collapse
|
30
|
Abstract
Cross sectional and longitudinal data on condom use among homosexually active men is presented. Data pertain to two waves of interviewing (1987/8 and 1991) from Project SIGMA, a large longitudinal study of male homosexual behaviour in the light of HIV. Aggregate changes across the time-period indicate an increase in condom use for both insertive and receptive anal intercourse, particularly with casual partners. Condom use is still much more prevalent with casual rather than regular partners. Longitudinal analysis show considerable changes at the individual level, with almost a third of men changing their practices. Half of those decreased their risk behaviours, whilst the other half increased them. Less than 1% used condoms for fellatio in the year preceding the 1991 interview, but 8.3% had used other barriers during sex, primarily for hygiene and fun reasons, rather than as disease prophylaxis. Some implications are drawn for condom promotion and HIV prevention.
Collapse
Affiliation(s)
- A J Hunt
- Department of Sociology, University of Essex, Colchester
| | | | | | | | | | | |
Collapse
|
31
|
Dawson J, Fitzpatrick R, Boulton M, McLean J, Hart G. Predictors of high risk sexual behaviour in gay and bisexual men. SOZIAL- UND PRAVENTIVMEDIZIN 1992; 37:79-84. [PMID: 1604939 DOI: 10.1007/bf01322737] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Evidence of high risk sex between gay men continues to be reported, as does a range of sexual behaviour. Three hundred and sixty-nine homosexually active men from different areas of England were each assessed twice at an an interval of 9 months in order to examine the extent to which a number of social-psychological factors predicted subsequent high risk sexual behaviour. Few of the variables were significantly related to unprotected receptive anal sex in the way that the Health Belief Model predicted, except for some perceptions of costs and benefits of safer sex. However, whether or not men were involved in a regular relationship with a partner was strongly associated with high risk behaviour. The implications of these results are that health education interventions should focus on alerting all men to the social context in which high risk sex is more likely to happen: the regular partnership.
Collapse
Affiliation(s)
- J Dawson
- Department of Public Health and Primary Care, University of Oxford
| | | | | | | | | |
Collapse
|