1
|
Westphal GA, Garcia VD, de Souza RL, Franke CA, Vieira KD, Birckholz VRZ, Machado MC, de Almeida ERB, Machado FO, Sardinha LADC, Wanzuita R, Silvado CES, Costa G, Braatz V, Caldeira Filho M, Furtado R, Tannous LA, de Albuquerque AGN, Abdala E, Gonçalves ARR, Pacheco-Moreira LF, Dias FS, Fernandes R, Giovanni FD, de Carvalho FB, Fiorelli A, Teixeira C, Feijó C, Camargo SM, de Oliveira NE, David AI, Prinz RAD, Herranz LB, de Andrade J. Guidelines for the assessment and acceptance of potential brain-dead organ donors. Rev Bras Ter Intensiva 2017; 28:220-255. [PMID: 27737418 PMCID: PMC5051181 DOI: 10.5935/0103-507x.20160049] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.
Collapse
Affiliation(s)
- Glauco Adrieno Westphal
- Corresponding author: Glauco Adrieno Westphal, Centro
Hospitalar Unimed, Rua Orestes Guimarães, 905, Zip code: 89204-060 -
Joinville (SC), Brazil. E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
|
3
|
Yang Z, Zhang S, Dong Z, Jin M, Han J. Prevalence of unprotected anal intercourse in men who have sex with men recruited online versus offline: a meta-analysis. BMC Public Health 2014; 14:508. [PMID: 24885058 PMCID: PMC4070357 DOI: 10.1186/1471-2458-14-508] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/21/2014] [Indexed: 11/13/2022] Open
Abstract
Background Men who have sex with men (MSM) are a high risk population for human immunodeficiency virus (HIV) infection. Our study aims to find whether MSM who were recruited online had a higher prevalence of self-reported unprotected anal intercourse (UAI) than those who were recruited offline. Methods A meta-analysis was conducted from the results of published studies. The analysis was stratified by the participants’ geographic location, the sample size and the date of the last reported UAI. Results Based on fourteen studies, MSM who were recruited online (online-based group) reported that 33.9% (5,961/17,580) of them had UAI versus 24.9% (2,700/10,853) of MSM who were recruited offline (offline-based group). The results showed that it is more likely for an online-based MSM group to have UAI with male partners than an offline-based MSM group [odds ratio (OR) = 1.35, 95% CI = 1.13-1.62, P < 0.01]. The subgroup analysis results also showed that the prevalence of UAI was higher in the European subsample (OR = 1.38, 95% CI = 1.17-1.63, P < 0.01) and in sample sizes of more than 500 individuals (OR = 1.32, 95% CI = 1.09-1.61, P < 0.01) in the online group compared to the offline group. The prevalence of UAI was also significantly higher when the time of the last UAI was during the last 3 or more months (OR = 1.40, 95% CI = 1.13-1.74, P < 0.05) in the online group compared to the offline group. A sensitivity analysis was used to test the reliability of the results, and it reported that the results remained unchanged and had the same estimates after deleting any one of the included studies. Conclusions A substantial percentage of MSM were recruited online, and they were more inclined to engage in UAI than MSM who were recruited offline. Targeted interventions of HIV prevention programs or services are recommended when designing preventive interventions to be delivered via the Internet.
Collapse
Affiliation(s)
| | | | | | - Meihua Jin
- Huzhou Center for Disease Control and Prevention, Huzhou 313000, Zhejiang Province, China.
| | | |
Collapse
|
4
|
Trends in HIV prevalence and HIV testing among young MSM: five United States cities, 1994-2011. AIDS Behav 2014; 18 Suppl 3:S237-47. [PMID: 23955658 DOI: 10.1007/s10461-013-0566-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We examined trends in cross-sectional HIV prevalence (a surrogate for incidence) and past 12 month testing behavior among young men who have sex with men (MSM). The Young Men's Survey and the National HIV Behavioral Surveillance System conducted interviews and HIV testing among MSM recruited by venue-based sampling during 1994-2011. Using data from five cities, we determined whether interview year was associated with HIV prevalence and recent testing for MSM ages 18-22 and 23-29 years, after adjusting for city, race/ethnicity, and education. Multivariable analysis demonstrated an overall increase in prevalence among MSM ages 23-29 years, driven by an increase in Baltimore. There was no change in HIV prevalence among MSM ages 18-22 years overall, although prevalence increased in Baltimore. HIV testing increased significantly for both age groups. Gains in HIV testing are encouraging, but increasing prevalence among young MSM in Baltimore suggests increasing incidence and the need for additional efforts for this population.
Collapse
|
5
|
Ramanathan S, Chakrapani V, Ramakrishnan L, Goswami P, Yadav D, Subramanian T, George B, Paranjape R. Consistent condom use with regular, paying, and casual male partners and associated factors among men who have sex with men in Tamil Nadu, India: findings from an assessment of a large-scale HIV prevention program. BMC Public Health 2013; 13:827. [PMID: 24020613 PMCID: PMC3854867 DOI: 10.1186/1471-2458-13-827] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 09/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are a marginalized population at high risk for HIV infection. Promoting consistent condom use (CCU) during anal sex is a key risk reduction strategy for HIV prevention among MSM. To inform effective HIV prevention interventions, we examined the factors associated with CCU among MSM with their regular, paying, and casual partners, as well as with all three types of partners combined. METHODS Data for this analysis were from a large-scale bio-behavioural survey conducted during 2009-2010 in Tamil Nadu, India. MSM aged 18 years or older were recruited for the survey using time-location cluster sampling at cruising sites in four districts of Tamil Nadu. Binary logistic regression analyses were conducted to assess the association of CCU with selected socio-demographic characteristics and other contextual factors. RESULTS Among 1618 MSM interviewed, CCU during anal sex with regular, paying, and a casual male partner was 45.3%, 50.8% and 57.9%, respectively. CCU with all three types of partners combined was 52.6%. Characteristics associated with increased odds for CCU with MSM having all three types of partners combined were frequent receptive anal sex acts with regular partners (adjusted odds ratio [AOR] 2.17, 95% confidence interval [CI] 1.01-4.65), fewer number of casual partners (AOR 3.41, 95% CI 1.50-7.73) and membership in a community-based organization (CBO) for MSM (AOR 3.54, 95% CI 1.62-7.74). CCU with regular partners was associated with membership in a CBO (AOR 1.96, 95% CI 1.23-3.11), whereas CCU with paying, and casual male partners was associated with perceived higher risk of acquiring HIV (AOR 1.92, 95% CI 1.22-3.01) and exposure to any HIV prevention intervention (AOR 3.62, 95% CI 1.31-10.0), respectively. Being aged 26 years or older, being in debt, and alcohol use were factors associated with inconsistent condom use across partner types. CONCLUSION HIV interventions among MSM need to promote CCU with all types (regular, paying, and causal) of male partners, and need to reach MSM across all age groups. In addition to enhancing interventions that focus on individual level risk reduction, it is important to undertake structural interventions that promote social acceptance of same-sex sexuality and address contextual barriers to condom use such as alcohol use.
Collapse
Affiliation(s)
- Shreena Ramanathan
- FHI 360 India, H-5 (Ground Floor), Green Park Extension, New Delhi 110016, India.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Parisi SG, Cruciani M, Scaggiante R, Boldrin C, Andreis S, Dal Bello F, Pagni S, Barelli A, Sattin A, Mengoli C, Palù G. Anal and oral human papillomavirus (HPV) infection in HIV-infected subjects in northern Italy: a longitudinal cohort study among men who have sex with men. BMC Infect Dis 2011; 11:150. [PMID: 21612634 PMCID: PMC3119070 DOI: 10.1186/1471-2334-11-150] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 05/25/2011] [Indexed: 01/05/2023] Open
Abstract
Background A study including 166 subjects was performed to investigate the frequency and persistence over a 6-month interval of concurrent oral and anal Human Papillomavirus (HPV) infections in Human Immunodeficiency Virus (HIV)-infected men who have sex with men (MSM). Methods Patients with no previously documented HPV-related anogenital lesion/disease were recruited to participate in a longitudinal study. Polymerase chain reaction (PCR) was performed to detect HPV from oral and anal swabs and to detect Human Herpes Virus 8 (HHV-8) DNA in saliva on 2 separate specimen series, one collected at baseline and the other collected 6 months later. A multivariate logistic analysis was performed using anal HPV infection as the dependent variable versus a set of covariates: age, HIV plasma viral load, CD4+ count, hepatitis B virus (HBV) serology, hepatitis C virus (HCV) serology, syphilis serology and HHV-8 viral shedding. A stepwise elimination of covariates with a p-value > 0.1 was performed. Results The overall prevalence of HPV did not vary significantly between the baseline and the follow-up, either in the oral (20.1 and 21.3%, respectively) or the anal specimens (88.6 and 86.3%). The prevalence of high-risk (HR) genotypes among the HPV-positive specimens was similar in the oral and anal infections (mean values 24.3% and 20.9%). Among 68 patients with either a HR, low-risk (LR) or undetermined genotype at baseline, 75% had persistent HPV and the persistence rates were 71.4% in HR infections and 76.7% in LR infections. There was a lack of genotype concordance between oral and anal HPV samples. The prevalence of HR HPV in anus appeared to be higher in the younger patients, peaking (> 25%) in the 43-50 years age group. A decrease of the high level of anal prevalence of all genotypes of HPV in the patients > 50 years was evident. HHV-8 oral shedding was positively related to HPV anal infection (p = 0.0046). A significant correlation was found between the persistence of HHV-8 shedding and HIV viral load by logistic bivariate analysis (Odds Ratio of HHV-8 persistence for 1-log increase of HIV viral load = 1.725 ± 0.397, p = 0.018). Conclusions A high prevalence of HPV infection was found in our cohort of HIV-infected MSM, with a negative correlation between anal HPV infection and CD4 cell count.
Collapse
Affiliation(s)
- Saverio G Parisi
- Department of Histology, Microbiology and Medical Biotechnology, Padua University, Via Gabelli 63, 35100 Padova, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
McFarland W, Chen YH, Raymond HF, Nguyen B, Colfax G, Mehrtens J, Robertson T, Stall R, Levine D, Truong HHM. HIV seroadaptation among individuals, within sexual dyads, and by sexual episodes, men who have sex with men, San Francisco, 2008. AIDS Care 2011; 23:261-8. [PMID: 21347888 DOI: 10.1080/09540121.2010.507748] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
"Seroadaptation" comprises sexual behaviors to reduce the risk of HIV acquisition and transmission based on knowing one's own and one's sexual partners' serostatus. We measured the prevalence of seroadaptive behaviors among men who have sex with men (MSM) recruited through time-location sampling (TLS) across three perspectives: by individuals (N = 1207 MSM), among sexual dyads (N = 3746 partnerships), and for sexual episodes (N = 63,789 episodes) in the preceding six months. Seroadaptation was more common than 100% condom use when considering the consistent behavioral pattern of individuals (adopted by 39.1% vs. 25.0% of men, respectively). Among sexual dyads 100% condom use was more common than seroadaptation (33.1% vs. 26.4%, respectively). Considering episodes of sex, not having anal intercourse (65.0%) and condom use (16.0%) were the most common risk reduction behaviors. Sex of highest acquisition and transmission risks (unprotected anal intercourse with a HIV serodiscordant or unknown status partner in the riskier position) occurred in only 1.6% of sexual episodes. In aggregate, MSM achieve a high level of sexual harm reduction through multiple strategies. Detailed measures of seroadaptive behaviors are needed to effectively target HIV risk and gauge the potential of serosorting and related sexual harm reduction strategies on the HIV epidemic.
Collapse
|
8
|
Feldman MB. A critical literature review to identify possible causes of higher rates of HIV infection among young black and Latino men who have sex with men. J Natl Med Assoc 2011; 102:1206-21. [PMID: 21287902 DOI: 10.1016/s0027-9684(15)30776-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Black and Latino young men who have sex with men (YMSM) are disproportionately impacted by HIV infection; however, the reason for this disparity is unclear. To identify possible causes of the higher rates of HIV infection in this population, data from studies of HIV infection and risk-related behaviors among black and Latino YMSM were used to evaluate a series of hypotheses adapted from Millett et al's literature review that might explain the disparity. High rates of HIV infection might be attributable to unrecognized HIV infection, social/sexual networks, and a history of childhood sexual abuse; however, they were not attributable to risk-related behaviors. More research is needed to understand the risk factors for HIV infection and how to address them in HIV prevention interventions.
Collapse
|
9
|
Coleman E, Horvath KJ, Miner M, Ross MW, Oakes M, Rosser BRS. Compulsive sexual behavior and risk for unsafe sex among internet using men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1045-53. [PMID: 19588239 PMCID: PMC3719393 DOI: 10.1007/s10508-009-9507-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 02/16/2009] [Accepted: 04/05/2009] [Indexed: 05/12/2023]
Abstract
The present study explored the relationship between compulsive sexual behavior (CSB) and unprotected anal intercourse (UAI) for men who have sex with men (MSM) across a number of ethnic/racial groups and who used the Internet to seek sexual partners. A sample of 2,716 MSM (512 Asian, 445 Black, 683 Latino, 348 Other, 728 White) completed on online survey that collected information about their sexual behaviors with partners met online and offline. The survey also included the Compulsive Sexual Behavior Inventory (CSBI). Consistent with the notion that CSB is a stable trait, higher scores on the CSBI were associated with greater odds for engaging in UAI, regardless of the context in which sex partners were met (online or offline). Differences in median CSB scores were generally similar across racial and ethnic groups. The median CSB score was significantly higher for HIV-positive participants than for HIV-negative participants. HIV-prevention interventions are needed among MSM, but should take into account that some may be resistant to risk reduction strategies because of CSB.
Collapse
Affiliation(s)
- Eli Coleman
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 S. 2nd Street, Suite 180, Minneapolis, MN, 55454 USA.
| | | | | | | | | | | |
Collapse
|
10
|
Prevalence of HIV infection and prior HIV testing among young men who have sex with men. The Baltimore young men's survey. AIDS Behav 2010; 14:904-12. [PMID: 17968648 DOI: 10.1007/s10461-007-9317-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022]
Abstract
Data are presented from the Baltimore Young Men's Survey, a cross-sectional, venue-based sample survey of risks associated with HIV and report of a prior HIV test, conducted between 1996 and 2000, and enrolling 843 young men who have sex with men (MSM) aged 15-29 years. HIV prevalence was 12.1% overall and racial disparities in HIV prevalence were pronounced (range, 2.9% among non-Hispanic whites to 27.1% among non-Hispanic blacks). Risks independently associated with being HIV-positive were: being between 26 and 29 years of age, being non-Hispanic black or of other/mixed race, having had 20 or more lifetime male sex partners, having been diagnosed with a sexually transmitted disease (STD), and not being currently enrolled in school. The majority of participants (78.9%) reported a prior HIV test. In multivariate analysis, being older, having had five or more lifetime male sex partners, having had anal intercourse with males, reporting an STD diagnosis, and reporting recent unprotected anal sex were associated with report of a prior HIV test. Prevention efforts must address high HIV prevalence among young non-Hispanic black MSM and must make testing and effective counseling for young MSM readily available.
Collapse
|
11
|
Salomon EA, Mimiaga MJ, Husnik MJ, Welles SL, Manseau MW, Montenegro AB, Safren SA, Koblin BA, Chesney MA, Mayer KH. Depressive symptoms, utilization of mental health care, substance use and sexual risk among young men who have sex with men in EXPLORE: implications for age-specific interventions. AIDS Behav 2009; 13:811-21. [PMID: 18709453 PMCID: PMC2718068 DOI: 10.1007/s10461-008-9439-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 07/16/2008] [Indexed: 11/26/2022]
Abstract
The EXPLORE study evaluated a behavioral intervention to prevent HIV infection among MSM. We examined depressive symptoms, utilization of mental health care, substance use and HIV risk taking behaviors in YMSM aged 16-25 years compared with their older counterparts. YMSM were more likely to report depressive symptoms (OR = 1.55) and less likely to report use of counseling (OR = 0.39) or medication (OR = 0.20) for psychiatric conditions. YMSM were more likely to report heavy alcohol and drug use. YMSM more often reported engaging in unprotected insertive (OR = 1.60) and receptive (OR = 2.07) anal intercourse with presumed HIV-uninfected partners, and unprotected receptive (OR = 1.72) anal intercourse with partners of unknown-HIV status. These findings suggest the need for more appropriate and accessible mental health care and substance use services for YMSM. Additionally, HIV prevention work with this population should provide comprehensive education about HIV testing and risk reduction counseling that focuses on communication about serostatus and safety in sexual situations.
Collapse
|
12
|
Anderson SA, Yang H, Gallagher LM, O'Callaghan S, Forshee RA, Busch MP, McKenna MT, Williams I, Williams A, Kuehnert MJ, Stramer S, Kleinman S, Epstein J, Dayton AI. Quantitative estimate of the risks and benefits of possible alternative blood donor deferral strategies for men who have had sex with men. Transfusion 2009; 49:1102-14. [DOI: 10.1111/j.1537-2995.2009.02124.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
13
|
Trends in evaluation for sexually transmitted infections among HIV-infected people, King County, Washington. Sex Transm Dis 2008; 34:940-6. [PMID: 18077843 DOI: 10.1097/olq.0b013e31813e0a48] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess clinician sexual risk assessment and sexually transmitted infection (STI) screening rates in a large cohort of human immunodeficiency virus (HIV)-infected patients in King County, Washington. METHODS We abstracted data from medical records of HIV-infected patients seen in diverse clinical settings during 2000-2003 and used [chi]2 and logistic regression to identify factors associated with higher rates of sexual risk assessment and STI testing. We defined patients as having had a sexual risk or STI assessment if the medical record included any information about the patient's recent sexual behavior or included laboratory test results for gonorrhea, chlamydial infection, syphilis, or trichomoniasis. RESULTS The proportion of patients with any recorded risk assessment or STI testing increased from 16% in 2000 to 46% in 2001, and thereafter remained stable. On multivariate analysis, having a sexual risk or STI evaluation was significantly associated with later time period of evaluation, receiving care in a HIV specialty clinic, higher number of outpatient visits, being men who have sex with men, Seattle residence (vs. residence outside Seattle), female gender, higher CD4 count, white race, and having never received antiretroviral therapy. CONCLUSION Although sexual risk and STI evaluation rates increased from 2000 to 2001, they now appear to be stable and many patients, particularly those seen outside of HIV specialty clinics, are not routinely evaluated for ongoing risks or STI. Clinicians and public health authorities need to develop better mechanisms to assure recommended risk assessments and STI testing among persons with HIV.
Collapse
|
14
|
Kipke MD, Weiss G, Wong CF. Residential status as a risk factor for drug use and HIV risk among young men who have sex with men. AIDS Behav 2007; 11:56-69. [PMID: 17265143 PMCID: PMC2930767 DOI: 10.1007/s10461-006-9204-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 12/05/2006] [Indexed: 11/27/2022]
Abstract
There is growing behavioral and epidemiological evidence to suggest that young men who have sex with men (YMSM) are at high risk for becoming HIV-infected. Unfortunately, relatively little research has been conducted to examine the range of individual, social, and community-level factors that put these young men at increased risk. To address existing gaps in the literature, the Healthy Young Men's (HYM) Study was launched in Los Angeles to examine the range of factors associated with HIV risk and protective behaviors within an ethnically diverse sample of 526 YMSM recruited using a venue-based stratified probability sampling design. In this paper we present findings that demonstrate that YMSM who experience residential instability, who have been forced to leave their home because of their sexuality, and/or who are precariously housed are at significantly greater risk for drug use and involvement in HIV risk-related behaviors.
Collapse
Affiliation(s)
- Michele D Kipke
- Community, Health Outcomes, and Intervention Research Program, The Saban Research Institute, Childrens Hospital Los Angeles, Los Angeles, CA 90027, USA.
| | | | | |
Collapse
|
15
|
Horvath KJ, Beadnell B, Bowen AM. A daily web diary of the sexual experiences of men who have sex with men: comparisons with a retrospective recall survey. AIDS Behav 2007; 11:537-48. [PMID: 17318430 DOI: 10.1007/s10461-007-9206-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 01/08/2007] [Indexed: 11/27/2022]
Abstract
The emergence of Internet technology provides a unique opportunity to collect real-time information on the sexual behaviors of persons at risk for HIV. However, relatively little is known of the utility and reliability of web diaries. To address this gap, 45 predominantly Caucasian and gay, Internet-using men who have sex with men completed a 4-week daily web diary of their sexual behaviors. Afterward, participants completed an online retrospective recall survey (RRS) of their sexual activities during the diary period and satisfaction ratings of the web diary method. Overall, web diary estimates of sexual behaviors differed from the RRS, with a tendency to over-report on the latter with the exception of insertive unprotected anal intercourse. Additionally, compliance rates were high and there was some evidence for reactivity. Participants evaluated the web diary method positively. Web diaries appear to be a promising tool for collecting information on health behaviors.
Collapse
Affiliation(s)
- Keith J Horvath
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | | | | |
Collapse
|
16
|
|
17
|
Xia Q, Osmond DH, Tholandi M, Pollack LM, Zhou W, Ruiz JD, Catania JA. HIV prevalence and sexual risk behaviors among men who have sex with men: results from a statewide population-based survey in California. J Acquir Immune Defic Syndr 2006; 41:238-45. [PMID: 16394858 DOI: 10.1097/01.qai.0000185574.98472.36] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate HIV prevalence, sexual risk behaviors, and HIV testing among men who have sex with men (MSM) between 18 and 64 years old living in California. DESIGN Cross-sectional study of a statewide population-based sample of MSM. METHODS Using data from the 2001 California Health Interview Survey (CHIS 2001), 398 men who self-identified as gay or bisexual were recontacted and interviewed by telephone for a follow-up study in 2002. Study participants were interviewed regarding their demographic characteristics and sexual behavior, HIV testing history, and HIV infection status. Those who self-reported as HIV-negative or of unknown status were offered an HIV test using a home urine specimen collection kit. RESULTS HIV prevalence among MSM in California was 19.1% (95% confidence interval [CI]: 12.8% to 25.3%) with higher rates seen among the following subgroups: high school or less education (40.4%), annual income less than dollar 20,000 (35.0%), or history of ever injecting recreational drugs (40.3%). Young age and Hispanic or African-American race/ethnicity were associated with higher proportions of risky sexual behavior and lower HIV testing rates. CONCLUSIONS HIV prevalence among MSM living in California continues to be high across the whole state, and population-based studies are needed periodically to complement findings from surveys using other sampling designs.
Collapse
Affiliation(s)
- Qiang Xia
- Office of AIDS, California Department of Health Services, Sacramento, CA, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Harawa NT, Greenland S, Bingham TA, Johnson DF, Cochran SD, Cunningham WE, Celentano DD, Koblin BA, LaLota M, MacKellar DA, McFarland W, Shehan D, Stoyanoff S, Thiede H, Torian L, Valleroy LA. Associations of race/ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. J Acquir Immune Defic Syndr 2005; 35:526-36. [PMID: 15021318 DOI: 10.1097/00126334-200404150-00011] [Citation(s) in RCA: 216] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Using data from a multisite venue-based survey of male subjects aged 15 to 22 years, we examined racial/ethnic differences in demographics, partner type, partner type-specific condom use, drug use, and HIV prevalence in 3316 US black, multiethnic black, Latino, and white men who have sex with men (MSM). We further estimated associations of these factors with HIV infection and their influence on racial/ethnic disparities in HIV prevalence. HIV prevalences were 16% for both black and multiethnic black participants, 6.9% for Latinos, and 3.3% for whites. Paradoxically, potentially risky sex and drug-using behaviors were generally reported most frequently by whites and least frequently by blacks. In a multiple logistic regression analysis, positive associations with HIV included older age, being out of school or work, sex while on crack cocaine, and anal sex with another male regardless of reported condom use level. Differences in these factors did not explain the racial/ethnic disparities in HIV prevalence, with both groups of blacks experiencing more than 9 times and Latinos experiencing approximately twice the fully adjusted odds of infection compared with whites. Understanding racial/ethnic disparities in HIV risk requires information beyond the traditional risk behavior and partnership type distinctions. Prevention programs should address risks in steady partnerships, target young men before sexual initiation with male partners, and tailor interventions to men of color and of lower socioeconomic status.
Collapse
Affiliation(s)
- Nina T Harawa
- County of Los Angeles, Department of Health Services, Los Angeles, CA 90005, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Kellerman S, Begley E, Boyett B, Clark H, Schulden J. Changes in HIV and AIDS in the United States: Entering the third decade. Curr Infect Dis Rep 2005; 7:138-143. [PMID: 15727742 DOI: 10.1007/s11908-005-0074-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The epidemiology of the HIV transmission in the United States has changed considerably since the epidemic began. Our increased understanding of the virus has fostered development of new treatments to prolong life, and vaccine research has increased hope for those at risk in both developed and less developed countries. In this review, we provide information about current trends in HIV and AIDS among those in the United States most affected by the epidemic.
Collapse
Affiliation(s)
- Scott Kellerman
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mail Stop E-46, Atlanta, GA 30333, USA.
| | | | | | | | | |
Collapse
|
20
|
|
21
|
Kellerman S, Begley E, Boyett B, Clark H, Schulden J. Changes in HIV and AID in the United States: Entering the third decade. Curr HIV/AIDS Rep 2004; 1:153-8. [PMID: 16091236 DOI: 10.1007/s11904-004-0024-9] [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: 10/22/2022]
Abstract
The epidemiology of the HIV transmission in the United States has changed considerably since the epidemic began. Our increased understanding of the virus has fostered development of new treatments to prolong life, and vaccine research has increased hope for those at risk in both developed and less developed countries. In this review, we provide information about current trends in HIV and AIDS among those in the United States most affected by the epidemic.
Collapse
Affiliation(s)
- Scott Kellerman
- Behavioral/Clinical Surveillance Branch, Div. of HIV/AIDS Prevention Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mail Stop E-46, Atlanta, GA 30333, USA.
| | | | | | | | | |
Collapse
|
22
|
Decline in HIV infectivity following the introduction of highly active antiretroviral therapy. AIDS (LONDON, ENGLAND) 2004. [PMID: 15090833 DOI: 10.1097/01.aids.0000096872.36052.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Little is known about the degree to which widespread use of antiretroviral therapy in a community reduces uninfected individuals' risk of acquiring HIV. We estimated the degree to which the probability of HIV infection from an infected partner (the infectivity) declined following the introduction of highly active antiretroviral therapy (HAART) in San Francisco. DESIGN Homosexual men from the San Francisco Young Men's Health Study, who were initially uninfected with HIV, were asked about sexual practices, and tested for HIV antibodies at each of four follow-up visits during a 6-year period spanning the advent of widespread use of HAART (1994-1999). METHODS We estimated the infectivity of HIV (per-partnership probability of transmission from an infected partner) using a probabilistic risk model based on observed incident infections and self-reported sexual risk behavior, and tested the hypothesis that infectivity was the same before and after HAART was introduced. RESULTS A total of 534 homosexual men were evaluated. Decreasing trends in HIV seroincidence were observed despite increases in reported number of unprotected receptive anal intercourse partners. Conservatively assuming a constant prevalence of HIV infection between 1994 and 1999, HIV infectivity decreased from 0.120 prior to widespread use of HAART, to 0.048 after the widespread use of HAART- a decline of 60% (P=0.028). CONCLUSIONS Use of HAART by infected persons in a community appears to reduce their infectiousness and therefore may provide an important HIV prevention tool.
Collapse
|
23
|
McFarland W, Chen S, Weide D, Kohn R, Klausner J. Gay Asian men in San Francisco follow the international trend: increases in rates of unprotected anal intercourse and sexually transmitted diseases, 1999-2002. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2004; 16:13-18. [PMID: 15058707 DOI: 10.1521/aeap.16.1.13.27723] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Worldwide, studies of men who have sex with men (MSM) report increases in HIV risk-related behavior. Less is known about trends within minority subpopulations of MSM, particularly those of Asian and Pacific Islander (A&PI) ethnicity. A&PI MSM are underrepresented among AIDS cases (2.7%) with respect to their estimated makeup in the gay community of San Francisco (4.5%). However, recent trends in unprotected anal intercourse (UAI) and sexually transmitted diseases suggest a reversal in the relative risk for HIV among A&PI MSM compared with White MSM. Starting from lower levels in 1999, UAI with multiple partners, UAI with multiple partners of unknown HIV serostatus, the incidence of male rectal gonorrhea, and the incidence of early syphilis among A&PI MSM surpassed levels among White MSM by 2002. A window of opportunity to prevent further spread of HIV among A&PI MSM may be closing.
Collapse
Affiliation(s)
- Willi McFarland
- San Francisco Department of Public Health, San Francisco, CA 94102-6033, USA.
| | | | | | | | | |
Collapse
|
24
|
Porco TC, Martin JN, Page-Shafer KA, Cheng A, Charlebois E, Grant RM, Osmond DH. Decline in HIV infectivity following the introduction of highly active antiretroviral therapy. AIDS 2004; 18:81-8. [PMID: 15090833 PMCID: PMC2442908 DOI: 10.1097/00002030-200401020-00010] [Citation(s) in RCA: 221] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Little is known about the degree to which widespread use of antiretroviral therapy in a community reduces uninfected individuals' risk of acquiring HIV. We estimated the degree to which the probability of HIV infection from an infected partner (the infectivity) declined following the introduction of highly active antiretroviral therapy (HAART) in San Francisco. DESIGN Homosexual men from the San Francisco Young Men's Health Study, who were initially uninfected with HIV, were asked about sexual practices, and tested for HIV antibodies at each of four follow-up visits during a 6-year period spanning the advent of widespread use of HAART (1994-1999). METHODS We estimated the infectivity of HIV (per-partnership probability of transmission from an infected partner) using a probabilistic risk model based on observed incident infections and self-reported sexual risk behavior, and tested the hypothesis that infectivity was the same before and after HAART was introduced. RESULTS A total of 534 homosexual men were evaluated. Decreasing trends in HIV seroincidence were observed despite increases in reported number of unprotected receptive anal intercourse partners. Conservatively assuming a constant prevalence of HIV infection between 1994 and 1999, HIV infectivity decreased from 0.120 prior to widespread use of HAART, to 0.048 after the widespread use of HAART- a decline of 60% (P=0.028). CONCLUSIONS Use of HAART by infected persons in a community appears to reduce their infectiousness and therefore may provide an important HIV prevention tool.
Collapse
Affiliation(s)
- Travis C. Porco
- San Francisco Department of Public Health, Community Health and Epidemiology Section, San Francisco
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Positive Health Program, University of California, San Francisco
| | | | - Amber Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Edwin Charlebois
- University of California, San Francisco, Department of Medicine
- EPI-Center, University of California, San Francisco, San Francisco General Hospital, San Francisco
| | - Robert M. Grant
- University of California, San Francisco, Department of Medicine
- Gladstone Institute of Virology and Immunology, and University of California, San Francisco, San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Dennis H. Osmond
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| |
Collapse
|
25
|
Sutmöller F, Penna TL, de Souza CTV, Lambert J. Human immunodeficiency virus incidence and risk behavior in the 'Projeto Rio': results of the first 5 years of the Rio de Janeiro open cohort of homosexual and bisexual men, 1994-98. Int J Infect Dis 2002; 6:259-65. [PMID: 12718818 DOI: 10.1016/s1201-9712(02)90158-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES In preparation for a phase III HIV vaccine trial, we report the results of men who have sex with men (MSM) cohort ('Projecto Rio'). METHODS HIV-negative MSM were followed 6-monthly over a 3-year period. RESULTS High seroprevalence for sexually transmitted disease (HIV, syphilis and hepatitis B seropositivities of 24%, 29%, and 37%, respectively) was seen in the 1165 potential volunteers, and this seroprevalence showed significant differences according to HIV serologic status. Among the 647 HIV-negative cohort participants, HIV incidence rate (IR) was 3.33 (95% CI 1.93-4.67) per 100 men-years, with 21 newly acquired HIV infections during 7572 men-months of observation. IR differences were observed in four categories: (1) non-commercial sex workers and non-transvestites who had protected sex prior to study entry (IR 1.6 per 100 men-years); (2) non-commercial sex workers and non-transvestites who had unprotected sex prior to study entry (IR 2.7 per 100 men-years); (3) commercial sex workers (IR 3.5 per 100 men-years); and (4) transvestite groups (IR 16.8 per 100 men-years). Unprotected penetrative anal sex was frequent (66%) in the 6 months before study entry, and when we take into consideration the fact that bisexual men engaged in unprotected vaginal intercourse with their female partners, the risk behavior in this group escalates to 73%. HIV seroconverters had high risk behavior prior to study entry (76%), and all but one admitted to having unprotected penetrative sex prior to infection. CONCLUSIONS MSM in this study had a high rate of unprotected penetrative sexual practices, which caused a significant HIV incidence rate, and, with improved study adherence, this study site could be used for future vaccine trials.
Collapse
Affiliation(s)
- Frits Sutmöller
- Center of Clinical Research, Evandro Chagas Hospital, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | | | | | | |
Collapse
|
26
|
Shafer KP, Hahn JA, Lum PJ, Ochoa K, Graves A, Moss A. Prevalence and correlates of HIV infection among young injection drug users in San Francisco. J Acquir Immune Defic Syndr 2002; 31:422-31. [PMID: 12447014 DOI: 10.1097/00126334-200212010-00009] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We assessed the prevalence of HIV infection and associated risk behaviors among street-recruited young injection drug users (IDUs) in San Francisco. METHODS In a cross-sectional study, 304 young (age <30 years) IDUs with a history of injecting in the previous 30 days were interviewed and tested for antibodies to HIV. Analyses assessing independent associations with HIV infection were limited to males only, due to the low number of infections in women. RESULTS The prevalence of HIV infection was 5.3% overall but was highly stratified by gender and sexual preference (15.6% among homosexual/bisexual men vs. heterosexual men) and recruitment neighborhood (18% in the Polk Street area). Of 16 HIV infections, 14 (88%) were in males. Factors independently associated with HIV infection in males included sexual preference (homosexual/bisexual vs. heterosexual: adjusted odds ratio [AOR], 7.5; 95% confidence interval [CI], 1.5-36.6), recruitment neighborhood (Polk Street neighborhood vs. other neighborhoods: AOR, 4.8; 95% CI, 1.4-16.7), and duration of residence in San Francisco (>or=1 year vs. <1 year: AOR, 11.8; 95% CI, 1.4-95.8). CONCLUSIONS The prevalence of HIV infection was highest among male IDUs who have sex with men. The strong associations between HIV infection and sexual orientation and HIV infection and recruitment locale suggest that risk may be attributable largely to sexual risk. In addition to successful prevention efforts aimed at reducing needle-associated risk, current intervention models aimed at young IDUs should target high-risk neighborhoods and emphasize sexual risk reduction measures, in particular among men who have sex with men.
Collapse
Affiliation(s)
- Kimberly Page Shafer
- Center for AIDS Prevention Studies, Department of Medicine, University of California at San Francisco, 94105, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Katz MH, Schwarcz SK, Kellogg TA, Klausner JD, Dilley JW, Gibson S, McFarland W. Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco. Am J Public Health 2002; 92:388-94. [PMID: 11867317 PMCID: PMC1447086 DOI: 10.2105/ajph.92.3.388] [Citation(s) in RCA: 298] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2001] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed the countervailing effects on HIV incidence of highly active antiretroviral treatment (HAART) among San Francisco men who have sex with men (MSM). METHODS Behavioral risk was determined on the basis of responses to cross-sectional community interviews. HIV incidence was assessed through application of an enzyme-linked immunoassay testing strategy. RESULTS Use of HAART among MSM living with AIDS increased from 4% in 1995 to 54% in 1999. The percentage of MSM who reported both unprotected anal intercourse and multiple sexual partners increased from 24% in 1994 to 45% in 1999. The annual HIV incidence rate increased from 2.1% in 1996 to 4.2% in 1999 among MSM who sought anonymous HIV testing, and the rate was high (5.3%) but stable in a blinded survey of MSM seeking sexually transmitted disease services. CONCLUSIONS Any decrease in per contact risk of HIV transmission due to HAART use appears to have been counterbalanced or overwhelmed by increases in the number of unsafe sexual episodes.
Collapse
Affiliation(s)
- Mitchell H Katz
- San Francisco Department of Public Health, 101 Grove Street, Room 308, San Francisco, CA 94102, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Goodenow C, Netherland J, Szalacha L. AIDS-related risk among adolescent males who have sex with males, females, or both: evidence from a statewide survey. Am J Public Health 2002; 92:203-10. [PMID: 11818292 PMCID: PMC1447043 DOI: 10.2105/ajph.92.2.203] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2001] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined the prevalence of AIDS-related risk behaviors among adolescent males with female, male, and both-sex sexual partners and explored factors related to these behaviors. METHODS Three waves of a population-based survey provided data on male high school students: 3065 with only female sexual partners, 94 with only male partners, and 108 with both. Logistic regression analyses were used to examine AIDS-related outcomes. RESULTS Youths with any same-sex experience reported less school AIDS education. Bisexual experience predicted multiple sexual partners, unprotected intercourse, sexually transmitted disease, and injection drug use. School AIDS education and condom instruction predicted less AIDS-related risk. CONCLUSIONS Bisexually active adolescent males report especially high levels of AIDS risk behavior. School-based AIDS prevention should address the needs of all sexually active youths.
Collapse
Affiliation(s)
- Carol Goodenow
- Massachusetts Department of Education, Malden, 02148, USA.
| | | | | |
Collapse
|
29
|
Colfax GN, Mansergh G, Guzman R, Vittinghoff E, Marks G, Rader M, Buchbinder S. Drug use and sexual risk behavior among gay and bisexual men who attend circuit parties: a venue-based comparison. J Acquir Immune Defic Syndr 2001; 28:373-9. [PMID: 11707675 DOI: 10.1097/00126334-200112010-00011] [Citation(s) in RCA: 194] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT HIV risk behavior among urban gay/bisexual men has recently increased. High-risk sexual activity and drug use may be particularly high during circuit party (CP) weekends, during which gay/bisexual men congregate for social activities and dancing. OBJECTIVES To compare prevalence of risk behaviors during CP weekends with those during non-CP weekends. DESIGN Cross-sectional study. PARTICIPANTS 295 gay/bisexual men from the San Francisco Bay Area. MAIN OUTCOME MEASURES Drug use and sexual risk behavior during a San Francisco CP weekend, a CP weekend held in another geographic area (distant weekends), and two non-CP weekends. RESULTS During their most recent distant CP weekend, 80% of participants used methylenedioxymethamphetamine (ecstasy), 66% ketamine, 43% crystal methamphetamines, 29% gamma-hydroxybutyrate or gamma-butyrolactone (GHB/GBL), 14% sildenafil (Viagra), and 12% amyl nitrites (poppers); 53% used four or more drugs. Drug use prevalence was greater during CP than non-CP weekends ( p <.001). Unprotected anal sex with partners of unknown or opposite HIV serostatus was most prevalent during distant CP weekends, reported by 21% of HIV-positive and 9% of HIV-negative participants. In multivariate analysis, predictors of unprotected anal sex with opposite or unknown HIV serostatus partners included being HIV-positive (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4-7.5), and weekend use of crystal methamphetamines (OR 2.4; 95% CI, 1.1-4.9), sildenafil (OR, 3.8; 95% CI, 2.0-7.3), and amyl nitrites (OR, 2.2; 95% CI, 1.3-4.0). CONCLUSIONS Prevalence of high-risk activity during these weekends suggests significant potential for HIV transmission in this population. Public health programs in communities hosting CPs should aim to reduce rates of drug use and sexual risk behavior among CP participants, especially HIV-positive men.
Collapse
Affiliation(s)
- G N Colfax
- HIV Research Branch, San Francisco Department of Public Health, San Francisco, California 94102-6033, USA.
| | | | | | | | | | | | | |
Collapse
|
30
|
Longitudinal Patterns of Sexual Behavior and Condom Use in a Cohort of HIV-Negative Gay and Bisexual Men in Vancouver, British Columbia, Canada, 1995–2000. J Acquir Immune Defic Syndr 2001. [DOI: 10.1097/00126334-200110010-00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Blake SM, Ledsky R, Lehman T, Goodenow C, Sawyer R, Hack T. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools. Am J Public Health 2001; 91:940-6. [PMID: 11392938 PMCID: PMC1446472 DOI: 10.2105/ajph.91.6.940] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study compared sexual risk behaviors of gay, lesbian, and bisexual (GLB) and heterosexual adolescents and evaluated associations between gay-sensitive HIV instruction and risk behaviors of GLB youths. METHODS A random sample of high school students and HIV education teachers completed surveys. Self-reported risk behaviors of heterosexual and GLB adolescents were compared, with control for student and community demographic characteristics. Sexual risk behaviors of GLB youths in schools with and without gay-sensitive instruction were compared. RESULTS GLB youths reported more substance use, high-risk sexual behaviors, suicidal thoughts or attempts, and personal safety issues than did heterosexual youths (P < .001). Among those who were sexually active, GLB youths reported more lifetime and recent sexual partners than did heterosexuals (P < .001), and more of them reported alcohol use before last sex (P < .01) and a history of pregnancy (P < .001). GLB youths in schools with gay-sensitive instruction reported fewer sexual partners, less recent sex, and less substance use before last sex than did GLB youths in other schools (P < .05). CONCLUSIONS The findings document increased risk behaviors among GLB youths and demonstrate the potential benefits of providing gay-sensitive HIV instruction in schools.
Collapse
Affiliation(s)
- S M Blake
- George Washington University School of Public Health and Health Services, 2175 K St, NW, Suite 700, Washington, DC 20037, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
OBJECTIVES To review current approaches to HIV surveillance among men who have sex with men (MSM), identify illustrative best practices and lessons learned, and outline ways to enhance surveillance systems. METHODS Review of the literature and institutional guidelines for HIV/AIDS, sexually transmitted infection (STI), and behavioral surveillance and summary of results of an international workshop. RESULTS On-going formative research, HIV/AIDS and STI case reporting, HIV prevalence and incidence studies, and behavioral surveys are essential components of an effective HIV surveillance system for MSM. Alliances with key organizations and actors in MSM communities provide points of access, assist in the development of measures, and guide appropriate use of data. Sampling techniques (convenience, snowball, quota, microsite, time-location, and population-based) offering a range of methods, complexity, and cost have been successfully implemented in MSM communities. Plausible estimates of the size of MSM populations, which are ultimately crucial to the interpretation of surveillance data, can be improved upon using primary and secondary data. CONCLUSIONS The purpose of HIV surveillance among MSM is not only to monitor disease occurrence and its antecedents, but to regularly use data to plan and evaluate prevention and care programs, advocate for prevention resources, and improve the health, social welfare and human rights of MSM. Practical, incremental steps can be taken to improve HIV surveillance among MSM in all regions of the world in all stages of the epidemic.
Collapse
Affiliation(s)
- W McFarland
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA.
| | | |
Collapse
|
33
|
Abstract
Now in its third decade, the epidemiology of human immunodeficiency virus (HIV) transmission in the United States has changed considerably since the epidemic began. Our increased understanding of the virus has fueled development of new treatments to prolong life, and research into a viable vaccine offers hope to those at risk in developed and less developed countries alike. In this review, we provide information about the current trends in HIV and Acquired Immune Deficiency Syndrome (AIDS) among those in the United States who are hardest hit by the epidemic. We also offer insights into and explanations of these changes; update the epidemiology of HIV subtypes and antiretroviral resistance; and describe current strategies for HIV surveillance.
Collapse
|
34
|
Koblin BA, Torian LV, Guilin V, Ren L, MacKellar DA, Valleroy LA. High prevalence of HIV infection among young men who have sex with men in New York City. AIDS 2000; 14:1793-800. [PMID: 10985317 DOI: 10.1097/00002030-200008180-00015] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence of HIV infection and risk behaviors among young men who have sex with men (MSM) aged 15-22 years in New York City. DESIGN An anonymous cross-sectional survey. METHODS The 1998 Young Men's Survey in New York City (YMS-NYC), was a multistage probability survey of 541 MSM aged 15-22 years who attend public venues. After identification of venues and their associated high attendance time periods, random samples of venues and time periods were selected on a monthly basis. At each sampling event, potential participants were approached to determine eligibility. Eligible and willing men were interviewed, counselled and had a blood specimen drawn. RESULTS Between December 1997 and September 1998, 115 sampling events were conducted. Of 612 men enrolled, 541 reported ever having had sex with a male partner. The HIV seroprevalence among the 541 MSM sampled was 12.1%. The HIV seroprevalence was 18.4% among African-Americans, 16.7% among persons of mixed race, 8.8% among Latino individuals and 3.1% among white men. HIV seroprevalence was 5.0% among 15-18 year olds and 16.4% among 19-22 year olds. A total of 65.5% of MSM were susceptible to hepatitis B virus infection (HBV). Almost half (46.1%) of the men reported unprotected anal sex in the previous 6 months and 16.3% reported ever having had an STD. Multiple regression analyses found that being older, of mixed race, black or ever having had an STD was associated with being HIV antibody positive. CONCLUSION These data identify a large subgroup of MSM in need of effective HIV and HBV primary and secondary prevention programs.
Collapse
Affiliation(s)
- B A Koblin
- Wolf Szumness Laboratory of Epidemiology, The New York Blood Center, NY 10021, USA.
| | | | | | | | | | | |
Collapse
|
35
|
Waldo CR, McFarland W, Katz MH, MacKellar D, Valleroy LA. Very young gay and bisexual men are at risk for HIV infection: the San Francisco Bay Area Young Men's Survey II. J Acquir Immune Defic Syndr 2000; 24:168-74. [PMID: 10935693 DOI: 10.1097/00126334-200006010-00012] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare HIV seroprevalence and sexual risk behavior among very young gay and bisexual men (aged 15-17 years) and their older counterparts (aged 18-22 years). To examine drug-use patterns and correlates of sexual risk behavior in both of these age groups. DESIGN AND METHODS An interviewer-administered cross-sectional survey of 719 gay and bisexual males between 15 and 22 years old was conducted through a venue-based sampling design. Blood specimens were collected and tested for HIV antibodies, hepatitis B, and syphilis. Interviews assessed sexual and drug-use behavior as well as psychosocial variables believed to be related to sexual risk-taking, including self-acceptance of gay or bisexual identity, perceptions of peer norms concerning safer sex, and perceptions of the ability to practice safer sex (safer sex self-efficacy). RESULTS Of the 719 participants, 100 (16.2%) were aged between 15 and 17 years. HIV seroprevalence was somewhat lower among those aged 15 to 17 years (2.0%) compared with those aged 18 to 22 years (6.8%). Overall, the prevalence of hepatitis-B core antibody was significantly lower in the younger age group (5.0%) than in the older group (14.1%). The men aged 15 to 17 years used alcohol, ecstasy, and heroin less frequently than those aged 18 to 22 years. The age groups did not differ in the proportion of men who reported any unprotected anal intercourse in the previous 6 months (31.2%). In both age groups, use of amphetamines, ecstasy, and amyl nitrate was associated with unprotected anal intercourse. Self-acceptance of gay or bisexual identity was related to less sexual risk for those aged 15 to 17 years. In both age groups, greater safer sex self-efficacy was linked to less HIV sexual risk-taking. In the younger group, perceptions of peer norms that support safer sex were related to less risk behavior. CONCLUSIONS Very young gay and bisexual men engage in unprotected anal sex at rates comparable with those for their somewhat older counterparts, raising serious concern over their risk of acquiring HIV infection. To prevent seroconversions, interventions must target those <18 years of age, and prevention programs should address the use of certain drugs in relation to sex and sexual risk-taking. To be most effective, programs should develop innovative communication strategies to take into account lack of self-acceptance of gay or bisexual identity and low self-efficacy for practicing safer sex.
Collapse
Affiliation(s)
- C R Waldo
- Center for AIDS Prevention Studies, AIDS Research Institute, and Department of Medicine, University of California, San Francisco 94105, USA.
| | | | | | | | | |
Collapse
|
36
|
Abstract
HIV prevention efforts for gay and bisexual men in the United States began as community-mobilizing efforts, but have drifted towards focusing more on the individual. Given lowering prevalence and incidence, it is unreasonable to expect continued community support for high levels of prevention activity. Structural and environmental interventions present one useful, complementary set of alternatives to support prevention efforts. This paper reviews the gay community's relationship with these interventions, including its intensely debated approaches to reducing HIV transmission within bathhouses. The implications for HIV prevention for gay men of larger societal factors, including economic development and economic motivation, migration, and legislation, are then considered. Individual rights, community and public-health interests must be given particularly cautious consideration when designing and implementing structural and environmental interventions.
Collapse
Affiliation(s)
- D Wohlfeiler
- UC Berkeley School of Public Health, California 94704, USA
| |
Collapse
|
37
|
Very Young Gay and Bisexual Men Are at Risk for HIV Infection: The San Francisco Bay Area Young Men's Survey II. J Acquir Immune Defic Syndr 2000. [DOI: 10.1097/00042560-200006010-00012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Abstract
HIV infection in adolescents continues to challenge health care providers, policy makers, and advocates for youth. Primary care providers working with parents of adolescents and at-risk youth are in a unique position to identify or help develop HIV prevention and care programs that address many needs. Effective interventions are those that move beyond moralism to realism and a willingness to engage youth and their families. Youth at high risk for HIV should be identified and engaged in primary care as soon as possible. HIV-infected youth need intensive individual and group interventions to keep themselves healthy and reduce transmission to others. Incumbent on all providers is to make adolescents' services visible, flexible, affordable, confidential, culturally appropriate, and available for all youth.
Collapse
Affiliation(s)
- D Futterman
- Adolescent AIDS Program, Montefiore Medical Center, Bronx, New York, USA.
| | | | | |
Collapse
|
39
|
McFarland W, Busch MP, Kellogg TA, Rawal BD, Satten GA, Katz MH, Dilley J, Janssen RS. Detection of early HIV infection and estimation of incidence using a sensitive/less-sensitive enzyme immunoassay testing strategy at anonymous counseling and testing sites in San Francisco. J Acquir Immune Defic Syndr 1999; 22:484-9. [PMID: 10961610 DOI: 10.1097/00126334-199912150-00009] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Timely estimates of HIV incidence are needed to monitor the epidemic and target primary prevention but have been difficult to obtain. We applied a sensitive/ less-sensitive (S/LS) enzyme immunoassay (EIA) testing strategy to stored HIV-positive sera (N = 452) to identify early infections, estimate incidence, and characterize correlates of recent seroconversion among persons seeking anonymous HIV testing in San Francisco from 1996 to 1998 (N = 21,292). Sera positive on a sensitive EIA but negative on a less-sensitive EIA were classified as early HIV infections; sera positive on both EIA were classified as long standing. Seventy-nine sera were from people with early HIV infection. Estimated HIV incidence was 1.1% per year (95% confidence interval [CI], 0.68%-1.6%) overall and 1.9% per year (95% CI, 1.2%-3.0%) among men who have sex with men (MSM). Early HIV infection among MSM was associated with injection drug use, unprotected receptive anal sex, and multiple sex partners in the previous year. No temporal trend in HIV incidence was noted over the study period. The S/LS strategy provides a practical public health tool to identify early HIV infection and estimate HIV incidence in a variety of study designs and settings.
Collapse
Affiliation(s)
- W McFarland
- Department of Public Health, San Francisco, California 94102-6033, USA.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Detection of Early HIV Infection and Estimation of Incidence Using a Sensitive/Less-Sensitive Enzyme Immunoassay Testing Strategy at Anonymous Counseling and Testing Sites in San Francisco. J Acquir Immune Defic Syndr 1999. [DOI: 10.1097/00042560-199912150-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
41
|
Home Collection Versus Publicly Funded HIV Testing in San Francisco: Who Tests Where? J Acquir Immune Defic Syndr 1999. [DOI: 10.1097/00126334-199908150-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
42
|
|