Obtaining HIV test results with a home collection test kit in a community telephone sample

Recruiting for diversity: a pilot test of recruitment strategies for a national alcohol survey with mail-in genetic data collection

We assessed the feasibility and acceptability of collecting a saliva sample for DNA through the mail from a national sample of drinkers and examined whether targeted messaging would increase the response rates of Black/African American and Hispanic/Latino participants. We invited respondents from two prior national population surveys to participate in a brief telephone survey regarding recent alcohol use and to mail in a self-administered saliva sample. Blacks/African Americans, Hispanics/Latinos, and Whites had similar rates of consenting to participate. A higher proportion of respondents with a college education and a family history of alcohol problems consented. The differences in participation between respondents receiving targeted and general messaging were not statistically significant. This study provides preliminary evidence for the feasibility of recruiting diverse participants into a genetic study of alcohol use disorder.

Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study

BACKGROUND

Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed.

OBJECTIVES

To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2).

DESIGN

A two-stage, mixed-methods design. Stage 1 involved a systematic literature review, focus groups and interviews with key stakeholders and black Africans. Data obtained provided the theoretical base for intervention development and operationalisation. Stage 2 was a prospective, non-randomised study of a provider-initiated, HIV SSK distribution intervention targeted at black Africans. The intervention was assessed for cost-effectiveness. A process evaluation explored feasibility, acceptability and fidelity.

SETTING

Twelve general practices and three community settings in London.

MAIN OUTCOME MEASURE

HIV SSK return rate.

RESULTS

Stage 1 - the systematic review revealed support for HIV SSKs, but with scant evidence on their use and clinical effectiveness among black Africans. Although the qualitative findings supported SSK distribution in settings already used by black Africans, concerns were raised about the complexity of the SSK and the acceptability of targeting. These findings were used to develop a theoretically informed intervention. Stage 2 - of the 349 eligible people approached, 125 (35.8%) agreed to participate. Data from 119 were included in the analysis; 54.5% (65/119) of those who took a kit returned a sample; 83.1% of tests returned were HIV negative; and 16.9% were not processed, because of insufficient samples. Process evaluation showed the time pressures of the research process to be a significant barrier to feasibility. Other major barriers were difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow.

LIMITATIONS

Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care.

CONCLUSIONS

Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV.

FUTURE WORK

Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223.

FUNDING

The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care.

High acceptability of rapid HIV self-testing among a diverse sample of MSM from Buenos Aires, Argentina

INTRODUCTION

The objective of this study was to explore the acceptability of rapid HIV self-testing (RHST) among men who have sex with men (MSM).

METHODS

During 2006-2009, a sample of 500 MSM was recruited through Respondent Driven Sampling for an HIV prevalence/incidence study. Attitude toward RHST was explored among HIV negative MSM. Data were weighted prior to analyses.

RESULTS

Participants reported they were likely to buy RHST (74%), test themselves more frequently than they currently do (77%), and that the procedure would simplify testing (70%). Furthermore, 71% reported they would probably use it alone, 66% would use it with a steady partner, and 56% with a friend/partner. While a majority acknowledged that RHST use would deprive them of receiving counseling (61%), 74% declared they would go for help if they tested positive; 57% would use an RHST in order to avoid condoms. Probability of use surpassed 70% among gay and non-gay identified MSM as well as those with and without a previous HIV test. Those likely to buy RHST were older (p = 0.025) and more likely to identify as gay (p = 0.036). A total of 17% said they would think about killing themselves and 9% would attempt suicide if they tested positive. These MSM were more likely to be younger (p<0.001), with lower mood level (p<0.001) and greater feelings of loneliness (p = 0.026).

CONCLUSIONS

The high acceptability of RHST found among MSM should encourage the authorities to consider the possibility of offering it for self-testing, as it can improve early diagnosis and prevention of future transmissions. However, further research is needed to understand how to best disseminate RHST among MSM who wish to use it and to offer support and linkage to care for those who test HIV-positive.

HIV self-testing in Nigeria: public opinions and perspectives

Nigeria views the HIV self-test (HIVST) as a possible mechanism to help increase HIV testing uptake and capture otherwise undiagnosed HIV cases. The purpose of this survey was to obtain perspectives of informed members of the Nigerian public on the use of the HIVST. A convenience sample of 1712 researchers, academics, journalists, community advocates, activists and HIV policy-makers and programmers including those working in the development sectors enlisted on the New HIV Vaccine and Microbicide Advocacy Society listserv were sent a brief survey. Respondents were asked to provide a 'yes' or 'no' response to an enquiry if they support the introduction of HIVST into Nigeria. Reasons for their response were also recorded. Information was collected anonymously with no identifiers. Only 157 (9.2%) provided a response. While the majority (54.8%) supported the introduction of HIVST, a significant number of respondents were concerned about possible risk associated with self-testing, especially suicide and partner violence. Others were concerned about poor linkages to care. Introduction of HIVST would need to be paired with intense media campaigns and education about its use. Once Nigeria commences HIVST, efforts should also focus on approaches to reach people in hard to reach areas of the country.

New strategies for biosample collection in population-based social research

This paper aims to increase understanding of the methodological issues involved in adding biomeasures to social research by investigating the potential of an event-triggered, self-collection technique for monitoring biological response to social events. We use data from the Relationship Dynamics and Social Life (RDSL) study, which collected saliva samples triggered by a life event important to the aims of the study - the end of a romantic relationship. Our investigation found little evidence that those who complied in the biosample collection were different from those who did not comply in terms of key study measures and sociodemographic characteristics. We also found no evidence that the biosample collection had adverse consequences for subsequent panel participation. We did find that prior cooperation in the study was an important predictor of biosample cooperation, which is important information in developing biosample collection strategies. As demand for biological samples directly linked to social data continues to grow, effective low-cost collection methods will become increasingly valuable. The evidence here indicates that self-collected biosamples may offer tremendous potential to meet this demand.

Acceptability of HIV self-testing: a systematic literature review

Background

The uptake of HIV testing and counselling services remains low in risk groups around the world. Fear of stigmatisation, discrimination and breach of confidentiality results in low service usage among risk groups. HIV self-testing (HST) is a confidential HIV testing option that enables people to find out their status in the privacy of their homes. We evaluated the acceptability of HST and the benefits and challenges linked to the introduction of HST.

Methods

A literature review was conducted on the acceptability of HST in projects in which HST was offered to study participants. Besides acceptability rates of HST, accuracy rates of self-testing, referral rates of HIV-positive individuals into medical care, disclosure rates and rates of first-time testers were assessed. In addition, the utilisation rate of a telephone hotline for counselling issues and clients` attitudes towards HST were extracted.

Results

Eleven studies met the inclusion criteria (HST had been offered effectively to study participants and had been administered by participants themselves) and demonstrated universally high acceptability of HST among study populations. Studies included populations from resource poor settings (Kenya and Malawi) and from high-income countries (USA, Spain and Singapore). The majority of study participants were able to perform HST accurately with no or little support from trained staff. Participants appreciated the confidentiality and privacy but felt that the provision of adequate counselling services was inadequate.

Conclusions

The review demonstrates that HST is an acceptable testing alternative for risk groups and can be performed accurately by the majority of self-testers. Clients especially value the privacy and confidentiality of HST. Linkage to counselling as well as to treatment and care services remain major challenges.

Assessing willingness to test for HIV among men who have sex with men using conjoint analysis, evidence for uptake of the FDA-approved at-home HIV test

Men who have sex with men (MSM) in the USA, represent a vulnerable population with lower rates of HIV testing. There are various specific attributes of HIV testing that may impact willingness to test (WTT) for HIV. Identifying specific attributes influencing patients' decisions around WTT for HIV is critical to ensure improved HIV testing uptake. This study examined WTT for HIV by using conjoint analysis, an innovative method for systematically estimating consumer preferences across discrete attributes. WTT for HIV was assessed across eight hypothetical HIV testing scenarios varying across seven dichotomous attributes: location (home vs. clinic), price (free vs. $50), sample collection (finger prick vs. blood), timeliness of results (immediate vs. 1-2 weeks), privacy (anonymous vs. confidential), results given (by phone vs. in-person), and type of counseling (brochure vs. in-person). Seventy-five MSM were recruited from a community-based organization providing HIV testing services in Los Angeles to participate in conjoint analysis. WTT for HIV score was based on a 100-point scale. Scores ranged from 32.2 to 80.3 for eight hypothetical HIV testing scenarios. Price of HIV testing (free vs. $50) had the highest impact on WTT (impact score = 31.4, SD = 29.2, p<0.0001), followed by timeliness of results (immediate vs. 1-2 weeks) (impact score = 13.9, SD = 19.9, p≤0.0001) and testing location (home vs. clinic) (impact score = 10.3, SD = 22.8, p=0.0002). Impacts of other HIV testing attributes were not significant. Conjoint analysis method enabled direct assessment of HIV testing preferences and identified specific attributes that significantly impact WTT for HIV among MSM. This method provided empirical evidence to support the potential uptake of the newly FDA-approved over-the-counter HIV home test kit with immediate results, with cautionary note on the cost of the kit.

Willingness to Take a Free Home HIV Test and Associated Factors among Internet-Using Men Who Have Sex with Men

OBJECTIVES

Online HIV prevention studies have been limited in their ability to obtain biological specimens to measure study outcomes. We describe factors associated with willingness of men who have sex with men (MSM) to take a free home HIV test as part of an online HIV prevention study.

METHODS

Between March and April 2009, we interviewed 6163 HIV-negative MSM and assessed the willingness to test for HIV infection using a home collection kit.

RESULTS

Men reported being very likely (3833; 62%) or likely (1236; 20%) to accept a home HIV test as part of an online HIV prevention study. The odds of being willing to home test were higher for men who were offered incentives of $10 or $25, were black, had unprotected anal intercourse in the past 12 months, and were unaware of their HIV status.

CONCLUSIONS

Home testing offered as part of online HIV prevention research is acceptable overall and in important subgroups of high-risk MSM.

Pilot of non-invasive (oral fluid) testing for HIV within a community setting

BACKGROUND

The present study sought to determine the level of undiagnosed HIV infection within a community setting of men who have sex with men (MSM) and identify any associated sexual risk behaviours.

METHODS

A total of 427 MSM were recruited in sex-on-premises venues (SOPV) and gay bars within the inner city of Brisbane. An additional 37 MSM were recruited in a smaller, regional centre (Toowoomba). Oral fluid testing for HIV antibodies was undertaken using the Orasure collection system and assay. Each participant was invited to complete a brief behaviour questionnaire and submit an oral fluid specimen. Confirmed serology results were linked to reported sexual behaviours, testing patterns and HIV status.

RESULTS

Of the 464 men surveyed, 33 identified as HIV-positive, and all of these were reactive by the Orasure assay. A further eight people who identified as negative or unknown serostatus, had confirmed Orasure reactive results, resulting in 1.9% of the 'non-HIV positive' MSM sample unaware of their positive HIV status. Therefore, 19.5% of the total confirmed HIV-positive individuals were not aware of their true serostatus.

CONCLUSIONS

A significant minority of HIV-positive MSM are currently unaware of their positive serostatus. However, an analysis of their risk behaviour does not seem to indicate any significant difference to those who are HIV-negative. Interestingly, 86% of those who were unaware they were HIV-positive identified that they had been tested in the previous 6 months and all of them claimed to have been tested in the previous 2 years.

Methamphetamine use and other club drug use differ in relation to HIV status and risk behavior among gay and bisexual men

This study compared associations between methamphetamine use, drug use other than methamphetamine, and HIV transmission factors among men who have sex with men, attending an sexually transmitted disease clinic. Of 6435 participants, newly recognized HIV status (OR: 3.02 95% CI: 2.30, 3.99) was associated with methamphetamine use compared with nondrug users, an association not found among other club drug users.

Measuring sexual risk for HIV: a Rasch scaling approach

In this study, we developed an HIV transmission risk scale and examined its psychometric properties using data on sexual behavior obtained from a probability sample of adult men who have sex with men living in Chicago. We used Messick's (Am Psychol 50:741-749, 1995) conceptualization of unified validity theory to organize the psychometric properties of data. Evidence related to scale content was investigated via Rasch item fit statistics, point-measure correlations, and expert evaluation. The substantive aspect of validity was addressed by interpreting the meaningfulness of the item difficulty hierarchy (continuum of risky behaviors) and assessment of person fit. The structural aspect of validity was assessed using Rasch item fit statistics, principal component analysis of standardized residuals, and other residual analyses. The generalizability aspect of validity was investigated via internal consistency reliability estimates for both items and persons, and aspects of external validity were addressed by examining between-group differences with respect to levels of risky behavior. Applications and suggested future studies are discussed.

Pilot of non-invasive (oral fluid) testing for HIV within a clinical setting

BACKGROUND

The objectives of the present study were: to determine the sensitivity and specificity of oral fluid testing compared with the performance of standard blood-based HIV enzyme immunoassay; to assess the feasibility of oral fluid specimen collection from clients for the purposes of HIV testing within a clinical setting; and to assess the clinical and laboratory impact regarding staffing, material resources, expertise and funding of oral fluid testing.

METHODS

A parallel comparative trial of oral fluid and blood testing was conducted among a group of HIV positive clients and a group of unknown HIV serostatus clients where each client was offered both tests. An ambulatory HIV clinic recruited 175 known HIV positive clients and 179 persons were recruited through an inner city sexual health clinic while attending for routine sexual health checks. Client responses to oral fluid collection were assessed. The sensitivity and specificity of oral fluid testing were calculated.

RESULTS

Of the 176 confirmed HIV reactive blood test results, the OraSure (OraSure Technologies, Beaverton, OR, USA) assay failed to detect only one of these, demonstrating a sensitivity of 99.4%. Of the 178 blood specimens that were tested as non-reactive by the AxSYM (Abbott Laboratories, Abbott Park, IL, USA) Combo system, OraSure recorded four of the corresponding oral fluid specimens as reactive (assumed to be false-positive), giving a specificity of 97.6%. Although evaluation of patients undergoing the test showed a large proportion (88.6%) preferred the OraSure test to conventional blood testing, a large minority of these (22.6%) made such a preference conditional on the OraSure test being as reliable as current blood testing.

CONCLUSIONS

This limited clinic based trial of oral fluid testing for HIV antibodies among an outpatient population has demonstrated the potential of oral fluid as a specimen for HIV testing. However, the lower performance of the test compared with current serum-based tests may limit the usefulness of OraSure to epidemiological studies or as an alternative screening tool in outreach settings among higher risk populations.

Prevalence of HIV infection and predictors of high-transmission sexual risk behaviors among men who have sex with men

OBJECTIVES

We sought to determine the prevalence of HIV and novel cofactors of high-transmission-risk behavior in a probability sample of men who have sex with men (MSM).

METHODS

We performed a cross-sectional telephone survey of 1976 adult MSM in San Francisco.

RESULTS

We found an HIV prevalence of 25.2%. Predictors of unprotected insertive anal intercourse with a serodiscordant (not having the same HIV/AIDS serostatus) partner among HIV-infected men included use of Viagra and a greater number of partners in the past 12 months. Unprotected receptive anal intercourse with a serodiscordant partner among men not known to be HIV infected was independently associated with having lived in San Francisco for less than 1 year, use of crystal methamphetamine and amyl nitrites, a greater number of partners, and agreement with the statement, "You are less careful about being safe with sex or drugs than you were several years ago because there are better treatments for HIV now."

CONCLUSIONS

Strategies to prevent HIV for urban MSM should focus on new predictors of HIV transmission.

Changes in prevalence of HIV infection and sexual risk behavior in men who have sex with men in San Francisco: 1997 2002

OBJECTIVES

We assessed differences in HIV prevalence and sexual risk behavior among men who have sex with men (MSM) between 1997 and 2002 in San Francisco.

METHODS

We used 2 population-based random-digit-dial telephone surveys of MSM households in San Francisco in 1997 (n=915) and 2002 (n=879).

RESULTS

Estimated HIV prevalence increased from 19.6% in 1997 to 26.8% in 2002. Measures of sexual risk also increased. Unprotected anal intercourse with a partner of different or unknown HIV serostatus increased from 9.3% to 14.6%. Mean number of male partners increased from 10.7 to 13.8. The largest reported increase was 18.9% to 26.8% for "serosorting," or choosing unprotected anal intercourse partners believed to have the same HIV serostatus as oneself. Men aged 30 to 50 reported the largest increase in unprotected anal intercourse, whereas men aged 18 to 29 reported the largest increase in serosorting. Changes in the age distribution did not explain the increase in risky behavior.

CONCLUSIONS

Both HIV prevalence and sexual risk increased substantially among MSM in San Francisco between 1997 and 2002. Serosorting is being adopted more frequently than condom use by young MSM, but its effectiveness as a harm reduction strategy is not known.

Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men, San Francisco

BACKGROUND

Increasing trends in high-risk sexual behavior are noted among men who have sex with men (MSM) worldwide. Less information is available on unprotected sex between persons of different HIV serostatus.

METHODS

From 1999 through 2001, volunteers of a community-based organization conducted interviews of 10,579 MSM at gay-oriented venues in San Francisco and in neighborhoods with high-volume MSM pedestrian traffic. The questionnaire recorded demographic and risk behavior information, including self-reported and partners' HIV serostatus.

RESULTS

Potentially serodiscordant unprotected anal intercourse (UAI) with at least 2 anal sex partners was reported by 12.7% and increased from 11.0% in 1999 to 16.2% in 2001. Stratifying by self-reported HIV serostatus, 20.8% of HIV-positive respondents, 12.1% of HIV-negative respondents, and 13.4% of MSM who did not know or report their own HIV serostatus had potentially serodiscordant UAI. Older MSM of white race were more likely to report potentially serodiscordant UAI among HIV-positive respondents, whereas younger MSM of white race were more likely to report potentially serodiscordant UAI among HIV-negative respondents. Among those with unknown HIV serostatus, MSM of color were more likely to engage in potentially serodiscordant UAI.

CONCLUSION

Recent increases in UAI among MSM in San Francisco are not only the result of increases in UAI between persons of the same HIV serostatus. Prevention messages must address disclosure of HIV serostatus to sexual partners specifically tailored to groups according to age, community, and HIV serostatus.

The HIV epidemic among older men who have sex with men

The authors present HIV prevalence and risk behavior data for urban men who have sex with men (MSM) aged 50 years or older. Data are based on a probability sample of MSM conducted in 1997 (n = 2881 total; 507 older MSM) in New York, Los Angeles, Chicago, and San Francisco. The authors determined HIV status through self-report and biologic measures. Risk behavior was assessed through self-report. The authors found that HIV prevalence was 19% (95% CI: 14, 25) for men in their 50s and 3% (95% CI: 1, 10) for men in their 60s. No men in their 70s were HIV-positive. Prevalence was at high levels for older blacks (30%), MSM who are injection drug users (21%), moderately heavy drug users (35%), and less closeted men (21%). High-risk sex between serodiscordant partners was relatively constant (4%-5%) across age groups older than 30 years of age and decreased among MSM in their 70s. Current levels of HIV among older urban MSM in the United States are very high, particularly among those in their 50s. High mortality rates among MSM with AIDS up to 1996 (before highly active antiretroviral therapy [HAART]) would account for the lower levels among men in their 60s and 70s. Because of HAART, we would expect HIV levels to increase in these age groups. Given high levels of risk behavior among MSM through the sixth decade of life, the authors would expect an older MSM epidemic of substantially larger proportion than that observed in the 1980s and 1990s.

Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men

OBJECTIVES

We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM).

METHODS

We conducted a cross-sectional household probability telephone sample of MSM in Chicago, Los Angeles, New York, and San Francisco.

RESULTS

Psychosocial health problems are highly intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection.

CONCLUSIONS

AIDS prevention among MSM has overwhelmingly focused on sexual risk alone. Other health problems among MSM not only are important in their own right, but also may interact to increase HIV risk. HIV prevention might become more effective by addressing the broader health concerns of MSM while also focusing on sexual risks.

Public policy regulating private and public space in gay bathhouses

Public policies prohibiting either public or private space in gay bathhouses vary across cities. New York, San Francisco, Los Angeles, and Chicago all have different policies. The objective of this study was to assess reported risk behavior as an indicator of success of one policy over another. Data are from a telephone survey of a probability sample of men living in the four cities who reported having sex with men. Analyses focused on city differences in behavior of adult men who, in the past year, were sexually active with a male and visited a bathhouse ( n= 827). Respondents reported numbers of sex partners, one-night stands, visits to bathhouses in the past year, and casual sex partners with whom they had engaged in unprotected anal intercourse (UAI) as well as whether they had UAI in a public setting. Among men who visit bathhouses, no significant city differences were observed except that there were city differences in where UAI occurred-i.e., San Francisco men were significantly less likely to report UAI in a public place than were men in other cities. The data suggest that different city policies may affect where, but not whether, UAI occurs.

Repeat HIV testing, risk behaviors, and HIV seroconversion among young men who have sex with men: a call to monitor and improve the practice of prevention

OBJECTIVES

We compared recent risk behaviors and HIV seroconversion among young men who have sex with men (MSM) who were first-time, infrequent, and repeat HIV testers.

METHODS

Male adolescents and young men aged 15 to 22 years were randomly sampled, interviewed, counseled, and tested for HIV at 194 gay-identified venues in seven U.S. cities from 1994 through 1998. Analyses were restricted to MSM who reported having never tested or last tested HIV-negative.

RESULTS

Of 3430 participants, 36% tested for the first time, 39% had tested infrequently (one or two times), and 26% had tested repeatedly (> or = three times). Compared with first-time testers, repeat testers were more likely to report recent risk behaviors and to acquire HIV (7% versus 4%). Over 75% of repeat testers who seroconverted acquired HIV within 1 year of their last test. Compared with repeat testers, first-time testers reported similar use of health care but delayed testing for nearly 2 additional years after initiating risk.

CONCLUSIONS

Many young MSM soon acquire HIV after repeated use of HIV counseling and testing services. Providers must strengthen practices to identify, counsel, and test young MSM and provide enhanced behavioral interventions for those with persistent risks.

The continuing HIV epidemic among men who have sex with men

OBJECTIVES

This study characterized the AIDS epidemic among urban men who have sex with men (MSM).

METHODS

A probability sample of MSM was obtained in 1997 (n = 2881; 18 years and older) from New York, Los Angeles, Chicago, and San Francisco, and HIV status was determined through self-report and biological measures.

RESULTS

HIV prevalence was 17% (95% confidence interval = 15%, 19%) overall, with extremely high levels in African Americans (29%), MSM who used injection drugs (40%), "ultraheavy" noninjection drug users (32%), and less educated men (< high school, 37%). City-level HIV differences were non-significant once these other factors were controlled for. In comparing the present findings with historical data based on public records and modeling, HIV prevalence appears to have declined as a result of high mortality (69%) and stable, but high, incidence rates (1%-2%).

CONCLUSIONS

Although the findings suggest that HIV prevalence has declined significantly from the mid-1980s, current levels among urban MSM in the United States approximate those of sub-Saharan countries (e.g., 14%-25%) and are extremely high in many population subsegments. Despite years of progress, the AIDS epidemic continues unabated among subsegments of the MSM community.

Health-related characteristics of men who have sex with men: a comparison of those living in "gay ghettos" with those living elsewhere

OBJECTIVES

This study investigated the limitations of probability samples of men who have sex with men (MSM), limited to single cities and to the areas of highest concentrations of MSM ("gay ghettos").

METHODS

A probability sample of 2881 MSM in 4 American cities completed interviews by telephone.

RESULTS

MSM who resided in ghettos differed from other MSM, although in different ways in each city. Non-ghetto-dwelling MSM were less involved in the gay and lesbian community. They were also less likely to have only male sexual partners, to identify as gay, and to have been tested for HIV.

CONCLUSIONS

These differences between MSM who live in gay ghettos and those who live elsewhere have clear implications for HIV prevention efforts and health care planning.

Use of antiretroviral therapies among HIV-infected men who have sex with men: a household-based sample of 4 major American cities

OBJECTIVES

This study sought to determine the prevalence and determinants of use of recommended antiretroviral regimens among urban seropositive men who have sex with men (MSM).

METHODS

A probability telephone sample of MSM was taken within regions of Chicago, Los Angeles, New York, and San Francisco. Analysis focused on use of antiretroviral therapies.

RESULTS

Although the majority of seropositive MSM with CD4 counts below 500 per microliter were using recommended antiretroviral regimens, 26% of seropositive MSM were not receiving such care. Men who were younger, who reported a sexual orientation other than homosexual, who had a more recent interview date, who were at middle levels of affiliation with the gay community, and who reported higher levels of perceived exclusivity on the part of the gay community were less likely to be using recommended antiretroviral regimens.

CONCLUSIONS

Although current efforts to make antiretroviral therapies available to HIV-seropositive MSM are reasonably effective, additional efforts are needed for MSM characterized by relative youth and lower social support.