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Daskalopoulou M, Rodger AJ, Phillips AN, Gilson R, Sherr L, Wayal S, Anderson J, Aderogba K, McDonnell J, Wilkins E, Youssef E, Speakman A, Burman WJ, Lampe FC. Attitudes to disclosure of HIV-serostatus to new sexual partners and sexual behaviours among HIV-diagnosed gay, bisexual and other men who have sex with men in the UK. AIDS Care 2020; 32:1323-1332. [PMID: 32114800 DOI: 10.1080/09540121.2020.1728218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We assessed attitudes to disclosure to new sexual partners and association with sexual behaviours among HIV-diagnosed gay, bisexual, and other men who have sex with men (GBMSM) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study in 2011-12. Among 1373 GBMSM diagnosed with HIV for ≥3 months and reporting sex in the past three months (84% on antiretroviral therapy (ART), 75% viral load (VL) ≤50c/mL), 56.3% reported higher sexual disclosure ("agree" or "tend to agree" with "I'd expect to tell a new partner I'm HIV-positive before we have sex"). GBMSM on ART with self-reported undetectable VL had lower disclosure than those on ART without self-reported undetectable VL and those not on ART. Higher sexual disclosure was associated with higher prevalence of CLS in the past three months; this was due to its association with CLS with other HIV-positive partners. Higher sexual disclosure was more common among GBMSM who had CLS with other HIV-positive partners only (72.1%) compared to those who had higher-risk CLS with HIV-serodifferent partners (55.6%), other CLS with HIV-serodifferent partners (45.9%), or condom-protected sex only (47.6%). Findings suggest mutual HIV-disclosure and HIV-serosorting were occurring in this population. Knowledge of VL status may have impacted on disclosure to sexual partners.
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Affiliation(s)
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | | | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
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Abuelezam NN, Reshef YA, Novak D, Grad YH, Seage Iii GR, Mayer K, Lipsitch M. Interaction Patterns of Men Who Have Sex With Men on a Geosocial Networking Mobile App in Seven United States Metropolitan Areas: Observational Study. J Med Internet Res 2019; 21:e13766. [PMID: 31516124 PMCID: PMC6746104 DOI: 10.2196/13766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/08/2019] [Accepted: 07/19/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The structure of the sexual networks and partnership characteristics of young black men who have sex with men (MSM) may be contributing to their high risk of contracting HIV in the United States. Assortative mixing, which refers to the tendency of individuals to have partners from one's own group, has been proposed as a potential explanation for disparities. OBJECTIVE The objective of this study was to identify the age- and race-related search patterns of users of a diverse geosocial networking mobile app in seven metropolitan areas in the United States to understand the disparities in sexually transmitted infection and HIV risk in MSM communities. METHODS Data were collected on user behavior between November 2015 and May 2016. Data pertaining to behavior on the app were collected for men who had searched for partners with at least one search parameter narrowed from defaults or used the app to send at least one private chat message and used the app at least once during the study period. Newman assortativity coefficient (R) was calculated from the study data to understand assortativity patterns of men by race. Pearson correlation coefficient was used to assess assortativity patterns by age. Heat maps were used to visualize the relationship between searcher's and candidate's characteristics by age band, race, or age band and race. RESULTS From November 2015 through May 2016, there were 2,989,737 searches in all seven metropolitan areas among 122,417 searchers. Assortativity by age was important for looking at the profiles of candidates with correlation coefficients ranging from 0.284 (Birmingham) to 0.523 (San Francisco). Men tended to look at the profiles of candidates that matched their race in a highly assortative manner with R ranging from 0.310 (Birmingham) to 0.566 (Los Angeles). For the initiation of chats, race appeared to be slightly assortative for some groups with R ranging from 0.023 (Birmingham) to 0.305 (Los Angeles). Asian searchers were most assortative in initiating chats with Asian candidates in Boston, Los Angeles, New York, and San Francisco. In Birmingham and Tampa, searchers from all races tended to initiate chats with black candidates. CONCLUSIONS Our results indicate that the age preferences of MSM are relatively consistent across cities, that is, younger MSM are more likely to be chatted with and have their profiles viewed compared with older MSM, but the patterns of racial mixing are more variable. Although some generalizations can be made regarding Web-based behaviors across all cities, city-specific usage patterns and trends should be analyzed to create targeted and localized interventions that may make the most difference in the lives of MSM in these areas.
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Affiliation(s)
- Nadia N Abuelezam
- William F Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Yakir A Reshef
- Department of Computer Science, Harvard University, Cambridge, MA, United States
| | - David Novak
- DSN Consulting, LLC, Boston, MA, United States
| | - Yonatan Hagai Grad
- Department of Immunology and Infectious Disease, Harvard TH Chan School of Public Health, Boston, MA, United States
- Division of Infectious Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - George R Seage Iii
- Department of Epidemiology, Harvard TH School of Public Health, Boston, MA, United States
| | | | - Marc Lipsitch
- Department of Epidemiology, Harvard TH School of Public Health, Boston, MA, United States
- Center for Communicable Disease Dynamics, Boston, MA, United States
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Przybyla SM, Krawiec G, Godleski SA, Crane CA. Meta-Analysis of Alcohol and Serodiscordant Condomless Sex Among People Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1351-1366. [PMID: 28975477 PMCID: PMC7864120 DOI: 10.1007/s10508-017-1050-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 05/24/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
While observational studies have found that alcohol consumption is associated with serodiscordant condomless sex among people living with HIV (PLHIV), no meta-analysis has yet examined this trend. We conducted a meta-analysis to synthesize empirical evidence on the association between alcohol and condomless sex with partners at risk of HIV acquisition. To meet inclusion criteria, studies: (1) specifically targeted PLHIV or provided stratified data for HIV-infected participants; (2) provided a quantitative measure of alcohol use; (3) provided a quantitative measure of condomless sex with serodiscordant partners; and (4) reported the results of statistical tests examining the relationship between alcohol use and serodiscordant condomless sex. Using random-effects models, weighted effect sizes were calculated. Three separate analyses were conducted to examine serodiscordant condomless sex in association with any alcohol consumption, binge/problematic drinking, and alcohol in a sexual context. A total of 36 independent effect sizes from 27 studies (including 25,065 HIV-infected participants) were pooled in the meta-analysis. Any alcohol consumption, binge/problematic drinking, and alcohol use in a sexual context were each associated with condomless sex with serodiscordant partners [OR 1.64 (95% CI 1.46-1.85); OR 1.65 (95% CI 1.14-2.39); OR 2.88 (95% CI 2.01-4.12), respectively]. Meta-analytic findings demonstrate a consistent positive relationship between alcohol use and serodiscordant condomless sex among PLHIV. Future public health programming for HIV-infected individuals needs to address the role of alcohol consumption in sexual risk-taking behavior.
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Affiliation(s)
- Sarahmona M Przybyla
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA.
| | - Gabriela Krawiec
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA
| | | | - Cory A Crane
- Biomedical Sciences, Rochester Institute of Technology, Rochester, NY, USA
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Abstract
BACKGROUND Alcohol is a recognized risk factor for sexually transmitted diseases acquisition, but the mechanism is unclear. Potentially, adolescents using alcohol in the 2 hours before sex (in-the-moment use) have riskier sexual partners. METHODS We used multivariable logistic regression to examine the association between in-the-moment alcohol use and partner risk characteristics reported for the most recent sex among primarily 17- to 18-year-old adolescents originally recruited from a representative sample of Chicago public elementary schools. We created 3 composite partner risk profiles: partner familiarity risk (casual and unexpected), partner context risk (age discordance and met in public), and overall risk using all measures except partner alcohol use. RESULTS Teens who reported any in-the-moment alcohol use were more likely than nondrinking teens to report casual (adjusted odds ratio [AOR], 3.2; 95% confidence interval [95% CI], 2.1-4.9), unexpected (AOR, 1.6; 95% CI, 1.0-2.5), age discordant (AOR, 3.0; 95% CI, 2.0-4.6), or met in public partners (AOR, 1.4; 95% CI, 1.0 to 2.1). For each composite measure, the number of partner risk characteristics reported increased linearly with the percent of teens drinking in the moment (Cochran-Armitage trend, P < 0.0001). Compared with zero characteristics, in-the-moment alcohol use was associated with increased odds of reporting 1 (AOR, 2.8; 95% CI, 1.7-4.5), 2 (AOR, 4.6; 95% CI, 2.7, 7.6), or 3 to 4 characteristics (AOR, 7.1; 95% CI, 3.3-15.3). CONCLUSIONS Our findings expand the link between in-the-moment alcohol use and partner risk reported in prior studies to encompass adolescents' general sexual experiences and additional partner characteristics including the highly associated composite characteristics.
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Hickson DA, Mena LA, Wilton L, Tieu HV, Koblin BA, Cummings V, Latkin C, Mayer KH. Sexual Networks, Dyadic Characteristics, and HIV Acquisition and Transmission Behaviors Among Black Men Who Have Sex With Men in 6 US Cities. Am J Epidemiol 2017; 185:786-800. [PMID: 28402405 PMCID: PMC5860251 DOI: 10.1093/aje/kww144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 12/24/2022] Open
Abstract
The role of sexual networks in the epidemiology of human immunodeficiency virus (HIV) among black men who have sex with men (MSM) is poorly understood. Using data from 1,306 black MSM in the BROTHERS Study (2009-2010) in the United States, we examined the relationships between multiple sexual dyadic characteristics and serodiscordant/serostatus-unknown condomless sex (SDCS). HIV-infected participants had higher odds of SDCS when having sex at least weekly (odds ratio (OR) = 2.41, 95% confidence interval (CI): 1.37, 4.23) or monthly (OR = 1.94, 95% CI: 1.17, 3.24) versus once to a few times a year. HIV-uninfected participants had higher odds of SDCS with partners met offline at sex-focused venues (OR = 1.79, 95% CI: 1.15, 2.78) versus partners met online. In addition, having sex upon first meeting was associated with higher odds of SDCS (OR = 1.49, 95% CI: 1.21, 1.83) than was not having sex on first meeting, while living/continued communication with sexual partner(s) was associated with lower odds of SDCS (weekly: OR = 0.64, 95% CI: 0.47, 0.85; monthly: OR = 0.60, 95% CI: 0.44, 0.81; yearly: OR = 0.58, 95% CI: 0.39, 0.85) versus discontinued communication. Persons with primary/steady nonprimary partners versus commercial partners had lower odds of SDCS regardless of HIV serostatus. This suggests the need for culturally relevant HIV prevention efforts for black MSM that facilitate communication with sexual partners especially about risk reduction strategies, including preexposure prophylaxis.
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Affiliation(s)
- DeMarc A. Hickson
- Correspondence to Dr. DeMarc A. Hickson, My Brother's Keeper Inc., Center for Research, Evaluation, and Environmental and Policy Change, 510 George Street, Jackson, MS 39202 (e-mail: )
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Correlates of sexual risk for HIV among US-born and foreign-born Latino men who have sex with men (MSM): an analysis from the Brothers y Hermanos study. J Immigr Minor Health 2016; 17:47-55. [PMID: 23949695 DOI: 10.1007/s10903-013-9894-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little research has been conducted to examine whether correlates of sexual risk vary by nativity among Latino men who have sex with men (MSM). We used cross sectional data collected from 870 Latino MSM recruited with respondent-driven sampling techniques. For each sub-sample (US-born and foreign-born), we assessed the association between each of the potential correlates (substance use, acculturation, social support, and social discrimination) and sexual risk behavior. Illicit drug use was associated with increased odds of sexual risk behavior in both US-born (OR = 2.17, 95% CI 1.17-4.03) and foreign-born (OR = 1.86, 1.14-3.05) subgroups. Multivariate correlates specific to foreign-born men included binge drinking (OR = 1.91, 1.17-3.14), 15 years or longer spent in the US (OR = 1.79, 1.06-3.03) and exposure to social discrimination (OR = 2.02, 1.03-3.99). Given the diversity of Latino MSM, information from research that identifies both common and different HIV risk factors across subgroups of Latino MSM may help better tailor HIV prevention programs.
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Tieu HV, Liu TY, Hussen S, Connor M, Wang L, Buchbinder S, Wilton L, Gorbach P, Mayer K, Griffith S, Kelly C, Elharrar V, Phillips G, Cummings V, Koblin B, Latkin C, HPTN 061. Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities. PLoS One 2015; 10:e0134085. [PMID: 26241742 PMCID: PMC4524662 DOI: 10.1371/journal.pone.0134085] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sexual networks may place U.S. Black men who have sex with men (MSM) at increased HIV risk. METHODS Self-reported egocentric sexual network data from the prior six months were collected from 1,349 community-recruited Black MSM in HPTN 061, a multi-component HIV prevention intervention feasibility study. Sexual network composition, size, and density (extent to which members are having sex with one another) were compared by self-reported HIV serostatus and age of the men. GEE models assessed network and other factors associated with having a Black sex partner, having a partner with at least two age category difference (age difference between participant and partner of at least two age group categories), and having serodiscordant/serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last six months. RESULTS Over half had exclusively Black partners in the last six months, 46% had a partner of at least two age category difference, 87% had ≤5 partners. Nearly 90% had sex partners who were also part of their social networks. Among HIV-negative men, not having anonymous/exchange/ trade partners and lower density were associated with having a Black partner; larger sexual network size and having non-primary partners were associated with having a partner with at least two age category difference; and having anonymous/exchange/ trade partners was associated with SDUI. Among HIV-positive men, not having non-primary partners was associated with having a Black partner; no sexual network characteristics were associated with having a partner with at least two age category difference and SDUI. CONCLUSIONS Black MSM sexual networks were relatively small and often overlapped with the social networks. Sexual risk was associated with having non-primary partners and larger network size. Network interventions that engage the social networks of Black MSM, such as interventions utilizing peer influence, should be developed to address stable partnerships, number of partners, and serostatus disclosure.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States of America
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
- * E-mail:
| | - Ting-Yuan Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Sophia Hussen
- Division of Infectious Diseases, Emory School of Medicine, Atlanta, GA, United States of America
| | - Matthew Connor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Lei Wang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Pamina Gorbach
- Department of Epidemiology, School of Public Health, Division of InfectiousDiseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Kenneth Mayer
- Fenway Community Health Center, Boston, MA, United States of America
| | - Sam Griffith
- FHI 360, Research Triangle Park, NC, United States of America
| | - Corey Kelly
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Vanessa Elharrar
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Gregory Phillips
- The George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC, United States of America
| | - Vanessa Cummings
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Beryl Koblin
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States of America
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Lacefield K, Negy C, Schrader RM, Kuhlman C. Comparing Psychosocial Correlates of Condomless Anal Sex in HIV-Diagnosed and HIV-Nondiagnosed Men Who Have Sex with Men: A Series of Meta-Analyses of Studies from 1993-2013. LGBT Health 2015; 2:200-20. [PMID: 26788669 DOI: 10.1089/lgbt.2014.0069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Men who have sex with men (MSM) continue to be overrepresented in rates of incidence and prevalence of human immunodeficiency virus (HIV). Both HIV-diagnosed (HIV-D) and HIV-nondiagnosed (HIV-N) MSM report a variety of reasons for intentional and unintentional nonuse of condoms. Elucidating and comparing reasons for continued engagement in condomless anal sex specific to both HIV-D and HIV-N MSM likely is important to identifying effective prevention. METHODS This study employed meta-analytic methods to evaluate and compare correlates to condomless anal sex in both HIV-D and HIV-N MSM from primary studies from 1993 to February 2013. RESULTS Of the 19 individual correlates assessed within the subgroup of HIV-D MSM, variables that achieved significant effect were alcohol, mind-altering substance use, sexual-enhancement medication, intentional condom nonuse, self-efficacy, attitudes toward condom use, social support, gay identity, compulsivity, trading sex, and number of sex partners. Those that were statistically non-significant were intention to use a condom, perceived risk, perceived norms, perceived responsibility, HIV medical management, treatment optimism, mental health, and setting. Of the 12 correlates assessed within the subgroup of HIV-N MSM, variables that achieved significant effect were alcohol, mind-altering substance use, intentional condom nonuse, attitudes toward condom use, perceived risk, and setting. Those observed as statistically non-significant were perceived norms, social support, gay identity, mental health, trading sex, and number of sex partners. CONCLUSION Study results have clinical implications that may guide future prevention research and practice by highlighting risk variables shared between HIV-N and HIV-D MSM, as well as variables observed to be unique to each group that may warrant more tailored intervention. Further investigation is recommended to elucidate the relationships among these variables such that optimal intervention can be determined.
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Affiliation(s)
- Katharine Lacefield
- 1 Department of Psychology, VA Maryland Healthcare System , Baltimore, Maryland.,2 Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles Negy
- 3 Department of Psychology, University of Central Florida , Orlando, Florida
| | - Ronald M Schrader
- 4 Department of Dialysis, DCI Corporate Quality Management , Albuquerque, New Mexico
| | - Christina Kuhlman
- 3 Department of Psychology, University of Central Florida , Orlando, Florida
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Halkitis PN, Kingdon MJ, Barton S, Eddy J. Facilitators and Barriers to HIV Status Disclosure Among HIV-positive MSM Age 50 and Older. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2015; 20:41-56. [PMID: 28496563 DOI: 10.1080/19359705.2015.1033797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Most HIV-positive men who have sex with men (MSM) ages 50 and older feel a responsibility to protect their sex partners from HIV transmission risk. For some, this is enacted through HIV disclosure, for others, this is realized through reduced risk behaviors. METHODS To examine this, we analyzed interviews of 23 HIV-positive MSM ages 50 and older. RESULTS We identified several contextual, relational, and psychosocial factors that served as either barriers or facilitators to HIV disclosure. CONCLUSIONS Our findings suggest HIV status disclosure is multifaceted and continues to impact sexual communication in the lives of MSM as they enter middle age.
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Affiliation(s)
- Perry N Halkitis
- The Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), The Steinhardt School of Culture, Education, and Human Development, Professor of Applied Psychology, Public Health, and Medicine, New York University, Global Institute of Public Health, 41 East 11th Street, #716, New York, NY 10003 212 998 5373
| | - Molly J Kingdon
- The Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | - Staci Barton
- The Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | - Jessica Eddy
- The Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
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Mendelsohn JB, Calzavara L, Daftary A, Mitra S, Pidutti J, Allman D, Bourne A, Loutfy M, Myers T. A scoping review and thematic analysis of social and behavioural research among HIV-serodiscordant couples in high-income settings. BMC Public Health 2015; 15:241. [PMID: 25885027 PMCID: PMC4365541 DOI: 10.1186/s12889-015-1488-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/28/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND While HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs. METHODS Ten electronic databases were searched. Studies were included if they were reported in English, used primary data, were from the combination antiretroviral (cART) era (>1996), reported on social or behavioural aspects, included any fraction of primary (i.e., stable) relationships, and were conducted in high-income settings. Studies that identified their unit of analysis as either the dyad or individual member of the couple were included. Studies were coded according to a thematic framework. RESULTS Included studies (n = 154) clustered into eight themes: risk behaviours (29%), risk management (26%), reproductive issues (12%), relationship quality (9%), serostatus disclosure (7%), adherence to antiretroviral therapy (7%), vulnerability (5%), and social support (3%). The proportion of studies conducted among heterosexual couples, same-sex male couples, and mixed cohorts were 42%, 34%, and 24%, respectively. Most studies (70%) were conducted in the United States, 70% of all studies were quantitative (including interventions), but only one-third were focused on couples (dyads) where both partners are recruited to a study. Over 25% of studies focused on sexual risk among same-sex male couples. CONCLUSIONS Future research efforts should focus on the interrelationship of risk management strategies and relationship quality, social determinants of health and wellbeing, HIV testing, vulnerable populations, reproductive issues among same-sex couples, disclosure of serodiscordant status to social networks, dyadic studies, population-based studies, and interventions to support risk management within couples. Additional population-based studies and studies among marginalized groups would be helpful for targeting research and interventions to couples that are most in need. As HIV-positive partners are typically the link to services and research, innovative ways are needed for reaching out to HIV-negative partners. Our review suggests that significantly more research is needed to understand the social and behavioural contexts of HIV-serodiscordant relationships.
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Affiliation(s)
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Amrita Daftary
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu Natal, Durban, South Africa.
| | - Sanjana Mitra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Joel Pidutti
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Dan Allman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Adam Bourne
- Sigma Research Group, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Rongkavilit C, Wang B, Naar-King S, Bunupuradah T, Parsons JT, Panthong A, Koken JA, Saengcharnchai P, Phanuphak P. Motivational interviewing targeting risky sex in HIV-positive young Thai men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:329-340. [PMID: 24668304 PMCID: PMC4177013 DOI: 10.1007/s10508-014-0274-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/08/2013] [Accepted: 08/29/2013] [Indexed: 05/28/2023]
Abstract
Motivational interviewing (MI) has been shown to reduce sexual risks among HIV-positive men who have sex with men (HMSM) in the US. We conducted a randomized trial of Healthy Choices, a 4-session MI intervention, targeting sexual risks among 110 HIV-positive youth ages 16-25 years in Thailand. Risk assessments were conducted at baseline, 1 month, and 6 months post-intervention. This report presents the analysis of 74 HMSM in the study. There were 37 HMSM in the Intervention group and 37 in the control group. The proportions of participants having anal sex and having sex with either HIV-uninfected or unknown partners in past 30 days were significantly lower in Intervention group than in Control group at 6 months post-intervention (38 vs. 65 %, p = .04; and 27 vs. 62 %, p < .01, respectively). There were no significant differences in general mental health scores and HIV stigma scores between the two groups at any study visit. Thirty-five (95 %) HMSM in the Intervention group vs. 31 (84 %) in control group attended ≥ 3 sessions. Loss to follow-up was 8 and 30 %, respectively (p = .04). Healthy Choices for young Thai HMSM was associated with sexual risk reduction. Improvements in mental health were noted in Intervention group. Healthy Choices is a promising behavioral intervention and should be further developed to serve the needs of young HMSM in resource-limited countries.
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Affiliation(s)
- Chokechai Rongkavilit
- The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI, 48201, USA,
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Sanchez TH, Kelley CF, Rosenberg E, Luisi N, O'Hara B, Lambert R, Coleman R, Frew P, Salazar LF, Tao S, Clarke W, Del Rio C, Sullivan PS. Lack of Awareness of Human Immunodeficiency Virus (HIV) Infection: Problems and Solutions With Self-reported HIV Serostatus of Men Who Have Sex With Men. Open Forum Infect Dis 2014; 1:ofu084. [PMID: 25734150 PMCID: PMC4281805 DOI: 10.1093/ofid/ofu084] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/08/2014] [Indexed: 11/10/2022] Open
Abstract
Using only self-reported information likely overestimates lack of awareness of HIV status for black MSM. Estimates that also incorporate laboratory and case surveillance measures do not show significant racial disparity in lack of awareness of HIV status. Background Lack of human immunodeficiency virus (HIV) infection awareness may be a driver of racial disparities in HIV infection among men who have sex with men (MSM). Lack of awareness is typically measured by comparing HIV test result to self-reported HIV status. This measure may be subject to reporting bias and alternatives are needed. Methods The InvolveMENt study examined HIV disparities between black and white MSM from Atlanta. Among HIV-positive participants who did not report knowing they were positive, we examined other measures of awareness: HIV viral load (VL) <1000 copies/mL (low VL), antiretroviral (ARV) drugs in blood, and previous HIV case surveillance report. Results Using self-report only, 32% (62 of 192) of black and 16% (7 of 45) of white MSM were not aware of their HIV infection (P = .03). Using self-report and low VL, 25% (48 of 192) black and 16% (7 of 45) white MSM lacked awareness (P = .18). Using self-report and ARVs, 26% (50 of 192) black and 16% (7 of 45) white MSM lacked awareness (P = .14). Using self-report and surveillance report, 15% (28 of 192) black and 13% (6 of 45) white MSM lacked awareness (P = .83). Conclusions Self-report only may overestimate true lack of awareness of HIV status for black MSM. If, as our data suggest, black MSM are not less likely to be aware of their HIV infection than are white MSM, then this factor is not a substantial driver of HIV disparity. Future HIV research that depends on accurate measurement of HIV status awareness should consider including additional laboratory and case surveillance data.
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Affiliation(s)
- Travis H Sanchez
- Rollins School of Public Health , Emory University and Emory Center for AIDS Research
| | - Colleen F Kelley
- Rollins School of Public Health , Emory University and Emory Center for AIDS Research ; Division of Infectious Disease, Department of Medicine , Emory University School of Medicine
| | - Eli Rosenberg
- Rollins School of Public Health , Emory University and Emory Center for AIDS Research
| | - Nicole Luisi
- Rollins School of Public Health , Emory University and Emory Center for AIDS Research
| | - Brandon O'Hara
- Rollins School of Public Health , Emory University and Emory Center for AIDS Research
| | | | - Raphael Coleman
- Rollins School of Public Health , Emory University and Emory Center for AIDS Research
| | - Paula Frew
- Rollins School of Public Health , Emory University and Emory Center for AIDS Research ; Division of Infectious Disease, Department of Medicine , Emory University School of Medicine
| | | | - Sijia Tao
- Laboratory of Biochemical Pharmacology , Emory University , Atlanta, Georgia
| | - William Clarke
- School of Medicine , Johns Hopkins University , Baltimore, Maryland
| | - Carlos Del Rio
- Rollins School of Public Health , Emory University and Emory Center for AIDS Research
| | - Patrick S Sullivan
- Rollins School of Public Health , Emory University and Emory Center for AIDS Research
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O'Byrne P, Holmes D, Roy M. Counselling about HIV serological status disclosure: nursing practice or law enforcement? a Foucauldian reflection. Nurs Inq 2014; 22:134-46. [PMID: 25053169 DOI: 10.1111/nin.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2014] [Indexed: 11/28/2022]
Abstract
Recently, focus groups and qualitative interviews with nurses who provide frontline care for persons living with HIV highlighted the contentiousness surrounding the seemingly innocuous activity of counselling clients about HIV-status disclosure, hereafter disclosure counselling. These empirical studies highlighted that while some nurses felt they should instruct clients to disclose their HIV-positive status if HIV transmission were possible, other nurses were equally adamant that such counselling was outside the nursing scope of practice. A review of these opposing perceptions about disclosure counselling, including an examination of the empirical evidence which supports each point, revealed that the dichotomous arguments needed to be nuanced. The empirical evidence about serostatus disclosure neither supported nor refuted either of these assertions; rather, it substantiated parts of each. To create this understanding, both empirical and theoretical works are used. First, the results of empirical studies about serostatus disclosure, or lack thereof and HIV transmission is presented; as part of this, Marks and Crepaz's HIV disclosure and exposure framework is examined. Second, the work of Michel Foucault on disciplinary and pastoral power is drawn from. The outcome is a nuanced understanding about the interrelationships between disclosure counselling and nursing practice and a final interpretation about what this understanding means for public health practice.
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Affiliation(s)
- Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Marie Roy
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
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Cai Y, Lau JTF. Multi-dimensional factors associated with unprotected anal intercourse with regular partners among Chinese men who have sex with men in Hong Kong: a respondent-driven sampling survey. BMC Infect Dis 2014; 14:205. [PMID: 24735186 PMCID: PMC3996134 DOI: 10.1186/1471-2334-14-205] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/10/2014] [Indexed: 11/14/2022] Open
Abstract
Background The HIV prevalence and incidence among men who have sex with men (MSM) are high. Unprotected anal intercourse (UAI) with male regular partners (RP) is an important but under-emphasized risk behavior. The current study aimed to describe the prevalence of UAI with regular partner and the associated multi-dimensional factors with UAI among MSM in Hong Kong, China. Methods Respondent Driven Sampling method was used to recruit participants. A total of 285 participants were recruited, of whom 211 (75.1%) had had anal sex with RP in the last six months and their data were analyzed in this report. Weighed data were presented and logistic regression methods were fit. Results Participants’ high risk behaviors in the last six months included high prevalence of having had UAI with RP (45.8%), having had non-regular male sex partners (NRP: 27.3%) and UAI with such partners (18.9%). Adjusted for socio-demographic variables, factors associated with UAI with RP included: 1) substances use prior to having anal sex (65.7% versus 43.8%; AOR =2.36; 95% CI =1.07-5.18), 2) worry that condom use symbolizes mistrust (67.9% versus 44.3%; AOR = 2.91; 95% CI =1.19-7.10), 3) a lower perceived degree of the RP’s acceptance of condom use (91.7% versus 38.3%; AOR = 22.70; 95% CI =6.20-83.10), and 4) a higher level of impulsivity (61.1% versus 35.0%; AOR =4.02; 95% CI = 1.62-9.97). Two of these four variables, substances use (ORm = 2.28, 95% CI = 1.01-5.16) and perceived lower level of RP’s acceptance of condom use (ORm = 17.22; 95% CI = 5.06-58.62) were selected by the forward stepwise logistic regression model. Conclusions MSM with RP in Hong Kong is subjected to high risk of HIV transmission. Risk factors of UAI are multi-dimensional and interventions need to take into account factors of structural, interpersonal and individual levels.
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Affiliation(s)
| | - Joseph T F Lau
- Centre for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F,, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong 030000, PR China.
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Lewnard JA, Berrang-Ford L. Internet-based partner selection and risk for unprotected anal intercourse in sexual encounters among men who have sex with men: a meta-analysis of observational studies. Sex Transm Infect 2014; 90:290-6. [DOI: 10.1136/sextrans-2013-051332] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Maulsby C, Millett G, Lindsey K, Kelley R, Johnson K, Montoya D, Holtgrave D. HIV among Black men who have sex with men (MSM) in the United States: a review of the literature. AIDS Behav 2014; 18:10-25. [PMID: 23620241 DOI: 10.1007/s10461-013-0476-2] [Citation(s) in RCA: 262] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In 2006, Millett published a seminal literature review that examined 12 hypotheses to explain the high rates of HIV among black MSM. This paper augments Millett's article by reviewing the recent literature on behavioral, biomedical, structural, social contextual, psychosocial, and social network factors that affect HIV rates among black MSM. We searched three databases: PubMed, Scopus, and Google Scholar. First we searched all articles that included black or African American and MSM and HIV. We then searched the following terms for each area: behavioral (drug use during sex, crack cocaine use, and serosorting); biomedical (circumcision, STDs, and STIs); structural (access to care, HIV care, ART, HAART, patient-provider communication, HIV quality of care); social contextual (stigma, discrimination, internalized homophobia, internalized heterosexism, medical mistrust, social isolation, and incarceration); psychosocial (peer support and mental health); and social network (sexual mixing, partner characteristics, and social networks) factors. We identified 39 articles to include in this review. We found inconclusive evidence that incarceration, stigma, discrimination, social isolation, mental health disparities, or social networks explain the elevated rates of HIV among black MSM. We found evidence that the differences in rates of HIV between black and white MSM may be explained by differences in STIs, undiagnosed seropositivity, access to care and treatment services, and use of HAART. There is an overwhelming need for HIV testing, linkage to care, retention in care, and adherence programs for black MSM.
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[High-risk sexual behaviour by partner type among men who have sex with men]. Enferm Infecc Microbiol Clin 2013; 32:341-9. [PMID: 24246777 DOI: 10.1016/j.eimc.2013.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/15/2013] [Accepted: 09/26/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify factors associated with high risk sexual practices among men who have sex with men (MSM) in Spain. METHODS An online survey was conducted in 2010, which included, among others, questions on HIV/STI sexual behaviours and prevention needs. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status in the past year was defined as a high risk sexual behaviour. RESULTS Of the 13,111 participants, 49.4% had had sex with steady partners (SP) and 73.4% with non-steady partners (NSP) in the last 12months; and the prevalence of high risk UAI was 25.4% and 29.4%, respectively. Factors associated with high risk UAI with SP were: living in a city of less than 500,000 inhabitants (OR=1.42 <100,000 inhabitants), being out to no-one or only a few people (OR=1.42), and being HIV-positive with undetectable viral load among those with a high level of HIV/STI knowledge (OR=3.18). Factors associated with high risk UAI with NSP were mainly: having a higher number of sexual partners (OR=4.31 >50 partners), having used drugs for sex (OR=1.33), and at parties (OR=1.19), having a medium (OR=1.82) or low (OR=1.33) level of HIV/STI knowledge, and being HIV-positive (OR=1.56). CONCLUSIONS Among MSM, the prevalence of high risk sexual practices is high with both SP and NSP. Factors associated with high risk UAI vary by type of sexual partner (e.g., having HIV with an undetectable viral load). These must be taken into account when planning strategies for primary and secondary prevention.
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Murphy RD, Gorbach PM, Weiss RE, Hucks-Ortiz C, Shoptaw SJ. Seroadaptation in a sample of very poor Los Angeles area men who have sex with men. AIDS Behav 2013; 17:1862-72. [PMID: 22644067 DOI: 10.1007/s10461-012-0213-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Data from 635 very poor men who have sex with men (MSM) were used to identify seroadaptation with 1,102 male partners reported between 2005 and 2007 in Los Angeles as part of the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program. The mean age of the sample was 41.7 years; 53 % had experienced homelessness in the past year. Condoms were reported in 51 % of sexual events involving anal intercourse. HIV seroconcordance was reported in 41 % of sexual partnerships among HIV-positive participants. HIV-positive men were more likely to have oral-only or unprotected receptive anal intercourse and less likely to have unprotected insertive anal intercourse with HIV-negative or unknown partners compared to HIV-positive partners. Even in the face of poverty, HIV-positive MSM report mitigating risks of HIV-transmission though seroadaptation in the context of modest rates of condom use.
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Winter AK, Sullivan PS, Khosropour CM, Rosenberg ES. Discussion of HIV status by serostatus and partnership sexual risk among internet-using MSM in the United States. J Acquir Immune Defic Syndr 2012; 60:525-9. [PMID: 22549381 PMCID: PMC3404205 DOI: 10.1097/qai.0b013e318257d0ac] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Men who have sex with men (MSM), particularly black MSM, are disproportionally infected with HIV. Little is known about how discussion of HIV status between partners varies among MSM by race/ethnicity and by HIV transmission risk. Among a national survey of 2031 MSM reporting 5410 partnerships, black MSM, especially black HIV-positive MSM, serodiscussed with unprotected anal intercourse partners less than did white MSM. Although non-black HIV-positive, non-black HIV-negative MSM, and black HIV-negative MSM were more likely to report serodiscussion with unprotected anal intercourse partners, black HIV-positive MSM were not. Differential serodiscussion may play a role in explaining the racial/ethnic disparity in HIV incidence.
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Affiliation(s)
- Amy K Winter
- Department of Epidemiology, Emory University's Rollins School of Public Health, Atlanta, GA 30322, USA
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Tieu HV, Spikes P, Patterson J, Bonner S, Egan JE, Goodman K, Stewart K, Frye V, Xu G, Hoover DR, Koblin BA. Sociodemographic and risk behavior characteristics associated with unprotected sex with women among black men who have sex with men and women in New York City. AIDS Care 2012; 24:1111-9. [PMID: 22533637 PMCID: PMC3704079 DOI: 10.1080/09540121.2012.672723] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objectives of this cross-sectional study were to compare sociodemographic and risk behavior characteristics between black men who have sex with both men and women (MSMW) and those who have sex with men only (MSMO) and assess factors associated with having any unprotected vaginal and/or anal intercourse (UVAI) with women in the last 3 months. Data from 326 black men who reported recent unprotected anal intercourse with a man in an HIV behavioral intervention study in New York City were analyzed. Baseline characteristics were compared between MSMW and MSMO, and factors associated with having any UVAI in the past 3 months with women among MSMW were evaluated. In total, 26.8% reported having sex with both men and women in the last 3 months. MSMW were less likely to be HIV infected, use amyl nitrates, and have unprotected receptive anal sex with most recent male partner. MSMW were more likely to be over 40 years old and use heroin. A total of 55.6% of MSMW reported having UVAI with women in the last 3 months. Compared to MSMW having only protected sex, MSMW having any UVAI with women were less likely to be HIV infected and to disclose having sex with men to female partners; they were more likely to have greater than four male sex partners in the last 3 months. In conclusion, HIV prevention interventions among black MSMW should directly address the risk of HIV transmission to both their female and male partners. Disclosure of bisexuality to female partners may be an important component of future prevention efforts.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA.
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Abstract
OBJECTIVE To test a new behavioral intervention for black MSM in reducing sexual risk and increasing social support and intentions to use condoms. DESIGN A single-site, unblinded randomized trial in New York City with 3-month follow-up. METHODS Participants (n = 283) reporting at least two sexual partners and unprotected anal intercourse with a man in the past 3 months were enrolled and randomized to a social-cognitive theory-based intervention or control comparison. Men in the intervention group participated in five 2-h group sessions focused on creating a group environment with sexual risk-reduction information and exercises woven into joint meal preparation and sharing activities, while exploring self-efficacy perceptions and outcome expectancies. Intervention (n = 142) and control (n = 141) groups received standard HIV counseling and testing at baseline. RESULTS No significant differences were found between study arms at 3 months in number of male partners, number of unprotected anal intercourse partners, proportion reporting unprotected sex, number of acts protected by condoms, self-efficacy, condom attitudes, condom intentions, social isolation and psychological distress. In both arms combined, declines from baseline to 3 months were observed in sexual risk behaviors, social isolation and psychological distress, whereas self-efficacy, condom attitudes and condom intentions improved. CONCLUSION As the HIV epidemic continues to have a dramatic impact on black MSM in the USA, the urgency to design innovative interventions continues.
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Berg RC, Ross MW, Tikkanen R. The effectiveness of MI4MSM: how useful is motivational interviewing as an HIV risk prevention program for men who have sex with men? A systematic review. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2011; 23:533-549. [PMID: 22201237 DOI: 10.1521/aeap.2011.23.6.533] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Among men who have sex with men (MSM), the principal risk practice for HIV infection is unprotected anal intercourse, often engaged in under the influence of alcohol and other substances. Both behaviors are targeted through the much-used counseling approach motivational interviewing (MI). We conducted a systematic review of the effectiveness of behavioral interventions adapting the principles and techniques of MI on HIV risk behaviors for MSM. Ten randomized controlled trials, which included 6,051 participants at baseline, were eligible for inclusion. Nine outcomes, of which seven were for sexual behavior outcomes, were sufficiently similar to compute meta-analyses. With the exception of one outcome, drinks per day at short-term follow-up, there were no significant differences between the groups receiving MI and the control groups. The effectiveness of MI as a prevention strategy for HIV risk behaviors among MSM is uncertain and continued work to craft more effective HIV prevention programming for this group should be done.
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Affiliation(s)
- Rigmor C Berg
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
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Kalichman SC, Pinkerton SD, Carey MP, Cain D, Mehlomakulu V, Carey KB, Simbayi LC, Mwaba K, Harel O. Heterosexual anal intercourse and HIV infection risks in the context of alcohol serving venues, Cape Town, South Africa. BMC Public Health 2011; 11:807. [PMID: 21999574 PMCID: PMC3207968 DOI: 10.1186/1471-2458-11-807] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 10/14/2011] [Indexed: 11/10/2022] Open
Abstract
Background The most efficient sexual behavior for HIV transmission is unprotected receptive anal intercourse. However, it is unclear what role heterosexual unprotected anal sex is playing in the world's worst HIV epidemics of southern Africa. The objective is to examine the prevalence of heterosexual unprotected anal intercourse among men and women who drink at informal alcohol serving establishments (shebeens) in South Africa. Methods Cross-sectional surveys were collected from a convenience sample of 5037 patrons of 10 shebeens in a peri-urban township of Cape Town, South Africa. Analyses concentrated on establishing the rates of unprotected anal intercourse practiced by men and women as well as the factors associated with practicing anal intercourse. Results We found that 15% of men and 11% of women reported anal intercourse in the previous month, with 8% of men and 7% of women practicing any unprotected anal intercourse. Multiple logistic regression showed that younger age, having primary and casual sex partners, and meeting sex partners at shebeens were independently associated with engaging in anal intercourse. Mathematical modeling showed that individual risks are significantly impacted by anal intercourse but probably not to the degree needed to drive a generalized HIV epidemic. Conclusions Anal intercourse likely plays a significant role in HIV infections among a small minority of South Africans who patronize alcohol serving establishments. Heterosexual anal intercourse, the most risky sexual behavior for HIV transmission, should not be ignored in HIV prevention for South African heterosexuals. However, this relatively infrequent behavior should not become the focus of prevention efforts.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT 06269, USA.
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