Risky sexual behaviour in context: qualitative results from an investigation into risk factors for seroconversion among gay men who test for HIV

Factors Associated with Condom Use in Anal Intercourse Among Spanish Men Who Have Sex with Men: Proposal for an Explanatory Model

Men who have sex with men (MSM) account for more than half of the new HIV diagnoses in Spain. This study aims to carry out a descriptive analysis of the sexual practices and frequency of condom use of MSM and identify the variables that explain inconsistent condom use during anal intercourse. The sample consists of 405 men between 18 and 60 years of age (M = 28.94; SD = 9.35). The results indicate that the percentage of consistent condom use is 72.9% for anal intercourse. Lack of risk perception, high self-esteem, and greater sensation-seeking are risk factors for risky sexual behavior. In contrast, high levels of sexual assertiveness and self-efficacy are protective factors. The proposed model explains between 33.8 and 49.2% of the variance. These findings highlight the importance of designing and implementing condom promotion programs for MSM who engage in anal intercourse with specific sections that consider the acquisition of assertive skills and reduce the risks associated with a perceived invulnerability to HIV.

The Impact of Pre-Exposure Prophylaxis (PrEP) Use on Sexual Anxiety, Satisfaction, and Esteem Among Gay and Bisexual Men

Gay and bisexual men (GBM) with heightened fears of human immunodeficiency virus (HIV) acquisition have reported high levels of sexual anxiety and low sexual self-esteem. Similarly, sexual satisfaction has been reported to be lower among some GBM who rely solely on condom use as HIV prevention. We sought to explore whether pre-exposure prophylaxis (PrEP) had an impact on the sexual satisfaction, anxiety, and esteem of GBM. As part of a longitudinal cohort study of 1,071 GBM, participants reported at three time points on PrEP use and completed the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ). A total of 137 GBM began taking PrEP in the 24 months following baseline. Comparing their responses during times before initiating PrEP and after, within adjusted multilevel models, there was a significant decrease in sexual anxiety (B = -0.27, p = 0.03) but no significant changes in sexual esteem or satisfaction. Our findings indicate important psychological improvements resulting from PrEP initiation. Further research should explore the potential for other psychological benefits of PrEP use among GBM.

A qualitative study exploring the social and environmental context of recently acquired HIV infection among men who have sex with men in South-East England

OBJECTIVES

A key UK public health priority is to reduce HIV incidence among gay and other men who have sex with men (MSM). This study aimed to explore the social and environmental context in which new HIV infections occurred among MSM in London and Brighton in 2015.

DESIGN

A qualitative descriptive study, comprising in-depth interviews, was carried out as a substudy to the UK Register of HIV Seroconverters cohort: an observational cohort of individuals whose date of HIV seroconversion was well estimated. An inductive thematic analysis was conducted in NVivo, guided by a socio-ecological framework.

SETTING

Participants were recruited from six HIV clinics in London and Brighton. Fieldwork was conducted between January and April 2015.

PARTICIPANTS

All MSM eligible for the UK Register Seroconverter cohort (an HIV-positive antibody test result within 12 months of their last documented HIV-negative test or other laboratory evidence of HIV seroconversion) diagnosed within the past 12 months and aged ≥18 were eligible for the qualitative substudy. 21 MSM participated, aged 22-61 years and predominantly white.

RESULTS

A complex interplay of factors, operating at different levels, influenced risk behaviours and HIV acquisition. Participants saw risk as multi-factorial, but the relative importance of factors varied for each person. Individual psycho-social factors, including personal history, recent life stressors and mental health, enhanced vulnerability towards higher risk situations, while features of the social environment, such as chemsex and social media, and prevalent community beliefs regarding treatment and HIV normalisation, encouraged risk taking.

CONCLUSIONS

Recently acquired HIV infection among MSM reflects a complex web of factors operating at different levels. These findings point to the need for multi-level interventions to reduce the risk of HIV acquisition among high-risk MSM in the UK and similar settings.

A Cross-Sectional Study on Selected Correlates of High risk Sexual Behavior in Polish Migrants Resident in the United Kingdom

Objective: To assess the correlates of the high risk sexual behaviors of Polish migrants in the United Kingdom (UK) after 2004, and to compare such behaviors before/after immigration. Methods: In 2013, a cross-sectional study was conducted through the use of a Computer-assisted web interviewing surveying technique with the use of a self-administered questionnaire. Results: Among 408 respondents (56.9% women), with a median age of 32 years, significantly more admitted to having unprotected sexual contact with a casual partner while in the UK (p < 0.0001) than while in Poland; more were engaged in sex after the use of recreational drugs and alcohol (p < 0.0001 and p = 0.001 respectively). Being a male was associated with greater odds of unprotected sex, sex after the use of alcohol, and having multiple partners. Being single and having only been a resident for a short time in the UK, presenting a lower self-esteem, were predictors of unprotected sex. A total of 19.6% of the respondents admitted to having been tested while in Poland, a lower (p < 0.0001) frequency than while in the UK (49.5%); this referred to both genders; 1.2% (95% CI: 0.79–2.83%) reported that they were HIV positive. Conclusions: Migration can create a vulnerability to STIs, especially for single male migrants with low self-esteem, staying in the UK for less than two years. The results point to strengthening strategies which help reduce high risk sexual behavior among Polish migrants, and to introduce interventions to promote an awareness of HIV sero-status.

Factors associated with visible anogenital warts among HIV-uninfected Peruvian men who have sex with men and transwomen: a cross-sectional study

BACKGROUND

Visible, anogenital warts may be associated with risk factors for HIV infection. This cross-sectional study examined the factors associated with visible anogenital warts among HIV-uninfected Peruvian men who have sex with men (MSM) and transwomen.

METHODS

Six hundred HIV-uninfected MSM and transwomen were recruited from a community-based setting in metropolitan Lima, Peru, through outreach activities. Participants were tested for syphilis, completed a behavioral questionnaire, and were examined for visible anogenital warts. Logistic regression was used to assess the independent association between sample characteristics, HIV-related risk factors, and visible anogenital warts.

RESULTS

A tertiary education versus a primary/secondary (adjusted odds ratio [AOR], 1.79; 95% confidence interval [CI], 1.07-2.99), a first experience of anal intercourse at age 20 years or older versus younger ages (AOR, 2.80; 95% CI, 1.45-5.38), and self-reporting of current sexually transmitted infection symptoms (AOR, 2.38; 95% CI, 1.61-3.52) were significant correlates of visible anogenital warts, whereas syphilis infection, transactional sex, receptive anal intercourse, and self-identifying as a transwoman were not.

CONCLUSIONS

Although not associated with key risk factors for HIV infection in Peruvian MSM and transwomen, the presence of visible anogenital warts should prompt clinicians to consider the possibility of unreported same-sex sexual behaviors and other risk sexually transmitted infection/HIV risk factors.

Opportunities for improving partner notification for HIV: results from a community-based participatory research study

To identify actionable opportunities for improving Partner Notification (PN) for HIV among men who have sex with men (MSM), we characterized the perspectives and experiences of PN among Medical Case Managers (case managers), Disease Intervention Specialists (DIS), and MSM. In partnership with an AIDS service organization and the Connecticut State Health Department, we conducted a focus group of case managers (n = 14) and in-depth interviews with DIS (n = 7) and MSM (n = 24). We found differences between MSM's and providers' (case managers and DIS) perspectives regarding (1) determinants of sexual risk behaviors; (2) considerations impacting HIV disclosure; and (3) barriers to trusting relationships between MSM and providers. Factors impacting MSM perspectives on PN were incompletely appreciated by both case managers and DIS. PN may be improved through improving provider understanding of the complexities for MSM regarding sexual risk behaviors and disclosure and transcending barriers to trusting relationships between MSM and providers.

Perceptions and attitudes about preexposure prophylaxis among seronegative partners and the potential of sexual disinhibition

OBJECTIVES

Preexposure prophylaxis (PrEP) is a promising strategy to prevent human immunodeficiency virus (HIV) infection, especially among high-risk individuals such as seronegative partners; however, many caveats such as the potential risk of sexual disinhibition and noncompliance need to be considered. We explored the sociodemographic and behavioral factors associated with the adoption of PrEP among HIV seronegative men who have sex with men and heterosexual partners.

METHODS

A prepiloted self-administered survey was conducted among seronegative partners in a Ryan White HIV/AIDS Clinic in South Carolina from 2010 to 2011. Bivariate and multivariable analyses were used to explore the data.

RESULTS

The survey was completed by 89 seronegative partners. The median age was 42 years (interquartile range 32-50) and a majority was men (56%), black (70%), and heterosexual (74%). A majority (94%) was willing to use PrEP if available; however, 26% of subjects suggested that they would be more likely to have unprotected sex with an HIV-positive partner while using PrEP, and 27% suggested that it would be difficult to take a daily dose of PrEP and consistently use condoms. The multivariable results suggest that the belief that a condom is no longer needed while taking PrEP was more likely among those who did not use a condom during their last sexual intercourse (adjusted odds ratio 7.45; 95% confidence interval 1.57-35.45) and among those with a higher HIV knowledge score (adjusted odds ratio 0.43; 95% confidence interval 0.23-0.78).

CONCLUSIONS

Overall, these results suggest high acceptability of PrEP among seronegative partners to lower the risk of HIV transmission; however, there is a substantial risk of sexual disinhibition and noncompliance while using PrEP that may be reduced by ongoing education.

Guidance and practice on frequency of HIV and sexually transmitted infection testing in men who have sex with men - what is the European situation?

Men who have sex with men (MSM) are at particular risk for HIV/sexually transmitted infections (STI). To investigate the European guidance used for MSM STI and HIV screening, risk level profiling and how this translated to practice, we conducted a questionnaire survey of leading physicians in the European branch of the International Union against Sexually Transmitted Infections (IUSTI). We identified that most European countries have limited guidance on screening intervals for MSM. Where risk profiling is advised, it is often left to clinicians to weight different behaviours and decide on screening frequency. Our results suggest that European MSM STI and HIV testing guidelines be developed with clear and specific recommendations around screening intervals and risk profiling. These guidelines will be particularly helpful due to rapidly evolving models of sexual healthcare, and the emergence of new providers who may benefit from guidelines that require less interpretation.

Factors associated with unprotected anal intercourse among men who have sex with men: results from a respondent driven sampling survey in Nanjing, China, 2008

Unprotected anal intercourse (UAI) is a well-documented risk factor for acquiring HIV, but not well-studied in China. We studied demographic and behavioral correlates for UAI among men who have sex with men (MSM) in a respondent-driven-sampling (RDS) survey in Nanjing, China. Four hundred and thirty MSM (including ten seeds) participated in this study, rendering an adjusted rate of UAI as 62.3 % (95 % CI 56.4-68.4 %). Adjusted HIV and syphilis prevalence rates were 6.6 % (95 % CI 3.0-10.4) and 12.6 % (95 % CI 8.1-18.3), respectively. HIV- and syphilis-positive cases were more likely to have engaged in UAI. Being unwilling to use condoms, meeting partners in non-conventional venues, having multiple male sex-partners in the past 6 months, having sex with regular and casual male partners in the past 6 months, and consumption of alcohol before sex were all positively associated with UAI. Based on the observed high prevalence of UAI among MSM in Nanjing, we can conclude that implementation of strategies to motivate MSM with high-risk behaviors to use condoms is urgently required in Nanjing.

Nomadic sexualities: an in-depth case study about unsafe sex

In an era when researchers are identifying increased rates of unsafe sex among gay and bisexual men, it is important that the practice of unsafe sex be adequately explored. While much literature is already dedicated to this topic, only recently have researchers begun to develop in-depth understandings of the personal meanings that people ascribe to unsafe sex. This study continues such explorations by examining (i) why one self-defined gay man engaged in unsafe sex, and (ii) how he defined unsafe sex. The findings suggest that, for this man, his sexuality is nomadic and that what he feels is unsafe sex is the outcome of his nomadic sexuality conflicting with social imperatives for sexual stratification.

Dilemma of concepts and strategies for the prevention of spread of HIV in relation to human behavior, law and human rights

The new prevalence data regarding the estimated global number of human immunodeficiency virus positive (HIV+) cases, i.e., including people who are either aware or unaware of their HIV infection in 2010, lead many to wonder why the increase in incidence has reached today's unprecedented level and escalated within such a short time. This, in spite of prevention campaigns in countries affected by HIV/acquired immune deficiency syndrome (AIDS) with their urgent messages aimed at preventing HIV transmission by promoting changes in individual's behavior. This article analyzes the background of the prevention strategies, in particular their political, social and legal concepts in terms of human rights, and reveals traits of human behavior not considered thus far. A radical reappraisal is necessary, at social and legislative levels, as well as options additional to current concepts. When ethical issues come up, they become blamed for outmoded moralistic positions. However, ignoring the reality has led to dire consequences from prioritizing individual human rights over society's collective need to prevent the spread of HIV.

Risk factors for HIV seroconversion in men who have sex with men in Victoria, Australia: results from a sentinel surveillance system

Objectives HIV diagnosis rates in men who have sex with men (MSM) began increasing in Australia 10 years ago, and there has been a major resurgence of syphilis. We determined predictors of HIV positivity and seroconversion among MSM in Victoria, Australia. Methods: We conducted a retrospective longitudinal analysis of data from MSM who underwent HIV testing between April 2006 and June 2009 at three primary care clinics. Logistic regression was used to determine predictors of HIV positivity and seroconversion. Results: During the study period, 7857 MSM tested for HIV. Overall HIV positivity was 1.86% (95% confidence interval (CI): 1.6–2.2). There were 3272 repeat testers followed for 4837 person-years (PY); 60 seroconverted and HIV incidence was 1.24 (95% CI: 0.96–1.60) per 100 PY. Independent predictors of HIV seroconversion were: an infectious syphilis diagnosis within the last 2 years (adjusted hazard ratio (AHR) = 2.5, 95% CI: 1.1–5.7), reporting six or more anal sex partners in the past 6 months (AHR = 3.3, 95% CI: 1.8–6.3), reporting an HIV-positive current regular partner (AHR = 3.4, 95% CI: 1.1–10.6) and reporting inconsistent condom use with casual partners in the past 6 months (AHR = 4.4, 95% CI: 1.7–11.5). Conclusion: Our results call for HIV prevention to target high-risk MSM, including men with a recent syphilis diagnosis or a high numbers of partners, men who have unprotected anal sex with casual partners and men in serodiscordant relationships. The HIV incidence estimate will provide a baseline to enable public health officials to measure the effectiveness of future strategies.

Condoms and developmental contexts in younger adolescent boys

BACKGROUND

Condom use is a key part of sexually transmitted infection (STI) prevention for young men. Yet little is known about how younger adolescent boys initially learn about and use condoms. We examined sources of information, attitudes towards, acquisition, practice and early use of condoms among 14-16-year-old boys.

METHODS

Thirty 14-16-year-old boys were recruited from a teen clinic serving a community with high STI rates and were asked open-ended questions about condoms, such as, "Where did you learn about condoms?" and "In what situations would you/would you not, use condoms." Interviews were audio recorded, transcribed and coded. Qualitative analysis focused upon key concepts and shared social cognitions related to condom use.

RESULTS

Both sexually inexperienced and experienced participants perceived that sex feels or would feel less pleasurable with condoms. For almost all participants, families were the primary source of both information about condoms and of condoms themselves. This information focused on pregnancy prevention, with STIs secondary. Participants' views of condoms fell into three developmental groups: not interested in condoms and equating their use with interest in sex; exploring condoms out of either curiosity or in preparation for sex; and experienced with condom use. Exploring included behaviours such as checking condoms out and trying them on.

CONCLUSIONS

Our findings of existing negative perceptions of condoms, the importance of families in learning about condoms and the developmental need to test and try on condoms before use have implications for adolescent STI prevention programmes.

Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS

BACKGROUND

New HIV infections are being observed among men who have sex with men (MSM). Understanding the fusion of risky sexual behaviors, stimulant and erectile dysfunction drug use with HIV seroconversion may provide direction for focused intervention.

METHODS

During the follow-up period (1998-2008), we identified 57 HIV seroconverters among 1667 initially HIV-seronegative men. Time to seroconversion was modeled using Cox proportional hazards regression analysis for 7 combinations of sex drugs (inhaled nitrites or "poppers", stimulants, and erectile dysfunction drugs) used at the current or previous semiannual visit, adjusting for other risk factors including sexual behavior, alcohol and other drugs used, and depression. Model-based adjusted attributable risks were then calculated.

RESULTS

The risk of seroconversion increased linearly with the number of unprotected receptive anal sex partners (URASP), with hazard ratios ranging from 1.73 [95% confidence interval (CI): 0.75 to 4.01] for 1 partner, to 4.23 (95% CI: 1.76 to 10.17) for 2-4 partners, and to 14.21 (95% CI: 6.27 to 32.20) for 5+ partners, independent of other risk factors. After adjustment, risks for seroconversion increased from 2.99 (95% CI: 1.02 to 8.76) for men who reported using stimulants only (1 drug) to 8.45 (95% CI: 2.67 to 26.71) for men who reported using all 3 sex drugs. The use of any of the 7 possible sex drug combinations accounted for 63% of the 9-year HIV seroincidence in the Multicenter AIDS Cohort Study. When contributions of increased URASP and combination drug use were analyzed together, the total attributable risk for HIV seroconversion was 74%, with 41% attributable to URASP alone and a residual of 33% due to other direct or indirect effects of sex drug use.

CONCLUSIONS

Use of poppers, stimulants, and erectile dysfunction drugs increased risk for HIV seroconversion significantly in this cohort. These data reinforce the importance of implementing interventions that target drug reduction as part of comprehensive and efficacious HIV prevention strategies.