Condom use and perceived risk of HIV transmission among sexually active HIV-positive men who have sex with men

Perceived risk of COVID-19 diagnosis and stigma among Nigerians

The World Health Organization (WHO) classified Nigeria as one of the 13 African countries with a higher risk of spreading COVID-19. Although the Nigerian government and its health agencies set directives in place to help curb the spread of COVID-19, there are instances of unconcerned attitudes and adherence to false and superstitious beliefs surrounding COVID-19 among Nigerians. The current study examined the general perception of COVID-19 risk among Nigerians. Additionally, it examined the fear of possible stigmatization if an individual is diagnosed with COVID-19. A cross-section of 332 Nigerian men and women responded to measures on perceived vulnerability to diseases, perception of risk of being infected with COVID-19, COVID-19 stigma, and social and demographic characteristics. The findings show that respondents with a higher perception of vulnerability to diseases reported higher COVID-19 risk and perception of COVID-19-related stigma. Further, we found that gender, age, and education impacted COVID-19 risk and perception of COVID-19-related stigma. Our findings suggest that risk perceptions and attitudes towards COVID-19 can impact the level of preparedness against a pandemic. Also, the findings could inform strategies for the proper implementation of health protective measures at national, state, and local government levels during a viral outbreak.

Older Adults Vastly Overestimate Both HIV Acquisition Risk and HIV Prevalence in Rural South Africa

Perceptions of HIV acquisition risk and prevalence shape sexual behavior in sub-Saharan Africa (SSA). We used data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa baseline survey. Data were collected through home-based interviews of 5059 people ≥ 40 years old. We elicited information on perceived risk of HIV acquisition and HIV prevalence among adults  ≥ 15 and ≥ 50 years old. We first describe these perceptions in key subgroups and then compared them to actual estimates for this cohort. We then evaluated the relationship between sociodemographic characteristics and accurate perceptions of prevalence in regression models. Finally, we explored differences in behavioral characteristics among those who overestimated risk compared to those who underestimated or accurately estimated risk. Compared to the actual HIV acquisition risk of < 1%, respondents vastly overestimated this risk: 35% (95% CI: 32-37) and 34% (95% CI: 32-36) for men and women, respectively. Respondents overestimated HIV prevalence at 53% (95% CI: 52-53) for those ≥ 15 years old and 48% (95% CI: 48-49) for those ≥ 50 years old. True values were less than half of these estimates. There were few significant associations between demographic characteristics and accuracy. Finally, high overestimators of HIV prevalence tested themselves less for HIV compared to mild overestimators and accurate reporters. More than 30 years into the HIV epidemic, older people in a community with hyperendemic HIV in SSA vastly overestimate both HIV acquisition risk and prevalence. These misperceptions may lead to fatalism and reduced motivation for prevention efforts, possibly explaining the continued high HIV incidence in this community.

HIV Prevention Responsibility Beliefs Among Men Who Have Sex With Men in the PrEP Era

BACKGROUND

Beliefs regarding responsibility for preventing HIV transmission may differ between individuals and their sexual partners. We assessed HIV prevention responsibility beliefs among men who have sex with men (MSM) participating in the 2017 National HIV Behavioral Surveillance survey.

METHODS

MSM were recruited using time-location sampling at clubs, bars, and street locations in San Francisco. HIV prevention responsibility beliefs were assessed on a four-point scale (1 = strongly disagree to 4 = strongly agree). Associations were assessed using generalizing estimating equations to adjust for behaviors within multiple partnerships.

RESULTS

A total of 316 HIV-negative men and 76 HIV-positive men reported on 1336 partnerships. HIV-negative compared with HIV-positive men had higher endorsement of mutual responsibility (mean 3.7 vs. 3.5; P < 0.01). Both groups had similar levels of endorsing responsibility on the HIV-negative or HIV-positive partner. HIV-positive men endorsing equal responsibility were more likely to know their partner's HIV status (P < 0.01) and less likely to have serodiscordant condomless anal intercourse (CAI) (P < 0.01) than men who did not endorse equal responsibility. HIV-negative men in partnerships with pre-exposure prophylaxis (PrEP) use were more likely to know their partner's HIV status (P = 0.02) and have serodiscordant CAI (P = 0.04) than men not in partnerships with PrEP use.

CONCLUSIONS

HIV-negative and HIV-positive men accept responsibility for preventing HIV. The finding that HIV-negative men in partnerships with PrEP use who engage in serodiscordant CAI is concerning because they are still at risk for other sexually transmitted infections, which are presently at elevated levels in San Francisco and other US cities.

Brief Report: Assessing the Impact of Race on HIV/STI Risk Perceptions Among Young Men Who Have Sex With Men Using an Experimental Approach

BACKGROUND

This study explores how character race may influence HIV/sexually transmitted infection (STI) risk perceptions of young men who have sex with men (MSM), using a social experimental study design.

METHODS

A sample of 134 MSM were recruited to participate in a 30- to 45-minute, in-person laboratory study at 3 Midwest universities. Data were collected from July 2015 to June 2016. Participants were randomly assigned to 1 of 3 experimental conditions. Each participant read and listened to 9 behaviorally specific vignettes describing sexual encounters between 2 male-identified characters. Vignettes were identical across all conditions with only the race and character name manipulated for condition. Participants were asked to rate the likelihood of HIV/STI transmission for each vignette using a 5-point Likert scale (1 = very unlikely and 5 = very likely).

RESULTS

Across all 9 vignettes, HIV/STI transmission risk was rated significantly higher in vignettes in which both characters were identified as Black compared with vignettes where both characters were White. For 8 of the vignettes, participants rated HIV/STI risk significantly higher among interracial character vignettes compared with vignettes in which both characters were identified as White. Overall, significant differences had medium effect sizes for each statistical comparison (0.065 ≤ η ≤ 0.124).

CONCLUSIONS

MSM may associate character race with HIV/STI risk even when behaviorally specific information is available. More specifically, MSM may be more likely to associate Black/African American men with higher HIV/STI risk compared with White men, regardless of sexual behavior (eg, oral sex and condomless anal sex) or engagement with HIV/STI prevention strategies (eg, condoms, pre-exposure prophylaxis, and antiretroviral therapy use).

Quantification of risk perception: Development and validation of the construction worker risk perception (CoWoRP) scale

INTRODUCTION

The construction sector is leading in the number of accidents and fatalities; risk perception is the key to driving these numbers. Previous construction safety studies on risk perception quantification have not considered affective risk perception of construction workers or conducted comprehensive reliability and validity testing. Thus, this study aims to fill this need by developing a psychometrically sound instrument - the Construction Worker Risk Perception (CoWoRP) Scale - to assess the risk perception of construction workers.

METHOD

Four phases of scale development, namely, item development, factor analysis, reliability assessment, and validity assessment were conducted with the collection and testing of data from a group (n = 469) of voluntary construction workers in Hong Kong.

RESULTS

The CoWoRP Scale with 13 items was shown to have acceptable test-retest reliability, internal consistency reliability, as well as content, convergent, discriminant, and criterion-related validity. Also, the CoWoRP Scale was affirmed to have three dimensions of worker risk perception, namely risk perception - probability, risk perception - severity, risk perception - worry and unsafe. These three dimensions of worker risk perception were negatively correlated with their risk-taking behavior.

CONCLUSIONS

The CoWoRP Scale is a reliable and valid instrument for measuring the risk perception of construction workers and is expected to facilitate the construction safety studies that take risk perception of construction workers into account. Practical applications: The CoWoRP Scale could serve as an aptitude test to identify the characteristics of construction workers most likely to perceive lower risk in risky work situations. In turn, this information could help safety management provide safety training programs to those workers to enhance their risk perception and thereby minimizing their risk-taking behavior, reducing unnecessary training costs, and improving the construction safety performance.

Sexually transmissible infection control programs for men who have sex with men - what will they look like in 2020?

The resurgence of sexually transmissible infections among men who have sex with men is a concern for sexual health. Traditional strategies have relied on the promotion of condom use, regular testing, treatment, and partner management. Future sexually transmissible infection control programs must combine current prevention methods with novel approaches that target the providers, patients, and mechanisms of health care delivery.

Cognitive and Emotional Factors Associated with Sexual Risk-Taking Behaviors Among Young Men Who Have Sex with Men

Young men who have sex with men (YMSM) between the ages of 13 and 24 account for a disproportionate number of new HIV infections in the U.S. Recognizing the unique developmental circumstances that YMSM face and building on the dual-process model, it is important to consider the role of cognitive and emotional factors as well as self-efficacy to negotiate safer sex when understanding experiences of sexual risk-taking among YMSM. This article used structural equation modeling to examine how the decisional balance to use condoms (a cognitive factor) and limerence (an emotional factor) are both directly and indirectly associated with sexual risk-taking behaviors (the number of insertive and receptive condomless anal intercourse partners), with indirect effects occurring via limited self-efficacy to negotiate safer sex. Data were from a cross-sectional online survey of YMSM (aged 18-24) in the U.S. who did not report being in a romantic relationship. Analysis included a sample of 1084 single YMSM who had never tested positive for HIV and who had engaged in anal intercourse in the previous 2 months. Results indicated that the decisional balance to use condoms was both directly and indirectly associated with reduced sexual risk-taking behaviors. Limerence was not directly associated with sexual risk-taking behaviors; however, it was indirectly associated with sexual risk-taking behavior through limited self-efficacy to negotiate safer sex. These findings highlight the importance of considering both cognitive and emotional factors, as well as self-efficacy to use condoms, in the development and implementation of HIV prevention interventions for YMSM.

Sexual behaviours in the context of the Ebola virus disease (EVD) in Ghana

Evidence suggests that Ebola virus disease can be transmitted through unprotected sexual intercourse, in particular through contact with the semen of an infected person. Yet few studies examine sexual behaviours in the context of Ebola. Using data collected from 460 women and 340 men within 40 selected communities in the Greater Accra Region of Ghana, this study employed hierarchical linear modelling to examine individual and community-level factors that influence willingness to engage in behaviours that protect against the sexual transmission of Ebola. Results indicate that both individual and community-level factors are significant predictors of respondents' willingness to engage in preventive behaviours. Compared with those with no risks, female respondents with low and medium risk perceptions were significantly more likely to indicate they would use condoms to prevent the sexual transmission of Ebola (AOR = 2.23; p < 0.01). Compared with men who were very concerned, those who were not very concerned (AOR = 0.356; p < 0.01) and not at all concerned (AOR = 0.356; p < 0.05) about Ebola were significantly less likely to protect against the sexual transmission of Ebola. Female respondents in communities with high knowledge about Ebola were significantly more likely to engage in behaviours preventing the sexual transmission of Ebola virus disease (AOR = 1.93; p < 0.05).

Disclosure of newly diagnosed HIV infection and condom use at first sex after diagnosis: a study of young Black men who have sex with men

Background The first purpose of the present study was to determine whether young Black men who have sex with men (YBMSM) disclose their newly diagnosed HIV infection to a male or female partner, and to determine whether this disclosure is related to condom use; the second was to identify correlates of disclosing newly diagnosed HIV infection to male sex partners, including a measure of partner-related barriers to condom use.

METHODS

A sample of 125 HIV-infected YBMSM (age 15-29 years) provided cross-sectional data used for both study purposes. Recruitment occurred in a mid-size city in the southern US experiencing inordinately high prevalence and incidence rates of HIV among YBMSM. Significance was defined by an α level of <0.05.

RESULTS

Eighty-eight YBMSM (70.4%) indicated disclosing their newly diagnosed HIV status to the first male partner they had sex with after being diagnosed. Of these, nine (9.1%) reported that condoms were not used during ensuing sex with that partner. However, of the men not disclosing, 27.0% reported not using condoms for ensuing sex (P=0.009). Similar findings were observed relative to sex with females (P=0.057). Regarding the second study purpose, in addition to a protective effect of advancing age, men scoring at or above the median on a measure of partner-related barriers to condom use were 2.4-fold more likely to not disclose compared with men scoring below the median (P=0.04).

CONCLUSION

For YBMSM, a beneficial counselling objective relative to disclosing newly diagnosed HIV may be to help men resolve perceptions of partner-related barriers to condom use.

Using participant-empowered visual relationship timelines in a qualitative study of sexual behaviour

This study examines how the use of participant-empowered visual relationship timelines adds to the quality of an ongoing qualitative data collection in a case study examining the influence of emotions on sexual risk-taking and perceptions of HIV risk among men who have sex with men. Gay and bisexual men (n = 25) participated in a 10-week, three-phase study. During a baseline in-depth interview, participants created a visual timeline using labelled stickers to retrospectively examine their dating/sexual histories. Participants then completed three web-based quantitative personal relationship diaries, tracking sexual experiences during follow-up. These data were extracted and discussed in a timeline-based debrief interview. The visual cues assisted with data collection by prompting discussion through the immediate identification of patterns, opportunities for self-reflection, and rapport-building. The use of flexible data collection tools also allowed for a participant-empowered approach in which the participant controlled the interview process. Through this process, we learned strategies for improving a participant-empowered approach to qualitative research, including: allowing visual activities to drive the interview, using flexible guidelines to prompt activities, and using discrete imagery to increase participant comfort. It is important that qualitative data collection utilise more participatory approaches for gains in data quality and participant comfort.

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

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.

Loneliness, HIV-related stigma, and condom use among a predominantly rural sample of HIV-positive men who have sex with men (MSM)

Most previous studies of the sexual behaviors of men who have sex with men (MSM) living with HIV are based on samples recruited within relatively urban and suburban areas of the United States. Using an internet-based questionnaire, we assessed HIV-related stigma, loneliness, and event-level sexual behaviors in a sample of HIV positive MSM (n = 100) residing within a largely rural area in the Midwestern United States. HIV-related stigma was correlated with loneliness (r = 0.619, p < 0.01). Loneliness was negatively associated with condom usage with the most recent partner of unknown status (p < 0.05). Namely, a 1-unit increase in the UCLA loneliness score was met with a 10% decrease in odds of condom usage. Further studies are warranted that explore loneliness, within the context of HIV-related stigma, among HIV-positive MSM residing in rural areas. More refined data will inform clinical and social service practice, as they provide much-needed information on sexual health outcomes and experiences of an often underserved and under studied population.

Perceived susceptibility to AIDS predicts subsequent HIV risk: a longitudinal evaluation of jail inmates

Theories of health behavior change suggest that perceived susceptibility to illness precedes health-protective behavior. We used a cross-lagged panel design to explore the relationship between perceived susceptibility to AIDS, and HIV risk behavior pre-incarceration and post-release in a sample of 499 jail inmates, a group at high risk for HIV. We also explored moderators of this relationship. HIV risk was calculated with a Bernoulli mathematical process model. Controlling for pre-incarceration HIV risk, perceived susceptibility to AIDS predicted less post-release HIV risk; the reverse relationship was not supported. Consistent with health behavior change theories, perceived susceptibility seemed to partially guide behavior. However, this relationship was not true for everyone. African-Americans and individuals high in borderline personality features exhibited no relationship between perceived susceptibility and changes in HIV risk. This suggests that targeted interventions are needed to use information about risk level to prevent HIV contraction.

Perceptions of HPV, genital warts, and penile/anal cancer and high-risk sexual behaviors among men who have sex with men in Hong Kong

The prevalence of HIV and HPV is high among men who have sex with men (MSM) in China. It is unclear whether cognitive and affective responses related to HPV and HPV-related diseases are negatively associated with HIV-related risk behaviors among MSM. This cross-sectional study interviewed 449 adult Chinese MSM in Hong Kong. The prevalence of unprotected anal intercourse (UAI) and having had anal sex with more than one man in the last 6 months (multiple male sex partnerships) was 39.0 and 71.3 %, respectively. After adjusting for four significant background variables (education level, cohabitation with a man, exposure to HIV prevention materials, and HIV voluntary counseling and testing), variables negatively associated with UAI and/or multiple male sex partnerships included (1) correct HPV-related knowledge (AOR = 0.48-0.66), (2) perceived susceptibility (AOR = 0.32-0.55) and perceived severity (AOR = 0.12-0.60) related to HPV and HPV-related diseases, and (3) fear towards contracting genital warts and penile/anal cancer (AOR = 0.40-0.55). Perceived high chance of contracting HPV was positively associated with multiple partnerships (AOR = 4.74). It is possible to reduce HIV-related risk behaviors by increasing levels of knowledge, cognitions, and fear related to HPV and related diseases. It is important to integrate prevention of HIV with prevention of sexually transmitted infections. Such interventions are warranted.

Syphilis-related perceptions not associated with risk behaviors among men who have sex with men having regular male sex partner(s) in Nanjing, China

The prevalence of HIV among men who sex with men (MSM)has been increasing sharply in China. The prevalence of unprotected anal intercourse (UAI)among them is very high, especially when male regular sex partners are involved. Many MSM having regular sex partners are engaged in multiple sex partnerships, which often involved UAI. This study interviewed 168 MSM in Nanjing, China, having had anal intercourse with at least one male regular sex partner in the last six months. Amongst the participants, 52.4% reported having had UAI with male regular sex partners whilst 50.0% reported multiple male sex partnerships in the last six months. Multivariate analysis showed that monthly personal income higher than 2000 RMB (multivariate OR = 0.49, 95% CI: 0.26-0.96), HIV antibody testing in the last year (multivariate OR = 0.19, 95% CI: 0.06-0.60), sexual position being both insertive and receptive during anal sex with male sex partners in general (multivariate OR = 0.43, 95% CI: 0.18-0.99; reference group: with receptive position only) were associated with lower likelihoods of UAI. Syphilis-related perceptions, including knowledge, cognitions (perceived susceptibility, perceived severity, self-efficacy in avoiding syphilis infection and perceived infectivity and perceived syphilis-related norms among MSM in general)were not associated with risk behaviors (UAI and multiple male sex partnerships). Our sampled MSM are exposed to very high risk of HIV/STD transmission. We found no association between syphilis-related perceptions and the two types of risk behaviors. Future studies are warranted to understand such associations in the context of sexual intercourse with non-regular sex partners among MSM.

Oral versus anal sex at last encounter -- behavioral differences among men who have sex with men in the District of Columbia

Oral sex may be used as a form of harm reduction against HIV transmission. We compared characteristics of men who have sex with men (MSM) in Washington, DC having oral sex versus those having anal sex at last encounter. Data collected through National HIV Behavioral Surveillance in 2008 using venue-based sampling were used. Men ≥18 years old disclosing MSM behavior in the past year were analyzed (n=500); OraQuick and Western Blot confirmation were used to assess HIV status. Multivariable methods were used for data analyses by type of sex at last encounter. A total of 71.8% of MSM had anal sex and 28.2% reported oral sex at last encounter. Men reporting oral sex were more likely to be white, older, insured, HIV-negative, unaware of last partner's HIV status, have a main partner, and not be HIV tested in the previous year. Significant demographic and behavioral differences exist between MSM reporting oral or anal sex; further studies should assess whether oral sex is being used as HIV prevention among MSM.

Factors associated with condom use among young adult ecstasy users

OBJECTIVE

This paper examines the prevalence of and the factors associated with condom use in a sample of 283 young adult ecstasy users.

METHODS

The study, which relied upon targeted sampling and ethnographic mapping, took place between 2002 and 2004. It entailed conducting two-hour-long, face-to-face interviews in the Atlanta, Georgia metropolitan area.

RESULTS

Condom use was inconsistent; only 35.2% of all sex acts were protected. Using multiple regression, five factors were related to condom use: race (Caucasians used condoms less than other groups), income (lower income = greater condom use), relationship status (persons involved in relationships reported less condom use than those who were not "involved"), multiple sex partners (multiple sex partners = more condom use), and condom use self-efficacy (higher efficacy level = more condom use).

CONCLUSIONS

Condom use rates were not optimal in this population. In particular, targeted interventions are needed for Caucasian ecstasy users. Intervention efforts ought to address relationship (in)fidelity as it pertains to engaging in safer sex practices, especially among persons involved in relationships. Intervention efforts also need to work to increase condom use self-efficacy.

DIFFERENCES IN HIV RISK PRACTICES SOUGHT BY SELF-IDENTIFIED GAY AND BISEXUAL MEN WHO USE INTERNET WEBSITES TO IDENTIFY POTENTIAL SEXUAL PARTNERS

Men who have sex with men (MSM) account for the largest number of persons diagnosed with AIDS in the United States, with higher-than-average rates of drug use and unprotected sex being cited as the principal reasons underlying their high rates of HIV infection. Recent evidence has suggested that the use of Websites specifically designed to promote unsafe sexual practices (e.g., Bareback.com, BarebackRT.com, Bare4ever.com) may be particularly common among MSM, thereby fostering their risky behaviors. In light of these findings, the present study, which compares HIV risk behaviors sought by self-identified gay and bisexual men, is based on a content analysis of 1,316 ads/profiles posted on one of the most popular men who have sex with other men (MSM) Websites (namely, Bare-back.com) that specifically fosters unprotected sex. Ads/profiles were selected randomly based on the American ZIP code of residence. Data were collected between September 2006 and January 2007. Rates of advertised-for high-risk sexual behaviors were very high for gay and bisexual men alike, particularly for oral sex involving ejaculation into the mouth, anal sex involving ejaculation into the anus, multiple partner sex, and felching (i.e., eating ejaculatory fluid out of an anus into which at least one person previously ejaculated). Analytical comparisons of gay and bisexual men showed that, on various dimensions, the bisexual men in this sample had either similar or lower levels of sexual risk compared to the gay men. The HIV intervention-related implications of these findings are discussed.

HIV risk practices sought by men who have sex with other men, and who use internet websites to identify potential sexual partners

Men who have sex with men (MSM) account for the largest number of persons diagnosed with AIDS in the USA, with higher than average rates of drug use and unprotected sex being cited as the principal reasons underlying their high rates of HIV infection. Recent evidence has suggested that the use of websites specifically designed to promote unsafe sexual practices may be particularly common among MSM, thereby fostering their risky behaviours. In light of these findings, the present study is based on a content analysis of 1316 ads/profiles posted on one of the most popular MSM websites that specifically fosters unprotected sex. Ads/profiles were selected randomly based on the American ZIP code of residence. Data were collected between September 2006 and January 2007. Rates of advertised for high-risk sexual behaviours were very high, particularly for oral sex involving ejaculation into the mouth (88.0% for receptive oral sex, 77.4% for insertive oral sex), anal sex involving ejaculation into the anus (79.7% for insertive anal sex, 69.4% for receptive anal sex), multiple partner sex (77.9%) and felching (16.5%). A multivariate analysis of the correlates of sexual risk preferences identified seven factors that were related to a propensity towards enhanced sexual risk: younger age (beta = 0.12, P = 0.0001), not being African American (beta = 0.05, P = 0.0341), self-identification as a sexual 'bottom' (beta = 0.20, P = 0.0001), not caring about one's potential sex partners' HIV serostatus (beta = 0.15, P = 0.0001), preferring to have sex while under the influence of drugs (beta = 0.08, P = 0.0022), a greater involvement in and commitment to the use of the website to locate potential unprotected sex partners (beta = 0.16, P = 0.0001) and not being HIV-negative (beta = 0.08, P = 0.0081). The HIV intervention-related implications of these findings are discussed.

Young adult Ecstasy users and multiple sexual partners: understanding the factors underlying this HIV risk practice

The purposes of this study are to (1) examine the extent to which young adult Ecstasy users recently reported having had multiple sex partners and (2) identify the factors predictive of engaging in this behavior. Potential predictors included demographic characteristics, background and experiences measures, childhood maltreatment experiences, substance use variables, and measures assessing psychological/psychosocial functioning. This research is based on a sample of 283 young adult recurrent users of the drug, Ecstasy. Study participants were recruited in Atlanta, Georgia between August 2002 and August 2004 using a targeted sampling and ethnographic mapping approach. Interviews took approximately two hours to complete. Nearly one-third of the study participants had more than one sex partner during the preceding month, and sexual protection rates tended to be low. Multivariate logistic regression analysis revealed seven predictors associated with an increased likelihood of having multiple sex partners: (1) being nonwhite, (2) knowing someone who was HIV-positive, (3) younger age of first sexual experience, (4) using Ecstasy for its touch-enhancing qualities, (5) higher self-esteem, (6) handling disagreements more dysfunctionally, and (7) not being involved in a romantic relationship. The HIV prevention- and intervention-related implications of these findings are discussed.