Recent multiple sexual partners and HIV transmission risks among people living with HIV/AIDS in Botswana

BACKGROUND: HIV prevalence in Botswana is among the highest in the world and sexual networking patterns represent an important dimension to understanding the spread of HIV/AIDS. AIM: To examine risk behaviour associated with recent multiple sexual partnerships among people living with HIV/AIDS in Botswana. METHODS: Confidential brief interviews were administered to 209 HIV positive men and 291 HIV positive women recruited conveniently from HIV/AIDS support groups and antiretroviral clinics. Measures included demographics, duration of HIV diagnosis, sexual partnerships, condom use, and HIV status disclosure. RESULTS: The response rate was 63% and 309 (62%) participants were currently sexually active, of whom 247 (80%) reported only one sex partner in the previous 3 months and 62 (20%) reported two or more partners during that time. Condom use exceeded 80% across partner types and regardless of multiple partnerships. Steady sex partners of participants with multiple partnerships were significantly less likely to be protected by condoms than steady partners of individuals with only one sex partner. Individuals with multiple sex partners were also significantly less likely to have disclosed their HIV status. CONCLUSIONS: Multiple sexual partnerships, many of which are probably concurrent, are not uncommon among sexually active people living with HIV in Botswana. HIV prevention is needed for all individuals who are at risk and assistance should be provided to HIV infected people who continue to practise unprotected sex with uninfected partners or partners of unknown HIV status.     

Disclosure of HIV status to sexual partners: predictors and temporal patterns.

BACKGROUND AND OBJECTIVES: Failure to disclose human immunodeficiency virus (HIV) infection to sexual partners interferes with risk reduction. GOAL OF THIS STUDY: The purpose of this study was to identify factors associated with disclosure and failure to disclose HIV infection to sexual partners and to describe condom use with nondisclosure. STUDY DESIGN: A longitudinal survey study of HIV seropositive persons recruited at a public STD clinic. RESULTS: Approximately 76% of the study population (n = 147) reported disclosing their HIV status to their last sex partner at baseline. Predictors of disclosure included consistent condom use and being in a monogamous relationship. Twenty-two percent of those who disclosed at baseline reported nondisclosure during follow-up. Approximately 23% reported not using a condom with a person to whom their status was not disclosed. CONCLUSIONS: These results suggest that ongoing partner notification may be necessary to increase disclosure of HIV status to sex partners over time.     

Sexual behaviour, condom use, and disclosure of HIV status in HIV infected heterosexual individuals attending an inner London HIV clinic

BACKGROUND: The National Strategy for Sexual Health and HIV for England (2001) emphasised the role of HIV services in reducing secondary transmission of HIV through prevention work with HIV infected people. OBJECTIVE: To determine the sexual behaviour, condom use, and disclosure of HIV status of HIV infected heterosexuals attending an inner London HIV clinic. DESIGN: Cross sectional questionnaire study of heterosexual HIV infected individuals attending an HIV outpatient clinic. METHODS: We collected demographic data for all respondents and sexual behaviour data for those sexually active over the past year using a self administered questionnaire. Viral load and CD4 count for responders and age, sex, ethnicity, viral load, and CD4 count for non-responders were obtained from the clinic database. RESULTS: The response rate was 47.3% (n = 142). 100 participants reported being sexually active in the past year, of whom 73% used condoms when they last had vaginal sex. Knowledge of partner's HIV status was the only variable significantly associated with the participant disclosing their HIV status to their partner (p<0.001). In those who had disclosed their status, only knowledge of partner's HIV status was significantly associated with condom use (p = 0.03). CONCLUSIONS: Issues relating to non-disclosure and partner notification in HIV infected heterosexuals will need to be better understood to improve sexual health in this group and to reduce onward transmission of HIV.     

Prevalence and correlates of HIV serostatus disclosure

BACKGROUND AND OBJECTIVE: A study of HIV-positive individuals in New Orleans, Louisiana, found that the majority of patients disclosed to their main partners and family members, but less than one fourth disclosed to any casual sex partner. Older age and lower CD4 cell counts were associated with disclosure. GOAL: The goal was to describe patterns of HIV serostatus disclosure among a diverse sample of patients at an HIV outpatient clinic in New Orleans, Louisiana. STUDY DESIGN: A convenience sample of HIV-seropositive patients provided information about disclosure of seropositivity, demographics, date of HIV diagnosis, CD4 cell count, mode of HIV acquisition, and sexual activity since HIV diagnosis. RESULTS: The 269 persons disclosed their HIV status to people in the following categories: main sex partner (74.2%), casual sex partner (24.8%), immediate family member (69.8%), other relative (27.0%), or friend (26.4%). Adolescents were less likely than adults to disclose to a main partner, immediate family member, or a friend. Immunosuppressed persons were more likely than nonimmunosuppressed persons to disclose to a main partner, immediate family member, or another relative. CONCLUSION: Many HIV-infected individuals delay disclosure until their disease has progressed. Interventions such as partner notification and skill-building to facilitate appropriate HIV disclosure are needed.     

HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa

OBJECTIVES: A cornerstone of HIV prevention in South Africa is voluntary HIV antibody counselling and testing (VCT), but only one in five South Africans aware of VCT have been tested. This study examined the relation between HIV testing history, attitudes towards testing, and AIDS stigmas. METHODS: Men (n = 224) and women (n = 276) living in a black township in Cape Town completed venue intercept surveys; 98% were black, 74% age 35 or younger. RESULTS: 47% of participants had been tested for HIV. Risks for exposure to HIV were high and comparable among people tested and not tested. Comparisons on attitudes toward VCT, controlling for demographics and survey venue, showed that individuals who had not been tested for HIV and those tested but who did not know their results held significantly more negative testing attitudes than individuals who were tested, particularly people who knew their test results. Compared to people who had been tested, individuals who were not tested for HIV demonstrated significantly greater AIDS related stigmas; ascribing greater shame, guilt, and social disapproval to people living with HIV. Knowing test results among those tested was not related to stigmatising beliefs. CONCLUSIONS: Efforts to promote VCT in South Africa require education about the benefits of testing and, perhaps more important, reductions in stigmatising attitudes towards people living with AIDS. Structural and social marketing interventions that aim to reduce AIDS stigmas will probably decrease resistance to seeking VCT.     

Recent HIV testing among young men who have sex with men: correlates, contexts, and HIV seroconversion

OBJECTIVES: We evaluated the correlates and contexts of HIV testing within the past year, subsequent risk reduction, and HIV seroconversion among young men who have sex with men (MSM). METHODS: Young men aged 23 to 29 years were approached, interviewed, counseled, and tested for HIV at 181 randomly sampled MSM-identified venues in six U.S. cities from 1998 through 2000. Analyses were restricted to 2,797 MSM who reported never testing HIV-positive. RESULTS: Of the 2,797 MSM, 1,281 (46%) either never previously tested or had not tested in the past year (never/remote testers); 1,516 (54%) had tested in the past year (recent testers); and 271 (10%) tested HIV-positive as part of the study. Of 1,885 recent sex partners reported by HIV-infected participants, 68% were partners of never/remote testers. Of recent testers, 50% tested anonymously, 51% tested because of specific risks, 59% were counseled, 47% reported reducing their risks after testing, and 8% tested HIV-positive (percent HIV-infected by race: blacks, 24%; Hispanics, 6%; whites, 4%; Asians, 1%). CONCLUSION: Nearly half of young MSM participants had not tested in the past year and HIV-infected never/remote testers accounted for approximately two thirds of recent partners potentially exposed to HIV. Of those who had tested recently, many MSM, especially those who are black, had already acquired HIV. To reduce HIV transmission and facilitate early diagnosis and entry into care, increased HIV testing among young at-risk MSM in the United States, especially those who are black, is needed.     

Sexually transmitted infections and sexual practices in injection drug users and their regular sex partners in Chennai, India

OBJECTIVE: Measuring sexually transmitted infections (STIs) and sexual practices in injection drug users (IDUs) and their regular sex partners. GOAL: Informing HIV intervention programs. DESIGN: Cross-sectional. RESULTS: One percent IDUs and 2% of their regular female sex partners were syphilis infected; 40% (84/211) and 38% respectively (81/211) were infected with HSV-2. 30% IDUs and 5% of their female regular sex partners were HIV positive. Serodiscordant results for syphilis and HSV-2 were noticed. Women having first sex at ageor=38 years had seven times the odds of having any non-HIV-STI. CONCLUSION: Reaching out to IDUs and their female regular sex partners with modified STI management guideline and promoting women-controlled safer sex measures are needed harm-reduction measures.     

Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men

OBJECTIVES: To estimate the percentage of men who have sex with men (MSM) who have used the Internet to look for sex partners and to examine the prevalence of risky sex among MSM who have and have not sought partners online. METHODS: Meta-analyses were conducted on findings from published English-language studies. High-risk sex was self-reported unprotected anal intercourse (UAI). Analyses were stratified by method of study recruitment (online versus offline venues) and participants' human immunodeficiency virus (HIV) status. RESULTS: In studies that recruited MSM offline, a weighted mean, based on 15 findings, indicated that 40% (95% confidence interval [CI], 35.2%-45.2%) of MSM had used the Internet to look for sex partners. In 3 findings from offline studies that stratified by participant HIV status, the weighted-mean percentage was higher among HIV-positive (49.6%; 95% CI, 44.9%-54.3%) than HIV-negative/unknown MSM (41.2%; 95% CI, 36.8%-45.6%). UAI with male sex partners was more likely among MSM who sought partners online than MSM who did not (odds ratio, 1.68; 95% CI, 1.18-2.40; k = 11). This group difference was observed for UAI with HIV-serodiscordant as well as HIV-seroconcordant partners, particularly among HIV-positive study participants. HIV-serodiscordant UAI was not more prevalent with partners met online than offline. CONCLUSIONS: A substantial percentage of MSM use the Internet to look for sex partners, and those who do are more likely to engage in unprotected sex. Additional research is needed to determine whether the Internet may increase risk behavior beyond that which occurs when men meet partners at offline venues.     

南宁市HIV感染者/艾滋病患者遭遇相关羞辱和歧视的影响因素调查研究

目的：了解南宁市HIV感染者/艾滋病患者遭遇的艾滋病相关羞辱和歧视的现状,并分析其产生相关羞辱和歧视的原因.方法：采用进行面对面的问卷调查方式,调查广西南宁市151例HIV感染者/艾滋病患者.结果：南宁市HIV感染者/艾滋病患者的文化程度、是否进行抗病毒治疗、职业及婚姻状况等因素可能与其产生自我相羞辱和歧视有关.结论：受教育的程度、社会网络及抗病毒治疗可能对HIV感染者/艾滋病患者产生自我羞辱和歧视有较大的影响,因此应加强对HIV感染者/艾滋病患者的艾滋病相关知识的宣传和教育以及足够的人文关怀,并培育公众的同情和互助意识,营造社会支持环境氛围,消除艾滋病歧视观念.     

HIV risk factors reported by two samples of male bathhouse attendees in Los Angeles, California, 2001-2002

BACKGROUND: We aimed to describe the use of voluntary HIV counseling and testing services, risk behaviors, and risk factors for unprotected anal sex (UAS) among men who have sex with men (MSM) who attended a bathhouse in Los Angeles during 2001-2002. METHODS: Using 2 cross-sectional study samples, we compared (in order below) 458 of 640 MSM who used voluntary HIV counseling and testing in the bathhouse with 398 MSM surveyed upon exit. Within each group, logistic regression identified factors associated with UAS at their most recent bathhouse visit. RESULTS: Of 640 MSM, 71 (11%) tested HIV-positive for the first time. Of the 50 HIV-positive MSM who completed a survey, 50% tested because of the convenient services. Similar proportions of MSM in both survey samples reported UAS (7%-8%) during their recent bathhouse visit. Risk factors associated with UAS in both survey samples were UAS with men outside the bathhouse and greater numbers of partners within the bathhouse. CONCLUSIONS: Comprehensive prevention services provided within bathhouses may reduce undiagnosed HIV infections among MSM, and targeting HIV prevention at the bathhouse may reduce risks with partners both inside and outside the bathhouse.     

HIV treatment adherence and unprotected sex practices in people receiving antiretroviral therapy

BACKGROUND: Poor HIV treatment adherence can result in the development of drug resistant strains of HIV and HIV positive people may transmit drug resistant virus to their sex partners. OBJECTIVE: To examine the association between HIV treatment adherence and sexual risk behaviour practices in people living with HIV-AIDS. METHODS: Surveys and interviews with 255 men and women living with HIV and receiving antiretroviral therapy. RESULTS: People who were currently taking antiretroviral medications and missed at least one dose of their medications in the past week scored significantly higher on a hopelessness scale and reported more current use of marijuana. People who had been non-adherent also reported significantly more sex partners, greater rates of unprotected vaginal intercourse, and less protected sex behaviours including less protected sex with partners who were HIV negative or of unknown HIV status. CONCLUSIONS: Associations between HIV treatment adherence and sexual transmission risk behaviours indicate the need for comprehensive and integrated health behaviour interventions for people living with HIV-AIDS.     

Don't ask, don't tell: patterns of HIV disclosure among HIV positive men who have sex with men with recent STI practising high risk behaviour in Los Angeles and Seattle

OBJECTIVES: A high incidence of HIV continues among men who have sex with men (MSM) in industrialised nations and research indicates many MSM do not disclose their HIV status to sex partners. Themes as to why MSM attending sexually transmitted infection (STI) clinics in Los Angeles and Seattle do and do not disclose their HIV status are identified. METHODS: 55 HIV positive MSM (24 in Seattle, 31 in Los Angeles) reporting recent STI or unprotected anal intercourse with a serostatus negative or unknown partner from STI clinics underwent in-depth interviews about their disclosure practices that were tape recorded, transcribed verbatim, coded, and content analysed. RESULTS: HIV disclosure themes fell into a continuum from unlikely to likely. Themes for "unlikely to disclose" were HIV is "nobody's business," being in denial, having a low viral load, fear of rejection, "it's just sex," using drugs, and sex in public places. Themes for "possible disclosure" were type of sex practised and partners asking/disclosing first. Themes for "likely to disclose" were feelings for partner, feeling responsible for partner's health, and fearing arrest. Many reported non-verbal disclosure methods. Some thought partners should ask for HIV status; many assumed if not asked then their partner must be positive. CONCLUSIONS: HIV positive MSM's decision to disclose their HIV status to sex partners is complex, and is influenced by a sense of responsibility to partners, acceptance of being HIV positive, the perceived transmission risk, and the context and meaning of sex. Efforts to promote disclosure will need to address these complex issues.     

Unsafe sexual behavior and correlates of risk in a probability sample of men who have sex with men in the era of highly active antiretroviral therapy

OBJECTIVE: To assess the levels and correlates of potential exposure to and transmission of HIV in a contemporary, community-based probability sample of men who have sex with men (MSM). METHODS: In 2003, 311 sexually active MSM participated in a random-digit dial telephone survey in Seattle neighborhoods with a high prevalence of MSM. The primary outcomes were potential exposure to and transmission of HIV, defined as unprotected anal intercourse with a man of opposite or unknown HIV status in the preceding 12 months. RESULTS: Fourteen percent of respondents reported being HIV-positive, 77% reported being HIV-negative, and 8% had not been tested. Of 241 HIV-negative MSM, 25 (10%; 95% confidence interval [CI], 7-15%) were potentially exposed to HIV; among 45 HIV-positive MSM, 14 (31%; 95% CI, 20-46%) were potential HIV-transmitters. Among HIV-negative men, the strongest bivariate correlates of potential exposure to HIV were recent bacterial sexually transmitted disease (odds ratio [OR], 5.8), number of recent male sexual partners (OR, 1.01 per partner), recent sex at a bathhouse (OR, 9.1), and recent use of sildenafil (OR, 4.4), amyl nitrite (OR, 6.2), and methamphetamine (OR, 8.0). Among HIV-infected men, the strongest correlates of potential HIV transmission were recent use of amyl nitrite (OR, 3.1), number of recent male sex partners (OR, 1.07 per partner), and having a male spouse or domestic partner (OR, 0.3). CONCLUSIONS: Most MSM knew their HIV status and adopted safer sexual behaviors to reduce their risk of HIV acquisition or transmission. However, 10% of HIV-negative MSM and 31% of HIV-positive MSM recently engaged in behaviors that placed them at high risk for acquiring or transmitting HIV.     

江西省2010年艾滋病疫情估计分析

目的：估计江西省艾滋病各类高危人群的规模并预测存活的艾滋病病毒感染者,病人人数,为艾滋病防治工作提供依据。方法：依据病例报告、哨点监测、专题调查等血清学数据,以县区为单位使用工作本簿方法（Workbook模型）进行艾滋病疫情估计。结果：江西省估计现有艾滋病病毒感染者和病人8241例,依次在嫖客（31．8％）、男男性行为者（23．9％）、外出务工者（15．7％）、吸毒者（10．9％）、高危人群性伴（10．5％）、暗娼（3．6％）中流行。结论：江西省艾滋病仍处于较低流行水平,性传播途径仍然是HIV感染的主要途径。     

Prevalence of risk factors for hepatitis C virus in HIV-infected and HIV/hepatitis C virus-coinfected patients

METHODS: A sample of patients with HIV completed a questionnaire identifying their demographic characteristics and risk factors for hepatitis C virus (HCV). A chart review was conducted to confirm the information obtained using the questionnaire. Risk factors associated with coinfection status at alpha level of 0.1 in univariate analysis were entered into a multivariate Cox regression model. RESULTS: Of the 242 HIV-positive patients analyzed, 168 were HIV-infected and 74 were HIV/HCV-coinfected. Risk factors that were significantly different between HIV-monoinfected and HIV/HCV-coinfected subjects included intravenous drug use, snorting drugs, sharing razors or toothbrushes, being in prison, the presence of one or more tattoos, sex for money or drugs, sex with an intravenous drug user and man who has sex with men. In a multivariate regression model, only intravenous drug use remained as a significant risk factor/predictor of HCV/HIV coinfection. A subanalysis identified risk factors more prevalent among coinfected men who have sex with men, including intravenous drug use, sharing razors/toothbrushes, tattoos, sex for money or drugs, sex with an intravenous drug user, and a history of having 11 or more sexual partners. A history of having had a sexually transmitted disease and 11 or more sex partners was more prevalent among HIV-monoinfected men who have sex with men. CONCLUSIONS: HIV/HCV coinfection was associated with intravenous drug use but not with sexual risk factors.     

青岛市吸毒者性行为特征及梅毒和艾滋病感染状况调查

目的:了解青岛市新型毒品吸食者的性行为特征并调查梅毒和艾滋病感染状况。方法:问卷调查新型毒品吸食者的性行为特征,并检测HIV和梅毒抗体。结果:共调查吸毒者564名,98.22%以吸食冰毒为主,54.09%最近1年有过临时性伴,55.14%最近1年发生过商业性性行为,15.60%最近1年提供过性服务;最近1个月有过性行为的人最近1次性行为安全套使用率为32.42%;HIV抗体阳性检出率为0.36%,梅毒阳性率为13.19%。结论:该人群以吸食新型毒品为主,梅毒流行率较高,应加强对该人群的宣传教育和行为干预,减少梅毒和艾滋病的发生率。     

HIV partner notification in the United States: a national survey of program coverage and outcomes

OBJECTIVE: The objective of this study was to define the scope and case-finding success of HIV partner notification (PN) in the United States. STUDY: The authors conducted an analysis of PN data from metropolitan areas >500,000 reporting > or =200AIDS cases in 2001. RESULTS: Data were collected from 28 (72%) of 39 eligible jurisdictions. In 22 jurisdictions with reportable HIV, health departments interviewed 32% of 20,353 persons with newly reported HIV. Among 6394 sex or needle-sharing partners, 19% had been previously HIV-diagnosed; 10% tested HIV-positive; 32% tested HIV-negative; and 39% were not notified, denied previous HIV diagnosis and refused HIV testing, or outcome was unknown. Health departments interviewed 13.8 persons to identify 1 new case of HIV (range, 1.0-196). Areas in which larger proportions of AIDS cases occurred among men who have sex with men reported less success identifying new cases of HIV through PN. CONCLUSIONS: HIV PN programs identify new cases of HIV but have variable success and affect a minority of persons reported with HIV.     

兰州市男男性接触者艾滋病知识知晓率及性行为危险性调查

目的了解兰州市男男性接触者(MSM)艾滋病知识知晓率及性行为危险性。方法采用全球基金艾滋病项目统一设计的调查问卷,对263名MSM进行匿名调查。结果最近6个月内,有201例(76.43%)与男性发生过性行为,74例(28.14%)与女性发生过性关系。除了与女性发生性行为时安全套使用率较高外,其余使用率都很低。调查者中H IV阳性2例,梅毒阳性9例。结论MSM是艾滋病传播的高危人群,应加大对这一人群的健康教育,采取适宜且实用的措施进行干预,以有效控制艾滋病、性病在这一人群中的传播与流行。     

Level of AIDS and HIV knowledge and sexual practices among sexually transmitted disease patients in China

BACKGROUND: Little is known about sex practices that increase the risk of contracting HIV infection or the level of HIV and AIDS knowledge among sexually transmitted disease (STD) patients in China. OBJECTIVE: To describe AIDS and HIV knowledge, sexual practices, and factors associated with never using condoms among patients at an STD clinic in Jinan, China. STUDY DESIGN: Clinic patients (n = 498) were randomly sampled to answer AIDS and HIV knowledge questions and to report sexual practices, including condom use. RESULTS: Patients had low levels of AIDS and HIV knowledge and engaged in high-risk sex behaviors. The majority of patients reported having had multiple sex partners. When having sex, few men and no women reported always using condoms. Gender, age, residence, AIDS and HIV knowledge, and having multiple sex partners were significantly associated with never using condoms. CONCLUSION: STD clinic patients report having engaged in high-risk sex behaviors. More research is needed to better understand the factors relevant to developing risk-reduction interventions for these patients in China.     

Prevalence of bisexual behaviors among men who have sex with men (MSM) in China and associations between condom use in MSM and heterosexual behaviors

OBJECTIVES: This study investigated the prevalence of bisexual behaviors and marital status among Chinese men who have sex with men (MSM) and the associations between MSM's condom use and their heterosexual behaviors. METHODOLOGY: Eight hundred ninety-six adult males in Yunnan Province, China, who reported to ever have engaged in MSM behaviors were interviewed. Data were acquired through the China-UK HIV/AIDS Prevention and Care Project from 2003 to 2006. RESULTS: Of all respondents, one-third had ever been married, 59% had ever engaged in bisexual behaviors, and 31% had done so in the past 6 months. High prevalence of inconsistent condom use was reported in heterosexual behaviors (71.9%), as well as with those who had engaged in MSM sexual behaviors in the past 6 months (30.8% with commercial sex workers and 54.7% with noncommercial sex partners) in the past 6 months. Those who did not use condoms with MSM partners were also more likely than others to not use condoms with their female sex partners (FSP). Those who had voluntary counseling and testing services were more likely than others to have used a condom in the last episode of sex with their FSP (multivariate odds ratio = 1.66). CONCLUSIONS: The clustering of unprotected sexual behaviors with male and FSP among bisexual MSM is revealed. The bridging effects of the risk for human immunodeficiency virus transmission from the MSM population to the female population are evident.