Correlates of Unprotected Receptive Anal Intercourse Among Gay and Bisexual Men: Kampala, Uganda

We conducted a respondent-driven sampling survey (N = 215) to characterize correlates of risk for HIV infection among gay and bisexual men in Kampala, Uganda. We used RDSAT software to produce population estimates for measures and created exportable weights for multivariable analysis. Overall, 60.5% of gay/bi men identify as gay and 39.5% as bisexual; 91.6% are Ugandans. Unprotected receptive anal intercourse (URAI) was associated with identifying as gay, being younger and having had an HIV test in the past 6 months. Perceptions of being low risk to acquire or transmit HIV infection were paradoxically associated with higher likelihood of URAI. Programs to address risk of HIV infection among gay and bisexual men in Kampala need to address perceptions of risk among gay identified men.     

The association of sexual orientation with self-rated health,and cigarette and alcohol use in Mexican adolescents and youths

Evidence of health inequities associated with sexual orientation has been gathered for industrialized countries. The situation for lesbians, gay males, and bisexuals (LGB) from middle- or low-income countries may be worse than those in industrialized nations. Here, we analyze the relationship of sexual orientation with self-rated health and cigarette and alcohol use among a representative sample of Mexican adolescents and youths between the ages of 12 and 29 years, in order to explore whether this association is mediated by discrimination and violence. Three dimensions of sexual orientation (affective attraction, sexual behavior, and identity) were assessed. The outcomes were self-rated health and cigarette and alcohol use. Compared to heterosexuals, LGB youths more frequently smoked ≥6 cigarettes per day, reported having experienced family violence, having crimes perpetrated against them, and having experienced violations of their rights. Among males, gays and bisexuals exhibited a higher risk of poor health than heterosexuals. Compared to heterosexual women, lesbians and bisexual women were more likely to consume alcohol. Many differences in self-rated health and substance use according to sexual orientation were explained by having experienced discrimination and violence. We concluded that lesbian and bisexual females have a higher prevalence of cigarette and alcohol use. It is necessary to develop policies and programs aimed at the reduction of substance abuse among LGB youths (focusing on females who engage in sexual contact with persons of the same gender) and to work against discrimination and violence experienced by LGB people, particularly against non-heterosexual males.     

An Invisible Population: Older Lesbian,Gay, Bisexual,and Transgender Individuals

Abstract

The main purpose of an Antiarrhythmic Emergency Use clinical trial is to provide alternative treatment to patients who manifest life-threatening arrhythmias and who are intolerant or refractory to marketed drugs. Such large scale, open-labelled programs involve heterogeneous patient populations without comparable control groups. This paper will discuss problems associated with the research practices and suggest an approach to manage and analyze data from Antiarrhythmic Emergency Use clinical trials.     

Other-Sensitive Motivation for Safer Sex Among Gay Men: Expanding Paradigms for HIV Prevention

Self-interest is not the only motivator to sexual safety among sexually active gay men. Indeed, limits to a self-interest prevention paradigm are significant, and growing. Semi-structured qualitative interviews in two cities with an ethnically diverse cohort of mixed-status, sexually active gay men reveal a wide range of other-sensitive motivators beyond self-interest whose roles in men's HIV safety decisions have not been recognized. Other-sensitive motivations fall into several categories: altruistic concern for sex partners, personal ethical/moral values, expressed desire for communal/collective survival, concerns about self-definition, and elaborate concerns over the effects of potential HIV infection on family and friends. Other-focused concerns seem to operate as key motivators among these men, lowering risk. Implications of other-sensitive concerns for a new generation of prevention strategies are discussed.     

An Analysis of Respondent Driven Sampling with Injection Drug Users (IDU) in Albania and the Russian Federation

Internet access has caused a global revolution in the way people of all ages and genders interact. Many have turned to the Internet to seek love, companionship, and sex, prompting researchers to move behavioral studies online. The sexual behavior of men who have sex with men (MSM) has been more closely studied than that of any other group online given the abundance of gay-oriented websites and concerns about increasing transmission of HIV and other sexually transmitted infections. Not only does the Internet provide a new medium for the conduct of behavioral research and for participant recruitment into an array of research studies, it has the as yet unrealized potential to reach huge numbers of MSM with innovative harm reduction and prevention messages tailored to individualized needs, interests, and risk behavior. Internet-based research on sexual behavior has many advantages in rapidity of recruitment of diverse samples which include individuals unreachable through conventional methods (i.e., non-gay identified and geographically and socially isolated MSM, etc.). Internet-based research also presents some new methodologic challenges in study design, participant recruitment, survey implementation, and interpretation of results. In addition, there are ethical issues unique to online research including difficulties in verifying informed consent, obstacles to surveying minors, and the ability to assure anonymity. This paper presents a review of Internet-based research on sexual behavior in MSM, a general discussion of the methodologic and ethical challenges of Internet-based research, and recommendations for future interdisciplinary research. Dr. Parsons is with the Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter College and the Graduate Center of the City University of New York, NY; Dr. Tesoriero is with the Office of Program Evaluation and Research, New York State Department of Health AIDS Institute, Menands, NY; Dr. Carballo-Dieguez is with the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY; Dr. Remien is with the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY.     

'HIV is HIV to me': The meanings of treatment,viral load and reinfection for gay men living with HIV

This paper identifies some aspects of the risk management practices of HIV positive gay men in relation to HIV treatments and sexual practice. The paper uses qualitative methods to examine sexual practice and HIV transmission in relation to HIV blood test viral load information. Questions of reinfection with HIV are also examined. Open-ended interviews were conducted with 25 gay and other homosexually active men and analysed for relevant themes. Interviewees spoke of different approaches to risk assessment in relation to viral load and reinfection, drawing on their experiences and advice. This diversity is connected with various risk management 'styles' that reflected positions about HIV transmission risk, the characteristics of the partner and the sexual situation. Some implications for HIV prevention are identified, including the need to address the links between prevention and treatment. HIV prevention strategies will need to address development of education in relation to evolving knowledge about treatment technologies and connections with HIV transmission.     

Parents Know and Parents Matter; Is It Time to Develop Family-Based HIV Prevention Programs for Young Men Who Have Sex with Men?

We examined the potential for a family-based HIV prevention approach for gay and bisexually identified young men who have sex with men (MSM). The majority of our urban, ethnically diverse sample disclosed their sexual orientation to parents, who were generally supportive. Family connectedness significantly decreased the odds of an HIV positive status.     

Ligation of the patent ductus arteriosus in premature infants: Report of 45 cases

Ligation of the PDA in premature infants is well tolerated when there is no underlying pulmonary or CNS hemorrhage or bronchopulmonary dysplasia. Many premature infants require interruption of the large left-to-right shunting PDA in the management of intractable cardiorespiratory failure. Prompt interruption of large left-to-right shunts through the PDA in mechanically ventilated premature infants with severe RDS may prevent the development of severe bronchopulmonary dysplasia, a major cause of mortality among these infants.     

Illicit drug use among gay and bisexual men in 44 cities: Findings from the European MSM Internet Survey (EMIS)

BackgroundAnecdotal evidence suggests that men who have sex with men (MSM) are increasingly combining sex and illicit drugs (an activity referred to as ‘chemsex’), in particular GHB/GBL, ketamine, crystal meth, or mephedrone (here called 4-chems). Use of such drugs has been associated with mental health and sexual health harms. We aim to compare patterns of illicit drug use among MSM in 44 European urban centres.MethodsIn 2010, EMIS recruited 174,209 men from 38 countries to an anonymous online questionnaire in 25 languages. As harm reduction services for drugs and sex are organised at a local level, we chose to compare cities rather than countries. We defined 44 cities based on region/postal code and settlement size. For multivariable regression analyses, three comparison groups of MSM not living in these cities were applied: MSM living in Germany, the UK, and elsewhere in Europe.ResultsData from 55,446 MSM living in 44 urban centres were included. Use of 4-chems (past 4 weeks) was highest in Brighton (16.3%), Manchester (15.5%), London (13.2%), Amsterdam (11.2%), Barcelona (7.9%), Zurich (7.0%) and Berlin (5.3%). It was lowest in Sofia (0.4%). The rank order was largely consistent when controlling for age, HIV diagnosis, and number of sexual partners. City of residence was the strongest demographic predictor of chemsex-drug use.ConclusionUse of drugs associated with chemsex among MSM varies substantially across European cities. As city is the strongest predictor of chemsex-drug use, effective harm reduction programmes must include structural as well as individual interventions.     

Repeated Measures Analysis of Alcohol Patterns among Gay and Bisexual Men in the Momentum Health Study

Background: This study analyzed repeated study visits (n = 2,624) of 693 gay and bisexual men (GBM) in the Momentum Health Study from July, 2012 to June, 2015. Based on recent cross-sectional analyses, we hypothesized that over the study period: (1) hazardous drinking levels would remain high, (2) GBM classified as Hazardous Drinkers will be consistently associated with high risk sex, and (3) GBM classified as Always Hazardous Drinkers differ significantly from Sometimes Hazardous Drinkers. Methods: AUDIT classified participants as Non-Hazardous Drinkers or Hazardous Drinkers, the Cochran–Mantel–Haenszel Test assessed hazardous drinking trends, and Generalized Estimating Equations (GEE) analysis identified Hazardous Drinking covariates. Logistic regression analysis of participants with at least two study visits (575) compared those who were Sometimes Hazardous Drinkers (n = 171) with Always Hazardous Drinkers (n = 129). Results: At baseline 40% of participants were Hazardous Drinkers, but there was a significant decline in hazardous drinking by visit and Hazardous Drinkers were not significantly associated with high risk sex. Always Hazardous Drinkers had significantly more high risk sex and gay bar attendance, but less often sought Internet sex partners compared to Sometimes Hazardous Drinkers. Conclusions: Analyses did not support the first two hypotheses, but distinguishing between Always and Sometimes Hazardous drinkers identified a young GBM subgroup associated with significantly higher levels of high risk sex and social support measures. These results suggest interventions programs based on Social Norms Theory, which predicts peer norms among youth are important factors in regulating drinking patterns, may be effective for these men.