Psychological distress among Ugandan adolescents living with HIV: Examining stressors and the buffering role of general and religious coping strategies

HIV infection increases the risk of psychological distress among adolescents living with HIV (ALHIV), which, in turn, increases risky behaviours such as medication non-adherence, substance use, and sexual risk-taking. The majority of studies on psychological distress among ALHIV have been conducted in high-income countries; data on the prevalence and correlates of psychological distress among ALHIV in sub-Saharan Africa (SSA) are scarce, yet over two-thirds of the global population of ALHIV resides in SSA. The purpose of this study was to identify the contextually relevant correlates of psychological distress among Ugandan ALHIV. Utilizing the stress and coping framework, we explored the risk and protective factors for psychological distress in cross-sectional sample of 464 ALHIV (aged 12–19; 53% female) at a large HIV treatment centre in Kampala, Uganda. The stressors associated with psychological distress included daily hassles, major negative life events, HIV-related quality of life, and stigma. Protective factors included psychosocial resources such as religious coping, satisfaction with social support, and general coping style and behaviours. Social support and optimism were significantly associated with psychological distress. Findings underscore the need for mental health services for ALHIV in Uganda and other resource-limited settings.     

Body Mass Index,Body Esteem,and Unprotected Receptive Anal Intercourse Among Young Men Who Have Sex with Men Who Seek Partners Online

Research examining the relationship between body mass index (BMI) and sexual risk outcomes among men who have sex with men (MSM) has yielded inconsistent results. Using a web-based survey, single-identified (e.g., not in a relationship) young MSM (N = 431) between the ages of 18 and 24 years who sought romantic partners online were asked to respond to items regarding their BMI, body image (e.g., attribution, dissatisfaction, and pride), and sexual risk behaviors. We used Poisson regressions to examine the relationships between BMI, body image, and the number of unprotected receptive anal intercourse (URAI) occasions and partners in the past 2 months. We found a curvilinear relationship between BMI and URAI occasions, and a linear relationship between BMI and URAI partners. These relationships persisted after accounting for body image. Further, we found that body attribution served as a protective factor whereas body pride served as a risk factor. We discuss the implications of our findings for sexual health education and HIV prevention.     

The Use of Rectal Douches among HIV-uninfected and Infected Men who Have Unprotected Receptive Anal Intercourse: Implications for Rectal Microbicides

Although some rectal douches result in surface epithelium loss and potential increase of HIV transmission, men who have sex with men (MSM) continue to use them. We describe the prevalence of this practice among MSM engaging in unprotected receptive anal intercourse (URAI) in risky circumstances. A multiethnic sample with overrepresentation of HIV-negative MSM who had URAI in the previous year was recruited exclusively through the Internet. Participants were 105 MSM (78 HIV-negative, 27 HIV-positive). A total of 53% of HIV-negative and 96% of HIV-positive men douched in preparation for sex, most of them frequently or always, mainly for hygienic purposes. 27% of HIV-negative and 44% of HIV-positive douched after sex, partly believing douching protected from infections. Douching practices started around age 25. Regression analyses found the association between HIV status and douching occasions persisted after controlling for demographic characteristics and number of URAI occasions. Rectal douching in preparation for sex is common among men who practice URAI. This population could benefit from alternatives to condoms, such as rectal microbicides. Given the popularity of pre-coital douching and its frequency, a harmless rectal douche that could deliver a rectal microbicide could have great acceptability.     

Acceptability of a Dapivirine/Placebo Gel Administered Rectally to HIV-1 Seronegative Adults (MTN-026)

AIDS and Behavior - This study describes the acceptability of a rectal microbicide gel formulation using dapivirine (DPV) among men and women from two countries (United States and Thailand)...     

Romantic Ideation, Partner-Seeking, and HIV Risk Among Young Gay and Bisexual Men

Structural changes in the acceptability of same-sex relationships may provide young gay and bisexual men (YGBM) with opportunities to develop expectations about their ideal future relationships. Expectations about the future may act as a promotive factor in youths’ lives and reduce HIV risk-taking behaviors; however, few studies have examined the relationship between ideation of a future relationship and sexual behaviors of YGBM. In this study, we examined the relationship between romantic ideation (i.e., intimacy, passion, and commitment) and number of sexual partners in a sample of young men (N = 431; M age = 21.49 years; 88% self-identified as gay) who reported using the Internet to meet other men. Using multivariate Poisson regressions, we found a negative association between commitment and number of partners for unprotected sex, both receptive and insertive, in the past two months. We found similar results when we examined the association between relationship exclusivity and number of partners. These associations persisted after accounting for age, race/ethnicity, sexual identity, and hours spent seeking casual and romantic partners online. We found no significant association between number of partners and ideation of an intimate or passionate relationship, respectively. We discuss the implications of our findings and conclude that there is a need to consider and include YGBM’s expectations about the future in on-going HIV prevention programs.     

Purpose and mastery as predictors of perceived health and substance use problems

We explored whether purpose in life and mastery predicted perceived physical health and problematic substance use among a sample of emerging adults who reported ever using alcohol or drugs. We examined perceived stress and coping as potential mediators of these associations and explored whether parental support moderated any of these associations. In a sample of emerging adults from across the United States (N = 2,564; M _age = 20.87, standard deviation = 1.75; 49.6% male), purpose in life and mastery were associated with better‐perceived health and fewer negative consequences of drug use via lower perceived stress and coping. In addition, parental support modified the relationship between purpose in life and stress and coping. The findings suggest potential health benefits associated with a greater purpose in life and mastery and indicate that parental support may enhance these associations.     

Long-term health outcomes of childhood sexual abuse and peer sexual contact among an urban sample of behaviourally bisexual Latino men

While previous research indicates high rates of childhood sexual abuse among Latino men who have sex with men, few studies have examined the long-term health outcomes of childhood sexual abuse specifically among behaviourally bisexual Latino men. In a sample of 148 behaviourally bisexual Latino men in New York City, we examined associations between childhood sexual abuse and multiple dimensions of adult health: sexual risk behaviours; sexually transmitted infections incidence; polydrug use; depressive symptoms; and perceived stress. We compared outcomes between those with histories of childhood sexual abuse, those reporting peer sexual contact prior to age 13 and those with no sexual contact prior to age 13. Over one-fifth (22.3%) reported a history of childhood sexual abuse, which was significantly associated with engaging in receptive condomless anal intercourse (aOR = 3.59, p < .01, SE = 2.0), high perceived stress (aOR = 2.48, p < .06, SE = 1.13) and clinically significant depressive symptoms (aOR = 2.7, p < .05, SE = 1.25). Across all variables, peer sexual contact did not impact these outcomes, underscoring a key distinction between abusive and non-abusive early sexual experiences. We recommend that sexual abuse prevention policies and programmes better engage Latino youth, and that practitioners serving this population across diverse areas of practice incorporate childhood sexual abuse screening and culturally appropriate treatment and care into practice.     

Rekanalisation langstreckiger Oberschenkelarterien-Obliteration mittels endovasculärer PTFE-Stentprothese (Typ Gore Hemobahn) Eine Alternative zum femoropoplitealen P1-Bypass

A few months ago an endovascular implantable PTFE stent graft became commercially available. Since May 1998 we have treated 15 patients with extensive vascular occlusion at the femoropopliteal level. The implantation is carried out via a single inguinal approach in combination with conventional vascular surgical techniques like orthograde ringstripping of the superficial femoral artery, local TEA and patch-grafting of the femoral bifurcation, angioplasty, local lysis, etc. The self-expanding thin-walled PTFE stent prothesis appears to be a viable alternative to the femoropopliteal P1 bypass and can be performed under local anesthesia, percutaneously or through a small inguinal incision. The implantation can be carried out with minimal tissue trauma.