Increasing incidence of HIV infections among young gay and bisexual men in Vancouver.

Since the beginning of the HIV epidemic in north America, the majority of HIV infections have occurred among men who engage in sexual relations with other men. As the HIV epidemic enters its third decade, gay and bisexual men continue to have among the highest rates of HIV infection. Previous studies have highlighted the decline in the incidence of HIV and risk behaviour among gay and bisexual men. However, several studies have suggested that young gay and bisexual men continue to engage in unprotected sexual behaviours and are at continued risk of HIV infection. Recent reports in the media and research literature have indicated an increase in the incidence of HIV among gay and bisexual individuals in many of the world's major cities. The purpose of this study was to determine trends in HIV incidence using data from a prospective cohort of young gay and bisexual men.     

HIV prevention interventions with gay or bisexual men and youth

This article describes and reviews the findings of several well-designed and controlled outcome trials of HIV prevention interventions that have been undertaken with men who have sex with men. The interventions reviewed have been of two types: face-to-face group or workshop interventions and community-level programs undertaken in gay communities. Both have shown robust effectiveness in promoting risk reduction behavior change among gay men and young people at risk for contracting HIV infection. Conclusions can now be reached about the benefits of these types of interventions. However, there remains an urgent need to develop and tailor HIV prevention approaches that can promote the maintenance of behavior change; to reach community segments that remain vulnerable, especially young and minority men who have sex with men; and to address the changing context of the epidemic.     

Out of the closet and into the trenches: gay male Baby Boomers, aging, and HIV/AIDS

Regardless of HIV status, all gay male Baby Boomers are aging in a context strongly shaped by HIV/AIDS. For this subcohort within the Baby Boom generation, the disproportionately high volume of AIDS deaths among gay men aged 25-44 years at the epidemic's peak (1987-1996) created a cohort effect, decimating their social networks and shaping their personal and social lives during the epidemic, throughout their life course, and into later years. But despite these lasting effects on an entire cohort of gay men, relevant scholarship narrowly focuses on older HIV-positive gay men using clinical, psychological, and social network approaches. It thus makes inadequate use of the life course perspective, which, by attention to timing, agency, and interdependence, can uncover the myriad interlocking and longitudinal aspects of the epidemic that affect this group. This article argues for the application of this latter approach to research into the lasting impacts of HIV/AIDS on this cohort of gay men. We examine HIV/AIDS mortality within this cohort at the epidemic's height, these deaths' concentration in urban gay communities, and the growing and increasingly diverse population of HIV-positive gay men born in the Baby Boom Years. Our conclusion suggests that a fuller examination of the role of HIV/AIDS in the lives of gay male Baby Boomers, using a life course perspective, is critical to appreciating this generation's heterogeneity and to expanding knowledge of how later life is shaped by the intersection between historical events, personal biography, and social and community ties.     

Conceptualizing and developing behavioral HIV prevention interventions for black gay men

ABSTRACT

In the United States, Black gay men continue to be disproportionately affected by HIV and their HIV incidence rates rival those of developing countries. Yet there are only two federally approved HIV prevention interventions that specifically target Black gay men. As a way of filling the gap, HIV/AIDS social workers can modify existing or develop “homegrown” behavioral HIV prevention interventions to assist their clients. This conceptual article outlines the authors’ eight-step process of developing a theory-based, gender- and culturally-appropriate behavioral intervention for Black gay men. This model can help social workers and agencies fill the need for “homegrown” HIV prevention interventions.     

Resilience as a Research Framework and as a Cornerstone of Prevention Research for Gay and Bisexual Men: Theory and Evidence

This commentary presents the content and results of a recent symposium held to discuss how resiliencies among gay and bisexual men, and other men who have sex with men, could inform HIV prevention interventions. We outline the argument for including resiliencies in prevention work and present a critique of the deficit-based approached to public health research as it applies to this line of inquiry. The commentary makes the case that HIV prevention work would be more efficacious if it were designed to incorporate naturally occurring resiliencies that manifest among gay male communities rather than primarily using interventions that address vulnerabilities among men who continue to reside in high risk contexts. The commentary concludes by listing a set of resiliency variables and constructs proposed at the meeting that could be tested in theoretically-based investigations to raise resiliencies among gay and bisexual men thereby lowering HIV risks in this population.     

Coming Out in a Hostile Social Environment

Abstract

Young people below the age of 24 years account for almost half of all new HIV infections in the United States; young men who have sex with men are disproportionately represented among this population (Centers for Disease Control, 2000). The major assertions of this article are: (1) the social context of coming out may be vital to the overall psychological health and well-being of gay youth and, in turn, to their HIV risk behavior; and (2) coming out is a multifaceted developmental process: different pathways of coming out may be related to different types and determinants of HIV risk behavior. Evidence of a milieu of stigmatization, anti-gay hatred, harassment and violence among gay youth suggests that merely addressing HIV risk with even high quality individual-level interventions that myopically focus on sexual behavior may be insufficient. Interventions targeting anti-gay attitudes and behaviors in families, schools and communities, as well as combating discriminatory social policies and institutions, may be a vital aspect of HIV prevention for gay youth.     

Behavioral intervention for meth-using MSM. Researchers want to spread word

While there is no shortage of substance abuse treatment programs, it's rare that such interventions focus on the particular problems involving methamphetamine abuse, a problem that new research indicates is linked to HIV transmission among men who have sex with men (MSM) across the country. However, researchers in Los Angeles have developed a program that targets the meth-abusing gay men specifically.     

It Gets Better: Resolution of Internalized Homophobia Over Time and Associations with Positive Health Outcomes Among MSM

Health disparities research among gay and bisexual men has focused primarily on risk and deficits. However, a focus on resiliencies within this population may greatly benefit health promotion. We describe a pattern of resilience (internalized homophobia (IHP) resolution) over the life-course and its associations with current health outcomes. 1,541 gay and bisexual men from the Multi-Center AIDS Cohort study, an ongoing prospective study of the natural and treated histories of HIV, completed a survey about life-course events thought to be related to health. The majority of men resolved IHP over time independent of demographics. Men who resolved IHP had significantly higher odds of positive health outcomes compared to those who did not. These results provide evidence of resilience among participants that is associated with positive health outcomes. Understanding resiliencies and incorporating them into interventions may help to promote health and well-being among gay and bisexual men.     

The promise of outreach for engaging and retaining out-of-care persons in HIV medical care

From the beginning of the HIV/AIDS epidemic, outreach workers have been on the frontlines of HIV prevention, working in community venues to increase knowledge and promote behaviors to reduce HIV transmission. As demographics of the HIV-infected population have changed, the need has grown to locate out-of-care individuals and learn how to engage and retain them in HIV care. Through the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Outreach Initiative, 10 sites across the United States implemented and evaluated enhanced outreach models designed to increase engagement and retention in HIV care for underserved, disadvantaged HIV-infected individuals. Although the models differed in response to local needs and organizational characteristics, all made use of a common conceptual framework, and all used the same data collection and reporting protocols. Study teams enrolled and provided behavioral interventions to HIV-infected individuals who have been noticeably absent from research and from practice. Their interventions incorporated coaching, skills-building, and education, and were successful in reducing or removing structural, financial, and personal/cultural barriers that interfered with equitable access to HIV care. Desired outcomes of increased engagement and retention in HIV health care were achieved. Results demonstrate that interventions to promote equitable access to HIV care for disadvantaged population groups can be built from outreach models. Qualitative and quantitative analysis of the multisite data indicates that further development and evaluation of outreach-based interventions will result in effective tools for reaching HIV-infected individuals who would otherwise remain without needed care.     

Experiences of and responses to social discrimination among Asian and Pacific Islander gay men: their relationship to HIV risk.

As the HIV/AIDS epidemic enters its third decade, rates of infection continue to rise in ethnic minority populations. Though the prevalence of HIV among Asian and Pacific Islander (A&PI) gay men remains to be clearly documented, research has shown that these men engage in relatively high rates of HIV risk behavior. The social discrimination that minority gay men experience may impact their HIV risk behavior and mental health (Diaz & Ayala, 2001). This article examines the experiences of and response to social discrimination among A&PI gay men, and their links to HIV risk behaviors. The study analyzes 166 narrative episodes of discrimination, as well as data on HIV risk obtained from in-depth interviews with 23 A&PI gay men. Results showed that A&PI gay men experience types of discrimination across a variety of contexts. Homophobia and anti-immigrant discrimination were linked to confrontation and social network-based responses whereas discrimination based in stereotypes of passivity / submission were linked with self-attribution. A&PI gay men who used confrontational, social network-based or avoidance response types showed less HIV risk than those who did not. Conversely, A&PI gay men who responded to discrimination with self-attribution showed greater HIV risk behaviors. These findings indicate that experiences of social discrimination and responses to discrimination may impact A&PI gay men's well-being and health.     

Report from the AIDS Impact Conference: the post-AIDS era and the effect of treatment advances

This article presents highlights of the AIDS Impact Conference. The effects of HIV treatment advances and the concept of a "post-AIDS era" were major topics of the conference. As highly active antiretroviral treatment (HAART) improves therapy outcomes, many AIDS agencies are shifting focus from physical health issues to mental health concerns and prevention efforts. However, in developing countries, drugs, physicians, and a medical infrastructure are often inaccessible. Therefore, focusing on prevention, nutrition, and family relationships may be the better approach for dealing with AIDS and HIV in these countries. Related conference topics included HIV prevention programs directed toward HIV-positive individuals, challenges to adherence, and whether HIV is a chronic manageable disease. Due to lack of scholarships, many individuals from developing countries could not attend the conference and most presentation pertained to the effects of HIV in developed countries and to gay men.     

Responsibility for HIV prevention: patterns of attribution among HIV-seropositive gay and bisexual men.

The Seroconversion Narratives for AIDS Prevention (SNAP) study elicited narratives from recently infected seropositive gay and bisexual men that described the circumstances of their own seroconversion. This analysis of the narratives explored participants' attributions of responsibility for HIV prevention before and after they became infected. Before becoming infected with HIV, responsibility for prevention was often attributed to HIV-negative individuals themselves. These retrospective attributions revealed themes that included feelings of negligence, a sense of consequences, followed by regret. After seroconversion, responsibility for HIV prevention was primarily attributed to HIV-positive individuals themselves. Themes within these attributions included pledges to avoid HIV transmission, a strong sense of burden related to the possibility of infecting someone, and risk reduction strategies that they implemented in an attempt to avoid HIV transmission. Greater understanding of ideas related to responsibility has the potential to increase the effectiveness of HIV prevention interventions.     

Sexual sensation seeking, reduced concern about HIV and sexual risk behaviour among gay men in primary relationships

Gay and bisexual men who indicated they were currently in a primary relationship with another man (N = 230) completed measures of HIV treatment attitudes, sexual risk behaviour and sexual sensation seeking. Results indicate non-primary partner sexual activity is common in many gay relationships and men in non-exclusive relationships possessed greater levels of sexual sensation seeking and treatment-related reduced concern about the dangerousness of HIV than men in exclusive relationships. Results also suggest that individuals who were members of HIV-seroconcordant relationships were more likely to engage in unprotected sexual activity with their primary sexual partners than gay men who were members of HIV-discordant couples. A series of regression analyses revealed that reduced concern about HIV mediated the relationship between sexual sensation seeking and sexual risk behaviour. The next generation of HIV prevention interventions must address the attitudinal shifts that have occurred among some gay men regarding the seriousness of HIV and should be sensitive to the dynamics of gay relationships.     

Sexual dysfunction in gay and bisexual men with HIV infection: evaluation, treatment and implications

Sexual dysfunction problems are common in people with HIV infection, but their relevance has been recently highlighted in response to the increased survival shown by many individuals with HIV, and the publicity surrounding the development of new treatments for male sexual dysfunction. Thirty-four gay/bisexual men with HIV infection presenting with sexual dysfunction were assessed. Antiretroviral combination therapy including protease inhibitors was taken by 44%, other combinations not including protease inhibitors by 24%, while 32% were not taking any antiretrovirals. Primarily psychogenic sexual dysfunction was thought to be present in 44%, primarily organic dysfunction in 22% and a mixed aetiology in 34%. Treatments offered included psychological interventions and physical methods of treatment, alone or in combination. Treatment was effective, with 76% reporting resolution of the problems, 14% reporting improvement and only 10% reporting no change. Practical and ethical issues raised by the findings are discussed.     

Serostatus and counseling

Seroconcordance and serodiscordance are important issues in counseling for both HIV-positive and HIV-negative gay men. Just as gay psychotherapists have used self-disclosure as a tool to help clients feel understood, serostatus disclosure by therapists could also be beneficial. By serving as role models, counselors can help gay men remain uninfected and help men with AIDS take care of themselves. At the same time, counselors can aid both infected and affected men in maintaining a sense of hope and intimacy. Role modeling has been useful for many HIV-negative gay men, who often feel abandoned by communities and social services that focus on the needs of the HIV-positive community. As a result, mental health and social service providers have begun developing services, including support groups, particularly for HIV-negative gay men.     

Promoting the sexual health of MSM in the context of comorbid mental health problems

Despite the moderate efficacy of HIV prevention interventions for at risk gay, bisexual, and other men who have sex with men (MSM), MSM continue to represent the largest group of new HIV infections and the largest number of individuals living with HIV in the US. Environmental factors such as sexual minority stress increase the vulnerability of MSM for mental health problems. These mental health problems can be a barrier to consistently engaging in self-care health behaviors such as sexual risk reduction. We consider the following observations critical to identifying priorities for HIV prevention among MSM: (1) gay, bisexual and other MSM have higher rates of mental health problems than general population estimates; (2) these mental health problems co-occur with each other and interact synergistically to increase HIV risk; and (3) comorbid mental health problems may compromise the impact of prevention programs, and integrating treatment of mental health issues into prevention programs may improve program efficacy. Novel prevention interventions for at risk MSM that integrate programming with the treatment of co-occurring and interfering mental health issues are the most promising avenue to increase prevention intervention efficacy and effectiveness. By addressing significant mental health issues and supporting broad based prevention efforts at the individual and community level, there is also the potential to improve the overall quality of life and public mental health of gay, bisexual, and other MSM.     

“It’s Like Our Own Little World”: Resilience as a Factor in Participating in the Ballroom Community Subculture

We are well into the third decade of the HIV epidemic. While strides have been made in HIV prevention, rates for African American men who have sex with men (AAMSM) and young AAMSM continue to increase—perhaps indicating that traditional deficit-approaches of HIV prevention are not effective for all populations. Following a recent call to investigate the resiliency of young gay men, this study identifies sources of resilience and strength within the House and Ball communities, a subculture comprised primarily of AAMSM. The mixed-methods design included survey data (N = 263) collected at community events, interviews with Ball attendees and focus group data with House members. Survey data indicate a relationship between participating in the House and Ball communities and seeking support, acceptance and entertainment. Qualitative data validate these findings and provide detail on motivations for AAMSM to participate and the perceived benefits of participation. Findings are discussed in relation to building strengths-based interventions, using concepts of resiliency including shamelessness, social creativity, social support and volunteerism.     

Educational status and young Dutch gay men's beliefs about using condoms

The higher levels of HIV risk behaviour that have been found in young gay men with lower socio-economic status (SES, among others defined as educational achievement) may result from unequal effects of safer sex interventions. We conducted semi-structured focus group interviews with an educationally diverse sample of 113 young gay men living in The Netherlands. The objective was to bring to light men's salient ('accessible') beliefs about using condoms since information about beliefs might facilitate the formulation of 'personally relevant' safer sex messages that enhance in-depth message processing. We found several educational differences in the areas of knowledge about HIV preventive behaviour, cognitive schemas about the factors involved in HIV transmission, perceived pros and cons of using condoms, perceived social pressure to use condoms and feelings of being in control of protective action. This may suggest that, for intervention efforts to be effective in motivating the diversity of young gay men to engage in safer sex, interventions should convey tailor-made messages that match recipients' educational degree. Several implications for the formulation of such messages are discussed.     

HIV Prevention Interventions for Adolescents and Young Adults: What About the Needs of Gay and Bisexual Males?

While rates of HIV infection among gay/bisexual male adolescents have been increasing in the U.S., there has not been a commensurate increase in the development of HIV prevention interventions targeted specifically for this population. This editorial review examines primary HIV prevention interventions published in peer-reviewed journals between 1991 and 2010 in order to explore the differential focus on heterosexual versus gay/bisexual male adolescents/young adults. Of the 92 articles reviewed, only 5 (5.44 %) included interventions that addressed gay/bisexual sexual orientation or same-gender sexual activity. HIV prevention interventions developed for adolescents/young adults in the U.S. are not targeting those at highest risk of infection. Recommendations for addressing this gap are discussed.     

Experiences of families caring for an HIV-infected child in KwaZulu-Natal, South Africa: an exploratory study

In South Africa, 2.5% of children are living with HIV. KwaZulu-Natal is the province most affected by the epidemic and has the highest number of pregnant women living with HIV. This study reports on a qualitative study to assess the views and experiences of those involved in caring for a child with HIV/AIDS. In-depth interviews were conducted in KwaZulu-Natal with 13 women who were the primary caregivers of a child with HIV/AIDS and 12 key informants who worked with children and families living with HIV/AIDS. The combination of widespread poverty and HIV-related stigma was perceived to compromise the health of a child with HIV/AIDS. Caregivers' primary focus was on economic survival and there was little income to meet basic human needs including the child's. Stigmatizing attitudes caused some caregivers to keep their child's sickness a secret and symptoms were sometimes ignored or treatment delayed. Little material and emotional support was available to caregivers who were overwhelmed by multiple stresses in this context. Support group interventions for caregivers of children with HIV/AIDS can be a useful resource provided that they jointly address the economic and psychological needs of caregivers. A stronger commitment at the national level to reduce poverty and HIV-related stigma is needed to strengthen the capacity of families who are caring for children with HIV/AIDS.