Sexual risk behaviour among gay men in a relationship.

OBJECTIVE: To examine whether gay men in a relationship have adopted negotiated safety as an HIV risk reduction strategy. METHODS: A confidential, anonymous questionnaire was completed by 1004 gay men attending gyms in central London in September-October 1997. Information was sought on sociodemographic characteristics, HIV testing and sexual risk behaviour. Men reporting unprotected anal intercourse (UAI) in the previous 3 months were classified as 'status-unknown' if they did not know their own HIV status, that of their UAI partner(s) or both. Men who knew their own and their UAI partner's HIV status were classified as 'status-known'. RESULTS: Of the 1004 men surveyed, 986 provided complete information on relationship, personal HIV test history and HIV status of UAI partner. Over half (539) said they were currently in a relationship with another man, of whom 173 reported UAI in the previous 3 months; 140 (80.9%) with their main partner only, 18 (10.4%) with a casual partner only and 15 (8.7%) with both their main and casual partners. Of the 140 men reporting UAI only with their main partner, 62 (44.3%) did not know their own HIV status or that of their partner. Overall, a quarter (26.0%) of the men in a relationship reported UAI only with their main partner in the previous 3 months; 11.5% status-unknown UAI, 14.5% status-known UAI. In a multivariate logistic model, both age and being in a relationship were significantly associated with UAI (status-unknown and status-known). CONCLUSION: Gay men in a relationship, surveyed in central London gyms, have for the most part adopted the first principle of negotiated safety: only to have UAI with their main partner. However, not all have embraced the second principle: to establish HIV seroconcordance. Nearly half the men reporting UAI only with their main partner were unaware of their own HIV status, their partner's or both. As a consequence, more than one in 10 men in a relationship reported high-risk (i.e. status-unknown) UAI with their main partner. Because the study population, from central London gyms, was not randomly selected, these findings may not be generalizable to all gay men in London. Nonetheless, HIV prevention programmes should continue to encourage gay men in a relationship to seek an HIV test and establish seroconcordance if they wish to have UAI with each other.     

Survey of risk behaviour and HIV prevalence in an English prison.

An anonymous, voluntary, linked cohort study was undertaken to determine the prevalence of HIV infection and identify risk factors for the spread of infection in an English prison. Three hundred and seventy-eight (68%) of the inmates participated. The HIV point prevalence was 0.26%. Injecting drug use (IDU) was the most significant HIV risk factor within 20% admitting IDU at any time, of whom 58% injected whilst in prison. Of those injecting in prison 73% shared needles. Two inmates admitted having sex with a male partner in prison. This study demonstrates that the potential exists in this setting for an outbreak of blood-borne virus infection; hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infection. Injecting drug use and needle sharing represent the greatest risk.     

Sexual behaviour, condom use and HIV risk situations in the general population of Quebec

We conducted 3501 telephone interviews to determine the sexual and protective behaviours of the general population in Quebec. Among the 858 respondents who had had at least one occasional partner during the last 5 years, 25.4% had had at least one occasional partner who refused to use a condom. More women had had an occasional partner who had refused than men (29.8% vs 21.1%, P<0.001) and fewer women than men succeeded in negotiating condom use, but more of these women decided not to have sexual relations. The frequency of condom use during the last sexual relation changes if the partner is a regular cohabiting partner (12.5%), a regular non-co-habiting partner (42.2%) or an occasional partner (70.8%). Our study provides important information for the development of prevention programmes for the heterosexual population and demonstrates the importance of the type of relationship maintained by the partners on the sexual behaviours.     

Quality of parent-child relationship and adolescent HIV risk behaviour in St. Maarten

The highest incidence rates of HIV/AIDS in the Caribbean are recorded in heterosexual and youth populations. With sparse prevention and intervention programmes in place, there is a pressing need to address the HIV/AIDS risk of youth. The objective of this analysis was to describe the extent of youth risk behaviour in St. Maarten and explore the relationship between quality of parental-child relationship and adolescent HIV risk behaviours. The sample consisted of 1,078 students (age range 14-18, mean 15.6 (s.d. 1.7). The data were collected by self-report survey in the Spring of 2001 in the classrooms of all seven secondary schools in St. Maarten. The survey instrument included demographic information, and used questions derived from the Center for Disease Control's (CDC) Youth Risk Behavior Survey (YRBS) to assess health risk behaviour prevalence, including tobacco, alcohol, and drug use, and sexual activity. The survey also asked youth to rate their relationship with their parents. Analysis showed a relatively high rate of risk behaviour in this school population. Multi-variate analysis showed that a 'great' relationship with both parents, as perceived by the student, was significantly associated with lower rates of tobacco and alcohol use as well as lower rates of sexual activity.     

HIV prevalence and risk behaviour among intravenous drug users attending HIV counselling and testing centres in Paris

This study was designed to analyse sexual and drug use behaviour, to determine whether increased awareness can lead to behaviour change, and to evaluate the association between HIV seropositivity and potential risk factors. A 4-month survey was carried out on 147 IVDUs attending three HIV counselling and testing centres, 98% of whom had been using heroin for an average of 7 years, 85% in association with other drugs. Two-thirds of injectors reported having used “safer” injecting practices in the previous year. Most of the IVDUs were heterosexual, and had had an average of three sexual partners in the previous year. More than half of them had had high risk partners. Condoms were used by only 25% of IVDUs, and were more likely to be used with seropositive partners (38% versus 12.7%, p = 0.02). Patients considering themselves to be well informed about HIV transmission shared syringes significantly less often, but had the same sexual behaviour patterns as other subjects. The HIV prevalence rate (8.2%) in our sample was not statistically related to any risk factor apart from drug use duration, the latter possibly reflecting a cumulative exposure to HIV risks. Since sexual risk appears to be a potential long-term hazard for IVDUs, it is important that more attention be paid to providing counselling to specifically address this issue.     

Trends in HIV testing and differences between planned and actual testing in the United States, 2000-2005

BACKGROUND: Increasing the rates of human immunodeficiency virus (HIV) testing among groups not traditionally perceived as being at high risk has been advanced as a primary strategy in the effort to combat the HIV epidemic. METHODS: We conducted a pooled cross-sectional analysis of data from 146 868 participants aged 18 to 64 years in the 2000-2005 National Health Interview Surveys to describe longitudinal trends in HIV testing rates in the US population and differences between planned and actual testing across demographic and risk groups. Multivariable logistic models were estimated to assess correlates of perceived risk for HIV infection and planned and actual HIV testing. Difference-in-differences models examine how differences between planned and actual testing varied with demographic characteristics, perceived risk, alcohol consumption, depression, and health behaviors and access. RESULTS: Rates of HIV testing remained relatively unchanged from 2000 to 2005 (mean rates for lifetime and past year, 37% and 10%, respectively) and varied substantially by sex and race, with female and minority (nonwhite) populations more likely to get tested. Rates were higher in individuals reporting greater risks of HIV infection. However, even among respondents reporting medium or high risks of contracting HIV, less than 25% reported an HIV test in the previous year. Those with a higher perceived risk, more alcohol consumption, and more depressive symptoms had higher rates of both planned and actual testing but also demonstrated the greatest deficit of actual relative to planned testing. CONCLUSIONS: In the United States, HIV testing rates remain low, nationally and in high-risk populations; low rates are likely contributing to a substantial number of undiagnosed cases of HIV. Despite above-average testing rates, populations considered to be at increased risk for HIV infection still demonstrate the need for improved access to and utilization of testing.     

Prevalence of the main cardiovascular risk factors in Morocco: results of a National Survey, 2000

OBJECTIVE: The aim of this study was to determine the prevalence of the main cardiovascular risk factors in Morocco and their distribution according to age, sex and residential area. METHODS: The study was conducted during the year 2000 on a Moroccan representative sample aged 20 years and over, considering the population distribution between urban and rural areas. The crude results were weighted according to the Moroccan population distribution by age and sex. In order to allow comparison with data from other countries, means and prevalence were standardized according to world population distribution by age. RESULTS: The participation rate was 90.1%. The prevalence of hypertension was 33.6% (30.2% for men and 37.0% for women). The means of systolic and diastolic blood pressure were 129.8 and 76.0 mmHg, respectively. The prevalence of diabetes was 6.6% and was similar for males and females. The prevalence of hypercholesterolaemia was 29.0%, and was higher in females. The means and prevalence of diabetes and hypercholesterolaemia were higher in urban areas. The prevalence of hypertension, diabetes and hypercholesterolaemia increased with age. The prevalence of obesity was markedly higher in females and in urban areas. The average body mass index was 23.8 and 25.6 kg/m2 in males and females, respectively. Thirty-four per cent of men smoked cigarettes, but women rarely smoked cigarettes (0.6%). CONCLUSIONS: The prevalence of cardiovascular risk factors was high in Morocco and it is necessary to increase action against the cardiovascular diseases and their risk factors.     

Sexual behaviour of drug injectors in London: implications for HIV transmission and HIV prevention

The importance of sharing infecting equipment in the transmission dynamics of HIV is well established. Comparatively less is known about the sexual behaviour of drug injectors and the risks posed to themselves and their sexual partners through the sexual transmission of HIV. Findings are reported from survey-based interviews undertaken in 1991 which investigated the sexual behaviour of 516 drug injectors, both in and out of treatment in London. The majority of respondents (80%) were sexually active in the 6 months preceding interview. During this time, respondents had a mean of 2.1 non-commercial opposite sex partners. Most (66%) had vaginal intercourse at least once a week, although 68% never used condoms with primary partners and 34% never used condoms with casual partners. Those having sexual intercourse most often were less likely to use condoms. Many had non-injecting sexual partners, and 62% of respondents' primary and casual partners did not inject drugs. Confirmed saliva HIV test results show 10% of respondents to be antibody positive, with a higher rate of prevalence (14% positive) among those with no experience of treatment. This group were also more likely la report casual sexual intercourse. The average rate of partner change, the high proportion of drug injectors with non-injecting partners and the infrequency of condom use within primary and casual relationships indicates the potential for HIV transmission between injectors and their non-injecting sexual partners. The paper concludes by emphasizing the importance of outreach and community-based intervention in safer sex health promotion.     

Prevalence of sexually transmitted infections with Chlamydia trachomatis,Neisseria gonorrhoeae,Mycoplasma genitalium and Trichomonas vaginalis: findings from the National Survey of Sexual Lifestyles,Attitudes and Health,Slovenia, 2016 to 2017

BackgroundTo inform prevention and control of sexually transmitted infections (STIs), we need reliable prevalence estimates.AimOne objective of the Slovenian National Survey of Sexual Lifestyles, Attitudes and Health was to estimate the prevalence of STIs with Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis.MethodsData were collected between October 2016 and July 2017 in a probability sample of the general population aged 18–49 years. Computer-assisted face-to-face interviewing and self-completion of questionnaires were used. Respondents were invited to provide urine samples to be tested for STIs.ResultsOf 1,929 survey participants, 1,087 individuals provided urine samples which were tested confidentially for C. trachomatis and a subset (n = 1,023) were tested anonymously for the other STIs. The prevalence of C. trachomatis was 0.5% (95% confidence interval (CI): 0.1–1.8) in men and 1.7% (95% CI: 0.9–3.2) in women. Age-specific prevalence was the highest among individuals aged 18–24 years, 2.8% (95% CI: 0.7–10.6) in men and 4.7% (95% CI: 1.7–12.3) in women. N. gonorrhoea was not detected. Prevalence of M. genitalium was 0.5% (95% CI: 0.1–2.2) in men and 0.3% (95% CI: 0.1–1.1) in women; the highest prevalence was among men aged 25–34 years (1.1%; 95% CI: 0.2–7.5) and women aged 35–49 years (0.5%; 95% CI: 0.1–2.0). T. vaginalis was detected in the sample from one woman (0.2%; 95% CI: 0.1–1.2).ConclusionThe substantial prevalence of C. trachomatis among young adults suggests gaps in testing, diagnosis and treatment.     

Sexual behavior of HIV discordant couples after HIV counseling and testing

BACKGROUND AND OBJECTIVES: Sexual behavior following voluntary HIV counseling and testing (VCT) is described in 963 cohabiting heterosexual couples with one HIV positive and one HIV negative partner ('discordant couples'). Biological markers were used to assess the validity of self-report. METHODS: Couples were recruited from a same-day VCT center in Lusaka, Zambia. Sexual exposures with and without condoms were recorded at 3-monthly intervals. Sperm detected on vaginal smears, pregnancy, and sexually transmitted diseases (STD) including HIV, gonorrhea, syphilis, and Trichomonas vaginalis were assessed. RESULTS: Less than 3% of couples reported current condom use prior to VCT. In the year after VCT, > 80% of reported acts of intercourse in discordant couples included condom use. Reporting 100% condom use was associated with 39-70% reductions in biological markers; however most intervals with reported unprotected sex were negative for all biological markers. Under-reporting was common: 50% of sperm and 32% of pregnancies and HIV transmissions were detected when couples had reported always using condoms. Positive laboratory tests for STD and reported extramarital sex were relatively infrequent. DNA sequencing confirmed that 87% of new HIV infections were acquired from the spouse. CONCLUSIONS: Joint VCT prompted sustained but imperfect condom use in HIV discordant couples. Biological markers were insensitive but provided evidence for a significant under-reporting of unprotected sex. Strategies that encourage truthful reporting of sexual behavior and sensitive biological markers of exposure are urgently needed. The impact of prevention programs should be assessed with both behavioral and biological measures.     

Sexual Mixing and HIV Risk Among Ethnic Minority MSM in Britain

We conducted a cross-sectional online survey of men who have sex with men (MSM) living in Britain in 2007–2008 to examine sexual mixing among ethnic minority MSM. The sample comprised 115 black, 112 South Asian, 47 Chinese and 4,434 white MSM who reported unprotected anal intercourse (UAI) in the previous 3?months. In each ethnic minority group, MSM were three times more likely to report UAI with a partner of the same ethnicity than would be expected by chance alone (χ²?>?8.43, p?<?0.05). Nonetheless, most (>80?%) ethnic minority MSM reported UAI with men from an ethnic group other than their own. In multivariable analysis there was statistical evidence that, compared with white British MSM, self-reported HIV seropositivity remained low for South Asian and Chinese MSM after adjusting for UAI with partners of the same ethnicity (e.g. South Asian MSM, adjusted odds ratio 0.35, 95?% CI 0.19–0.66). This analysis suggests that differences in self-reported HIV seropositivity between ethnic minority and white MSM in Britain cannot be explained by sexual mixing with partners from the same ethnic group.