Sexual Risk, Serostatus and Intimate Partner Violence Among Couples During Pregnancy in Rural South Africa

The aim of this study was to describe sexual risk behavior among 239 couples during pregnancy and to examine the relationship of sexual risk behavior with HIV serostatus and intimate partner violence. One-third (31.8 %) of pregnant women and 20.9 % of male partners were HIV positive. HIV risk factors included lack of knowledge of partners’ HIV serostatus, unprotected sexual intercourse and multiple sexual partners. Among men, multivariate logistic regression identified awareness of HIV negative partner status, multiple sexual partners and low levels of partner violence and among women Zulu or Swati ethnicity were associated with unprotected intercourse. HIV positive concordance was associated with protected sex and in multilevel analysis of couples HIV positive status and awareness of the partner’s HIV positive status were associated with protected sex. High levels of HIV risk behaviour was found among couples during pregnancy calling for HIV risk reduction interventions.     

HIV Transmission Risk among HIV Seroconcordant and Serodiscordant Couples: Dyadic Processes of Partner Selection

Selecting sex partners of the same HIV status or serosorting is a sexual risk reduction strategy used by many men who have sex with men. However, the effectiveness of serosorting for protection against HIV is potentially limited. We sought to examine how men perceive the protective benefits of factors related to serosorting including beliefs about engaging in serosorting, sexual communication, and perceptions of risk for HIV. Participants were 94 HIV negative seroconcordant (same HIV status) couples, 20 HIV serodiscordant (discrepant HIV status) couples, and 13 HIV positive seroconcordant (same HIV status) couples recruited from a large gay pride festival in the southeastern US. To account for nonindependence found in the couple-level data, we used multilevel modeling which includes dyad in the analysis. Findings demonstrated that participants in seroconcordant relationships were more likely to believe that serosorting reduces concerns for condom use. HIV negative participants in seroconcordant relationships viewed themselves at relatively low risk for HIV transmission even though monogamy within relationships and HIV testing were infrequent. Dyadic analyses demonstrated that partners have a substantial effect on an individual’s beliefs and number of unprotected sex partners. We conclude that relationship partners are an important source of influence and, thus, intervening with partners is necessary to reduce HIV transmission risks.     

HIV transmission risk behaviours among HIV-positive persons in serodiscordant relationships

As many as one in three persons living with HIV-AIDS continue to practise unprotected sexual intercourse and these practices often occur with HIV-negative or unknown HIV serostatus (serodiscordant) partners. The current study examined the rates of HIV transmission risk behaviours in non-regular (e.g. casual) and regular (e.g. steady) serodiscordant relationships. HIV positive men (n = 269) and women (n = 114) responded to measures of demographic characteristics, health and mental health status, and sexual behaviours assessed in partner-by-partner interviews. 257 (67%) participants were sexually active in the preceding three months and 182 (71%) of the sexually active persons had engaged in vaginal or anal intercourse with serodiscordant partners. Comparisons of persons with non-regular (n = 97) and regular (n = 85) serodiscordant partners showed that overall rates of unprotected and protected intercourse were greater with regular partners than non-regular partners. Disclosure of HIV status to regular and non-regular serodiscordant partners did not appear to influence the pattern of results. Mathematical modelling showed that HIV transmission estimates over a one-year horizon were significantly greater for male regular partners of HIV-positive men than non-regular partners and there was a trend toward greater HIV transmission rates from HIV-positive men to their regular serodiscordant female partners compared to non-regular partners. Results suggest an urgent need for HIV transmission risk reduction interventions for HIV serodiscordant couples, particularly for couples in established, regular relationships.     

Knowledge of HIV/AIDS and emotional adjustment in a cohort of men with haemophilia and HIV infection: final report

This study presents the final report of a long-term psychological assessment of men with haemophilia and HIV infection. The knowledge, emotional impact regarding HIV infection and prospective changes over time and the need for psychological support were evaluated. The study group comprised 118 men with haemophilia, 66 HIV seropositive and 52 seronegative, from the Haemophilia Centres in Bari, Florence, Milan and Naples. All subjects performed psychological tests (STAI: state and trait anxiety inventory; SDS: self-rating depression scale) and completed questionnaires to ascertain their knowledge and the emotional impact of AIDS. After enrollment (1992-93) the assessment was repeated twice over a 2-year period. A high percentage of subjects in both groups answered the questionnaire on knowledge correctly and, more specifically, all (100%) admitted knowing that sexual intercourse was a risk factor for HIV infection, adding that sexual partners of haemophiliacs with HIV should be regularly tested. The percentage, however, decreased for seropositives who admitted to always using a condom during sexual intercourse (86%) and for those who declared that partners were periodically tested for HIV (60%). The most important feature of the study is that, contrary to predicted expectations, seropositive and seronegative subjects presented the same degree of emotional involvement: there are no statistically significant differences in average scores between groups either on the anxiety or depression scales. Moreover, for certain aspects, seronegatives revealed greater emotional involvement: at baseline evaluation, they felt more fear and unhappiness with statistically significant differences compared to asymptomatics. Furthermore, seronegatives more than seropositives continue to feel reluctance towards infusion and avoid blood products after learning of AIDS. These results emphasize the importance of paying due attention to the emotional status of seronegatives. Their reluctance towards the use of blood products (despite present safety) is a very important issue for the possible consequences of treatment with the risk of worsening the clinical condition. In conclusion, we believe that counselling on HIV infection/AIDS needs to address every person with haemophilia regardless of HIV status.     

Close relationships and safer sex among HIV-infected men with haemophilia

The present study sought to inform future behavioural intervention efforts by obtaining information from HIV-positive heterosexual men with haemophilia about their attitudes towards close relationships, attitudes towards risk reduction practices, and actual risk reduction practices. HIVinfected males with haemophilia ( n = 358) responded to a self-administered questionnaire. Men who reported being involved in a close relationship ( n = 237) were compared to men who said that they were not involved at the time of data collection ( n = 121). Involved men were more likely than uninvolved men to agree that close relationships provide benefits such as physical intimacy and communication, and that these benefits are important. Men who were not involved perceived more negative consequences of discussing HIV risk reduction with partners (including partner rejection and negative emotional reactions) than did involved men and were much more concerned about the potential negative consequences of risk reduction discussions. Involvement was associated with having disclosed HIV-seropositivity and having discussed HIV risk reduction. Risk reduction interventions for men with haemophilia who are not involved in close, sexual relationships should address positive and negative attitudes towards close relationships and towards discussing risk reduction. Interventions should emphasize communication skills and rehearsal of serostatus disclosure as well as of risk reduction discussions.     

Uptake of HIV and syphilis testing of pregnant women and their male partners in a programme for prevention of mother-to-child HIV transmission in Uganda

Objective To describe uptake of HIV and syphilis testing in a prevention of mother‐to‐child HIV transmission programme in Uganda. Methods Analysis of data from routine HIV and syphilis testing at Entebbe Hospital antenatal services. Results A total of 20 738 women attended antenatal services. Exactly 62.8% of women, but only 1.8% of their male partners, accepted testing for HIV; 82.2% of women, but only 1.1% of their male partners accepted syphilis testing. Partners of women with positive HIV results were more likely to come for subsequent testing. Of 200 couples whose partners accepted HIV‐testing within 30 days of one another, 19 (9.5%) were HIV‐discordant, representing 65.5% of couples with at least one partner HIV‐positive. HIV prevalence was 12.6% for women and 10.8% for men; syphilis prevalence was 4.0% for women and 6.2% for men. Conclusion Uptake of HIV and syphilis testing was fairly good among pregnant women attending antenatal clinics at Entebbe Hospital, but very low among their male partners. The level of HIV‐discordant couples was high. These clinics should be made more couples‐friendly to identify both HIV‐positive men for treatment and discordant couples for HIV prevention.     

Safer sex decision-making among men with haemophilia and HIV and their female partners

An exploratory qualitative study of adult heterosexual men with haemophilia and HIV and women who were their sexual partners was conducted as formative research to better understand cognitive factors involved in behavioural intentions and practices which comprise HIV risk-reduction for sexual transmission. The study sought to generate hypotheses, uncover themes, and develop a broad perspective on possible determinants of behaviours related to HIV transmission risk reduction. Qualitative analysis of these data served as a basis for developing a subsequent quantitative, hypothesis-testing survey and an intervention. Face-to-face interviews were conducted with 23 single men and 28 married men with haemophilia and HIV infection, and 28 married women partners selected through stratified, purposeful sampling. The interviews identified beliefs, attitudes, and values underlying decisions regarding target behaviours related to preventing sexual transmission of HIV, including (1) using condoms consistently during vaginal intercourse and (2) talking to partners about risk reduction. The interviews elicited information about perceived advantages and disadvantages of performing each of the targeted behaviours, and factors that facilitate or prevent performing them. Qualitative analysis of coded responses yielded important themes regarding how choices are made about sexual activity and safer sex. Most notably, communication between partners (1) plays a direct, key role in facilitating condom use and (2) forms the basis for maintaining emotional intimacy in these relationships. The link between condom use and communicating about safer sex was viewed as pivotal in achieving HIV prevention for individuals in serodiscordant couples. Recommendations for risk reduction intervention development are discussed.     

HIV transmission in sexual partners of persons with HIV/AIDS attending the Infectious Diseases Hospital, Yangon

A study was conducted in the Infectious Diseases Hospital, Yangon, for one year from August 1996 to 1997, to assess the extent and the factors related to HIV transmission among sexual partners of HIV/AIDS cases. It was a cross-sectional comparative study on 67 (61 males, 6 females) HIV positive individuals with or without AIDS, and their sexual partners. Separate interviews of index cases and partners were done, and clinical examination and laboratory tests for HIV and sexually transmitted diseases (STDs) were performed. HIV transmission was found in 41.8% of the partners. Male-to-female transmission was 39.3% (n=61) and female to male transmission was 66.7% (n=6), Seven and one half percent of the partners were suffering from AIDS. There were 4 (6.6%) pregnant mothers and 1 (25%) was HIV positive. Though 75% of the partners did not use condoms during their married life, HIV transmission was significantly reduced in the condom users (odds ratio (OR) = 0.18, 95% confidence interval (CI) 0.02-0.98 p = < 0.05). The seropositive men who were less than 30 years of age had greater HIV transmission (OR = 5.67, 95% CI 1.13-36.46). However, socio-demographic factors, number of marital partners and age of first sex partners, duration of marriage, number of sexual relationships between these couples, duration of HIV positivity and AIDS infection, immunological status of the index group and STD positivity among partners had no significant association with the transmission of HIV. This study demonstrated that the transmission of HIV was high among the sexual partners of persons with HIV infection. It also highlighted the requirement of effective counseling and preventive measures against HIV infection among the couples.     

Mobility and HIV in Tanzanian couples: both mobile persons and their partners show increased risk

OBJECTIVE: To investigate how mobility is related to sexual risk behavior and HIV infection, with special reference to the partners who stay behind in mobile couples. METHODS: HIV status, sexual behavior and demographic data of 2800 couples were collected in a longitudinal study in Kisesa, rural Tanzania. People were considered short-term mobile if they had slept outside the household at least once on the night before one of the five demographic interviews, and long-term mobile if they were living elsewhere at least once at the time of a demographic round. RESULTS: Overall, whereas long-term mobile men did not report more risk behavior than resident men, short-term mobile men reported having multiple sex partners in the last year significantly more often. In contrast, long-term mobile women reported having multiple sex partners more often than resident women (6.8 versus 2.4%; P = 0.001), and also had a higher HIV prevalence (7.7 versus 2.7%; P = 0.02). In couples, men and women who were resident and had a long-term mobile partner both reported more sexual risk behavior and also showed higher HIV prevalence than people with resident/short-term mobile partners. Remarkably, risk behavior of men increased more when their wives moved than when they were mobile themselves. CONCLUSIONS: More sexual risk behavior and an increased risk of HIV infection were seen not only in mobile persons, but also in partners staying behind. Interventions aiming at reducing risk behavior due to mobility should therefore include partners staying behind.     

HIV testing is associated with increased knowledge and reductions in sexual risk behaviours among men in Cape Town,South Africa

HIV testing benefits those who test positive, allowing them to receive treatment, but the benefits for those who test negative remain controversial. We evaluated the impact of testing on HIV knowledge and sexual risk among men in South Africa. Men were recruited from townships outside Cape Town and completed a survey that assessed testing history, knowledge, and sexual behaviours. Among the 820 participants, 516 (63%) reported being tested (82% tested negative, 6% tested positive, and 12% unknown). Compared to those who had never been tested for HIV, men who tested for HIV were more knowledgeable about HIV transmission, but did not differ on sexual risk behaviour. Knowledge moderated the effect of testing on sexual risk such that men reported fewer sexual partners (incidence rate ratio (IRR) = 0.91, 95% CI = 0.84, 0.98) and fewer unprotected anal sex events (IRR = 0.81, 95% CI = 0.66, 1.00) if they had been tested for HIV and were knowledgeable about HIV transmission. For men testing HIV-negative, knowledge predicted fewer sexual risk behaviours. Previous HIV testing is associated with enhanced knowledge, which moderates sexual risk behaviour among South African men living in Cape Town. Results suggest that HIV testing may increase knowledge and lead to reductions in sexual risk even when results are negative.     

Heterosexual transmission of human immunodeficiency virus among intravenous drug users

To examine sexual transmission of human immunodeficiency virus (HIV) among heterosexual intravenous drug users (IVDUs), HIV antibody status of IVDUs with intravenous drug-using sexual partners (IVSPs) was compared with that of IVDUs with no IVSPs. Initial bivariate analyses indicated IVDUs with IVSPs were more likely to be HIV antibody-positive than those with no IVSPs. Analyses by gender indicated that this relationship held for men but not women. IVDUs with IVSPs also differed from those without IVSPs demographically, in drug use, and in other sexual behaviors. When effects of other variables were controlled, no statistically significant relationship was found between injection history of sex partners and HIV status for the total sample or separately for men or women.     

Impact of HIV-Related Stigma on Health Behaviors and Psychological Adjustment Among HIV-Positive Men and Women

HIV-related stigmatization remains a potent stressor for HIV-positive people. This study examined the relationships among stigma-related experiences and depression, medication adherence, serostatus disclosure, and sexual risk among 221 HIV-positive men and women. In bivariate analyses that controlled for background characteristics, stigma was associated with depressive symptoms, receiving recent psychiatric care, and greater HIV-related symptoms. Stigma was also associated with poorer adherence and more frequent serostatus disclosure to people other than sexual partners, but showed no association to sexual risk behavior. In a multivariate analysis that controlled for all correlates, depression, poor adherence, and serostatus disclosure remained as independent correlates of stigma-related experiences. Findings confirm that stigma is associated with psychological adjustment and adherence difficulties and is experienced more commonly among people who disclose their HIV status to a broad range of social contacts. Stigma should be addressed in stress management, health promotion, and medication adherence interventions for HIV-positive people.     

Health care provider and self-assessment of health status and sexual behaviour in HIV-seropositive young men with haemophilia

We hypothesized that persons with HIV who perceive themselves as having waning health status may participate in fewer sexual behaviours than HIV-infected persons without HIV-related health problems. The object-ives of this study were to compare health care provider responses with participant responses for health status and for sexual activity and to examine the relationship of HIV-related health status to the sexual behaviour of HIV-seropositive adolescents and young men with haemophilia. A detailed questionnaire designed by researchers from 11 participating US haemophilia treatment sites and CDC personnel was administered to 306 HIV-seropositive young men with haemophilia aged 12–25 years. A health care provider from the haemophilia treatment centre also completed a questionnaire on each respondent. Self-assessment of HIV-related health status was similar to provider assessment of health status. Providers accurat-ely assessed participant sexual activity (overall Kappa = 0.62). Participation in vaginal intercourse and condom use was independent of health status. Following extensive educational efforts, most HIV-seropositive adolescents and young men with haemophilia are aware of the relationship between their HIV seropositivity and health status. Waning health status does not reduce participation in penetrative sexual behaviours or increase use of condoms. HIV prevention efforts should continue for this population.     

Correlates of requesting home HIV self-testing kits on online social networks among African-American and Latino men who have sex with men

High levels of HIV stigma are one of the main difficulties in engaging African-American and Latino men who have sex with men (MSM) in HIV testing. The availability of home HIV test and the possibility of self-testing in private may improve uptake and counteract stigma. This paper sought to determine the correlates of requesting home HIV test kits among a sample of MSM social media users. The odds of participants requesting a test kit were significantly associated with using social networks to seek sexual partners (aOR: 2.47, 95% CI: 1.07–6.06) and thinking it is easier to use social networks for seeking sexual partners (1.87, 1.2–3.12), uncertain HIV status (4.29, 1.37–14.4), and having sex under the influence of alcohol (2.46, 1.06–5.77). Participants who had not been tested for more than 6 months were more likely to request a test kit than those who were tested in the past 6 months (2.53, 1.02–6.37). Participants who frequently talked to others about having sex with men online were less likely to request a test kit (0.73, 0.56–0.92). By reaching people over social media and offering them access to test kits, we were able to reach at-risk individuals who were uncertain about their HIV status and had not been regularly tested. The findings of the study will help to inform future HIV testing interventions.     

Relationship Dynamics as Predictors of Broken Agreements About Outside Sexual Partners: Implications for HIV Prevention Among Gay Couples

Agreements about sex with outside partners are common among gay couples, and breaks in these agreements can be indicative of HIV risk. Using longitudinal survey data from both partners in 263 HIV-negative and -discordant gay couples, we investigate whether relationship dynamics are associated with broken agreements. Twenty-three percent of respondents reported broken agreements. Partners with higher levels of trust, communication, commitment, and social support were significantly less likely to report breaking their agreement. Promoting positive relationship dynamics as part of HIV prevention interventions for gay couples provides the opportunity to minimize the occurrence of broken agreements and, ultimately, reduce HIV risk.     

Partner-Provided Social Support Influences Choice of Risk Reduction Strategies in Gay Male Couples

We investigated the influence of partner-provided HIV-specific and general social support on the sexual risk behavior of gay male couples with concordant, discordant, or serostatus-unknown outside partners. Participants were 566 gay male couples from the San Francisco Bay Area. HIV-specific social support was a consistent predictor for reduced unprotected anal intercourse (UAI) with both concordant outside partners (all couple types) and outside partners of discordant or unknown serostatus (concordant negative and discordant couples). General social support was associated with increased UAI with concordant outside partners for concordant negative and concordant positive couples (i.e., serosorting). Our findings suggest that prevention efforts should target couples and identify the level of HIV-specific support that partners provide. Partner-provided support for HIV-related behaviors could be an additional construct to consider in gay male relationships, akin to relationship satisfaction and commitment, as well as an important component of future HIV prevention interventions.     

When good news is bad news: psychological impact of false positive diagnosis of HIV

HIV testing is known to be stressful, however the impact of false positive HIV results on individuals is not well documented. This is a series of four case who developed psychological difficulties and psychiatric morbidities after being informed they had been misdiagnosed with HIV-positive status. We look into documented cases of misdiagnosis and potential risks of misdiagnosis. The case series highlights the implications a false diagnosis HIV-positive status can have, even when the diagnosis is rectified. Impact of misdiagnosis of HIV can lead to psychosocial difficulties and psychiatric morbidity, have public health and epidemiological implications and can lead to medico-legal conflict. This further reiterates the importance of HIV testing carried out ethically and sensitively, and in line with guidelines, respecting confidentiality and consent, and offering counselling pre-test and post-test, being mindful of the reality of erroneous and false positive HIV test results. The implications of misdiagnosis are for the individual, their partners and social contacts, as well as for the community.     

Morality, responsibility and risk: negative gay men's perceived proximity to HIV

In order to examine the ways in which men's perceptions of their social surroundings influence how they experience and negotiate sexual risk, we conducted a qualitative study with 36 men who lived in London or Birmingham, had five or more male partners in the previous year and believed themselves to be HIV negative. Men were recruited into two sub-samples (18 men each). The high proximity group personally knew someone with HIV and had a positive sexual partner in the year prior to interview. The low proximity group had never personally known anyone with HIV and had never had a sexual partner who they knew or believed to be HIV positive. Data was collected via semi-structured interviews. Men in the low proximity groups used moral discourses to articulate beliefs and social norms around the disclosure of HIV which may act as a deterrent to sexual partners disclosing. Although most expected positive sexual partners to disclose, they had difficulty in articulating how they would respond to disclosure and how they would manage any consequent sexual risk. For the men in the high proximity group, living around HIV constituted a part of everyday life. Disclosure and discussion of HIV did not violate their social norms. The majority did not expect positive sexual partners to disclose to them and knew how they would respond to such disclosure if it occurred. Men in this group did not use moral discourses but talked practically about better and worse ways of managing disclosure. Proximity to HIV is mediated by strong social norms and self-perpetuating moral discourses which effectively creates a social divide between men who perceive themselves to be in low proximity to HIV and their HIV positive contacts and sexual partners. Men with perceived low proximity to HIV are appropriate as a target group for HIV prevention.     

Self-Esteem in HIV-Positive and HIV-Negative Gay and Bisexual Men: Implications for Risk-Taking Behaviors with Casual Sex Partners

Research suggests that self-esteem in gay and bisexual men may be linked with sexual risk-taking behaviors. As part of a larger investigation into the sexual practices of gay and bisexual men, we assessed serostatus, self-esteem, condom use, and HIV disclosure to sexual partners. Among HIV-negative men, no relationships were found between their self-esteem and tendency to discuss their and their partners’ HIV status. However, among HIV-positive men, there was a positive relationship between self-esteem and disclosure to receptive and insertive anal sex partners. These results suggest greater attention to the self-esteem of HIV-positive men by attending healthcare workers and social support groups.     

Condom use in multi-partnered males: importance of HIV and hepatitis B status

The objective of the research was to determine the demographic, sexual and social risk factors associated with condom use in 7,089 multi-partnered men attending the Sydney Sexual Health Centre. A review of computerized medical records from 1991 to 1999 was carried out. Males with two or more partners in the last three months were divided into three condom use groups: consistent, sometimes and never. Men reporting sex with men (MSM) were more likely to use condoms than men having sex with only women (p=0.001). HIV positive men were more likely to use condoms consistently than those who were negative (p=0.001). In HIV negative non-hepatitis-B carriers, factors independently associated with inconsistent condom use included alcohol consumption, intravenous drug use (odds ratio (OR) 0.6 (95% confidence interval (CI) 0.47-0.77)) and being married (OR 0.2 (95% CI 0.21-0.31)). Factors associated with consistent condom use were MSM (OR 1.8 (95% CI 1.26-2.49)) and having three or more partners in the last 3 months (OR 2.4 (95% CI 2.023-2.83)). In the 508 hepatitis B carriers, consistent condom users were less likely to be married or intravenous drug users (OR 0.4 (95% CI 0.23-0.85)). In the 200 HIV antibody positive men, those with three or more partners were less likely to be consistent condom users than those with two (OR 0.3 (95% CI 0.11-0.82)). The conclusions are that a small number of HIV positive men report unsafe sex with multiple partners. Health promotion activities should be directed at this group.