Predictors of HIV risk among men seeking treatment for substance abuse in India

The purpose of this study was to investigate the prevalence and correlates of HIV risk among men receiving treatment for substance abuse in India. Consecutive inpatients from the major substance abuse hospital in southern India were screened using a structured interview and standardized measures to obtain demographic, psychiatric, sexual behavior, and substance use data at the time of admission. Seventy-seven percent of the 352 men who were screened reported that they were sexually active during the past year, and 13% reported that they had engaged in sexual practices associated with greater risk. The most common risk practices in the past year included having multiple sexual partners (7%), paying for sex (5%), and having unprotected anal sex (4%). Engaging in risky sexual practices was associated with the presence of a co-occurring psychiatric disorder and higher scores on a drug abuse screening measure. Assessing HIV risk in substance abuse settings can help to identify patients who may benefit from HIV-risk reduction programs.     

Self-Disclosure of HIV Status to Sexual Partners: A Qualitative Study of Issues Faced by Gay Men

Objective:This study aimed to explore the range of issues faced by HIV-positive and HIV-negative gay men concerning HIV serostatus self-disclosure to sexual partners. Methods: In-depth semistructured interviews of 1–2 hr each were conducted with 26 HIV-positive and 15 HIV-negative gay men who were recruited from a larger cohort of gay men followed longitudinally for several years at a major medical center. Interviews were audiotaped, transcribed, and content-analyzed by two independent raters. Results: Several themes emerged concerning how disclosure was viewed, who and what was told, why disclosure occurred, and how disclosure decisions related to sexual behavior. Variations occurred in when and why men disclosed, and in the contents and definitions of their disclosures. Men disclosed using codes and indirect hints. Various rationalizations arose for not telling as well. Many men adopted the position that they do not tell, but practice safer sex, yet definitions of safer sex varied such that what some men consider safe, others do not. Conclusion: Recognition thus needs to be increased among clinicians, researchers, patients, and others that definitions of disclosure and of safer sex can vary significantly. The data have critical implications for designing appropriate interventions to limit the further spread of HIV.     

E-dating, identity and HIV prevention: theorising sexualities, risk and network society

This paper addresses how London gay men use the internet to meet sexual partners, or for e-dating. Based on qualitative interviews conducted face-to-face or via the internet, this research develops an account of how information technologies mediate the negotiation of identity and risk in connection with sexual practice. E-dating itself is a bricolage, or heterogeneous DIY practice of internet-based-communication (IBC). A central aspect of IBC is "filtering" in and out prospective e-dates based on the images and texts used to depict sexual identities. Interpretations and depictions of personal HIV risk management approaches in IBC are framed by the meanings of different identities, such as the stigma associated with being HIV positive. This paper argues for a sexualities perspective in a theory of network society. Further, HIV prevention in e-dating can potentially be addressed by considering the interplay of the HIV prevention imperatives associated with different HIV serostatus identities. There is a case for encouraging more explicit IBC about risk in e-dating and incorporating the expertise of e-daters in prevention activity. There is also a need to rethink traditional conceptions of risk management in HIV prevention to make space for the risk management bricolage of network society.     

The 'loss of community' and other problems for sexual citizenship in recent HIV prevention

Increases in reported unsafe sex among gay men have been explained as resistance to HIV prevention, or most recently, with the idea that a hyper-individualization of sexual action contributes to the loss of sexual community. This turning in HIV prevention has come to focus on the sexual action of gay men with HIV through the frames of: sexual transgression, sometimes called 'barebacking'; and altruism. Adopting the perspective of sexual citizenship in connection with qualitative interviews, this paper considers how gay men with HIV account for their sexual practice in light of the dual discourse of transgression/altruism. The paper will argue that gay men with HIV are deeply aware of what transgression/altruism implies for their identities and sexual relations, indicating the continued salience of community for sexual practice. Further, in the circumstances of blaming in relation to the moral labour of safer sex, gay men with HIV are trying to work out a co-operative practice for HIV prevention based on self-care, a moderated altruism and the voluntary action of sexual partners.     

Cultural factors in young heterosexual men's perception of HIV risk

This paper analyses why HIV risk perceptions vary in a sample of 19-year-old Glaswegian men. The main approaches to explain risk behaviour can be characterised as: individual cognition theories, cultural theories and phenomenology. To date there have been few empirical applications of cultural theory. This paper explores how far a cultural approach can explain the variability in HIV risk perceptions and behaviour, focusing on two key socio-cultural factors: current occupation and stage in partnership career. The analysis shows that young men's perceptions of HIV risk are shaped in part by the cultural meanings associated with their lifestyles and friendship groups, which largely arise from their occupational paths, and in part by the meanings that come with a particular stage of their partnership career. Recognising the role of cultural factors in lay people's response to a new health threat has broader implications for health promotion.     

Assessing the effectiveness of HIV prevention peer education workshops for gay men in community settings

Objective : To use existing evaluation data of community‐based HIV prevention peer education workshops (PEWs) for gay men to explore the challenges in evaluating such programs in community settings. Methods : Data came from 33 PEWs conducted with gay and bisexual men. A basic pre/post‐test design was used to measure sexual health capacity. The Sexual Health Capacity Scale (SHCS) was anonymously completed before participation and twice afterward, with the men measuring perceptions of themselves before participation and perceptions of themselves after participation. The anonymous nature of the SHCS created problems for matching data so, for the most part, independent samples tests were used for analysis. Results : Overall, 399 gay and bisexual men participated in PEWs. Participants perceived themselves as having more sexual health capacity after participation than before (p<0.001). Those who had previously been HIV tested before the PEW had higher perceived capacity (p<0.001). Conclusions and Implications : Participation in the PEWs appeared to increase the perceived sexual health capacity of gay and bisexual male participants. Several limitations in the data arose from issues in the original data collection. A mixture of anonymous and identifiable data‐sources meant that data could not always be matched to individuals. Stronger partnerships between HIV researchers and professionals within community organisations could significantly improve evaluation of the effectiveness of HIV peer education.     

Sex and the community: the implications of neighbourhoods and social networks for sexual risk behaviours among urban gay men

Gay neighbourhoods have historically served as vital places for gay socialising, and gay social networks are important sources of social support. Yet, few studies have examined the influence of these forms of community on sexual health. Informed by theoretical frameworks on neighbourhoods and networks, we employ multi‐level modelling to test hypotheses concerning whether gay neighbourhoods and social network factors are associated with five sexual risk behaviours: receptive and insertive unprotected anal intercourse (UAI), barebacking identity, recent internet use for finding sexual partners, and ‘Party and Play’ (PnP). Our analyses of a community‐based sample of gay men in New York City reveal little evidence for the direct effect of gay enclaves on sexual risk with the exception of PnP, which was more likely among gay enclave residents. Having a network composed predominantly of other gay men was associated with insertive UAI, PnP, and internet use for meeting sexual partners. This network type also mediated the association between gay neighbourhoods and higher odds of insertive UAI as well as PnP. Our findings highlight the sexual health implications of two important facets of gay community and, in doing so, indicate the need to better contextualise the sexual health risks faced by gay men.     

秦皇岛地区1077名MSM艾滋病相关高危行为及HIV等感染状况调查

目的了解秦皇岛地区男男性接触者（MSM）性行为特征及人类免疫缺陷病毒（HIV）等感染状况及其影响因素。方法采用横断面调查,采取＂滚雪球＂抽样的方法,利用外展干预服务和艾滋病咨询检测（VCT）作为平台,于2010年4月—2012年8月,对在秦皇岛范围内活动的MSM就艾滋病知识态度、VCT知晓情况、高危行为特征进行面对面问卷调查,并采集血样进行HIV﹑丙肝病毒（HCV）及梅毒（TP）抗体血清学检测,对数据进行统计分析。结果有效问卷1 077份,平均年龄（25.9±6.0）岁,主要寻找性伴的途径以网络居多,占58.7%。45.1%的人知晓VCT,38.2%的人知晓并在VCT门诊做过HIV检测。对HIV传播途径知晓率高达90%。90.1%被调查者近6个月有过同性肛交行为,安全套坚持使用比例为39.5%,最近6个月有异性性行为者占25.5%。血清学检测结果显示,HIV抗体初筛阳性率为3.53%,TP血清双阳率为4.46%。与HIV感染率相关的因素包括：是否主要通过互联网寻找性伴﹑正确使用安全套可预防艾滋病的知晓情况﹑近1年曾被诊断性病情况﹑近6月肛交情况（P〈0.05）。结论秦皇岛地区MSM对艾滋病防治知识知晓率较高,但VCT知晓并运用率较低;该人群感染属于HIV呈低流行态势,宜以此为锲机,开发针对性的干预模式,如VCT综合干预、网络干预,有效遏制HIV的流行。     

Like a prayer: the role of spirituality and religion for people living with HIV in the UK

Over 40,000 people are now living with diagnosed HIV in the UK. There is, however, uncertainty about how people with HIV use religion or spirituality to cope with their infection. Adopting a modified grounded theory approach, we analysed individual and group interviews with the people most affected by HIV in the UK: black African heterosexual men and women and gay men (mostly white). For the majority of black African heterosexual men and women in our study, religion was extremely important. We found that gay men in the study were less religious than black Africans, although many were spiritual in some way. Black African individuals constructed their spiritual narratives as largely Christian or collective, while gay men described more individualistic or 'New Age' approaches. We developed a six-level heuristic device to examine the ways in which prayer and meditation were deployed in narratives to modulate subjective wellbeing. These were: (i) creating a dialogue with an absent counsellor; (ii) constructing a compassionate 'life scheme'; (iii) interrupting rumination; (iv) establishing mindfulness; (v) promoting positive thinking, and (vi) getting results. That people with HIV report specific subjective benefits from prayer or meditation presents a challenge to secular healthcare professionals and sociologists.     

女性吸毒者HIV相关危险行为特征研究

目的 了解广东省女性吸毒艾滋病相关危险行为特征以及HIV、HCV和梅毒感染情况。方法 自拟调查表以匿名方式对广东省某妇教所143名女性吸毒进行面对面调查，同时采集静脉血5m1进行HIV、HCV和梅毒血清学检测。结果 (1)共收集女性吸毒血液标本143份，其中7例经确认试验证实为HIV阳性，感染率为4．9％，HCV感染率为83．2％(119／143)，梅毒感染率为32．9％(47／143)。其中115名注射吸毒(IDUs)的HIV感染率为6．1％(7／115)，HCV感染率为95．7％(110／115)，梅毒感染率为32．8％(42／115)。(2)115名IDUs有72．2％曾共用注射器，44．5％的人在进妇教所前1个月里曾共用注射器，其中48％的人曾与固定性伴共用注射器。(3)进妇教所前1年里有性交史的128名，其中40．6％的人有多性伴(性伴数＞1)，有57．8％的人有IDU性伴，有27．3％的人有以性换毒品／金钱的情况。在进所前一个月有74．1％的人与固定性伴性交不用安全套。(4)进妇教所前1年里有14％的人自述有性病，50％的人自述有性病相关症状。结论 女性吸毒中已经有较高的HIV感染率和梅毒感染率，并且与艾滋病相关的吸毒行为和不安全性行为普遍存在，应该尽快采取有效干预措施以防止艾滋病在女性吸毒人群流行并通过此人群向一般人群的蔓延。     

中小城市男男性接触者HIV感染行为调查

目的调查中小城市男男性接触者(MSM)的艾滋病高危行为。方法用方便抽样法和雪球抽样法选取对象,用《同志心理与行为》问卷开展调查。结果共调查191名MSM,在最近6个月内,67.34%的调查对象性伴数超过3个,肛交和口交率分别达到74.87%和69.63%,肛交时安全套使用率低于10%,口交时则没有人使用;52.11%在婚或离异,37.7%与女性发生过性关系;45.03%发生过生殖器和肛门病变,其中仅9.30%的人到公立医院就诊。结论HIV在该人群高度流行并向一般人群传播的可能性极大,在中小城市的MSM中开展艾滋病干预工作是一项迫在眉睫的工作。     

Homelessness and HIV risk behaviors among injection drug users

This article uses data from an 8-year study of injection drug users to examine whether homelessness independently influenced the likelihood of engaging in human immunodeficiency virus (HIV) risk behaviors. Fixed effects regression analyses are used to estimate the associations between four different housing contexts and four different behaviours related to transmitting HIV infections. Results showed that 16% of the study group experienced homelessness at some point during the study, and that homelessness was significantly associated with a higher likelihood of frequenting shooting galleries (odds ratio=2.05), but did not have a significant effect on sharing syringes, sharing other injection drug paraphernalia, or participating in paid sex. These results provide limited support for positing homelessness as independently associated with increased levels of HIV-related risk behavior among injection drug users and highlights the need for more research that examines the housing dynamics among this population.     

Contributions of an intensive HIV prevention programme in increasing HIV testing among men who have sex with men in Andhra Pradesh,India

The objective of this study was to identify the factors associated with uptake of HIV testing and to assess their relative contributions in increasing HIV testing. Data are drawn from two rounds of cross-sectional Integrated Behavioural and Biological Assessment (IBBA) surveys of self-identified men who have sex with men (MSM) from Andhra Pradesh, India, recruited through probability-based sampling in 2005–2006 and 2009–2010 (IBBA1, n = 1621; IBBA2, n = 1608, respectively). Logistic regression model was used to assess the relationship between socio-demographic characteristics, sexual behaviours, programme exposure and HIV testing. Significant factors were further parsed using decomposition analysis to examine the contribution of different components of that factor towards the change in HIV testing. There was a significant increase in the proportion of MSM reporting HIV testing from IBBA1 to IBBA2. Higher literacy levels, being 25–34 years old, being a kothi (predominantly receptive), engaging in both commercial and non-commercial sexual relationships and intervention programme exposure contributed the most to the increase in HIV testing.     

广东省吸毒者HIV感染状况和危险因素调查

目的 了解广东省吸毒HIV感染及相关危险行为因素。方法 对广东省戒毒所内戒毒和社区吸毒进行面对面调查，并采集静脉血5ml进行HIV、HCV抗体检测。结果 共调查655名吸毒，HIV感染率为29．0％，HCV感染率为91．6％；吸毒对有关艾滋病传播途径的综合知晓率为65．3％；在最近一个月中，98．6％的吸毒有静脉注射吸毒行为。且42．1％有共用针具行为。共用针具的主要原因是毒瘾发作时没有注射器，占80．5％；吸毒与临时性伴的安全套使用率为21．3％，与固定性伴的使用率仅为9．5％。结论 广东省吸毒有较高的HIV和HCV感染率，感染HIV的相关危险行为普遍存在。应尽快采取有效措施。控制艾滋病的进一步蔓延。     

新疆HIV单阳家庭阴性配偶血清阳转情况及影响因素分析

目的了解新疆艾滋病病毒(HIV)单阳家庭阴性配偶血清阳转情况,探讨其影响因素,为遏制艾滋病在单阳家庭间传播,实施高危行为干预提供理论依据。方法于2010年1月—2015年3月在新疆招募HIV单阳家庭阴性配偶,建立前瞻性队列,每3个月进行1次定位随访,每6个月进行1次血清学检测及危险行为调查,计算人年血清阳转率;利用Cox比例风险模型分析HIV单阳家庭阴性配偶血清阳转的影响因素。结果共纳入1 162名单阳家庭阴性配偶,总观察人时为2 496.23人年,随访期间42名阴性配偶发生血清阳转,血清阳转率为1.68/100人年。多因素分析显示,近6个月性行为频次> 2次/月(aHR=2.48,95%CI=1.22～5.02,P=0.012)、先证者最近1次CD^+T淋巴细胞计数<200个/μL (aHR=2.88,95%CI=1.37～6.08,P=0.006)是单阳家庭阴性配偶血清阳转的危险因素;坚持使用安全套(aHR=0.32,95%CI=0.16～0.63,P=0.003)、知晓HIV的传播途径(aHR=0.20,95%CI=0.07～0.60,P=0.004)是单阳家庭阴性配偶血清阳转的保护因素。结论新疆HIV单阳家庭阴性配偶的血清阳转率仍处于较高水平,应进一步在单阳家庭内推广安全套的使用,加大艾滋病相关知识宣传力度。     

If I was infected with HIV,I would be letting my family down: Family influences on risk and protective factors for unsafe sex among gay Asian Pacific Islander men

This article examines family influences on risk and protective factors associated with unsafe sex among gay Asian Pacific Islander men. Twenty-five gay Asian Pacific Islanders completed individual interviews regarding factors that may lead them to engage in unsafe sex as well as factors that may lead them to engage in protective sex. Analysis of qualitative data revealed three ways by which family members influence sexual behaviour. We found that the way that (1) the way these men perceived family obligation and the need to avoid shame, (2) the level of active family participation, and (3) internalisation of what these men perceived to be ‘Asian’ values influenced whether their families acted as a protective factor or not in terms of HIV risk behaviours.     

合成毒品使用人群中HIV感染状态及危险因素研究进展

合成毒品使用者中HIV感染率的地区分布变化较大,注射使用合成毒品者及使用合成毒品的男男性接触者中HIV感染的风险较高.在合成毒品使用者中,未婚、无业者,多药滥用,注射使用毒品以及共用注射器等毒品使用行为,多性伴、无保护性行为、性交易及性暴力等不安全性行为以及合并感染多种疾病等因素为HIV感染与传播的危险因素.加强禁毒力度,积极采取有针对性的干预和治疗措施,以期预防和减少HIV在我国合成毒品滥用者中的感染与传播.