HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men--five U.S. cities, June 2004-April 2005

Well into the third decade of the human immunodeficiency virus (HIV) epidemic, rates of HIV infection remain high, especially among minority populations. Of newly diagnosed HIV infections in the United States during 2003, CDC estimated that approximately 63% were among men who were infected through sexual contact with other men, 50% were among blacks, 32% were among whites, and 16% were among Hispanics. Studies of HIV infection among young men who have sex with men (MSM) in the mid to late 1990s revealed high rates of HIV prevalence, incidence, and unrecognized infection, particularly among young black MSM. To reassess those findings and previous HIV testing behaviors among MSM, CDC analyzed data from five of 17 cities participating in the National HIV Behavioral Surveillance (NHBS) system. This report summarizes preliminary findings from the HIV-testing component of NHBS, which indicated that, of MSM surveyed, 25% were infected with HIV, and 48% of those infected were unaware of their infection. To decrease HIV transmission, MSM should be encouraged to receive an HIV test at least annually, and prevention programs should improve means of reaching persons unaware of their HIV status, especially those in populations disproportionately at risk.     

Determinants of condom use to prevent HIV infection among youth in Ghana

Purpose: To identify the psychosocial and behavioral factors that influence condom use to reduce the risk of human immunodeficiency virus (HIV) infection among young men in Ghana.Methods: This study used a cross-sectional design in which data on a community-based sample of 601 young men, 15–24 years of age, were collected by a household survey instrument. For a conceptual framework, the study used constructs from the Health Belief Model (HBM) and Social Learning Theory (SLT) in the Ghanaian context.Results: While 65% of the sexually active male respondents had used condoms at least once, only 25% had used condoms at last intercourse. Findings from multiple logistic regression analysis indicate that perceived susceptibility to HIV infection, perceived self-efficacy to use condoms, perceived barriers to condom use, and perceived social support were significant predictors of condom use. The most important finding, however, is that perceived barriers significantly interacted with perceived susceptibility and self-efficacy. Subjects who perceived a high level of susceptibility to HIV infection and a low level of barriers to condom use were almost six times as likely to have used condoms at last intercourse, compared to others. Similarly, young men who perceived a high level of self-efficacy to use condoms and a low level of barriers to condom use were nearly three times more likely to have used condoms at last intercourse when compared to others.Conclusion: These results suggest that HIV prevention programs for youth should emphasize personal vulnerability to acquired immunodeficiency syndrome, instill in youth the self-belief that they can use condoms any time, and address how to overcome barriers to condom use.     

Survival now versus survival later: immediate and delayed HIV risk assessment among young Jamaican men who have transactional sex with men

This study explored the experiences of young Jamaican men who have sex with men who engaged in transactional sex as a result of homelessness, family neglect or limited financial resources. It further examined the circumstances that affect their immediate or delayed decisions around sexual risk and increased vulnerability for HIV infection. Barriers experienced when accessing condoms, healthcare, HIV testing and other prevention services are also described. Twenty in-depth interviews and one focus group with 10 participants in various parishes in Jamaica were conducted. Findings from this study reveal how stigma and discrimination in the form of pervasive homophobia-influenced participation in the street economy via transactional sex. Socio-structural factors at family and commity level led to diminished social/economic prospects, which extended into adulthood. Sexual decision making was based on immediate needs for protection, food or shelter; concerns about acquiring HIV were considered only after meeting those immediate needs. Future HIV prevention strategies must take seriously the socio-structural factors that influence HIV risk behaviours among young men who have sex with men in Jamaica.     

Inappropriate lubricant use with condoms by homosexual men.

Use of condoms has been advocated as an important method of reducing the risk of human immunodeficiency virus (HIV) transmission among high-risk groups such as homosexual and bisexual men, prostitutes, intravenous drug users, adolescents, and hemophiliacs. Despite risk-reduction education campaigns directed to gay men since the early 1980s, evidence shows continued deficits in condom-use skills and knowledge among gay men. Because most failures in the use of condoms are attributed to errors in use, increasing knowledge and skills in condom use is important in preventing HIV infection. Two groups of homosexual and bisexual men were sampled, those entering a risk-reduction education program and participants in a Gay Pride event. They were surveyed on their current sex practices and their efforts to reduce their risk of HIV infection. They were asked about their numbers of sex partners, specific sexual behaviors, use of condoms, types of condoms used, and lubricants used for genital-anal sex. The characteristics of those surveyed were similar to those of respondents in other studies of risk reduction among gay men. The use of an oil-based lubricant with condoms has been shown to weaken latex and to increase the likelihood of condom breakage, which use of water-based lubricants does not. Among respondents who reported having genital-anal sex, 60 percent reported use of an oil-based lubricant with a condom at least once during the year before the survey. Gay men in sexually exclusive relationships engaged in less consistent use of condoms for receptive genital-anal sex than did single gay men.(ABSTRACT TRUNCATED AT 250 WORDS)     

Highway cowboys, old hands, and Christian truckers: risk behavior for human immunodeficiency virus infection among long-haul truckers in Florida

This paper reports the results of ethnographic research to describe risk for human immunodeficiency virus (HIV) infection among long-haul truck drivers and the contexts and factors that influence risk and protective behaviors. Drivers were selected using purposive and snowball sampling at trucking-related businesses along major truck routes in Florida. Interview information was used to categorize truckers' levels of potential risk, describe behavioral characteristics of each group, identify sex partners, and assess perceptions of the risk of HIV infection. One-third of the 71 men interviewed had frequent sexual intercourse on the road with multiple partners, but few ever used condoms. Commercial sex workers were their most frequent partners for on-the-road sex. The risk was compounded by occupational conditions, which motivated truckers to drive long hours, often using drugs to stay alert. Sex, alcohol, and drugs were perceived as quick, effective stress relievers during downtime on long, lonely trips. Despite their high-risk behaviors, truckers tended to consider themselves at low risk for HIV infection and expressed a number of misconceptions regarding HIV transmission. For example, many truckers did not associate HIV risk with heterosexual contact or think that condoms were effective in preventing HIV transmission. In addition, many truckers maintained strong homophobic and anti-government opinions that reinforced their suspicion of safe-sex messages. These findings suggest that high-risk sexual behavior is common among long-haul truckers in the US, who may be at risk for HIV infection primarily because of unprotected sexual intercourse with multiple sex partners. Also, drug use may be associated with HIV risk behavior. The authors recommend establishing prevention programs that are developed by and for truckers, determining HIV seroprevalence rates of truckers, addressing drug and alcohol abuse among truckers, and altering industry policy that keeps truckers on the road too long for their own and others' safety.     

Talking the talk,walking the walk: Social network norms,communication patterns,and condom use among the male partners of female sex workers in La Romana,Dominican Republic

Male partners of female sex workers are rarely targeted by HIV prevention interventions in the commercial sex industry, despite recognition of their central role and power in condom use negotiation. Social networks offer a naturally existing social structure to increase male participation in preventing HIV. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic. Male partners (N = 318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioral outcome was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months. In general, men reported small, dense networks with high levels of communication about condoms and consistent condom use. Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members. Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of communication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners.     

萍乡市男男同性恋性病艾滋病哨点监测结果分析

目的了解男同人群的性相关危险因素特点,找出有效的途径或策略,进一步有效控制艾滋病的流行。方法问卷调查与实验室检测。结果总共监测310名男同,其中酒吧会所监测占30.97%,网络监测占69.03%;90%被监测男同是高中以上文化程度;最近一年患性病的占14.19%;310人当中HIV感染者8例,感染率为2.58%;网络招募人中HIV感染为3.27%。艾滋病知识知晓率为98.71%;有将近15%的感染者有过商业性行为(包括3名感染者);有商业性行为的男男同性恋艾滋病感染率与没有商业性行为的男男同性恋的艾滋病感染率两者比较有明显差异;与女性发生性关系的时候有三分之一不使用安全套,每次都会使用的不到一半,最近一次与女性发生性关系有三分之一没有使用安全套。结论男同容易将艾滋病性病进行婚内、外传播;男同存在掌握相关HIV防治知识与实际防范结果背离现象;网络加大了男同交往的频率和范围,也加大了艾滋病传播风险;同性商业性行为风险性更高;男同的双性性关系及无保护性性交在艾滋病传播中起到一个非常重要的桥梁作用;今后要把宣传干预重点放在双性恋、男性性商业服务人群、男同配偶或性伴、甚至青年妇女、青年学生身上。     

Protective behaviours among young African American women with non-monogamous sexual partners

In the USA, partner non-monogamy is reported to be more common among African American women than White women and may contribute to African American women’s increased risk for HIV and other sexually transmitted infections (STIs). Few studies have explicitly and comprehensively described the protective behaviours that African American women employ with non-monogamous partners to reduce their HIV risk. We conducted interviews to examine protective behaviours among 11 African American women aged 18–24 years who perceived that a partner in the preceding 12 months had another sex partner. Participants described three types of partnerships with 29 non-monogamous men; these partnerships clustered into three categories. Narrative analysis revealed an overall paucity of protective behaviours with non-monogamous partners. Protective behaviours (i.e. communication and condom use) were informed by partnership type, rather than perceptions of non-monogamy. There were few instances in which partner non-monogamy motivated women to terminate sex partnerships. Rather, these decisions were often motivated by changes in other relationship dynamics. To address HIV/STI risk related to partner non-monogamy, HIV prevention strategies for young African American women should emphasise the importance of condom use in all non-marital partnership types. Interventions where testing is available may be effective for women who frequently test for HIV/STIs but do not use condoms.     

Unhealthy environments,unhealthy consequences: Experienced homonegativity and HIV infection risk among young men who have sex with men

Unfavourable social environments can negatively affect the health of gay, bisexual, and other men who have sex with men (MSM). We described how experienced homonegativity – negative perceptions and treatment that MSM encounter due to their sexual orientations – can increase HIV vulnerability among young MSM. Participants (n?=?44) were young MSM diagnosed with HIV infection during January 2006–June 2009. All participants completed questionnaires that assessed experienced homonegativity and related factors (e.g. internalised homonegativity). We focus this analysis on qualitative interviews in which a subset of participants (n?=?28) described factors that they perceived to have placed them at risk for HIV infection. Inductive content analysis identified themes within qualitative interviews, and we determined the prevalence of homonegativity and related factors using questionnaires. In qualitative interviews, participants reported that young MSM commonly experienced homonegativity. They described how homonegativity generated internalised homonegativity, HIV stigma, silence around homosexuality, and forced housing displacement. These factors could promote HIV risk. Homonegative experiences were more common among young Black (vs. non-Black) MSM who completed questionnaires. Results illustrate multiple pathways through which experienced homonegativity may increase HIV vulnerability among young MSM. Interventions that target homonegativity might help to reduce the burden of HIV within this population.     

Social-cognitive predictors of consistent condom use among young people in Moscow

CONTEXT: Russia is experiencing an explosive HIV epidemic, and young people aged 15-29 have the highest incidence of infection. Understanding factors associated with condom use in this age-group is important in developing effective prevention interventions. METHODS: Telephone interviews were conducted with 1,203 Muscovites aged 15-29 in September 2002 to assess condom use, HIV knowledge and sexual behavior. Multivariate logistic regression was used to determine independent predictors of consistent condom use. RESULTS: Forty-four percent of sexually experienced respondents reported using condoms consistently. In multivariate analysis, the likelihood of consistent use was elevated among single women and men (odds ratios, 1.8 and 2.6, respectively), those who considered condoms reliable protection against unwanted pregnancy (2.4 and 1.6) and those who believed that most of their peers use condoms (2.9 and 4.6). For women, having recently had multiple partners was associated with increased odds of consistent use, and consistent use declined with age. CONCLUSIONS: Strategies to promote condom use should increase awareness about their effectiveness against not only unwanted pregnancies but also HIV and other STDs. Condoms should be recommended for married couples and people with one permanent partner as a contraceptive option as well as for disease prevention.     

Are Partner Race and Intimate Partner Violence Associated with Incident and Newly Diagnosed HIV Infection in African-American Men Who Have Sex with Men?

Black gay, bisexual, and other men who have sex with men (BMSM) experience a disparate rate of HIV infections among MSM. Previous analyses have determined that STI coinfection and undiagnosed HIV infection partly explain the disparity. However, few studies have analyzed the impact of partner-level variables on HIV incidence among BMSM. Data were analyzed for BMSM who attended the Los Angeles LGBT Center from August 2011 to July 2015 (n = 1974) to identify risk factors for HIV infection. A multivariable logistic regression was used to analyze predictors for HIV prevalence among all individuals at first test (n = 1974; entire sample). A multivariable survival analysis was used to analyze predictors for HIV incidence (n = 936; repeat tester subset). Condomless receptive anal intercourse at last sex, number of sexual partners in the last 30 days, and intimate partner violence (IPV) were significant partner-level predictors of HIV prevalence and incidence. Individuals who reported IPV had 2.39 times higher odds (CI 1.35–4.23) and 3.33 times higher hazard (CI 1.47–7.55) of seroconverting in the prevalence and incidence models, respectively. Reporting Black partners only was associated with increased HIV prevalence, but a statistically significant association was not found with incidence. IPV is an important correlate of both HIV prevalence and incidence in BMSM. Further studies should explore how IPV affects HIV risk trajectories among BMSM. Given that individuals with IPV history may struggle to negotiate safer sex, IPV also warrants consideration as a qualifying criterion among BMSM for pre-exposure prophylaxis (PrEP).     

Determinants of condom use among young people in urban Cameroon

To reduce the prevalence of reproductive health problems among adolescents, governmental and nongovernmental organizations in Cameroon are implementing youth-oriented reproductive health programs. To facilitate the design of effective programs to increase condom use, this study examines survey data on the determinants of having ever used condoms and on current condom use with regular and casual partners among unmarried young people in urban Cameroon. While most adolescents have tried condoms at least once, use remains inconsistent. Parental support, personal risk perception, and self-efficacy are found to be associated with higher levels of condom use. Youth-oriented programs seeking to increase the number of new condom users among the young should promote parental support for condom use and enhance young people's perceptions of personal risk. Programs that work to convince the young that their sexual history can put them at risk of HIV infection and that dispel the myth that HIV risk with regular partners is low may serve to increase personal risk perception. Finally, communications programs should aim to increase adolescents' self-efficacy, particularly in terms of their perceived ability to convince partners to use condoms and to use them correctly.     

成都市男男性行为人群HIV检测影响因素分析

目的 了解成都市男男性行为(MSM)人群的性行为状况以及HIV检测情况,探索成都市MSM人群HIV检测的影响因素.方法 采用立意抽样与“滚雪球”抽样相结合方法对成都市291名男男性行为者进行一对一问卷调查,并采用Logistic回归模型对该人群HIV检测的影响因素进行分析.结果 调查对象中48.5％的人在近6个月存在多性伴的现象;90.2％的人有肛交性行为;51.6％的人没有坚持使用安全套;在对肛交中的性角色回答中,49.8％的对象表示1/0皆有,只做0或1的分别为26.2％和24.0％;近1年接受过HIV检测的占59.3％.30个艾滋病知识/信息条目平均知晓率为76.4％.Logistic回归显示,条目“成都同志关爱小组每周五、周日提供免费艾滋病检测服务”以及“《艾滋病防治条例》规定相关机构应为艾滋病感染者的个人信息保密”的知晓对MSM人群HIV检测起促进作用.结论 成都市MSM人群HIV检测率不高,影响因素主要为该人群缺乏HIV检测的具体信息以及害怕因为检测而暴露自己的身份,建议今后有针对性地进行干预,从检测条件以及检测信息的保密性等方面加大宣传力度,以降低艾滋病的感染风险.     

Trends and determinants of contraceptive use in Rakai District, Uganda, 1995-98

A prospective study conducted between 1995 and 1998 assessed trends in contraceptive use in rural Rakai District, Uganda. Over a period of 30 months, women's use of modern contraceptives increased significantly from 11 percent to 20 percent. Male condom use increased from 10 percent to 17 percent. The prevalence of pregnancy among sexually active women 15-49 declined significantly from 15 percent to 13 percent. Women practicing family planning for pregnancy prevention were predominantly in the 20-39-year age group, married, better educated, and had higher parity than others, whereas women or men adopting condoms were predominantly young, unmarried, and better educated. Condom use was particularly high among individuals reporting multiple sexual partners or extramarital relationships. Contraceptive use was higher among women who desired fewer children, among those who wished to space or terminate childbearing, and among women with previous experience of unwanted births or abortions. Self-perception of HIV risk increased condom use, but HIV testing and counseling had only modest effects. Contraception for pregnancy prevention and for HIV/STD prophylaxis are complementary.     

High-Risk Sexual Behavior, HIV/STD Prevalence, and Risk Predictors in the Social Networks of Young Roma (Gypsy) Men in Bulgaria

Roma (Gypsies), the largest and most disadvantaged ethnic minority group in Europe, are believed to be vulnerable to HIV/AIDS. This study’s aim was to examine HIV risk in 6 Roma male sociocentric networks (n = 405 men) in Bulgaria. Participants were interviewed concerning their risk practices and tested for HIV/STDs. High-risk sexual behaviors were common. Over 57% of men had multiple sexual partners in the past 3 months. Over one-third of men reported both male and female partners in the past year. Condom use was low. Greater levels of sexual risk were associated with lower intentions and self-efficacy for using condoms, drug use, having male partners, knowing HIV-positive persons, and having higher AIDS knowledge but no prior HIV testing. Two men had HIV infection, 3.7% gonorrhea, and 5.2% chlamydia. HIV prevention interventions directed toward high-risk social networks of Roma are needed before HIV infection becomes more widely established.     

Factors associated with nonuse of condoms in heterosexual men and women attending an HIV testing clinic in Israel.

OBJECTIVES: To examine gender differences in HIV-related knowledge, perceived vulnerability, beliefs in self-control, type of sexual partnership, and their associations with nonuse of condoms. METHODS: Heterosexual men and women who voluntarily attended an HIV testing clinic in Israel were asked to complete a self-report questionnaire. Scales of HIV knowledge and control and a single item for vulnerability were used. Type of sexual relationship (monogamous vs. nonmonogramous) and condom use in vaginal sex (never vs. ever) referred to the previous 6 months. Response rate was 84%; 154 men and 109 women participated. RESULTS: Beliefs in self-control did not form a reliable scale and single items were used. No statistically significant gender differences were found in knowledge, vulnerability, or beliefs in self-control. Levels of correct HIV-related knowledge were high, but so were some misconceptions. The vast majority (87%) perceived themselves as vulnerable to HIV infection. The beliefs in self-control were moderate in some items, and low in others. In logistic regression models, different factors were significantly associated with nonuse of condoms in the two genders: the belief that their lifestyle protected them against HIV infection (OR = 2.72, CI = 1.06-7.03) among men, and being monogamous (OR = 3.72, CI = 1.28-10.8) among women. CONCLUSION: Heterosexual men and women attending an HIV testing clinic need counseling to further lower misconceptions about HIV transmission and additional gender-specific counseling to address HIV-related beliefs.     

Sexual practices and AIDS knowledge among women partners of HIV-infected hemophiliacs.

About 12 percent of the women sex partners of hemophilic men who are seropositive for the human immunodeficiency virus (HIV) have themselves become seropositive. Questionnaires were completed in January 1988 by 15 women who were in long-term, monogamous relationships with HIV-positive hemophiliacs; 11 of the women were not HIV seropositive and 4 were. None of the couples was abstaining from sexual intercourse, and during the 4 weeks prior to responding, the couples had intercourse a mean of 6.2 times. Sixty percent always used condoms, 13 percent did so most of the time, and the remaining 27 percent did sometimes. Condom use was not significantly related to either frequency of intercourse, the women's knowledge of acquired immunodeficiency syndrome (AIDS) and AIDS-risk reduction, the actual HIV status of both partners and the women's perceived status of both, the extent of the women's worry about contracting AIDS, their reported degree of negative impact from AIDS, or to their mood, age, or education. All women who reported not always using condoms had been informed of their own and their partner's HIV status; were counseled repeatedly regarding risk reduction; acknowledged the possibility of heterosexual HIV transmission; said they knew of recommendations for the use of condoms; recognized their risk of HIV infection; claimed some degree of worry about acquiring HIV through sexual activity; had children at home; and were not, with one exception, trying to become pregnant. There were several possible factors influencing the decision by women at high risk for acquiring HIV not to use condoms. Among them were complaints that the women found condoms unpleasant or an unwanted reminder of AIDS, a sense of obligation or a drive to continue unaltered sexual relations, the false reassurance of HIV-negative test results for some of the women who did not always use condoms, a willingness to sacrifice and to share their partner's fate, a desire to avoid communicating rejection and adding to their partner's burdens, and difficulty changing long-standing behavior patterns despite logical understanding of the risks involved.     

HIV risk perceptions,knowledge and behaviours among female sex workers in two cities in Turkmenistan

Abstract

This paper describes HIV risk behaviour patterns among street- and bar-based female sex workers in the Turkmenistan cities of Ashgabat and Mary. Street-based sex workers had little to no knowledge of HIV and primarily used condoms when condom use was initiated by clients. Bar-based sex workers had HIV knowledge and reported regularly using condoms mainly with first-time clients. While sex workers perceived themselves to be at low risk for acquiring HIV, they were aware of other sexually transmitted infections (STI) and expressed a strong desire for free STI testing and treatment services.     

The limitations of ‘Black MSM’ as a category: Why gender,sexuality, and desire still matter for social and biomedical HIV prevention methods

ABSTRACT

The USA faces disproportionate and increasing HIV incidence rates among Black men who have sex with men (BMSM). New biomedical technologies such as pre-exposure prophylaxis (PrEP) have been developed to address their HIV risk. Very little consideration, however, has been given to the diversity obscured by ‘BMSM’ as a category, to how this diversity relates to men's sexual partnering strategies, or to the relevance of these issues for new HIV prevention methods. We conducted a community-based ethnography from June 2013 to May 2014 documenting factors that affect the acceptance of and adherence to PrEP among BMSM. We conducted in-depth interviews with 31 BMSM and 17 community stakeholders, and participant observation. To demonstrate the diversity of social identities, we present a taxonomy of indigenous categories organised along the axes of sexual identity, sexual positioning, and gender performance. We analyse how HIV prevention strategies, such as PrEP, may be more effective if programmes consider how gender, sexuality, and sexual desire shape sexual partnering strategies. This article underlines the importance of attending to the diversity of sexual and social subjectivities among BMSM, of bringing the study of sexuality back into HIV prevention, and of integrating biomedical prevention approaches into community-based programmes.