Are HIV/AIDS Prevention Interventions for Heterosexually Active Men in the United States Gender-Specific?

Although gender-specific theories are often deployed in interventions to reduce women''s HIV risks, the same is often not true for interventions among men. Theories of masculinity are not guiding most US research on the risky sexual behavior of heterosexual men or on what can be done to intervene.We first assess the extent to which evidence-based HIV-prevention interventions among heterosexually active men in the United States draw upon relevant theories of masculinity. Next, we introduce a useful framework within masculinity and gender studies that can be applied to HIV-prevention interventions with heterosexually active men.Finally, we make suggestions to improve the gender specificity of HIV-prevention interventions for heterosexually active men in the United States.ALTHOUGH THE FIRST AIDS cases in the United States were attributed to men who had sex with men, more than 70% of HIV infections worldwide are now estimated to occur as a result of heterosexual sex.¹ Most HIV-positive women were infected through heterosexual sex.²Despite wide regional variation in the percentage of cases attributable to heterosexual transmission, it is clear that the proportion of women with HIV is rising in many parts of the world. In Asia, 30% of adults living with HIV are women, and in Sub-Saharan Africa, 60% of adults living with HIV are women.² Globally, increases in the proportion of women infected with HIV have occurred in a relatively short period of time: in 1985, 30% of infected persons were women; this percentage now stands at approximately 50%, and the absolute numbers of infected women, as well as the percentages, are increasing in many parts of the world.²In the United States, where the main subgroup affected by HIV/AIDS is men who have sex with men, heterosexual transmission is the primary means of transmission among women.³ Among women diagnosed in the United States, heterosexual transmission as the identified source of transmission more than tripled from 1985 to the present, and the Centers for Disease Control and Prevention has reported that 80% of cases of HIV infection among women are diagnosed as being heterosexually transmitted.^3,4 Of this 80%, approximately one third are the result of having sex with a male partner who is an injection drug user.^3,4 Combined, these facts suggest that sexual behavior change among heterosexually active men will be key to controlling the HIV epidemic for both heterosexual men and women.Analyses of why these trends are occurring have come to the same conclusions: gender and gender inequality in particular have been identified as a major “root cause” of what shapes and exacerbates the course of the epidemic.^5–8 Some argue that these findings underscore how HIV studies need to “adequately address the contextual issues of heterosexual relationship dynamics”^6(p873) on a domestic and global level. It seems clear that the structure of gender relations needs to be examined and challenged for both women and men.To what extent has this examination already occurred? Very little, it appears. Indeed, HIV-prevention interventions for heterosexually active adults have largely targeted women, as they are said to need structural, cultural, institutional, and technologically based empowerment and protection. But what do heterosexually active men need? What do gender relations have to do with HIV prevention? Because women and men are equally shaped by gender, how can we use theories of masculinity to understand what puts men at risk for HIV infection and to guide researchers in creating effective prevention interventions?Ten years ago, Exner et al. underscored that:

While many HIV risk reduction interventions have been focused among women, heterosexual men have less frequently been the focus of such efforts … yet it is imperative that heterosexually-active men be included in strategic efforts to reduce heterosexual transmission because sexual behavior is dyadic and men are the partners of women.^9(p348)

To examine the state of the field, Exner et al. reviewed HIV-prevention interventions from 1981 to 1998 that focused on reducing risky heterosexual behavior among North American men. Intervention programs were described as “informational” (e.g., providing HIV/AIDS, alcohol, and sexuality information), “condom skills” (e.g., ensuring consistent and correct condom use), “relational skills building” (including negotiating safer sex, assertiveness, and communication), and “individual risk counseling” and “community street outreach” (for injection drug users). Of the 20 interventions they found to meet rigorous methodological standards, seven were for injection drug users. Of the remaining 13 interventions, three targeted men exclusively, whereas the remainder focused on both women and men. At that time, the authors made a call to bolster prevention efforts for heterosexually active men.How far have we come since then? Lyles et al.¹⁰ carried out a systematic review of the intervention literature from 2000 to 2004 and detailed 18 interventions that met rigorous criteria for best evidence. Of the six best-evidence interventions that were designed for sexual risk reduction among heterosexually active HIV-negative adults, four were for women, two were for both women and men (of which one focused on those receiving outpatient psychiatric care and the other on couples communication), and none were designed for heterosexually active men only. Although one of the two interventions among both women and men focused on issues of gender norms and gender power, all of the women-only interventions focused on these topics. The women-only interventions also emphasized the need to infuse women with more safer-sex negotiating power vis-à-vis a male partner.Notably, in both of the previously mentioned reviews—and even in a third review from 2002 that focused on interventions with heterosexually active men¹¹—despite the large number of interventions, the word masculinity was not mentioned once. The reviews included no overt discussion about the ways in which men have gender or are affected by a system of gender inequality. There was also no mention of how masculinity and gender relations should be a guiding theoretical framework to understand—and intervene about—what puts heterosexually active men at risk for HIV infection.     

Sexuality in Young Adult Men Aged 18–24 with Epilepsy

The aim of this study was to determine the extent of sexual dysfunction in young male patients (18–24 years) with epilepsy. Forty-five male patients with epilepsy aged between 18 and 24, and forty-four age- matched healthy male volunteers were included in the study. Participants completed a battery of self-reported tests (ASEX: Arizona Sexual Experiences Scale, HADS: Hospital Anxiety and Depression Scale). Demographic and clinical variables were recorded. Serum total testosterone was measured between 8:00 and 10:00 a.m. in patients with epilepsy. Sexual function scores (sexual drive and penile erection) were higher in patients with epilepsy than those of the control group (p < 0.001 and p = 0.008, respectively). The difference between the mean total ASEX scores, which were 13.9 and 11.4 in patients with epilepsy and controls, respectively, was significant (p = 0.009). HAD anxiety scores were significantly higher in patients with epilepsy than controls (p = 0.01) (Table 2). HAD-depression scores of both groups were similar (p = 0.09). This study demonstrates that young male patients with epilepsy have lower levels of sexual activity and drive and more erectile problems. Impaired sexual function is associated with anxiety scores.     

Viewing Pornography Depicting Unprotected Anal Intercourse: Are There Implications for HIV Prevention Among Men Who Have Sex with Men?

We used an Internet-based questionnaire to investigate whether viewing pornography depicting unprotected anal intercourse (UAI) was associated with engaging in UAI in a sample of 821 non-monogamous men who have sex with men (MSM). In the 3 months prior to interview, 77.2% viewed pornography depicting UAI, 42.6% engaged in insertive UAI, and 38.9% engaged in receptive UAI. Polytomous logistic regression of the 751 subjects who provided data on pornography viewing showed significantly elevated odds ratios for having engaged in receptive UAI, insertive UAI, and both receptive and insertive UAI associated with increasing percentage of pornography viewed that depicted UAI. We also found independently significant associations of engaging in UAI with age, use of inhalant nitrites, and HIV status. Although the data cannot establish causality, our findings indicate that viewing pornography depicting UAI and engaging in UAI are correlated. Further research is needed to determine if this observation may have utility for HIV prevention.     

Men Sex Workers and Other Men Who Have Sex With Men: How Do Their HIV Risks Compare in New Zealand?

Sex workers have their perspective on HIV transmission, claiming that in general they are more similar than different from other people in HIV status and the practice of safe sex. Such an assertion of similarity goes against public and professional opinion that prostitution is a major vector in the spread of AIDS. Taking the sex workers' similarity claim seriously, this paper considers the conditions under which it would be valid. We focus on those factors that make a population more or less vulnerable to HIV and how they affect its spread into the sex work population. Data from New Zealand comparing men sex workers and other men who have sex with men is used to evaluate these ideas. Data partially support the hypothesis in that these two groups of men are similar with regard to their HIV status. We do find the sex workers to be different, however, in their being less likely to engage in safe sex practices. We provide an explanation for why this has not lead to their having a higher rate of seropositivity.     

Ready or Not—Intrapartum Prevention of Perinatal HIV Transmission in Illinois

Objectives: The overall readiness of Illinois birthing hospitals to comply with the 2003 Illinois HIV Perinatal Prevention Act and prevent perinatal HIV transmission, and the hospital characteristics that predict readiness were examined. Methods: Nurse Managers of all 137 Illinois birthing hospitals were surveyed regarding current labor and delivery (L&D) practices for HIV status identification, documentation, testing and zidovudine (AZT) availability in March 2004. Bivariate and multivariable regression analysis was performed. Results: All 137 hospitals returned the surveys. Almost forty seven percent of Illinois birthing hospitals had adequate maternal HIV status documentation on arrival in L&D, 72.3% documented prenatal HIV results in the L&D chart, 65.7% documented prenatal HIV in the newborn chart, 38.7% ordered HIV tests on L&D if no prenatal HIV status was available, and 61.3% had AZT available. Only 17 hospitals (12.4%) met requirements for overall readiness to prevent perinatal HIV transmission. Sixteen hospitals (11.6%) met a minimal level of readiness (prenatal HIV status documentation and AZT availability). Conclusions: Despite passage of legislation to increase perinatal HIV testing and reduce transmission, Illinois birthing hospitals had an overall low level of readiness to implement the intrapartum interventions that are an essential part of eradicating pediatric HIV infection. Perinatal reduction protocols and implementation guidelines would improve the overall readiness of Illinois birthing hospitals to prevent perinatal HIV transmission.     

Overcoming HIV Stigma? A Qualitative Analysis of HIV Cure Research and Stigma Among Men Who Have Sex with Men Living with HIV

Despite global progress in HIV stigma reduction, persistent HIV stigma thwarts effective HIV service delivery. Advances in HIV biomedical research toward a cure may shift perceptions of people living with HIV and HIV stigma. The purpose of this study was to examine how men who have sex with men (MSM) living with HIV in Guangzhou, China perceive HIV cure research and its potential impact on MSM and HIV stigma. We conducted in-depth interviews with 26 MSM living with HIV about their perceptions of HIV cure research and the potential impact of an HIV cure on their lives. Thematic coding was used to identify themes and structure the analysis. Two overarching themes emerged. First, participants stated that an HIV cure may have a limited impact on MSM-related stigma. Men noted that most stigma toward MSM was linked to stereotypes of promiscuity and high rates of sexual transmitted diseases in the MSM community and might persist even after a cure. Second, participants believed that an HIV cure could substantially reduce enacted, anticipated, and internalized stigma associated with HIV. These findings suggest that a biomedical cure alone would not remove the layered stigma facing MSM living with HIV. Comprehensive measures to reduce stigma are needed.     

Why the Wait? Delayed HIV Diagnosis among Men Who Have Sex with Men

We sought to identify factors associated with delayed diagnosis of human immunodeficiency virus (HIV; testing HIV-seropositive 6 months or more after HIV seroconversion), by comparing delayed testers to non-delayed testers (persons who were diagnosed within 6 months of HIV seroconversion), in King County, Washington among men who have sex with men (MSM). Participants were recruited from HIV testing sites in the Seattle area. Delayed testing status was determined by the Serologic Testing Algorithm for Recent HIV Seroconversion or a self-reported previous HIV-negative test. Quantitative data on sociodemographic characteristics, health history, and drug-use and sexual behaviors were collected via computer-assisted self-interviews. Qualitative semi-structured interviews regarding testing and risk behaviors were also conducted. Multivariate analysis was used to identify factors associated with delayed diagnosis. Content analysis was used to establish themes in the qualitative data. Out of the 77 HIV-seropositive MSM in this sample, 39 (51%) had evidence of delayed diagnosis. Factors associated with delayed testing included being African-American, homeless, “out” to 50% or less people about male-male sex, and having only one sex partner in the past 6 months. Delayed testers often cited HIV-related sickness as their reason for testing and fear and wanting to be in denial of their HIV status as reasons for not testing. Delayed testers frequently did not identify as part of the MSM community, did not recognize that they were at risk for HIV acquisition, and did not feel a responsibility to themselves or others to disclose their HIV status. This study illustrates the need to further explore circumstances around delayed diagnosis in MSM and develop outreach methods and prevention messages targeted specifically to this potentially highly marginalized population in order to detect HIV infections earlier, provide HIV care, and prevent new infections.     

AZT Availability in Illinois Birthing Hospitals: Is the Perinatal HIV Prevention Safety Net in Place?

Objectives: To prevent perinatal HIV transmission, providers must identify HIV status for all women in labor and newborns, and provide timely antiretroviral therapy if necessary. The objective of this study is to evaluate the availability and accessibility of zidovudine (AZT) in Illinois birthing hospitals. Methods: We surveyed all Illinois birthing hospital pharmacies by telephone in February 2005 regarding availability, accessibility, and protocols surrounding AZT use in the perinatal period. Results: All 137 pharmacies participated. Only 43.1% reported having syrup and IV AZT available and only 37.2% indicated the ability to have AZT available on labor and delivery within 30 min during off hours. Protocols for treating HIV positive women in labor and exposed newborns were available in only 37.2% of pharmacies while 72.4% had protocols for antiretroviral therapy for occupational post-exposure prophylaxis. Variables associated with pharmacies having AZT available included being a major academic hospital and serving a predominately (greater than 96%) white patient population. Timely provision of AZT was more likely to occur in urban, major academic hospitals serving a predominately white population. Conclusions: In order to further reduce perinatal HIV transmission, availability and timely access to both syrup and IV AZT must be improved in Illinois birthing hospitals.     

COVID-19-Related Disruptions to HIV Testing and Prevention Among Young Sexual Minority Men 17–24 Years Old: A Qualitative Study Using Synchronous Online Focus Groups,April–September 2020

Prior research has highlighted the impact of the COVID-19 pandemic on HIV prevention services within the U.S., but few studies have explored this impact through an exploratory, qualitative lens. In this study, we sought to highlight the voices of young sexual minority men (YSMM) 17–24 years old and explored the perceived impact of the pandemic on HIV prevention among a diverse, nationwide sample of YSMM who participated in synchronous online focus group discussions between April and September 2020. Forty-one YSMM described the negative effects of the COVID-19 pandemic on HIV testing and prevention services, including limited and disrupted access to HIV testing, HIV pre-exposure prophylaxis (PrEP), and HIV post-exposure prophylaxis. COVID-19-related challenges were compounded by ongoing, pre-COVID-19 barriers experienced by YSMM in the U.S. For instance, many YSMM relocated back home with family, causing men to avoid HIV prevention services for fear of outing themselves to relatives. YSMM also worried about placing their family at increased risk of COVID-19 by attending clinical appointments. YSMM who did seek HIV prevention services, including access to PrEP, experienced significant barriers, including limited appointment availability and services not tailored to YSMM. Further efforts are needed to support YSMM re-engaging in HIV prevention during and after the COVID-19 era.

     

A Qualitative Analysis of Father–Son Relationships among HIV-Positive Young Black Men Who Have Sex with Men

Young black men who have sex with men (YBMSM) are experiencing high and rising rates of HIV infection, more than any other age-risk group category in the USA. Contributors to HIV risk in this group remain incompletely elucidated. We conducted exploratory qualitative interviews with 20 HIV-positive YBMSM aged 17–24 and found that father–son relationships were perceived to be important sociocontextual influences in participants’ lives. Participants discussed the degree of their fathers’ involvement in their lives, emotional qualities of the father–son relationship, communication about sex, and masculine socialization. Participants also described pathways linking father–son relationships to HIV risk, which were mediated by psychological and situational risk scenarios. Our thematic analysis suggests that father–son relationships are important to the psychosocial development of YBMSM, with the potential to either exacerbate or attenuate sexual risk for HIV. Interventions designed to strengthen father–son relationships may provide a promising direction for future health promotion efforts in this population.     

HIV Prevalence and Awareness of Positive Serostatus Among Men Who Have Sex With Men and Transgender Women in Bogotá, Colombia

Objectives. We estimated HIV prevalence among men who have sex with men (MSM) and transgender women in Bogotá, Colombia, and explored differences between HIV-positive individuals who are aware and unaware of their serostatus.Methods. In this cross-sectional 2011 study, we used respondent-driven sampling (RDS) to recruit 1000 MSM and transgender women, who completed a computerized questionnaire and received an HIV test.Results. The RDS-adjusted prevalence was 12.1% (95% confidence interval [CI] = 8.7, 15.8), comparable to a previous RDS-derived estimate. Among HIV-positive participants, 39.7% (95% CI = 25.0, 54.8) were aware of their serostatus and 60.3% (95% CI = 45.2, 75.5) were unaware before this study. HIV-positive–unaware individuals were more likely to report inadequate insurance coverage, exchange sex (i.e., sexual intercourse in exchange for money, goods, or services), and substance use than other participants. HIV-positive–aware participants were least likely to have had condomless anal intercourse in the previous 3 months. Regardless of awareness, HIV-positive participants reported more violence and forced relocation experiences than HIV-negative participants.Conclusions. There is an urgent need to increase HIV detection among MSM and transgender women in Bogotá. HIV-positive–unaware group characteristics suggest an important role for structural, social, and individual interventions.Colombia ranks second among countries in Latin America in HIV prevalence, with estimates ranging from 0.7% to 1.1% of the adult population.1 Men who have sex with men (MSM) represent the group most strongly affected, with prevalence of 18% to 20% based on venue-based convenience samples2,3 and 15% based on respondent-driven sampling (RDS).4 Colombia has a long history of armed conflict, and the pervasive conditions of violence, internal displacement, and poverty can be relevant to HIV transmission.5 “Social cleansing” by armed groups has been aimed at MSM and transgender women, as well as people living with HIV,5 and the stigma associated with homosexuality and HIV is widespread and inherent in structural inequalities in Colombia.6,7 Social epidemiological models posit that HIV is influenced by such structural (e.g., civil unrest, migration) and social factors (e.g., social networks, community attitudes), as well as individual characteristics (e.g., psychological characteristics, behavior).8Public health efforts emphasize the importance of detecting and treating undiagnosed HIV as a means of reducing HIV incidence.9–11 In the United States, approximately 20% of HIV-positive individuals are thought to be unaware of their infection, but this group is estimated to be responsible for nearly half of new transmissions.12 There is limited research concerning awareness of serostatus in Latin America. Undiagnosed infection was found to be 89% among HIV-positive MSM sampled in Peru in 2011,13 and rates are likely to be high in Colombia because of low levels of testing,6 including among MSM.4,14 Recent studies of MSM in France, Peru, and the United States have found associations between undiagnosed infection and demographic characteristics such as age, income, and education13,15,16; risk behaviors14,17,18; family or intimate partner violence19; and health insurance coverage.20 We also examined awareness in relation to violence and forced relocation, conditions specific to the Colombian context.Respondent-driven sampling was developed as a means of obtaining unbiased estimates from hidden populations,21–23 and it has been shown to capture a more diverse24,25 and hidden26 group of MSM than time–location or snowball sampling. Research has suggested, however, that biases can occur.27–29Our current study and a study conducted by the United Nations Population Fund and the Colombian Ministry of Health and Social Protection (UNFPA/MSPS) were independently funded at approximately the same time to address the limited information about behavioral risk and HIV prevalence among Colombian MSM. Comparison of findings from the 2 studies provides evidence concerning reliability of the RDS-derived prevalence estimates. We estimated HIV prevalence among MSM and transgender women in Bogotá, Colombia, examined reliability of RDS-derived estimates in relation to the UNFPA/MSPS study,4 and investigated the role of the social and structural context of Colombia in both prevalence and awareness of positive serostatus.     

High Risk for HIV Following Syphilis Diagnosis Among Men in Florida, 2000–2011

Objective

Multiple interventions have been shown to reduce the risk of HIV acquisition, including preexposure prophylaxis with antiretroviral medications, but high costs require targeting interventions to people at the highest risk. We identified the risk of HIV following a syphilis diagnosis for men in Florida.

Methods

We analyzed surveillance records of 13- to 59-year-old men in Florida who were reported as having syphilis from January 1, 2000, to December 31, 2009. We excluded men who had HIV infection reported before their syphilis diagnosis (and within 60 days after), then searched the database to see if the remaining men were reported as having HIV infection by December 31, 2011.

Results

Of the 9,512 men with syphilis we followed, 1,323 were subsequently diagnosed as having HIV infection 60–3,753 days after their syphilis diagnosis. The risk of a subsequent diagnosis of HIV infection was 3.6% in the first year after syphilis was diagnosed and reached 17.5% 10 years after a syphilis diagnosis. The risk of HIV was higher for non-Hispanic white men (3.4% per year) than for non-Hispanic black men (1.8% per year). The likelihood of developing HIV was slightly lower for men diagnosed with syphilis in 2000 and 2001 compared with subsequent years. Of men diagnosed with syphilis in 2003, 21.5% were reported as having a new HIV diagnosis by December 31, 2011.

Conclusion

Men who acquire syphilis are at very high risk of HIV infection.Antiretroviral medications have reduced acquired immunodeficiency syndrome mortality in the United States from 50,260 adults in 1995 to 17,770 adults in 2009.^1,2 However, the risk of acquiring human immunodeficiency virus (HIV) infection remains high, particularly for men who have sex with men (MSM). An estimated 30,000 MSM have acquired HIV in each of the past several years.^3,4 The White House''s National HIV/AIDS Strategy states that to reduce HIV incidence, we must (1) intensify HIV prevention efforts in communities where HIV is most heavily concentrated and (2) expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches.⁵ By estimating the percentage of men in the population who are MSM, researchers have estimated the HIV incidence for all MSM as 0.66% per year in Florida (in 2006)⁶ and 0.67% per year in 37 states (in 2008).⁷ This risk might be reduced by a variety of interventions, including antiretroviral preexposure prophylaxis (PrEP), which reduced the incidence of HIV by 44% among MSM in a blinded randomized controlled trial.⁸ If PrEP could be widely implemented with high-use effectiveness, it could have an impact on HIV incidence; however, the high cost of PrEP will require targeting MSM at highest risk.⁹ Some groups of high-risk MSM have been identified. For example, MSM recruited into HIV vaccine efficacy studies have had incidence rates as high as 2.7% per year.¹⁰People diagnosed with other sexually transmitted infections (STIs) have long been known to be at increased risk for having HIV coinfection.¹¹ Among 212 men with early syphilis in Los Angeles, California, in 2002–2004, 35% had HIV coinfection, and HIV incidence was estimated to be 17% in the preceding year.¹² Among 363 MSM with early syphilis in Atlanta, Georgia; San Francisco, California; or Los Angeles in 2004–2005, 47% had HIV coinfection, and 10 of these coinfections were recently diagnosed, suggesting an incidence of 12%.¹³ However, preventing infection requires identifying high-risk people before they acquire HIV. A recent study in San Francisco''s City Clinic retrospectively followed MSM for two years after they were diagnosed with rectal gonorrhea or chlamydia and found that 27 acquired HIV, for an incidence of 2.3% per year.¹⁴In Florida, all syphilis, gonorrhea, and chlamydia infections are reportable to the state health department, and the reports are maintained in a common database. This database is routinely cross-matched with the HIV surveillance database to determine if any of the people with other STIs have been reported as having HIV. Gender of sex partners is not available for all reported cases of STI, but since the early 2000s, syphilis cases have been increasingly concentrated among MSM.¹⁵ We used this database to study all men in Florida who were reported as having early syphilis and to determine their risk of subsequent diagnosis and report of HIV infection.     

Are HIV-Negative Men Who Have Sex with Men and Who Bareback Concerned About HIV Infection? Implications for HIV Risk Reduction Interventions

The emergence of barebacking (intentional unprotected anal intercourse in situations where there is risk of HIV infection) among men who have sex with men (MSM) has been partially attributed to a decrease in HIV-related concerns due to improved anti-retroviral treatment. It is important to understand the level of concern these men have regarding HIV infection because it can affect their interest in risk reduction behaviors as well as their possible engagement in risk reduction interventions. As part of a study on MSM who use the Internet to seek sexual partners, 89 ethnic and racially diverse men who reported never having an HIV-positive test result completed an in-depth qualitative interview and a computer-based quantitative assessment. Of the 82 men who were asked about concerns of HIV infection during the qualitative interviews, 30 expressed “significant concern” about acquiring HIV, 42 expressed “moderate concern,” and 10 expressed “minimal concern.” Themes that emerged across the different levels of concern were their perceptions of the severity of HIV infection, having friends who were HIV positive, and their own vulnerability to HIV infection. However, these themes differed depending on the level of concern. Among the most frequently mentioned approaches to decrease risk of HIV infection, participants mentioned avoiding HIV-positive sex partners, limiting the number of partners with whom they barebacked, and not allowing partners to ejaculate inside their rectum. Findings suggest that many MSM who bareback would be amenable to HIV prevention efforts that do not depend solely on condom use.     

‘Men usually say that HIV testing is for women’: gender dynamics and perceptions of HIV testing in Lesotho

In Lesotho, men have lower HIV testing rates, less contact with HIV clinical settings and less knowledge of HIV prevention than women. However, women's HIV prevalence has consistently remained higher than men's. This paper explores gender norms, sexual decision-making and perceptions of HIV among a sample of Basotho men and women in order to understand how these factors influence HIV testing and prevention. A total of 200 women and 30 men were interviewed in Lesotho between April and July 2011. Participants reported reluctance among women to share information about HIV prevention and testing with men, and resistance of men to engage with testing and/or prevention services. Findings demonstrate a critical need for educational initiatives for men, among other strategies, to engage men with HIV testing and prevention. This study highlights how gender issues shape perceptions of HIV and sexual decision-making and underlines the importance of engaging men along with women in HIV prevention efforts. More studies are needed to determine the most effective strategies to inform and engage men.     

Gender Differences in Associations of Sexual and Romantic Stimuli: Do Young Men Really Prefer Sex over Romance?

Theory and research emphasize differences in men’s and women’s sexual and romantic attitudes, concluding that men have stronger preferences for sexual than romantic stimuli as compared to women. However, most of the research on gender differences have relied on self-reports, which are plagued by problems of social desirability bias. The current study assessed young men’s and women’s implicit attitudes toward sexual and romantic stimuli to test whether, in fact, men have a stronger preference for sexual over romantic stimuli compared to women. We also assessed associations between implicit and explicit attitudes, as well as sex role ideology and personality. College students (68 men and 114 women) completed an Implicit Association Test (IAT) that assessed strengths of associations of sexual and romantic stimuli to both pleasant and unpleasant conditions. Results revealed that both men and women more strongly associated romantic images to the pleasant condition than they associated the sexual images to the pleasant condition. However, as predicted, women had a stronger preference toward romantic versus sexual stimuli compared to men. Our study challenges a common assumption that men prefer sexual over romantic stimuli. The findings indicate that measures of implicit attitudes may tap preferences that are not apparent in studies relying on self-reported (explicit) attitudes.     

Men’s moralising discourses on gender and HIV risk in rural KwaZulu-Natal,South Africa

Various interventions have resulted in increased rates of HIV testing. However, encouraging men to acknowledge their risk for HIV, to test and link to treatment remains a challenge. In this study, we examine men’s perspectives on navigating HIV risk in rural KwaZulu-Natal, South Africa. Qualitative interviews were conducted at four intervals over a three-year time period with a baseline cohort of 126 men and women. We found that men navigated HIV risk in their sexual relationships mainly by monitoring their partner’s behaviour. Men expressed concerns about female respectability, invoking discourses on hlonipha rooted in Zulu cultural ideals and Christian ideals about women staying close to home. In the post-apartheid era, these concerns were inflected by anxieties over changing gender norms and the high rates and risks of infection in the region. HIV prevention discourses on behaviour intersected with men’s efforts to assert their masculinity through the monitoring and controlling of women’s behaviour. The potential negative impacts of this should be addressed. Prevention efforts need to focus on men’s vulnerability to infection in terms of their own behaviour as well as the contexts in which they live.     

Stability of Intimate Partner Violence by Men across 12?Years in Young Adulthood: Effects of Relationship Transitions

The present study examined the stability of young men??s intimate partner violence (IPV) over a 12-year period as a function of relationship continuity or discontinuity. Multiwave measures of IPV (physical and psychological aggression) were obtained from 184 men at risk for delinquency and their women partners. The effects of relationship continuity versus transitions on change in IPV were examined using multilevel analyses. In general, men??s IPV decreased over time. Men??s physical aggression in their early 20s predicted levels of physical aggression about 7?years later, and men??s psychological aggression in their early 20s predicted levels of psychological aggression about 10?C12?years later. As hypothesized, higher stability in IPV was found for men who stayed with the same partners, whereas men experiencing relationship transitions showed greater change. The IPV of new partners was linked to the changes in men??s IPV that occurred with repartnering. There was less change in men??s IPV over time as men changed partners less frequently.     

Injection Drug Users’ Perspectives on Placing HIV Prevention and Other Clinical Services in Pharmacy Settings

In their role as a source of sterile syringes, pharmacies are ideally situated to provide additional services to injection drug users (IDUs). Expanding pharmacy services to IDUs may address the low utilization rates of healthcare services among this population. This qualitative study of active IDUs in San Francisco explored perspectives on proposed health services and interventions offered in pharmacy settings, as well as facilitators and barriers to service delivery. Eleven active IDUs participated in one-on-one semistructured interviews at a community field site and at a local syringe exchange site between February and May 2010. Results revealed that most had reservations about expanding services to pharmacy settings, with reasons ranging from concerns about anonymity to feeling that San Francisco already offers the proposed services in other venues. Of the proposed health services, this group of IDUs prioritized syringe access and disposal, clinical testing and vaccinations, and provision of methadone. Pharmacists’ and pharmacy staff’s attitudes were identified as a major barrier to IDUs’ comfort with accessing services. The findings suggest that although IDUs would like to see some additional services offered within pharmacy settings, this is contingent upon pharmacists and their staff receiving professional development trainings that cultivate sensitivity towards the needs and experiences of IDUs.     

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).