HIV sex-risk behaviors among in- versus out-of-treatment heroin-addicted adults

Background: Relatively limited empirical evidence exists comparing the impact on HIV sex risk behavior for patients admitted to methadone treatment programs (MTPs) as compared with nontreatment seekers. Methods: This longitudinal cohort study examined HIV sex-risk behavior among 164 out-of-treatment heroin-dependent adults recruited from the street and 351 newly admitted MTP patients. The AIDS Risk Assessment was administered at baseline, 6 months, and 12 months. Generalized linear mixed model and generalized estimating equation analyses were used to examine the changes in sex risk behavior over time. Results: The participants mean age was 41.5 years, 74.8% were African-American, 24.3% were White, and 54.4% were men. There were no significant differences between the groups in age, race, or gender. At baseline, the out-of-treatment group compared with the in-treatment group reported more sex partners (p < .001) and higher frequency of sex (p = .001). There was a group x time interaction for three of the sex-risk items and the out-of-treatment group reported having significantly more sex partners at both follow-up time points and having significantly more frequent unprotected sex while high at 6 months (all values of p < .01). Conclusions: Nontreatment seekers are at higher HIV risk than those entering MTPs and should be a focus of sex-risk reduction interventions, even if they are not interested in treatment at that time.     

Effect of Continuing Care for Cocaine Dependence on HIV Sex-Risk Behaviors

Evaluate the effect of continuing care interventions for cocaine use with HIV risk-reduction components on HIV sex-risk. Explore whether cocaine use at treatment initiation interacts with the type of continuing care intervention to affect HIV sex-risk. Cocaine dependent participants (N = 321) were randomized to: (1) Treatment as usual (TAU): intensive outpatient treatment, (2) TAU and telephone monitoring and counseling (TMC), and (3) TAU and TMC plus incentives for participation in telephone contacts (TMC+). Participants in TMC and TMC+ received a brief HIV intervention, with booster sessions as needed. Generalized estimating equations analysis compared TAU, TMC and TMC+ at 6, 12, 18, 24 months post-baseline on the following outcomes: overall HIV sex-risk, number of sexual partners, condom usage, exchange of drugs for sex, exchange of sex for drugs, exchange of money for sex, exchange of sex for money, and crack house visits. Overall sex-risk decreased for all treatment conditions at follow-up, with no treatment main effects. For people with no cocaine use at baseline, TAU experienced greater sex-risk reductions than TMC (p < .01) and TMC+ (p < .001). The three treatment conditions are effective in reducing HIV sex-risk. TMC with HIV risk-reduction components is unnecessary for cocaine-dependent clients who stop using cocaine early in treatment.     

Relationship-level analysis of drug users' anticipated changes in risk behavior following HIV vaccination

Formative research into the behavioral factors surrounding HIV vaccine uptake is becoming increasingly important as progress is made in HIV vaccine development. Given that the first vaccines on the market are likely to be partially effective, risk compensation (i.e., increased risk behavior following vaccination) may present a concern. This study characterized the relationships in which HIV vaccine-related risk compensation is most likely to occur using dyadic data collected from people who use drugs, a high-risk group markedly underrepresented in extant literature. Data were collected from 433 drug users enrolled in a longitudinal study in the USA. Respondents were asked to provide the first name and last initial of individuals with whom they had injected drugs and/or had sex during the past six months. For each partner, respondents reported their likelihood of increasing risk behavior if they and/or their partner received an HIV vaccine. Using generalized linear mixed models, relationship-level correlates to risk compensation were examined. In bivariate analysis, risk compensation was more likely to occur between partners who have known each other for a shorter time (odds ratio [OR] = 0.95, 95% confidence interval [CI]: 0.90–0.99, p = 0.028) and between those who inject drugs and have sex together (OR = 2.52, CI: 1.05–6.04, p = 0.039). In relationships involving risk compensation, 37% involved partners who had known each other for a year or less compared to only 13% of relationships not involving risk compensation. Adjusting for other variables, duration (OR: 0.95, CI: 0.90–1.00, p = 0.033) was associated with risk compensation intent. These analyses suggest that risk compensation may be more likely to occur in less established relationships and between partners engaging in more than one type of risk behavior. These data provide further support for the need to expand measures of risk compensation in HIV vaccine preparedness studies to assess not only if people will change their behavior, but also with whom.     

Computerized Assessment Facilitates Disclosure of Sensitive HIV Risk Behaviors among African Americans Entering Substance Abuse Treatment

Background: Individuals entering substance abuse treatment are at elevated risk for HIV infection, and clinicians must generally rely on patient self-report to gauge their involvement in risk behaviors. Strategies to improve accurate reporting of personally sensitive or stigmatizing risk behaviors are needed. Objective: This study compared computerized and face-to-face interview methods in eliciting self-disclosure of HIV risk behaviors among a high-risk sample of urban African Americans entering substance abuse treatment (N = 146). Methods: Participants completed a standardized HIV risk behavior screening as a face-to-face interview. Several days later, the same participants completed a computerized self-interview with the same measure, covering the same time frame. Results: Disclosure rates for many sensitive risk behaviors were considerably higher on the computerized interview. Participants had significantly higher odds of disclosure on the computerized interview compared to the face-to-face interview on 2 of 6 drug risk behaviors examined (ORs between 2.75 and 3.15) and 9 of 13 sex risk behaviors examined (ORs between 1.60 and 6.45). The advantage of the computerized interview was most evident for highly stigmatized behaviors, such as unprotected sex with someone other than a spouse or main partner (OR = 3.93; p < .001), unprotected sex during a commercial sex transaction (OR = 5.63; p < .001), unprotected anal sex (OR = 6.45; p < .001), and using unsterilized syringes (OR = 3.15; p < .05). Conclusions and scientific significance: Findings support the utility of computerized risk behavior assessment with African Americans entering substance abuse treatment. Computerized assessment of HIV risk behaviors may be clinically useful in substance abuse treatment and other healthcare venues serving high-risk populations.     

High-risk sexual behaviors of intravenous drug users in- and out-of-treatment: implications for the spread of HIV infection.

This paper examines the sexual behaviors of 255 intravenous drug users (IVDUs) to assess the potential for the sexual transmission of HIV and to examine differences in sexual behaviors between in- and out-of-treatment IVDUs. In-treatment subjects (N = 152) were a random sample of clients at a large, publicly funded methadone maintenance program. Out-of-treatment subjects (N = 103) were recruited through a chain referral technique, using the in-treatment subjects. Forty-five percent of the study subjects reported multiple partners and 32% reported exchanging sex for money or drugs in the preceding 6 months. Fifty-three percent reported no use of condoms. After controlling for demographic differences between the in- and out-of-treatment groups, out-of-treatment IVDUs reported significantly more partners than in-treatment IVDUs (4.6 vs 2.3, significant t < 0.01), and more often had exchanged sex for money or drugs (44 vs 26%, relative odds 1.8, p < .05). In- and out-of-treatment subjects did not differ with respect to condom use. We conclude that IVDUs both in- and out-of-treatment continue to be at risk of contracting and spreading HIV infection through sexual behaviors, and that being in drug treatment is associated with a lower incidence of high risk sexual behaviors.     

Risk factors associated with HIV infection among young persons aged 15–24 years: Evidence from an in-depth analysis of the 2005–06 Zimbabwe Demographic and Health Survey

This study focuses on factors that predispose young persons aged 15–24 years in Zimbabwe to infection from HIV. Using the Mosley and Chen framework, multivariate modelling was used to assess the effect of demographic, socio-economic and behavioural factors on the risk of HIV infection among this target group. The study utilised data from the Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005–06. Only the variables that were significant in the bivariate analysis were included in the multivariate binary logistic regression. Young females aged 15–24 years are associated with a significant two-fold elevated risk of HIV infection relative to their male peers (p?<?0.000). Young persons aged 15–24 years who were divorced, widowed or not living together have significantly elevated risk compared with their never-married counterparts, OR?=?5.267 (p?=?0.000); OR?=?4.323 (p?=?0.000) and OR?=?3.272 (p?=?0.000), respectively. Young persons whose age at first sexual intercourse was less than 14 years are significantly associated with 2.696 times more risk of HIV infection relative to their peers whose age at first sexual intercourse was 20–24 years (p?=?0.000). Young persons aged 15–24 years with two or more sex partners in the past 12 months preceding the 2005–06 ZDHS survey had a significantly elevated risk of HIV infection of 1.568 times relative to their counterparts with no sex partners in the same period of time. Great challenges still exist for the control of HIV and AIDS among young persons in Zimbabwe. HIV prevention programmes targeted at young persons aged 15–24 years should provide invigorated focus on marital status, age at sexual debut, number of sexual partners, sexually transmitted infections and condom use so as to mitigate these predisposing factors for HIV infection.     

Using social and behavior change communication to increase HIV testing and condom use: the Malawi BRIDGE Project

While overall HIV prevalence in Malawi has decreased, it is still high in the southern region of the country. Behavioral prevention activities are crucial to continue the reduction in HIV prevalence. Behavior change is influenced by many factors. Previous work indicates knowledge about HIV transmission, self-efficacy to protect oneself from exposure, and accurate risk perception of one's susceptibility all impact sexual behavior. The current study looks at the effects of a behavior change communication program in Malawi called the BRIDGE II Project on psychosocial and behavioral variables. The program sought to address barriers to individual action and confront societal norms related to sexual risk behavior through a mix of community-based activities and mass media messages delivered through local radio stations. Using cohort data (n = 594), we examined the effect of BRIDGE exposure on three variables that affect HIV behaviors: knowledge, self-efficacy, and risk perception, as well as two behavioral outcomes: HIV testing and condom use at last sex. Data were collected at baseline and for a midterm evaluation. Regression analyses showed exposure to BRIDGE was significantly associated with knowledge level (β = 0.20, p < .001) and self-efficacy (β = 0.35, p < .001) at midterm when controlling for baseline scores, but not risk perception. Psychosocial variables did not show a significant relationship to either behavioral outcome. However, program exposure was a significant predictor of both HIV testing in the past year (odds ratio [OR] = 1.40, p < .001) and condom use at last sex (OR = 1.26, p < .05). This study suggests such a communication intervention may play an important role in not only affecting HIV-related behaviors themselves, but also critical factors that affect HIV behaviors, including knowledge and self-efficacy. It is recommended that communication efforts around HIV risk reduction be increased.     

The association between social networks and self-rated risk of HIV infection among secondary school students in Moshi Municipality,Tanzania

Abstract

This study describes the social networks of secondary school students in Moshi Municipality, and their association with self-rated risk of human immunodeficiency virus (HIV) infection. A cross-sectional analytical study was conducted among 300 students aged 15–24 years in 5 secondary schools in Moshi, Tanzania. Bonding networks were defined as social groupings of students participating in activities within the school, while bridging networks were groups that included students participating in social groupings from outside of the school environs. A structured questionnaire was used to ask about participation in bonding and bridging social networks and self-rated HIV risk behavior. More participants participated in bonding networks (72%) than in bridging networks (29%). Participation in bridging networks was greater among females (25%) than males (12%, p?<?.005). Of 300 participants, 88 (29%) were sexually experienced, and of these 62 (70%) considered themselves to be at low risk of HIV infection. Factors associated with self-rated risk of HIV included: type of school (p?<?.003), family structure (p?<?.008), being sexually experienced (p?<?.004), having had sex in the past three months (p?<?.009), having an extra sexual partner (p?<?.054) and non-condom use in last sexual intercourse (p?<?.001), but not the presence or type of social capital. The study found no association between bonding and bridging social networks on self-rated risk of HIV among study participants. However, sexually experienced participants rated themselves at low risk of HIV infection despite practicing unsafe sex. Efforts to raise adolescents' self-awareness of risk of HIV infection through life skills education and HIV/acquired immunodeficiency syndrome risk reduction strategies may be beneficial to students in this at-risk group.     

HIV-related thought avoidance,sexual risk,and alcohol use among men who have sex with men

HIV-related “cognitive escape” refers to a tendency to avoid thoughts associated with HIV, which may be particularly common among men who have sex with men (MSM) who are often inundated with HIV information, potentially to the point of fatigue. HIV-related cognitive escape is associated with increased sexual risk behaviors, such as condomless sex, and heavier alcohol use patterns. Other studies show that some MSM may use alcohol specifically to facilitate sex. These sexual motives for drinking (SMDs) could be one mechanism whereby cognitive escape leads to health risk behaviors. In this study, we tested models exploring whether cognitive escape was associated with markers of sex risk (condom use, number of sex partners) and alcohol use/problems, and examined whether SMDs mediated these associations. Heavy drinking, HIV-negative men (N?=?196) aged?≥?21 years who self-reported past year condomless anal sex with men completed assessments as part of a larger study. Results suggest that cognitive escape was associated with higher number of anal sex partners (incidence rate ratio [IRR]?=?1.50, SE?=?0.04, p?B?=??0.30, SE?=?0.14, p?=?.028), and increased alcohol-related problems (IRR?=?1.28, SE?=?0.07, p?=?.001) but not with drinking quantity. Sexual motives for drinking appeared to partially mediate the observed relationship between cognitive escape and alcohol-related problems, but other relationships did not show evidence of mediation. Findings suggest that those who tend to avoid HIV-related thoughts may be at increased risk for HIV and alcohol-related problems. Drinking to facilitate sex may partially account for the higher risk for alcohol-related problems conferred by cognitive escape. Alcohol interventions for MSM may be more effective if they address alcohol’s role in coping with HIV threat and in facilitating sex under these circumstances.     

Sex with older partners,condomless anal sex and unrecognized HIV infection among Chinese men who have sex with men

We examined the prevalence of sex with older male partner (SWOMP) and its association with condomless anal intercourse (CAI) with male partners and unrecognized HIV infection among young men who have sex with men (MSM) in Shanghai, China. The analytic sample included 243 MSM who were 18–45 years and HIV negative or of unknown HIV serostatus. Older male partner refers to male sex partner who was at least 10 years older than themselves. Overall, 99 (43.0%) and 50 (20.7%) reported having SWOMP in lifetime and in the last 3 months, respectively. Having any CAI with male partners in the last 3 months was independently associated with SWOMP and sex with stable male partners in the last 3 months. Unrecognized HIV infection was independently associated with being HSV-2 positive and having any CAI with male partners as well as SWOMP in last 3 months. Sex with stable male partner in the last 3 months was also marginally significantly associated with unrecognized infection (p?=?0.084). Older partner selection is common among young MSM in China. Prevention programs should incorporate education messages about the HIV risk associated with SWOMP. MSM should be informed that having condomless sex with stable partners may place them at HIV risk.     

Estimating self-reported sex practices,drug use,depression, and intimate partner violence among MSM in China: a comparison of three recruitment methods

Men who have sex with men (MSM) are the group at highest risk for HIV in China. Researchers have used various recruitment methods to reach this population hidden from the hetero-normative culture. To inform future recruitment strategies, we compared estimates of socio-demographic characteristics, HIV risk behaviors, depression, and intimate partner violence (IPV) across three samples of MSM and money boys in Shanghai, China. Data were collected from three community-based samples of MSM and money boys (n?=?1352) recruited via respondent-driven sampling (RDS) (n?=?404), community popular opinion leaders (CPOL) (n?=?385), and Internet and venue-based sampling (VBS) (n?=?546). Different recruitment methods generated samples with statistically significant differences among a number of socio-demographic characteristics, sexual behaviors, drug use, depression scores, and exposure to IPV. Specifically, RDS participants had lower education (p?=?.002), income levels (p?p?p?p?=?.009), more than 10 male partners in the past 30 days (p?p?=?.001). VBS participants had lowest depression score (p?=?.005) and were more likely to report lifetime drug use (p?=?.003). Our findings reinforce that each recruitment method may reach a sub-group of MSM with a specific risk profile, so multiple methods may be needed to obtain a representative sample of MSM. Interventions may use specific recruitment methods to target certain segments of the MSM population.     

Dangerous Subtlety: Relationship-Related Determinants of Consistency of Condom Use Among Female Sex Workers and Their Regular,Non-Commercial Partners in Hai Phong,Viet Nam

Research indicates female sex workers use condoms more consistently with their clients than with regular, non-commercial partners (partners). The purpose of this study was to better understand the relationship between couple communication and HIV risk behavior by examining (1) sex worker-partner divergence on communication measures and (2) the association between intra-couple communication divergence and consistent condom use. In this cross-sectional study, 50 sex workers and their partners in Hai Phong, Viet Nam were separately asked about their relationships and condom use. When asked about HIV risk communication in their relationship, sex workers reported significantly higher HIV communication content than their partners (p < 0.001). Higher communication divergence between partners was associated with a decreased likelihood of consistent condom use (OR 0.54 95% CI 0.30, 0.97). Sex workers urgently need interventions that build their communication skills and address their risk behavior in non-commercial relationships.     

Sexual risk behaviors following circumcision among HIV-positive men in Rakai,Uganda

Objective: To determine whether circumcision of HIV-positive men is associated with increased subsequent sexual risk behaviors which may place their female partners at risk.

Methods: Newly circumcised and uncircumcised HIV-positive men in the Rakai Community Cohort Study were followed from baseline (July 2013–January 2015) to determine trend in sexual risk behaviors and association of circumcision with subsequent sexual risk behaviors at follow up (February 2015–September 2016). Risk behaviors included sexual activity, alcohol before sex, transactional sex, multiple sex partners, casual sex partners, and inconsistent condom use with casual partners. The association was evaluated using modified Poisson regression, and sensitivity analyses were performed after multiple imputation with chained equations for missing data.

Results: We identified 538 eligible men, of whom 113(21.0%) were circumcised at baseline and 425(79.0%) were uncircumcised. Men in fishing communities were more likely to be circumcised (p?=?0.032) as well as those exposed to targeted HIV messaging (p?p?=?0.020). Among those followed up, behaviors remained largely unchanged with no differences by circumcision status. Transactional sex appeared to be associated with circumcision in unadjusted analyses (PR?=?1.58, 95%CI?=?1.01,2.48; p?=?0.045, p?=?0.05) and adjusted analyses (adj.PR?=?1.54, 95%CI?=?1.06,2.23; p?=?0.022). However, the association was no longer significant in sensitivity analyses after accounting for loss to follow up (adj.PR?=?1.43, 95%CI?=?0.98,2.08; p?=?0.066). No association with circumcision was observed for other sexual risk behaviors.

Conclusion: We found no association between circumcision of HIV-positive men and subsequent sexual risk behavior.     

Childhood Sexual Abuse and HIV Risk-Taking Behavior Among Gay and Bisexual Men

We explored the prevalence of childhood sexual abuse among adult gay and bisexual men and measured the association between childhood sexual abuse and high-risk sexual behavior in adulthood. Two separate population-based samples of gay and bisexual men (n = 1,941) residing in Portland and Tucson were surveyed. Over one quarter reported a history of childhood sexual abuse (sexual behavior with someone at least 5 years older prior to age 13, or with someone at least 10 years older when between ages 13 and 15). Men who were abused were more likely to engage in sexual risk behavior than men who were not abused (e.g., unprotected anal intercourse with non-primary partners in the previous 12 months: 21.4% vs. 15.0%, p < .001). Perception of having been coerced was associated with greater sexual risk. Furthermore, childhood sexual abuse and level of coercion were associated with reported levels of HIV infection among gay and bisexual men. It is recommended that existing programs for those at risk for HIV be modified to deal with these issues, and that efforts to bring about behavior change will require approaches that go beyond simply increasing knowledge and awareness.     

Perceived HIV risk as a predictor of sexual risk behaviors and discrimination among high-risk women

HIV risk perception and discrimination are important determinants of HIV prevention among vulnerable populations. Using Detroit’s 2016 National HIV Behavioral Surveillance (NHBS) Survey, we evaluated demographic variables, risk behaviors, and perception of HIV stigma and discrimination stratified by perceived HIV risk (high, medium, low) in a sample of high-risk women. Significant variables were identified using Pearson Chi-squared tests and one-way analysis of variance tests. Among 541 females surveyed, 93.0% were black and 87.7% lived in poverty. Women’s poverty (p?=?.010), employment (p?=?.012), insurance (p?=?.024) and homelessness status (p?<?.001) were all significantly associated with their level of HIV risk perception. Among women with low HIV risk perception (76.7%), the majority did not know their partner’s HIV status at last intercourse (68.7%, p?=?.007), had unprotected anal/vaginal sex in the past year (86.7%, p?=?.025), participated in sex exchange (63.4%, p?<?.001), and did not use condoms with a partner with HIV-unknown status (87.2%, p?<?.001). Half of the women agreed or strongly agreed most people would not be friends with someone with HIV (50.4%), and 46.3% agreed or strongly agreed most people would support PLWH to live or work where they want. Compared to women with low HIV risk perception, women with high perceived HIV risk were more likely to agree or strongly agree most people would discriminate against someone with HIV (87.3% vs. 76.8%) and that people who got HIV via sex exchange or drugs got what they deserve (46.6% vs. 25.8%). Women’s perceived HIV risk was not significantly associated with these discriminatory attitudes. Despite multiple risk behaviors significantly associated with the level of perceived HIV risk in the sample, the NHBS survey demonstrates many women with high-risk behaviors still perceive themselves to be at low risk. Our findings highlight a complex interaction of risk perception, risk behaviors and stigma surrounding HIV in high-risk women.     

Alcohol Use and Sexual Risk Taking Among Hazardously Drinking Drug Injectors Who Attend Needle Exchange

BACKGROUND: To determine if sex-risk days are also alcohol use days for active injection drug users. METHODS: Cross-sectional interview of 187 active injection drug users who scored positively (> or =8) on the Alcohol Use Disorders Identification Test who were recruited between February 1998 and October 1999 from a needle exchange program in Providence, Rhode Island. A sex-risk day was defined as "vaginal sex, anal sex or oral sex without a condom," measured by using a 30 day timeline follow-back procedure. RESULTS: The sample was 64% male and 87% white, and 85% met DSM-IV criteria for alcohol abuse/dependence. Of the total days analyzed (n = 5610), 19% were sex-risk days; on 52% of these days drinking also occurred. By using a generalized estimating equation model to cluster by subject, alcohol use was associated with sex-risk days (odds ratio, 1.76; 95% confidence interval, 1.35-2.29; p < 0.001), when we controlled for gender, age, race, education, cocaine use, injection frequency, exchanging sex for money or drugs, number of sexual partners, and perceived sexual risk of acquiring human immunodeficiency virus from partners. CONCLUSIONS: Alcohol use is associated with sex risk-taking behavior among injection drug users. A substantial majority of participants reported using alcohol before or during sexual relations, which temporally links alcohol use with human immunodeficiency virus injection risk.     

Effect of savings-led economic empowerment on HIV preventive practices among orphaned adolescents in rural Uganda: results from the Suubi-Maka randomized experiment

Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents’ cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10–17 years, to either the control group receiving usual orphan care plus mentoring (n?=?167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n?=?179). Assessments were conducted at baseline, 12, and 24 months. Results indicated that intervention adolescents significantly increased their cash savings over time (b?=?$US12.32, ±1.12, p?p?_T1?T0?=?+14.9, p?_T1?T0?=?+8.8, p?T1?T0?=?+6.7, p?b?=?+0.19, ±0.09, p?n?=?159), sexual abstinence or postponement (91.6%, n?=?152), and consistent condom use (93.4%, n?=?144). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score (OR?=?2.017, 95%CI: 1.43–2.84). To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions.     

Sexual risk behavior and uptake of HIV counseling and testing among youth in Metropolitan Kumasi,Ghana

Research on HIV counselling and testing (HCT) has proliferated in Ghana but limited evidence exists about the uptake of HCT among a large population that has been shown to engage in HIV risk-related behavior in Metropolitan Kumasi. With retrospective cross-sectional data from a representative sample of sexually active young people, multivariate logistic regression models examine the variables associated with HCT uptake in Kumasi. Among 906 participants (male 51% and female 49%, with a mean age ±SD, 25?±?6), 22% had utilized HCT in the last six months despite the higher knowledge of HCT (84%) mainly through mass media (65%) and health providers (27%). Besides, less than 20% of the sample intended to undergo HCT services. Multivariate logistic regression analysis showed that female gender (adjusted odds ratio [aOR]?=?1.830; 95% CI: 1.280–47.831; p?p?=?0.040), having sexual intercourse with irregular partner (aOR?=?5.597; 95% CI: 1.776–17.638; p?=?0.018), practiced unprotected sex (aOR?=?2.614; 95% CI: 1.821–6.472; p?=?0.002), having multiple sex partners (aOR?=?2.902; 95% CI: 1.405–7.226; p?p?相似文献   

Implementation and impact of a technology-based HIV risk-reduction intervention among Thai men who have sex with men using “Vialogues”: a randomized controlled trial

ABSTRACT

We conducted a randomized control trial to evaluate the impact of a novel technology-based intervention on HIV risks and condom use behaviors among Thai men who have sex with men (MSM). Between April 2016 and August 2017, participants aged 18 years and above, and having engaged in unprotected sex in past six months were randomly assigned to control and intervention arm, and received HIV testing at baseline, month 6 and 12. Intervention arm participants engaged in 12-monthly HIV/STI prevention educational sessions delivered via Vialogues.com. Of 76 MSM enrolled, 37 were randomized to intervention and 39 to control arm. Median age was 28 (IQR 24–32) years. Thirty-three (89.2%) intervention arm participants completed all 12-monthly Vialogues sessions. At month 12, intervention arm had higher retention rate (p?=?0.029) and higher median percentage of condom use for anal intercourse (p?=?0.023) versus control arm. Over the 12-month period, intervention arm reported significant reduction in self-perceived HIV risk (p?=?0.001), popper usage (p?=?0.002), median number of sexual partners (p?=?0.003), and increased median condom use percentage (p?=?0.006). Our study highlights that “Vialogues” intervention significantly reduced number of sexual partners and condomless anal intercourse rates among Thai MSM, and has positive implications for reducing epidemic among key populations.