Sexual Identity Formation and AIDS Prevention: An Exploratory Study of Non-Gay-Identified Puerto Rican MSM from Working Class Neighborhoods

As a subgroup of men who have sex with men (MSM), non-gay-identified (NGI) behaviorally bisexual Latino MSM are associated with heightened probabilities of HIV transmission, yet they have eluded HIV/AIDS interventionists. This exploratory study of Puerto Rican MSM drug users employed multi-session qualitative interviews to examine early life experiences related to gender identity and sexual orientation, and the place of risky drug and sexual behaviors in the process of sexual identity formation. NGI participants experienced sexual debut between ages 13 and 20, and most were recruited to prostitution as young teens by NGI age mates who were also members of drug use networks. Participants emphasized their role as insertive sexual partners and that they maintained relationships with pasivo biological males. It is feasible to recruit NGI MSM through primary male sexual partners and drug use networks. HIV/AIDS prevention based on awareness of developmental histories holds promise for intervening before NGI youth engage in male prostitution or injection drug use.     

上海市男男同性性传播AIDS病人的临床流行病学研究

目的通过对上海艾滋病(AIDS)抗反转录病毒治疗(ART)病人的流行病学研究,为国家艾滋病防治专家提供基本信息,针对不同地区因地制宜采取侧重点不同的防控措施。方法采集662例男性病人的相关信息,分为同性性传播组和非同性性传播组进行相关数据的统计学分析。结果通过同性性传播感染的男性病人为318例(48.04%),且占男性病人的比例由2005年的38.71%上升至2010年的57.14%。开始ART时的年龄分别为同性性传播组(36.14±11.05)岁,非同性性传播组(45.80±11.08)岁,差异有统计学意义(P<0.01)。婚姻状况方面前者未婚为198例(62.26%),后者为56例(16.28%),差异有统计学意义(P<0.01)。两组已婚的病人中均有配偶感染的情况。在学历方面,两组差异有统计学意义(P<0.01),具有大专及以上学历的病人前者137例(43.08%),后者36例(10.47%)。在病人发现感染至治疗时间间隔方面,两组分别为(10.43±15.83)个月和(10.76±17.80)个月,差异无统计学意义(P=0.802)。结论因同性性传播途径感染的病人的比例迅速上升,均为年轻且具有较高学历的国家有用人才,应引起各参与防治工作人员的重视,采取更有效的方式和模式来减少未采取保护措施的肛交(UAI)的发生。男男同性恋尚不能得到社会的承认,有些人不得不结婚生子,因此在关注男男同性恋的同时,也应该关注其婚姻状况,以及其配偶可能感染的问题。     

A Telephone Based Brief Intervention Using Motivational Enhancement to Facilitate HIV Risk Reduction Among MSM: A Pilot Study

We conducted a randomized controlled pilot intervention to evaluate the efficacy of a telephone-based brief counseling intervention to reduce sexual risk taking among men who have sex with men (MSM) in Seattle, Washington. The study targeted individuals who were currently engaging in unsafe sex but were not committed to making changes toward safer behaviors. Counselors used motivational interviewing strategies in a single 90-min session to enhance readiness for change, promote greater intentions to use condoms, and to support safer sex practices. Results are based on 89 MSM randomly assigned to Immediate counseling or a Delayed counseling control condition. Among minority participants, Immediates were significantly less likely to have engaged in unprotected anal intercourse at follow-up, compared to Delays. Immediate participants reported significantly less ambivalence about practicing safer sex at follow-up, and tended to report greater increases in intentions to use condoms. These findings support the potential efficacy of a brief intervention based upon motivational enhancement principles for promoting safer sex practices among at-risk MSM.     

An Approach to Improve Validity of Responses in a Sexual Behavior Study in a Rural Area of China

A survey of sexual behavior was conducted among rural residents of Anhui, China, in 1997 to determine if using a tape recorder with earphones to administer sensitive questions increased the acceptance and accuracy of the survey. Validity of the responses was evaluated by determining the internal consistency of responses to related questions, comparing reported sexual activities and frequencies reported by husband and wife within a couple, and by resurveying a cluster. Among the 1,269 individuals selected, 185 were not home. Most (62%) had migrated to cities. Among the 1,084 at home, 1,057 (97.5%) participated in the survey, compared to 70–80% in similar surveys in China. The percentage inconsistency among related questions was < 1%. The discordance within couples was 5% for premarital sex, 3% for oral–genital and/or anal–genital sexual intercourse, and 19% for coital frequency within the past 4 weeks. A repeat survey gave similar results. The authors suggest that use of a tape recorder, earphones, and an anonymous answer sheet contributed to the very high acceptance rate for this sexual behavior survey and enhanced the validity of the responses. This strategy may enhance the response rate for similar surveys in other countries.     

Danish Patients' Attitudes to Scientific-Ethical Questions: An Interview Study Focusing Therapeutic Trials

ABSTRACT One hundred and fourteen in- and out-patients from a department of internal medicine were interviewed, on the basis of a questionnaire with the following key questions: 1) Their attitudes to medical trials with man as the subject. 2) Their emphasis on informed consent. 3) Their attitudes to inclusion of patients not being able to give informed consent. 4) Their attitudes to tentative participation in 4 concrete projects. In all, 98% considered doctors' and patients' collaboration on new therapeutical methods both necessary and desirable. Eighty-eight per cent considered information of patients participating in trials a prerequisite. Eighty-six per cent accepted participation in scientific trials based on the guarantee of the doctors responsible. Of these 86%, 58% felt that a scientific-ethical committee's accept of the project implied an extra element of security. Seventy-five per cent replied that patients not being able to give informed consent themselves could be included in scientific trials. The majority, 77%, added that patients' relatives would then have to accept, 20% that such trials could be based on the participating doctors' responsibility, and only 2% that such a responsibility was to place on scientific-ethical committees. In the 4 concrete projects, answers followed a uniform trend: full information of patients was demanded by approximately 80%, and acceptance of participation resting with responsible doctors in more than 80%. Less than half of these 80% felt that evaluation by a scientific-ethical committee would add to patients' security.     

对男男性接触者AIDS高危性行为健康干预研究

目的　评价健康干预措施对男男性接触者 (MSM)艾滋病 (AIDS)高危性行为的影响效果。方法　采用不记名问卷调查方式 ,并用Spss软件进行统计。结果　干预时间超过 1年的MSM ,近 1年肛交性伴侣数和无保护性被动肛交的发生率显著低于 <1年者 (P <0 0 5 ) ;但近 1年性伴侣数、偶遇性伴侣数、外地性伴侣数、外地偶遇性伴侣数、无保护性肛交的偶然性伴侣数、近 1年用过安全套、最近 1次保护性肛交及近 1年无保护性主动肛交的比例 ,近 1年在公共场所寻找偶遇性伴侣、参与性交易及参加群交的比例 ,随着干预时间的延长有不同程度的改变 ,但改变无显著的统计学意义 (P >0 0 5 )。结论　健康干预可减少MSM的AIDS高危性行为 ,但它是一个长期而复杂的工程 ,需要深入持久地开展     

Depressive Symptoms, Utilization of Mental Health Care, Substance Use and Sexual Risk Among Young Men Who have Sex with Men in EXPLORE: Implications for Age-Specific Interventions

The EXPLORE study evaluated a behavioral intervention to prevent HIV infection among MSM. We examined depressive symptoms, utilization of mental health care, substance use and HIV risk taking behaviors in YMSM aged 16–25 years compared with their older counterparts. YMSM were more likely to report depressive symptoms (OR = 1.55) and less likely to report use of counseling (OR = 0.39) or medication (OR = 0.20) for psychiatric conditions. YMSM were more likely to report heavy alcohol and drug use. YMSM more often reported engaging in unprotected insertive (OR = 1.60) and receptive (OR = 2.07) anal intercourse with presumed HIV-uninfected partners, and unprotected receptive (OR = 1.72) anal intercourse with partners of unknown-HIV status. These findings suggest the need for more appropriate and accessible mental health care and substance use services for YMSM. Additionally, HIV prevention work with this population should provide comprehensive education about HIV testing and risk reduction counseling that focuses on communication about serostatus and safety in sexual situations.     

Using the Internet to Recruit Rural MSM for HIV Risk Assessment: Sampling Issues

The Internet is an emerging research tool that may be useful for contacting and working with rural men who have sex with men (MSM). Little is known about HIV risks for rural men and Internet methodological issues are only beginning to be examined. Internet versus conventionally recruited samples have shown both similarities and differences in their demographic characteristics. In this study, rural MSM from three sizes of town were recruited by two methods: conventional (e.g. face-to-face/snowball) or Internet. After stratifying for size of city, demographic characteristics of the two groups were similar. Both groups had ready access to the Internet. Patterns of sexual risk were similar across the city sizes but varied by recruitment approach, with the Internet group presenting a somewhat higher HIV sexual risk profile. Overall, these findings suggest the Internet provides a useful and low cost approach to recruiting and assessing HIV sexual risks for rural White MSM. Further research is needed on methods for recruiting rural minority MSM.     

Childhood Sexual Abuse and Its Relationship to High-Risk Behavior in Women Volunteering for an HIV and STD Prevention Intervention

This study examines the extent of childhood sexual abuse and its relationship to risky sexual and drug-using behaviors, condom use, and lifetime sexually transmitted diseases (STDs) in women volunteering for the WINGS intervention in New York City, Baltimore, and Seattle. Responses to structured interviews from 825 eligible women recruited from the community, clinics, and drug programs in 1995 and 1996 were analyzed. Thirty-eight percent to 66% of women across sites reported childhood sexual abuse before age 18. Q statistics and t tests measured the bivariate relationships between sexual abuse and outcomes. Then regression analysis was used to control for ethnicity and race, age, age at first intercourse, and site in predicting the adjusted effects of sexual abuse. Compared to nonabused women, abused women reported more lifetime partners, more episodes of different STDs, lower odds of using condoms at most recent sexual intercourse with main partners, and increased odds of using drugs or alcohol before sex. Researchers need to develop and test STD and HIV interventions tailored for victims of early sexual abuse and compare them with more general interventions for at-risk women.Correspondence should be addressed to Judith Greenberg, Centers for Disease Control and Prevention, 1600 Clifton Rd., N.E. (E44), Atlanta, Georgia 30333     

Factors associated with PrEP awareness according to age and willingness to use HIV prevention technologies: the 2017 online survey among MSM in Brazil*

ABSTRACT

Brazil has the largest population of individuals living with HIV/AIDS in Latin America with a disproportional prevalence of infection among men who have sex with men (MSM). This study evaluated PrEP awareness by age (18–24, 25–35, ≥36 years), its associated factors and the willingness to use HIV prevention technologies among MSM using a GSN app in Brazil. Inclusion criteria were ≥18 years-old, cisgender men and HIV-negative serostatus. Of 7242 individuals, 4136 (57%) completed the questionnaire. PrEP awareness was reported by 51% (though lower among MSM aged 18–24 and ≥36 years) and its associated factors were higher family income, most friends with the same sexual orientation, high number of male sexual partners and marijuana use. HIV testing (never vs. at least once) lead to an almost 3-fold increase in the odds of PrEP awareness. High HIV risk perception led to increased PrEP awareness only among MSM aged 18–24 years. A total of 2335 (56%) was willing to use daily oral PrEP. PrEP awareness remains low in Brazil and mobile tools are key strategies to reach MSM and increase awareness of prevention technologies. Community-based interventions could add to online campaigns to reach the most vulnerable, which include young, non-white and lower-income MSM.     

Sexual Risk Behavior and Venues for Meeting Sex Partners: An Intercept Survey of Gay and Bisexual Men in LA and NYC

Understanding the link between venues for meeting sex partners and sexual risk behavior is critical to developing and placing effective sexual health education and HIV prevention services. Non-monogamous gay and bisexual men (n = 886) were surveyed in New York and Los Angeles about the venues that they met recent sex partners: bathhouses, private sex parties, gay bars/clubs, the gym, via public cruising, and the Internet. Bars/clubs, bathhouses, and the Internet were the most endorsed venues for meeting partners. Men having met a majority of their partners (i.e., “preference”) via these three venues were compared/contrasted. Those having preference for bars/clubs were dissimilar from men with preference for bathhouses or the Internet on multiple levels (e.g. age, number of sex partners, temptation for unsafe sex). However, these men were proportionally similar in whether they had engaged in a recent episode of unprotected anal intercourse (UAI). Logistic regressions predicting UAI suggested venues might not play a role in differentiating men who had preference for bars/clubs, bathhouses or the Internet. Additional regression analyses utilizing all six venues to predict UAI suggested other person-factors such as identity as a barebacker and temptation for unsafe sex better explain UAI. This research suggests HIV prevention and educational campaigns targeted within venues need also address socio-psychological person-factors in addition to environmental/venue contexts.     

Changes in sexual function in middle-aged and older men: longitudinal data from the Massachusetts Male Aging Study

OBJECTIVES: To describe within-individual change in sexual function over a 9-year period and to determine whether the amount of change differs by age group. DESIGN: Cohort study; participants interviewed at baseline (1987-89) and follow-up (1995-97). SETTING: Population-based; communities surrounding Boston, Massachusetts. PARTICIPANTS: One thousand eighty-five men aged 40 to 70 at baseline (born between 1917 and 1947) with complete baseline and follow-up sexual function data. MEASUREMENTS: Within-person change (follow-up minus baseline) in the following sexual function variables: sexual intercourse, erection frequency, sexual desire, ejaculation with masturbation, satisfaction with sex, and difficulty with orgasm. RESULTS: Unadjusted analyses showed significant longitudinal changes over the 9-year period in all domains of sexual function except frequency of ejaculation with masturbation, which showed no change between baseline and follow-up. Adjusted for baseline sexual function, within-person change in all outcomes was strongly related to age, with decline in sexual function becoming more pronounced with increasing age. For example, over the 9-year study period, sexual intercourse or activity frequency decreased by less than once per month, two times per month, and three times per month in men in their 40s, 50s, and 60s, respectively. Number of erections per month declined by 3, 9, and 13 in men in their 40s, 50s, and 60s, respectively. CONCLUSION: This research fills a major gap in the literature by providing age-specific estimates of change in sexual functioning over a 9-year period in a cohort of unselected men.     

The Role of Drugs in the Sexual Lives of Men Who Have Sex with Men: Continuing Barriers to Researching This Question

Barriers to researching links between drug use among men who have sex with men (MSM) and HIV risk fall into three categories: (1) institutional barriers, (2) lack of appropriate theoretical models, and (3) stigmatization of sexual minorities. This paper reviews the status of the progress on the first two issues and presents a historical account of research on the role of drugs in the sexual lives of MSM during the AIDS epidemic. The paper first reviews the history of research on drug use and sexual behavior using Rofes' four-stage model of the gay community's responses to the AIDS epidemic (crisis stage, organizing stage, degaying stage, and post-AIDS stage) as an organizing strategy. Discussions follow which address the institutional and theoretical barriers that remain and progress that has been made in overcoming these barriers. Finally, there is a review of the published literature on HIV prevention interventions for homosexually active drug users with a focus on their relevance for drug-using (DU) MSM and recommendations for future research. While the published literature on interventions for DU-MSM is in its infancy, it indicates that a variety of intervention models can produce significant changes in drug-related sexual behavior and HIV-risk taking. The future of this field holds promise in both the development of effective interventions for DU-MSM and increased understanding of the causal mechanisms which link drug use to risky sexual behaviors.     

Changing blood donor screening criteria from permanent deferral for men who have sex with men to individual sexual risk assessment: no evidence of a significant impact on the human immunodeficiency virus epidemic in Italy

Background

In 2001, the criteria for blood donor eligibility in Italy were modified by a ministerial decree from a permanent deferral for "men who have sex with men" to an individual risk assessment of sexual behaviours. The aim of this study was to evaluate the impact of this change in donor screening criteria on the human immunodeficiency virus epidemic among blood donors in Italy.

Materials and methods

We used the data obtained from the Italian blood donor epidemiological surveillance system. We compared data collected in 2009 and 2010, when the individual risk assessment policy was applied, with data collected in 1999 when permanent deferral was applied for men who have sex with men based on a declaration of sexual orientation. We evaluated the change over time in the relative proportion of HIV antibody-positive donors who likely acquired the infection from men who have sex with men vs heterosexual sexual exposure; the relative risk was calculated using 1999 as the reference year.

Results

In all 3 years, the majority of HIV antibody-positive donors reported sexual exposure as a risk factor for HIV infection; this proportion increased over time, although not statistically significantly. Heterosexuals always accounted for at least 40% of all HIV antibody-positive cases. The rate of HIV antibody-positive donors increased similarly in men who have sex with men and heterosexuals; specifically, the rate of HIV antibody-positive cases per 100,000 donors was more than 2-fold higher among men who have sex with men in 2009–2010 than in 1999 (2009–2010 vs 1999, RR =2.8; P =0.06), and that among heterosexuals was 1.5 fold higher (P =0.18).

Discussion

When comparing the period before (1999) and after (2009–2010), the implementation of the individual risk assesment policy in 2001, no significant increase in the proportion of men who have sex with men compared to heterosexuals was observed among HIV antibody-positive blood donors, suggesting that the change in donor deferral policy did not lead to a disproportionate increase of HIV-seropositive men who have sex with men.     

Disclosure of Microbicide Gel Use to Sexual Partners: Influence on Adherence in the CAPRISA 004 Trial

Young women in sub-Saharan Africa are disproportionately affected by HIV, making the development of women initiated and controlled methods of prevention, including microbicides, a priority. Adherence is pivotal to microbicide efficacy and partner related factors are known to impact adherence. An analysis of disclosure of gel use to sexual partners and adherence in CAPRISA 004 women was conducted to better understand this relationship. Partner disclosure was significantly associated with a modest 4.2 % increased adherence (71.0 vs. 66.8 %, p = 0.03). Most women rated the experience of disclosure as positive, despite 6.7 % of partners expressing a negative reaction.Participants who disclosed were more likely to reside with their regular partner (14.4 vs. 8.4 %; p = 0.01) and reported consistent condom use at baseline (32.9 vs. 20.9 %; p < 0.01). Partner disclosure needs to be better understood as a potential facilitator or barrier to microbicide adherence.     

Disclosure appraisal mediating the association between perceived stigma and HIV disclosure to casual sex partners among HIV+ MSM: a path model analysis

HIV stigma is widely believed to be related to HIV disclosure. However, there is a dearth of studies examining the mechanisms that link stigma to disclosure. This is a specific study to assess the relationship between perceived stigma and HIV disclosure to casual sex partners based on a social cognitive theory. HIV+ men who have sex with men (MSM) from two US cities (N?=?297) completed questionnaires administered using audio computer-assisted self-interviewing. Path modeling analysis was used to assess the theory-based structural relationships. Perceived stigma was negatively associated with attitudes, intention and behavior of HIV disclosure to casual sex partners. The association was fully mediated by disclosure appraisal, including disclosure outcome expectations, costs and self-efficacy. Findings of this study add new knowledge regarding HIV stigma and disclosure, and provide timely data supporting more effective behavioral interventions to encourage HIV disclosure among MSM.     

Prospective Study of Attitudinal and Relationship Predictors of Sexual Risk in the Multicenter AIDS Cohort Study

We examined the influence of attitudes concerning HIV transmission, safe sex, and sexual sensation seeking, as well as negotiated risk reduction with primary partners, on the proportion of unprotected sexual partners (%UASP) among men who have sex with men (MSM). Participants were 263 HIV-seropositive and 238 HIV-seronegative MSM in the Multicenter AIDS Cohort Study between 1999 and 2003 who completed a 20-item attitude survey twice. Behavioral data were collected concurrently and 6–12 months after each survey. Among seropositives, decreased HIV concern and increased safer sex fatigue were associated with higher %UASP at 6 and 12 months. Among seronegatives, increased %UASP at 12 months was associated with safer sex fatigue. At 6 months and 12 months, risk reduction agreements were associated with increased %UASP among seronegatives in seroconcordant monogamous relationships, reflecting their abandonment of condoms in such partnerships. We conclude that HIV prevention efforts should target modifiable attitudes (reduced concern about HIV and safer sex fatigue) and increases in sexual risk-taking of MSM, particularly among HIV+ men having sex with serodiscordant partners.