Sexual Risk Profile of Young Men in Vancouver, British Columbia, Who Have Sex with Men and Inject Drugs

We compared sexual risk behaviors of men who have sex with men and inject drugs (MSM/IDU) with those of other men who have sex with men (MSM). Of 910 MSM surveyed, 106 (12%) injected drugs in the previous year. MSM/IDU were younger than MSM and more likely to be HIV-seropositive, Aboriginal, economically disadvantaged, engaged in the trade of sex for money or drugs, and to report having female sexual partners. MSM/IDU reported more casual sexual partners and in multivariate analyses were twice as likely to report unprotected receptive anal intercourse with casual partners. These results, combined with those from previous analyses, suggest that the higher risk for HIV seroconversion among MSM/IDU in this cohort is attributable mainly to sexual rather than injection-related exposures. Controlled assessments are needed to identify optimal sexual risk reduction strategies for MSM/IDU.     

Alcohol and Sexual HIV Risk Behavior Among Problem Drinking Men Who Have Sex With Men: An Event Level Analysis of Timeline Followback Data

While heavy drinking among men who have sex with men (MSM) has been shown to be associated with an increase in sexual risk taking, a temporal relationship between drinking and an increase in subsequent HIV risk behaviors among adult samples has been less obvious. This study used an event level analysis to examine this relationship among HIV negative problem drinking MSM. Within subjects analyses show a higher probability of unprotected anal intercourse after drinking. Post-hoc analyses of within subjects data indicate that drinking increases risk taking when engaging in receptive anal intercourse but not for insertive anal intercourse. Findings from this study support evidence that drinking is a factor that increases risk taking among HIV negative problem drinking MSM, particularly for receptive anal intercourse.     

Psychosocial,Behavioral, and Cultural Predictors of Sexual Risk for HIV Infection Among Latino Men Who Have Sex with Men

This study sought to replicate and extend an investigation by Diaz et al. (1999) on determinants of HIV risk among Latino gay and bisexual men living in San Francisco who were predominantly English-speaking. Compared to the Diaz et al. study, the current study sample consisted of predominantly Spanish-speaking MSM, who resided outside of HIV/AIDS epicenters and whose countries of origin were primarily Central & South American. The relationships of unprotected anal sex and multiple sexual partners with demographic, developmental, behavioral, cultural and psychosocial variables were examined. Data were collected in a convenience sample of 250 participants (primarily immigrants from El Salvador) residing in Virginia. Most men in the sample had more than one sexual partner in the last 3 months (62%) and more than a third had unprotected anal sex with a casual partner in the same time period. Communication about HIV, sexual attraction, machismo, and experiences of discrimination based on homosexual behavior were predictive of HIV risk behaviors. The findings support an integrative approach to investigating HIV risk among Latino MSM. Implications for prevention programs are discussed.     

Sexual Behavior and Depression Among HIV-Positive Gay Men

As a result of medical advances seropositive men may expect to have a longer and healthier life span than in the past. It is therefore increasingly important to determine which factors are related to the mental health of seropositive gay men, as well as those associated with a satisfying, yet safe sexual lifestyle. This study examined sexual behavior, indicators of mental health, and determinants of AIDS-preventive behavior among a group of seropositive gay men and a control group of seronegative gay men in the Netherlands. Most seropositive men consistently practiced AIDS-preventive behavior. Nevertheless, if the definition of potentially unsafe sexual behavior is broadened to include oral sex to ejaculation, a sizable proportion of seropositive men had to be categorized as having had unsafe sex. Depression scores were higher among seropositive men than among the general population, but not significantly higher than among seronegative controls. Depression was not related to unprotected anal sex. The attitudes and the intention toward condom use were positive. Seropositive men used recreational (noninjection) drugs relatively often, but this was generally not associated with unprotected anal sex. Seropositive men attached more value to anal sex than seronegative controls, but again, this preference was not related to practicing unprotected anal sex. In the relatively few cases that unprotected anal sex among seropositive men did occur, it appeared to be related to lower behavioral control and to a weaker safe-sex intention. Perceived barriers to condom use and low perceived risk were also associated with unprotected anal sex among seropositive men. Although depression was not directly related to unprotected anal sex, seropositive men with higher depression levels were less motivated to use condoms and perceived more barriers to condom use.     

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.     

Risk Perception and Sexual Risk Behaviors Among HIV-Positive Men on Antiretroviral Therapy

There are reports of increased sexual risk behavior among people on highly active antiretroviral therapy (HAART) due to beliefs about risk of HIV transmission when on HAART. In a cross-sectional study (Seropositive Urban Mens Study), we examined the relationship between risk perception and sexual risk behavior among sexually active, culturally diverse HIV positive men who have sex with men (N = 456). Less than twenty-five percent engaged in unprotected anal sex (either with an HIV negative, or unknown-status partner, or an HIV positive partner) within the past 3 months. Most men believed there was significant health risk (to partner or self) associated with unprotected sex when on HAART. There was no increased risk behavior associated with being on HAART, although the perception of negative health consequences, including HIV transmission, when on HAART was significantly lower for the relatively small subset of men who reported unprotected sex. Prevention strategies need to be tailored to address risk perception associated with HAART.     

Partner Violence and Sexual HIV Risk Behaviors Among Women in Methadone Treatment

To examine associations between recent partner violence and sexual HIV risk behaviors and their implications for HIV prevention among women in methadone treatment, we conducted structured interviews covering demographics, drug use, trauma history, partner violence, and sexual risk behavior with 147 sexually active women who were at risk of HIV infection. Almost one third (30.5%) of the women reported that they had been physically or sexually abused by a spouse or boyfriend during the previous year. Multiple logistic regression analysis indicated that after adjusting for potential confounders, recently abused women were less likely to report using condoms (OR = 0.41, CI = 0.17, 0.99) and more likely than non-recently abused women to report having contracted a sexually transmitted disease (STD) (OR = 3.6, CI = 1.6, 8.5), exchanged sex for money (OR = 2.4, CI = 1.1, 5.4), and having had sex with an HIV-infected partner (OR = 2.5, CI = 1.0, 6.1). The study findings underscore the importance of developing HIV-risk reduction strategies that target the specific needs of abused women in drug treatment.     

Sexual HIV Risk Behavior Levels Among Young and Older Gay Men Outside of AIDS Epicenters: Findings of a 16-City Sample

Although AIDS rates have leveled among older gay men in large original epicenters, HIV seroincidence remains high among young men who have sex with men (MSM) in many areas of the country. This research examined patterns of risk behavior among young (age 25 years or less) and older (age 26 years and over) MSM. Nearly 2,000 men entering gay bars in 16 small U.S. cities completed an anonymous survey of their sexual practices in the past 2 months and of psychosocial risk-related characteristics. Young men were more likely than older men to have engaged in unprotected anal intercourse and, specifically, receptive intercourse in the past 2 months. Younger men also reported more frequent occurrences of unprotected anal intercourse. A progressive decline in risk behavior levels was associated with increasing age. Young men less often personally knew someone who had died of AIDS, and deaths were not primarily within their close social networks. Continued HIV prevention efforts directed toward young MSM are needed, including cities traditionally considered as second tier with respect to AIDS.     

Sexual Health Risks Among Young Thai Women: Implications for HIV/STD Prevention and Contraception

This paper examines factors that may place female Thai adolescents and young adults at risk for HIV, sexually transmitted diseases (STDs), and unintended pregnancies. A total of 832 female vocational students participated in a cross-sectional audio-computer-assisted self-interview (ACASI) survey after providing informed consent. The questionnaire covered: sociodemographic characteristics; knowledge, attitudes, and beliefs related to HIV and STDs; contraceptive practices; sexual experiences and behaviors; and drug use. Oral fluid was tested for HIV antibodies and urine was tested for illicit drugs and for the presence of gonococcal or chlamydial nucleic acids. A total of 359 women (43.1%) reported sexual intercourse history, with an average age at first sex of 17.6 years, and a 2.6 mean number of lifetime sex partners. Twenty-one percent of the entire sample reported coerced sexual contact or intercourse. Among those with sexual intercourse experience, 27.3% (n = 98) had been pregnant and the majority of their most recent pregnancies were terminated. Three tested positive for HIV antibodies. Sexually active young Thai women report behaviors or experiences that may expose them to HIV/STD infection and unintended pregnancy in the future. These include unprotected intercourse, sexual coercion, low levels of contraceptive use, and drug and alcohol use. Culturally appropriate interventions that increase their awareness of and ability to respond to these sexual health risks are needed.     

Asking and Telling: Communication About HIV Status Among Latino HIV-Positive Gay Men

Communication about HIV status—that is, asking about a sex partner's status as well as disclosing one's own status—was examined in a sample of 129 Latino HIV-positive gay men interviewed as part of a larger study conducted in New York, Miami, and Los Angeles. Asking and telling were strongly related to each other; however, participants were more likely to disclose their positive serostatus to sex partners than to solicit information about their partners' serostatus. Region of birth was associated with both asking and telling. Participants with bilingual friendship networks reported more communication with partners. Higher levels of social isolation were related to lower levels of communication, and perceived negative consequences—beliefs that disclosure would result in negative consequences or rejection—were related to less telling. Contrary to expectations, reported experiences of gay discrimination were positively associated with communication of serostatus.     

Predictors of Unprotected Anal Intercourse Among HIV-Positive Latino Gay and Bisexual Men

This study examined sexual behaviors in a sample of 155 HIV-positive Latino gay and bisexual men. Nearly half the sample had engaged in unprotected anal intercourse in the past 12 months; unprotected anal intercourse was more likely when the partner was also HIV-positive. Separate regression models predicted the number of receptive and insertive partners for unprotected anal intercourse. Participants reported both more unprotected insertive and receptive partners if they had sex under the influence of alcohol or drugs. Older participants and those with lower levels of Latino acculturation reported having more partners with whom they took the receptive role during unprotected anal intercourse, whereas those with higher levels of depression reported having more partners with whom they took the insertive role. Hierarchical set logistic regression revealed that the dyadic variable of seroconcordance added to the prediction of unprotected anal sex with the most recent male partner, beyond the individual characteristics. Results show the importance of examining both individual and dyadic characteristics in the study of sexual behavior.     

Sexual Compulsivity in a Sample of HIV-Positive Methamphetamine-using Gay and Bisexual Men

Little research has been done on the relationship between sexual compulsivity and the sexual risk behaviors of methamphetamine (meth) users. This exploratory study sought to identify correlates of sexual compulsivity in a sample of 217 HIV-positive meth-using gay and bisexual men. Participants reported a mean score of 2.4 on the Sexual Compulsivity Scale (SCS) (SD=.76, range 1–4). Sexual compulsivity was positively associated with high-risk sexual behaviors (e.g., number of unprotected sex acts with anonymous partners, total number of HIV-negative or unknown serostatus partners). In multivariate analyses, higher scores on sexual compulsivity were associated with older age, meth use before or during sex, visits to sex clubs and street corners to find sex partners, lower self-efficacy for condom use, lower levels of self-esteem, higher scores on a measure of disinhibition, and a greater number of HIV-negative or unknown serostatus partners. The results suggest that more attention should be focused on sexual compulsivity and its correlates to determine how they may contribute to resistance to sexual behavior change in this high-risk population.     

Longitudinal Modeling of Methamphetamine Use and Sexual Risk Behaviors in Gay and Bisexual Men

The purpose of the analyses was to examine the associations between methamphetamine and other club drug use with sexual risk taking across time in cohort of gay and bisexual men. Data were collected from a community-based sample. Assessments of unprotected anal intercourse with casual partners, and use of methamphetamine and other illicit drugs, were assessed at baseline, and at 4-month intervals over the course of a year, and were analyzed using hierarchical linear modeling. Methamphetamine use was related to the frequency of unprotected insertive and receptive intercourse with both HIV-positive and status unknown casual partners across time. The association between methamphetamine use and unprotected acts also was more pronounced for HIV-positive participants. These findings suggest that methamphetamine, and unprotected anal intercourse are co-occurring risk behaviors, that potentially heighten the risk of HIV transmission among gay and bisexual men. HIV prevention and intervention should concurrently target both these behaviors.     

Association Between Cannabis Use and Sexual Risk Behavior Among Young Heterosexual Adults

To study the association between cannabis use and frequent sexual risk behavior, we tested the hypothesis of a situational influence of cannabis use in sexual encounters using a combination of global association study and event-level analysis and examined possible mediator variables, including the personality trait of hedonism/risk preference, psychosocial stress, and HIV-related beliefs, using mediation models. The results of a computer-assisted telephone interview of a random sample of 2790 heterosexual men and women aged 16–24 years showed that risky sexual behavior was more frequent in cannabis-using men and women than in non-using persons. The results did not support a situational effect of cannabis intoxication on sexual risk behavior. The more frequent sexual risk behavior among cannabis users was mediated by decreased intentions to use HIV protection, by lower HIV-self-efficacy, and higher risk preference/hedonism. Only among women psychosocial stress was a partial mediator. The findings show that HIV prevention programs for cannabis-using young adults should emphasize the role of person variables instead of situation variables.     

Mental Health Problems and Sexual Abuse Among Adolescents in Foster Care: Relationship to HIV Risk Behaviors and Intentions

Adolescents in foster care present with multiple psychosocial and mental health problems that individually are associated with increased risk for HIV infection. However, few studies have examined empirically the interrelationships among these problems and HIV risk behaviors in this population. This study examined the sexual abuse histories and mental health problems among 343 youths in foster care to determine their association with HIV-risk behaviors and behavioral intentions. Results indicated that 25% reported internalizing behaviors (withdrawn, somatic complaints, depressed) and 28.3% reported externalizing behaviors (delinquent and aggressive behaviors). Of the sample, 37% reported some form of prior sexual abuse. Multivariate analyses using simultaneous entry of variables indicated that controlling for demographic variables and behavioral intentions, externalizing behaviors showed the strongest relationship with HIV-risk behaviors. Likewise, in the multivariate model, it was most strongly associated with behavioral intentions. Moreover, there was a significant race-by-gender interaction, with White females engaging in more risky behaviors than their male counterparts and youths of color.     

Predictors of HIV Sexual Risk Behaviors in a Community Sample of Injection Drug-Using Men and Women

Injection risk practices and unprotected sex between injection drug users (IDUs) and their sexual partners are responsible for a high proportion of AIDS cases and new HIV infections in the United States. The purpose of this study was to investigate the links between drug use behaviors and psychosocial factors with high-risk sexual behaviors among male and female IDUs. Understanding the determinants of sexual risk practices among drug users can lead to the development of more effective programs to prevent sexual HIV and STD transmission. This study enrolled a community sample of 101 IDUs (males = 65, females = 36), primarily African American and unemployed, who injected drugs and had unprotected sex in the past 3 months. The sample was categorized into highest sexual risk (multiple partners and intercourse without condoms) and lower sexual risk subgroups. Univariate analyses showed that IDUs at highest sexual risk had lower sexual risk reduction self-efficacy (p =.01) and were more likely to be African American (p =.02). Drug users at highest sexual risk also used noninjected cocaine and crack more frequently (p =.05), were less likely to inject heroin (p =.04), and tended to more often inject cocaine (p =.05). IDUs at highest sexual risk also tended to more often use crack and methamphetamines. Logistic regression analyses showed that injecting cocaine or crack, sexual risk reduction self-efficacy, and race were independent predictors of sexual risk behavior levels. Sexual risk reduction programs for this population are needed, with HIV prevention programs tailored to specific IDU risk reduction needs.     

Changes in the Meaning of Sexual Risk Behaviors Among Gay and Bisexual Male Methamphetamine Abusers Before and After Drug Treatment

Methamphetamine is widely used among gay and bisexual men in the West Coast of the United States, and is often used in combination with high-risk sexual activities. This study combined quantitative and qualitative research methodologies to examine sexual risk behaviors among gay and bisexual male methamphetamine abusers as they entered treatment and at 1-year follow-up evaluations. Findings from the quantitative follow-up data demonstrate that gay and bisexual men reduce sexual risk behaviors and sustain those reductions following substance abuse treatment, and qualitative data reveal the meaning of these behavior changes from the perspective of the participant. At 1-year evaluations, associated behaviors of methamphetamine use and sexual risk behaviors were lessened. Although condom use decreased slightly, participants reported fewer anonymous sexual partners, reductions in episodes of both receptive and insertive anal intercourse, and an increased sense of responsibility to disclose their HIV status. This study further demonstrates the value of coupling quantitative with qualitative data in understanding the meanings behind reductions in high-risk behaviors.     

Disclosure of HIV status and psychological well-being among Latino gay and bisexual men

This study examined disclosure of HIV-positive serostatus by 301 Latino gay and bisexual men to members of their social networks and the mental health consequences of such disclosure. The sample was recruited from clinics, hospitals, and community agencies in New York City, Washington, DC, and Boston. Proportions disclosing differed depending on the target, with 85% having disclosed to closest friend, 78% to male main partner, 37% to mother, and 23% to father. Although there were differences depending on the target, disclosure was related to greater quality of social support, greater self-esteem, and lower levels of depression. Moreover, findings indicated that social support mediated the relationship between disclosure of serostatus and both self-esteem and depression. Thus, disclosure resulted in greater social support, which in turn had positive effects on psychological well-being. Findings demonstrate that generally Latino gay men are selective in choosing people to whom they disclose their serostatus and that disclosure tends to be associated with positive outcomes.     

Social Anxiety as a Risk Factor for Unprotected Intercourse Among Gay and Bisexual Male Youth

The current study proposed that social anxiety, which may be elevated among gay and bisexual youth, may increase their risk for unprotected sexual intercourse. Social anxiety predicted increased probability of having engaged in unprotected insertive anal intercourse in the past six months. Further examination suggested that social anxiety continued to be associated with unprotected insertive anal intercourse above and beyond the effects of communication about condom use and social support variables. Findings suggest the need to consider the impact of social fears when designing HIV prevention interventions.     

From Networks to Populations: The Development and Application of Respondent-Driven Sampling Among IDUs and Latino Gay Men

One of the challenges in studying HIV-risk behaviors among gay men is gathering information from a non-biased sample, as traditional probability sampling methods cannot be applied in gay populations. Respondent-Driven Sampling (RDS) has been proposed as a reliable and bias-free method to recruit “hidden” populations, such as gay men. The aim of this study is to assess the feasibility and effectiveness of RDS to sample Latino gay men and transgender persons. This was carried out when we used RDS to recruit participants into a study that investigated community involvement on HIV/AIDS sexual risk behaviors among Latino gay and bisexual men, and transgender (male-to-female) persons in Chicago and San Francisco. The population coverage of RDS was then compared to simulated time-location sampling (TLS). Recruitment differences were observed across cities, but the samples were comparable. RDS showed broader population coverage than TLS, especially among individuals at high risk for HIV.