Relationship of psychosocial factors to HIV risk among Haitian women.

This study describes the prevalence of HIV risk behaviors among low-income, Haitian women, identifies theoretically relevant mediating psychosocial HIV risk predictors, and provides formative data for developing culturally and gender sensitive interventions for this distinctive, high risk, and understudied population. Confidential interview surveys were administered to 101 women of Haitian descent while they awaited their medical appointments at a local low-income, community medical clinic. Moderately high levels of sexual risk behavior (i.e., unprotected sex with nonmonogamous partners; multiple lifetime partners) were reported. On average, these women reported a belief in their HIV susceptibility, relatively little HIV-related anxiety, somewhat inadequate levels of communication regarding safer sex practices, and lack of adequate confidence in their ability to negotiate safer behaviors in sexual encounters. Both personal and partner condom attitudes were unfavorable and these attitudes predicted condom use levels. It was concluded that interventions need to be developed for Haitian women to improve their attitudes toward condom use and their confidence in negotiating safer sexual practices. However, these interventions cannot be developed in a vacuum. Although it is crucial to consider the woman's individual attitudes and behaviors, it is also important to consider the male partner's attitudes toward sex and the woman's relationship with her male partner within the context of Haitian culture. Only by determining and targeting important potential motivations for safe sex within the cultural context can we most effectively reduce HIV sex risk behavior in Haitian women.     

Intimate Partner Violence Perpetration and Condom Use-Related Factors: Associations with Heterosexual Men’s Consistent Condom Use

Intimate partner violence victimization has been linked to sexual HIV risk behavior among heterosexual women. The unique role of perpetration of intimate partner violence (IPV) in sexual risk behavior among men has not been studied as well. Based on interviews with 518 heterosexual men recruited via street-intercept between 2005 and 2007 in New York City, we assessed the relationship between perpetration of IPV against a main female partner and inconsistent condom use with that same partner, while controlling for condom use-related factors. Multivariate logistic regression revealed that men who perpetrated physical IPV were half as likely to report consistent condom use as compared with men who did not use violence, while controlling for sociodemographic, condom use-related and other factors. Physical IPV perpetration by heterosexual men makes an independent contribution to consistent condom use. Designing interventions for heterosexual men that simultaneously address both IPV and sexual risk behaviors is critical.     

Choice-Disability and HIV Infection: A Cross Sectional Study of HIV Status in Botswana, Namibia and Swaziland

Interpersonal power gradients may prevent people implementing HIV prevention decisions. Among 7,464 youth aged 15–29 years in Botswana, Namibia and Swaziland we documented indicators of choice-disability (low education, educational disparity with partner, experience of sexual violence, experience of intimate partner violence (IPV), poverty, partner income disparity, willingness to have sex without a condom despite believing partner at risk of HIV), and risk behaviours like inconsistent use of condoms and multiple partners. In Botswana, Namibia and Swaziland, 22.9, 9.1, and 26.1% women, and 8.3, 2.8, and 9.3% men, were HIV positive. Among both women and men, experience of IPV, IPV interacted with age, and partner income disparity interacted with age were associated with HIV positivity in multivariate analysis. Additional factors were low education (for women) and poverty (for men). Choice disability may be an important driver of the AIDS epidemic. New strategies are needed that favour the choice-disabled.     

Determinants of HIV Serostatus Disclosure to Sexual Partner Among HIV-Positive Alcohol Users in Haiti

This study examined the relationship between antiretroviral therapy use, participants’ knowledge of partner’s HIV serostatus, number of sex partners, perceived infectivity and HIV disclosure to a main sexual partner among 258 HIV-positive Haitian alcohol users. Only 38.6 % had disclosed their HIV serostatus to sexual partners. Logistic regression analyses revealed that participants who self-reported having an HIV-negative partner (OR = 0.36, 95 % CI 0.13–0.97) or a partner of unknown HIV status (OR = 0.09, 95 % CI 0.04–0.22) were less likely to disclose their HIV serostatus than participants who self-reported having an HIV-positive partner. Participants who had more than one sexual partner in the past 3 months (OR = 0.41, 95 % CI 0.19–0.90) were also less likely to disclose than participants who had one partner. These findings suggest the need for couples-based programs to assist people living with HIV (PLWH) with the disclosure process, especially among PLWH who have more than one sexual partner and/or are in serodiscordant relationships.     

Union break-up after HIV diagnosis among sub-Saharan African migrants in France: disclosing HIV status is linked with staying in union

Sub-Saharan African migrants living in France are particularly affected by HIV. Due to the fear of sexual transmission of the virus, those in a relationship could experience a union break-up after an HIV diagnosis. Based on data from the time-event ANRS-Parcours survey that was conducted among a representative sample of sub-Saharan migrants living with HIV (France, 2012–2013), we studied union break-ups after HIV diagnosis among people who were in a relationship at the time of their diagnosis. Women experienced a more rapid union break-up after HIV diagnosis than did men. The living conditions of men were not correlated to their risk of union break-up while among women, having a personal dwelling reduced the risk of union break-up. For both sexes, less established relationships were more likely to break up after HIV diagnosis. Having disclosed the HIV status to a partner was associated with a reduced risk of separation between partners, after adjustment on socio-economic conditions and migration characteristics.     

In the Heart or in the Head: Relationship and Cognitive Influences on Sexual Risk Among Young Couples

Few studies examine how relationship factors influence sexual risk. We investigated gender differences of the influence of relationship functioning on sexual risk behavior and sexually transmitted infections (STIs) among 296 young pregnant couples. Compared to women, men were twice as likely to have a concurrent partner, were less likely to intend to be monogamous in the future, had less HIV/STI knowledge and more perceived risk for HIV/STI, negative attitudes and efficacy toward condom use (all P < 0.05). For men, poor relationship functioning related to less intentions to be monogamous, more partner concurrency, worse sexual communication, and more condom use. For women, poor relationship functioning related to worse sexual communication and less condom use. In addition, women who had good relationship functioning and women who had partners with poor relationship functioning were more likely to have an STI. These results demonstrate the need to include heterosexual men and relationship factors in HIV prevention.     

Results from Two Online Surveys Comparing Sexual Risk Behaviors in Hispanic,Black, and White Men Who Have Sex with Men

Many men who have sex with men (MSM) are among those who increasingly use the internet to find sexual partners. Few studies have compared behavior by race/ethnicity in internet-based samples of MSM. We examined the association of race/ethnicity with HIV risk-related behavior among 10,979 Hispanic, black, and white MSM recruited online. Significant variations by race/ethnicity were found in: age, income level, sexual orientation, number of lifetime male and female sexual partners, and rates of unprotected anal intercourse (UAI). Black and Hispanic men were more likely to report anal intercourse during the last sexual encounter, but white men were more likely to report UAI. In multivariate analysis, UAI was associated with HIV infection and sex with a main partner. Significant risk behavior variations by race/ethnicity were found. Research is needed to better target online interventions to MSM who engage in UAI or have other risk factors for transmitting or acquiring HIV.     

Sexual Risk Behaviors Among Adolescents in Port-au-Prince,Haiti

Engagement in sexual activity among Haitian youth is increasing. The present cross-sectional study examined the independent correlates of sexual risk behaviors among 200 (108 male/92 female) 13–18 year-old adolescents in Port-au-Prince, Haiti using face-to-face interviews. The majority (60.0 %) had engaged in sexual intercourse. Multivariate modeling found males to be 3.52 times more likely to have had sex, 5.42 times more likely to report sexual debut before age 14, 9.75 times more likely to have >1 sexual partner, and 3.33 times more likely to not have used a condom during last sex. Adolescents living with parents, grandparents, aunts or uncles were less likely to report having unprotected sex compared with those without adult family members in the home (AOR range 0.26–0.51). The high prevalence of risky sex among males and the protective influence of stable family cohesiveness have important implications for HIV prevention efforts.     

Sexual risk behavior among HIV-positive patients at an urban clinic in Santiago, Dominican Republic

More than 1% of adults in the Dominican Republic are HIV-infected and most infections are acquired sexually. We studied sexual risk behaviors in a group of HIV-positive patients treated in Santiago, Dominican Republic. Interviews were conducted with 129 participants seen in May 2006 at one of the country's largest public hospital HIV clinics. Questions included demographics, sexual history, condom use, and focused on patients' last sexual encounter. Most patients (72.4%) had been sexually active since their HIV diagnosis. Following their diagnosis, 72.8% of sexually active patients used condoms more frequently, 21.7% used condoms with the same frequency, and 5.4% used condoms less often. The most common reason cited for not using a condom after HIV diagnosis differed by gender; men cited decreased sexual pleasure (70.0%) and women reported that their partner had refused to use a condom (71.8%). Sexually active patients who believed that their partner did not have HIV were much more likely to report using a condom at their last sexual encounter than those who did not know their partner's HIV status (odds ratio [OR] = 16.9). HIV-positive patients reported using condoms more frequently following their HIV diagnosis and were more likely to use a condom if they believed their partner did not have HIV. Increased HIV testing may lead to reduced sexual risk behavior in the Dominican Republic.     

Latent Class Analysis of HIV Risk Behaviors Among Russian Women at Risk for Alcohol-Exposed Pregnancies

The number of HIV cases attributed to heterosexual contact and the proportion of women among HIV positive individuals has increased worldwide. Russia is a country with the highest rates of newly diagnosed HIV infections in the region, and the infection spreads beyond traditional risk groups. While young women are affected disproportionately, knowledge of HIV risk behaviors in women in the general population remains limited. The objectives of this study were to identify patterns of behaviors that place women of childbearing age at high risk for HIV transmission and determine whether socio-demographic characteristics and alcohol use are predictive of the risk pattern. A total of 708 non-pregnant women, aged between 18 and 44 years, who were at risk for an alcohol-exposed pregnancy were enrolled in two regions in Russia. Participants completed a structured interview focused on HIV risk behaviors, including risky sexual behavior and alcohol and drug use. Latent class analysis was utilized to examine associations between HIV risk and other demographic and alcohol use characteristics and to identify patterns of risk among women. Three classes were identified. 34.93% of participants were at high risk, combining their risk behaviors, e.g., having multiple sexual partners, with high partner’s risk associated with partner’s drug use (class I). Despite reporting self-perceived risk for HIV/STI, this class of participants was unlikely to utilize adequate protection (i.e., condom use). The second high risk class included 13.19% of participants who combined their risky sexual behaviors, i.e., multiple sexual partners and having STDs, with partner’s risk that included partner’s imprisonment and partner’s sex with other women (class II). Participants in this class were likely to utilize protection/condoms. Finally, 51.88% of participants were at lower risk, which was associated primarily with their partners’ risk, and these participants utilized protection (class III). The odds of being in class I compared with class III were 3.3 (95% CI [1.06, 10.38]) times higher for those women who had Alcohol Use Disorders Identification Test scores ≥ 8 than those who had lower scores, and were 3.9 (95% CI [1.69, 8.97]) times higher for those who used alcohol before sex than those who did not. In addition, women who drank more days per week were 1.36 times more likely to be in class II than in class III. The study informs prevention by identifying specific population groups and targets for interventions. Alcohol use is a significant predictor and an overarching factor of HIV risk in women. Since at-risk drinking is common among young Russian women, alcohol risk reduction should be an essential component of HIV prevention efforts.     

Intravenous drug users' HIV-risk behaviors with primary/other partners

The objective of this study was to determine how injection drug users' (IDUs) HIV-risk behavior differs with primary and other sex partners. Interviews were conducted with injection drug users from a needle exchange program (n = 243). Those with one sexual partner were more likely to report never using condoms with primary partners than were those with more than one partner (74% vs. 54%, p < 0.001). Those with more than one partner differed, between primary and other sexual partners, in their disclosure of HIV and IDU status, condom use, and drug use in combination with sex. Primary sexual partners of IDUs are placed at risk from IDUs' risk behavior with other sexual partners. Those planning HIV-risk reduction interventions for IDUs should consider risk behavior with primary partners separately from behavior with other partners. Evaluation of intervention effects should use partner-specific assessments of risk behavior.     

Predictors of Relationship Power Among Drug-Involved Women

Gender-based relationship power is frequently linked to women's capacity to reduce sexual risk behaviors. This study offers an exploration of predictors of relationship power, as measured by the multidimensional and theoretically grounded sexual relationship power scale, among women in outpatient substance abuse treatment. Linear models were used to test nine predictors (age, race/ethnicity, education, time in treatment, economic dependence, substance use, sexual concurrency, partner abuse, and sex role orientation) of relationship power among 513 women participating in a multi-site HIV risk reduction intervention study. Significant predictors of relationship control included having a non-abusive male partner, only one male partner, and endorsing traditional masculine (or both masculine and feminine) sex role attributes. Predictors of decision-making dominance were interrelated, with substance use × partner abuse and age × sex role orientation interactions. Results contribute to the understanding of factors which may influence relationship power and to their potential role in HIV sexual risk reduction interventions.     

上海市徐汇区MSM人群艾滋病高危行为及健康需求分析

目的了解徐汇区男男性行为人群(MSM)艾滋病高危行为和影响因素,以及其健康需求,为对MSM人群开展有效的艾滋病防治工作提供建议。方法采用非政府组织(NGO)小组动员、网络招募和"滚雪球"等方法,对154名MSM开展横断面匿名问卷调查,采集人口学特征、性取向、性活动、安全套使用、HIV抗体检测以及健康需求和建议等相关信息,使用SPSS 16.0进行统计分析。结果调查对象平均年龄28.5岁,文化程度较高,以外省为主。同性恋占66.9%,双性恋占32.4%。主要通过网络、同志酒吧、私人住宅、浴室等方式寻找同性性伴。有过固定男性伴、多次男性伴、偶遇男性伴和女性性伴的比例分别为55.8%、51.9%、48.7%和26.0%;其高危性行为发生比例分别达到37.2%、35.0%、32.0%和55.0%。婚姻状况是双性性行为发生的主要影响因素,经济收入是高危性行为发生的主要影响因素。77.3%的对象曾接受过HIV抗体检测。结论加强对MSM人群宣传教育,提高该人群对自身高危行为风险的认识,扩大咨询检测覆盖面和安全套的可及性。重点关注该人群中的已婚双性恋者和商业性服务者,对感染者和病人给予更多的关爱、心理支持和平等救治的机会。     

Spatial Mobility,Alcohol Use,Sexual Behavior and Sexual Health Among Males in India

This paper examines the linkages of permanent migration, temporary mobility and alcohol consumption with risky sexual behavior and sexually transmitted infections (STIs) including HIV infection among males in India using a nationally representative dataset. The study shows that non-migrant men and migrant men do not differ significantly in any indicator of risky sexual behavior and STIs. Temporary long duration mobile men reported significantly more often than the non-mobile men or short duration mobile men that they had sex with multiple sex partners during their lifetime as well as sex with a high risk partner and had paid sex in the 12 months preceding the survey. Males who drank alcohol almost every day notwithstanding with their migration or mobility status were most prone to lifelong as well as more recent sexual risk behavior. Controlling for sociodemographic characteristics long duration mobile men and men who used alcohol almost daily had higher sexual risk behaviors and STI infections. Further migration and mobility did not show any significant relationship with tested HIV prevalence among males in India, controlling for sociodemographic characteristics. Males who had lifetime multiple sex partners were at the highest risk of tested HIV infection controlling for sociodemographic characteristics, migration, mobility, alcohol use and STI infection. Interventions focusing on HIV prevention in India need to target both non-migrant and migrant men, particularly those who drink alcohol more frequently or daily. Targeted interventions are required for temporary mobile men, particularly for those mobile men who have to stay away from their homes continuously for a longer duration. Long duration mobile men are most prone to regular alcohol use and risky sexual behavior.     

Unprotected Sexual Behavior and HIV Risk in the Context of Primary Partnerships for Transgender Women

Previous research has reported that transgender women are likely to be exposed to HIV through unprotected sex with a male primary partner. We examined prevalence and correlates of unprotected sex with a primary male partner in a sample of n = 174 transgender women. Participants completed surveys on demographic characteristics, relationship dynamics with their male primary partner, sexual behavior, substance use, and psychosocial factors. Overall, 41% reported HIV positive status, 13% had another sexually transmitted infection during the past year, and 34% had unprotected sex with a male primary partner during the past 3 months. Factors associated with unprotected sex with a primary partner included living with the partner, drug use, alcohol use, education level, low self-efficacy to use condoms, and perceived discrimination. Notably, 35% of transgender women in HIV-discordant primary partnerships had unprotected sex with their male primary partner during the past 3 months, and 18% of transgender women in HIV-positive concordant primary partnerships had unprotected sex with an outside partner during the past 3 months. HIV prevention interventions for transgender women must address risk behavior in the context of primary partnerships as well as sex with concurrent partners outside the relationship. Couples-focused interventions involving transgender women and their male primary partners can be particularly promising.     

Sociodemographic and risk behavior characteristics associated with unprotected sex with women among black men who have sex with men and women in New York City

The objectives of this cross-sectional study were to compare sociodemographic and risk behavior characteristics between black men who have sex with both men and women (MSMW) and those who have sex with men only (MSMO) and assess factors associated with having any unprotected vaginal and/or anal intercourse (UVAI) with women in the last 3 months. Data from 326 black men who reported recent unprotected anal intercourse with a man in an HIV behavioral intervention study in New York City were analyzed. Baseline characteristics were compared between MSMW and MSMO, and factors associated with having any UVAI in the past 3 months with women among MSMW were evaluated. In total, 26.8% reported having sex with both men and women in the last 3 months. MSMW were less likely to be HIV infected, use amyl nitrates, and have unprotected receptive anal sex with most recent male partner. MSMW were more likely to be over 40 years old and use heroin. A total of 55.6% of MSMW reported having UVAI with women in the last 3 months. Compared to MSMW having only protected sex, MSMW having any UVAI with women were less likely to be HIV infected and to disclose having sex with men to female partners; they were more likely to have greater than four male sex partners in the last 3 months. In conclusion, HIV prevention interventions among black MSMW should directly address the risk of HIV transmission to both their female and male partners. Disclosure of bisexuality to female partners may be an important component of future prevention efforts.     

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.     

The Role of Relationship Intimacy in Consistent Condom Use Among Female Sex Workers and Their Regular Paying Partners in the Dominican Republic

Prior research has demonstrated an important link between relationship intimacy and condom use. Limited research has been conducted on this connection within the realm of female sex work. We examined the association between perceived relationship intimacy and consistent condom use among 258 female sex workers and 278 male regular paying partners who participated in a cross-sectional survey in the Dominican Republic. In multivariate analysis, higher intimacy among sex workers and regular paying partners was negatively associated with consistent condom use. Among those reporting higher perceived intimacy, male participants were more than twice as likely to report consistent condom use as female participants. Female sex workers in relationships of higher perceived intimacy are at greater risk of HIV/AIDS than their male regular paying partners. Gender-sensitive HIV prevention programs are needed to address the differential influence of relationship intimacy on condom use in the context of sex work.     

Needle sharing and high-risk sexual behaviors among IV drug users in Southern Thailand

This study sought to determine the prevalence of needle sharing and high HIV risk sexual behaviors and to identify characteristics associated with these practices in southern Thailand. Data were obtained using a structured questionnaire from 298 male intravenous drug users (IVDUs) seen in a methadone clinic during the previous year. The prevalence of HIV was 37%, and that of needle-sharing in the preceding months was 45%, although only 10% claimed to have had unsafe sex with a casual partner or prostitute in the same period. Determinants for needle sharing included shorter duration of drug injection, diminished knowledge of HIV prevention, a carefree attitude toward risk of HIV infection, and lower levels of income. Young single IVDUs with a low knowledge of HIV prevention were most likely not to use a condom. In conclusion, needle sharing among the study subjects was still a common practice, whereas high HIV risk sexual behavior was not. Attitudinal change may be necessary to reduce needle-sharing behavior and not just information on disease transmission.     

Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa

OBJECTIVES: To examine associations between the perpetration of intimate partner violence and HIV risk behaviour among young men in rural South Africa. DESIGN: An analysis of baseline data from men enrolling in a randomized controlled trial of the behavioural intervention, Stepping Stones. METHODS: Structured interviews with 1275 sexually experienced men aged 15-26 years from 70 villages in the rural Eastern Cape. Participants were asked about the type, frequency, and timing of violence against female partners, as well as a range of questions about HIV risk behaviours. RESULTS: A total of 31.8% of men reported the perpetration of physical or sexual violence against female main partners. Perpetration was correlated with higher numbers of past year and lifetime sexual partners, more recent intercourse, and a greater likelihood of reporting casual sex partners, problematic substance use, sexual assault of non-partners, and transactional sex. Men who reported both physical and sexual violence against a partner, perpetration both before and within the past 12 months, or more than one episode of perpetration reported significantly higher levels of HIV risk behaviour than men who reported less severe or less frequent perpetration of violence. CONCLUSION: Young men who perpetrate partner violence engage in significantly higher levels of HIV risk behaviour than non-perpetrators, and more severe violence is associated with higher levels of risky behaviour. HIV prevention interventions must explicitly address the links between the perpetration of intimate partner violence and HIV risk behaviour among men, as well as the underlying gender and power dynamics that contribute to both.