Sexual Mixing and HIV Risk Among Ethnic Minority MSM in Britain

We conducted a cross-sectional online survey of men who have sex with men (MSM) living in Britain in 2007–2008 to examine sexual mixing among ethnic minority MSM. The sample comprised 115 black, 112 South Asian, 47 Chinese and 4,434 white MSM who reported unprotected anal intercourse (UAI) in the previous 3?months. In each ethnic minority group, MSM were three times more likely to report UAI with a partner of the same ethnicity than would be expected by chance alone (χ²?>?8.43, p?<?0.05). Nonetheless, most (>80?%) ethnic minority MSM reported UAI with men from an ethnic group other than their own. In multivariable analysis there was statistical evidence that, compared with white British MSM, self-reported HIV seropositivity remained low for South Asian and Chinese MSM after adjusting for UAI with partners of the same ethnicity (e.g. South Asian MSM, adjusted odds ratio 0.35, 95?% CI 0.19–0.66). This analysis suggests that differences in self-reported HIV seropositivity between ethnic minority and white MSM in Britain cannot be explained by sexual mixing with partners from the same ethnic group.     

HIV Prevalence,Sexual Partners,Sexual Behavior and HIV Acquisition Risk Among Trans Men,San Francisco, 2014

We surveyed 122 trans men using a hybrid sampling method that included randomly selected physical and online venues and peer referral to measure HIV prevalence and risk behaviors. HIV prevalence was 0% (one-sided 97.5% confidence interval 0–3.3%). Of 366 partnerships described, 44.8% were with cisgender women, 23.8% with cisgender men, 20.8% with trans men, and 10.7% with trans women. Condomless receptive anal and front hole/vaginal sex averaged one to three episodes per six months. HIV prevalence in trans men is likely closer to heterosexual cisgender men and women in San Francisco than trans women or MSM. Prevention prioritizing trans women and MSM, coupled with individualized and relevant sexual health education for trans men with partners from these populations, may best address the HIV prevention needs of trans men. Systematic collection of transgender status in Census and health data is needed to understand other health disparities among trans men.     

Relationship-Based Predictors of Sexual Risk for HIV Among MSM Couples: A Systematic Review of the Literature

Behavioral and epidemiological studies report high risk for HIV among MSM couples. Over the last decade, studies have examined relationship dynamics associated with sexual risk for HIV. It is important to examine the impact this research has had on HIV prevention and what is still needed. We conducted a review of the literature focusing on relationship dynamics associated with sexual risk for HIV among MSM couples. Procedures used for this review were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses established to provide a framework for collecting, reviewing and reporting studies systematically (Mohler et al. in Ann Intern Med 151(4):264-269, 2009). We found that positive relationship dynamics are associated with less risk with partners outside the relationship, but were associated with greater odds of unprotected anal intercourse with primary partners. We also discuss other factors including sexual agreements about outside partners and make recommendations for next steps in HIV prevention research among MSM couples.     

HIV, Sexually Transmitted Infections, and Sexual Risk Behavior Among Transgenders in Indonesia

Behavioral surveillance was undertaken among 1,150 male-to-female transgenders (waria) in Java, Indonesia, 2007; samples were collected for HIV and STI testing (n?=?748). Almost all waria had ever sold sex (median duration 10?years). Prevalence of HIV was 24.4%, syphilis 26.8% and rectal gonorrhea and/or chlamydia 47.0%. Syphilis and rectal STIs were associated with HIV infection. Consistent condom use during receptive anal sex with clients was reported by 35.9% waria and was higher among those who visited an STI clinic and who knew their HIV status. Efforts should continue to strengthen behavior change and STI care in future HIV prevention programs.     

Sexual Behavior and Risk Factors for HIV Infection Among Homosexual and Bisexual Men in Thailand

HIV prevalence and associated risk behaviors were examined among Thai bisexually active men (MSMW, n = 450) and men who have sex with men only (MSM-only, n = 1,125). Cross sectional venue-day-time sampling was used to collect data. Chi-square and logistic regression were used to identify HIV risk factors. HIV prevalence was 8.2% among MSMW and 21.2% among MSM-only. Consistent condom use with male partners was higher among MSMW (77.6%) than MSM-only (62.9%), and lower with female partners (44.4%). Lack of family confidant, migration, concern about acquiring HIV infection, and self-reported STD were associated with HIV prevalence among MSMW. Older age, lower educational level, residing in Bangkok or Chiang Mai, living away from family, recruitment from a sauna, increased frequency of visiting the surveyed venue, practicing receptive or both receptive and insertive anal intercourse, inconsistent condom use with male paying partners, and a history of drug use were associated with HIV prevalence in MSM-only.     

Factors Associated with Sexual Risk Behavior Among Persons Living with HIV: Gender and Sexual Identity Group Differences

Factors associated with HIV transmission risk may differ between subgroups of persons living with HIV/AIDS (PLWHA). This study examined such factors in a sample of PLWHA recruited in 3 US metropolitan areas. Sexually active participants were categorized as gay or bisexual men (GBM) (n = 545), heterosexual men (HSM, n = 223), or women (n = 214). Of 982 participants, 27.1% reported serodiscordant unprotected anal or vaginal sex (SDUAV). SDUAV was associated with multiple (2 or more) partners, using poppers, and lower safer sex self-efficacy among GBM. SDUAV was associated with multiple partners among HSM. Among women, factors examined were not associated with SDUAV. These findings are consistent with prior research and facilitate our ability to target those who may be most at risk for transmitting HIV among HIV-positive GBM. More research must be conducted to identify factors associated with risk behavior among HSM and women.     

Association Between Enacted Stigma and HIV-Related Risk Behavior Among MSM,National HIV Behavioral Surveillance System, 2011

MSM bear a disproportionate burden of the HIV epidemic. Enacted stigma (overt negative actions) against sexual minorities may play an important role in increasing HIV risk among this population. Using data from the 2011 National HIV Behavioral Surveillance system, MSM cycle, we examined the independent associations between three measures of enacted stigma (verbal harassment, discrimination, physical assault) and engagement in each of four HIV-related risk behaviors as outcomes: condomless anal intercourse (CAI) at last sex with a male partner of HIV discordant or unknown status and, in the past 12 months, CAI with a male partner, ≥4 male sex partners, and exchange sex. Of 9819 MSM, 32% experienced verbal harassment in the past 12 months, 23% experienced discrimination, and 8% experienced physical assault. Discordant CAI at last sex with a male partner was associated with previous discrimination and physical assault. Past 12 month CAI with a male partner, ≥4 male sex partners, and exchange sex were each associated with verbal harassment, discrimination, and physical assault. These findings indicate that a sizable proportion of MSM report occurrences of past 12 month enacted stigma and suggest that these experiences may be associated with HIV-related risk behavior. Addressing stigma towards sexual minorities must involve an integrated, multi-faceted approach, including interventions at the individual, community, and societal level.     

Body Mass Index, Depression and Sexual Transmission Risk Behaviors Among HIV-Positive MSM

Depression has been shown to be a risk factor for serodiscordant unprotected anal intercourse (SDUAI) in some studies, but not others. Body mass index (BMI) has recently been associated with SDUAI; however, to date, no published study has investigated the interactive effect of depression and BMI on SDUAI. The current study assessed the association between depression, BMI, and SDUAI among HIV-positive MSM. Participants were 430 HIV-positive MSM recruited in a Boston community health center where they received primary care. Participants completed audio computer-assisted self interview (ACASI) measures. Objective height and weight and other clinical variables were accessed through participants' electronic medical records. Depression was positively associated with SDUAI. This association was significantly moderated by BMI. Elevated levels of depression were only associated with SDUAI for underweight participants. These findings suggest that underweight, depressed HIV-positive MSM may be particularly likely to engage in SDUAI.     

A Pilot RCT of an Intervention to Reduce HIV Sexual Risk and Increase Self-acceptance Among MSM in Chennai,India

This is a 2-arm pilot randomized controlled trial (N = 96) of a behavioral intervention (4 group and 4 individual sessions) integrating risk reduction counseling with counseling to foster self-acceptance in MSM in India compared to enhanced standard of care (ESOC). Both conditions involved HIV and STI testing and counseling at baseline and 6-months, and assessments of condomless sex at baseline, 3-, and 6-months. A significant condition by time interaction suggested a difference in the rate of change in number of anal sex acts without condoms in the intervention versus ESOC (p < 0.0001). Post hoc contrasts suggested that the overall difference was due to intervention-response at 3-months. The incidence of bacterial STIs was 17.5 % in the intervention condition and a 28.6 % in ESOC. Addressing self-acceptance and related psychosocial concerns in the context sexual risk reduction counseling for MSM in India was feasible and acceptable. Testing the intervention for efficacy is justified.     

HIV Knowledge and Sexual Risk Behavior Among Pregnant Couples in South Africa: The PartnerPlus Project

In sub-Saharan Africa, 60 % of people living with HIV are women and most are of childbearing age. Alarmingly, seroconversion rates during pregnancy are high and increase as pregnancy progresses, highlighting the importance of increasing HIV-knowledge among pregnant women and their partners. This study compared sexual risk behavior, HIV knowledge and condom use pre- to post-partum among South African couples (n = 239 couples) randomly assigned to an intervention or an enhanced standard of care with the PMTCT protocol at rural community health antenatal clinics. Consistent condom use and HIV-related knowledge increased baseline to post-intervention and was maintained at long term follow up post-partum among participants in the intervention condition. HIV knowledge mediated the relationship between the intervention and consistent condom use. Results from this pilot study provide support for the integration of HIV risk reduction interventions for both women and men into existing PMTCT services during and following pregnancy.     

Cultural Beliefs,Partner Characteristics,Communication, and Sexual Risk Among Latino MSM

This study examined factors associated with communication about condom use and unprotected anal intercourse (UAI) in a U.S. sample of immigrant Latino MSM (N = 356), with a focus on culturally based beliefs. Logistic regression analysis revealed that communication about condom use at participants’ most recent encounter was associated with a lower likelihood of UAI during that encounter. UAI was more likely when the partner was a main partner and there was seroconcordance. A separate logistic regression indicated that communication about condom use was less likely when the most recent encounter involved a main partner, greater sexual desire, and intoxication due to substance use. Although cultural beliefs were not predictive of communication about condom use or UAI at the most recent encounter, they were related to the occurrence of UAI in the previous three months. There is a need for more research on the interplay of culture, safer sex communication, and sexual risk.     

HIV Risk Behavior Patterns Among Young Thai Men

Correlates of behavior associated with HIV exposure risk were evaluated in cross-sectional data from 3,839 Royal Thai Army (RTA) recruits whose birthplaces and residences were located away from Thailand's main HIV epicenter. Participants were generally 21 years old, unmarried, educated at the primary school level, and previously had been engaged in agriculture or unskilled labor. HIV prevalence in the sample was 1.8%. Condom use with commercial sex workers (CSW) was less than universal, and a small subset of men emerged who had multiple categories of partners. Nonetheless, CSW patronage appeared lower than in early studies in the Thai epicenter of the Upper North, and the venues patronized generally were not low-cost, high-turnover brothels. Sexual experience with girlfriends was more frequent than CSW experience, and the rate of condom use with girlfriends was relatively low. Lifetime injection drug use (IDU) was reported by 4.1% of the total sample and was associated with recent urban residence, CSW patronage, and sexual precocity. Findings suggest gaps in Thailand's condom campaign and the need to better address HIV risk associated with having multiple partners.     

Depression in the Pathway of HIV Antiretroviral Effects on Sexual Risk Behavior Among Patients in Uganda

HIV antiretroviral therapy (ART) can increase safe sex or lead to disinhibition and less condom use. We conducted one of the first controlled studies of ART effects on sexual risk behavior in sub-Saharan Africa, and the potential explanatory roles of physical and mental health. Participants (302 non-ART, 300 ART) were followed for the first 12?months of HIV care in Uganda. Multivariate intention-to-treat regression analysis showed that frequency of sex increased significantly in both groups, but more among ART patients; when added to the model in separate analyses, changes in physical health functioning and depression were both significant predictors, as was time in HIV care, but there was no longer an ART effect. Both ART and non-ART groups had similar dramatic increases in consistent condom use over time; however, change in depression, unlike physical health functioning, was a significant predictor of consistent condom use when added to this model, and there remained a similar level of increased condom use among ART and non-ART patients. HIV care and ART increase sexual activity and condom use, but depression undercuts the prevention benefits of ART, highlighting the need to integrate mental health services into HIV care.     

Moderating Effect of Age on the Association Between Alcohol Use and Sexual Risk in MSM: Evidence for Elevated Risk Among Younger MSM

Men who have sex with men (MSM) are substantially impacted by HIV/AIDS in the United States. Alcohol use is frequently studied as a predictor of sexual risk in MSM, but findings for this association have been mixed. Developmental differences in this effect may help to explain equivocal findings. 143 MSM (analytic sample 137) ages 16–40 completed weekly diaries of sexual encounters and associated situational factors for 12 weeks. Analyses were conducted with Hierarchical Linear Modeling. Alcohol use before sex was not associated with sexual risk across all participants. Participant age moderated this effect; alcohol use before sex was associated with increased odds of sexual risk in younger MSM only. These analyses expand on previous findings by utilizing a wider age range than most prior studies and adjusting for the effects of several theoretically-selected covariates. Young MSM are an important group to target for addressing alcohol use in the context of sexual behavior.     

Substance Use During Sex and Sensation Seeking as Predictors of Sexual Risk Behavior Among HIV+ and HIV− Gay Men

Substance use (i.e., use of recreational drugs and alcohol) has been associated with HIV-related sexual risk behavior in several studies involving gay men. One explanatory hypothesis proposes that substance use and sexual risk behavior are both a function of underlying personality traits. This paper examines sensation seeking and alcohol and drug use during sex as predictors of unprotected anal and oral sex and of a sexual risk index. The sample includes 117 predominantly gay-identified men (73 HIV+ and 44 HIV–) who participated in a 5-year natural history study of HIV disease in New York City. Repeated measures regression analyses tested predictor variables individually and in models including all predictor variables simultaneously. Alcohol use, drug use, and sensation seeking were each significantly associated with all sexual risk behavior variables when entered individually. When predictor variables were entered simultaneously in analyses involving unprotected receptive and insertive anal sex, sensation seeking remained a significant predictor, with substance use typically falling to marginal significance. However, significant associations between substance use and the other sexual risk behavior variables (oral sex and a risk index) are maintained even when controlling for sensation seeking. The results suggest that sensation seeking may partially account for the association between substance use and sexual risk behavior, but substantial independent associations also exist.