Study confirms the link between MSM and web. San Francisco officials use on-line interventions

When the number of early syphilis cases in San Francisco increased from 41 in 1998 to 495 in 2002, and more than two-thirds of these cases also were HIV-positive, health department officials decided that new prevention interventions were needed. The syphilis outbreak also was notable in how it mainly involved men who have sex with men (MSM) by 2002. In 1998, only 22% of the early syphilis cases involved MSM, whereas in 2002, 88% involved MSM. Investigators with the San Francisco Department of Public Health discovered that a significant majority of the MSM syphilis cases listed the Internet as venue for meeting sexual partners.     

Incidence of the acquired immunodeficiency syndrome in San Francisco, 1980-1983

Incidence data for the acquired immunodeficiency syndrome (AIDS) are presented on the basis of a surveillance file maintained by the San Francisco Bureau of Communicable Disease Control. The incidence of AIDS among residents of San Francisco rose steadily from the first case diagnosed in the last quarter of 1980 through the last quarter of 1983. New cases were diagnosed at a rate of 25 per month in the last quarter of 1983. Reported incidence declined in mid-1983, but the decline was probably a case-finding artifact. Smoothed incidence rates show a steady progressive rise, which is approximated equally well by quadratic or exponential curves. Among the patients diagnosed in San Francisco, 99% were homosexual or bisexual men. The cumulative incidence rate among homosexual or bisexual men was estimated to be 770 per 100,000 in the last quarter of 1983. The incidence rate of AIDS increased with age, and the increase was greater than that found with other sexually transmitted diseases. The difference in the age distributions between cases of AIDS and syphilis suggests either that susceptibility to AIDS increases with age or that the average latency associated with AIDS is longer than previously thought.     

A new meeting place: chatting on the Internet, e-dating and sexual risk behaviour among Dutch men who have sex with men

OBJECTIVE: To describe the process of Internet chatting, and subsequent dating and sexual (risk) behaviour among Dutch men who have sex with men (MSM), and to compare the demographic profile of the Internet sample with a traditional Dutch MSM sample. DESIGN: A self-selected anonymous Internet sample. METHODS: Enrolment via a prominent gay chat room. Potential respondents were asked to complete an online questionnaire about chatting and dating, and sexual (risk) behaviour with their last date via chatting (e-date). In 26 days, 5302 questionnaires were returned. Of these, 4984 were evaluated as reliable and were used in the analyses. RESULTS: Eighty-two per cent chatted at least once a week, 88% had ever dated through chatting, and of these 89% had had sex with one or more e-dates. With respect to the last e-date, almost 50% had had anal sex with their last e-date, and 15% reported unprotected anal sex. Especially among HIV-positive men, a high percentage of unprotected anal sex was reported (39%). After correcting for the disclosure of HIV status, this percentage remained twice as high compared with HIV-negative and never-tested men (28 versus 14%). Compared with a traditional MSM sample, the Internet sample was significantly younger, and comprised more non-Dutch and bisexual men, whereas the level of sexual risk behaviour with casual partners was comparable. CONCLUSION: The Internet is a popular new meeting place for MSM, and attracts men with a different demographic profile. The level of risk behaviour warrants that opportunities for interventions on the Internet are explored, with special attention to HIV-positive chatters.     

The Internet, HIV serosorting and transmission risk among men who have sex with men, San Francisco

In a community-based, time-location sampling survey in San Francisco, Internet-met partners were not more likely to be HIV seroconcordant among HIV-negative and HIV-positive men who have sex with men (MSM) compared with partners met at bars and dance clubs. In addition, HIV-negative MSM were more likely to have unprotected anal intercourse with potentially serodiscordant partners met on the Internet compared with those met at bars and dance clubs (adjusted OR 1.5, 95% CI 1.1-2.0, P = 0.01).     

Socioeconomic Position and HIV Risk-Relevant Behavior Among Lower-Income Heterosexuals in San Francisco

We assess whether there is evidence of an association between socioeconomic position (SEP) and HIV risk-relevant behavior among lower income heterosexual men and women in San Francisco. Respondents residing in low income areas with high heterosexual AIDS case burden in San Francisco were recruited through long-chain referral in 2006–2007. Risk measures included unprotected vaginal intercourse, concurrency and exchange sex. SEP was defined as household annual income, per capita income, and employment. Analyses utilized mixed and fixed effects models. A total of 164 men and 286 women were included in the study. SEP was only significant in the case of exchange sex among men: men reporting annual income greater than $30,000 had significantly lower odds of exchange sex relative to other men. Evaluating the connection between economic status and HIV requires additional studies covering diverse populations. Future studies should focus on community economic context as well as individual SEP.     

Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections

BACKGROUND: Syphilitic ulcers are known to facilitate the transmission of HIV infection, but the effect of syphilis infection on HIV viral loads and CD4 cell counts is poorly understood. METHODS: We abstracted medical records for HIV-infected male syphilis patients seen at three clinics in San Francisco and Los Angeles from January 2001 to April 2003. We compared plasma HIV-RNA levels and CD4 cell counts during syphilis infection with those before syphilis infection and after syphilis treatment, using the Wilcoxon signed rank test. RESULTS: Fifty-two HIV-infected men with primary or secondary syphilis had HIV viral load and CD4 cell count data available for analysis; 30 (58%) were receiving antiretroviral therapy. Viral loads were higher during syphilis compared with pre-syphilis levels by a mean of 0.22 RNA log10 copies/ml (P = 0.02) and were lower by a mean of -0.10 RNA log10 copies/ml (P = 0.52) after syphilis treatment. CD4 cell counts were lower during syphilis infection than before by a mean of -62 cells/mm3 (P = 0.04), and were higher by a mean of 33 cells/mm3 (P = 0.23) after syphilis treatment. Increases in the HIV viral load and reductions in the CD4 cell count were most substantial in men with secondary syphilis and those not receiving antiretroviral therapy. CONCLUSION: Syphilis infection was associated with significant increases in the HIV viral load and significant decreases in the CD4 cell count. The findings underscore the importance of preventing and promptly treating syphilis in HIV-infected individuals.     

Are sexual partners met online associated with HIV/STI risk behaviours? Retrospective and daily diary data in conflict

The association between Internet sex-seeking and sexual risk-taking was explored using both retrospective and daily diary methodology. Men who have sex with men (MSM) (N=113) were recruited through a variety of Internet sites. Participants completed retrospective questionnaires on their history of Internet use to seek sexual partners and their engagement in sexual risk-taking behaviours. Participants also completed daily diaries for up to 30 days, which assessed if partners were met through the Internet and what types of sexual contact occurred. Multilevel modelling was used to analyze the daily diary data. The retrospective and daily diary data produced opposite results. In the retrospective data, a history of online sex-seeking was associated with greater numbers of sexual partners in the last year, one-time sex partners, sex without condoms and failure to discuss partners' sexual histories. In the daily diary data, unprotected anal intercourse (UAI) was less likely to occur with partners met online than with partners met by other means. These data suggest that men who engage in high-risk sex with other men use the Internet as a tool for meeting sexual partners, not that meeting partners online causes high-risk sex.     

Is offering post-exposure prevention for sexual exposures to HIV related to sexual risk behavior in gay men?

OBJECTIVE: To examine the impact of the availability of postexposure prevention (PEP) for sexual exposures to HIV on sexual risk behavior among gay men. METHODS: Two cross-sectional samples of 529 gay men in San Francisco (June 1998, January 1999) completed face-to-face street interviews assessing sexual risk behavior and whether they had heard of PEP in general as well as whether they knew that PEP was available in San Francisco. The second sample was collected after a community-wide outreach campaign had been conducted to increase people's knowledge that PEP was available in San Francisco. RESULTS: Of those who had heard of PEP at Time 1, 24% had recently had unprotected anal intercourse, versus 26% of those who had not heard of PEP. At Time 2, 37% of those who had heard of PEP had recently engaged in unprotected anal intercourse versus 26% of those who had not heard of PEP (chi2, 4.06; P = 0.03). At both time points, however, men who actually knew that PEP was available in San Francisco did not report more risk behavior than men who did not know PEP was available in San Francisco. In addition, only a small percentage at both time points self-reported that PEP had the effect of increasing their sexual risk behavior. CONCLUSIONS: There is little evidence that the availability of PEP for sexual exposures may be related to increased sexual risk-taking among gay men in San Francisco. The potential impact of PEP on risk behavior must, however, still be considered as part of the larger context of HIV/AIDS treatment optimism and possibly escalating levels of risk behavior among gay men.     

Sexual behavior before AIDS: the hepatitis B studies of homosexual and bisexual men

Data on sexual practices, collected during studies of hepatitis B virus (HBV) infection in 1978 and 1979, were analyzed for 4910 homosexual and bisexual men from Chicago, Denver, Los Angeles, San Francisco, and St Louis. Data on sexual practices in 1978 showed that white participants had larger numbers of non-steady male sexual partners and engaged in oral-genital activities more frequently but were equally likely to engage in anal intercourse as black and Hispanic participants. San Francisco participants had more non-steady sex partners and were more likely to engage in receptive anal intercourse with non-steady partners than participants from all other sites. Analysis of data on 606 HBV-antibody-negative men interviewed on three occasions in 1978 and 1979 showed no changes in risk indices for insertive and receptive anal intercourse between these years, except in San Francisco where significant declines occurred in insertive anal intercourse and receptive anal intercourse without ejacultion in a small, highly select group of participants.     

Summary of minutes of the GRAPPA meeting adjacent to the American Academy of Dermatology 67th Annual Meeting

At a half-day meeting adjacent to the 67th annual meeting of the American Academy of Dermatology (AAD) in San Francisco, USA, in 2009, dermatology members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) met to discuss recognition of psoriatic arthritis (PsA) in the dermatology clinic; multidisciplinary management of psoriasis patients; examples of physician tiering; comparative treatments for psoriasis and PsA; and biomarkers as predictors of response to treatment. Key results and minutes of the San Francisco meeting were presented at the 2009 GRAPPA annual meeting in Stockholm, Sweden, and are summarized here.     

Examining Racial and Ethnic Minority Differences Among YMSM During Recruitment for an Online HIV Prevention Intervention Study

HIV disproportionately affects racial and ethnic minority young men who have sex with men (YMSM). HIV prevention research does not include these YMSM commensurate to their HIV burden. We examined racial and ethnic differences during a unique three-step recruitment process for an online, YMSM HIV prevention intervention study (N = 660). Step one was completed in-person; steps two and three online. Fewer Black and Latino YMSM completed step two-initiating online participation-than White YMSM. Internet use frequency accounted for the Latino versus White difference in initiating online participation, but not the Black versus White difference. Future online HIV prevention interventions recruiting diverse YMSM should focus on initiating online engagement among Black participants.     

Comparing Internet-Based and Venue-Based Methods to Sample MSM in the San Francisco Bay Area

Methods of collecting behavioral surveillance data, including Web-based methods, have recently been explored in the United States. Questions have arisen as to what extent Internet recruitment methods yield samples of MSM comparable to those obtained using venue-based recruitment methods. We compare three recruitment methods among MSM with respect to demographic and risk behaviors, one sample was obtained using time location sampling at venues in San Francisco, one using a venue based like approach on the Internet and one using direct-marketing advertisements to recruit participants. The physical venue approach was most successful in completing interviews with approached men than both Internet approaches. Respondents recruited via the three methods reported slight differences in risk behavior. Direct marketing internet recruitment can obtain large samples of MSM in a short time.     

Use of gay Internet sites and views about online health promotion among men who have sex with men

In May-June 2002, 4,974 men who have sex with men (MSM), average age 31 years, completed a self-administered questionnaire online accessed through two popular gay Internet sites in the UK (gaydar and gay.com UK). Most men were white (95%), employed (83%), lived in the UK (91%) and self-identified as gay (85%). Nearly half (46%) had not been tested for HIV, while 6% said they were HIV-positive. One-third (31%) reported high-risk sexual behaviour in the previous three months, i.e. unprotected anal intercourse with a partner of unknown or discordant HIV status. Nearly all the men (82%) had looked for a sexual partner on the Internet and three-quarters had been doing so for more than a year. Almost half the men (47%) said they preferred to meet men through the Internet rather than in bars or other 'offline' venues. Although nearly 40% of men said the most important reason for using these Internet sites was to find sexual partners, a further 17% said they primarily used them to have contact with other men, 16% because they were bored, 12% for entertainment, 4% because they were lonely and 3% because they were addicted to it. The majority of men in this survey had favourable attitudes towards online health promotion. Most men thought that Internet sites should allow health workers into chat-rooms (75%); would click on a banner to find out about sexual health (78%); and said if they met a health worker in a chat-room they would find out what they had to say (84%). In multivariate analysis, being HIV-positive, older age and high-risk sexual behaviour were all independently associated with an increased frequency of using the Internet to look for sex (p<0.05). The Internet has emerged as an important meeting place for men who have sex with men. As online HIV prevention initiatives are developed it will be important to monitor the extent to which the favourable attitudes seen here are reflected in preventive behaviours.     

Men Who Have Sex with Transgender Women: Challenges to Category-based HIV Prevention

Although transgender women are acknowledged as a priority population for HIV prevention, there is little knowledge on men who have sex with transgender women (MSTGWs). MSTGWs challenge conventional sexual orientation categories in public health and HIV prevention research, and warrant increased attention from the public health community. This paper used qualitative techniques to analyze how MSTGWs describe their sexual orientation identities, and to explore the correspondence between men’s identities and sexual behaviors with transgender women. We conducted in-depth semi-structured individual interviews with 46 MSTGWs in San Francisco. We observed a diversity in the ways participants identified and explained their sexual orientation, and found no consistent patterns between how men described their sexual orientation identity versus their sexual behavior and attraction to transgender women. Findings from this qualitative study question the utility of category-based approaches to HIV prevention with MSTGWs and offer insights into developing HIV interventions for these men.     

Methamphetamine use and sexual risk behaviours among men who have sex with men diagnosed with early syphilis in Los Angeles County

Methamphetamine use has been associated with risky sexual behaviour and sexually transmitted disease (STD)/HIV transmission among men who have sex with men (MSM). Field interview records for MSM early syphilis (ES) patients were reviewed for factors associated with methamphetamine use during January 2001 through December 2004. There were a total of 2915 ES cases reported during the study period. Of these, 1904 (65%) were MSM. Of these MSM, 167 reported methamphetamine use. Methamphetamine use was associated with having multiple sex partners (prevalence ratios [PR] 1.8, 95% confidence interval [CI] 1.4-2.4), not using condoms (PR 2.0, 95% CI 1.3-2.5), having anonymous sex partners (PR 1.1 95% CI 1.03-1.2), history of recent incarceration (PR 5.4, 95% CI 3.3-8.7), and meeting sex partners via the Internet (PR 1.6, 95% CI 1.3-2.1), at bathhouses (PR 1.6, 95% CI 1.2-2.0) and on the streets (PR 2.6, 95% CI 1.7-4.0). In multivariate analysis having multiple sex partners, not using condoms, recent incarceration and meeting sex partners at bathhouses were significantly associated with methamphetamine use. In conclusion, effective STD risk reduction interventions targeting MSM methamphetamine users are needed to curb risky sexual behaviour.     

Treatment of alcohol abuse: an evidence-based review

This article represents the proceedings of a symposium at the 2002 annual meeting of the Research Society on Alcoholism in San Francisco, CA, organized and cochaired by Mats Berglund and Sten Thelander. The presentations were (1) Preventive interventions against hazardous consumption of alcohol, by Mikko Salaspuro; (2) Treatment of alcohol withdrawal, by Johan Franck; (3) Psychosocial treatment for alcohol problems, by Sven Andréasson and Agneta Ojehagen; and (4) Pharmacological treatment of alcohol dependence, by Mats Berglund.     

HIV Sexual Risk Behavior by Men Who use the Internet to Seek Sex with Men: Results of the Men’s INTernet Sex Study-II (MINTS-II)

This study sought to identify the magnitude of HIV risk in a diverse sample of Men who use the Internet to seek Sex with Men (MISM), and test if specific subpopulations are at sufficiently increased risk to warrant tailored interventions. A sample of 2,716 American MISM, stratified by race/ethnicity, completed an Internet survey of online and offline sex seeking behavior during the last 3 months. Across most demographics, a minority of MISM reported unprotected anal intercourse with male partners (UAIMP). Across all demographics, risk of UAIMP substantially increased with partners met online. Other predictors of increased online partner risk include being 30–39 years old, having children, not living in the Northeast, and low income. HIV-positive men and African Americans reported increased online and offline partner risk. To address higher risk of UAIMP, online HIV interventions should prioritize the needs of MISM, especially HIV-positive men, with content focused on online-mediated liaisons.     

Factors Influencing HIV Serodisclosure Among Men Who Have Sex with Men in the US: An Examination of Online Versus Offline Meeting Environments and Risk Behaviors

One key component in HIV prevention is serostatus disclosure. Until recently, many studies have focused on interpersonal factors and minimally considered meeting venues as they pertain to disclosure. Using data (N = 3,309) from an online survey conducted across 16 U.S. metropolitan statistical areas, we examined whether HIV serodisclosure varies by online/offline meeting venues in both protected and unprotected anal intercourse encounters. Most of the sample (76.9 %) reported meeting men for sex (last 90 days) both online and offline, versus 12.7 % offline only and 10.4 % online only. After controlling for other variables, we found that the men who meet partners in both online and offline were 20~30 % more likely to report disclosing their HIV status prior to sex than men who met their partners exclusively either offline or online. While previous studies have identified the Internet as a risk environment, our findings suggest bi-environmental partner seeking may also have beneficial effects.     

HIV Risk and the Internet: Results of the Men’s INTernet Sex (MINTS) Study

This study assessed the feasibility of online recruitment of high-risk Latino men who have sex with men (MSM) for HIV prevention survey research and investigated the relationship between Internet use and unsafe sex. Participants (N = 1,026) were Internet-using Latino MSM living in the U.S. recruited using online banner advertisements. Respondents completed a cross-sectional, online survey in English or Spanish. Sample characteristics reflected national statistics within 5%. Nearly all (99%) reported having used the Internet to seek sex with another man. Two-thirds of respondents reported having unprotected anal sex with ≥1 man in the last year, 57% of these with multiple partners. Participants reported engaging in anal sex and unprotected anal sex with nearly twice as many men first met online versus offline, but risk proportions did not differ. Internet-based HIV prevention research is possible even with geographically-dispersed minority populations. Efficiency appears the primary risk associated with meeting partners online.     

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.