Sex purchasing and associations with HIV/STI among a clinic-based sample of US men

BACKGROUND: Despite high rates of human immunodeficiency virus/sexually transmitted infection (HIV/STI) among commercial sex workers and international concern that male clients may constitute a critical bridge population for HIV/STI transmission, little empirical data exist within the United States to characterize men who purchase sex or to assess their sexual risk and HIV/STI infection. METHODS: The study involves the analysis of a community-based survey of men aged 18-35 years attending urban health centers (n=1515) to assess the prevalence of engagement in sex purchasing during the past year and to evaluate relations with self-reported HIV/STI diagnosis and symptoms across this same period. RESULTS: More than 1 in 12 (8.7%) men reported exchanging drugs, money, or a place to stay for sex with a female partner in the past year. Such behavior was associated with additional sexual risk taking and emerged as an independent predictor of self-reported HIV/STI diagnosis [adjusted odds ratio (ORadj)=2.99; 95% confidence interval (CI): 1.51 to 5.94] and STI symptoms (ORadj=2.57; 95% CI: 1.57 to 4.22) in the past year in analyses adjusted for alternate HIV/STI risk sources. CONCLUSIONS: Sex purchasing is a common form of HIV/STI risk among the population sampled. Men engaging in such behavior are more likely to be HIV/STI infected and, thus, represent a risk to the sexual health of both commercial and noncommercial sex partners. Further research is needed to inform interventions targeted toward male clients of prostituted women.     

Life stressors,mastery, and perceived partner engagement in HIV‐Risk behavior

The relationships among level of personal mastery, economic stress, number of sexual partners, pregnancy status, and perceived partner engagement in HIV‐risk behaviors (i.e., intravenous drug use, imprisonment, and sex with other partners) were studied in a sample of 1069 single, inner‐city women. African American and European Americans were equally represented. We predicted that greater economic stress, a lower sense of personal mastery, and more sexual partners would be associated with greater perceptions of partner engagement in HIV‐risk behavior. We also predicted that personal mastery would serve as a moderating variable in the presence of life stressors (e.g., being pregnant, having multiple sexual partners). The findings supported the hypotheses. Women with more economic stress, multiple sexual partners, and lower personal mastery reported higher perceived partner engagement in HIV‐risk behavior than women with lower economic stress, one sexual partner, and higher personal mastery. Personal mastery had a greater impact for women with multiple sexual partners and for those who were pregnant. These findings were qualified by women's ethnicity. © 2001 John Wiley & Sons, Inc.     

Condom use rather than serosorting explains differences in HIV incidence among men who have sex with men

BACKGROUND: HIV incidence is high and increasing among men who have sex with men (MSM) attending the Sexually Transmitted Infection (STI) Outpatient Clinic in Amsterdam but remains low among MSM in the Amsterdam Cohort Studies (ACS). We studied whether sexual behaviors in these 2 groups are consistent with serosorting and if serosorting explains the difference in HIV incidence. METHODS: In 2004 to 2006, a survey of sexual behaviors and HIV status regarding up to 4 traceable partners in the prior 6 months was performed in MSM attending the STI Outpatient Clinic (high-risk) and in MSM in the ACS (lower risk). Moreover, pooled information was collected on anonymous partners. We used logistic regression to test whether sexual behaviors are consistent with serosorting and to test whether risk group is associated with having concordant traceable partners among men reporting unprotected anal intercourse (UAI). RESULTS: We included 513 MSM (54% lower risk and 75% HIV-negative). Lower risk and high-risk MSM with concordant traceable partners were more likely to have UAI than MSM with discordant partners or partners of unknown HIV status (P < 0.001). Risk group was not associated with having concordant UAI. Compared with lower risk MSM, however, high-risk MSM frequently had UAI with nonconcordant traceable partners and with anonymous partners. CONCLUSIONS: Sexual risk behaviors with traceable partners are consistent with serosorting. Nonetheless, the higher level of UAI with anonymous or nonconcordant traceable partners more likely explains the increasing HIV incidence seen among STI Outpatient Clinic attendees than a difference in serosorting behavior.     

Gender-based violence, alcohol use, and sexual risk among female patrons of drinking venues in Cape Town, South Africa

Gender-based violence is a well-recognized risk factor for HIV infection among women. Alcohol use is associated with both gender-based violence and sexual risk behavior, but has not been examined as a correlate of both in a context of both high HIV risk and hazardous drinking. The purpose of this paper is to examine the association between recent abuse by a sex partner with alcohol and sexual risk behavior among female patrons of alcohol serving venues in South Africa. Specifically, the aim of this study is to determine whether sexual risk behaviors are associated with gender-based violence after controlling for levels of alcohol use. We surveyed 1,388 women attending informal drinking establishments in Cape Town, South Africa to assess recent history of gender-based violence, drinking, and sexual risk behaviors. Gender-based violence was associated with both drinking and sexual risk behaviors after controlling for demographics among the women. A hierarchical logistic regression analysis showed that after controlling for alcohol use sexual risk behavior remained significantly associated with gender-based violence, particularly with meeting a new sex partner at the bar, recent STI diagnosis, and engaging in transactional sex, but not protected intercourse or number of partners. In South Africa where heavy drinking is prevalent women may be at particular risk of physical abuse from intimate partners as well as higher sexual risk. Interventions that aim to reduce gender-based violence and sexual risk behaviors must directly work to reduce drinking behavior.     

Differences in perceptions of what constitutes having "had sex" in a population of people living with HIV/AIDS

The reduction of high-risk sexual behavior among HIV-infected individuals is a major aspect of prevention strategies to reduce HIV infection in the United States. These prevention efforts assume a common understanding between clinicians and HIV-infected individuals of the terms "sex" and what constitutes having "had sex." The purpose of this study was to determine what sexual behaviors HIV-infected individuals perceive as having had sex and to examine the variability of these perceptions. Surveys were done of 279 HIV-positive adults receiving services at an HIV-focused community health center in Dallas, TX. Responses from participants about whether they perceived a given behavior as constituting having had sex were analyzed by Chi-squared analysis. Overall, only 80.9% of respondents perceived penile-vaginal intercourse as "sex," while 76.9% said they "had sex" if someone had oral contact with their genitals. There were gender and ethnicity differences in what was perceived as having had sex. Females were significantly less likely than males to perceive anal intercourse as having had sex. Variability exists among HIV-positive individuals regarding what they perceive as having had sex. Results support the need for clinicians to more precisely ascertain sexual perceptions and risks to achieve HIV prevention goals.     

HIV knowledge and risk factors among men who have sex with men in Ho Chi Minh City,Vietnam

OBJECTIVES: To describe health risk behavior, knowledge, and attitudes about HIV/AIDS and its prevention in men who have sex with men (MSM) in Ho Chi Minh City (HCMC), Vietnam. METHODS: A cross-sectional survey of 219 MSM using a standardized questionnaire. RESULTS: Men who have sex with men were easy to locate and willing to answer detailed questions about their sexual behavior. Self-identified sexual orientation was 67% homosexual, 31% bisexual, and 1.4% heterosexual. High-risk sexual behavior was common. The mean number of sexual partners was 3.3 in the previous month and 14.8 in the previous year. Only 32% used condoms during their last intercourse, and only 40% used a condom when their last intercourse included anal sex. Eighty-one percent reported sex with nonregular male partners, and 22% also had sex with women in the past year. Drug use other than alcohol was rare. Most correctly identified high-risk sexual behavior and body fluids that could transmit HIV; however, only about half knew that someone who appeared healthy could transmit HIV or that there was no cure for AIDS. Self-rated risk for HIV was very low, and fewer than one third believed that homosexuals in Vietnam are at increased risk for HIV. CONCLUSION: Men who have sex with men in HCMC are at high risk for HIV. Knowledge about HIV transmission and prevention could be improved. Education and interventions specifically aimed at MSM are needed, because education targeted at the general population may not reach MSM or influence their behavior.     

Moderators of peer contagion: a longitudinal examination of depression socialization between adolescents and their best friends.

This longitudinal study examined peer contagion of depressive symptoms over an 18-month interval within a sample of 100 11th-grade adolescents. Three types of peer contagion moderators were examined, including characteristics of adolescents (social anxiety, global self-worth), friends (level of friends' peer-perceived popularity), and the relationship between them (friendship quality). Measures were collected using adolescents' and their friends' reports of depressive symptoms, adolescents' reports of social anxiety, global self-worth, friendship quality, and a sociometric assessment of peer-perceived popularity. Results indicated that among girls higher levels of social anxiety were associated with adolescents' greater susceptibility to peer contagion. Among boys, higher levels of friends' peer perceived popularity and lower levels of positive friendship quality each were associated with greater susceptibility to depressive symptom contagion.     

Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men,San Francisco

BACKGROUND: Increasing trends in high-risk sexual behavior are noted among men who have sex with men (MSM) worldwide. Less information is available on unprotected sex between persons of different HIV serostatus. METHODS: From 1999 through 2001, volunteers of a community-based organization conducted interviews of 10,579 MSM at gay-oriented venues in San Francisco and in neighborhoods with high-volume MSM pedestrian traffic. The questionnaire recorded demographic and risk behavior information, including self-reported and partners' HIV serostatus. RESULTS: Potentially serodiscordant unprotected anal intercourse (UAI) with at least 2 anal sex partners was reported by 12.7% and increased from 11.0% in 1999 to 16.2% in 2001. Stratifying by self-reported HIV serostatus, 20.8% of HIV-positive respondents, 12.1% of HIV-negative respondents, and 13.4% of MSM who did not know or report their own HIV serostatus had potentially serodiscordant UAI. Older MSM of white race were more likely to report potentially serodiscordant UAI among HIV-positive respondents, whereas younger MSM of white race were more likely to report potentially serodiscordant UAI among HIV-negative respondents. Among those with unknown HIV serostatus, MSM of color were more likely to engage in potentially serodiscordant UAI. CONCLUSION: Recent increases in UAI among MSM in San Francisco are not only the result of increases in UAI between persons of the same HIV serostatus. Prevention messages must address disclosure of HIV serostatus to sexual partners specifically tailored to groups according to age, community, and HIV serostatus.     

Sexual risk reduction in a cohort of injecting drug users in Bangkok, Thailand

OBJECTIVE: Interventions to reduce sexual risk behavior among injecting drug users (IDUs) have generally had very modest effects, but almost all such interventions have been conducted within short time frames. This study assessed whether long-term participation in interventions to reduce sexual risk behavior was associated with reduced sexual risk behavior. METHODS: A total of 806 IDUs participated in the Bangkok HIV Vaccine Trial Preparatory Cohort Study from 1995-1998 and remained in the study for at least 4 follow-up visits (approximately 16 months). Participants received HIV counseling and testing every 4 months and free condoms were provided. Structured interviews including questions on sexual behavior were administered every 4 months. RESULTS: Approximately 40% of participants reported engaging in unprotected sex (vaginal intercourse without always using a condom) with a regular partner at each study visit, without any decline over time in this behavior. There were declines in the proportions of participants reporting unprotected sex with casual partners and with paid partners (men only) over time, but the declines were confined to the early period of the study. Unprotected sex with casual partners was associated with amphetamine use. Condom use increased substantially among participants who seroconverted for HIV during the study. CONCLUSIONS: Interventions to reduce sexual risk behavior among HIV-seronegative IDUs over extended periods were no more likely to be effective than shorter interventions. New programs are needed to reduce sexual risk behavior among amphetamine users and among IDUs who are currently seronegative but are engaging in injection risk behaviors and in unprotected sex with regular partners.     

柳州市不同层次暗娼人群梅毒及艾滋病感染状况分析

目的了解柳州市不同层次商业性工作者人群特征、艾滋病相关知识、行为及梅毒、艾滋病病毒感染等现状。方法采用二阶段整群抽样方法抽取调查对象,使用健康问卷面对面调查并采集血样检测HIV和梅毒抗体。结果本次研究共调查403人,部分调查对象认为能够从表面区分艾滋病感染者,与客人发生性行为时安全套使用率较高,但与固定性伴安全套使用率很低。不同档次对象的年龄、婚姻和文化程度略有不同,安全套使用率也略有差别。调查者中1d接客最多20人,1周接客最多25人;首次性行为年龄最小12岁,首次商业性服务年龄最小14岁。58.50%的调查者最近1年患过性传播疾病。未发现HIV阳性者,但发现梅毒RPR初筛阳性者10人,阳性率为2.48%。结论在干预活动时应针对不同层次人群特点,对有配偶或固定性伴者应当加大干预力度和采取不同的策略促其使用安全套,以减少HIV进一步传播。     

Longitudinal patterns of sexual behavior and condom use in a cohort of HIV-negative gay and bisexual men in Vancouver, British Columbia, Canada, 1995-2000

OBJECTIVE: To characterize longitudinal patterns of sexual behavior in a cohort of young gay and bisexual men and determine their reasons for not using condoms. METHODS: Prospective data from a cohort of young gay and bisexual men aged 18 to 30 years were studied. Study participants had completed a baseline questionnaire and HIV test between May 1995 and April 1996 and four annual follow-up questionnaires. RESULTS: A total of 130 HIV-negative Vanguard participants met the eligibility criteria for this analysis. The median age at baseline was 26 years (range, 24-28). Most were white (79%), had completed high school (85%), were currently employed (82%), lived in stable housing (95%), and reported annual incomes of > or =$10,000 (82%). (All dollar amounts are given in Canadian dollars.) Consistently over the 5-year study period, > 70% of study subjects reported having > or =1 regular male sexual partners in the previous year. During each of the five successive 1-year periods, between 34% and 40% of respondents reported having had unprotected receptive anal intercourse with regular partners. Slightly fewer individuals (between 29%-39%) reported having had unprotected insertive anal intercourse with regular partners. Between 13% and 25% of participants reported having had insertive unprotected anal intercourse with casual sexual partners; and between 9% and 18% reported having had unprotected receptive anal intercourse with casual sexual partners. Reasons for engaging in unprotected anal intercourse varied depending on type of sexual partnership. CONCLUSION: High-risk sexual behaviors remained fairly consistent over a 5-year period in this study. This suggests that it is critically important to understand the motivations for unprotected sex when designing and implementing programs aimed at reducing HIV risk among young gay and bisexual men.     

Adolescents' and their friends' health-risk behavior: factors that alter or add to peer influence

OBJECTIVE: To examine models of risk for adolescent health-risk behavior, including family dysfunction, social acceptance, and depression as factors that may compound or mitigate the associations between adolescents' and peers' risk behavior. METHODS: Participants were 527 adolescents in grades 9-12. Adolescents reported on their substance use (cigarette and marijuana use, heavy episodic drinking), violent behavior (weapon carrying, physical fighting), suicidality (suicidal ideation and attempts), and the health-risk behavior of their friends. RESULTS: Adolescents' substance use, violence, and suicidal behavior were related to their friends' substance use, deviance, and suicidal behaviors, respectively. Friends' prosocial behavior was negatively associated with adolescent violence and substance use. Family dysfunction, social acceptance, and depression altered the magnitude of association between peers' and adolescents' risk behavior. In cumulative risk factor models, rates of adolescent health-risk behavior increased twofold with each added risk factor. CONCLUSIONS: Results supported both additive and multiplicative models of risk. Implications for intervention and primary prevention are discussed.     

Partner-specific sexual behavioral differences between phase 3 HIV vaccine efficacy trial participants and controls: Project VISION

OBJECTIVE: To assess and compare sexual behaviors using partner-specific data between HIV-negative men who have sex with men (MSM) recruited for an HIV vaccine efficacy trial and a control group. METHODS: HIV-negative MSM from an HIV vaccine trial (n = 525) and controls (n = 732) were recruited by similar strategies and interviewed about behaviors with the 3 most recent partners in the past 6 months, obtained by audio computer-assisted self-interview (A-CASI). RESULTS: Vaccine trial participants were more likely than controls to report an HIV-positive partner (24.7% and 14.1%, respectively) or an HIV-positive primary partner (16.1% and 6.8%, respectively) and were less likely to report occasional or single-time partners of unknown HIV status (51.6% and 63.2%, respectively; P < 0.05 for each comparison). Vaccine trial participants more often reported receptive unprotected anal intercourse (UAI) during their last sexual encounter with an HIV-positive partner (adjusted odds ratio [OR] = 2.7, 95% confidence interval [CI]: 1.0 to 7.9). Most believed their HIV-positive partners were receiving antiretroviral treatment (ART), however, and after adjustment for perceived ART use, the association between vaccine study participation and receptive UAI with an HIV-positive partner was not significant. CONCLUSIONS: High-risk sexual behavior was reported by many VAX004 participants and controls. Differences between vaccine trial and control participants in the highest risk per contact behavior, receptive UAI with HIV-positive partners, was partly accounted for by perceived ART use. Partner level data are useful in refining risk assessment, which is important in the evaluation of HIV vaccine and other prevention trials.     

HIV-positive men's sexual practices in the context of self-disclosure of HIV status

OBJECTIVE: To examine whether disclosure of HIV-positive status to sex partners at risk for HIV infection is associated with safer sex practices and to examine the prevalence and correlates of specific disclosure/sexual behavior patterns. METHODS: Cross-sectional assessment of 206 HIV-positive men (41% homosexual, 35% bisexual, 24% heterosexual) sampled randomly at an outpatient HIV clinic in Los Angeles, who reported that their most recent sex partner was HIV-negative or of unknown serostatus. Unsafe sex was defined as unprotected anal or vaginal intercourse with that partner. RESULTS: Twenty-five percent of the men engaged in unsafe sex, and 48% of the total sample withheld disclosure from the partner. The prevalence of safer sex was not significantly higher among disclosers than among nondisclosers (unadjusted odds ratio = 1.29; 95% confidence interval: 0.69-2.45), and disclosure was not significantly associated with safer sex in any of 25 demographic or partner subgroups examined in the study. In the full sample, 40% of the men disclosed and engaged in safer sex (informed protection), 35% withheld disclosure and engaged in safer sex (uninformed protection), 12% informed their partner and engaged in unsafe sexual behavior (informed exposure), and 13% withheld disclosure and engaged in unsafe sex (uninformed exposure). Risky behavior patterns were associated with using alcohol/drugs before sex, having an HIV-unknown partner, being less emotionally involved with one's partner, and testing seropositive in the previous 3 years. CONCLUSIONS: Interventions for seropositive men that focus primarily on increasing disclosure of serostatus to sex partners may not reduce the prevalence of unsafe sex. Interventions are needed to address the social and psychologic processes that give rise to risky behavior patterns in HIV-infected men. Improved substance abuse counseling also may be needed.     

Cruising on the Internet highway

This study evaluated differences in sexual behavior and risk for sexually transmitted diseases (STDs) among men who have sex with men (MSM) who met their partners on-line and those who did not. A self-administered questionnaire on sexual behavior was offered to a convenience sample of patients seeking public STD services. Thirty-two percent of MSM patients reported meeting a sexual partner over the Internet in the past year. MSM with on-line partners were younger, more likely to report sex with an HIV-positive person in the last year, and more likely to report casual partners in the last year compared with MSM with only off-line partners. HIV-negative MSM with on-line partners were more likely than HIV-negative MSM with only off-line partners to have received money or drugs for sex in the past year and to report sex with an HIV-positive partner in the past year. Although meeting partners on the Internet was common and associated with increased risk for STDs in MSM, it also presents new untapped opportunities for on-line health promotion and disease prevention.     

Negotiated safety relationships and sexual behavior among a diverse sample of HIV-negative men who have sex with men

OBJECTIVE: To examine the prevalence of negotiated safety (NS) in a diverse sample of HIV-negative men who have sex with men (MSM), characteristics of MSM practicing NS, and adherence to NS. METHODS: This was a cross-sectional survey of San Francisco MSM recruited from venues and community organizations. NS relationships were defined as those in which HIV-negative men were in seroconcordant primary relationships for >/=6 months, had unprotected anal intercourse (UA) together, and had rules prohibiting UA with others. Adherence to NS was determined from self-reported sexual behavior in the prior 3 months. Presence of an agreement with NS partners to disclose rule breaking was also determined. RESULTS: Of 340 HIV-negative participants, 76 (22%) reported a current seroconcordant primary relationship for >/=6 months. Of these 76 men, 38 (50%) had NS relationships, 30 (39%) had no UA with primary partners, and 8 (11%) had UA with primary partners without rules prohibiting UA with others. In multivariate analysis, NS was more common than no UA with primary partners in younger men. Among 38 NS men, 29% violated their NS-defining rule in the prior 3 months, including 18% who reported UA with others, and 18% reported a sexually transmitted infection (STI) in the prior year. Only 61% of NS men adhered fully to rules and agreed to disclose rule breaking. CONCLUSIONS: Although NS was commonly practiced among HIV-negative men in seroconcordant relationships, some men violated NS-defining rules, placing themselves and potentially their primary partners at risk for HIV infection. Prevention efforts regarding NS should emphasize the importance of agreement adherence, disclosure of rule breaking, and routine STI testing.     

Adolescent peer crowd affiliation: linkages with health-risk behaviors and close friendships

OBJECTIVE: To examine adolescents' peer crowd affiliation and its linkages with health-risk behaviors, their friends' health-risk behaviors, the presence of close friends in the same peer crowd, and adolescents' social acceptance. METHODS: We interviewed 250 high school students and identified six categories: popular, jocks, brains, burnouts, nonconformists, or average/other. Adolescents also reported on their health-risk behaviors (including use of cigarettes, alcohol, marijuana and other drugs; risky sexual behaviors; and other risk-taking behaviors), the health-risk behaviors of their friends, the peer crowd affiliation of their closest friends, and their perceived social acceptance. RESULTS: Burnouts and nonconformists had the highest levels of health-risk behaviors across the areas assessed, the greatest proportions of close friends who engaged in similar behaviors, and relatively low social acceptance from peers. Brains and their friends engaged in extremely low levels of health-risk behaviors. Jocks and populars also showed evidence of selected areas of health risk; these teens also were more socially accepted than others. In general, adolescents' closest friends were highly nested within the same peer crowds. CONCLUSIONS: The findings further our understanding of adolescent behaviors that put them at risk for serious adult onset conditions associated with high rates of morbidity and mortality. We discuss the implications of the findings for developing health promotion efforts for adolescents.     

HIV Treatment Beliefs and Sexual Transmission Risk Behaviors among HIV Positive Men and Women

People are living longer and healthier with HIV infection because of successful combination antiretroviral therapies. HIV treatment beliefs are often associated with sexual practices among people living with HIV/AIDS but these associations may depend on the HIV status of sex partners. In a sample of 158 HIV positive men and women who were receiving HIV treatments, we examined the association between HIV treatment beliefs, HIV transmission risk perceptions, medication adherence, viral load and engaging in unprotected intercourse with any sex partners and specifically with sex partners who were not HIV positive (non-concordant). Results showed having missed medications in the past two days and treatment-related beliefs were significantly associated with engaging in unprotected intercourse with all sex partners as well as non-concordant partners. However, multivariate models showed that only treatment beliefs were significantly associated with engaging in unprotected intercourse with non-concordant partners. These results extend past research by demonstrating that the HIV status of sex partners sets the context for whether prevention-related treatment beliefs are associated with HIV transmission risk behaviors among people living with HIV/AIDS.     

Sexual functioning throughout menopause: the perceptions of women in a British cohort

OBJECTIVE: Previous studies on menopausal transition and sexual functioning have mixed findings. Most are cross-sectional, exclude hormone therapy users and hysterectomized women, and are unable to separate the effects of age from menopause or account for psychosocial, vasomotor, and somatic factors. We examine relationships between women's reports of a change in sex life and difficulties with intercourse and their experience of menopausal transition, use of hormone therapy, and hysterectomy. DESIGN: A British cohort study with 1,525 women were followed since their birth in 1946 and annually from age 47 to 54 years. The outcome measures were self-reported change in sex life and difficulties with sexual intercourse over 8 consecutive years. RESULTS: Compared with women who remained premenopausal, peri- and postmenopausal women reported a decline in sex life (mean difference [95% CI]: perimenopausal, -0.1 [-0.2 to -0.03]; became postmenopausal, -0.1 [-0.2 to -0.1]) and were more likely to report difficulties with intercourse (perimenopausal, 0.6 [0.1 to 1.1]; postmenopausal, 1.0 [0.5 to 1.5]) beyond the effects of aging and other psychosomatic factors. Women reported difficulties with intercourse more often if they had been on hormone therapy for more than a year (0.5 [0.03 to 1.0]) or if they had undergone a hysterectomy (0.6 [0.1 to 1.1]); no differences were found for change in sex life. For both outcomes, vaginal dryness was the major risk factor. Married women were also more likely to report adverse outcomes. Somatic symptoms and hot flushes/cold sweats were associated with difficulties with intercourse, whereas psychological symptoms, stressful lives, increasing age, and smoking were associated with a decline in sex life. CONCLUSIONS: Menopausal transition status had an independent effect on the reported change in sex life and difficulties with intercourse. The results support health professionals in their development of management strategies that (a) consider treatments directly for vaginal dryness, (b) identify somatic symptoms for difficulties with intercourse, (c) investigate psychological factors for a reported decline in sex life, and (d) for both outcomes, consider the potential role of intimate partners.     

Risk factors associated with HIV infection among young gay and bisexual men in Canada

OBJECTIVE: To assess risk factors associated with HIV prevalence and incidence among gay and bisexual men in two prospective Canadian cohorts. METHODS: The Vanguard Project and the Omega Cohort are prospective cohort studies of gay and bisexual men ongoing in Vancouver and Montreal, respectively. For this analysis, baseline sociodemographic characteristics, sexual behavior, and substance use data from these two cohorts were combined. Assessment of risk factors for HIV seroprevalence and seroconversion were carried out using univariate and multivariate analysis. RESULTS: This analysis was based on 1373 gay and bisexual men aged 16 to 30 years. Men who were HIV-seropositive at baseline (n = 48) were more likely to report living in unstable housing, to have had less than a high school education, and to have been unemployed than those who were HIV-negative (n = 1325). HIV-positive men were also more likely to report having engaged in sexual risk behavior, including having had consensual sex at a younger age, having had at least 6 partners during the previous year, ever having been involved in the sex trade, and having engaged in unprotected receptive anal intercourse. With respect to substance use, HIV-positive men were more likely to report the use of crack, cocaine, heroin, and marijuana and to use injection drugs. Similarly, men who seroconverted during the course of the studies (n = 26) were more likely to report having less than a high school education and having lived in unstable housing at baseline. Compared with HIV-negative men, men who seroconverted were more likely to report ever having been involved in the sex trade and engaging in unprotected receptive anal intercourse. Reports of cocaine use and injection drug use were also significantly higher for men who seroconverted compared with HIV-negative men. CONCLUSIONS: Our data indicate that HIV-positive gay and bisexual men are more likely to be living in unstable conditions and to report more risky sexual and substance use behaviors than HIV-negative men.