Patterns and correlates of deliberate abstinence among men and women with HIV/AIDS

OBJECTIVES: We examined correlates of deliberate sexual abstinence among gay/bisexual men, heterosexual men, and women in a national probability sample of adults with HIV. METHODS: Participants in the HIV Cost and Services Utilization Study (HCSUS; n=1339) answered questions about oral, anal, or vaginal sexual intercourse in the past 6 months; those who reported none of these behaviors (n=415) were asked about their reasons for abstinence. Of these, 201 participants (11% of gay/bisexual men, 18% of women, 18% of heterosexual men) indicated that their abstinence was deliberate. Multivariate models were used to predict deliberate abstinence. RESULTS: In multivariate analyses, not having a primary relationship partner/spouse was a significant correlate of deliberate abstinence for all 3 groups. Higher perceived responsibility for limiting disease transmission and nondrinking status were related to deliberate abstinence only among gay/bisexual men. Worse health was associated with deliberate abstinence only among heterosexual men. CONCLUSIONS: Perhaps because HIV is more common in gay communities, abstinence choices may be more closely linked to a higher sense of responsibility for reducing transmission among gay/bisexual men, and their illness may be less of an impediment to sexual activity.     

HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, California.

Few data are available on human immunodeficiency virus (HIV) infection and risk behaviors among lesbians and bisexual women. A total of 498 lesbians and bisexual women was sampled from public venues in San Francisco and Berkeley, Calif, during 1993. The overall HIV seroprevalence was 1.2%. Ten percent of participants reported injecting drugs since 1978. Forty percent of the participants reported unprotected vaginal or anal sex with men during the past 3 years, including unprotected sex with gay and bisexual men and male injection drug users. The high rates of injection drug use and unsafe sexual behaviors suggest that lesbians and bisexual women frequenting public venues in San Francisco and Berkeley are at risk for HIV infection.     

Indirect methods for estimating prevalent HIV infections: adults in England and Wales at the end of 1993.

Two indirect methods were used to estimate the point prevalence of HIV infection in England and Wales at the end of 1993 using data on diagnosed HIV infections, AIDS cases, HIV-related deaths and HIV testing behaviour from unlinked anonymous surveys. The methods estimated the proportion of all prevalent HIV infections that diagnosed infections represented. Most of those exposed to HIV infection through injecting drug use or sexual intercourse between men had had their infections diagnosed compared to less than half of those exposed through heterosexual intercourse. The total estimated number of prevalent infections was 22,350 for the diagnosis interval method and 20,540 for the test history method, and about 56-57% of these were in homo/bisexual men. These indirect methods are cheap and simple applications of surveillance data which provide estimates that compare favourably with those produced by more complex methods.     

The African‐American Health Project (AAHP): Study overview and select findings on high risk behaviors and psychiatric disorders in African American men

The AAHP investigated the neurobehavioral and psychosocial sequelae of HIV‐1 and substance use in urban African American men. A community resident sample of 502 African American men stratified by HIV‐1 serostatus, drug use and sexual orientation were recruited. A comprehensive battery of measures of neurobehavioral and health status, lifestyle and psychosocial characteristics were administered to all participants, and a stratified sub‐sample of 120 participants were tested using state of the art brain imaging techniques to investigate differences in the functional and neurophysiologic effects of HIV‐1 and substance use.

An overview of the methodology of the AAHP and results on high risk sexual and substance use behaviors, and psychiatric disorders are presented and discussed. The sample was primarily HIV‐negative (63%), heterosexual (49% gay or bisexual) and a high percentage used substances during the past year (56% used drugs and 30% moderate/heavy drinkers). High‐risk sexual practices were relatively prevalent, and a high percentage reported a history of STDs and other infections. Finally, 25% had a current psychiatric disorder, with gays/bisexuals and HIV‐seropositives evidencing greater psychiatric vulnerability. More research is needed to further explore the apparent greater risk for psychiatric disorders among gay and bisexual men, and to determine whether being African American and lower social class exacerbate this risk.     

Suicide and HIV as leading causes of death among gay and bisexual men: a comparison of estimated mortality and published research

Gay and bisexual men experience numerous health disparities relative to heterosexual men, including high rates of HIV and suicidal behavior. Systematic community health assessments could provide direct comparisons of the burden of mortality across diseases and thus facilitate the prioritization of public health activities; however, such assessments have been precluded by the absence of sexual orientation information in vital statistics records. In this context, we used population attributable fraction to derive and compare indirect estimates of mortality for both HIV and suicide. Assuming that 2% of Canadian men are gay or bisexual, and that these men are 42 times more likely to die from HIV and 4 times more likely to die from suicide, we estimated that in 2011, suicide resulted in 46 deaths per 100,000 gay and bisexual men, while HIV resulted in 30 deaths per 100,000. Based on these estimates, suicide surpassed HIV as a leading cause of premature mortality for gay and bisexual men in 2007. Despite the large burden of suicide among gay and bisexual men, research attending to the issue in biomedical, psychology, and social science literatures is sparse, with at least 10 times fewer citations than for HIV between 2003 and 2012. We urge researchers, practitioners, and community leaders to broaden the scope of gay and bisexual men’s public health priorities to include suicide and other high burden health inequities.     

Researchers sound alarm about HIV complacency

A 3 year decline in AIDS deaths in the United States has stabilized, and the rates of HIV infection are rising sharply among young gay men. New drug treatments have lulled the nation into complacency about HIV, especially among young gay and bisexual men in urban centers. Researchers have revealed that a new test, Serologic Testing Algorithm for Recent HIV Seroconversions (STARHS), can distinguish between new and long-standing HIV infections. Through this distinction, the test can help show where the epidemic is emerging. Researchers have found that higher rates of new infection are occurring among gay and bisexual African-Americans (11 percent per year) than for Hispanics (7.7 percent) or whites (6.5 percent). Two studies suggest bisexual African-American men may be contributing to the spread of the epidemic to black women.     

HIV in gay and bisexual men in the United Kingdom: 25 years of public health surveillance

It is more than 25 years since the first case of AIDS was reported in the United Kingdom. In December 1981 a gay man was referred to a London hospital with opportunistic infections indicative of immunosuppression. National surveillance began the following year, in September 1982, with the notification of deaths and clinical reports of AIDS and Kaposi's sarcoma plus laboratory reports of opportunistic infections. Since then epidemiological surveillance systems have evolved, adapting to, and taking advantage of advances in treatments and laboratory techniques. The introduction of the HIV antibody test in 1984 led to the reporting of HIV-positive tests by laboratories and the establishment of an unlinked anonymous survey in 1990 measuring undiagnosed HIV infection among gay men attending sexual health clinics. The widespread use of highly active antiretroviral therapies (HAART) since 1996 has averted many deaths among HIV-positive gay men and has also resulted in a large reduction in AIDS cases. This led to a need for an enumeration of gay men with HIV accessing NHS treatment and care services (1995 onwards), more clinical information on HIV diagnoses for epidemiological surveillance (2000 onwards) and the routine monitoring of drug resistance (2001 onwards). Twenty-five years after the first case of AIDS was reported, gay and bisexual men remain the group at greatest risk of acquiring HIV in the United Kingdom. Latest estimates suggest that in 2004, 26 500 gay and bisexual men were living with HIV in the United Kingdom, a quarter of whom were undiagnosed. In this review, we examine how national surveillance systems have evolved over the past 25 years in response to the changing epidemiology of HIV/AIDS among gay and bisexual men in the United Kingdom as well as advances in laboratory techniques and medical treatments. We also reflect on how they will need to continue evolving to effectively inform health policy in the future.     

‘The big ole gay express’: sexual minority stigma,mobility and health in the small city

Abstract

Recent research has examined how gay and bisexual men experience and navigate the variations in sexual minority stigma that exist across geographic contexts, with implications for their health. We extend this literature on stigma, mobility, and health by considering the unique and understudied setting of the small city. Drawing on semi-structured interviews (n = 29) conducted in two small US cities (New Haven and Hartford), we find that these small cities serve as both destinations and points of departure for gay and bisexual men in the context of stigma. New Haven and Hartford attracted gay and bisexual men from surrounding suburbs where sexual minority stigma was more prevalent and where there were fewer spaces and opportunities for gay life. Conversely, participants noted that these small cities did not contain the same identity affirming communities as urban gay enclaves, thus motivating movement from small cities to larger ones. Our data suggest these forms of mobility may mitigate stigma, but may also produce sexual health risks, thus drawing attention to small cities as uniquely important sites for HIV prevention. Furthermore, our analysis contributes to an understanding of how place, stigma and mobility can intersect to generate spatially distinct experiences of stigmatised identities and related health consequences.     

Characteristics and trends of newly diagnosed HIV-infections, 2000-2004

OBJECTIVE: To describe the characteristics and trends of newly diagnosed HIV-infections. METHODS: We analysed all newly diagnosed HIV-infections among residents of the Canary Islands, Ceuta, La Rioja, Navarre and the Basque Country (Spain) between 2000 and 2004. RESULTS: In total, 1,807 HIV-infections -74.4 per million inhabitants, per year- were diagnosed. The heterosexual transmission category was the most frequent (48.6%), followed by that of homo/bisexual men (23.0%) and injecting drug users (IDU) (22.5%). From 2000 to 2004, the rate of new diagnoses of HIV infection decreased by 29.8% (p < 0.0001). The rate of diagnoses of infections acquired by IDU diminished by 58.5% (p < 0.0001), and the rate of infections associated with homo/bisexual practices in men descended by 33.9% (p = 0.0318). Nevertheless, the rate of diagnoses of infections by heterosexual transmission has not undergone significant changes. In the period 2002-2004, 28.7% of cases were diagnosed in foreigners, but the rate of diagnoses in the population of non-Spanish origin diminished by 24% (p = 0.0534). 39.7% of HIV diagnoses were delayed (with CD4 < 200 cells/microlitre or coinciding with the diagnosis of AIDS). This situation was less frequent in women (odds ratio = 0.5; p < 0.001) and increased with age amongst people over 30. The proportion of delayed diagnoses reached a maximum in 2001 (47.5%) and then declined until 2004 (38.6%; p = 0.022). CONCLUSIONS: Although none of the analysed indicators evolved unfavourably, it is important to insist on the prevention of sexual transmission, the early diagnosis of HIV infection, and the need to adapt preventive activities and focus them on people from other countries.     

The Invisible Stereotypes of Bisexual Men

Bisexual men have little public visibility, yet previous reports indicate that heterosexuals have specific prejudicial attitudes towards them. This article reports on two studies that examined the stereotypical beliefs of heterosexual men and women regarding bisexual men. In Study 1 (n = 88), we examined awareness of social stereotypes (stereotype knowledge). Most of the participants were unable to describe the various stereotypes of bisexual men. Contrary to previous studies, low-prejudiced participants had more stereotype knowledge than high-prejudiced participants. In Study 2 (n = 232), we examined prejudice in a contextual evaluation task that required no stereotype knowledge. Participants evaluated a single target character on a first date: a bisexual man dating a heterosexual woman, a bisexual man dating a gay man, a heterosexual man dating a heterosexual woman, or a gay man dating a gay man. The findings indicated that participants implemented stereotypical beliefs in their evaluation of bisexual men: compared to heterosexual and gay men, bisexual men were evaluated as more confused, untrustworthy, open to new experiences, as well as less inclined towards monogamous relationships and not as able to maintain a long-term relationship. Overall, the two studies suggest that the stereotypical beliefs regarding bisexual men are prevalent, but often not acknowledged as stereotypes. In addition, the implementation of stereotypes in the evaluations was shown to be dependent on the potential romantic partner of the target. Possible theoretical explanations and implications are discussed.     

Drug use and risk behaviour among regular ecstasy users: Does sexuality make a difference?

This study aimed to compare homo/bisexual men and women with their heterosexual counterparts who were regular ecstasy users, to consider whether patterns of drug use or risk differed across these groups. Respondents (n = 852 ecstasy users) were recruited via advertisements in entertainment street press, gay and lesbian newspapers, music and clothing stores and at university campuses. Interviewer contacts and 'snowball' sampling were also utilized. In total, 23% of females in the sample self-identified as lesbian or bisexual and 13% of males interviewed self-identified as homo/bisexual. Rates of use of 'newer' drugs on the dance scene--crystal methamphetamine and ketamine--were higher among homo/bisexual men and women. Self-reported risk behaviours such as unprotected sex and needle sharing (among those who had injected drugs) did not differ according to sexuality. However, homo/bisexual men and women were significantly more likely than heterosexual men and women to report a greater number of sexual partners and higher rates of injecting drug use. These findings suggest that among a group of people who were selected because they were regularly involved in the party drug market, initiatives designed to reduce harms related to injecting and sex risk may be needed for a greater proportion of homo/bisexual males and females who are involved in the dance/nightclub scene.     

Original Research: AIDS Educational Videos for Gay and Bisexual Men: A Content Analysis

Objective: To systematically describe the content of AIDS educational videos targeting gay and bisexual men, and to compare it to the content of videos for heterosexual African American and Latino audiences. Design: AIDS videos targeting gay/bisexual men (n = 35), heterosexual African Americans (n = 14), and heterosexual Latinos (n = 25) were coded for the presence or absence of messages identified by various theoretical models as relevant to HIV education and risk reduction. Results and Conclusions: Videos targeting gay and bisexual men typically emphasized sexual risk reduction techniques, whereas videos for heterosexual minority viewers were more likely to provide information about HIV transmission and audience members' vulnerability to AIDS. Despite their focus on reducing personal risk, most gay/bisexual videos did not depict partner negotiation for safer sex, reinforce the perception that social norms favor sexual risk reduction, or eroticize safer sex practices. Suggestions are offered for future research and for production of AIDS educational videos.     

Testing for HIV infection among heterosexual,bisexual and gay men

Abstract: This paper answers the questions: who is and is not tested for human immunodeficiency virus (HIV) antibodies, why, where are they tested, and what do they find difficult about the testing process? The data came from two samples of sexually active heterosexual, bisexual and gay men in Perth (N = 545). Bisexual and gay men were much more likely to be tested than heterosexual men, although the commonest reason for testing for all three groups was risky sex. The three groups differed on reasons for not having the HIV antibody test: heterosexual men most commonly claimed that they were not at risk; bisexual men explained that they had been meaning to go but kept putting it off; and gay men primarily feared a positive test result and lacked trust in the confidential treatment of results. Gay men were more likely to trust their regular doctors than were heterosexual and bisexual men who had more trust in state health clinics. Waiting for test results was the most difficult part of the testing process for all respondents. Few respondents agreed that employers and the police should be notified by a doctor of an antibody-positive test result; nearly all agreed that those who had contracted HIV should be notified; notification of surgeons received moderate support. Knowing one's HIV infection status appears to be strongly associated with safer sex practices, and therefore the HIV antibody test could be promoted as part of a preventive health care program.     

Age-Concordant and Age-Discordant Sexual Behavior Among Gay and Bisexual Male Adolescents

There is evidence that risks for HIV and sexually transmitted infections among adolescent females are higher for those with older male sexual partners. Yet, little empirical research has been conducted with male adolescents who engage in sexual activity with older men. In this article, we summarize in a number of ways the range of sexual activity reported by an ethnically diverse sample of 200 gay and bisexual male youth (15–22 years old) in Chicago and Miami. A general pattern of progression from oral sex with men to both receptive and insertive anal sex with men appeared to characterize the sample during their adolescence. Further, there appeared to be a high degree of “versatile” positioning among the sexually active gay and bisexual young men, in both age-discrepant and age-concordant dyads. Risk analysis revealed having primarily age-concordant partners to be a significant predictor of sexual risk behavior. HIV risk among young gay and bisexual men engaging in sexual activity with older men may occur not only within a distinct biological context from their heterosexual counterparts, but also in a social context that may not as rigidly bound to traditional assumptions about age, gender, and power. The significant associations among participants with partners who were the same age and the risk behavior measures in this analysis have implications for HIV prevention efforts.     

HIV Risk Profiles Among HIV-Positive,Methamphetamine-Using Men Who Have Sex with Both Men and Women

This study examined demographic characteristics, sexual risk behaviors, sexual beliefs, and substance use patterns in HIV-positive, methamphetamine-using men who have sex with both men and women (MSMW) (n = 50) as compared to men who have sex with men only (MSM) (n = 150). Separate logistic regressions were conducted to predict group membership. In the final model, of 12 variables, eight were independently associated with group membership. Factors independently associated with MSMW were acquiring HIV through injection drug use, being an injection drug user, using hallucinogens, using crack, being less likely to have sex at a bathhouse, being less likely to be the receptive partner when high on methamphetamine, having greater intentions to use condoms for oral sex, and having more negative attitudes about HIV disclosure. These results suggest that, among HIV-positive methamphetamine users, MSMW differ significantly from MSM in terms of their HIV risk behaviors. Studies of gay men and HIV often also include bisexual men, grouping them all together as MSM, which may obscure important differences between MSMW and MSM. It is important that future studies consider MSM and MSMW separately in order to expand our knowledge about differential HIV prevention needs for both groups. This study showed that there were important differences in primary and secondary prevention needs of MSM and MSMW. These findings have implications for both primary and secondary HIV prevention among these high-risk populations.     

Experiences of harassment, discrimination, and physical violence among young gay and bisexual men

OBJECTIVES: We examined the 6-month cumulative incidence of anti-gay harassment, discrimination, and violence among young gay/bisexual men and documented their associations with mental health. METHODS: Gay/bisexual men from 3 cities in the southwestern United States completed self-administered questionnaires. RESULTS: Thirty-seven percent of men reported experiencing anti-gay verbal harassment in the previous 6 months; 11.2% reported discrimination, and 4.8% reported physical violence. Men were more likely to report these experiences if they were younger, were more open in disclosing their sexual orientation to others, and were HIV positive. Reports of mistreatment were associated with lower self-esteem and increased suicidal ideation. CONCLUSIONS: Absent policies preventing anti-gay mistreatment, empowerment and community-building programs are needed for young gay/bisexual men to both create safe social settings and help them cope with the psychological effects of these events.     

A comparison of HIV seropositive and seronegative young adult heroin- and cocaine-using men who have sex with men in New York City, 2000–2003

The purpose of this analysis was to determine the prevalence and correlates of HIV infection among a street-recruited sample of heroin-and cocaine-using men who have sex with men (MSM). Injection (injecting ≦3 years) and non-injection drug users (heroin, crack, and/or cocaine use<10 years) between 18 and 40 years of age were simultaneously street-recruited into two cohort studies in New York City, 2000–2003, by using identical recruitment techniques. Baseline data collected among young adult men who either identified as gay/bisexual or reported ever having sex with a man were used for this analysis. Nonparametric statistics guided interpretation. Of 95 heroin/ cocaine-using MSM, 25.3% tested HIV seropositive with 75% reporting a previous HIV diagnosis. The majority was black (46%) or Hispanic (44%), and the median age was 28 years (range 18–40). HIV-seropositive MSM were more likely than seronegatives to be older and to have an HIV-seropositive partner but less likely to report current homelessness, illegal income, heterosexual identity, multiple sex partners, female partners, and sex for money/drug partners than seronegatives. These data indicate high HIV prevalence among street-recruited, drug-using MSM compared with other injection drug use (IDU) subgroups and drug-using MSM; however, lower risk behaviors were found among HIV seropositives compared with seronegatives. Large-scale studies among illicit drug-using MSM from more marginalized neighborhoods are warranted.     

Are US populations appropriate for trials of human immunodeficiency virus vaccine? The HIVNET Vaccine Preparedness Study

Questions exist about whether testing of preventive human immunodeficiency virus (HIV)-1 vaccines, which will require rapid recruitment and retention of cohorts with high HIV-1 seroincidence, is feasible in the United States. A prospective cohort study was conducted in 1995-1997 among 4,892 persons at high risk for HIV infection in nine US cities. At 18 months, with an 88% retention rate, 90 incident HIV-1 infections were observed (1.31/100 person-years (PY), 95% confidence interval (CI): 1.06, 1.61). HIV-1 seroincidence rates varied significantly by baseline eligibility criteria--1.55/100 PY among men who had sex with men, 0.38/100 PY among male intravenous drug users, 1.24/100 PY among female intravenous drug users, and 1.13/100 PY among women at heterosexual risk-and by enrollment site, from 0.48/100 PY to 2.18/100 PY. HIV-1 incidence was highest among those men who had sex with men who reported unprotected anal intercourse (2.01/100 PY, 95% CI: 1.54, 2.63), participants who were definitely willing to enroll in an HIV vaccine trial (1.96/100 PY, 95% CI: 1.41, 2.73), and women who used crack cocaine (1.62/100 PY, 95% CI: 0.92, 2.85). Therefore, cohorts with HIV-1 seroincidence rates appropriate for HIV-1 vaccine trials can be recruited, enrolled, and retained.     

Global rights,local realities: Negotiating gender equality and sexual rights in the Caprivi Region,Namibia

This study aimed to compare homo/bisexual men and women with their heterosexual counterparts who were regular ecstasy users, to consider whether patterns of drug use or risk differed across these groups. Respondents (n = 852 ecstasy users) were recruited via advertisements in entertainment street press, gay and lesbian newspapers, music and clothing stores and at university campuses. Interviewer contacts and ‘snowball’ sampling were also utilized. In total, 23% of females in the sample self‐identified as lesbian or bisexual and 13% of males interviewed self‐identified as homo/bisexual. Rates of use of ‘newer’ drugs on the dance scene—crystal methamphetamine and ketamine—were higher among homo/bisexual men and women. Self‐reported risk behaviours such as unprotected sex and needle sharing (among those who had injected drugs) did not differ according to sexuality. However, homo/bisexual men and women were significantly more likely than heterosexual men and women to report a greater number of sexual partners and higher rates of injecting drug use. These findings suggest that among a group of people who were selected because they were regularly involved in the party drug market, initiatives designed to reduce harms related to injecting and sex risk may be needed for a greater proportion of homo/bisexual males and females who are involved in the dance/nightclub scene.     

Developing surveillance for HIV transmission and risk behaviours among high-risk groups in a central London health district.

BACKGROUND: Our aim was to describe surveillance data on HIV transmission and risk behaviours in Camden and Islington, an inner London health district (population 360 000). This information is required to assess the effectiveness of HIV-AIDS prevention. METHODS: We focused on two groups in the local population most severely affected by the HIV epidemic: homosexual and bisexual men, and injecting drug users. Data were drawn from routine and survey data, national and local sources, and a special local survey. RESULTS: There were estimated to be 9250 homosexual men, with an estimated prevalence of 7.7 per cent (confidence interval (CI) 5.9-11.0) diagnosed with HIV infection resident within the health district, and 9900 injecting drug users, with an estimated prevalence of 0.8 per cent (CI 0.6-1.1), diagnosed with HIV infection. New HIV infections diagnosed amongst homosexual men having a named test in HIV testing services averaged 281 and was unchanged between 1992 and 1996. However, unlinked anonymous seroprevalence surveys showed a decline in HIV prevalence for both homosexual men attending a genito-urinary medicine clinic and for injecting drug users attending services. Local surveys indicated that, in the preceeding year, one in three homosexual men had had unprotected anal intercourse with a man, and 13 per cent of intravenous drug users had shared equipment. There appeared to be no change in these levels over the years studied. CONCLUSION: Population-based information on HIV is available at local level in England. It can be used for surveillance of HIV transmission and behaviour in high-risk groups, especially homosexual and bisexual men and intravenous drug users. Resources for HIV prevention are provided to all NHS districts, and surveillance is a cost-effective measure of the outcome of HIV prevention.