The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female sex partners

Heterosexual transmission of HIV is a growing problem for women, but many women do not know how their partners acquired HIV. We described a group of HIV-infected men and women, and focused on: (1) sexual identity and bisexual behaviour in men, and (2) the proportion of women who acknowledged having a bisexual male partner. This study examined HIV-infected persons who participated in a cross-sectional interview project from January 1995 through July 2000; 5,156 men who have sex with men (MSM), and 3,139 women. The proportion of MSM who reported having sex with women (MSM/MSW) varied by race: 34% of black MSM, 26% of Hispanic MSM, and 13% of white MSM. While 14% of white women acknowledged having a bisexual partner, only 6% of black and 6% of Hispanic women reported having a bisexual partner. Most behaviourally bisexual men identified as either bisexual (59%) or homosexual (26%). Among MSM/MSW, 30% had more female partners than male partners, while only 10% had more male partners than female partners. These data suggest that bisexual activity is relatively common among black and Hispanic HIV-infected MSM, few identify as heterosexual, and their female partners may not know of their bisexual activity.     

A community-based rapid assessment of HIV behavioural risk disparities within a large sample of gay men in southeastern USA: a comparison of African American, Latino and white men

Because the southeastern USA is experiencing a disproportionate HIV infection rate compared to other regions of the country, we explored HIV behavioural risk disparities by race/ethnicity among self-identifying gay men. Conceived and implemented as a community-based participatory research (CBPR) study, this rapid assessment collected demographic and HIV risk-behaviour data from men in five gay bars in the northwestern part of the state of North Carolina, using an assessment available in English and Spanish. Of 719 participants, 34.8% reported inconsistent condom use during anal intercourse in the past three months, 11.4% reported ever having had a sexually transmitted disease (STD), 3.6% reported being HIV-seropositive and 26% reported illicit drug use during the past 30 days. Compared to white participants, African American/black and Hispanic/Latino participants were more likely to report inconsistent condom use during anal intercourse with multiple partners during the past three months. African American/black participants were more likely to report illicit drug use during the past 30 days. Hispanic/Latino participants were more likely to have never been tested for HIV. Rates of HIV risk behaviours among gay men remain high and racial/ethnic differences indicate the need for targeted and tailored prevention strategies.     

Differences across sexual orientation on HIV risk behaviours in injecting drug users.

Injecting drug users (IDUs) play a disproportionate role in the spread of HIV given their injecting and sexual contacts, and thereby act as conduits between these risk groups. We investigated differences in risk behaviour and HIV seroprevalence in a Sydney sample of 1,245 IDUs. Significant differences were observed across sexual orientation in HIV serostatus for males, with homosexual men having the highest HIV seroprevalence rate (35%), bisexual men intermediate (12%) and heterosexual men lowest (3%). Sexual HIV risk behaviours were lowest for homosexual men, intermediate for bisexual men, and highest for heterosexual men in the case of condom use: however, for numbers of partners, seroprevalence, and anal sex the trends were reversed. There were no differences across sexual orientation for either sex for injecting drug risk behaviours. Both male and female respondents reported having more than 50% of sexual contacts while under the influence of drugs. This study suggests that risk reduction in the sexual domain has not generalized to the injecting risk domain regardless of sexual orientation, and demonstrates that sexual risk behaviours in IDUs are lowest in homosexual, intermediate in bisexual, and highest in heterosexual IDU men.     

Relationship between sexual partners influences rates and correlates of condom use.

A common finding in studies of heterosexual young adults is that condom use is more likely with casual partners than with regular partners. However, few studies have examined whether correlates of condom use differ with different partners. In this study, 103 heterosexual men and women completed a condom use diary for a period of up to 6 months. Condom use during sexual encounters with regular partners was mainly determined by established patterns of behavior. In contrast, condom use with casual partners was determined by the interaction between the sexual partners during the encounter, and was not influenced by the attitudes and beliefs of the individual. These differences have implications for interventions. They suggest that condom use with casual partners may be increased by furnishing young adults with skills and confidence for negotiating condom use. For young adults in regular relationships, we must ensure that routine patterns of condom use are appropriate for the levels of risk to which the partners are exposed.     

Patterns and Correlates of Sexual Activity and Condom Use Behavior in Persons 50-Plus Years of Age Living with HIV/AIDS

This study characterized rates of sexual activity and identified psychosocial and behavioral correlates of sexual activity and condom use in a metropolitan sample of 290 HIV-infected adults 50-plus years of age. Thirty-eight percent of participants were sexually active in the past three months, 33% of whom had at least one occasion of anal or vaginal intercourse that was not condom protected. Rates and correlates of sexual activity and condom use differed between gay/bisexual men, heterosexual men, and heterosexual women. In the past three months, 72% of heterosexual men were sexually active compared to only 36% of gay/bisexual men and 21% of heterosexual women. However, among sexually active persons, only 27% of heterosexual men reported inconsistent condom use compared to 37% of gay/bisexual men and 35% of heterosexual women. As the number of older adults living with HIV/AIDS in the U.S. continues to increase, age-appropriate secondary risk-reduction interventions are urgently needed.     

The impact of sexuality and race/ethnicity on HIV/AIDS risk among Asian and Pacific Island American (A/PIA) gay and bisexual men in Hawai'i.

The prevalence of HIV/AIDS in Asian and Pacific Island Americans (A/PIAs) has been relatively low in proportion to other racial/ethnic groups in the United States. However, HIV infection among A/PIA gay and bisexual men, and men who have sex with men has steadily increased in urban and other geographic areas with large Asian and Pacific Island populations. In this study of race/ethnicity and HIV risk among A/PIA gay and bisexual men in Hawai'i, respondents reported significant conflicts between loyalty to one's A/PIA family of origin and the enactment of individual sexual identity. Idealization of love and intimacy, intentional decisions to suspend safer sex practices, and Pacific Island cultural expressions of giving to others are all factors that may compromise HIV risk reduction in this population. Implications for HIV/AIDS prevention focus on integrating A/PIA, gay/bisexual, and "local" (born and raised in Hawai'i) identities in the development of multilevel interventions.     

Alcohol Use, Anal Sex, and Other Risky Sexual Behaviors Among HIV-Infected Women and Men

Effective sexual risk reduction strategies for HIV-infected individuals require an understanding of alcohol’s influence on specific sexual behaviors. We conducted audio-computer-assisted-self-interviews on 910 patients from two HIV primary care programs. The association between alcohol use and risky sexual behaviors was examined using multivariable logistic regression adjusting for age, education, race/ethnicity and drug use. Frequent/binge drinking was associated with engaging in anal sex and having multiple sex partners among women, engaging in insertive anal sex among gay/bisexual men, and was unrelated to risky sexual behaviors among heterosexual men. Infrequent drinkers did not differ in sexual risk behaviors from abstainers among women or men. Finally, there was no interaction effect between race/ethnicity and alcohol use on the association with sexual risk behaviors. The study has yielded important new findings in several key areas with high relevance to HIV care. Results underscore the importance of routinely screening for alcohol use and risky sexual behaviors in HIV primary care.     

HIV Risk Behaviors Among Homeless Injection Drug Users of Different Ethnicities

The objectives of this study were to assess the prevalence of HIV risk behaviors among homeless injection drug users (IDUs) and to determine whether these risk behaviors vary by ethnicity. A face-to-face interview was administered to 769 homeless IDUs in Portland, Oregon, from 1993 to 1996. Homeless IDUs had a high prevalence of needle sharing and sexual intercourse with casual partners, and a low prevalence of condom use. African Americans had the lowest rate of needle sharing, and Hispanics the highest. Compared to Whites, African Americans and Hispanics were both more likely to have had sex with casual partners in the last 30 days. African Americans were most likely to have used a condom with casual partners. Results indicate the need for more effective and culturally tailored interventions. Special efforts are needed to reduce needle sharing and increase condom use among Hispanic homeless IDUs, who exhibited the highest rates of risk behaviors.Correspondence should be directed to Jin T. Song, Oregon Health, Division, 800 NE Oregon St., Suite 550, Portland, Oregon 97232     

Social, structural and behavioral drivers of concurrent partnerships among African American men in Philadelphia

African Americans face disproportionately higher risks of HIV infection. Concurrent sexual relationships, or sexual partnerships that overlap in time, are more common among African Americans than individuals of other races and may contribute to racial disparities in HIV infection. However, little is known about attitudes, norms and practices among individuals engaged in concurrent partnerships. Little is also known about the processes through which structural, behavioral, and social factors influence concurrent sexual relationships. We recruited 24 heterosexual African American men involved in concurrent sexual relationships from a public health clinic in Philadelphia. We conducted in-depth interviews exploring these men's sexual practices; social norms and individual attitudes about concurrency; perceived sexual health risks with main and non-main partners; and the social, structural, and behavioral factors contributing to concurrent sexual relationships. Twenty-two men reported having one main and one or more non-main partners; two reported having no main partners. Respondents generally perceived sexual relationships with non-main partners as riskier than relationships with main partners and used condoms far less frequently with main than non-main partners. Most participants commented that it is acceptable and often expected for men and women to engage in concurrent sexual relationships. Social factors influencing participants' concurrent partnerships included being unmarried and trusting neither main nor non-main partners. Structural factors influencing concurrent partnerships included economic dependence on one or more women, incarceration, unstable housing, and unemployment. Several men commented that individual behavioral factors such as alcohol and cocaine use contributed to their concurrent sexual partnerships. Future research and interventions related to sexual concurrency should address social and structural factors in addition to conventional HIV risk-taking behaviors.     

Heterosexuals at risk for HIV: differences between private and commercial partners in sexual behaviour and condom use

To study the prevalence of HIV and other sexually transmitted diseases (STDs), sexual behaviour and condom use among heterosexuals, 193 women and 157 men entered a longitudinal study. Participants were recruited through an STD clinic, and had had five or more heterosexual partners in the preceding 6 months but had no other AIDS risk factors. Participants were divided in groups with respect to private and/or commercial sexual partners. One hundred and thirty-six (71%) women worked as prostitutes and had, on average, 115 customers a month, and 99 (63%) men had visited, on the average, eight prostitutes in the past 4 months. One hundred and seventy-one (89%) women (114 prostitutes) had had, on average, four partners, and 112 (78%) men (of whom 64 had visited prostitutes) had had, on average, seven private partners in the past 4 months. Vaginal intercourse was often or always reported by all participants whilst anal contact was seldom reported. Non-high-risk sexual techniques (for example, oro-oral, masturbation) were practised more frequently with private than with commercial partners (P less than 0.001). Although no differences were found in the frequency of practising high-risk sexual techniques (for example, vaginal, ano-genital), differences were found for frequency of condom use. Condom use during vaginal intercourse was reported more frequently with commercial than with private partners (P less than 0.01). However, if the number of partners is taken into account, prostitutes had unprotected vaginal intercourse with an estimated average number of 160 partners in 4 months, which is far more than customers (seven) and men and women with private partners only (four).(ABSTRACT TRUNCATED AT 250 WORDS)     

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

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

中国男同/双性爱者AIDS高危性行为监测与比较

目的 了解男同／双性爱者的高危性行为状况，为行为干预提供理论依据。方法 以定向抽样法从30个省、自治区、直辖市获取男男性接触者(MSM)样本，采用匿名自填问卷方式进行调查，对其中的男同／双性爱者的性行为进行比较。结果 双性爱者的女性伙伴数(平均2．85个)多于同性爱者(2．06个)；同性爱者近1年内有无保护性被动肛交的比例(60．70％)高于双性爱者(44．44％)；近1年内双性爱者与女性性交时的安全套使用率(50．48％)低于男男性交时的安全套使用率(73．64％)；同／双性爱者曾接受同性性服务的比例(分别为14．77％、13．56％)均高于从事同性性工作者的比例(分别为4．67％、6．55％)。结论 中国男同/双性爱者在性方面相当活跃。多性伙伴、无保护性性交和参与性交易等是其主要的高危性行为。为此，必须制定相应的干预计划，减少感染艾滋病病毒的风险。     

Consistent condom use among drug-using youth in a high HIV-risk neighbourhood

The objectives of this study were to determine predictors of consistent condom use in heterosexual relationships of young adults who use hard drugs in a neighbourhood with widespread drug-use-connected HIV. We interviewed 196 18-24 year olds who injected drugs or used heroin, cocaine or crack in the prior year and lived in the Bushwick neighbourhood of New York City. Interviews covered sociodemographics, substance use and sexual networks. The unit of analysis is the relationship; the dependent variable measures consistent condom use over the prior 30 days in a given relationship. Consistent condom use was reported in 26% of 377 non-commercial relationships and in all of 22 commercial relationships. Using multiple logistic regression, consistent condom use in non-commercial relationships was more likely in relationships that are not 'very close'; for men (but not women) with peers whose norms are more favourable to condom use; and for subjects who had concurrent sex partners in the last 12 months. In conclusion, we found that: (1) the lack of relationship between the peer norms of drug-using women and their condom use suggests they may have little control over condom use in their relationships-programmes should attempt to empower young women drug users and to develop ways for their peers to influence the men in their lives; (2) epidemiologically, the positive association of concurrency to consistent condom use suggests that condom use may be restricting HIV spread through the community-the presence of consistent condom use in all of the commercial sexual relationships also may restrict HIV spread; (3) prevention efforts should attempt to change peer cultures as a way to develop self-sustaining risk reduction. These changes should include changes in gender roles and power relations.     

Predictors of Unprotected Sex among Young Sexually Active African American,Hispanic, and White MSM: The Importance of Ethnicity and Culture

Despite the recognized need for culturally tailored HIV prevention interventions for gay, bisexual, and questioning youth, few studies have examined if predictors of unprotected sex vary for youth from different ethnic groups. This study reports on a sample of 189 gay, bisexual, and questioning youth (age 15–22) from three racial/ethnic backgrounds (African American, Hispanic, and White) recruited in Chicago, IL and Miami-Dade and Broward Counties, Florida. For African American youth, being in a long-term relationship, having been kicked out of the home for having sex with men, and younger age at initiation of sexual behavior were associated with unprotected sex. For Hispanic youth, higher ethnic identification and older age at initiation of sexual behavior were associated with unprotected sex. For White youth, no predictors were associated with unprotected sex. Our findings point to the importance of understanding the varying predictors of unprotected sex and integrating them into tailored prevention interventions.     

Racial Discrimination, Social Support, and Sexual HIV Risk among Black Heterosexual Men

Numerous studies document the adverse impact of racial discrimination on African Americans’ health outcomes, but few have focused on HIV risk. We examined the relationship between racial discrimination and sexual risk in a sample of 526 Black heterosexual men and tested the hypothesis that social support would moderate this relationship. Participants in the predominantly low-income urban sample ranged in age from 18 to 45. High social support had a buffering impact on the relationship between racial discrimination and sexual risk. Among men reporting high racial discrimination, those with more social support reported less sexual risk than men with low social support. Men who reported high racial discrimination and low social support reported more sexual risk than men in any of the other groups. The study highlights social support as an important but understudied protective factor that may reduce sexual risk for Black heterosexual men who report high levels of racial discrimination.     

It takes two: the role of partner ethnicity and age characteristics on condom negotiations of heterosexual Chinese and Filipina American college women.

To date, limited attention is paid to how partners influence the condom negotiation process. This study examined whether partner ethnicity and age were associated with condom negotiations (i.e., verbal-direct, verbal-indirect, nonverbal-direct, nonverbal-indirect) in heterosexual Chinese and Filipina American college women. Results from 181 women across four California universities indicated significant effects of partner ethnicity and age on condom negotiation strategies. Asian women with non-Asian partners were more likely to use nonverbal-direct strategies than those with Asian partners. Asian women with older partners were less likely to use verbal strategies (verbal-direct, verbal-indirect) than those with same-age partners. This study suggests that Asian women's safer sex communication varies by partner characteristics. Obtaining information such as partner ethnicity and age can help health educators provide more culturally appropriate sexual communication skills to clients.     

Sexual behaviour and HIV infection risks in Indian homosexual men: a cross-cultural comparison.

A comparison of sexual activities in 49 homosexually active northwest Indian men attending STD clinics was made with 173 homosexually active Australian men from a community sample. There were major differences between the two on frequency of marriage and of bisexual behaviour (significantly higher in the Indian sample), condom use for anal intercourse, and of oral sex (significantly higher in the Australian sample). There was also a substantial level of heterosexual anal intercourse reported in the Indian sample. While preliminary and based on nonmatched and nonrandom samples, these data suggest that the sexual activity profile and degree of risk of homosexual behaviour may differ considerably between the two cultures, and that data on homosexual activities in western societies should not be generalized to nonwestern cultures.     

Sexual behaviour patterns and condom use in Tanzania: results from the 1996 Demographic and Health Survey

We conducted this study to determine the factors associated with high-risk sexual behaviour and condom use among men and women who participated in the 1996 Tanzania Demographic and Health Survey (TDHS); and to assess changes in sexual behaviour between 1991/92 and 1996 TDHS. Respondents were regarded to have practised high-risk sexual behaviour if they were married or cohabiting and had other regular or non-regular sexual partners; or if they were unmarried and had non-regular partners or multiple regular partners. About 8% of women and 29% of men practised high-risk sexual behaviour. High-risk sexual behaviour was common among younger men and women, and decreased with increasing level of education in women. Respondents who were unmarried, Muslims and those who perceived themselves at increased risk of HIV/AIDS were more likely to practise high-risk sexual behaviour. About 4% of women and 15% of men reported to have used condoms during their last sexual encounter. Condom users were significantly more likely to practise high-risk sexual behaviour. Overall, no major changes in sexual behaviour and condom use were observed during the period between the two surveys. Predictors of high-risk sexual behaviour and condom use identified in this report provide valuable information that can be used to design targeted HIV/AIDS interventions in Tanzania.     

HIV prevention heuristics and condom use among African-Americans at risk for HIV

The goal of this study was to improve understanding of whether incorrect HIV/AIDS heuristics and characteristics-based risk theories are barriers to HIV prevention among young African-Americans at increased risk for HIV. We explored: (1) the beliefs of men and women regarding disease prevention strategies, and (2) the relationship of such beliefs to safer sexual behaviours. In Phase I, semistructured individual interviews were conducted with both members of 22 heterosexual couples at increased risk for HIV/STIs. Subsequently, in Phase II, structured individual interviews were conducted with another 40 women and 40 men (not couples). Participants in Phase I reported use of condoms and monogamy as major strategies for disease prevention. The beliefs that were endorsed by the largest percentage of Phase II participants were related to the 'known partners are safe partners' and 'trusted partners are safe partners' heuristics. Moreover, stronger endorsement of the 'known partners' heuristic was negatively associated with measures of condom use and pregnancy prevention behaviour. Our findings highlight the need for interventions and programmes to encourage intimate partners to consistently use condoms until both members of the dyad are tested and agree to mutual monogamy.     

Sexual behaviour, condom use and HIV risk situations in the general population of Quebec

We conducted 3501 telephone interviews to determine the sexual and protective behaviours of the general population in Quebec. Among the 858 respondents who had had at least one occasional partner during the last 5 years, 25.4% had had at least one occasional partner who refused to use a condom. More women had had an occasional partner who had refused than men (29.8% vs 21.1%, P<0.001) and fewer women than men succeeded in negotiating condom use, but more of these women decided not to have sexual relations. The frequency of condom use during the last sexual relation changes if the partner is a regular cohabiting partner (12.5%), a regular non-co-habiting partner (42.2%) or an occasional partner (70.8%). Our study provides important information for the development of prevention programmes for the heterosexual population and demonstrates the importance of the type of relationship maintained by the partners on the sexual behaviours.