Reducing sexual risk and promoting acceptance of men who have sex with men living with HIV in India: Outcomes and process evaluation of a pilot randomised multi-level intervention

ABSTRACT

HIV-positive men who have sex with men (HIV+MSM) in India need culturally-relevant interventions to promote safer sex. We tested a multi-level intervention among HIV+MSM that targeted individual, interpersonal, and community factors, based on the Social-Personal and Social Ecological Models. We conducted a 2?×?2 factorial RCT with 119 HIV+MSM randomised to receive either an individual-level intervention (ILI) using motivational interviewing to promote safer sex, a community-level intervention (CLI) to strengthen community norms toward safer sex and reduce stigma among MSM communities, a multi-level intervention combining the individual- and community-level interventions (ILI?+?CLI), or standard-of-care control. Participants completed pre- and post-intervention assessments of a composite sexual risk score and a process evaluation to assess fidelity and satisfaction. Out of the 119 HIV+MSM, 106 (89.0%) completed pre- and post-intervention assessments. Generalised Estimating Equation models showed that both CLI (Incidence Rate Ratio [IRR]?=?.67, 95% CI .47 to .96) and ILI?+?CLI (IRR?=?.66, 95% CI .48 to .91) groups had a statistically significant decrease in sexual risk compared to the standard-of-care. The interventions had high levels of fidelity and satisfaction. This pilot RCT demonstrated feasibility and potential effectiveness of a multi-level intervention that addresses individual, interpersonal and community-level contributors of sexual risk among HIV+MSM.     

The role of the Black Church in the lives of young Black men who have sex with men

In the USA, the Black Church is among the most important institutions in the Black community, offering numerous spiritual, social and health benefits. Yet, the presence of homonegativity in many Black Churches may mitigate those effects for gay Black youth. This research examines the role of the Church in the lives of gay and bisexual Black youth to understand how they reconcile any tension between their religious and sexual identities. Through interviews with pastors of Black churches (n = 21) and young Black men who have sex with men (n = 30), we explored homonegativity and young men’s experiences within the Black Church. Findings reveal that despite the prevalence of homonegativity within Black churches, religious involvement remains important for young men and many remain involved in non-affirming churches. The importance of the Church for young men stems from their significant involvement as youth and the integration of religion, family and community. Young men may not be able to leave their religious homes as readily as other gay youth given the cultural relevance of the Church. As a result, young men made attempts to conceal their sexuality in church to avoid shame and gossip and find opportunities to balance their sexuality and religiosity.     

Making meaning of the virginity experience: young men's perceptions in the United States

ABSTRACT

A qualitative grounded theory approach was used to analyze 34 narratives from young men about their experience of retaining, losing, or giving away their virginity, where 7 said they were virgins, 26 said they were non-virgins, and one did not mention his virginity status. We found that virginity is a multidimensional concept, with two distinct dimensions: the experiential and the developmental. The experiential dimension refers to young men's perception and understanding of their virginity in four overlapping areas: physical, spiritual, relational, and emotional. The developmental dimension refers to young men's perception of their underlying sexual identity growth processes and the gendered and sexual double standards that influence this understanding. Clinical implications of this study are useful in education and counseling. They seek to empower young men with information relating to the multidimensional nature of virginity experience, and minimize the negative effects on romantic relationships, sexual adjustment, and self-identity development. The findings are helpful in designing interventions for young men and women who are at high risk for sexually transmitted infections and can help them negotiate mutually safe and pleasurable experiences regarding their virginity.     

‘Sex’ – it’s not only women’s work: a case for refocusing on the functional role that sex plays in work for both women and men

Mention of the term sex work often invokes images of marginalized women at risk for HIV infection. Such images, however, are counterintuitive to the functional role intended by the movement that spawned use of the terms ‘sex work’ and ‘sex worker.’ This article looks at the sexual practices of men in urban China to argue for a return to a functional definition of ‘sex work’, which was originally meant to legitimize the role sex plays in work. The progenitors of this movement intended to use ‘sex work’ as a means to legitimize sex as an income-generating activity for women involved in prostitution. I show that sex can also serve a functional role in the work-related duties of men seeking economic and political success in contemporary urban China. Men in China utilize sex as one way for demonstrating the loyalty necessary to access state-owned and controlled resources in a market economy governed under a Leninist system. Overall, the article demonstrates that reclaiming perception of sex work as a functional rather than behavioral category can expand its use for preventing HIV among the broad subset of people who engage in sex as part of their work.     

Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention

Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals participated in the microfinance component and 30 peer leaders were recruited and trained in the peer health leadership component. We collected and analysed observational data from trainings, monitoring data on loan repayment, and reports of peer conversations to assess the feasibility and acceptability of the intervention. Eighteen of the loan recipients (82%) paid back their loans, and of these 15 (83%) received a second, larger loan. Among the loan defaulters, one died, one had chronic health problems, and two disappeared, one of whom was imprisoned for theft. The majority of conversations reported by peer health leaders focused on condoms, sexual partner selection, and HIV testing. Few peer leaders reported conversations about GBV. We demonstrated the feasibility and acceptability of this innovative HIV and GBV prevention intervention. The lessons learned from this pilot have informed the implementation of a cluster-randomised trial of the microfinance and peer health leadership intervention.     

Sexual fantasies of heterosexual and homosexual men

Heterosexual men and homosexual men rated how arousing different sexual fantasies were and how often they had used these fantasies over the previous year. Within each group, sensual and genital same-orientation fantasies were more arousing than either public-sex or dominance-submissive fantasies, which in turn were more arousing than aggressive-sex fantasies. For both heterosexual and homosexual men the extent to which a fantasy was arousing correlated with the person's experience of the activity depicted in the fantasy. The frequency of use of a fantasy correlated positively with its arousal level but not always subtantially so. The results are discussed in the context of the mediating role of fantasy in human sexual arousal.     

血清痩素对老年男性骨质疏松的影响

目的 探讨血清瘦素水平对老年男性骨质疏松的影响。方法 选取年龄在60-92岁的158例老年男性，采用双能X线法（DXA）检测骨密度，并根据测值将受试者分为骨质疏松组与非骨质疏松组，用放射免疫法（RIA）检测两组空腹血清瘦素浓度，进行比较研究。结果 血清瘦素测值在不同年龄组间的差异无统计学意义，而在肥胖组与非肥胖组间有显著差异（P〈0．01）。在老年男性骨质疏松组血清瘦素测值明显低于非骨质疏松组，两者具有显著差异（P〈0．05）。结论 血清瘦索测值并不随老年男性的年龄而变化。但与老年男性的体重指数呈正相关，血清瘦素对老年男性骨质疏松有较好的预示及保护作用。     

庚酸睾酮男性抗生育作用的临床研究

62名健康男性,自愿接受每周1次200mg庚酸睾酮(TE)肌肉注射的避孕方法研究。4人非医学原因中断试验,其余受试者先后实现无精子,自第1次注射TE到全部达到无精子的平均时间为108(58～232)天,在此后的连续12个月共592个妇女月避孕效果观察中,有1例怀孕,临床避孕率为98％(Pearl指数为2.02/100妇女年)。停药后,平均188(135～254)天全部受试者的精子密度恢复到用药前水平或高于20×10~6/ml。在用药期间,除预料的血清睾酮升高、促性腺激素(FSH、LH)受抑制、睾丸体积缩小、体重和血红蛋白轻度增加以及2例出现轻度痤疮外,其余检查,包括血脂代谢、肝肾功能、前列腺大小、血压和性功能等均无显著性改变。结果表明,由TE抑制生精作用的男性激素避孕方法具有效果好,可逆和毒副作用小的优点。