Physical and sexual abuse among homeless and unstably housed adults living with HIV: prevalence and associated risks

We examined the prevalence and risks associated with interpersonal (physical and sexual) abuse among HIV-seropositive homeless or unstably housed adults. Data were obtained from the Housing and Health Study of participants living in Baltimore, Chicago, and Los Angeles (n = 644). We used logistic regression to identify risks associated with abuse. About 77% of men and 86% of women reported ever experiencing abuse. Women were at greater risk than men for intimate partner physical abuse, childhood sexual abuse (CSA), and adulthood sexual abuse. Men and women experiencing intimate partner physical abuse reported increased risk of unprotected sex. Other risks associated with abuse include sex exchange; lifetime alcohol abuse; and depressive symptoms. Abuse prevalence among sample exceeds those found in other samples of general USA, HIV-seropositive, and homeless populations. Identifying persons at risk of abuse is needed to reduce risk among homeless or unstably housed persons living with HIV.

Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS

OBJECTIVES

We sought to compare health status, health care use, HIV anti-retroviral medication use, and HIV medication adherence among homeless and housed people with HIV/AIDS.

METHODS

Data were obtained from a cross-sectional, multisite behavioral survey of adults (N=7925) recently reported to be HIV positive.

RESULTS

At the time interviews were conducted, 304 respondents (4%) were homeless. Self-ratings of mental, physical, and overall health revealed that the health status of homeless respondents was poorer than that of housed respondents. Also, homeless respondents were more likely to be uninsured, to have visited an emergency department, and to have been admitted to a hospital. Homeless respondents had lower CD4 counts, were less likely to have taken HIV anti-retroviral medications, and were less adherent to their medication regimen. Homeless respondents needed more HIV social and medical services, but nearly all respondents in both groups had received needed services. Housing status remained a significant predictor of health and medication outcomes after we controlled for potential confounding variables.

CONCLUSIONS

Homeless people with HIV/AIDS are at increased risk of negative health outcomes, and housing is a potentially important mechanism for improving the health of this vulnerable group.

Beliefs about personal and partner responsibility among HIV-seropositive men who have sex with men: measurement and association with transmission risk behavior

Beliefs of people living with HIV about their own responsibility for preventing HIV transmission (personal responsibility) and their sex partners' responsibility for protecting themselves (partner responsibility) are poorly understood. A sample of 1163 HIV-seropositive men who have sex with men (MSM; 55% men of color) completed an A-CASI assessment of sexual behavior and psychosocial measures. A two-dimensional model that represents four orientations toward responsibility was tested: (1) self-high personal and low partner responsibility, (2) other-low personal and high partner responsibility, (3) shared-high personal and high partner responsibility, and (4) diminished-low personal and low partner responsibility. As predicted, the self-responsibility group demonstrated the lowest risk of HIV transmission; the other responsibility group had the highest risk. Intermediate risk was observed in the shared and diminished responsibility groups. Implications for future research and HIV prevention efforts are discussed.

A comparison of on-line and off-line sexual risk in men who have sex with men: an event-based on-line survey

OBJECTIVE

To assess whether men who have sex with men (MSM) are more likely to report unprotected anal intercourse (UAI) with partners met on-line compared with those met off-line.

METHODS

A total of 6122 individuals consented to participate in an anonymous behavioral survey on-line. This event-based analysis is limited to the 1683 men from the United States and Canada who had sex in the 3 months before the study and reported that their last sexual encounter included a new or casual male partner or partners. Prevalence and predictors of UAI were analyzed separately for the 386 men reporting more than 1 partner (multiple) and the 1297 men reporting only 1 (single) partner in their last encounter.

RESULTS

Of the 1683 MSM recruited on-line, 51% met their partner(s) in their last sexual encounter on-line and 23% reported UAI. No difference in risk for UAI was found for partners met on-line versus off-line in the bivariate or multivariate analyses. In a multivariate analysis of men with multiple-partner encounters, UAI was significantly associated with being HIV-seropositive (adjusted odds ratio [OR] = 2.87; P = 0.02) in a model that included age; education; whether partners were met on-line or off-line; and use of crystal methamphetamine, sildenafil, or alcohol before sex. Using the same model, significant predictors of UAI in men reporting a single-partner encounter were use of crystal methamphetamine (adjusted OR = 5.67; P = 0.001) and no college degree (adjusted OR = 1.63; P = 0.01).

CONCLUSIONS

MSM recruited on-line who reported a new or casual sex partner(s) in the prior 3 months are at considerable risk of HIV or other sexually transmitted infections, but they are equally likely to report UAI whether sex partners were met on-line or off-line. The Internet may be an ideal venue for reaching high-risk MSM.

Relative efficacy of a multisession sexual risk-reduction intervention for young men released from prisons in 4 states

OBJECTIVES

We compared the effects of an enhanced multisession intervention with a single-session intervention on the sexual risk behavior of young men released from prison.

METHODS

Young men, aged 18 to 29 years, were recruited from US prisons in 4 states and systematically assigned to the prerelease single-session intervention or the pre- and postrelease enhanced intervention. Both interventions addressed HIV, hepatitis, and other sexually transmitted infections; the enhanced intervention also addressed community reentry needs (e.g., housing, employment). Assessment data were collected before intervention, and 1, 12, and 24 weeks after release.

RESULTS

A total of 522 men were included in intent-to-treat analyses. Follow-up rates ranged from 76% to 87%. Unprotected vaginal or anal sex during the 90 days before incarceration was reported by 86% of men in the enhanced intervention and 89% in the single-session intervention (OR=0.78; 95% CI=0.46, 1.32). At 24 weeks, 68% of men assigned to the enhanced intervention reported unprotected vaginal or anal sex compared with 78% of those assigned to the single-session intervention (OR=0.40; 95% CI=0.18, 0.88).

CONCLUSION

Project START demonstrated the efficacy of a sexual risk-reduction intervention that bridges incarceration and community reentry.

Self-identification as "down low" among men who have sex with men (MSM) from 12 US cities

Men who have sex with men (MSM) who are on the "down low" (DL) have been the subject of considerable media attention, but few data on this population exist. This exploratory study (N=455) compared MSM who considered themselves to be on the DL with MSM who did not (non-DL MSM). 20% self-identified as DL. Blacks and Hispanics were more likely than Whites to self identify as DL. MSM who did not identify as gay were more likely than gay-identified MSM to describe themselves as DL. DL-identified MSM were less likely to have had seven or more male partners in the prior 30 days, but were more likely to have had a female sex partner and to have had unprotected vaginal sex. DL-identified MSM were less likely to have ever been tested for HIV than were non-DL MSM. Prevention agencies should expand existing programs for MSM to include specific efforts to reach DL MSM.

Greater risk for HIV infection of black men who have sex with men: a critical literature review

HIV rates are disproportionately higher for Black men who have sex with men (MSM) than for other MSM. We reviewed the literature to examine 12 hypotheses that might explain this disparity. We found that high rates of HIV infection for Black MSM were partly attributable to a high prevalence of sexually transmitted diseases that facilitate HIV transmission and to undetected or late diagnosis of HIV infection; they were not attributable to a higher frequency of risky sexual behavior, nongay identity, or sexual nondisclosure, or to reported use of alcohol or illicit substances. Evidence was insufficient to evaluate the remaining hypotheses.Future studies must address these hypotheses to provide additional explanations for the greater prevalence of HIV infection among Black MSM.

Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men

Stigma surrounding HIV/AIDS has existed since the beginning of the epidemic, but little is known about HIV/AIDS stigma within the gay community and how it affects men who have sex with men (MSM) living with HIV. A better understanding of the effects of stigma on this population is needed to reduce it and its harmful effects. Our study used quantitative data from 206 HIV-positive MSM and qualitative data from 250 to document beliefs about HIV/AIDS stigma within the gay community and to measure its effects on sexual risk behaviors, substance use behaviors, serostatus disclosure, and mental health. Stigma was associated with increased levels of anxiety, loneliness, depressive symptoms, engaging in avoidant coping strategies, and history of suicidal ideation. HIV/AIDS stigma exists within the gay community and has a negative effect on the mental health of people living with HIV. HIV/AIDS stigma should be monitored closely so that we may better understand how to address it.

Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials

OBJECTIVE

To conduct a meta-analytic review of HIV interventions for people living with HIV (PLWH) to determine their overall efficacy in reducing HIV risk behaviours and identify intervention characteristics associated with efficacy.

METHODS

Comprehensive searches included electronic databases from 1988 to 2004, hand searches of journals, reference lists of articles, and contacts with researchers. Twelve trials met the stringent selection criteria: randomization or assignment with minimal bias, use of statistical analysis, and assessment of HIV-related behavioural or biologic outcomes at least 3 months after the intervention. Random-effects models were used to aggregate data.

RESULTS

Interventions significantly reduced unprotected sex [odds ratio (OR), 0.57; 95% confidence interval (CI) 0.40-0.82] and decreased acquisition of sexually transmitted diseases (OR, 0.20; 95% CI, 0.05-0.73). Non-significant intervention effects were observed for needle sharing (OR, 0.47, 95% CI, 0.13-1.71). As a whole, interventions with the following characteristics significantly reduced sexual risk behaviours: (1) based on behavioural theory; (2) designed to change specifically HIV transmission risk behaviours; (3) delivered by health-care providers or counsellors; (4) delivered to individuals; (5) delivered in an intensive manner; (6) delivered in settings where PLWH receive routine services or medical care; (7) provided skills building, or (8) addressed a myriad of issues related to mental health, medication adherence, and HIV risk behaviour.

CONCLUSION

Interventions targeting PWLH are efficacious in reducing unprotected sex and acquisition of sexually transmitted diseases. Efficacious strategies identified in this review should be incorporated into community HIV prevention efforts and further evaluated for effectiveness.

Prevention with HIV-seropositive men who have sex with men: lessons from the Seropositive Urban Men's Study (SUMS) and the Seropositive Urban Men's Intervention Trial (SUMIT)

SUMMARY

Men who have sex with men (MSM) are disproportionately affected by HIV, and HIV-seropositive (HIV-positive) MSM are an especially important group for prevention efforts. This article describes findings from the Seropositive Urban Men's Study (SUMS, N = 456) and the Seropositive Urban Men's Intervention Trial (SUMIT, N = 1168). These studies were conducted from 1996 to 2002 with racially diverse samples from New York and San Francisco. Patterns of sexual behavior often reflected an understanding of the relative risks of specific sexual practices and were generally consistent with harm reduction strategies to reduce the risk of HIV transmission to uninfected partners. Some men, however, continued to engage in behaviors that placed themselves and their partners at risk for exposure to HIV and other sexually transmitted infections. Correlates of unprotected sex included self-efficacy, personal responsibility, substance use, mental health, and contextual influences. Disclosure of HIV status was a difficult issue for many HIV-positive MSM. Most participants had disclosed to their main partner, but they disclosed to less than half of their non-main partners before first sex. The interest of HIV-positive MSM in prevention efforts, the design of the SUMIT intervention trial, and implications for future research and programmatic efforts are discussed.

Risk Perception and sexual risk behaviors among HIV-positive men on antiretroviral therapy

There are reports of increased sexual risk behavior among people on highly active antiretroviral therapy (HAART) due to beliefs about risk of HIV transmission when on HAART. In a cross-sectional study (Seropositive Urban Men's Study), we examined the relationship between risk perception and sexual risk behavior among sexually active, culturally diverse HIV positive men who have sex with men (N = 456). Less than twenty-five percent engaged in unprotected anal sex (either with an HIV negative, or unknown-status partner, or an HIV positive partner) within the past 3 months. Most men believed there was significant health risk (to partner or self) associated with unprotected sex when on HAART. There was no increased risk behavior associated with being on HAART, although the perception of negative health consequences, including HIV transmission, when on HAART was significantly lower for the relatively small subset of men who reported unprotected sex. Prevention strategies need to be tailored to address risk perception associated with HAART.

Partner awareness of the serostatus of HIV-seropositive men who have sex with men: impact on unprotected sexual behavior

Prior research has provided conflicting evidence about the association between partner awareness of an HIV-seropositive person's serostatus and HIV transmission behavior via unprotected intercourse. The current study examined partner awareness of participant HIV-seropositive status and sexual behavior in a multiethnic sample of HIV-seropositive men who have sex with men. Most HIV-seropositive men reported that their primary partners are aware, and most reported that at least some non-primary partners are aware the participant was HIV-seropositive before first having sex. Partner awareness of participant HIV-serostatus was related to unprotected sexual behavior during the past 3 months in a non-linear fashion, as men with partners who were inconsistently aware had higher rates of unprotected receptive anal intercourse than men with partners who were consistently aware or consistently unaware. Men with partners who were inconsistently aware also had higher rates of insertive oral intercourse than men with partners who were consistently aware. However, there were no differences in HIV transmission risk behavior between men with partners who were consistently aware and men with partners who were consistently unaware a participant was HIV-seropositive.

Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation

OBJECTIVE

This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk.

METHOD

The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques.

RESULTS

City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco.

CONCLUSION

Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

Barebacking identity among HIV-positive gay and bisexual men: demographic, psychological, and behavioral correlates

OBJECTIVES

To determine the correlates associated with barebacking identity among HIV-positive gay and bisexual men.

DESIGN

An analysis of data from the baseline quantitative assessment of a randomized controlled intervention study of 1168 HIV-positive gay and bisexual men from New York City and San Francisco.

METHODS

Participants were actively and passively recruited from mainstream gay venues, AIDS service organizations, and public and commercial sex environments. Participants completed a computerized quantitative questionnaire assessing their identity as a barebacker, sexual behavior, demographic factors, psychosocial states, perceptions of health risks, and substance use.

RESULTS

Men of color were less likely to identify themselves as barebackers. Men who did identify themselves as barebackers were slightly younger. They were more likely to miss a dose of medication; report drug use (non-injection and injection); exhibit higher levels of sexual compulsivity and lower personal responsibility for safer sex; and report higher rates of unprotected insertive anal intercourse, unprotected receptive anal intercourse, and unprotected insertive oral intercourse with all partners, regardless of their HIV serostatus.

CONCLUSION

Barebacking and its corresponding behaviors pose immediate public health risks for HIV-positive gay and bisexual men. Further work is needed to understand this phenomenon more fully in relation to the psychological, sociological, biomedical, and cultural realities.

Consistent, inconsistent, and non-disclosure to casual sexual partners among HIV-seropositive gay and bisexual men

OBJECTIVE

This study examined the disclosure of HIV status to casual sex partners, factors related to disclosure, and the relationship between disclosure and HIV sexual risk behaviors among a sample of HIV-positive gay and bisexual men in New York City and San Francisco. Comparisons were made particularly among men who reported consistent disclosure, inconsistent disclosure, and non-disclosure.

METHOD

The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising, and other techniques.

RESULTS

Consistent disclosers reported greater self-efficacy for disclosing and more intentions to disclose than other men. They also reported less drug use, lower incomes, and more perceived viral consequences resulting from unsafe sex than did inconsistent disclosers. Overall, sexual risk behaviors were greater among inconsistent disclosers, followed by non-disclosers, with consistent disclosers reporting the fewest HIV sexual risk behaviors.

CONCLUSION

Disclosure is not an all-or-nothing process, as evidenced by the 38% of men in the sample who reported disclosing to some, but not all, of their casual sexual partners. These inconsistent disclosers, who reported the most sexual risk practices, seem to lack strategies to deal with disclosure and risky sex. Some men who never disclose appear to have been able to adopt strategies by which they do not engage in sexual risk with casual partners. Interventions to improve self-efficacy for disclosure and help HIV-positive gay and bisexual men to identify and adopt specific strategies to address disclosure and safe sex are needed.

Effects of a peer-led behavioral intervention to reduce HIV transmission and promote serostatus disclosure among HIV-seropositive gay and bisexual men

OBJECTIVES

To evaluate the effects of an enhanced peer-led intervention on transmission risk behavior and serostatus disclosure of HIV-seropositive gay and bisexual men.

DESIGN

A randomized intervention trial.

METHODS

HIV-seropositive gay and bisexual men were recruited from New York City and San Francisco and were randomly assigned to either a standard or an enhanced intervention. The standard intervention consisted of one session that provided safer sex information. The enhanced intervention consisted of six sessions and included safer sex information, interactive learning activities, and discussion groups that were facilitated by HIV-seropositive peers. Participants completed audio computer-assisted self interview (A-CASI) assessments at baseline and 3 and 6-month follow-ups. Optional testing for sexually transmitted infections was offered at baseline and the 6-month follow-up.

RESULTS

A total of 811 participants met the inclusion criteria for outcome analyses. Of these, 85 and 90% were retained for the 3 and 6-month follow-ups, respectively. Compared with the standard intervention, fewer men assigned to the enhanced intervention reported unprotected receptive anal intercourse with a negative or unknown-serostatus partner at 3 months (21 versus 26%, P < 0.05). However, there were no other significant differences in transmission risk or serostatus disclosure at 3 or 6 months.

CONCLUSION

The enhanced intervention was associated with only a limited reduction in transmission risk at 3 months relative to the standard intervention. The characteristics of the intervention that may have reduced its efficacy are identified and directions for future research are suggested.

Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men

OBJECTIVES

We sought to identify the determinants of sexual transmission risk behavior by HIV-positive individuals. We examined social cognitive theory (SCT) variables, which have been found to mediate the effectiveness of HIV risk reduction interventions. We also sought to identify contextual influences that might contribute to initial levels of SCT factors such as self-efficacy.

METHOD

In the present study, a series of social cognitive variables and a number of factors hypothesized to influence self-efficacy were assessed among participants at baseline in the Seropositive Urban Men's Intervention Trial. Variables tested for their effects on self-efficacy included hedonistic and self-evaluative outcome expectancies, sexual compulsivity, a history of childhood sexual abuse, drug use, and race. Models predicting condom use during anal sex with partners of HIV-negative or unknown status were tested separately for main partners and for non-main partners.

RESULTS

Self-efficacy was associated with condom use in both analyses. Contextual influences on condom use with main partners were fewer and operated mostly via effects on self-efficacy. Influences on condom use with non-main partners exerted both direct effects on condom use and effects mediated by self-efficacy. Drug use was predictive of condom use with non-main, but not main, partners.

DISCUSSION

The present results support the approach of addressing both standard SCT factors, and when possible contextual factors in interventions for HIV-positive men.

Prevention with gay and bisexual men living with HIV: rationale and methods of the Seropositive Urban Men's Intervention Trial (SUMIT)

OBJECTIVES

To provide a public health rationale for prevention with HIV-seropositive gay and bisexual men and to describe the methods of the Seropositive Urban Men's Intervention Trial (SUMIT).

DESIGN

A randomized intervention trial.

METHODS

Self-identified HIV-positive gay and bisexual men were recruited from community-based venues in New York City and San Francisco. Eligible participants completed an A-CASI baseline assessment, were asked to provide samples for sexually transmitted infection (STI) testing, and were randomly assigned to either a single-session intervention or a six-session enhanced intervention designed to reduce HIV transmission risk and promote serostatus disclosure. Participants who attended the first intervention session were assessed 3 and 6 months post-intervention. STI testing was offered at the 6-month assessment.

RESULTS

A total of 1168 self-identified HIV-seropositive gay and bisexual men completed the baseline assessment, and 1110 of these (95%) opted for STI testing. A total of 811 attended the first intervention session, of which 85% were assessed at 3 months and 90% were assessed at 6 months. Of those assessed at 6 months, 92% (670/729) provided a blood or urine sample for STI testing.

CONCLUSION

SUMIT demonstrates the feasibility and acceptability of prevention research with HIV-seropositive gay and bisexual men. The study provides new information about the sexual behavior, serostatus disclosure practices, and the efficacy of an intervention to reduce HIV transmission risk.

Seroconcordant sexual partnerings of HIV-seropositive men who have sex with men

OBJECTIVES

To describe the sexual behaviors of HIV-positive men with their seroconcordant partners and to determine the factors associated with unprotected anal intercourse (UAI) in these sexual partnerings.

METHODS

The data were drawn from the baseline assessment of a randomized controlled intervention study of 1168 HIV-positive men who have sex with men recruited from mainstream gay venues, AIDS service organizations, and public/commercial sex environments.

RESULTS

Of the 1168 men, 596 engaged in sexual experiences with other HIV-positive men, and 371 of the 596 (62%) practised UAI with their seroconcordant partners. Those who engaged in UAI expressed less self-evaluation with regard to their unsafe sexual practices, had higher levels of hedonism associated with unsafe sex, and were more likely both to inject recreation drugs and use methamphetamine in particular. Furthermore, these participants expressed less concern with regard to HIV re-infection, infection with other sexually transmitted infections, and the transmission of pathogens causing opportunistic infections.

CONCLUSION

Our findings suggest that at least three sets of factors predispose HIV-positive men to engage in unsafe anal sexual behaviors with their concordant partners: a decreased belief that infection with other pathogens or re-infection with HIV present health problems; less evaluation of sexual activities and behaviors; more hedonistic expectations of sex and higher levels of sexual compulsivity, as well as recreational drug use with and without sex.

Predictors of the use of viagra, testosterone, and antidepressants among HIV-seropositive gay and bisexual men

OBJECTIVE

To examine the use and correlates of the use of prescription drugs that may affect sexual behavior among HIV-positive gay and bisexual men.

METHODS

In a cross-sectional assessment of baseline data from a behavioral intervention, we recruited 1168 HIV-positive gay and bisexual men in 2000-2001 from community venues in New York City and San Francisco, and determined the point prevalence of the use of viagra, testosterone, and antidepressants. We examined bivariate and multivariate associations between the use of each drug and demographics, health status, substance use, psychological symptoms, and sexual risk.

RESULTS

The current use of antidepressants was 21%, testosterone 19%, and viagra 12%. Some viagra users reported using drugs that could interact dangerously with viagra. The use of viagra, testosterone, or antidepressants was related to unprotected receptive anal intercourse and unprotected insertive oral intercourse (UIOI) with both HIV-positive and HIV-negative/unknown-status casual partners. The use of viagra was also associated with unprotected insertive anal intercourse. In multivariate models, viagra use was associated with being older, more educated, using ketamine, and engaging in UIOI with HIV-negative/unknown-status casual partners. Testosterone use was associated with being more educated and using nitrites (poppers). Antidepressant use was associated with race, using poppers, and being more depressed.

CONCLUSION

Prescription medications used by HIV-positive men can have unintended negative effects such as drug interactions or associations with risky sexual behavior, particularly a drug such as viagra that is fast acting, short lasting, and provides a desirable effect. Physicians should discuss these issues with patients when prescribing, and interventions should address these challenges.

Condom use and perceived risk of HIV transmission among sexually active HIV-positive men who have sex with men

This study examined the association between HIV transmission risk perception and the sexual risk behaviors of HIV-positive men who have sex with men. Respondents rated the degree of risk of transmitting HIV through insertive anal intercourse and insertive oral sex. We examined (a) the perceived level of HIV transmission risk assigned to each sexual behavior and (b) the association between perceived risk for HIV transmission and condom use during insertive anal intercourse and insertive oral sex. We found for behaviors that have achieved less risk consensus that as transmission risk perception increases, so too does the likelihood of condom use. This study highlights the need for more research in understanding how perceived health risk to others influences protective behaviors.

Sexual risk of HIV transmission is missed by traditional methods of data collection

Brief acts of unprotected anal sex (i.e.'dipping') have not been systematically measured in AIDS research. Eleven per cent of HIV-positive men who reported that they had not engaged in any unprotected insertive anal intercourse with an HIV-negative or unknown status partner reported that they did engage in insertive 'dipping'. Men reported 'dipping' an average of 5.1 times, representing 773 acts of insertive intercourse that would have been missed by traditional methods of sexual data behavior.

Self-Perceived Responsibility of HIV-Seropositive Men Who Have Sex with Men for Preventing HIV Transmission

Relatively little attention has been paid to unique factors that may motivate HIV-seropositive men who have sex with men (MSM) to prevent HIV transmission. This study examines the beliefs of 250 HIV-seropositive MSM about their responsibility for protecting sex partners from HIV infection. Participants completed an open-ended interview about their sexual practices, substance use, and other HIV-related issues. Seventy percent of participants were men of color. Most participants (72%) spontaneously mentioned issues related to responsibility that were represented by three themes: (1) personal responsibility for protecting sex partners, (2) partners' responsibility for protecting themselves, and (3) mutual responsibility. These beliefs were expressed by 63%, 24%, and 12% of respondents, respectively. Motivations underlying beliefs about personal responsibility included altruism, self-standards, and self-interest. Beliefs about personal responsibility were influenced by participant characteristics, partner characteristics, disclosure of HIV status, and contextual factors. The findings suggest that self-perceived responsibility may be an important factor that affects HIV-seropositive MSM's sexual decision making.

Correlates of sexual risk behaviors among HIV-positive men who have sex with men

This study examines correlates of unprotected sexual risk practices of an ethnically diverse sample of HIV-seropositive men who have sex with men (MSM) from the New York City and San Francisco metropolitan areas. Participants completed a self-report survey that assessed sexual risk behaviors and potential correlates. A total of 367 men reported sex with a casual male partner in the previous 3 months. Participants were divided into three groups based on level of HIV-transmission risk with HIV negative or unknown-status partners: no unprotected anal sex (58.9%), unprotected receptive anal sex only (14.2%), and unprotected insertive anal sex (22.6%). Multivariate logistic regression analyses indicated that men reporting unprotected anal insertive sex perceived less responsibility to protect their partners from HIV. Men reporting no unprotected anal sex also reported less use of nitrate inhalants, lower temptation for unsafe sex, and fewer HIV-negative and unknown-status partners. Men reporting unprotected receptive anal sex were less anxious than the other two groups but also reported greater depression than those not reporting unprotected anal sex and greater loneliness than those reporting unprotected anal insertive sex. Implications for interventions with HIV-positive MSM are presented.

Interests in HIV prevention topics of HIV-seropositive men who have sex with men

As improved medical treatments have extended the lives of persons with HIV, prevention programs increasingly address these persons' ability to adopt and sustain HIV risk reduction behavior. Little is known about which HIV-seropositive persons would most likely use prevention programs or what program topics would best meet the needs of this population. A diverse sample of HIV-seropositive men who have sex with men (MSM, N = 206) rated their interest in a variety of program topics addressing physical and mental health issues. Topics specific to HIV prevention were of interest to most MSM, but the level of interest was generally lower than for other topics. Compared with White MSM, African American MSM had higher overall interest in programs addressing safer sex and programs addressing serostatus disclosure. Higher active coping was related to more interest in a broad range of program topics for HIV-seropositive men, programs addressing safer sex, and programs addressing serostatus disclosure. Risk behavior was not associated with program interests. Gaining a better understanding of interest in a variety of program topics among persons living with HIV is an important step in enhancing HIV transmission prevention programs.