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Zeng W, Luo Y, Liu F, Han Z, Zhan L, Lu Y, Cai Y, Xu H, Gu Y. Impact of Awareness of Sexual Partners' HIV Serostatus on the HIV Acquisition among Men Who Have Sex with Men in Guangzhou, China: A Nested Case-Control Study. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:3655-3662. [PMID: 39152320 DOI: 10.1007/s10508-024-02971-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/24/2024] [Accepted: 07/30/2024] [Indexed: 08/19/2024]
Abstract
This study aimed to investigate the impact of sexual partners' HIV serostatus awareness on the HIV acquisition among men who have sex with men (MSM) in Guangzhou, China. A nested case-control study was conducted based on a prospective cohort of MSM in Guangzhou. Within the cohort, individuals who underwent HIV seroconversion were identified as the case group, and each case was matched with four controls from the non-seroconverted participants. Information regarding the awareness of sexual partners' HIV serostatus over the preceding 6 months was gathered. Of the 161 participants, 36.0% were aware of the HIV serostatus of all their sexual partners. The practice of engaging in condomless anal sex with partners of unknown HIV serostatus and being aware of the HIV serostatus of only some casual partners were positively correlated with an elevated risk of acquiring HIV. Conversely, being fully aware of the HIV serostatus of all sexual partners, including regular ones, was associated with a diminished risk of HIV incidence. Regular communication with sexual partners regarding HIV testing outcomes, honest disclosure of one's own HIV serostatus, and refusal of sexual contact with partners of unknown HIV serostatus can potentially mitigate the risk of acquiring HIV among MSM.
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Affiliation(s)
- Wenting Zeng
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China
- Huangpu District Center for Disease Control and Prevention, Guangzhou, China
| | - Yefei Luo
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China
| | - Fanghua Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China
| | - Zhigang Han
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China
| | - Lishan Zhan
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China
| | - Yongheng Lu
- Lingnan Partner Community Support Center, Guangzhou, China
| | - Yanshan Cai
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China
| | - Huifang Xu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China
- Guangdong Association of STD and AIDS Prevention and Control, Guangzhou, China
| | - Yuzhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China.
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Kota KK, Gelaude D, Carnes N, Schoua-Glusberg A, Frew PM, Randall L, Gale B, Betley V, Mansergh G. Low Self-Perceived Need for PrEP and Behavioral Indications of MSM Who Recently Refused Daily PrEP: A Mixed Methods Study in Three U.S. Cities. AIDS Behav 2024; 28:1845-1857. [PMID: 38457051 PMCID: PMC11216258 DOI: 10.1007/s10461-024-04276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/09/2024]
Abstract
Pre-exposure prophylaxis (PrEP) reduces sexual risk for HIV transmission by 99% when used appropriately, but remains underutilized among gay, bisexual, and other men who have sex with men (MSM). In this mixed-method study, we describe reasons for PrEP refusal associated with low self-perceived need for PrEP among MSM who recently declined daily oral PrEP when offered by a provider. Data are from a quantitative behavioral survey of MSM (N = 93) living in Atlanta, Chicago, and Raleigh-Durham, who also either responded to an in-depth interview (n = 51) or participated in one of 12 focus groups (n = 42). Themes of low self-perceived need for PrEP were: low self-perceived risk for HIV acquisition (33% of respondents); confidence in remaining HIV-negative (35%); using condoms (81%); limiting number of partners and choosing partners carefully (48%); asking partners about their HIV status before having sex (45%); engaging in safer sexual positions or oral sex (28%); being in a monogamous relationship or exclusivity with one partner (26%); and regular HIV testing (18%). Low self-perceived risk for HIV acquisition and high confidence in other prevention strategies were important factors related to low self-perceived need in MSM refusing daily oral PrEP when offered. Providers should continue to discuss the benefits of PrEP as a safe and highly effective option for HIV prevention.
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Affiliation(s)
- Krishna Kiran Kota
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H18-3, Atlanta, GA, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Deborah Gelaude
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H18-3, Atlanta, GA, USA
| | - Neal Carnes
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H18-3, Atlanta, GA, USA
| | | | - Paula M Frew
- Emory University School of Medicine, Atlanta, GA, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Laura Randall
- Emory University School of Medicine, Atlanta, GA, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Bryan Gale
- American Institutes for Research, Arlington, VA, USA
| | | | - Gordon Mansergh
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H18-3, Atlanta, GA, USA
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3
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Jiménez-Rivagorza L, Orozco R, Medina-Mora ME, Rafful C. HIV-Related Stigma and Treatment Adherence Among Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Meth in the Metropolitan Area of Mexico City. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1561-1574. [PMID: 38409457 PMCID: PMC10954905 DOI: 10.1007/s10508-024-02816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/28/2024]
Abstract
Internationally, HIV-related stigma and crystal methamphetamine (meth) use have been described as barriers to treatment adherence among gay, bisexual, and other men who have sex with men (gbMSM). Crystal meth use has been increasing among gbMSM in the Metropolitan Area of Mexico City (MAMC). Therefore, this study aimed to determine the association between HIV-related stigma and HIV treatment adherence among gbMSM who use crystal meth in the MAMC. This study was undertaken as part of an exploratory study of crystal meth use in the MAMC. The data were collected from September to December 2021 through an encrypted online survey. Participants (n = 89) were gbMSM adults living with HIV who reported crystal meth use in the past month that were recruited through an online snowball sampling. The online survey included questions about HIV treatment adherence, sexual behaviors, the Alcohol, Smoking, and Substance Involved Screening Test, and the HIV-Related Stigma Mechanisms Scale. Logistic regression analyses assessed the association between HIV-related stigma and HIV treatment adherence. The multivariate logistic regression model showed that, controlling for health insurance [adjusted odds ratio (AOR) = 0.13; 95% confidence intervals (CI) = 0.02-0.59] and educational level (AOR = 0.16; 95% CI = 0.02-0.88), non-adherence to HIV treatment was independently associated with higher HIV-related stigma (AOR = 1.06; 95% CI = 1.01-1.12). Public health policies must include HIV-related stigma and substance use in treating gbMSM with HIV.
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Affiliation(s)
- Leonardo Jiménez-Rivagorza
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico
| | - Ricardo Orozco
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - María Elena Medina-Mora
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria, 04510, Coyoacan, Mexico City, Mexico.
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico.
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Malekinejad M, Jimsheleishvili S, Barker EK, Hutchinson AB, Shrestha RK, Volberding P, Kahn JG. Sexual Practice Changes Post-HIV Diagnosis Among Men Who Have Sex with Men in the United States: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:257-278. [PMID: 35829969 PMCID: PMC9834435 DOI: 10.1007/s10461-022-03761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Men who have sex with men (MSM) often change sexual behaviors following HIV diagnosis. This systematic review examined such changes, including sero-adaptive behaviors (i.e., deliberate safer-sex practices to reduce transmission risk) to better understand the magnitude of their association with HIV diagnosis. We searched four databases (1996-2017) and reviewed references from other systematic reviews. We included studies conducted in the United States that compared sexual behavior among HIV-infected "aware" versus "unaware" MSM. We meta-analytically pooled RRs and associated 95% confidence intervals (CI) using random-effects models, and assessed risk of bias and evidence quality. Twenty studies reported k = 131 effect sizes on sexual practices outcomes, most of which reported changes in unprotected sex (k = 85), and on sex with at-risk partners (k = 76); 11 reported sero-adaptive behaviors. Unprotected anal intercourse with an HIV-uninfected/unknown-status partner was less likely among aware MSM (insertive position: k = 2, RR 0.26, 95% CI 0.17, 0.41; receptive position: k = 2, RR 0.53, 95% CI 0.37, 0.77). Risk of not always serosorting among aware MSM (k = 3) was RR = 0.92 (0.83, 1.02). Existing evidence, although low-quality, suggests that HIV-infected MSM tend to adopt safer sexual practices once aware of their diagnosis. Variation in reporting of outcomes limits their comparability. Sero-adaptive behavior data are sparse.
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Affiliation(s)
- Mohsen Malekinejad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA ,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA ,Consortium to Assess Prevention Economics, University of California, San Francisco, San Francisco, CA USA ,550 16th Street, San Francisco, CA 94158 USA
| | - Sopiko Jimsheleishvili
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA
| | - Erin K. Barker
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA
| | - Angela B. Hutchinson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Ram K. Shrestha
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Paul Volberding
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA ,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA ,Consortium to Assess Prevention Economics, University of California, San Francisco, San Francisco, CA USA
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Uzun Jacobson E, Li Z, Bingham A, Farnham PG, Sansom SL. Assessing the individual benefits of reducing HIV diagnosis delay and increasing adherence to HIV care and treatment. AIDS Care 2022; 35:1007-1013. [PMID: 36524868 DOI: 10.1080/09540121.2022.2147478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We used an agent-based simulation model (Progression and Transmission of HIV) to follow for 20 years a cohort of persons in the United States infected with HIV in 2015. We assessed the benefits of reducing the delay between HIV infection and diagnosis and increasing adherence to HIV care and treatment on the percent of persons surviving 20 years after infection, average annual HIV transmission rates, and time spent virally suppressed. We examined average diagnosis delays of 1.0-7.0 years, monthly care drop-out rates of 5% to 0.1%, and combinations of these strategies. The percent of the cohort surviving the first 20 years of infection varied from 70.8% to 77.5%, and the annual transmission risk, from 1.5 to 5.2 HIV transmissions per 100 person-years. Thus, individuals can enhance their survival and reduce their risk of transmission to partners by frequent testing for HIV and adhering to care and treatment.
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Affiliation(s)
- Evin Uzun Jacobson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zihao Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adrienna Bingham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul G. Farnham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie L. Sansom
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lentz C, Lopez-Rios J, Dolezal C, Kutner BA, Rael CT, Balán IC. Negotiating Use of a Blood-Based, Dual HIV and Syphilis Test with Potential Sexual Partners Among a Sample of Cisgender Men and Transgender Women Who Have Sex with Men in New York City. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2015-2025. [PMID: 35449365 PMCID: PMC9197957 DOI: 10.1007/s10508-021-02275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 05/03/2023]
Abstract
Cisgender men who have sex with men (cMSM) and transgender women (TGW) are disproportionally burdened by HIV. Among these populations, HIV partner-testing is a highly acceptable harm reduction tool. Particularly, cMSM and TGW report a stronger preference for blood-based tests that include assays for multiple STIs. However, no existing research has explored how these populations negotiate blood-based testing with sexual partners. In the SMARTtest study, 48 sexually active cMSM and TGW took home dual, blood-based HIV/Syphilis kits for self- and partner-testing. After 3 months, they completed a follow-up assessment and in-depth interviews about their experiences initiating testing. Of the 42 responding participants, 27 (64%) reported that it had been "fairly" or "very easy" to raise the idea of testing with partners. Participants predominantly employed partner-conscious communication strategies, including framing the testing proposal as a mandatory, non-personal component of their participation in a research study, gradually incorporating testing mentions into discussions about sexual health, and using the kits to facilitate joint testing. Yet, 21 (44%) participants reported having sex with at least one partner they did not ask to test. Concern regarding partner reactions emerged as a significant barrier to discussing test use; similarly, many partners were averse to taking a blood-based test in the context of a casual sexual encounter. Nonetheless, these findings suggest that dual, blood-based HIV/STI rapid tests may represent acceptable harm reduction tools among similar populations of cMSM and TGW, particularly if future partner-testing research is broadened to consider key couples' dynamics that may impact test usage.
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Affiliation(s)
- Cody Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Javier Lopez-Rios
- Department of Community Health and Prevention, Dornsife School of Public Health at Drexel University, Philadelphia, PA, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Christine Tagliaferri Rael
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- College of Nursing, Anschutz Medical Campus at Colorado University, Aurora, CO, USA
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA.
- Center for Translational Behavioral Science, Florida State University College of Medicine, 2010 Levy Avenue Building B, Suite B0266, Tallahassee, FL, 32310, USA.
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Mann LM, Kelley CF, Siegler AJ, Stephenson R, Sullivan PS. Seroadaptive Strategy Patterns of Young Black Gay, Bisexual, and Other Men Who Have Sex With Men in Atlanta, Georgia. J Acquir Immune Defic Syndr 2022; 89:40-48. [PMID: 34878433 PMCID: PMC8711639 DOI: 10.1097/qai.0000000000002816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Young Black gay, bisexual, and other men who have sex with men (YBMSM) are disproportionally affected by HIV. Seroadaptive strategies-modification of sexual behavior based on an individual's perceived serostatus, the perceived status of the partner, and/or HIV transmission risk by the type of sex act-are often used to reduce the risk of HIV transmission or acquisition. METHODS We used demographic, behavioral, and clinical data from Ele[MEN]t, a prospective cohort study of YBMSM aged 18-29 years in Atlanta, GA, conducted during 2015-2019. The prevalence of seroadaptive strategies at baseline was reported, and latent class analysis was used to identify the latent classes of strategies for both YBMSM known and not known to be living with HIV. Latent classes were compared by key behavioral and clinical characteristics to validate our findings. RESULTS In a 4-class model, the most common latent class of YBMSM not known to be living with HIV (32.4%) was characterized by all individuals reporting only having sex with men not perceived to be living with HIV. The most common latent class of YBMSM known to be living with HIV (48.2%) was characterized by a combination of serosorting strategies, including using condoms for anal sex with partners not known to be living with HIV and avoiding sex with men not known to be living with HIV. CONCLUSIONS YBMSM use various patterns of strategies to reduce their HIV transmission or acquisition risk. Our study highlights the need for targeted HIV prevention recommendations based on individual behaviors.
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Affiliation(s)
- Laura M. Mann
- Department of Epidemiology, Emory University, Atlanta, GA
| | - Colleen F. Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA
| | | | - Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI
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8
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Goodreau SM, Maloney KM, Sanchez TH, Morris M, Janulis P, Jenness SM. A Behavioral Cascade of HIV Seroadaptation Among US Men Who Have Sex with Men in the Era of PrEP and U = U. AIDS Behav 2021; 25:3933-3943. [PMID: 33884510 PMCID: PMC8528882 DOI: 10.1007/s10461-021-03266-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 10/25/2022]
Abstract
Seroadaptive behaviors help reduce HIV risk for some men who have sex with men (MSM), and have been well documented across MSM populations. Advancements in biomedical prevention have changed the contexts in which seroadaptive behaviors occur. We thus sought to estimate and compare the prevalence of four stages of the "seroadaptive cascade" by PrEP use in the recent era: knowledge of own serostatus, knowledge of partner serostatus; serosorting (matching by status), and condomless anal intercourse. Serosorting overall appeared to remain common, especially with casual and one-time partners. Although PrEP use did not impact status discussion, it did impact serosorting and the likelihood of having condomless anal intercourse. For respondents not diagnosed with HIV and not on PrEP, condomless anal intercourse occurred in just over half of relationships with HIV-positive partners who were not on treatment. Biomedical prevention has intertwined with rather than supplanted seroadaptive behaviors, while contexts involving neither persist.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology and Center for Studies in Demography and Ecology, University of Washington, Campus Box 353100, Seattle, WA, 91895, USA.
| | - Kevin M Maloney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington, Seattle, WA, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Sharma A, Paredes-Vincent A, Kahle EM. Awareness, Utilization, and Preferences for Traditional and Contemporary HIV Prevention Strategies Among Facebook and Instagram-Using MSM in the United States. J Int Assoc Provid AIDS Care 2021; 20:23259582211024770. [PMID: 34132144 PMCID: PMC8212379 DOI: 10.1177/23259582211024770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
HIV prevention research among men who have sex with men (MSM) has traditionally
focused on individual risk reduction strategies. Our study evaluated awareness,
utilization, and preferences for 10 complementary HIV prevention strategies
among 1,286 MSM recruited via Facebook and Instagram from June-August 2018. Ages
ranged from 18-85 years, and the majority were non-Hispanic white (n = 1,019,
79.24%), college-educated (n = 819, 63.69%), gay-identifying (n = 1,074,
83.51%), and partnered (n = 808, 62.83%). Post-exposure prophylaxis was the
least familiar option, and engaging in sexual activities other than anal sex was
the most utilized option. Progressively older and bisexual-identifying MSM were
less likely, but those with higher educational levels and easy access to local
HIV resources were more likely to be aware of and to be utilizing a greater
number of strategies. Additionally, Hispanic MSM were less likely to be aware
of, and those in a “closed” relationship were less likely to be utilizing a
greater number of strategies. In a subset of 775 multiple strategy users,
pre-exposure prophylaxis, regularly testing for HIV, and limiting the number of
sex partners emerged as the most preferred options. Combination intervention
packages for MSM should be tailored to personal circumstances, including sexual
orientation, relationship characteristics and access to local HIV resources.
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Affiliation(s)
- Akshay Sharma
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Ariana Paredes-Vincent
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Erin M Kahle
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
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10
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Schnarrs PW, Jones SS, Parsons JT, Baldwin A, Rosenberger JG, Lunn MR, Rendina HJ. Sexual Subcultures and HIV Prevention Methods: An Assessment of Condom Use, PrEP, and TasP Among Gay, Bisexual, and Other Men Who Have Sex with Men Using a Social and Sexual Networking Smartphone Application. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1781-1792. [PMID: 32728870 PMCID: PMC10388693 DOI: 10.1007/s10508-020-01784-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
Despite being grouped together in epidemiological risk categories, gay, bisexual, and other men who have sex with men (GBM) are not a homogenous group. In addition to traditional segmentation along race, ethnicity, and socioeconomic status, many GBM also identify with sexual subcultural communities. Previous research has shown differences across a variety of health outcomes between these sexual subcultural communities. The purpose of this study was to determine whether HIV prevention practices among GBM differed according to sexual subcultural community. The study was conducted in collaboration with a popular social and sexual networking smartphone application company. A total of 23,577 GBM responded to the survey. A latent class analysis identified 6 distinct classes related to sexual subcultural community identification. We found significant differences across sociodemographic characteristics, HIV prevention practices, and condomless anal sex in the past 6 months related to sexual subculture identification. Findings suggest that sexual subcultural identity is related to decision-making around HIV prevention among GBM. Differences in HIV prevention strategies are likely a function of group norms, unique shared experiences among GBM identifying with a particular sexual subculture community, and sociodemographic characteristics associated with these groups. As such, sexual subculture identity should be considered in developing interventions and social marketing campaigns to increase uptake of biomedical HIV prevention tools among GBM. Identifying group norms and shared experiences related to HIV prevention practices among sexual subcultures is necessary to understand the role these identities play in lives of GBM, especially as it relates to their sexual health and well-being.
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Affiliation(s)
- Philip W Schnarrs
- Division of Community Engagement and Health Equity, Department of Population Health, Dell Medical School, The University of Texas at Austin, Health Discovery Building 4.814, 1601 Trinity Street, Austin, TX, 78712, USA.
- The Population Research Center, The University of Texas at Austin, Austin, TX, USA.
| | - Stephen Scott Jones
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Aleta Baldwin
- Department of Public Health, California State University at Sacramento, Sacramento, CA, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, USA
| | - Mitchell R Lunn
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University, Stanford, CA, USA
| | - H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
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11
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Sexual Dysfunction in Men Who Have Sex With Men. Sex Med Rev 2021; 10:130-141. [PMID: 33931381 DOI: 10.1016/j.sxmr.2021.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Historically, sexual health research has focused on men who have sex with women (MSW) and most research examining the sexual health of men who have sex with men (MSM) has focused on HIV transmission. Despite a high prevalence of sexual health disorders among MSM, there is limited research that has evaluated the diversity of sexual issues in these patients. OBJECTIVES The purpose of this review is to describe the unique sexual behaviors, concerns, and dysfunctions of MSM by evaluating the literature on sexual health in this specific patient population. METHODS A PubMed literature search was conducted through December 2020 to identify all relevant publications related to the sexual health, sexual practices, and sexual dysfunction of MSM. Original research, review articles, and meta-analyses were reviewed, including comparisons of sexual behavior and dysfunction between MSM and non-MSM populations and between gay/bisexual men and heterosexual men. Approximately 150 relevant articles were reviewed and 100 were included in the manuscript. RESULTS Minority stress can lead to an increase in high-risk sexual behavior, sexual dysfunction, and mental health disorders in MSM. MSM engage in a variety of sexual behaviors, which can lead to differences in sexual dysfunction, such as anodyspareunia during receptive anal intercourse. MSM have higher rates of erectile dysfunction than non-MSM counterparts. MSM have unique activators of sexual pathologies, such as insertive anal intercourse for Peyronie's disease. Prostate cancer treatment may cause MSM to change sexual roles and practices following treatment due to ED, anodyspareunia, or decrease in pleasure from receptive anal intercourse after prostatectomy. CONCLUSION MSM have been neglected from sexual medicine research, which translates to disparities in health care. Further research that focuses on the MSM population is necessary to better educate healthcare practitioners so that MSM patients can receive adequate care that is tailored to their specific needs. PJ Cheng, Sexual Dysfunction in Men Who Have Sex With Men. Sex Med Rev 2021;XX:XXX-XXX.
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Storholm ED, Mutchler MG, Ghosh-Dastidar B, Balan E, Mokhbat J, Kegeles SM, Wagner GJ. Gearing up for PrEP in the Middle East and North Africa: An Initial Look at Willingness to Take PrEP among Young Men Who Have Sex with Men in Beirut, Lebanon. Behav Med 2021; 47:111-119. [PMID: 31851587 PMCID: PMC7299800 DOI: 10.1080/08964289.2019.1661822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/03/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022]
Abstract
The Middle East and North Africa (MENA) is one of only two global regions where rates of HIV are currently on the rise. In Lebanon, new HIV infections are increasing most rapidly among young men who have sex with men (YMSM). While, the majority of YMSM in Lebanon report having recently engaged in condomless anal intercourse, many report reluctance to seek HIV prevention services for fear of stigma and discrimination. Pre-exposure prophylaxis (PrEP) is an effective alternative HIV prevention strategy but there is a dearth of research looking at willingness to take PrEP among YMSM in MENA. This study is the first to delineate factors associated with willingness to take PrEP among a cohort of 218 YMSM recruited from Beirut, Lebanon. Over half (55.5%) reported willingness to take PrEP. At the bivariate level, knowledge of HIV risk, awareness of PrEP, being in a relationship, greater judgementalism about sex in communication with peers, greater number of types of gay-related discrimination experienced, sense of community among YMSM, having had recent condomless anal sex with positive or unknown status partner, and the use of substances just prior to or during sex were each associated with greater willingness to take PrEP. When entered into a linear regression analysis, use of substances just prior to or during sex and sense of community among YMSM remained significant predictors of PrEP willingness. Intervention efforts focused on increasing PrEP uptake among YMSM in MENA should consider the influence substance use and social factors on willingness to take PrEP.
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Affiliation(s)
| | - Matt G Mutchler
- Urban Community Research Center, California State University
| | | | - Elie Balan
- Arab Foundation for Freedom and Equality
| | - Jacques Mokhbat
- Department of Medicine, Lebanese American University School of Medicine
| | - Susan M Kegeles
- School of Medicine, Division of Prevention Science, University of California, San Francisco
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Truong HHM, Mehrotra ML, Grant RM. Brief Report: Seroadaptive Behaviors Varied Among Geographically Diverse iPrEx Participants. J Acquir Immune Defic Syndr 2021; 86:e43-e47. [PMID: 33093331 DOI: 10.1097/qai.0000000000002551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seroadaptive behaviors refer to a wide range of harm reduction practices to decrease HIV transmission risk. Effective implementation of seroadaptive behaviors is dependent on knowledge of one's own serostatus and that of one's sexual partners. Partner-level and environmental-level attributes may affect seroadaptation practices. We assessed factors associated with seroadaptive behaviors. METHODS Men who have sex with men and transgender women were recruited from an HIV pre-exposure prophylaxis clinical trial (iPrEx) with study sites in the US, Peru, Ecuador, Brazil, Thailand, and South Africa. Partnership-level data were collected at the baseline visit for the 3 most recent partners. Participants were considered to have practiced seroadaptive behaviors if: (1) they believed their partner to be HIV-negative, that is, serosorting; or (2) no condomless receptive sex occurred with an HIV-positive or unknown status partner, that is, seropositioning. RESULTS Of 2331 participants, 41% always practiced seroadaptive behaviors, 36% sometimes did, and 23% never did. Participants enrolled at study sites in the US (P < 0.001) and Peru/Ecuador (P < 0.001) were more likely to practice seroadaptive behaviors, whereas transgender women were less likely to do so (P < 0.001). Seroadaptive behaviors were more likely to occur in relationships with steady partners (P = 0.005) and emotionally close relationships (P = 0.013). CONCLUSIONS Seroadaptive behaviors were more frequently observed among iPrEx participants from the US, Peru, and Ecuador study sites and among participants in relationships with partners who they were more committed to and felt emotionally close to. Our findings suggest that seroadaptive behaviors may be influenced by social norms that vary geographically and culturally.
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Affiliation(s)
| | - Megha L Mehrotra
- Epidemiology and Biostatistics, University of California, San Francisco, CA
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Mansergh G, Stephenson R, Hirshfield S, Sullivan P. Understanding HIV Sexual Protection and Its Association With Substance Use During Sex Among MSM in an Era of Multiple Primary Prevention Products. J Acquir Immune Defic Syndr 2020; 85:e67. [PMID: 33136756 DOI: 10.1097/qai.0000000000002480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gordon Mansergh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Broaching the Topic of HIV Self-testing with Potential Sexual Partners Among Men and Transgender Women Who Have Sex with Men in New York and Puerto Rico. AIDS Behav 2020; 24:3033-3043. [PMID: 32239360 DOI: 10.1007/s10461-020-02851-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Men who have sex with men (MSM) and transgender women (TGW) are highly affected by HIV and need novel prevention strategies. Using HIV self-testing (HIVST) kits to screen sexual partners may represent a viable risk-reduction alternative; however, more research is needed on effective strategies for broaching HIVST with partners. In the ISUM study, 136 MSM and TGW were given ten HIVST kits for self- and partner-testing. After 3 months, they returned for a follow-up assessment; thirty participants were also selected for in-depth interviews about their experiences initiating HIVST with partners. Most found proposing HIVST to a diverse array of partners relatively easy. They employed strategies such as joint testing and integrating HIVST into larger discussions about protection and sexual health, with moderate success. Nonetheless, real or anticipated negative partner reactions were a significant barrier. Future research can inform best practices for safely and successfully broaching HIVST with sexual partners.
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Sullivan MC, Cruess DG, Huedo-Medina TB, Kalichman SC. Substance Use, HIV Serostatus Disclosure, and Sexual Risk Behavior in People Living with HIV: An Event-Level Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2005-2018. [PMID: 31863314 DOI: 10.1007/s10508-019-01531-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/21/2019] [Accepted: 07/31/2019] [Indexed: 05/22/2023]
Abstract
People living with HIV (PLWH) face difficult decisions about disclosing their HIV status to new sexual partners. Alcohol and other drug use could impact these decision-making processes and subsequent sexual risk behavior. We sought to examine the event-level relationships between substance use, HIV disclosure, and condom use in PLWH and their first-time HIV-negative or unknown status sexual partners. Adult PLWH were recruited from care settings in a southeastern U.S. city. Participants reported their sexual behavior for 28 consecutive days via text message prompts. We employed multilevel covariation in a causal system to examine the event-level relations between substance use and condom use. We proposed that this relationship would be mediated by HIV disclosure and moderated by viral suppression status. A total of 243 participants (83% male, 93% Black) reported 509 sexual events with first-time HIV-negative/unknown status sexual partners. Substance use at the time of sex was negatively associated with disclosure in PLWH with suppressed viral load (OR 0.29, β = - 1.22, 95% CI [- 2.42, - 0.03], p = .045), but differentially associated with condom use in PLWH with detectable versus undetectable viral load. In PLWH with viral suppression, participants who always disclosed versus who never disclosed their HIV status were more likely to use condoms (β = 1.84, 95% CI [0.35, 3.53], p = .017), but inconsistent disclosers were less likely to use a condom after disclosing (OR 0.22, 95% CI [0.07, 0.68], p = .008). Event-level analysis offers a more nuanced understanding of the proximal (substance use, HIV disclosure) and person-level (substance use, viral load) determinants of HIV transmission risk behavior in PLWH.
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Affiliation(s)
- Matthew C Sullivan
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA.
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA.
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
| | - Tania B Huedo-Medina
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
- Allied Health Sciences Department, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
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Wang L, Moqueet N, Lambert G, Grace D, Rodrigues R, Cox J, Lachowsky NJ, Noor SW, Armstrong HL, Tan DHS, Burchell AN, Ma H, Apelian H, Knight J, Messier-Peet M, Jollimore J, Baral S, Hart TA, Moore DM, Mishra S. Population-Level Sexual Mixing According to HIV Status and Preexposure Prophylaxis Use Among Men Who Have Sex With Men in Montreal, Canada: Implications for HIV Prevention. Am J Epidemiol 2020; 189:44-54. [PMID: 31612213 PMCID: PMC7119299 DOI: 10.1093/aje/kwz231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022] Open
Abstract
Using cross-sectional survey data (Engage, 2017–2018) from 1,137 men who have sex with men, ≥16 years old, in Montreal, we compared observed human immunodeficiency virus (HIV) seroconcordance in previous-6-months’ sexual partnerships with what would have been observed by chance if zero individuals serosorted. Of 5 recent partnerships where both individuals were HIV-negative, we compared observed concordance in preexposure prophylaxis (PrEP) use with the counterfactual if zero individuals selected partners based on PrEP use. We estimated the concordance by chance using a balancing-partnerships approach assuming proportionate mixing. HIV-positive respondents had a higher proportion of HIV-positive partners (66.4%, 95% confidence interval (CI): 64.0, 68.6) than by chance (23.9%, 95% CI: 23.1, 24.7). HIV-negative respondents (both on and not on PrEP) had higher proportions of HIV-negative partners (82.9% (95% CI: 81.1, 84.7) and 90.7% (95% CI: 89.6, 91.7), respectively) compared with by chance (76.1%, 95% CI: 75.3, 76.9); however, those on PrEP had a higher proportion of HIV-positive partners than those not on PrEP (17.1% (95% CI: 15.3, 18.9) vs. 9.3% (95% CI: 8.3, 10.4). Those on PrEP also had a higher proportion of partners on PrEP among their HIV-negative partners (50.6%, 95% CI: 42.5, 58.8) than by chance (28.5%, 95% CI: 27.5, 29.4). The relationship between PrEP and sexual-mixing patterns demonstrated by less population-level serosorting among those on PrEP and PrEP-matching warrants consideration during PrEP roll-out.
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Affiliation(s)
- Linwei Wang
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Nasheed Moqueet
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Gilles Lambert
- Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ricky Rodrigues
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Syed W Noor
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Heather L Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Darrell H S Tan
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ann N Burchell
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Huiting Ma
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Herak Apelian
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jesse Knight
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Marc Messier-Peet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharmistha Mishra
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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Li DH, Newcomb M, Macapagal K, Remble T, Mustanski B. Condom-Associated Erectile Function, But Not Other Domains of Sexual Functioning, Predicts Condomless Insertive Anal Sex Among Young Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:161-174. [PMID: 31980999 PMCID: PMC7018619 DOI: 10.1007/s10508-020-01642-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 05/09/2023]
Abstract
Condoms effectively prevent against HIV, especially when used in conjunction with biomedical strategies such as PrEP and viral suppression. However, consistent use of condoms in the real world has been a continual health promotion challenge, even among populations at highest risk, such as young men who have sex with men (YMSM). Inconsistent condom use may be related to poor sexual functioning, but limited research exists. The analytic sample comprised 688 racially diverse YMSM aged 16-29 (M = 22.9 years) living in Chicago, IL (19.2% living with HIV). Using multivariable logistic regression, we examined longitudinal associations between condom-associated sexual functioning (erectile function, orgasm satisfaction, global satisfaction, and anal discomfort) and condomless insertive anal sex (CIAS) and condomless receptive anal sex (CRAS) 6 months later. CIAS at Time 2 was associated with condom-associated erectile function at the bivariate and multivariable levels, even after controlling for CIAS at Time 1 (p < .05). Condom-associated erectile function, orgasm satisfaction, and global satisfaction predicted Time 2 CRAS in bivariate models, but none remained significant in the multivariable models. Age, having had a serious partner in the past 6 months, and HIV/PrEP status at Time 2 were significant predictors of CIAS/CRAS in some but not all models. Future interventions to improve consistent condom use should specifically highlight information and skills on how to use condoms within real-world contexts rather than from a clinical perspective. Our results also support the importance of biomedical strategies for those who have continued problems with sexual functioning when using condoms.
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Affiliation(s)
- Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA.
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Michael Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Thomas Remble
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Kim H, Harling G, Vandormael A, Tomita A, Cuadros DF, Bärnighausen T, Tanser F. HIV seroconcordance among heterosexual couples in rural KwaZulu-Natal, South Africa: a population-based analysis. J Int AIDS Soc 2020; 23:e25432. [PMID: 31916420 PMCID: PMC6949466 DOI: 10.1002/jia2.25432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/08/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION High levels of HIV seroconcordance at the population level reduce the potential for effective HIV transmission. However, the level of HIV seroconcordance is largely unknown among heterosexual couples in sub-Saharan Africa. We aimed to quantify the population level HIV seroconcordance in stable heterosexual couples in rural South Africa. METHODS We followed adults (≥15 years old) using a population-based, longitudinal and open surveillance system in KwaZulu-Natal, South Africa, from 2003 to 2016. Sexual partnerships and HIV status were confirmed via household surveys and annual HIV surveillance. We calculated the proportions of HIV seroconcordance and serodiscordance in stable sexual partnerships and compared them to the expected proportions under the assumption of random mixing using individual-based microsimulation models. Among unpartnered individuals, we estimated the incidence rates and hazard of sexual partnership formation with HIV-positive or HIV-negative partners by participants' own time-varying HIV status. Competing risks survival regressions were fitted adjusting for sociodemographic and clinical factors. We also calculated Newman's assortativity coefficients. RESULTS A total of 18,341 HIV-negative and 11,361 HIV-positive individuals contributed 154,469 person-years (PY) of follow-up. Overall, 28% of the participants were in stable sexual partnerships. Of the 677 newly formed stable sexual partnerships, 7.7% (95% CI: 5.8 to 10.0) were HIV-positive seroconcordant (i.e. both individuals in the partnership were HIV-positive), which was three times higher than the expected proportion (2.3%) in microsimulation models based on random mixing. The incidence rates of sexual partnership formation were 0.54/1000PY with HIV-positive, 1.12/1000PY with HIV-negative and 2.65/1000PY with unknown serostatus partners. HIV-positive individuals had 2.39 (95% CI: 1.43 to 3.99) times higher hazard of forming a sexual partnership with an HIV-positive partner than did HIV-negative individuals after adjusting for age, opposite-sex HIV prevalence (by 5-years age groups), HIV prevalence in the surrounding community, ART coverage and other sociodemographic factors. Similarly, forming a sexual partnership with an HIV-negative partner was 1.47 (95% CI: 1.01 to 2.14) times higher in HIV-negative individuals in the adjusted model. Newman's coefficient also showed that assortativity by participant and partner HIV status was moderate (r = 0.35). CONCLUSIONS A high degree of population level HIV seroconcordance (both positive and negative) was observed at the time of forming new sexual partnerships. Understanding factors driving these patterns may help the development of strategies to bring the HIV epidemic under control.
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Affiliation(s)
- Hae‐Young Kim
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNYUSA
| | - Guy Harling
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Institute for Global HealthUniversity College LondonLondonUK
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMAUSA
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt)University of the WitwatersrandJohannesburgSouth Africa
| | - Alain Vandormael
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- School of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
- Heidelberg Institute of Global HealthFaculty of MedicineUniversity of HeidelbergHeidelbergGermany
| | - Andrew Tomita
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- Centre for Rural HealthSchool of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Diego F Cuadros
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Department of Geography and Geographic Information ScienceUniversity of CincinnatiCincinnatiOHUSA
| | - Till Bärnighausen
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Heidelberg Institute of Global HealthFaculty of MedicineUniversity of HeidelbergHeidelbergGermany
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Frank Tanser
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMAUSA
- Lincoln Institute for HealthUniversity of LincolnLincolnUK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
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Pleasure and HIV biomedical discourse: The structuring of sexual and drug-related risks for gay and bisexual men who Party-n-Play. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:181-190. [PMID: 31627160 DOI: 10.1016/j.drugpo.2019.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/21/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
Party-n-Play (PNP) is a social practice that refers to sex that occurs under the influence of drugs. This study critically examined the risk and pleasure discourses of gay and bisexual men who PNP to explore how epistemic shifts associated with advancements in HIV biomedical sciences influence gay and bisexual men's perceptions of HIV risks and their sexual and drug-related practices. This study also aims to provide a more nuanced understanding of how sexual and drug-related risk practices of gay and bisexual men are entangled with their search for pleasure. The study was framed within poststructural Critical Discourse Analysis (CDA) methodology. In-depth one-hour interviews were conducted with 44 self-identified gay, bisexual, queer, or Two-Spirit men, who lived in Toronto, and who reported using drugs before or during sex with another man. The findings from this study demonstrated the capacity of biomedical discourses to affect respondents' HIV risk perceptions and practices. The transition from condom-centered prevention to today's context where new highly effective biomedical tools for HIV prevention are available created possibilities for greater intimacy, increased pleasure, and less anxiety about HIV tranmission, while challenging many years of preventive socialization among gay and bisexual men. However, this new context also rekindled deep-seated fears about HIV risk and viral load verifiability, reinforced unequal forms of biomedical self-governance and citizenship, and reproduced practices of biopolitics. While discourses on risk and pleasure were interwoven within complex PNP assemblages, the notion of pleasure was mobilized as a discursive tactic of self-control, and the division between normative and non-normative pleasures highlighted the consequence of biopolitical forces governing the production of discourses on sex and drugs. Future HIV social science research needs to attend to the fluid nature of the discursive environments of HIV prevention science, and consider how both the material context of PNP and its social/discursive elements operate together.
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Working memory moderates the association between condom use intentions and behavior among moderate-to-heavy drinking men who have sex with men. J Behav Med 2019; 43:666-671. [PMID: 31414333 DOI: 10.1007/s10865-019-00090-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023]
Abstract
Men who have sex with men (MSM) are a high-risk population for HIV infection and this risk is increased for those who consume alcohol. Condomless anal intercourse (CAI) is the central transmission risk factor for this population. This study examined whether individual differences in working memory moderated the association between intentions to use condoms and the frequency of CAI among MSM who engaged in anal intercourse over a subsequent 6-week period. Moderate- and heavy-drinking MSM (n = 207) completed questionnaires regarding alcohol use and condom use intentions and an operation span task to assess working memory at baseline. Participants then completed 6 weeks of morning surveys via a mobile phone app to assess anal intercourse frequency with and without condoms. Negative binomial regression analyses showed that the association between intentions to use condoms and episodes of CAI during the monitoring period was moderated by working memory such that intentions predicted CAI for those high in working memory but not those low in working memory. These results support the view that self-reported intentions may be less-likely to translate into health behaviors among those with poorer executive functioning skills.
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22
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Awareness and Perceived Effectiveness of HIV Treatment as Prevention Among Men Who Have Sex with Men in New York City. AIDS Behav 2019; 23:1974-1983. [PMID: 30697639 DOI: 10.1007/s10461-019-02405-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To assess perceptions of HIV treatment as prevention (TasP), we conducted an online survey of MSM in New York City (n = 732) asking them to rate the effectiveness of different strategies to reduce HIV risk during serodiscordant condomless anal sex between men. Only 6.1% reported not knowing what TasP was, with significantly less awareness among non-gay-identified MSM, men with less education, men who reported fewer anal sex partners in the prior 3 months, and HIV-negative/unaware men who had never used PrEP. The strategy most frequently perceived to offer "a lot" or "complete" protection from HIV was daily PrEP (70.0%), followed by TasP (39.1%), intermittent PrEP (16.6%), strategic positioning (15.8%), and withdrawal before ejaculation (10.8%). Men who were HIV positive, who had ever used PrEP, and who identified as gay/homosexual were significantly more likely to see TasP as effective. Further studies should investigate MSM's apparent skepticism towards TasP.
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23
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Goldstein ND, LeVasseur MT, Tran NK, Purtle J, Welles SL, Eppes SC. Modeling HPV vaccination scale-up among urban young men who have sex with men in the context of HIV. Vaccine 2019; 37:3883-3891. [PMID: 31155416 DOI: 10.1016/j.vaccine.2019.05.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Young men who have sex with men (YMSM) are at high risk to contract human papillomavirus (HPV). While an effective vaccination exists, its use among YMSM is markedly lower compared to non-MSM and women. This study compares scaling up HPV vaccination in conjunction with other prevention strategies. METHODS An agent-based model of urban YMSM (≤26 years of age) reflective of the demography of Philadelphia, PA, simulated for up to ten years of follow-up to examine anal and oral transmission of the HPV genotypes covered in the nonavalent (9v) vaccine: 6, 11, 16, 18, 31, 33, 45, 52, 58. Starting HPV prevalences ranged from a high of 18% (type 6) to a low of 6% (type 31); overall 65% of individuals carried any HPV genotype. Simulated levels of vaccination were ranged from 0% to 13% (present-day level), 25%, 50%, 80% (Healthy People 2020 target), and 100% in conjunction with condom use and HIV seroadaptive practices. The primary outcome was the relative reduction in HPV infection. RESULTS Compared to present-day vaccination levels (13%), scaling-up vaccination led to expected declines in 10-year post-simulation HPV prevalence. Anal HPV (any 9v types) declined by 9%, 27%, 46%, and 58% at vaccination levels of 25%, 50%, 80%, and 100%, respectively. Similarly, oral HPV (any 9v types) declined by 11%, 33%, 57%, and 71% across the same levels of vaccine uptake. Comparing the prevention strategies, condoms blocked the greatest number of anal transmissions when vaccination was at or below present-day levels. For oral transmission, vaccination was superior to condom use at all levels of coverage. CONCLUSIONS Public health HPV preventions strategies should continue to emphasize the complementary roles of condoms and vaccination, especially for preventing oral infection. Improving vaccination coverage will ultimately have the greatest impact on reducing HPV infection among YMSM.
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Affiliation(s)
- Neal D Goldstein
- Department of Pediatrics, Christiana Care Health System, 4745 Ogletown-Stanton Road, MAP 1, Suite 116, Newark, DE 19713, United States; Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA 19104, United States.
| | - Michael T LeVasseur
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA 19104, United States
| | - Nguyen K Tran
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA 19104, United States
| | - Jonathan Purtle
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA 19104, United States
| | - Seth L Welles
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA 19104, United States
| | - Stephen C Eppes
- Department of Pediatrics, Christiana Care Health System, 4745 Ogletown-Stanton Road, MAP 1, Suite 116, Newark, DE 19713, United States
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24
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Klassen BJ, Fulcher K, Chown SA, Armstrong HL, Hogg RS, Moore DM, Roth EA, Lachowsky NJ. "Condoms are … like public transit. It's something you want everyone else to take": Perceptions and use of condoms among HIV negative gay men in Vancouver, Canada in the era of biomedical and seroadaptive prevention. BMC Public Health 2019; 19:120. [PMID: 30691426 PMCID: PMC6350294 DOI: 10.1186/s12889-019-6452-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men. METHODS We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies. RESULTS Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk. CONCLUSIONS These findings indicate that notions of "safety" and "risk" based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men's current prevention needs. Interventions should advance gay men's communication and self-advocacy skills in order to optimize these strategies.
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Affiliation(s)
- Benjamin J Klassen
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of History, Simon Fraser University, Burnaby, BC, Canada
| | - Karyn Fulcher
- School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada
| | | | - Heather L Armstrong
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada.,Centre for Addictions Research of British Columbia, Victoria, BC, Canada
| | - Nathan J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. .,School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada.
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25
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Poon CM, Wong NS, Kwan TH, Wong HTH, Chan KCW, Lee SS. Changes of sexual risk behaviors and sexual connections among HIV-positive men who have sex with men along their HIV care continuum. PLoS One 2018; 13:e0209008. [PMID: 30540851 PMCID: PMC6291138 DOI: 10.1371/journal.pone.0209008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/27/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While HIV incidence among men who have sex with men (MSM) is increasing in Hong Kong, unprotected sex apparently remains prevalent among those infected but virally non-suppressed. Little is known about how sexual behaviours and sexual connections may change among MSM along their HIV care continuum. METHODS In this retrospective cross-sectional study, HIV-positive MSM attending the largest HIV specialist clinic in Hong Kong between October and December 2014 were invited to complete a self-administrated structured questionnaire. Their behavioural profile and partner sourcing patterns during the one-year period respectively (a) before HIV diagnosis, (b) after HIV diagnosis, (c) after initiation of antiretroviral treatment and (d) preceding the survey were examined. RESULTS Of 345 recruited MSM, 304 (88.1%) had treatment initiated and 272 (78.8%) had viral load suppressed. In the first year after HIV diagnosis, the proportion reporting inconsistent condom use dropped from 47.0% to 17.5% (p<0.05) and from 49.6% to 17.8% (p<0.01) for anal sex with main and casual partners respectively. Except for mobile applications, usage of most sex-networking venues decreased significantly after diagnosis. Inconsistent condom usage rate remained at around 20% after treatment initiation and viral load suppression, but the frequency of use of sex-networking venues further varied among virally suppressed MSM. CONCLUSIONS Most HIV-positive MSM had persistently low level of sexual risk behaviours along their care continuum and achieved viral load suppression, conferring a general reduction of secondary transmission risk in Hong Kong. To increase the effectiveness of Treatment as Prevention strategy, uptake of HIV testing for undiagnosed HIV-positive MSM shall be emphasised.
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Affiliation(s)
- Chin Man Poon
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong
| | - Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong
| | - Tsz Ho Kwan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Horas Tze Hoo Wong
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Kenny Chi Wai Chan
- Integrated Treatment Centre, Centre for Health Protection, Department of Health, Hong Kong
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong
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26
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Dangerfield DT, Carmack CC, Gilreath TD, Duncan DT. Latent Classes of Sexual Positioning Practices and Sexual Risk Among Men Who Have Sex with Men in Paris, France. AIDS Behav 2018; 22:4001-4008. [PMID: 30173344 DOI: 10.1007/s10461-018-2267-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV/STI risk varies by sexual positioning practices; however, limited data have characterized the behavioral profiles of men who have sex with men (MSM) in France. This study used latent class analysis (LCA) to explore sexual risk profiles among MSM in Paris, France. LCA was used to classify sexual positioning and serosorting profiles among MSM in Paris (n = 496). Age, HIV status, relationship status, substance use, group sex, and PrEP history were used in a multinomial regression model predicting class membership. Three latent classes were identified: majority top/serosorters, versatile/low partners, and majority bottom/some serosorters. Majority top/serosorters had the highest probability of condomless serosorting; majority bottom/some serosorters had the highest mean number of partners (~ 12 partners) for condomless receptive anal intercourse. HIV-positive MSM were more likely to be classified as majority bottom/some serosorters than versatile/low partners (AOR 7.61; 95% CI 2.28, 25.3). Findings support the need for tailored and targeted interventions for highest-risk individuals.
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Affiliation(s)
- Derek T Dangerfield
- The REACH Initiative, Johns Hopkins School of Nursing, 525 N. Wolfe St, SON House 104, Baltimore, MD, 21205, USA.
| | - Chakema C Carmack
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Tamika D Gilreath
- Department of Health and Kinesiology, Texas A & M University, College Station, TX, USA
| | - Dustin T Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, USA
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27
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Dangerfield DT, Ober AJ, Smith LR, Shoptaw S, Bluthenthal R. Exploring and Adapting a Conceptual Model of Sexual Positioning Practices and Sexual Risk Among HIV-Negative Black Men Who Have Sex With Men. JOURNAL OF SEX RESEARCH 2018; 55:1022-1032. [PMID: 29466064 PMCID: PMC6105556 DOI: 10.1080/00224499.2018.1433287] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Estimates show a 50% lifetime human immunodeficiency virus (HIV) risk among Black men who have sex with men (BMSM) in the United States(U.S.). Studying the dynamics of sexual positioning practices among BMSM could provide insights into the disparities observed among U.S. groups of men who have sex with men (MSM). This study explored sexual positioning dynamics among HIV-negative BMSM and how they aligned with a theoretical model of sexual positioning and HIV/sexually transmitted infection (STI) risk among MSM. In-depth qualitative interviews were conducted with 29 HIV-negative BMSM between ages 25 and 35 in Los Angeles. Comments related to sexual behaviors were reviewed for relevance regarding oral or anal sexual positioning practices. Data presented represent the range of themes related to decision making regarding sexual positioning. Personal preference, partner attraction, HIV avoidance, and feeling obligated to practice partner preferences influenced sexual positioning. Drug use also affected decision making and was sometimes preferred in order to practice receptive anal intercourse. These variables build on the conceptual model of sexual positioning practices and sexual risk, and add understanding to the relationship between preferences, practices, and risk management. Future research on risk among HIV-negative BMSM should quantify the relative impact of personal preferences, partner attraction, partner type, compromise, and substance use on sexual positioning practices and risk.
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Affiliation(s)
| | | | - Laramie R. Smith
- University of California, San Diego, Division of Global Public Health, La Jolla, CA
| | - Steven Shoptaw
- University of California, Los Angeles, Department of Family Medicine, Los Angeles, CA
| | - Ricky Bluthenthal
- University of Southern California Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA
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28
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Calendar trends in sexual behaviours in a cohort of HIV-infected MSM at the era of treatment as prevention of HIV infection. AIDS 2018; 32:1871-1879. [PMID: 29927787 DOI: 10.1097/qad.0000000000001916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With the advent of treatment as prevention of HIV infection (TasP), we assessed trends in sexual behaviours between 2000 and 2017 among HIV-infected MSM enrolled in the French ANRS PRIMO cohort. METHODS At each cohort visit, a clinical questionnaire including laboratory values was completed and a self-administered questionnaire was used to collect sexual behaviours, that is, the number, type (steady/casual) and HIV status (positive or negative/unknown) of partners, and condom use. The possible influence of viral load (undetectable/detectable) measured at the preceding visit on the evolution over time of sexual behaviour was assessed with logistic regression models fitted by generalized estimating equations (GEE), taking into account longitudinal data. RESULTS We analyzed data from 10657 follow-up visits by 1364 MSM. Overall, whatever the considered behavioural variable: at least one sexual partner, steady and/or casual, condomless sex with steady, casual partners, serodiscordant or not, we observed a calendar increase with a particularly more marked rise from 2010 (P < 0.0001). Inconsistent condom use did not differ according to the viral load status (detectable vs. undetectable). Trends in inconsistent condom use increased across different generations of MSM, as defined by the year they were diagnosed with HIV infection. CONCLUSIONS 'Having a sexual partner' and condomless sex, both increased in frequency between 2000 and 2017. Viral load status did not influence condom use as could have been expected from the 2008 Swiss Statement.
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29
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Grov C, Jonathan Rendina H, Patel VV, Kelvin E, Anastos K, Parsons JT. Prevalence of and Factors Associated with the Use of HIV Serosorting and Other Biomedical Prevention Strategies Among Men Who Have Sex with Men in a US Nationwide Survey. AIDS Behav 2018; 22:2743-2755. [PMID: 29550942 PMCID: PMC6051908 DOI: 10.1007/s10461-018-2084-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PrEP and treatment-as-prevention (TasP) are biomedical strategies to reduce HIV transmission. Some men who have sex with men (MSM) are combining biomedical strategies with HIV serosorting-termed "biomed matching" when both partners are either on PrEP or TasP, or "biomed sorting" when one partner is using PrEP and the other TasP. Nevertheless, there is limited data on the extent of biomed matching/sorting in large geographically diverse samples. In 2016-2017, 5021 MSM from across the US were surveyed about their HIV status and HIV viral load/PrEP use, as well as that of their recent casual male partners. For each participant, we calculated the proportion of his partners who were (1) HIV-positive and undetectable, (2) HIV-positive and detectable/unknown, (3) HIV unknown/undiscussed, (4) HIV-negative on PrEP, (5) HIV-negative, not on PrEP. In total, 66.6% (n = 3346) of participants were HIV-negative and not on PrEP, 11.9% (n = 599) on PrEP, 14.1% (n = 707) HIV-positive and undetectable, 1.1% (n = 55) HIV-positive and viral load detectable/unknown, and 6.2% (n = 313) HIV unsure/unknown. A participant's own HIV and PrEP status/was significantly associated with that of his partners (all p < 0.001), evincing evidence of both serosorting and biomed matching. Among men on PrEP and those who were HIV-undetectable, there was also some evidence to suggest these participants dually engaged in biomed matching as well as biomed sorting. We found evidence of biomed matching and sorting, which may compound its effectiveness for those using it (i.e., both partners bring biomedical protection). Unintended consequences of biomed matching/sorting include that men not using a biomedical strategy may be less likely to benefit from a partner's use of the strategy-potentially further driving disparities in HIV infections. Public health campaigns might be well served to highlight not only the benefits that biomedical HIV prevention strategies provide for their users (e.g., "being on PrEP protects me from getting HIV"), but also the benefits that a user brings to his partners (e.g., "my use of PrEP means my partners won't get HIV"), and the benefits of being with a partner who is using a biomedical strategy (e.g., "my partner's use of PrEP/TasP protects me from HIV").
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA.
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA.
| | - H Jonathan Rendina
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
- Department of Psychology, Hunter College of CUNY, New York, NY, USA
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of CUNY, New York, NY, USA
| | - Viraj V Patel
- Division of General Internal Medicine, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth Kelvin
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Kathryn Anastos
- Division of General Internal Medicine, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey T Parsons
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
- Department of Psychology, Hunter College of CUNY, New York, NY, USA
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of CUNY, New York, NY, USA
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30
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Cruess DG, Burnham KE, Finitsis DJ, Goshe BM, Strainge L, Kalichman M, Grebler T, Cherry C, Kalichman SC. A Randomized Clinical Trial of a Brief Internet-based Group Intervention to Reduce Sexual Transmission Risk Behavior Among HIV-Positive Gay and Bisexual Men. Ann Behav Med 2018; 52:116-129. [PMID: 29538626 PMCID: PMC6361295 DOI: 10.1093/abm/kax031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background HIV disproportionately affects sexual minority men, and developing strategies to reduce transmission risk is a public health priority. Purpose The goal was to empirically test a newly developed, Information, Motivation, Behavioral skills (IMB) theoretically derived, online HIV sexual risk reduction intervention (called HINTS) among a sample of sexual minority men living with HIV. Methods Participants were 167 men randomized to either the four-session online HINTS intervention or to a time-matched, online control condition. Participants were assessed at baseline and at 6-month follow-up for demographic, medical and psychosocial factors, and sexual risk behavior. Analyses examined group differences in incidence rates of condomless anal sex (CAS) at follow-up with all male sex partners and by partner serostatus, either seroconcordant or serodiscordant for HIV infection. Results Men assigned to the HINTS intervention reported decreased CAS with serodiscordant partners, a behavior that confers high risk of HIV transmission, compared to the control group. Men assigned to the HINTS intervention also reported increased CAS with seroconcordant partners, a behavior indicative of serosorting. Although the IMB model did not appear to mediate these intervention effects, some IMB components were associated with behavioral outcomes at 6-month follow-up. Conclusions A new group-based sexual risk reduction intervention conducted exclusively online was successful in reducing HIV transmission risk behavior in a sample of gay and bisexual men living with HIV. Future work should consider utilizing this intervention with other groups living with HIV, perhaps in combination with biomedical HIV prevention strategies.
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Affiliation(s)
- Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Kaylee E Burnham
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - David J Finitsis
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Brett M Goshe
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Lauren Strainge
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Moira Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Tamar Grebler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Chauncey Cherry
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
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31
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An Event-Level Analysis of Condom Use During Anal Intercourse Among Self-Reported Human Immunodeficiency Virus-Negative Gay and Bisexual Men in a Treatment as Prevention Environment. Sex Transm Dis 2018; 43:765-770. [PMID: 27832026 DOI: 10.1097/olq.0000000000000530] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We sought to identify factors associated with condom use during anal intercourse among self-identified human immunodeficiency virus-negative gay, bisexual, and other men who have sex with men (GBM) in Vancouver, Canada following "treatment as prevention" (TasP) scale-up in 2010. METHODS Sexually active GBM were recruited using respondent-driven sampling from 2012 to 2014. We analyzed participants' most recent sexual encounter with up to their last 5 sexual partners within the past 6 months. In addition to individual- and event-level explanatory factors, we assessed potential associations with TasP awareness, TasP-related prevention practice (viral load sorting), and TasP-related attitudes (human immunodeficiency virus treatment optimism). Accounting for clustering at the respondent-driven sampling chain-level and participant-level, factors associated with event-level condom use versus nonuse were determined using a multivariable generalized linear mixed model built using backward selection and AIC minimization. RESULTS Of 513 participants, 436 GBM (85%) reported a total of 1196 anal sex events with 56% condom use. The proportion of condom-protected sexual events decreased monthly over the study period (odds ratio [OR], 0.95 per month, 95% confidence interval [CI], 0.92-0.98). The TasP practices and attitudes were significantly associated with lower odds of condom use at the univariate level, but were no longer significant at multivariate level. In the multivariable model, event-level partner methamphetamine use (adjusted OR [aOR], 0.18; 95% CI, 0.06-0.58), frequency of recent anal intercourse with that partner (aOR, 0.97 per act; 95% CI, 0.95-0.98) and time since first sex with that partner (aOR, 0.97 per 6 months; 95% CI, 0.95-0.99) were associated with lower odds of condom use, whereas event-level participant alcohol use (aOR, 1.41; 95% CI, 1.01-1.98) and no planned future sex with that partner (aOR, 1.56; 95% CI, 1.08-2.27) were associated with greater odds of condom use. Event-level receptive-only (aOR, 2.10; 95% CI, 1.38-3.20) or insertive-only (aOR, 2.53; 95% CI, 1.64-3.90) sexual positions were associated with greater odds of condom use compared with reporting both positions. CONCLUSIONS The TasP-related factors were not the most salient predictors of GBM's condom use. Health promotion must consider associations between condomless anal sex and substance use and relational factors.
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32
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Card KG, Lachowsky NJ, Cui Z, Carter A, Armstrong H, Shurgold S, Moore D, Hogg RS, Roth EA. A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:95-106. [PMID: 27987086 PMCID: PMC5474217 DOI: 10.1007/s10508-016-0879-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/16/2016] [Accepted: 10/08/2016] [Indexed: 05/30/2023]
Abstract
Initial research into seroadaptive strategies suggests that, individually, they are potentially effective behavioral methods to reduce risk of HIV transmission. Combining strategies, therefore, has the potential to increase risk reduction. The aim of this study was to determine how gay and bisexual men (GBM) combine strategies. To this end, a total of 774 sexually active GBM, aged ≥16 years, in Metro Vancouver, Canada, were recruited. Grouped by self-reported HIV status, latent class analysis of self-reported condom use, strategic positioning, anal sex avoidance, serosorting, viral-load sorting, and withdrawal were conducted. Multinomial logistical regression identified explanatory variables of class membership (i.e., sensation seeking, treatment optimism, sexual altruism, relationship status, number of partners, anal sex preference). Four latent classes were identified: Condom Users, Multiple Prevention Users, Viral-Load Sorters, and Serosorters. The majority of HIV-negative/unknown men (72 %) and a large proportion of HIV-positive men (42 %) belonged to the Condom Users class. Class membership was associated with age, relationship status, treatment optimism, sexual altruism, sensation seeking, number of recent male anal sex partners, and recent condomless anal sex with a serodiscordant or unknown-status partner. Understanding these distinct patterns allows for tailored interventions addressing GBM's sexual health needs.
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Affiliation(s)
- Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada.
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Allison Carter
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Heather Armstrong
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Susan Shurgold
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
- Centre for Addiction Research of British Columbia, University of Victoria, Victoria, BC, Canada
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The Effect of PrEP on HIV Incidence Among Men Who Have Sex With Men in the Context of Condom Use, Treatment as Prevention, and Seroadaptive Practices. J Acquir Immune Defic Syndr 2017; 77:31-40. [PMID: 28961679 DOI: 10.1097/qai.0000000000001555] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV preexposure prophylaxis (PrEP) is an effective tool in preventing HIV infection among high-risk men who have sex with men (MSM). It is unknown how effective PrEP is in the context of other implemented HIV prevention strategies, including condom use, seroadaption, and treatment as prevention (TasP). We evaluate the impact of increasing uptake of PrEP in conjunction with established prevention strategies on HIV incidence in a high-risk population of MSM through simulation. METHODS Agent-based simulation models representing the sexual behavior of high-risk, urban MSM in the United States over the period of 1 year were used to evaluate the effect of PrEP on HIV infection rates. Simulations included data for 10,000 MSM and compared increasing rates of PrEP uptake under 8 prevention paradigms: no additional strategies, TasP, condom use, seroadaptive behavior, and combinations thereof. RESULTS We observed a mean of 103.2 infections per 10,000 MSM in the absence of any prevention method. PrEP uptake at 25% without any additional prevention strategies prevented 30.7% of infections. In the absence of PrEP, TasP, condom use, and seroadaptive behavior independently prevented 27.1%, 48.8%, and 37.7% of infections, respectively, and together prevented 72.2%. The addition of PrEP to the 3 aforementioned prevention methods, at 25% uptake, prevented an additional 5.0% of infections. CONCLUSIONS To achieve a 25% reduction in HIV infections by 2020, HIV prevention efforts should focus on significantly scaling up access to PrEP in addition to HIV testing, access to antiretroviral therapy, and promoting condom use.
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Marcus U, Schink SB, Sherriff N, Jones AM, Gios L, Folch C, Berglund T, Nöstlinger C, Niedźwiedzka-Stadnik M, Dias SF, Gama AF, Naseva E, Alexiev I, Staneková D, Toskin I, Pitigoi D, Rafila A, Klavs I, Mirandola M. HIV serostatus knowledge and serostatus disclosure with the most recent anal intercourse partner in a European MSM sample recruited in 13 cities: results from the Sialon-II study. BMC Infect Dis 2017; 17:730. [PMID: 29178847 PMCID: PMC5702243 DOI: 10.1186/s12879-017-2814-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022] Open
Abstract
Background Knowledge of HIV status can be important in reducing the risk of HIV exposure. In a European sample of men-who-have-sex-with-men (MSM), we aimed to identify factors associated with HIV serostatus disclosure to the most recent anal intercourse (AI) partner. We also aimed to describe the impact of HIV serostatus disclosure on HIV exposure risks. Methods During 2013 and 2014, 4901 participants were recruited for the bio-behavioural Sialon-II study in 13 European cities. Behavioural data were collected with a self-administered paper questionnaire. Biological specimens were tested for HIV antibodies. Factors associated with HIV serostatus disclosure with the most recent AI partner were examined using bivariate and multilevel multivariate logistic regression analysis. We also describe the role of serostatus disclosure for HIV exposure of the most recent AI partner. Results Thirty-five percent (n = 1450) of the study participants reported mutual serostatus disclosure with their most recent AI partner or disclosed having HIV to their partner. Most of these disclosures occurred between steady partners (74%, n = 1077). In addition to the type of partner and HIV diagnosis status, other factors positively associated with HIV serostatus disclosure in the multilevel multivariate logistic regression model were recent testing, no condom use, and outness regarding sexual orientation. Disclosure rates were lowest in three south-eastern European cities. Following condom use (51%, n = 2099), HIV serostatus disclosure (20%, n = 807) was the second most common prevention approach with the most recent AI partner, usually resulting in serosorting. A potential HIV exposure risk for the partner was reported by 26% (111/432) of HIV antibody positive study participants. In 18% (20/111) of exposure episodes, an incorrect HIV serostatus was unknowingly communicated. Partner exposures were equally distributed between steady and non-steady partners. Conclusions The probability of HIV exposure through condomless AI is substantially lower after serostatus disclosure compared to non-disclosure. Incorrect knowledge of one’s HIV status contributes to a large proportion of HIV exposures amongst European MSM. Maintaining or improving condom use for anal intercourse with non-steady partners, frequent testing to update HIV serostatus awareness, and increased serostatus disclosure particularly between steady partners are confirmed as key aspects for reducing HIV exposures amongst European MSM. Electronic supplementary material The online version of this article (10.1186/s12879-017-2814-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrich Marcus
- Department of Infectious Diseases Epidemiology, Robert Koch-Institute, Berlin, Germany.
| | | | | | - Anna-Marie Jones
- University of Brighton, Health Sciences, Brighton, UK.,Mill View Hospital, Sussex Education Centre, Research & Development, Brighton, UK
| | - Lorenzo Gios
- Department of Health, Verona University Hospital, CReMPE - Regional Coordination Centre for European Project Management, Verona, Veneto Region, Italy
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Badalona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Torsten Berglund
- Department of Monitoring & Evaluation, Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Sonia F Dias
- Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Lisbon, Portugal
| | - Ana F Gama
- Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Lisbon, Portugal
| | - Emilia Naseva
- Ministry of Health, Program "Prevention and Control of HIV/AIDS", Sofia, Bulgaria
| | - Ivailo Alexiev
- National Centre of Infectious and Parasitic Diseases, National Reference Laboratory of HIV, Sofia, Bulgaria
| | - Danica Staneková
- Slovak Medical University, National Reference Centre for HIV/AIDS, Bratislava, Slovakia
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Daniela Pitigoi
- University of Medicine and Pharmacy Carol Davila, Department Clinic 2, Epidemiology, Bucharest, Romania.,National Institute for Infectious Diseases "Prof Dr Matei Bals", Bucharest, Romania
| | - Alexandru Rafila
- Department of Microbiology, National Institute of Infectious Diseases "Prof Dr Matei Bals", Bucharest, Romania
| | - Irena Klavs
- National Institute of Public Health, Communicable Diseases Centre, Ljubljana, Slovenia
| | - Massimo Mirandola
- Department of Health, Infectious Disease Section, Verona University Hospital, CReMPE - Regional Coordination Centre for European Project Management, Verona, Veneto Region, Italy
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Mayer KH, Maloney KM, Levine K, King D, Grasso C, Krakower DS, Rosenberg ES, Boswell SL. Sociodemographic and Clinical Factors Associated With Increasing Bacterial Sexually Transmitted Infection Diagnoses in Men Who Have Sex With Men Accessing Care at a Boston Community Health Center (2005-2015). Open Forum Infect Dis 2017; 4:ofx214. [PMID: 29181421 PMCID: PMC5695616 DOI: 10.1093/ofid/ofx214] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/28/2017] [Indexed: 11/14/2022] Open
Abstract
Background The reasons why bacterial sexually transmitted infections (BSTIs) are increasing in US men who have sex with men (MSM) have not been fully characterized. Methods An open cohort of MSM accessing medical care at a Boston community health center was used to assess secular trends in BSTI diagnoses. Frequency of infection and the estimated population size were used to calculate diagnosis rates. Poisson models were fit for multivariable analyses. Results Between 2005 and 2015, 19 232 men had at least 1 clinic visit. Most (72.4%) were white; 6.0% were black, and 6.1% were Latino. Almost half had documented self-report of identifying as gay (42.6%) or bisexual (3.2%). Most had private health insurance (61.7%); 5.4% had Medicare, 4.6% had Medicaid, and 8.4% reported no insurance. Between 2005 and 2015, BSTI diagnoses increased more than 8-fold. In 2015, of 1319 men who were diagnosed with at least 1 BSTI; 291 were diagnosed with syphilis, 554 with gonorrhea (51.4% rectal, 31.0% urogenital), and 679 with chlamydia (69.1% rectal, 34.3% urogenital). In 2015, 22.7% of BSTIs were diagnosed among HIV-infected patients (15.4% of the clinic population), and 32.8% of BSTIs were diagnosed among HIV-uninfected patients using pre-exposure prophylaxis (PrEP; 10.1% of all men in care). In multivariable analyses, age 18 to 24 years, being HIV-infected, using PrEP, being nonwhite, or reporting Medicaid or not reporting having private insurance or Medicare were independently associated with being diagnosed with a new BSTI. Conclusions Over the past decade, BSTI diagnosis rates increased in HIV-infected and uninfected MSM, with disproportionate increases in PrEP users, racial and ethnic minority MSM, those aged 25 to 34 years, and those without stable health insurance, warranting focused education, screening, and accessible services for these key subpopulations.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kevin M Maloney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kenneth Levine
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Stephen L Boswell
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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36
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Hess KL, Crepaz N, Rose C, Purcell D, Paz-Bailey G. Trends in Sexual Behavior Among Men Who have Sex with Men (MSM) in High-Income Countries, 1990-2013: A Systematic Review. AIDS Behav 2017; 21:2811-2834. [PMID: 28555317 PMCID: PMC5708163 DOI: 10.1007/s10461-017-1799-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV diagnoses among men who have sex with men (MSM) have been increasing in several high-income countries. A better understanding of the sexual behavior trends among MSM can be useful for informing HIV prevention. We conducted a systematic review of studies that examined behavioral trends (1990-2013) in any condomless anal sex, condomless anal sex with an HIV-discordant partner, and number of partners. Studies included come from the United States, Europe, and Australia. We found increasing trends in condomless anal sex and condomless anal sex with an HIV-discordant partner, and a decreasing trend in number of partners. The increase in condomless anal sex may help to explain the increase in HIV infections. More explanatory research is needed to provide insight into factors that contribute to these behavior trends. Continuous monitoring of HIV, risk behaviors, and use of prevention and treatment is needed to evaluate prevention efforts and monitor HIV transmission risk.
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Affiliation(s)
- Kristen L Hess
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA.
| | - Nicole Crepaz
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Charles Rose
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - David Purcell
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
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Khosropour CM, Dombrowski JC, Hughes JP, Manhart LE, Simoni JM, Golden MR. Operationalizing the Measurement of Seroadaptive Behaviors: A Comparison of Reported Sexual Behaviors and Purposely-Adopted Behaviors Among Men who have Sex with Men (MSM) in Seattle. AIDS Behav 2017; 21:2935-2944. [PMID: 28097616 DOI: 10.1007/s10461-017-1682-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Seroadaptive behaviors are traditionally defined by self-reported sexual behavior history, regardless of whether they reflect purposely-adopted risk-mitigation strategies. Among MSM attending an STD clinic in Seattle, Washington 2013-2015 (N = 3751 visits), we used two seroadaptive behavior measures: (1) sexual behavior history reported via clinical computer-assisted self-interview (CASI) (behavioral definition); (2) purposely-adopted risk-reduction behaviors reported via research CASI (purposely-adopted definition). Pure serosorting (i.e. only HIV-concordant partners) was the most common behavior, reported (behavioral and purposely-adopted definition) by HIV-negative respondents at 43% and 60% of visits, respectively (kappa = 0.24; fair agreement) and by HIV-positive MSM at 30 and 34% (kappa = 0.25; fair agreement). Agreement of the two definitions was highest for consistent condom use [HIV-negative men (kappa = 0.72), HIV-positive men (kappa = 0.57)]. Overall HIV test positivity was 1.4 but 0.9% for pure serosorters. The two methods of operationalizing behaviors result in different estimates, thus the choice of which to employ should depend on the motivation for ascertaining behavioral information.
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38
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Hughes AJ, Chen YH, Scheer S. Condomless Anal Sex Among HIV-Positive Men Who Have Sex with Men: Biomedical Context Matters. AIDS Behav 2017; 21:2886-2894. [PMID: 28702853 DOI: 10.1007/s10461-017-1852-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Data from Medical Monitoring Project was used to determine if partner type is associated with condomless anal sex (CAS) and insertive condomless anal sex (ICAS) among HIV-positive men who have sex with men. Participants reported HIV status and PrEP use of up to five anal sex partners. Partner type was categorized as HIV-positive, HIV status unknown, HIV-negative on PrEP or HIV-negative not on PrEP. To account for correlation of multiple observations per participant, generalized estimating equations were used to calculate adjusted prevalence ratios and 95% confidence intervals of CAS and ICAS. Condom use during anal sex and insertive anal sex varied based on partner type. There was a higher prevalence of CAS and ICAS in partnerships with HIV-positive partners or HIV-negative partners on PrEP compared to HIV-negative partners not on PrEP.
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39
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Bird JDP, Eversman M, Voisin DR. "You just can't trust everybody": the impact of sexual risk, partner type and perceived partner trustworthiness on HIV-status disclosure decisions among HIV-positive black gay and bisexual men. CULTURE, HEALTH & SEXUALITY 2017; 19:829-843. [PMID: 28050947 DOI: 10.1080/13691058.2016.1267408] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
HIV remains an intractable public health concern in the USA, with infection rates notably concentrated among Black gay and bisexual men. Status disclosure by HIV-positive individuals can be an important aspect of risk reduction but doing so poses dilemmas concerning privacy, stigma and self-protection, especially among populations subjected to multiple types of stigmatisation. Understanding the factors related to the disclosure process can help to inform prevention efforts. Using exploratory in-depth interviews, this qualitative study examines the disclosure process among a sample of twenty HIV-positive Black gay and bisexual men (mean age = 40) recruited through a non-profit health centre in a mid-western city in the USA. Data were analysed using a thematic analysis approach with HIV-disclosure as an a priori sensitising concept. Fears of stigma and secondary disclosure within social networks were critical barriers to talking about HIV with sexual partners and disclosure decisions involved a complex process centred on three primary themes: degree of sexual risk, partner type and perceived partner trustworthiness. The unique combinations of these contextual factors resulted in increased or decreased likelihood of disclosure. A conceptual model explicating a potential process by which these contextual factors influence disclosure decisions is presented.
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Affiliation(s)
- Jason D P Bird
- a Department of Social Work , College of Arts and Sciences, Rutgers University-Newark , Newark , USA
| | - Michael Eversman
- a Department of Social Work , College of Arts and Sciences, Rutgers University-Newark , Newark , USA
| | - Dexter R Voisin
- b School of Social Service Administration , University of Chicago , Chicago , USA
- c School of Social Service Administration , STI/HIV Intervention Network , Chicago , USA
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40
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Bird JDP, Morris JA, Koester KA, Pollack LM, Binson D, Woods WJ. "Knowing Your Status and Knowing Your Partner's Status Is Really Where It Starts": A Qualitative Exploration of the Process by Which a Sexual Partner's HIV Status Can Influence Sexual Decision Making. JOURNAL OF SEX RESEARCH 2017; 54:784-794. [PMID: 27485155 PMCID: PMC5290286 DOI: 10.1080/00224499.2016.1202179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Gay and bisexual men are at disproportionate risk for human immunodeficiency virus (HIV) infection. While prevention efforts often emphasize consistent condom use, there is growing evidence that men are using seroadaptive safer-sex strategies, such as serosorting and seropositioning. This qualitative analysis of 204 HIV-negative and HIV-positive gay and bisexual men explored the ways that a sexual partner's HIV status can influence safer-sex strategies and sexual decisions. The majority of the respondents reported that they were influenced by their partners' HIV status. Those respondents who reported no influence discussed adhering to safer-sex rules that were not dependent on partner status and a lack of concern about HIV. Conversely, respondents who reported influence identified three primary areas of influence: psychological impacts, partner preference and selection, and specific behavioral intentions and strategies. A conceptual model explicating a potential process by which respondents use partner serostatus information in shaping sexual decisions is presented.
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Affiliation(s)
- Jason D. P. Bird
- Department of Social Work, Rutgers University – Newark, Newark, New Jersey
| | - Joseph A. Morris
- Center for AIDS Prevention Studies, University of California - San Francisco, San Francisco, California
| | - Kimberly A. Koester
- Center for AIDS Prevention Studies, University of California - San Francisco, San Francisco, California
| | - Lance M. Pollack
- Center for AIDS Prevention Studies, University of California - San Francisco, San Francisco, California
| | - Diane Binson
- Center for AIDS Prevention Studies, University of California - San Francisco, San Francisco, California
| | - William J. Woods
- Center for AIDS Prevention Studies, University of California - San Francisco, San Francisco, California
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41
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Roth EA, Cui Z, Rich A, Lachowsky N, Sereda P, Card KG, Jollimore J, Howard T, Armstrong H, Moore D, Hogg R. Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment. JOURNAL OF HOMOSEXUALITY 2017; 65:524-539. [PMID: 28506154 PMCID: PMC6110384 DOI: 10.1080/00918369.2017.1324681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
British Columbia's treatment as prevention policy has provided free access to highly active antiretroviral therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a seroadaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n = 556) and HIV-positive (n = 218) serostatus participants. Analyses indicated that both groups reported VLS, and that serostatus and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers' Diffusion Of Preventative Innovations Model, and they have important implications for HIV research and GBM sexual decision-making.
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Affiliation(s)
- Eric Abella Roth
- a Centre for Addiction Research of British Columbia , University of Victoria , Victoria , British Columbia , Canada
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Ashleigh Rich
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Nathan Lachowsky
- c School of Medicine , University of British Columbia, Vancouver, British Columbia; and British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Paul Sereda
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Kiffer George Card
- d Faculty of Health Sciences , Simon Fraser University, Vancouver, British Columbia, Canada; and British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Jody Jollimore
- e Health Initiatives for Men , Vancouver , British Columbia , Canada
| | - Terry Howard
- f Positive Living Society of BC , Vancouver , British Columbia , Canada
| | - Heather Armstrong
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - David Moore
- g School of Medicine , University of British Columbia, Vancouver, British Columbia, Canada, British Columbia; and Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Robert Hogg
- h Faculty of Health Sciences , Simon Fraser University, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
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42
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Card KG, Lachowsky NJ, Cui Z, Sereda P, Rich A, Jollimore J, Howard T, Birch R, Carter A, Montaner J, Moore D, Hogg RS, Roth EA. Seroadaptive Strategies of Gay & Bisexual Men (GBM) with the Highest Quartile Number of Sexual Partners in Vancouver, Canada. AIDS Behav 2017; 21:1452-1466. [PMID: 27568338 PMCID: PMC5329166 DOI: 10.1007/s10461-016-1510-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite continued research among men with more sexual partners, little information exists on their seroadaptive behavior. Therefore, we examined seroadaptive anal sex strategies among 719 Vancouver gay and bisexual men (GBM) recruited using respondent-driven sampling. We provide descriptive, bivariable, and multivariable adjusted statistics, stratified by HIV status, for the covariates of having ≥7 male anal sex partners in the past 6 months (Population fourth quartile versus <7). Sensitivity Analysis were also performed to assess the robustness of this cut-off. Results suggest that GBM with more sexual partners are more likely to employ seroadaptive strategies than men with fewer partners. These strategies may be used in hopes of offsetting risk, assessing needs for subsequent HIV testing, and balancing personal health with sexual intimacy. Further research is needed to determine the efficacy of these strategies, assess how GBM perceive their efficacy, and understand the social and health impacts of their widespread uptake.
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Affiliation(s)
- Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
| | - Paul Sereda
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
| | - Ashleigh Rich
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
| | - Jody Jollimore
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
- Health Initiative for Men, Vancouver, BC, Canada
| | - Terry Howard
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
- Positive Living Society of BC, Vancouver, BC, Canada
| | - Robert Birch
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
| | - Allison Carter
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Julio Montaner
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Eric Abella Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
- Centre for Addiction Research of British Columbia, University of Victoria, Victoria, BC, Canada
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Johnston LG, McFarland W, Sabin ML, Prybylski D, Sabin K, Baral S, Kim AA, Raymond HF. Measuring self-reported HIV status in bio-behavioural surveys. Bull World Health Organ 2017; 93:287-287A. [PMID: 26229196 PMCID: PMC4431523 DOI: 10.2471/blt.15.153064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lisa G Johnston
- Global Health Sciences, University of California-San Francisco, 550 - 16th Street (3rd floor), San Francisco, CA 94158, United States of America (USA)
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, USA
| | - Miriam Lewis Sabin
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Dimitri Prybylski
- US Centers for Disease Control and Prevention, Global AIDS Program Asia Regional Office, Nonthaburi, Thailand
| | - Keith Sabin
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - Andrea A Kim
- US Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, USA
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Préau M, Laguette V, March L, Rabaud C, Hardel L, Protopopescu C, Granier P, Pierret J, Leport C, Raffi F. Discussing HIV Status: Is It Easier After 10 Years of Antiretroviral Treatment? The ANRS CO8 APROCO-COPILOTE Cohort. AIDS Behav 2017; 21:118-128. [PMID: 26910336 DOI: 10.1007/s10461-016-1328-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study's objective was to explore the factors associated with the belief (or not) by people living with HIV that it is easier to talk about their seropositivity 10 years after initiating a protease inhibitor-containing ART. All patients in the ANRS CO8 APROCO-COPILOTE cohort who completed a self-administered questionnaire at 10 years of follow-up were included in this study. Forty-four percent of patients declared that discussing their seropositivity with their family was easier 10 years later, while 28 % declared this was true for discussing their status with a new sexual partner. Having a low socioeconomic status, not receiving social support from a steady partner and declaring a low number of discomforting symptoms 12 months after PI initiation were all independently associated with less difficulty in discussing seropositivity. This study highlights the difficulties in disclosing HIV 10 years after PI initiation, and the important influence of psychosocial factors and patients' daily-life experience on disclosure.
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45
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Otis J, McFadyen A, Haig T, Blais M, Cox J, Brenner B, Rousseau R, Émond G, Roger M, Wainberg M. Beyond Condoms: Risk Reduction Strategies Among Gay, Bisexual, and Other Men Who Have Sex With Men Receiving Rapid HIV Testing in Montreal, Canada. AIDS Behav 2016; 20:2812-2826. [PMID: 26961381 PMCID: PMC5108827 DOI: 10.1007/s10461-016-1344-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) have adapted their sexual practices over the course of the HIV/AIDS epidemic based on available data and knowledge about HIV. This study sought to identify and compare patterns in condom use among gay, bisexual, and other MSM who were tested for HIV at a community-based testing site in Montreal, Canada. Results showed that while study participants use condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also make use of various other strategies such as adjusting to a partner's presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.
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Affiliation(s)
- Joanne Otis
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
- CIHR Canadian HIV Trials Network, Vancouver, Canada.
| | - Amélie McFadyen
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Thomas Haig
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
- CIHR Canadian HIV Trials Network, Vancouver, Canada
- COCQ-SIDA, Montreal, QC, Canada
| | - Martin Blais
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Joseph Cox
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Bluma Brenner
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Gilbert Émond
- Applied Human Sciences, Concordia University, Montreal, QC, Canada
| | - Michel Roger
- Laboratoire de Biologie Moléculaire, Centre hospitalier de l'université de Montréal, Montreal, QC, Canada
| | - Mark Wainberg
- Faculty of Medicine, McGill University, Montreal, QC, Canada
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46
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Abstract
Serosorting (i.e., choosing partners of the same HIV serostatus to reduce the risk of transmission with unprotected sex) and other forms of seroadaptation (i.e., engaging in diverse behaviors according to a hierarchy of risk by type of sex and partner serostatus) are phenomena widely described for men who have sex with men (MSM) in the developed world. We assessed seroadaptive behaviors among MSM surveyed in Yangon, Myanmar in 2013-2014. Among HIV-negative MSM, 43.1 % engaged in some form seroadaptation including serosorting (21.8 %), using condoms with potentially serodiscordant anal sex (19.3 %), and seropositioning (1.7 %). Among HIV-positive MSM, 3.5 % engaged in serosorting, 36.0 % in using condoms with potentially serodiscordant anal sex, 7.0 % in seropositioning, and 46.5 % in any form of seroadaptation. For HIV-negative and HIV-positive MSM, seroadaptation was more common than consistent condom use (38.0 and 26.7 %, respectively). MSM in Myanmar are engaging in seroadaptive behaviors in magnitude and ways similar to MSM in industrialized countries.
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Affiliation(s)
- Tin Aung
- Population Services International-Myanmar, Yangon, Myanmar
| | - Si Thu Thein
- Population Services International-Myanmar, Yangon, Myanmar
| | - Willi McFarland
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6033, USA.
- University of California, San Francisco, San Francisco, CA, USA.
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47
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Gopalappa C, Farnham PG, Chen YH, Sansom SL. Progression and Transmission of HIV/AIDS (PATH 2.0). Med Decis Making 2016; 37:224-233. [PMID: 27646567 DOI: 10.1177/0272989x16668509] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND HIV transmission is the result of complex dynamics in the risk behaviors, partnership choices, disease stage and position along the HIV care continuum-individual characteristics that themselves can change over time. Capturing these dynamics and simulating transmissions to understand the chief sources of transmission remain important for prevention. METHODS The Progression and Transmission of HIV/AIDS (PATH 2.0) is an agent-based model of a sample of 10,000 people living with HIV (PLWH), who represent all men who have sex with men (MSM) and heterosexuals living with HIV in the U.S.A. Persons uninfected were modeled as populations, stratified by risk and gender. The model included detailed individual-level data from several large national surveillance databases. The outcomes focused on average annual transmission rates from 2008 through 2011 by disease stage, HIV care continuum, and sexual risk group. RESULTS The relative risk of transmission of those in the acute phase was nine-times [5th and 95th percentile simulation interval (SI): 7, 12] that of those in the non-acute phase, although, on average, those with acute infections comprised 1% of all PLWH. The relative risk of transmission was 24- to 50-times as high for those in the non-acute phase who had not achieved viral load suppression as compared with those who had. The relative risk of transmission among MSM was 3.2-times [SI: 2.7, 4.0] that of heterosexuals. Men who have sex with men and women generated 46% of sexually acquired transmissions among heterosexuals. CONCLUSIONS The model results support a continued focus on early diagnosis, treatment and adherence to ART, with an emphasis on prevention efforts for MSM, a subgroup of whom appear to play a role in transmission to heterosexuals.
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Affiliation(s)
| | - Paul G Farnham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS)
| | - Yao-Hsuan Chen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS)
| | - Stephanie L Sansom
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS)
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49
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Methods and Approaches to HIV Prevention. J Assoc Nurses AIDS Care 2016; 28:19-24. [PMID: 27751633 DOI: 10.1016/j.jana.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/13/2016] [Indexed: 11/22/2022]
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50
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How Different are Men Who Do Not Know Their HIV Status from Those Who Do? Results from an U.S. Online Study of Gay and Bisexual Men. AIDS Behav 2016; 20:1989-99. [PMID: 26767536 DOI: 10.1007/s10461-015-1284-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We compared self-described HIV-positive (31.6 %, n = 445), HIV-negative (56.8 %, n = 801), and HIV-unknown (11.6 %, n = 164) gay and bisexual men on sociodemographic and behavioral characteristics. Participants from across the U.S. were enrolled via a popular sexual networking website to complete an online survey. In total, 44.8 % of HIV-negative and HIV-unknown men said they had not been tested for HIV in the CDC-recommended last 6 months. HIV-unknown men significantly differed from HIV-negative and HIV-positive men in sexual behavior and HIV status disclosure patterns. HIV-unknown men were more willing than HIV-negative men to take PrEP; however, HIV-unknown men were significantly less likely than others to have health insurance or a primary care provider. Given the observed differences, researchers should consider analyzing men who are HIV-unknown distinctly from HIV-negative and HIV-positive men.
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