1
|
Johnson KA, Hunt T, Puglisi L, Chapman B, Epa-Llop A, Elumn J, Braick P, Bhagat N, Ko E, Nguyen A, Johnson R, Graham HK, Gilbert L, El-Bassel N, Morse DS. HIV/STI/HCV Risk Clusters and Hierarchies Experienced by Women Recently Released from Incarceration. Healthcare (Basel) 2023; 11:1066. [PMID: 37107900 PMCID: PMC10137919 DOI: 10.3390/healthcare11081066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
This study examines cross-sectional clusters and longitudinal predictions using an expanded SAVA syndemic conceptual framework-SAVA MH + H (substance use, intimate partner violence, mental health, and homelessness leading to HIV/STI/HCV risks)-among women recently released from incarceration (WRRI) (n = 206) participating in the WORTH Transitions (WT) intervention. WT combines two evidence-based interventions: the Women on the Road to Health HIV intervention, and Transitions Clinic. Cluster analytic and logistic regression methods were utilized. For the cluster analyses, baseline SAVA MH + H variables were categorized into presence/absence. For logistic regression, baseline SAVA MH + H variables were examined on a composite HIV/STI/HCV outcome collected at 6-month follow-up, controlling for lifetime trauma and sociodemographic characteristics. Three SAVA MH + H clusters were identified, the first of which had women with the highest overall levels of SAVA MH + H variables, 47% of whom were unhoused. Hard drug use (HDU) was the only significant predictor of HIV/STI/HCV risks in the regression analyses. HDUs had 4.32-fold higher odds of HIV/STI/HCV outcomes than non-HDUs (p = 0.002). Interventions such as WORTH Transitions must differently target identified SAVA MH + H syndemic risk clusters and HDU to prevent HIV/HCV/STI outcomes among WRRI.
Collapse
Affiliation(s)
- Karen A. Johnson
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Timothy Hunt
- Social Intervention Group, School of Social Work, Columbia University, New York, NY 10027, USA
| | - Lisa Puglisi
- SEICHE Center for Health and Justice, School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Ben Chapman
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA
| | - Amali Epa-Llop
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA
| | - Johanna Elumn
- SEICHE Center for Health and Justice, School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Peter Braick
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA
| | - Navya Bhagat
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA
| | - Elizabeth Ko
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA
| | - Antoinette Nguyen
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA
| | - Rachel Johnson
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA
| | - Heather K. Graham
- Educational Studies in Psychology, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Louisa Gilbert
- Social Intervention Group, School of Social Work, Columbia University, New York, NY 10027, USA
| | - Nabila El-Bassel
- Social Intervention Group, School of Social Work, Columbia University, New York, NY 10027, USA
| | - Diane S. Morse
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY 14642, USA
| |
Collapse
|
2
|
Orser L, O'Byrne P, Holmes D. Perceptions, motivations, and beliefs about HIV risk and pre-exposure prophylaxis (PrEP) among participants in a nurse-led PrEP service (PrEP-RN). BMC Infect Dis 2022; 22:196. [PMID: 35227202 PMCID: PMC8883450 DOI: 10.1186/s12879-022-07146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background While HIV pre-exposure prophylaxis (PrEP) has become more readily available in Canada, its uptake among HIV priority populations continues to be affected by system-level and individual factors. Such impediments relate to challenges by healthcare providers in assessing HIV-related risk and variability in patients’ motivations for PrEP initiation and continued engagement in care. Methods In Ottawa, Canada, a group of researchers implemented Canada’s first nurse-led HIV prevention program, known as PrEP-RN. As part of this pilot, qualitative interviews were completed with fourteen patients who had accessed PrEP-RN. The purpose of these interviews was to understand participants’ perspectives related to HIV prevention and experiences accessing care through a nurse-led service. Interviews were analyzed using thematic analysis, which were organized into the two major themes of (1) motivations for PrEP initiation and (2) beliefs about the benefits of PrEP. Results Findings revealed participants’ motivations for PrEP differed from healthcare provider’s views of risk, which were influenced by external life factors and personal perceptions of risk. In addition, participants discussed the benefits of PrEP in terms of its ability to manage their potential mistrust of sexual partners, control their sexual health, and liberate fears and anxieties related to HIV. Conclusions Based on these findings, health and allied providers should consider incorporating individual motivations and beliefs into patient education and counselling about PrEP to better target HIV prevention care at persons are at elevated risk of HIV. These perspectives could also be used to re-structure web and social media campaigns to increase PrEP uptake among HIV priority populations.
Collapse
Affiliation(s)
- Lauren Orser
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada. .,Sexual Health and Harm Reduction Services, Ottawa Public Health, Ottawa, ON, Canada.
| | - Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.,Sexual Health and Harm Reduction Services, Ottawa Public Health, Ottawa, ON, Canada
| | - Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
3
|
Jaspal R, Lopes B. Psychological wellbeing facilitates accurate HIV risk appraisal in gay and bisexual men. Sex Health 2021; 17:288-295. [PMID: 32586413 DOI: 10.1071/sh19234] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 04/28/2020] [Indexed: 01/07/2023]
Abstract
Background Accurate HIV risk appraisal is key to effective HIV prevention. This study focuses on the role of psychological wellbeing in determining perceived HIV risk in a sample of gay and bisexual (GBM) in the UK. METHODS Overall, 191 HIV-negative GBM completed a cross-sectional survey, in which they provided demographic information and completed measures of engagement in actual sexual risk behaviours, diagnosis with a sexually transmissible infection in the past 12 months, frequency of HIV testing, use of post-exposure prophylaxis (PEP), perceived HIV risk, lesbian, gay, bisexual and transgender (LGBT) identity, sexual identity openness and psychological wellbeing. RESULTS Results showed that there was a correlation between engagement in actual HIV risk behaviours and perceived HIV risk, suggesting relatively accurate HIV risk appraisal in the participant sample. LGBT identity and sexual identity openness were associated with increased psychological wellbeing. Structural equation modelling showed that psychological wellbeing has an effect on perceived HIV risk through the mediator of LGBT identity. CONCLUSIONS It appears that a state of psychological wellbeing facilitates the construction of a strong and robust LGBT identity, which can be displayed to others, and that a strong LGBT identity in turn facilitates accurate HIV risk appraisal in GBM. In order to achieve our target of zero new HIV infections by 2030, it will be essential to focus on enhancing psychological wellbeing in people at risk of HIV.
Collapse
Affiliation(s)
- Rusi Jaspal
- Nottingham Trent University, School of Social Sciences, 58 Shakespeare Street, Nottingham, NG1-4FQ, UK; and Corresponding author.
| | - Barbara Lopes
- Universidade de Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculdade de Psicologia e de Ciências da Educação, Coimbra, 3000-115, Portugal
| |
Collapse
|
4
|
Bennett CL, Marks SJ, Rosenberger JG, Bauermeister JA, Clark MA, Liu T, Mayer KH, Merchant RC. Factors Associated with the Discordance between Perception of Being HIV Infected and HIV Sexual Risk Taking among Social Media-Using Black, Hispanic, and White Young Men Who Have Sex with Men. J Int Assoc Provid AIDS Care 2021; 19:2325958220919260. [PMID: 32314651 PMCID: PMC7175048 DOI: 10.1177/2325958220919260] [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: 11/17/2022] Open
Abstract
Among HIV-uninfected, social media-using black, Hispanic, and white young men who have sex with men (YMSM) who had condomless anal sex but had not been HIV tested within the past year, we aimed to determine the extent of discordance between perception of having an undiagnosed HIV infection and HIV risk-taking behaviors. Despite reporting condomless anal sex without HIV testing, 64% of 358 YMSM participants perceived having an undiagnosed HIV infection as "unlikely" and 12% as "impossible." Having a primary care provider and being Hispanic were associated with greater discordance. Interventions to decrease the discordance between perceived and actual HIV risk are needed for this higher HIV risk population.
Collapse
Affiliation(s)
- Christopher L Bennett
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah J Marks
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | | | - Melissa A Clark
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Kenneth H Mayer
- Fenway Health and Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Felner JK, Mittal ML, Hoenigl M, Amico KR, Grelotti DJ, Eanes A, Hess K, Crawford J, Smith LR. Constructions of HIV Risk Among a Diverse Sample of HIV-Negative Young Men Who Have Sex With Men Who Are Repeat Testers. J Acquir Immune Defic Syndr 2021; 86:e126-e133. [PMID: 33394615 PMCID: PMC7933095 DOI: 10.1097/qai.0000000000002614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To end the HIV epidemic, HIV prevention and pre-exposure prophylaxis (PrEP) promotion efforts must reach young men who have sex with men (YMSM) at greatest risk for HIV. This study qualitatively explored whether common metrics used by clinicians, scientists, and public health officials to objectively assess HIV risk align with how YMSM conceptualize their risk for HIV and the factors that shape YMSM's risk perceptions. METHODS Interviews with a racially/ethnically diverse sample of HIV-negative YMSM (ages 19-24 years, 60% Latinx; n = 20) examined conceptualizations of HIV risk within the context of repeat HIV testing. Iterative, applied thematic analysis examined how participants conceptualized and constructed their HIV risk, and compared participants' descriptions of their risk with a validated quantitative assessment of HIV risk that reliably predicts HIV seroconversion in this group. RESULTS Objective quantitative assessments of HIV risk poorly aligned with participants' perceived HIV risk. Participants described their current risk in relative terms (relative to past risk and relative to friends'/peers' risk) and described age/developmental stage and changes in knowledge about HIV prevention as key factors in risk changes over time. Other factors included substance use and trust/mistrust in sexual partners and scientific advances in HIV prevention (eg, U = U and PrEP). Factors that influenced participants' perceived HIV risk were similar regardless of objective risk assessment. CONCLUSIONS Quantitative assessments of risk may poorly align with risk perception among YMSM. Although objective metrics can effectively target YMSM at greatest risk for HIV transmission, interventions to improve prevention behaviors and PrEP uptake may be more effective when tailored to bridge the disconnection between objective HIV risk assessments and YMSM's constructions of risk.
Collapse
Affiliation(s)
- Jennifer K. Felner
- San Diego State University, Institute for Behavioral and Community Health and School of Public Health, 9245 Sky Park Court, Suite 224, San Diego, CA 92123
| | - Maria Luisa Mittal
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - Martin Hoenigl
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - K. Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - David J. Grelotti
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego School of Medicine, 200 Dickinson St, Suite B, San Diego, CA 92103
| | - Alex Eanes
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- NASTAD, 444 North Capitol Street NW, Suite 339, Washington, D.C. 20001
| | - Kristen Hess
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- Clinical Trials Administration, Renown Health, 1155 Mill Street, G14, Reno, NV 89502
| | - Jessica Crawford
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Laramie R. Smith
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| |
Collapse
|
6
|
Holt M, Draper BL, Pedrana AE, Wilkinson AL, Stoové M. Comfort Relying on HIV Pre-exposure Prophylaxis and Treatment as Prevention for Condomless Sex: Results of an Online Survey of Australian Gay and Bisexual Men. AIDS Behav 2018; 22:3617-3626. [PMID: 29564695 DOI: 10.1007/s10461-018-2097-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV-negative and untested gay and bisexual men from Victoria, Australia (n = 771) were surveyed during August-September 2016 about their comfort having condomless sex with casual male partners in scenarios in which pre-exposure prophylaxis (PrEP) or treatment as prevention were used. Men not using PrEP were most comfortable with the idea of condomless sex with HIV-negative partners (31%), followed by partners using PrEP (23%). PrEP users were more comfortable with the idea of condomless sex with these partner types (64 and 72%, respectively). Very few men not taking PrEP were comfortable with condomless sex with HIV-positive partners (3%), even with undetectable viral loads (6%). PrEP users were more comfortable with condomless sex with HIV-positive partners (29%), and those with undetectable viral loads (48%). Being on PrEP, having recent condomless sex with casual partners or a HIV-positive regular partner were independently associated with comfort having condomless sex.
Collapse
Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW, Level 2, John Goodsell Building, Sydney, NSW, 2052, Australia.
| | | | - Alisa E Pedrana
- The Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Nutrition, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| | - Anna L Wilkinson
- The Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark Stoové
- The Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
7
|
Down I, Ellard J, Triffitt K, Zablotska I, Hurley M, Brown G, Bradley J, Prestage G. High-risk sexual behaviours among gay and bisexual men: comparing event-level casual sex encounters among seroconverters and non-seroconverters. Sex Transm Infect 2017; 93:327-331. [PMID: 28325770 DOI: 10.1136/sextrans-2016-052749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/17/2017] [Accepted: 03/01/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND With increasing use of non-condom-based HIV risk reduction strategies by gay and bisexual men (GBM), we compared occasions of condomless anal intercourse with casual partners (CLAIC) that resulted in HIV transmission and similar occasions when HIV transmission did not occur. METHODS We compared two demographically similar samples of Australian GBM. The HIV Seroconversion Study (SCS) was an online cross-sectional survey of GBM recently diagnosed with HIV. The Pleasure and Sexual Health (PASH) study was an online cross sectional survey of GBM generally. Using logistic regression, we compared accounts of CLAIC reported by men in SCS as being the event which led to them acquiring HIV, with recent CLAIC reported by HIV-negative men in PASH. RESULTS In SCS, 85.1% of men reported receptive CLAIC, including 51.8% with ejaculation; 32.1% reported having previously met this partner and 28.6% believed this partner to be HIV-negative. Among HIV-negative men in PASH reporting recent CLAIC, 65.5% reported receptive CLAIC, including 29.9% with ejaculation; 59.3% reported having previously met this partner and 70.1% believed this partner to be HIV-negative. CONCLUSIONS While both groups of men engaged in CLAIC, how they engaged in CLAIC differed, and the context in which they did so was different. A generic measure of CLAIC conceals the critical elements of HIV risk, particularly the role of receptive CLAIC, among GBM that distinguish those who seroconverted and those who did not. Detailed information about the context and nature of the practise of CLAIC is required for a more complete understanding of HIV risk among GBM.
Collapse
Affiliation(s)
- Ian Down
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jeanne Ellard
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Kathy Triffitt
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Iryna Zablotska
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Michael Hurley
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Graham Brown
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Jack Bradley
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
8
|
Down I, Prestage G, Ellard J, Triffitt K, Brown G, Callander D. Australian Gay Men Describe the Details of Their HIV Infection Through a Cross-Sectional Web-Based Survey. J Med Internet Res 2016; 18:e227. [PMID: 27663447 PMCID: PMC5055591 DOI: 10.2196/jmir.5707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/10/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022] Open
Abstract
Background With emerging opportunities for preventing human immunodeficiency virus (HIV) transmission, it remains important to identify those at greatest risk of infection and to describe and understand the contexts in which transmissions occur. Some gay and bisexual men with recently diagnosed HIV infection are initially unable to identify high-risk behaviors that would explain their HIV infection. We explored whether Web-based data collection could assist them in identifying the circumstances of their infection. Objective To assess the capacity of a Web-based survey to collect reliable self-report data on the event to which gay and bisexual men ascribe their HIV infection. Methods The HIV Seroconversion Study included a Web-based survey of gay and bisexual men with recently diagnosed HIV infection in Australia. Participants were asked if they could identify and describe the event they believe led to their infection. Men were also asked about their sexual and other risk practices during the 6 months before their diagnosis. Results Most (403/506, 79.6%) gay and bisexual men with newly diagnosed HIV infection were able to identify and describe the circumstances that likely led to their infection. Among those who were initially unable to identify possible exposure events, many could nonetheless provide sensible information that ostensibly explained their seroconversion. Free-text responses allowed men to provide more detailed and contextual information, whereas questions about the totality of their sexual behavior before diagnosis provided opportunities for men to describe their sexual risk behavior in general. Overall, 84.0% indicated having engaged in condomless anal intercourse before their HIV diagnosis, including 71.8% in the receptive position. Conclusions This study demonstrates the effectiveness of using Internet-based technologies to capture sensitive information about the circumstances in which HIV infection occurs among gay and bisexual men. By providing a range of opportunities for relaying experience, this research reveals some of the complexity in how individuals come to understand and explain their HIV infection. These findings may assist in obtaining detailed sexual history in the clinical setting.
Collapse
Affiliation(s)
- Ian Down
- Kirby Institute, University of New South Wales Australia, Sydney, Australia.
| | | | | | | | | | | |
Collapse
|
9
|
Willingness to Act upon Beliefs about 'Treatment as Prevention' among Australian Gay and Bisexual Men. PLoS One 2016; 11:e0145847. [PMID: 26741143 PMCID: PMC4704706 DOI: 10.1371/journal.pone.0145847] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/09/2015] [Indexed: 02/04/2023] Open
Abstract
HIV ‘treatment as prevention’ (TasP) is highly effective in reducing HIV transmission in serodiscordant couples. There has been little examination of gay and bisexual men’s attitudes towards TasP, particularly regarding men’s willingness to act on beliefs about TasP. We conducted an online cross-sectional survey of Australian men in late 2012 to investigate knowledge and beliefs about new developments in HIV prevention. Amongst 839 men (mean age 39.5 years), men tended to disagree that TasP was sufficiently effective to justify reduced condom use, although HIV-positive men had more favourable attitudes. Only a minority of men were aware of any evidence for TasP; and one-quarter incorrectly believed that evidence for the effectiveness of TasP already existed for the homosexual population. One-fifth (20.5%) of men reported that they would be willing to have condomless anal intercourse with an opposite-status sexual partner when the HIV-positive partner was taking HIV treatments. Factors independently associated with such willingness were: HIV-positive serostatus, reporting any serodiscordant or serononconcordant condomless anal intercourse with a regular male partner in the previous six months, reporting any condomless anal intercourse with a casual male partner in the previous six months, and having greater beliefs in the effectiveness of TasP. This indicated that the men most willing to rely on TasP to prevent transmission were already engaging in higher risk practices. Biomedical HIV prevention represents a rapidly changing environment with new research as well as community and policy responses emerging at a fast pace. For men with serodiscordant sexual partners to successfully apply TasP to reducing transmission risk, more support and education is needed to enable better utilisation of TasP in specific relational and sexual contexts.
Collapse
|
10
|
Rich AJ, Lachowsky NJ, Cui Z, Sereda P, Lal A, Birch R, Montaner J, Moore D, Hogg RS, Roth EA. Substance use, sexual behaviour and prevention strategies of Vancouver gay and bisexual men who recently attended group sex events. CULTURE, HEALTH & SEXUALITY 2015; 18:361-76. [PMID: 26443295 PMCID: PMC4773192 DOI: 10.1080/13691058.2015.1084649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Group sex events are an epidemiologically important part of some gay and bisexual men's sexual culture in Canada. Associated with condomless anal intercourse and polysubstance use, such events have been cited as disproportionally contributing to HIV infection rates. We analysed questionnaire data from the Momentum Health Study in Vancouver, Canada, to understand substance use, sexual behaviour, psychosocial variables (Sexual Sensation Seeking, Sexual Escape Motivation, Treatment Optimism) and HIV prevention strategies (sero-sorting, strategic positioning, avoiding anal sex, disclosure, treatment as prevention) of men attending such events, which were defined as group (n ≥ 4 partners) sex parties, blackout events and darkrooms. Analysis by multivariable logistic regression compared men attending group sex events within the past six months (n = 180) with non-attendees (n = 539). Results showed that attendees reported: (1) significantly higher use of sex drugs and alcohol consumption, (2) higher scores on the Sexual Sensation Scale, more anal sex partners, greater odds of any condomless anal sex with sero-discordant partners and greater odds of reporting fisting and sex toy use and (3) different prevention practices that varied by HIV-serostatus. Findings are interpreted in light of the importance of pleasure, sociality and HIV/STI prevention strategies associated with group sex events. Findings contribute to the development of appropriate education and intervention for attendees.
Collapse
Affiliation(s)
- Ashleigh J Rich
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nathan J Lachowsky
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Zishan Cui
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Allan Lal
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert Birch
- Department of Anthropology, University of Victoria, Victoria, Canada
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, Canada
| | - Julio Montaner
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Moore
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, Canada
| |
Collapse
|
11
|
Bogowicz P, Moore D, Kanters S, Michelow W, Robert W, Hogg R, Gustafson R, Gilbert M. HIV testing behaviour and use of risk reduction strategies by HIV risk category among MSM in Vancouver. Int J STD AIDS 2015; 27:281-7. [PMID: 25736346 DOI: 10.1177/0956462415575424] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/22/2015] [Indexed: 11/16/2022]
Abstract
We carried out an analysis of a serobehavioural study of men who have sex with men >19 years of age in Vancouver, Canada to examine HIV testing behaviour and use of risk reduction strategies by HIV risk category, as defined by routinely gathered clinical data. We restricted our analysis to those who self-identified as HIV-negative, completed a questionnaire, and provided a dried blood spot sample. Of 842 participants, 365 (43.3%) were categorised as lower-risk, 245 (29.1%) as medium-risk and 232 (27.6%) as higher-risk. The prevalence of undiagnosed HIV infection was low (lower 0.8%, medium 3.3%, higher 3.9%; p = 0.032). Participants differed by risk category in terms of having had an HIV test in the previous year (lower 46.5%, medium 54.6%, higher 67.0%; p < 0.001) and in their use of serosorting (lower 23.3%, medium 48.3%, higher 43.1%; p < 0.001) and only having sex with HIV-positive men if those men had low viral loads or were taking HIV medication (lower 5.1%, medium 4.8%, higher 10.9%; p = 0.021) as risk reduction strategies. These findings speak to the need to consider segmented health promotion services for men who have sex with men with differing risk profiles. Risk stratification could be used to determine who might benefit from tailored multiple health promotion interventions, including HIV pre-exposure prophylaxis.
Collapse
Affiliation(s)
- Paul Bogowicz
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Steve Kanters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Warren Michelow
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Robert
- Health Initiative for Men, Vancouver, BC, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | |
Collapse
|
12
|
Australian gay and bisexual men's attitudes to HIV treatment as prevention in repeated, national surveys, 2011-2013. PLoS One 2014; 9:e112349. [PMID: 25386943 PMCID: PMC4227707 DOI: 10.1371/journal.pone.0112349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/13/2014] [Indexed: 11/29/2022] Open
Abstract
Objective Assess the acceptability of HIV treatment as prevention and early antiretroviral treatment among gay and bisexual men in Australia and any changes in attitudes over time. Methods National, online, cross-sectional surveys of gay and bisexual men were repeated in 2011 and 2013. Changes in attitudes to HIV treatment over time were assessed with multivariate analysis of variance. The characteristics of men who agreed that HIV treatment prevented transmission and thought that early treatment was necessary were identified with multivariate logistic regression. Results In total, 2599 HIV-negative, untested and HIV-positive men participated (n = 1283 in 2011 and n = 1316 in 2013). Attitudes changed little between 2011 and 2013; most participants remained sceptical about the preventative benefits of HIV treatment. In 2013, only 2.6% of men agreed that HIV treatment prevented transmission; agreement was associated with being HIV-positive, having an HIV-positive regular partner, and having received HIV post-exposure prophylaxis. In contrast, 71.8% agreed that early antiretroviral treatment is necessary; younger men were more likely and HIV-positive men and participants with HIV-positive partners were much less likely to agree with this. Conclusions Promoting the individual health benefits of HIV treatment rather than its preventative benefits remains more acceptable to Australian gay and bisexual men.
Collapse
|