Factors Associated with Sexual Risk of HIV Transmission Among HIV-Positive Latino Men Who have Sex with Men on the U.S.-México Border

Risk factors associated with HCV co-infection amongst MSM and transgender women living with HIV in Mexico City: A case-control study

INTRODUCTION AND OBJECTIVES

Hepatitis C virus infection (HCV) is a major cause of co-morbidity in people living with HIV (PLWHIV). The modes of HCV transmission in the local population of PLWHIV are still unclear. We conducted this study to identify risk factors for HCV transmission amongst PLWHIV in central Mexico.

MATERIAL AND METHODS

We enrolled HIV/HCV co-infected cases and HIV controls receiving care in two outpatient clinics in Mexico City. Structured questionnaires were applied, covering demographics, history of percutaneous exposures, sexual behaviors, self-reported STD and recreational drug use. The statistical analysis for between-group comparisons were multivariate logistic regression models to assess the risk factors associated with HCV co-infection. We limited the final analysis to men who have sex with men (MSM) to avoid confounders potentially related to HCV acquisition in other populations.

RESULTS

Three hundred and thirty-four MSM with HIV (175 with HCV co-infection and 159 without) were analysed. We did not identify percutaneous exposures as risk factors for HCV. Intravenous drug use (IVDU) occurred in two cases and one control case. Risk factors independently associated with acquiring HCV co-infection were: history of an ulcerative STD (aOR=2.65, 95%CI=1.44-4.88), a HCV positive partner (aOR=5.25, 95%CI=2.78-9.91), having practiced insertive fisting (aOR=2.62, 95%CI=1.01-6.90), and rectal administration of drugs during sex (aOR=2.46, 95%CI=1.25-4.84).

CONCLUSIONS

Risky sexual behaviors and chemsex seem to be the main drivers of HIV/HCV co-infection amongst PLWHIV in Central Mexico. IVDU and percutaneous exposures have a minor role in the local HCV epidemic. These findings highlight the importance of testing for HCV in sexually active MSMs.

Assessing the Determinants of Quality of Life and the Impact on HIV Prevention Measures among HIV-Negative and Status-Unknown Young Men Who Have Sex with Men: A Study in Two U.S. Metropolitan Areas

Young men who have sex with men (YMSM) in the United States (U.S.) are disproportionally burdened by HIV and experience adverse social determinants of health. Minimal research has examined quality of life (QoL) and psychosocial/behavioral determinants among HIV-negative or status-unknown YMSM. We conducted a study with YMSM from two U.S. cities to assess their QoL scores, and whether specific QoL domains (e.g., physical, psychological, social, and environment) were associated with their demographics, psychosocial determinants, behavioral risk factors, and HIV prevention measures. Black YMSM, YMSM of low socioeconomic status (below high school education, income < $20,000, and lack of health insurance), and YMSM who did not disclose their sexual orientation had the lowest QoL scores across all domains. Substance use and unprotected anal intercourse were negatively associated with men’s physical/psychosocial health. Housing/food instability and perceived stress were among the strongest predictors of lower QoL in all domains. Higher physical/psychological and environment QoL scores were associated with a higher likelihood of HIV testing and PrEP use. The identification of YMSM within these demographic, behavioral, and psychosocial sub-groups is important for targeted intervention to enhance their well-being and engagement with HIV prevention.

Challenges and Barriers to HIV Care for Mexican Born Men Living in Chicago

BACKGROUND

Latinx men are disproportionately impacted by HIV. Research often looks at Latinx people as a heterogeneous population. This paper describes baseline characteristics and barriers to HIV care among Mexican born men enrolled in an HIV care engagement intervention at a public health clinic in Chicago.

METHODS

Survey and medical chart data were collected.

RESULTS

66 Mexican born men enrolled in the project. Over half (60%) were newly diagnosed; 40% were reengaging in care or establishing care for the first time. Participants reported significant pre and postmigration concerns including poverty, social stigma, late entry to care, and concurrent health concerns, including 47% screening positive for depression. Barriers to care and mental health concerns were significantly related to Stage 3 HIV.

DISCUSSION

More prevention and intervention research is needed to ameliorate the negative socioeconomic and health ramifications of immigration and bolster mental and sexual health, reduce HIV transmission, and increase testing, linkage and care retention.

Getting by with a Little Help from Our Friends: The Role of Social Support in Addressing HIV-related Mental Health Disparities among Sexual Minorities in the Lower Rio Grande Valley

This study examines how social support and perceived discrimination influence depressive symptoms of sexual minorities (including, lesbian, gay, bisexual-identifying individuals, and others with same-sex sexual partners) relative to heterosexual peers, while considering the role of HIV-positive status. We surveyed low-income, predominantly Hispanic/Latino/as residents receiving STI-testing and/or HIV/AIDS care in the lower Rio Grande Valley of southernmost Texas. Respondents aged 18+ took a self-administered survey in English or Spanish in a clinic waiting room (N= 273). Based on OLS regression, HIV-positive status (OLS coefficient = 2.54, p< .01) and social support (OLS coefficient = -0.17, p< .001) were significant predictors of depressive symptoms among sexual minorities, but not those who identified as heterosexual. Perceived discrimination was uniquely associated with increased depressive symptoms among sexual minorities (interaction coefficient = 0.21, p< .05). Clinicians treating sexual minority patients for depression should consider developing and applying resources tailored to individuals' level of social support and ongoing experiences of social discrimination.

High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems

Latino immigrants with substance use and mental health problems are at risk for undiagnosed HIV and sexually transmitted infections (STIs). Participants in a randomized control trial were recruited in Boston, USA and Madrid and Barcelona, Spain. Eligibility criteria were Latino self-identification, age 18-70, elevated substance use and mental health symptoms, and not currently in substance or mental health care. A multinomial logistic regression examined predictors of HIV/STI testing decline and lost to follow-up (LTFU) prior to testing compared with acceptance. Of 341 participants, 74% accepted testing, 4% declined, and 22% were LTFU. The odds of LTFU were higher in those with high concern for HIV and those whose main partner had done HIV testing. Age ≥ 35 years, females, higher education, and higher report of discrimination lowered the odds of LTFU. Delivery of HIV/STI testing through community agencies and outreach could overcome barriers to HIV/STI diagnosis in this population of Latinos.Clinical Trial Number: NCT02038855.

Condomless Sex and Psychiatric Comorbidity in the Context of Constrained Survival Choices: A Longitudinal Study Among Homeless and Unstably Housed Women

We sought to identify the prevalence and independent correlates of condomless sex within a cohort of community-recruited homeless and unstably housed cisgender adult women who were followed biannually for 3 years (N = 143 HIV+ , N = 139 HIV-). Nearly half (44%) of participants reported condomless sex in the 6 months before baseline, which increased to 65% throughout the study period. After adjusting for having a primary partner, longitudinal odds of condomless sex among women with HIV were significantly higher among those reporting < daily use of alcohol or cannabis (AOR = 2.09, p =.002, and 1.88, p =.005, respectively) and PTSD (AOR = 1.66, p =.034). Among women without HIV, adjusted longitudinal odds of condomless sex were significantly higher for those reporting < daily methamphetamine use (AOR = 2.02, p =.012), panic attack (AOR = 1.74, p =.029), and homelessness (AOR = 1.67, p = .006). Associations were slightly attenuated when adjusting for sex exchange. Targeted HIV/STI programs for unstably housed women should address anxiety and trauma disorders, infrequent substance use, and housing challenges.

HIV- and AIDS-related knowledge and attitude of residents in border regions of Vietnam

BACKGROUND

Residents in border areas are vulnerable to HIV/AIDS due to high rates of risk behaviors such as unprotected sexual practices or illicit drug use. Improving knowledge and attitude toward HIV/AIDS prevention and treatment are vital to diminish the burden of the HIV epidemic in this setting. However, evidence about this issue in Vietnam has been limited. This study aims to explore the knowledge and attitude toward HIV/AIDS among people in Vietnam border zones.

METHODS

We conducted a cross-sectional study in three border communes in Thanh Hoa province with 600 HIV(-) residents. Data about socio-demographic characteristics, general HIV knowledge, knowledge about prevention of mother-to-child transmission, treatment and care, HIV testing services, and attitude toward HIV/AIDS were collected. Multivariate Tobit regression was used to determine related factors with the knowledge and attitude.

RESULTS

The highest percentage of people having correct statements was for "HIV could be transmitted from mother to child" (98.2%), while the lowest percentage was for item "Know health facilities where HIV-positive people could register for care and check-up" (28.2%). People had the highest score in "Knowledge about HIV transmission routes" and the lowest score in "Knowledge about HIV/AIDS prevention measures". Most of the people were not afraid of being exposed to HIV-positive individuals (66.0%), willing to buy goods from HIV-positive sellers (78.9%), and willing to take care of people living with HIV in their family (90.1%). Education, ethnic, marital status, occupations, and HIV/AIDS information sources were found to be associated with knowledge and attitude toward HIV/AIDS.

CONCLUSIONS

The general knowledge and attitude on HIV/AIDS of residents were relatively good. Educational campaigns to improve knowledge and attitude toward PLWH, involving peer educators and local associations, are potential strategies for sustaining HIV intervention in this remote setting.

Meta-Analysis of Alcohol and Serodiscordant Condomless Sex Among People Living with HIV

While observational studies have found that alcohol consumption is associated with serodiscordant condomless sex among people living with HIV (PLHIV), no meta-analysis has yet examined this trend. We conducted a meta-analysis to synthesize empirical evidence on the association between alcohol and condomless sex with partners at risk of HIV acquisition. To meet inclusion criteria, studies: (1) specifically targeted PLHIV or provided stratified data for HIV-infected participants; (2) provided a quantitative measure of alcohol use; (3) provided a quantitative measure of condomless sex with serodiscordant partners; and (4) reported the results of statistical tests examining the relationship between alcohol use and serodiscordant condomless sex. Using random-effects models, weighted effect sizes were calculated. Three separate analyses were conducted to examine serodiscordant condomless sex in association with any alcohol consumption, binge/problematic drinking, and alcohol in a sexual context. A total of 36 independent effect sizes from 27 studies (including 25,065 HIV-infected participants) were pooled in the meta-analysis. Any alcohol consumption, binge/problematic drinking, and alcohol use in a sexual context were each associated with condomless sex with serodiscordant partners [OR 1.64 (95% CI 1.46-1.85); OR 1.65 (95% CI 1.14-2.39); OR 2.88 (95% CI 2.01-4.12), respectively]. Meta-analytic findings demonstrate a consistent positive relationship between alcohol use and serodiscordant condomless sex among PLHIV. Future public health programming for HIV-infected individuals needs to address the role of alcohol consumption in sexual risk-taking behavior.

Examining the Effects of Transphobic Discrimination and Race on HIV Risk Among Transwomen in San Francisco

Transwomen, in particular transwomen of color (TWOC), are among the most vulnerable populations at risk for HIV. This secondary analysis is organized using a gender minority stress framework to examine the effects of transphobic discrimination and race on HIV risk factors. We describe the sample of 149 HIV- adult transwomen in San Francisco and use binary logistic regression to examine the relationship between levels of transphobic discrimination and TWOC status on binge drinking and condomless receptive anal intercourse (CRAI), controlling for potential confounders. Those with high levels of transphobic discrimination had 3.59 fold greater odds of engaging in binge drinking compared to those who reported a low level of transphobic discrimination (95% CI 1.284-10.034; P = 0.015). TWOC had nearly threefold greater odds of CRAI compared to white transwomen (95% CI 1.048-8.464; P = 0.040). We discuss implications for gender minority stress research and future interventions for this population.