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Ludwig A, Monico LB, Gryczynski J, Lertch E, Schwartz RP, Fishman M, Dionne R, Mitchell SG. Drug and sexual HIV-risk behaviors among adolescents and young adults with opioid use disorder. J Subst Abuse Treat 2021; 130:108477. [PMID: 34118711 DOI: 10.1016/j.jsat.2021.108477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Opioid use disorder (OUD) among adolescents and young adults (youth) is associated with drug use and sexual HIV-related risk behaviors and opioid overdose. This mixed methods analysis assesses risk behaviors among a sample of 15-21-year-olds (N = 288) who were being treated for OUD in a residential drug treatment program in Baltimore, Maryland. Participants were enrolled in a parent study in which they received either extended-release naltrexone (XR-NTX) or Treatment as Usual (TAU), consisting of outpatient counseling with or without buprenorphine, prior to discharge. At baseline, participants were administered the HIV-Risk Assessment Battery (RAB), and clinical intake records were reviewed to determine participants' history of sexual, physical, or other abuse, as well as parental and partner substance use. A sub-sample of study participants completed semi-structured qualitative interviews (N = 35) at baseline, three-, and six-month follow-up periods. This analysis identified gender (e.g., female IRR = 1.63, CI 1.10-2.42, p = .014), the experience of dependence (e.g., previous detoxification IRR = 1.08, CI 1.01-1.15, p = .033) and withdrawal (e.g., severe withdrawal symptoms IRR = 1.41, CI 1.08-1.84, p = .012), and the role of relationships (e.g., using with partner IRR = 2.45, CI 1.15-5.22, p = .021) as influencing high-risk substance use behaviors. Similarly, high-risk sex was influenced by gender (e.g., female IRR = 1.43, CI 1.28-1.59, p < .001), and the role of relationships (e.g., using with partner IRR = 0.78, CI 0.62-0.98, p = .036). These are key targets for future prevention, treatment, and intervention.
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Affiliation(s)
- Ariel Ludwig
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Laura B Monico
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Jan Gryczynski
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Elizabeth Lertch
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Ross Dionne
- Pacifica Graduate Institute, 249 Lambert Rd., Carpinteria, CA 93013, United States of America
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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Westmoreland DA, Gorbach P, Holloway IW, Arah OA, Javanbakht M. Individual and Partnership Factors Associated with Heterosexual Anal Intercourse Among Attendees of Public Sexually Transmitted Disease Clinics in Los Angeles County. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:347-358. [PMID: 33175271 PMCID: PMC7880871 DOI: 10.1007/s10508-020-01831-7] [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: 10/23/2019] [Revised: 07/25/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Abstract
Heterosexual anal intercourse (HAI) is an understudied sexual behavior and poses unique challenges to the prevention of sexually transmitted diseases (STDs). This study aimed to explore individual and partnership characteristics associated with HAI. This study used data collected from 243 young people who attended STD clinics in Los Angeles County between April 2012 and May 2014. Participants reported on sexual behaviors with their last three sexual partners. Hierarchical, mixed effects, repeated-measures analyses were used to assess partner-level (demographic) and individual-level (demographic and behavioral) factors associated with recent (past 6 months) HAI. Thirty-two percent of participants (n = 243) reported HAI with at least one recent sex partner, and 49% reported ever having anal intercourse (AI). After adjusting for demographic characteristics, HAI was more than twice as likely to occur in relationships (n = 503) lasting more than a year compared to relationships lasting less than one month. HAI was also more likely to occur in relationships where intimate partner violence (IPV) was reported either as IPV initiated by the respondent (aOR = 2.18, 95% CI 1.08-4.41) or IPV initiated by the partner (aOR = 2.38, 95% CI 1.27-4.47). Among our participants, a substantial proportion reported HAI in the recent past 6 months and nearly half reported lifetime AI. Notably, our results indicate the importance of relationship contexts for people engaging in HAI and highlight the increased risk of STD/HIV transmission in the context of relationships with intimate partner violence victimization and perpetration.
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Affiliation(s)
- Drew A Westmoreland
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
- Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, Room 626, New York, NY, 10027, USA.
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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3
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Buttram ME, Kurtz SP, Paul RJ. Sexual risk behaviours associated with unlicensed driving among young adults in Miami's electronic dance music nightclub scene. Sex Health 2019; 14:584-586. [PMID: 28578756 DOI: 10.1071/sh17073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/26/2017] [Indexed: 11/23/2022]
Abstract
Literature indicates that unlicensed driving (UD) offenders report substance use risk behaviours, yet data related to sexual risk behaviours is unknown. This study examined sexual and other risk behaviours among young adults in Miami, Florida, comparing UD and non-UD offenders (n=498). Compared with others, UD offenders were more likely to report group sex history, being high for sex half the time or more, purchasing sex and sexually transmissible infection history. Results suggest that locating sexual risk reduction interventions inside of the justice system would benefit UD offenders.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL 33138, USA
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL 33138, USA
| | - Roddia J Paul
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL 33138, USA
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Narvaez JCDM, Remy L, Bermudez MB, Scherer JN, Ornell F, Surratt H, Kurtz SP, Pechansky F. Re-traumatization Cycle: Sexual Abuse, Post-Traumatic Stress Disorder and Sexual Risk Behaviors among Club Drug Users. Subst Use Misuse 2019; 54:1499-1508. [PMID: 31020892 DOI: 10.1080/10826084.2019.1589521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Club drug users are high risk and vulnerable population for adverse drug-related consequences and sexual risk behaviors. Few investigations have addressed the possible interrelationship between early trauma and PTSD among young club drug using populations. Objective: Exposure to traumatic experiences - especially in childhood, has been linked to risk behaviors exposure and substance use disorder. This study aimed to assess and compare drug use patterns and the presence of childhood sexual abuse (CSA) experiences among ecstasy and LSD users with and without Posttraumatic Stress Disorder (PTSD). Method: This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals. The Global Appraisal of Individual Needs questionnaire was used as the primary assessment instrument. Participants were from 18 to 39 years of age, had used ecstasy and/or LSD in the 90 days prior to the interview, and were not in treatment for alcohol and other drug problems. Results: Out of the 240 participants, 123 (51.2%) presented PTSD symptoms. Those presenting PTSD were younger, less educated, with lower income, and presented higher drug use severity than those without PTSD symptoms. Moreover, a higher prevalence of sexual risk behavior was verified among those with PTSD. There was an association between PTSD symptoms and CSA history, where 64.2% of individuals with PTSD also presented CSA, compared to 47% among those without PTSD (p = .028). Individuals with co-occurring history of CSA and PTSD symptoms reported earlier use of ecstasy, LSD, and cocaine compared to individuals with a history of CSA but without PTSD. Conclusions: In the present study, participants with a history of PTSD demonstrate a history of CSA, as well as pronounced severity in several areas - precocity of use, severity of addiction, and greater exposure to situations of sexual risk. Thus, a cycle of traumatization may be established through early potential trauma, which can remain unprocessed and contribute to earlier and more severe substance use and sexual risk behaviors. Identification of PTSD symptoms and risk for HIV and other STIs among young club drug users is critical to address focused treatment approaches for this vulnerable population.
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Affiliation(s)
- Joana Corrêa de Magalhães Narvaez
- a Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA) , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , Brazil
| | - Lysa Remy
- a Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA) , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , Brazil
| | - Mariane Bagatin Bermudez
- a Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA) , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , Brazil
| | - Juliana Nichterwitz Scherer
- a Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA) , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , Brazil
| | - Felipe Ornell
- a Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA) , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , Brazil
| | - Hilary Surratt
- b Center for Health Services Research , University of Kentucky , Lexington , Kentucky , USA
| | - Steven P Kurtz
- c Center for Applied Research on Substance Use and Health Disparities (ARSH) , Nova Southeastern University , Miami , Florida , USA
| | - Flavio Pechansky
- a Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre (HCPA) , Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , Brazil
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Remy LS, Scherer J, Guimarães L, Surratt HL, Kurtz SP, Pechansky F, Kessler F. Anxiety and depression symptoms in Brazilian sexual minority ecstasy and LSD users. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 39:239-246. [DOI: 10.1590/2237-6089-2016-0081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/21/2017] [Indexed: 02/04/2023]
Abstract
Abstract Background This study examined drug use patterns and psychiatric symptoms of anxiety and depression among young Brazilian sexual minority ecstasy and LSD users and compared findings with those reported for their heterosexual peers. Method This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not on treatment for alcohol and drug abuse. Results Of the 240 subjects enrolled (mean age: 22.9±4.5 years), 28.7% were gay or bisexuals. Multivariate regression analysis showed that the prevalence of depression symptoms in the past 12 months in the sexual minority group was 37% higher than among heterosexuals (prevalence ratio [PR]=1.79; 95% confidence interval [95%CI] 1.03-3.11; p=0.037). Conclusion Strategies should be developed to assess and address individual needs and treatment approaches should be tailored to address depressive symptoms in young, sexual minority club drug users.
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Affiliation(s)
- Lysa S. Remy
- Universidade Federal do Rio Grande do Sul, Brazil
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Buttram ME, Pagano ME, Kurtz SP. Residential Proximity to Electronic Dance Music Nightclubs and Associations with Substance Use, Sexual Behaviors, and Related Problems. JOURNAL OF DRUG ISSUES 2017; 48:4-16. [PMID: 32189722 DOI: 10.1177/0022042617726075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines the association between proximity of place of residence to preferred nightclub and substance use, sexual risk behaviors, and related problems, among a sample of 498 young adult substance users in Miami who report regular nightclub participation. Hierarchal linear models and logistic regressions were constructed to examine the impact of residential proximity to preferred nightclub on risk behaviors. Compared with participants residing in closer proximity to their preferred nightclub, participants residing further away reported higher intensities of alcohol and cocaine use (p < .01), greater condomless vaginal sex frequencies (p < .001), and more substance dependence symptoms (p < .05). Conversely, participants residing in closer proximity to their preferred nightclub had higher likelihood of arrest history (p < .05) than participants residing further away. Results suggest that participants residing further from their preferred nightclubs may be more invested in the nightclub outing and, therefore, engage in more risk behaviors.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL
| | - Maria E Pagano
- Department of Psychiatry, Division of Child Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL
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Hess KL, DiNenno E, Sionean C, Ivy W, Paz-Bailey G. Prevalence and Correlates of Heterosexual Anal Intercourse Among Men and Women, 20 U.S. Cities. AIDS Behav 2016; 20:2966-2975. [PMID: 26781872 PMCID: PMC4949144 DOI: 10.1007/s10461-016-1295-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Heterosexual anal intercourse (HAI) is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. We examined data from heterosexuals recruited in 20 US cities for the 2013 National HIV Behavioral Surveillance system. We assessed correlates of reporting HAI in the previous year. Then, among people reporting HAI in the past year, we assessed what event-level factors are associated with having HAI at last sex. Thirty percent of women and 35 % of men reported HAI in the past year. Among people who had HAI in the past year, those who had HAI at last sex were more likely to have a partner who was HIV-positive or of unknown status or to have exchanged money or drugs for sex at last sex. Information that highlights the risk of HIV transmission associated with HAI would complement existing HIV prevention messages focused on heterosexuals in the U.S.
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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 Rd, MS-E47, Atlanta, GA, 30329, USA.
| | - Elizabeth DiNenno
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E47, Atlanta, GA, 30329, USA
| | - Catlainn Sionean
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E47, Atlanta, GA, 30329, USA
| | - Wade Ivy
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E47, 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 Rd, MS-E47, Atlanta, GA, 30329, USA
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Buttram ME, Kurtz SP. Alternate Routes of Administration among Prescription Opioid Misusers and Associations with Sexual HIV Transmission Risk Behaviors. J Psychoactive Drugs 2016; 48:187-94. [PMID: 27224253 DOI: 10.1080/02791072.2016.1187319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Literature suggests that young adult prescription opioid misusers who are using alternate routes of administration (e.g., snorting, injecting) may be engaging in sexual and non-sexual HIV risk behaviors. This study examines demographics, substance use, sexual risk behavior, and health and social problems associated with alternate routes of administration of prescription opioids among a sample of young adult prescription opioid misusers. Data are drawn from baseline assessments from a behavioral intervention trial. Eligible participants were ages 18-39, and reported recent (past 90 days) heterosexual sex, and recent and regular substance use and attendance at large, recognized local nightclubs. The analyses include 446 racially/ethnically diverse participants. In bivariate regression models, compared to those who did not, participants reporting alternate routes of administration (n = 209) were more likely to be White (p < 0.025) and report group sex participation history (p = 0.002), sex with an injection drug user (p = 0.003), sexual victimization history (p = 0.003), and severe mental distress (p < 0.000). White race, group sex participation history, and severe mental distress remained significant in the multivariate model. Alternate routes of administration of prescription opioids are associated with sexual HIV transmission risk behaviors. Early prevention and intervention efforts that address sexual and non-sexual HIV risk behaviors are warranted.
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Affiliation(s)
- Mance E Buttram
- a Assistant Professor and Associate Director, Center for Applied Research on Substance Use and Health Disparities , Nova Southeastern University , Miami , FL , USA
| | - Steven P Kurtz
- b Professor and Director, Center for Applied Research on Substance Use and Health Disparities , Nova Southeastern University , Miami , FL , USA
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Reynolds GL, Fisher DG, Laurenceau JP, Fortenberry JD. An Electronic Daily Diary Study of Anal Intercourse in Drug-Using Women. AIDS Behav 2015; 19:2325-32. [PMID: 25835461 PMCID: PMC4592690 DOI: 10.1007/s10461-015-1045-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Women (N = 138) with histories of illicit drug use were recruited into an electronic diary study that used Android smartphones for data collection. The diary was to be completed each day for 12 weeks using an "app" created in HTML5 and accessed over the Internet via smartphone. Data collection included information on sexual behaviors with up to 10 partners per day and contextual factors surrounding sexual behavior such as drug use before/after, type of sexual behavior (oral, vaginal, anal), and other activities such as using condoms for vaginal and anal intercourse and use of sexual lubricants. The sample was predominantly African American (58 %); 20 % Latina, 20 % White and 2 % reported as Other. Most women reported either less than a high school education (33 %) or having a high school diploma (33 %). The mean age was 39 years (SD = 11.78). Anal intercourse occurred on days when women also reported using illicit drugs, specifically methamphetamine and cocaine. Anal intercourse was not an isolated sexual activity, but took place on days when vaginal intercourse and giving and receiving oral sex also occurred along with illicit drug use. Anal intercourse also occurred on days when women reported they wanted sex. HIV prevention interventions must address the risks of anal intercourse for women, taking into account concurrent drug use and sexual pleasure that may reduce individual harm-reduction behaviors.
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Affiliation(s)
- Grace L Reynolds
- Center for Behavioral Research and Services, California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA, 90840, USA.
| | - Dennis G Fisher
- Center for Behavioral Research and Services, California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA, 90840, USA
| | | | - J Dennis Fortenberry
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Order of orifices: sequence of condom use and ejaculation by orifice during anal intercourse among women: implications for HIV transmission. J Acquir Immune Defic Syndr 2015; 67:424-9. [PMID: 25356778 DOI: 10.1097/qai.0000000000000314] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For women, the order of penile insertion, condom use, and ejaculation by orifice during sexual events affects the probability of HIV transmission and design of HIV prevention methods. METHODS From October 2006 to June 2009, 431 women in Los Angeles and Baltimore in a rectal health study reported the sequence of penile insertion, condom use, and ejaculation by orifice location by computer-assisted self-interview. Multinomial logistic regression identified predictors of condom use by orifice among women who reported vaginal intercourse (VI) during their last anal intercourse (AI) event. RESULTS Of the 192 reporting on a last AI event, 96.3% (180/187) reported VI. Of these, 83.1% had VI before AI. Including the 36% who ejaculated in both the rectum and vagina, 66% report any ejaculation in the vagina and 45% in the rectum. One-third used a condom for both VI and AI, <10% for VI only or AI only, and half used no condoms. After adjusting for race, partner type, and substance use, compared with women who used condoms for both VI and AI at last AI, being older (units = 5 years) [adjusted odds ratio (AOR) = 0.76; 95% confidence interval (CI): 0.60 to 0.96], with serodiscordant partners (AOR = 0.22; 95% CI: 0.08 to 0.61), and HIV-positive with seroconcordant partners (AOR = 0.15; 95% CI: 0.04 to 0.54) were associated with not using condoms. CONCLUSIONS For most of the women in our study VI accompanied AI, with AI usually occurring after VI. This evidence for use of multiple orifices during the same sexual encounter and low use of condoms across orifices supports the need for a multicompartment HIV prevention strategy.
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Duby Z, Colvin C. Conceptualizations of heterosexual anal sex and HIV risk in five East African communities. JOURNAL OF SEX RESEARCH 2014; 51:863-873. [PMID: 24611445 DOI: 10.1080/00224499.2013.871624] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Heterosexual anal sex is underresearched and little understood, particularly in the African context. Existing prevalence data indicate that heterosexual anal sex is a widespread practice, yet little is known about the way in which it is conceptualized and understood. Describing findings from qualitative research conducted in Kenya, Tanzania, and Uganda, we shed light on conceptualizations of heterosexual anal sex and its relation to human immunodeficiency virus (HIV). These findings suggest that penile-anal sex is practiced by men and women in Africa for a range of reasons, including virginity maintenance, contraception, fulfillment of male pleasure, relationship security, menstruation, in the presence of vaginal complications, financial gain, fidelity, and prestige. Despite anal sex being the most efficient way to transmit HIV sexually, there is widespread lack of knowledge about its risks. These findings describe the ways in which anal sex is conceptualized in five East African communities, highlighting how penile-anal intercourse is often not considered "sex" and how the omission of anal sex in safe-sex messaging is interpreted as meaning that anal sex is safe. In light of its frequency and risks, greater attention must be paid to heterosexual anal sex in Africa to ensure a comprehensive approach to HIV prevention.
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Affiliation(s)
- Zoe Duby
- a School of Public Health and Family Medicine, University of Cape Town
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12
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Remy L, Narvaez J, Sordi A, Guimarães LSP, Von Diemen L, Surratt H, Kurtz S, Pechansky F. Correlates of unprotected sex in a sample of young club drug users. Clinics (Sao Paulo) 2013; 68:1384-91. [PMID: 24270948 PMCID: PMC3812551 DOI: 10.6061/clinics/2013(11)01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/17/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview. METHODS This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse. RESULTS Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PR = 1.26; 95% confidence interval (CI): 1.044-1.543; p = 0.017) and the use of alcohol/drugs to make sex last longer (PR = 1.430; 95% CI: 1.181-1.732; p<0.001) are associated with unprotected sex. CONCLUSIONS The implementation of intervention strategies aimed at reducing sexually risky behaviors should take into consideration the specific characteristics of drug users and should include the development of safer sex negotiation skills.
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Affiliation(s)
- Lysa Remy
- Center for Drug and Alcohol Research, Federal University of Rio Grande do Sul, Porto AlegreRS, Brazil
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Hess KL, Reynolds GL, Fisher DG. Heterosexual anal intercourse among men in Long Beach, California. JOURNAL OF SEX RESEARCH 2013; 51:874-881. [PMID: 24024565 PMCID: PMC3864563 DOI: 10.1080/00224499.2013.809512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Anal intercourse poses a greater risk for human immunodeficiency virus (HIV) transmission than vaginal intercourse, and in recent years there has been a growing understanding that heterosexual anal intercourse (HAI) is not uncommon. However, the majority of the anal intercourse literature has focused on men who have sex with men. The little research on HAI has mostly looked at women, with limited work among men. This analysis examined the association between HAI and high-risk behaviors (N = 1,622) and sexual sensation seeking (N = 239) in a sample of men recruited from 2001 to 2012 in Long Beach, California. Almost half of the sample was non-Hispanic Black. The median age was 42 years, 42% were homeless, and 20% reported recent HAI. Men who reported HAI were likely to be Hispanic, were likely to be homeless, had a male partner, engaged in sex exchange, and used cocaine or amphetamines during sex. Men who reported HAI scored higher on the Sexual Sensation Seeking scale. This research supports other work showing the relationship between HAI and high-risk behaviors. More important, it contributes new knowledge by demonstrating the association between HAI and sexual sensation seeking. This research highlights the importance of personality traits when trying to understand sexual behavior and when developing HIV prevention interventions.
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Affiliation(s)
- Kristen L. Hess
- Center for Behavioral Research and Services, California State University, Long Beach Long Beach, California
| | - Grace L. Reynolds
- Center for Behavioral Research and Services, California State University, Long Beach Long Beach, California
| | - Dennis G. Fisher
- Center for Behavioral Research and Services, California State University, Long Beach Long Beach, California
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Ajduković D, Štulhofer A, Baćak V. Rising popularity of anal intercourse and sexual risk taking: findings from two national probability studies of young Croatian adults. Int J STD AIDS 2012; 23:785-91. [DOI: 10.1258/ijsa.2012.011415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the prevalence and correlates of heterosexual anal intercourse in two national probability samples of young Croatian adults aged 18–25 years, which were collected in 2005 and 2010. The lifetime prevalence of anal intercourse increased from 27% to 36%. In multivariate analysis, reporting four or more lifetime sexual partners was the only correlate of the experience of anal intercourse that was significant among both women (odds ratios [ORs] = 1.78–3.27, P < 0.05) and men (ORs = 3.14–4.63, P < 0.01). Information about condom use at most recent anal intercourse was collected in the 2010 study wave only. Age (OR = 0.80, P < 0.05), female gender (OR = 0.29, P < 0.01), holding more negative attitudes towards condoms (OR = 0.28–0.32, P < 0.05) and reporting condom use at most recent vaginal intercourse (OR = 11.45, 95% Confidence interval [CI] = 5.68–23.06) were associated with using a condom at most recent anal intercourse. Given the substantial prevalence of anal intercourse among young heterosexual adults and considerable sexually transmitted infection/HIV risks associated with the practice, sex education programmes should promote the discussion of health risks associated with anal eroticism.
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Affiliation(s)
- D Ajduković
- Vuk Vrhovac University Clinic, Merkur University Hospital, University of Zagreb, Zajčeva 19, Zagreb 10000
| | - A Štulhofer
- Sexology Unit, Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - V Baćak
- Sexology Unit, Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
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Pechansky F, Remy L, Surratt HL, Kurtz SP, Rocha TBM, Von Diemen L, Bumaguin DB, Inciardi J. Age of Sexual Initiation, Psychiatric Symptoms, and Sexual Risk Behavior among Ecstasy and LSD Users in Porto Alegre, Brazil: A Preliminary Analysis. JOURNAL OF DRUG ISSUES 2011; 41:217. [PMID: 22287797 PMCID: PMC3266349 DOI: 10.1177/002204261104100204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on their use among young, middle-class, club goers in Brazil. We conducted standardized face-to-face interviews with 200 male and female ecstasy and/or LSD users, focusing on drug use and sexual history, current risk behaviors, and psychiatric symptomatology. Participants with early sexual debut (before 14) were more likely to report lifetime use of marijuana and powder and crack cocaine than those with later sexual initiation. Early sexual debut was associated with past year sexual risk behaviors, including having sex while high (Prevalence Ratio (PR)=1.3), having two or more sex partners (PR=1.3), as well as history of sexual abuse (PR=13.6). Depression and anxiety scores were similar by age of sexual initiation. The implications of these findings are discussed.
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Štulhofer A, Baćak V. Is anal sex a marker for sexual risk-taking? Results from a population-based study of young Croatian adults. Sex Health 2011; 8:384-9. [DOI: 10.1071/sh10078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 10/19/2010] [Indexed: 11/23/2022]
Abstract
Background
There is evidence that anal sex is becoming increasingly popular among heterosexual women and men. Several studies carried out in especially vulnerable populations (e.g. sex workers and low-income youth) suggested that anal sex may indicate a more general propensity to sexual risk-taking. Methods: To assess whether this epidemiologically important finding holds in the case of young adults from the general population, we analysed data from a cross-sectional probability survey carried out in 2010 on 1005 Croatian women and men aged 18–25. Results: Anal intercourse was reported by 36.5% of 861 sexually experienced participants (42.7% of men and 29.8% of women). About one-third of them (34%) used a condom at most recent anal intercourse. The experience of anal sex was significantly associated (P < 0.001) with all four indicators of sexual risk-taking (condom use at most recent vaginal intercourse, number of sexual partners in the past year, concurrent sexual relationships and anonymous sex in the past year), as well as with negative attitudes and beliefs about condom use (P < 0.01). Sexual sensation-seeking mediated the relationship between anal sex and some of the sexual risk-taking behaviours. Conclusion: According to the findings, heterosexual anal sex is directly and indirectly associated with increased behavioural risks of acquiring HIV and other sexually transmissible infections (STI). Sex education and STI prevention programs should focus on the importance of using protection when practicing anal sex.
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