Sexual risk behavior in men attending Mardi Gras celebrations in New Orleans, Louisiana

Recreational substance use among international travellers

BACKGROUND

Drug tourism reflects the expanding illicit drug market, posing health risks in unfamiliar travel settings. Existing knowledge specifically addressing substance use among international travellers is sparse and has not been reviewed to date. This review aimed to describe the recreational substance abuse in international travellers.

METHODS

A literature search was conducted on PubMed, Google Scholar and Scopus using keywords related to recreational substances and international travellers. A total of 11 021 articles were reviewed, charted and summarized for the evidence on prevalence, patterns and characteristics of substance abuse and their health- and non-health-related problems on international travellers.

RESULTS

A total of 58 articles were included. Most were cross-sectional studies and review articles. In total, 20 articles addressed the prevalence of substance abuse in travellers, 33 looked at characteristics and patterns of substance abuse in travellers and 39 investigated the health- and non-health-related problems from substance abuse. Estimated prevalence of recreational substances abuse varied from 0.7% to 55.0%. Rates of substances abuse were 9.45-34.5% for cannabis, 20.4-35.9% for alcohol intoxication, 2.82-40.5% for MDMA, 2-22.2% for cocaine, 2-15% for psychedelic agents and 2% for methamphetamine. The prevalence varied according to travellers' characteristics and travel destinations. Direct health problems included neuropsychiatric problems. Indirect problems included accident and unintentional injuries, crime and violence, risky sexual behaviours and sexual violence and blood-borne infections. Non-health-related problems included air rage, deportation and violation of local laws.

CONCLUSION

Substance abuse among international travellers is an underestimated problem that requires intervention. These findings emphasize the importance of addressing this issue to mitigate both health and well-being problems among travellers whilst promoting safer and more responsible travel experiences. In the context of travel health practices, practitioners should counsel travellers whose itineraries may include substance abuse, informing them about associated risks and consequences.

The Information-Motivation-Behavioral Skills Model and Unprotected Sex: Assessing the Model's Utility and Predictability Among Bar Patrons in Tshwane, South Africa

The Information-Motivation-Behavioral skills (IMB) model has been a useful tool for understanding sexual risk behavior. However, its utility in predicting sexual risk behaviors among bar patrons, for whom the bar setting poses a higher risk of alcohol-related sexual risk behavior, has been underexplored. We assessed (1) the extent to which the IMB predicted number of episodes of unprotected sex in the past six months and (2) whether incorporating sex under the influence of alcohol and alcohol use improved the predictability of the model among bar patrons. Hierarchical regression models were conducted on data from 406 men and women from bars in rural areas of North-West province, South Africa. Behavioral skills were the sole IMB variable to predict unprotected sex with main partners (β = - 0.40; p < .001), explaining 18% of the variance. Variance explained increased to 21% with addition of sex under the influence of alcohol (β = 0.13; p = .019) and further increased to 26% with the addition of alcohol use (β = 0.24; p < .001). Motivation (β = - 0.21; p = .006) and behavioral skills (β = - 0.21; p = .006) were the significant IMB predictors of unprotected sex with casual partners (explaining 15% of the variance). Variance explained increased to 22% with the addition of sex under the influence of alcohol (β = 0.26; p = .001), but alcohol consumption was not an independent predictor of episodes of unprotected sex with casual partners. Interventions for improving HIV prevention behaviors among bar patrons should focus on enhancing individuals' behavioral skills and motivation and reducing their alcohol consumption.

Information and Motivation Predict HIV-Serostatus Among a Population of High-Risk Men and Transgender Women Who Have Sex with Men

Two constructs from the information-motivation-behavioral skills model were used to predict HIV-serostatus among a sample of men and transgender women who have sex with men. Hypotheses were that lower levels of HIV knowledge and lower levels of motivation to remain HIV-negative would be associated with an increased likelihood of receiving a positive HIV test result at a study eligibility-screening session. Results of a backwards stepwise logistic regression analysis demonstrated that lower levels of HIV knowledge, lower levels of motivation to remain HIV-negative, lower levels of education, and identifying as Hispanic/Latinx were associated with greater odds of receiving a positive HIV test result. These findings are consistent with the broader HIV-prevention literature that demonstrates that information and motivation are fundamental determinants of HIV preventive behavior. This work has implications for informing the development and improvement of HIV-prevention interventions.

Insights on HPV vaccination in the United States from mothers' comments on Facebook posts in a randomized trial

In the United States, parents' health beliefs affect HPV vaccination decisions for children. Our team acquired insights into mothers' health beliefs from their reactions and comments to posts on HPV vaccination in a social media adolescent health campaign in a randomized trial (n = 881 mothers; 63.1% reported daughters had 1+ doses of the HPV vaccine) evaluating communication intended to reduce daughters' indoor tanning. A total of 10 HPV vaccination messages in didactic (n = 7) and narrative (n = 3) formats were posted on vaccination need, uptake, and effectiveness and stories of young women who died from cervical cancer and a mother's decision to vaccinate her daughters. These posts received 28 reactions (like, love, and sad buttons; mean = 2.8 per post) and 80 comments (mean = 8.0 per post). More comments were favorable (n = 43) than unfavorable (n = 34). Data was not collected on views for posts. The most common favorable comment reported that daughters were vaccinated (n = 31). Unfavorable comments cited safety concerns, lack of physician support, distrust of pro-vaccine sources, and increased sexual activity of daughters. Mothers posting unfavorable (18.2%) as opposed to favorable (78.6%) comments or not commenting (64.0%) were less likely to have had their daughters vaccinated (chi-square = 22.27, p < 0.001). Favorable comments often did not state reasons for vaccinating. Concerns about lack of vaccine safety remain a barrier. Mothers may express distrust in pro-vaccine sources to reduce discomfort with not vaccinating daughters to reduce their risk for HPV infection. Many mothers who remained silent had vaccinated daughters, which suggests they did not resisit HPV vaccination.

Prevalence and correlates of hazardous alcohol consumption and binge drinking among men who have sex with men (MSM) in San Francisco

Objectives

To describe heavy alcohol use patterns and correlates in a diverse sample of MSM.

Methods

We used respondent-driven sampling (RDS) to enroll 252 alcohol-using MSM in San Francisco from March 2015-July 2017. We examined heavy alcohol use patterns and conducted RDS-adjusted multivariable analyses to characterize correlates of hazardous alcohol consumption and binge drinking.

Results

RDS-adjusted prevalence of weekly and at least weekly binge drinking was 24.9% and 19.3%, respectively. Hazardous consumption was common; prevalence of mid- and high-levels of hazardous drinking was 11.4% and 29.9%, respectively. In multivariable analyses, identifying as Hispanic/Latino or mixed/other race; being moderately or extremely interested in reducing alcohol use; ever receiving alcohol treatment; using ecstasy; reporting syphilis diagnosis; and having more than 5 male partners were independently associated with hazardous alcohol consumption. Less hazardous consumption was associated with having a bachelor's degree or completing post-graduate studies; and not being in a relationship. Reporting chlamydia infection; being somewhat, moderately or extremely interested in reducing alcohol use; and having multiple male sex partners were associated with higher odds of at least weekly binge drinking. Lower odds of binge drinking were associated with completing post-graduate studies. Moreover, for the outcomes of hazardous alcohol consumption and binge-drinking, we observed significant interaction effects between race/ethnicity and interest in reducing alcohol, past receipt of alcohol treatment, use of ecstasy, syphilis diagnosis, and number of male partners.

Conclusion

Among alcohol-using MSM in San Francisco, heavy drinking patterns were common and independently associated with greater number of male sexual partners and sexually transmitted infections (STI). Moreover, significant racial/ethnic and socioeconomic disparities related to heavy alcohol use were observed and race/ethnicity modified the effect of the risk factors associated with these outcomes. These findings underscore the need to develop more MSM-specific interventions that jointly address heavy alcohol use and HIV/STI risk, as well as culturally-tailored and targeted strategies to alleviate health disparities.

Mitigating circumstances: A model-based analysis of associations between risk environment and infrequent condom use among Chinese street-based sex workers

Background

Little is known about how freelance street-based sex workers navigate condom use while soliciting. Traditional behavioural model may fail to account for the complex risk environment that most street-based sex workers work within. We examine first the association of self-efficacy and the infrequent condom use, then we investigated the roles of clients and venues frequented on this association.

Method

Using a purposive chain-referral sampling method, we surveyed 248 street-based sex workers in Shanghai. The survey focused on sex workers HIV risk factors, sex work patterns, HIV knowledge, and related HIV self-efficacy. Clients types and behaviours, and characteristics of the venues frequented by these commercial sex workers were also collected. We conducted a series of multiple logistic regression models to explore how the association between a sex worker’s self-efficacy with infrequent condom use change as client and venue characteristics were added to the models.

Results

We find that within the basic model, low self-efficacy was marginally associated with infrequent condom use (54.9% vs. 45.1%, AOR = 1.70, 95% CI = 0.95–3.03). As client- and venue- characteristics were added, the associations between self-efficacy and condom use were strengthened (AOR = 2.10 95% CI = 1.12–3.91 and 2.54 95% CI = 1.24–5.19 respectively). Those who reported middle-tiered income were more likely to report infrequent condom use compared to their peers of high income (AOR = 3.92 95% CI = 1.32–11.70) whereas such difference was not found between low income and high income sex workers. Visiting multiple venues and having migrant workers as clients were also associated with infrequent condom use.

Conclusion

Our findings suggest sex worker’s self-efficacy matters in their HIV risk behaviours only when environment characteristics were adjusted. Risk environment for street-based sex workers are complex. Programming addressing behavioural changes among female sex workers should adopt holistic, multilevel models with the consideration of risk environments.

A Randomized Clinical Trial of a Brief Internet-based Group Intervention to Reduce Sexual Transmission Risk Behavior Among HIV-Positive Gay and Bisexual Men

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.

A Randomized Trial of an Advanced Sun Safety Intervention for Vacationers at 41 North American Resorts

Taking vacations in sunny locations is associated with the development of skin cancer. This study tested a multi-component sun protection intervention based on diffusion of innovations theory and transportation theory designed to increase vacationers' comprehensive sun protection, i.e., use of clothing, hats, and shade, and use, pre-application, and reapplication of sunscreen. The trial enrolled 41 warm weather resorts in North America in a pair-matched group randomized pretest-posttest design and assessed samples of adult vacationers at resort outdoor recreation venues regarding sun protection at pretest (n = 3,531) and posttest (n = 3,226). While results showed no overall effect of the intervention on comprehensive sun protection across venues, the intervention produced statistically significant improvements in sun protection at waterside venues (pools and beaches). The intervention's overall effects may have been impeded by a lack of uniformly robust implementation, low interest in skin cancer prevention by guests, or shortcomings of the theories used to create prevention messages. The intervention may have worked best with guests in the highest-risk recreation venue, i.e., waterside recreation where they exposed the most skin. Alternative approaches that alter resort organizations, such as through changes in policy, environmental features, or occupational efforts might be more effective than targeting vacationers with behavior-change messages.

Vengeance, sexual compulsivity and self-efficacy among men who have sex with men living with HIV

Vengeance is defined as a continuum of thoughts and/or actions ranging from harmless thoughts to destruction or death, due to feelings of hurt or anger, as a result of a perceived personal attack. Studies assessing the association between vengeance and HIV risk behavior are extremely lacking. The primary aims of this study were to examine the associations between vengeance and sexual compulsivity (SC), and self-efficacies (SEs) for condom use, HIV disclosure, and negotiation of safer sex practices. Data were obtained from 266 men who have sex with men (MSM) living with HIV. Simple and multiple linear regression were used to explore the associations between vengeance, SC and SE. After adjusting for sociodemographic and HIV-related factors, there was a negative association between vengeance and SE for HIV disclosure: (most vengeful: β = -1.49; 95% CI: -2.40, -0.58; more vengeful: β = -1.17; 95% CI: -2.12, -0.22; vengeance (continuous: β = -0.03; 95% CI: -0.05, -0.01). Intervention programs geared towards improving SE for HIV disclosure among MSM living with HIV should endeavor to reduce vengeful feelings.

Effect of an intervention on observed sun protection by vacationers in a randomized controlled trial at North American resorts

During vacations, many individuals receive high-risk sun exposure that is associated with skin cancer. Vacationers in outdoor recreation venues (pretest n=4347; posttest n=3986) at warm-weather destination resorts in North America (n=41) were enrolled in a pair-matched, group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Print, audiovisual, and online messages based on Transportation Theory and Diffusion of Innovation Theory and promoting advanced sun protection (e.g., use of clothing, hats, shade and pre-application/reapplication of sunscreen and reliable cues to high UV) were delivered through resort channels. Vacationers' sun protection practices observed by trained research staff (i.e., body coverage and shade use analyzed individually and in combined scores) did not differ by experimental condition (p>0.05) or intervention implementation (p>0.05). However, recreation venue moderated intervention impact. The intervention improved sun protection at waterside recreation venues (z-score composite: intervention pre=-22.74, post=-15.77; control pre=-27.24, post=-23.24) but not non-waterside venues (z-score composite: intervention pre=20.43, post=20.53; control pre=22.94, post=18.03, p<0.01). An additional analysis showed that resorts with greater program implementation showed more improvements in sun protection by vacationers at waterside (z=score composite: high implementation pre=-25.45, post=-14.05; low implementation pre=-24.70, post=-21.40) compared to non-waterside (z-score composite: high implementation pre=14.51, post=19.98; low implementation pre=24.03, post=18.98, p<0.01) recreation venues. The intervention appeared effective with the vacationers in recreation venues with the highest-risk for sun exposure, waterside venues. However, it was not effective throughout all the resort venues, possibly because of the sun-seeking desires of vacationers, information overload at the resorts, and constraints on clothing styles and sun protection by recreation activity.

Engaging Moms on Teen Indoor Tanning Through Social Media: Protocol of a Randomized Controlled Trial

Background

Indoor tanning elevates the risk for melanoma, which is now the most common cancer in US women aged 25-29. Public policies restricting access to indoor tanning by minors to reduce melanoma morbidity and mortality in teens are emerging. In the United States, the most common policy restricting indoor tanning in minors involves parents providing either written or in person consent for the minor to purchase a tanning visit. The effectiveness of this policy relies on parents being properly educated about the harms of indoor tanning to their children.

Objective

This randomized controlled trial will test the efficacy of a Facebook-delivered health communication intervention targeting mothers of teenage girls. The intervention will use health communication and behavioral modification strategies to reduce mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning relative to an attention-control condition with the ultimate goal of reducing indoor tanning in both daughters and mothers.

Methods

The study is a 12-month randomized controlled trial comparing 2 conditions: an attention control Facebook private group where content will be relevant to teen health with 25% focused on prescription drug abuse, a topic unrelated to tanning; and the intervention condition will enter participants into a Facebook private group where 25% of the teen health content will be focused on indoor tanning. A cohort of 2000 mother-teen daughter dyads will be recruited to participate in this study. Only mothers will participate in the Facebook groups. Both mothers and daughters will complete measures at baseline, end of intervention (1-year) and 6 months post-intervention. Primary outcomes include mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning, teenage daughters’ perception of their mothers’ permissiveness, and indoor tanning by both mothers and daughters.

Results

The first dyad was enrolled on March 31, 2016, and we anticipate completing this study by October 2019.

Conclusions

This trial will deliver social media content grounded in theory and will test it in a randomized design with state-of-the-art measures. This will contribute much needed insights on how to employ social media for health behavior change and disease prevention both for indoor tanning and other health risk behaviors and inform future social media efforts by public health and health care organizations.

ClinicalTrial

Clinicaltrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807 (Archived by WebCite at http://www.webcitation.org/6mDMICcCE).

Feasibility, Acceptability, and Tolerability of Targeted Naltrexone for Nondependent Methamphetamine-Using and Binge-Drinking Men Who Have Sex with Men

BACKGROUND

There are no effective pharmacologic strategies for nondependent methamphetamine (meth)-using and binge-drinking men who have sex with men (MSM) at high-risk for HIV. We sought to determine the feasibility of enrolling and retaining this population in a pharmacologic trial; the acceptability of pharmacotherapy study procedures; and the tolerability of targeted naltrexone versus placebo.

METHODS

Thirty meth-using and binge-drinking MSM were randomly assigned 1:1 to 50 mg naltrexone or placebo for 8 weeks for targeted administration (ie, during craving or in anticipation of meth or alcohol use). Substance use counseling and behavioral assessments were conducted every 2 weeks. Medication use was measured using WisePill dispensers.

RESULTS

Trial completion was 93%; visit completion rate was 95%. Mean weekly number of medication pills taken was 2.1 and was similar between arms. Participant satisfaction rate was 96%. There were neither serious adverse events nor differences in adverse event rates between arms. In exploratory intention-to-treat analyses, there were no differences in meth use and drinking. Naltrexone participants had greater reductions in serodiscordant receptive anal intercourse [incident rate ratio (IRR) = 0.15; 95% CI = 0.05 to 0.42] and serodiscordant condomless receptive anal intercourse (IRR = 0.11; 95% CI = 0.03 to 0.37), compared with placebo. In subgroup analyses among frequent meth users, naltrexone participants had greater reductions in meth-using days (IRR = 0.78; 95% CI = 0.62 to 0.99). In as-treated analyses, frequent study medication users in the naltrexone arm had greater reductions in binge drinking days (IRR = 0.72; 95% CI = 0.54 to 0.97).

CONCLUSIONS

Targeted naltrexone is a feasible, acceptable, and tolerable intervention strategy for nondependent meth-using and binge-drinking MSM. Naltrexone was associated with significant sexual risk reductions; and for some individuals, naltrexone was associated with meth and binge-drinking reductions.

Rationale, design, samples, and baseline sun protection in a randomized trial on a skin cancer prevention intervention in resort environments

INTRODUCTION

Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A trial evaluated an intervention to promote advanced sun protection (sunscreen pre-application/reapplication; protective hats and clothing; use of shade) during vacations.

MATERIALS AND METHODS

Adult visitors to hotels/resorts with outdoor recreation (i.e., vacationers) participated in a group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Hotels/resorts were pair-matched and randomly assigned to the intervention or untreated control group. Sun. protection (e.g., clothing, hats, shade and sunscreen) was measured in cross-sectional samples by observation and a face-to-face intercept survey during two-day visits.

RESULTS

Initially, 41 hotel/resorts (11%) participated but 4 dropped out before posttest. Hotel/resorts were diverse (employees=30 to 900; latitude=24° 78' N to 50° 52' N; elevation=2ft. to 9726ft. above sea level), and had a variety of outdoor venues (beaches/pools, court/lawn games, golf courses, common areas, and chairlifts). At pretest, 4347 vacationers were observed and 3531 surveyed. More females were surveyed (61%) than observed (50%). Vacationers were mostly 35-60years old, highly educated (college education=68%) and non-Hispanic white (93%), with high-risk skin types (22%). Vacationers reported covering 60% of their skin with clothing. Also, 40% of vacationers used shade; 60% applied sunscreen; and 42% had been sunburned.

CONCLUSIONS

The trial faced challenges recruiting resorts but result showed that the large, multi-state sample of vacationers were at high risk for solar UV exposure.

Factors associated with non-use of condoms in an online community of frequent travellers

BACKGROUND

Millions of travellers around the world have gathered together into online communities. The objective is to analyse the factors associated with risky sexual behaviour among travellers.

METHODS

Cross-sectional study was conducted within an online community of travellers using an online survey; we included travellers who had engaged in sexual activity while on their last trip. Risky sexual behaviour was defined as inconsistent condom use (<100%), and the factors associated were evaluated using the prevalence ratio (PR).

RESULTS

Of the 468 participants, 245 had sex during their last trip. 59.7% did not consistently use condoms, and one out of every four participants reported never using condoms. Having a travel destination of Latin America or the Caribbean was significantly associated with inconsistent condom use. This association was maintained (PR 1.37, CI 95% 1.06–1.77) after adjusting for gender, age, migration, the presence of travel partners, and the use of drugs and alcohol prior to sexual activity.

CONCLUSION

An association was observed between travel destination (specifically Latin America or the Caribbean) and risky sexual behaviour. For this reason, tourists should be educated in STI transmission and regional STI and HIV incidences both before and during their travels; public health systems ought to work together with travel agencies, international airports, etc., in order to distribute this information and ensure a responsible travel experience.

Pervasive Heavy Alcohol Use and Correlates of Increasing Levels of Binge Drinking among Men Who Have Sex with Men, San Francisco, 2011

Heavy episodic drinking, "binge drinking", is highly prevalent among men who have sex with men (MSM) and is associated with sexual risk behaviors and HIV seroconversion in this population. We characterized the magnitude of binge drinking and explored correlates of increasing levels of binge drinking among MSM in San Francisco. In this study, 67% of MSM reported binge drinking in the prior year. The mean number of drinking days in the past month was 11.6. On average, we estimate that 2,699,372 drinks are consumed by MSM in San Francisco every month. Increasing levels of binge drinking was independently associated with younger age, modest income, being born in the United States, never accessing alcohol treatment and reporting unprotected insertive anal intercourse. Our findings underscore the need to target effective strategies to address heavy alcohol consumption and highlight the urgent need to develop novel interventions beyond traditional alcohol treatment settings among MSM.

Factors associated with drug use among male motorbike taxi drivers in urban Vietnam

A cross-sectional study was conducted on a sample of 291 male motorbike taxi drivers (MMTDs) recruited through social mapping technique in Hanoi, Vietnam, for face-to-face interviews to examine factors associated with drug use among MMTDs using Information-Motivation-Behavioral skills (IMB) model. Among 291 MMTDs, 17.18% reported drug use sometime in their lives, 96% of whom were drug injectors. Being depressed, being originally borne in urban cities, currently residing in rural areas, having a longer time living apart from their wives/lovers, using alcohol, following Buddhism, and reporting lower motivation of HIV prevention predict significantly higher odds of uptaking drugs.

Social responsibility, substance use, and sexual risk behavior in men who have sex with men

Considerable public health literature focuses on relationships between problematic human characteristics (e.g., psychopathology) and unhealthy behaviors. A recent movement termed positive psychology emphasizes the advantages of assessing relationships between human strengths (e.g., altruism) and beneficial health behaviors. The present study assessed social responsibility, an orientation to help or protect others even when there is nothing to be gained as an individual, and its relationship to HIV-relevant behaviors. In our sample of 350 men who have sex with men (MSM), social responsibility was negatively correlated with substance use and HIV risk behaviors. Men who had been tested for HIV and knew their HIV status-a behavior that helps men protect their partners but does not protect themselves from the virus-also scored higher in social responsibility. Interventions designed to reduce HIV risk behavior in MSM may benefit from efforts to promote human strengths.

Attitudes toward methamphetamine use and HIV risk behavior in men who have sex with men

BACKGROUND AND OBJECTIVES

Methamphetamine use has been strongly associated with high-risk sexual behaviors, and its use has been increasing among men who have sex with men (MSM). Although the behavioral implications of methamphetamine use and sexual risk have been broadly examined, fewer studies have examined attitudes about methamphetamine use.

METHODS

This study investigates the relationship between personal beliefs regarding methamphetamine use, patterns of use, and sexual risk behaviors within a sample of MSM attending a gay pride event (N= 342).

RESULTS

A minority of MSM reported lifetime (27%) or recent (7%) methamphetamine use. Only a minority of MSM who had used methamphetamine believed that it enhanced sexual pleasure (32%) or incorporated methamphetamine use into their sexual activity (31%). Individuals who used methamphetamine during sexual activity were more likely to be recent users of the drug and more likely to engage in high-risk behaviors. A significant minority of participants endorsed items assessing the disinhibiting effects of methamphetamine including being less likely to use a condom (35%) and less selective in their choice of partners (26%).

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Results suggest that prevention efforts may benefit from targeting the minority of methamphetamine users who perceive methamphetamine as enhancing sexual activity and use it for this purpose.

Risk behaviors among HIV-positive gay and bisexual men at party-oriented vacations

OBJECTIVE

This study examined substance use (intended and actual), unprotected sex, and HIV disclosure practices (disclosure and questioning) among HIV-positive men who have sex with men (MSM) at two party-oriented vacations, where substance use and sexual risk may be heightened.

METHOD

A random sample of 489 MSM attending one of two party-oriented vacations participated in PartyIntents, a short-term longitudinal survey. Nearly half (47%) completed a follow-up assessment at the event or online for up to 2 weeks after the event. We examined rates of baseline intentions to use substances, actual substance use, and unprotected intercourse among HIV-positive men in attendance.Rates among HIV-negative men were estimated for comparison. Multiple logistic regression was used to assess the impact of illegal drug use and HIV status on unprotected anal intercourse (UAI).

RESULTS

HIV-positive attendees (17%) were significantly more likely than HIV-negative attendees to use nitrite inhalants (or "poppers") (24.3% vs. 10.7%). HIV-positive attendees were also significantly more likely to have insertive UAI (64.3% vs. 34.1%) and receptive UAI (68.8% vs. 22.2%). Multivariate models showed associations between HIV status and illegal drug use with UAI (for HIV status, odds ratio [OR] = 4.5, p = .001; for any illegal drug use, OR = 16.4, p < .001). There was no evidence that the influence of drug use moderated risk by HIV status. Rates of HIV disclosure and questioning did not differ by HIV status.

CONCLUSIONS

HIV-positive men attending these events engaged in higher rates of illegal drug use and sexual risk than HIV-negative men. Prevention campaigns targeting MSM at high-risk events should include messages geared toward HIV-positive men.

Understanding the needs of township men who have sex with men (MSM) health outreach workers: exploring the interplay between volunteer training, social capital and critical consciousness

This article considers the complex ways volunteer outreach workers can frame their engagement with a community-based HIV prevention programme for South African township MSM. Drawing on research conducted during the Ukwazana programme in Cape Town it begins by exploring limitations towards MSM participation with programme facilitators (namely previous feelings of mistrust and community homophobia) and strategies developed to offset these concerns. It then considers how great care must also be taken to appreciate how volunteers from marginalised groups can frame training as a key condition for participation. To understand this it is therefore necessary for facilitators to acknowledge a number of additional concerns. These include community status, a lack of bonding social capital between volunteers and a highly developed from of critical consciousness by volunteers regarding HIV prevention possibilities. This article therefore suggests that effort to initially engage marginalised communities must also be met with effort to understand the complex ways volunteers relate to other MSM and to each other.

Predictors of reducing sexual and reproductive risk behaviors based on the information-motivation-behavioral skills (IMB) model among unmarried rural-to-urban female migrants in Shanghai, China

Background

Due to the increase of premarital sex and the lack of reproductive health services, unmarried rural-to-urban female migrants experience more risks of sex and reproductive health (SRH). This study was designed to describe SRH related knowledge, attitude and risk behaviors among unmarried rural-to-urban female migrants and examine the predictors of reducing sexual and reproductive risk behaviors based on information-motivation-behavioral skills (IMB) model and to describe the relationships between the constructs.

Methods

We conducted a cross-sectional study to assess SRH related information, motivation, behavioral skills and preventive behaviors among unmarried rural-to-urban female migrants in Shanghai, one of the largest importers of migrant laborers in China. Structural equation modeling (SEM) was used to assess the IMB model.

Results

A total of 944 subjects completed their questionnaires. The mean age was 21.2 years old (SD = 2.3; range 16 to 28). Over one-fourth of participants reported having had premarital sex (N = 261, 27.6%) and among whom 15.3% reported having had the experience of unintended pregnancy, 14.6% with the experience of abortion. The final IMB model provided acceptable fit to the data (CFI = 0.99, RMSEA = 0.034). Reducing sexual and reproductive risk behaviors was significantly predicted by SRH related information (β = 0.681, P<0.001) and behavioral skills(β = 0.239, P<0.001). Motivation (β = 0.479, P<0.001) was the significant indirect predictor of reducing sexual and reproductive risk behaviors mediated through behavioral skills.

Conclusions

The results highlight the importance and necessity of conducting reproductive health promotion among unmarried rural-to-urban female migrants in China. The IMB model could be used to predict reducing sexual and reproductive risk behaviors and it suggests future interventions should focus on improving SRH related information and behavioral skills.

An exploration into the role of depression and self-efficacy on township men who have sex with men's ability to engage in safer sexual practices

Men who have sex with men (MSM) in South Africa remain at particular risk of HIV infection. The Ukwazana baseline survey is the first to explore this risk in relation to psychological factors associated with unprotected anal intercourse (UAI). A cohort of 316 MSM from township peri-urban Cape Town took part in the survey. The survey found that 55.2% had engaged in UAI over the preceding 6 months. Depression was significantly associated with UAI. Respondents with self-efficacy scores less than two standard deviations above the mean were also more likely to have engaged in UAI. A Sobel test for mediation highlighted that the depression-UAI association was partially mediated by self-efficacy, indicating that most of the effect of depression on UAI was not covarying with self-efficacy. This study, therefore, highlights that both depression and self-efficacy should be considered factors to be addressed in HIV-prevention programmes aimed at peri-urban MSM.

A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men

In the United States, there continues to be high incidence of HIV infection among men who have sex with men (MSM), who represent 57% of new infections in 2009. While many studies report associations between non-injection substance use and sexual risk behavior among MSM, overall results are mixed. Summarizing these studies is difficult because researchers have used a variety of assessment periods for substance use and sexual behavior. We review the scientific literature on event-level measures, which assess substance use and sexual risk behavior immediately before or during a sexual encounter and provide the most precise link between these two behaviors. From January 2009 through March 2010, we searched four databases: Ovid (MEDLINE and PsycINFO), Web of Knowledge, and Sociofile. Across studies, results varied by substance with little within substance consistency or a lack of research except for two notable exceptions: methamphetamine and binge alcohol use. The findings underscore the importance of providing HIV risk-reduction interventions for substance-using MSM.

Internet use, recreational travel, and HIV risk behaviors in men who have sex with men

Previous studies have documented higher rates of HIV risk behavior in gay and bisexual men traveling for leisure. Most of these studies collected data in high-risk tourist areas known for promoting alcohol and other substance use. The present study sampled a broader range of men by collecting data at a Gay Pride celebration, and asking participants about vacation experiences over the past 12 months. We also collected information about men's use of the Internet to find sexual partners before they traveled. Overall, two-thirds of participants reported recreational travel in the previous year. Of these men, 17% reported having sex with a new partner during their most recent vacation. Forty-three percent of the respondents were sexually active during their vacation. Sexually-active participants reported a mean of 2.01 unprotected anal sex acts during their brief vacation stay (M = 6.2 days). Close to half of the sexually-active men reported having sex with a partner of unknown HIV status. Alcohol and drug use were associated with unprotected sex. Men who used the Internet to set up dates prior to travel reported significantly more sexual partners and were significantly more likely to report having sex with a new partner. Many gay and bisexual men on vacation report behaviors that may place their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors in this population are needed.

PartyIntents: a portal survey to assess gay and bisexual men's risk behaviors at weekend parties

PartyIntents examines whether portal survey methods could be used to anonymously survey gay and bisexual men about HIV-risk behaviors before and after a weekend party-oriented vacation. The study recruited 97% of eligible men and of these 489 participants 47% completed the follow-up assessment. Approximately one half of the men intended to use illegal drugs over the weekend, and almost 20% thought that they might have anal intercourse and not use a condom. The methodology can be applied and provides useful information about HIV risk at these events, though refinements may be needed to increase the follow-up rates.

Adapting the information-motivation-behavioral skills model: predicting HIV-related sexual risk among sexual minority youth

Young sexual minority males are among those at highest risk for HIV infection, yet we know relatively little about the impact of sexual identity development on HIV risk. This study used cross-sectional data to investigate factors associated with HIV-related sexual risk among a sample of sexual minority males (n = 156), ages 14 to 21 years, using an extended version of the information-motivation-behavioral skills (IMB) model tailored for this population. Path analysis results indicated that the extended model predicted a sizable amount of primary and secondary sexual risk (r (2) = .35 and .42). In addition to increasing HIV prevention information and motivation and decreasing substance use, study findings suggest that interventions with young sexual minority males should focus on sexual identity development factors including youths' attitudes toward LBGT people, sex-centered versus identity-centered development, and with specific emphasis on youth with non-male exclusive sexual orientations.

Are Information, Motivation, and Behavioral Skills Linked with HIV-Related Sexual Risk among Young Men Who Have Sex with Men?

Young men who have sex with men are disproportionately affected by HIV/AIDS, yet relatively little is known about the most effective theoretical frameworks for preventive interventions with this population. This study investigated the fit of the Information-Motivation-Behavioral Skills (IMB) model for predicting sexual risk among a sample of ethnically diverse young men who have sex with men aged 14-21. Path analysis results indicated that the IMB model predicted a moderate amount of variance in primary and secondary sexual risk for young men who have sex with men (r(2) = .26 and .21, respectively). Fit of this model was acceptable on most indicators of model fit for primary and secondary risk.

Social influence and individual risk factors of HIV unsafe sex among female entertainment workers in China

Female entertainment workers in China are at increased sexual risk of HIV, but causes of their unprotected sex remain poorly understood. We develop a model that integrates information-motivation-behavioral skills (IMB) with social influences and test the model in a venue-based sample of 732 female entertainment workers in Shanghai. Most IMB and social influence measures are statistically significant in bivariate relationships to condom use; only HIV prevention motivation and behavioral self-efficacy remain significant in the multiple regressions. Self-efficacy in condom use is the most proximate correlate, mediating the relationship between information and motivation and condom use. Both peer and venue supports are important, but their influences over condom use are indirect and mediated through prevention motivation and/or self-efficacy. Behavioral intervention is urgently needed and should take a multilevel approach, emphasizing behavioral skills training and promoting a supportive social/working environment.

Unprotected anal intercourse among immigrant Latino MSM: the role of characteristics of the person and the sexual encounter

Theoretical models of sexual risk-taking have traditionally focused on personal characteristics, but conceptual approaches emphasizing the social and situational context have also been proposed. This study examined the impact of characteristics of the person and of the sexual encounter on unprotected anal intercourse (UAI) among 482 immigrant Latino MSM. Analyses included logistic regression and hierarchical linear modeling. The personal characteristic of self-efficacy for safer sex was negatively associated with UAI over the previous three months, at the most recent encounter, and over multiple encounters reported by each participant. In addition, a cross-level interaction of self-efficacy at the person-level and sexual desire at the encounter-level showed that increased sexual desire was associated with greater likelihood of UAI for those with low self-efficacy, but not those with high self-efficacy. Likelihood of UAI was also linked to the situational characteristics of closeness to the partner, seroconcordance, and concern about STIs in the encounter.