1
|
Furegato M, Mitchell H, Ogaz D, Woodhall S, Connor N, Hughes G, Nardone A, Mohammed H. The role of frequent HIV testing in diagnosing HIV in men who have sex with men. HIV Med 2017; 19:118-122. [PMID: 28984407 DOI: 10.1111/hiv.12558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In the UK, quarterly HIV testing is recommended for high-risk men who have sex with men (MSM). In this manuscript we determined the risk of being newly diagnosed with HIV in MSM by their HIV testing history, considering both the frequency and periodicity of testing. METHODS Data on HIV incidence in MSM attending a sexual health clinic (SHC) in England in 2013-2014 with testing history (previous 2 years) were obtained from GUMCAD, the national sexually transmitted infection (STI) surveillance system in England. HIV testing patterns among MSM were defined using the frequency and periodicity of testing, based on 3 month intervals, in the year preceding the first attendance during the study period. Cox proportional hazards regression was used to determine the association between HIV testing pattern and time to HIV diagnosis with and without adjustment for demographic confounders. Analyses were stratified by risk stratum, with 'high risk' defined as a history of a bacterial STI in the past year. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) are reported. RESULTS Among the 37 702 HIV-negative MSM attending an SHC in 2013-2014, 1105 (3%) were diagnosed with HIV infection within 1 year of their first attendance. The probability of HIV diagnosis was highest in MSM who were tested quarterly compared with those who were not tested in the past year (aHR 2.51; 95% CI 1.33-4.74); this increased 1.8-fold among high-risk MSM (aHR 4.48; 95% CI 0.97-21.17). CONCLUSIONS The probability of subsequent HIV diagnosis was greatest in high-risk MSM who were tested most frequently. Quarterly HIV testing increased the likelihood of identifying undiagnosed HIV infection and should remain a continued recommendation for high-risk MSM.
Collapse
Affiliation(s)
- M Furegato
- National Infection Service, Public Health England, London, UK
| | - H Mitchell
- National Infection Service, Public Health England, London, UK
| | - D Ogaz
- National Infection Service, Public Health England, London, UK
| | - S Woodhall
- National Infection Service, Public Health England, London, UK
| | - N Connor
- National Infection Service, Public Health England, London, UK
| | - G Hughes
- National Infection Service, Public Health England, London, UK
| | - A Nardone
- National Infection Service, Public Health England, London, UK
| | - H Mohammed
- National Infection Service, Public Health England, London, UK
| |
Collapse
|
2
|
Hess KL, Crepaz N, Rose C, Purcell D, Paz-Bailey G. Trends in Sexual Behavior Among Men Who have Sex with Men (MSM) in High-Income Countries, 1990-2013: A Systematic Review. AIDS Behav 2017; 21:2811-2834. [PMID: 28555317 PMCID: PMC5708163 DOI: 10.1007/s10461-017-1799-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV diagnoses among men who have sex with men (MSM) have been increasing in several high-income countries. A better understanding of the sexual behavior trends among MSM can be useful for informing HIV prevention. We conducted a systematic review of studies that examined behavioral trends (1990-2013) in any condomless anal sex, condomless anal sex with an HIV-discordant partner, and number of partners. Studies included come from the United States, Europe, and Australia. We found increasing trends in condomless anal sex and condomless anal sex with an HIV-discordant partner, and a decreasing trend in number of partners. The increase in condomless anal sex may help to explain the increase in HIV infections. More explanatory research is needed to provide insight into factors that contribute to these behavior trends. Continuous monitoring of HIV, risk behaviors, and use of prevention and treatment is needed to evaluate prevention efforts and monitor HIV transmission risk.
Collapse
Affiliation(s)
- Kristen L Hess
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA.
| | - Nicole Crepaz
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Charles Rose
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - David Purcell
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| |
Collapse
|
3
|
Leblanc NM, Mitchell JW, De Santis JP. Negotiated safety - components, context and use: an integrative literature review. J Adv Nurs 2017; 73:1583-1603. [PMID: 27906471 DOI: 10.1111/jan.13228] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to examine the components and use of negotiated safety in the context of HIV prevention and to identify reported factors associated with the concept. BACKGROUND There is an emerging interest in dyadic approaches to address HIV transmission. Although there are theoretical foundations for how interpersonal relationships influence individual behaviour, how these dyadic processes influence on health is still not wholly understood. DESIGN Integrative review of empirical and theoretical literature. DATA SOURCES The Cumulative Index for Nursing and Allied Health Literature (CINAHL) MEDLINE and PsychINFO electronic databases were accessed. REVIEW METHODS Articles were read to gain a historical context of the term and identify varying interpretations of the concept. Factors warranting consideration in association with NS were identified and clinical and public health implications were noted. RESULTS Forty-eight studies were reviewed. Negotiated safety included the following components: (i) HIV sero-negative concordant men within a primary relationship; (ii) joint HIV screening and mutual disclosure of their HIV status; (iii) explicit relationship boundaries which establish either nonexclusively that allows for the dispensing of condoms within the primary relationship and consistent condom use for extra-dyadic sex; or dispensing of condoms within a primary partnership and exclusivity; and (iv) a breach clause that allows communication to re-establish the agreement if needed. CONCLUSION Negotiated safety is a prescriptive approach to HIV risk reduction among couples. Researchers and practitioners could benefit from promoting this approach to HIV prevention.
Collapse
Affiliation(s)
- Natalie M Leblanc
- School of Nursing and Health Sciences, University of Miami, Florida, USA
| | - Jason W Mitchell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Joseph P De Santis
- Graduate Programs, School of Nursing and Health Sciences, University of Miami, Florida, USA
| |
Collapse
|
4
|
Bourne A, Dodds C, Keogh P, Weatherburn P. Non-condom related strategies to reduce the risk of HIV transmission: Perspectives and experiences of gay men with diagnosed HIV. J Health Psychol 2016; 21:2562-2571. [PMID: 25947230 DOI: 10.1177/1359105315581066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gay men with diagnosed HIV can adopt a number of strategies to reduce the risk of transmitting HIV to others, although research has typically focussed on condom use. Interviews with 42 HIV-positive gay men who reported recent engagement in anal intercourse without condoms explored their awareness of sexual risk and their perceptions of non-condom-related strategies to reduce it. In articulating men's ambivalence for strategies that can only reduce the risk of transmission, rather than eliminating, the findings have implications for the consideration and integration of new biomedical interventions to reduce the likelihood of HIV transmission.
Collapse
Affiliation(s)
- Adam Bourne
- 1 London School of Hygiene & Tropical Medicine, UK
| | | | | | | |
Collapse
|
5
|
Sanchez TH, Sineath RC, Kahle EM, Tregear SJ, Sullivan PS. The Annual American Men's Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Protocol and Key Indicators Report 2013. JMIR Public Health Surveill 2015; 1:e3. [PMID: 27227126 PMCID: PMC4869242 DOI: 10.2196/publichealth.4314] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV) and there is evidence that this population is participating in increasingly risky sexual behavior. These changes are occurring in the context of new modes of online social interaction-many MSM now report first meeting their sex partners on the Internet. Better monitoring of key behavioral indicators among MSM requires the use of surveillance strategies that capitalize on these new modes of interaction. Therefore, we developed an annual cross-sectional behavioral survey of MSM in the United States, the American Men's Internet Survey (AMIS). OBJECTIVE The purpose of this paper was to provide a description of AMIS methods. In addition we report on the first cycle of data collection (December 2013 through May 2014; AMIS-2013) on the same key indicators used for national HIV behavioral surveillance. METHODS AMIS-2013 recruited MSM from a variety of websites using banner advertisements or email blasts. Adult men currently residing in the United States were eligible to participate if they had ever had sex with a man. We examined demographic and recruitment characteristics using multivariable regression modeling (P<.05) stratified by the participants' self-reported HIV status. RESULTS In the AMIS-2013 round, 79,635 persons landed on the study page and 14,899 were eligible, resulting in 10,377 completed surveys from MSM representing every US state. Participants were mainly white, 40 years or older, living in the US South, living in urban areas, and recruited from a general social networking website. Self-reported HIV prevalence was 10.73% (n=1113). Compared to HIV-negative/unknown status participants, HIV-positive participants were more likely to have had anal sex without a condom with any male partner in the past 12 months (72.24% versus 61.24%, respectively; P<.001) and more likely to have had anal sex without a condom with their last male sex partner who was discordant/unknown HIV status (42.95% versus 13.62%, respectively; P<.001). Illicit substance use in the past 12 months was more likely to be reported by HIV-positive participants than HIV-negative/unknown status participants (39.17% versus 26.85%, respectively; P<.001). The vast majority of HIV-negative/unknown status participants (84.05%) had been previously HIV tested, but less than half (44.20%) had been tested in the past 12 months. Participants 18-24 years of age were more likely than those 40 years or older to have had anal sex without a condom with a discordant/unknown HIV status partner, were more likely to report substance use, and were less likely to have been HIV tested. Compared to general social networking, those from a geospatial social networking website were more likely to have reported all risk behaviors but were more likely to have been HIV tested. CONCLUSIONS The first round of AMIS generated useful behavioral measures from more than 10,000 MSM Internet users. Preliminary findings identified some subgroups of MSM Internet users that are at potentially higher risk of HIV acquisition/transmission. AMIS will provide an ongoing data source for examining trends in sexual risk behavior of MSM. This will help to plan and monitor the impact of programs to improve this population's health.
Collapse
|
6
|
Hickson F, Tomlin K, Hargreaves J, Bonell C, Reid D, Weatherburn P. Internet-based cohort study of HIV testing over 1 year among men who have sex with men living in England and exposed to a social marketing intervention promoting testing. Sex Transm Infect 2014; 91:24-30. [PMID: 25270006 DOI: 10.1136/sextrans-2014-051598] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Increasing HIV testing among men who have sex with men (MSM) is a major policy goal in the UK. Social marketing is a common intervention to increase testing uptake. We used an online panel of MSM to examine rates of HIV testing behaviour and the impact of a social marketing intervention on them. METHOD MSM in England were recruited to a longitudinal internet panel through community websites and a previous survey. Following an enrolment survey, respondents were invited to self-complete 13 surveys at monthly intervals throughout 2011. A unique alphanumeric code linked surveys for individuals. Rates of HIV testing were compared relative to prompted recognition of a multi-part media campaign aiming to normalise HIV testing. RESULTS Of 3386 unique enrolments, 2047 respondents were included in the analysis, between them submitting 15,353 monthly surveys (equivalent to 1279 years of follow-up), and recording 1517 HIV tests taken, giving an annual rate of tests per participant of 1.19 (95% CI 1.13 to 1.25). Tests were highly clustered in individuals (61% reported no test during the study). Testing rates were higher in London, single men and those aged 25-34 years. Only 7.6% recognised the intervention when prompted. After controlling for sociodemographic characteristics and exposure to other health promotion campaigns, intervention recognition was not associated with increased likelihood of testing. Higher rates of testing were strongly associated with higher number of casual sexual partners and how recently men had HIV tested before study enrolment. CONCLUSIONS This social marketing intervention was not associated with increased rates of HIV testing. More effective promotion of HIV testing is needed among MSM in England to reduce the average duration of undiagnosed infection.
Collapse
Affiliation(s)
- Ford Hickson
- London School of Hygiene & Tropical Medicine, London, UK
| | - Keith Tomlin
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - David Reid
- London School of Hygiene & Tropical Medicine, London, UK
| | | |
Collapse
|
7
|
Lachowsky NJ, Saxton PJW, Dickson NP, Hughes AJ, Summerlee AJS, Dewey CE. Factors associated with recent HIV testing among younger gay and bisexual men in New Zealand, 2006-2011. BMC Public Health 2014; 14:294. [PMID: 24684728 PMCID: PMC3977686 DOI: 10.1186/1471-2458-14-294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 03/20/2014] [Indexed: 11/18/2022] Open
Abstract
Background Understanding HIV testing behaviour is vital to developing evidence-based policy and programming that supports optimal HIV care, support, and prevention. This has not been investigated among younger gay, bisexual, and other men who have sex with men (YMSM, aged 16-29) in New Zealand. Methods National HIV sociobehavioural surveillance data from 2006, 2008, and 2011 was pooled to determine the prevalence of recent HIV testing (in the last 12 months) among YMSM. Factors associated with recent testing were determined using manual backward stepwise multivariate logistic regression. Results Of 3,352 eligible YMSM, 1,338 (39.9%) reported a recent HIV test. In the final adjusted model, the odds of having a recent HIV test were higher for YMSM who were older, spent more time with other gay men, reported multiple sex partners, had a regular partner for 6-12 months, reported high condom use with casual partners, and disagreed that HIV is a less serious threat nowadays and that an HIV-positive man would disclose before sex. The odds of having a recent HIV test were lower for YMSM who were bisexual, recruited online, reported Pacific Islander or Asian ethnicities, reported no regular partner or one for >3 years, were insertive-only during anal intercourse with a regular partner, and who had less HIV-related knowledge. Conclusion A priority for HIV management should be connecting YMSM at risk of infection, but unlikely to test with appropriate testing services. New generations of YMSM require targeted, culturally relevant health promotion that provides accurate understandings about HIV transmission and prevention.
Collapse
Affiliation(s)
- Nathan J Lachowsky
- Department of Population Medicine, University of Guelph, Guelph, Canada.
| | | | | | | | | | | |
Collapse
|
8
|
Bourne A, Hammond G, Hickson F, Reid D, Schmidt AJ, Weatherburn P. What constitutes the best sex life for gay and bisexual men? Implications for HIV prevention. BMC Public Health 2013; 13:1083. [PMID: 24256555 PMCID: PMC4225579 DOI: 10.1186/1471-2458-13-1083] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 11/13/2013] [Indexed: 11/30/2022] Open
Abstract
Background While a large body of research has sought to understand HIV transmission risk behaviours among gay men, bisexual men and other men who have sex with men (MSM), less attention has been paid to the wider sexual health and well-being of this population. While some community-based organisations aim to support a more holistic sense of sexual well-being there is little evidence to draw on to inform their interventions. The current study sought to explore gay and bisexual men’s conceptions of what constitutes the ‘best sex’. Method The EMIS survey of 2010 recruited more than 180,000 respondents from 38 European countries to complete an online questionnaire about sexual health and behaviour. The 12,942 English language, UK-based responses to the open ended question, “What’s your idea of the best sex life?” were subjected to a detailed content analysis. A framework was devised to reflect and describe the key themes emerging from the data, which was then used to code all responses to one (or more) of these themes. Further statistical analysis sought to establish if and how responses differed according to key demographic variables. Results Eight themes emerged that capture the diversity of gay and bisexual men’s sexual desires. Most common among responses was a desire for sex within committed relationships, followed by a desire for sex which is emotionally or psychologically connected. Men also expressed a desire for volume and variety in their sexual lives, and for sex that is free from physical, social or psychological harm. Comparative analysis identified that older men were less likely to idealise a relationship or emotional connection, but were more likely to specify the sexual acts or behaviours they wished to engage in. Conclusions Attending to what men value or aspire to can help ensure interventions are engaging and meaningful to the target population. HIV prevention interventions need to attend to the broad range of sexual desires held by gay and bisexual men in delivery of holistic sexual health promotion that can help them to have the best sex with the least harm.
Collapse
Affiliation(s)
- Adam Bourne
- Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | | | | | | |
Collapse
|