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Callander D, Park SH, Al-Ajlouni YA, Schneider JA, Khan MR, Safren SA, Duncan DT. Condomless Group Sex Is Associated With HIV Pre-Exposure Prophylaxis Knowledge and Interest Uptake: A Cross-Sectional Study of Gay and Bisexual Men in Paris, France. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:127-135. [PMID: 30917015 PMCID: PMC6557130 DOI: 10.1521/aeap.2019.31.2.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As a prevention strategy, HIV pre-exposure prophylaxis (PrEP) may benefit men who participate in group sex, but little is known about PrEP among this group internationally and virtually nothing is known of the European context. This study used an online survey of gay men living in Paris, France to assess associations between group sex and awareness of, use and interest in PrEP in its once-daily, episodic, injectable, and microbicidal forms. Men reporting recent (within 3 months) condomless group sex were much more likely to report once-daily PrEP use than men with no group sex experience (41.5% vs 7.7%, p < .001). Uptake was similarly low among men who had group sex with condoms (8.0%) and those with less-recent experience (6.43%). Overall, willingness to use PrEP-including its non-daily forms-was high among men reporting group sex, suggesting opportunities for outreach and implementation.
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Affiliation(s)
- Denton Callander
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
| | - Su Hyun Park
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
| | - Yazan A Al-Ajlouni
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
| | - John A Schneider
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
- Chicago Center for HIV Elimination, University of Chicago School of Medicine, Chicago, Illinois
| | - Maria R Khan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, Florida
| | - Dustin T Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York
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Frank K. Rethinking Risk, Culture, and Intervention in Collective Sex Environments. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:3-30. [PMID: 29748787 DOI: 10.1007/s10508-018-1153-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 11/28/2017] [Accepted: 01/11/2018] [Indexed: 05/16/2023]
Abstract
This article provides a narrative overview of research on HIV/STI risk and collective sexual behavior based on an inclusive analysis of research on environments where people gather for sexual activity-sex clubs, swingers' clubs, bathhouses, parks, private sex parties, etc. The aim is to analyze how collective sex has been approached across disciplines to promote conversation across paradigms and suggest new lines of inquiry. Attention to context-such as the location of sex-was a necessary redress to universalizing models of sexual risk-taking behavior, leading to insights rooted in the particularities of each environment and its users. However, the identification of ever more precise risk groups or environmental idiosyncrasies eventually becomes theoretically restrictive, leading to an overestimation of the uniqueness of sexual enclaves, and of the difference between any given enclave and the broader social milieu. Using a theoretical framework of transgression to interpret the interdisciplinary literature, similarities in the spatial and social organization of collective sex environments are identified. Insights generated from this complementary perspective are then applied to understandings of collective sex: first, the example of male-female (MF) "swingers" is used to illustrate the need to establish, rather than assume, the distinctiveness of each non-normative sexual enclave, and to broaden the conceptualization of context; second, questions are raised about the practicality of interventions in collective sex environments. Finally, new lines of intellectual inquiry are suggested to shed light not just on collective sex but on sociosexual issues more generally, such as increasing protective sexual health behavior or negotiating consent in sexual encounters.
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Affiliation(s)
- Katherine Frank
- Department of Sociology, University of Nevada, Las Vegas, Las Vegas, NV, 89557, USA.
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Is Group Sex a Higher-Risk Setting for HIV and Other Sexually Transmitted Infections Compared With Dyadic Sex Among Men Who Have Sex With Men? Sex Transm Dis 2016; 43:99-104. [PMID: 26766526 DOI: 10.1097/olq.0000000000000389] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Group sex has been suggested as a potential high-risk setting for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM). We investigated whether group sex is associated with lower condom use during anal sex and higher proportions of STIs compared with dyadic sex among HIV-negative MSM between 2009 and 2012. METHODS Cross-sectional data from 7 data waves of the Amsterdam Cohort Studies were used. The sample consisted of 465 MSM who either reported both group and dyadic sex (at n = 706 visits) or dyadic sex only (at n = 1339 visits) in the preceding 6 months. Logistic regression with generalized estimating equations was used to investigate the association between sexual setting (group vs. dyadic sex), condomless anal sex, and STI. RESULTS Group sex was reported at 35% (706/2045) of visits. Condomless sex was more often reported during dyadic than group sex (odds ratio, 3.64 95% confidence interval, 2.57-5.16). Men who had group sex were more likely diagnosed as having gonorrhea compared with men with dyadic sex (odds ratio, 1.71; 95% confidence interval, 1.08-2.97), but this effect was not retained in the multivariate model. CONCLUSIONS Results demonstrate within-person differences in sexual behavior during group and dyadic sex among MSM. Men were more likely to use condoms during group sex than during dyadic sex. Thus, for some, group sex may not necessarily be risky for HIV infection compared with dyadic sex. However, group sex may be a higher-risk setting for acquiring STIs other than HIV, such as gonorrhea. Group sex encounters should be recognized as distinct sexual settings with specific risk characteristics that need to be addressed accordingly.
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Rice CE, Lynch CD, Norris AH, Davis JA, Fields KS, Ervin M, Turner AN. Group Sex and Prevalent Sexually Transmitted Infections Among Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1411-1419. [PMID: 26392187 DOI: 10.1007/s10508-015-0554-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 04/02/2015] [Accepted: 04/21/2015] [Indexed: 06/05/2023]
Abstract
We evaluated the direct relation between group sex and prevalent sexually transmitted infections (STI) in a cross-sectional study of men who have sex with men (MSM) presenting at an urban STI clinic in the Midwestern US. Among 231 men who enrolled and reported that they have sex with men, we collected behavioral data using a combination of interviewer and self-administered surveys and extracted STI data from electronic health records. We used modified Poisson regression to examine the unadjusted and adjusted associations between group sex participation and prevalent STI. One-quarter of participants (n = 58) reported group sex participation in the last 3 months. Eighteen percent of participants (n = 42) had gonorrhea and 19 % (n = 45) had chlamydial infection. Men who reported recent group sex were more likely to be HIV-positive, to report recent drug use, and to report unprotected receptive anal intercourse in the past 3 months. After adjustment for age, race, and recent drug use, recent participation in group sex was associated with prevalent gonorrhea infection (prevalence ratio [PR] = 2.11, 95 % confidence interval [CI] = [1.13, 3.95]) but not chlamydia infection (PR = 1.03, 95 % CI = [0.58, 1.84]). We performed a sensitivity analysis in which we also adjusted for unprotected receptive anal intercourse and the results were not substantively changed. In summary, participation in group sex in the past 3 months was associated with a more than twofold increased prevalence of gonorrhea, but not with chlamydia. These findings support group sex participation as a potential contributor to increased STI prevalence.
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Affiliation(s)
- Cara E Rice
- Division of Epidemiology, College of Public Health, The Ohio State University, N1144 Doan Hall, 410 West 10th Ave., Columbus, OH, 43210, USA.
| | - Courtney D Lynch
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alison H Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, N1144 Doan Hall, 410 West 10th Ave., Columbus, OH, 43210, USA
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John A Davis
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Karen S Fields
- Sexual Health Clinic, Columbus Public Health, Columbus, OH, USA
| | - Melissa Ervin
- Sexual Health Clinic, Columbus Public Health, Columbus, OH, USA
| | - Abigail Norris Turner
- Division of Epidemiology, College of Public Health, The Ohio State University, N1144 Doan Hall, 410 West 10th Ave., Columbus, OH, 43210, USA
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA
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Risky sexual networks and concentrated HIV epidemics among men who have sex with men in Wenzhou, China: a respondent-driven sampling study. BMC Public Health 2015; 15:1246. [PMID: 26673429 PMCID: PMC4682249 DOI: 10.1186/s12889-015-2591-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 12/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background The high and continually increasing prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases among men who have sex with men (MSM) in China underscores the critical importance of examining the exact sexual networks that result in HIV transmission, as well as HIV infection, using powerful sampling methods, such as respondent-driven sampling (RDS), to improve the sexual health of this population. Methods Using RDS, a cross-sectional study was conducted among MSM in Wenzhou, Zhejiang province, China from December 2013 to June 2014. The type of sex, numbers of anal sex partners, male oral sex partners and vaginal sex partners, condom use during each type of sex over the previous 6 months, prevention behaviors, risk perception, and the burdens of HIV and syphilis were investigated and analyzed. Results Of 424 MSM, a great number of them did anal sex, male oral sex, and vaginal sex during the previous 6 months, and weighted estimates for the prevalence that MSM did not conduct these sexual behaviors were 11.2 % (95 % confidence interval [CI] =6.7–16.50 %), 20.3 % (95 % CI = 15.2–27.1 %), and 58.9 % (95 % CI = 52.1–65.8 %), respectively. Multiple sexual partners, engaging in regular, casual and commercial sex, and lack of condom use during all types of sex were common among MSM. The estimated HIV and syphilis prevalences were 22.8 % (95 % CI = 16.9–28.5 %) and 9.7 % (95 % CI = 6.4–13.6 %), respectively. Of the participants, 53.5 % (95 % CI = 45.3–60.2 %) received HIV-related interventions during the previous year, 48.1 % (95 % CI = 39.7–55.1 %) had never been tested for HIV, and only 14.1 % (95 % CI =10.1–19.2 %) perceived a risk of contracting HIV. Multiple logistic regression analysis revealed that age over 44 years (adjusted odds ratio [AOR] = 3.60, 95 % CI = 1.34–9.64), a monthly income of 3001–4000 yuan (approximately 470–630 US$) (AOR = 1.96, 95 % CI = 1.67–3.60), multiple anal sex partners (AOR = 1.93, 95 % CI = 1.15–3.24), awareness of the possibility of contracting HIV (AOR = 3.18, 95 % CI = 1.56–6.48), and current syphilis infection (AOR = 3.01, 95 % CI = 1.44–6.29) were predictors of HIV infection. Conclusions HIV transmission has become highly prevalent and will likely become more prevalent among MSM and their female partners if these risky sexual networks persist. Our findings call for urgent and effective interventions to prevent the rapid transmission of HIV among MSM in Wenzhou. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2591-7) contains supplementary material, which is available to authorized users.
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Correlates of group sex among a community-based sample of men who have sex with men (MSM) in Washington, DC. AIDS Behav 2014; 18:1413-9. [PMID: 23700223 DOI: 10.1007/s10461-013-0527-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Participation of MSM in group sex events (GSEs) is an understudied phenomenon. Studies on GSEs identified significant proportions of MSM engaging in unprotected anal intercourse (UAI). We sought to identify the prevalence of group sex participation among MSM in Washington, DC and to characterize these experiences. Data were collected for NHBS-MSM-3 in 2011. More than one-quarter of MSM (27.2 %) reported engaging in group sex in the prior year, with one-third reporting no condom use with their sex partners (33.0 %). In multivariable logistic regression, men who participated in a GSE in the prior year were significantly younger, more likely to be white, and to have used crystal meth, poppers, and downers in the past year. The high prevalence of UAI during GSEs, especially in view of the fact that HIV-positive MSM were significantly less likely to report condom use, offers an opportunity to develop risk reduction interventions specific to GSE attendees.
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Bowers JR, Branson CM, Fletcher JB, Reback CJ. Predictors of HIV Sexual Risk Behavior among Men Who Have Sex with Men, Men Who Have Sex with Men and Women, and Transgender Women. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2012; 24:290-302. [PMID: 24660042 PMCID: PMC3960284 DOI: 10.1080/19317611.2012.715120] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Men who have sex with men, men who have sex with men and women, and transgender women are at high risk for HIV infection. This study seeks to clarify which known HIV risk factors (partner type, sex location, serodiscordance, multiple sex partners, substance use during sex) contribute to engagement in high-risk (unprotected receptive anal) sex in each population. Data collected from June 2005 through June 2008 indicate all three populations display different HIV sexual risk profiles. The data suggest that HIV-prevention interventions should be individually tailored to address the specific needs of these three highly vulnerable and impacted populations.
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Affiliation(s)
- Jane Rohde Bowers
- Office of AIDS Programs & Policy, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Catherine M. Branson
- School of Nursing, University of California at Los Angeles, Los Angeles, California, USA
| | | | - Cathy J. Reback
- Friends Research Institute, Inc., Los Angeles, California, USA
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California, USA
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Moskowitz DA, Seal DW, Rintamaki L, Rieger G. HIV in the leather community: rates and risk-related behaviors. AIDS Behav 2011; 15:557-64. [PMID: 19904599 DOI: 10.1007/s10461-009-9636-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There exist many subcultures of men who have sex with men (MSM), all with differing values and health behaviors. The Leathermen comprise one such subculture, which is characterized by a heightened valuation of hypersexuality and adherence to sexual control dynamics (i.e., submission and dominance). No previous research has specifically examined this community for differences in sexual health (e.g., HIV rates) and sexual health behaviors (e.g., condom use). We conducted a large survey of men (N = 1,554) at one leather and non-leather event, collecting data from 655 Submissives, Dominants, Switches, and non-orienting Leathermen. Leathermen were 61% more likely to be HIV-positive than non-Leathermen. Decreased condom use found in HIV-positive Leathermen (relative to HIV-positive non-Leathermen) was a potential factor contributing to heightened HIV rates. Universal low condom use in Submissives engaging in receptive, and Dominants engaging in insertive, anal intercourse was an additional trend that potentially contributed to increased numbers of HIV-positive Leathermen. Our recommendation is for heightened awareness of the risks associated with sex among Leathermen, especially unprotected anal intercourse with sero-uncertain Submissives.
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Abstract
Group sex is relatively common among gay men, and is a likely risk factor for infection with HIV and other sexually transmissible infections (STI). The 5,432 participants in the 2008 Gay Community Periodic Survey in Sydney, Melbourne and Brisbane, Australia, were asked about their participation in group sex. Nearly half (44.0%) of those who reported sex with casual male partners in the previous 6 months also reported engaging in group sex. Among other factors, using drugs odds ratios (OR) and confidence intervals (CI) (OR = 1.89, CI = 1.61-2.21), being HIV-positive (OR = 1.62, CI = 1.13-2.32), and engaging in anal intercourse, both with a condom (OR = 3.03, CI = 2.46-3.73) and without a condom (OR = 5.68, CI = 4.53-7.12) were independently associated with having engaged in group sex. This study suggests that gay men who engage in group sex represent an important priority for targeted HIV and STI prevention activities and research.
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Abstract
Private sex parties are an emerging risk environment for HIV among men who have sex with men (MSM). In 2009, 103 participants who reported attending at least one sex party in Massachusetts in the prior 12 months completed an in-depth, interviewer-administered quantitative assessment. Multivariable logistic regression analyses were conducted to examine associations with having engaged in one or more serodiscordant unprotected anal sex (SDUAS) acts at the most recent sex party attended. Nearly one-third (32%) of the sample reported engaging in SDUAS at the most recent sex party attended. Adjusting for age, race/ethnicity, and educational attainment, variables associated with an increased odds of engaging in SDUAS at the most recent sex party were: total number of unprotected anal receptive sex acts at sex parties in the past 12 months, self-perception of being at-risk for transmitting or acquiring HIV, and sexual sensation seeking. Examined in the same model, if condoms were provided/available at the most recent sex party attended, participants were at a decreased odds of engaging in SDUAS at that sex party. The majority (80%) expressed an interest in HIV prevention activities for MSM who attend sex parties. HIV prevention interventions are needed to reach MSM who attend sex parties and should take into account individual and contextual factors that may contribute to sexual risk. Environmental factors in the sex party setting, in particular the presence and availability of condoms, may potentially mitigate individual-level factors such as unprotected anal sex.
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Semple SJ, Strathdee SA, Zians J, Patterson TL. Factors associated with sex in the context of methamphetamine use in different sexual venues among HIV-positive men who have sex with men. BMC Public Health 2010; 10:178. [PMID: 20359362 PMCID: PMC2858118 DOI: 10.1186/1471-2458-10-178] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 04/01/2010] [Indexed: 11/25/2022] Open
Abstract
Background Harm reduction has focused primarily on reduction of high-risk substance using behaviors rather than reductions in high-risk sexual behaviors. Furthermore, most studies focus on individual behavior change, with less attention paid to the social and environmental context. This paper promotes understanding of the interplay between the individual and the social context by examining the psychosocial and behavioral characteristics of 321 methamphetamine-using HIV-positive men who have sex with men (MSM) in San Diego, CA based on the locations or venues of their sexual activities when "high" on methamphetamine. Methods Participants in a safer-sex intervention study underwent a baseline assessment that queried demographic and psychosocial characteristics as well as drug use and sexual risk behaviors. For purposes of analysis, respondents were classified according to their preference of sexual venue: private (e.g., home), commercial (e.g., bathhouse), or public (e.g., public park or restroom). Results The commercial venue group was younger, better educated, more likely to identify as gay, and significantly more likely to have used "club drugs" as compared to the other two groups. Men in the commercial- and public-venue groups reported more high-risk sex compared to the private-venue group. The public-venue group reported heavier drug and alcohol use, had significantly higher Beck depression scores, reported more experiences of stigma, and scored higher on a measure of sexual compulsivity than did the other two groups. Conclusion In an effort to reduce HIV/STI risk-behaviors, future studies should investigate the feasibility of modifying personal, psychosocial and structural factors associated with the use of risky sexual venues where HIV-positive methamphetamine users engage in sexual activity when "high" on methamphetamine. Trial registration ClinicalTrials.gov NCT00432926
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry (MC 0680), University of California - San Diego, 9500 Gilman Drive, La Jolla, California 92093-0680, USA
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Mimiaga MJ, Reisner SL, Goldhammer H, Tetu AM, Belanoff C, Mayer KH. Sources of Human Immunodeficiency Virus and Sexually Transmitted Disease Information and Responses to Prevention Messages among Massachusetts Men Who Have Sex with Men. Am J Health Promot 2010; 24:170-7. [DOI: 10.4278/ajhp.08042841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Sexually transmitted disease (STD) rates have continued to increase among men who have sex with men (MSM). The present study used qualitative methods to assess sources of human immunodeficiency virus (HIV)/STD information and responses to HIV/STD prevention messages among MSM. This was done to understand how to design more effective media campaigns on HIV/STD prevention and testing for this population. Design. One-on-one semistructured, qualitative interviews and a brief demographic written survey were conducted. Setting. A Massachusetts community-based organization specializing in HIV/AIDS healthcare. Participants. A novel, modified, respondent-driven sampling method was used to recruit a diverse sample of 50 Massachusetts MSM between January and April 2005; qualitative interviews were conducted until redundancy in responses was achieved. Method. Qualitative data were analyzed using content analysis. NVIVO software was used to organize transcripts, identify themes, and report frequency of responses. Results. Respondents reported having derived information on sexual health from multiple media sources. Direct outreach, gay- and HIV-centered organizations, print and broadcast media, public transportation ads, and the Internet held the greatest potential for dissemination. Primary care providers were also frequently seen as trusted sources of HIV/STD prevention information. Ideas for content often included having “people just like you” in ads. Conclusion. Health messages that focus on getting tested for HIV and STDs, practicing safe sex, and incorporating straightforward and accurate information on prevention may be the most acceptable to MSM. Providers should be proactive in disseminating information about HIV/STD prevention.
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Affiliation(s)
- Matthew J. Mimiaga
- Matthew J. Mimiaga, ScD, MPH; San L. Reisner, MA; Hilary Goldhammer, ScM; Ashley M. Tetu, MPH; and Kenneth H. Mayer, MD, are with The Fenway Institute, Fenway Community Health, Boston, Massachusetts. Matthew J. Mimiaga, ScD, MPH, is with Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts. Ashley M. Tetu, MPH, is with Boston University, School of Public Health, Boston, Massachusetts. Candice Belanoff, MPH, is with the Harvard School of Public Health, Boston, Massachusetts
| | - Sari L. Reisner
- Matthew J. Mimiaga, ScD, MPH; San L. Reisner, MA; Hilary Goldhammer, ScM; Ashley M. Tetu, MPH; and Kenneth H. Mayer, MD, are with The Fenway Institute, Fenway Community Health, Boston, Massachusetts. Matthew J. Mimiaga, ScD, MPH, is with Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts. Ashley M. Tetu, MPH, is with Boston University, School of Public Health, Boston, Massachusetts. Candice Belanoff, MPH, is with the Harvard School of Public Health, Boston, Massachusetts
| | - Hilary Goldhammer
- Matthew J. Mimiaga, ScD, MPH; San L. Reisner, MA; Hilary Goldhammer, ScM; Ashley M. Tetu, MPH; and Kenneth H. Mayer, MD, are with The Fenway Institute, Fenway Community Health, Boston, Massachusetts. Matthew J. Mimiaga, ScD, MPH, is with Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts. Ashley M. Tetu, MPH, is with Boston University, School of Public Health, Boston, Massachusetts. Candice Belanoff, MPH, is with the Harvard School of Public Health, Boston, Massachusetts
| | - Ashley M. Tetu
- Matthew J. Mimiaga, ScD, MPH; San L. Reisner, MA; Hilary Goldhammer, ScM; Ashley M. Tetu, MPH; and Kenneth H. Mayer, MD, are with The Fenway Institute, Fenway Community Health, Boston, Massachusetts. Matthew J. Mimiaga, ScD, MPH, is with Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts. Ashley M. Tetu, MPH, is with Boston University, School of Public Health, Boston, Massachusetts. Candice Belanoff, MPH, is with the Harvard School of Public Health, Boston, Massachusetts
| | - Candice Belanoff
- Matthew J. Mimiaga, ScD, MPH; San L. Reisner, MA; Hilary Goldhammer, ScM; Ashley M. Tetu, MPH; and Kenneth H. Mayer, MD, are with The Fenway Institute, Fenway Community Health, Boston, Massachusetts. Matthew J. Mimiaga, ScD, MPH, is with Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts. Ashley M. Tetu, MPH, is with Boston University, School of Public Health, Boston, Massachusetts. Candice Belanoff, MPH, is with the Harvard School of Public Health, Boston, Massachusetts
| | - Kenneth H. Mayer
- Matthew J. Mimiaga, ScD, MPH; San L. Reisner, MA; Hilary Goldhammer, ScM; Ashley M. Tetu, MPH; and Kenneth H. Mayer, MD, are with The Fenway Institute, Fenway Community Health, Boston, Massachusetts. Matthew J. Mimiaga, ScD, MPH, is with Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts. Ashley M. Tetu, MPH, is with Boston University, School of Public Health, Boston, Massachusetts. Candice Belanoff, MPH, is with the Harvard School of Public Health, Boston, Massachusetts
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Nettles CD, Benotsch EG, Uban KA. Sexual risk behaviors among men who have sex with men using erectile dysfunction medications. AIDS Patient Care STDS 2009; 23:1017-23. [PMID: 19909171 DOI: 10.1089/apc.2009.0029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined relationships between use of the phosphodiesterase type-5 (PDE-5) inhibitors (erectile dysfunction medications) sildenafil (Viagra), Pfizer, New York, NY), tadalafil (Cialis), Eli Lily, Indianapolis, IN), and/or vardenafil (Levitra), Bayer, Berlin, Germany), substance use, perceptions of risk, and sexual behavior in men who have sex with men (MSM). MSM (N = 342) attending a gay pride festival completed a brief survey assessing sexual behavior, risk perceptions, and substance use, including the use and the source of PDE-5 inhibitors. More than a quarter of the sample (26.3%, n = 89) reported having ever used a PDE-5 inhibitor. Those reporting use of PDE-5 inhibitors had higher rates of sexual risk behaviors and differed in their assessment of the risk of HIV transmission for unprotected anal sex. Users who received PDE-5 inhibitors from their doctors did not report sexual behaviors that differed significantly from those who received PDE-5 inhibitors from nonphysician sources. In a sequential logistic regression analysis, recent PDE-5 inhibitor use was associated with unprotected anal sex after accounting for the influence of age, education, ethnic identity, and substance use. Many MSM users of erectile dysfunction drugs report behaviors that may place their and others' health at risk. Interventions to reduce risk among MSM PDE-5 inhibitor users should be explored.
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Affiliation(s)
| | - Eric G. Benotsch
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Kristina A. Uban
- Department of Pyschology, University of British Columbia, Vancouver, British Columbia
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Prestage GP, Hudson J, Down I, Bradley J, Corrigan N, Hurley M, Grulich AE, McInnes D. Gay men who engage in group sex are at increased risk of HIV infection and onward transmission. AIDS Behav 2009; 13:724-30. [PMID: 18818998 DOI: 10.1007/s10461-008-9460-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
Abstract
Among 746 participants in the Three or More Study (TOMS) of gay men who engaged in group sex in the previous 6 months, 22.4% reported unprotected anal intercourse (UAI) with any partners they did not know to be the same HIV serostatus as themselves. Not knowing oneself to be HIV-negative, not having a clear intention to use condoms, and more frequent group sex were independently associated with UAI. This study shows that gay men who engage in group sex represent an important priority for targeted HIV prevention activities and research.
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Aynalem G, Smith L, Bemis C, Taylor M, Hawkins K, Kerndt P. Commercial sex venues: a closer look at their impact on the syphilis and HIV epidemics among men who have sex with men. Sex Transm Infect 2006; 82:439-43. [PMID: 16885184 PMCID: PMC2563878 DOI: 10.1136/sti.2006.020412] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To provide insight into the role of commercial sex venues in the spread of syphilis and HIV among men who have sex with men (MSM). STUDY A cross sectional study of 1351 MSM who were diagnosed with early syphilis who did and did not encounter sexual partners at commercial sex venues. RESULTS Overall, 26% MSM diagnosed with syphilis had sexual encounters at commercial sex venues. Of these, 74% were HIV positive, 94% reported anonymous sex, and 66% did not use a condom. Compared to those who did not have a sexual encounter at these venues, they were twice as likely to be HIV positive (OR = 1.91, 95% CI 1.36 to 2.68), six times more likely to have anonymous sex (OR = 6.18, 95% CI 3.37 to 11.32), twice as likely not to use condom (OR = 2.02, 95% CI 1.71 to 2.38), and twice as likely to use non-injecting drugs (OR = 1.65, 95% CI 1.21 to 2.37). CONCLUSIONS MSM diagnosed with syphilis who frequent commercial sex venues are engaging in high risk behaviours for syphilis and HIV transmission and acquisition. Thus commercial sex venues are one of the focal points of syphilis and HIV transmission and acquisition.
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Affiliation(s)
- G Aynalem
- MPH, Los Angeles County STD Program, 2615 South Grand Ave, Room 500, Los Angeles, CA 90007, USA.
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16
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Abstract
PURPOSE The purpose of the article is to examine "appropriate" health care for men who have sex with men (MSM), which is not to suggest "special" health care. As a group, MSM are at increased risk for sexually transmitted infections, anal cancer, and mental health disorders. Focus areas in this article will address health issues that the primary care nurse practitioner (NP) may encounter in clinical practice: anal carcinoma, sexually transmitted diseases (STDs), high-risk sexual practices, depression, and substance abuse were topics chosen for inclusion in this article. These topics were among those highlighted in the Healthy People 2010 Companion Document for LGBT Health, which served to examine the healthcare disparities and lack of access to needed services related to sexual orientation. DATA SOURCE Extensive literature review of research articles, journals, clinical practice guidelines, books, and public health department Internet Web sites. CONCLUSIONS There are unique health disparities that exist for MSM related to social, emotional, and mental health factors, in addition to physical issues such as STDs. There is an increasing need for primary care providers to be aware of these disparities, as well as the factors that influence these disparities, in order to provide multidimensional care and health counseling that is unique to NP practice. IMPLICATIONS FOR PRACTICE Both the primary care NP and the patient should be aware of the unique healthcare issues among MSM that should be incorporated into the patient's routine health maintenance program. As primary care providers, it is within the standards of practice for NPs to provide culturally competent care, along with health promotion and disease prevention for MSM.
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Affiliation(s)
- Royal Gee
- Sacramento Family Medical Clinic, Sacramento, California, USA.
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Relf MV, Huang B, Campbell J, Catania J. Gay Identity, Interpersonal Violence, and HIV Risk Behaviors: An Empirical Test of Theoretical Relationships among a Probability-Based Sample of Urban Men Who Have Sex with Men. J Assoc Nurses AIDS Care 2004; 15:14-26. [PMID: 15090130 DOI: 10.1177/1055329003261965] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The highest absolute number of new HIV infections and AIDS cases still occur among men who have sex with men (MSM). Numerous theoretical approaches have been used to understand HIV risk behaviors among MSM; however, no theoretical model examines sexual risk behaviors in the context of gay identity and interpersonal violence. Using a model testing predictive correlational design, the theoretical relationships between childhood sexual abuse, adverse early life experiences, gay identity, substance use, battering, aversive emotions, HIV alienation, cue-to-action triggers, and HIV risk behaviors were empirically tested using confirmatory factor analysis and structural equation modeling. The relationships between these constructs are complex, yet childhood sexual abuse and gay identity were found to be theoretically associated with HIV risk behaviors. Also of importance, battering victimization was identified as a key mediating variable between childhood sexual abuse, gay identity, and adverse early life experiences and HIV risk behaviors among urban MSM.
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Affiliation(s)
- Michael V Relf
- Department of Professional Nursing, Georgetown University School of Nursing and Health Studies, Washington, D.C., USA
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18
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Parsons JT, Halkitis PN. Sexual and drug-using practices of HIV-positive men who frequent public and commercial sex environments. AIDS Care 2002; 14:815-26. [PMID: 12511214 DOI: 10.1080/0954012021000031886] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An ethnically diverse sample (69.7% men of colour) of HIV-seropositive MSM from the New York City and San Francisco metropolitan areas were recruited from a variety of social settings. While only 27.0% of the participants were recruited from PSEs (public sex environments where men 'cruise' for potential sex partners, such as parks) and CSEs (commercial sex environments where an admission is paid for entrance, such as bathhouses and sex clubs), 49.6% reported attending PSEs and 40.7% reported attending CSEs. Only a minority of participants from the full sample reported sexual behaviours that would have placed a partner at highest risk for HIV seroconversion. However, differences between those who frequented CSEs and those who did not emerged on several psychosocial factors (sexual sensation seeking, depression, perceived responsibility towards protecting sexual partners from HIV infection), sexual risk behaviours (unprotected oral and anal sex) and types of recreational drugs used. Fewer differences were found between those who frequented PSEs and those who did not.
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Affiliation(s)
- J T Parsons
- Department of Psychology, Hunter College of the City University of New York (CUNY) and Center for HIV/AIDS Educational Studies and Training (CHEST), New York University, New York 10021, USA.
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Fox KK, del Rio C, Holmes KK, Hook EW, Judson FN, Knapp JS, Procop GW, Wang SA, Whittington WL, Levine WC. Gonorrhea in the HIV era: a reversal in trends among men who have sex with men. Am J Public Health 2001; 91:959-64. [PMID: 11392941 PMCID: PMC1446475 DOI: 10.2105/ajph.91.6.959] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Gonorrhea cases among men who have sex with men (MSM) declined in the early years of the HIV epidemic. We evaluated more recent trends in gonorrhea among MSM through the Centers for Disease Control and Prevention's Gonococcal Isolate Surveillance Project. METHODS Isolates and case information were collected from 29 US sexually transmitted disease (STD) clinics. Gonococcal urethritis cases among MSM were compared with those among heterosexual men, and cases among MSM in 1995 to 1999 were compared with earlier MSM cases. RESULTS Of 34,942 cases, the proportion represented by MSM increased from 4.5% in 1992 to 13.2% in 1999 (P < .001). Compared with heterosexuals, MSM were older, more often White, and more often had had gonorrhea previously, although fewer had had gonorrhea in the past year. MSM with gonorrhea in 1995 to 1999 were slightly older than those with gonorrhea in 1992 to 1994, and a higher proportion had had gonorrhea in the past year. CONCLUSIONS MSM account for an increasing proportion of gonococcal urethritis cases in STD clinics. Given recent evidence that gonorrhea may facilitate HIV transmission, these trends demand increased attention to safe sexual behaviors and reducing STDs among MSM.
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Affiliation(s)
- K K Fox
- Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-02, Atlanta, GA 30333, USA.
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21
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Sowell RL. Identifying HIV/AIDS research priorities for the next millennium: a Delphi study with nurses in AIDS care. J Assoc Nurses AIDS Care 2000; 11:42-52. [PMID: 10826303 DOI: 10.1016/s1055-3290(06)60275-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to identify HIV/AIDS research priorities for the next millennium from the perspective of nurses in AIDS care. The study used a three-round Delphi technique, with study participants (the panel of experts) selected from the membership of the Association of Nurses in AIDS Care. In the first round of the Delphi study, 317 nurses identified more than 2,000 topics they viewed as important for overall HIV/AIDS research and for HIV/AIDS nursing research. Using qualitative analysis, 12 priority topics were generated in the overall research category and 12 priority topics in the nursing research category. In Round II of the Delphi survey, study participants ranked the 12 topics in categories (overall and nursing research priorities) identified in Round I. Finally, in Round III, the top five priority topics from Round II were prioritized in each category. The overall HIV/AIDS research topics identified were (a) HIV community-level education and prevention; (b) development of more tolerable drugs; (c) HIV prevention focusing on individual or specific group behavior; (d) vaccine development; and (e) development of new and more effective drugs. The HIV/AIDS nursing research priorities identified were (a) symptom management; (b) community-level HIV education and prevention; (c) quality of life issues in chronic HIV disease; (d) HIV prevention focusing on individual or specific group behavior; and (e) research related to adherence to drug therapy.
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Affiliation(s)
- R L Sowell
- Department of Administrative and Clinical Nursing, University of South Carolina, Columbia, USA
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Sowell RL. Balance: have we learned the lesson? J Assoc Nurses AIDS Care 1999; 10:19-20. [PMID: 10491800 DOI: 10.1016/s1055-3290(06)60340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Williams LA, Klausner JD, Whittington WL, Handsfield HH, Celum C, Holmes KK. Elimination and reintroduction of primary and secondary syphilis. Am J Public Health 1999; 89:1093-7. [PMID: 10394323 PMCID: PMC1508824 DOI: 10.2105/ajph.89.7.1093] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study was conducted to define factors associated with the epidemic spread, elimination, and reintroduction of primary and secondary syphilis in King County, Washington, from 1987 through 1998. METHODS Reports of primary and secondary syphilis in King County from 1987 through 1998 were reviewed retrospectively. RESULTS During the epidemic spread of syphilis, only 15.8% of cases were imported. A total of 24.0% of patients reported cocaine use, and 18.3% of female patients reported having commercial sex. During the elimination of syphilis, significantly higher percentages of cases were imported and lower percentages of patients reported cocaine use or female commercial sex. During the reintroduction of syphilis in 1997-1998, 68% of patients were men who reported sex with men; of this 68%, 66% were sero-positive for HIV. Most men reporting sex with men were 30 years or older and recruited many anonymous partners. CONCLUSIONS As syphilis wanes, local control must focus on outbreaks following its reintroduction. Resurgence of syphilis among men reporting sex with men recapitulates the epidemiology of syphilis before the historical advent of AIDS, warranting immediate attention to this problem.
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Affiliation(s)
- L A Williams
- Department of Medicine and Epidemiology, University of Washington, Seattle 98122, USA
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Bradley-Springer LA. THE COMPLEX REALITIES OF PRIMARY PREVENTION FOR HIV INFECTION IN A "JUST DO IT" WORLD. Nurs Clin North Am 1999. [DOI: 10.1016/s0029-6465(22)02362-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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