Condom use in multi-partnered males: importance of HIV and hepatitis B status

Aggregate and event-level associations between substance use and sexual behavior among gay and bisexual men: Comparing retrospective and prospective data

BACKGROUND

Despite limited research, some evidence suggests that examining substance use at multiple levels may be of greater utility in predicting sexual behavior than utilizing one level of measurement, particularly when investigating different substances simultaneously. We aimed to examine aggregate and event-level associations between three forms of substance use - alcohol, marijuana, and club drugs - and two sexual behavior outcomes - sexual engagement and condomless anal sex (CAS).

METHOD

Analyses focused on both 6-week timeline follow-back (TLFB; retrospective) and 30-day daily diary (prospective) data among a demographically diverse sample of 371 highly sexually active HIV-positive and HIV-negative gay and bisexual men.

RESULTS

Models from both TLFB and diary showed that event-level use of alcohol, marijuana, and club drugs was associated with increased sexual engagement, while higher aggregated frequency marijuana and any frequency club drug use were associated with decreased sexual engagement. Event-level use of club drugs was consistently associated with increased odds of CAS across both TLFB and diary models while higher frequency marijuana use was most consistently associated with a lower odds of CAS.

CONCLUSIONS

Findings indicated that results are largely consistent between retrospective and prospective data, but that retrospective results for substance use and sexual engagement were generally greater in magnitude. These results suggest that substance use primarily acts to increase sexual risk at the event-level and less so through individual-level frequency of use; moreover, it primarily does so by increasing the likelihood of sex on a given day with fewer significant associations with the odds of CAS on sex days.

Correlates of condom use among male high school students in Nairobi, Kenya

BACKGROUND

Correct and consistent condom use is an effective strategy to reduce the risk of sexually transmitted infections (STIs). This study examines sociodemographic, behavioral, and psychosocial characteristics of 3 groups of adolescent males: consistent, sporadic, and non-condom users.

METHODS

The sample consisted of 931 sexually experienced male high school students in Nairobi, Kenya. Cross tabulations and general linear models were used to test the relation between each explanatory variable and condom user group.

RESULTS

Fifty-three percent of respondents reported having used condoms. Compared with nonusers and sporadic users, consistent users engaged in sexual intercourse for the first time at an older age and reported higher condom use self-efficacy, more positive peer attitudes toward safe sex, and stronger attitudes toward condom use. Compared with sporadic and consistent users, nonusers reported fewer sexual partners, less substance use, and more frequent intercourse with non-romantic partners. Sporadic users, compared with the other 2 groups, had more sexual partners and stronger attitudes that support that males and females have separate roles. The 3 groups did not differ in HIV/AIDS knowledge. On average, respondents responded correctly to two thirds of the questions. All groups perceived their risk of contracting an STI as low, and this perception did not differ by condom use. Differences in participants' age by group were minimal.

CONCLUSIONS

The study supports the need for interventions that target specific condom use groups.

Alcohol use and risk of HIV infection among men who have sex with men

In the United States, men who have sex with men (MSM) currently represent more than 50% of those living with HIV and over 70% of HIV+ men (CDC 2007, http://www.cdc.gov/hiv/topics/msm/resources/factsheets/pdf/msm.pdf ). Male-to-male sexual contact has been identified as the predominant route of transmission among this sub-group, which underscores the need for research that targets risk factors associated with risky sex-related HIV acquisition. Along these lines, research has shown that one potentially important predictor variable for risky sex among MSM is alcohol use. The major aim of this paper is to review and integrate empirical evidence on the association of alcohol use and risky sex among MSM. A summary of the quantitative research is provided first, followed by a critique of the reviewed literature, a discussion of the consistency of the existing empirical evidence with predictions of current theories, and finally, recommendations for future research designed to evaluate alcohol-related sexual risk in MSM.

Unprotected anal intercourse and substance use before and after HIV diagnosis among recently HIV-infected men who have sex with men

OBJECTIVE

The objective of this study was to assess associations between unprotected anal intercourse (UAI) and substance use before and after HIV diagnosis among recently HIV-infected MSM.

STUDY DESIGN

Two hundred seven MSM completed computer-assisted self-interviews regarding type and timing of sexual activity and substance use with their last 3 partners. Date of HIV diagnosis was extracted from medical records. Generalized estimating equations, including interaction terms, were used to assess associations between substance use and UAI before and after HIV diagnosis.

RESULTS

Among partners with whom sexual activity occurred before diagnosis, UAI was associated with methamphetamine use alone (odds ratio = 7.12) and a combination of methamphetamine and other substances (odds ratio = 4.06). However, after HIV diagnosis, UAI was associated with use of substances other than methamphetamine (odds ratio = 3.36), but not methamphetamine alone.

CONCLUSIONS

Use of illicit substances may be differentially associated with UAI based on knowledge of HIV status and could have implications for prevention of HIV transmission.

Intentional unprotected anal intercourse among sex who have sex with men: barebacking - from behavior to identity

Unprotected sex among gay/bisexual men throughout the AIDS epidemic has usually been described as unintentional due to a relapse from safer sex behavior. The term "barebacking" emerged among HIV-positive men explicitly seeking unprotected sex with seroconcordant partners, but has come into use in the larger gay community to simply mean condomless sex. Some men have also taken on the identity as a "barebacker." The present study assessed prevalence and predictors of bareback identity in a sample 687 gay/bisexual men attending community events. Barebackers reported significantly more use of crystal methamphetamine and higher peer norms for unprotected sex; HIV-negative barebackers were higher in sexual compulsivity while HIV-positive barebackers were higher in romantic obsession as well as drug/alcohol influenced sexual expectancies. HIV prevention efforts targeting barebackers and barebacking must be carefully developed if programs and campaigns are to be effective given the open debates about this phenomenon in the gay community.

Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection

OBJECTIVES

To examine within-subjects and combined between- and within-subjects associations between substance use and unprotected anal intercourse (UAI) among men who have sex with men (MSM) with recent HIV infection.

METHODS

One hundred ninety-four MSM who were recently infected with HIV completed a computer-assisted questionnaire regarding sexual behaviors and substance use with their last 3 partners. Associations between UAI and substance use were assessed using conditional logistic regression (CLR) to assess associations among the 116 MSM reporting UAI with some but not all partners and generalized linear mixed effects models (GLMMs) to examine a combination of within- and between-subjects associations in the entire sample (N = 194).

RESULTS

In multivariate CLR models and GLMMs, UAI was associated with the use of methamphetamine (odds ratio [OR] = 4.9 and OR = 3.5, respectively), marijuana (OR = 4.0 and OR = 2.2, respectively) and erectile dysfunction medications (EDMs) when used with a main partner (OR = 13.8 and OR = 10.1, respectively).

CONCLUSIONS

Results indicate that a direct association may exist between specific substances and UAI and provide evidence that the use of methamphetamine and EDMs may contribute to HIV transmission.

Failure to embrace the barrier/condom use message

The objective of this study was to examine the consistency of barrier/condom use among men who have sex with men in the Kansas City metropolitan area. The authors sought to determine if barrier/condom usage patterns were associated with the type of sex act and whether it was insertive or receptive, HIV testing frequency, and number of sexual partners. Data were extracted from a 2003 community health assessment of the gay, lesbian, bisexual, and transgendered community in the metropolitan area. The health assessment instrument was anonymous, self-administered, and distributed at events in that community. Responses from 623 men indicated that consistent use of a barrier/condom was low regardless of the sex act. There was no relationship between barrier/condom usage patterns and HIV testing frequency for any sex act or the number of sex partners, with the exception of anal intercourse. The authors concluded that a different approach is needed to translate the barrier/condom use message into a behavioral response.