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Qoza P, van Heerden A, Essack Z. The dynamics of sexual risk amongst South African youth in age-disparate relationships. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1125552. [PMID: 37533508 PMCID: PMC10390765 DOI: 10.3389/frph.2023.1125552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/22/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction South Africa has the highest burden of HIV in the world with over 8 million people living with HIV. Young women and girls account for a quarter of new HIV infections while making up only 10% of the population. A key driver of HIV incidence is transactional and survival sex between adolescent girls or young women and older men (the latter referred to as 'sugar-daddies' or 'blessers'). This paper expands on the existing literature on age-disparate and intergenerational relationships to provide social and behavioural interpretations of how young men, commonly omitted from studies on this topic, and women in concurrent relationships with both their peers and older partners perceive and navigate sexual risk. Method We conducted a qualitative study in a rural setting of uMgungundlovu District, KwaZulu-Natal Province, with purposively selected male and female participants aged 18-24 years old in age-disparate relationships. Semi-structured in-depth interviews (IDI) were conducted and analysed using interpretative phenomenological analysis (IPA) to explore existing information, motivations, and behavioural practices around relationships and sexual risk. Results The themes and related sub-themes found through IPA included the following: (1) navigating dating: narratives that show a strong preference for being in an age-disparate relationship; the challenges that young people face when choosing an older person as a side partner; and social media applications seen as creating opportunities to meet side partners; and (2) the distribution of love and trust in a multi-party sexual network: condom (mis)use differentiates between straights-those in a serious relationship-and sides; and the power of eye-test seroguessing, the praxis of testing people visually for HIV in nullifying existing knowledge about sexual and reproductive health risk. Discussion This research offers an understanding of how schemas of non-condom use are organised. We observed that while condom-less sex is often viewed as essential to building social capital in a serious relationship, it is not the only factor that determines sexual relationship power. Eye-test seroguessing not only develops consortium (trust, reciprocity, and solidarity), but it fulfils the psycho-social need to belong to a network of serious relationships. Moreover, it is critical to the enactment of masculinities because it consolidates femininity to keep men happy, i.e., by being passive in the sexual encounter, women constrain their self-efficacy to act contrary to the conventions of reputable women. Therefore, it is plausible that in the serosorting that occurs prior to unprotected sexual acts, the power of eye-test seroguessing limits the ability to engage in safe sexual practices.
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Affiliation(s)
- Phiwokazi Qoza
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zaynab Essack
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Goodreau SM, Maloney KM, Sanchez TH, Morris M, Janulis P, Jenness SM. A Behavioral Cascade of HIV Seroadaptation Among US Men Who Have Sex with Men in the Era of PrEP and U = U. AIDS Behav 2021; 25:3933-3943. [PMID: 33884510 PMCID: PMC8528882 DOI: 10.1007/s10461-021-03266-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 10/25/2022]
Abstract
Seroadaptive behaviors help reduce HIV risk for some men who have sex with men (MSM), and have been well documented across MSM populations. Advancements in biomedical prevention have changed the contexts in which seroadaptive behaviors occur. We thus sought to estimate and compare the prevalence of four stages of the "seroadaptive cascade" by PrEP use in the recent era: knowledge of own serostatus, knowledge of partner serostatus; serosorting (matching by status), and condomless anal intercourse. Serosorting overall appeared to remain common, especially with casual and one-time partners. Although PrEP use did not impact status discussion, it did impact serosorting and the likelihood of having condomless anal intercourse. For respondents not diagnosed with HIV and not on PrEP, condomless anal intercourse occurred in just over half of relationships with HIV-positive partners who were not on treatment. Biomedical prevention has intertwined with rather than supplanted seroadaptive behaviors, while contexts involving neither persist.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology and Center for Studies in Demography and Ecology, University of Washington, Campus Box 353100, Seattle, WA, 91895, USA.
| | - Kevin M Maloney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington, Seattle, WA, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Undetectable or Unknown? A Longitudinal Event-Level Analysis of Disclosure of HIV Serostatus and Undetectability Among Gay, Bisexual, and Other Men Who have Sex with Men (gbMSM) in Metro Vancouver. AIDS Behav 2021; 25:2630-2643. [PMID: 33751314 DOI: 10.1007/s10461-021-03224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
We examined temporal trends and factors associated with reporting partner's serostatus and viral load among a sample of gay, bisexual and other men who have sex with men (gbMSM) in Vancouver, Canada. Participants were recruited using respondent-driven sampling and we collected prospective cohort data from 09/2014 to 02/2017 using a computer-assisted questionnaire and nurse-administered STI/HIV testing. Our study included 481 participants reporting on 3780 sexual events. Among HIV-negative/unknown gbMSM we found a trend towards decreased proportions of sexual events reporting an unknown HIV-status partner (42-19%; p = < 0.001) and found increased proportions among gbMSM living with HIV (11-27%; p = 0.043). More participants living with HIV reported sex with undetectable partners, compared to HIV-negative/unknown participants (14.8% versus 5%). Our multivariable model found that compared with unknown status partners, undetectable partners were older, were from longer sexual relationships and were more likely to engage in condomless anal sex. Findings indicate that HIV-negative gbMSM seem more aware of the serostatus of their partners over time, but knowledge of partners' viral load over time was not significant. Further research should assess the degree to which new campaigns such as Undetectable = Untransmittable (U = U) are associated with discussions about HIV disclosure and viral load status.
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Haas SM, Perazzo JD, Ruffner AH, Lyons MS. Exploring Current Stereotypes and Norms Impacting Sexual Partner HIV-Status Communication. HEALTH COMMUNICATION 2020; 35:1376-1385. [PMID: 31257927 DOI: 10.1080/10410236.2019.1636340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study sought to explore HIV-related stereotypes and norms that impact HIV-status communication with potential sexual partners. A series of focus groups and in-depth interviews were conducted (N = 59) with HIV-positive and HIV-negative MSM (75%) and Heterosexuals (25%). Findings indicate that HIV stereotypes and stigma remain as barriers to HIV-status discussion. Differences also emerged across groups: 1) HIV-negative MSM were more likely to report engaging in HIV-status communication, 2) HIV-positive MSM described inconsistent HIV-status communication and reported concealing their status at times, and 3) Heterosexuals reported being least likely to engage in HIV-status communication; often using the blanket question "Are you clean?" to encompass all STIs and avoiding direct HIV-status discussion. Overall, findings indicate that many HIV stereotypes and stigma-related communication norms persist that discourage discussion of sexual partners' HIV-status prior to sexual activity.
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Biello KB, Goedel WC, Edeza A, Safren SA, Mayer KH, Marshall BD, Latkin C, Mimiaga MJ. Network-Level Correlates of Sexual Risk Among Male Sex Workers in the United States: A Dyadic Analysis. J Acquir Immune Defic Syndr 2020; 83:111-118. [PMID: 31929400 PMCID: PMC7262793 DOI: 10.1097/qai.0000000000002230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Male sex workers (MSWs) are at increased risk of HIV infection in the United States. Research is limited on sexual and drug use network characteristics of MSWs. SETTING Community-based organization and health center in 2 US Northeast cities. METHODS One hundred MSWs completed a behavioral assessment and sexual and drug network inventory. Using dyadic analyses, we assessed whether network characteristics, including sex worker-male client age, race, and HIV status homophily and risk multiplexity (ie, overlap in drug-use and sex networks), were associated with condom use. RESULTS MSW participants' mean age was 33.6. Two-thirds identified as Black or Latino, 12% identified as heterosexual, and 90% reported recent drug use. Participants reported an average of 5.3 male clients in the past month (SD = 3.4), and having anal sex with 74% of these clients, at a rate of 2.2 times per month (SD = 4.6). Participants reported inconsistent condom use during anal sex with 53% of clients. In multivariable models, inconsistent condom use was more common in relationships with presumed HIV status homophily [odds ratio (OR): 1.25; 95% confidence interval (CI): 1.07 to 1.46] and sexual and drug network multiplexity (OR: 1.19; 95% CI: 1.09 to 1.30); and less common within relationships where the client is older than the MSW participant (OR: 0.83; 95% CI: 0.74 to 0.93). Number of multiplex relationships was positively associated with number of condomless anal sex acts with male clients (incidence rate ratio: 1.35; 95% CI: 1.19 to 1.54). CONCLUSIONS Network characteristics may contribute to disproportionate HIV risk among MSWs. Modeling studies should include network characteristics when simulating HIV transmission, and future HIV interventions should address the role of networks.
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Affiliation(s)
- Katie B. Biello
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
- Fenway Institute, Fenway Health, Boston, MA
| | - William C. Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Steven A. Safren
- Fenway Institute, Fenway Health, Boston, MA
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, Florida
| | - Kenneth H. Mayer
- Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Global Health and Population, T.H. Chan School of Public Health, Harvard University, Cambridge, MA
| | - Brandon D.L. Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Matthew J. Mimiaga
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
- Fenway Institute, Fenway Health, Boston, MA
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Ricks JM, Crosby RA, Mena L. Relationship power and HIV risk among young Black men who have sex with men in the Southern United States. Sex Health 2019; 15:292-297. [PMID: 29709213 DOI: 10.1071/sh17084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/16/2017] [Indexed: 11/23/2022]
Abstract
Background The purpose of this study was to examine the impact of relationship power on HIV risk behaviour among young Black men who have sex with men (MSM) in the Southern US. METHODS Data from 425 Black/African American males aged 18-29 years who reported recent anal intercourse with a male partner were analysed. Five selected measures of relationship power were tested for correlation and association with protected receptive anal intercourse using contingency tables and logistic regression analysis. RESULTS Acts of 100% protected receptive anal intercourse were common (n=277, 65.2%). Men who reported low barriers to condom negotiation were significantly more likely to report protected acts (P<0.001). Men who reported 100% protected acts were less likely to report financial dependence on male sexual partners and serosorting behaviour (12.0% vs 20.7%, P=0.02; 31.5% vs 49.8%, P<0.001 respectively). CONCLUSION Future efforts should further examine the role of relationship power in HIV risk among young Black MSM, including the intersection of individual, dyadic and social-structure risks.
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Affiliation(s)
- JaNelle M Ricks
- Health Behavior and Health Promotion, Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210, USA
| | - Richard A Crosby
- Health, Behavior & Society, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA
| | - Leandro Mena
- Division of Infectious Diseases, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
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Villa-Rueda AA, Onofre-Rodríguez DJ, Churchill S, Ramírez-Barajas F, Benavides-Torres RA. Multilevel elements associated with HIV serosorting for sexual encounters: a scoping literature review. CIENCIA & SAUDE COLETIVA 2019; 26:2183-2194. [PMID: 34231730 DOI: 10.1590/1413-81232021266.13142019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/05/2019] [Indexed: 11/22/2022] Open
Abstract
A scoping literature review to identify the multilevel HIV serosorting related elements was developed. Articles from EBSCO, PubMed, PsyNET and Science Direct with serosort* or serosorting at the tittle or abstract, written in English or Spanish were included. No restriction in type of population or design were applied. 239 records were retrieved after duplicates removed, but 181 references were extracted for full-text review. Individual level: HIV knowledge, serostatus, risk perceptions, abilities to disclose and for condom use negotiation, motivations, use of drugs, stigma, attitudes toward condom use, and perceptions/beliefs about the HIV and related treatments, HIV infection rates/testing and behavioral factors. Interpersonal level: social networks, abilities (sexual behavior negotiation, and communication). Community level: stigma, social norms, access to HIV related services. Structural level: political context, HIV related funding and public policies. HIV Serosorting is not solely an interpersonal behavior it involves multilevel elements that must be acknowledged by professionals and stakeholders.
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Affiliation(s)
- Alma Angélica Villa-Rueda
- School of Nursing, Universidad Autónoma de Baja California. Calle G S/N Z.C. 21100. Mexicali Baja California México
| | - Dora Julia Onofre-Rodríguez
- School of Nursing, Universidad Autónoma de Nuevo León. Dr. José Eleuterio González #1500, Mitras Centro, Z.C. 64460 Monterrey Nuevo León México
| | - Siobhan Churchill
- Department of Epidemiology and Biostatistics, University of Western Ontario. London ON Canada
| | - Fernanda Ramírez-Barajas
- School of Nursing, Universidad Autónoma de Nuevo León. Dr. José Eleuterio González #1500, Mitras Centro, Z.C. 64460 Monterrey Nuevo León México
| | - Raquel Alicia Benavides-Torres
- School of Nursing, Universidad Autónoma de Nuevo León. Dr. José Eleuterio González #1500, Mitras Centro, Z.C. 64460 Monterrey Nuevo León México
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Brown G, Leonard W, Lyons A, Power J, Sander D, McColl W, Johnson R, James C, Hodson M, Carman M. Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape. Sex Health 2019; 14:111-118. [PMID: 27977386 DOI: 10.1071/sh16052] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
Improvements in biomedical technologies, combined with changing social attitudes to sexual minorities, provide new opportunities for HIV prevention among gay and other men who have sex with men (GMSM). The potential of these new biomedical technologies (biotechnologies) to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). At the structural level, stigma regarding gay men and HIV can influence the scale-up of new biotechnologies and negatively affect GMSM's access to and use of these technologies. At the personal level, stigma can affect individual gay men's sense of value and confidence as they negotiate serodiscordant relationships or access services. This paper argues that maximising the benefits of new biomedical technologies depends on reducing stigma directed at sexual minorities and people living with HIV and promoting positive social changes towards and within GMSM communities. HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM's incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention. The HIV response must become bolder in resourcing, designing and evaluating programs that interact with and influence stigma at multiple levels, including structural-level stigma.
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Affiliation(s)
- Graham Brown
- La Trobe University, Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - William Leonard
- La Trobe University - Gay and Lesbian Health Victoria, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Anthony Lyons
- La Trobe University, Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Jennifer Power
- La Trobe University, Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Dirk Sander
- Deutsche AIDS-Hilfe e.V, Wilhelmstraße 138, 10963 Berlin, Germany
| | - William McColl
- AIDS United, 1424K Street, N.W., Suite 200, Washington, DC 20005, USA
| | - Ronald Johnson
- AIDS United, 1424K Street, N.W., Suite 200, Washington, DC 20005, USA
| | - Cary James
- Terrence Higgins Trust, 314-320 Gray's Inn Road, London, WC1X 8DP, UK
| | - Matthew Hodson
- GMFA, Unit 22, Eurolink Business Centre, 49 Effra Road, London SW2 1BZ, UK
| | - Marina Carman
- La Trobe University, Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, Vic. 3000, Australia
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Holt M, Lea T, Mao L, Zablotska I, Lee E, de Wit JBF, Prestage G. Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys. Sex Health 2019; 14:72-79. [PMID: 27567489 DOI: 10.1071/sh16072] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/18/2016] [Indexed: 11/23/2022]
Abstract
Background In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect individuals at high risk of HIV and reduce onward transmission. METHODS The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia's primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000-15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed. RESULTS Between 2000 and 2015, there were significant increases (P<0.001) in annual HIV testing (56.1-64.8%), condomless sex with casual partners (26.8-38.8%) and the proportion of HIV-positive men on HIV treatment (72.5-88.4%) and with an undetectable viral load (73.7-94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level. CONCLUSIONS Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.
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Affiliation(s)
- Martin Holt
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Toby Lea
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Limin Mao
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Iryna Zablotska
- The University of New South Wales, The Kirby Institute, Sydney, NSW 2052, Australia
| | - Evelyn Lee
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - John B F de Wit
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Garrett Prestage
- The University of New South Wales, The Kirby Institute, Sydney, NSW 2052, Australia
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Mitchell JW, Wu Y, Gamarel KE. Timing and Sequence of Events: HIV Status Disclosure, Condomless Anal Sex, and Sexual Agreement Formation Among Same-Sex Male Couples. JOURNAL OF SEX RESEARCH 2019; 56:728-739. [PMID: 30295545 DOI: 10.1080/00224499.2018.1523361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite the implications for human immunodeficiency virus (HIV) prevention and sexual health, little is known about the timing and chronological order of when same-sex male couples disclose their HIV serostatus, establish a sexual agreement, and first engage in condomless anal sex (CAS) in their relationships. Dyadic data from 357 dyads were used to describe when these respective events occurred; whether members of a couple concurred about when the events happened; and the chronological order of these events. For many, disclosure and CAS happened within the first month, whereas an agreement tended to occur much later (if at all). Couples' concordance of when disclosure and agreement formation happened differed by their serostatus, whereas there was little difference by serostatus for CAS. The chronological order of these events revealed interesting patterns and varied substantially. Although two-thirds of partners reported disclosure had occurred first, some reported events happening on the same day. These findings reveal that the first few months in a same-sex male couple's relationship is a critical time period for when information and decisions about sexual health occur. Suggestions are provided for how current and future HIV prevention efforts could assist couples with their sexual health needs.
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Affiliation(s)
- Jason W Mitchell
- a Myron B. Thompson School of Social Work, Office of Public Health Studies , University of Hawaii at Manoa
| | - Yanyan Wu
- a Myron B. Thompson School of Social Work, Office of Public Health Studies , University of Hawaii at Manoa
| | - Kristi E Gamarel
- b Department of Health Behavior and Health Education , University of Michigan School of Public Health
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Crosby RA, Mena L, Geter A. Favourable attitudes towards serosorting are associated with overall less frequent condom use among young Black men having sex men. Sex Health 2018; 13:91-2. [PMID: 26433647 DOI: 10.1071/sh15156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/12/2015] [Indexed: 11/23/2022]
Abstract
This study determined whether YBMSM endorsing serosorting are less likely to use condoms. A questionnaire assessed men's attitudes towards serosorting with a three-item scale; various sexual risk behaviours were measured using a 90-day recall period. Favourable attitudes toward serosorting were associated with a greater likelihood of condomless sex as a top (P<0.001) and as a bottom (P<0.001), as well as a lower likelihood of using condoms with main partners (P=0.003). Findings suggest that YBMSM having favourable attitudes toward serosorting may be more likely to report condomless sex than their counterparts without favourable attitudes.
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Affiliation(s)
- Richard A Crosby
- College of Public Health at the University of Kentucky, 151 Washington Avenue, Lexington, KY 40506-0003, USA
| | - Leandro Mena
- University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Angelica Geter
- College of Public Health at the University of Kentucky, 151 Washington Avenue, Lexington, KY 40506-0003, USA
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12
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Koester KA, Erguera XA, Kang Dufour MS, Udoh I, Burack JH, Grant RM, Myers JJ. "Losing the Phobia:" Understanding How HIV Pre-exposure Prophylaxis Facilitates Bridging the Serodivide Among Men Who Have Sex With Men. Front Public Health 2018; 6:250. [PMID: 30238001 PMCID: PMC6135985 DOI: 10.3389/fpubh.2018.00250] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/15/2018] [Indexed: 01/27/2023] Open
Abstract
The use of HIV serostatus information has played a pivotal role in partner selection norms. A phenomenon known as serosorting is the practice of selecting a partner based on a perception that they are of the same HIV status in order to avoid transmission from one partner to the other. An understudied aspect of serosorting is that it has a divisive effect-one accepts or rejects a potential partner based on a singular characteristic, the partner's HIV status, and thus excludes all others. This division has been formally referred to as the HIV serodivide. In this study, we explored partner selection strategies among a group of HIV-negative, young men who have sex with men (n = 29) enrolled in a PrEP demonstration project in Northern California. We found that trends in serosorting were in fact shifting, and that a new and opposite phenomenon was emerging, something we labeled "seromixing" and that PrEP use played a part in why norms were changing. We present three orientations in this regard: (1) maintaining the phobia: in which men justified the continued vigilance and exclusion of people living with HIV as viable sex or romantic partners, (2) loosening/relaxation of phobia: among men who were reflecting on their stance on serosorting and its implications for future sexual and/or romantic partnerships, and (3) losing the phobia: among men letting go of serosorting practices and reducing sentiments of HIV-related stigma. The majority of participants spoke of changing or changed attitudes about intentionally accepting rather than rejecting a person living with HIV as a sex partner. For those who maintained strict serosorting practices, their understandings of HIV risk were not erased as a result of PrEP use. These overarching themes help explain how PrEP use is contributing to a closing of the HIV serodivide.
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Affiliation(s)
- Kimberly A Koester
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Xavier A Erguera
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ifeoma Udoh
- East Bay AIDS Center, Sutter Health, Oakland, CA, United States
| | | | - Robert M Grant
- Virology and Immunology, Gladstone Institutes, University of California, San Francisco, San Francisco, CA, United States
| | - Janet J Myers
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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13
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Meunier É, Siegel K. Sexual Risk Behaviors and Perceptions of Men Who Go to Gay Sex Parties in New York City: Comparisons Between Three HIV Groups. JOURNAL OF SEX RESEARCH 2018; 55:880-891. [PMID: 29148839 DOI: 10.1080/00224499.2017.1393042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Men who have sex with men (MSM) who attend group-sex events often engage in risky sexual behaviors that contribute to the high human immunodeficiency virus (HIV) incidence among this population. We conducted an online survey with 211 New York City MSM who attended sex parties in the prior year and asked them to describe their behaviors and perceptions of risk. We compared responses from HIV-positive-undetectable men (n = 36), HIV-negative men on pre-exposure prophylaxis (PrEP; n = 62), and HIV-negative men never on PrEP (n = 113). In bivariate analyses, undetectable and on-PrEP men had been to more sex parties in the prior six months, had more anal sex partners there, and had higher rates of sexually transmitted infection (STI) diagnoses than men never on PrEP. Although less than the other groups, 43% of the presumably HIV-negative men never on PrEP reported condomless anal sex at a party in the prior six months. About half of participants agreed that, at sex parties, they made assumptions about others' HIV status, that they sometimes took more risks than intended, and that the atmosphere of these events was conducive to risk taking. Most disagreed that there was discussion of HIV status at sex parties. Implications for sexual health interventions are discussed.
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Affiliation(s)
- Étienne Meunier
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health
| | - Karolynn Siegel
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health
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Shuper PA, MacLachlan DJ, Joharchi N, Guimond TH, Maxwell J, Adam BD. HIV Risk and Protective Factors in the Context of Alcohol and Substance Use During Pride. AIDS Behav 2018; 22:2797-2806. [PMID: 29680936 DOI: 10.1007/s10461-018-2117-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This investigation sought to identify HIV-risk and -protective factors among men-who-have-sex-with-men (MSM) who engaged in anal sex following alcohol or substance use during an international Pride Festival. MSM attending World Pride were surveyed regarding (1) alcohol, substance use, and sex during the past 24 h; and (2) HIV-risk and -protective factors. Valid data were provided by 1123 MSM. Anal sex was reported by 195 MSM, among whom the majority (n = 105) consumed alcohol or substances prior to sex. Among MSM aware of their HIV status who consumed alcohol or substances prior to sex (n = 99), those who engaged in serodiscordant condomless anal sex (n = 22) were more likely to be HIV+ (AOR = 10.14, 95% CI 1.48-69.35); report multiple sex partners (AOR = 9.05, 95% CI 1.70-48.12); and possess lower condom efficacy (AOR = 0.47, 95% CI 0.23-0.93) and social support (AOR = 0.08, 95% CI 0.01-0.46). Bolstering condom negotiation skills and social support could potentially reduce HIV acquisition/transmission-risk behavior, even when under the influence of alcohol or substances.
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Affiliation(s)
- Paul A Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | | | - Narges Joharchi
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Tim H Guimond
- St. Michael's Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Barry D Adam
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Canada
- Ontario HIV Treatment Network, Toronto, Canada
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15
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Desai S, Burns F, Schembri G, Williams D, Sullivan A, McOwan A, Antonucci S, Mercey D, Hughes G, Hart G, Gill ON, Nardone A. Sexual behaviours and sexually transmitted infection outcomes in a cohort of HIV-negative men who have sex with men attending sexual health clinics in England. Int J STD AIDS 2018; 29:1407-1416. [PMID: 30114995 DOI: 10.1177/0956462418789333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Men who have sex with men (MSM) attending sexual health (SH) clinics are at high risk for HIV acquisition and are disproportionately affected by sexually transmitted infections (STIs). We collected standardised behavioural data from MSM attending clinics to characterise sexual behaviours and identify predictors for HIV and STIs. In 2012–2013, HIV-negative MSM attending five SH clinics in England reported sexual behaviours in the previous three months via a self-administered questionnaire. Behaviours were linked to the individual’s clinical records using national surveillance. The prevalence and incidence of bacterial STIs (gonorrhoea, Chlamydia, lymphogranuloma venereum and syphilis) and incidence of HIV were calculated. Adjusted odds ratios and hazard ratios with 95% confidence interval (CI) were reported for significant predictors. Of 1278 HIV-negative MSM, 54% were of white ethnicity and UK-born and 43% were 25–34 years old. Almost all men reported at least one partner in the last three months. Half reported condomless anal sex and 36% condomless receptive anal intercourse (CRAI). Incidence of bacterial STIs was 46/100 (95%CI 39–54) person years (py) and of HIV was 3.1/100 (95%CI 1.7–5.6) py. A STI at baseline and CRAI with increasing numbers of partners were associated with both incident infections. In this cohort of MSM high-risk behaviours and STIs were prevalent. Engagement in CRAI increased the likelihood of subsequent infection, while men diagnosed with a bacterial STI were at increased risk of a future STI. Clinical and behavioural risk assessments to determine an individual’s risk of infection could allow a more nuanced prevention approach that has greater success in reducing transmission.
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Affiliation(s)
- S Desai
- HIV&STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.,Research Department of Infection & Population Health, University College London, London, UK
| | - F Burns
- Research Department of Infection & Population Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - G Schembri
- Manchester Centre for Sexual Health, Manchester, UK
| | - D Williams
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Antonucci
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - D Mercey
- Central North West London NHS Foundation Trust, London, UK
| | - G Hughes
- HIV&STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - G Hart
- Research Department of Infection & Population Health, University College London, London, UK
| | - O N Gill
- HIV&STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Anthony Nardone
- HIV&STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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16
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Grov C, Jonathan Rendina H, Patel VV, Kelvin E, Anastos K, Parsons JT. Prevalence of and Factors Associated with the Use of HIV Serosorting and Other Biomedical Prevention Strategies Among Men Who Have Sex with Men in a US Nationwide Survey. AIDS Behav 2018; 22:2743-2755. [PMID: 29550942 PMCID: PMC6051908 DOI: 10.1007/s10461-018-2084-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PrEP and treatment-as-prevention (TasP) are biomedical strategies to reduce HIV transmission. Some men who have sex with men (MSM) are combining biomedical strategies with HIV serosorting-termed "biomed matching" when both partners are either on PrEP or TasP, or "biomed sorting" when one partner is using PrEP and the other TasP. Nevertheless, there is limited data on the extent of biomed matching/sorting in large geographically diverse samples. In 2016-2017, 5021 MSM from across the US were surveyed about their HIV status and HIV viral load/PrEP use, as well as that of their recent casual male partners. For each participant, we calculated the proportion of his partners who were (1) HIV-positive and undetectable, (2) HIV-positive and detectable/unknown, (3) HIV unknown/undiscussed, (4) HIV-negative on PrEP, (5) HIV-negative, not on PrEP. In total, 66.6% (n = 3346) of participants were HIV-negative and not on PrEP, 11.9% (n = 599) on PrEP, 14.1% (n = 707) HIV-positive and undetectable, 1.1% (n = 55) HIV-positive and viral load detectable/unknown, and 6.2% (n = 313) HIV unsure/unknown. A participant's own HIV and PrEP status/was significantly associated with that of his partners (all p < 0.001), evincing evidence of both serosorting and biomed matching. Among men on PrEP and those who were HIV-undetectable, there was also some evidence to suggest these participants dually engaged in biomed matching as well as biomed sorting. We found evidence of biomed matching and sorting, which may compound its effectiveness for those using it (i.e., both partners bring biomedical protection). Unintended consequences of biomed matching/sorting include that men not using a biomedical strategy may be less likely to benefit from a partner's use of the strategy-potentially further driving disparities in HIV infections. Public health campaigns might be well served to highlight not only the benefits that biomedical HIV prevention strategies provide for their users (e.g., "being on PrEP protects me from getting HIV"), but also the benefits that a user brings to his partners (e.g., "my use of PrEP means my partners won't get HIV"), and the benefits of being with a partner who is using a biomedical strategy (e.g., "my partner's use of PrEP/TasP protects me from HIV").
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA.
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA.
| | - H Jonathan Rendina
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
- Department of Psychology, Hunter College of CUNY, New York, NY, USA
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of CUNY, New York, NY, USA
| | - Viraj V Patel
- Division of General Internal Medicine, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth Kelvin
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Kathryn Anastos
- Division of General Internal Medicine, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey T Parsons
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
- Department of Psychology, Hunter College of CUNY, New York, NY, USA
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of CUNY, New York, NY, USA
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17
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Iakunchykova O, Burlaka V, King EJ. Correlates of Serosorting and Knowledge of Sexual Partner's HIV Status Among Men Who have Sex with Men in Ukraine. AIDS Behav 2018; 22:1955-1964. [PMID: 29218602 DOI: 10.1007/s10461-017-2002-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Ukraine has among the highest rates of newly diagnosed HIV infections in the WHO European region. Men who have sex with men (MSM) is the least studied group in the context of the HIV epidemics in Ukraine. The present paper aims to estimate the prevalence and correlates of knowledge of sexual partner's HIV status and potentially discordant anal intercourse (failure to serosort) among MSM. Data of the cross-sectional study among 8100 MSM in Ukraine in 2013 were used for this analysis. Less than half of the participants (42.5%) reported that they knew the HIV serostatus of their most recent male sexual partner, and about 13% of participants reported failure to serosort during their most recent anal sexual intercourse with a male partner. Targeted interventions can be implemented to increase knowledge about sexual partner's HIV status, both among HIV-negative and HIV-positive MSM, to reduce the risk of HIV acquisition and transmission.
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Affiliation(s)
- Olena Iakunchykova
- School of Public Health, SUNY University at Albany, Rensselaer, NY, USA.
| | - Viktor Burlaka
- Department of Social Work, University of Mississippi, Oxford, MS, USA
| | - Elizabeth J King
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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18
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Kampman CJG, Heijne JCM, Kistemaker-Koedijk PHM, Koedijk FDH, Visser M, Hautvast JLA. Determinants of frequent and infrequent STI testing and STI diagnosis related to test frequency among men who have sex with men in the eastern part of the Netherlands: a 6-year retrospective study. BMJ Open 2018; 8:e020495. [PMID: 29858416 PMCID: PMC5988078 DOI: 10.1136/bmjopen-2017-020495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Men who have sex with men (MSM) remain vulnerable to sexually transmitted infections (STIs) and are advised to be tested at least twice a year. The aim of this study was to assess the determinants of test frequency and their associations with an STI diagnosis. DESIGN A 6-year retrospective study. SETTING 5 STI clinics in the eastern part of the Netherlands. PARTICIPANTS MSM whose mean test interval was 6 months or more were grouped as 'infrequently tested' (n=953), and those with a mean test interval less than 6 months were grouped as 'frequently tested' (n=658). PRIMARY AND SECONDARY OUTCOME MEASURES Test frequency and STI diagnosis and determinants. RESULTS MSM who were ever diagnosed with an STI (OR=1.4, 95% CI 1.1 to 1.7), MSM who had never had STI symptoms (OR=0.8, 95% CI 0.6 to 1.0), and MSM who had ever had sex with both men and women (OR=0.6, 95% CI 0.5 to 0.8) were more often frequently tested. Moreover, in both groups, MSM who had ever been notified by a partner (OR=2.2, 95% CI 1.7 to 2.9 infrequently tested; OR=2.0, 95% CI 1.4 to 2.9 frequently tested), MSM who had ever had STI symptoms (OR=1.6, 95% CI 1.2 to 2.1 infrequently tested; OR=1.8, 95% CI 1.3 to 2.6 frequently tested) and MSM who were ever diagnosed with HIV (OR=2.7, 95% CI 1.5 to 4.6 infrequently tested; OR=6.8, 95% CI 2.6 to 17.5 frequently tested) were more likely to be diagnosed with an STI. CONCLUSIONS Among MSM visiting STI clinics, those who were ever diagnosed with HIV were more often diagnosed with an STI, but did not visit STI clinics more frequently than HIV-negative MSM. This highlights the necessity of encouraging MSM who are diagnosed with HIV to have STI tests more frequently.
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Affiliation(s)
| | - Janneke C M Heijne
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | | | - Maartje Visser
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jeannine L A Hautvast
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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19
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Haas SM, Perazzo JD, Ruffner AH, Ancona RM, Lyons M. The Know∗Now Project: Facilitated Serosorting in HIV-Status Sexual Partner Communication. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:432-442. [PMID: 29068717 DOI: 10.1521/aeap.2017.29.5.432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An intervention was conducted providing access to clinic-verified HIV test results via a secure, web-based informatics platform to facilitate sexual partner HIV-status communication. Participants (N = 28) were men who have sex with men (MSM; HIV- n = 8, HIV+ n = 8) and heterosexuals (Non-MSM, n = 12). Focus groups with same-group members explored interest in using the intervention and baseline attitudes and practices relevant to serosorting. HIV-negative participants overwhelmingly expressed interest, regardless of MSM status. Interest among HIV-positive MSM was mixed. Six month follow-up interviews (n = 16) indicated 94% of all groups accessed the website, 69% had shown documented results to a sexual partner to initiate HIV-status discussion, and 88% reported future interest in using the 24/7 web-based tool with prospective sexual partners. Implications for future interventions facilitating HIV serosorting and sexual partner communication are discussed.
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Affiliation(s)
- Stephen M Haas
- Associate Professor, Department of Communication, University of Cincinnati, Cincinnati, Ohio
| | - Joseph D Perazzo
- Assistant Professor, College of Nursing, University of Cincinnati
| | | | | | - Michael Lyons
- Department of Emergency Medicine, University of Cincinnati
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20
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Pines HA, Karris MY, Little SJ. Sexual Partner Concurrency Among Partners Reported by MSM with Recent HIV Infection. AIDS Behav 2017; 21:3026-3034. [PMID: 28702851 PMCID: PMC5983362 DOI: 10.1007/s10461-017-1855-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We examined concurrency among sexual partners reported by men who have sex with men (MSM) with recent (acute or early) HIV infection in San Diego, California (2002-2015). Partners overlapping in time in the past 3 months were considered concurrent. Logistic generalized linear mixed models were used to identify factors associated with concurrency at the partner-level. 56% (388/699) of partners were concurrent to ≥1 other partner. The odds of concurrency were higher among partners >10 years younger than the participant (vs. within 10 years of age) [adjusted odds ratio (AOR) = 2.22, 95% confidence interval (CI) 1.09-4.52], longer term partners (AOR per month = 1.02, 95% CI 1.01-1.03), and partners met online (AOR = 1.56, 95% CI 0.98-2.48). Concurrency is common among partners of recently HIV-infected MSM. Tailored HIV prevention strategies for MSM with older partners, longer term partners, and partners met online may help minimize the potential impact of concurrency on HIV transmission.
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Affiliation(s)
- Heather A Pines
- Department of Medicine, University of California, San Diego, 9500 Gilman Dr, MC 0507, La Jolla, CA, 92093-0507, USA.
| | - Maile Y Karris
- Department of Medicine, University of California, San Diego, 9500 Gilman Dr, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Susan J Little
- Department of Medicine, University of California, San Diego, 9500 Gilman Dr, MC 0507, La Jolla, CA, 92093-0507, USA
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Abstract
BACKGROUND Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. OBJECTIVE We examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country's severe AIDS epidemic. METHODS We use interviewers' ratings of respondents' attractiveness, along with HIV test results and women's assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15-35. RESULTS Results show that women who are rated by interviewers as 'much less' or 'less' attractive than other women their age are 9% more likely to test positive for HIV. We also find that attractiveness is associated with women's own assessments of their HIV risk: Among women who tested negative, those perceived as 'much less' or 'less' attractive than average report themselves to be at greater risk of HIV infection. CONCLUSIONS These results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. CONTRIBUTION This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings.
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Affiliation(s)
| | - Sophia Chae
- Population Council, USA. The author's affiliation is included for informational purposes only. This work was not conducted under the auspices of the Population Council
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22
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Down I, Ellard J, Triffitt K, Zablotska I, Hurley M, Brown G, Bradley J, Prestage G. High-risk sexual behaviours among gay and bisexual men: comparing event-level casual sex encounters among seroconverters and non-seroconverters. Sex Transm Infect 2017; 93:327-331. [PMID: 28325770 DOI: 10.1136/sextrans-2016-052749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/17/2017] [Accepted: 03/01/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND With increasing use of non-condom-based HIV risk reduction strategies by gay and bisexual men (GBM), we compared occasions of condomless anal intercourse with casual partners (CLAIC) that resulted in HIV transmission and similar occasions when HIV transmission did not occur. METHODS We compared two demographically similar samples of Australian GBM. The HIV Seroconversion Study (SCS) was an online cross-sectional survey of GBM recently diagnosed with HIV. The Pleasure and Sexual Health (PASH) study was an online cross sectional survey of GBM generally. Using logistic regression, we compared accounts of CLAIC reported by men in SCS as being the event which led to them acquiring HIV, with recent CLAIC reported by HIV-negative men in PASH. RESULTS In SCS, 85.1% of men reported receptive CLAIC, including 51.8% with ejaculation; 32.1% reported having previously met this partner and 28.6% believed this partner to be HIV-negative. Among HIV-negative men in PASH reporting recent CLAIC, 65.5% reported receptive CLAIC, including 29.9% with ejaculation; 59.3% reported having previously met this partner and 70.1% believed this partner to be HIV-negative. CONCLUSIONS While both groups of men engaged in CLAIC, how they engaged in CLAIC differed, and the context in which they did so was different. A generic measure of CLAIC conceals the critical elements of HIV risk, particularly the role of receptive CLAIC, among GBM that distinguish those who seroconverted and those who did not. Detailed information about the context and nature of the practise of CLAIC is required for a more complete understanding of HIV risk among GBM.
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Affiliation(s)
- Ian Down
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jeanne Ellard
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Kathy Triffitt
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Iryna Zablotska
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Michael Hurley
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Graham Brown
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Jack Bradley
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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23
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Duncan I, Curtis R, Reyes JC, Abadie R, Khan B, Dombrowski K. Hepatitis C serosorting among people who inject drugs in rural Puerto Rico. Prev Med Rep 2017; 6:38-43. [PMID: 28271018 PMCID: PMC5328718 DOI: 10.1016/j.pmedr.2017.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/10/2016] [Accepted: 02/05/2017] [Indexed: 12/15/2022] Open
Abstract
Due to the high cost of treatment, preventative measures to limit Hepatitis C (HCV) transmission among people who inject drugs (PWID) are encouraged by many public health officials. A key one of these is serosorting, where PWID select risk partners based on concordant HCV status. Research on the general U.S. population by Smith et al. (2013) found that knowledge of one's own HCV status facilitated serosorting behaviors among PWID, such that respondents with knowledge of their own status were more likely to ask potential partners about their status prior to sharing risk. Our objective was to see if this held true in rural Puerto Rico. We replicate this study using a sample of PWID in rural Puerto Rico to draw comparisons. We used respondent driven sampling to survey 315 participants, and have a final analytic sample of 154. The survey was heavily modeled after the National HIV Behavioral Survey, which was the dataset used by the previous researchers. We found that among PWID in rural Puerto Rico, unlike in the general population, knowledge of one's own HCV status had no significant effect on the selection of one's most recent injection partner, based on his/her HCV status. We conclude that PWID in rural Puerto Rico differ from the general U.S. population when it comes to serosorting behaviors, and that these differences should be taken into account in future outreaches and intervention strategies. Recent study finds PWID ask potential partners about infections once own status known. We replicate this using similar measures with a sample in rural Puerto Rico. Find no evidence this happens in rural Puerto Rico, though women more likely to ask. Null finding may be due to small sample size, but pattern still appears unique.
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Affiliation(s)
- Ian Duncan
- University of Nebraska – Lincoln, United States
- Corresponding author.
| | - Ric Curtis
- John Jay College of Criminal Justice, United States
| | | | | | - Bilal Khan
- University of Nebraska – Lincoln, United States
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24
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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.
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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
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25
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Otis J, McFadyen A, Haig T, Blais M, Cox J, Brenner B, Rousseau R, Émond G, Roger M, Wainberg M. Beyond Condoms: Risk Reduction Strategies Among Gay, Bisexual, and Other Men Who Have Sex With Men Receiving Rapid HIV Testing in Montreal, Canada. AIDS Behav 2016; 20:2812-2826. [PMID: 26961381 PMCID: PMC5108827 DOI: 10.1007/s10461-016-1344-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) have adapted their sexual practices over the course of the HIV/AIDS epidemic based on available data and knowledge about HIV. This study sought to identify and compare patterns in condom use among gay, bisexual, and other MSM who were tested for HIV at a community-based testing site in Montreal, Canada. Results showed that while study participants use condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also make use of various other strategies such as adjusting to a partner's presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.
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Affiliation(s)
- Joanne Otis
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
- CIHR Canadian HIV Trials Network, Vancouver, Canada.
| | - Amélie McFadyen
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Thomas Haig
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
- CIHR Canadian HIV Trials Network, Vancouver, Canada
- COCQ-SIDA, Montreal, QC, Canada
| | - Martin Blais
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Joseph Cox
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Bluma Brenner
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Gilbert Émond
- Applied Human Sciences, Concordia University, Montreal, QC, Canada
| | - Michel Roger
- Laboratoire de Biologie Moléculaire, Centre hospitalier de l'université de Montréal, Montreal, QC, Canada
| | - Mark Wainberg
- Faculty of Medicine, McGill University, Montreal, QC, Canada
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Abstract
Serosorting (i.e., choosing partners of the same HIV serostatus to reduce the risk of transmission with unprotected sex) and other forms of seroadaptation (i.e., engaging in diverse behaviors according to a hierarchy of risk by type of sex and partner serostatus) are phenomena widely described for men who have sex with men (MSM) in the developed world. We assessed seroadaptive behaviors among MSM surveyed in Yangon, Myanmar in 2013-2014. Among HIV-negative MSM, 43.1 % engaged in some form seroadaptation including serosorting (21.8 %), using condoms with potentially serodiscordant anal sex (19.3 %), and seropositioning (1.7 %). Among HIV-positive MSM, 3.5 % engaged in serosorting, 36.0 % in using condoms with potentially serodiscordant anal sex, 7.0 % in seropositioning, and 46.5 % in any form of seroadaptation. For HIV-negative and HIV-positive MSM, seroadaptation was more common than consistent condom use (38.0 and 26.7 %, respectively). MSM in Myanmar are engaging in seroadaptive behaviors in magnitude and ways similar to MSM in industrialized countries.
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Affiliation(s)
- Tin Aung
- Population Services International-Myanmar, Yangon, Myanmar
| | - Si Thu Thein
- Population Services International-Myanmar, Yangon, Myanmar
| | - Willi McFarland
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6033, USA.
- University of California, San Francisco, San Francisco, CA, USA.
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27
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Vosvick M, Fritz S, Henry D, Prybutok V, Sheu S, Poe J. Correlates and Racial/Ethnic Differences in Bareback Sex Among Men Who Have Sex with Men with Unknown or Negative HIV Serostatus. AIDS Behav 2016; 20:2798-2811. [PMID: 26983950 DOI: 10.1007/s10461-016-1366-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Men who have sex with men (MSM), particularly racial/ethnic minority MSM, are disproportionately affected by HIV in the United States and Texas. Bareback sex or condomless anal intercourse (CAI) can be a high HIV risk behavior. Despite this, a majority of MSM continues to engage in barebacking. Research suggests racial/ethnic differences in barebacking exist; however, these conclusions remain unclear due to insufficient sample sizes to compare racial/ethnic groups. Our cross-sectional correlational design explores barebacking correlates (substance use during sex, safe sex fatigue, and optimistic HIV treatment beliefs) within and between racial/ethnic groups among 366 MSM. Regression models are significant for Latino and African-American MSM alone and for all MSM combined, though not significant for European-American and Other Race/Ethnicity MSM alone. Our findings suggest motivations and behaviors underlying barebacking among MSM vary by racial/ethnic membership with clinical implications for informing culturally sensitive HIV interventions and prevention programs for target racial/ethnic groups.
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Affiliation(s)
- Mark Vosvick
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA.
| | - Sarah Fritz
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Doug Henry
- Department of Anthropology, University of North Texas, Denton, TX, USA
| | - Victor Prybutok
- Department of Information Technology & Decision Sciences, University of North Texas, Denton, TX, USA
| | - Shane Sheu
- TB/HIV/STD Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Jonathon Poe
- TB/HIV/STD Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
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28
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Serosorting and Sexual Risk for HIV Infection at the Ego-Alter Dyadic Level: An Egocentric Sexual Network Study Among MSM in Nigeria. AIDS Behav 2016; 20:2762-2771. [PMID: 26910338 DOI: 10.1007/s10461-016-1311-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of this egocentric network study was to investigate engagement in serosorting by HIV status and risk for HIV between seroconcordant and serodiscordant ego-alter dyads. Respondent-driving sampling was used to recruit 433 Nigerian men who have sex with men (MSM) from 2013 to 2014. Participant (ego) characteristics and that of five sex partners (alters) were collected. Seroconcordancy was assessed at the ego level and for each dyad. Among 433 egos, 18 % were seroconcordant with all partners. Among 880 dyads where participants knew their HIV status, 226 (25.7 %) were seroconcordant, with 11.7 % of HIV positive dyads seroconcordant and 37.0 % of HIV negative dyads seroconcordant. Seroconcordant dyads reported fewer casual sex partners, less partner concurrency, and partners who had ever injected drugs, but condom use did not differ significantly. Serosorting may be a viable risk reduction strategy among Nigerian MSM, but awareness of and communication about HIV status should be increased. Future studies should assess serosorting on a partner-by-partner basis.
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29
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Entre pulsion et raison : dimensions psychodynamiques et sociologiques de la sexualité d’hommes gais séropositifs. Étude Hepaig, 2007–2008, France. EVOLUTION PSYCHIATRIQUE 2016. [DOI: 10.1016/j.evopsy.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Murphy PJ, Hevey D, O'Dea S, Ní Rathaille N, Mulcahy F. Serostatus Disclosure, Stigma Resistance, and Identity Management Among HIV-Positive Gay Men in Ireland. QUALITATIVE HEALTH RESEARCH 2016; 26:1459-1472. [PMID: 26386024 DOI: 10.1177/1049732315606687] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this study, we examined how non-infectiousness due to antiretroviral therapy has affected HIV-positive gay men's experience of serostatus disclosure to casual sex partners. Interviews were conducted with 15 seropositive gay men living in Ireland. Using grounded theory, three constructions of non-disclosure were proposed-as self-protection, as a morally permissible act, and as a rejection of the HIV-positive identity. Each construction entailed an aspect related to the sexual exclusion of those living with HIV, and an aspect related to their social exclusion. The extent to which the lives of those interviewed were affected by stigma was starkly revealed, as was the extent to which they stigmatized others living with HIV and rejected the HIV-positive identity. The research highlights the failure to socially normalize HIV and that interventions are needed to reduce the distress associated with seropositivity.
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31
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Kuhn E, Potthoff A, Dirks H, Borgmann R, Esser S, Scherbaum N, Brockmeyer NH, Skaletz-Rorowski A. Viral load strategy: impact on risk behaviour and serocommunication of men who have sex with men in specialized care. J Eur Acad Dermatol Venereol 2016; 30:1561-6. [PMID: 27393373 DOI: 10.1111/jdv.13672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/15/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Incidence and prevalence of HIV are continuously high in German men, who have sex with men (MSM). Different transmission risk minimizing strategies have been observed. The viral load strategy rates patients unlikely to be sexually infectious if their viral load under effective therapy is stably suppressed during 6 months and no other sexually transmitted infections are present. OBJECTIVES We aim to objectify the current popularity of the viral load strategy, the adherence to basic conditions and its impact on risk behaviour and serocommunication. Until now, no data on a German sample of HIV-positive MSM in regular specialized outpatient care are available. METHODS Cross-sectional study with group comparisons between user group and non-user-group of the viral load strategy. Self-report questionnaires were conducted with 269 sexually active German HIV+MSM under effective treatment in specialized outpatient care. Structured interviews gathered additional information about approach to and realization of definite action levels concerning sexual risk behaviour and transmission risk minimizing strategies. RESULTS Twenty-seven of 269 participants (10%) affirmed knowledge of having an undetectable viral load and stated this to be criteria for unprotected sexual behaviour. This subgroup reported more unprotected insertive (P = 0.018) and receptive anal intercourse (P = 0.042), more anonymous sex partners (P = 0.008) and less consistent safer sex. Analysing serocommunication, less addressing HIV/AIDS in general (P = 0.043) and less disclosing to sex partners (P = 0.023) was found, especially in anonymous settings. Differentiating serocommunication characteristics, a focus on seroguessing was depicted. CONCLUSIONS The user group of the viral load strategy is small. But a less frequent, more reactive and assumptive serocommunication leads to an imprecise information exchange paired with higher frequency of risky behaviour, especially in anonymous settings, where frank serocommunication is often avoided. The targeted group of the viral load strategy diverges greatly from the user group.
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Affiliation(s)
- E Kuhn
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, Ruhr-Universität Bochum, Bochum, Germany
| | - A Potthoff
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, Ruhr-Universität Bochum, Bochum, Germany.,Competence Network for HIV/AIDS, Ruhr-Universität Bochum, Bochum, Germany
| | - H Dirks
- Department of Addiction Medicine and Addictive Behaviour, LVR-Klinikum Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
| | - R Borgmann
- Department of Addiction Medicine and Addictive Behaviour, LVR-Klinikum Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
| | - S Esser
- Department of Dermatology and Venerology, University Hospital Duisburg-Essen, Essen, Germany
| | - N Scherbaum
- Department of Addiction Medicine and Addictive Behaviour, LVR-Klinikum Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
| | - N H Brockmeyer
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, Ruhr-Universität Bochum, Bochum, Germany.,Competence Network for HIV/AIDS, Ruhr-Universität Bochum, Bochum, Germany
| | - A Skaletz-Rorowski
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, Ruhr-Universität Bochum, Bochum, Germany.,Competence Network for HIV/AIDS, Ruhr-Universität Bochum, Bochum, Germany
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32
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Conroy AA, Gamarel KE, Neilands TB, Dilworth SE, Darbes LA, Johnson MO. Relationship Dynamics and Partner Beliefs About Viral Suppression: A Longitudinal Study of Male Couples Living with HIV/AIDS (The Duo Project). AIDS Behav 2016; 20:1572-83. [PMID: 27150895 DOI: 10.1007/s10461-016-1423-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Accurate beliefs about partners' viral suppression are important for HIV prevention and care. We fit multilevel mixed effects logistic regression models to examine associations between partners' viral suppression beliefs and objective HIV RNA viral load tests, and whether relationship dynamics were associated with accurate viral suppression beliefs over time. Male couples (N = 266 couples) with at least one HIV-positive partner on antiretroviral therapy completed five assessments over 2 years. Half of the 407 HIV-positive partners were virally suppressed. Of the 40 % who had inaccurate viral load beliefs, 80 % assumed their partner was suppressed. The odds of having accurate viral load beliefs decreased over time (OR = 0.83; p = 0.042). Within-couple differences in dyadic adjustment (OR = 0.66; p < 0.01) and commitment (OR = 0.82; p = 0.022) were negatively associated with accurate viral load beliefs. Beliefs about a partner's viral load may factor into sexual decision-making and social support. Couple-based approaches are warranted to improve knowledge of partners' viral load.
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Affiliation(s)
- Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA.
| | - Kristi E Gamarel
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA
| | - Samantha E Dilworth
- Department of Medicine, Center for AIDS Prevention Studies, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Mallory O Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California - San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA
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33
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Hotton AL, French AL, Hosek SG, Kendrick SR, Lemos D, Brothers J, Kincaid SL, Mehta SD. Relationship Dynamics and Sexual Risk Reduction Strategies Among Heterosexual Young Adults: A Qualitative Study of Sexually Transmitted Infection Clinic Attendees at an Urban Chicago Health Center. AIDS Patient Care STDS 2015; 29:668-74. [PMID: 26588197 DOI: 10.1089/apc.2015.0146] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Few studies have examined risk-reduction alternatives to consistent condom use for HIV prevention among heterosexual young adults. We used qualitative methodology to explore risk reduction strategies and contextual factors influencing attempts to reduce risk in an urban, high morbidity sexually transmitted infection (STI) clinic. Focus groups were conducted October-December 2014 with heterosexually identified men (n = 13) and women (n = 20) aged 18-29 seeking STI screening at an urban clinic. Groups were audio recorded, transcribed verbatim, and analyzed for thematic content using Atlas.ti software. Quantitative information included sociodemographics, HIV/STI testing history, and 6-month sexual behaviors. Among 33 predominantly African-American participants with a median age of 22, risk-reduction strategies included monogamy agreements, selective condom use with casual and high-risk partners, and frequent HIV/STI testing, though testing was commonly used as a post-hoc reassurance after risk exposure. Many men and women used implicit risk assessment strategies due to mistrust or difficulty communicating. Concurrency was common but rarely discussed within partnerships. Despite attempts to reduce risk, monogamy agreements were often poorly adhered to and not openly discussed. Alcohol and substance use frequently interfered with safer sexual decisions. Participants were aware of HIV/STI risk and commonly practiced risk-reduction strategies, but acknowledged faulty assumptions and poor adherence. This work provides insights into risk-reduction approaches that are already used and may be strengthened as part of effective HIV/STI prevention interventions.
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Affiliation(s)
- Anna L. Hotton
- Department of Medicine, CORE Center/John Stroger Hospital of Cook County, Chicago, Illinois
- Department of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, Illinois
| | - Audrey L. French
- Department of Medicine, CORE Center/John Stroger Hospital of Cook County, Chicago, Illinois
- Rush University Medical Center, Chicago, Illinois
| | - Sybil G. Hosek
- Department of Psychiatry, CORE Center/John Stroger Hospital of Cook County, Chicago, Illinois
| | - Sabrina R. Kendrick
- Department of Medicine, CORE Center/John Stroger Hospital of Cook County, Chicago, Illinois
- Rush University Medical Center, Chicago, Illinois
| | - Diana Lemos
- Department of Psychiatry, CORE Center/John Stroger Hospital of Cook County, Chicago, Illinois
| | - Jennifer Brothers
- Department of Psychiatry, CORE Center/John Stroger Hospital of Cook County, Chicago, Illinois
| | - Stacey L. Kincaid
- Department of Medicine, CORE Center/John Stroger Hospital of Cook County, Chicago, Illinois
| | - Supriya D. Mehta
- Department of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, Illinois
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34
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Rich AJ, Lachowsky NJ, Cui Z, Sereda P, Lal A, Birch R, Montaner J, Moore D, Hogg RS, Roth EA. Substance use, sexual behaviour and prevention strategies of Vancouver gay and bisexual men who recently attended group sex events. CULTURE, HEALTH & SEXUALITY 2015; 18:361-76. [PMID: 26443295 PMCID: PMC4773192 DOI: 10.1080/13691058.2015.1084649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Group sex events are an epidemiologically important part of some gay and bisexual men's sexual culture in Canada. Associated with condomless anal intercourse and polysubstance use, such events have been cited as disproportionally contributing to HIV infection rates. We analysed questionnaire data from the Momentum Health Study in Vancouver, Canada, to understand substance use, sexual behaviour, psychosocial variables (Sexual Sensation Seeking, Sexual Escape Motivation, Treatment Optimism) and HIV prevention strategies (sero-sorting, strategic positioning, avoiding anal sex, disclosure, treatment as prevention) of men attending such events, which were defined as group (n ≥ 4 partners) sex parties, blackout events and darkrooms. Analysis by multivariable logistic regression compared men attending group sex events within the past six months (n = 180) with non-attendees (n = 539). Results showed that attendees reported: (1) significantly higher use of sex drugs and alcohol consumption, (2) higher scores on the Sexual Sensation Scale, more anal sex partners, greater odds of any condomless anal sex with sero-discordant partners and greater odds of reporting fisting and sex toy use and (3) different prevention practices that varied by HIV-serostatus. Findings are interpreted in light of the importance of pleasure, sociality and HIV/STI prevention strategies associated with group sex events. Findings contribute to the development of appropriate education and intervention for attendees.
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Affiliation(s)
- Ashleigh J Rich
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nathan J Lachowsky
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Zishan Cui
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Allan Lal
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert Birch
- Department of Anthropology, University of Victoria, Victoria, Canada
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, Canada
| | - Julio Montaner
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Moore
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- Department of Epidemiology & Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, Canada
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35
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Zeglin RJ. Assessing the role of masculinity in the transmission of HIV: a systematic review to inform HIV risk reduction counseling interventions for men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1979-1990. [PMID: 25917411 PMCID: PMC5502076 DOI: 10.1007/s10508-015-0501-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/24/2015] [Accepted: 01/28/2015] [Indexed: 05/31/2023]
Abstract
HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: (1) number of partners, (2) attitudes toward condoms, (3) drug use, (4) sexual positioning, (5) condom decision-making, (6) attitudes toward testing, and (7) treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a masculinity model of community HIV transmission. Opportunities for counseling interventions include identifying how masculinity informs a client's cognitions, emotions, and behaviors as well as adapting gender-transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence.
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Affiliation(s)
- Robert J Zeglin
- Department of Counseling and Human Development, George Washington University, 2134 G St. NW, 3rd Floor, Washington, DC, 20037, USA,
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36
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Grov C, Rendina HJ, Moody RL, Ventuneac A, Parsons JT. HIV Serosorting, Status Disclosure, and Strategic Positioning Among Highly Sexually Active Gay and Bisexual Men. AIDS Patient Care STDS 2015; 29:559-68. [PMID: 26348322 PMCID: PMC4598914 DOI: 10.1089/apc.2015.0126] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Researchers have identified harm reduction strategies that gay, bisexual, and other men who have sex with men (GBMSM) use to reduce HIV transmission--including serosorting, status disclosure, and strategic positioning. We report on patterns of these behaviors among 376 highly sexually active (i.e., 9+partners, <90 days) GBMSM: mean age of 37, 49.5% men of color, 87.8% gay identified, 57.5% college educated. We found evidence that many men engaged in serosorting, status disclosure, and strategic positioning; however, rates varied based on the participant's HIV status. HIV-positive and HIV-negative men both engaged in sex with men of similar status more often than they engaged in sex with men known to be a different HIV status (i.e., serosorting). However, HIV-negative men disclosed their HIV-status with about half of their partners, whereas HIV-positive participants disclosed with only about one-third. With regard to strategic positioning, HIV-positive participants were the receptive partner about half the time with their HIV-negative partners and with their HIV-positive partners. In contrast, strategic positioning was very common among HIV-negative participants-they rarely bottomed with HIV-positive partners, bottomed about one-third of the time with status-unknown partners, and 42% of the time (on average) with HIV-negative partners. Highly sexually active GBMSM are a critical population in which to both investigate HIV prevention strategies as well as develop effective intervention programs. Providers and clinicians might be well served to include a wide range of behavioral harm reduction strategies in addition to condom use and biomedical approaches to reduce onward HIV transmission.
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Affiliation(s)
- Christian Grov
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York (CUNY), Brooklyn, New York
- CUNY School of Public Health, New York, New York
| | - H. Jonathon Rendina
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
| | - Raymond L. Moody
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Ana Ventuneac
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
| | - Jeffrey T. Parsons
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
- CUNY School of Public Health, New York, New York
- Department of Psychology, Hunter College of CUNY, New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
- Basic and Applied Social Psychology Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
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37
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Tuddenham S, Ghanem KG. Emerging trends and persistent challenges in the management of adult syphilis. BMC Infect Dis 2015; 15:351. [PMID: 26286439 PMCID: PMC4545322 DOI: 10.1186/s12879-015-1028-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/15/2015] [Indexed: 01/13/2023] Open
Abstract
There are an estimated 10.6 million incident cases of syphilis worldwide each year. We highlight some persistent challenges and emerging trends in the clinical management of syphilis with a particular focus on therapy, serology, diagnostics, and prevention. Decades after the introduction of penicillin, the optimal management of early syphilis continues to be a controversial topic, particularly in the setting of HIV co-infection. Similarly, the need for routine lumbar puncture in HIV co-infected asymptomatic persons is an unanswered question. Despite advances in both automation and point-of-care diagnostics, we continue to rely on indirect measures of disease activity to manage this infection. As syphilis rates in some populations continue to rise, novel and effective prevention strategies are needed.
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Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Center Tower #378, Baltimore, MD, 21224, USA. .,Division of Infectious Diseases, 1830 E. Monument Street, Room 442, Baltimore, MD, 21287, USA.
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Center Tower #378, Baltimore, MD, 21224, USA. .,Division of Infectious Diseases, 1830 E. Monument Street, Room 442, Baltimore, MD, 21287, USA.
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Dodds C, Weait M, Bourne A, Egede S. Keeping confidence: HIV and the criminal law from HIV service providers' perspectives. CRITICAL PUBLIC HEALTH 2015; 25:410-426. [PMID: 26692653 PMCID: PMC4647852 DOI: 10.1080/09581596.2015.1019835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/05/2015] [Indexed: 11/24/2022]
Abstract
We present qualitative research findings about how perceptions of criminal prosecutions for the transmission of HIV interact with the provision of high-quality HIV health and social care in England and Wales. Seven focus groups were undertaken with a total of 75 diverse professionals working in clinical and community-based services for people with HIV. Participants' understanding of the law in this area was varied, with many knowing the basic requirements for a prosecution, yet lacking confidence in the best way to communicate key details with those using their service. Prosecutions for HIV transmission have influenced, and in some instances, disrupted the provision of HIV services, creating ambivalence and concern among many providers about their new role as providers of legal information. The way that participants approached the topic with service users was influenced by their personal views on individual and shared responsibility for health, their concerns about professional liability and their degree of trust in non-coercive health promotion approaches to managing public health. These findings reveal an underlying ambivalence among many providers about how they regard the interface between criminal law, coercion and public health. It is also apparent that in most HIV service environments, meaningful exploration of practical ethical issues is relatively rare. The data presented here will additionally be of use to managers and providers of HIV services in order that they can provide consistent and confident support and advice to people with HIV.
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Affiliation(s)
- Catherine Dodds
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Adam Bourne
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Siri Egede
- Department of Sociology, University of Copenhagen, Copenhagen, Denmark
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Wilkerson JM, Noor SW, Breckenridge ED, Adeboye AA, Rosser BRS. Substance-use and sexual harm reduction strategies of methamphetamine-using men who have sex with men and inject drugs. AIDS Care 2015; 27:1047-54. [PMID: 25837492 DOI: 10.1080/09540121.2015.1020280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Research indicates that men who have sex with men (MSM), use methamphetamine, and inject drugs are at high risk of HIV infection and they employ multiple harm reduction strategies simultaneously to reduce that risk. In this study, we identified substances most commonly injected and harm reduction strategies most often employed by methamphetamine-using MSM, used latent class analysis (LCA) to identify patterns of harm reduction strategies, and differentiated MSM within each class by individual characteristics. We analyzed data from 284 participants who completed an online cross-sectional survey. Commonly injected substances were methamphetamine (93.70%), gamma-hydroxybutyrate/gamma-butyrolactone (41.55%), flunitrazepam (40.49%), and cocaine (35.56%). The substance-use strategies most often used were avoidance of sharing needles (85.92%) and use of bleach to clean drug paraphernalia (64.08%). The sexual strategy most often used was avoidance of condomless anal intercourse (CAS) while using drugs (77.11%). Using an LCA approach, we identified three classes distinguishable by age, race/ethnicity, and outness. One class (19%) employed lay strategies to reduce harm: they avoided sharing drug preparation equipment, serosorted when sharing needles and equipment or having CAS, and practiced withdrawal when having CAS. The largest class (53%) combined sexual and substance-use strategies: they avoided sharing needles, used bleach to clean needles and equipment, avoided CAS when using drugs, and used extra lubricant when having CAS. The remaining class (28%) employed only substance-use rather than sexual strategies. More MSM of color were in the substance-use class, and more young, non-Hispanic White men were in the lay class. The low utilization of sexual strategies by younger, non-Hispanic White men in the lay class is concerning as they are just as likely as older, non-Hispanic White men in the combined class to have CAS with multiple male partners. Interventionists should consider these differences when developing interventions tailored to methamphetamine-using MSM.
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Affiliation(s)
- J Michael Wilkerson
- a Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, School of Public Health , The University of Texas Health Science Center at Houston (UTHealth) , Houston , TX , USA
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Bogowicz P, Moore D, Kanters S, Michelow W, Robert W, Hogg R, Gustafson R, Gilbert M. HIV testing behaviour and use of risk reduction strategies by HIV risk category among MSM in Vancouver. Int J STD AIDS 2015; 27:281-7. [PMID: 25736346 DOI: 10.1177/0956462415575424] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/22/2015] [Indexed: 11/16/2022]
Abstract
We carried out an analysis of a serobehavioural study of men who have sex with men >19 years of age in Vancouver, Canada to examine HIV testing behaviour and use of risk reduction strategies by HIV risk category, as defined by routinely gathered clinical data. We restricted our analysis to those who self-identified as HIV-negative, completed a questionnaire, and provided a dried blood spot sample. Of 842 participants, 365 (43.3%) were categorised as lower-risk, 245 (29.1%) as medium-risk and 232 (27.6%) as higher-risk. The prevalence of undiagnosed HIV infection was low (lower 0.8%, medium 3.3%, higher 3.9%; p = 0.032). Participants differed by risk category in terms of having had an HIV test in the previous year (lower 46.5%, medium 54.6%, higher 67.0%; p < 0.001) and in their use of serosorting (lower 23.3%, medium 48.3%, higher 43.1%; p < 0.001) and only having sex with HIV-positive men if those men had low viral loads or were taking HIV medication (lower 5.1%, medium 4.8%, higher 10.9%; p = 0.021) as risk reduction strategies. These findings speak to the need to consider segmented health promotion services for men who have sex with men with differing risk profiles. Risk stratification could be used to determine who might benefit from tailored multiple health promotion interventions, including HIV pre-exposure prophylaxis.
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Affiliation(s)
- Paul Bogowicz
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Steve Kanters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Warren Michelow
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Robert
- Health Initiative for Men, Vancouver, BC, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada British Columbia Centre for Disease Control, Vancouver, BC, Canada
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Jin F, Prestage GP, Mao L, Poynten IM, Templeton DJ, Grulich AE, Zablotska I. "Any Condomless Anal Intercourse" is No Longer an Accurate Measure of HIV Sexual risk Behavior in Gay and Other Men Who have Sex with Men. Front Immunol 2015; 6:86. [PMID: 25774158 PMCID: PMC4343002 DOI: 10.3389/fimmu.2015.00086] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmission of HIV in gay and other men who have sex with men (MSM). A variety of measures of CLAI have been commonly used in behavioral surveillance for HIV risk and to forecast trends in HIV infection. However, gay and other MSM's sexual practices changed as the understanding of disease and treatment options advance. In the present paper, we argue that summary measures such as "any CLAI" do not accurately measure HIV sexual risk behavior. METHODS Participants were 1,427 HIV-negative men from the Health in Men cohort study run from 2001 to 2007 in Sydney, Australia, with six-monthly interviews. At each interview, detailed quantitative data on the number of episodes of insertive and receptive CLAI in the last 6 months were collected, separated by partner type (regular vs. casual) and partners' HIV status (negative, positive, and HIV status unknown). RESULTS A total of 228,064 episodes of CLAI were reported during the study period with a mean of 44 episodes per year per participant (median: 14). The great majority of CLAI episodes were with a regular partner (92.6%), most of them with HIV-negative regular partners (84.8%). Participants were more likely to engage in insertive CLAI with casual than with regular partners (66.7 vs. 55.3% of all acts of CLAI with each partner type, p < 0.001). Men were more likely to report CLAI in the receptive position with HIV-negative and HIV status unknown partners than with HIV-positive partners (p < 0.001 for both regular and casual partners). CONCLUSION Gay and other MSM engaging in CLAI demonstrate clear patterns of HIV risk reduction behavior. As HIV prevention enters the era of antiretroviral-based biomedical approach, using all forms of CLAI indiscriminately as a measure of HIV behavioral risk is not helpful in understanding the current drivers of HIV transmission in the community.
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Affiliation(s)
- Fengyi Jin
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Garrett P. Prestage
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Limin Mao
- The Centre for Social Research in Health, University of New South Wales, Kensington, NSW, Australia
| | - I. Mary Poynten
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - David J. Templeton
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
- RPA Sexual Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Andrew E. Grulich
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Iryna Zablotska
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
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Blackwell CW. Serosorting Sexual Partners by Gay and Bisexual Men to Prevent HIV Infection: Implications for Public Health Clinicians. Public Health Nurs 2015; 32:555-64. [PMID: 25655303 DOI: 10.1111/phn.12181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The most recent Centers for Disease Control and Prevention epidemiological statistics in the United States demonstrate that gay and bisexual men are at most risk for acquiring new HIV infections. While public health campaigns aimed at gay and bisexual males have resulted in improved HIV screening and greater awareness of the need for safer sex practices, barebacking has become a practice of increasing incidence. This act carries the highest risk of HIV transmission and acquisition; and data suggest HIV disease burden is higher among ethnic minorities. Serosorting-purposely seeking HIV serocordant partners--to help lower risk of HIV infection is common. While this can be a positive step in preventing the spread of HIV, it carries serious threats that must be acknowledged. The purpose of this article was to explore the positive and negative aspects of serosorting in the prevention of HIV, describe ways in which health care providers can approach the topic with clients, provide clinical practice implications, and suggest some direction for future research.
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Matser A, Heijman T, Geskus R, de Vries H, Kretzschmar M, Speksnijder A, Xiridou M, Fennema H, Schim van der Loeff M. Perceived HIV status is a key determinant of unprotected anal intercourse within partnerships of men who have sex with men in Amsterdam. AIDS Behav 2014; 18:2442-56. [PMID: 24920343 DOI: 10.1007/s10461-014-0819-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The practice of unprotected anal intercourse (UAI) involves at least two partners. We examined the associations between insertive or receptive UAI and perceived HIV seroconcordance and partnership type in self-perceived HIV-negative and self-perceived HIV-positive men who have sex with men (MSM). MSM (age ≥ 18 years) were recruited for a cross-sectional survey at the sexually transmitted infections clinic in Amsterdam, the Netherlands, in 2008-2009. Participants completed a questionnaire concerning partnerships in the preceding 6 months. Associations were quantified via multinomial logistic regression models using generalized estimating equations. The outcomes were 'no, or safe anal intercourse', 'insertive UAI', and 'receptive UAI'. We included 5,456 partnerships from 1,890 self-perceived HIV-negative men and 1,861 partnerships from 558 self-perceived HIV-positive men. Within the partnerships, perceived HIV status of the partner was an important determinant of UAI (p < 0.001). Among HIV-negative men, perceived HIV discordance was negatively associated with receptive UAI compared with no or safe UAI (OR 0.57; 95 % CI 0.36-0.92); when the partners were more familiar with each other, the risk of receptive UAI was increased relative to no or safe anal intercourse. Among HIV-positive men, perceived HIV discordance was negatively associated with insertive UAI (OR 0.05; 95 % CI 0.03-0.08). Within partnerships, perceived HIV status of the partner was one of the strongest determinants of UAI among self-perceived HIV-negative and HIV-positive MSM, and discordant serostatus was negatively associated with UAI. The findings suggest that serosorting is one of the main strategies when engaging in UAI.
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Affiliation(s)
- Amy Matser
- Department of Research, Cluster of Infectious Diseases, Public Health Service of Amsterdam, Postbox 2200, 1000 CE, Amsterdam, The Netherlands,
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Przybyla S, Golin C, Widman L, Grodensky C, Earp JA, Suchindran C. Examining the role of serostatus disclosure on unprotected sex among people living with HIV. AIDS Patient Care STDS 2014; 28:677-84. [PMID: 25397358 DOI: 10.1089/apc.2014.0203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Given the increasing prevalence of HIV, it is important to identify factors associated with safer sex behaviors between people living with HIV and their partners. Utilizing a diverse sample of 242 HIV-infected adults [n=69 men who have sex with men (MSM); n=68 men who have sex with women (MSW); n=105 women who have sex with men (WSM)], we examined the association between serostatus disclosure and unprotected anal or vaginal intercourse (UAVI) and the moderating effect of sexual behavior group on this association. Overall, 88.7% disclosed to their current partner. Approximately 18.8% of MSM, 17.7% of MSW, and 29.5% of WSM reported UAVI. Controlling for age, time since diagnosis, and partner serostatus, we found main effects on UAVI for disclosure and sexual behavior group; specifically, disclosure was inversely related to unprotected sex [AOR=0.09, 95% CI (0.02, 0.43), p<0.001], and MSM were less likely to engage in UAVI relative to WSM [AOR=0.11, 95% CI (0.17, 0.82), p<0.05]. However, the relationship between disclosure and UAVI was not moderated by sexual behavior group. Future strategies that aim to increase disclosure to partners may consider focusing on its value as a means by which to reduce sexual risk behavior.
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Affiliation(s)
- Sarahmona Przybyla
- 1 Research Institute on Addictions, State University of New York at Buffalo , Buffalo, New York
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45
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Bui TC, Nyoni JE, Ross MW, Mbwambo J, Markham CM, McCurdy SA. Sexual motivation, sexual transactions and sexual risk behaviors in men who have sex with men in Dar es Salaam, Tanzania. AIDS Behav 2014; 18:2432-41. [PMID: 24890184 DOI: 10.1007/s10461-014-0808-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Understanding the associations between sexual motivation and sexual risk behaviors of men who have sex with men (MSM) is critical for developing effective HIV prevention interventions. To examine these associations, we employed data from a survey of 200 MSM in Dar es Salaam, Tanzania, recruited through respondent driven sampling. Results showed that 44.5 % of surveyed participants most often looked for love/affection when having sex, and 36.5 % most often looked for money. Money-motivated MSM were more likely to identify themselves as bisexual, more likely to have anal sex, and had significantly higher numbers of partners of both sexes. Those who most often looked for love/affection were less likely to ask for condom use, to actually use a condom, and to use lubrication in anal sex. MSM with different sexual motivations had dissimilar sexual risk behaviors. Tailored health interventions for each group to reduce these sexual risks for STIs/HIV prevention are needed.
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O'Byrne P, Phillips JC, Kitson C, Bryan A. HIV status and sexual behaviour among gay men in Ottawa: considerations for public health. BMJ Open 2014; 4:e005065. [PMID: 25239290 PMCID: PMC4170207 DOI: 10.1136/bmjopen-2014-005065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV prevention efforts, particularly among men who have sex with men (MSM), have not achieved maximum effectiveness. A survey of MSM in Ottawa, Canada was completed to ascertain whether there were differences in how the perceived HIV status of participants and their partners influenced sexual practices. METHODS Self-directed surveys were administered to a convenience sample of 721 MSM in Ottawa, Canada from November 2011 through May 2012. Data collection occurred at 14 sites. The survey identified whether participants identified as HIV positive, negative or unsure of their HIV status. RESULTS The findings indicated variation between HIV-negative MSM and those who are unsure of their HIV status. Men who were unsure of their HIV status were less likely to report that they asked sexual partners or have had their partners ask about HIV status. CONCLUSIONS The results of this study indicate that some MSM may base decisions about HIV prevention on discussion about HIV status with their partners, rather than condom use. These practices may increase, rather than decrease, HIV transmission. Survey findings and extant literature demonstrate a need to inform MSM about the limitations of serosorting as a prevention strategy, and to provide facilitated access to sexually transmitted infection testing and treatment to further reduce onward HIV transmission.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - J Craig Phillips
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia Kitson
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Alyssa Bryan
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Knight V, Ryder N, Bourne C, McNulty A. A cross sectional study of how people diagnosed with a bacterial sexually transmitted infection inform their partners. Sex Transm Infect 2014; 90:588-91. [PMID: 25237126 DOI: 10.1136/sextrans-2013-051482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the methods used by patients diagnosed with a sexually transmissible infection (STI) to inform their partners during contact tracing. METHODS At a large Australian sexual health clinic between March and May 2010, we undertook a retrospective, cross sectional analysis of the methods used by patients diagnosed with a bacterial STI to inform their partners. RESULTS Of the 172 index patients contacted 1 week after treatment, 163 (95%) chose patient referral, 3 (2%) provider referral and 6 (3%) could not contact any partners. Index patients nominated 1010 sexual partners of whom 494 (49%) were reported as contactable. A total of 447/494 (91%) of these partners were successfully informed; telephone (37%) and face to face (22%) were the most used methods. After multivariate analysis, predictors of using face to face contact methods were age <30 years (AOR: 2.8; 95% CI 1.4 to 5.7), fewer than 2 sexual partners (AOR 3.6; 95% CI 1.7 to 7.6) and speaking a language other than English (adjusted OR (AOR) 3.1; 95% CI 1.3 to 7.2). The single predictor of using interactive contact methods (face to face+telephone) was reporting fewer than 2 sexual partners (AOR 2.7; 95% CI 1.3 to 5.5). People diagnosed with syphilis were significantly less likely to use an interactive contact tracing method (AOR 0.24; 95% CI 0.09 to 0.67). CONCLUSIONS Most patients diagnosed with a bacterial STI at our sexual health clinic report informing their contactable partners directly either face to face or by telephone. Electronic communications methods were more popular for people with more sexual partners and those with syphilis. Effective contact tracing requires access to a range of methods for patients to inform their partners.
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Affiliation(s)
- Vickie Knight
- Sydney Sexual Health Centre, South East Sydney Local Health District, Sydney, New South Wales, Australia The Kirby Institute, Wallace Worth Building, UNSW Australia, Sydney, New South Wales, Australia
| | - Nathan Ryder
- Sexual Health and Blood Borne Virus Unit, Department of Health, Darwin, Northern Territory, Australia
| | - Chris Bourne
- Sydney Sexual Health Centre, South East Sydney Local Health District, Sydney, New South Wales, Australia STI Programs Unit, NSW Ministry of Health, Sydney, New South Wales, Australia School of Public Health and Community Medicine, University of NSW, Kensington, New South Wales, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, South East Sydney Local Health District, Sydney, New South Wales, Australia STI Programs Unit, NSW Ministry of Health, Sydney, New South Wales, Australia
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O'Byrne P, Holmes D, Roy M. Counselling about HIV serological status disclosure: nursing practice or law enforcement? a Foucauldian reflection. Nurs Inq 2014; 22:134-46. [PMID: 25053169 DOI: 10.1111/nin.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2014] [Indexed: 11/28/2022]
Abstract
Recently, focus groups and qualitative interviews with nurses who provide frontline care for persons living with HIV highlighted the contentiousness surrounding the seemingly innocuous activity of counselling clients about HIV-status disclosure, hereafter disclosure counselling. These empirical studies highlighted that while some nurses felt they should instruct clients to disclose their HIV-positive status if HIV transmission were possible, other nurses were equally adamant that such counselling was outside the nursing scope of practice. A review of these opposing perceptions about disclosure counselling, including an examination of the empirical evidence which supports each point, revealed that the dichotomous arguments needed to be nuanced. The empirical evidence about serostatus disclosure neither supported nor refuted either of these assertions; rather, it substantiated parts of each. To create this understanding, both empirical and theoretical works are used. First, the results of empirical studies about serostatus disclosure, or lack thereof and HIV transmission is presented; as part of this, Marks and Crepaz's HIV disclosure and exposure framework is examined. Second, the work of Michel Foucault on disciplinary and pastoral power is drawn from. The outcome is a nuanced understanding about the interrelationships between disclosure counselling and nursing practice and a final interpretation about what this understanding means for public health practice.
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Affiliation(s)
- Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Marie Roy
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
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Davis M. After the clinic? Researching sexual health technology in context. CULTURE, HEALTH & SEXUALITY 2014; 17:398-411. [PMID: 24955722 DOI: 10.1080/13691058.2014.928371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
There is great interest in what testing, pharmaceutical, information and social media technology can do for sexual health. Much programmatic and research activity is focused on assessing how these technologies can be used to best effect. Less obvious are analyses that place technology into historical, political and real-world settings. Developing an 'in-context' analysis of sexual health technology, this paper draws on interviews with leading community advocates, researchers and clinicians in Australia, Canada and the UK and looks across examples, including social media, rapid HIV testing, pre-Exposure Prophylaxis for HIV and polymerase chain reaction Chlamydia testing. The analysis is framed by studies of techno-society and the dialectics of sex-affirmative advocacy with biomedical authority and attends to: the rationalistic and affective dimensions of the imaginary associated with technology; the role of technology in the re-spatialisation and re-temporalisation of the sexual health clinic; and the re-invention of technology in its real-world contexts. This in-context approach is important for: the effective implementation of new technology; strengthening the social science contribution to the field; and enriching social theory in general on life in techno-societies.
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Affiliation(s)
- Mark Davis
- a School of Social Sciences, Monash University , Melbourne , Australia
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50
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Holt M. Gay men's HIV risk reduction practices: The influence of epistemic communities in HIV social and behavioral research. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:214-223. [PMID: 24846484 DOI: 10.1521/aeap.2014.26.3.214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Since the mid-1980s, Australian social researchers have investigated the sexual practices of gay men, describing those that protect men from HIV or put them at risk of infection. Ground-breaking (and controversial) publications have highlighted a variety of ways in which gay men protect themselves and their partners, including condom use and non-condom-based risk reduction strategies. HIV social research in Australia has been heavily influenced by a distinctive network of experts or epistemic community with shared principles and beliefs and a commitment to influencing policy and practice. This epistemic community has articulated a 'social public health' view of HIV that emphasises partnership, agency, understanding practices and reflexivity. This approach has clashed with those of other epistemic communities, notably around ideas of relapse and unsafe sex. This article uses the examples of negotiated safety and serosorting to illustrate this Australian epistemic community's approach to HIV risk reduction among gay men.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, University of New South Wales, Australia
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