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Dai M, Xia S, Calabrese C, Ma X, Chen T. Risk and demographic factors associated with STI testing adherence among non-single men who have sex with men (MSM) in the United States. J Behav Med 2024:10.1007/s10865-024-00524-z. [PMID: 39356454 DOI: 10.1007/s10865-024-00524-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/17/2024] [Indexed: 10/03/2024]
Abstract
Though men who have sex with men (MSM) are disproportionately affected by sexually transmitted infections (STIs), factors that impact STI testing adherence among non-single MSM remain under-explored. While being in a relationship per se does not necessarily increase one's risk for STIs, certain behavioral risks and demographic factors may impact STI testing adherence. Through a sample of 296 non-single MSM located in the United States, we examined key behavioral and demographic factors and their associations with adherence to CDC's STI testing guidelines. Overall, the results showed inconsistent STI testing adherence rates among divergent subgroups of higher-risk non-single MSM. First, non-single MSM who take PrEP were more likely to adhere to STI testing and showed significantly higher adherence rates than those who do not take PrEP, but adherence rates were not related to nor significantly different than those who reported extra-relational sex or condomless anal sex. Further, STI testing adherence was positively associated with having a shorter relationship length, identifying as non-White, and living in an LGBTQ+-friendly neighborhood. Practical implications and recommendations for clinical practices, persuasive messages, and promotion strategies are discussed.
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Affiliation(s)
- Minhao Dai
- School of Communication and Media, Kennesaw State University, Kennesaw, GA, 30144, USA.
| | - Shilin Xia
- Department of Communication, University of Maryland, College Park, MD, USA
| | | | - Xin Ma
- Department of Communication, University of Macau, Macao, China
| | - Tianen Chen
- Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
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Chen S, Yu P, Fang Y, Xin M, Yu FY, Ip M, Mo PKH, Wang Z. Patterns and Factors of the Sexual Agreement for Extra-Dyadic Sex Among Men Who Have Sex with Men in Hong Kong, China: A Cross-Sectional Survey. JOURNAL OF SEX & MARITAL THERAPY 2023; 50:303-314. [PMID: 37981896 DOI: 10.1080/0092623x.2023.2279096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This study investigated patterns of sexual agreement for extra-dyadic sex and their associations with sexual risk behaviors among men who have sex with men (MSM) having a regular male sex partner (RP) in China. A cross-sectional telephone survey was conducted among 530 MSM recruited through multiple sources in Hong Kong, China, between April and December 2020. This study was based on a subsample of 368 participants who had an RP in the past 6 months. Logistic regression models were fitted. Among the participants, 27.2%, 13.0%, and 3.0% had a closed agreement, an in-between agreement, and an open agreement, respectively. Compared to no agreement, a closed agreement was associated with fewer extra-dyadic partners and fewer instances of condomless sex with extra-dyadic partners. Those who had more positive attitudes toward a closed agreement, perceived more support from significant others to create a closed agreement, and perceived higher behavioral control of refraining from sex with extra-dyadic partners were more likely to have a closed agreement with RP. Those who were concerned that a closed agreement would impair freedom and sexual desire were less likely to have such an agreement. A closed agreement is a potentially useful risk reduction strategy for Chinese MSM with an RP.
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Affiliation(s)
- Siyu Chen
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Peishi Yu
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, the Education University of Hong Kong, Hong Kong, China
| | - Meiqi Xin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, the Hong Kong Polytechnic University, Hong Kong, China
| | - Fuk-Yuen Yu
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Mary Ip
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Cao Z, Jiang H, He W, Pan H, Zhang C, Zhong X. The Potential Risk Compensation after Receiving HPV Vaccination among Men Who Have Sex with Men in Southwest China: A HAPA-Based Analysis. Vaccines (Basel) 2023; 11:1429. [PMID: 37766106 PMCID: PMC10538197 DOI: 10.3390/vaccines11091429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Background: men who have sex with men (MSM) are a high-risk group for human papillomavirus (HPV) infection, and the HPV vaccine is effective in preventing it. However, according to risk compensation theory, people may increase sexual risk behaviors after receiving HPV vaccination. Based on the Health Action Process Approach (HAPA), this study investigated the influencing factors to predict intention to reduce condom use (risk compensation intention) among MSM after taking HPV vaccination in southwest China. Methods: we conducted a cross-sectional study among 948 MSM in southwest China using a non-probability sampling method and an electronic questionnaire including sociodemographic characteristics, sexual risk behavior characteristics, HPV-related prevention behavior, and the HAPA scale. Confirmatory factor analysis was performed using a structural equation model. Results: among 948 MSM, the incidence rate of reducing the frequency of condom use was 14.1%. The structural equation model showed that self-efficacy (β = -0.378, p = 0.020) and positive outcome expectancy (β = 0.366, p < 0.05) had greater effects on behavioral intention, followed by negative outcome expectancy (β = -0.296, p < 0.05) and risk perception (β = -0.232, p < 0.05). Conclusions: risk compensation may not be a major barrier to receiving HPV vaccination among MSM. Nevertheless, the recognition of possible risk compensation is necessary to implement appropriate interventions to reduce the occurrence of risk compensation.
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Affiliation(s)
| | | | | | | | | | - Xiaoni Zhong
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (Z.C.); (H.J.); (W.H.); (H.P.); (C.Z.)
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Sharkey T, Parker R, Wall KM, Malama K, Pappas-DeLuca K, Tichacek A, Peeling R, Kilembe W, Inambao M, Allen S. Use of "Strengthening Our Vows" Video Intervention to Encourage Negotiated Explicit Sexual Agreements in Zambian Heterosexual HIV Seroconcordant-Negative Couples. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2649-2667. [PMID: 37024634 PMCID: PMC10524092 DOI: 10.1007/s10508-023-02590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 02/09/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
Negotiating sexual agreements in combination with couples' voluntary HIV counseling and testing (CVCT) may help further reduce HIV transmission in Zambian concordant HIV-negative couples (CNC). Though CVCT has been shown to reduce HIV transmission in CNC by 47%, approximately half of residual infections occur in this group. We developed a "Strengthening Our Vows" video session to foster communication and negotiation of explicit sexual agreements to reduce concurrent sexual exposures and prevent HIV transmission to the spouse due to unprotected, extramarital sex. CNC were recruited through CVCT services at five clinics in Lusaka and Ndola in 2016. Enrolled CNC attending the facilitated group video sessions were encouraged to discuss sexual agreements at home and return 1-2 weeks later for follow-up assessment. One-fourth of the 580 CNC returning reported a history of extramarital partners and/or a sexually transmitted infection (STI) prior to enrollment. More than 95% reported a friendly, supportive 15-60 min negotiation culminating in an agreement to remain monogamous or disclose sexual contacts and use condoms together until a repeat HIV test 30 days after an outside sexual exposure. Two-thirds of participants identified at least one threat to adherence of their agreements including alcohol use, financial pressures, travel, discord in the home, and post-partum or menstrual abstinence. CNC negotiated explicit sexual agreements to avoid exposure to HIV through concurrent partnerships and protect the spouse in the event of an outside sexual contact. Open communication was a consistent theme to facilitate mutual protective efforts. Long-term follow-up of HIV/STI incidence is ongoing to assess the impact of these agreements.Trial registration This sub-study is part of a trial retrospectively registered on ClinicalTrials.gov (Identifier: NCT02744586) on April 20, 2016.
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Affiliation(s)
- Tyronza Sharkey
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA.
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK.
| | - Rachel Parker
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Kristin M Wall
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Kalonde Malama
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Katina Pappas-DeLuca
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Amanda Tichacek
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Rosanna Peeling
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - William Kilembe
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Mubiana Inambao
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Susan Allen
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
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Bachman VF, Montaño MA, Ulrich A, Villaran M, Cabello R, Gonzalez P, Sanchez H, Lama JR, Duerr A. Correlates of condomless anal intercourse with different types of sexual partners among men who have sex with men and transgender women in Lima, Peru. AIDS Care 2023; 35:791-799. [PMID: 34702087 PMCID: PMC9038957 DOI: 10.1080/09540121.2021.1994517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
CLINICAL TRIAL REGISTRATION The Sabes study was registered in March 2013 with the National Institutes of Health at ClinicalTrials.gov (identifier: NCT01815580).
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Affiliation(s)
- Victoria F Bachman
- University of Washington Internal Medicine Residency Program, Seattle, Washington
| | | | - Angela Ulrich
- University of Washington, Department of Epidemiology, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Manuel Villaran
- Asociación Civil Impacta Salud y Educación, Lima, Peru
- Dirección Científica y Académia, AUNA, Lima, Peru
| | | | | | | | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Ann Duerr
- University of Washington, Department of Epidemiology, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- University of Washington, Department of Global Health, Seattle, Washington
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Santhakumar A, David JK, Nagaraj J, Mathiyazhakan M, Ganesh B, Manikandan N, Padmapriya VM, Kumar P, Rajan S, Elangovan A. Socio-demographic and behavioural determinants of HIV prevalence among homosexual and bisexual men having sex with men (MSM) in India: Integrated bio-behavioural surveillance. Afr Health Sci 2023; 23:67-80. [PMID: 38223617 PMCID: PMC10782288 DOI: 10.4314/ahs.v23i2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background HIV prevalence among men who have sex with men (MSM) is 16.5 times higher than adult HIV prevalence. With a socio-cultural context that demands marriage, a considerable proportion of MSM in India have female sexual partners and act as a bridge population. Stratified analysis of HIV risk factors among homosexual and bisexual MSM will be instrumental in identifying the high-risk MSM. We aim to identify the socio-demographic and behavioural factors associated with HIV risk among homosexual and bisexual MSM. Methods Overall, 23081 MSM were enrolled in the IBBS conducted across India between October 2014 and November 2015. Data and blood samples were collected. Chi-square test, univariate and multivariable logistic regression methods were used in data analysis. Results HIV prevalence was significantly higher among homosexual MSM than bisexual MSM. Older age, lesser education, being a sex worker, being married, living with a male or hijra partner, younger age at initiation of MSM behaviour, duration, injecting drugs, and having STI symptoms were associated with higher prevalence. The prevalence of new homosexual MSM was 11.4%. Nearly 75% of the bisexual MSM reported inconsistent condom usage with female partners. Conclusion Interventions for early identification of new MSM and advocacy for safe sex with alternative preventive techniques are recommended.
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Affiliation(s)
- Aridoss Santhakumar
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Joseph K David
- Scientist-D (Former), ICMR - National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu
| | - Jaganathasamy Nagaraj
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Malathi Mathiyazhakan
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Balasubramanian Ganesh
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Natesan Manikandan
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - VM Padmapriya
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
| | - Pradeep Kumar
- National AIDS Control Organization, Ministry of Health Family Welfare, Government of India, 36 Janpath road, New Delhi-110 001, India
| | - Shobini Rajan
- National AIDS Control Organization, Ministry of Health Family Welfare, Government of India, 36 Janpath road, New Delhi-110 001, India
| | - Arumugam Elangovan
- ICMR-National Institute of Epidemiology, R-127, 2 Main Road, TNHB, Ayapakkam, Chennai – 600 077, Tamil Nadu, India
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Caballero-Hoyos R, Monárrez-Espino J, Ramírez-Ortíz MG, Cárdenas-Medina FM. Factors Associated with Unprotected Anal Sex among Men Who Have Sex with Men in Mexico. Infect Dis Rep 2022; 14:547-557. [PMID: 35893477 PMCID: PMC9326714 DOI: 10.3390/idr14040058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
The global prevalence of HIV is notably higher in men who have sex with men (MSM) compared with other male populations. Unprotected anal intercourse is the riskiest sexual behavior for HIV acquisition and/or transmission among this minority population. The purpose of the study was to identify if the syndemic of psychosocial stressors and experienced stigma are predictors of unprotected anal sex in Mexican MSM. A cross-sectional analytic study was carried out. It included adults residing in Manzanillo, Mexico, with oral/anal sex practices within the last year. Informed consent was given by 142 participants selected using snowball sampling. Collected data included sociodemographic characteristics, psychosocial stressors, experienced stigma, HIV knowledge, knowing a friend/acquaintance living with HIV/AIDS, and sexual risk behaviors. Adjusted logistic regression was used to identify predictors of unprotected anal sex within the last six months. Presence of syndemic of psychosocial stressors, drug use during sex, having friends/acquaintances with HIV/AIDS, and experiencing high stigma were positively associated; high level of HIV knowledge was negatively linked. Reducing psychosocial stressors and integrating stigma-mitigation strategies are key elements to reduce HIV transmission.
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Affiliation(s)
- Ramiro Caballero-Hoyos
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Colima 28040, Mexico;
| | - Joel Monárrez-Espino
- Department of Health Research, Christus Muguerza del Parque Hospital, University of Monterrey, Chihuahua 31000, Mexico
- Medicine and Health Sciences Unit, Zacatecas Autonomous University, Zacatecas 98000, Mexico
- Correspondence:
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Schwartz J, Grimm J, Zimmerman R, Clement M. Information Seeking and MSM's Beliefs about PrEP and Condoms. HEALTH COMMUNICATION 2022; 37:889-896. [PMID: 33494635 DOI: 10.1080/10410236.2021.1876323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study examined how frequently men who have sex with men (MSM) used a selection of sources, including news media, social media, health organizations, and dating/hookup apps, for HIV information. Additionally, the study explored the extent to which MSM's efficacy beliefs about pre-exposure prophylaxis (PrEP) and perceptions of condom importance could be predicted by the sources they used. A sample of MSM (N= 969) were surveyed online. Results showed that respondents obtained information about HIV most often from HIV organizations, LGBT organizations, and dating/hookup apps, particularly the apps Growlr, Scruff, and Grindr. Use of the app Scruff was the strongest source-based predictor of beliefs about both PrEP and condoms. Implications for health promotion are discussed.
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Affiliation(s)
- Joseph Schwartz
- Department of Communication Studies, Northeastern University
| | - Josh Grimm
- Manship School of Mass Communication, Louisiana State University
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9
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Walsh AR, Sullivan S, Stephenson R. Inter-partner Agreement of Condom Use and Sexual Positioning in Male Couples. JOURNAL OF SEX RESEARCH 2022; 59:212-223. [PMID: 33983091 DOI: 10.1080/00224499.2021.1924606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Accurate, reliable self-reports of sexual behavior are a crucial component of valid HIV risk-estimation and behavioral intervention evaluation, yet this data's reliability remains understudied. The goal of this study was to describe interpartner agreement on recent receptive anal intercourse (AI) and condomless receptive AI frequencies, among a sample of male couples. We quantified interpartner agreement on self-reported receptive AI and condomless receptive AI (absolute and relative to AI frequency), and position and condom use during a couple's most recent AI, using cross-sectional data from male partners (US, 2016-2017; N = 718 individuals). Proportional and statistical agreement (intraclass correlation coefficients (ICC), kappa (k)) were assessed. Observed agreement for receptive AI frequency was 49.44% (ICC (95% CI): 0.82(0.79, 0.84)) and for relative receptive frequency, 59.05% (ICC: 0.96 (0.85, 0.96). Agreement on condomless receptive AI was 90.21% (ICC: 0.78 (0.75, 0.82), and for relative condomless receptive AI, 91.15% (ICC: 0.80 (0.77, 0.83). Most recent AI position agreement was 89.42% (k (95% CI): 0.84 (0.80, 0.88)), and condom use, 98.89% (k: 0.82 (0.87, 0.98)). Observed agreement was higher among those who reported consistent positioning and condom use. Further research on self-reported sexual behavior data is needed to improve research validity and intervention effectiveness.
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Affiliation(s)
- Alison R Walsh
- Center for Sexuality and Health Disparities, University of Michigan
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing
| | - Stephen Sullivan
- Center for Sexuality and Health Disparities, University of Michigan
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing
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James D, Rosentel K, VandeVusse A, Motley DN, Hill BJ. Psychosocial Support, Sexual Health, and HIV Risk among Older Men Who Have Sex with Younger Men. JOURNAL OF HOMOSEXUALITY 2021; 68:2490-2508. [PMID: 32841109 DOI: 10.1080/00918369.2020.1809890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study examines the extent to which older males are willing to offer psychosocial and sexual health promoting support to their younger male partners, as well as the individual and relationship-level factors associated with this willingness to provide support. In total, 324 men over the age of 45, who currently or previously had younger male sexual partners, completed an anonymous online survey. Results show that participants were most willing to provide emotional support to their younger male partners, followed by health-related encouragement, HIV/STI testing support, and financial support. Of note, HIV positive status and being in a "main partnership" were associated with greater willingness to provide financial support. These results suggest that older men are willing to provide psychosocial and health promotive support to younger male partners, which could be leveraged in targeted interventions to reduce HIV transmission.
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Affiliation(s)
- Drexler James
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
- Department of Psychology, Denison University, Granville, Ohio, USA
| | - Kris Rosentel
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Alicia VandeVusse
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Darnell N Motley
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Brandon J Hill
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
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Sharkey T, Wall KM, Parker R, Tichacek A, Pappas-DeLuca KA, Kilembe W, Inambao M, Malama K, Hoagland A, Peeling R, Allen S. A cluster randomized trial to reduce HIV risk from outside partnerships in Zambian HIV-Negative couples using a novel behavioral intervention, "Strengthening Our Vows": Study protocol and baseline data. Contemp Clin Trials Commun 2021; 24:100850. [PMID: 34622087 PMCID: PMC8481973 DOI: 10.1016/j.conctc.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/02/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Heterosexual couples contribute to most new HIV infections in areas of generalized HIV epidemics in sub-Saharan Africa. After Couples' Voluntary HIV Counseling and Testing (CVCT), heterosexual concordant HIV negative couples (CNC) in cohabiting unions contribute to approximately 47% of residual new infections in couples. These infections are attributed to concurrent sexual partners, a key driver of the HIV epidemic in Zambia. METHODS/DESIGN Ten Zambian government clinics in two of the largest cities were randomized in matched pairs to a Strengthening Our Vows (SOV) intervention or a Good Health Package (GHP) comparison arm. SOV addressed preventing HIV infection from concurrent partners and protecting spouses after exposures outside the relationship. GHP focused on handwashing; water chlorination; household deworming; and screening for hypertension, diabetes and schistosomiasis. CNC were referred from CVCT services in government clinics. Follow-up includes post-intervention questionnaires and outcome assessments through 60 months. Longitudinal outcomes of interest include self-report and laboratory markers of condomless sex with outside partners and reported sexual agreements. We present baseline characteristics and factors associated with study arm and reported risk using descriptive statistics. RESULTS The mean age of men was 32 and 26 for women. On average, couples cohabited for 6 years and had 2 children. Baseline analyses demonstrated some failures of randomization by study arm which will be considered in future primary analyses of longitudinal data. An HIV/STI risk factor composite was not different in the two study arms. Almost one-quarter of couples had an HIV risk factor at baseline. DISCUSSION In preparation for future biomedical and behavioral interventions in sub-Saharan Africa, it is critical to understand and decrease HIV risk within CNC.
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Affiliation(s)
- Tyronza Sharkey
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- London School of Hygiene and Tropical Medicine, UK
| | - Kristin M. Wall
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Katina A. Pappas-DeLuca
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - William Kilembe
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Mubiana Inambao
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Kalonde Malama
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Alexandra Hoagland
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | | | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
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12
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Alcantar Heredia JL, Goldklank S. The relevance of pre-exposure prophylaxis in gay men's lives and their motivations to use it: a qualitative study. BMC Public Health 2021; 21:1829. [PMID: 34627221 PMCID: PMC8502319 DOI: 10.1186/s12889-021-11863-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background HIV has affected gay men disproportionately in the U.S. for four decades. Pre-exposure prophylaxis (PrEP) was developed as a prevention strategy for individuals at high risk of HIV infection. Although highly effective, many gay and other men who have sex with men continue not to take PrEP. Researchers have focused on sexual risk behaviors as the primary determinant of who should be on PrEP and identified various objective systemic and societal barriers to PrEP access. Public health measures have promoted PrEP based on these objective criteria. Researchers have recently begun to inquire into subjective and relational motivators for PrEP usage beyond self-perceived risk. Methods Participants were recruited through snowball sampling. Data were collected between August and November 2018 from PrEP users (n = 7) and PrEP non-users (n = 6). Data were analyzed in a modified grounded theory qualitative analysis. Results The thirteen participants’ narratives contained three superordinate categories: (1) what it’s like to be someone on PrEP, (2) an environment of changing sexual norms, and (3) the continued importance of education. These categories comprised ten themes, each of which had various repeating ideas. The ten themes were the following: (1) PrEP’s social acceptability, (2) PrEP and HIV stigma, (3) PrEP and sexual relationships, (4) dissatisfaction with condoms, (5) negotiating risk, (6) peace of mind, (7) developing a relationship with PrEP, (8) putting yourself first, (9) PrEP awareness, and (10) PrEP logistics. Conclusions The gay men in our study took into consideration their social roles and relationships, their personal beliefs, and emotional histories as well as risk as prominent motivators for PrEP use. They stated that PrEP use is associated with their sense of belonging, trust, and security about their sexuality. They also identified the most relevant aspects of the medication (e.g., side effects, adherence, and awareness) to their lives. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11863-w.
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Affiliation(s)
- Jorge L Alcantar Heredia
- Adult Clinical PsyD Program, Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., The Bronx, NY, 10003, New York, USA.
| | - Shelly Goldklank
- Adult Clinical PsyD Program, Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., The Bronx, NY, 10003, New York, USA
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Skeen SJ, Starks TJ, Jimenez RH, Rendina HJ, Cain D. Heterosexual Cisgender Men Partnered with Transgender Women Exhibit Higher HIV/STI Sexual Risk than Their Gay, Bisexual, and Queer Counterparts: Findings from a U.S.-Based Convenience Sample Recruited Online. AIDS Behav 2021; 25:3279-3291. [PMID: 34050403 PMCID: PMC10062375 DOI: 10.1007/s10461-021-03314-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 01/15/2023]
Abstract
Cisgender men are frequently vectors for HIV transmission among transgender women. Despite this, the correlates of sexual risk among these men remain under-examined. The purpose of the present study was to explore potential differences in relationship characteristics, sexual risk-taking, and risk-reduction strategies among cisgender men partnered with transgender women. The study utilized secondary screening data provided by adult cis men who reported being in a primary relationship with a trans woman (N = 710). Gay men (18%) were comparatively older, and most likely to report both HIV seropositivity and committed pairings. Heterosexual men (14%) were more likely to report exchange sex, briefer relationships, extra-dyadic sex, lesser serostatus awareness or PrEP uptake. Queer men (7%) were youngest, and most likely to access PrEP. Heterosexual cis men with trans women partners may be subject to unique socio-cultural drivers of sexual risk, such as heteronormative pressures and relationship stigma.
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Affiliation(s)
- Simone J Skeen
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA.
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, USA.
| | - Tyrel J Starks
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center, CUNY, New York, NY, USA
| | - Ruben H Jimenez
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
| | - H Jonathon Rendina
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center, CUNY, New York, NY, USA
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
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14
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Neilands TB, Chakravarty D, Darbes LA, O’Brien NP, Gonzalez IS, Hoff CC. Assessing Self-Efficacy and Communication Regarding Sexual Agreements among Men Who Have Sex with Men in the USA: Development and Validation of Two Novel Scales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189727. [PMID: 34574657 PMCID: PMC8466800 DOI: 10.3390/ijerph18189727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/18/2022]
Abstract
HIV disproportionately impacts men who have sex with men (MSM) in the USA. Building upon research on relationship constructs unique to MSM couples’ HIV-prevention needs, we developed two new scales measuring sexual agreement self-efficacy (SASE) and importance of sexual agreement communication (ISAC). Following qualitative item development, we used two large independent samples of MSM couples (N1 = 441, N2 = 388) to conduct scale validation. Exploratory factor analyses indicated both SASE and ISAC to be unidimensional with 7 and 5 items (eigenvalues = 5.68 and 3.50), respectively, with strong factor loadings. Confirmatory factor analyses yielded satisfactory model fit for SASE (CFI = 0.99; SRMR = 0.03) and ISAC (CFI = 0.99; SRMR = 0.05). Reliability was high for SASE (ω = 0.92) and ISAC (ω = 0.84). Predictive validity analysis revealed a protective association between higher scores on both scales and the outcomes of sexual risk behavior and agreement breaks. Convergent and discriminant validity analyses demonstrated associations in the expected directions between these scales and multiple measures of relationship quality. Therefore, SASE and ISAC are two brief, valid, and reliable scales that can facilitate more in-depth explorations of sexual agreements in MSM and thereby contribute greatly to improving our understanding of and ability to intervene on sexual agreements to improve health and relationship outcomes.
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Affiliation(s)
- Torsten B. Neilands
- Center for AIDS Prevention Studies, Department of Medicine, Division of Prevention Sciences, University of California San Francisco, San Francisco, CA 94158, USA;
- Correspondence:
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, Department of Medicine, Division of Prevention Sciences, University of California San Francisco, San Francisco, CA 94158, USA;
| | - Lynae A. Darbes
- Center for Sexuality and Health Disparities, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI 48104, USA;
| | - Nathan P. O’Brien
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA 94103, USA; (N.P.O.); (I.S.G.); (C.C.H.)
| | - Ilse S. Gonzalez
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA 94103, USA; (N.P.O.); (I.S.G.); (C.C.H.)
| | - Colleen C. Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA 94103, USA; (N.P.O.); (I.S.G.); (C.C.H.)
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15
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Stephenson R, Garofalo R, Sullivan PS, Hidalgo MA, Bazzi AR, Hoehnle S, Bratcher A, Finneran CA, Mimiaga MJ. Stronger Together: Results from a Randomized Controlled Efficacy Trial of a Dyadic Intervention to Improve Engagement in HIV Care Among Serodiscordant Male Couples in Three US Cities. AIDS Behav 2021; 25:2369-2381. [PMID: 33630199 PMCID: PMC8247634 DOI: 10.1007/s10461-021-03199-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 12/23/2022]
Abstract
Engagement in HIV care and a high level of antiretroviral therapy (ART) adherence for people living with HIV is crucial to treatment success and can minimize the population burden of the disease. Despite this, there is a critical gap in HIV prevention science around the development of interventions for serodiscordant male couples. This paper reports on the results of a randomized controlled trial to assess the efficacy of Stronger Together, a dyadic counseling intervention aimed at increasing engagement in and optimizing HIV care among serodiscordant male couples in Atlanta, GA, Boston, MA, and Chicago, IL. Between 2014 and 2017, 159 male serodiscordant couples (total N = 318) in Atlanta, GA, Boston, MA, and Chicago, IL were enrolled and equally randomized to either the Stronger Together intervention arm (a three-session dyadic intervention involving HIV testing and adherence counseling) or a standard of care (SOC) control arm. Couples completed individual study assessments via an audio computer assisted self-interviewing (ACASI) system at baseline, 6, 12 and 18 months. Primary outcomes included being prescribed and currently taking ART, and fewer missed doses of ART in the past 30 days; because the trial was not powered to examine viral suppression, we examined this as an exploratory outcome. Longitudinal data analysis was by an intention-to-treat approach. Participants ages ranged from 18 to 69 (mean = 35.9), and are predominantly white (77.5%), and college educated (68.4% earned a college degree or higher). Participants randomized to the Stronger Together arm had a significantly greater odds of being prescribed and currently taking ART over time than those in the SOC arm (at 12 months OR 2.75, 95%CI 1.35-4.67, p-value 0.020, and at 18 months OR 2.91, 95%CI 1.61-4.88, p-value 0.013). Similarly, those in the Stronger Together arm had a significantly lower odds of missing a dose of ART in the past 30 days over time compared to those in the SOC arm (at 12 months OR 0.28, 95%CI 0.09-0.81, p-value 0.019, and at 18 months OR 0.25, 95%CI 0.07-0.82, p-value 0.023). Among male couples in serodiscordant relationships, the Stronger Together intervention resulted in significantly improved HIV treatment outcomes at both 12 and 18 months of follow-up. This trial is the first to date to demonstrate evidence of efficacy for a dyadic counseling intervention and has the potential to fill a critical gap in secondary HIV prevention interventions for serodiscordant male couples.
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Affiliation(s)
- Rob Stephenson
- Department of Systems, Population and Leadership & The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109, USA.
| | - Robert Garofalo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Marco A Hidalgo
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Samuel Hoehnle
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anna Bratcher
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Matthew J Mimiaga
- Center for LGBTQ Advocacy, Research, and Health, UCLA, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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16
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Olawore O, Crowell TA, Ketende SC, Ramadhani HO, Liu H, Ake JA, Kokogho A, Adebajo S, Charurat ME, Nowak RG, Baral SD. Individual and partnership characteristics associated with consistent condom use in a cohort of cisgender men who have sex with men and transgender women in Nigeria. BMC Public Health 2021; 21:1277. [PMID: 34193101 PMCID: PMC8243438 DOI: 10.1186/s12889-021-11275-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 06/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background This study reports on the individual and partnership characteristics that influence consistent condom use in cisgender men who have sex with men (MSM) and transgender women (TGW) attending trusted community centers that provide HIV prevention and treatment services in Nigeria. Methods Adults assigned male at birth who reported anal sex with male partners who enrolled between March 2013–2019 and had information about at least one male sexual partner were included in these analyses. At enrollment and follow-up visits every 3 months for up to 18 months, participants were administered detailed questionnaires that collected information about demographics, sexual practices, HIV risk behaviors, and characteristics and behaviors of their partners in the previous year (at enrollment) or the preceding 3 to 6-months (at follow-up visits). Logistic regression models with generalized estimating equations were used to assess the odds ratio (OR) and 95% confidence intervals (CI) of individual, partner, and partnership characteristics associated with consistent condom use (CCU). A participant was defined as consistently using condom if they reported always using condoms all the time they had insertive, receptive or both types of anal sex with a male partner. Results At the individual level, CCU was positively associated with higher education, disclosure of key population status to a healthcare worker and negatively associated with poor access to condoms. At the partner and partnership level, CCU was associated with partners with higher education (aOR: 1.36; 95% CI: 1.07–1.72), casual relationships (aOR: 1.22; 95% CI: 1.11–1.34) and relationships in which partners encouraged the participant to use condoms with other partners (aOR: 1.14; 95% CI: 1.02–1.28). Relationships in which the partner was married to a woman and/or the partner’s HIV status positive or unknown were negatively associated with CCU. Conclusions These findings suggest that individuals in relationships where partners were more open and encouraged safer sex were more likely to consistently use condoms. HIV prevention programs should consider leveraging communication to sexual partners to encourage condom use as this may support condom use with other sexual partners. Given sustained and growing HIV and STI epidemics among MSM and TGW, even with pre-exposure prophylaxis scale-up, it is crucial to continue to study optimal implementation strategies to increase condom use. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11275-w.
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Affiliation(s)
- Oluwasolape Olawore
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite 3507, Baltimore, MD, 21205, USA.
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sosthenes C Ketende
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite 3507, Baltimore, MD, 21205, USA
| | - Habib O Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hongjie Liu
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Afoke Kokogho
- HJF Medical Research International, Abuja, Nigeria.,U.S. Army Medical Research Directorate - Africa, Nairobi, Kenya
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation (MGIC), Abuja, Nigeria
| | - Man E Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite 3507, Baltimore, MD, 21205, USA
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17
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Chen S, Yang Q, He J, Fan X, Liu Z, Qiu J, Zheng Z, Gu J, Cheng W, Hao Y, Li J, Hao C. The effects of intimate relationship characteristics on unprotected anal intercourse among same-sex male couples in China: a dyadic analysis using the actor-partner interdependence model. BMC Infect Dis 2021; 21:593. [PMID: 34157968 PMCID: PMC8218385 DOI: 10.1186/s12879-021-06317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unprotected anal intercourse (UAI) within the context of concurrent sexual relationship are prevalent among men who have sex with men (MSM) who have regular male sex partners and it aggravates the risk of HIV infection among this community. The aim of this study was to assess the effect of intimate relationship characteristics on UAI among MSM couples at the dyadic level. METHODS Two hundred four MSM couples were recruited from a HIV testing clinic from April 2017 to April 2018 in Guangzhou, China. The actor-partner interdependence model (APIM) was applied for dyadic analysis. Each MSM couple was divided into the insertive role and the receptive role according to their regular anal sex role. In this context, actor effect is the impact of an MSM's intimate relationship characteristics on his own UAI, and partner effect is the impact of his partner's intimate relationship characteristics on his UAI. RESULTS Of the 408 participants, 58.82% had UAI with regular male sex partner (UAI-RP) and 8.09% had concurrent UAI. Intimate relationship characteristics were associated with concurrent UAI, but not associated with UAI-RP. For the receptive role, his relationship investment exerted significant actor and partner effects on concurrent UAI (AOR actor = 1.31, P < 0.001; AOR partner = 1.17, P < 0.001). Meanwhile, receptive role's violence experience within relationship exerted significant actor effects on his own concurrent UAI (AOR actor = 6.43, P = 0.044). CONCLUSIONS Relationship investment and violence experience influenced concurrent UAI among MSM couples and it varied in different sex roles. Additional assistance on empowerment, relationship therapy and sexual agreement is urgently needed to reduce their high possibility on engagement of HIV-related risk behaviors.
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Affiliation(s)
- Sha Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qingling Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Juan He
- Institution of Drug Clinical Trial, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
| | - Xiongzhi Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhongqi Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jialing Qiu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhiwei Zheng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China.
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China.
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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18
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Dellucci TV, Carmichael C, Starks TJ. Arrangements versus Agreements: Evaluating Two Approaches to Measuring Male Couples' Rules and Understandings Around Sex with Outside Sex Partners. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1689-1700. [PMID: 32128651 PMCID: PMC7809916 DOI: 10.1007/s10508-019-01621-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 05/06/2023]
Abstract
One- to two-thirds of new HIV infections among sexual minority men occur within the context of main partnerships. This has led to increasing attention to the rules and boundaries male couples form around sex with outside partners as a mechanism to manage HIV risk. These rules and boundaries have generally been operationalized either as a sexual agreement-the decisions couples make together about their sexual boundaries with outside partners-or a sexual arrangement-how couples handle sex outside the relationship, which may or may not involve an implicit or explicit consensus between partners. The goal of the current study was to examine the correspondence of these two approaches to the operationalization of rules and boundaries. Additionally, the study tested whether agreements and arrangements were differentially associated with dyadic communication and sexual behavior with casual partners. Results indicated a high level of correspondence between assessment methods. Similarly, patterns of sexual behaviors with casual partners were consistent across both sexual agreements and sexual arrangements. In contrast, patterns of communication varied as a function of assessment type. Specifically, constructive, avoidant, and sexual communication varied across sexual agreement types, whereas sexual arrangement types only differed with respect to constructive communication. These findings suggest that there is substantial overlap between arrangements and agreements. Findings particularly related to associations with sexual behavior may largely generalize across these methods of operationalization. In contrast, survey-reported sexual agreements were a more sensitive correlate of dyadic communication.
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Affiliation(s)
- Trey V Dellucci
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York, New York, NY, 10016, USA
| | - Cheryl Carmichael
- Department of Psychology, Brooklyn College of the City University of New York, New York, NY, USA
| | - Tyrel J Starks
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York, New York, NY, 10016, USA.
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA.
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19
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Jin H, Biello K, Garofalo R, Lurie M, Sullivan PS, Stephenson R, Mimiaga MJ. Better Communication Regarding Sexual Agreements Within Serodiscordant Male Couples Leads to Improved Antiretroviral Therapy Adherence Among the HIV-Positive Partner. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1771-1779. [PMID: 34021459 DOI: 10.1007/s10508-021-01954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
Sexual agreements (SAs)-guidelines that outline what type of sexual behaviors are permissible with sexual partners outside of their primary relationship-are often negotiated within same-sex male relationships to reduce their risk for HIV infection. However, HIV risk is not only a function of sexual behavior, but is also affected by factors such as antiretroviral therapy (ART) adherence. We examined whether HIV-positive partners in serodiscordant male couples who have better communication about SAs and report concordant SAs with their partners have greater odds of being adherent to ART to not only improve their health, but to also reduce the risk of transmitting HIV to partners. We analyzed longitudinal data from 135 HIV-positive partners in serodiscordant male couples recruited from Atlanta, GA, Boston, MA, and Chicago, IL to examine the relationship between optimal ART adherence and two independent variables: communication about SAs and if the couples have discrepant SAs. HIV-positive male partners who reported high levels of communication regarding SAs had nearly three times the odds of optimal adherence to ART compared to those who reported lower levels. The HIV-positive partners with discrepant SAs with their male partner had approximately half the odds of optimal adherence to ART compared to those with concordant SAs. Our findings suggest that integrating communication skills training into dyad-level HIV interventions to improve communication regarding HIV may provide more opportunities for couples to discuss ways of reducing the risk of HIV transmission. Couples may benefit from interventions that assist them in composing SAs.
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Affiliation(s)
- Harry Jin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Johns Hopkins Bloomberg School of Public Health, 615 S Wolfe St., Baltimore, 21205, USA.
| | - Katie Biello
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Robert Garofalo
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Population and Leadership and The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
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20
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Truong HHM, Mehrotra ML, Grant RM. Brief Report: Seroadaptive Behaviors Varied Among Geographically Diverse iPrEx Participants. J Acquir Immune Defic Syndr 2021; 86:e43-e47. [PMID: 33093331 DOI: 10.1097/qai.0000000000002551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seroadaptive behaviors refer to a wide range of harm reduction practices to decrease HIV transmission risk. Effective implementation of seroadaptive behaviors is dependent on knowledge of one's own serostatus and that of one's sexual partners. Partner-level and environmental-level attributes may affect seroadaptation practices. We assessed factors associated with seroadaptive behaviors. METHODS Men who have sex with men and transgender women were recruited from an HIV pre-exposure prophylaxis clinical trial (iPrEx) with study sites in the US, Peru, Ecuador, Brazil, Thailand, and South Africa. Partnership-level data were collected at the baseline visit for the 3 most recent partners. Participants were considered to have practiced seroadaptive behaviors if: (1) they believed their partner to be HIV-negative, that is, serosorting; or (2) no condomless receptive sex occurred with an HIV-positive or unknown status partner, that is, seropositioning. RESULTS Of 2331 participants, 41% always practiced seroadaptive behaviors, 36% sometimes did, and 23% never did. Participants enrolled at study sites in the US (P < 0.001) and Peru/Ecuador (P < 0.001) were more likely to practice seroadaptive behaviors, whereas transgender women were less likely to do so (P < 0.001). Seroadaptive behaviors were more likely to occur in relationships with steady partners (P = 0.005) and emotionally close relationships (P = 0.013). CONCLUSIONS Seroadaptive behaviors were more frequently observed among iPrEx participants from the US, Peru, and Ecuador study sites and among participants in relationships with partners who they were more committed to and felt emotionally close to. Our findings suggest that seroadaptive behaviors may be influenced by social norms that vary geographically and culturally.
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Affiliation(s)
| | - Megha L Mehrotra
- Epidemiology and Biostatistics, University of California, San Francisco, CA
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21
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Giano Z, Kavanaugh KE, Durham AR, Currin JM, Wheeler DL, Croff JM, Hubach RD. Factors Associated with Condom Use among a Sample of Men Who Have Sex with Men (MSM) Residing in Rural Oklahoma. JOURNAL OF HOMOSEXUALITY 2020; 67:1881-1901. [PMID: 31125299 DOI: 10.1080/00918369.2019.1616430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Public health literature often neglects populations from rural communities, particularly with men who have sex with men (MSM). Although HIV/STI infections are decreasing slightly, there is an increase within rural MSM, thus opening the door for further research on condom use behavior in a rural context. In-depth interviews were conducted with 40 MSM in rural Oklahoma regarding their condom use and sexual behaviors. A qualitative analysis revealed five themes with respect to condom usage: physical discomfort of condoms, relationship trust, usage based on the type of sexual act, substance use, and knowledge of a partner's HIV/STI status. A sixth theme within the context of rural Oklahoma revealed participants' fear of physical/verbal abuse, hesitations seeking medical help due to confidentially issues, and general acknowledgment of the lack of education and resources available. Implications include increasing mobile testing locations and a push for marketing greater confidentially within health service providers.
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Affiliation(s)
- Zachary Giano
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Katherine E Kavanaugh
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - André R Durham
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Joseph M Currin
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - Denna L Wheeler
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Julie M Croff
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Randolph D Hubach
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
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22
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Abstract
Sexual agreements are an important HIV risk reduction strategy enacted by men in male-male partnerships. Greater levels of relationship quality have been associated with sexual agreement formation and adherence. However, current evidence supporting the associations between relationship quality and sexual agreements for male dyads is based primarily on the responses of just one partner. Understanding that relationship quality and decisions about sexual agreements are inherently influenced by both partners, the present analysis uses dyadic-level data to examine the sexual agreements among 199 HIV serodiscordant and seroconcordant male dyads (n = 398 individuals). Specifically, the analysis examines measures of love, trust, and conflict style as they relate to (1) the type of agreement established, (2) concordance in agreement reporting, (3) satisfaction with the agreement, and (4) broken agreements. A discrepancy in love between partners was associated with the type of agreement established, whether they reported the same agreement type, and whether one of the partners reported a broken agreement, but it was not associated with either partner's satisfaction with the agreement. A discrepancy in trust was associated with agreement concordance and agreement breaks, but it was not associated with the type of agreement established or satisfaction with the agreement. Lastly, a discrepancy in conflict style was associated with each of the agreement outcomes. Future research and intervention efforts should focus on understanding the behavioral and communication skills necessary for couples to make successful sexual agreements.
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23
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Knox J, Boyd A, Matser A, Heijman T, Sandfort T, Davidovich U. Types of Group Sex and Their Association with Different Sexual Risk Behaviors Among HIV-Negative Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1995-2003. [PMID: 32500245 PMCID: PMC7321909 DOI: 10.1007/s10508-020-01744-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/26/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
The current study sought to identify types of group sex acts among HIV-negative men who have sex with men (MSM) and assess their association with different sexual risk behaviors using cross-sectional data of group sex acts reported during 6 waves (2015-2018) of the Amsterdam MSM Cohort Study. Latent class analysis was performed to identify group sex types based on size, familiarity with partners, location, planning, and drug use. Associations between group sex types and sexual behaviors were evaluated using logistic regression with generalized estimating equations, employing the sample mean as a reference. Data at the level of group sex acts were analyzed, while correcting variance estimations for repeated measurements within MSM. A total of 392 MSM engaged in group sex ≥ 1 times, totaling 1033 group sex acts. Four types of group sex emerged: familiar (29%), intimate (27%), impromptu (36%), and party (8%). Familiar group sex (characterized by high proportions of mostly known partners, occurring in private places and involving drug use) had an increased adjusted odds of risky fingering (aOR 1.6, 95%CI 1.3-2.0) and of risky fisting and/or use of sex toys (aOR 2.3, 95%CI 1.6-3.1). Intimate group sex (characterized by high proportions of threesomes, occurring in private places, and not involving drug use) had a decreased adjusted odds of risky fisting and/or use of sex toys (aOR 0.6, 95%CI 0.4-0.9). Impromptu group sex (characterized by high proportions of spontaneity, mostly unknown partners, and taking place in public places) had a decreased adjusted odds of risky fisting and/or use of sex toys (aOR 0.5, 95%CI 0.3-0.7) and of condomless anal intercourse (CAI) (OR 0.6, 95%CI 0.5-0.8). Party group sex (characterized by high proportions of larger groups, mostly unknown partners, and being planned) had an increased adjusted odds of risky fisting and/or use of sex toys (aOR 1.6, 95%CI 1.0-2.7) and of CAI (aOR 1.5, 95%CI 1.1-2.1). The identified types of group sex reflect different dynamics and characteristics, with some types riskier for STIs and others riskier for HIV. HIV and STI prevention efforts could be tailored accordingly. For example, in certain type of public sex environments (e.g., cruising parks), traditional HIV and STI prevention efforts, such as promoting of condom use and PrEP, might be sufficient. However, in other settings (e.g., private parties), where group sex is more likely to be planned and where behaviors such as fisting, sharing of sex toys, and CAI are more likely to take place, which carry different levels of risk for HIV and STI transmission, including that of Hepatitis C, different approaches might be needed, such as broader HIV and STI prevention education efforts or targeting the organizers of group sex events.
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Affiliation(s)
- Justin Knox
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA.
| | - Anders Boyd
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Amy Matser
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Titia Heijman
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Infectious Diseases, STI Outpatient Clinic, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Udi Davidovich
- Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Kahle EM, Sharma A, Sullivan S, Stephenson R. The Influence of Relationship Dynamics and Sexual Agreements on Perceived Partner Support and Benefit of PrEP Use Among Same-Sex Male Couples in the U.S. AIDS Behav 2020; 24:2169-2177. [PMID: 31950307 DOI: 10.1007/s10461-020-02782-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Use of Pre-exposure prophylaxis (PrEP) for HIV prevention by men who have sex with men (MSM) may be impacted by relationship dynamics. We assessed perceived partner support of PrEP use and benefit of PrEP by relationship characteristics among male couples. Baseline data from a randomized control trial of video-based HIV counseling and testing among male couples in the U.S. were used in adjusted multilevel regression models to assess individual and dyadic characteristics. Among 659 participants, 73.3% thought their partner would be supportive of their PrEP use; 26.7% reported their partner would not support PrEP use, which was significantly associated with intimate partner violence (IPV) (p = 0.008). Most (57.7%) did not believe PrEP would be beneficial to them or their partner. Couples with a sexual agreement allowing outside partners were significantly associated with higher perceived support of partners for PrEP (p < 0.001) and benefit of PrEP use (p < 0.001). Perceived partner support of PrEP was high but perceived benefit of PrEP was low, both shaped by relationship dynamics that highlight the need for tailored dyadic interventions. The association between perceived PrEP support and IPV points to the need to integrate relationship contexts in HIV prevention programs.
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25
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Kim B, Regan SD, Callander D, Goedel WC, Chaix B, Duncan DT. Associations of spatial mobility with sexual risk behaviors among young men who have sex with men in New York City: A global positioning system (GPS) study. Soc Sci Med 2020; 258:113060. [PMID: 32473485 DOI: 10.1016/j.socscimed.2020.113060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
Spatial contexts and spatial mobility are important factors of the HIV epidemic and sexually transmitted infections. Using global positioning system (GPS) devices, we examined the associations of objectively measured spatial mobility with sexual risk behaviors among gay, bisexual and other men who have sex with men (MSM) in New York City. This observational study included a subgroup of 253 HIV-negative MSM from the Project 18 Cohort Study, who participated in the GPS monitoring sub-study. Spatial mobility was measured as (1) distance traveled and (2) activity space size defined as daily path area during 2-week of GPS tracking. We examined the associations of these measures with numbers of male sexual partners and condomless anal intercourse (CAI) acts during last six months using quasi-Poisson models, adjusting for socio-demographics. Results demonstrated that spatial mobility was positively associated with sexual risk behaviors, for example, with CAI (incidence rate ratio [IRR] = 1.01 for a 10 km increase in distance traveled and IRR = 1.04 for a 1 km2 increase in 50 m-buffer activity space size). Our findings may enhance the understanding of spatial contexts of HIV risk. Future studies should be conducted to examine the mechanisms for the associations between spatial mobility behaviors with sexual risk behaviors as well as the influence of neighborhood characteristics in various neighborhood contexts, which may guide the place-based HIV prevention services.
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Affiliation(s)
- Byoungjun Kim
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States.
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Denton Callander
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Nemesis Team, F75012, Paris, France
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
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26
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Relationship Characteristics Associated with Perceptions of Partners' HIV Testing Behavior Among Male Couples. AIDS Behav 2020; 24:516-531. [PMID: 31758348 DOI: 10.1007/s10461-019-02740-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Partnered men who have sex with men are not immune to the risk of HIV. Analyzing dyadic data from 360 male couples recruited from April 2016 to June 2017, we examined how relationship characteristics might influence HIV testing behavior and perceptions of partners' HIV testing. Increasing levels of mutual trust were associated with lower odds of both partners (versus neither) having been tested in the past year (aOR = 0.91, 95% CI 0.83-0.99), but increasing levels of communal coping were associated with higher odds (aOR = 1.06, 95% CI 1.02-1.10). Only one partner was more likely to be correct about whether or not his partner had been tested in the past year (versus both) if someone had broken their sexual agreement (aOR = 2.60, 95% CI 1.17-5.76). Increasing differences in trust (aOR = 1.10, 95% CI 1.01-1.20) were also associated with higher odds of only one partner being correct. Dyadic HIV prevention efforts should incorporate skills building around negotiating sexual agreements and constructive communication.
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27
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Robles G, Dellucci TV, Stratton MJ, Jimenez RH, Starks TJ. The Utility of Index Case Recruitment for Establishing Couples' Eligibility: An Examination of Consistency in Reporting the Drug Use of a Primary Partner Among Sexual Minority Male Couples. ACTA ACUST UNITED AC 2019; 8:221-232. [PMID: 32395393 DOI: 10.1037/cfp0000128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sexual minority men are disproportionately impacted by substance use, which is associated with greater HIV transmission behaviors. Novel approaches to drug use prevention and treatment are needed. Couple-based approaches have garnered significant attention. The recruitment of couples into substance use interventions has proven challenging. We evaluate an index-case approach to screening participants in couples' research. Seventy index cases, aged 18-29, and their main partner (140 individuals), were recruited. At screening, index participants reported their drug use and their partners' drug use for the previous 30 days. At baseline, both partners reported their drug use over the past 30 days. Individuals' self-reports and perceptions of their partner's concurrency were compared within couples using the κ (Kappa) coefficient. We found high levels of personal predictive accuracy from screening to baseline for cannabis (κ = .81, p < .01) and cocaine/crack (κ = .70, p < .01). Predictive accuracy of index case reporting of their partner's drug use behavior were moderately high among cocaine/crack use (κ = .68, p < .01) and MDMA/GHB/Ketamine (κ = .56, p < .01). Perceived partner similarity for recent drug use was also high for all drugs, with the highest levels among cocaine/crack (κ =.82) and prescription drugs (κ =.81). This study demonstrates that index partners report drug use with differing levels of agreement between drug types. Index recruitment has advantages in determining drug use-related eligibility requirements. Discrepancies in reporting were more frequently false positives, which reduces the risk of screening out potentially eligible couples.
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Affiliation(s)
- Gabriel Robles
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA
| | - Trey V Dellucci
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of City University of New York, New York, NY. USA
| | - Mark J Stratton
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA
| | - Ruben H Jimenez
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, New York, NY. USA.,Health Psychology and Clinical Science Doctoral Program, Graduate Center of City University of New York, New York, NY. USA
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28
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Robles G, Bosco SC, Dellucci TV, Starks TJ. Integrating intra-individual and dyadic factors in examining health among gay and bisexual men: A narrative review of recent literature. JOURNAL OF GLBT FAMILY STUDIES 2019; 16:488-513. [PMID: 33041710 PMCID: PMC7546157 DOI: 10.1080/1550428x.2019.1682740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Gay and bisexual men (GBM) experience disproportionate rates of mental health and other negative health outcomes. For GBM in relationships, contextualizing the myriad of negative outcomes as a dyadic process may provide insight into the mechanisms through which these adverse outcomes develop. The objective of this review is to examine the current state of the relationship science literature using a health framework, Relationship Process and Health. We conducted a search for articles using PubMed, PsycInfo, and Web of Science for empirical articles in English published in the past 15 years on GBM in a relationship, assessing attachment, and relationship functioning as predictors of health outcomes. We found 649 articles. After screening, 23 articles were identified and reviewed. Findings overwhelming identified HIV risk as the primary health outcome. Attachment was associated with relationship functioning and sexual risk behaviors. Relationship-specific components were largely used as predictors of sexual HIV transmission risk behaviors. Together, these studies suggest that relationship functioning is a prospective link between attachment and health-related outcomes. The literature has yet to examine empirically dyadic-level mechanisms that may explain the association between individual attachment and health outcomes aside from HIV risk, and needs more examination of other health disparities affecting GBM.
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Affiliation(s)
- Gabriel Robles
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Stephen C. Bosco
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
| | - Trey V. Dellucci
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
| | - Tyrel J. Starks
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave, New York, NY 10065, USA
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29
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Vasilenko SA, Espinosa-Hernández G, Rice CE, Biello KB, Novak DS, Mayer KH, Mimiaga MJ, Rosenberger JG. Patterns of Sexual Behaviors in Young Men Who Have Sex With Men in Mexico. JOURNAL OF SEX RESEARCH 2019; 56:1168-1178. [PMID: 30638395 PMCID: PMC6626694 DOI: 10.1080/00224499.2018.1563667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Recent research has documented the importance of understanding the multidimensional nature of sexual risk behavior. However, little is known about patterns of sexual behavior among men who have sex with men (MSM) in Mexico, men who are at greatest risk for HIV and sexually transmitted infections compared to other subpopulations in the country. This study applied latent class analysis to data from a large, HIV-negative sample of 18- to 25-year-old Mexican MSM recruited from a social and sexual networking website (N = 3,722) to uncover multidimensional patterns of sexual behaviors, partner factors, and protective behaviors, and examine how these were associated with health and well-being correlates. We selected a model with seven classes. The most common class included those who reported both insertive and receptive behaviors with more than one partner, but smaller groups of individuals were in classes marked by only insertive or receptive anal sex, romantic relationships, or sexual inactivity. Class membership differed by sexual orientation, age, depressive symptoms, alcohol problems, and self-acceptance, with individuals in a class marked by same-sex relationships generally reporting more positive outcomes. Findings suggest heterogeneity of behaviors among Mexican MSM and the possible efficacy of prevention messages tailored to individuals' specific patterns of sexual behavior.
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Affiliation(s)
- Sara A Vasilenko
- Department of Human Development and Family Science, Syracuse University
| | | | - Cara E Rice
- The Methodology Center, Pennsylvania State University
| | - Katie B Biello
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University, and The Fenway Institute
| | | | - Kenneth H Mayer
- The Fenway Institute and Department of Global Health and Population, Harvard University
| | - Matthew J Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University and The Fenway Institute
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Starks TJ, Dellucci TV, Gupta S, Robles G, Stephenson R, S Sullivan P, Parsons JT. A Pilot Randomized Trial of Intervention Components Addressing Drug Use in Couples HIV Testing and Counseling (CHTC) with Male Couples. AIDS Behav 2019; 23:2407-2420. [PMID: 30887190 PMCID: PMC6910720 DOI: 10.1007/s10461-019-02455-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Men who have sex with men (MSM) experience high rates of substance use and HIV infection. Main partners are the source of many (35-68%) of these new HIV infections. This study developed and examined the efficacy of two adjunct components to couples HIV testing and counseling (CHTC)-communication training (CT) videos and a substance use module (SUM)-to reduce drug use and sexual HIV transmission risk in MSM couples. Participants included 70 male couples randomized into one of four conditions: CHTC, CHTC + CT videos, CHTC + SUM, and CHTC + CT videos + SUM. Participants completed a survey pre-intervention and 1-, 3-, and 6-months later. Completion of the SUM in the absence of CT videos was associated with significant immediate decreases in drug use and related problems; however, at 3- and 6-month follow ups, the SUM was only associated with reductions in drug use and related problems among men who also viewed the CT videos. There were no between-condition differences in sexual behavior. CHTC may serve as a vehicle for the delivery of brief substance use intervention for MSM couples.ClinicalTrails.gov NCT # 03125915.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA.
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY, USA.
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA.
| | - Trey V Dellucci
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY, USA
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
| | - Sugandha Gupta
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY, USA
| | - Gabriel Robles
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
| | - Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing, and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY, USA
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
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31
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Jiang T, Zhou X, Wang H, Luo M, Pan X, Ma Q, Chen L. Psychosocial Factors Associated with Quality of Life in Young Men Who Have Sex with Men Living with HIV/AIDS in Zhejiang, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2667. [PMID: 31349674 PMCID: PMC6696375 DOI: 10.3390/ijerph16152667] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To explore the quality of life (QOL) status and related factors in young human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) aged 16 to 24 years in Zhejiang province. METHODS A cross-sectional study was conducted in 22 counties of Zhejiang province, and 395 subjects took part in our research. A t-test, one-way Analysis of variance (ANOVA), and multivariate stepwise linear regression analysis were used to investigate the factors associated with QOL in young HIV-infected MSM. RESULTS The total score on the QOL was 86.86 ± 14.01. The multivariate stepwise linear regression analysis revealed that self-efficacy and discrimination were associated with all domains on the QOL assessment, monthly income was associated with QOL for all domains except spirituality and consistent condom use during oral sex with men in the past three months was associated with QOL for all domains except the relationship domain. Those individuals within the group of young HIV-infected MSM who have higher self-efficacy, a higher monthly income, greater social support, safer sexual behaviors, a higher level of education, and a higher cluster of differentiation 4 (CD4) count have a better QOL. CONCLUSIONS These findings suggest that to improve the QOL of this population, greater emphasis should be placed on improving social support, self-efficacy, and antiviral therapy adherence and on reducing discrimination, disease progression, and high-risk behaviors.
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Affiliation(s)
- Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Xin Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Mingyu Luo
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China.
| | - Lin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China.
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32
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Hoff CC, Chakravarty D, Darbes L, Neilands TB. Studying the Motivations Behind Sexual Agreements: A First Look at the Motivations Behind Agreement (MBA) Scale for Male Couples. JOURNAL OF SEX RESEARCH 2019; 56:718-727. [PMID: 30028213 PMCID: PMC6339841 DOI: 10.1080/00224499.2018.1489490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual agreements are ubiquitous among male couples, yet little is known about motivations behind agreements and their association with sexual risk for human immunodeficiency virus (HIV). Qualitative interviews with 39 couples informed the development of the items in the Motivations Behind Agreement (MBA) scale. The scale was validated via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) using quantitative data from two (790 and 882 men) independent samples of couples. The EFA yielded two factors: relationship quality enhancement motive (RQEM) and sex life enhancement motive (SLEM). The CFA indicated satisfactory global model data fit. Finally, in predicting sexual risk, RQEM and SLEM showed significant interactions with agreement type. For men with monogamous agreements, higher RQEM was associated with less condomless anal sex (CAS) with an outside partner of discordant or unknown serostatus (aOR = 0.15; 95% CI = 0.05, 0.46). For men with nonmonogamous agreements, higher RQEM was associated with less CAS (aOR = 0.76; 95% CI = 0.60, 0.97) while higher SLEM was associated with greater odds of CAS (aOR = 1.57; 95% CI = 1.18, 2.08). Men whose agreements were highly motivated by relationship enhancement were less likely to engage in sexual risk with outside partners regardless of agreement type. HIV-prevention interventions targeting male couples will benefit from incorporating an understanding of couples' agreement motivations.
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Affiliation(s)
- Colleen C Hoff
- a Center for Research and Education on Gender and Sexuality , San Francisco State University
| | - Deepalika Chakravarty
- b Center for Research and Education on Gender and Sexuality, San Francisco State University Department of Medicine, Center for AIDS Prevention Studies , University of California, San Francisco
| | - Lynae Darbes
- c Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing , University of Michigan
| | - Torsten B Neilands
- d Department of Medicine, Center for AIDS Prevention Studies , University of California, San Francisco
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Starks TJ, Feldstein Ewing SW, Lovejoy T, Gurung S, Cain D, Fan CA, Naar S, Parsons JT. Adolescent Male Couples-Based HIV Testing Intervention (We Test): Protocol for a Type 1, Hybrid Implementation-Effectiveness Trial. JMIR Res Protoc 2019; 8:e11186. [PMID: 31199341 PMCID: PMC6592501 DOI: 10.2196/11186] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/24/2018] [Accepted: 11/16/2018] [Indexed: 01/29/2023] Open
Abstract
Background Young men who have sex with men (YMSM), particularly those who are partnered, are at unique risk for HIV. YMSM are among those at highest risk for HIV. Meanwhile, despite the fact that primary partners account for many—possibly most—new HIV infections, partnered men who have sex with men perceive themselves to be at much lower risk for HIV infection and therefore test less often than single men. In response to the risk of primary partner HIV transmission, couples HIV testing and counseling (CHTC) procedures have been developed for use in adult populations. Although promising, YMSM couples may require additional support to complete CHTC given their developmental context in which sexual and romantic relationships are relatively new, and communication skills are emergent. Objective The aim of this study was to test the additive benefit of adjunct treatment components tailored for YMSM, which enhance communication skills before the completion of CHTC. The intervention tests a continuum of prevention packages including assertive communication training videos and motivational interviewing focused on assisting with identification and development (MI-AID) before entering into the dyadic intervention components. This protocol is part of the Adolescent Medicine Trials Network (ATN) Scale It Up program described in this issue. Methods This is a comparative effectiveness trial that will be executed in 3 phases. Phase 1 will gather qualitative data related to intervention development and implementation from partnered YMSM at 4 subject recruitment venues (SRVs). Phase 2 will compare a continuum of these interventions in a pilot randomized controlled trial (RCT) at 2 SRVs. Phase 3 will compare the most successful adapted intervention package from phase 2 to CHTC as usual in a larger RCT at 4 SRVs. This phase is focused on implementation and sustainment phases of the Exploration, Preparation, Implementation, and Sustainment framework. Results Phase 1 data will be drawn from qualitative interviews with partnered YMSM (n=24) and staff from ATN sites (n=20). Baseline enrollment for phase 2 is expected to begin across 2 SRVs in June 2018 (ncouples=36). In phase 2, survey data collection along with HIV and sexually transmitted infection (STI) testing will occur at baseline, and 1- and 3-month (postintervention) follow-ups. Phase 3 will begin enrollment across 4 SRVs in September 2019 (ncouples=144) and follow-ups will occur at 1, 3, 6, and 9 months postintervention. Conclusions Although MI-AID, video-based assertive communication training, and CHTC have established efficacy when administered on their own, this study will be the first to evaluate the strongest adjunctive version of these interventions to address the specific developmental needs of partnered YMSM. Trial Registration ClinicalTrials.gov NCT03386110; http://clinicaltrials.gov/ct2/show/NCT03386110 (Archived by WebCite at http://www.webcitation.org/75mlO7GCx) International Registered Report Identifier (IRRID) DERR1-10.2196/11186
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Affiliation(s)
- Tyrel J Starks
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.,Hunter College Department of Psychology, Hunter College, City University of New York, New York, NY, United States.,Health Psychology and Clinical Science Doctoral Program, Graduate Center, City University of New York, New York, NY, United States
| | | | - Travis Lovejoy
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States
| | - Sitaji Gurung
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States
| | - Demetria Cain
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States
| | - Carolyn A Fan
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States
| | - Sylvie Naar
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Jeffrey T Parsons
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.,Hunter College Department of Psychology, Hunter College, City University of New York, New York, NY, United States.,Health Psychology and Clinical Science Doctoral Program, Graduate Center, City University of New York, New York, NY, United States
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Morris MD, Andrew E, Tan JY, Maher L, Hoff C, Darbes L, Page K. Injecting-related trust, cooperation, intimacy, and power as key factors influencing risk perception among drug injecting partnerships. PLoS One 2019; 14:e0217811. [PMID: 31150518 PMCID: PMC6544289 DOI: 10.1371/journal.pone.0217811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
Sharing of injection drug use paraphernalia is a dyadic process linked to the transmission of HIV and hepatitis C virus (HCV). Despite this, limited research exists identifying specific dyadic interpersonal factors driving injecting partners' engagement in needle/syringe and ancillary injecting equipment sharing among young adults. Using semi-structured in-depth interview data collected between 2014 and 2015 from twenty-seven people who inject drugs (PWID), we applied an inductive approach to identify key injection drug-related interpersonal factors and developed a conceptual model integrating the findings based on interdependence theory. Interactions between injecting partners resulted in varying levels of injecting-related trust, cooperation, intimacy, and power. These factors interacted to collectively influence the type and level of risk perceived and enacted by injecting partners. The relationship between these injecting-related interpersonal factors, on the one hand, and risk perception on the other was dynamic and fluctuated between actions that protect the self (person-centered) and those that protect the partnership (partnership-centered). These findings indicate that the interpersonal context exerts substantial influence that shapes risk perception in all types of injecting partnerships. Partnership-focused prevention strategies should consider the dynamics of trust, cooperation, intimacy, and power, in characterizing dyadic risk perceptions and in understanding risky injecting practices among PWID.
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Affiliation(s)
- Meghan D. Morris
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, United States of America
| | - Erin Andrew
- Nursing Science, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Judy Y. Tan
- Center for AIDS Prevention Science, University of California, San Francisco, San Francisco, CA, United States of America
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Colleen Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, United States of America
| | - Lynae Darbes
- Center for Sexuality and Health Disparities, Department of Health Behavior & Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
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Patterns of Sexual Behavior and Sexually Transmitted Infections in Young Men Who Have Sex With Men. Sex Transm Dis 2019; 45:387-393. [PMID: 29465677 DOI: 10.1097/olq.0000000000000767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Young men who have sex with men (MSM) are at an increased risk for sexually transmitted infections (STIs). Recent research has documented the importance of understanding the multidimensional nature of sexual risk behavior; however, little is known about how multidimensional patterns of sexual behavior among MSM may be associated with STIs. METHOD This study applies latent class analysis to data from a large, HIV- sample of 18- to 25-year-old MSM recruited from social and sexual networking Web sites (N = 5965; 76% white, 11% Latino, 5% black, 4% Asian, 4% other; 74% homosexual, 21% bisexual, 1% heterosexual, 3%, unsure/questioning 1% other) to uncover multidimensional patterns of past-year sexual behaviors, partner factors, and protective behavior and their associations with self-reported STI diagnosis. RESULTS We selected a model with 8 classes, with nearly half of participants belonging to a class marked by multiple behaviors with more than 1 partner, and smaller numbers of individuals in classes with a smaller number of behaviors, romantic relationships, and sexual inactivity. Class membership was associated with recent STI diagnosis, with classes marked by no penetrative sex or receptive anal sex with consistent condom use having lower prevalence than those with inconsistent condom use, including those engaging in only insertive anal sex. CONCLUSIONS Findings suggest heterogeneity of behaviors within MSM and that prevention messages may be more effective if they are tailored to individuals' patterns of sexual behavior, as well as demographic and sociocontextual factors.
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36
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Goldenberg T, Stephenson R, Bauermeister J. Cognitive and Emotional Factors Associated with Sexual Risk-Taking Behaviors Among Young Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1127-1136. [PMID: 30607713 PMCID: PMC6872980 DOI: 10.1007/s10508-018-1310-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 08/22/2018] [Accepted: 09/15/2018] [Indexed: 06/09/2023]
Abstract
Young men who have sex with men (YMSM) between the ages of 13 and 24 account for a disproportionate number of new HIV infections in the U.S. Recognizing the unique developmental circumstances that YMSM face and building on the dual-process model, it is important to consider the role of cognitive and emotional factors as well as self-efficacy to negotiate safer sex when understanding experiences of sexual risk-taking among YMSM. This article used structural equation modeling to examine how the decisional balance to use condoms (a cognitive factor) and limerence (an emotional factor) are both directly and indirectly associated with sexual risk-taking behaviors (the number of insertive and receptive condomless anal intercourse partners), with indirect effects occurring via limited self-efficacy to negotiate safer sex. Data were from a cross-sectional online survey of YMSM (aged 18-24) in the U.S. who did not report being in a romantic relationship. Analysis included a sample of 1084 single YMSM who had never tested positive for HIV and who had engaged in anal intercourse in the previous 2 months. Results indicated that the decisional balance to use condoms was both directly and indirectly associated with reduced sexual risk-taking behaviors. Limerence was not directly associated with sexual risk-taking behaviors; however, it was indirectly associated with sexual risk-taking behavior through limited self-efficacy to negotiate safer sex. These findings highlight the importance of considering both cognitive and emotional factors, as well as self-efficacy to use condoms, in the development and implementation of HIV prevention interventions for YMSM.
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Affiliation(s)
- Tamar Goldenberg
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Jose Bauermeister
- Department of Family and Community, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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37
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Fortenberry JD. Trust, Sexual Trust, and Sexual Health: An Interrogative Review. JOURNAL OF SEX RESEARCH 2019; 56:425-439. [PMID: 30289286 DOI: 10.1080/00224499.2018.1523999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Trust is experienced almost constantly in all forms of social and interpersonal relationships, including sexual relationships, and may contribute both directly and indirectly to sexual health. The purpose of this review is to link three aspects of trust to sexual health: (1) the role of trust in sexual relationships; (2) the role of trust in sexually transmitted infection (STI) prevention, particularly condom use; and (3) the relevance of trust in sexual relationships outside of the traditional model of monogamy. The review ends with consideration of perspectives that could guide new research toward understanding the enigmas of trust in partnered sexual relations in the context of sexual and public health.
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Sharma A, Garofalo R, Hidalgo MA, Hoehnle S, Mimiaga MJ, Brown E, Thai J, Bratcher A, Wimbly T, Sullivan PS, Stephenson R. Do Male Couples Agree on Their Sexual Agreements? An Analysis of Dyadic Data. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1203-1216. [PMID: 30895490 PMCID: PMC6458080 DOI: 10.1007/s10508-019-1391-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 11/01/2018] [Accepted: 01/02/2019] [Indexed: 05/07/2023]
Abstract
Male couples often formulate sexual agreements, but little is known about the extent to which partners concur about their exact terms. Disagreements, particularly with respect to sex outside the relationship, may induce stress and potentially increase the risk of HIV and other sexually transmitted infections. Our study sought to describe concordance between male partners on several aspects of their sexual agreements, overall, as well as stratified by dyadic HIV serostatus and relationship duration. Between July 2014 and May 2016, we collected bidirectional data from 160 male couples residing in Atlanta, Boston, and Chicago. Overall, we observed weak concordance for whether or not couples had a mutual agreement about sex with outside partners. Even among 110 couples in which both partners reported having an agreement, there was weak-to-moderate concordance for general rules that might apply to having sex outside the relationship (e.g., forming emotional relationships is not allowed, outside sexual activities must be disclosed), and for specific sexual behaviors allowed or disallowed (e.g., topping without a condom, bottoming without a condom). Concordance for the type of sexual agreement was higher within HIV seroconcordant negative partnerships compared to HIV serodiscordant partnerships, and lower within relationships ≥ 5 years and 1 to < 5 years compared to those < 1 year. Dyadic interventions for male couples (e.g., couples HIV testing and counseling, relationship education programs) can offer unique opportunities for skills building around negotiating sexual agreements and might especially benefit HIV serodiscordant partnerships, and those in the formative stages of their relationships.
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Affiliation(s)
- Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan, 400 N Ingalls St., Ann Arbor, MI, 48109, USA.
- School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Robert Garofalo
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marco A Hidalgo
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samuel Hoehnle
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- School of Public Health, Brown University, Providence, RI, USA
| | - Emily Brown
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jennie Thai
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Anna Bratcher
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Taylor Wimbly
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, 400 N Ingalls St., Ann Arbor, MI, 48109, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Neilands TB, Dworkin SL, Chakravarty D, Campbell CK, Wilson PA, Gomez AM, Grisham KK, Hoff CC. Development and Validation of the Power Imbalance in Couples Scale. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:763-779. [PMID: 29850977 PMCID: PMC6269212 DOI: 10.1007/s10508-018-1190-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 02/28/2018] [Accepted: 03/03/2018] [Indexed: 05/03/2023]
Abstract
Few researchers have quantitatively explored the relationship power-HIV risk nexus in same-sex male couples. We developed and validated the Power Imbalance in Couples Scale (PICS) to measure relationship power among men in same-sex, committed relationships and its association with sexual risk behaviors. We recruited three independent and diverse samples of male couples in the greater San Francisco and New York City metropolitan areas and conducted qualitative interviews (N1 = 96) to inform item development, followed by two quantitative surveys (N2 = 341; N3 = 434) to assess the construct, predictive, convergent, and discriminant validity of the PICS. Exploratory factor analysis of the first survey's data yielded four factors-overtly controlling partner, supportive partner, conflict avoidant actor, and overtly controlling actor-that accounted for more than 50% of the shared variance among the PICS items. Confirmatory factor analysis (CFA) of the second survey's data supported these four factors: χ2(1823) = 2493.40, p < .001; CFI = .96, RMSEA = .03 and WRMR = 1.33. Strong interfactor correlations suggested the presence of a higher-order general perception of power imbalance factor; a higher-order factor CFA model was comparable in fit to the correlated lower-order factors' CFA: χ2(2) = 2.00, p = .37. Internal reliability of the PICS scale was strong: α = .94. Men perceiving greater power imbalances in their relationships had higher odds of engaging in condomless anal intercourse with outside partners of discordant or unknown HIV status (OR 1.27; 95% CI 1.01-1.60; p = .04). The PICS is an important contribution to measuring relationship power imbalance and its sequelae among male couples; it is applicable to research on relationships, sexuality, couples, and HIV prevention.
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Affiliation(s)
- Torsten B Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Shari L Dworkin
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Marker St., #523, San Francisco, CA, 94103, USA
| | - Chadwick K Campbell
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Kirk K Grisham
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Marker St., #523, San Francisco, CA, 94103, USA.
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Klassen BJ, Fulcher K, Chown SA, Armstrong HL, Hogg RS, Moore DM, Roth EA, Lachowsky NJ. "Condoms are … like public transit. It's something you want everyone else to take": Perceptions and use of condoms among HIV negative gay men in Vancouver, Canada in the era of biomedical and seroadaptive prevention. BMC Public Health 2019; 19:120. [PMID: 30691426 PMCID: PMC6350294 DOI: 10.1186/s12889-019-6452-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men. METHODS We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies. RESULTS Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk. CONCLUSIONS These findings indicate that notions of "safety" and "risk" based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men's current prevention needs. Interventions should advance gay men's communication and self-advocacy skills in order to optimize these strategies.
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Affiliation(s)
- Benjamin J Klassen
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of History, Simon Fraser University, Burnaby, BC, Canada
| | - Karyn Fulcher
- School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada
| | | | - Heather L Armstrong
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada.,Centre for Addictions Research of British Columbia, Victoria, BC, Canada
| | - Nathan J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. .,School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada.
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Hill AO, Bavinton BR, Armstrong G. Prevalence and correlates of lifetime and recent HIV testing among men who have sex with men (MSM) who use mobile geo-social networking applications in Greater Tokyo. PLoS One 2019; 14:e0209933. [PMID: 30673729 PMCID: PMC6343926 DOI: 10.1371/journal.pone.0209933] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/13/2018] [Indexed: 12/18/2022] Open
Abstract
Men who have sex with men (MSM) are disproportionately burdened by the human immunodeficiency virus (HIV), accounting for 78% of all Japanese male HIV cases in 2016. Over 30% of newly identified HIV infections in Japan are diagnosed as AIDS annually, suggesting a large proportion of people living with HIV were unaware of their own infection status. An estimated two-thirds of Japanese men who have sex with men (MSM) are not attached to the gay community, and previous studies have largely sampled gay venues, thus, previous studies have likely failed to reach many men in this population. This study therefore examined HIV testing prevalence and correlates among MSM in Greater Tokyo who use gay mobile geo-social networking applications (gay mobile apps), which have been found to increase access to MSM not traditionally accessible through venue-based surveys. Among a sample of 1657 MSM recruited through advertisements on gay mobile apps, the prevalence of lifetime and six-monthly HIV testing was 72.8% and 29.7% respectively. In multiple regression analysis, higher lifetime HIV testing was associated with older age, education, HIV knowledge, anal intercourse with regular and casual male partners, and gay venue attendance. Testing was negatively associated with regular male partner condom use, marriage, residing outside central Tokyo and having both male and female partners. These results indicated that MSM who use gay mobile apps in Greater Tokyo do not meet the CDC yearly testing recommendations for high risk populations. Considering limited HIV prevention funding in Japan for MSM, moderate lifetime and recent testing, and the large number of gay mobile app users, utilization of popular gay mobile apps to promote nearby HIV testing facilities may be an effective prevention policy to target non-community attached MSM, particularly at-risk youth and individuals at risk of sudden-onset AIDS.
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Affiliation(s)
- Adam O. Hill
- Faculty of Arts, School of Social and Political Sciences, University of Melbourne, Parkville, VIC, Australia
| | | | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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Concordance in Reported Love, Trust, and Relationship Quality among Same-Sex Male Relationships. ACTA ACUST UNITED AC 2019; 9. [PMID: 31447951 DOI: 10.1017/jrr.2018.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper examines concurrence of self-reported love, trust, and dyadic quality experiences between partners in 293 male couples. Significant yet poor concurrence was observed for all three self-reported relationship measures, but varied by relationship characteristics. Using an actor-partner interdependence model (APIM), actor and partner characteristics were shown to be associated with self-reported relationship concerns, such as satisfaction and intimate partner violence. This knowledge is important in the development and delivery of couples-based health interventions, such as couples HIV testing and counseling, for interventions that respect the unique relationship dynamics of each couple are needed to effectively address dyadic health.
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Abstract
A sexual agreement is a mutual understanding between two partners regarding sexual and relational behaviors both within and outside of their relationship. Sexual agreements have been central to research and programming efforts around HIV prevention, primarily for male couples. A comprehensive scoping review of the primary literature on sexual agreements, including negotiated safety, was performed to identify what is known about sexual agreements among couples (n = 66). Results indicate a wide range of prevalence of agreements and measurements used to characterize sexual agreements. Findings also report associations between sexual agreements and health and relational outcomes. Several knowledge gaps were identified; specifically, the need to expand sexual agreements research beyond MSM populations and the need to better understand agreement breaks, break disclosure, and how variation in agreement categorization may impact reported prevalence. This review demonstrates the importance of broadening the evidence-base of sexual agreements research and programmatic focus.
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Starks TJ, Robles G, Bosco SC, Dellucci TV, Grov C, Parsons JT. The Prevalence and Correlates of Sexual Arrangements in a National Cohort of HIV-Negative Gay and Bisexual Men in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:369-382. [PMID: 30465312 PMCID: PMC6349557 DOI: 10.1007/s10508-018-1282-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/31/2018] [Accepted: 07/26/2018] [Indexed: 05/22/2023]
Abstract
Sexual agreements have received considerable attention as an aspect of dyadic functioning associated with HIV risk. To date, this research has primarily utilized convenience samples which overrepresented men from large urban areas and with higher HIV risk. The current study utilized a national cohort of 1061 HIV-negative gay and bisexual men recruited to be geographically diverse within the U.S. The sample included 531 (50.0%) men who identified as single. Of the 530 partnered men, 240 (45.3%) were monogamous; 238 (44.9%) were in open relationships (where sex with outside partners was permitted); and 52 (9.8%) were in monogamish relationships (where sex with outside partners was limited to instances where both primary partners were present). Regardless of urban (vs. non-urban) residence, men in monogamous relationships engaged in less anal sex generally and condomless anal sex (CAS) specifically with casual partners. Single men reported significantly more frequent anal sex with casual partners compared to open and monogamish men; however, there were no significant differences among these three groups with respect to CAS with casual partners. In multivariable models, monogamish men reported significantly more frequent marijuana use and alcohol consumption compared to all other groups. Urban (vs. non-urban) residence moderated associations between sexual arrangements and depression as well as the use of illicit drugs other than marijuana. These findings point to the need to better examine the potentially unique mechanisms which confer risk and resilience for gay male couples in urban versus non-urban settings. The observed association between sexual arrangements and substance use suggests interventions which facilitate the negotiation of sexual agreements may present an opportunity to engage in dyadic substance use intervention.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY, 10065, USA
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Gabriel Robles
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
| | - Stephen C Bosco
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Trey V Dellucci
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY, 10065, USA.
- Center for HIV/AIDS Educational Studies and Training, New York, NY, USA.
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA.
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Prevalence and Factors Associated with Inconsistent Condom Use among Men who Have Sex with Men (MSM) who use Mobile Geo-Social Networking Applications in Greater Tokyo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122815. [PMID: 30544768 PMCID: PMC6313488 DOI: 10.3390/ijerph15122815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 11/29/2018] [Accepted: 12/07/2018] [Indexed: 12/26/2022]
Abstract
This study examined the prevalence and factors associated with inconsistent condom use among men who have sex with men (MSM) who use gay mobile geo-social networking applications (gay mobile apps) in Greater Tokyo. Among a sample of 1657 MSM recruited through advertisements on gay mobile apps, inconsistent condom use was reported by over one-third (37%) of participants with regular male partners, 18% with casual male partners, and 20% with female partners. In multiple regression analysis, inconsistent condom use with both regular and casual male partners was more commonly reported among participants without a university education, and among participants reporting lower self-efficacy for safer sex. Inconsistent condom use with casual male partners was more commonly reported among participants living in the central 23 wards of Tokyo. Inconsistent condom use with regular male partners was more commonly reported among participants who identified as a member of the gay community, and who only had male partners. These results indicate that a substantial proportion of Greater Tokyo gay mobile app users use condoms inconsistently, particularly with regular partners, and may be at risk for HIV. This paper provides useful information to help design tailored strategies to reduce inconsistent condom use.
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Starks TJ, Millar BM, Doyle KM, Bertone P, Ohadi J, Parsons JT. Motivational interviewing with couples: A theoretical framework for clinical practice illustrated in substance use and HIV prevention intervention with gay male couples. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2018; 5:490-502. [PMID: 30581887 PMCID: PMC6300150 DOI: 10.1037/sgd0000297] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epidemiological data indicate the need to address substance use and sexual HIV transmission risk among gay and bisexual men in relationships. While brief Motivational Interviewing (MI) delivered to the individual has shown efficacy in reducing sexual HIV risk with casual partners and substance use, the application of MI with couples has received less attention. Most studies of MI with couples have conceptualized the "spouse" or partner as an adjunct participant in the treatment of an identified client. We propose a theoretical framework for conducting MI with a couple, which approaches the couple as the identified client, and may be adopted when either one or both partners engage in the target behavior. We then discuss similarities between MI-processes conceptualized with our proposed framework and those that are salient in existing couples therapies. We utilize case examples from brief MI sessions targeting substance use and sexual HIV risk in gay male couples to illustrate three phenomena unique to the implementation of MI with couples: 1) interpersonal ambivalence; 2) the role of dyadic functioning in tolerating and resolving interpersonal ambivalence; and 3) joint goal formation as a prerequisite to the planning phase of MI. Connecting these phenomena with the transformation of motivation and accommodation processes outlined in Couples Interdependence Theory, this paper suggests that brief MI may be a promising modality for substance use and HIV risk reduction interventions with couples generally and gay couples specifically.
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Affiliation(s)
- Tyrel J. Starks
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave, New York, NY 10065, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY 10034, USA
| | - Brett M. Millar
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Kendell M. Doyle
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Paula Bertone
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Jonathan Ohadi
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Jeffrey T. Parsons
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave, New York, NY 10065, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY 10034, USA
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Wang X, Wang Z, Jiang X, Li R, Wang Y, Xu G, Zou H, Cai Y. A cross-sectional study of the relationship between sexual compulsivity and unprotected anal intercourse among men who have sex with men in shanghai, China. BMC Infect Dis 2018; 18:465. [PMID: 30219033 PMCID: PMC6139151 DOI: 10.1186/s12879-018-3360-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background HIV prevalence among men who have sex with men (MSM) in China is rising rapidly, and unprotected anal intercourse (UAI) is associated with HIV transmission. Recent research has shown that associations between UAI and other factors can differ according to the type of sex partners, including regular partners and casual partners. This study aimed to explore the relationship between sexual compulsivity and UAI according to partner type among MSM in Shanghai, China. Methods A cross-sectional study was conducted among 547 MSM from four districts in Shanghai, China. All participants were recruited using snowball sampling. The Sexual Compulsivity Scale was used to evaluate participants’ sexual compulsivity. Multivariable logistic regression was used to identify factors associated with sexual compulsivity and UAI. The mediation effects of substance use before sex on the relationship between sexual compulsivity and UAI were tested through mediation analyses. Results After adjusting for sociodemographic variables, sexual compulsivity was associated with overall UAI (adjusted odds ratios [AOR] = 1.039, 95% confidence intervals [CI] = 1.004–1.075), UAI with non-regular sex partners (AOR = 1.089, 95% CI = 1.033–1.148) and UAI with commercial sex partners (AOR = 1.185, 95% CI = 1.042–1.349). No significant association was found between sexual compulsivity and UAI with regular sex partners (AOR = 1.029, 95% CI = 0.984–1.077). Mediation analyses indicated that the relationship between sexual compulsivity and UAI was not mediated by either alcohol use before sex or drug use before sex. Conclusions The association between sexual compulsivity and UAI varies depending on the type of UAI partner. Therefore, individuals may engage in different types of UAI for different reasons, and tailored HIV cognitive–behavioral intervention programs are needed.
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Affiliation(s)
- Xin Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Zezhou Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Xueqin Jiang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Rui Li
- Department of Public Health Science, School of Medicine and Dentistry, University of Rochester, New York, USA
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Gang Xu
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China. .,School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China. .,Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China.
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Longitudinal Findings on Changes in and the Link Between HIV-Related Communication, Risky Sexual Behavior, and Relationship Status in Men Who Have Sex With Men Living With HIV. Sex Transm Dis 2018; 44:732-738. [PMID: 28876301 DOI: 10.1097/olq.0000000000000680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reducing the risk of HIV transmission among men who have sex with men (MSM) is a national health priority. This study longitudinally examined changes in and the link between HIV-related communication, unprotected anal intercourse (UAI), and relationship status among MSM. METHODS Data were obtained from 337 MSM living with HIV who participated in a randomized controlled study. Approximately equal percentages of men were randomized to either the disclosure intervention group or the attention control case management group. Repeated measures were collected at 5 time points for 12 months and included health-protective sexual communication (HPSC), HIV disclosure, insertive and receptive UAI, and relationship status. Data were analyzed using mixed-effects models. RESULTS Independent of the treatment condition, HPSC and HIV disclosure increased over time; insertive UAI showed a curvilinear pattern but no significant decrease over time. Relationship status was related to HIV-related communication and UAI. Greater HPSC was related to less insertive and receptive UAI; disclosure was positively related to insertive UAI. CONCLUSIONS Based on the findings, prevention programs should continue to focus on improving HIV-related communication among MSM and consider relationship status in prevention messages. Intervention studies are needed to continue to identify and test factors that help reduce risky sexual behaviors.
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Goldenberg T, Darbes LA, Stephenson R. Inter-partner and Temporal Variations in the Perception of Sexual Risk for HIV. AIDS Behav 2018; 22:1870-1884. [PMID: 28831758 DOI: 10.1007/s10461-017-1876-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study uses longitudinal qualitative methods to examine how gay and bisexual men perceive sexual risk across both a variety of partners and across time. Over ten weeks, participants completed three quantitative personal relationship diaries (PRD) describing sexual encounters during that time period. Participants then completed a timeline-based individual in-depth interview to unpack the PRD data. Participants used multiple factors to determine their own sexual risk (e.g., type of sex, partner concurrency, emotional connections), which often resulted in inconsistencies in defining sexual risk and determining the level of risk both within and across partners and across time. These findings can inform HIV prevention messages and programming.
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Relationship Characteristics and Dyadic Approaches to HIV Health-Enhancing Behaviours Among a Sample of Same-Sex Male Couples From Three U.S. Cities. ACTA ACUST UNITED AC 2018. [DOI: 10.1017/jrr.2018.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Recent modelling estimates up to two-thirds of new HIV infections among men who have sex with men occur within partnerships, indicating the importance of dyadic HIV prevention efforts. Although new interventions are available to promote dyadic health-enhancing behaviours, minimal research has examined what factors influence partners’ mutual engagement in these behaviours, a critical component of intervention success. Actor-partner interdependence modelling was used to examine associations between relationship characteristics and several dyadic outcomes theorised as antecedents to health-enhancing behaviours: planning and decision making, communication, and joint effort. Among 270 male-male partnerships, relationship satisfaction was significantly associated with all three outcomes for actors (p = .02, .02, .06 respectively). Latino men reported poorer planning and decision making (actor p = .032) and communication (partner p = .044). Alcohol use was significantly and negatively associated with all outcomes except actors’ planning and decision making (actors: p = .11, .038, .004 respectively; partners: p = .03, .056, .02 respectively). Having a sexual agreement was significantly associated with actors’ planning and decision making (p = .007) and communication (p = .008). Focusing on interactions between partners produces a more comprehensive understanding of male couples’ ability to engage in health-enhancing behaviours. This knowledge further identifies new and important foci for the tailoring of dyadic HIV prevention and care interventions.
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