Increasing trend of HIV/AIDS among Arab and Jewish male persons in Israel, 1986-2010

The social construction of HIV: A narrative study of Israeli Arabs

"Social determinants of health"-that is, nonmedical care-related factors, forces, and structures that have a strong influence on health-play a vital role in HIV prevention and treatment. In this study, we focused on one such key factor: culture. Israeli Arabs, the largest minority group in Israel, share a unique culture. Although the incidence of HIV/AIDS is lower among Israeli Arabs than among Jews, Arabs account for only 1% of HIV tests in Israel and report poorer HIV-related knowledge, whereas the majority of newly diagnosed Arabs are usually diagnosed with full-blown AIDS. This study explored how HIV/AIDS is socially constructed in Israeli Arab society. A sample of 31 HIV-negative Israeli Arab participants wrote stories about a man living with HIV. Thematic analysis was used to analyze the data. The analysis identified two themes. The first, "HIV and 'forbidden' sexual practices," constructed HIV/AIDS as a sexually transmitted disease associated primarily with premarital sex (a norm transgression in Arab culture). The second theme, "living with HIV," involved two opposing subthemes: "life goes on" and "a ruined life." The former portrayed the life of men with HIV as moving on, at times into a successful future. The latter depicted the point of diagnosis as signifying a turn for the worst-a bleak and hopeless future. The findings suggest that HIV/AIDS is stigmatized among Israeli Arabs and the nature and extent of the stigma corresponds with cultural norms, stressing the importance of designing culturally informed interventions for HIV/AIDS prevention and treatment.

HIV/AIDS stigma and beliefs about HIV transmission among Israeli Jews and Arabs: an exploratory study

Although HIV/AIDS incidence in Israel is lower than in most Western countries, HIV/AIDS burden in Israel is on the rise. The Arabs are the largest ethnic minority in Israel. Medical experts in Israel believe that HIV infection rates among Israeli Arabs are underestimated. Moreover, unofficial data suggest that Arabs are significantly less likely than Jews to be tested for HIV and that Arabs are typically diagnosed at a late stage of their disease. Since data concerning the levels of HIV/AIDS stigma and knowledge can inform policy, this exploratory study compares the extent of HIV/AIDS stigma and beliefs about HIV transmission of Jews to those of Arabs. A convenience sample of 183 Israelis was drawn (135 Jews, 48 Arabs). Data were collected via a computerized, open-ended, self-report questionnaire. The main findings revealed that compared to Jews, Arabs reported more misinformation about HIV transmission. Arabs differed from Jews in key manifestations of stigma (support for coercive policies, attribution of blame and responsibility, anger and fear), but not others (avoidance intentions and discomfort). Arabs scored higher on the Summary Index of Stigma, than did Jews. These preliminary findings indicate a need to design culturally-specific interventions to enhance HIV transmission-related knowledge and to debunk stigma among Israeli Arabs.

Sexual Orientation and Behavior of Adult Jews in Israel and the Association With Risk Behavior

Estimating the size of key risk groups susceptible to HIV/sexually transmitted diseases (STI) is necessary for establishment of interventions and budget allocation. This study aimed to identify various dimensions of sexual orientation and practices in Israel, and correlate the findings with sexual risk behavior (SRB). It used a random representative sample of the Jewish population aged 18-44 years who completed online questionnaires regarding their self-identified sexual orientation, attraction and practices, and SRB. Concordant heterosexuals were those who self-reported heterosexual identity, were attracted and had sex only with the opposite gender. National estimates regarding prevalence of gay, lesbian, and bisexual men and women were based on the civil census. The sample included 997 men and 1005 women, of whom 11.3 and 15.2 % were attracted to the same-gender, 10.2 and 8.7 % reported lifetime same-gender encounters, while 8.2 and 4.8 % self-identified as gay or bisexual men and lesbian or bisexual women, respectively. The estimated population of self-identified Jewish gay or bisexual men and lesbian or bisexual women aged 18-44 in Israel was 94,176, and 57,671, respectively. SRB was more common among self-identified gays or bisexual men and among discordant heterosexual men and women. Those who reported same-gender sexual practices reported greater SRB than those who only had opposite-gender encounters. Interestingly, SRB among discordant heterosexuals was associated with same-sex behavior rather than attraction. Health practitioners should increase their awareness of sexual diversity among their clientele, and should recognize that risk for HIV/STI may exist among self-identified heterosexuals, who may not disclose their actual sexual attraction or practices.

Same-sex sexual attraction, behavior, and practices of Jewish men in Israel and the association with HIV prevalence

In order to efficiently direct efforts and resources required for the prevention of HIV and other sexually transmitted infection among men who have sex with men (MSM) in Israel, it is necessary to define their particular behaviors, estimate their size, and asses the HIV-burden. This cross-sectional study included a sub-sample from a random representative National study performed in Israel, which included Jewish males aged 18-44 who completed online anonymous questionnaires regarding their sexual attraction and practices, commercial sex-work, as well as condom and substances' use. Additionally, participants were asked to identify themselves as gay, bisexual, or heterosexual. National estimates regarding prevalence of risk-behaviors and HIV-infection among MSM were based on the Statistical Abstract of Israel and the National HIV Registry, respectively. Of the total sample of 997 men, 11.9% reported lifetime male sex encounters, while 4.5% and 3.7% self-identified as gay or bisexual, respectively. The estimated population of self-identified Jewish gays/bisexuals aged 18-44 in Israel was 94,176, and in Tel-Aviv 33,839. HIV prevalence among MSM was estimated at 0.7% in Israel and 1.0% in Tel-Aviv. MSM were more likely to live in Tel-Aviv, had higher levels of education, and were scored higher on several determinants of sexual risk in comparison to those attracted to women, including early sexual debut, greater number of sexual partners, ever paid/been paid for sex, sexually coerced, and substance use. In conclusion, MSM were involved in greater risk behaviors than those who only had female sex partners. Most MSM were living in Tel-Aviv and their estimated HIV prevalence was 1.0%.

Arab men who have sex with men in Israel: knowledge, attitudes and sexual practices

OBJECTIVES

Arab men who have sex with men (AMSM) are becoming visible in society, and reports of HIV infection and sexually transmitted infections (STIs) are emerging. This study aimed to assess the knowledge of AMSM regarding HIV transmission, their attitudes towards condom use and their sexual practices compared with Jewish MSM (JMSM), and to evaluate AMSM-JMSM friendships and sexual encounters.

METHODS

Participants in this cross-sectional study completed questionnaires in Arabic or Hebrew. The outcome variable was unprotected anal sex (UAI) in the previous 6 months with a partner(s) whose HIV status was discordant or unknown. AMSM and JMSM indicated if they had friends or sexual encounters from the other ethnic group.

RESULTS

The questionnaires were completed by 342 (16.2%) AMSM and 1775 (83.8%) JMSM in 2012. AMSM were more likely to be religious, 'closeted' and married than JMSM; their knowledge regarding HIV transmission was inferior and attitudes towards condom use were less favourable. AMSM reported less alcohol and drug use than JMSM, were more likely to be attracted to and have sex with women, and reported a greater number of sexual partners and more UAI. Being AMSM was a predictive variable for UAI in the multivariate model. While 178 AMSM (52.0%) reported that most of their close friends were JMSM, 251 (73.4%) had only/mostly sexual encounters with JMSM. Among JMSM, 41 (2.3%) reported that their close friends were AMSM, and 308 (17.3%) had only/mostly sexual encounters with AMSM.

CONCLUSIONS

The knowledge of AMSM regarding HIV transmission and their attitudes towards condom use were less favourable than those of JMSM, and they performed more UAI. AMSM may benefit from targeted interventions, including reconciling their same-sex attraction in positive terms. Same-sex attraction and gay identity may provide common ground to strengthen Arab-Jew communication in Israel.

Missing data in substance abuse research? Researchers' reporting practices of sexual orientation and gender identity

BACKGROUND

Lesbian, gay, bisexual, and transgender individuals are at higher risk for substance use and substance use disorders than heterosexual individuals and are more likely to seek substance use treatment, yet sexual orientation and gender identity are frequently not reported in the research literature. The purpose of this study was to identify if sexual orientation and gender identity are being reported in the recent substance use literature, and if this has changed over time.

METHOD

The PsycINFO and PubMed databases were searched for articles released in 2007 and 2012 using the term "substance abuse" and 200 articles were randomly selected from each time period and database. Articles were coded for the presence or absence of sexual orientation and gender identity information.

RESULTS

Participants' sexual orientation was reported in 3.0% and 4.9% of the 2007 and 2.3% and 6.5% of the 2012 sample, in PsycINFO and PubMed sample articles, respectively, while non-binary gender identity was reported in 0% and 1.0% of the 2007 sample and 2.3% and 1.9% of the 2012 PsycINFO and PubMed sample articles. There were no differences in rates of reporting over time.

CONCLUSIONS

Sexual orientation and gender identity are rarely reported in the substance abuse literature, and there has not been a change in reporting practices between 2007 and 2012. Recommendations for future investigators in reporting sexual orientation and gender identity are included.

Tuberculosis incidence in HIV/AIDS patients in Israel, 1983-2010

Objectives

People living with HIV/AIDS (PLWHA) who develop tuberculosis disease are at greater mortality-risk. This study aimed to assess tuberculosis disease incidence among all PLWHA in Israel and identify populations at high-risk for developing tuberculosis.

Design and Methods

Retrospective cohort-study based on the National HIV and Tuberculosis Registries, which were cross-matched and followed for the last 28-years. PLWHA who developed tuberculosis were compared to those who did not by the Cox-proportional analysis to generate hazard-ratios, and survival-analysis was performed by Log-Rank test.

Results

Of all the 6579 PLWHA reported between 1983 and 2010, corresponding to 55737 person-years, 384 (5.8%) developed tuberculosis. Of those, 14 were Israeli-born and 370 were non-Israeli born. The overall tuberculosis incidence-density was 6.9 cases/1000 person-years (95% CI 1.8–12.0). The cumulative tuberculosis-incidence among PLWHA in 2010 was 586 times higher than in HIV-negative individuals (3400 and 5.8 cases per 100000 population, respectively). Higher hazard-ratios to developing tuberculosis were found in migrant citizens PLWHA who were males, non-Israeli born, those who were diagnosed with HIV/AIDS after 1997, those who originated in high-tuberculosis prevalence country and those who acquired HIV by heterosexual or drug-injection transmission. PLWHA who developed tuberculosis had higher odds of dying than other PLWHA (36.5% and 16.6%, respectively, p<0.001, odds ratio = 2.8, 95% confidence-interval 2.3–3.6). In survival-analysis, time to develop tuberculosis was shorter among males than females, in PLWHA who were reported with HIV after 1997, in heterosexual who originated in high-tuberculosis countries, followed by injecting drug-users, heterosexual from low-tuberculosis burden countries and men who have sex with men.

Conclusion

Tuberculosis-incidence is higher among non-Israeli born PLWHA, with decreasing trends from 1991. Despite the moderate TB-rate disease among PLWHA, it remains an important cause for severe morbidity and mortality. Tuberculosis in PLWHA reflects mainly the tuberculosis-burden in the originating country and possibly also the mode of HIV-transmission.