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Pimentel V, Pineda-Peña A, Sebastião CS, de Paula JL, Ahagon CM, Pingarilho M, Martins MRO, Coelho LPO, Matsuda EM, Alves D, Abecasis AB, Brígido LFM. Dynamics and features of transmission clusters of HIV-1 subtypes in the state of São Paulo, Brazil. Front Public Health 2024; 12:1384512. [PMID: 38903572 PMCID: PMC11187794 DOI: 10.3389/fpubh.2024.1384512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Background Molecular epidemiology techniques allow us to track the HIV-1 transmission dynamics. Herein, we combined genetic, clinical and epidemiological data collected during routine clinical treatment to evaluate the dynamics and characteristics of transmission clusters of the most prevalent HIV-1 subtypes in the state of São Paulo, Brazil. Methods This was a cross-sectional study conducted with 2,518 persons living with HIV (PLWH) from 53 cities in São Paulo state between Jan 2004 to Feb 2015. The phylogenetic tree of protease/reverse transcriptase (PR/RT) regions was reconstructed by PhyML and ClusterPicker used to infer the transmission clusters based on Shimodaira-Hasegawa (SH) greater than 90% (phylogenetic support) and genetic distance less than 6%. Results Of a total of 2,518 sequences, 2,260 were pure subtypes at the PR/RT region, being B (88%), F1 (8.1%), and C (4%). About 21.2% were naïve with a transmitted drug resistance (TDR) rate of 11.8%. A total of 414 (18.3%) of the sequences clustered. These clusters were less evident in subtype B (17.7%) and F1 (15.1%) than in subtype C (40.2%). Clustered sequences were from PLWH at least 5 years younger than non-clustered among subtypes B (p < 0.001) and C (p = 0.037). Men who have sex with men (MSM) predominated the cluster in subtype B (51%), C (85.7%), and F1 (63.6%; p < 0.05). The TDR rate in clustered patients was 15.4, 13.6, and 3.1% for subtypes B, F1, and C, respectively. Most of the infections in subtypes B (80%), C (64%), and F1 (59%) occurred within the state of São Paulo. The metropolitan area of São Paulo presented a high level of endogenous clustering for subtypes B and C. The São Paulo city had 46% endogenous clusters of subtype C. Conclusion Our findings showed that MSM, antiretroviral therapy in Treatment-Naive (ART-naïve) patients, and HIV1-C, played an important role in the HIV epidemic in the São Paulo state. Further studies in transmission clusters are needed to guide the prevention intervention.
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Affiliation(s)
- Victor Pimentel
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Andrea Pineda-Peña
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Cruz S. Sebastião
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Angola
- Instituto Nacional de Investigação em Saúde (INIS), Luanda, Angola
| | | | | | - Marta Pingarilho
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - M. Rosário O. Martins
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | | | - Elaine M. Matsuda
- Instituto Adolfo Lutz, São Paulo, Brazil
- Secretaria da Saúde de Santo André, São Paulo, Brazil
| | - Daniela Alves
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Ana B. Abecasis
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
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Wong HY, Rajasuriar R, Wong PL, Lee YK. "I suppose in our culture, old means no sex": PLWH and healthcare provider views on factors influencing late HIV testing and diagnosis among older adults in Malaysia. AIDS Care 2024:1-15. [PMID: 38526987 DOI: 10.1080/09540121.2024.2331220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/08/2024] [Indexed: 03/27/2024]
Abstract
The proportion of new HIV diagnoses among older adults aged ≥50 years continues to rise. Older adults are at higher risk of late diagnosis which is associated with higher treatment complexity and poorer health outcomes. Few studies in the Asia-Pacific region have explored factors contributing to late presentation and diagnosis in this population. Thus, our study aimed to explore factors influencing late HIV diagnosis among older adults ≥50 years in Malaysia. We conducted in-depth interviews with 16 older adults newly diagnosed with HIV (OPLWH) and focus group discussions with seven healthcare providers (HCPs) from different specialties in an academic tertiary hospital in Malaysia. All sessions were audio-recorded, transcribed verbatim and analysed thematically. Three main themes related to late diagnosis among OPLWH emerged: (1) challenge in recognizing HIV symptoms among older persons, (2) older persons and HCPs having low index of suspicion of HIV and (3) poor acceptance of HIV testing among older persons due to perceived personal and social identities. HCPs often missed HIV symptoms and these collectively culminated in OPLWH experiencing complex diagnostic journeys resulting in late HIV diagnosis. To reduce delays in HIV diagnosis, strategies are needed to improve HIV knowledge and risk perception among both older adults and HCPs.
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Affiliation(s)
- Hoi Yee Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pui Li Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Murayama H, Pearson CAB, Abbott S, Miura F, Jung SM, Fearon E, Funk S, Endo A. Accumulation of Immunity in Heavy-Tailed Sexual Contact Networks Shapes Mpox Outbreak Sizes. J Infect Dis 2024; 229:59-63. [PMID: 37402631 PMCID: PMC10786257 DOI: 10.1093/infdis/jiad254] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 07/06/2023] Open
Abstract
Many countries affected by the global outbreak of mpox in 2022 have observed a decline in cases. Our mathematical model accounting for heavy-tailed sexual partnership distributions suggests that mpox epidemics can hit the infection-derived herd immunity threshold and begin to decline, with <1% of sexually active men who have sex with men infected regardless of interventions or behavioral changes. We consistently found that many countries and US states experienced an epidemic peak, with cumulative cases of around 0.1% to 0.5% among men who have sex with men. The observed decline in cases may not necessarily be attributable to interventions or behavioral changes primarily.
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Affiliation(s)
- Hiroaki Murayama
- School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Carl A B Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Republic of South Africa
| | - Sam Abbott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Fuminari Miura
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Center for Marine Environmental Studies, Ehime University, Ehime, Japan
| | - Sung-mok Jung
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Fearon
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine
- Institute for Global Health, University College London, London, United Kingdom
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Akira Endo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Janulis P, Jenness SM, Risher K, Phillips G, Mustanski B, Birkett M. Substance use and variation in sexual partnership rates among young MSM and young transgender women: Disaggregating between and within-person associations. Drug Alcohol Depend 2023; 252:110968. [PMID: 37774516 PMCID: PMC10615872 DOI: 10.1016/j.drugalcdep.2023.110968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Substance use has been extensively linked to sexual behavior and HIV/STI risk among men who have sex with men (MSM) and transgender women (TW). However, the impact of specific substances and on specific partnership types is not well characterized. The current study seeks to estimate the association between specific substances and partnership rates while carefully disaggregating between and within-person associations to characterize the nature of these associations and inform prevention interventions. METHODS Using data from a longitudinal cohort (n = 1159) of young MSM (YMSM) and young TW (YTW), we utilized a series of hybrid mixed effect models to estimate the associations between substance use (i.e., heavy episodic drinking [HED], marijuana, cocaine, ecstasy, methamphetamine, poppers, prescription stimulant, prescription painkiller, and prescription depressants) and partnerships (i.e., one-time, casual, and main). RESULTS Results from multivariable models indicated people using substances had higher one-time (HED, poppers) and casual (HED, methamphetamine, poppers) partnership rates. In addition, participants reported higher rates of one-time (HED, ecstasy, methamphetamine, poppers) and casual partners (HED, marijuana, cocaine, methamphetamines, poppers) during periods of substance use. CONCLUSION These findings confirm that the highest rates of sexual activity occur among YMSM-YTW using substances during periods of substance use. Yet, these findings should caution researchers against simplistic generalizations as these associations differ across substance and partnership types. Efforts to promote the health of MSM-YTW who use substances should carefully consider this complexity as interventions accounting for the unique cultural context of substance use in these populations are most likely to be successful.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States.
| | | | - Kathryn Risher
- Department of Public Health Sciences, Penn State College of Medicine, United States
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
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Brainard J, Smith LE, Potts HWW, Rubin GJ. The relationship between age and sex partner counts during the mpox outbreak in the UK, 2022. PLoS One 2023; 18:e0291001. [PMID: 37682827 PMCID: PMC10490899 DOI: 10.1371/journal.pone.0291001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Understanding the dynamics of an infectious disease outbreak linked to sexual activity requires valid expectations of likely counts of unique sex partners during the infectious period. Typically, age is the key demographic trait linked to expected partner count, with many transmission models removing adults from the sexually active pool abruptly at a pre-specified age threshold. Modelling the rate of decline in partner counts with age would benefit from a better description of empirical evidence. METHODS During the 2022 mpox epidemic in the UK, we asked individuals about their partner counts in the preceding three weeks, which is about the same as usual infectious period for persons with active mpox. We used negative binomial regression (all responses) and Weibull regression (non-zero responses) to analyse the relationship between age and partner counts, adjusted for other demographic data (such as education level and occupation), sub-dividing by three types of respondent: men who have sex with men (MSM), men who have sex with women, and women who have sex with men. RESULTS Most respondents had zero or one recent partner, all distributions were skewed. There was a relatively linear declining relationship between age and partner counts for heterosexual partnership groups, but a peak in partner counts and concurrency for MSMs in middle age years (age 35-54), especially for MSM who seemed to be in a highly sexually active subgroup. CONCLUSION Useful data were collected that can be used to describe sex partner counts during the British mpox epidemic and that show distinctive partner count relationships with age, dependent on partnership type.
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Affiliation(s)
- Julii Brainard
- Norwich Medical School, University of East Anglia Norwich, Norwich, United Kingdom
| | - Louise E. Smith
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Henry W. W. Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - G. James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Fernandes G, Maldonado V. Behavioral aspects and the transmission of Monkeypox: A novel approach to determine the probability of transmission for sexually transmissible diseases. Infect Dis Model 2023; 8:842-854. [PMID: 37502608 PMCID: PMC10369468 DOI: 10.1016/j.idm.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Motivated by the 2022 worldwide Monkeypox (MPox) outbreak, a compartmental model is proposed to predict the evolution of the disease. Numerous models have been proposed for infectious diseases so far, although the number of variables makes it difficult to establish causation relations between individual factors and transmission rates. In order to evaluate the reaction of susceptible people to avoid infection during the outbreak, the rate of transmission is modeled through a unique phenomenological probabilistic approach, allowing the expression of the rate of generation of new cases in terms of two characteristics of the susceptible group: the frequency of sexual encounters and the probability of transmission given that there is a sexual encounter. Transmission rates are obtained and compared for the U.S. and several other countries. Results show reductions of up to 71% in the transmissibility parameter, which may be combined with variations in the frequency of sexual encounters (obtained through behavioral research) to determine the changes in the probability of transmission during an outbreak in a much more convenient way than current alternatives. This framework presents a valuable tool to health authorities in the understanding of future sexually transmissible disease outbreaks.
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Russ S, Zhang C, Przybyla S, Liu Y. Racial Differences of Psychosocial Characteristics, HIV Risk-Taking and HIV Prevention Uptake between Men Who Have Sex with Men Only and Men Who Have Sex with Men and Women: A Community-Based Study in Two US Cities. JOURNAL OF HOMOSEXUALITY 2023; 70:1959-1977. [PMID: 35271427 DOI: 10.1080/00918369.2022.2048160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bisexual behavior preference plays an important role in shaping HIV risks among men who have sex with men (MSM), yet few studies have examined the racial differences in the patterns of sexual risk and HIV prevention uptake between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). We conducted a community-based study to identify and compare psychosocial characteristics, sexual risks, HIV testing frequency, and pre-exposure prophylaxis (PrEP) engagement between Black and White MSMW and MSMO in two US cities. Findings indicate that White MSMW were most likely to engage in HIV risk-taking behaviors (e.g., alcohol/drug use before sex, condomless/group sex), while Black MSMW were least likely to recently test for HIV or report awareness (aPR: 0.32, 95% CI: 0.17-0.61), willingness (aPR: 0.58, 95% CI: 0.30-0.98), and use (aPR: 0.59, 95% CI: 0.31-0.93) of PrEP. Findings from our study supplement salient information for designing culturally tailored HIV prevention interventions for specific MSM subgroups in the US.
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Affiliation(s)
- Savanah Russ
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Chen Zhang
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Yu Liu
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
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Feijoo-Cid M, Fernández-Cano MI, Zalazar V, Moriña-Soler D, García-Sierra R, Arreciado Marañón A, Sued O. Assessing the Underestimation of HIV Risk Infection among Young Men Who Have Sex with Men in Argentina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15269. [PMID: 36429984 PMCID: PMC9690491 DOI: 10.3390/ijerph192215269] [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: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study is to describe the discordance between the self-perceived risk and actual risk of HIV among young men who have sex with men (YMSM) and its associated factors. An online, cross-sectional study was conducted with 405 men recruited from an Argentinian NGO in 2017. Risk discordance (RD) was defined as the expression of the underestimation of risk, that is, as a lower self-perception of HIV risk, as measured with the Perceived Risk of HIV Scale, than the current risk of HIV infection, as measured by the HIV Incidence Risk Index. Multivariate logistic regression models were used to analyze the associations between the RD and the explanatory variables. High HIV risk was detected in 251 (62%), while 106 (26.2%) showed high self-perceived risk. RD was found in 230 (56.8%) YMSM. The predictors that increased RD were consistent condom use with casual partners (aOR = 3.8 [CI 95:1.5-11.0]), the use of Growler to meet partners (aOR = 10.38 [CI 95:161-121.94]), frequenting gay bars (aOR = 1.9 [95% CI:1.1-3.5]) and using LSD (aOR = 5.44 [CI 95:1.32-30.29]). Underestimation of HIV risk in YMSM is associated with standard HIV risk behavior and modulated by psychosocial aspects. Thus, prevention campaigns aimed at YMSM should include these factors, even though clinical practice does not. Health professionals should reconsider adapting their instruments to measure the risk of HIV in YMSM. It is unknown what score should be used for targeting high-risk YMSM, so more research is needed to fill this gap. Further research is needed to assess what score should be used for targeting high-risk in YMSM.
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Affiliation(s)
- Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra, Spain
- Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - María Isabel Fernández-Cano
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra, Spain
- Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - Virginia Zalazar
- Dirección de Investigaciones, Fundación Huésped, Buenos Aires C1202ABB, Argentina
| | - David Moriña-Soler
- Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Riskcenter-IREA, 08035 Barcelona, Spain
| | - Rosa García-Sierra
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra, Spain
- Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
| | - Antonia Arreciado Marañón
- Department of Nursing, Faculty of Medicine, Universitat Autónoma de Barcelona, 08193 Bellaterra, Spain
- Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - Omar Sued
- Dirección de Investigaciones, Fundación Huésped, Buenos Aires C1202ABB, Argentina
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Zhang T, Yu Z, Song D, Chen Y, Yao T, Peixoto E, Huang H, Zhang H, Yang J, Gong H, Chen J, Liu Y, Li C, Yu M, Cui Z, Ma J. Sexual Behavior Transition and Acute and Early HIV Infection Among Men Who Have Sex With Men: Evidence from an Open Cohort in China, 2011-2019. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3557-3568. [PMID: 35904694 DOI: 10.1007/s10508-022-02320-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 12/14/2021] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
The present study examined how sexual behaviors transit over time among men who have sex with men (MSM) and whether these transitions were associated with acute and early HIV (AEH) infection. An open cohort study was conducted using snowball sampling to recruit MSM via physical venues and Internet venues from 2011 to 2019, in China. Cox models were used to estimate the correlates of risk factors and AEH infection. We used Latent Transition Analysis (LTA) to describe behavioral profile and explore latent behavioral "trans-phenotypes," then examined the effect between different "trans-phenotypes" and AEH infection risk and explored the effect of characteristics as possible predictors of sexual behavior transition. Of 6502 MSM, a total of 1974 individuals with negative human immunodeficiency virus (HIV) tests at baseline and at least 2 visit records were included in the final analysis from 2011 to 2019. During an average 1.84 years of follow-up, 64 AEH infections were documented. In the multivariable Cox model, the association between condom use in last anal sex (HR: 0.095, 0.038-0.205), fewer sexual partners (HR: 0.375, 0.205-0.712), low frequency of condom use (HR: 3.592, 1.186-11.272), and AEH acquisition were found. The percentage of MSM with "maintain/develop safety-profile," "consistent risky-profile," and "safety-profile to risky-profile" were 52.48, 40.17, and 7.35%, respectively. Compared with "maintain\develop safety-profile," "consistent or develop risky-profile" had an increasing likelihood of AEH infection. Meanwhile, male sex workers (MSWs) or older MSM were more likely to consist or transit in "risky-profile." Having middle education is a risk factor to transit in "risky-profile" for MSM with "safety-profile" at baseline. In addition, MSM who accept health services in the past year engaged in higher proportion of developing safety-profile. Approximately half of MSM maintain or develop risky behavior with the increasing likelihood of AEH acquisition in China, which suggested that targeted and intensive interventions should be prioritized to maintain safety-profile. Clinical Trial Number: ChiCTR2000039500.
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Affiliation(s)
- Tiantian Zhang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Zeyang Yu
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Desheng Song
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yang Chen
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Tingting Yao
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Elissa Peixoto
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Huijie Huang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Honglu Zhang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Jie Yang
- Tianjin Shenlan Community-Based Organization, Tianjin, China
| | - Hui Gong
- STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jiageng Chen
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yuanyuan Liu
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Changping Li
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Zhuang Cui
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.
| | - Jun Ma
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
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Alibudbud R. Social and Psychological Factors Influencing HIV Sexual Risk Behaviors among Young Adult Filipino Men Who Have Sex with Men (MSM) in Metro Manila. SEXUAL HEALTH & COMPULSIVITY 2022. [DOI: 10.1080/26929953.2022.2056555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Janulis P, Goodreau SM, Birkett M, Phillips G, Morris M, Mustanski B, Jenness SM. Temporal Variation in One-Time Partnership Rates Among Young Men Who Have Sex With Men and Transgender Women. J Acquir Immune Defic Syndr 2021; 87:e214-e221. [PMID: 33675616 PMCID: PMC8192435 DOI: 10.1097/qai.0000000000002679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Volatility in sexual contact rates has been recognized as an important factor influencing HIV transmission dynamics. One-time partnerships may be particularly important given the potential to quickly accumulate large number of contacts. Yet, empirical data documenting individual variation in contact rates remain rare. This study provides much needed data on temporal variation in one-time partners to better understand behavioral dynamics and improve the accuracy of transmission models. METHODS Data for this study were obtained from a longitudinal cohort study of young men who have sex with men and transgender women in Chicago. Participants provided sexual network data every 6 months for 2 years. A series of random effects models examined variation in one-time partnership rates and disaggregated within and between associations of exposure variables. Exposure variables included prior number of one-time partners, number of casual partners, and having a main partner. RESULTS Results indicated substantial between-person and within-person variation in one-time partners. Casual partnerships were positively associated and main partnerships negatively associated with one-time partnership rates. There remained a small positive association between prior one-time partnerships and the current number of one-time partnerships. CONCLUSIONS Despite the preponderance of a low number of one-time partners, substantial variation in one-time partnership rates exists among young men who have sex with men and transgender women. Accordingly, focusing on high contact rate individuals alone may be insufficient to identify periods of highest risk. Future studies should use these estimates to more accurately model how volatility impacts HIV transmission and better understand how this variation influences intervention effectiveness.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Steven M Goodreau
- Departments of Anthropology and Epidemiology, University of Washington
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
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12
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Sherriff NS, Jones AM, Mirandola M, Gios L, Marcus U, Llewellyn C, Rosinska M, Folch C, Dias S, Toskin I, Alexiev I, Kühlmann-Berenzon S. Factors related to condomless anal intercourse between men who have sex with men: results from a European bio-behavioural survey. J Public Health (Oxf) 2021; 42:e174-e186. [PMID: 31090894 PMCID: PMC7251420 DOI: 10.1093/pubmed/fdz052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/17/2019] [Indexed: 12/11/2022] Open
Abstract
Background Relationship status is an important factor associated with condomless anal intercourse (CAI) amongst men who have sex with men (MSM). Methods A multi-centre bio-behavioural survey with MSM was conducted in 13 European cities (n = 4901) exploring factors associated with CAI via bivariate and multivariate multilevel logistic regression analyses. Results Likelihood of CAI with casual partners was associated with being ‘out’ to a majority (AOR = 1.19;95% CI 1,1.42); knowing their HIV status (AOR = 1.86; 95% CI 1.25,2.76); using substances (1–2 AOR = 1.39; 95% CI 1.16,1.63, 2+ AOR = 1.81; 95% CI 1.35,2.42); being older (AOR = 0.98; 95% CI 0.97,0.99); successful sero-communication (AOR = 0.79; 95% CI 0.67,0.94); and, not having a recent HIV test (AOR = 0.78; 95% CI 0.66,0.92). CAI with steady partners was associated with successful sero-communication (AOR = 2.72; 95% CI 2.72,3.66); not having a recent HIV test (AOR = 1.26; 95% CI 1.09,1.46), and; being older (AOR = 0.99; 95% CI 0.98,0.99). Conclusions Understandings of partner type and/or relationship status in relation to CAI amongst MSM can potentially play an important role in the development of culturally appropriate HIV/STI prevention and risk-reduction efforts targeting at-risk MSM. Our results speak to the need to consider segmented and tailored public health and health promotion initiatives for MSM with differing CAI behaviours and relationship profiles.
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Affiliation(s)
- N S Sherriff
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, Brighton, BN1 9PH, UK
| | - A M Jones
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom, BN13 3EP, UK
| | - M Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - L Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - U Marcus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - C Llewellyn
- Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK
| | - M Rosinska
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - C Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya / CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - S Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública & GHTM, Universidade NOVA de Lisboa, Portugal
| | - I Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - I Alexiev
- National Reference Laboratory of HIV, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - S Kühlmann-Berenzon
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
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13
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Zhao M, Liu H, Chen X, Feldman MW. Sexual network and condom use among male migrants in the context of China's gender imbalance. AIDS Care 2021; 34:1048-1052. [PMID: 34115571 DOI: 10.1080/09540121.2021.1938965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the context of China's gender imbalance, this study addresses the characteristics of sexual networks and their association with condom use in a sample of 713 male migrants (aged 28-64) who have rural hukou (household registration) in China. Descriptive statistics, univariate analyses, and multilevel random intercept models were used to investigate the characteristics of sexual networks and their associations with condom use. We found that age, marital status, type of sex partners, support (the main help given to each sex partner by the participant), type of sexual intercourse, and stability of sexual relationships were associated with condom use. The sexual networks were mainly composed of sex partners of similar age (58.46%), unmarried people (50.53%), and regular partners (49.38%). Married male migrants were more likely to use condoms with casual partners; unmarried male migrants were less likely to use condoms in emotional and stable relationships. Variation in individual factors, sex partners, and sexual relationship characteristics contribute to participation in condomless sex by male migrants. HIV prevention strategies should target unmarried male migrants and their casual sex partners by increasing their awareness of the risk of HIV transmission and the availability of free condoms.
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Affiliation(s)
- Min Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Huijun Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Xiangjun Chen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, People's Republic of China
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14
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Hendrickx DM, Delva W, Hens N. Influence of sexual risk behaviour and STI co-infection dynamics on the evolution of HIV set point viral load in MSM. Epidemics 2021; 36:100474. [PMID: 34153622 DOI: 10.1016/j.epidem.2021.100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/17/2021] [Accepted: 06/07/2021] [Indexed: 11/27/2022] Open
Abstract
HIV viral load (VL) is an important predictor of HIV progression and transmission. Anti-retroviral therapy (ART) has been reported to reduce HIV transmission by lowering VL. However, apart from this beneficial effect, increased levels of population mean set-point viral load (SPVL), an estimator for HIV virulence, have been observed in men who have sex with men (MSM) in the decade following the introduction of ART in The Netherlands. Several studies have been devoted to explain these counter-intuitive trends in SPVL. However, to our knowledge, none of these studies has investigated an explanation in which it arises as the result of a sexually transmitted infection (STI) co-factor in detail. In this study, we adapted an event-based, individual-based model to investigate how STI co-infection and sexual risk behaviour affect the evolution of HIV SPVL in MSM before and after the introduction of ART. The results suggest that sexual risk behaviour has an effect on SPVL and indicate that more data are needed to test the effect of STI co-factors on SPVL. Furthermore, the observed trends in SPVL cannot be explained by sexual risk behaviour and STI co-factors only. We recommend to develop mathematical models including also factors related to viral evolution as reported earlier in the literature. However, this requires more complex models, and the collection of more data for parameter estimation than what is currently available.
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Affiliation(s)
- Diana M Hendrickx
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium.
| | - Wim Delva
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium; The South African Department of Science and Technology-National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa; Department of Global Health, Faculty of Medicine and Health, Stellenbosch University, Stellenbosch, South Africa; International Centre for Reproductive Health, Ghent University, Ghent, Belgium; Rega Institute for Medical Research, KU Leuven, Leuven, Belgium; School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Niel Hens
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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15
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Moshiri N, Smith DM, Mirarab S. HIV Care Prioritization Using Phylogenetic Branch Length. J Acquir Immune Defic Syndr 2021; 86:626-637. [PMID: 33394616 PMCID: PMC7933099 DOI: 10.1097/qai.0000000000002612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The structure of the HIV transmission networks can be dictated by just a few individuals. Public health intervention, such as ensuring people living with HIV adhere to antiretroviral therapy and remain virally suppressed, can help control the spread of the virus. However, such intervention requires using limited public health resource allocations. Determining which individuals are most at risk of transmitting HIV could allow public health officials to focus their limited resources on these individuals. SETTING Molecular epidemiology can help prioritize people living with HIV by patterns of transmission inferred from their sampled viral sequences. Such prioritization has been previously suggested and performed by monitoring cluster growth. In this article, we introduce Prioritization using AnCesTral edge lengths (ProACT), a phylogenetic approach for prioritizing individuals living with HIV. METHODS ProACT starts from a phylogeny inferred from sequence data and orders individuals according to their terminal branch length, breaking ties using ancestral branch lengths. We evaluated ProACT on a real data set of 926 HIV-1 subtype B pol data obtained in San Diego between 2005 and 2014 and a simulation data set modeling the same epidemic. Prioritization methods are compared by their ability to predict individuals who transmit most after the prioritization. RESULTS Across all simulation conditions and most real data sampling conditions, ProACT outperformed monitoring cluster growth for multiple metrics of prioritization efficacy. CONCLUSION The simple strategy used by ProACT improves the effectiveness of prioritization compared with state-of-the-art methods that rely on monitoring the growth of transmission clusters defined based on genetic distance.
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Affiliation(s)
- Niema Moshiri
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, 92093, USA
| | - Davey M. Smith
- Department of Medicine, University of California, San Diego, La Jolla, 92093, USA
| | - Siavash Mirarab
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, 92093, USA
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16
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Understanding the HIV Epidemic Among MSM in Baltimore: A Modeling Study Estimating the Impact of Past HIV Interventions and Who Acquired and Contributed to Infections. J Acquir Immune Defic Syndr 2021; 84:253-262. [PMID: 32141958 PMCID: PMC8432604 DOI: 10.1097/qai.0000000000002340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Supplemental Digital Content is Available in the Text. Men who have sex with men (MSM) in the United States are disproportionately affected by HIV. We estimated the impact of past interventions and contribution of different population groups to incident MSM HIV infections.
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17
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Xu X, Chow EPF, Ong JJ, Hoebe CJPA, Williamson D, Shen M, Kong FYS, Hocking JS, Fairley CK, Zhang L. Modelling the contribution that different sexual practices involving the oropharynx and saliva have on Neisseria gonorrhoeae infections at multiple anatomical sites in men who have sex with men. Sex Transm Infect 2020; 97:183-189. [PMID: 33208511 DOI: 10.1136/sextrans-2020-054565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The spectrum of sexual practices that transmit Neisseria gonorrhoeae in men who have sex with men (MSM) is controversial. No studies have modelled potential Neisseria gonorrhoeae transmission when one sexual practice follows another in the same sexual encounter ('sequential sexual practices'). Our aim was to test what sequential practices were necessary to replicate the high proportion of MSM who have more than one anatomical site infected with gonorrhoea ('multisite infection'). METHODS To test our aim, we developed eight compartmental models. We first used a baseline model (model 1) that included no sequential sexual practices. We then added three possible sequential transmission routes to model 1: (1) oral sex followed by anal sex (or vice versa) (model 2); (2) using saliva as a lubricant for penile-anal sex (model 3) and (3) oral sex followed by oral-anal sex (rimming) or vice versa (model 4). The next four models (models 5-8) used combinations of the three transmission routes. RESULTS The baseline model could only replicate infection at the single anatomical site and underestimated multisite infection. When we added the three transmission routes to the baseline model, oral sex, followed by anal sex or vice versa, could replicate the prevalence of multisite infection. The other two transmission routes alone or together could not replicate multisite infection without the inclusion of oral sex followed by anal sex or vice versa. CONCLUSIONS Our gonorrhoea model suggests sexual practices that involve oral followed by anal sex (or vice versa) may be important for explaining the high proportion of multisite infection.
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Affiliation(s)
- Xianglong Xu
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China.,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric P F Chow
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason J Ong
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China.,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Christian J P A Hoebe
- Department of Infectious Diseases, South Limburg Public Health Services, Geleen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Deborah Williamson
- Melbourne Diagnostic Unit Public Health Laboratory, University of Melbourne, Melbourne, Victoria, Australia.,Doherty Applied Microbial Genomics, Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mingwang Shen
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Fabian Yuh Shiong Kong
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane S Hocking
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China.,Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Christopher K Fairley
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China.,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Lei Zhang
- China Australia Joint Research Center for Infectious Diseases, Xian Jiaotong University, Xi'an, Shaanxi, China .,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
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18
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Guillon M, Fouéré S, Segouin C, Simon A. The association between future time perspective and sexual behaviours in individuals attending HIV testing centres. Eur J Public Health 2020; 29:1037-1042. [PMID: 30903179 DOI: 10.1093/eurpub/ckz040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most European countries are still facing a high burden of sexually transmitted infections (STIs) cases each year. Available literature has found associations between time preference, i.e. the relative weight given by individuals to future outcomes compared to present ones, and various health behaviours such as tobacco or alcohol consumption, vaccination or participation in cancer screening programmes. Our objective is to investigate the role of future preference in risky sexual behaviours. METHODS We conducted a cross-sectional study using self-administered questionnaires in three HIV testing centres in Paris. We collected data on sexual behaviours, risk perceptions, risk attitude, future preference (Considerations of Future Consequences scale) and socioeconomic and demographic variables. Full data for variables used in regression analyses were available for 1090 respondents. We study factors associated with condom use at the first sexual encounter, with the frequency of condom use and with the number of sexual partners. RESULTS In the full sample, future preference is positively correlated with both measures of condom use while it is negatively correlated with the number of sexual partners. Decomposing the analysis by risk group, our results indicate that future preference has more impact on sexual behaviours, especially condom use, among men who have sex with men compared to heterosexual men and, to a lesser extent, compared to heterosexual women. CONCLUSION If future time perspective is confirmed as a determinant of safer sexual behaviours, prevention campaigns could be shifted towards greater information on short-term consequences of STIs.
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Affiliation(s)
- Marlène Guillon
- Montpellier Recherche en Economie, Université de Montpellier, Montpellier, France
| | - Sébastien Fouéré
- CeGIDD Saint-Louis, Fernand-Widal, Le Checkpoint, Hôpitaux Universitaires Sant-Louis, Lariboisière, Fernand-Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Christophe Segouin
- CeGIDD Saint-Louis, Fernand-Widal, Le Checkpoint, Hôpitaux Universitaires Sant-Louis, Lariboisière, Fernand-Widal, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne Simon
- CeGIDD Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique des Hôpitaux de Paris, Paris, France
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19
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Lee J, Cassels S. Immigrant Generational Differences in Social Support and Sexual Risk Behaviors Among Men Who Have Sex With Men in Seattle, Washington. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:282-295. [PMID: 32897132 PMCID: PMC8055472 DOI: 10.1521/aeap.2020.32.4.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Different immigrant generations may encounter distinct sexual opportunities with implications for HIV transmission. Yet, few studies have examined how immigrant generational status is associated with sexual risk behaviors among men who have sex with men (MSM). We explored relationships between immigrant generational status, social support, and sexual risk behaviors among English-speaking MSM using data from surveys conducted in Seattle, Washington, in 2014 (n = 323). We compared the sexual risk behaviors and social support of first-generation, second-generation, and third- and higher-generation MSM, and examined whether immigrant generational status and social support were associated with sexual risk behaviors using logistic regression models. Second-generation MSM reported lower friend social support than first- or third- and higher-generation MSM (p < .05). However, immigrant generational status was not associated with sexual risk behavior outcomes, even after accounting for social support. Results suggest that differences in immigration processes such as acculturation may be more predictive of risk behaviors than generational status alone.
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Affiliation(s)
- Jane Lee
- School of Social Work, University of Washington, Seattle, Washington
| | - Susan Cassels
- Department of Geography, University of California, Santa Barbara, California
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20
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Moshiri N, Ragonnet-Cronin M, Wertheim JO, Mirarab S. FAVITES: simultaneous simulation of transmission networks, phylogenetic trees and sequences. Bioinformatics 2020; 35:1852-1861. [PMID: 30395173 DOI: 10.1093/bioinformatics/bty921] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 11/14/2022] Open
Abstract
MOTIVATION The ability to simulate epidemics as a function of model parameters allows insights that are unobtainable from real datasets. Further, reconstructing transmission networks for fast-evolving viruses like Human Immunodeficiency Virus (HIV) may have the potential to greatly enhance epidemic intervention, but transmission network reconstruction methods have been inadequately studied, largely because it is difficult to obtain 'truth' sets on which to test them and properly measure their performance. RESULTS We introduce FrAmework for VIral Transmission and Evolution Simulation (FAVITES), a robust framework for simulating realistic datasets for epidemics that are caused by fast-evolving pathogens like HIV. FAVITES creates a generative model to produce contact networks, transmission networks, phylogenetic trees and sequence datasets, and to add error to the data. FAVITES is designed to be extensible by dividing the generative model into modules, each of which is expressed as a fixed API that can be implemented using various models. We use FAVITES to simulate HIV datasets and study the realism of the simulated datasets. We then use the simulated data to study the impact of the increased treatment efforts on epidemiological outcomes. We also study two transmission network reconstruction methods and their effectiveness in detecting fast-growing clusters. AVAILABILITY AND IMPLEMENTATION FAVITES is available at https://github.com/niemasd/FAVITES, and a Docker image can be found on DockerHub (https://hub.docker.com/r/niemasd/favites). SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Niema Moshiri
- Bioinformatics and Systems Biology Graduate Program, UC San Diego, La Jolla, USA
| | | | | | - Siavash Mirarab
- Department of Electrical and Computer Engineering, UC San Diego, La Jolla, USA
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21
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Starks TJ, Doyle KM, Shalhav O, John SA, Parsons JT. An Examination of Gay Couples' Motivations to Use (or Forego) Pre-exposure Prophylaxis Expressed During Couples HIV Testing and Counseling (CHTC) Sessions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:157-167. [PMID: 29651646 DOI: 10.1007/s11121-018-0892-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While many gay couples perceive themselves to have little risk for HIV transmission, research estimates that 35-68% of new HIV infections are transmitted within main partnerships. Pre-exposure prophylaxis (PrEP) is recommended for those partnered gay and bisexual men (GBM) who engage in sex outside their primary relationship or who have an HIV-positive partner. There is reason to believe that couples' sero-status and sexual agreement will shape perceptions of PrEP's personal relevance among gay couples. The current study examined motivations for and ambivalence towards PrEP uptake reported in a sample of 67 gay couples during completion of a brief CDC-recommended prevention intervention: Couples HIV Testing and Counseling. Findings suggest that all types of couples identified some circumstances in which they would consider PrEP; however, PrEP messaging should be crafted to avoid undermining current prevention strategies or threatening the trust and legitimacy of the relationship.
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Affiliation(s)
- Tyrel J Starks
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36th Street, 9th Floor, New York, NY, 10018, USA.
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA.
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10016, USA.
| | - Kendell M Doyle
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36th Street, 9th Floor, New York, NY, 10018, USA
| | - Ore Shalhav
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36th Street, 9th Floor, New York, NY, 10018, USA
| | - Steven A John
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36th Street, 9th Floor, New York, NY, 10018, USA
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36th Street, 9th Floor, New York, NY, 10018, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY, 10016, USA
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22
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Trends in Number and Composition of Sex Partners Among Men Who Have Sex With Men in the United States, National HIV Behavioral Surveillance, 2008-2014. J Acquir Immune Defic Syndr 2020; 81:257-265. [PMID: 31194702 DOI: 10.1097/qai.0000000000002025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Social and legal acceptance of long-term same-sex partnerships in the United States has increased over the past decade which may impact sexual partnering among men who have sex with men (MSM). Identifying whether and how partnering trends have evolved at a national level could improve understanding of HIV transmission and prevention among MSM partnerships. METHODS We used Centers for Disease Control and Prevention's National HIV Behavioral Surveillance data (2008, 2011, and 2014) to study trends in the number and partner type composition (main/casual) of male sex partners among US MSM. Changes over time were assessed in Poisson regression models with the link function tailored to the count and binary outcomes. RESULTS The mean total number of partners in the past year increased, while the mean number of main partners remained stable. The percentage of MSM with both main and casual partners increased, and we observed a shift from having ≥1 main and 0 casual partners to having ≥1 main and ≥2 casual partners. Condomless anal sex in the past year increased regardless of partner composition. DISCUSSION Findings suggest casual partnering among MSM has increased in recent years, including among those with ≥1 main partners. Both partner-based and individual prevention programs remain critical to reaching MSM.
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Sociodemographic and Behavioral Factors Associated with HIV Vulnerability according to Sexual Orientation. AIDS Res Treat 2020; 2020:5619315. [PMID: 32411453 PMCID: PMC7212321 DOI: 10.1155/2020/5619315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/15/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To analyze sociodemographic and behavioral factors associated with vulnerability to HIV according to sexual orientation. Method This is a cross-sectional study conducted using data on 3,818 people in the city of Imperatriz, Brazil, during 2015 and 2016. The survey's questionnaires addressed sociodemographic and behavioral variables. For the data analysis, association (chi-square test) and strength of association (odds ratio) were observed. A significance level of p < 0.05 and adjustment for age and gender were taken into consideration. Results A substantial portion of the sample stated they were heterosexual (88.8%). These individuals demonstrated a lower chance of HIV infection (p < 0.001), sexually transmitted infections (p < 0.001), alcohol use (p < 0.001) and condom use (p < 0.001), compared to men who have sex with men and/or bisexuals. In this group, after adjusting for confounding variables, the factors associated with HIV infection were being male (p < 0.001), unmarried (p < 0.001), having completed higher education (p < 0.001) and boasting multiple sexual partners (p < 0.001). Conclusion Behavioral and sociodemographic factors of vulnerability to HIV are predominant among men who have sex with men and/or are bisexual.
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Longo LM, Ertl MM, Pazienza R, Agiliga AU, Dillon FR, Martin JL. Associations among Negative Urgency, Sensation Seeking, Alcohol Use, Self-Esteem, and Casual Sexual Behavior for College Students. Subst Use Misuse 2020; 55:796-805. [PMID: 31876218 DOI: 10.1080/10826084.2019.1703748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The present study proposed a moderated mediation model of relations among negative urgency, sensation seeking, alcohol use, self-esteem, and casual sexual behavior among college students. We hypothesized students' alcohol use would mediate a positive relation between two facets of impulsivity, negative urgency and sensation seeking, with casual sexual behavior. We also examined the influence of self-esteem on alcohol use and casual sexual behavior to determine if self-esteem may serve as a point of intervention. We hypothesized that self-esteem might moderate the relation between casual sexual behavior and alcohol use, such that students who report high alcohol use in addition to low self-esteem would engage in more casual sexual behavior than individuals who report relatively higher levels of self-esteem. Methods: Data were collected in 2015 from 413 undergraduate students at a large Northeastern public university. Structural equation modeling tested the moderated mediation model. Results: Contrary to hypotheses, the theorized model demonstrated an inadequate fit to the data when self-esteem was included. A second structural model was calculated to test alcohol use as a mediator of associations between negative urgency and sensation seeking, and casual sexual behavior. As hypothesized, students' alcohol use was found to be a mediator of the positive associations between negative urgency and casual sexual behavior and sensation seeking and casual sexual behavior. Conclusions: Findings suggest that alcohol use, negative urgency, and sensation seeking may serve as points of intervention to address casual sexual behavior, as appropriate, among college student populations.
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Affiliation(s)
- Laura M Longo
- Center for Behavioral Health Promotion and Applied Research, Health and Counseling Center, University at Albany, State University of New York, Albany, New York, USA
| | - Melissa M Ertl
- Center for Behavioral Health Promotion and Applied Research, Health and Counseling Center, University at Albany, State University of New York, Albany, New York, USA
| | - Rena Pazienza
- Center for Behavioral Health Promotion and Applied Research, Health and Counseling Center, University at Albany, State University of New York, Albany, New York, USA
| | - Alexandra U Agiliga
- Center for Behavioral Health Promotion and Applied Research, Health and Counseling Center, University at Albany, State University of New York, Albany, New York, USA
| | - Frank R Dillon
- Department of Counseling and Counseling Psychology, Arizona State University, Tempe, Arizona, USA
| | - Jessica L Martin
- Center for Behavioral Health Promotion and Applied Research, Health and Counseling Center, University at Albany, State University of New York, Albany, New York, USA
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Siegler AJ, Brock JB, Hurt CB, Ahlschlager L, Dominguez K, Kelley CF, Jenness SM, Wilde G, Jameson SB, Bailey-Herring G, Mena LA. An Electronic Pre-Exposure Prophylaxis Initiation and Maintenance Home Care System for Nonurban Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13982. [PMID: 31199326 PMCID: PMC6592500 DOI: 10.2196/13982] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is highly efficacious for preventing HIV but has not yet been brought to scale among at-risk persons. In several clinical trials in urban areas, technology-based interventions have shown a positive impact on PrEP adherence. In rural and small-town areas in the United States, which often do not have geographically proximal access to PrEP providers, additional support may be needed. This may be particularly true for younger persons who are more likely to face multiple barriers to accessing PrEP services. Home-based care, accomplished through a tailored mobile phone app, specimen self-collection (SSC), and interactive video consultations, could increase both PrEP initiation and persistence in care. OBJECTIVE The goal of this study is to assess the initiation and persistence in PrEP care for those randomized to a home-care intervention (electronic PrEP, ePrEP) relative to those assigned to the standard of care (control) condition. We will conduct additional assessments, including quantitative and qualitative analyses, to contextualize trial results and facilitate scale-up. METHODS This 2-arm, randomized controlled trial will enroll young men who have sex with men (YMSM) aged between 18 and 24 years from rural areas of Georgia, Mississippi, and North Carolina. The trial will seek to recruit a diverse sample, targeting 50% participation among highly impacted groups of black or Latino men who have sex with men. Intervention participants will receive a study app that incorporates a messaging platform, a scheduling and milestone-based tracking system for PrEP care progress, electronic behavioral surveys, and interactive video consultations with a clinician. Complemented by SSC kits mailed to laboratories for standard PrEP-related monitoring, the ePrEP system will allow participants to access PrEP care without leaving their homes. YMSM randomized to the control condition will receive a listing of nearest local PrEP providers to receive standard PrEP care. Both groups will complete quarterly electronic surveys. The primary outcome, assessed at 6 and 12 months after randomization, will be the difference in the proportion of intervention versus control participants that achieve protective levels of the active metabolite of oral PrEP (tenofovir diphosphate in dried blood spots). RESULTS Enrollment will begin in May 2019, with study completion in 2022. CONCLUSIONS This trial will determine whether home PrEP care provided through an app-based platform is an efficacious means of expanding access to PrEP care for a diverse group of YMSM in rural and small-town areas of the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT03729570; https://clinicaltrials.gov/ct2/show/NCT03729570 (Archived by WebCite at http://www.webcitation.org/78RE2Qizf). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/13982.
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Affiliation(s)
- Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - James B Brock
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Christopher B Hurt
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lauren Ahlschlager
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Karen Dominguez
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Gretchen Wilde
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Samuel B Jameson
- Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Gina Bailey-Herring
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Leandro A Mena
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States.,Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
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Boyer CB, Greenberg L, Korelitz J, Harper GW, Stewart-Campbell R, Straub D, Sanders R, Reid LH, Futterman D, Lee S, Ellen JM. Sexual Partner Characteristics, Relationship Type, and HIV Risk Among a Community Venue-based Sample of Urban Adolescent and Young Adult Men Who Have Sex with Men. YOUTH & SOCIETY 2019; 51:219-246. [PMID: 30983642 PMCID: PMC6456077 DOI: 10.1177/0044118x16669259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Few studies have examined sexual partnerships and HIV risk in diverse samples of African American/black and Hispanic/Latino adolescent and young adult men who have sex with men (YMSM), a group that have a high burden of HIV in the U.S. A community-venue recruitment approach was used, which identified significant differences in HIV risk by sexual partner type among 1215 YMSM. Those with casual partners had a higher number of sexual partners, had more STIs, and were more likely to engage in transactional sex, to use alcohol, marijuana, or other substances compared with those with main partners only. Among those with female sexual partners, many used condoms "every time" when engaging in vaginal sex with casual partners, but a sizeable proportion "never/rarely" used condoms with their main partners. Our findings demonstrate a need for tailored HIV prevention education and counseling with necessary skills regarding consistent and correct condom use with all sexual partnerships.
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Affiliation(s)
- Cherrie B Boyer
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, CA
| | | | | | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Diane Straub
- Department of Pediatrics, University of South Florida, Tampa, FL
| | - Renata Sanders
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Donna Futterman
- Adolescent AIDS Program, Children's Hospital at Montefiore Einstein College of Medicine, Bronx, NY
| | - Sonia Lee
- Eunice Kennedy Shriver National Institute on Child Health and Human Development/Maternal and Pediatric Infectious Disease Branch, Bethesda, MD
| | - Jonathan M Ellen
- Johns Hopkins Children's Center, Johns Hopkins University, Baltimore, MD
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A Cost Analysis of Gyrase A Testing and Targeted Ciprofloxacin Therapy Versus Recommended 2-Drug Therapy for Neisseria gonorrhoeae Infection. Sex Transm Dis 2019; 45:87-91. [PMID: 29329176 DOI: 10.1097/olq.0000000000000698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Novel approaches to combating drug-resistant Neisseria gonorrhoeae infections are urgently needed. Targeted therapy with ciprofloxacin has been made possible by a rapid assay for genotyping the gyrase A (gyrA) gene; a nonmutated gene reliably predicts susceptibility to ciprofloxacin. METHODS We determined the costs of running the gyrA assay, 500 mg of ciprofloxacin, 250 mg of ceftriaxone injection, and 1000 mg of azithromycin. Cost estimates for gyrA testing included assay reagents and labor. Cost estimates for ceftriaxone included medication, injection, administration, supplies, and equipment. We measured the cost of using the gyrA assay and treatment based on genotype using previously collected data over a 13-month period between November 2015 and November 2016 for all N. gonorrhoeae cases diagnosed at UCLA. We subsequently developed 3 cost models, varying the frequency of testing and prevalence of N. gonorrhoeae infections with ciprofloxacin-resistant or genotype-indeterminate results. We compared those estimates with the cost of recommended 2-drug therapy (ceftriaxone and azithromycin). RESULTS Based on a 65.3% prevalence of cases with ciprofloxacin-resistant or genotype indeterminate N. gonorrhoeae infections when running an average of 1.7 tests per day, the per-case cost of gyrA genotyping and targeted therapy was US $197.19. The per-case cost was US $155.16 assuming a 52.6% prevalence of ciprofloxacin-resistant or genotype-indeterminate infections when running an average of 17 tests per day. The per-case cost of 2-drug therapy was US $142.75. CONCLUSIONS Direct costs of gyrA genotyping and targeted ciprofloxacin therapy depend on the prevalence of ciprofloxacin-resistant or genotype-indeterminate infections and testing frequency.
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Barry MC, Threats M, Blackburn NA, LeGrand S, Dong W, Pulley DV, Sallabank G, Harper GW, Hightow-Weidman LB, Bauermeister JA, Muessig KE. "Stay strong! keep ya head up! move on! it gets better!!!!": resilience processes in the healthMpowerment online intervention of young black gay, bisexual and other men who have sex with men. AIDS Care 2019; 30:S27-S38. [PMID: 30632775 PMCID: PMC6430674 DOI: 10.1080/09540121.2018.1510106] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Overlapping stigmas related to sexual minority-, race/ethnicity-, and HIV-status pose barriers to HIV prevention and care and the creation of supportive social networks for young, Black, gay, bisexual, and other men who have sex with men (GBMSM). A risk-based approach to addressing the HIV epidemic focuses on what is lacking and reinforces negative stereotypes about already-marginalized populations. In contrast, a strengths-based approach builds on Black GBMSM’s existing strengths, recognizing the remarkable ways in which they are overcoming barriers to HIV prevention and care. HealthMpowerment (HMP) is an online, mobile phone optimized intervention that aimed to reduce condomless anal intercourse and foster community among young Black GBMSM (age 18–30). Applying a resilience framework, we analyzed 322 conversations contributed by 48 HMP participants (22/48 living with HIV) on the intervention website. These conversations provided a unique opportunity to observe and analyze dynamic, interpersonal resilience processes shared in response to stigma, discrimination, and life challenges experienced by young Black GBMSM. We utilized an existing framework with four resilience processes and identified new subthemes that were displayed in these online interactions: (1) Exchanging social support occurred through sharing emotional and informational support. (2) Engaging in health-promoting cognitive processes appeared as reframing, self-acceptance, endorsing a positive outlook, and agency and taking responsibility for outcomes. (3) Enacting healthy behavioral practices clustered into modeling sex-positive norms, reducing the risk of acquiring or transmitting HIV, and living well with HIV. (4) Finally, empowering other gay and bisexual youth occurred through role modeling, promoting self-advocacy, and providing encouragement. Future online interventions could advance strengths-based approaches within HIV prevention and care by intentionally building on Black GBMSM’s existing resilience processes. The accessibility and anonymity of online spaces may provide a particularly powerful intervention modality for amplifying resilience among young Black GBMSM.
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Affiliation(s)
- Megan C Barry
- a Department of Maternal and Child Health, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Megan Threats
- b School of Information and Library Science , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Natalie A Blackburn
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Sara LeGrand
- d Duke Global Health Institute , Duke University , Durham , USA
| | - Willa Dong
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Deren V Pulley
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Greg Sallabank
- e Center for Sexuality and Health Disparities , University of Michigan , Ann Arbor , USA
| | - Gary W Harper
- f Department of Health Behavior and Health Education , University of Michigan , Ann Arbor , USA
| | - Lisa B Hightow-Weidman
- g Institute for Global Health and Infectious Diseases , The University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Jose A Bauermeister
- h Department of Family and Community Health , University of Pennsylvania , Philadelphia , USA
| | - Kathryn E Muessig
- c Department of Health Behavior, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , USA
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Watson RJ, Fish JN, Allen A, Eaton L. Sexual Identity Disclosure and Awareness of HIV Prevention Methods Among Black Men Who Have Sex With Men. JOURNAL OF SEX RESEARCH 2018; 55:975-983. [PMID: 29023141 PMCID: PMC5897190 DOI: 10.1080/00224499.2017.1375452] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Black men who have sex with men (BMSM) are disproportionately affected by the human immunodeficiency virus (HIV) epidemic, yet we know little about how HIV-negative BMSM of different sexual orientations access HIV prevention strategies. Identity development, minority stress, and disclosure theories suggest that for people of different sexual orientations, disclosure of sexual identity may be related to health behaviors. We performed a latent class analysis on a sample of 650 BMSM (Mage = 33.78, SD = 11.44) from Atlanta, Georgia, to explore whether sexual orientation, disclosure of sexual identity, and relationship status were related to HIV prevention strategies, including awareness of PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) and frequency of HIV testing. We found three distinct BMSM classes referred to as (1) closeted bisexuals, (2) sexual identity managers, and (3) gay, out, and open; all classes primarily engaged in casual sex. Classes differed in their awareness and access to HIV prevention strategies. The closeted bisexual class was least aware of and least likely to access HIV prevention. Findings have important implications for future research, namely the consideration of sexual identity and disclosure among BMSM. With this knowledge, we may be able to engage BMSM in HIV/sexually transmitted infection (STI) prevention services.
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Affiliation(s)
- Ryan J Watson
- c Department of Human Development and Family Studies , University of Connecticut
| | - Jessica N Fish
- b Population Research Center , University of Texas at Austin
| | | | - Lisa Eaton
- c Department of Human Development and Family Studies , University of Connecticut
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Jeffries WL, Greene KM, Paz-Bailey G, McCree DH, Scales L, Dunville R, Whitmore S. Determinants of HIV Incidence Disparities Among Young and Older Men Who Have Sex with Men in the United States. AIDS Behav 2018; 22:2199-2213. [PMID: 29633094 DOI: 10.1007/s10461-018-2088-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study sought to determine why young men who have sex with men (MSM) have higher HIV incidence rates than older MSM in the United States. We developed hypotheses that may explain this disparity. Data came from peer-reviewed studies published during 1996-2016. We compared young and older MSM with respect to behavioral, clinical, psychosocial, and structural factors that promote HIV vulnerability. Compared with older MSM, young MSM were more likely to have HIV-discordant condomless receptive intercourse. Young MSM also were more likely to have "any" sexually transmitted infection and gonorrhea. Among HIV-positive MSM, young MSM were less likely to be virally suppressed, use antiretroviral therapy, and be aware of their infection. Moreover, young MSM were more likely than older MSM to experience depression, polysubstance use, low income, decreased health care access, and early ages of sexual expression. These factors likely converge to exacerbate age-associated HIV incidence disparities among MSM.
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Affiliation(s)
- William L Jeffries
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA.
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS E40, Atlanta, GA, 30333, USA.
| | - Kevin M Greene
- Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Donna Hubbard McCree
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Lamont Scales
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Richard Dunville
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Suzanne Whitmore
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
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DeVost MA, Beymer MR, Weiss RE, Shover CL, Bolan RK. App-Based Sexual Partner Seeking and Sexually Transmitted Infection Outcomes: A Cross-Sectional Study of HIV-Negative Men Who Have Sex With Men Attending a Sexually Transmitted Infection Clinic in Los Angeles, California. Sex Transm Dis 2018; 45:394-399. [PMID: 29465675 PMCID: PMC5948131 DOI: 10.1097/olq.0000000000000770] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM) face higher rates of sexually transmitted infections (STIs) compared with the general population. The association between venues where sexual partners are met and STI transmission is dynamic and poorly understood, especially among those who use geosocial networking (GSN) apps. This study aimed to determine whether there is a difference in STI incidence between MSM who met their last sexual partner through a GSN app and MSM who met their last partner via other venues. METHODS Data were analyzed from HIV-negative MSM attending the Los Angeles LBGT Center between August 2015 and July 2016 (n = 9499). Logistic regression models were used to investigate the relationship between STI incidence and whether or not an individual met his last partner through a GSN app. RESULTS No relationship was detected between STI incidence and whether one's last sexual partner was met via GSN app. However, an association was detected between STI incidence and having used GSN apps to meet sexual partners in the past 3 months. A dose-response relationship was observed between the number of venues used to meet partners and testing positive for any STI (adjusted odds ratio, 1.08; 95% confidence interval, 1.02-1.14). CONCLUSIONS The relationship between how people meet sexual partners and STI acquisition is much more nuanced than previously thought. Geosocial networking apps do not inherently expose users to high-risk reservoirs of STIs, but further understanding of the complexity of sexual networks and networking methods is warranted, given increasing rates of STIs.
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Abstract
OBJECTIVE Sexual risk behaviour changes during a person's life course. Insights in sexual risk behaviour trajectories of MSM may provide starting points for the timing of HIV prevention methods. We aimed to study longitudinal trajectories of sexual risk behaviour predictive of HIV acquisition from sexual debut onwards. DESIGN A longitudinal study among 815 HIV-negative participants of the Amsterdam Cohort Studies (ACS) who completed extensive questionnaires about their sexual behaviour every 6 months between 2007 and 2017. METHODS A comprehensive behavioural risk score predictive of HIV seroconversion was developed. On the basis of this risk score, linear trajectories of sexual risk behaviour and MSM group membership were estimated using latent class growth mixture modelling. Associations between longitudinal trajectories and demographic and psychosocial factors were examined. RESULTS Three trajectories of sexual risk behaviour were identified, which were labelled Low risk (90.3% of the sample), Falling high risk (6.5%) and Rising high risk (3.3%). MSM following the Falling high risk (20.5%) and Rising high risk (25.0%) trajectories were more likely to acquire HIV during follow-up. The Falling high risk trajectory was associated with younger age at sexual debut, fewer steady partnerships and high percentages of substance use. The Rising high-risk trajectory was associated with increasing percentages of substance use over time. CONCLUSION MSM follow different trajectories of changing sexual risk behaviour over time. Early identification of MSM following a trajectory of falling or rising high-risk behaviour and adequate timing of individual-based preventive interventions may reduce HIV transmission.
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Armstrong HL, Roth EA, Rich A, Lachowsky NJ, Cui Z, Sereda P, Card KG, Jollimore J, Howard T, Moore DM, Hogg RS. Associations between sexual partner number and HIV risk behaviors: implications for HIV prevention efforts in a Treatment as Prevention (TasP) environment. AIDS Care 2018; 30:1290-1297. [PMID: 29558813 DOI: 10.1080/09540121.2018.1454583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Previous research indicates that gay and bisexual men (GBM) have significantly more sexual partners than same-aged heterosexual men and women. As a result, some HIV intervention programs have focused on partner reduction. However, new research findings question the relevance of sexual partner number as a sexual risk measure for GBM given Treatment as Prevention (TasP) programs and new seroadaptive strategies which have led to lower GBM community viral load and new HIV prevention behaviors. To assess if sexual partner number continues to remain an important measure of sexual risk for GBM living in a city that actively promotes TasP as provincial policy, we analysed cross-sectional data from 719 GBM recruited through respondent-driven sampling in Vancouver, Canada. Multivariable negative binomial regression analysis showed that partner number was significantly associated with previously identified HIV risk factors including condomless anal intercourse with serodiscordant and/or unknown serostatus partners, using sex toys, attending group sex events, receiving money for sex, and sex drug use. These results indicate that sexual partner number remains an important proximate HIV risk measure. However, more nuanced measures of HIV treatment status and greater understanding of the possible causes of increased partner number among GBM are needed.
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Affiliation(s)
- Heather L Armstrong
- a Department of Medicine , University of British Columbia , Vancouver , Canada.,b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Eric Abella Roth
- c Centre for Addictions Research of British Columbia , University of Victoria , Victoria , Canada.,d Department of Anthropology , University of Victoria , Victoria , Canada
| | - Ashleigh Rich
- a Department of Medicine , University of British Columbia , Vancouver , Canada.,b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Nathan J Lachowsky
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,e School of Public Health and Social Policy , University of Victoria , Victoria , Canada
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Paul Sereda
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Kiffer G Card
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,f Faculty of Health Sciences , Simon Fraser University , Vancouver , Canada
| | - Jody Jollimore
- g Community Based Research Centre for Gay Men's Health , Vancouver , Canada
| | - Terry Howard
- h Community Advisory Board, Momentum Health Study , Vancouver , Canada
| | - David M Moore
- a Department of Medicine , University of British Columbia , Vancouver , Canada.,b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Robert S Hogg
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,f Faculty of Health Sciences , Simon Fraser University , Vancouver , Canada
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Zhao Q, Mao Y, Li X, Shen Z, Zhou Y. Age differences in sexual risk behaviors and related factors among people living with HIV in Guangxi, China. AIDS Care 2018; 30:523-530. [PMID: 29357682 DOI: 10.1080/09540121.2018.1429560] [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: 10/18/2022]
Abstract
Sexual risk behaviors by people living with HIV (PLHIV) can result in secondary HIV transmission and other health problems. Given the dearth of research on age differences in sexual behaviors among PLHIV, the objective of the study is to compare sexual risk behaviors and related factors among PLHIV by age groups. Data used in the current study were derived from a cross-sectional survey conducted from 2012 to 2013 in Guangxi, China. PLHIV were selected randomly from 12 sites with the largest number of HIV/AIDS cases. The 2,987 PLHIV completing the survey were included in the study. Participants were asked about key sociodemographic characteristics, health condition, same-sex behavior, and sexual risk behaviors (number of sex partners, condom use consistency, and change in condom use after HIV diagnosis). Univariate logistic regression analyses were conducted to evaluate associations of sexual risk behaviors with age and other factors. Those variables with a p-value of less than 0.2 were entered into multivariate logistic regression models. All statistical analyses were conducted using SAS 9.4. Differences in sexual risk behaviors across age groups were observed. Compared with their younger counterparts, who were ≥ 50 years of age were more likely to have multiple partners, use condoms inconsistently, and use condoms less than before HIV diagnosis. Moreover, lower education attainment, being in the lowest or highest category of income, having a sero-concordant or sero-unknown steady partner or no steady partner, and having contracted HIV from steady or casual/commercial partners, or through injection drug use appeared to be predictive of at least one of the sexual risk behaviors examined in the study. The findings call for HIV prevention interventions to be tailored to different age groups. The interventions that can help reduce unprotected sex among older PLHIV are urgently needed.
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Affiliation(s)
- Qun Zhao
- a School of Law & Public Affairs , Nanjing University of Information Science & Technology , Nanjing , People's Republic of China
| | - Yuchen Mao
- b Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , USA
| | - Xiaoming Li
- a School of Law & Public Affairs , Nanjing University of Information Science & Technology , Nanjing , People's Republic of China.,b Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , USA
| | - Zhiyong Shen
- c Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Yuejiao Zhou
- c Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
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The Effect of PrEP on HIV Incidence Among Men Who Have Sex With Men in the Context of Condom Use, Treatment as Prevention, and Seroadaptive Practices. J Acquir Immune Defic Syndr 2017; 77:31-40. [PMID: 28961679 DOI: 10.1097/qai.0000000000001555] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV preexposure prophylaxis (PrEP) is an effective tool in preventing HIV infection among high-risk men who have sex with men (MSM). It is unknown how effective PrEP is in the context of other implemented HIV prevention strategies, including condom use, seroadaption, and treatment as prevention (TasP). We evaluate the impact of increasing uptake of PrEP in conjunction with established prevention strategies on HIV incidence in a high-risk population of MSM through simulation. METHODS Agent-based simulation models representing the sexual behavior of high-risk, urban MSM in the United States over the period of 1 year were used to evaluate the effect of PrEP on HIV infection rates. Simulations included data for 10,000 MSM and compared increasing rates of PrEP uptake under 8 prevention paradigms: no additional strategies, TasP, condom use, seroadaptive behavior, and combinations thereof. RESULTS We observed a mean of 103.2 infections per 10,000 MSM in the absence of any prevention method. PrEP uptake at 25% without any additional prevention strategies prevented 30.7% of infections. In the absence of PrEP, TasP, condom use, and seroadaptive behavior independently prevented 27.1%, 48.8%, and 37.7% of infections, respectively, and together prevented 72.2%. The addition of PrEP to the 3 aforementioned prevention methods, at 25% uptake, prevented an additional 5.0% of infections. CONCLUSIONS To achieve a 25% reduction in HIV infections by 2020, HIV prevention efforts should focus on significantly scaling up access to PrEP in addition to HIV testing, access to antiretroviral therapy, and promoting condom use.
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White D, Grey JA, Gorbach PM, Rothenberg RB, Sullivan PS, Rosenberg ES. Racial Differences in Partnership Attributes, Typologies, and Risk Behaviors Among Men Who Have Sex With Men in Atlanta, Georgia. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:961-975. [PMID: 27169406 PMCID: PMC5106333 DOI: 10.1007/s10508-016-0743-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 05/31/2023]
Abstract
The role of main partnerships in shaping HIV transmission dynamics among men who have sex with men (MSM) has gained recognition in recent studies, but there is little evidence that existing definitions of partnership type are accurate or have consistent meaning for all men. Using data collected from 2011 to 2013 on 693 partnerships described by 193 Black and White MSM in Atlanta, GA, partnership attributes and risk behaviors were examined and compared by race, stratified in two ways: (1) by commonly used definitions of partnerships as "main" or "casual" and (2) by a new data-driven partnership typology identified through latent class analysis (LCA). Racial differences were analyzed using chi-square, Fisher's exact, and Wilcoxon-Mann-Whitney tests. Black participants were less likely to report condomless anal sex (CAS) within partnerships they labeled as main, yet they were also less likely to describe these partnerships as "primary" on a parallel question. In contrast, within strata defined by the LCA-derived typology, most partnership attributes were comparable and the likelihood of CAS was equivalent by race. These findings suggest that classification of partnerships as main or casual does not accurately capture the partnership patterns of MSM, resulting in differential misclassification by race. Future studies and interventions should refine and utilize more evidence-based typologies.
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Affiliation(s)
- Darcy White
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195, USA.
| | - Jeremy A Grey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Richard B Rothenberg
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Expanded antiretroviral treatment, sexual networks, and condom use: Treatment as prevention unlikely to succeed without partner reduction among men who have sex with men in China. PLoS One 2017; 12:e0171295. [PMID: 28406992 PMCID: PMC5390964 DOI: 10.1371/journal.pone.0171295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 01/19/2017] [Indexed: 12/26/2022] Open
Abstract
Background To project the impact of partner reduction on preventing new HIV infections among men who have sex with men (MSM) under varying conditions of enhanced HIV testing and treatment (T&T) and condom use in Beijing, China. Methods and findings A complex network model was fitted to predict the number of new HIV infections averted from 2014 to 2023 under four scenarios of sexual behavior risk reduction (S)—S1: Male sexual partners decrease (reduced by a random value m from 1–50) while condom use increases (risk constant p is a random value between 0.2 and 1]); S2: Both sexual partners and condom use decrease (m 1, 50; p 1, 1.8); S3: Sexual partners reduce (m 1, 10) while condom use increases or decreases (p 0.2, 1.8); S4: Only MSM with ≥100 male sexual partners reduce their partners (m 1, 50) while condom use increases (p 0.2, 1). HIV prevalence will reach 23.2% by 2023 among Beijing MSM if T&T remains at the 2013 level. The three most influential factors are: T&T coverage; partner reduction (m); and the background risk (p). Under scenarios 1–4 of sexual behavioral changes with enhanced T&T interventions, the cumulative HIV new infections prevented over the 10 years will be 46.8% for S1 (interquartile range [IQR] 32.4%, 60.1%); 29.7% for S2 (IQR 18.0%, 41.4%), 23.2% for S3 (IQR 12.2%, 37.0%) and 11.6% for S4 (IQR 4.0%, 26.6%), respectively. The reproduction number R0 could drop below 1 if there were a substantial reduction of male sexual partners and/or expanded condom use. Conclusion Partner reduction is a vital factor within HIV combination interventions to reduce HIV incidence among Beijing MSM, with substantial additional benefits derived from condom use. T&T without substantial partner reduction and increased condom use is less promising unless its implementation were extremely (and improbably) efficient.
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Gurski KF, Hoffman KA. Influence of concurrency, partner choice, and viral suppression on racial disparity in the prevalence of HIV infected women. Math Biosci 2016; 282:91-108. [PMID: 27712990 DOI: 10.1016/j.mbs.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/28/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
In 1992, Watts and May introduced a simple dynamical systems model of the spread of HIV based on disease transmission per partnership including the length of partnership duration. This model allowed for the treatment of concurrent partnerships, although it was hampered by the assumption of an important latent phase which generated a non-autonomous system. Subsequent models including concurrency have been based on networks, Monte Carlo, and stochastic simulations which lose a qualitative understanding of the effects of concurrency. We present a new autonomous deterministic model of the effect of concurrent sexual partnerships that allows for an analytical study of disease transmission. We incorporate the effect of concurrency through the newly derived force of infection term in a mathematical model of the transmission of HIV through sexual contact in a population stratified by sexual behavior and race/ethnicity. The model also includes variations in population mixing (partner choice) and non-uniform Highly Active Anti-Retroviral Treatment (HAART) leading to viral suppression. We use this mathematical model to understand the non-uniform spread of HIV in women who were infected through heterosexual contact. In addition, an analytical study shows the importance of continued condom use in virally suppressed MSM. Numerical simulations of the reproduction number as a function of concurrency, viral suppression level, and mixing show a reservoir of disease present in both heterosexual and MSM populations. Statistical analysis of parameter values show that viral suppression level, mixing and progression to AIDS without viral suppression have a strong correlation (either positive or negative) with the number of HIV positive women. Concurrency and assortative mixing are shown to be essential to reproduce infection levels in women, as reported by 2010 data from the Center for Disease Control (CDC).
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Affiliation(s)
- K F Gurski
- Department of Mathematics, Howard University, Washington, DC 20059, United States.
| | - K A Hoffman
- Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, MD, United States
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Moore CL, Gidding HF, Jin F, Mao L, Petoumenos K, Zablotska IB, Poynten IM, Prestage G, Law MG, Grulich AE, Amin J. Patterns of Drug Use and Drug-related Hospital Admissions in HIV-Positive and -Negative Gay and Bisexual Men. AIDS Behav 2016; 20:2372-2386. [PMID: 26837635 DOI: 10.1007/s10461-016-1303-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We aimed to compare rates of illicit drug-related hospitalisations in HIV-negative (HIV-ve) (n = 1325) and HIV-positive (HIV+ve) (n = 557) gay and bisexual men (GBM) with rates seen in the general male population and to examine the association between self-reported illicit drug use and drug-related hospitalisation. Participants were asked how often they used a range of illicit drugs in the previous 6 months at annual interviews. Drug-related hospital admissions were defined as hospital admissions for mental or behavioural disorders due to illicit drug use (ICD 10: F11-16, F18, F19), drug poisoning (T40-T45, T50) or toxic effect of gases (T53, T59, T65). Drug-related hospitalisations were 4.8 times higher in the HIV-ve cohort [SIR 4.75 (95 % CI 3.30-6.91)] and 3.5 times higher in the HIV+ve cohort [SIR 3.51 (1.92-5.88)] compared with the general population. Periods of weekly drug use [IRR 1.86 (1.01-3.46)], poly-drug use [IRR 2.17 (1.07-4.38)] and cannabis use [low use-IRR 1.95 (1.01-3.77), high use-IRR 2.58 (1.29-5.16)] were associated with drug-related hospitalisation in both cohorts, as was being a consistently high meth/amphetamine user throughout follow-up [IRR 3.24 (1.07-9.83)] and being an inconsistent or consistent injecting drug user throughout follow-up [IRR 3.94 (1.61-9.66), IRR 4.43(1.04-18.76), respectively]. Other risk factors for drug-related hospitalisation indicated the likelihood of comorbid drug and mental health issues in GBM hospitalised for drug use.
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Affiliation(s)
- Cecilia L Moore
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Heather F Gidding
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - I Mary Poynten
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Matthew G Law
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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Gopalappa C, Farnham PG, Chen YH, Sansom SL. Progression and Transmission of HIV/AIDS (PATH 2.0). Med Decis Making 2016; 37:224-233. [PMID: 27646567 DOI: 10.1177/0272989x16668509] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND HIV transmission is the result of complex dynamics in the risk behaviors, partnership choices, disease stage and position along the HIV care continuum-individual characteristics that themselves can change over time. Capturing these dynamics and simulating transmissions to understand the chief sources of transmission remain important for prevention. METHODS The Progression and Transmission of HIV/AIDS (PATH 2.0) is an agent-based model of a sample of 10,000 people living with HIV (PLWH), who represent all men who have sex with men (MSM) and heterosexuals living with HIV in the U.S.A. Persons uninfected were modeled as populations, stratified by risk and gender. The model included detailed individual-level data from several large national surveillance databases. The outcomes focused on average annual transmission rates from 2008 through 2011 by disease stage, HIV care continuum, and sexual risk group. RESULTS The relative risk of transmission of those in the acute phase was nine-times [5th and 95th percentile simulation interval (SI): 7, 12] that of those in the non-acute phase, although, on average, those with acute infections comprised 1% of all PLWH. The relative risk of transmission was 24- to 50-times as high for those in the non-acute phase who had not achieved viral load suppression as compared with those who had. The relative risk of transmission among MSM was 3.2-times [SI: 2.7, 4.0] that of heterosexuals. Men who have sex with men and women generated 46% of sexually acquired transmissions among heterosexuals. CONCLUSIONS The model results support a continued focus on early diagnosis, treatment and adherence to ART, with an emphasis on prevention efforts for MSM, a subgroup of whom appear to play a role in transmission to heterosexuals.
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Affiliation(s)
| | - Paul G Farnham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS)
| | - Yao-Hsuan Chen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS)
| | - Stephanie L Sansom
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS)
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Dolling DI, Desai M, McOwan A, Gilson R, Clarke A, Fisher M, Schembri G, Sullivan AK, Mackie N, Reeves I, Portman M, Saunders J, Fox J, Bayley J, Brady M, Bowman C, Lacey CJ, Taylor S, White D, Antonucci S, Gafos M, McCormack S, Gill ON, Dunn DT, Nardone A. An analysis of baseline data from the PROUD study: an open-label randomised trial of pre-exposure prophylaxis. Trials 2016; 17:163. [PMID: 27013513 PMCID: PMC4806447 DOI: 10.1186/s13063-016-1286-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 03/14/2016] [Indexed: 01/20/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) has proven biological efficacy to reduce the sexual acquisition of the human immunodeficiency virus (HIV). The PROUD study found that PrEP conferred higher protection than in placebo-controlled trials, reducing HIV incidence by 86 % in a population with seven-fold higher HIV incidence than expected. We present the baseline characteristics of the PROUD study population and place the findings in the context of national sexual health clinic data. Methods The PROUD study was designed to explore the real-world effectiveness of PrEP (tenofovir-emtricitabine) by randomising HIV-negative gay and other men who have sex with men (GMSM) to receive open-label PrEP immediately or after a deferral period of 12 months. At enrolment, participants self-completed two baseline questionnaires collecting information on demographics, sexual behaviour and lifestyle in the last 30 and 90 days. These data were compared to data from HIV-negative GMSM attending sexual health clinics in 2013, collated by Public Health England using the genitourinary medicine clinic activity database (GUMCAD). Results The median age of participants was 35 (IQR: 29–43). Typically participants were white (81 %), educated at a university level (61 %) and in full-time employment (72 %). Of all participants, 217 (40 %) were born outside the UK. A sexually transmitted infection (STI) was reported to have been diagnosed in the previous 12 months in 330/515 (64 %) and 473/544 (87 %) participants reported ever having being diagnosed with an STI. At enrolment, 47/280 (17 %) participants were diagnosed with an STI. Participants reported a median (IQR) of 10 (5–20) partners in the last 90 days, a median (IQR) of 2 (1–5) were condomless sex acts where the participant was receptive and 2 (1–6) were condomless where the participant was insertive. Post-exposure prophylaxis had been prescribed to 184 (34 %) participants in the past 12 months. The number of STI diagnoses was high compared to those reported in GUMCAD attendees. Conclusions The PROUD study population are at substantially higher risk of acquiring HIV infection sexually than the overall population of GMSM attending sexual health clinics in England. These findings contribute to explaining the extraordinary HIV incidence rate during follow-up and demonstrate that, despite broad eligibility criteria, the population interested in PrEP was highly selective. Trial registration Current Controlled TrialsISRCTN94465371. Date of registration: 28 February 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1286-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David I Dolling
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Monica Desai
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK.,HIV/STI Department, Public Health England, London, UK
| | - Alan McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Richard Gilson
- The Mortimer Market Centre, Central and Northwest London NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Claude Nichol Centre, Royal Surrey Sussex County Hospital, Brighton, UK
| | - Martin Fisher
- Claude Nichol Centre, Royal Surrey Sussex County Hospital, Brighton, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ann K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicola Mackie
- St Mary's Hospital, Imperial College NHS Foundation Trust, London, UK
| | - Iain Reeves
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Mags Portman
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - John Saunders
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jake Bayley
- King's College Hospital NHS Foundation Trust, London, UK
| | - Michael Brady
- King's College Hospital NHS Foundation Trust, London, UK
| | - Christine Bowman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - David White
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Simone Antonucci
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Mitzy Gafos
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Sheena McCormack
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK.
| | - Owen N Gill
- HIV/STI Department, Public Health England, London, UK
| | - David T Dunn
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
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Hypersexual, Sexually Compulsive, or Just Highly Sexually Active? Investigating Three Distinct Groups of Gay and Bisexual Men and Their Profiles of HIV-Related Sexual Risk. AIDS Behav 2016; 20:262-72. [PMID: 25750052 DOI: 10.1007/s10461-015-1029-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Emerging research supports the notion that sexual compulsivity (SC) and hypersexual disorder (HD) among gay and bisexual men (GBM) might be conceptualized as comprising three groups-Neither SC nor HD; SC only, and Both SC and HD-that capture distinct levels of severity across the SC/HD continuum. We examined data from 370 highly sexually active GBM to assess how the three groups compare across a range of risk factors for HIV infection. Comparisons focused on psychosexual measures-temptation for condomless anal sex (CAS), self-efficacy for avoiding CAS, sexual excitation and inhibition-as well as reports of actual sexual behavior. Nearly half (48.9 %) of this highly sexually active sample was classified as Neither SC nor HD, 30 % as SC Only, and 21.1 % as Both SC and HD. While we found no significant differences between the three groups on reported number of male partners, anal sex acts, or anal sex acts with serodiscordant partners, the Both SC and HD group reported higher numbers of CAS acts and CAS acts with serodiscordant partners and also had a higher proportion of their anal sex acts without condoms compared to the SC Only group. Our findings support the validity of a three-group classification system of SC/HD severity in differentiating psychosexual and HIV-related sexual risk behavior outcomes in a sample of GBM who report similarly high levels of sexual activity. Notwithstanding the need for sex positive HIV prevention programs, interventions that attempt to help Both SC and HD men deal with distress and address their psychosexual needs specifically may derive HIV prevention benefits.
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Marcus U, an der Heiden M, Gassowski M, Kruspe M, Drewes J. The impact of meeting locations for men having sex with men on the risk for bacterial sexually transmitted infections: analyses from a cross-sectional online survey. BMJ Open 2015; 5:e009107. [PMID: 26537499 PMCID: PMC4636635 DOI: 10.1136/bmjopen-2015-009107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Opportunities for men having sex with men (MSM) to meet each other have very much improved by new communication technologies. Meeting venue-based characteristics can impact how many partners are met and how much sexual risk is taken. We analysed the association between physical and virtual venues and the risk for bacterial sexually transmitted infections (bSTIs) among participants in an MSM online survey. METHODS Data were collected during 2013/2014 with a survey targeting MSM living in Germany. The impact of the meeting place with the last non-steady anal sex partner on diagnosis with a bSTI in the previous year was analysed using bivariate and multivariate regression analysis, taking into account self-reported HIV status, serostatus communication, condom use, partner number, age and city size. RESULTS The study sample consisted of 8878 respondents (7799 not diagnosed with HIV; 1079 diagnosed with HIV). Meeting partners online was most common (62% HIV-/51% HIV+), followed by sex venues (11% HIV-/25% HIV+); other venues were each reported by 2-6% of the respondents. Venue-dependent proportions reporting bSTIs in the recent year were 2-4 folds higher among men diagnosed with HIV. In multivariate analysis, HIV status was the strongest predictor for bSTIs (OR=5.0; 95% CI 2.8 to 8.7). Compared with meeting partners online, sex (OR 1.6; 95% CI 1.0 to 2.5) and social venues (OR 1.9; 95% CI 1.4 to 2.6) were associated with increased bSTI risk for men not diagnosed with HIV, but the risk when meeting partners by smartphone apps was only of borderline significance (OR 1.5; 95% CI 0.9 to 2.3). For men diagnosed with HIV, bSTI risk increased for sex venues (OR 1.5; 95% CI 1.1 to 2.1), and was lower for non-gay/other venues (OR 0.2; 95% CI 0.1 to 0.5). CONCLUSIONS Venues are connected to social-behavioural facets of corresponding sexual encounters, and may be important arenas for differential HIV and STI education, treatment and prevention.
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Affiliation(s)
- U Marcus
- Department of Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany
| | - M an der Heiden
- Department of Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany
| | - M Gassowski
- Department of Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany
| | - M Kruspe
- Department of Public Health, Free University, Berlin, Germany
| | - J Drewes
- Department of Public Health, Free University, Berlin, Germany
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Grov C, Rendina HJ, Moody RL, Ventuneac A, Parsons JT. HIV Serosorting, Status Disclosure, and Strategic Positioning Among Highly Sexually Active Gay and Bisexual Men. AIDS Patient Care STDS 2015; 29:559-68. [PMID: 26348322 PMCID: PMC4598914 DOI: 10.1089/apc.2015.0126] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Researchers have identified harm reduction strategies that gay, bisexual, and other men who have sex with men (GBMSM) use to reduce HIV transmission--including serosorting, status disclosure, and strategic positioning. We report on patterns of these behaviors among 376 highly sexually active (i.e., 9+partners, <90 days) GBMSM: mean age of 37, 49.5% men of color, 87.8% gay identified, 57.5% college educated. We found evidence that many men engaged in serosorting, status disclosure, and strategic positioning; however, rates varied based on the participant's HIV status. HIV-positive and HIV-negative men both engaged in sex with men of similar status more often than they engaged in sex with men known to be a different HIV status (i.e., serosorting). However, HIV-negative men disclosed their HIV-status with about half of their partners, whereas HIV-positive participants disclosed with only about one-third. With regard to strategic positioning, HIV-positive participants were the receptive partner about half the time with their HIV-negative partners and with their HIV-positive partners. In contrast, strategic positioning was very common among HIV-negative participants-they rarely bottomed with HIV-positive partners, bottomed about one-third of the time with status-unknown partners, and 42% of the time (on average) with HIV-negative partners. Highly sexually active GBMSM are a critical population in which to both investigate HIV prevention strategies as well as develop effective intervention programs. Providers and clinicians might be well served to include a wide range of behavioral harm reduction strategies in addition to condom use and biomedical approaches to reduce onward HIV transmission.
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Affiliation(s)
- Christian Grov
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York (CUNY), Brooklyn, New York
- CUNY School of Public Health, New York, New York
| | - H. Jonathon Rendina
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
| | - Raymond L. Moody
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Ana Ventuneac
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
| | - Jeffrey T. Parsons
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, New York
- CUNY School of Public Health, New York, New York
- Department of Psychology, Hunter College of CUNY, New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
- Basic and Applied Social Psychology Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
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45
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Shah M, Risher K, Berry SA, Dowdy DW. The Epidemiologic and Economic Impact of Improving HIV Testing, Linkage, and Retention in Care in the United States. Clin Infect Dis 2015; 62:220-229. [PMID: 26362321 DOI: 10.1093/cid/civ801] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/02/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Recent guidelines advocate early antiretroviral therapy (ART) to decrease human immunodeficiency virus (HIV) morbidity and prevent transmission, but suboptimal engagement in care may compromise impact. We sought to determine the economic and epidemiologic impact of incomplete engagement in HIV care in the United States. METHODS We constructed a dynamic transmission model of HIV among US adults (aged 15-65 years) and conducted a cost-effectiveness analysis of improvements along the HIV care continuum : We evaluated enhanced HIV testing (annual for high-risk groups), increased 3-month linkage to care (to 90%), and improved retention (50% relative reduction in yearly disengagement and 50% increase in reengagement). Our primary outcomes were HIV incidence, mortality, costs and quality-adjusted life-years (QALYs). RESULTS Despite early ART initiation, a projected 1.39 million (95% uncertainty range [UR], 0.91-2.2 million) new HIV infections will occur at a (discounted) cost of $256 billion ($199-298 billion) over 2 decades at existing levels of HIV care engagement. Enhanced testing with increased linkage has modest epidemiologic benefits and could reduce incident HIV infections by 21% (95% UR, 13%-26%) at a cost of $65 700 per QALY gained ($44 500-111 000). By contrast, comprehensive improvements that couples enhanced testing and linkage with improved retention would reduce HIV incidence by 54% (95% UR, 37%-68%) and mortality rate by 64% (46%-78%), at a cost-effectiveness ratio of $45 300 per QALY gained ($27 800-72 300). CONCLUSIONS Failure to improve engagement in HIV care in the United States leads to excess infections, treatment costs, and deaths. Interventions that improve not just HIV screening but also retention in care are needed to optimize epidemiologic impact and cost-effectiveness.
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Affiliation(s)
| | - Kathryn Risher
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - David W Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Tieu HV, Liu TY, Hussen S, Connor M, Wang L, Buchbinder S, Wilton L, Gorbach P, Mayer K, Griffith S, Kelly C, Elharrar V, Phillips G, Cummings V, Koblin B, Latkin C. Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities. PLoS One 2015; 10:e0134085. [PMID: 26241742 PMCID: PMC4524662 DOI: 10.1371/journal.pone.0134085] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sexual networks may place U.S. Black men who have sex with men (MSM) at increased HIV risk. METHODS Self-reported egocentric sexual network data from the prior six months were collected from 1,349 community-recruited Black MSM in HPTN 061, a multi-component HIV prevention intervention feasibility study. Sexual network composition, size, and density (extent to which members are having sex with one another) were compared by self-reported HIV serostatus and age of the men. GEE models assessed network and other factors associated with having a Black sex partner, having a partner with at least two age category difference (age difference between participant and partner of at least two age group categories), and having serodiscordant/serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last six months. RESULTS Over half had exclusively Black partners in the last six months, 46% had a partner of at least two age category difference, 87% had ≤5 partners. Nearly 90% had sex partners who were also part of their social networks. Among HIV-negative men, not having anonymous/exchange/ trade partners and lower density were associated with having a Black partner; larger sexual network size and having non-primary partners were associated with having a partner with at least two age category difference; and having anonymous/exchange/ trade partners was associated with SDUI. Among HIV-positive men, not having non-primary partners was associated with having a Black partner; no sexual network characteristics were associated with having a partner with at least two age category difference and SDUI. CONCLUSIONS Black MSM sexual networks were relatively small and often overlapped with the social networks. Sexual risk was associated with having non-primary partners and larger network size. Network interventions that engage the social networks of Black MSM, such as interventions utilizing peer influence, should be developed to address stable partnerships, number of partners, and serostatus disclosure.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States of America
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
- * E-mail:
| | - Ting-Yuan Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Sophia Hussen
- Division of Infectious Diseases, Emory School of Medicine, Atlanta, GA, United States of America
| | - Matthew Connor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Lei Wang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Pamina Gorbach
- Department of Epidemiology, School of Public Health, Division of InfectiousDiseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Kenneth Mayer
- Fenway Community Health Center, Boston, MA, United States of America
| | - Sam Griffith
- FHI 360, Research Triangle Park, NC, United States of America
| | - Corey Kelly
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Vanessa Elharrar
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Gregory Phillips
- The George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC, United States of America
| | - Vanessa Cummings
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Beryl Koblin
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States of America
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Zhang H, Lu H, Pan SW, Xia D, Zhao Y, Xiao Y, He X, Yue H, Sun Z, Xu Y, Ruan Y, Shao Y. Correlates of unprotected anal intercourse: the influence of anal sex position among men who have sex with men in Beijing, china. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:375-387. [PMID: 25548064 DOI: 10.1007/s10508-014-0396-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 06/04/2023]
Abstract
Understanding barriers to consistent condom use among men who have sex with men (MSM) requires consideration of the context in which risk behaviors occur. Anal sex position is one such context. This pooled cross-sectional study used survey data from 1,230 MSM and their 2,618 reported male sexual partnerships. Overall, nearly half of the participants engaged in unprotected anal intercourse (UAI) with at least one of upto three partners in the past 6 months. "Insertive" men engaged in less UAI (39 %) than "receptive" (53 %) or "versatile" (51 %) men. Regardless of sexual position, UAI was associated with cohabiting with a male or female partner and perceiving great or moderate risk of HIV from male contact at the individual level, and steady (vs. casual) partnership at the dyad level. However, early MSM anal sex debut, high number of male partners, alcohol use, receiving and buying condoms, HIV testing, and MSM sex-seeking venues were found to be only statistically significantly correlated with UAI among some but not all sexual positions, implying that interventions to increase condom use should take into account how anal sex position may influence willingness and ability to engage in safer sex. Dyad level data appear to provide additional insight into the influence of sexual positions, and should be used to complement individual data for future intervention designs.
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Affiliation(s)
- Heng Zhang
- Epidemiology and Biostatistics Branch of Division of Virology and Immunology, State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
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48
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Rosenberg ES, Rothenberg RB, Kleinbaum DG, Stephenson RB, Sullivan PS. Assessment of a new web-based sexual concurrency measurement tool for men who have sex with men. J Med Internet Res 2014; 16:e246. [PMID: 25386801 PMCID: PMC4260005 DOI: 10.2196/jmir.3211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 08/22/2014] [Accepted: 08/30/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are the most affected risk group in the United States' human immunodeficiency virus (HIV) epidemic. Sexual concurrency, the overlapping of partnerships in time, accelerates HIV transmission in populations and has been documented at high levels among MSM. However, concurrency is challenging to measure empirically and variations in assessment techniques used (primarily the date overlap and direct question approaches) and the outcomes derived from them have led to heterogeneity and questionable validity of estimates among MSM and other populations. OBJECTIVE The aim was to evaluate a novel Web-based and interactive partnership-timing module designed for measuring concurrency among MSM, and to compare outcomes measured by the partnership-timing module to those of typical approaches in an online study of MSM. METHODS In an online study of MSM aged ≥18 years, we assessed concurrency by using the direct question method and by gathering the dates of first and last sex, with enhanced programming logic, for each reported partner in the previous 6 months. From these methods, we computed multiple concurrency cumulative prevalence outcomes: direct question, day resolution / date overlap, and month resolution / date overlap including both 1-month ties and excluding ties. We additionally computed variants of the UNAIDS point prevalence outcome. The partnership-timing module was also administered. It uses an interactive month resolution calendar to improve recall and follow-up questions to resolve temporal ambiguities, combines elements of the direct question and date overlap approaches. The agreement between the partnership-timing module and other concurrency outcomes was assessed with percent agreement, kappa statistic (κ), and matched odds ratios at the individual, dyad, and triad levels of analysis. RESULTS Among 2737 MSM who completed the partnership section of the partnership-timing module, 41.07% (1124/2737) of individuals had concurrent partners in the previous 6 months. The partnership-timing module had the highest degree of agreement with the direct question. Agreement was lower with date overlap outcomes (agreement range 79%-81%, κ range .55-.59) and lowest with the UNAIDS outcome at 5 months before interview (65% agreement, κ=.14, 95% CI .12-.16). All agreements declined after excluding individuals with 1 sex partner (always classified as not engaging in concurrency), although the highest agreement was still observed with the direct question technique (81% agreement, κ=.59, 95% CI .55-.63). Similar patterns in agreement were observed with dyad- and triad-level outcomes. CONCLUSIONS The partnership-timing module showed strong concurrency detection ability and agreement with previous measures. These levels of agreement were greater than others have reported among previous measures. The partnership-timing module may be well suited to quantifying concurrency among MSM at multiple levels of analysis.
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Affiliation(s)
- Eli S Rosenberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States.
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49
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Ren J, Ning Z, Kirkness CS, Asche CV, Wang H. Risk of using logistic regression to illustrate exposure-response relationship of infectious diseases. BMC Infect Dis 2014; 14:540. [PMID: 25282153 PMCID: PMC4287313 DOI: 10.1186/1471-2334-14-540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/25/2014] [Indexed: 01/23/2023] Open
Abstract
Background In most biological experiments, especially infectious disease, the exposure-response relationship is interrelated by a multitude of factors rather than many independent factors. Little is known about the suitability of ordinary, categorical exposures, and logarithmic transformation which have been presented in logistic regression models to assess the likelihood of an infectious disease as a function of a risk or exposure. This study aims to examine and compare the current approaches. Methods A simulated human immunodeficiency virus (HIV) population, dynamic infection data for 100,000 individuals with 1% initial prevalence and 2% infectivity, was created. Using the Monte Carlo method (computational algorithm) to repeat random sampling to obtain numerical results, linearity between log odds and exposure, and suitability in practice were examined in the three model approaches. Results Despite diverse population prevalence, the linearity was not satisfied between log odds and raw exposures. Logarithmic transformation of exposures improved the linearity to a certain extent, and categorical exposures satisfied the linear assumption (which was important for modelling). When the population prevalence was low (assumed < 10%), performances of the three models were significantly different. Comparing to ordinary logistic regression, the logarithmic transformation approach demonstrated better accuracy of estimation except that at the two inflection points: likelihood of infection increased from slowly to sharply, then slowly again. The approach using categorical exposures had better estimations around the real values, but the measurement was coarse due to categorization. Conclusions It is not suitable to directly use ordinary logistic regression to explore the exposure-response relationship of HIV as an infectious disease. This study provides some recommendations for practical implementations including: 1) utilize categorical exposure if a large sample size and low population prevalence are provided; 2) utilize a logarithmic transformed exposure if the sample size is insufficient or the population prevalence is too high (such as 30%). Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-540) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jinma Ren
- Center for Outcomes Research, University of Illinois College of Medicine at Peoria, One Illini Drive, Box 1649, Peoria, IL 61656, USA.
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Risk factors associated with HIV infection among male homosexuals and bisexuals followed in an open cohort study: Project Horizonte, Brazil (1994-2010). PLoS One 2014; 9:e109390. [PMID: 25279670 PMCID: PMC4184869 DOI: 10.1371/journal.pone.0109390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 09/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There has recently been an increase in HIV infection rates among men who have sex with men (MSM). This study aimed at investigating risk factors associated with incident HIV infection in a MSM cohort-Project Horizonte, Belo Horizonte, Minas Gerais, Brazil. METHODOLOGY This is a nested case-control study in an ongoing open cohort of homosexual and bisexual men, carried out in 1994-2010, during which 1,085 volunteers were enrolled. Each HIV seroconverted volunteer (case) was compared with three randomly selected HIV negative controls, matched by admission date and age (±3 years). During follow-up, 93 volunteers seroconverted and were compared with 279 controls. PRINCIPAL FINDINGS The risk factors associated with HIV seroconversion were: contact with partner's blood during sexual relations (OR 3.7; 95% CI 1.2-11.6), attendance at gay saunas in search for sexual partners (OR 2.6; 95% CI 1.3-5.4), occasional intake of alcohol when flirting and engaging in sexual activity (OR 2.5; 95% CI 1.3-5.1), inconsistent use of condoms in receptive anal sex (OR 2.4; 95% CI 1.1-5.4), little interest to look up information about AIDS (OR 2.6; 95% CI 1.0-6.7) particularly in newspapers (OR 3.4; 95% CI 1.4-8.1). CONCLUSIONS This study shows that MSM are still engaging in risk behavior, such as unprotected anal intercourse, despite taking part in a cohort study on various preventive measures. New preventive strategies in touch with the epidemic's development and the specificities of this particular population are needed.
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