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Liu Y, Fu G, Chen Y, Wu L, Pan M, Yang Y, Chen Z, Cao Y, Li Y, Wang H, Wang B, Lv C, Du R, Xiong Y, Liu W, Xu N, Xia X, Li Q, Ruan F, Wang J. Discordance between perceived risk and actual risky sexual behaviors among undergraduate university students in mainland China: a cross-sectional study. BMC Public Health 2022; 22:729. [PMID: 35413860 PMCID: PMC9006618 DOI: 10.1186/s12889-022-13132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV prevention, diagnosis, treatment and care services might be hampered by inaccurate risk assessment. This study aimed to investigate the extent of and factors associated with the discordance between perceived risk and actual risky sexual behaviors among undergraduates in mainland China, guided by the Anderson's behavioral model. METHODS This study involved a secondary analysis of cross-sectional data collected during the fall semester of 2018-2019 academic year. The present analysis was restricted to 8808 undergraduates with low risk perception. Those who had low perceived risk but actually engaged in risky sexual behaviors were categorized as risk discordance (RD). Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with RD. RESULTS Overall, the discordance rate between perceived and actual risk was 8.5% (95% CI: 7.9%-9.1%). Multivariate Logistic regression analysis indicated that non-heterosexual women (AOR = 0.41, 95% CI:0.27-0.60), heterosexual men (AOR = 0.45, 95% CI:0.33-0.61) and women (AOR = 0.26, 95% CI:0.19-0.35) were less likely to exhibit RD, when compared with non- heterosexual men. Furthermore, non-freshmen (AOR = 1.57, 95% CI:1.30-1.90), early initiators of sexual intercourse (AOR = 5.82, 95% CI:4.10-8.26), and those who had lower levels of HIV knowledge (AOR = 1.28, 95% CI:1.08-1.51), displayed higher levels of stigma against PLHIV (AOR = 1.50, 95% CI:1.26-1.77) and had ever been tested for HIV (AOR = 1.36, 95% CI:1.04-1.77) were more prone to reporting RD. Those with more enabling resources [i.e., displaying high levels of condom use self-efficacy (AOR = 0.70, 95% CI:0.59-0.84) and being knowledge of local testing center (AOR = 0.71, 95% CI:0.60-0.83)] were less likely to report RD. However, spending more than 2000 Yuan a month on basic needs (AOR = 2.55, 95% CI:2.07-3.14), residing in urban areas (AOR = 1.35, 95% CI:1.15-1.59) and being knowledgeable of the national AIDS policy (AOR = 1.40,95% CI:1.18-1.66) increased the chance of exhibiting RD. CONCLUSIONS Comprehensive interventions, including targeting students with high-risk characteristics, improving the acceptability of PrEP and PEP, conducting health education, enhancing self-efficacy for using condoms and making opt-out HIV testing routine in college campus, should be taken to reduce the discordance between perceived and actual HIV risk and finally to reach the goal of Zero AIDS.
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Affiliation(s)
- Yusi Liu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Guochen Fu
- National Demonstration Center for Experimental General Medicine Education of Hubei University of Science and Technology, Xianning City, China
| | - Yifan Chen
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Lei Wu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Mingliang Pan
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yuli Yang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Zhuo Chen
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yu Cao
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yong Li
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Hao Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Bixiang Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Chengcheng Lv
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Ruyi Du
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Yanting Xiong
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Wei Liu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Nuo Xu
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Xiaobao Xia
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Qianqian Li
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Fang Ruan
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China
| | - Junfang Wang
- Department of Preventive Medicine, School of Basic Medical Sciences, Hubei University of Science and Technology, No.88 Xianning Avenue, Xianning City, Hubei Province, 437100, China.
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Truong HHM, Fatch R, McFarland W, Raymond HF. HIV Prevention Responsibility Beliefs Among Men Who Have Sex With Men in the PrEP Era. J Acquir Immune Defic Syndr 2021; 87:e222-e228. [PMID: 33587501 DOI: 10.1097/qai.0000000000002659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Beliefs regarding responsibility for preventing HIV transmission may differ between individuals and their sexual partners. We assessed HIV prevention responsibility beliefs among men who have sex with men (MSM) participating in the 2017 National HIV Behavioral Surveillance survey. METHODS MSM were recruited using time-location sampling at clubs, bars, and street locations in San Francisco. HIV prevention responsibility beliefs were assessed on a four-point scale (1 = strongly disagree to 4 = strongly agree). Associations were assessed using generalizing estimating equations to adjust for behaviors within multiple partnerships. RESULTS A total of 316 HIV-negative men and 76 HIV-positive men reported on 1336 partnerships. HIV-negative compared with HIV-positive men had higher endorsement of mutual responsibility (mean 3.7 vs. 3.5; P < 0.01). Both groups had similar levels of endorsing responsibility on the HIV-negative or HIV-positive partner. HIV-positive men endorsing equal responsibility were more likely to know their partner's HIV status (P < 0.01) and less likely to have serodiscordant condomless anal intercourse (CAI) (P < 0.01) than men who did not endorse equal responsibility. HIV-negative men in partnerships with pre-exposure prophylaxis (PrEP) use were more likely to know their partner's HIV status (P = 0.02) and have serodiscordant CAI (P = 0.04) than men not in partnerships with PrEP use. CONCLUSIONS HIV-negative and HIV-positive men accept responsibility for preventing HIV. The finding that HIV-negative men in partnerships with PrEP use who engage in serodiscordant CAI is concerning because they are still at risk for other sexually transmitted infections, which are presently at elevated levels in San Francisco and other US cities.
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Affiliation(s)
| | - Robin Fatch
- University of California, San Francisco, CA; and
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, CA
| | - Henry F Raymond
- San Francisco Department of Public Health, San Francisco, CA
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Abstract
PURPOSE OF REVIEW This study aims to review the epidemiology of sexually transmitted infections (STIs) among men who have sex with men (MSM) and suggest control measures. RECENT FINDINGS Despite declines in new HIV diagnosis, bacterial STIs among MSM have dramatically risen since the late 1990s. This increase occurred concurrent with introduction of effective antiretroviral therapy, the advent of electronic mechanisms for meeting sex partners and population-level changes in sexual behavior, including decreased condom use. HIV pre-exposure prophylaxis (PrEP) is now further diminishing condom use, though its impact on STIs is uncertain. A plan to confront the MSM STI epidemic should include increased HIV/STI testing promoted through expanded public health clinical infrastructure, health care system reform to improve the care of gender and sexual minorities and promote low-barrier care, re-invigorated condom promotion, and scientific innovation. There is an urgent need to implement new STI control measures while continuing to expand PrEP use.
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4
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Jiang Y, Su S, Borné Y. A meta-analysis of the efficacy of HAART on HIV transmission and its impact on sexual risk behaviours among men who have sex with men. Sci Rep 2020; 10:1075. [PMID: 31974510 PMCID: PMC6978405 DOI: 10.1038/s41598-019-56530-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 11/04/2019] [Indexed: 11/23/2022] Open
Abstract
Evidence showed preventive impacts of the highly active antiretroviral therapy (HAART) on the Human Immunodeficiency Virus (HIV) transmission amomg heterosexual population, however, that is of deficit among men who have sex with men (MSM). The aim was to systematically examine the efficacy of HAART on HIV transmission and the association between the HAART initiation and unprotected anal intercourse (UAI) in MSM population. Three electronic databases were fully searched for articles published in peer-reviewed journals between 1996 and 2017. Of 1616 identified articles, fifteen articles were eligible for meta-analyses. The summary incidence rate (IR) of HIV was 6.63/100 person-year (95%CI 2.06–11.20/100 person-year)(p = 0.004). The pooled per-contact rate (PCR) of HIV was 0.42% (95% CI 0.21–0.63%)(p < 0.05). The HAART initiation (vs non-HAART) was not associated with engaging in UAI, with odds ratio (OR) 1.09 (95% CI 0.90–1.34)(p > 0.05). In the stratified analysis, participants with no less than 6 months recall period was slightly more likely to engage in UAI (OR 1.32; 95% CI 1.01–1.74)(p < 0.05). It indicated that HAART has potential efficacy on reducing infectivity of HIV positive individuals in anal intercourses. The relationship between the HAART initiation and UAI was not significant and may be influenced by some social-demographic factors. Consistent condom use and education on safe sex among MSM are crucial.
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Affiliation(s)
- Ying Jiang
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Shu Su
- School of public health and preventive medicine, Monash University, Melbourne, Australia
| | - Yan Borné
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Lund, Sweden
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5
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Colyer SP, Moore DM, Cui Z, Zhu J, Armstrong HL, Taylor M, Edward J, Howard T, Dickie C, Olarewaju G, Montaner JSG, Hogg RS, Roth EA, Lachowsky NJ. Crystal Methamphetamine Use and Initiation among Gay, Bisexual, and Other Men Who Have Sex with Men Living with HIV in a Treatment as Prevention Environment. Subst Use Misuse 2020; 55:2428-2437. [PMID: 33059493 PMCID: PMC7657389 DOI: 10.1080/10826084.2020.1833925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Risk compensation in an HIV Treatment as Prevention (TasP) environment may increase high-risk sexual and substance use behaviors among people living with HIV. Objective: To examine recent crystal methamphetamine (CM) use/initiation in a longitudinal cohort of gay, bisexual, and other men who have sex with men (GBMSM) living with HIV in Metro Vancouver, Canada. Methods: Eligible participants were GBMSM aged >15 years who reported sex with another man in the past six months. Participants were recruited using respondent-driven sampling and self-completed a computer questionnaire every six months. We used multi-level generalized mixed-effect models to evaluate trends in recent CM use (past six months), multivariable logistic regression to identify covariates of recent CM use, and multivariable survival analysis to identify predictors of CM initiation. Results: Of 207 GBMSM living with HIV at enrollment, 44.3% reported recent CM use; there was a statistically non-significant decrease over the study period (41% in first period to 25% in final period, p = 0.087). HIV treatment optimism was not associated with CM use/initiation. CM use was positively associated with depressive symptomology, sexual escape motivation, transactional sex, number of anal sex partners, condomless anal sex with seroconcordant partners, STIs, and other substance use. Recent CM use was negatively associated with viral load sorting. CM initiation was predicted by escape motivation, transactional sex, and group sex participation. Conclusion: Results suggest that CM use among GBMSM living with HIV is prevalent and increased CM use/initiation is not a consequence of TasP public policy.
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Affiliation(s)
- Sean P Colyer
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - David M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Zishan Cui
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julia Zhu
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Heather L Armstrong
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada.,Department of Psychology, University of Southampton, Southampton, UK
| | | | - Joshua Edward
- Health Initiative for Men Society, Vancouver, Canada
| | - Terry Howard
- Community Advisory Board, Momentum Health Study, Vancouver, Canada
| | - Chad Dickie
- Community Advisory Board, Momentum Health Study, Vancouver, Canada
| | - Gbolahan Olarewaju
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio S G Montaner
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
| | - Nathan J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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6
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Pleasure and HIV biomedical discourse: The structuring of sexual and drug-related risks for gay and bisexual men who Party-n-Play. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:181-190. [PMID: 31627160 DOI: 10.1016/j.drugpo.2019.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/21/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
Party-n-Play (PNP) is a social practice that refers to sex that occurs under the influence of drugs. This study critically examined the risk and pleasure discourses of gay and bisexual men who PNP to explore how epistemic shifts associated with advancements in HIV biomedical sciences influence gay and bisexual men's perceptions of HIV risks and their sexual and drug-related practices. This study also aims to provide a more nuanced understanding of how sexual and drug-related risk practices of gay and bisexual men are entangled with their search for pleasure. The study was framed within poststructural Critical Discourse Analysis (CDA) methodology. In-depth one-hour interviews were conducted with 44 self-identified gay, bisexual, queer, or Two-Spirit men, who lived in Toronto, and who reported using drugs before or during sex with another man. The findings from this study demonstrated the capacity of biomedical discourses to affect respondents' HIV risk perceptions and practices. The transition from condom-centered prevention to today's context where new highly effective biomedical tools for HIV prevention are available created possibilities for greater intimacy, increased pleasure, and less anxiety about HIV tranmission, while challenging many years of preventive socialization among gay and bisexual men. However, this new context also rekindled deep-seated fears about HIV risk and viral load verifiability, reinforced unequal forms of biomedical self-governance and citizenship, and reproduced practices of biopolitics. While discourses on risk and pleasure were interwoven within complex PNP assemblages, the notion of pleasure was mobilized as a discursive tactic of self-control, and the division between normative and non-normative pleasures highlighted the consequence of biopolitical forces governing the production of discourses on sex and drugs. Future HIV social science research needs to attend to the fluid nature of the discursive environments of HIV prevention science, and consider how both the material context of PNP and its social/discursive elements operate together.
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7
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Eke AN, Johnson WD, O’Leary A, Rebchook GM, Huebner DM, Peterson JL, Kegeles SM. Effect of a Community-Level HIV Prevention Intervention on Psychosocial Determinants of HIV Risk Behaviors among Young Black Men Who Have Sex with Men (YBMSM). AIDS Behav 2019; 23:2361-2374. [PMID: 31016504 DOI: 10.1007/s10461-019-02499-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In contrast to intervention studies that assess psychosocial factors only as mediators or moderators of HIV risk, the present study assessed the effects of an Mpowerment-based community-level intervention on psychosocial determinants (e.g., depressive symptoms, sexual stigma) of HIV risk behavior among young black MSM. Approximately 330 respondents were surveyed annually for 4 years in each of two sites. General linear models examined change across time between the intervention and comparison communities, and participation effects in the intervention site. Social diffusion (spreading information within networks) of safer sex messages (p < 0.01) and comfort with being gay (p < 0.05) increased with time in intervention versus control. Cross-sectionally, intervention participants responded more favorably (p < 0.05) on social diffusion and depressive symptoms, but less favorably (p < 0.01) on sex in difficult situations and attitudes toward condom use. Findings suggest a need to address broader health issues of MSM as well as sexual risk.
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8
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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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9
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Przybyla SM, Krawiec G, Godleski SA, Crane CA. Meta-Analysis of Alcohol and Serodiscordant Condomless Sex Among People Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1351-1366. [PMID: 28975477 PMCID: PMC7864120 DOI: 10.1007/s10508-017-1050-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 05/24/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
While observational studies have found that alcohol consumption is associated with serodiscordant condomless sex among people living with HIV (PLHIV), no meta-analysis has yet examined this trend. We conducted a meta-analysis to synthesize empirical evidence on the association between alcohol and condomless sex with partners at risk of HIV acquisition. To meet inclusion criteria, studies: (1) specifically targeted PLHIV or provided stratified data for HIV-infected participants; (2) provided a quantitative measure of alcohol use; (3) provided a quantitative measure of condomless sex with serodiscordant partners; and (4) reported the results of statistical tests examining the relationship between alcohol use and serodiscordant condomless sex. Using random-effects models, weighted effect sizes were calculated. Three separate analyses were conducted to examine serodiscordant condomless sex in association with any alcohol consumption, binge/problematic drinking, and alcohol in a sexual context. A total of 36 independent effect sizes from 27 studies (including 25,065 HIV-infected participants) were pooled in the meta-analysis. Any alcohol consumption, binge/problematic drinking, and alcohol use in a sexual context were each associated with condomless sex with serodiscordant partners [OR 1.64 (95% CI 1.46-1.85); OR 1.65 (95% CI 1.14-2.39); OR 2.88 (95% CI 2.01-4.12), respectively]. Meta-analytic findings demonstrate a consistent positive relationship between alcohol use and serodiscordant condomless sex among PLHIV. Future public health programming for HIV-infected individuals needs to address the role of alcohol consumption in sexual risk-taking behavior.
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Affiliation(s)
- Sarahmona M Przybyla
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA.
| | - Gabriela Krawiec
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA
| | | | - Cory A Crane
- Biomedical Sciences, Rochester Institute of Technology, Rochester, NY, USA
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Wu Y, Dijkstra A, Dalley SE, Roerink FS. An experimental test to reveal negative side-effects of high treatability information on preventative health behaviour. Psychol Health 2018; 33:1028-1048. [PMID: 29616825 DOI: 10.1080/08870446.2018.1456290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES When the course of a disease can be positively changed by health professionals the disease can be indicated as 'highly treatable'. This 'high treatability information' (HTI) may have negative side-effects on people's preventative motivation. This study examined the effects of HTI regarding skin cancer on preventative motivation. DESIGN This study employed a 2 (high treatability (HTI) versus low treatability (LTI)) × 2 (high versus low susceptibility)-experiment with a hanging control group. (family) History and self-efficacy were assessed as moderators. Participants (N = 309) were randomly assigned to one of the five conditions. MAIN OUTCOME MEASURES The main outcome was intention to engage in preventative actions regarding skin cancer. RESULTS HTI significantly lowered the intention compared to LTI, under the condition of high susceptibility in people with low self-efficacy. In addition, in people with a (family) history of skin cancer, HTI significantly lowered the intention compared to the no-information group. CONCLUSION HTI regarding skin cancer can cause a drop in the preventative motivation. The effects can be conceptualised as negative side-effects of HTI. As substantial proportions of the general population have a (family) history of skin cancer or low self-efficacy, the side-effects may be widespread, possibly increasing the incidence of skin cancer.
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Affiliation(s)
- Yingqiu Wu
- a Department of Social Psychology , University of Groningen , Groningen , the Netherlands
| | - Arie Dijkstra
- a Department of Social Psychology , University of Groningen , Groningen , the Netherlands
| | - Simon E Dalley
- a Department of Social Psychology , University of Groningen , Groningen , the Netherlands
| | - Florentine S Roerink
- a Department of Social Psychology , University of Groningen , Groningen , the Netherlands
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11
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Swartz JA, McCarty-Caplan D. A Study of the Longitudinal Patterns of Stimulant and Amyl Nitrite Use and Sexual Behavior Pre- and Post-HIV Seroconversion Among MSM. AIDS Behav 2018; 22:1395-1409. [PMID: 29248970 DOI: 10.1007/s10461-017-2008-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The use of stimulant drugs alone or in combination with amyl nitrites (stimulant/nitrites) has been associated with higher rates of risky sexual behavior and predictive of HIV infection among men who have sex with men. However, the temporal pattern of stimulant/nitrite use pre- and post-seroconversion has not been well established. This study assessed changes in stimulant/nitrite use and risky sexual behavior among seroconverting MSM over time. Data were collected in the Baltimore-Washington, DC; Pittsburgh; Chicago; and Los Angeles sites of the Multicenter AIDS Cohort Study (MACS), a longitudinal study of the natural history of HIV infection among MSM. We used propensity scores to select 1044 MSM from 7087 MACS participants composed of 348 seroconverting, 348 seronegative, and 348 seroprevalent participants matched on demographics, recruitment cohort, and study visits. We centered up to four-years of semi-annual data around the seroconversion visit of the seroconverting case within each matched group of participants. Mixed effects regressions estimated the effects of serostatus, recruitment cohort, and time on self-reported stimulant/nitrite use, numbers of male intercourse partners, and numbers of unprotected receptive anal intercourse (URAI) partners. Covariates included demographics, binge drinking, and marijuana use. Seroconverters had the highest odds of stimulant/inhaled nitrite use (AOR 10.3, CI 4.8-22.0), incident rates of intercourse (IRR 1.6, CI 1.3-2.1), and URAI partners (IRR 5.1, CI 3.5-7.3). All participants decreased drug use and sexual risk behavior over time. However, the decreases were largest for seroconverters who nevertheless maintained the highest rates of stimulant/nitrite use and sexual risk. Cohort-related effects were associated with sharp reductions in stimulant/nitrite use and URAI in the early 1990s that rebounded considerably within the first decade of the 2000s. Although all participants decreased risky sexual behavior and stimulant and/or nitrite use over time, seroconverters had the largest decreases. There was no evidence for abrupt or substantial increases in drug use or risky sex post-seroconversion. However, there was substantial variation at the individual level, with the factors underlying this variation not well understood and worth further study. Moreover, stimulant/nitrite use and risky sexual behavior appear to have been strongly influenced by contextual historical and socio-cultural effects. The manner in which contextual factors influence individual behavior is also not well understood and also warrants further study.
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12
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Colyer SP, Lachowsky NJ, Cui Z, Zhu J, Armstrong HL, Taylor M, Edward J, Olarewaju G, Hogg RS, Roth EA, Moore DM. HIV treatment optimism and crystal methamphetamine use and initiation among HIV-negative men who have sex with men in Vancouver, Canada: A longitudinal analysis. Drug Alcohol Depend 2018; 185:67-74. [PMID: 29427917 PMCID: PMC5889742 DOI: 10.1016/j.drugalcdep.2017.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment as Prevention (TasP) leading to increased HIV treatment optimism among men who have sex with men (MSM) has been previously associated with behavioural risk compensation, though not yet via crystal methamphetamine (CM) use. Among HIV-negative MSM in a TasP environment, this study aimed to investigate the prevalence of recent CM use over time, examine the association between HIV treatment optimism and CM use and initiation, and identify correlates of recent CM use and predictors of CM initiation. METHODS Using data from a prospective behavioural cohort study of sexually active MSM in the Vancouver area, we used multi-level generalized mixed effect models to evaluate temporal trends in CM use, univariable and multivariable logistic regression to identify covariates of recent CM use, and univariable and multivariable survival analysis to identify predictors of CM initiation. RESULTS Of 497 HIV-negative cohort participants, 10.3% reported any recent CM use at enrollment. From 2012-2016, there were no statistically significant temporal trends in overall CM use or with routes of administration. In multivariable logistic regression analyses, HIV treatment optimism was not associated with recent CM use (not retained in final model) or CM initiation (aHR = 1.06, 95% CI:0.98-1.15). Significant correlates of CM use include recent gamma-hydroxybutyrate (GHB) and ecstasy use, and having received/given drugs for sex. CONCLUSIONS Among HIV-negative MSM in Vancouver, HIV treatment optimism does not appear to be independently associated with CM use or initiation of use, though use of CM was both prevalent and stable over time.
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Affiliation(s)
- Sean P. Colyer
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julia Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Heather L. Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | | | | | | | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A. Roth
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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13
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Condomless Sex Among Virally Suppressed Women With HIV With Regular HIV-Serodiscordant Sexual Partners in the Era of Treatment as Prevention. J Acquir Immune Defic Syndr 2018; 76:372-381. [PMID: 29077673 DOI: 10.1097/qai.0000000000001528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sexual HIV transmission does not occur with sustained undetectable viral load (VL) on antiretroviral therapy (ART). Awareness of ART prevention benefits and its influence on condom use among women with HIV (WWH) remain unexplored. We estimated prevalence and correlates of condomless sex with regular HIV-serodiscordant partners among WWH with undetectable VL on ART. METHODS We used baseline questionnaire data from the community-based longitudinal Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). We included WWH self-reporting vaginal/anal sex with ≥1 HIV-negative/unknown status regular partner within 6 months, and undetectable VL (<50 copies/mL) on ART. We excluded participants exclusively reporting female partners or missing condom-use data. Condomless sex was defined as <100% condom use within 6 months. The primary explanatory variable was awareness of ART prevention benefits. Logistic regression identified factors independently associated with condomless sex. RESULTS Of 271 participants (19% of the CHIWOS cohort), median age was 41 (interquartile range: 34-47), 51% were in a relationship, 55% reported condomless sex, and 75% were aware of ART prevention benefits. Among women aware, 63% reported condomless sex compared with 32% of women not aware (P < 0.001). Factors independently associated with condomless sex included being aware of ART prevention benefits (adjusted odds ratio: 4.08; 95% confidence interval: 2.04 to 8.16), white ethnicity, ≥high-school education, residing in British Columbia, and being in a relationship. CONCLUSIONS Virally suppressed women aware of ART prevention benefits had 4-fold greater odds of condomless sex. Advancing safer sex discussions beyond condoms is critical to support women in regular serodiscordant partnerships to realize options for safe and satisfying sexuality in the Treatment-as-Prevention era.
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14
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Zimmerman RS, Kirschbaum AL. News of Biomedical Advances in HIV: Relationship to Treatment Optimism and Expected Risk Behavior in US MSM. AIDS Behav 2018; 22:367-378. [PMID: 28293758 DOI: 10.1007/s10461-017-1744-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
HIV treatment optimism and the ways in which news of HIV biomedical advances in HIV is presented to the most at-risk communities interact in ways that affect risk behavior and the incidence of HIV. The goal of the current study was to understand the relationships among HIV treatment optimism, knowledge of HIV biomedical advances, and current and expected increased risk behavior as a result of reading hypothetical news stories of further advances. Most of an online-recruited sample of MSM were quite knowledgeable about current biomedical advances. After reading three hypothetical news stories, 15-24% of those not living with HIV and 26-52% of those living with HIV reported their condom use would decrease if the story they read were true. Results suggest the importance of more cautious reporting on HIV biomedical advances, and for targeting individuals with greater treatment optimism and those living with HIV via organizations where they are most likely to receive their information about HIV.
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15
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Card KG, Lachowsky NJ, Cui Z, Carter A, Armstrong H, Shurgold S, Moore D, Hogg RS, Roth EA. A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:95-106. [PMID: 27987086 PMCID: PMC5474217 DOI: 10.1007/s10508-016-0879-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/16/2016] [Accepted: 10/08/2016] [Indexed: 05/30/2023]
Abstract
Initial research into seroadaptive strategies suggests that, individually, they are potentially effective behavioral methods to reduce risk of HIV transmission. Combining strategies, therefore, has the potential to increase risk reduction. The aim of this study was to determine how gay and bisexual men (GBM) combine strategies. To this end, a total of 774 sexually active GBM, aged ≥16 years, in Metro Vancouver, Canada, were recruited. Grouped by self-reported HIV status, latent class analysis of self-reported condom use, strategic positioning, anal sex avoidance, serosorting, viral-load sorting, and withdrawal were conducted. Multinomial logistical regression identified explanatory variables of class membership (i.e., sensation seeking, treatment optimism, sexual altruism, relationship status, number of partners, anal sex preference). Four latent classes were identified: Condom Users, Multiple Prevention Users, Viral-Load Sorters, and Serosorters. The majority of HIV-negative/unknown men (72 %) and a large proportion of HIV-positive men (42 %) belonged to the Condom Users class. Class membership was associated with age, relationship status, treatment optimism, sexual altruism, sensation seeking, number of recent male anal sex partners, and recent condomless anal sex with a serodiscordant or unknown-status partner. Understanding these distinct patterns allows for tailored interventions addressing GBM's sexual health needs.
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Affiliation(s)
- Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada.
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Allison Carter
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Heather Armstrong
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Susan Shurgold
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
- Centre for Addiction Research of British Columbia, University of Victoria, Victoria, BC, Canada
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Matsutaka Y, Koyano J, Hidaka Y. Perceptions of Reducing HIV-Preventive Behaviors among Men Who Have Sex with Men Living with HIV in Japan. Health (London) 2018. [DOI: 10.4236/health.2018.1012130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Levy ME, Phillips G, Magnus M, Kuo I, Beauchamp G, Emel L, Hucks-Ortiz C, Hamilton EL, Wilton L, Chen I, Mannheimer S, Tieu HV, Scott H, Fields SD, Del Rio C, Shoptaw S, Mayer K. A Longitudinal Analysis of Treatment Optimism and HIV Acquisition and Transmission Risk Behaviors Among Black Men Who Have Sex with Men in HPTN 061. AIDS Behav 2017; 21:2958-2972. [PMID: 28352984 PMCID: PMC5623129 DOI: 10.1007/s10461-017-1756-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Little is known about HIV treatment optimism and risk behaviors among Black men who have sex with men (BMSM). Using longitudinal data from BMSM in the HPTN 061 study, we examined participants' self-reported comfort with having condomless sex due to optimistic beliefs regarding HIV treatment. We assessed correlates of treatment optimism and its association with subsequent risk behaviors for HIV acquisition or transmission using multivariable logistic regression with generalized estimating equations. Independent correlates of treatment optimism included age ≥35 years, annual household income <$20,000, depressive symptoms, high HIV conspiracy beliefs, problematic alcohol use, and previous HIV diagnosis. Treatment optimism was independently associated with subsequent condomless anal sex with a male partner of serodiscordant/unknown HIV status among HIV-infected men, but this association was not statistically significant among HIV-uninfected men. HIV providers should engage men in counseling conversations to assess and minimize willingness to have condomless sex that is rooted in optimistic treatment beliefs without knowledge of viral suppression.
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Affiliation(s)
- Matthew E Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave NW, 5th Floor, Washington, DC, USA.
| | - Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave NW, 5th Floor, Washington, DC, USA
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave NW, 5th Floor, Washington, DC, USA
| | - Geetha Beauchamp
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lynda Emel
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Christopher Hucks-Ortiz
- Division of HIV Prevention and Care, John Wesley Community Health Institute, Los Angeles, CA, USA
| | | | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Iris Chen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sharon Mannheimer
- Department of Medicine, Harlem Hospital and Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Sheldon D Fields
- Nicole Weirtheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Carlos Del Rio
- Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kenneth Mayer
- Fenway Health, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, MA, USA
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18
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Gourlay A, Fox J, Gafos M, Fidler S, Nwokolo N, Clarke A, Gilson R, Orkin C, Collins S, Porter K, Hart G. A qualitative study exploring the social and environmental context of recently acquired HIV infection among men who have sex with men in South-East England. BMJ Open 2017; 7:e016494. [PMID: 28851787 PMCID: PMC5629694 DOI: 10.1136/bmjopen-2017-016494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES A key UK public health priority is to reduce HIV incidence among gay and other men who have sex with men (MSM). This study aimed to explore the social and environmental context in which new HIV infections occurred among MSM in London and Brighton in 2015. DESIGN A qualitative descriptive study, comprising in-depth interviews, was carried out as a substudy to the UK Register of HIV Seroconverters cohort: an observational cohort of individuals whose date of HIV seroconversion was well estimated. An inductive thematic analysis was conducted in NVivo, guided by a socio-ecological framework. SETTING Participants were recruited from six HIV clinics in London and Brighton. Fieldwork was conducted between January and April 2015. PARTICIPANTS All MSM eligible for the UK Register Seroconverter cohort (an HIV-positive antibody test result within 12 months of their last documented HIV-negative test or other laboratory evidence of HIV seroconversion) diagnosed within the past 12 months and aged ≥18 were eligible for the qualitative substudy. 21 MSM participated, aged 22-61 years and predominantly white. RESULTS A complex interplay of factors, operating at different levels, influenced risk behaviours and HIV acquisition. Participants saw risk as multi-factorial, but the relative importance of factors varied for each person. Individual psycho-social factors, including personal history, recent life stressors and mental health, enhanced vulnerability towards higher risk situations, while features of the social environment, such as chemsex and social media, and prevalent community beliefs regarding treatment and HIV normalisation, encouraged risk taking. CONCLUSIONS Recently acquired HIV infection among MSM reflects a complex web of factors operating at different levels. These findings point to the need for multi-level interventions to reduce the risk of HIV acquisition among high-risk MSM in the UK and similar settings.
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Affiliation(s)
- Annabelle Gourlay
- Faculty of Population Health Sciences, University College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, London, UK
| | - Julie Fox
- Guys and St Thomas’ NHS Trust/ King’s College London, London, UK
| | - Mitzy Gafos
- Faculty of Population Health Sciences, University College London, London, UK
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Nneka Nwokolo
- 56 Dean Street, Department of HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Elton John Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospital, Brighton, UK
| | - Richard Gilson
- Faculty of Population Health Sciences, University College London, London, UK
| | - Chloe Orkin
- Ambrose King Centre, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Kholoud Porter
- Faculty of Population Health Sciences, University College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, London, UK
| | - Graham Hart
- Faculty of Population Health Sciences, University College London, London, UK
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Parcesepe AM, Tymejczyk O, Remien R, Gadisa T, Kulkarni SG, Hoffman S, Melaku Z, Elul B, Nash D. Psychological distress, health and treatment-related factors among individuals initiating ART in Oromia, Ethiopia. AIDS Care 2017; 30:338-342. [PMID: 28820273 DOI: 10.1080/09540121.2017.1363367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
HIV diagnosis may be a source of psychological distress. Late initiation of antiretroviral therapy (ART) and treatment-related beliefs may intensify psychological distress among those recently diagnosed. This analysis describes the prevalence of psychological distress among people living with HIV (PLWH) and examines the association of recent HIV diagnosis, late ART initiation and treatment-related beliefs with psychological distress. The sample includes 1175 PLWH aged 18 or older initiating ART at six HIV clinics in Ethiopia. Psychological distress was assessed with Kessler Psychological Distress Scale. Scores ≥ 29 were categorized as severe psychological distress. Individuals who received their first HIV diagnosis in the past 90 days were categorized as recently diagnosed. Multivariable logistic regression modeled the association of recent diagnosis, late ART initiation and treatment-related beliefs on severe psychological distress, controlling for age, sex, education, area of residence, relationship status, and health facility. Among respondents, 29.5% reported severe psychological distress, 46.6% were recently diagnosed and 31.0% initiated ART late. In multivariable models, relative to those who did not initiate ART late and had longer time since diagnosis, odds of severe psychological distress was significantly greater among those with recent diagnosis and late ART initiation (adjusted OR [aOR]: 1.9 [95% CI 1.4, 2.8]). Treatment-related beliefs were not associated with severe psychological distress in multivariable models. Severe psychological distress was highly prevalent, particularly among those who were recently diagnosed and initiated ART late. Greater understanding of the relationship between psychological distress, recent diagnosis, and late ART initiation can inform interventions to reduce psychological distress among this population. Mental health screening and interventions should be incorporated into routine HIV clinical care from diagnosis through treatment.
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Affiliation(s)
- Angela M Parcesepe
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | - Olga Tymejczyk
- b Institute for Implementation Science in Population Health , City University of New York , New York , NY , USA.,c Graduate School of Public Health and Health Policy , City University of New York , New York , NY , USA
| | - Robert Remien
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA
| | | | - Sarah Gorrell Kulkarni
- b Institute for Implementation Science in Population Health , City University of New York , New York , NY , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies , Columbia University and New York State Psychiatric Institute , New York , NY , USA.,e Department of Epidemiology , Columbia University , New York , NY , USA
| | | | - Batya Elul
- e Department of Epidemiology , Columbia University , New York , NY , USA
| | - Denis Nash
- b Institute for Implementation Science in Population Health , City University of New York , New York , NY , USA.,c Graduate School of Public Health and Health Policy , City University of New York , New York , NY , USA
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20
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Roth EA, Cui Z, Rich A, Lachowsky N, Sereda P, Card KG, Jollimore J, Howard T, Armstrong H, Moore D, Hogg R. Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment. JOURNAL OF HOMOSEXUALITY 2017; 65:524-539. [PMID: 28506154 PMCID: PMC6110384 DOI: 10.1080/00918369.2017.1324681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
British Columbia's treatment as prevention policy has provided free access to highly active antiretroviral therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a seroadaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n = 556) and HIV-positive (n = 218) serostatus participants. Analyses indicated that both groups reported VLS, and that serostatus and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers' Diffusion Of Preventative Innovations Model, and they have important implications for HIV research and GBM sexual decision-making.
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Affiliation(s)
- Eric Abella Roth
- a Centre for Addiction Research of British Columbia , University of Victoria , Victoria , British Columbia , Canada
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Ashleigh Rich
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Nathan Lachowsky
- c School of Medicine , University of British Columbia, Vancouver, British Columbia; and British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Paul Sereda
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Kiffer George Card
- d Faculty of Health Sciences , Simon Fraser University, Vancouver, British Columbia, Canada; and British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Jody Jollimore
- e Health Initiatives for Men , Vancouver , British Columbia , Canada
| | - Terry Howard
- f Positive Living Society of BC , Vancouver , British Columbia , Canada
| | - Heather Armstrong
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - David Moore
- g School of Medicine , University of British Columbia, Vancouver, British Columbia, Canada, British Columbia; and Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Robert Hogg
- h Faculty of Health Sciences , Simon Fraser University, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
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Prescription of Postexposure Prophylaxis for HIV-1 in the Emergency Room: Correct Transmission Risk Assessment Remains Challenging. J Acquir Immune Defic Syndr 2017; 74:359-366. [PMID: 27906766 DOI: 10.1097/qai.0000000000001265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited data are available about the accuracy of postexposure prophylaxis (PEP) prescription in the emergency rooms. Here, we evaluated PEP prescription decision making with respect to the risk of sexual HIV transmission and the exposed person's fear vis-à-vis HIV. METHODS Using a risk assessment algorithm, we retrospectively evaluated the adequacy of PEP prescription for all persons presenting at the emergency room of the University Hospital Zurich after consensual sex from 2007 to 2013. We used logistic regression to identify factors that correlate with risk-concordant and risk-discordant decisions. RESULTS We documented 975 persons with a total of 1051 visits for PEP: 83% were men, 71% were Swiss, and 37% were men who have sex with men. In 74% of visits, the decisions were concordant with the risk evaluation algorithm (22% discordant, 4% unknown). In 61% (644/1051) PEP was prescribed; however, in 12% (76/644) the prescriptions were without indication of HIV transmission risk and were attributed to the exposed person's request. Importantly, in 10% (101/1051) of all visits, there were potential risks but PEP was not prescribed, either because of physician's decision or exposed person's refusal. The presence of the source partner strongly correlated with appropriately withholding PEP (adjusted odds ratio for giving PEP 0.05; 95% confidence interval: 0.03 to 0.08). CONCLUSIONS We found that 22% of PEP decisions were risk discordant because of exposed person's request, incorrect estimation of the sexual transmission risk by the physician, or exposed person's refusal to accept PEP. Emergency physicians may benefit from specialized risk assessment training and patients from education in HIV transmission risk awareness.
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Edwards WM, Hamilton AR, Miner MH, Coleman E. Measuring sexual health: preliminary development of a sexual health inventory. SEXUAL AND RELATIONSHIP THERAPY 2017. [DOI: 10.1080/14681994.2016.1225154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Autumn R. Hamilton
- Department of Health Science, Minnesota State University, Mankato, MN, USA
| | - Michael H. Miner
- Program in Human Sexuality, University of Minnesota, Minneapolis, MN, USA
| | - Eli Coleman
- Program in Human Sexuality, University of Minnesota, Minneapolis, MN, USA
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Bourne A, Dodds C, Keogh P, Weatherburn P. Non-condom related strategies to reduce the risk of HIV transmission: Perspectives and experiences of gay men with diagnosed HIV. J Health Psychol 2016; 21:2562-2571. [PMID: 25947230 DOI: 10.1177/1359105315581066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gay men with diagnosed HIV can adopt a number of strategies to reduce the risk of transmitting HIV to others, although research has typically focussed on condom use. Interviews with 42 HIV-positive gay men who reported recent engagement in anal intercourse without condoms explored their awareness of sexual risk and their perceptions of non-condom-related strategies to reduce it. In articulating men's ambivalence for strategies that can only reduce the risk of transmission, rather than eliminating, the findings have implications for the consideration and integration of new biomedical interventions to reduce the likelihood of HIV transmission.
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Affiliation(s)
- Adam Bourne
- 1 London School of Hygiene & Tropical Medicine, UK
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Pantalone DW, Puckett JA, Gunn HA. Psychosocial Factors and HIV Prevention for Gay, Bisexual, and Other Men Who Have Sex with Men. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2016. [DOI: 10.1111/spc3.12234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Watts PJ, Greenberg HL, Khachemoune A. Unusual primary syphilis: Presentation of a likely case with a review of the stages of acquired syphilis, its differential diagnoses, management, and current recommendations. Int J Dermatol 2016; 55:714-28. [PMID: 26756536 DOI: 10.1111/ijd.13206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/06/2015] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Abstract
Syphilis is an ancient disease that has re-emerged in the last decade. It is prevalent among men who have sex with men and has increased in incidence with certain ethnic groups. It usually presents as primary or secondary syphilis and can progress to tertiary syphilis if not treated. Primary syphilis will classically manifest as a single, painless ulcer with smooth, clean, and raised borders on the genitals or less often on the oral mucosa. Unusual primary syphilis cases have been reported and can be easily misdiagnosed with a resulting delay of treatment. Secondary syphilis is a systemic disease, wherein the treponemes have disseminated to various organ systems, typically presenting with characteristic mucocutaneous lesions. Tertiary syphilis has a higher rate of morbidity and mortality; as such, the aim of this article is to provide the readers with tools to recognize early syphilis and prevent its progression to late stages. In this review, we present a likely case of unusual primary syphilis mimicking herpes progenitalis as well as a compilation of all atypical cases of primary syphilis from 1973 to 2015. We will also review the differential diagnosis, management, and recommendations for each stage of syphilis.
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Affiliation(s)
- Paula J Watts
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | | - Amor Khachemoune
- Department of Dermatology, Veterans Affairs Medical Center Brooklyn and SUNY Downstate, Brooklyn, NY, USA
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Li H, Holroyd E, Lau J. Exploring Unprotected Anal Intercourse among Newly Diagnosed HIV Positive Men Who Have Sex with Men in China: An Ethnographic Study. PLoS One 2015; 10:e0140555. [PMID: 26461258 PMCID: PMC4604142 DOI: 10.1371/journal.pone.0140555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 09/27/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Unprotected anal intercourse (UAI) is a major pathway towards secondary HIV transmission among men who have sex with men (MSM). We explored the socio-cultural environment and individual beliefs and experiences conducive to UAI in the context of Southern China. METHODS We employed an ethnographic approach utilizing a socio-ecological framework to conduct repeated in-depth interviews with thirty one newly diagnosed HIV positive MSM as well as participant observations in Shenzhen based healthcare settings, MSM venues and NGO offices. RESULTS Some men (6/31) reported continuing to practice UAI after an initial diagnosis of being HIV positive. For MSM who had existing lovers or stable partners, the fear of losing partners in a context of non-serostatus disclosure was testified to be a major concern. MSM with casual partners reported that anonymous sexual encounters and moral judgments played a significant role in their sexual risk behaviors. Simultaneously, self-reported negative emotional and psychological status, perception and idiosyncratic risk interpretation, as well as substance abuse informed the intrapersonal context for UAI. CONCLUSION UAI among these HIV positive MSM was embedded in an intrapersonal context, related to partner type, shaped by anonymous sexual encounters, psychological status, and moral judgments. It is important that prevention and intervention for secondary HIV transmission among newly diagnosed HIV positive MSM in China take into account these contextual factors.
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Affiliation(s)
- Haochu Li
- School of Public Health, Shandong University, Jinan, China
- UNC Project-China, Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Eleanor Holroyd
- School of Health Sciences, RMIT University, Melbourne, Australia
- Centre for Women’s Health, Gender & Society, The University of Melbourne, Melbourne, Australia
| | - Joseph Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
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Lacefield K, Negy C, Schrader RM, Kuhlman C. Comparing Psychosocial Correlates of Condomless Anal Sex in HIV-Diagnosed and HIV-Nondiagnosed Men Who Have Sex with Men: A Series of Meta-Analyses of Studies from 1993-2013. LGBT Health 2015; 2:200-20. [PMID: 26788669 DOI: 10.1089/lgbt.2014.0069] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Men who have sex with men (MSM) continue to be overrepresented in rates of incidence and prevalence of human immunodeficiency virus (HIV). Both HIV-diagnosed (HIV-D) and HIV-nondiagnosed (HIV-N) MSM report a variety of reasons for intentional and unintentional nonuse of condoms. Elucidating and comparing reasons for continued engagement in condomless anal sex specific to both HIV-D and HIV-N MSM likely is important to identifying effective prevention. METHODS This study employed meta-analytic methods to evaluate and compare correlates to condomless anal sex in both HIV-D and HIV-N MSM from primary studies from 1993 to February 2013. RESULTS Of the 19 individual correlates assessed within the subgroup of HIV-D MSM, variables that achieved significant effect were alcohol, mind-altering substance use, sexual-enhancement medication, intentional condom nonuse, self-efficacy, attitudes toward condom use, social support, gay identity, compulsivity, trading sex, and number of sex partners. Those that were statistically non-significant were intention to use a condom, perceived risk, perceived norms, perceived responsibility, HIV medical management, treatment optimism, mental health, and setting. Of the 12 correlates assessed within the subgroup of HIV-N MSM, variables that achieved significant effect were alcohol, mind-altering substance use, intentional condom nonuse, attitudes toward condom use, perceived risk, and setting. Those observed as statistically non-significant were perceived norms, social support, gay identity, mental health, trading sex, and number of sex partners. CONCLUSION Study results have clinical implications that may guide future prevention research and practice by highlighting risk variables shared between HIV-N and HIV-D MSM, as well as variables observed to be unique to each group that may warrant more tailored intervention. Further investigation is recommended to elucidate the relationships among these variables such that optimal intervention can be determined.
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Affiliation(s)
- Katharine Lacefield
- 1 Department of Psychology, VA Maryland Healthcare System , Baltimore, Maryland.,2 Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles Negy
- 3 Department of Psychology, University of Central Florida , Orlando, Florida
| | - Ronald M Schrader
- 4 Department of Dialysis, DCI Corporate Quality Management , Albuquerque, New Mexico
| | - Christina Kuhlman
- 3 Department of Psychology, University of Central Florida , Orlando, Florida
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Where does treatment optimism fit in? Examining factors associated with consistent condom use among people receiving antiretroviral treatment in Rio de Janeiro, Brazil. AIDS Behav 2014; 18:1945-54. [PMID: 24531794 DOI: 10.1007/s10461-014-0711-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the era of highly active antiretrovirals, people living with HIV (PLWH) have resumed sexual activity in the context of longer and healthier lives, and thus the chances of transmitting the HIV virus, as well as the potential to be re-infected also increase. HIV treatment optimism has been found to be associated with sexual risk behaviors among PLWH in different settings. A cross sectional survey was conducted to examine the relationship between treatment optimism, safer sex burnout and consistent condom use as well as variables associated with treatment optimism in a sample of PLWH on antiretrovirals (ARVs) in Rio de Janeiro, Brazil (n = 604). Seventy-two percent of participants always used a condom in the last 6 months. Homosexual, bisexual, transexual persons were less likely to use condoms consistently than heterosexuals (AOR .58 CI .42-.78). Those who were treatment optimistic (AOR .46 CI .25-.88) were more likely not use a condom consistently in the past 6 months, as were participants who reported safer sex burnout (AOR .58 CI .36-.90). Sexual orientation, safer sex burnout, and lower education levels were significantly associated with higher treatment optimism in multivariate analysis. Study findings highlight the need to address psychosocial factors such as treatment optimism and safer sex burnout associated with lower consistent condom use among PLWH in Rio de Janeiro, Brazil.
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Boyson AR, Zimmerman RS, Shoemaker S. Exemplification of HAART and HIV/AIDS: A News Experiment. HEALTH COMMUNICATION 2014; 30:901-910. [PMID: 25204328 DOI: 10.1080/10410236.2014.903222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recent data show that the number of deaths from HIV has declined but the disease continues to spread. An emerging line of research suggests that the apparent increase may be due to complacency, whereby faith in medicine encourages risk-taking behavior. This study examines the hypothesis that certain approaches in the news media could disproportionately influence perceptions of treatment success even when paired with statistics. College students and gay men, recruited in the community, were exposed to a fictional news story in which the ratio of four cases of people taking antiretroviral (ARV) medications was varied in two conditions. The story was either consistent with or inconsistent with the success-rate data presented by an alleged medical expert in the story. Participants' perceptions of ARV success were estimated following exposure to the story. As expected, the personal news stories influenced estimation of ARV success more than the presence of statistical success rate data. Consistent with previous exemplification research, the size of the effect suggests that the stories influenced judgments of the true success rate by roughly 10 to 20%. The effect was moderated by sexual orientation, but not by gender. Exemplification as a journalistic tendency may be one factor that contributes to unrealistic faith in medical advancements. These data suggest that future research should explore in detail the extent and context of HIV/AIDS reporting using exemplification theory with considerations for how reporting might be modified to have less of an effect on increased sexual risk-taking.
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Affiliation(s)
- Aaron R Boyson
- a Department of Communication , University of Minnesota Duluth
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Ferrer L, Furegato M, Foschia JP, Folch C, González V, Ramarli D, Casabona J, Mirandola M. Undiagnosed HIV infection in a population of MSM from six European cities: results from the Sialon project. Eur J Public Health 2014; 25:494-500. [PMID: 25161202 DOI: 10.1093/eurpub/cku139] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The purpose of this article is to assess the distribution of undiagnosed HIV infection in men who have sex with men (MSM) in Southern and Eastern European countries, to describe the differences in epidemiology and behaviour between undiagnosed, diagnosed HIV-positive and HIV-negative MSM and to identify factors associated with undiagnosed HIV infection in the study population. METHODS A multi-centre biological and behavioural cross-sectional study was conducted in 2008. Time-location sampling was used to recruit men attending different venues. A self-administered questionnaire was completed and oral fluid samples were collected to estimate HIV prevalence. RESULTS HIV prevalence was 17% in Barcelona, 12% in Verona, 6% in Bratislava, 5% in Ljubljana, 5% in Bucharest and 3% in Prague while undiagnosed HIV infection was 47, 62, 67, 83, 85 and 57%, respectively. Diagnosed HIV-positive men reported more casual partners than HIV-negative MSM (mean: 19 and 9, respectively) (P < 0.001), and they were more likely to self-reported condyloma in the last year than undiagnosed HIV-positive and HIV-negative men (15, 1 and 3%, respectively) (P < 0.001). Factors associated with undiagnosed HIV infection included attending sex-focused venues (OR = 2.49), reporting syphilis in the previous 12 months (OR = 2.56), using poppers at last sexual intercourse (OR = 3.36) and having had an HIV test in the previous year (OR = 2.00). CONCLUSIONS Many HIV infections remain undiagnosed, and there is evidence of the persistence of frequent risk behaviours and sexually transmitted infections (STI) despite knowledge of HIV-positive status, emphasising the need for a multidimensional approach to HIV/STI prevention. Access to HIV testing should be considered a priority in prevention programs targeted at MSM, especially in Eastern Europe.
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Affiliation(s)
- Laia Ferrer
- 1 Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain 2 Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain 3 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Martina Furegato
- 4 Regional Center for Health Promotion, Veneto Region, Verona, Italy
| | | | - Cinta Folch
- 1 Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain 2 Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain 3 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain 5 Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Victoria González
- 1 Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain 2 Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain 3 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain 6 Microbiology Service, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Dunia Ramarli
- 7 Immunology Section, Verona University Hospital, Verona, Italy
| | - Jordi Casabona
- 1 Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain 2 Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain 3 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain 5 Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Massimo Mirandola
- 8 Infectious Diseases Section, Department of Pathology, Verona University Hospital, Verona, Italy
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Wim VB, Christiana N, Marie L. Syndemic and other risk factors for unprotected anal intercourse among an online sample of Belgian HIV negative men who have sex with men. AIDS Behav 2014; 18:50-8. [PMID: 23681697 DOI: 10.1007/s10461-013-0516-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Men who have sex with men (MSM) are confronted with different health problems. Next to a higher HIV prevalence and a higher reporting of depressive symptoms and other mental health problems, there is also evidence of substance dependence and sexual compulsivity occurring simultaneously. Using a sample of 591 HIV-negative Belgian MSM, we examine the relationships between depressive symptoms and other risk factors of unprotected anal intercourse (UAI) practice with casual partners. These risk factors include depressive symptoms, sexual behavioural indicators, individual risk perception of UAI, intrapersonal factors measured by the sexual sensation seeking scale, substance use, sources of social support and social norming regarding condom use and finally the location where or media through which men find sex partners. Our findings show that multifactorial, intertwined factors contribute to the explanation of UAI among MSM at risk for HIV infection. These findings underline the need for an integrated sexual health approach for MSM.
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Vanden Berghe W, Nöstlinger C, Hospers H, Laga M. International mobility, sexual behaviour and HIV-related characteristics of men who have sex with men residing in Belgium. BMC Public Health 2013; 13:968. [PMID: 24139406 PMCID: PMC3853336 DOI: 10.1186/1471-2458-13-968] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022] Open
Abstract
Background European men who have sex with men (MSM) continue to be disproportionally affected by the human immunodeficiency virus (HIV). Several factors are contributing to the rates of new HIV infections among MSM. The aim of this study was to investigate the potential role of travel behaviour and sexual mobility in the spread of HIV and sexually transmitted infections (STI) among European MSM. Methods Belgian data from the first pan-European MSM internet survey EMIS was used (n=3860) to explore individual and contextual determinants of sexual behaviour among MSM, who resided in Belgium at the time of data collection and who reported having had sexual contact abroad in the last 12 months. Descriptive and bivariate analyses were performed. Odds ratios and 95% confidence intervals were calculated by means of logistic regression. Results MSM who practiced unprotected anal intercourse UAI during their last sexual encounter abroad were less likely to be living in a large city (OR:0.62, 95% CI:0.45-0,86, p<0.01) and more likely to be HIV positive (OR:6.20, 95% CI:4.23-9.06, p<0.001) ), to have tested HIV positive in the last 12 months (OR:3.07, 95% CI:1.07-8.80, p<0.05), to have been diagnosed with any STI in the last 12 months (OR:2.55; 95% CI:1.77-3.67, p<0.05), to have used party drugs (OR:2.22, 95% CI:1.59-3.09, p<0.001), poppers (OR:1.52, 95% CI:1.07-2.14, p<0.001) and erection enhancing substances (OR:2.23, 95% CI:1.61-3.09, p<0.001) compared to MSM who did not have UAI with their last sexual partner abroad. Men having had UAI in the last 12 months were more likely to have done so in a neighbouring country of Belgium (OR:1.66, 95% CI:1.21-2.29, p<0.001). Different sexual behavioural patterns related to condom use and drug use were identified according to HIV test status among travelling men. Conclusions The results of this study provide evidence for the role of international mobility and sexual behavior while travelling, in the spread of HIV and STI among MSM in Europe. Further, the findings underline the need for development of European cross-border HIV and STI interventions with coherent messages and prevention policies for MSM.
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Affiliation(s)
- Wim Vanden Berghe
- Department of Public Health, Institute of Tropical Medicine HIV/AIDS Center (IHAC), Antwerp, Belgium.
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Chen Y. Treatment-related optimistic beliefs and risk of HIV transmission: a review of recent findings (2009-2012) in an era of treatment as prevention. Curr HIV/AIDS Rep 2013; 10:79-88. [PMID: 23239272 DOI: 10.1007/s11904-012-0144-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The promising outlook for HIV treatment as prevention (TasP) offered by the recent success in clinical trials has highlighted the need for effort against over-optimism toward anti-retroviral therapy (ART). It has been of a central concern that such optimistic beliefs may fuel an increase in risk behaviors to counter the protective effect of ART on reducing overall transmissibility of HIV. The current review was conducted to provide an updated look at the potential impact of treatment-related optimistic beliefs on the risk of HIV transmission. The review yielded a total of 14 studies published during the past 4 years that have examined the role of treatment-related optimistic beliefs in changing people's adoption of sexual risk behaviors. Findings from quantitative studies were largely in support of an association between optimistic beliefs and risk of HIV transmission. Results from qualitative studies discovered additional information concealed under the numerical associations, and pointed to the need of more rigorous and comprehensive examination of the relationship between optimistic beliefs and HIV transmission risk. Gaps in the current literature were identified and suggestions for future research were provided.
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Affiliation(s)
- Yiyun Chen
- Department of Psychology, University of Connecticut, 206 Babbige Road, Unit 1020, Storrs, CT 06269, USA.
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Prestage G, Brown G, Down IA, Jin F, Hurley M. "It's hard to know what is a risky or not a risky decision": gay men's beliefs about risk during sex. AIDS Behav 2013; 17:1352-61. [PMID: 22430641 DOI: 10.1007/s10461-012-0180-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gay men increasingly use non condom-based risk reduction strategies to reduce the possibility of HIV transmission. Such strategies rely on men's knowledge and communication with each other, but how they employ these strategies may depend as much on their attitudes toward risk and pleasure. We explored current beliefs about safe sex, sexual desire and risk behavior in an online survey of 2306 Australian gay men. The survey included free text components to explore men's beliefs about risk and pleasure. We conducted a principal components factor analysis on the safe sex belief items in the survey, and thematic analysis of the qualitative material was used to interrogate the concepts underpinning these beliefs. We identified two measures of safe sex beliefs: risk reduction optimism (HRRO; α = 0.703); and viral load optimism (α = 0.674). In multivariate analysis, unprotected anal intercourse with casual partners (UAIC) was associated with HRRO among non HIV-positive men only (p < 0.001), but, regardless of HIV serostatus, UAIC was associated with a belief that serosorting could be an effective risk reduction strategy and with being more sexually adventurous in general. Using the qualitative data we identified four themes in how men think about HIV: 'seeking certainty', 'regretful actions', 'nothing is safe', and 'acting on beliefs'. Each theme interacted with the safe sex beliefs measures to provide a highly contextualised understanding of men's beliefs about safe in specific circumstances. Gay men think about the risk of HIV transmission in qualitatively different ways depending on specific circumstances. While measures of belief about relative risk of HIV transmission are useful indicators of men's propensity to take risk, they oversimplify men's thinking about risk, and fail to account for the role of desire, both in influencing men's thinking about risk, and in how they balance their perception of relative risk against the pursuit of pleasure.
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Affiliation(s)
- Garrett Prestage
- Kirby Institute, University of New South Wales, Corner West and Boundary Streets, Darlinghurst, Sydney, NSW 2010, Australia.
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Frasca T, Ventuneac A, Balan I, Carballo-Diéguez A. Inner contradictions among men who bareback. QUALITATIVE HEALTH RESEARCH 2012; 22:946-956. [PMID: 22645221 PMCID: PMC3578522 DOI: 10.1177/1049732312443592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Barebacking, or intentional unprotected anal intercourse when HIV transmission can occur, emerged as a descriptive term in the 1990s, and marked greater acceptance by gay and bisexual men of dispensing with condom use under certain circumstances. In an exploratory study of men who used Internet sites to meet partners and reported recent episodes of barebacking, respondents outlined numerous strategies they deployed to avoid HIV infection instead of universal condom use. However, in interviews many participants acknowledged uneasiness with the flaws in their chosen strategies, and the contradiction between their urgent desire to remain HIV-free and their sexual practices. For some, the dissonance between the conflicting cognitions could be resolved through self-justification, mental compartmentalization, or invincibility beliefs so that barebacking could continue. For this subpopulation, continued reiteration of cognitive-based prevention messages has the potential to reinforce rather than undermine their attachment to inadequate strategies for disease avoidance.
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Abstract
PURPOSE OF REVIEW This article will discuss some of the potential clinical implications of the widespread use of antiretroviral treatment-as-prevention in patients with high CD4 cell counts, including the balance of clinical benefit vs. toxicity, adherence, drug resistance, and risk compensation. RECENT FINDINGS Recent studies have definitively demonstrated that antiretroviral treatment (ART) markedly reduces heterosexual transmission of HIV-1 to HIV-uninfected partners among patients with CD4 counts less than 550 cells/μl. At the same time, an increasing body of evidence suggests that uncontrolled HIV replication may be associated with immune activation and inflammation, both of which increase the risk of non-HIV-related diseases; and that initiation of ART at even higher CD4 counts might improve patient outcomes. ART regimens continue to become better-tolerated, safer, and easier to take, and rates of adherence and virologic suppression also appear to be improving. Nevertheless, acceptability of and adherence to 'treatment for prevention' are unknown, and the spread of drug resistance in the setting of suboptimal adherence among less-motivated patients are substantive concerns with treatment-for-prevention. SUMMARY Earlier ART may confer clinical benefits, and ART regimens are becoming safer and better-tolerated. However, high-quality data are urgently needed with regards to the acceptability of, adherence to, and clinical outcomes with treatment-for-prevention among patients with high CD4 counts, as well as risk compensation and the emergence and spread of drug resistance that may occur with implementation of this HIV prevention strategy.
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Lim SH, Christen CL, Marshal MP, Stall RD, Markovic N, Kim KH, Silvestre AJ. Middle-aged and older men who have sex with men exhibit multiple trajectories with respect to the number of sexual partners. AIDS Behav 2012; 16:590-8. [PMID: 21390536 PMCID: PMC3584179 DOI: 10.1007/s10461-011-9916-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to examine trajectories with respect to the number of sexual partners among older men who have sex with men and to determine characteristics associated with trajectory groups. Nagin's group-based modeling was used to identify trajectories for 237 men from the Pitt Men's Study with respect to the number of male intercourse partners from age 50.0 to 59.5. Three distinct trajectory groups were identified. Most men (69.2%) had a median of two sexual partners in the past 6 months across the age range of the study. A smaller group (19.4%) had low or no sex partners. The smallest group (11.4%) had 30 or more sexual partners in the past 6 months at age 50. The groups were statistically different with respect to race, HIV status, drug use (marijuana, poppers, crack cocaine, and Viagra), the number of unprotected anal sex partners, and personal attitudes towards sex.
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Affiliation(s)
- Sin How Lim
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA.
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Heijman T, Geskus RB, Davidovich U, Coutinho RA, Prins M, Stolte IG. Less decrease in risk behaviour from pre-HIV to post-HIV seroconversion among MSM in the combination antiretroviral therapy era compared with the pre-combination antiretroviral therapy era. AIDS 2012; 26:489-95. [PMID: 22156971 DOI: 10.1097/qad.0b013e32834f9d7c] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To gain insight in the ongoing HIV transmission, we compared sexual risk behaviour pre-HIV and post-HIV seroconversion in 206 MSM participating in the Amsterdam Cohort Studies (1984-2008) before and after the introduction of combination antiretroviral therapy (cART). DESIGN AND METHODS MSM completed behavioural questionnaires and were tested for HIV antibodies every 6 months. Trends in anal intercourse and number of sex partners from 4 years before HIV seroconversion until 4 years after diagnosis were analysed with latent class random effects logistic regression models. RESULTS The risk of having unprotected anal intercourse (UAI) 1 year after HIV diagnosis decreased significantly when compared with 1 year before diagnosis in both the pre-cART era [difference, 30%; 95% confidence interval (CI), 22-36%] and cART era (difference, 19%; 95% CI, 9-30%). In contrast to a continuing decrease of UAI in the pre-cART era, the probability of UAI in the cART era increased again to preseroconversion levels (61%; 95% CI, 48-74%)) 4 years after diagnosis. CONCLUSION This study provides evidence that recently seroconverted MSM reduce their sexual risk behaviour following HIV diagnosis both in the pre-cART as well as the cART period. However, in the cART period this reduction in sexual risk behaviour is less and returns to pre-cART levels within 4 years. These findings not only confirm the need for early HIV testing but also make it clear that much more effort should go into identifying, counselling, and possibly treating recently seroconverted MSM who have been found to be one of the most important drivers of HIV transmission among MSM.
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Ambrosioni J, Calmy A, Hirschel B. HIV treatment for prevention. J Int AIDS Soc 2011; 14:28. [PMID: 21612619 PMCID: PMC3123616 DOI: 10.1186/1758-2652-14-28] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 05/25/2011] [Indexed: 11/13/2022] Open
Abstract
"No virus, no transmission." Studies have repeatedly shown that viral load (the quantity of virus present in blood and sexual secretions) is the strongest predictor of HIV transmission during unprotected sex or transmission from infected mother to child. Effective treatment lowers viral load to undetectable levels. If one could identify and treat all HIV-infected people immediately after infection, the HIV/AIDS epidemic would eventually disappear. Such a radical solution is currently unrealistic. In reality, not all people get tested, especially when they fear stigma and discrimination. Thus, not all HIV-infected individuals are known. Of those HIV-positive individuals for whom the diagnosis is known, not all of them have access to therapy, agree to be treated, or are taking therapy effectively. Some on effective treatment will stop, and in others, the development of resistance will lead to treatment failure. Furthermore, resources are limited: should we provide drugs to asymptomatic HIV-infected individuals without indication for treatment according to guidelines in order to prevent HIV transmission at the risk of diverting funding from sick patients in urgent need? In fact, the preventive potential of anti-HIV drugs is unknown. Modellers have tried to fill the gap, but models differ depending on assumptions that are strongly debated. Further, indications for antiretroviral treatments expand; in places like Vancouver and San Francisco, the majority of HIV-positive individuals are now under treatment, and the incidence of new HIV infections has recently fallen. However, correlation does not necessarily imply causation. Finally, studies in couples where one partner is HIV-infected also appear to show that treatment reduces the risk of transmission. More definite studies, where a number of communities are randomized to either receive the "test-and-treat" approach or continue as before, are now in evaluation by funding agencies. Repeated waves of testing would precisely measure the incidence of HIV infection. Such trials face formidable logistical, practical and ethical obstacles. However, without definitive data, the intuitive appeal of "test-and-treat" is unlikely to translate into action on a global scale. In the meantime, based on the available evidence, we must strive to provide treatment to all those in medical need under the current medical guidelines. This will lead to a decrease in HIV transmission while "test-and-treat" is fully explored in prospective clinical trials.
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Affiliation(s)
- Juan Ambrosioni
- HIV Unit, Department of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland
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Reflecting on HIV disclosure laws in the context of unsafe sex and the harm-reduction strategy. SOCIAL THEORY & HEALTH 2011. [DOI: 10.1057/sth.2011.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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