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GPS: A Randomized Controlled Trial of Sexual Health Counseling for Gay and Bisexual Men Living With HIV. Behav Ther 2021; 52:1-14. [PMID: 33483108 DOI: 10.1016/j.beth.2020.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/22/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBM) continue to have high rates of HIV and sexually transmitted infections, including syphilis. GBM have therefore been identified by public health agencies as a high-priority population to reach with prevention initiatives. Despite the importance of mental health in preventing HIV and related infections, there is a shortage of credentialed mental health professionals to deliver behavioral Counseling interventions. The current study evaluated the efficacy of GPS, a community-based and peer-delivered sexual health promotion motivational interviewing-based intervention for HIV-positive GBM who engaged in condomless anal sex (CAS) in the past 2 months. GPS prevention counseling demonstrated a 43% relative reduction at 3-month follow-up in CAS with serodiscordant partners and significant reductions in sexual compulsivity. The study demonstrated that community-based counselors can administer an efficacious motivational interviewing program, and suggests a continued benefit of counseling methods to promote the sexual health of higher risk populations.
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Noor SW, Sutherland JE, Vernon JRG, Adam BD, Brennan DJ, Hart TA. Measuring Adverse Childhood Experiences: Comparing Individual, Composite, Score-based and Latent Profile-based Scoring Schemas Among Gay, Bisexual, and Other Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1741-1754. [PMID: 32385583 DOI: 10.1007/s10508-020-01719-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Adverse childhood experiences (ACEs; e.g., neglect, sexual abuse) among gay, bisexual, and other men who have sex with men (GBM) may not occur in isolation, but may be connected and occur in clusters. Most studies have measured ACEs individually, hierarchically, additively, or in a binary fashion (presence or absence of ACEs), rather than treating them as connected and clustered. This study examined these competing approaches of scoring ACEs and their relative power at predicting health outcomes. We examined abuse (sexual, physical, and emotional) and neglect (physical and emotional) experiences among a non-random sample of 470 Toronto GBM using the Childhood Trauma Questionnaire Short Form subscales. We compared five scoring schemas: (1) five individual scores for each form of maltreatment; (2) a composite score summing all of the maltreatment scores; (3) a hierarchical regression model with sexual abuse entered first then followed by physical abuse, emotional abuse, physical neglect, and emotional neglect; (4) a severity-based categorization; and (5) a latent profile-based categorization. Experiences of abuse and neglect were not uncommon (22-33%) and some participants experienced multiple forms of abuse and neglect (r = .33-.65, df = 464-467; p < .001; shared variance, r2 = 11-43%). Results show the dose-response effects of ACEs and highlight the importance of examining ACEs in clusters rather than individually. Latent profile analysis identified GBM who experienced multiple and frequent ACEs, and also identified the types of ACEs they experienced: crucial information that was obscured in score-based or severity-based approaches.
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Affiliation(s)
- Syed W Noor
- Department of Psychology, Ryerson University, Toronto, ON, M5B 2K3, Canada.
| | | | - Julia R G Vernon
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Barry D Adam
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, ON, M5B 2K3, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Factors Associated With Increased Syphilis Screening Among People Living With Human Immunodeficiency Virus. Sex Transm Dis 2020; 46:521-526. [PMID: 31295220 DOI: 10.1097/olq.0000000000001015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Antiretroviral therapy effectively reduces the risk of human immunodeficiency virus transmission, but in the context of undetectable equals untransmittable and decreased condom use, rates of syphilis are increasing. In Oregon, syphilis has risen over 20-fold in the past decade, from less than 30 to approximately 600 cases annually during 2016 and 2017. Although many cases are among people living with human immunodeficiency virus infection (PLWH), screening for syphilis among PLWH is often lacking. The objective of this study was to estimate the prevalence of past-year syphilis testing among PLWH in Oregon to identify facility-level and individual-level factors associated with testing. METHODS We examined 2015 to 2016 Medical Monitoring Project interview and medical records data in Oregon and conducted supplemental interviews with participants' medical providers. We used generalized mixed effects models to identify factors associated with syphilis screening. RESULTS Sixty-nine percent of Medical Monitoring Project participants had past-year syphilis screening. Patients receiving care from facilities with written sexually transmitted infection screening policies were far more likely to be screened than those receiving care from facilities without written policies (94% vs. 43%, P < 0.001). Participants who identified as male were more likely to have been tested, even after adjusting for facility-level characteristics. Clustering within facility accounted for about 15% of the unexplained variability in the adjusted mixed effects models. CONCLUSIONS Written sexually transmitted infection screening policies at medical facilities appear to be an important tool for ensuring syphilis screening occurs as recommended to prevent the continued rise in syphilis.
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Hart TA, Noor SW, Vernon JRG, Antony MM, Gardner S, O'Cleirigh C. Integrated Cognitive-Behavioral Therapy for Social Anxiety and HIV/STI Prevention for Gay and Bisexual Men: A Pilot Intervention Trial. Behav Ther 2020; 51:503-517. [PMID: 32402264 DOI: 10.1016/j.beth.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
Given the alarmingly high HIV and sexually transmitted infection (STI) incidence among gay and bisexual men (GBM) worldwide, there is a critical need for HIV prevention interventions specifically for GBM. Social anxiety, or anxiety about being evaluated in interpersonal situations, is a risk factor for condomless anal sex (CAS) among GBM (e.g., Hart & Heimberg, 2005; Hart, James, Purcell, & Farber, 2008). Social anxiety may also increase substance use in sexual situations, which is another risk factor for HIV/STIs in this risk group (Semple, Strathdee, Zians, McQuaid, & Patterson, 2011). The goal of the Sexual Confidence Study was to provide initial evidence of efficacy for a 10-session integrated cognitive-behavioral therapy for social anxiety, substance use management in sexual situations, and HIV sexual risk reduction for HIV-negative GBM. Diagnostic and self-report assessments were completed at baseline, posttreatment, 3-month follow-up, and 6-month follow-up. In this open trial design, we observed a 50% reduction in engagement in HIV/STI sexual risk behavior at 6-month follow-up. We also observed large uncontrolled treatment effect sizes for reductions in social anxiety disorder and problematic alcohol use. These preliminary findings suggest that the present treatment may offer an efficient way of concurrently reducing social anxiety, problematic alcohol use, and the risk of contracting HIV and STIs via CAS with serodiscordant partners among HIV-negative GBM.
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Affiliation(s)
| | | | | | | | | | - Conall O'Cleirigh
- Massachusetts General Hospital/Harvard Medical School and Fenway Health, Boston
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Grov C, Jonathan Rendina H, Patel VV, Kelvin E, Anastos K, Parsons JT. Prevalence of and Factors Associated with the Use of HIV Serosorting and Other Biomedical Prevention Strategies Among Men Who Have Sex with Men in a US Nationwide Survey. AIDS Behav 2018; 22:2743-2755. [PMID: 29550942 PMCID: PMC6051908 DOI: 10.1007/s10461-018-2084-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PrEP and treatment-as-prevention (TasP) are biomedical strategies to reduce HIV transmission. Some men who have sex with men (MSM) are combining biomedical strategies with HIV serosorting-termed "biomed matching" when both partners are either on PrEP or TasP, or "biomed sorting" when one partner is using PrEP and the other TasP. Nevertheless, there is limited data on the extent of biomed matching/sorting in large geographically diverse samples. In 2016-2017, 5021 MSM from across the US were surveyed about their HIV status and HIV viral load/PrEP use, as well as that of their recent casual male partners. For each participant, we calculated the proportion of his partners who were (1) HIV-positive and undetectable, (2) HIV-positive and detectable/unknown, (3) HIV unknown/undiscussed, (4) HIV-negative on PrEP, (5) HIV-negative, not on PrEP. In total, 66.6% (n = 3346) of participants were HIV-negative and not on PrEP, 11.9% (n = 599) on PrEP, 14.1% (n = 707) HIV-positive and undetectable, 1.1% (n = 55) HIV-positive and viral load detectable/unknown, and 6.2% (n = 313) HIV unsure/unknown. A participant's own HIV and PrEP status/was significantly associated with that of his partners (all p < 0.001), evincing evidence of both serosorting and biomed matching. Among men on PrEP and those who were HIV-undetectable, there was also some evidence to suggest these participants dually engaged in biomed matching as well as biomed sorting. We found evidence of biomed matching and sorting, which may compound its effectiveness for those using it (i.e., both partners bring biomedical protection). Unintended consequences of biomed matching/sorting include that men not using a biomedical strategy may be less likely to benefit from a partner's use of the strategy-potentially further driving disparities in HIV infections. Public health campaigns might be well served to highlight not only the benefits that biomedical HIV prevention strategies provide for their users (e.g., "being on PrEP protects me from getting HIV"), but also the benefits that a user brings to his partners (e.g., "my use of PrEP means my partners won't get HIV"), and the benefits of being with a partner who is using a biomedical strategy (e.g., "my partner's use of PrEP/TasP protects me from HIV").
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA.
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA.
| | - H Jonathan Rendina
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
- Department of Psychology, Hunter College of CUNY, New York, NY, USA
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of CUNY, New York, NY, USA
| | - Viraj V Patel
- Division of General Internal Medicine, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth Kelvin
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Kathryn Anastos
- Division of General Internal Medicine, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey T Parsons
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
- Department of Psychology, Hunter College of CUNY, New York, NY, USA
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of CUNY, New York, NY, USA
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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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Hart TA, Noor SW, Adam BD, Vernon JRG, Brennan DJ, Gardner S, Husbands W, Myers T. Number of Psychosocial Strengths Predicts Reduced HIV Sexual Risk Behaviors Above and Beyond Syndemic Problems Among Gay and Bisexual Men. AIDS Behav 2017; 21:3035-3046. [PMID: 28050650 DOI: 10.1007/s10461-016-1669-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Syndemics research shows the additive effect of psychosocial problems on high-risk sexual behavior among gay and bisexual men (GBM). Psychosocial strengths may predict less engagement in high-risk sexual behavior. In a study of 470 ethnically diverse HIV-negative GBM, regression models were computed using number of syndemic psychosocial problems, number of psychosocial strengths, and serodiscordant condomless anal sex (CAS). The number of syndemic psychosocial problems correlated with serodiscordant CAS (RR = 1.51, 95% CI 1.18-1.92; p = 0.001). When adding the number of psychosocial strengths to the model, the effect of syndemic psychosocial problems became non-significant, but the number of strengths-based factors remained significant (RR = 0.67, 95% CI 0.53-0.86; p = 0.002). Psychosocial strengths may operate additively in the same way as syndemic psychosocial problems, but in the opposite direction. Consistent with theories of resilience, psychosocial strengths may be an important set of variables predicting sexual risk behavior that is largely missing from the current HIV behavioral literature.
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Affiliation(s)
- Trevor A Hart
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Syed W Noor
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Barry D Adam
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON, Canada
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Julia R G Vernon
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Hess KL, Crepaz N, Rose C, Purcell D, Paz-Bailey G. Trends in Sexual Behavior Among Men Who have Sex with Men (MSM) in High-Income Countries, 1990-2013: A Systematic Review. AIDS Behav 2017; 21:2811-2834. [PMID: 28555317 PMCID: PMC5708163 DOI: 10.1007/s10461-017-1799-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV diagnoses among men who have sex with men (MSM) have been increasing in several high-income countries. A better understanding of the sexual behavior trends among MSM can be useful for informing HIV prevention. We conducted a systematic review of studies that examined behavioral trends (1990-2013) in any condomless anal sex, condomless anal sex with an HIV-discordant partner, and number of partners. Studies included come from the United States, Europe, and Australia. We found increasing trends in condomless anal sex and condomless anal sex with an HIV-discordant partner, and a decreasing trend in number of partners. The increase in condomless anal sex may help to explain the increase in HIV infections. More explanatory research is needed to provide insight into factors that contribute to these behavior trends. Continuous monitoring of HIV, risk behaviors, and use of prevention and treatment is needed to evaluate prevention efforts and monitor HIV transmission risk.
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Affiliation(s)
- Kristen L Hess
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA.
| | - Nicole Crepaz
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Charles Rose
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - David Purcell
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
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Kalichman SC, Price D, Eaton LA, Burnham K, Sullivan M, Finneran S, Cornelius T, Allen A. Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997-2015. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:895-902. [PMID: 28168543 PMCID: PMC5967889 DOI: 10.1007/s10508-016-0934-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/13/2016] [Accepted: 12/28/2016] [Indexed: 05/15/2023]
Abstract
Community-wide awareness that antiretroviral therapies (ART) provides protection against HIV has the potential to increase perceived safety and thereby increase condomless anal sex among men who have sex with men (MSM). Furthermore, reductions in condom use can increase exposure to sexually transmitted infections, which in turn can reduce the protective effects of ART on HIV transmission. The current study extends previous community-based behavioral surveillance research on beliefs regarding use of ART for HIV prevention and sexual practices among MSM. Anonymous cross-sectional community surveys were collected from 1831 men at the same gay pride event in Atlanta, GA four times over nearly two decades; 1997, 2005-2006 (the 2006 survey over-sampled African-Americans to diversify the study), and 2015. Results indicate clear and consistent trends of increasing beliefs that HIV treatments reduce HIV transmission risks, reflecting the dissemination of HIV prevention research findings. Changes in treatment beliefs coincide with increased rates of condomless anal intercourse. Increased beliefs that treatments prevent HIV and increased condomless anal sex were observed for both HIV positive men and men who had not tested HIV positive. Results illustrate the emergence of an era where ART is the focus of HIV prevention and community-held beliefs and behaviors regarding definitions of risk create a new and potentially problematic environment for HIV transmission.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA.
| | - Devon Price
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Lisa A Eaton
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Kaylee Burnham
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Matthew Sullivan
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Stephanie Finneran
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Talea Cornelius
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Aerielle Allen
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
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How Different are Men Who Do Not Know Their HIV Status from Those Who Do? Results from an U.S. Online Study of Gay and Bisexual Men. AIDS Behav 2016; 20:1989-99. [PMID: 26767536 DOI: 10.1007/s10461-015-1284-7] [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: 10/22/2022]
Abstract
We compared self-described HIV-positive (31.6 %, n = 445), HIV-negative (56.8 %, n = 801), and HIV-unknown (11.6 %, n = 164) gay and bisexual men on sociodemographic and behavioral characteristics. Participants from across the U.S. were enrolled via a popular sexual networking website to complete an online survey. In total, 44.8 % of HIV-negative and HIV-unknown men said they had not been tested for HIV in the CDC-recommended last 6 months. HIV-unknown men significantly differed from HIV-negative and HIV-positive men in sexual behavior and HIV status disclosure patterns. HIV-unknown men were more willing than HIV-negative men to take PrEP; however, HIV-unknown men were significantly less likely than others to have health insurance or a primary care provider. Given the observed differences, researchers should consider analyzing men who are HIV-unknown distinctly from HIV-negative and HIV-positive men.
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Grov C, Rodríguez-Díaz CE, Jovet-Toledo GG. Male Escorts' and Male Clients' Sexual Behavior During Their Last Commercial Sexual Encounter: Comparing and Contrasting Findings from Two Online Studies. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:965-73. [PMID: 25953422 DOI: 10.1007/s10508-015-0531-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/09/2015] [Accepted: 03/13/2015] [Indexed: 05/10/2023]
Abstract
Much of what is known about commercial sexual encounters between men is based on data gathered from escorts. With few exceptions, studies have not compared male clients' reports of behavior during commercial sexual encounters with male escorts'. The present study draws from two datasets, a 2012 survey of clients (n = 495) and a 2013 survey of escorts (n = 387)--both used virtually identical measures of sexual behavior during the most recent commercial sexual encounter. For clients and escorts, the majority eschewed having sex without a condom, and kissing and oral sex were among the most common behaviors reported. Using logistic regression, both samples were compared across 15 sexual behaviors, finding significant differences in six--the escort sample had greater odds of reporting their last commercial sexual encounter involved watching the client masturbate, viewing porn, role play (dad/son, dominant/submissive), and having prior sexual experience with their commercial partner. The escort sample had lower odds of reporting that the client watched the escort masturbate, and being told partner's HIV status. In multivariable modeling, both samples did not significantly differ in reports of condomless anal sex. Male-male commercial sexual encounters appear to be involved in a wide range of sexual behaviors, many of which convey low-to-no risk of HIV transmission.
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Affiliation(s)
- Christian Grov
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York (CUNY), 2900 Bedford Avenue, Brooklyn, NY, 11210, USA.
- Doctoral Program in Public Health, The Graduate Center of CUNY, New York, USA.
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, USA.
| | - Carlos E Rodríguez-Díaz
- Department of Social Sciences, School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
- Center for Sexual Health Promotion and Health Equity, School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
| | - Gerardo G Jovet-Toledo
- Center for Sexual Health Promotion and Health Equity, School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
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Field N, Prah P, Mercer CH, Rait G, King M, Cassell JA, Tanton C, Heath L, Mitchell KR, Clifton S, Datta J, Wellings K, Johnson AM, Sonnenberg P. Are depression and poor sexual health neglected comorbidities? Evidence from a population sample. BMJ Open 2016; 6:e010521. [PMID: 27009148 PMCID: PMC4809090 DOI: 10.1136/bmjopen-2015-010521] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/10/2016] [Accepted: 02/29/2016] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To examine associations between sexual behaviour, sexual function and sexual health service use of individuals with depression in the British general population, to inform primary care and specialist services. SETTING British general population. PARTICIPANTS 15,162 men and women aged 16-74 years were interviewed for the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), undertaken in 2010-2012. Using age-adjusted ORs (aAOR), relative to a comparator group reporting no treatment or symptoms, we compared the sexual health of those reporting treatment for depression in the past year. OUTCOME MEASURES Sexual risk behaviour, sexual function, sexual satisfaction and sexual health service use. RESULTS 1331 participants reported treatment for depression (5.2% men; 11.8% women). Relative to the comparator group, treatment for depression was associated with reporting 2 or more sexual partners without condoms (men aAOR 2.07 (95% CI 1.38 to 3.10); women 2.22 (1.68 to 2.92)), and concurrent partnerships (men 1.80 (1.18 to 2.76); women 2.06 (1.48 to 2.88)), in the past year. Those reporting depression treatment were more likely to be dissatisfied with their sex lives (men 2.32 (1.74 to 3.11); women 2.30 (1.89 to 2.79)), and to score in the lowest quintile on the Natsal-sexual function measure. They were also more likely to report a recent chlamydia test (men 1.92 (1.15 to 3.20)); women (1.27 (1.01 to 1.60)), and to have sought help regarding their sex life from a healthcare professional (men 2.92 (1.98 to 4.30); women (2.36 (1.83 to 3.04)), most commonly from a family doctor. Women only were more likely to report attending a sexual health clinic (1.91 (1.42 to 2.58)) and use of emergency contraception (1.98 (1.23 to 3.19)). Associations were broadly similar for individuals with depressive symptoms but not reporting treatment. CONCLUSIONS Depression, measured by reported treatment, was strongly associated with sexual risk behaviours, reduced sexual function and increased use of sexual health services, with many people reporting help doing so from a family doctor. The sexual health of depressed people needs consideration in primary care, and mental health assessment might benefit people attending sexual health services.
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Affiliation(s)
- Nigel Field
- Research Department of Infection and Population Health, UCL, London, UK
| | - Philip Prah
- Research Department of Infection and Population Health, UCL, London, UK
| | | | - Greta Rait
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Michael King
- Division of Psychiatry (Faculty of Brain Sciences), UCL, London, UK
| | - Jackie A Cassell
- Division of Primary Care and Public Health, University of Brighton, Brighton, UK
| | - Clare Tanton
- Research Department of Infection and Population Health, UCL, London, UK
| | - Laura Heath
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kirstin R Mitchell
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Soazig Clifton
- Research Department of Infection and Population Health, UCL, London, UK
| | - Jessica Datta
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kaye Wellings
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, UCL, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, UCL, London, UK
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