Behavioral risk factors for HIV infection among homosexual men at a Boston community health center

Men's Sexual Risk Factors for HIV Infection: Racial Differences in Behavior, Knowledge, and Self-Perceptions

HIV transmission most often results from individually-induced activities. Previous research into HIV transmission has identified both high-risk groups and high-risk behaviors. This research identifies differences between white and African-American men and their participation in HIV-risk behaviors, HIV-related knowledge, and self-perceived likelihood for HIV infection. Findings show a contradiction between reported HIV-risk behaviors and self-perceived risk of contracting HIV for all male participants. Furthermore, racial differences are significantly related to both the type and number of sexual partners, participation in and frequency of condom use for various sexual activities, and levels of self-perceived knowledge of HIV/AIDS. These findings and implications on current and future HIV prevention/intervention efforts are discussed.

Psychosocial Factors and Aids-Related Behavior of Homosexual Men

The primary objective of this study was to conduct measurement and data-reduction procedures of selected psychosocial measures used in AIDS-related behavioral research. Secondly, we investigated the associations of the psychosocial scales relative to other personal and health serviceslinformation factors with one selected AIDS protective behavior among asymptomatic homosexual/bisexual mern Data were collected using a self-administered questionnaire. Factor analysis and regression modeling were used to address the study objectives. Factor analyses validated the relationships between 53 survey items and 12 hypothesized constructs suggested by several theories of behavior change. These constructs included perceptions of susceptibility, beliefs of social network members, opinions about HPV testing, medical efficacy, related health habits and barriers to behavior change. Regression modeling demonstrated the relative importance of psychosocial scales to other variables in understanding associations with total number of sexual partners.

The oral mucosa immune environment and oral transmission of HIV/SIV

The global spread of human immunodeficiency virus (HIV) is dependent on the ability of this virus to efficiently cross from one host to the next by traversing a mucosal membrane. Unraveling how mucosal exposure of HIV results in systemic infection is critical for the development of effective therapeutic strategies. This review focuses on understanding the immune events associated with the oral route of transmission (via breastfeeding or sexual oral intercourse), which occurs across the oral and/or gastrointestinal mucosa. Studies in both humans and simian immunodeficiency virus (SIV) monkey models have identified viral changes and immune events associated with oral HIV/SIV exposure. This review covers our current knowledge of HIV oral transmission in both infants and adults, the use of SIV models in understanding early immune events, oral immune factors that modulate HIV/SIV susceptibility (including mucosal inflammation), and interventions that may impact oral HIV transmission rates. Understanding the factors that influence oral HIV transmission will provide the foundation for developing immune therapeutic and vaccine strategies that can protect both infants and adults from oral HIV transmission.

Psychosocial contexts of the homosexuality of Filipino men in heterosexual unions

The Philippines is one developing country in which a systematic inquiry on the homosexuality of men in heterosexual consensual union is rare. With the thought that the public can be guided more knowledgeably in forming some responsible knowledge and opinion about homosexual men's lives within heterosexual unions, a small-scale exploratory study was carried out and completed in 1997 among 15 married or co-habiting men in Metro Manila, the Philippines. The research delved into respondents' sexual histories; their perceptions of own homosexual attraction, desire and orientation; and their reasons, motivations and expectations for marrying or cohabiting. It also looked into respondents' reports of whether their partners knew their sexual orientation; respondents' roles and responsibilities in household management and decision making; and effects of respondents' homosexuality on marital and familial relationships.

Risk behaviours and HIV infection among men having sexual relations with men: baseline characteristics of participants in the Omega Cohort Study, Montreal, Quebec, Canada

OBJECTIVE

To describe characteristics of men having sex with men (MSM) participating in the Omega Cohort, to describe HIV-positive participants at baseline interview, and to estimate HIV incidence.

METHODS

The Omega Cohort is a study on the incidence and psychosocial determinants of HIV infection among MSM living in Montreal. MSM complete a questionnaire and are tested for HIV every six months.

RESULTS

During the previous six months, 31% and 12% of 810 participants (mean age = 33 years) reported unprotected anal sex with regular and casual partners, respectively. Eight participants (0.98%) were HIV-infected at baseline. HIV incidence was 0.89 per 100 person-years (7/787 person-years) [95% confidence interval: 0.36-1.83].

CONCLUSION

A significant proportion of participants reported current risk behaviours. Despite this, HIV incidence is relatively low. It is important to target MSM who do not practice safe sex and to encourage those practicing safe sex to sustain these behaviours.

Risk behaviours and HIV infection among men having sexual relations with men: baseline characteristics of participants in the Omega Cohort Study, Montreal, Quebec, Canada

OBJECTIVE

To describe characteristics of men having sex with men (MSM) participating in the Omega Cohort, to describe HIV-positive participants at baseline interview, and to estimate HIV incidence.

METHODS

The Omega Cohort is a study on the incidence and psychosocial determinants of HIV infection among MSM living in Montreal. MSM complete a questionnaire and are tested for HIV every six months.

RESULTS

During the previous six months, 31% and 12% of 810 participants (mean age = 33 years) reported unprotected anal sex with regular and casual partners, respectively. Eight participants (0.98%) were HIV-infected at baseline. HIV incidence was 0.89 per 100 person-years (7/787 person-years) [95% confidence interval: 0.36-1.83].

CONCLUSION

A significant proportion of participants reported current risk behaviours. Despite this, HIV incidence is relatively low. It is important to target MSM who do not practice safe sex and to encourage those practicing safe sex to sustain these behaviours.

Unsafe sex in men who have sex with both men and women

The sexual behaviors of bisexually active men, defined as men having sex with a man and a woman in previous 6 months, were compared with men who had sex with men only. Differential sexual practices associated with HIV risk between the two groups of men, as well as in the bisexual men with their male and female partners, were evaluated. Cross-sectional analyses were performed on baseline data from a prospective cohort of 508 young gay men recruited from bars, college campuses, and a health center in Boston from 1993 to 1994. Odds ratios (OR) and 95% confidence intervals (CI) were calculated on categorical variables, and McNemar's chi2 was used to compare the behaviors of bisexual men with their male versus female sex partners. Six months before the interview, 47 (10%) men had male and female sex partners, and 383 men had only male sex partners during the past year or ever. Fifty-eight percent of the men in the study had a female sexual partner in their lifetime, and 18% during the past year. Bisexual men were more likely to have drinking problems as identified by the Michigan Alcoholism Screening Test (MAST; OR = 3.96, 95% CI = 1.54-10.20), and fewer male partners over their lifetime (mean +/- standard deviation [SD], 24+/-42; median, 7; versus mean +/- SD, 69+/-516; median, 12), although this difference was not statistically significant. The two groups had similar levels of unprotected anal intercourse (25.5% versus 29.5%); however, bisexual men were half as likely to have anal sex as homosexual men (OR = 0.50; 95% CI = 0.27-0.93). Bisexual men were three times as likely to have unprotected sex with their female partner as their male partner (OR = 3.0; 95% CI = 1.02-8.8). Stratified analysis revealed similar discordant behavior while sober (OR = 4.0), drinking (OR = 7.0), and while drinking with concurrent drug use (OR = 8.0). Among this cohort of men who have sex with men (MSM), a sizable proportion also had vaginal sex with female partners in the previous 6 months. Bisexually active men were more likely to have unprotected sex with their female partners compared with their male partners, potentially increasing the risk for HIV and other sexually transmitted diseases. Behavioral interventions directed toward MSM need to address bisexual behaviors.

Interest among gay/bisexual men in greater Boston in participating in clinical trials of preventive HIV vaccines

To estimate interest in HIV preventive vaccine trials, we administered questionnaires to two otherwise demographically similar cohorts of older (mean 40 years) and younger (mean 23 years) gay men in Boston. Questionnaire responses were linked to concurrent behavioral and demographic data. Univariate analyses, performed separately for older and younger cohorts, identified factors that distinguished participants who were "very interested" from those who were "not at all interested". Multivariate logistic regression analyses were used to adjust for confounding. Among all 630 participants, 215 (34%) were "not at all" interested in participating, 306 (49%) were "somewhat" interested, and 102 (16%) were "very" interested. Older men were significantly more likely than younger men to be "very" interested and less likely to be "not at all interested." Among both older and younger men, perceived peer willingness to enroll in vaccine trials predicted interest after adjusting for confounding. Among older men, optimism about success in vaccine development also predicted interest. In the younger cohort, men recruited in community settings (e.g., bars, nightclubs) were more interested in vaccine trial participation than were those recruited by outreach workers and word of mouth on college campuses. Vaccine-induced seroconversion evoked significant concern.

Pattern of gp120 sequence divergence linked to a lack of clinical progression in human immunodeficiency virus type 1 infection

Differential rates of AIDS development and/or T4 lymphocyte depletion in HIV-1-infected individuals remain unexplained. The hypothesis that qualitative differences in selection pressure in vivo may account for different rates of disease progression was addressed in nine eligible study participants from a cohort of 315 homosexual men who have been followed since 1985. Disproportionately fewer changes in variable regions and more in C3 of gp12O were found to be significantly associated with slower disease progression. Our finding provides the first example to demonstrate that differential selection pressure related to the emergence of HIV-1 variants is associated with long term nonprogression. Candidate vaccines that elicit strong selection pressure on C3 of gp120 are likely to provide better protection than those targeting variable regions.

The Young Men's Survey: methods for estimating HIV seroprevalence and risk factors among young men who have sex with men

Traditional sampling methods are unsuitable for determining the levels of human immunodeficiency virus type I infection and related behavioral risk factors among young men who have sex with men. Most surveys of this hard-to-reach population have used nonprobability samples of young men in clinical or public settings. While these studies have revealed high rates of HIV infection and risk behaviors, their findings are not generalizable to broader populations of young men who have sex with men. To better understand the epidemiology of HIV within this population, the Centers for Disease Control and Prevention, in collaboration with state and local health departments, has developed a venue-based probability survey of young men who have sex with men. Conducted in seven metropolitan areas in the United States, the Young Men's Survey combines outreach techniques with standard methods of sample surveys to enumerate, sample, and estimate prevalence outcomes of a population of young men who frequent public venues and who have sex with other men. Venues where young men who have sex with men are sampled include dance clubs, bars, and street locations. At sampled venues, young men are enumerated, consecutively approached, and offered enrollment if they are determined eligible. Young men who agree to participate in the Young Men's Survey are interviewed, counseled, and tested for human immunodeficiency virus, hepatitis B, and syphilis in vans parked near sampled venues. The Young Men's Survey provides data on the locations and times at which demographic and behavioral subgroups of young men who have sex with men may be targeted for prevention activities. Behaviors and psychosocial factors associated with human immunodeficiency virus infection can be used to design culturally relevant and age-specific prevention activities for young men who have sex with men.

Drug-related behavior change for HIV transmission among American injection drug users

While high risk drug-related behaviors for human immunodeficiency virus (HIV) transmission among injection drug users (IDUs) are asserted to have declined over time in response to the AIDS epidemic, evidence from longitudinal cohorts has been sparse. In a cohort of 810 IDUs (442 seronegatives and 368 seropositives) in Baltimore, we identified drug-related risk behaviors at four consecutive semi-annual visits. Using robust methods for repeated measurements and multiple logistic regression, we estimated the probabilities of maintaining and reducing risk behaviors according to HIV serostatus and time in the study. Seropositive participants were more likely to maintain lower risk behaviors, and behavior maintenance increased with time in study for both seronegative and seropositive IDUs. Greater risk reduction (towards non-use and not sharing injection equipment) was seen among seropositive IDUs, with behavior change occurring soon after enrollment in the study. While behavior changes have been reported, many active IDUs, especially those still at risk for acquiring HIV infection, have not adequately reduced their risk. Continuing prevention programs and efforts in vaccine development are imperative to reduce the risk of HIV infection among IDUs.

Correlates of sexual risk-taking among gay male substance abusers

This paper examines sexual risk-taking within a sample of sexually active gay and bisexual men entering substance abuse treatment (n = 383), and identifies correlates of unprotected anal sex within this group. Sexual risk-taking was high, with 55% of these men engaging in anal intercourse without a condom within a 90-day period. Correlates of unprotected anal sex varied somewhat when looking at unprotected anal sex with a primary partner only and with non-primary partners; substance use variables (number of drugs used, use of inhalant nitrites or stimulant drugs with sex, length of time since use of alcohol/drugs, loss of control problems associated with alcohol/drug use) appear to play more of a role in unprotected anal sex with non-primary partners. Overall, logistic regression analyses indicated that sexual risk was greater for those who were more sexually active, enjoyed unprotected anal sex with withdrawal prior to ejaculation, did not approve of sex outside of a love relationship, and identified themselves as more risky. In addition, those who reported more social problems due to substance use had fewer expectations that substance use increased risk, had been HIV-tested, and used reappraisal/problem-solving coping strategies showed greater risk with a primary partner only. Sexual risk with non-primary partners was greater for those who used more drugs, reported more difficulty avoiding high-risk sex when aroused and were HIV+. The paper discusses the implications of these findings for the design of sexual risk-reduction interventions.

Risky business: the cultural construction of AIDS risk groups

AIDS researchers and policy makers have often employed the concept of 'culture' to characterize 'high risk groups' and explain why members of these groups continue to practice 'risky behavior.' We argue that the widespread interest in ethnography tends to reflect a usage of the concept of culture that distances and subordinates. People with AIDS are portrayed as either minority street people abandoned by friends and family or as white gay men who live within a gay community, and in either case as socially deviant. This construction of HIV disease has facilitated distancing and denial of personal risk by persons outside the 'high risk groups,' impeding prevention efforts. Perceptions of subcultures of risk groups are contrasted with data on a random sample of persons with AIDS in New Jersey.

A comparison of risk factors for human immunodeficiency virus and hepatitis B virus infections in homosexual men

We analyzed cross-sectional data from 1062 homosexual men recruited in Baltimore during 1984, to directly compare risk factors for human immunodeficiency virus (HIV) and hepatitis B virus (HBV). Using polychotomous logistic regression, risk factor odds ratios (ORs) and 95% confidence intervals were determined for men with HIV alone, men with HBV alone, and men with both HIV and HBV, compared to seronegative men, and paired comparisons among these subgroups. Factors associated with the serologic prevalence of HIV alone and HBV alone (with respective ORs) included and receptive intercourse (HIV OR = 1.23; HBV OR = 1.12), history of gonorrhea (HIV OR = 4.58; HBV OR = 2.52), and rectal douching (HIV OR = 1.41; HBV OR = 1.20). Additional factors associated with HBV alone were years of homosexual activity (OR = 1.65), sexual activity with a person who developed acquired immunodeficiency syndrome (AIDS) (OR = 1.98), and lifetime number of male sex partners (OR = 1.25). HIV and HBV coprevalence was associated with anal receptive intercourse (OR = 1.36), history of gonorrhea (OR = 2.94), rectal douching (OR = 1.45), sexual activity with a person who developed AIDS (OR = 3.87), lifetime number of male sex partners (OR = 1.21), and the lifetime sum of sexually transmitted diseases (OR = 1.47). These findings reinforce the need for following safer-sex guidelines to prevent both infections and in the case of HBV, the prevention strategies should include vaccination.

Entangled epidemics: cocaine use and HIV disease

Over the past decade, two epidemics have had a severe impact on public health in this country. These health problems involve cocaine abuse and AIDS (or HIV disease). The processes of these two conditions are clearly not independent of each other and may be quite complex. Understanding of this relationship has been hampered by a myriad of social, biological and behavioral variables that are entangled with the basic cocaine-HIV association. This article presents a paradigm for discussion of the interaction between cocaine exposure and HIV disease based on three mechanisms: the relationship between cocaine exposure and increased opportunity for HIV exposure, the direct role that cocaine plays in altering susceptibility to HIV infection, and the influence that cocaine use has on the progression of HIV disease. The goal of this structured approach is to enhance conceptual understanding of the cocaine-HIV relationship while recognizing the complexity of the issue and the limitations of current research efforts. This model will serve as a framework for the discussion of implications for future research, clinical practice, and public policy.

Demographic characteristics, risk behaviors, and HIV seroprevalence among intravenous drug users by site of contact: results from a community-wide HIV surveillance project

We investigated differences in behaviors important for human immunodeficiency virus (HIV) transmission and HIV antibody status among 927 recent needle users enrolled in a multi-site HIV surveillance project in Worcester, Massachusetts. Subjects were enrolled at drug abuse treatment centers reported less risky injection practices unexplained by demographic variables. Risky sexual practices were in general reported more frequently by men at the jail than men at other sites. However, HIV status showed little relation to enrollment site. These results have implications both for targeting of acquired immunodeficiency syndrome (AIDS) prevention programs to needle users not in drug abuse treatment and for potential selection bias in studies of intravenous drug users.

Awareness and use of hepatitis B vaccine among homosexual male clients of a Boston community health center

Factors associated with awareness and acceptance of hepatitis B vaccine were identified among 150 homosexual male clients of a Boston community health center. Five percent of the subjects were unaware of hepatitis B and 25 percent had a history of hepatitis. Among the remaining 106 men, 68 percent were aware of the vaccine, and 25 percent of these had been vaccinated. Awareness of vaccine was associated with education beyond the baccalaureate level. Factors associated with vaccination included at least one prior visit to the health center, having health insurance, and extent of knowledge of the effects of hepatitis B. Among those not vaccinated, 68 percent would like to be but were deterred by the perceived high cost of the vaccine. The predominant reason given by the 31 percent who have decided not to be vaccinated was the perception that they were not at risk because of monogamous sexual relationships, or "safer" sexual practices. Strategies for maximizing vaccine use among homosexually active men should focus on increasing both awareness of the vaccine and appropriate perceptions of risk.

Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men

This study assesses the effects of HIV (human immunodeficiency virus) antibody testing on subsequent (one year) sexual behavior among 270 homosexual men at a Boston community health center, 21 per cent of whom were unaware of their test result. Except for the number of steady partners, the levels of all sexual activities of all groups of study participants declined over time. No effects of test awareness of antibody status were found on protective behavior for receptive anogenital contact. Elimination of unprotected insertive anogenital contact (by elimination of the practice or by condom use) was reported somewhat more often among seropositive men who became aware of their test result. Increased negative emotional reactions were reported by HIV seropositive men who were aware of their test result. These results suggest some behavioral impact of HIV antibody test knowledge in this cohort, but may not be generalizable to other populations.