No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Associations of Race/Ethnicity with HIV Prevalence and HIV-Related Behaviors among Young Men Who Have Sex with Men in 7 Urban Centers in the United States
Abstract
Using data from a multisite venue-based survey of male subjects aged 15 to 22 years, we examined racial/ethnic differences in demographics, partner type, partner type-specific condom use, drug use, and HIV prevalence in 3316 US black, multiethnic black, Latino, and white men who have sex with men (MSM). We further estimated associations of these factors with HIV infection and their influence on racial/ethnic disparities in HIV prevalence. HIV prevalences were 16% for both black and multiethnic black participants, 6.9% for Latinos, and 3.3% for whites. Paradoxically, potentially risky sex and drug-using behaviors were generally reported most frequently by whites and least frequently by blacks. In a multiple logistic regression analysis, positive associations with HIV included older age, being out of school or work, sex while on crack cocaine, and anal sex with another male regardless of reported condom use level. Differences in these factors did not explain the racial/ethnic disparities in HIV prevalence, with both groups of blacks experiencing more than 9 times and Latinos experiencing approximately twice the fully adjusted odds of infection compared with whites. Understanding racial/ethnic disparities in HIV risk requires information beyond the traditional risk behavior and partnership type distinctions. Prevention programs should address risks in steady partnerships, target young men before sexual initiation with male partners, and tailor interventions to men of color and of lower socioeconomic status.
... non-BMSM) reported fewer sexual risk behaviors, including fewer male sex partners and less condomless anal intercourse [3]. Contextualizing individual-level behaviors within sexual networks by race may highlight key differences in network risk environments and race-specific patterns of sexual networks that are contributing to racial disparities in HIV incidence [4][5][6]. ...
... Black indexes were no more likely that non-Black indexes to report sex partner concurrency. Table 1 Characteristics of indexes (participants) (N = 371) and partnerships (N = 836) overall and by index race in the Understanding Sexual Health in Networks Study (USHINE), Baltimore City, July 2018-March 2020 1 Determined by an HIV rapid test with ELISA confirmation, medical record documentation, or in a few cases, participant self-report 2 Defined as daily PrEP/ART use in the past one month vs. infrequent or no PrEP/ART use 3 Defined as a rapid plasma reagin (RPR) titer greater than 1:8 in combination with a positive treponemal test 4 Determined by nucleic acid amplification test (NAAT) at any anatomic site 5 Defined as a partnership between an HIV positive index with an HIV negative or HIV unknown partner or vice versa. If the index reported PrEP or ART use for himself or his partner in the past one month, the partnership was not coded as an HIV transmission potential. ...
... Table 2 Characteristics of indexes (participants) (N = 371) and partnerships (N = 836) by index race and HIV transmission potential (TPP) in the Understanding Sexual Health in Networks Study (USHINE), Baltimore City, July 2018-March 2020 1 Defined as a partnership between an HIV positive index with an HIV negative or HIV unknown partner or vice versa. If the index reported he or his partner was on PrEP or ARTs, the partnership was not coded as an HIV transmission risk partnership regardless of the partner's HIV serostatus 2 Determined by an HIV rapid test with ELISA confirmation, medical record documentation, or in a few cases, participant self-report 3 Defined as a rapid plasma reagin (RPR) titer greater than 1:8 in combination with a positive treponemal test 4 Determined by nucleic acid amplification test (NAAT) 5 Determined by index self-report 6 Determined by index self-report of whether their partner was having sex with other people while having sex with them ...
We determined whether racial disparities in HIV infection among gay and bisexual men (MSM) may be partially explained by racial differences in the HIV transmission potential (i.e. mixing of people living with HIV and people not living with HIV or of unknown HIV serostatus) and density (i.e. sex partner concurrency) of sexual networks. Data included a behavioral survey, testing for HIV, and an egocentric sexual network survey. Mixed effects logistic regressions were used for hypothesis testing. Black (vs. non-Black) MSM were more likely to not know their partner’s HIV serostatus (21.8% vs. 9.6%). Similar proportions reported sex partner concurrency (67.1% vs. 68.0%). In adjusted analyses, among Black MSM, sex partner concurrency significantly increased the odds of an HIV transmission potential partnership (TPP), and this association was not significant among non-Black indexes. The association between an HIV TPP and sex partner concurrency may help explain persistent racial disparities in HIV prevalence.
... Associations of ethnicity with HIV prevalence and among young MSM were measured in seven urban centres in the United States (Harawa et al. 2004). In a multiple logistic regression analysis, positive associations with HIV included older age, being out of school or work, sex while on crack cocaine, and anal sex with another male regardless of reported condom use level. ...
... Black methamphetamine users were more likely to be HIV-positive than other methamphetamine users. Associations of ethnicity with HIV prevalence and among young MSM were measured in 7 urban centres in the United States (Harawa et al. 2004). This study showed that factors positively associated with HIV did not explain racial/ethnic disparities in HIV prevalence. ...
... This study also provides evidence for temporality, as drug use occurred before UAI. All but two (Harawa et al., 2004;Mattison et al., 2001) of the nine cross-sectional studies demonstrated that either methamphetamine or amphetamine were consistently associated with the majority of risk behaviours or disease outcomes measured. Of the seven studies demonstrating positive associations, most had risk ratios above 1.5 with confidence intervals that excluded one. ...
... Research has not fully considered the underlying drivers of racial and ethnic inequities in HIV transmission. It is well documented that racial/ethnic minorities compared to whites are less likely to engage in high-risk behaviors including unprotected sex and needle sharing [1][2][3][4]. For example, about 3% fewer blacks compared to whites engaged in unprotected sex and shared needles [4]. ...
... It is well documented that racial/ethnic minorities compared to whites are less likely to engage in high-risk behaviors including unprotected sex and needle sharing [1][2][3][4]. For example, about 3% fewer blacks compared to whites engaged in unprotected sex and shared needles [4]. Thus, we desperately need to better understand why racial/ethnic minorities acquire HIV at a higher rate than their white counterparts. ...
... Underlying this argument is the premise that individuals do in fact seek some value in their relationships, whether that be coping or financial stability, regardless of the consequences these relationships may pose. This warrants further investigation since experiences of 4 Only includes those who reported spending time in jail or prison in their lifetime (n = 237) Table 4 Unadjusted and adjusted incidence rate ratios (and 95% confidence intervals) of the relationship between discrimination experiences and changes in the proportion of risk network members between baseline and the six-month follow-up among PWUD, NYC The limited availability and access to beneficial social relationships may be another driving force for how social networks are formed. According to Rothenberg and colleagues, geographic space creates a tangible limitation of physical boundaries for available relationships among PWUD [50]. ...
Experiences of discrimination, or social marginalization and ostracism, may lead to the formation of social networks characterized by inequality. For example, those who experience discrimination may be more likely to develop drug use and sexual partnerships with others who are at increased risk for HIV compared to those without experiences of discrimination. This is critical as engaging in risk behaviors with others who are more likely to be HIV positive can increase one's risk of HIV. We used log-binomial regression models to examine the relationship between drug use, racial and incarceration discrimination with changes in the composition of one's risk network among 502 persons who use drugs. We examined both absolute and proportional changes with respect to sex partners, drug use partners, and injecting partners, after accounting for individual risk behaviors. At baseline, participants were predominately male (70%), black or Latino (91%), un-married (85%), and used crack (64%). Among those followed-up (67%), having experienced discrimination due to drug use was significantly related to increases in the absolute number of sex networks and drug networks over time. No types of discrimination were related to changes in the proportion of high-risk network members. Discrimination may increase one's risk of HIV acquisition by leading them to preferentially form risk relationships with higher-risk individuals, thereby perpetuating racial and ethnic inequities in HIV. Future social network studies and behavioral interventions should consider whether social discrimination plays a role in HIV transmission.
... African American and Hispanic/Latino MSM do not engage in more risky behaviors (i.e., having multiple partners, not using condoms) than MSM of other racial/ethnic groups. 30,[33][34][35][36][37] The higher background prevalence of HIV 30,33,34,37 and assortative partner selection practices 33,36,37 in these communities, along with stigma [33][34][35][36]38,39 and homonegative attitudes, [33][34][35][36][38][39][40] place African American and Latino MSM at higher risk for HIV infection than MSM of other racial/ethnic groups. Compared with MSM of other racial/ethnic groups, African American MSM are also less likely to be aware of their HIV status, and those who are aware of their status have lower rates of linkage to care, retention in care, and viral suppression. ...
... African American and Hispanic/Latino MSM do not engage in more risky behaviors (i.e., having multiple partners, not using condoms) than MSM of other racial/ethnic groups. 30,[33][34][35][36][37] The higher background prevalence of HIV 30,33,34,37 and assortative partner selection practices 33,36,37 in these communities, along with stigma [33][34][35][36]38,39 and homonegative attitudes, [33][34][35][36][38][39][40] place African American and Latino MSM at higher risk for HIV infection than MSM of other racial/ethnic groups. Compared with MSM of other racial/ethnic groups, African American MSM are also less likely to be aware of their HIV status, and those who are aware of their status have lower rates of linkage to care, retention in care, and viral suppression. ...
... African American and Hispanic/Latino MSM do not engage in more risky behaviors (i.e., having multiple partners, not using condoms) than MSM of other racial/ethnic groups. 30,[33][34][35][36][37] The higher background prevalence of HIV 30,33,34,37 and assortative partner selection practices 33,36,37 in these communities, along with stigma [33][34][35][36]38,39 and homonegative attitudes, [33][34][35][36][38][39][40] place African American and Latino MSM at higher risk for HIV infection than MSM of other racial/ethnic groups. Compared with MSM of other racial/ethnic groups, African American MSM are also less likely to be aware of their HIV status, and those who are aware of their status have lower rates of linkage to care, retention in care, and viral suppression. ...
Since the early 1980s, substantial progress has been made in the prevention and treatment of human immunodeficiency virus (HIV) infection in the United States. However, HIV remains a major public health concern due in part to significant disparities1 in rates of infection among racial/ethnic minority communities,
with black/African American (hereinafter referred to as African American) and Hispanic/Latino populations being the most affected subgroups.2 African Americans comprised 44% of new HIV diagnoses in 2014, despite representing only 12% of the population; 23% of new HIV diagnoses were among Hispanics/Latinos, who represent about 16% of the U.S. population. Gay, bisexual, and other men who have sex with men (MSM) are the most disproportionately affected subpopulations among African Americans and Hispanics/Latinos. In
2014, an estimated 78% of diagnosed HIV infections among African American males and 84% of diagnosed HIV infections among Hispanic/Latino males resulted from male-to-male sexual contact.2 The causes of these disparities are complex and interrelated and can be attributed to myriad individual, social, contextual, and environmental factors. Accordingly, prevention strategies to reduce disparities must be based on an integrated, targeted approach that addresses the individual, social, structural, and contextual environments in which disparities occur.3 The White House released the National HIV/AIDS Strategy (NHAS) for the United States in 2010 and updated it in July 2015. Both the 2010 and 2015 NHAS provide a plan for federal agencies to address HIV-related disparities by reducing mortality in communities at high risk for HIV, adopting community
approaches to reduce new HIV infections, and reducing HIV-related stigma and discrimination. The updated NHAS lists action steps to reduce HIV-related disparities, including scaling up effective, evidence-based programs that address social determinants of health and promoting evidence-based public health
approaches to HIV prevention and care.4,5 In 2012, a multidisciplinary workgroup was convened in the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention (CDC) to review research on factors that contribute to disparities in rates of HIV infection among racial/ethnic groups and develop an approach for achieving the health equity goals of the updated NHAS in African American and Hispanic/Latino communities. In this article, we discuss the existing literature on factors that contribute to disparities in rates of HIV infection
among racial/ethnic groups and present an approach for achieving the equity goals of the updated NHAS in
African American and Hispanic/Latino communities. Practitioners, policy makers, intervention program
managers, community-based organizations, and other partners in HIV prevention can use this approach to
guide collective actions and monitor progress toward health equity in these communities.
... For example, higher rates of HIV infection among Black men who have sex with men do not seem to relate to engaging in riskier sexual or drug-using behaviors but instead to higher underlying HIV prevalence among potential sexual partners in their social networks. 22 Nevertheless, reported risk behaviors signal to providers and to patients themselves the potential need for PrEP, and guidance to providers on PrEP prescribing emphasizes patients' risk behaviors. 23,24 To account for different levels of behavioral risk, our analysis accounted for a specific, largely behavioral indicator of HIV risk that is derived from the Behavioral Risk Factor Surveillance System (BRFSS). ...
... White, Black, and Asian males showed generally higher uptake rates (for example, more than 0.4 percent for males ages 25-34) than Hispanic males (for example, 0.3 percent for males ages 25-34). In general, among both males and females in each racial/ ethnic group, the youngest (ages [16][17][18][19][20][21][22][23][24] and the oldest (ages 55-69) age groups had the lowest PrEP uptake rates. ...
One of the pillars of efforts in the US to curb HIV incidence is pre-exposure prophylaxis (PrEP). We examined racial/ethnic and sex disparities in PrEP uptake among California Medicaid enrollees. Claims data from 2019 identified enrollees and PrEP users in each racial/ethnic, sex, and age group, yielding crude uptake rates. We then predicted age-adjusted uptake rates from multivariable logit regressions and divided PrEP uptake estimates by each group's number of new HIV diagnoses to estimate PrEP-to-need ratios. Predicted uptake was highest for White (0.29 percent) and Black (0.23 percent) males and lowest (0.16 percent) for Hispanic males. Rates for males exceeded those for females; however, Black females had twice the rate of PrEP uptake of White females. Black males and females and Hispanic males had PrEP-to-need ratios that were less than one-third (4.0-6.3) those of Asian and White males and females (14.4-19.9). Low PrEP use rates and disparities in uptake threaten efforts to end the HIV epidemic. Policy makers must craft the rollout of innovations such as PrEP in a manner that narrows HIV disparities instead of widening them.
... In 2014, HIV prevalence among Black MSM was 36% (866/2403), higher than that among White MSM which is 15% (487/3283) [15]. Other researchers used a sample collected in seven urban cities in US to explore factors associated with HIV infection among MSM, which showed that being older, being unemployed, sex while on cocaine use, and anal sex with male sexual partners are positively associated with HIV infection [18]. However, few studies among MSM have been done in New Jersey. ...
... Both had moderately lower percentages of binge drinking, compared to results of a national study in 2017 [20]. Unlike previous studies [18,21], we did not find the association of HIV infection among MSM and unprotected sex with a male partner. Both groups of men had a higher percentage of unprotected sex with a male partner in last 12 months but both were lower than national levels, which were 72% and 72% respectively. ...
This study assessed the HIV prevalence among MSM in the greater Newark New Jersey area including Essex, Hudson, Morris and Union Counties and examined correlates of HIV infection among those men. By analyzing National HIV Behavioral Surveillance data on MSM from four counties in New Jersey (N = 175), which were collected via a venue-based sampling method in 2017, this study shows that HIV prevalence among all races/ethnicities (12.5–31.9%) and all age groups (15.1–47.8%) were high. Casual sex and unprotected sex with male partners were prevalent among these men, regardless of HIV test results. MSM who were tested HIV positive were more likely to have diagnosed any sexual transmitted diseases in the last 12 months (AOR: 6.7; 95% CI 2.2, 21.3) and less likely to have had alcohol use in the past 12 months (AOR: 0.3; 95% CI 0.1, 0.8). Findings from behavioral surveillance strengthens the response to the HIV epidemic by providing policy makers and care/prevention providers with peer reviewed data to base their decisions on.
... Significant health inequities exist between lesbian, gay, bisexual, and transgender (LGBT) youth and non-LGBT youth. 1 More specifically, poor sexual health outcomes such as teen pregnancy, sexually transmitted infections, and HIV infection are disproportionately higher in youth who identify as LGBT (Beyrer et al., 2012;Charlton et al., 2013;Garofalo, Deleon, Osmer, Doll, & Harper, 2006;Parkes et al., 2011;Saewyc, Pettingell, & Skay, 2004;Saewyc, Poon, Homma, & Skay, 2008). These outcomes are seen at an even higher rate in LGBT youth of color (Garofalo et al., 2006;Harawa et al., 2004). ...
... LGBT youth are more likely to engage in sexual risk behaviors such as early sexual intercourse debut, unprotected intercourse, and having multiple sexual partners (Herrick, Marshal, Smith, Sucato, & Stall, 2011;Kann, 2011;Pathela & Schillinger, 2010). The prevalence of sexual risk behaviors among LGBT youth of color is particularly high (Celentano, 2005;Garofalo et al., 2006;Harawa et al., 2004). This may be due, in part, to the fact that LGBT youth are at an increased risk for experiencing harmful social environmental factors, such as higher levels of sexual abuse, parental physical abuse, partner violence, and victimization at school as compared to their heterosexual and cis-gendered peers (Bontempo & D'Augelli, 2002;Friedman et al., 2011;Halpern, Young, Waller, Martin, & Kupper, 2004). ...
Context:
Lesbian, gay, bisexual, and transgender (LGBT) youth show higher rates of sexual risk behaviors than heterosexual and cisgender youth; yet, most school-based sexual health education is largely heteronormative and cisnormative and does not recognize the spectrum of sexual and gender identity. New York City's Departments of Health and Education collaborated to create an LGBT-inclusive supplement to the Reducing the Risk curriculum and implement it in 21 South Bronx high schools.
Method:
Teachers completed an electronic survey to report the number of students reached and an online log to measure curriculum adherence. Students were administered an anonymous 74-item pre- and posttest to measure demographics, sexual health knowledge, and student satisfaction with the curriculum. Chi-square and t tests were used to assess differences in student demographics and changes in knowledge scores.
Results:
Reducing the Risk was implemented in 21 schools reaching 230 classes and 5,673 students; with 161 classes receiving the supplement. Teachers reported completing an average of 70% of LGBT supplement activities. Students who received the supplement reported higher satisfaction and greater knowledge scores than students who did not.
Conclusion:
New York City experience shows that being more inclusive of LGBT teens while implementing preexisting evidence-based sexual and reproductive health programs is possible and replicable.
... Sexual Risk Taking was assessed using instances of condomless anal sex with non-primary partners during the 3 months prior to participating in the study (i.e., data collected at Visit 1). This measure has been used across several studies and is considered to be a valid measure of sexual risk taking [10,19,20,[36][37][38]. Although the other dimensions of sexual risk taking are valuable, we wanted to explore the unique risk of condomless anal sex with nonprimary partners. ...
... This research lays the groundwork for systematic consideration of identity conflict among high-risk YMSM and two factors that moderate these effects when predicting sexual risk taking. Black and Latino YMSM are at a higher risk of HIV infection compared to White YMSM [1,36,[54][55][56]. Much of the prior research either aggregates Black and Latino YMSM, or investigates these populations separately. ...
Young (aged 18–30) Black and Latino men who have sex with men are at a higher risk of contracting HIV than their White counterparts. In order to better understand the unique nature of sexual risk-taking, we examined the extent to which ethnic group, ethnic identity, and sexual pride predicted condomless anal sex with casual partners among 161 young men who have sex with men (YMSM) who identify as Black or Latino. Negative binomial regressions were conducted using a cross-sectional design. Sexual pride was a negative predictor of condomless anal sex across all participants, but this effect was moderated by ethnic exploration and ethnic group; the relationship between sexual pride and condomless anal sex was strengthened by greater ethnic exploration among Latino YMSM, and weakened by greater ethnic exploration among Black YMSM. Implications for intersectional identity, identity conflict, and HIV prevention among young gay men of color are discussed.
... Sexual Risk Taking was assessed using instances of condomless anal sex with non-primary partners during the 3 months prior to participating in the study (i.e., data collected at Visit 1). This measure has been used across several studies and is considered to be a valid measure of sexual risk taking [10,19,20,[36][37][38]. Although the other dimensions of sexual risk taking are valuable, we wanted to explore the unique risk of condomless anal sex with nonprimary partners. ...
... This research lays the groundwork for systematic consideration of identity conflict among high-risk YMSM and two factors that moderate these effects when predicting sexual risk taking. Black and Latino YMSM are at a higher risk of HIV infection compared to White YMSM [1,36,[54][55][56]. Much of the prior research either aggregates Black and Latino YMSM, or investigates these populations separately. ...
Young (aged 18–30) Black and Latino men who have sex with men are at a higher risk of contracting HIV than their White counterparts. In order to better understand the unique nature of sexual risk-taking, we examined the extent to which ethnic group, ethnic identity, and sexual pride predicted condomless anal sex with casual partners among 161 young men who have sex with men (YMSM) who identify as Black or Latino. Negative binomial regressions were conducted using a cross-sectional design. Sexual pride was a negative predictor of condomless anal sex across all participants, but this effect was moderated by ethnic exploration and ethnic group; the relationship between sexual pride and condomless anal sex was strengthened by greater ethnic exploration among Latino YMSM, and weakened by greater ethnic exploration among Black YMSM. Implications for intersectional identity, identity conflict, and HIV prevention among young gay men of color are discussed.
... A few studies have expanded the main/casual dichotomy, providing participants with more response options and incorporating references to the seriousness or steadiness of a relationship to define differentpartner types (Harawa et al.,2004;Kelly, Difranceisco, St. Lawrence, Amirkhanian, & Anderson-Lamb, 2013;Newcomb, Ryan, Garofalo, & Mustanski, 2014). Perhaps the most comprehensive and specific partnership typology in the literature, developed through qualitative research with MSM, includes seven partnership types that are distinguished with contextual details such as whether the partner is someone the participant normally socializes with and whether they had met before (Gorbach,Drumright,Daar,&Little,2006)(seeAppendix 1).Although these definitions provide more details to define types of partners, there is no evidence that the array of categories is meaningful and relevant to all men. ...
... In particular, it is important to consider whether existing categories of partnership type are applied consistently by race. Attempting to explain the pronounced disparity in HIV prevalence and incidence between Black and White MSM (Millett et al., 2012), studies have found that Black MSM report fewer partners overall (Berry, Raymond, & McFarland, 2007;Bingham et al., 2003;Harawa et al., 2004;Magnus et al., 2010;Millett et al., 2012;Sullivan et al., 2014a), fewer casual partners (Rosenberg et al., 2011), and lower likelihood of engaging in condomless anal sex (CAS) with their main partners (Millett et al., 2012). However, in the context of high levels of social and internalized stigma (Maulsby et al., 2014;Quinn et al., 2015), it is possible that Black MSM adopt different patterns of sexual partnering than White MSM, such that partnerships labeled main and casual may be qualitatively distinct by race. ...
The role of main partnerships in shaping HIV transmission dynamics among men who have sex with men (MSM) has gained recognition in recent studies, but there is little evidence that existing definitions of partnership type are accurate or have consistent meaning for all men. Using data collected from 2011 to 2013 on 693 partnerships described by 193 Black and White MSM in Atlanta, GA, partnership attributes and risk behaviors were examined and compared by race, stratified in two ways: (1) by commonly used definitions of partnerships as “main” or “casual” and (2) by a new data-driven partnership typology identified through latent class analysis (LCA). Racial differences were analyzed using chi-square, Fisher’s exact, and Wilcoxon–Mann–Whitney tests. Black participants were less likely to report condomless anal sex (CAS) within partnerships they labeled as main, yet they were also less likely to describe these partnerships as “primary” on a parallel question. In contrast, within strata defined by the LCA-derived typology, most partnership attributes were comparable and the likelihood of CAS was equivalent by race. These findings suggest that classification of partnerships as main or casual does not accurately capture the partnership patterns of MSM, resulting in differential misclassification by race. Future studies and interventions should refine and utilize more evidence-based typologies.
... Young men of color who have sex with men (such as the Latino and African American men who have sex with men) are disproportionately impacted by HIV/AIDS in the United States. [1][2][3] As per the National HIV Surveillance System (2018), while the incidence of HIV has declined among White MSM over years, it has remained constant for Black men having sex with men (MSM) and increased for Latino/Hispanic MSM. 4 Data from the HIV network for prevention trials vaccine preparedness study, EXPLORE behavioral efficacy trial, and VAX004 vaccine efficacy trials found that the average risk per contact for unprotected receptive anal (URA) intercourse and unprotected insertive anal intercourse (UIA) with HIV seropositive partners were higher among younger participants of the trials and among the Latino participants when compared to White participants--indicating a higher need of PrEP for HIV prevention among these groups. 5 Minority stress (social stress faced by sexual minority populations due to their stigmatized social status relative to heterosexual populations) 6 may lead to decreased self-care, lower access to safe sex resources, and create sexual health disparities. ...
Young men of color who have sex with men are vulnerable to HIV and experience poor PrEP uptake and retention. We conducted a secondary data analysis and calculated adjusted Prevalence Odds Ratios (aPORs) for PrEP retention along with 95% CIs at 90, 180, and 360 days at an organization running safety net clinics in Texas for gay and bisexual men. We found statistically significant association with age, race, in-clinic versus telehealth appointments, and having healthcare insurance. White clients had an aPOR of 1.29 [1.00, 1.67] as compared to Black clients at 90 days. Age group of 18–24 had a lower aPOR than all other age groups except 55 or older at all three time periods. Clients who met providers in person had an aPOR of 2.6 [2.14, 3.19] at 90, 2.6 [2.2, 3.30] at 180 days and 2.84 [2.27, 3.54] at 360 days. Our findings highlight the need for population-specific targeted interventions.
... Although BSMM and BTW do not engage in greater levels of sexual risk behaviors than SMM of other races/ethnicities [5][6][7][8], they may be more likely to be exposed to STI/ HIV than their non-Black counterparts, due to the increased prevalence of STI/HIV among their sexual partners, as well as the increased likelihood of undiagnosed and/or untreated STI/HIV within their sexual networks [9]. ...
Incarceration among Black sexual minority men and Black transgender women (BSMM/BTW) is disproportionately high in the United States. Limited research has documented the disruptive effect of incarceration on sexual networks and sexual partnership exchange among BSMM/BTW. We estimate the influence of incarceration on selling sex and mediating pathways among 1169 BSMM/BTW enrolled in the HIV Prevention Trials Network (HPTN) 061 cohort to assess this relationship. Mediators investigated were social support, violence, illicit drug use, and distress due to experienced racism and homophobia. During the 6 months following baseline, 14% of the cohort was incarcerated, including 24% of BTW. After adjustment, recent incarceration was associated with 1.57 (95% CI 1.02, 2.42) times the risk of subsequently selling sex. The hypothesized mediators together explained 25% of the relationship, with an indirect effect risk ratio of 1.09 (95% CI 0.97, 1.24). Our results document an association and call for more research investigating mechanisms.
... Nevertheless, MSM still comprise the largest group living with HIV in the US, accounting for 75% of all new infections annually [3][4][5]. Stark racial disparities in new HIV infections exist among MSM, especially among Black MSM [4][5][6][7][8]. Black MSM account for one out of every four new HIV diagnoses [9]. ...
We evaluated whether different types of substance use predicted HIV seroconversion among a cohort of 449 Black men who have sex with men (MSM) and transgender women (TGW). A community-based sample was recruited in Atlanta, GA between December 2012 and November 2014. Participants completed a survey and were tested for STIs (Chlamydia and gonorrhoeae using urine samples and rectal swabs) at baseline. HIV testing was conducted at 12-months post enrollment. Multivariable binary logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for associations between substance use and HIV seroconversion. By 12-month follow-up, 5.3% (n = 24) of participants seroconverted. In multivariable analyses, daily marijuana use was positively associated with HIV seroconversion (aOR 3.07, 95% CI 1.11–8.48, P = 0.030). HIV incidence was high and daily marijuana use was associated with a more than threefold increased odds of HIV seroconversion among a community-based cohort of Black MSM and TGW.
... Gay, bisexual and other cisgender men who have sex with men (MSM) comprise the largest group living with HIV in the United States (US), accounting for 75% of all new infections annually [1][2][3]. Stark racial disparities in HIV prevalence and new infections exist among MSM, especially among Black MSM [2][3][4][5][6]. Nationally and in New York City (NYC), nearly one in three MSM living with HIV are Black [7,8]. ...
The Information-Motivation-Behavioral Skills (IMB) Model has been used to understand adherence to medications and intentions to uptake pre-exposure prophylaxis (PrEP) to prevent HIV infection. In the current study, the IMB Model was used to understand factors that predict adherence to PrEP among a community-based cohort of 204 Black men who have sex with men (MSM) and transgender women (TGW) using structural equation modeling. PrEP motivation was directly associated with PrEP behavioral skills (β = 0.320, p = 0.009), and PrEP behavioral skills were directly associated with PrEP adherence (β = 0.416, p = 0.001). PrEP knowledge and PrEP motivation were not associated with PrEP adherence, directly or indirectly. The analysis identified intervenable factors that predicted PrEP adherence. Screening for motivation and behavioral skills could be used to identify where additional support to improve PrEP adherence is needed, or whether to offer alternative PrEP modalities or delivery strategies.
... Assessing reproductive intentions among gay and bisexual men may be particularly important in black and Latinx communities because socio-cultural norms promoting masculinity and anti-homosexual expectations may preclude gay and bisexual men from communicating openly about HIV and condom use or disclosing their sexuality. [29][30][31][32][33] However, we note the prevalence estimate for other/non-Hispanic men was less precise as indicated by the wider confidence interval. Furthermore, there does not appear to be a difference in reproductive intentions between Hispanic and white/non-Hispanic gay and bisexual men. ...
Introduction
We assessed reproductive intentions and associated characteristics among men enrolled in the Sustainable Health Center Implementation pre-exposure prophylaxis (PrEP) Pilot (SHIPP) Study.
Methods
We analyzed baseline data from 1275 men who self-identified as gay or bisexual and participated in the SHIPP study. SHIPP was a cohort study of PrEP implementation in five community health centers in Chicago, Jackson, Philadelphia, and Washington, D.C. conducted from 2014 to 2016. Participants completed audio computer-assisted self-interviews querying intentions to have a child in the future. We estimated the association between participants’ reproductive intentions and their characteristics using Poisson regression models.
Results
Approximately 47% of participants indicated their intentions to have a child. Black/non-Hispanic (aPR = 1.40; 95% CI: 1.10–1.78) and other/non-Hispanic participants (aPR = 1.40; 95% CI: 1.01–1.93) were more likely to report intentions to have a child than white/non-Hispanic participants. Participants were less likely to report intentions to have children as age increased (18–29 years, reference group; 30–39 years, aPR = 0.80, 95% CI: 0.64–0.99; 40–49 years, aPR = 0.49, 95% CI: 0.33–0.72; 50+ years, aPR = 0.07, 95% CI: 0.02–0.21).
Conclusions
Clinicians offering PrEP to black and other/non-Hispanic gay and bisexual men should assess their reproductive intentions as family-planning counseling may be an opportunity to introduce PrEP to HIV-negative gay and bisexual men.
... Additionally, for reasons that are not known, African American and Hispanic Perceived Stress and Molecular-BV in the NIH LSVF 2375 women have a higher prevalence of BV compared with White women (20,23), corresponding with marked racial disparities in the prevalence of STIs in population-based US studies (24)(25)(26)(27). Individual risk factors, including sexual behaviors, do not fully explain these health disparities (28)(29)(30)(31)(32)(33)(34). ...
Vaginal microbiota provide the first line of defense against urogenital infections primarily through protective actions of Lactobacillus spp. Perceived stress increases susceptibility to infection through several mechanisms, including suppression of immune function. We investigated if stress was associated with deleterious changes to vaginal bacterial composition in a subsample of 572 women in the Longitudinal Study of Vaginal Flora, sampled from 1999 through 2002. Using Cox proportional-hazard models, both unadjusted and adjusted for sociodemographics and sexual behaviors, participants who exhibited a 5 unit-increase in Cohen’s perceived stress scale had greater risk (aHR=1.40, 95% CI 1.13-1.74) of developing molecular bacterial vaginosis (BV), a state with low Lactobacillus abundance and diverse anaerobic bacteria. A 5-unit stress increase was also associated with greater risks for transitioning from the L. iners-dominated community state type (26% higher) to molecular-BV (aHR=1.26, 95% CI 1.01-1.56) or maintaining molecular-BV from baseline (aHR=1.23, 95% CI 1.01-1.47). Inversely, women with baseline molecular-BV reporting a 5-unit stress increase were less likely to transition to microbiota dominated by L. crispatus, L. gasseri, or L. jensenii (aHR=0.81, 95% CI 0.68-0.99). These findings suggest psychosocial stress is associated with vaginal microbiota composition, inviting a more mechanistic exploration of the relationship between psychosocial stress and molecular-BV.
... Latino sexual minority men face a disproportionate risk for HIV relative to their White counterparts Crepaz et al. 2019;Harawa et al. 2004). Despite the implementation of behavioural and psychosocial interventions to promote condom use and HIV testing among this population (Rhodes et al. 2015;, the number of new HIV diagnoses between 2012 and 2016 has increased by 12% among Hispanic/ Latino gay and bisexual men, while decreasing by 14% among their White counterparts (Centers for Disease Control and Prevention 2019). ...
In a body of research typically focused on risk reduction and disease prevention, other factors motivating the sexual behaviours of Latino sexual minority men, such as resource-based power and sexual pleasure, are less well understood. To this end, Latino immigrant sexual minority men living in New York City were surveyed about their sexual behaviours, perceived power differentials, and pleasure from insertive and receptive anal intercourse. Power and pleasure were examined as associations with behavioural profiles identified through latent class analysis, adjusting for age and partner type. Four latent classes of Latino sexual minority men were identified based on behaviours reported during the most recent sexual event: behaviourally insertive (14.2%), behaviourally versatile (25.9%), behaviourally receptive (29.2%), and limited penetrative behaviour (30.7%). Participants who derived pleasure from insertive and receptive anal intercourse had higher odds of belonging in the behaviourally insertive and behaviourally receptive class, respectively. Perceptions of resource-based power were not associated with class membership. Findings highlight the importance of sexual pleasure as a driver of sexual behaviour, irrespective of power dynamics. Sexual health curricula and interventions for sexual minority men should consider sexual pleasure and sex-affirmative frameworks when providing sexuality education and promoting sexual wellbeing.
... The higher per-capita contribution of younger MSM may be explained by the fact that they report more partners than older MSM. We found that black MSM were particularly vulnerable to HIV, with higher incidence and greater total numbers of HIV infections acquired and contributed, mainly due to their larger population size and higher HIV prevalence, but also their lower ART coverage, and greater annual number of new sexual partners (reported in 2008-2014 Baltimore NHBS data, contrasting with other US studies finding fewer sexual partners reported by black vs white MSM 15,[39][40][41]. ...
Introduction:
Men who have sex with men (MSM) in the United States (US) are disproportionately affected by HIV. We estimated the impact of past interventions and contribution of different population groups to incident MSM HIV infections.
Setting:
Baltimore, US METHODS:: We used a deterministic model, parameterised and calibrated to demographic and epidemic Baltimore MSM data, to estimate the fraction of HIV infections among MSM averted by condoms and antiretroviral therapy (ART) over 1984-2017 and the fraction of infections acquired and transmission contributed by MSM from different demographic groups and disease and care continuum stages over 10-year periods from 1988 to 2017, using population attributable fractions (PAFs).
Results:
Condom use and ART averted 19% (95% uncertainty interval: 14-25%) and 23% (15-31%) of HIV infections that would have occurred since 1984 and 1996, respectively. Over 2008-2017, 46% (41-52%) of incident infections were acquired by, and 35% (27-49%) of transmissions contributed by MSM aged 18-24 years old (who constitute 27% of all MSM, 19% of HIV+ MSM). MSM with undiagnosed HIV infection, those with diagnosed infection but not in care, and those on ART contributed to 41% (31-54%), 46% (25-56%), and 14% (7-28%) of transmissions, respectively.
Conclusion:
Condoms and ART have modestly impacted the HIV epidemic among Baltimore MSM to date. Interventions reaching MSM with diagnosed infection who are not in care should be implemented since the largest percentage of HIV transmissions among Baltimore MSM are attributed to this group.
... Among HIV-positive YTW, 23% were involved in sex work, compared with 6% who were not [9]. In a large study of YMSM of color (n=3316; median age 19 years), roughly 12% reported engaging in sex work at some point in the past 6 months [37]. Given the illegal nature of this work, migration to these nontraditional economies places black and Latinx YMSM, YTW, and GNC youth at risk for further marginalization and economic instability, should they be arrested. ...
Background:
HIV continues to have a disparate impact on young cisgender men who have sex with men (YMSM), young trans women (YTW), and gender-nonconforming (GNC) youth who are assigned male at birth. Outcomes are generally worse among youth of color. Experiences of discrimination and marginalization often limit educational attainment and may even more directly limit access to gainful employment. Though seemingly distal, these experiences influence young people's proximity to HIV risk by limiting their access to health care and potentially moving them toward sex work as a means of income as well as increased substance use. Work2Prevent (W2P) aims to achieve economic stability through employment as a structural-level intervention for preventing adolescent and young adult HIV infection. The study will pilot-test an effective, theoretically driven employment program (increased individual income and independence [iFOUR]), for HIV-positive adults, and adapt it to the needs of black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years who are vulnerable to HIV exposure.
Objective:
This paper aimed to describe the protocol for the exploratory phase of W2P. The purpose of this phase was to determine the essential components needed for a structural-level employment intervention aimed at increasing job-seeking self-efficacy and career readiness among black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years.
Methods:
The exploratory phase of the W2P study consisted of in-depth interviews and focus groups with members of the target community as well as brief interviews with lesbian, gay, bisexual, transgender, and queer (LGBTQ)-inclusive employers. The study team will conduct in-depth interviews with up to 12 YMSM and 12 YTW and GNC youth, up to 10 focus groups with a maximum of 40 YMSM and 40 YTW and GNC youth, and up to 40 brief interviews with LGBTQ-inclusive employers. Participants will be recruited through a community-based recruiter, passive recruitment in community spaces and on social media, and active recruitment by research staff in community spaces serving LGBTQ youth.
Results:
In-depth interviews were conducted with 21 participants, and 7 focus groups were conducted with 46 participants in total. In addition, 19 brief interviews with LGBTQ-inclusive employers were conducted. The analysis of the data is underway.
Conclusions:
Preliminary findings from the formative phase of the study will be used to inform the tailoring and refinement of the iFOUR adult-based intervention into the youth-focused W2P intervention curriculum. Perspectives from YMSM, YTW, GNC youth, and LGBTQ-inclusive employers offer a multidimensional view of the barriers and facilitators to adolescent and young adult LGBTQ employment. This information is critical to the development of a culturally appropriate and relevant youth-focused intervention.
Trial registration:
ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310.
International registered report identifier (irrid):
DERR1-10.2196/16384.
... Among HIV-positive YTW of color living in Washington, DC, 23% were involved in sex work-underscoring the link between adolescent and young adult sex work and HIV exposure [27]. In a large US study of YMSM (N=3316, median age 19 years), roughly 12% reported engaging in sex work in the past 6 months [28]. Sex work and HIV risk are further complicated by drug and alcohol abuse [16]. ...
Background:
Young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth of color face substantial economic and health disparities. In particular, HIV risk and infection among these groups remains a significant public health issue. In 2017, 17% of all new HIV diagnoses were attributed to male-to-male sexual contact among adolescents and young adults aged 13 to 24 years. However, such disparities cannot be attributed to individual-level factors alone but rather are situated within larger social and structural contexts that marginalize and predispose YMSM, YTW, and GNC youth of color to increased HIV exposure. Addressing social and structural risk factors requires intervention on distal drivers of HIV risk, including employment and economic stability. The Work2Prevent (W2P) study aims to target economic stability through job readiness and employment as a structural-level intervention for preventing adolescent and young adult HIV among black and Latinx YMSM, YTW, and GNC youth. This study seeks to assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce sexual risk behaviors.
Objective:
The goal of the research is to pilot-test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color. This intervention was adapted from Increased Individual Income and Independence, an existing evidence-based employment program for HIV-positive adults during phase 1 of the W2P study.
Methods:
The employment intervention will be pilot-tested among vulnerable YMSM, YTW, and GNC youth of color in a single-arm pre-post trial to assess feasibility, acceptability, and preliminary estimates of efficacy.
Results:
Research activities began in March 2018 and were completed in November 2019. Overall, 5 participants were enrolled in the pretest and 51 participants were enrolled in the pilot.
Conclusions:
Interventions that address the social and structural drivers of HIV exposure and infection are sorely needed in order to successfully bend the curve in the adolescent and young adult HIV epidemic. Employment as prevention has the potential to be a scalable intervention that can be deployed among this group.
Trial registration:
ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310.
International registered report identifier (irrid):
DERR1-10.2196/16401.
... Notably, existing research on the non-biomedical benefits of PrEP has largely been with samples of primarily White MSM and may not accurately reflect the experiences of young Black MSM, for whom the benefits of PrEP may differ. For example, although Black MSM engage in condomless anal sex less frequently than their white counterparts [11,12], they remain disproportionately affected by HIV and syphilis [13]. Such disparities highlight the importance of continuing to examine condom use behaviors and preferences among Black MSM. ...
Pre-exposure prophylaxis (PrEP) is effective at reducing new HIV infections among adherent users. However, there are potential benefits of PrEP beyond HIV prevention that remain understudied, particularly among young Black gay, bisexual, and other men who have sex with men (MSM). In 2018, we conducted six focus groups (n = 36) in four midwestern cities: Milwaukee, WI; Minneapolis, MN; Detroit, MI; and Kansas City, MO with current and former PrEP users who identified as Black MSM. The focus groups covered medical care and provider experiences, patterns of PrEP use and adherence, relationships while on PrEP, and PrEP stigma. Results revealed four unanticipated benefits of PrEP for young Black MSM: (1) improved engagement in medical care, (2) reduced sexual and HIV anxiety, (3) increased sexual comfort and freedom, and (4) positive sexual relationships with people living with HIV. Findings from this study fill a gap in our understanding of the potential benefits of PrEP beyond HIV prevention. Public health campaigns and messaging around PrEP should incorporate such benefits to reach young Black MSM who may be motivated by benefits beyond HIV prevention.
... Differences in social or sexual networks can place certain groups at greater risk of HIV (Berry, Raymond, & McFarland, 2007). Indeed previous research has shown among black MSM in the United States, higher HIV prevalence despite lower risk behaviour (Berry et al., 2007;Harawa et al., 2004). Risk clustering can be utilized to reduce health disparities, for instance employing social networks to increase testing uptake among MSM-NW, so-called social network testing (SNT). ...
Improving testing uptake among men who have sex with men with a non-western migration background (MSM-NW) is a public health priority, as people who are unaware of their HIV infection are at higher risk of transmitting HIV and are unable to benefit from HIV treatment. Formative semi-structured interviews with 13 MSM-NW assessed key factors for the successful implementation of social network testing with HIV self-tests (SNT-HIVST). Interviews were thematically analysed. Participants mentioned that SNT-HIVST might overcome barriers to regular HIV testing including; being seen while testing, disclosure of sexual identity, and stigma related to HIV and sexual practices. Trust between the HIVST distributer and receiver was important. Finally, SNT-HIVST requires tailored peer support to address practical, informational, and emotional needs. MSM-NW distributing HIVST can have an important role in reducing health disparities in testing uptake among MSM-NW. Provided sufficient trust among MSM-NW; key factors found for successful implementation were education through an e-tool, and establishing quality support by a peer-coordinator for unanticipated questions. In conclusion, HIVST distribution has the potential to reduce health disparities in testing uptake, in particular, if adjusted to MSM-NWs individual preferences and the needs and preferences of the person they are inviting to test.
... One such factor is age. One study reported that older age was associated with less UAS (Ramirez-Valles, Garcia, Campbell, Diaz, & Heckathorn, 2008), while another study reported that younger age was associated with UAS (Harawa, Greenland, Bingham, & Johnson, 2004). A qualitative study of 27 Hispanic MSM reported that issues such as worthlessness, internalized blame, and homophobia resulted in unsafe sexual behaviors such as UAS. ...
Introduction
HIV infection continues to be a serious health concern globally. Of the 1.2 million people with HIV infection in the United States, men who have sex with men (MSM) account for 57% of cases. Hispanic/Latino individuals accounted for 24% of new HIV diagnoses, with male-to-male sexual contact responsible for the majority of cases. A factor in HIV prevention is the sexual decision-making process. The purpose of this study was to describe the process by which sexual decision making occurs among Hispanic MSM.
Method
Utilizing a grounded theory approach, 19 in-depth, semistructured interviews were conducted from participants ages 25 to 65 years living in South Florida. After consent, participants completed an in-depth interview. Interviews were audio-recorded and transcribed verbatim. Data were analyzed to identify categories and subcategories.
Findings
A theory grounded in the data called Contemplating Co-Occurring Cultures (Hispanic, gay, and health cultures) emerged that described the central phenomenon. These co-occurring cultures were the foundation of sexual decision making among participants.
Conclusion
Clinicians providing care to this population should be aware of the complexity of the sexual decision-making process. Awareness of these factors may provide the opportunity for HIV risk reduction strategies developed specifically for Hispanic MSM.
... Latinos were twice as likely and Blacks were four times as likely to be infected with HIV than were Whites. 37,38 Alarm that these groups were not getting the message sparked new, vigorous responses to HIV. Created by the grassroots Stop AIDS Project (SAP), "HIV is no picnic" exposed fi ssures among activists worried about a resurgence of AIDS within a gay community grown weary of safer sex messages. ...
Fear is now commonly used in public health campaigns, yet for years ethical and efficacy-centered concerns provided a challenge to using fear in such efforts. From the 1950s through the 1970s, the field of public health believed that using fear to influence individual behavior would virtually always backfire. Yet faced with the limited effectiveness of informational approaches to cessation, antitobacco campaigns featured fear in the 1960s. These provoked little protest outside the tobacco industry. At the outset of the AIDS epidemic, fear was also employed. However, activists denounced these messages as stigmatizing, halting use of fear for HIV/AIDS until the 21st century. Opposition began to fracture with growing concerns about complacency and the risks of HIV transmission, particularly among gay men. With AIDS, fear overcame opposition only when it was framed as fair warning with the potential to correct misperceptions. © 2018 American Public Health Association Inc. All rights reserved.
... Based on the current HIV incidence rate in the US, about 1 in 2 black men who have sex with men (BMSM) will be diagnosed with HIV during their lifetime [1]. Studies show significant racial disparities in HIV, and BMSM have up to 4 times the risk of infection compared to white men who have sex with men (MSM) [2][3][4]. A growing body of literature has tried to explain the elevated rates of HIV among BMSM [5][6][7], but found prevalence of sexual risk behaviors using person-level measures (e.g., frequencies of a given behavior in a defined recall period) among BMSM is actually comparable to or lower than white MSM [5][6][7][8][9]. ...
Despite the high HIV incidence and prevalence among black men who have sex with men (BMSM), little research has examined partner characteristics, partner seeking venue, sexual position, substance use, and sexual risk behavior at the sex event-level among BMSM. Using the baseline data from a multi-site study of 807 BMSM stratified by their HIV status, the goal of this study was to conduct a detailed event-level analysis of 1577 male anal sex events to assess the factors associated with condomless anal intercourse (CLAI) with a HIV-discordant or HIV status-unknown partner. We found CLAI with an HIV-discordant or unknown HIV status partner among HIV-negative BMSM was negatively associated with having sex with a main partner, and was positively associated with taking both receptive and insertive sexual positions during sex. As compared to a sex partner met at bar, night club or dance club, HIV-positive BMSM were less likely to engage in CLAI with HIV-discordant and unknown HIV status partner met at party or friend’s house or at community organizations. HIV-positive BMSM had lower odds of engaging in CLAI with HIV-discordant and unknown HIV status partner if they had insertive sexual position or both receptive and insertive sexual positions. These results underscore the importance of delineating unique sex event-level factors associated with sexual risk behavior depending on individuals’ HIV status. Our findings suggest event-level partner characteristics, sexual position, and partner seeking venues may contribute to disparities in HIV incidence.
... Infection with HSV-2, which we used as an operational definition of high sexual risk, is twice as prevalent among African Americans as among Whites in the general US population. 26 Racial/ethnic disparities exist for many sexually transmitted infections in the United States, 27 including HIV among MSM and among "high risk heterosexuals," 28,29 and we suspect that the social network and social structural factors, including HSV-2 infection, 26 generating these disparities are operating among PWID as well as persons who do not inject drugs. Indeed, that risk network and social structural factors operating in conjunction with sexual risk lead to persistence of racial/ethnic disparities among PWID in New York City may be both the most comprehensive and parsimonious explanation for our results. ...
Objectives:
To examine whether racial/ethnic disparities persist at the "end of the HIV epidemic" (prevalence of untreated HIV infection < 5%; HIV incidence < 0.5 per 100 person-years) among persons who inject drugs (PWID) in New York City.
Methods:
We recruited 2404 PWID entering New York City substance use treatment in 2001 to 2005 and 2011 to 2015. We conducted a structured interview, and testing for HIV and herpes simplex virus 2 (HSV-2; a biomarker for high sexual risk). We estimated incidence by using newly diagnosed cases of HIV. Disparity analyses compared HIV, untreated HIV, HIV-HSV-2 coinfection, HIV monoinfection, and estimated HIV incidence among Whites, African Americans, and Latinos.
Results:
By 2011 to 2015, Whites, African Americans, and Latino/as met both criteria of our operational "end-of-the-epidemic" definition. All comparisons that included HIV-HSV-2-coinfected persons had statistically significant higher rates of HIV among racial/ethnic minorities. No comparisons limited to HIV monoinfected persons were significant.
Conclusions:
"End-of-the-epidemic" criteria were met among White, African American, and Latino/a PWID in New York City, but elimination of disparities may require a greater focus on PWID with high sexual risk. (Am J Public Health. Published online ahead of print May 18, 2017: e1-e7. doi:10.2105/AJPH.2017.303787).
... HIV-positive diagnoses increased by 87% for Black YGBMSM between 2005 and 2014, and recent projections declare that nearly 50% of all Black GBMSM and 25% of all Latino GBMSM will receive a positive diagnosis for HIV during their lifetime (CDC, 2016a, b). Black and Latino gay and bisexual men as a whole continue to experience disparate rates of HIV incidence and prevalence when compared to YGBMSM in other demographic categories (CDC, 2013(CDC, , 2015Hall et al., 2007;Harawa, Greenland, Bingham, Johnson, & Cochran, 2004), making these populations a priority for continued public health research and intervention. ...
Young gay/bisexual and other men who have sex with men (YGBMSM; ages 18–24) are experiencing an increase in HIV infection rates, particularly if they are Black or Latino. Psychosocial functioning is consistently implicated in HIV risk behaviors; however, less is known about the role of these factors in YGBMSM’s decision-making process to use condoms (i.e., decisional balance to use condoms; DBC). We examined whether YGBMSM’s psychological functioning was associated differentially with their DBC across racial/ethnic groups. Using data from a cross-sectional web-survey of single YGBMSM (N = 1380; 9.9% Black; 18.6% Latino; 71.5% White), we performed racial/ethnic-specific multivariable regression models to explore the association between DBC and psychological factors (e.g., depression, anxiety), demographics (e.g., age, education, HIV status, prior STI diagnosis), and perceived difficulty implementing safer sex strategies. Black YGBMSM reported lower DBC if they reported higher depression symptoms (β = −.31, p < .05), were HIV-negative (β = −.20, p < .05), and had greater difficulty implementing safer sex strategies (β = −.32, p < .001). Latino participants reported greater DBC to use condoms if they reported greater anxiety symptoms (β = .21, p < .05). White participants reported greater DBC if they were younger (β = −.09, p < .01), did not report a prior STI (β = .10, p < .001), and had fewer difficulties implementing safer sex strategies (β = −.27, p < .001); DBC had no association to psychological well-being among White participants. Psychological factors may be differentially associated with DBC across racial/ethnic group categories. Health promotion initiatives targeting condom use may benefit from culturally tailored interventions that address psychosocial functioning and its role in YGBMSM’s condom use decision-making.
... While African Americans are estimated to account for almost half (44%) of persons living with HIV in the US as well as of newly diagnosed cases of HIV, African American youth aged 13 to 24 represents 34% of these newly diagnosed cases, about 7000 new HIV infections added to persons living with HIV each year [3]. Young African American men who have sex with men (MSM) are at the highest risk (as much as 11 times more than young white males) and African American women are more vulnerable compared to women of any other race in that age group (as much as 20 times more than young white females) [4][5][6]. The high prevalence of HIV in the African American community alone increases the risk of contracting HIV, as African American youth are more likely to engage in sexual relations with other African Americans, sometimes without protection [7][8][9]. ...
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) disproportionately burdens African American youth and young adults. In studies conducted in Historically Black Colleges and Universities (HBCU) settings, African American youth generally perceive themselves as having a low risk of contracting HIV and sexually transmitted diseases (STDs) despite having higher rates of unprotected sexual encounters, multiple sex partners, and particularly low rates of HIV testing and awareness of HIV status. These findings position HBCUs in a pivotal role for theory-based research and practice to modify behaviors in order to decrease HIV acquisition risk. Get Students Mobilized and Retooled to Transform (SMART) is an interventional research project in an urban HBCU in a northeastern metropolitan area in the US. The project is designed to assess and then address irresponsible behavior among students on college campuses that leads to illicit drug use, excessive alcohol consumption and underage drinking, and risky sexual behaviors that increase the likelihood of acquiring HIV and STDs. As gender plays a critical role in interventions, this article explores gender similarities and differences to inform the planning and implementation of Get SMART and any subsequent projects that address substance and alcohol use and HIV in an HBCU setting. Survey research was conducted to find similar and different factors that may be valuable in implementing and tailoring evidence-based interventions in a predominantly African American campus setting. Survey results revealed that more young adult women consume alcohol and use marijuana than young adult men. Young adult men were also more likely to be tested for HIV when compared to young adult women.
... Data were collected between 2012 and 2014 as a part of participants' baseline assessments for ''Connections Creating Change'' (C3), a randomized HIV prevention social network intervention trial for Black MSM. The study recruited social networks of African American MSM in Milwaukee, WI, Cleveland, OH, and Miami, FL, all cities in which HIV incidence is disproportionately high among racial minority MSM [47][48][49]. ...
This study examined social and health-related correlates of AIDS conspiracy theories among 464 African American men who have sex with men (MSM). Exploratory factor analysis revealed two subscales within the AIDS conspiracy beliefs scale: medical mistrust and AIDS genocidal beliefs. Multiple regression analyses revealed medical mistrust and AIDS genocidal beliefs were both associated negative condom use attitudes and higher levels of internalized homonegativity. Medical mistrust was also associated with lower knowledge of HIV risk reduction strategies. Finally, we conducted bivariate regressions to examine the subsample of participants who reported being HIV-positive and currently taking HIV antiretroviral therapy (ART) to test associations between sexual behavior and HIV treatment and AIDS conspiracy theories. Among this subsample, medical mistrust was associated with having a detectable viral load and not disclosing HIV-status to all partners in the previous 3 months. Collectively, these findings have implications for HIV prevention and treatment for African American MSM.
... [17][18][19][20] Related to HIV infection, several studies have identified poorer health outcomes among individuals with HIV with adverse neighborhood living conditions. 17,21,22 More detailed analyses to evaluate how neighborhood characteristics and social support are related as well as their associations with HIV management are currently lacking. Specifically, the relationships between social support and neighborhood perceptions through measures of perceived neighborhood disorder, collective efficacy, and perceived fear may provide a better understanding of potential interventions to enhance engagement in HIV care. ...
Social support has been noted to improve health outcomes for individuals with HIV. Understanding how neighborhoods contribute to feelings of social support is beneficial to create environments where populations with HIV can be supported. This study assessed the relationship between neighborhood perceptions and social support with HIV management. A total of 201 individuals were recruited; individuals with HIV, 18 years or older, who were eligible to participate in the 2-hour interview. Psychiatric diagnostic interviews were conducted alongside assessments of social support and neighborhood perceptions; biomedical markers were abstracted from medical records. Correlations and linear regression analyses were performed to assess relationships between social support and neighborhood perceptions with HIV management biomarkers. The majority of the sample was male (68.8%) and African American (72.3%), with a mean age of 43.1 years. Overall, 78% were receiving combination antiretroviral therapy (cART) prescriptions, with 69% being virally suppressed. Fear of neighborhood activities was independently associated with receiving current cART. Reports of social support and neighborhood perceptions were highly correlated. Findings suggest that supportive home environments likely would improve perceptions of social support.
... Another small body of research has focused upon people who inject drugs and the MSM within those samples (Campbell et al., 2013;Knowlton et al., 2001). When research has focused on BMSM, the emphasis has been on examining lifetime risk of cocaine and heroin use, substances most commonly used by older BMSM (Harawa et al., 2004;Millett et al., 2007;Valleroy, 2000) with limited attention to marijuana which is very commonly used by YBMSM. ...
Background:
Young Black men who have sex with men (YBMSM) are at highest risk for HIV seroconversion in the United States. Successful movement through the HIV care continuum is an important intervention for limiting onwards HIV transmission.
Objective:
Little data exists on how substances most commonly used by YBMSM, such as marijuana, are related to the HIV continuum, which represents the primary aim of this study.
Methods:
A cohort of YBMSM (n = 618) was generated through respondent-driven sampling. Frequency of marijuana use and marijuana use as a sex-drug were assessed across the HIV care continuum using weighted logistic regression models.
Results:
Study participants reported more intermittent marijuana use (n = 254, 56.2%) compared to heavy use (n = 198, 43.8%). Our sample contained 212 (34.3%) HIV seropositive participants of which 52 (24.5%) were unaware of their HIV positive status. Study participants who were heavy marijuana users were more likely to be unaware of their HIV seropositive status (AOR: 4.18; 95% CI 1.26, 13.89). All other stages in the care continuum demonstrated no significant differences between those who use marijuana intermittently or heavily or as a sex-drug and nonusers.
Conclusions:
YBMSM who used marijuana heavily were more likely to be HIV-positive unaware than those who never used marijuana. Findings were inconclusive regarding the relationships between marijuana use and other HIV care continuum metrics. However, knowledge of ones' HIV status is a critical requirement for engaging in care and may have implications for onwards HIV transmission.
... Reports also suggest that Latino and non-Latino SMYoC have riskier attitudes about sex and engage in risky sexual behaviors (e.g., unprotected sexual behavior, multiple partners) at higher levels compared to White, non-Latino gay and bisexual youth ( Marsiglia, Nieri, Valdez, Gurrola, & Marrs, 2009;Ryan, Huebner, Diaz, & Sanchez, 2009). It is important to note, however, that other reports found no differences in sexual risk behavior by racial-ethnic group ( Hipwell et al., 2013;Rosario, Schrimshaw, & Hunter, 2004;Solorio, Swendeman, & Rotheram-Borus, 2003) or found riskier sexual behaviors among White youth compared to young MSM of color ( Harawa et al., 2004;Torres et al., 2013). Further, SMYoC shared that they experienced racial-ethnic discrimination or stereotypes in their sexual encounters (e.g., partner's expectations of certain sexual behaviors because of their background; partner's preferences for a particular background), but these experiences were not associated with more risky behavior ( Hidalgo et al., 2013). ...
This study analyzed the content of 125 unique reports published since 1990 that have examined the health and well-being—as well as the interpersonal and contextual experiences—of sexual minority youth of color (SMYoC). One-half of reports sampled only young men, 73% were non-comparative samples of sexual minority youth, and 68% of samples included multiple racial-ethnic groups (i.e., 32% of samples were mono-ethnic/racial). Most reports focused on health-related outcomes (i.e., sexual and mental health, substance use), while substantially fewer attended to normative developmental processes (i.e., identity development) or contextual and interpersonal relationships (i.e., family, school, community, or violence). Few reports intentionally examined how intersecting oppressions and privileges related to sexual orientation and race-ethnicity contributed to outcomes of interest. Findings suggest that research with SMYoC has been framed by a lingering deficit perspective, rather than emphasizing normative developmental processes or cultural strengths. The findings highlight areas for future research focused on minority stress, coping, and resilience of SMYoC.
Prior research suggests that stigma plays a role in racial/ethnic health disparities. However, there is limited understanding about the mechanisms by which stigma contributes to HIV-related disparities in risk, incidence and screening, treatment, and survival and what can be done to reduce the impact of stigma on these disparities. We introduce the Stigma and HIV Disparities Model to describe how societal stigma related to race and ethnicity is associated with racial/ethnic HIV disparities via its manifestations at the structural level (e.g., residential segregation) as well as the individual level among perceivers (e.g., discrimination) and targets (e.g., internalized stigma). We then review evidence of these associations. Because racial/ethnic minorities at risk of and living with HIV often possess multiple stigmas (e.g., HIV-positive, substance use), we adopt an intersectionality framework and conceptualize interdependence among co-occurring stigmas. We further propose a resilience agenda and suggest that intervening on modifiable strength-based moderators of the association between societal stigma and disparities can reduce disparities. Strengthening economic and community empowerment and trust at the structural level, creating common ingroup identities and promoting contact with people living with HIV among perceivers at the individual level, and enhancing social support and adaptive coping among targets at the individual level can improve resilience to societal stigma and ultimately reduce racial/ethnic HIV disparities.
Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1—stigma-focused vs. health information evaluation–focused counseling, main effect 2—offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.
HIV stigma negatively affects the social experiences of people living with HIV (PLWH) and remains a challenge to HIV prevention, treatment, and care. Research has overwhelmingly focused on individual cognitive measures of HIV stigma (e.g., internalized, anticipated, and experienced). However, little research explores the interactions and societal structures through which HIV stigma is produced. Data from qualitative interviews with 30 black gay and bisexual men living with HIV in the U.S. Deep South revealed an interconnected and interdependent set of processes that produce and reproduce HIV stigma. These included social interactions (silence, euphemism, and gossip), witnessed acts of marginalization, word-of-mouth transmission of HIV misinformation, and laws and policies carried out within the education and criminal justice systems. Efforts to reduce stigma that focus on individual beliefs and attitudes are critical to improving the well-being of PLWH. However, reducing HIV stigma requires intervening on the social interactions and structures through which HIV stigma is produced and reproduced.
Background:
The association between drug use and condomless anal sex (CAS) is well documented among sexual minority men (SMM). Less is known about whether this association generalizes to marijuana and across relationship status and sexual agreements groups (single, partnered monogamous, partnered open -outside partners permitted, and partnered monogamish -outside partners permitted when main partners are together).
Methods:
A nationwide sample of SMM (N = 65,707) were recruited through a geosocial networking app between November 2017 and November 2019. Participants reported on drug use and instances of CAS with casual partners in the previous 30 days.
Results:
Both marijuana and club drug use were associated with the occurrence of CAS with casual partners among single men. Only club drug use was associated with CAS frequency in this group. The association between marijuana and the occurrence of CAS did not differ significantly among monogamous men, while the associations between club drug use and the occurrence as well as frequency of CAS were significantly weaker. Meanwhile, the associations between club drug use and the occurrence as well as frequency of CAS did not differ significantly between single and non-monogamous (open and monogamish) subgroups; however, the association between marijuana and the occurrence of CAS was significantly weaker.
Conclusions:
Findings largely replicated the robust association between club drug use and CAS with casual partners. They support the assertion that marijuana use predicts sexual risk for some SMM subgroups. Finally, they illustrate the potential for relationship status - and sexual agreements - to contextualize associations between drug use and CAS.
Purpose
The challenges of producing adequate estimates of HIV prevalence among men who have sex with men (MSM) are well known. No one, to our knowledge, has published annual estimates of HIV prevalence among MSM over an extended period and across a wide range of geographic areas.
Methods
This article applies multilevel modeling to data integrated from numerous sources to estimate and validate trajectories of HIV prevalence among MSM from 1992 to 2013 for 86 of the largest metropolitan statistical areas in the United States.
Results
Our estimates indicate that HIV prevalence among MSM increased, from an across–metropolitan statistical area mean of 11% in 1992 to 20% in 2013 (S.D. = 3.5%). Our estimates by racial/ethnic subgroups of MSM suggest higher mean HIV prevalence among black and Hispanic/Latino MSM than among white MSM across all years and geographic regions.
Conclusions
The increases found in HIV prevalence among all MSM are likely primarily attributable to decreases in mortality and perhaps also to increasing HIV incidence among racial/ethnic minority MSM. Future research is needed to confirm this. If true, health care initiatives should focus on targeted HIV prevention efforts among racial/ethnic minority MSM and on training providers to address cross-cutting health challenges of increased longevity among HIV-positive MSM.
Young black and Latinx men who have sex with men (YBLMSM) and transgender women (YBLTW) are disproportionately impacted by HIV. Structural and social marginalization, the social barriers, and structures that unevenly distribute benefits and burdens to different groups, may contribute to inability for youth to access prevention and treatment care services. Yet, few reports have examined the community and health care experiences of social marginalization among youth service providers who have multiple roles in the community (i.e., serve as a service provider and are a member or prior member of the YBLMSM and YBLTW population). Eighteen key informants (KIs), defined as youth, young adults, or adults who were members of or connected to the YBLMSM and young black and Latinx transgender (YBLTG) community, participated in a one-time, face-to-face, or telephone key informant interview (KII) lasting ∼45 min. KIs were defined as youth service providers because they described working with the target population and either being a member of or closely connected to the target population. KIs described key themes related to marginalization: lack of competent care among health care providers and both clinical and community spaces that left out key populations. HIV stigma and medical mistrust continues to create a barrier to care in this population and for interventions to be effective interventions will need to use an intersectional approach that simultaneously address all identities, and the social and structural needs of youth.
Purpose:
Psychosocial stress has been associated with susceptibility to many infectious pathogens. We evaluated the association between perceived stress and incident sexually transmitted infections (STIs; Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis genital infections) in a prospective study of women. Stress may increase vulnerability to STIs by suppressing immune function and altering the protective vaginal microbiota.
Methods:
Using the 1999 Longitudinal Study of Vaginal Flora (n = 2439), a primarily African American cohort of women, we fitted Cox proportional hazards models to examine the association between perceived stress and incident STIs. We tested bacterial vaginosis (measured by Nugent Score) and sexual behaviors (condom use, number of partners, and partner concurrence) as mediators using VanderWeele's difference method.
Results:
Baseline perceived stress was associated with incident STIs both before and after adjusting for confounders (adjusted hazard ratio = 1.015; 95% confidence interval, 1.005-1.026). Nugent score and sexual behaviors significantly mediated 21% and 65% of this adjusted association, respectively, and 78% when included together in the adjusted model.
Conclusions:
This study advances understanding of the relationship between perceived stress and STIs and identifies high-risk sexual behaviors and development of bacterial vaginosis-both known risk factors for STIs-as mechanisms underlying this association.
Background
The purpose of this study was to examine the impact of relationship power on HIV risk behaviour among young Black men who have sex with men (MSM) in the Southern US. Methods: Data from 425 Black/African American males aged 18–29 years who reported recent anal intercourse with a male partner were analysed. Five selected measures of relationship power were tested for correlation and association with protected receptive anal intercourse using contingency tables and logistic regression analysis. Results: Acts of 100% protected receptive anal intercourse were common (n = 277, 65.2%). Men who reported low barriers to condom negotiation were significantly more likely to report protected acts (P < 0.001). Men who reported 100% protected acts were less likely to report financial dependence on male sexual partners and serosorting behaviour (12.0% vs 20.7%, P = 0.02; 31.5% vs 49.8%, P < 0.001 respectively). Conclusion: Future efforts should further examine the role of relationship power in HIV risk among young Black MSM, including the intersection of individual, dyadic and social-structure risks.
While correlates of pre-exposure prophylaxis (PrEP) uptake have been explored among older men who have sex with men (MSM), less is known about the facilitators and barriers that encourage uptake among younger MSM (YMSM). This study explores the association between willingness to take PrEP and demographic characteristics, sexual risk, and substance use, and attitudinal factors among YMSM in California who use geosocial networking applications (GSN apps). Based on survey data from YMSM recruited through GSN apps (n = 687), PrEP willingness was positively associated with Hispanic ethnicity [adjusted odds ratio (aOR): 1.73; confidence interval (CI): 1.01-2.98; p = 0.046], concerns about drug effects (aOR: 0.46; CI: 0.33-0.65; p < 0.001), medical mistrust (aOR: 0.71; CI: 0.53-0.96; p < 0.001), and concerns about adherence (aOR: 0.65; CI: 0.49-0.89; p = 0.005). PrEP willingness was positively associated with medium (aOR: 1.87; CI: 1.14-3.07; p = 0.014) and high concern (aOR: 1.84; CI: 1.13-3.01; p < 0.001) about contracting HIV and perceived benefits of taking PrEP (aOR: 2.59; CI: 1.78-3.78; p < 0.001). In addition to emphasizing the benefits of using PrEP, campaigns that address concerns regarding adherence and side effects may increase interest in and demand for PrEP among YMSM. More opportunities are needed to educate YMSM about PrEP, including addressing their concerns about this new prevention strategy. Providers should speak openly and honestly to YMSM considering PrEP about what to do if side effects occur and how to handle missed doses. Outreach using GSN apps for PrEP education and screening may be an effective way to reach YMSM.
Background:
Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to 'seek, test, treat and retain' people living with HIV/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia (BC), Canada in 2011-2013.
Methods:
Using a previously-validated dynamic, compartmental HIV transmission model, linked individual-level health administrative data for PLHIV and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department, outpatient), ART initiation and ART retention initiatives, versus a counterfactual scenario approximating the status quo. HIV incidence, mortality, costs (in 201530,216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective by international standards. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at an incremental cost of $55,258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV.
Conclusions:
HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to re-engage PLHIV lost to care is a priority moving forward.
Background:
HIV pre-exposure prophylaxis (PrEP) is an effective tool in preventing HIV infection among high risk men who have sex with men (MSM). It is unknown how effective PrEP is in the context of other implemented HIV prevention strategies, including condom use, seroadaption, and treatment as prevention (TasP). We evaluate the impact of increasing uptake of PrEP in conjunction with established prevention strategies on HIV incidence in a high risk population of MSM through simulation.
Methods:
Agent-based simulation models representing the sexual behavior of high risk, urban MSM in the United States over the period of one year were used to evaluate the effect of PrEP on HIV infection rates. Simulations included data for 10,000 MSM and compared increasing rates of PrEP uptake under eight prevention paradigms: no additional strategies, TasP, condom use, seroadaptive behavior, and combinations thereof.
Results:
We observed a mean of 103.2 infections per 10,000 MSM in the absence of any prevention method. PrEP uptake at 25% without any additional prevention strategies prevented 30.7% of infections. In the absence of PrEP, TasP, condom use, and seroadaptive behavior independently prevented 27.1, 48.8, 37.7% of infections, respectively, and together prevented 72.2%. The addition of PrEP to the three aforementioned prevention methods, at 25% uptake, prevented an additional 5.0% of infections.
Conclusions:
In order to achieve a 25% reduction in HIV infections by 2020, HIV prevention efforts should focus on significantly scaling up access to PrEP in addition to HIV testing, access to antiretroviral therapy, and promoting condom use.
Black gay, bisexual, and other men who have sex with men (BMSM) experience a disparate rate of HIV infections among MSM. Previous analyses have determined that STI coinfection and undiagnosed HIV infection partly explain the disparity. However, few studies have analyzed the impact of partner-level variables on HIV incidence among BMSM. Data were analyzed for BMSM who attended the Los Angeles LGBT Center from August 2011 to July 2015 (n = 1974) to identify risk factors for HIV infection. A multivariable logistic regression was used to analyze predictors for HIV prevalence among all individuals at first test (n = 1974; entire sample). A multivariable survival analysis was used to analyze predictors for HIV incidence (n = 936; repeat tester subset). Condomless receptive anal intercourse at last sex, number of sexual partners in the last 30 days, and intimate partner violence (IPV) were significant partner-level predictors of HIV prevalence and incidence. Individuals who reported IPV had 2.39 times higher odds (CI 1.35-4.23) and 3.33 times higher hazard (CI 1.47-7.55) of seroconverting in the prevalence and incidence models, respectively. Reporting Black partners only was associated with increased HIV prevalence, but a statistically significant association was not found with incidence. IPV is an important correlate of both HIV prevalence and incidence in BMSM. Further studies should explore how IPV affects HIV risk trajectories among BMSM. Given that individuals with IPV history may struggle to negotiate safer sex, IPV also warrants consideration as a qualifying criterion among BMSM for pre-exposure prophylaxis (PrEP).
The initiation of romantic and sexual relationships during adolescence is a normative and integral part of adolescent identity development. In the United States, the overwhelming majority of young people have romantic relationships (Carver et al. 2003) and initiate sexual activity during their high school years (Guttmacher Institute 2011); this trend has continued for decades (Finer 2007). American adult attitudes toward adolescent sexual behavior, however, continue to be characterized by fear, concern, and a focus on risk (Russell 2005; Schalet 2004), as evidenced by debates surrounding sex education in schools. Similarly, research on adolescent sexuality is largely focused on preventing sexual risk-taking and negative sexual outcomes, especially in the area of demography (Tolman and McClelland 2011). For example, sexual initiation is often characterized as a problem behavior, and the focus is overwhelmingly on contraceptive use, sexually transmitted infections, and pregnancy.
Purpose:
HIV disproportionately affects young men who have sex with men (YMSM), particularly black YMSM. Increasingly, researchers are turning to social, economic, and structural factors to explain these disproportionate rates. In this study, we explore the relationship between socioeconomic disconnection and HIV status and factors related to HIV infection, including drug use, condomless anal sex, and binge drinking. We operationalize socioeconomic disconnection in this young population as lack of engagement in educational and employment opportunities.
Methods:
Baseline data were analyzed from a longitudinal cohort study of YMSM aged 16-20 years recruited from the Chicago area (N = 450). Bivariate analyses of the association of socioeconomic disconnection and HIV-positive status, drug and alcohol use, and condomless anal sex were assessed using chi-square tests. The relationship of socioeconomic disconnection and HIV-positive status was then examined in multivariate logistic regression models, controlling for age and race/ethnicity and significant behavioral factors.
Results:
Among study participants, 112 (25%) were not in school, 310 (69%) were not currently working, and 81 (18%) were neither in school nor working. Black MSM were more likely to be socioeconomically disconnected (neither in school nor working; n = 56, 23.3%). The results revealed that disconnected YMSM were more likely to binge drink (AOR = 2.34; 95% CI = 1.16, 4.74) and be HIV positive (AOR = 2.24; 95% CI = 1.04, 4.83). Subpopulation analysis for black participants revealed similar associations (AOR of binge drinking = 2.92; 95% CI = 1.07, 8.01; AOR of HIV positive = 2.38; 95% CI = 1.03, 5.51). Controlling for substance use, the association between disconnection and HIV-positive status remained significant (AOR = 2.37; 95% CI = 1.08, 5.20).
Conclusion:
Socioeconomic disconnection is significantly and positively associated with HIV status among YMSM, suggesting that the two factors are related. Socioeconomic factors present an important area for future research focusing on HIV infection in this high-risk group.
HIV was first discovered in the United States 30 years ago. Since then, one characteristic of the epidemic has remained constant: gay men (or men who have sex with men (MSM) have been among the most severely impacted of any social group in the nation. While MSM account for less than 5% of all men in most behavioral surveys, they currently account for nearly 60% of all new HIV infections in the United States [1]. A recent CDC analysis calculated that MSM are 60 and 61 times more likely to be infected with HIV and syphilis, respectively, than heterosexual men and are 54 and 93 times more likely to be infected with HIV and syphilis, respectively, than women [2].
HIV-1 and related viruses require co-receptors, in addition to CD4, to infect target cells. The chemokine receptor CCR-5 (ref. 1) was recently demonstrated to be a co-receptor for macrophage-tropic (M-tropic) HIV-1 strains2-6, and the orphan7 receptor LESTR (also called fusin) allows infection by strains adapted for growth in transformed T-cell lines (T-tropic strains). Here we show that a mutant allele of CCR-5 is present at a high frequency in caucasian populations (allele frequency, 0.092), but is absent in black populations from Western and Central Africa and Japanese populations. A 32-base-pair deletion within the coding region results in a frame shift, and generates a non-functional receptor that does not support membrane fusion or infection by macrophage- and dual-tropic HIV-1 strains. In a cohort of HIV-1-infected caucasian subjects, no individual homozygous for the mutation was found, and the frequency of heterozygotes was 35% lower than in the general population. White blood cells from an individual homozygous for the null allele were found to be highly resistant to infection by M-tropic HIV-1 viruses, confirming that CCR-5 is the major co-receptor for primary HIV-1 strains. The lower frequency of heterozygotes in seropositive patients may indicate partial resistance.
Context
Studies conducted in the late 1980s on human immunodeficiency virus
(HIV) infection among older men who have sex with men (MSM) suggested the
epidemic had peaked; however, more recent studies in younger MSM have suggested
continued high HIV incidence.Objective
To investigate the current state of the HIV epidemic among adolescent
and young adult MSM in the United States by assessing the prevalence of HIV
infection and associated risks in this population in metropolitan areas.Design
The Young Men's Survey, a cross-sectional, multisite, venue-based survey
conducted from 1994 through 1998.Setting
One hundred ninety-four public venues frequented by young MSM in Baltimore,
Md; Dallas, Tex; Los Angeles, Calif; Miami, Fla; New York, NY; the San Francisco
(Calif) Bay Area; and Seattle, Wash.Subjects
A total of 3492 15- to 22-year-old MSM who consented to an interview
and HIV testing.Main Outcome Measures
Prevalence of HIV infection and associated characteristics and risk
behaviors.Results
Prevalence of HIV infection was high (overall, 7.2%; range for the 7
areas, 2.2%-12.1%) and increased with age, from 0% among 15-year-olds to 9.7%
among 22-year-olds. Multivariate-adjusted HIV infection prevalence was higher
among blacks (odds ratio [OR], 6.3; 95% confidence interval [CI], 4.1-9.8),
young men of mixed or other race (OR, 4.8; 95% CI, 3.0-7.6), and Hispanics
(OR, 2.3; 95% CI, 1.5-3.4), compared with whites (referent) and Asian Americans
and Pacific Islanders (OR, 1.1; 95% CI, 0.5-2.8). Factors most strongly associated
with HIV infection were being black, mixed, or other race; having ever had
anal sex with a man (OR, 5.0; 95% CI, 1.8-13.8); or having had sex with 20
or more men (OR, 3.0; 95% CI, 2.0-4.7). Only 46 (18%) of the 249 HIV-positive
men knew they were infected before this testing; 37 (15%) were receiving medical
care for HIV, and 19 (8%) were receiving medical drug therapy for HIV. Prevalence
of unprotected anal sex during the past 6 months was high (overall, 41%; range,
33%-49%).Conclusions
Among these young MSM, HIV prevalence was high, underscoring the need
to evaluate and intensify prevention efforts for young MSM, particularly blacks,
men of mixed race or ethnicity, Hispanics, and adolescents.
By the late 1980s, the human immunodeficiency virus (HIV) epidemic among
men who have sex with men (MSM) in the United States appeared to have peaked.1- 6
However, studies in the 1980s mainly sampled men 30 years of age and older;
analyses of the small subsamples of men younger than 30 years suggested higher
HIV incidence3- 4 and more sexual
risks2- 3,5,7
than among older men. In the 1990s, 6 cross-sectional surveys that focused
on small samples of young MSM found high prevalence of HIV and sexual risk
behaviors.8- 13
These and other findings involving sexually transmitted diseases (STDs) and
unsafe sex,14- 15 and HIV seroincidence16- 18 signal a significant
and continuing HIV epidemic among MSM.
The 1992 through 1993 Young Men's Survey (YMS), conducted in San Francisco
and Berkeley, Calif, was 1 of the 6 cross-sectional surveys focusing on young
MSM in the 1990s.10 Of the 425 participants
aged 17 to 22 years, 9.4% were HIV positive, and 32.7% reported having unprotected
anal sex in the past 6 months. To determine whether this public health problem
was widespread, the Centers for Disease Control and Prevention (CDC) and local
public health officials adapted and expanded the YMS conducted in the years
1994 through 1998 to include the San Francisco Bay Area (San Francisco, Oakland,
and San Jose, Calif), Baltimore, Md; Dallas, Tex; Los Angeles, Calif; Miami,
Fla; New York, NY; and Seattle, Wash. In this first multisite report of the
1994 though 1998 YMS, we confirm that the 1992 through 1993 YMS findings held
true not only in the San Francisco Bay Area19
but also in the 6 other areas.
focus on methodological issues associated with studying AIDS [acquired immune deficiency syndrome]-related sexual behavior among blacks / these issues involve understanding cultural context as a determinant of behavior; cultural biases inherent in standard methodological, sampling, and measurement procedures; and cultural biases in our attempts as social scientists to model and predict individual risk reduction behaviors within the various subpopulations of the black community (PsycINFO Database Record (c) 2012 APA, all rights reserved)
By means of prospective cohort data from the Sydney AIDS Project, we report on 55 homosexual or bisexual men who have become infected with human immunodeficiency virus (HIV), as measured by the development of serum HIV antibodies (seroconversion). We have compared the sexual practices, recreational drug abuse, history of sexually-transmissible diseases, and antecedent immunological findings of the men who seroconverted with those of 588 subjects who persistently remained seronegative in the same time-period. The cumulative incidence rate of HIV infection over the three years of observation was 8.5%. The cumulative incidence rate ranged from less than 1% for the six months before August 1, 1984, to a peak of 5% in the six months before August 1, 1985. Of those subjects for whom we had data for the period of seroconversion, all but two of the subjects who seroconverted admitted to a recognized high-risk sexual practice in the six months before the first visit at which they were found to be seropositive. Univariate analysis found that men who seroconverted were significantly more likely to have had a greater number of recent sexual partners (relative risk per partner, 1.02; P less than 0.001), to have engaged in receptive anal intercourse (incidence rate ratio, 3.1; 95% confidence interval [CI], 1.3-7.6; P = 0.01) and to have used nitrite inhalant (incidence rate ratio, 2.6; 95% CI, 1.2-5.9; P = 0.02) and amphetamine (incidence rate ratio, 4.8; 95% CI, 2.2-10.5; P less than 0.001) drugs. The men who seroconverted were significantly (incidence rate ratio, 2.7; 95% CI, 1.2-6.1; P = 0.014) more likely to have antecedent T-suppressor-cell counts of greater than 800 cells/microL. Factors that retained significance in multivariate analysis were the number of recent sexual partners, recent amphetamine abuse and a T-suppressor-cell count of greater than 800 cells/microL.
The smoking of "crack" cocaine is thought to be associated with high-risk sexual practices that accelerate the spread of infection with the human immunodeficiency virus (HIV). We studied 2323 young adults, 18 to 29 years of age, who smoked crack regularly or who had never smoked crack. The study participants, recruited from the streets of inner-city neighborhoods in New York, Miami, and San Francisco, were interviewed and tested for HIV. This report presents the findings for the 1967 participants (85 percent) who had never injected drugs.
Of the 1137 crack smokers, 15.7 percent were positive for HIV antibody, as compared with 5.2 percent of the 830 nonsmokers (prevalence ratio adjusted for the city, 2.4; 99 percent confidence interval, 1.7 to 3.6). The prevalence of HIV was highest among the crack-smoking women in New York (29.6 percent) and Miami (23.0 percent). Of the 283 women who had sex in exchange for money or drugs, 30.4 percent were infected with HIV as compared with 9.1 percent of the 286 other women (prevalence ratio, 3.1; 99 percent confidence interval, 1.9 to 5.1); of the 91 men who had anal sex with other men, 42.9 percent were infected with HIV as compared with 9.3 percent of the 582 men who did not have anal sex with other men (prevalence ratio, 4.7; 99 percent confidence interval, 3.0 to 7.4). In multivariable analyses, these high-risk sexual practices accounted for the higher prevalence of HIV infection among the crack smokers, as compared with those who did not smoke crack. Women who had recently had unprotected sex in exchange for money or drugs were as likely to be infected as men who had had sex with men (40.9 percent vs. 42.9 percent).
In poor, inner-city communities young smokers of crack cocaine, particularly women who have sex in exchange for money or drugs, are at high risk for HIV infection. Crack use promotes the heterosexual transmission of HIV.
Recent studies suggest very high human immunodeficiency virus (HIV) infection rates in some populations of younger homosexual men, but these studies may represent only particularly high-risk populations. The current study obtained population-based data on the HIV epidemic in young homosexual/bisexual men.
A household survey of unmarried men 18 through 29 years of age involved a multistage probability sample of addresses in San Francisco. A follow-up interview and HIV test for men who were HIV negative at baseline were completed; the median follow-up was 8.9 months.
Sixty-eight of 380 homosexual/bisexual men (17.9%) tested HIV seropositive. Sixty-three percent of men reported one or more receptive anal intercourse partners in the previous 12 months, and 41% of those men did not use condoms consistently. The HIV seroincidence rate among those seronegative at first study was 2.6% per year.
HIV infection rates in young homosexual men in San Francisco are lower than those in the early 1980s; however, the rate of infection in these men, most of whom became sexually active after awareness of AIDS had become widespread, threatens to continue the epidemic in the younger generation at a level not far below that of a decade ago.
This study examined test-retest reliabilities of self-reported human immunodeficiency virus (HIV) sexual and drug injection behaviors among 246 prior drug users admitted to either of two residential drug treatment programs in Westborough, Massachusetts, and Providence, Rhode Island, between June 1990 and September 1992. Participants, selected by their date of admission, were administered admission and reliability questionnaires pertaining to HIV risk behaviors, the latter at approximately 2 weeks after admission. Estimated reliabilities (kappa coefficients) of the sexual behaviors ranged from 0.72 to 0.91; those for the drug injection variables ranged from 0.63 to 0.98. These results were consistent across groups defined by sex and injection of drugs. The consistently good reliabilities are significant to the design of independent studies of drug treatment populations utilizing self-report measures of sexual and drug behaviors.
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.
Trends in sexual behavior associated with incident infection with human immunodeficiency virus (HIV) type 1 are described and a case-control study was conducted to examine risk factors for HIV seroconversion in homosexual men who became infected with HIV between 1982 and 1994 from four geographic sites: Amsterdam, the Netherlands; San Francisco, California; Vancouver, Canada; and Sydney, Australia. Changes in sexual behaviors were evaluated from cohort visits in the preseroconversion, seroconversion, and postseroconversion intervals and were further examined over three time periods: 1982-1984, 1985-1987, and 1988-1994. In a case-control study, sexual behaviors, substance use, and presence of sexually transmitted disease were compared between 345 HIV-positive cases and 345 seronegative controls matched by visit date and site. Receptive anal intercourse was the sexual behavior most highly associated with seroconversion. The odds ratio (OR) per receptive anal intercourse partner increase was 1.05 (95% confidence interval (CI) 1.02-1.09). To more carefully examine risk associated with receptive oral intercourse, analyses were done in a subgroup of men who reported no or one receptive anal intercourse partner. The risk (OR) associated with receptive oral intercourse partner increase was 1.05 (95% CI 1.0-1.11). In multivariate conditional logistic regression analyses, presence of sexually transmitted disease (OR = 3.39, 95% CI 1.95-5.91) and amphetamine use (OR = 2.55, 95% CI 1.26-5.15) were independently associated with seroconversion. Although the prevalence of major risk factors has decreased over time, the associations of these behaviors and HIV infection persist, suggesting that these risk behaviors remain important avenues for public health interventions.
Several recent studies have shown high rates of HIV infection and risk behavior among young men who have sex with men (MSM). To assess the direction of the epidemic in this population, we replicated a venue-based study performed in the San Francisco Bay Area during 1992 and 1993. From May 1994 to September 1995, we surveyed 675 MSM aged between 17 and 22. After statistical adjustment for age, ethnicity, residence, and site of recruitment, seroprevalence did not change significantly between the 1992 to 1993 (8.4%) and the 1994 to 1995 (6.7%) surveys. Similarly, no significant changes were found in the rates during the previous 6 months of unprotected receptive anal intercourse (23.4% versus 24.9%), injection drug use (8.0% versus 7.8%), or needle sharing among injection drug users (56.3% versus 64.5%) between the two surveys. Despite the increased attention that the problem of high risk behavior among young MSM has received, effective prevention interventions for MSM are needed as profoundly now as they had been several years ago.
To determine the prevalence of HIV infection and risk behaviors among young men who have sex with men (MSM) aged 15-22 years in New York City.
An anonymous cross-sectional survey.
The 1998 Young Men's Survey in New York City (YMS-NYC), was a multistage probability survey of 541 MSM aged 15-22 years who attend public venues. After identification of venues and their associated high attendance time periods, random samples of venues and time periods were selected on a monthly basis. At each sampling event, potential participants were approached to determine eligibility. Eligible and willing men were interviewed, counselled and had a blood specimen drawn.
Between December 1997 and September 1998, 115 sampling events were conducted. Of 612 men enrolled, 541 reported ever having had sex with a male partner. The HIV seroprevalence among the 541 MSM sampled was 12.1%. The HIV seroprevalence was 18.4% among African-Americans, 16.7% among persons of mixed race, 8.8% among Latino individuals and 3.1% among white men. HIV seroprevalence was 5.0% among 15-18 year olds and 16.4% among 19-22 year olds. A total of 65.5% of MSM were susceptible to hepatitis B virus infection (HBV). Almost half (46.1%) of the men reported unprotected anal sex in the previous 6 months and 16.3% reported ever having had an STD. Multiple regression analyses found that being older, of mixed race, black or ever having had an STD was associated with being HIV antibody positive.
These data identify a large subgroup of MSM in need of effective HIV and HBV primary and secondary prevention programs.
Associations between substance use and sexual behavior were examined among 3220 seronegative men who have sex with men (MSM) in a HIV vaccine preparedness study. Relationships between current and past substance use and current sexual risk were evaluated using crude odds ratios and logistic regression to adjust for confounding variables. Heroin and injection drug use were uncommon (<2%). Substances most often used were alcohol (89%), marijuana (49%), nitrite inhalants (29%), amphetamines or similarly acting stimulants (21%), cocaine 14% and hallucinogens (14%). Increased adjusted odds for unprotected sex were significantly associated with current heavy alcohol use (OR 1.66; CI 1.18, 2.33), past alcohol problems (OR 1.25; CI 1.05, 1.48), and current drug use (OR 1.26; CI 1.08, 1.48). When associations with specific drugs and nitrite inhalants were examined separately, current use of cocaine and other stimulants (OR 1.25; CI 1.01, 1.55), hallucinogens (OR 1.40; CI 1.10, 1.77), and nitrite inhalants (some (OR 1.61; CI 1.35, 1.92); heavy (OR 2.18; CI 1.48, 3.20)), were independently associated with unprotected sex. Those with past drug use or past heavy alcohol use but not currently using demonstrated no increase in sexual risk, suggesting an important role for substance-focused interventions in risk reduction efforts among MSM.
Data generated by the authors' field research on the bisexual and homosexual behaviors of men of Mexican origin living in southern California are presented and compared with the same behaviors of Anglo men in California and Mexican men in Mexico. Preferences for playing either the anal receptive or insertive sexual role and a focus on anal intercourse by unacculturated and less acculturated men of Mexican origin who have sex with men are the sexual behaviors judged to be most significantly different from Anglo men who have sex with men in California. Sexual socialization and acculturation were found to be the most important determinants of whether an individual's adult patterns of homosexual behavior will be more or less influenced by Mexican or Anglo homosexuality in spite of the length of time they may have lived in California. Evidence is presented about the effects that acculturation, preference for a sexual role in anal intercourse, and endogamy have on the spread of the AIDS virus in the Mexican origin population in California.
Objective: To investigate evidence for resistance to HIV-1 infection associated with the heterozygous genotype CCR5-+/[DELTA]32 and with the homozygous genotype CCR5- [DELTA]32/[DELTA]32, which results in a nonfunctional CCR5 receptor.
Design: Cohort study of initially HIV-seronegative high-risk individuals from eight different cities. Enrollment data were analyzed to investigate the association of demographic factors and risk behaviors with CCR5 genotypes on the assumption that increased genotype prevalence among persons with histories of longer or more intensive exposure to HIV would indicate HIV resistance associated with that genotype. Longitudinal data were analyzed to investigate the association of HIV seroincidence with CCR5 genotypes. The cohort of 2996 individuals included 1892 men who have sex with men (MSM), 474 male injection drug users (IDUs), 347 women at heterosexual risk, and 283 female IDUs.
Measurements: CCR5 genotype, HIV serostatus, demographic factors, and risk behaviors during the 6 months before enrollment, followed by measurement of HIV seroincidence during the subsequent 18 months (for men) and 24 months (for women).
Results: Forty (1.3%) subjects were homozygous CCR5-[DELTA]32/[DELTA]32 and 387 (12.9%) were heterozygous CCR5-+/[DELTA]32. All but 1 CCR5-[DELTA]32/[DELTA]32 individuals and 51 CCR5- +/[DELTA]32 individuals were Caucasian. Among 1531 Caucasian MSM, CCR5-+/[DELTA]32 individuals were present more frequently (22.3%) among those reporting unprotected receptive anal intercourse than among those not reporting this risk (15.9%) (p = .002), suggesting a selective advantage of the heterozygous genotype. CCR5-+/[DELTA]32 individuals also had a significantly reduced relative risk of HIV seroconversion adjusted for unprotected receptive anal intercourse compared with CCR5-+/+ individuals (relative risk = 0.30, 95% confidence interval [CI]: 0.08-0.97). CCR5-[DELTA]32/[DELTA]32 prevalence among Caucasian MSM was significantly associated with age among subjects recruited from high HIV seroprevalence cities (New York City and San Francisco) (odds ratio [OR] for each decade increase in age = 2.57, CI: 1.56-4.21) but not among those recruited from lower HIV prevalence sites (Boston, Chicago, Philadelphia, Seattle, and Providence/Pawtucket, Rhode Island) (OR = 1.20, CI: 0.75-1.89).
Conclusions: Cross-sectional and longitudinal analyses indicated that among high-risk HIV seronegative MSM, CCR5-+/[DELTA]32 and CCR5-[DELTA]32/[DELTA]32 are associated with protection against HIV infection. These findings imply that strategies aimed at reducing susceptibility to HIV infection by blocking CCR5 receptor sites need not seek blockage of all receptor sites to achieve an imperfect but substantial degree of protection.
(C) 2001 Lippincott Williams & Wilkins, Inc.
Associations between substance use and sexual behavior were examined among 3220 seronegative men who have sex with men (MSM) in a HIV vaccine preparedness study. Relationships between current and past substance use and current sexual risk were evaluated using crude odds ratios and logistic regression to adjust for confounding variables. Heroin and injection drug use were uncommon (<2%). Substances most often used were alcohol (89%), marijuana (49%), nitrite inhalants (29%), amphetamines or similarly acting stimulants (21%), cocaine 14% and hallucinogens (14%). Increased adjusted odds for unprotected sex were significantly associated with current heavy alcohol use (OR 1.66; CI 1.18, 2.33), past alcohol problems (OR 1.25; CI 1.05, 1.48), and current drug use (OR 1.26; CI 1.08, 1.48). When associations with specific drugs and nitrite inhalants were examined separately, current use of cocaine and other stimulants (OR 1.25; CI 1.01, 1.55), hallucinogens (OR 1.40; CI 1.10, 1.77), and nitrite inhalants (some (OR 1.61; CI 1.35, 1.92); heavy (OR 2.18; CI 1.48, 3.20)), were independently associated with unprotected sex. Those with past drug use or past heavy alcohol use but not currently using demonstrated no increase in sexual risk, suggesting an important role for substance-focused interventions in risk reduction efforts among MSM.
Thesis (Ph. D.)--University of California, Los Angeles, 2001. Typescript (photocopy). Vita. Includes bibliographical references.
Some aspects of the mestizoized urban culture in Mexico are linked to male homosexuality in support of the theory that cultural factors play an important role in the kind of life styles and sex practices of males involved in homosexual behavior. The following factors are considered relevant: the sharp dichotomization of gender roles, dual categorization of females as good or bad, separate social networks maintained by males before and after marriage, proportion of unmarried males, and distribution of income. One result of the sharp dichotomization of male and female gender roles is the widely held belief that effeminate males generally prefer to play the female role rather than the male. Effeminacy and homosexuality are also linked by the belief that as a result of this role preference effeminate males are sexually interested only in masculine males with whom they play the passive sex role. The participation of masculine males in homosexual encounters is related in part to a relatively high level of sexual awareness in combination with the lack of stigmatization of the insertor sex role and in part to the restraints placed on alternative sexual outlets by available income and/or marital status. Males involved in homosexual behavior in Mexico operate in a sociocultural environment which gives rise to expectations that they should play either the insertee or insertor sex role but not both and that they should obtain ultimate sexual satisfaction with anal intercourse rather than fellatio. In spite of cultural imperatives, however, individual preferences stemming from other variables such as personality needs, sexual gratification, desires of wanted partners, and amount of involvement may override the imperatives with resulting variations in sexual behavior patterns.
Epidemiologic studies exploring risks for sexually transmitted diseases, including human immunodeficiency virus infection, typically rely on self-report of sexual behaviors. Estimates of the incidence and prevalence of sexual practices are important measures for assessment of behavioral interventions as well as for examining disease transmission. This study examined the degree of agreement within heterosexual couples reporting frequency and type of sexual behaviors, including condom use. Self-reports were obtained from 71 couples attending Baltimore sexually transmitted disease clinics in 1989-1990 regarding the number of days and number of episodes of three specific sexual practices (any type of sexual activity, vaginal sex, and vaginal sex with condom use) over a 30-day period. Paired t test analysis revealed both sexes to be very consistent in their reporting of recent sexual experiences. Multivariate analysis showed that agreement did not vary by socioeconomic status, by whether the partners were married to each other, or by age. These findings suggest that reliable information regarding sexual behaviors may be obtained from men or women.
Unique substantive and methodological issues are involved in conducting survey research on sexual and HIV risk related behaviors among Americans of African descent. Problem conceptualization, sampling, design of instruments, mode of data collection, interviewer/respondent characteristics, community resistance, and data analysis and interpretation are discussed. The lack of survey research on sensitive health issues is noted. Possible methods for addressing these issues are drawn from the experiences of the authors in conducting national research on the general and at risk Black community populations. It is concluded that attention to these issues can substantially improve the quality of research on AIDS related behaviors on Black communities. Finally, it is suggested that behavioral theories and sophisticated methodological and analytic approaches, sensitive to the special cultural dimensions of racial/ethnic life in the United States, would contribute substantially to the scientific armamentarium needed to successfully meet the challenge of the AIDS epidemic.
Infant footprinting and photographs are the principal means used by most neonatal care facilities for determining infant identity in instances in which identity may be questioned or unknown. These methods have been shown to be an ineffective and unreliable means of establishing identity, particularly for infants and neonates. We examined the utility of the Antibody Profile Assay, a 60-minute immunoblot-based serotyping assay, as an accurate means of determining infant identity. Fifty-four neonatal cord blood samples were evaluated in this study for the ability of the assay to match respective maternal sample profile patterns. Visual comparison of profiles allowed matching of infant samples to each respective maternal sample. Eight of the 54 paired samples demonstrated slight differences in staining that did not affect the ability to identify sample pairs. In one instance, an additional minor band was detected in the maternal profile that was not apparent in the newborn infant profile. This discrepancy within an otherwise identical pattern did not affect the ability to correctly match the maternal and newborn infant samples. We conclude that the antibody profile assay is a rapid, accurate, and positive means of identifying newborn infants.
Risk behaviour and egocentric sexual network data collected from a large random sample of young gay men in San Francisco were analysed to assess the importance of sexual mixing (i.e. sexual networks) in the acquisition of HIV. These data were collected in 1993, during wave one of a longitudinal cohort study of HIV transmission in gay men; the seroprevalence level in the sample was 18%. We identify recent sexual mixing patterns and we demonstrate that seropositives and seronegatives have very different age-stratified sexual mixing patterns. We show that sexual mixing can explain the current seroprevalence patterns in the young gay community; seroprevalence levels in risk groups reflect the degree of sexual mixing with the older (and more heavily infected) age group. Our results suggest that seropositives became infected with HIV not simply owing to an increased rate of acquisition of sex partners, but also as a result of their sexual mixing pattern. We develop and apply a simple methodology that uses the sexual network data in combination with risk behaviour data to estimate the future number of seroconverters. Our methodology is validated by testing our predictions against the observed seroconversion data collected during wave two of the cohort study in 1994. Our analyses empirically demonstrate (for the first time) the significance of sexual mixing as a risk factor for HIV transmission.
Studies of sexual behavior and of interventions designed to reduce human immunodeficiency virus risk usually depend on self-report. Validation of self-reported condom use measures has not been previously reported in an urban population at high risk for sexually transmitted diseases and human immunodeficiency virus.
A prospective cohort study was performed in subjects recruited from sexually transmitted disease clinics in Baltimore. At enrollment, a questionnaire was administered that assessed human immunodeficiency virus risk factors and sexually transmitted disease history, and used a retrospective calendar to assess sexual events and condom use over the previous 30 days. Clinical evaluation was performed for sexually transmitted diseases. At follow-up 3 months later, the same procedures were repeated. Incident sexually transmitted diseases at follow-up were defined as new culture or serologically documented diagnoses of gonorrhea, chlamydia, syphilis, or trichomoniasis.
In the 323 male and 275 female (total = 598) subjects who completed a follow-up visit, 21% reported using condoms for every act of sexual intercourse over the previous 30 days, 21% reported occasionally using condoms, and 59% reported not using condoms. At follow-up, 21% of subjects had new incident gonorrhea, chlamydia, syphilis, or trichomoniasis. Fifteen percent of the men who were "always" condom users had incident sexually transmitted diseases compared with 15.3% of "never users;" 23.5% of women who were "always" users had incident sexually transmitted diseases compared with 26.8% of "never" users.
In this high-risk population, self-reported condom use is not associated with lower sexually transmitted disease incidence. This finding suggests that self-reported condom use measures, even in a research setting, may be subject to substantial reporting bias.
