- [Show abstract] [Hide abstract] ABSTRACT: Unequal gender norms and age-disparate sexual relationships can lead to power imbalances and are also associated with intimate partner violence (IPV), sexual coercion and violence, and sexual risk behaviors. The present study examined these variables from both victim and perpetrator perspectives among adolescent gang members. Age-disparate sexual relationships were defined as sex partners 5 or more years older among female participants and 5 or more years younger among male participants. Participants were recruited from a mid-sized Midwestern city and completed a 60–90-min audio computer-assisted self-interview in a community-based setting. Participants in this study included 107 female gang members (68 % African-American, 19 % Latina; mean age, 17.6) and 169 male gang members (62 % African-American, 28 % Latino; mean age, 17.7). As hypothesized, endorsing unequal gender norms toward women was significantly related to IPV victimization among female participants and perpetration among male participants, and engagement in group sex in the past month among both female and male participants (ps < 0.05). Additionally, unequal gender norms were significantly related to male participants’ perpetrating rape (p < 0.05). As hypothesized, female gang members who had been in age-disparate sexual relationships were significantly more likely to have experienced more IPV and report being raped and males gang members who had age-disparate sexual relationships were significantly more likely to perpetrate IPV in the past year and perpetrate rape (ps < 0.05). Age-disparate sexual relationships were also significantly related to being gang raped among female gang members and participating in a gang rape among male gang members, and engaging in group sex among both female and male gang members (ps < 0.05). Female participants who had been in age-disparate sexual relationships were more likely to have been pregnant (ps < 0.05). It is essential for researchers and public health practitioners to create programs for female adolescents to reduce or avoid risky situations, such as inability to negotiate condom use with older sex partners. Additionally, programs must be developed for both female and male gang members to help them understand and identify unequal gender norms, and interpersonal and sexual coercion/violence. Early intervention will also be necessary as these adolescent gang members are already engaged in extremely high-risk, coercive, and violent behaviors.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men (MSM). Methods: We recruited social networks composed of 445 Black MSM from 2012 to 2014 in Milwaukee, Wisconsin; Cleveland, Ohio; and Miami Beach, Florida. Participants reported past-3-month sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics. Results: Condomless anal intercourse outside main concordant partnerships, reported by 34.4% of MSM, was less likely in the case of no alcohol and marijuana use in the past 30 days, and higher risk-reduction behavioral intentions. High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing. Conclusions: Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions. (Am J Public Health. Published online ahead of print November 12, 2015: e1-e7. doi:10.2105/AJPH.2015.302945).
- [Show abstract] [Hide abstract] ABSTRACT: Black men who have sex with men (MSM) carry a disproportionate burden of HIV in the United States. Such disparities cannot be attributed to individual behavioral risk factors alone, prompting the exploration of social and contextual factors experienced by minority MSM. Societal homonegativity and the internalization of those attitudes by Black MSM may play an important role in understanding racial and ethnic disparities in HIV incidence and prevalence. This study explores the correlates of internalized homonegativity in a large multi-site sample of Black MSM. Findings reveal a number of significant contextual and psychosocial factors related to internalized homonegativity including religiosity, resilience, and gay community acculturation, which have important implications for HIV risk, HIV testing, and social and psychological wellbeing for Black MSM.
- [Show abstract] [Hide abstract] ABSTRACT: Black men who have sex with men (MSM) bear a disproportionate burden of human immunodeficiency (HIV) incidence in the United States. Little research has focused on the associations between social media use and sexual behavior among Black MSM. 205 Black MSM completed measures assessing social media use and sexual behaviors. Men spent an average of 34 h per week on social media sites. 53 % arranged sexual hookups online in the previous 3 months, and did so a mean of 10 times. Overall, users of social media and men who arranged sexual hookups online engaged in more risky behaviors than non-users and men who did not arrange sexual hookups online. However, partner-level data indicated that men engaged in fewer risky behaviors with partners met online compared to partners met in other ways such as at bars or through friends. Social media-based interventions designed to decrease HIV transmission among racial minority MSM are needed.
- [Show abstract] [Hide abstract] ABSTRACT: To test a novel social network HIV risk-reduction intervention for MSM in Russia and Hungary, where same-sex behavior is stigmatized and men may best be reached through their social network connections. A 2-arm trial with 18 sociocentric networks of MSM randomized to the social network intervention or standard HIV/STD testing/counseling. St. Petersburg, Russia and Budapest, Hungary. Eighteen 'seeds' from community venues invited the participation of their MSM friends who, in turn, invited their own MSM friends into the study, a process that continued outward until eighteen three-ring sociocentric networks (mean size = 35 members, n = 626) were recruited. Empirically identified network leaders were trained and guided to convey HIV prevention advice to other network members. Changes in sexual behavior from baseline to 3-month and 12-month follow-up, with composite HIV/STD incidence, measured at 12 months to corroborate behavior changes. There were significant reductions between baseline, first follow-up, and second follow-up in the intervention versus comparison arm for proportion of men engaging in any unprotected anal intercourse (UAI) (P = 0.04); UAI with a nonmain partner (P = 0.04); and UAI with multiple partners (P = 0.002). The mean percentage of unprotected anal intercourse acts significantly declined (P = 0.001), as well as the mean number of UAI acts among men who initially had multiple partners (P = 0.05). Biological HIV/STD incidence was 15% in comparison with condition networks and 9% in intervention condition networks. Even where same-sex behavior is stigmatized, it is possible to reach MSM and deliver HIV prevention through their social networks.
- [Show abstract] [Hide abstract] ABSTRACT: African American men who have sex with men (MSM) in the United States bear a disproportionate burden of HIV infection and disease incidence. 178 Black MSM provided detailed situational information concerning their most recent act of anal intercourse (AI) with a male partner including condom use, partner characteristics, serostatus disclosure, and substance use. Participants completed scales assessing AIDS-related as well as broader contextual domains. Most recent AI acts occurred with same-race partners outside of main relationships. Over one-third of AI acts were unprotected, and almost half of the unprotected acts were not between known HIV-concordant partners. Nearly half of men reported substance use before sex. In a multiple regression analysis, unprotected AI with a partner not known to be concordant was predicted by low risk reduction intentions and indicators of a casual relationship. The findings highlight issues and partner contexts associated with risk for contracting HIV infection among Black MSM.
- [Show abstract] [Hide abstract] ABSTRACT: Black men who have sex with men (MSM) contract HIV at disproportionately high rates, and National HIV/AIDS Strategy goals to reduce HIV incidence cannot be successful without improved HIV prevention among racial minority MSM. A total of 210 Black MSM from three cities (Cleveland, Miami, and Milwaukee) completed measures assessing their sexual behavior and demographic characteristics, as well as AIDS-specific psychosocial scales, broader contextual domains, and substance use. Nearly 50% of men reported recent unprotected anal intercourse (UAI), often with non-main partners, with partners not known to be HIV seroconcordant, or with multiple partners. Thirty-seven percent of men reported being HIV positive. In multiple regression analyses, higher levels of unprotected behavior were predicted by weaker perceived peer norms for condom use, weaker risk reduction behavioral intentions, being HIV negative, and recent use of marijuana, cocaine/crack, and poppers. Greater number of UAI partners was associated with weaker perceived peer condom use norms, lower risk reduction intentions, illicit use of prescribed opiates, and fewer AIDS conspiracy beliefs. These findings suggest important factors that should be targeted in HIV prevention programs for Black MSM.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: We explored associations between awareness of New Jersey's HIV exposure law and the HIV-related attitudes, beliefs, and sexual and seropositive status disclosure behaviors of HIV-positive persons. Methods: A statewide convenience sample (n = 479) completed anonymous written surveys during 2010. We recruited participants through networks of community-based organizations in the state's 9 health sectors. The survey assessed participants' awareness of New Jersey's HIV exposure law, their sexual and serostatus disclosure behavior in the past year, and their HIV-related attitudes and beliefs. We compared responses of participants who were and were not aware of the law through univariate analyses. Results: Fifty-one percent of participants knew about the HIV exposure law. This awareness was not associated with increased sexual abstinence, condom use with most recent partner, or seropositive status disclosure. Contrary to hypotheses, persons who were unaware of the law experienced greater stigma and were less comfortable with positive serostatus disclosure. Conclusions: Criminializing nondisclosure of HIV serostatus does not reduce sexual risk behavior. Although the laws do not appear to increase stigma, they are also not likely to reduce HIV transmission.
- [Show abstract] [Hide abstract] ABSTRACT: Men's risk behavior during a 3-month period prior to parole revocation was assessed. Frequent alcohol use was higher among men who had more children, were homeless, or had a history of alcohol and other drug abuse treatment. The use of drugs was greater among men who were younger or had a history of sexually transmitted infection (STI). The use of hard drugs was higher among men who had history of injection drug use. Unprotected vaginal or anal sex was increased among men who were younger, single, or had a history of STIs. Sex with a high-risk partner was greater among men who were older, used hard drugs, or had a history of STIs. Findings highlight the importance of developing risk-reduction programs for men on parole.
- [Show abstract] [Hide abstract] ABSTRACT: Roma (Gypsies), the largest and most disadvantaged ethnic minority group in Europe, are believed to be vulnerable to HIV/AIDS. This study's aim was to examine HIV risk in 6 Roma male sociocentric networks (n = 405 men) in Bulgaria. Participants were interviewed concerning their risk practices and tested for HIV/STDs. High-risk sexual behaviors were common. Over 57% of men had multiple sexual partners in the past 3 months. Over one-third of men reported both male and female partners in the past year. Condom use was low. Greater levels of sexual risk were associated with lower intentions and self-efficacy for using condoms, drug use, having male partners, knowing HIV-positive persons, and having higher AIDS knowledge but no prior HIV testing. Two men had HIV infection, 3.7% gonorrhea, and 5.2% chlamydia. HIV prevention interventions directed toward high-risk social networks of Roma are needed before HIV infection becomes more widely established.
- [Show abstract] [Hide abstract] ABSTRACT: Although the dire life circumstances of labor migrants working in Russia are well-known, their HIV risk vulnerability and prevention needs are understudied. Low socioeconomic status, lack of access to services, separation from family, and limited risk awareness all contribute to migrants' HIV vulnerability. Male labor migrants in St. Petersburg (n = 499) were administered assessments of their sexual behavior practices, substance use, and psychosocial characteristics related to risk and well-being. Thirty percent of migrants reported multiple female partners in the past 3 months. Condom use was low, ranging from 35% with permanent to 52% with casual partners. Central Asian migrants had very low AIDS knowledge, low levels of substance use, moderate sexual risk, high depression, and poor social supports. Eastern European migrants had higher AIDS knowledge, alcohol and drug use, and sexual risk. Improved HIV prevention efforts are needed to reduce the risk vulnerability of migrants who relocate to high disease prevalence areas.
- [Show abstract] [Hide abstract] ABSTRACT: The objectives of the project were (1) to determine the extent to which HIV-positive persons living in Michigan were aware of and understood Michigan's criminal HIV exposure law, (2) to examine whether awareness of the law was associated with seropositive status disclosure to prospective sex partners, and, (3) to examine whether awareness of the law was associated with potential negative effects of the law on persons living with HIV (PLWH) including heightened HIV-related stigma, perceived societal hostility toward PLWH, and perceived need to conceal one's HIV infection. The study design was cross-sectional. A statewide sample of 384 PLWH in Michigan completed anonymous pen and paper surveys in 1 of 25 data collection sessions. A majority of participants were aware of Michigan's HIV exposure law. Awareness of the law was not associated with increased seropositive status disclosure to all prospective sex partners, decreased HIV transmission risk behavior, or increased perceived responsibility for HIV transmission prevention. However, awareness of the law was significantly associated with disclosure to a greater proportion of sex partners prior to respondents' first sexual interaction with that partner. Awareness of the law was not associated with increased HIV-related stigma, perceived societal hostility toward PLWH, or decreased comfort with seropositive status disclosure. Evidence of an effect of Michigan's HIV exposure law on seropositive status disclosure was mixed. Further research is needed to examine the various forms of HIV exposure laws among diverse groups of persons living with or at increased risk of acquiring HIV.
- [Show abstract] [Hide abstract] ABSTRACT: Russia has seen one of the world's fastest-growing HIV epidemics. Transmission risk behavior, HAART-taking, and psychosocial distress of the growing population of Russian people living with HIV (PLH) in the HAART era are understudied. Participants of a systematically-recruited cross-sectional sample of 492 PLH in St. Petersburg completed measures of sexual and drug injection practices, adherence, perceived discrimination, and psychosocial distress. Since learning of their status, 58% of participants had partners of HIV-negative or unknown serostatus (mean = 5.8). About 52% reported unprotected intercourse with such partners, with 30% of acts unprotected. Greater perceived discrimination predicted lower condom use. A 47% of IDU PLH still shared needles, predicted by having no primary partner, lower education, and more frequently-encountered discrimination. Twenty-five percentage of PLH had been refused general health care, 11% refused employment, 7% fired, and 6% forced from family homes. Thirty-nine percentage of participants had probable clinical depression, 37% had anxiety levels comparable to psychiatric inpatients, and social support was low. Of the 54% of PLH who were offered HAART, 16% refused HAART regimens, and 5% of those on the therapy took less than 90% of their doses. Comprehensive community services for Russian PLH are needed to reduce AIDS-related psychosocial distress and continued HIV transmission risk behaviors. Social programs should reduce stigma and discrimination, and promote social integration of affected persons and their families.
- [Show abstract] [Hide abstract] ABSTRACT: Past studies have primarily focused on individual-level factors influencing the HIV risk practices of gay or bisexual men. The role of one's social network has been less explored. This study identified 75 indexes in venues frequented by men who have sex with men and then recruited all willing persons named as members of each index's egocentric social network. Two hundred fifty-five unique network members completed assessments of risk-related characteristics and also sociometric measures that were used to identify the influence leader of each network. White and African American networks were composed primarily of men of the same race. Over 70% of men reported recent casual sexual partners. About one fourth of men engaged in unprotected anal intercourse (UAI) with a casual partner or with multiple partners in the past 3 months. The social network to which a man belonged, weaker risk reduction intentions, and greater substance use independently predicted a range of high-risk sexual behaviors. There were modest but significant correlations between the risk-related characteristics of network members and network leaders. Social network-level approaches are feasible for reaching hidden subgroups of MSM at high risk for contracting HIV.
- [Show abstract] [Hide abstract] ABSTRACT: Assessment of the frequency of sexual behavior relies on participants' ability to arithmetically aggregate information over time and across partners. This study examines the effect of numeracy (arithmetic skills) on the accuracy of retrospective reports of sexual behavior. For 91 days, the participants completed daily reports about their sexual activity. Participants then completed a survey on sexual behavior over the same period. The discrepancies between the survey-based and the diary-based measures of frequency of vaginal and anal intercourse were evaluated. Multiple regression analysis showed that the discrepancy between retrospective and diary measurements of sexual intercourse increased with lower numeracy (P = 0.026), lower education (P = 0.001), aggregate question format compared to partner-by-partner format (P = 0.031) and higher frequency of intercourse occasions (P < 0.001). Lower numeracy led to a 1.5-fold increase (adjusted mean = 14.1-20.9) in the discrepancy for those using the aggregate question format and a 2.0-fold increase (adjusted mean = 3.7-7.6) for those using the partner-by-partner format.
- [Show abstract] [Hide abstract] ABSTRACT: In the USA, a high proportion of men of Mexican descent (MMD) test for HIV late in the course of the infection and miss opportunities for prevention. Given the need to promote timely HIV testing among MMD, we studied how MMD's motivations and previous experiences with disease prevention influence their intentions to seek (i.e., client-initiated HIV testing) and accept (i.e., provider-initiated HIV testing) an HIV test. We conducted a survey (N=302) at a large Mexican festival in the Midwestern USA. We elicited MMD's sexual risk behavior, social norms and culturally supported HIV testing expectations, previous experiences with disease prevention, and their intentions to seek and accept a free HIV test. Forty-one percent of MMD intended to actively seek an HIV test and 70% said they would accept it from a provider. Multivariate analyses indicated that MMD's intentions to seek and intentions to accept an HIV test were stronger when they expected desirable outcomes of an HIV test, including benefits for their family and community. Whereas MMD's intentions to actively seek an HIV test were stronger when they had more previous experiences with disease prevention and normative support, their intentions to accept an HIV test from a provider were stronger when they expected less negative outcomes from testing for HIV (e.g., stigma). Provider-initiated HIV testing may improve HIV testing access, particularly among MMD with lower experience and support. However, efforts to promote provider-initiated HIV testing among MMD should challenge negative HIV testing expectations and associate HIV testing with positive outcomes.
- [Show abstract] [Hide abstract] ABSTRACT: The sexual behaviors of HIV/sexually transmitted infection (STI) prevention intervention participants can be assessed on a partner-by-partner basis: in aggregate (i.e., total numbers of sex acts, collapsed across partners) or using a combination of these two methods (e.g., assessing five partners in detail and any remaining partners in aggregate). There is a natural trade-off between the level of sexual behavior detail and the precision of HIV/STI acquisition risk estimates. The results of this study indicate that relatively simple aggregate data collection techniques suffice to adequately estimate HIV risk. For highly infectious STIs, in contrast, accurate STI risk assessment requires more intensive partner-by-partner methods.
Article: Living with HIV infection[Show abstract] [Hide abstract] ABSTRACT: By its chronic nature, HIV infection represents a period of time where persons are coping with the social and physiological changes of the infection across the spectrum of acute infection, illness, and death. As a person moves through the stages of infection, he or she also experiences different psychological states, whether they be a reaction to the disease process itself, to social reactions to HIV/AIDS, or to the threat of developing AIDS in the future. The purpose of this article is to describe in both quantitative and qualitative terms the psychosocial functioning of infected men from the time they learn they are seropositive to their demise, and to contrast this to seronegative men. This paper specifically examines the longitudinal patterns of psychological states, social support, social conflict, and HIV-risk behavior as measured prospectively in a cohort of homosexual men in Chicago. The men participating in the Chicago Multicenter AIDS Cohort and Coping and Change Studies enrolled in 1984, before the development of the HIV-1 antibody test, and voluntarily received their test results and counseling beginning November, 1985. This allowed us to follow their psychological and behavioral patterns over time after receiving HIV serostatus information. By comparing these patterns for prevalent seropositive men with those for consistently seronegative men, we are able to observe the time course of psychological and behavioral adaptation, both before and after learning serostatus, and relate those patterns to the natural history of HIV infection in homosexual men.
- [Show abstract] [Hide abstract] ABSTRACT: This study recruited four sociocentric networks (n = 156) of men who have sex with men in Budapest, Hungary, and St. Petersburg, Russia. The sampling approach was based on identifying an initial "seed" in the community for each network, and then recruiting three successive friendship group waves out from the seed. HIV prevalence in the networks was 9%, and the composite rate of other sexually transmitted diseases was 6%. 57% of participants reported both main and casual male partners, and two thirds reported unprotected anal intercourse in the past 3 months. Fifty-five percent of men's most recent anal intercourse acts were with nonexclusive partners, and 56% of most recent anal intercourse acts were unprotected. Sexual risk predictors were generally consistent with behavioral science theory. In addition, risk was associated with more often talking with friends about AIDS, higher ecstasy use, and less often drinking. Sociocentric social network sampling approaches are feasible and constitute a modality for reaching hidden high-risk populations inaccessible through conventional methods.
- [Show abstract] [Hide abstract] ABSTRACT: African-American men bear a disproportionate burden of HIV infection in the United States. HIV testing is essential to ensure that HIV-infected persons are aware of their HIV-positive serostatus, can benefit from early initiation of antiretroviral therapy, and can reduce their risk of transmitting the virus to sex partners. This cross-sectional study assessed HIV testing history and healthcare utilization among 352 young African-American men recruited in urban neighborhoods in a Midwestern city. The self-administered survey measured sexual risk behaviors, factors associated with HIV testing, and barriers to testing. The acceptability of community venues for HIV testing was also assessed. Of the respondents, 76% had been tested for HIV at some time in their lives, 52% during the prior 12 months. Of the participants, 70% had unprotected intercourse during the prior 12 months, 26% with two or more partners. Nearly three-quarters (72%) of participants had seen a healthcare provider during the prior year. In univariate analyses, those who had at least one healthcare provider visit during the prior 12 months and those who had a primary doctor were more likely to have been tested in the prior 12 months. In multivariate analyses, having a regular doctor who recommended HIV testing was the strongest predictor of having been tested [OR=7.38 (3.55, 15.34)]. Having been diagnosed or treated for a sexually transmitted disease also was associated with HIV testing [OR=1.83 (1.04, 3.21)]. The most commonly preferred testing locations were medical settings. However, community venues were acceptable alternatives. Having a primary doctor recommend testing was strongly associated with HIV testing and most HIV testing occurred at doctors' offices. But, a substantial proportion of persons were not tested for HIV, even if seen by a doctor. These results suggest that HIV testing could be increased within the healthcare system by increasing the number of recommendations made by physicians to patients. The use of community venues for HIV testing sites could further increase the number of persons tested for HIV.
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
- Center for AIDS Intervention Research