Investigating partner abuse among HIV-positive men who have sex with men

High rates of partner abuse (PA) of all types—physical, sexual, and psychological—have been identified in studies of HIV-positive individuals. We examined both the prevalence and correlates of same-sex PA in HIV-positive men who have sex with men (MSM). Participants recruited from public outpatient HIV clinics (N = 168) completed CASI surveys about PA and current physical and mental health. Electronic medical record data were obtained for HIV biomarkers. Results indicate high rates of past year PA (physical, 19%; sexual, 17%; psychological, 51%; any, 54%), with rates comparable to, or higher than, those reported in recent studies of HIV-positive women and older studies of HIV-positive MSM. Overall, participants endorsing past year PA reported poorer mental but not physical health. Participants who endorsed past year physical PA, specifically, reported the largest number of mental health problems. HIV care providers should routinely assess PA, especially physical PA, in all MSM patients.     

Depression and anxiety among HIV-positive men who have sex with men and men who have sex with women in China

ABSTRACT

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). Minority stress theory posits that marginalized populations experience additional stress, which influences experiences of psychological distress and health outcomes. This study aimed to understand psychological distress of MSM relative to men who have sex with women (MSW) in an urban Chinese setting. Cross-sectional survey data were collected from 162 HIV-positive Chinese men receiving HIV treatment at Beijing’s Ditan Hospital. Multiple linear regression with imputation was used to identify correlates of psychological distress. Relative to MSW, MSM were younger, more educated, and less likely to be in a relationship or have children. While both groups reported clinically elevated levels of depression and anxiety, sexual behavior was not associated with either outcome. Higher endorsement of depression symptomology was associated with worse reported physical health (β?=??1.37, p?<?.05) and greater endorsement of maladaptive coping (β?=?2.39, p?<?.05), whereas higher endorsement of anxiety symptomology was associated with greater endorsement of adaptive coping (β?=?0.78, p?<?.05), diminished physical health (β?=??0.86, p?<?.05), and a high school or greater level of education (β?=?4.13, p?<?.05). These findings suggest that interventions targeting coping strategies may address psychological distress among HIV-positive Chinese men.     

Determinants of condom use among HIV-positive men who have sex with men

The main objectives of this study were to identify the determinants of condom use among HIV-positive men having anal sex with HIV-negative men or men of unknown HIV status and moderators of the intention-behaviour relationship. A cohort of 237 sexually active HIV-positive men having sex with men was followed over a period of six months. The cognitive variables measured were guided by an extended version of the theory of planned behaviour. Results indicated that past behaviour (odds ratio [OR] = 9.75; 95% confidence interval [CI]: 4.48-21.26), intention (OR = 3.13; 95% CI: 1.25-7.81), self-efficacy (OR = 3.62; 95% CI: 1.40-9.37) and use of sex drugs (OR = 0.16; 95% CI: 0.06-0.45) contributed to the prediction of 100% condom use. Self-efficacy also interacted with intention as a significant moderator of the intention-behaviour relationship (OR = 20.96; 95% CI: 2.90-151.51). Interventions promoting condom use should increase self-efficacy to use condoms and target users of sex drugs.     

Correlates of sexual risk behaviors among HIV-positive men who have sex with men.

This study examines correlates of unprotected sexual risk practices of an ethnically diverse sample of HIV-seropositive men who have sex with men (MSM) from the New York City and San Francisco metropolitan areas. Participants completed a self-report survey that assessed sexual risk behaviors and potential correlates. A total of 367 men reported sex with a casual male partner in the previous 3 months. Participants were divided into three groups based on level of HIV-transmission risk with HIV negative or unknown-status partners: no unprotected anal sex (58.9%), unprotected receptive anal sex only (14.2%), and unprotected insertive anal sex (22.6%). Multivariate logistic regression analyses indicated that men reporting unprotected anal insertive sex perceived less responsibility to protect their partners from HIV. Men reporting no unprotected anal sex also reported less use of nitrate inhalants, lower temptation for unsafe sex, and fewer HIV-negative and unknown-status partners. Men reporting unprotected receptive anal sex were less anxious than the other two groups but also reported greater depression than those not reporting unprotected anal sex and greater loneliness than those reporting unprotected anal insertive sex. Implications for interventions with HIV-positive MSM are presented.     

Binge use of methamphetamine among HIV-positive men who have sex with men: pilot data and HIV prevention implications.

This study compared the social and behavioral characteristics of binge users and nonbinge users of methamphetamine (meth) in a sample of 90 HIV-positive men who have sex with men. Forty-one participants (46%) self-identified as a binge user. Meth binges ranged from 2 to 33 days (mean = 5.6), and average consumption was 3.1 grams. Binge users were significantly more likely than nonbinge users to be ethnic minority and to have lower education. The two groups did not differ in terms of the total amount of meth used in the past 30 days; however, binge users reported significantly more social difficulties, more mental and physical health problems, and more sexual risk behaviors as compared with nonbinge users. The findings are discussed in relation to drug treatment approaches and the development of behavioral interventions.     

Condom use and perceived risk of HIV transmission among sexually active HIV-positive men who have sex with men.

This study examined the association between HIV transmission risk perception and the sexual risk behaviors of HIV-positive men who have sex with men. Respondents rated the degree of risk of transmitting HIV through insertive anal intercourse and insertive oral sex. We examined (a) the perceived level of HIV transmission risk assigned to each sexual behavior and (b) the association between perceived risk for HIV transmission and condom use during insertive anal intercourse and insertive oral sex. We found for behaviors that have achieved less risk consensus that as transmission risk perception increases, so too does the likelihood of condom use. This study highlights the need for more research in understanding how perceived health risk to others influences protective behaviors.     

HIV serostatus disclosure to sexual partners among HIV-positive methamphetamine-using gay, bisexual, and other men who have sex with men.

Nineteen semistructured interviews with HIV-positive methamphetamine-using gay, bisexual, or other MSM were analyzed qualitatively and using Critical Incident Measure (CIM). Among those who reported successful disclosure, themes regarding disclosure strategies and precontact disclosure emerged. Although few men spontaneously discussed the association between methamphetamine and disclosure, those who did reported less inclination to ascertain partner serostatus while under the influence. Men who reported disclosure to an HIV-seroconcordant partner were more likely to report not exchanging semen in this encounter compared with nondisclosers, whereas condom nonuse emerged as a theme across disclosure groups. Most of those who reported nondisclosure described their most recent encounter under the influence as occurring in the context of a public sex environment and/or with multiple partners. Understanding the interaction between methamphetamine use and serostatus disclosure practices, particularly among HIV-positive men, and how this interaction impacts sexual risk-taking has important implications for HIV prevention work.     

Peer referral for HIV case-finding among men who have sex with men

OBJECTIVE: To evaluate the effectiveness and cost-effectiveness of a health department-based peer referral program for identifying previously undiagnosed cases of HIV among men who have sex with men (MSM). DESIGN AND METHODS: Between 2002 and 2005, 283 MSM peer recruiters were enrolled in a public health program in King County, Washington, USA. Peer recruiters were enrolled from a sexually transmitted disease (STD) clinic, an HIV clinic, via media advertisements and through collaboration with community-based organizations (CBO). The peer recruiters underwent a brief training and were then paid US$ 20 for each peer they referred to be tested for HIV, STD and viral hepatitis. Peers were paid US$ 20 for being tested. The main outcome measure was the number of new cases of HIV identified and cost per case of HIV identified. RESULTS: Recruiters referred 498 peers for HIV, STD and hepatitis testing. Among 438 peers not previously diagnosed with HIV, 22 (5%) were HIV positive, of whom 18 received their HIV test results. Other infections were variably prevalent among tested peers: gonorrhea [23/307 (8%)], chlamydia [6/285 (2%)], syphilis [1/445 (0.2%)], hepatitis C [61/198 (31%)], surface antigen positive hepatitis B [8/314 (3%)]. Excluding the costs of testing for viral hepatitis and STDs other than HIV, the cost per new HIV case identified was US$ 4929. During the same period, the cost per new case of HIV detected through bathhouse-based HIV testing and through the county's largest CBO-based HIV testing program were US$ 8250 and US$ 11 481, respectively. CONCLUSIONS: Peer referral is an effective means of identifying new cases of HIV among MSM.     

Increased HIV incidence among men who have sex with men in Rome

Among 976 men who have sex with men (MSM) who had undergone repeat HIV testing between 1984 and 2003 at a sexually transmitted infection clinic in Rome, Italy, we observed a dramatic increase in HIV incidence in 2002 and 2003, with the cumulative incidence for 2000-2003 being twice as high as that for 1984-1995, and significantly higher than that for 1996-1999. This trend suggests the need for interventions aimed at encouraging behavioural changes among MSM.     

Risk factors for HIV infection among men who have sex with men

OBJECTIVES: Risk factors for HIV acquisition were examined in a recent cohort of men who have sex with men (MSM). DESIGN: A longitudinal analysis of 4295 HIV-negative MSM enrolled in a randomized behavioral intervention trial conducted in six US cities. METHODS: MSM were enrolled and assessed for HIV infection and risk behaviors semi-annually, up to 48 months. RESULTS: In multivariate analysis, men reporting four or more male sex partners, unprotected receptive anal intercourse with any HIV serostatus partners and unprotected insertive anal intercourse with HIV-positive partners were at increased risk of HIV infection, as were those reporting amphetamine or heavy alcohol use and alcohol or drug use before sex. Some depression symptoms and occurrence of gonorrhea also were independently associated with HIV infection. The attributable fractions of high number of male partners, use of alcohol or drugs before sex, and unprotected receptive anal intercourse with unknown status partners and the same with presumed negative partners accounted for 32.3, 29.0, 28.4 and 21.6% of infections, respectively. CONCLUSIONS: The challenge is to develop strategies to identify men in need. Interventions are needed to help men reduce their number of sexual partners, occurrences of unprotected anal intercourse, alcohol or drug use before sex and address other mental health issues.     

性网络与男男性行为人群的HIV传播

性网络是男男性行为人群(MSM)经性途径传播艾滋病病毒(HIV)的直接通道。网络分析方法可揭示性网络构成与个体感染HIV风险及与群体中HIV传播的动力学关系。为深入探讨MSM HIV传播风险,为预防干预定位提供信息,该文对性网络与MSMHIV传播关系的研究现况做一简要概述。     

HIV,syphilis and heterosexual bridging among Peruvian men who have sex with men

OBJECTIVES: To determine prevalence of and risk factors associated with HIV and syphilis seropositivity and estimate incidence of HIV infection among Peruvian men who have sex with men (MSM) and characterize behaviors of men who report sex with both men and women ('bridgers'). DESIGN: Cross-sectional study of MSM in Lima, Peru. METHODS: Four-hundred and fifty-one MSM (of whom 442 responded to the question regarding sexual orientation) recruited through street outreach. Each was interviewed and underwent serologic testing for syphilis and HIV, including the less sensitive enzyme immunoassay test to estimate HIV incidence. RESULTS: Overall, HIV and syphilis prevalence were 18.5% and 16.0%, respectively, with highest prevalence among cross-dressers (33.3% and 51.1%, respectively). The estimated overall HIV seroincidence was 11.2% per year (95% confidence interval, 4.8-23.6). Overall, 47.1% of men reported ever having sex with a woman: 78.6% of men self-identifying as heterosexuals, 85.1% of bisexuals, 35.5% of homosexuals, and 12.5% of cross-dressers. Of these, 26.5% were 'bridgers', of whom 55% reported two or more female partners during the last year. 'Bridgers' were less likely to have always used condoms during the past year for vaginal sex (17%) than for insertive anal sex with men (25.5%). CONCLUSIONS: Among MSM in Peru, HIV and syphilis prevalence and HIV incidence were high, especially among cross-dressers. The high prevalence of bisexuality and low rates of consistent condom use, especially with female sexual partners indicates potential HIV transmission into the heterosexual population.     

International travel among HIV-positive and HIV-negative men who have sex with men, San Francisco, USA

We measured the prevalence of international travel, the demographic and risk profile of international travellers and risk and preventive behaviours of travellers among HIV-negative and HIV-positive men who have sex with men (MSM), based in San Francisco, CA, USA, through the addition of questions to the local implementation of the National HIV Behavioral Surveillance survey in 2008. Of 270 MSM participating in the survey, slightly more than one-quarter (26.3%) had travelled internationally in the last year. Those with a history of international travel were more likely to be foreign born, of a higher socioeconomic status and HIV uninfected. Of eight HIV-positive MSM who travelled internationally (11.3% of HIV-positive MSM), all were on antiretroviral therapy and only three recalled being vaccinated for hepatitis A and B. Human papillomavirus infection was also higher among international travellers. Travel health services must be improved to address special needs of this population of international travellers.     

Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

We examined HIV infection and estimated the population-attributable risk percentage (PAR%) for HIV associated fellatio among men who have sex with other men (MSM). Among 239 MSM who practised exclusively fellatio in the past 6 months, 50% had three partners, 98% unprotected; and 28% had an HIV-positive partner; no HIV was detected. PAR%, based on the number of fellatio partners, ranges from 0.10% for one partner to 0.31% for three partners. The risk of HIV attributable to fellatio is extremely low.     

Relationship between illness representations and mental health among HIV-positive men who have sex with men

Illness representations play a significant role on mental health across various health conditions. The present study explores the associations between illness representations of HIV and mental health (suicidal ideation and depression), and the mediation effects of emotional representations on the associations between cognitive representations and mental health among men who have sex with men who were newly diagnosed with HIV (ND-MSM) in China. A total of 225 ND-MSM were recruited from a non-governmental organisation and were invited to complete a cross-sectional survey. Results showed that 48.0% had suicidal ideation since HIV diagnosis and 48.4% scored higher than the cut-off for mild depression or above. Stepwise regression analyses showed that higher levels of emotional representations of HIV and lower levels of treatment control were associated with both suicidal ideation and depression. Emotional representations were shown to mediate the associations between some cognitive representations variables and mental health. Findings suggest that both cognitive and emotional representations of HIV were important factors of mental health among ND-MSM. Interventions to promote the mental health of ND-MSM are warranted and should seek to improve their cognitive and emotional representations of HIV.     

两代酶联免疫试剂在男男性行为人群HIV检测中的应用

目的通过使用第四代与第三代艾滋病病毒(HIV)抗体酶联免疫试剂检测结果及核酸检测结果的比较,评估其在天津市男性性行为人群(MSM)HIV感染筛查中的应用效果。方法对天津市某区自愿咨询检测点进行咨询检测的男男性行为人群用EDTA抗凝管采集血液样品,同时使用两代HIV抗体筛查试剂进行检测,阳性者进行确证检测,两种筛查试剂检测结果均为阴性的样品,采用集合核酸检测方法进行检测。结果共计检测MSM人群血液样本2 065份,共对87份样品进行了确证试验,1 978份HIV抗体筛查阴性样品经核酸检测,有1份集合样品呈阳性。HIV抗体确证试验为阴性和不确定的6份样品,进行单份核酸检测,有4份HIV-1RNA阳性,病毒载量检测结果均符合HIV急性感染特征。此次研究中的MSM人群HIV感染率为4.16%(86/2 065),95%可信区间3.34%～5.12%。发现5例HIV急性感染者,估计该人群年发病率为3.16%,95%可信区间1.01%～7.35%。使用第三代抗体试剂进行筛查时,总费用为148 360元,其敏感性为94.2%(81/86)、特异性为100%,发现HIV感染者的单位成本为1 832.6元。使用第四代抗体试剂进行筛查时,总费用为166 080元,其敏感性为98.8%(85/86)、特异性为99.9%(1 977/1 979),发现HIV感染者的单位成本为1 953.9元。结论此次研究估测该人群的HIV感染年发病率为1.01%～7.35%,提示其高危性行为程度较高。在该人群中,使用第四代试剂筛查时,HIV感染者发现数比使用第三代试剂增加4.9%,发现HIV感染者的单位成本增加6.2%,提示具有推广应用价值。     

HIV testing and HIV knowledge among men who have sex with men in Natal,Northeast Brazil

Background

Men who have sex with men (MSM) account for the highest prevalence of HIV in Brazil. HIV testing allows to implement preventive measures, reduces transmission, morbidity, and mortality.