Risk behaviours of an interrelated syphilis-infected sexual network of men who have sex with men

AIMS AND OBJECTIVES:

We examined the risk behaviours in an interrelated sexual network of 33 syphilis-infected men who have sex with men on the use of condoms, substances and websites to meet sexual partners. Our study used a descriptive exploratory design to investigate co-occurring high-risk behaviours in this interrelated sexual network to inform future health interventions and research directions.

BACKGROUND:

Although the risk behaviours for human immunodeficiency virus transmission in men who have sex with men have been studied, few have studied the high-risk population of men who already have syphilis, and even fewer have studied the risk behaviours in sexual networks of syphilis-infected men who have sex with men who were identified using contact tracing.

DESIGN/METHODS:

The data were collected from semi-structured, individual interviews at a not-for-profit lesbian, gay, bisexual and transgender health centre in a large city in the Midwestern USA.

RESULTS:

Inconsistent condom use was substantial during both insertive (92%) and receptive (88%) anal intercourse. Most participants (97%) reported using one or more substances prior to or during anal intercourse, and Internet websites were the most common place to meet sexual partners (88%).

CONCLUSIONS:

High-risk behaviours were significant within this syphilis-infected sexual network of men who have sex with men. The majority of our 33 participants were non-Hispanic Whites (n = 27, 82%), possessed a baccalaureate degree or higher (n = 23, 70%), and actively sought out unprotected anal intercourse [21 participants (64%) used BareBackRT.com, a website to seek out unprotected anal intercourse].

RELEVANCE TO CLINICAL PRACTICE:

Nurses should be more informed about the risk factors of a high-risk sexual network of syphilis-infected men who have sex with men. Interrelated sexual networks have high levels of similarity among participants' high-risk behaviours; contact tracing may be used to identify individual participants for relevant risk-reduction interventions.

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By:  Diesterheft R¹, Brady JP², Shattell M^1,3.

¹School of Nursing, DePaul University, Chicago, IL, USA.

²Department of Psychology, DePaul University, Chicago, IL, USA.

³Department of Community, Systems, and Mental Health Nursing, Rush University, DePaul University, Chicago, IL, USA.

J Clin Nurs. 2016 Apr 22. doi: 10.1111/jocn.13209. [Epub ahead of print]

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Sexual Risk Behaviors and Substance Use among Men Sexually Victimized by Women

OBJECTIVES:

To investigate whether forced sex of men by women was associated with sexual risk behaviors, and whether this association was mediated by substance use.

METHODS:

Data from US men aged 18 years or older at interview in the National Survey of Family Growth 2006-2010 (n = 8108) who reported sexual behavior history. Outcome variables were condom use at most recent sex and number of lifetime sexual partners. Sexual activity covariates included age at first consensual sex and treatment of sexually transmitted infections. Alcohol and drug use were the mediating factors.

RESULTS:

Six percent of men reported forced sex by a woman at a mean age of 18 years. On average, victimized men had 3 more lifetime sexual partners than nonvictimized men (P < .01). Furthermore, victimized men who reported drug use had, on average, 4 more female sexual partners (P < .01) than nonvictimized men. Marijuana (P < .05) and crack cocaine use (P < .05) partially mediated the association between forced sex and number of female partners. Neither condom use nor number of male partners differed between victimized and nonvictimized men.

CONCLUSIONS:

A nontrivial fraction of men experience forced sex by women; some of them have elevated sexual risk behaviors. 

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By:  Cook MC1, Morisky DE1, Williams JK1, Ford CL1, Gee GC1.

• 1Mekeila C. Cook is with the University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs, Los Angeles, CA. Donald E. Morisky, Chandra L. Ford, and Gilbert C. Gee are with the UCLA Fielding School of Public Health, Department of Community Health Sciences. John K. Williams is with the UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior. 
• Am J Public Health. 2016 Apr 14:e1-e7.

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The impact of violence on sex risk and drug use behaviors among women engaged in sex work in Phnom Penh, Cambodia

HIGHLIGHTS

• Almost half the women engaged in sex work reported violence in the past 12 months.
• Prior physical violence exposure associated with subsequent sexual risk taking.
• Physical violence was associated with amphetamine type stimulant (ATS) use.
• Sexual violence was associated lower levels of condom use with non-paying partners.

BACKGROUND:

Violence, substance use, and HIV disproportionately impact female entertainment and sex workers (FESW), but causal pathways remain unclear.

METHODS:

We examined data from an observational cohort of FESW age 15-29 in Phnom Penh, Cambodia for associations between violence exposure and sexual risk and drug use. Validated measures of physical and sexual violence were assessed at baseline. Self-reported outcomes measured quarterly over the next 12-months included past month sexual partners, consistent condom use by partner type, sex while high, and amphetamine type stimulant (ATS) use. Biomarkers measured quarterly included prostate specific antigen (PSA) and urine toxicology. Generalized estimating equations were fit adjusting for age, education, marital status and sex work venue.

RESULTS:

Of 220 women, 48% reported physical or sexual violence in the preceding 12-months. Physical violence was associated with increased number of sex partners (adjusted incidence rate ratio [aIRR] 1.33; 95% CI: 1.04-1.71), greater odds of sex while high (adjusted odds ratio [aOR] 2.42; 95% CI: 1.10-5.33), increased days of ATS use (aIRR 2.74; 95% CI: 1.29-5.84) and increased odds of an ATS+ urine screen (aOR 2.80, 95%CI: 1.38-5.66). Sexual violence predicted decreased odds of consistent condom use with non-paying partners (aOR 0.24; 95% CI: 0.10-0.59) and greater odds of a PSA+ vaginal swab (aOR 1.83; 95% CI: 1.13-2.93).

CONCLUSIONS:

Physical and sexual violence are prevalent among Cambodian FESW and associated with subsequent sexual risk and drug use behaviors. Clinical research examining interventions targeting structural and interpersonal factors impacting violence is needed to optimize HIV/AIDS prevention among FESW.

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By:  Draughon Moret JE1, Carrico AW2, Evans JL3, Stein ES4, Couture MC5, Maher L6, Page K7; Young Women’s Health Study Collaborative.

• 1The Betty Irene Moore School of Nursing at UC Davis, 4610 X Street, #4202 Sacramento, CA 95817, United States. Electronic address: jdmoret@ucdavis.edu.
• 2University of California San Francisco, School of Nursing, 2 Koret Way, San Francisco, CA 94143, United States. Electronic address: adam.carrico@ucsf.edu.
• 3UCSF Global Health Sciences/Prevention and Public Health Group, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States. Electronic address: jennifer.evans@ucsf.edu.
• 4UCSF Global Health Sciences/Prevention and Public Health Group, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States. Electronic address: ellen.stein@ucsf.edu.
• 5University of San Francisco, School of Nursing and Health Professions, Department of Population Sciences, 2130 Fulton St., San Francisco, CA 94117, United States. Electronic address: mcouture@usfca.edu.
• 6The Kirby Institute for Infection and Immunity, UNSW Australia, Sydney, NSW 2052, Australia. Electronic address: lmaher@kirby.unsw.edu.au.
• 7Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico Health Sciences Center, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States. Electronic address: pagek@salud.unm.edu.
• Drug Alcohol Depend. 2016 Apr 1;161:171-7. doi: 10.1016/j.drugalcdep.2016.01.028. Epub 2016 Feb 6. 

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Mediators of the Relation Between Community Violence and Sexual Risk Behavior mong Adults Attending a Public Sexually Transmitted Infection Clinic

Prior research shows that violence is associated with sexual risk behavior, but little is known about the relation between community violence (i.e., violence that is witnessed or experienced in one's neighborhood) and sexual risk behavior. 

To better understand contextual influences on HIV risk behavior, we asked 508 adult patients attending a publicly funded STI clinic in the U.S. (54 % male, M _age = 27.93, 68 % African American) who were participating in a larger trial to complete a survey assessing exposure to community violence, sexual risk behavior, and potential mediators of the community violence-sexual risk behavior relation (i.e., mental health, substance use, and experiencing intimate partner violence). 

A separate sample of participants from the same trial completed measures of sexual behavior norms, which were aggregated to create measures of census tract sexual behavior norms. 

Data analyses controlling for socioeconomic status revealed that higher levels of community violence were associated with more sexual partners for men and with more episodes of unprotected sex with non-steady partners for women. 

For both men and women, substance use and mental health mediated the community violence-sexual risk behavior relation; in addition, for men only, experiencing intimate partner violence also mediated this relation. 

These results confirm that, for individuals living in communities with high levels of violence, sexual risk reduction interventions need to address intimate partner violence, substance use, and mental health to be optimally effective.

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By:  Senn TE1, Walsh JL2,3, Carey MP2.

• 1School of Nursing, University of Rochester, Box SON, 601 Elmwood Ave., Rochester, NY, 14642, USA. Theresa_Senn@urmc.rochester.edu.
• 2Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University, 164 Summit Ave., Providence, RI, 02906, USA.
• 3Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA. 
• Arch Sex Behav. 2016 Mar 21.

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Trauma Symptoms, Internalized Stigma, Social Support & Sexual Risk Behavior among HIV-Positive Gay & Bisexual MSM Who Have Sought Sex Partners Online

Gay, bisexual, and other men who have sex with men (MSM) remain the highest risk group for HIV infection. One reason is the increased use of the Internet to meet potential sex partners, which is associated with greater sexual risk behavior. 

To date, few studies have investigated psychosocial predictors of sexual risk behavior among gay and bisexual men seeking sex partners online. The purpose of the current study was to test a conceptual model of the relationships between trauma symptoms indexed on the event of HIV diagnosis, internalized HIV stigma, and social support on sexual risk behavior among gay and bisexual MSM who seek sex partners online. 

A sample of 142 gay and bisexual MSM recruited on- and offline completed a comprehensive online assessment battery assessing the factors noted above. A number of associations emerged; most notably internalized HIV stigma mediated the relationship between trauma-related symptoms indexed on the event of HIV diagnosis and sexual risk behavior with HIV-negative and unknown serostatus sex partners. This suggests that gay and bisexual MSM who are in greater distress over their HIV diagnosis and who are more sensitive to HIV stigma engage in more HIV transmission risk behavior. 

As sexual risk environments expand with the increasing use of the Internet to connect with others for sex, it is important to understand the predictors of sexual risk behavior so that tailored interventions can promote sexual health for gay and bisexual MSM seeking sex online.

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By:  Burnham KE1, Cruess DG1, Kalichman MO1, Grebler T1, Cherry C1, Kalichman SC1.

• 1 Department of Psychology , University of Connecticut , Storrs , CT , USA. 
• AIDS Care. 2016 Mar;28(3):347-53. doi: 10.1080/09540121.2015.1096894. Epub 2015 Oct 13.

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Pathways to Adolescent Sexual Risk Behaviors: Effects of Prenatal Cocaine Exposure

Highlights

• Prenatal cocaine exposure (PCE) was related to adolescent sexual risk.
• PCE is related to externalizing behavior, which increased early sexual intercourse.
• Substance use was related to early sexual intercourse and sexual risk behaviors.
• Reducing maternal drug use may mitigate offspring sexual risk behavior.

BACKGROUND:

To assess the impact of prenatal cocaine exposure (PCE) on adolescent sexual risk behaviors. Externalizing behavior, teen substance use, and early sexual intercourse were examined as pathways mediating the effects of PCE on sexual risk behaviors.

METHODS:

Adolescents (N=364; 185 PCE, 179 non-cocaine exposure (NCE); 205 girls, 159 boys), primarily African-American and of low socioeconomic status, were prospectively enrolled in a longitudinal study at birth. Risky sexual behaviors were assessed at ages 15 and 17. Externalizing behavior at 12 years was assessed with the Youth Self-Report. Substance use, via self-report and biologic assays, and early (before age 15) sexual intercourse were assessed at age 15. Path analyses with the weighted least squares estimator with mean and variance adjustments were performed.

RESULTS:

The final structural equation model-based path model, χ(2)=31.97 (df=27), p=.23, CFI=.99, TLI=.99, RMSEA=.021, WRMR=.695, indicated a direct effect of PCE on sexual risk behavior (β=.16, p=.02). Although PCE was related to greater externalizing behavior (β=.14, p=.009), which in turn, predicted early sexual intercourse (β=.16, p=.03), leading to sexual risk behavior (β=.44, p<.001), bootstrapping indicated a non-significant indirect effect (β=.01, p>.10). Substance use was correlated with early sexual intercourse (r=.60, p<.001) and predicted sexual risk behavior by age 17 (β=.31, p=.01).

CONCLUSIONS:

Prenatal cocaine exposure was related to more engagement in sexual risk behaviors, suggesting the importance of reducing substance use among pregnant women as a means of prevention of offspring substance use and sexual risk behavior.

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By:  Min MO1, Minnes S2, Lang A2, Albert JM3, Kim JY2, Singer LT4.

• 1Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Cleveland, OH, United States. Electronic address: meeyoung.min@case.edu.
• 2Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Cleveland, OH, United States.
• 3School of Medicine, Department of Epidemiology and Biostatistics, Cleveland, OH, United States.
• 4Departments of Environmental Health Sciences, Psychiatry & Pediatrics, Cleveland, OH, United States. 
• Drug Alcohol Depend. 2016 Apr 1;161:284-91. doi: 10.1016/j.drugalcdep.2016.02.013. Epub 2016 Feb 16.

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Characterization of HIV Transmission in South-East Austria

To gain deeper insight into the epidemiology of HIV-1 transmission in South-East Austria we performed a retrospective analysis of 259 HIV-1 partial pol sequences obtained from unique individuals newly diagnosed with HIV infection in South-East Austria from 2008 through 2014. 

After quality filtering, putative transmission linkages were inferred when two sequences were ≤1.5% genetically different. Multiple linkages were resolved into putative transmission clusters. Further phylogenetic analyses were performed using BEAST v1.8.1. Finally, we investigated putative links between the 259 sequences from South-East Austria and all publicly available HIV polymerase sequences in the Los Alamos National Laboratory HIV sequence database. 

We found that 45.6% (118/259) of the sampled sequences were genetically linked with at least one other sequence from South-East Austria forming putative transmission clusters. Clustering individuals were more likely to be men who have sex with men (MSM; p<0.001), infected with subtype B (p<0.001) or subtype F (p = 0.02). Among clustered males who reported only heterosexual (HSX) sex as an HIV risk, 47% clustered closely with MSM (either as pairs or within larger MSM clusters). One hundred and seven of the 259 sequences (41.3%) from South-East Austria had at least one putative inferred linkage with sequences from a total of 69 other countries. 

In conclusion, analysis of HIV-1 sequences from newly diagnosed individuals residing in South-East Austria revealed a high degree of national and international clustering mainly within MSM. Interestingly, we found that a high number of heterosexual males clustered within MSM networks, suggesting either linkage between risk groups or misrepresentation of sexual risk behaviors by subjects.

Below:  Intersection between the Global HIV Type 1 Endemic and South East Austria. A total of 107 (41.3%) of 259 sequences obtained in South-East Austria shared a putative link with sequences from foreign countries/regions. In this heat map with a gradient from 1 to 40 linkages, countries are colored by the number of putative links from yellow to red (i.e. red is 40 or more linkages). Unlinked countries are colored in white. 

Full article at:  http://goo.gl/FfuY0M

By:  

Martin Hoenigl, Antoine Chaillon, Susan J. Little, Sanjay R. Mehta
Division of Infectious Diseases, University of California San Diego, San Diego, California, United States of America

Martin Hoenigl
Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria

Martin Hoenigl
Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria

Harald H. Kessler, Evelyn Stelzl, Karin Weninger
Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria

Bernhard Haas
Department of Infectious Diseases, Landeskrankenhaus Graz West, Graz, Austria

Sanjay R. Mehta
Veterans Affairs Healthcare System, San Diego, California, United States of America

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Injecting Drug Use, Sexual Risk, HIV Knowledge & Harm Reduction Uptake in a Large Prison in Bali, Indonesia

Purpose
The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia. Design/methodology/approach - A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix. 

Findings
Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8 percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV. 

Research limitations/implications
The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics. 

Practical implications
The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting. Originality/value - This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

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By:  Sawitri AA1, Hartawan AA, Craine N, Sari AK, Septarini NW, Wirawan DN.

• 1Department of Community and Preventive Medicine, Udayana University Bali, Denpasar, Indonesia. 
• Int J Prison Health. 2016 Mar 14;12(1):27-38. doi: 10.1108/IJPH-05-2014-0011.

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Feasibility and Acceptability of Global Positioning System (GPS) Methods to Study the Spatial Contexts of Substance Use and Sexual Risk Behaviors among Young Men Who Have Sex with Men in New York City

BACKGROUND:

No global positioning system (GPS) technology study has been conducted among a sample of young gay, bisexual, and other men who have sex with men (YMSM). As such, the purpose of this study was to evaluate the feasibility and acceptability of using GPS methods to understand the spatial context of substance use and sexual risk behaviors among a sample of YMSM in New York City, a high-risk population.

METHODS:

Data came from a subsample of the ongoing P18 Cohort Study (n = 75). GPS feasibility and acceptability among participants was measured with: 1) a pre- and post-survey and 2) adherence to the GPS protocol which included returning the GPS device, self-report of charging and carrying the GPS device as well as objective data analyzed from the GPS devices. Analyses of the feasibility surveys were treated as repeated measures as each participant had a pre- and post-feasibility survey. When comparing the similar GPS survey items asked at baseline and at follow-up, we present percentages and associated p-values based on chi-square statistics.

RESULTS:

Participants reported high ratings of pre-GPS acceptability, ease of use, and low levels of wear-related concerns in addition to few concerns related to safety, loss, or appearance, which were maintained after baseline GPS feasibility data collection. The GPS return rate was 100%. Most participants charged and carried the GPS device on most days. Of the total of 75 participants with GPS data, 75 (100%) have at least one hour of GPS data for one day and 63 (84%) had at least one hour on all 7 days.

CONCLUSIONS:

Results from this pilot study demonstrate that utilizing GPS methods among YMSM is feasible and acceptable. GPS devices may be used in spatial epidemiology research in YMSM populations to understand place-based determinants of health such as substance use and sexual risk behaviors.

Below:  Comparison of Pre- and Post-GPS Feasibility and Acceptability Survey Items

Full article at:   http://goo.gl/Yw6u5Y

By:  Duncan DT1,2,3,4,5,6, Kapadia F1,2,3,4,5, Regan SD1, Goedel WC1,2, Levy MD4, Barton SC4, Friedman SR5,7, Halkitis PN1,2,3,4,5.

• 1Department of Population Health, New York University School of Medicine, New York, NY, United States of America.
• 2College of Global Public Health, New York University, New York, NY, United States of America.
• 3Population Center, New York University, New York, NY, United States of America.
• 4Center for Health, Identity, Behavior and Prevention Studies, New York University, New York, NY, United States of America.
• 5Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, United States of America.
• 6Center for Data Science, New York University, New York, NY, United States of America.
• 7Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY, United States of America. 
• PLoS One. 2016 Feb 26;11(2):e0147520. doi: 10.1371/journal.pone.0147520.

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Costa Rican Sex Workers’ Risk Behaviors and Attitudes Toward Government Regulation of Safe Sex Practices: An Exploratory Study

Via:  http://goo.gl/AJ1DMc