Correlates and Racial/Ethnic Differences in Bareback Sex among Men Who Have Sex with Men with Unknown or Negative HIV Serostatus

Men who have sex with men (MSM), particularly racial/ethnic minority MSM, are disproportionately affected by HIV in the United States and Texas. Bareback sex or condomless anal intercourse (CAI) can be a high HIV risk behavior. Despite this, a majority of MSM continues to engage in barebacking. Research suggests racial/ethnic differences in barebacking exist; however, these conclusions remain unclear due to insufficient sample sizes to compare racial/ethnic groups. 

Our cross-sectional correlational design explores barebacking correlates (substance use during sex, safe sex fatigue, and optimistic HIV treatment beliefs) within and between racial/ethnic groups among 366 MSM. Regression models are significant for Latino and African-American MSM alone and for all MSM combined, though not significant for European-American and Other Race/Ethnicity MSM alone. 

Our findings suggest motivations and behaviors underlying barebacking among MSM vary by racial/ethnic membership with clinical implications for informing culturally sensitive HIV interventions and prevention programs for target racial/ethnic groups.

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By:  Vosvick M1, Fritz S2, Henry D3, Prybutok V4, Sheu S5, Poe J5.

• 1Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA. Mark.Vosvick@unt.edu.
• 2Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA.
• 3Department of Anthropology, University of North Texas, Denton, TX, USA.
• 4Department of Information Technology & Decision Sciences, University of North Texas, Denton, TX, USA.
• 5TB/HIV/STD Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA. 
• AIDS Behav. 2016 Mar 16.

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Pre-Exposure Prophylaxis (PrEP) for Safer Conception among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities

Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV transmission among serodifferent couples trying to conceive, yet provider knowledge, attitudes, and experience utilizing PrEP for this purpose are largely unexamined. 

Trained interviewers conducted phone interviews with healthcare providers treating patients with HIV in seven cities (Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco, N = 85 total). 

Quantitative and qualitative data were analyzed to describe experience, concerns, and perceived barriers to prescribing PrEP for safer conception. Providers (67.1% female, 43 mean years of age, 70.4% white, 10 mean years treating HIV+ patients, 56% in academic vs. community facilities, 62.2% MD) discussed both benefits and concerns of PrEP for safer conception among serodifferent couples. 

Only 18.8% of providers reported experience prescribing PrEP, 74.2% were willing to prescribe it under ideal circumstances, and 7.0% were not comfortable prescribing PrEP. Benefits included added protection and a greater sense of control for the HIV-negative partner. Concerns were categorized as clinical, system-level, cost, or behavioral. 

Significant differences in provider characteristics existed across sites, but experience with PrEP for safer conception did not, p = 0.14. Despite limited experience, most providers were open to recommending PrEP for safer conception as long as patients understood the range of concerns and could make informed decisions. 

Strategies to identify and link serodifferent couples to PrEP services and clinical guidance specific to PrEP for safer conception are needed.

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By:  Finocchario-Kessler S1, Champassak S2, Hoyt MJ3, Short W4, Chakraborty R5, Weber S6, Levison J7, Phillips J3, Storm D3, Anderson J8.

• 1 Department of Family Medicine, University of Kansas Medical Center , Kansas City, Kansas.
• 2 Health Services and Outcomes Research, Children's Mercy Hospital , Kansas City, Missouri.
• 3 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey , Newark, New Jersey.
• 4 Division of Infectious Diseases, Perelman Schools of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
• 5 Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia .
• 6 HIVE, University of California San Francisco , San Francisco, California.
• 7 Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, Texas.
• 8 Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions , Baltimore, Maryland. 
• AIDS Patient Care STDS. 2016 Jan 29

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What's in the Telling? Understanding Social, Psychological & Clinical Aspects of HIV Disclosure

The course of HIV infection includes a parallel pathway of disclosure (Asudani, Corser, & Patel, 2004). Multiple types of HIV disclosure have been identified across a wide spectrum of HIV prevention and treatment cascade (Arnold, 2008; Arun, Singh, Lodha, & Kabra, 2009; Ateka, 2006; Bairan et al., 2007). They all need to be under the spotlight of academic research. HIV testing, often seen as an entry point to diagnosis and disease management, involves disclosure of risk behaviors and disclosure of partners on the part of the individual being tested and disclosure of test results on the part of the healthcare providers (Atuyambe et al., 2014; Bachanas et al., 2013; Bedell, van Lettow, & Landes, 2014). Onward disclosure of serostatus is then the complex behavior under consideration in most HIV disclosure research (Afifi & Afili,2009).

Disclosure, or self-disclosure, is a process in which personal (often private or confidential) information is verbally communicated from one person (i.e., the discloser) to another person (i.e., the target; Chelune,1979). HIV disclosure includes an array of behaviors associated with the practice in which HIV-infected persons disclose their HIV serostatus to their partners, family members, or friends; or when a child is informed of her/his own HIV status (Qiao, Li, & Stanton, 2013b). Essentially, it is the process of moving from unawareness to knowledge, invariably a unidirectional, irrevocable act (Li, de Wit, Qiao, & Sherr,2015). Disclosure has been viewed as an integral component in the public health effort to reduce incident HIV infections and improve HIV treatment and care (Remis, 2013). In detail, much research has also been done in terms of factors enabling or hindering disclosure, correlates and predictors of disclosure, preparation for disclosure and consequences of disclosure (Jorjoran Shushtari, Sajjadi, Forouzan, Salimi, & Dejman,2014; Kumar, Waterman, Kumari, & Carter, 2006; Latkin et al., 2012; Lee, Bastos, Bertoni, Malta, & Kerrigan, 2014; Liamputtong & Haritavorn, 2014; Linda, 2013; Lyimo et al., 2014).

Existing research and theorizing suggest that HIV disclosure is not a single event but a process of gradual and selective delivery of information embedded in the context of a social relationship (Lesch et al., 2007; Moses & Tomlinson, 2013). A growing number of empirical studies have focused on the process of HIV disclosure, including decision-making, disclosure patterns, and post-disclosure adjustment. These elements are shaped by various social, psychological and clinical factors (Bott & Obermeyer, 2013; Letteney, Krauss, & Kaplan, 2012; Li et al., 2007). Studies have elaborated a cycle of how HIV disclosure has had complex, often reciprocal influences on behavioral, psychosocial, and clinical aspects of the lives of HIV-infected individuals (Butler et al., 2009; Carballo-Dieguez, Miner, Dolezal, Rosser, & Jacoby, 2006; Dageid, Govender, & Gordon, 2012; De Baets, Sifovo, Parsons, & Pazvakavambwa, 2008). Disclosure has also been found to be layered with different needs, demands, and ramifications of various forms of disclosure ranging from sexual partners, to close family members, to friends and social acquaintances, to children, to employers, and to employees (Eustace & Ilagan, 2010; Fesko, 2001). Conceptual frameworks need to provide understanding of the drivers and inhibitors of disclosure, on variations in the disclosure process and how these may (or may not) affect various physical or psychosocial outcomes (Chaudoir & Fisher, 2010; Chaudoir, Fisher, & Simoni, 2011; Qiao et al., 2013b). Both intended and unintended consequences of disclosure need to be considered (Serovich, McDowell, & Grafsky, 2008; Shamu, Zarowsky, Shefer, Temmerman, & Abrahams, 2014). Active, coerced, and accidental disclosure may all have different effects on the behavior and mental health of all individuals concerned (Feigin, Sapir, Patinkin, & Turner, 2013)...

Full article at:   http://goo.gl/fTNxQ6

By:  Xiaoming Li, a , * Shan Qiao, a John de Wit, b and Lorraine Sherr c

^aDepartment of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA

^bCenter for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia

^cResearch Department of Infection & Population Health, University College London, London, UK

Contact Xiaoming Li ; Email: ude.cs.xobliam@gnimoaix

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Cross Sectional Study of Factors Associated to Self-Reported Blood-Borne Infections among Drug Users

The study’s aim was to estimate the self-reported prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV), and to describe their associated risk factors in a population of users of illicit drugs recruited in Catalonia- Spain, during 2012.

Cross-sectional study. People with illicit drugs use were selected in three different types of healthcare centres. The questionnaire was a piloted, structured ad hoc instrument. An analysis was made to identify factors associated to self-reported HCV, HIV and co-infection. Correlates of reported infections were determined using univariate and multivariate Poisson regression (with robust variance).

Among 512 participants, 39.65 % self-reported positive serostatus for HCV and 14.84 % for HIV, co-infection was reported by 13.48 %. Among the 224 injecting drug users (IDUs), 187 (83.48 %), 68 (30.36 %) and 66 (29.46 %) reported being positive for HCV, HIV and co-infection, respectively. A higher proportion of HIV-infected cases was observed among women, (18.33 % vs. 13.78 % in men). Prevalence of HCV, HIV and co-infection were higher among participants with early onset of drug consumption, long periods of drug injection or who were unemployed. A positive serostatus was self-reported by 21(7.34 %) participants who did not report any injection; among them 16 and eight, reported being positive for HCV and HIV, respectively; three reported co-infection. Only two people declared exchanging sex for money. For those that reported a negative test, the median time since the last HIV test was 11.41 months (inter-quartile range (IQR) 4–12) and for the HCV test was 4.5 months (IQR 2–7).

Among drug users in Catalonia, HIV, HCV and co-infection prevalence are still a big issue especially among IDUs. Women and drug users who have never injected drugs are groups with a significant risk of infection; this might be related to their high-risk behaviours and to being unaware of their serological status.

Full article at:  http://goo.gl/z6uwMi

By: Juliana Reyes-Urueña¹²³⁴, M. Teresa Brugal⁴⁵, Xavier Majo⁶, Antonia Domingo-Salvany^2*and Joan A. Caylà¹⁴⁵⁷

¹Department of Paediatrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain

²Drug Use Epidemiology Research Group, IMIM-Hospital del Mar Medical Research Institute, Dr Aiguader 88, Barcelona, 08003, Spain

³Teaching Unit of Preventive Medicine and Public Health, PSMAR-UPF-ASPB, Barcelona, Spain

⁴Public Health Agency of Barcelona, Barcelona, Spain

⁵Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain

⁶Department of Health Government of Catalonia, Barcelona, Spain

⁷CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain

 

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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.

Purchase full article at: http://goo.gl/gB0nHw

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

• 1a Department of Psychology , University of Connecticut , Storrs , CT , USA.  

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Seroadaptive Behaviors of Men Who Have Sex with Men in Myanmar

Serosorting (i.e., choosing partners of the same HIV serostatus to reduce the risk of transmission with unprotected sex) and other forms of seroadaptation (i.e., engaging in diverse behaviors according to a hierarchy of risk by type of sex and partner serostatus) are phenomena widely described for men who have sex with men (MSM) in the developed world. We assessed seroadaptive behaviors among MSM surveyed in Yangon, Myanmar in 2013-2014. 

Among HIV-negative MSM, 

• 43.1 % engaged in some form seroadaptation including 
• serosorting (21.8 %), 
• using condoms with potentially serodiscordant anal sex (19.3 %), and 
• seropositioning (1.7 %). 

Among HIV-positive MSM,

• 3.5 % engaged in serosorting, 
• 36.0 % in using condoms with potentially serodiscordant anal sex, 
• 7.0 % in seropositioning, and 
• 46.5 % in any form of seroadaptation. 

For HIV-negative and HIV-positive MSM, seroadaptation was more common than consistent condom use (38.0 and 26.7 %, respectively). MSM in Myanmar are engaging in seroadaptive behaviors in magnitude and ways similar to MSM in industrialized countries.

Purchase full article at: http://goo.gl/4Txc1a

By: Aung T1, Thein ST1, McFarland W2,3.

• 1Population Services International-Myanmar, Yangon, Myanmar.
• 2San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6033, USA. willi_mcfarland@hotmail.com.
• 3University of California, San Francisco, San Francisco, CA, USA. willi_mcfarland@hotmail.com.

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