Exchange Sex and HIV Infection among Men Who Have Sex with Men: 20 US Cities, 2011

This study assessed the prevalence of exchanging sex for money or drugs among men who have sex with men (MSM) in the 2011 US National HIV Behavioral Surveillance system. Prevalence of HIV, being HIV-positive but unaware (HIV-positive-unaware), risk behaviors and use of services were compared between MSM who did and did not receive money or drugs from one or more casual male partners in exchange for oral or anal sex in the past 12 months. 

Among 8411 MSM, 7.0 % exchanged sex. MSM who exchanged sex were more likely to be non-Hispanic black, live in poverty, have injected drugs, have multiple condomless anal sex partners, be HIV-positive and be HIV-positive-unaware. 

In multivariable analysis, exchange sex was associated with being HIV-positive-unaware (aPR 1.34, 95 % CI 1.05-1.69) after adjusting for race/ethnicity, age, education, poverty, and injecting drugs. 

MSM who exchange sex represent an important group to reach with HIV prevention, testing, and care services as they were more likely to report behavioral risk factors that put them at risk of HIV.

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

By: M Nerlander L^1,2, Hess KL³, Sionean C³, E Rose C³, Thorson A⁴, Broz D³, Paz-Bailey G³.

¹Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E46, Atlanta, GA, 30329, USA. vif7@cdc.gov.

²Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. vif7@cdc.gov.

³Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E46, Atlanta, GA, 30329, USA.

⁴Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

AIDS Behav. 2016 Jun 15. [Epub ahead of print]

  

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Syphilis among middle-aged female sex workers in China: A three-site cross-sectional study

OBJECTIVES:

This study addresses the lack of empirical studies about the epidemic of syphilis among middle-aged female sex workers (FSWs). The objectives of this study were to investigate prevalence of syphilis, and its potential risk factors among middle-aged FSWs in China.

DESIGN:

A cross-sectional study with respondent-driven sampling (RDS).

SETTING:

A multisite study conducted at three Chinese cites (Nanning, Hefei, and Qingdao) with different levels of sexually transmitted diseases in 2014.

PARTICIPANTS:

1245 middle-aged female sex workers who were over 35 years old (about 400 per study site).

MAIN OUTCOME MEASURES:

Unprotected commercial sex, and syphilis and HIV infection were biologically tested and measured.

RESULTS:

The RDS-adjusted prevalence of active syphilis was 17.3% in Hefei, 9.9% in Qingdao, and 5.4% in Nanning. The RDS-adjusted prevalence of prevalent syphilis was between 6.8% and 33.6% in the three cities. The proportion of unprotected sex in the past 48 h verified by the prostate-specific antigen test (PSA) was between 27.8% and 42.4%. Multiple log-binomial regression analyses indicate that middle-aged FSWs who had 5 or more clients in the past week prior to interviews and engaged in unprotected sex were more likely to be active syphilitic cases. Middle-aged FSWs who had rural residency were less likely to be active syphilitic cases.

CONCLUSIONS:

In contrast with previous studies that reported low prevalence of syphilis and high prevalence of protected sex among FSWs in China, both the prevalence of syphilis and unprotected sex were high among middle-aged FSWs. Evidence-based intervention programmes should be developed and evaluated among this vulnerable population in China and other countries with similar settings.

Below: Location of the three study sites (Qingdao, Hefei, and Nanning)

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

By:  Liu H¹, Dumenci L², Morisky DE³, Xu Y⁴, Li X⁵, Jiang B⁶.

¹Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA.

²Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA.

³Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA.

⁴Department of AIDS/STD Prevention, Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China.

⁵Department of AIDS/STD Prevention, Hefei Center for Disease Control and Prevention, Hefei, Anhui, China.

⁶Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandon, China.

BMJ Open. 2016 May 10;6(5):e010420. doi: 10.1136/bmjopen-2015-010420.

  

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HIV Disclosure and Transmission Risks to Sex Partners among HIV-Positive Men

Disclosure of HIV-positive status to sex partners is critical to protecting uninfected partners. In addition, people living with HIV often risk criminal prosecution when they do not inform sex partners of their HIV status. 

The current study examined factors associated with nondisclosure of HIV status by men living with HIV in Atlanta, GA (92% African African, mean age = 43.8), who engage in condomless sex with uninfected sex partners. 

Sexually active HIV-positive men (N = 538) completed daily electronic sexual behavior assessments over the course of 28 days and completed computerized interviews, drug testing, medication adherence assessments, and HIV viral load retrieved from medical records. 

Results showed that 

• 30% men had engaged in condomless vaginal or anal intercourse with an HIV-uninfected or unknown HIV status sex partner to whom they had not disclosed their HIV status. 
• Men who engaged in nondisclosed condomless sex were 
• less adherent to their HIV treatment, 
• more likely to have unsuppressed HIV, 
• demonstrated poorer disclosure self-efficacy, 
• enacted fewer risk reduction communication skills, and 
• held more beliefs that people with HIV are less infectious when treated with antiretroviral therapy. 

We conclude that undisclosed HIV status is common and related to condomless sex with uninfected partners. Men who engage in nondisclosed condomless sex may also be more infectious given their nonadherence and viral load. 

Interventions are needed in HIV treatment as prevention contexts that attend to disclosure laws and enhance disclosure self-efficacy, improve risk reduction communication skills, and increase understanding of HIV infectiousness.

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By:  Kalichman SC1, Kalichman MO1, Cherry C1, Grebler T1.

• 1Department of Psychology, University of Connecticut , Storrs, Connecticut.
• AIDS Patient Care STDS. 2016 May;30(5):221-8. doi: 10.1089/apc.2015.0333. 

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Viewing of Internet-Based Sexually Explicit Media as a Risk Factor for Condomless Anal Sex among Men Who Have Sex with Men in Four U.S. Cities

The last decade has seen a dramatic increase in the availability of sexually explicit media (SEM) on the Internet. Men who have sex with men (MSM) report near universal use of SEM. However, this widespread use of SEM among MSM may contribute to more condomless anal sex. 

To examine the association of viewing SEM on the Internet and the number of condomless anal sex encounters among MSM, in 2012, an online survey was conducted of 265 MSM from New York, Philadelphia, Baltimore, or Washington D.C. who reported viewing SEM online in the past 3 months. Analyses were performed using negative binomial regression. 

Nearly all men reported viewing SEM featuring anal sex with (91%) or without (92%) condoms in the past 3 months. Neither viewing more hours of SEM per week or compulsively viewing SEM were associated with more condomless anal sex encounters. Rather, viewing a greater proportion of SEM containing condomless anal sex was associated with engaging in more condomless anal encounters (IRR = 1.25), while viewing a greater proportion of SEM containing anal sex where condoms were used was associated with fewer condomless anal sex encounters (IRR = 0.62). MSM reported that viewing SEM caused changes in their sexual fantasies, desires, and behaviors. 

These findings provide important insights for health policy and the design of interventions addressing SEM and condomless sex among MSM. The findings suggest that condom use by SEM performers may benefit not only actor health, but also have health implications for SEM viewers.

Below:  Perceptions of the Influence of SEM (N = 265)

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

By:

Eric W. Schrimshaw, Nadav Antebi-Gruszka
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America

Martin J. Downing Jr.
Research and Evaluation, Public Health Solutions, Inc., New York, New York, United States of America

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The Influence of Sensation-Seeking & Parental & Peer Influences in Early Adolescence on Risk Involvement through Middle Adolescence

This study examined the relationships between youth and parental sensation-seeking, peer influence, parental monitoring and youth risk involvement in adolescence using structural equation modeling. 

Beginning in grade-six, longitudinal data were collected from 543 students over three years. Youth sensation-seeking in grade six contributed to risk involvement in early adolescence (grades six and seven) indirectly through increased peer risk influence and decreased parental monitoring but did not have a direct contribution. It contributed directly and indirectly to risk involvement in middle adolescence (grades eight and nine). 

Parent sensation-seeking at baseline was positively associated with peer risk influence and negatively associated with parental monitoring; it had no direct effect on adolescent risk involvement. Parental monitoring buffers negative peer influence on adolescent risk involvement. 

Results highlight the need for intervention efforts to provide normative feedback about adolescent risky behaviors and to vary among families in which parents and/or youth have high sensation-seeking propensities.

Proportions of youth involved in risky behaviors at baseline, 12, 24, and 36 months

Risky behaviors	Baseline	12 months	24 months	36 months	z
Sample size	543	494	458	451
Delinquent behaviors
Was suspended from school	1.9%	2.5%	11.9%	16.9%	9.12c
Was truant	3.2%	1.9%	3.8%	3.6%	0.82
Carried a weapon	4.4%	4.1%	5.3%	9.7%	3.45c
Engaged in a fight	33.2%	21.8%	22.5%	24.6%	3.20b
Substance use behaviors
Smoked cigarettes	2.0%	1.6%	2.4%	1.8%	0.01
Drank alcohol	18.5%	14.7%	18.6%	29.3%	3.60c
Used marijuana	0.4%	1.0%	1.1%	2.7%	2.97b
Sold or carried drugs	1.1%	0.6%	1.3%	2.2%	1.58
Been asked to sell drugs	1.5%	1.6%	2.4%	2.7%	1.47
Sexual behaviors
Ever had sex	3.6%	9.6%	20.8%	28.6%	13.90c
Had sex in the last 6 months	1.0%	3.1%	7.9%	13.7%	9.15c
Ever had anal sex	0.8%	2.1%	6.8%	8.7%	8.14c
Had multiple sex partners	0.2%	0.6%	2.9%	4.4%	6.12c
Did not use a condom during last sexual encounter	66.7%	59.6%	44.0%	27.3%	5.04c

Full article at:   http://goo.gl/IZYp7q

By:  Bo Wang,1 Lynette Deveaux,2 Sonja Lunn,2 Veronica Dinaj-Koci,1 Xiaoming Li,1 and Bonita Stanton1

¹Pediatric Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, USA

²Office of HIV/AIDS, the Bahamas Ministry of Health, Nassau, The Bahamas

Corresponding author: Bo Wang, Ph.D., Pediatric Prevention Research Center, Wayne State University School of Medicine, 4707 St. Antoine, Suite W534, Detroit, MI 48201, Phone: 313-966-2366, Fax: 313-745-4993

Youth Soc. 2016 Mar; 48(2): 220–241.

Published online 2013 May 6. doi:  10.1177/0044118X13487228

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Relationships among Substance Use, Multiple Sexual Partners & Condomless Sex: Differences Between Male & Female U.S. High School Adolescents

Male and female students manifest different behaviors in condomless sex. This cross-sectional, exploratory, correlational study examined the differences in risk factors for condomless sex between male and female high school students, using secondary data from 4,968 sexually active males and females participating in the 2011 National Youth Risk Behavior Survey. 

Results in descriptive statistics and multivariate binary logistic regressions revealed that condomless sex was reported as 39.70% in general. A greater proportion of females engaged in condomless sex (23.26%) than did males (16.44%). 

Physical abuse by sex partners was a common reason for failure to use condoms regardless of gender. Lower condom use was found in 

• those experiencing forced sex by a partner in males, 
• female smokers, and 
• female with multiple sex partners. 

Thus, sexual health education should address the different risk factors and consider gender characteristics to reduce condomless sex.

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By:  Zhao YL1, Kim H2, Peltzer J3.

• 1School of Nursing, University of Kansas, Kansas City, KS, USA School of Nursing, Boise State University, Boise, ID, USA.
• 2College of Nursing, Yonsei University, Seoul, South Korea Mo-Im Kim Nursing Research Institute, Seoul, South Korea hkim80@yuhs.ac.
• 3School of Nursing, University of Kansas, Kansas City, KS, USA. 
• J Sch Nurs. 2016 Mar 31. pii: 1059840516635712

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An Initial Typology of Contexts of Dyadic Sexual Encounters Between Men & Associations with Sexual Risk & Pleasure

Background:

Although many within-subjects comparisons conducted on samples of men who have sex with men have sought to understand the association between specific situational characteristics (e.g. drug use or location of sex) and sexual risk behaviour, none have considered the 'clustering' of patterns of situational characteristics. An initial typology of sexual encounters is derived and the relationship of this typology to condomless anal intercourse (CAI) and pleasure is tested.

Methods:

Data from a longitudinal survey of men who have sex with men living in England were used. Multilevel latent class analyses were estimated to determine an optimal class solution on the situational characteristics, and then pseudo-imputation was used to estimate the association between class and both CAI and pleasure.

Results:

A three-class solution fit the data best, with a scaled relative entropy of 92.4%. Classes were characterised as featuring: regular steady partners in private locations with low drug use

• Class 1, casual partners with increased probability of sex occurring in a sex-on-premises venue 
• Class 2, and high levels of polydrug use together with increased probability of casual partners
• Class 3. Encounters were different both in pairwise comparisons and overall on probability of CAI. 

They were different overall but not necessarily pairwise on pleasure.

Conclusions:

These initial findings demonstrate the possibility of understanding sexual encounters in terms of the contexts, or classes, within which they occur. This may have implications for tailoring HIV prevention to specific encounter types. Future research should seek to extend encounter-level typologies to specific drug use variables.

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By:  G. J. Melendez-Torres A D, Ford Hickson B, David Reid B, Peter Weatherburn B andChris Bonell C 

A Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry. B Sigma Research, London School of Hygiene and Tropical Medicine. C Department of Social Science, UCL Institute of Education, University College London D Corresponding author. Email: G.Melendez-Torres@warwick.ac.uk 

Sex Health. 2016 Mar 9. doi: 10.1071/SH15218

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Alcohol Abuse Increases the Risk of HIV Infection & Diminishes Health Status of Clients Attending HIV Testing Services in Vietnam

BACKGROUND:

Vietnam is among those countries with the highest drinking prevalence. In this study, we examined the prevalence of alcohol use disorders (AUDs) and its associations with HIV risky behaviors, health care utilization, and health-related quality of life (HRQOL) among clients using voluntary HIV testing and counseling services (VCT).

METHODS:

A cross-sectional survey of 365 VCT clients (71 % male; mean age 34) was conducted in Hanoi and Nam Dinh province. AUD and HRQOL were measured using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and EuroQol-five dimensions-five levels (EQ-5D-5L). Risky sexual behaviors, concurrent opioid use, and inpatient and outpatient service use were self-reported.

RESULTS:

67.2 % clients were lifetime ever drinkers of those 62.9 % were hazardous drinkers and 82.0 % were binge drinkers. There were 48.8 % respondents who had ≥2 sex partners over the past year and 55.4, 38.3, and 46.1 % did not use condom in the last sex with primary/casual/commercial sex partners, respectively. Multivariate models show that AUD was significantly associated with risky sexual behaviors, using inpatient care and lower HRQOL among VCT clients.

CONCLUSIONS:

AUD was prevalent, was associated with increased risks of HIV infection, and diminished health status among VCT clients. It may be efficient to screen for AUD and refer at-risk clients to appropriate AUD counseling and treatment along with HIV-related services.

Sexual risk behaviors and history of drug use among VCT clients in 2013 (n = 365)

Factors	Rural		Urban		Total		p value
	N	%	N	%	N	%
Ever had sex	90	90.9	257	96.6	347	95.1	0.03
Number of sex partners (in the last 12 months)
Not had anyone	34	34.3	18	6.8	52	14.3	<0.01
One sex partners	52	52.5	118	44.4	170	46.6
2–3 sex partners	6	6.1	94	35.3	100	27.4
>4 sex partners	7	7.1	36	13.5	43	11.8
Type of sex partners
Primary partners	68	68.7	238	89.5	306	83.8	<0.01
Casual sex partners	0	0.0	64	24.1	64	17.5	<0.01
Sex workers	16	16.2	64	24.1	80	21.9	0.10
Non-condom use with last sex
With primary sex partners (n = 305)	42	62.3	127	53.4	169	55.4	0.18
With casual sex partners (n = 60)	0	0.0	23	38.3	23	38.3	-
With sex workers (n = 76)	16	100.0	19	31.7	35	46.1	<0.01
Ever drug use	4	4.0	34	12.8	38	10.4	0.02
Ever inject drug	2	2.0	23	8.7	25	6.9	0.03
Current drug use	2	50.0	13	38.2	15	39.5	0.65

Full article at:   http://goo.gl/3cJBg1

By:  Tran BX1,2, Nguyen LH3,4, Nguyen CT5, Phan HT6, Latkin CA7.

• 1Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. bach@hmu.edu.vn.
• 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. bach@hmu.edu.vn.
• 3Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
• 4School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
• 5Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
• 6Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
• 7Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 
• Harm Reduct J. 2016 Feb 16;13(1):6. doi: 10.1186/s12954-016-0096-z.

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