Reasons for the adoption of celibacy among older men and women living with HIV/AIDS

The reasons for becoming celibate following diagnosis with HIV/AIDS were examined using focused interviews with 63 infected older adults (ages 50 ‐ 68). Forty‐eight percent reported they were currently celibate or had been celibate following diagnosis with HIV/AIDS. Women reported celibacy (78%) more than men (36%). Although men and women reported some similar reasons for celibacy, most notably fear of infecting others and fear of reinfection, we also found gender differences in the reasons for celibacy. Additional reasons offered by women included loss of interest in sex, anger and distrust of men, and desire to focus on themselves rather than men. Other reasons offered by men included fear of rejection or stigma‐tization, difficulty with sexual performance, and negative body image. The prevalence of celibacy and the finding that many reasons for celibacy are related to fear, anger, and distrust suggests that older adults may have difficulty resuming healthy sexual relationships following diagnosis with HIV/AIDS.     

Reasons for the adoption of celibacy among older men and women living with HIV/AIDS

The reasons for becoming celibate following diagnosis with HIV/AIDS were examined using focused interviews with 63 infected older adults (ages 50-68). Forty-eight percent reported they were currently celibate or had been celibate following diagnosis with HIV/AIDS. Women reported celibacy (78%) more than men (36%). Although men and women reported some similar reasons for celibacy, most notably fear of infecting others and fear of reinfection, we also found gender differences in the reasons for celibacy. Additional reasons offered by women included loss of interest in sex, anger and distrust of men, and desire to focus on themselves rather than men. Other reasons offered by men included fear of rejection or stigmatization, difficulty with sexual performance, and negative body image. The prevalence of celibacy and the finding that many reasons for celibacy are related to fear, anger, and distrust suggests that older adults may have difficulty resuming healthy sexual relationships following diagnosis with HIV/AIDS.     

How Far to Gay? The Politics of HIV in Learning Disability

This paper examines work in sexual health and HIV prevention in services for people with learning disabilities from a political stance associated with the rehomosexualisation of AIDS in Britain. Arguments are made for the re-homosexualisation of AIDS in services for people with learning disabilities, based on evidence of where HIV risk lies in relation to men with learning disabilities who have sex with men. This provides an opportunity to critically review approaches and responses to HIV risk assessment and risk management in services for people with learning disabilities, with reference to the assumptions which underpin practice and issues of sexual identity. The case is made for a more radical sexual politics in learning disability to help combat HIV and to provide more realistic approaches to service commissioning and safer sex education. Pointers for service development and key areas where the re-homosexualisation of AIDS can inform practice and resource development are also provided.     

Factors Associated with HIV Sexual Risk Behavior in Male Couples of Mixed HIV Status

Abstract

There are concerns that rates of unprotected anal intercourse and new HIV infections among some gay men have remained at or returned to dangerous levels, similar to those seen in the first decade of the epidemic. Most research on sexual risk behavior of gay men has focused on individuals even though several studies have indicated that unprotected anal intercourse (the most risky of sexual behaviors) is most likely to occur between two men who are regular partners.

This study was conducted with 75 HIV serodiscordant (“mixed HIV status”) male couples. The goals were to assess the types and prevalence of sexual risk behaviors within these dyads, to identify reasons given for engaging in risk behavior with their partner of opposite HIV status, and to examine the association, if any, between risk behaviors and potential individual and partner related factors and context. Both members of the couple were included in all assessments.

There was a tendency for unprotected anal sex to occur more often among younger men, newer couples, Latino men, and men with less education. Lower risk perception and self-efficacy for condom use, desire for sexual spontaneity, intimacy, and personal and partner satisfaction were all related to sexual risk behavior. The men in these relationships also used specific “harm reduction” strategies, based on their own understanding of transmission risk. Therefore it is important to integrate biological and behavioral knowledge to develop effective prevention campaigns. And prevention programs need to consider the ongoing emotional needs of both the HIV seronegative (HIV-) and HIV sero-positive (HIV+) partner.     

Vietnamese American sexual behaviors & HIV infection

This brief report presents some preliminary findings of an on‐going ethnosexual field study of Vietnamese American sexual behaviors in Orange County, California, and indicates how they may be related to HIV infection. The primary objective of the study is to gather data on those sexual behaviors having the highest likelihood of transmitting the AIDS virus. The field research data indicate that in the ‘Vietnamese American population, highly acculturated Vietnamese homosexual men, whose partner preference is primarily for Anglo men with whom they play both sexual roles in anal intercourse, appear at present to be at highest risk for HIV infection. Transmission of the AIDS virus within the Vietnamese American population may be facilitated by Vietnamese American men who practice unsafe sex with both Anglo and Vietnamese men. The field research data also indicate that a potential exists for the spread of HIV into the heterosexual population through the sexual activity of Vietnamese men with non‐Vietnamese female prostitutes in California and Mexico, and through the sexual activity of ‘Vietnamese men with Thai and Vietnamese prostitutes in Thailand and Vietnam while on return visits to Southeast Asia.     

Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men

Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N = 647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.     

HIV and the Cycle of Trauma in Gay Men

Summary

Forged within the sociocultural context of the collective trauma of AIDS, HIV prevention efforts became rigid, focusing almost exclusively on patient education as risk reduction. However, while some people have not been able to incorporate risk reduction into their behavioral patterns, others have indeed returned to high-risk behavior after a period of reduced risk as evidenced by the “Bareback” movement. HIV prevention education has overlooked the effect of oppression and sexual trauma on the lives of gay men, and the impact of these phenomena on the gay male's interest in, and ability to, negotiate safer sex. Sexual trauma has been shown to have a direct effect on HIV risk and seropositivity. Additionally, as sexual trauma (often in the form of homophobia) and HIV infection have numerous parallels, the gay man may have analogous ways of relating to, processing and dealing with the two phenomena. Case histories are offered to illustrate how the relationship between HIV and sexual trauma may be examined in an effort to enhance the self-esteem and self-concept of the gay man, and thereby offer greater possibilities for him to protect himself.     

Human immunodeficiency virus (HIV) seropositive homeless men: Behavioral and social characteristics

Homeless persons living in U.S. innercities are at risk for human immunodeficiency virus (HIV) infection, but few studies have examined the continued risk behaviors of HIV infected homeless men. We investigated the sexual behavior of 32 homeless men who had tested HIV seropositive. Twenty-five percent of HIV positive men reported a history of injection drug use, 34% had sex with men, over 40% had participated in commercial sex, and 59% had been treated for a non-HIV sexually transmitted disease. HIV seropositive men also reported recent sexual behavior, with 62% having sex in the previous month and 50% currently sexually active. Condom use was inconsistent among seropositive men; 44% of vaginal and 50% of anal intercourse occasions in the preceding three months did not involve condoms, and 28% of HIV seropositive men did not use a condom during their most recent sexual encounter. Substance use was frequently associated with unprotected sexual behavior among HIV seropositive men. Finally, measures of life satisfaction showed that HIV seropositive men were most satisfied with their relationships, mental health, and spiritual well being. These data suggest a need for intensive behavioral interventions tailored for homeless HIV infected men and we recommend that existing substance use treatment and holistic care be incorporated into behavioral interventions for HIV infected men.     

Research with Gay Drug Users and the Interface with HIV

Abstract

Studying the co-occurrence of drug use and sexual risk behaviors among gay men poses special challenges for research. The importance of conducting such research, however, is underscored by current trends in the gay community, including increases in methamphetamine and club drug use. This increase has been associated with high-risk behavior for the transmission of HIV and other diseases (e.g., hepatitis B and hepatitis C). The author describes methodological issues related to initiating and conducting research among gay male drug users, and discusses how such research can guide more effective prevention, treatment, and policy initiatives related to drug abuse and HIV/AIDS.     

Chapter 10: Issues in HIV/AIDS Service Delivery to High Risk Youth

Homeless and runaway youth engage in behavior that puts them at risk for infection with HIV, the virus that causes AIDS. Prevalence of HIV disease in homeless and runaway youth is higher than it is among other adolescents. In addition, homeless and runaway youth are often forced to engage in sex as a means of survival. Although they engage in high risk behavior, AIDS education programs have neglected them as a target group for education. To some extent, they have been included in other more general categories of persons with AIDS risk behaviors, such as men who have sex with men or intravenous drug users. However, the number of adolescents receiving age-specific HIV/AIDS information is far below the number infected (Hein et al., 1992). Often high risk youth are disenfranchised, having been forced from home by their families after disclosing their gay or lesbian identities. Lacking a political voice and having no spokesperson, they represent a group with complex unmet needs. These youth typically have immediate needs for food, shelter, and clothing. In addition, they often need medical management, mental health and drug counseling, crisis management, and HIV/AIDS information. These needs are often overwhelming to the agencies that serve youth. This article examines the barriers and issues that exist in providing services to high risk youth. Then, suggsetions for removing those barriers by empowering both service providers and youth are offered. Some of the suggestions are based upon the authors' own experience in providing HIV/AIDS in-service training to service providers to high risk youth. The article makes recommendations for policy on youth and HIV/AIDS.     

HIV Risk in Gay and Lesbian Adolescents

Adolescents, regardless of sexual orientations, are not increased risk for HIV infection. Although the number of infected adolescents remains small, the number of adolescent AIDS cases is approximately doubling each year. This suggests that the rate of HIV infection among adolescents is expanding in a similar fashion to that seen among gay men in the early years of the epidemic. The purpose of this paper is to provide a framework for understanding the problems of HIV infection as it related to the gay and lesbian adolescent. This framework is grounded in developmental theory, though key social, political, economic, and policy factors which are believed to contribute to the infection of HIV among gay and lesbian adolescents will also be presented. It will be argued that social practitioners who are working in the HIV and AIDS arena would do well to reexamine the paradigm, which governs existing practice methodology.     

Minority Stress Theory: An Examination of Factors Surrounding Sexual Risk Behavior Among Gay and Bisexual Men Who Use Club Drugs

Background: Few studies have examined the impact of minority stress theory (MST) upon sexual risk behavior among gay and bisexual men using club drugs. Similar studies have focused on ethnic minorities and women; however, gay and bisexual men demonstrate greater likelihood for risk behaviors leading to HIV/AIDS. Objective: This study examines sexual risk behavior from the perspective of minority stress theory upon substance-using gay and bisexual men and their partners. Methods: Multivariable logistic regression analysis examined minority stress associations with participant sexual risk behaviors, drug use, and partner type, controlling for demographics. Results: 396 gay and 54 bisexual respondents, ages 18–67, reported at least one-time drug use while engaging in sexual risk behavior. In the adjusted model, expectations of rejection associated with lower odds of sexual risk behavior, while older age approached significance. Conclusions: Theoretical origins for examining risk behavior among gay and bisexual men may underscore risk and protective factors, while ultimately holding implications for prevention and treatment interventions.     

Human Immunodeficiency Virus (HIV) Seropositive Homeless Men: Behavioral and Social Characteristics

Homeless persons living in US. innercities are at risk for human immunodeficiency virus (HW) infection, but few studies have examined the continued risk behaviors of HIV infected homeless men. We investigated the sexual behavior of 32 homeless men who had tested HIV seropositive. Twenty-five percent of HW positive men reported a history of injection drug use, 34% had sex with men, over 40% had participated in commercial sex, and 59% had been treated for a non-HIV sexually transmitted disease. HIV seropositive men also reported recent sexual behavior, with 62% having sex in the previous month and 50% currently sexually active. Condom use was inconsistent among seropositive men; 44% of vaginal and 50% of anal intercourse occasions in the preceding three months did not involve condoms, and 28% of HW seropositive men did not use a condom during their most recent sexual encounter. Substance use was frequently associated with unprotected sexual behavior among HW seropositive men. Finally, measures of life satisfaction showed that HIV seropositive men were most satisfied with their relationships, mental health, and spiritual well being. These data suggest a need for intensive behavioral.interventions tailored for homeless HW infected men and we recommend that existing substance use treatment and holistic care be incorporated into behavioral interventions for HW infected men.     

Contributions of Qualitative Research in Informing HIV/AIDS Interventions Targeting Black MSM in the United States

This article presents a systematic review of qualitative studies focusing on human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among Black men who have sex with men (BMSM) in the United States. We reviewed studies that were published between 1980 and 2014. Qualitative methods employed in the studies reviewed include in-depth interviews, focus groups, participant observation, and ethnography. We searched several databases (PubMed, PsychINFO, JSTOR, ERIC, Sociological Abstracts, and Google Scholar) for relevant articles using the following broad terms: “Black men” “Black gay/bisexual” or “Black men who have sex with men,” and “qualitative” and/or “ethnography.” We include 70 studies in this review. The key themes observed across studies were (1) heterogeneity, (2) layered stigma and intersectionality, (3) risk behaviors, (4) mental health, (5) resilience, and (6) community engagement. The review suggests that sexual behavior and HIV-status disclosure, sexual risk taking, substance use, and psychological well-being were contextually situated. Interventions occurring at multiple levels and within multiple contexts are needed to reduce stigma within the Black community. Similarly, structural interventions targeting religious groups, schools, and health care systems are needed to improve the health outcomes among BMSM. Community engagement and using community-based participatory research methods may facilitate the development and implementation of culturally appropriate HIV/AIDS interventions targeting BMSM.     

Aging with HIV: Historical and Intra-Community Differences in Experience of Aging with HIV

Gay men living with HIV/AIDS face a complex of health issues, including those associated with the aging process, long-term HIV infection (25 years or more), and side effects from Highly Active Anti-Retroviral Therapy (HAART). If aging can increase marginalization, this is more likely for the aging HIV positive gay man, who is already marginalized for being queer and living with a stigmatizing disease. This article presents findings from a study of a long-running HIV support group. It locates the members, all gay men living with HIV, in a specific historical and political context to explore how feelings of loss and the struggle to sustain community affect long-term survivors and other older HIV+ gay men. We identify specific challenges presented by aging for men who contracted HIV early in the epidemic, contrasting them with those faced by men infected with the virus later in life. While both groups appear to struggle with a vision of what life could have been, had AIDS not forced loss and change, they also celebrate the community their shared plight has enabled.     

Gay Men and HIV

SUMMARY

This paper reports on the results of qualitative studies examining the personal experiences of sex and sexual negotiation for British gay men who are diagnosed HIV positive and those who know or presume themselves to be uninfected. These are contrasted with the results of a study of representations of HIV and AIDS within an international review of community health promotion literature aimed at gay men. The paper highlights the disparity between specific community responses to the epidemic as engendered in the cultural production of health promotion materials and the individual experience of HIV, suggesting a! paradigm for a community response to the epidemic which reflects the personal experience of gay men both infected and uninfected.     

Chapter 7: Lesbians and Gays of Color and HIV/AIDS:

Motivated by a desire to determine if the human service literature reflected the "changing face of AIDS," we reviewed 40 articles addressing needs and issues of gays and lesbians of color. Our review of the multidisciplinary literature confirmed our initial assumption that, despite considerable discussion about the particular needs of lesbians and gay HIV-infected people of color, we could not find an extensive qualitative or quantitative body of research about those needs. An additional finding was the total neglect of minority lesbians and their need for HIV-prevention information. The articles specific to minority gay men were few in number. The majority of studies reviewed dealth quite generally with the risk of HIV transmission among people of color, without specific reference to sexual orientation.     

Sexual behavior patterns of gay university men: implications for preventing HIV infection.

Gay male university students less than 25 years old were studied to determine whether they had changed their sexual activity patterns to reduce the risk of HIV infection. Most had not established sexual behavior patterns typical of the older gay men who had been studied in earlier research. Although most of the participants surveyed were concerned about HIV infection, some did engage in risky sexual behavior. The risk-reduction strategies most often used were having fewer sexual partners and being more selective in choosing partners. Future HIV-prevention interventions must be designed to address the needs of this generation of gay men.     

Body image, body satisfaction, and unsafe anal intercourse among men who have sex with men

Using survey results from the 1998 Twin Cities Lesbian, Gay, Bisexual, and Transgender (LGBT) Pride Festival (N = 535), we explored associations between body image and unsafe anal intercourse (UAI) among men who have sex with men (MSM), and evaluated whether body satisfaction mediated this association. MSM who reported underweight body image had lower odds than those who reported average weight of UAI (AOR = 0.33; 95% CI = 0.13, 0.85); body satisfaction was not found to mediate this association. 13.3% of men who reported overweight/obese body image had engaged in UAI compared with 21.6% of those who reported average weight and 8.2% of those who reported underweight (p < .05). Compared with MSM in exclusive relationships, MSM in non exclusive relationships had increased odds of UAI (AOR = 5.78; 95% CI = 2.96, 11.29) as did men who were not partnered (AOR = 3.20; 95% CI = 1.72, 5.93). These findings highlight the importance of including body image in sexual behavior models of MSM to better understand body image's role in influencing sexual risk and sexually transmitted infections (STI)/human immunodeficiency virus (HIV) transmission.