Disparities Between HIV Testing Levels and the Self-Reported HIV-Negative Status of Sexually Active College Students

The methodological issues of using self-reported human immunodeficiency virus (HIV) testing history to determine HIV infection status are understudied. This study aimed to assess the disparities between HIV testing history and self-reported HIV status, with a specific objective of estimating the prevalence of self-reported HIV-negative status in sexually active students who had never had an HIV test (inaccurate self-disclosure). Participants were recruited from four Hong Kong universities; 255 students were included in the analysis, with 16.1% of participants being men who have sex with men (MSM). Overall, 81.6% of participants reported they never had been tested for HIV, with inaccurate self-disclosure by 65.9% of participants. Among participants who used condoms inconsistently, only 20.2% had had HIV tests, with inaccurate self-disclosure by 66.7% of subjects. Among MSM students, only 36.6% had had HIV tests, with inaccurate self-disclosure by 61.0% of participants. Among MSM students who used condoms inconsistently, only 35.1% had had HIV tests, with inaccurate self-disclosure by 62.2% of participants. The findings raise concerns about the use of self-reported HIV status in clinical practice and research. The low prevalence of HIV testing found suggests that interventions to promote HIV testing should be continued.     

Conundrum of Sexual Decision Making in Marital Relationships: Safer-Sex Knowledge,Behavior, and Attitudes of Married Women in Zambia

Recent research suggests that Zambian women face an increasing risk of contracting human immunodeficiency virus (HIV) within marital relationships. Married women's perceived ability to negotiate safer sex or adopt self-efficacy practices is recognized as critical in preventing new infections within marriage. Yet women's self-efficacy practices, such as requesting condom use or refusing sex within marriage, are influenced by individual and context-specific factors. Using the 2007 Zambia Demographic and Health Survey data from 4,306 married women, this article examines the association between married women's perceived ability to negotiate safer sex and a range of attitudinal, knowledge, and sociodemographic variables. Results from complementary log-log regression models reveal that married women who have factual knowledge about HIV transmission and prevention, as well as those who have been tested for their HIV serostatus, were more likely to report they can request that their husbands use a condom. Rural married women were more likely to report they can refuse their husbands sex compared to woman in urban areas. Likewise, married women who agree that a wife is justified in refusing her husband sex if he sleeps with other women were more likely to report they can negotiate safer sex compared to women who disagree. These findings suggest that married women are able to negotiate safer sex if they have correct factual knowledge about HIV transmission and are aware of their rights within marital relations.     

Women at Risk for Human Immunodeficiency Virus

This article reports results from a survey among women at risk for contracting human immunodeficiency virus (HIV) as well as transmitting it in a vertical (to offspring) and horizontal (sexual partner or intravenous [IV] drug usage) mode. Little is known about the extent of HIV knowledge, sexual behaviors and IV drug usage for women at risk for HIV infection. The sample (N = 620) consisted of Black (50.6%), Caucasian (28.7%), Hispanic (13.4%) and Haitian (5.0%) adult non-pregnant women from South Florida. Data concerning their drug usage, sexual behaviors and other risk factors for HIV infection are presented alone with their knowledge about HIV infection and acquired immunodeficiency syndrome (AIDS). The women had an adequate knowledge base about HIV and AIDS; however the results indicated that our sample was at risk due to the following risk factors: (1) unprotected sexual intercourse, both vaginal and anal, with men who were at high risk for HIV infection (i.e., men who were bisexual and/or used IV drugs); (2) IV drug usage by the woman themselves including needle sharing in "shooting galleries"; (3) the practice of prostitution by the women and; (4) the use of various non-IV drugs that have been shown to impair judgement and lower inhibitions regarding sexual practices. Results indicate differences in risk behaviors and knowledge about AIDS by race/ethnicity.     

Predictors of HIV Sexual Risk Behavior Among Men Who Have Sex with Men,Men Who Have Sex with Men and Women,and Transgender Women

ABSTRACT

Men who have sex with men, men who have sex with men and women, and transgender women are at high risk for HIV infection. This study seeks to clarify which known HIV risk factors (partner type, sex location, serodiscordance, multiple sex partners, substance use during sex) contribute to engagement in high-risk (unprotected receptive anal) sex in each population. Data collected from June 2005 through June 2008 indicate all three populations display different HIV sexual risk profiles. The data suggest that HIV-prevention interventions should be individually tailored to address the specific needs of these three highly vulnerable and impacted populations.     

Sexual Risk Behavior Among Women with Injected Drug Use Histories

This study documents the sexual risk, behavior for HIV infection and transmission in inner-city women with a history of injected drug use (IDU). The sample consists of N = 38 HIV+ and N = 37 HIV- women who were demographically comparable. A surprisingly high number of women in both. groups reported both male and female sex partners during their lifetime, and significantly more HIV+ women currently identified as bisexual and lesbian. Overall, HIV+ women had had more lifetime male and female sex partners, although the two groups did not differ in their current sexual behavior regarding numbers of partners and sex occasions. Both groups of women had little information about risk characteristics of their male sex partners, except for a history of IDU that was common among partners of both HIV+ and HIV- women. Sex for money was practiced by a subgroup of women in both groups and sex in exchange for drugs by very few women. A disturbingly high number of HIV+ and HIV- women reported occasions of unprotected sex during the past six months (86% vs. 97%), a finding that suggests that educational efforts for behavior change in IDU women need to be intensified.     

HIV/AIDS Risk Reduction Intervention for Women who have Experienced Intimate Partner Violence

A growing body of literature highlights the association between women who have experienced intimate partner abuse (IPA) and their heightened risk for HIV/AIDS (human immune deficiency syndrome/ acquired immune deficiency syndrome) infection. Finding HIV risk reduction strategies that are contextually relevant for this population is an important public policy priority. This qualitative study researched women who have experienced intimate partner abuse in order to develop a HIV/AIDS risk reduction intervention unique to their circumstances. This pilot study explored the critical components of such an intervention among a racially/ethnically stratified (African-American, Mexican-American and Anglo) sample of women (n=43) who have experienced IPA. Focus groups were conducted and transcribed, and a content analysis was used to identify major themes. In all five focus groups, participants viewed the research as interesting, good, beneficial, and/or important based on their perceptions of risk for infection. Respondents felt that they knew of ways to protect themselves from infection in non-abusive relationships; however, acknowledged the difficulties of doing so given the context of their abusive relationships. Examining the racial/ethnic differences across focus groups showed that the language used by women is quite variable. The ways in which survivors define rape, sexual abuse, and their own experiences are all unique; however, their actual experiences have many similarities. Discussed at length are the topics participants shared as critical in informing the design of an intervention and the relevance of the findings to social work clinical practice is explained.     

The Impact of Religiosity on Lesbian and Bisexual Women's Psychosexual Development

SUMMARY

We examined the relation between religiosity (importance of religion) and child maltreatment, psychosexual development, self-disclosure of homosexuality and reactions to same with two samples of sexual minority women (Internet n = 84, Coffee House n = 92) obtained with block sampling designs. Extremely important religiosity currently was associated with precocious psychosexual development and self-disclosure in the Internet sample only. Very important religiosity currently was associated with psychosexual development and self-disclosure of minority sexual orientation at significantly older ages. We discuss these results in the context of arguments that religiosity may be a risk factor for sexual minorities. Although not a risk factor in our samples, religiosity appeared to have lost the protective influence observed in studies of the general population.     

Internalized homophobia and depression in lesbian women: The protective role of pride

This study sought to examine the association between internalized homophobia and depressive symptoms in lesbian women, and establish whether such a relationship was mediated by collective self-esteem, self-esteem, and self-disclosure. Participants were 225 self-identified lesbian women in the community. Structural equation modeling was used to demonstrate that an underlying construct, labeled pride, reflected participants’ levels of self-esteem, collective self-esteem, and self-disclosure. Internalized homophobia was moderately and negatively predictive of pride, and pride was strongly and negatively predictive of depression. Results highlight the potentially protective role of pride in the prevention of depression among lesbian women.     

Role versatility among men who have sex with men in urban Peru

Role versatility refers to the practice in which individual men who have sex with men (MSM) play both insertive and receptive sexual roles over time. Versatility has been thought to be relatively uncommon among Latin American MSM but possibly rising. Versatility has also been shown to be a potentially large population-level risk factor for HIV infection. In this study we examine the correlates of versatile behavior and identity among 2,655 MSM in six Peruvian cities. Versatile behavior with recent male partners was found in 9% of men and versatile ("moderno") identity was reported by 16%. Significant predictors included high education, white-collar occupation, sex work, and residence in Lima. Age was not significant in any analysis. Since sex work is negatively correlated with other predictors, versatile men appear to comprise two distinct sub-populations. Insertive-only men appear to play a strong role in bridging the HIV epidemic between MSM and women.     

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.     

Briefly Noted

Researchers have found that mirtazapine, in addition to counseling for substance use, reduced methamphetamine use and some HIV risk behaviors in cisgender men and transgender women who have sex with men. Mirtazapine, an antidepressant also known as Remeron, showed benefits after treatment ended, even if patients didn't always take their medication or took less than they were supposed to. The study follows a previous study of mirtazapine finding reductions in methamphetamine use and sexual risk behaviors among men who have sex with men. “Effects of mirtazapine for methamphetamine use disorder among cisgender men and transgender women who have sex with men: A placebo‐controlled randomized clinical trial” was published in JAMA Psychiatry online last week by Phillip Coffin, M.D. and colleagues. The RCT took place over a course of 24 weeks from 2013 to 2017 in San Francisco. Main outcomes measured were urine tests for methamphetamine and sexual risk behaviors, with sleep, methamphetamine craving, dependence severity, and adverse events also assessed. Sexual risk behaviors included number of sexual partners, and frequency of condomless anal sex. Participants assigned to mirtazapine also had reductions in depressive symptoms.     

Theory-Based Community Practice for HIV Prevention in Midlife and Older Women

ABSTRACT

In the last decade there has been a significant increase in HIV transmission among midlife and older women, particularly those from racial/ethnic minority communities. Although the number of women aged 50 and older diagnosed with HIV infection in the United States is increasing, they are rarely included in community HIV prevention strategies. This article presents integrating social capital with social justice themes into a socioecological framework for community practice that can significantly impact the efficacy of HIV prevention programs for midlife and older women. It also reviews the research and program implications for including midlife and older women in community interventions to halt the spread of HIV infection in this at-risk group. Suggestions for HIV prevention community practice with this underserved population are presented.     

The Trouble With Condoms: Norms and Meanings of Sexuality and Condom Use Among School-Going Youth in Kenya

ABSTRACT

Despite knowledge of the effectiveness of condoms in preventing HIV transmission, condoms continue to be reported in only a minority of sexual encounters even with nonpermanent partners. This study used focus-group discussions with youth and interviews with community leaders from 22 communities in the Nyanza and Rift Valley provinces, Kenya, to examine the sociocultural influences on condom use among school-going youth. Three overarching themes emerged from a thematic analysis of the data. Condoms did not fit with the purposes, meanings, and understandings of sexuality; in fact, condom use violated most of these. Condoms were also thought to be dangerous for girls and women, to contribute to the spread of HIV, and to be unnecessary for protection against HIV. Finally, given the hardships of life and multiple diseases and circumstances that threatened life, HIV was seen as just another trouble of living. Sex without a condom, within this context, was described as one of the pleasures of a short life. The complexities of sexuality evidenced in the discussions of these youth and adults challenge the viability of the ABC (abstain, be faithful, use a condom) message as a preventive measure against HIV transmission.     

The relationship between Black and gay community involvement and HIV-related risk behaviors among Black men who have sex with men

Black gay men must navigate identities and stigmas related to being gay and Black, and report higher HIV incidence relative to their White male counterparts although they report lower rates of drug use and risky sexual behaviors. This study examined whether closeness to the gay or Black community correlated with HIV-related risk and protective behaviors. Data were drawn from uConnect, a population-based cohort study of young Black men who have sex with men (YBMSM) on Chicago's South Side. The sample consists of 618 Black MSM ranging in age from 16 to 29. Cross-sectional measures for this study include Black and gay community closeness, drug use, sexual risk behaviors, HIV testing, and health promotion behaviors. Closeness with the gay community was associated with greater pre-exposure prophylaxis (PrEP) knowledge as well as participating in health promotion programs along with higher rates of transactional sex and having sex under the influence of substances, and increased odds of self-reported HIV seropositivity. Involvement in the Black community was associated with lower odds of reporting being HIV positive. Findings suggest that programs and initiatives are needed to help promote the positive aspects of the Black and gay communities, while minimizing the negative correlates of such involvements.     

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.     

The Healthy Young Men's Study: Sampling Methods to Recruit a Random Cohort of Young Men Who Have Sex With Men

Recruiting a scientifically sound cohort of young men who have sex with men (YMSM) is an enduring research challenge. The few cohort studies that have been conducted to date on YMSM have relied on nonprobability sampling methods to construct their cohorts. While these studies have provided valuable information about HIV risk behaviors among YMSM, their generalizability to broader YMSM populations is limited. In this article, the authors describe a venue-based sampling methodology used to recruit a large and diverse cohort of YMSM from public venues in Los Angeles County, California. Venue-based sampling is a multistage probability sampling design that uses standard outreach techniques and standard survey methods to systematically enumerate, sample, and survey hard-to-reach populations. The study design allowed the authors to estimate individual, familial, and interpersonal psychosocial factors associated with HIV risk and health-seeking behaviors for a cohort of YMSM with known properties. Study participants completed an extensive baseline survey and over a 2-year period completed four follow-up surveys at 6-month intervals. The baseline survey was administered in both English and Spanish.     

Women's risk for revictimization by a new abusive partner: for what should we be looking?

The purpose of this article was to examine the prevalence of, as well as risk factors for, revictimization by a new partner. Data was collected via face-to-face interviews at Time 1 (about 5 weeks after obtaining a protective order against a violent partner [DVO partner]) and at Time 2 (approximately 12 months later). Of those women who reported having a new partner at Time 2 (n = 412), 35.2% reported abuse. Findings indicate that there is a subset of women who are at greater risk of experiencing abuse by future partners: women with greater cumulative lifetime victimization and those who abuse or are dependent on illicit drugs. Intervening with women when they obtain a protective order is a critical point of intervention to reduce women's risk for revictimization.     

Women in India: The Context and Impact of HIV/AIDS

ABSTRACT

The response to the HIV/AIDS epidemic on the Indian subcontinent has been hampered by several factors, including societal stigma, lack of educational resources, lack of economic opportunities, and the competing priorities for a nation just growing and developing an infrastructure for education, industry, and health. In particular, Indian women are silent victims in this epidemic because they do not readily have a respected voice in decision making and priority setting for the government. The epidemic is increasingly affecting and infecting Indian women (e.g., female commercial sex workers, married women, and pregnant women). The status of Indian women has placed them at extreme disadvantage because India is a country with socially progressive laws but has been slow to change its social norms. The reported HIV prevalence is low although many researchers agree a large amount of underreporting occurs. For India to address this emerging epidemic among women appropriately, it should focus on three intervention areas: (1) short-term solutions such as treatment options for those already infected with HIV to prevent further infection to sexual partners and children; (2) intermediate solutions such as education for those who are uninfected but engaging in behaviors that may put them at risk, such as injection drug use, engaging in commercial sex work, engaging in extramarital sexual relations, and having sexual partners who are not monogamous; and 3) long-term solutions such as addressing the root causes of inequality (e.g., disparities in education and employment and unwillingness to change social norms).