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.     

Heterosexual Anal Intercourse among Men in Long Beach,California

Anal intercourse poses a greater risk for human immunodeficiency virus (HIV) transmission than vaginal intercourse, and in recent years there has been a growing understanding that heterosexual anal intercourse (HAI) is not uncommon. However, the majority of the anal intercourse literature has focused on men who have sex with men. The little research on HAI has mostly looked at women, with limited work among men. This analysis examined the association between HAI and high-risk behaviors (N = 1,622) and sexual sensation seeking (N = 239) in a sample of men recruited from 2001 to 2012 in Long Beach, California. Almost half of the sample was non-Hispanic Black. The median age was 42 years, 42% were homeless, and 20% reported recent HAI. Men who reported HAI were likely to be Hispanic, were likely to be homeless, had a male partner, engaged in sex exchange, and used cocaine or amphetamines during sex. Men who reported HAI scored higher on the Sexual Sensation Seeking scale. This research supports other work showing the relationship between HAI and high-risk behaviors. More important, it contributes new knowledge by demonstrating the association between HAI and sexual sensation seeking. This research highlights the importance of personality traits when trying to understand sexual behavior and when developing HIV prevention interventions.     

Sexual agreements and intimate-partner violence among male couples

Objectives: In the United States, HIV continues to disproportionately affect men who have sex with men. One promising area of research that may inform the development of behavioral interventions among male–male couples is within the realm of sexual agreements. Methods: The purpose of our analysis was to determine whether respondents who report having an open agreement or an agreement breakage also report a higher incidence of recent (within the previous 12 months) intimate-partner violence (IPV) compared to respondents who report having a monogamous agreement or no agreement breakage after controlling for demographic variables. Results: Results showed that men who have an open agreement are less likely to report recent physical IPV. Conclusions: The results highlight the need to develop dyadic behavior interventions that address sexual agreements and stress management.     

Correlates of Human Immunodeficiency Virus/Sexually Transmitted Infection (HIV/STI) Testing and Disclosure Among HIV-Negative Collegiate Men Who Have Sex With Men

Abstract

Objective: To determine the extent to which personal, behavioral, and environmental factors are associated with human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing and disclosure. Participants: Nine hundred thirty HIV-negative collegiate men who have sex with men (MSM) who completed an online survey about alcohol use and sexual behavior. Methods: Correlates of testing and disclosure significant in bivariate analyses (p < .05) were grouped into personal, behavioral, or environmental factors and entered into multivariable logistic regression models. Results: About half of participants tested for HIV (51.9%) and for STIs (45.8%) at least annually. Over half (57.8%) of participants always/almost always discussed HIV status with new sex partners; 61.1% with new unprotected sex partners. Personal and behavioral factors (age and outness) explained differences in testing, and the behavioral factor (routine testing) explained differences in disclosure. Conclusions: Collegiate MSM should be supported in coming out, encouraged to engage in routine testing, and counseled on discussing HIV/STI status with potential sex partners.     

Gender Differences in the Path From Sexual Victimization to HIV Risk Behavior Among Homeless Youth

ABSTRACT

Experiencing sexual victimization prior to becoming homeless is common among homeless youth and is associated with increased HIV risk behavior. This study examined mediating variables that underlie this association, adding to the understanding of gender differences in these paths. Participants were homeless youth in Los Angeles recruited through service access centers who completed a computerized self-administered interview in English or Spanish using an iPad. Findings indicate a high presence of sexual victimization across both genders. Female participants experienced posttraumatic stress disorder and subsequent engagement with exchange sex, whereas male participants were primarily involved in substance use risk pathways. Results indicate paths in the association between sexual victimization and HIV risk behavior differ between male and female homeless youth. Gender-specific, mental-health-informed interventions targeting sexual risk reduction are warranted.     

Relative Efficacy of a Pregnancy,Sexually Transmitted Infection,or Human Immunodeficiency Virus Prevention–Focused Intervention on Changing Sexual Risk Behavior Among Young Adults

Abstract

Objectives: Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior. Participants: Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008–2009. Methods: The authors compared the efficacy of 3 theory-based, sexual risk–reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up. Results: Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention. Conclusions: The focus of sexual risk–reduction interventions may lead to differential behavior change among young adults.     

Determinants Influencing Male Condom use Among University Students in Portugal

ABSTRACT. A self-administered questionnaire was carried out among university students in Portugal, with the aim to examine determinants influencing male condom use, according to the information–motivation–behavioral skills model (J. Fisher & Fisher, 1992). Students’ levels of information, motivation, and behavioral skills regarding preventive sexual behavior (male condom use) were ascertained and were used to determine their association with condom use among 880 male and 1,807 female students aged 18 to 35 years old. Although 86.9% of respondents indicated that they used a condom during their first sexual intercourse, only 32.8% used a condom always during sexual intercourse in the last 12 months. Most young people, especially women, had a good level of information regarding HIV/AIDS transmission/prevention. They also showed reasonable positive attitudes and had positive subjective norms and intentions toward HIV/AIDS preventive behaviors. Men presented a higher perceived difficulty and a lower perceived effectiveness of HIV/AIDS preventive behavior, therefore reporting higher risk acceptance. A path analysis revealed that preventive sexual behavior did not depend directly on information level but on motivation and behavioral skills (especially among men). Information about HIV prevention/transmission was not significantly associated with condom use. The finding that motivation and behavioral skills were the strongest determinants of condom use suggested that these may be important factors in effective sexually transmitted infection-prevention programs.     

Electronic Media Access and Use for Sexuality and Sexual Health Education Among Men Who Have Sex With Men in Four Cities in Tanzania

Abstract

Background: Electronic media use is an important avenue for reaching stigmatized populations. We examined Internet access and use of sexually related electronic media among men who have sex with men (MSM) in 4 cities in Tanzania. Methods: A questionnaire was administered to 231 MSM in Dar es Salaam, Mwanza, Arusha, and Tanga regarding electronic media type, times of use, type of use and frequency of use of sexually-related media. Results: Mean age was 25.7?years, and 52% had completed high school. Half had access to the internet through personal electronic devices, a further quarter had access through work, 10% through friends’ devices, and only 2% had no access to the internet. Most frequently used electronic devices were personal computer followed by work smartphone, with work computer a close third. These patterns were consistent for both seeking other men for sex and finding sexual health information. All respondents had accessed sexual material electronically at some time. Substantial logged-in time was reported each week seeking/chatting with potential sexual partners (median?=?48 hr), looking at “porn” (median?=?24 hr), and searching for health information (median?=?7 hr). Over 98% indicated that they would use an anonymous/confidential online service for HIV and sexually transmitted infection testing. The majority (79%) had found sexual partners throughout the Internet in the last 24?hours, and 52% sought sexual health education online 2–3 times per week. Peak search time was evenings, increasing during weekends. Discussion: For Tanzanian MSM in cities, sexual electronic media use is high and includes work devices. Sexual health information seeking, and openness to electronic counseling and testing was almost universal. Electronic sites for sexual health access should be explored and evaluated.     

Implications of Sex Guilt: A Meta-Analysis

A meta-analysis of the literature examining the outcomes related to feelings of sex guilt was conducted. The analysis demonstrates gendered differences in the experience of sex guilt and myriad attitudinal and behavioral impacts. Specifically, men report lower levels of sex guilt, r?=??.227 than do women and implications of sex guilt experience are vast, including its association with engagement in less sexual activity, r?=??.337, less favorable attitudes toward sex and lessened use of contraceptives, r?=??.276, reduced reports of sexual arousal in response to an explicitly sexual media content, r?=??.308, less positive emotional response to sexually explicit media content, r?=??.367, reduced level of sexual information accuracy, r?=??.324, and less positive attitudes toward sexual behavior, r?=??404. Sex guilt is positively related to level of religiosity/religious behavior, r?=?.439. The findings suggest that sex guilt provides a consistent set of responses to sexual information and media content as well as a motivational basis for behavior. These outcomes are further explicated and discussed.     

Prevalence of Human Immunodeficiency Virus Testing and Associated Risk Factors in College Students

Abstract

Objective: This study documents the prevalence of human immunodeficiency virus (HIV) testing in a sample of college students and examines associated demographic and behavioral characteristics. Participants: College students aged 18 or older were randomly selected to participate in a health behavior survey at a southeastern university in September 2011. Methods: Only sexually active students were included (N = 905). Relationships between demographic and sexual behavior characteristics were explored using logistic regression and classification regression tree (p ≤.05). Results: Only 36.2% reported having been tested for HIV. Age was the most significant factor associated with testing. Factors associated with those least likely to be tested were race and anal sexual activity. Unsafe sexual behaviors were also associated with lower rates of HIV testing. Conclusions: Findings support the need for targeted HIV interventions on college campuses. Such interventions need to be tailored for at-risk students and take into consideration factors likely to contribute to HIV testing.     

Condoms and Contexts: Profiles of Sexual Risk and Safety Among Young Heterosexually Active Men

Heterosexual men's sexual safety behavior is important to controlling the U.S. epidemic of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). While sexual safety is often treated as a single behavior, such as condom use, it can also be conceptualized as resulting from multiple factors. Doing so can help us achieve more nuanced understandings of sexual risk and safety within partner-related contexts. We used latent class analysis with data collected online from 18- to 25-year-old heterosexually active U.S. men (n = 432) to empirically derive a typology of the patterns of sexual safety strategies they employed. Indicators were sexual risk-reduction strategies used in the past year with the most recent female sex partner: condom use, discussing sexual histories, STI testing, agreeing to be monogamous, and discussing birth control. We identified four subgroups: Risk Takers (12%), Condom Reliers (25%), Multistrategists (28%), and Relationship Reliers (35%). Partner-related context factors—number of past-year sex partners, relationship commitment, and sexual concurrency—predicted subgroup membership. Findings support tailoring STI prevention to men's sexual risk-safety subgroups. Interventions should certainly continue to encourage condom use but should also include information on how partner-related context factors and alternate sexual safety strategies can help men reduce risk for themselves and their partners.     

Age Cohort Differences in Sexual Behaviors Among Black Men Who Have Sex With Men and Women

Little attention has focused on generational or age-related differences in human immunodeficiency virus/sexually transmitted infection (HIV/STI) risk behaviors among Black men who have sex with men and women (BMSMW). We examined sexual risk behaviors between BMSMW ages 40 and under compared to over age 40. Analysis was conducted using Centers for Disease Control and Prevention (CDC)–sponsored intervention data among BMSMW in Los Angeles, Chicago, and Philadelphia (n = 546). Pearson’s chi-square tests were conducted to evaluate associations between age groups and behavioral outcomes. Logistic regression was used to evaluate the odds of behavioral outcomes by age group, adjusting for sexual orientation and study location, within strata of HIV status. HIV-positive BMSMW over age 40 had 62% reduced odds of having a nonmain female partner of HIV-negative or unknown status compared to those ages 40 and under (adjusted odds ratio [AOR] 0.38, 95% confidence interval [CI] = 0.15, 0.95). Among HIV-negative BMSMW, the older cohort was associated with greater odds of having condomless insertive anal intercourse (IAI) with most recent main male partner (AOR 2.44, 95% CI = 1.12, 5.32) and having a concurrent partnership while with their recent main female partner (AOR = 2.6, 95% CI = 1.10, 4.67). For both groups, odds of engaging in certain risk behaviors increased with increasing age. Prevention efforts should consider generational differences and age in HIV risks among BMSMW.     

Sexual inactivity among men who have sex with men living with hiv in europe

Objectives: Most people living with HIV stay sexually active, but some remain inactive. This study investigated prevalence and correlates of sexual inactivity among European HIV-positive men who have sex with men (MSM). Methods: An anonymous sexual health questionnaire was distributed in 17 HIV outpatient clinics throughout Europe. Ninety-seven (11.6%) of 838 respondents reported absence of sexual activity. Results: Multivariable regression analysis identified older age, relationship status, and less satisfaction with general health and sexual desire as being associated with sexual inactivity. Conclusions: Prevalence of sexual inactivity has declined since the introduction of antiretroviral therapy to levels similar to those of HIV-negative MSM, suggesting a tendency toward normalization of HIV-positive MSM's sex lives.     

Personal Network Correlates and Predictors of Homelessness for Injection Drug Users in Baltimore,Maryland

Injection drug users are at high risk for homelessness and human immunodeficiency virus (HIV) infection. This study sought to examine incidence rates and the social and economic antecedents of homelessness of impoverished inner-city injection drug users. Of the 569 participants, from a nontreatment sample who participated HW prevention study, intelViewed at baseline, 324 (57%) were reintelViewed 5.2 months late!: At baseline 48% of the participants reported that they had been homeless in the past 10 years. Of the 324, 18% reported that at both intelViews they had been homeless within the prior 6 months, 12% reported homelessness at baseline but not at follow-up, and 8% reported homelessness at follow-up but not at baseline. At baseline personal social support network characteristic of size of material aid and size of sex network was found to be associated with self-reports of homelessness. Baseline reports ofpresence of mother in personal network, size of material aid network, and network density were found to be associated with reports of homelessness at follow-up. These result suggest the need for alternative approaches to addressing issues of homelessness injection drug users.     

Predictors of Safer Sex on the College Campus: A Social Cognitive Theory Analysis

Abstract

In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N ? 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjuction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.     

The Relationship Between Use of Sexually Explicit Media and Sexual Risk Behavior in Men Who Have Sex with Men: Exploring the Mediating Effects of Sexual Self-Esteem and Condom Use Self-Efficacy

ABSTRACT

Objectives: This study tests the following 3 hypotheses: (1) there is a direct association between consumption of sexually explicit media (SEM) depicting non-condom use and sexually transmitted infection (STI)-related sexual risk behavior among men who have sex with men (MSM); (2) the association between SEM consumption and STI-related sexual risk behavior is mediated by men's sexual self-esteem; and (3) the relationship between SEM consumption and sexual risk behavior is mediated by condom use self-efficacy. Methods: A cross-sectional, Internet-based survey on exposure to SEM and sexual behavior of 1,391 MSM in the United States was conducted in 2011. Results: The results confirmed Hypotheses 1 and 3, while Hypothesis 2 was rejected. Accordingly, a significant association between the use of SEM picturing condom use and STI-related sexual risk behavior among MSM was found. Likewise, we found that the association between the use of SEM and sexual risk behavior was mediated by condom use self-efficacy in an indirect path. However, SEM did not influence sexual risk behavior via sexual self-esteem. Conclusions: To promote STI prevention, the actors in SEM may be used as role models in managing condom use in sexual contexts.     

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.     

Social,Relational and Network Determinants of Unprotected Anal Sex and HIV Testing Among Men Who Have Sex with Men in Beirut,Lebanon

Objectives: We examined the social, relational and network determinants of condom use and HIV testing among men who have sex with men (MSM) in Beirut. Methods: Two-hundred thirteen men were recruited via respondent driven sampling and administered a survey. Results: Sixty-four percent reported unprotected anal intercourse (UAI), including 23% who had UAI with unknown HIV status partners (UAIU); 62% of participants had tested for HIV. In multivariate analysis, being in a relationship was associated with UAI and HIV testing; lower condom self-efficacy was associated with UAIU and HIV testing; gay discrimination was associated with UAIU; MSM disclosure was associated with UAI, UAIU and HIV testing; and network centralization was associated with HIV testing. Conclusions: Multi-level social factors influence sexual health in MSM.