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.     

Sexual Risk Behaviors and Perceptions of Men Who Go to Gay Sex Parties in New York City: Comparisons Between Three HIV Groups

Men who have sex with men (MSM) who attend group-sex events often engage in risky sexual behaviors that contribute to the high human immunodeficiency virus (HIV) incidence among this population. We conducted an online survey with 211 New York City MSM who attended sex parties in the prior year and asked them to describe their behaviors and perceptions of risk. We compared responses from HIV-positive-undetectable men (n = 36), HIV-negative men on pre-exposure prophylaxis (PrEP; n = 62), and HIV-negative men never on PrEP (n = 113). In bivariate analyses, undetectable and on-PrEP men had been to more sex parties in the prior six months, had more anal sex partners there, and had higher rates of sexually transmitted infection (STI) diagnoses than men never on PrEP. Although less than the other groups, 43% of the presumably HIV-negative men never on PrEP reported condomless anal sex at a party in the prior six months. About half of participants agreed that, at sex parties, they made assumptions about others’ HIV status, that they sometimes took more risks than intended, and that the atmosphere of these events was conducive to risk taking. Most disagreed that there was discussion of HIV status at sex parties. Implications for sexual health interventions are discussed.     

QUADRATIC PREFERENCES AND GOAL PROGRAMMING

One of the shortcomings of goal programming lies in its linearity, assumption, specifically in the objective function. This assumption compels one to work with constant marginal utilities and rates of substitution. In this paper a quadratic preference function, which is more consistent with economic theory and reality, is formulated and introduced into goal programming. In an effort to facilitate the understanding of the proposed procedure, two illustrative examples—one with symmetric preferences and the other with asymmetric preferences, both applied to the objective function—are solved and compared with a goal programming solution.     

Are Adult Patients More Tolerant of Treatment Risks Than Parents of Juvenile Patients?

Understanding patient-specific differences in risk tolerance for new treatments that offer improved efficacy can assist in making difficult regulatory and clinical decisions for new treatments that offer both the potential for greater effectiveness in relieving disease symptoms, but also risks of disabling or fatal side effects. The aim of this study is to elicit benefit-risk trade-off preferences for hypothetical treatments with varying efficacy and risk levels using a stated-choice (SC) survey. We derive estimates of "maximum acceptable risk" (MAR) that can help decisionmakers identify welfare-enhancing alternatives. In the case of children, parent caregivers are responsible for treatment decisions and their risk tolerance may be quite different than adult patients' own tolerance for treatment-related risks. We estimated and compared the willingness of Crohn's disease (CD) patients and parents of juvenile CD patients to accept serious adverse event (SAE) risks in exchange for symptom relief. The analyzed data were from 345 patients over the age of 18 and 150 parents of children under the age of 18. The estimation results provide strong evidence that adult patients and parents of juvenile patients are willing to accept tradeoffs between treatment efficacy and risks of SAEs. Parents of juvenile CD patients are about as risk tolerant for their children as adult CD patients are for themselves for improved treatment efficacy. SC surveys provide a systematic method for eliciting preferences for benefit-risk tradeoffs. Understanding patients' own risk perceptions and their willingness to accept risks in return for treatment benefits can help inform risk management decision making.