Heterosexual African Men Research Articles

Understanding the factors associated with HIV and STIs diagnosis among Black heterosexual men in Ottawa and Windsor, Ontario.

Background: The African, Caribbean and Black (ACB) men living in Canada share a heightened risk of infection by Human Immunodeficiency Virus and other sexually transmitted illnesses (STIs) and the associated risky behaviours such as suboptimal use of family planning services such as condom use. The African, Caribbean and Black (ACB) heterosexual men living in Canada are disproportionately exposed to HIV and other sexually transmitted infections. The present paper aims to assess the relationship between knowledge, attitude and use of condom with diagnosis of HIV and STIs among ACB heterosexual men in Ontario.Design and Methods: This was a cross-sectional study on 430 participants consisting of black heterosexual men living two communities, Ottawa and Windsor in Ontario. The outcome variables were ever being diagnosed with HIV (Yes/No) and other STIs (Yes/No). Data were analysed using descriptive, and logistic regression techniques.Results: Findings indicated that 70.20% did not have good knowledge of HIV, 68.10% had positive attitude towards condom use, and 62.82% were not regular condom user. Men who reported experiencing difficulty in accessing healthcare services had significantly higher odds of reporting HIV and STI diagnosis. Men with positive attitude towards condom use had lower odds of both HIV (odds ratio= 0.48, 95%CI=0.30,0.76) and STI diagnosis (odds ratio= 0.27, 95%CI=0.08,0.90). Similarly, condom users also had lower odds of both HIV and (odds ratio= 0.21, 95%CI=0.09,0.49) STI diagnosis (odds ratio= 0.62, 95%CI=0.39,0.99).Conclusions: A large proportion of the sample with positive attitude to condom use was not a reflection of the large sample who did not have correct knowledge of HIV. Several factors were also found to be associated with heightened odds of being diagnosed with HIV and other STIs. The most notable of these factors were experiences of difficulty in accessing healthcare and utilisation of condoms. Significance for public health In Canada, the African, Caribbean and Black (ACB) men are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted illnesses (STIs). Addressing this situation requires research evidence on the barriers to protective behaviours such as use of condom. This study is the first to assess the relationship between knowledge, attitude and use of condom with diagnosis of HIV and STIs among ACB heterosexual men in Ontario. The findings provide evidence regarding significant racial disparities in diagnosis with HIV and STIs and recommends undertaking tailored strategies for prevention and intervention of the STIs in this vulnerable population.

‘The own’ and ‘the wise’ as social support for older people living with HIV in the United Kingdom

AbstractAs the HIV population ages, how the ageing and HIV experiences intersect to shape the lives of older people living with HIV (PLWH) becomes an increasingly pressing question. This multi-method study investigated social support, mental health and quality of life among 100 older PLWH in the United Kingdom. Drawing on data from three focus groups and 74 life-history interviews with older (aged 50+) White men who have sex with men (MSM), and Black African and White heterosexual men and women, living with HIV, we explore participants’ distinctions between, evaluations of and access to sources of social support. Participants distinguished between support from the HIV-negative (Goffman's ‘the own’) and experientially based support from other PLWH (Goffman's ‘the wise’), and viewed the former, while valuable, as needing to be supplemented by the latter. Furthermore, access to experientially based support varied across participant groups, whose communities had different histories with HIV/AIDS and thus different degrees of knowledge about HIV and avenues for connecting to other PLWH. Thus, social support among older PLWH cannot be neatly divided into ‘formal’ and ‘informal’ domains, or fully appreciated by applying traditional social support measures, including, in the context of health conditions, ‘peer support’ created through formal service organisations. Rather, older PLWH's own distinctions and evaluations better illuminate the complexities of social support in the context of ageing with HIV.

Sexual and behavioral health disparities among African American sexual minority men and women

ABSTRACT Introduction: Sexual and behavioral health disparities have been consistently demonstrated between African American and White adults and between sexual minority and heterosexual communities in the United States; however, few studies using nationally representative samples have examined disparities between sexual minority and heterosexual adults within African American populations. The purpose of this study was to examine the prevalence of sexual and behavioral health outcomes between sexual minority and heterosexual African American adults and to examine whether there were different patterns of disparities for African American sexual minority men and women, respectively. Methods: We analyzed data from 4502 African American adults who participated in the 2001–2015 waves of the National Health and Nutrition Examination Survey. Using multivariable analyses, we examined differences in HIV, sexually transmitted infections, mental health, and substance use among African American sexual minority and heterosexual men and women. Results: After adjusting for sociodemographic variables, African American sexual minority men had significantly higher odds of HIV, sexually transmitted infections, and poor mental health compared to their heterosexual male counterparts, whereas African American sexual minority women had significantly higher odds of Hepatitis C, poor mental health, and substance use compared to their heterosexual female counterparts. Conclusions: These findings demonstrate notable sexual orientation disparities among African American adults. Disparities persisted beyond the role of sociodemographic factors, suggesting that further research utilizing an intersectional approach is warranted to understand the social determinants of adverse health outcomes among African American sexual minority men and women.

What influences quality of life in older people living with HIV?

BackgroundPeople with HIV with access to treatment are growing older and living healthier lives than in the past, and while health improvements and increased survival rates are welcome, the psychological and social consequences and quality of life of ageing are complex for this group. Understanding how ageing, HIV and quality of life intersect is key to developing effective interventions to improve QoL.MethodsOne hundred people with HIV over the age of 50 (range 50–87, mean 58), were recruited through HIV community organizations, and clinics, and included men who have sex with men (MSM), and Black African and White heterosexual men and women. The WHOQOL-HIV BREF was used, as well as the Every Day Memory Questionnaire, and additional questions on anxiety and depression to supplement the WHOQOL.ResultsWhile most rated their quality of life (QoL) positively, bivariate analysis showed that better QoL (total score and most domains) was strongly associated with being a man; in a relationship; in paid employment; having higher level of income; not on benefits, and to a lesser degree with being MSM, having higher level of education, and diagnosed after the age of 40. Multivariate analysis showed that not being on benefits was the variable most consistently associated with better quality of life, as was being partnered. Concerns about everyday memory difficulties, and anxiety and depression scores were strong predictors of poorer quality of life.ConclusionWhile the cross-sectional nature of the investigation could not establish that the associations were causal, the findings indicate that concerns about memory difficulties, anxiety and depression, as well as gender, ethnicity, financial factors, and relationship status, are important contributors to QoL in this group. These findings point towards the need for further research to clarify the mechanisms through which the factors identified here affect QoL, and to identify possible interventions to improve the QoL of older people living with HIV.

Refusal of HIV testing among black Africans attending sexual health clinics in England, 2014: a review of surveillance data

ObjectivesBlack Africans are one of the key risk groups for HIV in the UK and, among those living with HIV, an estimated 16% and 12% of black African heterosexual men...

Antiretroviral Pre-Exposure Prophylaxis Does Not Enhance Immune Responses to HIV in Exposed but Uninfected Persons.

Antiretroviral preexposure prophylaxis (PrEP), using daily oral combination tenofovir disoproxil fumarate plus emtricitabine, is an effective human immunodeficiency virus (HIV) prevention strategy for populations at high risk of HIV acquisition. Although the primary mode of action for the protective effect of PrEP is probably direct antiviral activity, nonhuman primate studies suggest that PrEP may also allow for development of HIV-specific immune responses, hypothesized to result from aborted HIV infections providing a source of immunologic priming. We sought to evaluate whether PrEP affects the development of HIV-specific immune response in humans. Within a PrEP clinical trial among high-risk heterosexual African men and women, we detected HIV-specific CD4(+) and CD8(+) peripheral blood T-cell responses in 10%-20% of 247 subjects evaluated. The response rate and magnitude of T-cell responses did not vary significantly between those assigned PrEP versus placebo, and no significant difference between those assigned PrEP and placebo was observed in measures of innate immune function. We found no evidence to support the hypothesis that PrEP alters either the frequency or magnitude of HIV-specific immune responses in HIV-1-exposed seronegative individuals. These results suggest that PrEP is unlikely to serve as an immunologic prime to aid protection by a putative HIV vaccine.

Phylogenetic analyses reveal HIV-1 infections between men misclassified as heterosexual transmissions.

HIV-1 subtype B infections are associated with MSM in the UK. Yet, around 13% of subtype B infections are found in those reporting heterosexual contact as transmission route. Using phylogenetics, we explored possible misclassification of sexual exposure among men diagnosed with HIV in the UK. Viral gene sequences linked to patient-derived information were used to identify phylogenetic transmission chains. A total of 22,481 HIV-1 subtype B pol gene sequences sampled between 1996 and 2008 were analysed. Dated phylogenies were reconstructed and transmission clusters identified as clades of at least two sequences with a maximum genetic distance of 4.5%, a branch support of at least 95% and spanning 5 years. The characteristics of clusters containing at least one heterosexually acquired infection were analysed. Twenty-nine percent of the linked heterosexuals clustered exclusively with MSM. These were more likely to be men than women. Estimated misclassification of homosexually acquired infections ranged between 1 and 11% of the reported male heterosexuals diagnosed with HIV. Black African heterosexual men were more often phylogenetically linked to MSM than other ethnic group, with an estimated misclassification range between 1 and 21%. Overall, a small proportion of self-reported heterosexual men diagnosed with HIV could have been infected homosexually. However, up to one in five black African heterosexual men chose not to disclose sex with men at HIV diagnosis and preferred to be identified as heterosexual. Phylogenetic analyses can enhance surveillance-based risk information and inform national programmes for monitoring and preventing HIV infections.

Mediation effects of problem drinking and marijuana use on HIV sexual risk behaviors among childhood sexually abused South African heterosexual men

HIV/AIDS prevalence in South Africa is one of the highest in the world with heterosexual, transmission predominantly promoting the epidemic. The goal of this study is to examine whether, marijuana use and problem drinking mediate the relationship between histories of childhood sexual, abuse (CSA) and HIV risk behaviors among heterosexual men. Participants were 1181 Black men aged, 18–45 from randomly selected neighborhoods in Eastern Cape Province, South Africa. Audio computer assisted, self-interviewing was used to assess self-reported childhood sexual abuse, problem drinking, and marijuana (dagga) use, and HIV sexual transmission behavior with steady and casual partners. Data were analyzed using multiple meditational modeling. There was more support for problem, drinking than marijuana use as a mediator. Findings suggest that problem drinking and marijuana use, mediate HIV sexual risk behaviors in men with histories of CSA. Focusing on men with histories of CSA, and their use of marijuana and alcohol may be particularly useful for designing strategies to reduce, HIV sexual transmission in South Africa.

P3.370 Daily Oral Emtricitabine/Tenofovir Pre-Exposure Prophylaxis and Prevention of HSV-2 Acquisition Among Heterosexual Men and Women

BackgroundDaily oral and pericoital tenofovir-based antiretroviral pre-exposure prophlyaxis (PrEP), reduced risk of HIV-1 acquisition in trials among high risk populations; oral emtricitabine(FTC)/tenofovir (TDF) received a label indication for HIV-1 prevention....

Roll-out of Medical Male circumcision (MMC) for HIV prevention in non-circumcising communities of Northern Uganda

IntroductionRecent studies have shown that circumcision reduces HIV/AIDS infection rates by 60% among heterosexual African men. Public health officials are arguing that circumcision of men should be a key weapon in the fight of HIV/AIDS in Africa. Experts estimate that more than 3 million lives could be saved in sub-Saharan Africa alone if the procedure becomes widely used. Some communities in Uganda have misconceptions to MMC and resist the practice.MethodsTo roll out MMC to a non-circumcising population of Northern Uganda from June 2011 as a strategy to increase access and prevent the spread of HIV/AIDS.ResultsCircumcision in a non-circumcising communities of Lango and Acholi sub-regions with a population of about 0.5 million mature males 15-49 years. Enrolment was voluntary, clinical officers, nurses carried out MMC after training in the surgical procedure. Mass sensitization and mobilization was conducted through radios, community leaderships and spouses. Cervical cancer screening was incorporated at circumcision sites and used as incentive for the women. Circumcisions were conducted at static sites, camps and outreach services where VCT and adverse events (AEs) were recorded and managed. All clients assented/or consented.ConclusionA total of 26, 150 males were circumcised in eight months. The AEs rate was 1.2% and was mild. 2,650 women were screened for cervical cancer and positive test rate was 1.7%. Mobilization and sensitization were by radios and spouses’ involvement in cervical cancer screening exercise.

Male circumcision to reduce sexual transmission of HIV

Three large trials among African heterosexual men in the last decade have confirmed that male circumcision reduces HIV acquisition. This review summarizes recent data regarding circumcision performed primarily to reduce HIV in high-prevalence settings. Male circumcision more than halved the acquisition of HIV in the trials, and was associated with few adverse events and high levels of satisfaction. An additional trial found no direct reduction in HIV risk for female partners of circumcised men. Evidence for an HIV-protective effect of circumcision in men who have sex with men is weak and inconclusive. Acquisition of HSV-2 and high-risk human papillomavirus are both reduced in circumcised heterosexual men, whereas acquisition of common male urethral pathogens are not. Concerns exist that behavioural disinhibition could offset benefits of this intervention, and it remains to be seen whether the low rate of adverse events and adoption of safer sexual practices observed in the trials will be maintained in circumcision programmes outside trial settings. The evidence that circumcision reduces HIV in African heterosexual men is clear. The impedance of political, cultural and logistic factors on expansion of much-needed African circumcision services requires urgent attention.

Cost-effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males.

BackgroundHIV incidence was substantially lower among circumcised versus uncircumcised heterosexual African men in three clinical trials. Based on those findings, we modeled the potential effect of newborn male circumcision on a U.S. male's lifetime risk of HIV, including associated costs and quality-adjusted life-years saved.Methodology/Principal FindingsGiven published estimates of U.S. males' lifetime HIV risk, we calculated the fraction of lifetime risk attributable to heterosexual behavior from 2005–2006 HIV surveillance data. We assumed 60% efficacy of circumcision in reducing heterosexually-acquired HIV over a lifetime, and varied efficacy in sensitivity analyses. We calculated differences in lifetime HIV risk, expected HIV treatment costs and quality-adjusted life years (QALYs) among circumcised versus uncircumcised males. The main outcome measure was cost per HIV-related QALY saved. Circumcision reduced the lifetime HIV risk among all males by 15.7% in the base case analysis, ranging from 7.9% for white males to 20.9% for black males. Newborn circumcision was a cost-saving HIV prevention intervention for all, black and Hispanic males. The net cost of newborn circumcision per QALY saved was $87,792 for white males. Results were most sensitive to the discount rate, and circumcision efficacy and cost.Conclusions/SignificanceNewborn circumcision resulted in lower expected HIV-related treatment costs and a slight increase in QALYs. It reduced the 1.87% lifetime risk of HIV among all males by about 16%. The effect varied substantially by race and ethnicity. Racial and ethnic groups who could benefit the most from circumcision may have least access to it due to insurance coverage and state Medicaid policies, and these financial barriers should be addressed. More data on the long-term protective effect of circumcision on heterosexual males as well as on its efficacy in preventing HIV among MSM would be useful.

‘You are not yourself’: Exploring masculinities among heterosexual African men living with HIV in London

It is now clear that gender is an essential factor shaping the narratives of men as well as women. However, there have been few studies of the daily lives or sexual activities of heterosexual men. Hence, strategies developed to prevent the spread of the HIV virus are rarely based on detailed knowledge of the men whose behaviours they are intended to change; this is especially evident in the developing world where the epidemic is most severe. Nor do we know very much about those men who have already been diagnosed as HIV positive. Around 13 million men are now living with HIV of whom around 96% are in low or middle income countries. Migrants from developing countries also make up the majority of positive people in a number of developed countries. In the UK, for example, heterosexual activity is now responsible for about half of all new HIV diagnoses with the majority of those involved being of African origin. But almost nothing is known about the ways in which different constructions of masculinity affect their experiences of illness. This study used qualitative methods to explore the experiences of a sample of black African men who defined themselves as heterosexual and were receiving treatment for HIV and/or AIDS in London. It explored their feelings, their needs, their hopes and their desires as they negotiated their lives in the diaspora.

Over fifty and living with HIV in London

Objective:To examine age at diagnosis, sexual behaviour and some social characteristics of people living with HIV in London who are over the age of 50 years, with particular reference to...

Circumcision Status and Risk of HIV and Sexually Transmitted Infections Among Men Who Have Sex With Men

Randomized controlled trials and meta-analyses have demonstrated that male circumcision reduces men's risk of contracting human immunodeficiency virus (HIV) infection during heterosexual intercourse. Less is known about whether male circumcision provides protection against HIV infection among men who have sex with men (MSM). To quantitatively summarize the strength of the association between male circumcision and HIV infection and other sexually transmitted infections (STIs) across observational studies of MSM. Comprehensive search of databases, including MEDLINE, EMBASE, ERIC, Sociofile, PsycINFO, Web of Science, and Google Scholar, and correspondence with researchers, to find published articles, conference proceedings, and unpublished reports through February 2008. Of 18 studies that quantitatively examined the association between male circumcision and HIV/STI among MSM, 15 (83%) met the selection criteria for the meta-analysis. Independent abstraction was conducted by pairs of reviewers using a standardized abstraction form. Study quality was assessed using the Newcastle-Ottawa Scale. A total of 53,567 MSM participants (52% circumcised) were included in the meta-analysis. The odds of being HIV-positive were not significantly lower among MSM who were circumcised than uncircumcised (odds ratio, 0.95; 95% confidence interval, 0.81-1.11; number of independent effect sizes [k]=15) [corrected].). Higher study quality was associated with a reduced odds of HIV infection among circumcised MSM (beta, -0.415; P = .01). Among MSM who primarily engaged in insertive anal sex, the association between male circumcision and HIV was protective but not statistically significant (odds ratio, 0.71; 95% confidence interval, 0.22-2.28; k=4) [corrected].Male circumcision had a protective association with HIV in studies of MSM conducted before the introduction of highly active antiretroviral therapy (odds ratio, 0.47; 95% confidence interval, 0.32-0.69; k = 3).Neither the association between male circumcision and other STIs (odds ratio, 1.06; 95% confidence interval, 0.97-1.15; k=8) nor its relationship with study quality was statistically significant (beta, 0.265; P=.47) [corrected]. Pooled analyses of available observational studies of MSM revealed insufficient evidence that male circumcision protects against HIV infection or other STIs. However, the comparable protective effect of male circumcision in MSM studies conducted before the era of highly active antiretroviral therapy, as in the recent male circumcision trials of heterosexual African men, supports further investigation of male circumcision for HIV prevention among MSM.

Social and economic hardship among people living with HIV in London

To examine the social and economic circumstances of people living with HIV in London. Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving treatment and care in north-east London National Health Service out-patient clinics completed a confidential, self-administered questionnaire. The questionnaire sought information on employment, income, education, residency status in the UK and housing. In total, 1604 respondents were included in the analysis: Black African heterosexual women (n=480) and men (224); White (646) and ethnic minority (i.e. non-White) homosexual men (112); White heterosexual men (64) and women (39); and Black Caribbean heterosexual women (26) and men (13). Black African heterosexual men and women consistently reported more difficulties than any other group in relation to employment, income, housing and residency status. Half the Black African heterosexual men (46.8%) and women (51.2%) reported insecure residency status in the UK, significantly more than any other group (P<0.001). Just under half the respondents (46.6%) were employed at the time of the survey; Black African heterosexual women (35.3%) and men (45.4%) were less likely to be employed than White (57.6%) or ethnic minority (53.7%) homosexual men (P<0.001). Forty per cent of Black African heterosexual men and women, 22.9% of ethnic minority homosexual men and 9.6% of White homosexual men did not have enough money to cover their basic needs (P<0.001). In this study of people living with HIV in London, a substantial number faced social and economic hardship, particularly Black African and other ethnic minority respondents. Our findings provide further evidence that in London HIV is associated with poverty, particularly among migrant and ethnic minority populations.

Disclosure of HIV Status

To examine HIV disclosure among people living with HIV in London. Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving medical care in National Health Service (NHS) clinics in northeast London completed a confidential, self-administered questionnaire. Respondents were asked whether they had told anyone else that they had HIV, and if so, whom. The analysis included 1407 people: 667 black African heterosexual respondents (453 women, 214 men) and 740 gay men (633 white, 107 ethnic minority). The majority of respondents (88.0%) had told at least 1 other person about their HIV infection, but this varied between groups: white gay men, 95.0%; ethnic minority gay men, 93.5%; black African heterosexual women, 84.8%; black African heterosexual men, 76.6% (P < 0.001). Black African heterosexual men (65.3%) and women (60.4%) were less likely to have told their current partner about their HIV infection than white (86.2%) or ethnic minority gay men (85.2%): black African men, adjusted odds ratio (AOR) 0.25, 95% confidence interval (CI) 0.14, 0.44, P < 0.001; black African women, AOR 0.24, 95% CI 0.15, 0.39, P < 0.001 (reference group, white gay men). Only 1 in 5 respondents (21.6%) had disclosed their HIV status to their employer (white gay men, 30.5%; ethnic minority gay men, 15.8%; black African heterosexual women, 10.5%; black African heterosexual men, 8.8%; P < 0.001). In this London study there were striking differences, by ethnicity, in the extent to which people with HIV disclosed their infection. This has important implications in light of the 2005 Disability Discrimination Act and recent prosecutions in the UK for the reckless transmission of HIV.

Like a prayer: the role of spirituality and religion for people living with HIV in the UK

Over 40,000 people are now living with diagnosed HIV in the UK. There is, however, uncertainty about how people with HIV use religion or spirituality to cope with their infection. Adopting a modified grounded theory approach, we analysed individual and group interviews with the people most affected by HIV in the UK: black African heterosexual men and women and gay men (mostly white). For the majority of black African heterosexual men and women in our study, religion was extremely important. We found that gay men in the study were less religious than black Africans, although many were spiritual in some way. Black African individuals constructed their spiritual narratives as largely Christian or collective, while gay men described more individualistic or 'New Age' approaches. We developed a six-level heuristic device to examine the ways in which prayer and meditation were deployed in narratives to modulate subjective wellbeing. These were: (i) creating a dialogue with an absent counsellor; (ii) constructing a compassionate 'life scheme'; (iii) interrupting rumination; (iv) establishing mindfulness; (v) promoting positive thinking, and (vi) getting results. That people with HIV report specific subjective benefits from prayer or meditation presents a challenge to secular healthcare professionals and sociologists.

Uptake of antiretroviral treatment among people living with HIV in London: ethnicity, gender and sexual orientation

Objective:To examine, by ethnicity, gender and sexual orientation, uptake of antiretroviral treatment among people living with HIV in London.Methods:Between June 2004 and June 2005, 1687 people living with HIV (73%...

Positive prevention: Contemporary issues facing HIV positive people negotiating sex in the UK

Over 40,000 people are now living with diagnosed HIV in the UK. The term ‘positive prevention’ has been coined to describe HIV prevention that focuses on people living with an HIV diagnosis. There is uncertainty, however, about how people with HIV manage risk and how their ability to prevent the transmission of HIV is linked to their mental health and social circumstances. We analysed 44 individual and three group interviews with the people most affected by HIV in the UK: black African heterosexual men and women and gay men (mostly white). We found that participants had similar as well as contextually different needs when it came to negotiating safe sex, assimilating prevention knowledge. The themes that emerged included taking ‘additional responsibility’ for partners, negotiating with partners who are willing to have unprotected (anal or vaginal) sex, links with mental health, constructing the moral ‘other’ and power differences. We conclude with a discussion of the priorities for positive prevention for men and women living with diagnosed HIV in the UK.