HIV-positive Gay Men Research Articles

The Study of the Prevention of Anal Cancer (SPANC): design and methods of a three-year prospective cohort study

BackgroundThe incidence of human papillomavirus (HPV)-associated anal cancer is increasing in men who have sex with men (MSM). Screening for the presumed cancer precursor, high-grade anal squamous intraepithelial lesions (HSIL) in a manner analogous to cervical cancer screening has been proposed. Uncertainty remains regarding anal HPV natural history and the role of anal cytology and high-resolution anoscopy (HRA) as screening tests. Well-designed cohort studies are required to address these issues.Methods/designThe SPANC study is a prospective study of the epidemiology of low-risk and high-risk anal HPV infection and related cytological and histological abnormalities in HIV-negative and HIV-positive homosexual men aged 35 years and over. The study aims to recruit 600 men from community-based settings in Sydney, Australia. There are six study visits over three years. At the first five visits men undergo a digital ano-rectal examination (DARE), an anal “Papanicolaou” (Pap) test for HPV detection, genotyping and anal cytology, followed by HRA and directed biopsy of any visible abnormalities. The men also complete a behavioural questionnaire before each visit. Questions include a detailed history of sexual behaviour, of anal symptoms, possible anal cancer risk factors and validated quality of life and psychosocial questions. Questionnaires are also completed 2 weeks and 3 months following the provision of test results and include questions on participant experience during the procedure and post-procedure symptoms, including pain and bleeding in addition to quality of life/ psychosocial outcomes.DiscussionRecruitment for the study began in September 2010 and will conclude in mid-2015, with follow up continuing to 2018. Thus far, over 350 men have been recruited from a variety of community-based settings and are broadly representative of the target screening population. The SPANC study is one of only a small number of cohort studies globally to perform HPV, cytology and HRA screening on all participants over multiple time points. The study results will contribute to understanding of the natural history of anal HPV and inform the possible development of guidelines for implementing anal cancer screening programs in this population.

The 18F-FDG PET/CT Finding of a Condyloma Acuminata Mimicking Primary Anorectal Carcinoma in an HIV-Infected Patient

This case report describes a condyloma acuminata with intense FDG uptake mimicking primary anorectal carcinoma in an HIV-infected patient.A 44-year-old HIV-positive homosexual man with a history of lymphoma underwent an 18F-FDG PET/CT for restaging. A focal intense hypermetabolic lesion around the anorectal area was found by the PET/CT and it was suggested as a tumorous lesion. However, the lesion was not detected on the contrast-enhanced abdominal CT. Via a sigmoidoscopy, cauliflower-like masses were visualized in the intra-anal area. The tumor was surgically excised and proven to be condyloma acuminata by permanent pathology.

Correlates of perceptual and behavioral definitions of abuse in HIV-positive sexual minority men.

Interpersonal violence researchers have begun to focus on the role of perception of abuse experiences in post-abuse adjustment, and have posited that there may be something critical about a mismatch between having experienced abuse and actually labeling an experience as Utilizing cross-sectional data collected from outpatient HIV care settings, this study is the first to examine the role of abuse self-definition in HIV-positive gay and bisexual men. The sample (N = 166) was divided into participants who self-defined their experiences as abuse and those who did not. Logistic regression was used to assess the impact of various factors (demographic, mental health, behavioral, and HIV health status) on the likelihood of self-defining child sexual abuse, child physical abuse, and partner abuse. Relationship to the perpetrator and characteristics of child sexual abuse experiences were explored as predictors of self-definition. Self-definition rates varied, with approximately 55% of child abuse victims and 24 to 31% of partner abuse victims labeling it as such. Participants who endorsed child sexual abuse experiences that involved force or coercion, and participants who reported a family member as the perpetrator, were more likely to define their experiences as abuse. These results suggest that screening for abuse history in clinical and research contexts should consistently utilize behaviorally anchored questions to minimize the likelihood of false negative reports. Further research is needed to better understand the process of labeling and the mechanisms underlying the labeling outcome relations.

Obstinate essentialism: identity transformations amongst gay men living with HIV

This article explores the ways gay men living with HIV talk about their identities in relationship to ideas concerning essentialism in the broader context of biomedicalisation. Data were collected from 36 HIV-positive gay men between 2001 and 2005 from two studies. All interview material was initially collected and analysed using broadly speaking thematic analysis. Identity-oriented themes were then further explored with a critical lens examining resonances with essentialism. We detail three related themes: ‘the intersections of homosexuality, HIV and the biomedical’; ‘being HIV: ontological crisis and obstinate essentialism’; and ‘identity and treating HIV’. These outline the ways in which both HIV- and gay identities are often interwoven (utilising shared narratives and concepts), embraced and/or resisted. We discuss the concept of essentialism within the wider transformation, or the ‘normalisation’, of both male homosexuality and HIV and draw attention to the salience of biomedicalisation and concomitant biopower within accounts of gay men living with HIV.

When ‘raw sex’ turns to a ‘raw deal’ … taking the opportunity to think about sex? Interviews with HIV-positive gay men diagnosed with acute hepatitis C

Since 2001, cases of hepatitis C virus (HCV) sexual transmission have been reported in France, among HIV-positive gay men who do not inject drugs. An earlier study focused on the incidence of acute hepatitis C and risk factors associated with HCV transmission. The present study, based on in-depth interviews, aimed to highlight the biography, the sexual practices and the experiences of gay men infected with HCV. Beyond an apparent uniformity, the group of interviewees illustrates a variety of situations, life stories and health pathways, depending on their age. These well-adjusted gay men were used to engaging in unprotected sexual practices, but before their diagnosis they largely ignored HCV-transmission risk, which was associated in their mind with a pejorative drug addict image. Once diagnosed with acute hepatitis C, they experienced a critical and emotional period during which they were open to discuss their sexual practices and reconsider risk-reduction procedures, without being willing to give up on their satisfying sex life. Health educators should consider labelling hepatitis C as an STI in order to disrupt its negative image and to help HIV-positive gay man raise their awareness of HCV-transmission risks and implement better risk-reduction strategies.

Size of anal squamous cell carcinomas at diagnosis: a retrospective case series

Anal squamous cell carcinoma is more common in HIV-positive homosexual men than in the general population and prognosis worsens with increasing tumour size. To identify opportunities for earlier diagnosis, we aimed to determine size and visibility of anal squamous cell carcinoma at diagnosis. We conducted a retrospective review of medical records between 1992 and 2010 from one hospital radiotherapy centre, a major centre for HIV care, in Melbourne, Australia. Of 128 cases of anal squamous cell carcinoma, 24 (19%) were in HIV-positive men. At diagnosis, half (52%) of the tumours were externally visible and mean estimated tumour size was 36 mm (29 mm in HIV-positive and 38 mm in HIV-negative patients; p = 0.04) and 114/121 (94%) tumours were 1 cm or larger. The most frequent symptoms were bleeding (43%) and pain (36%) and mean duration of symptoms was 22 weeks. This suggests most anal squamous cell carcinoma were visible or palpable for some time before diagnosis, meaning that screening high-risk groups by anal inspection and palpation is plausible.

Anxiety Specific Pathways to HIV Sexual Transmission Risk Behavior Among Young Gay and Bisexual Men

This study evaluated whether specific anxiety disorders increased the likelihood of sexual transmission risk behavior (TRB) in younger (ages 20–29) versus older (ages 30+) HIV positive gay and bisexual men. Participants completed screening measures for Posttraumatic Stress Disorder (PTSD), Social Phobia, and Panic Disorder, and an assessment of recent TRB. Moderated regression analyses indicated that PTSD was associated with greater risk of TRB in younger but not older men, independent of HIV disease stage or treatment status. Efficacy of secondary HIV prevention efforts for younger men may be augmented by addressing the context of trauma history and consequent mental health issues.

Stigmatisierungserleben bei HIV/AIDS: erste deutsche Adaptation der HIV-Stigma Skala (HSS-D)

Despite improvements in medical treatment and numerous public health campaigns stigmatization remains a potent stressor for people living with HIV/ AIDS. This study provides an initial German adaptation of the HIV Stigma Scale (HSS-D). Participants were 167 HIV-positive homosexual men aged 22-74 years. Exploratory factor analysis replicated the original four-factor structure (subscales: enacted stigma, disclosure concerns, negative self-image, concern with public attitudes). Further psychometric analysis led to a revised version comprising 21 items (HSS-D21). The scale showed high reliability (α=0.90). Significant associations with anxiety, depres-sion, life satisfaction and perceived social support confirmed for construct validity. The majority of the respondents expressed high acceptance of the stigma measure. In order to eslish a thorough German adaptation further research with diverse samples is needed.

Association of social determinants of health with self-rated health among Australian gay and bisexual men living with HIV

Despite a vast improvement in the survival of people living with HIV (PLHIV) since the introduction of combination antiretroviral treatment (cART), little change in the self-rated health of PLHIV has been observed since the introduction of cART in Australia. Difficulties with attaining employment or achieving financial security have been noted as some of the key challenges still facing PLHIV in the post-cART era. As a result, we investigated the independent association of a number of key social determinants of health with self-rated health among HIV-positive gay and bisexual men in Australia. Data from two recent national, cross-sectional surveys of PLHIV (the HIV Futures 5 and 6 surveys) were used. Logistic regression was used to assess the independent association of ethnicity, region of residence, education level, employment status, after-tax income, experience of HIV-related discrimination, level of social support, relationship status and recent sexual activity with reporting good–excellent self-rated health, after adjusting for clinical factors and other social determinants of health. Multiple imputation was used to estimate missing data for variables with >5% missing data. Of the 1713 HIV-positive gay/bisexual men who responded to the HIV Futures 5 and 6 surveys, information on self-rated health was available for 99.3%. Close to three-quarters of these respondents (72.1%) reported their self-rated health as good or excellent; the remainder (27.9%) reported their self-rated health as poor or fair. In multivariable analysis involving 89.3% of respondents, being employed, reporting recent sexual activity, a greater number of sources of social support and a higher weekly after-tax income were found to be independently associated with reporting good–excellent self-rated health. Despite the inability of this study to detect causal associations, addressing barriers to employment and sexual activity, and mechanisms to increase social support, is likely to have positive health effects for PLHIV in Australia.

Acceptability of digital anal cancer screening examinations in HIV‐positive homosexual men

Anal cancer is more common in HIV-positive homosexual men than in HIV-negative homosexual men and the general population. Earlier diagnosis leads to improved prognosis. We aimed to determine if regular anal inspection and digital examination of asymptomatic homosexual men attending for routine HIV care were acceptable and to record the rate of referral for diagnosis of potentially malignant anal lesions. We offered anal examinations to consecutive homosexual men with HIV infection aged ≥ 35 years during their routine HIV clinic visits, aiming to complete three examinations over a 12-month period. Acceptability questionnaires were completed at baseline and after each examination and doctors recorded examination findings and all resulting interventions. Hospital referral outcomes were collected and interventions were costed using the Australian Medical Benefits Schedule. Of 142 men who were offered enrolment in the study, 102 [72%; 95% confidence interval (CI) 64-79%] participated. Following the initial anal examinations, four men were referred to surgeons. Cancer was excluded in three men (3%; 95% CI 1-8%) and one was diagnosed with anal squamous cell carcinoma (SCC). Three men had anoscopy performed at the time and two were referred for colonoscopy. Ninety-eight per cent (95% CI 93-100%) of respondents said that they would probably have the examination next time. The intervention was estimated to cost approximately Australian $16 per examination. Regular anal digital examinations are an acceptable and inexpensive addition to the routine care of homosexual men with HIV infection.

Aggregate Versus Day Level Association Between Methamphetamine Use and HIV Medication Non-adherence Among Gay and Bisexual Men

Methamphetamine use is associated with HIV infection, especially among gay and bisexual men. Methamphetamine use contributes to disease progression both directly, by increasing viral load and damaging the immune system, and indirectly, by decreasing medication adherence. Research examining the association of methamphetamine use and non-adherence has traditionally compared groups of users and nonusers on adherence, compared methamphetamine use between participants above or below some threshold level of adherence (e.g. >90 % dose adherence), or examined aggregate relationships. Using Timeline Follow-back procedures, the present study examined aggregate, threshold, and day-level associations of methamphetamine use with non-adherence in 210 HIV-positive gay and bisexual methamphetamine-using men. Methamphetamine use was not associated with adherence behavior at the aggregate-level, but methamphetamine use on a given day was associated with 2.3 times the odds of non-adherence on that day. Threshold results were equivocal. These data suggest that the methamphetamine and non-adherence relationship is complicated: non-adherence is more likely to occur on days in which methamphetamine is used, but participants reported more non-adherence days in which methamphetamine was not used. This seeming paradox generates questions about the selection of analytical techniques and has important implications for behavioral interventions targeting substance use and adherence among HIV-positive individuals.

Feasibility, Acceptability and Preliminary Efficacy of an Online Peer-to-Peer Social Support ART Adherence Intervention

This study describes the results of an online social support intervention, called "Thrive with Me" (TWM), to improve antiretroviral therapy (ART) adherence. HIV-positive gay or bisexually-identified men self-reporting imperfect ART adherence in the past month were randomized to receive usual care (n = 57) or the eight-week TWM intervention (n = 67). Self-reported ART outcome measures (0-100 % in the past month) were collected at baseline, post-intervention, and 1-month follow-up. Follow-up assessment completion rate was 90%. Participants rated (1-7 scale) the intervention high in information and system quality and overall satisfaction (Means ≥ 5.0). The intervention showed modest effects for the overall sample. However, among current drug-using participants, the TWM (vs. Control) group reported significantly higher overall ART adherence (90.1 vs. 57.5% at follow-up; difference = 31.1, p = 0.02) and ART taken correctly with food (81.6 vs. 55.7% at follow-up; difference = 47.9, p = 0.01). The TWM intervention appeared feasible to implement, acceptable to users, and demonstrated greatest benefits for current drug users.

Religiousness, Spirituality, and Existential Well-being Among HIV-Positive Gay, Bisexual, and Other MSM Age 50 and Over

The religious and spiritual experiences of HIV-positive gay, bisexual, and other men who have sex with men (MSM) are severely understudied, especially among those over 50. However, literature supports that religious/spiritual experiences are related to both physical and mental health among older adults. In this exploratory analysis we assessed the relations that exist among a sample of HIV-positive gay, bisexual, and other MSM over 50 in regard to sociodemographic factors and two established measures of religiosity/spirituality. Differences emerged in relation to both race/ethnicity and age for the Ironson-Woods Spirituality/Religiousness (SR) Index, while, for the Existential Well-being subscale, differences emerged in relation to race/ethnicity and perceived socioeconomic status.

Can additive measures add to an intersectional understanding? Experiences of gay and ethnic discrimination among HIV-positive Latino gay men.

The current study investigated a methodological question of whether traditional, additive, quantitative data can be used to address intersectional issues, and illustrated such an approach with a sample of 301 HIV-positive, Latino gay men in the United States. Participants were surveyed using A-CASI. Hierarchical logistic set regression investigated the role of sets of variables reflecting demographic characteristics, gender nonconformity, and gay and ethnic discrimination in relation to depression and gay collective identity. Results showed the discrimination set was related to depression and to gay collective identity, as was gender nonconformity. Follow-up logistic regression showed that both types of discrimination were associated with greater depression, but gender nonconformity was not. Gay discrimination and gender nonconformity were positively associated with gay collective identity, whereas ethnic discrimination was negatively associated. Results are discussed in terms of the use of traditional quantitative data as a potential means of understanding intersectional issues, as well as of contributing to knowledge about individuals facing multiple structural inequalities.

Human papillomavirus types 6 and 11 seropositivity: Risk factors and association with ano-genital warts among homosexual men

Human papillomavirus (HPV) types 6 and 11 are most commonly associated with ano-genital warts. There are few data on the sero-epidemiology of HPV6 and HPV11 among homosexual men. Behavioural data and sera for antibodies to HPV6 and HPV11 capsid protein L1 were collected annually for 1427 HIV negative and 245 HIV positive homosexual men. For HIV negative men, a combined variable, HPV6/11, was created (HPV 6 and/or 11) to analyse predictors of seroprevalence and seroincidence. High rates of HPV6 and HPV11 seroprevalence were found (39.2-53.2% of men). For HPV6/11 (HIV negative men only), seroprevalence was associated with higher numbers of sexual partners, longer history of sexual activity and seropositivity for several sexually transmissible infections. Each year, 12.6% of men younger than 25 years seroconverted. Seroincidence (5.9/100PY) was associated with younger age, more recent male sexual partners, receptive anal fingering and anal chlamydia. Seropositivity and seroconversion were strongly associated with past and incident anal warts. HPV6 and HPV11 seropositivity were common among homosexual men. Among HIV negative men, HPV6/11 seroprevalence and seroincidence correlated closely with markers of sexual activity. The high numbers of young men seroconverting each year suggests a role for prophylactic vaccination of young gay men. Ano-genital warts, caused by human papillomavirus, are very common. In a community cohort of Australian homosexual men, HPV6 and 11 seroprevalence and seroincidence were high and were associated with past and incident anal warts and other markers of sexual activity.

“Cum Play” among Gay Men

The exchange of semen, often referred to as "cum play," has featured in gay literature and may be a unique aspect of many gay men's sexual behavior. We investigated the prevalence of "cum play" and its context among 1153 HIV-negative and 147 HIV-positive Australian gay men in an online survey. Receptive cum play (partner ejaculating or rubbing his semen over participant's anus, or participant using partner's semen as lubricant) was reported by one in six HIV-negative and one quarter of HIV-positive men on the same occasion of protected anal intercourse with a casual partner (PAIC). HIV-negative men who engaged in receptive cum play during PAIC often believed that their partner was HIV seroconcordant and tended to trust that partner. They were also generally more optimistic about the likelihood of HIV transmission, and they often only used condoms at their partners' instigation. Cum play was not uncommon and highlights the narrowness (or danger) of focusing on condom use without considering the implications of broader sexual practices and their meaning for sexual health promotion. "Safe sex" for some gay and bisexual men does not necessarily mean consistent commitment to condom use or to avoiding semen exchange. Many feel confident in their knowledge of their partner's HIV serostatus and only use condoms with these partners at their partner's request. Their commitment to safe sex may not necessarily be compromised by their practice of cum play, but the extent to which this could represent a risk for HIV transmission depends on the reliability of their assessment of their partners' HIV serostatus.

HIV Illness Narratives in New Zealand: The Significance of the Experiences of HIV-Positive Homosexual Men Between 1983 and 1997

HIV Illness Narratives in New Zealand: The Significance of the Experiences of HIV-Positive Homosexual Men Between 1983 and 1997

The combination treatment using CO2 laser and photodynamic therapy for HIV seropositive men with intraanal warts

We evaluate the effectiveness of combination treatment using photodynamic therapy after carbon dioxide laser in preventing the recurrence of condylomata acuminata for intraanal warts in HIV positive homosexual men. A retrospective survey of 41 patients referred to the STD clinic of the Fourth People's Hospital of Shenzhen for the treatment of intraanal warts among HIV positive homosexual men between Janurary 2009 and September 2011. The patients who accepted CO₂ laser monotherapy for the same diagnosis were used as the comparison group. After the confirmation of the diagnosis of HIV infection and intraanal warts, the patients were treated with the combination treatment using PDT with 5-ALA thermal gel immediately after CO₂ laser ablation of the warts. PDT was performed with irradiation of 100 J/cm² at an irradiance of 100-150 mW/cm² with a semiconductor laser, wavelength 635 nm. PDT therapy was repeated twice with 2 weekly intervals. Follow up examinations including an anoscopy every 4 weeks after the latest PDT. After 3 cycles of PDT treatments, 39 cases of anoscopy examination showed no new or recurrent lesions. At the end of the sixth months, recurrence occurred in 12(29%) cases. HPV 11 was present in 6 (50%) of these recurrences. HPV 6/11 or 16/18 remains positive in 19 cases (46.3%) and HPV negative in 22 cases. The combination treatment with CO₂ laser and PDT is much more effective in reducing the treatment cycles and the time intervals of the whole treatment for intraanal warts in HIV infected people.

Identity-Related Growth and Loss in a Sample of HIV-Positive Gay and Bisexual Men: Initial Scale Development and Psychometric Evaluation

Past examinations of the impact of chronic illness on identity have focused primarily on positive adaptation (i.e., benefit finding or posttraumatic growth). Given that associations between these constructs and psychosocial wellbeing are equivocal, greater investigation is needed into interactions among perceived positive and negative identity changes pursuant to illness. A cross-sectional study was conducted between 2006 and 2007 with an ethnically diverse sample of 129 HIV-positive gay and bisexual men. Participants completed a brief quantitative survey, including a new measure, the Impact on Self-Concept Scale (ISCS), as well as gay-related stigma, quality of life, and regulatory focus. Factor analysis supported the existence of two ISCS subscales: self-growth and self-loss. Both subscales demonstrated strong internal consistency and were weakly but positively correlated. Preliminary assessment of construct validity indicated distinct patterns of association, with self-loss being more strongly associated with stigma and quality of life than self-growth. In multivariate models, associations between self-loss and both quality of life and regulatory focus were moderated by self-growth. The ISCS demonstrated preliminary reliability and validity in this sample. Findings suggest that self-growth and self-loss are meaningfully distinct constructs that may interact to produce important implications for understanding the experience of chronic illness.

HIV-Negative and HIV-Positive Gay Men’s Attitudes to Medicines, HIV Treatments and Antiretroviral-based Prevention

We assessed attitudes to medicines, HIV treatments and antiretroviral-based prevention in a national, online survey of 1,041 Australian gay men (88.3% HIV-negative and 11.7% HIV-positive). Multivariate analysis of variance was used to identify the effect of HIV status on attitudes. HIV-negative men disagreed with the idea that HIV drugs should be restricted to HIV-positive people. HIV-positive men agreed and HIV-negative men disagreed that taking HIV treatments was straightforward and HIV-negative men were more sceptical about whether HIV treatment or an undetectable viral load prevented HIV transmission. HIV-negative and HIV-positive men had similar attitudes to pre-exposure prophylaxis but divergent views about 'treatment as prevention'.