HIV-related Sexual Behaviors Research Articles

Temporal changes in HIV-related stigma and sexual behaviours: An examination of 22 African countries.

ABSTRACTDespite non-trivial success against the HIV epidemic, health experts in Sub-Saharan Africa (SSA) remain concerned about new infections, stigma attitudes, and increasing rates of higher-risk sexual behaviours (HRSBs). Although this concern has produced voluminous scholarship on the behavioural consequences of belonging to stigmatised populations, scholars have only recently examined the behavioural consequences of holding stigmatising attitudes. Existing work generally finds a positive relationship between stigmatising beliefs and the practice of HRSBs. Yet, it is unknown whether this relationship has changed for countries over the past two decades. We fill this gap using Demographic and Health Survey data from 22 SSA countries. We first find that in most countries, the practice of HRSBs has increased, while stigma beliefs have become more tolerant. Second, the relationship between stigma beliefs and HRSBs changed in only six countries: Nigeria, Kenya, Mozambique, Sierra Leone, Ethiopia, and Lesotho. It changed from non-existent or negative to positive in Nigeria, Kenya, Mozambique, and Ethiopia, but non-existent to negative in Sierra Leone. In Lesotho, the positive association weakened over time. These findings highlight the importance of social and epidemic contexts when considering how stigma impacts sexual behaviours and HIV rates in SSA.

Uptake of HIV testing and its correlates among sexually experienced college students in Southwestern, China: a Web-Based online cross-sectional study

BackgroundThe prevalence of human immunodeficiency virus (HIV) is becoming more common among college students in China. However, latest data on the prevalence and correlates of HIV testing among sexually experienced college students is rarely.MethodsAn online survey was conducted among college students aged 18 years or older using multistage stratified cluster sampling from 16 colleges. Data on socio-demographic, HIV testing, HIV-related awareness, attitudes, sexual education and behaviors were collected. Propensity score matching (PSM) and logistic regression model were used to identify factors associated with HIV testing.ResultA total of 108,987 students participated the survey, of which 13,201 sexually experienced college students were included in this study. 1,939 (14.69%) college students with sexual experience reported uptake of HIV testing in the preceding year. The uptake of HIV testing increased for college students with a rising HIV knowledge score and sexual health knowledge. Being awareness of HIV-related knowledge (aOR = 1.15, 95%CI: 1.01–1.30), accepting one-night stands (aOR = 1.16, 95%CI:1.03–1.32), obtaining satisfactory sexual interpretation from parent(s) (aOR = 1.24, 95%CI: 1.07–1.43), ever had unintended pregnancy (aOR = 1.78, 95%CI: 1.32–2.38), ever had received HIV-related preventive service(s) (aOR = 1.37, 95%CI: 1.10–1.70), ever had participated HIV-related preventive services (aOR = 3.76, 95%CI: 2.99–4.75) and ever had anal sex (aOR = 2.66, 95%CI: 2.11–3.34) were positively associated with uptake of HIV testing. However, accepting premarital sex (aOR = 0.76, 95%CI: 0.66–0.88), accepting cohabitation (aOR = 0.75, 95%CI: 0.61–0.92), occasionally discussing sex with parent(s) (aOR = 0.68, 95%CI: 0.50–0.91), and being with moderate satisfaction of school sex courses (aOR = 0.74, 95%CI: 0.58–0.95) were negatively associated with uptake of HIV testing.ConclusionThe prevalence of HIV testing was relatively low. Participation in HIV-related services and high-risk sexual behaviors were important enablers for testing. Improving sex education for students, increasing HIV preventive services on campus, and improving family sex education are necessary to increase HIV testing among college sexually experienced students.

HIV-Related Knowledge and Sexual Behaviors among Teenagers: Implications for Public Health Interventions.

Background: Teenagers are at a turning point in people's physical and psychological maturity and are also in a critical period in reproductive and sexual health. It is reported that the initial age at first sexual behavior is younger than decades ago, which implies that the risky sexual behavior among teenagers may be on the rise. However, it is unclear about the changes of sexual knowledge and behaviors in recent years. Methods: Based on the national sentinel surveillance survey in 2011-2021 among students in Hangzhou, we selected out teenagers aged 10-19 years as our study sample. Demographic characteristics (gender, age, marital status, etc.), knowledge of HIV and sexual behaviors were collected. The sexual knowledge score and sexual behaviors were analyzed, and their influencing factors were explored. Results: In total, 1355 teenagers were incorporated in this study; the awareness rates of sexual knowledge in 2011, 2013, 2014 and 2021 were 74.9%, 71.8%, 89.3% and 95.8%, respectively, which showed an overall upward trend. The results of binary logistic regression showed that the survey year, whether students had received and participated in HIV-related publicity services and whether they had sexual behaviors, had a significant influence on whether the awareness rate ≥ 75%. The survey year and whether the awareness rate ≥ 75% had a significant influence on whether students had sexual behaviors. Conclusions: Both the average scores and awareness rates of teenagers' sexual knowledge showed an overall upward trend from 2011 to 2021. Teenagers' initial sexual behavior was at a low age, and the proportion of teenagers who had fixed, temporary and commercial heterosexual sex was still relatively high despite no significant increasing. Therefore, we should further strengthen health education on the risks of sexual behaviors from schools, families and health-related institutions to ensure teenagers receive HIV-related publicity services.

Does self-perceived HIV risk mediate the potential association between HIV-related symbolic stigma and sexual behaviour among young adult women in Cape Town, South Africa?

BackgroundPerception of risk is a central construct of models of health behaviour change as it is assumed to be an intermediate step before adoption of the related safer behaviour. In the context of HIV/AIDS, the literature suggests that psychosocial factors such as stigmatising attitudes related to stereotyping people who contract HIV may influence how people perceive their own risk of HIV infection. However, findings on the relationships between HIV-related stigma, HIV risk perception and sexual behaviour have been inconsistent. We investigated the potential mediating role of HIV risk perception on the link between HIV-related symbolic stigma and sexual behaviour.MethodsData used in this study are a sub-sample of 384 young adult women, aged 17–25 years, who participated in the Cape Area Panel Study conducted in Cape Town, South Africa. Study participants were asked questions relating to their demographic details, their social and economic situation, and sexual and reproductive health behaviour. The outcome measure was a composite measure of sexual behaviour derived from whether the young adult women ever had sex before, previous number of sexual partners and condom use. The mediator variable was self-perceived risk of contracting HIV. The independent variable was HIV-related symbolic stigma attitudes. Mediation analysis within the structural equation modeling (SEM) framework was used to examine if participants who held elevated stigma attitudes perceived their risk of HIV infection to be low and as a result ended up engaging in unsafe sex.ResultsHigher HIV-related symbolic stigma attitudes were associated with perception of reduced risk of contracting HIV (β = -0.248, p = 0.008, 95% CI = [-0.431, -0.066]) and perception of higher risk of contracting HIV was significantly associated with unsafe sex practices (β = 0.179, p = 0.038, 95% CI = [0.010, 0.348]). The indirect path was not significant (β = -0.044, p = 0.084, 95% CI = [-0.095, 0.006]), suggesting no mediation relationship.ConclusionsStigmatising attitudes towards groups of people stereotyped as at risk of HIV infection was associated with perception of invulnerability to HIV, and the question on how this relationship affects risk sexual behaviour needs further investigation.

Psychosocial characteristics pattern correlated with HIV-related risky sexual behavior among HIV-negative men who have sex with men: a latent profile analysis

Men who have sex with men (MSM) have become a high risk population of HIV infection due to their risky sexual behaviors. The latent pattern of psychosocial characteristics plays an important effect in HIV-related risky behaviors among HIV-negative MSM. Participants were recruited from Wuhan, Nanchang, and Changsha city from September 2017 to January 2018. Social support was assessed by the multidimensional scale of social support, Connor-Davidson Resilience scale-10 items for reliance, the assessment of Stigma towards Homosexuality for sexual minority stigma, the Likert subscale of nondisclosure for identity concealment, the ACE questionnaire-Kaiser-CDC for adverse childhood experience, the Centers for Epidemiological Studies Depression Scale for depression. Latent profile analysis (LPA) and multivariate regression were used to analyze the data. Three psychosocial characteristic patterns were revealed by the LPA. "Social support and resilience group" (SR group), "Identity concealment group" (IC group) and "Adverse childhood experience" (ACE group) were identified, respectively. In comparison with "SR group", "IC group" have a higher likelihood of one-night male partners (AOR = 2.74, 95%CI = [1.54, 4.90]), both fixed and one-night male partners (AOR = 2.01, 95%CI = [1.34, 3.01]) and HIV-unsure male partner (AOR = 2.12, 95%CI = [1.44, 3.13]). Similarly, "ACE group" were more likely having inconsistent condom use (AOR = 2.58, 95%CI = [1.41, 4.73]), and having sex with HIV-positive male partner (AOR = 4.90, 95%CI = [1.95, 12.30]) with comparison of "SR group". In addition, we further revealed that "ACE group" had a higher ratio (90.0%) of inconsistent condom use among MSM whose male partners were HIV-positive. Six important psychosocial factors were divided into three latent pattern classes. Compared with "SR group", "IC group" and "ACE group" were more likely to engage in HIV-related risky sexual behaviors. Further research may pay more attention to "IC group" and "ACE group" for targeted intervention.

Knowledge of viral load, PrEP, and HIV-related sexual risk among men who have sex with men in the Waterloo region

Gay, bisexual, and other men who have sex with men (GBMSM) remain most disproportionately affected by HIV in Canada. HIV-related sexual risk behaviours have been linked to high HIV risk among GBMSM, but prior research has not focused on knowledge of viral load, and the risk it presents for HIV acquisition. The purpose of this study was to explore the relationship between HIV-related sexual risk behaviour and knowledge of viral load among GBMSM. A cross-sectional survey was conducted using a convenience sample of individuals age 16 and older who self-identified as LGBTQ and lived, worked, or resided in the Waterloo region, an urban-rural area in southwestern Ontario ( N = 526). Responses were analyzed from those identifying as GBMSM ( N = 269). Logistic regression models were created to explore sociodemographic, outness, social support, and HIV-related sexual risk variables associated with knowledge of viral load. Multivariable regression models were built to explore the same associations while controlling for confounders. HIV risk was not associated with knowledge of viral load in bivariate or multivariable analyses. Point estimates for low/negligible (odds ratio [OR] 1.10; 95% CI 0.46–2.51) and high risk (OR 1.88; 95% CI 0.68–5.20) suggest trends of higher knowledge with increased HIV risk. Men who engage in sexual risk behaviour may have increased sexual health literacy and awareness of biomedical interventions (e.g., pre-exposure prophylaxis, or PrEP) that reduce HIV risk. Policies are needed that promote acceptance of sexual orientation, improve awareness and access to PrEP, and ensure optimal delivery of HIV education to at-risk groups prior to engagement in higher risk activities.

Knowledge of viral load, PrEP, and HIV-related sexual risk among men who have sex with men in the Waterloo region

Gay, bisexual, and other men who have sex with men (GBMSM) remain most disproportionately affected by HIV in Canada. HIV- related sexual risk behaviours have been linked to high HIV risk among GBMSM, but prior research has not focused on knowledge of viral load, and the risk it presents for HIV acquisition. The purpose of this study was to explore the relationship between HIV-related sexual risk behaviour and knowledge of viral load among GBMSM. A cross-sectional survey was conducted using a convenience sample of individuals age 16 and older who self-identified as LGBTQ and lived, worked, or resided in the Waterloo region, an urban-rural area in southwestern Ontario ( N = 526). Responses were analyzed from those identifying as GBMSM ( N = 269). Logistic regression models were created to explore sociodemographic, outness, social support, and HIV-related sexual risk variables associated with knowledge of viral load. Multivariable regression models were built to explore the same associations while controlling for confounders. HIV risk was not associated with knowledge of viral load in bivariate or multivariable analyses. Point estimates for low/negligible (odds ratio [OR] 1.10; 95% CI 0.46–2.51) and high risk (OR 1.88; 95% CI 0.68–5.20) suggest trends of higher knowledge with increased HIV risk. Men who engage in sexual risk behaviour may have increased sexual health literacy and awareness of biomedical interventions (e.g., pre-exposure prophylaxis, or PrEP) that reduce HIV risk. Policies are needed that promote acceptance of sexual orientation, improve awareness and access to PrEP, and ensure optimal delivery of HIV education to at-risk groups prior to engagement in higher risk activities.

Religion and Moral Judgments of HIV-related Sexual Behaviors

ABSTRACT Introduction The percentage of individuals diagnosed with human immunodeficiency virus (HIV) increases yearly, and occurs at disproportionate rates. Previous research suggests that religion may be an important coping mechanism for individuals with HIV, who have lost loved ones to HIV, or who have engaged in risky sexual behaviors (e.g., Pargament et al., 2004). However, research examining the impact that religion has on an individual's moral judgment of engaging in HIV-related sexual behaviors remains unclear. Objective To examine the impact of religious beliefs, identity, and practices on women's moral judgements towards scenarios involving potential HIV transmission. Methods Women (N = 578) were asked to indicate their moral judgments towards three items separately for male and female actors: (1) having sex with someone who discloses that they have HIV and using condoms; (2) having sex with someone who discloses that they have HIV and not using condoms; and (3) getting diagnosed with HIV and not telling new sex partners. Results Multiple regression analysis revealed that the more women listened to religious music and participated in behaviors during religious services (e.g., reading scriptures), the more morally wrong they viewed male actors for having sex with someone who discloses that they have HIV and not using condoms. Further, the more women believed in souls, the more morally wrong they viewed male and female actors for getting diagnosed with HIV and not telling new sex partners. These associations held when controlling for important confounds such as age and relationship status. Conclusions The results of this study provide further understanding about the relevance of religion on individual's’ perceptions of sexual behavior. Because religious individuals tend to be interested in long-term, highly reproductive lifestyles (e.g., Hone et al., 2021), they may view a host of sexual behaviors-including HIV-related behaviors-as morally wrong as they associate them with promiscuity. Discussion focuses on how an evolutionary perspective of religion may provide insight into aspects of women's moral judgments of sexual behaviors that have yet to be systematically explored. Disclosure No

Partnership Dynamics and HIV-Related Sexual Behaviors Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data

PurposeIn South Africa, adolescent mothers have a three times higher risk of HIV acquisition than nonadolescent mothers. Yet, limited evidence exists regarding how early childbearing may affect HIV risk. A better understanding of adolescent mothers’ partnership dynamics and sexual behaviors is critical to tailoring interventions to prevent new infections. MethodsData are from HIV Prevention Trials Network 068, a longitudinal study of adolescent girls and young women (AGYW) aged 13–20 in South Africa who were followed annually for up to 6 years. Log-binomial regression models were used to assess whether adolescent motherhood was associated with partnership dynamics (intimate partner violence, gender inequitable norms, low relationship power, no HIV prevention communication) and if the association between partnership dynamics and sexual behaviors (unprotected sex and transactional sex) varied by adolescent motherhood. Generalized estimating equations, with an exchangeable correlation structure, were used to account for nonindependence. ResultsAdolescent mothers were more likely than nonadolescent mothers to be in partnerships characterized by intimate partner violence, low relationship power, gender inequitable norms, and no HIV prevention communication. A higher proportion were also more likely to experience these dynamics, as well as engage in transactional sex, after giving birth. Poor partnership dynamics put AGYW at a higher risk for unprotected sex and transactional sex, regardless of adolescent motherhood status. DiscussionEngaging adolescent mothers in interventions post birth and developing interventions that address power imbalances in AGYW’s sexual partnerships have the potential to reduce engagement in HIV-related sexual behaviors and HIV risk in the long term.

A cohort study on the incidence of HIV infection in drug abusers among men who have sex with men in Shanghai and Tianjin

Objective: To analyze the incidence of HIV infection and identify associated risk factors in drug abusers among men who have sex with men (MSM) in Tianjin and Shanghai through a cohort study and provide a basis for HIV prevention in this population. Methods: A prospective cohort study was conducted among MSM who had a history of drug abuse in the past six months from June 2016 to June 2018 in the two cities. MSM were investigated to obtain information on sociodemographic characteristics, HIV-related sexual behaviors, and drug abuse. Follow-up investigation and HIV testing were carried out based on the baseline survey and testing. Cox regression analysis was conducted to identify the risk factors for HIV infection. Results: There were 455 eligible subjects, and 16 new HIV infection cases were identified in the 2-year follow-up survey. The cumulative follow-up time was 586.08 person-years, and the incidence of HIV infection was 2.73/100 person-years. The multivariate Cox regression analysis results showed that compared with those aged ≥25 years, consistent condom use during anal sex with men in the past six months, without mixed-use of drugs, these aged <25 years (HR=5.01, 95%CI: 1.09-23.11), inconsistent condom use during anal sex with men in the past six months (HR=1.58, 95%CI: 1.04-2.41) and mixed-use of drugs (HR=1.92, 95%CI: 1.08-3.40) were significantly associated with HIV infection in this cohort. Conclusions: The younger age, inconsistent condom use during anal sex with men, and mixed drug use appeared as risk factors of new HIV infection in drug abusers among MSM. HIV prevention and intervention in this population should be further strengthened.

Lack of agency and sexual behaviors among married women: a study of population-based HIV impact assessment (PHIA) surveys in Malawi, Tanzania and Zambia

Background Educational campaigns to prevent HIV/AIDS have shown mixed success in Africa. We hypothesized that women’s lack of agency in decision-making and taking discernible actions reduces the beneficial impact of HIV-related knowledge. Methods We used data from Population-based HIV Impact Assessment (PHIA) surveys in Malawi, Tanzania and Zambia. A subsample of surveys that were completed by married adult women were selected for the HIV knowledge module which included responses for household decision-making questions. We created a binary variable for agency (ability to participate in decision-making about household matters, health, and sex), and scalar variables for HIV-related knowledge and sexual behaviors. We used regression analysis using survey weights with the behaviors as dependent variables. Results We pooled survey results from 16,822 women (63% from Tanzania, 19% from Malawi and 18% from Zambia). Altogether, 13.5% of women (17% of those 15-24 years old) exhibited poor agency. Those with a higher degree of agency had higher education, were working, and were wealthier. Women lacking agency were significantly less likely to use condoms (4.7% vs. 6.2%, P=0.022). Approximately 95% reported having a single partner over past 12 months, while Zambian women with no agency showed significantly lower rate of 92% (odds ratio, OR=0.66, 95% confidence interval, CI=0.45-0.95, P=0.027). The rate of HIV testing across the three countries was 83%-92%. In Tanzania, presence of good knowledge and agency together increased the odds of HIV testing by 60% (interaction term). However, among those with good knowledge yet reporting poor agency, the likelihood of HIV testing decreased by 65%, nullifying knowledge impact. We did not observe similar associations in Malawi. Among women with poor knowledge, lack of agency reduced the odds of condom use by 50% compared to those with agency. Alternatively, for women who exhibited good knowledge without agency, the odds of condom use was more than double compared to women with some agency (OR=2.14, 95% CI=1.07-4.27, P=0.032)). Conclusions We detected a moderating effect for agency on knowledge-driven behavior. Results on different behaviors and across individual countries are mixed and suggest caution to derive definitive conclusions. Despite limitations, these findings indicate that policies that increase women’s agency may help anti-HIV programs’ success.

Sexual Behavior Problems in Adolescents with Intellectual Disabilities: A Systematic Review

BACKGROUND: Several studies conducted on adolescents with intellectual disabilities (ID) have reported various problems of sexual behavior that occurs in the group, including HIV-related risky sexual behavior and other health-related concerns. AIM: This review aims to synthesize studies on the problems regarding sexual behavior in adolescents with ID to obtain data on the types of risky sexual behavior problems. MATERIALS AND METHODS: Synthesis was conducted on nine studies of children aged 10–20 years old with intellectual disabilities as subjects who have no other psychiatric comorbidities and met the appraisal criteria based on the checklist for analytical cross-sectional studies of the Joanna Briggs Institute (JBI). RESULTS: Several behaviors were found in the group of adolescents with ID. Masturbation is the type of solitary behavior that appears the most, besides other behaviors like touching genitals and getting naked in public places. Sexual intercourse is the most widely reported in the type of “involving other persons.” Sexual intercourse with more than 1 person without using contraception to protect against sexual transmitted disease (STD) is at risk for HIV infection or other infectious diseases. CONCLUSIONS: The results of this review have indicated that adolescents with ID have sexual needs and experience sexual behavior problems similar to ordinary adolescents in general. They actually have a higher risk for having risky sexual behavior because they lack understanding of sexuality. These findings emphasize the need for sex education so that young people with disabilities can have healthy sexual behavior and a safe life.

Psychosocial characteristics and HIV-related sexual behaviors among cisgender, transgender, and gender non-conforming MSM in China

BackgroundWhile a growing number of studies focus on men who have sex with men (MSM), they typically ignore the heterogeneity of gender minorities within the MSM population. The recognition of new sub-groups among gender minorities (i.e., transgender and gender non-conforming), who also identify as MSM, play a considerable role in new HIV infections in China. Information on the psychosocial factors and HIV-related sexual behaviors require further consideration to understand the prevalence of HIV infection among MSM within these gender minority sub-groups.MethodsFrom September 2017 to January 2018, MSM without HIV were recruited in Wuhan, Nanchang, and Changsha cities in China. Participants were asked to fill out a structured self-administered questionnaire to assess depression, perceived social support, resilience, identity concealment, and HIV-related risky sexual behaviors.ResultsA total of 715 MSM completed the structured questionnaire, the number of MSM identifying as gender minorities were 63 and accounted for 8.8% of the population. Compared to the cisgender MSM population, transgender MSM were more likely to have a one-night stand/occasional partner (AOR = 3.49, 95% CI =1.02–11.98), to have sex after drug use in the past 6 months (AOR = 2.57, 95%CI =1.05–6.29), and to have reported a significantly lower likelihood of identity concealment (mean difference = − 3.30, 95%CI = -5.86, − 0.74, P = 0.01).ConclusionsThe findings highlight the significance of providing targeted interventions for different gender minorities within the MSM population. Research is required to further understand the relationship between gender identity, mental health, and HIV-related sexual behaviors.

Increases in HIV status disclosure and sexual communication between South African men who have sex with men and their partners following use of HIV self-testing kits

ABSTRACT Availability of HIV self-testing may increase HIV testing frequency among men who have sex with men (MSM). It is unclear, however, if self-testing may impact HIV-related sexual behaviors among MSM, including HIV status disclosure and condom use. We conducted a mixed methods analysis of changes in HIV-related behaviors after HIV self-testing introduction, using data from 110 MSM participating in a feasibility and acceptability study of HIV self-testing in Mpumalanga Province, South Africa. We found increased HIV status disclosure from study participants to sexual partners after HIV self-testing introduction, from 61.8% at baseline to 75.5% at 6-month follow-up (p = 0.04), but decreased condom use with female partners (p = 0.03). Qualitative interviews reveal that some participants used test results to inform condom use. Distribution of self-testing kits can improve mutual disclosure, but should be accompanied by information stressing that the tests may not detect early HIV infections or other sexually transmitted infections.

‘I married when I was 16… due to poverty, I had no other way’: multi-level factors influencing HIV-related sexual risk behaviours among adolescent girls in Zambézia, Mozambique

This paper explores individual, interpersonal- and household-level factors influencing HIV-related sexual risk behaviour among adolescent girls who participated in an intervention to reduce HIV risk in a rural setting in Mozambique. Twenty-eight adolescent girls ages 13–19, 30 heads of household, and 53 influential men participated in in-depth interviews at two time points. Comparative analysis compared girls who reported reducing risk behaviours over time to girls who did not and identified factors that respondents described as influential to behaviour change. Among the twenty girls self-reporting sexual risk at the first time point, half had reduced these behaviours one year later. Changes in girls’ behaviours were contingent upon household- and interpersonal-level factors, particularly households’ economic stability and family members’ financial support. Future interventions with adolescents in similar settings should evaluate and leverage household and family support to achieve sexual risk reduction.

Sex Partner Behavior Variation Related to Network Position of and Residential Proximity to Sex Partners Among Young Black Men Who Have Sex with Men.

This analysis examines how sex behaviors are influenced by a sex partner's network bridging position and the residential proximity between the two. The study sample consisted of 437 young black men who have sex with men (YBMSM) in Chicago and their sex partners (2013-2014). Dyadic analyses that clustered on individuals using generalized estimating equations (n = 1095 relationships) were conducted to assess the associations between different HIV-related sexual behaviors and the network position of and residential proximity to a partner. The odds of group sex was higher with partners who had high network bridging, regardless of how close they lived to one another. The odds of transactional sex was higher with partners who had high network bridging and lived in a different region of the city. Sex behaviors associated with an increased risk of HIV transmission were associated with the network structural position of and residential proximity to partners among YBMSM.

Gender Identity and Sexual Orientation in Chinese Men Who Have Sex with Men: A Latent Class Analysis.

Men who have sex with men (MSM) are a diverse population yet are often treated as a monolithic risk group. In China, MSM have long been characterized as a "bridge population" of closeted men who are married to (or will marry) women due to sociocultural expectations. Latent class models can inform a more nuanced yet empirical characterization of this population. In total, 1424 eligible respondents recruited online provided self-reported behavioral data. Nine items related to constructs including sexual behaviors, sexual orientation, and gender identity informed the latent class model. Logistic regression was used to measure associations between latent class membership and HIV-related sexual and health-seeking behaviors. Model fit indicated a population structure made up of four classes that we characterized as "Gender nonconforming" (4.3%), "Closeted-unmarried" (29.9%), "Closeted-married" (24.6%), and "Out" (41.2%). Members of the "gender nonconforming" class were more likely to report HIV-related risk behaviors, and "Closeted-unmarried" class members were less likely to report health-seeking behaviors, both relative to "Out" members. The largest latent class was made up of members of the "Out" class, an enlightening revision of a population traditionally viewed as largely closeted men. Two types of "closeted" classes emerged, distinguished by divergent tendencies regarding marriage and health seeking. Findings suggest that current understandings of Chinese MSM are simplistic (regarding closeted behaviors) and too narrow (in its definition of MSM as cisgender men). A more nuanced understanding of MSM subgroups and their heterogeneous risk behaviors will be critical for provision of more meaningful prevention services.

Predictors of HIV-related high-risk sexual behaviors among female substance users

ABSTRACTThis study aimed to explore predictors of human immunodeficiency virus (HIV)-related risky sexual behaviors among women with substance use. A total of 150 women were selected from harm reduction centers in Tehran, Iran, and completed the risk behavior assessment, the Beck depression inventory, the revised self-efficacy scale, and the peer group beliefs regarding HIV-related risk behaviors scale. The results showed that age (β = −.07, P ˂ .01) and exchange of sex for drugs or money (β = 3.34, P ˂ .001) were significant predictors of whether women had multiple sex partners. Moreover, depression (β = .06, P ˂ .05), exchange of sex for drugs or money (β = 1.42, P ˂ .01), and self-efficacy (β = −.19, P ˂ .001) significantly predicted unprotected sex among women with substance use. Accordingly, providing female substance users with harm reduction services and developing HIV prevention programs are likely to decrease high-risk sexual behaviors and consequent HIV infection within this vulnerable group.

Living Conditions as a Driving Factor in Persistent Methicillin-resistant Staphylococcus aureus Colonization Among HIV-infected Youth

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been linked to HIV-related sexual and social behaviors. MRSA risk factors may be different for HIV-infected children, adolescents and young adults. We investigated the association of MRSA colonization, persistent colonization and genotypes with potential risk factors among HIV-infected youth. For this case-control study, patients 24 years of age or younger attending 2 HIV reference centers were recruited from February to August 2012 and followed for 1 year. Nasal swabs were collected at enrollment and every 3 months. MRSA clones were characterized by staphylococcal chromosomal cassette mec typing, spa typing and multilocus sequence typing. We compared MRSA colonization and persistent colonization with patient demographic and clinical characteristics. Among 117 participants, MRSA colonization frequency (calculated for each collection based on the number of positive cultures per patient) was 12.8% at the first collection. The average MRSA colonization frequency was 10.4%. Our results showed 11.1% were persistent carriers (subjects with more than 1 positive culture in at least 3). Crowding was the only factor associated with MRSA colonization (P = 0.018). Persistent carriers had significantly higher (4.2 times) odds of living in a crowded household (95% confidence interval-1.1-16.2). We observed high genetic diversity among MRSA isolates, with t002/ST5 and t318/ST30 being the most frequent. MRSA colonization among HIV-infected youth is more closely related to living in a low-income or slum community than to HIV-related clinical factors. High genetic MRSA isolate diversity in our population suggests frequent transmission.

The role of family interactions in HIV risk for gay and bisexual male youth: A pilot study

ABSTRACTDespite ongoing prevention efforts, young gay and bisexual males continue to engage in sexual behaviors that place them at disproportionately high risk for HIV infection. Parental monitoring and parent–child communication have been found to be associated with low-risk sexual behavior among heterosexual youth, but the role of family interactions for gay and bisexual male youth remains largely unexplored. To help address this gap, an exploratory study of recorded and coded interactions among 35 gay and bisexual youth and their parents was done to begin to identify which types of family interactions were associated with youth high-risk sexual behavior. Parent–son communication that was mutual and low in conflict was found to be most prevalent among youth with the fewest reported high-risk sexual behaviors. These preliminary findings, along with a case example, demonstrate how social workers can coach families to engage in productive and potentially influential interactions that reduce HIV-related sexual behaviors among young gay and bisexual males.