HIV-seropositive Gay Men Research Articles

A Mediation Model to Explain HIV Antiretroviral Adherence Among Gay and Bisexual Men

Based on quantitative data describing a sample of 300 HIV seropositive gay and bisexual men living in New York City who were on antiretroviral drug therapy, variables of interest were collapsed into 4 latent constructs-SES (including health care provision), psychological states, drug use impairment, and HIV treatment adherence-and structural equation modeling was used to test the relations among them. Our model indicated a complex interplay between socioeconomic factors, drug use impairment, psychological states, and adherence. It is imperative for counselors and clinicians working with this population to understand the complex relationships between cultural, social, and psychological realities and adherence to HIV antiviral medications and to develop effective socially relevant and culturally nested interventions.

Use of illicit drugs among gay men living with HIV in Sydney

Illicit drug use among gay men is common and is associated with behaviours that are at high risk for HIV transmission. We explored illicit drug use within an ongoing cohort study of gay men living with HIV in Sydney, Australia. Most (84.3%) of the 274 New South Wales participants interviewed in 2004 for the Positive Health Cohort of HIV-seropositive gay men had used illicit drugs in the 6 months before their baseline interview. One in six men (17.8%) used 'party drugs' at least monthly. At 12 months' follow-up, in 2005, these patterns of illicit drug use were similar. Being younger, participating in gay 'party scenes' and engaging in 'esoteric sex practices' at baseline were associated with any and more frequent use of party drugs, both in 2004 and 2005. Illicit drug use was, however, not associated with condom use at the most recent sexual encounters. Illicit drug use appears to be highly contextual among these gay men living with HIV, and the association with risk behaviour may reflect participation in sexually adventurous subcultures as much as a direct causal effect.

HIV+ sex: the psychological and interpersonal dynamics of HIV-seropositive gay and bisexual men's relationships

HIV+ Sex: The Psychological and Interpersonal Dynamics of HIV-Seropositive Gay and Bisexual Men's Relationships edited by Perry N. Halkitis, Cynthia A. Gomez, and Richard J. Wolitski. Washington, DC: American Psychological Association, 2005, pp. 272. In the United States, HIV/AIDS afflicts primarily men, mostly men of color and men who have sex with men (MSM). The Centers for Disease Control and Prevention (CDC) report that, among all those diagnosed with HIV since the start of the epidemic, more than 80% are men. Although the proportion of men living with HIV is decreasing, as recently as 2003 they accounted for 72% of those newly diagnosed. African-American and Latino men are disproportionately represented in these figures, and the largest transmission risk category remains MSM, accounting for 49% of all new cases in 2003. Advances in antiretroviral therapy have improved the health and prolonged the lives of men living with HIV, meaning the pursuit of sexual and romantic partners need not be abruptly interrupted by an HIV+ diagnosis or medical complications of the disease. Therefore, data are needed on ways to improve the psychological adaptation of HIV+ men, including the vitality of their Additionally, since up to one third of HIV+ individuals continue to have unprotected sex after seroconverting, research is needed to develop appropriate risk-reduction interventions for this group. Perfectly timed to address these needs is the volume HIV+ Sex: The Psychological and Interpersonal Dynamics of HIV-Seropositive Gay and Bisexual Men's Relationships, edited by three seasoned HIV researchers. Based on data from 250 qualitative interviews with HIV+ MSM from New York and San Francisco, conducted as part of the CDC-funded Seropositive Urban Men's Study, each of the book's 15 chapters explores the myriad factors related to sexual decision making. The study's original mission was to identify factors associated with serostatus disclosure and safer sex in order to identify potential cognitive, behavioral, and emotional targets for prevention interventions. The goal of addressing the health of gay and bisexual men's relationships, however, was not specifically outlined in the original study and is not emphasized in this volume. Indeed, the title is somewhat misleading since its last word should probably be sexualities and not relationships. The lack of focus on relationship initiation and development and on relationships as a context for the expression of sexuality is unfortunate given the book's frequent descriptions of men engaging in sex as a maladaptive or ineffective effort to cope with emotional pain. …

Prevention with gay and bisexual men living with HIV: rationale and methods of the Seropositive Urban Men's Intervention Trial (SUMIT)

To provide a public health rationale for prevention with HIV-seropositive gay and bisexual men and to describe the methods of the Seropositive Urban Men's Intervention Trial (SUMIT). A randomized intervention trial. Self-identified HIV-positive gay and bisexual men were recruited from community-based venues in New York City and San Francisco. Eligible participants completed an A-CASI baseline assessment, were asked to provide samples for sexually transmitted infection (STI) testing, and were randomly assigned to either a single-session intervention or a six-session enhanced intervention designed to reduce HIV transmission risk and promote serostatus disclosure. Participants who attended the first intervention session were assessed 3 and 6 months post-intervention. STI testing was offered at the 6-month assessment. A total of 1168 self-identified HIV-seropositive gay and bisexual men completed the baseline assessment, and 1110 of these (95%) opted for STI testing. A total of 811 attended the first intervention session, of which 85% were assessed at 3 months and 90% were assessed at 6 months. Of those assessed at 6 months, 92% (670/729) provided a blood or urine sample for STI testing. SUMIT demonstrates the feasibility and acceptability of prevention research with HIV-seropositive gay and bisexual men. The study provides new information about the sexual behavior, serostatus disclosure practices, and the efficacy of an intervention to reduce HIV transmission risk.

Consistent, inconsistent, and non-disclosure to casual sexual partners among HIV-seropositive gay and bisexual men

This study examined the disclosure of HIV status to casual sex partners, factors related to disclosure, and the relationship between disclosure and HIV sexual risk behaviors among a sample of HIV-positive gay and bisexual men in New York City and San Francisco. Comparisons were made particularly among men who reported consistent disclosure, inconsistent disclosure, and non-disclosure. The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising, and other techniques. Consistent disclosers reported greater self-efficacy for disclosing and more intentions to disclose than other men. They also reported less drug use, lower incomes, and more perceived viral consequences resulting from unsafe sex than did inconsistent disclosers. Overall, sexual risk behaviors were greater among inconsistent disclosers, followed by non-disclosers, with consistent disclosers reporting the fewest HIV sexual risk behaviors. Disclosure is not an all-or-nothing process, as evidenced by the 38% of men in the sample who reported disclosing to some, but not all, of their casual sexual partners. These inconsistent disclosers, who reported the most sexual risk practices, seem to lack strategies to deal with disclosure and risky sex. Some men who never disclose appear to have been able to adopt strategies by which they do not engage in sexual risk with casual partners. Interventions to improve self-efficacy for disclosure and help HIV-positive gay and bisexual men to identify and adopt specific strategies to address disclosure and safe sex are needed.

Effects of a peer-led behavioral intervention to reduce HIV transmission and promote serostatus disclosure among HIV-seropositive gay and bisexual men

To evaluate the effects of an enhanced peer-led intervention on transmission risk behavior and serostatus disclosure of HIV-seropositive gay and bisexual men. A randomized intervention trial. HIV-seropositive gay and bisexual men were recruited from New York City and San Francisco and were randomly assigned to either a standard or an enhanced intervention. The standard intervention consisted of one session that provided safer sex information. The enhanced intervention consisted of six sessions and included safer sex information, interactive learning activities, and discussion groups that were facilitated by HIV-seropositive peers. Participants completed audio computer-assisted self interview (A-CASI) assessments at baseline and 3 and 6-month follow-ups. Optional testing for sexually transmitted infections was offered at baseline and the 6-month follow-up. A total of 811 participants met the inclusion criteria for outcome analyses. Of these, 85 and 90% were retained for the 3 and 6-month follow-ups, respectively. Compared with the standard intervention, fewer men assigned to the enhanced intervention reported unprotected receptive anal intercourse with a negative or unknown-serostatus partner at 3 months (21 versus 26%, P < 0.05). However, there were no other significant differences in transmission risk or serostatus disclosure at 3 or 6 months. The enhanced intervention was associated with only a limited reduction in transmission risk at 3 months relative to the standard intervention. The characteristics of the intervention that may have reduced its efficacy are identified and directions for future research are suggested.

Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men

We sought to identify the determinants of sexual transmission risk behavior by HIV-positive individuals. We examined social cognitive theory (SCT) variables, which have been found to mediate the effectiveness of HIV risk reduction interventions. We also sought to identify contextual influences that might contribute to initial levels of SCT factors such as self-efficacy. In the present study, a series of social cognitive variables and a number of factors hypothesized to influence self-efficacy were assessed among participants at baseline in the Seropositive Urban Men's Intervention Trial. Variables tested for their effects on self-efficacy included hedonistic and self-evaluative outcome expectancies, sexual compulsivity, a history of childhood sexual abuse, drug use, and race. Models predicting condom use during anal sex with partners of HIV-negative or unknown status were tested separately for main partners and for non-main partners. Self-efficacy was associated with condom use in both analyses. Contextual influences on condom use with main partners were fewer and operated mostly via effects on self-efficacy. Influences on condom use with non-main partners exerted both direct effects on condom use and effects mediated by self-efficacy. Drug use was predictive of condom use with non-main, but not main, partners. The present results support the approach of addressing both standard SCT factors, and when possible contextual factors in interventions for HIV-positive men.

Predictors of the use of viagra, testosterone, and antidepressants among HIV-seropositive gay and bisexual men

To examine the use and correlates of the use of prescription drugs that may affect sexual behavior among HIV-positive gay and bisexual men. In a cross-sectional assessment of baseline data from a behavioral intervention, we recruited 1168 HIV-positive gay and bisexual men in 2000-2001 from community venues in New York City and San Francisco, and determined the point prevalence of the use of viagra, testosterone, and antidepressants. We examined bivariate and multivariate associations between the use of each drug and demographics, health status, substance use, psychological symptoms, and sexual risk. The current use of antidepressants was 21%, testosterone 19%, and viagra 12%. Some viagra users reported using drugs that could interact dangerously with viagra. The use of viagra, testosterone, or antidepressants was related to unprotected receptive anal intercourse and unprotected insertive oral intercourse (UIOI) with both HIV-positive and HIV-negative/unknown-status casual partners. The use of viagra was also associated with unprotected insertive anal intercourse. In multivariate models, viagra use was associated with being older, more educated, using ketamine, and engaging in UIOI with HIV-negative/unknown-status casual partners. Testosterone use was associated with being more educated and using nitrites (poppers). Antidepressant use was associated with race, using poppers, and being more depressed. Prescription medications used by HIV-positive men can have unintended negative effects such as drug interactions or associations with risky sexual behavior, particularly a drug such as viagra that is fast acting, short lasting, and provides a desirable effect. Physicians should discuss these issues with patients when prescribing, and interventions should address these challenges.

Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation

This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk. The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques. City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco. Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

Alcohol use and stigmatized sexual practices of HIV seropositive gay and bisexual men

HIV seropositive (HIV+) gay and bisexual men continue to report unprotected sexual practices. Although numerous research studies have examined the relationship between alcohol use and unsafe sex, few have examined this from a qualitative perspective. In this paper, we examined the impact of alcohol use on stigmatized sexual practices among HIV+ gay and bisexual men with alcohol-use disorders. An ethnically diverse sample (81% men of color) from the New York City metropolitan area was recruited from a variety of settings frequented by gay and bisexual men. Using a qualitative interview, contextual issues regarding sexual activities under the influence of alcohol were examined. Qualitative analysis revealed that alcohol use facilitates engagement in sexual practices that are perceived as stigmatic while sober. Interventions targeting alcohol use and unsafe sex should be sensitive to the role which alcohol plays in the sexual practices among HIV+ gay and bisexual men.

Self regard and concealment of homosexuality as predictors of CD4+ cell count over time among hiv seropositive gay men

Living with HIV can challenge core features of a person’s sense of identity and ultimately lead to a diminished sense of self regard. Self-regard has been defined as the extent to which a person experiences an integrated sense of identity. Gay men with HIV may also face struggles related to their identity in deciding whether to disclose or conceal their homosexuality. This study examined whether concealment of homosexuality and a person’s sense of self regard would be associated with CD4+ cell count over time among HIV seropositive gay men. 53 HIV seropositive gay men completed questionnaires at one time point. CD4+ cell counts were measured at the time of questionnaire completion and 24 months later. Greater self regard at baseline was associated with higher CD4+ counts at 24 months. The association between baseline self regard and CD4+ count at 24 months was strongest among persons with less concealment of homosexuality.

Correlates of sexual risk-taking behaviour among HIV seropositive gay men in concordant primary partner relationships

This study sought to understand how person, perceived health risks, psychosocial, and mental health factors relate to unprotected anal intercourse (UAI) among 91 HIV seropositive (HIV + ) gay men in concordant primary partner relationships. The data was drawn from a larger sample of 464 HIV + men-who-have-sex-with-men (MSM) from mainstream gay venues, AIDS service organizations, and public sex environments in New York City and San Francisco. The findings from this study suggest that UAI is a common behaviour among HIV + gay men in seroconcordant couples, which may compromise their health due to the possibility of HIV reinfection and the transmission of other sexually transmitted diseases. Results from our analyses indicated that lower perceived risk of HIV reinfection, lower behavioural intentions for condom use, and higher CD4 counts were predictive of HIV + gay men engaging in UAI with their HIV + primary partner. In situations where there is discordance in HIV strain type or in dyads where monogamy is not maintained, the practice of UAI may present health risks for the men in HIV + seroconcordant relationships.

Concealment of homosexual identity, social support and CD4 cell count among HIV-seropositive gay men

Objective: Previous research has indicated that the concealment of homosexuality is related to poorer health among gay men with HIV. This study explored mechanisms by which concealment of homosexuality may be related to HIV disease status by examining associations between concealment of homosexuality, social support, social constraints, depressive symptoms and CD4 count among HIV-seropositive gay men. Method: Questionnaires assessing concealment of homosexuality, social support, depressive symptoms and social constraints were administered to 73 HIV-seropositive gay men. Medical charts were accessed to gather HIV disease information including CD4 counts. Regression analyses were conducted to examine associations between psychosocial variables and CD4 counts. Results: Concealment of homosexuality was associated with lower CD4 count, greater social constraints, greater depressive symptoms and less social support. The association between concealment of homosexuality and CD4 count varied according to level of social support. Among participants with higher levels of social support, those with greater concealment had lower CD4 counts than those with lower concealment. Concealment of homosexuality was not related to CD4 count among participants reporting low social support. Conclusion: Concealment of homosexuality among HIV-seropositive gay men is associated with lower CD4 counts, depressive symptoms and strained social relationships. In addition, the benefits of being open about homosexuality may be most evident under conditions of greater social support.

Support Group Participation, HIV Viral Load and Sexual-risk Behavior

To examine the impact of participation in community-based support groups and human immunodeficiency virus (HIV) viral load on sexual behavior among gay men. Using self-administered questionnaires, 46 seropositive support-group participants and 20 seropositive comparison subjects were asked about viral load and frequency of unprotected anal intercourse in 1996 and 1997 following the XI International Conference on AIDS. Support group participants reported less unprotected receptive anal sex at follow-up than did comparison subjects. Overall, study participants with undetectable viral loads reported more unprotected anal intercourse at follow-up than did participants with detectable viral loads. Among HIV-seropositive gay men, knowledge of an undetectable viral load may contribute to high-risk sexual-risk behavior.

Awareness and use of untested barrier methods by HIV-seropositive gay and bisexual men.

Little is known about HIV-seropositive men's awareness and use of untested barrier methods during anal intercourse. A sample of 240 HIV-seropositive men (69.2% men of color) completed a self-administered survey that included items on nonoxynol-9 (N-9), female condoms, and the simultaneous use of two male condoms (double bagging). Most participants (79.6%) had heard of N-9 being used to prevent HIV transmission during anal intercourse. Of these, 20.0% rated N-9 as more effective than condoms, and 14.6% had used N-9 instead of condoms. Fewer men (35.4%) were aware of female condoms being used during anal intercourse. Overall, few respondents (5.4%) had used female condoms; 53.8% of whom rated the device as more pleasurable than male condoms. Most men (69.6%) had heard of double bagging, and 35.2% had engaged in this practice. Of these, 45.1% rated the practice as less pleasurable than using a single condom. Few associations were observed between participant characteristics and the awareness or use of these barrier methods. The widespread use of these untested methods emphasizes the urgent need to further educate HIV-seropositive men about the potential risks of N-9 use and to test the effectiveness of other strategies that may serve as alternatives to male condom use.

An Exploration of Perceptions of Masculinity among Gay Men Living with HIV

An ethnographic investigation was undertaken to explore the social construct of masculinity. Fifteen HIV seropositive gay men in New York City were interviewed via electronic medium in order to characterize behaviors and associated meanings attached to the conception of masculinity as physicality. Structured interviews were utilized to ascertain these data in order to illustrate how some men define masculinity in terms of their physical appearance and sexual adventurism. The data indicate that men who possess this ideological stance regarding masculinity seek to remain healthy, appear physically strong, and attract sexual partners. This hegemonic standard of masculinity is a result of both the men's HIV infection as well as their perceptions of gay community norms. Emphasis on physical strength and sexual prowess as means of defining masculinity has become a standard in the last two decades for some seropositive gay men.

Religiosity is Associated with Affective Status in Symptomatic HIV-infected African-American Women

This study examined the relationship between religiosity and the affective and immune status of 33 HIV-seropositive mildly symptomatic African-American women (CDC stage B) in a replication of a prior study that reported an association between religiosity and affective and immune status in HIV-seropositive gay men. All women completed an intake interview, a set of psychosocial questionnaires, and provided a venous blood sample. Consistent with prior work, factor analysis of 12 religious-oriented response items revealed two distinct aspects to religiosity: religious coping and religious behavior. Religious coping (e.g. placing trust in God, seeking comfort in religion) was significantly associated with lower depression and anxiety. Regression analyses revealed the association between religious coping and depressive symptoms appears to be mediated by an active coping style. However, the association between religious coping and anxiety does not appear to be mediated by either active coping or sense of self-efficacy in these women. In contrast to prior work, neither religious coping nor religious behavior was significantly associated with immune status as measured by T helper-inducer (CD41) cell counts.

Pain and depression in HIV illness.

The purpose of this study was to examine the relationship among pain and depression, hopelessness, and quality of life in human immunodeficiency virus (HIV)-infected gay men, taking into account the role of HIV symptoms. One hundred sixty-one HIV+ gay men were assessed, with 40 men endorsing HIV-related pain. The HIV+ men with pain had a modal rating of pain within the mild range. They had significantly more advanced disease, more physical and depressive symptoms, and reported less life satisfaction than the men without pain. However, when HIV illness variables are accounted for, the higher depression scores in the men with pain were largely accounted for by somatic rather than cognitive symptoms. While pain is associated with greater physical distress in this cohort of HIV-seropositive gay men, it does not appear to be independently associated with cognitive symptoms of depression. These findings apply to HIV-infected men with mild pain and may not apply to those who experience more severe pain. Nonetheless, these observations highlight the overlap between symptoms of depression and pain and the challenge that clinicians face in assessing patients suffering from pain.

HIV serostatus disclosure among gay and bisexual men in four American cities: General patterns and relation to sexual practices

The present study examined patterns of serostatus disclosure among previously untested HIV-seropositive and HIV-seronegative gay and bisexual men recruited from four American cities (n=701). Six months after learning their HIV serostatus, 97% of study participants had disclosed their test results to at least one other individual. Consistent with earlier studies, test results were most frequently shared with friends and the respondent's primary partner. HIV serostatus was disclosed less frequently to family members, co-workers, and non-primary sex partners. Compared with HIVseronegative men, HIV-seropositive men were more likely to have disclosed their status to a health care provider and less likely to have shared this information with family members. Of seropositive men, 11% did not disclose their serostatus to their primary partner and 66% did not disclose to a non-primary sex partner. Of HIV-seropositive men with one or more non-primary partners, 16% of those who did not disclose their serostatus reported inconsistent condom use during anal intercourse with these partners. No significant differences in self-reported sexual practices were observed for HIV-seropositive disclosers versus non-disclosers. Compared with HIV-seronegative men who did not disclose, seronegative men who shared information about their serostatus were more likely to have had receptive anal intercourse with their primary partner (p less than 0.05) and to have engaged in mutual masturbation (p less than 0.005), receptive oral sex (p less than 0.005) and insertive anal intercourse (p less than 0.05) with non-primary partners. No significant differences were observed between disclosers and nondisclosers with regard to condom use. Implications of the findings for future research and HIV prevention programmes are discussed.

UNUSUAL CASES OF BREAST CANCER IN HIV INFECTED WOMEN

BACKGROUND: HIV infected persons are at risk for various malignancies, including lymphoma, KS and cervical cancer, which are AIDS-defining. The incidence of additional cancers has significantly increased in HIV seropositive gay men in recent years, when compared to seronegative controls (Lyter, Proc ASCO, 1996). Although the incidence of breast cancer has not increased in HIV infected women, it remains the second most common cancer affecting women in the U.S. Further, the eventual immune deficiency inherent to HIV could predispose to the development of neoplastic disease of the breast. We therefore evaluated all diagnosed cases of breast cancer occurring in HIV positive and negative participants of the national WIHS study. METHODS: We identified each woman enrolled in the WIHS study who reported a history of breast cancer during the baseline study evaluation, and in subsequent 6-monthly visits. Permission for chart review was obtained from all, and pathology reports, clinical records and HIV status were examined. RESULTS: At entry, 11 of 2069 (0.5%) HIV seropositive women and 2 of 574 (0.3%) HIV seronegatives reported a history of breast cancer. In follow-up (6-12 months), 2 of 1699 (0.1%) additional HIV positives and no seronegative reported a new dx of breast cancer. Two cases (1 HIV+; 1 HIV neg) were subsequently unconfirmed at path review, and 5 HIV cases are yet to be reviewed. Of the 7 HIV+ cases with pathologic confirmation to date, the median age at dx of cancer was 47 years(32-64). Median CD4 count at entry to WIHS was 196 (93-205). Pathologic types of ca in HIV+ women included: infiltrating ductal and intraductal, grade III (high), with neuroendocrine features; invasive non comedo intraductal with prominent mucin production and dissection of mucin into stromal tissue; metaplastic carcinoma with histiocyte-like giant cells; poorly differentiated invasive adenocarcinoma; adenocarcinoma; infiltrating ductal; and ductal carcinoma in situ, with focal invasion. Of interest, follicular hyperplasia was seen in adjacent lymph nodes. CONCLUSIONS: Unusual pathologic types of breast cancer have been diagnosed in HIV positive women, whose median age at diagnosis is relatively young. Further evaluation over time will be important to ascertain the true significance of this observation.