Multiple Female Sexual Partners Research Articles

Incarceration, HIV Risk-Related Behaviors, and Partner Characteristics Among Heterosexual Men at Increased Risk of HIV Infection, 20 US Cities.

The effect of incarceration on HIV risk-related behaviors among at-risk heterosexual men is understudied. The objective of our study was to examine the association between incarceration and HIV risk-related behaviors among a sample of predominantly non-Hispanic black and Hispanic heterosexual men residing in urban areas in the United States with a high prevalence of AIDS. We analyzed data from the 2013 National HIV Behavioral Surveillance system on 5321 at-risk heterosexual men using log-linked Poisson regression models, adjusted for demographic characteristics and clustered on city. Of 5321 men, 1417 (26.6%) had recently been incarcerated (in the past 12 months), 2781 (52.3%) had ever been incarcerated but not in the past 12 months, and 1123 (21.1%) had never been incarcerated. Recent incarceration was associated with multiple casual female sexual partners (adjusted prevalence ratio [aPR] = 1.23; 95% confidence interval [CI], 1.05-1.44), condomless sex with multiple female sexual partners (aPR = 1.32; 95% CI, 1.06-1.66), injection drug use (aPR = 3.75; 95% CI, 2.64-5.32), and having sexual partners who were more likely to have ever injected drugs (aPR = 1.84; 95% CI, 1.48-2.28), been incarcerated (aPR = 2.28; 95% CI, 2.01-2.59), or had a concurrent sexual partner (aPR = 1.08; 95% CI, 1.05-1.11), as compared with never-incarcerated men. Incarceration history was associated with HIV risk-related behaviors among heterosexual men from urban areas in the United States. Correctional rehabilitation initiatives are needed to promote strategies that mitigate HIV risk-related behaviors and promote healthy reentry into communities among heterosexual men at high risk for HIV.

Masculinity and Risk: How Gender Constructs Drive Sexual Risks in the Caribbean

Between 2006 and 2008, detailed interviews were conducted with 138 men with a median age of 24 years (ranging from 16 to 39) from seven Anglophone Caribbean countries and one territory: Anguilla, Grenada, Guyana, Jamaica, St Kitts and Nevis, St Lucia, St Vincent and the Grenadines, and Trinidad and Tobago. The interviews investigated prevalent construction(s) of masculinity in the region, with particular attention to transitions from childhood to manhood, boys' education, risk-taking, health, violence, and crime. This paper examines the relationship between masculinity and risk. Far from being considered antisocial and to be avoided, risk-taking serves to define youthful masculinity and is sought out and experienced as a rite of passage. Having multiple female sexual partners is a hallmark of a "real man" and not being considered a "real man" is shameful—potentially fatal in homophobic settings. Paradoxically, by stigmatizing "insufficient" sexual interest in women and valorizing the quest for multiple female partners, homophobia acts as a potent driver of heterosexual risk. While risk was definitive of masculinity, safety was not. Avoiding a reputation for "sexual failure" often takes precedence over the threat of pregnancy or catching a sexually transmissible infection. On the contrary, pregnancy confirms manhood and sexual potency—even when it is unwanted. The research found that safety directly challenges the obligations of manhood and this may explain why HIV control has been so difficult. Condoms are foregone if there is a risk of appearing sexually inexperienced or of losing an erection, especially if details of this "failure" might leak out. Likewise, abstinence and sticking to one partner are incompatible with virile masculinity and displaying insufficient heterosexual interest can imply homosexuality and provoke homophobic consequences. All forms of sexual safety as they are currently framed—condoms, partner reduction, and abstinence—implicitly challenge masculine norms and all convey notions of emasculation.

An Unwelcome Synergy: Leishmaniasis and HIV

m PRESENTATION When patients with HIV/AIDS travel to the United States from other parts of the world, they can bring more exotic opportunistic infections with them. In November 2010, a 29-year-old man presented to the emergency department after a few days of fever, chills, diffuse abdominal pain, vomiting, and dysuria. For the previous 6 months, he also had experienced diarrhea and unintentional weight loss, totaling 40 lb (18 kg). Two weeks prior to his acute presentation, he had been treated for pyelonephritis at an outside institution, where he also had reported 2-3 weeks of worsening diarrhea. The patient had been diagnosed with HIV/AIDS in 2007. At the time of diagnosis, he was treated for cerebral toxoplasmosis with pyrimethamine, sulfadiazine, and leucovorin. In 2008, he was treated with intraocular ganciclovir for cytomegalovirus retinitis. Since his diagnosis, he had been intermittently adherent to antiretroviral therapy with Atripla, (Bristol-Myers Squibb, New York, NY), a combination of efavirenz, emtricitabine, and tenofovir disoproxil fumarate and to his maintenance therapy for the aforementioned opportunistic infections. He also had a history of pancytopenia, diagnosed in 2008; a bone marrow biopsy was hypocellular with poorly-formed noncaseating granulomas. His attendance at follow-up visits was erratic, preventing further workup. Born in Honduras, the patient worked on a farm, and moved to the United States in 2004, where has worked in construction. He had had a single male sexual contact and multiple female sexual partners. Condom use was inconsistent.

HIV Prevalence and Risk Behaviours from Three Consecutive Surveys Among Men Who Have Multiple Female Sexual Partners in Cape Town

HIV bio-behavioural surveillance surveys conducted at regular intervals are critical for monitoring of, and informing a targeted response to the HIV pandemic. We used Respondent-driven Sampling in 2006, 2008 and 2010 to recruit men who have multiple female sexual partners. We performed several logistic regression analyses to compare HIV sexual risk behaviours, and HIV infection over time. Decreases in inconsistent condom use with main partners were not sustained in 2010. Inconsistent condom use with non-main partners, partner numbers and having one-time partners continued to decrease over time. Levels of alcohol consumption in 2010 reverted to a level higher than in 2006. Non-significant increases in HIV prevalence and reporting a symptom of a sexually transmitted infection (STI) were found. The decrease in numbers of and one-time sexual partners, and in inconsistent condom use with non-main partners augers well for decreasing HIV incidence among men in the study community, but might be offset by decreases in consistent condom use with main partners, and increases in alcohol consumption and STIs.

Ocular Syphilis: Staring Straight at You (P01.122)

Objective: Syphilis is known as the great 9imitator9 of a myriad of presenting symptoms. This case presentation highlights the difficulty of diagnosing syphilis in the setting of unilateral photophobia. A 54 year old heterosexual male presented with a four month history of progressive left eye photophobia. He denied diplopia or visual field defects. Four months prior, he was treated with topical and oral steroids for inflammatory keratitis with relief; however, photophobia was exacerbated with steroid taper. He served in the Korean War during which he had multiple female sexual partners and did not use barrier contraception. Currently, he is in a four-year monogamous heterosexual relationship. Vital signs stable. Patient is alert and oriented with visual acuity of the right eye 20/20 and left eye 20/400. Fundoscopic exam of the left eye showed interior endothelial keratic precipitates. Neurological exam was unremarkable. Rapid plasma reagin was negative; however, fluorescent treponemal antibody absorption and treponema pallidum hemagglutination were both positive. Lumbar puncture revealed positive CSF RPR and FTA-MB, confirming our suspicion for neurosyphilis. Serology for HIV and assays for the detection of fungal antigen gave negative results. Patient was treated with IV penicillin G 24 million units daily for 14 days. At four month follow up his visual acuity improved and the uveoscleritis had resolved. A re-emergence of syphilis has been reported in the United States and Europe. This case demonstrates that the eye may be one of the numerous sites of syphilitic inflammation and damage. Secondary syphilis caused a progressive deterioration of ocular findings in our patient. This condition may result in permanent loss of vision if not adequately treated. In conclusion, ocular involvement should be carefully evaluated in patients with syphilis, and, at the same time, this infection should be considered as a potential cause of ocular inflammation. Disclosure: Dr. Faridani has nothing to disclose. Dr. Moore has nothing to disclose.

Associations between alcohol misuse and risks for HIV infection among men who have multiple female sexual partners in Cape Town, South Africa

The occurrence of high rates of alcohol consumption in a context of high HIV prevalence in South Africa poses a significant health challenge for this country. This paper aims to answer three questions that could further our knowledge regarding the links between alcohol use and HIV infection: (a) “Are problem drinkers more likely to have multiple concurrent partners than those who are not?”; (b) “Are condoms applied less effectively and less consistently by problem drinkers compared to those who are not?”; (c) “Are the female sexual partners of problem drinkers different from those who are not?” Two cross-sectional HIV bio-behavioural surveillance surveys using Respondent-Driven Sampling were conducted in two peri-urban settings on the outskirts of Cape Town, South Africa. Eight hundred and forty-eight men aged 25–55 years who have multiple, concurrent female sexual partners were recruited. Problem drinkers had a score of ≥3 on the CAGE questionnaire. Questions enquired about partner numbers, condom use and partner traits. Multivariate logistic regression models were developed to determine significant associations between outcome variables and problem drinking. Fifty-eight percent of men were problem drinkers. Compared to non-problem drinkers, problem drinkers were significantly more likely to report having any symptom of a STI; not using condoms due to drinking; inconsistent condom use with all partner types; that their most recent once-off partner was unemployed; having met their most recent partner at an alcohol-serving venue; and having had a once-off sexual relationship. Alcohol may fuel once-off sexual encounters, often characterised by transactional sex and women's limited authority to negotiate sex and condom use; factors that can facilitate transmission of HIV. HIV prevention interventions specifically targeting drinkers, the contexts in which problem drinking occurs and multiple sexual partnering are urgently needed.

Male injecting drug users in the Deep South: bisexual behaviour is a marker for elevated HIV risk

This study determined whether bisexual male injecting drug users (IDUs) as compared with heterosexual IDUs were more likely to engage in HIV-associated risk behaviours. Respondent-driven sampling was employed to recruit a sample of 382 male IDUs residing in the southeastern USA. Data were collected in face-to-face interviews. Weighted analyses showed that bisexual IDUs in the past 12 months were 4.6 times as likely to share needles and 3.5 times as likely to share a cooker; having multiple female sexual partners and trading money or drugs for sex with women were marginally significant. Bisexual IDUs were 10 times as likely to self-report HIV. Male IDUs, who engage in bisexual behaviour, are also engaging in HIV-associated drug and to some degree sexual-risk behaviours with women more so than heterosexual IDUs. Their higher prevalence of HIV infection coupled with their risk behaviours place themselves and other IDUs at heightened risk of both acquiring and transmitting HIV.

Acute Hepatitis B Is Lingering In the Shadows

Purpose: A 44 y/o single African American male with a history of hypertension, type II diabetes mellitus, and dyslipidemia presented with lower extremity rash and arthralgias of three days. Two weeks prior to his admission, the patient had been experiencing several days of throbbing, intermittent, occipital headache radiating to the back of his neck and upper extremities accompanied by subjective low-grade fever, chills, and myalgias. Subsequently, the patient developed a maculopapular rash that originated in the groin region and extended to both lower extremities. He also complained of arthralgias localized to the hands. History of multiple female sexual partners and had unprotected intercourse three days prior to the appearance of the rash. No penile discharge, intravenous drug use, sick contacts, recent travel, tick bites, blood transfusions, new medications/detergents, drug allergies and history of sexually transmitted diseases. His examination was unremarkable except for PIP/DIP hand joint tenderness and bilateral lower extremity non-blanching, palpable purpura that extended medially from the groin to the feet with trace pedal edema. CT head and lumbar puncture was were negative. After sending urethral/rectal cultures, the patient was treated with ceftriaxone and azithromycin for presumed disseminated gonococcal/chlamydia infection (cultures were later found to be negative). The patient was treated with prednisone for possible vasculitis. On admission, significant laboratory findings were: AST 285 U/L, ALT 694 U/L, GGT 239 U/L, ESR 35. Additional blood work included a hepatitis panel, ANA, cryoglobulin, HIV, and Lyme titers, of which the only positive results were a reactive hepatitis B surface antigen and hepatitis B core IgM antibody by Day 3. Prednisone was immediately discontinued. The diagnosis established was acute hepatitis B (Hep B), most likely associated with leukocytoclastic vasculitis (LV) of the lower extremities. The patient was discharged 5 days later and with resolution of rash a week later. An 6 month outpatient hepatologist follow up showed complete serologic recovery of acute Hep B infection. With the advent of the hepatitis vaccine, the acute presentation of Hep B is slowly decreasing. We present a rare case of acute Hep B in which palpable purpura of the lower extremities was the initial clinical identifier. Our patient initially experienced two weeks of flu-like symptoms followed by palpable purpura of the lower extremities. This unique finding was later identified as acute hepatitis B-associated LV. The morbid consequences of Hep B justify the timely identification of Hep B thus preventing the life threatening complications of this disease.

Effectiveness of Respondent-Driven Sampling to Recruit High Risk Heterosexual Men Who Have Multiple Female Sexual Partners: Differences in HIV Prevalence and Sexual Risk Behaviours Measured at Two Time Points

Regular HIV bio-behavioural surveillance surveys (BBSS) among high risk heterosexual (HRH) men who have multiple female sexual partners is needed to monitor HIV prevalence and risk behaviour trends, and to improve the provision and assessment of HIV prevention strategies for this population. In 2006 and 2008 we used respondent-driven sampling to recruit HRH men and examine differences in HIV prevalence and risk behaviours between the two time points. In both surveys, the target population had little difficulty in recruiting others from their social networks that were able to sustain the chain-referral process. Key variables reached equilibrium within one to six recruitment waves and homophily indices showed neither tendencies to in-group nor out-group preferences. Between 2006 and 2008 there were significant differences in condom use with main sexual partners; numbers of sexual partners; and alcohol consumption. Further BBSS among this population are needed before more reliable trends can be inferred.

HIV Risk Behaviours and their Relationship to Intimate Partner Violence (IPV) Among Men Who Have Multiple Female Sexual Partners in Cape Town, South Africa

HIV/AIDS and intimate partner violence (IPV) are growing public health concerns in South Africa. Knowledge about adult men's perpetration of IPV and links between HIV risk behaviours and IPV is limited. Respondent driven sampling was used to recruit men who have multiple concurrent female sexual partners. Forty-one percent of the 428 recruited men had perpetrated IPV. Inconsistent condom use was associated with physical IPV; experiencing a symptom of a sexually transmitted infection and engaging in transactional sex were associated with physical and sexual IPV; problem alcohol use was associated with physical, and any IPV, but not sexual IPV; having five or more partners was associated with sexual IPV; perceptions of partners' infidelity were associated with physical and any IPV. HIV risk reduction interventions among men, especially those with multiple female sex partners, should incorporate strategies to change the underlying construction of masculinity that combines the anti-social and risky behaviours of IPV perpetration, inconsistent condom use, transactional sex and heavy alcohol consumption.

Increased HIV Risk Associated with Criminal Justice Involvement among Men on Methadone

This paper examines the relationship between HIV risk and criminal justice involvement among a random sample of 356 men enrolled in methadone maintenance treatment programs in New York City. Bivariate and logistic regression analyses were performed to estimate the associations between measures of criminal justice involvement and participant HIV risk, controlling for socio-demographic variables. A lifetime history of incarceration was significantly associated with being HIV positive (Adjusted OR=5.08). Recent arrest was associated with unprotected vaginal sex and having multiple female sexual partners. Sex trading was associated with both arrest and incarceration, and the strongest association was found between selling sex and recent incarceration (Adjusted OR=5.69). Results suggest that recent criminal justice involvement among men with substance abuse histories is associated with increased HIV risk behaviors. Findings underscore the need for targeted HIV prevention efforts for men on methadone with a recent history of arrest or incarceration.

The gender ratio imbalance and its relationship to risk of HIV/AIDS among African American women at historically black colleges and universities

African American women are at increased risk of HIV transmission through heterosexual contact. HIV/AIDS is the leading cause of death among African American women between 25 to 34 years of age, and many of these women were likely infected while in college. Four focus groups were conducted with African American students attending Historically Black Colleges and Universities (HBCUs) in order to learn about the college dating environment and how it influenced women's risk of HIV infection. We used constant comparison techniques and visual display matrixes to analyse the data. Students identified the gender ratio imbalance of more women to men on campus as a key element of the campus dating environment and described how it places women at an increased risk for HIV infection. Primary consequences of this gender ratio imbalance were men having multiple female sexual partners during the same time period and women complying with men's condom use preferences. HIV preventive intervention programmes at HBCUs must address the gender ratio imbalance and its consequences to reduce women's risk of contracting the infection.

HIV risk behaviour correlates among injecting drug users in Greek prisons.

To identify the correlates of injecting drug use within prison. A national cross-sectional study, participation being voluntary and anonymous. Ten Greek prisons. A representative sample of 1000 male inmates; 861 questionnaires were completed and analysed. A self-report questionnaire for demographics, penal history, drug use and sharing injecting equipment. Two hundred and ninety inmates (33.7%) reported injecting drugs at some time in their lives, of whom 174 (60%) had injected while imprisoned. Among those who had injected while imprisoned, 145 (83%) had shared equipment while incarcerated. Logistic regression analysis suggested that total time in prison, previous drug conviction, being a convict (as opposed to on remand) and having multiple female sexual partners 1 year before incarceration were significant HIV risk behaviour correlates. For every year of imprisonment, the risk of injection in prison increased by about 17% [OR = 1.17 (95% CI: 1.07-1.27)]. Inmates with a previous drug-related conviction were about twice as likely to inject within prison [OR = 1.97 (95% CI: 1.16-3.33)]. Finally, convicted inmates were marginally significantly more prone to inject in prison [OR = 1.58 (95% CI: 0.92-2.74)]. Variables related to the inmates' prison career influence HIV risk behaviours within prison. There is a need to assist IDUs in reducing the likelihood of high-risk behaviour by considering factors such as frequency of incarceration, length of time incarcerated and availability of detoxification programmes within prison.

Widespread Papules and Nodules in a Ugandan Man With Acquired Immunodeficiency Syndrome

REPORT OF A CASE A 30-year-old man from Uganda, Africa, presented in October 1993 with a several-month history of a large, painful nodule on the right side of his forehead, which failed to heal despite oral and topical antibiotic therapy. He also complained of fever, night sweats, and a 4.5- to 6.8-kg weight loss. His medical history was unremarkable except for multiple female sexual partners. He denied homosexual encounters, intravenous drug use, or a history of blood transfusion. He had moved from Africa to California in 1992 and then to Colorado shortly thereafter. Physical examination revealed a tender, 2-cm-diameter ulcerated nodule on the right side of his forehead ( Figure 1 ). In addition, numerous 1- to 3-mm-diameter papules and pustules were noted on the face, neck, back, abdomen, and upper and lower extremities. The patient was unavailable for follow-up until January 1994, when he presented to the emergency department with a