Non-steady Partners Research Articles

HIV-Risk Related Attitudes and Behaviors Among Older Impoverished Women Living in Puerto Rico.

HIV has increasingly impacted older adults regarding sero-prevalence and sero-incidence as long-term survivors of HIV/AIDS are living longer. This study examines the relationship between age and HIV-related attitudes and risk behaviors among female public housing residents in Puerto Rico. Using a self-administered survey instrument, 1,138 female public housing residents were surveyed between April and August 2006. Bivariate results showed that older women (aged 50+ years) were significantly less likely to report HIV testing and to discuss safer sex with their most recent "steady" sex partner than women under the age of 50years. Older women were also more likely to express anxiety associated with condoms and more barriers to using condoms. The older versus younger groups did not significantly differ regarding condom use, which was extremely low across the groups. In the past three and 12months, older women were less likely than younger women to report having (a) multiple sex partners and; (b) oral and anal sex with their most recent steady sex partner; (c) oral sex with their most recent non-steady sex partner and, (d) engaging in sexual activity in the previous three and 12months. Age-specific messages concerning their increased risk of HIV among other interventions would likely curtail the increase in the number of new HIV cases being reported among members of this sub-population.

Hepatitis C virus infection and its relationship to certain sexual practices in men-who-have-sex-with-men in Spain: Results from the European MSM internet survey (EMIS)

ObjectivesTo compare sexual practices and risk behaviours between MSM who were first diagnosed with hepatitis C (HCV) in the previous 12 months and those who were never diagnosed; and, to identify factors associated with a diagnosis of HCV. MethodsThe European-MSM-Internet-Survey (EMIS) was implemented for 3 months during 2010, mainly on websites for MSM. Data on socio-demographic characteristics, sexual behaviour, drug use, STI history, and other sexual health variables were collected. The Chi-square test and logistic regression analysis were used to analyse the data. ResultsData from 13,111 respondents were analysed. The proportion of MSM who had ever been diagnosed with HCV infection was 1.9% (n=250), and of those currently infected with the virus was 0.6% (n=78). The percentage of those first diagnosed in the last 12 months was 0.4% (n=46), of whom 70% were HIV-negative and 22% had HIV coinfection. Having a first diagnosis of HCV in the last 12 months was more common among HIV-positive than among HIV-negative MSM (0.9% vs 0.4%) and among MSM born abroad than among Spanish-born (0.7% vs 0.3%). MSM diagnosed with HCV in the last 12 months were more likely to have had: more than 10 sexual partners, sex abroad, receptive anal intercourse, insertive/receptive fisting, and unprotected anal intercourse with non-steady partners of unknown or discordant HIV-status. Likewise, they reported more frequent visits to sex-focused venues, higher drug use, as well as a higher proportion of STI diagnosis. In the multivariate model, visiting a public sex-focused venue, practicing receptive fisting, using erection enhancing medication and having a diagnosis of syphilis were independently associated with a first diagnosis of HCV in the last 12 months. ConclusionsHCV infection does not seem to be restricted to HIV-infected MSM. Certain sexual behaviour (fisting, visiting sex-focused venues), drug use, and ulcerative STI seem to be associated with a diagnosis of HCV.

Conductas sexuales de alto riesgo en hombres que tienen relaciones sexuales con hombres según tipo de pareja sexual

ObjectiveTo identify factors associated with high risk sexual practices among men who have sex with men (MSM) in Spain. MethodsAn online survey was conducted in 2010, which included, among others, questions on HIV/STI sexual behaviours and prevention needs. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status in the past year was defined as a high risk sexual behaviour. ResultsOf the 13,111 participants, 49.4% had had sex with steady partners (SP) and 73.4% with non-steady partners (NSP) in the last 12months; and the prevalence of high risk UAI was 25.4% and 29.4%, respectively. Factors associated with high risk UAI with SP were: living in a city of less than 500,000 inhabitants (OR=1.42 <100,000 inhabitants), being out to no-one or only a few people (OR=1.42), and being HIV-positive with undetectable viral load among those with a high level of HIV/STI knowledge (OR=3.18). Factors associated with high risk UAI with NSP were mainly: having a higher number of sexual partners (OR=4.31 >50 partners), having used drugs for sex (OR=1.33), and at parties (OR=1.19), having a medium (OR=1.82) or low (OR=1.33) level of HIV/STI knowledge, and being HIV-positive (OR=1.56). ConclusionsAmong MSM, the prevalence of high risk sexual practices is high with both SP and NSP. Factors associated with high risk UAI vary by type of sexual partner (e.g., having HIV with an undetectable viral load). These must be taken into account when planning strategies for primary and secondary prevention.

S15.3 Modification of Sexual Networks and Sexual Risk For Men Having Sex with Men (MSM) by the Internet

The Internet provides new opportunities for sexual minorities to communicate and interact. Access to internet may facilitate coming-out for young MSM, sexual identity formation, and community building. On the other...

Condom Use and Human Papillomavirus in Men

of decreasing exposure risk, were no steady sex partner; nonmonogamous, nonsteady sex partner; nonmonogamous, steady sex partner; and monogamous. Condom use in the previous 6 months was defined at a single time point (the baseline visit) and assessed at 3 levels (always, sometimes, and never). This baseline measure was extrapolated to represent condom use during the entire follow-up period. HPV infection was classified into 3 categories on the basis of HPV type: any HPV type, oncogenic HPV types, and nononcogenic HPV types. In the highest HPV exposure risk category (ie, men with no steady sex partners), those who reported always using condoms in the 6 months before study entry were about 50% less likely to become newly infected with any HPV types in the 12-month follow-up period, compared with men who never used condoms (adjusted hazard ratio [HR], 0.54; 95% confidence interval [CI], .31–.95). Similar reductions were reported when HPV types were stratified by oncogenic risk, but these associations did not reach statistical significance. No significant associations were observed between condom use and HPV incidence in the other 3 HPV exposure risk groups. Evaluating duration of infection, the authors found a faster rate of oncogenic HPV clearance only in the group of men who reported always using condoms with their nonsteady sex partners, compared with men who reported never using condoms (adjusted HR, 1.29; 95% CI, 1.03– 1.61). Condom use did not impact the duration of infection in the other 3 HPV exposure risk groups, including the group with no steady sex partners, the same group for which consistent use decreased HPV incidence. Condom use is a frequently examined cofactor in epidemiologic investigations of HPV infection and associated diseases in both men and women. Yet findings from a growing number of studies, including the present one, have been difficult to interpret, partly because many are based on secondary analyses of studies that were not designed to evaluate condom effectiveness [3–20]. Evaluating condom usein observational studies of sexually transmitted infections (STIs), particularly HPV infection, is inherently complex and subject to measurement errors that contribute to the heterogeneity in findings [21, 22]. Importantly, because incorrect or inconsistent use can diminish the protective

Consistent Condom Use Reduces the Genital Human Papillomavirus Burden Among High-Risk Men: The HPV Infection in Men Study

Data supporting the efficacy of condoms against human papillomavirus (HPV) infection in males are limited. Therefore, we examined the effect of consistent condom use on genital HPV acquisition and duration of infection. A prospective analysis was conducted within the HPV Infection in Men Study, a multinational HPV cohort study. Men who were recently sexually active (n = 3323) were stratified on the basis of sexual risk behaviors and partnerships. Using Cox proportional hazards regression, type-specific incidence of HPV infection and clearance were modeled for each risk group to assess independent associations with condom use. The risk of HPV acquisition was 2-fold lower among men with no steady sex partner who always used condoms, compared with those who never used condoms (hazard ratio, 0.54), after adjustment for country, age, race, education duration, smoking, alcohol, and number of recent sex partners. The probability of clearing an oncogenic HPV infection was 30% higher among nonmonogamous men who always used condoms with nonsteady sex partners, compared with men who never used condoms (hazard ratio, 1.29), after adjustment for country, age, race, education duration, marital status, smoking, alcohol, and number of recent sex partners. No protective effects of condom use were observed among monogamous men. Condoms should be promoted in combination with HPV vaccination to prevent HPV infection in men.

Internalised homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country cross-sectional study: some public health implications of homophobia

ObjectivesInternalised homonegativity (IH) is hypothesised to be associated with HIV risk behaviour and HIV testing in men who have sex with men (MSM). We sought to determine the social and...

Condom-Use Patterns among Women Who Live in Public Housing Developments in Ponce, Puerto Rico

Abstract:Background. Understanding condom-use patterns and the reasons that women have for choosing not to use condoms with their sexual partners, (both steady and non-steady), is important to the development and implementation of targeted, culturally appropriate interventions that can promote condom use in low-income and impoverished women. Methods. A total of 386 women from four public housing developments in Ponce, Puerto Rico, underwent HIV/STI testing and completed a self-administered questionnaire. Data were collected from August 2008 to October 2010. Results. Reported levels of condom use were low with both steady and non-steady sexual partners. Reasons given for not using condoms with both partner types included the respondent claiming to know her partner well, a general dislike for condoms, not having condoms available, and perceiving no need for them. Conclusions. These findings provide a foundation on which to build an intervention to promote condom use among impoverished women who live in public housing in Puerto Rico in addition to other disadvantaged or impoverished women. It is imperative that health practitioners consider the reasons that these women have for not using condoms in order to inform the development and implementation of effective HIV-prevention interventions.

P2-S4.06 Knowledge of HSV-2 serostatus in asymptomatic adults may result in change in sexual behaviour and possible risk reduction

BackgroundHSV-2 is the main cause of genital ulcer disease worldwide. It is frequently under- recognised because it is often clinically silent. Serologic testing for HSV antibody reliably identifies individuals infected...

Rapid implementation of an integrated large-scale HIV counseling and testing, malaria, and diarrhea prevention campaign in rural Kenya.

BackgroundIntegrated disease prevention in low resource settings can increase coverage, equity and efficiency in controlling high burden infectious diseases. A public-private partnership with the Ministry of Health, CDC, Vestergaard Frandsen and CHF International implemented a one-week integrated multi-disease prevention campaign.MethodResidents of Lurambi, Western Kenya were eligible for participation. The aim was to offer services to at least 80% of those aged 15–49. 31 temporary sites in strategically dispersed locations offered: HIV counseling and testing, 60 male condoms, an insecticide-treated bednet, a household water filter for women or an individual filter for men, and for those testing positive, a 3-month supply of cotrimoxazole and referral for follow-up care and treatment.FindingsOver 7 days, 47,311 people attended the campaign with a 96% uptake of the multi-disease preventive package. Of these, 99.7% were tested for HIV (87% in the target 15–49 age group); 80% had previously never tested. 4% of those tested were positive, 61% were women (5% of women and 3% of men), 6% had median CD4 counts of 541 cell/µL (IQR; 356, 754). 386 certified counselors attended to an average 17 participants per day, consistent with recommended national figures for mass campaigns. Among women, HIV infection varied by age, and was more likely with an ended marriage (e.g. widowed vs. never married, OR.3.91; 95% CI. 2.87–5.34), and lack of occupation. In men, quantitatively stronger relationships were found (e.g. widowed vs. never married, OR.7.0; 95% CI. 3.5–13.9). Always using condoms with a non-steady partner was more common among HIV-infected women participants who knew their status compared to those who did not (OR.5.4 95% CI. 2.3–12.8).ConclusionThrough integrated campaigns it is feasible to efficiently cover large proportions of eligible adults in rural underserved communities with multiple disease preventive services simultaneously achieving various national and international health development goals.

Contraception usage among young adult men in a developing country

Contraception usage among young adult men in a developing country Paul A Bourne1, Christopher AD Charles2,31Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica;&nbsp;2King Graduate School, Monroe College, Bronx, New York, NY, USA; 3Center for Victim Support, Harlem Hospital Center, New York, NY, USABackground: Jamaica is a Third World country with an increasing population and public resource constraints to address development imperatives, one of which is reproductive health.Aims: This study examines the method of contraception used by men in Jamaica and the factors that influence their choice of contraceptives.Materials and methods: The investigation was carried out with a stratified random sample of 2,437 men drawn from the National Family Planning Board dataset of men aged 15&ndash;24. The measures included variables such as age, crowding, area of residence, church attendance, method of contraception used, being in a relationship, the number of partners, having a pregnant woman partner, and being sexually active among other variables.Results: The majority of the men had engaged in sexual intercourse in the last 30 days. Frequent church attendance increased sexual abstinence. The majority of the men who mostly got their contraceptives from the pharmacy mostly used a condom. Lesser used methods were the pill and the rhythm method, among others. The method of contraception used was significantly determined by having had sexual intercourse in the last 30 days with a nonsteady partner (OR = 2.00, 95% CI: 1.40&ndash;2.86), sharing sanitary facilities with a nonhousehold member (OR = 0.62, 95% CI: 0.42&ndash;0.94) and having a pregnant partner (OR = 0.08, 95% CI: 0.04&ndash;0.16).Conclusion: A national reproductive health policy is needed that takes into account the type of contraceptives used, the institutional sources of information, the sources of contraceptives, the risk of sexually transmitted infections, and the three explanatory factors for the methods of contraception used.Keywords: young men, reproductive health, contraception, sexual relations, developing nation

The socio-demographic patterning of sexual risk behaviour: a survey of young men in Finland and Estonia.

BackgroundSexually transmitted infections (STIs) among the youth are an increasing challenge for public health in Europe. This study provided estimates of men's (18–25 years) sexual risk behaviour and self-reported STIs and their socio-demographic patterning in Finland and Estonia; two countries that are geographically close, but have very different STI epidemics.MethodNationally representative cross-sectional population surveys with comparable survey questions were used. Data from self-administered questionnaires for 1765 men aged 18–25 years in Finland (85% of the age cohort was included in the sampling frame, 95% of the sample responded) and 748 in Estonia, with a response rate of 43% respectively, were analysed. Socio-demographic patterning of multiple partners, condom use and self-reported STIs are presented was studied using multiple logistic regression analysis.ResultsThe main findings focus on associations found within each country. In Finland, higher age, low education and to a lesser extent relationship with a non-steady partner increased the likelihood of reporting multiple lifetime-partners, while in Estonia only higher age and low education revealed this effect. In relation to unprotected intercourse, in Finland, higher age, low education and relationship status with a steady partner increased the likelihood of reporting unprotected intercourse. In Estonia, the same was observed only for relationship status. In Finland the likelihood of self-reported STIs increased by older age and lower education and decreased by being with a non-steady partner, while in Estonia, a non-significant increase in self-reported STIs was observed only in the older age group.ConclusionA clear socio-demographic patterning for sexual behaviour and self-reported STIs was revealed in Finland, but a less consistent trend was seen in Estonia. The findings of this study suggest that prevention strategies should focus in Finland on less educated singles and in Estonia on young men generally.

Sexual partner concurrency among STI clinic patients with a steady partner: correlates and associations with condom use

Objectives: Partner concurrency facilitates the transmission of HIV and other sexually transmitted infections (STIs). In this study, we sought to (1) determine the correlates of concurrency among patients with a...

Do Protective Behaviors Follow the Experience of Testing Positive for Herpes Simplex Type 2?

To test the hypothesis that individuals attending a sexually transmitted disease (STD) clinic would adopt sexual protective behaviors after receiving a positive test for herpes simplex virus 2 (HSV-2). Recruitment (N = 360) occurred in a publicly funded STD clinic located in a metropolitan area of the southern United States. Participants were tested for HSV-2 using a rapid test manufactured by Biokit (Lexington, MA) and they completed a self-administered questionnaire before and 3 months after being tested for HSV-2. Follow-up questionnaires were completed by 256 participants (71.1%). Of those completing follow-up, 43.4% (n = 111) tested positive for HSV-2 at enrollment. Significant differences between participants testing positive and those testing negative (at baseline) for HSV-2 over the follow-up period were not observed for frequency of sex, frequency of condom use, avoiding sex, and number of sex partners. Controlling for statistically identified covariates did not alter the null findings for these between group analyses. When analyzing change (baseline to follow-up) among only those testing positive, significant differences were not found with the exception of reporting greater frequency of condom use with steady (P = 0.037) and nonsteady partners at follow-up (P = 0.017). However, repeated measures analyses yielded only 1 significant group x time interaction; this indicated a greater increase in condom use frequency with steady partners among persons testing negative compared with those testing positive. Among STD clinic attendees, diagnosis of HSV-2 was unrelated to the adoption of sexual behaviors protective against further acquisition and transmission of STDs. In the absence of education beyond posttest counseling, becoming aware of HSV-2 positive serostatus may not be sufficient to motivate the adoption of safer sex behaviors among this population.

Is suspicion of genital herpes infection associated with avoiding sex? A clinic-based study

The present study tested the research hypothesis that sexually transmissible disease (STD) clinic patients suspecting genital herpes infection would be more likely than their 'non-suspecting' counterparts to abstain from sex to avoid transmission of a perceived STD. Recruitment (n = 351) occurred in a publicly-funded STD clinic located in a metropolitan area of the southern USA. Participants were tested for herpes simplex virus type 2 (HSV-2) using a rapid test manufactured by Biokit (Lexington, MA, USA) and they completed a self-administered questionnaire (using a 3-month recall period). Well over one-third (38.7%) of those indicating suspicion also indicated avoiding sex with steady partners because of concerns about STDs as compared with 28.0% among those not indicating suspicion (prevalence ratio = 1.38; 95% CI = 1.02-1.87, P = 0.036). The relationship between suspicion and avoiding sex with non-steady partners was not significant (P = 0.720). The relationship with steady partners only applied to people who were female (P = 0.013), single (P = 0.017), reported symptoms of genital herpes (P = 0.003), perceived that genital herpes would have a strong negative influence on their sex life (P = 0.0001), and who subsequently tested positive for HSV-2 (P = 0.012). Among STD clinic attendees, suspicion of genital herpes infection may translate into partner protective behaviour, but only for a minority of people and only with respect to sex with steady partners. Clinic-based and community-based education programs may benefit public health by teaching people (especially single women) how to effectively recognise symptoms of primary genital herpes infections. Reversing the often prevailing ethic of genital herpes as a 'community secret' will clearly be a challenge to these education programs.

Validation of a Partner Sexual Communication Scale for Use in HIV/AIDS Prevention Interventions

Abstract This paper reports on three studies in which the Partner Communication Scale (PCS) is validated. The PCS assesses African American adolescent females' frequency of sexual communication with male sex partners. The PCS was administered to three samples of African American female adolescents (N = 522; N = 280; N = 715) ranging in age from 14 to 21. The PCS demonstrated strong internal consistency and acceptable stability over 6-month and 12-month follow-up periods. Scores on the PCS were correlated with frequency of parent communication, sexual communication self-efficacy, sexual refusal self-efficacy, fear of communication about condoms, partner-related barriers to condom use, relationship satisfaction, self-esteem, exposure to communication-related sex education in schools and condom use, particularly with nonsteady male sex partners. The present investigation indicates that the PCS is a reliable and valid measure of frequency of sexual communication for female adolescents with their male sex part...

Alcohol use, partner type, and risky sexual behavior among college students: Findings from an event-level study

Alcohol use is prevalent among college students and may contribute to elevated rates of sexual risk taking. Using event-level data, the hypothesis that partner type would moderate the effect of alcohol consumption on condom use was tested. Sexually active college students ( N = 330; 67% female) reported on characteristics of their most recent sexual encounter, including partner type, alcohol use, and condom use, along with measures of sex-related alcohol expectancies, sensation seeking, and typical alcohol use. Unprotected vaginal sex (UVS) was reported by 39% of the sample and 32% reported alcohol use prior to sex. For the complete sample, UVS was just as likely for non-drinking events as for events involving alcohol use. However, for sexual encounters involving a non-steady partner, alcohol consumption was associated with an increase in UVS, whereas rates of UVS did not vary by drinking status for encounters involving a steady partner. These effects remained in analyses that controlled for sex-related alcohol expectancies, sensation seeking, and typical alcohol use. Findings confirm that the effects of alcohol vary according to the context in which it is used.

Need Fulfillment in the Sexual Relationships of HIV-Infected Men Who Have Sex With Men

This article explores the associations among sexual need fulfillment, partner selection, and risky sexual behavior, using a functional/motivational perspective. The authors suggest that sexual needs influence partner selection (e.g., steady versus nonsteady), and engaging in UAI is influenced by sexual needs and partner selection. A sample of 108 HIV-positive gay men completed measures of sexual frequency, sexual risk-taking behaviors, and sexual need fulfillment. Results indicated support for both objectives. These men were more likely to choose a steady partner when they possessed greater relationship needs, whereas while men with higher substitution and pleasure needs were more likely to select nonsteady partners. In addition, only men who reported greater substitution needs were more likely to engage in UAI. The results suggest that certain sexual needs influence partner selection, but that sexual needs also influence what activities occur in the encounter.

Condom Use and Correlates of African American Adolescent Females' Infrequent Communication With Sex Partners About Preventing Sexually Transmitted Diseases and Pregnancy

This study of 522 African American female adolescents, ages 14 to 18, investigated associations between condom use and infrequently communicating with sex partners about sexually transmitted diseases (STDs) and pregnancy prevention. Correlates of infrequent communication were identified. Sexually active adolescents were recruited from schools and adolescent medicine clinics in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a self-administered survey and face-to-face interview. Communication frequency was assessed using a five-item scale. Infrequent communication was significantly associated with lower odds of condom use. Multivariate correlates of infrequent communication were less frequent communication with parents about STD/pregnancy prevention, recent sex with a nonsteady partner, low perceived ability to negotiate condom use and fear of this negotiation, and low motivation to use condoms. Given the importance of partner communication in promoting safer sex behaviors, STD and pregnancy prevention programs may benefit adolescents by addressing the identified psychosocial correlates of infrequent communication with their partners.

Condom use and correlates of African American adolescent females' infrequent communication with sex partners about preventing sexually transmitted diseases and pregnancy.

This study of 522 African American female adolescents, ages 14 to 18, investigated associations between condom use and infrequently communicating with sex partners about sexually transmitted diseases (STDs) and pregnancy prevention. Correlates of infrequent communication were identified. Sexually active adolescents were recruited from schools and adolescent medicine clinics in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a self-administered survey and face-to-face interview. Communication frequency was assessed using a five-item scale. Infrequent communication was significantly associated with lower odds of condom use. Multivariate correlates of infrequent communication were less frequent communication with parents about STD/pregnancy prevention, recent sex with a nonsteady partner, low perceived ability to negotiate condom use and fear of this negotiation, and low motivation to use condoms. Given the importance of partner communication in promoting safer sex behaviors, STD and pregnancy prevention programs may benefit adolescents by addressing the identified psychosocial correlates of infrequent communication with their partners.