Partners Of Unknown HIV Serostatus Research Articles

The Relationship Between Housing Status and Substance Use and Sexual Risk Behaviors Among People Currently Seeking or Receiving Services in Substance Use Disorder Treatment Programs.

Although HIV risk behaviors such as substance use and condomless sex are prevalent among people currently seeking or receiving services at substance use disorder (SUD) treatment programs, associations with housing status in this population have not been well studied. We examined the associations between housing status, substance use and HIV-related sexualriskbehaviors among 1281 participants from 12 US community-based SUD programs. In addition, substance use was examined as a potential mediator of the relationship between housing status and sexual risk behaviors. We conducted Chi-square, univariate and multivariate logistic regression models on data from the National Drug Abuse Treatment Clinical Trials Network HIV Rapid Testing and Counseling study. Path analysis was used to test the mediation and indirect effects. Unstable housing was significantly associated with having multiple concurrent condomless sex partners, condomless sex with non-primary partners, and partners of unknown HIV serostatus. Homelessness was significantly associated with condomless vaginal sex and condomless sex with any substance use. The path between unstable housing and sexual risk behaviors was mediated by problematic drug use, particularly by cocaine, opioids, and marijuana use. Because housing status impacts HIV risk behaviors for individuals in SUD treatment programs, both housing status and substance use behaviors should be assessed upon program entry in order to identify and mitigate risk behaviors.

Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean.

Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.

Factors associated with prior engagement in high-risk sexual behaviours among adolescents (10\u201319\u2009years) in a pastoralist post-conflict community, Karamoja sub-region, North eastern Uganda

BackgroundAdolescent sexual risky behaviours continue to be significant drivers of the HIV epidemic globally. The objective of this study was to determine factors associated with prior engagement in high-risk sexual behaviours among adolescents (10–19 years) in Karamoja sub-region, a pastoralist and post-conflict community in North-eastern Uganda.MethodsBetween August and September 2016, we conducted a cross-sectional study among 1439 adolescents receiving primary healthcare services at nine public health facilities located in five of the seven districts that make up Karamoja sub-region. High-risk sexual behaviour was defined as engaging in sex with two or more (2+) sexual partners in the 6 months preceding the survey or exchanging sex for money or gifts with no or inconsistent use of condoms over the same period of time. Factors associated with prior engagement in high-risk sexual behaviours were analysed using a modified Poison regression model with log-link and Poisson-family via a generalized linear model.ResultsEighty-two percent (81.8%, n = 1177) of the respondents had ever tested for HIV while 62 % (61.5%, n = 885) had ever had sex. Of those that had ever had sex, 11.4% (n = 101) reported prior engagement in high-risk sexual behaviours. Prior engagement in high-risk sexual behaviours was lower among men than women (adjusted prevalence ratio (adj. PR) = 0.46; 95% Confidence Interval (95% CI): 0.33, 0.62) and those whose sex debut was above 14 years (adj.PR = 0.63; 95% CI: 0.57, 0.69). However, prior engagement in high-risk sexual behaviours was significantly higher in adolescents who were not aware of their recent sexual partner’s HIV status (adj.PR = 2.43; 95% CI: 1.68, 3.52) and those who used illicit drugs (adj.PR = 2.76; 95% CI: 1.88, 4.05).ConclusionPrior engagement in high-risk sexual behaviours was significantly associated with having sex with partners of unknown HIV sero-status and use of illicit drugs. These findings suggest a need for targeted interventions to improve mutual HIV status disclosure between sexual partners while minimizing their use of illicit drugs/substances.

Conversation about Serostatus decreases risk of acquiring HIV: results from a case control study comparing MSM with recent HIV infection and HIV negative controls.

BackgroundData on knowledge, attitudes, behaviour and practices (KABP) of persons with recent HIV infection compared to controls with negative HIV test result provide information on current risk patterns and can help to re-focus HIV prevention strategies.MethodsFrom March 2008 through May 2010, persons newly diagnosed with HIV (cases) and HIV-negative controls were recruited by physicians in Germany. To distinguish recent (< 5 months) from longstanding (> 5 months) infection, dried blood spots from people newly diagnosed with HIV were tested with the BED IgG-capture ELISA. Cases and controls completed a KABP-questionnaire. We compared cases with recent infection and controls among men having sex with men (MSM) regarding reported risk behaviour in the previous 6 months. To detect differences, unadjusted Odds Ratios (OR) were calculated and multivariate analysis was performed.ResultsCases and controls did not differ in terms of knowledge on transmission risks, HIV testing frequency, partnership status, or regarding the frequency of any unprotected sex with partners known to be HIV-positive or assumed to be HIV-negative. Cases more often reported a shorter duration of partnership (< 6 months) with a primary partner than controls (OR = 3.9; p = 0.003) and indicated lower rates of condom use outside of primary relationships, with acquaintances (OR = 2.5; p = 0.01), and with persons met online (OR = 4.5; p = 0.04). Unprotected sex with persons of unknown HIV-serostatus was more often indicated by cases than controls (OR = 3.0; p = 0.003). Having a conversation about HIV serostatus before having sex was associated with a lower risk of infection (OR = 0.2; p = 0.01). In multivariate analysis “being always safe” (always using a condom when having sex in different situations outside of a relationship) and talking about serostatus before sex (OR = 0.23; p = 0.004; OR = 0.14; p = 0.014) were negatively associated with HIV- infection.ConclusionsThere were no significant differences regarding knowledge about HIV-transmission risks among cases and controls. Differences in risk behaviour were observed regarding unprotected sex with partners of unknown HIV-serostatus and duration of primary partnership at the time of diagnosis, suggesting some HIV-transmissions occurring in newly formed partnerships. The practice of discussing serostatus with prospective sex partners before engaging in sex seems to be protective for HIV-transmission.

Nonoccupational post‐exposure prophylaxis source tracing: is it really feasible in Australia?

A Swiss nonoccupational post-exposure prophylaxis (NPEP) source-tracing study successfully reduced unnecessary NPEP prescriptions by recruiting and testing source partners of unknown HIV serostatus. The Victorian NPEP Service in Australia attempted to replicate this study with the addition of HIV rapid testing and a mobile service. Patients presenting to two busy NPEP sites who reported a source partner of unknown HIV status were routinely asked if their source could be traced. If the exposed person indicated that their source partner was traceable they were asked to contact them and discuss the possibility of having an HIV test. No sources were enrolled and the study was terminated. We hypothesize that there are a number of differences between Australia and Switzerland that make source tracing unfeasible in Australia.

Sexual Risk Behaviors Among HIV-Positive Black Men Who Have Sex With Women, With Men, or With Men and Women: Implications for Intervention Development

We compared demographics and sexual and drug risk behaviors among HIV-positive Black men who have sex with women only, with men only, or with men and women to assess differences among and between these groups. We analyzed cross-sectional data from the Supplement to HIV and AIDS Surveillance Project for 2038 HIV-positive Black men who reported being sexually active. We classified the participants by their reported sexual behaviors in the past year: intercourse with women (n = 1186), with men (n = 741), or with men and women (n = 111). Respondents whose sexual partners were both men and women reported more noninjection drug use, sexual exchange, and sexual partners than did the other 2 groups. Bisexual respondents were also more likely than were heterosexuals to report unprotected intercourse with a steady female partner and were more likely than were both other groups to report having steady partners of unknown HIV serostatus and using drugs during their last sexual episode. HIV-positive Black men with both male and female sexual partners engaged in more sexual and drug risk behaviors than did their heterosexual and homosexual peers. More information concerning the prevention needs of behaviorally bisexual HIV-positive Black men is needed.

Oral contraception and unprotected sex with occasional partners of women HIV-infected through injection drug use

Among HIV-infected women, unprotected sex with the main sexual partner is common practice. Conversely, studies about condom use with sexual partners of unknown HIV sero-status are sparsely reported. We aimed to assess the impact of oral contraception on unsafe sexual behaviours with occasional partners in women HIV-infected through injection drug use. The analysis focused on 90 women, enrolled in the French cohort MANIF 2000 and reported having engaged in sexual relationships with occasional partners during a 48-month period. Visits where women reported unprotected sex with occasional partners in the prior 6 months were compared to visits where they reported protected sex using a logistic model based on Generalised Estimating Equations. Unprotected sex with occasional partners was independently associated with oral contraception (OR[95%CI] = 3.2[1.4–7.2]), reporting only one occasional partner (OR[95%CI] = 3.1[1.6–6.2]) and antiretroviral treatment receipt. No significant association was found between unprotected sex and CD4 level or plasma viral load. With the growing population of people living with HIV as a chronic infection, the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority. Risk reduction counselling and interventions are needed to promote either the use of dual contraception or, alternatively, that of female condom.

HIV/AIDS among Asians and Pacific Islanders in the United States

Asians and Pacific Islanders (APIs) are one of the fastest growing ethnic minority groups in the United States. From 1980 to 2000, APIs more than doubled from 1.6% to 4.2% of the U.S. population (Barnes & Bennett, 2002). By the year 2050, it is estimated that the API population will increase to 8% of the U.S. total, reaching 33.4 million persons (U.S. Census Bureau, 2004). According to the Centers for Disease Control and Prevention (CDC), there were an estimated 7,166 APIs diagnosed with AIDS in the United States as of December 2003 (CDC, 2004). Although APIs account for 0.8% of all U.S. AIDS cases, the number of estimated AIDS cases increased from 1999 to 2003 at a higher rate for APIs (35%) compared to African Americans (8%), Latinos (7%), and Native Americans (21%; CDC, 2004). By comparison, the number of AIDS cases decreased by 3% for Whites during the same time period. Moreover, recent data from San Francisco, where nearly one in seven APIs with AIDS live (Zaidi et al., this issue), find an increase in risk for HIV infection among API men who have sex with men (MSM; McFarland, Chen, Weide, Kohn, & Klausner, 2004). Unprotected anal intercourse with two or more sex partners of unknown HIV serostatus in the past six months increased from 6% in 1999 to 16% in 2002 among API MSM. During the same time period, the incidence of male rectal gonorrhea increased from 200 to 800 per 100,000 for API men. Another survey conducted in San Francisco between June 2004 and April 2005 shows a higher HIV prevalence of 3.9% among young API MSM ages 18–29 (H. Fisher Raymond, personal communication, July 20, 2005) than the 2.6% prevalence found for the same group in 2000–2001 (Choi et al., 2004). Although APIs may increasingly be at greater risk for HIV, less attention has been paid to their concerns due to the small number of reported API AIDS cases. This thematic issue presents seven articles to highlight HIV–related problems that confront APIs in the United States. The first article describes the epidemiology of HIV/AIDS, behavioral risk, and HIV testing among APIs. Zaidi et al. (this issue) analyzed HIV/AIDS cases reported to the CDC between 1999 and 2002 and data from the 1997–2002 Behavioral Risk Factor Surveillance System survey. Their analyses show that the prevalence of HIV and AIDS is lower among APIs compared to other racial/ethnic groups, but APIs are as likely as other racial/ethnic groups to engage in AIDS Education and Prevention, 17(5), iii–v, 2005 © 2005 The Guilford Press

Gay Asian men in San Francisco follow the international trend: increases in rates of unprotected anal intercourse and sexually transmitted diseases, 1999-2002.

Worldwide, studies of men who have sex with men (MSM) report increases in HIV risk-related behavior. Less is known about trends within minority subpopulations of MSM, particularly those of Asian and Pacific Islander (A&PI) ethnicity. A&PI MSM are underrepresented among AIDS cases (2.7%) with respect to their estimated makeup in the gay community of San Francisco (4.5%). However, recent trends in unprotected anal intercourse (UAI) and sexually transmitted diseases suggest a reversal in the relative risk for HIV among A&PI MSM compared with White MSM. Starting from lower levels in 1999, UAI with multiple partners, UAI with multiple partners of unknown HIV serostatus, the incidence of male rectal gonorrhea, and the incidence of early syphilis among A&PI MSM surpassed levels among White MSM by 2002. A window of opportunity to prevent further spread of HIV among A&PI MSM may be closing.

CONTINUING INCREASES IN SEXUAL RISK BEHAVIOR AND SEXUALLY TRANSMITTED DISEASES AMONG MEN WHO HAVE SEX WITH MEN: SAN FRANCISCO, CALIF, 1999–2001

We recently reported on worrisome increases in sexual risk behavior, sexually transmitted diseases (STDs), and HIV incidence among men who have sex with men (MSM) during a period of increasing use of highly active antiretroviral therapy (HAART), from 1994 to 1999.1 We have since obtained data on sexual risk behavior for 2000 and 2001. In addition, we have added to our surveys questions on whether unsafe sex was occurring with partners of unknown HIV serostatus, updated trends in male rectal gonorrhea, and provided data on primary and secondary syphilis cases among MSM. As previously reported, the Stop AIDS Project conducts serial cross-sectional surveys of MSM in a variety of community settings in the course of outreach health education. The street-based intercept survey asks questions about sexual behavior in the preceding 6 months, including anal sex, condom use, number of sexual partners, and knowledge of partners’ HIV serostatus. Overall, 10 568 MSM completed the survey between 1999 and 2001. The proportion of MSM reporting any anal sex in the last 6 months increased from 67% in 1999 to 74% in 2001 (Figure 1a ▶). The proportion of respondents reporting any unprotected anal sex increased from 32% to 38%, with a parallel increase from 18% to 23% in the proportion reporting unprotected anal sex with 2 or more partners (Figure 1b ▶). Between 1999 and 2001, the proportion reporting unprotected anal sex with 2 or more partners of unknown HIV serostatus increased from 10% to 15% for respondents who reported being HIV-negative and from 19% to 25% for those who said they were HIV-positive (Figure 1c ▶). Although a decline in the number of respondents was noted from 1999 to 2001, there were no substantial shifts in respondents’ age or race over time and no differences in trends in sexual risk behavior within demographic groups. FIGURE 1 —Trends in sexual risk behavior and sexually transmitted diseases among men who have sex with men: San Francisco, Calif, 1999–2001. STD surveillance data corroborate continued increases in sexual risk behavior. Reported cases of male rectal gonorrhea increased from 162 in 1999 (updated from 160 in our prior report1 owing to delays in reporting) to 237 in 2001 (Figure 1d ▶). The number of primary and secondary syphilis cases among MSM increased from only 6 cases in 1998 to 115 cases in 2001. We conclude that the increases in unsafe sex seen from 1994 to 1999, in association with the availability of HAART, were not isolated but rather reflect an ongoing trend. Moreover, data on HIV serostatus of partners suggest that much of this unsafe sex is occurring among partners who are serodiscordant.

Situational factors associated with AIDS risk behavior lapses and coping strategies used by gay men who successfully avoid lapses.

While most gay men have reduced behavior practices at high risk for HIV infection, there is growing evidence that many also lapse to unsafe sex. This study examined situational factors related to risk behavior lapses as well as coping strategies used by men who successfully resist lapse urges. A convenience sample of 470 men patronizing gay bars or attending social organization meetings in four cities was surveyed. Forty-five percent of men were classified as "lapsers" (those who had had unprotected anal intercourse in the previous 6 months) and 24% were classified as "resisters" (those who successfully resisted urges to engage in this behavior). All provided information concerning the importance of factors related to the most recent occurrence of either unsafe sex or resisting unsafe urges. Most episodes of unsafe sex occurred outside monogamous relationships and with partners of unknown HIV serostatus, although simply inquiring about partner serostatus was relatively common. Lapsers rated affectionate feelings and wishing to please a partner as well as spontaneity of unsafe sex as the most important situational factors surrounding high-risk behavior. Resisters of unsafe sex urges reported active cognitive self-guidance, experience in safe sex, and recall of both AIDS fears and safety benefits as their most important coping strategies. Gay men who continue high-risk behavior may be overrelying on partner reports of negative serostatus. Lapse prevention approaches tailored to situations that create increased risk vulnerability must be developed. Teaching skills already used by men who successfully resist unsafe sex urges might be one approach.