Rates Of High-risk Sexual Behaviors Research Articles

Alcohol use and High-Risk Sexual Behaviors among Members of a Latino Migrant Worker Community in Central Florida

Background: Latino and Latina migrant workers constitute a vast amount of the agricultural workforce within the United States. A few studies indicate that a significant segment of the Latino migrant worker population in the United States is at high risk for alcohol abuse and related high-risk behaviors. Information about the prevalence of alcohol use and abuse and its association with high-risk sexual behaviors is needed to design effective prevention strategies in this underserved population. Aims: To assess the association between alcohol use and high-risk sexual behaviors in this population. Methods: Cross-sectional data was obtained from March 2018 through December 2019 as part of a study entitled “Project Salud: HIV Prevention among Latino Migrant Workers in Florida.” Study participants were recruited from neighborhoods and migrant camps in the Immokalee area in Central Florida by means of a stratified network-based (snowball) sampling design. Of the 782 screened participants, 671 (86%) met eligibility criteria and consented to participate in the study. Participants were grouped based on ‘‘no alcohol use” “alcohol use” and ‘‘binge drinking.” Results: More than one-third (36.2%) of the sample reported no alcohol use during the last 30 days prior to the interview. The rest of study participants reported alcohol use (28.5%) and binge drinking (35.3%). Binge drinking was more common among male participants compared to their female counterparts (41.6% vs 29.6%). Among Latino migrant workers, rates of high-risk sexual behaviors in the last 30 days were generally high and did not vary as a function of alcohol use. Among Latina migrant workers, rates of vaginal sex were high for all study participants, but this behavior did not vary as a function of alcohol use. However, binge drinking was found to be significantly associated with increase rates of anal sex and multiple sex partners. Conclusion: High-risk sexual behaviors are prevalent in the Latino migrant worker community. Among Latina migrant workers, these behaviors significantly increase among those who engage in binge drinking. Further research on the intersection of alcohol use and high-risk behaviors in the Latino migrant worker community, especially among Latina migrant workers, is necessary to develop and implement appropriate interventions.

S\xf3lo Se Vive Una Vez: Evaluation of a Social Marketing Campaign Promoting HIV Screening and Prevention for Immigrant Latinxs

Latinxs in the U.S. are disproportionately affected by HIV and more likely to have delayed diagnosis than their non-Latinx peers. We developed and implemented Sólo Se Vive Una Vez (You Only Live Once), the first Spanish-language campaign aimed at improving HIV testing and prevention among Latinx immigrants in Baltimore, Maryland. Sólo Se Vive Una Vez featured a website (www.solovive.org) and social marketing campaign promoting free HIV testing through the Baltimore City Health Department (BCHD) clinic and Latinx outreach team. The campaign was not associated with a change in the overall number of Latinxs obtaining HIV testing. However, Latinx HIV testers who reported being exposed to the campaign had significantly higher rates of high-risk sexual behaviors, mean number of sexual partners, and substance use. The campaign was also associated with increased PrEP referrals through the BCHD Latinx outreach team.

Development and Feasibility Testing of a Video Game to Reduce High-Risk Heterosexual Behavior in Spanish-Speaking Latinx Adolescents: Mixed Methods Study.

BackgroundSimilar to broader health disparities, Latinx adolescents have higher rates of high-risk sexual behavior resulting in pregnancy rates that are 2 times higher and sexually transmitted infection rates that are 5 to 8 times higher than non-Hispanic, white adolescents. Novel approaches are needed to reduce high-risk sexual behavior among Spanish-speaking Latinx adolescents who represent the fastest-growing group of US immigrants.ObjectiveThis study aimed to partner with Spanish-speaking Latinx adolescents in a participatory design process to develop and test a Spanish-language video game intervention to decrease high-risk heterosexual behavior.MethodsThis is an iterative, two-phase, mixed methods study. In phase 1, we conducted focus groups with Spanish-speaking Latinx adolescents to elicit feedback on the content and format of an existing English-language video game. Feedback was then incorporated into an expanded and culturally adapted Spanish-language video game. In phase 2, we pilot tested the feasibility, acceptability, and preliminary efficacy of the new Spanish-language video game intervention by measuring known antecedents to sexual behavior (intentions, self-efficacy, risk perception, and knowledge) assessed at enrollment and 12-week follow-up. We applied a thematic analysis to examine focus group feedback and a bivariate analysis to analyze pre- and postquantitative data.ResultsIn phase 1, 15 Spanish-speaking Latinx adolescents provided feedback for further video game development. A Spanish-language video game was then produced and tested in phase 2. We recruited and enrolled 24 Spanish-speaking Latinx adolescents aged 15 to 17 years. Participants played the video game for an average of 4.2 hours during monitored sessions. Pilot testing demonstrated feasibility and acceptability; 65% (3/20) of participants stated that they would play it again, and 65% (3/20) said they would recommend it to friends. Condom-specific knowledge did significantly increase between baseline and follow-up (P=.007). Other variables of sexual behavior antecedents did not differ significantly between baseline and 12-week follow-up.ConclusionsAn iterative participatory design process in partnership with Spanish-speaking adolescents produced an innovative and acceptable Spanish-language video game intervention aimed at decreasing high-risk sexual behavior in adolescents. Pilot testing demonstrated preliminary feasibility and yielded essential information for further video game development.

Lues Maligna in a Patient with Human Immunodeficiency Virus: Case Report and Review of the Literature

Syphilis is a sexually transmitted infection with rising incidence in recent years due to increased rates of highrisk sexual behaviors. Often called “the great imitator,” syphilis can have many different presentations in its various stages: latent, primary, secondary and tertiary. One form of secondary syphilis is ulceronodular syphilis, also known as lues maligna. We report a case of a 48-year-old Filipino man who presented with a diffuse, ulcerating, papular rash and was subsequently diagnosed concurrently with both lues maligna and human immunodeficiency virus.

Sexual Minority, Justice-Involved Youth: A Hidden Population in Need of Integrated Mental Health, Substance Use, and Sexual Health Services

PurposeWe sought to compare the demographic characteristics, drug and alcohol use, sexual behaviors, delinquency, and mental health indicators of sexual minority and nonsexual minority first-time offending, court-involved, nonincarcerated adolescents. MethodsUsing adolescent- and caregiver-reported baseline data from the Epidemiologic Study Involving Children in the Court, a prospective cohort study of 423 adolescent-caregiver dyads recruited from a Northeastern family court system, we compared demographic and behavioral health characteristics of sexual minority and nonsexual minority first-time offending, court-involved, nonincarcerated adolescents. ResultsNearly one-third of the adolescents (31.4%, n = 133) were classified as a sexual minority; 19.6% (n = 81) self-identified with a nonheterosexual sexual orientation. Sexual minority adolescents were more likely than their nonsexual minority peers to identify as female, to have used psychiatric services or psychotropic medications, to have used an illicit drug or alcohol or to know peers who use these substances, to report alcohol/drug use during sex, to endorse more severe mental health problems, to have more recent post-traumatic symptoms, and to have engaged in self-harm behaviors. However, sexual minority adolescents did not differ from nonsexual minority adolescents in other demographic characteristics (including school performance) or delinquent behavior. ConclusionsOne-third of court-involved, nonincarcerated adolescents may be sexual minorities. Specificscreening methods are necessary to identify these adolescents and to address their unique risk characteristics, which include more severe mental health difficulties and higher rates of high-risk sexual behavior and drug/alcohol use compared with their nonsexual minority peers.

Long-term nitrite inhalant exposure and cancer risk in MSM.

Objectives:Nitrite inhalants (poppers) are commonly used recreational drugs among MSM and were previously associated with elevated rates of high-risk sexual behavior, HIV and human herpesvirus type 8 (HHV-8) seroconversion, and transient immunosuppressive effects in experimental models. Whether long-term popper use is associated with cancer risk among MSM in the HAART era is unclear.Design:Prospective cohort study of cancer risk in 3223 HIV-infected and uninfected MSM in the Multicenter AIDS Cohort Study from 1996–2010.Methods:Poisson regression models were used to examine the association between heavy popper use (defined as daily or weekly use for at least 1 year) and risk of individual cancers or composite category of virus-associated cancers.Results:Among all participants, heavy popper use was not associated with increased risk of any individual cancers. Among HIV-uninfected men aged 50–70, heavy popper use was associated with increased risk of virus-associated cancer with causes linked to human papillomavirus, HHV-8, and Epstein–Barr virus in models adjusted for demographics, number of sexual partners, immunological parameters (CD4+ cell counts or CD4+/CD8+ ratios), and hepatitis B and C viruses [incidence rate ratio (IRR), 95% confidence interval (CI) 3.24, 1.05–9.96], or sexually transmitted infections (IRR 3.03, 95% CI, 1.01–9.09), as was cumulative use over a 5-year period (IRR 1.012, 95% CI 1.003–1.021; P = 0.007). There was no significant association between heavy popper use and virus-associated cancer in HIV-infected men.Conclusions:Long-term heavy popper use is associated with elevated risk of some virus-associated cancers with causes related to human papillomavirus, HHV-8, and Epstein–Barr virus infections in older HIV-uninfected MSM independent of sexual behavior and immunological parameters.

Examining the efficacy of a computer facilitated HIV prevention tool in drug court

BackgroundAlthough they have demonstrated efficacy in reducing substance use and criminal recidivism, competing priorities and limited resources may preclude drug court programs from formally addressing HIV risk. This study examined the efficacy of a brief, three-session, computer-facilitated HIV prevention intervention in reducing HIV risk among adult felony drug court participants. MethodsTwo hundred participants were randomly assigned to an HIV intervention (n=101) or attention control (n=99) group. All clients attended judicial status hearings approximately every six weeks. At the first three status hearings following study entry, clients in the intervention group completed the computerized, interactive HIV risk reduction sessions while those in the control group viewed a series of educational life-skill videos of matched length. Outcomes included the rate of independently obtained HIV testing, engagement in high risk HIV-related behaviors, and rate of condom procurement from the research site at each session. ResultsResults indicated that participants who received the HIV intervention were significantly more likely to report having obtained HIV testing at some point during the study period than those in the control condition, although the effect was marginally significant when examined in a longitudinal model. In addition, they had higher rates of condom procurement. No group differences were found on rates of high-risk sexual behavior, and the low rate of injection drug reported precluded examination of high-risk drug-related behavior. ConclusionsThe study provides support for the feasibility and utility of delivering HIV prevention services to drug court clients using an efficient computer-facilitated program.

No evidence of sexual transmission of Kaposi's sarcoma herpes virus in a heterosexual South African population

The transmission of Kaposi's sarcoma herpes virus (KSHV) in men who have sex with men is clearly associated with sexual risk factors, but evidence of heterosexual transmission of KSHV is conflicting. Sera were obtained from 2103 South African individuals (862 miners, 95 sex workers, 731 female and 415 male township residents; mean age 33.2 years; +/- 10.1). All sera were tested for antibodies to KSHV lytic K8.1 and latent Orf73, HIV, gonococcus, herpes simplex virus type 2 (HSV-2), syphilis and chlamydia. Information on social, demographic and high-risk sexual behavior was linked to laboratory data, to evaluate risk factors, expressed as odds ratios (95% confidence interval) for KSHV. Overall KSHV and HIV prevalences were 47.5 and 40%, respectively (P = 0.43). The risk of HIV infection was highest in sex workers then female residents and miners, compared with male residents (P < 0.001). HSV-2 infection was highly prevalent (66%) and lower, but still substantial, prevalences (6-8%) were observed for other sexually transmitted infections (STI). No significant difference in KSHV infection was observed among the residential groups (P > 0.05). KSHV was not associated with any of the STI or any measures of sexual behavior (P > 0.05). The pattern of HIV and STI in sex workers suggests high rates of high-risk sexual behavior in this population. The lack of association with high-risk sexual behavior, particularly in sex workers, and with any markers of STI strongly suggest that the sexual mode does not play a significant role in KSHV transmission in this South African population.

The Use of an Educational Video During Informed Consent in an HIV Clinical Trial in Haiti

Research volunteers from developing countries who enroll in HIV clinical trials may be illiterate and unfamiliar with the conduct of medical research. Educating volunteers about the contents of the consent form is essential but can be difficult and time consuming. We evaluated the feasibility and effectiveness of an educational video during the informed consent process for an HIV clinical trial conducted in Port-au-Prince, Haiti. HIV-seronegative volunteers were recruited into a longitudinal cohort to study rates of high-risk sexual behavior and incidence of HIV-1 infection. Before enrollment, all volunteers received information about the consent form during 2 educational sessions. In the first session, groups of 5 to 10 volunteers viewed an educational video on the essential elements of the consent form. In the second, the volunteers met one-on-one with a social worker. Volunteers' comprehension was then evaluated orally by 16 true-false questions and 4 open-ended questions. Volunteers who failed the first evaluation received additional education and had a second evaluation. Two hundred fifty volunteers received education, and 186 (74%) passed the first evaluation. Higher formal education was a significant predictor of passing the first evaluation (odds ratio, 1.60; 95% confidence interval, 1.05-2.44). Of the 64 who failed, 47 returned for a repeat one-on-one education session and a second evaluation. Among these 47, 39 (83%) passed, and 8 (7%) failed the second evaluation. In total, 225 (90%) of 250 individuals passed either the first or second evaluation and were eligible to enroll in the study. Informed consent using an educational video ensured good comprehension in most of the volunteers. Additional educational sessions may be necessary for some participants with lower educational level.

The impact of substance dependence on HIV sexual risk-reduction among men with severe mental illness

We explored the impact of substance dependence on the efficacy of an HIV sexual risk reduction intervention previously shown to be effective among men with severe mental illness by comparing rates of high-risk sexual behaviors among men with (n=26) and without (n=31) a lifetime history of substance dependence. We sub-divided subjects by alcohol and drug dependence status, comparing each intervention sub-group to the corresponding control sub-group. At each follow-up interval (six, 12 and 18 months), the intervention group as a whole and the non-substance dependent participants showed a significant reduction in risk; the substance-dependent men showed no difference from controls. These data suggest that among men with severe mental illness, substance dependence may be a further impediment to HIV risk reduction.

If HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM?

Systematic reviews of HIV prevention research provide clear evidence that behavioral interventions can influence the sexual behavior of men who have sex with men (MSM). However, if HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM in major European, Australian, Canadian, and U.S. cities? The evidence generated by systematic reviews alone may not provide a clear answer to this question. This is because (a) it is uncertain whether experimental interventions shown to be effective in one setting, place, or moment in time can be repeated successfully in another; (b) we have limited understanding of the processes that underlie the interventions; (c) interventions shown to work in an experimental study may not necessarily be effective in everyday life. To answer the question, we need to be alert to the changing risk environment in which men have sex with other men. We also need to develop a new program of research addressing the transferability, sustainability, and effectiveness of sexual health promotion among MSM. Randomized controlled trials will remain one of the optimal means of evaluating behavioral interventions in such a program. By further strengthening the evidence base, we may identify opportunities for innovative as well as effective HIV prevention initiatives.

Psychiatric and Substance Dependence Comorbidities, Sexually Transmitted Diseases, and Risk Behaviors Among Methamphetamine-Dependent Gay and Bisexual Men Seeking Outpatient Drug Abuse Treatment

This article describes psychiatric and substance dependence comorbidities, lifetime rates of infectious disease, and reported high-risk sexual behaviors for methamphetamine-dependent, gay and bisexual men at entry to outpatient drug abuse treatment in Los Angeles. Participants' selfreports of high-risk sexual and drug use behaviors and of history of infectious disease status were correlated with diagnostic information from 155 Structured Clinical Interviews for the DSM-IV (SCID). A total of 82 participants met criteria for lifetime depressive disorders; 44 participants met criteria for lifetime anxiety disorders. Compared to those without psychiatric diagnoses, significant differences were observed in lifetime prevalence of sexually transmitted infections among those who have generalized anxiety disorder (higher rates of genital gonorrhea), specific phobia and major depressive disorder (higher rates of oral gonorrhea), social phobia (higher rates of syphilis) and bipolar disorder, type I (higher rates of HIV). Differences in infectious disease prevalence did not correspond to significantly different rates of high-risk sexual behaviors. Findings indicate that gay and bisexual men seeking outpatient treatment for methamphetamine dependence are likely to experience psychiatric comorbidity and to have high rates of infectious disease, including HIV, syphilis and gonorrhea.

Older male partners, high rates of incarceration and marginal economic activities in the sexual networks of a random digit dial sample of 14–19 year old economically disadvantaged African American youth

Conclusions: To the extent that incarceration is correlated with STD risk the presence of a large percentage of male sex partners with a history of incarceration suggests that improved screening and treatment of incarcerated adolescents and young adults could benefit the reproductive health of all youth in the community. The disproportionate rates of STDs among African American female adolescents cannot be explained by their rates of high-risk sexual behaviors. Geographic segregation and partner selection may be more important determinants of their STD risk. (excerpt)

Prevalence and determinants of sexually transmitted diseases: an analysis of young Jamaican males.

Jamaican adolescents have high rates of sexually transmitted diseases (STDs). Since the sexual behaviors that put an individual at risk for HIV are the same as for other STDs, the prevalence and determinants of STD symptoms among a sample of young Jamaican males were examined. As part of the 1997 Reproductive Health Survey, male adolescents and young adults in Jamaica were surveyed about symptoms of STDs and related sex behaviors. Overall, 9% of the sample reported symptoms of STDs in the year before the interview. Rates of high-risk sexual behaviors were high. Logistic regression analyses indicated that being older and having multiple sex partners were associated with having symptoms of STDs. Prevention programs should recognize that various factors can increase the risk of contracting and transmitting STDs, including HIV. Interventions should be targeted to those with high-risk behaviors that are conducive to continued participation in high-risk sexual behaviors.

Predictors of Continued High-Risk Sexual Behavior in a Community Sample of Persons Living with HIV/AIDS

Most HIV prevention research has focused on persons who are HIV-seronegative. However, some persons aware of their HIV infection may continue to engage in high-risk sexual behavior patterns that place their sexual partners at risk for HIV infection. The present study delineates rates of high-risk sexual behavior in a community sample of persons living with HIV/AIDS and identifies predictors of continued high-risk sex. An anonymous self-report survey assessing social support, access to health care services, health-related quality of life, perceptions of loneliness, life satisfaction, and sexual behavior was completed by 277 persons living with HIV/AIDS in a midwestern state. Predictors of continued high-risk sex included being in an affectionate relationship, greater physical well-being, more barriers to health care services due to geography and distance, and having a greater number of male sexual partners. HIV prevention programs are needed for persons living with HIV disease who have difficulty avoiding high-risk sexual behavior.