Serodiscordant Unprotected Anal Intercourse Research Articles

Sexualized drug use ('chemsex') and high-risk sexual behaviours in HIV-positive men who have sex with men.

ObjectivesThe incidence of sexually transmitted infections (STIs) and HIV infection remains high in gay, bisexual, and other men who have sex with men (MSM) in the UK, and sexualized drug use (“chemsex”) and injecting drug use (“slamsex”) may play a part in this. We aimed to characterize HIV‐positive MSM engaging in chemsex/slamsex and to assess the associations with self‐reported STI diagnoses and sexual behaviours.MethodsData from a 2014 survey of people attending HIV clinics in England and Wales were linked to clinical data from national HIV surveillance records and weighted to be nationally representative. Multivariable logistic regression assessed the associations of chemsex and slamsex with self‐reported unprotected anal intercourse (UAI), serodiscordant UAI (sdUAI) (i.e. UAI with an HIV‐negative or unknown HIV status partner), sdUAI with a detectable viral load (>50 HIV‐1 RNA copies/mL), hepatitis C, and bacterial STIs.ResultsIn the previous year, 29.5% of 392 sexually active participants engaged in chemsex, and 10.1% in slamsex. Chemsex was significantly associated with increased odds of UAI [adjusted odds ratio (AOR) 5.73; P < 0.001], sdUAI (AOR 2.34; P < 0.05), sdUAI with a detectable viral load (AOR 3.86; P < 0.01), hepatitis C (AOR 6.58; P < 0.01), and bacterial STI diagnosis (AOR 2.65; P < 0.01). Slamsex was associated with increased odds of UAI (AOR 6.11; P < 0.05), hepatitis C (AOR 9.39; P < 0.001), and bacterial STI diagnosis (AOR 6.11; P < 0.001).ConclusionsThree in ten sexually active HIV‐positive MSM engaged in chemsex in the past year, which was positively associated with self‐reported depression/anxiety, smoking, nonsexual drug use, risky sexual behaviours, STIs, and hepatitis C. Chemsex may therefore play a role in the ongoing HIV and STI epidemics in the UK.

Unprotected Anal Intercourse With Casual Male Partners in Urban Gay, Bisexual, and Other Men Who Have Sex With Men.

Objectives. We investigated trends in, and predictors of, unprotected anal intercourse (UAI) with casual male partners of gay, bisexual, and other men who have sex with men (GBMSM). Methods. We analyzed data from cross-sectional intercept surveys conducted annually (2003-2008) at 2 large lesbian, gay, and bisexual community events in New York City. Survey data covered GBMSM's highest-risk behaviors for HIV acquisition (HIV-negative or unknown status GBMSM, any UAI) and transmission (HIV-positive GBMSM, any serodiscordant unprotected UAI). Results. Across years, 32.3% to 51.5% of the HIV-negative or unknown status men endorsed any UAI, and 36.9% to 52.9% of the HIV-positive men endorsed serodiscordant UAI. We observed a few statistically significant fluctuations in engagement in high-risk behavior. However, these do not appear to constitute meaningful trends. Similarly, in some years, one or another demographic predictor of UAI was significant. Across years, however, no reliable pattern emerged. Conclusions. A significant proportion of urban GBMSM engage in high-risk sex, regardless of serostatus. No consistent demographic predictors emerged, implying a need for broad-based interventions that target all GBMSM.

Sexually Explicit Online Media and Sexual Risk Among Men Who Have Sex with Men in the United States

This study aimed to describe sexually explicit online media (SEOM) consumption among men who have sex with men (MSM) in the United States and examine associations between exposure to unprotected anal intercourse (UAI) in SEOM and engagement in both UAI and serodiscordant UAI. MSM in the U.S. who accessed a men-seeking-men website in the past year (N = 1,170) were recruited online for a cross-sectional, Internet-based survey of sexual risk and SEOM consumption. In the 3 months prior to interview, more than half (57 %) of the men reported viewing SEOM one or more times per day and almost half (45 %) reported that at least half of the SEOM they viewed portrayed UAI. Compared to participants who reported that 0-24 % of the SEOM they viewed showed UAI, participants who reported that 25-49, 50-74, or 75-100 % of the SEOM they viewed portrayed UAI had progressively increasing odds of engaging in UAI and serodiscordant UAI in the past 3 months. As SEOM has become more ubiquitous and accessible, research should examine causal relations between SEOM consumption and sexual risk-taking among MSM as well as ways to use SEOM for HIV prevention.

Fluctuations in depression and well-being are associated with sexual risk episodes among HIV-positive men.

Research has suggested a weak association between depression and sexual risk behavior in men who have sex with men (MSM). The purpose of this study was to investigate the relationship between within-person fluctuations in depression and well-being and episodes of sexual risk-taking among HIV-positive MSM. One hundred six sexually active HIV-positive MSM living in New York City completed a structured weekly survey over 6 weeks. In Weeks 1, 3, and 5, they responded to items assessing their sexual behavior, depression, and well-being in the prior week. Multilevel logistic regression analyses were conducted to explore the relationship between changes in levels of depression and well-being, and episodes of unprotected anal intercourse (UAI). Within-person deviations from participants' average levels of depression and well-being were associated with the probability of risk. The probability of a risk episode was higher in weeks when depression was higher than participants' average levels (any UAI episode: odd ratio [OR] = 1.71, 95% confidence interval [CI] [1.00, 2.90], p < .05; serodiscordant UAI episode: OR = 2.49, 95% CI [1.31, 4.73], p < .05). The probability of a risk episode was lower in weeks when well-being was higher than participants' average levels (any UAI: OR = 0.40, 95% CI [0.22, 0.74], p < .05; serodiscordant UAI: OR = 0.42, 95% CI [0.22, 0.81], p < .05). Between-person differences in depression and well-being were not associated with risk episodes (ps > .05). This study is among the first to examine the association of within-person changes in depression and well-being with sexual risk behavior in a diverse sample. It contributes new evidence to literature exploring the relationship between depression and sexual risk. Future research should employ longitudinal designs to explore pathways linking within-person changes in depression with risk behavior.

Diaries for observation or intervention of health behaviors: factors that predict reactivity in a sexual diary study of men who have sex with men.

Behavioral diaries for observation of health-related behaviors assume absence of reactivity (i.e., change in behavior resulting from observation), while self-monitoring diaries maximize reactivity for behavior change. Little is known about when and for whom behavioral diary studies become self-monitoring interventions. This study evaluated the moderating effects of social cognitive variables on reactivity in sexual risk behavior and risk appraisals in a diary study of men who have sex with men (MSM). One hundred forty-three MSM completed weekly online sexual diaries for 3months. Analyses were conducted with hierarchical linear modeling. There was no evidence of reactivity for the sample as a whole. Social cognitive variables (e.g., risk reduction motivation, condom use intentions, and social norms) moderated reactivity in study outcomes. For example, more highly motivated MSM experienced declines in serodiscordant unprotected anal intercourse over time. Effectiveness of behavioral self-monitoring strategies may vary depending on social cognitive domains.

Substance Use and HIV Risk Behavior among Men Who Have Sex with Men: The Role of Sexual Compulsivity

The relationship between substance use, sexual compulsivity and sexual risk behavior was assessed with a probability-based sample of men who have sex with men (MSM). Stimulant, poppers, erectile dysfunction medication (EDM), alcohol use, and sexual compulsivity were independently associated with higher odds of engaging in any serodiscordant unprotected anal intercourse (SDUAI). The association of sexual compulsivity with SDUAI was moderated by poppers and EDM use. Behavioral interventions are needed to optimize biomedical prevention of HIV among substance using MSM.

Dose-Response Associations Between Number and Frequency of Substance Use and High-Risk Sexual Behaviors Among HIV-Negative Substance-Using Men Who Have Sex With Men (SUMSM) in San Francisco

We evaluated the relationship between frequency and number of substances used and HIV risk [ie, serodiscordant unprotected anal intercourse (SDUAI)] among 3173 HIV-negative substance-using MSM. Compared with nonusers, the adjusted odds ratio (AOR) for SDUAI among episodic and at least weekly users, respectively, was 3.31 [95% confidence interval (CI), 2.55 to 4.28] and 5.46 (95% CI, 3.80 to 7.84) for methamphetamine, 1.86 (95% CI, 1.51 to 2.29) and 3.13 (95% CI, 2.12 to 4.63) for cocaine, and 2.08 (95% CI, 1.68 to 2.56) and 2.54 (95% CI, 1.85 to 3.48) for poppers. Heavy alcohol drinkers reported more SDUAI than moderate drinkers [AOR, 1.90 (95% CI, 1.43 to 2.51)]. Compared with nonusers, AORs for using 1, 2, and ≥3 substances were 16.81 (95% CI, 12.25 to 23.08), 27.31 (95% CI, 18.93 to 39.39), and 46.38 (95% CI, 30.65 to 70.19), respectively. High-risk sexual behaviors were strongly associated with frequency and number of substances used.

Association Between Serosorting and Bacterial Sexually Transmitted Infection Among HIV-Negative Men Who Have Sex With Men at an Urban Lesbian, Gay, Bisexual, and Transgender Health Center

Serosorting, selecting sex partners of the same HIV status, may be associated with increased risk of sexually transmitted infection (STI). We examined the association between unprotected anal intercourse (UAI) with a seroconcordant partner and STIs among HIV-negative men who have sex with men (MSM) at an urban lesbian, gay, bisexual, and transgender STI clinic. Subjects reported how they assessed their most recent sex partner's HIV status. Those who reported getting tested together or asking were classified as known concordant; those who determined their partner's serostatus based on appearance, age, or social aspects were classified as assumed concordant. Generalized estimating equations generated prevalence ratios for associations between seroconcordance and STIs. From May 2010 through October 2011, 961 HIV-negative MSM were screened for gonorrhea, chlamydia, and syphilis at 1110 visits. Sexually transmitted infection prevalence was 20.1%: 20.2% at visits with known seroconcordant UAI, 35.3% at visits with assumed seroconcordant UAI, 29.5% at visits where UAI with an unknown status partner was reported, 34.8% at visits with serodiscordant UAI, and 16.1% at visits with no reported UAI. Assumed serodiscordant UAI (adjusted prevalence ratio [aPR], 2.51; 95% confidence interval [CI], 1.79-3.51), unknown status partner (aPR, 1.76; 95% CI, 1.31-2.38), and serodiscordant UAI (aPR, 2.57; 95% CI, 1.76-3.75) were significant predictors of STI after controlling for age and race/ethnicity, STI history, alcohol use, substance use, and multiple sex partners. Known seroconcordant UAI was not associated with STI. Assumed seroconcordant UAI was associated with increased STI prevalence, although known seroconcordant UAI was not. The risk associated with UAI with a partner of assumed seroconcordance should be emphasized for HIV-negative MSM.

An Online Randomized Controlled Trial Evaluating HIV Prevention Digital Media Interventions for Men Who Have Sex with Men

BackgroundAs HIV infection continues unabated, there is a need for effective interventions targeting at-risk men who have sex with men (MSM). Engaging MSM online where they meet sexual partners is critical for HIV prevention efforts.MethodsA randomized controlled trial (RCT) conducted online among U.S. MSM recruited from several gay sexual networking websites assessed the impact of 2 HIV prevention videos and an HIV prevention webpage compared to a control condition for the study outcomes HIV testing, serostatus disclosure, and unprotected anal intercourse (UAI) at 60-day follow-up. Video conditions were pooled due to reduced power from low retention (53%, n = 1,631). No participant incentives were provided.Principal FindingsFollow-up was completed by 1,631 (53%) of 3,092 eligible men. In the 60 days after the intervention, men in the pooled video condition were significantly more likely than men in the control to report full serostatus disclosure (‘asked and told’) with their last sexual partner (OR 1.32, 95% CI 1.01–1.74). Comparing baseline to follow-up, HIV-negative men in the pooled video (OR 0.70, 95% CI 0.54–0.91) and webpage condition (OR 0.43, 95% CI 0.25–0.72) significantly reduced UAI at follow-up. HIV-positive men in the pooled video condition significantly reduced UAI (OR 0.38, 95% CI 0.20–0.67) and serodiscordant UAI (OR 0.53, 95% CI 0.28–0.96) at follow-up.Conclusions/SignificanceFindings from this online RCT of MSM recruited from sexual networking websites suggest that a low cost, brief digital media intervention designed to engage critical thinking can increase HIV disclosure to sexual partners and decrease sexual risk. Effective, brief HIV prevention interventions featuring digital media that are made widely available may serve as a complementary part of an overall behavioral and biomedical strategy for reducing sexual risk by addressing the specific needs and circumstances of the target population, and by changing individual knowledge, motivations, and community norms.Trial RegistrationClinicalTrials.gov NCT00649701

A Systematic Review of Behavioral and Treatment Outcome Studies Among HIV-Infected Men Who Have Sex with Men Who Abuse Crystal Methamphetamine

Men who have sex with men (MSM) have the highest incidence of HIV infection in the United States. One of the contributing factors to HIV spread among this group is the use of crystal methamphetamine ("meth"). The objective was to review the behavioral impact of crystal meth use in HIV-infected MSM and potential treatment options. A systematic review of MEDLINE identified studies that evaluated the clinical effects of crystal meth on the HIV-infected MSM population. Search terms included HIV, methamphetamine, MSM, antiretroviral therapy, adherence, resistance, and treatment. U.S. citations in the English language in peer-reviewed journals until December 2010 were included. The primary author reviewed eligible articles, and relevant data including study design, sample, and outcomes were entered into an electronic data table. The 61 included studies highlight that HIV-infected MSM who use crystal meth are more likely to report high-risk sexual behaviors, incident sexually transmitted infections, and serodiscordant unprotected anal intercourse, compared to HIV-infected MSM who do not use crystal meth. Medication adherence in this population is notably low, which may contribute to transmission of resistant virus. No medications have proven effective in the treatment of crystal meth addiction, and the role of behavioral therapies, such as contingency management are still in question. HIV-infected MSM who abuse crystal meth have worse HIV-related health outcomes. Behavioral interventions have shown variable results in treating crystal meth addiction, and more investigation into rehabilitation options are needed. The results presented support efforts to develop and implement novel interventions to reduce crystal meth use in HIV-infected MSM.

Body Mass Index, Depression and Sexual Transmission Risk Behaviors Among HIV-Positive MSM

Depression has been shown to be a risk factor for serodiscordant unprotected anal intercourse (SDUAI) in some studies, but not others. Body mass index (BMI) has recently been associated with SDUAI; however, to date, no published study has investigated the interactive effect of depression and BMI on SDUAI. The current study assessed the association between depression, BMI, and SDUAI among HIV-positive MSM. Participants were 430 HIV-positive MSM recruited in a Boston community health center where they received primary care. Participants completed audio computer-assisted self interview (ACASI) measures. Objective height and weight and other clinical variables were accessed through participants' electronic medical records. Depression was positively associated with SDUAI. This association was significantly moderated by BMI. Elevated levels of depression were only associated with SDUAI for underweight participants. These findings suggest that underweight, depressed HIV-positive MSM may be particularly likely to engage in SDUAI.

‘I’ve Had Unsafe Sex So Many Times Why Bother Being Safe Now?’: The Role of Cognitions in Sexual Risk Among American Indian/Alaska Native Men Who Have Sex with Men

American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission. This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM. AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed. Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both. Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.

O2-S4.05 Serosorting behaviours and beliefs among MSM at an urban LGBT health center

BackgroundSerosorting, preferentially engaging in unprotected anal intercourse (UAI) with partners of the same HIV status, is practiced by some MSM as a risk reduction strategy.MethodsMay through November 2010, we assessed...

Predictors of HIV Transmission Risk Behavior and Seroconversion Among Latino Men Who have Sex with Men in Project EXPLORE

In the US, Latino MSM are disproportionately affected by HIV, yet there is a paucity of data for this risk group. To this end, we examined data on Latino and non-Latino white MSM who participated across six cities in a 2-year randomized behavioral intervention study-Project EXPLORE. At baseline, Latinos reported significantly more serodiscordant unprotected anal intercourse (SDUA) than non-Latinos. Longitudinal predictors of SDUA included marijuana, poppers, amphetamines and heavy drinking, as well as lower self-efficacy, poorer communication skills, weaker safe-sex norms and more enjoyment of risky sex. For HIV infection, Latinos had significantly higher seroconversion rate over follow-up than non-Latinos. Longitudinal predictors of seroconversion among Latinos included poppers and SDUA. Intervention effects did not significantly differ between Latino and non-Latinos. Findings support HIV intervention work with Latino MSM that includes skills training/counseling to address attitudes about safe sex and impact of substance use on HIV-risk behavior and acquisition.

The Importance of Measuring Internalized Homophobia/Homonegativity

The Importance of Measuring Internalized Homophobia/Homonegativity

Effects of a behavioral intervention to reduce serodiscordant unsafe sex among HIV positive men who have sex with men: the Positive Connections randomized controlled trial study

Few behavioral interventions have been conducted to reduce high-risk sexual behavior among HIV-positive Men who have Sex with Men (HIV+ MSM). Hence, we lack well-proven interventions for this population. Positive Connections is a randomized controlled trial (n = 675 HIV+ MSM) comparing the effects of two sexual health seminars--for HIV+ MSM and all MSM--with a contrast prevention video arm. Baseline, 6-, 12- and 18-month follow-up surveys assessed psychosexual variables and frequency of serodiscordant unprotected anal intercourse (SDUAI). At post-test, intentions to avoid transmission were significantly higher in the sexual health arms. However, SDUAI frequency decreased equally across arms. HIV+ MSM engaging in SDUAI at baseline were more likely to leave the study. Tailoring interventions to HIV+ MSM did not increase their effectiveness in this study. A sexual health approach appeared as effective as an untailored video-based HIV prevention intervention in reducing SDUAI among HIV+ MSM.

Ascertaining Partner HIV Status and its Association with Sexual Risk Behavior Among Internet-Using Men Who Have Sex with Men

The aims of this study were to understand strategies and consistency of strategy used by HIV-negative and HIV-positive men who have sex with men (MSM) to ascertain the HIV status of their male sexual partners and their associations with unprotected anal intercourse (UAI) and serodiscordant UAI (SDUAI) in the past 3months. Participants (n=640) completed an online survey in December 2007. The most commonly reported strategy was checking online profiles (85%), followed by talking before sex (82%), talking after sex (42%), and guessing (29%). Adjusting for demographic and behavioral factors, guessing the HIV status of sex partners was associated with greater UAI and SDUAI partners, as was using an inconsistent strategy. Ascertaining HIV status before having sex was associated with fewer SDUAI partners. Prevention should target MSM who guess the HIV status of their sex partners and emphasize explicit safer sex agreements.

Comparison of Substance Use and Risky Sexual Behavior Among a Diverse Sample of Urban, HIV-Positive Men Who Have Sex with Men

ABSTRACT The purpose of this study was to examine substance use among a racially and ethnically diverse group of HIV-positive men who have sex with men (MSM) living in six U.S. cities, model associations between drug use and serodiscordant unprotected anal intercourse (SDUAI), and characterize users of the substances strongly associated with risky sexual behavior. Baseline questionnaire data from 675 participants of the Positive Connections intervention trial were analyzed. Overall, substance use was common; however, the highest percentage of stimulant (30%), methamphetamine (27%), and popper (i.e., amyl nitrite) (46%) use was reported among white MSM and crack/cocaine (38%) use was highest among African American MSM. Popper use versus non-use (odds ratio = 2.46; 95% confidence interval = 1.55–3.94) and condom self-efficacy (1 standard deviation (sd) increase on scale; odds ratio = .58; 95% confidence interval = .46–.73) were significantly associated with SDUAI after adjusting for key demographic and psychosocial factors. These results highlight the importance of addressing drug use in the context of sex for possible HIV transmission risk.

Use of Viral Load to Negotiate Condom Use Among Gay Men in Sydney, Australia

Using two cohort studies (Health in men-HIM and positive health-PH) and repeated large cross-sectional surveys (Gay Community Periodic Survey-GCPS) of gay men in Sydney, Australia, we examined the association between viral load and unprotected anal intercourse (UAI) between HIV sero-discordant regular partners. Between 2001 and 2007, we conducted 243 interviews with 102 HIV-negative gay men in HIM and 148 interviews with 99 HIV-positive gay men in PH who were in regular relationships with HIV sero-discordant partners. During the same time period, 437 HIV positive men with HIV sero-discordant regular partners completed questionnaires for the GCPS. All completed interviews or questionnaires during that time period were used for these analyses. Amongst the HIV-negative respondents, sero-discordant UAI was more likely to be reported when the men believed their HIV-positive regular partner had an undetectable rather than a detectable viral load (P = 0.002). Amongst the HIV-positive respondents, sero-discordant UAI was as likely to be reported when they themselves reported having an undetectable or a detectable viral load. Use of viral load in negotiating condom use between sero-discordant gay couples may be understood very differently by the HIV-negative and HIV-positive men within those partnerships.

The relationship of internalized homonegativity to unsafe sexual behavior in HIV-seropositive men who have sex with men.

We studied internalized homonegativity (IH) in 675 HIV-positive men who have sex with men (MSM) from six epicenters across the United States who attended an HIV prevention workshop. Participants included 300 African American and over 150 Hispanic White and White non-Hispanic men. Higher IH was significantly associated with African American race. Compulsive sexual behavior, openness as MSM, sexual comfort, depression, education level, and importance of religion also were associated with IH and independently predicted a third of this outcome's variance. For those with higher IH, two significant paths led to unsafe sexual behavior: first, to serodiscordant unprotected anal intercourse (SDUAI) through being less "out"--thus disclosing serostatus to secondary partners less frequently, and second, to lower condom self-efficacy and SDUAI through lower sexual comfort. These data provide information on the demographic, sexual and mental health variables associated with IH. They offer an indication of the paths through which IH is associated with serodiscordant risk behavior in HIV-positive MSM.