Serodiscordant Condomless Anal Sex Research Articles

Sexual network characteristics, condomless anal intercourse, and the HIV care cascade among MSM living with controlled versus uncontrolled HIV infection in Lima, Peru: a population-based cross-sectional analysis

Despite high rates of HIV transmission among men who have sex with men (MSM) in Lima, Peru, limited data exist on the sexual network characteristics or risk factors for secondary HIV transmission among MSM with uncontrolled HIV infection. We report the frequency of serodiscordant, condomless anal intercourse (CAI) and associated sexual network characteristics among MSM in Lima with detectable HIV viremia and compare to those with undetectable viremia. This cross-sectional analysis includes MSM who tested positive for HIV-1 during screening for a trial of partner management and STI control (June 2022-January 2023). Participants were tested for HIV, gonorrhoea, chlamydia, and syphilis, and completed questionnaires on their demographic characteristics, sexual identity and behaviour, sexual network structures and engagement in HIV care. Of 665 MSM, 153 (23%) had detectable (>200 copies/mL) viremia. 75% (499/662) of men living with HIV were previously diagnosed, with 94% (n=469/499) reporting that they were on ART, and 93% (n=436/469) virally suppressed. 96% (n=147/153) of men with detectable viremia reported serodiscordant CAI with at least one of their last three sexual partners, and 74% (n=106/144) reported the same with all three of their recent partners. In contrast, 62% (n=302/489) of men with undetectable viral load reported serodiscordant CAI with all of their last three partners (p<0.01). 23% of men living with HIV in Peru had detectable viremia, of whom almost all (96%) reported recent serodiscordant CAI. The primary gap in the HIV care cascade lies in awareness of HIV serostatus, suggesting that improved access to HIV testing could be a key prevention strategy in Peru. Funding for this study was provided by NIH/NIMH grants R01 MH118973 (PI: Clark) and R25 MH087222 (PI: Clark).

1517. Sexual Network Characteristics of MSM with Detectable Viremia Living with HIV in Lima, Peru

Abstract Background In Lima, Peru, the HIV epidemic is concentrated among men who have sex with men (MSM) and transgender women (TW). Few data exist on the sexual network characteristics of MSM with detectable HIV-1 viremia, yet these networks have important implications to control transmission. We report data on frequency of sero-discordant, condomless anal intercourse (CAI) among MSM in Lima with detectable viremia. Methods This cross-sectional secondary analysis includes MSM screened for a STI trial in Lima, Peru between June 2022 and January 2023. Participants completed questionnaires on demographics, sexual identity and role, and sexual network characteristics. Participants were screened for HIV infection and those who tested positive were included and HIV-1 RNA was measured. Descriptive and comparative statistics are reported for those with detectable and undetectable viremia. Results 665 MSM with HIV were included. 153 (23%) had detectable ( &amp;gt;200 copies/mL) viremia. Among those with detectable viremia, the median (IQR) age was 29 (25, 35) years. 70% identified as homosexual and 57% identified their sexual role during intercourse as “moderno” or “versatil”. The median (IQR) number of sexual partners in the last 3 months was 15 (5,20). 55/153 (35.6%) of the detectable group were aware of their HIV diagnosis, 33/55 (60%) reported being on anti-retroviral therapy (ART) and 15/32 (47%) believed they were virally suppressed. Among all participants living with HIV, 499/662 (75%) were aware of their HIV status, 469/499 (94%) reported to be on ART and 436/469 (93%) were virally suppressed. 147/153 (96%) of men with detectable viremia reported sero-discordant CAI with at least one of their last three sexual partners, and 106/144 (74%) reported this with all three of their last partners. In the undetectable group, 302/489 (62%) reported sero-discordant CAI with all three of their last partners (p &amp;lt; 0.01). Conclusion In this sample of MSM living with HIV in Lima, Peru, almost all men with detectable HIV-1 viremia reported sero-discordant CAI, more often than those with undetectable viremia. The primary gap in the HIV care cascade was participant awareness of their HIV status, suggesting that broader HIV testing and improved access to resources for secondary HIV prevention are key objectives in Peru. Disclosures Jordan Lake, MD, Gilead Sciences: Grant/Research Support|Theratechnologies: Advisor/Consultant

HIV Prevention Responsibility Beliefs Among Men Who Have Sex With Men in the PrEP Era.

Beliefs regarding responsibility for preventing HIV transmission may differ between individuals and their sexual partners. We assessed HIV prevention responsibility beliefs among men who have sex with men (MSM) participating in the 2017 National HIV Behavioral Surveillance survey. MSM were recruited using time-location sampling at clubs, bars, and street locations in San Francisco. HIV prevention responsibility beliefs were assessed on a four-point scale (1 = strongly disagree to 4 = strongly agree). Associations were assessed using generalizing estimating equations to adjust for behaviors within multiple partnerships. A total of 316 HIV-negative men and 76 HIV-positive men reported on 1336 partnerships. HIV-negative compared with HIV-positive men had higher endorsement of mutual responsibility (mean 3.7 vs. 3.5; P < 0.01). Both groups had similar levels of endorsing responsibility on the HIV-negative or HIV-positive partner. HIV-positive men endorsing equal responsibility were more likely to know their partner's HIV status (P < 0.01) and less likely to have serodiscordant condomless anal intercourse (CAI) (P < 0.01) than men who did not endorse equal responsibility. HIV-negative men in partnerships with pre-exposure prophylaxis (PrEP) use were more likely to know their partner's HIV status (P = 0.02) and have serodiscordant CAI (P = 0.04) than men not in partnerships with PrEP use. HIV-negative and HIV-positive men accept responsibility for preventing HIV. The finding that HIV-negative men in partnerships with PrEP use who engage in serodiscordant CAI is concerning because they are still at risk for other sexually transmitted infections, which are presently at elevated levels in San Francisco and other US cities.

Predictors of Condomless Anal Intercourse in Young HIV-Positive Men Who Have Sex With Men With Detectable Viral Loads

PurposeA minority of young, gay, bisexual, and other men who have sex with men (YGBMSM) living with HIV in the U.S. achieve viral suppression, thus increasing the likelihood of viral transmission during condomless anal intercourse (CAI). The purpose of this study was to explore potential risk factors for CAI and serodiscordant CAI (SD-CAI) among YGBMSM with detectable viremia. MethodsA total of 146 YGBMSM (aged 16–24 years) with a detectable viremia enrolled in a mobile health adherence intervention. Baseline characteristics, stratified by any CAI and any SD-CAI (past 3 months), were computed. Random Forests and regression methods were used to assess factors associated with each type of CAI. Adjusted prevalence rate ratios (aPRR) and 95% confidence intervals (CIs) were calculated. ResultsHalf (51.9%) reported engaging in CAI; 57.1% of those reported SD-CAI. There was strong agreement between the Random Forests and regression methods. Significant risk factors of CAI included marijuana use (aPRR = 1.97, 95% CI: 1.21–3.21), problematic substance use (aPRR = 1.56, 95% CI: 1.11–2.20), and being in a committed relationship (aPRR = 1.66, 95% CI: 1.21–2.27). Only 47% believed they were less likely to transmit HIV through CAI when virally suppressed. ConclusionHigh rates of CAI, including engagement in SD-CAI in a population of YGBMSM with detectable viral loads, pose significant concerns for onward transmission. Individual, dyadic, and structural predictors of CAI were associated with engagement in risk in this priority population. Addressing these factors in concert with ensuring viral suppression will be key to ending the epidemic among youth.

Acculturation as a Moderator of HIV Risk Behavior Correlates Among Latino Men Who Have Sex with Men.

Acculturation is associated with increased sexual risk behaviors among heterosexual Latinos, but its influence among Latino gay, bisexual, and other men who have sex with men (MSM) remains less clear. Elements of acculturation may create distinct lived experiences among sexual minority Latinos, moderating how beneficial and adverse influences contribute to their sexual risk behaviors. Latino MSM living in New York City (n = 412) were recruited using a modified time-space venue- and web-based sampling method. Negative binomial regression models estimated associations between indicators of acculturation (i.e., language use, nativity status, ethnic identification), sexual minority stressors (i.e., internalized homophobia, sexual orientation-based discrimination), peer condom use norms, and the number of serodiscordant condomless anal intercourse (SDCAI) encounters. Acculturation indicators were then tested as simultaneous moderators of the influence of each predictor variable on the outcome. The association between internalized homophobia and SDCAI was significant only among English language speakers (aIRR = 3.05 [2.13, 4.37]) and those born outside of the U.S. (foreign-born = 0, aIRR = 0.17 [0.08, 0.36]). Sexual orientation-based discrimination and SDCAI were also positively associated among both English-speaking (aIRR = 1.82 [1.22, 2.72]) and foreign-born men (aIRR = 0.34 [0.14, 0.84]). Stronger ethnic identification also moderated the protective effects of peer condom use norms on SDCAI (aIRR = 0.28 [0.15, 0.52]). Results suggest that different dimensions of acculturation help shape how both stressors and protective factors influence HIV risk among Latino MSM. Future research is needed to examine the mechanisms through which these differences in acculturation may act on sexual risk behaviors among Latino MSM.

Evaluation of Sex Positive! A Video eHealth Intervention for Men Living with HIV.

Sex Positive![+] is a two-arm, video-based web intervention aimed at reducing condomless anal sex (CAS) with partners of known and unknown serostatus that was delivered online to a racially and ethnically diverse sample of 830 gay, bisexual, and other men who have sex with men living with HIV. Men in each arm received 6 weekly videos after completing a baseline assessment and 4 weekly booster videos following a 6-month assessment. Follow-up assessments were conducted every 3months for 1year. At 3-month follow-up, men in the intervention arm reported significantly reduced risk of having unknown serodiscordant CAS partners than men in the control arm (RR 0.60, 95% CI 0.39-0.92), partially supporting study hypotheses. Aside from this finding, similar reductions in sexual risk behaviors were observed in both arms over the study period. There is much to be learned about video-based web interventions in terms of methodological development and intervention delivery, including frequency and duration of intervention components.

Longitudinal Effects of Syndemics on HIV-Positive Sexual Minority Men's Sexual Health Behaviors.

This study examined the longitudinal effects of co-occurring psychosocial concerns, or syndemics, on HIV-positive sexual minority men's likelihood of engaging in serodiscordant condomless anal sex (CAS), a health behavior with implications for personal and public health. Participants included 390 HIV-positive sexual minority men from two prior secondary prevention trials. Over the course of the 1-year data collection period (up to 5 observations per participant), participants completed self-report measures of CAS, as well as six syndemic factors: post-traumatic stress disorder, childhood sexual abuse, depression, anxiety, alcohol abuse, and polysubstance/stimulant use. We employed multilevel modeling to examine the longitudinal additive effect of syndemics on serodiscordant CAS (binary) over the 1-year period. The number of syndemic conditions was a significant predictor of CAS, with each additional syndemic associated with 1.41 greater odds of CAS (p = .0004; 95% CI [1.16, 1.70]). Both the between-person (p = .0121, 95% CI [1.07, 1.69]) and within-person (p = .01, 95% CI [1.11, 2.10]) effects of syndemics were significant predictors, showing that an increase in the number of syndemic conditions across person and time both increased odds of CAS. Interventions addressing HIV-positive sexual minority men's sexual health behaviors should address the potential impact of co-occurring psychosocial concerns that affect these behaviors. This will benefit this population's personal sexual health and reduce transmission of HIV and STIs among sexual minority men.

Awareness and Perceived Effectiveness of HIV Treatment as Prevention Among Men Who Have Sex with Men in New York City.

To assess perceptions of HIV treatment as prevention (TasP), we conducted an online survey of MSM in New York City (n = 732) asking them to rate the effectiveness of different strategies to reduce HIV risk during serodiscordant condomless anal sex between men. Only 6.1% reported not knowing what TasP was, with significantly less awareness among non-gay-identified MSM, men with less education, men who reported fewer anal sex partners in the prior 3months, and HIV-negative/unaware men who had never used PrEP. The strategy most frequently perceived to offer "a lot" or "complete" protection from HIV was daily PrEP (70.0%), followed by TasP (39.1%), intermittent PrEP (16.6%), strategic positioning (15.8%), and withdrawal before ejaculation (10.8%). Men who were HIV positive, who had ever used PrEP, and who identified as gay/homosexual were significantly more likely to see TasP as effective. Further studies should investigate MSM's apparent skepticism towards TasP.

Whose Responsibility Is It? Beliefs About Preventing HIV Transmission Among Men Who Have Sex With Men.

HIV-negative and HIV-positive men believed that they both are responsible for preventing HIV. Responsibility beliefs, however, did not always correspond with discussing HIV status or refraining from serodiscordant condomless anal sex. Discrepancies between individuals' HIV prevention responsibility beliefs and their sexual risk behaviors merit further examination, particularly in the preexposure prophylaxis era.

Correlates of Serodiscordant Condomless Anal Intercourse Among Virologically Detectable HIV-Positive Young Men Who Have Sex with Men.

Sexual transmission risk occurs in the context of serodiscordant condomless anal intercourse (CAI) where the seropositive partner is virologically detectable (VL+) and/or seronegative partner is not on PrEP. We analyzed correlates of serodiscordant CAI among 688 VL+ young men who have sex with men (YMSM). In multivariable analyses, serodiscordant CAI was associated with a receiving a HIV diagnosis in the past 6months, greater depressive symptoms, and cocaine use during the past 90days. Although HIV+ YMSM currently experience disparities across the continuum of care, those new to care may need support adopting risk reduction strategies with their sexual partners.

HIV Risk and Protective Factors in the Context of Alcohol and Substance Use During Pride.

This investigation sought to identify HIV-risk and -protective factors among men-who-have-sex-with-men (MSM) who engaged in anal sex following alcohol or substance use during an international Pride Festival. MSM attending World Pride were surveyed regarding (1) alcohol, substance use, and sex during the past 24h; and (2) HIV-risk and -protective factors. Valid data were provided by 1123 MSM. Anal sex was reported by 195 MSM, among whom the majority (n = 105) consumed alcohol or substances prior to sex. Among MSM aware of their HIV status who consumed alcohol or substances prior to sex (n = 99), those who engaged in serodiscordant condomless anal sex (n = 22) were more likely to be HIV+ (AOR = 10.14, 95% CI 1.48-69.35); report multiple sex partners (AOR = 9.05, 95% CI 1.70-48.12); and possess lower condom efficacy (AOR = 0.47, 95% CI 0.23-0.93) and social support (AOR = 0.08, 95% CI 0.01-0.46). Bolstering condom negotiation skills and social support could potentially reduce HIV acquisition/transmission-risk behavior, even when under the influence of alcohol or substances.

Belief in Treatment as Prevention and Its Relationship to HIV Status and Behavioral Risk.

We evaluated attitudes toward treatment as prevention (TasP) among gay, bisexual, and other men who have sex with men (GBM) in Vancouver, Canada. Sexually active GBM, aged ≥16 years, were recruited between 2012 and 2015 using respondent-driven sampling. At each 6-month follow-up, participants completed a computer-administered questionnaire and nursing visit. Repeated-measures latent class analysis, grouped by self-reported serostatus, identified patterns of TasP endorsement by considering TasP-related awareness, attitudes, and behavior. Binary logistic regression identified covariates of class membership. Bivariate interactions with visit number identified factors associated with longitudinal changes in class membership. A total of 774 men provided 2590 observations. Of these, 698 enrolled in the cohort, 575 had at least 1 follow-up visit. Among these, the median follow-up time was 1.98 years (Q1-Q2: 1.49-2.49 years). Repeated-measures latent class analysis identified 3 classes: "unaware" (64.2% HIV negative/unknown vs. 29.2% of HIV positive), "skeptical" (29.7% vs. 23.1%), and "believing" (6.1% vs. 47.7%). Membership in classes representing higher TasP endorsement was associated with greater odds of condomless anal sex and having more sexual partners. Age, sexual orientation, ethnicity, substance use, and social time spent with other GBM were also associated with class membership. Longitudinally, class membership was stable among HIV-positive men but shifted toward greater TasP endorsement among HIV-negative/unknown men. For HIV-negative/unknown men, increasing endorsement was positively associated with greater education, being employed, being in a relationship, and substance use and inversely associated with recent serodiscordant condomless anal sex or sexually transmitted infection diagnosis. Over time, disparities in TasP diffusion by HIV status have lessened, although continue to persist across other key social strata.

Factors associated with perceived accuracy of the Undetectable=Untransmittable slogan among men who have sex with men: Implications for messaging scale-up and implementation.

IntroductionRecent research has shown high efficacy of HIV treatment for reducing the risk of HIV transmission to sexual partners. As the efficacy of treatment as prevention (TasP) has proliferated, a new messaging campaign, Undetectable = Untransmittable, has been gaining popularity. The purpose of this paper was to assess factors associated with the perceived accuracy of this TasP messaging strategy among a large and diverse sample of gay, bisexual, and other men who have sex with men (GBMSM) in order to inform subsequent efforts at large‐scale and implementation of the HIV prevention message.MethodsWe conducted a nationwide survey of GBMSM in the U.S. recruited from an online social networking site and a mobile sexual networking app. We analysed data from 12,222 GBMSM separately by HIV status to examine sociodemographic and behavioural factors associated with ratings of the accuracy of the Undetectable = Untransmittable message, which included the option to indicate not understanding what “undetectable” meant.ResultsAmong HIV‐negative and unknown men, multivariable linear regression indicated that being on pre‐exposure prophylaxis (PrEP), identifying as gay or queer (versus bisexual or straight), recent serodiscordant condomless anal sex (CAS), testing every six months or more often, less concern about sexually transmitted infection (STI) infection, and lower perceived risk of HIV infection were the factors with the largest independent effect on rating the Undetectable = Untransmittable statement as more accurate. Fewer factors emerged as associated with accuracy ratings among HIV‐positive participants—reporting an undetectable viral load, a lifetime acquired immune deficiency syndrome (AIDS) diagnosis, and lower concern about STI infection were the factors most strongly associated with rating the statement as more accurate.ConclusionsThe findings of the current study highlight variability in the perceived accuracy of the Undetectable = Untransmittable message, suggesting potential subgroups who might benefit from targeted educational campaigns, perhaps broadcast utilizing sexual networking apps. Numerous factors, particularly among HIV‐negative and unknown GBMSM, were associated with rating the message as more accurate. In particular, being on PrEP and testing regularly were two of the variables most strongly associated with higher accuracy ratings among HIV‐negative GBMSM, suggesting HIV prevention services as potential points of intervention for increasing HIV knowledge and decreasing HIV stigma.

Sexual risk taking and the HIV care continuum in an online sample of men who have sex with men

ABSTRACTAntiretroviral Therapy (ART) suppresses HIV replication, reducing the risk of transmission. However, many people living with HIV in the US are not virally suppressed even after diagnosis and initiating ART, and may become disengaged from care at each stage of the HIV care continuum (HCC). In the current study we assessed the sexual risk behaviors of MSM by HCC stage. US MSM who completed an online survey (N = 12,995) in 2015 were categorized into 6 HCC groups. Mean age was 39.2 and a majority identified as White (49.6%). At every stage of the HCC, we found higher proportions of individuals engaged in care compared to CDC estimates. A majority of the sample was HIV-positive and engaged in care, with 67.2% of HIV-positive participants reporting viral suppression with ART. Across HCC groups, participants reported high rates of past 6-month condomless anal sex (CAS) (79.2%–84.8%) and CAS with serodiscordant or unknown status partners (38.0%–84.1%). Notably, MSM with unknown HIV serostatus reported the highest proportion of CAS and serodiscordant CAS. HIV-positive MSM not on ART were more likely to report an STI diagnosis (p < .002) compared to those unaware of their HIV status or HIV negative. Moreover, young Black MSM were less likely to be on ART (p < .002) or virally suppressed (p < .002) compared to older White MSM. Our findings highlight potentially problematic sexual risk behaviors among MSM by level of HCC engagement, which can impede the preventive impact of ART. Online platforms provide an avenue to assess the progress of MSM along the HCC, as well as other subpopulations in need of appropriate behavioral interventions to decrease HIV incidence.

Partner-level substance use associated with increased sexual risk behaviors among men who have sex with men in San Francisco, CA

BackgroundSubstance use is highly prevalent among men who have sex with men (MSM) and is associated with individual-level sexual risk behaviors. However, few studies have explored the relationship between substance use and HIV risk behaviors within partnerships. MethodsWe examined partner-level data between MSM participants (n=23) and their sexual partners (n=52). We used multivariable generalized estimating equations (GEE) logistic regression to assess the relationship between partner-level substance use during their last sexual encounter with each partner, and engaging in condomless anal intercourse (CAI) and serodiscordant CAI. ResultsIn multivariable analyses, participants had significantly higher adjusted odds ratio (AOR) of CAI when the participant (AOR=22.2, 95%CI=2.5–199.5) or their partners used any drugs (AOR=21.8, 95%CI=3.3–144.3); their partners (AOR=5.7, 95%CI=1.7–19.3) or both participant and partner had concordant use of methamphetamine (AOR=10.5, 95%CI=2.2–50.6); or when both used poppers (AOR=11.4, 95%CI=1.5–87). There were higher odds of SDCAI if the participant binge drank (AOR=4, 95%CI=1.01–15.8), used more than one substance (AOR=15.8, 95%CI=1.9–133), or used other drugs (AOR=4.8, 95%CI=1.3–18.4); if their partner used poppers (AOR=7.6, 95%CI=1.5–37.6), or used more than one substance (AOR=7.9, 95%CI=1.9–34.1); and when both participant and partner had concordant use of poppers (AOR=4.4, 95%CI=1.2–16.8). ConclusionsThis study observed significant relationship between substance use and HIV risk behaviors within partnerships. Specifically, when either the participant, the partner, or both used any drugs there was an increased odds of sexual risk behaviors. Findings suggest that partner-level substance use behaviors should be taken in account when developing sexual risk reduction interventions.

Number of Psychosocial Strengths Predicts Reduced HIV Sexual Risk Behaviors Above and Beyond Syndemic Problems Among Gay and Bisexual Men.

Syndemics research shows the additive effect of psychosocial problems on high-risk sexual behavior among gay and bisexual men (GBM). Psychosocial strengths may predict less engagement in high-risk sexual behavior. In a study of 470 ethnically diverse HIV-negative GBM, regression models were computed using number of syndemic psychosocial problems, number of psychosocial strengths, and serodiscordant condomless anal sex (CAS). The number of syndemic psychosocial problems correlated with serodiscordant CAS (RR=1.51, 95% CI 1.18-1.92; p=0.001). When adding the number of psychosocial strengths to the model, the effect of syndemic psychosocial problems became non-significant, but the number of strengths-based factors remained significant (RR=0.67, 95% CI 0.53-0.86; p=0.002). Psychosocial strengths may operate additively in the same way as syndemic psychosocial problems, but in the opposite direction. Consistent with theories of resilience, psychosocial strengths may be an important set of variables predicting sexual risk behavior that is largely missing from the current HIV behavioral literature.

Congruence of Home, Social and Sex Neighborhoods among Men Who Have Sex with Men, NYCM2M Study.

Substantial literature demonstrates the influence of the neighborhood environment on health behaviors and outcomes. But limited research examines on how gay and bisexual men experience and exist in various geographic and virtual spaces and how this relates to their sexual behavior. New York City Men 2 Men (NYCM2M) was a cross-sectional study designed to identify neighborhood-level characteristics within the urban environment that influence sexual risk behaviors, substance use, and depression among men who have sex with men (MSM) living in NYC. The sample was recruited using a modified venue-based time-space sampling methodology and through select websites and mobile applications. Whether key neighborhoods of human activity, where a participant resided (termed home), socialized (termed social), or had sex most often (termed sex), were the same or different was evaluated. "Congruence" (or the sameness) of home, social, and most often sex neighborhood was reported by 17% of men, while 30% reported that none of their neighborhoods were the same. The largest group of men (39%) reported that their home and sex neighborhoods were the same but their social neighborhood was different while 10% reported that their home neighborhood was different than their social and sex neighborhood; 5% men reported same home and social neighborhoods with a different sex neighborhood. Complete neighborhood incongruence was highest among men who were Black and/or Latino, had lower education and personal income levels, and had greater financial insecurity. In adjusted analysis, serodiscordant condomless anal intercourse and condomless anal intercourse with partners from the Internet or mobile applications were significantly associated with having the same social and sex (but not home) neighborhoods. Understanding the complexity of how different spaces and places relate to the health and sexual behavior of MSM is essential for focusing interventions to best reach various populations of interest.

Erectile Dysfunction Medication Prescription and Condomless Intercourse in HIV-Infected Men Who have Sex with Men in the United States.

Using nationally representative data, we assessed the prevalence of erectile dysfunction medication (EDM) prescription, and its association with insertive condomless anal intercourse (CAI) with an HIV-serodiscordant partner among sexually-active HIV-infected men who have sex with men (MSM) receiving medical care in the United States. Overall, 14% (95% CI 12-16) were prescribed EDM and 21% (95% CI 19-23) engaged in serodiscordant CAI. MSM who were prescribed EDM were more likely to engage in insertive CAI with a serodiscordant casual partner than those not prescribed EDM after adjusting for illicit drug use before or during sex (adjusted prevalence ratio=1.38; 95% CI 1.01-1.88). We found no association with main partners. Only 40% (95% CI 36-44) of MSM prescribed EDM received risk-reduction counseling from healthcare professionals. Risk-reduction counseling should be provided at least annually to all HIV-infected persons as recommended, especially at the time of EDM prescription.

Extending the Minority Stress Model to Incorporate HIV-Positive Gay and Bisexual Men's Experiences: a Longitudinal Examination of Mental Health and Sexual Risk Behavior.

Minority stress theory represents the most plausible conceptual framework for explaining health disparities for gay and bisexual men (GBM). However, little focus has been given to including the unique stressors experienced by HIV-positive GBM. We explored the role of HIV-related stress within a minority stress model of mental health and condomless anal sex. Longitudinal data were collected on a diverse convenience sample of 138 highly sexually active, HIV-positive GBM in NYC regarding sexual minority (internalized homonegativity and gay-related rejection sensitivity) and HIV-related stressors (internalized HIV stigma and HIV-related rejection sensitivity), emotion dysregulation, mental health (symptoms of depression, anxiety, sexual compulsivity, and hypersexuality), and sexual behavior (condomless anal sex with all male partners and with serodiscordant male partners). Across both sexual minority and HIV-related stressors, internalized stigma was significantly associated with mental health and sexual behavior outcomes while rejection sensitivity was not. Moreover, path analyses revealed that emotion dysregulation mediated the influence of both forms of internalized stigma on symptoms of depression/anxiety and sexual compulsivity/hypersexuality as well as serodiscordant condomless anal sex. We identified two targets of behavioral interventions that may lead to improvements in mental health and reductions in sexual transmission risk behaviors-maladaptive cognitions underlying negative self-schemas and difficulties with emotion regulation. Techniques for cognitive restructuring and emotion regulation may be particularly useful in the development of interventions that are sensitive to the needs of this population while also highlighting the important role that structural interventions can have in preventing these disparities for future generations.

Developing a Video-Based eHealth Intervention for HIV-Positive Gay, Bisexual, and Other Men Who Have Sex with Men: Study Protocol for a Randomized Controlled Trial.

BackgroundGay, bisexual, and other men who have sex with men (GBMSM) accounted for 67% of new US human immunodeficiency virus (HIV) infections in 2012; however, less than 40% of HIV-positive GBMSM are virally suppressed. Preventing transmission from virally unsuppressed men who have condomless anal sex (CAS) with serodiscordant partners is a public health imperative. New HIV infections in GBMSM are attributed in part to online access to sex partners; therefore, low-cost eHealth interventions are a unique opportunity to reach men where they meet partners.ObjectiveTo describe the protocol of a randomized controlled trial evaluating whether video-based messaging delivered online may lead to reductions in serodiscordant CAS and increased HIV disclosure.MethodsSex Positive![+] is a two-arm, phase III, video-based randomized controlled trial delivered online to GBMSM living with HIV. Participants in the intervention arm receive 10 video vignettes grounded in social learning and social cognitive theories that are designed to elicit critical thinking around issues of HIV transmission and disclosure. Participants in the attention control arm receive 10 video vignettes that focus on healthy living. All videos are optimized for mobile viewing. The study protocol includes five online assessments conducted over a 1-year period among 1500 US white, black, or Hispanic/Latino GBMSM living with HIV who report suboptimal antiretroviral therapy (ART) adherence or a detectable viral load in the past 12 months and recent CAS (past 6 months) with HIV-negative or unknown status male partners. Compared to the control arm, we hypothesize that men who watch the intervention videos will report at 12-month follow-up significantly fewer serodiscordant CAS partners, increased HIV disclosure, and improved social cognition (eg, condom use self-efficacy, perceived responsibility).ResultsParticipant recruitment began in June 2015 and ended in December 2015.ConclusionsThis protocol describes the underlying theoretical framework and measures, study design, recruitment challenges, and antifraud measures for an online, video-based randomized controlled trial that has the potential to decrease HIV transmission risk behaviors among HIV-positive GBMSM who struggle with ART adherence. The Sex Positive![+] intervention allows for participation through multiple Internet-based mediums and has the potential to reach and engage a broader population of HIV-positive GBMSM who are virally unsuppressed.ClinicalTrial ClinicalTrials.gov NCT02023580; https://clinicaltrials.gov/ct2/show/NCT02023580 (Archived by WebCite at http://www.webcitation.org/6iHzA8wRG)