Use For Anal Sex Research Articles

HIV prevention during a sexual health consultation; a suggested quality audit

We therefore reviewed the medical records of clients attending MSHC who had tested HIV-negative and who subsequently tested HIV-positive at MSHC within 1 year of their last negative test. We reviewed all new HIV-positive cases over a 3-year period from 1January 2004. We extracted epidemiological data and clinical notes relating to risk, interventions and discussions held during consultations. Quantitative data was analysed using SPSS software (SPSS Inc, Chicago, IL, USA). Annotated records were examined and transcribed by two researchers (SP, RC), independently. A process of qualitative thematic analysis then occurred in order to generate common themes. All 20 clients who fulfilled the inclusion criteria were men who have sex with men (MSM) and had a mean age of 32 years. At their last HIV-negative consultation before testing HIVpositive, 16 reported inconsistent condom use for anal sex among 23median male partners (range 1 to 200) over the previous 12 months. Over half (13) clients had at least one documented sexually transmissible infection (chlamydia/ gonococcal/herpes simplex virus) diagnosed at the Centre in the year before HIV positive diagnosis. In the medical records of the HIV-negative consultations, qualitative themes generated relating to their risk of acquiring HIV included drug and alcohol use (n=1), depression (n=6), serodiscordant relationships (n=6) and history of sexual abuse (n=2). Post HIV diagnosis, the medical records indicated the same themes at higher rates and, in particular, drug and alcohol use during high-risk events (n=9). Depression was slightly higher (n=7), as was a history of sexual abuse (n=3). Despite reporting considerable levels of risk for HIV transmission at the last HIV-negative consultation, only seven records documented an offer of counselling and in only five of these cases were the clients referred for counselling or other services to assess risk. Two records indicated that referral to these services had been declined. We found that while these clients often reported unsafe sex, the full context of the sexual encounter was often not documented in the medical record at the time of the negative test but was documented later. Of particular note only one client had drug or alcohol use documented initially, but after the HIV diagnosis, nine had this documented. While we acknowledge medical records may not fully reflect the extent of discussions held during a consultation, these findings indicate that documentation needs to be improved in medical records and also that a more proactive process of referral for counselling should be implemented in the Centre. We are, therefore, implementing a quality improvement process to ensure enhanced documentation of contributing factors that predispose to unsafe sex and for the offer of referral to counselling services and the outcome of that offer. The recommendation is that HIV-negative MSM are asked questions relating to the context of high-risk events and that the offer of appropriate services be made if these co-contributors are acknowledged during sexual history taking. Wepropose that seroconversion to HIV among clients seen at a sexual health service could be used as an important quality marker that should be regularly audited. Given the current rises in HIV seen in Australia, fine-tuning services for MSM is one way of reducing future HIV cases. 1

Sexual decision-making in HIV-positive men who have sex with men: how moral concerns and sexual motives guide intended condom use with steady and casual sex partners.

Determinants of intended condom use with steady and casual sex partners were examined among Dutch HIV-positive men who have sex with men (MSM) (N = 296). Given the proposition that safer sex behavior among HIV-positive people is a form of prosocial behavior, the present study extended the general framework of the Theory of Planned Behavior with Schwartz’s norm-activation theory and tested the assumption that personal norms would mediate the effects of other psychosocial factors on intended condom use for anal sex. In addition, it was hypothesized that, depending on the context in which sex occurs, specific motives for unprotected anal sex may have a negative influence on intended condom use and, as such, undermine a prosocial tendency to practice safer sex. Therefore, we also investigated the influence of sexual motives for unprotected anal sex on intended condom use with steady and casual sex partners. Results indicated that the Theory of Planned Behavior adequately predicted condom use intentions (for casual sex partners and steady sex partners, the explained variance was 52% and 53%, respectively). However, our proposed model of sexual decision-making significantly improved the prediction of behavioral intentions. For steady and casual sex partners, the assumption of the mediating role of personal norms on condom use intention was confirmed empirically. Additionally, sexual motives for unprotected anal sex exerted, as expected, a direct, negative effect on condom use intention with casual sex partners. The implications of the findings for future research and the development of HIV-prevention programs for HIV-positive MSM are discussed.

Heterogeneity of risk among African-American men who have sex with men

The objective of this study was to examine the social mixing and sexual risk taking of African-American men who have sex with men (AAMSM). The design was a cross-sectional survey with targeted, ethnographically informed recruitment of respondents (n = 95), and subsequent recruitment of their network partners (n = 63). We ascertained current demographics, occupation, peer norms for sexual activity, community involvement, and information about members of their social and sexual network. Risk level was categorized by the frequency of anal sex and the consistency of condom use for anal sex. Twenty-nine of 158 (18.4%) persons were classified as being at high risk (any anal intercourse in the past three months with less than 100% condom use); 79 of 158 (50%) were at medium risk (any anal intercourse in the past three months with 100% condom use reported), and 50 (31.7%) were at low risk (no reported anal intercourse). The risk groups were similar with regard to perception of behavioural and community norms. White-collar workers associated predominantly with each other and other groups mixing preferentially with white-collar workers. Clustering within contact networks (the extent to which partners to a respondent know each other) was high for all risk groups (approximately 0.4-0.5), indicating dense, interactive networks. In conclusion, this study group demonstrates a greater degree of social mixing and heterogeneity than is commonly assumed for AAMSM. At least some portion of AAMSM has internalized public health messages about safer sexual activity. Intervention programmes should avoid the pitfalls of assumed homogeneity.

“Risks Both Known and Unknown”

The idea of situation has gained increased attention in HIV/STD prevention research and practice. In the context of prevention, situationdoes not simply connote settingor placebut also incorporates meanings people attached to the physical setting and how the complex interrelation of setting, meaning, and behaviors influences decisions regarding sexual behaviors and prevention measures. Kenneth Burke's pentadic analysis provides a means to illuminate how situation influences decisions regarding sexual behaviors and risk taking. This manuscript describes the pentadic method, its application to situation and sexual risk behaviors, and its utility through content analysis of transcribed interviews (or texts) with men who patronize bathhouses, bath house staff members, and release forms from bathhouse establishments in three geographic areas. In this case, the analysis reveals that bathhouse patrons and policies perceive bathhouses as situations that privilege expedient sexual release rather than individuals and over how those releases occur. This predominant perspective impedes, but does not preclude, risk reduction. The authors provide recommendations for promoting condom use for anal sex in the bathhouse setting as well as for the utility of pentadic analysis in related research.

Reflecting on the experience of interviewing online: perspectives from the Internet and HIV study in London

This paper considers some of the strengths and weaknesses of conducting synchronous online interviews for qualitative research. It is based on a study among gay/bisexual men that used both qualitative and quantitative methods to explore the association between seeking sex through the Internet and HIV transmission risk. Between June 2002 and January 2004, 128 gay/bisexual men living in London were interviewed one-to-one by the first author (MD) about their experience of using the Internet to find sexual partners and negotiating condom use for anal sex. Thirty-five men were interviewed online, while 93 were interviewed face-to-face (i.e. offline). This paper draws on MD's experience of conducting these interviews—both online and face-to-face. Synchronous online interviews have the advantage of being cheap, convenient and attractive to people who do not like face-to-face interviews. However, some of the social conventions and technical limitations of computer-mediated-communication can introduce ambiguity into the online dialogue. To minimize this ambiguity, both interviewer and interviewee have to edit their online interaction. One of the distinctive features of the online interview is that it emerges as a form of textual performance. This raises fundamental questions about the suitability of the synchronous online interview for exploring sensitive topics such as risky sexual behaviour.

Factors influencing MSMs' intentions to always use condoms for vaginal, anal and oral sex with their regular partners

A revised behavioural prediction model integrating components of several psychosocial theories was used to predict men who have sex with mens' (MSM) (N = 139) intentions to always use condoms with their regular partner for anal, oral and vaginal sex. The behavioural model successfully predicted MSMs' condom use intentions for all three behaviours (R = 0.70, R = 0.75 and R = 0.78 for vaginal, anal and oral sex, respectively). Consistent with expectations, the relative importance of the underlying theoretical determinants differed for the three behaviours in question. For condom use for vaginal sex, the partner norm (beta = 0.54) and the mean of the weighted control beliefs (beta = 0.28) were most important. For condom use for anal sex, the partner norm (beta = 0.50), attitude (beta = 0.28) and perceived behavioural control (beta = 0.17) were most important. With respect to oral sex, attitude (beta = 0.51) and partner norm (beta = 0.38) were most important in independently influencing MSMs' intentions to always use condoms.

Correlates of condom failure in a sexually active cohort of men who have sex with men.

Condom failure (slippage or breakage) has been shown to be associated with HIV seroconversion among men who have sex with men (MSM), but predictors of failure have been poorly elucidated. Of 2592 HIV-seronegative MSM participants in the HIV Network for Prevention Trials (HIVNET) multisite Vaccine Preparedness Study who reported condom use for anal sex in the 6 months before enrollment, condom failure was reported by 16.6%, with failure rates of 2.1/100 episodes of condom usage (2.5 failures/100 episodes for receptive anal sex and 1.9/100 episodes for insertive anal sex). In separate multivariate models evaluating predictors of condom failure reported by the insertive and receptive partners, more frequent condom use was associated with a decreased per-condom failure rate and amphetamine and heavy alcohol use with increased rates in both models. Being employed, having private medical insurance, and using lubricants for >80% of anal sex acts were significantly associated with decreased failure rates in the insertive model. Safer sex counseling should particularly target men of lower socioeconomic status, promote proper and consistent use of condoms with appropriate lubricants, and address the impact of drug use, especially amphetamines and alcohol, on condom failure.

Relationship between safe sex and acculturation into the gay subculture

There is some evidence, although conflicting, to suggest that socialization or acculturation into the gay community is associated with lower levels of unsafe sex. We attempted to determine the relationship between acculturation and sexual safety. We examined data from 282 men (from the Dallas AIDS Community Demonstration Project) who had sex with men and were not in a monogamous relationship to determine the associations between safer sex and indices of acculturation. The indices of acculturation included regular reading of local and national gay newspapers and magazines, and belonging to an organization for gay men. The data indicated that there were significant relationships between acculturation, talking to sexual partners about HIV risk reduction and sexual identity, and the dependent variable of frequency of condom use for anal sex. A regression equation indicated that 21% of the variance of anal condom use was predicted by these variables. These data suggest that acculturation into the gay community is associated with safer sexual behaviour, and we discuss the implications of these data for using role models and normative beliefs in HIV prevention programmes.