York City Men Research Articles

Redefining Prevention and Care: A Status-Neutral Approach to HIV.

Recent biomedical advances inspire hope that an end to the epidemic of HIV is in sight. Adopting new approaches and paradigms for treatment and prevention in terms of both messaging and programming is a priority to accelerate progress. Defining the key sequential steps that comprise engagement in HIV care has provided a useful framework for clinical programs and motivated quality improvement initiatives. Recently, the same approach has been applied to use of pre-exposure prophylaxis for HIV prevention. Building on the various prevention and care continua previously proposed, we present a novel schematic that incorporates both people living with HIV and people at risk, making it effectively “status-neutral” in that it proposes the same approach for engagement, regardless of one’s HIV status. This multidirectional continuum begins with an HIV test and offers 2 divergent paths depending on the results; these paths end at a common final state. To illustrate how this continuum can be utilized for program planning as well as for monitoring, we provide an example using data for New York City men who have sex with men, a population with high HIV incidence and prevalence.

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.

The high risk of an HIV diagnosis following a diagnosis of syphilis: a population-level analysis of New York City men.

Epidemiologic studies have shown that syphilis is associated with risk for human immunodeficiency virus (HIV) infection. We used population-level syphilis and HIV data to quantify HIV incidence among men following primary or secondary (P&S) syphilis diagnoses and identify the highest-risk subgroups for intensified prevention, such as pre-exposure prophylaxis with antiretroviral medications. Male cases reported to the New York City HIV/AIDS and Sexually Transmitted Disease (STD) surveillance registries were matched using a deterministic algorithm. We measured HIV incidence following P&S syphilis diagnosed between 2000 and June 2010 and identified risk factors for HIV infection using Cox proportional hazards models. Of 2805 men with syphilis contributing 11 714 person-years of follow-up, 423 (15.1%) acquired HIV; annual incidence was 3.61% (95% confidence interval [CI], 3.27%, 3.97%). HIV incidence was high among: men who have sex with men (MSM) (5.56%, 95% CI, 5.02%-6.13%); males with secondary compared with primary syphilis (4.10% vs 2.64%, P < .0001); and males diagnosed with another bacterial STD after syphilis (7.89%, 95% CI, 6.62%-9.24%). HIV incidence among men diagnosed with syphilis is high; one in 20 MSM were diagnosed with HIV within a year. Our data have implications for syphilis and HIV screening and may be useful for further targeting HIV-negative populations for pre-exposure prophylaxis.

Community Associated Methicillin Resistant Staphylococcus aureus Among New York City Men Who have Sex with Men: Qualitative Research Findings and Implications for Public Health Practice

Academic literature has recorded increased microbial resistance in the United States and recent news media has adversely portrayed men who have sex with men (MSM) at increased risk for community associated methicillin resistant Staphylococcus aureus (CA-MRSA) transmission. CA-MRSA is a specific type of bacteria resistant to certain antibiotics, which limits treatment options for those needing clinical care. Infection can manifest as painful abscesses and can cause severe illness. With increased CA-MRSA infections overall, and attention given to MSM populations regarding CA-MRSA, as well as the fact that limited data on sociocultural factors that may facilitate transmission, we undertook a qualitative study to explore contextual influences that may fuel infection among MSM in New York City so that public health professionals can better recognize, and respond appropriately to, potential future outbreaks. In-depth interviews were used to qualitatively investigate perceptions and beliefs regarding transmission, as well as community understandings of treatment options. Participants included thirteen MSM who reported a previous CA-MRSA infection and nine community practitioners. A thematic content analysis of these interviews was conducted and data suggests that behaviors and exposures associated with transmission of CA-MRSA are common in certain MSM networks. Specifically, sociocultural influences and methamphetamine use activities were found to contribute to CA-MRSA transmission. We underscore the role of public health and health services practitioners in providing appropriate CA-MRSA awareness and education to MSM populations.

Participation in Online and Offline HIV Prevention Among Men who have Sex with Men who use the Internet to Meet Sex Partners in New York City

This report presents data on participation in online or offline prevention activities among a sample of New York City men who have sex with men (MSM) recruited online between April-August of 2007 who use the Internet to meet sex partners. The analysis focuses on the 1,124 men who reported sex with a main or casual partner in the past 12 months. Over half (53%) of the MSM reported unprotected anal intercourse (UAI) in the past year. Data from our multivariate analysis indicate that MSM who participate in online or offline prevention activities were less likely to engage in UAI.

Cybercartography of Popular Internet Sites Used by New York City Men Who Have Sex With Men Interested In Bareback Sex

A systematic method was used to elicit the names of the six most popular free Internet sites used by gay men and other men who have sex with men in New York City, to meet partners for "bareback" sex. An analysis of the sites characteristics shows that men can use mainstream Internet sites, gay-specific sites, and sex-focused sites free of charge to search for bareback sex partners, selecting by location, physical attributes, sexual mode, HIV-serostatus, and other characteristics. Many individuals use these sites, producing the impression that bareback sex is not an oddity confined to just a few. The official language of the bareback sites associates bareback sex with masculinity and courage, prioritizing pleasure, freedom, choice, and intimacy over HIV-transmission prevention. The sites facilitate sexual experimentation and the expansion of bareback networks. Although some consider bareback sex to represent a failure of HIV prevention, this study suggests that harm reduction strategies may be viable within bareback networks.

Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men

Persons reporting sexual identity that is discordant with their sexual behavior may engage in riskier sexual behaviors than those with concordant identity and behavior. The former group could play an important role in the spread of sexually transmitted diseases. To describe discordance between self-described sexual identity and behavior among men who have sex with men and associations between identity-behavior and risk behaviors. Cross-sectional, random digit-dialed telephone survey of health status and risk behaviors. New York City. Population-based sample of 4193 men. Concurrent measures of sexual identity and sexual behaviors, including number and sex of sex partners, condom use during last sexual encounter, and recent testing for HIV infection. Sex partner information was ascertained in a separate section from sexual identity; all participants were asked about the number of male sex partners and then were asked about the number of female sex partners in the past year. Of New York City men reporting a sexual identity, 12% reported sex with other men. Men who had sex with men exclusively but self-identified as heterosexual were more likely than their gay-identified counterparts to belong to minority racial or ethnic groups, be foreign-born, have lower education and income levels, and be married. These men were more likely than gay-identified men who have sex with men to report having only 1 sexual partner in the previous year. However, they were less likely to have been tested for HIV infection during that time (adjusted prevalence ratio, 0.6 [95% CI, 0.4 to 0.9]) and less likely to have used condoms during their last sexual encounter (adjusted prevalence ratio, 0.5 [CI, 0.3 to 1.0]). The survey did not sample groups that cannot be reached by using residential telephone services. Many New York City men who have sex with men do not identify as gay. Medical providers cannot rely on patients' self-reported identities to appropriately assess risk for HIV infection and sexually transmitted diseases; they must inquire about behavior. Public health prevention messages should target risky sexual activities rather than a person's sexual identity.

This Wicked World: Masculinities and the Portrayals of Sex, Crime, and Sports in the National Police Gazette, 1879–1906

For generations during the late nineteenth and early twentieth centuries, the National Police Gazette was a leading New York City men's tabloid magazine that celebrated scandal, crime, sex and sports. It used splashy woodcut illustrations to highlight various aspects of masculinities and challenges to masculinities, gaining large numbers of mostly male readers in taverns, barbershops and gambling halls. A content analysis of Gazette illustrations during this period demonstrates its evolving use of pictures of men and women in varying roles. The analysis showed that the Gazette's sexually suggestive portrayals remained remarkably consistent over the years; during the same period, depictions of sports increased, while crime illustrations decreased. The tabloid used such portrayals to highlight, decry and sensationalize the reactions of men and women to the vices of Victorian America.

A “critical time” intervention reduced homelessness in inner city men with psychiatric problems

Susser E, Valencia E, Conover S, et al. Preventing recurrent homelessness among mentally ill men: a “critical time” intervention after discharge from a shelter. Am J Public Health 1997 Feb;...

Nemesis revisited: tuberculosis infection in a New York City men's shelter.

In November 1990, a screening was conducted to determine the point prevalence of tuberculosis infection in a volunteer sample of homeless men (n = 161) living in a congregate shelter in New York City. Of those for whom we have results (n = 134), 79% were positive for tuberculosis. The mean length of shelter stay from date of shelter entry was 31.8 months and was significantly associated with the tuberculosis infection rate. The findings suggest that crowded living conditions and the presence of a stable resident pool in crowded congregate shelters may be associated with transmission of tuberculosis infection.

Estimated condom failure and frequency of condom use among gay men.

Condoms are designed to bar transmission of the human immunodeficiency virus (HIV), but they sometimes fail. This paper explores the effect of experience with condoms on condom failure among gay men. Risk of condom failure (breakage or slippage) on a single occasion is estimated for four sexual acts reported over 12 months by a sample of gay New York City men (n = 741). The estimation procedure assumes that each episode in which a condom is used is an independent event. Evidence is offered to support this assumption. Risk of condom failure in a single episode was fairly high, particularly in anal intercourse, for men who had engaged in each act only a few times in the previous year. It declined rapidly with experience (e.g., to below 1% for receptive anal intercourse after about 10 episodes in the previous year). Condoms failed less often in oral than anal sex, but estimated risk of failure also decreased with experience. Gay men should be especially cautious the first few times they use a condom; after moderate experience, however, they may expect a low risk of condom failure.

Prevalence of HIV infection among psychiatric patients in a New York City men's shelter.

We report on the prevalence of human immunodeficiency virus (HIV) infection among psychiatric patients in a New York City shelter for homeless men. We reviewed the records of all 90 men discharged from the shelter psychiatry program to community housing over a 2-year period. HIV serostatus was recorded for 62 of the 90 men. Of these 62, 12 (19.4%) were positive. There were 28 men whose serostatus was not recorded. Data on the HIV risk behaviors of these 28 men suggested that seroprevalence could have been similarly high among them. The results indicate an urgent need to develop and apply preventive interventions for HIV in this population.

HIV seroprevalence among patients admitted to two psychiatric hospitals

The authors determined the seroprevalence of HIV-1 among patients admitted to two psychiatric hospitals in New York City. Patients consecutively admitted to an acute psychiatric unit in Manhattan and a large state hospital in Queens were anonymously tested for HIV-1 antibodies from December 1989 through July 1990. Test results were linked to age, gender, ethnicity, and two risk behaviors: male homosexual activity and injection drug use. Blood was obtained from 83.0% of the eligible patients. The prevalence of HIV was 5.5% (25 of 451). Black patients accounted for 38.0% of the patients tested and 76.0% of positive results (N = 19), a rate of 11.1% for this group. The rate of seropositivity was comparable in women and men. Clinicians had charted risk behavior for nine (36.0%) of the 25 HIV-positive patients. Infection control records suggested that clinicians were aware of seven (28.0%) of the positive cases. One in every 18 patients admitted to two public psychiatric hospitals in New York City was HIV positive. Clinical staff largely failed to identify HIV-positive patients. Ethnicity and a history of homosexual activity among men or use of injected drugs were strongly associated with seropositivity. This pattern of infection may be linked to needle sharing and/or sexual activity with partners who have shared needles. Future research should clarify how psychiatric illness affects risk-taking behavior, focus on improving detection by clinicians, and identify effective prevention strategies in this population.

The Spectrum of Tuberculosis in a New York City Men's Shelter Clinic (1982-1988)

The objective of this study was to determine the prevalence of tuberculous infection and the incidence of active tuberculosis in homeless men attending a shelter-based clinic and to examine risk factors for acquisition of infection and development of active disease. The design was a prospective cross-sectional survey. Men were evaluated by standardized interviews using a questionnaire. Where indicated, skin testing with PPD, collection of sputum for smear and culture for acid-fast bacilli, and chest x-ray films were performed. The setting was an on-site clinic at a men's shelter in New York City. The patients were men attending the clinic for physical examinations for the work program or requesting evaluation of various medical problems. A total of 1,853 men were evaluated over a 73-month period. The overall rate of infection was 42.8 percent, including 27.0 percent with a positive PPD test, 9.8 percent with a history of a positive PPD test, and 6.0 percent with active tuberculosis. Increasing age, length of stay in the shelter system, black race, and intravenous drug use were found to be independently associated with tuberculous infection. Age, length of stay in the shelter system, and intravenous drug use were independently associated with active tuberculosis. We achieved a compliance rate of 36 percent completing treatment and 13 percent receiving treatment at the conclusion of the study.