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Recruiting minority men who have sex with men for HIV research: results from a 4-city campaign.

We describe the efforts of a 4-city campaign to recruit Black and Hispanic men who have sex with men into an established HIV epidemiological study. The campaign used community organizing principles and a social marketing model that focused on personnel, location, product, costs and benefits, and promotion. The campaign was developed at the community, group, and individual levels to both increase trust and reduce barriers.The proportion of Hispanic men recruited during the 2002-2003 campaign doubled compared with the 1987 campaign, and the proportion and number of White men decreased by 20%. The proportion of Black men decreased because of the large increase in Hispanic men, although the number of Black men increased by 56%. Successful recruitment included training recruitment specialists, involving knowledgeable minority community members during planning, and having an accessible site with convenient hours.

Black or African American↗

HIV risk behaviors and obstacles to condom use among Puerto Rican men in New York City who have sex with men.

OBJECTIVES: This paper describes the sexual risk behaviors of Puerto Rican men who have sex with men and their perceived obstacles to condom use. METHODS: Interviews were conducted with 182 Puerto Rican men living in New York, NY. RESULTS: Condoms were used inconsistently or not at all by half of the men who had anal sex with other men, by two thirds of the men who had vaginal sex, and by three fifths of those who had anal sex with women. Most of the men had had unprotected oral sex and more than one sexual partner in the previous year. Three of 10 were positive for the human immunodeficiency virus (HIV). Dislike of condoms was the most frequently cited obstacle, followed by perception of low risk, trust in and emotional connection with partner, unavailability and inconvenience of condom use, lack of control, and indifference. CONCLUSIONS: Barrier methods other than condoms, such as a microbicidal, gel, need to be developed.

Condoms↗

The Circuit Party Men's Health Survey: findings and implications for gay and bisexual men.

OBJECTIVES: This study examined characteristics of gay and bisexual men who attend circuit parties, frequency of and motivations for attending parties, drug use and sexual behavior during circuit party weekends, and use of risk reduction materials available at parties. METHODS: A cross-sectional survey was conducted among 295 gay and bisexual men from the San Francisco Bay Area who had attended a circuit party in the previous year. RESULTS: One fourth of the men reported a drug "overuse" incident in the previous year. Nearly all respondents reported use of drugs during circuit party weekends, including ecstasy (75%), ketamine (58%), crystal methamphetamine (36%), gamma hydroxybutyrate or gamma butyrolactone (25%), and Viagra (12%). Two thirds of the men reported having sex (oral or anal), 49% reported having anal sex, and 28% reported having unprotected anal sex during the 3-day period. An association was found between use of drugs and sexual risk behavior. Prevention materials were observed at party events by some men; however, relatively few men used the materials. Common motivations for attending the parties were "to listen to music and dance" and "to be with friends." CONCLUSIONS: Intensive, targeted health promotion efforts are needed for gay and bisexual men who attend circuit parties.

Adult↗

Are women with acute myocardial infarction managed as well as men? Does it have consequences on in-hospital mortality? Analysis of an unselected cohort of 801 women and 1,718 men.

OBJECTIVE: This study sought to compare characteristics and management of myocardial infarction in men and women, and whether a difference in management would translate into a difference in in-hospital mortality. METHODS AND RESULTS: Data were prospectively collected in 2,519 patients (801 women) admitted in all hospitals in three departments in the Rhĵne-Alpes region in France between September 1, 1993 and January 31, 1995. Women were older than men (76 vs. 64 years). The interval between symptom onset and initial medical intervention was longer in women than in men (median: 180 vs. 135 minutes), as was the interval between symptom onset and hospital admission (median: 315 vs. 255 minutes). After age-adjustment, women were less often smokers, and more often hypertensive or diabetic than men, location of infarction was more often anterior in women, as congestive heart failure at admission. In multivariate analysis, thrombolysis rate was not significantly different in both sexes, whereas noninvasive tests, coronary arteriography, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting were significantly less often performed in women than in men. Although in-hospital mortality was higher in women than in men (21% vs. 11%), this difference disappeared after age-adjustment (relative risk = 0.99). In multivariate analysis, gender was not an independent predictor of survival. CONCLUSIONS: Although in-hospital mortality after myocardial infarction was similar in both sexes, rates of diagnostic and therapeutic procedures were lower in women than in men. This raises the question of whether mortality would decrease in women if management were similar in both sexes.

Age Factors↗

Lower toenail chromium in men with diabetes and cardiovascular disease compared with healthy men.

OBJECTIVE: Chromium may improve insulin sensitivity, which can modify the risk of diabetes and cardiovascular disease (CVD). Therefore, we evaluated the association between toenail chromium and CVD in diabetic men. RESEARCH DESIGN AND METHODS: We performed cross-sectional and nested case-control analyses among men aged 40-75 years within the Health Professionals Follow-up Study. The cross-sectional analysis compared men with diabetes only (n = 688), diabetes with prevalent CVD (n = 198), and healthy control subjects (n = 361). The nested case-control study included 202 men with baseline diabetes who developed incident CVD and 361 matched control subjects. RESULTS: Mean toenail chromium (microg/g) was 0.71 in healthy control subjects, 0.61 in diabetes-only subjects, and 0.52 in diabetic subjects with prevalent CVD (P for trend = 0.003). In the cross-sectional analysis, the multivariate odds ratio (OR) between extreme quartiles was 0.74 (95% CI 0.49-1.11; P for trend = 0.18), comparing diabetes only with healthy control subjects. A similar comparison between diabetic subjects with prevalent CVD and healthy control subjects yielded an OR of 0.45 (0.24-0.84; P for trend = 0.003). In the nested case-control study, comparing diabetic men with incident CVD with healthy control subjects, the multivariate OR was 0.65 (0.36-1.17; P for trend = 0.16) between extreme quartiles. When we combined prevalent and incident CVD cases among diabetic men and compared them with healthy control subjects, the OR was 0.62 (0.39-1.01; P for trend = 0.02) between extreme quartiles. CONCLUSIONS: Our results suggest that diabetic men with CVD have lower toenail chromium than healthy control subjects. However, this study could not distinguish between the effects of chromium on diabetes and those on CVD. Long-term clinical trials are needed to determine whether chromium supplementation is beneficial for preventing CVD among diabetic patients.

Adult↗

Should African-American men be tested for prostate carcinoma at an earlier age than white men?

BACKGROUND: There have recently been challenges to testing high risk populations, i.e., African-American men younger than 50 years, for prostate carcinoma (PCa). The mortality rate of patients with PCa between ages 40 and 60 years is nearly 3 times greater among African-American men (AAM) compared with white men (WM). The literature in support of testing AAM at an earlier age than WM is sparse. Therefore, the authors present clinical and histologic data that support the testing of AAM at a younger age, utilizing data on patients with clinically localized PCa. METHODS: Examination of consecutive radical prostatectomy specimens from AAM and WM was performed from January 1991 to June 1996 among AAM and WM at Wayne State University, Harper Hospital, Detroit, Michigan. International, salvage prostatectomy, and neoadjuvant hormonal therapy patients were excluded, as were patients with lymph node metastasis. The authors examined biochemical recurrences of PCa in this cohort of men treated from January 1991 through December 1995. Univariate analysis of contingency tables was performed, using chi-squared-tests to assess the correlation between stage and race after stratification of patients by age group. Biochemical recurrence was analyzed using the Kaplan-Meier method and the log rank test. RESULTS: The authors examined radical prostatectomy specimens from 759 patients and biochemical recurrence outcome of 655 patients. AAM patients ages 50-69 years had higher prostate specific antigen levels, worse Gleason scores, more advanced stages of disease, and a higher recurrence rate. However, among men ages 70-79 years, there was no difference in these parameters between AAM and WM. Among men ages 40-49 years, a larger sample size is necessary to make meaningful comparisons. CONCLUSIONS: Data on the outcomes of men treated for clinically localized PCa demonstrated more advanced disease and more frequent recurrence among young AAM than among WM, young and of advanced age. These differences in disease severity and recurrence, in addition to the disproportionate mortality among young AAM, are strong evidence that AAM should be tested for PCa at an earlier age than WM.

Black or African American↗

HIV prevention research for men who have sex with men: a systematic review and meta-analysis.

A systematic review of HIV prevention reports published or distributed in the United States as of June 1998 yielded 9 rigorous controlled trials reporting intervention effects on unprotected sex for men who have sex with men. A summary measure of these effects was favorable (odds ratio,.69), statistically significant (95% confidence interval, 0.56-0.86), and very homogeneous. This summary value indicates a 26% reduction in the proportion of men engaging in unprotected anal intercourse. The most clearly favorable effects were observed among interventions that promoted interpersonal skills, were delivered in community-level formats, or focused on younger populations or those at higher behavioral risk. These studies demonstrate that interventions can promote risk reduction among men who have sex with men. Yet given the epidemiology of HIV in the United States, the small number of rigorous controlled intervention trials for this population is striking. Many more rigorous evaluations of HIV prevention efforts with men who have sex with men are needed to ascertain with confidence the effects of specific intervention components, population characteristics, and methodologic features.

Acquired Immunodeficiency Syndrome↗

Greater incidence of electrocardiographic left ventricular hypertrophy in black men than in white men in Evans County, Georgia.

Population-based studies of black populations in the United States and Puerto Rico have reported higher prevalences of electrocardiographic left ventricular hypertrophy compared to white or lighter-skinned populations residing in the same areas. This study examines the incidence and correlates of electrocardiographic left ventricular hypertrophy in a population-based, biracial cohort of 435 white and 163 black men from the Evans County, Georgia, Heart Study, who were examined at entry in 1960 and reexamined in 1967. Only men over 35 years of age who were free of cardiovascular disease and had normal electrocardiograms at entry were eligible. Black men had a nearly fourfold greater incidence of electrocardiographic left ventricular hypertrophy compared to white men (13.5% vs 3.7%, respectively; incidence ratio 3.7; 95% CI 3.2-4.4). After statistically adjusting for age, systolic blood pressure, weight, and the change in weight and blood pressure, black men had a threefold greater incidence of electrocardiographic left ventricular hypertrophy compared to white men (logistic odds ratio 3.0; 95% CI 1.6-6.1). In summary, black men showed a significantly greater risk of developing electrocardiographic left ventricular hypertrophy at 7-year follow-up in Evans County compared to their white counterparts. This elevated risk could not be explained by the independent or joint effects of risks factors for electrocardiographic left ventricular hypertrophy.

Adult↗

Health care screening for men who have sex with men.

Men who have sex with men often do not reveal their sexual practices or sexual orientation to their physician. Lack of disclosure from the patient, discomfort or inadequate training of the physician, perceived or real hostility from medical staff, and insufficient screening guidelines limit preventive care. Because of greater societal stresses, lack of emotional support, and practice of unsafe sex, men who have sex with men are at increased risk for sexually transmitted diseases (including human immunodeficiency virus infection), anal cancer, psychologic and behavioral disorders, drug abuse, and eating disorders. Recent trends indicate an increasing rate of sexual risk-taking among these men, particularly if they are young. Periodic screening should include a yearly health risk and physical assessment as well as a thorough sexual and psychologic history. The physician should ask questions about sexual orientation in a nonjudgmental manner; furthermore, confidentiality should be addressed and maintained. Office practices and staff should be similarly nonjudgmental, with confidentiality maintained. Targeted screening for sexually transmitted diseases, depression, substance abuse, and other disorders should be performed routinely. Screening guidelines, while inconsistent and subject to change, offer some useful suggestions for the care of men who have sex with men.

Homosexuality, Male↗

An exploration of the down-low identity: nongay-identified young African-American men who have sex with men.

The Centers for Disease Control and Prevention urges that strategies are needed to increase the proportion of young men who have sex with men (MSM) who are linked to primary care and prevention services. One subgroup of young men engaging in male-male sex, those that do not identify as gay, may be less likely to be reached by prevention and intervention services that are aimed at the broader MSM community. Additionally, nongay-identified young men engaging in male-male sex may have risk-reduction needs that are different from those that identify as gay. At present, very little is known about this subgroup of men. This study qualitatively interviewed six nongay-identified young men engaging in male-male sex about their sexual identity, their relationships with both men and women, their perceptions of their own sexual risk behavior and their comfort in accessing primary care services. The information gathered in these interviews can be used to increase the understanding of this understudied population while improving prevention and primary care services aimed at these youth.

Adult↗

Men who have sex with men--a management approach for GPs.

BACKGROUND: At least one in 20 Australian men report sexual contact with another man in their lifetime. Men who have sex with other men have higher rates of sexually transmitted infections, and are more likely to experience mental health problems and use recreational drugs and alcohol. OBJECTIVE: This article describes the health problems and sexual behaviour of men who have sex with men and provides an outline and an approach to discussing sexuality in general practice. DISCUSSION: Sexuality can be difficult to discuss in general practice. A nonjudgmental approach to men who have sex with men may facilitate early identification of the relevant health issues.

Australia↗

Clinical, immunologic, and serologic findings in men at risk for acquired immunodeficiency syndrome. The San Francisco Men's Health Study.

Forty-nine percent of homosexual/bisexual men were positive for antibody to the human immunodeficiency virus (HIV) in a population-based probability sample of 1034 single men recruited from San Francisco. All heterosexual men were negative. Among seropositive men, marked lymphadenopathy was present in 29%, and 16% had at least two other symptoms or signs suggestive of HIV infection. However, lymphadenopathy alone failed to indicate severity of immune impairment. The occurrence of two or more clinical signs and symptoms, except for marked lymphadenopathy, correlated with HIV infection, diminished skin test reactivity, and reduction in Leu 3a T cells. Twenty-nine percent of seropositive men had fewer than 400 absolute Leu 3a T helper cells per microliter (less than 0.4 X 10(9)/L). Seronegative homosexual/bisexual men did not differ from heterosexual men in any clinical or laboratory variables except for increased numbers of suppressor Leu 2a T suppressor cells per microliter.

Acquired Immunodeficiency Syndrome↗

Seroprevalence of HIV and risk behaviors among young homosexual and bisexual men. The San Francisco/Berkeley Young Men's Survey.

OBJECTIVE: To estimate the prevalence of human immunodeficiency virus (HIV) infection and risk behaviors among young homosexual and bisexual men sampled from public venues in San Francisco and Berkeley, Calif. DESIGN: A survey of 425 young homosexual and bisexual men sampled from 26 locations during 1992 and 1993. Participants were interviewed and blood specimens were drawn and tested for HIV, level of CD4+ T lymphocytes, and markers of hepatitis B and syphilis. SETTING: Public venues in San Francisco and Berkeley, including street corners and sidewalks, dance clubs, bars, and parks. POPULATION STUDIED: Homosexual and bisexual men aged 17 to 22 years. MAIN OUTCOME MEASURES: Prevalence of HIV infection and risk behaviors. RESULTS: The HIV seroprevalence was 9.4% (95% confidence interval, 6.8% to 12.6%). The prevalence of markers for hepatitis B was 19.8% (95% confidence interval, 16.1% to 23.9%), and that for syphilis was 1.0% (95% confidence interval, 0.3% to 2.4%). The HIV seroprevalence was significantly higher among African Americans (21.2%) than among other racial/ethnic groups (P = .002). Approximately one third (32.7%) of the participants reported unprotected anal intercourse, and 11.8% reported injecting drug use in the previous 6 months. At the time of interview, 70.0% of the HIV-infected men did not know that they were HIV seropositive, and only 22.5% were receiving medical care for HIV infection. CONCLUSIONS: The prevalence of HIV infection is high among this young population of homosexual and bisexual men, particularly among young African-American men. The high rates of HIV-related risk behaviors suggest a considerable risk for HIV transmission in this population. Prevention programs and health services need to be tailored to address the needs of a new generation of homosexual and bisexual men.

Adolescent↗

Sex hustling, injection drug use, and non-gay identification by men who have sex with men. Associations with high-risk sexual behaviors and condom use.

OBJECTIVE: To explore differences in demographic characteristies, risk practices, and preventive behaviors among subgroups of men who have sex with men (MSM), including gay- and non-gay-identified MSM, MSM who inject drugs, and those engaging in sex hustling. DESIGN: A secondary analysis of cross-sectional data collected through interviewer-administered questionnaires in a purposive sample of MSM. SETTING: Gay bars, bath houses, adult video arcades, and out-door crusing areas in Denver and Long Beach. PARTICIPANTS: Men who reported oral or anal sex with another man in the past year with oversampling of non-gay-identified MSM. RESULTS: Of 1,290 MSM, 417 (32%) did not gay-identify, 86 (7%) were drug injectors, and 117 (9%) were hustlers. Of drug-injecting MSM, 55% reported sex hustling and 40% of hustlers reported injection drug use. Hustling was associated with higher number of partners, more frequent anal sex with men and women, and less frequent condom use during anal sex with occasional male partners. Hustlers and drug-injecting MSM used condoms less consistently during vaginal intercourse with female partners than did other MSM. CONCLUSIONS: Among MSM, subgroups at particularly high risk for HIV can be identified. Although these subgroups may be relatively small, they may be important epidemiologic links to the larger MSM and heterosexual communities and warrant focused behavioral interventions to prevent the further spread of HIV.

Adult↗

Seroepidemiology of human herpesvirus 8 among young men who have sex with men.

BACKGROUND: The modes of transmission of human herpesvirus 8 (HHV-8) remain unclear. GOAL: To study HHV-8 seroprevalence and risk factors among young men. STUDY DESIGN: The Young Men's Survey was a multisite cross-sectional HIV seroprevalence and behavioral risk survey of men aged 15 to 22 years who attended public venues frequented by young men who have sex with men (MSM). Blood specimens were tested for HHV-8 by using an immunofluorescence assay at a 1:40 dilution among 488 participants in Seattle-King County, WA. RESULTS: Total HHV-8 seroprevalence was 6% among MSM and 5% among men who have sex only with women (MSW). In multivariate analysis, unprotected receptive anal sex during the past 6 months, injection drug use, and cytomegalovirus infection were associated with HHV-8 seropositivity in MSM. CONCLUSION: The HHV-8 seroprevalence among these young MSM was similar to the HHV-8 seroprevalence among young MSW, but lower than seroprevalence estimates in earlier studies of older MSM. The association of MSM between HHV-8 infection and unprotected receptive anal sex supports previous findings that HHV-8 is sexually transmitted. Although CMV infection and injection drug use may be markers for unsafe sexual practices, it is also possible that these are independent risk factors for acquiring HHV-8.

Adolescent↗

Correlates of sexual risk behaviors among HIV-positive men who have sex with men.

This study examines correlates of unprotected sexual risk practices of an ethnically diverse sample of HIV-seropositive men who have sex with men (MSM) from the New York City and San Francisco metropolitan areas. Participants completed a self-report survey that assessed sexual risk behaviors and potential correlates. A total of 367 men reported sex with a casual male partner in the previous 3 months. Participants were divided into three groups based on level of HIV-transmission risk with HIV negative or unknown-status partners: no unprotected anal sex (58.9%), unprotected receptive anal sex only (14.2%), and unprotected insertive anal sex (22.6%). Multivariate logistic regression analyses indicated that men reporting unprotected anal insertive sex perceived less responsibility to protect their partners from HIV. Men reporting no unprotected anal sex also reported less use of nitrate inhalants, lower temptation for unsafe sex, and fewer HIV-negative and unknown-status partners. Men reporting unprotected receptive anal sex were less anxious than the other two groups but also reported greater depression than those not reporting unprotected anal sex and greater loneliness than those reporting unprotected anal insertive sex. Implications for interventions with HIV-positive MSM are presented.

Adolescent↗

Sylvian fissure morphology and asymmetry in men and women: bilateral differences in relation to handedness in men.

The anatomy of the sylvian fissure in the human brain was studied to develop reliable criteria for anatomical landmarks of the posterior part of the fissure for use in its definition and measurement; to quantify right-left asymmetries in segments of the sylvian fissure; to assess whether any anatomical features are associated with hand preference (selected as one index of hemispheric functional asymmetry); and whether structure-function relationships are similar in men and women. A sample of 67 brain specimens (24 men and 43 women, mean age = 53 years) was studied postmortem (with the aid of dissection) from people who had been tested before death for detailed hand preference. Sylvian fissure anatomy in the human brain is very variable and no agreement exists as to the point of its posterior termination. The posterior ascending ramus, originating at the posterior bifurcation of the fissure, was found to be the continuation of the main limb of the sylvian fissure. Three segments of the sylvian fissure were defined and measured: anterior, horizontal, and vertical. The anterior segment showed no asymmetry; the horizontal segment was twice as large on the left side as on the right; and the vertical segment twice as large on the right. The two asymmetries counterbalanced each other, and overall asymmetry in the posterior region (horizontal plus vertical) was minimal. The basic asymmetry is in the position at which the fissure turns up, resulting in the different extent and position of the surrounding right and left parietal and temporal gyri and associated cytoarchitectonic regions. The possible embryological course of the asymmetry is discussed. Handedness correlated with anatomy of the sylvian fissure in men. In contrast to general expectation, hand preference was associated with a bilateral feature of morphology, and not with less asymmetry in non-right-handers. Men having consistent-right-hand preference had longer horizontal segments in both hemispheres compared to men not having consistent-right-hand preference. The direction and magnitude of asymmetry did not differ between the two male hand-preference groups. Since hand preference is an index of other motor and perceptual functions which are asymmetrically represented in the two hemispheres in gyri surrounding the sylvian fissure, it is suggested that anatomy of the sylvian fissure is related to functional asymmetries in men. A sex difference in structure-function relationship was observed. No association was found between hand preference and sylvian fissure anatomy in women.(ABSTRACT TRUNCATED AT 400 WORDS)

Brain↗