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PubMed2006

Association of herpes simplex virus type 2 infection and syphilis with human immunodeficiency virus infection among men who have sex with men in Peru.

BACKGROUND: We evaluated associations between human immunodeficiency virus (HIV) infection, herpes simplex virus type 2 (HSV-2) infection, and syphilis among men who have sex with men (MSM) in Peru. METHODS: A surveillance survey of 3280 MSM was conducted; sexual behavior was assessed with a structured computer-assisted self-interview, and serum antibody testing was performed for HIV, HSV-2, and Treponema pallidum. RESULTS: HIV, HSV-2, and syphilis seroprevalences of 13.9%, 46.3%, and 13.4% were detected, respectively. HSV-2 seroprevalence was twice as high in HIV-infected subjects (80.5%) than it was in HIV-uninfected subjects (40.8%) (P < .01), and HSV-2 seropositivity (adjusted odds ratio [AOR], 5.66) was found to be strongly associated with HIV infection. In addition, homosexual self-definition (AOR, 3.12), exchange of sex for money (AOR, 1.61), unprotected sex (no condom) (AOR, 2.81), history of sex work (AOR, 1.89), oral receptive sex (AOR, 1.43), and cocaine use before/during sex (AOR, 2.53) within the preceding 6 months, as well as such sexually transmitted infections (STIs) and STI syndromes as proctitis (AOR, 2.80), genital ulcer disease (GUD) (AOR, 2.06), prior syphilis (AOR, 2.64), genital warts (AOR, 1.70), and self-reported STIs within the preceding 6 months (AOR, 1.61), were also found to be significant predictors of HIV infection. CONCLUSIONS: We found a strong association between HSV-2 seropositivity and HIV infection. Intervention measures against GUD due to HSV-2 infection and syphilis, such as routine testing, early detection, HSV-2 suppressive treatment, and condom distribution, need to be enhanced as part of STI prevention strategies at a national level to effectively reduce HIV infection among MSM in Peru.

Adolescent↗
PubMed1998

Trends in AIDS-related opportunistic infections among men who have sex with men and among injecting drug users, 1991-1996.

Incidence trends for the 13 most frequent AIDS-defining opportunistic infections (OIs) among men who have sex with men (MSM, n = 15,588) and injecting drug users (IDUs, n = 4475) were examined using data abstracted from medical records in >90 hospitals and clinics in nine US cities during 1991-1996. Among MSM, the most frequent OIs were Mycobacterium avium complex (MAC) disease, Pneumocystis carinii pneumonia (PCP), and cytomegalovirus (CMV) retinitis; decreasing (P < or = .05) trends occurred for 11 OIs (MAC disease, PCP, CMV retinitis, Kaposi's sarcoma, esophageal candidiasis, CMV disease, extrapulmonary cryptococcosis, toxoplasmic encephalitis, tuberculosis, chronic herpes simplex, and disseminated histoplasmosis). Among IDUs, the most frequent OIs were PCP, MAC disease, and esophageal candidiasis; decreasing trends occurred for 5 OIs (PCP, esophageal candidiasis, tuberculosis, chronic herpes simplex, and chronic cryptosporidiosis) and an increase occurred in recurrent pneumonia. The differences in trends for MSM and IDUs may be due to differences in medical care and adherence to preventive medications.

AIDS-Related Opportunistic Infections↗
PubMed2006

First case of HIV Type 1 subtype F among men who have sex with men in Colombia.

To study the molecular epidemiology of human immunodeficiency virus (HIV) strains among men who have sex with men (MSM), the main high-risk group for HIV infection in Colombia, 113 HIV-positive MSM subjects recruited in Bogotá during the year 2002 were genotyped. By heteroduplex mobility assay (env HMA) all samples were classified as subtype B. Partial sequencing of the protease and the reverse transcriptase (Pro/RT) regions performed on a random subset of 10 samples revealed that nine were classified as subtype B, and one sample was subtype F. The specimen that is subtype F in pol and subtype B in env is likely to be is either a recombinant or a dual infection. In this study, we identify the HIV F subtype for the first time in Colombia.

Adolescent↗
PubMed2005

HIV disclosure by men who have sex with men to immediate family over time.

Previous researchers have comprehensively documented rates of HIV disclosure to family at discrete time periods yet none have taken a dynamic approach to this phenomenon. The purpose of this study was to address the trajectory of HIV serostatus disclosure to family members. Time to disclosure was analyzed from data provided by 135 HIV-positive men who have sex with men. Results indicated that mothers remain the family member to be told in greatest proportion, yet the proportion of family members told changes over time in a different manner than presented in earlier research. Additionally, the rate at which family members are told at all time points generally does not significantly differ from each other when accounting for characteristics of participants and family members.

Adult↗
PubMed2006

Sexual risk and HIV acquisition among men who have sex with men travelers to Key West, Florida: a mathematical modeling analysis.

The present study investigated the sexual risk behaviors of men who have sex with men (MSM) traveling to a popular gay tourist destination in the United States. In 2004, a brief survey was administered to 247 MSM tourists recruited from gay-oriented venues in Key West, Florida. Data collected included demographics, HIV status, length of stay, substance use, and sexual risk behaviors. A probabilistic model of HIV transmission was used to translate participants' reports of their sexual behaviors while in Key West into estimates of their risk of acquiring HIV. Twenty-two percent of participants reported anal sex with multiple partners over a relatively brief period (M = 4.1 days), and approximately one third reported having sex with a partner met during the vacation period. Modeling analyses suggested that sexual activity among vacationing MSM would account for approximately 201 new HIV infections among MSM visitors to Key West each year. Although previous studies have documented sexual risk behavior in travelers, quantitative estimates of the impact of these behaviors on the spread of HIV are lacking. Findings suggest that the risk-taking behavior of MSM on vacation may play an important role in the dissemination of HIV and other sexually transmitted diseases (STDs). Future research should assess additional factors (e.g., use of highly active antiretroviral therapy) that may affect HIV transmission in MSM travelers. In addition, efforts are needed to develop effective risk-reduction interventions for this population.

Adult↗
PubMed2006

The intent and practice of condom use among HIV-positive men who have sex with men in Japan.

To evaluate the intent and practice of condom use among Japanese HIV-positive men who have sex with men (MSM), a survey using anonymous questionnaires was carried out and 117 respondents were investigated. For anal sex and oral sex, respectively, 58.1% and 15.2% intended to use condoms and 47.2% and 12.4% used condoms all of the time. The intent of condom use decisively affected the practice of condom use and was closely related to the perceived risk level of HIV/sexually transmitted (STI) transmission. In anal sex, willingness to protect sexual partners from HIV infection was strongly related not only to the intent but also to the practice. Enhancement of willingness to protect oneself from STI was suggested to enhance willingness to protect his/her sexual partners from HIV infection with secondary enhancement of the intent or the practice of condom use. Specific support of MSM with HIV for improving the intent and practice of condom use is urgently needed.

Adult↗
PubMed2006

Systematic development of a self-help and motivational enhancement intervention to promote sexual health in HIV-positive men who have sex with men.

The objective of this study was to describe the application of a systematic process-Intervention Mapping-to developing a theory- and evidence-based intervention to promote sexual health in HIV-positive men who have sex with men (MSM). Intervention Mapping provides a framework that gives program planners a systematic method for decision-making in each phase of intervention development. In Step 1, we focused on the improvement of two health-promoting behaviors: satisfactory sexual functioning and safer sexual behavior. These behaviors were then linked with selected personal and external determinants, such as attitudes and social support, to produce a set of proximal program objectives. In Step 2, theoretical methods were identified to influence the proximal program objectives and were translated into practical strategies. Although theoretical methods were derived from various theories, self-regulation theory and a cognitive model of behavior change provided the main framework for selecting the intervention methods. The main strategies chosen were bibliotherapy (i.e., the use of written material to help people solve problems or change behavior) and motivational interviewing. In Step 3, the theoretical methods and practical strategies were applied in a program that comprised a self-help guide, a motivational interviewing session and a motivational interviewing telephone call, both delivered by specialist nurses in HIV treatment centers. In Step 4, implementation was anticipated by developing a linkage group to ensure involvement of program users in the planning process and conducting additional research to understand how to implement our program better. In Step 5, program evaluation was anticipated based on the planning process from the previous Intervention Mapping steps.

Condoms↗
PubMed2004

Substance use and sexual risk: a participant- and episode-level analysis among a cohort of men who have sex with men.

Prior reports associating substance use with sexual risk behavior have generally used summary measures and have not adjusted for participants' background levels of substance use. In this 1999-2001 US study (the EXPLORE study), the authors determined whether substance use during sex was independently associated with sexual risk during recent sexual episodes, as reported by 4,295 human immunodeficiency virus-negative men who have sex with men. The main outcome measure was serodiscordant unprotected anal sex (SDUA). The influence of participant-level characteristics was examined by using repeated-measures logistic models. In assessing the influence of episode-level predictors on SDUA, the influence of participant-level characteristics, including 6-month substance use, was removed by using conditional logistic regression, in effect making each participant his own control. The authors also adjusted for partner characteristics. Eleven percent of participants reported heavy alcohol use, 37% used poppers, 19% sniffed cocaine, and 13% used amphetamines. In the participant-level analysis, use of poppers, amphetamines, and sniffed cocaine as well as heavy alcohol use in the prior 6 months were independently associated with SDUA. In the conditional analysis, consumption of > or = 6 alcoholic drinks or use of poppers, amphetamines, or sniffed cocaine just before or during sex was independently associated with SDUA. The authors concluded that programs aimed at preventing human immunodeficiency virus transmission should emphasize the influence of substance use during sex on increased risk behavior.

Adolescent↗
PubMed2004

Developing and testing measures predictive of hepatitis A vaccination in a sample of men who have sex with men.

Studies continue to show that the majority of men who have sex with men (MSM) in the US remain unvaccinated against the hepatitis A virus (HAV). Such limited vaccination coverage is a missed opportunity to prevent disease. This study was designed to develop reliable and valid theory-based quantitative measures to understand beliefs and attitudes regarding HAV vaccination among MSM. A convenience sample of 358 patrons of two gay bars in Birmingham, Alabama, completed a theory-based questionnaire. Data were randomly split into two groups. Exploratory factor analysis (EFA) was performed on the first split-half sample to identify factor structure using standard principal component analysis. Confirmatory factor analysis (CFA) was performed on the remaining half sample using structural equation modeling. EFA revealed five scales measuring beliefs about HAV vaccination, including: perceived barriers and benefits associated with HAV vaccination; perceived severity and susceptibility related to hepatitis A infection; and perceived self- efficacy to complete the two-dose vaccine series. CFA revealed acceptable absolute model fits for four scales and excellent comparative model fits for all five scales. Multivariable analysis further validated the scales. Although the results should be tested further, these findings propose standardized measures that may be useful in assessing the beliefs and attitudes of MSM towards HAV vaccination to guide intervention design and evaluation.

Adult↗
PubMed2000

Offspring sex ratio of subfertile men and men with abnormal sperm characteristics.

Previous work has suggested an association between male subfertility and a female-biased offspring sex ratio. This study of the reproduction of men who had a semen analysis at the Sperm Analysis Laboratory in Copenhagen in the period 1963-1993 showed that the subfertile men had an offspring sex ratio as expected (51.0% boys versus 51.3%, P: = 0.56), and within the cohort, the offspring sex ratio had no material association with particular semen characteristics. Our results thus suggest that no important association exists between general male subfertility and a female-biased offspring sex ratio.

Cohort Studies↗
PubMed2003

High human immunodeficiency virus type 1 seroprevalence in men who have sex with men in Buenos Aires, Argentina: risk factors for infection.

OBJECTIVE: To determine human immunodeficiency virus (HIV) seroprevalence in a sample of men who have sex with men (MSM) in Buenos Aires City and to identify risk factors associated with HIV type 1 infection. METHODS: Participants were invited to receive HIV counselling and testing at "NEXO" (a gay non-governmental organization) by means of informative leaflets distributed in gay nightclubs, porno cinemas, gymnasiums, and in the streets. During the encounter, the study was explained by a trained social worker and individuals were invited to volunteer for the study. Diagnosis of HIV was performed using two screening tests and Western Blot assay was used as confirmatory. RESULTS: Human immunodeficiency virus was detected in 96 (13.8%; 95% CI: 11.4-16.7) of 694 MSM. Fourteen (14.6%) of the 96 HIV-positive MSM were already aware of their HIV serostatus. In univariate analysis, HIV-1 infection (odds ratio [OR] >1.5) was found to be associated with older age (30-39 years), being unemployed, a previous sexually transmitted disease (STD) history, and having an HIV-positive partner. Cocaine consumption and irregular use of condoms with occasional partners were also found to be risk factors. In multivariate logistic regression analysis, being unemployed (OR = 3.42; 95% CI: 1.17-9.99) and having an HIV-positive partner (OR = 2.67; 95% CI: 1.09-6.52) remained significant risk factors. DISCUSSION: The high HIV-1 prevalence observed suggests an urgent need for implementation of effective prevention campaigns. This represents the first cross-sectional epidemiological study of HIV among the high-risk group of MSM in Argentina.

Adult↗
PubMed2003

Sexual risk reduction among HIV-positive drug-using men who have sex with men.

According to the US Centers for Disease Control, the majority of new HIV infections are the direct result of unprotected sexual relations between serodiscordant individuals. Thus, the development of behavioral interventions to increase the safer sex practices of HIV-positive individuals has the potential to reduce the number of new infections. Currently, less than 1% of the total US population is infected with HIV. Targeting behavioral interventions to this smaller group of HIV-positive individuals has the potential for making cost-effective reductions in the number of new infections. Despite reports that some HIV-positive individuals continue to engage in high-risk behaviors, interventions designed to prevent secondary transmission of HIV are rare. In this era of highly active antiretroviral therapy (HAART), interventions for HIV-positive individuals are more critical than ever to address the unique challenges and issues they face regarding disclosure and partner notification, use of HAART and sexual risk behavior, and HIV-related stigma. Although a growing number of reports document the efficacy of sexual risk reduction interventions for HIV-positive individuals, to date none of these studies have focused on drug-using populations. This article focuses on sexual risk reduction interventions for HIV-positive men who have sex with men (MSM), the largest group of HIV-positive individuals in the United States. It reviews factors associated with high-risk behaviors and discusses some findings from research with HIV-positive methamphetamine users, including (1) data from a small qualitative study and its implications for the development of new interventions, and (2) baseline data from an ongoing large-scale study of the efficacy of a theory-based sexual risk reduction intervention for HIV-positive methamphetamine-using MSM. The article concludes with a discussion of future research issues, including, for example: Can sexual risks be reduced in the context of active drug use? Are different patterns of drug use, or specific drugs, associated with increased risk behavior? How do gender, race, and culture relate to the efficacy of specific interventions?

Amphetamine-Related Disorders↗
PubMed2003

Adherence to HIV medications in a cohort of men who have sex with men: impact of September 11th.

Adherence to highly active antiretroviral therapy (HAART) regimens remains a challenge for people living with human immunodeficiency virus (HIV). Severe traumas like that of September 11, 2001, can exacerbate the difficulties already associated with adherence. A community-based sample of 68 HIV-seropositive men who have sex with men (MSM) living in New York City who were on protease inhibitor HAART regimens completed quantitative assessments to examine adherence in the aftermath of September 11th. Data were drawn from a larger study of drug use and HIV medication adherence. Assessments conducted from September 24, 2001 to October 24, 2001 were compared to assessments taken 2-4 months prior to September 11th. Repeated measures analyses of variance were used to analyze the number of missed and suboptimal doses (doses taken outside the prescribed time by +/-4 hours) reported in the 2 weeks prior to each respective assessment. The results indicated a significant increase in the number of missed doses and the number of suboptimal doses immediately after the events of September 11th. Differences in adherence were not influenced, however, by sociodemographic characteristics. These results suggest that the events of September 11th had an impact on adherence to HIV medications among MSM in New York City and provide further support for the notion that the events of September 11th may have adversely impacted the lives of seropositive individuals. Attention should be paid by clinicians working with HIV-positive individuals on how this event has been incorporated into lives of individuals already burdened by a chronic and demanding disease.

Acquired Immunodeficiency Syndrome↗
PubMed2004

An HIV prevalence-based model for estimating urban risk populations of injection drug users and men who have sex with men.

Issues of cost and complexity have limited the study of the population sizes of men who have sex with men (MSM) and injection drug users (IDUs), two groups at clearly increased risk for human immunodeficiency virus (HIV) and other acute and chronic diseases. We developed a prototypical, easily applied estimation model for these populations and applied it to Miami, Florida. This model combined HIV prevalence estimates, HIV seroprevalence rates, and census data to make plausible estimates of the number and proportion of MSM and IDUs under a number of assumptions. Sensitivity analyses were conducted to test the robustness of the model. The model suggests that approximately 9.5% (plausible range 7.7%-11.3%) of Miami males aged 18 years or older are MSM (point estimate, N = 76,500), and 1.4% (plausible range 0.9%-1.9%) of the total population aged 18 years or older are IDUs (point estimate, N = 23,700). Males may be about 2.5 times more likely than females to be IDUs. The estimates were reasonably robust to biases. The model was used to develop MSM and IDU population estimates in selected urban areas across Florida and should be replicable in other medium-to-large urban areas. Such estimates could be useful for behavioral surveillance and resource allocation, including enhanced targeting of community-based interventions for primary and secondary HIV prevention.

Adult↗
PubMed2005

Drug and sexual risk in four men who have sex with men populations: evidence for a sustained HIV epidemic in New York City.

The objective of this article was to examine drug and sexual risk in four salient groups of men who have sex with men (MSM) in New York City (NYC): (1) nonhomeless young MSM (YMSM), (2) homeless YMSM, (3) adult MSM Speed users, and (4) HIV-positive "POZ Party" MSM. Lifetime and current exposure to drugs, drug injection, and selected drug-sex interactions are highlighted in each group. Data derive from recently completed field-based, ethnoepidemiological studies that used venue-oriented/targeted sampling and semistructured interviews. Across all four groups, findings show that both drug and sexual risk remain prevalent in the MSM population in NYC. This is especially troubling given the already high background prevalence of HIV and other sexually transmitted diseases in NYC and the widespread suffering and death already wrought by HIV/AIDS among MSM. These findings suggest that available public health interventions today are, in many respects, failing to reach, engage, and affect critical risk groups within the NYC MSM population.

Adolescent↗
PubMed2005

HIV prevalence and risk behaviors among men who have sex with men and inject drugs in San Francisco.

The dual risks of male-to-male sex and drug injection have put men who have sex with men and inject drugs (MSM-IDU) at the forefront of the HIV epidemic, with the highest rates of infection among any risk group in the United.States. This study analyzes data collected from 357 MSM-IDU in San Francisco between 1998 and 2002 to examine how risk behaviors differ by HIV serostatus and self-identified sexual orientation and to assess medical and social service utilization among HIV-positive MSM-IDU. Twenty-eight percent of the sample tested HIV antibody positive. There was little difference in risk behaviors between HIV-negative and HIV-positive MSM-IDU. Thirty percent of HIV-positive MSM-IDU reported distributive syringe sharing, compared to 40% of HIV negatives. Among MSM-IDU who reported anal intercourse in past 6 months, 70% of positives and 66% of HIV negatives reported unprotected anal intercourse. HIV status varied greatly by self-identified sexual orientation: 46% among gay, 24% among bisexual, and 14% among heterosexual MSM-IDU. Heterosexual MSM-IDU were more likely than other MSM-IDU to be homeless and to trade sex for money or drugs. Gay MSM-IDU were more likely to have anal intercourse. Bisexual MSM-IDU were as likely as heterosexual MSM-IDU to have sex with women and as likely as gay-identified MSM-IDU to have anal intercourse. Among MSM-IDU who were HIV positive, 15% were currently on antiretroviral therapy and 18% were currently in drug treatment, and 87% reported using a syringe exchange program in the past 6 months. These findings have implications for the development of HIV interventions that target the diverse MSM-IDU population.

Adolescent↗
PubMed2005

Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of san francisco men who have sex with men.

Most prior studies examining drug use among men who have sex with men (MSM) have been cross-sectional or retrospective and have not determined whether periods of increased drug use are associated with high-risk sexual behavior at the individual level. In this article, we describe patterns of use of methamphetamines, poppers, and sniffed cocaine and sexual risk behavior among 736 San Francisco MSM enrolled in the EXPLORE study and followed for up to 48 months. In longitudinal analysis, use of methamphetamines, poppers, and sniffed cocaine declined during follow-up. However, compared with older participants, younger participants were more likely to increase their drug use over time. Results of conditional logistic regression demonstrated that high-risk sexual behavior was more common during reporting periods characterized by increased methamphetamine, poppers, or sniffed cocaine use. This within-person analysis found that compared with periods of no drug use, periods of both light drug use (less than weekly use of drugs) and heavier drug use (at least weekly use of at least one drug) were significantly associated with increased risk of engaging in unprotected anal sex with an HIV-positive or unknown-status partner. These results suggest that even intermittent, recreational use of these drugs may lead to high-risk sexual behavior, and that, to reduce and prevent risks of HIV, no level of use of these drugs should be considered "safe." HIV prevention interventions should target MSM who report either light or heavy use of methamphetamines, poppers, and sniffed cocaine.

Adolescent↗
PubMed2005

Methamphetamine-using HIV-positive men who have sex with men: correlates of polydrug use.

Methamphetamine use has become a major problem among communities of men having sex with men (MSM), where it has been associated with high-risk behaviors. Methamphetamine is often combined with other drugs that may increase its risks and adverse health consequences. To examine differences in background characteristics, HIVrisk behaviors, and psychosocial variables among polydrug-using HIV-positive MSM, the researchers classified a sample of 261 HIV-positive, methamphetamine-using MSM into three user groups: (1) methamphetamine only; (2) methamphetamine, marijuana, and poppers (light polydrug users); and (3) methamphetamine and other drugs (e.g., cocaine, heroin, hallucinogens, and ketamine; heavy polydrug users). Only 5% reported using only methamphetamine during the past 2 months; 31% were classified as light polydrug users, and 64% were classified as heavy polydrug users. Heavy polydrug users were significantly younger than light polydrug users (35.6 vs. 38.4, P<.01) and reported using methamphetamine for significantly fewer years (10.3 vs. 14.2 years, P<.001), but did not differ in the amount and frequency of methamphetamine or alcohol consumed. Heavy polydrug users reported significantly more sex partners of HIV-negative and unknown serostatus and had more unprotected sex with these partners. Heavy polydrug users had significantly higher scores on impulsivity and negative self-perceptions, as compared with those of light polydrug users. In this sample of HIV-positive MSM, most of those who used methamphetamine had a pattern of polydrug use. Heavy polydrug users reported significantly more high-risk sexual behaviors and tended toward higher levels of impulsivity than light polydrug users. The implications of these findings are two-fold: (1) Longitudinal research is needed to establish causal relationships among methamphetamine use, impulsivity, negative self-perceptions, and sexual risk behavior in this target population; (2) behavioral interventions should evaluate whether methamphetamine use and sexual risk behavior can be reduced by modifying impulsivity and negative self-perceptions.

Adult↗