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At least 685 records · Page 38Linked to original sources
PubMed1996

Overall and cause-specific mortality in a cohort of homo-/bisexual men, injecting drug users, and female partners of HIV-infected men. Pulmonary Complications of Human Immunodeficiency Virus Infection Study Group.

OBJECTIVE: To study the overall and cause-specific HIV-related mortality in a cohort of HIV-seropositive subjects according to transmission category, race/ethnicity, sex and severity of immunosuppression. DESIGN: A cohort of 1129 HIV-seropositive homo-/bisexual men, injecting drug users, and female partners of HIV-infected men were enrolled at six centers in San Francisco, Los Angeles, Chicago, Newark, Detroit and New York between 1 November 1988 and 1 November 1989. Subjects were evaluated every 6 months at least until 31 March 1994. METHODS: The analyses of overall mortality for the subgroups of interest were performed with Kaplan-Meier plots and Cox proportional hazards models. Cause-specific analyses were performed on the primary cause of death using rates per 100 person-years of exposure. RESULTS AND CONCLUSIONS: Baseline severity of immunosuppression is the strongest predictor of mortality. There were no statistically significant differences in overall HIV-related mortality among transmission categories, race/ethnicity groups or sexes. There were differences, however, in cause-specific mortality among the different risk groups.

AIDS-Related Opportunistic Infections↗
PubMed1997

Cost-effectiveness of HIV-prevention skills training for men who have sex with men.

OBJECTIVE: A previous study empirically compared the effects of two HIV-prevention interventions for men who have sex with men: (i) a safer sex lecture, and (ii) the same lecture coupled with a 1.5 h skills-training group session. The skills-training intervention led to a significant increase in condom use at 12-month follow-up, compared with the lecture-only condition. The current study retrospectively assesses the incremental cost-effectiveness of skills training to determine whether it is worth the extra cost to add this component to an HIV-prevention intervention that would otherwise consist of a safer sex lecture only. DESIGN: Standard techniques of incremental cost-utility analysis were employed. METHODS: A societal perspective and a 5% discount rate were used. Cost categories assessed included: staff salary, fringe benefits, quality assurance, session materials, client transportation, client time valuation, and costs shared with other programs. A Bernoulli-process model of HIV transmission was used to estimate the number of HIV infections averted by the skills-training intervention component. For each infection averted, the discounted medical costs and quality-adjusted life years (QALY) saved were estimated. One- and multi-way sensitivity analyses were performed to assess the robustness of base-case results to changes in modeling assumptions. RESULTS: Under base-case assumptions, the incremental cost of the skills training was less than $13,000 (or about $40 per person). The discounted medical costs averted by incrementally preventing HIV infections were over $170,000; more than 21 discounted QALY were saved. The cost per QALY saved was negative, indicating cost-savings. These results are robust to changes in most modeling assumptions. However, the model is moderately sensitive to changes in the per-contact risk of HIV transmission. CONCLUSIONS: Under most reasonable assumptions, the incremental costs of the skills training were outweighed by the medical costs saved. Thus, not only is skills training effective in reducing risky behavior, it is also cost-saving.

Acquired Immunodeficiency Syndrome↗
PubMed2001

HIV surveillance among men who have sex with men.

OBJECTIVES: To review current approaches to HIV surveillance among men who have sex with men (MSM), identify illustrative best practices and lessons learned, and outline ways to enhance surveillance systems. METHODS: Review of the literature and institutional guidelines for HIV/AIDS, sexually transmitted infection (STI), and behavioral surveillance and summary of results of an international workshop. RESULTS: On-going formative research, HIV/AIDS and STI case reporting, HIV prevalence and incidence studies, and behavioral surveys are essential components of an effective HIV surveillance system for MSM. Alliances with key organizations and actors in MSM communities provide points of access, assist in the development of measures, and guide appropriate use of data. Sampling techniques (convenience, snowball, quota, microsite, time-location, and population-based) offering a range of methods, complexity, and cost have been successfully implemented in MSM communities. Plausible estimates of the size of MSM populations, which are ultimately crucial to the interpretation of surveillance data, can be improved upon using primary and secondary data. CONCLUSIONS: The purpose of HIV surveillance among MSM is not only to monitor disease occurrence and its antecedents, but to regularly use data to plan and evaluate prevention and care programs, advocate for prevention resources, and improve the health, social welfare and human rights of MSM. Practical, incremental steps can be taken to improve HIV surveillance among MSM in all regions of the world in all stages of the epidemic.

Cluster Analysis↗
PubMed2002

No increase in HIV incidence observed in a cohort of men who have sex with other men in Montreal.

To monitor HIV incidence we tested a cohort of men who have sex with men in Montreal for HIV every 6 months. Between 1996 and 2001, 17 out of 1244 participants seroconverted, for an HIV incidence of 0.56 per 100 person-years (py) (95% CL 0.29, 0.83). The incidence decreased over the study period, from 0.75 to 0.34 per 100 py; which was not statistically significant. An in-depth evaluation of the situation in Montreal could identify useful lessons for prevention efforts elsewhere.

Adult↗
PubMed2002

Increases in HIV incidence among men who have sex with men undergoing repeat diagnostic HIV testing in Ontario, Canada.

OBJECTIVE: To estimate HIV incidence density for different exposure categories among people undergoing repeat testing in Ontario, Canada. METHODS: Persons using voluntary, diagnostic HIV testing at least twice were identified by computerized and manual record linkage. In the 1992-2000 period, 980 seroconverters and 340 994 repeat negative testers contributed 936 145 person years (PY) of observation. Incidence density (ID) was calculated according to Kitayaporn et al. Poisson regression was used to evaluate differences in incidence. RESULTS: Among men who have sex with men (MSM), ID declined between 1992-1996, from 1.23 per 100 PY in 1992 to 0.79 per 100 PY in 1996 [relative risk (RR), 0.86 per year; 95% confidence interval (CI), 0.77-0.96]. Subsequently, ID increased to 1.39 per 100 PY in 1999 (RR, 1.18 per year; 95% CI, 1.05-1.34). In 2000, ID was 1.16 per 100 PY but this decrease was not statistically significantly different from 1999. MSM in their twenties had the highest ID in 1992-1996, but in 1996-2000 MSM in their thirties had the highest risk of infection. Among injecting drug users (IDU), ID decreased from 0.64 per 100 PY in 1992 to 0.14 per 100 PY in 2000 (RR, 0.87 per year; 95% CI, 0.80-0.94). Among heterosexuals, annual incidence remained constant at about 0.03 per 100 PY in 1992-2000. CONCLUSIONS: Increases in ID were identified among MSM from 1996 to 1999. These findings are consistent with other research. Continued vigilance and improved surveillance are needed to better understand and control the epidemic.

AIDS Serodiagnosis↗
PubMed2004

HIV incidence appears constant in men who have sex with men despite widespread use of effective antiretroviral therapy.

OBJECTIVE: To estimate the trend in HIV incidence between 1995 and 2001 in men who have sex with men (MSM) attending sexually transmitted infection (STI) clinics in the UK. DESIGN: The Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) was applied to serum specimens from MSM attending 15 STI clinics collaborating in an HIV unlinked anonymous prevalence serosurvey. METHODS: STARHS was performed on anti-HIV-1 positive specimens and HIV incidence rates determined. Specimens from MSM with previously diagnosed HIV or an AIDS defining condition were excluded. National data on uptake of antiretroviral therapy (ART), AIDS mortality and diagnoses of gonorrhoea in MSM were used to aid interpretation of the HIV incidence findings. RESULTS: Of 43,100 specimens collected from MSM 3565 were anti-HIV-1 positive. Of these, 1645 were eligible and available for STARHS testing, of which 317 were deemed to come from recently acquired infections. The overall estimated annual incidence ranged from 1.5% (1999) to 3.3% (1996). In 2001 it was 2.45%, with a 3.1% incidence in London and 1.0% elsewhere. No significant trends in HIV incidence were found. CONCLUSIONS: Despite the widespread use of ART there was no significant decline in HIV incidence. Individuals whose HIV infection has been diagnosed should be less infectious. However, over 20% of infections in MSM remain undiagnosed, many with acute STI, and this pool of unmanaged HIV infection may be an important driver of the ongoing epidemic. Initiatives to diagnose and treat a greater proportion of HIV infections may be the key to reducing HIV incidence in MSM.

Adult↗
PubMed2002

Epidemiology of anorectal chlamydial and gonococcal infections among men having sex with men in Seattle: utilizing serovar and auxotype strain typing.

BACKGROUND: Bacterial sexually transmitted diseases (STDs) among men who have sex with men (MSM) have recently increased in Seattle. GOALS: Serovar and auxotype typing of strains was used to assess the epidemiology of anorectal chlamydial and gonococcal infections among MSM attending an STD clinic. STUDY DESIGN: The prevalences of anorectal chlamydial infection and gonorrhea among MSM attending an STD clinic during the period of 1994 to 1996 were compared with prevalences during 1997 to 1999. A retrospective case-control study of MSM attending an STD clinic between 1997 and 1999 was performed. Anorectal chlamydial isolates were characterized by serovar and gonococcal isolates were characterized by serovar and auxotype. Infected MSM were mapped by residence and strain type. RESULTS: Prevalences of anorectal chlamydial and gonococcal infections increased from 4.0% and 6.3%, respectively, during 1994-1996 to 7.6% and 8.7%, respectively, during 1997-1999 (P = 0.004 and P = 0.013 for chlamydial infection and gonorrhea, respectively). Most chlamydial infections were caused by serovars G (47.9%) and D (29.6%), and most gonococcal infections were caused by auxotype/serovar classes Proto/IB-1 (43.3%), Proto/IB-3 (16.5%), and Proto/IB-2 (10.3%). MSM with anorectal chlamydial infection more often had chlamydial urethritis (P = 0.005) and were not white (P = 0.046), in comparison with controls. MSM with anorectal gonorrhea more often had pharyngeal gonorrhea (P < 0.001), had a history of gonorrhea (P = 0.003), and were younger than age 30 years (P = 0.039), in comparison with controls. Residences of MSM with anorectal gonorrhea were clustered in urban areas, whereas those of MSM with anorectal chlamydial infection were more dispersed. CONCLUSION: Prevalences of anorectal chlamydial infection and gonorrhea among MSM in Seattle have increased dramatically over the past 3 years. Serovar and auxotype analyses indicate these increases are not clonal but are due to the spread of unique distributions of strains that differ from those causing urogenital infections in the same community.

Adult↗
PubMed2003

Factors affecting hepatitis vaccination refusal at a sexually transmitted disease clinic among men who have sex with men.

BACKGROUND: Men who have sex with men (MSM) attending sexually transmitted disease (STD) clinics should be considered candidates for hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination. However, vaccination rates in STD clinics remain less than optimal. GOAL: The goal was to identify factors that affect HAV and HBV vaccination refusals. STUDY DESIGN: A survey was administered to MSM eligible for the vaccinations attending an STD clinic. Vaccines were offered at the end of the clinic visit. RESULTS: Rates of refusal of HAV (RefuseA) and HBV (RefuseB) vaccinations were 36% and 38%. Health motivation was associated with acceptance, while clinical barriers such as "want to test first for immunity," and "want to talk to own doctor first" were associated with refusal. "Not enough time this evening" was most strongly predictive of refusal, relative to strongly disagree (risk ratios [RRstrongly agree] and 95% confidence limits for RefuseA and RefuseB were 2.69 [1.43, 5.05] and 2.02 [1.05, 3.87], respectively). CONCLUSIONS: To increase acceptance, patients less health-motivated should be identified for prevaccination counseling. Some perceived barriers such as time may be a partial excuse; staff should identify and address other perceptions that may be influencing patients' decisions.

Adolescent↗
PubMed1998

Geographic differences in noninjection and injection substance use among HIV-seropositive men who have sex with men: western United States versus other regions. Supplement to HIV/AIDS Surveillance Study Group.

To study the prevalence of and factors associated with the use of alcohol and nonprescription drugs by HIV-seropositive men who have sex with men (MSM) and to describe variations in alcohol and nonprescription drug use by geographic region, we analyzed data from a multistate, population- and facility-based interview study conducted in 12 U.S. states and metropolitan areas. Among 9735 MSM with HIV infection or AIDS who completed a 45-minute interview, nearly one third reported possible alcohol abuse. Large proportions of MSM also reported the use of marijuana (51%), noninjected cocaine (31%), and crack cocaine (16%) in the 5 years before the interview. Smaller proportions of MSM reported ever having injected cocaine (13%), stimulants (8%), and heroin (8%). Results of logistic regression indicated that in the 5 years before interview, white MSM were significantly (p < .01) more likely than referent (mostly Hispanic) MSM to report use of hallucinogens, marijuana, nitrites, noninjected amphetamines, and diazepam; black MSM were significantly more likely than referent MSM to report use of noninjected crack cocaine. Use of injected stimulants was significantly associated with white race versus referent MSM, and residing in the West versus East. The prevalence of alcohol and drug use among HIV-seropositive MSM is high, and prevalences and types of substance use differ by region and racial/ethnic group. To prevent HIV transmission in this population, health departments and community-based organizations must understand the unique local patterns of substance use to develop effective substance abuse prevention and treatment programs.

Adult↗
PubMed2007

Identifying HIV prevention service needs of African American men who have sex with men: an application of spatial analysis techniques to service planning.

BACKGROUND: Black men who have sex with men (MSM) are a priority population for HIV prevention. METHOD: We applied spatial analysis techniques to map the availability of HIV prevention services to young black MSM in Chicago to guide prevention planning. GIS was used to map characteristics of ZIP codes in Chicago. Choropleth maps and descriptive statistics were used to visualize and analyze the data. RESULTS: Areas where young black MSM reside typically have low HIV service densities. HIV service density also corresponds poorly to some ZIP codes in which young black MSM who report high rates of unprotected sexual behavior reside. CONCLUSION: Spatial analysis can show whether services are located near specific populations of interest. Data from multiple sources can be integrated to explore relationships among characteristics of geographic zones.

Black or African American↗
PubMed2000

Correlates of risky behaviors among young and older men having sexual relations with men in Montréal, Québec, Canada. Omega Study Group.

OBJECTIVE: To assess characteristics associated with 1) age and 2) recent unprotected anal sex with casual partners among men having sexual relations with men (MSM) participating in the Omega Cohort, Montréal, Québec, Canada. METHODS: The Omega Cohort is a study of the incidence and psychosocial determinants of HIV infection among MSM living in Montréal. MSM complete a questionnaire and are tested for HIV every 6 months. RESULTS: Thirteen percent of young MSM (< 30 years of age, n = 355) and 12% of older MSM (> or = 30 years of age, n = 455) reported recent unprotected anal sex with casual partners. The predictors of this latter behavior were: not living with a male sexual partner, unprotected anal sex with regular partner, > 5 casual partners, alcohol/drug use before anal sex, and having difficulties with procedures needed for safe sex. Among young MSM, additional predictors were: to have been living in Montreal for less than 1 year and to have exchanged money for sex. Among older MSM, additional predictors were: female sexual partners, unprotected anal sex with an HIV-infected partner, and feeling invulnerable to AIDS. CONCLUSION: Young Omega participants do not have more risky behaviors than older participants. Some predictors of recent risk behaviors with casual partners were different between the two groups. Prevention programs should be adapted consequently.

Adolescent↗
PubMed2003

Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men.

OBJECTIVE: To determine strategies to overcome barriers to HIV testing among persons at risk. METHODS: We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic. RESULTS: Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home self-testing (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to prefer home self-testing compared with other strategies. Blacks were significantly more likely to prefer urine testing. CONCLUSIONS: Strategies for improving acceptance of HIV counseling and testing include information about access to anonymous testing and early treatment. Expanding options for rapid testing, urine testing, and home self-testing; providing alternatives to venipuncture; making pretest counseling optional; and allowing telephone results disclosure may encourage more persons to learn their HIV status.

Adult↗
PubMed2003

Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men, San Francisco.

BACKGROUND: Increasing trends in high-risk sexual behavior are noted among men who have sex with men (MSM) worldwide. Less information is available on unprotected sex between persons of different HIV serostatus. METHODS: From 1999 through 2001, volunteers of a community-based organization conducted interviews of 10,579 MSM at gay-oriented venues in San Francisco and in neighborhoods with high-volume MSM pedestrian traffic. The questionnaire recorded demographic and risk behavior information, including self-reported and partners' HIV serostatus. RESULTS: Potentially serodiscordant unprotected anal intercourse (UAI) with at least 2 anal sex partners was reported by 12.7% and increased from 11.0% in 1999 to 16.2% in 2001. Stratifying by self-reported HIV serostatus, 20.8% of HIV-positive respondents, 12.1% of HIV-negative respondents, and 13.4% of MSM who did not know or report their own HIV serostatus had potentially serodiscordant UAI. Older MSM of white race were more likely to report potentially serodiscordant UAI among HIV-positive respondents, whereas younger MSM of white race were more likely to report potentially serodiscordant UAI among HIV-negative respondents. Among those with unknown HIV serostatus, MSM of color were more likely to engage in potentially serodiscordant UAI. CONCLUSION: Recent increases in UAI among MSM in San Francisco are not only the result of increases in UAI between persons of the same HIV serostatus. Prevention messages must address disclosure of HIV serostatus to sexual partners specifically tailored to groups according to age, community, and HIV serostatus.

Adult↗
PubMed2003

Viagra use in a community-recruited sample of men who have sex with men, San Francisco.

The authors conducted a community-based anonymous survey of 837 men who have sex with men (MSM) to gauge the extent of Viagra (sildenafil citrate) use, its association with high-risk sexual behavior, and its combination with other drugs. Participants' mean age was 35 years, 67% were white, and 66% had a college degree. The majority (76%) reported anal sex in the past 6 months, with 49% reporting always using condoms. Overall, 32% had ever used Viagra (CI: 29%-36%). Significant independent predictors of Viagra use were white race, older age, HIV positivity, illicit drug use, and having had unprotected anal sex with potentially serodiscordant partners. Over one third of Viagra users had combined Viagra with other drugs, 18% with amyl nitrate. Only a minority (44%) obtained Viagra under the care of a physician. For some MSM, Viagra appears to be an emerging contributing factor to unsafe sex, potentially increasing HIV transmission. HIV care and prevention providers should target Viagra users for enhanced education on safer sex and potentially harmful drug interactions.

Adult↗
PubMed2003

HIV infection and associated risks among young men who have sex with men in a Florida resort community.

OBJECTIVE: Several recent studies have reported high rates of sexual risk-taking and HIV infection among young men who have sex with men (MSM). Most of these studies used samples of convenience. The authors obtained population-based data on young MSM living in South Beach (Miami Beach, Florida), a resort community where some of the highest AIDS rates in the United States have been reported. METHODS: A household probability sample was drawn to survey unmarried 18- to 29-year-old MSM living in South Beach. Subjects were interviewed, completed self-administered questionnaires, and provided oral specimens for HIV antibody testing. RESULTS: From the 2,622 screened residential units, 100 mostly white and Hispanic MSM (92.6% of eligible participants) were enrolled in the study. Fifteen percent of the sample tested positive for antibodies to HIV. White and Hispanic MSM had similar rates. Forty-five percent of the sample reported engaging in unprotected anal intercourse (UAI) in the prior 12 months, and 31% reported UAI with a nonprimary partner. The estimated annual incidence of HIV infection was 6.3%. CONCLUSION: The high prevalences of UAI and HIV infection in South Beach attest to a previously undocumented public health concern. The extremely high estimated incidence for young MSM in South Beach highlights the urgent need for more effective risk-reduction interventions and further epidemiological research on resort areas.

Adult↗
PubMed2005

The influence of partner type and risk status on the sexual behavior of young men who have sex with men living with HIV/AIDS.

OBJECTIVES: The influence of partner type and risk status on the unprotected sexual behavior of young men living with HIV (YMLH) who have sex with men is examined. METHODS: Sexual behavior and sexual partner characteristics of 217 YMLH recruited from adolescent care clinics in 4 AIDS epicenters (Los Angeles, San Francisco, New York, and Miami) were assessed. YMLH were categorized by sexual behavior pattern, and sexual partners were classified by type and risk status. Generalized linear modeling employing overdispersed Poisson distribution was used to analyze the effect of partner type and partner risk status on unprotected sex acts. RESULTS: Most YMLH (62%) reported multiple partners, 26% reported 1 sexual partner, and 12% reported abstinence in the past 3 months. Approximately 34% of polygamous and 28% of monogamous youth engaged in unprotected sex. Monogamous youth were most likely to have unprotected sex with HIV-positive partners. Polygamous youth were most likely to have unprotected sex with HIV-positive partners, irrespective of whether the partner was regular or casual. For polygamous YMLH, unprotected sex did not differ among single-time/new partners with different risk levels. CONCLUSIONS: Partner characteristics influence the condom use behavior of YMLH. YMLH make decisions regarding condom use based on perception of their partner's risk. Preventive interventions must include skills for acquiring accurate information about partner risk status and education regarding the health risks of unprotected sex with HIV seroconcordant partners.

Adolescent↗
PubMed2004

The bisexual bridge revisited: sexual risk behavior among men who have sex with men and women, San Francisco, 1998-2003.

From 1998 to 2003 in San Francisco, unprotected anal intercourse (UAI) with one or more partner of unknown HIV serostatus (potentially serodiscordant UAI) increased among bisexual men who have sex with men (MSM) in parallel and in magnitude compared with other MSM. Potentially serodiscordant UAI and unprotected vaginal intercourse increased from 1998 to 2001 then decreased from 2001 to 2003. Although elements of a 'bisexual bridge' are present, we note an encouraging decrease in risk from 2001 to 2003.

Bisexuality↗
PubMed2005

Targeted screening for primary HIV infection through pooled HIV-RNA testing in men who have sex with men.

HIV-RNA testing may identify individuals with primary HIV infection. Men who have sex with men (MSM) having HIV testing through Public Health, Seattle and King County were screened for primary infection through pooled RNA testing. Eighty-one out of 3525 specimens (2.3%) had detectable antibody and RNA, and seven out of 3439 antibody-negative specimens (0.2%) had HIV RNA. Targeted screening for primary infection through pooled RNA testing in MSM is a useful addition to HIV case finding.

Antibodies, Viral↗