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PubMed2005

Amphetamine use is associated with increased HIV incidence among men who have sex with men in San Francisco.

We examined the association between amphetamine use and HIV incidence for 2991 men who have sex with men (MSM) who tested anonymously for HIV in San Francisco. HIV incidence among 290 amphetamine users was 6.3% per year (95% CI 1.9-10.6%), compared with 2.1% per year (95% CI 1.3-2.9%) among 2701 non-users (RR 3.0, 95% CI 1.4-6.5). HIV prevention programmes in San Francisco should include efforts to reduce amphetamine use and associated high-risk sexual behaviors.

Adult↗
PubMed2005

Increased HIV incidence among men who have sex with men in Rome.

Among 976 men who have sex with men (MSM) who had undergone repeat HIV testing between 1984 and 2003 at a sexually transmitted infection clinic in Rome, Italy, we observed a dramatic increase in HIV incidence in 2002 and 2003, with the cumulative incidence for 2000-2003 being twice as high as that for 1984-1995, and significantly higher than that for 1996-1999. This trend suggests the need for interventions aimed at encouraging behavioural changes among MSM.

Adolescent↗
PubMed2005

Anal intraepithelial neoplasia in the highly active antiretroviral therapy era among HIV-positive men who have sex with men.

OBJECTIVES: The incidence of anal cancer among men who have sex with men (MSM) has continued to increase since the introduction of highly active antiretroviral therapy (HAART). The prevalence of the putative anal cancer precursor, anal intraepithelial neoplasia (AIN) was high among HIV-positive MSM prior to the availability of HAART but little is known about AIN since HAART was introduced. We characterized the prevalence of AIN among HIV-positive MSM and examined the association between AIN and various factors including use of HAART. DESIGN AND METHODS: A baseline point-prevalence analyses in a prospective cohort study of AIN was performed at a university-based research clinic. A total of 357 HIV-positive MSM with no history of anal cancer completed a questionnaire detailing behaviors and medical history, anal cytology and human papillomavirus (HPV) testing, and high-resolution anoscopy with biopsy for detection of AIN. RESULTS: Eighty-one percent of participants with available CD4+ cell counts at baseline had AIN of any grade; 52% had AIN 2 or 3; and 95% had anal HPV infection. In multivariate analysis, detection of > or = 6 HPV types [odds ratio (OR), 36; 95% confidence interval (CI), 7.4-171) and use of HAART (OR, 10; 95% CI, 2.6-38) were associated with AIN after adjustment for length of time participants were HIV-positive, CD4+ cell count and HIV viral load. CONCLUSIONS: The prevalence of AIN has remained high among HIV-positive MSM after the introduction of HAART. Our data indicate that HAART is not associated with a reduced prevalence of AIN and support measures to prevent anal cancer among HIV-positive MSM whether or not they are using HAART.

AIDS-Related Opportunistic Infections↗
PubMed2005

A randomized social network HIV prevention trial with young men who have sex with men in Russia and Bulgaria.

OBJECTIVE: To evaluate the effects of an HIV prevention intervention with social networks of young men who have sex with men (YMSM) in St. Petersburg, Russia and Sofia, Bulgaria. DESIGN: A two-arm randomized trial with a longitudinally-followed community cohort. METHODS: Fifty-two MSM social networks were recruited through access points in high-risk community venues. Network members (n = 276) were assessed to determine risk characteristics, administered sociometric measures to empirically identify the social leader of each network, and counseled in risk reduction. The leaders of 25 experimental condition networks attended a nine-session program that provided training and guidance in delivering ongoing theory-based HIV prevention advice to other network members. Leaders successively targeted network members' AIDS risk-related knowledge and risk reduction norms, attitudes, intentions, and self-efficacy. Participants were re-administered risk assessment measures at 3- and 12-month follow-ups. RESULTS: Among changes produced, the percentage of experimental network members reporting unprotected intercourse (UI) declined from 71.8 to 48.4% at 3-month follow up (P = 0.0001). The percentage who engaged in UI with multiple partners reduced from 31.5 to 12.9% (P = 0.02). After 12 months, the effects became attenuated but remained among participants who had multiple recent sexual partners, the most vulnerable group. Little change was found in control group networks. CONCLUSIONS: Interventions that engage the identified influence leaders of at-risk YMSM social networks to communicate theory-based counseling and advice can produce significant sexual risk behavior change. This model is culturally pertinent for HIV prevention efforts in former socialist countries, as well as elsewhere for other hard-to-reach vulnerable community populations.

Adult↗
PubMed2005

Optimistic perception of HIV/AIDS, unprotected sex and implications for prevention among men who have sex with men, São Paulo, Brazil.

BACKGROUND: This study examines the association between optimistic perceptions about AIDS and unprotected sex among men who have sex with men (MSM) in the city of São Paulo, Brazil. METHODS: A cross-sectional study was carried out among MSM in leisure areas of São Paulo in 2003. We interviewed 161 participants aged 18-30 years. RESULTS: Thirty-nine per cent (95% confidence interval 32-47%) reported unprotected anal sex with steady or casual partners in the previous 6 months. The optimistic perception score created for this study was associated with unprotected sex (P = 0.01) and higher education (P = 0.02). The quartile with the most optimistic perception was 1.8 times more likely to engage in unprotected anal sex compared with the quartile with the least optimistic perception. CONCLUSION: This study suggests that the current situation regarding AIDS, which is seemingly favourable, may create optimistic perceptions leading to unprotected sexual practices. Prevention programmes, particularly for MSM, need to take this into account.

Adolescent↗
PubMed2006

CCR5 expression and duration of high risk sexual activity among HIV-seronegative men who have sex with men.

OBJECTIVES: To test the hypothesis that in comparison with those with shorter risk duration, individuals with longer HIV risk duration would have reduced susceptibility to HIV-1 infection as measured by CCR5 expression, and to evaluate whether variation in CCR5 expression could be explained by known genetic polymorphisms. DESIGN AND METHODS: A cross-sectional study of HIV-1 exposed but uninfected men who have sex with men. The risk duration was estimated from self-reported years since first receptive anal intercourse. CCR5 expression on peripheral blood CD4+ monocytes and T cells was determined by flow cytometry. The CCR5-Delta32 mutation and polymorphisms in the CCR5 promoter and CCR2 as well as the copy number of CCL3L1 were analyzed by polymerase chain reaction. Plasma levels of MIP-1alpha (CCL3), MIP-1beta (CCL4) and RANTES (CCL5) were also measured. As risk duration varied with age, analyses were restricted to 67 individuals aged 30-49 years. RESULTS: Multiple linear regression analyses, adjusted for age and race, showed a significant negative association between HIV risk duration and CCR5 expression on monocytes (P = 0.01), and in a separate model, a similar negative association with CCR5 expression on T cells (P = 0.03). Low CCR5 expression was attributable mainly to CCR5-Delta32 heterozygosity and the CCR5-59029G allele. CONCLUSIONS: We confirmed a role for reduced CCR5 expression in HIV-1 resistance. CCR5-Delta32 heterozygosity and the CCR5-59029G allele were significant predictors of low CCR5 expression. Individuals with high CCR5 expression who resisted infection despite long HIV risk duration form an interesting group within which to search for additional mechanisms of resistance to HIV infection.

Adult↗
PubMed2006

Peer referral for HIV case-finding among men who have sex with men.

OBJECTIVE: To evaluate the effectiveness and cost-effectiveness of a health department-based peer referral program for identifying previously undiagnosed cases of HIV among men who have sex with men (MSM). DESIGN AND METHODS: Between 2002 and 2005, 283 MSM peer recruiters were enrolled in a public health program in King County, Washington, USA. Peer recruiters were enrolled from a sexually transmitted disease (STD) clinic, an HIV clinic, via media advertisements and through collaboration with community-based organizations (CBO). The peer recruiters underwent a brief training and were then paid US$ 20 for each peer they referred to be tested for HIV, STD and viral hepatitis. Peers were paid US$ 20 for being tested. The main outcome measure was the number of new cases of HIV identified and cost per case of HIV identified. RESULTS: Recruiters referred 498 peers for HIV, STD and hepatitis testing. Among 438 peers not previously diagnosed with HIV, 22 (5%) were HIV positive, of whom 18 received their HIV test results. Other infections were variably prevalent among tested peers: gonorrhea [23/307 (8%)], chlamydia [6/285 (2%)], syphilis [1/445 (0.2%)], hepatitis C [61/198 (31%)], surface antigen positive hepatitis B [8/314 (3%)]. Excluding the costs of testing for viral hepatitis and STDs other than HIV, the cost per new HIV case identified was US$ 4929. During the same period, the cost per new case of HIV detected through bathhouse-based HIV testing and through the county's largest CBO-based HIV testing program were US$ 8250 and US$ 11 481, respectively. CONCLUSIONS: Peer referral is an effective means of identifying new cases of HIV among MSM.

AIDS Serodiagnosis↗
PubMed2004

An opportunity for prevention: prevalence, incidence, and sexual risk for HIV among young Asian and Pacific Islander men who have sex with men, San Francisco.

OBJECTIVES: We investigated HIV prevalence and incidence and related risk factors among young Asian and Pacific Islander (API) men who have sex with men (MSM). DESIGN: We conducted a cross-sectional survey. METHODS: A venue-based sample of 496 young API MSM in San Francisco completed face-to-face questionnaires and received HIV counseling and testing. RESULTS: HIV prevalence was 2.6% and annualized HIV incidence was 1.8% per year. In multivariate analysis, being American-born, having 51+ lifetime sex partners, and having attended a "circuit party" (multiday large MSM gatherings) were associated with HIV infection. Forty-seven percent of the sample reported unprotected anal intercourse in the past 6 months. CONCLUSIONS: The current levels of HIV prevalence, HIV incidence, and sexual risk behavior suggest an emerging HIV epidemic among young API MSM in San Francisco.

Adolescent↗
PubMed2004

Unprotected anal intercourse associated with recreational drug use among young men who have sex with men depends on partner type and intercourse role.

OBJECTIVE: The objective of this study was to measure associations of unprotected anal intercourse (UAI) and substance use by sexual partner (regular vs. casual) and role [insertive (I) vs. receptive (R)]. GOAL: The goal of this study was to identify determinants of the association of specific drugs and UAI. STUDY: We conducted a prospective study of young men who have sex with men (MSM), 1997-2002. Odds ratios (ORs) for association of substance use and UAI during the previous year were adjusted for age and calendar year. RESULTS: UAI was significantly associated with sexual situation-specific use of marijuana (OR, 1.43), crystal methamphetamine (OR, 1.75), ecstasy (OR, 1.88), and ketamine (OR, 2.17); global use associations were similar. Situation-specific associations with alcohol (OR, 1.93) and gamma-hydroxybutyrate (GHB; OR, 1.98) were not seen with global measures. GHB and ketamine were specifically associated with IUAI with regular partners, and methamphetamine with RUAI with casual partners. CONCLUSION: Type of drug use measure, partner, and role are important determinants of the association of specific substances and UAI.

Adult↗
PubMed2004

Correlates of Internet use to meet sex partners among men who have sex with men diagnosed with early syphilis in Los Angeles County.

OBJECTIVE: The objective of this study was to evaluate use of the Internet to solicit sex partners by men who have sex with men (MSM) who were diagnosed with early syphilis infection. STUDY: Field interview records for syphilis patients were reviewed for factors associated with Internet use. RESULTS: Internet users were more likely to be of white race (prevalence ratio [PR], 1.6; 95% confidence interval [CI], 1.4-1.8), to report anal insertive sex (PR, 1.1; 95% CI, 1.1-1.2), sex with anonymous partners (PR, 1.2; 95% CI, 1.1-1.3), intravenous drug use (PR, 2.7; 95% CI, 1.1-6.7), and nonintravenous drug use (PR, 1.4; 95% CI, 1.1-1.8). Controlling for race and sexual risk behaviors, white race (odds ratio [OR], 2.8; 95% CI, 1.8-4.6), having anonymous sex partners (OR, 3.4; 95% CI, 1.6-7.0), and nonintravenous drug use (OR, 1.6; 95% CI, 1.1-2.6) were associated with meeting sex partners through the Internet. CONCLUSIONS: Effective sexually transmitted disease risk reduction interventions using the Internet are needed to reach Internet-using, sex-seeking MSM populations engaging in high-risk behaviors.

Adult↗
PubMed2005

High level of hepatitis B infection and ongoing risk among Asian/Pacific Islander men who have sex with men, San Francisco, 2000-2001.

OBJECTIVES: This study examined serologic markers of hepatitis B virus (HBV) infection and immunity among young Asian/Pacific Islander men who have sex with men (API MSM) in San Francisco. METHODS: Participants were 496 API MSM, aged 18 to 29 years, recruited to participate in a cross-sectional survey using a random, venue-based, time-space sampling method. RESULTS: Of 489 subjects tested, 28.0% had evidence of past HBV infection, including 8.2% who were chronically infected; 24.9% were immune as a result of vaccination; and 47.0% were susceptible to infection. Self-reported vaccination history was low overall and discrepant with serologic findings. CONCLUSIONS: HBV infection persists as a significant health problem among API MSM as a result of childhood infection, low vaccination coverage in Asia and the United States, and continuing adult exposure through male-male sex. Although challenging, vigorous efforts are needed to increase vaccination coverage among adult API MSM.

Adolescent↗
PubMed2005

Viagra (sildenafil) use in a population-based sample of U.S. men who have sex with men.

OBJECTIVE/GOAL: The objective of this study was to examine sildenafil (Viagra) use and its relationship to sexual risk behavior for HIV and sexually transmitted diseases among men who have sex with men (MSM). STUDY: A population-based telephone sample of MSM in San Francisco was interviewed about sexual behavior, substance use, HIV and health status, and demographic characteristics. RESULTS: Recent Viagra use was reported by 29% of the sample and was associated with HIV serostatus, greater numbers of male sexual partners, higher levels of unprotected anal sex, and higher levels of illicit recreational drug use. Viagra use was not associated with age, race, or socioeconomic status. CONCLUSIONS: Viagra use appears to have become a stable fixture of the sexual culture of MSM, crossing age, race, and socioeconomic subgroups. Its use is associated with a general behavioral risk pattern for HIV/STD transmission.

HIV Infections↗
PubMed2005

Reaching out to boys at bars: utilizing community partnerships to employ a wellness strategy for syphilis control among men who have sex with men in New York City.

OBJECTIVE: To explore the impact of a holistic approach for syphilis control to improve the sexual health and well-being of men who have sex with men (MSM). GOAL: The New York City Department of Health & Mental Hygiene (NYC DOHMH) developed Hot Shot! to address a variety of general MSM health issues, including syphilis, gonorrhea, chlamydia, and human immunodeficiency virus (HIV)/acquired immunodeficiency virus. RESULTS: Between November 2003 and June 2004, 9 Hot Shot! events were held throughout NYC. Services delivered at events included STD/HIV screening; relevant adult vaccinations, cardiovascular health screenings; and mental health, tobacco, and other drug use assistance. Of 1634 attendees, 445 persons accessed > or =1 service; 4 persons were newly diagnosed with syphilis and 7 with HIV. CONCLUSIONS: The Hot Shot! approach to syphilis control can facilitate STD education, screening, and treatment of MSM while addressing comprehensive health issues. Future integrated health service delivery programs may be more successful by using stable venues for events to ensure continuity of care for MSM.

Adult↗
PubMed2005

Interventions in the commercial sex industry during the rise in syphilis rates among men who have sex with men (MSM).

OBJECTIVE: Describe sexually transmitted disease/human immunodeficiency virus prevention interventions targeting men who have sex with men (MSM) in commercial sex venues (CSV). STUDY: Compilation of descriptive and evaluation data from the CDC 8-city MSM Syphilis Response on interventions conducted in bathhouses/sex clubs, circuit parties, the Internet, male sex workers, and the adult film industry. RESULTS: Interventions in the commercial sex industry (CSI) often involved multiple collaborative efforts between public health departments (PHD), community-based organizations (CBO), and CSV owners and managers. Education and condoms were provided at multiple venues, including circuit parties, bathhouses, and sex clubs. CBO staff reported one-on-one street and CSV outreach to engage MSM at risk. Evaluation data demonstrate that MSM exposed to media campaigns were more aware of syphilis and more likely to have been tested for syphilis than MSM who did not see the campaigns. CONCLUSIONS: PHD and CBO are using multiple means of reaching MSM in the CSI. Evaluations are needed to determine which of these efforts decreases syphilis transmission.

Cities↗
PubMed2005

Activities to increase provider awareness of early syphilis in men who have sex with men in 8 cities, 2000-2004.

OBJECTIVE: Describe provider awareness campaigns undertaken in response to syphilis epidemics among men who have sex with men (MSM). METHODS: Descriptive data from 8 cities facing MSM syphilis epidemics was compiled. RESULTS: Provider awareness efforts included medical alerts, provider visits, lectures to providers on symptom recognition and treatment, and ongoing provision of syphilis and other sexually transmitted diseases (STD) morbidity information through mailings, visits, and e-mail communications. Increases in private provider reporting of syphilis cases followed provider visits in Atlanta and overall provider education efforts in New York City. Decreases in reporting delays and increases in physician calls to the STD program were reported in San Francisco following provider syphilis lectures. Increases in provider participation in community action meetings followed provider awareness efforts in Houston, Chicago, and Miami. CONCLUSIONS: Various methods were used to increase provider awareness of syphilis in these 8 cities. The cost and impact of these activities merits more formal evaluation to determine their contribution to syphilis control in MSM.

Disease Outbreaks↗
PubMed2005

Syphilis partner notification with men who have sex with men: a review and commentary.

BACKGROUND: Eight US cities experienced large outbreaks of syphilis among men having sex with men (MSM), beginning during 2000-2001. Provider-assisted partner notification via disease intervention specialists has traditionally composed a large part of syphilis control efforts. OBJECTIVES: Report current effectiveness of syphilis partner notification for MSM and identify related problems and solutions. RESULTS: One thousand five hundred seventeen MSM diagnosed with syphilis claimed 10,254 sex partners. Many claimed anonymous partners (median = 65%), or provided insufficient locating information (median = 42%). Median cases found per index case were 0.09 (total = 116), although an additional 197 partners had been previously treated. Principal impediments to partner notification fell into 3 areas: (1) diagnosis outside health department settings delayed interviews, (2) partners were often anonymous, and (3) mistrust among MSM, public health professionals, and health care providers in private settings. CONCLUSIONS: Characteristics of the current outbreaks among MSM make traditional partner notification more difficult than in the past. Some modifications, complements, and even alternatives to partner notification are either planned or in operation.

Cities↗
PubMed2006

Epidemiology of human immunodeficiency virus, viral hepatitis (B and C), treponema pallidum, and human T-cell lymphotropic I/II virus among men who have sex with men in Buenos Aires, Argentina.

BACKGROUND: Human immunodeficiency virus (HIV) and sexually transmitted infections (STI) are prevalent among men who have sex with men (MSM). GOAL: To estimate the prevalence of HIV and STIs in this group. STUDY: A total of 694 MSM were tested for HIV, hepatitis B (HBV), hepatitis C (HCV), human T-cell lymphotropic (HTLV-I/II) viruses and Treponema pallidum infection. RESULTS: HIV, HBV, and T pallidum were detected in 13.8%, 37.7%, and 16.9% of subjects, respectively. Prevalences of 1.9% and 0.3% were detected for HCV and HTLV-I/II. A prior history of STI was the most predictor for HIV, HBV, and T pallidum. Use of illegal drugs, blood transfusion history, and multiple sexual partners were associated with HCV. The 2 most common co-infections were HBV/T pallidum and HIV/HBV. CONCLUSIONS: Infection with HIV, HBV, and T pallidum was elevated among MSM. Routine testing, education, vaccine-based prevention, and control programs need to be implemented in this high-risk population.

Adolescent↗
PubMed2006

Incidence of sexually transmitted diseases and HIV infection in men who have sex with men related to knowledge, perceived susceptibility, and perceived severity of sexually transmitted diseases and HIV infection: Dutch MSM-Cohort Study.

BACKGROUND: This longitudinal study was conducted to investigate whether knowledge, perceived susceptibility, and perceived severity of HIV infection and sexually transmitted diseases (STDs) are associated with the incidence of STDs and new HIV infections among men who have sex with men (MSM). METHODS: A 3-year cohort study was conducted among 190 HIV-negative MSM. Data were collected on the incidence of STDs and new HIV infections, as well as on knowledge and perceived susceptibility to and perceived severity of HIV infection and STDs. Knowledge and perceptions were assessed in self-administered questionnaires. RESULTS: In the course of the 3-year study, six MSM (3.2%) HIV-seroconverted and 78 (41.1%) participants were diagnosed with at least one STD. MSM seemed to be better informed about HIV infection compared with STDs, and HIV infection was perceived as more severe than other STDs. In multivariable analyses, low perceived severity of HIV infection significantly (P = 0.025) predicted increased likelihood of infection with STDs or HIV, and the practice of anal intercourse was (marginally) associated with an increased risk of acquiring STDs or HIV (P = 0.052). CONCLUSIONS: A high perceived severity of HIV infection seems to induce sexual behavior that protects against STDs and HIV infection. More research is needed to establish the specific behaviors by which perceived severity of STDs/HIV influences the incidence of STDs and HIV.

Adolescent↗