Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997-2005.

OBJECTIVE: Beliefs about HIV treatment effectiveness and the impact of HIV treatments on HIV transmission risks were initially related to sexual risk-taking in the late 1990s when multidrug HIV treatments first became available. This study examined changes in beliefs about the effects of HIV treatment for preventing HIV transmission and their association to sexual risk behaviors between the years 1997 and 2005. DESIGN: Anonymous surveys were administered to a convenience sample of gay and bisexual men attending a large community event in Atlanta, Georgia in 1997 (N = 498) and again at the same community event in 2005 (N = 448). Analyses were performed for men living with HIV/AIDS and for men who have not been diagnosed with HIV/AIDS. MAIN OUTCOME MEASURES: Rates of unprotected anal intercourse in the previous 3 months. RESULTS: There were significant increases in high-risk sexual practices that coincided with increased beliefs that HIV treatments can reduce the chance of transmitting HIV. However, optimistic beliefs about the health benefits of HIV treatments decreased over the 8 years and were not related to risk behaviors. CONCLUSIONS: Beliefs about how HIV treatments impact HIV infectiousness remain associated with HIV transmission risk behavior and interventions targeting at-risk as well as HIV-positive men who have sex with men must directly address these beliefs and perceptions.     

Misperception Among Gay Men of the Risk for AIDS Associated with Their Sexual Behavior1

Until a vaccine against AIDS is developed, the most effective strategy for preventing the spread of the disease among gay men, the largest risk group, is to persuade them to abstain from particular kinds of sexual practices implicated in the transmission of the AIDS virus. Motivation to comply with risk-reduction guidelines, however, is dependent in part on a realistic appraisal of the degree of risk associated with one's sexual practices. Data are presented from 160 asymptomatic gay men. Their subjective assessment of the riskiness of their sexual behavior is compared to an objective assessment of the riskiness of their sexual practices. Factors associated with a tendency to underestimate the riskiness of one's practices are examined. Finally, the implications of the findings for public health education efforts among gay men are discussed.     

The Relationships among Childhood Maltreatment,Emotion Regulation,and Sexual Risk Taking in Men from Urban STD Clinics

This study sought to examine the relationships among emotion regulation difficulties, childhood maltreatment, and risky sexual behavior in a sample of 320 heterosexual men recruited from urban sexually transmitted disease clinics. Overall childhood maltreatment and several specific types of child abuse were significantly associated with emotion dysregulation, number of sexual partners, and sexually transmitted infection (STI) diagnosis. There was evidence of an additive effect of multiple forms of maltreatment on difficulties with emotion regulation and sexual risk taking. Impulse control difficulties and access to emotion regulation strategies, two components of emotion dysregulation, were related to measures of risky sexual behavior. Furthermore, limited access to emotion regulation strategies mediated the relationship between frequency of childhood sexual abuse and a greater number of lifetime sexual partners. This study has important implications for developing effective interventions to reduce the spread of STIs and HIV by expanding affect regulation and distress tolerance strategies among men who have experienced childhood maltreatment.     

‘Coming out’ and sexual debut: understanding the social context of HIV risk-related behaviour

This paper explores HIV risk-related behaviour in the context of men's entry into the gay community. It is an exploratory study which employed a qualitative approach to describe men's accounts of the process of acculturation. Twenty in-depth interviews were conducted with working-class gay men from Barnsley, UK. These were translated and analysed, using interpretative phenomenological analysis, for recurrent themes which reflect the way gay men thought about HIV risk-related behaviour, ‘coming out’ and their sexual debut. As men began to socialize with other gay men in their local community they had much to learn with regard to local gay culture, e.g. a distinct new vocabulary and local sexual mores. By virtue of their lack of experience and the personal impact of first sexual experiences, some men reported feelings of disempowerment with their initial sexual partners. Theoretical accounts relating to gay men's sexual health would benefit from a consideration of the way gay men report the process of acculturation. Sexual debut and the particular vulnerabilities of entry into the gay community highlight a temporal context in which affective experiences are privileged above considerations of sexual health. © 1998 John Wiley & Sons, Ltd.     

Virtual and physical venues as contexts for HIV risk among rural men who have sex with men.

Rural men who have sex with men (MSM) have few identifiable venues in which to congregate and meet potential sex partners. The Internet provides a venue for rural MSM to meet, and this is potentially troubling because studies of urban MSM suggest that HIV risk is higher for men who date online. The goals of this study were to identify venues where rural MSM meet their sexual partners and to examine their association with high-risk sexual practices. Six hundred sixty-three predominantly single, gay, Caucasian MSM completed an online survey of their sexual activities. Results showed that the Internet and bars were the most popular venues for meeting sex partners. Highest rates of risk behaviors were associated with Internet dating and venues in which immediate sexual encounters typically occur, suggesting that prevention in rural areas should target multiple-risk environments.     

Perceptions of sugar mommy practices in South Africa

The study sought to explore sugar mommy practices regarding their occurrence, acceptability as well as perceived reasons why older women and younger men enter into sugar mommy relationships. An exploratory qualitative study involving 135 participants from 11 diverse focus groups in terms of age, gender (females=27%) and geotype throughout the nine South African provinces was conducted. Data on the participants’ views, opinions and experiences of sugar mommy practices were collected using focus group interviews. The data were thematically analyzed. The study found that sugar mommy practices were prevalent in South Africa. The perceived reasons for acceptability were: love, survival, and correctness. Perceived reasons why older women have sexual relationships with younger men included: sexual fulfilment, domination, reduction of stress, physical attraction, procreation, lack of self-control, youthful feeling, migrancy, difficulty in finding partners of compatible age and young men being seen as not demanding. Perceived reasons why younger men have sexual relationships with older women included: material gain, reduction of stress, being enticed, rejection by women of compatible age, peer influence and belief that older women are purer. Given the increase in sugar mommy practices, which may have significant implications for the prevalence of HIV/AIDS, it is necessary to understand the underlying perceptions of these practices, in order to develop culturally relevant and socially acceptable intervention programmes.     

High risk behaviors in a sample of Mexican-American college students

This study explored different types of high risk behaviors of Mexican-American college students attending a small university in south Texas. High risk behaviors for contracting HIV/AIDS examined in this study included unprotected sex, drug use, and alcohol abuse. In 1995 in the United States, HIV/AIDS is the leading cause of death in people between the ages of 25 and 44. Because use of alcohol and certain recreational drugs lowers inhibitions, their use could increase the possibility of having unprotected and unplanned sex with multiple partners. Thus, it was expected that Mexican-American college students who use drugs and alcohol would be more likely to engage in unprotected sex. Data were from 105 men and 211 women between the ages of 18 and 30 years. Drug use and alcohol abuse were significantly associated with high risk sexual behavior. Individuals in monogamous relationships were more likely to not use condoms than those involved in casual relationships. Self-reported religiosity was not correlated with high risk behaviors, although there were implications that stronger religious affiliation did alter sexual beliefs and practices. Lastly, parental communication was not significantly associated with high risk behaviors, but family unity did seem related to some risky sexual practices.     

Gender Relations and HIV Transmission in North-Central Nigeria

Nigeria’s most recent National HIV/AIDS and Reproductive Health Survey of 2012 shows a decline in the national prevalence rate from 3.6% in 2007 to 3.0% in 2012. Despite this moderate decrease, the rate for the North-central geopolitical zone: (5.7 and 3.4%, respectively) remained higher than the national average for both years. Besides, virtually all of the HIV and AIDS surveys conducted in Nigeria from 1999 till date have consistently shown higher rates among females than males. For instance, it was 4.0 and 3.5% among females; and 3.5 and 3.3% in males in 2007 and 2012 respectively. UNAIDS reported that studies on the mode of transmission in 2008 found the bulk of new infections among cohabiting and married sexual partners who are not engaged in high risk sex (42.2%) compared to casual heterosexual sex (9.1%) and sex workers (3.4%). Higher vulnerability among married females implies higher risk of parent to child transmission, yet married women are perceived as a “low risk” group. Against this backdrop, I studied some gender related socio-cultural factors that influence HIV transmission among married women in two ethnic groups in North-central Nigeria. Results of the qualitative study conducted through 24 in-depth interviews and 36 focus group discussions in six communities indicate that marital consent; women’s poor access to safe sex; double standards in marital sexual practices; gender based violence against women; among others influence the spread of HIV infection in married heterosexual couples. In conclusion, marriage does not necessarily reduce HIV vulnerability in women.     

Are Transgender Persons at Higher Risk for HIV Than Other Sexual Minorities? A Comparison of HIV Prevalence and Risks

SUMMARY

Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and nontransgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either nontransgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts.     

angels,bandidos, outlaws,and pagans: the evolution of organized crime among the big four 1% motorcycle clubs

This study presents an examination of characteristics of men who engage in bareback sex for purposes of bug chasing and bug giving. Drawing on personal ads posted on an Internet website geared for men seeking male sexual partners, the present analysis focuses on identifying characteristics of men seeking to become HIV infected (bug chasers) and men seeking to intentionally infect others with HIV (bug givers). Nearly one in ten ads posted during a one-year period are identified as from bug chasers or bug givers and serve as the sample for analysis. Results reveal a profile of bug chasers and bug givers, with demographic, appearance, sexual activity preferences, and degree of openness differences between the two groups.     

Perceptions of South African Emerging Adult FET College Students on Sexual Practices in Relation to Religion

HIV and AIDS are rapidly spreading amongst the world’s 15- to 24-year age group, particularly in sub-Saharan Africa. Despite vigorous government interventions and campaigns, 10 % of South African youth in the age cohort 15–24 are infected with HIV and AIDS. Furthermore, for the first time in history the world has its largest number of individuals under the age of 30 years. Researchers are desperately seeking a solution and have found religion to play an important role in moderating risky sexual behaviour amongst youth. This exploratory qualitative study aims to increase our understanding of emerging adult Further Education and Training (FET) students’ perceptions of the role of religion and religious beliefs in their sexual decision-making and practices. The qualitative data emerged from five focus group discussions, each consisting of 12 heterosexual emerging adult FET college students aged 18–24 years, selected using random sampling. Participants were representative of all the major South African racial groups (Blacks, Whites, Coloured and Indians) as well as different religious and cultural groupings. Secularisation theory was used as a theoretical framework for this study. These focus group discussions revealed the following themes: Theme 1—religious institutions need to embrace change in order to become effective social agents of change. Theme 2—a need for open discussion and communication concerning current issues related to young people’s sexual health (by religious institutions/religious leaders). Theme 3—perceptions of religion’s negative sanctions towards sexual behaviour. Theme 4—religious leaders’ indifference and abdication of responsibility to the problems that youth face. Theme 5—religion and condom-related beliefs. Theme 6—perceptions of religious leaders as role models. Theme 7—emerging adults general concern for the moral decay of society. Theme 8—perceptions of whether religion has an influence on young people’s sexual decision-making and practices.     

Guidance for professionals in health promotion: Keeping it simple–but not too simple

Abstract

People with haemophilia have been infected by HIV through blood products required for the treatment of their bleeds. In a recent study in Scotland their knowledge of HIV/AIDS and their behavioural changes were explored. It was found that people with severe haemophilia were better informed about HIV and AIDS than the mildly/moderately affected, bur only the knowledge of precautions in mildly/moderately affected patients was positively associated with their change of sexual practices. Mildly/moderately affected patients, who were less at risk of contracting HIV, reduced their treatment more than the severely affected patients. Only one third of patients applied safe-sex practices and a greater proportion of those who did not were single men, some of them HIV antibody positive.     

Working class homosexuality and HIV/AIDS prevention some recent research from Sydney,Australia

Abstract

Surveys on gay and bisexual men in Sydney and non-metropolitan New South Wales (NSW) indicate uneven patterns of HIV/AIDS knowledge and sexual behaviour change. As a follow-up action-research study, the Class, Homosexuality and AIDS Prevention (CHAP) project pursued audio-recorded, semistructured interviews with men in western Sydney and Nullangardie, a provincial city in NSW, to investigate the relationship between homosexuality and class.

One-to-one interviews with working-class, homosexually active men revealed particular patterns of homosexual initiation and sexual relationships, and a distinct culture being slowly affected by notions of being “gay” and “gay community”. This impact of modern gay life on western Sydney was different from that in the provincial city. More prominent were the effects of class—unemployment, poor education, poverty, and cultural marginalisation—on the experience and elaboration of homosexuality. Group interviews confirmed an experience of “difference” from prominent gay communities, especially Sydney's “Oxford Street” gay quarter. Working-class men offered a critique of gay community-initiated HIV/AIDS prevention strategies, pointing toward different education initiatives involving local social networks.

Case studies are presented to argue the importance of the relation between sexuality and class, and its consequences for HIV/AIDS education.     

HIV/AIDS communication among adolescents in psychiatric care and their parents.

The authors examined HIV/AIDS communication among 207 parent-adolescent dyads in psychiatric care to better understand the relationship between family communication and sexual risk behavior in an at-risk population. Dyads reported content and rated quality of family HIV/AIDS discussions, and adolescent sexual risk was assessed. Families discussed transmission, prevention, consequences, myths, and compassion. Parent-reported discussion of consequences was associated with greater sexual risk behavior, but only for girls. Higher quality communication reported by adolescents was associated with less sexual risk. Parents may send different messages about HIV/AIDS to sons versus daughters, and messages related to consequences may not effectively reduce risk among daughters. However, for boys and girls in psychiatric care, teaching parents how to discuss HIV/AIDS may promote safer sexual behavior.     

Differing sexual practices of men and women screened for HIV (AIDS) antibody

This study describes the results of a survey of all persons screened for antibodies to the Human Immunodeficiency Virus (HIV) during a 3-mo. period at a county health department. Complete interviews and serologic analysis for antibodies to HIV using the enzyme-linked immunosorbent assay were obtained from all 43 persons. HIV antibodies, confirmed by Western blot assay, were present in 7 or 16% of the sample. Self-reported changes in sexual practices among the 27 seronegative homosexual men occurred prior to counseling and screening, but 9 seronegative women reported no change in high-risk behaviors. The number of black men and women screened were disproportionately smaller than their representation in the community. These findings suggest that stronger educational efforts are needed to disseminate information to women and blacks who are at risk for HIV infection.     

Safe and Unsafe Sexual Intentions and Behavior: The Effects of Norms and Attitudes1

A study of 85 heterosexual men, 85 heterosexual women, and 82 homosexual men was undertaken to examine the variables that influence intentions to engage in different sexual practices and actual sexual behavior. On the basis of Fishbein and Ajzen's (1975) theory of reasoned action, it was predicted that the strength of intentions would be related to whether behavior was in accord with intentions. Consistent with expectations, the strength of intention to engage in six different sexual practices (e. g., vaginal intercourse, anal intercourse, oral sex) and the three strategies that modify the risk of HIV transmission (sex with an exclusive partner, sex wearing a condom, and looking for a new partner) predicted actual behavior. Second, it was proposed that attitudes toward one's sexual practices and norms would be related to intentions to engage in safe sex. To reflect differential levels in the safety of behavioral intentions, five safety intention groups were formed: (a) nonpenetrative sex, (b) penetrative sex in an exclusive relationship with a condom, (c) penetrative sex in an exclusive relationship without a condom, (d) penetrative sex in a nonexclusive relationship with a condom, and (e) penetrative sex in a nonexclusive relationship without a condom. Norms, rather than attitudes, distinguished the five safety intention groups. the groups intending to engage in safe sex (nonpenetrative sex or penetrative sex with a condom) perceived lower levels of social approval for their sexual practices than the noncondom groups. Additional analyses showed that past behavior had a stabilizing effect on the intention-behavior relationship, but only for the nonpenetrative and noncondom safety intention groups.     

Combating Homophobia in AIDS Education

Homophobia is a central theme in response to the AIDS epidemic. In this article we review literature explicating the connection between homophobia and AIDS and then call for the integration of antihomophobia elements into AIDS education. We discuss negative messages in portrayals of gay and bisexual men and in discussions of safer sexual practices, as well as materials and educational strategies that explicitly contradict such homophobic messages. We then discuss the emerging trend to exclude lesbian women and gay men in education and programs, suggest guidelines for countering such exclusion, and give examples of creative approaches to inclusion.     

Sexual Identity,Mental Health,HIV Risk Behaviors,and Internalized Homophobia Among Black Men Who Have Sex With Men

The purpose of this study was to determine the relationships between sexual identity, depression, self‐esteem, HIV risk behaviors, HIV status, and internalized homophobia in Black men who have sex with men. Results demonstrated a positive relationship between depression, HIV risk behaviors, and internalized homophobia; a negative relationship with self‐esteem; and differences in internalized homophobia by HIV status (i.e., positive, negative, or unknown). Counseling recommendations are provided for working with this population.