Andrew E. Petroll

Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States.

Background Most men who have sex with men (MSM) within the United States acquire human immunodeficiency virus (HIV) while in a same-sex relationship. Few studies have examined HIV and sexually transmitted infection (STI) testing rates among MSM couples. Interestingly, the patterns that MSM test for HIV while in their relationships remain largely unknown. The current study helps fill this gap in knowledge by assessing HIV testing patterns and HIV and STI testing rates from a large convenience sample of Internet-using MSM couples. Methods The current study used a cross-sectional study design to collect dyadic data from 361 MSM couples who lived throughout the United States. A novel recruitment strategy that included placing paid targeted advertisements on Facebook enrolled both men in the couple to independently complete the confidential electronic survey. Results Nearly half of the HIV-negative men indicated either not having been tested for HIV since their relationship started or only testing if they believed they were at risk. Few men reported testing every 3 to 4 months. HIV/STI testing rates varied among the sample of couples. Few men reported having been diagnosed with a recent STI. Testing patterns and rates were mostly similar, irrespective of whether unprotected anal intercourse was practiced within and/or outside the relationship. Conclusions HIV testing and prevention services must target men who are at risk for acquiring HIV within MSM couples. To help accomplish this goal, additional research is needed to examine the specific barriers and facilitators to HIV and STI testing among MSM in couples.

Factors Associated with Men in HIV-Negative Gay Couples Who Practiced UAI Within and Outside of Their Relationship

Despite recent advances in research with gay male couples, less data exists about men who have had UAI within and outside of their HIV-negative seroconcordant relationship. Multilevel modeling with dyadic data from 142 couples was used to identify the characteristics associated with men who have had UAI with both their main partner and a casual MSM partner within the same timeframe. Analyses revealed that men were more likely to have had UAI within and outside of their relationship if they perceived their main partner has had a recent HIV test. Men were less likely to have had UAI within and outside of their relationship if they valued their sexual agreement and reported having a sexual agreement that does not allow sex outside of their relationship. Research with a more diverse sample of couples is warranted. Future interventions must consider the complexity of relationships and sexual behaviors among gay male couples.ResumenA pesar de avances recientes en el estudio de parejas gay, existe poca data sobre hombres VIH-negativo en relaciones seroconcordantes que tienen sexo anal desprotegido dentro y fuera de sus relaciones pareja. Modelaje a multinivel con data diádica de 142 parejas fue utilizado para identificar las características asociadas con hombres que tienen sexo anal desprotegido en el mismo periodo con su pareja principal y con una pareja casual. El análisis reveló que los hombres eran más dados a tener sexo anal desprotegido dentro y fuera de la relación principal si ellos percibieron que su pareja principal se hizo una prueba de VIH recientemente. Los hombres fueron menos dado a tener sexo anal desprotegido dentro y fuera de su relación principal si ellos valoran su acuerdo sexual y reportaron tener un acuerdo sexual que no permite sexo fuera de la relación principal. Estudios con muestras más diversas es necesario. Intervenciones en el futuro deben considerar la complejidad de las relaciones de pareja y del comportamiento sexual en las parejas gay.

PrEP Awareness, Familiarity, Comfort, and Prescribing Experience among US Primary Care Providers and HIV Specialists.

HIV pre-exposure prophylaxis (PrEP) was FDA approved in 2012, but uptake remains low. To characterize what would facilitate health care providers’ increased PrEP prescribing, we conducted a 10-city, online survey of 525 primary care providers (PCPs) and HIV providers (HIVPs) to assess awareness, knowledge, and experience with prescribing PrEP; and, comfort with and barriers to PrEP-related activities. Fewer PCPs than HIVPs had heard of PrEP (76 vs 98%), felt familiar with prescribing PrEP (28 vs. 76%), or had prescribed it (17 vs. 64%). PCPs were less comfortable than HIVPs with PrEP-related activities such as discussing sexual activities (75 vs. 94%), testing for acute HIV (83 vs. 98%), or delivering a new HIV diagnosis (80 vs. 95%). PCPs most frequently identified limited knowledge about PrEP and concerns about insurance coverage as prescribing barriers. PCPs and HIVPs differ in needs that will facilitate their PrEP prescribing. Efforts to increase PrEP uptake will require interventions to increase the knowledge, comfort, and skills of providers to prescribe PrEP.ResumenProfilaxis pre-exposición por VIH (PrEP) fue aprobado por la FDA en 2012, pero su utilización ha sido lento. Para caracterizar lo que facilataría un aumento de la prescripción de profilaxis pre-exposición entre los proveedores de salud, se realizó una encuesta en línea con 525 proveedores de atención primaria (PAP) y los proveedores de VIH (PVIH) en diez ciudades, para evaluar la conciencia, conocimiento y la experiencia con la prescripción de profilaxis pre-exposición; y comodidad con y barreras a las actividades relacionadas con la prescripción de PrEP. Menos PAPs que PVIHs habían oído hablar de profilaxis pre-exposición (76 vs 98%), se sentía familiarizado con prescripción de profilaxis pre-exposición (28 vs. 76%), o habían prescrito (17 vs. 64%). Los PAPs eran menos cómodo que PVIHs con actividades relacionadas con la PrEP como hablar sobre las actividades sexuales (75 vs. 94%), las pruebas de VIH aguda (83 vs. 98%), o la entrega de un nuevo diagnóstico de VIH (80 vs. 95%). Los PAPs frecuentemente identificaron un conocimiento limitado sobre PrEP y preocupaciones acerca de la cobertura de seguro como barreras de prescripción. PAPs y PVIHs difieren en las necesidades que van a facilitar su prescripción de PrEP. Los esfuerzos para aumentar la absorción de la PrEP requerirán intervenciones para aumentar el conocimiento, la comodidad, y las habilidades de los proveedores para prescribir PrEP.

HIV Testing Rates and Factors Associated With Recent HIV Testing Among Male Couples

Less data exist on HIV testing rates among male couples. By using dyadic data from 142 male couples, we found that less than a quarter of the men had been tested for HIV in the previous 3 months. Few factors also were associated with their most recent HIV test.

Engagement in HIV Medical Care and Technology Use among Stimulant-Using and Nonstimulant-Using Men who have Sex with Men

Aims of this study were to assess the associations between stimulant use and attitudes toward and engagement in HIV medical care and to examine technology use among stimulant-using and nonstimulant-using men who have sex with men (MSM). HIV-positive MSM (n = 276; mean age = 42 years; 71% white, non-Hispanic; 43% with college degree) completed an online survey in 2009. Most men (69%) had not missed any scheduled HIV medical appointments in the past year, while 23% had missed at least one, and 9% had not attended any appointments. Stimulant use was significantly associated with not attending any HIV medical appointments in the unadjusted model (relative risk ratio (RRR) = 2.84, 95% CI [1.07, 7.58]), as well as in models adjusted for demographic (RRR = 3.16, 95% CI [1.13, 8.84]) and psychosocial (RRR = 3.44, 95% CI [1.17, 10.15]) factors (Ps < 0.05). Fewer stimulant-using than non-stimulant-using men rated HIV medical care a high priority (57% versus 85%; P < 0.01). Few significant differences were found in online social networking or mobile phone use between stimulant-using and non-stimulant-using MSM, even when stratified by engagement in HIV care. Findings indicate that stimulant use is uniquely associated with nonengagement in HIV medical care in this sample, and that it may be possible to reach stimulant-using MSM using online social networking and mobile technologies.

The Essentials of HIV: A Review for Nurses

The US HIV epidemic began in 1981. The number of HIV-infected individuals in the United States and throughout the world is increasing each year. Given the increasing number of HIV-infected individuals, knowledge of the basic pathogenesis of HIV disease and the principles of antiretroviral therapy is important for all healthcare professionals. This article describes epidemiologic trends in HIV and reviews HIV transmission, testing, and treatment. It also discusses the risk of HIV transmission to healthcare workers from occupational exposures and reviews the principles of postexposure prophylaxis used to reduce the likelihood of HIV transmission in appropriate circumstances.

Health Insurance and Disclosure of Same-Sex Sexual Behaviors Among Gay and Bisexual Men in Same-Sex Relationships

PURPOSE Gay and bisexual men (GBM) have poorer health outcomes than the general population. Improved health outcomes will require that GBM have access to healthcare and that healthcare providers are aware of their sexual behaviors. This study sought to examine factors associated with having health insurance and disclosure of same-sex sexual behaviors to primary care providers (PCPs) among GBM in primary same-sex relationships. METHODS We conducted an online survey of a national sample of 722 men in same-sex couples living in the United States. Logistic regression and multinomial regression models were conducted to assess whether characteristic differences existed between men who did and did not have health insurance, and between men who did and did not report that their PCP knew about their same-sex sexual activity. RESULTS Our national sample of same-sex partnered men identified themselves predominantly as gay and white, and most reported having an income and health insurance. Having health insurance and disclosing sexual behavior to PCPs was associated with increasing age, higher education, and higher income levels. Insurance was less prevalent among nonwhite participants and those living in the south and midwest United States. Disclosure of sexual behavior was more common in urban respondents and in the western United States. In 25% of couples, one partner was insured, while the other was not. CONCLUSIONS Having health insurance and disclosing ones sexual behavior to PCPs was suboptimal overall and occurred in patterns likely to exacerbate health disparities among those GBM already more heavily burdened with poorer health outcomes. These factors need to be considered by PCPs and health policymakers to improve the health of GBM. Patient- and provider-targeted interventions could also improve the health outcomes of GBM.

Marketing the HIV Test to MSM: Ethnic Differences in Preferred Venues and Sources

Lack of awareness of HIV status is associated with an increased likelihood of HIV transmission. We surveyed 633 men who have sex with men (MSM) from diverse ethnic groups recruited from a variety of community venues in a U.S. Midwestern city with rising HIV infection rates. Our first aim was to describe patterns of sexual risk, annual HIV testing frequency, and venues where information about HIV and HIV testing could be disseminated to inner-city MSM. Our second aim was to identify preferred sources to receive information about HIV testing and determine whether these preferences differed by ethnic background. Results indicated that despite similar proportions of high–sexual risk behaviors, compared with African American and Latino MSM, smaller proportions of non-Hispanic White MSM had received an HIV test in the last 12 months. Despite ethnic differences in health care access, a physician’s office was the most common HIV testing site. Overall, a majority conveyed a preference to see advertisements in mainstream media outlets. However, when preferences were stratified by ethnicity, African American MSM were the least likely to prefer receiving information from mainstream media and conveyed a stronger preference to receive information from authority figures than non-Hispanic White and Hispanic MSM.

HIV-Negative Seroconcordant Gay Male Couples' Attitudes, Intentions, and Perceived Behavioral Control for Planned Condom Use Within and Outside of Their Relationships

ABSTRACT Despite high HIV rates among gay male couples, limited research exists about their attitudes, intentions, social norms, and perceived behavioral control for planned condom use within and outside of their relationships. Our cross-sectional study used multilevel modeling with dyadic data from 142 HIV-negative gay male couples to examine and identify which factors were statistically associated with planned condom use within and outside the relationship. Several differences for planned condom use were also noted based on the samples prior history of unprotected anal intercourse and relationship type. Findings suggest additional prevention tools are needed for some HIV-negative gay male couples who are at risk for HIV.

Seoul Virus Infection in a Wisconsin Patient with Recent Travel to China, March 2009: First Documented Case in the Midwestern United States

Diagnosis of Seoul virus-associated hemorrhagic fever with renal syndrome (HFRS) cases among United States residents is rare. We describe confirmation of a Seoul virus infection in a 36-year-old scientist who worked with laboratory rats in Milwaukee, Wisconsin, but most likely acquired the infection during a trip to Shenyang, China.