Diane Binson

Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men

OBJECTIVES We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM). METHODS We conducted a cross-sectional household probability telephone sample of MSM in Chicago, Los Angeles, New York, and San Francisco. RESULTS Psychosocial health problems are highly intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection. CONCLUSIONS AIDS prevention among MSM has overwhelmingly focused on sexual risk alone. Other health problems among MSM not only are important in their own right, but also may interact to increase HIV risk. HIV prevention might become more effective by addressing the broader health concerns of MSM while also focusing on sexual risks.

Differential HIV Risk in Bathhouses and Public Cruising Areas

OBJECTIVES This report investigates differences in risk behaviors among men who have sex with men (MSM) who went to gay bathhouses, public cruising areas, or both. METHODS We used a probability sample of MSM residing in 4 US cities (n = 2,881). RESULTS Men who used party drugs and had unprotected anal intercourse with nonprimary partners were more likely to go to sex venues than men who did not. Among attendees, MSM who went to public cruising areas only were least likely, and those who went to both public cruising areas and bathhouses were most likely to report risky sex in public settings. CONCLUSIONS Distinguishing between sex venues previously treated as a single construct revealed a significant association between pattern of venue use and sexual risk. Targeting HIV prevention in the bathhouses would reach the segment of men at greatest risk for HIV transmission.

EFFECTS OF INTERVIEWER GENDER, INTERVIEWER CHOICE, AND ITEM WORDING ON RESPONSES TO QUESTIONS CONCERNING SEXUAL BEHAVIOR

The authors examined factors influencing responses to questions on sexual behavior among adult respondents 18-49 years old (unweighted N = 2,030) obtained through a random-digit dialing survey. Based on self-disclosure and perceived control theory, they hypothesized that giving people a choice in selecting the gender of their interviewer rather than being assigned an interviewer, and using questions that are supportive of what may be perceived of as nonnormative behavior (enhanced items), would increase data quality relative to, respectively, matched-or opposite-gender interviewer conditions and standard worded items. The enhanced items facilitated responding to a number of sensitive topics. However, the effects of item wording on item response are often mediated by interviewer conditions. The choice results suggest that giving respondents greater control decreases question threat. However, the overall findings argue for matching respondents and interviewers on gender over opposite-gender interviewers or allowing respondents to select their interviewers gender. Wording and interviewer manipulations reduced the discrepancies between mens and womens self-reports of sexual behavior, but they did not eliminate them, and in some cases they had no effect. The present findings suggest that males tend to be influenced by variations in item wording, interviewer gender, and respondent control across a somewhat wider range of sexual topics. In general, the findings recommend matching respondents and interviewers on gender and the use of more supportive wording in sexual behavior questions. However, for assessment of some topics (e.g., sexual violence) in particular segments of the population (e.g., men), other procedures, such as increasing respondent control, may be a better choice. Overall, the data support the view that in terms of preferred procedures, not all sexual topics are created equal

Suicide Attempts Among Gay and Bisexual Men: Lifetime Prevalence and Antecedents

OBJECTIVES We examined lifetime prevalence of suicide attempts and psychosocial correlates in a large population-based sample of men who have sex with men (MSM). METHODS A telephone probability sample of US urban MSM (n = 2881) were interviewed between November 1996 and February 1998. RESULTS Twenty-one percent had made a suicide plan; 12% had attempted suicide (almost half of those 12% were multiple attempters). Most who attempted suicide made their first attempt before age 25. Although prevalence of parasuicide (i.e., attempted suicide) has remained constant across birth cohorts, mean age at initial attempts has declined. CONCLUSIONS MSM are at elevated risk for suicide attempts, with such risk clustered earlier in life. Some risk factors were specific to being gay or bisexual in a hostile environment.

Prevalence and Social Distribution of Men Who Have Sex with Men: United States and Its Urban Centers

Prevalence data on the social distribution and AIDS‐related risk behavior of men who have sex with men are presented from two national probability surveys [General Social Survey (GSS) and National Health and Social Life Survey (NHSLS)] and a probability survey of urban centers in the U.S. [National AIDS Behavioral Surveys (NABS)]. Men residing in large cities, the highly educated, and Whites were more likely to report sex with men. In the urban sample (NABS), one third reported sex with women. In addition, minority men were more likely to report sex with men and women. More than half of the men with an HIV risk factor reported consistent condom use. The surveys were based on two different modes of interviewing (self‐administered and telephone), conducted independently of each other and by different organizations. The prevalence estimates from these surveys are consistent with each other and with other population‐based surveys in the United States and Europe. We discuss these data in light of the ongoing d...

Tobacco Use and Cessation Among a Household-Based Sample of US Urban Men Who Have Sex With Men

OBJECTIVES We examined tobacco use and cessation among a probability sample of urban men who have sex with men (MSM) living in 4 large US cities. METHODS Of the 2402 men who were eligible for follow-up from a previously recruited probability sample, 1780 (74%) completed tobacco surveys between January and December 1999. RESULTS Current smoking rates were higher for urban MSM (31.4%; 95% confidence interval [CI]=28.6%, 34.3%) than for men in the general population (24.7%; 95% CI=21.2%, 28.2%). Among MSM, 27% were former smokers. A complex set of sociodemographic, tobacco-related, and other factors were associated with cessation. CONCLUSIONS Results support earlier reports that smoking rates are higher for MSM compared with men in the general population. Findings related to cessation underscore the need to target tobacco control efforts for MSM.

Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of national significance initiative.

Background:Surveillance points to an urgent public health need for HIV prevention, access, and retention among young men of color who have sex with men (YMSM). The purpose of this multisite study was to evaluate the association between organizational- and individual-level characteristics and retention in HIV care among HIV-positive YMSM of color. Methods:Data were collected quarterly via face-to-face interviews and chart abstraction between June 2006 and September 2008. Participants were aged 16-24 years, enrolled at 1 of 8 participating youth-specific demonstration sites, and engaged or reengaged in HIV care within the last 30 days. Generalized estimating equations were used to examine factors associated with missing research and care visits. Stata v.9.0se was used for analysis. Results:Of 224 participants, the majority were African American (72.7%), 19-22 years old (66.5%), had graduated high school or equivalent (71.8%), identified as gay or homosexual (80.8%), and disclosed having had sex with a man before HIV diagnosis (98.2%). Over the first 2¼ years of the study, only 11.4% of visits were missed without explanation or patient contact. Characteristics associated with retention included being <21 years old, a history of depression, receipt of program services, and feeling respected at clinic; those associated with poorer retention included having a CD4 count <200 at baseline and being Latino. Conclusions:Special Projects of National Significance programs were able to achieve a high level of retention over time, and individual and program characteristics were associated with retention. Latino YMSM, those not receiving services, and those not perceiving respect at the clinic were at increased risk of falling out of care. Retention is essential to providing HIV+ adolescents with treatment, including reducing antiretroviral resistance development. Innovative programs that address the needs of the YMSM of color population may result in improved retention.

How many HIV infections cross the bisexual bridge? An estimate from the United States

Objective: Most heterosexual women with AIDS have been infected by male sex partners who acquired HIV via injecting drug use or sex with men. The contribution of bisexuality to heterosexual HIV however, has been poorly quantified. In this paper, we estimate the number of HIV infections that spread from the homosexual community to women who have sex with bisexual men. Methods: We developed an HIV transmission model and assigned values to the models parameters using data from a probability survey of US cities with a high risk of HIV. Results: We estimated that there are about 400 HIV infections transmitted annually from HIV‐infected bisexual men in high‐risk cities to their female sex partners; two‐thirds of these infections are transmitted to main female partners and one‐third to casual partners. Uncertainties in the value of model parameters lead to variation in expected HIV infections mostly within the range 200 to 600, and for one parameter up to nearly 800. Conclusion: We conclude that transmission via bisexuality is a relatively minor component of the estimated 40 000 annual HIV infections in the USA.

HIV and STD risk behavior among 18- to 25-year-old men released from U.S. prisons: provider perspectives.

Ninety-seven service providers, representing 83 agencies, were interviewed about sexual and drug use HIV/STD risk behaviors and their determinants among young men who have been released from prison. Providers believed that men frequently practiced sexual risk behavior, often in conjunction with substance use. Individual determinants of risk behavior primarily focused on “making up for lost time,” being a man, degree of HIV/STD knowledge and vulnerability, desire to escape, and future orientation. Peers, partners, and family were portrayed as strong interpersonal influences on risk behavior, both positively and negatively. The dominant contextual determinant of risk behavior was the co-occurrence of sex and drug use. Structural determinants of reduced risk included stable housing, economic sufficiency, and positive community support for safer behavior (e.g., drug treatment access, needle exchange). The findings highlight the need for comprehensive, transitional case management for young men as they reintegrate into the community, including HIV/STD prevention.

IV. Multiple Sexual Partners Among Young Adults in High-Risk Cities:

Among a sample of 1,334 urban heterosexuals aged 18-25 from the 1990-1991 National AIDS Behavioral Surveys, 24% report having had more than one sexual partner during the past year. Young men are more than twice as likely as young women, and unmarried respondents are eight times as likely as married respondents, to have multiple partners. A multiple regression analysis of the interaction between race or ethnicity and education indicates that among whites, young people with 12 or more years of education are four times as likely to have multiple partners as are those with less than a high school education; among Hispanics and blacks, educational level is not related to having more than one partner. Among those with multiple partners, approximately 40% never use condoms with primary or secondary partners, and condom use decreases with increasing number of partners.