Harm J. Hospers

Differences in psychosocial factors and fat consumption between stages of change for fat reduction

Abstract Differences in fat consumption and psychosocial factors between subjects in different trans-theoretical stages of change for fat reduction were studied. Data on fat consumption, self-rated fat intake, attitudes, social support and self-efficacy were collected among a sample of 507 adults. Analysis of variance with Scheffes multiple-comparison test was used to study differences in these factors between stages of change. Attitudes and social support were most positive among subjects in preparation and action. Self-efficacy expectations were lowest among subjects in contemplation and preparation. Fat consumption was highest among precontemplators hut no substantial differences between other stages were found. It is concluded that subjects in different stages of change differ in psychosocial factors that are regarded as important determinants of behavioral change. Based on these differences it is recommended to develop stage-tailored nutrition education. A majority of subjects in maintenance consume...

International mobility, sexual behaviour and HIV-related characteristics of men who have sex with men residing in Belgium

BackgroundEuropean men who have sex with men (MSM) continue to be disproportionally affected by the human immunodeficiency virus (HIV). Several factors are contributing to the rates of new HIV infections among MSM. The aim of this study was to investigate the potential role of travel behaviour and sexual mobility in the spread of HIV and sexually transmitted infections (STI) among European MSM.MethodsBelgian data from the first pan-European MSM internet survey EMIS was used (n=3860) to explore individual and contextual determinants of sexual behaviour among MSM, who resided in Belgium at the time of data collection and who reported having had sexual contact abroad in the last 12 months. Descriptive and bivariate analyses were performed. Odds ratios and 95% confidence intervals were calculated by means of logistic regression.ResultsMSM who practiced unprotected anal intercourse UAI during their last sexual encounter abroad were less likely to be living in a large city (OR:0.62, 95% CI:0.45-0,86, p<0.01) and more likely to be HIV positive (OR:6.20, 95% CI:4.23-9.06, p<0.001) ), to have tested HIV positive in the last 12 months (OR:3.07, 95% CI:1.07-8.80, p<0.05), to have been diagnosed with any STI in the last 12 months (OR:2.55; 95% CI:1.77-3.67, p<0.05), to have used party drugs (OR:2.22, 95% CI:1.59-3.09, p<0.001), poppers (OR:1.52, 95% CI:1.07-2.14, p<0.001) and erection enhancing substances (OR:2.23, 95% CI:1.61-3.09, p<0.001) compared to MSM who did not have UAI with their last sexual partner abroad. Men having had UAI in the last 12 months were more likely to have done so in a neighbouring country of Belgium (OR:1.66, 95% CI:1.21-2.29, p<0.001). Different sexual behavioural patterns related to condom use and drug use were identified according to HIV test status among travelling men.ConclusionsThe results of this study provide evidence for the role of international mobility and sexual behavior while travelling, in the spread of HIV and STI among MSM in Europe. Further, the findings underline the need for development of European cross-border HIV and STI interventions with coherent messages and prevention policies for MSM.

Factors associated with unprotected anal sex with multiple non-steady partners in the past 12 months: results from the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS 2010).

BackgroundPractising unprotected anal intercourse (UAI) with high numbers of partners is associated with increased risk for acquiring and transmitting HIV and other sexually transmitted infections. Our aim was to describe factors associated with UAI with multiple partners in a large sample of MSM from 38 European countries recruited for an online survey in 2010.MethodsData are from the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS). The analysis was restricted to men who reported any anal sex with a non-steady partner in the past 12xa0months, and who were either never diagnosed with HIV, or who had been diagnosed with HIV more than 12xa0months ago, reported a detectable viral load and did not exclusively serosort (nu2009=u200991,477). Multivariable logistic regression was used to compare men reporting UAI with four or more (4+) non-steady partners to two comparison groups: a) no UAI with non-steady partners, and b) UAI with 1-3 non-steady partners.ResultsOverall, 9.6xa0% of the study population reported UAI with 4+ partners in the past 12xa0months. In both models, factors consistently associated with this behaviour were: having been diagnosed with HIV, lower educational levels, use of nitrite inhalants, drugs associated with sex and parties, or erectile dysfunction drugs in the past 4 weeks, using sex-on-site venues in the past 4 weeks, buying or selling sex in the past 12xa0months, having experienced physical violence due to sexual attraction to men in the past 12xa0months, reporting sexual happiness, being out to all or almost all of one’s acquaintances, and knowing that ART reduces HIV transmissibility.ConclusionsEffective antiretroviral treatment drastically reduces HIV transmission for men diagnosed with HIV, irrespective of partner numbers. Apart from reducing partner numbers or increasing condom use no other recommendations are currently in place to reduce the risk of HIV acquisition and onward transmission for HIV-negative men practicing UAI with multiple partners. A range of factors were identified as associated with UAI with four or more partners which allow the strengthening and targeting of prevention strategies to reduce HIV transmission risks resulting from condomless anal intercourse with multiple partners.

The Importance of Gender and Gender Nonconformity for Same-Sex-Attracted Dutch Youth's Perceived Experiences of Victimization Across Social Contexts

In this survey study, the impact of gender and gender nonconformity on Dutch same-sex-attracted youths perceived experiences of same-sex sexuality-related victimization was systematically compared across social contexts. Participants were between ages 16 and 18 and enrolled in secondary education (n = 305). In contexts of school and strangers, boys and participants reporting more gender nonconformity reported more perceived experiences of victimization. Effects were negligible in contexts of parents, extended family, and heterosexual friends. The effect of gender nonconformity was not stronger for boys than girls in any social context. Our findings underpin the role of context in victimization research.

Predicting adherence to combination antiretroviral therapy for HIV in Tanzania: A test of an extended theory of planned behaviour model

Objectives: Combination antiretroviral therapy (cART) for HIV is widely available in sub-Saharan Africa. Adherence is crucial to successful treatment. This study aimed to apply an extended theory of planned behaviour (TPB) model to predict objectively measured adherence to cART in Tanzania. Design: Prospective observational study (n = 158) where patients completed questionnaires on demographics (Month 0), socio-cognitive variables including intentions (Month 1), and action planning and self-regulatory processes hypothesised to mediate the intention–behaviour relationship (Month 3), to predict adherence (Month 5). Main outcome measures: Taking adherence was measured objectively using the Medication Events Monitoring System (MEMS) caps. Model tests were conducted using regression and bootstrap mediation analyses. Results: Perceived behavioural control (PBC) was positively (β = .767, p < .001, R2 = 57.5%) associated with adherence intentions. Intentions only exercised an indirect effect on adherence (B = 1.29 [0.297–3.15]) through self-regulatory processes (B = 1.10 [0.131–2.87]). Self-regulatory processes (β = .234, p = .010, R2 = 14.7%) predicted better adherence. Conclusion: This observational study using an objective behavioural measure, identified PBC as the main driver of adherence intentions. The effect of intentions on adherence was only indirect through self-regulatory processes, which were the main predictor of objectively assessed adherence.

S15.3 European MSM Internet Survey (EMIS): differences in sexually transmissible infection testing in European countries

Background Comparing rates of sexually transmissible infections (STIs) among men who have sex with men (MSM) in different European countries is challenging due to national differences in reporting systems, healthcare systems, infectious disease surveillance methods, quality of data, and/or levels of social acceptance of homosexual behaviours and openness about homosexuality. Methods From June through August 2010, the European MSM Internet Survey (EMIS) mobilised more than 180u2008000 respondents from 38 European countries to complete an online questionnaire in one of 25 languages. The questionnaire covered sexual happiness, HIV and STI-testing and diagnoses, unmet prevention needs, intervention performance, HIV-related stigma and gay-related discrimination. Recruitment was organised predominantly online, through gay social media, and links and banners on more than 100 websites for MSM all over Europe. Results Perceptions on access to free/affordable STI-testing differed across Europe (median: 80%; range: 40–95%); and was substantially correlated with reported recent STI-testing (R2=0.27). Quality of STI-testing was highly diverse: While blood-testing was common in all participating countries, only Ireland, Malta, and the UK seem to offer penile or particularly anal examinations as standard of care. In all participating countries HIV-positive respondents reported higher rates of both STI-testing and diagnosis. Self-reported STI-screening among men without HIV diagnosis ranged from 10% (Turkey) to 37% (Netherlands). Substantial correlations between rates of testing procedures appropriate for MSM (such as anal or genital swabs) and diagnosed gonorrhoea (R2HIV-pos=0.24) or Chlamydia infections were observed (R2HIV-pos=0.50; R2others=0.29). Conclusion Self-reported testing and diagnosis rates for bacterial STIs suggest high levels of under-diagnosis and unmet sexual healthcare needs in most European countries. In Europe, there is an urgent need to implement or improve sexual healthcare tailored to MSM-specific needs.