Heather A. Joseph

An Online Randomized Controlled Trial Evaluating HIV Prevention Digital Media Interventions for Men Who Have Sex with Men

Background As HIV infection continues unabated, there is a need for effective interventions targeting at-risk men who have sex with men (MSM). Engaging MSM online where they meet sexual partners is critical for HIV prevention efforts. Methods A randomized controlled trial (RCT) conducted online among U.S. MSM recruited from several gay sexual networking websites assessed the impact of 2 HIV prevention videos and an HIV prevention webpage compared to a control condition for the study outcomes HIV testing, serostatus disclosure, and unprotected anal intercourse (UAI) at 60-day follow-up. Video conditions were pooled due to reduced power from low retention (53%, n = 1,631). No participant incentives were provided. Principal Findings Follow-up was completed by 1,631 (53%) of 3,092 eligible men. In the 60 days after the intervention, men in the pooled video condition were significantly more likely than men in the control to report full serostatus disclosure (‘asked and told’) with their last sexual partner (OR 1.32, 95% CI 1.01–1.74). Comparing baseline to follow-up, HIV-negative men in the pooled video (OR 0.70, 95% CI 0.54–0.91) and webpage condition (OR 0.43, 95% CI 0.25–0.72) significantly reduced UAI at follow-up. HIV-positive men in the pooled video condition significantly reduced UAI (OR 0.38, 95% CI 0.20–0.67) and serodiscordant UAI (OR 0.53, 95% CI 0.28–0.96) at follow-up. Conclusions/Significance Findings from this online RCT of MSM recruited from sexual networking websites suggest that a low cost, brief digital media intervention designed to engage critical thinking can increase HIV disclosure to sexual partners and decrease sexual risk. Effective, brief HIV prevention interventions featuring digital media that are made widely available may serve as a complementary part of an overall behavioral and biomedical strategy for reducing sexual risk by addressing the specific needs and circumstances of the target population, and by changing individual knowledge, motivations, and community norms. Trial Registration ClinicalTrials.gov NCT00649701

Older partner selection, sexual risk behaviour and unrecognised HIV infection among black and Latino men who have sex with men

Objectives The authors examine whether young black and Latino men who have sex with men (MSM) who have older sex partners are more likely than those who do not have older sex partners to have unrecognised HIV infection. The authors examine whether the association stems from (1) increased sexual risk behaviour with male partners of any age, (2) heightened risk of being exposed to HIV infection by older partners or (3) a combination of these two factors. Methods The analytical sample consisted of 723 black and Latino MSM, aged 18–35 years, who were HIV negative or of unknown serostatus at study entry. Participants completed a self-administered questionnaire and were tested for HIV infection. Men who reported having a male sex partner who was at least 4 years older than themselves were compared with those who did not. Outcomes included unprotected receptive anal intercourse (URAI) with male partners of any age (past 3 months) and having unrecognised HIV infection. Results Men with older partners reported a higher prevalence of URAI (AOR=1.50, 95% CI 1.02 to 2.21). A second model found that men with older partners had increased odds of having unrecognised HIV infection (AOR=2.51, 95% CI 1.18 to 5.34) after controlling for the number of URAI partners of any age, which remained an independent predictor. Conclusions Young black and Latino MSM who had older male sex partners were at increased risk of having unrecognised HIV infection. This heightened risk was associated with sexual risk behaviour with partners of any age as well as possible increased exposure to HIV infection from older partners.

Beliefs about transmission risk and vulnerability, treatment adherence, and sexual risk behavior among a sample of HIV-positive men who have sex with men

Abstract Advances in HIV treatment have generated optimistic beliefs about HIV transmission risk and sexually transmitted infection vulnerability, which can influence motivation to practice safer sex. This study sought to better understand the relationships between these beliefs and different types of sexual risk behavior. A second objective was to determine the association between treatment adherence and sexual risk behaviors. Data collected from 842 HIV-positive men who have sex with men on treatment were examined. Eleven questions measured beliefs regarding HIV transmission risk and vulnerability to other infections or negative health outcomes. The main outcomes were concordant and discordant unprotected anal sex with main and non-main male partners. Thirty-four percent reported concordant and 41% reported discordant unprotected anal sex in the past three months: 26% reported discordant insertive unprotected anal sex. In all multivariate logistic regression models predicting sexual risk behaviors, at least one belief item remained statistically significant. Different patterns of associations between beliefs and sexual risk were observed across partner type and serostatus. Compared to transmission risk beliefs, more vulnerability beliefs were associated with sexual risk. Missing at least one treatment dose in the past month was associated with concordant and discordant sexual risk with non-main partners, while intentionally missing a dose was associated with only discordant risk with non-main partners. Post hoc moderator analysis explored potential interaction between beliefs and adherence. The belief that a low viral load lowers transmission risk was positively associated with discordant sex with non-main partners only among those who missed a dose intentionally. These results underscore the complex relationship between HIV transmission risk and vulnerability beliefs and sexual behavior with different types of partners. Prevention programs should carefully consider how to craft and tailor messages about medical advances while at the same time reinforcing the need for continued sexual safety.

TB perspectives among a sample of Mexicans in the United States: results from an ethnographic study.

ObjectiveA study was conducted to describe the sociocultural aspects of tuberculosis (TB) among Mexicans in the U.S. and to provide TB programs with practical recommendations for serving this population.MethodsIn-depth, structured, open-ended interviews were conducted with 50 persons from Mexico living in the U.S. Local bilingual, bicultural researchers conducted the interviews with respondents recruited from TB clinics and surrounding communities. Both qualitative and quantitative strategies were used to analyze the data.ResultsWe found diverse TB perceptions and attitudes, but few were associated with specific participant characteristics. We detected widespread misperceptions about TB transmission and low perceptions of risk. Anticipated TB stigma among those with no history of disease was qualitatively greater than reported stigma among those who had TB disease. We also detected missed opportunities for TB education. Reported barriers to care included lack of transportation, limited clinic hours, cost of services, inconvenient clinic location, and communication problems with staff.ConclusionsTo address the diverse needs of Mexican-born clients, we recommend that TB programs provide culturally-appropriate, patient-centered care. We suggest several strategies aimed at raising risk awareness and reducing stigma. Finally, we encourage programs to facilitate access by providing language-appropriate services, extending clinic hours, and facilitating transportation.

Girlfriends: evaluation of an HIV-risk reduction intervention for adult transgender women.

This study evaluated Girlfriends, a behavioral HIV intervention, developed for male-to-female transgender persons, for whom there are few scientifically evaluated prevention programs. The Girlfriends intervention included four group-level sessions. We used a single group, pre-post test design to assess changes in sexual risk behaviors at 3-month follow-up. We enrolled 63 transgender women into the study. Forty-six percent were Hispanic and 35% were African American. Three months after the intervention, participants had fewer sexual partners (p = .043) and were less likely to have any unprotected anal intercourse (UAI) with male exchange partners (p = .013) and unprotected sex at last vaginal or anal sex episode with female and male partners (p = .039). The findings of this study are promising. We observed behavioral effects among a largely ethnic minority sample of transgender women. Replication with a larger sample and a control group is needed.

HIV testing among sexually active Hispanic/Latino MSM in Miami-Dade County and New York City: opportunities for increasing acceptance and frequency of testing.

HIV testing behavior is important in understanding the high rates of undiagnosed infection among Hispanic/Latino men who have sex with men (MSM). Correlates of repeat/recent testing (within the past year and ≥5 tests during lifetime) and test avoidance (never or >5 years earlier) were examined among 608 sexually active Hispanic/Latino MSM (Miami-Dade County and New York City). Those who reported repeat/recent testing were more likely to have incomes over

Keep it up: development of a community-based health screening and HIV prevention strategy for reaching young African American men.

30,000, speak English predominately, and have visited and disclosed same-sex behavior to a health care provider (HCP) in the past year. Those who were classified as test avoiders were less likely to have incomes over

Anal intercourse without condoms among HIV-positive men who have sex with men recruited from a sexual networking web site, United States.

10,000 and to have seen an HCP in the past year. The main reason for not testing (in both groups) was fear of HIV positivity; however, twice as many test avoiders considered this their main reason, and more test avoiders had confidentiality concerns. Results suggest that messages to encourage testing among Hispanic/Latino MSM may be most effective if past testing patterns and reasons for not testing are considered. HCPs can play an important role by consistently offering HIV tests to MSM and tailoring messages based on prior testing histories.

Elevation as a proxy for mosquito-borne Zika virus transmission in the Americas.

This article addresses the challenge of developing HIV prevention interventions that not only prove to be efficacious but also are designed from the outset to overcome obstacles to reaching priority populations. We describe how community input has informed development of Keep It Up (KIU), a community health screening and behavioral prevention program for young Black men. KIU embeds HIV prevention in a broader health promotion campaign, with the goal of reducing stigma and reaching a population that bears a disproportionate burden of HIV/AIDS and other health problems-hypertension, high cholesterol, diabetes, asthma, and obesity. Information from community partners, expert advisers, and focus groups was collected at key junctures and incorporated into four core components: social marketing, a computerized behavioral learning module, biological testing for HIV and other conditions, and a personalized health profile and risk reduction plan. A pilot with 116 participants provided evidence that the KIU model of integrating HIV prevention with other health screening is acceptable and has the potential to reach Black men at risk for HIV as well as other chronic health conditions.

Structural Interventions in HIV Prevention: A Taxonomy and Descriptive Systematic Review

Background The changing landscape of HIV prevention in the United States underscores the need to improve our ability to efficiently reach HIV-positive men who have sex with men (MSM) who engage in behaviors that could transmit HIV. Methods We examined the prevalence of anal intercourse (AI) without condoms with HIV-negative or unknown serostatus partners (“at-risk partners”) among 1319 HIV-positive adult male members of a sexual networking Web site for MSM. Sexual behaviors and substance use were measured over a 60-day recall period. Logistic regression was used to identify correlates of insertive and receptive AI without condoms with at-risk partners. Results Approximately 25% of the men had been diagnosed as having HIV 12 months or less before study enrollment. Overall, 32% of men engaged in AI without condoms with at-risk partners. Multiple logistic regression identified behavioral predictors of insertive AI without condoms with at-risk partners, including HIV diagnosis within the last 12 months, sex with multiple male partners, substance use in conjunction with sex, and use of phosphodiesterase type 5 inhibitors. Receptive AI without condoms with at-risk partners was associated with younger age (19–24 years), residing outside metropolitan cities, substance use in conjunction with sex, and having multiple male partners. Conclusions High levels of sexual risk were found among these MSM. Increased Internet-based HIV prevention marketing efforts and prevention strategies should be considered to efficiently reach HIV-positive MSM who engage in serodiscordant AI without condoms.