Jeffrey T. Parsons

Sexual harm reduction practices of HIV-seropositive gay and bisexual men : serosorting, strategic positioning, and withdrawal before ejaculation

Objective:This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk. Method:The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques. Results:City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco. Conclusion:Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

A Double Epidemic: Crystal Methamphetamine Drug Use in Relation to HIV Transmission Among Gay Men

Abstract Emerging research on methamphetamine use among gay men suggests that growth in the use of this drug could present serious problems for HIV/AIDS prevention within the gay community. This article summarizes current studies on the extent, role, and context of methamphetamine use among gay men and its relationship to high risk sexual behaviors related to HIV transmission. Methamphetamine is often used by gay men to initiate, enhance, and prolong sexual encounters. Use of the drug is, therefore, associated with particular environments where sexual contact among gay men is promoted, such as sex clubs and large “circuit” parties. Research with gay and bisexual men indicates that methamphetamine use is strongly associated with risky sexual behaviors that may transmit HIV. This relationship, coupled with emerging evidence that methamphetamine use is on the rise among gay men, suggests that the drug could exacerbate the HIV/AIDS epidemic among this community. The article offers recommendations for further research and suggestions for prevention programs regarding methamphet-amine use by gay men.

Race, ethnicity, gender, and generational factors associated with the coming‐out process among gay, lesbian, and bisexual individuals

Age at coming out among gay/lesbian/bisexual (GLB) persons and sexual debut with same‐gendered partners has typically been investigated in samples that do not reflect the racial and ethnic diversity of these communities. Addressing this limitation, data were collected from a diverse sample of men and women attending large‐scale GLB community events in New York and Los Angeles in 2003 (N = 2,733). Compared to older cohorts, younger cohorts (18–24 year olds) of both men and women reported significantly earlier ages for sexual debut with same‐gendered partners, and earlier ages for coming out to themselves and to others. Also, women began the process at later ages than men, as they reported coming out to themselves and sexual debut with a same‐gender partner approximately two years later than men. There were no racial or ethnic differences in age out to self or others; however, people of color were less likely to be out to their parents. Service providers, sexuality educators, and researchers should attend to the diversity in experience of coming out among GLB populations as they relate to the individuals’ gender, age, and racial and ethnic backgrounds.

Barebacking Among Gay and Bisexual Men in New York City: Explanations for the Emergence of Intentional Unsafe Behavior

This study was undertaken to assess the frequency with which gay and bisexual men in New York City engage in intentional unprotected anal sex, or “barebacking,” and to examine explanations about the emergence of barebacking. A total of 518 men completed a brief intercept survey. Of the 448 men who were familiar with the term “barebacking,” 204 (45.5%) reported bareback sex in the past 3 months prior to assessment. HIV seropositive men were significantly more likely than HIV seronegative men to report this behavior and reported significantly more sexual partners with which they had engaged in intentional unprotected anal intercourse. Participants reported significantly more acts of seroconcordant bareback sex (intentional unprotected anal intercourse with a partner of the same HIV status) than those of serodiscordant bareback sex. Men who reported barebacking also reported significantly more benefits associated with this behavior. The Internet and the availability of sexually oriented chat rooms, HIV treatment advances, emotional fatigue regarding HIV, and the increased popularity of “club” drugs were commonly cited as reasons for the barebacking phenomenon.

Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men

We examined substance use in relationship to transmission risk behavior (unprotected insertive, UIAI, or receptive anal intercourse, URAI) between HIV-positive men who have sex with men (MSM) and their HIV-negative or unknown serostatus partners. Men who engaged in transmission risk behavior with casual partners were more likely than men who did not engage in such behavior to have used various substances. Users of certain drugs were specifically less likely to use condoms with HIV-negative or unknown status partners than users. Of men who drank alcohol, those who drank more frequently before or during sex engaged in significantly more UIAI with casual partners. Of men who used drugs, those who used more frequently before or during sex were more likely to engage in URAI with casual partners. In multivariate analyses, use of inhalants as well as drinking before or during sex predicted UIAI, while use of inhalants as well as noninjection drug use before or during sex predicted URAI. HIV prevention programs for HIV-positive MSM should focus on decreasing substance use and use specifically before or during sex. Developing prevention programs for substance-using MSM is critical to improve community health and decrease HIV transmissions.

Sexual Compulsivity, Co-Occurring Psychosocial Health Problems, and HIV Risk Among Gay and Bisexual Men: Further Evidence of a Syndemic

OBJECTIVES We evaluated whether sexual compulsivity fits into a syndemic framework, in which sexual compulsivity is one of a number of co-occurring psychosocial health problems that increase HIV risk among men who have sex with men (MSM). METHODS In 2003 and 2004, we conducted an anonymous cross-sectional survey of MSM in New York City (n = 669) by approaching attendees at gay, lesbian, and bisexual community events. We analyzed data by bivariate and multivariate logistic regression. RESULTS We found strong positive interrelationships among syndemic factors including sexual compulsivity, depression, childhood sexual abuse, intimate partner violence, and polydrug use. In bivariate analyses, all syndemic health problems except for childhood sexual abuse were positively related to HIV seropositivity and high-risk sexual behavior. Our multivariate models revealed an array of interrelationships among psychosocial health problems. We found amplified effects of these problems on HIV seropositivity and on the likelihood of engaging in high-risk sexual behavior. CONCLUSIONS Our findings support the conclusion that sexual compulsivity is a component of a syndemic framework for HIV risk among MSM. HIV prevention interventions should consider the overlapping and compounding effects of psychosocial problems, including sexual compulsivity.

Preexposure Prophylaxis and Predicted Condom Use Among High-Risk Men Who Have Sex With Men

Objectives:Preexposure prophylaxis (PREP) is an emerging HIV prevention strategy; however, many fear it may lead to neglect of traditional risk reduction practices through behavioral disinhibition or risk compensation. Methods:Participants were 180 HIV-negative high-risk men who have sex with men recruited in New York City, who completed an Audio Computer Assisted Self Interview-administered survey between September 2007 and July 2009. Bivariate and multivariate logistic regression models were used to predict intention to use PREP and perceptions that PREP would decrease condom use. Results:Almost 70% (n = 124) of participants reported that they would be likely to use PREP if it were at least 80% effective in preventing HIV. Of those who would use PREP, over 35% reported that they would be likely to decrease condom use while on PREP. In multivariate analyses, arousal/pleasure barriers to condom use significantly predicted likelihood of PREP use (odds ratio = 1.71, P < 0.05) and risk perception motivations for condom use significantly predicted decreased condom use on PREP (odds ratio = 2.48, P < 0.05). Discussion:These data provide support for both behavioral disinhibition and risk compensation models and underscore the importance of developing behavioral interventions to accompany any wide-scale provision of PREP to high-risk populations.

Loneliness and HIV-related stigma explain depression among older HIV-positive adults

Abstract Advances in the treatment of HIV have resulted in a large growing population of older adults with HIV. These aging adults face added social, psychological, and physical challenges associated with the aging process. Correlations between depression, loneliness, health, and HIV/AIDS-related stigma have been studied, but there is little evaluation of these associations among HIV-positive adults over the age of 50. Data for these analyses were taken from the Research on Older Adults with HIV study of 914 New York City-based HIV-positive men and women over the age of 50. In total, 39.1% of participants exhibited symptoms of major depression (CES-D>23). Multivariate modeling successfully explained 42% of the variance in depression which was significantly related to increased HIV-associated stigma, increased loneliness, decreased cognitive functioning, reduced levels of energy, and being younger. These data underscore the need for service providers and researchers to assert more aggressive and innovative efforts to resolve both psychosocial and physical health issues that characterize the graying of the AIDS epidemic in the USA. Data suggest that focusing efforts to reduce HIV-related stigma and loneliness may have lasting effects in reducing major depressive symptoms and improving perceived health.

Recreational Drug Use and HIV-Risk Sexual Behavior Among Men Frequenting Gay Social Venues

Abstract The complex relationships between recreational non-injection drug use and HIV sexual risk behaviors have been documented throughout the epidemic. The purpose of this study was to (1) assess the extent of non-injection recreational drug use among gay and bisexual men frequenting gay social venues, as well as to assess recent initiation of substance use, especially “club drugs” and (2) document the interaction between drug use and risky sexual practices. Street recruitment methods were used to administer a survey to 202 gay or bisexual men recruited at ten gay social venues in New York City. The majority of participants reported substance use, and more than half reported the use of drugs other than alcohol. Participation in gay social venues such as bars, dance clubs, and bathhouses was associated with more substance use. Polydrug use, participation in gay venues, and HIV status were found to be associated with unprotected behaviors while under the influence. In multivariate analyses, the use of inhalant nitrates and alcohol were found to be the two substances that best predicted unprotected oral and analsexual behaviors.

Motivational Interviewing and Cognitive-Behavioral Intervention to Improve HIV Medication Adherence Among Hazardous Drinkers: A Randomized Controlled Trial

Objective:To assess the efficacy of a behavioral intervention designed to improve HIV medication adherence and reduce alcohol consumption among HIV-positive men and women. Design:A randomized controlled trial conducted between July 2002 and August 2005. Setting:A behavioral research center in New York City. Participants:HIV-positive men and women (n = 143) who were on HIV antiretroviral medication and met criteria for hazardous drinking. Intervention:Participants were randomly assigned to an 8-session intervention based on motivational interviewing and cognitive-behavioral skills building or a time- and content-equivalent educational condition. Outcome Measures:Viral load, CD4 cell count, and self-reported adherence and drinking behavior were assessed at baseline and at 3- and 6-month follow-ups. Results:Relative to the education condition, participants in the intervention demonstrated significant decreases in viral load and increases in CD4 cell count at the 3-month follow-up and significantly greater improvement in percent dose adherence and percent day adherence. There were no significant intervention effects for alcohol use, however, and effects on viral load, CD4 cell count, and adherence were not sustained at 6 months. Conclusions:An 8-session behavioral intervention can result in improvement in self-report and biologic markers of treatment adherence and disease progression. This type of intervention should be considered for dissemination and integration into HIV clinics providing comprehensive care for HIV-positive persons with alcohol problems. Although the effect was attenuated over time, future studies might test the added effectiveness of booster sessions or ongoing adherence counseling.