Kyung-Hee Choi

Prevention of HIV infection.

This paper presents a study which critically reviews the scientific literature on AIDS prevention programs in an attempt to determine the extent to which behavioral intervention research has demonstrated the efficacy of methods for risk behavior reduction. Its focus is on addressing the three most critical questions in intervention research: 1) have AIDS prevention programs had long-term success in behavior change; 2) what recommendations can be made to program developers; and 3) where should HIV prevention research be heading.

Positive and negative life events after counselling and testing : the Voluntary HIV-1 Counselling and Testing Efficacy Study

IntroductionThe results of the Voluntary HIV-1 Counselling and Testing Efficacy Study support the efficacy and cost-effectiveness of HIV voluntary counselling and testing (VCT) for reducing risk behaviors in three developing countries. MethodsThis report explores the social consequences of HIV VCT by examining the incidence of positive and negative life events at the first follow-up (an average of 7.3 months after recruitment). The incidence of positive and negative life events was compared between: (i) those who were randomly assigned to HIV VCT versus health information (HI); (ii) those who tested seronegative and those who tested seropositive; and (iii) those who disclosed their serostatus and those who did not. ResultsThe occurrence of most negative life events was rare (0–4%); positive life events were more common (17–39%). With few exceptions, those assigned to HIV VCT were no more likely to experience negative life events than those who were assigned to HI. For individuals, positive serostatus was associated with increased support from health professionals, the break-up of a marriage and being neglected or disowned by their family. Serodiscordant couples with an HIV-positive woman were most likely to report the break-up of a marriage (20 versus 0–7% for other groups) and the break-up of a sexual relationship (45 versus 22–38% for other groups). Disclosure was associated with strengthening of a sexual relationship except for HIV-seropositive women. ConclusionThese findings, in combination with findings supporting the efficacy and cost-effectiveness of HIV VCT, support the dissemination of HIV VCT with appropriate support services in developing countries.

Emerging HIV-1 epidemic in China in men who have sex with men

China is currently undergoing a serious HIV-1 epidemic in intravenous drug users, sex workers, and former plasma donors. Little is known, however, about HIV-1 risk in Chinese men who have sex with men. In this study of seroprevalence in such men in Beijing, we recorded 15 (3.1%, 95% CI 1.8-5.1) of 481 men infected with HIV-1. Overall, 238 (49%) of participants reported unprotected anal intercourse during the previous 6 months. HIV-1 seropositivity was independently associated with being older than 39 years and having had more than 20 male sexual partners. Most men older than 39 years had been married. Our findings suggest the potential for spread of HIV-1 between men who have sex with men and to their heterosexual partners.

The influence of social and sexual networks in the spread of HIV and syphilis among men who have sex with men in Shanghai, China.

Objectives:To analyze characteristics of social and sexual networks and their role as risk factors for HIV and syphilis among men who have sex with men (MSM) in Shanghai, China. Design:A cross-sectional study. Methods:We recruited 477 participants using a snowball sampling method. We administered a face-to-face questionnaire and provided testing and counseling for HIV and syphilis. Results:The prevalences of HIV and markers for syphilis were 1.47% (95% confidence interval [CI]: 0.59 to 3.01) and 13.47% (95% CI: 10.53 to 16.88), respectively. The independent factors associated with lower risk for syphilis infection were having a contact network, overlap of social and sexual networks, meeting other MSM at the gym or through the Internet, having 3 to 5 lifetime male anal sex partners, and having a female steady sex partner. A larger male sexual network size, having been married, being more knowledgeable about HIV, having 6 or more lifetime male anal sex partners, and having steady male or female sex partners were independently associated with having unprotected anal or vaginal intercourse. Conclusions:Significant associations were found between network characteristics and syphilis infection and unprotected sex. Network-based interventions should be developed to reduce this HIV risk among MSM in China.

Extramarital sex and HIV risk behavior among US adults: results from the National AIDS Behavioral Survey.

Data from the National AIDS Behavioral Survey were used to examine the social distribution of extramarital sex and risk for human immunodeficiency virus (HIV) infection among married individuals in the United States. Of 1686 married respondents living across the United States, 2.2% reported extramarital sex; of 3827 married respondents living in 23 urban areas with large Hispanic or African-American populations, 2.5% reported having sexual partners outside marriage. The data indicate that the correlates of extramarital sex varied by race/ethnicity. Low levels of condom use were found among people reporting extramarital sex (8% to 19% consistent users).

Injecting drug use and HIV infection in southwest China.

Objectives:To determine the prevalence of drug injection among drug users, the seroprevalence of HIV and risk factors for HIV infection among injecting drug users (IDU), and to determine heterosexual transmission of HIV among IDU and their spouses in southwest China. Methods:Using a cross-sectional design, we conducted an HIV seroprevalence and behavioral survey in three rural counties of Yunnan province, Ruili, Longchuan and Luxi in southwest China, bordering Myanmar (Burma). A total of 860 drug users were recruited in randomly selected communities at the three study sites (response rate, 97%). In addition, a random sample of 62 wives of HIV-infected IDU were assembled from 460 known HIV-positive IDU in Ruili and Longchuan (response rate, 81%). Results:In the sample of 860 drug users, 33% reported injecting drugs. Among the 282 subjects who injected drugs, 82% began intravenous drug use after 1988; 64% injected drugs at least once every day. All subjects shared needles but none cleaned the injection equipment with alcohol or bleach. Overall, 49% tested HIV-positive. HIV seropositivity was independently correlated with a longer history of drug injecting, daily injecting, frequent needle-sharing, being younger, and living in Ruili county. Among the 62 wives of HIV-positive IDU, none used condoms during sex and 10% tested HIV-positive. Conclusions:We conclude that the introduction of HIV into drug-using communities and the rapid increase in heroin injecting in this population appear to have triggered an explosive HIV epidemic among IDU in southwest China. We recommend that AIDS prevention efforts should begin immediately and focus on discouraging the shift from opium smoking to heroin injecting, needle-sharing, and unprotected sex among drug users and their partners.

The efficacy of brief group counseling in HIV risk reduction among homosexual Asian and Pacific Islander men.

ObjectivesThe incidence of AIDS is increasing at a higher rate among homosexual Asian and Pacific Islanders (API) than white homosexual men in the United States. The number of homosexual API men engaging in unsafe sex is increasing at an alarming rate. HIV risk reduction is urgently needed in this population. Subjects and methodsWe developed and evaluated culturally appropriate brief group counseling with 329 self-identified homosexual API recruited in San Francisco between 1992 and 1994. Participants were randomized into a single, 3-h skills training group or a wait-list control group. The intervention consisted of four components: (1) development of positive self-identity and social support, (2) safer sex education, (3) eroticizing safer sex, and (4) negotiating safer sex. Data were collected at baseline and 3 months after the intervention. ResultsSignificant reductions in number of sexual partners were observed among all treatment subjects, regardless of ethnicity (P= 0.003). Treatment decreased the number of partners reported at 3-month follow-up by 46% [95% confidence interval (CI), 28–77]. Chinese and Filipino men further benefited from the intervention: treatment subjects from these two ethnic groups reduced unprotected anal intercourse at follow-up by more than half when compared to their counterparts (odds ratio = 0.41; 95% CI, 0.19–0.89; P= 0.024). ConclusionsWe demonstrated the efficacy of brief group counseling in reducing HIV risk among homosexual API. Cities with significant API populations should adopt culturally tailored skills training as part of HIV prevention strategies for this group of homosexual men.

Assessment of Stigma Towards Homosexuality in China: A Study of Men Who Have Sex with Men

Previous research has documented the deleterious impact of homosexuality stigma on HIV sexual risk behavior among men who have sex with men (MSM) and the vulnerability of this group in China for HIV acquisition. Factor analysis of 10 survey items from 477 MSM from Shanghai yielded two factors: Perceived stigma assessed participants’ impressions of the degree of societal stigmatization of homosexuals whereas enacted stigma measured direct personal experiences of stigmatizing behaviors. Enacted stigma exhibited satisfactory internal reliability and was associated with HIV sexual risk behavior. Further research is needed to refine perceived and other stigma constructs for Chinese MSM.

Strategies for Managing Racism and Homophobia among U.S. Ethnic and Racial Minority Men Who Have Sex with Men.

Despite widespread recognition that experiences of social discrimination can lead to poor physical and mental health outcomes for members of minority groups, little is known about how U.S. ethnic minority men who have sex with men (MSM) manage their experiences of racism and homophobia. We conducted six focus group discussions (n = 50) and 35 in-depth interviews with African American, Latino, and Asian and Pacific Islander MSM (aged 18 or older) recruited in Los Angeles. This process revealed five strategies that MSM of color employed in order to mitigate the impact of racism and homophobia. To minimize opportunities for stigmatization, men used (a) concealment of homosexuality and (b) disassociation from social settings associated with stigmatization. To minimize the impact of experienced stigma, men (c) dismissed the stigmatization and (d) drew strength and comfort from external sources. Men also actively countered stigmatization by (e) direct confrontation. More research is needed to understand the efficacy of these coping strategies in mitigating negative health consequences of stigmatization and discrimination.

Social Discrimination, Concurrent Sexual Partnerships, and HIV Risk Among Men Who have Sex with Men in Shanghai, China

We examined the potential mediating role of sex partner concurrency in explaining associations between experiences of homophobia and financial hardship and HIV risk behavior among a sample of 477 men who have sex with men (MSM) recruited in Shanghai, China from 2004 to 2005. We found significant positive direct associations of experiences of homophobia and financial hardship with having unprotected anal sex with men. These associations were not mediated by male partner concurrency. However, male partner concurrency had a direct effect on having unprotected anal sex with men. Male and female partner concurrency did not mediate the significant association between experiences of homophobia and having unprotected anal/vaginal sex with both men and women, but was positively associated with having unprotected anal/vaginal sex with both men and women. These results suggest that homophobia, financial hardship, and sex partner concurrency should be addressed to help reduce sexual risk for HIV among MSM in China.