M. Isabel Fernandez

High Rates of Club Drug Use and Risky Sexual Practices Among Hispanic Men Who Have Sex with Men in Miami, Florida

This study measured use of club drugs among 262 Hispanic men who have sex with men (MSM) recruited at community venues in Miami-Dade County, Florida in 2001. More than 50% of men used club drugs, and 36% used them in the last 3 months. Lifetime and 3-month rates were: ecstasy (36% and 20%), cocaine (34% and 12%), amyl nitrates (28% and 9%), and crystal methamphetamine (20% and 15%). Thirty-six percent had used two or more drugs (polydrug use) in their lifetime and 20% reported polydrug use in the last 3 months. Club drug users had significantly more sex partners in the last 12 months than nonclub drug users. High rates (35%) of unprotected anal sex in the last 3 months were reported by both groups. Men who reported polydrug use in the last 3 months were significantly more likely than men who used a single club drug to have had sex under the influence of club drugs (83% vs. 57%; X2 = 7.4, p = 0.006). At the multivariate level, a significant association between preference for use of English and lifetime club drug use emerged. Effective interventions to reduce club drug use and risky sex for Hispanic MSM are needed.

The acceptability and feasibility of an HIV preexposure prophylaxis (PrEP) trial with young men who have sex with men.

Background:This study examined the feasibility of a combination prevention intervention for young men who have sex with men (YMSM), an anticipated target population for HIV preexposure prophylaxis (PrEP). Methods:Project PrEPare, a pilot study using a randomized 3-arm design, compared an efficacious behavioral HIV prevention intervention (Many Men, Many Voices—3 MV) alone, 3 MV combined with PrEP (tenofovir/emtricitabine), and 3 MV combined with placebo. Eligible participants were 18- to 22-year-old HIV-uninfected men who reported unprotected anal intercourse in the past year. Participants were screened for preliminary eligibility at youth venues and community organizations and were also referred through social networks. Laboratory screening determined final eligibility. Behavioral and biomedical data were collected at baseline and every 4 weeks thereafter for 24 weeks. Results:Sixty-eight youth (mean age = 19.97 years; 53% African American, 40% Latino) were enrolled; 58 were randomized. Self-reported medication adherence averaged 62% (range, 43%–83%), whereas rates of detectable tenofovir in plasma of participants in the emtricitabine/tenofovir disoproxil fumarate arm ranged from 63.2% (week 4) to 20% (week 24). There were 5 ≥ grade 2 adverse events possibly/probably related to the study medication. Sexual risk behavior declined from baseline to week 24 in all study arms. Conclusions:The feasibility of enrolling at-risk youth, particularly young men who have sex with men of color, into Project PrEPare has been demonstrated. The acceptability of the group intervention along with counseling and testing was high. Self-reported medication adherence and corresponding plasma drug concentrations were low indicating the need for enhanced adherence counseling. Exploration of PrEP use among youth in nonrandomized open label trials is warranted.

Predictors of Unprotected Sex among Young Sexually Active African American, Hispanic, and White MSM: The Importance of Ethnicity and Culture

Despite the recognized need for culturally tailored HIV prevention interventions for gay, bisexual, and questioning youth, few studies have examined if predictors of unprotected sex vary for youth from different ethnic groups. This study reports on a sample of 189 gay, bisexual, and questioning youth (age 15–22) from three racial/ethnic backgrounds (African American, Hispanic, and White) recruited in Chicago, IL and Miami-Dade and Broward Counties, Florida. For African American youth, being in a long-term relationship, having been kicked out of the home for having sex with men, and younger age at initiation of sexual behavior were associated with unprotected sex. For Hispanic youth, higher ethnic identification and older age at initiation of sexual behavior were associated with unprotected sex. For White youth, no predictors were associated with unprotected sex. Our findings point to the importance of understanding the varying predictors of unprotected sex and integrating them into tailored prevention interventions.

Psychosocial and Behavioral Correlates of Depression Among HIV-Infected Pregnant Women

This study addressed two aims: (1) to assess the level of depressive symptoms among pregnant, HIV-infected racial and ethnic minority women and (2) to identify potentially modifiable factors associated with prenatal depression in order to foster proactive clinical screening and intervention for these women. Baseline interview data collected from HIV-infected women participating in the Perinatal Guidelines Evaluation Project were analyzed. Participants were from prenatal clinics in four areas representative of the U. S. HIV/AIDS epidemic among women. Of the final sample (n = 307), 280 were minorities (218 blacks [African American and Caribbean], 62 Hispanic). Standardized interviews assessed potential psychosocial factors associated with pregnancy-related depression and psychological distress (life stressors, inadequate social support, and ineffective coping skills) in a population for whom little work has been done. Depressive symptomatology was considerable, despite excluding somatic items in order to avoid confounding from prenatal or HIV-related physical symptoms. The psychosocial factors significantly predicted the level of prenatal depressive symptoms beyond the effects of demographic and health-related factors. Perceived stress, social isolation, and disengagement coping were associated with greater depression, positive partner support with lower depression. These findings demonstrate that psychosocial and behavioral factors amenable to clinical intervention are associated with prenatal depression among women of color with HIV. Routine screening to identify those currently depressed or at risk for depression should be integrated into prenatal HIV-care settings to target issues most needing intervention.

Intimacy and sexual behavior among HIV-positive men-who-have-sex-with-men in primary relationships

Unprotected anal intercourse among men-who-have-sex-with-men (MSM) occurs more frequently between partners in a primary relationship than between nonprimary partners. Although research supports the role of social support in risky sex, findings also suggest that the reasons associated with risky sex differ depending on both the relationship status and HIV-serostatus of MSM. This study assessed whether level of intimacy within a primary relationship helps to explain risky sex among a sample of 78 HIV-positive MSM currently involved in a primary relationship. Findings suggest that both drug use prior to sex and HIV status of the primary partner moderate the relationship between intimacy and sexual risk behaviors. Under levels of low drug use, greater intimacy functioned as a protective factor within seroconcordant relationships whereas it functioned as a risk factor within serodiscordant relationships. Implications for educational and clinical interventions are discussed.

Sexual and ethnic identity development among gay-bisexual-questioning (GBQ) male ethnic minority adolescents.

Identity development is a critical task of adolescence and occurs across multiple areas of self-identification. Although research on the identity development process among individuals who are ethnic and sexual minorities has been conducted for individuals who have 1 minority status or the other, few studies have examined these processes in people who are both ethnic and sexual minorities. In this qualitative study, the authors examined the dual identity development processes related to ethnic and sexual identity among gay-bisexual-questioning (GBQ) Latino and African American male adolescents. Results indicated that the processes associated with the development of sexual orientation and ethnic identity occur concurrently. However, the actual processes involved with the development of each identity not only differed, but seemed to be independent of each other because neither process was referenced in the development of the other. Overall, the process of ethnic identity development involved the process of becoming aware of ones ethnic and cultural heritage, whereas sexual identity development involved finding ones own personally relevant sexual orientation label and connecting to that community. The implications of these findings for the development of interventions to assist in the healthy development of GBQ adolescents are discussed.

Perceived stress mediates the effects of coping on the quality of life of HIV-positive women on highly active antiretroviral therapy

This study examined the relationship between three HIV-specific coping strategies (cognitive coping strategies, denial, and religious coping) and quality of life (QoL) in 90 HIV+, predominately minority women on highly active antiretroviral therapy. Religious coping was unrelated to QoL; however, use of cognitive coping strategies was related to greater QoL, and denial was related to poorer QoL. Baron and Kennys model of mediation was then used to test perceived stress as a mediator of the relationships between denial and cognitive coping strategies and QoL. These relationships were both mediated by perceived stress. Results suggest that utilization of certain coping strategies may lessen or heighten perceptions of life stressfulness, thereby influencing QoL in this understudied population.

Surfing New Territory: Club-Drug Use and Risky Sex Among Hispanic Men Who Have Sex with Men Recruited on the Internet

The Internet presents unique and growing opportunities for conducting HIV/STD research. This article reports on the first 171 participants enrolled in an ongoing study examining use of the Internet to recruit Hispanic men who have sex with men (HMSM) living in an AIDS epicenter to participate in community-based studies. First, it descibes initial success with chatroom recruitment. Second, it compares the demographic, psychosocial, and sexual risk practices among HMSM recruited through the Internet who had used club drugs in the last 6 months and those who had not. In 2 months, 211 hours were spent recruiting in chatrooms; 735 chatroom users were engaged. Researchers used a scripted dialogue to describe the study and to invite chatroom users to visit the study’s community sites for screening and enrollment. One bundred and seventy-six men came to the community sites; 172 (98%) were eligible and completed an audio-computer assisted self-interview. In the last 6 months, 48.5% of the sample had used club drugs [defined as cocaine, crystal methamphetamines (crystal), amyl nitrites (poppers), Ecstasy, gammahydroxybutyrate (GHB), ketamine (Special K), and Viagra]. The proportion of men reporting use of each drug was: cocaine (15.8%), crystal (11.7%), poppers (31.6%), Ecstasy (14%), GHB (3.5%), Special K (3.5%), and Viagra (19.3%). In multivariate analyses, having higher number of sex partners, having higher social isolation scores, and having engaged in unprotected receptive anal intercourse were significantly associated with club-drug use. These initial findings suggest that high-risk HMSM can be successfully recruited through chatroom dialogues to participate in community-based HIV studies. The alarmingly high rates of club-drug use and risky sexual practices among HMSM underscore the need for effective HIV preventive interventions for this population.

Correlates of Heterosexual Anal Intercourse Among At-Risk Adolescents and Young Adults

OBJECTIVES We sought to learn what factors are associated with anal intercourse among adolescents and young adults. We examined demographic, behavioral, relationship context, attitudinal, substance use, and mental health correlates of recent heterosexual anal intercourse among adolescents and young adults who reported engaging in recent unprotected sex. METHODS Among 1348 at-risk adolescents and young adults aged 15 to 21 years in 3 US cities, we assessed sexual risk behavior with each sexual partner in the past 90 days. Data were collected from 2000 to 2001. RESULTS Recent heterosexual anal intercourse was reported by 16% of respondents. Females who engaged in anal intercourse were more likely to be living with a sexual partner, to have had 2 or more partners, and to have experienced coerced intercourse. For males, only a sexual orientation other than heterosexual was a significant predictor of engaging in heterosexual anal intercourse. CONCLUSIONS Our findings document the prevalence of heterosexual anal intercourse among adolescents and young adults who had recent unprotected sex. Among females, the variables associated with anal intercourse relate to the context and power balance of sexual relationships. Different influences for males and females suggest different foci for interventions.

Physical and Sexual Violence During Pregnancy and After Delivery: A Prospective Multistate Study of Women With or at Risk for HIV Infection.

OBJECTIVES We sought to describe and compare prevalence rates of and risk factors for violence against women during pregnancy and postpartum. METHODS Physical and sexual violence and violence risk factors were assessed during late pregnancy and 6 months postpartum in a prospective study of pregnant women with (n=336) and without (n=298) HIV in 4 US states. RESULTS Overall, 10.6% of women reported having experienced violence, 8.9% during pregnancy and 4.9% after delivery. Of these women, 61.7% were abused only during their pregnancy, 21.7% were repeatedly abused, and 16.7% were abused only after their delivery. Sexual violence rarely occurred in the absence of physical violence. The strongest predictor of violence was engaging in bartered sex (adjusted odds ratio [OR]=5.54; 95% confidence interval [CI] =2.0, 15.4). Other predictors included frequent changes in residence (adjusted OR=1.57; 95% CI=1.1, 2.2), financial support from family or partners (adjusted OR=0.42; 95% CI=0.2, 0.8), and HIV diagnosis during current pregnancy (adjusted OR=0.30; 95% CI=0.1, 0.7). CONCLUSIONS Women more commonly experienced violence during than after their pregnancy, but violence was best predicted by socioeconomic and behavioral indicators whose influence did not vary over time.