Nancy Willard

Methamphetamine Use and Risk for HIV Among Young Men Who Have Sex With Men in 8 US Cities

OBJECTIVES To examine methamphetamine use and its association with sexual behavior among young men who have sex with men. DESIGN Cross-sectional observational analysis. SETTING Eight US cities. PARTICIPANTS As part of the Adolescent Trials Network for HIV/AIDS Interventions, adolescent boys and young men who have sex with men, aged 12 to 24 years, were recruited from social venues (e.g., clubs, parks, and street corners) between January 3, 2005, and August 21, 2006, to complete a study survey. MAIN OUTCOME MEASURES Reported methamphetamine use in the past 90 days and reported sexual risk behavior compared with individuals reporting no hard drug use and individuals reporting hard drug use in the past 90 days. RESULTS Among 595 adolescent boys and young men, 64 reported recent methamphetamine use, and 444 reported no recent hard drug use (87 reported use of hard drugs other than methamphetamine). Recent methamphetamine use was associated with a history of sexually transmitted diseases (51.6%), 2 or more sex partners in the past 90 days (85.7%), sex with an injection drug user (51.6%), and sex with someone who has human immunodeficiency virus (32.8%) compared with individuals reporting no recent hard drug use (21.1%, 63.1%, 10.7%, and 11.1%, respectively; P < .05 for all [n = 441]). Recent users of methamphetamine were more likely to have a history of homelessness (71.9%) and were less likely to be currently attending school (35.9%) compared with individuals reporting no recent hard drug use (28.4% and 60.4%, respectively; P < .001 for both). CONCLUSIONS Adolescent boys and young men who have sex with men and use methamphetamine seem to be at high risk for human immunodeficiency virus. Prevention programs among this age group should address issues like housing, polydrug use, and educational needs.

MOBILIzINg COMMUNITIES AROUND HIV PREVENTION FOR YOUTH: HOW THREE COALITIONS APPLIED KEY STRATEgIES TO BRINg ABOUT STRUCTURAL CHANgES

Increasingly, HIV prevention efforts must focus on altering features of the social and physical environment to reduce risks associated with HIV acquisition and transmission. Community coalitions provide a vehicle for bringing about sustainable structural changes. This article shares lessons and key strategies regarding how three community coalitions located in Miami and Tampa, Florida, and San Juan, Puerto Rico engaged their respective communities in bringing about structural changes affecting policies, practices and programs related to HIV prevention for 12-24-year-olds. Outcomes of this work include increased access to HIV testing and counseling in the juvenile correctional system (Miami), increased monitoring of sexual abuse between young women and older men within public housing, and support services to deter age discordant relationships (Tampa) and increased access to community-based HIV testing (San Juan).

Correlates of HIV Testing History among Urban Youth Recruited through Venue-Based Testing in 15 US Cities

Background: Adolescents and young adults comprise disproportionately high percentages of individuals living with human immunodeficiency virus (HIV) and those with undiagnosed HIV. Our objective was to determine factors associated with history of HIV testing and receipt of results among a sample of urban, high-risk, sexually active adolescents in 15 US cities. Methods: A total of 20 to 30 sexually active youths, aged 12 to 24 years, were recruited to participate in an anonymous survey and HIV antibody testing at 2 to 3 venues per city identified by young men who have sex with men, young women of color, or intravenous drug users. Results: Of the 1457 participants, 72% reported having been previously tested for HIV (89% of whom were aware of their test results). Our sample was diverse in terms of gender, race/ethnicity, and sexual orientation. Factors found to be predictive of testing typically reflect high risk for HIV, except for some high-risk partner characteristics, including having had a partner that made the youth have sex without a condom or had a partner with unknown HIV status. Factors associated with knowledge of serostatus are reported. HIV testing seems to be more associated with sexually transmitted infection testing services than with primary care. Conclusions: More strategies are needed that increase testing, including targeting partners of high-risk individuals, insuring receipt of test results, and increasing testing in primary care settings.

Prevalence of Neisseria Gonorrhoeae among men screened for Chlamydia Trachomatis in four United States cities, 1999-2003.

Objectives: Neisseria gonorrhoeae infections are the second most commonly reported disease in the United States and cause significant morbidity. We describe the prevalence of gonorrhea in a large sample of men tested for gonorrhea and Chlamydia trachomatis in Baltimore, Denver, San Francisco, and Seattle. Methods: Gonorrhea prevalence was measured among 17,712 men tested in a variety of non–sexually transmitted disease (STD) clinic venues using urine-based nucleic acid amplification tests. Results: Among 16,850 asymptomatic men, prevalence ranged from 0% to 1.5% by city (P = 0.20): Baltimore 1.3%, Denver 1.5%, San Francisco 1.5%, and Seattle 0%. Among 862 symptomatic men, the gonorrhea prevalence varied from 0.0% to 28.3% by city (P <0.01). Conclusions: The high prevalence of gonorrhea in symptomatic men supports the importance of testing for symptomatic men. The prevalence of gonorrhea among asymptomatic men is low, and routine screening cannot be recommended when screening is performed for chlamydia, unless a substantial local prevalence of gonorrhea can be documented in specific targeted venues or population groups.

Sex partner selection, social networks, and repeat sexually transmitted infections in young men: A preliminary report

Goal: The goal of this study was to examine the risk for repeat sexually transmitted infections (STIs) associated with reducing the number of sex partners who come from within the social networks of males 13 to 25 years old in Baltimore, Maryland, and Denver, Colorado. Study: Asymptomatic males diagnosed with chlamydia and/or gonorrhea as part of an asymptomatic chlamydia and gonorrhea male screening project were recruited and interviewed about their sexual behaviors and their perceptions of social characteristics and sexual behaviors of their sex partners. We characterized the sex partners of each participant as belonging to or not belonging to his social network. We examined whether a decrease in percentage of sex partners who were in the participant’s social network was associated with repeat infection. Results: There were 47 participants in Baltimore and 92 in Denver. In both cities, there was a trend toward a finding that decreasing the percentage of sex partners belonging to a participant’s social network was protective for repeat STI. Conclusion: These data suggest that interventions may need to be designed to reduce the prevalence of infection in the social networks of infected men.

Screening asymptomatic adolescent men for Chlamydia trachomatis in school-based health centers using urine-based nucleic acid amplification tests.

Background: Urine-based screening for Chlamydia trachomatis using highly sensitive and specific nucleic acid amplification tests offers a unique opportunity to screen men attending school-based health centers. Methods: As part of a large multicenter chlamydia screening project in men, 1434 students were enrolled; 1090 in high schools in Baltimore and 344 middle and high-school students in Denver. Students were screened for chlamydia using urine-based nucleic acid amplification tests at well adolescent visits, acute care visits, or visits for other reasons, such as sports physicals. A self-administered survey to ascertain sexual risk behaviors was used. Data were analyzed separately for Baltimore and Denver, with univariate and multivariate logistic regression analysis. Results: The overall prevalence in asymptomatic adolescent men was 6.8% (7.5% in Baltimore and 4.7% in Denver, P = n.s.). Students in Denver were older, more racially diverse, and more likely to have had intercourse in the previous 2 months than students in Baltimore. Students in Baltimore were more likely than those in Denver to have used a condom at last intercourse with casual and main partners. Among men in Denver but not Baltimore, condom use at last intercourse with both casual (OR 0.15, 95% CI, 0.03, 0.78) and main partners (OR 0.30, 95% CI, 0.10, 0.91) was protective against infection. The only risk factor for CT infection in Baltimore students was age (OR 1.47, 95% CI, 1.23, 1.75). In multivariate analysis that included age (as a continuous variable), race, history of an STI, any sex partner in the last 2 months, >1 sex partner in the past 12 months, a new partner in the last 2 months, and condom use with last main and last casual partner, age (adjusted odds ratio 1.34, 95% CI, 1.11, 1.62) and black race (adjusted odds ratio 2.37, 95% CI, 1.21, 4.63) were the only variables associated with testing chlamydia positive. Conclusions: School-based health centers are important venues in which to perform urine-based screening for chlamydia in sexually active, asymptomatic males, especially in high prevalence communities, and such screening provides the opportunity to identify and treat substantial numbers of chlamydia infections.

Connect to Protect®: Utilizing Community Mobilization and Structural Change To Prevent HIV Infection among Youth

Infection with HIV often results in myriad negative social, physical, and psychological consequences for adolescents and young adults. At the end of 2007, an estimated 25,036 adolescents and young adults 13 to 24 years of age were living with HIV in the 37 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting (CDC, 2010). HIV is not equally distributed among adolescents of all ethnic groups. In 2008, 50% of adolescents/young adults living with HIV were African American, 29% were White, 20% were Latino, and 1% each were Asian, American Indian/Alaska Native, and multi-ethnic (CDC, 2010). Although the primary route of HIV transmission among youth is sexual activity, differences exist across gender and sexual activity categories. In 2008, males accounted for approximately 71% of adolescents aged 13–19 years diagnosed with HIV, and 80% of young adults aged 20–24 years (CDC, 2010). HIV infections resulting from male-to-male sexual activity among adolescents/young adults increased from 57% in 2005 to 68% in 2008—the rates of HIV due to heterosexual contact decreased from 32% to 25% during this time (CDC, 2010). As HIV continues to proliferate in the adolescent and young adult populations, its impact is most predominate among young gay, bisexual, and other men who have sex with men (especially young men of color) and heterosexual young women of color. These are populations that experience varying degrees of social control and power in most societies, and experience oppression in the form of ageism, sexism, racism, and heterosexism (Diaz, Ayala, & Bein, 2004; Harper, 2007; Harper & Schneider, 2003). Such individuals may lack the social power and resources to access HIV prevention services, as well as primary medical care if they do become infected. In addition, the available HIV prevention approaches that are being implemented in communities where these young people live may be limited with regard to their cultural appropriateness (both ethnic culture and sexual orientation culture), and may not impact the larger social forces and structures that may place these youth at risk for HIV. Further, despite the disproportionately high rates of HIV infection among gay/bisexual male adolescents and other young men who have sex with men, prior reviews of rigorously evaluated HIV prevention programs for adolescents in peer-reviewed journals have almost exclusively been focused on heterosexual youth (Kim, Stanton, Li, Dickersin & Galbraith 1997; Pedlow & Carey, 2003, 2004; Robin, Dittus, Whitaker, Crosby, Ethier, et al., 2004; Rotheram-Borus, O’Keefe, Kracker & Foo, 2000; Stanton, Kim, Galbraith & Parrott, 1996).

Cross-sectional survey comparing HIV risk behaviours of adolescent and young adult men who have sex with men only and men who have sex with men and women in the US and Puerto Rico

Objective To examine the HIV risk behaviours of men who have sex with men only (MSMO) and men who have sex with men and women (MSMW), aged 12–24 years, in five US cities and in San Juan, Puerto Rico. Methods Data were collected through four annual cross-sectional anonymous surveys at community venues and included questions about sexual partnerships, sexual practices including condom use and substance use. Demographic and risk profiles were summarised for both groups. Results A total of 1198 men were included in this analysis, including 565 MSMO and 633 MSMW. There were statistically significant differences between the two groups for many risk factors examined in multivariable models. MSMW were more likely to identify as bisexual, be in a long-term relationship, have a history of homelessness, have ever used marijuana, have ever been tested for HIV and to have been tested for HIV within the past 6 months. MSMW may be more likely to ever exchange sex for money and ever have a sexually transmitted infection than MSMO. Conclusions MSMW were more likely to report several markers of socioeconomic vulnerability or behaviours associated with increased risk for HIV than MSMO. MSMW contribute to HIV prevalence in the USA, and better understanding of the risk profile of this group is essential to understand heterosexual HIV transmission. MSMW, particularly those who identify as bisexual or questioning, may feel uncomfortable participating in programmes that are designed for gay-identified men. Therefore, prevention strategies need to target distinct subgroups that compose the population of MSM.

Connect to Protect® Researcher-Community Partnerships: Assessing Change in Successful Collaboration Factors over Time

Fifteen research sites within the Adolescent Medicine Trials Network for HIV/AIDS Interventions launched Connect to Protect community coalitions in urban areas across the United States and in Puerto Rico. Each coalition has the same overarching goal: Reducing local youth HIV rates by changing community structural elements such as programs, policies, and practices. These types of transformations can take significant amounts of time to achieve; thus, ongoing successful collaboration among coalition members is critical for success. As a first step toward building their coalitions, staff from each research site invited an initial group of community partners to take part in Connect to Protect activities. In this paper, we focus on these researcher-community partnerships and assess change in collaboration factors over the first year. Respondents completed the Wilder Collaboration Factors Inventory at five time points, approximately once every two to three months. Results across all fifteen coalitions show significant and positive shifts in ratings of process/structure (p<.05). This suggests that during the first year they worked together, Connect to Protect researcher-community partners strengthened their group infrastructures and operating procedures. The findings shed light on how collaboration factors evolve during coalition formation and highlight the need for future research to examine change throughout subsequent coalition phases.

Sexually transmitted infection risk behaviors in rural Thai adolescents and young adults: support for sex- and age-specific interventions.

Sexually transmitted infection (STI) prevalence and risks in a sample of rural Thai adolescents and young adults (14-29 years) were examined. Unprotected sex with a casual partner conferred the greatest risk for prevalent STIs, particularly for younger adolescents, and alcohol use increased the STI risk for women but not for men.