Pilgrim Spikes

Correlates of Risk Patterns and Race/Ethnicity among HIV-Positive Men who have Sex with Men

Behaviors related to HIV infection vary by race, with African American and Latino men who have sex with men (MSM) more likely to report sex with women than are European–American MSM. The epidemic among African Americans, in particular, is growing rapidly among both men and women. Some have hypothesized that bisexually active men may be contributing to the epidemic among women. However, little is known about risk patterns among men of different races who are already infected. In this study of 456 HIV-seropositive MSM we found that, like HIV-negative MSM, African American MSM who are HIV-positive were less likely than European American men to identify as gay, more likely to report sex with women, and less comfortable discussing their MSM behavior with close friends and acquaintances. African American participants also exhibited higher levels of internalized homophobia, as well as lower self-efficacy for disclosing their HIV status to sex partners. Implications for interventions for this population are discussed.

Sexual Risk Behaviors Among HIV-Positive Black Men Who Have Sex With Women, With Men, or With Men and Women: Implications for Intervention Development

OBJECTIVES We compared demographics and sexual and drug risk behaviors among HIV-positive Black men who have sex with women only, with men only, or with men and women to assess differences among and between these groups. METHODS We analyzed cross-sectional data from the Supplement to HIV and AIDS Surveillance Project for 2038 HIV-positive Black men who reported being sexually active. We classified the participants by their reported sexual behaviors in the past year: intercourse with women (n = 1186), with men (n = 741), or with men and women (n = 111). RESULTS Respondents whose sexual partners were both men and women reported more noninjection drug use, sexual exchange, and sexual partners than did the other 2 groups. Bisexual respondents were also more likely than were heterosexuals to report unprotected intercourse with a steady female partner and were more likely than were both other groups to report having steady partners of unknown HIV serostatus and using drugs during their last sexual episode. CONCLUSIONS HIV-positive Black men with both male and female sexual partners engaged in more sexual and drug risk behaviors than did their heterosexual and homosexual peers. More information concerning the prevention needs of behaviorally bisexual HIV-positive Black men is needed.

Differences in the Social Networks of African American Men Who Have Sex With Men Only and Those Who Have Sex With Men and Women

OBJECTIVES We compared social network characteristics of African American men who have sex with men only (MSMO) with social network characteristics of African American men who have sex with men and women (MSMW). METHODS Study participants were 234 African American men who have sex with men who completed a baseline social network assessment for a pilot behavioral HIV prevention intervention in Baltimore, Maryland, from 2006 through 2009. We surveyed the men to elicit the characteristics of their social networks, and we used logistic regression models to assess differences in network characteristics. RESULTS MSMO were significantly more likely than were MSMW to be HIV-positive (52% vs 31%). We found no differences between MSMO and MSMW in the size of kin networks or emotional and material support networks. MSMW had denser sexual networks, reported more concurrent and exchange partners, used condoms with more sexual partners, and reported interaction with a larger number of sexual partners at least once a week. CONCLUSIONS Although there were many similarities in the social and sexual network characteristics of MSMO and MSMW, differences did exist. HIV prevention interventions should address the unique needs of African American MSMW.

Social network predictors of disclosure of MSM behavior and HIV-positive serostatus among African American MSM in Baltimore, Maryland.

This study examined correlates of disclosure of MSM behavior and seropositive HIV status to social network members among 187 African American MSM in Baltimore, MD. 49.7% of participants were HIV-positive, 64% of their social network members (excluding male sex partners) were aware of their MSM behavior, and 71.3% were aware of their HIV-positive status. Disclosure of MSM behavior to network members was more frequent among participants who were younger, had a higher level of education, and were HIV-positive. Attributes of the social network members associated with MSM disclosure included the network member being HIV-positive, providing emotional support, socializing with the participant, and not being a female sex partner. Participants who were younger were more likely to disclose their positive HIV status. Attributes of social network members associated with disclosure of positive serostatus included the network member being older, HIV-positive, providing emotional support, loaning money, and not being a male sex partner.ResumenEste estudio examinó los correlatos de la divulgación de tener relaciones sexuales con hombres (HSH) y serología VIH positiva a los miembros de la red social en 187 HSH Afro-Americanos en Baltimore, MD. 49,7% de los participantes eran VIH-positivos, y la mayoría (64%) de sus miembros de la red social (excluyendo parejas sexuales masculina) estaban al tanto de su comportamiento HSH y su estado VIH-positivos (71,3%). La divulgación de la conducta HSH a los miembros de la red fue más frecuente entre los participantes que eran más jóvenes, tenían un mayor nivel de educación, y eran VIH-positivos. Atributos de los miembros de la red social asociado con la revelación HSH incluyeron el miembro de la red es VIH-positivo, provee apoyo emocional, es con quien socializa, y no es una pareja sexual femenina. Los participantes que eran más jóvenes tenían más probabilidades de dar a conocer su estado VIH positivo. Atributos de los miembros de la red social asociado con la revelación del estado serológico VIH positivo incluyeron el miembro de la red tiene mayor edad, es VIH-positivo, provee apoyo emocional, presta dinero, y no es una pareja sexual masculina.

Sexual partner characteristics, serodiscordant/serostatus unknown unprotected anal intercourse and disclosure among human immunodeficiency virus-infected and uninfected black men who have sex with men in New York City.

Objectives: Black men who have sex with men (MSM) are disproportionately infected with human immunodeficiency virus (HIV) in the United States. This study describes sexual partner characteristics and disclosure of HIV serostatus and evaluates factors associated with sexual risk behaviors during last sex among black MSM. Design and Methods: Between 2008 and 2009, 328 black MSM who reported recent unprotected anal intercourse were enrolled in an HIV behavioral intervention study in New York City. Factors associated with serodiscordant/serostatus unknown UAI (defined as having UAI with a partner of different or unknown HIV serostatus) with a male partner during last sex were assessed using logistic regression. Results: A total of 205 HIV-infected and 123 uninfected men were enrolled in this study. Almost all men (91.6%) reported having a black male partner during last sex. About half (47.3%) of men used alcohol and 38.7% used other substances before or during last sex. About two-thirds (68.8%) of participants disclosed their HIV status to their last sex partner, while 57.2% of partners disclosed. In multivariate analysis, meeting a partner on the internet or chat line was associated with serodiscordant/serostatus unknown UAI during last sex among HIV-infected men. The only factor associated with serodiscordant/serostatus unknown UAI during last sex among HIV-uninfected men was the partner being a non-main partner. Conclusions: A significant proportion of black MSM in this study did not disclose their HIV status. Our data highlight the need for more data on dyadic variables and sexual risk behaviors among black MSM, as well as interventions to encourage communication between partners.

Exploring the Mental Health of Black Men Who Have Sex with Men

AbsractCurrent research indicates that black men who have sex with men (MSM) are disproportionately burdened by depressive distress and anxiety disorders as compared to their white gay and heterosexual counterparts. This study utilizes focus groups to qualitatively explore issues surrounding the mental health status of this population in an attempt to shed light on potential influencing and determinant factors. Twenty-two self-identified black, or multi-racial including black, MSM residing in Atlanta, Georgia participated in two focus groups—11 subjects each, respectively. Categories that emerged from data analysis include: knowledge/experiences, attitudes/beliefs, societal action/behavior, identity development, relationship functionality, and mental health status. Overarching themes for each category were delineated.

Unity in Diversity Results of a Randomized Clinical Culturally Tailored Pilot HIV Prevention Intervention Trial in Baltimore, Maryland, for African American Men Who Have Sex With Men

Unity in Diversity was a randomized controlled trial of a culturally tailored HIV prevention intervention for African American men who have sex with men. The intervention condition was six group-based sessions and one individual session. The control condition was a single-session HIV prevention review. Participants were aged 18 years or older, identified as African American/Black race, reported having at least two sex partners in the prior 90 days (at least one of whom must be a male partner), unprotected anal sex with male partner in the prior 90 days, and willing to test for HIV. Retention exceeded 95% at 3-month follow-up. Results of multivariate logistic regression analysis adjusting for baseline risk, HIV status, and health insurance indicate intervention efficacy in decreasing the number of male sex partners and marginal effects on condom use with male partners and HIV-negative/unknown partners. Specifically, intervention condition was associated with increased odds of zero male sex partners (adjusted odds ratio [AOR] = 3.03, 95% confidence interval [CI] = 1.26-7.28), condom use with male partners (AOR = 2.64, 95% CI = 0.95-7.36), and HIV-negative/unknown status partners (AOR = 3.19, 95% CI = 0.98-10.38) at follow-up. These results contribute to the limited number of culturally appropriate models of HIV prevention intervention that are urgently needed for African American men who have sex with men to address their persistently high rates of HIV.

Sociodemographic and Risk Behavior Characteristics Associated with Unprotected Sex with Women among Black Men Who Have Sex with Men and Women in New York City

Abstract The objectives of this cross-sectional study were to compare sociodemographic and risk behavior characteristics between black men who have sex with both men and women (MSMW) and those who have sex with men only (MSMO) and assess factors associated with having any unprotected vaginal and/or anal intercourse (UVAI) with women in the last 3 months. Data from 326 black men who reported recent unprotected anal intercourse with a man in an HIV behavioral intervention study in New York City were analyzed. Baseline characteristics were compared between MSMW and MSMO, and factors associated with having any UVAI in the past 3 months with women among MSMW were evaluated. In total, 26.8% reported having sex with both men and women in the last 3 months. MSMW were less likely to be HIV infected, use amyl nitrates, and have unprotected receptive anal sex with most recent male partner. MSMW were more likely to be over 40 years old and use heroin. A total of 55.6% of MSMW reported having UVAI with women in the last 3 months. Compared to MSMW having only protected sex, MSMW having any UVAI with women were less likely to be HIV infected and to disclose having sex with men to female partners; they were more likely to have greater than four male sex partners in the last 3 months. In conclusion, HIV prevention interventions among black MSMW should directly address the risk of HIV transmission to both their female and male partners. Disclosure of bisexuality to female partners may be an important component of future prevention efforts.

Characteristics of bisexually active men in the Seropositive Urban Mens’ Study (SUMS)

Abstract Characteristics of bisexually-active men were compared with those of their homosexually-active counterparts in a study of HIV-seropositive men who have sex with men (MSM). Men who had had sex with women in the prior year were younger and more likely to be African American than those reporting sex only with men. They reported higher levels of internalised homophobia and less participation in the gay community. They tended to be recruited through friend referral rather than public sex environments or AIDS service organisations. However, they did not seek sex partners from different venues than other participants. Implications for HIV transmission risk-reduction interventions for this population are discussed.

A randomized trial of a behavioral intervention for black MSM: the DiSH study.

Objective:To test a new behavioral intervention for black MSM in reducing sexual risk and increasing social support and intentions to use condoms. Design:A single-site, unblinded randomized trial in New York City with 3-month follow-up. Methods:Participants (n = 283) reporting at least two sexual partners and unprotected anal intercourse with a man in the past 3 months were enrolled and randomized to a social-cognitive theory-based intervention or control comparison. Men in the intervention group participated in five 2-h group sessions focused on creating a group environment with sexual risk-reduction information and exercises woven into joint meal preparation and sharing activities, while exploring self-efficacy perceptions and outcome expectancies. Intervention (n = 142) and control (n = 141) groups received standard HIV counseling and testing at baseline. Results:No significant differences were found between study arms at 3 months in number of male partners, number of unprotected anal intercourse partners, proportion reporting unprotected sex, number of acts protected by condoms, self-efficacy, condom attitudes, condom intentions, social isolation and psychological distress. In both arms combined, declines from baseline to 3 months were observed in sexual risk behaviors, social isolation and psychological distress, whereas self-efficacy, condom attitudes and condom intentions improved. Conclusion:As the HIV epidemic continues to have a dramatic impact on black MSM in the USA, the urgency to design innovative interventions continues.