HIV-negative gay men's perceived HIV risk hierarchy: imaginary or real (original) (raw)
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Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2009
We explored seroguessing (serosorting based on the assumption of HIV seroconcordance) and casual unprotected anal intercourse (UAIC) associated with seroguessing. The ongoing Positive Health and Health in Men cohorts, Australia, provided data for trends in seroconcordant UAIC and HIV disclosure to sex partners. In event-level analyses, we used log-binomial regression adjusted for within-individual correlation and estimated prevalence rate ratios (PRRs) and 95% confidence intervals (95% CIs) for the association between the knowledge of a casual partner's seroconcordance and UAIC. UAIC and HIV disclosure significantly increased during 2001Á2006. HIVpositive men knew partners were seroconcordant in 54% and assumed it in 13% of sex encounters (42 and 17% among HIV-negative men). Among HIV-positive men, the likelihood of UAIC was higher when a partner's status was known (Adjusted PRR 05.17, 95% CI: 3.82Á7.01) and assumed seroconcordant because of seroguessing (Adjusted PRR 03.70, 95% CI: 2.56Á5.35) compared with unknown. Among HIV-negative men, the likelihood of UAIC was also higher when a partner's status was known (Adjusted PRR 01.88, 95% CI: 1.58Á2.24) and assumed seroconcordant (Adjusted PRR 02.12, 95% CI: 1.72Á2.62) compared with unknown. As levels of UAIC remain high, seroguessing increasingly exposes gay men to the risk of HIV infection. Because both HIV-positive and HIV-negative men often seroguess, education and prevention programs should address the fact that HIVnegative men who engage in UAI due to this practice may be at high risk of HIV infection. HIV prevention should take into account these contemporary changes in behaviors, especially among HIV-negative gay men.
Frontiers in Immunology, 2015
Background: Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmission of HIV in gay and other men who have sex with men (MSM). A variety of measures of CLAI have been commonly used in behavioral surveillance for HIV risk and to forecast trends in HIV infection. However, gay and other MSM's sexual practices changed as the understanding of disease and treatment options advance. In the present paper, we argue that summary measures such as "any CLAI" do not accurately measure HIV sexual risk behavior. Methods: Participants were 1,427 HIV-negative men from the Health in Men cohort study run from 2001 to 2007 in Sydney, Australia, with six-monthly interviews. At each interview, detailed quantitative data on the number of episodes of insertive and receptive CLAI in the last 6 months were collected, separated by partner type (regular vs. casual) and partners' HIV status (negative, positive, and HIV status unknown). Results: A total of 228,064 episodes of CLAI were reported during the study period with a mean of 44 episodes per year per participant (median: 14). The great majority of CLAI episodes were with a regular partner (92.6%), most of them with HIV-negative regular partners (84.8%). Participants were more likely to engage in insertive CLAI with casual than with regular partners (66.7 vs. 55.3% of all acts of CLAI with each partner type, p < 0.001). Men were more likely to report CLAI in the receptive position with HIV-negative and HIV status unknown partners than with HIV-positive partners (p < 0.001 for both regular and casual partners). Conclusion: Gay and other MSM engaging in CLAI demonstrate clear patterns of HIV risk reduction behavior. As HIV prevention enters the era of antiretroviral-based biomedical approach, using all forms of CLAI indiscriminately as a measure of HIV behavioral risk is not helpful in understanding the current drivers of HIV transmission in the community.
Frontiers in immunology, 2015
Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmission of HIV in gay and other men who have sex with men (MSM). A variety of measures of CLAI have been commonly used in behavioral surveillance for HIV risk and to forecast trends in HIV infection. However, gay and other MSM's sexual practices changed as the understanding of disease and treatment options advance. In the present paper, we argue that summary measures such as "any CLAI" do not accurately measure HIV sexual risk behavior. Participants were 1,427 HIV-negative men from the Health in Men cohort study run from 2001 to 2007 in Sydney, Australia, with six-monthly interviews. At each interview, detailed quantitative data on the number of episodes of insertive and receptive CLAI in the last 6 months were collected, separated by partner type (regular vs. casual) and partners' HIV status (negative, positive, and HIV status unknown). A total of 228,064 episodes of CLA...
Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2005
The objective of the paper was to compare encounters involving unprotected anal intercourse (UAI) and protected anal intercourse (PAI) among HIV-negative gay men in Sydney. Data were from those completing baseline face-to-face interviews to end June 2003 for the Health in Men open cohort of HIV-negative gay men in Sydney. The 1,148 participants ranged in age from 18 to 75 years (median=36). Three hundred and fifty-two (30.7%) reported an occasion of UAI with a casual partner in the previous 6 months and 531 (46.3%) reported an occasion of UAI with a regular partner in that same time. The men's most recent sexual contact with a casual partner involving UAI was distinguished from those involving PAI by a greater likelihood for both partners to disclose HIV serostatus (p=0.006) and by respondents being more inclined to restrict themselves to the insertive position or to practise withdrawal during occasions involving any UAI than when a condom was used (p=0.003 and p=0.001 respectively). Neither location nor recreational drug use differentiated men's most recent sexual contacts involving UAI from those involving PAI. The decision by HIV-negative gay men to use condoms during sexual encounters with either regular or casual partners is guided more by HIV serostatus and risk reduction strategies than by other factors.
Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2006
In recent years, increases in both risk behavior and in seroconversion among homosexually active men have been noted in a number of parts of the world. Data were available from 903 HIV negative homosexual men regarding number of acts of unprotected anal intercourse (UAI), separated into receptive and insertive UAI, with and without ejaculation, with steady and with casual partners. Partners were classified according to serostatus as reported by respondents. Men (N = 325) reported 13,692 UAI acts, most of which were with steady partners, of whom most were reported to be HIV-negative. With HIV-positive partners, both steady and casual, and with casual partners of unknown serostatus, receptive UAI with ejaculation was relatively rare. Insertive UAI without ejaculation was relatively common with casual partners of unknown serostatus. Patterns of UAI suggest that risk of transmission may be greater with steady partners. Men appear to modify practice according to both the nature of the relationship (steady or casual) and (assumed) serostatus of partner. KEY WORDS: HIV; risk behavior; behavioral surveillance; homosexually active men.
Managing unprotected anal intercourse The perspective of gay men who have not tested HIV positive
In the last year, approximately one third of HIV-uninfected gay men engaged in unprotected anal intercourse (UAI, ie. anal intercourse without the protection of a condom) with another man. This would not be any cause for concern if about 2% had not become HIV infected doing so (one in fifty of those who engage in UAI, or 1,500 men; see Hickson et al., 1997). Understanding why men have UAI is essential if HIV prevention is to be effective. Since sex between men accounts for at least three quarters of new HIV infections occurring in England, it will only be through a reduction in HIV acquired in this way that a significant reduction will be made in our national HIV incidence (in England, every year, approximately 2,000 new infections occur among 49,000,000 people). This paper reports original research data generated by Sigma Research as part of a rolling programme of HIV health promotion facilitation. The data concerns unprotected anal intercourse between men and HIV. All the data comes from men who were resident in England in1997, had sex with a man in the last year and had not, at the time of interview, been diagnosed HIV positive. This research builds on earlier work (Hickson, Davies & Weatherburn, 1998) and is complementary to other ongoing investigations of the perspective of men with diagnosed HIV infection (Keogh & Beardsell, 1997). It is intended as a contribution to an integrated picture of UAI among gay men (see for example Keogh et al., 1998; Keogh et al., 1999). The methods used in the current research included both face-to-face interviews and selfcompletion surveys. Therefore, this paper includes data in the form of numbers and proportions, as well as narrative accounts in the men's own words. It is hoped that, through more detailed knowledge of the circumstances under which UAI occurs, and the reasons why it occurs, more HIV health promoters are more able to work with a greater diversity of gay men, more effectively, and more sensitively. The paper is being distributed through the CHAPS Partnership, an Englandwide HIV health promotion planning programme coordinated by the Terrence Higgins Trust.
Use of Viral Load to Negotiate Condom Use Among Gay Men in Sydney, Australia
Aids and Behavior, 03/2009; 13(4):645-51., 2009
Using two cohort studies (Health in men—HIM and positive health—PH) and repeated large cross-sectional surveys (Gay Community Periodic Survey—GCPS) of gay men in Sydney, Australia, we examined the association between viral load and unprotected anal intercourse (UAI) between HIV sero-discordant regular partners. Between 2001 and 2007, we conducted 243 interviews with 102 HIV-negative gay men in HIM and 148 interviews with 99 HIV-positive gay men in PH who were in regular relationships with HIV sero-discordant partners. During the same time period, 437 HIV positive men with HIV sero-discordant regular partners completed questionnaires for the GCPS. All completed interviews or questionnaires during that time period were used for these analyses. Amongst the HIV-negative respondents, sero-discordant UAI was more likely to be reported when the men believed their HIV-positive regular partner had an undetectable rather than a detectable viral load (P = 0.002). Amongst the HIV-positive respondents, sero-discordant UAI was as likely to be reported when they themselves reported having an undetectable or a detectable viral load. Use of viral load in negotiating condom use between sero-discordant gay couples may be understood very differently by the HIV-negative and HIV-positive men within those partnerships.
Danger and Context: Unsafe Anal Sexual Practice among Homosexual and Bisexual Men in the AIDS Crisis
Journal of Sociology, 1990
Exploring the social dimension of sexuality is crucial to prevention strategies for AIDS. New developments in social theories of sexuality can inform empirical research. A survey of 535 gay and bisexual men in New South Wales and the Australian Capital Territory was designed in the light of practicebased analyses of gender and sexuality. Anal intercourse without condoms ranks high in physical and emotional significance though it is known to be relatively unsafe with regard to transmission of the human immunodeficiency virus. This practice shows few statistical connections to variables describing social structure, but is linked to variables describing gay social milieu attachment, patterns of sexuality, and awareness of the situation created by the AIDS crisis. Potentially dangerous anal practice is more common within established relationships and especially common with men who describe themselves as 'monogamous'. This creates dilemmas for prevention strategy. Connections between social variables and the frequency of unprotected anal intercourse point to the importance of informed social support for safer sex. Prevention strategy needs to emphasise collective action, not just personal change.