Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-17 (of 17 Records) |
Query Trace: Colfax G[original query] |
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Alcohol and cocaine use among Latino and African American MSM in 6 US cities
Zaller N , Yang C , Operario D , Latkin C , McKirnan D , O'Donnell L , Fernandez M , Seal D , Koblin B , Flores S , Spikes P . J Subst Abuse Treat 2017 80 26-32 Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. MSM comprise roughly 2% of the US population, yet approximately two-thirds of new HIV infections are among MSM (Centers for Disease Control and Prevention, 2016). Additionally, significant racial and ethnic disparities exist with respect to HIV transmission among MSM. Based on the current HIV diagnoses rates in the US, about 1 in 2 African American men who have sex with men (AAMSM), 1 in 4 Latino MSM (LMSM) and 1 in 11 white MSM will be diagnosed with HIV during their lifetime (Center for Disease Control and Prevention (CDC), 2016a). In general, substance-using MSM are among the groups with the greatest risk for HIV infection (Centers for Disease Control and Prevention, 2011; Margolis, Joseph, Hirshfield, et al., 2014; Pines, Gorbach, Weiss, et al., 2014; Plankey, Ostrow, Stall, et al., 2007); nearly a third of incident HIV infections among MSM may be associated with non-injection drug use (Mansergh et al., 2008; Van Tieu & Koblin, 2009). Substance-using sexual minorities are more likely to underutilize substance use treatment (McCabe, Bostwick, Hughes, West, & Boyd, 2010) and may be an HIV transmission bridge to non-drug-using populations (Lambert et al., 2011). | With respect to alcohol use, high rates of both alcohol consumption and binge drinking have been documented among MSM populations (Finlayson et al., 2011). Additionally, previous studies have found associations between heavy drinking, as define as having 6 or more drinks on one occasion or 4 or more drinks daily, and HIV risk behaviors among MSM, such as condomless anal intercourse and greater number of sexual patterns (Colfax et al., 2004; Greenwood et al., 2001; Koblin et al., 2003a; Woolf & Maisto, 2009). Previous studies also suggest that many substance-using MSM populations engage in use of multiple substances, often concomitantly (Santos et al., 2013). There also may be a dose response with number and frequency of substances used with respect to condomless anal sex among HIV negative MSM (Santos et al., 2013). However, patterns of substance-use vary across racial and ethnic MSM populations, e.g. African American substance-using MSM being more likely to use crack/cocaine relative to other substance-using MSM populations (Goldstein, Burstyn, LeVasseur, & Welles, 2016; Halkitis & Jerome, 2008; Hatfield, Horvath, Jacoby, & Simon Rosser, 2009; Mimiaga, Reisner, Fontaine, et al., 2010; Paul, Boylan, Gregorich, Ayala, & Choi, 2014). Thus, it is important to better understand patterns of concomitant substance-use, e.g. methamphetamine, crack/cocaine and alcohol, across specific sociodemographic categories among MSM populations (Santos et al., 2013). Sociodemographic characteristics which may be particularly relevant for specific MSM populations include poverty and history of incarceration. For example, pronounced racial disparities have been found between AAMSM and other MSM populations with respect to structural barriers, such as low income, unemployment and incarceration, associated with HIV infection (Millet, Peterson, Flores, Hart, et al., 2012). Additionally, a recent study conducted by Rutledge et al, found a high proportion of MSM reporting both a history of incarceration and substance use. This study found rates of incarceration highest among men who classified themselves as “down-low”, e.g. endorsing secrecy about same-sex sexual behavior, promting the authors to posit that this population may engage in trading sex for money more often and thus increase their risk for incarceration (Rutledge, Jemmott, O'Leary, & Icard, 2016). |
Depressive symptoms by HIV serostatus are differentially associated with unprotected receptive and insertive anal sex among substance-using men who have sex with men in the United States
Hanson KE , Mansergh G , Koblin BA , Flores SA , Hudson SM , Myers L , Colfax GN . J Acquir Immune Defic Syndr 2015 68 (1) e13-6 Men who have sex with men (MSM) are still disproportionately affected by HIV/AIDS in the United States. While gay, bisexual, and other MSM represent an estimated 2% of the US population,1 as of 2010, this population accounted for approximately 56% of those living with HIV and 63% of new HIV infections.2 Studies of a syndemic association of multiple physical and mental health factors (eg, depression, substance use or abuse, childhood sexual abuse, experienced gay, or bisexual stigma) among MSM have found those factors to be associated with each other and with risk for HIV transmission.3,4 There are mixed research findings regarding the specific association of depression and unprotected anal sex (ie, without a condom), with supporting evidence found in some studies5 but not others.6,7 Recent studies that tend to support an association of depression and sexual risk among MSM5,8 have applied broad definitions of behavior and not stratified analyses by HIV serostatus or specific sexual risk behaviors. For example, Reisner et al8 assessed a combined variable of all unprotected sex (anal and/or vaginal) for both men and women, whereas Fendrich et al5 reported unprotected receptive and insertive anal sex separately but not stratified by HIV serostatus before calculating odds ratios. Stratified analysis for specific behaviors is critical in understanding nuanced associations for the highest risk behaviors for HIV acquisition/transmission by HIV serostatus (ie, unprotected receptive anal sex for HIV-negative MSM; unprotected insertive anal sex for HIV-positive MSM). This study examines the association of depressive symptoms and unprotected insertive and receptive anal sex, separately and by HIV serostatus, among substance-using MSM who reported recent unprotected sexual behavior. | A convenience sample of HIV-negative and HIV-positive MSM (n = 1203) who reported unprotected anal sex and substance use during anal sex in the previous 6 months was enrolled in the Project MIX trial in Chicago, Los Angeles, NY City, and San Francisco. The purpose of the trial was to test a behavioral intervention to reduce sexual risk behavior of substance-using MSM; study methods and results are discussed in detail elsewhere.9 CDC and local Institutional Review Boards in each city approved the study protocol. Participants completed a baseline assessment in 2005–2006 that measured self-reported demographic variables, HIV status (including only men first diagnosed as HIV positive >6 months before study enrollment), recent unprotected anal sex (UA, ie, without a condom in the past 3 months) with a nonprimary male partner [including unprotected receptive (URA) and insertive (UIA)], drug use during the sexual encounter, depressive symptoms, and other psychosocial variables. Depressive symptoms in the past week were measured using 7 items from Santor and Coyne's 9-item short version of the Center for Epidemiological Studies—Depression (CES-D) scale, Cronbach alpha = 0.87.10 Two items were dropped due to low interitem correlations, as done earlier.11 A mean overall score for each participant was dichotomized to indicate depressive symptoms occurred “never” or “sometimes” (1–2) or “more than sometimes” (>2 to 4) in the past week. |
Internalised homophobia is differentially associated with sexual risk behaviour by race/ethnicity and HIV serostatus among substance-using men who have sex with men in the United States
Mansergh G , Spikes P , Flores SA , Koblin BA , McKirnan D , Hudson SM , Colfax GN . Sex Transm Infect 2014 91 (5) 324-8 OBJECTIVES: There is a continuing need to identify factors associated with risk for HIV transmission among men who have sex with men (MSM), including a need for further research in the ongoing scientific debate about the association of internalised homophobia and sexual risk due partly to the lack of specificity in analysis. We assess the association of internalised homophobia by race/ethnicity within HIV serostatus for a large sample of substance-using MSM at high risk of HIV acquisition or transmission. METHODS: Convenience sample of substance-using (non-injection) MSM reporting unprotected anal sex in the prior 6 months residing in Chicago, Los Angeles, New York and San Francisco. The analytic sample included HIV-negative and HIV-positive black (n=391), Latino (n=220), and white (n=458) MSM. Internalised homophobia was assessed using a published four-item scale focusing on negative self-perceptions and feelings of their own sexual behaviour with men, or for being gay or bisexual. Analyses tested associations of internalised homophobia with recent risk behaviour, stratified by laboratory-confirmed HIV serostatus within race/ethnicity, and controlling for other demographic variables. RESULTS: In multivariate analysis, internalised homophobia was inversely associated (p<0.05) with recent unprotected anal sex among black MSM, and not significantly associated with sexual risk behaviour among white and Latino MSM. CONCLUSIONS: More research is needed to further identify nuanced differences in subpopulations of MSM, but these results suggest differentially targeted intervention messages for MSM by race/ethnicity. |
Adapted personalized cognitive counseling for episodic substance-using men who have sex with men: a randomized controlled trial
Coffin PO , Santos GM , Colfax G , Das M , Matheson T , DeMicco E , Dilley J , Vittinghoff E , Raiford JL , Carry M , Herbst JH . AIDS Behav 2014 18 (7) 1390-400 Episodic drug use and binge drinking are associated with HIV risk among substance-using men who have sex with men (SUMSM), yet no evidence-based interventions exist for these men. We adapted personalized cognitive counseling (PCC) to address self-justifications for high-risk sex among HIV-negative, episodic SUMSM, then randomized men to PCC (n = 162) with HIV testing or control (n = 164) with HIV testing alone. No significant between-group differences were found in the three primary study outcomes: number of unprotected anal intercourse events (UAI), number of UAI partners, and UAI with three most recent non-primary partners. In a planned subgroup analysis of non-substance dependent men, there were significant reductions in UAI with most recent non-primary partners among PCC participants (RR = 0.56; 95 %CI 0.34-0.92; P = 0.02). We did not find evidence that PCC reduced sexual risk behaviors overall, but observed significant reductions in UAI events among non-dependent SUMSM. PCC may be beneficial among SUMSM screening negative for substance dependence. |
A roadmap for adapting an evidence-based HIV prevention intervention: Personal Cognitive Counseling (PCC) for episodic substance-using men who have sex with men
Knight KR , Das M , DeMicco E , Raiford JL , Matheson T , Shook A , Antunez E , Santos GM , Dadasovich R , Dilley JW , Colfax GN , Herbst JH . Prev Sci 2014 15 (3) 364-75 Episodic (less than weekly) drug use and binge drinking increase HIV-related sexual risk behaviors among men who have sex with men (MSM), yet no evidence-based interventions exist for these men. We describe an adaptation process of the Personalized Cognitive Counseling (PCC) intervention for utilization with high-risk, HIV-negative episodic, substance-using MSM. Participants (N = 59) were racially diverse, and reported unprotected anal intercourse and concurrent binge drinking (85 %), use of poppers (36 %), methamphetamine (20 %) and cocaine (12 %). Semi-structured interviews with 20 episodic, substance-using MSM elicited sexual narratives for engaging in unprotected anal intercourse while using alcohol or drugs. Emergent qualitative themes were translated into self-justifications and included in a revised PCC self-justification elicitation instrument (SJEI). The adapted SJEI was pretested with 19 episodic, substance-using MSM, and the final adapted PCC was pilot-tested for acceptability and feasibility with 20 episodic, substance-using MSM. This process can be used as a roadmap for adapting PCC for other high-risk populations of MSM. |
Substance use and drinking outcomes in Personalized Cognitive Counseling randomized trial for episodic substance-using men who have sex with men
Santos GM , Coffin PO , Vittinghoff E , Demicco E , Das M , Matheson T , Raiford JL , Carry M , Colfax G , Herbst JH , Dilley JW . Drug Alcohol Depend 2014 138 234-9 BACKGROUND: Non-dependent alcohol and substance use patterns are prevalent among men who have sex with men (MSM), yet few effective interventions to reduce their substance use are available for these men. We evaluated whether an adapted brief counseling intervention aimed at reducing HIV risk behavior was associated with secondary benefits of reducing substance use among episodic substance-using MSM (SUMSM). METHODS: 326 episodic SUMSM were randomized to brief Personalized Cognitive Counseling (PCC) intervention with rapid HIV testing or to rapid HIV testing only control. Both arms followed over 6 months. Trends in substance use were examined using GEE Poisson models with robust standard errors by arm. Reductions in frequency of use were examined using ordered logistic regression. RESULTS: In intent-to-treat analyses, compared to men who received rapid HIV testing only, we found men randomized to PCC with rapid HIV testing were more likely to report abstaining from alcohol consumption (RR=0.93; 95% CI=0.89-0.97), marijuana use (RR=0.84; 95% CI=0.73-0.98), and erectile dysfunction drug use (EDD; RR=0.51; 95% CI=0.33-0.79) over the 6-month follow-up. PCC was also significantly associated with reductions in frequency of alcohol intoxication (OR=0.58; 95% CI=0.36-0.90) over follow-up. Furthermore, we found PCC was associated with significant reductions in number of unprotected anal intercourse events while under the influence of methamphetamine (RR=0.26; 95% CI=0.08-0.84). CONCLUSION: The addition of adapted PCC to rapid HIV testing may have benefits in increasing abstinence from certain classes of substances previously associated with HIV risk, including alcohol and EDD; and reducing alcohol intoxication frequency and high-risk sexual behaviors concurrent with methamphetamine use. |
Correlates of unprotected vaginal or anal intercourse with women among substance-using men who have sex with men
Greene E , Frye V , Mansergh G , Colfax GN , Hudson SM , Flores SA , Hoover DR , Bonner S , Koblin BA . AIDS Behav 2013 17 (3) 889-99 The role men who have sex with men and women (MSMW) play in heterosexual HIV transmission is not well understood. We analyzed baseline data from Project MIX, a behavioral intervention study of substance-using men who have sex with men (MSM), and identified correlates of unprotected vaginal intercourse, anal intercourse, or both with women (UVAI). Approximately 10% (n=194) of the men reported vaginal sex, anal sex, or both with a woman; of these substance-using MSMW, 66% (129) reported UVAI. Among substance-using MSMW, multivariate analyses found unemployment relative to full/part-time employment (OR=2.28; 95% CI 1.01, 5.17), having a primary female partner relative to no primary female partner (OR=3.44; CI 1.4, 8.46), and higher levels of treatment optimism (OR=1.73; 95% CI 1.18, 2.54) increased odds of UVAI. Strong feelings of connection to a same-race gay community (OR=0.71; 95% CI 0.56, 0.91) and Viagra use (OR=0.31; 95% CI 0.10, 0.95) decreased odds of UVAI. This work suggests that although the proportion of substance-using MSM who also have sex with women is low, these men engage in unprotected sex with women, particularly with primary female partners. This work highlights the need for further research with the substance using MSMW population to inform HIV prevention interventions specifically for MSMW. |
Dose-response associations between number and frequency of substance use and high-risk sexual behaviors among HIV-negative substance-using men who have sex with men (SUMSM) in San Francisco
Santos GM , Coffin PO , Das M , Matheson T , Demicco E , Raiford JL , Vittinghoff E , Dilley JW , Colfax G , Herbst JH . J Acquir Immune Defic Syndr 2013 63 (4) 540-4 We evaluated the relationship between frequency and number of substances used and HIV risk (i.e. serodiscordant unprotected anal intercourse [SDUAI]) among 3173 HIV-negative substance-using MSM. Compared to non-users, the adjusted odds ratio(AOR) for SDUAI among episodic and at least weekly users, respectively, was 3.31(95%CI 2.55-4.28) and 5.46(3.80-7.84) for methamphetamine, 1.86(1.51-2.29) and 3.13(2.12-4.63) for cocaine, and 2.08(1.68-2.56) and 2.54(1.85-3.48) for poppers. Heavy alcohol drinkers reported more SDUAI than moderate drinkers (AOR=1.90(1.43-2.51)). Compared to non-users, AORs for using one, two, and ≥ three substances were 16.81(12.25-23.08), 27.31(18.93-39.39), and 46.38(30.65-70.19), respectively. High-risk sexual behaviors were strongly associated with frequency and number of substances used. |
Sexual risk behavior among HIV-uninfected men who have sex with men (MSM) participating in a tenofovir pre-exposure prophylaxis (PrEP) randomized trial in the United States
Liu AY , Vittinghoff E , Chillag K , Mayer K , Thompson M , Grohskopf L , Colfax G , Pathak S , Gvetadze R , O'Hara B , Collins B , Ackers M , Paxton L , Buchbinder SP . J Acquir Immune Defic Syndr 2013 64 (1) 87-94 OBJECTIVE: To evaluate for changes in sexual behaviors associated with daily pill-use among MSM participating in a PrEP trial. DESIGN: Randomized, double-blind, placebo-controlled trial. Participants were randomized 1:1:1:1 to receive tenofovir disoproxil fumarate or placebo at enrollment or after a 9-month delay and followed for 24 months. METHODS: 400 HIV-negative MSM reporting anal sex with a man in the past 12 months and meeting other eligibility criteria enrolled in San Francisco, Atlanta, and Boston. Sexual risk was assessed at baseline and quarterly visits using Audio Computer-Assisted Self-Interview. The association of pill-taking with sexual behavior was evaluated using logistic and negative-binomial regression for repeated measures. RESULTS: Overall indices of behavioral risk declined or remained stable during follow-up. Mean numbers of partners and proportion reporting unprotected anal sex (UAS) declined during follow-up (p<0.05), and mean UAS episodes remained stable. During the initial 9 months, changes in risk practices were similar in the group that began pills immediately vs. those in the delayed arm. These indices of risk did not differ significantly after initiation of pill-use in the delayed arm or continuation of study medication in the immediate arm. Use of poppers, amphetamines, and sexual performance-enhancing drugs were independently associated with one or more indices of sexual risk. CONCLUSIONS: There was no evidence of risk compensation among HIV-uninfected MSM in this clinical trial. Monitoring for risk compensation should continue now that PrEP has been shown to be efficacious in MSM and other populations and will be provided in open-label trials and other contexts. |
Implementing rapid HIV testing with or without risk-reduction counseling in drug treatment centers: results of a randomized trial
Metsch LR , Feaster DJ , Gooden L , Matheson T , Mandler RN , Haynes L , Tross S , Kyle T , Gallup D , Kosinski AS , Douaihy A , Schackman BR , Das M , Lindblad R , Erickson S , Korthuis PT , Martino S , Sorensen JL , Szapocznik J , Walensky R , Branson B , Colfax GN . Am J Public Health 2012 102 (6) 1160-7 OBJECTIVES: We examined the effectiveness of risk reduction counseling and the role of on-site HIV testing in drug treatment. METHODS: Between January and May 2009, we randomized 1281 HIV-negative (or status unknown) adults who reported no past-year HIV testing to (1) referral for off-site HIV testing, (2) HIV risk-reduction counseling with on-site rapid HIV testing, or (3) verbal information about testing only with on-site rapid HIV testing. RESULTS: We defined 2 primary self-reported outcomes a priori: receipt of HIV test results and unprotected anal or vaginal intercourse episodes at 6-month follow-up. The combined on-site rapid testing participants received more HIV test results than off-site testing referral participants (P < .001; Mantel-Haenszel risk ratio = 4.52; 97.5% confidence interval [CI] = 3.57, 5.72). At 6 months, there were no significant differences in unprotected intercourse episodes between the combined on-site testing arms and the referral arm (P = .39; incidence rate ratio [IRR] = 1.04; 97.5% CI = 0.95, 1.14) or the 2 on-site testing arms (P = .81; IRR = 1.03; 97.5% CI = 0.84, 1.26). CONCLUSIONS: This study demonstrated on-site rapid HIV testing's value in drug treatment centers and found no additional benefit from HIV sexual risk-reduction counseling. (Am J Public Health. Published online ahead of print April 19, 2012: e1-e8. doi:10.2105/AJPH.2011.300460.) |
'Less education' is associated with use and sharing of antiretroviral medications for prophylaxis of HIV infection by US men who have sex with men
Mansergh G , Koblin B , Colfax GN , Flores SA , Hudson SM . Sex Transm Infect 2011 87 (6) 510 Pre-exposure prophylaxis (PrEP) of HIV infection with antiretroviral therapy (ART) was recently found to reduce HIV infection through sexual contact in men who have sex with men (MSM).1 Non-prescribed use and sharing of ART to prevent HIV infection were reported by MSM in the USA before efficacy was determined.2 We report on demographic factors associated with ART use for prophylaxis purposes prior to known efficacy. | A convenience sample of MSM was enrolled in Chicago, Los Angeles, New York City and San Francisco.2 3 We assessed pre-efficacy use of ART medications by HIV-negative MSM (n=454) and sharing of ART medications by HIV-positive MSM (n=557) with their sex partners for use ‘before sex’ (PrEP) and ‘after sex’ (post-exposure prophylaxis, PEP) to prevent HIV infection. Demographic characteristics included: 22% 18–29 years, 35% 30–39 years and 43% 40+ years old; 33% black, 18% Hispanic, 38% white and 11% other race/ethnicity; and 31% high school equivalency or less, 34% some post-high school education and 35% college degree or more education. | HIV-negative men with a high school diploma/equivalency or less (‘less education’) were more likely than others to report using PrEP (5% vs 1%, p<0.05) and PEP (8% vs 3%, p<0.05) in the prior 6 months. In multivariate analysis adjusting for age, race/ethnicity and city, ‘less education’ was associated with recent use of PEP (OR=3.5, 95% CI=1.1 to 11.8) but not PrEP (p>0.05) compared with those with at least a college degree; none of the other demographic variables was associated with PrEP or PEP use (p>0.05) by HIV-negative men. |
Condom use decision making in the context of hypothetical pre-exposure prophylaxis efficacy among substance-using men who have sex with men: Project MIX
Koblin BA , Mansergh G , Frye V , Van Tieu H , Hoover DR , Bonner S , Flores SA , Hudson SM , Colfax GN . J Acquir Immune Defic Syndr 2011 58 (3) 319-27 OBJECTIVE: To examine condom use decision making in the context of hypothetical pre-exposure prophylaxsis (PrEP) efficacy among men who have sex with men (MSM) who use alcohol and other substances during sex. METHODS: Substance-using MSM were recruited in four US cities for a behavioral intervention trial. Three groups were defined: men who indicated that in order to not use a condom for receptive/insertive anal intercourse (UAI) while using PrEP, PrEP would need to be: 1) almost always or always effective (high efficacy); 2) effective at least half the time or more but not almost always or always (mid-range efficacy corresponding to recent PrEP trial results); 3) effective less than half the time (low efficacy). The mid-range efficacy group was compared to the low efficacy group (as the reference) and to the high efficacy group (as the reference). RESULTS: Among 630 men who never used PrEP, 15.2% were in the mid-range efficacy group for receptive UAI and 34.1% in the mid-range efficacy group for insertive UAI. Scores on difficulty communicating about safer sex while high were significantly higher in the mid-range efficacy group compared to each of the other groups for both receptive and insertive UAI. Men who appeared to be differentiating PrEP use by anal sex role also scored higher on communication difficulties, while scoring lower on condom intentions. CONCLUSIONS: Communication about safer sex while under the influence of alcohol or other substances and condom intentions are important factors to consider for HIV prevention interventions for PrEP users. |
Depression is associated with sexual risk among men who have sex with men, but is mediated by cognitive escape and self-efficacy
Alvy LM , McKirnan DJ , Mansergh G , Koblin B , Colfax GN , Flores SA , Hudson S . AIDS Behav 2011 15 (6) 1171-9 Men who have sex with men (MSM) show high rates of HIV infection, and higher rates of depression than non-MSM. We examined the association between depression and sexual risk among "high risk" MSM. Evidence has been mixed regarding the link between depression and risky sex, although researchers have rarely considered the role of psychosocial vulnerabilities such as self-efficacy for sexual safety or "escape" coping styles. In a national sample (N = 1,540) of HIV-positive and HIV-negative MSM who reported unprotected sex and drug use with sex partners, we found evidence that depression is related to HIV transmission risk. Self-efficacy for sexual safety and cognitive escape mediated the link between depression and risk behavior, suggesting that psychosocial vulnerability plays an important role in the association of depression with sexual risk. These findings may help us construct more accurate theories regarding depression and sexual behavior, and may inform the design of sexual safety interventions. |
HIV-related attitudes and intentions for high-risk, substance-using men who have sex with men: associations and clinical implications for HIV-positive and HIV-negative MSM
Mansergh G , McKirnan DJ , Flores SA , Hudson SM , Koblin BA , Purcell DW , Colfax GN . J Cogn Psychother 2010 24 (4) 281-293 This study compared HIV-related attitudes and intentions by respondent HIV-status in a large sample of substance-using men who have sex with men (MSM) in the United States. Attitudes and intentions included self-efficacy for safer sex; difficulty communicating with sex partners about safer sex; intent to use condoms consistently and to not use substances before sex in the next 3 months; and less concern for HIV given effective antiviral treatments. Differences were found for behavior during the most recent anal sex encounter by HIV-status, including (a) insertive and (b) receptive anal sex risk behavior, and (c) substance use before or during the encounter. Self-efficacy for safer sex was associated with less risk behavior among HIV-negative men but not among HIV-positive men, suggesting that self-efficacy for safer sex continues to be a relevant issue to address in counseling uninfected MSM. HIV-positive men who reported less concern for HIV given treatments were more likely to report receptive risk behavior, as were HIV-negative men who reported difficulty communicating about safer sex. Implications are discussed for potentially heightened client desire and therapeutic opportunity to reduce future substance use during sex for clients who report recent substance use during sex. 2010 Springer Publishing Company. |
Preefficacy use and sharing of antiretroviral medications to prevent sexually-transmitted HIV infection among US men who have sex with men
Mansergh G , Koblin BA , Colfax GN , McKirnan DJ , Flores SA , Hudson SM . J Acquir Immune Defic Syndr 2010 55 (2) e14-6 Preexposure and postexposure prophylaxis (PrEP and PEP, respectively) of HIV infection with antiretroviral therapy (ART) may reduce HIV infection through sexual contact.1 Although laboratory2,3 and mother-to-child4 transmission research have found that ART is effective in reducing HIV infection through nonoccupational exposure, human efficacy studies for preexposure prevention of sexual transmission are still underway. Men who have sex with men (MSM) will be a target population for ART prophylaxis if this strategy is found to be efficacious because they account for most HIV infections in the United States and are the only risk group with increasing incidence.5,6 We examined recent use and sharing of ART medications for the purposes of PrEP and PEP among high-risk substance-using MSM. | A convenience sample of HIV-negative and HIV-positive MSM who reported unprotected anal sex and substance use during anal sex in the previous 6 months were enrolled in a behavioral intervention trial (Project MIX) in Chicago, Los Angeles, New York City, and San Francisco.7 Men participated in a baseline and 12-month follow-up assessment (2006-2008). In multivariate analytic models, we examined baseline demographic variables (race/ethnicity, age group, education level, city), unprotected anal sex, treatment optimism (ie, “less concerned” about HIV infection because of effective treatments), and PrEP (ie, used “before sex”) and PEP (ie, used “only after sex”) use to prevent HIV infection via sexual exposure within the previous 6 months. The analytic sample (n = 1011) consisted of men with data at the 12-month follow-up (84% retention of n = 1204 at baseline) and was diverse in terms of race/ethnicity (33% black, 18% Hispanic, 38% white, 11% other), age group (22% 18-29 years, 35% 30-39 years, 43% 40+ years), and education level (31% high school equivalency or less, 34% some post high school education, 35% college degree or more). Analyses were stratified by respondent HIV status (n = 454 HIV negative, n = 557 HIV positive). At baseline, two-thirds of the men (59% of HIV negative and 74% of HIV positive men, P < 0.0001) had engaged in unprotected anal sex during their most recent anal sex encounter (prior 3 months), and over one-third (35% of HIV negative and 39% of HIV positive men, P = 0.22) had unprotected anal sex with a partner of unknown or different HIV status than their own. |
An intervention to reduce HIV risk behavior of substance-using men who have sex with men: a two-group randomized trial with a nonrandomized third group
Mansergh G , Koblin BA , McKirnan DJ , Hudson SM , Flores SA , Wiegand RE , Purcell DW , Colfax GN . PLoS Med 2010 7 (8) e1000329 BACKGROUND: Substance use during sex is associated with sexual risk behavior among men who have sex with men (MSM), and MSM continue to be the group at highest risk for incident HIV in the United States. The objective of this study is to test the efficacy of a group-based, cognitive-behavioral intervention to reduce risk behavior of substance-using MSM, compared to a randomized attention-control group and a nonrandomized standard HIV-testing group. METHODS AND FINDINGS: Participants (n = 1,686) were enrolled in Chicago, Los Angeles, New York City, and San Francisco and randomized to a cognitive-behavioral intervention or attention-control comparison. The nonrandomized group received standard HIV counseling and testing. Intervention group participants received six 2-h group sessions focused on reducing substance use and sexual risk behavior. Attention-control group participants received six 2-h group sessions of videos and discussion of MSM community issues unrelated to substance use, sexual risk, and HIV/AIDS. All three groups received HIV counseling and testing at baseline. The sample reported high-risk behavior during the past 3 mo prior to their baseline visit: 67% reported unprotected anal sex, and 77% reported substance use during their most recent anal sex encounter with a nonprimary partner. The three groups significantly (p<0.05) reduced risk behavior (e.g., unprotected anal sex reduced by 32% at 12-mo follow-up), but were not different (p>0.05) from each other at 3-, 6-, and 12-mo follow-up. Outcomes for the 2-arm comparisons were not significantly different at 12-mo follow-up (e.g., unprotected anal sex, odds ratio = 1.14, confidence interval = 0.86-1.51), nor at earlier time points. Similar results were found for each outcome variable in both 2- and 3-arm comparisons. CONCLUSIONS: These results for reducing sexual risk behavior of substance-using MSM are consistent with results of intervention trials for other populations, which collectively suggest critical challenges for the field of HIV behavioral interventions. Several mechanisms may contribute to statistically indistinguishable reductions in risk outcomes by trial group. More explicit debate is needed in the behavioral intervention field about appropriate scientific designs and methods. As HIV prevention increasingly competes for behavior-change attention alongside other "chronic" diseases and mental health issues, new approaches may better resonate with at-risk groups. TRIAL REGISTRATION: ClinicalTrials.gov NCT00153361 Please see later in the article for the Editors' Summary. |
Gay identity-related factors and sexual risk among men who have sex with men in San Francisco
Flores SA , Mansergh G , Marks G , Guzman R , Colfax G . AIDS Educ Prev 2009 21 (2) 91-103 This study explored the relationship between gay identity-related factors (gay community involvement, gay bar attendance, gay identity importance, and self-homophobia) and unprotected anal sex (UA) in the past 3 months among men who have sex with men (MSM) of three different race/ethnicity groups. Four hundred eighty-three MSM (mean age 34) were recruited in the San Francisco Bay Area (33% African American, 34% Latino and 33% White). Compared with White MSM, African American and Latino MSM were less likely to identify as gay, and to attend gay bars/clubs, and more likely to report self-homophobia. Just over one third of the sample reported UA (did not vary by race). Gay community involvement was associated with receptive UA with all partners (adjusted odds ratio [AOR = 1.30, 95% Confidence Interval (CI) = 1.06-1.60). Gay bar attendance was associated with insertive UA with all partners (AOR = 1.20, 95% CI = 1.01-1.43) and with HIV-discordant partners (AOR = 1.35, 95% CI = 1.08-1.69). Implications for prevention include addressing community norms and encouraging alternatives to bars as settings in which to meet and socialize with other MSM. |
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