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The AIDS epidemic in Sub-Saharan Africa continues to affect all facets of life throughout the subcontinent. Deaths related to AIDS have driven down the life expectancy rate of residents in Zambia, Kenya, and Uganda with far-reaching implications. This book details the current state of the AIDS epidemic in Africa and what is known about the behaviors that contribute to the transmission of the HIV infection. It lays out what research is needed and what is necessary to design more effective prevention programs.
HIV remains a critical public health issue facing men who have sex with men (MSM) in the United States. Young MSM (YMSM) ages 13-34 years account for the greatest number of new HIV infections in MSM, with Black YMSM bearing the highest burden of disease. Sexual risk behaviors (e.g. unprotected sex) continue to be the leading transmission mode for HIV among all YMSM and studies have indicated that these behaviors are associated with a number of psychosocial and environmental factors, including adverse childhood experiences (ACEs), exposure to violence, substance use, and mental health problems. Moreover, recent studies based on the syndemic model of HIV risk have shown that exposure to violence, substance use, mental health problems may interact to increase HIV risk in vulnerable populations, including YMSM. However, the relationships among these risk factors and their association with sexual risk behaviors in YMSM are not yet fully understood. Therefore, the purpose of this cross-sectional, quantitative study was to: 1) describe the degree to which YMSM engage in HIV risk behaviors, are exposed to ACEs and other multiple forms of violence, experience mental health problems, and use substances; 2) identify the ACEs and violence exposure, substance use, and mental health problems that significantly predict HIV risk behaviors in Black and White YMSM; and 3) test the indirect (through substance use and mental health pathways) effects of violence exposure on HIV risk behaviors. Data was collected using structured computer-assisted personal interviews from a convenience sample of 168 Black (97) and White (71) YMSM recruited at AIDS service organizations that provide HIV prevention programs and testing for YMSM in the St. Louis and Kansas City metropolitan areas. The current study contributed to knowledge regarding HIV risk behaviors and related syndemic risk factors in service-using YMSM. This study was unique in the assessment of adverse childhood experiences, multiple types of violence exposure, experiences of multiple types of mental health problems, and use of multiple substances in a service-using sample of HIV-negative Black and White YMSM, the populations at highest risk for HIV infection in the US. This study found that a substantial proportion of YMSM are exposed to multiple adverse childhood experiences, intimate partner violence, and community violence, all of which were previously unexplored or understudied in YMSM. Additionally, findings from the study identified unique significant mental health and substance use predictors of unprotected anal sex and number of male sex partners for YMSM when controlling for demographic factors. Further, although relationships between adverse childhood experiences or intimate partner violence and HIV risk behaviors were not significant in multiple regression models, this study demonstrated that adverse childhood experiences and intimate partner violence indirectly affect HIV risk behaviors through polydrug use, whereby higher rates of violence exposure lead to more polydrug use, which leads to a higher rate of multiple male sex partners. The results of this study have implications for social work practice and policy changes that lead to integration of mental health and substance use screening and referral into AIDS service organization that provide HIV prevention services. Moreover, results can be used by researchers to adapt theoretical models of HIV risk and prevention for YMSM.
It is widely recognized that current HIV intervention models are falling short of their goals. What are the alternatives?To answer this question, New International Directions in HIV Prevention for Gay and Bisexual Men presents a collection of articles from European and American authors that rival dominant paradigms of HIV prevention. Researchers, practitioners, and community organizations will be challenged to examine current assumptions and to consider neglected aspects of risk behavior such as love, trust, and the dynamics of sexual intimacy. New International Directions in HIV Prevention for Gay and Bisexual Men explores models and theories that will help you develop more effective HIV prevention programs to better serve patients and clients.New International Directions in HIV Prevention for Gay and Bisexual Men offers you fresh perspectives on prevention work by examining risk behaviors in the interactional, communal, and social contexts in which they are practiced. You will receive alternative explanations and reasons for HIV risk that go beyond current approaches and that introduce possibilities for new intervention strategies. Written by experts in the field, the chapters in New International Directions in HIV Prevention for Gay and Bisexual Men will give you insight into new ideas and developments, including: placing a greater emphasis on improving successful risk management strategies as opposed to quantifying risk factors examining the meaning and context of sexual acts which occur in casual encounters or steady partnerships and incorporating their relevancy into prevention work considering the effects that cultural context and socially constructed meanings have on prevention work and incorporating individuals’values and feelings into prevention strategies focusing on more realistic goals of harm reduction that take sexual decision making into consideration as opposed to expecting abstinence relating the various aspects of sexual encounters--physical attraction, intimacy, reciprocity, and power--to reasons why men choose not to use condomsExamining how gay men can underestimate the risk of HIV in order to meet needs of intimacy, New International Directions in HIV Prevention for Gay and Bisexual Men will help you understand the symbolic dimension of sexual contact. The normal, everyday reasons for having sex without a condom are explored, questioning models which often characterize unprotected sex as being the result of low self-esteem, substance abuse, or some other psychological vulnerability. Presenting data from both qualitative and quantitative research conducted at group and individual levels, this book reveals the complexity of risk behavior, the richness of sexual experience, and the importance of respecting the unique context in which gay men live their sexual lives. New International Directions in HIV Prevention for Gay and Bisexual Men will help you understand this point of view, enabling you to provide patients and clients with more effective HIV prevention and risk management services.
Abstract: Although the incidence of HIV transmission among other groups is rising, men who have sex with men (MSM) account for more than forty percent of all new HIV infections. It stands to reason then, that both HIV-positive and HIV-negative MSM continue to engage in unsafe sexual behaviors. Efforts to curtail the spread of HIV infection have included safer sex campaigns, education and prevention programs, and the application of risk reduction models typically designed for HIV-negative individuals. Yet, HIV-positive MSM continue to engage in risk-taking sexual behaviors. The quandary with most HIV prevention programs is that they require an elimination of sexual behaviors that MSM have reported as important, in effect reducing their sexual freedom. Therefore, MSM may be motivated to regain the sexual freedom that existed prior to the HIV epidemic. Psychological reactance (Brehm, 1966) is a framework that describes why individuals become motivated to restore freedoms that have been threatened or eliminated. The purpose of this research was to test the theory of psychological reactance as applied to the risk-related sexual behaviors of HIV-positive MSM. According to the theory, the more important a behavior is, the greater the magnitude of reactance. The crux of this research rests on the premise that sexual importance contributes to MSM engaging in risky sexual behaviors. Psychological reactance was measured by the Therapeutic Reactance Scale (TRS) and the Questionnaire for Measuring Psychological Reactance (QMPR). This research utilized multiple linear regression analysis to test hypotheses asserting that the interaction term (reactance X sexual importance) predicts risk-related sexual behaviors in HIV-positive MSM. Results indicated that sexual importance was the most significant predictor of risk-related sexual behaviors of HIV-positive MSM. The interaction term (TRS X sexual importance) was significant for sexual practices, number of sexual encounters, number of sexual partners, and unprotected anal intercourse. The interaction term (QMPR X sexual importance) was significant for attitude, sexual practices, and unprotected anal intercourse. The implications for behavioral interventions and clinical practice as well as for future research are discussed.
Recent clinical trial results suggest that new HIV prevention interventions, such as pre-exposure prophylaxis and treatment as prevention, protect against HIV infection. However, several barriers to widespread implementation of these interventions have been identified. In response to some of these challenges, many argue that new HIV prevention interventions should only be delivered to high-risk populations within integrated HIV prevention programs that consist of biomedical, behavioral, and structural interventions. In the United States, men who have sex with men (MSM) remain the most heavily HIV affected population, and thus will likely be the target of such programs. This dissertation aims to inform the development of MSM-specific HIV prevention programs by providing a better understanding of the situations in which new prevention strategies could have the greatest impact within this population. More specifically, this dissertation examines longitudinal patterns of sexual risk behavior, socio-demographic and behavioral factors associated with partnership type and serostatus, and individual-level and sexual event-level predictors of condom use during receptive anal intercourse among MSM. Chapter 2 is based on data from the Multicenter AIDS Cohort Study (MACS) and demonstrates that HIV-negative MSM exhibit distinct sexual risk trajectories and that those following a high risk trajectory exhibit "seasons of risk" over time. Chapter 3 also uses data from the MACS to show that the reported number of male sexual partners is associated with partnership type and serostatus and that the magnitude and direction of this relationship differs by HIV status. Chapter 4 is based on longitudinal data from a cohort of racially/ethnically diverse HIV-negative MSM followed for one year in Los Angeles, and demonstrates that the effect of methamphetamine use on condom use during receptive anal intercourse at the sexual event-level is greatest in the context of non-main partnerships. Findings from this dissertation expand the current understanding of risk behaviors among MSM, and have implications for the development of integrated HIV prevention programs for MSM in the United States.
Human Rights; Risk behavior; Cost-effectiveness; Low and middle income countries; Human Immunodeficiency Virus; Epidemic; Men who have sex with men; Attributable fraction; Intervention/Prevention; Homosexuality.
Academic Paper from the year 2017 in the subject Health - Public Health, De La Salle University (College of Liberal Arts), language: English, abstract: This report reviews published research-based data on the prevalence of anal intercourse without using condoms (AIWC) among men having sex with men (MSM) samples and the characteristics of MSM having AIWC. The number of MSM in various parts of the world and who are contracting sexually transmitted infections (STI), including human immunodeficiency virus infection, is increasing. Risk-reduction interventions need more nuanced information to further understand how AIWC, the main driver of the growth in the STI prevalence among MSM populations, can be better addressed. Overall, the findings indicate that there are large numbers of MSM samples reported to have engaged in AIWC (range: 12%-72%). There are a variety of characteristics found to be statistically significantly related with AIWC, many of which are related with the general life aspects of MSM. Risk-reduction interventions need to do more in reaching out to the MSM populations by broadening the focus, substance and impact of their efforts.