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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.
Recent multicenter, randomized, double blind clinical trials have shown no association between HIV preexposure prophylaxis (PrEP) and increased sexual risk behavior among high-risk men who have sex with men (MSM). However, little research has been conducted under natural conditions devoid of clinical trial controlled environment to confirm the lack of association between PrEP and increased sexual risk behavior. Also, research has shown conflicting associations between sociodemographic characteristics and sexual risk behavior among MSM. In this cross-sectional, web-based, primary data analysis, MSM who reside in United States of America and who make use of PrEP for HIV prevention were examined to determine and explain the relationship between PrEP and sexual risk behavior using the theory of health belief model.
Human Development and Criminal Behavior proposes an exten- sive agenda for crime research. The book is part of a pio- neering effort to understand the causes of crime, particu- larly its developmental course. It defines and sets the con- ditions necessary to conduct an accelerated longitudinal study of individuals at risk to become engaged in criminal careers. This work offers a blueprint for research to eluci- date and possibly prevent crime in our society.
Dissertation Aims - 1) review the literature to examine if PrEP is associated with changes in risk behavior in MSM; 2) determine the reasons why MSM who self-identify as low risk for HIV request PrEP; and 3) determine how PrEP use affects condom use and STIs rates in MSM who self-identify as high risk for HIV.
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.
"The general aim of this thesis is to provide insights into the contextual and cognitive factors that affect sexual-risk behaviors and adopted HIV-prevention strategies among men who have sex with men (MSM) with casual partners using psychosocial and epidemiological data. In the general introduction, we provided a brief historical overview of the HIV epidemic among MSM. In chapter 2.1, we investigated the proportion of HIV-negative MSM who engage in 'serosorting', and whether this risk-reduction strategy offers sufficient protection against HIV infection. In chapter 2.2, we examined another prevention strategy, called 'viral load sorting' among HIV-positive MSM. Sexual behaviors with different types of casual partners were investigated in chapter 3.1. In chapter 3.2, we investigated the context of group sex, sexual behaviors and STIs. To further increase our understanding of men's setting-specific sexual behaviors, in chapter 3.3 we examined sexual risk-related perceptions and behaviors in different physical and online settings across the Netherlands. Finally, in chapter 4, we were interested in core individual values that might play a role in shaping sexual risk choices. In the general discussion we concluded that MSM engage in a wide range of protective sexual behaviors according to different settings and types of sex partners and that different external factors and internal motives influence engagement in such behaviors. We call for this knowledge to be used by HIV-prevention professionals to support MSM in their decision to engage in protective behaviors that best suit their desires and needs and to address the consequences of the strategies chosen."--Samenvatting auteur.
This Handbook provides a comprehensive overview of the theories, methods and approaches for reducing HIV-associated risk behaviors. It represents the first single source of information about HIV prevention research in developed and developing countries. It will be an important resource for students, researchers and clinicians in the field.