This study examined demographic characteristics, sexual risk behaviors, sexual beliefs, and substance use patterns in HIV-positive, methamphetamine-using men who have sex with both men and women (MSMW) (n = 50) as compared to men who have sex with men only (MSM) (n = 150). Separate logistic regressions were conducted to predict group membership. In the final model, of 12 variables, eight were independently associated with group membership. Factors independently associated with MSMW were acquiring HIV through injection drug use, being an injection drug user, using hallucinogens, using crack, being less likely to have sex at a bathhouse, being less likely to be the receptive partner when high on methamphetamine, having greater intentions to use condoms for oral sex, and having more negative attitudes about HIV disclosure. These results suggest that, among HIV-positive methamphetamine users, MSMW differ significantly from MSM in terms of their HIV risk behaviors. Studies of gay men and HIV often also include bisexual men, grouping them all together as MSM, which may obscure important differences between MSMW and MSM. It is important that future studies consider MSM and MSMW separately in order to expand our knowledge about differential HIV prevention needs for both groups. This study showed that there were important differences in primary and secondary prevention needs of MSM and MSMW. These findings have implications for both primary and secondary HIV prevention among these high-risk populations.

Background

Harm reduction has focused primarily on reduction of high-risk substance using behaviors rather than reductions in high-risk sexual behaviors. Furthermore, most studies focus on individual behavior change, with less attention paid to the social and environmental context. This paper promotes understanding of the interplay between the individual and the social context by examining the psychosocial and behavioral characteristics of 321 methamphetamine-using HIV-positive men who have sex with men (MSM) in San Diego, CA based on the locations or venues of their sexual activities when "high" on methamphetamine.

Methods

Participants in a safer-sex intervention study underwent a baseline assessment that queried demographic and psychosocial characteristics as well as drug use and sexual risk behaviors. For purposes of analysis, respondents were classified according to their preference of sexual venue: private (e.g., home), commercial (e.g., bathhouse), or public (e.g., public park or restroom).

Results

The commercial venue group was younger, better educated, more likely to identify as gay, and significantly more likely to have used "club drugs" as compared to the other two groups. Men in the commercial- and public-venue groups reported more high-risk sex compared to the private-venue group. The public-venue group reported heavier drug and alcohol use, had significantly higher Beck depression scores, reported more experiences of stigma, and scored higher on a measure of sexual compulsivity than did the other two groups.

Conclusion

In an effort to reduce HIV/STI risk-behaviors, future studies should investigate the feasibility of modifying personal, psychosocial and structural factors associated with the use of risky sexual venues where HIV-positive methamphetamine users engage in sexual activity when "high" on methamphetamine.

Substance use has been identified as a risk factor for elevated levels of obsessive-compulsive disorder (OCD). This study examined methamphetamine use and sexual risk behaviors as correlates of OCD in a sample of 245 HIV-positive men having sex with men (MSM) in San Diego, CA. In a logistic regression analysis, OCD was associated with greater frequency of methamphetamine use, more depressive symptoms, seeking out risky venues and risky sexual partners when "high" on methamphetamine, and reporting fewer sex acts in the past 2 months. These data suggest the need for increased awareness and understanding of the role that OCD may play in the drug use behaviors and risky sexual practices of methamphetamine users.

Objectives

HIV testing is critical to the delivery of comprehensive HIV prevention and care services, yet coverage of sexual minorities by HIV testing programmes remains insufficient in many low- and middle-income countries, including Mexico. The objective of this study was to identify the prevalence and correlates of HIV testing among men who have sex with men (MSM) in Tijuana, Mexico.

Methods

We conducted a cross-sectional study (2012-2013) among 189 MSM recruited via respondent-driven sampling (RDS). RDS-weighted logistic regression was used to identify correlates of prior HIV testing.

Results

RDS-adjusted prevalence of prior and recent (≤ 12 months) HIV testing was 63.5% (95% CI 51.9% to 73.5%) and 36.8% (95% CI 25.4% to 46.4%), respectively. Prior HIV testing was positively associated with older age (adjusted OR (AOR)=1.09, 95% CI 1.04 to 1.15), being born in Tijuana (AOR=2.68, 95% CI 1.05 to 6.86), higher levels of education (AOR=2.65, 95% CI 1.08 to 6.53), identifying as homosexual or gay (AOR=3.73, 95% CI 1.48 to 9.42), being more 'out' about having sex with men (AOR=1.28, 95% CI:1.02 to 1.62), and a history of sexual abuse (AOR=3.24, 95% CI 1.06 to 9.86). Prior HIV testing was negatively associated with reporting more condomless anal intercourse acts (past 2 months) (AOR=0.95, 95% CI 0.92 to 0.98) and greater internalised homophobia (AOR=0.92, 95% CI 0.86 to 0.99).

Conclusions

Our findings indicate an urgent need for expanded HIV testing services for MSM in Tijuana. Innovative, non-stigmatising, confidential HIV testing interventions targeted at young, less educated, migrant and non-gay identifying MSM may facilitate HIV testing and timely linkage to HIV care and treatment within this population.

The Substance Abuse, Violence, and HIV/AIDS (SAVA) syndemic model describes how the confluence of the three epidemics of substance abuse, violence, and HIV risk work synergistically to create excess burden among populations. We sought to identify risk factors associated with recent intimate partner violence (IPV) victimization among heterosexual methamphetamine (meth)-using men (n = 108) and women (n = 122) enrolled in FASTLANE-II, an HIV behavioral intervention in San Diego, CA. Women and men reported high rates of physical-only (women: 20%; men: 18%) and sexual (women: 25%; men: 23%) IPV. Multinomial regression analysis revealed that individuals who reported lower social support and individuals who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were more likely to report IPV versus no IPV. Women who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were 1.58 times more likely to report physical-only IPV versus no IPV, while men who reported similar behaviors were 1.15 times more likely to report physical-only IPV versus no IPV. Our findings highlight the influence of interpersonal factors on IPV. This research supports further study on gender-specific risk/protective factors and the development of gender-specific interventions targeting the SAVA syndemic among meth users.

AbstractBackgroundAlthough men who have sex with men (MSM) are disproportionately affected by HIV/AIDS in Mexico, data on current risk behaviors in this population are lacking. This study investigated the prevalence and correlates of unprotected anal intercourse (UAI) in a sample of 260 MSM in Tijuana, Mexico.MethodsIn June 2010, men attending a gay pride celebration were invited to complete a sexual risk survey. Men who reported UAI with a male partner in the past year were compared with men who reported only protected anal sex during the same period.ResultsMean age of participants was 29.7; 54% had a high school diploma or less; and 43% were unemployed. In the past year, 55% had been tested for HIV, 21% reported using illicit drugs before or during sex, and 94% had sex only with men. Overall, 50% reported having UAI with another male in the past year. Factors independently associated with UAI in the past year were unemployment (AOR = 1.87), attending adult movie theaters (AOR = 2.21), using illicit drugs before or during sex (AOR = 2.43), and not having a recent HIV test (AOR = 1.85).ConclusionsInterventions to promote HIV testing and condom use among men who have sex with men may want to consider venue-specific approaches, as well as focus on drug-use issues in the context of unsafe sex.

Methamphetamine use poses increased risk for HIV and other sexually transmitted infections. There is robust evidence that methamphetamine use increases sexual risk behavior, like condomless sex, primarily among men who have sex with men but also among heterosexual women and men. Gender differences have been found among women and men who use meth, and there is a high degree of interconnectedness between meth use, depression, and condomless sex. The aims of the current study are to evaluate the efficacy of a theory-based, tri-focal intervention designed to reduce depression, meth use, and condomless sex among women and men, and to examine gender as a moderator of efficacy. A total of 432 HIV-negative women and men who use meth participated in a two-arm randomized controlled trial and completed baseline and follow-up assessments at 4, 8, and 12 months. We used latent growth curve modeling techniques to analyze the data. Results showed that while all participants exhibited reductions in depression, meth use, and condomless sex, the intervention and comparison groups did not differ in changes over time. However, we did find a significant gender moderation effect, such that among men, those in the intervention arm reported greater reductions in meth use relative to those in the comparison group; reduced meth use was associated with reduced condomless sex, but not depression. In contrast, women in the intervention condition did not differ from women in the comparison condition in changes in any of the three outcome variables. Interventions targeting heterosexual women and men who use meth must be gender-specific, and take into account the unique vulnerabilities and experiences of women, including the perceived positive aspects of using meth, gendered power dynamics, higher depression, and violence.

Most studies of heterosexual sex risk practices have focused on condomless vaginal sex despite evidence that condomless anal sex has a significantly higher risk of HIV transmission. The present study focused on male clients' anal sex practices with female sex workers (FSWs) in Tijuana, Mexico, where an HIV epidemic is growing among high-risk groups. Logistic regression analyses were used to identify psychosocial and behavioral correlates of anal sex among male clients. Our sample of HIV-negative men (N = 400) was predominantly Latino (87.5 %), born in Mexico (78.8 %), never married (36.8 %) or in a regular or common-law marriage (31.5 %), and employed (62.8 %), with an average age and education of 37.8 and 9.2 years, respectively. Eighty-nine percent identified as heterosexual and 11 % as bisexual. By design, 50 % of the sample resided in Tijuana and the other 50 % in San Diego County. Nearly half (49 %) reported at least one incident of anal sex with a FSW in Tijuana in the past 4 months; of those participants, 85 % reported that one or more of their anal sex acts with FSWs had been without a condom. In a multivariate model, anal sex with a FSW in the past 4 months was associated with bisexual identification, methamphetamine use with FSWs, repeat visits to the same FSW, higher scores on perceived stigma about being a client of FSWs, and sexual compulsivity. Prevention programs are needed that address the behavioral and psychosocial correlates of heterosexual anal sex in order to reduce HIV/STI transmission risk among male clients, FSWs, and their sexual network members.

Objectives

We sought to test the efficacy of a sexual risk intervention for male clients of female sex workers (FSWs) and examine whether efficacy was moderated by syndemic risk.

Methods

From 2010 to 2014, we conducted a 2-arm randomized controlled trial (60-minute, theory-based, safer sex intervention versus a didactic time-equivalent attention control) that included 400 male clients of FSWs on the US-Mexico border with follow-up at 4, 8, and 12 months. We measured 5 syndemic risk factors, including substance use and depression. Primary outcomes were sexually transmitted infections incidence and total unprotected sex with FSWs.

Results

Although participants in both groups became safer, there was no significant difference in behavior change between groups. However, baseline syndemic risk moderated intervention efficacy. At baseline, there was a positive association between syndemic risk and unprotected sex. Then at 12 months, longitudinal analyses showed the association depended on intervention participation (B = -0.71; 95% confidence interval [CI] = -1.22, -0.20; P = .007). Among control participants there still existed this modest association (B = 0.36; 95% CI = -0.49, 1.22; P = .09); among intervention participants there was a significant negative association (B = -0.35; 95% CI = -0.63, -0.06; P = .02).

Conclusion

A brief intervention might attenuate syndemic risks among clients of FSWs. Other populations experiencing syndemic problems may also benefit from such programs.