Opportunities for improving partner notification for HIV: results from a community-based participatory research study.

To identify actionable opportunities for improving Partner Notification (PN) for HIV among men who have sex with men (MSM), we characterized the perspectives and experiences of PN among Medical Case Managers (case managers), Disease Intervention Specialists (DIS), and MSM. In partnership with an AIDS service organization and the Connecticut State Health Department, we conducted a focus group of case managers (n = 14) and in-depth interviews with DIS (n = 7) and MSM (n = 24). We found differences between MSM's and providers' (case managers and DIS) perspectives regarding (1) determinants of sexual risk behaviors; (2) considerations impacting HIV disclosure; and (3) barriers to trusting relationships between MSM and providers. Factors impacting MSM perspectives on PN were incompletely appreciated by both case managers and DIS. PN may be improved through improving provider understanding of the complexities for MSM regarding sexual risk behaviors and disclosure and transcending barriers to trusting relationships between MSM and providers.

Stigma, substance use and sexual risk behaviors among HIV-infected men who have sex with men: A qualitative study.

BACKGROUND: Public health HIV-service providers, including Medical Case Managers (case managers) and Disease Intervention Specialists (DIS) have a key role to play in identifying and addressing clients' complex mental health needs and substance use which contribute to sexual risk behaviors, yet their understanding and its consensus with HIV-infected men who have sex with men (MSM) have not been well characterized. METHODS: Together with an AIDS Service Organization and the Connecticut State Department of Public Health in 2011-2012, we conducted a focus group of case managers (n = 14) and interviewed DIS (n = 7) and HIV-infected MSM (n = 17) in Connecticut. We used the constant comparison method, grounded theory, and a community-based participatory approach to guide analysis. RESULTS: We identified three themes characterizing public health HIV-service providers' and MSM's perspectives regarding factors contributing to substance use and sexual risk behaviors in the context of HIV infection: 1) While both MSM and providers described a co-occurrence of HIV, stigma, substance use, and sexual risk behaviors, only MSM identified a causal relationship between these factors; 2) MSM and providers both described varying levels of self-efficacy in readiness to decrease substance use and sexual risk behaviors among MSM; both identified the social network as the key barrier to overcome; 3) Providers described how the co-occurrence of HIV, stigma and sexual risk behaviors leads to multi-faceted client needs for which they lacked sufficient training and collaboration. CONCLUSIONS: Provider education, skills-based training, and interventions targeting social networks may decrease sexual risk behaviors among HIV-infected MSM.

Time, dual roles, and departments of public health: lessons learned in CBPR by an AIDS service organization.

Community-based participatory research (CBPR) is an important approach to inform the development and implementation of HIV/AIDS prevention and treatment strategies. However, there is a paucity of literature describing CBPR from the perspective of community-based organizations (CBOs), specifically AIDS service organizations (ASO). Focusing on the perspective of the executive director (ED) from the partnering ASO, we describe in this paper lessons learned during Project Counseling Others About Contacts and Exposures with HIV (COACH), a CBPR, qualitative study intended to examine perspectives and experiences of professionals and clients regarding partner notification (PN) for HIV. Specifically, we describe opportunities and challenges associated with the time investment, balancing a dual role of service provider and researcher, and partnering with the department of public health. This description of the perspective of the ED from the ASO and the associated lessons learned may inform the actions of other CBOs, including ASOs, considering partnering with academic institutions for CBPR.

Sex partner meeting venues and out-of-state sex partners among men who have sex with men with early syphilis in Connecticut.

OBJECTIVES: To examine sex partner meeting venues and out-of-state sex partners among men who have sex with men (MSM) with syphilis in Connecticut, a state with moderate syphilis prevalence. GOAL: To better understand transmission dynamics in the current syphilis epidemic. STUDY DESIGN: Review of health department records. RESULTS: A total of 185 MSM were diagnosed with early syphilis in Connecticut from 2000 to 2005 (mean age, 36 years; 56% white, 37% HIV-positive). Fifty-two percent of cases reported meeting sex partners at venues that facilitate multiple and/or anonymous sexual encounters including gay clubs or bars (22%), Internet (18%), and adult bookstores (12%). Meeting sex partners in venues increased over time and was associated with nonmetropolitan residence of the case. Forty-three percent of cases had an out-of-state sex partner during the time in which they likely acquired their infection. Having out-of-state sex partners decreased during the study period. Throughout 2000-2005, having out-of-state sex partners was positively associated with bathhouse use and negatively associated with use of adult bookstores. CONCLUSIONS: The observed pattern of increased meeting sex partners in venues located within the state and decreased out-of-state sex partners over time is suggestive of increasing transmission within the state of Connecticut.

Early syphilis among men in Connecticut: epidemiologic and spatial patterns.

OBJECTIVE: The objective of this study was to describe the epidemiology of early syphilis among men in Connecticut, a moderate-prevalence region, in 2004. STUDY DESIGN: The authors conducted a cross-sectional analysis of health department data. RESULTS: Fifty-five cases were reported from 25 different towns. A majority of cases (82%) were reported among men who have sex with men, and 22% reported coinfection with HIV. Spatial analysis indicated moderate clustering of cases. Approximately half of 197 reported sex partners were not from Connecticut, including 28% from New York City and 20% from other states/countries. The median distance between partners was 48 km (30 miles). Twenty-three percent of syphilis cases had both local and nonlocal partners. CONCLUSIONS: The current epidemiology of early syphilis in Connecticut is consistent with national trends. However, the dispersal of cases throughout the state and the high proportion of reported sex partners residing outside of Connecticut suggest that this state is not a core area of endemic transmission.