HIV Serodisclosure and Sexual Behavior During International Travel.

When traveling internationally, HIV serodisclosure and knowledge of partners' serostatus were hampered by the lack of a common language. Condomless anal intercourse was less likely to occur in partnerships where HIV serostatus was not disclosed or known. Taken together, these observations suggest that language barriers may affect sexual decision making.

Gay and bisexual men engage in fewer risky sexual behaviors while traveling internationally: a cross-sectional study in San Francisco.

BACKGROUND: International travel poses potential challenges to HIV prevention. A number of studies have observed an association between travel and behavioural disinhibition. In the present study, we assessed differences in sexual behaviour while travelling internationally and within the USA, compared with being in the home environment. METHODS: A probability-based sample of men who have sex with men (MSM) from the San Francisco Bay Area who had travelled internationally in the previous 12 months was recruited through an adapted respondent-driven sampling methodology (N=501). Participants completed interviewer-administered, computer-assisted surveys. RESULTS: Detailed partner-by-partner behavioural data by destination type were collected on 2925 sexual partnerships: 1028 while travelling internationally, 665 while travelling within the USA and 1232 while staying in the San Francisco Bay Area. The proportion of partnerships during international travel that involved unprotected anal intercourse (UAI) was lower compared with during domestic travel and staying locally. International travel was associated with decreased odds of receptive UAI (AOR=0.65, p=0.02) compared with staying locally and there was a trend towards decreased odds of insertive UAI (AOR=0.70, p=0.07). CONCLUSIONS: MSM engaged in proportionately fewer sexual activities which present a high HIV transmission risk when travelling internationally, namely unprotected receptive and insertive anal intercourse and particularly with HIV serodiscordant partners. The lower sexual risk-taking during international travel was robust to controlling for many factors, including self-reported HIV serostatus, age, relationship status and type of partnership. These findings suggest that when travelling internationally, MSM may experience behavioural disinhibition to a lesser extent than had been described previously.

Effectiveness of an HIV prevention program for women visiting their incarcerated partners: the HOME Project.

Having an incarcerated partner presents a unique HIV risk for women, particularly low-income women of color. We developed a population-specific risk reduction intervention for women visiting men in prison that was peer educator-based and included individual and community-level intervention components. Women who were assessed prior to the intervention period had a positive association between the number of unprotected penetrative intercourse (UPI) episodes prior to their partners' incarceration and the number of UPI episodes following partners' release from prison. However, this association was negated among women assessed during the intervention. Intervention participants also were more likely to be tested for HIV, to have partners who got tested, and to talk with their partners about significantly more HIV-related topics. Conducting intervention and evaluation activities with women visiting incarcerated men is feasible and is a useful model for reaching more at-risk women.

The first condom machine in a US jail: the challenge of harm reduction in a law and order environment.

Most US jails and prisons do not provide condoms to prisoners because of concerns about possible negative consequences. Since 1989, the jail system of San Francisco, California, has provided condoms to male prisoners through 1-on-1 counseling sessions. Given the limitations of this approach, we installed, stocked, and monitored a free condom-dispensing machine in a jail to examine the feasibility of this method of providing condoms to jail prisoners. After the machine was installed, we observed increases in prisoners' awareness of programmatic access to condoms and in their likelihood of having obtained condoms. Particularly large increases in condom uptake were reported among those in high-risk groups. Sexual activity did not increase, custody operations were not impeded, and staff acceptance of condom access for prisoners increased.

Investments in the future of behavioral science: the University of California, San Francisco, Visiting Professors Program.

A need exists for the promotion of diversity in the scientific workforce to better address health disparities. In response to this need, funding agencies and institutions have developed programs to encourage ethnic-minority and early-career scientists to pursue research careers. We describe one such program, the University of California, San Francisco, Visiting Professors Program, which trains scientists to conduct HIV/AIDS-related research in communities of color. The program provides training and mentoring in navigating grant processes and developing strong research proposals and provides crucial networking opportunities. Although this program is focused on community-based HIV prevention, its principles and methods are widely applicable.

Partners at risk: motivations, strategies, and challenges to HIV transmission risk reduction among HIV-infected men and women in Uganda.

Prevention with positives (PWP) is a fundamental component of HIV prevention in industrialized countries. Despite the estimated 22.4 million HIV-infected adults in Africa (UNAIDS, 2006), culturally appropriate PWP guidelines have not been developed for this region. In order to inform these guidelines, we conducted 37 interviews (17 women, 20 men, no couples) from October 2003 to May 2004 with purposefully selected HIV-infected individuals in care in Uganda. Participants reported increased condom use and reduced intercourse frequency and numbers of partners after testing HIV-positive. Motivations for behavior change included concerns for personal health and the health of others, and decreased libido. Gender-power inequities (sometimes manifesting in forced sex), pain experienced by women while using condoms, decreased pleasure for men while using condoms, lack of social support, and desire for children appear to have resulted in increased risk for uninfected partners. Interventions addressing domestic violence, partner negotiation, use of lubricants and alternative sexual activities could increase condom use and/or decrease sexual activity and/or numbers of partners, thereby reducing HIV transmission risk.

Sexual HIV Risk Among Male Parolees and Their Female Partners: The Relate Project.

BACKGROUND: The massively disproportionate impact of America's prison boom on communities of color has raised questions about how incarceration may affect health disparities, including disparities in HIV. Primary partners are an important source of influence on sexual health. In this paper, we investigate sexual HIV risk among male-female couples following a man's release from prison. METHODS: We draw upon data from the Relate Project, a novel cross-sectional survey of recently released men and their female partners in Oakland and San Francisco, California (N=344). Inferential analyses use the actor-partner model to explore actor and partner effects on sexual HIV risk outcomes. RESULTS: Dyadic analyses of sexual HIV risk among male parolees and their female partners paint a complex portrait of couples affected by incarceration and of partners' influences on each other. Findings indicate that demographic factors such as education level and employment status, individual psycho-social factors such as perception of risk, and relationship factors such as commitment and power affect sexual HIV risk outcomes. CONCLUSION: The Relate Project provides a novel dataset for the dyadic analysis of sexual risk among male parolees and their female partners, and results highlight the importance of focusing on the couple as a unit when assessing HIV risk and protective behaviors. Results also indicate potentially fruitful avenues for population-specific interventions that may help to reduce sexual health disparities among couples affected by incarceration.

An ecosystem-based intervention to reduce HIV transmission risk and increase medication adherence among inmates being released to the community.

HIV+ inmates reentering their communities are at increased risk for poor health outcomes and for transmitting HIV. This article reports on a randomized trial comparing an ecosystem-based intervention and an individually focused intervention for reducing HIV transmission risk and improving medication adherence. Reincarceration was considered as a secondary variable. Both groups decreased sexual risk behavior over the 12-month follow-up period. Unexpectedly, the ecosystem intervention group was less likely to be taking medication or to be adherent and more likely to have been reincarcerated. Failure to demonstrate a significant advantage of the ecosystem intervention may have resulted from the difficulty of engaging family and other ecosystem members in the intervention. Implications for developing and applying interventions for this population are discussed.

Health status, sexual and drug risk, and psychosocial factors relevant to postrelease planning for HIV+ prisoners.

The prevalence of HIV infection among male prison inmates is significantly higher than in the U.S. population. Adequate planning to ensure continued medication adherence and continuity of care after release is important for this population. This study describes the prerelease characteristics of 162 incarcerated HIV-positive men (40 from jails and 122 from prisons). The results include a demographic description of the sample and the participants' sexual risk behaviors, substance use, health status and HIV medication adherence, health care utilization, mental health, and family and social support. The results highlight a potentially high level of need for services and low levels of support and social connectedness. Postrelease planning should include support for improving HIV medication adherence as well as reducing both sexual and injection drug-related transmission risk for these individuals.

Informing interventions: the importance of contextual factors in the prediction of sexual risk behaviors among transgender women.

This study identifies contextual factors that predict risky sexual behavior among 153 transgender women who participated in a structured survey soliciting information on demographics, substance use, HIV status, risk behaviors, and other health and psychosocial factors. Multivariate logistic regression models were used to determine predictors. Inconsistent condom use was associated with stimulant use, unstable housing, and recruitment site. Substance use during sex was associated with unstable housing and stimulant use. Sex work was associated with hormone use, gender confirming surgeries, and younger age. When developing interventions for transgender women, it may be useful to focus on predictors of risk behavior rather than predictors of current HIV status (i.e., race/ethnicity as "risk factor"), because these behaviors are the target of interventions aimed at sexual risk reduction. Implications include potential benefits of context-specific interventions, structural interventions addressing barriers to housing and health care, and culturally specific substance abuse treatment programs for transgender women.