Psychosocial Correlates of HIV Testing Frequency Among Men Who Have Sex with Men in Guangzhou, China.

We examined sociodemographic and psychosocial factors associated with HIV testing patterns in the past 2 years among 492 HIV-negative men who have sex men (MSM) at an HIV testing center in Guangzhou, China. MSM who tested for HIV frequently were more likely to be older, reside in Guangzhou, and have higher monthly income. Compared with MSM who tested frequently, MSM who never tested were less likely to report that their sexual partner(s) had ever received HIV tests or that their good friends had ever received HIV tests, and were less likely to report having an HIV-positive gay friend or ever discussing HIV with sexual partners; they were more likely to report perceiving barriers to HIV testing. Compared with MSM who tested frequently, those who tested irregularly were less likely to report having HIV-positive gay friends or to disclose their sexual orientation to non-gay friends; reported greater barriers to HIV testing; and higher internalized homophobia.

Inflammation and Risk of Depression in HIV: Prospective Findings From the Multicenter AIDS Cohort Study.

Studies suggest that inflammation might be involved in the pathogenesis of depression. Individuals with human immunodeficiency virus (HIV) have a higher risk of depression and elevated inflammatory profiles. Despite this, research on the link between inflammation and depression among this high-risk population is limited. We examined a sample of men who have sex with men from the Multicenter AIDS Cohort Study in prospective analyses of the association between inflammation and clinically relevant depression symptoms, defined as scores >20 on Center for Epidemiological Studies Depression Scale. We included 1,727 participants who contributed 9,287 person-visits from 1984 to 2010 (8,218 with HIV (HIV+) and 1,069 without (HIV-)). Exploratory factor analysis (EFA) was used to characterize underlying inflammatory processes from 19 immune markers. Logistic regression with generalized estimating equations was used to evaluate associations between inflammatory processes and depressive symptoms stratified by HIV serostatus. Three EFA-identified inflammatory processes (EIPs) were identified. EIP-1 scores-described by soluble tumor necrosis factor receptor 2 (sTNF-R2), soluble interleukin-2 receptor α (sIL-2Rα), sCD27, B-cell activating factor, interferon γ-induced protein 10 (IP-10), soluble interleukin-6 receptor (sIL-6R), sCD14, and sGP130-were significantly associated with 9% higher odds of depressive symptoms in HIV+ participants (odds ratio = 1.09; 95% confidence interval: 1.03, 1.16) and 33% higher odds in HIV- participants (odds ratio = 1.33; 95% confidence interval: 1.09, 1.61). Findings suggest that immune activation might be involved in depression risk among both HIV+ and HIV- men who have sex with men.

Elevated HIV Prevalence and Correlates of PrEP Use Among a Community Sample of Black Men Who Have Sex With Men.

BACKGROUND: The HIV epidemic among black men who have sex with men (BMSM) demands urgent public health attention. Pre-exposure prophylaxis (PrEP) is a highly efficacious option for preventing HIV, but characteristics of PrEP use among community samples of BMSM are not well-understood. METHODS: A serial cross-sectional survey assessment (N = 4184 BMSM reporting HIV-negative/unsure status) and HIV testing were conducted at Black Gay Pride events in 6 US cities in 2014, 2015, 2016, and 2017. RESULTS: HIV prevalence was higher among BMSM self-reporting current PrEP use (1 of 3 participants) than BMSM not self-reporting current PrEP use (1 of 5 participants) [32.3%, N = 103/319 vs. 20.0%, N = 639/3,193, adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.31 to 2.15]. BMSM reporting current PrEP use (N = 380) were more likely to report having a greater number of male sex partners (aOR = 1.02, 95% CI: 1.01 to 1.03), a sexually transmitted infection diagnosis (aOR = 2.44, 95% CI: 1.88 to 3.16), and stimulant drug use (aOR = 2.05, 95% CI, 1.21 to 3.47) when compared with BMSM not reporting current PrEP use (N = 3804). PrEP use increased from 4.7% (2014) to 15.5% (2017) (aOR = 1.19, 95% CI: 1.13 to 1.25). Among PrEP users, inability to afford health care coverage was associated with testing HIV-positive (aOR = 2.10, 95% CI: 1.24 to 3.56). CONCLUSIONS: The high prevalence of HIV infection among BMSM reporting PrEP use is concerning. It does not, however, challenge the efficacy of PrEP itself but rather the uptake of the surrounding preventative package including behavioral risk reduction support, sexually transmitted infection treatment, and medication adherence counseling. Further research to understand barriers to fully effective PrEP is needed to guide operational and behavioral interventions that close the gap on incident infection.

Correlates of HIV Testing Among Transgender Women in Ho Chi Minh, Vietnam.

HIV prevalence among transgender women (TW) in Ho Chi Minh City is estimated at 18 %. However, no evidence-based programs or surveillance data exist in Vietnam specific to HIV testing uptake. We examined prevalence and correlates of past-year HIV testing among TW (n = 204) recruited in 2015 via snowball sampling. 59.3 % reported HIV testing in the previous year. In adjusted models, factors positively associated with HIV testing included consistent condom use during sex work with male clients; STI testing in past year; sex with casual partners in the past month; and experiences of police harassment. Factors negatively associated with recent HIV testing included daily/weekly alcohol use and post-traumatic stress symptoms. This study found significant associations between greater safety in sexual behaviors and higher rates of HIV testing. Targeted and specific services are needed for TW in Vietnam in order to address sexual risk behaviors and provide appropriate access to regular HIV testing.

Psychosocial and Behavioral Characteristics of High-Risk Men Who Have Sex with Men (MSM) of Unknown HIV Positive Serostatus in Bangkok, Thailand.

HIV prevalence remains high in men who have sex with men (MSM) in Bangkok. Even though resources for HIV testing and treatment are available for all, a large proportion of MSM still do not get HIV tested. We studied high risk MSM who are unaware of their HIV status to help maximize effectiveness of our resources. Convenience sampling was conducted among MSM who came for HIV testing at the Thai Red Cross Anonymous Clinic and two popular drop-in centers in Bangkok. Inclusion criteria were MSM aged >18 years, have not been tested positive for HIV, who reported ≥1 of the following in the previous 6 months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection diagnosis. Audio-Computer-Assisted Self-Interview was used to assess psychosocial profile, sexual risks, and HIV testing patterns prior to being informed of their HIV positive status. Among 499 high-risk MSM enrolled, the median age was 24.8 years and 112 (22 %) tested HIV-positive. Among the HIV-positive participants, 92 % self-identified as gay (versus bisexual), 39 % attained a bachelors degree or higher, 65 % had monthly income 10,000-29,999 baht ($280-830 USD), 10 % had vaginal or anal sex with a woman in the past 12 months, 39 % had condomless receptive sex with men and 21 % went to Lat Phrao to find a sexual partner. Compared to HIV negative MSM, HIV-positive MSM had less HIV testing: 31 % had ever been tested for HIV, 12 % had been tested in the past 6 months; but were more likely to guess correctly their positive status (31 %). Regarding psychosocial variables among HIV-positive MSM, 7 % had regular methamphetamine use in the past 3 months, 10 % had >2 sources of discrimination, and 8 % had >2 sources of discrimination due to being MSM. In multivariable model, age<30 year old, self-identified as gay, had monthly income <50,000 baht ($1400 USD), had anal sex with men in past 12 months, had >2 sources of discrimination because of being MSM, did not get HIV test in past 6 months, and guess of positive HIV were significantly associated with HIV positive status. Young MSM with lower socioeconomic status (SES) should be prioritized for innovative approaches to promoting awareness and uptake of HIV testing. Societal stigmatization of MSM should be addressed as a potential barrier to uptake of voluntary HIV testing. Resilience factors among these marginalized MSM who still test frequently and remain HIV-negative despite residing in a context with community viral loads and discrimination should also be studied in order to curb the HIV epidemic in Bangkok.

HIV and Syphilis Prevalence Among Transgender Women in Ho Chi Minh City, Vietnam.

Globally, transgender women have higher risk for HIV than the general population and men who have sex with men, but there is little data on this population in Vietnam. In 2015 we conducted a biological and behavioral survey of 205 transgender women in Ho Chi Minh City, Vietnam. Factors associated with HIV and syphilis infection were assessed through multivariable logistic regression models. Median age was 25 years (range 18-64). Overall prevalence was 18.0 % for HIV and 17.6 % for syphilis. Factors independently associated with HIV infection included risky alcohol use [adjusted Odds Ratio (aOR) 3.55, 95 % confidence interval (CI) 1.53-8.21], amphetamine stimulant use (aOR 2.90, 95 % CI 1.27-6.61), sex with male sex workers (aOR 4.73, 95 % CI 1.72-13.0), and history of sex with an adult before the age of 18 years (aOR 2.97, 95 % CI 1.06-8.34). Two factors associated with syphilis infection were HIV infection (aOR 2.37, 95 % CI 1.03-5.45) and condomless anal sex with casual partners (aOR 2.27, 95 % CI 1.03-5.00). In order to address the HIV and syphilis epidemics in Vietnamese transgender women, interventions are needed to make HIV and sexually transmitted infection screening and treatment more accessible.

Psycho-social Correlates of Condom Use and HIV Testing among MSM Refugees in Beirut, Lebanon.

MSM refugees have to deal with personal challenges and social/structural adversaries based on their refugee status on top of their sexual identity. To better customize interventions beside this population, we explored psycho-social and structural correlates of condom use and HIV testing in Lebanon by surveying and testing 150 participants. 67 % self-identified as gay. 84.6 % reported any unprotected anal intercourse (UAI) with men in the prior 3 months. Those who engaged in UAI, were lest comfortable with a doctor, didn't know where to get free HIV testing, experienced discrimination based on their refugee status and spent more time with their refugee peers, were less inclined to have seen a doctor in the past 12 month or knew where to get free HIV testing. Ever having been HIV tested was associated with being comfortable with medical doctors, knowing where to get HIV testing and spending time with other peer refugees. HIV prevention and testing promotion efforts targeting MSM refugees need to account for structural barriers, while fighting discrimination is crucial for a healthy sexual identity development.

HIV Prevalence and Demographic Determinants of Unprotected Anal Sex and HIV Testing among Male Refugees Who have Sex with Men in Beirut, Lebanon.

Men who have sex with men (MSM), the same as refugees are at higher risk for health issues including HIV infection. With the large influx of refugees to Lebanon, and to better understand HIV transmission in this setting, we explored the socio-demographic correlates of condom use and HIV testing among MSM refugees in Beirut, by surveying and testing 150 participants. 67 % self-identified as gay, 84.6 % of respondents reported unprotected anal intercourse (UAI) in the prior 3 months, and 56.7 % with men of positive or unknown HIV status (UAIPU). 2.7 % tested positive for HIV, and 36 % reported having engaged in sex work. Men in a relationship and men who self-identified as gay had higher odds of UAI, of ever been tested, but lower odds of UAIPU. HIV prevention and testing promotion efforts targeting MSM refugees need to account for how men self-identify in relation to their sexual behavior and relationship status. Such efforts also should place emphasis on MSM of lower socio-economic status.

HIV and STIs Among MSM in Tajikistan: Laboratory-Confirmed Diagnoses and Self-Reported Testing Behaviors.

Little is known about the prevalence and associations of HIV/STI diagnoses and testing behaviors among men who have sex with men (MSM) in Tajikistan. A non-governmental organization conducted a cross-sectional study of MSM (n = 502) assessing laboratory-confirmed HIV/STI diagnoses, HIV/STI testing behavior in the past 6 months, sociodemographics, HIV/STI risk factors, and victimization/discrimination. Overall, 2.6 % were diagnosed with HIV, 2.2 % with syphilis, 17.6 % with chlamydia, and 56.0 % with herpes. Recent testing rates were low for HIV (35.9 %) and STIs (14.1 %). Compared to MSM who completed university, MSM with a high school education or less had lower odds of recent HIV and STI testing; however, victimization and healthcare discrimination were associated with greater odds of recent STI testing. Given the low HIV prevalence, there is a window of opportunity to extinguish the epidemic before it worsens. Non-governmental organizations are indispensable for expanding testing strategies because they can efficiently reach MSM in Tajikistan.

Differences Between Men Who Have Sex with Men (MSM) with Low CD4 Cell Counts at Their First HIV Test and MSM with Higher CD4 Counts in Bangkok, Thailand.

Although HIV prevalence remains high among Bangkok's MSM early HIV testing as an entry point to ART has not been successfully implemented among in this population. Men who present late for initial HIV testing are a particular concern in the context of the Bangkok HIV epidemic, in that if long-term positives have had condomless sex during the time that they remained untreated they are likely to have been efficient transmitters of infection, to say nothing of the implications for their own health. A sequential sample of MSM who tested HIV positive, and CD4 counts, was taken at the Thai Red Cross Anonymous Clinic and two drop-in centers in Bangkok. Inclusion criteria were MSM aged >18 years, having not tested HIV positive earlier, who reported ≥1 of the following in the previous 6 months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection (STI) diagnosis. Analysis was conducted by distinguishing between three groups of CD4 counts: <200, 200-500, >500 cells/µ to identify the social and behavioral characteristics of the men who presented late for HIV testing. Median CD4 was 325 cells/µ(n = 95). MSM with initial CD4< 200 cells/µ were significantly more likely to report problematic alcohol use. They were also more likely to report receptive anal sex and more likely to be engaged in sex work. MSM with CD4< 200 cells/µ were less likely to report recent HIV testing. Main barriers to HIV testing included being afraid of finding out that they were HIV positive and concerns about efficacy and side effects of HIV treatment. HIV stigma and concerns about treatment are still widespread and are potential barriers to HIV care among MSM in Bangkok. These barriers may work to keep men from finding out their positive HIV status in a timely manner. Thai MSM need to be made aware of the current availability of friendly HIV testing and ART services, and public health programs need to work to change their perceptions regarding ART itself. These same types of strategies might also work to destigmatize HIV and MSM within Thai society as a whole.

Risk of the Metabolic Syndrome in Sexual Minority Women: Results from the ESTHER Study.

OBJECTIVE: Compared to heterosexuals, sexual minority women (SMW) have higher rates of the metabolic syndrome risk factors (e.g., obesity, smoking, heavy drinking, and depression). Yet, no published research has examined whether SMW have higher rates of the metabolic syndrome. The aim of this study is to describe the prevalence of the metabolic syndrome and its individual factors in a sample of heterosexuals and SMW, and identify whether SMW are at greater risk of having the metabolic syndrome. MATERIALS AND METHODS: Data are from the Epidemiologic STudy of HEalth Risk in Women (ESTHER), a cross-sectional convenience sample of 479 SMW and 400 heterosexual women from Pittsburgh, Pennsylvania. Participants provided self-report questionnaire data, clinical data, and blood work. RESULTS: Compared to heterosexuals, SMW had higher mean waist circumference, fasting glucose, and systolic and diastolic blood pressure. Nearly one-quarter (24.3%) of SMW had the metabolic syndrome compared to 15.6% of heterosexual women (p = 0.002). After controlling for demographic and risk factors, SMW had a 44% higher risk of having the metabolic syndrome than heterosexuals (p = 0.031). CONCLUSIONS: To our knowledge, this is the first study to identify this health disparity in SMW. Future studies should explore differential risk of mortality and metabolic health between SMW and heterosexuals.

Depression and sexual dysfunction among HIV-positive and HIV-negative men who have sex with men: mediation by use of antidepressants and recreational stimulants.

Erectile dysfunction and other forms of sexual dysfunction are highly prevalent among HIV+ men who have sex with men (MSM). Research has not previously identified the mechanisms by which depression may be associated with sexual dysfunction among HIV-positive and HIV-seronegative (HIV-negative) MSM. The present study examined the role of antidepressant use, stimulant use, and smoking as mediators of the relation between depression and sexual dysfunction among HIV-positive and HIV-negative MSM. Participants enrolled in the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural and treated histories of HIV infection among MSM in the United States, completed a modified version of the International Index of Erectile Function for MSM. The study sample included 1,363 participants, with 619 HIV-positive men and 744 HIV-negative men. A structural equation model examined depression as a predictor of subsequent sexual dysfunction, mediated by antidepressant use, stimulant use, and smoking. Depression predicted subsequent sexual function among both HIV-negative and HIV-positive MSM. This effect appeared to be both a direct effect and an indirect effect via antidepressant use. Findings suggest that antidepressant medication use may partially explain sexual dysfunction among MSM.

Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery.

BACKGROUND: Despite evidence supporting pre-exposure prophylaxis (PrEP) efficacy, there are concerns regarding the feasibility of widespread PrEP implementation among men who have sex with men (MSM). To inform the development of targeted PrEP delivery guidelines, sexual risk trajectories among HIV-negative MSM were characterized. METHODS: At semiannual visits from 2003 to 2011, HIV-negative MSM (N = 419) participating in the Multicenter AIDS Cohort Study provided data on sexual risk behaviors (SRBs) since their last visit. Based on their reported behaviors, participants were assigned a SRB score at each visit as follows: 0 = no insertive or receptive anal intercourse, 1 = no unprotected insertive or receptive anal intercourse, 2 = only unprotected insertive anal intercourse, 3 = unprotected receptive anal intercourse with 1 HIV-negative partner, 4 = condom serosorting, 5 = condom seropositioning, and 6 = no seroadaptive behaviors. Group-based trajectory modeling was used to examine SRB scores (<4 vs. ≥4) and identify groups with distinct sexual risk trajectories. RESULTS: Three sexual risk trajectory groups were identified: low-risk (n = 264; 63.0%), moderate-risk (n = 96; 22.9%; mean duration of consecutive high-risk intervals ∼1 year), and high-risk (n = 59; 14.1%; mean duration of consecutive high-risk intervals ∼2 years). Compared to low-risk group membership, high-risk group membership was associated with younger age (in years) [adjusted odds ratio (AOR) = 0.92, 95% confidence interval (CI): 0.88 to 0.96], being White (AOR = 3.67, 95% CI: 1.48 to 9.11), earning an income ≥$20,000 (AOR = 4.98, 95% CI: 2.13 to 11.64), distress/depression symptoms (Center for Epidemiologic Studies Depression Scale ≥ 16) (AOR = 2.36, 95% CI: 1.14 to 4.92), and substance use (AOR = 2.00, 95% CI: 1.01 to 3.97). CONCLUSIONS: Screening for the sociodemographic and behavioral factors described above may facilitate targeted PrEP delivery during high-risk periods among MSM.

Accessing HIV testing and treatment among men who have sex with men in China: a qualitative study.

Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, seven focus group (FG) discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, nondisclosure to families, misconceptions of domestically produced antiretroviral drugs (ARVs) and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed.

Application of syndemic theory to black men who have sex with men in the Multicenter AIDS Cohort Study.

This study analyzed data from a large prospective epidemiologic cohort study among men who have sex with men (MSM), the Multicenter AIDS Cohort Study, to assess syndemic relationships among black MSM in the cohort (N = 301). We hypothesized that multiple interconnections among psychosocial health conditions would be found among these men, defining syndemic conditions. Constituents of syndemic conditions measured included reported depression symptoms, sexual compulsiveness, substance use, intimate partner violence (IPV), and stress. We found significant evidence of syndemics among these black men: depression symptoms were independently associated with sexual compulsiveness (odds ratios [OR]: 1.88, 95% CI = 1.1, 3.3) and stress (OR: 2.67, 95% CI = 1.5, 4.7); sexual compulsiveness was independently associated with stress (OR: 2.04, 95% CI = 1.2, 3.5); substance misuse was independently associated with IPV (OR: 2.57, 95% CI = 1.4, 4.8); stress independently was associated with depression symptoms (OR: 2.67, 95% CI = 1.5, 4.7), sexual compulsiveness (OR: 2.04, 95% CI = 1.2, 3.5) and IPV (OR: 2.84, 95% CI = 1.6, 4.9). Moreover, men who reported higher numbers of syndemic constituents (three or more conditions) reportedly engaged in more unprotected anal intercourse compared to men who had two or fewer health conditions (OR: 3.46, 95% CI = 1.4-8.3). Findings support the concept of syndemics in black MSM and suggest that syndemic theory may help explain complexities that sustain HIV-related sexual transmission behaviors in this group.

The cumulative effects of medication use, drug use, and smoking on erectile dysfunction among men who have sex with men.

INTRODUCTION: Erectile dysfunction (ED) is highly prevalent among human immunodeficiency virus-seropositive (HIV+) men who have sex with men (MSM). There is a need for additional research to determine the correlates of HIV+ and HIV-seronegative (HIV-) MSM, especially regarding nonantiretroviral medication use. AIMS: This study examined the prevalence of ED and the sociodemographic, medical conditions, medication use, and substance use correlates of ED among HIV+ and HIV- MSM. METHODS: A modified version of the International Index of Erectile Function (IIEF) for MSM was self-administered by participants enrolled in the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural and treated histories of HIV infection among MSM in the United States. The study sample included 1,340 participants, including 612 HIV+ and 728 HIV- men. Poisson regression with robust error variance was used to estimate prevalence ratios of ED in multivariable models in combined (HIV+/-) and separate analyses. MAIN OUTCOME MEASURE: ED was determined by the summed scores of a modified version of the IIEF validated among MSM. RESULTS: Twenty-one percent of HIV+ MSM and 16% of HIV- MSM reported ED. Being >55 years of age, black race, cumulative pack years of smoking, cumulative antihypertensive use, and cumulative antidepressant use had significant positive associations with the prevalence of ED in the total sample. Among HIV+ men, duration of antihypertensive use and antidepressant use were significantly associated with increasing prevalence of ED. Among HIV- men, being >55 years of age, black race, and cigarette smoking duration were associated with increased prevalence of ED. CONCLUSION: Predictors of ED may differ by HIV status. Although smoking cessation and effective medication management may be important as possible treatment strategies for ED among all MSM, there may be a burden on sexual functioning produced by non-HIV medications for HIV+ men.

Changes in stimulant drug use over time in the MACS: evidence for resilience against stimulant drug use among men who have sex with men.

Stimulant drug use is associated with numerous health problems among men who have sex with men (MSM). This paper describes how stimulant drug use changes over a four and one-half year period from 2003 until 2008. Participants were 2,389 men (17,222 person-visits) from The Multicenter AIDS Cohort Study (MACS)-an ongoing, prospective study of HIV infection among MSM. Group-based trajectory analyses of data from these men over the study period yielded a four groups solution: consistent users (9.8%), men whose use increased (5.4%), men whose use declined (6.9%), and abstinent or rarely-using men (77.9%). There were significant differences between groups in terms of demographic, behavioral risk and HIV serostatus. Men who increased or decreased stimulant drug use over time reported congruent changes in sexual risk taking. The fact that sexual risk levels parallel stimulant drug use over time suggests that finding ways to lower rates of stimulant drug use among MSM could be a tool in HIV prevention.

Tobacco use and cessation among a household-based sample of US urban men who have sex with men.

OBJECTIVES: We examined tobacco use and cessation among a probability sample of urban men who have sex with men (MSM) living in 4 large US cities. METHODS: Of the 2402 men who were eligible for follow-up from a previously recruited probability sample, 1780 (74%) completed tobacco surveys between January and December 1999. RESULTS: Current smoking rates were higher for urban MSM (31.4%; 95% confidence interval [CI]=28.6%, 34.3%) than for men in the general population (24.7%; 95% CI=21.2%, 28.2%). Among MSM, 27% were former smokers. A complex set of sociodemographic, tobacco-related, and other factors were associated with cessation. CONCLUSIONS: Results support earlier reports that smoking rates are higher for MSM compared with men in the general population. Findings related to cessation underscore the need to target tobacco control efforts for MSM.

Fatores psicossociais e a infecçäo por HIV em mulheres, Maringá, PR / Psychosocial aspects of HIV infection among women in Brazil

OBJETIVO: Analisar a percepçäo do risco de infecçäo em mulheres infectadas pelo HIV, antes de elas receberem o resultado positivo para essa patologia. MÉTODOS: Estudo exploratório com entrevistas em profundidade em amostra de conveniência constituída de 26 mulheres que freqüentavam o ambulatório de um centro regional de saúde em Maringá, PR. A entrevista foi semidirigida com um roteiro de perguntas fechadas e abertas sobre características sociodemográficos, conhecimento sobre prevençäo primária e secundária, percepçäo de risco antes do teste positivo para HIV, impacto do resultado em suas vidas ó inclusive a sexual ó depois de saberem ser portadoras do vírus. Os resultados foram analisados pela metodologia de análise de conteúdo. RESULTADOS: Apesar de ter consciência de que essa doença pode atingir qualquer um, nenhuma das 26 mulheres estudadas acreditava estar infectada pelo HIV/Aids. Os mecanismos psicológicos, "negaçäo", "evitaçäo", "onipotência do pensamento" e "projeçäo" foram os que puderam ser identificados como aqueles que as mulheres mais utilizaram para lidar com as dificuldades e as ansiedades decorrentes da percepçäo de risco e das normas e relaçöes de gêneros hegemônicas presentes na cultura brasileira. Verificou-se que, se o uso desses mecanismos alivia a angústia, por outro lado aumenta a vulnerabilidade das mulheres. Elas se sentem incapazes de atuar, e muitas mantêm relaçöes sexuais desprotegidas com os parceiros, expondo-se à gravidez indesejada e à reinfecçäo. CONCLUSOES: Os programas de prevençäo do HIV devem considerar também aspectos psicológicos, socioeconômicos e culturais que interferem na vulnerabilidade das mulheres, antes e depois da infecçäo. Para haver maior alcance de suas açöes, os programas devem ir além da distribuiçäo massiva de informaçöes e usar abordagens psicoeducativas em pequenos grupos que estimulem a conscientizaçäo das mulheres para além das informaçöes biomédicas

Caminhoneiros de rota curta e sua vulnerabilidade ao HIV, Santos, SP / Vulnerability to HIV and AIDS of short distance truck drivers stationed, Brazil

OBJETIVO: Descrever a vulnerabilidade, de caminhoneiros de rota curta, à transmissäo sexual do HIV e da Aids. MÉTODOS: Foram entrevistados 279 caminhoneiros com vínculo de trabalho na cidade de Santos, SP, em locais de concentraçäo na área portuária e suas proximidades, sindicatos e associaçöes, recrutados pela amostragem do tipo "bola-de-neve". Foram realizadas entrevistas utilizando perguntas abertas e fechadas sobre questöes sociodemográficas, práticas sexuais, uso de drogas, conhecimento sobre o HIV e a Aids, contato prévio com programas de prevençäo à Aids em Santos, percepçäo de sua vulnerabilidade ao HIV e à Aids. Foi realizada análise descritiva da amostra, e apresentados relatos para ilustrar algumas situaçöes de vulnerabilidade. RESULTADOS: Do total de 279 caminhoneiros entrevistados, 93 por cento declararam ter parceira fixa, 40 por cento referiram manter relaçöes sexuais com parceiras casuais, e 19 por cento referiram manter relaçöes sexuais com parceiras freqüentes. A principal situaçäo de vulnerabilidade ao HIV ocorre devido ao uso inconsistente do preservativo, interligado ao vínculo estabelecido com cada parceira. O tempo fora de casa parece näo ser o principal fator para situaçöes de vulnerabilidade, conforme demonstram estudos com caminhoneiros de rota longa. CONCLUSOES: A cultura "machista" e os papéis tradicionais masculinos säo emblemáticos entre os caminhoneiros de rota curta. Certamente é necessário investir mais na prevençäo nessa categoria profissional. A prevençäo em locais de trabalho parece promissora, pois permite entender melhor seu universo, propiciando intervençöes educativas adequadas a essa categoria profissional