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1.
Lancet HIV ; 8(3): e175-e180, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33662266

RESUMO

There is widespread unawareness and disbelief regarding the evidence-based conclusion that people who have a sustained undetectable HIV viral load cannot sexually transmit HIV-ie, undetectable=untransmittable (U=U). Long-standing, misguided fear about HIV transmission persists; consequently, so does the policing of sexual expression and the penalisation of pleasure faced by people with HIV. Many people with HIV with an undetectable viral load have unnecessarily abstained from condomless sex, avoided serodifferent partnering, and had anxiety about onward sexual transmission due to perceived HIV risk that is now known to be non-existent. Some health professionals have refrained from correcting this misinformation because of concerns that people with HIV will engage in more condomless sex or have more sexual partners upon learning of U=U. Withholding information about U=U is thus rooted in behavioural assumptions and is scientifically unfounded. Moreover, withholding such information violates medical ethics, perpetuates health inequities, and infringes on the sexual health and human rights of people with HIV. Health professionals and the broader public health community have an ethical responsibility to actively address misinformation about HIV transmission and disseminate the U=U message to all people.


Assuntos
Comunicação , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Comportamento Sexual/estatística & dados numéricos , Carga Viral/estatística & dados numéricos , Preservativos , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Risco , Assunção de Riscos , Parceiros Sexuais , Sexo sem Proteção/psicologia
2.
Lancet Glob Health ; 9(4): e446-e455, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33740407

RESUMO

BACKGROUND: Men who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention. METHODS: We did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resilience-related mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294. FINDINGS: Between Sept 4, 2015, and June 28, 2018, we enrolled 608 participants; 305 (50%) were assigned to the psychosocial intervention condition and 303 (50%) were assigned to the control condition. 510 (84%) of 608 men completed an assessment at 4 months after randomisation, 483 (79%) at 8 months, and 515 (85%) at 12 months. 512 (99%) of 515 men had STI data from the 12-month assessment. The intervention condition had a 56% larger reduction in condomless anal sex acts (95% CI 35-71; p<0·0001) from baseline to 4-month follow-up, 72% larger reduction (56-82; p<0·0001) from baseline to 8-month follow-up, and 72% larger reduction (53-83; p<0·0001) from baseline to 12-month follow-up, compared with the standard-of-care control condition (condition by time interaction; χ2=40·29, 3 df; p<0·0001). Improvements in self-esteem and depressive symptoms both mediated 9% of the intervention effect on condomless anal sex acts. Bacterial STI incidence did not differ between study conditions at 12-month follow-up. INTERPRETATION: A resilience-based psychosocial intervention for MSM at risk of HIV acquisition or transmission in India was efficacious in reducing condomless anal sex acts, with evidence for mediation effects in two key target resilience variables. HIV prevention programmes for MSM in India should address mental health resilience to augment reductions in the risk of sexually transmitted HIV. FUNDING: National Institute of Mental Health.


Assuntos
Infecções por HIV/prevenção & controle , Reabilitação Psiquiátrica/métodos , Resiliência Psicológica , Minorias Sexuais e de Gênero/psicologia , Estigma Social , Adulto , Aconselhamento/métodos , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Índia/epidemiologia , Masculino , Comportamento de Redução do Risco , Comportamento Sexual/psicologia , Resultado do Tratamento , Sexo sem Proteção/prevenção & controle , Sexo sem Proteção/psicologia , Adulto Jovem
3.
West J Emerg Med ; 21(3): 640-646, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32421513

RESUMO

INTRODUCTION: Adolescents who seek care in the emergency department (ED) are a cohort at increased risk of unintended pregnancy. Although adolescents are interested in learning about pregnancy prevention in the ED, there is a lack of effective educational interventions in this setting. Long-acting reversible contraceptives (LARC) are highly effective and safe in teens, yet are underutilized. This study assessed contraception use among adolescents in the ED and evaluated the impact of an educational video on their interest in and uptake of LARCs. METHODS: We conducted a two-arm randomized controlled trial on a convenience sample of sexually active females 14 to 21 years old in an urban pediatric ED. Participants were randomized to an educational video or standard care. All participants completed a survey and were given an informational card about affiliated teen clinics with the option to schedule an appointment. We assessed pre-post mean differences between control and intervention participants and pre-post differences among intervention participants. Participants were followed three months after their ED visit to examine use of contraception. RESULTS: A total of 79 females were enrolled (42 control and 37 intervention). The mean age was 17 years, and most were youth of color. The proportion of participants with a prior pregnancy was 18%. Almost all participants reported wanting to avoid pregnancy, yet 18% reported not using contraception at last intercourse. At baseline, 17.7% of participants were somewhat or very interested in the intrauterine device (IUD) or implant. After watching the video, 42.3% were somewhat or very interested in the IUD and 35.7% in the implant. Among those who watched the video, there were significant increases in interest in using an IUD or implant (p<.001). Compared to controls, adolescents who watched the video were also significantly more likely to report wanting an IUD (p<0.001) or implant (p=0.002). A total of 46% were reached for follow-up. Of these, 16% had initiated a LARC method after their ED visit (p=NS). CONCLUSION: Most adolescent females in the ED want to avoid pregnancy, but are using ineffective methods of contraception. A brief educational video on LARCs was acceptable to adolescents and feasible to implement in a busy urban ED setting. Adolescents who watched the video had significantly greater interest in using LARCs, but no demonstrated change in actual adoption of contraception.


Assuntos
Serviço Hospitalar de Emergência , Contracepção Reversível de Longo Prazo/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Gravidez na Adolescência/prevenção & controle , Sexo sem Proteção/prevenção & controle , Adolescente , Comportamento do Adolescente/psicologia , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Dispositivos Intrauterinos/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gravidez , Gravidez na Adolescência/psicologia , Gravidez não Planejada , Gravidez não Desejada , Estudos Prospectivos , Sexo sem Proteção/psicologia , Gravação em Vídeo , Adulto Jovem
4.
PLoS One ; 15(5): e0232889, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437352

RESUMO

Due to the complex role of sexual excitation in risky sexual behaviors, this study aimed to disentangle this phenomenon by jointly analyzing the combined role of three forms of sexual excitation: genital and subjective, and individual´s propensity. Therefore, we examined the relationship between the components of the Dual Control Model, that is, propensity for sexual excitation/inhibition, in addition to genital and subjective arousal, and sexual assertiveness and intention to engage in casual sexual encounters in which sexual risk was implicitly or explicitly present. The sample consisted of 99 heterosexual young adults (55 men and 45 women) with ages ranging from 18 to 32 years. Participants performed an experiment in the laboratory, which involved them watching a sexual clip and then being presented with two erotic excerpts (stories) depicting casual sexual encounters in which there was an existence of implicit and explicit sexual risks. In men, the propensity for sexual inhibition was the most determining variable in preventing them from sexual risk-taking. In women, intention to engage in risky sexual behaviors was better determined by their propensity for sexual excitation and sexual assertiveness in negotiating the use of contraceptive methods. This research highlights the relevance of excitation and inhibition as a trait, in addition to subjective arousal and sexual assertiveness in intention to engage in risky sexual behaviors.


Assuntos
Assertividade , Comportamentos de Risco à Saúde , Intenção , Assunção de Riscos , Sexo sem Proteção/psicologia , Adolescente , Adulto , Nível de Alerta/fisiologia , Comportamento Contraceptivo/psicologia , Tomada de Decisões , Feminino , Comportamentos de Risco à Saúde/fisiologia , Heterossexualidade/fisiologia , Heterossexualidade/psicologia , Humanos , Inibição Psicológica , Masculino , Sexo sem Proteção/fisiologia , Adulto Jovem
6.
PLoS One ; 15(4): e0230242, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275669

RESUMO

BACKGROUND: Sexually explicit media exposure during early adolescence has been found to be associated with risky sexual behavior. However, previous study suffered from methodological issue, such as selection bias. Furthermore, little is known about the effect of multi-modality sexually explicit media exposure on risky sexual behavior, and how this relationship can be applied to non-western societies. OBJECTIVES: This study aimed to improve upon previous studies by using instrumental variable estimation. In addition, this study also included multi-modality of sexually explicit media and three risky sexual behavior measure from a sample of Taiwanese adolescents. METHODS: Participants were recruited from a prospective longitudinal study (Taiwan Youth Project). All were in 7th grade (mean age = 13.3) when the study was initiated in 2000. Sexually explicit media exposure, including ever-exposure and number of modalities exposed to, was measured in wave 2 (8th grade). Risky sexual behavior was measured in waves 8 (mean age = 20.3) and 10 (mean age = 24.3). A two-stage least squares regression was employed, with pubertal timing as the instrumental variable. RESULTS: About 50% of participants had been exposed to sexual media content by 8th grade, from an average of one modality. Sexually explicit media exposure predicted early sexual debut, unsafe sex, and multiple sexual partners (all: p < .05). Furthermore, exposure to more media modalities increased the likelihood of risky sexual behaviors. However, only the effect on early sexual debut was gender invariant. CONCLUSIONS: Exposure to sexually explicit media in early adolescence had a substantive relationship with risky sexual behavior in the emerging adulthood. Knowledge of this causal like effect provides a basis for building better preventive programs in early adolescence. One prominent way is early education on media literacy, and physicians themselves may need to be familiar with such content to initiate it.


Assuntos
Meios de Comunicação , Literatura Erótica , Comportamentos de Risco à Saúde , Sexo sem Proteção/psicologia , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Taiwan
8.
Clin Ter ; 171(2): e130-e136, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32141484

RESUMO

AIMS: Evaluation of the knowledge and behavioral risks related to sexually transmitted infections (STIs) among the student population of the degree course in nursing at the University of Palermo. MATERIAL AND METHODS: An anonymous online a survey was provided to students that investigate to socio-demographic information, sexual habits and the level of knowledge of the STIs. Multivariable logistic regression was performed, considering it as a dependent variable "Do you permanently have unprotected sex (without a condom)? Yes", in order to evaluate the role of the variables of the questionnaire. Results are expressed as adjusted Odds Ratio (aOR). RESULTS: The sample size consists of 405. The average age of the sample is 21.65 years (standard deviation±3.24). The analysis shows that the risk of having permanently unprotected sex (without condom) is significantly associated with the following variables: "Are you engaged or single? Engaged" (aOR 3.24, 95% CI 1.66 - 6.33); "Sexual orientation. Homosexual or Bisexual (aOR 4.45, 95% CI 1.30 - 15.29); "Have you occasionally had unprotected sex (without a condom)? Yes" (aOR 5.09, 95% CI 2.69 - 9.62); "How would you define your knowledge of sexually transmitted diseases? Good" (aOR 2.07, 95% CI 1.05 - 4.08); "How would you define your knowledge about contraceptive methods? Good" (aOR 2.51, 95% CI 1.23 - 5.15); "Have you or have you ever had a sexually transmitted disease? Yes (aOR 4.43, 95% CI 1.71 - 11.53); "Do you know that men can also undergo HPV vaccination? Yes" (aOR 2.57, 95% CI 1.03 - 6.40); "Age. As the unit increase" (aOR 1.14, 95% CI 1.02 - 1.26). CONCLUSIONS: These results highlight the importance of involving university students in programs aimed at improving the knowledge in terms of STIs and increase of Sexual and reproductive health. Further, because STIs prevention is based mainly on human behavior, tailored intervention is needed especially because behavior change remains a complex challenge.


Assuntos
Preservativos , Estudantes de Enfermagem/psicologia , Sexo sem Proteção/estatística & dados numéricos , Preservativos/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Comportamento Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários , Sexo sem Proteção/psicologia , Adulto Jovem
11.
J Pediatr Adolesc Gynecol ; 33(4): 332-338, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32087402

RESUMO

Adolescents in the United States are too often involved in relationships characterized by coercion and violence. An emerging body of research suggests that dating violence is linked with other health risks in adolescent relationships, particularly sexual risk behavior. The confluence of risks conferred by dating violence and sexual risk behavior are particularly acute for adolescent girls. Adolescent gynecology providers need to understand the nature of dating violence in adolescence and the ways in which dating violence and sexual risk behavior are mutually influential. This article reviews the literature on the links between dating violence and sexual risk in adolescent girls' relationships. The prevalence, risk factors, and consequences of dating violence in adolescence are discussed, followed by a review of the research linking dating violence and sexual risk, with a focus on common mechanisms underlying these relationship risk behaviors. The review concludes with implications for screening, prevention, intervention, and future directions for research.


Assuntos
Violência por Parceiro Íntimo/psicologia , Saúde Sexual , Sexo sem Proteção/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Feminino , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Prevalência , Fatores de Risco , Sexo sem Proteção/prevenção & controle
13.
Am J Addict ; 29(2): 111-119, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31908109

RESUMO

BACKGROUND AND OBJECTIVES: Methamphetamine (meth) use and its related risk behaviors for HIV among men who have sex with men (MSM) are a public health concern across the Mexico-US border. This study aims to contribute to the limited literature of meth use and sexual risk behaviors among Latino MSM on the Mexico-US border. METHODS: Data were drawn from the Meth Pilot Study (2014-2015) among men who use meth (n = 100). Descriptive statistics and bivariate analysis comparing MSM to non-MSM were conducted using Pearson's χ2 test, Fisher's exact tests, and Mann-Whitney U test; all tests were conducted using SPSS v.25. RESULTS: Most participants obtained meth in El Paso, Texas (87.2%), used meth orally (65.2%) or smoked (78.3%), and the most common reason for initiation was curiosity. Significant differences (P < .05) in meth use behaviors and sexual risk behaviors between MSM and non-MSM who used meth included: median number of sex partners (7 vs 3), being penetrated anally by last sexual partner (31.6% vs 1.4%), and engaging in transactional sex ever (63.2% vs 9.6%) and past 12 months (52.6% vs 6.8%). Finally, rates of HIV positivity were higher among MSM than non-MSM (10.5% vs 1.4%). DISCUSSION AND CONCLUSIONS: Among men who use meth, MSM are engaging in higher HIV risk behaviors compared with non-MSM. Understanding these risks could help identify candidates for pre-exposure prophylaxis (PrEP) and evidence-based substance use disorder treatment options. SCIENTIFIC SIGNIFICANCE: This study reveals that Latino MSM who use meth is a high-risk group for HIV and a need for tailored interventions. (Am J Addict 2020;29:111-119).


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Hispano-Americanos/psicologia , Homossexualidade Masculina/psicologia , Drogas Ilícitas , Metanfetamina , Assunção de Riscos , Sexo sem Proteção/psicologia , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/complicações , Estudos Transversais , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Humanos , Masculino , México , Pessoa de Meia-Idade , Projetos Piloto , Texas
14.
Sex Transm Infect ; 96(5): 355-357, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31653680

RESUMO

BACKGROUND: Individuals with risk-loving attitudes may be more likely to participate in high-risk sex and gambling. We investigated whether a lottery-based financial incentive to have a negative syphilis test may attract Chinese men who have sex with men (MSM) who practised risky sexual behaviours. METHODS: In July 2018, a national online cross-sectional survey was conducted in China. We collected information on willingness to participate in a lottery-based financial incentive where men were eligible if they tested negative for syphilis, and the minimum prize that would attract them to participate. We used a validated risk attitude scale which asked about the willingness to take risks in six domains, ranging from 0 (avoids taking risk) to 10 (fully prepared to take risks). To avoid multicollinearity, we used principal components analysis to create a 'risk attitude index'. Bivariable and multivariable logistic regression explored factors associated with willingness to test negative for syphilis. RESULTS: 699 MSM enrolled with a median age of 26 years (IQR: 23-30). 70% self-identified as gay and 52% reported ever testing for syphilis. 64% stated they were likely or very likely to test for syphilis linked with a lottery-based incentive. The median desired amount for the lottery had an expected value of ¥10 (US$1.50, IQR: ¥5-¥30). Men who had greater odds of willingness to participate in the lottery-based incentive were those scoring highest on the risk attitude index (adjusted OR (AOR) 2.6, 95% CI 1.5 to 4.3), those reporting more than one sexual partner in the last 3 months (AOR 1.7, 95% CI 1.2 to 2.4), those who had not used condoms during their last sex (AOR 1.5, 95% CI 1.0 to 2.2) and those who ever had group sex (AOR 1.5, 95% CI 1.0 to 2.2). CONCLUSION: Chinese MSM with higher risk attitudes and who reported riskier sexual behaviours indicated greater interest in the concept of a lottery-based incentive for syphilis testing. A lottery-based incentive may be a promising strategy for promoting condom use among risk-loving men.


Assuntos
Atitude Frente a Saúde , Motivação , Minorias Sexuais e de Gênero/estatística & dados numéricos , Sífilis/diagnóstico , Sexo sem Proteção/estatística & dados numéricos , Adulto , Bissexualidade , China , Preservativos/estatística & dados numéricos , Estudos Transversais , Homossexualidade Masculina , Humanos , Masculino , Razão de Chances , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Inquéritos e Questionários , Sexo sem Proteção/psicologia , Adulto Jovem
15.
AIDS Behav ; 24(3): 812-822, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31531737

RESUMO

Violence is associated with HIV and HIV risk behaviors among female sex workers (FSW). However, few studies assess multiple forms of violence and multiple HIV risk behaviors to build a comprehensive picture of how violence is implicated in HIV risk. Using respondent-driven sampling, 754 FSW were recruited in the Russian Federation. Surveys collected data on lifetime exposure to client, police, intimate partner, and pimp violence, as well as recent HIV risk behavior in the forms of injecting drug use (IDU), and inconsistent condom use with intimate partners and clients. Multivariable log-binomial and Poisson regression were used to assess associations between violence and HIV risk behavior outcomes. Lifetime client (31.7%), police (16.0%), intimate partner (15.7%), and pimp (11.4%) violence were prevalent. IDU (10.7%) and inconsistent condom use with intimate partners (45.1%) and clients (22.5%) were common. Intimate partner violence (IPV) and client violence were associated with IDU (ARRIPV 2.12, 95% CI 1.10, 4.10; ARRClient 2.75, 95% CI 1.19, 6.32), IPV and police violence were associated with inconsistent condom use with intimate partners (ARRIPV 1.10, 95% CI 1.01, 1.19; ARRPolice 1.11, 95% CI 1.01, 1.21), and IPV and police violence were associated with inconsistent condom use with clients (ARRIPV 1.49, 95% CI 1.02, 2.17; ARRPolice 1.65, 95% CI 1.19, 2.29). Each perpetrator-specific type of violence was associated with a unique set of HIV risk behaviors. Comprehensive violence prevention programming that addresses multiple perpetrators of violence against FSW, including clients, intimate partners and police, is critical for reducing sexual and drug-related HIV risk in FSW.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/transmissão , Assunção de Riscos , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Violência/estatística & dados numéricos , Adolescente , Adulto , Feminino , Infecções por HIV/prevenção & controle , Humanos , Relações Interpessoais , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Prevalência , Federação Russa/epidemiologia , Sexo Seguro , Trabalho Sexual , Comportamento Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Sexo sem Proteção/psicologia
16.
AIDS Behav ; 24(5): 1365-1375, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31696370

RESUMO

Recent studies among men who have sex with men suggest that sexual behaviors associated with risk of sexually transmitted infections increase following initiation of pre-exposure prophylaxis (PrEP) for HIV prevention. We used longitudinal data from HIV-uninfected participants (n = 1013) enrolled in an open-label study of PrEP delivered to Ugandan and Kenyan heterosexual HIV serodiscordant couples to understand the association between PrEP initiation and HIV risk-related sexual behaviors among these couples. In the month following PrEP initiation, the mean number of monthly sex acts within couples decreased from 7.9 to 6.9 (mean difference: - 1.1; 95% CI - 1.5, - 0.7) and the proportion of couples having condomless sex decreased from 65% to 32% (percentage point change: - 33%; 95% CI - 37%, - 30%); these behaviors then remained relatively constant over 2 years. We found no evidence of sexual risk compensation following PrEP initiation within African serodiscordant couples. However, roughly a third of couples continued to engage in condomless sex during follow up, emphasizing the importance of continued PrEP use to sustain HIV protection.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Heterossexualidade , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição/métodos , Sexo sem Proteção/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Preservativos/estatística & dados numéricos , Feminino , Soronegatividade para HIV , Soropositividade para HIV , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Quênia , Masculino , Estudos Prospectivos , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais , Uganda , Sexo sem Proteção/psicologia
18.
Sex Transm Infect ; 96(1): 40-46, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31406001

RESUMO

OBJECTIVES: Drug use during sex has been associated with sexually transmitted infections (STI). While a growing body of research has investigated drug use during sex among men who have sex with men, data in swingers is limited. Swingers are heterosexual couples who have sex with others and singles who have sex with these couples. Our study assessed the prevalence of drug use during sex and perceived benefits and risks among swingers. METHODS: In 2018, 1005 swingers completed an online questionnaire that was advertised at Dutch swinger-websites. We assessed the associations between drug use during sex <6 months (any drug use excluding alcohol and erection medicines) and sociodemographic characteristics, alcohol use and condomless sex using backward multivariable logistic regression analysis. We compared drug use, motives, beliefs and experienced effects between heterosexual male, bisexual male and female drug-using swingers using χ2-tests. RESULTS: Drug use during sex was reported by 44% (443/1005): 51% in women, 44% in bisexual men and 39% in heterosexual men (P<0.01). Condomless vaginal (46%) and anal sex (22%) was higher in drug-using swingers (vs 34% and 13% in non-drug-using swingers, P<0.001). Among drug-using swingers, XTC (92%), GHB (76%) and laughing gas (69%) were mostly used. Prolonging sex (68%) and increasing arousal (66%) were the most reported motives. Most reported positive effects were feeling happy (78%) and increasing energy (78%). Ninety-four per cent considered drug use to be pleasurable. The most reported negative effect was feeling tired (53%), 7% reported that they might become addicted or felt uncomfortable having sex without drugs. CONCLUSION: This study among a large group of swingers shows that drug use during sex is highly prevalent. STI clinics should discuss drug use during sex among swingers and provide information on safer sex and drug use, while acknowledging the perceived benefits, such as the increased quality of sex.


Assuntos
Usuários de Drogas/psicologia , Doenças Sexualmente Transmissíveis/psicologia , Adulto , Estudos Transversais , Usuários de Drogas/estatística & dados numéricos , Feminino , Heterossexualidade/psicologia , Heterossexualidade/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Parceiros Sexuais/psicologia , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Sexo sem Proteção/psicologia , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
19.
Sex Transm Infect ; 96(1): 58-61, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30683755

RESUMO

OBJECTIVES: Little is known about the sexual networks of young transwomen, leaving a major gap in what we know about transmission dynamics and the elevated rates of HIV in this population. The objective of this study was to understand partnership-level factors associated with condomless anal sex among young transwomen. METHODS: A secondary data analysis of the sexual partnerships of young transwomen was conducted using baseline data from the SHINE study. Generalised estimating equation logistic regressions were used to assess for partnership-level associations between partnership type, age, injection drug use and racial concordance, HIV seroconcordance, sexual role and condomless receptive (CRAI) and insertive anal intercourse (CIAI). RESULTS: Our analysis included 187 young transwomen that reported a total of 464 sexual partnerships where they had at least one episode of anal sex in the past 6 months. We found casual (n=232 or 50%) and commercial partnerships (n=106 or 22.8%) to be significantly associated with a lower odds of CIAI (OR=0.53, 95% CI 0.32 to 0.86 and OR=0.39, 95% CI 0.18 to 0.82) and CRAI (OR=0.30, 95% CI 0.19 to 0.47 and OR=0.35, 95% CI 0.2 to 0.62) compared with main partnerships (n=126 or 27.2%). Additionally, HIV-positive seroconcordant (n=25 or 5.4%, OR=4.05, 95% CI 1.44 to 11.40) and injection-drug using partnerships (n=25 or 5.4%, OR=3.66, 95% CI 1.34 to 9.95) were found to be significantly associated with an increased odds of CIAI among participants compared with HIV-negative seroconcordant (n=330 or 71.1%) and non-using partnerships (n=338 or 72.8%), respectively. CONCLUSION: Young transwomen, like other populations, engage in condomless sex more often with main than casual and commercial partners, suggesting a need for interventions that address sexual practices with steady main partners.


Assuntos
Parceiros Sexuais/psicologia , Pessoas Transgênero/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Masculino , Assunção de Riscos , São Francisco/epidemiologia , Pessoas Transgênero/estatística & dados numéricos , Sexo sem Proteção/psicologia , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
20.
AIDS Behav ; 24(3): 724-737, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31093819

RESUMO

Drug use during sex increases risks for HIV acquisition. Male clients of female sex workers (FSW) represent both a key population at risk for HIV as well as a transmission bridge population. In Tijuana, Mexico, drug use is prevalent and there is a need to understand male clients' drug use during sex with FSW. Characteristics of sex work venues may confer higher risks for drug use, risky sex, and HIV/STI. It is essential to understand the venue-related social and structural factors associated with drug use during sex in order to inform HIV prevention interventions with male clients in this region. We used a Mixed-Methods Sequential Explanatory Design to conduct an enriched examination of drug use during sex among male clients of FSW in Tijuana. Findings from logistic regression analysis showed that drug use during sex was significantly correlated with police harassment (AOR = 4.06, p < .001) and methamphetamine use (AOR = 33.77, p < .001). In-depth interview data provided rich meaning behind and context around the quantitative associations. Social and structural interventions to reduce police harassment, methamphetamine use, and promote condom availability are needed to reduce risks for HIV among male clients of FSW in Tijuana.


Assuntos
Infecções por HIV/transmissão , Trabalho Sexual/estatística & dados numéricos , Profissionais do Sexo , Doenças Sexualmente Transmissíveis/transmissão , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Sexo sem Proteção/psicologia , Adolescente , Adulto , Preservativos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , México/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Assunção de Riscos , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
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