Men Who Have Sex With Men and HIV Risk Behavior: Exploring the Influence of Masculinity Within the Social Ecological Model

In the United States, gay, bisexual men, and men who have sex with men (MSM) represent 86% of new HIV infections among males. Approximately 1 in 7 men with HIV are unaware of their HIV status (CDC, 2017, 2019a, 2020a). To explore influences on MSM HIV risk behavior, the authors performed a systematic review of quantitative studies conducted in the U.S. assessing what is purported as masculinity. From 30 identified studies, significant findings were framed within the Social Ecological Model (SEM) levels (e.g., Individual, Relationship, Community). SEM level themes were applied to create the Masculinity 10, a preliminary 10-item assessment to explore the influence of masculinity on MSM HIV risk behavior. To increase MSM engagement in HIV prevention and treatment, the influences of masculinity (e.g., attitude toward sexual minorities, appearance, emotion, temperament, substance use, sexual activity, social support, intimate relationships, health care) on HIV risk behavior should be further explored.

Emotional Violence is Associated with Increased HIV Risk Behavior Among South African Adolescent Girls and Young Women in the HPTN 068 Cohort

Limited research has explored how emotional intimate partner violence (IPV) shapes HIV risk behaviors. Using cross-sectional data from the HPTN 068 post-trial visit (N = 1942), we assessed the association between emotional IPV and its sub-domains (verbal abuse and threats) with condomless sex, transactional sex, and frequent alcohol use among young women in South Africa. In adjusted multivariable logistic regression models, any emotional IPV and verbal IPV were associated with increased odds of condomless sex (aOR: 1.47; 95% CI: 1.15, 1.87; and aOR: 1.48; 95% CI: 1.15, 1.89), transactional sex (aOR: 2.32; 95% CI: 1.74, 3.08; and aOR: 2.02; 95% CI: 1.51, 2.71) and alcohol use (aOR: 1.88; 95% CI: 1.39, 2.53; and aOR: 1.87; 95% CI: 1.37, 2.55). Threats were associated with transactional sex (aOR: 3.67; 95% CI: 2.62, 5.14). Future research should examine this relationship over-time and HIV prevention programs should consider and address emotional IPV.

Condom-use negotiation, alcohol consumption, and HIV-risk sexual behavior among female sex workers in Kupang, East Nusa Tenggara, Indonesia: A cross-sectional study

Background: Female sex workers play a crucial part in HIV transmission. Having unprotective condom during sexual activity can lead to HIV infection. Having lower power in condom negotiation with clients can lead FSW not to using condoms during sexual activity. Alcohol consumption was also mediated HIV risk behavior among FSW. This study aimed to evaluate the relationship between condom use-negotiation, alcohol consumption and HIV-risk sexual behavior among female sex workers (FSW) in Kupang.Design and Methods: A cross-sectional study was conducted with 125 FSWs aged 18 to 60 years recruited from Yayasan Tanpa Batas Kupang with consecutive sampling. The data were analyzed using univariate and the Chi-square test.Results: The majority of FSWs (61.6%) reported had low negotiation condom use with their clients, about 77.6% reported high levels of alcohol consumption and 64.8% had high-risk sexual behavior. Condom-use negotiation (p-value: 0.003) and alcohol consumption (p-value: 0.037) were found to be significantly associated with HIV-risk sexual behavior.Conclusions: Future interventions on HIV prevention should focus on empowering young FSWs with condom negotiation skills in order to increase condom use. It is also recommended to include information about alcohol consumption and its relationship with HIV-risk behavior in order to have better health outcomes for FSW.

Acceptance of Couples’ HIV Counseling and Testing among Pregnant Women Attending Antenatal Clinic in Likoni sub-County, Mombasa County, Kenya

Couples’ HIV Counseling and Testing (CHCT) is an essential component of an effective response to AIDS pandemic worldwide and serves as an entry point to HIV care and support. However, it has become increasingly apparent that couples have overlooked the services yet they are too at risk of HIV infection. This study sought to determine level of acceptance of CHCT among pregnant women attending antenatal care services in Likoni sub-County, Mombasa County, Kenya. A descriptive cross-sectional study design was used with structured questionnaires and an observation checklist to collect data from couples while an interview schedule was used to solicit data from health care workers. Results showed uptake of CHCT in the study area was relatively low (33.5%). Statistically significant associations were found between CHCT and demographic factors such as education (χ2 = 29.54; p = 0.005), marital status (χ2 = 12.41; p = 0.010), occupation (χ2 = 18.18; p < 0.001), income (χ2 = 23.02; p < 0.001). In operation factors, statistically significant associations were found between CHCT and distance to health facility (χ2 = 8.31; p = 0.040), means of transport (χ2 = 10.28, p = 0.040), cost of transport (χ2 = 10.92; p = 0.010), appropriateness and convenience of time allocated (χ2 = 11.88, p <, 0.001), an individual’s working hours per day (χ2 = 14.46; p < 0.001), and education/information on CHCT (χ2 = 5.97; p = 0.020). In HIV related knowledge, attitude and practice of couples on HIV risk behavior, significant associations were found between CHCT and prevention of discordant partners from contracting HIV (χ2 = 53.71; p < 0.001), helping couples adhere to ART (χ2 = 43.34; p < 0.001), helping to reduce morbidity and mortality due to HIV and other opportunistic infections (χ2 = 48.66; p < 0.001), increasing trust among partners (χ2 = 45.16; p < 0.001), and increasing marital cohesion among partners (χ2 = 65.78; p < 0.001). Logistic regression revealed that determinants of CHCT were significant for married status (p < 0.001), unemployed (p = 0.020), that CHCT increases trust among partners (p = 0.020), and that CHCT increases marital cohesion among partners (p = 0.001). Based on these findings, there is need to improve awareness on CHCT to enhance positive attitudes towards couples testing.

Prisoners’ access to HIV services in southern Malawi: a cross-sectional mixed methods study

Background The prevalence of Human Immunodeficiency Virus (HIV) among prisoners remains high in many countries, especially in Africa, despite a global decrease in HIV incidence. Programs to reach incarcerated populations with HIV services have been implemented in Malawi, but the success of these initiatives is uncertain. We explored which challenges prisoners face in receiving essential HIV services and whether HIV risk behavior is prevalent in prisons. Methods We conducted a mixed-methods (qualitative and quantitative), cross-sectional study in 2018 in six prisons in Southern Malawi, two large central prisons with on-site, non-governmental organization (NGO) supported clinics and 4 smaller rural prisons. Four hundred twelve prisoners were randomly selected and completed a structured questionnaire. We conducted in-depth interviews with 39 prisoners living with HIV, which we recorded, transcribed and translated. We used descriptive statistics and logistic regression to analyze quantitative data and content analysis for qualitative data. Results The majority of prisoners (93.2%) were male, 61.4% were married and 63.1% were incarcerated for 1–5 years. Comprehensive services were reported to be available in the two large, urban prisons. Female prisoners reported having less access to general medical services than males. HIV risk behavior was reported infrequently and was associated with incarceration in urban prisons (adjusted odds ratio [aOR] 18.43; 95% confidence interval [95%-CI] 7.59–44.74; p = < 0.001) and not being married (aOR 17.71; 95%-CI 6.95–45.13; p = < 0.001). In-depth interviews revealed that prisoners living with HIV experienced delays in referrals for more severe illnesses. Prisoners emphasized the detrimental impact of poor living conditions on their personal health and their ability to adhere to antiretroviral therapy (ART). Conclusions Malawian prisoners reported adequate knowledge about HIV services albeit with gaps in specific areas. Prisoners from smaller, rural prisons had suboptimal access to comprehensive HIV services and female prisoners reported having less access to health care than males. Prisoners have great concern about their poor living conditions affecting general health and adherence to ART. These findings provide guidance for improvement of HIV services and general health care in Malawian institutionalized populations such as prisoners.