bluuebunny/crossref_metadata_2025_split huggingface dataset:
O2-S1.01 Developmental changes in masculinity, sexual behaviour, and STI risk among adolescent boys
Authors: Ott M , Bell D , Fortenberry J. D 
Published: July 2011

BackgroundSuccessful STI prevention for younger boys should tap into a cultural understanding of boys' romantic and sexual relationships. However, little data exist. We describe developmental changes in boys' relationships, masculinity, sexual behaviour, and STI risk across adolescence.MethodsAfter IRB approval, thirty-three 14–16-year-old boys were recruited from a teen clinic serving high STI prevalence urban areas, and participated in 3 one-hour qualitative interviews, approximately 6–9 months apart. Urine was tested for gonorrhoea, chlamydia and trichomonas using DNA-based tests. Over 80% were retained at each follow-up. Baseline interviews were coded, then each boy's three interviews were read as a group, looking for changes across the interviews in relationship experience, masculine beliefs, sexual communication and decision-making, sexual experiences, and STI prevention.ResultsMean age was 14.9 years, all were Medicaid-eligible (low income), 90% were African American, and 16/33 were sexually experienced. We observed changes over time in relationships, masculinity, and sexual decision-making. At baseline, boys described girls as having more relationship power, with girls frequently initiating relationships and the decision to have sex. As boys gained experience, they perceived themselves as having more agency, and initiating sex more often. At baseline, we observed low levels of masculine beliefs, with many boys wanting meaningful and emotionally involved relationships, few viewing sex as a conquest, and most worrying about their own relationship and sexual competency. Three trajectories of masculinity emerge. A small number of Players” embodied a subset of masculine beliefs that included sex as a conquest, women as objects, and lack of emotional involvement. “Emotionally distant” was more common; these boys described initially trusting girls, “being burned” by someone they had been close to, and then not investing emotionally so as not to be hurt again. “Caretakers,” also a small minority, emphasised men's role to protect and care for women. Sexual communication, mostly indirect or nonverbal at baseline, became more direct. Despite a baseline interest in sex within relationships, experiences of 1st sex were generally outside of relationships.ConclusionsFor STI prevention programs to have relevance to younger boys, they need to tap into developmental changes in the cultural, relational, and behavioural contexts of sex.
O2-S1.04 Effective ART, viral load and sexual behaviour of HIV positive men who have sex with men: changes from 2000 to 2010
Authors: Wayal S , Cassell J , Copas A , Mercer C , Edwards S , Hart G 
Published: July 2011

BackgroundEarly initiation of combination antiretroviral treatment (ART) is being considered as a HIV prevention strategy. Thus, it is important to examine the association between ART, viral load (VL) and the sexual behaviour of HIV+ve patients. We compared the reporting of unprotected anal sex (UAI) in 2010 and 2000 among HIV+ve men who have sex with men (MSM) and its association with VL.MethodsHIV+ve MSM attending a central London HIV clinic were recruited in cross-sectional surveys in 2000 (411 men) and 2010 (423 men). Data on recent plasma VL (detectable (DVL) or undetectable (UVL)); ART status (treatment naïve or receiving ART); UAI with a boyfriend (main partner) and casual partners in the last 6 and 12 months respectively; boyfriend's HIV status (unknown/negative, or positive) were collected. Nonconcordant UAI (ncUAI) was defined as UAI with unknown/negative HIV status partner(s) and concordant UAI (cUAI) as UAI only with HIV+ve partner(s). Men reporting cUAI and ncUAI were treated as engaging in ncUAI. OR for 2010 compared to 2000 for UAI with casual partners were adjusted for age and DVL/UVL. Analysis for UAI with a boyfriend was adjusted also for boyfriend's HIV status and is restricted to those reporting a boyfriend.ResultsCompared to 2000, 2010 respondents were more likely to be on ART with UVL (76% vs 40%), but less likely to be on ART with DVL (6% vs 32%) or treatment naïve (19% vs 28%), p<0.001. They were older (age ≥45 years: 46% vs 22%, p<0.001), more likely to report an HIV+ve boyfriend (41% vs 25%; p=0.001). An increase in cUAI with a boyfriend (27% vs 14%) remained significant after adjustment, (OR: 2.84, 95% CI: 1.59% to 5.06%; p<0.001). ncUAI with a boyfriend did not change (12% vs 11%; p=0.63). With regards to casual partners, cUAI decreased over time (OR: 0.50, 95% CI: 0.29% to 0.86%; p=0.01) but ncUAI increased (34% vs 17%; OR: 2.79, 95% CI: 1.93% to 4.04%; p<0.001). UVL was not associated with ncUAI with casual partners or boyfriend, but was associated with increased cUAI with casual partners (OR: 1.83, 95% CI: 1.08% to 3.13%; p=0.02).ConclusionsIn comparison with 2000, cUAI with a boyfriend has increased, perhaps due to increased serosorting. In casual partnerships cUAI decreased and ncUAI increased. The latter has implications for onward HIV transmission and needs to be addressed by health promotion programmes. As UVL was not associated with ncUAI, these data do not suggest that early initiation of effective ART will increase HIV transmission.
O2-S1.06 Community responses to an HIV epidemic in South India: knowledge, moral panic and cultural inertia
Authors: Bradley J , Rajaram S , Ramesh BM , Bhattacharjee P , Isac S , Lobo A , Moses S , Blanchard J , Washington R , Alary M 
Published: July 2011

BackgroundStudies have shown that as communities face serious threats to traditional values, such as that posed by HIV, cultural inertia may result, whereby existing trends towards more liberalised views of sexuality are stalled, particularly among the educated and youth. We examined changes in attitudes around HIV in Bagalkot district, south India, between 2003 and 2009.MethodsGeneral population surveys were conducted in 2003 and 2009, among approximately 6600 randomly sampled men and women in 10 villages and 20 urban blocks. Questions about HIV knowledge, sexuality, gender and condoms were included.ResultsKnowledge of HIV increased from 77% in 2003 to 88% in 2009, and condom awareness increased significantly (37.4%–65.4%). However, in 2009, only 23% of people mentioned condoms spontaneously as a means of preventing transmission (an increase from 8% in 2003). There was an increase in those who thought sex workers should be compulsorily tested for HIV (63.0% vs 73.5%, p=0.01). An increasing number of people agreed that it is wrong to talk about sex" (24.2% vs 29.2%, p=0.05), especially women (21.9% vs 32.4%, p<0.01). There was an increase in those who thought it “wrong to talk about AIDS in a respectable family” (16.4% vs 0.22.1%, p=0.01), largely among urban women, youth and the more educated, and more in 2009 thought it improper for respectable people to discuss condoms (5.5% vs 17.9%, p<0.01). In 2003, 11.8% agreed that “access to condoms promotes promiscuity”, increasing to 29.5% in 2009 (p<0.01). Men, educated people, urbanites and young people under 25 were the most likely to believe this. Sex education was thought to be equally damaging, especially among women and young people, with more agreeing that it promotes sexual activity and promiscuity in 2009 than in 2003 (19.3% vs 30.2%, p<0.01).ConclusionsAlthough scapegoats (in the form of sex workers) were increasingly identified by the community, stigma towards those with HIV appeared to have reduced significantly. Despite increased knowledge and positive changes around stigma, fear of change to cultural mores was apparent, with unwillingness to embrace openness and discuss sexuality. Young and educated respondents appeared to be the most regressive thinkers, reflecting a cultural inertia that mirrors studies of other threats to traditional societal values. More effort is required to educate young people about healthy sexuality, openness and safe sex.
O2-S4.03 The cost-effectiveness of human papillomavirus vaccination of females over age 12 years in the USA
Authors: Chesson H , Markowitz L 
Published: July 2011

BackgroundAlthough the recommended age for Human Papillomavirus (HPV) vaccination of females is 11 to 12 years in the USA, catch-up" vaccination is recommended for females aged 13–26 years who have not been previously vaccinated. The objective of this study was to evaluate the cost-effectiveness of catch-up vaccination strategies for females aged 13–30 years in the USA.MethodWe revised and updated a previously-published, spreadsheet-based model of HPV vaccination to estimate the costs and benefits of female HPV vaccination. The health outcomes we included were: cervical intraepithelial neoplasia, genital warts, recurrent respiratory papillomatosis, and HPV associated cancers (cervical, vaginal, vulvar, anal, oropharyngeal, and penile). We examined the cost-effectiveness of catch-up vaccination for three age groups: ages 13–21 years, ages 21–26 years, and ages 27 to 30 years. We examined a 100-year time horizon. Routine vaccination of 12 year olds was assumed to occur in all 100 years, with coverage set at 20%, 30%, or 75%. The annual probability of receiving catch-up vaccination was 5% for ages 13 to 18 years and 1.25% for ages 19 years and older. The duration of the catch-up vaccination program was varied from 1 to 20 years.ResultsCatch-up vaccination generally became less cost-effective as routine coverage increased and as the duration of the catch-up program increased. When vaccine coverage and the duration of the catch-up program were varied (and all other parameters were set to their base case values), the incremental cost per QALY gained by extending the duration of catch-up vaccination ranged from $5000 to $40 000 for ages 13 to 21, from $50 000 to $85 000 for ages 21 to 26, and was >$140 000 for ages 27 to 30 years. The relatively favourable cost-effectiveness ratios for vaccination of ages 13 to 21 years and the relatively unfavourable cost-effectiveness ratios for vaccination of ages 27 to 30 years were consistent regardless of routine vaccine coverage and the duration of the catch-up vaccine program.ConclusionOur preliminary findings support the current recommendations of the Advisory Committee on Immunisation Practices (ACIP) for female vaccination. However, although catch-up vaccination for ages 21 to 26 years might be considered cost-effective now, the cost per QALY gained by catch-up vaccination may increase as time goes by and as vaccine coverage increases.
O1-S02.03 Multiple sex partners and lack of condom use for anal sex are associated with multiple anal HPV infections among men having sex with men: the HIM study
Authors: Nyitray A , Villa L L , Carvalho da Silva R J , Baggio M L , Lu B , Smith D , Abrahamsen M , Papenfuss M , Lazcano-Ponce E , Giuliano A R 
Published: July 2011

BackgroundHuman Papillomavirus (HPV) infection is the primary cause of anal cancer. While multiple HPV infections in the anal canal may accelerate disease progression, there are no reports of behavioural factors associated with multiple anal HPV infections among men having sex with men (MSM) and men having sex with women (MSW). We hypothesised that infection with multiple HPV types in the anal canal among MSM was associated with multiple sex partners and lack of condom use for recent anal sex. For comparison, we also assessed the role of multiple partners and condom use among MSW.MethodsGenotyping for 37 HPV types was conducted on anal canal exfoliated cell specimens from men, ages 18–70, from São Paulo, Brazil; Cuernavaca, Mexico; and Tampa, Florida, USA. Specimens from the pre-enrolment visit of a 4-year prospective study were analysed. Eligibility included no history of genital warts and no current STD diagnosis including HIV. Exfoliated cell samples between the anal verge and the dentate line of the anal canal were obtained with a saline-wetted swab. A total of 193 MSM and 1407 MSW provided evaluable specimens. For multivariable analyses we used Poisson regression with a robust sandwich estimator. Association estimates were adjusted for potential confounders.ResultsMultiple HPV infections were present in the anal canal of 34.7% of MSM and 4.0% of MSW. Prevalence of multiple HPV infections was stable by age group among MSW (p trend=0.65) but declined among MSM (p trend=0.009). After adjustment for potential confounders, ≥2 male anal sex partners in the past 3 months (OR 2.47, 95% CI 1.43% to 4.27% vs 0–1 men) and lack of condom use at last anal sex (OR 1.51, 95% CI 1.07% to 2.12% vs condom use) were associated with detection of multiple anal HPV infections among MSM. Among MSW, ≥2 female sex partners in the past 6 months (OR 1.81, 95% CI 1.02% to 3.21% vs 0–1 women) was associated with detection of multiple anal HPV infections while condom use at last vaginal sex was not associated with infection (no condom use: OR 0.90, 95% CI 0.51% to 1.61% vs condom use).ConclusionsThese data suggest that lowering the number of sex partners may reduce infection with multiple HPV types at the anal canal among MSM and MSW. Additionally, using condoms during anal sex among MSM, even among men with multiple partners, may reduce multiple anal HPV infections at the anal canal. Questions:alan.nyitray@moffitt.org
O2-S4.06 Exploring enema practices among men who have sex with men in the USA: implications for sexual health
Authors: Rosenberger J G. , Herbenick D , Van Der Pol B , Novak D S , Reece M , Fortenberry J D 
Published: July 2011

PurposeRecent literature has suggested that use of hygiene products (ie, douching) by women and men prior to sexual activity, changes the biological makeup of vaginal and anal tissue, potentially affecting risk for HIV/STI acquisition. While men who have sex with men (MSM) continue to be disproportionately impacted by HIV/STI, little information exists about men's lifetime enema behaviours, the situational contexts impacting their use, and attitudes towards use of such products.MethodsData were collected via an internet survey from 27 690 18–80 year old MSM. Measures included sociodemographics, recent/lifetime sexual behaviour history, and items related to enema use.ResultsParticipants' median age was 39.0 years; ethnicities included white (84.5%), Latino (6.4%), African American (3.5%); and, most (79.9%) identified as homosexual. Over half (54.2%) of men indicated that they were not currently in a romantic relationship and the majority (88.9%) reported having two or more sexual partners in the past year. Most men (64.5%) reported lifetime enema use, with 33.8% reporting use in the past month. Most common reasons for starting enema use were to avoid feces during sex (72.5%) and to feel clean during sex (65.6%). Among enema users, 34.4% reported use of a disposable store bought enema, while 62.5% indicated having used a refillable enema or one that attached to the shower. Men somewhat or strongly agreed that enema use increased comfort with their anus (75.8%), made sex more enjoyable (75.5%), and increased the likelihood of being the receptive partner (75.8%). During the most recent sexual event, enema use was reported both before (37.1%) and after (8.1%) sex, with most (42.0%) reporting use 30 min–1 h prior to sex. Enema use at last sex was more likely to occur among men who were Caucasian (p <0.01), who engaged in anal intercourse (p <0.01), and whose sexual partner was someone they just met (p <0.05).ConclusionsThese data provide one of the first examinations of enema practices among MSM in the US. Findings highlight use of enemas prior to sexual activity as a common behaviour, and one associated with positively enhancing the sexual experience. The acceptability of enema use in this population may provide a vehicle for microbicide or virocide delivery once such compounds are fully developed. Future research should examine the relationship between behavioural practices and biological impacts of enema use in relation to HIV/STI.
O2-S5.02 The association between alcohol use and HIV sexual risk behaviours
Authors: Somji A , Bello B , Delany-Moretlwe S 
Published: July 2011

BackgroundThis study aimed to investigate the associations between alcohol use and sexual risk behaviour in migrant men and women living in Johannesburg.Methods1465 men and 1008 women living in six hostels and five neighbouring informal settlements respectively were surveyed. Using logistic regression, the association between five measures of alcohol use (current alcohol consumption, frequency of drinking, drunk in the past week, daily alcohol consumption, drinking habit) and five sexual risk behaviours (transactional sex, inconsistent condom use, coercive sex, multiple sexual partners and concurrency) in men and women was assessed.ResultsMore men than women reported current alcohol use (42% vs 12%). Among current drinkers, 23% of men and 29% of women reported being drunk in the past week. Consistent condom use was low in both men and women (6%). More men (53%) than women (7%) reported multiple sexual partnerships. In men, frequent drinking (Adjusted OR [AOR] for upper category: 3.1, 95% CI: 1.7% to 5.5%) and being drunk in the past week (AOR: 3.3, 95% CI: 1.8% to 6.0%) were associated with coercive sex. Frequent drinking (AOR for upper category: 1.5, 95% CI: 1.1% to 2.2%) and being drunk (AOR: 2.0, 95% CI 1.4% to 3.0%) was also associated with multiple sexual partnerships. In women, frequent drinking (AOR for upper category: 3.0, 95% CI: 1.0% to 8.9%) and being drunk in the past week (AOR: 3.4, 95% CI: 1.3% to 9.4%) were experiencing coercive sex. Alcohol use did not appear to influence reported condom use.ConclusionsAlcohol use was associated with several high-risk sexual behaviours in both men and women. Future HIV prevention interventions should focus on the associations between alcohol, partner violence and HIV risk.
O2-S5.03 Sex, drugs and structural interventions: unstable housing associated with increased HIV risk behaviour in a cohort of people on treatment in British Columbia, Canada
Authors: Parashar S , Palmer A , O'Brien N , Chan K , Milan D , Samji H , Montaner J , Hogg R 
Published: July 2011

BackgroundUnstable living conditions may increase risk for HIV exposure and transmission. This analysis examines housing as a structural factor associated with drug and sexual risk behaviours among individuals accessing antiretroviral treatment (ART). We hypothesised that unstable housing is significantly associated with sex exchange and recent injection drug use (IDU).MethodsThe LISA cohort is a cross-sectional study of individuals on ART in British Columbia. Interviewer-administered surveys collect information regarding housing, drug use, utilisation of health services and other clinically relevant socio-demographic factors. Clinical variables, such as CD4 count and viral load, were obtained through longitudinal linkages with the Drug Treatment Program (DTP) at the BC Centre for Excellence in HIV/AIDS. In order to examine the effect of housing status on HIV risk behaviour, multivariate logistic regression was used with three outcomes: sex exchange, unprotected intercourse and recent IDU.ResultsBetween 2007 and 2010 approximately 1000 participants were interviewed. The survey was modified part way through the study to stratify sexual behaviour based on partner-type. This analysis is thus restricted to 477 interviews with full information on all outcomes. Median age was 45 (IQR=39–51) and 29.8% (142) were female. After adjusting for potential confounders, unstable housing was significantly associated with a history of exchanging sex for food, money or drugs (Adjusted OR [AOR]=1.92; 95% CI=1.11% to 3.33%) and recent IDU (AOR=2.39; 95% CI=1.41% to 4.03%). Unprotected sexual intercourse with regular partners, casual contacts and clients, was not significantly associated with housing status.ConclusionGreater levels of sexual exchange and injection drug use among unstably housed populations are associated with aspects of transient living conditions, as well as the increased need and opportunity for sexual exchanges for food, shelter, drugs and money. Our findings suggest that secure and affordable housing is an important structural intervention that may reduce HIV risk behaviour.
O2-S5.04 Outlier populations: heightened risk for HIV, HCV and HIV/HCV co-infection among solvent-using injection drug users
Authors: Shaw S , Deering K , Jolly A , Wylie J 
Published: July 2011

IntroductionGlobally, substantial heterogeneity in the prevalence of HIV and other sexually transmitted infections (STIs) among most at-risk populations (MARPs) has been demonstrated. Examining factors related to heterogeneity can inform targeted programming. In Winnipeg, Canada, particularly high risk for HIV and hepatitis C (HCV) has been observed in injection drug users (IDUs) with a history of solvent use (S-IDUs). However, comparisons to other MARPs have been limited. Thus this study examined the association between HIV/STIs and S-IDUs in comparison to IDUs and other MARPs.MethodsData were from a 2008 to 2009 cross-sectional study of Winnipeg MARPs (IDUs, sex work- and street-involved individuals); subjects were recruited through respondent-driven sampling (RDS) methods. Adjusted ORs (AORs) from multivariable logistic regression models were estimated, examining the risk of HIV, HCV and HIV/HCV co-infection, and corrected for RDS-chain clustering using generalised estimating equations.ResultsTotal sample was 499, of which 13% recently injected drugs (ie, last 6 months), 5% recently inhaled solvents, 6% were recent S-IDUs, and 76% did not inject drugs or inhale solvents. HIV and HCV prevalence among recent S-IDU was 21% and 79%, respectively; HIV/HCV co-infection was 18%. In multivariable models, S-IDUs were at highest risk of HIV (AOR: 3.6, 95% CI: 1.6% to 7.9%; p<0.001), HCV (AOR: 19.3, 95% CI: 6.8% to 58.3%; p<0.001) and HIV/HCV co-infection (AOR: 6.0, 95% CI:2.5% to 14.7%; p<0.001). Comparatively, AORs for IDU-only were 3.3 (95% CI: 1.3% to 7.6%), 3.8 (95% CI: 2.3% to 7.5%) and 4.9 (95% CI: 2.1% to 14.7%). Among lifetime S-IDUs, elevated risk for HIV (AOR: 7.4, 95% CI: 2.3% to 26.2%) and HCV (AOR: 22.7, 95% CI: 11.0% to 47.0%) was observed, but not for HIV/HCV co-infection.ConclusionsSolvent use occurs among the most marginalised of MARPs, representing unique and complicated drug use trajectories. As the HIV epidemic in Canada becomes increasingly complex, examination of outlier populations such as S-IDU can inform public health by elucidating important pathways by which structural, environmental and individual factors interact to create the highest risk for HIV/STIs and other bloodborne pathogens.