Has anal sex gone out of vogue? What does this mean for HIV prevention?

via the HIV MSM blog

So the Advocate recently reported the findings of a large-scale survey on sexual behaviors.  Apparently, only 37.2% of over 24,000 gay and bisexually identified men indicated that their last sexual encounter consisted of anal sex.   The most practiced activities were kissing (almost 75%) and mutual masturbation (73%).

The survey, entitled  ‘The Gay and Bisexual Men’s National Sex Survey’ was sponsored by Manhunt,  its sexual health affiliate Manhunt Cares (see my past post here about them) and  its research partners, present the findings in a cutesy interactive graphical form which can be accessed from clicking on the picture on the left (i.e. I found out that 80.8 % of surveyed men have eaten cum at some point in their lives!) The abstract of the study, which appears in the Journal of Sexual Medicine can be found here.

Now before we give up our lube and condoms and other devices we find makes our anal sex experience more comfortable, there a few things to keep in mind.  For some reason, the majority of respondents in this latest conducted by researchers from Indiana University and George Mason University were Caucasian males.  Perhaps results would be changed if there was some diversity in the subject pool.  Also, one should note that the respondents were “self identified” gay or bisexual.  Perhaps if behaviors of non-identified men who have sex with men, (i.e. heterosexual identifying men) were recorded the results would also show a higher indication of anal sex.  However, I like the point that one of the commentators made:   Anal sex does require a lot of effort (much like vaginal penile sex as well) and perhaps people don’t want to go through such effort simply to get off.

Read the rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

The European MSM Internet Survey (EMIS) - See What They Learned!

via EMIS

This is the second community report written especially for you - members of Europe’s diverse LGBT communities. We hope that you find this information interesting and helpful! The first community report covered testing for HIV, knowledge about testing, being ‘out’, sexual happiness and the ‘sexiest man on the planet’. All EMIS community reports are available in 25 languages at www.emis-project.eu.

In this second report we will focus on a range of topics dealing with sex and the number and type of sexual partners, as well as testing for STIs other than HIV. Please be aware that this information is only preliminary, and that we are in the process of preparing a more detailed report for publication later in 2011. Similar to the previous community report, we have included an overview of the data discussed in this report on page three. When reading the table, if you compare the numbers of EMIS respondents in the left column with the first report, you will notice that they have slightly decreased. This is due to changes in the criteria used to exclude respondents’ data from the study if responses were not consistent. We do our best not to report on data from men who hastily clicked through the survey and who did not provide answers that actually corresponded to their knowledge and experiences.

Who You Had Sex With

In each country a significant number of you, who completed the EMIS questionnaire, did not identify as ‘gay or homosexual’. This means we clearly reached a wide range of men who have sex with men. Indeed, around 15% of all respondents reported having had sex with a woman in the twelve months prior to completing the survey. As the table on page three shows, this went from a low of nearly ‘one in ten’ of you in Belgium (.be), the Netherlands (.nl), Poland (.pl) and France (.fr) to over a quarter of you in Slovenia (.si), Bulgaria (.bg) Romania (.ro) and Bosnia & Herzegovina (.ba).

How Many Men You Had Sex With

In the table on page three you can see in which countries partner numbers were particularly high or low. Many of you (43% to 59%) had between two and ten partners, while having more than ten partners went from 10% to over 25% across the 38 countries. The number of sexual partners tells us a few things, such as, how easy or difficult it is to find partners (because they might not be ‘out’ or there might be no places or venues for you to meet). This may also tell us about how hard it might be for many of you to build steady relationships, particularly in societies where same sex couples are not officially recognised or allowed. Of course many men choose to have multiple sex partners. It is advised that the more partners you have, the more often you need to have a sexual health check-up.

Where You Met Men to Have Sex

We asked you where you met your last non-steady male sex partner (of those who had a non-steady partner in the last twelve months). The most common response was “on the Internet”, followed by various sex venues including gay saunas and backrooms of bars and clubs.

Read the rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Transmission of Hepatitis C in HIV-positive populations

via pubmed.gov, by Danta M, Rodger AJ.

Abstract

Purpose of Review
The epidemiology of hepatitis C virus (HCV) in HIV has changed significantly over the past decade. This review will outline the current epidemiology of HCV in HIV infection, focusing on the recent changes and factors which have been related to the increase in HCV transmission in HIV-infected men who have sex with men (MSM).

Recent Findings
Since 2000 there has been recognition in the postindustrialized world that there has been a dramatic rise in the incidence of HCV in HIV-infected MSM. Whereas sexual transmission of HCV remains controversial in the general population, there is increasing evidence that permucosal (sexual and mucosally administered drugs) rather than parenteral risks have become key factors in HCV transmission in HIV-infected MSM. At the most basic level, transmission depends on disruption of a barrier and exposure to infected fluids, usually blood. Whereas transmission factors are often closely entwined, they can be characterized as behavioural and biological factors.

Summary
With an improved understanding of the epidemiology of HCV in this population, interventions by relevant health authorities could be better focused.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

What HIV-Positive MSM Want from Sexual Risk Reduction Interventions: Findings from a Qualitative Study

via pubmed.gov, by Vanable PA, Carey MP, Brown JL, Littlewood RA, Bostwick R, Blair D

Abstract

To facilitate the development of a tailored intervention that meets the needs of HIV-positive men who have sex with men (HIV-positive MSM), we conducted formative research with 52 HIV-positive MSM. We sought to (a) identify major barriers to consistent condom use, (b) characterize their interest in sexual risk reduction interventions, and (c) elicit feedback regarding optimal intervention format. Men identified several key barriers to consistent condom use, including treatment optimism, lessened support for safer sex in the broader gay community, challenges communicating with partners, and concerns about stigmatization following serostatus disclosure. Many men expressed an interest in health promotion programming, but did not want to participate in an intervention focusing exclusively on safer sex. Instead, they preferred a supportive group intervention that addresses other coping challenges as well as sexual risk reduction. Study results reveal important considerations for the development of appealing and efficacious risk reduction interventions for HIV-positive MSM.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

New study finds gay and bisexual men have varied sexual repertoires

via Indiana University

"The data revealed some interesting information on the types of sexual behavior that MSM reported, including that less than 40 percent of men engaged in anal intercourse during their most recent sexual event."

"Of all sexual behaviors that men reported occurring during their last sexual event, those involving the anus were the least common," Rosenberger said. "There is certainly a misguided belief that 'gay sex equals anal sex,' which is simply untrue much of the time."

A new study by researchers at Indiana University and George Mason University found the sexual repertoire of gay men surprisingly diverse, suggesting that a broader, less disease-focused perspective might be warranted by public health and medical practitioners in addressing the sexual health of gay and bisexual men.
 
The study, published online ahead of print in the Journal of Sexual Medicine, tapped the largest sample of its kind in the United States to examine the sexual behaviors of gay and bisexual men. In collaboration with the OLB Research Institute at Online Buddies, Inc., researchers were able to include feedback from nearly 25,000 men. While gay study participants reported 1,308 unique combinations of behaviors, the most commonly reported behavior was kissing a partner on the mouth.

From a public health standpoint, say the researchers, this study provides professionals with data on the behavior of men having sex with men (MSM) that was missing from the sexual health discussion.

Read the rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Pleasure as "Key Motivator" for Safe or Unsafe Sex

via The Pleasure Project, by Revati

I've been at the Asia Pacific AIDS conference for a week and so far, in all the sessions I have attended, only one person has spoken about pleasure and the need to recognise pleasure as a key motivator for safe or unsafe sex and that was a question from the audience.

But hurrah. At last I found someone who confronted the elephant in the room. Dr Malonzo, from Brokenshire College in The Phillipines, please step forward and take a bow.

Dr Malonzo’s study looks at why men having sex with men choose not to us condoms, or have “intentionally condom-less sex” aka “bare-backing”. bare- backing was initially a description used in the 1990′s by HIV positive men who declared their intention to have sex with other HIV positive men without condoms. It has now become the term used to describe condom less sex in a more generic view, regardless of HIV status. So for example, there are pornography studios who specialise in bare back films, sex workers or dating sites who use the term. Dr Malonzo studies the current phenomenon in Davao City in The Philippines in interviews with 40 young gay men.

Read the rest.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Sexual Pleasure is Key for Successful Microbicides

via WeNews, by Amy Littlefield

Participants in Kate Morrow's [IRMA Steering Committee Member] recent study may not have felt like they were fighting the global HIV epidemic.

In fact, what they were literally feeling were gels of various consistencies inside their vaginas.

The women in Morrow's Project LINK answered questions after handling the gels, inserting them vaginally, walking around and simulating intercourse with a fake phallus. Did the gel leak out? Did it inhibit the experience . . . or did they actually enjoy it?

Morrow has developed a set of scales to show the range of sensations and experiences women reported. Her goal now is to connect those sensations to data about which gels women would use to prevent HIV. Do they prefer gels that are smooth, thin or thick like hair gel? The answers to those questions could help lead to a microbicide that women will tolerate--and perhaps even enjoy.

For decades, women's health advocates have known that women need a way to protect themselves from HIV that is not dependent on a male partner. Vaginal microbicide gels are among an array of options--including pills, rectal microbicides and vaginal rings--that may one day help. Advocates hope microbicides could even be combined with birth control and help prevent other sexually-transmitted illnesses.

Read the rest.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

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Gay Men: PrEP Acceptable and Unlikely to Change Risk Behaviour

Via AIDSMap, by Michael Carter.

Approximately 50% of gay men said they were likely to use pre-exposure prophylaxis (PrEP), but few reported that it would lead to a change in their risk behaviour, according to data presented to the International AIDS Society conference in Rome.

Nevertheless, the investigators were concerned that even minor increases in rates of unprotected anal sex could offset the benefits of pre-exposure prophylaxis.

The IPrEX study showed that PrEP significantly reduced the risk of infection with HIV for gay and bisexual men. Overall, men who took PrEP had their risk of HIV reduced by 44%. If adherence was high, the risk was reduced by 73%.

“PrEP offers much promise as the first biomedical intervention to have success in at-risk men who have sex with men,” comment the researchers.

They therefore undertook further analysis to see how likely the men who participated in the study were to use PrEP and if its availability would change their HIV risk behaviour.

They undertook a survey in December 2010, immediately following the release of the IPrEX results, using Facebook and Black Gay Chat to recruit participants. A total of 1155 gay and other men who have sex with men were recruited to the study.

Participants completed a questionnaire about their knowledge and willingness to use PrEP; perceptions of the risk of HIV infection from unprotected anal sex with or without PrEP; perceptions of sexual pleasure; and perception of likelihood to experience sexual pleasure with or without a condom and with or without PrEP.

The men had an average age of 33 years, 75% were white, and 51% reported unprotected anal sex at least once in the last twelve months.

Only a third of men had heard of PrEP before the release of the study results. Just under half of individuals reported that they were “very” or “extremely” likely to use PrEP.

Unprotected anal sex without a condom was widely considered to involve a high risk of HIV.

The availability of PrEP did not alter the perception of the risk associated with HIV in the majority of men, regardless of whether they were the insertive (75%) or receptive (60%) partner in anal sex.

Three-quarters of men stated that the 44% efficacy of PrEP in the IPrEX study would not affect their use of condoms. However, 7% reported that they would use condoms less frequently.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Why So Anal about Pleasure?

Via EmpowHer, by Hannah Cutts.

Whether you are a committed fan, a non-subscriber, or have been considering engaging in anal play, I believe it is a subject that women should make an effort to include in their sexual awareness and conversations, even if only to expand their education on the female body and become resources for friends/family members who may have questions about the behavior.

According to the Center for Disease Control and Prevention’s National Survey of Family Growth, anal sex between heterosexual partners has been on the rise over the past decade. In 1992, 20.4 percent of women reported engaging in anal sex with a male partner, while in 2005, 32.6 percent indicated they include anal in part of their heterosexual repertoire (New York Magazine, 2006). While anal sex has historically been associated with gay couples, it is clear that people who enjoy sex with the opposite gender have adopted the practice, perhaps finally realizing what they have been missing out on. It is time for women—straight, gay and anywhere in between—to get the facts on anal play and what makes it worthwhile.

The bottom line is, like your vagina, your anus is packed with sensitive nerve endings that feel great when touched or stimulated. Although experimenting with this somewhat fragile opening is not necessarily a stand-alone endeavor (it requires some foreplay and careful lubrication), gentle exploration of the anus is a tremendous complement to other pleasure-giving (think cunnilingus). By slowly introducing the stimulation of this third hole into your sexual repertoire one step (or to be more accurate, one finger) at a time, you are opening yourself up to sensations that you won’t feel with vaginal-only penetration. Many sources suggest you begin simply with a massage of the anal opening, an action that carries almost no risk and allows both partners to get comfortable with the touch.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Study - Addressing Social Drivers of HIV/AIDS for the Long-Term Response: Conceptual and methodological Considerations

Via MSMGF.

A key component of the shift from an emergency to a long-term response to AIDS is a change in focus from HIV prevention interventions focused on individuals to a comprehensive strategy in which social/structural approaches are core elements. Such approaches aim to modify social conditions by addressing key drivers of HIV vulnerability that affect the ability of individuals to protect themselves and others from HIV. The development and implementation of evidence-based social/structural interventions have been hampered by both scientific and political obstacles that have not been fully explored or redressed. This paper provides a framework, examples, and some guidance for how to conceptualise, operationalise, measure, and evaluate complex social/structural approaches to HIV prevention to help situate them more concretely in a long-term strategy to end AIDS.

Conclusion:

After nearly 30 years of the HIV/AIDS pandemic, there have been woefully few examples of truly successful HIV prevention initiatives conceived and implemented by national policy makers and programme planners. To ensure measurable HIV prevention success by 2031, the 50th anniversary of the epidemic, it will be necessary to move beyond the limited, individualistic, urgency-based approaches of the past. Shifting from an emergency framework and mounting a long-term response to AIDS requires new approaches that engage with underlying social-structural drivers of patterns of practices that influence vulnerability and facilitate the spread of HIV, as part of comprehensive, strategic programming (or ‘combination prevention’).

Patterns of behaviour and practices arise from combinations of drivers, operating in specific social, economic, and political contexts. As such, no single causal pathway can be drawn from a social driver to a set of practices or behaviours; rather, a range of potential outcomes may arise. Making causal inference about correlations between social drivers and HIV burden involves identifying ‘sociologically plausible’ pathways drawn from extant social science and epidemiological data. Engaging with social drivers requires methods and approaches beyond traditional conceptualisations that seek to identify and intervene on single, causal determinants or universal mechanisms of influence. HIV prevention researchers and advocates should reject and resist over-simplified language for social drivers. Statements that particular social-structural factors ‘do’ or ‘do not’ lead to HIV transmission are almost always too simplistic; language should shift to discussing how, in what circumstances, and for whom particular combinations of factors contribute to HIV vulnerability (or, conversely, resilience). In order to be rigorous, design of HIV prevention programmes and interventions aiming to address social-structural factors should:

• Begin with an assessment of the social and structural factors that may be
• increasing HIV vulnerability in targeted populations and settings.
• Identify (hypothesise) sociologically plausible causal chains between distal structural factors and specific individual or group practices.
• Identify levels of possible influence, in line with the HIV prevention programme’s or intervention’s scope and aim.
• Articulate any assumptions about such influences and aims including potential expected and unexpected consequences of the programme or intervention (including other social impacts).
• Build in evaluation mechanisms that are both feasible and appropriate to the aim, level, scope and method of the programme or intervention as a way to enable validation of assumptions, investigation of the mechanisms by which structures affect risk and vulnerability, and appropriate assessment of outcomes and impact.

Find the whole study here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Narrow Window To Avert HIV Epidemics Among MSM in Middle East and North Africa

Via AIDSMap, by Michael Carter.

HIV epidemics are emerging among men who have sex with men (MSM) in a number of Middle Eastern and North African countries, an international team of investigators report in the online journal PLoSMedicine.

Prevalence of HIV was as high as 28% among some populations of MSM in Pakistan, and in 2008 over 50% of new HIV infections in Lebanon were in men who reported anal sex with another man.

High levels of risk behaviour in many countries suggested that there was the potential for further spread of HIV.

Alarmed by their findings, the investigatorssuggest “there is an urgent need to expand HIV surveillance and access to testing, prevention, and treatment services in a rapidly narrowing window of opportunity to prevent the worst of HIV transmission among MSM in the Middle East and North Africa.”

Worldwide, MSM are one of the groups most affected by HIV. The epidemic in most industrialised countries is focused on MSM, and research conducted in sub-Saharan Africa has found evidence of large but generally hidden MSM epidemics. Moreover, epidemics in MSM are well established and growing in Latin America and South East Asia.

In contrast, little is known about the MSM HIV epidemic in Middle Eastern and North African countries. Sex between men is often highly stigmatised in this setting, and in five countries homosexuality is punishable by death.

Given this lack in knowledge, a team of investigators lead by Dr Ghina Mumtaz undertook a systematic literature review to gain a better understanding of the HIV prevalence in MSM, their risk behaviour and knowledge of HIV in 23 North African and Middle Eastern Countries.

The authors believe their study “provides an integrated analysis and synthesis of the evidence to address the gap in our knowledge of what could potentially materialise as the key risk group for HIV sexual transmission in this region in the next decade.”

A total of 26 studies were included in the investigators’ analysis. They defined MSM as men who had insertive or receptive anal sex. However, the researchers emphasised that there was a huge diversity in MSM self-identity, role and behaviour in the region.

Overall, the prevalence of MSM behaviour was consistently between 2-3%. However, in some populations such as truck drivers (9%-49%) or street children (15%-77%) it was considerably higher.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Zimbabwe lawmaker advocates once-a-month sex to curb AIDS

Via Associated Press.

A Zimbabwean lawmaker has called on scientists to develop a chemical to dull men's libido and enable them to have sex once a month to curb the spread of HIV/AIDS, a state daily reported.

Senator Sithembile Mlotshwa told the upper house of parliament that scientists should "look into the issue of trying to inject men with a substance that will make them lose appetite..." during a debate on access to HIV/AIDS treatment.

"I want to contribute by saying all the other avenues have been looked into and the only avenue left is for us parliamentarians to decide or suggest reducing the appetite of men and their insatiable greed for women."

Zimbabwe is one of the countries worst affected by the HIV/AIDS pandemic although the rate of infection has gone down.

Extra-marital relationships are among the drivers spreading the pandemic.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

The death of sex?

Via Salon, by Tracy Clark-Flory.

 In case you've missed these dispatches, allow me to fill you in on what you've been missing (aside from sex, apparently): First, the New York Observer ran an article proclaiming, "Young New Yorkers no longer care about having sex." Meg Wolitzer, author of "The Uncoupling," a magical realist novel about a sex-strike, followed up with a commentary in the New York Times about whispers in her friend circle of 40-plus women about growing "sexual disengagement." That brings us to this past weekend, which saw the publication of a Times Op-Ed by Erica Jong lamenting the sexlessness of young women today.

This concern isn't new, it's just the latest in a long history of arguments about how sex is being corrupted or destroyed. Previously, cultural commentators put the blame on the pervasiveness of pornography and sexually aggressive girls who scare boys out of their boners; and let's not forget the ever-present argument that sex before marriage is sinful and perverse. It seems that no matter the state of the current sexual union, someone somewhere is gravely concerned that everyone else is doing it wrong. More often than not, though, concerns about what other people are doing behind closed doors are really just our own projected anxieties about sex -- whether it's about what goes on in our own bedrooms, or our ability to maintain some semblance of control over the driving force of desire.

Beyond this customary nosiness, these recent reports specifically reflect current anxieties. What all three pieces have in common is that they link this alleged sexual malaise to technology. The Observer piece claims that young New Yorkers are more enamored with the smooth body of their iPhones than actual human flesh, more invested in upping their number of Twitter followers than notches on their bedposts. These caricatured young professionals get off on onanistic maintenance of their Facebook profiles, not on real-life human interaction. It strikes me that this is really just a way of expressing the depth of despair over the fact that, as I've written in the past, we feel "more connected, and yet more isolated, than ever."

Sex often stands in as a marker of personal and relationship health. As Wolitzer, who also gave a nod to the "seductions" of Facebook, Wikipedia and pornography, wrote in the Times, "[I]t's as if we still believe sex equals strength, health and life; and therefore, not-sex equals weakness, illness and death." Maybe it isn't as simple as that, but the connections are certainly there. Pointing the finger at technology -- whether it's addictive social media or the abundance of online pornography -- is a way to escape the uncomfortable self-examination that follows from asking whether we're intentionally avoiding something and, if so, what. It's no surprise that Jong pinpoints it: "We want to keep the chaos of sex trapped in a device we think we can control."

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Risk factors for HIV vary between African cities, need tailored responses

Via AIDSMap, by Carole Leach-Lemens.

A comparative study in three large cities in southern Africa has found big differences in risk factors for acquisition of HIV infection, emphasising the importance of locally tailored HIV prevention strategies and up-to-date information on local risk factors.

The study looked at behavioural risk factors associated with acquiring HIV infection in 5000 sexually active women in Harare, Durban and Johannesburg who took part in a large trial of an HIV prevention method based on use of the diaphgram.

Sue Napierala Mavedsnege and colleagues report the findings of their prospective cohort analysis in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

A total of 309 incident HIV infections were identified. Durban reported the highest incidence rate, followed by Johannesburg and then Harare (6.75 per 100 person years, 95% CI: 5.74-7.93; 3.33 per 100 person years, 95% CI: 2.51-4.44; 2.72 per 100 person years CI: 2.26-3.26, respectively).

Having more than one partner in the last three months was the only common factor associated with HIV incidence.

The majority of the estimated 35 million people living with HIV live in sub-Saharan Africa where 70% of all new infections occur. Women represent over 60% of all infections. Southern Africa, with the highest regional prevalence, reflects different phases of the epidemic.

In Zimbabwe, with an estimated prevalence of 14.3%, the epidemic began early, peaked in 1998 with a subsequent decline in incidence and prevalence.

From 1990-1998 South Africa had an exponential increase followed by a moderate increase until 2004 when apparent stabilisation began. In 2008 estimated provincial prevalence rates ranged from 5.3% to 25.8%.

In Gauteng province, with Johannesburg its largest city, prevalence appears to have peaked in 2002 at 20.3% and declined to 15.2% in 2008. In contrast, Kwa Zulu Natal province where Durban is the largest city, estimated prevalence rose from 15.7% in 2002 to 25.8% in 2008.

While cross-sectional studies looking at risk factors associated with HIV have taken place in Zimbabwe and South Africa, few have looked at risk factors for HIV incidence in women. A better understanding of these factors within local contexts will help develop targeted interventions so reducing transmission.

The authors looked at factors associated with differences of HIV incidence among women in Harare, Johannesburg and Durban enrolled between September 2003 and September 2005 in the Methods for Improvement of Reproductive Health (MIRA) study, a randomised clinical trial to look at the effect of the diaphragm plus lubricant gel for the prevention of HIV. The intervention did not reduce HIV incidence.

The authors undertook a prospective cohort analysis of trial participants who were followed for a median of 21 months (12-24 months).

Socio-demographic, biological and behavioural data were collected at baseline and at quarterly visits. Testing for HIV and STIs were conducted at each quarterly visit.

Each location had distinct characteristics as well as different patterns of individual risk factors.

In Harare women were more likely to live with their partner, be employed and not use alcohol or drugs but more likely to wipe inside their vagina. While they had a later sexual debut and fewer partners than in Durban or Johannesburg there was more transactional sex (for money, food, drugs or shelter) within the last three months.

Early sexual debut was more common in Durban, while in Johannesburg consumption of alcohol within the last three months, multiple sexual partners and sex under the influence of drugs or alcohol were more likely.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Self-Perceived Risk of HIV Infection and Attitudes About PrEP Among STD Clinic Attendees

Via Liebert Online, by Y. Omar Whiteside, Tammy Harris, Christopher Scanlon, Stephen Clarkson, and Wayne Duffus

Background

Despite the advances in the prevention of and treatment for HIV infection, the estimated rates of HIV infections remained constant from 2005 to 2008. More importantly, during this period the estimated number of newly diagnosed HIV/AIDS cases increased 8%. In 2008, blacks accounted for more than half (52%) of all new HIV cases diagnosed. The South, where the majority of black/African Americans live, continues to suffer disproportionately from the HIV/AIDS epidemic. The Centers for Disease Control and Prevention's (CDC) 2008 HIV Surveillance Report documented that the death rate among persons with AIDS increased in both the South and the Midwest and that the South has the highest number of AIDS diagnoses of any region in the country. Because of this region's epidemiology, the need to prevent new HIV infections is of paramount importance.

South Carolina, a southern state, has one of the highest AIDS rates in the United States (2008 AIDS rate: 15.5 per 100,000 population in South Carolina; 12.2 per 100,000 population in the United States) In 2008, Columbia, South Carolina, ranked seventh in its AIDS case rate (25.6 per 100,000 population) among metropolitan statistical areas. Of increasing concern to South Carolina public health officials is the high prevalence of HIV-infected residents and the potential for unabated transmission.

Methods

This was an exploratory study on self-perceived risk of HIV infection and attitudes about using PrEP among sexually transmitted diseases (STD) clinic attendees. It was designed as a cross-sectional study and was conducted from January 2009 to May 2009 and October 2010 to December 2010 in an STD clinic in South Carolina. An STD clinic was chosen as the location from which to draw participants because individuals with an STD have an increased risk for both HIV infection and transmission. The inclusion criteria were that participants be at least 16 years of age; have had oral, anal, or vaginal sex within the past 6 months; be seeking STD clinic services, self-report being HIV-negative, and not have previously completed the survey. Participants were given a 20-min, self-administered, paper-based, anonymous survey that measured demographic information; sexual exposure history; self-perceived risk perception for HIV infection; and attitudes about PrEP.

Results

Compared to heterosexual participants, homosexual participants were significantly more likely to have knowledge of PrEP (odds ratio [OR]=6.7, 95% confidence interval [CI]: 1.70–26.1). Compared to those participants who had 1 sexual partner in the past 3 months, individuals who had 2 to 4 sexual partners in the past 3 months were approximately 2.35 times as likely to have a lower level of agreement with the statement “I believe I am at risk of getting HIV” (p=0.0003). Compared to female participants, respondents who were male were approximately 2.8 times as likely to have a lower level of agreement with the statement “If I had to it would be very difficult for me (or my partner) to both use condoms and take daily pills to prevent HIV infection” (p<0.0001). These results suggest the need for the creation of PrEP implementation programs that are tailored to self-perceived risk perception, age, and gender.

Read the full study here.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

NYT: For a Sex Survey, Privacy Goes a Long Way

via New York Times, by Nicholas Bakalar

It is not easy to ask people about their sex lives, and getting honest answers may be even harder. But there are ways to do it. One good method is to have a computer ask the questions, while the interviewee listens through earphones and enters the answers on the screen — without the intervention, or even the presence, of another hum

Last month the Centers for Disease Control and Prevention published a report on sexual behavior that used this technique with laptops to gather data on Americans’ sexual behavior, attraction and identity by age, marital status, education and race. Anjani Chandra, the lead author, said the process was developed to assure total anonymity for the respondents.

Dr. Chandra, a demographer with the agency, explained: “The computer tells the interviewees what key to press to lock away the responses. When they return the laptop to the interviewers, they can’t get in. It’s transmitted to a central place where the data processing happens without names or addresses. We get a file that can’t be linked back to the person.”

The researchers got a 75 percent response rate, very high for a household survey, when they interviewed more than 13,000 people ages 15 to 44 from 2006 to 2008.

Read the rest.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Bringing Up The Rear

Via salon.com, by Tracy Clark-Flory

It's no secret that more Americans are having anal sex than ever before: A study published last year in the Journal of Sexual Medicine found that more than 45 percent of women in their late 20s had tried anal sex.

On the flip side, women rarely get the opportunity to be penetrators. Virginia Vitzthum exquisitely described the appeal of taking on the male role in a piece for Salon back in 1999 -- before we even called it "pegging"

"In a way I'd never understood those words before, he was mine. The knowledge I could really hurt this person by being less than careful made me feel responsible, protective. The vulnerability appalled me at the same time; it was vaguely disgusting that he would let someone do this to him. Mixed in with the disgust was possessiveness. The thought of anyone else penetrating him seemed revolting. These observations clicked into place in quick succession; I felt like a projector being loaded with slides of maleness, of male seeing."

But, taboos change, and so do the cultural meanings of particular sexual acts. Just as the gay community has long debated the politics of being a top or a bottom, the hetero world is slowly catching up -or, um, bringing up the rear. As Pulley puts it, "We only have so many orifices. You'd think we'd all be itching to take advantage of them all, right?"

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More Teen Virgins? Not So Fast

Via RHrealitycheck.org, by Martha Kempner

In 2006–2008, 29 percent of females and 27 percent of males ages 15 to 24 reported that they had never had sexual contact with another person. This was a small but statistically significant change from 2002 when it was 22 percent for both males and females.

Many teens are making responsible decisions when it comes to their sexual behavior; they delay sex, have fewer partners, and use contraception. And yet, we adults give them so little credit for behaving, in many ways, better than us.

AND THE SURVEY SAYS…

Traditionally, when thinking about sex and surveying individuals about their behavior, we have concentrated on penile-vaginal intercourse. This focus makes some sense from a public health perspective as it is the only behavior that can lead to both pregnancy and STDs. That said, other behaviors certainly carry a risk of STDs, and, the focus on vaginal sex by nature excludes all same-sex behavior. Still, I sense that the primary reason for this focus is something different—a societal understanding (however, inaccurate, incomplete, and exclusionary) that only penile-vaginal sex is sex.

There are lots of different theories about why the percentages of young people who had vaginal intercourse dropped during those years. Some argue that this is when teens started becoming highly aware of the risk of HIV and that a life-threatening STD was a game changer for teenagers.

Others credit sexuality education while still others undoubtedly credit abstinence-only-until-marriage programs. One mother of a teenager jokingly argued it was all because of video games, "if teens are really logging 30 hours a week of screen time, when would they possibly have time to have sex?" We may never really know but it is worth trying to understand as the numbers seem to have leveled out in recent years.


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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Is being an HIV Gay a punishment from God?

Via bulawayo24.com, by Yngve Sjolund

In 2000, an ex-partner accused Adam of infecting him with HIV. He went to Adam’s employers and told them that he had infected him with HIV. Adam was forced to go for an HIV test by his employers which came back showing that he was HIV positive.

Adam remembers: “I felt kind of betrayed that my employers were falling for the blackmail. I had broken up with this person – and so he said I infected him with HIV because he wanted me to give him money and food, because I had a job. He wanted support from me.”

Today Adam (38), living in Soweto, considers himself as a self-identified black gay man and explains: “I always believed that when a person is born they are born for a reason, and they are born with different sexual orientations. There are straight people and there are gay people. Especially amongst the gay population in the black community people will say it is a foreign thing to be gay. They will say it is a white man’s disease, and as our Zimbabwean President will say, they are ‘worse than pigs and dogs’.

Adam is determined to make a change and sees a way forward for his peers: “I think people should embrace who they are. I personally feel that their conscience should guide them. If we look at culture, culture has its own imbalances, and as a gay and a Christian man I believe God created everybody differently, for a purpose. God did not make a mistake creating me as a gay person. And I don’t believe it is the work of the devil that somebody sleeps with the same sex. God created it that way. And he made me that – he is the one that created me as a man and gave me the feelings to be gay and have feelings for other men.”

Many people today still believe that being gay and contracting HIV is a “punishment from God”, but Adam explains that it is actually more a case of being lucky or unlucky. “I personally believe HIV has exposed me to so many things – I was lucky to get HIV. And because I have had bad publicity about me which I would not like to discuss. You get HIV for a variety of reasons. It is not a punishment.

It is just like another disease, like you can get cancer. Some people don’t even go around saying ‘I want cancer’ or ‘I want sugar diabetes.’ It is unfortunate that HIV is stigmatised to sex and people will think that a person has to be a pervert to have sex to get HIV. But it is just unfortunate.”

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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

African Girls Getting World Bank Cash Deters Sex With 'Sugar Daddies'

Via Bloomberg, by Simon Clark

Young women in sub-Saharan Africa have HIV infection rates up to three times higher than their male peers, largely because of relationships with older "sugar daddies" who give them money in exchange for sex.

The phenomenon contributes significantly to HIV's spread, said Ester Etkin of loveLife, South Africa's largest anti-AIDS group.

A World Bank study in Malawi examined cash incentives among approximately 3,800 females ages 13-22. One group received roughly $10 a month and payment for school fees if they regularly attended class, while the control received no incentives. HIV infection rates at 18-month follow-up were 60 percent lower among girls who were given cash: 1.2 percent, compared with 3 percent. The study also showed a delay in the start of sexual activity among beneficiaries and a decline in the number of partners among those who were sexually active.

Though the study's results are being assessed by a peer-reviewed journal, plans are underway to repeat the experiment elsewhere in Africa, said Mayra Buvinic, director of gender and development at the World Bank. "The potential could be huge to reduce HIV rates in teenage girls," she said.

But some experts question whether cash payouts are an appropriate strategy. "We could end up creating an environment of dependency that cannot be sustained," warned Peter Lamptey, a Family Health International physician practicing in Ghana. "Paying people to influence their sexual behavior won't solve the wider problems of abuse, esteem, neglect and inequality that cause them to get HIV," said Sophie Harman, a senior lecturer at London's City University who has studied World Bank AIDS policies.

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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]