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Intentional Abstinence Among Homeless and Unstably Housed Persons Living with HIV/AIDS

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Abstract

Some persons living with HIV/AIDS (PLWHA) engage in periods of sexual abstinence. Baseline data from a larger study of homeless/unstably housed PLWHA indicated that 20% (125/644) intentionally abstained from sex in the past 90 days. Reasons included: (1) ‘not interested’ (n = 78); (2) did not want to infect someone (n = 46); and (3) did not have a partner (n = 37). Abstinence was less likely among all who had a main partner. Among men who have sex with men (MSM), abstinence was less likely among those with a detectable viral load. It was more likely among heterosexual men who were experiencing current housing problems and who had at least a high school education. Among women, abstinence was less likely among African Americans and those whose social networks were more aware of their HIV status. Better understanding of motivations to abstain may improve how programs serving PLWHA address this issue.

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References

  • Adam, B. D., & Sears, A. (1994). Negotiating sexual relationships after testing HIV-positive. Medical Anthropology, 16, 63–77.

    Article  CAS  PubMed  Google Scholar 

  • Aidala, A. A., Cross, J. E., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9, 251–265. doi:10.1007/s10461-005-9000-7.

    Article  PubMed  Google Scholar 

  • Aidala, A. A., Lee, G., Garbers, S., & Chiasson, M. A. (2006). Sexual behaviors and sexual risk in a prospective cohort of HIV-positive men and women in New York City, 1994–2002: Implications for prevention. AIDS Education and Prevention, 18, 12–32. doi:10.1521/aeap.2006.18.1.12.

    Article  PubMed  Google Scholar 

  • Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults—Evaluation of a short-form of the CES-D. American Journal of Preventive Medicine, 10, 77–84.

    CAS  PubMed  Google Scholar 

  • Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Zolopa, A. R., Holodniy, M., Sheiner, L., et al. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS (London, England), 14, 357–366. doi:10.1097/00002030-200003100-00008.

    CAS  Google Scholar 

  • Beckett, M., Burnam, A., Collins, R. L., Kanouse, D. E., & Beckman, R. (2003). Substance use and high-risk sex among people with HIV: A comparison across exposure groups. AIDS and Behavior, 7(2), 209–219. doi:10.1023/A:1023906610710.

    Article  PubMed  Google Scholar 

  • Bogart, L. M., Collins, R. L., Kanouse, D. E., Cunningham, W., Beckman, R., Golinelli, D., et al. (2006). Patterns and correlates of deliberate abstinence among men and women with HIV/AIDS. American Journal of Public Health, 96, 1078–1084. doi:10.2105/AJPH.2005.070771.

    Article  PubMed  Google Scholar 

  • Buchacz, K., van der Straten, A., Saul, J., Shiboski, S. C., Gomez, C. A., & Padian, N. (2001). Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples. Journal of Acquired Immune Deficiency Syndromes, 28(3), 289–297.

    CAS  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2001). Prevalence of risk behaviors for HIV infection among adults—United States, 1997. Morbidity and Mortality Weekly Report, 50, 262–265.

    Google Scholar 

  • Colfax, G., Vittinghoff, E., Husnick, M. J., McKirnan, D., Buchbinder, S., Koblin, B., et al. (2004). Substance use and sexual risk: A participant- and episode-level analysis among a cohort of men who have sex with men. American Journal of Epidemiology, 159(10), 1002–1012. doi:10.1093/aje/kwh135.

    Article  PubMed  Google Scholar 

  • Courtenay-Quirk, C., Pals, S. L., Colfax, G., McKirnan, D., Gooden, L., & Eroglu, D. (2008). Factors associated with sexual risk behavior among persons living with HIV: Gender and sexual identity group differences. AIDS and Behavior, 12, 685–694. doi:10.1007/s10461-007-9259-y.

    Article  PubMed  Google Scholar 

  • Crepaz, N., Hart, T. A., & Marks, G. (2004). Highly active antiretroviral therapy and sexual risk behavior—A meta-analytic review. Journal of the American Medical Association, 292, 224–236. doi:10.1001/jama.292.2.224.

    Article  CAS  PubMed  Google Scholar 

  • Galvao, M. T. G., & Marcondes-Machado, J. (2001). Use of a condom in sex relations by HIV carriers. Revista da Sociedade Brasileira de Medicina Tropical, 34, 181–186.

    CAS  PubMed  Google Scholar 

  • Guzman, R., Buchbinder, S., Mansergh, G., Vittinghoff, E., Marks, G., Wheeler, S., et al. (2006). Communication of HIV viral load to guide sexual risk decisions with serodiscordant partners among San Francisco men who have sex with men. AIDS Care, 18, 983–989. doi:10.1080/09540120500497908.

    Article  CAS  PubMed  Google Scholar 

  • Harawa, N. T., Williams, J. K., Ramamurthi, H. C., & Bingham, T. A. (2006). Perceptions towards condom use, sexual activity, and HIV disclosure among HIV-positive African American men who have sex with men: Implications for heterosexual transmission. Journal of Urban Health, 83, 682–694. doi:10.1007/s11524-006-9067-0.

    Article  PubMed  Google Scholar 

  • Heckman, T. G., Kelly, J. A., & Somlai, A. M. (1998). Predictors of continued high-risk sexual behavior in a community sample of persons living with HIV/AIDS. AIDS and Behavior, 2(2), 125–135. doi:10.1023/A:1022194829791.

    Article  Google Scholar 

  • Henny, K. D., Kidder, D. P., Stall, R., & Wolitski, R. J. (2007). Physical and sexual abuse among homeless and unstably housed adults living with HIV: Prevalence and associated risks. AIDS and Behavior, 11, 842–853. doi:10.1007/s10461-007-9251-6.

    Article  PubMed  Google Scholar 

  • Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley.

    Google Scholar 

  • Kalichman, S. C. (1999). Psychological and social correlates of high-risk sexual behaviour among men and women living with HIV/AIDS. AIDS Care, 11(4), 415–427. doi:10.1080/09540129947794.

    Article  CAS  PubMed  Google Scholar 

  • Kalichman, S. C., Kelly, J. A., & Rompa, D. (1997). Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services. Health Psychology, 16(4), 369–373. doi:10.1037/0278-6133.16.4.369.

    Article  CAS  PubMed  Google Scholar 

  • Keegan, A., Lambert, S., & Petrak, J. (2005). Sex and relationships for HIV-positive women since HAART: A qualitative study. AIDS Patient Care and STDs, 19, 645–654. doi:10.1089/apc.2005.19.645.

    Article  PubMed  Google Scholar 

  • Kidder, D. P., Wolitski, R. J., Royal, S., Aidala, A., Courtenay-Quirk, C., Holtgrave, D. R., et al. (2007). Access to housing as a structural intervention for homeless and unstably housed people living with HIV: Rationale, methods, and implementation of the housing and health study. AIDS and Behavior, 11, S149–S161. doi:10.1007/s10461-007-9249-0.

    Article  Google Scholar 

  • Kilmarx, P. H., Hamers, F. F., & Peterman, T. A. (1998). Living with HIV—Experiences and perspectives of HIV-infected sexually transmitted disease clinic patients after posttest counseling. Sexually Transmitted Diseases, 25, 28–37. doi:10.1097/00007435-199801000-00007.

    Article  CAS  PubMed  Google Scholar 

  • Kipke, M. D., Weiss, G., & Wong, C. F. (2007). Residential status as a risk factor for drug use and HIV risk among young men who have sex with men. AIDS and Behavior, 11, S56–S69. doi:10.1007/s10461-006-9204-5.

    Article  Google Scholar 

  • Klinkenberg, W. D., Sacks, S., & HIV/AIDS Treatment Adherence, Health Outcomes, Cost Study Group. (2004). Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care, 16(Suppl 1), S22–S42. doi:10.1080/09540120412331315303.

    Article  PubMed  Google Scholar 

  • Lazo, M., Gange, S. J., Wilson, T. E., Anastos, K., Ostrow, D. G., Witt, M. D., et al. (2007). Patterns and predictors of changes in adherence to highly active antiretroviral therapy: Longitudinal study of men and women. Clinical Infectious Diseases, 45, 1377–1385. doi:10.1086/522762.

    Article  PubMed  Google Scholar 

  • Leigh, B. C., Temple, M. T., & Trocki, K. F. (1993). The sexual-behavior of United-States adults—Results from a national survey. American Journal of Public Health, 83, 1400–1408.

    Article  CAS  PubMed  Google Scholar 

  • Marks, G., Crepaz, N., Senterfitt, J. W., & Janssen, R. S. (2005). Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes, 39, 446–453. doi:10.1097/01.qai.0000151079.33935.79.

    Article  PubMed  Google Scholar 

  • Moatti, J. P., Prudhomme, J., Traore, D. C., Juillet-Amari, A., Akribi, H. A. D., Msellati, P., et al. (2003). Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Cote d’Ivoire. AIDS (London, England), 17, S69–S77. doi:10.1097/00002030-200317003-00010.

    Google Scholar 

  • O’Leary, A., Wolitski, R. J., Remien, R. H., Woods, W. J., Parsons, J. T., Moss, S., et al. (2005). Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men. AIDS (London, England), 19(Suppl 1), S67–S75.

    Google Scholar 

  • Raj, A., Silverman, J. G., & Amaro, H. (2004). Abused women report greater male partner risk and gender-based risk for HIV: Findings from a community-based study with Hispanic women. AIDS Care, 16, 519–529. doi:10.1080/09540120410001683448.

    Article  CAS  PubMed  Google Scholar 

  • Reilly, T., & Woo, G. (2001). Predictors of high-risk sexual behavior among people living with HIV/AIDS. AIDS and Behavior, 5, 205–217. doi:10.1023/A:1011384408761.

    Article  Google Scholar 

  • Remien, R. H., Exner, T. M., Morin, S. F., Ehrhardt, A. A., Johnson, M. O., Correale, J., et al. (2007). Medication adherence and sexual risk behavior among HIV-Infected adults: Implications for transmission of resistant virus. AIDS and Behavior, 11, 663–675. doi:10.1007/s10461-006-9201-8.

    Article  PubMed  Google Scholar 

  • Reynolds, N. R. (2004). Adherence to antiretroviral therapies: State of the science. Current HIV Research, 2, 207–214. doi:10.2174/1570162043351309.

    Article  CAS  PubMed  Google Scholar 

  • Salazar, L. F., Crosby, R. A., Holtgrave, D. R., Head, S., Hadsock, B., Todd, J., et al. (2007). Homelessness and HIV-associated risk behavior among African American men who inject drugs and reside in the urban south of the United States. AIDS and Behavior, 11, S70–S77. doi:10.1007/s10461-007-9239-2.

    Article  Google Scholar 

  • Senn, T. E., Carey, M. P., Vanable, P. A., Coury-Doniger, P., & Urban, M. A. (2006). Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic. Journal of Consulting and Clinical Psychology, 74, 720–731. doi:10.1037/0022-006X.74.4.720.

    Article  PubMed  Google Scholar 

  • Siegel, K., & Scrimshaw, E. W. (2003). Reasons for the adoption of celibacy among older men and women living with HIV/AIDS. Journal of Sex Research, 40, 189–200.

    Article  PubMed  Google Scholar 

  • US Census Bureau. (2004). Housing data between the Censuses: The American Housing Survey. Rep. AHS/R/04-1, US Census Bureau, Washington, D.C.

  • Wagner, G. J., Rabkin, J. G., & Rabkin, R. (1993). Sexual activity among HIV-seropositive gay men seeking treatment for depression. The Journal of Clinical Psychiatry, 54, 470–475.

    CAS  PubMed  Google Scholar 

  • Ware, J. E., Kosinski, M., & Dewey, J. E. (2000). How to score version 2 of the SF-36(r) health survey. Lincoln, RI: QualityMetric Inc.

    Google Scholar 

  • Wenzel, S. L., Tucker, J. S., Elliott, M. N., & Hambarsoomians, K. (2007). Sexual risk among impoverished women: Understanding the role of housing status. AIDS and Behavior, 11, S9–S20. doi:10.1007/s10461-006-9193-4.

    Article  Google Scholar 

  • Wight, R. G., Rotheram-Borus, M. J., Klosinski, L., Ramos, B., Calabro, M., & Smith, R. (2000). Screening for transmission behaviors among HIV-infected adults. AIDS Education and Prevention, 12, 431–441.

    CAS  PubMed  Google Scholar 

  • Wiktor, S. Z., Biggar, R. J., Melbye, M., Ebbesen, P., Colclough, G., DiGioia, R., et al. (1990). Effect of knowledge of human immunodeficiency virus-infection status on sexual-activity among homosexual men. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 3, 62–68.

    CAS  Google Scholar 

  • Wolitski, R. J., Kidder, D. P., & Fenton, K. A. (2007). HIV, homelessness, and public health: Critical issues and a call for increased action. AIDS and Behavior, 11, S167–S171. doi:10.1007/s10461-007-9277-9.

    Article  Google Scholar 

  • Wolitski, R. J., Pals, S. L., Kidder, D. P., Courtenay-Quirk, C., & Holtgrave, D. R. (2008). The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS and Behavior. doi:10.1007/s10461-008-9455-4.

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Acknowledgments

Funding for the research study was provided by the Centers for Disease Control and Prevention to RTI International under contract 200-2001-0123, Task 9; and funding for tenant-based permanent supportive rental housing assistance was provided by the Department of Housing and Urban Development. We thank the HUD grantee agencies in the participating cities and the following persons for their many contributions to the research: Angela Aidala (Columbia University), Paul Dornan (HUD), David Harre, David R. Holtgrave (Johns Hopkins University), Fred Licari (RTI), Scott Royal (RTI), William Rudy (HUD), Ron Stall (University of Pittsburgh), Esther Sumartojo (CDC), David Vos (HUD), Kirk Henny (CDC), Sherri L. Pals (CDC), and Daniel Kidder (CDC).

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Authors and Affiliations

  1. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-37, Atlanta, GA, 30333, USA

    Cari Courtenay-Quirk & Richard J. Wolitski

  2. Business Computer Applications, Atlanta, GA, USA

    Jun Zhang

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  1. Cari Courtenay-Quirk
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  2. Jun Zhang
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  3. Richard J. Wolitski
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Correspondence to Cari Courtenay-Quirk.

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Courtenay-Quirk, C., Zhang, J. & Wolitski, R.J. Intentional Abstinence Among Homeless and Unstably Housed Persons Living with HIV/AIDS. AIDS Behav 13, 1119–1128 (2009). https://doi.org/10.1007/s10461-008-9461-6

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