AIDS and Behavior

, Volume 13, Issue 6, pp 1129–1142 | Cite as

Psychosocial Characteristics and Sexual Behaviors of People in Care for HIV Infection: An Examination of Men Who Have Sex with Men, Heterosexual Men and Women

  • Carol Golin
  • Gary Marks
  • Julie Wright
  • Mary Gerkovich
  • Hsiao-Chuan Tien
  • Shilpa N. Patel
  • Lytt Gardner
  • Christine O’Daniels
  • Tracey E. Wilson
  • Mark Thrun
  • Melanie Thompson
  • Stephen Raffanti
  • E. Byrd Quinlivan
Original Paper


Few studies have examined the psychosocial factors associated with sexual transmission behaviors among HIV-positive men who have sex with men (MSM), heterosexual men (MSW) and women. We enrolled 1,050 sexually active HIV-positive patients at seven HIV clinics in six US cities as part of a clinic-based behavioral intervention. We describe the sexual transmission behaviors and examine demographic, clinical, psychosocial, and clinic prevention variables associated with unprotected anal or vaginal intercourse (UAVI). Twenty-three percent of MSM, 12.3% of MSW and 27.8% of women engaged in UAVI with partners perceived to be HIV-negative or of unknown serostatus. Among MSM and MSW, having multiple partners and lower self-efficacy were associated with increased odds of UAVI. Self-rating one’s health status as excellent/very good was a risk factor for UAVI among MSM. Among women, binge drinking and stressful life events were associated with UAVI. These findings identify variables that warrant attention in targeted interventions.


HIV HIV prevention Sexual behavior STDs STD prevention 


  1. 1.
    Hall HI, Song R, Rhodes P, Prejean J, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20:1447–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Kalichman SC. HIV transmission risk behaviors of men and women living with HIV-AIDS: prevalence, predictors and emerging clinical interventions. Clin Psych: Sci Prac. 2000;1:32–47.CrossRefGoogle Scholar
  4. 4.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. 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. J Acquir Immune Defic Syndr. 2005;39:446–53.CrossRefPubMedGoogle Scholar
  5. 5.
    Weinhardt LS, Kelly JA, Brondino MJ, et al. HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States. J Acquir Immune Defic Syndr. 2004;36:1057–66.CrossRefPubMedGoogle Scholar
  6. 6.
    Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. Am J Epidemiol. 1999;150:306–11.PubMedGoogle Scholar
  7. 7.
    van Kesteren NM, Hospers HJ, Kok G. Sexual risk behavior among HIV-positive men who have sex with men: a literature review. Patient Educ Couns. 2007;65:5–20.CrossRefPubMedGoogle Scholar
  8. 8.
    O’Leary A, Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, National Centers for HIV, STE and TB Prevention, The National Institutes of Mental Health Multisite HIV Prevention Trial Group. Health Psych. 2001;20(5):369–376.Google Scholar
  9. 9.
    Crepaz N, Hart T, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA. 2004;292:224–36.CrossRefPubMedGoogle Scholar
  10. 10.
    Morin SF, Myers JJ, Shade SB, Koester K, Maiorana A, Dawson-Rose C. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav. 2007;11:S6–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Courtenay-Quirk C, Pals SL, Colfax G, McKirnan D, Gooden L, Eroğlu D. Factors associated with sexual risk behavior among persons living with HIV: gender and sexual identity group differences. AIDS Behav. 2007;12(5):685–94.CrossRefPubMedGoogle Scholar
  12. 12.
    Aidala AA, Lee G, Garbers S, Chiasson MS. 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 Educ Prev. 2006;18(1):12–32.CrossRefPubMedGoogle Scholar
  13. 13.
    Kalichman SC. Psychological and social correlates of high risk sexual behavior among men and women living HIV/AIDS. AIDS Care. 1999;11(4):415–27.CrossRefPubMedGoogle Scholar
  14. 14.
    Bogart LM, Collins RL, Cunningham W, et al. The association of partner abuse with risky sexual behaviors among women and men with HIV/AIDS. AIDS Behav. 2005;9(3):325–33.CrossRefPubMedGoogle Scholar
  15. 15.
    McGowan JP, Shah SS, Ganea CE, et al. Risk behavior for transmission of human immunodeficiency virus (HIV) among HIV-seropositive individuals in an urban setting. Clin Infect Dis. 2004;38(1):122–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Des Jarlais DC, Paone D, Milliken J, et al. Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: a quasi-randomized trial. Lancet. 1999;353:1657–61.CrossRefPubMedGoogle Scholar
  17. 17.
    Turner CF, Ku L, Rogers SM, Lindberg LD, Pleck JH, Sonenstein FL. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science. 1998;280:867–73.CrossRefPubMedGoogle Scholar
  18. 18.
    Wu AW, Hays RD, Kelly S, Malitz F, Bozzette SA. Applications of the medical outcomes study health-related quality of life measures in HIV/AIDS. Qual Life Res. 1997;6:531–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Chirgwin K, DeHovitz JA, Dillon S, McCormack WM. HIV infection, genital ulcer disease, and crack cocaine use among patients attending a clinic for sexually transmitted diseases. Am J Public Health. 1991;81:1576–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Cornish JW, O’Brien CP. Crack cocaine abuse: an epidemic with many public health consequences. Annu Rev Public Health. 1996;17:259–73.CrossRefPubMedGoogle Scholar
  21. 21.
    Rolfs RT, Goldberg M, Sharrar RG. Risk factors for syphilis: cocaine use and prostitution. Am J Public Health. 1990;80:853–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Chesney MA, Koblin BA, Barresi PJ, et al. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE Study. Am J Public Health. 2003;93:933–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Koblin BA, Chesney MA, Husnik MJ, et al. High-risk behaviors among men who have sex with men in 6 US cities: baseline data from the EXPLORE Study. Am J Public Health. 2003;93:926–32.CrossRefPubMedGoogle Scholar
  24. 24.
    Holmes TH, Rahe RH. Homes-Rahe life changes scale. J Psychosom Res. 1967;11:213–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Cecil H, Pinkerton SD. Reliability and validity of a self-efficacy instrument for protective sexual behaviors. J Am Coll Health. 1998;47:113–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Radloff LS. The CES-D scale: a new self-report depression scale for research in the general population. Appl Psych Meas. 1977;1:385–401.CrossRefGoogle Scholar
  27. 27.
    Bonferroni CE. Teoria statistica delle classi e calcolo delle probability `a. Pubblicazioni del R Instituto Superiore di Scienze Economiche e Commerciali di Firenze. 1936;8:3–62.Google Scholar
  28. 28.
    Fisher JD, Fisher WA, Cornman DH, Amico RK, Bryan A, Friedland GH. Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. J Acquir Immune Defic Syndr. 2006;41:44–52.CrossRefPubMedGoogle Scholar
  29. 29.
    Kozal MJ, Amico KR, Chiarella J, et al. A population-based and longitudinal study of sexual behavior and multidrug-resistant HIV among patients in clinical care. Medscape J Med. 2006;8:72.Google Scholar
  30. 30.
    Richardson JL, Milam J, McCutchan A, et al. Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS. 2004;18:1179–86.CrossRefPubMedGoogle Scholar
  31. 31.
    Morin SF, Steward WT, Charlebois ED, et al. Predicting HIV transmission risk among HIV-infected men who have sex with men: findings from the healthy living project. J Acquir Immune Defic Syndr. 2005;40:226–35.CrossRefPubMedGoogle Scholar
  32. 32.
    Colfax GN, Guzman R, Wheeler S, et al. Beliefs about HIV reinfection (superinfection) and sexual behavior among a diverse sample of HIV-positive men who have sex with men. J Acquir Immune Defic Syndr. 2004;36:990–2.CrossRefPubMedGoogle Scholar
  33. 33.
    Guzman R, Colfax GN, Wheeler S, et al. Negotiated safety relationships and sexual behavior among a diverse sample of HIV-negative men who have sex with men. J Acquir Immune Defic Syndr. 2005;38:82–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Parsons J, Schrimshaw EW, Wolitski RJ, et al. Sexual harm reduction practices of HIV -seropositive gay and bisexual men: serosorting, strategic positioning and withdrawal before ejaculation. AIDS. 2005;19(suppl):S13–25.CrossRefPubMedGoogle Scholar
  35. 35.
    Hoffman S, Jarrett ST, Kelvin EA, et al. HIV and sexually transmitted infection risk behaviors and beliefs among black West Indian immigrants and US-born blacks. Am J Public Health. 2008;98:2042–50.CrossRefPubMedGoogle Scholar
  36. 36.
    Paranjape A, Bernstein L, St George DM, Doyle J, Henderson S, Corbie-Smith G. Effect of relationship factors on safer sex decisions in older inner-city women. J Womens Health. 2006;15:90–7.CrossRefGoogle Scholar
  37. 37.
    Carter PA. Family caregivers’ sleep loss and depression over time. Cancer Nurs. 2003;26:253–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Chesney MA, Chambers DB, Taylor JM, Johnson LM, Folkman S. Coping effectiveness training for men living with HIV: results from a randomized clinical trial testing a group-based intervention. Psychosom Med. 2003;65:1038–46.CrossRefPubMedGoogle Scholar
  39. 39.
    Folkman S, Chesney MA, Pollack L, Phillips C. Stress, coping, and high-risk sexual behavior. Health Psych. 1992;11:218–22.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Carol Golin
    • 1
    • 2
    • 3
    • 4
  • Gary Marks
    • 7
  • Julie Wright
    • 6
  • Mary Gerkovich
    • 6
  • Hsiao-Chuan Tien
    • 4
  • Shilpa N. Patel
    • 3
  • Lytt Gardner
    • 7
  • Christine O’Daniels
    • 7
    • 8
  • Tracey E. Wilson
    • 9
  • Mark Thrun
    • 10
  • Melanie Thompson
    • 11
  • Stephen Raffanti
    • 12
  • E. Byrd Quinlivan
    • 1
    • 4
    • 5
  1. 1.Department of MedicineUNC School of MedicineChapel HillUSA
  2. 2.Department of Health Behavior and Health Education, UNC School of Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.UNC Cecil G. Sheps Center for Health Services ResearchChapel HillUSA
  4. 4.UNC Center for AIDS ResearchChapel HillUSA
  5. 5.UNC Center for Infectious DiseasesChapel HillUSA
  6. 6.School of Medicine University of Missouri-Kansas CityKansas CityUSA
  7. 7.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  8. 8.McKing Consulting CorporationAtlantaUSA
  9. 9.Department of Preventive Medicine and Community HealthState University of New York, Downstate Medical CenterBinghamtonUSA
  10. 10.Denver Public HealthDenverUSA
  11. 11.AIDS Research Consortium of AtlantaAtlantaUSA
  12. 12.Vanderbilt University Medical CenterNashvilleUSA

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