Archives of Sexual Behavior

, Volume 44, Issue 2, pp 357–365 | Cite as

Unprotected Sexual Practices Among Men Who Have Sex with Women and Men Who Have Sex with Men Living with HIV/AIDS in Rio de Janeiro

  • Renata Siqueira Julio
  • Ruth Khalili Friedman
  • Cynthia B. Cunha
  • Raquel Brandini De Boni
  • Sandra Wagner Cardoso
  • Thiago Torres
  • Carla Almeida Alves
  • Cristiane Castro
  • Nilo Martinez Fernandes
  • Valdilea G. Veloso
  • Beatriz Grinsztejn
Original Paper

Abstract

Combined antiretroviral therapy is now acknowledged for preventing new HIV infections, besides decreasing mortality and morbidity. However, in many Latin America countries the epidemic is still driven by unprotected sexual intercourse. This study aims to describe sexual practices related to HIV/STD and to evaluate factors associated to unprotected sex among men who have sex with women (MSW) and men who have sex with men (MSM) under care at a reference center for HIV in Rio de Janeiro, Brazil. A cross-sectional study, nested in a Brazilian clinical cohort, evaluated the sexual practices of 404 sexually active HIV-positive MSW and men who have MSM. Approximately 30 % of them reported unprotected sexual practices during the 6 months prior to the interview. Most frequent risky practices reported were unprotected vaginal sex among MSW and unprotected receptive anal sex among MSM. Factors increasing the chance of unprotected sexual practices among MSW were the partner’s desire of becoming pregnant (OR 2.81; CI 95 %: 1.36–5.95). To have received comments about excessive consumption of alcohol (OR 2.43; CI 95 %: 1.01–5.83), illicit drug use (OR 4.41; CI 95 %: 1.75–11.60) and lived in marital situation (OR 2.10; CI 95 %: 1.09–4.08) were significantly associated with unsafe sexual practices among MSM. The results highlight that health care of men living with HIV, as well as the prevention strategies, must consider the particularities of sexual behavior practiced by people who differ in sexual orientation.

Keywords

HIV/AIDS Unprotected sexual behavior MSM MSW 

References

  1. Aidala, A. A., Lee, G., Howard, J. M., Caban, M., Abramson, D., & Messeri, P. (2006). HIV-positive men sexually active with women: Sexual behaviors and sexual risks. Journal of Urban Health, 83(4), 637–655. doi: 10.1007/s11524-006-9074-1.PubMedCentralCrossRefPubMedGoogle Scholar
  2. Baggaley, R. F., White, R. G., & Boily, M.-C. (2010). HIV transmission risk through anal intercourse: Systematic review, meta-analysis and implications for HIV prevention. International Journal of Epidemiology, 39(4), 1048–1063. doi: 10.1093/ije/dyq057.PubMedCentralCrossRefPubMedGoogle Scholar
  3. Baral, S. D., Poteat, T., Strömdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. The Lancet Infectious Diseases, 13(3), 214–222. doi: 10.1016/S1473-3099(12)70315-8.CrossRefPubMedGoogle Scholar
  4. Barbosa Junior, A., Szwarcwald, C. L., Pascom, A., & Souza Jr., P. (2009). Tendências da epidemia de AIDS entre subgrupos sob maior risco no Brasil, 1980-2004. Cad.Saúde Pública, 25(4), 727–737.Google Scholar
  5. Benn, P., Fisher, M., & Kulasegaram, R. (2011). UK guideline for the use of post-exposure prophylaxis for HIV following sexual exposure (2011). International Journal of STD and AIDS, 22(12), 695–708. doi: 10.1258/ijsa.2011.171011.CrossRefPubMedGoogle Scholar
  6. Benotsch, E. G., Kalichman, S. C., & Pinkerton, S. D. (2001). Sexual compulsivity in HIV-positive men and women: Prevalence, predictors, and consequences of high-risk behaviors. Sexual Addiction and Compulsivity, 8, 83–99. doi: 10.1080/10720160127561.CrossRefGoogle Scholar
  7. Beyrer, C., Sullivan, P. S., Sanchez, J., Dowdy, D., Altman, D., Trapence, G., … Mayer, K. H. (2012). A call to action for comprehensive HIV services for men who have sex with men. Lancet, 380(9839), 424–438. doi: 10.1016/S0140-6736(12)61022-8.PubMedCentralCrossRefPubMedGoogle Scholar
  8. Beyrer, C., Trapence, G., Motimedi, F., Umar, E., Iipinge, S., Dausab, F., … Baral, S. (2010). Bisexual concurrency, bisexual partnerships, and HIV among southern African men who have sex with men. Sexually Transmitted Infections, 86, 323–327. doi: 10.1136/sti.2009.040162.CrossRefPubMedGoogle Scholar
  9. Bruce, D., Kahana, S., Harper, G. W., Fernández, M. I., & The ATN. (2013). Alcohol use predicts sexual risk behavior with HIV-negative or partners of unknown status among young HIV-positive men who have sex with men. AIDS Care, 25(5), 559–565. doi: 10.1080/09540121.2012.720363.PubMedCentralCrossRefPubMedGoogle Scholar
  10. Chin-Hong, P. V., Deeks, S. G., Liegler, T., Hagos, E., Krone, M. R., Grant, R. M., … Martin, J. N. (2005). High-risk sexual behavior in adults with genotypically proven antiretroviral-resistant HIV infection. Journal of Acquired Immune Deficiency Syndromes, 40(4), 463–471.CrossRefPubMedGoogle Scholar
  11. Clark, J., Salvatierra, J., Segura, E., Salazar, X., Konda, K., Perez-Brumer, A., … Coates, T. (2013). Moderno love: Sexual role-based identities and HIV/STI prevention among men who have sex with men in Lima, Peru. AIDS and Behavior, 17(4), 1313–1328. doi: 10.1007/s10461-012-0210-5.PubMedCentralCrossRefPubMedGoogle Scholar
  12. Cohen, M., Chen, Y., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy, N., … HPTN 052 Study Team. (2011). Prevention of HIV-1 Infection with early antiretroviral therapy. New England Journal of Medicine, 365, 493–505. doi:  10.1056/NEJMoa1105243.
  13. Courtenay-Quirk, C., Pals, S. L., Colfax, G., McKirnan, D., Gooden, L., & Eroğlu, D. (2008). Factors associated with sexual risk behavior among persons living with HIV: Gender and sexual identity group differences. AIDS and Behavior, 12(5), 685–694. doi: 10.1007/s10461-007-9259-y.CrossRefPubMedGoogle Scholar
  14. Crepaz, N., Marks, G., Liau, A., Mullins, M. M., Aupont, L. W., Marshall, K. J., … Wolitski, R. J. (2009). Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: A meta-analysis. AIDS, 23(13), 1617–1629. doi: 10.1097/QAD.0b013e32832effae.CrossRefPubMedGoogle Scholar
  15. De Boni, R. B., Veloso, V., & Grinsztejn, B. (2014). The epidemiology of HIV in Latin America and the Caribbean. Current Opinion in HIV and AIDS, 9(2), 192–198. doi: 10.1097/COH.0000000000000031.CrossRefPubMedGoogle Scholar
  16. De Castro, C. A. V., Grinsztejn, B., Veloso, V. G., Bastos, F. I., Pilotto, J. H., & Morgado, M. G. (2010). Prevalence, estimated HIV-1 incidence and viral diversity among people seeking voluntary counseling and testing services in Rio de Janeiro, Brazil. BMC Infectious Diseases, 10, 224. doi: 10.1186/1471-2334-10-224.PubMedCentralCrossRefPubMedGoogle Scholar
  17. Delvaux, T., & Nöstlinger, C. (2007). Reproductive choice for women and men living with HIV: Contraception, abortion and fertility. Reproductive Health Matters, 15(29 Suppl), 46–66. doi: 10.1016/S0968-8080(07)29031-7.CrossRefPubMedGoogle Scholar
  18. Desquilbet, L., Deveau, C., Goujard, C., Hubert, J.-B., Derouineau, J., & Meyer, L. (2002). Increase in at-risk sexual behaviour among HIV-1-infected patients followed in the French PRIMO cohort. AIDS, 16(17), 2329–2333.CrossRefPubMedGoogle Scholar
  19. Dodge, B., Schnarrs, P. W., Reece, M., Martinez, O., Goncalves, G., Malebranche, D., … Fortenberry, J. D. (2013). Sexual behaviors and experiences among behaviorally bisexual men in the midwestern United States. Archives of Sexual Behavior, 42(2), 247–256. doi: 10.1007/s10508-011-9878-2.
  20. Durham, M. D., Buchacz, K., Richardson, J., Yang, D., Wood, K., Yangco, B., … Brooks, J. T. (2013). Sexual risk behavior and viremia among men who have sex with men in the HIV Outpatient Study (HOPS), USA, 2007–2010. Journal of Acquired Immune Deficiency Syndromes, 63, 372–378. doi: 10.1097/QAI.0b013e31828c20d8.CrossRefPubMedGoogle Scholar
  21. Eisele, T. P., Mathews, C., Chopra, M., Brown, L., Silvestre, E., Daries, V., … Kendall, C. (2008). High levels of risk behavior among people living with HIV Initiating and waiting to start antiretroviral therapy in Cape Town South Africa. AIDS and Behavior, 12(4), 570–577. doi: 10.1007/s10461-007-9279-7.CrossRefPubMedGoogle Scholar
  22. Fisher, J., Smith, L., & Lenz, E. (2010). Secondary prevention of HIV in the United States: Past, current and future perspectives. Journal of Acquired Immune Deficiency Syndromes, 55(Suppl 2), S106–S115. doi: 10.1097/QAI.0b013e3181fbca2f.Secondary.PubMedCentralCrossRefPubMedGoogle Scholar
  23. Glick, S. N., Morris, M., Foxman, B., Aral, S. O., Manhart, L. E., Holmes, K. K., … Golden, M. R. (2012). A comparison of sexual behavior among men who have sex with men and heterosexual men and women. Journal of Acquired Immune Deficiency Syndromes, 60(1), 83–90. doi: 10.1097/QAI.0b013e318247925e.A.PubMedCentralCrossRefPubMedGoogle Scholar
  24. Golin, C., Marks, G., Wright, J., Gerkovich, M., Tien, H.-C., Patel, S. N., … Quinlivan E. B. (2009). 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. AIDS and Behavior, 13(6), 1129–1142. doi: 10.1007/s10461-009-9613-3.PubMedCentralCrossRefPubMedGoogle Scholar
  25. Grinsztejn, B., Veloso, V., Friedman, R., Moreira, R., Luz, P., Campos, D., … Moore, R. (2009). Early mortality and cause of deaths in patients using HAART in Brazil and the United States. AIDS, 23(16), 107–114. doi: 10.1097/QAD.0b013e32832ec494.CrossRefGoogle Scholar
  26. Grov, C., Parsons, J. T., & Bimbi, D. S. (2010). Sexual compulsivity and sexual risk in gay and bisexual men. Archives of Sexual Behavior, 39(4), 940–949. doi: 10.1007/s10508-009-9483-9.PubMedCentralCrossRefPubMedGoogle Scholar
  27. Guimarães, M. D. C., Grinsztejn, B., Chin-Hong, P. V., Campos, L. N., Gomes, V. R., Melo, V. H., … Palefsky, J. M. (2008). Behavior surveillance: Prevalence and factors associated with high-risk sexual behavior among HIV-infected men in Brazil in the post-HAART era. AIDS and Behavior, 12(5), 741–747. doi: 10.1007/s10461-008-9407-z.CrossRefPubMedGoogle Scholar
  28. Halkitis, P. N., Kapadia, F., Siconolfi, D. E., Moeller, R. W., Figueroa, R. P., Barton, S. C., … Blachman-Forshay, J. (2013). Individual, psychosocial, and social correlates of unprotected anal intercourse in a new generation of young men who have sex with men in New York City. American Journal of Public Health, 103(5), 889–895. doi: 10.2105/AJPH.2012.300963.PubMedCentralCrossRefPubMedGoogle Scholar
  29. Hart, G. J., & Williamson, L. M. (2005). Increase in HIV sexual risk behaviour in homosexual men in Scotland, 1996–2002: Prevention failure? Sexually Transmitted Infections, 81(5), 367–372. doi: 10.1136/sti.2004.013995.PubMedCentralCrossRefPubMedGoogle Scholar
  30. Kelly, B. C., Bimbi, D. S., Nanin, J. E., Izienicki, H., & Parsons, J. T. (2009). Sexual compulsivity and sexual behaviors among gay and bisexual men and lesbian and bisexual women. Journal of Sex Research, 46(4), 301–308. doi: 10.1080/00224490802666225.
  31. Kerani, R. P., Handsfield, H. H., Stenger, M. S., Shafii, T., Zick, E., Brewer, D., … Golden, M. R. (2007). Rising rates of syphilis in the era of syphilis elimination. Sexually Transmitted Diseases, 34(3), 154–161. doi: 10.1097/01.olq.0000233709.93891.e5.CrossRefPubMedGoogle Scholar
  32. Lim, S. H., Ostrow, D., Stall, R., Chmiel, J., Herrick, A., Shoptaw, S., … Plankey, M. (2012). Changes in stimulant drug use over time in the MACS: Evidence for resilience against stimulant drug use among men who have sex with men. AIDS and Behavior, 16(1), 151–158. doi: 10.1007/s10461-010-9866-x.PubMedCentralCrossRefPubMedGoogle Scholar
  33. Liu, A. Y., Kittredge, P. V., Vittinghoff, E., Raymond, H. F., Ahrens, K., Matheson, T., …Buchbinder S. P. (2008). Limited knowledge and use of HIV post- and pre-exposure prophylaxis among gay and bisexual men. Journal of Acquired Immune Deficiency Syndromes, 47(2), 241–247.CrossRefPubMedGoogle Scholar
  34. Malta, M., Magnanini, M. M. F., Mello, M. B., Pascom, A. R. P., Linhares, Y., & Bastos, F. I. (2010). HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A systematic review and meta-analysis. BMC Public Health, 10, 317. doi: 10.1186/1471-2458-10-317.PubMedCentralCrossRefPubMedGoogle Scholar
  35. Mansergh, G., Flores, S., Koblin, B., Hudson, S., McKirnan, D., & Colfax, G. N. (2008). Alcohol and drug use in the context of anal sex and other factors associated with sexually transmitted infections: Results from a multi-city study of high-risk men who have sex with men in the USA. Sexually Transmitted Infections, 84(6), 509–511. doi: 10.1136/sti.2008.031807.CrossRefPubMedGoogle Scholar
  36. Marks, G., Ruiz, M. S., Richardson, J. L., Reed, D., Mason, H. R., Sotelo, M., … Turner, P. A. (1994). Anal intercourse and disclosure of HIV infection among seropositive gay and bisexual men. Journal of Acquired Immune Deficiency Syndromes, 7(8), 866–869.PubMedGoogle Scholar
  37. Mayer, K. H. (2011). Sexually transmitted diseases in men who have sex with men. Clinical Infectious Diseases, 53(Suppl 3), S79–S83. doi: 10.1093/cid/cir696.
  38. Mayer, K., Wang, L., Hoffman, I., McCauley, A., Li, X., Safren, S., … Cohen, M. (2013). Sustained treatment as prevention: continued decreases in unprotected sex and increases in virological suppression after HAART initiation among participants in HPTN 052. In 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lampur: IAS.Google Scholar
  39. Mimiaga, M. J., Case, P., Johnson, C. V., Safren, S. A., & Mayer, K. H. (2009). Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: Limited knowledge and experience but potential for increased utilization after education. Journal of Acquired Immune Deficiency Syndromes, 50(1), 77–83. doi: 10.1097/QAI.0b013e31818d5a27.PubMedCentralCrossRefPubMedGoogle Scholar
  40. Ministério da Saude Brasil. (2012). Boletim Epidemiologico de AIDS/DST. Brasilia.Google Scholar
  41. Mocroft, A., Ledergerber, B., Katlama, C., Kirk, O., Reiss, P., d’Arminio Monforte, A., … Lundgren J. D. (2003). Decline in the AIDS and death rates in the EuroSIDA study: An observational study. Lancet, 362(9377), 22–29.CrossRefPubMedGoogle Scholar
  42. Morin, S. F., Myers, J. J., Shade, S. B., Koester, K., Maiorana, A., & Rose, C. D. (2007). Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS and Behavior, 11(5 Suppl), S6–S16. doi: 10.1007/s10461-007-9253-4.CrossRefPubMedGoogle Scholar
  43. New York State Department of Health AIDS Institute. (2013). HIV prophylaxis following non-occupational exposure. New York. Retrieved from http://www.hivguidelines.org/wp-content/uploads/2013/09/hiv-prophylaxis-following-non-occupational-exposure.pdf.
  44. Page-Shafer, K., Shiboski, C., Osmond, D., Dilley, J., McFarland, W., Shiboski, S., … Greenspan, J. (2002). Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men. AIDS, 16, 2350–2352.CrossRefPubMedGoogle Scholar
  45. Parsons, J. T., Kutnick, A. H., Halkitis, P. N., Punzalan, J. C., & Carbonari, J. P. (2005). Sexual risk behaviors and substance use among alcohol abusing HIV-positive men who have sex with men. Journal of Psychoactive Drugs, 37(1), 27–36.PubMedCentralCrossRefPubMedGoogle Scholar
  46. Purcell, D. W., Mizuno, Y., Metsch, L. R., Garfein, R., Tobin, K., Knight, K., … Latka, M. H. (2006). Unprotected sexual behavior among heterosexual HIV-positive injection drug using men: Associations by partner type and partner serostatus. Journal of Urban Health, 83(4), 656–668. doi: 10.1007/s11524-006-9066-1.PubMedCentralCrossRefPubMedGoogle Scholar
  47. Rocha, G. M., Kerr, L. R. F. S., de Brito, A. M., Dourado, I., & Guimarães, M. D. C. (2013). Unprotected receptive anal intercourse among men who have sex with men in Brazil. AIDS and Behavior, 27(3), 427–435. doi: 10.1097/QAD.0b013e32835ad504.Google Scholar
  48. Sander, P. M., Cole, S. R., Stall, R. D., Jacobson, L. P., Eron, J. J., Napravnik, S., … Ostrow D. G. (2013). Joint effects of alcohol consumption and high-risk sexual behavior on HIV seroconversion among men who have sex with men. AIDS, 27(5), 815–823. doi: 10.1097/QAD.0b013e32835cff4b.PubMedCentralCrossRefPubMedGoogle Scholar
  49. Scanavino, M. de T. (2011). Sexual dysfunctions of HIV-positive men: Associated factors, pathophysiology issues, and clinical management. Advances in Urology. doi: 10.1155/2011/854792.
  50. Scanavino, M. de. T., Ventuneac, A., Abdo, C. H. N., Tavares, H., do Amaral, M. L. S., Messina, B., … Parsons, J. T. (2013). Compulsive sexual behavior and psychopathology among treatment-seeking men in São Paulo, Brazil. Psychiatry Research, 209(3), 518–524. doi: 10.1016/j.psychres.2013.01.021.
  51. Schmidt, M. I., Duncan, B. B., Azevedo e Silva, G., Menezes, A. M., Monteiro, C. A., Barreto, S. M., … Menezes, P. R. (2011). Chronic non-communicable diseases in Brazil: Burden and current challenges. Lancet, 377(9781), 1949–1961. doi: 10.1016/S0140-6736(11)60135-9.
  52. Semple, S. J., Strathdee, S. A., Zians, J., & Patterson, T. L. (2011). Methamphetamine-using parents: The relationship between parental role strain and depressive symptoms. Journal of Studies on Alcohol and Drugs, 72(6), 954–964.PubMedCentralCrossRefPubMedGoogle Scholar
  53. Seng, R., Rolland, M., Beck-Wirth, G., Souala, F., Deveau, C., Delfraissy, J.-F., … Meyer, L. (2011). Trends in unsafe sex and influence of viral load among patients followed since primary HIV infection, 2000–2009. AIDS, 25(7), 977–988. doi: 10.1097/QAD.0b013e328345ef12.CrossRefPubMedGoogle Scholar
  54. Smith, D., Grohskopf, L., Black, R., Auerbach, J., Veronese, F., Struble, K., … Greenberg, A. (2005). Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: Recommendations from the U.S. Department of Health and Human Services. MMWR, 54(RR-2), pp. 1–20.Google Scholar
  55. Stolte, I. G., de Wit, J. B. F., van Eeden, A., Coutinho, R. A., & Dukers, N. H. T. M. (2004). Perceived viral load, but not actual HIV-1-RNA load, is associated with sexual risk behaviour among HIV-infected homosexual men. AIDS, 18(14), 1943–1949.CrossRefPubMedGoogle Scholar
  56. UNAIDS. (2013). Global report: UNAIDS report on the global AIDS epidemic. Geneva: Author.Google Scholar
  57. Van de Ven, P., Kippax, S., Knox, S., Prestage, G., & Crawford, J. (1999). HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne. AIDS, 13(16), 2289–2294.CrossRefPubMedGoogle Scholar
  58. Varghese, B., Maher, J. E., Peterman, T. A., Branson, B. M., & Steketee, R. W. (2002). Reducing the risk of sexual HIV transmission: Quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sexually Transmitted Diseases, 29(1), 38–43.Google Scholar
  59. Wolitiski, R., Bailey, C., O’Leary, A., Gomez, C., & Parsons, J. (2003). Self-perceived responsibility of HIV-seropositive men who have sex with men for preventing HIV transmission. AIDS and Behavior, 7(4), 363–372.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Renata Siqueira Julio
    • 1
  • Ruth Khalili Friedman
    • 2
  • Cynthia B. Cunha
    • 2
  • Raquel Brandini De Boni
    • 2
  • Sandra Wagner Cardoso
    • 2
  • Thiago Torres
    • 2
  • Carla Almeida Alves
    • 2
  • Cristiane Castro
    • 2
  • Nilo Martinez Fernandes
    • 2
  • Valdilea G. Veloso
    • 2
  • Beatriz Grinsztejn
    • 2
  1. 1.Superintendência Regional de Saúde de Varginha/Centro Universitário do Sul de MinasVarginhaBrazil
  2. 2.Instituto de Pesquisa Clínica Evandro Chagas/FIOCRUZRio de JaneiroBrazil

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