Journal of Community Health

, Volume 35, Issue 2, pp 115–123 | Cite as

Unsafe Sex Among HIV Positive Individuals: Cross-Sectional and Prospective Predictors

  • Thom Reilly
  • Susan I. Woodruff
  • Laurie Smith
  • John D. Clapp
  • Jerry Cade
Original Paper

Abstract

A follow-up study was conducted on a sample of 120 ethnically diverse HIV positive men and women first interviewed in 2000. Of the 86 survivors, 37 (43%) were able to be contacted 7–8 years later to conduct an exploratory examination of cross-sectional and prospective predictors of unsafe sexual behavior. Predictors that emerged as significant in the two cross-sectional analyses and the prospective analysis tended to be different variables, perhaps underscoring changing needs, perceptions, and behaviors among HIV positive persons over time. The cross-sectional analysis conducted at the baseline time frame showed a considerable number of significant correlates of unsafe sex, including several demographic/background variables. The cross-sectional analysis conducted on data collected 7 years later, on the other hand, showed far fewer significant correlates of unsafe sex, none of which were demographic/background variables, and which tended to be different correlates than those found in the baseline cross-sectional analysis. Significant predictors in the prospective analysis tended to be social support factors. This different pattern of prediction may be important to those designing interventions to influence risky sexual behavior.

Keywords

HIV Predictors Follow-up study Unsafe sex 

References

  1. 1.
    Centers for Disease Control and Prevention. (2008). HIV/AIDS Surveillance Report, 2006 (Vol. 18). Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
  2. 2.
    Crepaz, N., & Marks, G. (2002). Towards an understanding of sexual risk behavior in people living with HIV: A review of social, psychological, and medical findings. AIDS, 16(2), 135–149.CrossRefPubMedGoogle Scholar
  3. 3.
    Semple, S. J., Patterson, T. L., & Grant, I. (2003). HIV-positive gay and bisexual men: Predictors of unsafe sex. AIDS Care, 15(1), 3–15.PubMedGoogle Scholar
  4. 4.
    Siegel, K., Schrimshaw, E., & Lekas, H. (2006). Diminished sexual activity, interest, and feelings of attractiveness among HIV-infected women in two eras of the AIDS epidemic. Archives of Sex Behavior, 35(4), 437–449.CrossRefGoogle Scholar
  5. 5.
    Weinhardt, L. S., Kelly, J. A., Brondino, M. J., et al. (2004). HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 36(5), 1057–1066.Google Scholar
  6. 6.
    Ciccarone, D. H., Kanouse, D. E., Collins, R. L., et al. (2003). Sex without disclosure of positive HIV serostatus in a US probability sample of persons receiving medical care for HIV infection. American Journal of Public Health, 93(6), 949–954.CrossRefPubMedGoogle Scholar
  7. 7.
    Denning, P. H., & Campsmith, M. L. (2005). Unprotected anal intercourse among HIV-positive men who have a steady male sex partner with negative or unknown HIV serostatus. American Journal of Public Health, 95(1), 152–158.CrossRefPubMedGoogle Scholar
  8. 8.
    McGowan, J. P., Shah, S. S., Ganea, C. E., et al. (2004). Risk behavior for transmission of human immunodeficiency virus (HIV) among HIV-seropositive individuals in an urban setting. Clinical Infectious Diseases, 38(1), 122–127.CrossRefPubMedGoogle Scholar
  9. 9.
    Parsons, J. T., Halkitis, P. N., Wolistski, R. J., & Gomez, C. A. (2003). Correlates of sexual risk behaviors among HIV-positive men who have sex with men. AIDS Education and Prevention, 15(5), 383–400.CrossRefPubMedGoogle Scholar
  10. 10.
    Parsons, J. T., Schrimshaw, E. W., Wolitski, R. J., et al. (2005). Sexual harm reduction practices of HIV-seropositive gay and bisexual men: Serosorting, strategic positioning, and withdrawal before ejaculation. AIDS, 19, S13–S25.CrossRefPubMedGoogle Scholar
  11. 11.
    Lynch, V. (2000). HIV/AIDS at year 2000: A sourcebook for social workers. Boston: Allyn & Bacon.Google Scholar
  12. 12.
    Vanable, P. A., McKirnan, D. J., Buchbinder, S. P., et al. (2004). Alcohol use and high-risk sexual behavior among men who have sex with men: The effects of consumption level and partner type. Health Psychology, 23(5), 525–532.CrossRefPubMedGoogle Scholar
  13. 13.
    O’Leary, A., Wolitski, R. J., Remien, R. H., et al. (2005). Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men. AIDS, 19, S67–S75.CrossRefPubMedGoogle Scholar
  14. 14.
    O’Leary, A., Fisher, H. H., Purcell, D. W., Spikes, P. S., & Gomez, C. A. (2007). Correlates of risk patterns and race/ethnicity among HIV-positive men who have sex with men. AIDS and Behavior, 11(5), 706–715.CrossRefPubMedGoogle Scholar
  15. 15.
    Rhodes, S. D., Yee, L. J., & Hergenrather, K. C. (2006). A community-based rapid assessment of HIV behavioural risk disparities within a large sample of gay men in southeastern USA: A comparison of African American, Latino and white men. AIDS Care, 18(8), 1018–1024.CrossRefPubMedGoogle Scholar
  16. 16.
    Koblin, B. A., Chesney, M. A., Husnik, M. J., et al. (2003). High-risk behaviors among men who have sex with men in 6 US cities: Baseline data from the EXPLORE study. American Journal of Public Health, 93(6), 926–932.CrossRefPubMedGoogle Scholar
  17. 17.
    Reilly, T., & Woo, G. (2001). Predictors of high-risk sexual behavior among people living with HIV/AIDS. AIDS and Behavior, 5(3), 205–215.CrossRefGoogle Scholar
  18. 18.
    Tyndall, M. W., Patrick, D., Spittal, P., Li, K., O’Shaughnessy, M. V., & Schechter, M. T. (2002). Risky sexual behaviours among injection drugs users with high HIV prevalence: Implications for STD control. Sexually Transmitted Infections, 78, i170–i175.CrossRefPubMedGoogle Scholar
  19. 19.
    Purcell, D. W., Mizuno, Y., Metsch, L., et al. (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), 659–668.CrossRefGoogle Scholar
  20. 20.
    Stein, J. A., Rothernam-Borus, M., Swendeman, D., & Milburn, N. G. (2005). Predictors of sexual transmission risk behaviors among HIV- positive young men. AIDS Care, 17(4), 433–442.PubMedGoogle Scholar
  21. 21.
    Bimbi, D. S., Nanin, J. E., Parsons, J. T., Vicioso, K. J., Missildine, W., & Frost, D. M. (2006). Assessing gay and bisexual men’s outcome expectancies for sexual risk under the influence of alcohol and drugs. Substance Use and Misuse, 41(5), 643–652.CrossRefPubMedGoogle Scholar
  22. 22.
    Essien, E. J., Meshack, A. F., Peters, R. J., Ogungbade, G. O., & Osemene, N. I. (2005). Strategies to prevent HIV transmission among heterosexual African-American men. BMC Public Health, 5, 3.CrossRefPubMedGoogle Scholar
  23. 23.
    Gorbach, P. M., Galea, J. T., Amani, B., et al. (2004). Don’t ask, don’t tell: Patterns of HIV disclosure among HIV positive men who have sex with men with recent STI practicing high risk behaviour in Los Angeles and Seattle. Sexually Transmitted Infections, 80(6), 512–517.CrossRefPubMedGoogle Scholar
  24. 24.
    Nanin, J. E., & Parsons, J. T. (2006). Club drug use and risky sex among gay and bisexual men in New York City. Journal of Gay and Lesbian Psychotherapy, 10(3), 111–112.CrossRefGoogle Scholar
  25. 25.
    Ostrow, D. E., Fox, K. J., Chmiel, J. S., et al. (2002). Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS, 16(5), 775–780.CrossRefPubMedGoogle Scholar
  26. 26.
    Wolitski, R. J., Parsons, J. T., & Gomez, C. A. (2004). Prevention with HIV-seropositive men who have sex with men. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 37, S101–S109.Google Scholar
  27. 27.
    Knight, K. R., Purcell, D., Dawson-Rose, C., Halkitis, P. N., & Gomez, C. A. (2005). Sexual risk taking among HIV-positive injection drug users: Contexts, characteristics, and implications for prevention. AIDS Education and Prevention, 17, 76–88.CrossRefPubMedGoogle Scholar
  28. 28.
    Cooperman, N. A., Arnsten, J. H., & Klein, R. S. (2007). Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS Education and Prevention, 19(4), 321–333.CrossRefPubMedGoogle Scholar
  29. 29.
    Semple, S. J., Patterson, T. L., & Grant, I. (2004). Psychosocial characteristics and sexual risk behavior of HIV+ men who have anonymous sex partners. Psychology and Health, 19(1), 71–87.CrossRefGoogle Scholar
  30. 30.
    Tun, W., Celentano, D. D., Vlahow, D., & Strathdee, S. A. (2003). Attitudes toward HIV treatments influence unsafe sexual and injection practices among injecting drug users. AIDS, 17(13), 1953–1962.CrossRefPubMedGoogle Scholar
  31. 31.
    Carballo-Dieguez, A. (2001). HIV, barebacking, and gay men’s sexuality, circa 2001. Journal of Sex Education and Therapy, 26(3), 225.Google Scholar
  32. 32.
    Halkitis, P. N., & Parsons, J. T. (2003). Intentional unsafe sex (barebacking) among HIV-positive gay men who seek sexual partners on the internet. AIDS Care, 15(3), 367–378.CrossRefPubMedGoogle Scholar
  33. 33.
    Kalichman, S. C., Weinhardt, L., DiFonzo, K., Austin, J., & Luke, W. (2002). Sensation seeking and alcohol use as markers of sexual transmission risk behavior in HIV-positive men. Annals of Behavioral Medicine, 24(3), 229–235.CrossRefPubMedGoogle Scholar
  34. 34.
    Mausbach, B. T., Semple, S. J., Strathdee, S. A., Zians, J. K., & Patterson, T. L. (2007). Effectiveness of a behavioral intervention for increasing safer sex behaviors in HIV-positive MSM methamphetamine users: Results from the EDGE study. Drug and Alcohol Dependence, 87, 249–257.CrossRefPubMedGoogle Scholar
  35. 35.
    Mimiaga, M. J., Skeer, M., Mayer, K. H., & Safren, S. A. (2008). Study of participation as a social group influencing sexual behaviors in an HIV-prevention trial for men who have sex with men. AIDS Care, 20(3), 346–355.CrossRefPubMedGoogle Scholar
  36. 36.
    Valente, T. W., & Vlahov, D. (2001). Selective risk taking among needle exchange participants: Implications for supplemental interventions. American Journal of Public Health, 91, 406–411.CrossRefPubMedGoogle Scholar
  37. 37.
    Reilly, T., & Woo, G. (2004). Social support and maintenance of safer sex practices among people living with HIV/AIDS. Health and Social Work, 29(2), 97–105.PubMedGoogle Scholar
  38. 38.
    Reilly, T., & Woo, G. (2003). Access to services and maintenance of safer sex practices among people living with HIV/AIDS. Social Work in Health Care, 36(2), 81–93.PubMedGoogle Scholar
  39. 39.
    Kalichman, S. C., & Rompa, D. (1995). Sexually coerced and noncoerced gay and bisexual men: Factors relevant to risk for human immunodeficiency virus (HIV) infection. Journal of Sex Research, 32, 45–50.CrossRefGoogle Scholar
  40. 40.
    Heckman, T., Somlai, A., Peters, J., et al. (1998). Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care, 10(3), 365–375.PubMedCrossRefGoogle Scholar
  41. 41.
    Peterson, J., Coates, T., Catania, J., Middleton, L., Hilliard, B., & Hearst, N. (1992). High-risk sexual behavior and condom use among gay and bisexual African-American men. American Journal of Public Health, 82, 1490–1494.CrossRefPubMedGoogle Scholar
  42. 42.
    Cox, L. (2002). Social support, medication compliance and HIV/AIDS. Social Work in Health Care, 35(1), 425–460.CrossRefPubMedGoogle Scholar
  43. 43.
    Bower, J. E., Kemeny, M. E., Taylor, S. E., & Fahey, J. L. (1998). Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men. Journal of Consulting and Clinical Psychology, 66(6), 979–986.CrossRefPubMedGoogle Scholar
  44. 44.
    Burgoyne, R. W. (2005). Exploring directions of causation between social support and clinical outcome for HIV-positive adults in the context of highly active antiretroviral therapy. AIDS Care, 17(1), 111–124.CrossRefPubMedGoogle Scholar
  45. 45.
    Goodwin, P. J., Leszcz, M., Ennis, M., et al. (2001). The effect of group psychosocial support on survival in metastatic breast cancer. New England Journal of Medicine, 345, 1719–1726.CrossRefPubMedGoogle Scholar
  46. 46.
    Saunders, D., & Burgoyne, R. (2001). Help-seeking patterns in HIV/AIDS outpatients. Social Work in Health Care, 32(3), 65–80.CrossRefPubMedGoogle Scholar
  47. 47.
    Taylor, S. E., & Aspinwall, L. G. (1996). Mediating and moderating processes in psychosocial stress: Appraisal, coping, resistance, and vulnerability. In H. B. Kaplan (Ed.), Psychosocial stress: Perspectives on structure, theory, life-course, and methods (pp. 71–110). San Diego, CA: Academic Press.Google Scholar
  48. 48.
    Turner, H., Peralin, L., & Mullan, J. (1998). Sources and determinants of social support for caregivers of persons with AIDS. Journal of Health and Social Behavior, 39, 137–151.CrossRefPubMedGoogle Scholar
  49. 49.
    Ennett, S. T., Baily, S. L., & Federman, E. B. (1999). Social network characteristics associated with risky behaviors among runaway and homeless youth. Journal of Health and Social Behavior, 40, 63–78.CrossRefPubMedGoogle Scholar
  50. 50.
    Rothenberg, R. B., Woodhouse, D. E., Potterat, J. J., Muth, S. Q., Darrow, W. W., & Klovdahl, A. S. (1995). Social networks in disease transmission: The Colorado Springs Study. NIDA Research Monographs, 151, 3–19.Google Scholar
  51. 51.
    Carey, M., & Lewis, B. (1999). Motivational strategies can enhance HIV risk reduction models. AIDS and Behavior, 3, 269–276.CrossRefPubMedGoogle Scholar
  52. 52.
    Van Kesteren, N. M. C., Hospers, H. J., & Kok, G. (2007). Sexual risk behavior among HIV-positive men who have sex with men: A literature review. Patient Education and Counseling, 65(1), 5–20.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Thom Reilly
    • 1
  • Susan I. Woodruff
    • 1
  • Laurie Smith
    • 2
  • John D. Clapp
    • 1
  • Jerry Cade
    • 3
  1. 1.School of Social WorkSan Diego State UniversitySan DiegoUSA
  2. 2.San Bernardino, Department of Social WorkCalifornia State UniversitySan BernardinoUSA
  3. 3.Touro University School of MedicineUMC Wellness Center/NARESLas VegasUSA

Personalised recommendations