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Accuracy of HIV Risk Perceptions Among Episodic Substance-Using Men Who Have Sex with Men

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Abstract

Using the HIV Incident Risk Index for men who have sex with men—an objective and validated measure of risk for HIV acquisition, and self-perceptions of belief and worry about acquiring HIV, we identified individuals who underestimated substantial risk for HIV. Data from a racially/ethnically diverse cohort of 324 HIV-negative episodic substance-using men who have sex with men (SUMSM) enrolled in a behavioral risk reduction intervention (2010–2012) were analyzed. Two hundred and fourteen (66%) SUMSM at substantial risk for HIV were identified, of whom 147 (69%, or 45% of the total sample) underestimated their risk. In multivariable regression analyses, compared to others in the cohort, SUMSM who underestimated their substantial risk were more likely to report: a recent sexually transmitted infection diagnosis, experiencing greater social isolation, and exchanging sex for drugs, money, or other goods. An objective risk screener can be valuable to providers in identifying and discussing with SUMSM factors associated with substantial HIV risk, particularly those who may not recognize their risk.

Resumen

Este estudio utilizó el índice de riesgo de incidentes de VIH para hombres que tienen sexo con hombres (HIRI-HSH)—una medida objetiva y validada de riesgo para la adquisición del VIH–y autopercepción de creencia y preocupación de contraer el VIH para identificar individuos que subestimaron su riesgo substancial para el VIH. Se analizaron los datos de un cohorte de diversidad racial/étnica de 324 HSH, VIH-negativos usadores de sustancias de forma episódica (por sus siglas en inglés, SUMSM) inscritos en una intervención de reducción de riesgo del comportamiento (2010-2012). Dos ciento catorce (66%) se identificaron SUMSM con substancial riesgo de VIH, de los cuales 147 (69% o 45% de la muestra total) subestima el riesgo. En el análisis multivariado de regresión, en comparación con el resto del cohorte, los SUMSM más propensos fueron los que subestimaron su riesgo sustancial: una reciente transmisión diagnóstico de infección, experimentando mayor aislamiento social y el intercambio de sexo por drogas, dinero ni otros cosas. La medida objetiva de riesgo para la adquisición de VIH, puede ser una herramienta valiosa para ayudar a los proveedores identificar e iniciar conversaciones con SUMSM sobre los factores importantes asociados con riesgo de VIH, particularmente para aquellos que no pueden reconocer conductas de riesgo.

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References

  1. Centers for Disease Control and Prevention. CDC Factsheet: Trends in HIV diagnosis 2005–2014. http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/hiv-data-trends-fact-sheet-508.pdf. Published February 2016. Accessed March 1, 2016.

  2. Beyrer C, Baral SD, Collins C, et al. The global response to HIV in men who have sex with men. Lancet. 2016;388(10040):198–206.

    Article  PubMed  Google Scholar 

  3. Smith DK, Pals SL, Herbst JH, Shinde S, Carey JW. Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2012;60(4):421–7.

    Article  PubMed  Google Scholar 

  4. MacKellar DA, Valleroy LA, Secura GM, Young Men’s Survey Study Group, et al. Perceptions of lifetime risk and actual risk for acquiring HIV among young men who have sex with men. AIDS Behav. 2007;11(2):263–70.

    Article  PubMed  Google Scholar 

  5. Maloney KM, Krakower DS, Ziobro, et al. Culturally competent sexual healthcare as a prerequisite for obtaining preexposure prophylaxis. LBGT Health. 2017.

  6. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.

    Article  PubMed  CAS  Google Scholar 

  7. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390–5.

    Article  PubMed  CAS  Google Scholar 

  8. Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q. 1984;11(1):1–47.

    Article  PubMed  CAS  Google Scholar 

  9. Fishbein M, Ajzen I. Theory-based behavior change interventions: comments on Hobbis and Sutton. J Health Psychol. 2005;10(1):27–31; discussion 37–43.

    Article  PubMed  Google Scholar 

  10. Coffin PO, Santos GM, Colfax G, et al. Adapted personalized cognitive counseling for episodic substance-using men who have sex with men: a randomized controlled trial. AIDS Behav. 2014;18(7):1390–400.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Colfax G, Vittinghoff E, Husnik MJ, et al. Substance use and sexual risk: a participant- and episode-level analysis among a cohort of men who have sex with men. Am J Epidemiol. 2004;159(10):1002–12.

    Article  PubMed  Google Scholar 

  12. Lewinsohn PM, Seeley JR, Roberts RE, Allen NB. Center for Epidemiological Studies-Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging. 1997;12:277–87.

    Article  PubMed  CAS  Google Scholar 

  13. Díaz RM, Ayala G, Bein E, Henne J, Marin BV. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health. 2001;91(6):927–32.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Díaz RM, Ayala G, Bein E. Sexual risk as an outcome of social oppression: data from a probability sample of Latino gay men in three US cities. Cult Divers Ethnic Minor Psychol. 2004;10(3):255–67.

    Article  Google Scholar 

  15. Oldenburg CE, Perez-Brumer AG, Reisner SL, et al. Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis. PLoS ONE. 2014;9(7):e103549.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Nerlander ML, Hess KL, Sionean C, et al. Exchange sex and HIV infection among men who have sex with men: 20 US cities, 2011. AIDS Behav. 2017;21(8):2283–94.

    Article  PubMed Central  Google Scholar 

  17. Gossop M, Darke S, Griffiths P, et al. The severity of dependence scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction. 1995;90(5):607–14.

    Article  PubMed  CAS  Google Scholar 

  18. Hoenigl M, Anderson CM, Green N, Mehta SR, Smith DM, Little SJ. Repeat HIV-testing is associated with an increase in behavioral risk among men who have sex with men: a cohort study. BMC Med. 2015;13:218.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kowalewski MR, Henson KD, Longshore D. Rethinking perceived risk and health behavior: a critical review of HIV prevention research. Health Educ Behav. 1997;24(3):313–25.

    Article  PubMed  CAS  Google Scholar 

  20. Oertelt-Prigione S, Seeland U, Kendel F, et al. Cardiovascular risk factor distribution and subjective risk estimation in urban women; The BEFRI Study: a randomized cross-sectional study. BMC Med. 2015;13:52.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Leaity S, Sherr L, Wells H, et al. Repeat HIV testing: high-risk behaviour or risk reduction strategy? AIDS. 2000;14(5):547–52.

    Article  PubMed  CAS  Google Scholar 

  22. Norton J, Elford J, Sherr L, Miller R, Johnson MA. Repeat HIV testers at a London same-day testing clinic. AIDS. 1997;11(6):773–81.

    PubMed  CAS  Google Scholar 

  23. Katz DA, Dombrowski JC, Bell TR, et al. HIV incidence among men who have sex with men following diagnosis with sexually transmitted infections. Sex Transm Dis. 2016;43(4):249–54.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pathelo P, Braunstein SL, Blank S, Schillinger JA. HIV incidence among men with and those without sexually transmitted rectal infections: estimates from matching against an HIV case registry. Clin Infect Dis. 2013;57(8):1203–9.

    Article  Google Scholar 

  25. Bernstein KT, Marcus JL, Nierri G, Philip SS, Klausner JD. Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion. JAIDS. 2010;52(4):527–43.

    Google Scholar 

  26. Festinger LA. Theory of cognitive dissonance. Stanford: Stanford University Press; 1957.

    Google Scholar 

  27. Ankomah A, Omoregie G, Akinyemi Z, Anyanti J, Ladipo O, Adebayo S. HIV-related risk perception among female sex workers in Nigeria. HIV/AIDS-Pallative Care. 2011;3:93–100.

    Article  Google Scholar 

  28. Whittle HJ, Palar K, Napoles T, et al. Experiences with food insecurity and risky sex among low-income people living with HIV/AIDS in a resource-rich setting. J Int AIDS Soc. 2015;18:20293.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Bekalu MA, Eggermont S, Viswanath KV. HIV/AIDS communication inequalities and associated cognitive and affective outcomes: a call for a socioecological approach to AIDS communication in Sub-saharan Africa. Health Commun. 2016;1:1–10.

    Google Scholar 

  30. Kontos EZ, Emmons KM, Puleo E, Viswanath K. Determinants and beliefs of health information mavens among a lower-socioeconomic position and minority population. Soc Sci Med. 2011;73(1):22–32.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hart T, Peterson JL. Predictors of risky sexual behavior among young African American men who have sex with men. Am J Public Health. 2004;94:1122–4.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Peterson JL, Rothenberg R, Kraft JM, Beeker C. Trotter R Perceived condom norms and HIV risks among social and sexual networks of young African American men who have sex with men. Health Educ Res. 2009;24(1):119–27.

    Article  PubMed  CAS  Google Scholar 

  33. Lewis MA, Litt DM, Cronce JM, Blayney JA, Gilmore AK. Underestimating protection and overestimating risk: examining descriptive normative perceptions and their association with drinking and sexual behaviors. J Sex Res. 2014;51(1):86–96.

    Article  PubMed  Google Scholar 

  34. Wilton J, Kain T, Fowler S, et al. Use of an HIV-risk screening tool to identify optimal candidates for PrEP scale-up among men who have sex with men in Toronto, Canada: disconnect between objective and subjective HIV risk. J Int AIDS Soc. 2016;2016(19):20777.

    Article  Google Scholar 

  35. Kesler MA, Kaul R, Myers T, et al. Perceived HIV risk, actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto, Canada. AIDS Care. 2016;28(11):1378–85.

    Article  PubMed  Google Scholar 

  36. Ross EL, Cinti SK, Hutton DW. Implementation and operational research: a cost-effective, clinically actionable strategy for targeting hiv preexposure prophylaxis to high-risk men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(3):e61–7.

    Article  PubMed  Google Scholar 

  37. Buchbinder SP, Glidden DV, Liu AY, et al. HIV pre-exposure prophylaxis in men who have sex with men and transgender women: a secondary analysis of a phase 3 randomized controlled efficacy trial. Lancet Infect Dis. 2014;14(6):468–75.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Kessler J, Myers JE, Nucifora KA, et al. Evaluating the impact of prioritization of antiretroviral pre-exposure prophylaxis in New York City. AIDS. 2014;28(18):2683–91.

    Article  PubMed  CAS  Google Scholar 

  40. Paltiel AD, Freedberg FA, Scoot CA, et al. HIV preexposure prophylaxis in the United States: impact on lifetime infection risk, clinical outcomes, and cost-effectiveness. Clin Infect Dis. 2009;48(6):806–15.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Schneider K, Gray RT, Wilson DP. A cost-effectiveness analysis of HIV preexposure prophylaxis for men who have sex with men in Australia. Clin Infect Dis. 2014;58(7):1027–34.

    Article  PubMed  Google Scholar 

  42. Herbst JH, Raiford JL, Carry MG, et al. Adaptation and national dissemination of a brief, evidence-based, HIV prevention intervention for high-risk men who have sex with men. MMWR Suppl. 2016;65(1):42–50.

    Article  PubMed  Google Scholar 

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Acknowledgements

The study was supported by the Centers for Disease Control and Prevention under cooperative agreement UR6PS000684 to Public Health Foundation Enterprises, City of Industry, California. We acknowledge all of the study participants who volunteered for this Project, Project ECHO facilitators and staff (Milo-Glen Santos, Erin Antunez, Reggie Gage, Alic Shook, Rand Dadasovich, Shannon Huffaker, Deirdre Santos and Kelly R. Knight), the recruitment coordinator, John Farley, and field recruitment team. The first author would also like to acknowledge Dr. Donna McCree and the ORISE Communities of Color Fellowship Program and colleagues Iddrisu Abdallah and Jeffry S. Becasen for their support.

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Author notes

  1. Jeffrey H. Herbst

    Present address: Division of Violence Prevention, CDC, Atlanta, GA, USA

Authors and Affiliations

  1. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE, Mailstop E-40, Atlanta, GA, 30333, USA

    Grace (Chela) Hall, Linda J. Koenig, Simone C. Gray, Jeffrey H. Herbst & Jerris Raiford

  2. Public Health Foundation Enterprises (San Francisco Department of Public Health AIDS Office), San Francisco, CA, USA

    Tim Matheson

  3. San Francisco Department of Public Health, Division of HIV/AIDS, University of California San Francisco, San Francisco, CA, USA

    Phillip Coffin

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  1. Grace (Chela) Hall
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  2. Linda J. Koenig
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  4. Jeffrey H. Herbst
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Correspondence to Grace (Chela) Hall.

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Funding

The study was supported by the Centers for Disease Control and Prevention under cooperative agreement UR6PS000684.

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Centers for Disease Control and Prevention and the University of California San Francisco (UCSF) committee on Human Research and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Hall, G.(., Koenig, L.J., Gray, S.C. et al. Accuracy of HIV Risk Perceptions Among Episodic Substance-Using Men Who Have Sex with Men. AIDS Behav 22, 1932–1943 (2018). https://doi.org/10.1007/s10461-017-1935-y

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  • DOI: https://doi.org/10.1007/s10461-017-1935-y

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