AIDS and Behavior

, Volume 7, Issue 4, pp 353–362

Why HIV Infections Have Increased Among Men Who Have Sex with Men and What to Do About It: Findings from California Focus Groups

  • Stephen F. Morin
  • Karen Vernon
  • John (Jay) Harcourt
  • Wayne T. Steward
  • Jonathan Volk
  • Thomas H. Riess
  • Torsten B. Neilands
  • Marisa McLaughlin
  • Thomas J. Coates
Article

Abstract

A resurgence of sexual risk taking, STDs, and HIV incidence has been reported among men who have sex with men (MSM) in several countries. We asked 113 MSM in 12 focus groups conducted in five California cities to identify factors leading to increased risk taking and assess prevention messages to reduce risk in this population. Participants perceived that HIV risk taking has increased because (1) HIV is not the threat it once was due to more effective therapies, (2) MSM communicate less about HIV, and social support for being safe has decreased, and (3) community norms have shifted such that unsafe sex is more acceptable. The prevention messages ranked most likely to motivate risk reduction encouraged individuals to seek social support from friends. Themes ranked least likely to succeed were those that described the negative consequences of HIV or reinforced existing safer sex messages.

HIV incidence Men who have sex with men community norms HIV communication HIV and social support 

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References

  1. Apanovitch, A. M., McCarthy, D., and Salovey, P. (2003). Using message framing to motivate HIV testing among low-income, ethnic minority women. Health Psychology, 22, 60–67.Google Scholar
  2. Blower, S. M., Gershengorn, H. B., and Grant, R. M. (2000). A tale of two futures: HIV and antiretroviral therapy in San Francisco. Science, 287, 650–654.Google Scholar
  3. Catania, J. A., Morin, S. F., Canchola, J., Pollack, L., Chang, J., and Coates, T. J. (2000). Health care policy. U.S. priorities–HIV prevention. Science, 290, 717.Google Scholar
  4. Centers for Disease Control and Prevention. (1997). Update: Trends in AIDS incidence, deaths, and prevalence–United States, 1996. JAMA, 277, 874–875.Google Scholar
  5. Centers for Disease Control and Prevention. (1999). Resurgent bacterial sexually transmitted disease among men who have sex with men–King County, Washington, 1997–1999. Atlanta, GA: Author.Google Scholar
  6. Centers for Disease Control and Prevention. (2001). HIV incidence among young men who have sex with men–Seven U.S. cities, 1994–2000. Atlanta, GA: Author.Google Scholar
  7. Communicable Disease Surveillance Centre. (2001, July 5). Syphilis transmission among homosexual and bisexual men in London and Manchester. CDR Weekly, 11.Google Scholar
  8. Dukers, N. H., Goudsmit, J., de Wit, J. B., Prins, M., Weverling, G. J., and Coutinho, R. A. (2001). Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS, 15, 369–378.Google Scholar
  9. Dupin, N., Jdid, R., N'Guyen, Y. T., Gorin, I., Franck, N., and Escande, J. P. (2001). Syphilis and gonorrhoea in Paris: The return. AIDS, 15, 814–815.Google Scholar
  10. Ekstrand, M. L., Stall, R. D., Paul, J. P., Osmond, D. H., and Coates, T. J. (1999). Gay men report high rates of unprotected anal sex with partners of unknown or discordant HIV status. AIDS, 13, 1525–1533.Google Scholar
  11. Elford, J., Bolding, G., Maguire, M., and Sherr, L. (2000). Combination therapies for HIV and sexual risk behavior among gay men. Journal of the Acquired Immune Deficiency Syndromes, 23, 266–71.Google Scholar
  12. Elford, J., Bolding, G., and Sherr, L. (2002). High-risk sexual behaviour increases among London gay men between 1998 and 2001: What is the role of HIV optimism? AIDS, 16, 1537–44.Google Scholar
  13. Flick, U. (1998). An introduction to qualitative research. London: Sage.Google Scholar
  14. Fox, K. K., del Rio, C., Holmes, K. K., Hook, E. W., 3rd, Judson, F. N., Knapp, J. S., Procop, G. W., Wang, S. A., Whittington, W. L., and Levine, W. C. (2001). Gonorrhea in the HIV era: A reversal in trends among men who have sex with men. American Journal of Public Health, 91, 959–964.Google Scholar
  15. Glaser, B., and Strauss, A. (1967). The discovery of grounded theory. Chicago: Aldine.Google Scholar
  16. Health Canada. (2001, May). National HIV prevalence and incidence estimates for 1999. In HIV/AIDS epi update. Ottawa: Author.Google Scholar
  17. Huebner, D. M., and Gerend, M. A. (2001). The relation between beliefs about drug treatments for HIV and sexual risk behavior in gay and bisexual men. Annals of Behavioral Medicine, 23, 304–312.Google Scholar
  18. Kalichman, S. C., Nachimson, D., Cherry, C., and Williams, E. (1998). AIDS treatment advances and behavioral prevention setbacks: Preliminary assessment of reduced perceived threat of HIV–AIDS. Health Psychology, 17, 546–550.Google Scholar
  19. Katz, M. H. (1997). AIDS epidemic in San Francisco among men who report sex with men: Successes and challenges of HIV prevention. Journal of Acquired Immune Definciency Syndromes and Human Retrovirology, 14(Supplement 2), S38-S46.Google Scholar
  20. Katz, M. H., Schwarcz, S. K., Kellogg, T. A., Klausner, J. D., Dilley, J. W., Gibson, S., and McFarland, W. (2002). Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco. American Journal of Public Health, 92, 388–394.Google Scholar
  21. Kegeles, S., Hays, R. B., and Coates, T. J. (1996). The Mpowerment Project: A community-level HIV prevention intervention for young gay men. American Journal of Public Health, 86, 1129–1136.Google Scholar
  22. Kegeles, S., Hays, R. B., Pollack, L., and Coates, T. (1999). Mobilizing young gay and bisexual men for HIV prevention: A two-community study. AIDS, 13, 1753–1762.Google Scholar
  23. Kelly, J. (2000). HIV prevention interventions with gay or bisexual men and youth. AIDS (Supplement 2), S34-S39.Google Scholar
  24. Kelly, J., St. Lawrence, J. S., Stevenson, L. Y., Hauth, A. C., Kalichman, S. C., Diaz, Y. E., Brasfield, T. L., Koob, J. J., and Morgan, M. G. (1992). Community AIDS/HIV risk reduction: The effects of endorsements by popular people in three cities. American Journal of Public Health, 82, 1483–1489.Google Scholar
  25. Mansergh, G., Colfax, G. N., Marks, G., Rader, M., Guzman, R., and Buchbinder, S. (2001). The Circuit Party Men's Health Survey: Findings and implications for gay and bisexual men. American Journal of Public Health, 91, 953–958.Google Scholar
  26. Ostrow, D. E., Fox, K. J., Chmiel, J. S., Silvestre, A., Visscher, B. R., Vanable, P. A., Jacobson, L. P., and Strathdee, S. A. (2002). Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS, 16, 775–780.Google Scholar
  27. Palella, F. J., Jr., Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J., Satten, G. A., Aschman, D. J., and Holmberg, S. D. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. New England Journal of Medicine, 338, 853–860.Google Scholar
  28. Pope, C., and Mays, N. (1995). Qualitative research: Reaching the parts other methods cannot reach: An introduction to qualitative methods in health and health services research. British Medical Journal, 311, 42–45.Google Scholar
  29. Power, R. (1998). The role of qualitative research in HIV/AIDS. AIDS, 12, 687–695.Google Scholar
  30. Quinn, T. C., Wawer, M. J., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., Meehan, M. O., Lutalo, T., and Gray, R. H. (2000). Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. New England Journal of Medicine, 342, 921–929.Google Scholar
  31. Remien, R. H., Wagner, G., Carballo-Dieguez, A., and Dolezal, C. (1998). Who may be engaging in high-risk sex due to medical treatment advances? AIDS, 12, 1560–1561.Google Scholar
  32. Rosengarten, M., Race, K., and Kippax, S. (2000). “Touch wood, everything will be OK”: Gay men's understandings of clinical markers in sexual practice. Sydney: National Centre in HIV Social Research, University of New South Wales.Google Scholar
  33. Rothman, A. J., and Salovey, P. (1997). Shaping perceptions to motivate healthy behavior: The role of message framing. Psychological Bulletin, 121, 3–19.Google Scholar
  34. Stolte, I. G., and Coutinho, R. A. (2002). Risk behaviour and sexually transmitted diseases are on the rise in gay men, but what is happening with HIV? Current Opinion in Infectious Disease, 15, 37–41.Google Scholar
  35. Stolte, I. G., Dukers, N. H., de Wit, J. B., Fennema, J. S., and Coutinho, R. A. (2001). Increase in sexually transmitted infections among homosexual men in Amsterdam in relation to HAART. Sexually Transmitted Infections, 77, 184–186.Google Scholar
  36. Strauss, A., and Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Thousand Oaks, CA: Sage.Google Scholar
  37. Van de Ven, P., and Crawford, J. (1998). Change in sexual practice among Australian men who have sex with men, 1992–1996. AIDS, 12(Supplement B), S66.Google Scholar
  38. Van de Ven, P., Prestage, G., French, J., Knox, S., and Kippax, S. (1998). Increase in unprotected anal intercourse with casual partners among Sydney gay men in 1996–98. Australian and New Zealand Journal of Public Health, 22, 814–818.Google Scholar
  39. Van de Ven, P., Kippax, S., Knox, S., Prestage, G., and Crawford, J. (1999). HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne. AIDS, 13, 2289–2294.Google Scholar
  40. Van de Ven, P., Prestage, G., Crawford, J., Grulich, A., and Kippax, S. (2000a). Sexual risk behaviour increases and is associated with HIV optimism among HIV-negative and HIV-positive gay men in Sydney over the 4 year period to February 2000. AIDS, 14, 2951–2953.Google Scholar
  41. Van de Ven, P., Prestage, G., Knox, S., and Kippax, S. (2000b). Gay men in Australia who do not have HIV test results. International Journal of STD and AIDS, 11, 456–460.Google Scholar
  42. Van de Ven, P., Rawstorne, P., Crawford, J., and Kippax, S. (2002). Increasing proportions of Australian gay and homosexually active men engage in unprotected anal intercourse with regular and with casual partners. AIDS Care, 14, 335–341.Google Scholar
  43. Vernazza, P. L., Eron, J. J., Fiscus, S. A., and Cohen, M. S. (1999). Sexual transmission of HIV: Infectiousness and prevention. AIDS, 13, 155–166.Google Scholar
  44. Williams, L. A., Klausner, J. D., Whittington, W. L., Handsfield, H. H., Celum, C., and Holmes, K. K. (1999). Elimination and reintroduction of primary and secondary syphilis. American Journal of Public Health, 89, 1093–1097.Google Scholar
  45. Wolitski, R. J., Valdiserri, R. O., Denning, P. H., and Levine, W. C. (2001). Are we headed for a resurgence of the HIV epidemic among men who have sex with men? American Journal of Public Health, 91, 883–888.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Stephen F. Morin
    • 1
  • Karen Vernon
    • 1
  • John (Jay) Harcourt
    • 1
  • Wayne T. Steward
    • 1
  • Jonathan Volk
    • 1
  • Thomas H. Riess
    • 1
  • Torsten B. Neilands
    • 1
  • Marisa McLaughlin
    • 1
  • Thomas J. Coates
    • 1
  1. 1.Center for AIDS Prevention StudiesUniversity of CaliforniaSan Francisco

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