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      Correlates of HIV Acquisition in a Cohort of Black Men Who Have Sex with Men in the United States: HIV Prevention Trials Network (HPTN) 061

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          Abstract

          Background

          Black men who have sex with men (MSM) in the United States (US) are affected by HIV at disproportionate rates compared to MSM of other race/ethnicities. Current HIV incidence estimates in this group are needed to appropriately target prevention efforts.

          Methods

          From July 2009 to October 2010, Black MSM reporting unprotected anal intercourse with a man in the past six months were enrolled and followed for one year in six US cities for a feasibility study of a multi-component intervention to reduce HIV infection. HIV incidence based on HIV seroconversion was calculated as number of events/100 person-years. Multivariate proportional hazards modeling with time-dependent covariates was used to identify correlates of HIV acquisition.

          Results

          Of 1,553 Black MSM enrolled, 1,164 were HIV-uninfected at baseline and included in follow-up. Overall annual HIV incidence was 3.0% (95% confidence interval (CI): 2.0, 4.4%) and 5.9% among men ≤30 years old (95% CI: 3.6, 9.1%). Men ≤30 years old reported significantly higher levels of sexual risk and were more likely to have a sexually transmitted infection diagnosed during follow-up. Younger men also were more likely to not have a usual place for health care, not have visited a health care provider recently, and to have unmet health care needs. In multivariate analysis, age ≤30 years (hazard ratio (HR): 3.4; 95% CI: 1.4, 8.3) and unprotected receptive anal intercourse with HIV-positive or unknown status partners (HR: 4.1; 95% CI: 1.9, 9.1) were significantly associated with HIV acquisition.

          Conclusion

          In the largest cohort of prospectively-followed Black MSM in the US, HIV incidence was high, particularly among young men. Targeted, tailored and culturally appropriate HIV prevention strategies incorporating behavioral, social and biomedical based interventions are urgently needed to lower these rates.

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          Most cited references10

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          Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents.

          The relationship between social and community ties and mortality was assessed using the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, California and a subsequent nine-year mortality follow-up. The findings show that people who lacked social and community ties were more likely to die in the follow-up period than those with more extensive contacts. The age-adjusted relative risks for those most isolated when compared to those with the most social contacts were 2.3 for men and 2.8 for women. The association between social ties and mortality was found to be independent of self-reported physical health status at the time of the 1965 survey, year of death, socioeconomic status, and health practices such as smoking, alcoholic beverage consumption, obesity, physical activity, and utilization of preventive health services as well as a cumulative index of health practices.
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            Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS.

            New HIV infections are being observed among men who have sex with men (MSM). Understanding the fusion of risky sexual behaviors, stimulant and erectile dysfunction drug use with HIV seroconversion may provide direction for focused intervention. During the follow-up period (1998-2008), we identified 57 HIV seroconverters among 1667 initially HIV-seronegative men. Time to seroconversion was modeled using Cox proportional hazards regression analysis for 7 combinations of sex drugs (inhaled nitrites or "poppers", stimulants, and erectile dysfunction drugs) used at the current or previous semiannual visit, adjusting for other risk factors including sexual behavior, alcohol and other drugs used, and depression. Model-based adjusted attributable risks were then calculated. The risk of seroconversion increased linearly with the number of unprotected receptive anal sex partners (URASP), with hazard ratios ranging from 1.73 [95% confidence interval (CI): 0.75 to 4.01] for 1 partner, to 4.23 (95% CI: 1.76 to 10.17) for 2-4 partners, and to 14.21 (95% CI: 6.27 to 32.20) for 5+ partners, independent of other risk factors. After adjustment, risks for seroconversion increased from 2.99 (95% CI: 1.02 to 8.76) for men who reported using stimulants only (1 drug) to 8.45 (95% CI: 2.67 to 26.71) for men who reported using all 3 sex drugs. The use of any of the 7 possible sex drug combinations accounted for 63% of the 9-year HIV seroincidence in the Multicenter AIDS Cohort Study. When contributions of increased URASP and combination drug use were analyzed together, the total attributable risk for HIV seroconversion was 74%, with 41% attributable to URASP alone and a residual of 33% due to other direct or indirect effects of sex drug use. Use of poppers, stimulants, and erectile dysfunction drugs increased risk for HIV seroconversion significantly in this cohort. These data reinforce the importance of implementing interventions that target drug reduction as part of comprehensive and efficacious HIV prevention strategies.
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              Development and psychometric assessment of a multidimensional measure of internalized HIV stigma in a sample of HIV-positive adults.

              There is a need for a psychometrically sound measure of the stigma experienced by diverse persons living with HIV/AIDS (PLHA). The goal of this study was to develop and evaluate a multidimentional measure of internalized HIV stigma that captures stigma related to treatment and other aspects of the disease among sociodemographically diverse PLHA. We developed a 28-item measure of internalized HIV stigma composed of four scales based on previous qualitative work. Internal consistency reliability estimates in a sample of 202 PLHA was 0.93 for the overall measure, and exceeded 0.85 for three of the four stigma scales. Items discriminated well across scales, and correlations of the scales with shame, social support, and mental health supported construct validity. This measure should prove useful to investigators examining in the role of stigma in HIV treatment and health outcomes, and evaluating interventions designed to mitigate the impacts of stigma on PLHA.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                26 July 2013
                : 8
                : 7
                : e70413
                Affiliations
                [1 ]Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
                [2 ]Fenway Health and Beth Israel Deaconess Hospital, Boston, Massachusetts, United States of America
                [3 ]Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
                [4 ]Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
                [5 ]Department of Medicine, Harlem Hospital/Columbia University and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
                [6 ]Department of Global Health, Emory University Rollins School of Public Health and Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
                [7 ]Department of Family Medicine, University of California Los Angeles, Los Angeles, California, United States of America
                [8 ]Department of Epidemiology and Biostatistics, School of Public Health and Health Services George Washington University, Washington, DC, United States of America
                [9 ]San Francisco Department of Public Health, San Francisco, California, United States of America
                [10 ]Department of Human Development, College of Community and Public Affairs, Binghamton University, New York, New York, United States of America
                [11 ]Florida International University-College of Nursing and Health Sciences, Miami, Florida, United States of America
                [12 ]FHI 360, Research Triangle Park, North Carolina, United States of America
                [13 ]Clinical Prevention Research Branch/PSP/DAIDS/NIAID/NIH, Bethesda, Maryland, United States of America
                [14 ]Graduate School of Social Work, Loyola University Chicago, Chicago, Illinois, United States of America
                University of Mississippi Medical Center, United States of America
                Author notes

                ¶ Membership of the HPTN 061 Protocol Team is provided in the Acknowledgments.

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: BAK KHM DW LW SDF SHE SG VE. Performed the experiments: BAK KHM SM CDR SS MM SB VC EP-M SG. Analyzed the data: LW T-YL BAK. Wrote the paper: BAK KHM SHE LW SG.

                Article
                PONE-D-13-22437
                10.1371/journal.pone.0070413
                3724810
                23922989
                4908a8b1-51b2-45c7-ad25-b3ee8346a4f6
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 29 May 2013
                : 22 June 2013
                Page count
                Pages: 9
                Funding
                HPTN 061 grant support provided by the National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA) and National Institute of Mental Health (NIMH): Cooperative Agreements UM1 AI068619, UM1 AI068617, and UM1 AI068613. Additional site funding - Fenway Institute Clinical Research Site (CRS): Harvard University CFAR (P30 AI060354) and CTU for HIV Prevention and Microbicide Research (UM1 AI069480); George Washington University CRS: District of Columbia Developmental CFAR (P30 AI087714); Harlem Prevention Center CRS and NY Blood Center/Union Square CRS: Columbia University CTU (5U01 AI069466) and ARRA funding (3U01 AI069466-03S1); Hope Clinic of the Emory Vaccine Center CRS and The Ponce de Leon Center CRS: Emory University HIV/AIDS CTU (5U01 AI069418), CFAR (P30 AI050409) and CTSA (UL1 RR025008); San Francisco Vaccine and Prevention CRS: ARRA funding (3U01 AI069496-03S1, 3U01 AI069496-03S2); UCLA Vine Street CRS: UCLA Department of Medicine, Division of Infectious Diseases CTU (U01 AI069424). The funder had a role in the design of the study by providing input into the design. The funder did not have a role in the data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology
                Population Biology
                Epidemiology
                Infectious Disease Epidemiology
                Medicine
                Epidemiology
                Infectious Disease Epidemiology
                Infectious Diseases
                Viral Diseases
                HIV
                HIV epidemiology
                HIV prevention
                Sexually Transmitted Diseases
                Public Health
                Social and Behavioral Sciences
                Sociology
                Sexual and Gender Issues

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