Social and behavioural factors associated with HIV seroconversion in homosexual men attending a central London STD clinic: A feasibility study

Abstract

An unmatched retrospective case control study was conducted to test the feasibility of investigating social and behavioural factors which may have contributed to recent HIV seroconversion in a group of homosexual men. Participants, recruited from a London sexually transmitted disease (STD) clinic, were sexually active and had had a negative HIV test with a subsequent test (positive (cases) or negative (controls)) within three to 15 months. Twenty cases and 22 controls were recruited between February and October 1995. There was no difference between cases and controls in: the number of regular or casual sexual partners, the proportion who were unaware of their regular partners' serostatus (cases 60%, controls 59%), or the proportion who had known HIV-positive regular partners (cases 20%, controls 23%). A significant difference in sexual behaviour was found only when the HIV status of partners, if known, was taken into account: cases were more likely than controls to have had unprotected receptive anal intercourse with a partner not known to be HIV-negative (OR = 5.5, CI = 1.15-29.50). Fifty per cent of the cases and 27% of the controls acquired acute STDs between the two HIV tests. All participants achieved high self-efficacy scores, but the controls believed their peers placed a greater value on safer sex. Cases cited emotional issues and the use of drugs and alcohol as contributing to their seroconversion, whereas controls cited a commitment to safer sex and the avoidance of high-risk situations as contributing to their remaining HIV-negative. The results illustrate the importance of acknowledging the concept of 'negotiated safety' in studies of sexual behaviour; seroconversion was only associated with unprotected sex with a partner not known to be HIV-negative. Despite high self-efficacy scores, indicating the skills to negotiate safer sex, high levels of unsafe anal intercourse were reported. Differences between cases and controls included the importance of safer sex, periods of emotional vulnerability, influence of peers and the appropriate use of condoms. There is a need for these results to be confirmed in a larger and more powerful study.

Urban African-American Men Speak Out on Sexual Partner Concurrency: Findings from a Qualitative Study

“…Negotiated safety is not risk-free: partners can violate the agreement (Davidovich et al, 2000;Guzman et al, 2004) and condom misuse may lead to slippage or breakage (e.g., Warner et al, 2008). Nonetheless, this strategy can help to prevent transmission of STDs and HIV (Gilbart et al, 2000). Negotiated safety was an implicit strategy cited in statements by men in our sample who discussed having an "understanding" with their sex partners, in which they agreed that they would not use a condom in their primary relationship, but it was not clear how explicit these understandings were.…”

Seroconversion in context

“…A case-control study investigating the social and behavioural factors contributing to HIV seroconversion (Gilbart et al ., 2000) included a request to participants to give an 'account of factors they personally felt were important in contributing to their subsequent seroconversion' (p. 51). The study participants, homosexual men, cited emotional issues and the use of drugs and alcohol as contributing to their seroconversion.…”

Effect of Bacterial Pneumonia on Lung Simian Immunodeficiency Virus (SIV) Replication in Alcohol Consuming SIV‐Infected Rhesus Macaques

“…Alcohol abuse and human immunodeficiency virus (HIV) infection are major public health problems in the United States and throughout the world (Karon et al., ; Stinson et al., ). Several studies have shown an association between alcohol consumption and the risk of becoming infected with HIV (Gilbart et al., ; Kalichman et al., ; Semple et al., ; Simbayi et al., ). The incidence of alcohol abuse among HIV‐infected individuals is greater than the population as a whole (Lefevre et al., ; Miguez et al., ).…”