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HIV-Positive Men Commonly Have Unprotected Sex With Their HIV-Negative Female Partners, Several Journal of Urban Health Studies Find

August 7, 2006

A special Journal of Urban Health issue on "Men's Role in the Heterosexual HIV Epidemic" found that unprotected sex between HIV-positive men and at-risk women was common and suggested interventions to help protect HIV-negative women from infection.

New York City -- A high proportion of HIV-positive men engage in unprotected sex with female partners who are HIV-negative or of unknown status, the most recent issue of the Journal of Urban Health: Bulletin of the New York Academy of Medicine reports, a significant danger to the women's health and a contributing factor to the HIV epidemic. Heterosexual contact is responsible for 35% of all new HIV/AIDS diagnoses in the United States today; 64% of these heterosexually acquired infections occur in women.

"Considering the growing numbers of new HIV infections among women due to heterosexual sex, prevention efforts should be focused on heterosexual HIV-positive men," said Mary Latka, a researcher at the Academy's Center for Urban Epidemiologic Studies who, with Victoria Frye, also at the Academy, co-organized the Journal of Urban Health's special issue on Men's Role in the Heterosexual HIV Epidemic. "Interventions for HIV-positive men have tended to focus on drug-using men or men who have sex with men, as opposed to heterosexual men."

Heterosexual transmission of HIV/AIDS is now the dominant mode of transmission worldwide. But, while women's sexual decision-making and sexual behaviors that put them at risk have been studied extensively, the sexual habits of HIV-positive heterosexual men are much less frequently the focus of research. Three papers in this special issue of the Journal of Urban Health serve to correct this deficiency by focusing on the sexual relationships, habits, and behaviors of heterosexual men living with HIV/AIDS. Researchers uncovered some startling facts, many of which were consistent across papers.

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  • A larger number of HIV positive men are sexually active with women than exclusively with other men, putting women at greater -- and increasing -- exposure to the disease.

  • Although many people living with HIV are aware of the harmful health effects of unsafe sex, a significant number engage in unsafe sex. In these studies, between 21 percent and 41 percent of HIV-positive men reported unprotected sex with an HIV-negative or unknown status female partner.

  • HIV-positive men tended to fluctuate in their sexual habits, initiating unsafe sex after a period of consistently safe sex experiences and vice versa.

  • Active drug use, problem drinking, homelessness, depression, recent incarceration, lower education, and exchanging sex for money, drugs, or housing increased the odds of unsafe sex, as did negative attitudes toward the use of condoms. Younger men living with HIV/AIDS and men with a spouse or steady partner were also much more likely to report unsafe sex.

  • Older age, higher self-efficacy, optimism, and being on antiretroviral medications reduced the likelihood of engaging in unsafe sex.

The Journal of Urban Health papers reporting these findings are entitled: "HIV-Positive Men Sexually Active with Women" by lead author Angela A. Aidala of the Mailman School of Public Health; "Correlates of Unprotected Sex Among Adult Heterosexual Men Living with HIV," by lead author Joel Milam of the University of California's Department of Preventive Medicine; and "Unprotected Sexual Behaviors among Heterosexual HIV-Positive Injection Drug Using Men," by lead author David W. Purcell of the Centers for Disease Control and Prevention.

Based on these findings, the authors of all three papers emphasized the need for prevention interventions aimed at men who engage in heterosexual sex. They suggested providing risk-screening and HIV-prevention counseling to HIV-positive men on an ongoing basis, not just when they enter into care. Increasing men's concern for their partners and comfort discussing condoms, offering counseling sessions for couples, and devising strategies aimed at empowering HIV-positive men to change their unsafe sexual behavior would likely reduce unsafe sexual behavior, the authors suggested.

Since the first AIDS case was diagnosed twenty-five years ago, the HIV epidemic has become increasingly feminized. In 1992, women accounted for an estimated 14 percent of adults and adolescents living with AIDS. By the end of 2004, this proportion had jumped to 23 percent, with nearly 80 percent of these women infected through heterosexual sex. According to the Centers for Disease Control, women demonstrate a "biologic vulnerability" to HIV/AIDS and are twice as likely as men to contract HIV infection during vaginal intercourse. Women of color are especially impacted by HIV infection; in 2002, it was the leading cause of death for African American women between the ages of 25 and 34. "Heterosexual transmission of HIV is a growing public health problem in the United States, particularly for women," Latka said. "These papers offer concrete information for interventionists and program designers developing strategies for working with HIV-positive men to prevent transmission and re-infection."




  
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This article was provided by The New York Academy of Medicine.
 

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