Rural Center for AIDS/STD Prevention

RAP Time

(Volume 2, No. 9, September 4, 1998)

Issue Contents

High Risk for HIV Found Among Some MSM Subgroups Regardless of Self-Identification

Research is yet to show whether drug-injecting men who have sex with men (MSM), hustlers, and non-gay-identified MSM represent behaviorally distinct subgroups of MSM. A recent study of 1290 MSM indicated that subgroups of MSM are at high risk for HIV infection: those who inject drugs (IDU), those who exchange sex for money or drugs (hustlers), and those who do not gay-identify.

Collection of Data
MSM were recruited from gay bars, bath houses, adult video arcades, and outdoor cruising areas in Denver, Colorado and Long Beach, California. Men ever having sex with a man were offered a screening interview. Of those screened, men reporting anal or oral sex with a man or those reporting IDU in the past 30 days were offered an in-depth interview about HIV risk and prevention behavior and HIV testing. Non-gay identified MSM were oversampled.

Description of the Sample
About one-third and one-half of the screened and interviewed, respectively, did not identify as gay. Seven percent and 13% of those screened and interviewed, respectively, injected drugs. Nine percent and 15% of those screened and interviewed, respectively, hustled. The majority of hustlers and IDUs interviewed did not gay-identify. The sample was mostly white (68%), with blacks and Hispanics comprising 10% and 17% of the sample, respectively. The mean age of the sample was 33 years.

Outcomes of the Study
Among MSM, subgroups at particuarlarly high risk for HIV can be identified.

  • A strong association was found between IDU and hustling, and a weaker, yet significant, assocation between these risk behaviors and non-gay identification was established. Hence, hustling and IDU were highly correlated among MSM, regardless of sexual self-identification.
  • The highest risk for potential HIV transmission was associated with the exchange of sex for money or drugs. Hustlers had the highest number of sex partners in the past 30 days and more of them enagaged in anal or oral sex with other men, as well as anal sex with female partners. However, fewer hustlers used condoms during anal sex with occasional male partners or during vaginal sex with female partners.
  • IDUs and hustlers used condoms less consistently during coitus with female partners than did other MSM.

Implications for Prevention
Hustlers and drug-injecting MSM constitute an important portion of the MSM community. Although these subgroups may be relatively small, they may be important epidemiologic links to the larger MSM and heterosexual communities and warrant focusued HIV prevention interventions. In rural America, prevention programs may benefit from recognition that a significant portion of MSM do not gay-identify.

SOURCE: Rietmeijer, C. A., et al. (1998). Sex hustling, injection drug use, and non-gay identification by men who have sex with men: Associations with high-risk sexual behaviors and condom use. Sexually Transmitted Diseases, 25, 353-360.

Youth Sexual Risk Behavior Stabilizes with Condom Use Up

Data indicate consistent patterns of sexual behavior (age at first intercourse, percent sexually experienced, current sexual activity, and lifetime number of sex partners) among U.S. high school students between 1991 and 1995, with a slight increase in condom use.

Data from the Youth Risk Behavior Survey from 1991-1993 and 1995 were compared to examine trends in sexual risk behavior between probability samples of at least 11,000 students for each of four years.

The proportion of students who reported being sexually experienced remained at 53%-54% from 1990 through 1995. The percent of sexually active students using condoms at last coitus rose from 46% to 54%. Median age of first coitus remained at 16.5 years during the study period. In all four years, nearly 20% reported four or more lifetime partners. Racial and gender differences were found.

SOURCE: Warren, C. W., et al,. (1998). Sexual behavior among U.S. high school students, 1990-1995. Family Planning Perspectives, 30, 170-172, 200.

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Domestic Abuse is Associated with HIV Risk for Women

A study of 40 women randomly sampled from shelters in Massachusetts showed that 42% had been physically abused, 70% had been psychologically abused, and 53% had been sexually abused.

Sixty percent of the sample reported their partner used illicit drugs, 63% reported their partner had other partners, 98% reported their partner never or rarely used a condom, and 50% reported their partner had infected them with at least one STD. Three quarters of the women had more than one risk factor for HIV infection.

Physical, psychological, and sexual abuse were each associated with multiple HIV risk, with the strongest association being psychological abuse. Eighty-five percent who were at multiple risk did not perceive any risk of HIV infection. Eighty percent had never asked their abusive partner to wear a condom.

Programs serving abused women should respond to the potential for elevated HIV-risk among their clients.

SOURCE: Molina, L. D., & Basinait-Smith, C. (1998). Revisiting the intersection between domestic abuse and HIV risk (letter). American Journal of Public Health, 88, 1267-1268.

Chlamydia Infection Rates Near 30% among Female Teens

A sample of 3202 sexually experienced female teens showed that 29.1% had a least one positive test for Chlamydia. Predictors of infection were not identified. Chlamydia screening every six months is recommended for sexually active girls.

SOURCE: Burstein, G. R.,et al. (1998). Incident Chlamydia trachomatis infections among inner-city adolescent females. Journal of the American Medical Association, 280, 521-526.

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Incidence of Reported Gonorrhea Decreased

Between 1981 and 1996, the incidence of reported gonorrhea in the U.S. decreased 71.3%, from 431.5 to 124.0 cases/100,000. Rates among blacks were 35 times higher than rates for whites in 1996. Among women of all races, 15 to 19 year olds had the highest rates in 1996.

SOURCE: Fox, K. K. , et al. (1998). Gonorrhea in the United States: Demographic and geographic trends. Sexually Transmitted Diseases, 25, 386-393.