title: The Predominant Relationship Between Sexual Environment Characteristics and HIV-Serodiscordant Condomless Anal Sex Among HIV-Positive Men Who Have Sex with Men (MSM).
abstract: In some studies, situational factors have been shown to be stronger predictors of condomless sex than individual risk factors. Cross-sectional relationships between condomless anal sex (CAS) with HIV-serodiscordant partners and risk factors across ecological levels (individual, sexual environment) were examined using a sample (N = 60) of HIV-positive men who have sex with men (MSM) who reported multiple recent episodes of CAS. Negative binomial regressions were used to evaluate the association of contextual risk factors (e.g., substance use during sex, transactional sex, public sex, sex at a sex party) with recent condomless sex, controlling for demographics and mental health. Results demonstrated that sexual environment factors, particularly sex under the influence of drugs or alcohol (B = .019, p < .05), transactional sex (B = .035, p < .01), and public sex (B = .039, p < .01) explained a large proportion of the variance in CAS. Only sex at a sex party was not related to CAS (p = .39). For each additional sexual environment in which men engaged, their rates of CAS increased (B = .39, p < .01). Secondary prevention interventions that are tailored to the proximal sexual environment could be maximally effective, particularly if they address substance use and other challenging sexual situations.
authors.affiliation: Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.|Department of Psychology, University of Utah, Salt Lake City, UT, 84112, USA.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Perry
authors.affiliation: Department of Social Work, Wheelock College, Boston, MA, 02215, USA.|Fenway Health, Boston, MA, 02215, USA.
authors.forename: S
authors.initials: S
authors.lastname: Wade Taylor
authors.affiliation: Fenway Health, Boston, MA, 02215, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Elsesser
authors.affiliation: Fenway Health, Boston, MA, 02215, USA.|Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. cocleirigh@mgh.harvard.edu.|Fenway Health, Boston, MA, 02215, USA. cocleirigh@mgh.harvard.edu.|Harvard Medical School, Boston, MA, 02115, USA. cocleirigh@mgh.harvard.edu.
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Condomless sex; Men who have sex with men (MSM); Positive prevention; Sexual environment