title: Comparing Psychosocial Correlates of Condomless Anal Sex in HIV-Diagnosed and HIV-Nondiagnosed Men Who Have Sex with Men: A Series of Meta-Analyses of Studies from 1993-2013.
abstract: OBJECTIVE
  Men who have sex with men (MSM) continue to be overrepresented in rates of incidence and prevalence of human immunodeficiency virus (HIV). Both HIV-diagnosed (HIV-D) and HIV-nondiagnosed (HIV-N) MSM report a variety of reasons for intentional and unintentional nonuse of condoms. Elucidating and comparing reasons for continued engagement in condomless anal sex specific to both HIV-D and HIV-N MSM likely is important to identifying effective prevention.
  
  
  METHODS
  This study employed meta-analytic methods to evaluate and compare correlates to condomless anal sex in both HIV-D and HIV-N MSM from primary studies from 1993 to February 2013.
  
  
  RESULTS
  Of the 19 individual correlates assessed within the subgroup of HIV-D MSM, variables that achieved significant effect were alcohol, mind-altering substance use, sexual-enhancement medication, intentional condom nonuse, self-efficacy, attitudes toward condom use, social support, gay identity, compulsivity, trading sex, and number of sex partners. Those that were statistically non-significant were intention to use a condom, perceived risk, perceived norms, perceived responsibility, HIV medical management, treatment optimism, mental health, and setting. Of the 12 correlates assessed within the subgroup of HIV-N MSM, variables that achieved significant effect were alcohol, mind-altering substance use, intentional condom nonuse, attitudes toward condom use, perceived risk, and setting. Those observed as statistically non-significant were perceived norms, social support, gay identity, mental health, trading sex, and number of sex partners.
  
  
  CONCLUSIONS
  Study results have clinical implications that may guide future prevention research and practice by highlighting risk variables shared between HIV-N and HIV-D MSM, as well as variables observed to be unique to each group that may warrant more tailored intervention. Further investigation is recommended to elucidate the relationships among these variables such that optimal intervention can be determined.
authors.affiliation: 1 Department of Psychology, VA Maryland Healthcare System , Baltimore, Maryland.|2 Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Katharine
authors.initials: K
authors.lastname: Lacefield
authors.affiliation: 3 Department of Psychology, University of Central Florida , Orlando, Florida.
authors.forename: Charles
authors.initials: C
authors.lastname: Negy
authors.affiliation: 4 Department of Dialysis, DCI Corporate Quality Management , Albuquerque, New Mexico.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Schrader
authors.affiliation: 3 Department of Psychology, University of Central Florida , Orlando, Florida.
authors.forename: Christina
authors.initials: C
authors.lastname: Kuhlman
mesh_terms: D001290:Attitude; D017280:Condoms / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008603:Mental Health; D015201:Meta-Analysis as Topic; D012309:Risk-Taking; D020377:Self Efficacy; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology; D066262:Social Norms; D012944:Social Support; D019966:Substance-Related Disorders / Q000453:epidemiology; D047568:Unsafe Sex / Q000523:psychology*
keywords: HIV; men who have sex with men (MSM); meta-analysis; risk factors.