ITM talk at APHA 2005

Tailoring HIV Prevention Interventions to HIV+ Men Who Have Sex With Men and Women: Racial/Ethnic Differences and Predictors of Unprotected Sex With Male and Female Primary Partners APHA, Philadelphia 2005: 

Tailoring HIV Prevention Interventions to HIV+ Men Who Have Sex With Men and Women: Racial/Ethnic Differences and Predictors of Unprotected Sex With Male and Female Primary Partners APHA, Philadelphia 2005 Matt G. Mutchler, Ph.D. Leonardo Colemon, M.A. Emily Elman, M.P.H., andamp; Mark A. Schuster, M.D., Ph.D. Funded by the Universitywide AIDS Research Program

Overview: In The Mix (ITM): 

Overview: In The Mix (ITM) Background and significance Methods and sample Results Racial/Ethnic differences Gendered strategies Discovered model: Importance of stigma Implications for HIV/AIDS policy and prevention practices

Research Significance: HIV+ MSMW: 

Research Significance: HIV+ MSMW The incidence of HIV infection is increasing among MSMW Little is known about HIV status disclosure, stigma, safer sex communication, and risk behaviors among HIV+ MSMW Most public health studies and interventions group MSMW with gay men

Background: 

Background Findings on associations between HIV status disclosure and HIV risk are mixed Very little exploration of role played by sexual stigma in previous research

Theoretical Framework: 

Theoretical Framework HIV/AIDS poses a unique challenge of disclosure to sexual partners HIV+ MSMW face multiple levels of stigma HIV/AIDS Stigma (Weitz, 1991) Living with HIV/AIDS (Adam andamp; Sears, 1996) Sexual Stigma (Plummer, 1975)

“In The Mix” Study Aims: 

'In The Mix' Study Aims Explore significant differences in HIV status disclosure, stigma, safer sex communication, and risk behaviors among HIV+ MSMW of participant by gender of sexual PRIMARY partner Assess the role played by stigma in models of HIV risk with study population

Study Design: 

Study Design Purposeful sampling: 150 HIV+ MSMW 50 African American, 50 Latino (25 English speaking andamp; 25 Spanish speaking), andamp; 50 white Cross-sectional design; convenience sample Data collected at 8 AIDS service organizations in Los Angeles County (LAC): September, 2003 through July, 2004

Demographic Information: 

Demographic Information Average age=40 28.7% have children 40.7% high school or less education 40.7% earn less than poverty level 16.8% homeless in last 3 months 53.3% ever in the correctional system

Sexual Identities: 

Sexual Identities

Some Key Racial/Ethnic Differences:: 

Some Key Racial/Ethnic Differences: Latino, African American, and Caucasian HIV+ MSMW

Latino HIV+ MSMW (P<.05): 

Latino HIV+ MSMW (Pandlt;.05) 1=Strongly Disagree, 5=Strongly Agree

African American HIV+ MSMW (P<.05): 

African American HIV+ MSMW (Pandlt;.05)

White HIV+ MSMW (P<.05): 

White HIV+ MSMW (Pandlt;.05) 1=Strongly Disagree, 5=Strongly Agree

Gendered Safer Sex Strategies:: 

Gendered Safer Sex Strategies: Differences in communication, disclosure, stigma and HIV risk patterns with male versus female primary partners

Key Differences (N=57): Male and Female Primary Partners (PP) (P<.05): 

Key Differences (N=57): Male and Female Primary Partners (PP) (Pandlt;.05)

Univariate Predictors (N=72):Unprotected Sex with FPP (P<.05): 

Univariate Predictors (N=72): Unprotected Sex with FPP (Pandlt;.05)

Discovered Model: Sexual Stigma and Communication about Safer Sex Predict Unprotected Sex with FPP: 

Discovered Model: Sexual Stigma and Communication about Safer Sex Predict Unprotected Sex with FPP MSMW Disclosure Unprotected Sex Sexual Stigma 12.7 NS Communication about Safer Sex .10

Univariate Predictors (N=106):Unprotected Sex with MPP (P<.05): 

Univariate Predictors (N=106): Unprotected Sex with MPP (Pandlt;.05)

Conclusion: Key Points: 

Strategies for disclosing health status/bisexuality, communicating about safer sex, and negotiating sexual risk behaviors are gendered Sexual stigma and communication about safer sex predict unprotected sex with female primary partners HIV status predicts unprotected sex with male primary partner (serosorting) Conclusion: Key Points

Implications: 

Implications Individuals enact innovative proxies for the disclosure of health statuses (such as safer sex communication) Sexual stigma increases HIV risk and may also impede other health behaviors such as anal health Social stigma, in general, needs to be considered in the larger field of HIV prevention

Recommendations: 

Recommendations HIV prevention interventions should be tailored to partner variables (e.g., gender) and race/ethnicity Interventions should include separate components for male and female partners to address communication, stigma, and sexual risk behaviors Build on safer sex strengths with partners Condom use discussions with female partners HIV+ MSMW may already be sero-sorting with their MPPs Address different perceptions/experiences of racial ethnic groups

Acknowledgments & Contact Information: 

Acknowledgments andamp; Contact Information Interviewer: Miguel Chion, M.D., M.P.H. The research andamp; evaluation core (REC) and training core (TTC) at APLA and the UCLA Center for Adolescent Health Promotion/RAND Please contact Dr. Matt G. Mutchler: mmutchler@apla.org