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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Among 178 HIV-infected men from the San Francisco City Clinic Cohort (SFCCC), we examined the association between health insurance and use of outpatient services and treatment. For men with private insurance, we also assessed the frequency of avoiding the use of health insurance. Men without private insurance reported fewer outpatient visits than men with fee-for-service or managed-care plans. Use of zidovudine for eligible men was similar for those with fee-for-service plans (74%), managed-care plans (77%), or no insurance (61%). Use of Pneumocytstis carinii pneumonia prophylaxis was similar for those with fee-for-service (93%) and managed-care plans (83%) but lower for those with no insurance (63%). Of 149 men with private insurance, 31 (21%) reported that they had avoided using their health insurance for medical expenses in the previous year. In multivariate analysis, the independent predictors of avoiding the use of insurance were working for a small company and living outside the San Francisco Bay Area. Having private insurance resulted in higher use of outpatient services, but the type of private insurance did not appear to affect the use of service or treatment. Fears of loss of coverage and confidentiality may negate some benefits of health insurance for HIV-infected persons.
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PMID:Health insurance and use of medical services by men infected with HIV. 854 47

While the notion of hormonal contraception for men has been around for at least 20 years, research in that direction has been slow. It is widely perceived that men will be reluctant to commit themselves to a systemic method of contraception. Furthermore, ovulation is physiologically easier to interrupt than spermatogenesis. Ovulation is suppressed naturally during pregnancy and lactation, but sperm production continues without interruption from puberty to death. The World Health Organization (WHO) has found that azoospermia is not easy to achieve with hormonal manipulation. The combined failure rate for oligospermic and azoospermic men of slightly less than 2 per 100 person-years suggests that the risk of method failure for oligospermic men may be unacceptably high. WHO will soon publish its analysis of sperm levels in relation to pregnancy risk. Whatever the outcome, the inability to achieve azoospermia reliably must be regarded as a serious limitation of the method. Regular injections of hormones will also be needed due to the high circulating concentrations needed to suppress spermatogenesis. Men may object to following an injection schedule. The possible risks and benefits of using androgens over the long term need to be assessed. Not all family planning experts believe that there is really a need to pursue new hormonal contraceptive methods for men. Professor Malcolm Potts of the University of California at Berkeley believes that research efforts would be better focused upon a vaginal microbicide to prevent HIV transmission. WHO and several independent groups are, nonetheless, actively pursuing the use of testosterone and progestagens as male hormonal contraceptives, while researchers at INSERM, in Paris, are exploring the potential in vivo use of RU-486 to immobilize sperm.
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PMID:What prospects for hormonal contraceptives for men? 862 59

During November 1991 to May 1993, interviews were conducted with and blood samples drawn from 120,216 male military recruits aged 21-29 of the Royal Thai Army (RTA) from every geographic region and social stratum of Thailand. 93.5% were 21 years old. These men are somewhat more representative of the general population than the traditional high risk groups since selection for military service is by lottery and includes all regions of Thailand. The overall HIV seroprevalence was 3.5%. Men from the Upper North region had the highest HIV seroprevalence rate (12.2% vs. 2-4%). This region encompassed the following provinces: Phayao, Chiang Rai, Chiang Mai, Lamphun, Lampang, Phrae, Nan, and Mae Hong Sun. The multivariate analysis of the 97,848 men with a complete set of demographic data and confirmed serostatus (83% of all men inducted) revealed that region of residence was a significant predictor of HIV infection. The odds ratio (OR) of HIV infection among men in the Upper North region was 7.83 (p 0.01). In every region of the country except Upper North, the risk of HIV infection was higher for men from urban areas than those from rural areas (OR = 1.37). In the Upper North region, rural residents were more likely to have HIV infection than urban residents. The higher the man's educational status, the less likely he was to have HIV infection (OR = 0.31 for 13-16 years of education; p 0.01). Risk of HIV infection attributable to age was only significant in unmarried men (OR = 1.76; p 0.01). Thailand has already introduced extensive AIDS education and prevention efforts; they should continue.
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PMID:Correlates of HIV-1 seropositivity among young men in Thailand. 860 95

Men with histories of both homosexual contact and injecting drug use (IDU) are at increased risk of HIV infection over men who have only one such risk. Despite this, their special needs and circumstances have been neglected by AIDS prevention programmes. A survey of a wide spectrum of homosexual male IDUs was carried out in Melbourne and Sydney in 1993 to inform the development of specific policy and programmes for HIV prevention in these subcultures. Of 169 men, self-reported HIV prevalence was 27%. Decreasing compliance with safe sex guidelines (as measured by numbers of casual partners, participation in anal intercourse and use of condoms) was associated with HIV seropositivity, increased age, and increased participation in sex work; having a regular male partner was not protective against unsafe sexual behaviour, no matter the length of the relationship. A substantial proportion (15%) reported inconsistent condom use during anal sex with more than two partners in the preceding month: they were slightly more likely to be engaging in sex work, less 'stable' and more likely to be HIV infected. Sexual risk was not strongly associated with unsafe injecting, which was in general safe. Men who both have homosexual sex and inject drugs are groups at high risk of HIV, more from unsafe sex than from shared injecting equipment; men who believed themselves to be HIV infected were continuing to have sex in such a way that would allow transmission. These are clearly groups in need of priority targeted interventions.
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PMID:Determinants of HIV risk among men who have homosexual sex and inject drugs. 865 99

One-hundred and seventy-four young New York City gay men (aged 18-24) were studied over a two-year period. We describe patterns of HIV risk taking behavior and factors that predict risk taking. Among men who engaged in receptive anal intercourse we discerned different patterns of behaviors. We defined risk takers as men who engaged in receptive anal intercourse. About two-thirds of the men fall into this category in each year, and about half of those (one third of the total) engaged in unprotected anal intercourse. Most of these men seem to make implicit decisions in managing their risk for HIV. Men who engaged in receptive anal intercourse were more likely to be in a coupled relationship and to know their partners' HIV status. Alcohol and/or drug use during sex, earlier sexual experiences, and greater integration into the gay community were also related to receptive anal intercourse. By contrast, a significant minority of the men, about 6% of the sample, engaged in very high risk behavior in each year of the study-defined as unprotected receptive anal intercourse with multiple partners. It appears that very high risk takers are qualitatively different from other risk takers: They reported more mental health problems, including more drug use, and higher levels of internalized homophobia and AIDS-related traumatic stress response. Implications for AIDS education and prevention are discussed.
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PMID:Patterns of sexual behavior and risk taking among young New York City gay men. 866 94

A documentation of the impact of AIDS on New York City during the first decade of the epidemic must highlight the extraordinary responses of the Gay Men's Health Crisis (GMHC) and other community-based organizations. Data collected from volunteers (n = 587) at the close of this decade are presented to address concerns about how successfully an organization such as GMHC will be able to confront the challenging future of the epidemic. Questionnaire data on demographics and prior AIDS experiences and responses to a GMHC Reasons for Volunteering Scale, developed for this study through exploratory and confirmatory factor analysis strategies, are brought to bear on questions about the (1) diversity of the volunteer community, (2) the extent to which volunteers are burdened by potentially debilitating AIDS-related experiences, and (3) the promise for the continued effective and inspirational functioning of GMHC suggested by volunteers' reasons for choosing to volunteer at this time. Volunteers, 62% of whom are gay men and 28% are heterosexual women, represent a wide age range but little diversity in race/ethnicity and educational background. They arrive at GMHC 8 years after its founding with a slight majority having had significant prior experience with HIV-related events. There are six basic kinds of reasons for their volunteering, in order of importance: Joining the AIDS Cause, Personal Growth, Social Contact, Helping the Gay Family, Coping with AIDS, and Career Enhancement.
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PMID:GMHC volunteers and the challenges and hopes for the second decade of AIDS. 866 99

This paper compares the prevalence of risk factors for sexual acquisition of human immunodeficiency virus infection (HIV-1) among blood donors with the risk in the general population. Sexual behaviour data collected as part of a cross-sectional survey of central London blood donors were compared, after indirect standardization for age and sex, with those collected among Greater London participants of the National Survey of Sexual Attitudes and Lifestyles (NATSSAL). Overall, male blood donors had lower risk sexual lifestyles than age-matched NATSSAL participants in that they had had fewer lifetime female sexual partners, were more likely to have had first sexual intercourse after 16 years and were less likely to have had a homosexual partner. Men who have had sex with men since 1977 were asked not to donate blood. Despite this, 3.6% of male donors had had some sexual experience with another man and 1.9% had had sexual intercourse with at least one male partner. In contrast, female donors had had more sexual partners, were more likely to have had first sexual intercourse before 16 years and had probable higher rates of sexually transmitted disease (STD) clinic attendance than NATSSAL participants, explained by the much higher proportion of single rather than married female blood donors at each age. In conclusion, male donors had lower risk sexual lifestyles than age-matched NATSSAL participants, although even low levels of homosexual contact give some cause for concern. Female donors appeared to have higher risk sexual lifestyles than the general population because a much higher proportion of the female blood donors were single. The results provide important insights for those defining blood donor referral criteria.
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PMID:Behavioural risk factors for HIV infection amongst blood donors in London. 869 45

Sexual risk for HIV transmission under the influence of alcohol and/or other drugs is not simply a cause-effect relationship: not everyone who drinks or uses other drugs has unprotected sex. The purpose of this study is to explore differences between substance using gay/bisexual men who use condoms during anal sex from those who do not. These differences are identified by comparing men whose anal sex while under the influence of alcohol and/or drugs is consistently protected to men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected. Gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and to be interviewed about sexual behavior, substance use, and related variables using an extended version of the Timeline Follow-back (TL). The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, and anal intercourse on each of the 30 days prior to the last date of alcohol and/or drug use. Men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected were significantly more likely to report having less than a college education (p = .04), more likely to have an income of less than $20,000 (p = .01), more likely to use amyl nitrite (p = .01) and cocaine (p = .02), and more likely to report a higher frequency of anal sex (p = .007). In addition, they were less likely to approve of sex without love (p = .003), less likely to perceive that safer sex is the community norm (p < .001), and less likely to have encouragement from friends to practice safer sex (p = .001). However, HIV status did not differentiate between the two groups. These two groups provide clear and interesting contrasts in terms of behavior, thus comparisons of the factors influencing sexual safety in these subgroups may enhance our understanding of risk taking. A better understanding of possible mediating variables can be important both in guiding future research in this area and in formulating intervention strategies to target gay men who drink or use drugs in combination with sexual activity.
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PMID:Condom use among gay/bisexual male substance abusers using the timeline follow-back method. 873 May 28

In mid-1991, in a Ugandan town on the trans-African highway, interviews were conducted with and blood specimens taken from 389 persons aged 13 to more than 45 years from 154 households to assess the prevalence of HIV-1 infection and to identify its risk factors. The overall HIV-1 prevalence rate stood at 40.4% (35.6% for men and 43.7% for women). The highest HIV-1 prevalence rates were among men aged 35-44 (56.7%) and women aged 20-24 and aged 25-34 (52.9% and 50.6%, respectively). The urban rate was higher than the semi-rural rate (44.1% vs. 25.6%; p 0.005). 65% of all households had at least one HIV-1 seropositive adult. Single adults had a lower HIV-1 seroprevalence rate than ever married adults (e.g., among men, 10.3% vs. 30.8-62.5%) (relative risk [RR] = 2.8; p 0.005). The Baganda ethnic group had the lowest rate, while the Rwandese group had the highest rate (35.8% vs. 59.2%; RR = 1.4). Education did not affect the prevalence rate. Employed persons were more likely to have HIV-1 infection than the unemployed (44.4% vs. 32.6%; p 0.05). The occupations with the highest HIV-1 infection rates were business person (56.2%) and bar attendant (50%). History of blood transfusion did not appear to be a risk factor for HIV-1 infection (28% vs. 41.3% for no history). 33 HIV-1 seropositive adults had never had sexual intercourse. Men were more likely to have had multiple sex partners than women (e.g., having at least 10 lifetime partners, 61% vs. 11%). Seropositivity rates increased greatly with rising numbers of lifetime sexual partners to a maximum of 3 for females, but it continued to rise for men. It increased for men as the number of contacts in the last month increased (p = 0.05 for trend). 14% of men and 18% of women had a genital ulcer disease in the last 6 months. These findings suggest a need for a three-pronged AIDS prevention strategy: improved sexually transmitted disease control, a reduction in partner change, and an increase in condom use.
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PMID:HIV-1 infection in a Ugandan town on the trans-African highway: prevalence and risk factors. 873 37

Guided by the AIDS Risk Reduction Model (ARRM), psychosocial correlates of HIV risk behavior were examined among noninjection cocaine dependent, heterosexual men (NI-CD-HM) in treatment. Subjects (N = 111) completed a structured interview to measure ARRM mediating variables and HIV risk behaviors. The results indicated that greater perceived susceptibility to contracting HIV, lower sexual self-efficacy, higher lifetime incidence of sexually transmitted diseases, and being under the influence of alcohol or other drugs during sex predicted having more sexual partners in the month prior to admission. Despite adequate knowledge of safer sex guidelines, subjects remained misinformed regarding certain aspects of HIV transmission. Men who perceived that their partners viewed condoms more positively and who exchanged drugs for sex were more likely to use condoms, yet condom use skills were typically inadequate to ensure effective prevention. These results suggest that HIV prevention interventions among NI-CD-HM should focus on improving knowledge, enhancing beliefs in the capacity to enact safer sex behaviors for preventing HIV and other STDs, building relevant skills (e.g., condom use, open sexual communication between partners), and emphasizing psychoactive substance abstinence. Couple interventions, in which partners actually rehearse safer sex negotiations, may be particularly effective in this regard.
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PMID:HIV risk correlates among non-injection cocaine dependent men in treatment. 880 51


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