Sexual Risk Behaviors of Selfidentified and Behaviorally Bisexual HIV Men'

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Sexual Risk Behaviors of Self-identified and
Behaviorally Bisexual HIV Men.

• By Matt G. Mutchler, PhD
• Miguel Chion, MD, MPH
• Nancy Wongvipat, MPH
• Lee E. Klosinski, PhD
• and Summra Shariff

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Background

• Research has been conducted by Doll and Beeker
  (1996) highlighting four contexts in which
  bisexual behavior is associated with HIV risk
• male prostitution.
• injecting drug use.
• sexual identity exploration.
• culturally specific roles in some African
  American and Hispanic communities.

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Background

• Heterosexual women represent an increasing
  proportion of persons living with AIDS nationally
  (CDC, 2000) and in L.A. County (DHS, LA County,
  2000).
• Prior research found that bisexual men report
  more female sexual partners compared to gay men
  and more unprotected sex with female partners
  compared to male partners. (Wold et al., 1998
  Ekstrand et al., 1994).

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Background

• HIV bisexual men faced with at least 2 social
  stigmas
• Bisexual identity.
• Living with HIV.

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Study Design

• Cross-sectional, mail administered survey.
• Administered in English and Spanish.
•  Data collected Oct 1999 Jan 2000.
• Survey participants were 113 HIV
  self-identified bisexual men drawn from a
  larger sample.

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Survey Domains

• Demographic
• General health
• Health status
• Sexual risk behaviors
• HIV status disclosure
• HIV medication adherence
• Tobacco use
• Drug and alcohol use

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Outcome Variables

• Unprotected anal or vaginal intercourse
• Non disclosure of HIV status to sexual partners

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Survey Limitations

• Based on self reported information
• The findings may not be generalizable to
  populations outside the sample

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Objective

• To assess demographic, health, HIV medication
  adherence, substance use, sexual risk and HIV
  status disclosure data gathered from
  self-identified bisexual men.

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Guiding Purposes

• Analyzing data on factors that significantly
  correlate with sexual risk behaviors among HIV
  bisexual men.
• Reporting HIV disclosure patterns among HIV
  bisexual men.
• Providing formative data for intervention studies
  targeting HIV bisexual men.
• Outlining a research trajectory.

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Statistical Analyses

• Univariate analyses performed to provide
  descriptive statistics.
• Bivariate analyses to assess associations between
  independent and dependent variables.
• Used SPSS software

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Results Age Race/Ethnicity
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Relationship Status
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Socio-Economic status

• 53.2 of participants reported being at or below
  the poverty level.

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HIV/AIDS Status
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Treatment Adherence

• Approximately half (49.5) of the respondents
  reported that they were adherent to their HIV
  medications.

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Sexual Risk Behaviors

• Among the HIV bisexual men, 66.3 reported being
  sexually active.
• Average number of partners was 3.9 in the past 6
  mos.
• 31 reported UAVI in past 6 mos.

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Sexual Risk Behaviors-cont.

• Participant who had sex with men
• 62.2 reported UAI
• 41 reported UAI with HIV negative or unknown
  partners
• Participants who had sex with women
• 50 reported having UAVI
• 38.5 reported UAVI with HIV negative partners of
  unknown status

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Sexual Risk Behaviors-cont.

• Non adherence to HIV medications, recreational
  drug use, tobacco use and feeling the effects of
  drugs or alcohol during sexual activities were
  positively correlated with unprotected anal and
  vaginal sex among the HIV bisexual males (Plt
  .05).

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Sexual Risk Behaviors-cont.

• HIV bisexual men more likely to report
  unprotected sex with seroconcordant male and
  female sexual partners compared to
  serodisconcordant male and female sexual
  partners.

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Sexual Risk Behaviors-cont.

• Highest rate of unprotected sex reported (23.1)
  with self reported HIV disconcordant sexual
  partners was in the category of unprotected anal
  or vaginal intercourse with female sexual partner
  of unknown HIV status

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HIV Status Disclosure

• 50 of bisexual men did not always disclose to
  male sexual partners.
• 47 of bisexual men did not always disclose to
  female sexual partners.

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Recommendations

• Little data exists to inform HIV prevention
  interventions about the sexual risk and
  disclosure behaviors of HIV bisexual men and
  MSMW and the unique implications for transmitting
  HIV to other male and female sexual partners.

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Recommendations-cont.

• Prevention educators need to consider that HIV
  bisexual men may be very likely to have
  unprotected sex with female partners of unknown
  HIV status.
• Programs need to impart communication and
  disclosure skills, especially with female
  partners.

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Recommendations-cont.

• Prevention programs should also address substance
  use issues as well as adherence to HIV
  medications.

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Recommendations-cont.

• Prevention efforts should focus on the potential
  for STD co-infection and possible HIV reinfection
  among HIV bisexual men and their HIV male and
  female sexual partners.

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Research Agenda

• Complex cultural factors and sexual scripts among
  particular racial/ethnic groups and in specific
  geographic context need to be examined to
  elucidate the HIV risk practices of HIV bisexual
  men and MSMW.
• Future research on HIV bisexual men and MSMW
  needs to examine associations between such
  factors and risk behaviors.

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Summary

• With the high rates of unprotected sex and low
  rates of HIV disclosure reported there is an
  urgent need to focus immediate prevention efforts
  on this population.
• More research is needed to understand contextual
  factors mediating such behaviors among varied
  sub-populations.
• Self identified bisexual men and MSMW who are
  living with HIV and AIDS need to be considered as
  unique groups in particular social, cultural and
  geographic contexts.

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Summary

• More quantitative data needed to identify
  predictors of risk among self-identified and
  behaviorally bisexual males.
• Qualitative data need to identify contexts of
  sexual risk and HIV disclosure behaviors among
  these populations.
• Such efforts will help curb the continuing spread
  of HIV and STDs among bisexual men, MSMW and
  their sexual partners.