Barcelona 2013
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| Abstract #392 - Prevention | ||||
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Session: 24.4: Prevention (Parallel) on Tuesday @ 11.00-13.00 in Teatre Chaired by Cate Hankins, Juanse Hernandez Authors: Presenting Author: Dr. Laura D'Anna - California State University, Long Beach, United States |
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| Additional Authors: Mr Henry Luyombya, Dr Eleanor Maticka-Tyndale, Dr Alan Li, Dr Josephine Wong, Dr Kenneth Fung, | ||||
| Aim: Previous research indicates that persons particularly at risk of being infected by or transmitting HIV are also more likely to engage in anal intercourse (AI). Studies have also found relatively high rates of AI among women. However, HIV prevention messaging targeted to heterosexual persons continues to emphasize vaginal intercourse transmission and not risks from AI. In this analysis we aimed to: 1) determine the prevalence of receptive AI in a sample of urban US STD clinic patients; 2) assess differences in condom use consistency for receptive AI among women and MSM; and 3) examine characteristics and cognitive factors predictive of condom use consistency. | ||||
| Method / Issue: Patients (n=1609) were enrolled in a behavioral sub-study of Safe in the City, a multi-site STD/HIV prevention trial that examined the effectiveness of a video-based intervention. Analyses were restricted to women and MSM who reported receptive AI with at least one partner in the prior 3 months at baseline or at the 3-month follow-up survey. Condom use was categorized as none (0%), inconsistent (1-99% of receptive acts of AI), and consistent (100% of receptive acts of AI). Bivariate relationships were assessed using chi-square tests. Two generalized estimating equation (GEE) models (one each for females and MSM) predicting condom use during receptive AI included characteristics and cognitive factors at 3 levels: (1)respondent-level (e.g., education, race/ethnicity, perceived STD/HIV risk, condom use knowledge, beliefs and intentions, and ability to stop having sex if condoms are unavailable),(2)partner-level (main/non-main status, concurrent sex partners, perceived STD risk), and (3)partnership-level (drunk/high during AI, perceived support for using condoms, condom use self-efficacy, intention for safer sex behaviors). | ||||
| Results / Comments: Of 555 women with 3330 partnerships, 171(30.8%) women reported AI at least once within 254 partnerships (7.6% of partnerships). Of these partnerships, 176(69.3%) reported no condom use, 19(7.5%) inconsistent use, and 59(23.2%) consistent use. In contrast, of 263 MSM with 765 partnerships, 184(70.0%) MSM reported receptive AI at least once within 425 partnerships (55.6% of partnerships). Of these partnerships, condoms were not used in 188(44.2%), used inconsistently in 45(10.6%) partnerships, and used consistently in 192(45.2%) (chi-square = 40.97, p=<0.0001). For females, multivariable analyses revealed the belief that women could stop having sex in situations when condoms were unavailable (e.g., even if really turned on or in love with partner) (OR=1.75;CI:1.09-2.81) and perceived partner support for condom use (OR=1.86; CI:1.18-2.96) predicted condom use consistency. For MSM, perceived partner support for condom use was predictive of condom use consistency (OR=1.81;CI:1.22-2.69), as were main partnership status (OR=3.72;CI:2.16-6.40), no perceived partner STD (OR=1.88;CI:1.14-3.11), partner-specific intention to use condoms (OR=4.75;CI:2.68-8.42), and partner-specific condom use self-efficacy (OR=1.69;CI:1.24-2.30). | ||||
| Discussion: Almost one-third of female and 70% of MSM participants reported engaging in AI at least once. Condoms were not used for a sizable proportion of receptive AI in female and MSM partnerships, but consistent condom use was significantly lower for females. Condom use counseling should consider barriers and facilitators unique to receptive anal sex for each population, and specifically, improving cognitive mediators for women and MSM may improve condom use consistency for both groups. | ||||
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