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Objectives: We sought to calculate HIV incidence in a retrospective cohort of young (13-29 years old) black men who have sex with men (YBMSM) accessing repeated HIV-antibody testing in a mid-size city in the USA., Methods: We aggregated site-specific HIV-antibody testing results from the project's inception among YBMSM who received an initial negative result and accessed at least one additional HIV-antibody test. From these data, we assessed number of seroconversions and person-years and calculated HIV incidence using a mid-P exact test to estimate 95% CIs., Results: Five seroconversions were documented over 42.3 person-years (the mean age at first onsite test: 19.7 years), resulting in an HIV incidence rate of 11.8% (95% CI 4.3% to 26.2%). The mean age at seroconversion was 20.4 (±3.0) years., Conclusions: Even in mid-size cities with low HIV prevalence rates in the general population, HIV incidence among YBMSM may be high. Community-based HIV-antibody testing organisations serving YBMSM should be encouraged and trained to track repeated HIV testing and calculate HIV incidence rates. Increased resources should be deployed to develop and encourage regular HIV testing in community health sites serving YBMSM., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Bisexual men experience significant health disparities likely related to biphobia. Biphobia presents via several preconceptions, including that bisexuality is transitory, and that bisexual men act as viral bridges between men who have sex with men and heterosexual populations. We analyzed data from a prospective cohort of gay and bisexual men, the Multicenter AIDS Cohort Study, to test these preconceptions. Men reporting both male and female sexual partners (MSMW) between 2002 and 2009 (n = 111) were classified as behaviorally bisexual. We assessed five hypotheses over two domains (transience of bisexual behavior and viral bridging). No evidence was found supporting the transitory nature of bisexuality. Trajectories of bisexual behavior were not transient over time. We found little evidence to support substantial viral bridging behavior. Notably, HIV-positive MSMW reported lower proportions of female partners than HIV-negative MSMW. Our results provide no empirical support for bisexual transience and scant support for viral bridging hypotheses. Our results provide key data showing that male bisexual behavior may be stable over long time periods and that behaviorally bisexual men's risk to female sexual partners may be lower than expected.

Though functional social support has been shown to serve as a protective factor for HIV viral load suppression in other populations, scant research has examined this relationship among men who have sex with men (MSM) in the United States. We assessed characteristics of social support, effects of social support on HIV viral load, and moderation by social support of the relationship between psychosocial indicators of a synergistic epidemic (syndemic) and HIV viral load. We analyzed longitudinal data from HIV-positive MSM using antiretroviral therapy who were enrolled in the Multicenter AIDS Cohort Study between 2002 and 2009 (n = 712). First, we conducted reliability assessments of a one-item social support measure. Then, we conducted a series of generalized longitudinal mixed models to assess our research questions. Moderation was assessed using an interaction term. A three-level (low/medium/high) social support variable demonstrated high reliability (intraclass correlation coefficients  = 0.72; 95% CI: 0.70, 0.75). Black and Hispanic MSM reported lower social support than their White counterparts (p < .0001). Recent sero-conversion was associated with higher social support (p < .05). Higher numbers of concomitant syndemic indicators (depression, polysubstance use, and condomless anal sex) were associated with lower social support (p < .0001). Medium and high social support levels were associated with greater viral load suppression and lower viral load means (p < .0001). Social support moderated the relationships between syndemic and HIV viral load (p < .05). HIV-positive MSM, particularly those of color, may benefit greatly from interventions that can successfully boost functional social support. Creating strengths-based interventions may also have particularly high impact among HIV-positive MSM with the highest psychosocial burdens.

Introduction: Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO., Methods: Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion., Results: MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01)., Discussion: Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.

Objectives: To estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively., Methods: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses., Results: We estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples., Conclusions: This represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population's HIV burden.

Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics ("syndemics") affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0-3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2-9.6); and syndemics predicted TS and CSS involvement (p < 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics.

Too many people with HIV have left the job market permanently and those with reduced work capacity have been unable to keep their jobs. There is a need to examine the health effects of labor force participation in people with HIV. This study presents longitudinal data from 1,415 HIV-positive men who have sex with men taking part in the Multicenter AIDS Cohort Study. Generalized Estimating Equations show that employment is associated with better physical and mental health quality of life and suggests that there may be an adaptation process to the experience of unemployment. Post hoc analyses also suggest that people who are more physically vulnerable may undergo steeper health declines due to job loss than those who are generally healthier. However, this may also be the result of a selection effect whereby poor physical health contributes to unemployment. Policies that promote labor force participation may not only increase employment rates but also improve the health of people living with HIV.

We conducted a critical literature review for possible reasons that may explain the lower HIV prevalence observed among API MSM compared to MSM of other races/ethnicities. Trends emerging from the literature suggest that traditional individual-level factors-unprotected anal intercourse, substance use, STD prevalence, rates and frequency of HIV testing, and utilization of HIV prevention services-do not appear to be related to the lower HIV prevalence among API MSM. Some evidence suggests that socio-cultural and structural factors might be the more critical forces in determining racial/ethnic disparities of HIV among MSM. For API MSM, these factors include structures of sexual networks, access to and reception of medical care and treatment among HIV-positive MSM, and influences of different levels and types of acculturation. Moreover, emerging risk reduction strategies, such as seroadaptive behaviors, could play a role. Future research should address these factors in intervention design. In addition, better theories of resilience and measurement of strengths and protective factors are needed to enhance the efficacy of HIV interventions.

While the intersection of HIV/AIDS and intimate partner violence (IPV) has gained increased attention, little focus has been given to the relationship among minority men and men who have sex with men (MSM). This pilot study, conducted at an urban clinic, explores the IPV experiences of HIV-positive persons involved in both heterosexual and homosexual relationships. Fifty-six HIV-positive individuals were interviewed to assess for verbal, physical, and sexual IPV, and for HIV-related abuse and attitudes regarding routine IPV screening. Approximately three quarters (73%) of the sample reported lifetime IPV and 20% reported current abuse. Physical IPV (85%) was cited the most by abused participants. IPV rates were highest among African-Americans and MSM. More than one-fourth (29%) of those abused felt the abuse was related to their HIV status. A majority of participants favored IPV screening by providers, but felt it might increase risk of IPV. IPV and its association to HIV are significant issues among this sample. Findings support the need for developing new programs that address these epidemics simultaneously.

We describe the efforts of a 4-city campaign to recruit Black and Hispanic men who have sex with men into an established HIV epidemiological study. The campaign used community organizing principles and a social marketing model that focused on personnel, location, product, costs and benefits, and promotion. The campaign was developed at the community, group, and individual levels to both increase trust and reduce barriers.The proportion of Hispanic men recruited during the 2002-2003 campaign doubled compared with the 1987 campaign, and the proportion and number of White men decreased by 20%. The proportion of Black men decreased because of the large increase in Hispanic men, although the number of Black men increased by 56%. Successful recruitment included training recruitment specialists, involving knowledgeable minority community members during planning, and having an accessible site with convenient hours.

HIV infection among people with severe mental illness (SMI) is a growing concern, and interventions have been designed to address HIV prevention among these individuals. However, little is known about the preparedness of mental health providers to support these interventions. This study concentrated on mental health case management as a locus for HIV-prevention services. Focus groups of case managers were conducted to learn participants' motivation to adopt HIV-prevention services and barriers/facilitators to such adoption. Participants reported they would be motivated to offer HIV prevention if services were to be presented in the context of existing client relationships and case-management tasks. Barriers and facilitators were discussed at client, provider, and community levels, and recommendations for training were offered. Findings have implications for diffusion of HIV-prevention services in case management, and the line of questioning in focus groups provides a basis for learning about other behavioral health service contexts as loci for disease prevention.

Objectives: This study was designed to augment an evaluation of Pennsylvania publicly funded HIV counseling and testing sites, particularly of the staff-client interaction., Methods: Actors were trained as research assistants and sent to 30 randomly chosen sites to be tested and counseled for HIV disease. Instruments based on Centers for Disease Control and Prevention (CDC) guidelines were designed and used to evaluate them., Results: Data were generated that identified the range of compliance with CDC guidelines and state policy. Among the findings were that 10 of 30 sites required signed consents despite a state policy allowing anonymous testing. Only 17% of providers developed a written risk reduction plan, even though 69% of all sites surveyed by mail asserted that such plans were developed. Only 2 of 5 HIV-positive actors were offered partner notification services, even though 100% of sites visited by an interviewer claimed to offer such services., Conclusions: The findings suggest that although evaluation methods such as mail surveys and site visits are useful for evaluating the existence of appropriate policies and protocols and gathering baseline data, they might not be sufficient for assessing actual staff-client interaction.

The success of efforts to prevent continued transmission of the human immunodeficiency virus (HIV) and to increase compliance with HIV prophylactic interventions among homosexual and bisexual men will depend in part on health care professionals' understanding of and ability to establish linkages with these men. In order to recruit men into a research project and an educational program, staff at the Pitt Men's Study, an epidemiological investigation of HIV infection, developed a process described here as "brokering," which was based on community organizing and marketing principles. Brokering is a dynamic process by which researchers and public health professionals exchange goods and services with formal and informal leaders of the gay community in order to establish strong, long-term linkages. To date, this process yielded 2,989 homosexual and bisexual recruits into the study, which began in 1983. After 8 years, 79% of those still alive continue to return for follow-up. While recruitment techniques will need to vary from city to city, the importance of establishing linkages with the local indigenous leadership remains of major importance.

The Centers for Disease Control reported in October 1991 that many people at risk for human immunodeficiency virus (HIV) infection had not been tested for antibodies to HIV. This study identifies differences among 110 gay and bisexual men in three small cities in Pennsylvania who decided whether to be tested for antibodies to HIV and, if so, whether to return for results. These men were given self-administered questionnaires and were offered free and confidential HIV antibody tests. Fifty percent of the men refused testing. Of those tested, only 35 percent returned to obtain test results. Contrary to other health prevention data, education was significantly and inversely related to being tested and to returning for results. Men who most often participated in the institutionalized gay community were least likely to be tested. The findings suggest that gay men who are most aware of the potential psychosocial problems associated with HIV antibody testing are more likely to avoid testing.

Data were collected from 1614 homosexual and bisexual men in 1984 through 1985 and from 1988 to 1992 in Pittsburgh. Of the men entering the study since 1988, 16% reported engaging in unprotected anal receptive intercourse with more than one partner during the 6 months before their visit. Approximately 7% of the younger men and 18% of the men over 22 years of age in the recent cohort were already infected with the human immunodeficiency virus, the same rates as those described 8 years ago. Aggressive risk-reduction programs are needed in high schools and existing networks in the gay community.

Because of new preventive therapies, HIV-antibody testing of asymptomatic individuals now has clear clinical benefits. Consequently, greater numbers of individuals are expected to seek testing. This article, based on the authors' experiences with disclosing HIV-antibody test results to a high-risk group of men, makes recommendations for how best to present HIV-antibody results. Disclosing HIV-antibody results provides an educational opportunity as well as a psychological challenge for clinicians. Some unusual client reactions are detailed in the case studies.