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This study examined awareness of and attitudes about highly active antiretroviral therapies (HAARTs) among adolescent and young men who have sex with men (MSM). As part of the multisite Young Men's Survey, 813 MSM aged 15-22 years who attended public venues in two cities were questioned about HAART in 1997-1998. Overall, 45.1% had heard of HAART, 61.6% in Seattle, Washington, and 35.0% in New York City. MSM in New York City who were the youngest, men of color, men who were human immunodeficiency virus (HIV) antibody negative, and men who resided in New Jersey were significantly less likely to be aware of HAART. Attitudes about HAART were not associated with sexual risk behaviors. Prevention efforts among young MSM should focus on other determinants of risk, but also include information on the changing nature of HIV therapies.

Background: This study examines the association between trauma and HIV risk behaviors among women at sexual risk for HIV infection., Methods: From April to August 1998, high-risk HIV negative women were recruited in the South Bronx into a year-long cohort study. At the 12-month visit, 116 women were interviewed face-to-face about recent and lifetime violent and non-violent traumas., Results: The women reported a substantial prevalence of sexual risk behaviors associated with the acquisition of HIV. At baseline, almost two-thirds (64%) reported unprotected vaginal sex in the previous six months, and in the previous year, 62% had smoked crack, 52% reported sex-for-money-or-drugs exchanges, and 47% had five or more male sex partners. The lifetime prevalence of trauma was high: 81% had experienced one or more violent traumas and 97% had experienced one or more non-violent traumas. Women who had experienced violent trauma--physical assault by a partner (OR = 2.88; 95% CI 1.12; 7.41)--and those who had experienced non-violent trauma--loss of a child to foster care (OR = 3.34; 95% CI 1.04; 10.65)--were more likely to use crack than others. Those who had experienced non-violent trauma, by witnessing a physical assault (OR = 2.31; 95% CI 0.99; 5.40), were also more likely than others to have exchanged sex., Conclusions: Both violent and non-violent traumas appear to play a role in the behaviors that place women at risk of HIV infection, particularly using crack and exchanging sex.

Project ACHIEVE, which conducts HIV prevention research studies, maintains a women's site in the South Bronx in NewYork City. Owing to a focused retention effort at the South Bronx site, high retention rates were achieved in a vaccine preparedness study for women at high risk of HIV infection. Comparable retention rates have been achieved in HIV vaccine trials with similar cohorts of women at this site. These results suggest that concerns about retaining hard-to-reach populations should not cause these populations to be excluded from HIV vaccine and prevention trials.

This paper identifies the recruitment strategies and human immunodeficiency virus (HIV) risk behaviors of at-risk women in an HIV vaccine preparedness study in New York City, assesses how these behaviors changed over time, and draws implications for women's involvement in HIV vaccine efficacy trials. Noninjecting HIV-1 negative women (N = 89) were recruited into an HIV vaccine preparedness study. An observational cohort study design was used. Women were recruited from clinics and community-based organizations (40%), through other study participants (24%), through newspaper advertisements (20%), and through street outreach (16%). Most women who refused (72%) also came from clinics and agencies. Retention after 12 months was 67%; after 18 months, it was 62%. The proportion of women reporting unprotected vaginal sex in the previous 3 months was 85% at baseline and declined to 70% after 12 months (P < .05). There have been no seroconversions detected. Recruitment efforts to include at-risk women in HIV vaccine efficacy trials must be diverse and actively involve community agencies. Successfully retaining these cohorts over time and detecting a high enough HIV seroincidence rate present ongoing challenges that will need to be addressed to ensure women's involvement in future trials in the US.

Objective: To determine the prevalence of HIV infection and risk behaviors among young men who have sex with men (MSM) aged 15-22 years in New York City., Design: An anonymous cross-sectional survey., Methods: The 1998 Young Men's Survey in New York City (YMS-NYC), was a multistage probability survey of 541 MSM aged 15-22 years who attend public venues. After identification of venues and their associated high attendance time periods, random samples of venues and time periods were selected on a monthly basis. At each sampling event, potential participants were approached to determine eligibility. Eligible and willing men were interviewed, counselled and had a blood specimen drawn., Results: Between December 1997 and September 1998, 115 sampling events were conducted. Of 612 men enrolled, 541 reported ever having had sex with a male partner. The HIV seroprevalence among the 541 MSM sampled was 12.1%. The HIV seroprevalence was 18.4% among African-Americans, 16.7% among persons of mixed race, 8.8% among Latino individuals and 3.1% among white men. HIV seroprevalence was 5.0% among 15-18 year olds and 16.4% among 19-22 year olds. A total of 65.5% of MSM were susceptible to hepatitis B virus infection (HBV). Almost half (46.1%) of the men reported unprotected anal sex in the previous 6 months and 16.3% reported ever having had an STD. Multiple regression analyses found that being older, of mixed race, black or ever having had an STD was associated with being HIV antibody positive., Conclusion: These data identify a large subgroup of MSM in need of effective HIV and HBV primary and secondary prevention programs.

Information on long-term survival after infection with human immunodeficiency virus type 1 (HIV-1) is limited. In hepatitis B vaccine trials in Amsterdam, New York City, and San Francisco, 362 gay men were followed up to 18 years (1978-1995). The median survival time from seroconversion was 12.1 years (95% confidence interval: 11.4, 12.9). The annual risk of dying increased at a constant rate until 8 years after seroconversion and then leveled off, suggesting a group that is relatively resistant to progression. These data provide a picture of the natural history of HIV-1 infection, especially in the era prior to widespread use of highly effective treatments.