Reseña del estudio "LINKS": Factores asociados a la infección por VIH en hombres que tienen sexo con hombres de Buenos Aires, Argentina / Review of the "LINKS" study: Factors associated with HIV infection in men who have sex with men in Buenos Aires, Argentina

Este artículo resume resultados publicados del proyecto LINKS. Un to-tal de 500 hombres que tienen sexo con hombres se incluyeron en un estudio de factores asociados a la infección por VIH, utilizando la meto-dología de Muestreo Dirigido por los Participantes (Respondent Driven Sampling, RDS, en inglés). El 24,5 % se identificó como homosexual, 36,2 % como bisexual, 21,9 % como heterosexual y 17,4 % como "otro". El 33 % de los participantes reportó haber tenido relaciones sexuales con hombres, mujeres y mujeres trans durante los 2 meses previos. La prevalencia de VIH, hepatitis B y sífilis fue de 17,3 %, 22,9 % y 20,5 %, respectivamente. Los participantes que sólo reportaron parejas sexua-les masculinas tuvieron prevalencias significativamente mayores. Más de dos tercios reportaron coito anal o vaginal sin protección durante los últimos dos meses. El 52 % nunca se había realizado el diagnóstico de VIH. El 25 % informó consumo ex-cesivo de alcohol y 34 % poli-consumo de drogas du-rante los dos meses previos. El 18 % de participantes reportó una experiencia sexual antes de los 13 años con una pareja al menos cuatro años mayor de edad. La aceptabilidad de los microbicidas y de la prueba casera del VIH fue alta

[Summary of the LINKS Study: Factors associated with HIV infection among men who have sex with men in Buenos Aires, Argentina]. / Reseña del estudio "LINKS": Factores asociados a la infección por VIH en hombres que tienen sexo con hombres de Buenos Aires, Argentina.

This article summarizes published findings from Project LINKS. A total of 500 men who have sex with men were recruited through Respondent Driven Sampling into this study on factors associated with HIV infection. Among participants, 24.5 % identified as gay, 36.2 % as bisexual, 21.9 % as heterosexual, and 17.4 % as "other"; 33 % reported having sex with men, women, and transgender women during the prior two months. Prevalence of HIV, Hepatitis B, and syphilis was 17.3 %, 22.9 %, and 20.5 %, respectively; rates were significantly higher among participants who only had male sex partners. Over two-thirds of participants reported unprotected anal or vaginal intercourse during the prior two months, and 52 %had never been tested for HIV. Twenty-five percent reported heavy drinking, and 34 % reported poly-drug use during the past two months. Eighteen percent of participants reported a sexual experience prior to the age of thirteen with a partner who was at least four years older. Acceptability of microbicides and HIV home testing was high.

Childhood sexual experiences with an older partner among men who have sex with men in Buenos Aires, Argentina.

This study sought to describe childhood sexual experiences with older partners (CSEOP) among men who have sex with men (MSM) in Buenos Aires, Argentina. MSM were recruited through respondent driven sampling. They responded to a computer administered self-interview with questions on CSEOP, operationalized as manual, oral, genital, or anal contact prior to age 13 with a partner at least 4 years older. Of the 500 respondents, only 25% identified as gay. Eighteen percent of the respondents reported CSEOP, the majority of whom did not feel they were hurt by the experience and did not consider it to be childhood sexual abuse (CSA). Over two-thirds of MSM who reported CSEOP said that their older partner was a female. Only 4% of those with a female partner felt their experience was CSA compared to 44% of those who had a male partner. Among all men reporting CSEOP, those who felt sexually abused were more likely to have been physically forced or threatened, physically hurt, and emotionally hurt than those who did not feel sexually abused. Having CSEOP, being hurt by the experiences, and perceiving the experiences as sexual abuse were not associated with current HIV sexual risk or substance use behavior. In this sample of MSM in Argentina, a substantial minority reported CSEOP. Those who felt they had been sexually abused were much more likely to have had an older male partner than an older female partner, and were more likely to report having been physically forced and threatened by their older partner.

The Motivations and Experiences of Young Women in a Microbicide Trial in the USA and Puerto Rico.

Young women are an important target group in microbicide research, yet little is known about why they participate and stay in microbicide trials. Our study examined motivations for participating in a Phase I microbicide trial among 61 women ages 18 - 24 years in the continental USA and Puerto Rico. We also examined their perspectives on study participation. Participants underwent a semi-structured in-depth interview in which they were asked about factors that motivated enrollment and their experiences while participating. They also completed a Web-based Computer Assisted Self Interview in which they were asked to rate study burden (1 = low to 4 = high). Factors that motivated enrollment were altruism (29%), compensation (17%), a combination of altruism and compensation (37%) and free medical exams (17%). Factors that encouraged participants to stay in the study were study staff (95%), confirmation of good health (41%), and the opportunity to learn about their bodies (17%). Mean ratings of study burden ranged from 1.83 (having to travel to site) to 2.41 (colposcopy), indicating that participants were not highly bothered by visits or procedures. Although Phase I trials require invasive procedures, participants were not highly bothered by them and recognized them as necessary. Good relationships with staff and clear information about how procedures contribute to study goals may encourage participants to remain in trials. Young women may be motivated to enter microbicide trials by stressing the role they will play in discovering better HIV-prevention methods and highlighting the comprehensive preventive exams they will receive.

Young women's experience with using videoconferencing for the assessment of sexual behavior and microbicide use.

BACKGROUND: Videoconferencing (VC) systems are increasingly recognized as a viable means of enhancing communication across different geographic regions and have been used within multiple settings. Until now, despite increased use and diverse applications, VC has received relatively little attention as a data collection tool in qualitative research. The literature on preferred data collection methods for sensitive topics offers different perspectives, with no clear consensus on the best approach for collecting sensitive data. We sought to determine if VC is a feasible tool for eliciting sexual history from participants in a vaginal microbicide study. SUBJECTS AND METHODS: Fifty-nine young women who participated in a Phase 1 microbicide safety and acceptability study at three sites (Tampa, FL; Pittsburgh, PA; and San Juan, Puerto Rico) were interviewed through VC from New York City. During the third VC session, participants gave feedback on their experience using the method. RESULTS: Most of the participants reported that they preferred VC to phone-only interviews. Participants noted that because of the sensitive nature of the interviews, geographical distance from the interviewer facilitated disclosure. Despite some technical problems, such as the time delay in video transmission and occasional loss of connection, participants expressed a high degree of satisfaction with using VC. CONCLUSIONS: VC seems to be a feasible alternative form of conducting in-depth interviews on sensitive topics. VC enables data collection from geographically dispersed research participants without the cost and time burden of traveling to sites or developing local interviewer capabilities when the number of interviews is small.

Use of a novel technology to track adherence to product use in a microbicide trial of short duration (MTN-007).

Adherence measurement in microbicide trials is challenging. To decrease recall and social desirability bias, we used an interactive voice response system (IVR) in a rectal microbicide trial. Forty-six participants were asked to report product use daily for 1 week. Participants received an incentive per call plus a bonus for calling every day. We examined adherence to calling the IVR and to gel use; we compared the latter to applicator counts. Adherence to calling the IVR daily was high (mean = 89.9 %, SD = 20.7 %). Adherence to gel use per IVR was very good (mean = 90.7 %, SD = 19.1 %), and consistent with applicator counts in 80.4 % of cases. Neither adherence to calling nor gel use were associated with temporal factors like day calls started, number of days since first call, or weekday vs. weekend. Daily reporting allowed identification of irregular product use. IVR appears useful for daily reporting in brief trials.

Variations in microbicide gel acceptability among young women in the USA and Puerto Rico.

In a multi-site study of vaginal microbicide acceptability conducted with sexually active young women, quantitative assessments revealed significant differences in acceptability by site. Participants in Puerto Rico rated the gel more favourably than mainland US participants in terms of liking the gel and likelihood of future use. To explain these differences, we examined responses to qualitative behavioural assessments. Young women in mainland USA associated gel leakage with uncomfortable sensations experienced during menstruation, while young women in Puerto Rico had positive associations of gel use with douching. These negative or positive associations affected assessments of the gel's physical qualities. In addition, young women's perceptions of primary partners' support for microbicide use influenced sexual satisfaction with the gel and, ultimately, product acceptability. Finally, geographic HIV-risk context contributed to heightened HIV-risk perception, which influenced likelihood of future microbicide use, even for women in stated monogamous relationships. Future microbicide acceptability studies should take into account potential differences in acceptability by site such as HIV-risk perception based on local HIV prevalence, popularity of vaginal hygiene products in a specific area and male attitudes in different cultures concerning women's use of HIV protection strategies.

"Tell Juliana": acceptability of the candidate microbicide VivaGel® and two placebo gels among ethnically diverse, sexually active young women participating in a phase 1 microbicide study.

This study assessed acceptability of the candidate microbicide VivaGel(®) and two placebo gels among 61 sexually active young US and Puerto Rican women at three sites. Participants were randomly assigned to use one of the gels twice per day for 14 days. At trial completion, 59% of the women in the VivaGel(®) group reported being likely to use the gel in the future, whereas 23% were unlikely to use it and 18% were undecided. Participants reported problems with all three gels, including the "universal" placebo containing hydroxyethyl cellulose (HEC). The most frequent complaints were leakage, interference with sexual behavior, and decreased sexual satisfaction. Some of the complaints are not new but remain unresolved. Women's perceived risk of HIV infection may determine whether the gels are used. Users also may want a choice of viscosity. Poor acceptability of vaginal microbicide formulations may result in poor adherence to gel use during efficacy trials and compromise validity of results.

Sexual pleasure and intimacy among men who engage in "bareback sex".

An ethnically diverse sample of 120 mostly gay-identified men who engaged in "bareback" intercourse was recruited via the Internet in New York City. By study design three quarters of participants were HIV-uninfected and engaged in condomless receptive anal intercourse. In the course of face-to-face in-depth interviews, participants were asked what led them to have their first bareback experience as well as to continue with the behavior. Qualitative analysis identified the pivotal role that sexual pleasure and intimacy have in this population and how drives for sexual satisfaction, adventure, intimacy, and love overpower health concerns and condom use recommendations. Men interested in bareback sex use a variety of defense mechanisms to account for, justify, and exonerate their behavior. HIV-prevention interventions have paid insufficient attention to libidinal drives, a crucial element of psychological functioning.