The aims of this study were to describe the overall pattern and predictors of attitudes toward criminalizing unprotected sex without disclosure by persons living with HIV among a broad sample of MSM living in the US, and to examine whether attitudes and sexual risk behavior differ by states with HIV-specific laws or no such laws. Participants (n=1,725) were recruited in a 3.5 month period to complete a cross-sectional 70-minute online survey assessing attitudes and high risk sexual behavior. Participants self-identified as male, 18 years of age or older, a US resident, and having ever had sex with a man. In addition, participants were coded as residing in a state with HIV-specific laws or not. Results showed that most (65%) respondents believed it should be illegal for persons living with HIV to have unprotected sex without disclosure. However, among the total sample and HIV-positive MSM, attitudes and unprotected sex with recent partners did not vary by state law. Believing that it should not be illegal for persons living with HIV to have unprotected sex without disclosure was associated with HIV-positive status (OR=0.33), higher education (ORs=0.42–0.64), gay orientation (non-gay orientation: OR=1.54), perceptions that state residents were somewhat or very accepting towards homosexuality (OR=0.75), UAI with 2 or more recent sexual partners (OR=0.72), and lower perceptions of responsibility (OR=0.75). The results did not support the proposition that HIV-specific laws deter high-risk sexual behavior, however further research is needed to examine whether they act as a barrier for MSM at highest risk for acquiring or transmitting HIV.
This study sought to identify how urban gay communities are undergoing structural change, reasons for that change, and implications for HIV prevention planning. Key informants (N=29) at the AIDS Impact Conference from 17 cities in 14 countries completed surveys and participated in a facilitated structured dialog about how gay communities are changing. In all cities, the virtual gay community was identified as now larger than the offline physical community. Most cities identified that while the gay population in their cities appeared stable or growing, the gay community appeared in decline. Measures included greater integration of heterosexuals into historically gay-identified neighborhoods and movement of gay persons into suburbs, decreased number of gay bars and clubs, less attendance at gay events, less volunteerism in gay or AIDS organizations and overall identification and visibility as a gay community. Participants attributed structural change to multiple factors including gay neighborhood gentrification, achievement of civil rights, less discrimination, a vibrant virtual community and changes in drug use. Consistent with social assimilation, across cities, gay infrastructure, visibility and community identification appears to be decreasing. HIV prevention planning, interventions, treatment services, and policies need to be re-conceptualized for MSM in post-gay communities. Four recommendations for future HIV prevention and research are detailed.
The promise of efficient and appropriate health care has never seemed brighter. Telemedicine is providing needed access to medical services to patients in remote locations, research in genetics and genomics is teaching us more about human physiology and making personalized medicine possible, injuries and illnesses that were disabling or lethal in the not-too-distant past are now preventable and treatable. One might think that these advancements would contribute to a minimal standard of care for most medical conditions regardless of where a patient lives and seeks treatment. But, as the current research on variations in medical care demonstrates, such thoughts are false [1]. For example, a patient living in Baltimore, Maryland, is five times more likely to undergo a lower-extremity bypass for peripheral arterial disease of the leg than one living in Temple, Texas, while a patient with prostate cancer is three times more likely to be treated with a radical prostatectomy if he lives in Salt Lake City, Utah, than if he lives in San Francisco, California [2]. Whether it is the underuse of care, the overuse of care, or the inappropriate use of medical resources, national standards for health care are elusive.
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