Sexual Behaviors of US Women at Risk of HIV Acquisition: A Longitudinal Analysis of Findings from HPTN 064

Abstract

We describe the sexual behaviors of women at elevated risk of HIV acquisition who reside in areas of high HIV prevalence and poverty in the US. Participants in HPTN 064, a prospective HIV incidence study, provided information about participants’ sexual behaviors and male sexual partners in the past 6 months at baseline, 6- and 12-months. Independent predictors of consistent or increased temporal patterns for three high-risk sexual behaviors were assessed separately: exchange sex, unprotected anal intercourse [UAI] and concurrent partnerships. The baseline prevalence of each behavior was >30% among the 2,099 participants, 88% reported partner(s) with > one HIV risk characteristic and both individual and partner risk characteristics decreased over time. Less than high school education and food insecurity predicted consistent/increased engagement in exchange sex and UAI, and partner's concurrency predicted participant concurrency. Our results demonstrate how interpersonal and social factors may influence sustained high-risk behavior by individuals and suggest that further study of the economic issues related to HIV risk could inform future prevention interventions.

Post-traumatic Stress Disorder Symptoms and Mental Health over Time among Low-Income Women at Increased Risk of HIV in the U.S.

“…16,17,58 Among the HPTN 064 cohort, we previously documented that, at baseline, 82% of the cohort had unprotected sex at their last sexual encounter, 40% reported concurrent sexual partnerships, 37% had exchanged sex for money in the last six months, and 38% reported anal sex in the last six months (for 80% of these cases, the anal sex was unprotected). 59 Controlling for other factors, women in HPTN 064 who suffered food insecurity and depression at baseline were 1.77 and 1.51 times as likely, respectively, to exchange sex for money, goods, drugs, or shelter than those who were not. 59 Such findings suggest some of the mechanisms by which poverty may place women at increased risk of sexually transmitted infections, such as HIV, indicating the need to consider integration of sexual health and mental health services into care for low-income women suffering from PTSD.…”

“…59 Controlling for other factors, women in HPTN 064 who suffered food insecurity and depression at baseline were 1.77 and 1.51 times as likely, respectively, to exchange sex for money, goods, drugs, or shelter than those who were not. 59 Such findings suggest some of the mechanisms by which poverty may place women at increased risk of sexually transmitted infections, such as HIV, indicating the need to consider integration of sexual health and mental health services into care for low-income women suffering from PTSD.…”

Food insecurity is associated with HIV, sexually transmitted infections and drug use among men in the United States

“…Food insecurity, defined as the limited or uncertain ability to access food of sufficient quality and quantity, or the inability to access these foods in socially acceptable ways [1, 2], is associated with increased frequency of HIV risk behaviors, including risky sex [3-12] and substance use [5, 13-16], across multiple settings even after accounting for income or other measures of socioeconomic status (SES). According to the Centers for Disease Control and Prevention (CDC), men represent the majority (80%) of new HIV diagnoses in the United States (US)[17]; among new HIV infections among men, men-who-have-sex-with-men (MSM) account for 78% [18].…”

Associations between neighborhood characteristics and sexual risk behaviors among HIV-infected and HIV-uninfected women in the southern United States

“…Studies exploring individual-level predictors of CAI among women suggest that CAI may be influenced by complex social and economic factors, yet no multilevel studies have explored relationships of neighborhoods characteristics to CAI specifically [28, 29, 36]. In this analysis, social disorder was inversely associated with CAI.…”

“…These a priori variables are classically included in analyses exploring associations of participant-level characteristics and sexual risk behaviors [27–29]. Covariates captured demographic characteristics and behaviors in the past 6 months and were binary unless otherwise noted: age in years (continuous, mean-centered), married or cohabitating, non-Hispanic African American, annual household income ≤$18,000, self-rated quality of life (QOL) as measured using an abbreviated Medical Outcomes Study Scale (continuous, mean-centered; scores ranged from 0 to 100 with higher scores indicative of better QOL) [30], alcohol or illicit substance use (>7 drinks in the past week, any injection or non-injection use of crack, cocaine, heroin, marijuana, hallucinogens, club drugs, methamphetamines, or recreational prescription drug use in the last 6 months), exchange of sex for drugs, money or housing, and homeless (currently living in a rooming or halfway house, shelter, welfare hotel, or on the street).…”