Sexual Risk, Substance Use and Undiagnosed Seropositivity among Men Who Have Sex with Men and Women in Miami, Florida

This paper utilizes the National HIV Behavioral Surveillance data in Miami for the men who have sex with men cycle (NHBS-MSM2) in 2008. We analyzed sexual risk, substance use and undiagnosed seropositivity in a diverse sample of men who have sex with men and women (MSMW) and compared them with MSM. Of 152 MSMW, 15.1% tested HIV positive with 73.9% previously undiagnosed. Almost half (44.1%) of the MSMW reported unprotected sex with male and female partners in the past year. More MSMW than MSM had undiagnosed HIV infection, exchanged sex for money or drugs, used crack and cocaine, been high during sex, and had not received HIV treatment if HIV positive. Undiagnosed HIV infection among MSMW was associated with Black race, older age, non-alcohol use and Ecstasy use. Our findings indicate that MSMW represent a unique population at risk of acquiring and transmitting HIV in Miami

HIV Testing Policies in Florida

To combat the HIV/AIDS epidemic, strong policies that promote HIV testing are a primary mechanism for helping public health officials to understand the populations at risk, informing prevention initiatives, and linking infected individuals to the timely care they need. This paper describes HIV testing policies with the goal of improving early diagnosis and treatment of Floridians

Trends in the HIV Epidemic among Men Who Have Sex with Men in Miami-Dade County, Florida, 2004-2014

Miami, Florida has a large population of Hispanic and black men who have sex with men (MSM), a population more likely to become HIV infected than white MSM. We present here HIV behavioral trends in this population that reflect the effects of public health prevention in Miami over a 10-year period. Using National HIV Behavioral Surveillance (NHBS) data of MSM in Miami-Dade County, Florida, in 2004-05, 2008, 2011 and 2014, chi-square trend analyses were used to assess the epidemiologic trends related to HIV infection rates, HIV testing rates, undiagnosed HIV infection, use antiretroviral therapy (ART) and access to HIV care. Of 258, 527, 511, and 536 MSM, HIV rates have remained steady between 22.5% (95% CI 17.4-27.6) in 2004-05 to a high of 25.9% (95% CI 22.2-29.6) in MSM4 in 2014, with no significant trend. There was an increase in HIV testing in the past six months between 2004 (48.4%;95% CI 41.8-55.0) and 2014 (55.8;95% CI 51.3-60.3), p \u3c .001; and a decrease in unrecognized HIV infection from 48.3% (95% CI 35.4- 61.2) in 2004 to 31.4% (95% CI 23.7-39.1) in 2014, p = .004, over the same period. Being currently on ART and knowledge of pre-exposure prophylaxis (PrEP) also increased significantly during this 10-year period. HIV surveillance is providing valuable information, notably, as HIV testing rates have gone up unrecognized infections have decreased. Continued use of the NHBS system should provide insights into the epidemic and assist in reaching public health goals for the control of HIV infections

Heroin Use and Sex: Some Patterns in Miami-Dade County, Florida

Much of the literature on heroin and opioid addiction holds that regular, long-term users of heroin and other opioids lose interest in sex as their drug using careers lengthen. Analysis of self-reports collected from IDUs in two cross- sectional surveys on patterns of risk behavior in Miami-Dade County, Florida, reveals that large proportions of IDUs report using heroin before or during sex across a wide range of self-injection experience, from as little as twelve months to over 40 years. One half or more of respondents to both surveys reported using heroin in their recent sexual experiences, with similar proportions reported by both males and females. The same IDUs, however, tend not to report using prescription painkillers before or during sex. This finding indicates that co-occurring risk behavior related to both sexual behavior and heroin use may be more prevalent among long-term IDUs than previous literature has suggested

HIV Seropositivity and Correlates of Infection Among Heterosexually Active Adults in High-Risk Areas in South Florida

The U.S. HIV/AIDS epidemic disproportionately impacts lower-income populations. We conducted a cross-sectional study of heterosexually active adults (N = 1076) in areas with high poverty and HIV/AIDS rates in South Florida in 2007. Using venue-based sampling, anonymous interviews and HIV tests were conducted at randomly selected venues (primarily retail businesses not associated with risk behaviors). The sample’s HIV infection rate was 7.1%. Half (52.2%) of the infections were previously undiagnosed. Our findings underscore the impact of social and environmental factors on HIV risk, as well as the need to increase and optimize HIV testing and other prevention services

HIV seroprevalence and risk behaviors among clients attending tuberculosis clinics in Miami-Dade County, Florida, 1989–1996

Miami-Dade County is a major HIV epicenter and a port of entry for immigrants from nations with high endemic rates of tuberculosis (TB). We analyzed data from an unlinked (blinded) serosurvey of clients attending four Miami TB clinics to elucidate the dynamic HIV seroprevalence patterns in relation to demographics and risk behaviors. Data were analyzed from 3,107 consecutive TB patients at four TB treatment clinics over eight years. Overall HIV seroprevalence was 23.6% with a significantly higher infection rate for men (26.6%) compared to women (17.3%) (p < 0.0001). In rank order, the HIV infection rates were 30.3% for black non-Hispanics, 24.7% for white non-Hispanics and 14.2% for Hispanics. U.S.-born clients had significantly higher HIV rates compared with foreign-born clients (32.4% vs. 18.5%, p < 0.0001). HIV rates declined over six years from (32.5% to 15.9%, p < 0.0001) with significant trends observed for men and women; and for blacks, whites and Hispanics. Seroprevalence was 15.7% for clients identifying heterosexual contact as their only risk. Highly significant increases in seroprevalence above this heterosexual-contact-only `baseline', were found for clients disclosing the following high-risk behaviors: male-to-male sex, drug injection, smoking crack cocaine, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner. While highly significant elevations in HIV seroprevalence were associated with each of these definitive risk behaviors, even the baseline HIV infection rate of 15.7% in heterosexual-contact-only clients was markedly higher than that of the general population. These findings underscore the need to obtain routine HIV serology on all TB patients

HIV Prevention and Transmission Myths Among Heterosexually Active Adults in Low-Income Areas of South Florida

Misconceptions about HIV transmission and prevention may inhibit individuals’ accurate assessment of their level of risk. We used venue-based sampling to conduct a cross-sectional study of heterosexually active adults (N = 1,221) within areas exhibiting high poverty and HIV/AIDS rates in Miami-Dade and Broward counties in 2007. Two logistic regression analyses identified correlates of holding inaccurate beliefs about HIV transmission and prevention. Belief in incorrect HIV prevention methods (27.2%) and modes of transmission (38.5%) was common. Having at least one incorrect prevention belief was associated with being Hispanic compared to white (non-Hispanic), being depressed, and not knowing one’s HIV status. Having at least one incorrect transmission belief was associated with being younger, heavy alcohol use, being depressed, not having seen a physician in the past 12 months, and not knowing one’s HIV status. Among low-income heterosexuals, HIV prevention and transmission myths are widespread. Debunking them could have HIV prevention value.Los conceptos erróneos acerca de la transmisión y la prevención del VIH pueden impedir que los individuos evalúen su nivel de riesgo de manera precisa. Utilizamos un muestreo basado en sitios para realizar un estudio transversal de adultos heterosexualmente activos (N = 1.221) dentro de áreas que presentan altos índices de pobreza y del VIH/SIDA en los condados de Miami-Dade y Broward en el 2007. En dos análisis de regresión logística se identificaron correlatos de creencias erróneas acerca de la transmisión y la prevención del VIH. Era común que se confiara en métodos de prevención (27.2%) y en modos de transmisión (38.5%) del VIH incorrectos. El hecho de tener al menos una creencia incorrecta sobre la prevención se asoció con los hispanos a diferencia de los blancos (no hispanos), la depresión y no conocer la condición de portador del VIH. El hecho de tener al menos una creencia incorrecta sobre la transmisión se asoció con las personas más jóvenes, el consumo excesivo de alcohol, la depresión, no haber consultado con un médico durante los últimos 12 meses y no conocer la condición de portador del VIH. Entre los heterosexuales de bajos ingresos, existen mitos generalizados sobre la prevención y la transmisión del VIH. Demostrar que estos mitos no son ciertos podría ser valioso para la prevención del VIH

HIV seroprevalence and risk behaviors among clients attending a clinic for the homeless in Miami/Dade County, Florida, 1990–1996

In the early 1990s, HIV seroprevalence was highest at the Miami homeless clinic among 16 homeless sites participating in a nationwide sentinel survey. To examine dynamic seroprevalence patterns in Miami's homeless clients in relation to demographics and risk behaviors over six years, we analyzed data from an unlinked (blinded) serosurvey of clients attending the principal primary care clinic serving Miami's homeless. Data were from 3,797 medical encounters with homeless persons who, on their initial clinic visit within an annual survey period, received routine serologic testing and a risk behavior survey. Overall HIV seroprevalence was 15.9% and infection rates for men (16.4%) and women (14.5%) did not differ. Seroprevalence for blacks (19.9%) was significantly higher than for Hispanics (9.1%) or whites (8.3%) (p < 0.0001). Seroprevalence was 12.6% (35 times the national rate) for clients reporting heterosexual contact as their only risk. Significant increases in seroprevalence, above this heterosexual-contact-only 'baseline', were found for clients disclosing high-risk behaviors: male-to-male sex, drug injection, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner (p < 0.0001). Seroprevalence declined over six years from 23.2 to 7.2% (p < 0.0001). Significant downward trends were observed for men and women, blacks and Hispanics, men who have sex with men, and clients reporting heterosexual contact. The proportion of clients reporting high-risk behaviors decreased sharply (p < 0.0001). Elevated HIV seroprevalence in Miami's homeless clients was strongly associated with high-risk behaviors. Expansion of HIV prevention and HIV/drug treatment services for homeless persons is strongly recommended

Awareness, Willingness, and Use of Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Washington, DC and Miami-Dade County, FL: National HIV Behavioral Surveillance, 2011 and 2014.

Despite the effectiveness of oral pre-exposure prophylaxis (PrEP) for HIV prevention, knowledge, and uptake of this new prevention intervention over time has not been fully studied. Using NHBS data from 2 urban areas highly impacted by HIV, we examined awareness, use, and willingness to use daily oral PrEP and factors associated with willingness to take oral PrEP among men who have sex with men (MSM) over time. MSM from Washington, DC and Miami, FL were recruited in 2011 and 2014 using venue-based sampling. Participants completed behavioral surveys and HIV testing. Awareness, use, and willingness to use oral PrEP were examined. Demographic and behavioral correlates of being "very likely" to use PrEP in 2011 and 2014 were assessed. PrEP awareness increased from 2011 to 2014 in both cities (DC: 39.1%-73.8% and Miami: 19.4%-41.2%), but use remained low in 2014 (DC: 7.7%; Miami: 1.4%). Being very likely to use PrEP decreased over time in DC (61%-48%), but increased in Miami (48%-60%). In DC, minority race was associated with increased odds of being very likely to use PrEP, whereas reduced odds of being very likely to use PrEP was observed for MSM with 1 or 2-5 partners versus having 6+ partners. In Miami, a higher proportion of white versus Hispanic MSM reported being very likely to use PrEP in 2011, but this observation was reversed in 2014. Geographic differences in awareness, use, and willingness to use PrEP indicate that innovative strategies are needed to educate MSM about this effective prevention strategy