Which HIV-infected men who have sex with men in care are engaging in risky sex and acquiring sexually transmitted infections: findings from a Boston community health centre

ObjectivesThe primary objective was to determine the prevalence of sexually transmitted infections (STI) in a cohort of HIV-infected men who have sex with men (MSM) in their primary care setting, and to identify the demographic and behavioural characteristics of those infected with STI and the correlates of sexual transmission risk behaviour.MethodsAt study entry, participants (n = 398) were tested for STI and their medical charts were reviewed for STI results in the previous year. Data on demographics, substance use, sexual behaviour and HIV disease characteristics were collected through a computer-assisted self-assessment and medical record extraction. Logistic regression analyses assessed characteristics of those with recent STI and recent transmission risk behaviour.ResultsThe sample was predominantly white (74.6%) and college educated (51.7%). On average, participants were 41.5 years old (SD 8.4) and had been HIV infected for 8.6 years (SD 6.7); 9% of the sample had an STI, with 6.4% testing positive for syphilis, 3.1% for gonorrhoea and 0.25% for chlamydia. Age and years since HIV diagnosis were significantly associated with testing positive for an STI, as was engaging in transmission risk behaviour and using methamphetamine, ketamine and inhalants. Substance use, particularly methamphetamine use, and being more recently diagnosed with HIV were each uniquely associated with transmission risk behaviour in a multivariable model.ConclusionsThese results underscore the need to develop more effective secondary prevention interventions for HIV-infected MSM, tailored to more recently diagnosed patients, particularly those who are younger and substance users

Making sense of ‘Intersex’ and ‘DSD’: how laypeople understand and use terminology

Various umbrella terms refer to sex characteristics that do not fit typical binary notions of somatic sex. Key terms include Intersex, reclaimed by 1990s activists, and Disorders of Sex Development (DSD) used in medicine since 2006. Professionals across diverse disciplines express strong preferences for specific terms, making assumptions about what those terms do. Here, we draw on 10 focus group-interviews (41 participants without particular knowledge of Intersex/DSD), and semi-structured face-to-face interviews with 33 parents and 22 young people with personal experience of Intersex/DSD to examine how diverse laypeople understand and use these two umbrella terms and their alternatives. Most participants agreed that ‘DSD’ was problematic. Most young people and parents used ‘descriptive explanations’ of how the body looked or worked. Many parents and young people also found ‘Intersex’ problematic, whilst a majority of focus group participants did not. We conclude that as ‘experts by experience’, young people and their parents use language pragmatically and flexibly in everyday life to a degree that people unfamiliar with their experiences can easily underestimate. We further conclude that prescriptive discussions on terminology in this area may be needlessly constraining for people with such personal experience