Relative Efficacy of a Multisession Sexual Risk–Reduction Intervention for Young Men Released From Prisons in 4 States

Objectives. We compared the effects of an enhanced multisession intervention with a single-session intervention on the sexual risk behavior of young men released from prison. Methods. Young men, aged 18 to 29 years, were recruited from US prisons in 4 states and systematically assigned to the prerelease single-session intervention or the pre- and postrelease enhanced intervention. Both interventions addressed HIV, hepatitis, and other sexually transmitted infections; the enhanced intervention also addressed community reentry needs (e.g., housing, employment). Assessment data were collected before intervention, and 1, 12, and 24 weeks after release. Results. A total of 522 men were included in intent-to-treat analyses. Follow-up rates ranged from 76% to 87%. Unprotected vaginal or anal sex during the 90 days before incarceration was reported by 86% of men in the enhanced intervention and 89% in the single-session intervention (OR=0.78; 95% CI=0.46, 1.32). At 24 weeks, 68% of men assigned to the enhanced intervention reported unprotected vaginal or anal sex compared with 78% of those assigned to the single-session intervention (OR=0.40; 95% CI=0.18, 0.88). Conclusion. Project START demonstrated the efficacy of a sexual risk–reduction intervention that bridges incarceration and community reentry

Greater Risk for HIV Infection of Black Men Who Have Sex With Men: A Critical Literature Review

HIV rates are disproportionately higher for Black men who have sex with men (MSM) than for other MSM. We reviewed the literature to examine 12 hypotheses that might explain this disparity. We found that high rates of HIV infection for Black MSM were partly attributable to a high prevalence of sexually transmitted diseases that facilitate HIV transmission and to undetected or late diagnosis of HIV infection; they were not attributable to a higher frequency of risky sexual behavior, nongay identity, or sexual nondisclosure, or to reported use of alcohol or illicit substances. Evidence was insufficient to evaluate the remaining hypotheses. Future studies must address these hypotheses to provide additional explanations for the greater prevalence of HIV infection among Black MSM

Health Status, Health Care Use, Medication Use, and Medication Adherence Among Homeless and Housed People Living With HIV/AIDS

Objectives. We sought to compare health status, health care use, HIV anti-retroviral medication use, and HIV medication adherence among homeless and housed people with HIV/AIDS

Estimating the Impact of State Budget Cuts and Redirection of Prevention Resources on the HIV Epidemic in 59 California Local Health Departments

<div><p>Background</p><p>In the wake of a national economic downturn, the state of California, in 2009–2010, implemented budget cuts that eliminated state funding of HIV prevention and testing. To mitigate the effect of these cuts remaining federal funds were redirected. This analysis estimates the impact of these budget cuts and reallocation of resources on HIV transmission and associated HIV treatment costs.</p> <p>Methods and Findings</p><p>We estimated the effect of the budget cuts and reallocation for California county health departments (excluding Los Angeles and San Francisco) on the number of individuals living with or at-risk for HIV who received HIV prevention services. We used a Bernoulli model to estimate the number of new infections that would occur each year as a result of the changes, and assigned lifetime treatment costs to those new infections. We explored the effect of redirecting federal funds to more cost-effective programs, as well as the potential effect of allocating funds proportionately by transmission category. We estimated that cutting HIV prevention resulted in 55 new infections that were associated with $20 million in lifetime treatment costs. The redirection of federal funds to more cost-effective programs averted 15 HIV infections. If HIV prevention funding were allocated proportionately to transmission categories, we estimated that HIV infections could be reduced below the number that occurred annually before the state budget cuts.</p> <p>Conclusions</p><p>Reducing funding for HIV prevention may result in short-term savings at the expense of additional HIV infections and increased HIV treatment costs. Existing HIV prevention funds would likely have a greater impact on the epidemic if they were allocated to the more cost-effective programs and the populations most likely to acquire and transmit the infection.</p> </div

Comparison of budget allocations: pre-cut allocation versus actual allocation in FY0910.

<p>Comparison of budget allocations: pre-cut allocation versus actual allocation in FY0910.</p

Estimates of the HIV annual transmission rate for HIV-infected individuals, the risk of infection for uninfected individuals, and the effectiveness achieved by HIV prevention activities.

<p>Estimates of the HIV annual transmission rate for HIV-infected individuals, the risk of infection for uninfected individuals, and the effectiveness achieved by HIV prevention activities.</p

One-way sensitivity analysis.

<p>We plotted the input parameters whose change to either the lower or the upper bound resulted in a change of 10% or more in the additional number of new infections associated with the first year of budget cuts. The shadow bar corresponds to the lower bound and the dotted bar corresponds to the upper bound value associated with a particular parameter. For example, if the annual number of sex acts for MSM was 365, the expected number of new infections associated with the first year of the budget cut would increase 236% to 183, from the baseline estimate of 55. If the annual number of sex acts for MSMs was 26, the expected number of new infections associated with the first year budget cuts would decrease by 55% to 25, from the baseline estimate.</p

Summary of key model parameters.

1<p>In the Bernoulli model, we assumed HET and IDU females engaged in vaginal receptive sex, while HET and IDU males engaged in vaginal insertive sex. We also considered transmission via contaminated needle sharing for IDU. For MSM, we assumed 50% of their sex acts were insertive anal and 50% were receptive anal.</p>2<p>We assumed every individual in a particular transmission category had the same number of annual sex acts. The annual number of sex acts for HET was reported in the National Survey of Family Growth (NSFG) and the National Survey of Sexual Health and Behavior (NSSHB) for HET. We assumed IDU and MSM had the same annual number of sex acts as HET.</p>3<p>The effect sizes of risk reduction for HIV-infected and uninfected at-risk individuals were estimated by the percent reduction in unprotected sex acts (unprotected vaginal sex or anal sex). We included behavioral studies that reported the reduction in number (or percent) of unprotected sex acts. We took the median values of the reviewed studies in which the reported reduction in unprotected sex acts between intervention and control groups was statistically significant.</p>4<p>The proportion of protected sex acts among HIV-positive aware persons who do not receive risk reduction was calculated from the proportion of protected sex for unaware HIV positive persons and the reduction in unprotected sex for aware HIV-infected persons. That is, the proportion of protected sex acts for aware HIV-infected persons = 1-(1- proportion of protected sex acts for unaware HIV-positive persons)×(1- reduction in unprotected sex acts for aware HIV-infected persons).</p