TY - JOUR
T1 - Circumstances Surrounding High-risk Sexual Experiences Among Primary Care Patients Living With and Without HIV
AU - Fredericksen, Rob J.
AU - Walcott, M.
AU - Yang, Frances Margaret
AU - Gibbons, L. E.
AU - Fitzsimmons, E.
AU - Brown, S.
AU - Mayer, K. H.
AU - Edwards, T. C.
AU - Loo, S.
AU - Gutierrez, C.
AU - Paez, E.
AU - Dant, L.
AU - Mathews, W. C.
AU - Mugavero, M. J.
AU - Patrick, D. L.
AU - Crane, P. K.
AU - Crane, H. M.
N1 - Publisher Copyright:
© 2018, Society of General Internal Medicine.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Introduction: Rates of sexually transmitted infection (STI) are rising in the USA, yet STI risk remains under-addressed by providers, even in HIV care, and with high-risk patients. We interviewed primary care patients living with and without HIV regarding circumstances surrounding sexual risk behavior to identify opportunities for providers to address and reduce STI risk. Methods: We conducted semi-structured 1:1 interviews with patients living with and without HIV reporting ≥ 1 sex partner and varying STI exposure risk in the past 12 months from four geographically diverse US HIV and primary care clinics. We audio-recorded, transcribed, and coded interviews by circumstance type, using double-coding to ensure inter-coder reliability. We used Fisher’s exact and T tests to determine associations with demographic/risk factors. Results: Patients (n = 91) identified a mean of 3 of 11 circumstances. These included substance use (54%), desire for physical/emotional intimacy (48%), lack of HIV/STI status disclosure (44%), psychological drivers (i.e., coping, depression; 38%), personal dislike of condoms (22%), partner condom dislike/refusal (19%), receiving payment for sex (13%), and condom unavailability (9%). Higher proportions of those who were high STI-exposure risk patients, defined as those with ≥ 2 sex partners in the past 3 months reporting never or sometimes using condoms, reported disliking condoms (p =.006); higher proportions of the high-risk and moderate-risk (≥ 2 partners and condom use “most of the time”) groups reported substance use as a circumstance (p =.04). Conclusion: Circumstances surrounding perceived STI exposure risk were diverse, often overlapping, and dependent on internal, environmental, and partner-related factors and inadequate communication. Meaningful care-based interventions regarding HIV/STI transmission behavior must address the diversity and interplay of these factors.
AB - Introduction: Rates of sexually transmitted infection (STI) are rising in the USA, yet STI risk remains under-addressed by providers, even in HIV care, and with high-risk patients. We interviewed primary care patients living with and without HIV regarding circumstances surrounding sexual risk behavior to identify opportunities for providers to address and reduce STI risk. Methods: We conducted semi-structured 1:1 interviews with patients living with and without HIV reporting ≥ 1 sex partner and varying STI exposure risk in the past 12 months from four geographically diverse US HIV and primary care clinics. We audio-recorded, transcribed, and coded interviews by circumstance type, using double-coding to ensure inter-coder reliability. We used Fisher’s exact and T tests to determine associations with demographic/risk factors. Results: Patients (n = 91) identified a mean of 3 of 11 circumstances. These included substance use (54%), desire for physical/emotional intimacy (48%), lack of HIV/STI status disclosure (44%), psychological drivers (i.e., coping, depression; 38%), personal dislike of condoms (22%), partner condom dislike/refusal (19%), receiving payment for sex (13%), and condom unavailability (9%). Higher proportions of those who were high STI-exposure risk patients, defined as those with ≥ 2 sex partners in the past 3 months reporting never or sometimes using condoms, reported disliking condoms (p =.006); higher proportions of the high-risk and moderate-risk (≥ 2 partners and condom use “most of the time”) groups reported substance use as a circumstance (p =.04). Conclusion: Circumstances surrounding perceived STI exposure risk were diverse, often overlapping, and dependent on internal, environmental, and partner-related factors and inadequate communication. Meaningful care-based interventions regarding HIV/STI transmission behavior must address the diversity and interplay of these factors.
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U2 - 10.1007/s11606-018-4675-4
DO - 10.1007/s11606-018-4675-4
M3 - Article
AN - SCOPUS:85053846717
SN - 0884-8734
VL - 33
SP - 2163
EP - 2170
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 12
ER -