Forging Resilience to HIV/AIDS: Personal Strengths of Middle-aged and Older Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV/AIDS

HIV-positive gay, bisexual, two-spirit, and other men who have sex with men (MSM) have exhibited significant resilience to HIV/AIDS in Canada since the start of the epidemic. Since 2012, most of the research that has been conducted on resilience to HIV/AIDS has utilized quantitative methods and deficits-based approaches, with a preferential focus on the plight of young MSM. In order to address apparent gaps in research on HIV/AIDS resilience, we conducted a community-based participatory research qualitative study that utilized a strengths-based approach to examine the perspectives and lived experiences of HIV-positive, middle-aged and older MSM on their individual attributes that helped forge their HIV/AIDS resilience. We conducted 41 semistructured interviews with diverse, HIV-positive, middle-aged and older MSM from Central and Southwestern Ontario, Canada. From our thematic analysis of our interviews, we identified four themes, which represented personal strengths that fostered resilience to HIV/AIDS: (a) proactiveness, (b) perseverance, (c) having the right mindset, and (d) self-awareness with self-control. This article discusses the importance of these personal strengths to fostering HIV/AIDS resilience, and how community-based resources could potentially lessen the need to muster such personal strengths, or alternatively, cultivate them.

The HIV prevalence in older men who have sex with men in Western & Central Europe and North America—a meta-analysis

The age of patients living with human immunodeficiency virus (HIV) is increasing and the greatest proportion of aged HIV patients occurred in Western and Central Europe and North America (WCENA). In aged HIV patients in WCENA, older MSM is the main population. The aim of our study was to evaluate the HIV prevalence in older MSM in WCENA. A meta-analysis was conducted. We searched Medline, Embase, PsycINFO, Web of Science, Cochrane library, Ageline databases, and government websites. Studies that estimated HIV prevalence in older MSM in WCENA were selected. The pooled HIV prevalence and odds ratio (OR) of the risk of living with HIV in older MSM were calculated. In total of 23000 records were initially records were identified and 12 records were included. The total sample size of older MSM was 6118. The pooled HIV prevalence in older MSM in WCENA was 26% (95% CI 18%–33%), which was much higher than that in younger MSM (18%, 95% CI 14%–21%). Notably, the HIV prevalence in older MSM has been continuously increasing in the past two decades in WCENA, raising from 16% to 33%. The pooled OR for older MSM to be living with HIV was 1.68 compared to younger MSM. The HIV prevalence in older MSM in WCENA is disproportionately high, with a continuously increasing trend in the past two decades. Older MSM also carry significantly higher risk of living with HIV than younger MSM.

Social Support and Frailty in HIV Positive and Negative Men Who Have Sex With Men

Social support is linked to a myriad of positive health outcomes, yet little is understood about its potential role on frailty development among older men who have sex with men (MSM). We evaluated data from 929 MSM aged 40-81 years enrolled in the MACS Health Aging sub-study. Social support (Social Provisions Scale[SPS-24]; range 24-96) was high, though slightly lower among the HIV-positive versus HIV-negative men (median: 80 vs. 82, p=0.12). Each SD increase in social support associated with a 21% decrease in incident frailty (Fried phenotype), independent of age, race, and education (aIRR=0.79, IQR[0.65, 0.97]), though attenuated after adjustment for depressive symptoms. This protective association was observed to be strongest among HIV-positive MSM. High social support is a strength among older MSM, which associates with positive frailty outcomes. Assessing and strengthening social support systems may have potential as a psychosocial component of frailty interventions.

Identifying the key nodes of HIV molecular transmission network among men who have sex with men in Guangzhou, China: A cross-sectional study

Background Identifying the most influential spreaders in HIV transmission networks is crucial to develop effective prevention strategies. The purpose of this study is to identify the key nodes of the molecular transmission network among MSM, which has significant insight into developing effective HIV prevention strategies. Methods We analyzed HIV-1 pol sequences provided through the Center for Disease Control and Prevention, Guangzhou, China. Sequences were obtained from newly-HIV diagnosed MSM during 2015–2017. We calculated pairwise genetic distance, identified linked pairs of sequences (those with distance ≤ 1.5%), and examined key nodes of these potential transmission partners. Results Of 184 HIV recently diagnosed men who have sex with men (MSM), 40.76% were linked to other MSM. Social network analysis demonstrated that there were 9 key nodes were detected. From the results of multivariate logistic regression model, young MSM born in the 1990s and 1980s was 0.06 and 0.12 times as likely to be a key node as was the older MSM born in the 1970s and before. Conclusions There were a lot of subgroups connected by sharing comembers in HIV molecular transmission network among MSM in Guangzhou. Some HIV-infected MSM called as key nodes mediated the transmission of HIV among different subpopulations. Young MSM were less likely to promote HIV transmission than older MSM.

HIV Testing Among Middle-Aged and Older Men Who Have Sex With Men (MSM): A Blind Spot?

Middle-aged and older men who have sex with men (MSM) are one of the most underestimated populations with regard to HIV/AIDS infection, despite the worldwide trend of increasing prevalence in recent years. This population also has low rates of testing, although rare studies are done exclusively with middle-aged and older MSM assessing the factors associated with this prevalence. Thus, based on data from an exclusive online survey with middle-aged and older MSM who use geolocation-based dating applications, the purpose of the study was to analyze factors associated with not taking the HIV test among middle-aged (50 years old) and older MSM in Brazil. Using a modification of time-location sampling adapted to virtual reality, 412 volunteers were approached in Grindr®, Hornet®, SCRUFF®, and Daddyhunt®. The multivariate logistic regression model was adopted to produce adjusted odds ratios (ORa), considering a significance level at .05. There were factors associated with not taking the test: being in a relationship (ORa: 0.24; 95% CI [0.10, 0.53]); knowing partner through the applications (ORa: 1.84; 95% CI [1.07, 3.15]); not knowing the serological status (ORa: 5.07; 95% CI [1.88, 13.67]); ejaculating outside of anal cavity (ORa: 1.79; 95% CI [1.04, 3.05]); practicing sex without penetration (ORa: 2.30; 95% CI [1.17, 4.50]); not taking the test as a form of prevention (ORa: 2.83; 95% CI [1.05, 7.68]); and rarely using Viagra in sexual intercourse (ORa: 1.91; 95% CI [1.20, 3.65]). There is a blind spot in the prevalence of HIV testing in older MSM because this population is not being covered by services, which compromises the overall response to HIV, the goals set for universal health coverage.

Surveillance of human immunodeficiency virus suggests that younger men who have sex with men are at higher risk of infection, European Union, 2003 to 2012

In 2012, newly reported human immunodeficiency virus diagnoses in the European Union /European Economic Area remained stable at around 30,000 cases. Since 2003, cases in men who have sex with men (MSM) aged 20 to 29 years-old doubled, while the proportion of late presenters in this group remained stable. Persistent declines occurred among older MSM age groups, particularly that between 30 and 39 years-old. Interventions targeting younger MSM are needed to prevent a resurgence of the epidemic in Europe.

45. Is there potential for use of the quadrivalent HPV vaccine as a post-treatment adjuvant?

Background The quadrivalent HPV (qHPV) vaccine (Gardasil®; Merck and Co., Whitehouse Station, NJ) is licensed to prevent anorectal HPV related disease in men and women through age 26 years. We demonstrated previously that qHPV was associated with decreased risk of recurrent HSIL among men who have sex with men (MSM; HR 0.50, 95% CI 0.26–0.98; P = 0.04). We endeavoured to determine if qHPV was effective in preventing condyloma development and recurrence in older MSM patients. Methods: A non-concurrent cohort study of patients vaccinated with qHPV compared with non-vaccinated patients. Those with a history of condyloma were disease free for 1 year. Results: 313 patients with a mean age of 42 years were followed for a median of 981 days. During 773.6 person-years follow-up, condyloma developed in 10 (8.6%) vaccinated patients (incidence 3.7 per 100 person-years) and 37 (18.8%) unvaccinated patients (incidence 7.3 per 100 person-years; P = 0.05). Multivariable hazards ratio showed that qHPV was associated with decreased risk of anal condyloma development (HR 0.45; 95% CI 0.22–0.92; P = 0.03). Kaplan–Meier (KM) survival analysis showed significantly reduced recurrence out to 4 years (cumulative incidence vaccinated 0.1 vs unvaccinated 0.25; P = 0.04). In the smaller subset of 103 patients with a history of condyloma, KM survival analysis showed striking separation of curves in the vaccinated vs unvaccinated with the cumulative incidence of recurrence (0.15, 0.35, respectively) but it did not reach significance (P = 0.12). Conclusions: The qHPV vaccine appears to prevent incident and recurrent condyloma in patients older than 26 years and might be a useful post treatment adjuvant.