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Drawing on data from a diverse sample of 1,910 men who have sex with men (MSM) living with HIV in four U.S. cities, Morin et al. (2005) found that 12.7% of these men engaged in at least one transmission-risk event (i.e., "unprotected vaginal or anal sex with a partner who was HIV negative or of unknown status" [p. 226]) within the preceding 3-month period. Of these events, 57% took place with a casual partner; the remainder took place with a steady partner. With casual partners, risk was associated with the use of stimulants (including crystal methamphetamine [meth]) and other drugs, failure to always disclose HIV-positive serostatus, and low coping self-efficacy. 2 With steady partners, stimulant use and nondisclosure of HIV-positive serostatus were associated with risk.
Morin and colleagues observe that these findings
point to the importance of developing interventions that respond differently to risk of transmitting in the context of primary relationships and risk occurring in casual partnerships. About two-thirds of transmission-risk events among MSM occurred with casual partners. Deficiencies in coping self-efficacy, a construct that can be modified through education and training, proved to be a significant predictor of this kind of risk. ... [R]isk of transmission with casual partners was also associated with using stimulants ... [such as crystal meth] and other drugs. Another third of transmission-risk events occurred with steady partners and were more likely to occur if a participant was younger or had used stimulants. Taken together, these findings suggest that stimulant use, particularly crystal [meth], contributes significantly to risk of HIV transmission and that interventions designed to minimize or eliminate its use should be an important component of primary HIV prevention. (p. 231)
These investigators further observe that "interventions such as coping effectiveness training have been shown to improve coping self-efficacy in HIV-infected MSM and these improvements have been found to be associated with other outcomes, including reduction in perceived stress and burnout. ... Fortunately, cognitive-behavioral and supportive group interventions have both been effective in enhancing coping in men living with HIV ..." (p. 231). Yet, "[f]or the nearly one-third of risk that is occurring in the context of steady serodiscordant couples," Morin and colleagues point out that "additional strategies are needed to respond to the relationship dynamics that are supporting the ongoing risk. Above all, we need to develop and implement these strategies in a way that involves and respects these men, so that they become partners in reducing HIV transmission" (p. 233).
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Winter 2006 Newsletter / Volume 7, Issue 2
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