Background: Men who have sex with men (MSM) are heterogeneous with respect to sexual behavior. We examined differences in sexual risk behaviors and HIV protective behaviors between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). Among MSMW, we also examined associations between partner gender and disclosure of same-sex attraction to sexual risk behaviors. Methods: Data for this analysis were from MSM who participated in National HIV Behavioral Surveillance (NHBS) in 2011 and 2014. Prevalence differences comparing MSMW and MSMO were calculated for demographics and behaviors. Adjusted prevalence ratios comparing MSMW to MSMO were calculated for the outcomes condomless sex, exchange sex, testing for HIV, and disclosure of same-sex behavior. Results: MSMW were less likely than MSMO to have condomless sex with male partners (aPR 0.77; 95%CI 0.73-0.80), to have been diagnosed with another STD (aPR 0.83; 95%CI 0.73-0.95), and to disclose their same-sex behavior to healthcare providers (aPR 0.72; 95%CI 0.69-0.76). However, MSMW were more likely than MSMO to engage in exchange sex (aPR 2.43; 95%CI 2.17-2.72) and to have ever injected drugs (aPR 2.00; 95%CI 1.76-2.28) Conclusions: MSMW have distinctive sexual risk behaviors and could benefit from tailored interventions to reduce the prevalence of HIV in this population.

In both his fiction and non-fiction, Lewis comments on myth, its characteristics and strengths, and its relation to Christian doctrine. His use of myth to examine and to illustrate Christian ideas is most important in the space trilogy, the Narnia series of children's books, and Till We Have Faces. These books are the primary sources for this thesis, and they will be examined in chronological order.

Notre étude cherche à rendre compte des contraintes que font porter les marqueurs aspectuels sur la signification des énoncés en MUST. Dans le cadre d'une théorie sémantique à deux niveaux, les valeurs conceptuelles des marqueurs d'aspect HAVE + EN, BE + ING et HAVE BEEN + ING et du modal MUST sont décrites puis rattachées à leur valeur linguistique sous-déterminée. A partir de là, des prédictions sur les configurations sémantiques permises par la combinaison MUST + MARQUEUR D'ASPECT sont effectuées, puis vérifiées et affinées grâce à l'analyse des données. Les contraintes qu'exercent les marqueurs d'aspect sur la signification de MUST sont étroitement liées aux rapports chronologiques entre la modalité et la proposition, mais l'hypothèse défendue est que les incompatibilités s'expliquent essentiellement par le fait que la composante opératoire commune aux catégories de l'aspect et de la modalité leur interdit de co-exister sur le même plan.

Men who have sex with men (MSM) are disproportionately affected by HIV infection and account for more than half of all new HIV infections diagnosed in the U. S. The purpose of this study was to explore factors that influence sexual behavior among sexually active HIV positive MSM using constructs from the health belief model (HBM). A cross-sectional, correlational study was conducted with a non-randomized sample of 216 HIV positive MSM. Participants were predominantly Black/African American (85.6%). The mean age of the sample was 43.02 years (SD = 9.74) and ages ranged from 19 to 66. More than 90% reported a high school educational level or greater; and nearly half (47.2%) had been diagnosed with HIV for more than 10 years. The overall model predicted that participants who had perceived less severity of living with HIV and who had a positive attitude toward condom use were more likely to practice safer sex, accounting for 24% of the variance in sexual behavior (p < .001). When controlling for demographic characteristics (age, number of years diagnosed as HIV positive, number of recent sexual partners, and current antiretroviral medication use), the overall model accounted for 41% of the variance (p < .001). Participants who had a fewer number of recent sex partners and who had a positive attitude toward condom use were more likely to practice safer sex. Additionally, those who practiced safer sex (n = 58, 27%) reported significantly higher levels of perceived severity of living with HIV (p = .037), perceived benefits of safe sex (p = .018), perceived barriers to safe sex (p < .001), and self-efficacy for negotiating safe sex (p = .013) compared to those who did not practice safer sex (n = 157, 73%). Results from the study indicated there was a high prevalence of unsafe sexual practices among the participants. These findings support the need for additional research to explore factors that influence sexual behavior among HIV positive MSM with an emphasis on testing interventions that support safe sex practices.

Objective: The rectal mucosa is highly susceptible to HIV infection. Mucosal fluid contains soluble immune proteins that influence HIV infection, and previous studies have shown unique mucosal protein expression in HIV-exposed seronegative (HESN) populations, which may contribute to reduced HIV susceptibility. However, the key correlates of susceptibility at the rectal mucosa have not been well defined, which is a critical knowledge gap for our understanding of HIV pathogenesis. Methods: Rectal lavage from low risk men was screened for HIV-neutralizing activity in a TZM-bl reporter cell line against an R5-tropic HIV virus. Label-free tandem mass spectrometry was used to characterize soluble proteins within rectal lavage samples from a low-risk cohort of men (n=15), and HESN men who have sex with men (MSM; n=25). Protein expression between populations was compared using adjusted t tests (p<0.05), and was interpreted using hierarchical clustering and DAVID biofunctional analysis. Protein expression was further analyzed using survey data on sexual behaviours. Proteins associated with the HESN population were screened for antiviral activity in TZM-bl and PBMC culture against an R5- and X4-tropic virus. Major Results: Rectal mucosal fluid was able to inhibit HIV infection in vitro by 40% (p<0.05). Mass spectrometry identified 30/341 (9%) proteins deferentially expressed (DE) in HESN MSM. DE proteins held functions in immunity (p=6.68x10-6, p=0.001) and epithelial barrier development (p=1.81x10-4; p=0.01); notably, specific antiproteases were elevated in HESN secretions, two of which were screened for antiviral activity. Serpin B4 (+2.52 L2FD; p=1.09x10-5), showed significant inhibition of HIV in TZM-bl (45% BaL, 34% IIIB; p<0.05) and PBMC culture (37% BaL, 49% IIIB; p<0.05); cystatin A (+1.52 L2FD; p=1.40x10-3) showed no inhibitory effects. Serpin B4 expression was not associated with frequency of oral intercourse (p=0.32), partner viral load (r=0.16; p=0.29) or presence of HIV neutralizing IgA in secretions (p=0.52). Conclusions: This thesis reports the use of proteomics to understand HIV-susceptibility at the rectal mucosa, and identified serpin B4 as a novel antiviral immune correlate in a population of HESN MSM. These results may help guide future studies of prevention technologies, such as microbicides or vaccines, which would ultimately help limit the spread of HIV. / February 2016

HIV in Karnataka, south India disproportionately burdens female sex workers (FSWs) and men who have sex with men (MSM). The best long-term strategy for managing the global HIV epidemic might involve a preventive vaccine; however, vaccine availability cannot guarantee its acceptability. An exploratory, cross-sectional study was conducted among frontline health service providers (HSPs) working with MSM/FSWs in relation to HIV-related health services in Karnataka. Face-to-face structured interviews were performed to better understand potential barriers/facilitators to acceptability/uptake of a future HIV vaccine among MSM/FSW communities. Descriptive analyses explored HSPs’ perceptions of vaccine acceptability/uptake and likelihood to recommend an HIV vaccine. Although HSPs mentioned numerous potential barriers to future HIV vaccine acceptability/uptake, most believed that MSM/FSWs would be willing to receive the vaccine to protect their health and avoid HIV. HSPs reported being very likely to recommend the vaccine, however young age of potential vaccine recipients negatively affected likelihood to recommend.

HIV in Karnataka, south India disproportionately burdens female sex workers (FSWs) and men who have sex with men (MSM). The best long-term strategy for managing the global HIV epidemic might involve a preventive vaccine; however, vaccine availability cannot guarantee its acceptability. An exploratory, cross-sectional study was conducted among frontline health service providers (HSPs) working with MSM/FSWs in relation to HIV-related health services in Karnataka. Face-to-face structured interviews were performed to better understand potential barriers/facilitators to acceptability/uptake of a future HIV vaccine among MSM/FSW communities. Descriptive analyses explored HSPs’ perceptions of vaccine acceptability/uptake and likelihood to recommend an HIV vaccine. Although HSPs mentioned numerous potential barriers to future HIV vaccine acceptability/uptake, most believed that MSM/FSWs would be willing to receive the vaccine to protect their health and avoid HIV. HSPs reported being very likely to recommend the vaccine, however young age of potential vaccine recipients negatively affected likelihood to recommend.

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Background: Patient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in resource-limited settings. Objective: This randomized controlled trial aimed to evaluate the effect of 2 different PN technologies on notification outcomes following syphilis diagnosis among MSM in Peru: A Web-based notification system and patient-delivered partner referral cards. Methods: During 2012-2014, we screened 1625 MSM from Lima, Peru, for syphilis infection and enrolled 370 MSM with symptomatic primary or secondary syphilis (n=58) or asymptomatic latent syphilis diagnosed by serology (rapid plasma reagin, RPR, and Microhemagglutination assay for Treponema pallidum antibody; n=312). Prior to enrollment, potential participants used a computer-based self-interviewing system to enumerate their recent sexual partnerships and provide details of their 3 most recent partners. Eligible participants were randomly assigned to one of 4 intervention arms: (1) counseling and patient-initiated Web-based PN (n=95), (2) counseling with Web-based partner notification and partner referral cards (n=84), (3) counseling and partner referral cards (n=97), and (4) simple partner notification counseling (control; n=94). Self-reported partner notification was assessed after 14 days among 354 participants who returned for the follow-up assessment. Results: The median age of enrolled participants was 27 (interquartile range, IQR 23-34) years, with a median of 2 partners (IQR 1-5) reported in the past month. Compared with those who received only counseling (arm 4), MSM provided with access to Web-based partner notification (arms 1 and 2) or printed partner referral cards (arms 2 and 3) were more likely to have notified one or more of their sexual partners (odds ratio, OR, 2.18, 95% CI 1.30-3.66; P=.003 and OR 1.68, 95% CI 1.01-2.79; P=.045, respectively). The proportion of partners notified was also higher in both Web-based partner notification (241/421, 57.2%; P<.001) and referral card (240/467, 51.4%; P=.006) arms than in the control arm (82/232, 35.3%). Conclusions: Both new Web-based technologies and traditional printed materials support patient-directed notification and improve self-reported outcomes among MSM with syphilis. Additional research is needed to refine the use of these partner notification tools in specific partnership contexts. / Revisión por pares / Revisión por pares