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Try out PMC Labs and tell us what you think. Learn More. Places where people meet new sex partners can be venues for the delivery of individual and environmental interventions that aim to reduce transmission of HIV and other sexually transmitted infections STI. A total of community informants identified public, private and commercial venues where people meet sex partners. Interviews with people men, women socializing at a random sample of 54 venues found high rates of HIV risk behaviors including concurrent sexual partnerships, transactional sex and illicit substance abuse.
Risk behaviors were more common among those at certain venue types including those that may be overlooked by public health outreach efforts. The systematic methodology used was successful in locating venues where risky encounters are established and reveal opportunities for targeted HIV prevention and testing programs as well as research. A substantial proportion of HIV-infected persons in the South live in metropolitan areas and in these small to mid-sized cities municipal and state governments, as well as their community partners, have implemented various HIV prevention initiatives.
However, whether these efforts have had an impact on the transmission of the virus HIV remains unclear and available evidence suggests that the behaviors that foster HIV acquisition, including partnership concurrency and underuse of condoms, remain widespread [ 23 ].
A recent meta-analysis of 38 randomized trials of individual- and group-level interventions to reduce risk behaviors for acquisition of HIV and among heterosexual African-Americans found such interventions to generally be efficacious [ 4 ]. Such interventions include those delivered at venues where risk behaviors actually occur.
For example, site-based condom distribution in hotels where commercial sex is available and brothels have been found to be effective [ 89 ]. However, for site-level interventions to be most efficacious, identification of the venues where risk behavior is initiated is an essential first step.
The selection of such priority venues may be based on perceptions regarding the clientele e. In addition, less conspicuous venues where sexual and drug-related risk behaviors are initiated may exist but remain unknown to those deing and implementing HIV prevention programs. Briefly, field work was implemented in three phases. In the first phase, we interviewed community informants aged 18 years or older assumed to be knowledgeable about the area to identify a list of public social venues where people meet new sexual partners in the study city.
Although community informants reported both fixed venues and periodic events e. If the venue was closed at first visit, the interviewer returned at least twice to attempt the interview. In the final phase, we administered a structured face-to-face sexual behavior survey to individuals socializing at a stratified random sample of the verified social venues. To ensure that the selection of venues represented different populations within the study area, the venues were categorized based on venue type prior to randomization. The of social interviews attempted per venue was based on venue size.
In addition, interviewers attempted to recruit a ratio of two men to one woman, as venue representatives reported men comprised a higher proportion of the venue population than women. A protocol was developed so that a representative sample of individuals socializing at each venue would be selected. Interviewers were distributed throughout the venue to minimize interviewer discretion in selecting respondents.
Selected respondents were brought to a private area to protect confidentiality. After confirming that respondents were at least 18 years old and appeared to the interviewer to be sober, the interviewer obtained verbal informed consent for an anonymous 15—20 min interview. While incentives were not offered, respondents who reported hunger were offered a small snack. Structured interviews included questions regarding respondent characteristics demographics, current employment status as well as items related to food security In the past 30 days, have you been concerned about having enough food for you or your family?
How many were new partners in the past 4 weeks? That is, the first time you had sex with the person was in the past 4 weekscondom use with last new sexual partner Think about your most recent new partner. The last Woman for oral sex Greensboro North Carolina you had sex with your most recent new partner, did you use a condom?
By sex we mean either vaginal, anal or oral sex. How many men, if any, have you had sex with in the past 12 months? Department of the Interior, US Geological Survey to map the spatial distribution of venues identified as places where people meet new sex partners. These venues were considered to comprise a part of the same supersite when the venue population socializing moved among these individual venues within the supersite e. We specified a log link, a Poisson distribution, an exchangeable correlation matrix structure, and a robust variance estimator to correct for overestimation of the error term resulting from use of Poisson regression with binomial data [ 12 — 14 ].
Behavioral variables see Table 3 were considered dichotomous. Two dichotomous sexual risk behavior outcomes, including an indicator of high risk partnerships, defined as having at least one new partner or multiple partners two or more in the past 4 weeks, and an indicator of transactional sex, defined as having given or received money, drugs or a place to stay in exchange for sex in the past 4 weeks, were also examined.
Excludes two individuals interviewed at venues that do not fit into any of the venue types included in the table. A variety of venue types were listed including traditional venues for socializing, as well as venues not obviously recognized as a meeting venue Table 1.
Twenty of the reported venues were either closed or could not be located. A comparison of these venues with the 25 where site representatives declined to be interviewed found the types of venues to be similar in each group. Formal and informal bars, restaurants, and apartments were the most commonly reported sites among the sites that did and did not participate. However, the two movie theaters reported as sites where people meet sexual partners both declined to participate.
Of the 98 venues visited, 54 were randomly selected for interviewing of those socializing at the venue. Since the venue population generally moves frequently between the venues within a super-site, it is difficult disaggregate venues within the super-site for the purpose of sampling. At five of the 54 venues no interviews were completed as there were very few individuals socializing and those approached for the interview refused to participate. At more than half of venues 27 venues fewer than 5 individuals were interviewed, and at the remaining venues 22 venuesgreater than five individuals were interviewed range: 5—38 individuals.
The demographic characteristics of these respondents are detailed in Table 2. The mean age of the sample was 32 years. Approximately one-third of men and one-quarter of women had not completed high school and unemployment was reported by more than one-third of men and women. High rates of incarceration for greater than 24 h were reported by men and women; one in five of the men had been imprisoned within the prior 12 months.
Use of any illicit drug during the prior 12 months was reported by one-third of men and one-fifth of women. The risk behaviors reported by individuals socializing at the venues studied are detailed in Table 3.
More than half of the respondents reported having at least one new sex partner or two or more sex partners during the past 4 weeks, however, prevalence rates were not ificantly different between venue types. Those socializing at the venue were more likely to report sex partners meet at the site than were site representatives interviewed at the same venue.
The PLACE methodology was able to successfully identify a diverse collection of venues in a US city where persons socialize and meet new potential sex partners. These venues included locations where the establishment of new partnerships was expected e. Indeed, most any type of locale in the study city where people congregate including churches, athletic events and even clinics were reported as venues where new partners are sought and found. Behaviors that heighten risk for acquisition of HIV as well as other STIs were commonly reported by participants, including illicit drug use, multiple sexual partnerships and the trading of sex.
ly, we have reported that for men and women socializing at these venues a personal history of incarceration and incarceration of a recent sexual partner were associated with sexual risk behaviors [ 15 ]. In this analysis we found that certain venues appear to attracted individuals with risky behaviors. Not surprisingly, among those at private homes used as brothels and bars risk behaviors were common; however, the finding of relatively high rates of risk behaviors among those socializing at convenience stores, open aired spaces and apartment complex public spaces was less anticipated.
Men at the homeless shelter had some of the greatest self-reported behavioral risks and this may reflect their incarceration history as well as other factors such as substance use and mental health disorders. In contrast, considerably less risk behavior was reported by patrons of formal bars and clubs, venues that are often the focus of HIV prevention outreach efforts.
Importantly, as was the case with application of the methodology to identify venues in sub-Saharan Africa, PLACE was readily accepted by the community partners who helped direct the initial stages of the study, as well as site representatives and those socializing at the site.
Interviews with those socializing at the venues were able to be successfully conducted despite the challenge of quickly questioning participants about personal behaviors in a social setting. With their identification, these venues can be considered for future community-based prevention initiatives. Such initiatives can include not only distribution of condoms and educational messages but also HIV testing and can be adapted, with community guidance, to be delivered at a variety of venue types. For example, at convenience stores frequented by persons engaged in sex Woman for oral sex Greensboro North Carolina, free condoms and HIV testing can be made available.
There are several study limitations. Foremost, the identification of venues was limited by the reports of community informants. While a diverse group of community informants was identified via discussions with persons knowledgeable about the community and the many of the venues listed were reported by more than one informant, there may be additional venues of interest that were not reported or remain unknown by the informants.
The higher than expected rate of condom use may reflect social desirability bias among those interviewed face-to-face compared to the computer assisted questioning conducted during the national survey [ 2021 ]. Respondents also had high rates of prior HIV testing, consistent with rates among those with higher HIV risk in the national survey, suggesting an appreciation of risk among those interviewed. A surprising finding was the high proportion of the listed venues that were where young people and students socialize.
However, due to ethical considerations regarding informed consent, minors under 18 years of age were not interviewed, a limitation of this study. Future study of minors socializing at such venues is warranted given their frequent presence at these venues. In conclusion, we found the PLACE methodology, a venue-based approach for the delivery of HIV prevention services, originally developed and implemented in sub-Saharan Africa, to be rapid, feasible and well-accepted when applied in a US city. PLACE can be a valuable initial step in a strategy that aims to locate diverse social venues where community-based interventions to promote condom use, HIV education and HIV testing can be implemented.
The conclusions expressed here are solely the responsibility of the authors and do not necessarily represent the views of the funders. We dedicate this research to the memories of Andrew Kaplan and Willie Garrison, who continue to inspire our efforts to prevent HIV transmission in North Carolina and beyond. David A. Maria R. Andrew M. Sharon S. National Center for Biotechnology InformationU. AIDS Behav. Author manuscript; available in PMC Jul 5. WohlMaria R. Kaplanand Sharon S. Author information Copyright and information Disclaimer. Corresponding author. Wohl: ude. Copyright notice. See other articles in PMC that cite the published article.
Abstract Places where people meet new sex partners can be venues for the delivery of individual and environmental interventions that aim to reduce transmission of HIV and other sexually transmitted infections STI. Open in a separate window.
Characteristics of Persons Socializing at the Venues Demographics Of the 98 venues visited, 54 were randomly selected for interviewing of those socializing at the venue. Illicit Drug Use Use of any illicit drug during the prior 12 months was reported by one-third of men and Woman for oral sex Greensboro North Carolina of women. Risk Behavior of Socializing Individuals and Venue Type The risk behaviors reported by individuals socializing at the venues studied are detailed in Table 3.
Discussion The PLACE methodology was able to successfully identify a diverse collection of venues in a US city where persons socialize and meet new potential sex partners. Contributor Information David A. References 1. Concurrent partnerships among rural African Americans with recently reported heterosexually transmitted HIV infection.
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Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low-income housing developments. Am J Public Health. A community level syphilis prevention programme: outcome data from a controlled trial. Sex Transm Infect. Promotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial.
Rojanapithayakorn W. Reprod Health Matters. People to places: focusing AIDS prevention efforts where it matters most. Longitudinal data analysis for discrete and continuous outcomes. Estimation of prevalence rate ratios from cross-sectional data. Int J Epidemiol. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol. Zou G. A modified poisson regression approach to prospective studies with binary data.
Incarceration and risky sexual partnerships in a southern US city.Woman for oral sex Greensboro North Carolina
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Locating the Places People Meet New Sexual Partners in a Southern US City to Inform HIV/STI Prevention and Testing Efforts