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Longitudinal predictors of unprotected anal intercourse among Internet-using men who have sex with men in United States

Tesema, Yohannes Bekele (2013)
Master's Thesis (60 pages)
Committee Chair / Thesis Adviser: Sullivan, Patrick S
Committee Members:
Research Fields: Health Sciences, Epidemiology; Health Sciences, Public Health
Partnering Agencies: US (Federal) agency other than CDC
Keywords: HIV/AIDS; men who have sex with men; unprotected anal intercourse; behavioral factors; longitudinal data; Internet
Program: Rollins School of Public Health, Epidemiology (Global Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/f4g5v

Abstract

Background: Since the first official report of AIDS in the United States, men who have sex with men (MSM) have been and remain at substantial risk for HIV infection. Unprotected anal intercourse (UAI) is a primary risk factor for HIV acquisition and transmission among MSM.
Objective: To explore key behavioral and structural factors associated with UAI among Internet-using MSM aged 18 years and older, and estimate the relative association of each factor by accounting for the natural heterogeneity between subjects.
Methods: A prospective longitudinal online study was conducted from May 2010 through December 2011 in United States. 652 Internet-using MSM aged 18 years and older, having at least one male sex partner in past 12 months, and recruited from social networking Web sites were followed for 12 months with six self-administered interviews. Logistic regression was used to model frequencies of UAI experiences among MSM with independent variables. A generalized linear mixed modeling was used to estimate parameters and test for significant variations in risk of UAI between study participants.
Results: The factor most strongly associated with reporting UAI was number of male sex partners in the past 12 months. In multivariate analysis, compared with a man who reported a single male sex partner in past 12 months, a man who reported > 5 male sex partners (aRR=8.5, P <.0001) and a man who reported having three to five male sex partners (aRR=5.1, P <.0001) were at increased risk of engaging in UAI. Other factors that were independently associated with reporting UAI were experience of physical violence with a current male sex partner (aRR=1.7, P = 0.03) and meeting at least one male sex partner on Internet (aRR= 2.1, P = 0.002).
Conclusions: Comprehensive HIV prevention packages for MSM should address number of sex partners and intimate partner violence. More focused studies are needed to investigate the relationship between Internet use for meeting male sex partners and UAI.

Table of Contents

TABLE OF CONTENTS -- 1. INTRODUCTION................................................................................ 1 -- 2. OBJECTIVE...................................................................................... 11 -- 3. METHODS........................................................................................ 12 -- 3.1. Study design and participation..................................................... 12 -- 3.2. Measures...................................................................................... 13 -- 3.3. Statistical analysis........................................................................ 15 -- 4. RESULTS.......................................................................................... 20 -- 4.1. Descriptive analysis...................................................................... 20 -- 4.2. Univariate analysis....................................................................... 21 -- 4.3. Multivariate analysis..................................................................... 22 -- 5. DISCUSSION................................................................................... 25 -- 6. STRENGTHS AND LIMITATIONS...................................................... 28 -- 6.1. Strengths..................................................................................... 28 -- 6.2. Limitations................................................................................... 28 -- 7. CONCLUSION.................................................................................. 30 -- 8. REFERENCES................................................................................... 32

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