Intimacy versus isolation: A qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia

Elizabeth F. Closson, Matthew J. Mimiaga, Susan G. Sherman, Arunrat Tangmunkongvorakul, Ruth K. Friedman, Mohammed Limbada, Ayana T. Moore, Kriengkrai Srithanaviboonchai, Carla A. Alves, Sarah Roberts, Catherine E. Oldenburg, Vanessa Elharrar, Kenneth H. Mayer, Steven Safren

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010-2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that similar intervention content may be effective for a range of settings.

Original languageEnglish (US)
Article numbere0120957
JournalPLoS One
Volume10
Issue number3
DOIs
StatePublished - Mar 20 2015
Externally publishedYes

Fingerprint

Zambia
Thailand
Brazil
HIV
gender
interviews
Acquired Immunodeficiency Syndrome
fearfulness
Health
Communication
risk behavior
Interviews
ejaculation
Secondary Prevention
Sexual Behavior
sexual behavior
Fear
communication (human)
stigma
Behavioral Sciences

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Intimacy versus isolation : A qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia. / Closson, Elizabeth F.; Mimiaga, Matthew J.; Sherman, Susan G.; Tangmunkongvorakul, Arunrat; Friedman, Ruth K.; Limbada, Mohammed; Moore, Ayana T.; Srithanaviboonchai, Kriengkrai; Alves, Carla A.; Roberts, Sarah; Oldenburg, Catherine E.; Elharrar, Vanessa; Mayer, Kenneth H.; Safren, Steven.

In: PLoS One, Vol. 10, No. 3, e0120957, 20.03.2015.

Research output: Contribution to journalArticle

Closson, EF, Mimiaga, MJ, Sherman, SG, Tangmunkongvorakul, A, Friedman, RK, Limbada, M, Moore, AT, Srithanaviboonchai, K, Alves, CA, Roberts, S, Oldenburg, CE, Elharrar, V, Mayer, KH & Safren, S 2015, 'Intimacy versus isolation: A qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia', PLoS One, vol. 10, no. 3, e0120957. https://doi.org/10.1371/journal.pone.0120957
Closson, Elizabeth F. ; Mimiaga, Matthew J. ; Sherman, Susan G. ; Tangmunkongvorakul, Arunrat ; Friedman, Ruth K. ; Limbada, Mohammed ; Moore, Ayana T. ; Srithanaviboonchai, Kriengkrai ; Alves, Carla A. ; Roberts, Sarah ; Oldenburg, Catherine E. ; Elharrar, Vanessa ; Mayer, Kenneth H. ; Safren, Steven. / Intimacy versus isolation : A qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia. In: PLoS One. 2015 ; Vol. 10, No. 3.
@article{23e9a80542144568819d2fac991fb585,
title = "Intimacy versus isolation: A qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia",
abstract = "The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010-2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that similar intervention content may be effective for a range of settings.",
author = "Closson, {Elizabeth F.} and Mimiaga, {Matthew J.} and Sherman, {Susan G.} and Arunrat Tangmunkongvorakul and Friedman, {Ruth K.} and Mohammed Limbada and Moore, {Ayana T.} and Kriengkrai Srithanaviboonchai and Alves, {Carla A.} and Sarah Roberts and Oldenburg, {Catherine E.} and Vanessa Elharrar and Mayer, {Kenneth H.} and Steven Safren",
year = "2015",
month = "3",
day = "20",
doi = "10.1371/journal.pone.0120957",
language = "English (US)",
volume = "10",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "3",

}

TY - JOUR

T1 - Intimacy versus isolation

T2 - A qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia

AU - Closson, Elizabeth F.

AU - Mimiaga, Matthew J.

AU - Sherman, Susan G.

AU - Tangmunkongvorakul, Arunrat

AU - Friedman, Ruth K.

AU - Limbada, Mohammed

AU - Moore, Ayana T.

AU - Srithanaviboonchai, Kriengkrai

AU - Alves, Carla A.

AU - Roberts, Sarah

AU - Oldenburg, Catherine E.

AU - Elharrar, Vanessa

AU - Mayer, Kenneth H.

AU - Safren, Steven

PY - 2015/3/20

Y1 - 2015/3/20

N2 - The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010-2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that similar intervention content may be effective for a range of settings.

AB - The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010-2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that similar intervention content may be effective for a range of settings.

UR - http://www.scopus.com/inward/record.url?scp=84961288530&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961288530&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0120957

DO - 10.1371/journal.pone.0120957

M3 - Article

C2 - 25793283

AN - SCOPUS:84961288530

VL - 10

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 3

M1 - e0120957

ER -