1. Psychosocial and behavioral predictors of partner notification for STD and HIV exposure among MSM Matthew J. Mimiaga, ScD, MPH, Sari L. Reisner, MA, Ashley M. Tetu, BS, Kevin Cranston, MDiv, David S. Novak, MSW, Kenneth H. Mayer, MD

2. Background
Men who have sex with men (MSM) continue to be at increased risk for STDs and HIV
Partner notification (PN) is an essential element of local and state-level STD and HIV prevention and control programs
Psychosocial risk factors such as depression, PTSD, and substance use play a role in STD and HIV acquisition and transmission
Few studies to date have explored the impact of psychosocial and behavioral constructs on PN activities; none have focused on predictors of PN use among MSM
More likely to engage in behavior that puts them at risk for HIV and STDs

3. Epidemiology: HIV (MA)
Percentage distribution of males diagnosed with HIV by exposure mode and year of diagnosis, Massachusetts,
MDPH, 2007

4. Epidemiology: STDs (MA)
Increases in STD and HIV among Massachusetts MSM,
MDPH, 2007

5. Study Aims
To assess psychosocial and behavioral factors most predictive of MSM utilizing department of public health (DPH) services to assist in PN after HIV or STD infection
To secondarily assess willingness and intentions
Willingness was defined as an openness to risk opportunity which was highly reactive to social circumstances and was conceived of as less effective at predicting behavior than intentions
Intentions were conceived of as proximal plans or goals and the best proximal predictor of a given behavior
In alignment with prior research on avoidant coping, we anticipated that more psychological distress (indicated by higher scores on psychosocial measures) would be predictive of increased willingness to use a state DPH for informing partners of STD exposure in the future, but not with increased intentions to notify

6. Methods Participants and Procedures
March 2006 and May 2007, 189 participants completed a quantitative survey
Participants were eligible if they were:
18 years of age or older
Massachusetts resident
MSM
Recruitment included:
Convenience sample (n = 63)
Modified RDS sample (n = 126)

7. Methods Predictors of Interest
Demographic, sexual behavior, and drug use questions were adapted from the CDC’s Behavioral Surveillance Survey
Condom Use Self-Efficacy Scale (CUSES)
Center for Epidemiologic Studies Depression Scale (CES-D)
SPAN: Post traumatic stress disorder (PTSD) symptomatology
SPIN: Symptoms of social anxiety
The CAGE: Screening instrument for alcoholism

8. Methods Outcome variables
Three separate dichotomous outcomes were assessed
Outcome 1: Prior PN use: Participants were asked about prior use of PN—either direct self-notification or use of state DPH services—for notifying their past sexual partners about HIV or STD exposure
Outcome 2: Willingness to use PN in the future: Participants were asked if they would be willing to use state DPH PN services in the future (if infected with HIV or a treatable STD) for notifying sexual partners of HIV or STD exposure

9. Methods
Outcome 3: Intentions to use PN in the future: Participants were asked about their intention to use state DPH services in the future (if infected with HIV or an STD) for notifying their sexual partners of exposure to HIV/STD

10. Methods Data Analysis SAS version 9.1
We combined both recruitment groups for analyses due to their similarities with respect to outcome variables and other demographics
Bivariate and multivariable logistic regression
Variables that were statistically significant in the bivariate regression analyses were retained in the final multivariable logistic regression models
All models controlled for age and race/ethnicity

11. Results: Demographics
Age: 19 to 66 (mean=41.48, SD=8.47)
66% ethnic/racial minorities
HIV and STD History
57% HIV-infected
54% had one or more STDs
17% syphilis, 35% gonorrhea, 12% chlamydia, and 13% other STDs
Sexual Risk Taking
Unprotected anal insertive (58%) and anal receptive (42%) sex with at least one non-monogamous male partner were commonly reported

12. Results: Demographics
Prior PN
37% reported that they had never engaged in PN activities in the past
Mental Health
50% had depressive symptoms; 60% positive for PTSD; 57% social anxiety symptoms
Substance and Alcohol Use
42% CAGE positive
48% marijuana, 40% poppers, 20% crystal methamphetamine, and 14% ecstasy

13. Odds Ratio (unadjusted) Odds Ratio* (adjusted)
Results
Predictors of prior partner notification of STD/HIV exposure
Odds Ratio (unadjusted)
P value
Odds Ratio* (adjusted)
HIV-infection
3.87
0.001
3.68
0.007
History or one or more STD (Chlamydia, gonorrhea or syphilis)
3.54
0.002
3.64
0.006
Gonorrhea
2.73
0.02 --
Syphilis
3.45
0.03
Unprotected insertive anal sex in the 12-months prior to study enrollment
2.12
0.05
2.25
0.09
Popper use during sex in the 12-months prior to study enrollment
2.65
0.018
1.57
0.35
*Final multivariable logistic regression model controlled for age and race/ethnicity

14. Odds Ratio (unadjusted) Odds Ratio* (adjusted)
Results
Only 34% of the sample reported that they would not be willing to use state DPH PN services in the future
Predictors of willingness to use state DPH PN services in the future for notifying sexual partners of HIV/STD exposure
Odds Ratio (unadjusted)
P value
Odds Ratio* (adjusted)
Social anxiety (SPIN)
2.63
0.016
2.42
0.05
Drinking problem (CAGE)
2.27
2.59
0.04
*Final multivariable logistic regression model controlled for age and race/ethnicity

15. Odds Ratio (unadjusted)
Results
Intention to use state DPH PN services in the future for notifying sexual partners of either STD (42% of the sample) or HIV (47% of the sample) exposure were robust
Predictors of Intentions to use state DPH PN services in the future for notifying sexual partners of HIV/STD exposure
Odds Ratio (unadjusted)
P value
History or one or more STD
2.30
0.03
Crystal meth use
2.41
0.06
Number of HIV infected partners
1.13

16. Discussion
Efforts to increase PN acceptability should focus on HIV-uninfected MSM, particularly those with a history of one or more STDs
Results further underscore the need for counseling as part of the notification process
Although some MSM may be willing to use PN in the future, avoidant-oriented coping may contribute to preventing them from translating willingness into action (intention)
Identifying psychosocial and behavioral predictors of PN provides vital information about how to increase acceptability and use of PN as a public health strategy for preventing STDs and HIV among at risk MSM