PubMed Health⌕ Search

Biomedical subjects

Jonathan Elford

Publications and source records attributed to Jonathan Elford.

At least 19 recordsLinked to original sources
PubMed2007

No evidence of an increase in serosorting with casual partners among HIV-negative gay men in London, 1998-2005.

Serosorting is an HIV risk reduction strategy whereby some gay men only engage in unprotected anal intercourse with casual partners of the same HIV status. There was no evidence of an increase in serosorting among HIV-negative gay men in London between 1998 and 2005 (1.7%, 1.2%; test for a trend P = 0.1). By way of comparison, the percentage of HIV-positive gay men who reported serosorting more than doubled during this time (6.8%, 17.7%, P < 0.01).

Attitude to Health↗
PubMed2007

Sexual behaviour of people living with HIV in London: implications for HIV transmission.

OBJECTIVE: To examine the sexual behaviour of gay men as well as black African heterosexual men and women living with diagnosed HIV in London, and to consider the implications for HIV transmission. METHODS: People living with HIV receiving treatment and care in outpatient clinics in north east London were asked to complete a confidential, self-administered questionnaire in 2004-2005. Respondents were asked about unprotected anal or vaginal intercourse in the previous 3 months, and the type (main or casual) and HIV status of their partner(s). RESULTS: A total of 1687 people with diagnosed HIV returned a completed questionnaire (response rate 73% of eligible clinic attenders) including 480 black African heterosexual women, 224 black African heterosexual men and 758 gay/bisexual men (464 white, 112 ethnic minority). One in five gay men with HIV (20.1%, 144/715) reported unprotected anal intercourse with a partner of unknown or discordant HIV status (usually a casual partner). This presents a risk of HIV transmission. By comparison, one in 20 (5.1%, 32/623) black African heterosexual men and women with HIV reported unprotected vaginal intercourse that presented a risk of HIV transmission; odds ratio (gay men versus black African men and women combined) 5.28, 95% confidence interval 3.52, 7.91, P<0.001. Neither viral load nor being on HAART were significantly associated with unprotected intercourse among gay men or black African heterosexual men and women (P>0.05). CONCLUSION: Behavioural research among people with diagnosed HIV in London shows that gay men are more likely than black African heterosexual men and women to engage in sexual behaviour that presents a risk of HIV transmission.

Adolescent↗
PubMed2007

Barebacking among HIV-positive gay men in London.

OBJECTIVES: The objectives of this study were to examine the extent to which HIV-positive gay men in London intentionally seek unprotected anal intercourse ("barebacking") and the contribution this makes to total sexual risk. STUDY DESIGN: In 2002 to 2003, HIV-positive gay men surveyed in an HIV outpatient clinic or on the Internet were asked whether they had intentionally looked for anal sex without a condom in the previous 12 months. RESULTS: Of 481 men in the clinic, 59 (12.3%) said they had intentionally looked for anal sex without a condom, 34 (7.1%) only with another HIV-positive man and 25 (5.2%) with a man of unknown or discordant HIV status. Overall, 85 men reported unprotected anal intercourse (UAI) with a casual partner of unknown or discordant HIV status; 20 (23.5%) had intentionally looked for UAI with such a partner, whereas the remaining 65 (76.5%) had not. Of 66 men surveyed on the Internet, 32 (48.5%) said they had intentionally looked for anal sex without a condom. CONCLUSION: Although barebackers made a disproportionate contribution to sexual risk, three-fourths of high-risk sex reported by HIV-positive gay men in London was not intentional. The Internet sample overestimated the prevalence of barebacking among HIV-positive gay men because of sampling bias.

Adult↗
PubMed2007

Men who have sex with men in Great Britain: comparison of a self-selected internet sample with a national probability sample.

OBJECTIVES: To compare the characteristics of a self-selected, convenience sample of men who have sex with men (MSM) recruited through the internet with MSM drawn from a national probability survey in Great Britain. METHODS: The internet sample (n = 2065) was recruited through two popular websites for homosexual men in Great Britain in May and June 2003. This sample was compared with MSM (n = 117) from the National Survey of Sexual Attitudes and Lifestyles (Natsal), a probability sample survey of adults resident in Great Britain conducted between May 1999 and February 2001. RESULTS: No significant differences were observed between the samples on a range of sociodemographic and behavioural variables (p>0.05). However, men from the internet sample were younger (p<0.001) and more likely to be students (p = 0.001), but less likely to live in London (p = 0.001) or report good health (p = 0.014). Although both samples were equally likely to report testing for HIV, men from the internet sample were more likely to report a sexually transmitted infection in the past year (16.9% v 4.8%, adjusted odds ratio 4.14, 95% CI 1.76 to 9.74; p = 0.001), anal intercourse (76.9% v 63.3%; p = 0.001) and unprotected anal intercourse in the past 3 months (45% v 36.6%; p = 0.064). CONCLUSIONS: The internet provides a means of recruiting a self-selected, convenience sample of MSM whose social and demographic characteristics are broadly similar to those of MSM drawn from a national probability survey. However, estimates of high-risk sexual behaviour based on internet convenience samples are likely to overestimate levels of sexual risk behaviour in the wider MSM population.

Adolescent↗
PubMed2006

Does the recent increase in HIV diagnoses among men who have sex with men in the UK reflect a rise in HIV incidence or increased uptake of HIV testing?

OBJECTIVES: To determine whether the increase in HIV diagnoses since 1997 among men who have sex with men (MSM) in the UK reflects a rise in HIV incidence or an increase in HIV testing. METHODS: Estimates of HIV incidence were derived using data from UK HIV surveillance systems (HIV diagnoses; CD4 surveillance; unlinked anonymous surveys) for 1997-2004. Data on HIV testing were provided by KC60 statutory returns, voluntary testing and unlinked anonymous surveys in sentinel genitourinary medicine (GUM) clinics. RESULTS: HIV diagnoses among MSM in the UK rose by 54% between 1997 and 2004 (from 1382 to 2124), with variation by age and geographical location. The number of HIV diagnoses among MSM <35 years of age in London showed no increase, but in all other groups it increased. Throughout the UK, uptake of HIV testing increased significantly among MSM attending GUM clinics between 1997 and 2004, including "at-risk" MSM (p<0.001). Direct incidence estimates (serological testing algorithm for recent HIV seroconversion assay) provided no evidence of a statistically significant increase or decrease in HIV incidence. Indirect estimates suggested that there may have been a rise in HIV incidence, but these estimates were influenced by the increased uptake of HIV testing. CONCLUSIONS: The number of HIV diagnoses increased among MSM in the UK between 1997 and 2004, except among younger MSM in London, in whom there was no change. The increase in HIV diagnoses among MSM in the UK since 1997 seems to reflect an increase in HIV testing rather than a rise in HIV incidence.

Adult↗
PubMed2006

Conducting Internet-based HIV/STD prevention survey research: considerations in design and evaluation.

The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.

HIV Infections↗
PubMed2006

HIV in East London: ethnicity, gender and risk. Design and methods.

BACKGROUND: While men who have sex with men remain the group at greatest risk of acquiring HIV infection in the UK, the number of new diagnoses among heterosexuals has risen steadily over the last five years. In the UK, three-quarters of heterosexual men and women diagnosed with HIV in 2004 probably acquired their infection in Africa. This changing epidemiological pattern is particularly pronounced in East London because of its ethnically diverse population. DESIGN AND METHODS: The objective of the study was to examine the social, economic and behavioural characteristics of patients with HIV infection currently receiving treatment and care in hospitals in East London. The research focused on ethnicity, gender, sexuality, education, employment, housing, HIV treatment, stigma, discrimination, religion, migration and sexual risk behaviour. People diagnosed with HIV infection attending outpatient treatment clinics at St Bartholomew's, the Royal London, Whipp's Cross, Homerton, Newham and Barking hospitals (all in East London) over a 4-6 month period were invited to participate in the study in 2004-2005. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire. During the study period, 2680 patients with HIV attended the outpatient clinics in the six participating hospitals, of whom 2299 were eligible for the study and 1687 completed a questionnaire. The response rate was 73% of eligible patients and 63% of all patients attending the clinics during the survey period. DISCUSSION: A clinic-based study has allowed us to survey nearly 1700 patients with HIV from diverse backgrounds receiving treatment and care in East London. The data collected in this study will provide valuable information for the planning and delivery of appropriate clinical care, social support and health promotion for people living with HIV not only in East London but in other parts of the capital as well as elsewhere in the UK.

Adult↗
PubMed2006

Women living with facial hair: the psychological and behavioral burden.

OBJECTIVE: While unwanted facial hair is clearly distressing for women, relatively little is known about its psychological impact. This study reports on the psychological and behavioral burden of facial hair in women with suspected polycystic ovary syndrome. METHODS: Eighty-eight women (90% participation rate) completed a self-administered questionnaire concerning hair removal practices; the impact of facial hair on social and emotional domains; relationships and daily life; anxiety and depression (Hospital Anxiety and Depression Scale); self-esteem (Rosenberg Self-esteem Scale); and quality of life (WHOQOL-BREF). RESULTS: Women spent considerable time on the management of their facial hair (mean, 104 min/week). Two thirds (67%) reported continually checking in mirrors and 76% by touch. Forty percent felt uncomfortable in social situations. High levels of emotional distress and psychological morbidity were detected; 30% had levels of depression above the clinical cut off point, while 75% reported clinical levels of anxiety; 29% reported both. Although overall quality of life was good, scores were low in social and relationship domains--reflecting the impact of unwanted facial hair. CONCLUSION: Unwanted facial hair carries a high psychological burden for women and represents a significant intrusion into their daily lives. Psychological support is a neglected element of care for these women.

Activities of Daily Living↗
PubMed2006

Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy.

PURPOSE OF REVIEW: To describe changing patterns of sexual behaviour in the era of highly active antiretroviral therapy among gay/bisexual men in Europe, Canada, USA and Australia. RECENT FINDINGS: While there has been a substantial increase in high-risk sexual behaviour among gay men since 1996, this now appears to be levelling off in some cities. Overall the empirical evidence does not support the suggestion that taking highly active antiretroviral therapy or having an undetectable viral load leads to risky sexual behaviour among people with HIV. Nor can HIV treatment optimism alone explain the recent increase in high-risk sexual behaviour. Since 1996, an increasing number of gay men have begun to use the Internet to look for sexual partners. By serosorting on the Internet, HIV-positive men are more likely to meet online, rather than off-line, other HIV-positive men for unprotected sex. While serosorting does not present a risk of HIV transmission to an uninfected person, it does present a risk of other sexually transmitted infections and co-infection with resistant virus for HIV-positive men themselves. This review also explores emerging behaviours such as barebacking and strategic positioning as well as the role of crystal meth and Viagra. SUMMARY: The review reminds us of the complexity of human and sexual behaviour. Among gay men, sexual behaviour in the era of highly active antiretroviral therapy has been characterized by risk reduction and stabilization as well as increasing risk. These changing patterns provide a new challenge as well as new opportunities for HIV prevention.

Antiretroviral Therapy, Highly Active↗
PubMed2006

Use of crystal methamphetamine among gay men in London.

AIM: To examine the use of crystal methamphetamine (crystal meth) and its association with high-risk sexual behaviour among gay men in London. DESIGN: Cross-sectional surveys using self-administered questionnaires. SETTINGS: National Health Service (NHS) out-patient human immunodeficiency virus (HIV) treatment clinic in London; NHS HIV testing/sexual health clinics in London; central London gyms. PARTICIPANTS: HIV-positive gay men attending the HIV treatment clinic in 2002-03 (n = 388); HIV-negative gay men attending the HIV testing/sexual health clinics in 2002-03 (n = 266); gay men using the gyms between January and March 2003 (n = 445), 2004 (n = 653) and 2005 (n = 494). MEASUREMENTS: Percentage of gay men who reported: (i) using crystal meth in the previous 12 months; (ii) using other recreational drugs (e.g. cocaine, ecstasy, ketamine); (iii) high-risk sexual behaviour in the previous 3 months. FINDINGS: The percentage of gay men who had used crystal meth in the previous year varied by sample (HIV treatment clinic, 12.6%; HIV testing/sexual health clinics, 8.3%; gyms, 19.5%; P < 0.001) but did not change over time in the gyms (19.8%, 20.7%, 17.8%; P = 0.5). In all samples, the majority of men used crystal meth only once or twice a year. Most crystal meth users (> 80%) had taken other recreational drugs. Crystal meth and other drug users were more likely to report high-risk sexual behaviour than other men, e.g. HIV treatment clinic sample: crystal meth users, 34.7%; other drug users, 18.9%, non-users, 10.6%, P < 0.001. Cause and effect could not be established. CONCLUSION: Among gay men in London surveyed in clinics, approximately one in 10 reported using crystal meth in the previous 12 months (HIV-positive men 12.6%; HIV-negative men 8.3%). Most men used it infrequently--only once or twice a year. There was no evidence of increasing use of crystal meth between 2003 and 2005.

Acquired Immunodeficiency Syndrome↗
PubMed2006

E-dating, identity and HIV prevention: theorising sexualities, risk and network society.

This paper addresses how London gay men use the internet to meet sexual partners, or for e-dating. Based on qualitative interviews conducted face-to-face or via the internet, this research develops an account of how information technologies mediate the negotiation of identity and risk in connection with sexual practice. E-dating itself is a bricolage, or heterogeneous DIY practice of internet-based-communication (IBC). A central aspect of IBC is "filtering" in and out prospective e-dates based on the images and texts used to depict sexual identities. Interpretations and depictions of personal HIV risk management approaches in IBC are framed by the meanings of different identities, such as the stigma associated with being HIV positive. This paper argues for a sexualities perspective in a theory of network society. Further, HIV prevention in e-dating can potentially be addressed by considering the interplay of the HIV prevention imperatives associated with different HIV serostatus identities. There is a case for encouraging more explicit IBC about risk in e-dating and incorporating the expertise of e-daters in prevention activity. There is also a need to rethink traditional conceptions of risk management in HIV prevention to make space for the risk management bricolage of network society.

Adult↗
PubMed2006

The Bolger conference on PDE-5 inhibition and HIV risk: implications for health policy and prevention.

INTRODUCTION: Recent reports have linked the use of phosphodiesterase type 5 (PDE-5) inhibitors with increased rates of high-risk sexual behavior and HIV transmission in some individuals. AIM: A National Institute of Mental Health (NIMH)-funded, multidisciplinary conference was convened to evaluate scientific research, clinical and ethical considerations, and public policy implications of this topic. MAIN OUTCOME MEASURES: Published and unpublished findings on effects of PDE-5 inhibitors on sexual behavior; published guidelines and management recommendations. METHODS: Leading investigators in relevant disciplines (e.g., public health, epidemiology, medical ethics, urology, psychology) participated in a 2-day meeting, including representatives of government, scientific, and regulatory agencies (the Centers for Disease Control, Food and Drug Administration, NIMH, and the National Institute on Drug Abuse). Panelists provided critical reviews of substantive areas of research, followed by question and answer sessions on each topic. On the second day, working groups were convened to identify critical gaps and priorities in three major areas: (i) research and evaluation needs; (ii) prevention strategies and clinical management issues; and (iii) policy and prevention implications. RESULTS: Research needs and priorities were categorized into four specific areas: (i) basic and clinical/laboratory research; (ii) epidemiology and risk factors; (iii) social-behavioral processes and interventions; and (iv) prevention/policy and educational needs. Identified gaps in the available data include populations at risk (e.g., risk among heterosexuals, risk profiles among subpopulations of men who have sex with men) and the specific role of PDE-5 inhibitors in HIV seroconversion. Specific areas of emphasis were the need for safer sex counseling, comprehensive sexually transmitted infection (STI) screening and follow-up when indicated, avoidance of potentially dangerous drug interactions, and potential benefits of testosterone replacement for HIV-positive men with decreased androgen and other symptoms of hypogonadism. Conclusions. A conference was convened on the topic of PDE-5 inhibition and HIV risk. This "white paper" summarizes the findings of the conference and recommendations for future research.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2006

Heterosexual men and women who seek sex through the Internet.

Heterosexual women (n = 330), heterosexual men (n = 319) and gay men (n = 331) attending a London HIV-testing clinic in 2002-03 completed a confidential self-administered questionnaire concerning their sexual behaviour and use of the Internet for seeking sexual partners (response rate 70%). One-in-twenty (5%) heterosexual women and one-in-ten (10%) heterosexual men had used the Internet to look for sexual partners in the previous 12 months compared with nearly half (43%) the gay men (P<0.001). Rates of high-risk sexual behaviour with a casual partner were elevated among those who used the Internet to look for sex (compared with those who did not). However, people who looked for sex through the Internet were just as likely to meet their high-risk casual partners offline as online. Our findings suggest that high-risk heterosexual women and men are selectively using the Internet to look for sex rather than the Internet per se leading to riskier sexual behaviour.

Adolescent↗
PubMed2005

High-risk sexual behaviour among London gay men: no longer increasing.

Among gay men surveyed annually in central London gyms, the percentage reporting high-risk sexual behaviour with a casual partner increased from 6.7% in 1998 to 15.2% in 2001 (P < 0.001). However, between 2002 and 2005 the percentage reporting high-risk sexual behaviour with a casual partner remained stable for HIV-negative and never-tested men (P > or = 0.3), with some evidence of a decline for HIV-positive men (adjusted odds ratio 0.69 per year, 95% confidence interval 0.48, 0.99, P = 0.047).

Adult↗
PubMed2005

Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners?

OBJECTIVE: To examine whether the excess risk for HIV and sexually transmitted infection (STI) seen among gay men who look for sex through the Internet occurs with men they meet online (through the Internet) rather than offline (in bars, clubs, etc). METHODS: In 2002-2003, 4225 London gay men were surveyed in an HIV treatment clinic, HIV testing clinic, gyms and on UK Internet sites (gaydar and gay.com). All men completed a self-administered questionnaire concerning Internet use and sexual risk behaviour. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status was classified as non-concordant. RESULTS: Between 40 and 50% of men surveyed in the clinics and gyms used the Internet to look for sex. HIV-positive men who looked for sex through the Internet were more likely to report UAI with HIV-positive casual partners they met online rather than offline (clinic sample: met online only 9.9%, met offline only 3.8%, McNemar P < 0.05). Regardless of HIV status, however, men who looked for sex through the Internet were no more likely to report UAI with non-concordant casual partners they met online than offline (eg, HIV-negative men, Internet sample: met online only 9.7%, offline only 11.1%, McNemar P = 0.6). CONCLUSIONS: In London, HIV-positive gay men appear to meet casual UAI partners of the same status through the Internet. This presents a risk for STI transmission. However, gay men were no more likely to meet casual UAI partners of unknown or discordant HIV status--which presents a risk for HIV transmission--online rather than offline.

Adolescent↗
PubMed2004

The Internet and HIV study: design and methods.

BACKGROUND: The Internet provides a new meeting ground, especially for gay men, that did not exist in the early 1990s. Several studies have found increased levels of high risk sexual behaviour and sexually transmissible infections (STI) among gay men who seek sex on the Internet, although the underlying processes are not fully understood. Research funded by the UK Medical Research Council (2002-2004) provided the opportunity to consider whether the Internet represents a new sexual risk environment for gay and bisexual men living in London. METHODS: The objectives of the Internet and HIV study are to: (i) measure the extent to which gay men living in London seek sexual partners on the Internet; (ii) compare the characteristics of London gay men who do and do not seek sex on the Internet; (iii) examine whether sex with Internet-partners is less safe than with other sexual partners; (iv) compare use of the Internet with other venues where men meet sexual partners; (v) establish whether gay men use the Internet to actively seek partners for unprotected anal intercourse; (vi) determine the potential for using the Internet for HIV prevention. These objectives have been explored using quantitative and qualitative research methods in four samples of London gay men recruited and interviewed both online and offline. The four samples were: (i) gay men recruited through Internet chat rooms and profiles; (ii) HIV positive gay men attending an NHS hospital outpatients clinic; (iii) gay men seeking an HIV test in an NHS HIV testing or sexual health clinic; (iv) gay men recruited in the community. RESULTS: Quantitative data were collected by means of confidential, anonymous self-administered questionnaires (n>4000) completed on-line by the Internet sample. Qualitative data were collected by means of one-to-one interviews (n = 128) conducted either face-to-face or on-line. CONCLUSION: The strength of the Internet and HIV study is its methodological plurality, drawing on both qualitative and quantitative research among online and offline samples, as well as taking advantage of recent advances in web survey design. The study's findings will help us better understand the role of the Internet in relation to gay men's sexual practice.

Adult↗