Social Responsibility,Substance Use,and Sexual Risk Behavior in Men Who Have Sex With Men

Considerable public health literature focuses on relationships between problematic human characteristics (e.g., psychopathology) and unhealthy behaviors. A recent movement termed positive psychology emphasizes the advantages of assessing relationships between human strengths (e.g., altruism) and beneficial health behaviors. The present study assessed social responsibility, an orientation to help or protect others even when there is nothing to be gained as an individual, and its relationship to HIV-relevant behaviors. In our sample of 350 men who have sex with men (MSM), social responsibility was negatively correlated with substance use and HIV risk behaviors. Men who had been tested for HIV and knew their HIV status—a behavior that helps men protect their partners but does not protect themselves from the virus—also scored higher in social responsibility. Interventions designed to reduce HIV risk behavior in MSM may benefit from efforts to promote human strengths.     

HIV Risk Among Men Who Have Sex with Men Only (MSMO) and Men Who Have Sex with Men and Women (MSMW) in Baltimore

Men who have sex with men and women (MSMW) are at high risk for HIV. However, the majority of research on populations of men who have sex with men (MSM) combines MSMW and men who have sex with men only (MSMO) samples, which limits our understanding of HIV risk behaviors and factors associated with HIV risk among MSMW populations. We used the BESURE-MSM2, a venue-based cross-sectional study of HIV risk behaviors among MSM in Baltimore, MD, to examine HIV risk among MSMW. MSMW were less likely to report unprotected receptive anal intercourse than MSMO (6.8% vs. 19.6%, p = .0024). Among MSMW, 43.0% reported unprotected sex with a woman in the past year, but only 19.4% reported unprotected sex with both men and women, representing only 5.0% of the total MSM sample. In multivariate analyses, we found that among MSMW having unprotected sex with women in the past year, disclosing same sex behavior and having a main female partner were associated with unprotected anal intercourse with male partners. HIV prevention programs for MSMW are needed that address the complex partnerships of MSMW and the social contextual factors within which relationships and behaviors are embedded.     

Age of Onset of Alcohol Consumption and Subsequent Negative Health Outcomes in Gay and Bisexual Men Who Have Sex With Men

ABSTRACT

The correlation between current alcohol use and sexual risk behaviors among men who have sex with men (MSM) is well documented, but little is known about age of drinking onset and current risks among this population. Data from a 2008 Internet survey of 8,452 MSM in the United States were used to assess factors associated with age of onset of alcohol use. In a multivariable model, drinking onset before age 15 was significantly associated with a higher number of lifetime male anal sex partners and being behaviorally bisexual in the past 12 months. Men who reported depressive symptoms in the past two weeks or who screened positive for alcohol abuse in the past 60 days were more likely to have early age of drinking onset. Findings suggest the need for targeting younger adolescents for alcohol screening, particularly sexual minority youth, to prevent risk behaviors in adulthood.     

Consideration of future consequences and unprotected anal intercourse among men who have sex with men

This study of men who have sex with men (MSM) examined whether tendencies to consider the future consequences of one's actions were associated with sexual behaviors that place oneself at risk for HIV infection. A total of 339 HIV-negative MSM responded to the Consideration of Future Consequences Scale (CFC; Strathman et al., 1994) and to questions about their anal intercourse practices in the past year. In bivariate analyses, men with a stronger future orientation were less likely to engage in anal intercourse unprotected by a condom (p < .05). Multivariate analyses revealed that CFC accounted for significant variance in three of four measures of unprotected anal sex after statistically controlling for demographic covariates (education, income, ethnicity, age). CFC was a better predictor of sexual behavior and accounted for more unique variance than any of the demographic factors. Additional research is needed to confirm that CFC is an antecedent of behavior and to examine the feasibility and efficacy of focusing on CFC in HIV prevention interventions.     

Sexual orientation identification of men who have sex with men in public settings in Canada

The present study attempts to determine how men who have sex with men (MSM) identify in terms of their sexual orientation. The sexual identity of MSM has important implications for the spread of HIV. The literature suggests that gay or bisexual identifying MSM are more likely to practice safer sex than heterosexually-identified MSM. A significant number of the MSM in public settings, such as parks, are believed to be heterosexual identifying. MSM in bathhouses are presumed to be gay or bisexual identifying. Parks have been the focus of safer sex outreach efforts targeted towards heterosexually-identified MSM. Sexual orientation self-identification was ascertained from park and bathhouse users via one-on-one interactions with outreach workers from 1996 to 1998. Chi-square analysis revealed no significant difference in the expressed sexual orientation of bath and park users, with both populations consisting mostly of gay-identified men. Heterosexually-identified MSM are not found in significant numbers in public settings. The current micro educational approach used to target these men may not be cost-effective. Alternative strategies are discussed.     

Lubricant Use Among Men Who Have Sex With Men Reporting Anal Intercourse in Bangkok,Thailand: Impact of HIV Status and Implications for Prevention

ABSTRACT

This analysis measures prevalence and correlates of consistent lubricant use among a cohort of Thai men who have sex with men (MSM). Lubricant use was queried at the 12-month follow-up visit. Consistent lubricant use was evaluated with logistic regression. Consistent lubricant use was reported by 77.0% of men and was associated with consistent condom use with casual partners, while binge drinking, payment for sex, and inconsistent condom use with casual, and steady, partners were negatively associated. Though consistent lubricant use is common among this Thai MSM cohort, further promotion is needed with MSM engaging in risky sexual practices.     

Sexual Behaviors,Sexual Health Practices,and Community Engagement Among Gay and Bisexually Identified Men Living in Rural Areas of the United States

Limited research has focused on the sexual behaviors of men who have sex with men (MSM) from rural communities. We examined the sexual and health-related behaviors of MSM living in rural areas of the United States in order to understand the sexual health repertoire of this population. A total of 5,357 participants living in rural settings were recruited online and completed an anonymous Internet-based survey that assessed sexual behaviors, condom use, and men’s engagement with various community activities and events. These data provide a greater understanding of sexual health profiles that exist among rural MSM and will help inform the design of effective programs for men in these often underserved communities.     

On Holiday: A Risk Behavior Profile for Men Who Have Vacationed at Gay Resorts

Sexual risk behavior is higher when people vacation as compared to when they are at home. The current study uses survey data to compare sexual risk behavior of gay men who vacation at gay resorts to those who do not. Independent predictors of vacationing at gay resorts included income level, relationship status, ever having attended a circuit party, and HIV serostatus. For men who visit resorts to meet sex partners, independent predictors included relationship status, ever having attended a circuit party, HIV serostatus, number of male sex partners in the past six months, and number of anal insertive male partners using a condom. These results show a need for the development of structural interventions in the gay resort and hotel setting.     

Understanding the demographic characteristics of urban men who have sex with men

We examined migration, closetedness, and family structure explanations of demographic profiles of urban men who have sex with men (MSM) using data from the Urban Men's Health Study and the Public Use Microdata Sample of the U.S. Census. The data suggested that the demographic profiles of urban MSM reflect a large in-migrating white, often young adult, population without children. Closetedness, an oft-cited bias in MSM population studies, did not significantly impact demographic patterns with minor exceptions. MSM urban subpopulations have demographics that differ substantially from the general population of the cities in which they reside.     

Hazardous journey in intimacy: HIV transmission risk behaviors of young men who are victims of past sexual abuses and who have sexual relations with men

The aim of this research was to explore the behavioral patterns and dynamics that may increase vulnerability towards HIV transmission among young men who have been sexually molested as children and who have sexual relations with men. In recent years, researchers have found that a larger number of gay or bisexual men have been sexually abused as children than other men. In this study, we wanted to explore the possible links between sexual victimization of young men and risky sexual behaviors related to HIV transmission among these men.     

Latino Gay and Bisexual Men's Relationships with Non-Gay-Identified Men Who Have Sex With Men

This study investigated relationships between Latino gay-identified men in metropolitan New York City and their non-gay-identified male partners. Phase 1 consisted of in-depth interviews (N = 33), and Phase 2 consisted of quantitative surveys (N = 120) with Brazilian, Colombian, and Dominican men who have sex with men (MSM). A majority of participants reported having had sex with heterosexually identified men, and in many cases, the relationship was sustained over time. We found mixed results concerning an attitude sometimes attributed to Latinos that sexual orientation is defined by sexual role, with receptive MSM seen as gay and insertive MSM seen as straight. Although there were no significant associations between partner sexual orientation and unprotected anal intercourse, gay men were less likely to take the insertive role in oral or anal sex with straight-identified male partners than with gay partners.     

The Effects of Three Types of Sexual Orientation Victimization on HIV Sexual Risk Behavior Among Black South African Men Who Have Sex With Men (MSM)

ABSTRACT

The goal of this study is to examine the relations between histories of three types of sexual orientation victimization (childhood, personal, and institutional) and HIV sexual risk behavior among Black South African men who have sex with men (MSM). Secondarily, this study examines whether marijuana use and problem drinking mediate the relations. Participants were 125 Black MSM recruited from neighborhoods in Eastern Cape Province, South Africa. Questionnaires administered through audio computerized self-interviewing assessed sexual orientation victimizations, problem drinking and marijuana use, and unprotected anal sex with casual partners. Data were analyzed using multiple regression and multiple mediation modeling.

Personal and institutional sexual victimizations were associated with condomless anal sex. Childhood sexual orientation victimization was positively associated with problem drinking. Neither problem drinking nor marijuana use mediated the relations between sexual orientation victimizations and having condomless anal sex with casual partners.     

Internalized Homophobia,HIV Knowledge,and HIV/AIDS Personal Responsibility Beliefs: Correlates of HIV/AIDS Discrimination among MSM in the Context of Institutionalized Stigma

ABSTRACT

There exists a paucity of research on the psychosocial risk factors of HIV/AIDS among men who have sex with men (MSM) in settings where they are stigmatized or face prosecution. The present study investigates discrimination against people living with HIV (PLHIV), internalized homophobia, HIV/AIDS personal responsibility beliefs and HIV knowledge in a purposive sample of 106 self-identified MSM obtained through a web-based survey disseminated by two voluntary welfare organizations. Results indicate that internalized homophobia is positively associated with discrimination against PLHIV. Internalized homophobia also substantially mediates the effect of HIV/AIDS personal responsibility beliefs on discrimination against PLHIV, highlighting the confounded nature of HIV/AIDS and homosexual stigma in a setting where stigma is deep-rooted and institutionalized. Internalized homophobia may thus serve as a barrier to the effectiveness of HIV prevention efforts among MSM in Singapore.     

Exploring First Sexual Intercourse,Sexual Orientation,and Sexual Health in Men

In this study the characteristics of the sexual debut of men who have sex with men (MSM) and men who have sex with women (MSW) age 35 or younger (N = 1,201) were compared with one another. We investigated whether these characteristics were associated with sexual health and behavior, and to what extent. Compared to MSW, MSM tended to be older when they had their first sexual intercourse; their first sex partner was older, they felt less ready, and they experienced more pain. We also found that they reported a higher number of lifetime sexual partners and less condom use compared to MSW. Similarities were also ascertained, such as the fact that individuals from both groups do not differ significantly regarding how they experienced their first sexual intercourse emotionally. Many differences between these groups should not always be seen as problematic, whereas others still indicate a need for targeted interventions.     

Comparing sexual behavioral patterns between two bathhouses: implications for HIV prevention intervention policy

There is a glaring lack of data to inform culturally appropriate HIV prevention interventions targeting environments such as bathhouses where men who have sex with men (MSM) practice sexual risk behaviors. This study compares sexual behavioral patterns across two bathhouse sites in order to identify important themes to address when tailoring HIV prevention interventions to bathhouse environments. We analyzed semi-structured interviews with workers and patrons at two bathhouses to explore similarities and differences. A coding scheme was established and data were organized according to conceptual themes. We found that differences between the two sites emerged in six key areas: bathhouse clientele, attraction to particular sites, sexual practices and condom use, communication about sex and HIV status, bathhouse rules, and substance use. Implications for HIV prevention intervention policy are discussed.     

Risk Behaviors Among Young Men Who Have Sex With Men in Bangkok: A Qualitative Study to Understand and Contextualize High HIV Incidence

ABSTRACT

The Bangkok Men Who Have Sex With Men (MSM) Cohort Study has shown high HIV incidence (8–12/100 person-years) among 18–21-year-old MSM. These data led to a further study using qualitative methods among young (18–24 years old) MSM in order to understand the factors driving the HIV epidemic among YMSM. We conducted eight focus group discussions and 10 key informant interviews among YMSM in Bangkok, Thailand. Sociodemographic and behavioral data were collected using a questionnaire. We audio-recorded, transcribed, and analyzed qualitative and questionnaire data using computer software. The categories relating to risk behavior were (1) the use of social networks for seeking sexual partners and the marketing promotions of MSM entertainment venues, (2) social influence by peers and older MSM, (3) easy access to high parties and group sex, (4) easy access to club drugs, (5) conceptions related to HIV risk, and (6) sexual preferences of YMSM. Increased HIV testing, same-sex education, and YMSM-specific HIV prevention efforts are urgently needed for YMSM in Bangkok.     

Public Sexual Cultures: A Systematic Review of Qualitative Research Investigating Men's Sexual Behaviors with Men in Public Spaces

Resurgent HIV and sexually transmitted infection incidence among men who have sex with men (MSM) requires an urgent re-examination of sexual transmission sites. To these ends, we systematically review qualitative literature concerning men's sexual behaviors within public sex environments (PSEs). Sex, therein, is negotiated by the highly codified, largely nonverbal practice of “cruising.” A generic, shared PSE sexual culture emerges from the literature—across locations, countries, and decades—because of the importance of concealment and common structural constraints on sexual encounters in PSEs. However, differences in local geography and facilities may transform key features of this, resulting in specific, local sexual cultures emerging for each locale. We argue that, although sexual cultures developed to minimize nonsexual cruising risks, they may be exploited to improve contemporary in situ outreach work.     

Several Common Bonds: Addressing the Needs of Gay and Bisexual Men in LGBT-Specific Recovery Housing

ABSTRACT

Recovery housing is a promising way to augment the substance use continuum of care, but we know little about the experiences of members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community who live in them or about residences specifically for them. Within the LGBTQ community, gay, bisexual, and other men who have sex with men (MSM) often experience co-occurring syndemic conditions (e.g., trauma, depression, HIV) that present unique recovery challenges. Using qualitative data gathered from residents living in a recovery residence specifically for gay and bisexual men and from community key informants, we examine the experiences of men living in the home and factors that facilitate operating it. Findings highlight the need for residences that can address syndemic burden among gay and bisexual men in recovery and identify programmatic and community-level factors critical to operating residences for this population.     

Designing an HIV counseling and testing program for bathhouses: the Seattle experience with strategies to improve acceptability

Bathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively few bathhouses routinely provide this service, and few data are available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results. The design included ways to provide client support and follow-up for partner notification and treatment counseling and to maintain relationships with bathhouse management for support of prevention activities. Early detection of HIV infection and HIV prevention can be achieved for some high-risk MSM through an accessible and acceptable HIV counseling and testing program in bathhouses. Keys to success include establishing community prevention collaborations between bathhouse personnel and testing agencies, ensuring that testing staff are supported in their work, and offering anonymous rapid HIV testing. Use of FDA approved, new rapid tests that do not require venipuncture, centrifugation, or laboratory oversight will further decrease barriers to testing and facilitate implementation of bathhouse testing programs in other communities.     

Suicidality and Associated Factors Among Men Who Have Sex With Men in Estonia

Many studies over the last decade provide strong evidence of elevated rates of suicidality among lesbian, gay, bisexual, and transgender populations compared to heterosexual populations. The aim of the current study was to investigate suicidal ideation and attempts and related factors among men who have sex with men (MSM) in Estonia. We conducted a nationwide Internet-based study among MSM with 265 eligible participants. Our results reveal high rates of self-reported suicidal ideation (lifetime prevalence 45%) and attempts (lifetime prevalence 11%) as well as a high rate of problem drinking (33%) and depressive symptoms (32%) among MSM. Recent suicidal ideation (14% had thought about suicide in the last 12 months) was related to depressive symptoms and lower socioeconomic situation. There is a need to develop specific interventions to address these issues among MSM and to provide gay-friendly mental health services.