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.     

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.     

Frequency of Sexual Activity With Most Recent Male Partner Among Young,Internet-Using Men Who Have Sex With Men in the United States

Sex frequency, defined here as the number of oral or anal sex acts with the most recent partner in the past year, is a potential driver of risk for sexually transmitted infections. However, few data on sex frequency have been reported for men who have sex with men (MSM). Data from an Internet survey of MSM were used to describe sex frequency with most recent main and casual male partners and to estimate factors associated with higher sex frequency. Among 5,193 MSM, higher sex frequency was associated with younger age, shorter relationship duration, and reporting a main (vs. casual) partner; and lower sex frequency with male partners was associated with heterosexual or bisexual (vs. homosexual) identity or Black race (vs. non-Hispanic White). Secondary analyses of estimates of sex frequency from 2 publicly available nationally representative datasets comprised of primarily heterosexual survey respondents (the 2008 General Social Survey and the 1992 National Health and Social Life Survey) were performed. Sex frequency among MSM respondents was similar to that reported by heterosexuals.     

The Role of Gay Identity Confusion and Outness in Sex-Seeking on Mobile Dating Apps Among Men Who Have Sex With Men: A Conditional Process Analysis

Mobile dating apps are now a popular platform for men who have sex with men (MSM) to connect with others. Based on the uses and gratifications (U&G) theory, this study explores the relationship between sex-seeking and the number of casual sex partners met through MSM-based mobile dating apps (Grindr, Jack’d, and SCRUFF). The conditional process analysis (N = 401) shows that this relationship was significant and was mediated by the intensity of app use. That is, sex-seeking indirectly affected the number of casual sex partners through the intensity of app use. Furthermore, gay identity confusion and outness to the world moderated this indirect effect: it was stronger when the user was either more confused about his sexuality or was less out to the world. This research introduces an alternative way to incorporate psychographics variables into the U&G framework.     

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.     

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.     

HIV disclosure and subsequent sexual behaviors among men who have sex with men who meet online

To assess HIV disclosure discussions and related sexual behaviors among men who have sex with men (MSM) who meet sex partners online, 28 qualitative interviews with Seattle-area MSM were analyzed using grounded theory methods and themes and behavior patterns were identified. MSM found a greater ease in communicating and could prescreen partners through the Internet. However, no consistent relationship was found between HIV disclosure and subsequent behaviors: some were safer based on disclosure while perceived HIV status led others to risky behaviors. Interventions need to promote accurate disclosure while acknowledging its limitations and the need for men to self-protect.     

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.     

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.     

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.     

Effects of Brief Messages About Antiretroviral Therapy and Condom Use Benefits Among Black and Latino MSM in Three U.S. Cities

This pilot study examined effects of HIV prevention messages about self and partner benefits of antiretroviral therapy (ART) and condom effectiveness on increased intentions for behavior change. Data were from Messages4Men, a study examining prevention messages among 320 HIV-positive and 605 HIV-negative Black and Latino MSM. Men completed a computer-based assessment after message exposure, and multivariable models controlled for risky sex and demographics. A majority of HIV-positive men reported increased intentions for ART use; 22% reported partner benefit information was new. HIV-positive men with a detectable viral load had significantly greater adjusted odds of reporting intentions for ART use. Over half of HIV-negative MSM reported ART benefit information was new, and 88% reported increased intentions to discuss ART use with infected partners. Black MSM anticipated they would increase condom use in response to the self and partner benefit messages. Tailored messages on benefits of ART are needed for MSM.     

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.     

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.     

The Social Environmental Context of Resilience Among Substance-Using African American/Black Men Who Have Sex With Men

ABSTRACT

Resilience theory has been suggested as a framework for research on HIV prevention among men who have sex with men. Among this population, literature indicates that African American/Black men who have sex with men experience additional health disparities including elevated HIV incidence rates, victimization, and poor physical health. Conceptualizing resilience as a part of one’s social environment, this qualitative study investigates resilience processes and HIV transmission risk among a sample of 21 substance-using African American/Black men who have sex with men. Data from in-depth interviews describe the social environmental context in which resilience is exhibited and document the influence of homophobia, expressions of agency, and access to social, economic, and cultural capital on resilience processes. Central to this are expressions of hidden resilience, in which African American/Black men who have sex with men mitigate risk and experience their lives as subjectively successful, whether or not outsiders see it as such.     

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.     

Gay Community Involvement: Its Interrelationships and Associations With Internet Use and HIV Risk Behaviors in Swedish Men Who Have Sex With Men

We measured aspects of “community involvement” chosen for men who have sex with men (MSM) in Sweden (gay places, media accessed, Internet, gay festivals, and social engagement, measured as proportion of gay friends) in two Swedish Internet-based samples from 2006 (n?=?3,202) and 2008 (n?=?4,715). Data showed low to moderate reliability with a moderate (0.57) alpha coefficient. While there is moderate internal consistency, as might be anticipated from measures of actual community involvement, they can be treated as scales. The Internet scale indicated the lowest reliability, perhaps due to respondents having Internet sites of primary choice, rather than a high level of usage across several sites. A hypothesized lack of correlation between traditional domains of the gay community and the Internet did not appear: correlations between the Internet measure and the other measures were positive and significant, but among the lowest correlations obtained between the community measures, ranging from 0.06 to 0.24. Those who use the Internet extensively are less likely to be involved in other aspects of the community. Sexual risk was associated with high social engagement at sexual meeting sites and with Internet use. Gay community involvement, including the Internet community, may be complex and associated with both increase in HIV sexual risk behaviors (by measuring use of sexual risk sites) and preventive measures (HIV testing).     

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.     

Gradients in Depressive Symptoms by Socioeconomic Position Among Men Who Have Sex With Men in the EXPLORE Study

ABSTRACT

This study examines gradients in depressive symptoms by socioeconomic position (SEP; i.e., income, education, employment) in a sample of men who have sex with men (MSM). Data were used from EXPLORE, a randomized, controlled behavioral HIV prevention trial for HIV-uninfected MSM in six U.S. cities (n = 4,277). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (short form). Multiple linear regressions were fitted with interaction terms to assess additive and multiplicative relationships between SEP and depressive symptoms. Depressive symptoms were more prevalent among MSM with lower income, lower educational attainment, and those in the unemployed/other employment category. Income, education, and employment made significant contributions in additive models after adjustment. The employment-income interaction was statistically significant, indicating a multiplicative effect. This study revealed gradients in depressive symptoms across SEP of MSM, pointing to income and employment status and, to a lesser extent, education as key factors for understanding heterogeneity of depressive symptoms.     

The Relationship Between Body Image and Sexual Functioning Among Gay and Bisexual Men

ABSTRACT

Gay and bisexual men report high body dissatisfaction compared to heterosexual counterparts, but no studies to date have examined how this may impact their sexual functioning. The present study investigated body image domains as predictors of sexual functioning problems (inhibited desire, erectile dysfunction, and premature ejaculation) among an online community sample of 185 gay and bisexual men, ages 18–40. Participants reported moderate to high body image satisfaction and sexual functioning consistent with previous literature with nonclinical male samples. Overall, the total variance accounted for by regression models was low. Body image variables were not predictive of sexual desire. However, increased drive for muscularity and lower affective body esteem were predictive of erectile difficulties. Additionally, negative behavioral body image in sexual situations and evaluative body dissatisfaction were associated with premature ejaculation. Understanding this relationship may have implications for gay and bisexual men’s health and wellbeing. Future research directions are discussed.