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.     

That Man Behind the Curtain: Investigating the Sexual Online Dating Behavior of Men Who Have Sex With Men but Hide Their Same-Sex Sexual Attraction in Offline Surroundings

This study investigates how men who have sex with men (MSM) use chat and dating sites based on theories of stigma-related offline behavior and online self-disclosure. We hypothesize that hidden MSM (those who self-label as heterosexual or who hide their same-sex sexual attraction from family, friends, acquaintances, or a female romantic partner) differ from open MSM in how they behave on gay chat and dating sites and in offline gay venues. Drawing on a survey of 12,002 MSM, we show that hidden MSM tend to mask their identity on gay chat and dating sites while avoiding offline gay venues. They also focus more strongly on online sexual activities (e.g., masturbating during online chats) when using gay chat and dating sites. However, they spend the same amount of time on these sites, and they use them to initiate offline sexual encounters as often and as fast as open MSM.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Impulsivity as a Risk Factor for HIV Transmission in Men Who Have Sex with Men: A Delay Discounting Approach

Delay discounting (DD) is a measure of impulsivity that describes the subjective decline in value of a consequence as the delay to that consequence increases. We sought to assess whether the results of a monetary DD task would be predictive of sexual risk-taking in a group of Internet-using men who have sex with men (MSM). 1402 participants completed an online survey that included questions about the participant’s demographics, sexual history and behavior, drug use, sexual compulsivity, and a monetary DD task. High DD was associated with increased odds of reporting >2 UAI partners in the past 12 months [aOR = 1.5 (1.1–2.1)]. Future studies should examine the utility of DD as a predictor of risky sexual behavior, as well as explore the possibility of HIV prevention interventions targeting DD.     

Non-Heterosexuality,Relationships, and Young Women’s Contraceptive Behavior

Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women’s higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.     

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.     

Is It Facebook Official? Coming Out and Passing Strategies of Young Adult Gay Men on Social Media

The rapid proliferation of social media, mobile applications, and Internet technologies has shifted a wide variety of social interaction from physical spaces to an online environment. Drawing from 42 semistructured, in-depth interviews with gay college-aged men between the ages of 18 and 27, this article explores these changing patterns of social interaction among gay men. I discuss three strategies of identity management college-aged gay men use to disclose or conceal their sexual identity to others. The first group of men, “Out and Proud,” uses Facebook as a way to celebrate and reaffirm their sexual identity, in addition to actively coming out to others on the social media Web site. The second group, “Out and Discreet,” uses Facebook to indirectly come out to some of their friends while hiding this information from others. The men in the last group I identify, “Facebook Closeted,” actively manage their online profiles to ensure their sexual identity is not exposed. Facebook is both transformative and risky for college-aged gay men, as it represents a new platform for them to come out as gay to friends and family, as well as other areas of their lives where they must actively manage the presentation of their sexual identity.     

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.     

Men and not-men: male gender-mixing statuses and homosexuality

Male gender-mixing statuses, such as Native American berdaches, consist of men who assume the cultural, symbolic attributes of women to attain the status of not-men. Remaining distinct from women, not-men are a culturally defined gender status whose indexing features include women's dress and behavior, occupational inversion, and some cultural traits of men. Another indexing feature of not-men is the absence of sexual relations with other not-men, which forces them to seek not-status men or women as sexual partners. The frequent equation of gender-mixing statuses with homosexuality is a misunderstanding: Sex with men is a secondary and derivative characteristic.     

Age Cohort Differences in the Developmental Milestones of Gay Men

ABSTRACT

As the social context in which gay men live changes due to greater visibility, greater acceptance, and easier access to gay subculture, gay males may self-identify and take part in gay social activities at earlier ages than in the past. This study examined whether developmental milestones associated with sexual orientation for gay men have changed over the past several decades. A large and diverse sample of 2,402 gay men who responded to a 1994 survey published in a national magazine provided retrospective information on the age at which they reached individual psychological, social, and sexual behavior developmental milestones. We found evidence that individual psychological and sexual behavior milestones (e.g., awareness of attraction to males, having an orgasm with other male) are slowly moving toward earlier chronological ages (by 1 year of age every 8–25 years, p?<?0.05), whereas social milestones (e.g., coming out) are moving more rapidly in a similar direction (by 1 year of age every 2–5 years, p?<?0.001). The authors perform an innovative sensitivity test to demonstrate the persistence of the finding after correcting for the bias attributable to underrepresentation of those who have not yet self-identified as gay in such samples.     

“Hedge Your Bets”: Technology’s Role in Young Gay Men’s Relationship Challenges

Technology is playing an increasingly pervasive role among young gay men in the process of meeting potential romantic or sexual partners. We investigated challenges posed by technology related to young gay men’s relationships. Focus groups (n = 9) of young gay men aged 18–24 (n = 43) were transcribed verbatim, and thematic analysis was used to identify two major themes regarding challenges to relationship development and maintenance. Subthemes include unrealistic expectations of relationships, inauthentic self-presentation online, sexual primacy over romance, increased opportunities for infidelity, and jealousy. The implications of this study for sexual education and sexual health promotion are discussed.     

Sexuality and relationship changes in married females following the commencement of bisexual activity

Some of the changes in sexual behavior and relationships with spouses and other females following the commencement of bisexual activity by women after the age of 30 were studied by conducting in-depth personal interviews with 50 women. Each participant, at the time of her first sexual activity with another female: (a) was married; (b) was at least 30; (c) was, with her spouse, engaging in consensual swinging activities; (d) was enjoying sex with males; and (e) had no history, prior to age 30, of sexual attraction to females. Generally, the subjects revealed high levels of participation in, and enjoyment of, sexual activity with other females, in addition to high levels of enjoyable heterosexual activity. Their generally happy and stable marriages tended somewhat to improve, as did their overall sex lives, and they saw their relationships with other females as significantly improved. Significant changes in sexual fantasies occurred. In all cases, sexual orientation became bisexual, but overall preference for male sex partners did not change.     

Sexual Coercion Among Gay and Bisexual Men in Aotearoa/New Zealand

Until recently, sexual coercion among gay men has been regarded as virtually oxymoronic. Discourses of male sexuality as ever-present and driven, and discourses of masculinity that portray men as in control and invulnerable, converge to almost disavow the possibilities that sex could be unwanted by men, or that men could be vulnerable to being pressured into sex against their will. This article reports on interviews with 19 gay and bisexual men about their experiences of forced, coerced, or unwanted sex. We identified four general patterns in these accounts: (1) incidents involving physical force; (2) experiences in which a man's ability to refuse sex was compromised by intoxication; (3) dynamics where young and inexperienced men were coerced or pressured into unwanted sex; and (4) situations in which men felt obligated to engage in unwanted sex. Specific issues included barriers to reporting sexual assault, power dynamics in intergenerational sex, and the difficulty of refusing unwanted sex. Importantly, many of the factors identified as driving sexual coercion relate not to gay sexuality per se, but rather to masculine sexuality. Conversely, some of the factors relating to men's vulnerability to coercion were exacerbated by some features of gay sexual culture; in particular those aspects associated with existing in a marginalized territory within a wider heteronormative context.