South African Men Who Have Sex With Both Men and Women and How They Differ From Men Who Have Sex With Men Exclusively

The label “men who have sex with men” (MSM) is used to categorize a diverse population exclusively on the basis of its sexual behavior. Understanding the diversity that this label comprises is critical for the development of health interventions that effectively reach the various populations subsumed under this label. In this cross-sectional study of South African MSM (N = 480) recruited through respondent-driven sampling (RDS), we explored differences between men who had sex with both men and women (MSMW) and men who had sex with men exclusively (MSME). We found significant differences between these two groups in terms of sexual attraction, sexual identity, sexual preferences, sexual histories, and current sexual practices. MSMW were more likely to be confused about their same-sex attraction, to experience internalized homophobia, and to have paid for sex in the previous year, while MSME were more gender nonconforming and more likely to have been forced to have sex in the previous year. These findings underscore that the MSM label comprises a diverse population and that exclusive sexual engagement with other men is a critical distinction to take into account in understanding this diversity and fully grasping the lived experiences of men who have sex with men.     

Correlates of Loneliness in Midlife and Older Gay and Bisexual Men

This study examined the correlates of psychosocial and behavioral factors on loneliness in midlife and older gay and bisexual men in South Florida. A community-based sample of 802 self-identified gay and bisexual men ages 40 to 94 years completed standardized measures of life orientation (optimism versus pessimism), internalized homonegativity, coping self-efficacy, and loneliness. Multivariate modeling successfully explained 45% of the variance in loneliness, which was significantly related to life orientation, coping self-efficacy, internalized homonegativity, and finding partners on the Internet (F = 96.140, df = 6, p < .001). The emphasis on skills building to increase coping self-efficacy and optimism and addressing the effects of internalized homonegativity may have lasting effects in reducing loneliness in older gay and bisexual men and thus improving their mental and physical well-being.     

A Pilot Study to Evaluate Ethnic/Racial Differences in Depressive Symptoms,Self-Esteem,and Sexual Behaviors Among Men Who Have Sex with Men

Men who have sex with men (MSM) are at risk for certain physical and psychological health conditions. Ethnic minority MSM are at an increased risk related to the combination of sexual minority and ethnic minority status. The purpose of this pilot study was to compare the levels of depressive symptoms, self-esteem, and sexual behaviors by ethnicity in a sample of MSM (N = 70) residing in South Florida. More than one-third of the sample (N = 26; 37%) had high levels of depressive symptoms. Using non-parametric statistics, statistically significant differences were noted in the levels of depressive symptoms as African-American MSM had higher levels of depressive symptoms when compared to the other ethnic groups. Statistically significant differences were not found when self-esteem and sexual behaviors were compared by ethnicity. Regardless of ethnicity, MSM in this study were at risk for the sequela of depressive symptoms and infections with HIV and/or sexually transmitted infections because of the high levels of unsafe sexual behaviors. More research is needed to explore the relationship of mental health and sexual behaviors among the various ethnic groups of MSM.     

The Relationship Among Population Size,Requests for Bareback Sex,and HIV Serostatus in Men Who Have Sex With Men Using the Internet to Meet Sexual Partners

Recent research has indicated the use of the Internet to meet sexual partners among men who have sex with men (MSM) is increasing. This medium also serves as a major source for social and sexual networking among MSM who live in more rural areas. In addition, data suggest the use of the Internet to initiate sexual relationships among this population may increase the risk of transmission of sexually transmitted infections, including HIV. The purpose of this study was to examine differences between self-reported HIV serostatus and requests for condomless bareback (BB) sex among a sample of Florida MSM (n = 483) using a popular Internet sexual networking site to meet sexual partners. Specifically, these variables were assessed in relation to population size among the site's seven geographic regions within the state. Findings indicated an overall statistically significant relationship among requests for BB sex and self-reported HIV serostatus. However, there was not a significant relationship among these variables and geographic region. Thus, although previous data have emphasized the importance of different HIV prevention strategies among rural versus urban MSM, there may not be major differences in HIV serostatus and requests for unsafe sexual practices among these men who use the Internet to meet sexual partners in comparison to MSM in more populated areas.     

Internet Sex Ads for MSM and Partner Selection Criteria: The Potency of Race/Ethnicity Online

The explosive growth in Internet use by men who have sex with men (MSM) to find sexual partners has been noted in the research literature. However, little attention has been given to the impact of participating in this online sexual marketplace for MSM of color, despite race and ethnicity as frequently used selection criterion in personal ads or profiles. Six focus group discussions (n = 50) and 35 in-depth qualitative interviews were conducted with African American, Latino, or Asian and Pacific Islander MSM in Los Angeles, which included discussion of their use of Internet sites to meet or interact with other MSM. Men reported race and ethnicity as a pervasive and powerful factor in facilitating or derailing Internet-mediated sexual encounters. The racialized interactions that MSM of color reported ranged from simple expressions of race-based preferences, to blatantly discriminatory or hostile interactions, and often demeaning race-based sexual objectification. Experiences of rejection and a perceived hierarchy of value in the sexual market based on race had definite costs for these MSM using these online sites. Furthermore, the private and solitary nature of seeking partners online meant that there was little to buffer the corrosive aspects of those negative experiences. These online dynamics have implications for the power balance in Internet-mediated sexual liaisons, including sexual decision making and sexual risk.     

Sexual Behavior Latent Classes Among Men Who Have Sex With Men: Associations With Sexually Transmitted Infections

Men who have sex with men (MSM) are at disproportionate risk of acquisition of sexually transmitted infections (STIs). We used latent class analysis (LCA) to examine patterns of sexual behavior among MSM and how those patterns are related to STIs. We examined patterns of sexual behavior using behavioral and clinical data from a cross-sectional study of 235 MSM who presented to an urban sexual health clinic for STI testing. Analyzed data were collected using a combination of interviewer- and self-administered surveys and electronic health records. We used LCA to identify underlying subgroups of men based on their sexual behavior, described the demographics of the latent classes, and examined the association between the latent classes and STI status. We identified three latent classes of sexual behavior: Unprotected Anal Intercourse (UAI) Only (67%), Partner Seekers (14%), and Multiple Behaviors (19%). Men in the Multiple Behaviors class had a 67% probability of being STI positive, followed by men in the UAI Only class (27%) and men in the Partner Seekers class (22%). Examining the intersection of a variety of sexual practices indicates particular subgroups of MSM have the highest probability of being STI positive.     

Contrasting Types of Puerto Rican Men Who Have Sex with Men (MSM)

Participants in this study were 182 men of Puerto Rican ancestry who lived in New York City and had sex with other men. They were recruited from various gay- and non-gay-identified environments. Qualitative and quantitative research methods were used to assess the participants' sexual attitudes and behavior. Based upon participants' self-labeling of their sexual behavior, four main groups were identified: straight MSM, bisexual MSM, gay MSM, and drag queens. Although similar in terms of age and the number of members infected with I-W, the four groups differed significantly on socioeconomic (SES), attitudinal, and behavioral parameters. It is postulated that MSM of low SES subscribe to stereotypical "machista" and "marianista" roles, while MSM of comparatively higher SES can feel more independent from those gender role expectations. It is concluded that Puerto Rican MSM are reachable and willing to participate in behavioral studies and behavioral change programs. Behavioral change programs must be sensitive to class and SES, tailored to different subgroups of MSM, and generated by a heterogeneous team that includes members of the target population.     

Patterns of Sexual Behaviors in Young Men Who Have Sex With Men in Mexico

Recent research has documented the importance of understanding the multidimensional nature of sexual risk behavior. However, little is known about patterns of sexual behavior among men who have sex with men (MSM) in Mexico, men who are at greatest risk for HIV and sexually transmitted infections compared to other subpopulations in the country. This study applied latent class analysis to data from a large, HIV-negative sample of 18- to 25-year-old Mexican MSM recruited from a social and sexual networking website (N = 3,722) to uncover multidimensional patterns of sexual behaviors, partner factors, and protective behaviors, and examine how these were associated with health and well-being correlates. We selected a model with seven classes. The most common class included those who reported both insertive and receptive behaviors with more than one partner, but smaller groups of individuals were in classes marked by only insertive or receptive anal sex, romantic relationships, or sexual inactivity. Class membership differed by sexual orientation, age, depressive symptoms, alcohol problems, and self-acceptance, with individuals in a class marked by same-sex relationships generally reporting more positive outcomes. Findings suggest heterogeneity of behaviors among Mexican MSM and the possible efficacy of prevention messages tailored to individuals’ specific patterns of sexual behavior.     

The Impact of HIV Pre-exposure Prophylaxis (PrEP) Use on the Sexual Health of Men Who Have Sex with Men: A Qualitative Study in Seattle,WA

This study explores the impacts of HIV pre-exposure prophylaxis (PrEP) use on the sexual health of men who have sex with men (MSM). The authors conducted in-depth interviews with MSM who use PrEP (n = 14). Data was analyzed using interpretative phenomenological analysis. PrEP use reduced fear and shame associated with sex and facilitated greater sexual satisfaction and intimacy. Although participants generally viewed PrEP as empowering and beneficial, they also experienced PrEP-related stigma. The authors’ analysis emphasizes the importance of understanding the reasons MSM use PrEP and highlights opportunities for reducing harm and fostering sexual health among MSM who are using or considering PrEP.     

Body Image,Body Satisfaction,and Unsafe Anal Intercourse Among Men Who Have Sex With Men

Using survey results from the 1998 Twin Cities Lesbian, Gay, Bisexual, and Transgender (LGBT) Pride Festival (N = 535), we explored associations between body image and unsafe anal intercourse (UAI) among men who have sex with men (MSM), and evaluated whether body satisfaction mediated this association. MSM who reported underweight body image had lower odds than those who reported average weight of UAI (AOR = 0.33; 95% CI = 0.13, 0.85); body satisfaction was not found to mediate this association. 13.3% of men who reported overweight/obese body image had engaged in UAI compared with 21.6% of those who reported average weight and 8.2% of those who reported underweight (p < .05). Compared with MSM in exclusive relationships, MSM in non exclusive relationships had increased odds of UAI (AOR = 5.78; 95% CI = 2.96, 11.29) as did men who were not partnered (AOR = 3.20; 95% CI = 1.72, 5.93). These findings highlight the importance of including body image in sexual behavior models of MSM to better understand body image's role in influencing sexual risk and sexually transmitted infections (STI)/human immunodeficiency virus (HIV) transmission.     

Still stressful after all these years: a review of lesbians' and bisexual women's minority stress

This article reviews the conceptualization of, and empirical literature on, lesbians' and bisexual women's sexual minority stress. In much of the early research, the experiences of sexual minority women and men were considered together (or women's experiences were inferred from men's), obscuring important differences. There is empirical and theoretical justification to consider the experiences of women and men separately and to develop and evaluate comprehensive models of sexual minority stress for women. Existing conceptualizations of sexual minority stress that include assessment of discrimination, victimization, harassment, concealment, internalized homonegativity may be applied, and perhaps adapted, to facilitate understanding of the unique stressors associated with women's sexual minority status. Future research must include mediators of the relationship between stressors and outcomes such as individual (e.g., coping and resilience) and group (e.g., social support, identification with a sexual minority community) resources. It is also essential to understand what factors may buffer the deleterious effects of these stressors.     

Tita Aida and Emerging Communities of Gay Men:

This article describes and analyzes the development of two gay men's organizations in Metro Manila, the Philippines. The members, who are predominantly salaried professionals, represent an emerging subculture among "men who have sex with men," self-identifying as gay. The HIV/AIDS epidemic, while eliciting different responses from the two organizations, is described as pivotal in challenging the groups' ethos about sexual identity, behavioral change, and community organizing. The potentials, as well as limitations, for further development of these groups are discussed.     

Correlates of Human Immunodeficiency Virus/Sexually Transmitted Infection (HIV/STI) Testing and Disclosure Among HIV-Negative Collegiate Men Who Have Sex With Men

Abstract

Objective: To determine the extent to which personal, behavioral, and environmental factors are associated with human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing and disclosure. Participants: Nine hundred thirty HIV-negative collegiate men who have sex with men (MSM) who completed an online survey about alcohol use and sexual behavior. Methods: Correlates of testing and disclosure significant in bivariate analyses (p < .05) were grouped into personal, behavioral, or environmental factors and entered into multivariable logistic regression models. Results: About half of participants tested for HIV (51.9%) and for STIs (45.8%) at least annually. Over half (57.8%) of participants always/almost always discussed HIV status with new sex partners; 61.1% with new unprotected sex partners. Personal and behavioral factors (age and outness) explained differences in testing, and the behavioral factor (routine testing) explained differences in disclosure. Conclusions: Collegiate MSM should be supported in coming out, encouraged to engage in routine testing, and counseled on discussing HIV/STI status with potential sex partners.     

Using social support levels to predict sexual identity development among college students who identify as a sexual minority

This study examined the impact of five domains of social support (a campus group for individuals who identify as a sexual minority, family, friends, significant others, and faith communities) on eight aspects of sexual minority identity development (identity uncertainty, internalized homonegativity, identity affirmation, acceptance concerns, identity superiority, concealment motivation, identity centrality, and difficulty in the identity development process). Support from a sexuality-specific campus group was the strongest predictor, followed by support from family members. Supports from friends and significant others had no significant impact on any aspect of sexual minority identity development, while faith community support was not correlated with identity development. Identifying as lesbian, bisexual, or as another sexual minority compared to identifying as gay also impacted sexual minority identity development.     

Shame,Internalized Homonegativity,and Religiosity: A Comparison of the Stigmatization Associated with Minority Stress with Gay Men in Australia and Malaysia

ABSTRACT

In this study we explore aspects of minority stress by comparing Malaysian (n = 234) and Australian (n = 123) gay men on internalized homonegativity (IH) and internalized shame (IS) in a 2 × 2 multivariate analysis (country × relationship status). Religious motivation (RM) was also included as a variable because of the importance of religion in Malaysia as compared to Australia. Malaysian gay men scored higher on IH, IS, and RM. Single men reported higher levels of IS than did those in relationships. These results are discussed in terms of the minority stress model (Meyer, 2003).     

Exploring and Adapting a Conceptual Model of Sexual Positioning Practices and Sexual Risk Among HIV-Negative Black Men Who Have Sex With Men

Estimates show a 50% lifetime human immunodeficiency virus (HIV) risk among Black men who have sex with men (BMSM) in the United States(U.S.). Studying the dynamics of sexual positioning practices among BMSM could provide insights into the disparities observed among U.S. groups of men who have sex with men (MSM). This study explored sexual positioning dynamics among HIV-negative BMSM and how they aligned with a theoretical model of sexual positioning and HIV/sexually transmitted infection (STI) risk among MSM. In-depth qualitative interviews were conducted with 29 HIV-negative BMSM between ages 25 and 35 in Los Angeles. Comments related to sexual behaviors were reviewed for relevance regarding oral or anal sexual positioning practices. Data presented represent the range of themes related to decision making regarding sexual positioning. Personal preference, partner attraction, HIV avoidance, and feeling obligated to practice partner preferences influenced sexual positioning. Drug use also affected decision making and was sometimes preferred in order to practice receptive anal intercourse. These variables build on the conceptual model of sexual positioning practices and sexual risk, and add understanding to the relationship between preferences, practices, and risk management. Future research on risk among HIV-negative BMSM should quantify the relative impact of personal preferences, partner attraction, partner type, compromise, and substance use on sexual positioning practices and risk.     

The Relationship Between Online Sexual Compulsivity,Dissociation, and Past Child Abuse Among Men Who Have Sex with Men

The objective of this study was to measure the relationships between online sexual compulsivity, three dimensions of dissociation (absorption, depersonalization, and amnesia), and past child abuse among men who have sex with men (MSM). A total of 517 MSM, recruited from Internet chat rooms, completed the survey. Results indicated that past child abuse was significantly related to dissociation but not online sexual compulsivity. It was also found that the amount of time MSM spent online in a one-week period, in general and specifically engaged in sexual activity, was significantly related to online sexual compulsivity and three dimensions of dissociation. Online sexual compulsivity was a significant predictor of absorption, depersonalization, and amnesia. Implications for clinicians and future research are presented.