Characteristics and Allowed Behaviors of Gay Male Couples’ Sexual Agreements

Research has shown that gay male couples’ sexual agreements may affect their risk for HIV. Few U.S. studies have collected dyadic data nationally from gay male couples to assess what sexual behaviors they allow to occur by agreement type and the sequence of when certain behaviors occur within their relationships. In our cross-sectional study, dyadic data from a convenience sample of 361 male couples were collected electronically throughout the United States by using paid Facebook ads. Findings revealed that couples discussed their HIV status before having unprotected anal intercourse (UAI) but established their agreement some time after having UAI. About half of the couples (N = 207) concurred about having an agreement. Among these couples, 58% concurred about explicitly discussing their agreement, 84% concurred about having the same type of agreement, and 54% had both men adhering to it. A variety of sexual behaviors were endorsed and varied by agreement type. Concordance about aspects of couples’ agreements varied, suggesting the need to engage couples to be more explicit and detailed when establishing and communicating about their agreements. The allowed behaviors and primary reasons for establishing and breaking sexual agreements further highlight the need to bolster HIV prevention for gay male couples.     

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.     

Co-Occurring Psychosocial Problems and Multiple Sexual Partners among Men Who Have Sex with Men in Shanghai,China: A Syndemic Approach

We aimed to apply syndemic theory to verify the association and reinforcing effects between psychosocial problems and multiple sexual partners (MSP) of men who have sex with men (MSM) in Shanghai, China. A cross-sectional study was conducted among 547 MSM in Shanghai, China using a face-to-face survey. Sociodemographic and psychosocial data were collected, as well as information on MSP and condomless anal sex. In the 6 months prior to the survey, 54.3% of the MSM sample had had MSP. Univariate analysis showed that self-esteem, depression, loneliness, sexual compulsivity, and involuntary subordination (IS) were associated with MSP. Sexual compulsivity (multivariate odds ratio [ORm] = 2.94, 95% CI = 1.76–4.91) and IS (ORm = 1.79, 95% CI = 1.14–2.81) remained significant in multivariate analysis. MSM with five or more psychosocial problems had greater odds of (adjusted odds ratios = 3.06, 95% CI = 1.49–6.25) having MSP in the previous 6 months than the non-syndemic group. Our findings provide preliminary confirmation of the additive relationship of syndemic psychosocial health conditions and MSP among MSM in Shanghai, China. An integrated intervention with special focus on sexual compulsivity and IS is needed.     

Differences in Sexual Orientation Diversity and Sexual Fluidity in Attractions Among Gender Minority Adults in Massachusetts

This study characterized sexual orientation identities and sexual fluidity in attractions in a community-based sample of self-identified transgender and gender-nonconforming adults in Massachusetts. Participants were recruited in 2013 using bimodel methods (online and in person) to complete a one-time, Web-based quantitative survey that included questions about sexual orientation identity and sexual fluidity. Multivariable logistic regression models estimated adjusted risk ratios (aRRs) and 95% confidence intervals (95% CIs) to examine the correlates of self-reported changes in attractions ever in lifetime among the whole sample (n = 452) and after transition among those who reported social gender transition (n = 205). The sample endorsed diverse sexual orientation identities: 42.7% queer, 19.0% other nonbinary, 15.7% bisexual, 12.2% straight, and 10.4% gay/lesbian. Overall, 58.2% reported having experienced changes in sexual attractions in their lifetime. In adjusted models, trans masculine individuals were more likely than trans feminine individuals to report sexual fluidity in their lifetime (aRR = 1.69; 95% CI = 1.34, 2.12). Among those who transitioned, 64.6% reported a change in attractions posttransition, and trans masculine individuals were less likely than trans feminine individuals to report sexual fluidity (aRR = 0.44; 95% CI = 0.28, 0.69). Heterogeneity of sexual orientation identities and sexual fluidity in attractions are the norm rather than the exception among gender minority people.     

Age Cohort Differences in Sexual Behaviors Among Black Men Who Have Sex With Men and Women

Little attention has focused on generational or age-related differences in human immunodeficiency virus/sexually transmitted infection (HIV/STI) risk behaviors among Black men who have sex with men and women (BMSMW). We examined sexual risk behaviors between BMSMW ages 40 and under compared to over age 40. Analysis was conducted using Centers for Disease Control and Prevention (CDC)–sponsored intervention data among BMSMW in Los Angeles, Chicago, and Philadelphia (n = 546). Pearson’s chi-square tests were conducted to evaluate associations between age groups and behavioral outcomes. Logistic regression was used to evaluate the odds of behavioral outcomes by age group, adjusting for sexual orientation and study location, within strata of HIV status. HIV-positive BMSMW over age 40 had 62% reduced odds of having a nonmain female partner of HIV-negative or unknown status compared to those ages 40 and under (adjusted odds ratio [AOR] 0.38, 95% confidence interval [CI] = 0.15, 0.95). Among HIV-negative BMSMW, the older cohort was associated with greater odds of having condomless insertive anal intercourse (IAI) with most recent main male partner (AOR 2.44, 95% CI = 1.12, 5.32) and having a concurrent partnership while with their recent main female partner (AOR = 2.6, 95% CI = 1.10, 4.67). For both groups, odds of engaging in certain risk behaviors increased with increasing age. Prevention efforts should consider generational differences and age in HIV risks among BMSMW.     

Motivations for Sexual Intimacy: Development of a Needs-Based Sexual Intimacy Scale

ABSTRACT

To assess motivations associated with sexual intimacy, a need for sexual intimacy scale (NSIS) was developed within a needs-based framework, focusing on needs for sex, affiliation, and dominance. Participants were 347 individuals associated with two large Southern California universities. Both exploratory and confirmatory factor analyses (EFA and CFA) were utilized, as were multiple attitudinal and behavioral measures for validation purposes. EFA found 22 items to be associated with the three need sets, with good internal consistency reliability. CFA confirmed these findings, and promising construct and criterion validities were also noted for the factors. Those reporting a greater need for sex noted more lifetime sex partners and one-night stands, but were less likely to use condoms. Individuals with affiliation needs were more likely to be truthful with their partners and more likely to practice safe-sex. Those reporting dominance needs want to control their partners sexually, but were less likely to use condoms. Men were found to exhibit greater needs for sex, while women reported higher levels of affiliation need. Sexual health and primary prevention concerns are discussed.     

Couples’ Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis

Research and clinical data have shown that couples with sexual problems report a lack of sexual communication. However, no published meta-analyses have evaluated the relationship between sexual communication and sexual function. This meta-analysis examines the correlation between couples’ sexual communication and dimension of sexual function across 48 studies. Sexual communication was positively associated with sexual desire (r = .16), sexual arousal (r = .21), lubrication (r = .17), orgasm (r = .23), erectile function (r = .19), less pain (r = .12), and overall sexual function (r = .35). The effect sizes for sexual desire (r = .21; r = .12) and orgasm (r = .26; r = .16) were higher for women than for men. For overall sexual function, studies with married participants (r = .47) had a larger effect size than studies with participants with multiple relationship types (r = .31) or than studies with dating participants (r = .11). Effect sizes were larger for studies conducted outside of the United States (r = .39) compared to studies conducted in the United States (r = .12). We discuss the importance of addressing the relationship between sexual communication and sexual function, as well as future directions for research in this area.     

Sexual agreements and intimate-partner violence among male couples

Objectives: In the United States, HIV continues to disproportionately affect men who have sex with men. One promising area of research that may inform the development of behavioral interventions among male–male couples is within the realm of sexual agreements. Methods: The purpose of our analysis was to determine whether respondents who report having an open agreement or an agreement breakage also report a higher incidence of recent (within the previous 12 months) intimate-partner violence (IPV) compared to respondents who report having a monogamous agreement or no agreement breakage after controlling for demographic variables. Results: Results showed that men who have an open agreement are less likely to report recent physical IPV. Conclusions: The results highlight the need to develop dyadic behavior interventions that address sexual agreements and stress management.     

Pathological Gambling, Problem Gambling and Sleep Complaints: An Analysis of the National Comorbidity Survey: Replication (NCS-R)

The purpose of this study is to investigate the relationship between sleep disturbances and gambling behavior. Data from the National Comorbidity Survey—Replication (NCS-R) was used to examine the relationship between three specific sleep complaints (difficulty initiating sleep [DIS], difficulty maintaining sleep [DMS], and early morning awakening [EMA]) and gambling behavior. Bivariate logistic regression models were used to control for potentially confounding psychiatric disorders and age. Almost half of respondents with problem gambling behavior (45.9%) and two thirds (67.7%) of respondents with pathological gambling behavior reported at least one sleep compliant. Compared to respondents with no gambling pathology, respondents with pathological gambling were significantly more likely to report at least one sleep complaint (Adjusted Odds Ratio [AOR] = 3.444, 95% CI = 1.538–7.713), to report all sleep complaints (AOR = 3.449, 95% CI = 1.503–7.914), and to report any individual complaint (DIS: OR = 2.300, 95% CI = 1.069–4.946; DMS: AOR = 4.604, 95% CI = 2.093–10.129; EMA: AOR = 3.968, 95% CI = 1.856–8.481). The relationship between problem gambling and sleep complaints were more modest (any sleep complaint: AOR = 1.794, 95% CI = 1.142–2.818; all three sleep complaints: AOR = 2.144, 95% CI = 1.169–3.931; DIS: AOR = 1.961, 95% CI = 1.204–3.194; DMS: AOR = 1.551, 95% CI = 0.951–2.529; EMA: AOR = 1.796, 95% CI = 1.099–2.935). Given the individual and societal ramifications linked with the presence of sleep problems, this study presents another health-related repercussion associated with gambling pathology rarely discussed in the literature.     

Transactional Sex and Preferences for Pre-Exposure Prophylaxis (PrEP) Administration Modalities Among Men Who Have Sex With Men (MSM)

Pre-exposure prophylaxis (PrEP) is an important biomedical human immunodeficiency virus (HIV) prevention tool gaining more popularity among Parisian men who have sex with men (MSM) who engage in transactional sex. This study examines the knowledge of, and willingness to use, different modalities of PrEP among this subgroup. Broadcast advertisements were placed on a geosocial-networking smartphone application with a link to a Web-based survey during three 24-hour periods in October 2016. Modified Poisson regression models were used to assess the association between engagement in transactional sex and preferences for each of these PrEP modalities. A total of 444 respondents were included. About 14% reported engagement in transactional sex. In all, 90% of MSM who engaged in transactional sex were knowledgeable of daily oral PrEP, while 13.3% were knowledgeable about long-acting injectable PrEP or penile or rectal microbicides. They were more likely to be aware of long-acting injectable PrEP (aRR = 2.52, 95% CI = 1.16 to 5.47) and willing to use daily oral PrEP (aRR = 1.48; 95% CI = 1.11 to 1.98) or long-acting injectable PrEP (aRR = 1.40; 95% CI = 1.09 to 1.81) than MSM who had not engaged in transactional sex. Long-acting injectable PrEP may be an important HIV-prevention option for MSM who engage in transactional sex if this modality is proven effective.     

Motivations for Extradyadic Infidelity Revisited

Relationship infidelities are motivated by many distinct factors, with previous research indicating motivations of dissatisfaction, neglect, anger, and sexual desire (Barta & Kiene, 2005). We expand on this by demonstrating additional, empirically distinct motivations for infidelity. Using an Internet-based questionnaire, participants (N = 495), most of whom were young adults, self-reported their infidelities. In addition to evidence for previously studied motivations, our data demonstrate additional factors, including lack of love (“I had ‘fallen out of love with’ my primary partner”), low commitment (“I was not very committed to my primary partner”), esteem (“I wanted to enhance my popularity”), gaining sexual variety (“I wanted a greater variety of sexual partners”), and situational factors (“I was drunk and not thinking clearly”). Our results also show personality correlates with infidelity motivations. Consistent with predictions, attachment insecurity was associated with motivations of anger, lack of love, neglect, low commitment, and esteem, while unrestricted sociosexual orientation was associated with sexual variety. Implicit beliefs (e.g., growth, destiny, romanticism) were differentially associated with sexual desire, low commitment, lack of love, and neglect. These findings highlight multifaceted motivations underlying infidelity, moving beyond relationship deficit models of infidelity, with implications for research and psychotherapy involving people’s romantic and sexual relationships.     

Toward the Tailoring of Sexual Health Education Messages for Young Women: A Focus on Tourist Experiences

Perceived anonymity and decreased influence of sexual double standards in tourism provide female travelers with opportunities for sexual experimentation and risk taking. The purpose of this study was (a) to identify the clusters of risk takers among young women based on their perceptions of and motivations for sexual risk taking in tourism and (b) to profile the clusters with respect to the psychological, sexual, demographic, and tourist characteristics. The data were collected through an online survey of 853 women (age in years: M = 23.5, SD = 6.67). Five clusters of sexual risk takers emerged based on their factor-analyzed risk perceptions and motivations. These clusters were interpreted as (a) diversely motivated broad risk perceivers; (b) fun-seeking broad risk perceivers; (c) diversely motivated physical risk perceivers; (d) anonymity- and empowerment-seeking risk disregarders; and (e) unmotivated broad risk perceivers. Women in these clusters differed in their intentions to engage in sexual risk taking in tourism, sensation-seeking propensities, perceptions of tourist characteristics, levels of sexual experience, and demographic backgrounds. Results suggest tailoring sexual health promotion messages based on cluster affiliation, leveraging cluster-specific risk perceptions, motivations, and personal characteristics. This study provides recommendations for individually tailored, context-specific, age-appropriate, and gender-sensitive sexual health education programs.     

Sociosexuality,Commitment, Sexual Infidelity,and Perceptions of Infidelity: Data From the Second Love Web Site

This study explored the association between sociosexuality (behavior, attitudes, and desire) and commitment to understand sexual infidelity in current relationships. We also explored how these variables were associated with attitudes toward infidelity. Participants were romantically involved heterosexuals (N = 252; 51 women, 201 men; M_age = 41.13, SD = 9.82) registered on a dating Web site directed at romantically involved individuals. Results showed that sociosexuality, alongside commitment, was associated with sexual infidelity. Individuals who had (versus had not) previously engaged in infidelity reported more unrestricted sociosexuality, while reporting less commitment. For individuals reporting prior sexual infidelity, unrestricted sociosexual desire and lesser commitment were associated with more permissive perceptions of infidelity. For individuals reporting no prior sexual infidelity, greater commitment was always associated with more strict perceptions of infidelity. No gender differences emerged in the analyses. Also, no differences were found according to individual motivations (i.e., looking to know other people versus seeking casual sex) or relational motivations (i.e., individual registration versus registration as a couple) underlying individuals’ registration on the Web site. These results are an important addition to the literature on infidelity by analyzing a specific sample motivated to engage in infidelity. Implications for future research are discussed.     

Are There Early Risk Markers for Pedophilia? A Nationwide Case-Control Study of Child Sexual Exploitation Material Offenders

Although prior research suggests associations between parental characteristics and later sexual offending in offspring, possible links between early pregnancy-related factors and sexual offending remain unclear. Early risk markers unique to sexual offending, however, may be more prominent among sexual offenders with atypical sexual interests, such as individuals involved with child sexual exploitation material (CSEM; also referred to as child pornography). We examined the prospective association between parental and pregnancy-related risk markers and a behavioral indicator of pedophilic interest, CSEM offending. All 655 men born in Sweden and convicted of CSEM offending between 1988 to 2009 were matched 1:5 on sex, birth year, and county of birth in Sweden to 3,928 controls without sexual or nonsexual violent convictions. Paternal age (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI] [1.1, 1.7]), parental education (AOR = 0.8, 95% CI [0.6, 0.9]), parental violent criminality (AOR = 2.9, 95% CI [2.2, 3.8]), number of older brothers (AOR = 0.8, 95% CI [0.6, 0.9] per brother), and congenital malformations (AOR = 1.7, 95% CI [1.2, 2.4]) all independently predicted CSEM convictions. This large-scale, nationwide study suggests parental risk markers for CSEM offending. We did not, however, find convincing evidence for pregnancy-related risk markers, with the exception of congenital malformations and having fewer older brothers.     

Gender-Specificity of Women's and Men's Self-Reported Attention to Sexual Stimuli

Men's sexual arousal is largely dependent on the actor's gender in a sexual stimulus (gender-specific), whereas for women, particularly androphilic women, arousal is less dependent on gender (gender-nonspecific). According to information-processing models of sexual response, sexual arousal requires that attention be directed toward sexual cues. We evaluated whether men's and women's self-reported attention to sexual stimuli of men or women were consistent with genital responses and self-reported arousal. We presented gynephilic men (n = 21) and women (n = 22) and androphilic men (n = 16) and women (n = 33) with audiovisual stimuli depicting men or women engaged in sexual activities. Genital responses were continuously recorded and, following each stimulus, participants reported the amount of attention paid to the video and feelings of sexual arousal. Self-reported attention was gender-specific for men and gender-nonspecific for women, and generally mirrored genital responses and self-reported arousal. Gender-specificity of genital responses significantly predicted gender-specificity of self-reported arousal; however, for men only, this effect was significantly mediated by gender-specificity of self-reported attention. Gender differences in gender-specificity of sexual arousal may be partially accounted for by differences in gender-specificity of self-reported attention, although attention may play a greater role in men's sexual arousal than women's.     

Sexual Risk Behaviors and Perceptions of Men Who Go to Gay Sex Parties in New York City: Comparisons Between Three HIV Groups

Men who have sex with men (MSM) who attend group-sex events often engage in risky sexual behaviors that contribute to the high human immunodeficiency virus (HIV) incidence among this population. We conducted an online survey with 211 New York City MSM who attended sex parties in the prior year and asked them to describe their behaviors and perceptions of risk. We compared responses from HIV-positive-undetectable men (n = 36), HIV-negative men on pre-exposure prophylaxis (PrEP; n = 62), and HIV-negative men never on PrEP (n = 113). In bivariate analyses, undetectable and on-PrEP men had been to more sex parties in the prior six months, had more anal sex partners there, and had higher rates of sexually transmitted infection (STI) diagnoses than men never on PrEP. Although less than the other groups, 43% of the presumably HIV-negative men never on PrEP reported condomless anal sex at a party in the prior six months. About half of participants agreed that, at sex parties, they made assumptions about others’ HIV status, that they sometimes took more risks than intended, and that the atmosphere of these events was conducive to risk taking. Most disagreed that there was discussion of HIV status at sex parties. Implications for sexual health interventions are discussed.     

The Impact of Body Dissatisfaction on Distressing Sexual Difficulties Among Men and Women: the Mediator Role of Cognitive Distraction

Research has demonstrated a negative impact of cognitive distraction on sexual activity, and body dissatisfaction has been associated with less satisfying and fewer sexual activities. In the current study we examined the extent to which cognitive distraction, based on body appearance and sexual performance, mediated the impact of body dissatisfaction on sexual difficulties among women and men. A sample of 493 women (M_age = 30.61) and 595 men (M_age = 37.90) completed an online survey. Women reported significantly higher levels of distressing sexual difficulties, significantly more body dissatisfaction, and greater cognitive distraction based on appearance than men. In contrast, men reported higher cognitive distraction based on performance than women. A path analysis model indicated that, for men, only cognitive distraction based on performance mediated the effects of body dissatisfaction on distressing sexual difficulties, and the mediation was only partial as body dissatisfaction had a significant direct effect on distressing sexual difficulties. In contrast, among women, both appearance-based cognitive distraction and performance-based cognitive distraction fully mediated the effects of body dissatisfaction on distressing sexual difficulties.     

Sexual Assault Risks Among Gay and Bisexual Men

The goal of this study was to examine lifetime patterns of sexual assault and associated risks among a purposive sample of gay and bisexual men (N = 183; 18 to 35 years old, M = 24.3). Cross-sectional data were collected via written, self-administered questionnaires and face-to-face, event-based qualitative interviews. Alcohol severity scores indicated high rates of hazardous drinking (53.0%) and possible dependence (14.2%) among participants. One-half of men (50.8%) reported childhood sexual abuse (CSA), and 67.2% reported adult sexual assault (ASA). Average age at most recent ASA was 21 years. Most perpetrators (83.9%) of recent ASA incidents were male; 67.0% of participants reported consuming alcohol and/or drugs prior to the most recent incident. Regression findings indicated more severe CSA experiences and past alcohol-related problems predicted recent severe ASA. Although we found similarities between gay and bisexual men in lifetime sexual assault history, we found some distinct differences in ASA risk factors. Bisexual men reported higher alcohol severity scores, more female ASA perpetrators, higher internalized homophobia scores, and fewer male sexual partners than gay men. Findings suggest the need for interventions that reduce ASA risk among sexual minority men—and the potential benefits of focusing on alcohol consumption in risk reduction efforts.