Homosexual role separation: Implications for analyzing and modeling the spread of HIV

The analysis of the spread of HIV in homosexual populations must be based on knowledge of all factors which promote or inhibit transmission. Recently, data were reported from the Amsterdam cohort study that imply that sexual role separation and the changes therein should be taken into account in analyzing and modeling the spread of HIV. In this paper, a role separation mixing model is described and linked to data from the Amsterdam cohort. The model allows one to study the impact of homosexual role separation on the spread of HIV. The homosexual men are classified into four sexual subgroups based on the preference for: 1) no anal intercourse; 2) anal insertive only; 3) anal receptive only; 4) both insertive and receptive. The analysis accounts for variability and change in homosexual role behavior and loss to follow up. The results support the conjecture that there are large differences between the risks of receptive and insertive anal intercourse, with the latter carrying only minimal risk. The analysis indicates that the spread of HIV is mostly restricted to subgroup 4, the largest and sexually most active subgroup. In this subgroup, the estimated probability of HIV transmission from an infected insertive partner (in subgroup 2 or 4) to a receptive susceptible (in subgroup 4) is between 1 and 5 percent (assuming a closed cohort).     

Letters to the editor

Relatively little attention has been paid to the use and importance of labels used by men who have sex with men to describe insertive or receptive sexual behavior during intercourse. This study examines sexual self‐labels, sexual behavior, HIV transmission risk, and psychological functioning among 205 HIV‐seropositive men who have sex with men. The majority of participants (88%) identified as a “top, “ a “bottom, “ or “versatile. “ Tops were more likely to engage in insertive anal intercourse than bottoms, and bottoms were more likely to engage in receptive anal intercourse than tops, with versatiles reporting intermediate rates of both behaviors. Although the results suggest preliminary evidence regarding the predictive utility of self‐labels, sexual behaviors of self‐label groups were greatly overlapping. Differences were found among self‐label groups in gay self‐identification, internalized homophobia, sexual sensation seeking, and anxiety. Results suggest an added value in assessing self‐labels in addition to asking about sexual behavior.     

Sexual behavior among HIV-positive men who have sex with men: what's in a label?

Relatively little attention has been paid to the use and importance of labels used by men who have sex with men to describe insertive or receptive sexual behavior during intercourse. This study examines sexual self-labels, sexual behavior, HIV transmission risk, and psychological functioning among 205 HIV-seropositive men who have sex with men. The majority of participants (88%) identified as a top, a bottom, or versatile. Tops were more likely to engage in insertive anal intercourse than bottoms, and bottoms were more likely to engage in receptive anal intercourse than tops, with versatiles reporting intermediate rates of both behaviors. Although the results suggest preliminary evidence regarding the predictive utility of self-labels, sexual behaviors of self-label groups were greatly overlapping. Differences were found among self-label groups in gay self-identification, internalized homophobia, sexual sensation seeking, and anxiety. Results suggest an added value in assessing self-labels in addition to asking about sexual behavior.     

Mexican and Mexican American male sexual behavior & spread of AIDS in California∗

Data generated by the authors' field research on the bisexual and homosexual behaviors of men of Mexican origin living in southern California are presented and compared with the same behaviors of Anglo men in California and Mexican men in Mexico. Preferences for playing either the anal receptive or insertive sexual role and a focus on anal intercourse by unacculturated and less acculturated men of Mexican origin who have sex with men are the sexual behaviors judged to be most significantly different from Anglo men who have sex with men in California. Sexual socialization and acculturation were found to be the most important determinants of whether an individual's adult patterns of homosexual behavior will be more or less influenced by Mexican or Anglo homosexuality in spite of the length of time they may have lived in California. Evidence is presented about the effects that acculturation, preference for a sexual role in anal intercourse, and endogamy have on the spread of the AIDS virus in the Mexican origin population in California.     

“It Takes a Man to Put Me on the Bottom”: Gay Men’s Experiences of Masculinity and Anal Intercourse

In anal intercourse between gay men, men who are typically insertive (“tops”) are often perceived as, and may identify as, more masculine than those who are typically receptive (“bottoms”). “Versatile” men, who may adopt either position, may be perceived as more gender balanced and may transcend the gender-role stereotypes associated with self-labeling as top or bottom. The aim of this study was to explore how gay men’s beliefs about masculinity were associated with their beliefs about the gendered nature of sexual self-labels and their behavior in anal intercourse. Individual semistructured interviews were undertaken with 17 UK-based gay men. Interpretative phenomenological analysis (IPA) identified that perceptions of tops and bottoms as gendered social identities varied depending on the extent to which gay men subscribed to the mandates of hegemonic masculinity, the dominant masculinity in Western society. The findings also suggested that some gay men differentiated between top and bottom as social identities and topping and bottoming as gendered behaviors. This had implications for gay men’s behaviors in anal intercourse. It is suggested that future efforts to engage with gay men about their sexual behavior should account for their beliefs regarding the gender-role stereotypes associated with gay sexual self-labels.     

Longitudinal Event-Level Analysis of Gay and Bisexual Men’s Anal Sex Versatility: Behavior,Roles, and Substance Use

Gay and bisexual Men Who Have Sex with Men (GBM) are sexually unique in that they can practice penile-anal sex versatility, i.e. engage in insertive and receptive anal sex. Individual-level versatility is extensively researched both as a sexual behavior linked to HIV/STI transmission, and as a GBM identity that can change over time. However, there is a dearth of research on event-level versatility (ELV), defined as taking the receptive and insertive role in the same sexual encounter. We analyzed event-level data from 644 GBM in the Momentum Health Study from February 2012-February 2017 to identify factors associated with ELV prevalence, the relationship between ELV and anal sex role preference, and sero-adaptive and sexualized drug use strategies. Univariate analysis revealed ELV prevalence rates between 15% and 20%. A multivariate generalized linear mixed model indicated ELV significantly (p < .05) associated with versatile role preference and condomless sex. However, the majority of ELV came from GBM reporting insertive or receptive role preferences, and there was significantly higher condom use among sero-discordant partners, indicating sero-adaptation. Multivariate log-linear modeling identified multiple polysubstance combinations significantly associated with ELV. Results provide insights into GBM sexual behavior and constitute empirical data useful for future HIV/STI transmission pattern modeling.     

EFFECTS OF OVERWEIGHT ON RISKY SEXUAL BEHAVIOR OF ADOLESCENT GIRLS

We use data from the National Longitudinal Survey of Adolescent Health to estimate effects of adolescent girls' overweight on their propensity to engage in risky sexual behavior. We estimate single equation, two‐stage, and sibling fixed‐effects models. We consider both absolute weight and weight relative to other girls in the individual's school. We focus on vaginal intercourse without a condom, any type of sexual activity while under the influence of alcohol, and anal intercourse. Our findings confirm previous research indicating that overweight or obese girls are less likely than their recommended‐weight counterparts to be sexually active. As a result, they are less likely to have vaginal intercourse without a condom. However, overweight or obese girls are not less likely to have sex under the influence of alcohol, and once they have had vaginal intercourse, their consistency of condom use is no different from that of their recommended‐weight peers. The most striking finding is that overweight or obese girls are at least 15% more likely than their recommended‐weight peers to have ever had anal intercourse regardless of whether they have ever had vaginal sexual intercourse. The results from this study underscore the importance of using multifaceted and contemporary measures of risky sexual behavior and have implications for the health and well‐being of adolescent girls. (JEL I12, J13)     

Club Drug Use,Sexual Behavior,and HIV Risk Among Community and Internet Samples of Hispanic MSM: Implications for Clinicians

ABSTRACT

Hispanic men who have sex with men (MSM) are at high risk of HIV infection. This study reports on the club drug use and sexual behaviors of two distinct samples (community and Internet) of Hispanic MSM living in the AIDS epicenter of Miami-Dade County. Both samples reported high rates of unprotected anal sex and high numbers of sex partners; rates of club drug use (cocaine, ecstasy, methamphetamines, GHB, amyl nitrites, and Viagra) were also high. Recent use of club drugs was associated with both unprotected receptive and insertive anal sex in the Internet sample, but not in the community sample. Implications for social work practice are discussed.     

A Preliminary Study of Body Image and HIV Sexual Risk Behavior in Black Gay and Bisexual Men: Implications for HIV Prevention

Nearly three decades since the onset of the AIDS epidemic, Black gay and bisexual men (BGBM) experience increasingly disproportionate rates of HIV and AIDS in the United States. The aim of this exploratory research investigation was to examine the relationship between body image and HIV sexual risk behavior in a community-based sample of 481 BGBM in the New York metropolitan area. Multivariable analyses demonstrated that men with a negative body image were less likely to use condoms during anal intercourse with a male sexual partner as compared to those respondents with a positive body image. These findings pose considerable implications for the influence of body image on HIV sexual risk behavior in BGBM.     

Factors Associated with HIV Sexual Risk Behavior in Male Couples of Mixed HIV Status

Abstract

There are concerns that rates of unprotected anal intercourse and new HIV infections among some gay men have remained at or returned to dangerous levels, similar to those seen in the first decade of the epidemic. Most research on sexual risk behavior of gay men has focused on individuals even though several studies have indicated that unprotected anal intercourse (the most risky of sexual behaviors) is most likely to occur between two men who are regular partners.

This study was conducted with 75 HIV serodiscordant (“mixed HIV status”) male couples. The goals were to assess the types and prevalence of sexual risk behaviors within these dyads, to identify reasons given for engaging in risk behavior with their partner of opposite HIV status, and to examine the association, if any, between risk behaviors and potential individual and partner related factors and context. Both members of the couple were included in all assessments.

There was a tendency for unprotected anal sex to occur more often among younger men, newer couples, Latino men, and men with less education. Lower risk perception and self-efficacy for condom use, desire for sexual spontaneity, intimacy, and personal and partner satisfaction were all related to sexual risk behavior. The men in these relationships also used specific “harm reduction” strategies, based on their own understanding of transmission risk. Therefore it is important to integrate biological and behavioral knowledge to develop effective prevention campaigns. And prevention programs need to consider the ongoing emotional needs of both the HIV seronegative (HIV-) and HIV sero-positive (HIV+) partner.     

Male Clients of Male Escorts: Satisfaction,Sexual Behavior,and Demographic Characteristics

Few studies have examined male clients who pay for sex with male escorts. In 2012, clients (n = 495) completed an online survey about their most recent hire. Most clients were White/Caucasian (87.7%), HIV negative (89.5%), employed full time (71.1%), single (58.6%), with a mean age of 54. Three-quarters of clients were gay identified, 18% bisexual, and 4% heterosexual. The median rate paid to escorts was $250 per hour with a modal appointment time of 1 to 2 hours (41.6%). Oral sex was common (80% gave, 69% received), 30% reported anal insertive sex, and 34% reported anal receptive sex. In total, few (12%) reported unprotected anal sex. Satisfaction with encounters was high. Receptive unprotected anal intercourse was associated with greater satisfaction in bivariate analyses but not in multivariable analyses. In a multivariable model, having receptive anal sex (whether protected or not) and rating the financial cost of the encounter as “worth it” were significantly associated with greater satisfaction. This study contributes to a scarce literature regarding clients of male sex workers and, in particular, provides information on the characteristics of men hiring men for sexual services, behavioral event-level data about their encounters, and analysis of factors directly associated with client satisfaction.     

Adaptive training for existing male transsexual gender role: A case history

The development of AIDS interventions for adolescents is hindered by the lack of data on the conditions that influence high‐risk sexual behavior. We examined psychosocial correlates of condom use and multiple partner sex for a sample of sexually‐active heterosexual adolescent women. Respondents reported higher levels of vaginal intercourse than the “average” adolescent. A minority were engaging in anal intercourse. Condom use was associated with perceived enjoyment of condoms and communication skills. Number of sexual partners was associated with susceptibility beliefs, social norms, and sexual communication skills. The findings support the general observation that AIDS interventions with adolescents should build sexual communication skills, address motivational issues, and teach people how to enjoy safe‐sex activities.     

An Episodic Analysis of Substance Use and Risky Sexual Behavior in a Racially Diverse Sample of Young Men Who Have Sex with Men

Many studies have examined the relations between drug use and sexual behaviors; however, few have utilized episodic data to examine the co-occurrence of both behaviors within the same episode. This study surveyed 403 racially and ethnically diverse gay, bisexual, and other young men who have sex with men (YMSM; ages 18–29) in New York City. Men were surveyed about their sexual behavior and concurrent use of illicit substances and alcohol during their most recent sexual encounter with their main and/or casual partner(s). Logistic regression models were built to analyze predictors of unprotected oral and anal intercourse with main and casual partners. Results suggest that use of inhalant nitrates and alcohol increased the odds of men engaging in unprotected receptive anal intercourse (URAI) and men who identified as middle or high socioeconomic status (SES) were at lower odds of engaging in URAI with their main partner. Use of other illicit substances was not associated with unprotected sexual intercourse. These findings indicate a need to further consider the role of licit substances used by YMSM as a means of further reducing the incidence of HIV infection in this population. In addition, the high rates of unprotected anal intercourse among men reporting a main partner has the potential to be a significant source of HIV risk, and should be further explored among YMSM.     

Demographic and Sexual Behavior Comparisons of Indian and U.S. Internet Samples of Men who have Sex with Men

ABSTRACT

Data were collected via the Internet on sexual behaviors of Indian men who have sex with men (MSM; n = 171); these data were compared to online American MSM (n = 682). Among Indian MSM, 51% had never been tested for HIV, 100% believed themselves to be HIV-uninfected, and 22% (secondary Internet male partners) to 43% (primary male partners) reported not using condoms during last anal intercourse. While U.S. MSM were more likely to not use condoms (42% for secondary Internet partners to 67% for primary male partners), most (88%) had been tested for HIV (.0001 ≤ p ≤ .002, all comparisons). Low rates of HIV testing, beliefs about being HIV-uninfected, and significant levels of unsafe anal intercourse could fuel the spread of infection among Indian MSM.     

Unwanted sexual experiences and sexual risks in gay and bisexual men: Associations among revictimization,substance use,and psychiatric symptoms

The data set of 2,182 gay/bisexual men's month‐long sexual diaries collected by the United Kingdom Socio‐sexual Investigations of Gay Men and Aids (Project SIGMA) was used to analyse the extent to which acts of anal intercourse (AI) are distributed among gay men, using the Lorenz/Gini methodology for measuring concentration. Most individuals (60%) who engage in AI do so only once or twice a month, but there is a long tail of those who do it much more. In terms of the amount of AI acts, one tenth of the individuals are performing half of the acts of AI. The Gini coefficient of concentration is high (0.55). Factors most affecting rates and concentration of risk behaviour include relationship status, HIV sero‐status and concordant/discordant partner status.     

A Review of: “An Insider's View of Sexual Science since Kinsey” edited by Ira L. Reiss

Masters, Johnson and Kolodny a volume which claims that risk understated by public This paper presents a brief analysis of the key data contained in MJK's book using simple mathematical models. The paper shows that the unconditional per partner risk of infection for the sexually active heterosexuals in the MJK study is exceeded by the similar risk for typical gay men in San Francisco by a factor of nearly fifty; that the conditional probability of infection given exposure via vaginal sex is about 2% for men and 3% for women per partner (both of these numbers are lower than the corresponding infec‐tivities for unprotected anal sex among gay men); and that an AIDS epidemic among the general heterosexual population would occur only if the average number of sexual partners per year exceeds about 5.3, an unlikely number given the data in MJK's study.     

Individual Growth Curves of Frequency of Sexual Intercourse Among Urban,Adolescent, African American Youth

Summary

In the current study we examined individual growth curves of frequency of sexual intercourse among a sample of urban, low-income, African American youth at increased risk for subsequent HIV/AIDS exposure. Three waves of longitudinal data from the Collaborative HIV-Prevention AdolescentMental Health (CHAMP) project were utilized. Participant ages ranged from 9 to 12 years (M = 11 years) at the first interview wave and from 15 to 19 years (M = 18 years) at the final interview wave. As such, we were able to map out true developmental trajectories of sexual intercourse over a 10-year period of adolescence (spanning ages 9 to 19 years). Results indicate that the average study participant was sexually abstinent (in terms of intercourse) during the pre-teen years, reported a single episode of sexual intercourse between ages 14 and 15, and by age 19, reported between 3 and 10 episodes of sexual intercourse. Significant variability in the acceleration of growth rates (as captured by a quadratic random effect) was observed, suggesting that some youth accelerated more rapidly (in their sexual intercourse histories) than did others. Participant gender predicted trajectory starting points; boys reported higher rates of sexual intercourse at age 12. Frequency of baseline exposure to sexual possibility situations (i.e., being in mixed-sex company in a private place in the absence of adult supervision) predicted growth curve acceleration, suggesting preteenswith more exposure to sexual possibility situations accelerated more rapidly in their rates of sexual intercourse over time. Developmental implications of these data are discussed.     

The lesbian dyad

Little is known regarding how respondents interpret terms that are commonly used in sexual behavior surveys. The present study assessed the impact of four factors on respondents’ judgments of whether the hypothetical actors “Jim” and “Susie “ would consider a particular behavior that they had engaged in to be “sex.” The four factors were respondent's gender, actor's gender, type of act (vaginal, anal, or oral intercourse), and who achieved orgasm (neither, Jim only, Susie only, or both). Two hundred twenty‐three undergraduates (22.2 ± 2.2 years; 65% female) were asked to read 16 scenarios featuring Jim and Susie and to judge whether each actor would consider the described behavior to be sex. Results indicated that vaginal and anal intercourse were considered sex under most circumstances. Whether oral intercourse was labeled as sex depended on the gender and viewpoint of the actor, and whether orgasm occurred. Findings suggest that items in sexual behavior surveys need to be clearly delineated to avoid subjective interpretations by respondents.     

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.     

Sexual behavior and AIDS knowledge of young male prostitutes in Manhattan

Despite their presumed high risk for AIDS, there are almost no sexual behavior data available which are sufficient for the development and assessment of intervention programs for male prostitutes. This study was designed to obtain such data. Fifty 14–27‐year‐old male prostitutes in Manhattan were interviewed using structured instruments to assess sexual orientation, sexual behavior, knowledge of AIDS, and substance abuse. The sample was 50% homosexual, 26% bisexual, and 24% heterosexual. High rates of condom use were found for anal intercourse (average 85%). Subjects were safest in sex with male customers, less safe with male partners for pleasure, and least safe with female partners. Differential use of condoms plus other unsafe sexual activities continue to place the male prostitute at risk for HIV infection. AIDS knowledge was high and positively correlated with safety of sex. Drug and alcohol abuse and dependence were frequent, although there was little intravenous drug use. These and other variables were not significantly associated with degree of safety in sex. The methods employed in this study can be used to assess other populations of male prostitutes as well as intervention programs.