Trust and Sexual Interaction: The Significance of the Internet on the Sex life and Sexual Risk Behaviors Of Gay and Bisexual Men in Spain

ABSTRACT

This study provides an understanding of the significance of the use of the Internet to find sexual partners, its impact on sexual life, and how it is linked to unprotected sex among gay and bisexual men. A grounded approach was used to analyze interviews with 31 men (aged 19 to 46 years) from Madrid, Barcelona, and Bilbao/San Sebastián, Spain. The results reveal that the Internet is impacting the form and style of life of many men, and particularly their experience of sexuality. Many men regard their sexual experiences with casual partners met through the Internet as unsatisfactory or frustrating. The men provided several reasons behind the search for sexual partners via the Internet: Some interviewees sought to channel needs other than the sexual (company, affection, stable partner). Trust and assumptions built into the virtual interaction become a key to understanding why some men have unprotected sex with partners met on the Internet.     

Research with Gay Drug Users and the Interface with HIV

Abstract

Studying the co-occurrence of drug use and sexual risk behaviors among gay men poses special challenges for research. The importance of conducting such research, however, is underscored by current trends in the gay community, including increases in methamphetamine and club drug use. This increase has been associated with high-risk behavior for the transmission of HIV and other diseases (e.g., hepatitis B and hepatitis C). The author describes methodological issues related to initiating and conducting research among gay male drug users, and discusses how such research can guide more effective prevention, treatment, and policy initiatives related to drug abuse and HIV/AIDS.     

The Interplay of Syndemic Production and Serosorting in Drug-Using Gay and Bisexual Men

The relationships between mental health, substance use, and sexual behaviors among gay and bisexual men in a sample of 450 club drug-using men from New York City were examined using syndemics theory. Risk scores for each participant were based on variables measuring substance use and mental health burden. Participants with higher risk scores were significantly more likely to engage in risk behaviors. Risk taking was also explained by serosorting, suggesting that syndemics theory in and of itself, while significant in explaining risk, is not sufficient. These findings suggest we need to understand the interplay between social, emotional, and cognitive factors to understand sexual risk taking.     

Predictors of HIV Sexual Risk Behavior Among Men Who Have Sex with Men,Men Who Have Sex with Men and Women,and Transgender Women

ABSTRACT

Men who have sex with men, men who have sex with men and women, and transgender women are at high risk for HIV infection. This study seeks to clarify which known HIV risk factors (partner type, sex location, serodiscordance, multiple sex partners, substance use during sex) contribute to engagement in high-risk (unprotected receptive anal) sex in each population. Data collected from June 2005 through June 2008 indicate all three populations display different HIV sexual risk profiles. The data suggest that HIV-prevention interventions should be individually tailored to address the specific needs of these three highly vulnerable and impacted populations.     

Clinical and Practical Considerations in Private Practice with Lesbians and Gay Men of Color

Abstract

The clinical and practical needs of people of color who come to private practitioners are diverse. Issues of coming out, spirituality, multiple identity, and gender role take on unique characteristics with persons of different racial and ethnic backgrounds. This chapter covers practical considerations clinicians are encouraged to stay mindful of when working with clients of different racial and cultural backgrounds, including social class, race, and boundary issues.     

Understanding the Influence of Loneliness on HIV Risk Behavior in Young Men Who Have Sex with Men

In this study we used grounded theory methodology to understand the influence of loneliness in YMSM in terms of HIV risk behavior. Twenty-two YMSM, 18–29 years of age, of HIV-negative/unknown status were interviewed. Results indicated that loneliness is defined in two ways: emotional and social. A cyclical pattern emerged that included negative symptoms, “self-treatment” of loneliness through drug use and sex, temporary relief, remorse related to engaging in HIV risk behaviors, negative self-image, and ultimately the reemergence of initial loneliness symptoms. Results suggest that loneliness in YMSM plays a greater role in HIV-related behavior than previously understood. A preliminary explanatory model, implications, and directions for future research 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.     

HIV and the Cycle of Trauma in Gay Men

Summary

Forged within the sociocultural context of the collective trauma of AIDS, HIV prevention efforts became rigid, focusing almost exclusively on patient education as risk reduction. However, while some people have not been able to incorporate risk reduction into their behavioral patterns, others have indeed returned to high-risk behavior after a period of reduced risk as evidenced by the “Bareback” movement. HIV prevention education has overlooked the effect of oppression and sexual trauma on the lives of gay men, and the impact of these phenomena on the gay male's interest in, and ability to, negotiate safer sex. Sexual trauma has been shown to have a direct effect on HIV risk and seropositivity. Additionally, as sexual trauma (often in the form of homophobia) and HIV infection have numerous parallels, the gay man may have analogous ways of relating to, processing and dealing with the two phenomena. Case histories are offered to illustrate how the relationship between HIV and sexual trauma may be examined in an effort to enhance the self-esteem and self-concept of the gay man, and thereby offer greater possibilities for him to protect himself.     

From Acute Palliation to Chronic Care: Using the Narratives of Two Gay Caregivers to Explore Experiences of Providing HIV Support Across Sociohistorical Contexts

Despite the longstanding shift in conceptualizing HIV/AIDS as a site of chronic care, versus one of acute palliation, few attempts have been made to examine caregiving in the context of this change. This study constitutes a preliminary attempt at exploring the evolving nature of HIV/AIDS caregiving among sexual minorities, primarily by comparing the narratives of two partnered caregivers of HIV-positive gay men whose stories are located in disparate sociohistorical contexts. Whereas one caregiver provided support during an era in which HIV/AIDS was primarily conceptualized as acutely life-limiting, the other did so in the contemporary period of chronic HIV care. Although similarities are noted across the stories, distinctions are also apparent in how the caregivers encounter expressions of homophobia and HIV stigma, and negotiate these realities distinctly as a function of sociohistorical context. In particular, despite the salience of these systemic barriers across the two narratives, these expressions of marginalization appear to occur more routinely and indefinitely in the context of chronic care. This article concludes with implications of the study's findings on theory, research, policy, and practice.     

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.     

The Adolescent Sexual Development of African American Gay Men with AIDS: Implications for Community-Based Practice

ABSTRACT

This qualitative study describes the adolescent sexual development of ten African American gay men living with AIDS. The informants retrospectively describe the challenges of being a gay adolescent in a mostly heterosexist and homophobic environment. They report unsupportive homophobic and heterosexist family members, community members and school officials. They also describe their burgeoning sexual orientation, sexual initiation as well as consensual and non-consensual sexual experiences with their peers. Additionally, several informants describe seeking sexual experiences with adult men. Later they suggest the adult men became their primary sources of emotional and psychological support. Implications for community practice, intervention and research with both African American gay adolescents and adult men living with AIDS are discussed.     

Providing HIV Education and Outreach via Internet Chat Rooms to Men who Have Sex with Men

Abstract

This article describes a pilot project that provided Internet-based outreach and HIV educational information to Men Who Have Sex with Men (MSM). The project provided services via chat rooms designated for MSM who meet there anonymously for sexual encounters. Services were designed to support behavior changes as well as serving a gateway function for additional services at the host agency. The experiences of the project suggest that the target population may engage in high-risk sexual activity more than what was initially assumed; and that Internet outreach provides a relevant means of conducting outreach to this group.     

Sociopolitical and Cultural Correlates of Internalized Homonegativity in Gay and Bisexual Men: Findings from a Global Study

Objectives: Based on the premise that internalized homonegativity (IH) is a product of the incorporation of environmental heterosexism, the authors examined the influence of sociopolitical and individual influences on IH. Methods: The cross-sectional study consisted of 109,382 gay and bisexual men across 77 countries. Results: Variables at the (European) country-level that were associated with higher levels of IH included lack of laws recognizing same-sex relationships and perceived and actual negative gay-related public opinion about homosexuals. Individual-level variables significantly associated with IH were public opinion about homosexuals and exposure to gay-related victimization/discrimination. Conclusions: An improved sociopolitical climate for LGB individuals is needed.     

Marital Aspirations,Sexual Behaviors,and HIV/AIDS in Rural Malawi

We explore how marital aspirations are related to the sexual behaviors of adolescents and young adults in Malawi, where HIV/AIDS prevalence among adults exceeds 10%. We also consider whether the specter of AIDS is shaping ideals about marriage. By combining survey data (N = 1,087) and in‐depth interviews (N = 133) with young Malawians from the Malawi Diffusion and Ideational Change Project, we show that looking for and finding a suitable spouse are linked to sexual behaviors and, thus, HIV risks. Moreover, concerns about contracting HIV are closely tied to the ideal characteristics of a future spouse. Our findings draw long‐overdue attention to the importance of marital aspirations in understanding adolescent sexual behaviors and risks in the era of AIDS.     

Experience of Older Gay and Bisexual Men Living with HIV/AIDS

Although HIV/AIDS definitely impacts gay and bisexual men of all ages, the impact on people in their later years has not been actively investigated. This exploratory study obtained detailed narratives from 14 adults between the ages of 51-72, all of whom were infected with HIV. Ten of the participants were potentially infected through male to male sexual contact. The subjects reported living with HIV for substantial periods with an average of 13 years of life since diagnosis, estimating a duration of HIV seropositivity from 1-20 years. Most had significant health problems, which may be related to aging, in addition to a number of HIV-related symptoms. They expressed community identification as people living with HIV; some were highly identified as gay men, while other were closeted or in denial regarding their same-sex activity. Half felt to some extent bisexual, and described relationships with wives or other women. Although many participants maintained active social lives, others expressed feelings of loneliness and isolation. This group was minimally active sexually and several of the participants expressed reservations about safer sex, especially condom usage. A strong theme was the sense of having lived a full life, which may help the individual cope with his diagnosis. The findings suggest the need to examine the diversity among older gay and bisexual men living with HIV, how these experiences vary by race and ethnicity, and identification of issues related to prevention and services.     

The Second Closet: A Qualitative Study of HIV Stigma Among Seropositive Gay Men in a Southern U.S. City

ABSTRACT

Objectives: Stigma connected with HIV/AIDS has decreased considerably since the early epidemic yet affects those living with HIV in many ways. Little research, particularly qualitative research, concerning HIV stigma from the perspective of gay men has emerged. The present qualitative study aimed to fill this evidence gap by examining how HIV stigma is perceived and experienced by gay men who have become HIV-infected and how they respond to this stigma. Methods: Thematic analysis of 19 gay men's narratives identified six main themes. Results: Encountering HIV stigmatization was common and was linked to the physical stigmata identifying respondents as HIV-positive. Overwhelmingly, they found stigmatization to be most intensely felt within gay communities. One profound theme was internalized HIV stigma, referring to respondents’ internalized negative feelings about their HIV status. A related theme was the closeted nature of HIV. Lastly, regarding how the men dealt with the HIV diagnosis and experiences of HIV stigma, a theme of adaptation became clear. Conclusions: Although exploratory, the results can serve as a beginning framework for understanding and assisting seropositive gay men who experience HIV stigma. The findings are important because it is realistic to expect that in a climate in which HIV has become increasingly invisible and closeted and in which infections are on the rise, gay and bisexual men will be increasingly affected and infected by HIV.     

Minority Stress Theory: An Examination of Factors Surrounding Sexual Risk Behavior Among Gay and Bisexual Men Who Use Club Drugs

Background: Few studies have examined the impact of minority stress theory (MST) upon sexual risk behavior among gay and bisexual men using club drugs. Similar studies have focused on ethnic minorities and women; however, gay and bisexual men demonstrate greater likelihood for risk behaviors leading to HIV/AIDS. Objective: This study examines sexual risk behavior from the perspective of minority stress theory upon substance-using gay and bisexual men and their partners. Methods: Multivariable logistic regression analysis examined minority stress associations with participant sexual risk behaviors, drug use, and partner type, controlling for demographics. Results: 396 gay and 54 bisexual respondents, ages 18–67, reported at least one-time drug use while engaging in sexual risk behavior. In the adjusted model, expectations of rejection associated with lower odds of sexual risk behavior, while older age approached significance. Conclusions: Theoretical origins for examining risk behavior among gay and bisexual men may underscore risk and protective factors, while ultimately holding implications for prevention and treatment interventions.     

Sexual Problems and Distress among Men and Women with Same-Sex and Opposite-Sex Sexual Partners: An Analysis of a Nationally Representative Sample of Adults in Great Britain

Abstract

Objective: This study aimed to examine differences in reporting sexual problems and distress among men and women with same-sex and opposite-sex sexual partners.

Methods: Multinomial regression was undertaken on risk of reporting sexual problems and/or distress using data from the third National Survey of Sexual Attitudes and Lifestyles.

Results: Differences were detected between men of different sexual behavior groups when considering the problems “lack of enjoyment in sex,” “felt anxious during sex,” “felt no excitement or arousal during sex,” “lack of interest in sex,” “did not reach/took a long time to reach climax,” and “getting or keeping an erection.” Fewer differences were detected among women.

Conclusions: Women reporting same sex sexual partners, and to a greater extent men reporting same sex sexual partners , have different sexual health needs and report sexual health problems and distress to a different extent than is the case for individuals who only have opposite-sex sexual partners     

A Qualitative Analysis of Cultural and Social Vulnerabilities to HIV Infection Among Gay,Lesbian, and Bisexual Asian Youth

Abstract

The study reported here was undertaken to investigate cultural and social barriers that may increase HIV risk among gay, lesbian, and bisexual Asian youth. Interviews and focus groups were used to collect the data because they are well suited for this type of exploratory research. A total of 15 gay, lesbian, and bisexual Asian youth (7 females and 8 males) were recruited. Most of the participants (n = 11) self-identified as lesbian or gay. The mean age was 20.7, ranging from 17 to 24. Twelve participated in one of three focus groups while the remaining three were interviewed. Categories and themes identified include: (1) the lack of sex education at home, (2) homophobia in Asian families, (3) unresponsive health and social service providers, (4) lack of social support, (5) negative stereotypes, (6) ideal standards of beauty, and (7) negative perceptions of safer sex practices among Asian lesbian and bisexual women. HIV prevention strategies are suggested based on the recommendations and needs of our participants.     

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.