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.     

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.     

A Novel,Self-guided,Home-Based Intervention to Improve Condom Use Among Young Men Who Have Sex With Men

Abstract

Objective: This pilot study tested the efficacy of a brief, novel, theory-driven, self-guided, home-based intervention designed to promote condom use among young men who have sex with men (YMSM). Participants: Thirty YMSM were recruited from a large public US midwestern university during spring of 2012. Methods: The intervention was tested using a repeated measures design with the primary follow-up assessment occurring 6 weeks after enrollment. Results: Forty-five percent of men reported a reduced frequency of unprotected insertive penile–anal intercourse in the past 30 days compared with baseline (p = .01). Consistency of condom use improved (p = .013), as did motivation to use condoms correctly, condom use self-efficacy, and condom attitudes. All participants indicated that they were glad they participated, would recommend the program, and that overall, they had liked the program. Conclusions: This pilot study supports an expanded trial of this intervention with MSM at high-risk of acquiring human immunodeficiency virus/sexually transmitted infections (HIV/STIs).     

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.     

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.     

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.     

The Social Environmental Elements of Resilience Among Vulnerable African American/Black Men Who Have Sex With Men

Resilience theory has been suggested as a strong framework for research on HIV prevention among men who have sex with men (MSM). Among this population, literature indicates that African American/Black MSM are particularly vulnerable to health and social disparities associated with HIV transmission risk. Conceptualizing resilience as a part of one’s social environment, this qualitative study investigates the specific elements of resilience, and the associated contexts and relationships, among a sample of 21 substance-using African American/Black MSM. Data indicate that (1) elements contributing to resilience are multiple and co-occurring, including inner strengths, social relationships, diversity of experience, religion/spirituality, altruism, and creativity; (2) as an element of resilience, social support was experienced differently among men who did and did not have supportive relationships with other gay and bisexual men, which has implications for social service provision and intervention approaches; and (3) diversity of experiences and relationships is an important influencing factor on expressions of resilience. Social services or interventions that facilitate the development of these elements of resilience will likely be especially beneficial for vulnerable African American/Black MSM.     

Exploring Dimensions of Racism,Homophobia, and Social Network As Concomitant Predictors of Condom Use in a Sample of Black MSM

With a convenience sample of 148 Black men who have sex with men (MSM) who primarily resided in the Washington, District of Columbia, metropolitan Area, the purpose of this research was to concomitantly use dimensions of racism, homophobia, and social network constructs in a regression model to predict condom use. In the model, analysis indicated that condom nonusers versus consistent users experienced more conversations with friends regarding salient topics (i.e., HIV status) (odds ratio [OR] = .86, p < .01) and fewer discussions with sexual partners about salient topics (OR = .77, p = .02). Furthermore, inconsistent condom users versus consistent users experienced higher levels of internalized homophobia (OR = 1.12, p = .04) and less racism associated with physical characteristics (OR = .89, p = .04). Notably, all of the racism dimensions identified in this research were nonsignificant as positive predictors of condom use. Overall, based on the findings, internalized homophobia may need to be isolated or targeted as an HIV-risk factor when implementing individual- and group-level HIV-prevention strategies for Black MSM. Moreover, improved communication skills among Black MSM pertaining to discussing salient topics (i.e., HIV status) with their sexual partners could also be used as a possible HIV-prevention strategy.     

Prevalence of and Factors Associated with Oral Sex Among Rural and Urban Malawian Men

ABSTRACT

Objectives: Despite medical evidence that female-to-male oral sex (fellatio) carries a lower risk for HIV transmission than unprotected vaginal intercourse, little research exists on the practice of fellatio in Africa. The objective of this study was to document the prevalence of oral sex in Malawi, and to provide the first evidence on factors associated with the practice in sub-Saharan Africa. Methods: We used two samples of men from Malawi—one rural and one urban—to examine the prevalence of oral sex, as well as factors that were associated with the knowledge and practice of oral sex. Results: While 97% of the rural sample and 87% of the urban sample reported having had vaginal sex, just 2% and 12%, respectively, said they had ever received oral sex. Only half of the rural sample, and less than three quarters of the urban sample, reported having heard of oral sex. Education, exposure to newspapers and television, and condom use significantly predicted oral sex knowledge after controlling for other confounding factors, while exposure to radio did not. Conclusions: The large gap between sexual activity and oral sex prevalence suggests that fellatio should be taken into consideration as a potential component of an HIV prevention strategy, but further quantitative and qualitative research that includes women as well as men is needed to understand potential benefits and drawbacks.     

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.     

Electronic Media Access and Use for Sexuality and Sexual Health Education Among Men Who Have Sex With Men in Four Cities in Tanzania

Abstract

Background: Electronic media use is an important avenue for reaching stigmatized populations. We examined Internet access and use of sexually related electronic media among men who have sex with men (MSM) in 4 cities in Tanzania. Methods: A questionnaire was administered to 231 MSM in Dar es Salaam, Mwanza, Arusha, and Tanga regarding electronic media type, times of use, type of use and frequency of use of sexually-related media. Results: Mean age was 25.7?years, and 52% had completed high school. Half had access to the internet through personal electronic devices, a further quarter had access through work, 10% through friends’ devices, and only 2% had no access to the internet. Most frequently used electronic devices were personal computer followed by work smartphone, with work computer a close third. These patterns were consistent for both seeking other men for sex and finding sexual health information. All respondents had accessed sexual material electronically at some time. Substantial logged-in time was reported each week seeking/chatting with potential sexual partners (median?=?48 hr), looking at “porn” (median?=?24 hr), and searching for health information (median?=?7 hr). Over 98% indicated that they would use an anonymous/confidential online service for HIV and sexually transmitted infection testing. The majority (79%) had found sexual partners throughout the Internet in the last 24?hours, and 52% sought sexual health education online 2–3 times per week. Peak search time was evenings, increasing during weekends. Discussion: For Tanzanian MSM in cities, sexual electronic media use is high and includes work devices. Sexual health information seeking, and openness to electronic counseling and testing was almost universal. Electronic sites for sexual health access should be explored and evaluated.     

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 Relationship Between Use of Sexually Explicit Media and Sexual Risk Behavior in Men Who Have Sex with Men: Exploring the Mediating Effects of Sexual Self-Esteem and Condom Use Self-Efficacy

ABSTRACT

Objectives: This study tests the following 3 hypotheses: (1) there is a direct association between consumption of sexually explicit media (SEM) depicting non-condom use and sexually transmitted infection (STI)-related sexual risk behavior among men who have sex with men (MSM); (2) the association between SEM consumption and STI-related sexual risk behavior is mediated by men's sexual self-esteem; and (3) the relationship between SEM consumption and sexual risk behavior is mediated by condom use self-efficacy. Methods: A cross-sectional, Internet-based survey on exposure to SEM and sexual behavior of 1,391 MSM in the United States was conducted in 2011. Results: The results confirmed Hypotheses 1 and 3, while Hypothesis 2 was rejected. Accordingly, a significant association between the use of SEM picturing condom use and STI-related sexual risk behavior among MSM was found. Likewise, we found that the association between the use of SEM and sexual risk behavior was mediated by condom use self-efficacy in an indirect path. However, SEM did not influence sexual risk behavior via sexual self-esteem. Conclusions: To promote STI prevention, the actors in SEM may be used as role models in managing condom use in sexual contexts.     

The relation between cultural values and condom use among Latino gay men

ABSTRACT

Latino men who have sex with men (MSM) are the second largest group to be affected by human immunodeficiency virus (HIV). Latino cultural values may influence sexual behaviors that can result in HIV acquisition. This study explored the relations among traditional machismo, caballerismo, familismo, unprotected anal intercourse (UAI), and the appeal of sex without condoms (ASWC) among Latino gay men. Results indicated that higher levels of familial honor and traditional machismo predicted higher levels of ASWC. These findings suggest that exploration of gender roles and family are important factors to be included in HIV prevention and intervention programs.     

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.     

Importance of Self-Forgiveness and Social Support in Potentially Reducing Loneliness in Men Who Have Sex with Men

Abstract

Higher levels of loneliness in men who have sex with men (MSM) are associated with negative outcomes such as depression, anxiety, and sexual impulsivity. By identifying what may reduce loneliness in MSM, counselors and public health professionals can alleviate the distress of their clients. A significant hierarchical multiple regression controlling for relationship status, F(9, 105)?=?16.36, p?<?0.001, R² = .62, indicated that higher levels of self-forgiveness (β?=??.19, p?=?.04) and perceived social support (β?=??.49, p?<?.001) predicted lower levels of loneliness in MSM. Implications and limitations are discussed.     

Attitudinal and Behavioral Factors Associated with Extramarital Sex Among Nigerian Men: Findings from a National Survey

ABSTRACT

Using couple data from a national survey, this article examines couple's characteristics associated with extramarital sex among Nigerian men. We found 15.4% of married men had extramarital sex in the past 12 months. Extramarital sex was significantly associated with men's attitude toward extramarital sex (OR = 1.7 [1.4–3.0]), early sexual debut (OR = 1.9 [1.6–2.3]), alcohol use (OR = 1.7 [1.4–2.1]), and intimate partner violence against wife (IPV) (OR = 1.4 [1.2–1.7]). Increased wife's education was associated with decreased husband's extramarital sex. Men living in rural areas and in the Central and Southern regions were also more likely to have extramarital sex. The findings suggest useful implications for HIV prevention programs in Nigeria. Interventions should focus on influencing social norms around protective behaviors for men to avoid risks associated with extramarital sex and IPV, helping men to change attitudes toward extramarital sex and IPV, and promoting delay in age at first sex among young men.     

Antecedents of Condom-Protected Oral Sex Among Young Black MSM

Oral sex among men who have sex with men (MSM) is a common mode of STI transmission. This study identified the prevalence and antecedents of condom-protected oral sex among a sample of 526 young Black MSM having oral sex in the past 90 days. Men engaging in condomless anal receptive sex were less likely to report always using condoms for oral sex (p = .007). Men agreeing that “condoms help me have better sex” (p = .004) and those indicating always discussing condom use before sex were more likely to always use condoms for oral sex (p = .002). These identified antecedents may inform behavioral intervention efforts.     

Human Immunodeficiency Virus (HIV) Seropositive Homeless Men: Behavioral and Social Characteristics

Homeless persons living in US. innercities are at risk for human immunodeficiency virus (HW) infection, but few studies have examined the continued risk behaviors of HIV infected homeless men. We investigated the sexual behavior of 32 homeless men who had tested HIV seropositive. Twenty-five percent of HW positive men reported a history of injection drug use, 34% had sex with men, over 40% had participated in commercial sex, and 59% had been treated for a non-HIV sexually transmitted disease. HIV seropositive men also reported recent sexual behavior, with 62% having sex in the previous month and 50% currently sexually active. Condom use was inconsistent among seropositive men; 44% of vaginal and 50% of anal intercourse occasions in the preceding three months did not involve condoms, and 28% of HW seropositive men did not use a condom during their most recent sexual encounter. Substance use was frequently associated with unprotected sexual behavior among HW seropositive men. Finally, measures of life satisfaction showed that HIV seropositive men were most satisfied with their relationships, mental health, and spiritual well being. These data suggest a need for intensive behavioral.interventions tailored for homeless HW infected men and we recommend that existing substance use treatment and holistic care be incorporated into behavioral interventions for HW infected men.