Patterns of Sexual Experience Among Urban Latino and African American Ninth Grade Students

This analysis assessed patterns of sexual experience, the order in which behaviors were initiated, and associated factors, among Latino and African American ninth grade students (average age 15.2) who self-administered audio-computer-assisted surveys on netbooks in classes at 10 Los Angeles–area public high schools. Lifetime experiences with vaginal and oral sex were most common (19% and 16%, respectively); fewer reported anal sex (6%). Of the 23% reporting any sex, 91% fell into four categories: 36% reporting both oral and vaginal sex; 23% vaginal only; 18% all three; and 13% oral only. Most sexually experienced students (88%) initiated with vaginal or oral sex (46% vaginal, 33% oral, 9% both same day). No dominant pathway of sexual onset emerged for those reporting all three types of sex. We found no evidence that oral or anal sex substituted for or delayed vaginal sex. Males, those with a current partner, and those reporting multiple partners were more likely than others to report all three sexual behaviors versus vaginal only (odds ratios [ORs] 2.0, 1.5, 3.0; p = .02, .06, < .01, respectively). Although vaginal intercourse dominated their early sexual behavior, one-fifth of sexually experienced students reported anal intercourse, highlighting the need for specific prevention messages surrounding this higher-risk behavior.     

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.     

Condom use among Latino college students

Recent reports indicate that Latinos, the largest racial/ethnic minority group in the United States, are disproportionately affected by HIV and AIDS. College health professionals, therefore, should understand current sexual behaviors and risk factors among Latino youth. The authors assessed students' condom use at their most recent sexual encounter by using data from those students who reported oral, vaginal, or anal sex during the last 30 days. Fewer than half of recently sexually active Latino students had used condoms during their last oral (4.9%), vaginal (41.3%), or anal (27.8%) sexual encounter. Predictors of condom use varied according to the type of sexual activity. Findings from this exploratory study offer current information about condom use and sexual behaviors among Latino college students and suggest that prevention interventions and messages should be tailored to students' gender and types of sexual activity.     

Heterosexual Women’s and Men’s Labeling of Anal Behaviors as Having “Had Sex”

This study explored labeling of penile–anal intercourse (PAI), manual–anal (MA), and oral–anal (OA) behaviors as having “had sex” among heterosexual men and women with such experience residing in the United States (n = 3,218). Adult men and women completed an online questionnaire assessing sexual behaviors and whether each counted as having had sex. With the exception of anal intercourse, there was high variation in whether a behavior was labeled having had sex. There was not consensus on which anal sexual behaviors constituted having had sex, with attitudes varying across age, gender, and behavioral experience. Those who were older, male, and had the specific behavioral experience were more likely to label it as having had sex. Behaviorally specific assessments of the various anal behaviors as part of the sexual repertoire is critical to more accurate evaluation of sexual histories and assessment of risks to sexual health.     

Some aspects of prostitution

This study was based on data collected from 87 men during and immediately following participation in a counseling program aimed at assisting them to reduce sexual behaviors associated with high HIV risk. All the men reported having engaged in same‐gender anal or oral sex without condoms during the year prior to enrollment. Three‐month retrospective reports of sexual behavior, solicited just after participation, were compared with reports collected weekly during the same three‐month period. Accuracy of recall over an ensemble of 10 behavior items was quite low, with amount of error positively associated with behavior frequency. In general, exaggerated reports were associated with low‐frequency behavior and underreports with high‐frequency behavior. Because of observed differences in the average frequency of occurrence of the various specific types of sexual behavior, adjustment for event frequency was required to provide adequate analysis of between‐behavior differences in memory error. Estimated functional relationships between behavior frequency and average memory error illustrated that for sexual activity occurring between 1 and 20 times in the three‐month period, there was a significant association between the HTV‐risk level of a behavior and the average extent to which the behavior was forgotten (i.e., underreported). After event‐frequency adjustment, anal activity without condoms—the behavior believed to entail the highest level of risk for HIV transmission, and the behavior about which the counseling program provided the least ambiguous cues regarding risk—was associated with the greatest underreporting error, and the ensemble of unprotected behaviors (i.e., those unaccompanied by condom usage) involved significantly greater underreporting than did protected behaviors. Error rates over the ensemble of behaviors were strikingly low for zero‐frequency events, suggesting the utility of dichotomous ever/never measures in research evaluating activity levels and behavior change. Other analysis techniques for reducing potential recall bias, allowing finer evaluations of behavior frequency and change, were also discussed.     

Heterosexual Women’s Anal Sex Attitudes and Motivations: A Focus Group Study

Focus group methods were used to explore heterosexual women’s receptive anal sex attitudes and motivations. Behaviors under investigation included penile–anal intercourse (PAI), manual–anal stimulation, oral–anal contact, and the use of sex toys. A total of 33 self-identified heterosexual women ages 18 to 30 recruited from two metropolitan areas in the Midwestern United States participated in one of six focus groups. The findings suggest that women viewed heterosexual anal sex as an emerging norm. Attitudes and motivations were complex and varied by behavior. Dominant themes included curiosity, pain, pleasure, and stigma. Relational factors, including acquiescence, coercion, and consent, were also salient among participants. Factors that influence anal sexual behaviors may not be entirely distinct from those that influence other sexual behaviors; however, factors that influence anal intercourse may be distinct from those that influence nonintercourse anal sex. Improved understanding will allow scientists to better understand the integration of anal sex behaviors into the broader sexual repertoire.     

Parenting Practices and Adolescent Sexual Behavior: A Longitudinal Study

The effects of parental attitudes, practices, and television mediation on adolescent sexual behaviors were investigated in a study of adolescent sexuality and media (N = 887). Confirmatory factor analyses supported an eight‐factor parenting model with television mediation factors as constructs distinct from general parenting practices. Logistic regressions indicated that adolescents reporting greater parental disapproval and limits on viewing at Wave 1 were less likely to initiate oral sex between Waves 1 and 2. Adolescents who reported more sexual communication with parents were more likely to initiate oral sex. Results for vaginal intercourse were similar to those for oral sex. Coviewing was a significant negative predictor of initiation of sexual behavior. Parental attitudes and television mediation can delay potentially risky adolescent sexual behaviors.     

The impact of touch‐tone data entry on reports of HIV and STD risk behaviors in telephone interviews

Respondents’ concerns about privacy can decrease reporting of HIV and STD risk behaviors in general population telephone surveys. The purpose of this paper is to describe the results of an experimental study evaluating whether one method for increasing privacy, touch‐tone data entry (TTDE), is effective in increasing estimates of sexual behaviors from a population‐based survey. We conducted a random‐digit‐dial telephone survey of adults in New Jersey (n = 405), with half the respondents using TTDE for answering sexual behavior questions. TTDE led to increased reports of same‐sex sexual behavior, certain HIV and STD risk factors, and concern about one's risk for HIV and STD transmission. TTDE also narrowed the difference between men's and women's reports of the number of different sexual partners over the past 10 years. The feasibility and limitations of TTDE are discussed, along with possible alternative interpretations that consider the impact of TTDE on the dynamics of the interaction between the respondent and the interviewer.     

Identifying the causal pathways from religiosity to delayed adolescent sexual behavior

This study used the Integrative Model as a framework to examine whether religiosity delays onset of coitus among a longitudinal sample of virgins, and investigated the causal pathways of this relationship. In addition, this study examined the behavioral beliefs about the consequences of engaging in sex, which distinguishes between youth who vary in level of religiosity. A further analysis was also conducted to examine whether religiosity offers protective effects in terms of progression toward sexual intercourse on a sexual behavior index. The sexual behavior index assumes a progressive nature of sexual behaviors, and includes the following seven behaviors: kissing, having breasts touched (touching for boys), genital touching, receiving oral sex, vaginal intercourse, giving oral sex, and receiving (or giving) anal sex. Religiosity at baseline was negatively associated with sexual debut one year later. This relationship was mediated through attitudes toward personally engaging in sexual intercourse. Religiosity at baseline was also negatively associated with scores on the sexual behavior index one year later. These results suggest that religiosity offers protective effects for both coital and noncoital sexual behaviors.     

Identifying the Causal Pathways from Religiosity to Delayed Adolescent Sexual Behavior

This study used the Integrative Model as a framework to examine whether religiosity delays onset of coitus among a longitudinal sample of virgins, and investigated the causal pathways of this relationship. In addition, this study examined the behavioral beliefs about the consequences of engaging in sex, which distinguishes between youth who vary in level of religiosity. A further analysis was also conducted to examine whether religiosity offers protective effects in terms of progression toward sexual intercourse on a sexual behavior index. The sexual behavior index assumes a progressive nature of sexual behaviors, and includes the following seven behaviors: kissing, having breasts touched (touching for boys), genital touching, receiving oral sex, vaginal intercourse, giving oral sex, and receiving (or giving) anal sex. Religiosity at baseline was negatively associated with sexual debut one year later. This relationship was mediated through attitudes toward personally engaging in sexual intercourse. Religiosity at baseline was also negatively associated with scores on the sexual behavior index one year later. These results suggest that religiosity offers protective effects for both coital and noncoital sexual behaviors.     

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.     

Briefly Noted

Researchers have found that mirtazapine, in addition to counseling for substance use, reduced methamphetamine use and some HIV risk behaviors in cisgender men and transgender women who have sex with men. Mirtazapine, an antidepressant also known as Remeron, showed benefits after treatment ended, even if patients didn't always take their medication or took less than they were supposed to. The study follows a previous study of mirtazapine finding reductions in methamphetamine use and sexual risk behaviors among men who have sex with men. “Effects of mirtazapine for methamphetamine use disorder among cisgender men and transgender women who have sex with men: A placebo‐controlled randomized clinical trial” was published in JAMA Psychiatry online last week by Phillip Coffin, M.D. and colleagues. The RCT took place over a course of 24 weeks from 2013 to 2017 in San Francisco. Main outcomes measured were urine tests for methamphetamine and sexual risk behaviors, with sleep, methamphetamine craving, dependence severity, and adverse events also assessed. Sexual risk behaviors included number of sexual partners, and frequency of condomless anal sex. Participants assigned to mirtazapine also had reductions in depressive symptoms.     

Sexual risk behaviors and alcohol: Higher base rates revealed using the unmatched‐count technique

HIV/AIDS is a disease whose only known prevention is behavioral. Risky sex is one of the ways in which people become infected with HIV, as well as other STDS. Estimating the base rates of risky sex and risky sex after drinking proves difficult. This study uses the unmatched‐count technique (UCT) to estimate base rates for sexual risk behaviors and sexual risk behaviors after drinking and compares the findings with those estimates found using conventional methods. UCT does not require the participant to directly answer sensitive questions, and, thus, may provide more accurate reporting than other methods. In a population of college students, the UCT revealed higher estimates of base rates for having had sex, having had sex without a condom, and having had sex without a condom after drinking than an anonymous self‐report survey. These higher estimates provide a better feel for the level of these risk behaviors, may help understand the relationship between alcohol and risky sex, and point to the need to target more interventions for condom use and condom use in the presence of drinking among college students.     

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.     

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.     

Factors related to childhood sexual abuse among gay/bisexual male Internet escorts

This exploratory investigation examined the relationship between childhood sexual abuse (CSA) and related psychosocial characteristics and sexual behaviors among 46 gay/bisexual male escorts who advertise via the Internet. More than a quarter of men (28.3%) reported some history of CSA. Men reporting CSA were more likely to be from an ethnic minority group, identify as bisexual, have a primary male partner, and were less likely to identify an anal receptive ("bottom") sexual role preference. Men with a history of CSA were more likely to report unprotected sex with work-related partners, increased internalized homophobia, and decreased adolescent isolation. Interventions designed for male escorts with a history of CSA should emphasize safer sex strategies with work partners and reducing internalized homophobia.     

Lost in Translation: Language,Terminology, and Understanding of Penile–Anal Intercourse in an HIV Prevention Trial in South Africa,Uganda, and Zimbabwe

Despite efforts to use culturally appropriate, understandable terms for sexual behavior in HIV prevention trials, the way in which participants interpret questions is underinvestigated and not well understood. We present findings from qualitative interviews with 88 women in South Africa, Uganda, and Zimbabwe who had previously participated in an HIV prevention trial. Findings suggested that participants may have misinterpreted questions pertaining to penile–anal intercourse (PAI) to refer to vaginal sex from behind and subsequently misreported the behavior. Three key issues emerge from these findings: first, the underreporting of socially stigmatized sexual behaviors due to social desirability bias; second, the inaccurate reporting of sexual behaviors due to miscomprehension of research terms; and third, the ambiguity in vernacular terms for sexual behavior and lack of acceptable terms for PAI in some languages. These findings highlight methodological challenges around developing clear and unambiguous definitions for sexual behaviors, with implications not only for clinical trials but also for clinical practice and sexual risk assessment. We discuss the challenges in collecting accurate and reliable data on heterosexual PAI in Africa and make recommendations for improved data collection on sensitive behaviors.     

Sexual diversity in urban Norwegians

The purpose of this study is to describe homosexual and heterosexual experiences in terms of sexual fantasies, sexual attraction, sexual conduct, and falling in love in an urban Norwegian population. In 1997, a random sample of 5,000 persons (18-49 years) was drawn from the population register in Oslo to participate in a sexual behavior survey. Data collection was carried out by means of postal questionnaires and 45% responded. The results indicated that exclusive homosexuality was rare in the population. One exception was the prevalence of homosexual fantasies in women. Compared to respondents who had had exclusively heterosexual contact, respondents reporting bisexual contacts had a significantly higher number of lifetime sex partners, higher frequency of anal and oral sex and masturbation, and lower age at orgasm and masturbation debut. What significantly separated the groups of exclusive heterosexuals, bisexuals, and exclusive homosexuals were attitudes towards various expressions of sexuality and number of lifetime sex partners.     

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.