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.     

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.     

Heterosexual Anal Intercourse among Men in Long Beach,California

Anal intercourse poses a greater risk for human immunodeficiency virus (HIV) transmission than vaginal intercourse, and in recent years there has been a growing understanding that heterosexual anal intercourse (HAI) is not uncommon. However, the majority of the anal intercourse literature has focused on men who have sex with men. The little research on HAI has mostly looked at women, with limited work among men. This analysis examined the association between HAI and high-risk behaviors (N = 1,622) and sexual sensation seeking (N = 239) in a sample of men recruited from 2001 to 2012 in Long Beach, California. Almost half of the sample was non-Hispanic Black. The median age was 42 years, 42% were homeless, and 20% reported recent HAI. Men who reported HAI were likely to be Hispanic, were likely to be homeless, had a male partner, engaged in sex exchange, and used cocaine or amphetamines during sex. Men who reported HAI scored higher on the Sexual Sensation Seeking scale. This research supports other work showing the relationship between HAI and high-risk behaviors. More important, it contributes new knowledge by demonstrating the association between HAI and sexual sensation seeking. This research highlights the importance of personality traits when trying to understand sexual behavior and when developing HIV prevention interventions.     

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.     

Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men

Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N = 647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.     

Willingness to Have Unprotected Sex

Little is known about people's willingness to engage in sex without protection from unwanted pregnancy. This study surveyed 1,497 women and men at 75 clinics and physician offices across California after their reproductive health care visits in late 2007 and early 2008. When asked if they would have sex without contraception, 30% said definitively that yes, they would have unprotected sex, and 20% indicated they would “sometimes” or “maybe” engage in unprotected sex. In multivariate models, compared to non-Latino White respondents, Latinos who responded to the survey in English were 52% more likely and African Americans were 75% more likely to report willingness to have unprotected intercourse. Wanting a child within the next three years was associated with increased willingness to have unprotected sex. Age, gender, parity, and relationship status were not significant in multivariate models. A considerable proportion of women and men may be willing to have unprotected sex, even with access to subsidized contraceptive services and even when recently counseled about birth control. The dominant behavioral models of contraceptive use need to acknowledge the widespread likelihood of occasional unprotected sex, even among people motivated to usually use contraceptives. Findings underscore the need to make contraceptive methods accessible, easy to use, and even pleasurable.     

A comparison of HIV risk practices among unprotected sex-seeking older and younger men who have sex with other men

Purpose: In recent years, much attention has been devoted to understanding the HIV risk behaviors of younger men who have sex with men (MSM). Recent data suggest that HIV is becoming an increasing problem for older adults, but little attention has been devoted to understanding their HIV risk behaviors or the factors that underlie their risk taking. This study provides a comparison of these issues among younger and older MSM. Methods: The data come from a subset of younger (ages 18–39, n?=?113) and older (ages 50+, n?=?109) men participating in a national study of 332 men who use the Internet to find other men for unprotected sex. Men were sampled randomly from 16 websites. Data were collected via telephone interviews conducted in 2008 and 2009. Results: Younger and older men reported comparable involvement in HIV risk, including involvement in unprotected sex, proportion of sex acts involving internal ejaculation, number of times having anonymous sex, and number of times having multiple-partner sex. Generally speaking, the factors underlying the risk practices of younger and older men were quite different (e.g. self-esteem and condom use self-efficacy for younger men, versus HIV serostatus and depression for older men). Conclusions: Older MSM using the Internet to find partners for unprotected sex engage in high rates of behaviors that place them at risk for contracting or transmitting HIV. They were just as likely as their younger counterparts to practice these behaviors. The factors “fueling” involvement in risk generally differ for older and younger men, thereby warranting the development of age-specific HIV interventions that can take into account the unique life circumstances and needs of older MSM.     

Heterosexual Anal Sex Among Men and Women in Substance Abuse Treatment: Secondary Analysis of Two Gender-Specific HIV-Prevention Trials

Receptive anal sex has high human immunodeficiency virus (HIV) transmission risk, and heterosexual substance-abusing individuals report higher anal sex rates compared to their counterparts in the general population. This secondary analysis evaluated the effectiveness of two gender-specific, evidence-based HIV-prevention interventions (Real Men Are Safe, or REMAS, for men; Safer Sex Skill Building, or SSSB, for women) against an HIV education (HIV-Ed) control condition on decreasing unprotected heterosexual anal sex (HAS) among substance abuse treatment-seeking men (n = 171) and women (n = 105). Two variables, engagement in any HAS and engagement in unprotected HAS, were assessed at baseline and three months postintervention. Compared to the control group, women in the gender-specific intervention did not differ on rates of any HAS at follow-up but significantly decreased their rates of unprotected HAS. Men in both the gender-specific and the control interventions reported less HAS and unprotected HAS at three-month follow-up compared to baseline, with no treatment condition effect. The mechanism of action for SSSB compared to REMAS in decreasing unprotected HAS is unclear. More attention to HAS in HIV-prevention interventions for heterosexual men and women in substance abuse treatment is warranted.     

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.     

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.     

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.     

Childhood sexual experiences and the perception of abuse among latino men who have sex with men

There is a lack of consensus on how to define childhood sexual abuse (CSA). In this study we explore the perceptions of CSA among men who had such experiences. One hundred Latino men (predominately gay) who had childhood sexual experiences with an older partner (CSEOP) were asked whether they considered their experiences sexual abuse (41 said no; 59 said yes). Those who felt abused were younger when the events happened and were more likely to have been physically forced, physically hurt, threatened, and emotionally hurt. Negative correlates of CSEOP in adulthood were also explored. Men who considered themselves the victims of CSA differed from those without CSEOP in having more alcohol use, unprotected anal sex, and male sex partners.     

Childhood sexual experiences and the perception of abuse among Latino men who have sex with men

There is a lack of consensus on how to define childhood sexual abuse (CSA). In this study we explore the perceptions of CSA among men who had such experiences. One hundred Latino men (predominately gay) who had childhood sexual experiences with an older partner (CSEOP) were asked whether they considered their experiences sexual abuse (41 said no; 59 said yes). Those who felt abused were younger when the events happened and were more likely to have been physically forced, physically hurt, threatened, and emotionally hurt. Negative correlates of CSEOP in adulthood were also explored. Men who considered themselves the victims of CSA differed from those without CSEOP in having more alcohol use, unprotected anal sex, and male sex partners.     

Prevalence of Sexual Trauma History Using Behaviorally Specific Methods of Assessment in First Year College Students

There are several challenges associated with evaluating the prevalence of sexual trauma, including child sexual abuse and adult sexual assault. The aim of this study was to assess sexual trauma prevalence rates among first year college students (N = 954) using behaviorally specific questions and a more representative recruitment sample that did not rely on self-selection. Participants completed a list of sexual trauma questions, including general questions containing labels such as “rape” or “abuse” as well as behaviorally specific questions that describe specific behaviors that qualify as sexual trauma without labels. Results indicated that 6.7% of the sample reported at least one incident of child sexual abuse, with similar rates for men and women. Women were more likely to report a history of adult sexual assault, which was reported by 12.4% of the total sample. Participants were also more likely to endorse a history of sexual trauma when answering behaviorally specific rather than general “label” questions. Women survivors in particular were more likely than men to identify their experiences as abuse/assault (66.7% versus 21.1% for child sexual abuse), which may help explain prevalence differences between men and women in prior research. Men may be less likely than women to label their experiences as abuse and may be underidentified in sexual trauma research without the use of behaviorally specific questions. Overall, the results of this study suggest that the prevalence of sexual trauma is better assessed using behaviorally specific questions and that this is an important topic of study among both men and women.     

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.     

Human immunodeficiency virus (HIV) seropositive homeless men: Behavioral and social characteristics

Homeless persons living in U.S. innercities are at risk for human immunodeficiency virus (HIV) 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 HIV 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 HIV seropositive men did not use a condom during their most recent sexual encounter. Substance use was frequently associated with unprotected sexual behavior among HIV 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 HIV infected men and we recommend that existing substance use treatment and holistic care be incorporated into behavioral interventions for HIV infected men.     

Impact of Religiosity on the Sexual Risk Behaviors of Young Men Who Have Sex With Men

Young men who have sex with men (YMSM), particularly Black YMSM, bear a disproportionate burden of new human immunodeficiency virus (HIV) infections in the United States. Several studies support the positive and protective role of religion in health and the prevention of morbidity and mortality. However, little empirical research has been conducted looking at religion with the context of YMSM and HIV prevention. We examined the impact of religious attendance and faithfulness on sexual risk among a community-based sample of 450 YMSM in Chicago ages 16 to 20. Participants were mostly racial/ethnic minorities, that is, Black (53.4%) and Latino (19.9%). Multivariate logistic regression indicated that faithfulness in combination with frequent formal religious attendance was associated with a decrease in reported number of unprotected anal sex acts, including unprotected receptive anal sex with male partners. These association trends were also found for the Black YMSM in our sample, suggesting that religious involvement and faithfulness is a potential protective factor for the acquisition of HIV among this high-risk population.     

Community reactions to campaigns addressing crystal methamphetamine use among gay and bisexual men in New York City

Crystal methamphetamine (aka "crystal meth") use with high-risk sex has become an emerging health problem for gay and bisexual men in New York City since the late 1990s. Public health campaigns were eventually developed to encourage gay and bisexual men to avoid or reconsider using crystal meth. Reactions to three campaigns were measured with a cross-sectional survey administered in 2004. Among an ethnically-diverse sample of 971 gay and bisexual men, 61.8% reported seeing the campaigns. Those who reported ever using crystal meth, recent use, and recent use with sex were significantly more likely to have seen the campaigns. In general, white men, HIV-negative men, and men not currently using crystal meth responded more positively to the campaigns than their counterparts; yet, more men of color reported having discussions with partners and friends about their crystal use as a result of these campaigns. Implications for researchers and practitioners are discussed.