Outcomes from a homegrown HIV prevention program for extremely high-risk,substance-using men who have sex with men with multiple health disparities

ABSTRACT

From February 2010 through December 2014, 585 substance-using men who have sex with men (MSM) were enrolled into a “homegrown” risk reduction intervention. Participants evidenced significant iterative factor reductions in the odds of substance use including alcohol (AOR = 0.79) and marijuana (AOR = 0.78; both p ≤ 0.05) and marginally significant reductions in the odds of methamphetamine use (AOR = 0.83; p ≤ 0.07). Participants also evidenced significant reductions in sexual risks including the odds of reporting drug/alcohol use before or during sex (AOR = 0.80) and of condomless anal intercourse (AOR = 0.72; all significant at p ≤ 0.05). Results demonstrate that the homegrown intervention was effective at reducing HIV risk behaviors among high-risk MSM.     

Sexual inactivity among men who have sex with men living with hiv in europe

Objectives: Most people living with HIV stay sexually active, but some remain inactive. This study investigated prevalence and correlates of sexual inactivity among European HIV-positive men who have sex with men (MSM). Methods: An anonymous sexual health questionnaire was distributed in 17 HIV outpatient clinics throughout Europe. Ninety-seven (11.6%) of 838 respondents reported absence of sexual activity. Results: Multivariable regression analysis identified older age, relationship status, and less satisfaction with general health and sexual desire as being associated with sexual inactivity. Conclusions: Prevalence of sexual inactivity has declined since the introduction of antiretroviral therapy to levels similar to those of HIV-negative MSM, suggesting a tendency toward normalization of HIV-positive MSM's sex lives.     

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.     

Difference in Condom Use Among Sexually Active Males at Historically Black Colleges and Universities

Black men who have sex with men (MSM) and black men who have sex with both men and women (MSMW) may not perceive themselves to be part of the larger gay community and hence may not heed prevention messages aimed at the community. Objective and Participants: To better understand the participants behaviors, the authors examined differences in condom use between black MSM/W (including MSM and MSMW) and men who have sex with women (MSW) at historically black colleges and universities (HBCUs). Methods: A paper-and-pencil questionnaire survey investigated sexual behaviors of 1,865 freshmen from 35 HBCUs during the 2001-2002 school year. Results: MSM/W were about 0.37 times less likely to always use condoms compared with MSW (adjusted odds ratio = 0.63, 95% confidence interval = 0.42-0.95). Sexual behavior, age at survey, total family income, and religion were also associated with condom use. Conclusions: These findings offer new directions for sexually transmitted disease and HIV prevention aimed at a highly marginalized population that remains at high risk for infection.     

Associations Between Sexual Abuse and Negative Health Consequences Among High-Risk Men Who Have Sex with Men

This study evaluated whether a history of sexual abuse could differentiate negative health consequences among men who have sex with men (MSM; N = 148) enrolled in a risk counseling program. More than half (51.4%) reported an experience of sexual abuse. A history of sexual abuse was associated with increased psychological distress, increased rates of alcohol (AOR = 2.91; p <.01) and/or drug abuse (AOR = 2; p <.01) treatment, increased risk of housing instability (AOR = 2.13; p <.05), and increased risk for suicidality (AOR = 4.3; p <.001). Findings demonstrate that screening for sexual abuse may be useful in determining the service needs of high-risk MSM.     

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.     

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.     

Masculine Gender-Role Congruence among Sexual Minority Men

Sexual minority men’s sexual identity may be vulnerable to feelings of masculine gender-role incongruence within heteronormative dominant cultural contexts. This study explored associations between masculine gender-role congruence/incongruence and various aspects of sexual identity development in a sample of 106 nonheterosexual men between ages 18 and 74?years (M?=?34.86, SD?=?14.32). The majority of the sample identified as gay (79%), with the rest of the sample identifying as bisexual (10%), and nonexclusively same-sex-attracted sexual identity labels (e.g., pansexual, queer; 10%). Slightly more than half of the men reported congruence between their actual self-perception of masculinity and their ideal masculine presentation. However, men who experienced greater masculine gender-role incongruence, specifically presenting with lower masculine appearance and behavior than they desired, reported higher levels of identity distress and self-consciousness. Thus, though masculine gender roles are being challenged and gender nonconformity is becoming more widely accepted, masculine gender roles are still relevant to the lives of sexual minority men. Future research and clinical implications are discussed.     

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.     

Social,Relational and Network Determinants of Unprotected Anal Sex and HIV Testing Among Men Who Have Sex with Men in Beirut,Lebanon

Objectives: We examined the social, relational and network determinants of condom use and HIV testing among men who have sex with men (MSM) in Beirut. Methods: Two-hundred thirteen men were recruited via respondent driven sampling and administered a survey. Results: Sixty-four percent reported unprotected anal intercourse (UAI), including 23% who had UAI with unknown HIV status partners (UAIU); 62% of participants had tested for HIV. In multivariate analysis, being in a relationship was associated with UAI and HIV testing; lower condom self-efficacy was associated with UAIU and HIV testing; gay discrimination was associated with UAIU; MSM disclosure was associated with UAI, UAIU and HIV testing; and network centralization was associated with HIV testing. Conclusions: Multi-level social factors influence sexual health in MSM.     

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.     

The Relationship Between Online Sexual Compulsivity,Dissociation, and Past Child Abuse Among Men Who Have Sex with Men

The objective of this study was to measure the relationships between online sexual compulsivity, three dimensions of dissociation (absorption, depersonalization, and amnesia), and past child abuse among men who have sex with men (MSM). A total of 517 MSM, recruited from Internet chat rooms, completed the survey. Results indicated that past child abuse was significantly related to dissociation but not online sexual compulsivity. It was also found that the amount of time MSM spent online in a one-week period, in general and specifically engaged in sexual activity, was significantly related to online sexual compulsivity and three dimensions of dissociation. Online sexual compulsivity was a significant predictor of absorption, depersonalization, and amnesia. Implications for clinicians and future research are presented.     

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.     

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.     

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.     

“Sometimes You Just Have to Have a Lot of Bitter to Make It Sweet”: Substance Abuse and Partner Abuse in the Lives of HIV-Positive Men Who Have Sex with Men

Although links between partner abuse (PA) and substance abuse (SA) are well-documented in the literature, we know less about these relations among HIV-positive men who have sex with men (MSM). We conducted a qualitative study with this group (N = 28). Participants reported (1) social modeling of SA in childhood and in adult social networks, (2) initial use of substance to cope with child abuse and neglect, and (3) the reinforcement of problematic SA by experiences of PA, whereby SA led to PA, resulting in increased SA. Recommendations for clinicians working with HIV-positive MSM are discussed.     

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.