Transactional Sex: Supply and Demand Among European Men Who have Sex with Men (MSM) in the Context of Local Laws

Objectives: Transactional sex (TS) is generally defined as the trading of sex for material goods. Cast within the broader context of prostitution laws, we examined variations in the sociodemographic profile of men who have sex with men engaging in TS by payment direction (buying/selling). Methods: The data were collected as part of the 38-country European Men who have sex with men Internet Survey project, conducted in 2010. Results: About 12% of respondents reported engaging in TS in the past year. TS was associated with laws, age, education, employment, and residence. Conclusions: The striking sociodemographic differences in TS by payment direction suggest a power differential and a leading role of socioeconomic factors in TS.     

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.     

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 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.     

Perceptions of Physical Sexual Health Among Young Men Who Have Sex with Men with a Previous History of Childhood Sexual Abuse

Childhood sexual abuse (CSA) has been reported to be disproportionately higher among young men who have sex with men (YMSM) than among heterosexual men. Most research and public health programs among YMSM CSA survivors have been mainly infectious disease-based, and research on the physical sexual health among this group is limited. This study sought to further understand components of physical sexual health among YMSM with CSA histories. Sixteen participants were recruited, and through a phenomenological approach, semi-structured interviews were conducted. Four themes were found, participants (1) reported a one-dimensional definition of sexual health; (2) had limitations in health insurance hindering preventative care; (3) described reoccurring anal pain during sexual intercourse; and (4) conveyed a positive perception of sexual satisfaction. These findings indicate a need for healthcare providers, health educators, and researchers to increase awareness about the comprehensive needs of YMSM with CSA histories.     

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.     

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.     

Recruitment Strategies of Indian Men Who Have Sex with Men in the State of Maharashtra Into an Online Survey

ABSTRACT

The authors reported lessons learned from their efforts to recruit Indian men and transgender women/hijras who have sex with men into an online cross sectional study. Between September 2013 and May 2014, we implemented a 7-phased recruitment strategy that included the use of online and offline strategies to enroll a total of 449 participants into an online survey about recent sexual behavior and various psychosocial measures. The phases were implemented sequentially and cost-per-eligible participant was calculated. Using social media and collaborating with organizers of community events proved the most effective strategies for recruiting Indian men who have sex with men into online research.     

Predicting disclosure of MSM status to providers in a primarily socially conservative state

ABSTRACT

Purpose: This study aimed to determine what predicts a man who identifies as MSM living in a conservative state to inform his provider of his sexual behaviors and/or his sexual orientation. Methods: We administered an anonymous online survey to 148 men who reported seeing a general medical provider in the last 12 months. All participants resided in Oklahoma. Results: When controlling for HIV status, previous STI diagnosis, and age, logistic regression modeling yielded significant results (x²(9) = 31.22, p <.001) predicting 70.3% of cases. Age and overall disclosure of sexual orientation and/or sexual behaviors were significant predictors. Conclusion: Individuals who did not disclose their sexual orientation or same-sex behaviors to friends and family members were less likely to inform their providers of their sexual orientation. Disclosure of MSM status provides additional opportunities to enhance primary and secondary prevention strategies in rural and conservative areas that are necessary to optimize health, including but not limited to HIV screening and discussion of pre-exposure prophylaxis that their counterparts in urban settings more readily receive.     

Risk Bases in Childhood and Adolescence Among HIV-Negative Young Adult Gay and Bisexual Male Barebackers

ABSTRACT

We sought to consider the phenomenon of intentional unprotected intercourse, known colloquially as barebacking, with regard to identities that gay men develop as barebackers and the developmental bases that may predispose some men to this identity. As part of a larger study, we analyzed the life history interviews of 12 diverse HIV-negative men in early adulthood, using thematic coding procedures to identify events, conditions, and emotional states in childhood and adolescence that might help to explain why uninfected young men might place themselves at risk for HIV seroconversion. These analyses elicited various risk bases in childhood and adolescence, including early sexual experiences, pronounced experimentation with and abuse of drugs and alcohol, feelings of loneliness, a lack of love relationships despite sexual activity, and early experiences of loss. These findings suggest a complex interplay between emotional factors and life events, which may help to explain these men as sexual risk takers.     

Exploring Queer Consciousness Among Social Workers

The purpose of this study is to examine the attitudes of MSW practitioners toward lesbians and gay men using a recently developed instrument. Whereas prior research focused on blatantly homophobic or heterosexist attitudes, this research uses a measurement tool based on the concept of queer consciousness (QC) and measures subtle forms of prejudice, including both positive and negative attitudes along four dimensions: Value gay and lesbian progress/diversity, resist traditional sex and gender roles, positive beliefs about lesbians, and positive beliefs about gay men. Research findings indicate negative attitudes toward lesbians and gay men in three out of the four dimensions for the sample of social work practitioners. This article concludes with suggestions for social work educators who want to redress areas of subtle prejudice and promote higher levels of QC.     

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.     

Sexuality in Older Adults (65+)—An Overview of the Literature,Part 1: Sexual Function and its Difficulties

Objectives: The aim of the current article was to provide an overview of literature on sexual function and sexual difficulties in older adults. Method: The authors conducted a narrative review of papers published in English between January 2005 and July 2015 based on an extensive search in PsycINFO. Results: The review showed that although common biological changes may adversely affect sexual function in old age, sexual experience seems to also be affected by psychological and interpersonal factors. Conclusions: Greater life expectancy and better medical care will result in older individuals with chronic diseases living longer. The need for help to cope with changes in sexual health is likely to increase in older adults, as sexuality may be negatively affected through several pathways.     

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.     

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.     

The Healthy Young Men's Study: Sampling Methods to Recruit a Random Cohort of Young Men Who Have Sex With Men

Recruiting a scientifically sound cohort of young men who have sex with men (YMSM) is an enduring research challenge. The few cohort studies that have been conducted to date on YMSM have relied on nonprobability sampling methods to construct their cohorts. While these studies have provided valuable information about HIV risk behaviors among YMSM, their generalizability to broader YMSM populations is limited. In this article, the authors describe a venue-based sampling methodology used to recruit a large and diverse cohort of YMSM from public venues in Los Angeles County, California. Venue-based sampling is a multistage probability sampling design that uses standard outreach techniques and standard survey methods to systematically enumerate, sample, and survey hard-to-reach populations. The study design allowed the authors to estimate individual, familial, and interpersonal psychosocial factors associated with HIV risk and health-seeking behaviors for a cohort of YMSM with known properties. Study participants completed an extensive baseline survey and over a 2-year period completed four follow-up surveys at 6-month intervals. The baseline survey was administered in both English and Spanish.     

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).     

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.