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.     

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.     

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.     

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.     

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.     

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 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.     

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.     

Reconciling Reality With Fantasy: Exploration of the Sociocultural Factors Influencing HIV Transmission Among Black Young Men Who Have Sex With Men (BYMSM) Within the House Ball Community: A Chicago Study

Studies involving the House Ball Community (HBC) have found high rates of HIV prevalence and undiagnosed HIV infection, as well as unique social and sexual network-related HIV risk and protective behaviors (Murrill et al., 2008; Sanchez, Finlayson, Murrill, Guilin, & Dean, 2010). Efforts to understand culturally appropriate and effective methods of HIV prevention services within the relatively understudied HBC are scarce (Phillips, Peterson, Binson, Hidalgo, & Magnus, 2011). This qualitative study, utilizing a diffusion of innovation theoretical framework, aimed to explore social norms regarding HIV and accessibility of HIV prevention services within the HBC. Thirty-seven participants (16 community leaders and 21 youths) engaged in focus group discussions. Participants discussed the perceptions of HIV and stigmatization within the HBC, general and HBC-specific risk factors for HIV transmission, as well as HIV prevention needs and strategies for culturally appropriate HIV interventions. Findings from this qualitative study highlight both the vulnerability of the HBC to HIV transmission and the corresponding support for HIV prevention interventions.     

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.     

Sexual Identity Disclosure and Awareness of HIV Prevention Methods Among Black Men Who Have Sex With Men

Black men who have sex with men (BMSM) are disproportionately affected by the human immunodeficiency virus (HIV) epidemic, yet we know little about how HIV-negative BMSM of different sexual orientations access HIV prevention strategies. Identity development, minority stress, and disclosure theories suggest that for people of different sexual orientations, disclosure of sexual identity may be related to health behaviors. We performed a latent class analysis on a sample of 650 BMSM (M_age = 33.78, SD = 11.44) from Atlanta, Georgia, to explore whether sexual orientation, disclosure of sexual identity, and relationship status were related to HIV prevention strategies, including awareness of PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) and frequency of HIV testing. We found three distinct BMSM classes referred to as (1) closeted bisexuals, (2) sexual identity managers, and (3) gay, out, and open; all classes primarily engaged in casual sex. Classes differed in their awareness and access to HIV prevention strategies. The closeted bisexual class was least aware of and least likely to access HIV prevention. Findings have important implications for future research, namely the consideration of sexual identity and disclosure among BMSM. With this knowledge, we may be able to engage BMSM in HIV/sexually transmitted infection (STI) prevention services.     

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.     

Understanding the Influence of Loneliness on HIV Risk Behavior in Young Men Who Have Sex with Men

In this study we used grounded theory methodology to understand the influence of loneliness in YMSM in terms of HIV risk behavior. Twenty-two YMSM, 18–29 years of age, of HIV-negative/unknown status were interviewed. Results indicated that loneliness is defined in two ways: emotional and social. A cyclical pattern emerged that included negative symptoms, “self-treatment” of loneliness through drug use and sex, temporary relief, remorse related to engaging in HIV risk behaviors, negative self-image, and ultimately the reemergence of initial loneliness symptoms. Results suggest that loneliness in YMSM plays a greater role in HIV-related behavior than previously understood. A preliminary explanatory model, implications, and directions for future research are discussed.     

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.     

Rates of Asymptomatic Nonurethral Gonorrhea and Chlamydia in a Population of University Men Who Have Sex With Men

ABSTRACT

Objective: To evaluate a text message (SMS) program as a booster to an in-person alcohol intervention with mandated college students. Participants: Undergraduates (N = 224; 46% female) who violated an on-campus alcohol policy over a 2-semester period in 2014. Methods: The SMS program sent drinking-related queries each Thursday and Sunday and provided tailored feedback for 6 weeks. Response rates to SMS drinking-related queries and the associations between weekend drinking plans, drinking-limit goal commitment, and alcohol consumption were examined. Gender differences were explored. Results: Ninety percent of SMS queries were completed. Weekend binge drinking decreased over 6 weeks, and drinking-limit goal commitment was associated with less alcohol consumption. Compared with women, men had greater reductions in alcohol consumption when they committed to a drinking-limit goal. Conclusions: Preliminary evidence suggests that an SMS program could be useful as a booster for helping mandated students reduce weekend binge drinking.     

Anal Cancer Screening: Barriers and Facilitators Among Ethnically Diverse Gay,Bisexual, Transgender,and Other Men Who Have Sex With Men

ABSTRACT

Knowledge and beliefs about anal cancer screening among gay and other men who have sex with men remains unclear, despite data that suggests significant risk for intra-anal HPV-related cancers. Nevertheless, community-based screening activities may be most effective when stakeholder perspectives are addressed. We conducted four focus groups among 16 male and 3 female health care advocates experienced in working with diverse gay and other men who have sex with men in Los Angeles. Barriers to anal cancer screening included lack of awareness, stigma, psychological and physical discomfort, the anus as hidden/private, primary concern with HIV, and men's lack of healthcare seeking. Facilitators were community screening sites, novel strategies such as home testing, health care system changes and targeted educational campaigns, which may increase anal cancer awareness and screening among ethnically diverse men who have sex with men.     

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.     

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.     

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.     

Addressing Sexually Transmitted Infections (STIs), including HIV/AIDS,in the Context of Sexual Health

ABSTRACT

Sexually transmitted infections (STIs) have occupied a central place in public health agendas for at least the past 500 years, but have been the subject of opinions, decrees and “moral positions” for much longer. Societies have long tried to control the sexual behaviors of their populations, not only for reasons of social control, but also with the objective of controlling the spread of disease—HIV is the latest example of how societies respond to infections spread through the most private of individual behaviors. The article outlines the burden of disease associated with sexually transmitted infections including HIV, and explores their impact on efforts to achieve the Millennium Development Goals (MDGs). A large number of options for prevention and care of the sexually transmitted infections and HIV are currently available in both resource-rich and resource-constrained settings. In this article I move beyond the narrow focus of biomedical interventions concentrated on the individual and explore the evidence for public health measures aimed at controlling these infections. Using a public health framework I outline the various measures that can be implemented for STI/HIV control, and in addition to exploring the evidence for their public health effectiveness, I also look at how each of these interventions can be delivered within a paradigm of sexual health more generally. Finally, the article proposes recommendations for which effective strategies should be incorporated into a broader framework for promoting sexual health.