Male Bisexuality and Condom Use at Last Sexual Encounter: Results From a National Survey

Relatively little is known about condom use among bisexual men as separate and distinct from exclusively homosexual and heterosexual men. Most previous research on bisexual men has relied on nonprobabilistic, high-risk samples with limited generalizability. We examined the relationship between behavioral bisexuality and condom use in the 2002 cycle of the National Survey of Family Growth (NSFG). Bisexually active men positively differed from heterosexually and homosexually active men on every indicator of confounding risk. Bisexually active men, however, did not report using condoms less often than other men during their last sexual encounters with males and females. Indeed, with female partners, bisexually active men reported higher rates of condom use than did other men. These relationships remained when all sociodemographic and confounding risk factors were held constant. Our results suggest that caution must be used when making assumptions about condom use in the general population of bisexual men from nonprobabilistic samples.     

“No strings attached”: A qualitative exploration of gay and bisexual men’s motivations for and attitudes toward engaging in casual sex while on vacation

Prior quantitative research with gay and bisexual men (GBM) has documented high rates of sexual risk behavior during recreational travel. Although some associations are known (e.g., substance use at the tourist destination is associated with sexual risk), less is known about GBM’s motivations for travel and the cognitive and attitudinal factors that influence their sexual behavior while vacationing. In the present study, we conducted qualitative interviews with 46 GBM recruited from three popular gay tourist destinations. Using the Health Belief Model (HBM) as a guiding theoretical framework, the findings of the study revealed that the gay-friendly, tropical, relaxing environments resulted in men letting their guard down and engaging in more risk than when they are at home. Various barriers such as peer pressure and substance use affect GBM’s ability to engage in healthier behaviors while traveling, with condom negotiation and HIV status disclosure as additional issues that impact the sex practices of this population. Results highlight the applicability of HBM constructs to provide insight for intervention development for this population.     

PartyIntents: a portal survey to assess gay and bisexual men's risk behaviors at weekend parties

PartyIntents examines whether portal survey methods could be used to anonymously survey gay and bisexual men about HIV-risk behaviors before and after a weekend party-oriented vacation. The study recruited 97% of eligible men and of these 489 participants 47% completed the follow-up assessment. Approximately one half of the men intended to use illegal drugs over the weekend, and almost 20% thought that they might have anal intercourse and not use a condom. The methodology can be applied and provides useful information about HIV risk at these events, though refinements may be needed to increase the follow-up rates.     

“Knowing Your Status and Knowing Your Partner’s Status Is Really Where It Starts”: A Qualitative Exploration of the Process by Which a Sexual Partner’s HIV Status Can Influence Sexual Decision Making

Gay and bisexual men are at disproportionate risk for human immunodeficiency virus (HIV) infection. While prevention efforts often emphasize consistent condom use, there is growing evidence that men are using seroadaptive safer-sex strategies, such as serosorting and seropositioning. This qualitative analysis of 204 HIV-negative and HIV-positive gay and bisexual men explored the ways that a sexual partner’s HIV status can influence safer-sex strategies and sexual decisions. The majority of the respondents reported that they were influenced by their partners’ HIV status. Those respondents who reported no influence discussed adhering to safer-sex rules that were not dependent on partner status and a lack of concern about HIV. Conversely, respondents who reported influence identified three primary areas of influence: psychological impacts, partner preference and selection, and specific behavioral intentions and strategies. A conceptual model explicating a potential process by which respondents use partner serostatus information in shaping sexual decisions is presented.     

The 90's

Gender differences in AIDS-related heterosexual concerns and sexual behavior with new sexual partners, with an emphasis on condom use and subjective condom experiences, were assessed by a questionnaire survey of middleclass bar patrons, on location, in New York City. Patrons were asked about their number of sexual partners, the extent of their AIDS-related womes and behavioral responses to such concerns, as well as their use of condoms in different sexual situations and their subjective condom experiences. Most people report that AIDS-related concerns have affected their behavior in some way, primarily in the increased use of condoms. Condom use varies according to type of relationship and type of sexual act and results generally in more peace of mind, but less sexual enjoyment. Peace of mind strongly predicts condom use during casual sex for both genders. In terms of gender differences, women worry about AIDS with new sexual partners more than men do and they tend to limit their number of partners more. Women appreciate the use of condoms more than men do, most likely because erection and ejaculatory concerns are fundamental aspects of men's, but not women's, condom experiences. "Worrying about AIDS" predicts condom use during casual sex for men, but not women. More men than women had a condom with them when surveyed.     

Reviews and abstracts

This study examines leading explanations for unsafe sex in light of in‐depth interviews with 102 high‐risk gay and bisexual men in Toronto to see how well they engage with the social circumstances and reasoning processes of men in their sexual relationships. We argue that there is an inadequate fit between some of the leading explanations and the discursive accounts provided by high risk men themselves. Their accounts focus on unsafe sex occurring as a resolution to condom and erectile difficulties, through momentary lapses and trade offs, out of personal turmoil and depression, and as a byproduct of strategies of disclosure and intuiting safety. This study examines, in particular, the circumstances and rationales associated with men who identify their practices as “barebacking.” We conclude with recommendations for communicating prevention messages to those most at risk based on the self‐understandings of gay and bisexual men who most frequently practice unprotected sex.     

Knowledge of Acute Human Immnuodeficiency Virus Infection Among Gay and Bisexual Male College Students

Abstract

Objective: To examine human immunodeficiency virus (HIV)–related knowledge, attitudes, and behaviors in at-risk college men who have sex with men (MSM), focusing on knowledge about acute HIV infection (AHI). Participants and Methods: A one-time anonymous survey was administered to college students attending a lesbian, gay, bisexual, transgender, and queer conference in February 2012. This article reports on a study subsample of MSM. Results: A total of 100 MSM completed the survey. Participants had an average age of 20.4 years. Sixty-six percent reported condom use the last time they had sex. Only 46% had ever heard of symptoms related to AHI. Forty-two percent would likely seek medical care when showing acute symptoms in a setting consistent with AHI. Conclusion: Despite having multiple risk factors for HIV infection, many MSM college students are unaware of AHI. HIV prevention programs should target this population and include information about signs, symptoms, and diagnosis of AHI.     

Minority Stress Theory: An Examination of Factors Surrounding Sexual Risk Behavior Among Gay and Bisexual Men Who Use Club Drugs

Background: Few studies have examined the impact of minority stress theory (MST) upon sexual risk behavior among gay and bisexual men using club drugs. Similar studies have focused on ethnic minorities and women; however, gay and bisexual men demonstrate greater likelihood for risk behaviors leading to HIV/AIDS. Objective: This study examines sexual risk behavior from the perspective of minority stress theory upon substance-using gay and bisexual men and their partners. Methods: Multivariable logistic regression analysis examined minority stress associations with participant sexual risk behaviors, drug use, and partner type, controlling for demographics. Results: 396 gay and 54 bisexual respondents, ages 18–67, reported at least one-time drug use while engaging in sexual risk behavior. In the adjusted model, expectations of rejection associated with lower odds of sexual risk behavior, while older age approached significance. Conclusions: Theoretical origins for examining risk behavior among gay and bisexual men may underscore risk and protective factors, while ultimately holding implications for prevention and treatment interventions.     

Accounting for unsafe sex: Interviews with men who have sex with men

Semi‐structured one‐on‐one interviews with 102 gay and bisexual men were conducted to examine the reasoning processes men use to exempt themselves from practicing safe sex. Qualitative analysis of the interviews revealed the following recurring themes: (a) Many men who were in couple relationships avoided condom use for reasons involving intimacy or trust, or because both partners were HIV‐negative; (b) unsafe sex sometimes occurred inadvertently or involuntarily; (c) negative moods and self‐images were associated with unsafe sex; (d) by “intuiting” that their partner was HIV‐negative, participants exempted themselves from the need for safe sex; and (e) when the boundary between safe and unsafe was unclear, participants used a combination of unofficial and official guidelines to determine what is safe.     

Prevalence of same‐gender sexual behavior and HIV in a probability household survey in Mexican men

The prevalence of male same‐gender sexual behavior in Mexico City in relation to HIV transmission was studied. A household probability survey of 8,068 adult men was conducted in 1992–93 using the Mexican National Health Survey sampling frame. The response rate was 59%. Differences between respondents and nonrespondents indicated no evidence for significant bias. A random subsample of 1,116 individuals provided serum or saliva for HIV testing. An estimated 2.5% of men practiced same‐gender sex in their lifetime: 2.1% (95% CI: 1.7 ‐ 2.4%) reported bisexual behavior and 0.4% (95% CI: 0.3 ‐ 0.6%) reported exclusively homosexual behavior. Among bisexuals, 70% reported sex only with women in the previous year, 7% reported sex only with men, 13% reported sex with both, and 10% were sexually inactive. A condom was used by 46% in their last homosexual encounter. An estimated 0.1% of married men were homosexually active in the previous year. The HTV prevalence estimate was 0.2% in the sample. The rate was 4% among homosexual/bisexual men and 0.09% in heterosexual men (p < 0.0001). Estimates of homosexual behavior and HTV infection from this population‐based sample are lower than results from nonprobability studies. The low prevalence of condom use anticipates future growth of the epidemic in the homosexual population. Bisexual behavior appeared to be infrequent and transitory, particularly among married men.     

Differences in the prevalence of risk behaviors between heterosexual and lesbian,gay, bisexual,and questioning (LGBQ) female adolescents in the juvenile justice system

Little is known about the behavioral risk factors for HIV and other sexually transmitted infections (STIs) among female youths who identify as lesbian, gay, bisexual, or questioning (LGBQ) and who are involved in the juvenile justice system. We examined the sexual and drug use risk profiles of heterosexual and LGBQ female adolescents in the justice system. Greater prevalence of alcohol and substance use was found among female LGBQ adolescents compared to their female heterosexual counterparts. Conversely, female LGBQ youths reported more consistent condom use for both vaginal and anal sex compared to heterosexual females. These data may be useful in tailoring interventions for justice-involved LGBQ youths.     

Experience of Older Gay and Bisexual Men Living with HIV/AIDS

Although HIV/AIDS definitely impacts gay and bisexual men of all ages, the impact on people in their later years has not been actively investigated. This exploratory study obtained detailed narratives from 14 adults between the ages of 51-72, all of whom were infected with HIV. Ten of the participants were potentially infected through male to male sexual contact. The subjects reported living with HIV for substantial periods with an average of 13 years of life since diagnosis, estimating a duration of HIV seropositivity from 1-20 years. Most had significant health problems, which may be related to aging, in addition to a number of HIV-related symptoms. They expressed community identification as people living with HIV; some were highly identified as gay men, while other were closeted or in denial regarding their same-sex activity. Half felt to some extent bisexual, and described relationships with wives or other women. Although many participants maintained active social lives, others expressed feelings of loneliness and isolation. This group was minimally active sexually and several of the participants expressed reservations about safer sex, especially condom usage. A strong theme was the sense of having lived a full life, which may help the individual cope with his diagnosis. The findings suggest the need to examine the diversity among older gay and bisexual men living with HIV, how these experiences vary by race and ethnicity, and identification of issues related to prevention and services.     

Hidden dangers among circuit parties—A systematic review of HIV prevalence,sexual behaviors and drug abuse during the biggest gay events

ABSTRACT

Circuit parties (CP) are extended celebrations, lasting from a day to a week, primarily attended by gay and bisexual men in their thirties and forties. The increasing popularity of circuit parties may play a significant role in the epidemiology of HIV and other sexually transmitted diseases. We performed a systematic literature search in MEDLINE, without any temporal limit, using the term “circuit party”. Only articles reporting cross-sectional studies were analyzed. Ten articles, published in the period from 2001 to 2015 were included in our systematic review and reported data on samples ranging from 173 to 13,883 gay/bisexual men. The HIV prevalence among men who attended the CPs was very high, ranging from 6% to 40.8%. Sexual risk behaviors (e.g. unsafe sex or multiple partners) and drug use were particularly frequent. It wo'uld be useful to promote efficient strategies with the cooperation of party planners, catching the participants before nightlife activities in order to prevent HIV transmission and the use of recreational drugs.     

Stage-Based Computer-Delivered Interventions to Increase Condom Use in Young Men

ABSTRACT

Objectives: The aim is to examine whether adopting or increasing condom use can be influenced by psychological treatment targeting both motivational and volitional aspects, when these components are matched to the characteristics of the recipients. Method: In a randomized controlled trial, 159 heterosexual young men (intervention groups, n = 113; control condition, n = 46) were exposed to 2 computer-delivered intervention arms, 1 targeting nonintenders (n = 36; motivational intervention arm) and the other targeting intenders (n = 77; volitional intervention arm). Intention and condom use were assessed through self-report questions at 3 points in time, each 2 weeks apart. Motivational intervention involved screen content requesting decisional balance for condom use and focus on past success to trigger self-efficacy. Volitional intervention encouraged the formation of specific if-then plans, where participants were required to choose and write about the most favourable situations by means of reflection on when, where, and how to carry them out, and of thinking about strategies for obstacles that might hinder condom use. Results: Experimental nonintenders obtained higher levels of condom use intention two weeks and one month later and of reported condom use one month later than control nonintenders. Experimental intenders reported an increase in condom use in comparison with control intenders one month later. Conclusions: At a 30-day follow-up, treatment was shown to have helped nonintenders to first increase their condom use intentions and later condom use, and intenders to improve condom use behavior. A stage-based computer-delivered intervention design including motivational and volitional treatment appears to be suitable for improving condom use motivation as well as behavior after a 1-month period.     

Sexual Compulsivity and Sexual Behaviors Among Gay and Bisexual Men and Lesbian and Bisexual Women

Within the existing body of research, the information pertaining to sexual compulsivity (SC) among women, both homo- and heterosexual, remains rather limited in comparison to men. The aim of this study was to assess the prevalence of SC in a community sample of gay and bisexual men and lesbian and bisexual women and to identify differences in sexual practices based on classification as sexually compulsive within gender. Supporting previous research, the findings indicated that gay and bisexual men were significantly higher in SC when compared to lesbian and bisexual women. Similarly, sexually compulsive gay and bisexual men were more likely to report drug use with sex than their non-sexually compulsive peers, suggesting that “party n' play” may play a larger role for men with SC. In addition, the findings demonstrated empirical support for the proposition that lesbian and bisexual women with symptoms of SC were more likely to engage in specialized sexual behaviors in comparison to their non-sexually compulsive peers. These data suggest that SC manifests differently in gay, lesbian, and bisexual men and women.     

Knowledge,attitudes, and behavior related to condom use and STDs in a high risk population

Since the mid‐1980s, the incidence of sexually transmitted diseases (STDs) among Blacks has increased dramatically nationwide, particularly in Philadelphia and other major urban areas. One approach to this public health problem is to prevent the further transmission of disease through the use of condoms during sexual activity. To provide a basis for condom‐promotion programs within a high risk Black urban community, we explored condom use behavior and the relationship between condom use and variables related to demographic characteristics, knowledge, attitudes, perceived risk and concern about STDs, and STD history. A household survey was conducted of a stratified, quota sample of 925 male and female adolescent and adult residents in North and West Philadelphia. These areas have the highest rate of STDs in the city and among the highest rates in the country. The survey revealed a trichotomy among respondents with respect to condom use: approximately one‐third of the sample used condoms consistently; one‐third used them intermittently, and one‐third never used condoms. Consistent condom users tended to use condoms with both steady and casual partners; less frequent condom users tended to use condoms with partners who could be considered higher risk: new partners and casual partners. Although condom use rates did not vary as a function of age among males, women under age 20 were far more likely to use condoms than were other female age groups. Knowledge about STDs and prevention was not found to predict condom use. Negative attitudes toward condoms were related to non‐use, with the exception of women who used condoms in perceived high risk situations despite negative attitudes.     

Condom Negotiation Strategies as a Mediator of the Relationship between Self-Efficacy and Condom Use

College students are a group at high risk of sexually transmitted infections due to inconsistent condom use and engaging in other risky sexual behaviors. This study examined whether condom use self-efficacy predicted the use of condom negotiation strategies (i.e., condom influence strategies) and whether condom influence strategies mediated the relationship between condom use self-efficacy and condom use within this population, as well as whether gender moderated the mediation model. Results showed a strong relationship between condom use self-efficacy and condom influence strategies. Additionally, condom influence strategies completely mediated the relationship between condom use self-efficacy and condom use. Although condom use self-efficacy was related to condom use, the ability to use condom negotiation strategies was the most important factor predicting condom use. The mediation model held across genders, except for the condom influence strategy withholding sex, where it was not significant for men. For women, condom use self-efficacy promoted the use of a very assertive negotiation strategy, withholding sex, and was consequently related to increased condom use. Overall, using assertive condom negotiation strategies (e.g., withholding sex and direct request) were found to be the most important aspects of increasing condom use for both women and men. Implications and suggestions for prevention programming are discussed.     

Sexual Decision Making for the “Better Than Average” College Student

Abstract

Objectives: To examine the impact of downward social comparison and the “known partner is a safe partner” heuristic on college students’ sexual decisions. Participants: One hundred-eighty heterosexual or bisexual undergraduate college students. Methods: Participants read dating vignettes that varied on perspective and familiarity and then rated the likelihood the couple would engage in sexual intercourse and use a condom. Results: There were no differences in rated likelihood based on familiarity, suggesting that the students did not view the 2 partner types as significantly different. Students rated the likelihood of sexual intercourse lower and condom use higher when the vignette was presented from the second person perspective. Conclusions: The students’ use of downward social comparison is consistent with the “better than average effect,” suggesting that the students perceive their own behavior as safe. The implication is that safer sex messages might be most effective if they focus on what students will gain by practicing safer sex behaviors, not just avoidance of a risk behavior.     

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.