“Allah will decide my life and death”: Religion and spirituality among populations at risk for HIV in Malaysia

ABSTRACT

We examined the influence of religion and spirituality on HIV risk contexts through in-depth interviews with men who have sex with men (n = 10) and female commercial sex workers (n = 10) in Malaysia. Using a grounded theory approach, five themes emerged from the interviews: (a) religion encourages caring for health, (b) health is influenced by a higher power, (c) prayer is a conduit to health assistance, (d) stigma is compounded by religion but it does not limit one’s spirituality, and (e) religion is not but should be incorporated into HIV campaigns. Incorporation of spirituality in service provision and addressing stigma is warranted.     

Sexual Behavior,Mental Health,Substance Use,and HIV Risk Among Agency-Based Male Escorts in a Small U.S. City

Abstract

Relatively little research has examined the personal sex lives of indoor male sex workers (MSWs) or possible connections in this group between sexual behavior and factors related to HIV risk. As part of a larger project, this study collected data from 30 agency-based indoor MSWs (mean = 22.4 years) about their sexual behavior, mental health, and substance use. Few HIV risk behaviors with clients occurred. Drug use and mental health problems were relatively frequent, but not related to increased risk behavior. Instead, MSWs appeared to employ rational decision-making and harm-reduction strategies. Conceptualization of MSW sexual behavior may be required where HIV risk is not attributed to sex work per se, but to other influences such as economic and relational factors.     

Predictors of Safer Sex on the College Campus: A Social Cognitive Theory Analysis

Abstract

In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N ? 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjuction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.     

Changing Directions in HIV Prevention: The Move Toward a Psychosocial Model

ABSTRACT

Although some HIV prevention programs have been successful in helping gay and bisexual men change their sexual behaviors, rates of HIV infection continue to increase. In an attempt to address this problem, social workers need to move beyond traditional HIV prevention approaches to a psychosocial model of HIV prevention. Based on the work of previous researchers, this approach assumes that a combination of individual, psychological, and social factors contribute to risky sex in gay and bisexual men. Because social workers are trained to view problems from a psychosocial framework, they are already in a position to develop programs incorporating the psychosocial model. This article examines the psychosocial model of HIV prevention and the various psychosocial factors that may contribute to high-risk sexual behavior and concludes with examples of prevention research that have already incorporated the model.     

Sexual Problems and Distress among Men and Women with Same-Sex and Opposite-Sex Sexual Partners: An Analysis of a Nationally Representative Sample of Adults in Great Britain

Abstract

Objective: This study aimed to examine differences in reporting sexual problems and distress among men and women with same-sex and opposite-sex sexual partners.

Methods: Multinomial regression was undertaken on risk of reporting sexual problems and/or distress using data from the third National Survey of Sexual Attitudes and Lifestyles.

Results: Differences were detected between men of different sexual behavior groups when considering the problems “lack of enjoyment in sex,” “felt anxious during sex,” “felt no excitement or arousal during sex,” “lack of interest in sex,” “did not reach/took a long time to reach climax,” and “getting or keeping an erection.” Fewer differences were detected among women.

Conclusions: Women reporting same sex sexual partners, and to a greater extent men reporting same sex sexual partners , have different sexual health needs and report sexual health problems and distress to a different extent than is the case for individuals who only have opposite-sex sexual partners     

Between Money,Morality and Masculinity

Abstract

This paper focuses on the supply-side of Chiang Mai's gay bars, that is, the male sex workers called dek bar or “bar boys”¹ in Thai. I formulate some explanations why these young men -more than half of whom do not consider themselves to be “homosexual” -take on a job as a male sex worker. In this analysis I focus on certain notions in traditional Thai society, trends in contemporary urban Thai society, the economics of work in a gay bar, as well as the sexual behaviour of male sex workers and the concepts they use to describe their work.     

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.     

Residential group care workers' recognition of depression: Assessment of mental health literacy using clinical vignettes

BackgroundResidential group-care workers have a critical role to play in recognizing mental health problems amongst children in their care. However, little is known about the extent to which workers recognize and respond to mental health and behavioral concerns.MethodA sample of 124 residential group care workers completed an online survey in which vignettes of children experiencing either internalized or externalized symptoms of depression and ‘typical’ behavior were presented. In order to explore aspects of mental health literacy, workers were asked to rate each vignette for severity of a specific mental health concern (adolescent depression), portrayed as internalized or externalized behavior. Ratings of worker confidence and concern for the young person were also obtained.ResultsWorkers were able to recognize the existence of depression in these fictional vignettes. Depression in the presence of externalized behavior was rated as both more severe and more concerning than depression accompanied by internalized behaviors. Furthermore, workers had greater confidence in endorsing the presence of a mental health issue when accompanied by externalized behavior compared to an internalized presentation.ConclusionsResidential group-care workers are able to recognize the existence of depression amongst children in their care. Externalized presentation of mental health appears to be more easily recognized by workers and they are also more confident in identifying mental health concern when it is accompanied by externalized, compared with internalized behaviors. The implications for training and support of residential group care workers are discussed.     

Testing a New Measure of Sexual Health Knowledge and Its Connections to Students' Sex Education,Communication, Confidence,and Condom Use

ABSTRACT

This study investigates the nature of college students' sexual health knowledge, prior sex education coverage, and sexual communication and confidence. We created a new, comprehensive sexual health knowledge measure to assess 347 undergraduates' knowledge of reproductive health, contraception, condom use, sexually transmitted diseases (STDs), and HIV/AIDS. Overall, students demonstrated a fairly poor understanding of sexual health issues. Women were more knowledgeable than men, specifically on the topics of contraception and STDs. Prior exposure to sex education covering mainstream reproductive health issues or newer contraception methods was correlated with greater knowledge across all domains, particularly for men. Greater knowledge was also correlated with greater sexual assertiveness and confidence with condoms among women.     

Entertainment Venue Visiting and Commercial Sex in China

ABSTRACT

Entertainment venues in China play an important role in the sexually transmitted disease (STD)/HIV epidemic. Most previous studies have focused on sex workers working in entertainment venues, but little is known about their clients. This study investigated the perceptions and behavior of the patrons visiting entertainment venues. Qualitative in-depth interviews were conducted with 30 male market vendors who visited entertainment venues at least once in the past 3 months in an eastern city in China. Information about their risky behavior, attitude toward commercial sex, and STD/HIV prevention approaches was collected. Saunas, karaoke bars, and massage centers are the most frequently visited entertainment venues. Seventy-three percent of study participants reported purchasing commercial sex at these entertainment venues. Participants expressed a very liberal attitude toward commercial sex. Seeking commercial sex was perceived as a characteristic of a male's nature. The perceived risks of STD/HIV infection do not deter participants from engaging in commercial sex. Commercial sex clients reported irregular condom use and a number of other misperceptions and improper practices toward preventing STD/HIV infection. Venue-based intervention is urgently needed to target the population. The sex workers themselves could potentially serve as “health educators” to communicate prevention information to their clients and encourage safer sex behavior.     

A Comparison of Male Sex Workers in Prague: Internet Escorts versus Men Who Work in Specialized Bars and Clubs

Prague, the Czech Republic, is a popular sex tourism destination where sex work is decriminalized and young men offer sexual services at low prices relative to countries in Western Europe. This quantitative survey aimed to identify some of the demographic characteristics of these young men and their experiences in the sex industry. Internet escorts (N = 20) and sex workers in bars and clubs (N = 20) completed the survey anonymously in spring 2011. The results showed that sex workers in clubs often had troubled pasts and were forced into sex work to survive. They also reported incidents of violence, serious alcohol and drug use, as well as frequent gambling. The larger group of sex workers in Prague is made up of Internet escorts who have backgrounds that are not atypical for the average Czech youth. They had fewer problems with drugs and alcohol but were twice as likely as sex workers in bars and clubs to be victims of violent crime. Plans for interventions to help those who would change their line of work, as well as the importance of sociocultural context in understanding sex workers, are discussed.     

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.     

Human Papillomavirus Vaccine Intention Among College Men: What's Oral Sex Got to Do With It?

Abstract

Objective: To identify associations between engaging in oral sex and perceived risk of oral cancer among college men. Also, to identify associations, and their moderating factors, between oral sex and human papillomavirus (HPV) vaccine acceptance. Methods: Young men were recruited from 2 university campuses in the South (N = 150). Men completed an audio computer-assisted self-administered interview. Results: With the exception of receiving fellatio, each measure of oral sex behavior was significantly associated with greater perceived risk of oral cancer. Four oral sex behaviors evidenced significant associations with vaccine acceptance. Men engaging in recent oral sex or reporting oral sex behaviors with more than 2 partners were more likely to indicate vaccine intent. African American/black race, communication with parents about sex-related topics, and HPV-related stigma/shame were identified as moderating factors. Conclusion: Young college men giving or receiving oral sex with multiple partners may be predisposed to HPV vaccination.     

Infidelity Goes Online: Communicating About Sexual Health in Personal Ads When Seeking Extra-Dyadic Relationships on Craigslist

Abstract

Objectives: The present study explored married and partnered individuals’ ads on Craigslist seeking extra-dyadic sexual relationships. An analysis of the ads containing words related to health and safety was conducted to better understand the ways that individuals communicate about safe sex when seeking extra-dyadic relationships online. Methods: A total of 819 ads containing 6,279 words were analyzed. Thematic analysis revealed that the words used in the ads fell into 8 unique categories, with one category comprising words related to health and safety. Results: The results revealed that men seeking men used more words related to health and safety than men seeking women, women seeking men, and women seeking women, though ads within all 4 groups noted health and safety concerns. For men seeking women, broader issues of safety (often pertaining to meeting up) were also expressed, and for women seeking men, issues of discretion arose. Lastly, women seeking women were the only group to mention polyamorous or nonmonogamous relationships, in addition to expressing concerns about sexual safety. Conclusions: The findings revealed that partnered or married men seeking sexual activity with other men posted the most ads and had the largest percentages for several key words related to safe sex, though such concerns were also prevalent in the ads of men seeking women, women seeking women, and to a limited degree (given the small sub-sample), women seeking men. These results suggest that interventions should aim at encouraging individuals who seek relationships online to not only state safe sex preferences and concerns, but also to continue such conversations and implement safe sex behaviors in offline contexts.     

Stigma Consciousness Concerns Related to Drug Use and Sexuality in a Sample of Street-Based Male Sex Workers

Abstract

Measurement of, and response to, three different stigmas and their exposure (homosexual behavior, sex work, and drug use) were studied a group of 90 key-informant recruited male sex workers in Houston, Texas who were over 18 and had exchanged sex for money in the previous 7 days. Respondents reported on self-identified sexual orientation and were interviewed, including providing responses on a measure of perceived stigma relating to sexual behavior and drug use. Two thirds were white, almost all had used drugs (many in the past week), and half had ever injected. A fifth identified as heterosexual, with the remainder split between gay and bisexually-identified men. There was a high level of homelessness and contact with the criminal justice system for drug and property offences. Consciousness about drug-related stigma was moderately associated with concerns about drug-related exposure and sensitivity to rejection as a drug user, but not to exposure as homosexual or as a sex worker. Drug-using status is related to greater concern about exposure as a sex worker. Data suggest that stigma is domain-specific and that there are different patterns of response to different stigmata in the same individual. Measurement of stigmata and concern about exposure and rejection need to be specific to stigmatized behaviors, and not generalized to other stigmatized behaviors since the data suggest that they are minimally related.     

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.     

The Impact of New Treatments and Other Trends on HIV Prevention for Gay and Bisexual Men in the United States

SUMMARY

This paper details how HIV prevention workers in the United States are being! impacted by advances in HIV/AIDS treatments and a changing HIV prevention paradigm. Approximately sixty participants attending the 1997 National Lesbian and Gay Health Conference and AIDS Fprum in Atlanta, GA, provided observations about how HIV prevention targeting men who have sex with men is changing in the United States. While new treatments may be the most noticeable change impacting HTV prevention, radical change due to the synergistic effects of several factors, not only recent medical advances, is seen as propelling a paradigm shift. Twelve challenges were identified and suggestions for facilitating progress in the changing paradigm enumerated. The future of HIV prevention is discussed.     

An Investigation of the Incidence of Client-Perpetrated Sexual Violence Against Male Sex Workers

ABSTRACT

This article discusses exploratory research investigating the incidence and context of client-perpetrated sexual violence against male sex workers. Four different methods (Web-based surveys, tick-box questionnaires, telephone, and face-to-face interviews) were employed in this study of 50 male escorts. The qualitative data were analyzed using an adapted form of grounded theory. It was found that client-perpetrated sexual violence within male sex work appears to be uncommon. However, when sexual violence did occur the cause was a disagreement over barebacking. Escorts’ explanations for the low level of sexual violence within this sector included (1) that gay men were non-confrontational, (2) their clients led clandestine lifestyles avoiding undue attention, and (3) comparatively, female sex workers were perceived to be more vulnerable resulting in the higher level of sexual violence within the female sex work industry.     

The Connections of Mental Health Problems,Violent Life Experiences,and the Social Milieu of the “Stroll” with the HIV Risk Behaviors of Female Street Sex Workers

Abstract

This paper examines the connections of mental health, victimization, and sexual risk behaviors among a sample of 278 street-based female sex workers in Miami. Using targeted sampling strategies, drug-using sex workers were recruited into an HIV prevention research program. Data were collected by trained interviewers, and focused on drug use and sexual risk for HIV, childhood abuse, recent victimization, and mental health. More than half of the participants reported histories of physical (51.1%) or sexual (53.1%) abuse as children, 37.4% were classified with moderate or severe anxiety symptoms, and 52.9% had symptoms of moderate or severe depression. Logistic regression analyses demonstrated significant associations between mental health issues and engagement in recent unprotected vaginal and oral sex. The program development and policy implications of these findings are discussed.