Bisexual MSM Research Articles

Condomless Vaginal Intercourse and Its Associates among Men Who Have Sex with Men in China.

BackgroundHIV prevalence has increased rapidly among men who have sex with men (MSM) in China reaching alarmingly high levels in some cities. Bisexual MSM have potential to transmit HIV and syphilis to their female partners through condomless vaginal intercourse (CVI). Thus, estimation of the burden of CVI and identification of its associates seemed necessary to control this cross-gender transmission.MethodIn a cross-sectional study, using respondent-driven-sampling and snowball sampling, 2958 MSM were recruited from seven Chinese cities, interviewed and tested for HIV and syphilis. Descriptive analysis of the socio-demographic and behaviors followed by simple and multiple logistic regressions [adjusted for income, city, race and social network size to determine adjusted odds ratio (aOR)] were performed using SAS-9.1.ResultsAmong participating MSM, 19.03% were engaged in CVI. Prevalence of HIV and syphilis among participants involved in CVI were 5.86% and 14.74% respectively. MSM who were older [aOR for aged 40–49 = 2.60 (95% CI: 1.54–4.37)], married [aOR = 6.13 (4.95–7.58)], attended primary school or below [aOR = 3.86 (2.26–6.69)], met male partners at spa/bathhouse/sauna/massage parlor [aOR = 3.52 (2.62–4.72)] and had heterosexual orientation [aOR = 13.81 (7.14–26.70)] were more likely to have CVI. Furthermore, correct knowledge regarding HIV [aOR = 0.70 (0.55, 0.88)] and exposure to HIV prevention interventions [aOR = 0.67 (0.54, 0.82)] were negatively associated with CVI.ConclusionsCVI was found to be common among MSM in China. To minimize the transmission of HIV and syphilis from bisexual MSM to their relatively female partners, targeted interventions should specifically focus on bisexual MSM especially the older and married subgroups.

Beyond Condoms: Risk Reduction Strategies Among Gay, Bisexual, and Other Men Who Have Sex With MenReceiving Rapid HIV Testing in Montreal, Canada.

Gay, bisexual, and other men who have sex with men (MSM) have adapted their sexual practices over the course of the HIV/AIDS epidemic based on available data and knowledge about HIV. This study sought to identify and compare patterns in condom use among gay, bisexual, and other MSM who were tested for HIV at a community-based testing site in Montreal, Canada. Results showed that while study participants use condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also make use of various other strategies such as adjusting to a partner’s presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.

Trauma symptoms, internalized stigma, social support, and sexual risk behavior among HIV-positive gay and bisexual MSM who have sought sex partners online

ABSTRACTGay, bisexual, and other men who have sex with men (MSM) remain the highest risk group for HIV infection. One reason is the increased use of the Internet to meet potential sex partners, which is associated with greater sexual risk behavior. To date, few studies have investigated psychosocial predictors of sexual risk behavior among gay and bisexual men seeking sex partners online. The purpose of the current study was to test a conceptual model of the relationships between trauma symptoms indexed on the event of HIV diagnosis, internalized HIV stigma, and social support on sexual risk behavior among gay and bisexual MSM who seek sex partners online. A sample of 142 gay and bisexual MSM recruited on- and offline completed a comprehensive online assessment battery assessing the factors noted above. A number of associations emerged; most notably internalized HIV stigma mediated the relationship between trauma-related symptoms indexed on the event of HIV diagnosis and sexual risk behavior with HIV-negative and unknown serostatus sex partners. This suggests that gay and bisexual MSM who are in greater distress over their HIV diagnosis and who are more sensitive to HIV stigma engage in more HIV transmission risk behavior. As sexual risk environments expand with the increasing use of the Internet to connect with others for sex, it is important to understand the predictors of sexual risk behavior so that tailored interventions can promote sexual health for gay and bisexual MSM seeking sex online.

Http://www.annexpublishers.com/full-text/JAHI/1301/Living-a-Dual-Life-Multiplicity-of-Sexual-Risks-among-Men-who-have-Sex-with-Men-and-Women-in-Bhutan.php

Among bisexual MSM also called “men-on-the-down-low”, sexuality driven risks stimulate spectrum of vulnerabilities for both genders. Pressure to marry may drive a greater proportion of MSM to have female partners, indicating the potential for bridging HIV transmission. However, these interactions are poorly understood and measurement of potential risk to MSM and their female partners is inconsistent especially in conservative societies like Bhutan, where sex is tabooed and homosexuality is restricted even in programmatic discussions.

Non-disclosure of Sexual Orientation to Parents Associated with Sexual Risk Behaviors Among Gay and Bisexual MSM in China.

The objective of this study was to explore the relationship between non-disclosure of sexual orientation to parents and sexual risk behaviors among gay and bisexual men who have sex with men (MSM) in China. A total of 295 eligible participants (gay n = 179, bisexual n = 116) were recruited from MSM venues and MSM organizations in Anhui Province, China. Overall, 16.6 % of participants chose to disclose their sexual orientation to parents. Fewer bisexual participants chose to disclose their sexual orientation than gay participants (9.5 vs. 21.2 %, p < 0.01). A multivariate logistic regression analysis indicated that non-disclosers were more likely than disclosers to report having one or more female sex partners among gay and bisexual MSM (AOR = 2.91), non-disclosure of sexual orientation to parents was positively associated with the number of female sex partners (AOR = 3.40) and with engagement in unprotected anal intercourse with men (AOR = 2.49) among gay MSM, in the past 6 months. Our findings indicated that HIV/AIDS intervention programs should promote the disclosure of sexual orientation and should design interventions specific to gay and bisexual MSM separately.

“They’re the modern-day gay bar”: Exploring the uses and gratifications of social networks for men who have sex with men

There currently exist many mobile social networks for men who have sex with men (MSM), from stand-alone applications like Grindr and Jack’d, to the on-the-go versions of established websites such as Adam4Adam or Manhunt. It has become increasingly common for MSM to seek out others by means of online social networks, and for a variety of purposes. This paper explores the motivations for MSM-specific social networking use, and the sought gratifications associated with this type of computer-mediated interpersonal interaction. In an online survey yielding 143 participants, men were asked their thoughts about social networking phone applications for gay, bisexual, and other MSM. Using these data, seven categories of sought gratifications were identified: safety, control, easiness, accessibility, mobility, connectivity, and versatility.

HIV in Thai men who have sex with men: a sustained emergency

In The Lancet HIV, Frits van Griensven and colleagues1 report high HIV incidence in men who have sex with men (MSM) in Bangkok, Thailand, in two different cohort settings: an MSM-friendly clinic, at which testing and counselling services and other sexual health services were provided on request and a closed prospective cohort of MSM testing at routine intervals. The HIV incidence of 5·5 per 100 person years in both groups is alarmingly high, but unsurprising because high and sustained transmission is being noted across the region in young homosexual, bisexual, and other MSM.

Sexual Behavior and HIV Testing Practices among Men who have Sex with Men in Portugal

The objective of the study was to explore sexual behavior and HIV-testing practices among men who have sex with men (MSM) in Portugal, in light of current international health guidelines that recommend frequent HIV testing for MSM who engage in high-risk behavior. Participants were 304 mostly young, gay or bisexual self-identified MSM. They provided information regarding their HIV status (67% negative, 7% positive, 26% didn’t know), 24% had never been tested for HIV, and 15.5% had been tested only once; main reasons for never having tested previously were: always using condoms, and not feeling at risk. Thus, HIV testing was infrequent and insufficient for early detection of infection, entry into treatment, and protection of sexual partners, since many unprotected sexual practices still occur. Those who tested more were older, self-identified as gay, living in major urban areas and employed. Linear regression predicted that the number of times MSM had penetrative sex without a condom was associated with the number of times they got tested, indicating that they might be using the test itself as a means to gain control of their unprotected sexual practices. Testing campaigns should aim to help MSM become more aware of their risk behavior, decrease fear of testing by explaining available treatment resources and decreasing the stigma associated with HIV, and by publicizing information about free and confidential testing locations.

Predictors of bisexual behaviour among MSM attending intervention sites may help in prevention interventions for this bridge to the heterosexual epidemic in India: data from HIV sentinel surveillance.

BackgroundIndian cultural tradition demanding marriage, many MSM howsoever they self-identify are likely to be married or have sex with women. To consolidate India's HIV prevention gains, it is important to understand and address the interaction between the MSM and heterosexual epidemics in India and create specific interventions for bisexual MSM. The challenge is to identify and intervene this hard to reach population. Data from HIV Sentinel Surveillance 2011 among MSM in four Indian states were analyzed to assess predictors and prevalence of bisexual behaviour in MSM.MethodsBetween March-May 2011, 4682 men (15–49 years) who had anal/oral sex with a male partner in the past month, attending intervention sites and consenting for an un-linked anonymous survey answered an 11- item questionnaire and provided blood for HIV test by finger stick at 19 designated surveillance sites.ResultsOf 4682 MSM tested overall, 5% were illiterate, 51% reported only receptive anal intercourse, 21% only penetrative and 28% both. 36% MSM had ever received money for sex. Overall 6.8% were HIV infected. 44% MSM were bisexual in the last six months. On multivariate analysis, ‘being bisexual’ was found to be independently associated with ‘older age’: 26–30 years [AOR = 3.1, 95% CI(2.7, 3.7)], >30 years [AOR = 6.5, 95% CI(5.5, 7.7)]; ‘reporting penetrative behaviour alone’ with other men [AOR = 5.8, 95% CI(4.8, 7.0), p<0.01] and ‘reporting both penetrative and receptive behaviour’ [AOR = 2.7, 95% CI(2.3, 3.1) p<0.01]. Those who both paid and received money for sex [AOR = 0.49, 95% CI (0.38, 0.62)] were significantly less likely to be bisexual.ConclusionsA substantial proportion of men receiving services from Targeted Intervention programs are bisexual and the easy opportunity for intervention in this setting should be capitalised upon. Focusing on older MSM, as well as MSM who show penetrative behaviour with other men, could help in reaching this population.

A Longitudinal Investigation of Syndemic Conditions Among Young Gay, Bisexual, and Other MSM: The P18 Cohort Study.

The persistence of disparities in STI/HIV risk among a new generation of emerging adult gay, bisexual, and other men who have sex with men (YMSM) warrant holistic frameworks and new methodologies for investigating the behaviors related to STI/HIV in this group. In order to better understand the continued existence of these disparities in STI/HIV risk among YMSM, the present study evaluated the presence and persistence of syndemic conditions among YMSM by examining the co-occurrence of alcohol and drug use, unprotected sexual behavior, and mental health burden over time. Four waves of data, collected over the first 18 months of a 7 wave, 36-month prospective cohort study of YMSM (n=600) were used to examine the extent to which measurement models of drug use, unprotected sexual behavior, and mental health burden remained consistent across time using latent class modeling. Health challenges persisted across time as these YMSM emerged into young adulthood and the measurement models for the latent constructs of drug use and unprotected sexual behavior were essentially consistent across time whereas models for mental health burden varied over time. In addition to confirming the the robustness of our measurement models which capture a more holistic understandings of the health conditions of drug use, unprotected sex, and mental health burden, these findings underscore the ongoing health challenges YMSM face as they mature into young adulthood. These ongoing health challenges, which have been understood as forming a syndemic, persist over time, and add further evidence to support ongoing and vigilant comprehensive health programming for sexual minority men that move beyond a sole focus on HIV.

Novel approaches to HIV prevention and sexual health promotion among Guatemalan gay and bisexual men, MSM, and transgender persons.

The burden of HIV is disproportionate for Guatemalan sexual minorities (e.g., gay and bisexual men, men who have sex with men [MSM], and transgender persons). Our bi-national partnership used authentic approaches to community-based participatory research (CBPR) to identify characteristics of potentially successful programs to prevent HIV and promote sexual health among Guatemalan sexual minorities. Our partnership conducted Spanish-language focus groups with 87 participants who self-identified as male (n=64) or transgender (n=23) and individual in-depth interviews with ten formal and informal gay community leaders. Using constant comparison, an approach to grounded theory, we identified 20 characteristics of potentially successful programs to reduce HIV risk, including providing guidance on accessing limited resources; offering supportive dialogue around issues of masculinity, socio-cultural expectations, love, and intimacy; using Mayan values and images; harnessing technology; increasing leadership and advocacy skills; and mobilizing social networks. More research is clearly needed, but participants reported needing and wanting programming and had innovative ideas to prevent HIV exposure and transmission.

The ecology of sexual health of sexual minorities in Guatemala City.

Guatemalan gay and bisexual men, men who have sex with men (MSM), and transgender persons carry disproportionate burden of HIV and other sexually transmitted infections compared with other Guatemalan subgroups. However, little is known about the determinants of sexual health to inform health promotion and disease prevention interventions among these sexual minorities. We sought to explore sexual health and HIV risk among Guatemalan sexual minorities, using a community-based participatory research approach. We conducted 8 focus groups (n = 87 participants total) and 10 individual in-depth interviews with gay and bisexual men, MSM, and transgender persons. Using constant comparison, an approach to grounded theory, we analyzed verbatim transcripts and identified 24 themes that we organized into five ecological factors influencing sexual health: intrapersonal (e.g. misconceptions about HIV transmission, low perceived susceptibility and lack of condoms use skills); interpersonal (e.g. family rejection and condom use as a barrier to intimacy); community (e.g. discrimination and stigma); institutional (e.g. limited access to health promotion resources); and public policy (e.g. perceived lack of provider confidentiality and anti-gay rhetoric). There is profound need for multiple-level interventions to ensure that Guatemalan sexual minorities have the knowledge and skills needed to reduce sexual risk. Interventions are warranted to increase social support among sexual minorities, reduce negative perspectives about sexual minorities, develop institutional resources to meet the needs of sexual minorities and reduce harmful anti-gay rhetoric. Understanding and intervening on the identified factors is especially important given that the health of Guatemalan sexual minorities has been to-date neglected.

Strategies to manage the HIV epidemic in gay, bisexual, and other men who have sex with men

HIV epidemic spread continues among gay, bisexual, and other MSM globally in 2013. These epidemics are occurring in rapidly shifting contexts among these men, which have important impacts on HIV spread, HIV programs, access to services and human rights. Current HIV prevention strategies are inadequate and are taken to insufficient scale to control HIV spread. We reviewed recent reports on epidemiology, HIV prevention advances, human rights, and epidemic disease control among MSM to understand why HIV epidemics among these men remain poorly controlled. Network level factors appear to be critically important for HIV epidemic spread among MSM. The only new prevention technology with evidence for efficacy in this population, daily oral chemoprophylaxis (PrEP), has been little used, particularly in low and middle-income countries. Much more vigorous prevention efforts are required, including the adaptation and expanded use of PrEP, if we are to reduce new infections among gay, bisexual and other MSM.

Are Wives of Gay Men Becoming the Next Target of HIV Infection in China?

To the Editor Homosexual exposure has become the primary route of HIV transmission in China.1–4 National HIV prevalence among men who have sex with men (MSM) was 6.3% in 2011,5 a 4.5-fold increase from 1.4% in 2001.6 Most (87.0%) infected cases remained undiagnosed.7 Marriage is a social, cultural, and familial obligation in China.8 Among the 3.1 to 6.3 million Chinese MSM,9 17% is currently married to a female, leading to a tongqi (“wives of MSM” in Chinese) population of 0.5 to 1.1 million.10 The actual population size would be much larger (2.5–5.0 million) because more than 80% Chinese MSM would eventually enter a heterosexual marriage during their lifetime.11 Tongqi is highly vulnerable to HIV infection owing to their unprotected sexual contacts with their highly at-risk husbands.10,12 Unprotected sex is naturally a mean for reproduction but also an important indication of husbands’ fidelity to their wives.13 Chinese women are not empowered to negotiate safe sex.14 Most husbands (88.8%) are not willing to disclose their homosexual identity to their wives.15 Even in cases of disclosure, most tongqi are reluctant to divorce because of their marriage commitment, financial dependence on husbands, fears of losing child custody, and perceived psychological adversities that a divorce might bring to their children.16 Shame, harassment, and isolation are common experiences among tongqi who choose to divorce.17 “Tongqi Family,” the first grassroots organization for tongqi was established in 2009. The organization provides psychological counseling, consolation, and legal advices for divorce to tongqi. Two years later, another grassroots organization “Guangzhou Gay Relatives Club” organized an event named “Voices from Tongqi” on the eve of 2011 World AIDS Day, which actively advocated for the rights of tongqi and communicated the issues and dilemma tongqi are facing.18 Although remained small and officially unregistered, these organizations represent an emerging platform for accessing this vulnerable population. “Know your epidemic, know your response” is of paramount importance in developing timely and appropriate HIV policies and prevention strategies.19 Paradoxically, by no means the Chinese health stakeholders can know the epidemic in tongqi, if this population are not even identifiable by themselves. The problem boils down to the willingness of disclosure of tongqi’s gay husbands, which is substantially hindered by stigma, rejection, estrangement, and lack of family support they experience. Unless stigma against homosexuality and traditional familial expectation of marriage change, tongqi will continue to be an invisible population that bears the consequences of high-risk behaviors of others. The 100% condom programs among bisexual MSM may have the most direct impacts on reducing HIV transmission through bisexual exposure. Interventions such as providing premarital counseling for MSM, promoting regular HIV testing targeted bisexual and married MSM, advocating safe sex in extramarital sex, stigma removal, and facilitating disclosure should be included in the existing programs for MSM.20 Incorporating the emerging tongqi organizations into the HIV sentinel surveillance system may provide access to epidemiological insights that inform responses to the epidemic. Strong governmental support is necessary to strengthen tongqi organizations to facilitate potential HIV interventions. Eric P.F. Chow, MPH The Kirby Institute University of New South Wales Sydney, NSW, Australia Melbourne Sexual Health Centre Alfred Hospital Melbourne, VIC, Australia Central Clinical School Faculty of Medicine Nursing and Health Sciences Monash University Melbourne, VIC, Australia Fung Kuen Koo, PhD Sydney Nursing School University of Sydney Sydney, NSW, Australia Lei Zhang, PhD The Kirby Institute University of New South Wales Sydney, NSW, Australia [email protected]

“Down-Low”: Overlapping Sexual Risks of Bisexual MSM Influencing Women’s Vulnerability to STI/HIV in Nepal

Among men “on the down-low,” bisexuality driven risks engender a spectrum of STI/HIV vulnerabilities for both genders. Yet, prevention programs principally focus on male-to-male risk disregarding women sufferers. We attempt to map these overlaps influencing women’s vulnerability to STI/HIV. Findings are based on primary data collected from 2182 men who have sex with men (MSM) following modified time-location cluster sampling in Nepal, 2010–2011. Bisexuality is pronounced as one-third of MSM below age 20 reported 4 or more female partners in the last 6 months. However, the adjusted effect of intensified MSM activity, especially with a commercial partner, enhances the overlapping sex (OR 5.2, p < 0.01). The frequency of protected sex with a female was reported to be very low. Further, over two-thirds of MSM who did not use a condom in the last sex with a noncommercial partner also reported the last sex with a female as unprotected. MSM targeted interventions should envisage beyond homosexuality, address bisexuality as a threat clouding prevention efforts, and prioritize and sensitize women partners of MSM about bisexuality and HIV vulnerabilities and risk.

A holistic approach to addressing HIV infection disparities in gay, bisexual, and other men who have sex with men.

Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected by HIV and AIDS since the beginning of the epidemic in the United States and in many other parts of the world. The HIV epidemic is inextricably tied to other health problems that disproportionately affect gay, bisexual, and other MSM including psychological comorbidities, substance use, sexual victimization, stigmatization, and multiple forms of discrimination. These interrelated health problems and social issues can be characterized as a syndemic of mutually reinforcing conditions or epidemics. Moreover, the syndemic is directed by biological, behavioral, psychosocial, and structural determinants. Addressing HIV within the context of a larger syndemic will require a more holistic approach to HIV prevention and treatment that recognizes the interplay between biological, behavioral, psychosocial, and structural factors that affect the health and well-being of sexual minority men.

Religiousness, Spirituality, and Existential Well-being Among HIV-Positive Gay, Bisexual, and Other MSM Age 50 and Over

The religious and spiritual experiences of HIV-positive gay, bisexual, and other men who have sex with men (MSM) are severely understudied, especially among those over 50. However, literature supports that religious/spiritual experiences are related to both physical and mental health among older adults. In this exploratory analysis we assessed the relations that exist among a sample of HIV-positive gay, bisexual, and other MSM over 50 in regard to sociodemographic factors and two established measures of religiosity/spirituality. Differences emerged in relation to both race/ethnicity and age for the Ironson-Woods Spirituality/Religiousness (SR) Index, while, for the Existential Well-being subscale, differences emerged in relation to race/ethnicity and perceived socioeconomic status.

How Willing are Men Who Have Sex with Men in China to Be Circumcised for the Sake of Protecting His Female Sex Partner?

The HIV prevalence among men who have sex with men (MSM) is increasing sharply in China. Many MSM have female sexual partners, representing a bridge of transmitting HIV to the general population. Circumcision reduces the risk of HIV prevention via heterosexual intercourse. The study investigated the prevalence and factors related to willingness to undergo circumcision when MSM were informed that circumcision could reduce risk of heterosexual HIV transmission. An anonymous cross-sectional survey was conducted in Jiangsu, China. A total of 157 MSM with bisexual behaviors in the last six months were recruited using snowball sampling. Self-reported circumcision status and foreskin conditions were recorded. HIV-related knowledge, risk perceptions, risky sexual behaviors, cognitive and behavioral intention factors regarding circumcision were assessed. Among all respondents, 5.7% were circumcised. In the uncircumcised subsample, the willingness to be circumcised increased from 8.1% to 35.1% after they were informed about the 50% risk reduction effect of circumcision regarding heterosexual HIV transmission. Risk behaviors, uncertainty about the prevalence of HIV among MSM, perception of overly long foreskin, peer's suggestion, disagreement with the statements "MSM in general are not willing to be circumcised" and "circumcisions are for children, not for adults" and self-efficacy for circumcision were significantly associated with willingness for circumcision given the hypothetical risk reduction effect (OR = 2.37 and 3.11, respectively, P < 0.05). Perception of overly long foreskin, self-efficacy, and having used a condom in the last episode of sex with a woman remained significantly associated with the conditional willingness for circumcision in the multivariate analysis (OR = 3.03, 2.84 and 2.42, respectively, P < 0.05). Interventions promoting circumcision among bisexual MSM, based on the risk reduction effect on heterosexual HIV transmission, are likely to be successful. Such programs should focus on increasing self-efficacy and may consider utilizing a peer educator approach.

Reaching black men who have sex with men: a comparison between respondent-driven sampling and time-location sampling

ObjectivesThe authors explored whether respondent-driven sampling (RDS) can generate a more diverse sample of black men who have sex with men (MSM) than time-location sampling (TLS) by comparing sample characteristics...

Nondisclosure Prosecutions and HIV Prevention: Results From an Ottawa-Based Gay Men's Sex Survey

Patrick O’Byrne, RN, PhD, is an Associate Professor, University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada. Alyssa Bryan, RN, MScN (student), is a Research Assistant, University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada. Cory Woodyatt, BA, BScN (student), is a Research Assistant, University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada. In 1998, the Supreme Court of Canada ruled that people living with HIV had a legal obligation to disclose their serostatus prior to the onset of activities that posed a ‘‘significant risk’’ for HIV transmission. As part of this ruling, the Supreme Court (1998) indicated that nondisclosure prosecutions would not undermine HIV-prevention efforts. This ruling, however, was made without any research on the effect of the law on HIV prevention. Accordingly, because the number of nondisclosure prosecutions is increasing in Canada (Mykhalovskiy, 2011), self-identifying gay, bisexual, and other men who have sex with men (MSM) in Ottawa were given self-administered surveys about their sexual practices and sexually transmitted infection (STI) and HIV testing practices. In total, 441 surveys were collected to help better tailor sexual health services for gay, bisexual, and other MSM in this region. In this paper, we present results detailing the relationships between perceptions about nondisclosure prosecutions and STI/HIV testing practices. We also provide comparisons of the self-reported sexual practices of the survey respondents. While this paper presents and discusses data that are Canada-specific, nondisclosure prosecutions are common in the United States as well (American Civil Liberties Union, 2008).