Condomless Insertive Anal Intercourse Research Articles

Association between saliva use for masturbation and urethral gonorrhoea in men who have sex with men: A cross-sectional study

ObjectivesThe saliva of individuals with oropharyngeal gonorrhoea can contain viable Neisseria gonorrhoeae. This study examined if using saliva as a lubricant for masturbation is a risk factor for urethral gonorrhoea among men who have sex with men (MSM). MethodsIn this cross-sectional study, MSM aged ≥18 years attending the Melbourne Sexual Health Centre between February 2021 and December 2023 were surveyed. Data were collected on sexual activities in the past 7 days, including receiving fellatio, condomless insertive anal sex, docking, and using saliva for masturbation. Multivariable logistic regression examined associations between these exposures and urethral gonorrhoea. ResultsThe median age of the 3114 men was 32 (IQR: 27-40), with 4.7% (n = 145) testing positive for urethral gonorrhoea. Urethral gonorrhoea was independently associated with an increasing number of partners for condomless insertive anal sex (P < 0.001). It was not significantly associated with receiving fellatio (P = 0.613), docking (P = 0.207), or using saliva for masturbation (P = 0.117). However, of the 110 men who only used saliva for masturbation, two (1.8%) had urethral gonorrhoea, and one (0.9%) had both urethral and oropharyngeal gonorrhoea. ConclusionCondomless insertive anal sex is the leading risk factor for urethral gonorrhoea and not using saliva as a lubricant for masturbation.

Incidence and prevalence of hepatitis C and B infections among men who have sex with men and transgender women enrolled in a United States HIV vaccine trial.

Rising hepatitis C and B virus (HCV and HBV) rates have been reported in men who have sex with men (MSM) and transgender women (TGW). This study characterizes HCV and HBV infections longitudinally among 2,496 MSM/TGW aged 18-50 years and at risk for HIV acquisition enrolled in an HIV-1 vaccine trial in 18 U.S. cities between 2009-2013. Participants completed behavioral surveys, HIV testing, and blood collection over 24 months. Of the 2,397 participants who consented for future testing, 1,792 (74.8%) had available paired stored blood samples at baseline and a later timepoint (Month 24 [N = 999]; if unavailable, M12 [N = 775] or M15 [N = 18]). Among 1,792 participants, 98.1% were MSM, 0.8% were TGW, and the median age was 30 years (IQR 24, 40). Participants reported a median number of 3 male sex partners (IQR 1,5) within the past 3 months. Condomless insertive anal sex was reported by 55.8% and condomless receptive anal sex by 46.7%.1.3% reported injection drug use. During follow-up, 1.4% reported pre-exposure prophylaxis (PrEP) use. At baseline 11/1792 (0.61%) participants had HCV infection (HCV AB positive, RNA detectable), with all having persistent detectable RNA and chronic HCV infection at follow-up. Phylogenetic analysis showed no clusters of HCV infection. 8 participants had HCV AB positive, RNA undetectable at baseline and follow-up, representing past HCV infection with clearance; only 2 acquired HCV, which cleared over 12-24 months. At baseline, 2 participants (2/1792 = 0.11%) had positive HBsAg, indicating chronic HBV infection. Over 12-24 months, 4 (4/1790, 0.22%) developed HBsAg positivity; these participants had HBcAB positivity at baseline, thereby likely representing reactivation. There were no new HBV infections during follow-up. Among 1,792 men who have sex with men and transgender women aged 18-50 years and at risk for HIV acquisition enrolled in a U.S. HIV-1 vaccine trial, incident hepatitis C infection rates were extremely low, with no cases of incident hepatitis B infection. These rates of incident HCV infection and HBSAg positivity are lower than previously reported among MSM/TGW.

Frequent chlamydia and gonorrhoea but very infrequent syphilis among men who have sex with men using HIV pre-exposure prophylaxis in West Africa

ObjectivesAlthough oral pre-exposure prophylaxis (PrEP) for HIV is being rolled out in West Africa, data on sexually transmitted infections (STIs) in PrEP users are scarce. We assessed the prevalence, incidence...

The Relationship Between Insertive Oral and Anal Sex and Select Measures of the Composition of the Urethral Microbiota Among Men Who Have Sex With Men.

Sexual behavior may influence the composition of the male urethral microbiota, but this hypothesis has not been tested in longitudinal studies of men who have sex with men (MSM). From December 2014 to July 2018, we enrolled MSM with nongonococcal urethritis (NGU) attending a sexual health clinic. Men attended 5 in-clinic visits at 3-week intervals, collected weekly urine specimens at home, and reported daily antibiotics and sexual activity on weekly diaries. We applied broad-range 16S rRNA gene sequencing to urine. We used generalized estimating equations to estimate the association between urethral sexual exposures in the prior 7 days (insertive oral sex [IOS] only, condomless insertive anal intercourse [CIAI] only, IOS with CIAI [IOS + CIAI], or none) and Shannon index, number of species (observed, oral indicator, and rectal indicator), and specific taxa, adjusting for recent antibiotics, age, race/ethnicity, HIV, and preexposure prophylaxis. Ninety-six of 108 MSM with NGU attended ≥1 follow-up visit. They contributed 1140 person-weeks of behavioral data and 1006 urine specimens. Compared with those with no urethral sexual exposures, those with IOS only had higher Shannon index ( P = 0.03 ) but similar number of species and presence of specific taxa considered, adjusting for confounders; the exception was an association with Haemophilus parainfluenzae . CIAI only was not associated with measured aspects of the urethral microbiota. IOS + CIAI was only associated with presence of H. parainfluenzae and Haemophilus . Among MSM after NGU, IOS and CIAI did not seem to have a substantial influence on measured aspects of the composition of the urethral microbiota.

Racial/Ethnic Disparities in Club Drug Use, Situational Club Drug Use during Sex, and Sexual Risk Behaviors among Alcohol-Using Men Who Have Sex with Men (MSM) in San Francisco

Background Club drug use—including 3,4-Methylenedioxymethamphetamine, ketamine, crack/cocaine, hallucinogens, gamma hydroxybutyrate, volatile nitrites, and methamphetamine—has been linked to sexual risk behaviors among MSM. Few studies examine how the use of club drugs and the association between club drug use during sex and sexual risk may differ by race/ethnicity. Methods Using data from a cross-sectional study among alcohol-using MSM in San Francisco (n = 252), we examined the associations between the interaction of race/ethnicity and club drug use during sex, and the following behavioral outcomes: any condomless anal intercourse (CAI), insertive CAI, receptive CAI, and any serodiscordant sex in the past six months. All models controlled for income, HIV status, relationship status, age, and current use of a biomedical HIV prevention tool (i.e., Pre-Exposure Prophylaxis [PrEP] or antiretroviral therapy). Results There were significant racial differences in club drug use (p < 0.001) and club drug use during sex (p = 0.01). Asian/Pacific Islander (API) and Latino participants reported using club drugs the most at 78.8% and 79%, respectively. Among users of club drugs, club drug use during sex was most common among Black (100%), and Latino MSM (93%). Significant interactions between race/ethnicity and club drug use during sex were observed for CAI (p = 0.02), insertive CAI (p = 0.01), and receptive CAI (p = 0.01). API participants who used club drug during sex had higher odds of reporting CAI (aOR = 15.27, CI = 1.50–155.34), insertive CAI (aOR = 21.11, CI = 2.04–218.10), and receptive CAI (aOR = 21.11, CI = 2.04–218.10). Conclusions Given the differing rates of club drug use during sex by race/ethnicity and the role race/ethnicity plays in modifying the relationships between club drug use during sex and sexual risk behaviors, culturally-tailored interventions may be needed to address the needs of ethnically-diverse, club drug-using MSM.

A Case of Acute HIV-1 and Monkeypox Coinfection After Condomless Insertive Anal Sex in the Previous 69 Days - Beijing Municipality, China, August-October, 2023.

The prevalence of monkeypox (mpox) infections is primarily observed among young men who engage in sexual activities with other men, and there is a possibility of sexual transmission. Co-occurring sexually transmitted infections have also been documented. In this report, we present a case of a patient in China who was simultaneously diagnosed with mpox, and acute human immunodeficiency virus (HIV) infection. The patient exhibited symptoms of fever and widespread papules on the trunk, face, and genital area. It is crucial for health agencies to prioritize HIV testing when mpox is suspected or diagnosed in individuals with recent engagement in high-risk sexual behavior.

Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial.

Substance use, particularly binge drinking of alcohol and noninjection substance use, is associated with increased risk for HIV infection among youth, but structured substance use screening and brief intervention are not often provided as part of HIV risk reduction. The purpose of the study was to test the efficacy of a fully automated electronic screening and brief intervention, called Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults presenting for HIV testing. Secondary objectives were reduction in sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention. Youth aged 16 years to 25 years who presented for HIV testing at community-based locations were recruited for study participation. Those who screened at moderate to high risk on the Alcohol Use Disorders Identification Test were randomized (1:1) to either an electronic brief intervention or a time-attention control. The primary outcome was change in alcohol use at 1, 3, 6, and 12-month follow-ups. Negative binomial and log binomial regression analyses with generalized estimating equations were conducted to evaluate the intervention efficacy. Among a sample of 329 youth, there were no significant differences in alcohol use outcomes between conditions over time or at the 1, 3, 6, or 12-month time points. In terms of secondary outcomes, there was evidence of reduction in condomless insertive anal sex under the influence of alcohol and drugs at 12 months compared with 3 months in the intervention versus the attention control condition (incidence rate ratio=0.15, 95% CI 0.05-0.44); however, there were no other significant differences in sexual risk and no difference in PrEP engagement. We found no effect of electronic brief intervention to reduce alcohol use and some effect on sexual risk among youth aged 16 years to 25 years who present for HIV testing. ClinicalTrials.gov number NCT02703116; https://clinicaltrials.gov/ct2/show/NCT02703116. RR2-10.1186/s12889-020-8154-6.

Correlates of HIV Infection among Men who have Sex with Men in Mvita Sub-County, Mombasa County, Kenya

Purpose: The broad objective of the study was to determine the correlates of HIV infection among men who have sex with men in Mvita sub-county, Mombasa County, by December 2020.&#x0D; Methodology: Descriptive cross-sectional study design using quantitative methods was used to collect data from a study population which included 121 HIV positive and 119 HIV negative MSM. The respondent-driven sampling (RDS) was used to obtain the sample of respondents while chi-square and multivariable logistic regression were used to identify the variables which were associated with HIV infection. Data generated from the questionnaires was collected, cleaned, coded and analyzed using STATA software Version 17. Level of significance was fixed at p=0.05, with a 95% confidence interval.&#x0D; Findings: Majority of the MSM (51%) were between 19-29 years, were single (71%), were christian (60%) had attained primary education (45%), were working (63%), 55% had an income of less than Ksh. 5000 but only 38% were married to a female. Majority (91%) of HIV negative MSM accessed PEP/PrEP and only 70% used PEP/PrEP for HIV prevention. However, majority (60%) of HIV positive MSM had anal sex with multiple casual male partners, 49% sometimes had condomless insertive anal sex while 49% had condomless receptive anal sex. HIV positive MSM also had anal sex more than once while high on alcohol (41%), always used drugs before engaging in anal sex (33%) and were non-adherent to ARVs, PrEP/PEP due to lack of transport (66%), alcohol use (24%), and drug use (15%), among other factors.&#x0D; Unique Contribution to Theory, Practice and Policy: From the study findings, the Government/NGO must address the MSM issues for instance, by increasing the number of HIV programmes targeting MSM, adequately funding them and actively engaging the MSM in running the them. Also, by sensitizing the communities, human right groups, religious leaders, politicians and other stake holders on matters pertaining MSM and lobbying for the review of the laws that criminalizes same sex relationship.

Adult Attachment Anxiety Is Protective Against the Effects of Internalized Homophobia on Condomless Sex Among Young Sexual Minority Men: The P18 Cohort Study

ABSTRACT Internalized homophobia, or the internalization of negative attitudes toward one’s sexual minority identity, is associated with sexual risk behaviors among young sexual minority men (YSMM). However, the formation and maintenance of secure or insecure socio-emotional bonds with friends, family members, and intimate partners (i.e., adult attachment) may mitigate or exacerbate the negative effects of exposure to internalized homophobia. Nevertheless, little is known about how adult attachment influences the association between internalized homophobia and sexual risk behaviors (e.g., condomless anal sex) among YSMM. Thus, this study examined the potential moderating effect of adult attachment on the association between internalized homophobia and condomless anal sex (CAS) behaviors (i.e., insertive CAS and receptive CAS) among a sample of N = 268 YSMM who participated in the study between June 2015-March 2017 using zero-inflated Poisson regression models. We found that adult attachment anxiety, but not adult attachment avoidance, significantly moderated the association between internalized homophobia and receptive CAS behaviors such that those higher on adult attachment anxiety and internalized homophobia had fewer receptive CAS events over the preceding 30 days as compared to those lower on adult attachment anxiety and internalized homophobia. Research efforts should focus on unpacking the complex associations between adult attachment, internalized homophobia, and sexual risk behaviors among YSMM.

Inadequate performance of a risk score to predict asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infection among cisgender men who have sex with men

ObjectivesEpidemiological treatment of persons who are sexual contacts to partners with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) often results in treatment of uninfected persons, which may increase the risk...

Getting Clear About Rectal Douching Among Men Who Have Sex With Men.

Receptive anal sex is the primary means through which HIV is transmitted among men who have sex with men (MSM). Recently, researchers have begun investigating the role that rectal douching may play in amplifying risk for transmission. Yet, there is limited research on the frequency with which MSM douche, the products they use, and how this may vary across sociodemographic characteristics. A U.S. national sample of 4745 MSM completed an online survey that assessed their douching behavior, demographic characteristics, sexual behavior, and their anal sexual positioning (i.e., top, bottom, versatile). Nearly two-thirds (65.8%) had engaged in rectal douching in the last three months. Among those who douched, water was commonly reported (84.2%) and 20.1% reported using commercial enemas (e.g., Fleet), as well as water and soap (15.0%)-numbers exceed 100% as some participants reported more than one. Men who douched reported significantly more receptive and insertive condomless anal sex acts in the prior 3months. One-in-ten men reported rectal bleeding after douching. Compared to HIV-negative participants who had not taken PrEP, participants had higher odds of reporting douching in the past 3months if they were HIV-negative and currently on PrEP (AOR = 1.82), HIV-negative and previously used PrEP (AOR = 1.58), and HIV-positive (AOR = 1.83). Douching was common in this sample. Given that douching could amplify risk for HIV transmission, healthcare providers should discuss douching safety with their patients, with a focus on harm reduction (e.g., reduce risk of bleeding, as opposed to abstinence from douching).

Exploring HIV risk behavior and sexual/gender identities among transgender women and their sexual partners in Peru using respondent-driven sampling

ABSTRACT HIV prevalence is high among transgender women, but little is known about cisgender men who have sex with transgender women (MSTW). The objective of this study was to investigate characteristics and behavior of MSTW compared to transgender women and men who have sex with men (MSM) using a modified respondent-driven sampling design. Seed participants completed a survey and invited up to three sex partners. Forward recruitment continued in waves through the referral of sex partners. Cross-sectional data were assessed using mixed effects models. From February to July 2018, 479 participants in Lima, Peru enrolled (n = 199 transgender women, n = 196 MSTW, and n = 45 MSM). MSTW behavior and identity differed significantly from that of transgender women and MSM. MSTW primarily identified as bisexual (69%) or heterosexual (15%) and only 6% reported male partners. Insertive condomless anal intercourse was reported by 61% of MSTW; 46% did not know their HIV serostatus. Compared to MSTW without male partners, those with recent male partners were more likely to sell sex (OR 15.7, 95% CI 4.1–60.5), and report condomless receptive anal intercourse (OR 89.0, 95% CI 19.1–414.8). This evidence suggests that MSTW are a distinct population from MSM, and highlights the critical need to include MSTW in HIV research and interventions.

Alcohol and Condomless Insertive Anal Intercourse Among Black/Latino Sexual-Minority Male Non-PrEP Users

ObjectiveThis study examined factors associated with alcohol use and condomlessinsertive anal sex among a sample of BLMSM (N = 188), self-identified as HIV- negative, ages 18–40. The influence of alcohol use on sexual positioning during condomless anal intercourse among Black and Latino men who have sex with men (BLMSM) warrants research attention because of the pervasive misinformation regarding the risk of HIV transmission and the disproportionate impact of the HIV epidemic for this population.MethodsSelf-report survey questionnaires were administered in real time at bars/clubs; public organized events; local colleges/universities; social media advertisements; private men's groups; and organized events in Los Angeles County.ResultsLogistic regression predicted those reporting risky sex when using alcohol were seven times more likely to report condomless insertive anal sex.ConclusionClear messaging about alcohol moderation, dispelling the myths about strategic positioning, and pre-exposure prophylaxis (PrEP) use among HIV negative BLMSM could potentially reduce HIV acquisition/transmission.

Top, Versatile, and Bottom Identities and Sexual Behaviors in Self-Identified Bisexual MSM

There is a lack of research concerning self-identified bisexual men who have sex with men (BMSM), specifically regarding their self-identification as top, versatile, or bottom and their sexual behaviors. As a result, this study seeks to examine the use of top, versatile, and bottom identity labels among a group of self-identified BMSM and to describe their sexual behaviors, examining any possible associations between sexual positions and condomless anal sex. This study recruited 278 BMSM, who ranged in age from 21 to 69 years old (Mage=44.92, SDage=10.74). This study recruited participants via websites, e-mail, and social media. All participants self-identified as bisexual men who have sex with other men. The majority of sample participants were married to a woman (32.7%) or single (30.7%), held a university degree, and lived in urban areas. Participants indicated relatively high bisexual identity acceptance levels (8.03 on a scale from 1 to 10). The survey included three categories of questions, encompassing sociodemographic information, sex role self-identifications, and (un)protected anal sex behaviors. Regarding typical anal sex behaviors, 41.4% of BMSM self-identified as bottoms, 30.3% as tops, and 28.3% as versatiles. The study found significant differences among BMSM for all types of anal sex practices based on sex role identities. Versatile men more frequently reported condomless receptive anal sex, whereas tops were the most likely to report partaking in condomless insertive anal sex. Finally, self-identified bottom BMSM perceived themselves as having shorter penises and being younger in age than BMSM self-identifying as tops, versatiles, or as older in age. This study shows that sexual position self-labeling among BMSM is complex, as well as the need for further research.

Retention of men who have sex with men in a pre-exposure prophylaxis programme: survival analysis from a crossover study

BackgroundAdherence to monitoring and prescription of pre-exposure prophylaxis (PrEP) is important in effectively preventing HIV infection. We aimed to establish the retention rate of men who have sex with men (MSM) who enrolled in a PrEP implementation study in Hong Kong, China. MethodsOur study was a survival analysis of a crossover study. A research clinic was set up in the teaching hospital of the university to recruit participants through community-based organisations or by self-referral. Participants were randomly assigned by block randomisation with a block size of four to two groups during the study period (32 weeks split into two 16-week phases); in the first group, participants were asked to take PrEP every day for the first 16 weeks then on demand for the remaining 16 weeks, and in the second group, participants took PrEP on demand for the first 16 weeks then ever day for the remaining 16 weeks. Eligible participants were adult HIV-negative MSM with a history of high HIV-risk behaviours or sexually transmitted infections in the preceding 6 months and an inclination to practice condomless sex in the coming 6 months. The exclusion criteria were hepatitis B virus infection, creatinine clearance lower than 60 mL per min, with or without mental illnesses. We assessed behavioural factors associated with retention by bivariate analysis. We used cox regression to characterise participants who had dropped out of the study. The study was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC 2016.719). The trial is registered with the Centre for Clinical Research and Biostatistics, The Chinese University of Hong Kong, Hong Kong, China (trial number CUHK_CCRB00606). FindingsBetween Aug 25, 2018, and Mar 23, 2019, we recruited 120 MSM. Of the 120 MSM recruited, one (<1%) tested positive for HIV at baseline and was therefore excluded and referred to HIV services. Of the remaining 119 participants, with a median age of 30 years (interquartile range 26–38 years), 59 (50%) were assigned to the daily-PrEP-first group and 60 (50%) were assigned to the on-demand-PrEP-first group. Some 103 (87%) MSM attended all scheduled visits. Study group was not associated with retention status (p=0·97) with 51 (86%) of 59 MSM completing 32 weeks follow-up in the daily-PrEP-first group and 52 (87%) of 60 MSM completing follow-up in the on-demand-PrEP-first group. Participants who discussed PrEP use with their boyfriends were more likely to drop out (p=0·030). After excluding one participant who defaulted after the first visit, results from cox regression showed that MSM who were on PrEP before joining this study had a dropout hazard of 0·256 and those who had HIV-positive sex partners had a dropout hazard of 9·513. The hazard increased by 10% for each year of age. Discordant results were found in the effect of sexual role. On a scale of 1 to 10 ranking inclination to have insertive condomless anal sex, the hazard decreased by 20% for each increasing point, whereas receptive roles increased by 30%. InterpretationThe retention was high in a trial setting. Defaulters who had receptive anal sex or HIV-positive sex partners might have continued HIV risk, therefore other prevention measures should be made available if PrEP was not sought elsewhere. The role of intimate or sex partners in retention in PrEP programmes should be explored. FundingAIDS Trust Fund (MSS 292 R).

Latent classes of partner-seeking venues and sexual risk among men who have sex with men in Paris, France.

In France, men who have sex with men (MSM) experience the highest HIV incidence. MSM who use multiple venues such as bars and smartphone apps to find sexual partners have greater HIV and sexually transmitted infection risk than those who use a single physical or online venue. To explore the role of venues and sexual behavior on HIV risk, we used latent class analysis to highlight underlying profiles of 580 MSM in Paris, France. Three latent classes emerged: Multi-venue Users (19%), Non-serosorting App Users (49%), and Serosorting App Users (32%). Multi-venue Users had the highest probabilities of condomless receptive anal intercourse (CRAI) and condomless insertive anal intercourse (CIAI), group sex, and meeting partners at venues such as bars or online. Non-serosorting App Users had the lowest probabilities of CRAI, CIAI, and condomless serosorting. Serosorting App Users had an 87% chance of condomless serosorting. MSM reporting a pre-exposure prophylaxis history had 14 and 5 times the odds of being classified as Multi-venue Users and Serosorting App Users than Non-serosorting App Users. MSM were 3% more likely to be Multi-venue Users than Non-serosorting App Users for every one-year increase in age. Interventions addressing sexual risk behaviors among MSM in France should consider tailored risk-reduction and prevention messaging.

Disclosure of HIV Status and HIV Sexual Transmission Behaviors among HIV-Positive Black Men Who Have Sex with Men in the BROTHERS (HPTN 061) Study.

We assessed whether disclosure of HIV status is significantly associated with reported HIV sexual risk behaviors among HIV positive Black/African American men who have sex with men (MSM) (Black MSM) in six cities in the USA. Participants from the BROTHERS (HIV Prevention Trials Network [HPTN 061]) study focused on assessing the feasibility and acceptability of a multifaceted HIV prevention intervention to reduce HIV infections among Black MSM enrolled between July 2009 and October 2010. All participants completed a behavioral assessment using an audio computer-assisted self-interview that included questions about HIV status disclosure, HIV sexual risk behaviors, and other behaviors. Biological samples were also collected. This analysis focused on baseline data of HIV-positive Black MSM in the HPTN 061 study. Of the 143 HIV-positive Black MSM (majority ≥ 35years of age) included in this analysis, 58% reported disclosing their HIV status to their last male anal sex partner. Forty-three percent and 42% reported condomless insertive and receptive anal intercourse respectively with their last male partner; whereas, 17% and 18% of the sample engaged in condomless insertive and receptive anal intercourse with a serodiscordant/unknown status partner, respectively. In multivariable logistic regression models, there was no statistically significant association between HIV status disclosure and condomless insertive anal intercourse (aOR = 0.35, 95% CI 0.11, 1.08; p = 0.30), condomless receptive anal intercourse (aOR = 2.48, 95% CI 0.94, 6.52; p = 0.20), or condomless receptive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.55, 95% CI 0.20, 1.49; p = 0.45). However, HIV status disclosure was significantly associated with lower odds of reporting condomless insertive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.19, 95% CI 0.06, 0.68; p ≤ 0.01). Among this multi-city sample of HIV-positive Black MSM, disclosure of HIV status was common and associated with lower HIV sexual risk behaviors. These findings should motivate and guide research to develop prevention messages to increase HIV status disclosures.

Condom-Associated Erectile Function, But Not Other Domains of Sexual Functioning, Predicts Condomless Insertive Anal Sex Among Young Men Who Have Sex with Men.

Condoms effectively prevent against HIV, especially when used in conjunction with biomedical strategies such as PrEP and viral suppression. However, consistent use of condoms in the real world has been a continual health promotion challenge, even among populations at highest risk, such as young men who have sex with men (YMSM). Inconsistent condom use may be related to poor sexual functioning, but limited research exists. The analytic sample comprised 688 racially diverse YMSM aged 16-29 (M = 22.9 years) living in Chicago, IL (19.2% living with HIV). Using multivariable logistic regression, we examined longitudinal associations between condom-associated sexual functioning (erectile function, orgasm satisfaction, global satisfaction, and anal discomfort) and condomless insertive anal sex (CIAS) and condomless receptive anal sex (CRAS) 6months later. CIAS at Time 2 was associated with condom-associated erectile function at the bivariate and multivariable levels, even after controlling for CIAS at Time 1 (p < .05). Condom-associated erectile function, orgasm satisfaction, and global satisfaction predicted Time 2 CRAS in bivariate models, but none remained significant in the multivariable models. Age, having had a serious partner in the past 6months, and HIV/PrEP status at Time 2 were significant predictors of CIAS/CRAS in some but not all models. Future interventions to improve consistent condom use should specifically highlight information and skills on how to use condoms within real-world contexts rather than from a clinical perspective. Our results also support the importance of biomedical strategies for those who have continued problems with sexual functioning when using condoms.

A Web-Based Study of HIV Prevention in the Era of Pre-Exposure Prophylaxis Among Vulnerable HIV-Negative Gay and Bisexual Men, Transmen, and Transwomen Who Have Sex With Men: Protocol for an Observational Cohort Study.

BackgroundGay, bisexual, and other men who have sex with men continue to bear a large burden of the HIV epidemic in the United States and are among the only populations with increasing incidence in recent years.ObjectiveThe Together 5000 (T5K) Study aimed to enroll a US-based, racially diverse sample of HIV-negative men, transmen, and transwomen who are not on pre-exposure prophylaxis (PrEP) into an observational cohort to inform the design, implementation, scale-up, and evaluation of HIV prevention programs.MethodsWe used internet-based strategies to enroll a large, racially diverse national sample of HIV-negative men, transmen, and transwomen aged 16 to 49 years at high risk of HIV acquisition via sexual networking apps. Study participants are contacted every 6 months (in between annual surveys) for a brief survey on HIV testing, HIV diagnosis, and PrEP use (ie, attempts to access, PrEP initiation, and PrEP discontinuation). Participants complete annual self-administered at-home HIV testing and Web-based surveys. Using baseline serologic data and self-reported HIV testing history, we reconstructed a cohort of persons who were HIV negative at 12 months before baseline to estimate HIV incidence leading up to cohort enrollment.ResultsThe study sample included 8777 participants from all 50 US states, Puerto Rico, and Guam; 50.91% (4468/8777) were persons of color and 25.30% (2221/8777) were young individuals aged 16 to 24 years. Per eligibility criteria, all T5K participants reported having sex with >2 male partners in the 90 days before enrollment, self-reported not having been diagnosed with HIV, and were not actively taking PrEP. In addition, 79.39% (6968/8777) reported >2 insertive condomless anal sex (CAS) acts, 61.02% (5356/8777) reported >1 receptive CAS acts in the past 90 days. Furthermore, most (7525/8777, 85.74%) reported never having taken PrEP. In total, 70.25% (6166/8777) were sent a self-administered at-home HIV test kit and 82.29% (5074/6166) of those sent a kit returned a sample for testing. The HIV incidence rate during the 12-month period leading up to enrollment was estimated to be 2.41 (95% CI 2.02-2.90) per 100 person-years.ConclusionsA large, national, and racially diverse fully Web-based cohort of HIV-negative men, transmen, and transwomen at high risk for HIV seroconversion has successfully been recruited into longitudinal follow-up. This cohort is at high risk for HIV acquisition and can provide important insights related to the real-world uptake, impact, and equity of HIV prevention interventions in the United States. Participants can be invited to participate in trials aimed at testing strategies to improve the uptake of and engagement in these interventions.International Registered Report Identifier (IRRID)RR1-10.2196/13715

Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries.

IntroductionThere are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries.Methods Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV‐positive partners had viral load (VL) tested; HIV‐negative partners reported sexual behaviour and perceptions of their HIV‐positive partner's VL results. Within‐couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom‐protected, biomedically protected (undetectable VL and/or pre‐exposure prophylaxis [PrEP]), or not protected by either (HIV‐negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation).ResultsA total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three‐quarters of HIV‐positive partners were consistently virally suppressed (<200 copies/mL) during follow‐up, and HIV‐negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One‐third of HIV‐negative partners used daily PrEP during follow‐up. Over follow‐up, 73.8% of couples had CLAI. HIV‐negative partners reported 31,532 acts of anal intercourse with their HIV‐positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom‐protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two‐thirds (n = 983) were when the HIV‐negative partner was insertive (strategic positioning). Of the 490 acts when the HIV‐negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation.ConclusionsCouples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.