MSM Status Research Articles

Health Care Access and Health Behaviors Among Men Who Have Sex With Men

Men who have sex with men (MSM) appear to experience barriers to health care compared with general population men. This report examines individual differences in health care access within a diverse sample of urban MSM (N = 871). The authors examined demographic differences in health care access and the relation between access and health-related attitudes, health behaviors, and HIV transmission risk. They operationalized health care access in terms of three indicators: perceived barriers, insurance status, and recent medical visit. Twenty-seven percent (n = 227) of MSM reported zero or one health care access indicator. African American and Latino race/ethnicity, lower income, and HIV-unknown status were associated with limited health care access. Limited health care access was related to health care attitudes (mistrust in the health care system and difficulty disclosing MSM status to providers), general health behaviors (smoking, never being HIV-tested, and drug abuse), and sexual risk-related variables (low self-efficacy for sexual safety, consistent drug use during sex, and HIV transmission risk). Overall, among MSM, less health care access relates to several adverse psychological constructs and health behaviors. Researchers and public health officials should address limited health care access, and its consequences, in this population.

The attitude of Canadian university students toward a behavior‐based blood donor health assessment questionnaire

In Canada, all men who have sex with men (MSM) are indefinitely deferred from donating blood. The purpose of this study was to determine the acceptability of an alternative behavior-based donor health questionnaire among Canadian university students. Further we sought to determine the perception of blood safety associated with specific risk behaviors. Questions found on the Canadian Blood Services' donor health assessment questionnaire as well as from studies assessing high-risk behavior for human immunodeficiency virus infection were included. For each question participants were asked to rate the acceptability, comfort in answering, perceived effect on blood safety, and whether the question would deter them from donating blood. Data were analyzed using nonparametric tests. A total of 741 students participated in the study. Questions regarding sexual practices of the donor were rated less important for blood safety compared to those assessing for sexually transmitted infections, sex for money, and injection drug use (30%-62% vs. 69%-95% unsafe). A total of 24.4% of students rated both questions on MSM status and a behavior-based alternative as equally unacceptable. We found an inverse correlation between perception of safety and acceptability of questions. Our findings suggest that a behavior-based screening modification is unlikely to change opinions or satisfy those who object to the MSM current policy in place. Acceptability of these questions might be related to a poor understanding of the effect of sexual practices on blood supply safety.

The Attitude of Canadian University Students towards a Behaviour-Based Blood Donor Health Assessment Questionnaire

AbstractAbstract 3342 Background:As part of Canadian Blood Services policy (CBS), men who have sex with men (MSM) are indefinitely deferred from donating blood due to an increased risk for HIV infection. This policy has generated controversy, especially amongst student populations, due its perceived discrimination against homosexual men. Objectives:1) To determine the acceptability of a behaviour-based donor health questionnaire amongst Canadian university students and assess its suitability as an alternative to the current MSM policy. 2) To determine the perception of blood safety associated with specific risk behaviours. Methods:We conducted a survey amongst students at the University of Western Ontario in London, Ontario, Canada. A questionnaire was designed that included questions found on the current CBS donor health survey, and behaviour-based questions derived from studies assessing high risk factors for HIV. For each question, participants were asked to rate its acceptability and its perceived effect on blood safety using 7-point Likert scales. They were also asked whether the question would deter them from future donations. Data was analyzed using non-parametric tests. Results:741/3500 (21.2%) students participated in the study. Students rated both current and behavioural questions as equally acceptable and the majority (89-97%) would not be deterred from donating blood in the future by any question. The response scores for both sets of questions were significantly correlated. Questions on donor's sexual practices were rated less acceptable compared to those on high risk behaviours. Sexually transmitted infections, injection drug use and sex for money were considered high risk behaviours for blood safety (69-95% unsafe). In contrast, sexual practices (MSM, anal intercourse, condom use, knowledge of partner's sexual background) were rated less important for blood safety (30 to 62% unsafe). We found an inverse correlation between the perception of safety and the acceptability of questions (Table). 24.4% of students rated both questions on MSM status and a behaviour-based alternative as equally unacceptable. Discussion:A behaviour-based screening modification is unlikely to change opinions or satisfy those who object the current MSM policy. Acceptability of these questions might be related to a poor understanding of the effect of sexual practices on blood supply safety. Disclosures:No relevant conflicts of interest to declare.

Elevated HIV prevalence despite lower rates of sexual risk behaviors among black men in the District of Columbia who have sex with men.

The District of Columbia (DC) has among the highest HIV/AIDS rates in the United States, with 3.2% of the population and 7.1% of black men living with HIV/AIDS. The purpose of this study was to examine HIV risk behaviors in a community-based sample of men who have sex with men (MSM) in DC. Data were from the National HIV Behavioral Surveillance system. MSM who were 18 years were recruited via venue-based sampling between July 2008 and December 2008. Behavioral surveys and rapid oral HIV screening with OraQuick ADVANCE ½ (OraSure Technologies, Inc., Bethlehem, PA) with Western blot confirmation on positives were collected. Factors associated with HIV positivity and unprotected anal intercourse were identified. Of 500 MSM, 35.6% were black. Of all men, 14.1% were confirmed HIV positive; 41.8% of these were newly identified HIV positive. Black men (26.0%) were more likely to be HIV positive than white (7.9%) or Latino/Asian/other (6.5%) men (p<0.001). Black men had fewer male sex partners than non-black, fewer had ever engaged in intentional unprotected anal sex, and more used condoms at last anal sex. Black men were less likely to have health insurance, have been tested for HIV, and disclose MSM status to health care providers. Despite significantly higher HIV/AIDS rates, black MSM in DC reported fewer sexual risks than non-black. These findings suggest that among black MSM, the primary risk of HIV infection results from nontraditional sexual risk factors, and may include barriers to disclosing MSM status and HIV testing. There remains a critical need for more information regarding reasons for elevated HIV among black MSM in order to inform prevention programming.

Beyond Anal Sex: Sexual Practices Associated with HIV Risk Reduction among Men Who Have Sex with Men in Boston, Massachusetts

Men who have sex with men (MSM) continue to bear a disproportionate HIV and sexually transmitted disease (STD) burden. The current study examined the frequency and associations of sexual risk reduction behaviors among a sample of MSM in the greater Boston, Massachusetts area. One hundred eighty-nine MSM completed a one-time behavioral and psychosocial assessment between March 2006 and May 2007. Logistic regression procedures examined the association of demographic, psychosocial, and behavioral factors with risk reduction practices. Twenty percent of the sample reported rimming, mutual masturbation, digital penetration, using sex toys, or 100% condom use as a means to reduce their risk of acquiring or transmitting HIV in the prior 12 months. In bivariate analyses, risk reducers were more likely to disclose their MSM status (i.e., be "out"; odds ratio [OR] = 3.64; p < 0.05), and report oral sex with a condom in the prior 12 months (OR = 4.85; p < 0.01). They were less likely to report: depression (Center for Epidemiologic Studies Depression Scale [CES-D] score 16+; OR = 0.48; p < 0.05), a history of one or more sexually transmitted diseases (STDs; OR = 0.40; p < 0.05), and meeting sexual partners at public cruising areas (OR = 0.32; p < 0.01). In a multivariable model, risk reducers were less likely to report: alcohol use during sex (adjusted odds ratio [AOR] = 0.33; p < 0.05), depression (CESD score 16+; AOR = 0.32; p < 0.05), or meeting sexual partners at public cruising areas (AOR = 0.30; p < 0.05), or via the Internet (AOR = 0.12; p < 0.05) in the previous 12 months. Identifying and understanding such factors associated with risk reduction behaviors may be important to consider in designing effective prevention interventions to promote sexual health for MSM.

Prevalence and Sociocultural Predictors of Sexual Dysfunction among Chinese Men Who Have Sex with Men in Hong Kong

Limited data are available on sexual dysfunction (SD) in men who have sex with men (MSM) population. The study investigates the prevalence and associated sociocultural factors of SD in MSM. With an informed consent, 324 MSM respondents were interviewed by trained peer workers in certain gay venues, and another 87 MSM self-administered the same questionnaire via a gay website. Self-reported pain during intercourse, premature ejaculation, anxiety about sex, erectile dysfunction, no pleasure from sex, no orgasm, and hypoactive sexual desire were evaluated. Of all respondents, 42.5% had at least one of the seven studied SD for at least three consecutive months in the last 12 months (pain during sex, 13.8%; premature ejaculation, 10.4%; anxiety, 18.7%; erectile problems, 6.3%; no pleasure, 13.8%; no orgasm, 5.6%; hypoactive sexual desire, 8.3%), whereas 11.4% were dissatisfied with their sexual life. Except for erectile dysfunction, age had no significant effects on individual SD. The results of the multivariate analyses show that unemployment, venue of recruitment, substance use, number of HIV-related behaviors practiced, unprotected anal sex, self-perceived discrimination against MSM, self-identity of sexual orientation, experience of being discriminated because of one's MSM status, uneasy or shame feeling about one's sexual orientation/status, and the count variable of social support received regarding one's MSM status were associated with SD (multivariate OR=1.68-5.57), whereas having no or few MSM friends and exposure to HIV-related education were associated with lower chances of having some SD problems (multivariate OR=0.16-0.46). Only associations with P<0.05 were considered statistically significant. The prevalence of SD among MSM in Hong Kong is relatively high. SD in this group is associated with HIV-related behaviors as well as sociocultural factors related to social support and acceptance of one's MSM status. A more supportive environment is essential for the promotion of sexual health in MSM.

High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India.

To estimate HIV and sexually transmitted disease (STD) prevalence and behavioral risk characteristics of men who have sex with men (MSM) in Chennai, India. A cross-sectional population-based random sample survey was conducted in 2001. Randomly selected residents of 30 slums in Chennai were interviewed for behavioral risk factors through face-to-face interviews. Sera and urine were examined for syphilis, HIV-1, gonorrhea, and chlamydia. Logistic regression analyses were used to assess associations between MSM status and HIV infection and to identify risk characteristics of MSM. Of 774 men, 46 reported (5.9%) sex with other men. MSM were more likely to be seropositive for HIV (odds ratio [OR] = 8.57; 95% confidence interval [CI]: 1.83, 40.23) and were more likely to have a history of STD (OR = 2.66; 95% CI: 1.18, 6.02) than non-MSM. Men who used illicit drugs in past 3 months (adjusted odds ratio [AOR] = 4.01; 95% CI: 1.92, 8.41), ever exchanged money for sex (AOR = 3.93; 95% CI: 1.97, 7.84), or were ever tested for HIV (AOR = 3.72; 95% CI: 1.34, 10.34) were significantly more likely to report sex with men. MSM in Chennai slums are at high risk for HIV. HIV prevention strategies aimed at changing unsafe drug and sexual practices should target the general population of men, with specific attention to areas with high rates of MSM.