Unprotected Insertive Anal Intercourse Research Articles

Homophobia and heteronormativity as dimensions of stigma that influence sexual risk behaviors among men who have sex with men (MSM) and women (MSMW) in Lima, Peru: a mixed-methods analysis

BackgroundStigma differentially influences HIV and STI care among MSM, especially regarding partner notification practices. Recognizing the heterogeneous behaviors/identities within the category “MSM,” we used mixed-methods to assess sexual risk behaviors among men who have sex with men only (MSMO) and behaviorally bisexual MSM (MSMW) with HIV and/or other STIs.MethodsMSMO/MSMW recently diagnosed (< 30 days) with HIV, syphilis, urethritis, or proctitis completed a cross-sectional survey assessing sexual risk behaviors, anticipated disclosure, and sexual partnership characteristics (n = 332). Multivariable generalized estimating equation models assessed characteristics associated with female compared to male partners in the last three partnerships. Follow-up qualitative interviews (n = 30) probed partner-specific experiences (e.g., acts and disclosure).ResultsAmong all participants, 13.9% (n = 46) described at least one of their last three sex partners as female (MSMW). MSMW (mean age of 31.8) reported a mean of 3.5 partners (SD = 4.5) in the past 3 months and MSMO (mean age 30.6) reported a mean of 4.6 partners (SD = 9.7) in the past 3 months. MSMW were more likely to report unprotected insertive anal sex (77.9%) than MSMO (43.1%; p < 0.01). Cisgender female partners were associated with condomless insertive sex in the last 3 months (aPR: 3.97, 95%CI: 1.98–8.00) and classification as a “primary” partnership (2.10, 1.34–3.31), and with lower prevalence of recent HIV diagnosis (0.26, 0.11–0.61). Planned notification of HIV/STI diagnoses was less common for female than for male partners (0.52, 0.31–0.85). Narratives illustrate internal (e.g., women as ‘true’ partners) and community-level processes (e.g., discrimination due to exposure of same-sex behavior) that position homosexual behavior and bisexual identity as divergent processes of deviance and generate vulnerability within sexual networks.ConclusionsMSMW recently diagnosed with HIV/STI in Peru report varying partnership characteristics, with different partner-specific risk contexts and prevention needs. Descriptions highlight how behaviorally bisexual partnerships cut across traditional risk group boundaries and suggest that HIV/STI prevention strategies must address diverse, partnership-specific risks.

Factors associated with concurrent sexual partnerships among men who have sex with men in Yangon, Myanmar.

ABSTRACTMen who have sex with men (MSM) are considered to be one of the groups most at risk of contracting HIV. However, to date, information regarding MSM’s sexual behaviors and the risk factors for their concurrent sexual partnerships (CSP) have not been known in Myanmar. This study aimed to identify factors associated with CSP among MSM.A cross-sectional study was conducted from September to October 2011 in Yangon, Myanmar. In total, 353 males who had self-reported sex with men were recruited using respondent-driven sampling method. Descriptive statistics and multivariate logistic regression analysis were performed. In total, 61.0% of the MSM reported having CSP. MSM who practiced sex trading in the past six months (adjusted odds ratio8.32; 95% confidence interval [CI]: 2.30–30.10), MSM who had diagnosed with STIs/HIV (AOR 6.71; 95% CI: 4.78–9.28), and MSM who engaged in unprotected insertive anal sex (AOR 1.27; 95% CI: 1.02–1.45) were more likely to have CSP. In contrast, MSM who used condoms consistently during the past six months (AOR = 0.27; 95% CI: 0.08–0.94), MSM who had a regular job (AOR = 0.21; 95% CI: 0.06–0.74), and MSM who initiated sexual activities later in their lives (AOR = 0.08; 95% CI: 0.03–0.25) were less likely to have CSP. Concurrent sexual partnerships are common among MSM in Myanmar. Findings suggest that interventions should focus on MSM who diagnosed with STIs/HIV, do not have regular jobs, and initiated their sexual activities at an early age.

Relationship between serostatus disclosure and categories of HIV transmission risk in men who have sex with men living with HIV.

In prior studies, the relationship between serostatus disclosure and reduced HIV transmission risk has been mixed. The demonstration of a clear connection may be restricted by three main methodological limitations. This study evaluates the relationship between (1) more refined measures of serostatus disclosure and (2) eight categories of HIV transmission risk (lowest to highest risk) among men who have sex with men (MSM) living with HIV, while (3) considering a number of control variables. Results demonstrate that disclosure is more likely in sexual encounters involving no intercourse or involving protected and unprotected anal intercourse with HIV-positive partners than unprotected insertive anal intercourse with HIV-negative/unknown status partners. Additionally, substance use prior to sexual encounters is less likely in lower risk categories than the highest risk category. Results of this study are important to the design of future studies, prevention, and intervention programs for MSM and to the methods used to evaluate their effectiveness.

Longitudinal Findings on Changes in and the Link Between HIV-Related Communication, Risky Sexual Behavior, and Relationship Status in Men Who Have Sex With Men Living With HIV.

Reducing the risk of HIV transmission among men who have sex with men (MSM) is a national health priority. This study longitudinally examined changes in and the link between HIV-related communication, unprotected anal intercourse (UAI), and relationship status among MSM. Data were obtained from 337 MSM living with HIV who participated in a randomized controlled study. Approximately equal percentages of men were randomized to either the disclosure intervention group or the attention control case management group. Repeated measures were collected at 5 time points for 12 months and included health-protective sexual communication (HPSC), HIV disclosure, insertive and receptive UAI, and relationship status. Data were analyzed using mixed-effects models. Independent of the treatment condition, HPSC and HIV disclosure increased over time; insertive UAI showed a curvilinear pattern but no significant decrease over time. Relationship status was related to HIV-related communication and UAI. Greater HPSC was related to less insertive and receptive UAI; disclosure was positively related to insertive UAI. Based on the findings, prevention programs should continue to focus on improving HIV-related communication among MSM and consider relationship status in prevention messages. Intervention studies are needed to continue to identify and test factors that help reduce risky sexual behaviors.

Assessing gender stereotypes and sexual risk practices in men who have sex with men

ObjectiveTo analyze the construct validity and the internal consistency of the 12-item Bem Sex Role Inventory (BSRI-12) questionnaire and to study the association between gender stereotypes and sexual risk practices in men who have sex with men (MSM). MethodsCross-sectional study of 601 MSM who voluntarily and anonymously responded to an online survey on risk practices and gender stereotypes. The BSRI-12 was used to obtain gender stereotypes (masculine, feminine, undifferentiated and androgynous). For data analysis, exploratory factor analysis (EFA) of the BSRI-12 and logistic regression were performed. ResultsTwo main factors (Cronbach alpha 0.95 and 0.81) were obtained from the EFA. Using the androgynous roles as the reference category, we found lower odds of engaging in unprotected anal intercourse (UAI) among those who endorse feminine roles (OR: 0.53; 95%CI: 0.29-0.95). Endorsing masculine roles with alcohol consumption (OR: 1.92; 95%CI: 1.15-3.20) or the undifferentiated when not knowing the partner's serological status (OR: 1.55; 95%CI: 1.02-2.35) were associated with higher odds of UAI compared to those endorsing the androgynous roles. Undifferentiated participants also perform receptive UAI using poppers (OR: 2.19; 95%CI: 1.24-3.87), and insertive UAI not knowing the serological status of the sexual partner (OR: 1.69; 95%CI: 1.04-2.76) compared to androgynous participants. ConclusionThe BSRI is a valid and consistent instrument for identifying gender stereotypes in MSM. A greater proportion of participants within the undifferentiated and the masculine category engage in risk practices with the influence of substance consumption and unawareness of their sexual partner's serological status. The information obtained may be useful to define intervention and prevention programs.

Evaluation of hepatitis C testing in men who have sex with men, and associated risk behaviours, in Manchester, UK

ObjectiveTo determine the prevalence of newly diagnosed hepatitis C virus (HCV) and associated risk behaviours among men who have sex with men (MSM) in Manchester.MethodA survey among MSM attending four...

Unsafe Sexual Behavior Among Gay/Bisexual Men in the Era of Combination Antiretroviral Therapy (cART).

The aim of this study was to determine the association between psychosocial determinants of unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI). Data from 417 HIV positive men who have sex with men (MSM) in the Multicenter AIDS Cohort Study from April 1999 to March 2012 were analyzed and adjusted odds were calculated. It was found that 66% (n=277) and 72% (n=299) reported any UIAI or URAI over follow-up, respectively. Cumulative cART-years (median=5.30years) was associated with 33 and 47% increases in UIAI and URAI, respectively. Not having reduced concern about HIV transmission (UIAI: OR 0.37, p-value=0.0004; URAI: OR 0.57, p-value=0.04), increased safe sex fatigue (UIAI: OR 2.32, 95% p-value=0.0002; URAI: OR 1.94, p-value=0.003), and sexual sensation seeking (UIAI: OR 1.76, p-value=0.002; URAI: OR 1.56, p-value=0.02) were associated with UIAI and URAI. Serosorting was associated with UIAI (OR 6.11, p-value<0.0001) and URAI (OR 6.80, p-value<0.0001). Findings suggest that negative attitudes about HIV transmission are sustained among older men who have sex with men.

Sexual Communication and Seroadaptation Practices in HIV-Negative Midlife and Older Men Who Have Sex With Men

ABSTRACTAdvances in treatments have increased the longevity of people with HIV. The high prevalence of HIV among men who have sex with men (MSM) creates a greater risk for exposure that increases with age. Seroadaptation, which includes serosorting (sexual behavior and condom use based on knowing the serostatus of self and partners) and strategic sexual positioning (choosing receptive versus insertive anal sex), is sometimes used as an HIV risk-reduction strategy. This study examined seroadaptation, sexual communication, and HIV-risk behaviors in 420 sexually active HIV-negative MSM aged 40–81 years in South Florida via anonymous pen-and-paper questionnaire. Recreational drug use and serosorting (i.e., not using condoms if the partner said he was HIV-negative) were associated with higher risk for unprotected receptive anal intercourse. Younger age, greater number of partners, and serosorting were associated with higher risk for unprotected insertive anal intercourse. Understanding these behaviors in this group might help guide HIV-prevention efforts. Future research may examine the role of HIV-prevention medication (PrEP) in influencing sexual behavior in midlife and older MSM.

Viral load strategy: impact on risk behaviour and serocommunication of men who have sex with men in specialized care.

Incidence and prevalence of HIV are continuously high in German men, who have sex with men (MSM). Different transmission risk minimizing strategies have been observed. The viral load strategy rates patients unlikely to be sexually infectious if their viral load under effective therapy is stably suppressed during 6 months and no other sexually transmitted infections are present. We aim to objectify the current popularity of the viral load strategy, the adherence to basic conditions and its impact on risk behaviour and serocommunication. Until now, no data on a German sample of HIV-positive MSM in regular specialized outpatient care are available. Cross-sectional study with group comparisons between user group and non-user-group of the viral load strategy. Self-report questionnaires were conducted with 269 sexually active German HIV+MSM under effective treatment in specialized outpatient care. Structured interviews gathered additional information about approach to and realization of definite action levels concerning sexual risk behaviour and transmission risk minimizing strategies. Twenty-seven of 269 participants (10%) affirmed knowledge of having an undetectable viral load and stated this to be criteria for unprotected sexual behaviour. This subgroup reported more unprotected insertive (P = 0.018) and receptive anal intercourse (P = 0.042), more anonymous sex partners (P = 0.008) and less consistent safer sex. Analysing serocommunication, less addressing HIV/AIDS in general (P = 0.043) and less disclosing to sex partners (P = 0.023) was found, especially in anonymous settings. Differentiating serocommunication characteristics, a focus on seroguessing was depicted. The user group of the viral load strategy is small. But a less frequent, more reactive and assumptive serocommunication leads to an imprecise information exchange paired with higher frequency of risky behaviour, especially in anonymous settings, where frank serocommunication is often avoided. The targeted group of the viral load strategy diverges greatly from the user group.

O014 Investigating attitudes towards HIV Pre-Exposure Prophylaxis (PrEP). A questionnaire study in men who have sex with men attending sexual health clinics

Background/introduction With the efficacy of HIV pre-exposure prophylaxis (PrEP) proven, provision of PrEP is currently being evaluated by commissioners. The question of who would wish to access PrEP, and where, is important in informing this process. Aim(s)/objectives To establish potential users’ attitudes towards, and experiences of, PrEP. Methods Ethical approval was obtained to conduct a multi-centre, prospective, anonymised questionnaire study of 1000 HIV negative MSM accessing sexual health clinics. Sexual behaviour, drug use, STI history and previous post exposure prophylaxis (PEP) use were collected. Opinions and attitudes towards PrEP and PrEP availability were assessed. Results Of 386 analysed questionnaires the majority were British-born (203, 53%), white (300, 78%) men. 345 (89%) reported anal sex within the last month with 168 (43%) and 139 (36%) reporting unprotected insertive and receptive anal intercourse, respectively (103, (26%) and 64, (17%) with multiple partners). 194 (50%) had recently used recreational drugs (within 3 months; 34% “Chemsex” substances). 157 (41%) reported a recent STI (6 months). 223 (58%) reported that they strongly believed they would benefit from PrEP. However, 42/223 (19%) reported no condomless sex. Concerns around taking PrEP were cited by 76 (20%). 167 (43%) expressed a preference for daily PrEP; 139 (38%) for coitally-driven. 311 (80%) supported PrEP delivery by sexual health clinics to MSM, and 233 (60%) to any-one who requests it. 112 (29%) agreed a prescription charge was appropriate. 17 respondents (4%) reported having already taken PrEP: 35% using medication acquired as PEP, and 30% acquiring PrEP privately. 7/17 (41%) reported decreased condom since commencing PrEP. Discussion/conclusion This comprehensive questionnaire study demonstrates a high willingness to use PrEP in a cohort of at-risk MSM. These data should inform the commissioning process of this efficacious biological intervention.

Confirmed inguinal lymphogranuloma venereum genovar L2c in a man who had sex with men, Slovenia, 2015.

A laboratory-confirmed lymphogranuloma venereum (LGV) case in Slovenia was reported in 2015, in a human immunodeficiency virus (HIV)-negative man presenting with inguinal lymphadenopathy. He reported unprotected insertive anal intercourse with two male partners in Croatia. Variant L2c of Chlamydia trachomatis was detected in clinical samples. Although the patient was eventually cured, the recommended treatment regimen with doxycycline had to be prolonged.

Measures of Attitudes Toward and Communication about Condom Use: Their Relationships With Sexual Risk Behavior Among Young Black Men Who Have Sex With Men.

The aim of this study was to construct and test measures of psychosocial mediators that could be used in intervention studies seeking to promote safer sex behavior among young black men who have sex with men (YBMSM). A total of 400 YBMSM, ages 18 to 29 years, were recruited from a clinic for sexually transmitted infection in the southern United States. All men had engaged in penile-anal sex with a man as a "top" in the past 6 months. The men completed an audio-computer-assisted self-interview and provided specimens used for nucleic acid amplification testing to detect Chlamydia and gonorrhea. Four measures were constructed and tested for criterion validity (Safer Sex Communication, Condom Turn-Offs, Condom Pleasure Scale, and a single item assessing frequency of condom use discussions before sexual arousal). With the exception of Safer Sex Communication, all of the measures showed criterion validity for both unprotected anal insertive and unprotected anal receptive sex. With the exception of the Condom Turn-Offs, the 3 other measures were supported by criterion validity for oral sex. Both the Condom Turn-Offs and Condom Pleasure Scale were significantly related to whether or not the men reported multiple partners as a top, but only the Condom Pleasure Scale was associated with reports of multiple partners as a "bottom." Only the Condom Turn-Offs Scale was positively associated with having been diagnosed with either Chlamydia or gonorrhea. Findings provide 3 brief scales and a single item that can be used in intervention studies targeting YBMSM. Perceptions about condoms being a turnoff and about condoms enhancing pleasure showed strong association with sexual risk behaviors.

Higher Frequency of Unprotected Insertive Anal Sex Among Young Black MSM Who are Circumcised

I read with great interest the recent paper by Crosby et al., in which the authors failed to find any significant difference in the prevalence of HIV (or other sexually transmitted infections) between circumcised and intact young black men who have sex with men (MSM) in the United States [1]. Their findings are in line with those of a 2011 Cochrane review showing no significant association overall between circumcision/foreskin status and HIV infection in MSM, although a subanalysis suggested a possible reduction in HIV risk among circumcised MSM who predominantly take the insertive role during anal sex [2]. However, a subsequent British study found no evidence that circumcision is protective against HIV among MSM who predominantly engage in anal sex as the insertive partner [3]. Crosby et al. highlight an additional, potentially noteworthy finding in their article’s abstract [1]. They report that ‘‘The mean frequency of unprotected insertive anal sex for circumcised men was about twice as high compared to those intact (P = .04).’’ This finding is consistent with evidence from another recent study by Feldblum et al. [4], which pointed to reduced condom use following adult circumcision among a large sample of Kenyan men. Unfortunately, Crosby et al. make no mention anywhere in the main text about this statistically significant finding. Perhaps the authors considered it to be a chance finding because, apparently, it was the only statistically significant result in their study. However, there are reasons why this finding may actually deserve some attention. First, such a result is plausible on anatomical and behavioral grounds. Since circumcision removes the adult equivalent of approximately 50 cm of touch-sensitive tissue (see below), one might expect an overall reduction in penile sensitivity as a function of the surgery. Since condoms tend to decrease penile sensitivity [5], circumcised men may have conscious or unconscious motivations to avoid any further desensitization during sex, which could explain their reduced condom use. Laboratory investigations have sought to determine whether the foreskin is a particularly sensitive penile structure, and have produced conflicting results. Some researchers have provided evidence that the foreskin is the most sensitive part of the penis [6], while others fail to confirm such findings [7]. However, regardless of whether sensitivity per square centimeter is actually higher in the foreskin compared to other parts of the penis, or the foreskin is merely as sensitive as other parts of the sexual organ, the overall sensory input from a circumcised penis during sex will be reduced in a manner that plausibly depends—at least to some extent—on the amount of foreskin removed. The obvious reason for this is that any sensation that would be experienced in the foreskin itself is necessarily eliminated by circumcision [8]. The adult foreskin—with its rich supply of nerve endings and specialized sensory structures [9]—may comprise up to 100 cm, with reported average values between 30 and 50 cm [10, 11]. The contribution of this motile sleeve of erogenous tissue to overall penile sensitivity is not known with certainty. However, any specific qualitative sensation elicited by the mechanical rolling and gliding movements of the foreskin during sexual activity will in fact be absent or reduced in circumcised men [8]. & Morten Frisch mfr@ssi.dk

Pareja, situaciones socioeconómicas y prácticas de riesgo en hombres que tienen sexo con hombres

ObjectiveMen who have sex with men (MSM) perform risk practices that pose a challenge to prevention strategies. The aim of this study was to analyse the association between receptive and insertive unprotected anal intercourse (RUAI and IUAI) according to the type of partner and the practice of barebacking with socioeconomic factors. MethodsA descriptive study was conducted through a self-administered questionnaire distributed by a software tool in social networks and non-governmental organizations from June-2014 to January-2015. Participants consisted of 601 people living in Spain. Pearson's χ2 test and logistic regression models were applied with odds ratios (OR) and 95% confidence intervals (95% CI). ResultsIn stable couples, the risk of RUAI increased in individuals with a medium income (OR: 1.79; 95%CI: 1.14-2.80) and in those who lived together (OR: 2.94; 95%CI: 1.74-4.98) and IUAI increased in individuals living with a partner (OR: 5.58; 95%IC: 3.24-9.59). When the partner was a friend, the risk of RUAI was higher among individuals with secondary education (OR: 2.20; 95%CI: 1.44-3.36) and those who were retired (OR: 3.6; 95%CI: 1.25-10.37), while living with a partner was a protective factor (OR: 0.56; 95%CI: 0.32-0.98). The risk of barebacking was greater in younger men (OR: 2.59; 95%CI: 1.27-5.28), in those with secondary education (OR: 1.51; 95%CI: 0.99-2.29) and in those living with a partner (OR: 3.64; 95%CI: 2.12-6.24). DiscussionThere is a need to reduce vulnerability due to socioeconomic factors that influence engagement in risk practices and to highlight the importance of barebacking, mainly in young MSM. Partner-based interventions and harm reduction strategies should be incorporated into preventive strategies.

Pervasive Heavy Alcohol Use and Correlates of Increasing Levels of Binge Drinking among Men Who Have Sex with Men, San Francisco, 2011.

Heavy episodic drinking, "binge drinking", is highly prevalent among men who have sex with men (MSM) and is associated with sexual risk behaviors and HIV seroconversion in this population. We characterized the magnitude of binge drinking and explored correlates of increasing levels of binge drinking among MSM in San Francisco. In this study, 67% of MSM reported binge drinking in the prior year. The mean number of drinking days in the past month was 11.6. On average, we estimate that 2,699,372 drinks are consumed by MSM in San Francisco every month. Increasing levels of binge drinking was independently associated with younger age, modest income, being born in the United States, never accessing alcohol treatment and reporting unprotected insertive anal intercourse. Our findings underscore the need to target effective strategies to address heavy alcohol consumption and highlight the urgent need to develop novel interventions beyond traditional alcohol treatment settings among MSM.

On the Efficacy and Mediation of a One-on-One HIV Risk-Reduction Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial.

We examined the efficacy and mediation of Being Responsible for Ourselves (BRO), an HIV/STI risk-reduction intervention for African American men who have sex with men (MSM), the population with the highest HIV-diagnosis rate in the US. We randomized African American MSM to one of two interventions: BRO HIV/STI risk-reduction, targeting condom use; or attention-matched control, targeting physical activity and healthy diet. The interventions were based on social cognitive theory, the reasoned-action approach, and qualitative research. Men reporting anal intercourse with other men in the past 90 days were eligible and completed pre-intervention, immediately post-intervention, and 6 and 12 months post-intervention surveys. Of 595 participants, 503 (85 %) completed the 12-month follow-up. Generalized-estimating-equations analysis indicated that, compared with the attention-matched control intervention, the BRO intervention did not increase consistent condom use averaged over the 6- and 12-month follow-ups, which was the primary outcome. Although BRO did not affect the proportion of condom-protected intercourse acts, unprotected sexual intercourse, multiple partners, or insertive anal intercourse, it did reduce receptive anal intercourse compared with the control, a behavior linked to incident HIV infection. Mediation analysis using the product-of-coefficients approach revealed that although BRO increased seven of nine theoretical constructs it was designed to affect, it increased only one of three theoretical constructs that predicted consistent condom use: condom-use impulse-control self-efficacy. Thus, BRO indirectly increased consistent condom use through condom-use impulse-control self-efficacy. In conclusion, although BRO increased several theoretical constructs, most of those constructs did not predict consistent condom use; hence, the intervention did not increase it. Theoretical constructs that interventions should target to increase African American MSM’s condom use are discussed.

HIV-testing behavior and associated factors among MSM in Chongqing, China: results of 2 consecutive cross-sectional surveys from 2009 to 2010.

The high and climbing human immunodeficiency virus (HIV) rates among Chinese men who have sex with men (MSM) bring huge pressure and challenge to acquired immune deficiency syndrome response work in China. This study examined HIV-testing behavior and describes the characteristics of recently tested MSM in Chongqing to address targeting HIV prevention interventions.Two consecutive cross-sectional surveys were conducted among Chongqing MSM using respondent-driven sampling in 2009 and 2010. Information was collected regarding details on demographic characteristics, sexual practices with male and female partners, and HIV-testing experiences. Univariate and multivariate logistic regression analyses were performed to identify factors independently associated with recent HIV testing.The final sample size included in our analyses was 992. The overall HIV prevalence was 13.4%, and HIV prevalence increased significantly from 11.6% in 2009 to 15.4% in 2010 (P = 0.08). The overall rate of HIV testing in the past 12 months was 44.6%, and the self-reported rates decreased significantly from 47.8% in 2009 to 41.1% in 2010 (P = 0.03). Factors independently associated with recent HIV testing included living in Chongqing >1 year (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI] 1.1–2.9), the age of most recent male partner ≤25 (AOR 1.5, 95% CI 1.1–2.1), not having unprotected insertive anal sex with most recent male partner in the past 6 months (AOR 1.5, 95% CI 1.1–2.0), disclosing HIV status to most recent male partner (AOR 2.8, 95% CI 2.0–3.8), and holding lower level of HIV-related stigma (AOR 1.1 per scale point, 95% CI 1.0–1.1).The extremely high HIV prevalence and low annual testing level put MSM at high risk of HIV infection and transmission, and it is a priority to promote regular HIV testing among this group in order to control the spread of HIV in Chongqing, China.

Sexual orientation- and race-based discrimination and sexual HIV risk behavior among urban MSM.

Understanding what social factors are associated with risk of HIV acquisition and transmission among gay, bisexual and other men who have sex with men (MSM) is a critical public health goal. Experiencing discrimination may increase risk of HIV infection among MSM. This analysis assessed relations between experiences of sexual orientation- and race-based discrimination and sexual HIV risk behavior among MSM in New York City. 1,369 MSM completed a self-administered computerized assessment of past 3-month sexual behavior, experience of social discrimination and other covariates. Regression models assessed relations between recent experience of discrimination and sexual HIV risk behavior. Mean age was 32years; 32% were white; 32% Latino/Hispanic; 25% African American/Black. Of MSM who self-reported HIV-positive or unknown status (377), 7% (N=27) reported having unprotected insertive anal intercourse with an HIV-negative or unknown status partner ("HIV transmission risk"). Of MSM who self-reported HIV-negativestatus (992), 11% (110) reported unprotected receptive anal intercourse with an HIV-positive or unknown status partner ("HIV acquisition risk"). HIV acquisition risk was positively associated with sexual orientation-based discrimination in home or social neighborhoods, but not race-based discrimination. We observed that sexual orientation-based discrimination was associated with sexual HIV risk behavior among urban-dwelling MSM. Addressing environmental sources of this form of discrimination, as well as the psychological distress that may result, should be prioritized in HIV prevention efforts.

Gay and bisexual men engage in fewer risky sexual behaviors while traveling internationally: a cross-sectional study in San Francisco

BackgroundInternational travel poses potential challenges to HIV prevention. A number of studies have observed an association between travel and behavioural disinhibition. In the present study, we assessed differences in sexual...

Heteronormativity and sexual partnering among bisexual Latino men.

Our analyses address the question of how bisexual Latino men organize their sexual partnerships. Heteronormativity can be understood as the set of social norms and normative structures that guide sexual partnering among men and women. We provide descriptive statistics to describe bisexual Latino men's sexual partnerships. Logistic and linear regression modeling were used to explore bivariate and multivariate relationships. Of our total sample (N = 142), 41.6 % had unprotected vaginal intercourse 2 months prior to the interview; 21.8 % had unprotected anal intercourse with female partners; 37.5 % had unprotected insertive anal intercourse with male partners; and 22.5 % had unprotected receptive anal intercourse with male partners. In our multivariate model, machismo was directly associated with meeting female partners through formal spaces (workplace, school, and/or church), but inversely associated with meeting male partners in formal spaces. Machismo was positively associated with meeting male sex partners through social networks (i.e., friendship and kinship networks). The more comfortable men were with homosexuality the less likely they were to meet men online and the more likely they were to meet men through social networks of friends and kinship. Interventions to reduce sexually transmitted diseases that target bisexual behavior as an epidemiological "bridge" of transmission from homosexual to heterosexual networks might very well benefit from a more complex understanding of how Latino bisexuality is patterned. Thus, this exploratory analysis might lead to a rethinking of how to address risk and vulnerability among Latino bisexual men and their sexual networks.