Sexual Partnering and HIV Risk among Black Men Who Have Sex with Men: New York City

Black men who have sex with men (MSM) are disproportionately affected with HIV in the US. Limited event-specific data have been reported in Black MSM to help understand factors associated with increased risk of infection. Cross-sectional National HIV Behavioral Surveillance Study data from 503 MSM who reported ≥1 male sexual partner in the past year in New York City (NYC) were analyzed. Case-crossover analysis compared last protected and last unprotected anal intercourse (UAI). A total of 503 MSM were enrolled. Among 349 tested for HIV, 18% were positive. Black MSM (N = 117) were more likely to test HIV positive and not know their HIV-positive status than other racial/ethnic groups. Case-crossover analysis of 208 MSM found that men were more likely to engage in protected anal intercourse with a first time partner and with a partner of unknown HIV status. Although Black MSM were more likely to have Black male partners, they were not more likely to have UAI with those partners or to have a partner aged >40 years. In conclusion, HIV prevalence was high among Black MSM in NYC, as was lack of awareness of HIV-positive status. Having a sexual partner of same race/ethnicity or older age was not associated with having UAI among Black MSM.     

Childhood Sexual Abuse and HIV-Related Risks Among Men Who Have Sex with Men in Washington,DC

Childhood sexual abuse (CSA) has been reported to be disproportionately higher among men who have sex with men (MSM) than among heterosexual men; it has also been found to be significantly positively associated with HIV status and HIV risk factors, including unprotected anal intercourse. The purpose of this study was to assess the correlates of CSA in a sample of community-recruited MSM, investigate race as a potential effect modifier, and describe the independent association between CSA and HIV infection in Washington, DC. A total of 500 MSM were recruited by venue-based sampling in 2008 as part of the National HIV Behavioral Surveillance. More than one-half of MSM identified as White, while one-third identified as Black. CSA was reported by 17.5 % of the 451 MSM, with the first instance of abuse occurring at a median age of 8.3 (interquartile range = 5.0, 11.0). In multivariable analysis, HIV-positive men were significantly more likely to report a history of CSA compared to HIV-negative men after adjusting for intimate partner violence in the last 12 months, having been arrested in the last 12 months, and depressive symptoms. HIV-positive MSM had more than four times the odds of reporting CSA after controlling for other correlates (aOR = 4.19; 95 % CI 2.26, 7.75). Despite hypothesizing that race modified the effect of CSA on HIV infection we found this was not the case in this sample. More research is needed to investigate the potential pathway between a history of CSA and HIV infection, and how this contributes to driving the HIV epidemic among MSM in Washington, DC.     

Vital Signs: HIV Infection,Diagnosis, Treatment,and Prevention Among Gay,Bisexual, and Other Men Who Have Sex with Men — United States, 2010–2019

BackgroundMen who have sex with men (MSM) accounted for two thirds of new HIV infections in the United States in 2019 despite representing approximately 2% of the adult population.MethodsCDC analyzed surveillance data to determine trends in estimated new HIV infections and to assess measures of undiagnosed infection and HIV prevention and treatment services including HIV testing, preexposure prophylaxis (PrEP) use, antiretroviral therapy (ART) adherence, and viral suppression, as well as HIV-related stigma.ResultsThe estimated number of new HIV infections among MSM was 25,100 in 2010 and 23,100 in 2019. New infections decreased significantly among White MSM but did not decrease among Black or African American (Black) MSM and Hispanic/Latino MSM. New infections increased among MSM aged 25–34 years. During 2019, approximately 83% of Black MSM and 80% of Hispanic/Latino MSM compared with 90% of White MSM with HIV had received an HIV diagnosis. The lowest percentage of diagnosed infection was among MSM aged 13–24 years (55%). Among MSM with a likely PrEP indication, discussions about PrEP with a provider and PrEP use were lower among Black MSM (47% and 27%, respectively) and Hispanic/Latino MSM (45% and 31%) than among White MSM (59% and 42%). Among MSM with an HIV diagnosis, adherence to ART and viral suppression were lower among Black MSM (48% and 62%, respectively) and Hispanic/Latino MSM (59% and 67%) compared with White MSM (64% and 74%). Experiences of HIV-related stigma among those with an HIV diagnosis were higher among Black MSM (median = 33; scale = 0–100) and Hispanic/Latino MSM (32) compared with White MSM (26). MSM aged 18–24 years had the lowest adherence to ART (45%) and the highest median stigma score (39).ConclusionImproving access to and use of HIV services for MSM, especially Black MSM, Hispanic/Latino MSM, and younger MSM, and addressing social determinants of health, such as HIV-related stigma, that contribute to unequal outcomes will be essential to end the HIV epidemic in the United States.     

Compulsive Sexual Behavior and Risk for Unsafe Sex Among Internet Using Men Who Have Sex with Men

The present study explored the relationship between compulsive sexual behavior (CSB) and unprotected anal intercourse (UAI) for men who have sex with men (MSM) across a number of ethnic/racial groups and who used the Internet to seek sexual partners. A sample of 2,716 MSM (512 Asian, 445 Black, 683 Latino, 348 Other, 728 White) completed on online survey that collected information about their sexual behaviors with partners met online and offline. The survey also included the Compulsive Sexual Behavior Inventory (CSBI). Consistent with the notion that CSB is a stable trait, higher scores on the CSBI were associated with greater odds for engaging in UAI, regardless of the context in which sex partners were met (online or offline). Differences in median CSB scores were generally similar across racial and ethnic groups. The median CSB score was significantly higher for HIV-positive participants than for HIV-negative participants. HIV-prevention interventions are needed among MSM, but should take into account that some may be resistant to risk reduction strategies because of CSB.     

Finding Sex Partners Through Social Media Among Men Who Have Sex with Men in Hanoi,Vietnam

Many men who have sex with men (MSM) in low and middle income countries search for male sexual partners via social media in part due to societal stigma and discrimination, yet little is known about the sexual risk profiles of MSM social media users. This cross-sectional study investigates the prevalence of social media use to find male sex partners in Hanoi, Vietnam and examines associations between social media use and sociodemographic and behavioral characteristics, including levels of internalized, perceived and enacted stigma, high-risk sexual behaviors, and HIV testing. 205 MSM were recruited from public venues where MSM congregate as well as through snowball sampling and completed an anonymous survey. MSM who found their male sexual partners using social media in the last year were more likely to have completed a university or higher degree (aOR 2.6; 95% CI 1.2–5.7), experience high levels of MSM-related perceived stigma (aOR 3.0; 95% CI 1.1–8.0), and have more than ten lifetime male sexual partners (aOR 3.2; 95% CI 1.3–7.6) compared to those who did not use social media. A niche for social media-based interventions integrating health and stigma-reduction strategies exists in HIV prevention programs for MSM.     

Internet Use and Sexual Health of Young Men Who Have Sex with Men: A Mixed-Methods Study

Young gay, bisexual, and other men who have sex with men (MSM) experience sexual health disparities due to a lack of support in settings that traditionally promote positive youth development. The Internet may help to fill this void, but little is known about how it is used for sexual health purposes among young MSM. This mixed-methods study reports quantitative results of a large survey of 18- to 24-year-old MSM in an HIV testing clinic (N = 329) as well as qualitative results from interviews. Level of Internet use was high in this sample and the majority of participants reported using the Internet to find HIV/AIDS information. Black and Latino youth used the Internet less frequently than White youth, and after controlling for age, education, and frequency of Internet use, Black youth were 70% less likely to use the Internet to find HIV/AIDS information. Qualitative analyses identified themes related to the role of the Internet in finding sexual health information, sexual minority identity development, and sexual risk taking behaviors. Participants reported that the Internet filled an important and unmet need for sexual health education. It allowed for connections to the gay community and support during the coming out process, but also exposure to homophobic messages. There was no evidence of increased risk behaviors with partners met online, but at the same time the potential for the use of the Internet to facilitate safer sex communication was largely untapped. Our findings generally present an optimistic picture about the role of the Internet in the development of sexual health among young MSM.     

Sexual Partner Selection and HIV Risk Reduction Among Black and White Men Who Have Sex With Men

Objectives. We examined differences in sexual partner selection between Black and White men who have sex with men (MSM) to better understand how HIV status of participants'' sexual partners and related psychosocial measures influence risk taking among these men.Methods. We collected cross-sectional surveys from self-reported HIV-negative Black MSM and White MSM attending a gay pride festival in Atlanta, Georgia.Results. HIV-negative White MSM were more likely than were HIV-negative Black MSM to report having unprotected anal intercourse with HIV-negative men, and HIV-negative Black MSM were more likely than were HIV-negative White MSM to report having unprotected anal intercourse with HIV status unknown partners. Furthermore, White MSM were more likely to endorse serosorting (limiting unprotected partners to those who have the same HIV status) beliefs and favorable HIV disclosure beliefs than were Black MSM.Conclusions. White MSM appear to use sexual partner–related risk reduction strategies to reduce the likelihood of HIV infection more than do Black MSM. Partner selection strategies have serious limitations; however, they may explain in part the disproportionate number of HIV infections among Black MSM.Men who have sex with men (MSM) continue to make up the majority of people who are HIV infected in the United States. About one third of US HIV infections among MSM occur in Black men¹; however, Black men account for only 13% of the US male population.² Several published reports of HIV risks that stratify risk behavior by race do not demonstrate elevated risk behavior among Black MSM as compared with White MSM.^3,4 For example, Black MSM overall report fewer sexual partners and similar rates of unprotected anal intercourse when compared with White MSM. Because rates of risk behaviors fail to explain the racial disparities in HIV infections, contextual factors may offer important information for explaining the disproportionate HIV infections. Alarming rates of HIV among Black MSM have led this group to be among the top priority HIV prevention populations in the United States.⁵ Thus, a comprehensive understanding of HIV risk factors relevant to this population is warranted.Multiple contextual factors potentially drive disparities in HIV/AIDS between Black MSM and White MSM. Perceived HIV prevention strategies such as selecting unprotected sexual partners thought to have the same HIV status, or serosorting, may play a role in explaining racial disparities in HIV infections. Many HIV-infected and non–HIV-infected men believe serosorting makes HIV transmission less likely and, thus, condom use unnecessary.^6,7 This relationship may stem from the tendency for people to dislike using condoms^8–10 and to practice alternative behaviors they believe are protective, such as serosorting. As a result, partner HIV serostatus is often a determining factor in sexual risk decision making.^11,12 Several studies have found that MSM commonly use serosorting in general, but less is known about serosorting among MSM of various ethnicities.^7,13–15Data on the effectiveness of serosorting are somewhat mixed, but it is known that serosorting can lead to HIV exposure.¹⁶ Although some studies have noted the potential for serosorting to reduce overall HIV rates,^17,18 limitations of this practice, including infrequent HIV testing, lack of open communication about HIV status, and acute HIV infection place MSM who serosort at risk for HIV transmission.^19,20There are at least 2 factors that directly influence whether or not an individual is motivated to serosort. First, individuals who serosort likely do so to lower their perceived risk for HIV infection, that is, to make them feel safe while not using condoms. In this sense, serosorting can reduce HIV transmission anxiety. Hence, the perception that serosorting makes unprotected sex safer is most likely driving sexual behavior risk taking. Notably, risk perceptions have been previously demonstrated to play an important role in predicting other health-related behaviors.^21–23 Second, serosorting requires explicit verbal discussion about HIV status. As such, those who engage in serosorting need to be capable of discussing their own and their partners'' HIV status.⁷ When serosorting, merely assuming the HIV status of a partner is often substituted for explicit disclosure²⁰; however, serosorting cannot be effective under these conditions.We sought to examine partner selection practices that potentially contribute to disparate HIV infection rates among Black MSM and White MSM. First, we examined the sexual behavior of Black MSM versus that of White MSM. On the basis of previous studies, we hypothesized that Black MSM and White MSM would report similar numbers of unprotected anal intercourse partners. However, because the HIV status of partners men choose may drive the differences in HIV infection rates, we hypothesized that Black MSM would report more partners of unknown or positive HIV status than would White MSM and that White MSM would report more partners of negative HIV status than would Black MSM. In keeping with these hypotheses, we also predicted that Black MSM would report less favorable beliefs about serosorting and HIV status disclosure. Finally, we predicted that Black MSM would report higher HIV perceived risk because of their choosing serodiscordant partners.     

Circumcision and HIV Infection among Men Who Have Sex with Men in Britain: The Insertive Sexual Role

The objective was to examine the association between circumcision status and self-reported HIV infection among men who have sex with men (MSM) in Britain who predominantly or exclusively engaged in insertive anal intercourse. In 2007–2008, a convenience sample of MSM living in Britain was recruited through websites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey which included questions on circumcision status, HIV testing, HIV status, sexual risk behavior, and sexual role for anal sex. The analysis was restricted to 1,521 white British MSM who reported unprotected anal intercourse in the previous 3 months and who said they only or mostly took the insertive role during anal sex. Of these men, 254 (16.7 %) were circumcised. Among men who had had a previous HIV test (n = 1,097), self-reported HIV seropositivity was 8.6 % for circumcised men (17/197) and 8.9 % for uncircumcised men (80/900) (unadjusted odds ratio [OR], 0.97; 95 % confidence interval [95 % CI], 0.56, 1.67). In a multivariable logistic model adjusted for known risk factors for HIV infection, there was no evidence of an association between HIV seropositivity and circumcision status (adjusted OR, 0.79; 95 % CI, 0.43, 1.44), even among the 400 MSM who engaged exclusively in insertive anal sex (adjusted OR, 0.84; 95 % CI, 0.25, 2.81). Our study provides further evidence that circumcision is unlikely to be an effective strategy for HIV prevention among MSM in Britain.     

Sexual Negotiation, HIV-Status Disclosure, and Sexual Risk Behavior Among Latino Men Who Use the Internet to Seek Sex with Other Men

As part of a wider study of Internet-using Latino men who have sex with men (MSM), we studied the likelihood that HIV-negative (n=200) and HIV-positive (n=50) Latino MSM would engage in sexual negotiations and disclosure of their HIV status prior to their first sexual encounters with men met over the Internet. We also analyzed the sexual behaviors that followed online encounters. Our results showed that both HIV-negative and positive men were significantly more likely to engage in sexual negotiation and serostatus disclosure on the Internet than in person. Those who engaged in sexual negotiations were also more likely to use condoms for anal intercourse. Compared to HIV-negative MSM, HIV-positive MSM were significantly less likely to disclose their serostatus, and 41% of them acknowledged having misrepresented their serostatus to a prospective sexual partner met over the Internet. Although similar proportions of HIV-positive and negative men had condomless anal intercourse, HIV-positive MSM were more likely to report lack of intention to use condoms. Pleasure was the reason most frequently cited for lack of condom use. Cybersex was reported by only one-fifth of the sample. We conclude that the Internet, an understudied milieu of sexual networking, may present new possibilities for the implementation of risk reduction strategies, such as the promotion of sexual negotiation prior to first in-person encounter and serostatus disclosure.     

Methods for Recruiting Men of Color Who Have Sex with Men in Prevention-for-Positives Interventions

Men who have sex with men (MSM), especially MSM of color, are disproportionately impacted by HIV/AIDS compared to heterosexuals and Caucasians. Nonetheless, fewer sexual and ethnic minorities participate in prevention interventions for people with HIV. We consider recruitment for Positive Connections, a randomized controlled trial comparing unsafe sex prevention interventions primarily for HIV-positive (HIV+) MSM in six US epicenters. One community-based organization (CBO) in each city recruited adult MSM, particularly men of color and HIV+. Recruitment methods included on-line and print advertising, outreach events, health professionals, and social networks. Data on demographics, HIV status, and recruitment method were collected at registration. We tested for differences in registration proportions and attendance rates by recruitment strategy, stratified on race/ethnicity and serostatus. Of the 1,119 registrants, 889 attended the intervention. The sample comprised 41% African American, 18% Latino/Hispanic, and 77% HIV+. Friend referral was reported by the greatest proportion of registrants, particularly among African American (33%) and HIV+ men (25%). Print advertising yielded the largest proportions of non-Hispanic white (27%) and HIV-negative registrants (25%). Registrants recruited on-line were the least likely to attend (45% versus 69% average); this effect was strongest among Latino/Hispanic (27% attendance) and non-Hispanic white men (36%). Retention during the follow-up period did not differ by serostatus, race/ethnicity, or recruitment method. Differential attendance and retention according to recruitment strategy, serostatus, and racial/ethnic group can inform planning for intervention sample size goals.     

History of Childhood Sexual Abuse and Unsafe Anal Intercourse in a 6-City Study of HIV-Positive Men Who Have Sex With Men

Objectives. We assessed rates of childhood sexual abuse and its demographic and mental health correlates among HIV-positive men who reported unsafe anal intercourse with other men in the past year.Methods. We conducted a cross-sectional analysis of baseline data from 593 HIV-positive men who have sex with men enrolled in the Positive Connections intervention.Results. Childhood sexual abuse was reported by 47% of participants; 32% reported frequency as often or sometimes. Men reporting abuse were more likely to be Latino (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.6, 4.2; P < .001) or African American (OR = 1.8; 95% CI = 1.2, 2.7; P = .005) than White. Among those who were abused, more frequent abuse was associated with more sexual contacts (for each, rate ratio [RR] = 1.3; P < .001) and unsafe anal intercourse (often, RR = 1.5; sometimes, RR = 2.0; P < .001) compared with men who were not abused.Conclusions. History of childhood sexual abuse is highly prevalent among HIV-positive men who engage in risky sexual behavior with other men and appears to be more common among men of color. Our findings suggest that abuse is associated with a significantly increased risk of sexually transmitted infections.Considerable evidence suggests that men who have sex with men (MSM) and who experienced childhood sexual abuse are at heightened risk for HIV infection and sexually transmitted infections (STIs) and associated sexual risk behaviors. Several publications have indicated that self-reported history of sexual abuse is indirectly associated with high-risk sexual behaviors among diverse samples of MSM, such as attendees at targeted events and members of support organizations for lesbian, gay, bisexual, and transgender adolescents.^1–4These reports corroborate earlier studies that found that MSM who reported childhood sexual abuse were at higher risk of becoming HIV positive and engaged in higher rates of unprotected anal intercourse. Few of these studies have focused on whether a history of childhood sexual abuse among HIV-positive MSM is associated with unprotected anal intercourse with partners who are HIV negative.^5–8 In a study of HIV-positive MSM recruited at gay venues in San Francisco and New York City, O''Leary et al. found an association between a history of childhood sexual abuse and unprotected anal intercourse with partners who were HIV negative or of unknown infection status.⁹ With little other research published on the effect of childhood sexual abuse on unsafe sexual behavior among HIV-positive MSM, the generalizability of this report is unknown.Few studies have had an adequate overall sample size to address differences in reported rates of childhood sexual abuse by race/ethnicity with precision. In a study of more than 1000 predominantly HIV-negative MSM, Doll et al. reported higher rates of childhood sexual abuse among African American and Latino than White MSM.¹⁰ Surveillance reports reveal very high rates of diagnosed and undiagnosed HIV infection among MSM of color^11,12; therefore it is critical to identify risk factors that may contribute to higher rates of unsafe sex among racial/ethnic subgroups of HIV-positive MSM.We examined the prevalence of self-reported history of childhood sexual abuse and the demographic and behavioral correlates of such abuse in a group of racially diverse HIV-positive MSM who reported anal intercourse with other men in the past year and who were enrolled in a weekend sexual health intervention to reduce unsafe sexual behavior. We hypothesized that men who reported childhood sexual abuse would also report higher rates of unprotected anal intercourse with men of HIV serodiscordant or unknown HIV infection status.     

History of Arrest and Associated Factors among Men Who Have Sex with Men

Incarceration has been proposed to be a driving factor in the disproportionate impact of HIV in African-American communities. However, few data have been reported on disparities in criminal justice involvement by race among men who have sex with men (MSM). To describe history of arrest and associated factors among, we used data from CDC’s National HIV Behavioral Surveillance system. Respondents were recruited by time–space sampling in venues frequented by MSM in 15 US cities from 2003 to 2005. Data on recent arrest (in the 12 months before the interview), risk behaviors, and demographic information were collected by face-to-face interview for MSM who did not report being HIV-positive. Six hundred seventy-nine (6.8%) of 10,030 respondents reported recent arrest. Compared with white MSM, black MSM were more likely to report recent arrest history (odds ratio (OR), 1.6; 95% confidence interval (CI), 1.3–2.1). Men who were less gay-identified (bisexual [OR, 1.5; 95% CI, 1.1–1.9] or heterosexual [OR, 2.0; 95% CI, 1.2–3.5]) were more likely to report recent arrest than homosexually identified men. In addition, men who reported arrest history were more likely to have used non-injection (OR, 3.0; 95% CI, 2.4–3.6) and injection (OR, 4.7; 95%, 3.3–6.7) drugs, exchanged sex (OR, 2.7; 95% CI, 2.1–3.4), and had a female partner (OR, 1.5; 95% CI, 1.2–2.0) in the 12 months before interview. Recent arrest was associated with insertive unprotected anal intercourse in the 12 months before interview (OR, 1.4; 95% CI, 1.2–1.7). Racial differences in arrest seen in the general US population are also present among MSM, and history of arrest was associated with high-risk sex. Future research and interventions should focus on clarifying the relationship between criminal justice involvement and sexual risk among MSM, particularly black MSM.     

Sexual Stereotypes Ascribed to Black Men Who Have Sex with Men: An Intersectional Analysis

Sexual stereotypes may adversely affect the health of Black men who have sex with men (MSM). Greater understanding of the nature and nuances of these stereotypes is needed. This online, survey-based study used an inductive, intersectional approach to characterize the sexual stereotypes ascribed to Black MSM by the U.S. general public, their distinctiveness from those ascribed to Black men and MSM in general, and their relative prototypicality as compared to dominant subgroups. Members of the public, recruited in 2014–2015, were randomly assigned to survey conditions that varied systematically by race (Black, White, or unspecified) and sexual orientation (gay, heterosexual, or unspecified) of a designated social group. Participants (n = 285) reported stereotypes of their assigned group that they perceived to exist in U.S. culture in an open-response format. Cross-condition comparisons revealed that, overall, Black gay male stereotypes were non-prototypical of Black men or gay men. Rather, stereotypes of Black men were more similar to Black heterosexual men and stereotypes of gay men were more similar to White gay men. Nonetheless, 11 of the 15 most frequently reported Black gay male stereotypes overlapped with stereotypes of Black men (e.g., large penis), gay men (e.g., deviant), or both (e.g., promiscuous). Four stereotypes were unique relative to both Black men and gay men: down low, diseased, loud, and dirty. Findings suggest that Black MSM face multiple derogatory sexual stereotypes, several of which are group-specific. These stereotypes are consistent with cultural (mis)representations of Black MSM and suggest a need for more accurate portrayals of existing sexual diversity within this group.     

Relationship Between Childhood Sexual Abuse and HIV-Related Risks Among Men Who Have Sex with Men: Findings from Mainland China

Men who have sex with men (MSM) carry the burden of HIV infection in China. Outside of China, a history of childhood sexual abuse (CSA) has been associated with HIV-related risks (behavioral, sexual, and mental health outcomes) among MSM. We therefore evaluated the relationship between CSA and these HIV-related risks among MSM in China. Cross-sectional data were collected via a survey from gay websites and social networking applications from MSM in 30 provinces in mainland China during a 3-month period in 2014 and 2015. Overall, 999 screened MSM who responded to questions on CSA were included. Multinomial logistic regression models—adjusted for sociodemographic confounders—showed that men who reported experiencing regular CSA and contact CSA, respectively, were more likely to use substances (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI] 1.39–2.62 and AOR, 1.70; 95% CI 1.25–2.31), had a history of sexually transmitted infections (AOR, 1.81; 95% CI 1.29–2.55 and AOR, 1.65; 95% CI 1.18–2.96), had more male sexual partners (AOR, 1.06; 95% CI 1.04–1.09 and AOR, 1.05; 95% CI 1.03–1.08), engaged in more condomless sex with men (AOR, 1.89; 95% CI 1.39–2.56 and AOR, 1.72; 95% CI 1.29–2.30), and experienced more psychological distress (AOR, 1.05; 95% CI 1.02–1.08 and AOR, 1.05; 95% CI 1.03–1.08). Both frequent and contact forms of CSA were positively associated with HIV-related risks among MSM, suggesting that general CSA prevention strategies and interventions are needed to support this population.     

Public Health Responses to the HIV Epidemic Among Black Men Who Have Sex With Men: A Qualitative Study of US Health Departments and Communities

In the United States, Black men who have sex with men (MSM) are disproportionately affected by HIV/AIDS. Thus, there is a need to understand the challenges facing health departments and community-based organizations responding to the HIV epidemic among this population. We interviewed 71 AIDS program directors, health department staff, and leaders of community-based organizations in 9 states and the District of Columbia. Participants identified psychosocial factors, a lack of capacity-building efforts, and stigma as barriers to HIV prevention responses targeting Black MSM. Participants identified culturally competent staff and culturally sensitive interventions as facilitating prevention responses. To ensure that HIV/AIDS interventions targeting Black MSM are effective, it is imperative to solicit the perceptions of frontline workers in health departments and community-based organizations.Black men who have sex with men (MSM) exhibit an extremely high and disproportionate rate of HIV infection in the United States relative to other groups. Three epidemiologic studies conducted within the past 10 years highlight this point. First, the Young Men''s Study employed a multisite, cross-sectional, venue-based survey methodology to collect behavioral and seroprevalence data from more than 3400 MSM between the ages of 15 and 22 years.¹ Findings from the study, released in 2000, showed that 14% of the Black MSM in the sample were HIV positive—the highest prevalence among the 5 ethnic groups represented by the sample. The study also showed that Black MSM were more than 6 times more likely than White MSM to be HIV positive.Second, a study conducted by the North Carolina Department of Health involved a retrospective review of North Carolina men aged 18 to 30 years who were diagnosed with HIV between 2000 and 2003.² The study reported an increase in HIV cases among male college students from 2 in 2000 to 56 in 2003. Of the 56 cases in 2003, 88% were Black, and almost all were MSM.Finally, the most disheartening seroprevalence data were published in 2005, from the Centers for Disease Control and Prevention''s 5-city study of MSM.³ The study, which used a methodology similar to that of the Young Men''s Study, showed an HIV prevalence of 46% among Black MSM, compared with 21% and 17% for White MSM and Latino MSM, respectively. Of the Black MSM who were HIV positive, 64% were unaware of their infection.Given the high and increasing rates of HIV infection among Black MSM, researchers have begun to place a greater emphasis on understanding the psychological, behavioral, sociocultural, and historical factors that may place these men at greater risk of becoming infected with HIV or transmitting the virus to sexual partners. For example, Millett et al.,⁴ in a seminal literature review, noted that rates of HIV risk behavior (e.g., unprotected anal intercourse, injection drug use, and substance use during sex) were no higher among Black MSM than among White or Latino MSM. However, their research suggested that the higher HIV incidence observed among Black MSM might be explained by the higher rates of sexually transmitted infections among this population. Sexually transmitted infections cause decreased immune-system functioning, thus making men more susceptible to the acquisition and transmission of HIV. The literature review also suggested that a lack of HIV testing and late HIV diagnosis among Black MSM could be linked to heightened risk for HIV among this group. Other work by Millett et al.^5,6 points toward characteristics of the sexual partners of Black MSM (e.g., older age, Black race, HIV-positive status) as important factors in explaining heightened HIV risk.Likewise, Malebranche,⁷ in pointing out steps for public health researchers and practitioners to take in thwarting the growth of the HIV/AIDS epidemic among Black MSM, suggested that a comprehensive understanding of HIV risk among Black MSM will require an examination of sexual networks, men''s understandings of masculinity and sexuality, health care access, and increased susceptibility related to social and environmental stressors, among other issues. Other researchers have noted that homophobia and AIDS stigma within the families and communities of Black MSM may also explain heightened HIV/AIDS risk.⁸ Homophobia and stigma may operate to reduce HIV testing and other protective behaviors among Black MSM and may impede HIV-status disclosure among HIV-positive Black MSM. These findings represent just a few of the myriad risk factors that may undergird the high rates of HIV infection and AIDS among Black MSM, highlighting the increased attention that needs to be focused on this public health crisis.     

Bridging Sexual Boundaries: Men Who Have Sex with Men and Women in a Street-Based Sample in Los Angeles

The purpose of the study was to determine the potential contribution of bisexual men to the spread of HIV in Los Angeles. We compare the characteristics and behaviors of men who have sex with men and women (MSMW) to men who have sex with only women (MSW) and men who have sex with only men (MSM) in Los Angeles. Men (N?=?1,125) who participated in one of the two waves of data collection from 2005 to 2007 at the Los Angeles site for NIDA’s Sexual Acquisition and Transmission of HIV—Cooperative Agreement Program were recruited using Respondent Driven Sampling. Participants completed Audio Computer Assisted Self Interviews and received oral HIV rapid testing with confirmatory blood test by Western Blot and provided urine specimens for detection of recent powder cocaine, crack cocaine, methamphetamine, or heroin use. MSM, MSW, or MSMW were defined by the gender of whom they reported sex with in the past 6 months. Chi-square tests and ANOVAs were used to test independence between these groups and demographic characteristics, substance use, and sexual behaviors. We fit generalized linear random intercept models to predict sexual risk behaviors at the partner level. Men were mostly of low income, unemployed, and minority, with many being homeless; 66% had been to jail or prison, 29% had ever injected drugs, and 25% had used methamphetamine in the past 30 days. The sample had high HIV prevalence: 12% of MSMW, 65% of MSM, and 4% of MSW. MSMW were behaviorally between MSW and MSM, except that more MSMW practiced sex for trade (both receiving and giving), and more MSMW had partners who are drug users than MSW. Generalized linear random intercept models included a partner-level predictor with four partner groups: MSM, MSMW-male partners, MSMW-female partners, and MSW. The following were significantly associated with unprotected anal intercourse (UAI): MSW (AOR 0.15, 95% CI 0.08, 0.27), MSMW-female partners (AOR 0.4, 95% CI 0.27, 0.61), HIV-positive partners (AOR 2.03, 95% CI 1.31, 3.13), and being homeless (AOR 1.37, 95% CI 1.01, 1.86). The factors associated with giving money or drugs for sex were MSMW-female partners (AOR 1.70, 95% CI 1.09, 2.65), unknown HIV status partners (AOR 1.72, 95% CI 1.29, 2.30), being older (AOR 1.02, 95% CI 1.00, 1.04), history of incarceration (AOR 1.64, 95% CI 1.17, 2.29), and being homeless (AOR 1.73, 95% CI 1.27, 2.36). The following were associated with receiving money or drugs for sex: MSW (AOR 0.53, 95% CI 0.32, 0.89), African American (AOR 2.42, 95% CI 1.56, 3.76), Hispanic (AOR 1.85, 95% CI 1.12, 3.05), history of incarceration (AOR 1.44, 95% CI 1.04, 2.01), history of injecting drugs (AOR 1.57, 95% CI 1.13, 2.19), and had been recently homeless (AOR 2.14, 95% CI 1.57, 2.94). While overall HIV-positive MSM had more UAI with partners of any HIV status than MSMW with either partner gender, among HIV-positive MSMW, more had UAI with HIV-negative and HIV status unknown female partners than male partners. Findings highlight the interconnectedness of sexual and drug networks in this sample of men—as most have partners who use drugs and they use drugs themselves. We find a concentration of risk that occurs particularly among impoverished minorities—where many men use drugs, trade sex, and have sex with either gender. Findings also suggest an embedded core group of drug-using MSMW who may not so much contribute to spreading the HIV epidemic to the general population, but driven by their pressing need for drugs and money, concentrate the epidemic among men and women like themselves who have few resources.     

Bridging Sexual Boundaries: Men Who Have Sex with Men and Women in a Street-Based Sample in Los Angeles

The purpose of the study was to determine the potential contribution of bisexual men to the spread of HIV in Los Angeles. We compare the characteristics and behaviors of men who have sex with men and women (MSMW) to men who have sex with only women (MSW) and men who have sex with only men (MSM) in Los Angeles. Men (N = 1,125) who participated in one of the two waves of data collection from 2005 to 2007 at the Los Angeles site for NIDA’s Sexual Acquisition and Transmission of HIV—Cooperative Agreement Program were recruited using Respondent Driven Sampling. Participants completed Audio Computer Assisted Self Interviews and received oral HIV rapid testing with confirmatory blood test by Western Blot and provided urine specimens for detection of recent powder cocaine, crack cocaine, methamphetamine, or heroin use. MSM, MSW, or MSMW were defined by the gender of whom they reported sex with in the past 6 months. Chi-square tests and ANOVAs were used to test independence between these groups and demographic characteristics, substance use, and sexual behaviors. We fit generalized linear random intercept models to predict sexual risk behaviors at the partner level. Men were mostly of low income, unemployed, and minority, with many being homeless; 66% had been to jail or prison, 29% had ever injected drugs, and 25% had used methamphetamine in the past 30 days. The sample had high HIV prevalence: 12% of MSMW, 65% of MSM, and 4% of MSW. MSMW were behaviorally between MSW and MSM, except that more MSMW practiced sex for trade (both receiving and giving), and more MSMW had partners who are drug users than MSW. Generalized linear random intercept models included a partner-level predictor with four partner groups: MSM, MSMW-male partners, MSMW-female partners, and MSW. The following were significantly associated with unprotected anal intercourse (UAI): MSW (AOR 0.15, 95% CI 0.08, 0.27), MSMW-female partners (AOR 0.4, 95% CI 0.27, 0.61), HIV-positive partners (AOR 2.03, 95% CI 1.31, 3.13), and being homeless (AOR 1.37, 95% CI 1.01, 1.86). The factors associated with giving money or drugs for sex were MSMW-female partners (AOR 1.70, 95% CI 1.09, 2.65), unknown HIV status partners (AOR 1.72, 95% CI 1.29, 2.30), being older (AOR 1.02, 95% CI 1.00, 1.04), history of incarceration (AOR 1.64, 95% CI 1.17, 2.29), and being homeless (AOR 1.73, 95% CI 1.27, 2.36). The following were associated with receiving money or drugs for sex: MSW (AOR 0.53, 95% CI 0.32, 0.89), African American (AOR 2.42, 95% CI 1.56, 3.76), Hispanic (AOR 1.85, 95% CI 1.12, 3.05), history of incarceration (AOR 1.44, 95% CI 1.04, 2.01), history of injecting drugs (AOR 1.57, 95% CI 1.13, 2.19), and had been recently homeless (AOR 2.14, 95% CI 1.57, 2.94). While overall HIV-positive MSM had more UAI with partners of any HIV status than MSMW with either partner gender, among HIV-positive MSMW, more had UAI with HIV-negative and HIV status unknown female partners than male partners. Findings highlight the interconnectedness of sexual and drug networks in this sample of men—as most have partners who use drugs and they use drugs themselves. We find a concentration of risk that occurs particularly among impoverished minorities—where many men use drugs, trade sex, and have sex with either gender. Findings also suggest an embedded core group of drug-using MSMW who may not so much contribute to spreading the HIV epidemic to the general population, but driven by their pressing need for drugs and money, concentrate the epidemic among men and women like themselves who have few resources.     

Economic,Legal, and Social Hardships Associated with HIV Risk among Black Men who have Sex with Men in Six US Cities

We assessed whether economic, legal, and social hardships were associated with human immunodeficiency virus (HIV) risk among a sample of Black men who have sex with men (MSM) and whether associations were moderated by city of residence. The study analyzed baseline and follow-up data from HIV Prevention Trials Network 061 (N = 1553). Binary logistic regression assessed associations between hardships and HIV risk indicators. Multivariate regressions were used to test if city of residence had a moderating effect for hardships and HIV risks. Adjusted analyses showed that Black MSM with recent job loss were more likely to engage in condomless insertive anal intercourse (adjusted odds ratios (AOR) = 1.37, 95 % CI 1.01–1.87) and that those with recent financial crisis were more likely to have had two or more male sexual partners in the past 6 months (AOR = 1.65; 95 % CI 1.18–2.29). Black MSM with recent convictions were more likely to have a sexually transmitted infection at 6 months (AOR = 3.97; 95 % CI 1.58–9.94), while those who were unstably housed were more likely to have a sexually transmitted infection at 12 months (AOR = 1.71; 95 %CI 1.02 = 2.86). There were no city of residence and hardship interaction effects on HIV risks. Hardships are important factors that influence HIV risk for Black MSM. Integrating strategies that address structural factors that influence HIV risk may enhance HIV prevention interventions implementation efforts.     

Preference for and Maintenance of Anal Sex Roles Among Men Who Have Sex with Men: Sociodemographic and Behavioral Correlates

Self-labeling of, and preference for, anal sex roles is an important aspect of identities and cultures among men who have sex with men (MSM) populations. In this article, we examined sociodemographic and behavioral correlates of preference for and maintenance of anal sex roles, and risk for HIV infection. Using time-location sampling, we conducted a cross-sectional survey of racially diverse MSM in San Francisco. Of the 386 men who reported an anal sex role preference, 41% preferred being “versatile” while 21 and 37% preferred being “bottom” and “top” only. Lower educated men, Asian/Pacific Islander men, and men born in Asia/Philippines were more likely to prefer being “bottom.” Among all racial/ethnic groups, men in general did not maintain their preferences 100% of the time in their reported sexual behavior, and none of the racial/ethnic groups maintained their preference at greater or lesser levels than any other group. There were no significant differences in all the behavioral risks between men who maintained their preferences and those who did not. Yet, prevalence of HIV infection was two times higher among men who were strictly “bottom.” Linguistically and/or culturally appropriate HIV prevention information/interventions at an appropriate educational level should be provided to those from the developing world and those of lower socioeconomic status, who may lack the knowledge of differential risks associated with anal sex activities.