Participation in Online and Offline HIV Prevention Among Men who have Sex with Men who use the Internet to Meet Sex Partners in New York City

This report presents data on participation in online or offline prevention activities among a sample of New York City men who have sex with men (MSM) recruited online between April–August of 2007 who use the Internet to meet sex partners. The analysis focuses on the 1,124 men who reported sex with a main or casual partner in the past 12 months. Over half (53%) of the MSM reported unprotected anal intercourse (UAI) in the past year. Data from our multivariate analysis indicate that MSM who participate in online or offline prevention activities were less likely to engage in UAI.     

A Daily Web Diary of the Sexual Experiences of Men who have Sex with Men: Comparisons with a Retrospective Recall Survey

The emergence of Internet technology provides a unique opportunity to collect real-time information on the sexual behaviors of persons at risk for HIV. However, relatively little is known of the utility and reliability of web diaries. To address this gap, 45 predominantly Caucasian and gay, Internet-using men who have sex with men completed a 4-week daily web diary of their sexual behaviors. Afterward, participants completed an online retrospective recall survey (RRS) of their sexual activities during the diary period and satisfaction ratings of the web diary method. Overall, web diary estimates of sexual behaviors differed from the RRS, with a tendency to over-report on the latter with the exception of insertive unprotected anal intercourse. Additionally, compliance rates were high and there was some evidence for reactivity. Participants evaluated the web diary method positively. Web diaries appear to be a promising tool for collecting information on health behaviors.     

An Online Needs Assessment of a Virtual Community: What Men Who Use the Internet to Seek Sex with Men Want in Internet-Based HIV Prevention

As part of a study to develop effective Internet-based HIV prevention interventions for Men who use the Internet to seek Sex with Men (MISM), we sought information from the target population on; (a) acceptability of sexually explicit media; (b) interest in specific content areas; and (c) identification of credible sources of information. A cross-sectional stratified Internet-based survey design was employed. Between September and November 2005, we recruited 2,716 MISM through Gay.com stratified across race/ethnicity to ensure adequate racial/ethnic diversity. Sixteen Likert-type items assessed acceptability of sexual explicitness, 24 items identified topics for inclusion, and two assessed sources of information. There was near universal acceptability for highly sexually explicit education. Over 75% reported high interest in 10 sexual health topics. HIV positive MISM and MISM engaged in unprotected anal sex with multiple male partners reported significantly less interest in HIV prevention specific content. Differences across age, race/ethnicity and education were identified. Idiosyncratic searches and gay sites were frequently cited sources of information; however blogs, government, and media sites were not. It is acceptable for web-based HIV prevention for MISM to be highly sexually explicit and to provide detailed content relevant to men’s sexual health. Since demographic differences in acceptability and content were minor, it is appropriate for interventions to target across demographics. Interventions to re-engage men engaging in high risk and HIV + MISM should be considered. Leading health agencies should review whether their web information is retrievable, credible and useful to those most at risk.     

Sexual behaviour patterns and condom use in Tanzania: results from the 1996 Demographic and Health Survey

We conducted this study to determine the factors associated with high-risk sexual behaviour and condom use among men and women who participated in the 1996 Tanzania Demographic and Health Survey (TDHS); and to assess changes in sexual behaviour between 1991/92 and 1996 TDHS. Respondents were regarded to have practised high-risk sexual behaviour if they were married or cohabiting and had other regular or non-regular sexual partners; or if they were unmarried and had non-regular partners or multiple regular partners. About 8% of women and 29% of men practised high-risk sexual behaviour. High-risk sexual behaviour was common among younger men and women, and decreased with increasing level of education in women. Respondents who were unmarried, Muslims and those who perceived themselves at increased risk of HIV/AIDS were more likely to practise high-risk sexual behaviour. About 4% of women and 15% of men reported to have used condoms during their last sexual encounter. Condom users were significantly more likely to practise high-risk sexual behaviour. Overall, no major changes in sexual behaviour and condom use were observed during the period between the two surveys. Predictors of high-risk sexual behaviour and condom use identified in this report provide valuable information that can be used to design targeted HIV/AIDS interventions in Tanzania.     

HIV Disclosure and Sexual Transmission Behaviors among an Internet Sample of HIV-positive Men Who Have Sex with Men in Asia: Implications for Prevention with Positives

The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR?=?37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR?=?1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1 and 5?years ago (AOR?=?2.23, 95% CI: 1.05, 4.74), and not knowing one's viral load (AOR?=?2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men.     

Receiving HIV Serostatus Disclosure from Partners Before Sex: Results from an Online Survey of Chinese Men Who Have Sex with Men

HIV serostatus disclosure before sex can facilitate serosorting, condom use and potentially decrease the risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men (MSM) in China. An online cross-sectional study was conducted among MSM in eight Chinese cities in July 2016. Participants completed questions covering sociodemographic information, sexual behaviors, HIV testing (including HIV self-testing) history, self-reported HIV status, and post-test violence. In addition, participants were asked whether they received HIV serostatus disclosure from their most recent partners before sex. Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. A minority (20.6%, 346/1678; 17.8%, 287/1608) of men received HIV serostatus disclosure from their most recent regular and casual male partners, respectively. Multivariate analysis indicated that participants who ever self-tested for HIV were more likely to have received HIV status disclosure from regular [adjusted OR (aOR) = 1.92, 95% CI 1.50–2.44] and casual (aOR = 2.34, 95% CI 1.80–3.04) male partners compared to never self-tested participants. Compared to participants who had not received HIV status disclosure from regular partners, participants who received disclosure from regular male partners had higher likelihood in experiencing post-test violence (aOR = 5.18, 95% CI 1.53–17.58). Similar results were also found for receiving HIV serostatus disclosure from casual partners. This study showed that HIV serostatus disclosure from partners was uncommon among Chinese MSM. Interventions and further implementation research to facilitate safe disclosure are urgently needed for MSM.     

The Synergistic Impact of Sexual Stigma and Psychosocial Well-Being on HIV Testing: A Mixed-Methods Study Among Nigerian Men who have Sex with Men

Although sexual stigma has been linked to decreased HIV testing among men who have sex with men (MSM), mechanisms for this association are unclear. We evaluated the role of psychosocial well-being in connecting sexual stigma and HIV testing using an explanatory sequential mixed methods analysis of 25 qualitative and 1480 quantitative interviews with MSM enrolled in a prospective cohort study in Nigeria from March/2013–February/2016. Utilizing structural equation modeling, we found a synergistic negative association between sexual stigma and suicidal ideation on HIV testing. Qualitatively, prior stigma experiences often generated psychological distress and perceptions of feeling unsafe, which decreased willingness to seek services at general health facilities. MSM reported feeling safe at the MSM-friendly study clinic but still described a need for psychosocial support services. Addressing stigma and unmet mental health needs among Nigerian MSM has the potential to improve HIV testing uptake.     

Prospective Measurement of Daily Health Behaviors: Modeling Temporal Patterns in Missing Data,Sexual Behavior,and Substance Use in an Online Daily Diary Study of Gay and Bisexual Men

Daily diary and other intensive longitudinal methods are increasingly being used to investigate fluctuations in psychological and behavioral processes. To inform the development of this methodology, we sought to explore predictors of and patterns in diary compliance and behavioral reports. We used multilevel modeling to analyze data from an online daily diary study of 371 gay and bisexual men focused on sexual behavior and substance use. We found that greater education and older age as well as lower frequency of substance use were associated with higher compliance. Using polynomial and trigonometric functions, we found evidence for circaseptan patterns in compliance, sexual behavior, and substance use, as well as linear declines in compliance and behavior over time. The results suggest potential sources of non-random patterns of missing data and suggest that trigonometric terms provide a similar but more parsimonious investigation of circaseptan rhythms than do third-order polynomial terms.     

Challenges in Research on Drug and Sexual Risk Practices of Men Who Have Sex with Men: Applications of Ethnography in HIV Epidemiology and Prevention

Epidemiological studies of persons who engage in illicit or illegal activities suffer from methodological difficulties in population definition and specification. Additionally, particularly in the context of HIV research, studies often lack the specificity and validity needed to understand and intervene in the behavioral practices by which viral pathogens such as HIV are transmitted. These limitations are particularly complicated in research among populations of drug-involved, men who have sex with men (DU/MSM), a hidden but internally diverse population which varies in both sexual behavior and drug use patterns across a number of complex and interacting dimensions. The challenges become even more profound when we factor in complexities of sexual identity and identity formation, the debilitating effects of multiple sources of stigma, and the economic imperatives that underpin drug and sexual risk practices among some groups of DU/MSM. This paper describes some of the uses of ethnographic methods, particularly participant-observation, in specifying the nature and interrelationship between risk practices among DU/MSM. We also show how ethnography can contribute to the process of disentangling the independent effects of age, period, and cohort factors, a perennial problem in epidemiological research in out-of-treatment populations.     

Understanding Differences in HIV Sexual Transmission among Latino and Black Men who have Sex with Men: The Brothers y Hermanos Study

HIV sexual transmission risk behaviors were examined among 1,065 Latino and 1,140 black men who have sex with men (MSM). Participants completed a computer-administered questionnaire and were tested for HIV infection. Of men who reported that their last HIV test was negative or that they had never been tested or did not get the result of their last test, 17% of black and 5% of Latino MSM tested HIV-positive in our study. In both ethnic groups, the three-month prevalence of unprotected anal intercourse (UAI) with HIV-negative or unknown serostatus partners was twice as high among men unaware of their HIV infection than men who knew they were HIV seropositive at the time of enrollment. UAI exclusively with HIV-positive partners was more prevalent among HIV-positive/aware than HIV-positive/unaware men. The findings advance understanding of the high incidence of HIV infection among black MSM in the U.S.     

Moderating Effects of Age on the Alcohol and Sexual Risk Taking Association: An Online Daily Diary Study of Men Who have Sex with Men

Men who have sex with men (MSM) account for the majority of HIV/AIDS diagnoses and data suggest infection rates are rising. Identification of factors that increase the risk of infection is key to the development of effective prevention programs. Previous research has been inconsistent regarding the link between alcohol consumption and sexual risk taking among MSM. Daily reports of alcohol consumption and sexual behavior were completed for up to 30 days by 143 HIV negative MSM recruited online. This resulted in 2,887 daily reports of number of sex partners and 549 episodes of sex. Independent variables included age, number of standard drinks consumed, and partner type. Outcome variables included sex with a partner, a composite sexual risk variable, and unprotected anal intercourse (UAI). Alcohol consumption significantly increased the odds of having sex and had a significant positive association with the sexual risk composite variable. Age was a significant moderator of the association between alcohol consumption and sexual risk taking, with the effects of alcohol increasing with age. For example, at the 75%tile of age (37 years old), the odds of UAI increase from ∼0.2 to 0.35 as the number of alcoholic drinks increases from zero to seven. Partner type did not have significant effects. Daily reports of alcohol consumption had a significant within-person association with sexual risk behaviors, particularly among older MSM. Findings highlight the importance of measuring individual differences as moderators of the association between alcohol and risky sexual behavior.     

Differences in HIV Risk and Prevention Among Cisgender Latino Sexual Minority Men by Language of Online Survey Completion: Analysis of National and Washington State Data

AIDS and Behavior - Internet-based surveys can be programmed and advertised in multiple languages to reach non-English-speaking individuals, but it is unclear the extent to which this enhances the...     

Correlates of Unprotected Anal Sex at Last Sexual Episode: Analysis from a Surveillance Study of Men who have Sex with Men in Montreal

Recent increases in rates of unprotected anal sex (UAS) among men who have sex with men (MSM) signal the need to continually refine our understanding of factors associated with risky sexual behavior. Data were collected using a questionnaire eliciting information about the last sexual episode (LSE) with another man in the past 6 months. Logistic regression was used to identify both event-level and background correlates of UAS at LSE. 965 participants who reported having sex with a partner with whom they were not in a couple relationship at LSE were studied. Several event-level variables were significantly associated with UAS after adjusting for background factors, including finding the partner at LSE sexually attractive and using alcohol or cocaine at LSE. Our findings parallel the results of other HIV prevention studies which have highlighted the importance of interpersonal factors that influence risk-taking at the moment of a sexual act among MSM.     

Feasibility, Acceptability, and Preliminary Efficacy of an Online HIV Prevention Program for Diverse Young Men who have Sex with Men: The Keep It Up! Intervention

Young men who have sex with men (YMSM) are disproportionately infected with HIV/AIDS and there are few prevention programs with published efficacy for this population. This study evaluated the feasibility, acceptability, and preliminary efficacy of an online, interactive, and highly engaging HIV prevention program called Keep It Up! The intervention was designed to be delivered to diverse YMSM upon receiving an HIV negative text result, with the goal for them to “Keep It Up” and stay negative. In a randomized clinical trial, the intervention was compared to an online didactic HIV knowledge condition. The study sample included 102 sexually active YMSM. Participants reported completing online modules in settings that were private and not distracting. Mixed methods data showed intervention participants felt the program was valuable and acceptable. Compared to the control condition, participants in the intervention arm had a 44 % lower rate of unprotected anal sex acts at the 12-week follow-up (p < 0.05).     

Behavioral Health and Social Normative Influence: Correlates of Concurrent Sexual Partnering Among Heterosexually-Active Homeless Men

Sexual concurrency poses significant HIV/STI transmission risk. The correlates of concurrency have not been examined among homeless men. A representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row area of Los Angeles reported on their mental health, substance use, and social network characteristics. Nearly 40% of men reported concurrency with one of their four most recent sex partners. Results indicated that HIV seropositivity (OR?=?4.39, CI: 1.10, 17.46; P?=?0.04), PTSD (OR?=?2.29, CI: 1.05, 5.01; P?=?0.04), hard drug use (OR?=?2.45, CI: 1.07, 5.58; P?=?0.03), and the perception that network alters engage in risky sex (OR?=?3.72, CI: 1.49, 9.30; P?=?0.01) were associated with increased odds of concurrency. Programs aimed at reducing HIV/STI transmission in this vulnerable population must take into account the roles that behavioral health and social networks may play in sexual concurrency.