Sexuality and Risk Behavior among Men Who have Sex with Men in León,Nicaragua: A Mixed Methods Approach

IntroductionHIV prevalence among men who have sex with men (MSM) is 38 times higher than among the general population in Nicaragua. There are little data about the sexuality and sexual behaviors of MSM. It is essential to gain a better understanding of this understudied population.AimsThe nature of sexual relationships among MSM, their reasons for engaging in risky sexual behaviors, and the sociocultural context in León, Nicaragua, were investigated through in-depth interviews. Our findings resulted in a structured overview of sociodemographic characteristics and HIV-related knowledge, attitudes, and risk behaviors.MethodsFifteen participants recruited by purposive sampling completed an in-depth interview that was then thematically analyzed. An additional 104 participants were surveyed by means of an interviewer-administered questionnaire.Main Outcome MeasuresThe in-depth interview guide and the survey covered topics related to sociodemographics, childhood, social and sexual relationships, knowledge and attitudes toward HIV and AIDS, identity, and networks.ResultsThe resulting ecological model explored sexuality and behaviors in four categories. It showed that despite a homophobic and heterosexist society, there is an increasing gay community and greater social acceptance of homosexuality. Nevertheless, interpersonal and intrapersonal factors continue to negatively influence MSM behavior. Quantitative findings demonstrate a satisfactory understanding of HIV transmission among this population, 75% of whom reported concerns of becoming infected with HIV in the future. Approximately one-half claimed that they always used condoms when having sex with men, but only one-third of the time with women, indicating inconsistent condom use. Negative attitudes toward HIV/AIDS were seldom heard.ConclusionsThis study is the first mixed methods approach in a Nicaraguan context that shows the interrelations among sex, sexuality, and identity at various levels of MSM life, and how they influence the sexual risk behaviors of individuals. Engaging in unprotected sex and postponing HIV testing are seen as cognitive dissonances. Ugarte Guevara WJ, Valladares Cardoza E, and Essén B. Sexuality and risk behavior among men who have sex with men in León, Nicaragua: A mixed methods approach. J Sex Med 2012;9:1634–1648.     

Versatility and HIV vulnerability: investigating the proportion of Australian gay men having both insertive and receptive anal intercourse

IntroductionThere is a lack of recent data on the extent to which gay men engage in insertive anal intercourse (IAI) and receptive anal intercourse (RAI). Accurate assessments of the overall risk of infection from HIV and other sexually transmitted infections (STIs) require such data because versatile men who engage in both roles have heightened vulnerability for becoming infected and infecting others.AimTo investigate the extent to which gay men are versatile with regard to having IAI and RAI.Main Outcome MeasuresPercentages of gay men who reported engaging in IAI, RAI, or both during the past 12 months and in their most recent sexual encounter.MethodsEight hundred fifty‐six Australian gay men completed an online survey to retrospectively report on their sexual practices over the past 12 months.ResultsOf men who had anal intercourse in the past 12 months, 83% had both IAI and RAI, of whom 57% were highly versatile in that they had approximately equal numbers of partners for IAI and RAI. Of men who had anal intercourse in their most recent sexual encounter, as many as one in five (20%) had reciprocal anal intercourse, having both IAI and RAI with the same partner in a single encounter. Condom use was significantly less likely with reciprocal (38%) than nonreciprocal anal intercourse (50%; P = 0.04). While highly versatile men were less likely to know their HIV status, practices at most recent sexual encounter such as reciprocal anal intercourse and condom use were not significantly related to either their HIV status or that of their partner.ConclusionsEngaging in both IAI and RAI appears to be common among gay men. HIV/STI prevention strategies would benefit from paying attention to the implications of high rates of versatile sexual practices, particularly the tendency for condoms to be used less often when having reciprocal anal intercourse. Lyons A, Pitts M, Smith G, Grierson J, Smith A, McNally S, and Couch M. Versatility and HIV vulnerability: Investigating the proportion of Australian gay men having both insertive and receptive anal intercourse. J Sex Med 2011;8:2164–2171.     

Gay Saunas and the Risks of HIV and Syphilis Transmissions in China—Results of a Meta‐Analysis

IntroductionPrevious studies suggest the risk of human immunodeficiency virus (HIV) transmission among men who have sex with men (MSM) is associated with characteristics of venues. However, very few studies have systematically compared HIV/sexually transmitted disease (STD) prevalence among MSM according to key venue type for sourcing sex partners.AimsThe aim of this study was to investigate the associations between HIV/syphilis prevalence and the types of venues, namely saunas, parks, gay bars, and the Internet, which are mostly used for sourcing male sex partners by MSM in China.MethodsMeta‐analyses using fixed‐effect and random‐effect methods were conducted. Secondary data were obtained from 10 concurrent surveys conducted in 10 cities basing on a common protocol. Pairwise comparisons (e.g., “saunas” vs. “parks”) were made.Main Outcomes MeasuresOdds ratios (OR) for HIV/syphilis infection in relations to venue type for partner sourcing.ResultsThe distribution of the most commonly used source to recruit male sex partner was 59.32% (Internet), 18.47% (gay bars), 14.18% (gay saunas), and 8.02% (parks). The median prevalence of HIV/syphilis was 10.49% and 19.38% (gay saunas), 2.12% and 16.25% (parks), 6.06% and 15.45% (Internet), and 4.41% and 11.90% (gay bars). We found significant between‐group differences when comparing “sauna” against “Internet” (HIV: OR = 2.27, 95% confidence interval [CI] = 1.65–3.12; syphilis: OR = 1.61, 95% CI = 1.07–2.41), “sauna” against “bars” (HIV: OR = 1.65, 95% CI = 1.14–2.39; syphilis: OR = 1.35, 95% CI = 1.02–1.78), and “parks” against “Internet” (syphilis: OR = 1.55, 95% CI = 1.12–2.15) as the main source to recruit male sex partners. Other pairwise comparisons were not statistically significant.ConclusionsThe results of this study suggest that those sourcing partners mainly from gay saunas have higher prevalence of HIV/syphilis when compared with those doing so via the Internet or gay bars. Venue based (sauna‐based) interventions using socio‐ecological approaches are greatly warranted in order to reduce HIV and syphilis prevalence among MSM in China. Lau JTF, Zhao J‐K, Wu X‐B, Gu J, and Hao C. Gay saunas and the risks of HIV and syphilis transmissions in China—results of a meta‐analysis. J Sex Med 2013;10:642–652.     

Are adolescent girls with Chlamydia infection notifying their partners?

OBJECTIVES: (1) To determine the proportion of inner-city adolescent girls diagnosed with chlamydial cervicitis who notify their sex partners; (2) to examine girls' attitudes and perceptions about partner notification and treatment; and (3) to assess whether or not girls knew if their partners were treated for chlamydia infection. DESIGN/METHODS: Adolescent girls who had a positive DNA hybridization test for chlamydial cervicitis from March 2000 to May 2002 completed a 37-item self-administered survey assessing sexual behavior and partner notification, as well as the Rosenberg self esteem scale. Subjects completed the survey 1-3 months after the diagnosis of chlamydia infection. RESULTS: Fifty-five adolescent girls (46% Hispanic, 36% African American) aged 13-21 years (mean 18.3 years) completed the survey. The median age at first intercourse was 14 (SD = 1.6); median number of lifetime sex partners was 4. Forty-one subjects (75%) notified their sex partners. The most common reasons for partner notification were"I did not want my sex partner to give the infection back to me"and"I wanted to let my sex partner know that he/she had given me the infection". There was a trend toward increased notification if the girls were 18 years of age or older (P = 0.07) or had only one lifetime sex partner (P = 0.08). Of the 41 subjects who notified their partners, 22 (54%) reported that the partners were treated; 16 did not know, and three knew that partners were not treated. CONCLUSIONS: The majority of inner-city girls in this study notified their partners about chlamydia infection. Self-protection from re-infection was an important reason given for notification and suggests that girls in committed ongoing relationships might be more likely to notify partners.     

Sex, life and the female condom: some views of HIV positive women

This article offers some insights into the experiences of HIV positive women with the female condom, drawing on my own personal experience and responses of 18 members of the International Community of Women Living with HIV/AIDS to an e-mail survey conducted in 2005. Major barriers reported to female condom use were cost and sporadic or very limited access. All respondents talked about needing to negotiate the use of female condoms with their male sex partners. Most felt more in control and more confident during sex when using the female condom than with the male condom or unprotected sex. Concerns about female condoms appear to be common, especially among women who have never used one; those who had used the female condom for long periods of time said good things about it. Women reclaiming our bodies is a central part of the joy and the challenge of promoting the female condom. For HIV positive women and girls, using a condom is more than protection against pregnancy, but a matter of life and death greater than the risks pregnancy can bring. Female condoms could make a critically important contribution to protecting HIV positive women's sexuality and continued sexual activity, as a fundamental part of our sexual and reproductive rights, if only they were more widely available and affordable.     

HIV and gender-based violence: welcome policies and programmes,but is the research keeping up?

The global HIV policy arena has seen a surge of interest in gender-related dimensions of vulnerability to HIV and violence. UNAIDS and other prominent actors have named gender-based violence a key priority, and there seems to be genuine understanding and commitment to addressing gender inequalities as they impact key populations in the AIDS response. In the quest for evidence-informed interventions, there is usually a strong connection between the research conducted and the policies and programmes that follow. Regarding gender, HIV and violence, is this the case? This discussion paper asks whether the relevant peer-reviewed literature is suitably representative of all affected populations – including heterosexual men, transgender men and women, women who have sex with women, and men who have sex with men – as well as whether the literature sufficiently considers gender norms and dynamics in how research is framed. Conclusions about violence in the context of heterosexual relationships, and with specific attention to heterosexual women, should not be presented as insights about gender-based violence more generally, with little attention to gender dynamics. Research framed by a more comprehensive understanding of what is meant by gender-based violence as it relates to all of the diverse populations affected by HIV would potentially guide policies and programmes more effectively.     

ORIGINAL RESEARCH–MEN'S SEXUAL HEALTH: Self-Reported Sexual Difficulties and Their Association with Depression and Other Factors among Gay Men Attending High HIV-Caseload General Practices in Australia

IntroductionSexual expression affects physical, mental and social well-being. There is a lack of understanding of male sexual dysfunction in homosexually active men.AimWe investigated gay men's self-report of a number of sexual problems.MethodsThe survey data were from a sample of 542 self-identified gay men, 40% of whom were HIV positive, recruited from six high HIV-caseload general practices in Australia.Main Outcome MeasuresThe reporting of experiencing three or more sexual problems over a period of at least 1 month in the 12 months prior to a survey was defined here as having “multiple” sexual problems. We explored a number of factors, including HIV status, depression, alcohol and other drug use, and sexual risk-taking with casual male partners, in association with multiple sexual problems.ResultsRates of a range of self-reported sexual problems were high, with erectile dysfunction and lack of sexual desire being the most commonly reported. These high rates were consistent with the limited data from previous Australian studies. Men who had multiple sexual problems were likely to suffer from major depression (P < 0.001). A higher proportion of the HIV-positive gay men (48.4%) reported multiple sexual problems than the HIV-negative men (35.1%, P = 0.002). Factors independently associated with multiple sexual problems among the HIV-negative gay men were poorer general health and interpersonal isolation, whereas for the HIV-positive gay men, they were adoption of avoidant strategies to cope with daily life stress, sexual risk-taking in casual encounters, and the use of antidepressants.ConclusionsOur findings underscore the complex interactions between depression, sexual dysfunction, sexual risk taking, HIV infection, and general well-being among homosexually active men. Mao L, Newman CE, Kidd MR, Saltman DC, Rogers GD, and Kippax SC. Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia. J Sex Med 2009;6:1378–1385.     

Reproduction in same sex couples: quality of parenting and child development

PURPOSE OF REVIEW: Same sex couples are steadily becoming more open about their relationships. One consequence of this growing openness is that more couples of the same sex are choosing to have children and infertility treatment centers are increasingly faced with requests for assistance in creating these families. The aim of this review is to address new trends in reproduction in same sex couples, to consider the quality of parenting in lesbian mother and gay father households, and to review the literature on the development of children raised by same sex couples. RECENT FINDINGS: The current literature on these families is limited by small sample sizes and a predominance of studies of lesbian mothers and their children, with few studies of gay fathers and their children. A recent study of adolescents living with same sex parents recruited from a large national sample supports the notion that adolescents raised by same sex couples are doing well psychologically and are not more likely to be homosexual. The authors concluded that it was the quality of parenting, not parental sexual orientation that accounted for developmental differences. SUMMARY: The literature supports the notion that children of lesbian mothers and gay fathers are not more likely to become homosexual and are not measurably different from children raised by heterosexual parents in terms of personality development, psychological development, and gender identity. Larger longitudinal studies of same sex parents, particularly gay men, are needed, including those who choose to become parents through the use of assisted reproduction.     

How Willing are Men Who Have Sex with Men in China to be Circumcised for the Sake of Protecting His Female Sex Partner?

IntroductionThe HIV prevalence among men who have sex with men (MSM) is increasing sharply in China. Many MSM have female sexual partners, representing a bridge of transmitting HIV to the general population. Circumcision reduces the risk of HIV prevention via heterosexual intercourse.AimThe study investigated the prevalence and factors related to willingness to undergo circumcision when MSM were informed that circumcision could reduce risk of heterosexual HIV transmission.MethodsAn anonymous cross‐sectional survey was conducted in Jiangsu, China. A total of 157 MSM with bisexual behaviors in the last six months were recruited using snowball sampling.Main Outcome MeasuresSelf‐reported circumcision status and foreskin conditions were recorded. HIV‐related knowledge, risk perceptions, risky sexual behaviors, cognitive and behavioral intention factors regarding circumcision were assessed.ResultsAmong all respondents, 5.7% were circumcised. In the uncircumcised subsample, the willingness to be circumcised increased from 8.1% to 35.1% after they were informed about the 50% risk reduction effect of circumcision regarding heterosexual HIV transmission. Risk behaviors, uncertainty about the prevalence of HIV among MSM, perception of overly long foreskin, peer's suggestion, disagreement with the statements “MSM in general are not willing to be circumcised” and “circumcisions are for children, not for adults” and self‐efficacy for circumcision were significantly associated with willingness for circumcision given the hypothetical risk reduction effect (OR = 2.37 and 3.11, respectively, P < 0.05). Perception of overly long foreskin, self‐efficacy, and having used a condom in the last episode of sex with a woman remained significantly associated with the conditional willingness for circumcision in the multivariate analysis (OR = 3.03, 2.84 and 2.42, respectively, P < 0.05).ConclusionsInterventions promoting circumcision among bisexual MSM, based on the risk reduction effect on heterosexual HIV transmission, are likely to be successful. Such programs should focus on increasing self‐efficacy and may consider utilizing a peer educator approach. Lau JTF, Yan H, Lin C, Zhang J, Choi K‐C, Wang Z, Hao C, Huan X, and Yang H. How willing are men who have sex with men in China to be circumcised for the sake of protecting his female sex partner? J Sex Med 2012;9:1921–1929.     

Adolescent girls with illegally induced abortion Dar es Salaam: The discrepancy between sexual behaviour and lack of access to contraception

This article reports on a study of induced abortion among adolescent girls in Dar es Salaam, Tanzania, who were admitted to a district hospital in Dar es Salaam because of an illegally induced abortion in 1997. In the quantitative part of the study, 197 teenage girls (aged 14–19) were asked for socio-economic details, contraceptive knowledge/use, age at first intercourse and number of sexual partners. In the qualitative part, 51 teenage girls were interviewed in-depth about their relationships with their partners, sexual behaviour, contraceptive use and reasons for non-use, and why they became pregnant. The girls were sexually active at an early age and having sex mainly with men older than themselves. Although most of the girls were in love with and enjoyed sex with their partners, they also entered these relationships to obtain money or gifts in exchange for sex. Most were not using contraception or condoms though they were also at risk of STDs and HIV. These girls were getting pregnant expecting their boyfriends to marry them, or because they did not think they could become pregnant or failed to use contraception correctly. Most adolescent girls are not aware of the 1994 Tanzanian policy that gave them the right to seek family planning services and in practice these services are not being provided. There is a need for youth-friendly family planning services and to make abortion safe and legal, in order to reduce unwanted pregnancies and abortion-related complications and deaths among adolescent girls.     

Adolescent girls with illegally induced abortion in Dar es Salaam: the discrepancy between sexual behaviour and lack of access to contraception.

This article reports on a study of induced abortion among adolescent girls in Dar es Salaam, Tanzania, who were admitted to a district hospital in Dar es Salaam because of an illegally induced abortion in 1997. In the quantitative part of the study, 197 teenage girls (aged 14-19) were asked for socio-economic details, contraceptive knowledge/use, age at first intercourse and number of sexual partners. In the qualitative part, 51 teenage girls were interviewed in-depth about their relationships with their partners, sexual behaviour, contraceptive use and reasons for non-use, and why they became pregnant. The girls were sexually active at an early age and having sex mainly with men older than themselves. Although most of the girls were in love with and enjoyed sex with their partners, they also entered these relationships to obtain money or gifts in exchange for sex. Most were not using contraception or condoms though they were also at risk of STDs and HIV. These girls were getting pregnant expecting their boyfriends to marry them, or because they did not think they could become pregnant or failed to use contraception correctly. Most adolescent girls are not aware of the 1994 Tanzanian policy that gave them the right to seek family planning services and in practice these services are not being provided. There is a need for youth-friendly family planning services and to make abortion safe and legal, in order to reduce unwanted pregnancies and abortion-related complications and deaths among adolescent girls.     

The right to love: the desire for parenthood among men living with HIV

Drug regimens and procedures now exist that will prevent parents from transmitting HIV to infants, and the ethical and legal obligation to promote and protect the reproductive rights of those living with HIV should form part of training for HIV/AIDS care and prevention. This paper reports a study that investigated issues of sexuality and reproduction with 250 Brazilian men living with HIV in S?o Paulo. We asked whether they wished to have children and whether health professionals in HIV/AIDS treatment clinics that they attended were supportive of their wishes. Health professionals were not considered by most participants to be supportive enough or even impartial about HIV-positive people having children, and paid little attention to men's fathering role. 80% of the men had sexual relationships, and 43% of them wanted children, especially those who had no children, in spite of expectations of disapproval. Few of the men received information about treatment options that would protect infants, however. In previous studies with HIV-positive women attending the same clinics, by comparison, greater knowledge about prevention of perinatal HIV transmission was reported, but women had fewer sexual relationships, fewer desired to have children, and they expected even more disapproval of having children from health professionals. We conclude that the rights of those with HIV to found a family depend as much on curing the ills of prejudice and discrimination, including among health professionals, as on medical interventions.     

I'll show you mine if you'll show me yours

Gay men occupy a strange position when masculinity is discussed or studied; neither truly inside nor entirely outside its domains. There is a growing gap between gay and non-gaymen and women, which this paper describes with regard to relations with women, differences to feminist thinking, concerns of daily life, dealing with the HIV/AIDS epidemic and, most troubling and difficult to resolve, with regard to sex. An international gay community has evolved and a gay life style and masculinity have been defined and developed within it, which from both outside and inside are seen as ‘other’ and separate. To overcome this growing divide and its negative consequences, this paper challenges feminists and heterosexual men to take on board the issues of homosexuality and homophobia as an integral part of trying to understand masculine heterosexual sex, masculinity and sexual politics.     

Demographic and psychosocial features of participants in bondage and discipline, "sadomasochism" or dominance and submission (BDSM): data from a national survey

IntroductionPeople with sexual interests in bondage and discipline, “sadomasochism” or dominance and submission (BDSM) have been seen by many professionals as damaged or dangerous.AimTo examine sexual behavior correlates of involvement in BDSM and test the hypothesis that BDSM is practiced by people with a history of sexual coercion, sexual difficulties, and/or psychological problems.MethodsIn Australia in 2001–2002, a representative sample of 19,307 respondents aged 16–59 years was interviewed by telephone. Weighted data analysis used univariate logistic regression.Main Outcome MeasuresSelf-reported demographic and psychosocial factors; sexual behavior and identity; sexual difficulties.ResultsIn total, 1.8% of sexually active people (2.2% of men, 1.3% of women) said they had been involved in BDSM in the previous year. This was more common among gay/lesbian and bisexual people. People who had engaged in BDSM were more likely to have experienced oral sex and/or anal sex, to have had more than one partner in the past year, to have had sex with someone other than their regular partner, and to have: taken part in phone sex, visited an Internet sex site, viewed an X-rated (pornographic) film or video, used a sex toy, had group sex, or taken part in manual stimulation of the anus, fisting or rimming. However, they were no more likely to have been coerced into sexual activity, and were not significantly more likely to be unhappy or anxious—indeed, men who had engaged in BDSM scored significantly lower on a scale of psychological distress than other men. Engagement in BDSM was not significantly related to any sexual difficulties.ConclusionOur findings support the idea that BDSM is simply a sexual interest or subculture attractive to a minority, and for most participants not a pathological symptom of past abuse or difficulty with “normal” sex. Richters J, de Visser RO, Rissel CE, Grulich AE, and Smith AMA. Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (BDSM): Data from a national survey.     

To push ... or not to push?

I was formally asked by my supervisor of midwives to reflect upon two episodes of care. Both of these involved women who would be termed as 'low risk' primigravida and in both instances the women had considered whether, had they been advised against pushing when it was 'too soon', they might have avoided caesarean sections. To help this process I used my own reflection triangle: 'What happened ... Was it OK ... What about next time?' informed by the Gibbs model (1998). In this paper I present my reflections alongside my reflection triangle.     

Characteristics of Vibrator Use by Gay and Bisexually Identified Men in the United States

IntroductionRecent reports indicate that vibrator use during solo and partnered sexual activities is common among heterosexual men and women in the United States. However, little research has comprehensively assessed vibrator use among gay and bisexually identified men.AimsThis study sought to document the extent to which gay and bisexually identified men report using vibrators, the sexual and relational situations within which they use them, and how men use vibrators on their own and their partners' bodies.MethodsData were collected from 25,294 gay and bisexually identified men from 50 U.S. states and from the District of Columbia via an internet-based survey.Main Outcome MeasureMeasures included sociodemographics, health-related indicators, sexual behaviors, and those related to recent and past use of vibrators during solo and partnered sexual interactions with other men.ResultsApproximately half (49.8%) of gay and bisexually identified men reported having used vibrators. Most men who had used a vibrator in the past reported use during masturbation (86.2%). When used during partnered interactions, vibrators were incorporated into foreplay (65.9%) and intercourse (59.4%). Men reported frequent insertion of vibrators into the anus or rectum when using them during masturbation (87.3%), which was also common during partnered interactions (~60%), but varied slightly for casual and relationship sex partners. For both masturbation and partnered interactions, men overwhelmingly endorsed the extent to which vibrator use contributed to sexual arousal, orgasm, and pleasure.ConclusionsVibrator use during both solo and partnered sexual acts was common among the gay and bisexually identified men in this sample and was described by men as adding to the quality of their sexual experiences. Reece M, Rosenberger JG, Schick V, Herbenick D, Dodge B, and Novak DS. Characteristics of vibrator use by gay and bisexually identified men in the United States.     

Gender roles and sexual behaviour

In social science studies, differences are identified between men's and women's perceptions of their own and the opposite sex's roles and responsibilities in society. In a Korean study of 849 school and university students, male respondents were significantly more accepting of their friends' sexual activities than were females. A study of 1000 young people in tertiary education institutions in Ilorin, Nigeria, found casual sex to be more than 5 times more common among males than among females. A study of young men and women in rural Thailand found that respondents who had not been married were more liberal about male premarital sexual activity than they were about women's activities. 98% of male and 44% of female factory workers surveyed in Chiang Mai, Thailand, believed premarital sex was acceptable for men. However, only 50% of the males and 15% of the females found such behavior acceptable for women. A study in Vietnam of the sexual behavior of university students found that a majority of both men and women believe sexual intercourse should occur only within marriage.     

Frequency,Reasons for,and Perceptions of Lubricant Use among a Nationally Representative Sample of Self‐Identified Gay and Bisexual Men in the United States

IntroductionFew previous studies have examined lubricant use among gay and bisexual men outside the context of human immunodeficiency virus risk reduction associated with condom use during penile–anal intercourse and the potential use of lubricants to deliver rectal microbicides. The vast majority of studies examining lubricant use among gay and bisexual men have employed convenience sampling strategies for participant recruitment. Additionally, most studies have collapsed gay men and bisexual men into one category of “gay and bisexual men.”AimsThis study aimed to provide overall rates of lubricant use and related factors among a nationally representative sample of self‐identified gay and bisexual men. Frequencies of lubricant use, reasons for using lubricant, and perceptions of lubricant use were examined separately for subsamples of both gay and bisexual men.MethodsData were from the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of women and men in the United States aged 18 and older, and we oversampled self‐identified gay and bisexual men and women; the results from male participants are included in this article.Main Outcome MeasuresMeasure included demographic characteristics, recent and lifetime commercial lubricant use, lubricant use during specific sexual behaviors, frequency of lubricant use, and reasons for lubricant use during sexual activity.ResultsOver 90% of both gay and bisexual male participants reported lifetime lubricant use. Use was most common during partnered sexual activities, particularly among men aged 25–29 years old. The most commonly reported reasons for lubricant use included to increase comfort during anal intercourse, curiosity, and to make sex more comfortable.ConclusionsMost gay and bisexual men in the United States have used lubricant to enhance a wide range of sexual activities, including but not limited to anal intercourse. Findings from this study will be of utility to clinicians and other health practitioners who seek to understand and promote sexual health among gay and bisexual men and other traditionally underserved public health populations. Dodge B, Schick V, Herbenick D, Reece M, Sanders SA, and Fortenberry JD. Frequency, reasons for, and perceptions of lubricant use among a nationally representative sample of self‐identified gay and bisexual men in the United States. J Sex Med 2014;11:2396–2405.     

Use of Illicit Drugs and Erectile Dysfunction Medications and Subsequent HIV Infection among Gay Men in Sydney,Australia

IntroductionUse of illicit drugs and oral erectile dysfunction medications (OEM) have been associated with risk behavior among gay men.AimTo determine the effects of illicit drugs and OEM as risk factors for HIV seroconversion in a community-based cohort of HIV-negative homosexually active men in Sydney, Australia.Main Outcome MeasuresDrug use in the previous 6 months and at the most recent sexual encounter; Most recent occasions of unprotected and protected anal intercourse; HIV-positive diagnosis.MethodsFrom June 2001 to June 2007, participants were followed up with 6-monthly detailed behavioral interviews and annual testing for HIV. Detailed information about sexual, drug-using and other behavior was collected.ResultsAmong 1,427 participants enrolled, 53 HIV seroconverters were identified by June 2007. At baseline, 62.7% reported using illicit drugs in the previous 6 months, including 10.7% who reported at least weekly use. Illicit drug use was associated with unprotected anal intercourse with casual partners (P < 0.001). Use of illicit drugs was associated with increased risk of HIV infection at a univariate level, and this risk increased with greater frequency of use. This was also true of the use of OEM. Use of each type of illicit drug was included in multivariate analysis, and after controlling for sexual risk behaviors, only use of OEM remained significantly predictive of HIV infection (Hazard ratios [HR] = 1.75, CI = 1.31–2.33, P < 0.001), although amyl nitrite was of borderline significance (HR = 1.26, CI = 0.98–1.62, P = 0.074).ConclusionThe association between drug use and increased risk of HIV infection was strongest for drugs used specifically to enhance sexual pleasure, particularly OEM. The risk of infection was substantially increased when both OEM and methamphetamine were used. Within more “adventurous” gay community subcultures, the interconnectedness of sexual behavior and drug use may be key to understanding HIV risk and is an appropriate priority in HIV-prevention efforts in this population. Prestage G, Jin F, Kippax S, Zablotska I, Imrie J, and Grulich A. Use of illicit drugs and erectile dysfunction medications and subsequent HIV infection among gay men in Sydney, Australia. J Sex Med 2009;6:2311–2320.     

HIV Risk in Group Sexual Encounters: An Event-Level Analysis from a National Online Survey of MSM in the U.S.

IntroductionResearchers have investigated group sexual encounters (GSEs) as potential sources for HIV/STI transmission among men who have sex with men (MSM); however, much of this work has focused on organized sex parties.AimTo compare behavioral and social characteristics of groups of men who engaged in three types of GSEs: threesomes, spontaneous group sex, and organized sex parties.MethodsIn 2012, 1,815 U.S.-based MSM completed an online survey.Main Outcome MeasureWe compared men based on their most recent type of GSE: threesome (68.2%), spontaneous group sex (19.7%), or organized sex party (12.1%).ResultsUsing multinomial logistic regression, with type of GSE as the dependent variable, MSM who were HIV-positive, used stimulants (cocaine, methamphetamine, crack), consumed five or more alcoholic drinks, and reported receptive unprotected anal intercourse (UAI) during the most recent GSE had significantly higher odds of having had spontaneous group sex as compared to a threesome. MSM who were HIV-positive, not in a relationship, and did not report receptive UAI during the most recent GSE had significantly higher odds of having attended an organized sex party as compared to a threesome. MSM who were in a relationship, had consumed five or more alcoholic drinks, had used stimulants, and reported receptive UAI during the most recent GSE had significantly higher odds of having had spontaneous group sex as compared to an organized sex party. Compared to others, those having engaged in a GSE were more likely to report recent UAI (65% vs. 45%).ConclusionsMen having engaged in a GSE were at greater risk for behaviors that transmit HIV and STIs. Unique social and behavioral characteristics inherent to threesomes, spontaneous group sex, and sex parties highlight the need to identify prevention strategies to help those who participate in GSEs reduce their risk for HIV and STI transmission. Grov C, Rendina HJ, Ventuneac A, and Parsons JT. HIV risk in group sexual encounters: An event-level analysis from a national online survey of MSM in the U.S. J Sex Med 2013;10:2285–2294.