Continuing unsafe sex: assessing the need for AIDS prevention counseling

To assess the need for acquired immunodeficiency syndrome (AIDS) prevention counseling for gay and bisexual men who were continuing to engage in unsafe sex, a nonprobability telephone survey--the data may not be generalizable to the population--was conducted in Seattle during March 1987. In a 4-week period, 141 callers phoned in response to local publicity and completed a 30-minute anonymous interview. This paper focuses on 106 male respondents who were behaviorally defined as gay (that is, sex during the past year exclusively with partners of the same sex, N = 74) or bisexual (sex with both men and women, N = 32). The modal respondent was a never-married white male in his thirties who had some college education and was employed full-time in a white collar occupation. The gay men were more likely than the bisexual men to report that their family members and friends knew of their sexual orientation and to indicate that they were able to discuss their concerns about unsafe sex with someone close to them. Gay men were also more likely to use condoms and to have engaged in anonymous sex during the 3 months before the interview. More gay men had engaged in unprotected receptive anal intercourse (27 percent) than had bisexual men (13 percent), and in considerably more insertive anal intercourse (42 percent versus 22 percent). Of the gay men interviewed, 73 percent indicated that they needed help in changing their high-risk sexual behaviors compared with 61 percent of bisexuals.(ABSTRACT TRUNCATED AT 250 WORDS)     

HIV transmission: Women's risk from bisexual men.

The purpose of this study was to characterize the risk of human immunodeficiency virus (HIV) infection for men who have sex with men and to identify the risk such men pose to their female sex partners. The subjects were 5480 men who were tested for HIV between January 1987 and December 1991 and who reported having had sex with a man since 1977. Men who identified themselves as bisexual or straight were more likely to use injection drugs, had a substantial HIV seroprevalence, and reported many more female partners than men who identified themselves as gay. Men who identify themselves as bisexual pose the greatest risk to their female partners.     

Gay and bisexual men’s interest in marriage: an Australian perspective

Same-sex marriage is a widely debated issue, including in Australia. This study used an online anonymous survey, with free-text responses, to investigate romantic and sexual relationships among Australian gay and bisexual men. We sought to identify what proportion of such men intended to marry their primary regular partner if marriage was made legally available to same-sex couples in Australia, as well as factors associated with intention or non-intention to marry. Most men in the sample did not intend to marry their primary regular partner. Even among men who considered themselves to be in a ‘relationship’ with their primary regular partner, less than half intended to marry him. However, many men who would not marry their current primary regular partner agreed that same-sex marriage should be available for gay and bisexual men in Australia. Reasons for intention to marry included a desire for social and legal equality, and ideas about marriage as a rite of passage, an expression of love and the most valued form of relationship in Australia. Those who did not intend to marry their primary regular partner offered a number of reasons, including that the nature of their relationship was incompatible with marriage, and reported a critical position towards marriage as a heteronormative institution.     

Comparing Gay and Bisexual Men on Sexual Behavior, Condom Use, and Psychosocial Variables Related to HIV/AIDS

Interviews were conducted with 750 men, recruited from a variety of sources in Chicago, who reported sex with men in the past 3 years. Behavioral criteria were used to establish groups of gay and bisexual men. We predicted that gay men, compared to bisexual men, would report more male sexual partners, more experience with receptive sex, and more tolerant attitudes toward homosexuality. The only reliable difference between the gay and bisexual men with respect to number of partners was that gay men were more likely to have had a steady male partner or lover. Gay men were more likely than bisexual men to have engaged in receptive sex, including unprotected receptive anal sex. Bisexual men were more self-homophobic and saw other people as less accepting of same-sex activity. There were no differences between gay and bisexual men in other psychosocial variables. Interventions designed to reduce the transmission of HIV/AIDS need to consider differences in gay and bisexual men's sexual behavior and attitudes toward homosexual behavior.     

男男性行为人群与男性性伴和女性性伴的性行为特征及影响因素

  目的  了解安徽省男男性行为人群（men who have sex with men,MSM）与其男性性伴和女性性伴的性行为特征及影响因素。  方法  以合肥、芜湖和六安3个城市为研究现场,采用滚雪球法和网络招募法招募MSM人群,对符合纳入标准的MSM进行匿名问卷调查。采用多因素Logistic回归分析模型分析MSM人群最近6个月发生异性性行为的危险因素。  结果  共招募1 200名MSM,最近6个月78.3% MSM与男性性伴有过肛交性行为,20.9%与女性性伴有过异性性行为,16.5%最近6个月与男性性伴、女性性伴均有过性行为。最近6个月异性性行为中的安全套坚持使用率（29.9%）明显低于同性性行为的安全套坚持使用率（53.0%）,在最近一次异性性行为中的安全套使用率（52.2%）也明显低于同性性行为中的安全套使用率（79.6%）（均有P < 0.05）。多因素分析结果显示,已婚（包括在婚/同居/离异/丧偶）、在调查城市居住时间>2年、有同性商业性行为的MSM更容易发生异性性行为。  结论  MSM人群存在较高比例的双性性行为,且安全套坚持使用率较低,应该加强对他们的性健康教育、风险感知教育和行为干预。     

The other side of the bridge: exploring the sexual relationships of men who have sex with men and their female partners in Mumbai,India

Behaviourally bisexual men have been identified as a ‘bridge’ population of HIV transmission to heterosexual women in India. Little is known about the sexual relationships that these men have with their female sex partners. The primary objective of this study was to explore the sexual practices and relationship dynamics between married and unmarried behaviourally bisexual men and their female sex partners in Mumbai, India. In 2009, semi-structured qualitative interviews were conducted with 32 men who reported sex with men and women. Participants discussed a variety of sexual practices and arrangements with female sex partners. Irrespective of marital status and sexual identity, many said that they had satisfying sexual experiences and feelings of affection for female sex partners. However, sexual incompatibility between married partners was also reported. Explanations of bisexual concurrency were discussed in terms of both sexual satisfaction and sexual preference. Self-perceived HIV risk related to same-sex sexual behaviour motivated many men to use condoms with female partners. Expectations of unprotected marital sex and perceptions of partner risk were barriers to condom use. HIV-prevention programmes for this population may benefit from tailored risk-reduction counselling that attends to the variations of these sexual and social relationship dynamics.     

男男性接触者艾滋病性病感染状况及行为特征和干预策略

目的分析男男性接触者(MSM)最高危人群及最危险的行为因素,提出更具针对性的干预措施。方法采用滚雪球法对江苏省三市2008年5月~2009年7月国家试点调查期间招募的MSM进行问卷调查和血样本采集。结果共调查符合招募条件的MSM 2 241例,自我认同同性恋者占47.66%,双性恋者占44.85%。最近6个月59.65%的MSM有过无保护肛交,36.77%与女性发生过性关系,且最近一次安全套使用率为35.19%。最近一年15.89%的MSM出现过性病相关症状,仅57.69%到综合医院/性病专科门诊求诊。53.27%的HIV阳性MSM为双性恋,39.02%在婚。三市平均HIV感染率为7.10%,梅毒感染率为17.63%,HIV合并梅毒感染率为2.72%。浴室型MSMHIV和梅毒感染率最高,分别为12.30%和27.34%。结论浴池型MSM和MSM感染者是干预重点人群,应尽快采取有效措施来遏制艾滋病在MSM人群以及通过该人群向一般人群中的传播。     

History of childhood sexual abuse and HIV risk behaviors in homosexual and bisexual men

OBJECTIVES: We examined the prevalence and frequency of childhood sexual abuse and their association with sexual risk among a sample of gay and bisexual men. Methods. Cross-sectional data were collected by survey from randomly selected gay and bisexual men who attended the 1997 and 1998 Minneapolis/St. Paul Gay, Lesbian, Bisexual, and Transgender Pride Festivals. Data included demographics, sexual activity, history of childhood sexual abuse, HIV status, history of sexually transmitted infection, use of sex-related drugs (such as crack, cocaine, Ecstasy, amyl nitrate, crystal methamphetamine, and Special K), and history of exchanging sex for payment. Results. childhood sexual abuse was reported by 15.5% of the survey respondents (n = 134). Those who reported experiencing abuse regularly were more likely to (1) be HIV positive, (2) have exchanged sex for payment, and (3) be a current user of sex-related drugs. Neither unsafe sex nor sexually transmitted infections were associated with childhood sexual abuse. CONCLUSIONS: These findings show that more than 1 in 7 gay and bisexual men in a non-clinical, festival-based setting were victims of childhood sexual abuse and that childhood sexual abuse was associated with alarmingly high rates of men who were HIV infected and antecedent risk behaviors.     

Inappropriate lubricant use with condoms by homosexual men.

Use of condoms has been advocated as an important method of reducing the risk of human immunodeficiency virus (HIV) transmission among high-risk groups such as homosexual and bisexual men, prostitutes, intravenous drug users, adolescents, and hemophiliacs. Despite risk-reduction education campaigns directed to gay men since the early 1980s, evidence shows continued deficits in condom-use skills and knowledge among gay men. Because most failures in the use of condoms are attributed to errors in use, increasing knowledge and skills in condom use is important in preventing HIV infection. Two groups of homosexual and bisexual men were sampled, those entering a risk-reduction education program and participants in a Gay Pride event. They were surveyed on their current sex practices and their efforts to reduce their risk of HIV infection. They were asked about their numbers of sex partners, specific sexual behaviors, use of condoms, types of condoms used, and lubricants used for genital-anal sex. The characteristics of those surveyed were similar to those of respondents in other studies of risk reduction among gay men. The use of an oil-based lubricant with condoms has been shown to weaken latex and to increase the likelihood of condom breakage, which use of water-based lubricants does not. Among respondents who reported having genital-anal sex, 60 percent reported use of an oil-based lubricant with a condom at least once during the year before the survey. Gay men in sexually exclusive relationships engaged in less consistent use of condoms for receptive genital-anal sex than did single gay men.(ABSTRACT TRUNCATED AT 250 WORDS)     

HIV and hepatitis B infection and risk behavior in young gay and bisexual men.

OBJECTIVES: To estimate the prevalence of and identify risk factors for human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) infections and unprotected anal intercourse among young homosexual and bisexual men. METHODS: The authors performed a cross-sectional analysis of data from a prospective cohort of 508 young gay and bisexual men ages 18-29. RESULTS: HIV-1 seroprevalence was 2.4%, with five (1.3%) of 390 college students and seven (6.0%) of 117 non-students infected. After adjusting for confounders, HIV-1 infection was associated with having a history of a sexually transmitted disease other than HIV-1 or hepatitis B. The prevalence of hepatitis B markers in unvaccinated men was 12.9%. The presence of hepatitis B markers in unvaccinated men was significantly associated with Asian ethnicity, off-campus residence, and history of a sexually transmitted disease other than HIV-1 or hepatitis B and inversely associated with recent non-intravenous drug use. Eighteen percent of the participants reported having had sex with women during the previous 12 months, and 26.4% reported a history of unprotected anal intercourse during the previous six months. Men who reported unprotected anal intercourse were more likely to have at least one steady partner, to have met their partners in anonymous settings, and to be identified as probably alcohol dependent. CONCLUSIONS: Although the prevalence of HIV-1 infection among young homosexual and bisexual men in Boston was relatively low, the high rates of unprotected anal intercourse suggest a potential for future HIV-1 and hepatitis B transmission. Interventions should focus on young men with histories of sexually transmitted diseases, alcohol abuse, and depression.     

“Cum Play” among Gay Men

The exchange of semen, often referred to as “cum play,” has featured in gay literature and may be a unique aspect of many gay men’s sexual behavior. We investigated the prevalence of “cum play” and its context among 1153 HIV-negative and 147 HIV-positive Australian gay men in an online survey. Receptive cum play (partner ejaculating or rubbing his semen over participant’s anus, or participant using partner’s semen as lubricant) was reported by one in six HIV-negative and one quarter of HIV-positive men on the same occasion of protected anal intercourse with a casual partner (PAIC). HIV-negative men who engaged in receptive cum play during PAIC often believed that their partner was HIV seroconcordant and tended to trust that partner. They were also generally more optimistic about the likelihood of HIV transmission, and they often only used condoms at their partners’ instigation. Cum play was not uncommon and highlights the narrowness (or danger) of focusing on condom use without considering the implications of broader sexual practices and their meaning for sexual health promotion. “Safe sex” for some gay and bisexual men does not necessarily mean consistent commitment to condom use or to avoiding semen exchange. Many feel confident in their knowledge of their partner’s HIV serostatus and only use condoms with these partners at their partner’s request. Their commitment to safe sex may not necessarily be compromised by their practice of cum play, but the extent to which this could represent a risk for HIV transmission depends on the reliability of their assessment of their partners’ HIV serostatus.     

育龄男女非婚性行为及避孕套使用情况调查

目的 了解我国育龄男女非婚性行为发生情况，为项目干预措施提供基础资料。方法 2005年11～12月采用分层、三阶段与规模成正比的容量比例抽样方法获得调查对象，采用统一调查问卷由统一培训的调查员入户进行面对面调查。结果 90％以上的育龄男女认为人应该只有1个性伴侣，其中约i／3认为多性伴增加性传播疾病和艾滋病的危险。20．2％的未婚男性有过性行为，其中47．8％在第1次性行为时没有使用任何避孕方法，42．2％使用了避孕套。8．7％的未婚女性有过性行为，30．4％在第1次性行为时没有采取避孕措施，43．5％使用了避孕套。1．6％的已婚男性、0．5％的已婚女性和25．6％有过性行为的未婚男性、4．3％有过性行为的未婚女性有过临时性伴侣，且相当比例在发生性行为时未使用避孕套。结论 虽然大多数认为应该只有1个性伴侣，但仍有一定比例非婚性行为的发生，并且在发生非婚性行为时避孕套的使用较少。在加强道德教育时，还应加大避孕套使用的宣传力度，保证安全性行为。     

Patterns and correlates of deliberate abstinence among men and women with HIV/AIDS

OBJECTIVES: We examined correlates of deliberate sexual abstinence among gay/bisexual men, heterosexual men, and women in a national probability sample of adults with HIV. METHODS: Participants in the HIV Cost and Services Utilization Study (HCSUS; n=1339) answered questions about oral, anal, or vaginal sexual intercourse in the past 6 months; those who reported none of these behaviors (n=415) were asked about their reasons for abstinence. Of these, 201 participants (11% of gay/bisexual men, 18% of women, 18% of heterosexual men) indicated that their abstinence was deliberate. Multivariate models were used to predict deliberate abstinence. RESULTS: In multivariate analyses, not having a primary relationship partner/spouse was a significant correlate of deliberate abstinence for all 3 groups. Higher perceived responsibility for limiting disease transmission and nondrinking status were related to deliberate abstinence only among gay/bisexual men. Worse health was associated with deliberate abstinence only among heterosexual men. CONCLUSIONS: Perhaps because HIV is more common in gay communities, abstinence choices may be more closely linked to a higher sense of responsibility for reducing transmission among gay/bisexual men, and their illness may be less of an impediment to sexual activity.     

Drug-using men who have sex with men: Sexual behaviours and sexual identities

Men who have sex with men (MSM) and use drugs are at high risk for H V. This study assessed drug and sex-related risk behaviours and sexual identities for MSM^Idrug injectors and crack smokers. One hundred and forty four MSM drug injectors and crack smokers from five USA cities were interviewed. One-third of the men were current injectors, twice as many reported lifetime injection. Most (56%) reported sex with women in the prior year; sex trading was reported by 32% with males and 53% with females. There were significant differences between private and public sexual identities. For example, while 31% reported being behaviourally bisexual, only 17% identified themselves to others as bisexual. Drug using MSM are clearly a heterogenous group and prevention messages addressing this diversity are needed.     

Patterns of change in sexual behavior among gay men in New York City

In the absence of a vaccine or effective treatment for AIDS, health education remains the most effective strategy for stemming the spread of the epidemic. Among homosexual and bisexual men, who continue to account for the majority of AIDS cases, sexual practices have been identified as the principal risk factor. Consequently, public health efforts aimed at this population have focused on raising awareness of the potential risks of HIV infection associated with certain sexual practices. A sample of 162 asymptomatic gay and bisexual men were studied to examine patterns of change and stability in sexual behavior. The data reveal that while the large majority (84%) had adopted at least modification in their sexual behavior, primarily in the form of reducing their total number of partners and their number of anonymous partners, a significant proportion (48%) continued to engage in risky sexual behavior; this, despite high levels of knowledge concerning risk-reduction guidelines. The findings suggest that the mere transfer of information concerning safer sex practices is not sufficient to induce the desired behavior changes in a substantial proportion of gay men. Alternative strategies for achieving behavior change are suggested.This research was supported in part by grants from the National Institute of Mental Health (MH39551) and the New York AIDS Institute (C00577). An earlier version of this paper was presented at the meetings of the American Sociological Association, New York City, August 1986.     

Internet Use,Recreational Travel,and HIV Risk Behaviors in Men Who Have Sex With Men

Previous studies have documented higher rates of HIV risk behavior in gay and bisexual men traveling for leisure. Most of these studies collected data in high-risk tourist areas known for promoting alcohol and other substance use. The present study sampled a broader range of men by collecting data at a Gay Pride celebration, and asking participants about vacation experiences over the past 12 months. We also collected information about men’s use of the Internet to find sexual partners before they traveled. Overall, two-thirds of participants reported recreational travel in the previous year. Of these men, 17% reported having sex with a new partner during their most recent vacation. Forty-three percent of the respondents were sexually active during their vacation. Sexually-active participants reported a mean of 2.01 unprotected anal sex acts during their brief vacation stay (M = 6.2 days). Close to half of the sexually-active men reported having sex with a partner of unknown HIV status. Alcohol and drug use were associated with unprotected sex. Men who used the Internet to set up dates prior to travel reported significantly more sexual partners and were significantly more likely to report having sex with a new partner. Many gay and bisexual men on vacation report behaviors that may place their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors in this population are needed.     

Suicide attempts among gay and bisexual men: lifetime prevalence and antecedents

OBJECTIVES: We examined lifetime prevalence of suicide attempts and psychosocial correlates in a large population-based sample of men who have sex with men (MSM). METHODS: A telephone probability sample of US urban MSM (n = 2881) were interviewed between November 1996 and February 1998. RESULTS: Twenty-one percent had made a suicide plan; 12% had attempted suicide (almost half of those 12% were multiple attempters). Most who attempted suicide made their first attempt before age 25. Although prevalence of parasuicide (i.e., attempted suicide) has remained constant across birth cohorts, mean age at initial attempts has declined. CONCLUSIONS: MSM are at elevated risk for suicide attempts, with such risk clustered earlier in life. Some risk factors were specific to being gay or bisexual in a hostile environment.     

HIV prevention and men who have sex with women and men in México: Findings from a qualitative study with HIV‐positive men

Unprotected sex between men is the major risk factor for HIV infection in México and many other Latin American countries. There is a substantial body of literature demonstrating that the relationship between sexual identity and sexual practice is not binary or causal — men who have sex with other men do not necessarily perceive themselves as gay — and there is increasing interest in HIV prevention with men who have sex with both men and women. In México, HIV prevention with men who have sex with women and men and who are not socially affiliated or identified with gay men is lacking. This paper explores the sexual histories and HIV‐risk perception of HIV‐positive Mexican men who indicated that they have sex with women in a screening interview and then in the context of an in‐depth interview also reported having had sex with men. We consider the sexual practices and sexual and social identities of these men, examining their explanations for having sex with other men, the strategies used to affirm their masculinity, the management of their sexual identity in their social networks, HIV‐risk perception before diagnosis and sexual practices after diagnosis. Recommendations are made to improve HIV prevention for men who have sex with men as well as women and who do not assume a gay or bisexual identity.