Health-related characteristics of men who have sex with men: a comparison of those living in "gay ghettos" with those living elsewhere

OBJECTIVES: This study investigated the limitations of probability samples of men who have sex with men (MSM), limited to single cities and to the areas of highest concentrations of MSM ("gay ghettos"). METHODS: A probability sample of 2881 MSM in 4 American cities completed interviews by telephone. RESULTS: MSM who resided in ghettos differed from other MSM, although in different ways in each city. Non-ghetto-dwelling MSM were less involved in the gay and lesbian community. They were also less likely to have only male sexual partners, to identify as gay, and to have been tested for HIV. CONCLUSIONS: These differences between MSM who live in gay ghettos and those who live elsewhere have clear implications for HIV prevention efforts and health care planning.     

A "Community Manifesto" for gay and bisexual men: an appeal to control HIV/STDs.

BACKGROUND: In response to increasing rates of sexually transmitted diseases (STDs) among men who have sex with men (MSM) in Seattle & King County, a task force including community members, HIV/AIDS professionals, and health department staff authored "A Community Manifesto: A New Response to HIV and STDs." The manifesto emphasized both personal and collective responsibility for gay and bisexual men to stop the spread of STDs. METHODS: The manifesto was published in local media over a 15-month period. We conducted a survey (via Web, mail-in, and street intercept), focus groups, and a community forum to evaluate the impact of the manifesto among Seattle & King County MSM. RESULTS: Most respondents supported the manifesto and reported that it made them think about their sexual behaviors; more than 25 percent reported changing sexual behavior as a result of the manifesto, but the document generated several controversies. CONCLUSIONS: Publicly declaring values associated with sexual behavior and attempting to establish and reinforce sexual norms within MSM communities can cause controversy; however, such efforts may increase awareness, dialogue, and behavior change at a community level and be important for increasing awareness and behaviors that demonstrate collective care and responsibility among MSM.     

男男性接触者梅毒感染危险因素病例-对照研究

目的探讨与男男性接触者（MSM）梅毒感染有关的危险因素。方法采用应答驱动抽样（RDS）、关键知情人介绍、网上招募、同志酒吧招募等方法在安徽省合肥、芜湖、淮南3个城市招募研究对象，共有261名符合条件的男男性接触者（MSM）接受了梅毒和人类免疫缺陷病毒（HIV）抗体血清学检测。采用病例对照研究方法，将梅毒初筛和确认试验均阳性者22例作为病例组。按年龄上下相差1岁以内、职业相近的条件进行1：4配比．从梅毒检测阴性者中选取了88人作为对照，对研究对象进行面对面问卷调查。结果单因素分析结果显示．MSM人群HIV／性传播疾病（STDS）感染危险性意识低．同性性伴总数≥10个，近6个月同性性伴数≥3个，经常参加同性恋组织聚会、有同性肛交偶然性伴以及肛交偶然性伴以及肛交安全套使用率低于75％与梅毒感染有关。多因素条件Logistic回归分析显示，HIV／STDS感染危险意识低，近6个月同性肛交偶然性伴数多、肛交安全套使用率低是梅毒感染的主要危险因素。结论在MSM人群进行性病的干预，重点为提高该人群HIV／STIs感染危险性意识，减少性伴数和提高安全套使用率。     

Factors influencing a communitywide campaign to administer hepatitis A vaccine to men who have sex with men

OBJECTIVES: A hepatitis A outbreak among men who have sex with men (MSM) led to a publicly funded vaccination campaign. We evaluated the MSM community's response. METHODS: A cohort of MSM from 5 community sites was surveyed. RESULTS: Thirty-four (19%) of 178 potential vaccine candidates received the vaccine during the campaign. We found a linear relation between the number of exposures to campaign information and the likelihood of vaccination (P < .001). Vaccination was independently associated with awareness of the outbreak and the vaccine, having had sexual relations with men for 12 years or longer, having recently consulted a physician, and routinely reading a local gay newspaper. CONCLUSIONS: The difficult task of vaccinating MSM can be aided by repetitive promotional messages, especially via the gay media.     

Sexual diversity among black men who have sex with men in an inner-city community

Dramatic increases in HIV-incidence rates have been documented for Black men who have sex with men (MSM). Moreover, MSM has become a more visible HIV-transmission route in the Black community, in part due to public interest in the “down low” (i.e., “straight” men who also have sex with men). Interviews were conducted with 21 Black MSM in central Brooklyn, New York City, in efforts to understand the diversity of MSM experience in a low income, high HIV-prevalence community. Two thirds of the men identified as either heterosexual (43%) or bisexual (24%) and 15 (71%) MSM reported recent sex with women. Conformity to masculine social role expectations made it difficult to identify sex partners in the community; therefore, men relied on private sex clubs and the Internet. The findings suggest that stigma surrounding both HIV and homosexuality may effectively insure that nonheterosexual preferences and practices remain hidden in the Black community. A focus on sexual orientation and bisexuality has obscured the issue of race in the HIV/AIDS epidemic among Black MSM. In the long term, public health promotion and HIV prevention will require greater tolerance and acceptance of sexual diversity in the Black community.     

Sexual identities and sexual health within the Celtic nations: An exploratory study of men who have sex with men recruited through social media

ABSTRACT

Associations of sexual identity with a range of sexual and sexual health behaviours were investigated amongst men who have sex with men (MSM). Data from 1816 MSM recruited from 4 Celtic nations (Scotland, Wales, Northern Ireland and the Republic of Ireland) were collected via a cross-sectional online survey advertised via social media. About 18.3% were non-gay identified MSM (NGI-MSM). In the last year, 30% of NGI-MSM reported high-risk unprotected anal intercourse and 45% reported never having had an sexually transmitted infection (STI) test. When compared to MSM who were gay identified (GI-MSM), NGI-MSM were more likely to be older, have a female partner, fewer sex partners, fewer anal sex partners, STI diagnoses and less likely to be HIV positive, more likely to never use the gay scene and be geographically further from a gay venue. NGI-MSM were also less likely to report STI and HIV testing behaviours. The findings highlight variations in risk by sexual identities, and unmet sexual health needs amongst NGI-MSM across Celtic nations. Innovative research is required regarding the utility of social media for reaching populations of MSM and developing interventions which target the heterogeneity of MSM and their specific sexual health needs.     

Time-space sampling in minority communities: results with young Latino men who have sex with men

OBJECTIVES: This study addressed methodological issues influencing the feasibility of time-space sampling in HIV prevention studies targeting hard-to-reach populations of minority young men who have sex with men (MSM). METHODS: We conducted interviews with 400 men in 32 venues where young Latino MSM congregate in New York City. Response rates and demographic and sexual risk profiles are compared by venue type. RESULTS: More than 90% of the men approached were screened. Among eligible men, participation rates exceeded 82%. Participation was higher at special events and gay venues compared with nongay venues (P < .05). Young MSM in nongay venues were less likely to self-identify as gay (P < .01) or to report recent anal sex with a male (P < .10). Condom use did not vary by venue type but was lower with women than with men. If surveys had been limited to gay venues, about half of the young MSM surveyed in nongay venues would have been missed. CONCLUSIONS: Time-space sampling of a relatively "hidden" minority young MSM population can be successful across a range of venues. However, the benefits of greater outreach must be weighed against the costs incurred recruiting participants in nongay venues.     

Public health challenges of the emerging HIV epidemic among men who have sex with men in China

A large-scale national survey was conducted in 2008 across 61 cities throughout China, covering over 18,000 men who have sex with men (MSM). The prevalence of human immunodeficiency virus (HIV) was 4.9% and incidence ranged from 2.6 to 5.4 per 100 person-years. The prevalence of sexually transmitted diseases ranged from 2.0% to 29.9% among MSM in different parts of China. Syphilis status, recruitment of sexual partners mainly from gay saunas, duration of MSM experience, and unprotected sex with regular male sex partners and multiple male sex partners predicted HIV seroconversion. The prevalence of consistent condom use was low during anal sex, ranging from 29.4% to 37.3%. Within this context, this paper considers the factors surrounding HIV prevention activity, and identifies a number of public health challenges which need to be considered if optimum outcomes are to be achieved. HIV prevention targeting MSM is a delayed response. The high risk associated with gay saunas and the need for steady condom supply at these venues needs urgent consideration. In addition, approximately one-third of MSM in China reported bisexual behavior, which may be attributed to sociocultural reasons and stigma against MSM. Female sex partners of MSM are seldom aware of their exposure to high risk of HIV transmission. Finally, the primitive nature of non-government organizations for HIV prevention and issues around their sustainability pose another serious challenge for the future of HIV prevention campaigns targeting MSM in China.     

Anthropological assessment for culturally appropriate interventions targeting men who have sex with men

Although social and cultural factors play a fundamental role in the health of sexual minority populations and the development of culturally appropriate interventions, public health activities and research have sometimes lacked appropriate sophistication or attention to issues of cultural competency. In areas such as HIV prevention for men who have sex with men (MSM), biomedical interpretations of same-sex phenomena should be applied with caution. Communities and societies may broadly understand same-sex desire, attraction, behavior, and identity through age-structured/initiatory, gender-defined, profession/social role-defined, or egalitarian/gay frameworks. When more detailed, locally specific information is required, such as for youth, ethnic minorities, or urban versus rural populations, the approach to rapid anthropological assessment presented can provide nuanced insights for effective health programs targeting 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.     

Seeking sexual partners on the internet: a marker for risky sexual behaviour in men who have sex with men

OBJECTIVE: In order to generate a generalizable estimate regarding risk for STI and HIV acquisition in men who have sex with men (MSM) who seek partners on the internet, we examined the sexual practices of MSM who seek partners on the internet compared to MSM who do not, using a community-based sample of MSM from British Columbia. METHODS: 'Sex Now', a questionnaire that was developed to examine trends in sexual behaviour in gay men, was offered to men attending Gay Pride events throughout the province of British Columbia, Canada between May and August 2004. Logistic regression analysis was used to model the association between seeking sexual partners online and other variables of interest, using odds ratio as the measure of association. RESULTS: Of the 2,312 MSM who completed the survey, 766 (33.1%) had used the internet to find a partner in the past year. In logistic regression analyses, MSM who found partners on the internet were more likely to have had more than 10 sexual partners in the past year (overall, insertive and receptive), and to engage in sexual activities in public venues. They were also more likely to agree with the statement "I think most guys in relationships have condom-free sex." MSM who sought partners on the net were more likely to be from specific geographic regions, including non-urban regions. Demographic characteristics, HIV status, and use of drugs were not significantly different between men who found partners on the internet and those who did not in multivariable modeling. DISCUSSION: MSM who sought to meet partners online had significantly more sexual partners, were more likely to be from specific geographic regions of the province and to have participated in seeking sexual partners in venues known to be associated with HIV and STI acquisition. This study confirms from a community-based sample of MSM that programming for prevention and treatment of HIV and STI need to be available and offered in the cyber setting, to ensure effective messaging and interventions reach this population.     

Attitudes toward online HIV/sexually-transmitted infection prevention programs and Internet user profiles among men who have sex with men

Objectives

To describe the attitudes of men who have sex with men (MSM) toward online HIV/sexually-transmitted infection (STI) prevention programs and to identify and characterize user profiles with regard to their attitudes toward online prevention programs.

Method

A survey in gay venues or via the internet was completed by 2,044 participants from Madrid, Barcelona, Bilbao and San Sebastián (Spain). The survey explored socio-demographic variables, sexual behavior and other risk behaviors associated with HIV infection, as well as attitudes toward online prevention programs. The statistical analysis included factor analysis and non-hierarchical cluster analysis.

Results

Most MSM had positive attitudes towards online HIV/STI prevention programs. Factor analysis revealed two factors: online prevention aimed at interaction and online prevention aimed at information. Based on these factors, three user profiles were identified: users oriented toward informative and interactive online prevention (53.5%), users oriented toward interactive online prevention (25.9%) and users were not oriented toward online prevention (20.7%). On characterizing these profiles, we observed a significant presence of men who were not interested in online prevention among those with a lower educational level, bisexual men and HIV-positive men. Conversely, those most receptive to online prevention were men self-identified as gay, those with a bachelors degree, those who had been tested for HIV and those who were HIV-negative.

Conclusion

The internet can facilitate sexual health promotion among MSM. Characterization of user profiles offers the possibility of segmenting prevention programs and of combining online and offline strategies.     

A qualitative assessment of health seeking practices among and provision practices for men who have sex with men in Malawi

Background

In the context of a generalized epidemic and criminalization of homosexuality, men who have sex with men (MSM) in Malawi have a disproportionate burden of HIV compared to other adults. Past research has documented low uptake of HIV prevention and health services among MSM, self-reported fear of seeking health services, and concerns of disclosure of sexual orientation and discrimination in health settings. Qualitative research was conducted among MSM and health service providers in Blantyre, Malawi to understand underlying factors related to disclosure and health seeking behaviors and inform the development of a community-based comprehensive HIV prevention intervention.

Methods

Using peer recruitment, eight MSM participants representing a range of ages, orientations, and social and behavioral characteristics were enrolled for in-depth interviews. Five service providers were recruited from the district hospital, local health and STI clinics, and a HIV prevention service organization. We use the Health Belief Model as a framework to interpret the influential factors on 1) health seeking and uptake among MSM, and 2) influences on provision of services by healthcare providers for MSM.

Results

Results highlight disclosure fears among MSM and, among providers, a lack of awareness and self-efficacy to provide care in the face of limited information and political support. Service providers reported concerns of adverse repercussions related to the provision of services to men in same sex sexual relationships. Some MSM demonstrated awareness of HIV risk but believed that within the wider MSM community, there was a general lack of HIV information for MSM, low awareness of appropriate prevention, and low perception of risks related to HIV infection.

Conclusions

Qualitative research highlights the need for appropriate information on both HIV risks and acceptable, effective HIV prevention options for MSM. Information and educational opportunities should be available to the wider MSM community and the health sector. Health sector interventions may serve to increase cultural and clinical competency to address health problems experienced by MSM. To ensure availability and use of services in light of the criminalization and stigmatization of same sex practices, there is need to increase the safety of uptake and provision of these services for MSM.

     

Health Care Services for men who have sex with men in different Australian states and territories since the emergence of HIV

The purpose of this article is to describe sexual health services available in Australia across the different states and territories for gay men and men who have sex with men (MSM) and their utilisation. An assessment of services available in different states is made, then the evidence about how MSM and people living with HIV/AIDS access health care in Australia is presented. This demonstrates that the number and location of sexual health services has changed over time. It also demonstrates that services available differ by state and territory. The availability of non-occupational post-exposure prophylaxis for HIV infection has been different in each state and territory, as has its utilisation. The majority of care for sexual health-related issues and for MSM and people living with HIV/AIDS is delivered in general practice settings in Australia, with hospital outpatient settings, including sexual health clinics, utilised commonly.     

泰安市男男性行为大学生艾滋病感染及相关行为状况

了解泰安市大中专院校大学生男男性行为者(men sho have sex with men,MSM)的艾滋病病毒(HIV)感染状况及其相关危险行为,为制定适宜的健康干预措施提供依据.方法 采用横断面调查研究,对泰安市大中专院校在校MSM人群通过自愿咨询检测(VCT)的方式获得方便样本,采用自填式问卷调查收集人口学特征和行为学信息,并采集血液样本进行HIV、梅毒和单纯疱疹病毒Ⅱ型(HSV-Ⅱ)的血清学检测.结果 共有127例男男性行为者参与研究.性行为角色以“肛交性行为的被插入方”为主的占42.5%.最常用的寻找性伴的方式是网络(89.0%),其中69人通过男同交友软件Blued,占54.3%.有79.4%的被试存在多性伴,近6个月与固定性伴、临时性伴发生无保护肛交的比例分别为60.4%(55/91),50.7%(37/73).最近一次肛交的安全套使用率仅为61.4%,未使用安全套的原因主要是认为和性伴彼此忠诚(18.4%)、身边没有(18.4%)、认为自己不会感染HIV(16.3%).大学生艾滋病知识知晓率为96.1%,但8题全部答对的比例仅为58.3%.大学生HIV感染率为3.1%,4.7%曾感染过梅毒,HSV-Ⅱ血清阳性率为3.1%.单因素分析显示,主要性行为方式以“肛交性行为的插入方”角色为主、使用Blued软件作为寻找性伴的主要方式、与固定性伴发生无保护性行为是HIV感染的危险因素,但Logistic回归分析均无统计学意义.结论 泰安市大中专院校学生MSM艾滋病流行已经显现.急需采取针对性措施提高感染风险意识,改变普遍存在的高危性行为.     

Structural and environmental factors are associated with internalised homonegativity in men who have sex with men: Findings from the European MSM Internet Survey (EMIS) in 38 countries

Internalised homonegativity refers to a gay person's negative feelings about homosexuality and is believed to stem from negative societal stereotypes and attitudes towards homosexuality. Surprisingly, little research has centred on this link. In this research, we aimed to examine the associations between internalised homonegativity and structural forces, cultural influence, and access to sexual health promotion measures among a sample of 144,177 men who have sex with men (MSM) in 38 European countries. Participants were recruited as part of the European MSM Internet Survey (EMIS) during 2010. It was a self-completion, multilingual Internet-based survey for men living in Europe who have sex with men and/or feel attracted to men. Assumed causal relations were tested through multiple regression models. Variables at the structure of rule-systems (macro-level) that were significantly and negatively associated with internalised homonegativity were the presence of laws recognising same-sex relationships and same-sex adoption. In the meso-level model, greater proportions of the population expressing that they would not like to have homosexuals as neighbours predicted higher internalised homonegativity. In the last model, five variables were significantly and negatively associated with internalised homonegativity: being exposed to HIV/STI information for MSM, access to HIV testing, access to STI testing, access to condoms, and experience of gay-related hostility. In turn, men who had tested for HIV in the past year evidenced lower internalised homonegativity. This is the largest and certainly most geographically diverse study to date to examine structural and environmental predictors of internalised homonegativity among MSM. Our results show that one insidious consequence of society's stigma towards homosexuals is the internalisation of that stigma by gay and bisexual men themselves, thus, drawing attention to the importance of promoting social equity for self-acceptance around gay identity in building a positive sense of self.     

The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse

Men who have sex with men (MSM) and women who have sex with women (WSW) are purportedly neutral terms commonly used in public health discourse. However, they are problematic because they obscure social dimensions of sexuality; undermine the self-labeling of lesbian, gay, and bisexual people; and do not sufficiently describe variations in sexual behavior.MSM and WSW often imply a lack of lesbian or gay identity and an absence of community, networks, and relationships in which same-gender pairings mean more than merely sexual behavior. Overuse of the terms MSM and WSW adds to a history of scientific labeling of sexual minorities that reflects, and inadvertently advances, heterosexist notions.Public health professionals should adopt more nuanced and culturally relevant language in discussing members of sexual-minority groups.     

The Circuit Party Men's Health Survey: findings and implications for gay and bisexual men

OBJECTIVES: This study examined characteristics of gay and bisexual men who attend circuit parties, frequency of and motivations for attending parties, drug use and sexual behavior during circuit party weekends, and use of risk reduction materials available at parties. METHODS: A cross-sectional survey was conducted among 295 gay and bisexual men from the San Francisco Bay Area who had attended a circuit party in the previous year. RESULTS: One fourth of the men reported a drug "overuse" incident in the previous year. Nearly all respondents reported use of drugs during circuit party weekends, including ecstasy (75%), ketamine (58%), crystal methamphetamine (36%), gamma hydroxybutyrate or gamma butyrolactone (25%), and Viagra (12%). Two thirds of the men reported having sex (oral or anal), 49% reported having anal sex, and 28% reported having unprotected anal sex during the 3-day period. An association was found between use of drugs and sexual risk behavior. Prevention materials were observed at party events by some men; however, relatively few men used the materials. Common motivations for attending the parties were "to listen to music and dance" and "to be with friends." CONCLUSIONS: Intensive, targeted health promotion efforts are needed for gay and bisexual men who attend circuit parties.     

Internet use and early syphilis infection among men who have sex with men--San Francisco, California, 1999-2003

During the summer of 1999, an outbreak of early syphilis among men who have sex with men (MSM) who met their sex partners on the Internet presaged a rapidly expanding syphilis epidemic in San Francisco. By 2002, San Francisco had the highest rates of primary and secondary syphilis of any metropolitan area in the United States. During 1998-2002, the number of early syphilis cases increased, from 41 cases in 1998 to 495 cases in 2002. Concomitant with the increase in early syphilis was an increase in the proportion of cases among MSM, from 22% in 1998 to 88% in 2002. To assess the association between early syphilis infection and use of the Internet by MSM to meet sex partners, the San Francisco Department of Public Health (SFDPH) analyzed surveillance data and case reports. This report summarizes the results of that analysis, which suggest that public health officials might find the Internet to be an important tool for 1) promoting disease awareness, prevention, and control and 2) accessing sex partners of syphilis patients to conduct appropriate partner notification, evaluation, and management. The findings underscore the need for public health officials to understand the role of the Internet in facilitating the spread of sexually transmitted diseases (STDs), including the human immunodeficiency virus (HIV). With the assistance of community partners, other jurisdictions can examine the online social/sexual networks that are used commonly in their gay and bisexual communities and develop an effective means of communicating prevention and control messages online.     

Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men

OBJECTIVES: We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM). METHODS: We conducted a cross-sectional household probability telephone sample of MSM in Chicago, Los Angeles, New York, and San Francisco. RESULTS: Psychosocial health problems are highly intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection. CONCLUSIONS: AIDS prevention among MSM has overwhelmingly focused on sexual risk alone. Other health problems among MSM not only are important in their own right, but also may interact to increase HIV risk. HIV prevention might become more effective by addressing the broader health concerns of MSM while also focusing on sexual risks.