Psychosocial Syndemic Correlates of Sexual Compulsivity Among Men Who Have Sex with Men: A Meta-Analysis

Efforts have been made to better understand sexual compulsivity by examining salient psychosocial syndemic correlates, though examination of such factors has yielded inconclusive results. Given that research on sexual compulsivity has predominately involved men who have sex with men (MSM), the aims of the current study were to establish the mean effect sizes of seven psychosocial syndemic indicators with sexual compulsivity, to determine if the effect varied as a function of the type of psychosocial syndemic, and investigate the potential moderating effects using MSM samples. A total of 95 studies were included for analyses among the psychosocial syndemic indicators of interest (i.e., depression, anxiety, alcohol use, drug use, intimate partner violence, childhood sexual abuse, and sexual risk behavior). Results revealed a medium mean effect size of sexual compulsivity, the strength of which was significantly moderated by type of psychosocial syndemic indicator. Significant mean effect sizes for all syndemic indicators on sexual compulsivity were found, with depression and anxiety having the strongest relationships; significant moderating effects were found and are discussed. Findings highlight clinical considerations regarding sexual compulsivity and its role within the HIV syndemic framework among MSM.     

Homonegativity and Associated Factors Among Men Who Have Sex with Men in Estonia

Men who have sex with men (MSM) continue to be at higher risk for negative health outcomes including HIV, STIs, depression, substance use, suicidality, and anxiety. Associative relationships between homonegativity (internal and external) and these outcomes are used to explain the observed disproportionate impact. The current study assessed associations between internalized homonegativity and high-risk behaviours, markers of substance use and symptoms of mental illness as well as openness and level of same sex attraction. A 2013 Internet-based survey was conducted among MSM, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity. The sample (n = 265) had a median age of 31 years, with 85 % employed at least part-time; at least a college-level education in 43 %; and 87 % lived in an urban setting. Sexual orientation was reported as: gay, 72 %; bisexual 23 %; other 5 %. Almost all men (97 %) reported ever having sex with a man, with more than one-third (36 %) having a steady male partner. Statistically significant higher homonegativity scores were detected among men reporting any level of opposite sex attraction compared to men attracted to only men; mostly men (p = 0.001), men and women equally (p = 0.002), and mostly women (p = 0.004), as well as less openness of same sex attraction to family and friends; >50 % family (p = 0.032), no family knowing (p = 0.042), and few friends knowing (p = 0.011). Anxiety risk and increased homonegativity also had a statistically significant increasing relationship. The identified associations between homonegativity and opposite sex attraction among MSM warrants further exploration as well as the relationship with increased anxiety risk.     

Correlates of Forced Sex Among Populations of Men Who Have Sex with Men in Thailand

Although forced sex is a correlate of HIV infection, its prevalence and associated risks are not well described among men who have sex with men (MSM) in developing-country settings. Between March and October 2005, we assessed the prevalence of forced sex and correlates among populations of MSM (this includes general MSM, male sex workers, and male-to-female transgender persons) in Thailand using a community-based sample. Participants were enrolled from venues around Bangkok, Chiangmai, and Phuket using venue day-time sampling. Handheld computer-assisted self-interviewing was used to collect demographic and behavioral data and logistic regression evaluated factors associated with forced sex, defined as ever being forced to have sexual intercourse against one’s will. Of the 2,049 participants (M age, 24.8 years), a history of forced sex was reported by 376 (18.4%) men and, of these, most were forced by someone they knew (83.8%), forced more than once (67.3%), and had first occurrence during adolescence (55.1%). In multivariate analysis, having a history of forced sex was significantly associated with being recruited in Phuket, classification as general MSM or transgender (versus classification as male sex worker), drug use, increased number of male sexual partners, and buying sex. The findings in our assessment were consistent with assessments from Western countries. Longitudinal studies are needed to understand the mechanisms of the relationships between forced sex correlates found in our assessment and HIV acquisition and transmission risks.     

Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S.

Archives of Sexual Behavior - Black men who have sex with men (MSM) engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have...     

Sexual Risk Behaviors by Relationship Type and Trauma History Among HIV-Positive Men Who Have Sex with Men

The association of trauma exposure and coping style to sexual risk behavior has yet to be fully examined in the context of primary and casual sexual partnerships. The current study assessed a high risk sexual behavior—unprotected anal intercourse (UAI)—in a high risk population of HIV-positive men who have sex with men (MSM) with a history of trauma. Using audio computer-assisted self-interview technology, 132 HIV-positive MSM completed measures of trauma exposure, trauma symptoms, coping strategies, and sexual risk behavior. Hierarchical logistic regression analyses indicated that completing more years of education and having experienced sexual abuse were positively associated with UAI with casual partners. Additionally, use of active coping was negatively associated with UAI with casual partners and the final model significantly predicted variance in UAI with casual partners. However, no variables were significantly associated with UAI with primary partners, suggesting that sexual risk behavior with primary partners may be associated with factors not commonly assessed in risk prediction or prevention research. We discuss the results in the context of developing new or modifying existing interventions to address rates of sexual risk in the relationships of HIV-positive MSM.     

Application of Syndemic Theory to Black Men Who Have Sex with Men in the Multicenter AIDS Cohort Study

This study analyzed data from a large prospective epidemiologic cohort study among men who have sex with men (MSM), the Multicenter AIDS Cohort Study, to assess syndemic relationships among Black MSM in the cohort (N = 301). We hypothesized that multiple interconnections among psychosocial health conditions would be found among these men, defining syndemic conditions. Constituents of syndemic conditions measured included reported depression symptoms, sexual compulsiveness, substance use, intimate partner violence (IPV), and stress. We found significant evidence of syndemics among these Black men: depression symptoms were independently associated with sexual compulsiveness (odds ratios [OR]: 1.88, 95% CI = 1.1, 3.3) and stress (OR: 2.67, 95% CI = 1.5, 4.7); sexual compulsiveness was independently associated with stress (OR: 2.04, 95% CI = 1.2, 3.5); substance misuse was independently associated with IPV (OR: 2.57, 95% CI = 1.4, 4.8); stress independently was associated with depression symptoms (OR: 2.67, 95% CI = 1.5, 4.7), sexual compulsiveness (OR: 2.04, 95% CI = 1.2, 3.5) and IPV (OR: 2.84, 95% CI = 1.6, 4.9). Moreover, men who reported higher numbers of syndemic constituents (three or more conditions) reportedly engaged in more unprotected anal intercourse compared to men who had two or fewer health conditions (OR: 3.46, 95% CI = 1.4–8.3). Findings support the concept of syndemics in Black MSM and suggest that syndemic theory may help explain complexities that sustain HIV-related sexual transmission behaviors in this group.     

The Association Between Penis Size and Sexual Health Among Men Who Have Sex with Men

Larger penis size has been equated with a symbol of power, stamina, masculinity, and social status. Yet, there has been little research among men who have sex with men assessing the association between penis size and social-sexual health. Survey data from a diverse sample of 1,065 men who have sex with men were used to explore the association between perceived penis size and a variety of psychosocial outcomes. Seven percent of men felt their penis was “below average,” 53.9% “average,” and 35.5% “above average.” Penis size was positively related to satisfaction with size and inversely related to lying about penis size (all ps < .01). Size was unrelated to condom use, frequency of sex partners, HIV status, or recent diagnoses of HBV, HCV, gonorrhea/Chlamydia/urinary tract infections, and syphilis. Men with above average penises were more likely to report HPV and HSV-2 (Fisher’s exact p ≤ .05). Men with below average penises were significantly more likely to identify as “bottoms” (anal receptive) and men with above average penises were significantly more likely to identify as “tops” (anal insertive). Finally, men with below average penises fared significantly worse than other men on three measures of psychosocial adjustment. Though most men felt their penis size was average, many fell outside this “norm.” The disproportionate number of viral skin-to-skin STIs (HSV-2 and HPV) suggest size may play a role in condom slippage/breakage. Further, size played a significant role in sexual positioning and psychosocial adjustment. These data highlight the need to better understand the real individual-level consequences of living in a penis-centered society.     

Drug Use and High-Risk Sexual Behaviors Among African American Men Who Have Sex With Men and Men Who Have Sex With Women

Objectives. We investigated covariates related to risky sexual behaviors among young African American men enrolled at historically Black colleges and universities (HBCUs).Methods. Analyses were based on data gathered from 1837 male freshmen enrolled at 34 HBCUs who participated in the 2001 HBCU Substance Use Survey. The covariates of risky sexual behavior assessed included condom nonuse, engaging in sexual activity with multiple partners, and history of a sexually transmitted disease.Results. Young Black men who had sex with men were more likely to engage in risky sexual behaviors than were young men who had sex with women. Two additional factors, early onset of sexual activity and consumption of alcohol or drugs before sexual activity, were independently associated with modestly higher odds of sexual risk behaviors.Conclusions. Services focusing on prevention of sexually transmitted diseases should be provided to all male college students, regardless of the gender of their sexual partners. Such a general approach should also address drug and alcohol use before sexual activity.Sexually transmitted diseases (STDs) threaten the sexual and reproductive health of adolescents and young adults, as indicated by the fact that an estimated half of the STD cases reported in 2000 occurred among those aged 15 to 24 years.¹ African Americans and men who have sex with men (MSM) are disproportionately affected by HIV/AIDS and other STDs. ^2–7 Moreover, although previous research indicates that Black MSM are no more likely than other MSM to engage in sexual risk behaviors,⁸ this group has been particularly affected by the HIV/AIDS epidemic.⁹Few studies have compared Black men who have same-gender and opposite-gender sexual partners. Thus, it is unclear whether Black MSM and Black men who have sex with women (MSW) differ in terms of their sexual risk behaviors. In addition, although a number of large studies have collected data from populations of young MSM,^10–14 few analyses have focused specifically on college populations.¹⁵In general, sexual risk-taking behaviors have received less attention among college students than among other groups; however, concerns regarding HIV/AIDS in this population were heightened by the rise in the number of HIV/AIDS diagnoses among male college students, particularly Black MSM, in North Carolina from 2001 to 2003.¹⁶ The majority of college students are sexually active, with prevalence estimates of lifetime sexual activity ranging from 74%¹⁵ to 86.1%.¹⁷ Less is known regarding students enrolled in historically Black colleges and universities (HBCUs). In one study of students enrolled at 8 HBCUs, 82% of the respondents reported a history of sexual intercourse and 59.6% reported that they had used a condom during their most recent intercourse.¹⁸Studies have identified risk and protective factors for sexual risk taking, including early onset of sexual activity,^19–21 substance use and early initiation of use,^22–25 and academic achievement.²⁶ Although the relation of other factors to risky sexual behaviors is less clear, some studies have shown that adolescents and college students with higher levels of religiosity are less likely to report a history of sexual activity.^27–29 However, findings regarding condom use are inconsistent,^28,30 and in 1 study individuals'' religiosity during adolescence was not related to their likelihood of contracting a sexually transmitted infection 6 years later.²⁶ Among college students, living situation may also be an important factor to consider, given previous research indicating that undergraduates who live with their parents are less likely than those who do not to use marijuana and alcohol.³¹We examined covariates of risky sexual behaviors, including inconsistent condom use, engaging in sexual activity with multiple partners, and history of STD infection (the latter as a proxy for risky behavior), among Black MSM and Black MSW attending HBCUs. In addition to the association between risky sexual behaviors and partner gender, we investigated relations between risky behaviors and early onset of sexual activity, substance use in conjunction with sexual activity, religiosity, and living situation.     

The Impact of Pre-exposure Prophylaxis on Sexual Well-Being Among Men Who Have Sex with Men

Archives of Sexual Behavior - Pre-exposure prophylaxis (PrEP) is a promising strategy to reduce HIV incidence among men who have sex with men (MSM). How and when PrEP is used could in part be...     

High Prevalence of Smoking Among Urban-Dwelling Canadian Men Who Have Sex with Men

A small but consistent literature from the United States suggests increased risk for smoking among lesbians and men who have sex with men (MSM). Few studies have investigated smoking among MSM in other countries where different social norms and restrictions on smoking in public apply. We measured smoking behaviours in a convenience sample of urban-dwelling young Canadian MSM (median age 28 years). We compared the prevalence of smoking among MSM with that among other men in British Columbia (BC) using National Population Health Survey data to compute an age-adjusted standardized prevalence ratio (SPR). Independent predictors of smoking among MSM were identified using adjusted odds ratios (OR) with 95% confidence intervals (CI). Smoking during the previous year was reported by twice as many MSM (54.5% of 354) as other men in BC (25.9%) (SPR = 1.94, 95% CI 1.48–2.59), with largest differentials observed among men under 25 years of age. In multivariable analyses, smoking among MSM was significantly associated with younger age (OR 0.94, CI 0.88–1.00 per year), greater number of depressive symptoms (OR 1.12, CI 1.06–1.19 per symptom) and Canadian Aboriginal ethnicity (OR 2.64, CI 1.05–6.60). In summary, MSM in our study were twice as likely to smoke as other men in BC; the greatest differences were observed among the youngest men. The design of effective prevention and cessation programs for MSM will require identification of the age-dependent determinants of smoking initiation, persistence, and attempts to quit. Lampinen, Bonner, Rusch, and Hogg are with the Division of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Lampinen, Rusch, and Hogg are with the Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada.     

Safer Sex Communication and Unsafe Sexual Behavior Among Young Men Who Have Sex with Men in California

Our objective was to investigate sexualcommunication and risk-taking behaviors among young menwho have sex with men (MSM). MSM aged 17 to 25 yearswere recruited from four areas throughout California. The construct Safer Sex Communication, assessedthrough principal-components analysis, was defined asperceived efficacy or experience in minimizing the riskof sexual HIV infection through communication with partners. In the 6 months prior to thesurvey, 35.6% of the MSM had participated in unprotectedanal intercourse (UAI). Adjusted logistic regressionanalyses found low Safer Sex Communication to be predictive of UAI. In addition, negativeattitudes toward safe sex, high perceived risk of HIVinfection, 10 or more male sex partners during theprevious 6 months, and use of cocaine in the past 6months were also independently related to UAI. SaferSex Communication skills should be an outcome ofinterventions designed to prevent HIV transmission amongyoung MSM.     

玉溪市男男性接触者安全套使用及影响因素分析

目的掌握玉溪市男男性接触者（MSM）人群安全套使用情况及其相关影响因素，为制定有针对性的干预措施提供依据。方法采用横断面调查和追踪调查相结合的方式，对105名MSM人群进行问卷调查。结果共调查MSM105人，其中未婚54．3％、在婚36．2％、离异或丧偶9．5％；最近1次肛交用安全套比例66．7％，其中未婚达78．9％、在婚55．3％、离异或丧偶40．0％，差异有统计学意义（P〈0．05）；MSM人群最近1次与异性发生性行为用安全套比例32．4％，其中在婚47．4％、未婚26．3％、离异或丧偶10．0％，差异有统计学意义（P〈0．05）；通过多因素Logistic回归分析，发现促进MSM使用安全套的影响因素包括高文化程度（OR=0．616），在婚、离异或丧偶的婚姻状态（OR=0．161、0．488），高艾滋病知识知晓（OR=0．444），接受过艾滋病咨询检测（OR=0．198），以及接受过同伴教育（OR=0．182）。结论玉溪市MSM人群安全套使用率偏低，影响因素较多。应进一步推广艾滋病咨询检测及同伴教育活动，注重完善MSM不同人群的干预措施。     

成都市男男性行为艾滋病哨点监测分析

目的描述成都市男男性行为（MSM）人群HIV感染率变化趋势,评价现阶段干预效果,为未来干预策略提供依据。方法使用滚雪球法募集成都市MSM人群1223人,开展问卷调查并采集血样,对HIV、梅毒和丙肝感染情况开展血清学检测。结果成都市MSM人群HIV感染率2009-2012年分别为14.9%、15.1%、16.3%和13.9%。MSM人群近6个月安全套使用率逐年上升。MSM人群最近6个月肛交时每次使用安全套的行为与是否做过HIV咨询检测（χ2=22.68,P〈0.01）和接受过安全套宣传/发放（χ2=7.441,P=0.006）相关。结论应将艾滋病防治知识健康教育与HIV咨询检测工作相结合,加大安全套宣传、发放工作力度。     

成都市男男性行为人群口交时安全套使用影响因素分析

目的探索成都市男男性行为人群口交行为时安全套使用的影响因素。方法采用滚雪球抽样选取成都市465名男男性行为者作为调查对象,通过问卷调查的方式收集人口学特征、艾滋病知晓率、高危行为等信息,用累积logistic模型分析成都市MSM人群发生口交行为时安全套使用的影响因素。结果共调查成都市465名MSM者,其中79.7%的调查对象最近6个月与性伴发生口交行为时从未使用安全套;最近6个月发生口交行为时安全套使用的影响因素有文化程度、寻找性伴最常去的场所、是否知道性伴的健康状况。结论成都市MSM人群口交行为时安全套使用率低,需通过多种途径对其进行健康教育,以提高安全套使用率。