Dissolution of Committed Partnerships during Incarceration and STI/HIV-Related Sexual Risk Behavior after Prison Release among African American Men

Incarceration is strongly associated with post-release STI/HIV risk. One pathway linking incarceration and STI/HIV risk may be incarceration-related dissolution of protective network ties. Among African American men released from prison who were in committed partnerships with women at the time of incarceration (N?=?207), we measured the association between committed partnership dissolution during incarceration and STI/HIV risk in the 4 weeks after release. Over one-quarter (28%) experienced incarceration-related partnership dissolution. In adjusted analyses, incarceration-related partnership dissolution was strongly associated with post-release binge drinking (adjusted odds ratio (AOR) 4.2, 95% confidence interval (CI); 1.4–15.5). Those who experienced incarceration-related partnership dissolution were much more likely to engage in multiple/concurrent partnerships or sex trade defined as buying or selling sex (64%) than those who returned to the partner (12%; AOR 20.1, 95% CI 3.4–175.6). Policies that promote maintenance of relationships during incarceration may be important for protecting health.     

A Randomized Controlled Trial to Reduce HIV-Related Risk in African American Men Who Have Sex with Men and Women: the Bruthas Project

Prevention Science - African American men who have sex with men and women (MSMW) are among the populations with the highest need for HIV prevention programs in the USA. We tested a theory-based,...     

Gender Role Conflict Among African American Men Who Have Sex With Men and Women: Associations With Mental Health and Sexual Risk and Disclosure Behaviors

Objectives. We investigated whether high gender role conflict (GRC; internal conflict with traditional gender-role stereotypes and an individual’s perceived need to comply with these roles) is associated with psychological distress and HIV-related risk behaviors in a sample of African American men who have sex with men and women (MSMW).Methods. We analyzed baseline data collected from questionnaires completed by 400 MSMW participating in the Men of African American Legacy Empowering Self project in Los Angeles, California, in 2007 to 2010 for associations between participants’ GRC and experiences of poor mental health and HIV risk outcomes.Results. MSMW who reported higher levels of GRC than other participants also reported more psychological distress, lower self-esteem, greater internalized homophobia, less HIV knowledge, lower risk reduction skills, less disclosure of same-sex behaviors to others, and more unprotected vaginal or anal intercourse with female partners.Conclusions. Future research should consider how high GRC affects African American MSMW’s lives and identify specific approaches to help alleviate the psychological distress and other negative behavioral outcomes associated with internal conflict caused by rigid gender role socialization.Despite the heavy toll the HIV/AIDS epidemic has exerted on the lives of African American men who have sex with men (MSM), conspicuously few behavioral interventions have been developed to reduce HIV transmission in this population.1,2 Behavioral HIV prevention interventions designed specifically for men of any race/ethnicity who have sex with both men and women (MSMW) are practically nonexistent. In response to a 2005 report of HIV prevalence as high as 46% among African American MSM,3 the Centers for Disease Control and Prevention and other funding agencies began making resources available to adapt existing HIV prevention interventions, developed originally for gay White men, and to design and evaluate theory-driven HIV interventions to address the specific prevention needs of gay-, bisexual-, and heterosexual-identified African American MSM.The Men of African American Legacy Empowering Self (MAALES) project, conducted in Los Angeles, California, is an example of a collaborative academic–community effort to develop and rigorously test a culturally appropriate behavioral HIV intervention for African American MSMW.4 The critical thinking and cultural affirmation model, one of the behavioral theories underlying the MAALES small-group intervention, posits that a healthy integration of racial/ethnic pride, gender role, and sexual identity will allow African American MSMW to operate from a culturally rooted foundation to make healthier choices in their lives and relationships with sexual partners. This model recognizes that concerns regarding the preservation of African American masculinity underlie much of the conflict and discourse regarding male homosexuality and bisexuality in African American communities. A unique component of the MAALES intervention—aimed at reducing HIV acquisition and transmission risk behaviors—is its reliance on a culturally congruent framework that bolsters racial and cultural pride while reducing HIV stigma and gender role conflict (GRC).4GRC refers to negative consequences that can result from individuals'' socialization regarding the roles ascribed to their gender and the need to comply with these roles. According to O’Neil, such consequences for men can stem from “negative critiques of self or others when conforming to, deviating from, or violating stereotypic gender role norms of masculinity ideology.”5^(p363) Previous research on how males are socialized into traditional gender roles and the negative impacts of high GRC on mental health and other issues was conducted in samples primarily comprising heterosexual men.6–9 With the exception of a recent investigation of the impact of high GRC on condom use in a sample of African American MSM,10 most investigations of the impact of GRC on the lives of MSM have enrolled samples largely consisting of White gay-identified men.11–13In recent work to develop more effective HIV prevention programs for African American MSMW, Operario et al. conducted qualitative interviews with heterosexual-identified, behaviorally bisexual African American men to better understand the context of MSMW’s sexual behaviors with both male and female partners and the need for secrecy and confidentiality regarding same-sex behaviors.14 The study findings revealed a high level of internal conflict among participants stemming from their desire for male partners in the context of community norms that valued rigid male gender roles, namely, an explicit expectation that “real” men will only partner with women. The investigators also found that participants emphasized the need to conceal their same-sex behaviors from female partners and members of their broader social network because of their perceptions that the African American community viewed homosexuality as a weakness. Previous quantitative research in samples of heterosexual men also found higher levels of GRC to be associated with greater psychological distress.15,16 Similarly, among predominantly gay-identified White MSM, high GRC has been associated with higher levels of depression and anxiety and lower self-esteem.12,17We expanded on previous work by quantitatively investigating whether high GRC is associated with psychological distress as well as HIV-related risk behaviors in a sample of behaviorally bisexual African American men. Our theoretical rationale was that GRC may be related to African American men’s engagement in HIV risks through 2 mechanisms: indirectly, by influencing poor mental health outcomes such as psychological distress and lower self-esteem, which may reduce protective, safer-sex practices, and directly, because men with greater GRC may view vulnerability (either physical or emotional) as contrary to society’s expectation of masculinity. In other words, men may try to avoid the appearance of physical vulnerability by electing not to use condoms, an act that may be perceived as showing fear about health threats such as HIV. Men with greater GRC may also avoid the appearance of emotional vulnerability demonstrated by their use of condoms to protect their sexual partners’ health. Similarly, men struggling with GRC may see a need to have multiple female partners or to have more insertive anal intercourse with men to reinforce their masculinity.Consistent with observations in other populations, we hypothesized that high GRC contributes to increased psychological distress and reduced self-esteem in African American MSMW. In addition, we hypothesized that high GRC contributes to increased homophobia by heightening concerns over the implications of intercourse with other men for masculine status. These factors, in turn, may influence HIV risk by reducing African American MSMW’s motivation to acquire HIV knowledge and skills and to practice HIV preventive behaviors, thus increasing the likelihood that they will engage in risky behaviors such as drug use prior to intercourse with other men. We used baseline data collected from MAALES project participants to examine whether African American MSMW with higher levels of GRC than other participants also reported (1) higher levels of psychological distress and poorer self-concept, (2) greater secrecy regarding MSM behaviors, and (3) higher frequencies of engagement in HIV risk behaviors.     

Risk Reduction for HIV-Positive African American and Latino Men with Histories of Childhood Sexual Abuse

While the HIV epidemic has disproportionately affected African American and Latino men who have sex with men (MSM), few HIV prevention interventions have focused on African American and Latino men who have sex with both men and women (MSMW). Even fewer interventions target HIV-positive African American and Latino MSM and MSMW with histories of childhood sexual abuse (CSA), a population that may be vulnerable to high-risk sexual behaviors, having multiple sexual partners, and depression. The Men's Health Project, a small randomized clinical trial, compared the effects of two 6-session interventions, the Sexual Health Intervention for Men (S-HIM), guided by social learning theory and aimed at decreasing high-risk sexual behaviors, number of sexual partners, and depressive symptoms, and a standard health promotion control (SHP). A community sample of 137 HIV-positive gay and non-gay identifying African American and Latino MSM and MSMW with histories of CSA was recruited. Results were based on an "intent to treat" analyses of baseline to post, 3 and 6 month follow-ups. The sample as a whole reported reductions in sexual risk behaviors and number of sexual partners from baseline to post-test, and from the 3 to 6 month follow-ups, although the decrease in sexual risk behavior from baseline to post-test was significant only for S-HIM participants. No significant differences between conditions were reported for depressive symptoms, but the total sample reported a significant decrease at 6 months. These findings highlight the importance of addressing sexual decision-making and psychological adjustment for ethnic men, while being sensitive to CSA histories and sexual minority status, and suggest the need to develop additional strategies to heighten HIV risk reduction over time.     

Early Onset of Sexual Intercourse and Parental Incarceration among African American Youth Living in Urban Public Housing

Mass incarceration, substance use, and adolescent early onset of sex (e.g., initiate sexual intercourse at 13 years of age or younger) are social problems with disparate impacts on low-income African American communities. Two out of every five inmates in state and federal prisons are African American and the vast majority of these inmates are from low-income communities. Furthermore, this population experiences more severe consequences of substance use and abuse compared to other populations. In sum, African American youth endure the lion share of problems that mass incarceration and substance use leave in their wake. It is likely that the early onset of sex reported by African American youth in national data is related to mass incarceration and substance use in their communities. Using a sample of 142 African American youth, this paper assesses whether parental incarceration or substance, or both, are related to the likelihood of early onset of sex. Analytic procedures included chi-square and sequential logistic regression. The sample reported a mean age of 19 and 36% reported early onset of sex. Being male, paternal incarcerated, and maternal alcohol problems were associated with an increased likelihood of early onset of sex. Results point to a need for supportive services for the children of incarcerated parents, particularly those living in urban public housing developments.     

Perceptions Towards Condom Use, Sexual Activity, and HIV Disclosure among HIV-Positive African American Men Who Have Sex with Men: Implications for Heterosexual Transmission

Disproportionately high HIV/AIDS rates and frequent non-gay identification (NGI) among African American men who have sex with men or with both men and women (MSM/W) highlight the importance of understanding how HIV-positive African American MSM/W perceive safer sex, experience living with HIV, and decide to disclose their HIV status. Thirty predominately seropositive and non-gay identifying African American MSM/W in Los Angeles participated in three semi-structured focus group interviews, and a constant comparison method was used to analyze responses regarding condom use, sexual activity after an HIV diagnosis, and HIV serostatus disclosure. Condom use themes included its protective role against disease and pregnancy, acceptability concerns pertaining to aesthetic factors and effectiveness, and situational influences such as exchange sex, substance use, and suspicions from female partners. Themes regarding the impact of HIV on sexual activity included rejection, decreased partner seeking, and isolation. Serostatus disclosure themes included disclosure to selective partners and personal responsibility. Comprehensive HIV risk-reduction strategies that build social support networks, condom self-efficacy, communication skills, and a sense of collective responsibility among NGI African American MSM/W while addressing HIV stigma in the African American community as a whole are suggested.Harawa is with the Charles B. Drew University of Medicine and Sciences, University of California, Los Angeles, CA, USA. Williams is with the Semel Institute of Neuroscience & Human Behavior, Suite C8-871C, 760 Westwood Plaza, Los Angeles, CA 90024-1759, USA. Williams and Ramamurthi are with the Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, USA; Bingham is with the Los Angeles Department of Health Services, HIV Epidemiology Program, Los Angeles, CA, USA.     

寻找性伴不同场所男男性接触者性行为学特征分析

目的比较柳州市男男性接触者(MSM)最常去的不同场所性寻找性伴的性行为学特征,为HIV知识宣传及行为干预提供理论依据。方法在2008年10~12月依托志愿者组织通过网络宣传、朋友介绍、干预宣传等方式招募被调查对象,采用匿名面对面询问方式进行问卷调查,对他们寻找性伴最常去的场所进行分类比较。结果共调查300人,其中50.7%的人寻找性伴最常去的场所为公园、公厕、草地(a组),38.3%的人寻找性伴经常通过互联网(b组)。a组首次性行为是男性性伴的比例(46.7%)低于b组(62.2%)。最近6个月a组与男性肛交的比例(87.5%)低于b组(92.2%);且肛交时每次都用安全套的比例均较低。最近6个月a组、b组与女性发生性行为的比例分别为47.4%、20.0%(P<0.01);且与女性发生性行为时每次都用安全套的比例均很低。a组通过付钱或为了得到钱,与男性发生性行为的比例均高于b组(P<0.01),且a组与男性发生肛交时使用安全套的比例均低于b组。结论a组在婚率和异性的比例较高,且与男性、女性发生无保护性行为的比例更高,应有针对性地加强对该人群的监测和综合干预。     

Childhood Sexual Abuse and HIV-Related Risks Among Men Who Have Sex with Men in Washington,DC

Childhood sexual abuse (CSA) has been reported to be disproportionately higher among men who have sex with men (MSM) than among heterosexual men; it has also been found to be significantly positively associated with HIV status and HIV risk factors, including unprotected anal intercourse. The purpose of this study was to assess the correlates of CSA in a sample of community-recruited MSM, investigate race as a potential effect modifier, and describe the independent association between CSA and HIV infection in Washington, DC. A total of 500 MSM were recruited by venue-based sampling in 2008 as part of the National HIV Behavioral Surveillance. More than one-half of MSM identified as White, while one-third identified as Black. CSA was reported by 17.5 % of the 451 MSM, with the first instance of abuse occurring at a median age of 8.3 (interquartile range = 5.0, 11.0). In multivariable analysis, HIV-positive men were significantly more likely to report a history of CSA compared to HIV-negative men after adjusting for intimate partner violence in the last 12 months, having been arrested in the last 12 months, and depressive symptoms. HIV-positive MSM had more than four times the odds of reporting CSA after controlling for other correlates (aOR = 4.19; 95 % CI 2.26, 7.75). Despite hypothesizing that race modified the effect of CSA on HIV infection we found this was not the case in this sample. More research is needed to investigate the potential pathway between a history of CSA and HIV infection, and how this contributes to driving the HIV epidemic among MSM in Washington, DC.     

Relationship Between Childhood Sexual Abuse and HIV-Related Risks Among Men Who Have Sex with Men: Findings from Mainland China

Men who have sex with men (MSM) carry the burden of HIV infection in China. Outside of China, a history of childhood sexual abuse (CSA) has been associated with HIV-related risks (behavioral, sexual, and mental health outcomes) among MSM. We therefore evaluated the relationship between CSA and these HIV-related risks among MSM in China. Cross-sectional data were collected via a survey from gay websites and social networking applications from MSM in 30 provinces in mainland China during a 3-month period in 2014 and 2015. Overall, 999 screened MSM who responded to questions on CSA were included. Multinomial logistic regression models—adjusted for sociodemographic confounders—showed that men who reported experiencing regular CSA and contact CSA, respectively, were more likely to use substances (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI] 1.39–2.62 and AOR, 1.70; 95% CI 1.25–2.31), had a history of sexually transmitted infections (AOR, 1.81; 95% CI 1.29–2.55 and AOR, 1.65; 95% CI 1.18–2.96), had more male sexual partners (AOR, 1.06; 95% CI 1.04–1.09 and AOR, 1.05; 95% CI 1.03–1.08), engaged in more condomless sex with men (AOR, 1.89; 95% CI 1.39–2.56 and AOR, 1.72; 95% CI 1.29–2.30), and experienced more psychological distress (AOR, 1.05; 95% CI 1.02–1.08 and AOR, 1.05; 95% CI 1.03–1.08). Both frequent and contact forms of CSA were positively associated with HIV-related risks among MSM, suggesting that general CSA prevention strategies and interventions are needed to support this population.     

Experiences of Racial Discrimination and Relation to Sexual Risk for HIV among a Sample of Urban Black and African American Men

This study aimed to examine racial discrimination and relation to sexual risk for HIV among a sample of urban Black and African American men. Participants of this cross-sectional study were Black and African American men (N = 703) between the ages of 18 and 65 years, recruited from four urban clinical sites in the northeast. Multivariate logistic regression models were used to analyze the relation of reported racial discrimination to the following: (1) sex trade involvement, (2) recent unprotected sex, and (3) reporting a number of sex partners in the past 12 months greater than the sample average. The majority of the sample (96 %) reported racial discrimination. In adjusted analyses, men reporting high levels of discrimination were significantly more likely to report recent sex trade involvement (buying and/or selling) (adjusted odds ratio (AOR) range = 1.7–2.3), having recent unprotected vaginal sex with a female partner (AOR = 1.4, 95 % confidence interval (CI), 1.1–2.0), and reporting more than four sex partners in the past year (AOR = 1.4, 95 % CI, 1.1–1.9). Findings highlight the link between experiences of racial discrimination and men''s sexual risk for HIV.     

A Sexual Risk and Stress Reduction Intervention Designed for HIV-Positive Bisexual African American Men With Childhood Sexual Abuse Histories

Objectives. HIV transmission risk is high among men who have sex with men and women (MSMW), and it is further heightened by a history of childhood sexual abuse (CSA) and current traumatic stress or depression. Yet, traumatic stress is rarely addressed in HIV interventions. We tested a stress-focused sexual risk reduction intervention for African American MSMW with CSA histories.Methods. This randomized controlled trial compared a stress-focused sexual risk reduction intervention with a general health promotion intervention. Sexual risk behaviors, psychological symptoms, stress biomarkers (urinary cortisol and catecholamines), and neopterin (an indicator of HIV progression) were assessed at baseline and at 3- and 6-month follow-ups.Results. Both interventions decreased and sustained reductions in sexual risk and psychological symptoms. The stress-focused intervention was more efficacious than the general health promotion intervention in decreasing unprotected anal insertive sex and reducing depression symptoms. Despite randomization, baseline group differences in CSA severity, psychological symptoms, and biomarkers were found and linked to subsequent intervention outcomes.Conclusions. Although interventions designed specifically for HIV-positive African American MSMW can lead to improvements in health outcomes, future research is needed to examine factors that influence intervention effects.HIV/AIDS continues to disproportionately affect African Americans relative to other racial/ethnic groups.1,2 In 2009, for example, African Americans represented only 14% of the US population but accounted for 44% of all new HIV diagnoses.1 Male-to-male sexual contact is the greatest category of risk among Blacks, accounting for 73% of new infections among Black men.1 HIV infection rates are higher among Black men who have sex with men (MSM) than in any other racial/ethnic MSM group.1,2 Despite this disparity, few interventions have been designed specifically for African American MSM3–6 or for men who have sex with men and women (MSMW).Prevention strategies that emphasize HIV education and access to condoms may be inadequate in effecting sexual risk reduction in these populations. Preexisting risk factors and mediational mechanisms may operate differently among African American MSMW, who may also be less likely to respond to interventions that are developed for gay men3,7–9 or to those that are not contextualized for African American experiences. Intervention strategies that focus on less commonly examined mediators may influence sexual behavior changes and HIV transmission and serve as new modalities for addressing the HIV epidemic among African American MSMW.Individual behavior change is complicated by personal, environmental, historical, and institutional factors.10 Trauma exposure, a social determinant operating at multiple ecological levels, may be contributing to the HIV epidemic. Childhood sexual abuse (CSA) is a significant predictor of generalized emotional distress, anxiety, and posttraumatic stress disorder (PTSD) in adulthood,11–15 and it has also been associated with an increased risk of sexual revictimization.16–22 Experiencing CSA not only affects people’s health, but it may also have an impact on their interpersonal relationships in adulthood (e.g., how they select and interact with their intimate sexual partners). Societal and environmental factors such as the stigma associated with sexual abuse may also contribute to negative psychosocial health outcomes.23Acute traumatic and chronic stress is also known to disrupt neurobiological mechanisms essential for survival. Preclinical research demonstrates that all vertebrates share a similar threat system.24 Stimuli identified as potentially challenging to the basic state of equilibrium (i.e., stressors) trigger immediate release of catecholamines and subsequent release of glucocorticoids (e.g., cortisol). These regulatory systems have feedback loops that ensure a return to homeostasis when the threat subsides. However, when chronic or excessive demands are placed on these systems, long-term changes occur in the areas of growth, reproduction, and immune activity.24 These well-known effects are embodied in the allostatic load model,25 which reflects the cumulative burden of stress disruptions on primary mediators such as cortisol and catecholamines. Over time, primary mediator disruptions compromise efficient and effective responses to new demands, secondary downstream mediators (e.g., blood pressure and body mass index) are dysregulated, and ultimately an increased risk of tertiary disease outcomes results.26,27Major life events, including trauma and abuse experiences, and common but chronic challenges such as problems at work and home or relationship issues may all contribute to cumulative stress burdens.28 Among members of ethnic minority groups, racially discriminatory experiences may also be perceived as threatening and precipitate a stress response.29–31 Such chronic stress is thought to contribute to health disparities in racial/ethnic minority groups in a framework referred to as the weathering hypothesis.32,33 In the case of African Americans, racial, sociocultural, and political inequities, as well as trauma experiences such as CSA, may contribute to increased disease risk.Associations between CSA and increased HIV sexual risk behaviors34–38 and mental health symptoms have been reported among men with abuse histories.38,39 However, these relationships are complex. For example, PTSD with co-occurring depression has been shown to act as both a moderating and a mediating variable in the relationship between CSA and number of lifetime sexual partners.38,39 One recent study suggested that the associations of sexual risk behaviors with CSA trauma and with mental health symptoms were influenced by trauma and symptom severity.40 Severe CSA (e.g., forcible penetration over multiple incidents) and an increased number of PTSD symptoms were linked to more sexual risk behaviors among HIV-infected African American men. Also, mixed linear regression models showed that clinically meaningful levels of PTSD symptoms predicted a composite indicator of primary neurohormones (cortisol, norepinephrine, epinephrine, and dopamine) reflecting physical health risks.Although researchers have attempted to identify racial/ethnic differences in risk behaviors to explain disproportionate HIV rates,41 characteristics of trauma and subsequent mental and physical health stress burden have not been adequately examined. Research exploring whether stress reduction intervention components can reduce sexual risk behaviors and improve mental and physical health is still in its infancy. Evidence from HIV interventions links social cognitive models emphasizing relaxation skills, cognitive coping strategies, and social support to the mediation of mood effects and stress-related neurohormones.42–45 Decreased urinary cortisol levels with corresponding decreases in depressive symptoms and decreased urinary norepinephrine levels with reduced anxiety symptoms have been reported.42,46Two meta-analyses showed that cognitive–behavioral interventions decreased psychological symptoms such as depression, anxiety, anger, and stress among people living with HIV/AIDS.43,44 Unfortunately, immune functioning, as evidenced by CD4^43,44 and viral load,43 showed little improvement. A study involving a 15-session individual stress management intervention for people with HIV reported a decreased frequency of unprotected sexual acts but no effect on depression and anxiety symptoms.47 Another intervention, employing cognitive and stress management strategies with people who had HIV/AIDS and a history of CSA, reported decreases in both traumatic stress symptoms48 and unprotected sex acts.49 Comprehensive interventions designed to reduce sexual risk behaviors, psychological difficulties, and stress-related neurohormones are lacking.We conducted a small, randomized clinical trial to develop and test the Enhanced Sexual Health Intervention for Men (ES-HIM) that targeted HIV-positive African American MSMW who did not self-identify as gay and who had histories of CSA. We compared ES-HIM with an attention-matched health promotion intervention (HP) with respect to their efficacy in reducing sexual risk behaviors (i.e., unprotected anal and vaginal sex), numbers of sexual partners, psychological symptoms of PTSD and depression, and primary neurohormonal mediators (cortisol and catecholamines). We also explored the intervention’s effects on neopterin, which is produced primarily in monocytes and macrophages. Because neopterin is responsive to immune-inflammatory stimuli, it can serve as an indicator of HIV disease progression (i.e., deterioration of one’s health status as a result of stress).     

Social Network Characteristics and HIV Sexual Risk Behavior among Urban African American Women

HIV/AIDS has emerged as a significant health threat for African American women with well-documented disparities. The purpose of this study was to assess the association between social network characteristics and high-risk sexual behaviors among a sample of urban African American women at risk of heterosexually acquired HIV/STIs. We performed a cross-sectional study of baseline data collected from the CHAT study, a randomized HIV-prevention trial targeting urban HIV-at-risk women in Baltimore, MD. Our primary outcomes were risky sexual behaviors defined as either (a) two or more sexual partners or (b) having a risky sex partner within the past 90 days. Bivariable and multivariable logistic regression examining the associations between individual and social network factors and our two outcomes of interest were conducted. The study population included 513 sexually active African American women with a mean age of 41.1 years. High levels of unemployment (89.5%), depressive symptoms (60.0%), and drug use (68.8%) were present among this high-risk urban cohort. Controlling for individual factors including participant drug use, age, and depression, having two or more sex partners within the past 90 days was associated with having a larger personal network (OR = 1.11; 95% CI, 1.06 and 1.17); more network members who pitched in to help (OR = 1.22; 95% CI, 1.04 and 1.44), provided financial support (OR = 1.33; 95% CI, 1.11 and 1.60), or used heroin or cocaine (OR = 1.26; 95% CI, 1.14 and 1.40). Having a risky sexual partner within the past 90 days was associated with having a larger social network (OR = 1.06; 95% CI, 1.00 and 1.12) and having more social networks who used heroin or cocaine (OR = 1.30; 95% CI, 1.14 and 1.49).In summary, social network characteristics are associated with HIV sexual risk behaviors among African American urban women. Social-network-based interventions that promote norms pertaining to HIV risk reduction and provide social support are needed for African American women at risk of heterosexually acquired HIV/STIs.     

某区男男性行为人群性伴网络特征与高危行为分析

[目的]了解男男性行为（MSM）人群性伴网络特征及该人群中高危性行为的发生情况,探讨性病（STDs）、人类免疫缺陷病毒（HIV）在该人群中传播及向普通人群传播的模式,为开展性病、艾滋病预防控制提供依据。[方法]通过艾滋病自愿咨询检测门诊、同性恋人群活动场所、同性恋QQ群内动员、＂滚雪球＂等途径寻找MSM人群,招募151人,采用面对面匿名问卷调查方式收集信息。[结果]151名被调查者中最近6个月有30人（19.9%）与异性发生过性行为,高危性行为的发生率为53.3%;与同性性活动情况,其中91人（60.3%）有同性固定性伴,76人（50.3%）与非固定同性性伴的人发生过多次男男性行为（简称有多次男性伴）,77人（51.0%）发生过偶遇性行为（简称有偶遇男性伴）,10人（6.6%）从事商业性行为。而在与固定性伴、多次男性伴、偶遇男性伴、商业性行为中高危性行为的发生率依次是69.2%、57.9%、50.6%、70.0%。与固定男性伴高危性行为的发生率高于与偶遇男性伴高危性行为的发生率（P=0.014）。最近6个月有2种及以上性伴类型占58.9%。30名已感染HIV者中有多次男性伴及偶遇男性伴类型的比例分别为53.3%和63.3%;有过多次男性伴、偶遇男性伴性行为者中发生高危性行为的比例分别为50.0%和63.2%。感染HIV者与固定男性伴发生高危性行为的率低于未感染HIV者（P=0.029）。[结论]MSM人群性伴网络复杂多样,高危性行为发生率高。不仅使HIV在该人群中容易传播,且该人群已成为向普通人群传播HIV的＂桥梁＂人群。     

The Urban Environment and Sexual Risk Behavior among Men who have Sex with Men

Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions. Frye, Latka, Putnam, Galea, and Vlahov are with the Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, USA; Koblin is with the New York Blood Center, New York, NY, USA; Halkitis is with the Department of Applied Psychology, New York University, New York, NY, USA; Vlahov is with the Department of Epidemiology, Columbia University, New York, NY, USA; Galea is with the Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.     

Sexual Partnering and HIV Risk among Black Men Who Have Sex with Men: New York City

Black men who have sex with men (MSM) are disproportionately affected with HIV in the US. Limited event-specific data have been reported in Black MSM to help understand factors associated with increased risk of infection. Cross-sectional National HIV Behavioral Surveillance Study data from 503 MSM who reported ≥1 male sexual partner in the past year in New York City (NYC) were analyzed. Case-crossover analysis compared last protected and last unprotected anal intercourse (UAI). A total of 503 MSM were enrolled. Among 349 tested for HIV, 18% were positive. Black MSM (N = 117) were more likely to test HIV positive and not know their HIV-positive status than other racial/ethnic groups. Case-crossover analysis of 208 MSM found that men were more likely to engage in protected anal intercourse with a first time partner and with a partner of unknown HIV status. Although Black MSM were more likely to have Black male partners, they were not more likely to have UAI with those partners or to have a partner aged >40 years. In conclusion, HIV prevalence was high among Black MSM in NYC, as was lack of awareness of HIV-positive status. Having a sexual partner of same race/ethnicity or older age was not associated with having UAI among Black MSM.     

Substance Use and HIV Risk Behavior among Men Who Have Sex with Men: The Role of Sexual Compulsivity

The relationship between substance use, sexual compulsivity and sexual risk behavior was assessed with a probability-based sample of men who have sex with men (MSM). Stimulant, poppers, erectile dysfunction medication (EDM), alcohol use, and sexual compulsivity were independently associated with higher odds of engaging in any serodiscordant unprotected anal intercourse (SDUAI). The association of sexual compulsivity with SDUAI was moderated by poppers and EDM use. Behavioral interventions are needed to optimize biomedical prevention of HIV among substance using MSM.     

Drug Use and Sexual Arrangements Among Gay Couples: Frequency, Interdependence, and Associations with Sexual Risk

Rates of drug use among gay men are higher than their heterosexual counterparts and drug use is a prominent risk factor for HIV transmission. Studies using heterosexual samples have found that being partnered reduces the risk of drug use and individuals in a relationship tend to have similar use patterns. Studies among gay men suggest that sexual agreements may be an important predictor of drug use. Data from 322 partnered gay men were collected and the 161 matched couples were categorized as monogamous (52.8 %), monogamish (14.9 %), open (13.0 %), and discrepant (19.3 %). Patterns of significance and significant trends suggested that monogamous men reported lower rates of marijuana and other drug use compared to open and monogamish men. Men in discrepant relationships did not differ from any other group. Partners’ marijuana and other drug use was significantly interdependent in the overall sample; however, substantial variation in the magnitude and significance of interdependence was observed across sexual arrangement categories. Sexual arrangement and the use of drugs during sex both contributed to the prediction of UAI with casual partners among non-monogamous men. Implications for substance use treatment and HIV prevention are discussed.