Sexual Health Behaviors and Sexual Orientation in a U.S. National Sample of College Students

Many studies have examined differences in sexual behavior based on sexual orientation with results often indicating that those with same-sex partners engage in higher risk sexual behavior than people with opposite sex partners. However, few of these studies were large, national sample studies that also include those identifying as unsure. To address that gap, this study examined the relationship of sexual orientation and sexual health outcomes in a national sample of U.S. college students. The Fall 2009 American College Health Association–National College Health Assessment was used to examine sexual health related responses from heterosexual, gay, lesbian, bisexual, and unsure students (N = 25,553). Responses related to sexual behavior, safer sex behaviors, prevention and screening behaviors, and diagnosis of sexual health related conditions were examined. The findings indicated that sexual orientation was significantly associated with engaging in sexual behavior in the last 30 days. Sexual orientation was also significantly associated with the number of sexual partners in the previous 12 months, with unsure men having significantly more partners than gay, bisexual and heterosexual men and heterosexual men having significantly less partners than gay, bisexual and unsure men. Bisexual women had significantly more partners than females reporting other sexual orientations. Results examining the associations between sexual orientation and safer sex, prevention behaviors, and screening behaviors were mixed. Implications for practice, including specific programmatic ideas, were discussed.     

Age-Concordant and Age-Discordant Sexual Behavior Among Gay and Bisexual Male Adolescents

There is evidence that risks for HIV and sexually transmitted infections among adolescent females are higher for those with older male sexual partners. Yet, little empirical research has been conducted with male adolescents who engage in sexual activity with older men. In this article, we summarize in a number of ways the range of sexual activity reported by an ethnically diverse sample of 200 gay and bisexual male youth (15–22 years old) in Chicago and Miami. A general pattern of progression from oral sex with men to both receptive and insertive anal sex with men appeared to characterize the sample during their adolescence. Further, there appeared to be a high degree of “versatile” positioning among the sexually active gay and bisexual young men, in both age-discrepant and age-concordant dyads. Risk analysis revealed having primarily age-concordant partners to be a significant predictor of sexual risk behavior. HIV risk among young gay and bisexual men engaging in sexual activity with older men may occur not only within a distinct biological context from their heterosexual counterparts, but also in a social context that may not as rigidly bound to traditional assumptions about age, gender, and power. The significant associations among participants with partners who were the same age and the risk behavior measures in this analysis have implications for HIV prevention efforts.     

Sex with Men Before Coming-Out: Relation to Sexual Activity and Sexual Risk-Taking Behavior

This study examined the difference in sequence of coming-out and first same-sex experience in relation to risk-taking behavior in a sample of Dutch gay and bisexual men. A questionnaire assessed age of disclosure (coming-out) and age of first same-sex experience, and information on sexual history, sexual relationships, and sexual behavior. It was found that 68% of respondents engaged in their first same-sex experience before coming-out. This proportion increased with age. Men who had sex with men before coming-out reported more lifetime sex partners and more casual sex partners in the past 6 months than men in which this sequence was reversed. In addition, among this group a higher proportion of men reported STDs, engaging in anal intercourse with casual partners in the previous 6 months, and unprotected anal sex with casual sex partners in the recent past, compared to men who came out before having their first same-sex experience. The extent to which external factors (such as tolerance toward homosexuals) or internal factors (such as personality factors) can account for the difference in sexual behaviors in general and sexual risk-taking behavior in particular could be subject of further study.     

The Psychology of Gay Men’s Cuckolding Fantasies

Cuckolding (also known as troilism) is a sexual interest in which one obtains sexual arousal from the experience of a romantic partner engaging in sexual activity with someone else. The present study investigated fantasies about and experiences with cuckolding in a large and diverse sample of predominately gay-identified men (N = 580). Compared to previous research focusing on heterosexual men’s cuckolding fantasies, our results indicate that gay men’s cuckolding fantasies share many common elements; however, they differ in some important ways. Most notably, interracial and BDSM themes do not appear to be as common in gay men’s cuckolding fantasies as they are among heterosexual men. Our findings also indicate that frequent fantasies about cuckolding are linked to several overlapping sexual interests (e.g., voyeurism, group sex) and, further, the content of these fantasies is associated with a number of individual differences (e.g., agreeableness, sensation seeking, sociosexuality). Finally, this study also suggests that gay men who act on their cuckolding fantasies tend to report positive experiences; however, the likelihood of reporting positive outcomes appears to depend upon one’s personality and attachment style.     

‘Top,bottom, versatile’: narratives of sexual practices in gay relationships in the Cape Metropole,South Africa

Abstract

Sexual practices among gay and other men who have sex with men are evolving in South Africa and heteronormative stereotypes are being contested. This paper draws from a larger qualitative study on how men construct a gay identity and negotiate their relationships within contemporary South African contexts, following constitutional and legal changes, in this respect. A feminist, social constructionist approach was used to collect and analyse data from in-depth interviews with 15 self-identified gay men, aged 20 to 46 years, drawn from a university in the larger Cape Metropole, South Africa. Interviews were audio-recorded, transcribed verbatim and analysed using thematic and narrative analysis. ‘Bottoms’ revealed being powerful in receptive sex. Other men deconstructed the binaries of masculine/feminine and resisted heteronormativity by engaging in fluid constructions in their relationships, whereby participants ‘switched’ or ‘flipped’ or did not recognise stereotypical roles when practising sex. There may be value in making these flexible and reciprocal sexual practices better known about and promoted as non-normative African models of sexual practice.     

Familial Aspects of Male Homosexuality

Research has generally supported the existence of familial–genetic factors for male sexual orientation, but has not shed much light on the specific nature of those influences. Gay men with gay brothers provide the opportunity to examine several hypotheses. Sixty-six men, representing 37 gay male sibling pairs, completed questionnaires assessing behavior on various measures including childhood and adult gender nonconformity, timing of awareness of homosexual feelings, self-acceptance, and the quality of family relationships. Consistent with prior findings using twins, gay brothers were similar in their degree of childhood gender nonconformity, suggesting that this variable may distinguish etiologically (e.g., genetically) heterogeneous subtypes. The large majority of gay men with brothers knew about their own homosexual feelings before they learned about their brothers' homosexual feelings, suggesting that discovery of brothers' homosexuality is not an important cause of male homosexuality.     

Sex Differences in the Flexibility of Sexual Orientation: A Multidimensional Retrospective Assessment

The flexibility of sexual orientation in men and women was examined by assessing self-reported change over time for three dimensions of sexual orientation (sexual fantasy, romantic attraction, and sexual behavior) across three categorical classifications of current sexual orientation (heterosexual, bisexual, and gay). The primary purpose of the study was to determine if there were sex differences in the flexibility (i.e., change over time) of sexual orientation and how such differences were manifested across different dimensions of orientation over the lifespan. Retrospective, life-long ratings of sexual orientation were made by 762 currently self-identified heterosexual, bisexual, and gay men and women, aged 36 to 60, via a self-report questionnaire. Cumulative change scores were derived for each of the three dimensions (fantasy, romantic attraction, and sexual behavior) of orientation by summing the differences between ratings over consecutive 5-year historical time periods (from age 16 to the present). Sex differences were observed for most, but not all, classification groups. There were significant sex differences in reported change in orientation over time for gays and heterosexuals, with women reporting greater change in orientation over time than did men. Bisexual men and women did not differ with respect to self-reported change in orientation.     

Young men’s rationales for non-exclusive gay sexualities

Recent evidence suggests it is useful to distinguish sexual identities among young men at the gay end of the spectrum because of group differences between primarily gay, mostly gay and gay orientations on several assessed physiological, behavioural and self-report measures. However, little is known about individuals’ rationales for choosing sexuality labels beyond traditional gay or bisexual categories. We addressed this issue by interviewing 24 young men with a non-exclusive gay orientation about their sexual desires and histories, drawing on both qualitative and numeric data. Undertaking an inductive analysis, we found four distinct rationales for identification with a sexual orientation label: sexual, romantic, intellectual and internalised homophobia. By examining what young men mean when they classify themselves as primarily gay, mostly gay or bisexual-leaning gay, this article provides data to understand these issues and proposes that greater focus should be placed on sexual identity for non-exclusive gay men. Although the sexual and affectional components of sexual orientation are meaningful, previous research has not sufficiently accounted for the importance of intellectual, cultural and romantic factors in non-exclusive sexual orientations. To address these issues, the use of in-depth interviews should be incorporated in future studies.     

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.     

Sexual Compulsivity and Sexual Risk in Gay and Bisexual Men

Much of our understanding of the association between the Sexual Compulsivity Scale (SCS) and sexual risk behavior among men who have sex with men (MSM) has been limited to samples of HIV positive MSM only. Using data from a community-based survey of gay and bisexual men (n = 1214), this analysis sought to further evaluate the association between the SCS and sexual risk behavior. The SCS was significantly associated with a variety of sexual risk behaviors, including having sex under the influence of club drugs, engaging in unprotected anal sex (receptive or insertive) with partners of the same and/or different HIV serostatus, identity as a barebacker, intentions to have bareback sex, number of recent sex partners, and temptation for unsafe sex. The SCS was also significantly associated with having engaged in a variety of specialized sexual behaviors (i.e., fetishes), many of which can increase HIV transmission risks. Finally, in multivariate analyses, the SCS significantly predicted unprotected sex with a non-main partner even when controlling for race, HIV serostatus, age, identity as a barebacker, and club drug use. These data indicate that the SCS may be able to serve as an indicator to detect HIV-associated sexual risk behavior in community-based samples of gay and bisexual men.     

When ‘raw sex’ turns to a ‘raw deal’ … taking the opportunity to think about sex? Interviews with HIV-positive gay men diagnosed with acute hepatitis C

Since 2001, cases of hepatitis C virus (HCV) sexual transmission have been reported in France, among HIV-positive gay men who do not inject drugs. An earlier study focused on the incidence of acute hepatitis C and risk factors associated with HCV transmission. The present study, based on in-depth interviews, aimed to highlight the biography, the sexual practices and the experiences of gay men infected with HCV. Beyond an apparent uniformity, the group of interviewees illustrates a variety of situations, life stories and health pathways, depending on their age. These well-adjusted gay men were used to engaging in unprotected sexual practices, but before their diagnosis they largely ignored HCV-transmission risk, which was associated in their mind with a pejorative drug addict image. Once diagnosed with acute hepatitis C, they experienced a critical and emotional period during which they were open to discuss their sexual practices and reconsider risk-reduction procedures, without being willing to give up on their satisfying sex life. Health educators should consider labelling hepatitis C as an STI in order to disrupt its negative image and to help HIV-positive gay man raise their awareness of HCV-transmission risks and implement better risk-reduction strategies.     

What’s In an Identity Label? Correlates of Sociodemographics,Psychosocial Characteristics,and Sexual Behavior Among African American Men Who Have Sex With Men

African American men who have sex with men (AAMSM) are vastly overrepresented among people with HIV/AIDS. Using data from 595 AAMSM in Philadelphia, we explored differences in sociodemographics, psychosocial characteristics related to beliefs about ethnicity, sexuality and masculinity, and sexual behavior with men and women by self-reported sexual identity (gay, bisexual, down low, straight). Roughly equivalent numbers identified as gay (40.6 %) and bisexual (41.3 %), while fewer identified as straight (7.6 %) or down low (10.5 %), with significant differences in age, income, history of incarceration, HIV status, alcohol and drug problems, childhood sexual abuse, and connection to the gay community evident among these groups. Analysis of psychosocial characteristics theorized to be related to identity and sexual behavior indicated significant differences in masculinity, homophobia, and outness as MSM. Gay and straight men appeared to be poles on a continuum of frequency of sexual behavior, with bisexual and down low men being sometimes more similar to gay men and sometimes more similar to straight men. The percentage of men having total intercourse of any kind was highest among down low and lowest among gay men. Gay men had less intercourse with women, but more receptive anal intercourse with men than the other identities. There were no significant differences by identity in frequency of condomless insertive anal intercourse with men, but gay men had significantly more condomless receptive anal intercourse. There were significant differences by identity for condomless vaginal and anal intercourse with women. This study demonstrates the importance of exploring differences in types of sex behavior for AAMSM by considering sexual identity.     

The Sociodemographic Characteristics of Concurrent Sexual Partnerships and their Risky Sexual Behaviors: Results of a Nationally Representative Sample of South Korean Adults

This study assessed the risky sexual behavior of a group of adult men and women with sexual experience within the past 1 year who, while in a relationship with a stable partner, reported having sex with another person. The data were collected in 2003 using a nationally representative, multi-stage stratified probability sample (n = 1,271) of women and men in South Korea. Via hierarchical regression models, we assessed the gendered effects of socioeconomic characteristics, health behavior, sex behavior, and safe sex attitude factors. According to the results, for groups with concurrent sexual partnership experience, if the subject was a single person with smoking and drinking who had engaged in sex resulting in unwanted pregnancy, and anal sex initiated before the age of 17, the likelihood of engaging in concurrent sexual partnerships was statistically significant. Furthermore, our gender-elaborated analysis demonstrated that the majority of sexual risk was borne by women. When the partners of concurrent sexual partnerships are categorized by type, the key characteristic of a casual relationship or relationship with female sex workers is one-night-stand sex, accompanied by drinking. This study found that, for groups with concurrent sexual partnerships experience, there is a statistical association between health risky variables and risky sexual behavior. We should attempt to intervene in these concurrent sexual partnerships groups for the effective management of sexually transmitted infections.     

Sexual stigma,psychological well-being and social engagement among men who have sex with men in Beirut,Lebanon

This qualitative study sought to explore sexual identity development among men who have sex with men in Beirut, Lebanon; the stigma experienced by these men; and how their psychological well-being and social engagement are shaped by how they cope with this stigma. Semi-structured interviews were conducted with 31 men who have sex with men and content analysis was used to identify emergent themes. While many men reported feeling very comfortable with their sexual orientation and had disclosed their sexual orientation to family, most men struggled at least somewhat with their sexuality, often because of perceived stigma from others and internal religious conflict about the immorality of homosexuality. Most participants described experiencing verbal harassment or ridicule or being treated as different or lesser than in social relationships with friends or family. Mechanisms for coping with stigma included social avoidance (trying to pass as heterosexual and limiting interaction with men who have sex with men to the internet) or withdrawal from relationships in an attempt to limit exposure to stigma. Findings suggest that effective coping with both internal and external sexual stigma is central to the psychological well-being and social engagement of men who have sex with men in Beirut, much as has been found in Western gay communities.     

“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.     

Can Some Gay Men and Lesbians Change Their Sexual Orientation? 200 Participants Reporting a Change from Homosexual to Heterosexual Orientation

Position statements of the major mental health organizations in the United States state that there is no scientific evidence that a homosexual sexual orientation can be changed by psychotherapy, often referred to as reparative therapy. This study tested the hypothesis that some individuals whose sexual orientation is predominantly homosexual can, with some form of reparative therapy, become predominantly heterosexual. The participants were 200 self-selected individuals (143 males, 57 females) who reported at least some minimal change from homosexual to heterosexual orientation that lasted at least 5 years. They were interviewed by telephone, using a structured interview that assessed same sex attraction, fantasy, yearning, and overt homosexual behavior. On all measures, the year prior to the therapy was compared to the year before the interview. The majority of participants gave reports of change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year. Reports of complete change were uncommon. Female participants reported significantly more change than did male participants. Either some gay men and lesbians, following reparative therapy, actually change their predominantly homosexual orientation to a predominantly heterosexual orientation or some gay men and women construct elaborate self-deceptive narratives (or even lie) in which they claim to have changed their sexual orientation, or both. For many reasons, it is concluded that the participants' self-reports were, by-and-large, credible and that few elaborated self-deceptive narratives or lied. Thus, there is evidence that change in sexual orientation following some form of reparative therapy does occur in some gay men and lesbians.     

An Internet Study of Cybersex Participants

Cybersex is a subcategory of online sexual activities (OSA) and is defined as when two or more people are engaging in sexual talk while online for the purposes of sexual pleasure and may or may not include masturbation. Cybersex is a growing phenomenon with a significant impact on participants but very little research has been done on this subject to date. This study is the first to attempt to delineate characteristics of those who engage in cybersex. Data were collected through an online questionnaire in Swedish, administered through the Swedish web portal Passagen.se. Out of the total sample (N = 1828), almost a third, both men and women, reported to have engaged in cybersex. A logistic regression analysis showed that age, sex, and sexual orientation were important demographic variables to consider when investigating cybersex. A comparison of interval data showed those engaging in cybersex to have a higher likelihood of spending more time online for OSA and having more offline sex partners than those not engaging in cybersex.This revised article was published online in June 2005 with the book reviews as separate articles     

Prevalence of Same-Sex Behavior and Orientation in England: Results from a National Survey

There are few data sources on the prevalence of same-sex sexual orientation in England. We aimed to measure the prevalence of same-sex orientation and behavior in the English general population and assess the impact of enquiry format on reporting. The Adult Psychiatric Morbidity Survey 2007 used a multi-stage, stratified probability-sampling design (n = 7,403). Two questions addressed sexual orientation and sexual partnership and each had two versions. Version A of the sexual orientation question used “homosexual.” Version B used “gay or lesbian.” Version A of the sexual partnership question required participants who had male and female partners to say which was predominant, while Version B had a midpoint response option: “about equally with men and women.” Participants were randomized between versions. Overall, 5.3% of men and 5.6% of women reported they were not entirely heterosexual. The question using “gay or lesbian” elicited higher (though not statistically significant) reporting of non-heterosexual orientation than the question using “homosexual.” A significantly larger proportion of men and women (96.0 and 96.1%) reported entirely heterosexual partnerships in response to Version A of the partnership question than in response to Version B (94.0 and 92.9%) where Version B asked specifically about “kissing, touching, intercourse, or any other form of sex.” These figures constitute the first national prevalence data on combined sexual orientation and sexual behavior in England, based on a random probability sample of the general population. They demonstrate that people are willing to report their sexual orientation in survey research, but reporting is sensitive to question wording.