Sexual Risk and Substance Use Behaviors Among African American Men Who Have Sex with Men and Women

African American men who have sex with men and women (MSMW), but who do not form a sexual identity around same-sex behavior, may experience risk for HIV infection and transmission. This paper reports cross-sectional survey findings on sexual behaviors and substance use of urban non-gay- or non-bisexual-identified African American MSMW (n = 68), who completed behavior assessment surveys using audio-computer assisted self-interviewing technology. Overall, 17.6% reported being HIV-positive. In the past 3 months, 70.6% had unprotected insertive sex with a female, 51.5% had unprotected insertive anal sex (UIAS) with a male, 33.8% had unprotected receptive anal sex (URAS) with a male, 25% had UIAS with a transgender female, and 10.3% had URAS with a transgender female. Findings indicated a bridging potential for HIV and sexually transmitted infections across groups, such that 38.2% reported concurrent unprotected sex with female and male partners and 17.6% reported concurrent unprotected sex with female and transgender female partners. In the past 3 months, 70.6% used alcohol before sex and 85% used drugs before sex. Men who used drugs before sex had a tenfold increased likelihood for unprotected sex with male partners, and men who injected drugs had a nearly fivefold increased likelihood for unprotected sex with a transgender female. Interventions to address sexual risk behaviors, especially partner concurrency, and substance use behavior for these men are warranted.     

Developmental Change in the Relationship Between Alcohol and Drug Use Before Sex and Sexual Risk Behavior in Young Men Who Have Sex with Men

Young men who have sex with men (YMSM) are the only group in which rates of new HIV infections are increasing in the United States. Alcohol and drug use have been linked to HIV risk, but evidence suggests that these associations may change across development and by relationship type. Data were taken from an analytic sample of 114 YMSM enrolled in a longitudinal study of lesbian, gay, bisexual and transgender youth with 4 years of participant follow-up. For the sample as a whole, alcohol use before sex was not associated with sexual risk, but drug use before sex was positively associated with sexual risk. A positive association between alcohol use and sexual risk emerged across development, and this association was stronger in serious relationships relative to casual sex partners. The positive association between drug use before sex and sexual risk decreased across development and was stronger in serious relationships. We discuss the need for addressing substance use before sex in dyadic interventions with YMSM.     

Alcohol and Sexual Risk Behavior Among Men Who Have Sex with Men in South African Township Communities

To our knowledge, no studies have considered the bidirectional relationship between HIV infected patients’ social/sexual lives and HAART adherence. To determine it’s potential impact the study sample consisted of 135 men starting HAART and being followed for 6 months. Twenty percent of men enrolled in the study self-reported non-adherence. Non-adherent patients reported a greater number and severity of adverse effects such as gastrointestinal and body changes. All participants were aware of these risks, requested support, and were advised by the health care providers. As many as 26% of the HIV infected men, at the second visit, reported sexual dysfunction and none received information regarding the possibility of this side effect. Of importance, patients reporting sexual dysfunction, were more likely to report not being fully adherent to the medication (RR = 2.46 95% CI 1.3–4.7; P = 0.04). Of most concern, none of the men reported looking for medical advice     

Sensation Seeking Moderates the Effects of Alcohol and Drug Use Prior to Sex on Sexual Risk in Young Men Who Have Sex with Men

Men who have sex with men (MSM) account for more than half of all new HIV/AIDS diagnoses in the United States each year, and young MSM (ages 13–24) have the highest increases in new infections. Identifying which young MSM engage in sexual risk-taking in which contexts is critical in developing effective behavioral intervention strategies for this population. While studies have consistently found positive associations between the use of certain drugs and sexual risk, research on alcohol use as a predictor of risk has been less consistent. Participants included 114 young MSM from a longitudinal study of LGBT youth (ages 16–20 at baseline). Participants reported number of unprotected sex acts with up to nine partners across three waves of data collection spanning a reporting window of 18 months, for a total of 406 sexual partners. Sensation seeking was evaluated as a moderator of the effects of both alcohol and drug use prior to sex on sexual risk. Higher levels of sensation seeking were found to significantly increase the positive associations between frequency of unprotected sex and frequency of both alcohol use and drug use with partners. Follow-up analysis found that average rates of alcohol use moderated the association between alcohol use prior to sex and sexual risk, such that decreases in average alcohol use increased the positive association between these variables. Results suggest that while drug use with partners increased sexual risk for all young MSM, the effects of alcohol use prior to sex were limited in low sensation-seeking young MSM as well as those who are high alcohol consumers on average. Implications for future research and behavioral interventions are discussed.     

Alcohol Use and Risk of HIV infection among Men Who Have Sex with Men

In the United States, men who have sex with men (MSM) currently represent more than 50% of those living with HIV and over 70% of HIV+ men (CDC 2007, ). Male-to-male sexual contact has been identified as the predominant route of transmission among this sub-group, which underscores the need for research that targets risk factors associated with risky sex-related HIV acquisition. Along these lines, research has shown that one potentially important predictor variable for risky sex among MSM is alcohol use. The major aim of this paper is to review and integrate empirical evidence on the association of alcohol use and risky sex among MSM. A summary of the quantitative research is provided first, followed by a critique of the reviewed literature, a discussion of the consistency of the existing empirical evidence with predictions of current theories, and finally, recommendations for future research designed to evaluate alcohol-related sexual risk in MSM.     

Dynamics of Sexual Risk Behavior in HIV-Infected Men Who Have Sex with Men

Much is known about the factors associated with risky sexual behavior among HIV-negative men who have sex with men (MSM) and among MSM whose HIV antibody status is unknown. However, little is known about the dynamics of continuing risky behavior among HIV-positive MSM. This research employed both questionnaire and extensive individual interview techniques to assess the levels of risky behavior, as well as the factors associated with risky behavior, in a sample of 42 seropositive MSM. Findings suggest that risky behavior occurs with some frequency, and that it is occasioned by informational, motivational, and behavioral skills-relevant deficits in the population at focus. Moreover, levels of risky behavior appear to differ with seropositive and seronegative primary partners. Implications for designing interventions for seropositive MSM are discussed.     

Alcohol Use and Associated Sexual and Substance Use Behaviors Among Men Who Have Sex with Men in Moscow,Russia

Alcohol use is a public health problem in the Russian Federation. This study explored relationships between alcohol use and behavioral risks for HIV transmission among men who have sex with men (MSM) in Moscow, Russia. Alcohol use disorder identification test (AUDIT) scores for 1367 MSM participating in a cross-sectional survey and HIV testing were categorized to: “abstinence/low use”, “hazardous use”, “harmful use/dependency”. Multiple logistic regression models compared dependent variables for sexual and drug use behaviors across alcohol use strata. Hazardous and harmful/dependent alcohol use were significantly associated with high-risk sexual behaviors and drug use. Harmful use/dependency was associated with an increased odds of having more than five male sex partners (last 12 months; adjusted odds ratios—AOR 1.69; 95 % CI 1.25–2.27), inconsistent condom use during anal intercourse (AOR 2.19; 95 % CI 1.61–2.96) and, among those using recreational drugs, injection drug use (last month; AOR 4.38: 95 % CI 1.13–17.07) compared to abstinent/low-level users. Harmful/dependent use was marginally associated with HIV infection (AOR 1.48; 95 % CI 0.97–2.25). HIV prevention efforts for MSM in Moscow may benefit from addressing problem alcohol use to mitigate high-risk behaviors.     

Online and Offline Sexual Health-Seeking Patterns of HIV-Negative Men Who Have Sex with Men

To inform health information targeting, we used cross-sectional data from 2577 HIV-negative MSM to identify groups of men who access similar sources. Offline, more men reported talking to a physician about HIV than about having sex with men; fewer than half attended a safer sex workshop. Online, men sought information primarily through Internet search engines, GLBT websites, or health websites. A latent class analysis identified four groups of health seekers: minimal health seekers, those who accessed online sources only, those who sought information mostly from health professionals, and those who sought information from diverse sources. Minimal health seekers, 9% of the sample, were the group of greatest concern. They engaged in unprotected anal sex with multiple partners but infrequently testing for HIV or sought sexual health information. By encouraging health seeking from diverse sources, opportunities exist to increase men’s knowledge of HIV/STI prevention and, when necessary, access to medical care.     

Association Between Alcohol Use and HIV-Related Sexual Risk Behaviors Among Men Who Have Sex with Men (MSM): Findings from a Multi-Site Bio-Behavioral Survey in India

This paper examines the association between alcohol use and HIV-related sexual risk behaviors among men who have sex with men (MSM). A cross-sectional bio-behavioral survey was conducted among 3,880 MSM, recruited using time-location cluster sampling from cruising sites in three Indian states. Nearly three-fifths of the participants reported alcohol use. Among frequent users (40 % of the sample), defined as those who consumed alcohol daily or at least once a week, 66 % were aged 25 years and above, 53 % self-identified as kothi (feminine/receptive), and 63 % consistently used condoms with male paying partners. Multivariate logistic regression demonstrated that frequent users were more likely to be aged 25 years and above, less likely to self-identify as kothi, and less likely to consistently use condoms with male paying (AOR = 0.7; 95 % CI 0.5–0.9) and male regular (AOR = 0.7; 95 % CI 0.6–0.9) partners. HIV prevention interventions for MSM need to provide tailored information on alcohol use-related sexual risk, especially for MSM in sex work and MSM with male regular partners.     

Sexual Risk Taking in Relation to Sexual Identification, Age, and Education in a Diverse Sample of African American Men Who Have Sex with Men (MSM) in New York City

HIV disproportionately affects African American men who have sex with men (MSM) in the United States. To inform this epidemiological pattern, we examined cross-sectional sexual behavior data in 509 African American MSM. Bivariate logistic regression analyses were conducted to examine the extent to which age, education, and sexual identity explain the likelihood of engaging in sex with a partner of a specific gender and the likelihood of engaging in unprotected sexual behaviors based on partner gender. Across all partner gender types, unprotected sexual behaviors were more likely to be reported by men with lower education. Younger, non-gay identified men were more likely to engage in unprotected sexual behaviors with transgender partners, while older, non-gay identified men were more likely to engage in unprotected sexual behaviors with women. African American MSM do not represent a monolithic group in their sexual behaviors, highlighting the need to target HIV prevention efforts to different subsets of African American MSM communities as appropriate.     

Residential Status as a Risk Factor for Drug Use and HIV Risk Among Young Men Who Have Sex with Men

There is growing behavioral and epidemiological evidence to suggest that young men who have sex with men (YMSM) are at high risk for becoming HIV-infected. Unfortunately, relatively little research has been conducted to examine the range of individual, social, and community-level factors that put these young men at increased risk. To address existing gaps in the literature, the Healthy Young Men’s (HYM) Study was launched in Los Angeles to examine the range of factors associated with HIV risk and protective behaviors within an ethnically diverse sample of 526 YMSM recruited using a venue-based stratified probability sampling design. In this paper we present findings that demonstrate that YMSM who experience residential instability, who have been forced to leave their home because of their sexuality, and/or who are precariously housed are at significantly greater risk for drug use and involvement in HIV risk-related behaviors.     

Drug Use, Unsafe Sexual Behavior, and Internalized Homonegativity in Men Who Have Sex With Men

Previous research has identified alcohol and drug use as predictive of unsafe sexual behavior among men who have sex with men (MSM). The purpose of this study was to assess whether substances associated with the greatest alteration in consciousness are associated with increased risk behavior, and to explore any relationship between internalized homonegativity and alcohol and other drug use. Participants in the study were 422 Midwestern MSM who volunteered to evaluate a seminar on sexuality and intimacy between men. Alcohol, chemical use, and dependency during the last 2 weeks were assessed using standardized questions and CAGE screening questions. Internalized homonegativity was assessed using the 26-item Reactions to Homosexuality scale. Components of unsafe sexual behavior during the preceding 3 months was assessed using dichotomous variables and collapsed into an overall measure of contextualized risk. Consistent and strong associations (ORs between 2.32 and 4.57) were found between unsafe sexual behavior and alcohol and other drug use. The greater the alcohol problem and the harder the drugs and the more they may impact consciousness or disinhibition, the greater the apparent association with unsafe sex. Degree of alteration of consciousness and disinhibition appear to be the common underlying dimensions of risk, although dose-level data were not available. The data did not support any consistent association between internalized homonegativity and use of drugs and alcohol.     

Event-Level Associations Among Drinking Motives,Alcohol Consumption,and Condomless Anal Sex in a Sample of Young Men Who Have Sex With Men

Young men who have sex with men (YMSM) are at increased risk for HIV and problematic alcohol use. Drinking motives are associated with alcohol use in cross-sectional studies, but their associations with alcohol use and condomless anal sex (CAS) at the event-level remain unclear. The current study examined these event-level associations in a sample of 189 YMSM who completed self-report measures on a daily or weekly basis for two months. Participants were recruited between August 2014 and April 2015 for a randomized trial designed to study behavioral reactivity in diary studies. YMSM consumed more alcohol on days when they drank to cope, to enhance pleasure, or to be more social. CAS with casual partners was more likely on days when they consumed more alcohol. Drinking motives were not associated with CAS. Interventions may benefit from addressing drinking motives and the influence of alcohol use on CAS in different types of relationships.     

Efficacy of a Web-Based Intervention to Reduce Sexual Risk in Men Who Have Sex with Men

To the extent that men who have sex with men (MSM) use the Internet, it serves as a promising medium for behavioral intervention. The present study sought to investigate the efficacy of a web-based skills training and motivational intervention in a randomized trial (N = 112) conducted completely online. After a detailed assessment, MSM were randomly assigned to an online intervention or a control website. The experimental intervention consisted of risk assessment and feedback, motivational exercises, skills training, and education while the control intervention focused on relaxation skills. Follow-up data were collected 3 months later and analyzed with repeated-measures MANOVA. Although both groups evidenced across-the-board reductions in unprotected sex, perhaps due to the detailed assessment, the experimental group showed greater reductions with the riskiest partners, those of positive or unknown serostatus. Thus, this study gives preliminary evidence that a brief web-based intervention offering cognitive behavioral skills training and motivational enhancement can effectively reduce sexual risk in MSM.     

Recruitment Source and Behavioral Risk Patterns of HIV-Positive Men Who Have Sex with Men

To effectively target HIV prevention activities, community outreach workers need to know how to locate persons at greatest risk for acquiring or transmitting HIV. This study compared the behavioral characteristics of HIV-positive men who have sex with men recruited from different sources: AIDS service organizations, mainstream gay environments, public/private sex environments, and friend referrals. Men recruited from sex environments exhibited the riskiest behavior: more male partners, more likely to have casual sex, more likely to have had unprotected insertive sex with men of HIV-negative or unknown status, less likely to have disclosed serostatus to primary partners, less comfortable discussing serostatus with others, and less feeling of personal responsibility for disclosure. A distinctive group of men, the referral group, did not identify with the gay community and reported sex with men and women. Future efforts should continue to assess the types of people that are recruited from different sources so that program and research efforts can be appropriately targeted.The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.An erratum to this article can be found at     

Sociodemographic Factors,Sexual Behaviors,and Alcohol and Recreational Drug Use Associated with HIV Among Men Who Have Sex with Men in Southern Vietnam

A total of 2768 MSM participated in a survey in southern Vietnam. Univariate and multivariate logistic regression analyses were performed to determine predictors of HIV infection. The prevalence of HIV among MSM was 2.6 %. HIV infection was more likely in MSM who were older, had a religion, had engaged in anal sex with a foreigner in the past 12 months, previously or currently used recreational drugs, perceived themselves as likely or very likely to be infected with HIV, and/or were syphilis seropositive. MSM who had ever married, were exclusively or frequently receptive, sometimes consumed alcohol before sex, and/or frequently used condoms during anal sex in the past 3 months were less likely to be infected with HIV. Recreational drug use is strongly associated with HIV infection among MSM in southern Vietnam. HIV interventions among MSM should incorporate health promotion, condom promotion, harm reduction, sexually transmitted infection treatment, and address risk behaviors.     

Associations Between Major Depressive Episode,Methamphetamine Use Disorder Severity,and Engagement in Sexual Risk-Taking Among Methamphetamine-Using Men Who Have Sex with Men

Depression and methamphetamine use have been associated with increased sexual risk-taking among men who have sex with men (MSM). This study estimated associations between current major depressive episode and/or methamphetamine use disorder and engagement in condomless anal intercourse (CAI). From March 2014 thru January 2016, 286 methamphetamine-using MSM were enrolled into a RCT to reduce methamphetamine use and sexual risk-taking. Analyses revealed that current major depressive episode was associated with a 92% increase in the rate of engagement in CAI with casual male partners (IRR 1.92; 95% CI 1.12–3.31) and a 76% increase in the rate of engagement in CAI with anonymous male partners (IRR 1.76; 95% CI 1.00–3.09). Additionally, for each unit increase in diagnostic methamphetamine use disorder severity, rates of engagement in CAI with anonymous male partners increased by 44% (IRR 1.44; 95% CI 1.11–1.87) and rates of engagement in CAI with exchange male partners increased by 140% (IRR 2.40; 95% CI 1.39–4.13). Neither diagnosis was associated with CAI with main male partners. Depression and methamphetamine use influence sexual risk-taking in unique ways, and interventions working with MSM should assess participants for both depression and methamphetamine use, and may tailor intervention content based on diagnostic outcomes.