Sexual HIV Risk Behavior Levels Among Young and Older Gay Men Outside of AIDS Epicenters: Findings of a 16-City Sample

Although AIDS rates have leveled among older gay men in large original epicenters, HIV seroincidence remains high among young men who have sex with men (MSM) in many areas of the country. This research examined patterns of risk behavior among young (age 25 years or less) and older (age 26 years and over) MSM. Nearly 2,000 men entering gay bars in 16 small U.S. cities completed an anonymous survey of their sexual practices in the past 2 months and of psychosocial risk-related characteristics. Young men were more likely than older men to have engaged in unprotected anal intercourse and, specifically, receptive intercourse in the past 2 months. Younger men also reported more frequent occurrences of unprotected anal intercourse. A progressive decline in risk behavior levels was associated with increasing age. Young men less often personally knew someone who had died of AIDS, and deaths were not primarily within their close social networks. Continued HIV prevention efforts directed toward young MSM are needed, including cities traditionally considered as second tier with respect to AIDS.     

Bisexual behavior among Chinese young migrant men who have sex with men: implications for HIV prevention and intervention

Data from 307 young migrant men who have sex with men (MSM) in Beijing were analyzed to examine bisexual behavior and the associated sociodemographic and behavioral factors among Chinese young migrant MSM. More than one-fourth (27%) of the MSM were also concurrently engaged in sexual behavior with women (MSMW). Among MSMW, 8.4% were infected with HIV, and 10.8% with Syphilis, compared to 4.9% and 23.7%, respectively, among men who have sex with men only (MSM-only). Various HIV-related risk behaviors among MSMW were similar to those of MSM-only, such as unprotected anal sex, multiple sexual partners, involvement in commercial sex, and substance use. Compared with MSM-only, MSMW were less likely to have tested for HIV, to participate in HIV prevention activities, and were less knowledgeable about condom use and HIV/AIDS. MSMW also had a higher rate of unprotected sex with female stable sexual partners than with male stable sexual partners (79.5% vs. 59.5%). Results indicated that MSMW were at a very high risk for both HIV infection and transmission. Intervention efforts are needed to target this subgroup of MSM and promote AIDS knowledge and HIV/STD testing among MSMW, and to reduce HIV transmission through MSM's bisexual behavior.     

Vengeance,Condomless Sex and HIV Disclosure Among Men Who Have Sex with Men Living with HIV

Vengeance has been shown to be a risk factor for HIV nondisclosure. Research examining the associations between vengeance, condomless sex, and HIV nondisclosure is lacking. The aim of the current study was to explore the association between vengeance, condomless sex and disclosure (behavior, attitude and intention) among men who have sex with men (MSM) living with HIV. Participants included 266 MSM who were a part of a disclosure intervention study. Men were recruited from local and state AIDS service organizations (ASOs), HIV-related venues and forums, and at local eating and drinking establishments in Tampa, Florida, and Columbus and Dayton, Ohio metropolitan statistical areas (MSAs). Advertisements were also placed in local daily newspapers. Vengeance was operationalized into three groups based on percentiles (least, more, and most vengeful) and as a continuous variable. Crude and multivariable logistic regression models were used to examine the association between vengeance and condomless sex in the past 30 days. Simple and multiple linear regression models were used to determine the association between vengeance and HIV disclosure. After adjusting for demographic and geographic characteristics, participants who were “most vengeful” had, on average, an approximate six-point decrease (β: ?5.46; 95% CI ?9.55, ?1.36) in disclosure intention compared to MSM who were “least vengeful.” Prevention and intervention programs geared towards improving disclosure among MSM should address vengeance.     

中国大陆男同性性接触者的艾滋病高危行为及影响因素研究(一)

目的本文描述了中国大陆男同性性接触者(MSM)与HIV/AIDS/STD相关的高危行为、认识和某些影响因素.方法通过自我填写问卷和当面访谈填写问卷两种形式,对426位男性进行了调查.结果本组主要生活在大中城市、接受过较好教育、较为年轻的MSM,平均约18岁开始与同性性交.4/5以上有口-生殖器性交,半数以上有肛门性交行为.累计性伴中位数9人.2/5以上在近一年内有偶遇性性伴.约半数人在调查时有固定性伴,但仅少数人与性伴保持闭合性性关系.约1/3已婚,近半数人与女性性交过.1/4曾患性传播疾病,近一年患病率为6.81%.仅1/10进行过HIV抗体检测,1人阳性.约1/3使用过安全套,通常在少数情况下使用,只有2人坚持使用.不用安全套的原因主要是认为安全套能降低快感、自己无感染HIV的可能和性伴健康,虽然他们已普遍具有关于HIV传播的一般知识.结论中国大陆部分MSM在性方面相当活跃,存在HIV在MSM中高水平流行的可能性.HIV在中国MSM中的流行速度高于90年代初中期在西方国家MSM中的流行速度,而且流行还会直接蔓延到妇女人群.由于社会文化等因素的阻力,对中国MSM的AIDS干预面临重大困难.     

Modeling the Impact of Post-Diagnosis Behavior Change on HIV Prevalence in Southern California Men Who Have Sex with Men (MSM)

Our objective here is to demonstrate the population-level effects of individual-level post-diagnosis behavior change (PDBC) in Southern Californian men who have sex with men (MSM), recently diagnosed with HIV. While PDBC has been empirically documented, the population-level effects of such behavior change are largely unknown. To examine these effects, we develop network models derived from the exponential random graph model family. We parameterize our models using behavioral data from the Southern California Acute Infection and Early Disease Research Program, and biological data from a number of published sources. Our models incorporate vital demographic processes, biology, treatment and behavior. We find that without PDBC, HIV prevalence among MSM would be significantly higher at any reasonable frequency of testing. We also demonstrate that higher levels of HIV risk behavior among HIV-positive men relative to HIV-negative men observed in some cross-sectional studies are consistent with individual-level PDBC.     

Psychosocial,Behavioral, and Cultural Predictors of Sexual Risk for HIV Infection Among Latino Men Who Have Sex with Men

This study sought to replicate and extend an investigation by Diaz et al. (1999) on determinants of HIV risk among Latino gay and bisexual men living in San Francisco who were predominantly English-speaking. Compared to the Diaz et al. study, the current study sample consisted of predominantly Spanish-speaking MSM, who resided outside of HIV/AIDS epicenters and whose countries of origin were primarily Central & South American. The relationships of unprotected anal sex and multiple sexual partners with demographic, developmental, behavioral, cultural and psychosocial variables were examined. Data were collected in a convenience sample of 250 participants (primarily immigrants from El Salvador) residing in Virginia. Most men in the sample had more than one sexual partner in the last 3 months (62%) and more than a third had unprotected anal sex with a casual partner in the same time period. Communication about HIV, sexual attraction, machismo, and experiences of discrimination based on homosexual behavior were predictive of HIV risk behaviors. The findings support an integrative approach to investigating HIV risk among Latino MSM. Implications for prevention programs are discussed.     

HIV Prevention Altruism and Sexual Risk Behavior in HIV-Positive Men Who Have Sex with Men

An understanding of men's motivations to avoid risk behavior is needed to create efficacious HIV prevention programs for HIV-positive men who have sex with men (MSM). This study investigates the relationship between sexual risk behavior and HIV prevention altruism, which is defined as the values, motivations, and practices of caretaking towards one's sexual partners to prevent the transmission of HIV. In a sample of 637 HIV-positive MSM, HIV prevention altruism significantly protects against serodiscordant unprotected anal intercourse (SDUAI) in crude analysis, but not after adjustment for drug use and compulsive sexual behavior. HIV prevention altruism is also related to not engaging in anal intercourse, but is not related to serodisclosure to secondary partners. Lack of altruism appears related to sexual risk behavior in HIV-positive MSM, although other psychological and contextual factors play significant roles. The promotion of HIV prevention altruism may provide a formidable new direction for HIV prevention programs.     

具有同性性接触的男性调查

目的 了解有同性性接触男性的与可能传播艾滋病、性病有关的性行为。方法 采用自拟的问卷对35例有同性性接触男性进行调查。结果 所有被访者中口交发生率94.3％,肛交68.6％,吻肛28.6％;他们中71.4％有异性性接触。结论 口交和肛交在他们的性接触中占重要位置,应加强防病意识教育。     

HIV Prevalence and Correlates of Unprotected Anal Intercourse Among Men Who Have Sex with Men, Jinan, China

China’s HIV epidemic may be shifting towards predominantly sexual transmission and emerging data point to potential increases in HIV prevalence among men who have sex with men (MSM). There is particular need to assess the extent of risk behavior among MSM outside of China’s most cosmopolitan cities. We conducted a respondent-driven sampling survey (N = 428) to measure HIV seroprevalence and risk behavior among MSM in Jinan, China, the provincial capital of Shandong. HIV prevalence was 0.5% (95% confidence interval [CI] 0.1–1.0). Unprotected anal intercourse (UAI) in the last 6 months (reported by 61.4%) was associated with buying or selling sex to a man in the last 6 months, syphilis infection, multiple partners in the last month, low HIV knowledge and migrant status. No participant had previously tested for HIV. Risk for HIV transmission is widespread among MSM throughout China; basic prevention programs are urgently needed.     

Homophobia is Associated with Sexual Behavior that Increases Risk of Acquiring and Transmitting HIV Infection Among Black Men Who Have Sex with Men

We investigated whether the experience of homophobic events increases the odds of engaging in unprotected anal intercourse (UAI) among black men who have sex with men (MSM) and whether social integration level buffered the association. Participants (N = 1,154) reported homophobic events experienced in the past 12 months. Social integration measures included social support, closeness with family members and friends, attachment to the black gay community, openness about sexuality within religious communities, and MSM social network size. Logistic regression analyses indicated that experiencing homophobia was associated with (1) UAI among men not previously diagnosed with HIV and (2) sexual HIV transmission risk behavior among men who knew they were HIV-infected. None of the social integration measures buffered these associations. Homophobia may promote acquisition and transmission of HIV infection among black MSM. Interventions are needed to reduce homophobia experienced by black MSM.     

Reducing AIDS Risk Among Men Who Have Sex with Men in Salvador, Brazil

Even though men who have sex with men (MSM) continue to account for a high proportion of AIDS cases in Brazil, relatively few prevention programs have been designed for them. We developed, implemented, and measured the impact of such a program in Salvador, Bahia, Brazil. This prospective cohort study used pre–post comparison to evaluate the impact of an intervention. We interviewed a cohort of 227 men recruited through snowball sampling before and up to 6 months after participating in brief AIDS prevention interventions. Knowledge and attitudes measures of HIV/AIDS and safer sex practices were raised and reported AIDS sexual risk behaviors declined after the intervention (all p values <.001). The proportion of men reporting unprotected anal intercourse in the prior month fell from 19% before the intervention to 1% after it. This study suggests that AIDS prevention activities designed for MSM in similar settings can be feasible and effective. More such prevention programs are urgently needed for MSM in developing countries such as Brazil.     

Results from Two Online Surveys Comparing Sexual Risk Behaviors in Hispanic,Black, and White Men Who Have Sex with Men

Many men who have sex with men (MSM) are among those who increasingly use the internet to find sexual partners. Few studies have compared behavior by race/ethnicity in internet-based samples of MSM. We examined the association of race/ethnicity with HIV risk-related behavior among 10,979 Hispanic, black, and white MSM recruited online. Significant variations by race/ethnicity were found in: age, income level, sexual orientation, number of lifetime male and female sexual partners, and rates of unprotected anal intercourse (UAI). Black and Hispanic men were more likely to report anal intercourse during the last sexual encounter, but white men were more likely to report UAI. In multivariate analysis, UAI was associated with HIV infection and sex with a main partner. Significant risk behavior variations by race/ethnicity were found. Research is needed to better target online interventions to MSM who engage in UAI or have other risk factors for transmitting or acquiring HIV.     

Perceptions of Lifetime Risk and Actual Risk for Acquiring HIV Among Young Men Who Have Sex with Men

Among young men who have sex with men (MSM) surveyed in six US cities, we evaluated the magnitude and correlates of perceived lifetime risk for acquiring HIV, and missed opportunities to increase risk perception by providers of health-care and HIV-testing services. Overall, approximately one quarter of young MSM perceived themselves at moderate/high risk for acquiring HIV. Adjusting for demographic, prior testing, and behavioral characteristics, moderate/high perceived risk had the strongest association with unrecognized HIV infection. However, half of the 267 young MSM with unrecognized infection perceived themselves at low lifetime risk for acquiring HIV, and many young MSM with low-risk perception reported considerable risk behaviors. Providers of health-care and HIV-testing services missed opportunities to assess risks and recommend testing for young MSM. To increase HIV testing, prevention providers should intensify efforts to assess, and to increase when needed, perceptions of lifetime risks for acquiring HIV among young MSM.     

High HIV Risk but Inadequate Prevention Services for Men in China Who Have Sex with Men: An Ethnographic Study

China is facing an emerging HIV epidemic among men who have sex with men (MSM). However, the HIV risk and prevention needs of these men are not well understood. We conducted in-depth qualitative interviews between August and October 2000 with 38 persons who identified as being MSM or knowledgeable about the MSM population in Beijing. Our ethnographic study identified 20 different segments of the population of MSM in Beijing and 14 distinct types of venues where these men congregate. Despite high levels of sexual risk taking, few men perceived themselves to be at risk for HIV. The main reasons cited for engaging in unsafe sex were economic survival, misconceptions about HIV, inaccurate assessment of a partner's risk, trusting a partner or needing to prove a partner trustworthy, meeting an attractive partner, and cruising in public sex environments. The HIV prevention services currently available in Beijing include mass media education, hotline information and counseling services, venue-based outreach, hospital-based services, and Internet sites, but few of these programs specifically targeted the MSM population. The major barriers to utilizing exiting services were lack of perceived risk, lack of privacy and anonymity, uninteresting program content, and distrust and questionable credibility of providers. Programs need to address issues broader than AIDS, be peer-designed and peer-led, be entertaining, and receive more government support. Our data suggest that many MSM are at high risk for HIV, but receive inadequate services. More effective and sustainable programs must be developed and implemented to prevent the further spread of HIV in this population.     

Correlates and Racial/Ethnic Differences in Bareback Sex Among Men Who Have Sex with Men with Unknown or Negative HIV Serostatus

Men who have sex with men (MSM), particularly racial/ethnic minority MSM, are disproportionately affected by HIV in the United States and Texas. Bareback sex or condomless anal intercourse (CAI) can be a high HIV risk behavior. Despite this, a majority of MSM continues to engage in barebacking. Research suggests racial/ethnic differences in barebacking exist; however, these conclusions remain unclear due to insufficient sample sizes to compare racial/ethnic groups. Our cross-sectional correlational design explores barebacking correlates (substance use during sex, safe sex fatigue, and optimistic HIV treatment beliefs) within and between racial/ethnic groups among 366 MSM. Regression models are significant for Latino and African-American MSM alone and for all MSM combined, though not significant for European-American and Other Race/Ethnicity MSM alone. Our findings suggest motivations and behaviors underlying barebacking among MSM vary by racial/ethnic membership with clinical implications for informing culturally sensitive HIV interventions and prevention programs for target racial/ethnic groups.     

HIV-testing behavior among young migrant men who have sex with men (MSM) in Beijing, China

Previous studies suggested a rapid increase of HIV prevalence among men who have sex with men (MSM) in China in recent years, from 0.4% in 2004 to 5.8% in 2006. However, some MSM had never been tested for HIV. In order to expand the accessibility to HIV testing, understanding HIV-testing behavior and barriers among MSM is important. Using data collected from 307 young migrant MSM (aged 18-29 years) in 2009 in Beijing, we aimed to identify psychological and structural barriers to HIV testing. MSM were recruited through peer outreach, informal social networks, Internet outreach, and venue-based outreach. Participants completed a confidential self-administered questionnaire. Results show that about 72% of MSM ever had an HIV test. Logistic regression analysis indicated that the HIV-testing behavior was associated with sexual risk behaviors (e.g., multiple sexual partners and inconsistent condom use for anal sex) and history of sexually transmitted diseases. Eighty four MSM (28%) who never had an HIV test reported that the psychological barriers mainly were perceived low risk of HIV infection and fears of being stigmatized. The structural barriers reported inconvenience of doing test and lack of confidentiality. Future HIV prevention programs should be strengthened among MSM to increase their awareness of HIV risk. Efforts are needed to increase access to quality and confidential HIV testing among MSM and reduce stigma against MSM.     

Men Who have Sex with Men: Racial/Ethnic Disparities in Estimated HIV/AIDS Prevalence at the State and County Level, Florida

Population-based HIV/AIDS prevalence estimates among men who have sex with men (MSM) have been unavailable, but have implications for effective prevention efforts. Prevalent (living) Florida HIV/AIDS cases reported through 2006 (numerators) were stratified by race/ethnicity and HIV exposure category. Based on previous research, MSM populations were posited as 4–10% of all males aged ≥13 years in each subgroup (denominators). At the estimated lower and upper plausible bounds, respectively, HIV/AIDS prevalence per 100,000 MSM was significantly higher among black (8,292.6–20,731.4); Hispanic (5,599.5–13,998.7); and Asian/Pacific Islander, American Indian or multi-racial (4,942.6–12,356.8) MSM than among white MSM (3,444.9–8,612.3). HIV/AIDS prevalence among all MSM was 13.8–36.9 times that among all other males. Across 19 high-morbidity counties, MSM HIV/AIDS prevalence was highest among those in the most populous counties and highest among blacks. This methodology, adaptable by other states, facilitates calculation of plausible MSM HIV/AIDS prevalence to guide HIV prevention/care community planners and MSM.     

Intertwining Epidemics: A Review of Research on Substance Use Among Men Who Have Sex with Men and Its Connection to the AIDS Epidemic

This paper reviews the (1) literature on substance use among men who have sex with men (MSM), (2) data that test whether connections between substance use and abuse and high-risk sexual behavior exist among MSM, and (3) ways that HIV interventions might address the effects of substance use on high-risk sexual behavior. We conclude that while alcohol use patterns are not substantially different between gay and heterosexual men, gay men do use more kinds of other drugs. Although there is considerable evidence to support the view that substance use patterns have declined among gay men since the mid-1980s, substance use should still be regarded as a health risk in this population. Although the associations between substance use and sexual risk-taking for HIV are complex, the inclusion of interventions to disentangle substance use and high-risk sexual practices may increase the efficacy of AIDS prevention efforts among gay men.     

深圳市男男性行为人群HIV／梅毒发病密度研究

目的了解深圳市男男性行为人群（MSM）的艾滋病病毒（HIV）/梅毒发病密度,探索防治性病对预防控制艾滋病的作用。方法知情同意原则下,招募符合纳入标准的MSM;建立并保持队列,收集社会人口学、性行为和安全套使用等资料;抽血检测HIV/梅毒,随访观察HIV/梅毒转归结局。结果 609例入选队列,HIV阴转阳19例,观察总人年数249.7人年,发病密度7.6[95%可信区间（CI）：4.6～11.9]/100人年;梅毒酶联免疫吸附试验（ELISA）阴转阳18例,观察总人年数134.9人年,发病密度13.3（95%CI：7.9～21.1）/100人年;梅毒ELISA阳性队列HIV发病密度是梅毒ELISA阴性队列HIV发病密度的2.2倍。结论梅毒对HIV传播具有协同作用,有必要在该人群中实施有效的性病预防措施以控制HIV传播     

Outcome Expectancy and Sexual Compulsivity Among Men Who Have Sex with Men Living with HIV

Sexual compulsivity is operationalized by engaging in repetitive sexual acts, having multiple sexual partners and/or the excessive use of pornography. Outcome expectancy refers to the beliefs about the consequences of engaging in a given behavior. Research examining the relationship between outcome expectancy and sexual compulsivity is limited. The aim of this study was to assess the association between outcome expectancy and sexual compulsivity among men who have sex with men (MSM) living with HIV. Data were obtained from 338 MSM. Simple and multiple linear regression models were used to assess the association between outcome expectancy and sexual compulsivity. After adjusting for age, race/ethnicity, income, education, and employment status, for every one point increase in outcome expectancies for condom use, HIV disclosure and negotiation of safer sex practices, there was, on average, an approximate one point decrease in sexual compulsivity score. Prevention and intervention programs geared towards reducing sexual compulsivity among MSM should focus on increasing outcome expectancies for condom use, HIV disclosure and negotiation of safer sex practices.