Explanations for the Origins of Sexual Compulsivity Among Gay and Bisexual Men

Sexual compulsivity (SC) is a condition characterized by sexual fantasies and behaviors that interfere with personal, interpersonal, or vocational pursuits. This article describes the ways in which gay and bisexual men with symptoms of SC understand and explain the origins of their condition. The data for this article were drawn from Project SPIN, a mixed-methods study of SC among 183 gay and bisexual men in New York City. The article provides an evaluation of how urban gay and bisexual men experience SC and describes how they think about it in their own words. These men articulated both intrinsic and extrinsic sources for the development of SC. Some participants endorsed a belief in a predisposition toward sexually compulsive behavior, whereas others identified factors such as emotional neglect, sexual abuse, or the availability and accessibility of sexual partners. These understandings may influence the ways in which SC can be treated, while also highlighting issues that may be critical in the identification and/or measurement of SC. Insights into the origins of SC may yield new therapeutic models that reduce not only the distress of contending with this condition but its negative health effects and impact on quality of life.     

Methamphetamine Use Trends among Street-Recruited Gay and Bisexual Males,from 1999 to 2007

Street outreach encounters were used to collect data of reported alcohol and other drug use among gay and bisexual males (N = 11,375) in Hollywood and West Hollywood, California over a 9-year period from January 1999 to December 2007. Analyses were conducted to assess demographic data, self-reported HIV status, and frequency of alcohol and other drug use. Participants averaged 32.3 (SD = 7.7) years, slightly over half were Caucasian/white (53%), and most were identified as gay (85.8%). Self-reported HIV seroprevalence was 20.7%. Observations began January to June 1999, with 46.0% reporting recent methamphetamine use, and ended July to December 2007, with 24.8% reporting recent use of methamphetamine. Percent reporting methamphetamine use peaked in the first half of 2002 at 53% and dipped to a low of 11.1% in the second half of 2006. Findings demonstrate the common use of methamphetamine over the observation period in this high-risk group even in the face of a recent decline in reported use. These data also indicate the need for ongoing methamphetamine abuse and HIV-prevention interventions in this particular high-risk population.     

Gay, Lesbian and Bisexual (GLB) Children: Implications for Early Childhood Development Professionals

This paper focuses on the issues of gay, lesbian, and bisexual children from the perspective of early child development professionals. Early child development professionals' response to children's sexual curiosity conveys to them important messages — either positive or negative — about themselves as sexual beings. Positive responses lay the foundation for sexual health by helping children feel good about being male or female, gay, lesbian, or bisexual, and good about adults in their lives who help them understand their confusion. Background information about homosexuality and bisexu-ality in American society, needs of gay, lesbian and bisexual children, and strategies and challenges in personnel, curriculum, policies, and parental involvement will be included.     

Condom Use and Concurrent Partnering among Heterosexually Active, African American Men: A Qualitative Report

African Americans are overrepresented among heterosexual cases of HIV/AIDS in the USA. Inconsistent condom use and concurrent partnering are two sexual behaviors driving the heterosexual HIV epidemic in the African American community. To inform the development of an HIV prevention behavioral intervention to decrease concurrent partnering and increase condom use among African American heterosexual men, we conducted formative research, including 61 structured interviews, 5 focus groups with 25 men, and 30 in-depth qualitative interviews between July and December 2009. We used a grounded theoretical approach and categorizing strategies to code and analyze the qualitative data. Results around condom use confirmed earlier findings among heterosexual men in general: condoms diminish pleasure, interfere with erection, and symbolize infidelity. Although valued by some as a form of disease prevention and pregnancy prevention, condoms are often used only with specific types of female partners, such as new or casual partners, or due to visual risk assessment. Sex partner concurrency was described as normative and ascribed to men’s “natural” desire to engage in a variety of sexual activities or their high sex drive, with little recognition of the role it plays in the heterosexual HIV epidemic. Fatherhood emerged among many men as a crucial life event and compelling motivation for reducing sexual risk behavior. Based on these results, we conclude that existing HIV prevention efforts to improve attitudes towards and motivate use of condoms either have not reached or have not been successful with African American heterosexual men. In designing behavioral interventions to decrease concurrent partnering and increase condom use, addressing negative attitudes towards condoms and partner risk assessment is critical, as is integrating novel motivational approaches related to identity as fathers and men in the African American community.     

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.     

中国男男性行为群体HIV干预面临的挑战：基于社区和已发表证据的循证评价

目的对中国男男性行为人群中艾滋病干预面临的挑战进行初步循证评价。方法社区证据来源于对相关工作者、专家的访谈以及近5年对国内同志艾滋病防治活动的参与经验。已发表文献的证据,通过确定检索策略、人选标准和特定关键词,采用系统化的文献检索,收集与研究目的有关的文献,检索数据库包括中国生物医学文献数据库（1996—2007）、MEDLINE（1996—2007）及相关网页。结果以社区组织为基础和以“扩散理论”为指导的干预模式在知识传播、行为改变方面面临巨大挑战。表现为传递的教育信息质量低、教育娱乐化、安全套可及性不足,心理社会支持重视不够等问题。此外,普遍存在的滥用公共卫生术语“MSM”的现象。缺乏对MSM群体的社会及文化特征的研究。结论中国MSM群体中的艾滋病防治策略需要做大的调整和改进。需要建立高效的媒体反应机制以消除错误信息,应在政策上纳入反对性倾向歧视,大力倡导感染者参与,鼓励对MSM中不同群体的社会、心理需求进行更多研究,民间组织在促进男同性性行为者的自我认同、心理支持方面进行更多工作。应将循证项目评估原理和方法整合成项目评估体系。     

Epidemiology of Early Monkeypox Virus Transmission in Sexual Networks of Gay and Bisexual Men,England, 2022

After community transmission of monkeypox virus was identified in Europe, interviews of 45 case-patients from England indicated transmission in international sexual networks of gay and bisexual men since April 2022. Interventions targeting sex-on-premises venues, geospatial dating applications, and sexual health services are likely to be critical for outbreak control.     

Accuracy of Self-reported Human Papillomavirus Vaccination Status Among Gay and Bisexual Adolescent Males: Cross-sectional Study

BackgroundMen who have sex with men are a risk group for anal human papillomavirus (HPV) and anal cancer. Australia introduced a universal school-based HPV vaccination program in 2013. Self-reported HPV vaccination status has been widely used in clinical and research settings, but its accuracy is understudied.ObjectiveWe aimed to examine the accuracy of self-reported HPV vaccination status among gay and bisexual adolescent males.MethodsWe included 192 gay and bisexual males aged 16-20 years from the Human Papillomavirus in Young People Epidemiological Research 2 (HYPER2) study in Melbourne, Australia. All participants had been eligible for the universal school-based HPV vaccination program implemented in 2013 and were asked to self-report their HPV vaccination status. Written informed consent was obtained to verify their HPV vaccination status using records at the National HPV Vaccination Program Register and the Australian Immunisation Register. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of self-reported HPV vaccination status.ResultsThe median age of the 192 males was 19 (IQR 18-20) years. There were 128 males (67%) who had HPV vaccination records documented on either registry. Self-reported HPV vaccination had a sensitivity of 47.7% (95% CI 38.8%-56.7%; 61/128), a specificity of 85.9% (95% CI 75.0%-93.4%; 55/64), a positive predictive value of 87.1% (95% CI 77.0%-93.9%; 61/70), and a negative predictive value of 45.1% (95% CI 36.1%-54.3%; 55/122).ConclusionsSelf-reported HPV vaccination status among Australian gay and bisexual adolescent males underestimates actual vaccination and may be inaccurate for clinical and research purposes.     

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

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

Using Google Trends to Inform the Population Size Estimation and Spatial Distribution of Gay,Bisexual, and Other Men Who Have Sex With Men: Proof-of-concept Study

BackgroundWe must triangulate data sources to understand best the spatial distribution and population size of marginalized populations to empower public health leaders to address population-specific needs. Existing population size estimation techniques are difficult and limited.ObjectiveWe sought to identify a passive surveillance strategy that utilizes internet and social media to enhance, validate, and triangulate population size estimates of gay, bisexual, and other men who have sex with men (gbMSM).MethodsWe explored the Google Trends platform to approximate an estimate of the spatial heterogeneity of the population distribution of gbMSM. This was done by comparing the prevalence of the search term “gay porn” with that of the search term “porn.”ResultsOur results suggested that most cities have a gbMSM population size between 2% and 4% of their total population, with large urban centers having higher estimates relative to rural or suburban areas. This represents nearly a double up of population size estimates compared to that found by other methods, which typically find that between 1% and 2% of the total population are gbMSM. We noted that our method was limited by unequal coverage in internet usage across Canada and differences in the frequency of porn use by gender and sexual orientation.ConclusionsWe argue that Google Trends estimates may provide, for many public health planning purposes, adequate city-level estimates of gbMSM population size in regions with a high prevalence of internet access and for purposes in which a precise or narrow estimate of the population size is not required. Furthermore, the Google Trends platform does so in less than a minute at no cost, making it extremely timely and cost-effective relative to more precise (and complex) estimates. We also discuss future steps for further validation of this approach.     

Ethnic differences and influence of perceived future certainty on adolescent and young adult sexual knowledge and attitudes

This study examined the effects of future certainty (the perceptions an individual has about how positive and certain their future is) on adolescents' and young adults' sexual knowledge and sexual attitudes. This longitudinal study measured sexual knowledge and attitudes one year after an initial measure of future certainty. Ethnic differences among these relationships were also examined for Hispanic, African American and white adolescents in an attempt to explain some of the variability in sexual risk for these ethnic groups. A total of 2900 male and 3081 female youth were drawn from the National Longitudinal Study of Adolescent Health (Add Health), and were measured on four aspects of future certainty: life certainty (e.g., life expectancy), health certainty (i.e., sexually transmitted infection risk), marriage certainty, and college certainty. Results using analysis of variance showed that white youth were less at-risk of perceiving negative and uncertain futures than their peers. Hierarchical multiple regression analyses also showed that the future certainty variables predicted sexual knowledge and permissive sexual attitudes one year later, after controlling for individual and family characteristics. However, the direction of the relationship was dependent on the type of future certainty, and not all relationships held for all three ethnic groups. The study provides important information for intervention research targeting youth who are at-risk for engaging in high risk sexual behaviours.     

Enablers and Barriers to HIV Services for Gay and Bisexual Men in the COVID-19 Era: Fusing Data Sets from Two Global Online Surveys Via File Concatenation With Adjusted Weights

BackgroundGay and bisexual men are 26 times more likely to acquire HIV than other adult men and represent nearly 1 in 4 new HIV infections worldwide. There is concern that the COVID-19 pandemic may be complicating efforts to prevent new HIV infections, reduce AIDS-related deaths, and expand access to HIV services. The impact of the COVID-19 pandemic on gay and bisexual men’s ability to access services is not fully understood.ObjectiveThe aim of this study was to understand access to HIV services at the start of the COVID-19 pandemic.MethodsOur study used data collected from two independent global online surveys conducted with convenience samples of gay and bisexual men. Both data sets had common demographic measurements; however, only the COVID-19 Disparities Survey (n=13,562) collected the outcomes of interest (HIV services access at the height of the first COVID-19 wave) and only the Global Men’s Health and Rights Survey 4 (GMHR-4; n=6188) gathered pre-COVID-19 pandemic exposures/covariates of interest (social/structural enablers of and barriers to HIV services access). We used data fusion methods to combine these data sets utilizing overlapping demographic variables and assessed relationships between exposures and outcomes. We hypothesized that engagement with the gay community and comfort with one’s health care provider would be positively associated with HIV services access and negatively associated with poorer mental health and economic instability as the COVID-19 outbreaks took hold. Conversely, we hypothesized that sexual stigma and experiences of discrimination by a health care provider would be negatively associated with HIV services access and positively associated with poorer mental health and economic instability.ResultsWith 19,643 observations after combining data sets, our study confirmed hypothesized associations between enablers of and barriers to HIV prevention, care, and treatment. For example, community engagement was positively associated with access to an HIV provider (regression coefficient=0.81, 95% CI 0.75 to 0.86; P<.001), while sexual stigma was negatively associated with access to HIV treatment (coefficient=–1.39, 95% CI –1.42 to –1.36; P<.001).ConclusionsHIV services access for gay and bisexual men remained obstructed and perhaps became worse during the first wave of the COVID-19 pandemic. Community-led research that utilizes novel methodological approaches can be helpful in times of crisis to inform urgently needed tailored responses that can be delivered in real time. More research is needed to understand the full impact COVID-19 is having on gay and bisexual men worldwide.     

Original Research: Confronting the Culture of Medicine: Gay Men's Experiences with Primary Care Physicians

Objective: To explore gay men's perspectives on primary health care. Design: Employing grounded theory methodology, structured interviews with 11 self-identified gay men from upper New York State were coded via the constant comparative approach. Measurement: Participants were asked open-ended questions about their past health care experiences, perceptions of the field of medicine, and thoughts regarding their relationships with their primary care providers. Results: Analysis suggested that gay men experience the field of medicine at two levels. At the macrolevel, medicine was thought to be homophobic and heterosexist, creating an unwelcoming environment for gay men. Participants believed that medicine was functioning in a state of ignorance because sexuality issues were not a priority in the training or practice of physicians. At the microlevel, gay men sought to build mutually comfortable physician–patient relationships based on open and honest communication. Participants differed in their beliefs of how the relevance of their gay identity related to health care needs. Disclosure of gay identity was not always seen as necessary for care, but being open in this regard was preferred. Conclusions: Gay men must navigate the medical field's cultural barriers to develop meaningful and stable relationships with their providers in order to receive appropriate care.     

Geosocial-Networking App Usage Patterns of Gay,Bisexual, and Other Men Who Have Sex With Men: Survey Among Users of Grindr,A Mobile Dating App

Background

Geosocial-networking apps like Grindr have been used increasingly among men who have sex with men (MSM) to meet anonymous partners. These mobile dating apps employ global positioning system technology to facilitate connections with other users based on their current location. These new technologies have generated quicker and easier modes for men who have sex with men to meet potential partners based on attraction and physical proximity.

Objective

The aim of this study is to describe geosocial-networking app use and recent sexual behaviors of MSM in the Atlanta metropolitan statistical area.

Methods

Our sample was recruited from Grindr, the most commonly used of these mobile apps among MSM, using broadcast advertising. Advertisements were displayed over the course of a 72-hour period and participants were directed to a Web-based survey.

Results

In total, 604 men clicked through the advertisement, and 92 users completed the survey. One-third (38.0%) of the men reported using these mobile apps to meet new sexual partners, and one-fifth (18.5%) used them to “kill time” when bored. Men reporting currently being in a relationship were less likely to report using these mobile apps to meet other MSM to date or to find a boyfriend or romantic partner, but more likely to report using these mobile apps to meet other MSM to have sex, X ² ₂₄=12.1, P=.016. Respondents had current accounts on 3.11 mobile apps (SD 1.84) on average, with Grindr being the most common (100%), followed by Scruff (52.5%), and Jack’d (45.7%). Most men were most active in the late night (40.2%), and on weekdays (64.1%). Each day, on average, men reported opening these mobile apps 8.38 times (SD 8.10) and spent 1.31 hours (SD 1.15) on these mobile apps. The age respondents began using these mobile apps was associated with the age at their first instance of insertive anal sex (r₈₀=.527, P<.001) and receptive anal sex (r₇₆=.527, P<.001).

Conclusions

These findings suggest that MSM use multiple mobile apps and spend significant time on them. For these reasons, HIV prevention interventions could be delivered on these mobile apps.     

Original Research: Sexual Risk in Lesbians and Bisexual Women

Objective: To describe the frequency of human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) sexual risk behaviors in lesbian and bisexual women. Design: Cross-sectional anonymous self-administered questionnaire. Setting: Women's cultural events; HIV/STD service organizations; women's health collectives. Participants: 504 self-identified lesbian and bisexual women. The sample was composed of predominantly white, well-educated women with a mean age of 35 years. Results: Both lesbian and bisexual women engaged in behaviors that potentially lead to transmission of HIV and other STDs. Lesbians were more likely to have a single sexual partner than were bisexual women. Bisexual women were more likely to report a history of STD. Of those sexually active with male partners, one-third reported multiple male partners in the previous year. Significantly more bisexual women reported condom use. Women with multiple partners were more likely to consider themselves at risk for HIV/STD. Having unprotected sex or male partners was not associated with an increased risk perception. Conclusions: Lesbian and bisexual women are engaging in sexual behaviors that may increase their risk for HIV or STD infection. Culturally sensitive prevention programs are needed.     

Population Size Estimates for Men who Have Sex with Men and Persons who Inject Drugs

Understanding geographic variation in the numbers of men who have sex with men (MSM) and persons who inject drugs (PWID) is critical to targeting and scaling up HIV prevention programs, but population size estimates are not available at generalizable sub-national levels. We analyzed 1999–2010 National Health and Nutrition Examination Survey data on persons aged 18–59 years. We estimated weighted prevalence of recent (past 12 month) male-male sex and injection drug use by urbanicity (the degree to which a geographic area is urban) and US census region and calculated population sizes. Large metro areas (population ≥1,000,000) had higher prevalence of male-male sex (central areas, 4.4 % of men; fringe areas, 2.5 %) compared with medium/small metro areas (1.4 %) and nonmetro areas (1.1 %). Injection drug use did not vary by urbanicity and neither varied by census region. Three-quarters of MSM, but only half of PWID, resided in large metro areas. Two-thirds of MSM and two-thirds of PWID resided in the South and West. Efforts to reach MSM would benefit from being focused in large metro areas, while efforts to reach PWID should be delivered more broadly. These data allow for more effective allocation of funds for prevention programs.     

A Qualitative Exploration of the Relationship Between Racism and Unsafe Sex Among Asian Pacific Islander Gay Men

Although reported cases of HIV/AIDS among gay Asian Pacific Islander (API) American men and API men who have sex with men (MSM) are still relatively low, current research findings indicate that incidences of unsafe sexual activity may be higher for this group than for any other group. Among the explanations offered to explain the levels of increasing unsafe sex among gay API men have been sexual norms found in Asian cultures, the lack of culturally relevant and/or linguistically appropriate intervention material, lack of integration into the mainstream gay community, and internalized homophobia. What are often ignored in these analyses are the contextual norms in which sexual behavior for gay API men occur. In this article, I develop the argument that racism within the gay community leads to socially and contextually prescribed sexual roles for gay API men that may also contribute to the practice of unsafe sex among this group.     

Intimate Partner Abuse among Gay and Bisexual Men: Risk Correlates and Health Outcomes

Little is known about the patterns and types of intimate partner abuse in same-sex male couples, and few studies have examined the psychosocial characteristics and health problems of gay and bisexual men who experience such abuse. Using a cross-sectional survey sample of 817 men who have sex with men (MSM) in the Chicago area, this study tested the effect of psychological and demographic factors generally associated with intimate partner abuse and examined their relationship to various health problems. Overall, 32.4% (n = 265) of participants reported any form of relationship abuse in a past or current relationship; 20.6% (n = 168) reported a history of verbal abuse (“threatened physically or sexually, publicly humiliated, or controlled”), 19.2% (n = 157) reported physical violence (“hit, kicked, shoved, burned, cut, or otherwise physically hurt”), and 18.5% (n = 151) reported unwanted sexual activity. Fifty-four percent (n = 144) of men reporting any history of abuse reported more than one form. Age and ethnic group were unrelated to reports of abuse. Depression and substance abuse were among the strongest correlates of intimate partner abuse. Men reporting recent unprotected anal sex were more likely to also report abuse, Wald (1, n = 773) = 9.02, p < .05, Odds Ratio (OR) = 1.61, Confidence Interval (CI) = 1.18–2.21. We discuss psychosocial issues faced by gay and bisexual men who experience intimate partner abuse as they may pertain to interventions among this group.     

非洲艾滋病的流行对我国教育的启示

人们对于疾病，尤其是传染病的了解和预防对健康起到至关重要的作用，同时人们文化程度的高低也影响对疾病的了解和预防。文章通过对非洲教育事业发展状况与艾滋病流行状况和二者之间的相互影响分析入手，分析非洲地区的艾滋病流行对我国预防教育方面的启示。     

Sex Parties among Young Gay,Bisexual, and Other Men Who Have Sex with Men in New York City: Attendance and Behavior

Very little information exists with regard to sex party behaviors in young men who have sex with men (YMSM), often defined as men ranging in age from 13 to 29 years. The current analysis examines sex party attendance and behavior in a sample of 540 emergent adult gay, bisexual, and other YMSM in New York City, ages 18–29 years. Findings indicate that 8.7% (n = 47) of the sample had attended a sex party 3 months prior to assessment. Sex party attendees reported that parties included both HIV-positive and HIV-negative men; attendees also reported unprotected sex and limited access to condoms and lubricant. As compared with those who did not attend sex parties, those who did indicated significantly more lifetime and recent (last 3 months) casual sex partners, drug use (both number of different drugs used and total lifetime use), psychosocial burden (history of partner violence and number of arrests), and total syndemic burden (a composite of unprotected anal sex, drug use and psychosocial burden). These results indicate that while only a small percentage of the overall sample attended sex parties, the intersection of both individual risk factors coupled with risk factors engendered within the sex party environment itself has the potential to be a catalyst in the proliferation of the HIV/AIDS epidemic in urban settings. Lastly, given that sex parties are different than other sex environments, commercial and public, with regard to how they are accessed, public health strategies may need to become more tailored in order to reach this potentially highly risky group.