Original Research: Racial/Ethnic Patterns of HIV Sexual Risk Behaviors Among Young Men Who Have Sex with Men

Objectives: Not enough is known about the HIV high-risk sexual behaviors of young men who have sex with men (YMSM), and this is especially the case among ethnic minorities. This study examined racial/ethnic differences in the prevalence of HIV risk behaviors among YMSM across the United States. Design: Face-to-face interviews were conducted among randomly selected participants in venues identified with large samples of ethnic minority YMSM. Methods: Participants (N = 2612) were systematically sampled from venues in 13 U.S. cities representing four ethnic strata (African American, Asian/Pacific Islander, Hispanic, and mixed ethnicity). Results: Twenty-two percent of the sample reported that their last sexual contact with their main sexual partner, someone other than a main sexual partner, or both involved unprotected anal intercourse. Participants from Asian/Pacific Islander sites, mixed sites, and Hispanic sites were more likely than participants from African American sites to report unprotected anal intercourse. Moreover, within the mixed sites, Hispanic participants, followed by Asian/Pacific Islander and White participants, were more likely than African American participants to report unprotected anal intercourse. Conclusions: Interventions are needed that are responsive to the racial/ethnic differences in HIV risk behaviors of YMSM throughout urban American cities.     

Modeling Minority Stress Effects on Homelessness and Health Disparities among Young Men Who Have Sex with Men

Sexual minority youth are more likely to experience homelessness, and homeless sexual minority youth report greater risk for mental health and substance abuse symptoms than homeless heterosexual youth, yet few studies have assessed determinants that help explain the disparities. Minority stress theory proposes that physical and mental health disparities among sexual minority populations may be explained by the stress produced by living in heterosexist social environments characterized by stigma and discrimination directed toward sexual minority persons. We used data from a sample of 200 young men who have sex with men (YMSM) (38 % African American, 26.5 % Latino/Hispanic, 23.5 % White, 12 % multiracial/other) to develop an exploratory path model measuring the effects of experience and internalization of sexual orientation stigma on depression and substance use via being kicked out of home due to sexual orientation and current homelessness. Direct significant paths were found from experience of sexual orientation-related stigma to internalization of sexual orientation-related stigma, having been kicked out of one’s home, experiencing homelessness during the past year, and major depressive symptoms during the past week. Having been kicked out of one’s home had a direct significant effect on experiencing homelessness during the past 12 months and on daily marijuana use. Internalization of sexual orientation-related stigma and experiencing homelessness during the past 12 months partially mediated the direct effect of experience of sexual orientation-related stigma on major depressive symptoms. Our empirical testing of the effects of minority stress on health of YMSM advances minority stress theory as a framework for investigating health disparities among this population.     

Sexual Health Screening Among Racially/Ethnically Diverse Young Gay,Bisexual, and Other Men Who Have Sex With Men

PurposeScreening for sexually transmitted infections (STIs) is a crucial element of improving health and reducing disparities, and young men who have sex with men (YMSM) face high rates of both STIs and human immunodeficiency virus. We examined sexual health screening among a diverse sample of adolescent YMSM living in New York City.MethodsBetween 2009 and 2011, cross-sectional data were collected from 590 YMSM in New York City. Separate multivariable logistic regression models were used to assess the relationship between sociodemographic, psychosocial, and health and healthcare related factors and two main outcomes: having sought a recent sexual health screening (past 6 months) and having a rectal sexual health screening (lifetime).ResultsOverall, 46% reported a sexual health screening in the prior 6 months, but only 16% reported ever having a rectal screening for STIs. Rates were higher among ethnic minority YMSM and men who accessed care at clinics. Multivariable results indicated that gay community affiliation, recent unprotected anal sex, and number of lifetime male partners were also associated with seeking a recent screening.ConclusionsThough half of the sample reported recent general screening, rates of lifetime rectal screening are low. Efforts to increase screening may focus on improving provider knowledge and guideline adherence, and educating and encouraging YMSM to access sexual health check-ups.     

基于轨迹模型的青少年男男性行为者HIV感染风险及影响因素

  目的  探究青少年男男性行为者(young men who have sex with men, YMSM)HIV感染风险发展轨迹,并分析HIV感染风险的影响因素。  方法  基于在湖北省、湖南省、江西省3地开展的动态随访队列,运用基于群组轨迹模型(group-based trajectory model, GBTM)分析YMSM人群HIV感染风险的发展轨迹,使用广义估计方程(generalized estimation equation, GEE)分析与HIV感染风险相关的因素。  结果  2017年9月20日―2018年1月21日共460名HIV阴性YMSM被纳入随访,GBTM识别出3组HIV感染风险发展轨迹,分别为低风险组、中风险组、高风险组,风险越高组的YMSM首次同性性行为年龄越低、农村户口比例更高,差异均有统计学意义(均有P＜0.05)。GEE结果显示首次性行为年龄、抑郁量表得分、同性恋歧视、心理韧性均与HIV感染风险存在关联(均有P＜0.05)。  结论  YMSM人群普遍存在HIV感染风险且感知歧视水平高者HIV感染风险高,应关注YMSM人群的心理健康。     

The Association between Incarceration and Transactional Sex among HIV-infected Young Men Who Have Sex with Men in the United States

Criminal justice practices in the USA disproportionately affect sexual and racial/ethnic minority men, who are at higher risk of incarceration. Previous research demonstrates associations between incarceration and sexual risk behaviors for men who have sex with men (MSM). However, little of this work focuses on young MSM (YMSM), particularly HIV-infected YMSM, despite nearly one-third reporting engagement in sexual risk behaviors, such as transactional sex. We therefore explored the association between incarceration and transactional sex among HIV-infected YMSM. We recruited 97 HIV-infected YMSM across 14 clinical sites in urban centers from August 2015 to February 2016. We used multivariate logistic regression to examine the relationship between incarceration and transactional sex among YMSM. The majority was 24 years old (78%) and racial/ethnic minority (95%); over half were not in school and reported an annual income of <?$12,000. In the multivariate model, having ever been incarcerated (aOR?=?3.20; 95% CI 1.07–9.63) was independently associated with a history of transactional sex. Being 24 years vs. younger (aOR?=?9.68; 95% CI 1.42–65.78) and having ever been homeless (aOR?=?3.71, 95% CI 1.18–11.65) also remained independently associated with a history of transactional sex. This analysis fills a gap in the literature by examining the relationship between incarceration and transactional sex among HIV-infected YMSM. Facilitating youths’ engagement with social services available in their HIV clinic may serve as a key strategy in promoting health. Public health efforts need to address social-structural factors driving disproportionate rates of arrest and incarceration and related harms among this population.     

Perceived Risks and Protective Strategies Employed by Young Men Who Have Sex With Men (YMSM) When Seeking Online Sexual Partners

This study examined the perceptions of risk by young men who have sex with men (YMSM) regarding meeting sexual partners through the Internet. Fifty-four YMSM ages 18–29 who reported engaging in bareback sex (“intentional unprotected anal intercourse in high-risk contexts”) completed a structured assessment and a face-to-face interview. Participants reported using the Internet to meet sexual partners at least once per week, having had multiple sexual partners in the past 2 months (M = 10.50, SD = 9.25), and engaging in occasions of unprotected receptive (M = 5.35, SD = 6.76) and insertive (M = 5.06, SD = 10.11) anal intercourse. A third of the sample reported having had unprotected sex with a partner who was serodiscordant or of unknown serostatus. Despite the obvious HIV risks, the most commonly perceived risks included threats to physical safety and difficulties trusting a stranger. Risk reduction strategies included leaving information about partner and whereabouts with a friend, meeting in a public place, and screening partner through online chatting. Those YMSM who meet partners online may be at risk for physical violence in addition to HIV or sexually transmitted infections (STIs). Public health campaigns should increase awareness of safety concerns when meeting sexual partners online and support YMSM's self-protective actions.     

性感觉寻求与青少年男男性行为人群危险性行为的关系

目的 研究25岁及以下青少年男男性行为人群(YMSM)性感觉寻求与其艾滋病相关危险性行为的关系。方法 于2013年5-11月通过互联网宣传、外展活动以及例行的艾滋病自愿咨询检测服务招募403名YMSM, 采用匿名问卷调查, 回收375份(93.05%)有效问卷。结果 YMSM中有37.9%首次同性性行为未使用安全套, 最近6个月有55.7%发生多性伴行为, 51.7%有“419”(一夜情)行为, 5.6%有群交行为。性感觉寻求与首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为呈正相关(偏相关系数分别为0.247、0.218、0.296、0.252)。分别以首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为作为因变量进行logistic回归分析, 结果显示性感觉寻求高者更有可能发生以上危险性行为。结论 青少年性感觉寻求水平对危险性行为有影响, 应加强基于人群性感觉寻求分析的艾滋病相关知识及行为教育, 强化艾滋病相关危险性行为的风险意识, 从而更有效开展YMSM艾滋病干预。     

Internet Use and Sexual Health of Young Men Who Have Sex with Men: A Mixed-Methods Study

Young gay, bisexual, and other men who have sex with men (MSM) experience sexual health disparities due to a lack of support in settings that traditionally promote positive youth development. The Internet may help to fill this void, but little is known about how it is used for sexual health purposes among young MSM. This mixed-methods study reports quantitative results of a large survey of 18- to 24-year-old MSM in an HIV testing clinic (N = 329) as well as qualitative results from interviews. Level of Internet use was high in this sample and the majority of participants reported using the Internet to find HIV/AIDS information. Black and Latino youth used the Internet less frequently than White youth, and after controlling for age, education, and frequency of Internet use, Black youth were 70% less likely to use the Internet to find HIV/AIDS information. Qualitative analyses identified themes related to the role of the Internet in finding sexual health information, sexual minority identity development, and sexual risk taking behaviors. Participants reported that the Internet filled an important and unmet need for sexual health education. It allowed for connections to the gay community and support during the coming out process, but also exposure to homophobic messages. There was no evidence of increased risk behaviors with partners met online, but at the same time the potential for the use of the Internet to facilitate safer sex communication was largely untapped. Our findings generally present an optimistic picture about the role of the Internet in the development of sexual health among young MSM.     

Sexual and behavioral health disparities among African American sexual minority men and women

ABSTRACT

Introduction: Sexual and behavioral health disparities have been consistently demonstrated between African American and White adults and between sexual minority and heterosexual communities in the United States; however, few studies using nationally representative samples have examined disparities between sexual minority and heterosexual adults within African American populations. The purpose of this study was to examine the prevalence of sexual and behavioral health outcomes between sexual minority and heterosexual African American adults and to examine whether there were different patterns of disparities for African American sexual minority men and women, respectively.

Methods: We analyzed data from 4502 African American adults who participated in the 2001–2015 waves of the National Health and Nutrition Examination Survey. Using multivariable analyses, we examined differences in HIV, sexually transmitted infections, mental health, and substance use among African American sexual minority and heterosexual men and women.

Results: After adjusting for sociodemographic variables, African American sexual minority men had significantly higher odds of HIV, sexually transmitted infections, and poor mental health compared to their heterosexual male counterparts, whereas African American sexual minority women had significantly higher odds of Hepatitis C, poor mental health, and substance use compared to their heterosexual female counterparts.

Conclusions: These findings demonstrate notable sexual orientation disparities among African American adults. Disparities persisted beyond the role of sociodemographic factors, suggesting that further research utilizing an intersectional approach is warranted to understand the social determinants of adverse health outcomes among African American sexual minority men and women.     

The Effects of Sexual Partnership and Relationship Characteristics on Three Sexual Risk Variables in Young Men Who Have Sex with Men

Young men who have sex with men (YMSM) in the United States are experiencing an alarming increase in HIV incidence. Recent evidence suggests that the majority of new HIV infections in YMSM occur in the context of serious relationships, which underscores the importance of examining predictors of sexual risk behavior in the context of sexual partnerships, including relationship type, sexual partner characteristics, and relationship dynamics. The current study aimed to evaluate relationship and sexual partnership influences on sexual risk behavior in YMSM, including differentiating between multiple sexual risk variables (i.e., any unprotected anal or vaginal intercourse, unprotected insertive anal or vaginal intercourse, and unprotected receptive anal intercourse). More serious/familiar partnerships were associated with more sexual risk across all three risk variables, while wanting a relationship to last was protective against risk across all three risk variables. Some variables were differentially linked to unprotected insertive sex (partner gender) or unprotected receptive sex (partner age, partner race, believing a partner was having sex with others, and partners repeated across waves). Sexual risk behavior in YMSM is inconsistent across sexual partnerships and appears to be determined in no small part by sexual partner characteristics, relationship dynamics, and sexual role (i.e., insertive or receptive partner). These influences are critical in understanding sexual risk in YMSM and provide important targets for intervention.     

Use and Perceptions of the Internet for Sexual Information and Partners: A Study of Young Men Who Have Sex with Men

The Internet has opened many doors with its accessibility to information, entertainment and web-based communities. For young men who have sex with men (YMSM), the Internet can provide access to information on relevant sexual behavior and health information, stories from other men about relationship issues, and a venue for locating potential sexual and dating partners. Understanding YMSM’s motivations for going online for information, advice or sexual relationships, is important as the Internet becomes increasingly used not only as a space to find sexual partners, but also as a venue for HIV and STI interventions. Having an understanding of the risks associated with searching for partners online, and how and why YMSM use the Internet for a variety of purposes, can inform the development of more effective Internet-based risk reduction programs. This article presents qualitative and quantitative data from the Healthy Young Men’s Study, a longitudinal study of an ethnically diverse cohort of 526 YMSM. Qualitative interviews (N = 24) described not only the prevalence of using the Internet for finding sexual partners and the possible benefits and risks associated with that practice, but also the processes and perceptions of using this mechanism. Our data indicate that YMSM used the Internet to find information related to sex and sexuality, seek friendships, sexual partners as well as “hook-ups” or casual sex. Findings were presented in relation to how YMSM researchers and interventionists can identify how to most effectively reach YMSM through online methods.     

Sexual Orientation Disparities in Sexually Transmitted Infection Risk Behaviors and Risk Determinants Among Sexually Active Adolescent Males: Results From a School-Based Sample

Objectives. We examined disparities in risk determinants and risk behaviors for sexually transmitted infections (STIs) between gay-identified, bisexual-identified, and heterosexual-identified young men who have sex with men (YMSM) and heterosexual-identified young men who have sex with women (YMSW) using a school-based sample of US sexually active adolescent males.Methods. We analyzed a pooled data set of Youth Risk Behavior Surveys from 2005 and 2007 that included information on sexual orientation identity, sexual behaviors, and multiple STI risk factors.Results. Bisexual-identified adolescents were more likely to report multiple STI risk behaviors (number of sex partners, concurrent sex partners, and age of sexual debut) compared with heterosexual YMSW as well as heterosexual YMSM and gay-identified respondents. Gay, bisexual, and heterosexual YMSM were significantly more likely to report forced sex compared with heterosexual YMSW.Conclusions. Our results provide evidence that sexual health disparities emerge early in the life course and vary by both sexual orientation identity and sexual behaviors. In particular, they show that bisexual-identified adolescent males exhibit a unique risk profile that warrants targeted sexual health interventions.Several studies have documented an elevated risk of acquiring sexually transmitted infections (STIs), including HIV/AIDS, among young men who have sex with men (YMSM).1 In recent years, HIV/AIDS infection rates have actually increased among this population.2,3 To develop more effective and targeted STI prevention programs, researchers have suggested using multiple measures of sexual minority status when examining disparities in STI risk by sexual orientation.4–8 Existing research on sexual health disparities among adolescents often uses community-based samples that rarely yield large enough sample sizes to examine multiple sexual minority statuses in any given study.6,9 This gap in the literature is particularly problematic given the documented incongruence between sexual orientation identity and sexual behaviors among sexual minority adolescents.10–12 Thus, although studies have demonstrated that both YMSM1,13–15 and bisexual- and gay-identified male adolescent16,17 are more likely to report a variety of STI risk factors, to our knowledge, no studies to date have used both indicators of sexual orientation identity and sexual behaviors to examine disparities in STI risk factors among adolescents.Elevated rates of STI among sexual minority adolescent males are due to a variety of factors, including social conditions, sexual networks, and, in particular, the excess biological risk associated with anal sex.1,18 Elevated STI risk, however, has also been attributed to sexual orientation disparities in a variety of risk behaviors, including earlier age of sexual debut, more sex partners,14,17,19 higher rates of substance use during sex,15 and lower rates of condom use.13,20 These disparities have been documented through use of sexual behaviors1,13–15 or sexual orientation identity16,17 to capture sexual minority status. As a result, STI risk interventions based on studies that use sexual orientation identity alone may not reach adolescents who engage in same-sex behavior but identify as heterosexual.1 Alternatively, focusing exclusively on sexual behavior obscures potentially important differences across social identities, which are critical for understanding and eliminating disparities in STIs.5 Studies that use either sexual orientation identity or behavior are therefore likely to capture different populations and provide an incomplete portrait of STI risk among sexual minority adolescents.21To develop appropriate STI intervention strategies, it is also critical to understand what factors might lead to risk-taking behaviors among sexual minority populations. Studies have shown that sexual minority adolescent males are more likely to report multiple sources of victimization, including forced sex16,22 and intimate partner violence (IPV),23–25 compared with their sexual nonminority peers. Forced sex may directly expose young men to STIs, but it also may have long-lasting implications for the development of sexual self-efficacy, safe sex communication skills, and normative attitudes surrounding sexual risk behaviors.26,27 IPV has been identified as a significant barrier to effective communication about safer sex behaviors and is linked to elevated STI risk among adolescents.28 Similar to the literature on STI risk behaviors, existing studies on forced sex and IPV among sexual minorities rely on single indicators of sexual orientation—either sexual orientation identity16,23 or the sex of sex partners.25 Given the stigma associated with gay or bisexual identity, sexual minority–identified respondents may be more likely to be targeted for victimization than YMSM who identify as heterosexual.Understanding which aspects of sexual minority status (e.g., sexual orientation identity, sex of sex partners) are related to STI risk factors during adolescence is critical for developing targeted prevention efforts to curb rising STI infection rates. New evidence suggests that STI risk varies by both sexual orientation identity and behaviors among young adult men.4 It is unclear whether similar patterns in STI risk behaviors and risk behavior determinants emerge during adolescence. Using a school-based sample of adolescent males, we aimed to determine whether sexual risk behaviors, including age of sexual debut, number of sex partners, concurrent sex partners, condom use, and drug and alcohol during sex, as well 2 indicators of risk behavior determinants (forced sex and IPV) vary at the intersection of sexual orientation identity and sexual behaviors.     

Venue-Based Network Analysis to Inform HIV Prevention Efforts Among Young Gay,Bisexual, and Other Men Who Have Sex With Men

In the USA, human immunodeficiency virus (HIV) incidence rates continue to increase among young gay, bisexual, and other men have sexual intercourse with men. Young men who have sex with men (YMSM) indicate interest in HIV prevention programming that is implemented in the social venues that they frequent when they want to socialize with other men. We sought to understand YMSM venues as a networked space to provide insights into venue-based HIV prevention intervention delivery. The present study used survey data reported by 526 YMSM (ages 18–24) in 2005 to conduct a venue-based social network analysis. The latter sought to determine if the structure and composition of the networks in Los Angeles could be used to facilitate the delivery of HIV prevention messages to YMSM. Degree of person sharing between venues was used to demonstrate interconnectivity between venues classified as low risk (e.g., coffee shops) and high risk (e.g., bars and clubs) by a Community Advisory Board. Sixty-five percent of the 110 venues nominated were bars and clubs. Nearly all YMSM were connected by a single venue and over 87 % were connected by the six most central venues. A handful of highly connected low-risk venues was central to the venue network and connected to popular high-risk venues. Venue-based network analysis can inform tailored HIV prevention messaging for YMSM. Targeted delivery of prevention messaging at low-risk centralized venues may lead to widespread diffusion among venue-attending YMSM.     

Disparities in Sexually Transmitted Infection/HIV Testing,Contraception, and Emergency Contraception Care Among Adolescent Sexual Minority Women Who Are Racial/Ethnic Minorities

PurposeSexual minority women and racial/ethnic minority women in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy. Yet, we know little about STI/HIV testing and contraceptive care among women who have sex with women only and women who have sex with both women and men, and who are racial/ethnic minorities. This study examined receipt of STI/HIV testing and contraceptive care among sexually active adolescent women by sex of sexual contact(s) and race/ethnicity.MethodsOur sample included 2,149 sexually active adolescent women from the National Survey of Family Growth (2011–2019). We examined receipt of sexual and reproductive health (SRH) services by sex of sexual contact(s) and race/ethnicity: STI and HIV testing, contraceptive counseling, contraceptive method, emergency contraception (EC) counseling, and EC method.ResultsService receipt was low for all adolescent women, with disparities by sex of sexual contact(s) and by race/ethnicity. Women who have sex with women only had the lowest rates across all services; women who have sex with both women and men had higher rates of STI and HIV testing and EC counseling than women who have sex with men only. Non-Hispanic Black women had higher rates of STI and HIV testing than non-Hispanic White peers, and non-Hispanic Black and Hispanic women had lower rates of contraception method receipt than their non-Hispanic White peers. Racial/ethnic disparities persisted when results were stratified by sex of sexual contact(s).DiscussionThere is an unmet need for improved SRH service delivery for all adolescent women and for services that are not biased by sex of sexual contact(s) and race/ethnicity.     

武汉市年轻男男性行为者偶遇性行为及相关因素分析

目的 了解年轻男男性行为人群（YMSM）偶遇性行为及相关危险行为状况,并分析影响偶遇性行为的因素,为降低该人群感染和传播艾滋病的风险提出针对性的措施。方法 2013年5－11月在武汉市通过互联网宣传、外展活动的组织以及艾滋病自愿咨询检测服务招募年龄≤25岁的YMSM参加匿名式问卷调查,招募403名YMSM,收集其人口学、性行为等相关信息,分析YMSM偶遇性行为的相关因素。结果 实际调查398名YMSM中,48.99%（195/398）报告最近6个月发生过偶遇性行为。与未报告偶遇性行为的YMSM比较,报告偶遇性行为的YMSM肛交、口交坚持使用安全套的比例均较低［34.29%（60/175）比49.08%（80/163）（χ²=7.61,P=0.01）、38.85%（61/157）比28.65%（49/171）（χ²=3.82,P=0.05）］。报告偶遇性行为的YMSM中,多性伴的比例高于未报告偶遇性行为的YMSM［76.80%（149/194）比33.15%（60/181）（χ²=77.36,P<0.01）］。多因素logistic回归分析显示,经常使用互联网、存在吸毒行为是YMSM发生偶遇性行为的影响因素（OR=4.89,95% CI：1.90～12.54;OR=2.72,95% CI：1.60～4.63）。结论 YMSM有过偶遇性行为者更容易发生无保护性行为和多性伴等高危行为,应加强互联网针对YMSM的行为干预。     

Evaluation of Respondent-Driven Sampling in a Study of Urban Young Men Who Have Sex with Men

Evidence suggests that respondent-driven sampling (RDS) is an efficient approach to sampling among varied populations of adult men who have sex with men (MSM) both in the USA and abroad, although no studies have yet evaluated its performance among younger MSM, a population with a steep rise in HIV infection in recent years. Young MSM (YMSM) may differ in terms of their connectedness to other YMSM (e.g., due to evolving sexual identity, internalization of sexual minority stigma, and lack of disclosure to others) and mobility (e.g., due to parental monitoring) which may inhibit the sampling process. The aims of this study were to evaluate the efficiency and effectiveness of RDS-based sampling among young urban MSM and to identify factors associated with recruitment success. We hypothesized that demographic, social, behavioral, and network factors, including racial/ethnic minority status, homelessness (i.e., as an indicator of socioeconomic marginalization), HIV-positive status, substance use problems, gay community connectedness, and network size would be positively related to recruitment productivity, while sexual minority stigmatization, environmental barriers (e.g., parental monitoring), and meeting sex partners on the internet (i.e., virtual venue) would be negatively related to recruitment productivity. Between December 2009 and February 2013, we used RDS to recruit a sample of 450 YMSM, ages 16–20. Findings suggest that the use of RDS for sampling among YMSM is challenging and may not be feasible based on the slow pace of recruitment and low recruitment productivity. A large number of seeds (38 % of the sample, n = 172) had to be added to the sample to maintain a reasonable pace of recruitment, which makes use of the sample for RDS-based population estimates questionable. In addition, the prevalence of short recruitment chains and segmentation in patterns of recruitment by race/ethnicity further hamper the network recruitment process. Thus, RDS was not particularly efficient in terms of the rate of recruitment or effective in generating a representative sample. Hypotheses regarding factors associated with recruitment success were supported for network size and internalized stigma (but not other factors), suggesting that participants with larger network sizes or high levels of internalized stigma may have more and less success recruiting others, respectively.     

Pathways towards Risk: Syndemic Conditions Mediate the Effect of Adversity on HIV Risk Behaviors among Young Men Who Have Sex with Men (YMSM)

Research shows that young men who have sex with men (YMSM) engage in higher rates of health risk behaviors and experience higher rates of negative health outcomes than their peers. The purpose of this study is to determine if the effects of adversity on HIV risk are mediated by syndemics (co-occurring health problems). Participants were 470 ethnically diverse YMSM ages 18 to 24 recruited between 2005 and 2006 and surveyed every 6 months for 24 months. Regression analyses examined the impact of adversity on syndemics (emotional distress, substance use, and problematic alcohol use) and the effects of both adversity and syndemics on HIV risk behaviors over time. Gay-related discrimination and victimization—among other adversity variables—were significantly associated with syndemics and condomless sex (CS). Syndemics mediated the effects of adversity on CS in all models. Adverse events impact HIV risk taking among YMSM through syndemics. These findings suggest that prevention programs aimed at reducing adversity may reduce both the synergistic effect of multiple psychosocial health problems and HIV risk taking.     

Racial/Ethnic Differences in the Association between Arrest and Unprotected Anal Sex among Young Men Who Have Sex with Men: The P18 Cohort Study

This analysis aimed to determine whether the relationship between a history of arrest and unprotected anal sex (UAS) is the same for Black/Latino gay, bisexual, and other young men who have sex with men (YMSM) as compared to White/Asian/Pacific Islander (API) YMSM in New York City (NYC). Baseline audio-computer-assisted self-interview (ACASI) and interviewer-administered survey data from a sample of 576 YMSM aged 18–19 years old who self-reported being HIV-negative were analyzed. Data included history of arrest and incarceration as well as UAS in the past 30 days. Race/ethnicity was an effect modifier of the association between arrest and UAS among YMSM: White/API YMSM with a lifetime arrest history were more than three times as likely to report UAS, and Black/Latino YMSM with a lifetime history of arrest were approximately 70 % less likely to report UAS as compared with White/API YMSM with no reported arrest history. Race/ethnicity may modify the relationship between arrest and sexual risk behavior because the etiology of arrest differs by race, as partially evidenced by racial/ethnic disparities in police stop, arrest, and incarceration rates in NYC. Arrest could not only be an indicator of risky behavior for White/API YMSM but also an indicator of discrimination for Black/Latino YMSM. Further research is needed to assess whether the differential associations observed here vis-à-vis race/ethnicity are robust across different populations and different health outcomes.     

STD and HIV risk factors among U.S. young adults: variations by gender, race, ethnicity and sexual orientation

CONTEXT: STDs, including HIV, disproportionately affect individuals who have multiple minority identities. Understanding differences in STD risk factors across racial, ethnic and sexual minority groups, as well as genders, is important for tailoring public health interventions. METHODS: Data from Waves 3 (2001–2002) and 4 (2007–2008) of the National Longitudinal Study of Adolescent Health were used to develop population‐based estimates of STD and HIV risk factors among 11,045 young adults (mean age, 29 at Wave 4), by gender, race and ethnicity, and sexual orientation (heterosexual, mixed‐oriented, gay). Regression analyses were conducted to examine associations between risk factors and young adults’ characteristics. RESULTS: Overall, sexual‐minority women in each racial or ethnic group had a higher prevalence of sexual risk behaviors—including a history of multiple partners, forced sex and incarceration—than their heterosexual counterparts. Mixed‐oriented women in each racial or ethnic group were more likely than heterosexual white women to have received an STD diagnosis (odds ratios, 1.8–6.4). Black men and sexual‐minority men also appeared to be at heightened risk. Gay men in all racial and ethnic groups were significantly more likely than heterosexual white men to report having received an STD diagnosis (2.3–8.3); compared with heterosexual white men, mixed‐oriented black men had the highest odds of having received such a diagnosis (15.2). CONCLUSIONS: Taking account of multiple minority identities should be an important part of future research and intervention efforts for STD and HIV prevention.     

Sexting Among Young Men Who Have Sex With Men: Results From a National Survey

PurposeWe know little about the prevalence of sexting behavior among young men who have sex with men (YMSM) or its association with their sexual behaviors.MethodsTo address these gaps, we used data from an online study examining the partner-seeking behaviors of single YMSM (N = 1,502; ages 18–24 years) in the United States. Most participants (87.5%) reported sexting, with 75.7% of the sample reporting having sent and received a sext.ResultsSexting was more frequent among sexually active YMSM, with YMSM who had sent and received a sext being more likely to report insertive anal intercourse, with and without condoms, than those who had not sexted. We found no association between sexting and receptive anal intercourse.ConclusionsOur findings suggest that sexting may vary by YMSM's sexual roles. We discuss our findings with attention to their implications for sexual health promotion.