Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools

OBJECTIVES: This study compared sexual risk behaviors of gay, lesbian, and bisexual (GLB) and heterosexual adolescents and evaluated associations between gay-sensitive HIV instruction and risk behaviors of GLB youths. METHODS: A random sample of high school students and HIV education teachers completed surveys. Self-reported risk behaviors of heterosexual and GLB adolescents were compared, with control for student and community demographic characteristics. Sexual risk behaviors of GLB youths in schools with and without gay-sensitive instruction were compared. RESULTS: GLB youths reported more substance use, high-risk sexual behaviors, suicidal thoughts or attempts, and personal safety issues than did heterosexual youths (P < .001). Among those who were sexually active, GLB youths reported more lifetime and recent sexual partners than did heterosexuals (P < .001), and more of them reported alcohol use before last sex (P < .01) and a history of pregnancy (P < .001). GLB youths in schools with gay-sensitive instruction reported fewer sexual partners, less recent sex, and less substance use before last sex than did GLB youths in other schools (P < .05). CONCLUSIONS: The findings document increased risk behaviors among GLB youths and demonstrate the potential benefits of providing gay-sensitive HIV instruction in schools.     

Factors mediating changes in sexual HIV risk behaviors among gay and bisexual male adolescents.

OBJECTIVES. Factors mediating changes in sexual behaviors that increase the risk of human immunodeficiency virus (HIV) infection were monitored in a group of gay and bisexual male adolescents. METHODS. One hundred thirty-six males aged 14 to 19 years (Hispanic, 51%; African-American, 31%) were recruited from one gay-identified agency, were assessed at four points over a 1-year period, and participated in HIV preventive intervention sessions. RESULTS. Significant reductions occurred in the number of unprotected same-sex anal and oral acts. Those with less risk in their previous sexual history, those who did not engage in commercial sex, and those who attended more HIV intervention sessions were more likely to reduce their sexual risk. The impact of sessions varied significantly by race/ethnicity: African-American youths reduced their risk acts most dramatically. Abstinence was consistently and significantly more likely among younger youths and those who had been abstinent before enrollment. The youths significantly reduced the number of sexual partners following the intervention; this reduction in partners was maintained through the 12-month follow-up and was greatest among youths with no involvement in commercial sexual activity (prostitution). CONCLUSIONS. The efficacy of HIV prevention programs must be empirically evaluated.     

Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior.

PURPOSE: To examine the link between victimization at school and health risk behaviors using representative data comparing lesbian, gay, and bisexual (LGB) youths and heterosexual youths. METHODS: Data from the 1995 Youth Risk Behavior Survey taken in Massachusetts and Vermont were examined. This sample included 9188 9th through 12th grade students; 315 of these students were identified as LGB. Analyses of variance were used to examine health risk behaviors by sexual orientation by gender by victimization level. RESULTS: The combined effect of LGB status and high levels of at-school victimization was associated with the highest levels of health risk behaviors. LGB youths reporting high levels of at-school victimization reported higher levels of substance use, suicidality, and sexual risk behaviors than heterosexual peers reporting high levels of at-school victimization. Also, LGB youths reporting low levels of at-school victimization reported levels of substance use, suicidality, and sexual-risk behaviors that were similar to heterosexual peers who reported low at-school victimization. CONCLUSIONS: The findings provide evidence that differences in health risks among LGB youth are mediated by victimization at school. Such victimization of LGB youth is associated with health risk behaviors.     

Substance use,gender inequity,violence and sexual risk among couples in Cape Town

Alcohol and other drug use, gender power inequities and violence are key contributors to sexual risks for HIV among South African men and women. Little is known about the intersection between these sex-risk behaviours among couples in established heterosexual relationships. We conducted 10 focus-group discussions with men and women in relationships of 1 year or longer recruited from shebeens (informal taverns) in Cape Town, South Africa. Participants described: high levels of alcohol consumption at shebeens; low levels of condom use with main and casual sex partners; gender roles disfavouring women's condom negotiating power that also promoted economic dependency on male partners; men often spending a portion of the household income on alcohol and other drugs and sex with others in shebeens; loss of household income driving women to trade sex to provide for their families; and sexual violence and the exploitation of women occurring in shebeens. Findings highlight how the social contexts of alcohol and other drug use, gender inequitable norms and gender violence promote HIV risk within established heterosexual relationships in South African communities. Evidence of this kind should inform the design of HIV-risk-reduction interventions tailored to heterosexual couples who drink alcohol in shebeens.     

HIV/AIDS education in Tanzania: The experience of at-risk children in poorer communities

This study has investigated human immunodeficiency virus (HIV) knowledge, attitudes and sexual at-risk behaviours of youths from disadvantaged communities of Dar es Salaam, Tanzania. Participants were 800 youths aged 12–15 years within three youth subgroups in these poorer communities: those children attending school; children who were not attending school but who were still residing within their communities; and children who were street children (more than 50% of them being orphans). Participants responded to questionnaires. In general, all youths showed low levels of HIV knowledge, experience with condom use and intention to use condoms. They exhibited moderate perceived behaviour control in using condom and positive subjective norms about the use of condoms, the value of sexual abstinence and having an exclusive sexual partner. Contrary to expectations, there were no significant differences between those in-school and those out-of-school with regard to HIV knowledge, intended condom use, subjective norms about condom use and abstinence. Indeed, the in-school children were more at risk for HIV infection, in that they reported the lowest condom experience and perceived behavioural control in condom use. There were systematic gender differences, in that girls scored lower than boys on all variables. The policy of basing HIV/acquired immunodeficiency syndrome (AIDS) education within the schools of Tanzania has not been as effective as desired. To be effective in “kicking AIDS out of Africa”, we need to re-evaluate the educational strategies being used.     

Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence

OBJECTIVES: We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. METHODS: In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. RESULTS: Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. CONCLUSIONS: Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.     

'I think condoms are good but, aai, I hate those things': condom use among adolescents and young people in a Southern African township

Levels of heterosexually transmitted HIV infection are high amongst South African youth, with one recent survey reporting levels of 18.9% amongst 17-20 year olds and 43.1% amongst 21-25 year olds. In these groups levels of knowledge about HIV are high, but perceived vulnerability and reported condom use are low. Much existing research into youth HIV in developing countries relies on survey measures which use individual knowledge, attitudes and reported behaviour as variables in seeking to explain HIV transmission amongst this group. This paper reports on a focus group study that seeks to complement existing individual-level quantitative findings with qualitative findings highlighting community and social factors that hinder condom use amongst youth in the township of Khutsong, near Carletonville. Study informants comprised 44 young women and men in the 13-25 year age group. Data analysis highlighted six factors hindering condom use: lack of perceived risk; peer norms; condom availability; adult attitudes to condoms and sex; gendered power relations and the economic context of adolescent sexuality. Informants did not constitute a homogenous group in terms of their understandings of sexuality. While there was clear evidence for the existence of dominant social norms which place young peoples' sexual health at risk, there was also evidence that many young people are self-consciously critical of the norms that govern their sexual behaviour, despite going along with them, and that they are aware of the way in which peer and gender pressures place their health at risk. There was also evidence that a minority of youth actively challenge dominant norms and behave in counter-normative and health-enhancing ways. The actively contested nature of dominant sexual norms provides a fertile starting point for peer education programmes that seek to provide the context for the collective negotiation of alternative sexual norms that do not endanger young peoples' sexual health.     

Interpersonal issues surrounding HIV counseling and testing, and the phenomenon of "testing by proxy"

This multimethod study explored challenges faced by women in close heterosexual relationships who decided to test for HIV, and their experiences with instituting safer sexual practices and partner testing. Eighty-one women who sought HIV counseling and testing and had a regular male sexual partner were interviewed on five occasions, and 18 of these women and 15 men later took part in one of four focus groups (women only, men only, or couples). Findings identified difficulty understanding the unpredictability of HIV transmission, gender differences in how partners interpret their susceptibility to HIV, and male resistance to safer sex and testing. We also identified a pervasive phenomenon of "testing by proxy"--the belief that if one partner tests negative for HIV after having unprotected intercourse, the untested partner's serostatus is deemed to be negative. This dangerous practice must be addressed in public health prevention efforts. Programs aiming to reduce heterosexual HIV risk for women must include their male partners and incorporate effective interpersonal communication skills.     

Sexual orientation, sexual abuse, and HIV-risk behaviors among adolescents in the Pacific Northwest

OBJECTIVES: We explored HIV risk behaviors, sexual orientation, and sexual abuse among 5 school-based cohorts in Seattle, Wash (SEA95 and SEA99:N=7477 and N=6590), and British Columbia (BC92, BC98, and BC03 [weighted]: N=239975, N=281576, and N=265132). METHODS: An HIV risk scale of 7 items assessed risky sexual behaviors and injection drug use. Self-identified sexual orientation included heterosexual, bisexual, gay/lesbian, and, in British Columbia only, mostly heterosexual. Analyses of covariance were conducted separately by gender and were adjusted for age and sexual abuse when comparing means. RESULTS: Gay/lesbian and bisexual adolescents had higher mean age-adjusted risk scores compared with heterosexual and mostly heterosexual adolescents. After we controlled for sexual abuse history, mean scores were 2 to 4 times higher among abused students than among nonabused students in each sexual orientation group. Age/abuse-adjusted models better explained the variance in risk scores (R(2)=0.10-0.31), but sexual orientation remained an independent predictor. CONCLUSION: Sexual minority adolescents who attended school reported higher HIV risk behaviors, and higher prevalence of sexual victimization may partially explain these risks.     

Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts

OBJECTIVES: The goal of this study was to identify differences between gay, lesbian, bisexual, and transgender (GLBT) homeless youths and their heterosexual counterparts in terms of physical and mental health difficulties. METHODS: A sample of 84 GLBT adolescents was matched in regard to age and self-reported gender with 84 heterosexual adolescents. The 2 samples were compared on a variety of psychosocial variables. RESULTS: GLBT adolescents left home more frequently, were victimized more often, used highly addictive substances more frequently, had higher rates of psychopathology, and had more sexual partners than heterosexual adolescents. CONCLUSIONS: Homeless youths who identify themselves as members of sexual minority groups are at increased risk for negative outcomes. Recommendations for treatment programs and implications for public health are discussed.     

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.     

Perceptions of condom use among African American men who have sex with men

The objectives of this study were to describe what African American men perceive as the risks of different sexual acts when not using condoms, the social and situational barriers to using condoms, the attitudes towards condom use of other men they know, and the strategies needed to promote condom use. In semi‐structured interviews, participants were asked questions regarding their perceptions of the risks of HIV infection from various sexual activities, barriers to condom use, condom attitudes of people in their social and sexual networks, and strategies necessary to promote condom use. Analyses indicated that African American men who sex with men (MSM) most often mentioned sex without a condom as risky sexual behaviour, specifically anal sex. The most frequently perceived barrier to safer sex practice was ‘sex on the spur of the moment’. Respondents also perceived several salient attitudes towards condom use held by the African American MSM they knew. In particular, respondents were divided in their perception of social support for condom use among their friends and acquaintances. Also, they perceived that men in their social and sexual networks held less favourable attitudes towards condom use in committed relationships. Findings are discussed in relation to various interpersonal (e.g., relationship issues) and contextual (e.g., social support and social networks) factors that may influence HIV sexual risk behaviours among African American MSM.     

Gender differences in condom usage among rural crack-using men and women

Consistent condom use is an important aspect of decreasing HIV transmission risk in heterosexual crack cocaine using populations. This study explores gender differences in attitudes and motivations to use condoms within a rural, economically disadvantaged sample. Qualitative data analysis identified recurrent themes regarding condom use and assessed how themes varied among men and women. Analyses showed that men and women exhibit different rationales for condom use, while both reported inconsistencies between their knowledge about safe sex, receptivity to condom use, and applications in practice. The findings suggest that prevention programs should be tailored to increase consistent condom use among main partners of crack smokers at risk for HIV.     

Gender Atypicality and Anxiety Response to Social Interaction Stress in Homosexual and Heterosexual Men

Gender non-conforming behavior and a homosexual sexual orientation have both been linked to higher levels of anxiety. This study examined the independent and interactive effects of gender atypicality and sexual orientation on levels of state anxiety immediately following a stressful social interaction task among a sample of homosexual and heterosexual Israeli men (n = 36). Gender atypicality was measured via both self-report and observer ratings. State anxiety was measured via both self-report immediately subsequent to the stressful social interaction task and pre- to post task changes in salivary cortisol. Results showed that self-reported gender atypicality and heterosexual sexual orientation predicted higher levels of self-reported social interaction anxiety, but not changes in cortisol. There were no sexual orientation by gender behavior interactions and there were no significant effects for observer rated gender atypicality. These findings suggest that gender atypicality, not homosexuality, place individuals at risk for increased anxiety.     

The development of an innovative,theory-driven,psychoeducational HIV/STI prevention intervention for heterosexually active black adolescents with mental illnesses

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), continue to disproportionately affect Black adolescents. Those experiencing the psychological sequelae of mental illnesses are at increased risk. Here, we outline the development of an HIV/STI prevention intervention for heterosexually active Black adolescents with mental illnesses. This research was guided by a psychosocial expansion of the Theory of Planned Behavior, nested within a broader social determinants of health framework. A youth community advisory board provided study oversight. Heterosexually active Black adolescents aged 14–17 were recruited from community-based outpatient mental health providers for focus groups, surveys and two ‘dress rehearsals’ of the intervention protocol (N = 68). The qualitative and quantitative findings indicated that knowledge, attitudes and skills related to consistent condom use, reduced number of sexual partners, routine HIV/STI testing, abstinence and emotion regulation were important areas to target. These elicitation data provided insight into the context of HIV/STI risk for the study population, and were used to develop the intervention content. ‘Project GOLD: We are Kings and Queens’ was designed to be delivered over two days (3 hours per day), with eight, 45-min modules. The activities address behaviors, as well as cognitive, emotional, psychological and social processes associated with HIV/STI risk. Alongside evidence-based HIV/STI prevention strategies (e.g. sexual partner communication skills), the intervention activities are rooted in principles of Cognitive Behavioral Therapy. Dress rehearsal participants were in favor of the intervention and provided feedback on activity length, gender and cultural relevance and strategies to sustain attention; this information was used to finalize the curriculum. In partnership with the community, we developed a theoretically driven, gender and culturally relevant, developmentally and psychologically appropriate HIV/STI prevention program. Our ultimate goal is to standardize sexual health assessment and intervention in outpatient mental health treatment settings to meet sexual health needs in this underserved population.     

Physical Dating Violence Victimization Among Sexual Minority Youth

Objectives. We examined (1) whether sexual minority youths (SMYs) are at increased risk for physical dating violence victimization (PDVV) compared with non-SMYs, (2) whether bisexual youths have greater risk of PDVV than lesbian or gay youths, (3) whether youths who have had sexual contact with both sexes are more susceptible to PDVV than youths with same sex–only sexual contact, and (4) patterns of PDVV among SMYs across demographic groups.Methods. Using 2 measures of sexual orientation, sexual identity and sexual behavior, and compiling data from 9 urban areas that administered the Youth Risk Behavior Surveys from 2001 to 2011, we conducted logistic regression analyses to calculate odds of PDVV among SMYs across demographic sub-samples.Results. SMYs have significantly increased odds of PDVV compared with non-SMYs. Bisexual youths do not have significantly higher odds of PDVV than gay or lesbian youths, but youths who had sexual contact with both-sexes possess significantly higher odds of PDVV than youths with same sex–only sexual contact. These patterns hold for most gender, grade, and racial/ethnic subgroups.Conclusions. Overall, SMYs have greater odds of PDVV versus non-SMYs. Among SMYs, youths who had sexual contact with both sexes have greater odds of PDVV than youths with same sex–only sexual contact. Prevention programs that consider sexual orientation, support tolerance, and teach coping and conflict resolution skills could reduce PDVV among SMYs.Dating violence refers to any stalking behaviors, psychological, physical or sexual violence perpetrated by a partner toward a current or former dating partner; violence may be perpetrated in-person or electronically (e.g., repeated unwanted texts, cyberstalking).1 The prevalence of dating violence victimization reported across studies varies by definition, measure, and population.2 In general, between 10% and 30% of adolescent samples reported experiencing some form of dating violence.2 There are few studies on dating violence among sexual minorities, defined either by sexual identity (e.g., gay or lesbian, bisexual) or by sexual contact (e.g., sexual contact with same sex–only or contact with both sexes), and they suggested that prevalence may vary from 11% to upwards of 40%.3–6 In a convenience sample of adolescents, Freedner et al. found that bisexual boys had 3.6 times the odds of experiencing any form of dating violence compared with heterosexual boys and lesbians had 2.4 times the odds of reporting fear for their safety in the context of a dating relationship compared with heterosexual girls.4 In a sample of 10 schools in New York, researchers found that 42% of lesbian, gay, and bisexual students reported experiencing physical dating violence compared with 29% of heterosexual students.3 Using data from 8 states, an analysis of the Youth Risk Behavior Surveys found that physical dating violence victimization (PDVV) in the past 12 months ranged from 6.1% to 13.8% among heterosexual students, from 19.1% to 29.2% among gay or lesbian students, and from 17.7% to 28.0% among bisexual students.6 Based on sex of sexual contact, the prevalence of dating violence victimization ranged from 11.5% to 17.1% among students who only had sexual contact with the opposite sex, from 16.3% to 26.2% among students who only had sexual contact with the same sex, and from 26.3% to 39.6% among students who engaged with both sexes.6 Only 1 study showed relatively low prevalence of PDVV―among 117 youths in the National Longitudinal Study of Adolescent Health who reported same-sex romantic or sexual relationships, 11% reported experiencing any physical violence in the past 18 months.5Many reasons exist for a higher prevalence of dating violence among sexual minority youths (SMYs). Although many youths face stressors in adolescence as they develop their social and sexual identities, this pressure may be more intense for SMYs who often grow up amidst individual and institutional stigma, prejudice, and discrimination toward sexual minorities. This hostile social environment may lead to feelings of shame and isolation, denying one’s sexuality, internalized homophobia, depression, negative health behaviors, less favorable perceptions of the quality of one’s relationships, and relationship violence.7–10 Other related reasons for increased relationship violence may include difficulties among some SMYs in navigating their gender identity and gender expression which may play a role among some SMYs and create tensions in relationships.11 SMYs, like their heterosexual peers are also influenced by strict gender roles and social norms of behaving depicted in the “mainstream” culture.12,13 For example, a partner may take on a more dominant role and expect the other partner to conform. Without visible role models, issues of dominance and submissiveness may become destructive.11 Other stressors within heterosexual couples also play out in sexual minority relationships such as power imbalances attributed to social class differences, jealousy, incompatibility, and a lack of recognition of unhealthy relationships stemming from absent role models.11 When SMYs do recognize violence in their relationships, they may be less likely to seek help for fear of reprisal or rejection upon coming out.14 Additionally, services and education received may lack cultural appropriateness.15 These factors may keep youths feeling stuck in violent relationships. SMYs may also be afraid to leave a violent relationship because they don’t see other relationship options for themselves given low visibility of sexual minorities in the community.11The short- and long-term consequences of dating violence have been well documented and include variety of negative physical, social, and mental health outcomes including injury, fear, depression, substance abuse, sexual risk behaviors, suicidal ideation, school failure, and eating disorders.12,16–19 Findings from 2 studies suggested that the consequences of dating violence among sexual minorities may be even more severe with increased risk of HIV infection in populations experiencing intimate partner violence.20,21 Numerous risk factors have been associated with dating violence in past research. These factors include having multiple sexual partners, depression, anxiety, substance use, or aggression, holding traditional gender views, having antisocial friends or friends who perpetrate dating violence, witnessing or experiencing family violence, having a poor relationship with parents, and low parental monitoring.22More research on the prevalence of dating violence among SMY youths is needed to guide research on etiology and prevention of such violence. According to Wolfe et al., adolescent dating violence may be a stepping-stone to adult intimate partner violence,23 so prevention is imperative. Specifically, understanding which sexual minorities are at increased risk is essential as sexual minorities are not a single homogenous group. Examining results within sexual minority groups (e.g., lesbian or gay or bisexual) requires large sample sizes. To date, most studies have employed relatively small convenience samples and have often grouped all sexual minorities together.4,5 Additionally, stratified analyses by race/ethnicity remain absent in the literature of dating violence among SMYs, perhaps because of sample size limitations.To address these gaps, we combined data from large population-based local Youth Risk Behavior Surveys from 2001 to 2011 to examine PDVV experienced by SMY groups and stratified analyses by demographic characteristics (e.g., gender or race/ethnicity). We used 2 measures of sexual orientation, sexual identity and sexual behavior, which allowed for the inclusion of more SMYs in the analyses, because not all youths who engage in same-sex behavior identify as a sexual minority and similarly not all youths who identify as a sexual minority engage in sexual behavior. We sought to examine the following: (1) whether SMYs (based on both definitions) are at increased risk for PDVV compared with non-SMYs, (2) whether bisexual youths have a higher risk of PDVV than do lesbian or gay youths, (3) whether youths with sexual contact with both-sexes have a higher risk of PDVV than do youths with same sex–only engagement, and (4) patterns of PDVV among SMYs in different demographic groups.     

BOOK REVIEWS

This multimethod study explored challenges faced by women in close heterosexual relationships who decided to test for HIV, and their experiences with instituting safer sexual practices and partner testing. Eighty-one women who sought HIV counseling and testing and had a regular male sexual partner were interviewed on five occasions, and 18 of these women and 15 men later took part in one of four focus groups (women only, men only, or couples). Findings identified difficulty understanding the unpredictability of HIV transmission, gender differences in how partners interpret their susceptibility to HIV, and male resistance to safer sex and testing. We also identified a pervasive phenomenon of “testing by proxy”—the belief that if one partner tests negative for HIV after having unprotected intercourse, the untested partner's serostatus is deemed to be negative. This dangerous practice must be addressed in public health prevention efforts. Programs aiming to reduce heterosexual HIV risk for women must include their male partners and incorporate effective interpersonal communication skills.     

Differences in Sexual Identity, Risk Practices, and Sex Partners between Bisexual Men and Other Men among a Low-Income Drug-Using Sample

Men who have sex with men and women (MSMW) represent an important target population for understanding the spread of HIV because of the inherent bridging aspect of their sexual behavior. Despite their potential to spread HIV between gender groups, relatively little recent data have been reported about this population as a subgroup distinct from men who have sex with men only. This paper analyzes data from the Chicago site of Sexual Acquisition and Transmission of HIV Cooperative Agreement Program to characterize 343 MSMW in terms of their demographics, drug use, sexual risk behavior, sexual identity, and sex partners. Results show the MSMW sample to be extremely disadvantaged; to have high rates of drug use, including injection and crack use; to report more female than male sex partners; to not differ from gay and heterosexual men in rates of condom use; and, for the most part, to report sexual identities that are consistent with their sex behavior. MSMW represent an important subpopulation in the HIV epidemic and should be targeted for risk reduction interventions.     

Gender Differences in Condom Usage Among Rural Crack-Using Men and Women

SUMMARY

Consistent condom use is an important aspect of decreasing HIV transmission risk in heterosexual crack cocaine using populations. This study explores gender differences in attitudes and motivations to use condoms within a rural, economically disadvantaged sample. Qualitative data analysis identified recurrent themes regarding condom use and assessed how themes varied among men and women. Analyses showed that men and women exhibit different rationales for condom use, while both reported inconsistencies between their knowledge about safe sex, receptivity to condom use, and applications in practice. The findings suggest that prevention programs should be tailored to increase consistent condom use among main partners of crack smokers at risk for HIV.