Obesity, Body Image, and Unsafe Sex in Men who have Sex with Men

Little is known about the relationship among body weight, body image, and HIV/AIDS sexual risk behaviors. We examined this issue in a midwestern U.S. metropolitan area community sample of 316 men who have sex with men, a group at relatively high risk for HIV/AIDS. All data were self-reported by questionnaire using standard items to assess current body image, height and weight, and HIV/AIDS sexual risk behaviors. Logistic regression models were used to estimate cross-sectional associations. Forty-nine (15%) of the 316 men were classified as obese, and 56 (18%) had unsafe sex in the past three months. Normal weight or overweight men were 3.6 times more likely than obese men to have had unsafe sex, after adjusting for differences in body image and age. Men with better body image were 1.4 times more likely than men with lower body image to have had anal sex, after adjusting for differences in body weight and age. Non-obese men were no more or less likely than were obese men to have engaged in anal sex or in any sex in the past three months. This is the first study showing a positive relationship between below-obese body weight and unsafe sex and between better body image and anal sex in men who have sex with men. Future research should investigate these novel findings, perhaps using other study designs and data collection tools with less measurement error. Advances in knowledge about HIV/AIDS risk factors, including body weight and body image, could potentially contribute to more effective approaches to reducing this risk.     

Correlates of Forced Sex Among Populations of Men Who Have Sex with Men in Thailand

Although forced sex is a correlate of HIV infection, its prevalence and associated risks are not well described among men who have sex with men (MSM) in developing-country settings. Between March and October 2005, we assessed the prevalence of forced sex and correlates among populations of MSM (this includes general MSM, male sex workers, and male-to-female transgender persons) in Thailand using a community-based sample. Participants were enrolled from venues around Bangkok, Chiangmai, and Phuket using venue day-time sampling. Handheld computer-assisted self-interviewing was used to collect demographic and behavioral data and logistic regression evaluated factors associated with forced sex, defined as ever being forced to have sexual intercourse against one’s will. Of the 2,049 participants (M age, 24.8 years), a history of forced sex was reported by 376 (18.4%) men and, of these, most were forced by someone they knew (83.8%), forced more than once (67.3%), and had first occurrence during adolescence (55.1%). In multivariate analysis, having a history of forced sex was significantly associated with being recruited in Phuket, classification as general MSM or transgender (versus classification as male sex worker), drug use, increased number of male sexual partners, and buying sex. The findings in our assessment were consistent with assessments from Western countries. Longitudinal studies are needed to understand the mechanisms of the relationships between forced sex correlates found in our assessment and HIV acquisition and transmission risks.     

玉溪市男男性接触者安全套使用及影响因素分析

目的掌握玉溪市男男性接触者（MSM）人群安全套使用情况及其相关影响因素，为制定有针对性的干预措施提供依据。方法采用横断面调查和追踪调查相结合的方式，对105名MSM人群进行问卷调查。结果共调查MSM105人，其中未婚54．3％、在婚36．2％、离异或丧偶9．5％；最近1次肛交用安全套比例66．7％，其中未婚达78．9％、在婚55．3％、离异或丧偶40．0％，差异有统计学意义（P〈0．05）；MSM人群最近1次与异性发生性行为用安全套比例32．4％，其中在婚47．4％、未婚26．3％、离异或丧偶10．0％，差异有统计学意义（P〈0．05）；通过多因素Logistic回归分析，发现促进MSM使用安全套的影响因素包括高文化程度（OR=0．616），在婚、离异或丧偶的婚姻状态（OR=0．161、0．488），高艾滋病知识知晓（OR=0．444），接受过艾滋病咨询检测（OR=0．198），以及接受过同伴教育（OR=0．182）。结论玉溪市MSM人群安全套使用率偏低，影响因素较多。应进一步推广艾滋病咨询检测及同伴教育活动，注重完善MSM不同人群的干预措施。     

Ecological and Syndemic Predictors of Drug Use During Sex and Transactional Sex among U.S. Black Men Who Have Sex with Men: A Secondary Data Analysis from the HPTN 061 Study

Archives of Sexual Behavior - Threats to sexual health among U.S. Black men who have sex with men (MSM) may manifest in a context of social adverse experiences. Situational sex is one such context,...     

Sex Trade Behavior among Heterosexually Active Homeless Men

Sex trade behavior is fairly common among homeless adults and may contribute to higher rates of HIV/AIDS in this population. This study provides a detailed examination of the sex trade-related attitudes and behaviors of homeless men by: (1) determining the prevalence of sex trade-related behaviors, including sex with female sex workers (FSWs); (2) identifying risk factors for having sex with FSWs; and (3) comparing men’s relationships with FSWs and non-FSWs in terms of relationship qualities and HIV-related risk behaviors, such as condom use. Structured interviews were conducted with a probability sample of 305 heterosexually active homeless men recruited from meal lines in Los Angeles. Recent sex with a FSW was reported by 26 % of men, and more likely among those who were older, used crack cocaine, had more sex partners, believed that sometimes men just need to have sex no matter what, and were embedded in networks that were denser and where risky sex was more normative. Compared to non-FSW partners, men with FSW partners felt less emotionally close to them, were more likely to believe the partner had never been tested for HIV, and were more likely to have sex with them under the influence of drugs or alcohol; however, they were not more likely to talk about using condoms or to use condoms with FSWs. Whether the relationship was considered “serious” was a stronger correlate of condom use than whether the partner was a FSW. Implications of these findings for HIV prevention efforts among homeless adults are discussed.     

Asymptomatic Lymphogranuloma Venereum in Men who Have Sex with Men,United Kingdom

We investigated prevalence of lymphogranuloma venereum (LGV) among men who have sex with men who were tested for chlamydia at 12 clinics in the United Kingdom during 10 weeks in 2012. Of 713 men positive for Chlamydia trachomatis, 66 (9%) had LGV serovars; 15 (27%) of 55 for whom data were available were asymptomatic.     

成都市男男性行为人群口交时安全套使用影响因素分析

目的探索成都市男男性行为人群口交行为时安全套使用的影响因素。方法采用滚雪球抽样选取成都市465名男男性行为者作为调查对象,通过问卷调查的方式收集人口学特征、艾滋病知晓率、高危行为等信息,用累积logistic模型分析成都市MSM人群发生口交行为时安全套使用的影响因素。结果共调查成都市465名MSM者,其中79.7%的调查对象最近6个月与性伴发生口交行为时从未使用安全套;最近6个月发生口交行为时安全套使用的影响因素有文化程度、寻找性伴最常去的场所、是否知道性伴的健康状况。结论成都市MSM人群口交行为时安全套使用率低,需通过多种途径对其进行健康教育,以提高安全套使用率。     

Anal Sex Role, Circumcision Status, and HIV Infection Among Men Who Have Sex with Men in Chongqing, China

Men who have sex with men (MSM) in China face a rapidly expanding HIV epidemic. Anal sex role plays a significant role in HIV infection. Research has already begun in China investigating the potential for circumcision-based interventions to slow the rise of HIV among Chinese MSM. Using peer referral recruitment, we sampled 491 men who reported anal sex role preference. We analyzed preferred anal sex role, enacted sex role during recent sexual behavior, and circumcision status and HIV infection among MSM in one Chinese city. Men reported on their anal sex role preference and reported on up to three male sexual partners. Men were asked to report on whether they were “top” or “bottom” with each of the partners. Those that preferred being bottom and versatile were significantly younger than those who preferred being top. Men who preferred bottoming and those that preferred the versatile role were significantly more likely to be HIV-infected than those who preferred to be tops. There was no significant association between circumcision and HIV infection among men who maintained their preferred top role. In terms of anal sex role behavior, prevalence was not statistically different across anal sex roles. Circumcision conferred no additional protection to men who preferred and who engaged the top role during anal sex. HIV interventions will need to address anal sex roles in more sophisticated ways than perhaps originally thought. Simplistic assumptions that anal sex role is a fixed behavior undermines interventions such as circumcision among MSM.     

Sexual Marathons and Methamphetamine Use among HIV-Positive Men Who Have Sex with Men

A sexual marathon is defined as prolonged sexual activity over hours and even days. This exploratory study examined the phenomenon of sexual marathons in a sample of 341 HIV-positive methamphetamine-using men who have sex with men (MSM). Eighty-four percent of the men reported engaging in marathon sex while high on methamphetamine. MSM who engaged in sexual marathons and those who did not were compared in terms of background characteristics, methamphetamine use variables, alcohol and illicit drug use, sexual risk behaviors, and psychosocial factors. Men who engaged in marathon sex used significantly more illicit drugs, were more likely to use sildenafil (Viagra) and amyl nitrates, and scored higher on a sexual compulsivity scale compared to men who did not engage in marathon sex. In multivariate analyses, use of sildenafil in the past two months was significantly correlated with participation in sexual marathons. Findings are discussed in terms of their implications for HIV/STI prevention and intervention.     

Sexual Behaviors of Non-gay Identified Non-disclosing Men Who Have Sex with Men and Women

The sexual behaviors of non-gay identified men who have sex with men and women (MSMW) who do not disclose their same-sex behavior to their female partners (referred to by some as men "on the down low") were examined, including the potential for these men to serve as a "bisexual bridge" for HIV and STD acquisition and transmission. Self-reported sexual behavior data were collected as part of an exploratory study of an ethnically diverse (41% African American, 35% Latino, 22% White, and 2% Asian) sample of 46 non-gay identified, non-disclosing MSMW in New York City. Men reported significantly more male than female sexual partners, but more frequent sex with females. The prevalence and frequency of unprotected sex did not differ significantly between male and female partners in the past 3 months. Men reported risk behavior more often with steady female and steady male partners (e.g., wives, girlfriends, boyfriends) than with more casual male and female partners (regular uncommitted partners, one-night stands). Men, especially African American/Black men, were significantly less likely to report receptive sexual behaviors with men than insertive behaviors. Unprotected sex was common with male and female partners in the past 3 months (e.g., 35% of anal sex with men; 50% of vaginal sex). Indeed, 22% of the sample (38% of those who had both recent males and female partners) reported both unprotected vaginal sex and unprotected anal sex with a male partner during the past 3 months. Although the study was limited by a small convenience sample, the findings suggest that non-gay identified non-disclosing MSMW are at risk for the acquisition and transmission of HIV and STDs, and may serve as a potential bridge, suggesting the need for further research and intervention targeting this unique population.     

Preferences for Injectable PrEP Among Young U.S. Cisgender Men and Transgender Women and Men Who Have Sex with Men

Young men who have sex with men account for approximately 20% of incident HIV infections in the U.S. Antiretroviral pre-exposure prophylaxis (PrEP) administered as a daily pill has been shown to decrease HIV acquisition in at-risk individuals. New modalities for PrEP are being developed and tested, including injectable PrEP; however, acceptability of these emerging modalities has not yet been examined in youth. We conducted six focus groups with 36 young men and transgender men and women who have sex with men in Boston, Chicago, and Los Angeles in 2016 to assess interest in and preference for different PrEP modalities. Youth were purposively recruited based on diversity of age, race/ethnicity, and prior PrEP experience. Data were coded using content coding based on key domains of the interview guide, in particular around the central themes of interest in and barriers and facilitators to injectable PrEP use. Participants were knowledgeable about oral PrEP but suggested barriers to broader uptake, including stigma, marginalization, and access to information. While participants were split on preference for injectable versus oral PrEP, they agreed quarterly injections may be more manageable and better for those who have adherence difficulties and for those who engage in sex more frequently. Concerns specific to injectable PrEP included: severity/duration of side effects, pain, level of protection prior to next injection, distrust of medical system and injections, and cost. Understanding barriers to and preferences for diverse prevention modalities will allow for more HIV prevention options, improved products, and better interventions, thus allowing individuals to make informed HIV prevention choices.     

柳州市不同性取向MSM性行为学特征分析

目的了解比较柳州市男同性恋或双性恋者性行为学特征,为HIV知识宣传及行为干预提供理论依据。方法于2008-10/12依托同性恋活动场所和志愿者组织通过网络宣传、朋友相互介绍、外展干预宣传等方式招募被调查对象,采用匿名面对面询问方式进行问卷调查,对其中男同性恋和男双性恋者的性行为进行比较分析。结果共调查300人,其中59.0%、39.0%分别自我认同为同性恋或双性恋者。男同性恋与男双性恋者中,20～29岁组分别占52.6%、38.5%;在婚比例分别为17.0%、49.6%(P均0.01)。同性恋者首次性行为是男性性伴的比例(69.5%)高于双性恋者(28.2%),与男性首次性行为的年龄(25.8岁)低于双性恋者(30.2岁)。最近6个月同性恋者与男性肛交的比例(89.3%)高于双性恋者(88.8%)(P0.05);且肛交时每次都用安全套的比例均较低,分别为(P0.05)。最近6个月同性恋、双性恋者与女性发生性行为的比例分别为26.0%、53.8%(P0.01);且与女性发生性行为时每次都用安全套的比例均很低。结论男双性恋者有较高比例的在婚率和异性性行为,男同性恋者与男性发生性行为的比例更高,且两者的多性伴、无保护性肛交的频率很高,应加强对该人群的监测和综合干预。     

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.     

Homonegativity and Associated Factors Among Men Who Have Sex with Men in Estonia

Men who have sex with men (MSM) continue to be at higher risk for negative health outcomes including HIV, STIs, depression, substance use, suicidality, and anxiety. Associative relationships between homonegativity (internal and external) and these outcomes are used to explain the observed disproportionate impact. The current study assessed associations between internalized homonegativity and high-risk behaviours, markers of substance use and symptoms of mental illness as well as openness and level of same sex attraction. A 2013 Internet-based survey was conducted among MSM, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity. The sample (n = 265) had a median age of 31 years, with 85 % employed at least part-time; at least a college-level education in 43 %; and 87 % lived in an urban setting. Sexual orientation was reported as: gay, 72 %; bisexual 23 %; other 5 %. Almost all men (97 %) reported ever having sex with a man, with more than one-third (36 %) having a steady male partner. Statistically significant higher homonegativity scores were detected among men reporting any level of opposite sex attraction compared to men attracted to only men; mostly men (p = 0.001), men and women equally (p = 0.002), and mostly women (p = 0.004), as well as less openness of same sex attraction to family and friends; >50 % family (p = 0.032), no family knowing (p = 0.042), and few friends knowing (p = 0.011). Anxiety risk and increased homonegativity also had a statistically significant increasing relationship. The identified associations between homonegativity and opposite sex attraction among MSM warrants further exploration as well as the relationship with increased anxiety risk.     

How Stigma Toward Anal Sexuality Promotes Concealment and Impedes Health-Seeking Behavior in the U.S. Among Cisgender Men Who Have Sex with Men

Archives of Sexual Behavior - Gay, bisexual, and other men who have sex with men (MSM) experience alarming HIV disparities alongside sub-optimal engagement in HIV interventions. Among MSM, stigma...     

Preference for and Maintenance of Anal Sex Roles Among Men Who Have Sex with Men: Sociodemographic and Behavioral Correlates

Self-labeling of, and preference for, anal sex roles is an important aspect of identities and cultures among men who have sex with men (MSM) populations. In this article, we examined sociodemographic and behavioral correlates of preference for and maintenance of anal sex roles, and risk for HIV infection. Using time-location sampling, we conducted a cross-sectional survey of racially diverse MSM in San Francisco. Of the 386 men who reported an anal sex role preference, 41% preferred being “versatile” while 21 and 37% preferred being “bottom” and “top” only. Lower educated men, Asian/Pacific Islander men, and men born in Asia/Philippines were more likely to prefer being “bottom.” Among all racial/ethnic groups, men in general did not maintain their preferences 100% of the time in their reported sexual behavior, and none of the racial/ethnic groups maintained their preference at greater or lesser levels than any other group. There were no significant differences in all the behavioral risks between men who maintained their preferences and those who did not. Yet, prevalence of HIV infection was two times higher among men who were strictly “bottom.” Linguistically and/or culturally appropriate HIV prevention information/interventions at an appropriate educational level should be provided to those from the developing world and those of lower socioeconomic status, who may lack the knowledge of differential risks associated with anal sex activities.     

Finding Sex Partners Through Social Media Among Men Who Have Sex with Men in Hanoi,Vietnam

Many men who have sex with men (MSM) in low and middle income countries search for male sexual partners via social media in part due to societal stigma and discrimination, yet little is known about the sexual risk profiles of MSM social media users. This cross-sectional study investigates the prevalence of social media use to find male sex partners in Hanoi, Vietnam and examines associations between social media use and sociodemographic and behavioral characteristics, including levels of internalized, perceived and enacted stigma, high-risk sexual behaviors, and HIV testing. 205 MSM were recruited from public venues where MSM congregate as well as through snowball sampling and completed an anonymous survey. MSM who found their male sexual partners using social media in the last year were more likely to have completed a university or higher degree (aOR 2.6; 95% CI 1.2–5.7), experience high levels of MSM-related perceived stigma (aOR 3.0; 95% CI 1.1–8.0), and have more than ten lifetime male sexual partners (aOR 3.2; 95% CI 1.3–7.6) compared to those who did not use social media. A niche for social media-based interventions integrating health and stigma-reduction strategies exists in HIV prevention programs for MSM.     

The Impact of Pre-exposure Prophylaxis on Sexual Well-Being Among Men Who Have Sex with Men

Archives of Sexual Behavior - Pre-exposure prophylaxis (PrEP) is a promising strategy to reduce HIV incidence among men who have sex with men (MSM). How and when PrEP is used could in part be...     

济南市635名男男性接触者相关病原感染状况调查

[目的]了解男男性接触者相关病原感染状况，为在该人群中开展预防干预措施提供依据。[方法]2005年1月至2007年3月，对济南市635名男男性接触者进行艾滋病病毒（HIV）、梅毒螺旋体（TP）、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）感染状况检测。[结果]检测635人，抗-HIV阳性率为2．21％，抗-TP阳性率为9．76％，HBsAg阳性率为7．56％，HBeAg阳性率为2．68％，抗-HBs阳性率为55．91％，抗-HBe阳性率为18．11％，抗-HBc阳性率为40．63％，抗-HCV阳性率为0．03％。[结论]济南市男男性接触者HIV感染率较高。