Mortality among Homeless Men

The mortality in a series of 6,032 homeless men in Stockholm was investigated. The observation period was up to 3 years. The observed number of deaths amounted to 327 compared to the expected 86·7, corresponding to an excess mortality ratio of about 4. Mortality was raised for all the causes of death studied. Most striking, however, was excess mortality from accidents and diseases of the digestive and respiratory systems. Accidental deaths were remarkably numerous, indicating that these are largely correlated to the social consequences of abuse. The same applies to deaths from pulmonary tuberculosis. Excess mortality from suicide was lower than that found in some earlier studies. This discrepancy is discussed. In comparison with the general population the high mortality from diseases such as cirrhosis of the liver and pancreatitis shows that many medically serious cases of alcoholism are included in the “Homeless Men” group.     

Criminality Among Homeless Men

A group consisting of 202 Swedish male citizens who, during 1969, were registered with a special Bureau for Homeless men, was investigated in regard to criminality. The persons studied were followed-up for a 3-year observation period. Compared to the general population there was a marked excess registration in the Criminal Register. Even the crime recurrence rate was high. Only a few persons, however, had been guilty of serious crimes with an element of violence, such as manslaughter, robbery with violence or rape. The fact that severe criminality is not particularly common in alcoholics is also reflected in the legal consequences. In view of the high rate of recidivism and the fact that the sentences often concerned several crimes simultaneously these were usually relatively mild. For one fourth of the persons registered, criminality had started before the age of 20, i.e. at an age when alcoholism had probably not attained its maximum degree of severity. Among those alcoholics who become criminal at an early age both alcohol abuse and criminality may be manifestations of other factors which contribute to the development of a deviating behavioural pattern.     

Inconsistent Condom Use with Steady and Casual Partners and Associated Factors among Sexually-Active Men who Have Sex with Men in Bangkok, Thailand

HIV/STD risk behavior has not been examined in community samples of men who have sex with men (MSM) in Thailand. The sexually-active sample (n=927) was recruited from bars, saunas, and parks; 20% identified as bisexual and 17% tested HIV-positive. Inconsistent (<100%) condom use was reported by 45% of those with steady partners and 21% of those with casual partners in the prior three months. 21% had heard of effective HIV treatments (n=194), among whom 44% believed HIV was less serious and 36% said their risk behavior had increased after hearing about the treatments. In multivariate analysis, HIV-positive status, gay-identification, getting most HIV information from the radio, believing HIV can be transmitted by mosquito bite, and concern about acquiring an STD were associated with inconsistent condom use during anal sex; slightly older age (25–29 vs. 18–24 years) was associated with more consistent condom use. HIV/STD risk-reduction strategies for MSM in Bangkok should clearly state sexual risk to individuals in this population.     

Affect and Condom Use Among Men Who have Sex with Men: A Daily Diary Study

Men who have sex with men (MSM) are disproportionally affected by HIV. Although some theoretical models created to explain why individuals engage in risky sexual behavior contain an affective component, there has been relatively little focus on the influence of affect on sexual risk-taking. The goal of this study is to investigate the association between affect and condom use among MSM using an archival dataset from a survey of users of a popular sex-oriented website. Multilevel modeling was used to analyze daily diary data from 2871 MSM. At the within-person level, positive affect was positively related to condomless anal sex (CAS), whereas negative affect was negatively related to CAS. However, these results were qualified by interactions of trait affect and relationship to sex partner. These findings suggest that interventions focused on emotional regulation may have the potential to reduce CAS among MSM.     

Correlates of Condom-Associated Erection Problems in Young, Heterosexual Men: Condom Fit, Self-Efficacy, Perceptions, and Motivations

Questionnaire data from 479 heterosexual men 18–24 years old were analyzed for correlates of CAEP during application (CAEP-Application) and CAEP during penile-vaginal intercourse (CAEP-PVI). Potential correlates were self-efficacy (condom application, product selection, and maintaining arousal), condom perceptions (condom worry/distraction, negative condom perceptions, concerns about application speed), condom fit, and motivation to use condoms. We conclude that (1) experiencing CAEP may become a repeating cycle, both affecting and being affected by, worry and distraction related to losing erections and maintaining arousal while using a condom (2) poorly fitting condoms may contribute to CAEP, and (3) CAEP may decrease motivation to use condoms.     

Condom Use at Last Sex Among Unmarried Latino Men: An Event Level Analysis

Information about a specific sexual event can shed light on factors that facilitate or impede condom use. Data were collected by a random digit-dialing telephone survey of unmarried Latino adults in 10 states with large Latino populations. In multivariate analyses, among heterosexually active unmarried Latino men (n = 591), those who reported having a condom available, engaging in a conversation about condoms, having a non-steady, casual partner or a one-time partner, were more likely to use condoms. Men were more likely to use condoms when no other birth control was used or pregnancy was not possible than other men. Findings were similar for both low and high acculturated men. Interventions that increase condom availability may be particularly useful for reducing HIV risk among Latino heterosexual men. An erratum to this article can be found at     

Racial Discrimination, Social Support, and Sexual HIV Risk among Black Heterosexual Men

Numerous studies document the adverse impact of racial discrimination on African Americans’ health outcomes, but few have focused on HIV risk. We examined the relationship between racial discrimination and sexual risk in a sample of 526 Black heterosexual men and tested the hypothesis that social support would moderate this relationship. Participants in the predominantly low-income urban sample ranged in age from 18 to 45. High social support had a buffering impact on the relationship between racial discrimination and sexual risk. Among men reporting high racial discrimination, those with more social support reported less sexual risk than men with low social support. Men who reported high racial discrimination and low social support reported more sexual risk than men in any of the other groups. The study highlights social support as an important but understudied protective factor that may reduce sexual risk for Black heterosexual men who report high levels of racial discrimination.     

Condom Use with Serious and Casual Heterosexual Partners: Findings from a Community Venue-Based Survey of Young Adults

Given the racial/ethnic disparities that characterize STI trends and recent increases in heterosexually transmitted HIV infection in the US, an understanding of factors underlying condom use among young adults in minority communities is vitally important. To this end, this paper presents findings from a community venue-based survey examining the influence of motivations, heuristics, and relationship factors on condom behaviors with serious and casual heterosexual partners in a sample of urban African American and Puerto Rican males and females ages 18–25 (n = 380). Condom use rates at time of last sex were considerably higher with casual partners (n = 87) than with serious (n = 313) partners, 77.9% vs. 38.7%. While dual pregnancy/STI prevention was the most frequently cited reason for use at last sex with casual partners, pregnancy prevention was the most frequently cited reason for use with serious partners. Bivariate conditional logistic regression analyses found two factors to be associated with condom use at last sex with casual partners: use at first sex with the partner and belief that neighborhood peers worried some/a lot about HIV. In contrast, such factors as condom heuristics (e.g., nonuse symbolizes trust), contraceptive status, and markers of emotional intimacy were associated with condom use with serious partners in both bivariate and multivariable analyses.     

A Theory-Based Approach to Understanding Condom Errors and Problems Reported by Men Attending an STI Clinic

We employed the information–motivation–behavioral skills (IMB) model to guide an investigation of correlates for correct condom use among 278 adult (18–35 years old) male clients attending a sexually transmitted infection (STI) clinic. An anonymous questionnaire aided by a CD-recording of the questions was administered. Linear Structural Relations Program was used to conduct path analyses of the hypothesized IMB model. Parameter estimates showed that while information did not directly affect behavioral skills, it did have a direct (negative) effect on condom use errors. Motivation had a significant direct (positive) effect on behavioral skills and a significant indirect (positive) effect on condom use errors through behavioral skills. Behavioral skills had a direct (negative) effect on condom use errors. Among men attending a public STI clinic, these findings suggest brief, clinic-based, safer sex programs for men who have sex with women should incorporate activities to convey correct condom use information, instill motivation to use condoms correctly, and directly enhance men’s behavioral skills for correct use of condoms.     

Patterns of Condom Use Among Men Who Have Sex with Men in China: A Systematic Review and Meta-Analysis

HIV is rapidly spreading among men who have sex with men (MSM) in China. We estimate and compare rates of condom use among MSM in different regions of China through a systematic literature review. Meta-analyses were conducted over a final set of 66 studies to estimate national and regional condom use rates among MSM with different types of male sex partners. Country-wide, there has been a modest increase in reported condom use at last sex among MSM, from 56.1% (95% CI: 53.4–58.7%) in 2003–2005 to 61.6% (95% CI: 58.4–64.8%) in 2006–2008. Consistent condom use has also increased, from 32.5% (95% CI: 28.6–36.7%) in 2003–2005 to 36.3% (95% CI: 33.7–38.9%) in 2006–2008. Condom use was greatest and increasing among commercial sex partners, from 49.8 to 75.2% at last anal sex. Further condom promotion is still required to reduce the incidence of HIV infection among MSM in China.     

Open, Closed, or In Between: Relationship Configuration and Condom Use Among Men Who Use the Internet to Seek Sex with Men

Nearly 70 % of HIV+ men who have sex with men (MSM) are estimated to have contracted HIV from a main partner. We examine whether condom use varies by relationship configuration, including open relationships with and without cheating. 656 MSM in committed relationships were recruited through a sexually explicit social networking website. Of the 55 % of MSM who had anal sex with a non-main partner in the past 90 days, two-thirds did not use a condom. Adjusting for covariates, MSM in relationships characterized as open with cheating versus monogamous were more likely to have unprotected anal sex with both main and non-main partners. MSM who perceived that their partner played around or cheated were more likely to have unprotected anal sex with a non-main partner. Prevention messages should attempt to reduce cheating and increase personal responsibility for protecting partners from HIV. Messages should be tailored to reflect open and monogamous relationships.     

Patterns of HIV Disclosure and Condom Use Among HIV-Infected Young Racial/Ethnic Minority Men Who Have Sex with Men

Recent findings highlight the continued rise in cases of HIV infection among racial/ethnic minority young men who have sex with men (YMSM). In adults, disclosure of HIV status has been associated with decreased sexual risk behaviors but this has not been explored among YMSM. In this study of 362 HIV-infected racial/ethnic minority YMSM, rates of disclosure were high, with almost all disclosing their status to at least one person at baseline. The majority had disclosed to a family member, with higher disclosure rates to female relatives compared with males. After adjustment for site, disclosure to sex partners and boyfriends was associated with an increase in condom use during both oral and anal sex. Future studies should consider skills training to assist youth in the disclosure process, facilitate how to determine who in their family and friend social network can be safely disclosed to and support family-based interventions.     

暗娼和嫖客避孕套使用情况调查

目的 评价暗娼和嫖客避孕套使用状况。方法 采用整群随机抽样方法对124名暗娼和155名螵客的避孕套相关知识和使用情况进行调查。结果 暗娼避孕套相关知识水平低于螵客,暗娼和嫖客每次都使用避孕套的比例分别为71.0％和47.1％。暗娼不使用避孕套的主要原因是“对方不喜欢”,螵客不使用避孕套的原因是“不使用避孕套无害”和“不舒服”。结论 推广使用避孕套的阻力主要来自嫖客。对固定性伴的“信任”是影响避孕套使用频率的主要原因。推广使用避孕套预防艾滋病的宣传教育和干预除在暗娼中进行外,还应以嫖客为重点对象。     

A Randomized Controlled Trial to Evaluate the Relative Efficacy of Enhanced Versus Standard Voluntary Counseling and Testing on Promoting Condom Use among Men Who Have Sex with Men in China

The randomized controlled trial investigated the relative efficacy of an enhanced (EVCT) versus standard (SVCT) voluntary counseling and testing in reducing unprotected anal intercourse (UAI) among men who have sex with men (MSM) in China. 295 participants who recruited by respondent driven sampling methods were randomly allocated to the two arms. In addition to the SVCT, the EVCT group watched a theory-based video narrated by a HIV positive MSM, received enhanced counseling and a reminder gift. As compared to the SVCT group, the EVCT group reported lower prevalence of UAI with any male sex partners (48.4% versus 66.7%, RR = 0.7, ARR = -18.3%, p = 0.010) and with regular male sex partners (52.2% versus 68.9%, RR = 0.8, ARR = -16.7%, p = 0.043) at Month 6, whilst baseline between-group differences were statistically non-significant. Between-group differences in HIV/syphilis incidence were statistically non-significant. Translational research should be conducted to integrate non-intensive enhancements such as the EVCT into regular testing services.     

Condom use among homosexual men

A postal questionnaire survey of 262 homosexual men was carried out to investigate patterns of sexual behaviour and the use of condoms. Two hundred and twenty-nine of these subjects had been sexually active during the past year, with the mean number of male sexual partners being 8.09. One hundred and eighty men engaged in oral sex, and 117 ejaculated during this activity, of whom 103 (88%) did not use a condom. One hundred and sixteen men had engaged in insertive anal intercourse in the past year, and 102 had ejaculated during this activity. Of these, 32 did not use a condom. Some, however, only engaged in this activity within a monogamous relationship. The overall proportion of men who continued to engage in very high-risk sexual activity was small, however a different picture emerged if the sample was analysed in terms of the number of encounters with different men during the past year. Of the total estimated number of such encounters, almost half involved anal intercourse, and about half of these were unprotected. The reason for the apparent discrepancy is that those who continue to engage in high risk behaviour tend to be particularly sexually active.     

Alcohol Use and Risk of HIV infection among Men Who Have Sex with Men

In the United States, men who have sex with men (MSM) currently represent more than 50% of those living with HIV and over 70% of HIV+ men (CDC 2007, ). Male-to-male sexual contact has been identified as the predominant route of transmission among this sub-group, which underscores the need for research that targets risk factors associated with risky sex-related HIV acquisition. Along these lines, research has shown that one potentially important predictor variable for risky sex among MSM is alcohol use. The major aim of this paper is to review and integrate empirical evidence on the association of alcohol use and risky sex among MSM. A summary of the quantitative research is provided first, followed by a critique of the reviewed literature, a discussion of the consistency of the existing empirical evidence with predictions of current theories, and finally, recommendations for future research designed to evaluate alcohol-related sexual risk in MSM.