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Research has shown the heightened risk for sexually transmitted infections (STIs), sexual risk behavior, and substance use in sexual and gender minority (SGM) individuals. Further research is necessary to understand understudied sexual risk behaviors in a sample of casual substance users as the implications of substance use are not just experienced by individuals with substance use disorders. Many emerging adults (ages 18-29) experiment with substance use during the transition from adolescence to adulthood and the relationship with sexual risk behaviors are important to understand in this population. Data were collected online through Prolific from 75 participants between the ages of 18-29 who identified as being a SGM. Participants completed a survey in March 2020 indicating their substance use. In November 2021, participants indicated their risky sexual behaviors. A path analysis indicated that cannabis use at Time 1 was significantly associated with greater oral sex without a condom or dental dam, sex under the influence of alcohol and other substances at Time 2. Cocaine use at Time 1 was significantly associated with increased sex under the influence of alcohol and sex with a stranger. Results illustrate long-term implications of casual substance use in SGM populations and highlights understudied sexual risk behaviors. [ABSTRACT FROM AUTHOR]

African American men who have sex with men (MSM) are disproportionately impacted by HIV and may benefit from the development of an HIV vaccine. African American MSM are adversely affected by discrimination as a function of both their race and sexual behaviors. This may further increase the challenges associated with persuading them to adopt an HIV vaccine. Developing a knowledge base characterizing African American MSM HIV vaccine perceptions, attitudes, and concerns may help strengthen how healthcare providers and other health stakeholders describe and discuss the advent of an HIV vaccine. This study assessed the knowledge, attitudes, beliefs, and intentions related to HIV vaccination among African American MSM. This study comprised 432 African American MSM, 18–64 years, residing in the United States. Vaccine intention was defined as how likely it is that an individual would adopt an HIV vaccine if a vaccine was available and it was 90% effective against HIV, easy to obtain, free, and had few side effects. Relative to African American MSM who intend to delay receiving an HIV vaccination, controlling for age, education, and income, early vaccine adopters who had received ≥ 2 COVID-19 vaccinations and who had high WHO HIV Vaccine Positive Attitude Scale scores were, respectively, 3.2 times and 2.4 times more likely to report the intention to vaccinate within one year. Early vaccine adopters were also 2.4 times more likely to feel that HIV prevention support discriminates against African American MSM. Those reporting three or more sexual partners and medical mistrust were, respectively, 60% and 59% more likely to report the intention to delay HIV vaccination. The lack of a knowledge base on HIV vaccine perceptions and acceptability is a missed opportunity to provide guidance on how stakeholders, such as health providers and policymakers, should address HIV vaccine hesitancy once this crucial vaccine is licensed. The key factors affecting vaccine adoption are valuable in developing and implementing campaigns to enhance the HIV vaccine coverage in this vulnerable population. [ABSTRACT FROM AUTHOR]

Introduction: Sexual minorities may experience sexual orientation-based discrimination in healthcare settings, and recent literature has aimed to explore this phenomenon. However, the findings of related literature and their implications have never been reviewed. Methods: A scoping review was conducted to identify the breadth of this literature, summarize findings, and appraise the tools being used to study perceived discrimination in healthcare. PubMed and Web of Science databases were searched for relevant literature published between 1992 and 2022. After duplicates were removed, the search yielded 3,467 results. After removing articles that did not meet inclusion criteria, fifty-eight papers remained and were assessed via full-text review for eligibility. Ultimately, twenty studies were determined to meet study criteria and were included in the present review. Results: Articles published on sexual orientation-based perceived discrimination in US healthcare settings are fairly limited and vary in approach. Measures being used vary widely across studies and generally lack psychometric grounding; common issues include using single-item measures, adapting existing measures without validating them for use in sexual minority samples, and using measures that are not based in underlying theory or informed by existing research. Perceived discrimination in healthcare was inversely associated with some healthcare utilization behaviors. Conclusions: Future research should use psychometrically evaluated instruments for studying perceived discrimination in healthcare due to sexual orientation. Policy Implications: Culturally competent policies that promote equitable care for sexual minorities are crucial for reducing discrimination in healthcare. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Expanding PrEP access necessitates training that supports healthcare providers' progression along the PrEP implementation cascade, moving from PrEP awareness to prescription. We surveyed 359 USA providers about PrEP training content and format recommendations. We examined the association between cascade location and training recommendations. Most providers were aware of PrEP (100%), willing to prescribe PrEP (97.2%), had discussed PrEP with patients (92.2%), and had prescribed PrEP (79.9%). Latent class regression analysis revealed that cascade location was associated with training recommendations. Although all providers recommended PrEP-specific content (e.g., patient eligibility), providers who were located further along the cascade also recommended more comprehensive content, including sexual history-taking and sexual and gender minority competence training. Providers further along the cascade were also more likely to recommend interactive training formats (e.g., role-playing). These insights from providers furthest along the cascade indicate the importance of including comprehensive content and interactive formats in future PrEP training initiatives. [ABSTRACT FROM AUTHOR]

Despite being grouped together in epidemiological risk categories, gay, bisexual, and other men who have sex with men (GBM) are not a homogenous group. In addition to traditional segmentation along race, ethnicity, and socioeconomic status, many GBM also identify with sexual subcultural communities. Previous research has shown differences across a variety of health outcomes between these sexual subcultural communities. The purpose of this study was to determine whether HIV prevention practices among GBM differed according to sexual subcultural community. The study was conducted in collaboration with a popular social and sexual networking smartphone application company. A total of 23,577 GBM responded to the survey. A latent class analysis identified 6 distinct classes related to sexual subcultural community identification. We found significant differences across sociodemographic characteristics, HIV prevention practices, and condomless anal sex in the past 6 months related to sexual subculture identification. Findings suggest that sexual subcultural identity is related to decision-making around HIV prevention among GBM. Differences in HIV prevention strategies are likely a function of group norms, unique shared experiences among GBM identifying with a particular sexual subculture community, and sociodemographic characteristics associated with these groups. As such, sexual subculture identity should be considered in developing interventions and social marketing campaigns to increase uptake of biomedical HIV prevention tools among GBM. Identifying group norms and shared experiences related to HIV prevention practices among sexual subcultures is necessary to understand the role these identities play in lives of GBM, especially as it relates to their sexual health and well-being. [ABSTRACT FROM AUTHOR]

Research has focused on adolescents' feelings about their first sexual experiences, but little research has examined this topic in sexual minority adolescents. In this study, we examined how experiencing emotional and physical satisfaction at first same-sex anal sex differed by age of first sex for young gay and bisexual men. We applied the time-varying effect model to data from an Internet survey of men who initiated first sex between ages 14–26 (n = 6401) to examine emotional and physical satisfaction at first same-sex anal sex across continuous age of onset and by partner factors. The majority of men reported satisfaction across all ages; however, satisfaction was generally less likely for men who had first anal sex with a non-relationship partner, an older partner, or a partner they had sex with only once and this was particularly true at earlier ages. Findings suggest that many young gay and bisexual men report satisfaction with their first anal sex and that relationship context can be important in predicting satisfaction, particularly at younger ages. [ABSTRACT FROM AUTHOR]

This study quantitatively explored racial preferencing behavior among American and Australian men on Jack’d, a gay dating app. Self-reported racial preferences found on users’ written profiles were compared with behavioral racial preferences accessed through the app’s “insight” feature, representing users’ actual behaviors. Data of 705 users from Los Angeles and 463 users from Sydney were collected. Findings show that while inclusionary racial preferencing was more prevalent than exclusionary racial preferencing, expressions of racial preference on profiles were uncommon overall. Looking at the behavioral data, the study reveals that Asian men were the most preferred mates among Asian and White users in both cities, whereas Black men were the most preferred among Black and Hispanic users in Los Angeles. Together, these findings suggest that some forms of racial hierarchies still operate in terms of actual behaviors on Jack'd. We argue that these findings have implications for the ways that gay dating apps approach the challenges of developing inclusive services. [ABSTRACT FROM AUTHOR]

Among HIV-uninfected, social media-using black, Hispanic, and white young men who have sex with men (YMSM) who had condomless anal sex but had not been HIV tested within the past year, we aimed to determine the extent of discordance between perception of having an undiagnosed HIV infection and HIV risk-taking behaviors. Despite reporting condomless anal sex without HIV testing, 64% of 358 YMSM participants perceived having an undiagnosed HIV infection as "unlikely" and 12% as "impossible." Having a primary care provider and being Hispanic were associated with greater discordance. Interventions to decrease the discordance between perceived and actual HIV risk are needed for this higher HIV risk population. [ABSTRACT FROM AUTHOR]

Recent research has documented the importance of understanding the multidimensional nature of sexual risk behavior. However, little is known about patterns of sexual behavior among men who have sex with men (MSM) in Mexico, men who are at greatest risk for HIV and sexually transmitted infections compared to other subpopulations in the country. This study applied latent class analysis to data from a large, HIV-negative sample of 18- to 25-year-old Mexican MSM recruited from a social and sexual networking website (N = 3,722) to uncover multidimensional patterns of sexual behaviors, partner factors, and protective behaviors, and examine how these were associated with health and well-being correlates. We selected a model with seven classes. The most common class included those who reported both insertive and receptive behaviors with more than one partner, but smaller groups of individuals were in classes marked by only insertive or receptive anal sex, romantic relationships, or sexual inactivity. Class membership differed by sexual orientation, age, depressive symptoms, alcohol problems, and self-acceptance, with individuals in a class marked by same-sex relationships generally reporting more positive outcomes. Findings suggest heterogeneity of behaviors among Mexican MSM and the possible efficacy of prevention messages tailored to individuals' specific patterns of sexual behavior. [ABSTRACT FROM AUTHOR]

Cisgender men (CM) who report transgender women (TW) as sexual partners are an understudied population in the HIV epidemic in Latin America. The current study sought to characterize this group in a 2012 cross-sectional online survey of Latin American CM who were members of a sexual networking website for men who have sex with men (N = 11,847). Multivariable logistic regression models were fit to estimate demographic, behavioral, and psychosocial correlates of having a TW sexual partner and engaging in condomless sex. Overall, 0.9% (n = 106) reported a TW sexual partner in the last 12 months; of these, 76.4% (n = 81) reported condomless sex in the last three months. Identifying as bisexual or heterosexual compared to gay, and specifying a versatile sexual role preference compared to insertive were associated with reporting a recent TW sex partner (all p < 0.05). HIV-negative serostatus, lifetime STI history, and alcohol dependence were associated with recent condomless sex (all p < 0.05). CM with TW sexual partners have distinct HIV-related vulnerabilities. Future research is needed to understand CM who report TW sexual partners, including their sexual preferences and practices, sexual networks, exposure to stigma, biomedical prevention interest and uptake, and acceptability of integrating alcohol abuse screening into sexual health services. [ABSTRACT FROM AUTHOR]

Cisgender men (CM) who report transgender women (TW) as sexual partners are an understudied population in the HIV epidemic in Latin America. The current study sought to characterize this group in a 2012 cross-sectional online survey of Latin American CM who were members of a sexual networking website for men who have sex with men (N = 11,847). Multivariable logistic regression models were fit to estimate demographic, behavioral, and psychosocial correlates of having a TW sexual partner and engaging in condomless sex. Overall, 0.9% (n = 106) reported a TW sexual partner in the last 12 months; of these, 76.4% (n = 81) reported condomless sex in the last three months. Identifying as bisexual or heterosexual compared to gay, and specifying a versatile sexual role preference compared to insertive were associated with reporting a recent TW sex partner (all p < 0.05). HIV-negative serostatus, lifetime STI history, and alcohol dependence were associated with recent condomless sex (all p < 0.05). CM with TW sexual partners have distinct HIV-related vulnerabilities. Future research is needed to understand CM who report TW sexual partners, including their sexual preferences and practices, sexual networks, exposure to stigma, biomedical prevention interest and uptake, and acceptability of integrating alcohol abuse screening into sexual health services. [ABSTRACT FROM AUTHOR]

Objectives: In the United States, all men who have sex with men (MSM) were banned from donating blood from 1985 through 2015. In 2016, the guideline was amended such that men who had sexual contact with other men within the previous 12 months could not donate blood. We aimed to identify blood donation practices and their relationship with HIV risk and testing among young adult MSM (YMSM) at risk for having HIV. Methods: In 2014, we recruited HIV-negative non-Hispanic black, Hispanic, and non-Hispanic white YMSM aged 18-24 from across the United States through social media platforms to complete an online survey. Among these YMSM who previously donated blood, we conducted a secondary analysis examining the relationship between having donated blood within the past 12 months and sexual risk behavior from recent condomless anal intercourse (CAI), HIV testing, and self-perceived risk of having an undiagnosed HIV infection. Results: Of the 2261 YMSM surveyed, 1104 (48.8%) had ever previously donated blood and 305 (13.5%) had donated blood within the past 12 months. Of the 305 blood donors, 50 (16.4%) had ever had CAI before their most recent blood donation. Among YMSM who donated blood, past–12-month blood donation was more likely among YMSM who never had CAI (adjusted odds ratio [aOR] = 1.84; 95% confidence interval [CI], 1.24-2.73) than among YMSM who had CAI and more likely among YMSM who believed it was not possible at all that they had an undiagnosed HIV infection (aOR = 1.57; 95% CI, 1.14-2.16) than among YMSM who believed there was any possibility of having an undiagnosed HIV infection; it was not related to past–12-month HIV testing. Conclusions: YMSM donated blood frequently, suggesting that the deferral process in place did not prevent YMSM from donating blood. The current donor screening process should be reconsidered if it is to prevent YMSM from donating blood. Future research could identify screening questions that permit YMSM with a low risk of HIV infection to donate blood while maintaining the safety of the blood supply. [ABSTRACT FROM AUTHOR]

In Latin America (LA), HIV prevalence among MSM is estimated at thirty times greater than in the general male population. Little is known about the role of social support or disclosure status in relation to the HIV care continuum among LA MSM. Using multivariable logistic generalized estimation equations, we assessed the impact of social support satisfaction and disclosure status on engagement in HIV care, ART initiation, and ART adherence with data from an online, multinational sample of HIV infected MSM in Latin America (N = 2,350). 80.0% were engaged in HIV care, 71% initiated ART, and among those, 37% reported missing at least one dose in the past month. In multivariable models, compared to being very satisfied with social support, being somewhat satisfied (aOR = 0.73, 95% CI 0.56, 0.95) or somewhat dissatisfied (aOR = 0.83, 95% CI 0.70, 0.98) were associated with reduced odds of reporting 100% ART adherence. Disclosure of status was associated with a greater odds of HIV care engagement (OR = 1.63, 95% CI 1.28, 2.07) and ART initiation (OR = 1.55, 95% CI 1.30, 1.84). Greater satisfaction with social support and comfort disclosing HIV status to these sources were associated with improved engagement in HIV care and greater initiation of ART among MSM in LA. [ABSTRACT FROM AUTHOR]

Discordance between self-perceived HIV risk and actual risk-taking may impede efforts to promote HIV testing among young adult men-who-have-sex-with-men (YMSM) in the United States (US). Understanding the extent of, and reasons for, the discordance of HIV risk self-perception, HIV risk-taking and voluntary HIV testing among black, Hispanic and white YMSM could aid in the development of interventions to increase HIV testing among this higher HIV risk population. HIV-uninfected 18–24-year-old black, Hispanic, and white YMSM were recruited from across the US through multiple social media websites. Participants were queried about their voluntary HIV testing history, perception of currently having an undiagnosed HIV infection, and condomless anal intercourse (CAI) history. We assessed the association between previous CAI and self-perceived possibility of currently having an HIV infection by HIV testing status using Cochran-Mantel-Haenszel testing. Of 2275 black, Hispanic and white social media-using 18–24 year-old YMSM, 21% had never been tested for HIV voluntarily, 87% ever had CAI with another man, 77% believed that it was perhaps possible (as opposed to not possible at all) they currently could have an undiagnosed HIV infection, and 3% who reported CAI with casual or exchange partners, but had not been tested for HIV, self-perceived having no possibility of being HIV infected. Of 471 YMSM who had not been HIV tested, 57% reported CAI with casual or exchange partners, yet self-perceived having no possibility of being HIV infected. Per the Cochran-Mantel-Haenszel test results, among those reporting HIV risk behaviors, the self-perception of possibly being HIV-infected was not greater among those who had never been tested for HIV, as compared to those who had been tested. Future interventions should emphasize promoting self-realization of HIV risk and translating that into seeking and accepting voluntary HIV testing among this higher HIV risk population. [ABSTRACT FROM PUBLISHER]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Young adult men-who-have-sex-with-men (YMSM) continue to have among the highest incidence of HIV infection in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe method of preventing HIV infection; however, despite US Food and Drug Administration approval, utilization remains low, in part, due to structural barriers, particularly access to healthcare. In this study, we used social media to recruit black, Hispanic, and white HIV-uninfected 18- to 24-year-old YMSM. Participants completed an online survey about their sexual behavior, healthcare access, and previous use of PrEP. Of the 2297 YMSM surveyed, only 3.4% had used PrEP. PrEP use was associated with higher levels of education, living alone, older age, higher levels of sexual activity, and greater healthcare access, specifically having healthcare insurance and a clinic or primary care provider (PCP) from whom they received care. Among PrEP nonusers, 65% met at least one of the US Centers for Disease Control and Prevention recommended indications for PrEP use, and of these, 59% had healthcare insurance and received care in a clinic and/or had a PCP. Multi-variable multi-nomial logistic regression modeling identified disparities in access to healthcare by age, race/ethnicity, education, and region. Specifically, older YMSM, blacks and Hispanics, those with fewer years of formal education, and residents of the southern and the western United States were more likely to lack healthcare access. These results demonstrate both potential opportunities and barriers to the scale-up of PrEP among YMSM. [ABSTRACT FROM AUTHOR]

The Internet is a commonly used medium for recruiting geographically dispersed, smaller populations quickly, such as young adult men-who-have-sex-with-men (YMSM). One approach to improve reach and representativeness is to employ multiple Internet platforms to recruit this hard-to-reach population. The utility of this approach has not been studied adequately, and its impact on the study sample recruited is not yet known. Using data from a study of 18- to 24-year-old HIV-uninfected, Black, Hispanic, and White United States (US) YMSM, this investigation compared advertising and enrollment metrics and participant characteristics of those recruited across Internet platforms. Of the 2,444 participants, their median age was 22 years old; 21% were Black, 37% Hispanic, and 42% White; 90% had been tested for HIV at least once in their life; and 87% reported prior condomless anal intercourse (CAI) with another man. There were noticeable differences across platforms in the number of people accessing the study website, meeting study eligibility requirements, consenting to participate, consenting to participate per day of advertising and per click, as well as costs of advertising per consented participant. Participants recruited also varied across platform by race/ethnicity, geographic area of residence in the US, health-care insurance status, years of formal education, history of HIV testing, and CAI by partner type and sexual positioning. The investigation results indicate that the Internet platforms used for recruitment significantly impact not only enrollment but also diversity and characteristics of the sample obtained and consequently, the observations and conclusions rendered. [ABSTRACT FROM AUTHOR]

This research investigates the sexuality of trans women (individuals who were assigned male status at birth who currently identify as women), by focusing on the "bodily techniques" (Crossley, 2006) they use in "doing" sexuality. The "doing sexuality" framework not only is modeled after the "doing gender" approach of West and Zimmerman (1987), but also utilizes the idea of "sexual embodiment" to emphasize the agency of trans women as they conceptualize and organize their sexuality in a socially recognized way. This is often difficult as they confront discrimination from medical and legal professionals as well as intimate partners who may find it difficult to adapt to the trans woman's atypical body and conception of gender. However, with a study group of 25 trans women from San Francisco, we found the study participants to be adept at overcoming such hurdles and developing techniques to "do" their sexuality. At the same time, we found trans women's agency constrained by the erotic habitus (Green, 2008) of the wider society. The interplay between innovation and cultural tradition provides an opportunity to fashion a more general model of "doing" sexuality. [ABSTRACT FROM AUTHOR]

In Venezuela, members of a social and sexual partner networking site for men who have sex with men (MSM) completed an online survey regarding sexual behaviours and HIV medical care. Among the 2851 respondents, self-reported HIV prevalence was 6.6%. Of participants living with HIV, 73.2% reported taking antiretroviral medication and 56.6% reported complete adherence within the past month. Participants living with HIV were more likely to be older (aOR = 1.04 per one-year increase in age, 95% CI: 1.02, 1.06) and diagnosed with a sexually transmitted infection in the previous year (aOR 3.26, 95% CI: 2.11, 5.04). These data provide further understanding of the HIV epidemic among MSM in Venezuela, and potential targets for HIV prevention interventions. [ABSTRACT FROM AUTHOR]

A sizable minority of women report lifetime sexual behavior with both men and women. In the present study, a multinational sample of women who reported genital contact with at least one man and one woman in their lifetime (N = 2,751) were asked to provide their behavioral definitions of “having sex with a woman” and “having sex with a man.” Replicating previous research, participants were asked “Would you say you ‘had sex’ with a woman/man if the most intimate behavior you engaged in with her/him was …” followed by a list of behaviors that differed based on the hypothetical partner gender. While most participants indicated that they would consider “having had sex” if they engaged in a variety of behaviors, behaviors involving genital contact were most often included within the participants’ definitions of having sex, regardless of partner gender. The percentage of behaviors included in the participants’ definitions of having sex with a woman (M = 59.40%,SD = 20.77%) was higher than the percentage of behaviors included in their definition of having sex with a man (M = 37.26%,SD = 28.97%). Broadening our understanding of “having sex” for individuals with diverse sexual experiences may have important implications for clinicians and researchers. [ABSTRACT FROM PUBLISHER]

Unlabelled: Background Relationship characteristics and day-to-day variation in affective state have been associated with HIV risk behaviour. However, no research has assessed the impact of these factors on event-level condom use among women engaging in transactional sex.Methods: Twenty-six women engaging in transactional sex were enrolled in a prospective study of their sexual health. They completed diaries about multi-level predictors of condom use during vaginal sex twice, daily.Results: Over 4 weeks, 18 participants reported 87 paid/traded vaginal intercourse events. Of these, 51.7% were condom protected. The majority of paid/traded events (81.5%) occurred with a non-romantic partner. After controlling for partner type, feeling in love on a given day was associated with higher odds of condom use during paid/traded sexual events, while having sex on the weekend and at night were associated with lower odds of condom use (all P≤0.05). There was a significant interaction between being in love and using condoms during transactional sex (P<0.01). In paid/traded sexual events with romantic partners, the frequency of condom use was 71.4% (5/7) when women did not report love and 40% (4/10) when love was reported. In sexual events with non-romantic partners, the frequency of condom use was 43.8% (14/32) when women did not report love and 59.5% (22/37) when love was reported.Conclusions: Women were less likely to report protected sex with romantic partners and more likely to report protected sex with non-romantic partners when they are in love. Interventions focusing on the link between day-to-day variation in affective state on condom use may help women with risk management across partner types. [ABSTRACT FROM AUTHOR]

Latin America has some of the highest levels of antiretroviral therapy (ART) coverage of any developing region in the world. Early initiation and optimal adherence to ART are necessary for improved health outcomes and reduction in onward transmission. Previous work has demonstrated the role of psychosocial problems as barriers to uptake and adherence to ART, and recently, a syndemic framework has been applied to the role of multiple psychosocial syndemic factors and adherence to ART, in the USA. However, to our knowledge, these associations have not been investigated outside of the USA, nor in a multi-country context. To address these gaps, we assessed the association between multiple co-occurring psychosocial factors and engagement in HIV-related medical care and adherence to ART among a large, multinational sample of sexually-active HIV-infected men who have sex with men in Latin America. Among the 2020 respondents, 80.7% reported currently receiving HIV-related medical care, 72.3% reported currently receiving ART; among those, 62.5% reported 100% adherence. Compared with experiencing no psychosocial health problems, experiencing five or more psychosocial health problems is associated with 42% lower odds of currently receiving HIV-related medical care (adjusted odds ratio, aOR = 0.58, 95% CI 0.36, 0.95) and of currently receiving ART (aOR = 0.58, 95% CI 0.38, 0.91). The number of psychosocial health problems experienced was associated with self-reported ART adherence in a dose–response relationship; compared to those with none of the factors, individuals with one syndemic factor had 23% lower odds (aOR = 0.77, 95% CI 0.60, 0.97) and individuals with five or more syndemic factors had 72% lower odds (aOR = 0.28, 95% CI 0.14, 0.55) of reporting being 100% adherent to ART. Addressing co-occurring psychosocial problems as potential barriers to uptake and adherence of ART in Latin America may improve the effectiveness of secondary prevention interventions. [ABSTRACT FROM PUBLISHER]

Research has shown that compared to younger individuals, older adults are at a similar risk for acquiring HIV. Additionally, screenings for HIV/STD tend to be lower among older adults, with this group seeing themselves at less risk for HIV/STD compared to their younger counterparts. Limited information exists concerning older bisexual men outside examining aggregated populations of sexual minority men (e.g., MSM). The purpose of this exploratory study was to examine the sexual health, behaviors, and evaluation of last sexual event among older (≥ 50 years old) compared to younger (< 50 years old) bisexual men. Data were collected in collaboration with a social and sexual networking website catering to men who have sex with men. Findings suggest that older bisexual men continue to be sexually active and that strategies need to be developed to better reach this population regarding HIV/STD prevention and education. [ABSTRACT FROM PUBLISHER]

HIV/AIDS in Latin America is concentrated among men who have sex with men (MSM). However, accurate estimates of engagement in HIV care in this population can be difficult to ascertain because many do not self-identify as MSM. Given evidence of decreased HIV transmissibility in the context of antiretroviral therapy (ART) adherence, identifying individuals not in care who are engaging in HIV transmission risk behavior is crucial for secondary prevention. Primary aims of this study were to examine engagement in care from testing to ART adherence among MSM using online social/sexual networking across Latin America, and whether individuals not in care at each step reported greater sexual transmission risk behavior than those in care. In the overall sample (n= 28,779), approximately 75% reported ever being tested for HIV, and 9% reported having received an HIV diagnosis. Among known HIV-infected individuals, 20% reported not being in care, 30% reported not taking ART, and 55% reported less than 100% ART adherence. Over one-third of HIV-infected individuals reported sexual HIV transmission risk behavior, defined as unprotected anal intercourse (UAI) with a male partner of different/unknown HIV serostatus in the past three months. HIV-infected individuals not engaged in care more often reported UAI compared to those in care (OR = 1.29; 95% CI = 1.01–1.66). Although not statistically significant, HIV-infected individuals not on ART more often reported UAI compared to those on ART (OR = 1.18; 95% CI = 0.94–1.47). Individuals who reported less than 100% ART adherence more often reported UAI compared to individuals with 100% adherence (OR = 1.55; 95% CI = 1.26–1.90). Findings demonstrate that a substantial portion of HIV-infected MSM in Latin America who are likely not virologically suppressed from lack of ART use or adherence report sexual HIV transmission risk. Tailoring secondary HIV prevention for MSM in Latin America who are not in HIV care or adherent to ART may be warranted. [ABSTRACT FROM AUTHOR]

There is a need to understand better the complex interrelationship between the adoption of masculinity during adolescence and the development of early romantic and sexual relationships. The purpose of this study was to describe features of adolescent masculinity and how it is expressed in the contexts of early to middle adolescent males’ romantic and sexual relationships. Thirty-three 14- to 16-year-old males were recruited from an adolescent clinic serving a community with high sexually transmitted infection rates and were asked open-ended questions about their relationships—how they developed, progressed, and ended. Participants described a high degree of relationally oriented beliefs and behaviors related to romantic and sexual relationships, such as a desire for intimacy and trust. The males also described a more limited degree of conventionally masculine beliefs and behaviors. These beliefs and behaviors often coexisted or overlapped. Implications for the clinical care of similar groups of adolescents are described. [ABSTRACT FROM PUBLISHER]

Objectives. We assessed factors associated with engagement in transactional sex among men who have sex with men recruited from one of the largest Internet sites for men seeking social or sexual interactions with other men in Latin America. Methods. We constructed multilevel logistic regression models to analyze factors associated with engagement in transactional sex in 17 Latin American countries in 2012. Results. Of 24 051 respondents, 1732 (7.2%) reported being paid for sexual intercourse in the past 12 months. In a multivariable model, higher country-level unemployment was associated with increased odds of transactional sex (adjusted odds ratio [AOR] = 1.07 per 1% increase in unemployment; 95% confidence interval [CI] = 1.00, 1.13). Individual or interpersonal factors associated with increased odds of engagement in transactional sex included self-reported HIV (AOR = 1.33; 95% CI = 1.04, 1.69) or sexually transmitted infection (AOR = 1.33; 95% CI = 1.11, 1.59), childhood sexual abuse history (AOR = 1.75; 95% CI = 1.48, 2.06), intimate partner violence (past 5 years, AOR = 1.68; 95% CI = 1.45, 1.95), and sexual compulsivity (AOR = 1.77; 95% CI = 1.49, 2.11). Conclusions. Structural-level economic interventions and those that address individual and interpersonal factors may improve HIV prevention efforts among men who have sex with men who engage in transactional sex. (Am J Public Health. 2015;105:e95–e102. doi:10.2105/AJPH.2014.302402) [ABSTRACT FROM AUTHOR]

Haiti is considered the poorest country in the Western Hemisphere. Rural settings are particularly vulnerable to inadequate access to food, clean water, and shelter. Research has shown that chronic malnutrition is one of the underlying problems affecting the overall status and stability of Haiti. In an attempt to understand food security in a rural town in northwest Haiti, a cross-sectional design using an interviewer-administered questionnaire was used to gather information on food availability and general health status. By assessing the food sources in the community, better understandings of the nutritional needs prevalent in this area were assessed. Further research needs to be completed to understand how to effectively implement a sustainable, long-term approach to fight food security issues and subsequent chronic malnutrition. [ABSTRACT FROM AUTHOR]

This article examines the experiences of 25 persons who were assigned female status at birth but do not wish to live as women and take on a masculine or queer gender identity. We employ the concept of 'gendered embodiment' and introduce the concept of 'sexualized embodiment' to highlight what is involved in this process. We ask how experiencing a masculine gender identity is reflexively tied to a trans man's sexuality and the ways in which these two embodiments are tightly, moderately, or loosely coupled. For example, a tight coupling appeared when trans men began to use testosterone and obtained surgery such as breast removal; a moderate coupling was found where gender validation was sought from a sexual partner (with this being related to sexual preference identities as well as the interpretation of vaginal penetration); the loosest coupling of the gender-sexuality embodiments was linked to the liberality of the locale and whether 'queer' identities could be easily adopted. In sum, our research demonstrates the link between gender and sexuality as a result of the body work trans men do and the historical and geographical situations in which they find themselves. [ABSTRACT FROM AUTHOR]

Black men who have sex with men (MSM) living in the U.S. are disproportionately affected by HIV/AIDS. An online survey of sexual behavior was completed by Black, White, Hispanic/Latino, Asian/Pacific Islander, and other-race MSM ( n=11,766) ages 18-87 years. Complete condom use, semen exposure, pre-coital rectal douching (enema use), and lubricant use at last male-partnered sexual event were compared by race, controlling for relevant sociodemographic variables and stratifying by sexual position (receptive, insertive, or both). Across sexual positions, 55-62% of Black MSM reported condom use, 5-8% reported semen exposure, 18-53% reported douching, and 33-43% reported lubricant use. Reported behavioral profiles were not significantly different from other races, except that Black MSM reported greater condom use than White MSM in the insertive position. Although findings argue against disproportionate rates of risk behavior accounting for racial disparities in HIV prevalence, they nonetheless highlight a need for continued behavioral intervention. [ABSTRACT FROM AUTHOR]

Objectives The development of safer sex recommendations for women who have sex with women (WSW) remains challenging given a limited understanding of sexual behaviour between women. The present study was conducted in order to investigate the sexual repertoires of WSW and the safer sex methods they use to reduce the likelihood of sexually transmitted infection acquisition. Methods An online survey targeted towards women with desire, attraction or previous sexual behaviour with women was distributed globally. Women (N=3116) who engaged in at least one sexual act with a woman in the previous year and were currently living in the USA, UK, Canada or Australia were included in the present study. Questions were based upon previously validated items in nationally representative studies. Results Participants indicated a wide diversity of sexual behaviours with the majority of women reporting a history of genital rubbing (99.8%), vaginal fingering (99.2%), genital scissoring (90.8%), cunnilingus (98.8%) and vibrator use (74.1%). Barrier use was reported by a minority (<25%) of the participants. Conclusions The variety of sexual acts reported by the sample points to the need for the development of more contextually appropriate sexual health guidelines for WSW. [ABSTRACT FROM AUTHOR]

Background: In 2010, the iPrEx trial demonstrated that oral antiretroviral pre-exposure prophylaxis (PrEP) reduced the risk of HIV acquisition among high-risk men who have sex with men (MSM). The impact of iPrEx on PrEP knowledge and actual use among at-risk MSM is unknown. Online surveys were conducted to assess PrEP awareness, interest and experience among at-risk MSM before and after iPrEx, and to determine demographic and behavioral factors associated with these measures. Methods and Findings: Cross-sectional, national, internet-based surveys were administered to U.S. based members of the most popular American MSM social networking site 2 months before (n = 398) and 1 month after (n = 4 558) publication of iPrEx results. Comparisons were made between these samples with regards to PrEP knowledge, interest, and experience. Data were collected on demographics, sexual risk, and experience with post-exposure prophylaxis (PEP). Regression analyses were performed to identify factors associated with PrEP awareness, interest, and experience post-iPrEx. Most participants were white, educated, and indicated high-risk sexual behaviors. Awareness of PrEP was limited pre- and postiPrEx (13% vs. 19%), whereas interest levels after being provided with a description of PrEP remained high (76% vs. 79%). PrEP use remained uncommon (0.7% vs. 0.9%). PrEP use was associated with PEP awareness (OR 7.46; CI 1.52-36.6) and PEP experience (OR 34.2; CI 13.3-88.4). PrEP interest was associated with older age (OR 1.01; CI 1.00-1.02), unprotected anal intercourse with ≥1 male partner in the prior 3 months (OR 1.40; CI 1.10-1.77), and perceiving oneself at increased risk for HIV acquisition (OR 1.20; CI 1.13-1.27). Conclusions: Among MSM engaged in online networking, awareness of PrEP was limited 1 month after the iPrEx data were released. Utilization was low, although some MSM who reported high-risk behaviors were interested in using PrEP. Studies are needed to understand barriers to PrEP utilization by at-risk MSM. [ABSTRACT FROM AUTHOR]

Introduction. Transactional sex has been associated with increased risk of adverse health outcomes, including sexually transmitted infections (STIs). Methods. Participants included female sex workers and men they recruited utilizing incentivized snowball sampling. Participants provided specimens for STI diagnostic testing and completed a semi-structured interview. Results. Forty-four participants aged 19DS65 were interviewed. Participants found self-sampling to be acceptable and overwhelmingly endorsed sampling outside of a clinic (90%) for reasons such as convenience, privacy, and lack of stigma. A substantial minority (38%) tested positive for at least one STI. Conclusion. Novel strategies may encourage sexual health care and prevent STIs among sex workers. High infection and screening acceptance rates across the sample suggests that individuals engaged in transactional sex would benefit from, and would be responsive to, community-based self-sampling for STI screening. [ABSTRACT FROM AUTHOR]

Little is known about men's potential motivations and barriers associated with specific sexually transmitted infections (STI) testing methods. In this study, we examined experiences of self-sampling for ano-rectal STI among men who have sex with men (MSM) in a midwestern community in the U.S. A total of 75 MSM were recruited from community venues throughout Indianapolis, Indiana. Participants completed semi-structured interviews, were asked to obtain ano-rectal self-sample in a private restroom, and were asked open-ended questions about their experiences with ano-rectal self-sampling for STI. Participants included 35 White, 27 Black, and 13 Latino MSM who ranged in age from 18 to 57 years. Regardless of sexual practices, most participants who obtained an ano-rectal self-sample (68/75) reported that the sampling procedure was relatively painless and physically easy. However, regardless of previous receptive anal sex, participants also expressed concerns about the nature of the test (i.e., inserting something into their rectum), which required increased levels of privacy and cleanliness compared to collection of urine samples. Self-sampling proved to be a feasible and acceptable method of collecting ano-rectal STI specimens among MSM. Increased testing for ano-rectal STI among MSM may require addressing the location of sampling and testing sites, existing negative perceptions of ano-rectal self-sampling, and the measures in place to promote privacy and cleanliness. [ABSTRACT FROM AUTHOR]

Public health messaging encourages men who have sex with men (MSM) to be tested for sexually transmitted infections (STI) and HIV at least yearly, and more frequently depending on sexual behaviors. However, despite engaging in a range of sexual behaviors, many MSM do not participate in regular STI testing. The objective of this study was to understand factors associated with STI testing among a nonclinic-based population of men accessing an Internet-based social and sexual networking site. We asked 25,736 men to complete a comprehensive behavioral and health assessment after being recruited from an Internet site popular among men seeking social or sexual interactions with other men. Analyses were performed using multivariate logistic regression with effects significant at p < 0.05. Two separate predictive models were assessed: STI diagnosis within the past 2 years and STI testing within the past year. Regarding previous STI diagnosis, men who used a condom some of the time or never during both insertive (odds ratio [OR] = 1.72) and receptive (OR = 1.41) anal sex were significantly more likely to have had an STI in the past 2 years. For STI testing, men who never used condoms during receptive anal sex were more likely to have had an STI test within the past year (OR = 1.31), but men who had a STI history were less likely to have been tested (OR = 0.24). Public health efforts directed toward MSM should continue to emphasize screening for STI other than HIV, particularly among those men prioritized during condom promotion campaigns. In addition to the benefits of learning one's STI status, the STI screening and treatment environment itself may provide an important venue for encouraging a range of sexual health promoting behaviors. [ABSTRACT FROM AUTHOR]

Sexual compulsivity has been associated with higher frequencies of sexual behaviors that may increase risk for transmission of HIV and other sexually transmitted infections (STI). In a rural midwestern region where social and community resources for the sexual health of men who have sex with men (MSM) are relatively few, the patterns of partner-seeking and sexual behavior, and their relations to sexual compulsivity, may be different than findings from other assessments of men in urban centers. Using a community-based participatory approach (CBPR), data were collected from 309 men who were primarily white, identified as gay or homosexual, and had a mean age of 29.37 years (SD = 11.33), to explore relations between scores on a measure of sexual compulsivity and their sexual partner-seeking, drug and alcohol use, and sexual behaviors with men and women. The majority of men reported having engaged in sexual activity with men in the past 30 days. Those scoring higher than the sample mean (1.65 [SD = 0.66]) on the sexual compulsivity measure reported patterns of having sex with partners met online and having been the insertive or receptive partner in unprotected anal intercourse. Given the unique patterns of sexual partner-seeking in this area, interventions to decrease sexual risk-taking should take into account that the vast majority of men in rural areas are using the Internet to locate sexual partners, and prevention messages focused on rural contexts need to be tailored to include men who have a propensity for sexually compulsive behaviors. Additionally, interventions created for virtual spaces may be more sustainable with rural communities than traditional approaches to HIV/STI prevention. [ABSTRACT FROM AUTHOR]

Circumcision's potential link to HIV/sexually transmitted infections (STI) has been at the center of recent global public health debates. However, data related to circumcision and sexual health remain limited, with most research focused on heterosexual men. This study sought to assess behavioral differences among a large sample of circumcised and noncircumcised men who have sex with men (MSM) in the United States. Data were collected from 26,257 U.S. MSM through an online survey. Measures included circumcision status, health indicators, HIV/STI screening and diagnosis, sexual behaviors, and condom use. Bivariate and regression analyses were conducted to determine differences between HIV/STI status, sexual behaviors, and condom use among circumcised and noncircumcised men. Circumcision status did not significantly predict HIV testing ( p > 0.05), or HIV serostatus ( p > 0.05), and there were no significant differences based on circumcision status for most STI diagnosis [syphilis, gonorrhea, chlamydia, human papilloma virus (HPV)]. Being noncircumcised was predictive of herpes-2 diagnosis, however, condom use mediated this relationship. These data provide one of the first large national assessments of circumcision among MSM. While being noncircumcised did not increase the likelihood of HIV and most STI infections, results indicated that circumcision was associated with higher rates of condom use, suggesting that those who promote condoms among MSM may need to better understand condom-related behaviors and attitudes among noncircumcised men to enhance the extent to which they are willing to use condoms consistently. [ABSTRACT FROM AUTHOR]

The article discusses the reasons why parents allowed their adolescent children to participate in longitudinal behavioral research on sexually transmitted infections (STI). Over half of the 134 participants cited benefits that include STI testing, positive interactions and sex education. The adolescents were asked to have an annual physical exam, participate in face-to-face interviews and keep 3-month diaries. The study also showed that parents who perceive that the adolescent is at risk are more likely to consent to their participation in STI research.

The article discusses the Internet as a valuable tool for promoting a new framework for sexual health among gay men and other men who have sex with men (MSM). The fundamental elements involved in a sexual health framework that promotes the overall well-being of MSM while reducing human immunodeficiency virus (HIV) incidence are described, including an assets-based approach to research and programs that focus on resilience in the individual and the community. The need for collaborative partnerships to reach MSM who frequent the Internet is discussed.