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Awareness of and discussions with a healthcare provider (HCP) around pre-exposure prophylaxis (PrEP), an effective HIV prevention method, are associated with PrEP uptake, yet few studies utilize representative samples or report on these outcomes using distinct behavioral risk subgroups. This cross-sectional study utilized responses given by men on the 2017–2019 National Survey of Family Growth, a nationally representative survey of Americans aged 15–49 years. Multiple logistic regression models were used to determine how respondents' sociodemographic characteristics and HIV risk behaviors were related to PrEP awareness and HCP discussions. PrEP awareness was low (29.40%) as was the proportion who reported ever discussing PrEP with an HCP (4.48%). Odds of being PrEP aware and discussing PrEP with an HCP varied significantly within sexual behavior subgroups based on sociodemographic and behavioral characteristics highlighting the differential risks within distinct behavioral subgroupings of men. Sexual behavior subgroupings should be considered when promoting PrEP awareness and discussions as HIV risk behaviors vary considerably and sexual identity alone may not sufficiently capture one's HIV risk. [ABSTRACT FROM AUTHOR]

Sexual minority youth are at increased risk of substance use compared to their heterosexual peers, and bisexual youth appear to be at greatest risk. However, little is known about their motivations for and against using substances, how they make decisions, and what consequences they experience. We used qualitative data from a study of 54 cisgender and transgender male youth (ages 14–17 years) who reported attractions to more than one gender or regardless of gender (i.e., bisexual, pansexual, or queer; collectively referred to as bi+) to explore these aspects of substance use. Participants completed a survey and an interview, and interviews were thematically analyzed. Qualitative analyses revealed that participants described diverse motivations for using substances (e.g., to cope with stress, to experiment, to have fun) and for not using them (e.g., concern about consequences, not having access). The most common sources of stress were mental health problems, school, and family. They did not describe sexual orientation-related stress as a motivation for their use, but they acknowledged that it could influence others' use. Participants also described thinking about when, where, and with whom they were going to use prior to doing so (e.g., only using in safe places and with people who they trusted). Finally, they described a range of consequences they experienced (e.g., getting sick, getting in trouble), and a subset of transgender participants described experiencing dependence symptoms. These findings suggest that substance use prevention and harm reduction interventions for bi+ male youth should address diverse motivations for use, including general stressors, which are often overlooked compared to minority-specific stressors. Further, interventions should approach youth as capable of making decisions. Findings also highlight the particular need to address substance use among transgender youth. [ABSTRACT FROM AUTHOR]

Introduction: Bisexual male youth are more likely to engage in certain behaviors that contribute to HIV/STI transmission (e.g., substance use) than are heterosexual and gay male youth. However, sexuality education rarely addresses the unique needs of sexual minority youth, especially bisexual, pansexual, and queer (bi+) youth, and little is known about their sexuality education experiences and preferences. As such, the goal of this study was to examine bi+ male youth's experiences learning about sex and their preferences for sexuality education. Methods: In 2019, 56 bi+ male youth ages 14–17 were surveyed and interviewed about their sexuality education experiences and preferences. Participants identified as bisexual (64%), pansexual (27%), and queer (9%), were racially/ethnically diverse (39% white, 32% Latinx, 20% Black, 9% other races), and included cisgender (79%) and transgender (21%) male youth. Results: Participants described varied experiences with school-based sexuality education (e.g., none, abstinence only, covered sexual health in some way), but it rarely addressed their unique needs. They typically learned about sex by searching for information online and from sexually explicit media. Participants identified several topics they wanted to learn more about (e.g., sex with same-gender partners, anal sex, consent), but they typically believed they were prepared to have sex. Finally, some participants described benefits of tailoring sexuality education to their unique needs, while others described benefits of more inclusive programs. Conclusions and Policy Implications: Findings suggest that bi+ male youth do not receive adequate sexuality education to make informed decisions about safer sex, highlighting the critical need for reform. [ABSTRACT FROM AUTHOR]

Introduction: Using data from the 2018 National Survey of Sexual Health and Behavior, we determined the prevalence and content of adolescents' and young adults' communication with healthcare providers about condom use. Methods: Adolescents (14–17 years old; n = 283) and young adults (18–24 years old, n = 225), who discussed sexual health with a healthcare provider in the past year, reported if they had discussed condom use with a healthcare provider, and among those who did, they also reported why healthcare providers recommended condoms, if they demonstrated correct condom use, and/or provided condoms. Data collection occurred in February and March 2018. Results: Most adolescents (71.0%) and young adults (66.7%) who discussed sexual health with a healthcare provider reported discussing condom use. Condoms were most often recommended for both pregnancy and STD prevention. Fewer adolescents and young adults were shown how to use condoms (11.4% of adolescents; 5.7% of young adults) or provided condoms (14.9% of adolescents; 14.7% of young adults). Only 3.2% of adolescents and 1.3% of young adults had healthcare providers who discussed, demonstrated, and provided condoms. Conclusions: Sexual health conversations with healthcare providers are likely to include condoms. But few adolescents and young adults were shown how to use condoms or provide condoms. Policy Implications: Providing healthcare providers with resources and trainings about how to talk about condoms with patients may lead to more adolescents and young adults learning medically accurate information about condoms. Healthcare offices and clinics could also provide condom use resources outside of provider-patient interactions. [ABSTRACT FROM AUTHOR]

Most prior bisexual research takes a monolithic approach to racial identity, and existing racial/ethnic minority research often overlooks bisexuality. Consequently, previous studies have rarely examined the experiences and unique health needs of biracial/multiracial and bisexual individuals. This exploratory qualitative study investigated the identity-related experiences of biracial/multiracial and bisexual adults within the context of health and well-being. Data were collected through 90-min semi-structured telephone interviews. Participants were recruited through online social network sites and included 24 adults between ages 18 and 59 years. We aimed to explore how identity-related experiences shape biracial/multiracial and bisexual individuals' identity development processes; how biracial/multiracial and bisexual individuals negotiate their identities; how the blending of multiple identities may contribute to perceptions of inclusion, exclusion, and social connectedness; and how biracial/multiracial and bisexual individuals may attribute positive and negative experiences to their identities. Interview transcripts were analyzed using an inductive thematic approach. Analysis highlighted four major themes: passing and invisible identities, not measuring up and erasing complexity, cultural binegativity/queerphobia and intersectional oppressions, and navigating beyond boundaries. Our findings imply promoting affirmative visibility and developing intentional support networks may help biracial/multiracial and bisexual individuals cultivate resiliency and navigate sources of identity stress. We encourage future research to explore mental health and chronic stress among this community. [ABSTRACT FROM AUTHOR]

Using data from a 2014 U.S. nationally representative probability survey and a 2014 content analysis of 2562 male–female videos from two popular pornographic websites, this study aimed to: (1) compare the prevalence of survey respondents' event-level sexual behaviors with those depicted in mainstream pornography online videos; (2) compare event-level condom use with condom use prevalence in pornographic videos; (3) compare event-level orgasm with prevalence of orgasms in pornographic videos; and (4) assess whether respondents' partnered use of pornography was associated with the sexual behaviors in which they report engaging. We found that kissing, male orgasm, female orgasm, and condom use were significantly less prevalent in the pornographic videos than in survey respondents' most recent sexual experiences. Conversely, penile–anal intercourse and fellatio were significantly more prevalent in the pornographic videos than in participants' reports of their most recent sexual experience. There were no significant differences between the prevalence of cunnilingus or sex toy use represented in the videos as compared to survey respondents' reports. Finally, we found that individuals who reported partnered pornography use during their most recent sexual experience were more likely to report having engaged in oral sex, penile–anal intercourse, and sex toy use and were also more likely to report female orgasm during their most recent sexual experience. [ABSTRACT FROM AUTHOR]

Compared to studies on sexually transmitted infections and pregnancy prevention, sexual pleasure has received limited attention in the adolescent sexual development literature. In the present study, we used data from 157 adolescents (66 females; 14 to 17 years old), with a partnered sexual experience in the past 12 months to explore adolescents' sexual pleasure. First, we examined adolescents' perceptions of pleasure during their most recent partnered sexual experience. We then used information about those sexual experiences to identify correlates of sexual pleasure. Adolescents' reports of sexual pleasure were mixed. Although 17.8% reported their sexual experience was extremely pleasurable and 36.5% reported it was quite pleasurable, 26.6% indicated moderate pleasure, 13.1% a little pleasure, and 3.3% reported no pleasure. Sexual pleasure was primarily associated with aspects of sexual experiences that reflected socioemotional intimacy and desire. Specifically, cuddling with partners, emotional intimacy, and wantedness were all associated with greater sexual pleasure. Additionally, adolescents found sex more pleasurable when it occurred with a friend, but less pleasurable when it involved genital rubbing. Most sexual behaviors, having experienced orgasm, and the situational context of sexual experiences were not associated with sexual pleasure. Thus, specific sexual behaviors and orgasm may have less impact on sexual pleasure than feelings of emotional intimacy and desire. The diversity of perceived sexual pleasure and its associations with intimacy and desire suggest that, during adolescence, partnered sexual experiences are not primarily motivated by anticipated physical pleasure. [ABSTRACT FROM AUTHOR]

We analyzed cross-sectional data collected from a U.S. nationally representative survey of individuals ages 14-24 years old on what sources of information from the past year they considered to be the most helpful about how to have sex (n = 600 adolescents ages 14-17 years old, and n = 666 young adults ages 18-24 years old). Among the 324 adolescents who indicated that they had been helped by at least one source of information, helpful information was most likely to have come from parents (31.0%) and friends (21.6%). Only 8.4% of adolescents said pornography was helpful. However, for those in the 18-24-year-old age group, pornography was the most commonly endorsed helpful source (24.5%), as compared to other possible options such as sexual partners, friends, media, and health care professionals. Multivariable regression analyses revealed that indicating that pornography was the most helpful source of information about how to have sex, compared to the other sources, was inversely associated with being female (OR = 0.32, p = .001), inversely associated with identifying as bisexual compared to heterosexual (OR = 0.15, p = .038), positively associated with being Black compared to being white non-Hispanic (OR = 4.26, p = .021), inversely associated with reporting a household income of either $25 K to $49,999 (OR = 0.31, p = .010) or $50 K to $74,999 (OR = 0.36, p = .019) compared to more than $75 K, and positively associated with having masturbated (OR = 13.20, p = .005). Subsequent research should investigate the role of pornography in both adolescent and adult sexual development, including why one-quarter of U.S. young adults say that pornography is a helpful source of information about how to have sex and what they think that they are learning from it. [ABSTRACT FROM AUTHOR]

Economic vulnerability, such as homelessness and unemployment, contributes to HIV risk among U.S. racial minorities. Yet, few economic-strengthening interventions have been adapted for HIV prevention in this population. This study assessed the feasibility of conducting a randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Primary feasibility objectives assessed recruitment, randomization, participation, and retention. Secondary objectives examined employment, sexual risk behaviors, and HIV preventive behaviors. Outcome assessments used an in-person pre- and post-intervention interview and a weekly text message survey. Several progression criteria for a definitive trial were met. Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19) of which 95% were retained. The comparison intervention enhanced willingness to be randomized and reduced non-participation. Mean age of participants was 21.0 years; 35% were male; 81% were unemployed. Fifty-eight percent (58%) of experimental participants completed ≥ 70% of intervention activities, and 74% completed ≥ 50% of intervention activities. Participation in intervention activities and outcome assessments was highest in the first half (~ 10 weeks) of the study. Seventy-one percent (71%) of weekly text message surveys received a response through week 14, but responsiveness declined to 37% of participants responding to ≥ 70% of weekly text message surveys at the end of the study. The experimental group reported higher employment (from 32% at baseline to 83% at week 26) and lower unprotected sex (79% to 58%) over time compared to reported changes in employment (37% to 47%) and unprotected sex (63% to 53%) over time in the comparison group. Conducting this feasibility trial was a critical step in the process of designing and testing a behavioral intervention. Development of a fully-powered effectiveness trial should take into account lessons learned regarding intervention duration, screening, and measurement. Trial Registration ClinicalTrials.gov. NCT03766165. Registered 04 December 2018. https://clinicaltrials.gov/ct2/show/NCT03766165 [ABSTRACT FROM AUTHOR]

Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective. [ABSTRACT FROM AUTHOR]

The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention. [ABSTRACT FROM AUTHOR]

We aimed to assess, among a U.S. probability sample of adult women: (1) the prevalence of, and reasons given for, faking and no longer faking orgasm, (2) women's histories of sexual non-communication and reasons for non-communication, (3) associations between sexual non-communication and sexual satisfaction and faking orgasm, (4) associations between specific sexual communication and recent sexual satisfaction, and (5) associations between specific sexual communication and faking orgasm. Respondents were 1008 adult women ages 18-94 from the GfK KnowledgePanel (a nationally representative probability sample of non-institutionalized and English-speaking adults), who completed a confidential Internet-based survey. Although 58.8% of female respondents reported having ever faked/pretended orgasm, 67.3% of those who had ever faked orgasm no longer did. Women who continued to fake orgasms were more likely to indicate embarrassment talking about sex with their partner in explicit ways and were less likely to agree that they and their partner are able to talk specifically about what makes sex more pleasurable for them. More than half (55.4%) of women reported they had wanted to communicate with a partner regarding sex but decided not to; the most common reasons were not wanting to hurt a partner's feelings (42.4%), not feeling comfortable going into detail (40.2%), and embarrassment (37.7%). Greater self-reported sexual satisfaction was associated with more comfortable sexual communication. Study findings and implications for professionals are discussed in the context of adult sexual development and learning. This includes growing more comfortable talking with a partner about sexual preferences and sexual pleasure. [ABSTRACT FROM AUTHOR]

Self-identified bisexual men are at increased risk for negative health outcomes, but there are no interventions tailored to their unique needs. In order to develop interventions for this population, it is first necessary to understand their preferences. As part of a larger study, 128 cisgender men who identified as bisexual reported on their preferences for different intervention components. Large proportions of participants prioritized addressing both health (e.g., mental health, HIV/STI) and psychosocial experiences (e.g., dating/relationships, discrimination/victimization). A slightly larger proportion of participants preferred an intervention for gay and bisexual men together compared to an intervention for bisexual men only. However, those who reported more discrimination and recent female sexual partners were more likely to prefer an intervention for bisexual men only. Larger proportions of participants preferred a group intervention compared to an individual intervention and an in-person intervention compared to an online intervention. These findings highlight the importance of addressing both health and psychosocial experiences in tailored interventions for self-identified bisexual men. Further, while in-person and group interventions may appeal to larger proportions of self-identified bisexual men, the appeal of an intervention for gay and bisexual men together compared to an intervention for bisexual men only may depend on individual and social/contextual factors. [ABSTRACT FROM AUTHOR]

Sexual orientation is a multi-dimensional concept, at a minimum comprised of sexual identity, sexual attraction, and sexual behavior. Our study aimed to assess relationships among self-identified sexual identity, sexual attraction, and sexual behaviors in a probability sample of adults in the U.S. and to identify associated factors with diverse patterns. We collected data from adults in the 2015 National Survey of Sexual Health and Behavior, an Internet-based nationally representative probability survey of the general U.S. population. Concordance between sexual identity versus sexual attraction and sexual behaviors was assessed using percent agreement. We identified correlates of discordance using logistic regression. Concordance between sexual identity versus sexual attraction and past-year sexual behaviors was 94% and 96%, respectively, though our sample was predominately composed of heterosexual individuals. Women and sexual minority individuals reported greater discordance across sexuality-related measures than men and heterosexual individuals. Younger adults (aged 18-24 years) were more likely to report sexual behaviors discordant with sexual identity compared with older adults (including those ages 25-34 years). Higher levels of educational attainment were significantly associated with less discordance of reported recent sexual activity and sexual identity. Measures of sexual identity, attraction, and behaviors are not interchangeable. Future research should consider multiple sexuality-related measures in order to capture the complexity and variability of sexualities. [ABSTRACT FROM AUTHOR]

Despite comprising the largest proportion of the "lesbian, gay, and bisexual" population, research focusing on the unique health concerns and needs of bisexual individuals is relatively scarce. While health disparities are increasingly well documented among lesbian, gay, bisexual, and transgender individuals relative to their heterosexual and cisgender counterparts, gaps remain in our basic understanding of how health status, behaviors, and outcomes vary within these groups, especially bisexual individuals. The lack of specified research on bisexual health is even more curious given that, when separated from both heterosexual and gay/lesbian individuals, bisexual individuals consistently report higher rates of a wide range of negative health outcomes, including mood and anxiety disorders, substance use, suicidality, as well as disparities related to healthcare access and utilization. Indeed, in scientific research, mass media, and in public health interventions, bisexual individuals remain relatively invisible. This Special Section represents an effort to shed light on a new generation of quantitative, qualitative, and mixed methods research studies that examine health-related concerns, outcomes, and intervention opportunities specifically among diverse samples of bisexual individuals from a variety of social and cultural contexts. The research herein focuses on intersections of multiple identities, the development of new measures, the use of large national data sets, and diverse groups of self-identified bisexual men (who tend to be least visible in health research). Findings from these studies will significantly advance our knowledge of factors associated with health disparities, as well as health and well-being more generally, among bisexual individuals and will help to inform directions for future health promotion research and intervention efforts. [ABSTRACT FROM AUTHOR]

Research examining the sexual identities, behaviors, and experiences of bisexual men outside of Western contexts (including in India) is limited. Individuals who self-identify as bisexual due to their orientation toward partners of more than one gender face distinct psychosocial challenges relative to exclusively heterosexual, gay/lesbian, or other individuals. We conducted four focus group discussions (n = 22) and in-depth interviews (n = 50) with self-identified bisexual men (age 18 years and older) who were recruited from the metropolitan area of Mumbai, India, between June and August 2013. We triangulated and analyzed focus group and interview data using standard qualitative research techniques. Findings from our study suggest that multiple factors influence the sexual experiences of self-identified bisexual men in Mumbai, including contexts of sexual interactions, sexual positioning, and the gender of sexual partners. Participants described cultural meaning systems and psychosocial dynamics that regulate bisexual identity development, disclosure, and sexual decision making with male, female, and other partners. Secrecy, discretion, and sexual pleasure also influenced sexual behaviors and relationships. Although Western sexual identity categories are not necessarily equivalent in the Indian context, it is interesting and important to note that a number of individuals in India continue to use the identity label of "bisexual." Before developing interventions to meet unique sexual health needs of bisexual men, it is crucial to understand how these men perceive themselves, reconcile the ordinary aspects of their lives with their sexuality, and structure their relationships with partners. [ABSTRACT FROM AUTHOR]

Bisexual parents have been notably absent from prior research on parenting, despite comprising the largest proportion of parents among "lesbian, gay, and bisexual" (LGB) individuals. Indeed, recent national probability data indicate that young bisexual women are more likely than their heterosexual counterparts to report having at least one child. Intentions to have children, patterns of family planning and contraception use, and related issues have important implications for health and healthcare-related decisions and priorities among bisexual parents. We conducted in-depth interviews with a sample of 33 bisexual parents from across the U.S. who reported having at least one child (genetic, adopted, step or foster child, guardian, and/or warden of the state). In cases of intentional pregnancies, participants considered relationship and financial stability, job security and their ideal family size. Unintentional pregnancies, as well as pregnancy terminations, were often reframed as positive experiences. After deciding not to have more children, participants reported using contraceptive methods, including sterilization or long-acting reversible contraceptive methods (e.g., intrauterine devices). Instances of deception, in which partners deceived participants with false beliefs regarding their contraceptive use, were recalled negatively for the relatively small number of participants who reported such experiences. Overall, our findings point to a diversity in the intentions and ways bisexual individuals become parents, similar to parents of other sexual identities. Acknowledgements of the diverse experiences and concerns faced by bisexual parents may be beneficial in improving efforts related to providing appropriate and relevant health- and healthcare-related services. [ABSTRACT FROM AUTHOR]

Researchers posit that negative attitudes, prejudice, and discrimination (i.e., binegativity) from heterosexual and gay/lesbian individuals may contribute to health disparities among bisexual individuals relative to heterosexual and gay/lesbian individuals. Recent studies have focused on gay, lesbian, and heterosexual people's (e.g., "others") attitudes toward bisexual people. No studies have investigated how bisexual individuals perceive others' attitudes toward bisexual people, which are generally known as "meta-perceptions." As part of the 2015 National Survey of Sexual Health and Behavior, we collected data from a nationally representative probability sample of 2999 adults, including from a subsample of 33 men and 61 women self-identified as bisexual. The Bisexualities: Indiana Attitudes Scale-bisexual (BIAS-b), a modified 5-item scale assessing bisexual people's perceptions of others' attitudes toward bisexual individuals, was included and was followed by an open-ended text box question. Quantitative scale data were analyzed using descriptive and gamma regression methods. Two coders thematically analyzed the open-ended text box data. The internal consistency of the BIAS-b was high (Cronbach's α = 0.85). An exploratory factor analysis supported a one-factor solution. Participants responded to statements regarding others' attitudes toward them as bisexual people, including the domains of confusion, HIV/STD risk, incapability of monogamy, promiscuity, and instability ("just a phase"). Participants' text box descriptions largely aligned with these five domains, with the exception of HIV/STD risk. Additionally, some participants reported others' positive perceptions of them as bisexual individuals. In sum, we observed a range of meta-perceptions, primarily neutral to negative, but also including some relatively positive. These results show the need for interventions to promote acceptance of bisexual individuals among heterosexual and gay/lesbian individuals. [ABSTRACT FROM AUTHOR]

Scant research has sought to explore the development of dimensions of sexual orientation among Black bisexual male adolescents (BBMA). Understanding how sexual attractions, behaviors, and identities evolve among BBMA over time is crucial to understanding the most appropriate support strategies to provide during this developmental period. We sought to understand and describe the sexual orientation development experiences in a sample of BBMA over the course of 1 year. We further sought to understand the sociocontextual factors that may play a role during this development process. Fifteen BBMA, aged 15-19 years, were interviewed about sexual debut experiences (baseline) and were re-interviewed three times over a 1-year period about sexual attractions, behaviors, and identity at each follow-up point. A three-person team used inductive open coding to analyze each participant's data set. The mean Kinsey scale score for the sample was 2.93 (SD = 1.2) most closely translating to "heterosexual/gay-equally." A case study analysis was used to identify themes related to sexual attractions, behavior, and identity over time, within and across participants. Among the sample of young men, two unique groups were identified based on self-reported sexual identity and experiences of same- and other-sex sexual attractions and behaviors over time. The first group consisted of seven young men who consistently described their sexual identity as bisexual from baseline to the final follow-up. These young men also described similar experiences related to same- and other-sex sexual and romantic attractions and more consistently described same- and other-sex sexual behaviors. The second group consisted of eight young men that described changing sexual identity and same- and other-sex sexual romantic attractions over time. Participants described sociocontextual factors such as religion, masculinity, and homophobia played during their development. Findings from this study underscore the complexity of sexual orientation development and sociocultural factors and expectations that may influence sexual identity and behavior among BBMA. [ABSTRACT FROM AUTHOR]

People in open and other consensually nonmonogamous partnerships have been historically underserved by researchers and providers. Many studies group such partnerships together with nonconsensual nonmonogamy (NCNM) under the banner of "concurrent sexual partnerships." Discrimination from service providers poses a substantial barrier to care. Responding to such concerns, this investigation explored sociodemographic correlates with open relationships and associations between relationship structure and sexual risk, HIV/STI testing, and relationship satisfaction in a nationally representative probability sample. Data were drawn from the 2012 National Survey of Sexual Health and Behavior (n = 2270). We used multinomial logistic regression to identify correlates with relationship structure, and linear and logistic regression to investigate associations between relationship structure and testing, condom use, and relationship satisfaction. Eighty-nine percent of participants reported monogamy, 4% reported open relationships, and 8% reported NCNM. Males, gay/lesbian individuals, bisexual individuals, and those who identified as "Other, Non-Hispanic" were more likely to report open relationships. Bisexual individuals and Black, Non-Hispanic participants were more likely to report NCNM; older participants were less likely to do so. Participants in open relationships reported more frequent condom use for anal intercourse and lower relationship satisfaction than monogamous participants. NCNM participants reported more HIV testing and lower satisfaction. Identities, experiences, and behaviors within open and other consensually nonmonogamous populations should be regarded as unique and diverse, rather than conflated with those common to other relationship structures. There is a need for greater awareness of diverse relationship structures among researchers and providers, and incorporation of related content into educational programming. [ABSTRACT FROM AUTHOR]

This study assessed the prevalence of sexual behaviors among a nationally representative sample of Latino men and women in the United States (US) (N = 432) including Spanish language data collection. Prior studies of sexual health among US Latinos have consisted of convenience samples, and focused mainly on assessing risk behaviors. We consider a broader range of sexual behaviors, subjective sexual experiences (e.g. pleasure and arousal), and STI testing behaviors. Analyses by language dominance and gender indicate a higher variability in sexual behaviors for English-dominant participants and a link between overall STI testing to regular medical examinations, especially women. Higher rates of pleasure, orgasms and arousal was reported by Spanish-dominant men and women, relative to the English-dominant group. Results represent a nuanced examination of internal differentiation among US Latinos and provides applicable data for reducing sexual health disparities in this population. [ABSTRACT FROM AUTHOR]

Collecting information on sexual identity is critical to ensuring the visibility of minority populations who face stigmatization and discrimination related to sexual identities. However, it is challenging to capture the nuances of sexual identity with traditional survey research methods. Using a mixed-methods approach, we gathered data on the sexual identities of 80 behaviorally bisexual women in the Midwestern United States through an online survey. When provided different types of measures (e.g., open ended and fixed response) and different contexts in which to identify (e.g., private and public), participants varied in how they reported their sexual identities. Qualitative analysis of participant narratives around identity change finds partitioning and ranking of attraction is a key component in understanding behaviorally bisexual women's identities. We further identify a division regarding the desired outcomes of identity development processes. Given the multiple ways in which participants identified depending upon the type of measure and the context specified, and the variation in identification over time, results support reconsidering the capability of typical measures and methods used in survey research to capture sexual identity information. Additionally, findings highlight the utility of including multiple, context-specific measures of sexual identities in future research. [ABSTRACT FROM AUTHOR]

The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the U.S., Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations between relationship factors and HIV risk among Latino MSM remain unknown. This mixed-method study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past 3 months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n = 175), approximately half reported multiple partners in the previous 3 months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants expressed commitment to and support for their partners. As such, prevention efforts involving Latino male couples must address relationship dynamics and the role they play in sexual health, including safer sex practices. [ABSTRACT FROM AUTHOR]

Previous social and behavioral research on identity among bisexual men, when not subsumed within the category of men who have sex with men (MSM), has primarily focused on samples of self-identified bisexual men. Little is known about sexual self-identification among men who are behaviorally bisexual, regardless of sexual identity. Using qualitative data from 77 in-depth interviews with a diverse sample of behaviorally bisexual men (i.e., men who have had sex with at least one woman and at least one man in the past six months) from a large city in the Midwestern United States, we analyzed responses from a domain focusing on sexual self-identity and related issues. Overall, participants' sexual self-identification was exceptionally diverse. Three primary themes emerged: (1) a resistance to, or rejection of, using sexual self-identity labels; (2) concurrent use of multiple identity categories and the strategic deployment of multiple sexual identity labels; and (3) a variety of trajectories to current sexual self-identification. Based on our findings, we offer insights into the unique lived experiences of behaviorally bisexual men, as well as broader considerations for the study of men's sexuality. We also explore identity-related information useful for the design of HIV/STI prevention and other sexual health programs directed toward behaviorally bisexual men, which will ideally be variable and flexible in accordance with the wide range of diversity found in this population. [ABSTRACT FROM AUTHOR]

Correction to: Sexuality Research and Social Policy https://doi.org/10.1007/s13178-021-00593-... The original version of this article unfortunately had a missing reference. Sexual health education for adolescent males who are interested in sex with males: An investigation of experiences, preferences, and needs. Correction to: A Mixed Methods Study of Sexuality Education Experiences and Preferences Among Bisexual, Pansexual, and Queer (Bi +) Male Youth. [Extracted from the article]

Over the past two decades, new anti-immigration policies and laws have emerged to address the migration of undocumented immigrants. A systematic review of the literature was conducted to assess and understand how these immigration policies and laws may affect both access to health services and health outcomes among undocumented immigrants. Eight databases were used to conduct this review, which returned 325 papers that were assessed for validity based on specified inclusion criteria. Forty critically appraised articles were selected for analysis; thirty articles related to access to health services, and ten related to health outcomes. The articles showed a direct relationship between anti-immigration policies and their effects on access to health services. In addition, as a result of these policies, undocumented immigrants were impacted by mental health outcomes, including depression, anxiety, and post-traumatic stress disorder. Action items were presented, including the promotion of cultural diversity training and the development of innovative strategies to support safety-net health care facilities serving vulnerable populations. [ABSTRACT FROM AUTHOR]

Although frequently cited as being at high risk for HIV/STI transmission, little is known about behaviorally bisexual men's patterns and experiences of condom use and nonuse with male and female sexual partners. Using a variety of recruitment techniques informed by a Community Advisory Committee, a total of 77 behaviorally bisexual men were recruited from Indianapolis, Indiana to participate in semi-structured interviews focused on sexual health. Qualitative data were collected containing detailed information on their patterns and experiences of condom use and nonuse with both male and female partners. Participants described numerous commonly reported barriers for consistent condom use, as well as distinct bisexual-specific barriers. The majority reported consistent condom use with male and female casual partners, but many who did not use condoms described doing so in the context of ongoing relationships. In addition, participants provided reasons for condom use and nonuse that varied based on the gender of the partner and the type of relationship with the partner. Future interventions focused on increasing condom use among behaviorally bisexual men should take into account the unique complexities of gender and relationship configurations in this distinct population. [ABSTRACT FROM AUTHOR]

Research examining the sexual behaviors and experiences of behaviorally bisexual men is limited. Most studies focus primarily on highlighting sexual risk behaviors among groups of 'men who have sex with men (MSM)' or 'gay and bisexual men,' which may not be appropriate in terms of behaviorally bisexual men's sexual repertoires with both men and women. This study aimed to assess a broad range of sexual behaviors and associated experiences among bisexual men living in the midwestern United States. An interviewer-administered questionnaire containing items from the National Survey of Sexual Health and Behavior assessed lifetime and recent (i.e., past 6 months and last event) sexual behaviors and experiences with both male and female partners among a diverse sample of 75 behaviorally bisexual men. Responses were quantified and analyzed using descriptive and multivariate statistics. A wide range of sexual behaviors with partners of both genders was found. Vaginal intercourse and oral sex with both men and women were the most commonly reported behaviors. Subjective reports of pleasure, arousal, and sexual function during sexual activity were similar with both male and female sexual partners. Many participants reported using condoms during insertive sexual behaviors with male and female partners, but less during oral sex. Unprotected receptive anal sex was less commonly reported. Overall, participants reported a variety of sexual behaviors and experiences; however, unlike other populations, they shared these with partners of both genders. Results have implications for interventions targeting the sexual behaviors and associated issues among behaviorally bisexual men. [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]

HIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. A theoretical perspective that bridges key individual level elements with important network elements can be a complementary foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual's relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual's current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks. [ABSTRACT FROM AUTHOR]

Little information is available about sexual risk, protective, and disclosure practices among Black bisexually active men and how these may be amenable to intervention when necessary. In-depth interviews were conducted with 30 at-risk urban Black men who have sex with both men and women (MSMW). Participants reported protecting themselves and their partners through routine HIV testing, using condoms consistently, engaging in strategic positioning during sexual activity, and limiting the number of sexual partners. In addition, they described several reasons for not using protection, including not having condoms available, enjoying sexual activity more without condoms, and perceiving female partners to be “safer” than male partners. Disclosure of bisexuality was complex and reportedly difficult, in particular to female and gay-identified male partners. Future interventions must not only build protection and disclosure skills among MSMW, but also increase broader social awareness and acceptance of male bisexuality. [ABSTRACT FROM AUTHOR]

Although a recent proliferation of mass media has drawn attention to “the new Down Low phenomenon” (presumably “secretive” homosexuality among married Black men), relatively little research has explored bisexual behavior and identity among ethnic minority men in the United States or elsewhere. Although the study of bisexuality in Black and Latino men is significant in its own right, disproportionate rates of HIV/AIDS among these men make the current dearth of scientific information even more urgent and concerning. In this special section, we have compiled a diverse array of empirical and theoretical perspectives on Black and Latino male bisexualities. A wide range of information on the individual, social, and sexual lives of these men, and potential relations to risk behavior, are presented. This article introduces this new body of work and offers suggestions for future research directions for culturally appropriate interventions for Black and Latino bisexual men. [ABSTRACT FROM AUTHOR]

The principles of community-based participatory research were applied to an exploratory sexual health study that examined "cruising for sex" among men on a college campus. In the context of a study seeking a broad interpretation of the health implications of cruising, and when faced with methodological challenges, the researchers found these principles to provide invaluable guidance. A review of the research process is offered and the manner in which the principles of community-based participatory research were operationalized for this study is described. [ABSTRACT FROM AUTHOR]

A correction to the article "Evaluating the Impact of Immigration Policies on Health Status Among Undocumented Immigrants: A Systematic Review" that was published in the previous issue is presented.