Search

We assessed the effects of beliefs about state HIV criminal law on condomless anal sex (CAS < 3 months) among men who have sex with men (MSM) residing in 16 US states (n = 2013; M = 36 years old; 75 % White; 82 % HIV-negative) completing an online survey in 2010 and stratified by residency in a state with any or sex-specific HIV criminal law(s) or where a HIV-related arrest, prosecution, or sentence enhancement (APSE) had occurred. Three-quarters of MSM reported that they were unsure of the law in their state. Men who believed there was a HIV law in their state but lived in states without any or a sex-specific HIV criminal law(s) had higher probabilities of CAS compared to those who were unsure of their state's law; men who believed there was a HIV law in their state and lived in a state where an APSE had occurred had higher probabilities of CAS compared to those who were unsure of their state's law. Correct knowledge of state law was not associated with CAS. Findings suggest that HIV criminal laws have little or counter-productive effects on MSM's risk behavior.

One key component in HIV prevention is serostatus disclosure. Until recently, many studies have focused on interpersonal factors and minimally considered meeting venues as they pertain to disclosure. Using data (N = 3,309) from an online survey conducted across 16 U.S. metropolitan statistical areas, we examined whether HIV serodisclosure varies by online/offline meeting venues in both protected and unprotected anal intercourse encounters. Most of the sample (76.9 %) reported meeting men for sex (last 90 days) both online and offline, versus 12.7 % offline only and 10.4 % online only. After controlling for other variables, we found that the men who meet partners in both online and offline were 20~30 % more likely to report disclosing their HIV status prior to sex than men who met their partners exclusively either offline or online. While previous studies have identified the Internet as a risk environment, our findings suggest bi-environmental partner seeking may also have beneficial effects.

We sought to 1) describe the settings or groups of settings where men who have sex with men (MSM) consume alcohol in 16 U.S. metropolitan statistical areas (MSA); and 2) investigate whether certain drinking settings or groups of settings are associated with higher levels of alcohol consumption, problem drinking, and sexual risk behavior. Latent class analysis was used to develop our measure of drinking settings. The final latent class model consisted of four distinct classes which captured the typical settings where MSM consumed alcohol: "home" "social," "bar/social," and "general" drinkers (i.e., drinks in all settings). Regression models showed that "general" drinkers were more likely than "social" drinkers to engage in frequent heavy drinking. Compared to 'social' drinkers, general drinkers were also more likely to engage in unprotected anal intercourse (UAIMP) and UAIMP with men met in bars and other venues (e.g., private parties, bath houses) while intoxicated. Assessment of drinking settings may be a means of identifying MSM who are at greater risk for frequent, heavy drinking and related sexual risk behavior., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Although research has been conducted over the last half century to test the hypothesis that pornography, or sexually explicit media (SEM), influences behavior, information regarding usage and its effect on men who have sex with men (MSM) is limited. It is important for researchers studying online risk factors for HIV to consider the relationship between SEM consumption and risky sexual behavior, particularly given the exponential increase in SEM exposure as a result of the near-compulsory use of the Internet. In this commentary, we review findings regarding this relationship from studies of international and heterosexual populations. We then suggest future directions for research regarding MSM in the United States and practical applications of such research if the results from other populations extend to them. Research suggests there might be ways to use SEM to create innovative approaches to online HIV prevention, particularly among such at-risk populations as youth and MSM of lower socio-economic statuses.

Online social media and mobile technologies hold potential to enhance adherence to antiretroviral therapy (ART), although little is known about the current use of these technologies among people living with HIV (PLWH). To address this gap in understanding, 312 PLWH (84% male, 69% White) US adults completed an online survey in 2009, from which 22 persons accepted an invitation to participate in one of two online focus groups. Results showed that 76% of participants with lower ART adherence used social networking websites/features at least once a week. Their ideal online social networking health websites included one that facilitated socializing with others (45% of participants) and ones with relevant HIV informational content (22%), although privacy was a barrier to use (26%). Texting (81%), and to a lesser extent mobile web-access (51%), was widely used among participants. Results support the potential reach of online social networking and text messaging intervention approaches.

The association between HIV treatment optimism--beliefs about susceptibility to transmit HIV, motivation to use condoms, and severity of HIV--and sexual risk behavior was examined among HIV-positive African American men who have sex with men (MSM). Participants were 174 men recruited in four major metropolitan areas of the United States to participate in a weekend HIV risk reduction intervention. Baseline results revealed that beliefs in less susceptibility to transmit HIV and less motivation to use condoms were significantly associated with more unprotected anal intercourse among serodiscordant casual partners. Less motivation to use condoms also predicted more unprotected insertive and receptive anal sex and was more important than susceptibility beliefs in predicting these behaviors. Suggestions are offered of ways to better inform HIV-positive African American MSM about their misperceptions about HIV treatment and how their level of optimism about HIV treatment may diminish or encourage condom use.

The Men's INTernet Study II included a randomized controlled trial to develop and test an Internet-based HIV prevention intervention for U.S men who use the Internet to seek sex with men. In 2008, participants (n = 560) were randomized to an online, interactive, sexual risk-reduction intervention or to a wait list null control. After 3 months, participants in both conditions reported varying degrees of change in sexual beliefs or behaviors. Using content analysis and logistic regression, this mixed-methods study sought to understand why these changes occurred. Level of critical self-reflection of assumptions appeared to facilitate the labeling of sexual beliefs and behaviors as risky, which in turn encouraged men to commit to and enact change. New HIV prevention interventions should include activities in their curriculum that foster critical self-reflection on assumptions.

Objective: The primary objective of this study was to develop and test a highly interactive Internet-based HIV prevention intervention for men who have sex with men (MSM). MSM remain the group at highest risk for HIV/AIDS in the United States and similar countries. As the Internet becomes popular for seeking sex, online interventions to reduce sexual risk are critical. Given previous studies, a secondary objective was to demonstrate that good retention is possible in online trials., Design: A randomized controlled trial with 3-month, 6-month, 9-month, and 12-month follow-up design was employed., Methods: In 2008, 650 participants were randomized to an online, interactive sexual risk reduction intervention or to a waitlist null control., Results: Retention was 76-89% over 12 months. At 3-month follow-up, results showed a 16% reduction in reported unprotected anal intercourse risk among those in the treatment condition versus control [95% confidence interval (95% CI) of rate ratio: 0.70-1.01]. No meaningful differences were observed at 12-month follow-up., Conclusion: Internet-based, persuasive computing programs hold promise as an effective new approach to HIV prevention for MSM, at least in the short term. Further, online trials can be conducted with acceptable retention provided strong retention protocols are employed. Four directions for future research are identified.

Unlabelled: This study was designed to examine the impact of HIV treatment optimism on sexual risk among a racially diverse sample of HIV-positive MSM. Survey data were collected from 346 racially diverse HIV-positive MSM., Inclusion Criteria: 18 years of age, male, at least one incident of unprotected anal intercourse (UAI) in the last year, currently on treatment. Other variables included demographics, sexual risk, depression, internalized homonegativity, HIV treatment history, alcohol/drug use and beliefs about HIV treatments (Susceptibility to transmit HIV, Severity of HIV infection and Condom Motivation). Those with lower income were more likely to report that HIV was less transmissible. A self-reported decrease in condom motivation was associated with being White, well-educated and increased alcohol/drug use. A decrease in Severity of HIV was associated with better mental health, being non-White and undetectable viral load. Sexual risk appears related to beliefs about how treatment affects the transmissibility of HIV. Race, socioeconomic status, alcohol/drug use, mental health and viral load were also associated with treatment beliefs.

This study examines mediation of the association between social norms and unsafe sexual behavior. Self-report data were collected from 675 HIV-infected men enrolled in a study exploring interventions for HIV risk behavior. Unsafe sex included any unprotected anal sex with HIV-negative or HIV status unknown partners in the last three months. Norms for condom use indirectly influenced unsafe sex through condom self-efficacy and/or safer sex intentions. Additionally, sexual behavior discontrol influenced unsafe sex regardless of other individual or social factors. Our results suggest that interventions consider the combined effects of condom self-efficacy, safer sex intentions and sexual behavior control.

This study assessed the feasibility of online recruitment of high-risk Latino men who have sex with men (MSM) for HIV prevention survey research and investigated the relationship between Internet use and unsafe sex. Participants (N = 1,026) were Internet-using Latino MSM living in the U.S. recruited using online banner advertisements. Respondents completed a cross-sectional, online survey in English or Spanish. Sample characteristics reflected national statistics within 5%. Nearly all (99%) reported having used the Internet to seek sex with another man. Two-thirds of respondents reported having unprotected anal sex with > or =1 man in the last year, 57% of these with multiple partners. Participants reported engaging in anal sex and unprotected anal sex with nearly twice as many men first met online versus offline, but risk proportions did not differ. Internet-based HIV prevention research is possible even with geographically-dispersed minority populations. Efficiency appears the primary risk associated with meeting partners online.

The purpose of this study was to examine substance use among a racially and ethnically diverse group of HIV-positive men who have sex with men (MSM) living in six U.S. cities, model associations between drug use and serodiscordant unprotected anal intercourse (SDUAI), and characterize users of the substances strongly associated with risky sexual behavior. Baseline questionnaire data from 675 participants of the Positive Connections intervention trial were analyzed. Overall, substance use was common; however, the highest percentage of stimulant (30%), methamphetamine (27%), and popper (i.e., amyl nitrite) (46%) use was reported among white MSM and crack/cocaine (38%) use was highest among African American MSM. Popper use versus non-use (odds ratio = 2.46; 95% confidence interval = 1.55-3.94) and condom self-efficacy (1 standard deviation (sd) increase on scale; odds ratio = .58; 95% confidence interval = .46-.73) were significantly associated with SDUAI after adjusting for key demographic and psychosocial factors. These results highlight the importance of addressing drug use in the context of sex for possible HIV transmission risk.

Objectives: We assessed rates of childhood sexual abuse and its demographic and mental health correlates among HIV-positive men who reported unsafe anal intercourse with other men in the past year., Methods: We conducted a cross-sectional analysis of baseline data from 593 HIV-positive men who have sex with men enrolled in the Positive Connections intervention., Results: Childhood sexual abuse was reported by 47% of participants; 32% reported frequency as often or sometimes. Men reporting abuse were more likely to be Latino (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.6, 4.2; P < .001) or African American (OR = 1.8; 95% CI = 1.2, 2.7; P = .005) than White. Among those who were abused, more frequent abuse was associated with more sexual contacts (for each, rate ratio [RR] = 1.3; P < .001) and unsafe anal intercourse (often, RR = 1.5; sometimes, RR = 2.0; P < .001) compared with men who were not abused., Conclusions: History of childhood sexual abuse is highly prevalent among HIV-positive men who engage in risky sexual behavior with other men and appears to be more common among men of color. Our findings suggest that abuse is associated with a significantly increased risk of sexually transmitted infections.

We studied internalized homonegativity (IH) in 675 HIV-positive men who have sex with men (MSM) from six epicenters across the United States who attended an HIV prevention workshop. Participants included 300 African American and over 150 Hispanic White and White non-Hispanic men. Higher IH was significantly associated with African American race. Compulsive sexual behavior, openness as MSM, sexual comfort, depression, education level, and importance of religion also were associated with IH and independently predicted a third of this outcome's variance. For those with higher IH, two significant paths led to unsafe sexual behavior: first, to serodiscordant unprotected anal intercourse (SDUAI) through being less "out"--thus disclosing serostatus to secondary partners less frequently, and second, to lower condom self-efficacy and SDUAI through lower sexual comfort. These data provide information on the demographic, sexual and mental health variables associated with IH. They offer an indication of the paths through which IH is associated with serodiscordant risk behavior in HIV-positive MSM.

This study sought to identify predictors of HIV disclosure and serodiscordant unprotected anal intercourse (SDUAI) among HIV-positive men who have sex with men (MSM). Between January 2005 and April 2006, 675 HIV-positive MSM were recruited into the Positive Connections intervention trial held in six US cities with intentional over-sampling of HIV-positive MSM of Color (74%) and men engaging in unprotected anal intercourse (UAI) in the previous year. Baseline survey data showed 30 and 31%, respectively, of participants disclosed to none or some of their secondary sex partners in the last 90 days. Greater disclosure to secondary partners was associated with having fewer sexual partners, being extremely out as MSM, longer HIV diagnosis, knowledge of CD4 count, detectable viral load and being white. Disclosure to all secondary partners was associated with lower SDUAI. Recommendations for prevention for HIV-positive MSM include the promotion of serodisclosure to all secondary partners and increasing comfort with, and outness about, one's sexuality.

The aim of this study was to examine online profile and in-person communication patterns and their associations with unprotected anal intercourse (UAI) in online and offline partnerships between men who have sex with men (MSM) who have never tested for HIV ("Never Tested"), had been tested at least once for HIV ("Tested"), and had tested positive for HIV. Between September and November 2005, 2,716 MSM participated in a one-time online survey. Although 75% and 72% of the Tested and Never Tested groups disclosed a HIV-negative status in all of their online profiles, 17% of HIV-positive participants did so. Exchanging HIV status information was highest among the Tested group, while HIV-positive men were most likely to negotiate UAI. Serodisclosure was not an independent predictor of UAI, although making an explicit agreement to engage in UAI was. Sexual communication and risk-taking patterns differed by testing status. Explicit agreements to avoid UAI were associated with reduced sexual risk-taking. Misrepresentation of HIV status is an identified challenge for HIV prevention.

Objectives: We examined the characteristics of young Internet-using men who have sex with men (MSM) and risks associated with seeking sex online, offline, or through both strategies., Methods: Data were obtained from MSM aged 18 to 24 years who completed a 45-minute online survey regarding sex and Internet use in the preceding 3 months., Results: Significantly more Internet-using MSM who had met sexual partners both online and offline (43%) reported unprotected anal intercourse than did those who had met sexual partners exclusively online (29%) or offline (34%). MSM who met sexual partners exclusively offline reported the fewest partners but the greatest proportion of partnerships involving unprotected anal intercourse (49%). Meeting sexual partners both online and offline (odds ratio [OR]=3.38-58.42) and being drunk (OR=1.57) or high (OR=2.24) increased the odds of having more sexual partners. The same factors increased the odds of having unprotected anal intercourse (online and offline sexual partners, OR=1.60; being drunk, OR=1.43; being high, OR=1.61)., Conclusions: Risky sexual behavior was prevalent among all of the study subgroups. Our findings suggest that online sex seeking is associated with greater numbers of sexual partners but neither promotes nor discourages unprotected anal intercourse. Regardless of where sexual partners met, being drunk and high were significant risks for unprotected anal intercourse.

Relatively few studies have examined the impact of modifying structural factors on HIV prevention efforts in the United States despite their high potential for lowering HIV prevalence rates. The aim of this study was to identify state-level characteristics of successful HIV prevention implementation. Structured interviews with 73 key informants in 13 rural states identified 'more successful' and 'less successful' states in HIV prevention. States were compared on demographic, religious, gay community, and funding variables. The 7 more successful states had both a wider variety and more MSM-targeted interventions. Overall funding, degree of epidemic, and "ruralness" were not significantly associated with success. Rather, successful states had less religious and Evangelical Protestant adherents and more 'gay community' infrastructure. They also spent a greater proportion of funds contracting community-based organizations and on MSM-targeted programming. Success in HIV prevention varies across rural states. Key demographic, social and economic indicators distinguish success in HIV prevention.

Male-to-female transgender persons are thought to be "vectors" for HIV/STI transmission, yet little quantitative information exists about the risk behavior of their male sexual partners who may serve as a "bridge" for HIV transmission into the general population. As part of an online survey examining the sexual risk behavior of Latino men who have sex with men (N = 1,026), we identified 44 (4%) participants who reported having had sex with a transgender partner. Compared with a randomly selected sub-sample of 200 men who did not report sex with a transgender person, sexual partners of transgender persons were almost three times more likely to have had unprotected sexual intercourse in the last three months. In addition, men who had sex with transgender persons were more likely to be HIV-positive; married, separated, or divorced; identify as bisexual or straight; have sex with women; and live in rural or small town communities. Regression analysis revealed that community size, sexual compulsivity, and having had a transgender partner were independent predictors of unprotected sex. Among Latino men who have sex with men, men with a history of sex with a transgender person appear more likely to be sexually compulsive and at greater risk for HIV and other sexually transmitted infections. These men may, therefore, also serve as a "bridge" for HIV transmission to (as opposed to from) the transgender population.

Compulsive sexual behavior (CSB) is a putative clinical syndrome characterized by the experience of sexual urges, sexually arousing fantasies, and sexual behaviors that are recurrent, intense, and a distressful interference in one's daily life. Although the putative phenomenology of CSB has been described in the literature, the lack of a reliable, valid assessment tool has made investigation of prevalence, co-factors, and etiologic factors difficult. This study examined the further development of the Compulsive Sexual Behavior Inventory (CSBI) using a sample of 1,026 Latino men who have sex with men recruited and assessed using web-based technology. The scale showed a two factor structure (control and violence). Further, the CSBI and its subscales showed indications of validity in that those engaging in CSB-type sexual behavior (being drunk or high, feeling lonely or depressed, and feeling driven) had scores indicative of greater CSB. Those with scores above the median had more sexual partners and engaged in more unprotected anal intercourse than those with CSBI scores below the median. Additionally, the instrument showed equivalence when administered in English and Spanish.

The Internet has developed as a major site for sexual activity, both cybersex and for making contacts for sex in real life (IRL). As part of a major study of HIV-risk behavior on the Internet and IRL , we obtained on-line responses from 1,017 Latino men who have sex with men (MSM) in the U.S. Open-ended questions solicited responses regarding whether respondents preferred to meet sexual partners first IRL (48.4%), on the Internet (31.6%), or "it depends" (20%), and "why?". Data were analyzed by theme, with themes grouped into overarching domains. Data indicate that for those preferring the Internet, themes represented were ease of Internet use, its advantages for people who were shy, and its anonymity, safety, the excitement and opportunity for experimentation of Internet contact, ability to avoid interpersonal contact, and control of visuals and the environment. Reasons for preferring meeting IRL included some of the same themes, but emphasizing the importance of a "real presence" and the possibility to build a relationship. Where "it depends", key themes were contextual: mood, time, setting, alcohol and drug use, sexual needs and urgency, and relationship intentions. Antagonistic advantages were often noted for cybersex and IRL. These data suggest that motivations for making Internet sexual contact in MSM are complex, depend on the context and nature of the relationship sought, and that the Internet has allowed the development of a class of sexual contacts located between IRL and fantasy.

As part of a wider study of Internet-using Latino men who have sex with men (MSM), we studied the likelihood that HIV-negative (n=200) and HIV-positive (n=50) Latino MSM would engage in sexual negotiations and disclosure of their HIV status prior to their first sexual encounters with men met over the Internet. We also analyzed the sexual behaviors that followed online encounters. Our results showed that both HIV-negative and positive men were significantly more likely to engage in sexual negotiation and serostatus disclosure on the Internet than in person. Those who engaged in sexual negotiations were also more likely to use condoms for anal intercourse. Compared to HIV-negative MSM, HIV-positive MSM were significantly less likely to disclose their serostatus, and 41% of them acknowledged having misrepresented their serostatus to a prospective sexual partner met over the Internet. Although similar proportions of HIV-positive and negative men had condomless anal intercourse, HIV-positive MSM were more likely to report lack of intention to use condoms. Pleasure was the reason most frequently cited for lack of condom use. Cybersex was reported by only one-fifth of the sample. We conclude that the Internet, an understudied milieu of sexual networking, may present new possibilities for the implementation of risk reduction strategies, such as the promotion of sexual negotiation prior to first in-person encounter and serostatus disclosure.

Experiences of men who have internet sex with men were studied to determine the level of misrepresentation in real life and on the Internet of physical, relationship, sexual interests, and HIV status. An internet-based questionnaire in English and Spanish ($20 compensation) recruited 1,026 Latino MISM over 3 weeks. Four 'fib' scales were created to measure misrepresentation by the respondent and to the respondent on the Internet and IRL. Overall, respondents rated being misrepresented to on the Internet significantly highest, followed by being misrepresented to IRL and misrepresenting themselves to others on the Internet, and misrepresenting themselves to others IRL lowest. For HIV status there were no differences between Internet and IRL misrepresentation by others and Internet and IRL misrepresentation by self, but a significant difference between HIV status misrepresentation by self and others. Misrepresenters were more likely to have had cybersex before meeting their last partner and to prefer cybersex, to be more sexually compulsive, and to speak and think more in Spanish. Social desirability considerations account for the higher misrepresentation on physical characteristics and sexual interests by others, and higher misrepresentation on the Internet. However, misrepresentation of HIV status was the lowest category and while it was misrepresented more often by others than self, there were no internet/IRL differences. Data suggest that HIV misrepresentation occurred for 20% of men and was lower than other forms of misrepresentation. Implications for HIV prevention are discussed, along with the concept of levels of accuracy in internet communications.

Cybersex (engaging in sexual self-stimulation while online with another person) and meeting partners for sex are commonly reported among men who have Internet sex with men (MISM). We studied 1,026 Latino MISM in the US and constructed a scale to measure beliefs about cybersex. Respondents were recruited to an online Internet study and compensated for their effort. Factor analysis indicated that there were three dimensions: (1) liking cybersex: perceived anonymity and safety of cybersex; (2) potential for greater IRL interaction in seeking partners on the Internet; and (3) a dimension of negative beliefs about Internet contacts which was not psychometrically stable. Safety referred to physical and HIV-related safety. We formed two scales to describe the first two dimensions. Respondents who were high on the 'liking cybersex: perceived anonymity and safety' scale were more likely than low scorers to use chat-rooms and webcams. They were also more likely than low scorers to have had cybersex and phone sex before meeting. Those who were high on the 'IRL interaction' scale were more likely than low scorers to use e-mail, bulletin boards and paid websites. However, there was significantly less disclosure about HIV status and discussion about safer sex by those higher on the 'IRL interaction scale', and when sex in real life did occur, those higher on the 'IRL interaction' scale were more likely to have receptive oral or anal sex, whereas those high on the 'liking cybersex: perceived anonymity/safety' scale were less likely to have insertive sex or be drunk/high. MISM scoring high on the 'IRL interaction' scale were significantly more likely than low scorers to prefer to meet partners on the Internet. We discuss the implications of the Internet for MSM and for sexual IRL interactions in the Internet age.

This randomized controlled trial evaluated an innovative culturally specific sexual health intervention-targeting, but not limited to, low-income African American women-in which HIV and sexually transmitted disease prevention strategies were combined with comprehensive sexuality education. The intervention was delivered and evaluated in community-based settings to 218 participants randomly assigned to treatment or a no-treatment control group. Participants were interviewed at pretest and 3 and 9 months after the intervention to assess changes in both sexuality and HIV risk variables. The intervention was effective in improving sexual anatomy knowledge at both 3- and 9-month follow-up. For a subset of women engaging in unprotected sex at pretest, the intervention group reported an increase in positive attitudes toward the female condom at 9-month follow-up. Reasons for the weak treatment effect are discussed in the context of challenges inherent in conducting community-based research with high-risk populations and sensitive topics. Recommendations are provided for improving sample attrition, statistical power, and response bias and for altering the intervention so as to strengthen its impact.

To date, publicly funded HIV/AIDS prevention efforts for homosexually active men have largely been limited to two traditional public health strategies: mass media information campaigns and HIV testing/contact notification programs. Health educators using either of these strategies have addressed the spread of HIV as they would many other infectious diseases and have relied heavily upon fear tactics or moral arguments to 'sell' the concept of safer sex. Grass-roots gay community efforts to prevent HIV transmission have also largely relied upon these two strategies, as well as upon more informal individual and group counseling activities. In general, however, strategies used by the gay community have tried to present more positive approaches to AIDS prevention, including eroticizing safer sex practices. This article reviews the efficacy of traditional public health approaches as well as the educational models underlying them, and argues that a major shift in focus is needed. A comprehensive health care and sexuality education model for homosexually active men based on the 'PLISSIST' sex therapy model is described and advocated. This model is presented as a more useful one for identifying populations at risk, reducing unsafe sexual behavior and promoting safer sex maintenance. The model identifies five sub-populations among homosexually active men and recommends specialized interventions appropriate to each. Adequate funding for the services included in this model is also advocated.