Social Determinants of HIV Among Men Who Have Sex with Men in Cape Town

Little is known about how social factors influence vulnerability to, and consequences of, HIV infection among men who have sex with men (MSM) in South Africa. This study aimed to analyse social stratification and its links with HIV among MSM in Cape Town, South Africa. Six interviews and six focus group discussions (n = 25) were conducted. Tools were based on the World Health Organisation’s Commission on the Social Determinants of Health framework. Directed content analysis was used to analyse data. Race and education were directly linked to social position. MSM from lower social positions were more vulnerable to HIV, and had more negative consequences of HIV infection, compared to wealthier MSM. Engagement with community leaders, health workers and police to promote inclusion could reduce vulnerability of MSM to HIV. Increased access to free, non-discriminatory HIV-related services would reduce inequities in access to HIV services by MSM.     

A Comparison of Sexual Relationships Among Hispanic Men by Sexual Orientation: Implications for HIV/STI Prevention

Hispanic men experience high rates of HIV infection and other sexually transmitted infections (STIs) when compared to non-Hispanic whites. Many factors contribute to HIV/STI risk among Hispanic men. Some researchers have suggested that primary relationships may be a source of HIV/STIs because some men engage in sexual relationships outside of the primary relationship. However, little is known about this among Hispanic men, and less is known about how sexual relationships differ by sexual orientation. The purpose of this study was twofold: (1) to determine if Hispanic men engage in sexual relationships outside of primary relationships; and (2) to compare sex outside of primary relationships by sexual orientation. Data for this study were obtained from a larger study that investigated health risks of Hispanic men residing in the U.S.–Mexico border community. Participants were recruited from agencies that provided services to Hispanic men. Participants completed a structured interview that included questions about primary relationships and sex outside of primary relationships. The sample consisted of 103 Hispanic men (50 heterosexual, 43 gay, and 10 bisexual Hispanic men), but two participants refused to answer relationship questions, resulting in a sample of 101 Hispanic men. About one-third of the participants (n = 29) reported sex outside of the primary relationship, but no differences were found between the gay/bisexual and heterosexual men, X ² (2, N = 101) = 9.91, p = .128. More gay/bisexual men reported sex with the primary partner and another person at the same time than heterosexual men, X ² (2, N = 101) = 13.32, p = .010. More gay/bisexual men reported open relationships when compared to heterosexual men, X ² (2, N = 101) = 17.23, p = .008, and more gay/bisexual men reported sex outside the primary relationship without the primary partner’s knowledge, X ² (2, N = 101) = 15.09. p = .020. However, more heterosexual men reported that condoms were not used for sex outside the primary relationship when compared to gay/bisexual men, X ² (2, N = 101) = 14.01, p = .029. Sex outside of primary relationships presents some implications for HIV/STI prevention among Hispanic men. Because gay/bisexual men experience higher rates of HIV/STI, more attention needs to be focused on all forms of relationships to prevent acquisition of HIV/STIs. Among heterosexual Hispanic men more attention needs to be given to reinforcement of safer sex practices both outside the primary relationship, and within the primary relationship if high risk sex is occurring outside the primary relationship. More research is needed on the reasons for sex outside the primary relationship among Hispanic men, as well as research to promote safer sex practices when sex occurs outside of the primary relationship.     

The Influence of Religion and Spirituality on HIV Prevention Among Black and Latino Men Who Have Sex with Men,New York City

Journal of Religion and Health - The influence of religion and spirituality (R/S) on HIV prevention has been understudied, especially for Black and/or Latino men who have sex with men (BLMSM), who...     

Performance of the Duke Religion Index and the Spiritual Well-Being Scale in Online Samples of Men Who Have Sex with Men

Religiosity is associated with behaviors that reduce the risk of HIV/STI infection among general-population and heterosexual-specific samples. Whether this association is similar to homosexual persons is unknown. Measures of religiosity have not been evaluated psychometrically among men who have sex with men (MSM), a population who, because of stigma, experience religiosity differently than heterosexual persons. We assessed the duke religion index and the spiritual well-being in two samples of MSM. Neither instrument produced adequate model fit. To study the association between religiosity and HIV/STI risk behaviors among MSM, scales are needed that measure the religious and spiritual experiences of MSM.     

Examining the relationship between use of sexually explicit media and sexual risk behavior in a sample of men who have sex with men in Norway

The purpose of this study was to investigate consumption patterns of gay‐oriented sexually explicit media (SEM) among men who have sex with men (MSM) in Norway, with a particular emphasis on a possible relationship between gay SEM consumption and HIV risk behavior. Participants included 529 MSM living in Norway recruited online to complete a SEM consumption and sexual risk survey. Of the 507 participants who responded to the all items measuring exposure to SEM, 19% reported unprotected anal intercourse with a casual partner (UAI) in last 90 days, and 14% reported having had sero‐discordant UAI. Among those with UAI experience, 23% reported receptive anal intercourse (R‐UAI) and 37% reported insertive anal intercourse (I‐UAI). SEM consumption was found to be significantly associated with sexual risk behaviors. Participants with increased consumption of bareback SEM reported higher odds of UAI and I‐UAI after adjusting for other factors using multivariable statistics. MSM who started using SEM at a later age reported lower odds of UAI and I‐UAI than MSM who started earlier. Future research should aim at understanding how MSM develop and maintain SEM preferences and the relationship between developmental and maintenance factors and HIV sexual risk behavior.     

Roman Catholic Gay Priests: Internalized Homophobia, Sexual Identity, and Psychological Well-Being

Using convenience sampling, a national sample of 156 actively ministering or retired Roman Catholic priests was obtained. One hundred and five (105) of these priests identified as gay/homosexual (67.3 %), 42 identified as heterosexual (26.9 %), and 9 identified as bisexual (5.8 %). Due to the small number of bisexual participants, the bisexual priests’ responses were excluded, and the whole sample was divided into a gay/homosexual group and a heterosexual comparison group. This confidential study yielded a response rate of 78 %. The priests were mailed self-report survey instruments, including the Scales of Psychological Well-Being, the Internalized Homonegativity Inventory, the Gay Identity Questionnaire, the Depression-Happiness Scale, and the Marlowe-Crowne Social Desirability Scale, as well as a demographics questionnaire. Results demonstrated that internalized homophobia was negatively correlated with psychological well-being and associated with depression. Internalized homophobia was also found to be related to less integration of sexual identity. There was no significant difference between the gay/homosexual and the heterosexual group in their psychological well-being and depression scores, and both groups emerged as high scorers on the measures of psychological well-being and depression-happiness (high scores on this bipolar instrument indicate happiness). Implications and limitations of the study are reviewed and discussed.     

Optimizing Contingency Management With Methamphetamine-Using Men Who Have Sex With Men

Among men who have sex with men (MSM), methamphetamine use is associated with multiple, overlapping syndemic conditions including increased risk for HIV seroconversion and onward HIV transmission. Contingency management (CM) is an evidence-based behavioral intervention implemented to curb methamphetamine use and optimize HIV/AIDS prevention among MSM in San Francisco since 2003. We conducted a program evaluation to document the evolution of this 12-week CM program to include delivery of brief, individual counseling incorporating motivational interviewing and behavioral skills. A drop-in group delivered concurrently with CM urine-screening visits also provides peer support as well as referrals for other social and medical services. From December 2011–October 2013, a total of 131 clients enrolled in the CM program and provided a median of 22 urine samples (Interquartile Range = 10–34) that were nonreactive for methamphetamine. Findings support the feasibility and acceptability of integrating individual and group counseling with community-based CM for methamphetamine-using MSM.     

Virtual and physical venues as contexts for HIV risk among rural men who have sex with men.

Rural men who have sex with men (MSM) have few identifiable venues in which to congregate and meet potential sex partners. The Internet provides a venue for rural MSM to meet, and this is potentially troubling because studies of urban MSM suggest that HIV risk is higher for men who date online. The goals of this study were to identify venues where rural MSM meet their sexual partners and to examine their association with high-risk sexual practices. Six hundred sixty-three predominantly single, gay, Caucasian MSM completed an online survey of their sexual activities. Results showed that the Internet and bars were the most popular venues for meeting sex partners. Highest rates of risk behaviors were associated with Internet dating and venues in which immediate sexual encounters typically occur, suggesting that prevention in rural areas should target multiple-risk environments.     

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample

In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD?=?5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR?=?0.85, 95% CI: 0.78-0.93; social support AOR?=?0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR?=?0.79, 95% CI: 0.71-0.89; social support AOR?=?0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR?=?0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.     

Sexually Explicit Media and Sexual Risk Behavior in a Sample of Men Who Have Sex with Men in Norway

The aim of this study was to explore the association between the consumption of sexually explicit media (SEM) depicting condom and non-condom use and HIV/STI-related sexual risk behavior among men who have sex with men (MSM) in Norway. We also explored whether the association between SEM consumption and STI-related sexual risk behavior is mediated by men’s sexual self-esteem and/or condom use self-efficacy. A cross-sectional online survey study was carried out in Norway in 2012. The final sample comprised 529 MSM in Norway. There was a bivariate association between the use of SEM picturing condom use and less STI-related sexual risk behavior. Further, the association between SEM consumption and sexual risk behavior was mediated by condom use self-efficacy. However, SEM did not influence sexual risk behavior via sexual self-esteem. The results offer important cross-cultural validation of recent comparative data from the US and may be used to promote HIV/STI prevention, in the sense that the actors in SEM may serve as role models in managing condom use in sexual contexts.     

Insert Discourse: Rectal Douching Among Young HIV-Positive and HIV-Negative Men Who Have Sex with Men in Vancouver,Canada

Douching is a common practice among certain groups of women and MSM, and it is conducted for the purpose of cleanliness as part of bodily hygiene maintenance. Although there has been considerable research about female vaginal douching, understandings of rectal douching (RD) for MSM are limited. In the epidemiological and medical literature, RD is presented as a behaviour that removes beneficial bacteria and the surface epithelium layer of the colon, which can, potentially, increase the risk of HIV transmission in MSM. The paucity of research on male douching practices is curious given the primacy of anal sex in HIV prevention initiatives and the widespread nature of rectal douching among this population. This paper provides preliminary data on RD and is intended to engender a dialogue about male douching and the need for additional research into the cultural construction of the body among MSM, namely with respect to the anus. Findings were derived from qualitative interviews with 12 young HIV-positive men who had recently become HIV-infected and 12 HIV-negative age-matched counterparts who were participating in a prospective cohort study. Beliefs about RD differed according to HIV serostatus; HIV-positive men discussed the practice much more openly than their counterparts did. Pre-coital RD is an embedded behaviour about which very little is known. However, it is a critical issue to include in the development of effective HIV prevention strategies and warrants an acknowledgement of importance of the anus in the lives, sexual practices, and identities among MSM.     

Self regard and concealment of homosexuality as predictors of CD4+ cell count over time among hiv seropositive gay men

Living with HIV can challenge core features of a person’s sense of identity and ultimately lead to a diminished sense of self regard. Self-regard has been defined as the extent to which a person experiences an integrated sense of identity. Gay men with HIV may also face struggles related to their identity in deciding whether to disclose or conceal their homosexuality. This study examined whether concealment of homosexuality and a person’s sense of self regard would be associated with CD4+ cell count over time among HIV seropositive gay men. 53 HIV seropositive gay men completed questionnaires at one time point. CD4+ cell counts were measured at the time of questionnaire completion and 24 months later. Greater self regard at baseline was associated with higher CD4+ counts at 24 months. The association between baseline self regard and CD4+ count at 24 months was strongest among persons with less concealment of homosexuality.     

Single-Session Personalized Cognitive Counseling to Change HIV Risk Behavior Among HIV-Negative Men Who Have Sex With Men: A Two-Part Case Study

Two previous randomized controlled clinical trials have shown the effectiveness of a single-session cognitive intervention, personalized cognitive counseling (PCC), in decreasing HIV risk among men who have sex with men (MSM; Dilley et al., 2002; Dilley et al., 2007). PCC is a counseling technique based on social cognitive theory and the stages of change model and incorporates techniques from cognitive therapy and motivational interviewing. Theoretically, PCC encourages the client to examine his self-justifications, or rationalizations, at the time of intercourse, so he will better understand the thinking behind his decision to have unprotected anal sex. Upon exploring self-justifications that increased risk, we hypothesize that men became more self-aware of the ways in which they made sexual decisions and were thereby better prepared to more realistically assess risk in future sexual situations and make different decisions to decrease their HIV risk.This case study analyzes the PCC intervention of 2 HIV-negative men who have high-risk unprotected sex with men of uncertain HIV status. We present excerpts from the recordings of the interventions to better understand how the technique works. We believe that PCC can be a powerful tool in changing HIV risk behavior and merits more application and study to decrease HIV transmission.     

Predictors of HIV-related stigma among young people living with HIV.

Enacted and perceived HIV stigma was examined among substance-using young people living with HIV (YPLH) in Los Angeles, San Francisco, and New York City (N = 147). Almost all YPLH (89%) reported perceived stigma, and 31% reported enacted experiences in the past 3 months; 64% reported experiences during their lifetime. The HIV stigma questions were characterized by factors of avoidance, social rejection, abuse, and shame. In multivariate models, enacted stigma was associated with gay or bisexual identity, symptomatic HIV or AIDS, and bartering sex. Perceived stigma was associated with female gender, symptomatic HIV or AIDS, bartering sex, lower injection drug use, and fewer friends and family knowing serostatus. Gay or bisexual YPLH who were also HIV symptomatic or AIDS diagnosed experienced more HIV stigma than their heterosexual peers.     

Sexual Debut Ages in Heterosexual,Lesbian, Gay,and Bisexual Young Adults in Norway

This study estimates sexual debut ages in young heterosexual, lesbian, gay, and bisexual men and women in Norway. A questionnaire survey was completed online by 27.2 % of a representative national web sample of 2090 persons aged 18–29 years. Three self-selected samples of 924 respondents completed an extended version of the survey online. Lesbian and bisexual women reported earlier experience of orgasm through masturbation than heterosexual women (median 13.1 vs. 15.2 years), and heterosexual men (median 13.5) reported earlier debut than heterosexual women. There was a statistically significant difference between heterosexual and lesbian and bisexual women’s age at the first experience of receptive vaginal sex (median 16.8 vs. 15.4 years). As regards experience of insertive vaginal sex, a significantly higher percentage of heterosexual men than women, and of heterosexual and lesbian and bisexual women, reported experience. It was more common among lesbian and bisexual women than heterosexual women to have had oral sex with another woman, but in neither group did the cumulative percent reach 50 % by the age of 29 years and the median could not be estimated. Gay and bisexual men reported earlier receptive anal sex debut than heterosexual men. With regard to insertive anal sex, gay and bisexual men accumulated experience earlier than heterosexual men, and lesbian and bisexual women acquired this experience earlier than heterosexual women. Compared to heterosexuals, LGB persons of both genders engage in more varied sexual activities. Lesbian and gay persons have same-sex experiences at an earlier age than bisexuals.     

Integrated Cognitive Behavioral Therapy for Social Anxiety and HIV Prevention for Gay and Bisexual Men

Little information is available to cognitive-behavioral therapists about how to integrate HIV prevention into standard cognitive behavioral (CBT) treatments among gay and bisexual men, especially for those gay and bisexual men who are at risk for contracting HIV due to their social anxiety. The purpose of the present paper is to assist cognitive behavioral therapists who are treating HIV-negative gay and bisexual men who have high social anxiety. This paper provides an overview of the extant research on social anxiety and its effects on sexual risk behaviors and how to integrate these two types of problems into a coherent treatment plan for gay and bisexual men. The treatment described here uses the framework of CBT for social anxiety (e.g., Hope, Heimberg, & Turk, 2010) and adapts it to include substance use management in interpersonal situations and to reduce sexual risk behavior. The application of empirically supported therapy techniques to reduce both social anxiety and HIV risk behavior for gay and bisexual men is illustrated using three case examples. The present treatment is potentially appropriate for HIV-negative gay and bisexual men who present with social anxiety and who wish to remain HIV-negative by decreasing their sexual risk behavior.     

The Gay and Lesbian Affirmative Development (GLAD) Model: Facilitating Positive Gay Identity Development

The Gay and Lesbian Affirmative Development (GLAD) model, a proactive, gay‐affirmative counseling approach, is proposed Parallels are drawn between Cass's (1979) Homosexual Identity Formation model and Ivey's (1990) cognitive‐behavioral Developmental Counseling Therapy model to help counselors assess and facilitate gay and lesbian clients' cognitive development related to the formation of a positive sexual orientation identity.     

Relationship Between Acculturation and Attitudes Toward Gay Men and Lesbians in the Vietnamese American Community

We examined the impact of acculturation on attitudes toward gay men and lesbians in the Vietnamese American community. We recruited 114 Vietnamese American participants at a large community organization. The Suinn–Lew Asian Self‐Identity Acculturation Scale ( Suinn, 1992 ) was used to measure participants' acculturation levels, while the Attitudes Toward Lesbian and Gay Men Scale ( Herek, 2004 ) was used to measure participants' attitudes toward homosexuality. It was hypothesized that Vietnamese Americans with higher levels of acculturation would have more positive attitudes toward homosexuality. The results supported this hypothesis. Additionally, we found a complicated pattern of results explaining attitudes based on acculturation level, age, and gender.