Validation of depressive symptoms, social support, and minority stress scales among gay, bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: a mixed methods approach

BACKGROUND

Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Global North. The validity and reliability of these instruments-to our knowledge-have never been thoroughly investigated among GBMSM in Nigeria. The aim of the current study was to determine the validity and reliability of the English versions of the Center for Epidemiologic Studies Depression Scale (CESD-R), Multidimensional Scale of Perceived Social Support (MSPSS), and LGBT Minority Stress Measure among a large multi-state sample of GBMSM Nigeria.

METHODS

Between January and June 2019, we conducted cognitive interviews (N = 30) and quantitative assessments (N = 406) with GBMSM in Nigeria. The cognitive interviews assessed comprehension of scale items and elicited suggestions for scale modifications. The quantitative assessment was used to gather psychosocial health data and to evaluate psychometric properties and construct validity of the modified scales. We utilized confirmatory factor analysis to assess factor structure, correlation coefficients, and Cronbach's alpha to examine scale validity and internal consistency.

RESULTS

Based on participant feedback from the cognitive interviews, we made slight modifications (i.e., culturally appropriate word substitutions) to all three scales. Results of quantitative analyses indicated good psychometric properties including high factor loadings, internal consistency and construct validity among the CESD-R, MSPSS, and LGBT Minority Stress Measure among GBMSM in Nigeria.

CONCLUSION

These results suggests that modifying research scales to be more culturally relevant likely do not jeopardize their validity and reliability. We found that modified scales measuring depressive symptoms, perceived social support, and minority stress among GBMSM in Nigeria remained valid. More research is needed to explore whether the psychometric properties remain if the scales are translated into broken English (Pidgin) and other traditional Nigerian languages (Yoruba, Igbo and Hausa).

Awareness of and intention to use an online sexually transmitted and blood-borne infection testing service among gay and bisexual men in British Columbia, two years after implementation

Objectives

This study assessed gay, bisexual, and other men who have sex with men’s (GBMSM) awareness of and intention to use GetCheckedOnline, an online sexually transmitted and blood-borne infection (STBBI) testing service.

Methods

A cross-sectional study was conducted two years after launch among GBMSM > 18 years of age in British Columbia, Canada. Participants were recruited through community venues, clinics, websites, and apps.

Results

Of 1272 participants, 32% were aware of GetCheckedOnline. Gay identity, regularly testing at an STBBI clinic, being out to one’s healthcare provider, attending GBMSM community venues, and frequent social media use were associated with awareness. Among participants who were aware but had not used GetCheckedOnline, knowing GetCheckedOnline users, using social media, not knowing where else to test, and not wanting to see a doctor were associated with intention to use GetCheckedOnline.

Conclusion

Early promotion of GetCheckedOnline resulted in greater awareness among those connected to GBMSM.

Very High HIV Incidence and Associated Risk Factors in a Longitudinal Cohort Study of Diverse Adolescent and Young Adult Men Who Have Sex with Men and Transgender Women

To report HIV incidence and associated factors among young men who have sex with men (YMSM) and transgender women (TW). Data were collected February 2015 to July 2018 in the RADAR longitudinal cohort study of YMSM/TW aged 16-29 years (N = 1093). Data included tests for HIV and rectal STIs and self-reported sexual behaviors and networks characteristics. HIV incidence rates were 2.91 per 100 person years (44 seroconversions among 1513 person years). Incidence was significantly higher in Black participants than white (IRR 8.81; 95% CI 2.72-45.26) and Latinx (IRR 3.15; 1.49-7.28) participants, but no significant differences by gender identity were found. Testing positive for rectal STIs (HR 2.50; 95% CI 1.27-4.92) and sex with a partner from a high HIV incidence community area (HR 2.46; 95% CI 1.19-5.07) were associated with higher incidence. HIV incidence was very high and Black YMSM/TW experienced higher HIV incidence attributable to partner race and geographic residence. Rectal STIs were associated with increased HIV incidence.

Gay Men's Relationship Agreements in the Era of Pre-exposure Prophylaxis: An Analysis of Australian Behavioural Surveillance Data

Using repeated, cross-sectional behavioural surveillance data from Australia, we assessed trends in relationship agreements and casual sex among HIV-negative and untested gay and bisexual men who had regular partners during 2013-2018. We conducted three analyses: (i) trends in relationship agreements and casual sex over time; (ii) bivariate comparisons of PrEP users and non-PrEP-users to identify factors associated with PrEP use; and (iii) multivariate logistic regression to identify factors independently associated with PrEP use. The analysis of trends over time included 21,593 men, from which a sub-sample (n = 3764) was used to compare PrEP users and non-PrEP-users. We found a large increase in agreements that allowed condomless sex with casual partners, particularly by PrEP users in relationships (nearly 40% of whom had such an agreement). A further 34% of PrEP users reported having casual condomless sex without an agreement that permitted that behaviour, while 13% of non-PrEP-users also reported condomless sex with casual partners without an agreement. PrEP use was independently associated with having agreements permitting condomless sex with casual partners, recent condomless sex with casual partners, having greater numbers of male partners, recent post-exposure prophylaxis use, having an HIV-positive regular male partner, and recent condomless sex with regular male partners. Our findings show a shift away from relationship agreements in which condomless sex was only sanctioned between regular partners.

Demographic, Behavioral, and Geographic Differences Between Men, Transmen, and Transwomen Currently on PrEP, Former PrEP Users, and Those Having Never Used PrEP

Many recent studies have compared men currently taking pre-exposure prophylaxis (PrEP) to men not taking PrEP. However, less is known about demographic, behavioral, and geographic characteristics of men formerly, but not currently, taking PrEP. Using a 2017-2018 U.S. national, internet-based sample (n = 10,504) of men, transmen, and transwomen who have sex with men, we compared three groups based on their PrEP experiences. Results highlight individual-level financial and geo-contextual barriers to PrEP use that can inform prevention efforts to improve PrEP initiation and continuation for both PrEP-naïve and PrEP-experienced individuals, respectively.

HCV knowledge, disclosure practices, and risk perceptions among gay and bisexual men who do and do not engage in group sex while using drugs

ABSTRACT Research suggests that hepatitis C virus (HCV) transmission is more likely among gay and bisexual men (GBM) who engage in sexually adventurous practices, including group sex while using drugs. The current study explored drug use, sexual practices, HCV knowledge, HCV disclosure, and beliefs about HCV transmission among GBM (n = 193) reporting group sex after/while using drugs compared to those who did not. Survey findings indicate that men who participated in group sex while using drugs were more likely to have engaged in other sexually adventurous practices, ever injected drugs, have greater knowledge of HCV, and to be living with HIV. They were also more likely to perceive themselves at risk of acquiring HCV and to know that their sexual activities put them at risk. Interestingly, they had lower expectations of HCV disclosure and were less concerned about the HCV status of their partners. The lower expectations around disclosure and concern about the HCV status of their partners reflect the challenges for GBM in managing HCV transmission where there are limited effective behavioural strategies for reducing sexual transmission, This research also highlights the need to promote HCV testing and treatment to GBM who engage in group sex while using drugs.

How Male Sex Workers and Their Clients Shifted from Reluctance About HIV Pre-exposure Prophylaxis to Advocating for Its Use: A Longitudinal Mixed Methods Study

We assessed individual and collective responses to HIV pre-exposure prophylaxis ('PrEP') among a network of male sex workers and clients. From 2011 to May 2017, keyword searches on an online discussion forum identified 668 posts that referenced PrEP. We conducted four analyses: (i) discourse analysis identifying reactions to PrEP, (ii) thematic analysis constructing rhetorical strategies, (iii) content analysis comparing discursive positions and rhetorical strategies, and (iv) longitudinal analyses assessing trends over time. Forum posts adopted one of three discursive positions (reluctance, interest, advocacy), drawing upon four non-exclusive strategies (deference to experts and evidence, acknowledging personal and shared experiences, establishing philosophical arguments, engaging in speculation). Posts from sex workers were more likely than clients to be supportive of PrEP (96% vs. 42%; χ² = 18.46, p < 0.001) while over time this network moved from being predominantly reluctant about PrEP (61% of posts in 2012) to advocating for its use (65% of posts in 2017; Z = 5.01, p < 0.001).

Gay and Bisexual Men's Strategies to Maintain Daily Adherence to Their HIV Pre-exposure Prophylaxis (PrEP) Medication: Results from a Qualitative Study

Since FDA approval in 2012, HIV pre-exposure prophylaxis (PrEP) has been adopted by key populations, including gay and bisexual men (GBM), to reduce their HIV transmission risk. Given that PrEP is optimally effective when taken as prescribed, it is critical to understand the adherence strategies GBM use. We conducted one-on-one, semi-structured interviews with GBM taking PrEP in 2015-2016 (n = 103). Using thematic analysis, we identified six adherence strategies, with most participants (84.3%) utilizing multiple strategies to maintain adequate adherence: (1) integrating PrEP into part of a daily routine, (2) using a pillbox, (3) cognitive strategies/visual cues, (4) setting recurring smartphone alarms or reminders, (5) keeping medication on oneself at all times, and (6) partner or peer support for reminders and/or pill sharing. Overall, participants reported high PrEP adherence (M = 1.6 missed doses in the prior 30 days), though nearly all described missing at least one dose unintentionally in the past. Participants credited their high levels of adherence in part to the strategies they adopted. Providers working with GBM prescribed PrEP, especially patients reporting difficulties with adherence, might consider recommending any or all of the six strategies described in this study.

Destabilising the 'problem' of chemsex: Diversity in settings, relations and practices revealed in Australian gay and bisexual men's crystal methamphetamine use

In Australia, the crystalline form of methamphetamine ("crystal") is a commonly used illicit substance associated with sexual activity among gay and bisexual men. Attention to psychoactive substance use among this population is the subject of increasing global concern regarding the intentional and simultaneous combination of sex and drugs, often referred to as "chemsex". While not all gay and bisexual men who use psychoactive substances report problematic use, those who do often become representative of chemsex practices more generally, and the harms they experience become attributable to all men who use drugs for sex. The way in which these practices have been framed over the past few decades contributes to the rise of a narrow set of understandings of chemsex defined by the circumstances and behaviours presumed of drug-enhanced sexual activity. In effect, these understandings now align recognisable combinations of sexual and drug-using practices with assumed correlates of risk. The Crystal, Pleasures and Sex between Men study conducted 88 interviews with gay and bisexual men in four Australian cities between 2017 and 2018. Findings from the project revealed that men used crystal in a variety of settings and relations, which mediated their sexual practices and patterns of use. In looking at the wider context in which practices were associated with the combination of sex and drugs, we identified experiences that the contemporary discourse of chemsex-in its rhetorical proposition of at-risk behaviours and circumstances-may leave out of consideration. Our findings indicate that researchers should remain open to the variability and contingency of settings, relations and practices in gay and bisexual men's different networks when recommending public health responses to their engagement in drug-enhanced sexual activity. Accordingly, we seek to destabilise the definition of chemsex that precludes consideration of the influence of experiences beyond pre-determined risk parameters.

Substance use patterns and awareness of biomedical HIV prevention strategies among sexual and gender minority men in Canada

Sexual and gender minority men (SGMM) who use drugs are frequently cited as at-risk for HIV. Fortunately, biomedical prevention can greatly reduce transmission, provided individuals are aware of and interested in the uptake of these strategies. We examined associations between substance use patterns and biomedical prevention among SGMM in Canada. Latent class analysis identified patterns of substance use. Demographic-adjusted logistic regression models assessed the associations between latent classes and key biomedical prevention indicators. Among 669 participants living with HIV (PLWH) and 7,184 HIV-negative participants, six substance use classes characterized "limited" (46.0%; infrequent/low use of drugs), "common" (31.9%; alcohol, cannabis, and tobacco), "club" (5.2%; alcohol, cocaine, and psychedelics), "sex" (4.8%; alcohol, crystal methamphetamine, GHB, poppers, and erectile drugs), "prescription" (11.0%; alcohol and prescription drugs), and "polydrug" (1.1%; most drugs) use. HIV-negative men in the "prescription" and "sex" substance use classes were more likely to know about the preventive benefits of HIV treatment. All non-"limited use" HIV-negative men were more likely to report interest in taking pre-exposure prophylaxis (PrEP). For PLWH, substance use patterns were not associated with detectable viral loads or treatment awareness. While PLWH exhibited high levels of undetectability and treatment awareness regardless of substance use class, a variety of substance use patterns were associated with increased awareness, interest, and uptake of risk management strategies among HIV-negative participants.

Prevalence, frequency, and motivations for alkyl nitrite use among gay, bisexual and other men who have sex with men in Australia

BACKGROUND AND AIMS

Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for poppers use and their relationship with HIV risk. We also discuss the implications of the recent scheduling changes to poppers by the Australian Therapeutic Goods Administration.

METHODS

Data were drawn from the Following Lives Undergoing Change (Flux) study, a prospective observational study of licit and illicit drug use among GBM. Between 2014 and 2018, 3273 GBM enrolled in the study. In 2018, 1745 GBM provided data relating to frequency of and motivations for poppers use and were included in this analysis.

RESULTS

Median age was 33 years (IQR 25-46) and 801 GBM (45.9%) had used poppers in the previous six months ('recent use'). Among these men, 195 (24.3%) had used them weekly or more frequently. Most recent users (77.4%) reported using poppers for a 'buzz' during sex or to facilitate receptive anal intercourse (60.8%). The majority (57.7%) of HIV-negative men reporting recent poppers use were concurrently taking HIV pre-exposure prophylaxis. Recent poppers use was independently associated with receptive anal intercourse with casual partners (aOR 1.71; 95%CI 1.35-2.16) and chemsex (aOR 4.32; 95%CI 3.15-5.94). Poppers use was not associated with anxiety, depression, or drug-related harms. Only 15.4% of current users indicated they would stop using poppers if they were criminalised; 65.0% said they would 'find other ways' to obtain them.

CONCLUSIONS

Poppers are commonly used by Australian GBM to functionally enhance sexual experiences, particularly to facilitate receptive anal intercourse. Few men experienced drug-related harms from poppers use. Regulatory changes must ensure potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma.

The Impact of Pre-Exposure Prophylaxis on Sexual Communication and Sexual Behavior of Urban Gay and Bisexual Men

Pre-exposure prophylaxis (PrEP) has altered the public health landscape for gay, bisexual, and other men who have sex with men (GBM) by significantly increasing protection against HIV infection. Early epidemiologic data showed GBM generally used PrEP as prescribed, i.e., as an additional protective tool over and above barrier protection, although subsequent reports have been equivocal. Irrespective of population-level trends, some GBM appear to have reevaluated their HIV risk tolerance and changed their interactions with sex partners. Scant published data have focused on factors that influence PrEP-using GBM's decisions about sexual behavior-including condom use as well as sex with HIV-positive partners-and sexual communication practices. Thus, in this study, we investigated those research concerns qualitatively via content analysis of individual interviews conducted with 103 GBM in New York City (M age 32.5 years, 50% White, 64% on PrEP > 6 months). Emergent themes reflect (1) participants' strong HIV knowledge; (2) changing GBM community norms about condom use on PrEP; (3) increased focus on risk tolerance with individual differences in post-PrEP condom use; (4) appreciation for routine sexually transmitted infection (STI) screening in PrEP care concomitant with some STI knowledge deficits; (5) decreased stigma concerning, and greater comfort with, HIV-positive sex partners; and (6) increased confidence discussing HIV status and condom use preferences with partners. Findings have implications for future research as well as for clinical practice, such as enhanced STI education and provider-initiated discussions about risk compensation, serosorting, and sexual communication skills.

Escape expectancies and sexualized substance use among gay, bisexual, and other men who have sex with men

McKirnan's Cognitive Escape Theory (1996) is often characterized by the hypothesis that drugs are used during sex by gay, bisexual, and other men who have sex with men (gbMSM) to relieve internal cognitive conflict over safe-sex norms and sexual desire. We examined how McKirnan's Cognitive Escape Scale (CES) is related to other widely used constructs relevant to sexualized substance use with hopes of better situating the theory within the evolving landscape of HIV-prevention. Associations between CES and trait anxiety, depression, treatment optimism, sexual altruism, sexual sensation seeking, and self-perceived risk for HIV transmission/acquisition were tested. Mediation analyses tested whether associated psychological measures mediated the effect of CES on the proportion of events in which participants reported co-occurrent substance use and condomless anal sex. Results indicated that CES is associated with higher sexual sensation seeking, treatment optimism, trait anxiety, and perceived likelihood of HIV transmission/acquisition. Mediation analyses suggest that CES is related to but operates independently of treatment optimism, sensation seeking, and trait anxiety. Nevertheless, the intersection of HIV-related worries and substance use expectancies are clearly more nuanced than is widely reported is discussions on cognitive escape.

Pleasure and HIV biomedical discourse: The structuring of sexual and drug-related risks for gay and bisexual men who Party-n-Play

Party-n-Play (PNP) is a social practice that refers to sex that occurs under the influence of drugs. This study critically examined the risk and pleasure discourses of gay and bisexual men who PNP to explore how epistemic shifts associated with advancements in HIV biomedical sciences influence gay and bisexual men's perceptions of HIV risks and their sexual and drug-related practices. This study also aims to provide a more nuanced understanding of how sexual and drug-related risk practices of gay and bisexual men are entangled with their search for pleasure. The study was framed within poststructural Critical Discourse Analysis (CDA) methodology. In-depth one-hour interviews were conducted with 44 self-identified gay, bisexual, queer, or Two-Spirit men, who lived in Toronto, and who reported using drugs before or during sex with another man. The findings from this study demonstrated the capacity of biomedical discourses to affect respondents' HIV risk perceptions and practices. The transition from condom-centered prevention to today's context where new highly effective biomedical tools for HIV prevention are available created possibilities for greater intimacy, increased pleasure, and less anxiety about HIV tranmission, while challenging many years of preventive socialization among gay and bisexual men. However, this new context also rekindled deep-seated fears about HIV risk and viral load verifiability, reinforced unequal forms of biomedical self-governance and citizenship, and reproduced practices of biopolitics. While discourses on risk and pleasure were interwoven within complex PNP assemblages, the notion of pleasure was mobilized as a discursive tactic of self-control, and the division between normative and non-normative pleasures highlighted the consequence of biopolitical forces governing the production of discourses on sex and drugs. Future HIV social science research needs to attend to the fluid nature of the discursive environments of HIV prevention science, and consider how both the material context of PNP and its social/discursive elements operate together.

High Adherence to HIV Pre-exposure Prophylaxis and No HIV Seroconversions Despite High Levels of Risk Behaviour and STIs: The Australian Demonstration Study PrELUDE

PrELUDE study evaluated daily pre-exposure prophylaxis (PrEP) in high-risk individuals in Australia. This open-label, single-arm study tested participants for HIV/STI and collected behavioural information three-monthly. We report trends over 18 months in medication adherence, side-effects, HIV/STI incidence and behaviour. 320 gay/bisexual men (GBM), 4 women and 3 transgender participants, followed on average 461 days, reported taking seven pills/week on 1,591 (88.5%) occasions and 4-6 pills/week on 153 (8.5%) occasions. No HIV infections were observed. STI incidence was high and stable, while gonorrhoea infections declined from 100.0 to 25.8/100 person-years between 6 and 15 months (p < 0.001). The number of HIV-positive and unknown-status sex partners, and condomless anal intercourse, significantly increased. In this high-risk cohort of mainly GBM, increases in risk behaviours and high STI incidence were not accompanied by HIV infections due to high adherence to daily PrEP. The study informed policy and further PrEP implementation among Australian GBM.

Recruiting vulnerable populations to participate in HIV prevention research: findings from the Together 5000 cohort study

PURPOSE

The aim of the article was to examine factors associated with completing enrollment milestones in the Together 5000 cohort of at-risk men (n = 8661), transmen (n = 53), and transwomen (n = 63) who have sex with men.

METHODS

Between 2017 and 2018, participants completed an online enrollment survey and were offered opportunities to complete an incentivized secondary online survey as well as self-administered at-home HIV testing (OraSure). We explored factors associated with completing each study component.

RESULTS

In total, 8777 individuals completed our enrollment survey, 6166 (70.3%) completed the secondary survey, and 5010 returned the at-home HIV test kit that was mailed to them (81.3% of those mailed a kit). In our multivariable models, those who were White, with more years of education, were more likely to complete study components, although the magnitude of these associations was small. For example, 50.9% of those enrolled, 47.9% of those completing the secondary survey, and 46.8% of those completing HIV testing were persons of color-a statistically significant, but meaningfully insignificant decline.

CONCLUSIONS

These findings highlight the need for researchers to identify barriers that may prevent persons of color and younger individuals from participating in research studies.

What's Sleep Got to Do with It?: Sleep Health and Sexual Risk-Taking Among Men Who have Sex with Men

Emerging evidence links poor sleep health with a range of adverse health behaviors, including condomless anal intercourse (CAI) among men who have sex with men (MSM). We tested associations between a range of sleep health indicators and sex outcomes in an online sample of 559 MSM in Paris France, recruited from a geosocial-networking phone application. Participants reported on sleep quality, sleep duration, problems falling asleep, and problems staying awake during wake-time activities, and four sex outcomes: numbers of receptive, insertive, and total CAI partners in the past three months, and use of substances before or during sex. In bivariate analyses, all four sleep variables were associated with the three CAI outcomes, whereas poor sleep quality and problems falling asleep were positively associated with using substances before or during sex. Most of these associations remained significant when adjusting for various socio-demographic and behavioral covariates. These findings highlight the importance of addressing sleep health to prevent HIV risk among MSM.

HIV Testing Among a Representative Community Sample of Gay, Bisexual, and Other Men Who Have Sex with Men in Vancouver, Canada

Earlier HIV diagnosis allows for improved treatment outcomes and secondary prevention. It is recommended that all individuals know their HIV status and that those at higher risk test more frequently. Using a representative community sample of gay, bisexual, and other men who have sex with men (GBMSM), we aimed to: (1) determine the proportion of GBMSM who have tested in the past 2 years, (2) determine reasons for testing and never having tested, and (3) explore correlates of testing. Of 535 eligible participants, 80.0% reported having had an HIV test in the past 2 years, most commonly as part of a regular testing schedule. The most common reason for not testing was low perceived HIV risk. Bisexual and older GBMSM, as well as those who lived outside of Vancouver, were less likely to have tested in the past 2 years. Rapid point-of-care testing may help improve testing rates and was shown to effectively engage some hard-to-reach GBMSM (e.g., those who had not tested for other STIs) in this sample.

"Condoms are … like public transit. It's something you want everyone else to take": Perceptions and use of condoms among HIV negative gay men in Vancouver, Canada in the era of biomedical and seroadaptive prevention

BACKGROUND

The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men.

METHODS

We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies.

RESULTS

Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk.

CONCLUSIONS

These findings indicate that notions of "safety" and "risk" based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men's current prevention needs. Interventions should advance gay men's communication and self-advocacy skills in order to optimize these strategies.

Interventions to address substance use and sexual risk among gay, bisexual and other men who have sex with men who use methamphetamine: A systematic review

BACKGROUND

Methamphetamine use is common among some populations of gay, bisexual and other men who have sex with men (gbMSM). This study reviewed the status of research on the efficacy of interventions that address harms among gbMSM who use methamphetamine.

METHODS

We searched MEDLINE, PsycINFO, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar to identify publications from inception to October 23, 2017, that assessed an intervention addressing methamphetamine use among gbMSM.

RESULTS

Of 1896 potential studies and 935 unique articles screened for inclusion, 28 eligible studies assessed 26 different interventions in the following categories: pharmacological (n = 5); psychosocial (n = 20); harm reduction (n = 1). Given that outcome variables were measured in highly variable ways, we were unable to conduct a meta-analysis of intervention effects. However, 22 studies reported a statistically significant effect on one or more methamphetamine-related outcomes. Among 21 studies that included measures of sexual health-related outcomes, 18 reported a significant effect on one or more sexual health-related outcomes, and 15 of those reported a concurrent effect on both drug- and sexual health-related outcomes.

CONCLUSIONS

This is the first review to provide compelling evidence that integrating interventions to address both drug- and sexual-related harms for gbMSM who use methamphetamine can be efficacious. Future research should focus on identifying differential effects of various intervention approaches by social positioning, as well as prioritize future evaluations of integrated harm reduction interventions (e.g., the distribution of harm reduction kits within sexual health care settings).

A Narrative Review of Internet Use, Interpersonal Connectedness, and Sexual Behaviour Among Gay, Bisexual and Other Men Who Have Sex With Men

Researchers have often considered the impact that online dating has had on gay communities; with some arguing that changes in social behavior may impact the spread of HIV. However, these conclusions are based on the premise that the Internet has fundamentally changed the way gay and bisexual men connect with their communities. Addressing this issue, we searched the PubMed and Web of Science databases for studies examining Internet use and interpersonal connectedness among gay and bisexual men to determine whether those who used the Internet to find sexual partners exhibited different patterns of community connectedness. Though sporadic, findings suggest that Internet use may be associated with lower gay identity, community attachment, and social embeddedness. However, recent reports have suggested that online sex seeking might be associated with greater, not less, interpersonal connectedness. We conclude that additional longitudinal analyses and consistent measurement of gay men's social behavior are needed to draw more definite conclusions.

Policing Heteronormativity and Sexual Risk-Taking Among Young Adult Men Who Have Sex with Men in the Detroit Metro Area

Policing gender and sexuality can have enduring health implications for the well-being of young men who have sex with men (YMSM). Using data from a community-based sample of YMSM in the Detroit Metro Area (N = 364), we examined the prevalence of lifetime heteronormative policing by gender (e.g., punished/restricted for femininity) and sexuality (e.g., attempts to alter same-sex attractions). We examined the associations of heteronormative policing attempts and the number of condomless insertive and receptive anal intercourse partners, respectively. We also tested whether internalized homophobia moderated the association between sexuality policing and sexual risk. Multivariable models demonstrated that policing sexuality, but not gender, was associated with a greater number of partners in which participants engaged in condomless intercourse as the receptive partner. We observed no interaction between policing sexuality and internalized homophobia. Multilevel efforts are needed to reduce the contribution of heteronormative policing on YMSM's HIV risk.

Perceived Social Norms About Oral PrEP Use: Differences Between African-American, Latino and White Gay, Bisexual and Other Men Who Have Sex with Men in Texas

Correct and consistent condom use has been the primary method of HIV prevention until the FDA approve the use of PrEP in 2012. While strong evidence existing regarding the efficacy of PrEP, uptake has remained slower than anticipated. While work is underway to better understand the factors impacting uptake, the majority of this work as been focused on white gay, bisexual, and other men who have sex with men (GBMSM) living in metropolitan regions of the coastal U.S. The current study used a community-based framework to assess perceived social norms through a elicitation survey. A total of 104 GBMSM met inclusion criteria for the study. Several analytic categories emerged across questions and a number of differences were found across race and ethnicity such as who would approve or disapprove off PrEP and who would be likely to use PrEP. Further, we found differences between injunctive and descriptive norms. These findings suggest that there are unique factors contributing to PrEP uptake among racial and ethnic minority GBMSM and that to fully understand uptake a more robust measure of perceived norms may be needed.

Why I Quit Pre-Exposure Prophylaxis (PrEP)? A Mixed-Method Study Exploring Reasons for PrEP Discontinuation and Potential Re-initiation Among Gay and Bisexual Men

Literature concerning pre-exposure prophylaxis (PrEP) among gay and bisexual identifying men (GBM) has explored facilitators and barriers to uptake and adherence. Far less reported are the reasons why GBM discontinue PrEP use. A national sample of 1071 GBM completed surveys about PrEP use and discontinuation. Participants who were still taking PrEP the 24-month follow up were compared to those that had stopped. Eighteen percent (n = 31) of GBM who reported ever using PrEP discontinued use. Younger (AOR = 0.96; 95% CI 0.92-1.00), and unemployed (AOR = 4.58; 95% CI 1.43-14.70) GBM were more likely to discontinue PrEP than their counterparts. Those that discontinued provided details on why via a free response question. The most common reasons for discontinuation were lower perceived HIV risk (50%) and cost/insurance (30%). Reasons for potential re-initiation included higher-risk sexual activities and changes to structural related barriers. More research is needed to inform interventions on how GBM can continue taking PrEP during changes to employment that effect insurance coverage and cost.

Drug Use and HIV Prevention With Young Gay and Bisexual Men: Partnered Status Predicts Intervention Response

The Young Men's Health Project (YMHP) has shown efficacy in reducing drug use and condomless anal sex (CAS) with casual partners among young gay, bisexual and other men who have sex with men (YGBMSM). The study examined whether relationship status at the time of intervention predicted response to YMHP by comparing baseline (pre-intervention) and follow-up (3, 6, 9, and 12 months post-intervention) data from the original trial. A group of 13 partnered YGBMSM who received YMHP was compared to a matched subsample of single YGBMSM. Among single men, drug use declined significantly at all follow-ups. Among partnered men, drug use was largely stable. While significant reductions were observed at 9 month assessment, 3, 6, and 12 month use did not differ significantly from baseline. Regardless of relationship status, CAS with casual partners declined significantly at 12 month follow-up. Results suggest the incorporation of components which address relationship factors, particularly those associated with drug use, may enhance benefits of YMHP for partnered YGBMSM.