The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse

Sexual orientation disparities in sexually transmitted infection risk behaviors and risk determinants among sexually active adolescent males: results from a school-based sample

OBJECTIVES

We examined disparities in risk determinants and risk behaviors for sexually transmitted infections (STIs) between gay-identified, bisexual-identified, and heterosexual-identified young men who have sex with men (YMSM) and heterosexual-identified young men who have sex with women (YMSW) using a school-based sample of US sexually active adolescent males.

METHODS

We analyzed a pooled data set of Youth Risk Behavior Surveys from 2005 and 2007 that included information on sexual orientation identity, sexual behaviors, and multiple STI risk factors.

RESULTS

Bisexual-identified adolescents were more likely to report multiple STI risk behaviors (number of sex partners, concurrent sex partners, and age of sexual debut) compared with heterosexual YMSW as well as heterosexual YMSM and gay-identified respondents. Gay, bisexual, and heterosexual YMSM were significantly more likely to report forced sex compared with heterosexual YMSW.

CONCLUSIONS

Our results provide evidence that sexual health disparities emerge early in the life course and vary by both sexual orientation identity and sexual behaviors. In particular, they show that bisexual-identified adolescent males exhibit a unique risk profile that warrants targeted sexual health interventions.

'Mobile men with money': HIV prevention and the erasure of difference

Mobile Men with Money is one of the latest risk categories to enter into HIV prevention discourse. Used in countries in Asia, the Pacific and Africa, it refers to diverse groups of men (e.g. businessmen, miners and itinerant wage labourers) who, in contexts of high population movement and economic disparity, find themselves at heightened risk of HIV as members of a 'most-at-risk population', or render others vulnerable to infection. How adequate is such a description? Does it make sense to develop HIV prevention programmes from such understandings? The history of the epidemic points to major weaknesses in the use of terminologies such as 'sex worker' and 'men who have sex with men' when characterising often diverse populations. Each of these terms carries negative connotations, portraying the individuals concerned as being apart from the 'general population', and posing a threat to it. This paper examines the diversity of men classified as mobile men with money, pointing to significant variations in mobility, wealth and sexual networking conducive to HIV transmission. It highlights the patriarchal, heteronormative and gendered assumptions frequently underpinning use of the category and suggests more useful ways of understanding men, masculinity, population movement, relative wealth in relation to HIV vulnerability and risk.

A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men

OBJECTIVES

We examined a syndemic of psychosocial health issues among young men who have sex with men (MSM), with men and women (MSMW), and with women (MSW). We examined hypothesized drivers of syndemic production and effects on suicide attempts.

METHODS

Using a pooled data set of 2005 and 2007 Youth Risk Behavior Surveys from 11 jurisdictions, we used structural equation modeling to model a latent syndemic factor of depression symptoms, substance use, risky sex, and intimate partner violence. Multigroup models examined relations between victimization and bullying experiences, syndemic health issues, and serious suicide attempts.

RESULTS

We found experiences of victimization to increase syndemic burden among all male youths, especially MSMW and MSM compared with MSW (variance explained = 44%, 38%, and 10%, respectively). The syndemic factor was shown to increase the odds of reporting a serious suicide attempt, particularly for MSM (odds ratio [OR] = 5.75; 95% confidence interval [CI] = 1.36, 24.39; P < .001) and MSMW (OR = 5.08; 95% CI = 2.14, 12.28; P < .001) compared with MSW (OR = 3.47; 95% CI = 2.50, 4.83; P < .001).

CONCLUSIONS

Interventions addressing multiple psychosocial health outcomes should be developed and tested to better meet the needs of young MSM and MSMW.

"Aren't labels for pickle jars, not people?" Negotiating identity and community in talk about 'being gay'

Understanding how people in any given population think about and experience their sexuality is fundamental to developing and implementing good health policy, research, and practice. Yet despite several decades of focus on sexual identity and HIV risk within health research, gay men as a category are often treated in an uncomplicated way. This article reports on focus group discussions held with 45 gay and other men who have sex with men in New Zealand to identify how they talked about issues of gay identity and gay community/ies. The men negotiated and renegotiated their gay identity and being gay was reported as just one part of most men's lives. Many men did not like to be labeled as gay and downplayed aspects of their gay identity. Only a few men proclaimed being gay. Men reported very mixed experiences with the gay community/ies. Understanding how men experience being gay, provides information vital to enhancing policy, research and practice responses to gay men's health issues. A major challenge for health service provision to appropriately engage with men who have sex with other men but resist being labeled as gay was identified.

Discursos sobre sexualidade em um Centro de Testagem e Aconselhamento (CTA)

Frente à centralidade da via sexual na transmissão do HIV, o trabalho analisa os discursos sobre sexualidade entre profissionais de saúde e usuários em um Centro de Testagem e Aconselhamento (CTA), do Estado do Rio de Janeiro. A metodologia envolveu observação direta do aconselhamento individual pré-teste e a realização de 384 questionários e 14 entrevistas com usuários. Observou-se que o aconselhamento é caracterizado pelo preenchimento do formulário de vigilância epidemiológica, havendo imprecisões na coleta e registro das práticas sexuais dos usuários, decorrentes da falta de estrutura do serviço. Durante o aconselhamento, as orientações ao usuário sobre DST/Aids foram centradas no tipo/número de parceiros sexuais, nos riscos ao HIV e no uso do preservativo. Tal abordagem não favorece o diálogo sobre a trajetória sexual do usuário, suas dúvidas e demandas relativas à sexualidade e a Aids. Os dados dos questionários e entrevistas revelaram a pouca familiaridade dos usuários em relação às categorias homo, hetero e bissexual. Recomenda-se: desvincular o aconselhamento do preenchimento do formulário SI-CTA; incorporar na formação dos aconselhadores os significados e diversidade das experiências sexuais dos sujeitos; investir na estrutura organizacional do serviço.

An exploration of terminology related to sexuality and gender: arguments for standardizing the language

There is currently no consensus on the best ways to define and operationalize research concepts related to sexuality and gender. This article explores some of the ways that sex/gender and sexuality terms have been used in health-related research and in keyword searches in the health sciences. Reasons for the diversity of terms and measurement approaches are explored and arguments for and against standardizing the language are presented. The article ends with recommendations for beginning a productive dialogue among health researchers to create some consistency in the terminology used to assess sexuality and gender.

Men who purchase sex, who are they? An interurban comparison

Most research concerning clients of commercial sex workers (CSWs) relies upon CSW reports of client characteristics and behavior. We describe correlates of ever purchasing sex among 3,829 men from three cities: São Paulo, Brazil; Cuernavaca, Mexico; and Tampa, USA. A computer-assisted self-interview collected data on demographics and sexual behavior. There were significant site differences-26.5 % paid for sex in São Paulo, 10.4 % in Cuernavaca, and 4.9 % in Tampa. In all cities, men who had sex with men and women (versus sex with women only) were more likely to have ever paid for sex. In São Paulo and Cuernavaca, CSW clients were older, had higher educational attainment, and were less likely to be married. In Tampa, older age was associated with being a CSW client but not education and marital status. In São Paulo and Cuernavaca, CSW clients had more partners than men who had never paid for sex. In São Paulo, CSW clients initiated vaginal sex at an earlier age, while in Cuernavaca they were more likely to self-report a sexually transmitted infection. CSW clients varied with respect to demographics across the three cities while the association between paying for sex and risky sexual behavior seems to be somewhat conserved. These findings suggest that interventions among CSW clients should focus on condom use with commercial and non-commercial partners as these men may be at increased risk for transmitting and acquiring sexually transmitted infections to and from their sex partners. Better understanding of client characteristics is needed for targeting interventions and creating culturally appropriate content.

A systematic review of the frequency and correlates of partner abuse in HIV-infected women and men who partner with men

Partner abuse (PA) is a highly prevalent and devastating social phenomenon, extracting an economic toll of more than $8 billion annually in the United States due to lost productivity alone. Many of the risk factors for PA increase vulnerability to acquiring HIV as well, yet little research has explored these overlapping epidemics. In this systematic review, we examine the frequency of PA victimization from male partners among persons living with HIV-both men who have sex with men (MSM) and women. We located 31 manuscripts reporting data from 24 unique samples, indicating a high lifetime frequency (but large range) of estimates for women/MSM, respectively, for physical (26-62%/15-39%), sexual (22-44%/8-33%), and psychological abuse (55%/22-73%). Data indicate strong and consistent associations of PA with poor mental health, engagement in health risk behaviors, and nonadherence to HIV medication for both groups. We discuss implications for clinical practice as well as future research directions.

Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America

BACKGROUND

Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one's life chances and overcome life's challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH.

METHODS

We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations.

RESULTS

Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence.

CONCLUSIONS

Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society's most vulnerable populations.

Invisible and at risk: STDs among young adult sexual minority women in the United States

CONTEXT

Sexual minority women are not adequately assessed by national STD surveillance systems, and research regarding STD burden in nationally representative samples of such women is rare. Moreover, few studies have assessed STD risk exclusively among young adult women.

METHODS

Wave 4 (2007-2008) data from the National Longitudinal Study of Adolescent Health on 7,296 females aged 24-32 were used to examine the relationship between sexual orientation and receipt of an STD diagnosis in the past year. Multivariate logistic regression analyses used two measures of sexual orientation: sexual identity and gender of sex partners.

RESULTS

Eighty percent of women considered themselves straight; 16% mostly straight; and 4% bisexual, mostly gay or gay. Eighty-five percent had had only male partners, while 7% had had one female partner, and 8% two or more female partners. In unadjusted models, women who identified themselves as mostly straight were more likely than straight women to have had an STD (odds ratio, 1.4); mostly gay or gay women were at lower risk (0.4). Women who had had two or more female partners had a higher STD risk than did women who had had only male partners (1.7). Adjusting for social and demographic characteristics did not substantially alter these results; however, the associations between sexual identity, gender of sex partners and STD diagnosis were eliminated after adjustment for sexual behaviors (e.g., having had anal sex).

CONCLUSIONS

Sexual identity, gender of sex partners and sexual behaviors should be taken into account in assessments of women's STD risk.

"Never reflected anywhere": body image among ethnoracialized gay and bisexual men

A growing body of literature has highlighted the increased prevalence of body image concerns and associations with health outcomes among gay and bisexual men (GBM). Little research, however, has examined the link between body image and social oppression for ethnoracialized GBM. Using an intersectionality lens and qualitative inductive analysis, data were collected through focus groups and interviews with GBM (n=61) who identify with one of four ethnoracial groups (Black, East/Southeast Asian, South Asian, Latino/Brazilian). Three main themes emerged: (1) body image idealization in gay/bisexual male culture, (2) negotiating a racialized body image, and (3) negotiating the impact of body image on relationship with self and others. The study results highlighted how multiple forms of oppression (e.g., racism, sexism) intersected with one another to impact the body image and overall well-being among ethnoracialized GBM.

A decade of research involving men who have sex with men in sub-Saharan Africa: current knowledge and future directions

It has been just over 10 years since the first large behavioral survey of men who have sex with men (MSM) was implemented in Senegal in 2001. Since then, behavioral and/or HIV prevalence surveys have been conducted in over 14 other countries in sub-Saharan Africa. Current available evidence and review have established that HIV prevalence among MSM in these countries are significantly higher than corresponding general populations, that MSM engage in sexual risk behaviors that place them and sexual partners at higher risk, and that issues of discrimination and stigmatization inhibit HIV interventions for MSM. This paper summarizes the existing knowledge, describes limitations of this evidence, and proposes new and enhanced research approaches to fulfill needed gaps to inform national HIV responses for MSM populations.

Intimate partner violence among men who have sex with men: a systematic review

This article presents results from a systematic review of the literature on intimate partner violence (IPV) among U.S. men who have sex with men (MSM). From 576 reviewed studies, a total of 28 met inclusion criteria and were included in the analysis. The population characteristics of each study, definitions of IPV, prevalences of different forms of IPV, and statistically tested correlates of IPV are summarized for each study. The results indicate that all forms of IPV occur among MSM at rates similar to or higher than those documented among women, although data on perpetration rates of IPV are scant, and consensus as to IPV correlates among MSM is absent. This review also finds significant limitations in the reviewed literature, notably the lack of a standardized, validated definition of IPV among MSM; use of unspecific recall periods for IPV; a lack of attention to nonphysical, nonsexual forms of IPV; and near-universal use of cross-sectional, convenience samples of urban MSM. Researchers should develop and validate an MSM-specific definition of IPV, use more rigorous epidemiological methods to measure IPV and its effects, and clarify the mental and physical health outcomes associated with both receipt and perpetration of IPV.

Sexual orientation disparities in sexually transmitted infections: examining the intersection between sexual identity and sexual behavior

The terms MSM (men who have sex with men) and WSW (women who have sex with women) have been used with increasing frequency in the public health literature to examine sexual orientation disparities in sexual health. These categories, however, do not allow researchers to examine potential differences in sexually transmitted infection (STI) risk by sexual orientation identity. Using data from the National Longitudinal Survey of Adolescent Health, this study investigated the relationship between self-reported STIs and both sexual orientation identity and sexual behaviors. Additionally, this study examined the mediating role of victimization and STI risk behaviors on the relationship between sexual orientation and self-reported STIs. STI risk was found to be elevated among heterosexual-WSW and bisexual women, whether they reported same-sex partners or not, whereas gay-identified WSW were less likely to report an STI compared to heterosexual women with opposite sex relationships only. Among males, heterosexual-identified MSM did not have a greater likelihood of reporting an STI diagnosis; rather, STI risk was concentrated among gay and bisexual identified men who reported both male and female sexual partners. STI risk behaviors mediated the STI disparities among both males and females, and victimization partially mediated STI disparities among female participants. These results suggest that relying solely on behavior-based categories, such as MSM and WSW, may mischaracterize STI disparities by sexual orientation.

Sexual attraction, sexual identity, and psychosocial wellbeing in a national sample of young women during emerging adulthood

Identity-based conceptualizations of sexual orientation may not account adequately for variation in young women's sexuality. Sexual minorities fare worse in psychosocial markers of wellbeing (i.e., depressive symptoms, anxiety, self esteem, social support) than heterosexual youth; however, it remains unclear whether these health disparities exclusively affect individuals who adopt a sexual minority identity or if they also may be present among heterosexually-identified youth who report same-sex attractions. We examined the relationship between sexual attraction, sexual identity, and psychosocial wellbeing in the female only subsample (weighted, n = 391) of a national sample of emerging adults (age 18-24). Women in this study rated on a scale from 1 (not at all) to 5 (extremely) their degree of sexual attraction to males and females, respectively. From these scores, women were divided into 4 groups (low female/low male attraction, low female/high male attraction, high female/low male attraction, or high female/high male attraction). We explored the relationship between experiences of attraction, reported sexual identity, and psychosocial outcomes using ordinary least squares regression. The results indicated sexual attraction to be predictive of women's psychosocial wellbeing as much as or more than sexual identity measures. We discuss these findings in terms of the diversity found in young women's sexuality, and how sexual minority status may be experienced by this group.

Sexually transmitted diseases: reflections on metaphors and ethics

Sexually transmitted diseases (STDs) are probably the most tabooed diseases we know. The taboos and the related stigmata shape patients reality and influence significantly health care policies, medical research, and actual problems in medical ethics. To better understand these complex influences of ancient but still powerful taboos, related metaphors associated with illness and disease are analyzed according to their historical development and actual impact on society. It becomes obvious that research and health care policies cannot be satisfyingly successful in helping people affected by STDs as long as they do not take the mechanisms of taboos and associated metaphors into account.

A mark that is no mark? Queer women and violence in HIV discourse

Lesbian, bisexual and queer women are invisible and ignored in HIV discourse, as epidemiological classifications result in their institutionalised exclusion from risk categories. Simultaneously, these women live with HIV, often in situations of societal exclusion and under threat of violence. In this paper, we consider the connections between discourse and violence to examine how both are reproduced through, applied to and dependent upon people. The ways lesbian, bisexual and queer women do (or do not) appear in HIV discourse tells us much about how people and categories operate in the global pandemic. The fault-lines of lesbian, bisexual and queer women's constrained visibility in HIV discourse can be seen in situations where they are exposed to HIV transmission through homophobic sexual assault. In dominant HIV discursive practices, such homophobic assault leaves Judith Butler's 'mark that is no mark', recording neither its violence nor its 'non-heterosexuality'. Structural violence theory offers a means to understand direct and indirect violence as it pertains to HIV and lesbian, bisexual and queer women. We call for forms of modified structural violence theory that better attend to the ways in which discourse connects with material realities. Our theoretical and epidemiological lens must be broadened to examine how anti-lesbian, bisexual and queer-women bias affects transnational understandings of human worth.

Heteronormativity hurts everyone: experiences of young men and clinicians with sexually transmitted infection/HIV testing in British Columbia, Canada

Heteronormative assumptions can negatively influence the lives of young gay and bisexual men, and recent sociological analyses have identified the negative impacts of heteronormativity on heterosexual men (e.g. 'fag discourse' targeted at heterosexual adolescents). However, insights into how heteronormative discourses may be (re)produced in clinical settings and how they contribute to health outcomes for gay, bisexual and heterosexual men are poorly understood. This analysis draws on in-depth interviews with 45 men (15-25 years old) and 25 clinicians in British Columbia, Canada, to examine how heteronormative discourses affect sexually transmitted infection testing. The sexually transmitted infection/HIV testing experience emerged as a unique situation, whereby men's (hetero)sexuality was explicitly 'interrogated'. Risk assessments discursively linked sexual identity to risk in ways that reinforced gay men as the risky 'other' and heterosexual men as the (hetero)normal and, therefore, relatively low-risk patient. This, in turn, alleviated concern for sexually transmitted infection/HIV exposure in heterosexual men by virtue of their sexual identity (rather than their sexual practices), which muted discussions around their sexual health. The clinicians also positioned sexual identities and practices as important 'clues' for determining their patients' social contexts and supports while concurrently informing particular tailored clinical communication strategies. These findings highlight how men's experiences with sexually transmitted infection/HIV testing can (re)produce heteronormative assumptions and expectations or create opportunities for more equitable gendered relations and discourses.

The relationship between gender role conflict and condom use among black MSM

Gender role conflict may influence condom use among black MSM. We examined relationships between the Gender Role Conflict Scale (GRCS), social/demographic variables and condom use among 456 black MSM. Higher total GRCS scores did not predict unprotected insertive anal intercourse (UIAI) or unprotected receptive anal intercourse (URAI) with men, but were associated with unprotected vaginal or anal intercourse (UVI/UAI) with women among bisexually active participants (n = 69). Higher perceived HIV risk reduced the likelihood of both UIAI and URAI with men. Internet recruitment venues, sexual discrimination experiences, higher numbers of sex partners and UVI/UAI with women all increased the likelihood of UIAI with men, while education (college/technical school or college degree) was associated with URAI with men. Future sexual health interventions for black MSM should emphasize broader social/demographic and alternative gender role variables with male sexual partners, while traditional GRCS variables may prove useful among those with female sexual partners.

"We don't exist": a qualitative study of marginalization experienced by HIV-positive lesbian, bisexual, queer and transgender women in Toronto, Canada

BACKGROUND

Lesbian, bisexual, queer and transgender (LBQT) women living with HIV have been described as invisible and understudied. Yet, social and structural contexts of violence and discrimination exacerbate the risk of HIV infection among LBQT women. The study objective was to explore challenges in daily life and experiences of accessing HIV services among HIV-positive LBQT women in Toronto, Canada.

METHODS

We used a community-based qualitative approach guided by an intersectional theoretical framework. We conducted two focus groups; one focus group was conducted with HIV-positive lesbian, bisexual and queer women (n = 7) and the second with HIV-positive transgender women (n = 16). Participants were recruited using purposive sampling. Focus groups were digitally recorded and transcribed verbatim. Thematic analysis was used for analyzing data to enhance understanding of factors that influence the wellbeing of HIV-positive LBQT women.

RESULTS

Participant narratives revealed a trajectory of marginalization. Structural factors such as social exclusion and violence elevated the risk for HIV infection; this risk was exacerbated by inadequate HIV prevention information. Participants described multiple barriers to HIV care and support, including pervasive HIV-related stigma, heteronormative assumptions in HIV-positive women's services and discriminatory and incompetent treatment by health professionals. Underrepresentation of LBQT women in HIV research further contributed to marginalization and exclusion. Participants expressed a willingness to participate in HIV research that would be translated into action.

CONCLUSIONS

Structural factors elevate HIV risk among LBQT women, limit access to HIV prevention and present barriers to HIV care and support. This study's conceptualization of a trajectory of marginalization enriches the discussion of structural factors implicated in the wellbeing of LBQT women and highlights the necessity of addressing LBQT women's needs in HIV prevention, care and research. Interventions that address intersecting forms of marginalization (e.g. sexual stigma, transphobia, HIV-related stigma) in community and social norms, HIV programming and research are required to promote health equity among LBQT women.

Application of syndemic theory to black men who have sex with men in the Multicenter AIDS Cohort Study

This study analyzed data from a large prospective epidemiologic cohort study among men who have sex with men (MSM), the Multicenter AIDS Cohort Study, to assess syndemic relationships among black MSM in the cohort (N = 301). We hypothesized that multiple interconnections among psychosocial health conditions would be found among these men, defining syndemic conditions. Constituents of syndemic conditions measured included reported depression symptoms, sexual compulsiveness, substance use, intimate partner violence (IPV), and stress. We found significant evidence of syndemics among these black men: depression symptoms were independently associated with sexual compulsiveness (odds ratios [OR]: 1.88, 95% CI = 1.1, 3.3) and stress (OR: 2.67, 95% CI = 1.5, 4.7); sexual compulsiveness was independently associated with stress (OR: 2.04, 95% CI = 1.2, 3.5); substance misuse was independently associated with IPV (OR: 2.57, 95% CI = 1.4, 4.8); stress independently was associated with depression symptoms (OR: 2.67, 95% CI = 1.5, 4.7), sexual compulsiveness (OR: 2.04, 95% CI = 1.2, 3.5) and IPV (OR: 2.84, 95% CI = 1.6, 4.9). Moreover, men who reported higher numbers of syndemic constituents (three or more conditions) reportedly engaged in more unprotected anal intercourse compared to men who had two or fewer health conditions (OR: 3.46, 95% CI = 1.4-8.3). Findings support the concept of syndemics in black MSM and suggest that syndemic theory may help explain complexities that sustain HIV-related sexual transmission behaviors in this group.

Check the box that best describes you: reflexively managing theory and praxis in LGBTQ health communication research

The intersections between identity and health communication are complex and dynamic, yet few studies employ a critical-empirical research strategy to understand how these factors affect patient experiences. And although other disciplines have examined lesbian, gay, bisexual, transgendered, and queer (LGBTQ)-specific issues surrounding identity and health care, there is a gap in communication studies literature on the topic. The present study examines how LGBTQ patients experience the language and structure of medical intake forms by analyzing both existing forms and patient survey responses. Relying on a queer theory framework, we illustrate how intake forms can foreclose on LGBTQ identity with heteronormative assumptions about sexuality, gender, and relationships. We also offer recommendations for creating queer-friendly intake forms and avoiding heteronormativity in health communication research. Overall, we argue that researchers must use reflexive methodology in considering how identity categories can both limit and assist LGBTQ patients.

Between hope and abandonment: black queer collectivity and the affective labour of biomedicalised HIV prevention

This paper investigates how current transformations in HIV prevention in the USA are intensifying a logic of viral containment rooted in biomedicine and behavioural science, in order to curb the recent rise in new HIV infections, predominantly among young African-American 'men who have sex with men'. Based on fieldwork in Baltimore, I examine how this paradigm shift is translated into concrete prevention activities that focus on HIV testing and treatment. By attending to the affective labour performed by members of Baltimore's Ballroom scene - a kinship system of black queer youth structured around competitive dance and performance - I show how the emergent 'Test & Treat' approach becomes a polyvalent object that attracts a host of optimistic investments in collective and individual prosperity, which nevertheless threaten to remain unrequited. Finally, I argue that the current move towards a biomedically mediated model of viral management depoliticises the struggle against HIV by suggesting that we can treat our way out of an epidemic that in fact remains intricately interwoven with racialised violence against the queer, the poor and the otherwise dispossessed.

STD and HIV risk factors among U.S. young adults: variations by gender, race, ethnicity and sexual orientation

CONTEXT

STDs, including HIV, disproportionately affect individuals who have multiple minority identities. Understanding differences in STD risk factors across racial, ethnic and sexual minority groups, as well as genders, is important for tailoring public health interventions.

METHODS

Data from Waves 3 (2001-2002) and 4 (2007-2008) of the National Longitudinal Study of Adolescent Health were used to develop population-based estimates of STD and HIV risk factors among 11,045 young adults (mean age, 29 at Wave 4), by gender, race and ethnicity, and sexual orientation (heterosexual, mixed-oriented, gay). Regression analyses were conducted to examine associations between risk factors and young adults' characteristics.

RESULTS

Overall, sexual-minority women in each racial or ethnic group had a higher prevalence of sexual risk behaviors-including a history of multiple partners, forced sex and incarceration-than their heterosexual counterparts. Mixed-oriented women in each racial or ethnic group were more likely than heterosexual white women to have received an STD diagnosis (odds ratios, 1.8-6.4). Black men and sexual-minority men also appeared to be at heightened risk. Gay men in all racial and ethnic groups were significantly more likely than heterosexual white men to report having received an STD diagnosis (2.3-8.3); compared with heterosexual white men, mixed-oriented black men had the highest odds of having received such a diagnosis (15.2).

CONCLUSIONS

Taking account of multiple minority identities should be an important part of future research and intervention efforts for STD and HIV prevention.

Health Care Access and Health Behaviors Among Men Who Have Sex With Men

Men who have sex with men (MSM) appear to experience barriers to health care compared with general population men. This report examines individual differences in health care access within a diverse sample of urban MSM ( N = 871). The authors examined demographic differences in health care access and the relation between access and health-related attitudes, health behaviors, and HIV transmission risk. They operationalized health care access in terms of three indicators: perceived barriers, insurance status, and recent medical visit. Twenty-seven percent ( n = 227) of MSM reported zero or one health care access indicator. African American and Latino race/ethnicity, lower income, and HIV-unknown status were associated with limited health care access. Limited health care access was related to health care attitudes (mistrust in the health care system and difficulty disclosing MSM status to providers), general health behaviors (smoking, never being HIV-tested, and drug abuse), and sexual risk–related variables (low self-efficacy for sexual safety, consistent drug use during sex, and HIV transmission risk). Overall, among MSM, less health care access relates to several adverse psychological constructs and health behaviors. Researchers and public health officials should address limited health care access, and its consequences, in this population.

Challenges and approaches to mobilizing communities for HIV prevention among young men who have sex with men of color

Young men who have sex with men (YMSM) of color are disproportionately impacted by HIV/AIDS in the United States. More HIV prevention interventions targeting risk factors of this group are needed, particularly at the structural level. This article focuses on Connect to Protect®: Partnerships for Youth Prevention Interventions (C2P), a multisite study employing community mobilization to decrease HIV acquisition and transmission among youth. Seven C2P sites are mobilizing their communities to prevent HIV among YMSM of color. These sites have faced a number of similar challenges. This article uses qualitative data to explore three domains relating to community mobilization at YMSM sites-forming community partnerships, maintaining the coalition, and facilitating structural-level coalition objectives. Challenges and approaches across domains illustrated themes related to stigma and discrimination, mobilization around YMSM of color, coalition participation and funding.

Let's talk about sex: helping substance abuse counsellors address HIV prevention with men who have sex with men

Integrating HIV prevention into substance abuse counselling is recommended to ameliorate the health outcomes of men who have sex with men. However, culture-based countertransferences (CBCs) may hamper this effort. Using a case illustration, this paper will explain the manifestation of CBCs held among substance abuse counsellors and how they hinder counsellors' work with men who have sex with men. The following CBCs will be explored: distancing, topic avoidance, heteronormativity, assumptions and denying client strengths. These CBCs allow counsellors to avoid discussions about sexual practices and curtail HIV prevention counselling, while undermining the counsellor-client relationship. Based on the empirical literature on HIV and substance abuse prevention with men who have sex with men, we provide recommendations to help counsellors overcome CBCs and integrate HIV prevention consistently with men who are in treatment for substance abuse.

Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study

OBJECTIVES

To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants.

BACKGROUND

Outbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood.

METHODS

Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection.

RESULTS

34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding.

CONCLUSIONS

Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.

The couple as context: Latino gay male couples and HIV

HIV-prevention efforts with gay men in relationships frequently omit primary partners. When they are considered, examinations of race/ethnicity are often overlooked despite higher infection rates among gay men of colour. Acknowledging both the need to contextualise the behaviours that may affect HIV risk for gay men of colour and the disproportionate impact of HIV on Latino gay men, the present study utilised semi-structured, qualitative interviews to explore relationship dynamics, sexual agreements and behaviours, safer sex choices and HIV risk among nine Latino gay male couples. All participants were HIV-negative and in concordant negative relationships. Additionally, nearly all reported closed agreements. Analysis revealed participants engaging in four behaviours that may actively reduce their HIV risk: approaching sexual agreements from a practical standpoint, maintaining a high literacy around HIV, having exposure to social support groups for Latino gay men and finding support in their relationship with another Latino gay man. Additional issues are raised where long-term HIV prevention is concerned. Intimate relationships are an important context for understanding both HIV risk and prevention among Latino gay men. Likewise, race/ethnicity provides an indispensable perspective on all research with gay couples. Future prevention efforts with gay men must strive to include both.

HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions

Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the United States. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. The article concludes that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, the article suggests that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors.

Pathways to HIV risk and vulnerability among lesbian, gay, bisexual, and transgendered methamphetamine users: a multi-cohort gender-based analysis

Background

Methamphetamine (MA) use continues to be a major public health concern in many urban settings. We sought to assess potential relationships between MA use and individual, social, and structural HIV vulnerabilities among sexual minority (lesbian, gay, bisexual or transgendered) drug users.

Methods

Beginning in 2005 and ending in 2008, 2109 drug users were enroled into one of three cohort studies in Vancouver, Canada. We analysed longitudinal data from all self-identified sexual minority participants (n = 248). Logistic regression using generalized estimating equations (GEE) was used to examine the independent correlates of MA use over time. All analyses were stratified by biological sex at birth.

Results

At baseline, 104 (7.5%) males and 144 (20.4%) females reported sexual minority status, among whom 64 (62.1%) and 58 (40.3%) reported MA use in the past six months, respectively. Compared to heterosexual participants, sexual minority males (odds ratio [OR] = 3.74, p < 0.001) and females (OR = 1.80, p = 0.003) were more likely to report recent MA use. In multivariate analysis, MA use among sexual minority males was associated with younger age (adjusted odds ratio [AOR] = 0.93 per year older, p = 0.011), Aboriginal ancestry (AOR = 2.59, p = 0.019), injection drug use (AOR = 3.98, p < 0.001), having a legal order or area restriction (i.e., "no-go zone") impact access to services or influence where drugs are used or purchased (AOR = 4.18, p = 0.008), unprotected intercourse (AOR = 1.62, p = 0.048), and increased depressive symptoms (AOR = 1.67, p = 0.044). Among females, MA use was associated with injection drug use (AOR = 2.49, p = 0.002), Downtown South residency (i.e., an area known for drug use) (AOR = 1.60, p = 0.047), and unprotected intercourse with sex trade clients (AOR = 2.62, p = 0.027).

Conclusions

Methamphetamine use was more prevalent among sexual minority males and females and was associated with different sets of HIV risks and vulnerabilities. Our findings suggest that interventions addressing MA-related harms may need to be informed by more nuanced understandings of the intersection between drug use patterns, social and structural HIV vulnerabilities, and gender/sexual identities. In particular, MA-focused prevention and treatment programs tailored to disenfranchised male and female sexual minority youth are recommended.

Implications of Discrimination Based on Sexuality, Gender, and Race/Ethnicity for Psychological Distress among Working-Class Sexual Minorities: The United for Health Study, 2003–2004

This study investigated the distribution of demographic characteristics, the prevalence of discrimination based on sexuality, gender, and race, and relationships with psychological distress among 178 working-class sexual minorities (i.e., who identified as lesbian, gay, or bisexual (LGB) or had ever engaged in same-sex sexual behaviors) recruited to the United for Health Study (2003–2004). The results indicated considerable heterogeneity in responses to items assessing sexual orientation and sexual behavior, with a majority of sexual minority participants not identifying as LGB (74.2%). The authors found significant demographic differences in LGB identification by gender, race/ethnicity, nativity, and socioeconomic factors. In addition, LGB participants had higher levels of psychological distress than non-LGB-identified sexual minorities. Linear regression analyses revealed that reports of racial/ethnic discrimination and sexuality discrimination were associated with higher levels of psychological distress among sexual minority participants. The results underscore the need to collect multiple measures of sexuality in conducting research on racially diverse working-class communities; to consider demographic factors in collecting sexuality data; and to disaggregate information on sexuality by LGB identification. Findings also highlight the importance of addressing discrimination in ameliorating problematic mental health outcomes among working-class sexual minorities.

Men who have sex with men in the United States: demographic and behavioral characteristics and prevalence of HIV and HSV-2 infection: results from National Health and Nutrition Examination Survey 2001-2006

OBJECTIVES

To describe demographic and behavioral characteristics and the prevalence of HIV and herpes simplex virus type 2 (HSV-2) infections in men who had sex with men identified through a nationally representative, population-based survey.

METHODS

As part of National Health and Nutrition Examination Surveys in 2001-2006, men 18 to 59 years of age were interviewed about sexual behavior using audio computer assisted self-interview and were tested for antibodies to HIV and HSV-2.

RESULTS

Of the 4319 men interviewed, 5.2% reported having ever had sex with men (MSM). MSM were more likely than non-MSM (those reporting female partners only) to have first sex at <15 years (31.9% vs. 17.3%), have > or =10 lifetime sex partners (73.6% vs. 40.8%), and have ever used cocaine (46.1% vs. 26.6%) (all P < 0.004). Among MSM, the prevalence of HIV and HSV-2 was 9.1% and 18.4%, respectively. Only 44.5% of MSM reported their sexual orientation as homosexual or gay. Comparing with bisexual and heterosexual MSM, homosexual MSM reported the highest number of lifetime male partners and had the highest HIV prevalence (16.5%).

CONCLUSIONS

In this population-based sample of men in the United States, self-reported same-sex behavior and homosexual orientation are strong markers for high risk of HIV infection.

Consistency and change in club drug use by sexual minority men in New York City, 2002 to 2007

We used repeated cross-sectional data from intercept surveys conducted annually at lesbian, gay, and bisexual community events to investigate trends in club drug use in sexual minority men (N = 6489) in New York City from 2002 to 2007. Recent use of ecstasy, ketamine, and γ-hydroxybutyrate decreased significantly. Crystal methamphetamine use initially increased but then decreased. Use of cocaine and amyl nitrates remained consistent. A greater number of HIV-positive (vs HIV-negative) men reported recent drug use across years. Downward trends in drug use in this population mirror trends in other groups.

Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa?: a systematic review and data synthesis

BACKGROUND

Men who have sex with men (MSM) bear a disproportionately higher burden of HIV infection than the general population. MSM in the Middle East and North Africa (MENA) are a largely hidden population because of a prevailing stigma towards this type of sexual behavior, thereby limiting the ability to assess infection transmission patterns among them. It is widely perceived that data are virtually nonexistent on MSM and HIV in this region. The objective of this review was to delineate, for the first time, the evidence on the epidemiology of HIV among MSM in MENA.

METHODS AND FINDINGS

This was a systematic review of all biological, behavioral, and other related data on HIV and MSM in MENA. Sources of data included PubMed (Medline), international organizations' reports and databases, country-level reports and databases including governmental and nongovernmental organization publications, and various other institutional documents. This review showed that onsiderable data are available on MSM and HIV in MENA. While HIV prevalence continues at low levels among different MSM groups, HIV epidemics appear to be emerging in at least few countries, with a prevalence reaching up to 28% among certain MSM groups. By 2008, the contribution of MSM transmission to the total HIV notified cases increased and exceeded 25% in several countries. The high levels of risk behavior (4-14 partners on average in the last six months among different MSM populations) and of biomarkers of risks (such as herpes simplex virus type 2 at 3%-54%), the overall low rate of consistent condom use (generally below 25%), the relative frequency of male sex work (20%-76%), and the substantial overlap with heterosexual risk behavior and injecting drug use suggest potential for further spread.

CONCLUSIONS

This systematic review and data synthesis indicate that HIV epidemics appear to be emerging among MSM in at least a few MENA countries and could already be in a concentrated state among several MSM groups. There is an urgent need to expand HIV surveillance and access to HIV testing, prevention, and treatment services in a rapidly narrowing window of opportunity to prevent the worst of HIV transmission among MSM in the Middle East and North Africa. Please see later in the article for the Editors' Summary.

Epidemiology of HIV infection in the Middle East and North Africa

OBJECTIVE

The Middle East and North Africa (MENA) region continues to be perceived as a region with very limited HIV epidemiological data, raising many controversies about the status of the epidemic in this part of the world. The objective of this review and synthesis was to address the dearth of strategic interpretable data on HIV in MENA by delineating a data-driven overview of HIV epidemiology in this region.

METHODS

A comprehensive systematic review of HIV, sexually transmitted infections (STIs) and risk behavior studies in MENA, irrespective of design, was undertaken. Sources of data included Medline for peer-reviewed publications, Google Scholar for other scientific literature published in nonindexed local and regional journals, international organizations reports and databases, country-level reports and database including governmental and nongovernmental organizations publications, as well as various other institutional documents.

RESULTS

Over 5000 sources of data related to HIV and STIs were identified and reviewed. The quality of data and nature of study designs varied substantially. There was no evidence for a sustainable HIV epidemic in the general population in any of the MENA countries, except possibly for southern Sudan. The general pattern in different countries in MENA points towards emerging epidemics in high-risk populations including injecting drug users, men who have sex with men (MSM) and to a lesser extent female sex workers, with heterogeneity between countries on the relative role of each of these high-risk groups. Exogenous HIV exposures among nationals linked to travel abroad appeared to be the dominant HIV transmission pattern in a few MENA countries with no evidence for much epidemic or endemic transmission. The role of bridging populations in bridging the HIV infection to the general population was found to be very limited.

CONCLUSION

Although they do not provide complete protection against HIV spread, near universal male circumcision and possibly the prevailing sexually conservative cultural norms seemed to have played so far a protective role in slowing and limiting HIV transmission in MENA relative to other regions. If the existing social and epidemiological context remains largely the same, HIV epidemic transmission is likely to remain confined to high-risk populations and their sexual partners, in addition to exogenous exposures. HIV prevention efforts in this region, which continue to be stymied by stigma associated with HIV/AIDS and related risk behaviors, need to be aggressively expanded with a focus on controlling HIV spread along the contours of risk and vulnerability. There is still a window of opportunity to control further HIV transmission among high-risk groups in MENA that, if missed, may entail a health and socioeconomic burden that the region, in large part, is unprepared for.

Identity, Stress, and Resilience in Lesbians, Gay Men, and Bisexuals of Color

The author addresses two issues raised in Moradi, DeBlaere, and Huang's Major Contribution to this issue: the intersection of racial/ethnic and lesbian, gay, and bisexual (LGB) identities and the question of stress and resilience. The author expands on Moradi et al.'s work, hoping to encourage further research. On the intersection of identities, the author notes that LGB identities among people of color have been construed as different from the identities of White LGB persons, purportedly because of an inherent conflict between racial/ethnic and gay identities. The author suggests that contrary to this, LGB people of color can have positive racial/ethnic and LGB identities. On the question of stress and resilience, hypotheses have suggested that compared with White LGB individuals, LGB people of color have both more stress and more resilience. The author addresses the competing hypotheses within the larger perspective of minority stress theory, noting that the study of stress and resilience among LGB people of color is relevant to core questions about social stress as a cause of mental disorders.

Negotiating exclusion: MSM, identity, and blood policy in the age of AIDS

In the US, blood donors face a variety of restrictions that leave many people excluded entirely from the donor pool. This paper explores the specific circumstances and meanings surrounding the donor ban on Men-who-have-Sex-with-Men (MSM). The ban on MSM is one of the few existing donor guidelines to receive considerable criticism on grounds that it effectively prohibits any sexually active gay man from donating blood and thus discriminates against gays. Due in part to these questions of fairness, the Blood Products Advisory Committee (BPAC) of the Food and Drug Administration (FDA) met to reconsider the decades-old policy, first in 1997 and again in 2000. The FDA asked its advisory committee to address the efficacy and utility of the MSM ban in light of technological developments in blood-banking, epidemiological data on the spread of HIV, and mounting pressures from gay rights and blood-banking organizations to update the policy. Through a detailed reading of meeting and conference transcripts that took place between 1997 and 2000, I argue that 'MSM' became a contested definitional category during the FDA's reappraisal of the policy. During and between the Committee's discussions, presenters and experts debated the differences between sexual behavior and sexual identity in relation to HIV and, eventually, HHV-8, a virus known to cause Kaposi's sarcoma in immunosuppressed individuals. I argue that the underlying flexibility in the meanings behind the term 'MSM' allowed Committee members, in the end, to retract their more nuanced discussions of human behavior and HIV and to uphold the contested policy. Finally, I suggest how the debates surrounding the MSM donor ban can help us to better understand the place of sexuality in discussions and claims of biopolitical citizenship in early 21st-century America.