Early male partnership patterns, social support, and sexual risk behavior among young men who have sex with men

Revisiting gendered parenting of adolescents: understanding its effects on psychosocial development

Introduction: Today's adolescents are growing up in a unique sociocultural climate in which gender issues are highly prominent. Alongside new ways of understanding gender identity, there are persistent gender disparities in social, health and mental health outcomes despite increasingly egalitarian views and a significant public focus on sexual assault and gender-based violence. Given gender-differentiated outcomes emerge during adolescence, it is critical to revisit factors influencing adolescent gender development. It has been argued that gendered parenting, reflected in differences in parenting attitudes and behaviors directed towards boys and girls, influences gender development. While numerous studies have examined gendered parenting with children, there has been no previous synthesis of gendered parenting of adolescents. Method: The current narrative review presents an overview of research into gendered parenting of adolescents, including parental modelling, gendered environments, and specific parenting practices, and draws together the available research on how it impacts adolescents. Gendered parenting is also examined in the context of LGBTQI + and gender non-conforming adolescents. Results: There is limited research investigating the presence of gendered parenting of adolescents, and even less assessing its impact on adolescent psychosocial outcomes. The available literature suggests that there may be effects of gendered parenting on adolescents, particularly on their gender role attitudes and gender-typed behaviors. Conclusions: Future work is needed to better understand how gendered parenting of adolescents manifests in the family home. In addition, research is needed to examine the longitudinal impact of gendered parenting, particularly within non-traditional families, and across a range of sociocultural contexts.

Disclosure of male attraction to primary care clinicians by adolescent sexual minority males

INTRODUCTION

Adolescent sexual minority males (ASMM) experience higher rates of HIV and other sexually transmitted infections (STIs) relative to their heterosexual peers. Primary care clinicians (PCCs) are well positioned to discuss sexual health and STI prevention with adolescent males; however, ASMM report they are rarely asked about their sexual health, especially with respect to attraction and identity. This study sought to determine variables associated with disclosure of male attraction ("being out") to a PCC.

METHODS

ASMM (N=206; 14 to 17 years in the United States) completed an online sexual health survey in 2017. We assessed socio-demographics, sexuality, being out to a guardian, and being out to a PCC, and calculated proportions and associations among the variables using univariable (Fisher exact) and multivariable (Firth logistic regression) analyses.

RESULTS

Only 20% (n=41) of ASMM were out to their PCC even though 53% (n=109) were out to a parent or guardian. ASMM who were out to a parent or guardian were seven times more likely to be out to their PCC (adjusted odds ratio = 6.69, 95% confidential interval 2.69 to 16.60). No other variables were associated with being out to a PCC.

CONCLUSIONS

Among ASMM, the only predictor of outness to a PCC in this study was outness to a parent or guardian, yet only half were out to a parent or guardian.

POLICY IMPLICATIONS

PCCs should proactively and routinely inquire about sexual health and screen adolescent males for same sex attraction and sexual minority identity in order to provide optimal health care.

Characteristics of Sexual and Gender Minority Caregivers of People With Dementia

Objectives: Given what little is known about the experiences of sexual and gender minority (SGM) caregivers of people with Alzheimer's disease and related dementias (ADRD), the aim of the current study was to describe psychosocial measures among these caregivers. Methods: We used an online survey and social media recruitment strategies. Results: Of 286 caregivers, the majority were gay men. Most respondents were white, with a third identifying as Latino American. The plurality of caregivers identified as a spouse/partner and were providing care for someone who identified as a sexual minority; one-fifth cared for someone transgender. Sexual orientation, perceived stress, caregiver stigma, and microaggressions were psychosocial factors associated with family quality of life and depressive symptoms in the caregivers. Discussion: This study is the first to provide a focused description of the characteristics and psychosocial needs of SGM caregivers of someone with ADRD, supporting development of targeted interventions for this population.

Family Factors and HIV-Related Risk Behaviors Among Adolescent Sexual Minority Males in Three United States Cities, 2015

Purpose: We examined the relationship between family factors and HIV-related sexual risk behaviors among adolescent sexual minority males (ASMM) who are affected disproportionately by HIV. Methods: We analyzed results from the National HIV Behavioral Surveillance among Young Men Who Have Sex with Men. Adolescent males ages 13-18 who identified as gay or bisexual, or who reported attraction to or sex with males were interviewed in 2015 in Chicago, New York City, and Philadelphia. Separate log-linked Poisson regression models were used to estimate associations between family factors and sexual risk behaviors. Results: Of the 569 ASMM, 41% had condomless anal intercourse in the past 12 months, 38% had ≥4 male sex partners in the past 12 months, and 23% had vaginal or anal sex before age 13. ASMM who had ever been kicked out of their house or run away, those who were out to their mother, and those who were out to their father, were more likely to engage in sexual risk behaviors. ASMM who were currently living with parents or guardians and those who received a positive reaction to their outness by their mother were less likely to engage in sexual risk behaviors. Conclusion: Our findings highlight the important role of family factors in HIV risk reduction among ASMM. A better understanding of the complex dynamics of these families will help in developing family-based interventions.

Sexual and Gender Minority Youth and Sexual Health Education: A Systematic Mapping Review of the Literature

PURPOSE

To synthesize the diverse body of literature on sexual and gender minority youth (SGMY) and sexual health education.

METHODS

We conducted a systematic search of the literature on SGMY and sexual health education, including SGMY perspectives on sexual health education, the acceptability or effectiveness of programs designed for SGMY, and SGMY-specific results of sexual health education programs delivered to general youth populations.

RESULTS

A total of 32 articles were included. Sixteen qualitative studies with SGMY highlight key perspectives underscoring how youth gained inadequate knowledge from sexual health education experiences and received content that excluded their identities and behaviors. Thirteen studies examined the acceptability or effectiveness of sexual health interventions designed for SGMY from which key characteristics of inclusive sexual health education relating to development, content, and delivery emerged. One study found a sexual health education program delivered to a general population of youth was also acceptable for a subsample of sexual minority girls.

CONCLUSIONS

Future research on SGMY experiences should incorporate populations understudied, including younger adolescents, sexual minority girls, and transgender persons. Further, the effectiveness of inclusive sexual health education in general population settings requires further study.

Brief Report: Sexual Debut Among 14- to 17-year-old Sexual Minority Males: A Preliminary Investigation of Early HIV Risk and Sexual Health Needs

BACKGROUND

Adolescent sexual minority males (ASMM) are disproportionately at risk of HIV.

PURPOSE

This study documents the sexual debut behaviors of ASMM, tests whether sexual debut and sexual behavior differed by race/ethnicity, and explores the association between early anal sex debut and engaging in condomless anal sex.

METHODS

Sexually active ASMM (N = 118; ages 14-17) in the United States completed an online sexual health survey. We used Fisher exact tests to explore differences by race/ethnicity in sexual debut characteristics and hypothesized relationships between sexual debut and risk behavior.

RESULTS

The average age of sexual debut with a male partner was 14 years (SD = 2.4). Approximately one-third (31%) reported anal sex at their sexual debut, with non-Latino black/African American ASMM more likely to report anal sex at debut (63%) compared with non-Latino white (28%), Latino (21%), or mixed race/other identified youth (19%; χ = 12.1, P = 0.01). All participants (100%) who reported an anal sex debut before the age of 14 years reported engaging in condomless anal sex in their lifetime, compared to 60% of those who reported an anal sex debut when they were 14 years old or older (χ = 5.6, P = 0.03). Participants wanted information about how to safely and comfortably have anal sex (59%) and skills around partner communication (>50%) before debut.

CONCLUSION

Sexually active ASMM begin engaging in sexual behavior with other males early and with incomplete knowledge and skills regarding sexual health and safety.

"Physical Sex Is Over for Now": Impact of COVID-19 on the Well-Being and Sexual Health of Adolescent Sexual Minority Males in the U.S

PURPOSE

This study aimed to explore how the COVID-19 pandemic and physical distancing measures have impacted the well-being and sexual health among adolescent sexual minority males (ASMM) during the initial phase of physical distancing mandates in the U.S.

METHODS

From March 27, 2020, to May 8, 2020, U.S. ASMM (N = 151; aged 14-17 years) completed the online baseline survey of a sexual health intervention trial. COVID-19-related closed- and open-ended questions were included. A mixed-methods approach assessed COVID-19-related changes in well-being and sexual health by outness with an accepting guardian.

RESULTS

The majority (57%) of participants reported being worried about COVID-19. Almost all (91%) were physically distancing. Participants noted that COVID-19 changed school, home, work, and family life. Participants highlighted that COVID-19 reduced their ability to socialize and had a deleterious effect on their mental health. In the past 3 months, participants reported seeing sexual partners in person less often, masturbating and viewing pornography more often, and sexting and messaging on men-seeking-men websites/phone applications about the same amount. Many described being physically distanced from sexual partners, and some noted an increase in their use of virtual ways to connect with partners (e.g., video chatting). There were no differences by outness with an accepting guardian in quantitative or qualitative responses.

CONCLUSIONS

These findings provide a snapshot of the initial effects of the COVID-19 pandemic among a convenience sample of U.S. ASMM and underscore the need to provide access to resources sensitive to their social, developmental, and sexual health needs during this crisis.

Sexual risk-taking among young Swedish men testing for STI

OBJECTIVES

This study investigates sexual risk-taking among young men testing for sexually transmitted infections (STI).

SAMPLING METHOD

452 participants (aged 18-30) completed surveys concerning their backgrounds, sexual risk-taking, and experience with STI.

RESULTS

Over one-third had used alcohol during their last sexual encounter, one-fifth were reluctant to use condoms due to concerns about erection difficulties, 14.7% had experienced sexual coercion and one-fifth reported having had contracted the most common STI, chlamydia trachomatis (CT). Older participants (aged 25-30) were more reluctant to use condoms because of erection worries and to report having had CT. Immigrant men reported more unprotected sex while men who have sex with men (MSM) were more exposed to sexual coercion than others, but less likely to use alcohol when having sex.

CONCLUSIONS

There are important differences in sexual risk-taking within the group of young men testing for sexually transmitted infections which need to be taken into account in developing effective counselling and promotion strategies in sexual and reproductive health care. Further research on young men's sexual risk-taking is needed to broaden understanding of factors associated with young men's sexual health.

Immigrant Generational Differences in Social Support and Sexual Risk Behaviors Among Men Who Have Sex With Men in Seattle, Washington

Different immigrant generations may encounter distinct sexual opportunities with implications for HIV transmission. Yet, few studies have examined how immigrant generational status is associated with sexual risk behaviors among men who have sex with men (MSM). We explored relationships between immigrant generational status, social support, and sexual risk behaviors among English-speaking MSM using data from surveys conducted in Seattle, Washington, in 2014 (n = 323). We compared the sexual risk behaviors and social support of first-generation, second-generation, and third- and higher-generation MSM, and examined whether immigrant generational status and social support were associated with sexual risk behaviors using logistic regression models. Second-generation MSM reported lower friend social support than first- or third- and higher-generation MSM (p < .05). However, immigrant generational status was not associated with sexual risk behavior outcomes, even after accounting for social support. Results suggest that differences in immigration processes such as acculturation may be more predictive of risk behaviors than generational status alone.

Family Characteristics in Sex Communication and Social Support: Implications for Emerging Adult Men Who Have Sex with Men's PrEP Engagement

While emerging adulthood (ages 18-25) is marked by increased independence from parents, parental support remains a strong correlate of positive sexual health outcomes for heterosexual youth. With the emergence of pre-exposure prophylaxis (PrEP), few studies have examined the potential for parent-child sex communication and PrEP adoption among emerging adult men who have sex with men (MSM). We aimed to describe the extent to which parents/family characteristics play supportive roles in emerging adult MSM's current PrEP use. PrEP-indicated participants (N = 222) were recruited via social media to complete an online survey. Multivariable logistic regression assessed associations between emerging adult MSM's current PrEP use and comfort with parent-child sex communication, family social support, family outness, and family prioritization, adjusted for sociodemographic variables. Thirty percent of participants reported current PrEP use. Only 20% reported moderate/high comfort with parent sex communication, 80% reported any family sexual identity disclosure, 70% reported moderate/high family social support, and 70% ranked family as a high/very high priority. Our multivariable model demonstrated an association between comfort with parent-child sex communication with current PrEP use only (AOR= 1.55, 95% CI 1.04-2.32). Our findings support that parents of emerging adult MSM possess a critical potential to reduce their sons' risk of HIV and promote PrEP uptake. Interventions that facilitate parents' efficacy to foster affirming, non-judgmental environments and discussions about their child's sexual behaviors, attractions/relationships, and health (e.g., PrEP) may be impactful in reducing the high HIV incidence rate that burdens emerging adult MSM.

Birth Cohort and Racial/Ethnic Differences in the Age of First Oral and Anal Sex Among U.S. Men Who Have Sex with Men

Earlier age of first sex has potential direct and indirect health effects later in life. Though there are multiple nationwide general population studies on ages of first sex, there is no such nationwide study of first male-male oral or anal sex among men who have sex with men (MSM). This may be important for understanding racial/ethnic disparities in HIV and sexually transmitted infection acquisition among young racial/ethnic minority MSM. Our study examined the birth cohort and racial/ethnic differences in ages of first male-male oral and anal sex using a diverse 2015 U.S. nationwide sample of 10,217 sexually active MSM. The mean age of first male-male oral sex was 18.0 years. Compared with older birth cohorts, those MSM born 1990-2000 were more likely to have younger age of first male-male oral sex. Compared to white MSM, Hispanic MSM and non-Hispanic black MSM were more likely to have younger age of first male-male oral sex with a man. The mean age of first male-male anal sex was 20.3 years. Compared with older birth cohorts, those MSM born 1990-2000 were more likely to have younger age of first male-male anal sex. Compared to white MSM, MSM of all other racial/ethnic groups were more likely to have younger age of first male-male anal sex. These findings emphasize the need for comprehensive and MSM-inclusive sexual health education for young teens and online sexual health resources for young gay, bisexual, queer, and other MSM.

Is Guardian Permission a Barrier to Online Sexual Health Research Among Adolescent Males Interested in Sex With Males?

Institutional review boards (IRBs) that refuse to grant waivers of guardian permission may hinder research to inform needed online sexual health interventions for adolescent males interested in sex with males (AMSM). Information on the challenges of obtaining (or waiving) guardian permission is imperative. In June and July 2017, AMSM (N = 206; ages 14 to 17) in the United States completed an online survey on sexual behaviors, sexually explicit media use, and sexual education exposure/needs. A mixed-methods approach assessed attitudes toward guardian permission for the current survey and future online sexual health intervention research. Logistic regression models assessed differences by "outness" to a guardian. A framework matrix analysis was conducted to summarize, then aggregate, qualitative responses. Findings indicated that most AMSM would not participate if guardian permission was required (current: 83%; future: 87%). Youth who were not out were more likely to say they would not participate (current: adjusted odds ratio [AOR] = 2.8, 95% confidence interval [CI]: 1.2 to 6.8); future: AOR = 4.7, 95% CI: 1.6 to 13.5). Participants reported that guardian permission would be an invasion of their privacy, lead to involuntary outing, and endanger participants. Overall, guardian permission appears to be a barrier to AMSM participation in online sexual health research. Investigators and IRBs should consider alternative practices and policies to facilitate such research.

Perceived social support, problematic drug use behaviors, and depression among prescription drugs-misusing young men who have sex with men

This study examined the relationship of perceived social support with problematic drug use behaviors and depression among young men who have sex with men (YMSM). A diverse sample of 191 substance-using YMSM (aged 18-29 years) reported on perceived social support, high-risk drug use behaviors (i.e., polydrug use and use of drugs before sex in the past 6 months, and lifetime injection drug use), and depression. Associations were examined using bivariate and multivariable logistic regression. Participants receiving higher levels of family social support were at lower odds of reporting polydrug use, drug use before sex, and depressive symptomology. Individuals with higher levels of friends' social support were at lower odds of reporting polydrug use, drug use before sex, and depression. Participants receiving higher levels of support from a special other were at lower odds of reporting depression. Intervention efforts should address YMSM's capacity to build supportive relationships and obtain adequate social support.

Sexually transmitted infections in privately insured adults with intellectual and developmental disabilities

Aim: Individuals with intellectual and developmental disabilities (I/DD) may have an increased risk of sexually transmitted infections (STIs) due to limited sexual health education and higher rates of sexual abuse, yet little is known about the prevalence of STIs and STI testing in this population. Methods: This study compared national samples of privately insured individuals with (n = 25,193) and without I/DD (n = 25,193) on the prevalence of STIs and STI testing. Results: In multivariable models, individuals with I/DD were significantly less likely to have an STI diagnosis and no difference was found between groups on the odds of STI testing overall. Conclusion: Findings may, in part, be explained by fewer sexual experiences, increased supervision in social settings and delayed onset of sexual activity among those with I/DD.

Applying resilience theory models to contextualize economic-dependent partnerships as a risk factor for HIV among young men who have sex with men

Economic-dependent partnerships (EDP) are an understudied HIV risk correlate among young men who have sex with men (YMSM) in the U.S. We explored whether YMSM's psychological resilience buffered against the effect of socioeconomic disadvantage on EDPs, after accounting for other psychosocial risks. Data come from an observational study assessing YMSM's HIV vulnerabilities. We developed indices for socioeconomic disadvantage, psychosocial profiles, and cumulative promotive factors. Multivariable logistic regressions tested the main associations of these indices on EDPs. Protective models tested whether psychosocial profiles exacerbated and cumulative promotive factors buffered the effects of socioeconomic disadvantage on EDPs. 31% and 23% of YMSM reported EDPs with main and casual partners, respectively. For both outcomes, we found support for adjusted compensatory models. Socioeconomic disadvantage was associated with increased odds of EDPs with main (AOR = 1.45, p < .001) and casual (AOR = 1.47, p < .001) partners. Psychosocial profiles were also associated with increased odds of EDPs with main (AOR = 1.53, p = .001) and casual (AOR = 1.67, p < .001) partners. Cumulative promotive factors was associated with decreased odds of EDPs with main (AOR = 0.66, p = .003) and casual (AOR = 0.72, p = .035) partners. Our findings elucidate the need for multilevel interventions that provide opportunities for socioeconomic advancement and improve psychosocial/psychological functioning for at-risk YMSM.

Sexual Health Education for Adolescent Males Who Are Interested in Sex With Males: An Investigation of Experiences, Preferences, and Needs

PURPOSE

There is a dearth of research to inform sexual education programs to address sexual health disparities experienced by adolescent males who are interested in sex with males (AMSM). The current study sought to determine where AMSM receive sexual health information, clarify their preferences, and explore relations with sexual behavior.

METHODS

AMSM (N = 207; ages 14-17) in the United States completed an online sexual health survey. Bivariate associations between sexual education exposure/preferences by sexual behavior were assessed using Fisher's exact tests and one-way analyses of variance.

RESULTS

Eighty-nine (43%) participants reported no sexual contact with male partners, 77 (37%) reported sexual contact without condomless anal sex, and 41 (20%) reported condomless anal sex. Participants received sexual health information from their parents/guardians (n = 122, 59%), formal sources (n = 160, 78%), and the Internet (n = 135, 65%). The most commonly covered topics by parents/guardians and formal sources were how to say no to sex, how to prevent HIV and other sexually transmitted infections, and methods of birth control. The most common online-researched topics were how to safely have anal sex, the types of sex you can have with a male partner, how to use a condom, and how to use lubrication. Participants noted preferring a sexually-explicit online sexual health program that addresses male-male sex.

CONCLUSIONS

Online sexual education programs that explicitly address male-male sex are needed. Tailored programs can help AMSM develop healthy sexual behaviors and decrease their HIV/STI risk.

Measuring exposure to sexually explicit media among young men who have sex with men: a pilot study

Background Sexually explicit media (SEM) consumption may contribute to sexual risk-taking among young men who have sex with men (YMSM).

METHODS

The prevalence and frequency of SEM consumption as well as associations with contextual and sexual risk characteristics among 61 YMSM were estimated.

RESULTS

All participants (n=61, 100%) reported viewing SEM; 45 (74%) in the past week. There were no significant associations between viewing SEM in the past week and measured characteristics.

CONCLUSION

SEM use among YMSM is extremely common. Future research should clarify potential relations between SEM and sexual risk-taking with larger samples of YMSM and specific measures, including SEM content and amount.

Depression and social support mediate the effect of HIV self-stigma on condom use intentions among Chinese HIV-infected men who have sex with men

HIV self-stigma in HIV positive men who have sex with men (HIVMSM) has been identified as one of the largest challenges of HIV prevention, and associates with numerous negative outcomes, including depression, decreased social support, and less condom use intentions. In the present study, 321 HIVMSM in Chengdu, China were recruited to examine the prevalence of condom use in the past months and intentions to use condoms in next six months; we also identify pathways between HIV self-stigma and intentions to use condoms by the structural equation modeling approach. Results showed that Chinese HIVMSM had the suboptimal prevalence of consistent condom use and low intentions to use condoms consistently. Additionally, depression and decreased social support were significant mediators between HIV self-stigma and condom use intentions. The complex pathways between HIV self-stigma and intentions to use condoms should be taken into account in the HIV prevention and intervention programs.

"I Have No Idea What's Going On Out There:" Parents' Perspectives on Promoting Sexual Health in Lesbian, Gay, Bisexual, and Transgender Adolescents

Lesbian, gay, bisexual, transgender, and other sexual and gender minority (LGBTQ) adolescents experience higher rates of negative sexual health outcomes relative to their heterosexual and cisgender peers. Healthy parent-adolescent relationships and effective parenting are robust predictors of sexual health in heterosexual adolescents, but very little is known about barriers to and facilitators of effective parenting from the perspective of parents of LGBTQ adolescents. This study conducted online focus groups with 44 parents of LGBTQ adolescents in order to describe the factors influencing effective sexual health communication and parental monitoring in this population. Parents described generally positive relationships with teens, but many noted they went through a transition process in which they struggled with their child's identity and were less supportive of their LGBTQ teen. Lack of understanding about LGBTQ-specific sexuality was a commonly endorsed barrier to effective communication, and this was most commonly endorsed by parents of cisgender girls. Parents of cisgender boys and transgender/gender-nonconforming teens described fears about long-term sexual health (i.e., sexual predators, consent) as a barrier to parental monitoring. Parents of LGBTQ adolescents need information and skills to optimize their teen's sexual health. Parent-based programs for LGBTQ adolescents are long overdue for addressing these issues.

Who counts as family? Family typologies, family support, and family undermining among young adult gay and bisexual men

Gay and bisexual men may form chosen families in addition to or in place of families of origin. However, the characteristics of these diverse families remain largely unexamined in the quantitative literature. The purpose of this study was to develop a family typology based on responses from a racially and ethnically diverse sample of young adult gay and bisexual men (YGBM) recruited from the Detroit Metropolitan Area (N=350; 18-29 years old). To explore the role of family, we then examined family social support and social undermining in relation to YGBM psychological distress within different family types. A series of multivariate regressions were used to examine associations between family social support and social undermining with depression and anxiety outcomes. The majority (88%) of YGBM included family of origin in their definitions of family and 63% indicated having chosen families. Associations between family social processes and psychological outcomes varied by type of family, suggesting that family composition shapes how perceptions of support and undermining relate to experiencing symptoms of depression and anxiety. Chosen families play a prominent role in the lives of YGBM and should not be overlooked in family research. Findings also highlight the importance of examining co-occurring family social support and social stress processes to further address psychological distress symptoms among YGBM.

"It Was Supposed To Be a Onetime Thing": Experiences of Romantic and Sexual Relationship Typologies Among Young Gay, Bisexual, and Other Men Who Have Sex with Men

Young gay, bisexual, and other men who have sex with men (MSM) are at elevated risk for HIV infection, highlighting the need to understand the elements of prevention and risk associated with their relationships. We employed a phenomenological approach to explore how young MSM become involved in different romantic and sexual experiences. We analyzed 28 semi-structured interviews conducted with young MSM living in Michigan. Using a phenomenological approach, we analyzed the data using an inductive coding strategy and thematic analysis. Participants defined their romantic and sexual interactions with a limited set of partner classifications (e.g., dating, hooking up, friends-with-benefits), but recognized how these classifications were shifting, sometimes unexpectedly so (e.g., a date turning into a hook up and vice versa). Young MSM described relationships in transition that at times defied available typologies or hybridized elements of multiple partner types at once. Based on our analyses, we underscore the need to acknowledge the fluctuating and contextual nature of young MSM's romantic and sexual experiences. We discuss the relevance of our findings in terms of the developmental period of young adulthood and the implications our findings have HIV prevention efforts among young MSM.

Systematic Mapping of Relationship-Level Protective Factors and Sexual Health Outcomes Among Sexual Minority Youth: The Role of Peers, Parents, Partners, and Providers

Sexual minority youth (SMY) experience elevated rates of adverse sexual health outcomes. Although risk factors driving these outcomes are well studied, less attention has been paid to protective factors that potentially promote health and/or reduce negative effects of risk. Many factors within interpersonal relationships have been identified as protective for the sexual health of adolescents generally. We sought to systematically map the current evidence base of relationship-level protective factors specifically for the sexual health of SMY through a systematic mapping of peer-reviewed observational research. Articles examining at least one association between a relationship-level protective factor and a sexual health outcome in a sample or subsample of SMY were eligible for inclusion. A total of 36 articles reporting findings from 27 data sources met inclusion criteria. Included articles examined characteristics of relationships with peers, parents, romantic/sexual partners, and medical providers. Peer norms about safer sex and behaviorally specific communication with regular romantic/sexual partners were repeatedly protective in cross-sectional analyses, suggesting that these factors may be promising intervention targets. Generally, we found some limits to this literature: few types of relationship-level factors were tested, most articles focused on young sexual minority men, and the bulk of the data was cross-sectional. Future work should expand the types of relationship-level factors investigated, strengthen the measurement of relationship-level factors, include young sexual minority women in samples, and use longitudinal designs. Doing so will move the field toward development of empirically sound interventions for SMY that promote protective factors and improve sexual health.

Developing Online Recruitment and Retention Methods for HIV Prevention Research Among Adolescent Males Who Are Interested in Sex with Males: Interviews with Adolescent Males

Background

Adolescent males interested in sex with males (AMSM) are an important audience for HIV prevention interventions, but they are difficult to reach due to their age and social stigma.

Objective

We aim to identify efficient methods to recruit and retain AMSM in online research.

Methods

Interviews with 14-to-18-year-old AMSM (N=16) were conducted at 2017 Pride events in Boston, MA and Providence, RI.

Results

Participants reported that (1) social media platforms are viable recruitment venues; (2) recruitment advertisements should describe the study using colorful/bright pictures, familiar words, and information about compensation; (3) surveys should be <20 minutes in length; (4) modest compensation (eg, email gift card, US $10 to $20) was preferred; and (5) communications that remind participants about the length and content of surveys, and compensation, should be sent between study activities to increase retention.

Conclusions

Soliciting input from AMSM provides critical guidance regarding recruitment and retention procedures to increase the efficiency of HIV prevention research for this at-risk group.

"I Won't Out Myself Just to Do a Survey": Sexual and Gender Minority Adolescents' Perspectives on the Risks and Benefits of Sex Research

Sexual and gender minority (SGM) adolescents under age 18 are underrepresented in sexual health research. Exclusion of SGM minors from these studies has resulted in a lack of knowledge about the risks and benefits youth experience from sexual health research participation. Institutional Review Boards' (IRB) overprotective stances toward research risks and requirements for guardian consent for SGM research are significant barriers to participation, though few have investigated SGM youth's perspectives on these topics. This study aimed to empirically inform decisions about guardian consent for sexuality survey studies involving SGM youth. A total of 74 SGM youth aged 14-17 completed an online survey of sexual behavior and SGM identity, and a new measure that compared the discomfort of sexual health survey completion to everyday events and exemplars of minimal risk research (e.g., behavioral observation). Youth described survey benefits and drawbacks and perspectives on guardian permission during an online focus group. Participants felt about the same as or more comfortable completing the survey compared to other research procedures, and indicated that direct and indirect participation benefits outweighed concerns about privacy and emotional discomfort. Most would not have participated if guardian permission was required, citing negative parental attitudes about adolescent sexuality and SGM issues and not being "out" about their SGM identity. Findings suggest that sexual health survey studies meet minimal risk criteria, are appropriate for SGM youth, and that recruitment would not be possible without waivers of guardian consent. Decreasing barriers to research participation would dramatically improve our understanding of sexual health among SGM youth.

Satisfaction and Condomless Anal Sex at Sexual Debut and Sexual Risk Among Young Black Same-Sex Attracted Men

First sex may be a sentinel event crucial to understanding sexual health trajectories of young Black same-sex attracted men (YBSSAM). We sought to understand whether satisfaction, condomless anal sex, and contextual factors during first sex were associated with sexual risk and recent condom use in YBSSAM. A total of 201 YBSSAM aged 15-24 years completed an Internet survey exploring first sex, current condom use, and sexual risk. High risk was defined as ≥3 of the following: new/concurrent sex partners, STI history, and no/inconsistent condom use. Multivariate logistic regression assessed the association between predictor (satisfaction and first condomless anal sex) and outcome (sexual risk and condomless sex in the past 3 months) variables. Mean age at first sex was 15.2 (SD = 2.9) years, and emotional satisfaction (51.7 %), physical satisfaction (63.7 %), and condomless first anal sex (55.2 %) were common. YBSSAM describing high levels of satisfaction were no more likely to be at high risk or engage in recent condomless sex. Condomless first sex (AOR = 4.57, p = .001), younger age (AOR = 3.43, p = .02), and having a partner >5 years older (AOR = 2.78, p = .03) at first sex were significantly associated with increased risk. Only condomless first sex (AOR = 4.28, p < .001) was associated with condomless recent sex. Satisfaction at first sex may not influence later sexual risk in YBSSAM. However, context of first sex, including condom use at first sex, may play an important role in subsequent risk. Prevention strategies on condom negotiation prior to first sex may help to mitigate HIV burden in YBSSAM.

Sexual Health Research With Young Black Men Who Have Sex With Men: Experiences of Benefits and Harms

Young Black men who have sex with men (YBMSM) are often underrepresented in sexual health research because of concerns about safety, privacy, and the potential for research harms. Empirical data are needed to understand YBMSM experience of participating in research, benefits and harms (discomfort), to inform policy and regulatory decisions. Using qualitative methods, this article examines 50 YBMSM, aged 15-19 years, experiences of benefits/harms, challenges of participating in sexual health research, and contextual factors impacting research experiences. Participants were asked about benefits and harms experienced in answering questions about sexual orientation, first same-sex attraction, and same-sex sexual experiences after completing an in-depth interview. Interviews were transcribed and coded. Inductive open coding was used to identify themes within and between interviews. Participants were able to describe perceived direct benefits resulting from research interview participation, including awareness of risky sexual behaviors, a safe space to share early coming out stories and same-sex sexual experiences, and a sense of empowerment and comfort with one's sexual orientation. Indirect benefits described by participants included perceptions of helping others and the larger gay community. Few participants described harms (discomfort recalling experiences). Our data suggest that participating in qualitative sexual health research focused on sexual orientation, sexual attraction, and early same-sex sexual experiences may result in minimal harms for YBMSM and multiple benefits, including feeling more comfortable than in a general medical visit.

Context of First Same-Sex Condom Use and Nonuse in Young Black Gay and Bisexual Males

Despite high human immunodeficiency virus (HIV) rates among young Black men who have sex with men (YBMSM), there are limited data about condom use during first same-sex (FSS). This study sought to understand socio-contextual factors of 50 YBMSM aged 15-19 years that influenced condom use during FSS. Condom use was influenced by individual, partner, and community factors. Individual factors-recent illness or sexually transmitted infections (STI)-prompted condom use, while frequent HIV testing prompted nonuse. Partner factors-proactive encouragement from partners-prompted condom use, while trust and condom discomfort prompted nonuse. Larger community factors-such as presence of females-were key for use, while limited sexual health information combined with peers who discouraged condoms prompted nonuse. A multilevel approach may be useful in developing sexual health programming for these young men.

"I Had to Go to the Streets to Get Love": Pathways From Parental Rejection to HIV Risk Among Young Gay and Bisexual Men

Young, gay, and bisexual men (YGBM) are at increased risk of family rejection, which is related to HIV infection. What remains unknown is how family rejection leads to HIV risk. In this exploratory study, qualitative interviews were conducted with 21 HIV-positive YGBM aged 18 to 24. Most participants reported family rejection, which decreased instrumental and emotional support and resulted in participants using riskier ways to support themselves, such as engaging in survival sex. Conceptualizing the findings using a family systems framework, we present a tentative conceptual model to describe the potential relationships between family rejection and HIV risk for YGBM.

Understanding Engagement in HIV Risk and Prevention Research Among Black Young Men Who Have Sex with Men and Transgender Women in the District of Columbia

PURPOSE

To develop optimal methods to study sexual health among black young men who have sex with men and transgender women (BYMSM/TW).

METHODS

We conducted a mixed-methods prospective study to identify recruitment and retention strategies for BYMSM/TW (age 16-21) in Washington D.C., and describe HIV risk behaviors and context.

RESULTS

Incentivized peer referral was highly productive, and 60% of BYMSM/TW were retained for 3 months. Participants reported high levels of sexual risk, homophobia, racism, and maternal support.

CONCLUSION

BYMSM/TW studies should utilize a combination of peer-based, in-person, and technology-based recruiting strategies. Additional research is needed to leverage mobile technology and social media to enhance retention.

Development of the scale of perceived social support in HIV (PSS-HIV)

Social support (SS) plays a key role for HIV/AIDS prevention and disease management. Numerous general and disease-specific SS instruments have been developed and perception of support has been increasingly considered, though no scales have been specifically developed to measure perceived social support (PSS) in HIV/AIDS. To help fill this gap a 12-item scale was developed. The study comprised 406 (HIV(+) and HIV(-)) participants from Chile and the UK. A principal component factor analysis yielded three factors explaining 77.0 % of the total variance: Belonging, Esteem and Self-development with Cronbach α of 0.759, 0.882 and 0.927 respectively and 0.893 on the full scale. The PSS-HIV is brief, easy-to-apply, available in English and Spanish and evaluates the perception of supportive social interactions. Further research is needed to corroborate its capacity to detect psycho-socio-immune interactions, its connection with Maslow's hierarchy of need theory and to evaluate its properties for different health states.