Sexual risk behavior of men who have sex with men: comparison of behavior at home and at a gay resort

Pornography, identification, alcohol, and condomless sex

Using national probability data from the 2022 National Survey of Sexual Health and Behavior, the present study evaluated whether moderators of the association between frequency of pornography exposure and condomless sex are consistent with the sexual script acquisition, activation, application model's (3AM) suppositions about the facilitating effects of wishful identification and decreased self-regulation and forethought capacity. Consistent with the 3AM, two-way interaction effect analysis indicated that the strength of the positive association between exposure frequency and condomless sex increased as identification intensified. Inconsistent with the 3AM, two-way interaction effect analysis indicated that the association between exposure frequency and condomless sex was not significantly different among those who had and had not consumed alcohol before their last sexual encounter. However, the three-way interaction between exposure frequency, identification, and alcohol use did suggest a role for each 3AM moderator, as the catalyzing effect of identification was operable among those who had consumed alcohol only.

Sex Abroad Among Men Who Have Sex With Men and Its Association With Chemsex, Sexual Risk Behavior, and Sexually Transmitted Diseases: A Cross-Sectional Study in the Netherlands

Almost half of men who have sex with men visiting Dutch sexually transmitted disease clinics reported sex abroad in the past 6 months, mainly in Western countries. One in 4 men who have sex with men who had sex abroad used drugs during sex ("chemsex") abroad. Having sex abroad was associated with having multiple sex partners and casual sex partner(s).

Latent classes of partner-seeking venues and sexual risk among men who have sex with men in Paris, France

In France, men who have sex with men (MSM) experience the highest HIV incidence. MSM who use multiple venues such as bars and smartphone apps to find sexual partners have greater HIV and sexually transmitted infection risk than those who use a single physical or online venue. To explore the role of venues and sexual behavior on HIV risk, we used latent class analysis to highlight underlying profiles of 580 MSM in Paris, France. Three latent classes emerged: Multi-venue Users (19%), Non-serosorting App Users (49%), and Serosorting App Users (32%). Multi-venue Users had the highest probabilities of condomless receptive anal intercourse (CRAI) and condomless insertive anal intercourse (CIAI), group sex, and meeting partners at venues such as bars or online. Non-serosorting App Users had the lowest probabilities of CRAI, CIAI, and condomless serosorting. Serosorting App Users had an 87% chance of condomless serosorting. MSM reporting a pre-exposure prophylaxis history had 14 and 5 times the odds of being classified as Multi-venue Users and Serosorting App Users than Non-serosorting App Users. MSM were 3% more likely to be Multi-venue Users than Non-serosorting App Users for every one-year increase in age. Interventions addressing sexual risk behaviors among MSM in France should consider tailored risk-reduction and prevention messaging.

Sex Tourism, Condomless Anal Intercourse, and HIV Risk Among Men Who Have Sex With Men

Sex tourism affects the sexual health of tourists and locals with whom they interact. However, a few studies have examined whether sex tourism is a risk factor for the acquisition of HIV and other sexually transmitted infections among men who have sex with men, and no such studies have been conducted in Western Europe. Almost 28% of our respondents reported engaging in sex tourism in their lifetime. Sex tourism was associated with an elevated risk of engagement in condomless receptive anal intercourse, use of alcohol/drugs during sex, participation in group sex, and an elevated risk of diagnosis with any type of sexually transmitted infection over the previous year, specifically gonorrhea and chlamydia. Research with men who have sex with men who engage in sex tourism should explore high-risk sexual behavior during sex tourism and also the feasibility and acceptability of the use of episodic pre-exposure prophylaxis for short periods of participation in elevated risk behaviors by tourists and local sex partners.

Sex Tourism and Pre-Exposure Prophylaxis Modality Preferences Among Men Who Have Sex With Men

Sex tourism among men who have sex with men (MSM) has been associated with increased risk for human immunodeficiency virus (HIV) due to sexually scripted environments characterized by multiple sexual partners, increased availability of alcohol and drugs, and limited availability of HIV-prevention services. The current study examined the knowledge of and likelihood of using different modalities of pre-exposure prophylaxis (PrEP), an important biomedical HIV-prevention strategy, among MSM in Paris who have engaged in sex tourism. A sample of 580 MSM from a highly popular geosocial-networking smartphone application in Paris, France, participated in the survey. Of the 580 MSM, 444 participants reported an HIV-negative status and represent the analytic sample for this study. Approximately 27% reported engaging in sexual tourism. MSM who engaged in sex tourism were more likely to aware of on-demand PrEP and more likely to express interest in using on-demand PrEP (adjusted risk ratio [aRR] = 1.26; 95% confidence interval [CI] = 1.03-1.53, aRR = 1.29; 95% CI = 1.04-1.61, respectively) than MSM who never engaged in sex tourism. Moreover, participants who engaged in sex tourism were more likely to express interest in rectal microbicides or both rectal and penile microbicides (aRR = 1.34; 95% CI = 1.13-1.59, aRR = 1.26; 95% CI = 1.03-1.55, respectively) than participants who had not engaged in sex tourism. With the high likelihood of interest in using alternative forms of PrEP in MSM who engage in sex tourism, this study suggests potential benefits for these alternative forms of PrEP for this specific population and underscores the importance of their continued development.

Rethinking Risk, Culture, and Intervention in Collective Sex Environments

This article provides a narrative overview of research on HIV/STI risk and collective sexual behavior based on an inclusive analysis of research on environments where people gather for sexual activity-sex clubs, swingers' clubs, bathhouses, parks, private sex parties, etc. The aim is to analyze how collective sex has been approached across disciplines to promote conversation across paradigms and suggest new lines of inquiry. Attention to context-such as the location of sex-was a necessary redress to universalizing models of sexual risk-taking behavior, leading to insights rooted in the particularities of each environment and its users. However, the identification of ever more precise risk groups or environmental idiosyncrasies eventually becomes theoretically restrictive, leading to an overestimation of the uniqueness of sexual enclaves, and of the difference between any given enclave and the broader social milieu. Using a theoretical framework of transgression to interpret the interdisciplinary literature, similarities in the spatial and social organization of collective sex environments are identified. Insights generated from this complementary perspective are then applied to understandings of collective sex: first, the example of male-female (MF) "swingers" is used to illustrate the need to establish, rather than assume, the distinctiveness of each non-normative sexual enclave, and to broaden the conceptualization of context; second, questions are raised about the practicality of interventions in collective sex environments. Finally, new lines of intellectual inquiry are suggested to shed light not just on collective sex but on sociosexual issues more generally, such as increasing protective sexual health behavior or negotiating consent in sexual encounters.

Not so different? Comparison of risk profile of gay men who acquired HIV while travelling with those who acquired HIV in Australia

ISSUE ADDRESSED

Many countries now identify HIV and international mobility as a priority issue within a global and shared epidemic, including Australia. To support health promotion in this complex area, we investigated recent HIV infections that occurred among Australian gay men while travelling and compared to HIV infections that occurred in Australia.

METHODS

446 gay men recently diagnosed with HIV completed an on-line survey regarding the high risk event (HRE) where they believed that they acquired HIV. Those who acquired HIV while in their usual place of residence (308 men), those who were travelling within Australia (59 men), and those who were travelling overseas (79 men) were compared.

RESULTS

Those who acquired HIV while overseas had very similar risk profiles, sexual behaviour, and made similar assumptions about their partners and their own HIV status, as those who acquired HIV in Australia. Only HIV status disclosure at the HRE differed across locations (P = .030). Three quarters (74.7%) of the men who acquired HIV while overseas were not diagnosed until they returned to Australia.

CONCLUSIONS

Our findings challenge the idea that there are necessarily differences in behaviour and assumptions for HIV transmission in Australia and overseas. However, the men travelling may be in communities where HIV status is less commonly disclosed, and where HIV prevalence is higher. SO WHAT?: A deeper understanding of contextual factors may be required for HIV prevention and health promotion strategies targeting gay men travelling to locations with different cultural, HIV prevalence, and HIV testing considerations. This would also identify opportunities for new tools such as Pre-Exposure Prophylaxis and self-testing.

A Pilot Trial of a Sexual Health Counseling Intervention for HIV-Positive Gay and Bisexual Men Who Report Anal Sex without Condoms

Background

Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior.

Method

HIV-positive (HIV+) peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors.

Results

There was a significant reduction in condomless anal sex (CAS) with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity.

Conclusions

The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men.

Trial Registration

ClinicalTrials.gov NCT02546271

Prediction of HIV Sexual Risk Behaviors Among Disadvantaged African American Adults Using a Syndemic Conceptual Framework

The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvantaged African American adults. The objective is to examine multiple factors associated with sexual HIV risk behaviors within a syndemic conceptual framework. Face-to-face, computer-assisted, structured interviews were conducted with 1535 individuals in Atlanta, Georgia. Bivariate analyses indicated a high level of relationships among the HIV sexual risks and other factors. Results from multivariate models indicated that gender, sexual orientation, relationship status, self-esteem, condom use self-efficacy, sex while the respondent was high, and sex while the partner was high were significant predictors of condomless sex. Additionally, a multivariate additive model of risk behaviors indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographic, and psychological functioning factors help explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems.

Association of Situational and Environmental Factors With Last Episode of Unprotected Anal Intercourse Among MSM in Hong Kong: A Case-Crossover Analysis

This study investigates event-specific factors that differentiate the last episodes of unprotected anal intercourse (UAI) from protected anal intercourse (PAI) with regular partner (RP) among 213 men who have sex with men (MSM) who did not use condoms consistently using case-crossover analysis. Factors positively associated with the last episode of UAI with RP included: two situational factors (i.e., participant's suggestion to have UAI, alcohol use) and three environmental/setting factors (i.e., sex took place overseas, during a weekday and not at home). Negative associations with an episode of UAI with RP included: five situational factors (i.e., discussion about condom use prior to sex, RP's suggestion to have PAI, participant's suggestion to have PAI, perception that RP would like to use a condom, participant's planning to use a condom) and two environmental/setting factors (i.e., condoms placed at the venue where sex took place, partner possessed a condom). Thus, these significant event-specific factors explained under which circumstances some MSM would use and would not use condoms during anal sex with RP.

Experiences of and attitudes towards HIV/STI prevention among holidaymaking men who have sex with men living in Sweden: a cross-sectional Internet survey

AIM

Foreign travellers and men who have sex with men (MSM) are prioritised groups for human immunodeficiency virus/sexually transmitted infection (HIV/STI) prevention efforts in Sweden because of high prevalence of sexual risk-taking. This study aims to describe experiences of and attitudes towards HIV/STI prevention efforts, prior to travelling abroad, among MSM, and to investigate the kinds of prevention efforts that are desirable.

METHODS

The study is based on survey responses from 656 MSM who had travelled abroad. Recruitment took place through a Nordic website, and had a cross-sectional design. The analysis has mainly been descriptive, but bivariate analyses were performed using the chi-square test. The level of significance was p <.05.

RESULTS

Only a few of the participants had encountered HIV/STI prevention efforts in Sweden (5%) and abroad (23%), and a majority (58%) felt that it should be more prevalent. Having free access to condoms and lubricants was preferred among 68% of the men. Furthermore, having written information, as opposed to oral, was also preferred (68% vs. 26%). MSM felt that it was easy to find out information (79%) and claimed they would use the Internet to do so (87%).

CONCLUSIONS

Service providers who offer their services to travellers are encouraged to provide helpful links to information about sexual health. Information that is geared towards risk groups such as young adults should be presented with awareness that MSM are also part of that group. It is important for information to be conveyed respectfully to everyone, but perhaps MSM in particular, since they may have experienced feelings of being stigmatised or discriminated against previously.

At home and away: gay men and high risk sexual practices

We aimed to describe HIV risk practices of gay men who travel locally, regionally and overseas. We analysed data from the Sydney Gay Community Periodic Survey 2009 about high-risk sexual practices in four locations (locally, while travelling in NSW, Australia and overseas) and with partners of HIV positive, negative and unknown serostatus in each location. Analyses of associations used generalized log-binomial estimation procedures with Type I error of 5 %. Of 1,839 sexually active participants, 70.1 % reported having sex locally. 19.7 % elsewhere in NSW, 20.1 % interstate and 18 % overseas. Unprotected anal intercourse (UAI) was reported by 29.9, 28.6, 21.3 and 19.3 % of men in each location respectively. There was no difference in the levels of UAI locally and elsewhere in NSW, but UAI levels were lower in other Australian locations [adjusted prevalence rate ratio (APRR) = 0.76; 95 % confidence interval (95 % CI) 0.66-0.88] and overseas (APRR = 0.76; 95 % CI 0.65-0.89). UAI was more likely if partners were seroconcordant HIV positive (APRR = 1.67; 95 % CI 1.32-2.11) and less likely if partners were of different HIV serostatus (APRR = 0.39; 95 % CI 0.33-0.47) as compared to seroconcordant HIV negative partners. UAI was associated with group sex and use of party drugs. In this community sample, UAI levels were higher in the local context than in travel destinations, suggesting that familiarity between partners may play a role. High-risk sexual practices can nevertheless contribute to bridging different HIV epidemics and HIV transmission across borders. HIV prevention programs should develop effective approaches to target sexually adventurous gay men and HIV transmission associated with travel.

Risk behaviors among HIV-positive gay and bisexual men at party-oriented vacations

OBJECTIVE

This study examined substance use (intended and actual), unprotected sex, and HIV disclosure practices (disclosure and questioning) among HIV-positive men who have sex with men (MSM) at two party-oriented vacations, where substance use and sexual risk may be heightened.

METHOD

A random sample of 489 MSM attending one of two party-oriented vacations participated in PartyIntents, a short-term longitudinal survey. Nearly half (47%) completed a follow-up assessment at the event or online for up to 2 weeks after the event. We examined rates of baseline intentions to use substances, actual substance use, and unprotected intercourse among HIV-positive men in attendance.Rates among HIV-negative men were estimated for comparison. Multiple logistic regression was used to assess the impact of illegal drug use and HIV status on unprotected anal intercourse (UAI).

RESULTS

HIV-positive attendees (17%) were significantly more likely than HIV-negative attendees to use nitrite inhalants (or "poppers") (24.3% vs. 10.7%). HIV-positive attendees were also significantly more likely to have insertive UAI (64.3% vs. 34.1%) and receptive UAI (68.8% vs. 22.2%). Multivariate models showed associations between HIV status and illegal drug use with UAI (for HIV status, odds ratio [OR] = 4.5, p = .001; for any illegal drug use, OR = 16.4, p < .001). There was no evidence that the influence of drug use moderated risk by HIV status. Rates of HIV disclosure and questioning did not differ by HIV status.

CONCLUSIONS

HIV-positive men attending these events engaged in higher rates of illegal drug use and sexual risk than HIV-negative men. Prevention campaigns targeting MSM at high-risk events should include messages geared toward HIV-positive men.

Internet use, recreational travel, and HIV risk behaviors in men who have sex with men

Previous studies have documented higher rates of HIV risk behavior in gay and bisexual men traveling for leisure. Most of these studies collected data in high-risk tourist areas known for promoting alcohol and other substance use. The present study sampled a broader range of men by collecting data at a Gay Pride celebration, and asking participants about vacation experiences over the past 12 months. We also collected information about men's use of the Internet to find sexual partners before they traveled. Overall, two-thirds of participants reported recreational travel in the previous year. Of these men, 17% reported having sex with a new partner during their most recent vacation. Forty-three percent of the respondents were sexually active during their vacation. Sexually-active participants reported a mean of 2.01 unprotected anal sex acts during their brief vacation stay (M = 6.2 days). Close to half of the sexually-active men reported having sex with a partner of unknown HIV status. Alcohol and drug use were associated with unprotected sex. Men who used the Internet to set up dates prior to travel reported significantly more sexual partners and were significantly more likely to report having sex with a new partner. Many gay and bisexual men on vacation report behaviors that may place their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors in this population are needed.

PartyIntents: a portal survey to assess gay and bisexual men's risk behaviors at weekend parties

PartyIntents examines whether portal survey methods could be used to anonymously survey gay and bisexual men about HIV-risk behaviors before and after a weekend party-oriented vacation. The study recruited 97% of eligible men and of these 489 participants 47% completed the follow-up assessment. Approximately one half of the men intended to use illegal drugs over the weekend, and almost 20% thought that they might have anal intercourse and not use a condom. The methodology can be applied and provides useful information about HIV risk at these events, though refinements may be needed to increase the follow-up rates.

On holiday: a risk behavior profile for men who have vacationed at gay resorts

Sexual risk behavior is higher when people vacation as compared to when they are at home. The current study uses survey data to compare sexual risk behavior of gay men who vacation at gay resorts to those who do not. Independent predictors of vacationing at gay resorts included income level, relationship status, ever having attended a circuit party, and HIV serostatus. For men who visit resorts to meet sex partners, independent predictors included relationship status, ever having attended a circuit party, HIV serostatus, number of male sex partners in the past six months, and number of anal insertive male partners using a condom. These results show a need for the development of structural interventions in the gay resort and hotel setting.

Circuits, networks, and HIV risk management

Drawing on a survey of men who have sex with men conducted at Toronto's largest gay and lesbian event (N = 947), this study examines the characteristics of men who report that they like to participate in the "bareback scene" and cruise "bareback Web sites" by comparing them with men who (a) report having had at least one incident of unprotected anal intercourse but no bareback connections, or (b) report consistently protected anal intercourse (UAI). Overall, 62.0% of the surveyed men reported having had a casual male partner in the last 6 months, 14.2% of whom reported having had UAI. Including these men, with men who report UAI with or without ejaculation, with casual or regular partners, accounts for 40.6% of the sample. MSM in bareback scenes or Web sites form a circuit insofar as they are significantly overrepresented in a set of bars, baths, parks, and Web sites, that aligns closely with one of the circuits identified in a factor analysis of venues attended by men in the sample. They also show a distinctive pattern of beliefs and perceptions of appropriate norms for sexual conduct, and are more likely to have had five or more partners in the last 6 months.

Sexual risk behavior in men attending Mardi Gras celebrations in New Orleans, Louisiana

Previous research with travelers points to higher risk behaviors during vacations. Relative to their day-to-day lives, leisure travelers have more free time to pursue sexual activities and are likely to engage in higher rates of substance use than when at home. Risk behaviors during vacation have not been thoroughly examined in men who have sex with men (MSM), a key group at risk for HIV. The present investigation examined substance use, sexual risk behaviors, and components of the Information-Motivation-Behavioral Skills (IMB) Model in MSM attending Mardi Gras celebrations in New Orleans. Almost half of the sexually active men reported having sex with a partner of unknown HIV status while in New Orleans and a similar number did not disclose their own HIV status to all of their sexual partners. Drug use and excessive alcohol use were associated with unprotected sex (ps < .05). Components of the IMB model also predicted sexual risk behavior: individuals with more accurate HIV transmission information reported fewer unprotected sex acts, and motivation to engage in sexual activity on vacation was associated with more unprotected sex (ps < .05). Findings suggest that some MSM on vacation are placing themselves at risk for HIV. Traditional HIV prevention interventions do not readily lend themselves for use with transient populations. New intervention approaches are needed to reduce sexual risk behaviors in persons traveling for leisure.

Substance Use, Medications for Sexual Facilitation, and Sexual Risk Behavior Among Traveling Men Who Have Sex With Men

OBJECTIVES

The objective of the study was to examine correlates of sexual risk behavior among men who have sex with men (MSM) traveling for leisure.

STUDY DESIGN

MSM (N = 304) visiting popular tourist areas completed a brief survey assessing sexual behavior and substances used while on vacation, including the use of erectile dysfunction medications (e.g., Viagra).

RESULTS

Forty-seven percent of the respondents were sexually active during their vacation, with a mean of 1.33 unprotected anal sex acts during their brief stay (mean = 3.6 days). More than half of the sexually active men reported sex with a partner of unknown HIV status. Individuals reporting substance use or taking erectile dysfunction medications reported higher rates of sexual risk behaviors.

CONCLUSION

Many MSM travelers report behaviors that may put their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors among MSM tourists are needed.

Sexual risk and HIV acquisition among men who have sex with men travelers to Key West, Florida: a mathematical modeling analysis

The present study investigated the sexual risk behaviors of men who have sex with men (MSM) traveling to a popular gay tourist destination in the United States. In 2004, a brief survey was administered to 247 MSM tourists recruited from gay-oriented venues in Key West, Florida. Data collected included demographics, HIV status, length of stay, substance use, and sexual risk behaviors. A probabilistic model of HIV transmission was used to translate participants' reports of their sexual behaviors while in Key West into estimates of their risk of acquiring HIV. Twenty-two percent of participants reported anal sex with multiple partners over a relatively brief period (M = 4.1 days), and approximately one third reported having sex with a partner met during the vacation period. Modeling analyses suggested that sexual activity among vacationing MSM would account for approximately 201 new HIV infections among MSM visitors to Key West each year. Although previous studies have documented sexual risk behavior in travelers, quantitative estimates of the impact of these behaviors on the spread of HIV are lacking. Findings suggest that the risk-taking behavior of MSM on vacation may play an important role in the dissemination of HIV and other sexually transmitted diseases (STDs). Future research should assess additional factors (e.g., use of highly active antiretroviral therapy) that may affect HIV transmission in MSM travelers. In addition, efforts are needed to develop effective risk-reduction interventions for this population.