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Shen Y, Zhang C, Valimaki MA, Qian H, Mohammadi L, Chi Y, Li X. Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis. BMC Infect Dis 2022; 22:850. [PMCID: PMC9661788 DOI: 10.1186/s12879-022-07843-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Despite a large amount of behavioral interventions to reduce human immunodeficiency virus (HIV)-related high-risk sexual behaviors, consistent condom use remains suboptimal among men who have sex with men (MSM). However, current databases are lack of synthesized evidence to explain why MSM practiced condomless sex.
Objective
Our study aims to conduct a systematic review and meta-synthesis of 39 eligible qualitative studies to explore the barriers to condom use among MSM.
Methods
A systematic review and meta-synthesis of qualitative studies (1994–2021). On March 4, 2021, a comprehensive search was conducted in 14 electronic databases. The study was conducted based on the Joanna Briggs Institute’s recommendations.
Results
Thematic analysis produced six synthesized themes, which were classified into three levels according to the Social-ecology Model. Individual level barriers to condom use included physical discomfort, lack of HIV/STI-related knowledge and substance use; interpersonal-level barrier was mainly the condom stigma, namely regarding using condom as symbols of distrust or HIV/sexually transmitted infections (STIs) prevention, or as violating traditional cognition of sex, or as an embarrassing topic; environmental/structural-level barriers included situational unavailability, unaffordability of condoms and power imbalance in the sexual relationship.
Conclusion
This meta-synthesis offered in-depth understanding of condom use barriers for MSM and could guide the development of multifactorial interventions according to the identified barriers, especially targeting to reduce condom stigma, which has not been focused and intervened previously.
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2
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Anakwe A, BeLue R, Xian H, Xaverius P. Men's Preconception Health and Fertility Intentions: A Latent Class Analysis Approach. Am J Mens Health 2022; 16:15579883221135764. [PMID: 36373425 PMCID: PMC9663665 DOI: 10.1177/15579883221135764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Men's pregnancy intention is associated with a host of positive outcomes for families, yet this topic remains understudied. Because unintended pregnancies are more likely to occur at suboptimal parental health, this study aimed to examine the extent to which men improve their preconception health in the context of future fertility planning. This study used pooled data from the 2011-2019 National Survey of Family Growth for a final sample size of 10,223. Latent class analysis (LCA) was used to identify distinct classes of men's preconception health. Eight preconception health risk factors were used to determine class membership. A classify-analyze approach was used to create the preconception health phenotype (PhP) exposure variable. The outcome of interest was men's fertility intentions. Multinomial regression models were used to examine the association between the exposure and the outcome. Three unique PhPs were identified (lowest risk, substance users, and sexual risk-takers) from the LCA model. Men in the substance users' group (22.9%) were characterized by high-risk alcohol use and drug use, while sexual risk-takers (8.1%) were characterized by having multiple sexual partners. Belonging in the phenotypes of substance users or sexual risk-takers was associated with increased odds for definite no fertility intention than definite yes intentions (adjusted odds ratio [aOR]: 1.47, 95% confidence interval [CI]: [1.18, 1.84] and aOR: 1.51, 95% CI: [1.13, 2.01], respectively). Results provide new insights on how preconception health can be measured and fills a knowledge gap on its relationship to men's future fertility planning. Findings can be applied to preconception care intervention frameworks, and guide family planning interventions and contraceptive counseling.
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Affiliation(s)
- Adaobi Anakwe
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA,Department of Health Sciences, University of Missouri, Columbia, MO, USA,Adaobi Anakwe, Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Room 403, St. Louis, MO 63104, USA.
| | - Rhonda BeLue
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA,College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Hong Xian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Pamela Xaverius
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA,University of Health Sciences and Pharmacy, St. Louis, MO, USA
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3
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Saiyed FK, Segura ER, Tan D, Clark JL, Lake JE, Holloway IW. Social networks and condomless intercourse with female partners among male sex workers in the Dominican Republic. Int J STD AIDS 2020; 32:176-183. [PMID: 33334269 PMCID: PMC10387283 DOI: 10.1177/0956462420920406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Male sex workers (MSW) in the Dominican Republic (DR) have multiple sexual partners, including personal and client-relationships, and are disproportionately affected by human immunodeficiency virus (HIV). We examined the prevalence of condomless anal and/or vaginal intercourse (CI) among MSW in the DR as a function of social network factors. Self-report surveys and social network interviews were administered to MSW recruited through venue-based sampling (N = 220). A generalized linear model was used to complete a Poisson Regression model and identify variables significantly associated with the outcome of interest. CI was more common with female (28.3%) than with male partners (4.9%). Factors associated with CI with the last female partner included older age of MSW, CI with the last male partner, having a stable female partner (a consistent or main partner), and having ≥1 family member in the participants' social network. Partner and social network characteristics associated with CI among MSW suggest the utility of dyadic and network interventions to reduce HIV risk.
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Affiliation(s)
- Faiez K Saiyed
- McGovern Medical School at UTHealth, Houston, TX, USA.,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Diane Tan
- Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, UCLA, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, UCLA, Los Angeles, CA, USA
| | - Jordan E Lake
- McGovern Medical School at UTHealth, Houston, TX, USA.,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ian W Holloway
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, UCLA, Los Angeles, CA, USA.,Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
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4
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Choi EPH, Fong DYT, Wong JYH. The use of the Multidimensional Condom Attitude Scale in Chinese young adults. Health Qual Life Outcomes 2020; 18:331. [PMID: 33032622 PMCID: PMC7545565 DOI: 10.1186/s12955-020-01577-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Attitude towards condom use is an important predictor of consistent condom use. However, this topic is an understudied area in Chinese populations, and no validated Chinese instrument is available to capture condom attitude. To fill this research gap, the present study aimed to evaluate the psychometric properties of the University of California, Los Angeles (UCLA) Multidimensional Condom Attitudes Scale (MCAS) and assessed the attitudes towards condom use amongst Chinese adults aged 18–29 years old.
Methods In this cross-sectional study, a total of 500 people aged 18–29 years old were randomly recruited in Hong Kong. The primary outcome was the attitude towards condom use as measured by the UCLA MCAS. Factor structure, internal construct validity, known-group validity and internal consistency were assessed. Results Instead of the five-factor structure designed by the original developers of the MCAS questionnaire, this study proposed a novel six-factor scale: (1) Reliability and Effectiveness, (2) Excitement, (3) Displeasure, (4) Identity Stigma, (5) Embarrassment about Negotiation and (6) Embarrassment about Purchase. The internal construct validity and reliability of the new scale were high. The revised MCAS could differentiate between subgroups, including gender, sexual orientation and sexual experience. In terms of attitudes, over 40% of the participants believed that condoms are not reliable, though the vast majority of the sample did not perceive any stigma related to condom use. In addition, more than half (55.4%) of the respondents felt embarrassed to be seen when buying condoms while a quarter (25.8%) felt uncomfortable buying condoms at all. Conclusions Overall, the psychometric analysis found that attitude to condom use is culturally specific. The study also highlighted the need for more public health campaigns and interventions to help people cope with the embarrassment of purchasing condoms.
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Affiliation(s)
- Edmond Pui Hang Choi
- School of Nursing, The University of Hong Kong, Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong.
| | - Daniel Yee Tak Fong
- School of Nursing, The University of Hong Kong, Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong
| | - Janet Yuen Ha Wong
- School of Nursing, The University of Hong Kong, Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong
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5
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Mackenzie S, Michels C, Chang J. Structures of Sexuality: Sexual Stigma, Disclosure, and HIV Risk with Primary Female Partners Among Behaviorally Bisexual Black Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:299-310. [PMID: 31562582 DOI: 10.1007/s10508-019-1463-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 03/29/2019] [Accepted: 04/27/2019] [Indexed: 06/10/2023]
Abstract
HIV continues to disproportionately impact bisexual Black men, as well as their female partners, in the U.S. There is a need to better understand how stigma and disclosure affect sexual risk for men and their female partners. This article describes the relationship between sexual stigma and HIV risk with primary female partners among a sample of 121 behaviorally bisexual Black men of mixed HIV status in the San Francisco Bay Area. Multivariate analyses tested to see if each of three stigma measures (bisexual stigma, internalized homophobia, difficulty with bisexual identity) would have any effect on participants' condom use. Quantitative analyses found that sexual stigma increased men's sexual risk through inhibiting disclosure of their sexual activity with men to their female partners. Men who reported higher levels of bisexual stigma and internalized homophobia reported that it was harder to disclose having sex with men to their primary female partner, which was significantly related to lower levels of condom use. Stigma reduction HIV prevention interventions are needed that address bisexual stigma experienced by Black men. HIV prevention interventions, including stigma reduction programs, must target both men and women to effectively reduce bisexual stigma and address the structural and relationship contexts of HIV.
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Affiliation(s)
- Sonja Mackenzie
- Public Health Program, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95053, USA.
| | - Cameron Michels
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Jason Chang
- Health Equity Institute, San Francisco State University, San Francisco, CA, USA
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6
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Feinstein BA, Dodge B. Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:217-232. [PMID: 31691076 DOI: 10.1007/s10508-019-1428-3)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 05/24/2023]
Abstract
The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., #14-047, Chicago, IL, 60611, USA.
| | - Brian Dodge
- Indiana University School of Public Health, Bloomington, IN, USA
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7
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Feinstein BA, Dodge B. Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:217-232. [PMID: 31691076 PMCID: PMC7018582 DOI: 10.1007/s10508-019-01468-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 05/02/2023]
Abstract
The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.
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Affiliation(s)
- Brian A Feinstein
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., #14-047, Chicago, IL, 60611, USA.
| | - Brian Dodge
- Indiana University School of Public Health, Bloomington, IN, USA
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8
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Feinstein BA, Moran KO, Newcomb ME, Mustanski B. Differences in HIV Risk Behaviors Between Self-Identified Gay and Bisexual Young Men Who are HIV-Negative. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:261-275. [PMID: 29508171 PMCID: PMC6123308 DOI: 10.1007/s10508-018-1148-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/22/2017] [Accepted: 01/06/2018] [Indexed: 05/18/2023]
Abstract
Young men who have sex with men (MSM) are disproportionately affected by HIV, but it remains unclear whether there are differences in HIV risk behaviors between self-identified gay and bisexual young men. To address this, the current study examined differences in condomless sex and substance use before sex with male partners between self-identified gay and bisexual young men who are HIV-negative. Additionally, we examined differences in HIV risk behaviors with male versus female partners among the bisexual men. We used four waves of data spanning 24 months from a cohort of young MSM ages 16-29. At each wave, participants reported on up to four partners, allowing us to examine within-person associations. Compared to gay men, bisexual men reported more insertive condomless anal sex (CAS) with casual partners, they were more likely to report marijuana use before sex, and they were less likely to report lifetime HIV testing and PrEP use. Alcohol and marijuana use before sex were associated with CAS for both gay and bisexual men, but the association between marijuana use and insertive CAS was stronger for bisexual men. Bisexual men reported more condomless sex with female partners compared to male partners, but this was not significant after accounting for alcohol and marijuana use. Bisexual men were more likely to report alcohol and marijuana use with female partners compared to male partners, but both alcohol and marijuana use were associated with condomless sex regardless of partner gender. Findings support the need for tailored HIV prevention for self-identified bisexual men to address their lack of preventive behaviors, their increased engagement in certain risk behaviors with male partners, and their engagement in risk behaviors with female partners.
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Affiliation(s)
- Brian A Feinstein
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
| | - Kevin O Moran
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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9
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Dolphin L, Fitzgerald A, Dooley B. Risky sex behaviours among college students: The psychosocial profile. Early Interv Psychiatry 2018; 12:1203-1212. [PMID: 29235241 DOI: 10.1111/eip.12526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/19/2017] [Accepted: 11/08/2017] [Indexed: 01/07/2023]
Abstract
AIMS Risky sex behaviours among college students are a growing public health concern. However, few studies have profiled these behaviours using a large range of psychosocial correlates. METHODS Participants were 6874 undergraduate and postgraduate students (64.7% female, age range 17-25 years, M = 20.43 years, SD = 1.86 years) drawn from 13 higher-level institutions in Ireland. RESULTS Regarding prevalence, 75% of the sample report that they have been, or are currently sexually active. Of this sexually active cohort (n = 5111), 27.2% report early sexual initiation, 29.5% report 5 or more lifetime sexual partners and 12.1% report 2 or more sexual partners in the past 3 months. In addition, 47.7% of students report inconsistent condom use and 39.5% report inconsistent use of other contraceptive methods in the past 3 months. Using multivariate logistic regression analyses, significant correlates of risky sex behaviour are identified across 5 groups of psychosocial predictors (demographic, sexuality and relationships, substance use, mental well-being and personal resources). Differences between males and females and between different sexual orientations are highlighted. CONCLUSIONS Suggestions are made for sexual education and intervention programs to specifically target subgroups of the student population.
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Affiliation(s)
- Louise Dolphin
- School of Psychology, University College Dublin, Belfield, Ireland
| | | | - Barbara Dooley
- School of Psychology, University College Dublin, Belfield, Ireland
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10
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Faílde Garrido JM, Ruiz Soriano L, Pérez Fernández MR, Lameiras Fernández M, Rodríguez Castro Y. Evolution of quality of life and health‐related behaviors among Spanish university students. Int J Health Plann Manage 2018; 34:e789-e801. [DOI: 10.1002/hpm.2692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Laura Ruiz Soriano
- Faculty of Education ScienceUniversity of Vigo (Ourense Campus) Pontevedra Spain
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11
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Dangerfield DT, Harawa NT, Smith LR, Jeffries WL, Baezconde-Garbanati L, Bluthenthal R. Latent Classes of Sexual Risk Among Black Men Who Have Sex with Men and Women. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2071-2080. [PMID: 29541914 PMCID: PMC6145093 DOI: 10.1007/s10508-017-1142-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/16/2017] [Accepted: 12/22/2017] [Indexed: 05/06/2023]
Abstract
Black men who have sex with men and women (BMSMW) are at high risk for HIV and other sexually transmitted infections (STIs). Despite knowing that HIV/STI risk varies by sexual positioning practices, limited data have characterized the risk profiles of BSMW. This study utilized latent class analysis (LCA) to explore BMSMW's sexual risk profiles regarding condomless sexual positioning practices. Participants were BMSMW in intervention studies in Los Angeles, Chicago, and Philadelphia. LCA was used to characterize their sexual risk profiles. Age, study location, HIV status, social support, and internalized homophobia were used as covariates in a multinomial regression model predicting the likelihood of class membership. Among the 546 participants, three latent classes of risk were identified: Seropositive Serosorters, Seronegative/unknown Serosorters, and Main Partners Only. All groups had the greatest probabilities of condomless sex with main partners. Seropositive Serosorters had the highest probabilities of condomless sex with HIV-positive partners. Seronegative/unknown Serosorters had the highest probabilities of condomless sex with HIV-negative or unknown status partners. HIV-positive BMSMW had 87% lower odds of being classified as Seronegative/unknown Serosorters than Seropositive Serosorters than HIV-negative/unknown status BMSMW (AOR = 0.13, 95% CI 0.06, 0.28). HIV-positive BMSMW had 71% lower odds of being classified as Main Partners Only than Seropositive Serosorters than HIV-negative/unknown status BMSMW (AOR = 0.29, 95% CI 0.16, 0.51). Findings highlight opportunities for clinicians to promote condom use and risk reduction among BMSMW with differing sexual risk profiles. Increased understanding of sexual positioning practices among BMSMW might help address HIV/STIs among this group.
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Affiliation(s)
| | - Nina T Harawa
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Laramie R Smith
- Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - William L Jeffries
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ricky Bluthenthal
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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12
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Green HD, Weeks MR, Berman M, Mosher HI, Abbott M, Garcia N. Managing the risk of intimacy: accounts of disclosure and responsiveness among people with HIV and intimate partners of people with HIV. CULTURE, HEALTH & SEXUALITY 2018; 20:1117-1129. [PMID: 29944072 PMCID: PMC6399062 DOI: 10.1080/13691058.2018.1479535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
It is well known that concerns about sexual risk tend to decline among people in intimate relationships where there is established commitment and trust. In the context of relationships at increased risk for HIV transmission, interactions involving disclosure and partner responsiveness are key to maintaining intimacy and physical safety. This paper explores concepts of risk and sexual intimacy articulated by a community sample of 30 people living with HIV and their intimate relationship partners. Data revealed the shifts in intimate relationship dynamics upon the disclosure of an HIV diagnosis, the importance of intimacy in the context of managing one or both partners' HIV care and responses to new advances in HIV prophylaxis. Findings suggest that participants' experiences of self-disclosure and partner responsiveness most often resulted in an increased sense of protectiveness from and for partners. This suggests that health-promoting messaging should be adapted to be more relevant to intimate couple communication and mutual support.
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Affiliation(s)
| | | | - Marcie Berman
- The Institute for Community Research, Hartford, CT, USA
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13
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Dangerfield DT, Smith LR, Williams J, Unger J, Bluthenthal R. Sexual Positioning Among Men Who Have Sex With Men: A Narrative Review. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:869-884. [PMID: 27178171 PMCID: PMC5357199 DOI: 10.1007/s10508-016-0738-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 01/08/2016] [Accepted: 03/08/2016] [Indexed: 05/11/2023]
Abstract
Sexual positioning practices among men who have sex with men (MSM) have not received a thorough discussion in the MSM and HIV literature, given that risks for acquiring or transmitting HIV and STIs via condomless anal sex vary according to sexual positioning. MSM bear a disproportionate burden of HIV compared to the general population in the United States; surveillance efforts suggest that HIV and STIs are increasing among domestic and international populations of MSM. We conducted a narrative review, using a targeted literature search strategy, as an initial effort to explore processes through which sexual positioning practices may contribute to HIV/STI transmission. Peer-reviewed articles were eligible for inclusion if they contained a measure of sexual positioning identity and/or behavior (i.e., "top", "bottom," etc.) or sexual positioning behavior (receptive anal intercourse or insertive anal intercourse), or assessed the relationship between sexual positioning identity with HIV risk, anal sex practice, masculinity, power, partner type, or HIV status. A total of 23 articles met our inclusion criteria. This review highlights dynamic psychosocial processes likely underlying sexual decision making related to sexual positioning identity and practices among MSM and MSM who have sex with women (MSMW), and ways these contexts may influence HIV/STI risk. Despite limited focus in the extant literature, this review notes the important role the contextual factors (masculinity stereotypes, power, partner type, and HIV status) likely to play in influencing sexual positioning identity and practices. Through this review we offer an initial synthesis of the literature describing sexual positioning identities and practices and conceptual model to provide insight into important areas of study through future research.
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Affiliation(s)
- Derek T Dangerfield
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA.
| | - Laramie R Smith
- Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Jeffery Williams
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA
| | - Jennifer Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA
| | - Ricky Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA
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14
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Ballester-Arnal R, Ruiz-Palomino E, Gil-Llario MD. Structural Equation Modeling Test of an Integrated Model of Spanish Youth's Condom Use. AIDS Behav 2017; 21:1407-1416. [PMID: 27217037 DOI: 10.1007/s10461-016-1430-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Heterosexual transmission represents 26 % of newly diagnosed infection in Spanish youth. Behavioral change models have emphasized the influence of multiple variables to predict condom use behavior. The aim of this study is to examine how those variables are organized and which theory explains the condom use behavior better. A sample of 424 young heterosexuals (M age = 20.62; SD = 2.16) filled out a battery of self-report questionnaires for assessing AIDS-related variables, personality traits and clinical variables (general, sexuality-related and health-related). A structural model was specified that included perceived pleasure and condom use self-efficacy as predictive variables. Depression and sexual compulsivity indirectly influence behavior. The final model accounted for 65.9 % of the variance in behavior. These results highlight the importance of cognitive and emotional variables as predictors of behavior (ex. expectations of pleasure and self-efficacy beliefs). This is important information for designing effective psychological interventions.
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Heijman T, Zuure F, Stolte I, Davidovich U. Motives and barriers to safer sex and regular STI testing among MSM soon after HIV diagnosis. BMC Infect Dis 2017; 17:194. [PMID: 28264658 PMCID: PMC5339973 DOI: 10.1186/s12879-017-2277-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background Understanding why some recently with HIV diagnosed men who have sex with men (MSM) choose for safer sex and regular STI testing, whereas others do not, is important for the development of interventions that aim to improve the sexual health of those newly infected. Methods To gain insight into motives and barriers to condom use and regular STI testing among MSM soon after HIV diagnosis, 30 HIV-positive MSM participated in semi-structured qualitative interviews on sexual health behaviours in the first year after HIV diagnosis. Results Typical barriers to condom use soon after diagnosis were emotions such as anger, relief, and feelings of vulnerability. Additional barriers were related to pre-diagnosis patterns of sexual-social behaviour that were difficult to change, communication difficulties, and substance use. Barriers to STI testing revolved around perceptions of low STI risk, faulty beliefs, and burdensome testing procedures. Conclusions The great diversity of motives and barriers to condom use and STI testing creates a challenge to accommodate newly infected men with information, motivation, and communication skills to match their personal needs. An adaptive, tailored intervention can be a promising tool of support.
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Affiliation(s)
- Titia Heijman
- STI outpatient Clinic, Amsterdam Public Health Service, Amsterdam, The Netherlands.
| | - Freke Zuure
- Department Infectious Diseases, Research and Prevention, Amsterdam Public Health Service, Amsterdam, The Netherlands.,Centre for Infection and Immunology Amsterdam (CINIMA), Academic Medical Centre (University of Amsterdam), Amsterdam, The Netherlands
| | - Ineke Stolte
- University of applied sciences InHolland, Haarlem, The Netherlands
| | - Udi Davidovich
- Department Infectious Diseases, Research and Prevention, Amsterdam Public Health Service, Amsterdam, The Netherlands.,Centre for Infection and Immunology Amsterdam (CINIMA), Academic Medical Centre (University of Amsterdam), Amsterdam, The Netherlands
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Ubrihien A, Davies SC, Driscoll T. Is cost a structural barrier preventing men who have sex with men accessing condoms? A systematic review. AIDS Care 2016; 28:1473-80. [PMID: 27240970 DOI: 10.1080/09540121.2016.1189999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A systematic review was undertaken to determine whether cost is a structural barrier preventing men who have sex with men (MSM) accessing condoms. Studies were examined from a range of countries where condoms have been distributed free to particular populations and also those where condoms were available at a cost to the individual. The study inclusion criteria were: published between January 1990 and September 2014 inclusive; published in any language, discussed cost as a barrier to condom use, discussed cost barriers to MSM accessing condoms and included a measure of outcome. Articles were systematically extracted from MEDLINE, Embase, PyschINFO and Informat using the five search terms; Male Homosexuality, Access, Cost, Cost and Cost analysis, Condoms. Sixty-four articles were initially identified and 11 included in the final review. The included studies used cost-utility analysis, qualitative, cross-sectional, cohort or randomised control trial design. Large-scale free distribution programmes and smaller targeted programmes showed positive correlations in reducing the burden of disease from HIV and other sexually transmitted infections through eliminating the issue of cost. Decreasing the cost of condoms, and providing them for no cost, appears to increase their utilisation amongst MSM and possibly reduce the burden from HIV and other sexually transmitted infections. Inequality and stigma remain important barriers to MSM accessing and using condoms particularly in the developing world.
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Affiliation(s)
- Ashley Ubrihien
- a Northern Sydney Sexual Health Service, Royal North Shore Hospital , St Leonards , NSW , Australia.,b School of Public Health, Sydney Medical School, University of Sydney , Sydney , NSW , Australia
| | - Stephen C Davies
- a Northern Sydney Sexual Health Service, Royal North Shore Hospital , St Leonards , NSW , Australia.,c Sydney Medical School, University of Sydney , Sydney , NSW , Australia
| | - Tim Driscoll
- b School of Public Health, Sydney Medical School, University of Sydney , Sydney , NSW , Australia
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Noor SW, Wilkerson JM, Schick V, Iantaffi A. Non-monosexual Partnerships: Information, Motivation and Self-Efficacy among Methamphetamine-Using Men Who Have Sex with Men Who Also Have Sex with Women or Transgender Persons. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2016; 28:205-215. [PMID: 28255423 PMCID: PMC5328189 DOI: 10.1080/19317611.2016.1168903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Sex with more than one gender is associated with higher substance use, and sexual HIV risk. METHODS We examined knowledge, motivation, and self-efficacy to engage in safer substance use and sexual behavior among methamphetamine-using U.S. men who have sex with more than one gender (N=343). RESULTS Almost half(46.2%) of the men reported having sex with a man and a woman or transgender partner in the last 30 days. Compared to monosexual MSM, non-monosexual MSM reported greater condom use self-efficacy however, they reported more sexual partners who inject drugs. CONCLUSION We observed distinct differences between men who do or do not have sex with more than one gender.
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Affiliation(s)
- Syed Wb Noor
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - J Michael Wilkerson
- The University of Texas Health Science Center at Houston (UT Health) School of Public Health, Houston, Texas, USA
| | - Vanessa Schick
- The University of Texas Health Science Center at Houston (UT Health) School of Public Health, Houston, Texas, USA
| | - Alex Iantaffi
- Program in Human Sexuality, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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18
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Dodge B, Banik S, Bowling J, Sivasubramanian M, Mengle S, Schick V, Herbenick D, Kavi AR, Anand V. Sexual Relationships, Behaviors, and Experiences among Bisexual Men in Mumbai, India. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2016; 28:70-84. [PMID: 27073588 PMCID: PMC4826728 DOI: 10.1080/19317611.2015.1116482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This exploratory study aimed to assess a range of sexual behaviors, relationships and related factors among a sample of bisexual men in Mumbai, India. Data collection occurred in two separate phases: 1. focus group discussions were facilitated with local community members in order to finalize an interviewer-administered questionnaire, and 2. structured interviews were conducted with a sample of 50 bisexual men using this questionnaire. Participants self-reported a wide range of sexual behaviors and relationships. Findings have implications for future research and practice focusing on bisexual men in India, as well as their partners of all genders.
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Affiliation(s)
- Brian Dodge
- Indiana University, Center for Sexual Health Promotion, Bloomington, IN, USA
| | - Swagata Banik
- Baldwin Wallace University, Public Health Program, Berea, OH, USA
| | - Jessamyn Bowling
- Indiana University, Center for Sexual Health Promotion, Bloomington, IN, USA
| | | | | | - Vanessa Schick
- University of Texas Health Science Center, Houston TX, USA
| | - Debby Herbenick
- Indiana University, Center for Sexual Health Promotion, Bloomington, IN, USA
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Baldwin A, Dodge B, Schick V, Hubach RD, Bowling J, Malebranche D, Goncalves G, Schnarrs PW, Reece M, Fortenberry JD. Sexual self-identification among behaviorally bisexual men in the midwestern United States. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:2015-26. [PMID: 25344028 PMCID: PMC4409915 DOI: 10.1007/s10508-014-0376-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/07/2014] [Accepted: 06/14/2014] [Indexed: 05/11/2023]
Abstract
Previous social and behavioral research on identity among bisexual men, when not subsumed within the category of men who have sex with men (MSM), has primarily focused on samples of self-identified bisexual men. Little is known about sexual self-identification among men who are behaviorally bisexual, regardless of sexual identity. Using qualitative data from 77 in-depth interviews with a diverse sample of behaviorally bisexual men (i.e., men who have had sex with at least one woman and at least one man in the past six months) from a large city in the Midwestern United States, we analyzed responses from a domain focusing on sexual self-identity and related issues. Overall, participants' sexual self-identification was exceptionally diverse. Three primary themes emerged: (1) a resistance to, or rejection of, using sexual self-identity labels; (2) concurrent use of multiple identity categories and the strategic deployment of multiple sexual identity labels; and (3) a variety of trajectories to current sexual self-identification. Based on our findings, we offer insights into the unique lived experiences of behaviorally bisexual men, as well as broader considerations for the study of men's sexuality. We also explore identity-related information useful for the design of HIV/STI prevention and other sexual health programs directed toward behaviorally bisexual men, which will ideally be variable and flexible in accordance with the wide range of diversity found in this population.
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Affiliation(s)
- Aleta Baldwin
- Indiana University, Center for Sexual Health Promotion, Bloomington, IN
| | - Brian Dodge
- Indiana University, Center for Sexual Health Promotion, Bloomington, IN
| | - Vanessa Schick
- University of Texas Health Science Center, Division of Management, Policy & Community Health, Houston, TX
| | - Randolph D. Hubach
- Oklahoma State University, School of Applied Health & Educational Psychology, Stillwater, OK
| | - Jessamyn Bowling
- Indiana University, Center for Sexual Health Promotion, Bloomington, IN
| | - David Malebranche
- University of Pennsylvania, Department of Medicine, Philadelphia, PA
| | - Gabriel Goncalves
- Indiana University, Center for Sexual Health Promotion, Bloomington, IN
| | - Phillip W. Schnarrs
- University of Texas, College of Education & Human Development, San Antonio, TX
| | - Michael Reece
- Indiana University, Center for Sexual Health Promotion, Bloomington, IN
| | - J. Dennis Fortenberry
- Indiana University, Center for Sexual Health Promotion, Bloomington, IN
- Indiana University School of Medicine, Division of Adolescent Medicine, Indianapolis, IN
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Cai R, Zhao J, Cai W, Chen L, Richardus JH, de Vlas SJ. HIV risk and prevention behaviors in men who have sex with men and women: a respondent-driven sampling study in Shenzhen, China. AIDS Behav 2014; 18:1560-8. [PMID: 24578012 DOI: 10.1007/s10461-014-0735-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Men who have sex with men and women (MSMW) may expand the HIV epidemic from men who have sex with men to the female population. From a respondent-driven sampling survey in Shenzhen, China, we quantified the burden of HIV/syphilis and studied patterns of risk and prevention behaviors in 107 MSMW, and compared these with those of 542 men who have sex with men only (MSM-only). HIV prevention behaviors and consistent condom use with male partners did not differ between the two groups. However, HIV risk behaviors were more common among MSMW than MSM-only. Moreover, among MSMW, the HIV prevalence was as high as 6 % and consistent condom use was extremely low with female partners in MSMW. We conclude that there is risk of HIV transmission from MSMW to the female population. Special efforts are needed to convince MSMW they should refrain from HIV risk behaviors.
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