Rethinking Risk, Culture, and Intervention in Collective Sex Environments

Managing the business of sex: swinger club managers and sexual health promotion

The increased popularity of swinger clubs across the UK in the past two decades has not been met with commensurate public health initiatives or interventions that engage with the relationship between swinger clubs and sexual health. Consequently, the responsibility for sexual health promotion within these establishments largely depends on the discretion of club managers. Drawing on data from semi-structured interviews with 10 managers from across the UK, the study suggests that the managers' perceptions of the club-consumer relationship shape the nature of sexual health promotion. Three distinct approaches were evident in the research: those who perceive sexual health promotion as financially detrimental; those who see it as an individual rather than a collective club concern; and those who consider it as part of a broader social community responsibility. These findings highlighted an implicit beneficence of managers towards their customers; a shared assumption that an ideal consumer was heterosexual, partnered and in their forties; and differing perceptions of manager responsibility towards the sexual health of customers. The paper concludes by suggesting that the swinger community is a blind spot in sexual health discussion in the UK and that by talking to the managers of swinger clubs we can further develop our understanding of the area.

Swingers and swinging: a critical review of early and current literature and theory

The last literature review on swingers was written by Richard J. Jenks in 1998, and for the past 25 years, no review has been published with a focus solely this group. Some individual studies have analysed swinging together with other consensual non-monogamies, while other research has looked at swinging in the context of sexual health. This paper presents early and recent literature on swinging, highlighting some of the directions taken in swinger research, and addressing the challenges of finding a theoretical framework suitable to explain swingers, swinger settings, and swinging.

Sex exceptionalism and erasure in porn health protocols

Porn production, like all forms of labour, entails certain occupational health and safety (OHS) risks. Porn production has generally not been subject to state occupational health oversight, and porn workers have instead implemented self-regulatory OHS systems. However, in California, where the industry is most established, governmental and non-governmental bodies have made several paternalist attempts to legislate standardised OHS protocols. Their proposed legislation exceptionalises sex work as uniquely dangerous while failing to tailor guidance to the specific needs of and practices associated with porn work. This is largely because: 1) regulators are ignorant of porn's self-regulatory processes; 2) industry self-regulation conceptualises the occupational hazard on porn sets as infectious bodily fluids, whereas external regulators perceive the hazard as sex itself; and 3) regulators devalue porn work and so do not take the viability of the labour into account when evaluating protocol effectiveness. Using critical-interpretive medical anthropology involving fieldwork and interviews with porn workers and a critical analysis of porn OHS texts, I argue that porn health protocols should be left to industry self-determination, to be developed by porn workers rather than for them.

"Oh! How Modern! And... Are You Ok with That?": Consensually Non-Monogamous People's Experiences When Accessing Sexual Health Care

The current research explored consensually non-monogamous peoples' experiences accessing sexual healthcare. Using a mixed method approach, a sample of 67 consensually non-monogamous individuals (48% Polyamorous; 42% Relationship Anarchy/Solo polyamory; 6% Swingers; 4% Uncategorized) reported having significantly lower rates of trust in healthcare professionals compared to standardized scores. Sixty-three percent of participants reported disclosing their relationship status to a clinician when accessing sexual health services, whereas 37% sometimes or never disclosed. Qualitative responses identified that some participants reported a willingness to be open about their relationships, but many chose to "pass" as monogamous to both simplify and streamline their interactions as well as to avoid potential stigma. Participants reported a wide range of experiences with clinicians from those who were accepting and professional, to some who displayed prejudice and withheld treatment. This research outlines some of the experiences and challenges presented to consensual non-monogamists when accessing sexual healthcare as well as providing suggestions for clinicians to help remove some of the barriers to appropriate patient care.

Collective Sex and Committed Relationships: A Qualitative Exploration of Relationship Desires Among Gay Men Who Attend Sex Clubs

Studies have documented gay men's engagement in collective sex (e.g., group sex in public or commercial environments) but little attention has been paid to these men's relationship desires or agreements. We report on qualitative interviews with 20 gay men who attended private sex clubs in New York City, asking how participants navigated sometimes conflicting desires for collective sex and committed relationships. Participants felt that collective sex was either a) incompatible with relationships, which should be monogamous; b) complementary to a primary non-monogamous relationship; or c) at least as important as relationships. Gay men attending sex clubs attribute different value to collective sex and to committed relationships, and experience different challenges in satisfying their desires for intimacy. Resources could help gay men navigating these apparently conflicting desires and making suitable choices regarding their relationships and/or sexual agreements.

Sexual and Gender Minority Individuals' Interest in Sexual Health Services at Collective Sex Venues in New York City

Sexual and gender minority individuals who attend collective sex venues (CSVs; establishments where people can have sex in groups or the presence of others) are at elevated risk for HIV and STIs. On-site sexual health interventions have been attempted at CSVs, but attendees' interest in receiving such services is under-investigated. This paper presents results from a 2020 online cross-sectional survey completed by 342 sexual and gender minority individuals who attended CSVs in New York City. Interest in services such as on-site testing for STIs, testing vans near CSVs, and informational referrals was overall high, particularly among younger participants. Among participants who reported being HIV negative, those of younger age and those who were not using PrEP reported being more likely to take an HIV test if it would be offered at CSVs. In open-text survey responses, participants expressed interest in CSVs providing free prevention services such as HIV/STI testing, PEP, PrEP, and STI medications or vaccination, as well as in ways to improve norms surrounding condom use and consent at these venues. Some participants expressed barriers to on-site services such as privacy concerns, preexisting access to health services, an emphasis on personal responsibility, and negative reactions to the presence of service providers. However, some participants also felt that these services could be delivered in a positive, acceptable, and non-judgmental way, especially by involving CSV organizers and attendees in their implementation. Findings from this study can inform future initiatives to develop sexual health interventions at CSVs.

Banishment through Branding: From Montréal’s Red Light District to Quartier des Spectacles

This paper analyzes how the City of Montréal employed tools of urban planning—including a district plan, street redesign, rezoning, selective public consultation, expropriation, policing and surveillance—to spatially banish sex work from its historic district, using the red light symbol as a branding strategy. This coincided with a change in federal law (Bill C-36) and a policy shift to reposition sex workers as passive victims of sex trafficking. Using a case study design, this work explores the state’s refusal to recognize the agency of those engaged in embodied socio-economic exchanges and the safety and solidarity possible in public space. In interviews, sex workers described strategies of collective organizing, resistance and protest to hold the city accountable during this process of displacement. We consider how urban planning might support sex work, sex workers and economic autonomy.

Hosts as Gatekeepers for North American Gay and Bisexual Men's Private Group Sex Parties

Gay and bisexual men's (GBM) group sex parties are considered HIV risk environments due to their association with concurrent sexual partners, condomless anal sex, and polysubstance use. The possibility of group sex party hosts acting as gatekeepers to minimize risks has been suggested, but remains understudied. We analyzed qualitative data from 20 in-depth interviews with North American GBM who recently attended private group sex parties to determine if hosts' actions constitute harm reduction strategies. Results showed hosts acting as gatekeepers before parties by establishing and disseminating themes and rules, screening applicants, and selecting guests. During parties hosts enforced rules and rejected uninvited guests. By their actions, hosts established a more controlled environment compared to public sex-on-premises bathhouses, and facilitated boundary play, the paradoxical behavior of simultaneously desiring risk and safety, previously noted for GBM circuit parties. Results suggest initiating education programs focusing on private group sex party hosts as gatekeepers.

Attitudes Toward Peer-Delivered Sexual-Health Services Among New York City Sexual and Gender Minority Individuals Who Have Sex with Men and Attend Collective Sex Venues

Collective sex venues such as sex clubs are strategic sites to promote sexual health among sexual and gender minority individuals. We present qualitative findings from a multiple-method study on the acceptability of sexual-health services at collective sex venues in New York City (NYC) among attendees who identified as men, transgender, or gender non-conforming. In a survey used for sample selection (n = 342), most respondents (82.7%) agreed that "having outreach workers at sex venues is a good thing." Interviewees (n = 30) appreciated how on-site services could promote sexual health in their community. They felt peer workers should be familiar with collective sex venues and share demographic characteristics with attendees. Some participants felt workers should keep some boundaries from attendees, while others felt they could be fully integrated in the environment, suggesting that either peer outreach or popular-opinion leader types of interventions could be feasible.

Web-Based Behavioral Intervention Utilizing Narrative Persuasion for HIV Prevention Among Chinese Men Who Have Sex With Men (HeHe Talks Project): Intervention Development

Background

In the era of potent antiretroviral therapy, a high level of condomless anal intercourse continues to drive increases in HIV incidence in recent years among men who have sex with men. Effective behavior change strategies for promoting HIV-preventive behaviors are warranted. Narrative persuasion is a novel health communication approach that has demonstrated its persuasive advantages in overcoming resistance to counterattitudinal messages. The efficacy of narrative persuasion in promoting health behavior changes has been well documented, but critical research gaps exist for its application to HIV prevention.

Objective

In this study, we aimed to (1) capitalize on narrative persuasion to design a web-based multisession intervention for reducing condomless anal intercourse among men who have sex with men in Hong Kong (the HeHe Talks Project) by following a systematic development process; and (2) describe the main components of the narrative intervention that potentially determine its persuasiveness.

Methods

Persuasive themes and subtopics related to reducing condomless anal intercourse were initially proposed based on epidemiological evidence. The biographic narrative interview method was used to elicit firsthand experiential stories from a maximum variation sample of local men who have sex with men with diverse backgrounds and experiences related to HIV prevention; different types of role models were established accordingly. Framework analysis was used to aggregate the original quotations from narrators into collective narratives under 6 intervention themes. A dedicated website was finally developed for intervention delivery.

Results

A series of video-based intervention messages in biographic narrative format (firsthand experiential stories shared by men who have sex with men) combined with topic-equivalent argumentative messages were produced and programmed into 6 intervention sessions. The 6-week intervention program can be automatically delivered and monitored online.

Conclusions

We systematically created a web-based HIV prevention intervention derived from peer-generated stories. Strategies used to enhance the efficacy of the narrative intervention have been discussed within basic communication components. This paper describes the methods and experiences of the rigorous development of a narrative communication intervention for HIV prevention, which enables replication of the intervention in the future.

Kinky Sex Gone Wrong: Legal Prosecutions Concerning Consent, Age Play, and Death via BDSM

This commentary begins by describing the author's research and expert witness practice serving sex and gender minorities, especially practitioners of BDSM/kinky sex. Then, it reviews the three most common reasons that BDSM is legally prosecuted. First, consent: was this assault, rape, and/or kidnapping, or was it consensual kinky sex that either got out of hand or is now being strategically employed to punish the other partner? Second, age play: was this adult trying to have sex with children or was he (and it is virtually always men) intending to age play with an adult who is pretending to be an adolescent? Third, death by kinky sex: was this a person who murdered their lover or was this an accidental death? Finally, this article concludes with recommendations for kinksters who wish to assure consent and safe play, and for litigators involved in the prosecution of kinky sex.

Service provision and barriers to care for men who have sex with men engaging in chemsex and sexualised drug use in England

BACKGROUND

Chemsex and sexualised drug use (SDU) among men who have sex with men (MSM) has become a public health issue because of its associated sexual risks. Some MSM engaging in SDU require further help and support, but it is not clear if this need is being met. This research seeks to understand MSM and service provider (SP) perspectives of the current standard of service provision for MSM engaging in SDU.

METHOD

Semi-structured interviews were conducted with 13 MSM and 16 SPs in England (January-December 2019). MSM who reported taking one of ten substances for sex in the past 12 months were recruited from a mailing list or a community organisation providing chemsex support. Potential SP participants were recruited via an email sent from their local healthcare NHS Trust. Data for MSM and SPs were analysed separately using thematic analysis.

RESULTS

MSM participants had a median age of 34 years (range 23-66).The majority of SPs recruited were genitourinary medicine (GUM) consultants. We found that the main reason for engagement in SDU was because of the enhanced sexual experience. Most MSM recruited were satisfied with their sexual health service provision, but barriers to care were highlighted by both MSM and SPs. Four themes relating to barriers to care were identified: accessibility of sexual health services, funding of services, SP's attitudes towards MSM who engage in SDU, and services outside sexual healthcare.

CONCLUSION

SPs appeared to have adopted a harm reduction approach to MSM engaging in SDU, but for MSM wanting further help and assistance in relation to their SDU additional barriers to care existed. Training healthcare providers outside of sexual health services regarding chemsex and SDU may reduce some of these barriers, but funding for sexual health services needs to be improved to maintain and further develop services.

COVID-19 et sexualités : l’émergence d’un nouveau paradigme des sexualités

Cet article vise à proposer un bilan provisoire de la recherche développée dans le contexte de la pandémie de COVID-19 depuis le début de l’année 2020. Il évalue les types de recherche déjà publiés, présente leurs méthodologies et analyse les questions posées. Il replace les recherches récentes dans la perspective de l’histoire des recherches empiriques sur la sexualité et notamment par rapport à celles qui ont été réalisées dans le contexte du VIH-sida. Situé dans une perspective d’histoire intellectuelle, l’article analyse les recherches actuellement développées comme la construction et la préfiguration d’un nouveau paradigme des sexualités qui distingue et associe les relations sexuelles qui se déroulent en présence d’un partenaire réel et celles qui se déroulent avec l’aide de toute une panoplie d’outils électroniques qualifiés de « virtuels » qui assurent un support à l’imagination et entretiennent l’excitation sexuelle en vue de la satisfaction personnelle.

COVID-19 and sexualities: The emergence of a new paradigm of sexualities

This paper aims to propose a provisional assessment of the research developed in the context of the COVID-19 pandemic since the beginning of 2020. It reviews the types of research already published, presents their methodologies and analyzes the questions posed. It places recent research in the perspective of the history of empirical research on sexuality, particularly in relation to research carried out in the context of HIV/AIDS. Situated in an intellectual history perspective, the article analyzes research currently being developed as the construction and prefiguration of a new paradigm of sexualities that distinguishes and associates sexual relations that take place in the presence of a real partner and those that take place with the help of a whole range of electronic devices qualified as “virtual” that provide support for the imagination and maintain sexual arousal for personal satisfaction.

Considerations for Research on Sexually Transmitted Infections (STIs): Reflections of an STI Clinician-Researcher

Sexually transmitted infections (STIs) have been explored in various sexual subgroups. While excellent, these analyses have primarily occurred from uniquely biologic, epidemiologic, or sociologic perspectives. Missing from these discussions has been in-depth presentations of the dynamics of STI transmission from all three viewpoints simultaneously. In this paper, I present information about STI transmission for each STI, including considerations of prevalence, and then review the STI research and of the concept of risk. I then apply these three considerations to a fictitious case study to show their importance and utility. I close by arguing that this information could strengthen future sociologic reviews of STIs and sexual health by helping such researchers include more nuanced understandings about STIs.

Types of Group Sex and Their Association with Different Sexual Risk Behaviors Among HIV-Negative Men Who Have Sex with Men

The current study sought to identify types of group sex acts among HIV-negative men who have sex with men (MSM) and assess their association with different sexual risk behaviors using cross-sectional data of group sex acts reported during 6 waves (2015-2018) of the Amsterdam MSM Cohort Study. Latent class analysis was performed to identify group sex types based on size, familiarity with partners, location, planning, and drug use. Associations between group sex types and sexual behaviors were evaluated using logistic regression with generalized estimating equations, employing the sample mean as a reference. Data at the level of group sex acts were analyzed, while correcting variance estimations for repeated measurements within MSM. A total of 392 MSM engaged in group sex ≥ 1 times, totaling 1033 group sex acts. Four types of group sex emerged: familiar (29%), intimate (27%), impromptu (36%), and party (8%). Familiar group sex (characterized by high proportions of mostly known partners, occurring in private places and involving drug use) had an increased adjusted odds of risky fingering (aOR 1.6, 95%CI 1.3-2.0) and of risky fisting and/or use of sex toys (aOR 2.3, 95%CI 1.6-3.1). Intimate group sex (characterized by high proportions of threesomes, occurring in private places, and not involving drug use) had a decreased adjusted odds of risky fisting and/or use of sex toys (aOR 0.6, 95%CI 0.4-0.9). Impromptu group sex (characterized by high proportions of spontaneity, mostly unknown partners, and taking place in public places) had a decreased adjusted odds of risky fisting and/or use of sex toys (aOR 0.5, 95%CI 0.3-0.7) and of condomless anal intercourse (CAI) (OR 0.6, 95%CI 0.5-0.8). Party group sex (characterized by high proportions of larger groups, mostly unknown partners, and being planned) had an increased adjusted odds of risky fisting and/or use of sex toys (aOR 1.6, 95%CI 1.0-2.7) and of CAI (aOR 1.5, 95%CI 1.1-2.1). The identified types of group sex reflect different dynamics and characteristics, with some types riskier for STIs and others riskier for HIV. HIV and STI prevention efforts could be tailored accordingly. For example, in certain type of public sex environments (e.g., cruising parks), traditional HIV and STI prevention efforts, such as promoting of condom use and PrEP, might be sufficient. However, in other settings (e.g., private parties), where group sex is more likely to be planned and where behaviors such as fisting, sharing of sex toys, and CAI are more likely to take place, which carry different levels of risk for HIV and STI transmission, including that of Hepatitis C, different approaches might be needed, such as broader HIV and STI prevention education efforts or targeting the organizers of group sex events.

Sex-on-premise venues, associated risk behaviors, and attitudes toward venue-based HIV testing among men who have sex with men in Lima, Perú

BACKGROUND

In Perú, HIV disproportionately affects men who have sex with men (MSM). Despite widespread access to treatment, the high rate of new HIV infections has remained unchanged over the last decade. Low knowledge of HIV status associated with late diagnosis is a key factor underlying the high HIV incidence observed in this setting, creating conditions for efficient onward transmission. Improving access to HIV testing and prevention services for those at highest risk is an important public health priority. Sex-on-premise venues (SOPVs) - saunas, sex clubs, pornographic movie theaters, hourly hotels, and bars/discos with areas where sex is permitted - may be opportune sites for outreach; however, further research on SOPVs and the populations who frequent them is needed to inform such efforts.

METHODS

We conducted a cross-sectional online survey of adult MSM in Lima, Perú to evaluate patterns of SOPV attendance, associated sexual risk behaviors, and attitudes toward SOPV-based interventions. Participants were recruited through outreach to social media networks affiliated with local LGBTQ-aligned community groups. Our primary analytic objective was to estimate the association of HIV-related sexual risk behaviors and SOPV attendance. Additionally, we performed exploratory analyses to describe risk behavior stratified by SOPV category and to examine the relationship between SOPV attendance and the use of online platforms to meet sex partners.

RESULTS

Overall, 389 MSM completed the survey from November 2018 through May 2019, of whom 68% reported attending an SOPV in the last 3 months. SOPV attendance was associated with multiple sexual risk behaviors, including transactional sex, group sex, substance use around the time of sex, and higher number of partners. Over two thirds of SOPV attendees indicated they would accept HIV testing if offered at SOPVs.

CONCLUSIONS

SOPV attendance was common among MSM in Lima who participated in our survey, and SOPV attendees reported significantly greater engagement in sexual risk behaviors related to HIV transmission. Attitudes toward hypothetical SOPV-based interventions were generally favorable. These findings suggest that outreach at SOPVs may be an effective mechanism for reaching a particularly high-risk sub-population of MSM in Perú to deliver targeted HIV testing and prevention interventions.

Condomless Group Sex Is Associated With HIV Pre-Exposure Prophylaxis Knowledge and Interest Uptake: A Cross-Sectional Study of Gay and Bisexual Men in Paris, France

As a prevention strategy, HIV pre-exposure prophylaxis (PrEP) may benefit men who participate in group sex, but little is known about PrEP among this group internationally and virtually nothing is known of the European context. This study used an online survey of gay men living in Paris, France to assess associations between group sex and awareness of, use and interest in PrEP in its once-daily, episodic, injectable, and microbicidal forms. Men reporting recent (within 3 months) condomless group sex were much more likely to report once-daily PrEP use than men with no group sex experience (41.5% vs 7.7%, p < .001). Uptake was similarly low among men who had group sex with condoms (8.0%) and those with less-recent experience (6.43%). Overall, willingness to use PrEP-including its non-daily forms-was high among men reporting group sex, suggesting opportunities for outreach and implementation.

Sex club/party attendance and STI among men who have sex with men: results from an online survey in New York City

OBJECTIVE

Prior studies have shown that men who have sex with men (MSM) who attend sex clubs or parties are at higher risk for HIV and other STIs than those who do not. We sought to provide data about MSM who attend sex clubs/parties in New York City (NYC) in the era of biomedical HIV prevention. METHODS : We conducted an online survey among MSM in NYC (n=766) in 2016-2017 and investigated differences between those who reported never attending a sex club/party (non-attendees 50.1%), those who had attended over a year ago (past attendees 18.0%) and those who attended in the prior year (recent attendees 30.1%). We also conducted multivariable analyses to explore associations with past-year STI diagnosis. RESULTS : Recent attendees were not more likely to be HIV positive than non-attendees. Among participants never diagnosed with HIV, recent attendees were more likely to use pre-exposure prophylaxis (PrEP, 32.6%) than non-attendees (14.5%) and past attendees (18.8%; p<0.001). Recent attendees reported the highest numbers of recent sex partners, including partners with whom they had condomless anal sex. Significantly more recent attendees reported an STI diagnosis in the prior year (27.9%) compared with non-attendees (14.0%) and past attendees (16.5%; p<0.001). However, 13.8% of non-attendees and 11.5% of past attendees reported having never tested for STIs, significantly more than recent attendees (6.0%, p=0.010). Multivariable analysis showed recent attendees to have 2.42 times the odds (compared with non-attendees) of reporting past-year STI diagnosis (95% CI 1.52 to 3.87, p<0.001).

CONCLUSIONS

Compared with those who had not done so, MSM who attended sex clubs/parties in NYC in the prior year were not only more likely to report past-year STI diagnoses but also more likely to report PrEP use or recent HIV/STI testing. Sexual health promotion among MSM who attend sex clubs/parties should address STI risk and prevention.