1
|
Saavedra-Roa A, Vallejo-Medina P. A non-latex condom has no influence on male physiological sexual arousal. Int J Clin Health Psychol 2024; 24:100442. [PMID: 38348144 PMCID: PMC10859562 DOI: 10.1016/j.ijchp.2024.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Background/Objective Men do not use external condoms for several reasons, which can result in public health problems. One of these is related to Condom-Associated Erectile Problems. This study aimed to examine the sexual arousal response of heterosexual men when using an external condom made of synthetic resin type AT-10. Method A total of 82 Colombian young men (Mage = 23.17 years, SD = 3.04, age range = 18-30) participated in this experimental study. Two random groups (experimental and control; n = 41 each) were compared. The experimental group used condoms, whereas the control group did not. Fit and feel condom perceptions, initial erectile scores, age, and substance use were controlled for. Erection was measured while viewing a sexual video by using penile plethysmography and subjective arousal. Results The results, obtained from comparing the experimental group (using pre-erection condoms) with the control group (not using condoms), revealed no significant difference in both subjective and physiological sexual arousal. This suggests that pre-erection condoms do not have an effect on the erectile response. Discussion More research is needed in this area to provide treatment and clinical interventions or sexual and reproductive education to mitigate the occurrence of sexual dysfunction, unplanned pregnancies, or sexually transmitted infections. Also, research addresses public health issues related to the prevention and/or intervention of sexual risk behaviors and sexual dysfunctions, highlighting their significance in sexual education and clinical practice.
Collapse
Affiliation(s)
- Alejandro Saavedra-Roa
- SexLab KL - Human Sexual Laboratory, Department of Psychology, Fundación Universitaria Konrad Lorenz, Bogotá D.C., Colombia
| | - Pablo Vallejo-Medina
- SexLab KL - Human Sexual Laboratory, Department of Psychology, Fundación Universitaria Konrad Lorenz, Bogotá D.C., Colombia
- Universitat Oberta de Catalunya, Department of Psychology and Education Sciences, Barcelona, Spain
| |
Collapse
|
2
|
Shen Y, Zhang C, Goldsamt LA, Peng W, Wang R, Li X. Condom-Related Stigma Scale among Men Who Have Sex with Men in China: Development and Psychometric Tests. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4779. [PMID: 36981688 PMCID: PMC10048750 DOI: 10.3390/ijerph20064779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Condom-related stigma is a frequently mentioned barrier to consistent condom use among men who have sex with men (MSM). Based on the concept and operational definition of condom-related stigma recently defined by our team, we developed the 20-item condom-related stigma scale (CRSS) and examined its psychometric properties among 433 MSM in China, following DeVellis's scale development guidelines. The content validity, convergent validity, empirical validity, factorial validity, scale score reliability, split-half reliability, and test-retest reliability for the CRSS were all assessed. The scale consists of four domains: perceived distrust, perceived potential HIV/STI risk, perceived embarrassment, and perceived violation of the traditional understanding of sexual intercourse. The CRSS has good validity (the scale-level content validity index was 0.99; the empirical validity was greater than 0.70) and high reliability (the Cronbach's alpha coefficient overall was 0.926; the split-half reliability overall was 0.795; the test-retest reliability overall was 0.950). This scale is recommended for assessing the level of condom-related stigma among Chinese MSM, which can serve as an evaluating indicator for safer-sex interventions to prevent HIV infection among the MSM population in a Chinese cultural context.
Collapse
Affiliation(s)
- Yan Shen
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Ci Zhang
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Lloyd A. Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA
| | - Wenwen Peng
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Run Wang
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Gesselman AN, Ryan R, Yarber WL, Vanterpool KB, Beavers KA, Francis H, Grant BT, Wood K, Graham CA, Milhausen R, Sanders SA, Crosby RA. An exploratory test of a couples-based condom-use intervention designed to promote pleasurable and safer penile-vaginal sex among university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1665-1672. [PMID: 33151840 DOI: 10.1080/07448481.2020.1818753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/29/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: Dual use of male condoms and female contraceptives is widely advocated for unplanned pregnancy prevention, yet college students often neglect condoms. This feasibility and acceptability study assessed the efficacy of a self-guided home-based condom-promotion intervention among college students in heterosexual relationships. Participants: Fifty-nine couples who had been together at least 30 days and had penile-vaginal sex at least twice weekly. Methods: Assessments were done at baseline and 6 months later. Outcomes were frequency of condom-unprotected penile-vaginal sex and four psychosocial mediators of condom use. Results: Frequency of unprotected penile-vaginal sex decreased over time. Several corresponding psychosocial mediators showed change, particularly among women. Using actor-partner interdependence modeling, men's increase in condom use was associated with an increase in women's sexual pleasure. Conclusion: Findings support implementation of a brief, self-guided, home-based condom-use intervention that could lower incidence of unplanned pregnancy and STIs among heterosexually active college students.
Collapse
Affiliation(s)
- Amanda N Gesselman
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
| | - Rebecca Ryan
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - William L Yarber
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
- Department of Gender Studies, Indiana University, Bloomington, Indiana, USA
| | - Karen B Vanterpool
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Karly A Beavers
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Heather Francis
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Brandon T Grant
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Katherine Wood
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Cynthia A Graham
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Psychology, University of Southampton, Southampton, UK
| | - Robin Milhausen
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada
| | - Stephanie A Sanders
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Gender Studies, Indiana University, Bloomington, Indiana, USA
| | - Richard A Crosby
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
5
|
Chan C, Bavinton BR, Prestage GE, Broady TR, Mao L, Rule J, Wilcock B, Holt M. Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998-2020. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2509-2521. [PMID: 35672592 PMCID: PMC9293873 DOI: 10.1007/s10508-022-02310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 05/30/2023]
Abstract
Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.
Collapse
Affiliation(s)
- Curtis Chan
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia.
| | - Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Garrett E Prestage
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - John Rule
- National Association of People with HIV Australia, Sydney, Australia
| | - Ben Wilcock
- Australia Federation of AIDS Organisations, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| |
Collapse
|
6
|
Dennermalm N, Persson KI, Thomsen S, Forsberg BC, Alvesson HM. Conceptualizing safer sex in a new era: Risk perception and decision-making process among highly sexually active men who have sex with men. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000159. [PMID: 36962224 PMCID: PMC10022342 DOI: 10.1371/journal.pgph.0000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are at the epicenter of the HIV epidemic. Efforts to prevent sexually transmitted infections (STIs) and HIV transmission have traditionally focused on condoms and abstinence from high risk sexual practices. Recently, additional methods such as pre-exposure prophylaxis (PrEP) and viral load sorting have been introduced. The aim of this study was to gain understanding about risk management and risk perception strategies for HIV among highly sexually active Swedish MSM with men in Berlin. METHODS Eighteen sexually active Swedish MSM who travelled to or lived in Berlin were recruited and interviewed in this study. The data were analyzed using content analysis. RESULTS AND DISCUSSION These men represent a group of knowledgeable MSM in terms of HIV. They acknowledged that having sex with men in Berlin was linked to high sexual risk taking due to the higher prevalence of HIV/STIs than in Sweden, but reported that they nevertheless did not alter their risk management strategies. The analysis resulted in a conceptual model of risk assessment that allows for a deeper understanding of the complexity of the risk reduction decision-making process. Three ontological perceptions of risk were identified: accepting, minimizing and rejecting risk. Seven practiced risk reduction methods were described. Some informants applied their preferred method or set of methods to all settings and partners, while others faced complex decision-making processes. CONCLUSION HIV is integrated into the core of MSM's sexuality, independently of how they ontologically related to the idea of risk. A constant navigation between pleasure, risk and safety, alongside having to relate to risk created a complex process. Efforts were made to remove HIV from their lives by rejecting the idea of risk, and thereby reject the idea of the homosexual body being a possible vessel for a virus and an epidemic.
Collapse
Affiliation(s)
- Nicklas Dennermalm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | | | - Sarah Thomsen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Birger C Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | |
Collapse
|
7
|
Hergenrather KC, Emmanuel D, Zeglin RJ, Ruda DJ, Rhodes SD. Men Who Have Sex With Men and HIV Risk Behavior: Exploring the Influence of Masculinity Within the Social Ecological Model. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:511-533. [PMID: 34874760 DOI: 10.1521/aeap.2021.33.6.511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the United States, gay, bisexual men, and men who have sex with men (MSM) represent 86% of new HIV infections among males. Approximately 1 in 7 men with HIV are unaware of their HIV status (CDC, 2017, 2019a, 2020a). To explore influences on MSM HIV risk behavior, the authors performed a systematic review of quantitative studies conducted in the U.S. assessing what is purported as masculinity. From 30 identified studies, significant findings were framed within the Social Ecological Model (SEM) levels (e.g., Individual, Relationship, Community). SEM level themes were applied to create the Masculinity 10, a preliminary 10-item assessment to explore the influence of masculinity on MSM HIV risk behavior. To increase MSM engagement in HIV prevention and treatment, the influences of masculinity (e.g., attitude toward sexual minorities, appearance, emotion, temperament, substance use, sexual activity, social support, intimate relationships, health care) on HIV risk behavior should be further explored.
Collapse
Affiliation(s)
| | | | | | - David J Ruda
- The George Washington University, Washington, D.C
| | - Scott D Rhodes
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
8
|
Sandset T, Villadsen K, Heggen K, Engebretsen E. Discipline for pleasure: a new governmentality of HIV prevention. BIOSOCIETIES 2021; 18:102-127. [PMID: 34608399 PMCID: PMC8481318 DOI: 10.1057/s41292-021-00257-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/21/2022]
Abstract
This article explores recent HIV prevention campaigns for pre-exposure prophylaxis (PrEP), focusing on how they integrate pleasure and desire in their calls for self-discipline through a continual use of pharmaceuticals. This emerging type of health promotion, here represented by ads promoting the preventive use of pharmaceuticals, no longer simply approaches target groups with demands to abstain from harmful substances or practices and thus control risks, but also includes messages that recognize individuals' habits, values, and their desires for pleasure. Drawing on Foucault's work concerning discipline and security, we suggest that a novel, permissive discipline is emerging in contemporary HIV prevention. Further guided by Barthes's theory of images, we analyse posters used in prevention campaigns, scrutinizing their culture-specific imagery and linguistic messages, i.e. how the words and images interact. We conclude that these campaigns introduce a new temporality of prevention, one centred on pleasure through the pre-emption and planning that PrEP enables.
Collapse
Affiliation(s)
- Tony Sandset
- grid.5510.10000 0004 1936 8921Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Villadsen
- grid.4655.20000 0004 0417 0154Department of Management, Politics, and Philosophy, Copenhagen Business School, Frederiksberg, Denmark
| | - Kristin Heggen
- grid.5510.10000 0004 1936 8921Institute for Interdisciplinary Health Education, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eivind Engebretsen
- grid.5510.10000 0004 1936 8921Institute for Interdisciplinary Health Education, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Shrader CH, Peters Jefferson K, Kanamori M, Rochat R, Siegler A. "I'd Rather Use a Refuse Bag:" A Qualitative Exploration of a South African Community's Perceptions of Government-Provided Condoms and Participant-Preferred Solutions. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:615-627. [PMID: 32367483 PMCID: PMC7609579 DOI: 10.1007/s10508-020-01701-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 05/26/2023]
Abstract
Despite South Africa experiencing one of the largest HIV epidemics in the world, condom use has decreased since 2008. However, condoms are the only low-cost HIV prevention technology widely available in South Africa. This study aims to explore a South African community's perceptions of condoms, recent condom use decrease, and suggestions for increasing condom use. In 2014, we conducted seven focus groups (n = 40 men) and 20 in-depth interviews (n = 9 men, n = 11 women) with participants aged ≥ 18 years recruited from four urban settlement health clinics in Cape Town, South Africa. Data were collected, coded, and analysed using a general inductive approach. Participants perceived government-provided condoms negatively, with themes including "disgust" for condom physical properties, concerns with social status associated with free condoms, and performance concerns. There was an intersection of themes surrounding masculinity, condom use, and sexual pleasure. Solutions to increase condom use included improving the quality and variety of free condoms and rebranding free condoms. Participants suggested that condoms are distributed with novel attributes (e.g., more colors, smells/flavors, sizes, and in-demand brands) and that government programs should consider offering all brands of condoms at no or low cost. This study suggests a substantial rethinking of condom branding for government-provided condoms. Our findings suggest that condom dissemination and promotion programs should proactively address public concerns regarding condoms. Existing societal and structural norms such as hegemonic masculinity must also be addressed using gender-transformative interventions. We also strongly suggest the creation of a Male Condom Acceptability Scale to understand condom users' needs.
Collapse
Affiliation(s)
- Cho-Hee Shrader
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Ste 1006, Miami, FL, 33132, USA.
| | | | - Mariano Kanamori
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Ste 1006, Miami, FL, 33132, USA
| | - Roger Rochat
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron Siegler
- Department of Epidemiology and Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
10
|
Hajek C. Gay Midlife Men's Intergenerational and Interpersonal (Non)Accommodation in the Negotiation of HIV Infection Risk: Implications for Sexual Vitality, Generational Distinctiveness, and Self-Preservation. HEALTH COMMUNICATION 2019; 34:1731-1740. [PMID: 30198777 DOI: 10.1080/10410236.2018.1517710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study utilizes interview data and a communication accommodation framework to explore how early midlife gay men negotiate HIV infection risk vis-à-vis a younger gay male sexual culture that has evolved in terms of its regard for dangers associated with HIV infection. Analysis of face-to-face interviews with 33 gay men (aged 40-53) in four U.S. cities revealed a model of gay intergenerational sexual (non)accommodation. The model includes forms of communicative convergence and nonaccommodating behavior that serve some men's achievement or continuation of sexual vitality and/or positive generational distinctiveness. Similarities and extensions to communication accommodation theory are discussed, as are the model's implications for understanding some gay men's management of sexual health at midlife.
Collapse
|
11
|
Mimiaga MJ, Hughto JMW, Reisner SL. A Randomized Pilot Study of a Group-Delivered HIV Risk Reduction Intervention for At-Risk Urban Men Who Have Sex with Men Who Regularly Attend Private Sex Events. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1059-1071. [PMID: 30805830 DOI: 10.1007/s10508-018-1326-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/24/2018] [Accepted: 10/04/2018] [Indexed: 06/09/2023]
Abstract
Across HIV prevention studies, as many as 25% of men who have sex with men (MSM) report meeting male partners at private sex events and attendance is associated with increased number of sexual partners, condomless anal sex (CAS), and HIV infection. Despite the need for effective HIV prevention interventions, no risk reduction interventions have been tested to reduce HIV sexual risk of MSM that regularly engage in sexual risk at private sex events. This randomized pilot study assessed the feasibility and acceptability of an HIV risk reduction intervention to reduce CAS among urban MSM (N = 14) reporting risk at a private sex event in the prior 12 months. The intervention arm received four group sessions (2 h/session) focusing on HIV risk reduction education and skills building. Both the intervention (n = 8) and control (n = 6) conditions received HIV testing and pre- and posttest risk reduction counseling and completed a sexual risk and psychosocial assessment visit at baseline and 3 months post-intervention. In addition, intervention participants completed a brief exit interview post-intervention. Mean age was 37 years, and 57% were racial/ethnic minorities. At follow-up, the intervention group reported greater reductions in sexual risk behavior in the past 3 months including number of CAS episodes, number of partners at private sex events, and CAS episodes at private sex events. The intervention group also reported reduced sexual compulsivity, increases in HIV disclosure, and reduced drug use at private sex events over study follow-up. Exit interviews revealed that participants found the intervention to be highly acceptable. Findings demonstrate feasibility of procedures, participant acceptability, and initial promise of a group-delivered HIV risk reduction intervention for MSM who attend and engage in CAS at private sex events. Further testing of this intervention in a larger pilot randomized controlled trial is warranted.
Collapse
Affiliation(s)
- Matthew J Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA.
- Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA.
| | - Jaclyn M W Hughto
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Sari L Reisner
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| |
Collapse
|
12
|
Polansky A, Levy I, Mor Z. Risk factors of syphilis co-infection among HIV -infected men who have sex with men in Tel-Aviv, Israel. AIDS Care 2019; 31:1157-1161. [PMID: 31035774 DOI: 10.1080/09540121.2019.1612006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Syphilis incidence in Israel and other industrialized countries has increased in the past decade, mainly among men who have sex with men (MSM) who were co-infected with HIV. This study aimed to assess the demographic characteristics and behavioral risk factors for syphilis infection among HIV-infected MSM in the Tel-Aviv region, Israel. This cross-sectional study compared HIV-infected MSM who were co-infected with syphilis since 2005 with HIV-infected MSM without syphilis, using an anonymous self-administered questionnaire distributed at the AIDS treatment clinic in central Israel in 2016. This study included 75 HIV-infected MSM who were diagnosed with syphilis after their HIV diagnosis and 99 HIV-infected MSM without syphilis. Variables associated with syphilis infection included inadequate adherence to antiretroviral therapy (ART) (OR = 1.8 [1.2-2.4]), frequent unprotected receptive anal intercourse (UAI) with casual sex partners (OR = 2.2 [1.5-8.2]), especially with HIV-infected partner (OR = 3.2 [1.1-7.9]). In conclusion, HIV and syphilis co-infection were associated with frequent UAI with casual sex partners, inadequate adherence to ART and limited partner notification. In order to minimize syphilis transmission among HIV-infected MSM, AIDS clinics should encourage HIV-infected MSM to use condoms, ensure that patients perform periodic syphilis serology testing and improve partner notifications.
Collapse
Affiliation(s)
- Amir Polansky
- a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Itzchak Levy
- a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,b Infectious Disease Unit , Sheba Medical Center , Ramat Gan , Israel
| | - Zohar Mor
- c Tel Aviv Department of Health , Ministry of Health , Tel Aviv , Israel.,d School of Health Sciences , Ashkelon Academic College , Ashkelon , Israel
| |
Collapse
|
13
|
Pre-exposure Prophylaxis Among Men Who have Sex with Men: Dual Motivational Model of Intention to Use Pre-exposure Prophylaxis. AIDS Behav 2019; 23:534-543. [PMID: 29980993 DOI: 10.1007/s10461-018-2214-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Men who have sex with men (MSM) account for most new HIV infections in the United States. Despite representing a fraction of the population, MSM make up an estimated 65% of new infections. To address this epidemic, pre-exposure prophylaxis (PrEP) is recommended to supplement condom use. Despite its effectiveness, PrEP uptake among MSM is low. Few studies have employed theoretical approaches to understand PrEP use intention. Incorporating factors like safe sex fatigue, expectation of better sexual experiences, and perceived risk are proposed in this dual motivational path model of PrEP use intention. This model hypothesized that PrEP use intention is influenced by two key pathways: (1) protection motivation pathway, and (2) sexual expectancy pathway. Data were collected using social networking applications from 402 MSM. The model was tested using structural equation modeling. We elaborate the complex decision-making process proposed by this novel theoretical model and discuss its practical implications.
Collapse
|
14
|
Klassen BJ, Fulcher K, Chown SA, Armstrong HL, Hogg RS, Moore DM, Roth EA, Lachowsky NJ. "Condoms are … like public transit. It's something you want everyone else to take": Perceptions and use of condoms among HIV negative gay men in Vancouver, Canada in the era of biomedical and seroadaptive prevention. BMC Public Health 2019; 19:120. [PMID: 30691426 PMCID: PMC6350294 DOI: 10.1186/s12889-019-6452-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men. METHODS We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies. RESULTS Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk. CONCLUSIONS These findings indicate that notions of "safety" and "risk" based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men's current prevention needs. Interventions should advance gay men's communication and self-advocacy skills in order to optimize these strategies.
Collapse
Affiliation(s)
- Benjamin J Klassen
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of History, Simon Fraser University, Burnaby, BC, Canada
| | - Karyn Fulcher
- School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada
| | | | - Heather L Armstrong
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada.,Centre for Addictions Research of British Columbia, Victoria, BC, Canada
| | - Nathan J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. .,School of Public Health & Social Policy, University of Victoria, room B202, HSD Building, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada.
| |
Collapse
|
15
|
Dangerfield DT, Carmack CC, Gilreath TD, Duncan DT. Latent Classes of Sexual Positioning Practices and Sexual Risk Among Men Who Have Sex with Men in Paris, France. AIDS Behav 2018; 22:4001-4008. [PMID: 30173344 DOI: 10.1007/s10461-018-2267-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV/STI risk varies by sexual positioning practices; however, limited data have characterized the behavioral profiles of men who have sex with men (MSM) in France. This study used latent class analysis (LCA) to explore sexual risk profiles among MSM in Paris, France. LCA was used to classify sexual positioning and serosorting profiles among MSM in Paris (n = 496). Age, HIV status, relationship status, substance use, group sex, and PrEP history were used in a multinomial regression model predicting class membership. Three latent classes were identified: majority top/serosorters, versatile/low partners, and majority bottom/some serosorters. Majority top/serosorters had the highest probability of condomless serosorting; majority bottom/some serosorters had the highest mean number of partners (~ 12 partners) for condomless receptive anal intercourse. HIV-positive MSM were more likely to be classified as majority bottom/some serosorters than versatile/low partners (AOR 7.61; 95% CI 2.28, 25.3). Findings support the need for tailored and targeted interventions for highest-risk individuals.
Collapse
Affiliation(s)
- Derek T Dangerfield
- The REACH Initiative, Johns Hopkins School of Nursing, 525 N. Wolfe St, SON House 104, Baltimore, MD, 21205, USA.
| | - Chakema C Carmack
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Tamika D Gilreath
- Department of Health and Kinesiology, Texas A & M University, College Station, TX, USA
| | - Dustin T Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
16
|
Dangerfield DT, Harawa NT, Fernandez MI, Hosek S, Lauby J, Joseph H, Frank HG, Bluthenthal RN. Age Cohort Differences in Sexual Behaviors Among Black Men Who Have Sex With Men and Women. JOURNAL OF SEX RESEARCH 2018; 55:1012-1021. [PMID: 29377734 PMCID: PMC6146075 DOI: 10.1080/00224499.2017.1423016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Little attention has focused on generational or age-related differences in human immunodeficiency virus/sexually transmitted infection (HIV/STI) risk behaviors among Black men who have sex with men and women (BMSMW). We examined sexual risk behaviors between BMSMW ages 40 and under compared to over age 40. Analysis was conducted using Centers for Disease Control and Prevention (CDC)-sponsored intervention data among BMSMW in Los Angeles, Chicago, and Philadelphia (n = 546). Pearson's chi-square tests were conducted to evaluate associations between age groups and behavioral outcomes. Logistic regression was used to evaluate the odds of behavioral outcomes by age group, adjusting for sexual orientation and study location, within strata of HIV status. HIV-positive BMSMW over age 40 had 62% reduced odds of having a nonmain female partner of HIV-negative or unknown status compared to those ages 40 and under (adjusted odds ratio [AOR] 0.38, 95% confidence interval [CI] = 0.15, 0.95). Among HIV-negative BMSMW, the older cohort was associated with greater odds of having condomless insertive anal intercourse (IAI) with most recent main male partner (AOR 2.44, 95% CI = 1.12, 5.32) and having a concurrent partnership while with their recent main female partner (AOR = 2.6, 95% CI = 1.10, 4.67). For both groups, odds of engaging in certain risk behaviors increased with increasing age. Prevention efforts should consider generational differences and age in HIV risks among BMSMW.
Collapse
Affiliation(s)
| | - Nina T. Harawa
- Department of Medicine, UCLA Geffen School of Medicine & Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - M. Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL
| | - Jennifer Lauby
- Research & Evaluation, Public Health Management Corporation, Philadelphia, PA
| | - Heather Joseph
- U.S. Public Health Service, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
17
|
Koester KA, Erguera XA, Kang Dufour MS, Udoh I, Burack JH, Grant RM, Myers JJ. "Losing the Phobia:" Understanding How HIV Pre-exposure Prophylaxis Facilitates Bridging the Serodivide Among Men Who Have Sex With Men. Front Public Health 2018; 6:250. [PMID: 30238001 PMCID: PMC6135985 DOI: 10.3389/fpubh.2018.00250] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/15/2018] [Indexed: 01/27/2023] Open
Abstract
The use of HIV serostatus information has played a pivotal role in partner selection norms. A phenomenon known as serosorting is the practice of selecting a partner based on a perception that they are of the same HIV status in order to avoid transmission from one partner to the other. An understudied aspect of serosorting is that it has a divisive effect-one accepts or rejects a potential partner based on a singular characteristic, the partner's HIV status, and thus excludes all others. This division has been formally referred to as the HIV serodivide. In this study, we explored partner selection strategies among a group of HIV-negative, young men who have sex with men (n = 29) enrolled in a PrEP demonstration project in Northern California. We found that trends in serosorting were in fact shifting, and that a new and opposite phenomenon was emerging, something we labeled "seromixing" and that PrEP use played a part in why norms were changing. We present three orientations in this regard: (1) maintaining the phobia: in which men justified the continued vigilance and exclusion of people living with HIV as viable sex or romantic partners, (2) loosening/relaxation of phobia: among men who were reflecting on their stance on serosorting and its implications for future sexual and/or romantic partnerships, and (3) losing the phobia: among men letting go of serosorting practices and reducing sentiments of HIV-related stigma. The majority of participants spoke of changing or changed attitudes about intentionally accepting rather than rejecting a person living with HIV as a sex partner. For those who maintained strict serosorting practices, their understandings of HIV risk were not erased as a result of PrEP use. These overarching themes help explain how PrEP use is contributing to a closing of the HIV serodivide.
Collapse
Affiliation(s)
- Kimberly A Koester
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Xavier A Erguera
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ifeoma Udoh
- East Bay AIDS Center, Sutter Health, Oakland, CA, United States
| | | | - Robert M Grant
- Virology and Immunology, Gladstone Institutes, University of California, San Francisco, San Francisco, CA, United States
| | - Janet J Myers
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
18
|
Sharma A, Kahle EM, Sullivan SP, Stephenson R. Birth Cohort Variations Across Functional Knowledge of HIV Prevention Strategies, Perceived Risk, and HIV-Associated Behaviors Among Gay, Bisexual, and Other Men Who Have Sex With Men in the United States. Am J Mens Health 2018; 12:1824-1834. [PMID: 30051744 PMCID: PMC6199423 DOI: 10.1177/1557988318790875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) in the United States remain heavily impacted by HIV. The purpose of this study was to describe intergenerational differences in functional knowledge of HIV prevention strategies, perceived risk, recent condomless anal sex (CAS), and HIV testing behavior. Eight hundred sexually active GBMSM were recruited via Facebook from August to September 2015, and administered a Web-based survey which included 12 multiple-choice questions to elicit data regarding functional knowledge of different HIV prevention approaches (e.g., condom use, pre-exposure prophylaxis post-exposure prophylaxis, treatment as prevention, circumcision). Cumulative logit and multivariable logistic models were formulated to examine birth cohort variations across four analytic outcomes. Younger generations were significantly more knowledgeable, as were GBMSM with higher education. Non-Hispanic non-White GBMSM and those reporting a bisexual/other sexual orientation had lower functional knowledge. Younger generations were equally concerned about contracting HIV as their older counterparts. Perceived risk was significantly higher among non-Hispanic non-White and Hispanic GBMSM, but lower among those with higher education and those in a relationship. Finally, birth cohort variations with respect to engaging in CAS with ≥2 men in the past 3 months and testing for HIV in the past year were not markedly pronounced. Younger GBMSM might be more knowledgeable about HIV prevention strategies compared to their predecessors, but are equally concerned about contracting HIV. Researchers and practitioners should consider intergenerational and other demographic differences while designing multifaceted HIV prevention programs for GBMSM.
Collapse
Affiliation(s)
- Akshay Sharma
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Erin M Kahle
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Stephen P Sullivan
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Rob Stephenson
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,2 Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
19
|
Williamson I, Papaloukas P, Jaspal R, Lond B. ‘There’s this glorious pill’: gay and bisexual men in the English midlands navigate risk responsibility and pre-exposure prophylaxis. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1497143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
20
|
Card KG, Armstrong HL, Lachowsky NJ, Cui Z, Zhu J, Roth EA, Hogg RS. Patterns of Online and Offline Connectedness Among Gay, Bisexual, and Other Men Who Have Sex with Men. AIDS Behav 2018; 22:2147-2160. [PMID: 29076033 PMCID: PMC5920783 DOI: 10.1007/s10461-017-1939-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study examined patterns of connectedness among 774 sexually-active gay, bisexual, and other men who have sex with men (GBM), aged ≥ 16 years, recruited using respondent-driven sampling in Metro Vancouver. Latent class analysis examined patterns of connectedness including: attendance at gay venues/events (i.e., bars/clubs, community groups, pride parades), social time spent with GBM, use of online social and sex seeking apps/websites, and consumption of gay media. Multinomial regression identified correlates of class membership. A three-class LCA solution was specified: Class 1 "Socialites" (38.8%) were highly connected across all indicators. Class 2 "Traditionalists" (25.7%) were moderately connected, with little app/website-use. Class 3 "Techies" (35.4%) had high online connectedness and relatively lower in-person connectedness. In multivariable modelling, Socialites had higher collectivism than Traditionalists, who had higher collectivism than Techies. Socialites also had higher annual incomes than other classes. Techies were more likely than Traditionalists to report recent serodiscordant or unknown condomless anal sex and HIV risk management practices (e.g., ask their partner's HIV status, get tested for HIV). Traditionalists on the other hand were less likely to practice HIV risk management and had lower HIV/AIDS stigma scores than Socialites. Further, Traditionalists were older, more likely to be partnered, and reported fewer male sex partners than men in other groups. These findings highlight how patterns of connectedness relate to GBM's risk management.
Collapse
Affiliation(s)
- Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada.
- C/O Faculty of Health Sciences, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Heather L Armstrong
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Julia Zhu
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Eric A Roth
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| |
Collapse
|
21
|
HIV-1 status is independently associated with decreased erectile function among middle-aged MSM in the era of combination antiretroviral therapy. AIDS 2018; 32:1137-1146. [PMID: 29746318 DOI: 10.1097/qad.0000000000001800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION HIV-1-infected MSM more often experience sexual dysfunctions than the general population. We assessed associations between HIV-1 status and decreased sexual functioning among MSM. METHODS We used cross-sectional data from 399 HIV-1-infected MSM mostly on combination antiretroviral therapy (cART) and 366 HIV-1-uninfected MSM aged at least 45 years participating in the AGEhIV Cohort Study. The study questionnaire included questions on erectile function, sexual satisfaction, and sexual desire. Multivariable logistic regression models were constructed to assess the association between HIV-1 status and these three sexual domains. We also explored HIV-1-related and ART-related parameters in multivariable models among HIV-1-infected participants. RESULTS Decreased erectile function (13.0 vs. 3.4%, P < 0.001), decreased satisfaction (17.8 vs. 11.8%, P = 0.02), and decreased desire (7.0 vs. 3.6% P = 0.03) were each more prevalent in HIV-1-infected than in HIV-1-uninfected participants. In multivariable models adjusted for age, ethnicity, waist-to-hip ratio, age-associated comorbidities, depression, frailty, use of antihypertensive and antidepressant medication, we found HIV-1 status significantly associated with decreased erectile function [adjusted odds ratio (aOR) 2.53, 95% CI 1.23-5.20], but not with decreased satisfaction (aOR 1.34, 95% CI 0.83-2.16), or decreased desire (aOR 1.77, 95% CI 0.80-3.91). Among HIV-1-infected participants, current exposure (aOR 5.39, 95% CI 2.09-13.92) and cumulative duration of exposure (aOR per year 1.20, 95% CI 1.07-1.35) to lopinavir/ritonavir were significantly associated with decreased erectile function in multivariable analysis. CONCLUSION Among MSM aged at least 45 years, HIV-1 status was independently associated with decreased erectile function. Exposure to lopinavir/ritonavir appeared to be an independent risk factor for decreased erectile function among MSM with HIV-1.
Collapse
|
22
|
Sullivan S, Stephenson R. Perceived HIV Prevalence Accuracy and Sexual Risk Behavior Among Gay, Bisexual, and Other Men Who Have Sex with Men in the United States. AIDS Behav 2018; 22:1849-1857. [PMID: 28488166 DOI: 10.1007/s10461-017-1789-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Interventions that promote HIV prevention and reduce sexual risk-taking among men who have sex with men (MSM) are needed. Decisions surrounding sexual behavior and prevention are in part shaped by how individuals gauge HIV risk, which may be influenced by perceptions of local HIV prevalence. Using an online sample of self-reported HIV-negative adult MSM (n = 1477, mean age = 45) recruited in 2015, we examine associations between accuracy of perceived local HIV prevalence and self-reported condomless anal sex (CAS) and HIV testing. Men who perceived their local HIV prevalence to be higher than actual were more likely to be recently HIV tested and less likely to engage in CAS. Men who estimated their local prevalence to be lower than actual were more likely to engage in CAS and less likely to have recently tested for HIV. Results suggest that how accurately MSM understand their HIV environment may contribute to prevention decisions.
Collapse
Affiliation(s)
- Stephen Sullivan
- Department of Health Behavior and Biological Sciences, School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls, Ann Arbor, MI, USA.
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls, Ann Arbor, MI, USA
| |
Collapse
|
23
|
Peng P, Su S, Fairley CK, Chu M, Jiang S, Zhuang X, Zhang L. A Global Estimate of the Acceptability of Pre-exposure Prophylaxis for HIV Among Men Who have Sex with Men: A Systematic Review and Meta-analysis. AIDS Behav 2018; 22:1063-1074. [PMID: 28176168 DOI: 10.1007/s10461-017-1675-z] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a new biomedical intervention for HIV prevention. This study systematically reviews the acceptability of PrEP among men who have sex with men (MSM) worldwide. We searched major English databases to identify English-language articles published between July 2007 and July 2016, which reported the acceptability of PrEP and associated population characteristics. Meta-analysis was conducted to estimate a pooled acceptability, and meta-regression and subgroup analysis were used to analyse heterogeneities. The estimated acceptance from included sixty-eight articles was 57.8% (95% confidence internal 52.4-63.1%). MSM who were younger (4/5 studies, range of adjusted odds ratio (aOR) = 1.39-3.47), better educated (aOR = 1.49-7.70), wealthier (aOR = 1.31-13.03) and previously aware of PrEP (aOR = 1.33-3.30) showed significantly higher acceptance. Male sex workers (84.0% [26.3-98.7%] were more likely to accept PrEP than general MSM. Self-perceived low efficacy, concern about side effects, adherence, affordability, and stigma were main barriers. This review identifies a moderate acceptability of PrEP in MSM. Efficacy, perception of HIV risk and experienced stigma determine its acceptance.
Collapse
|
24
|
Glowacka M, Yardley L, Stone N, Graham CA. Feasibility and Preliminary Effectiveness of the Homework Intervention Strategy (eHIS) Program to Enhance Male Condom Use: Research Protocol. JMIR Res Protoc 2018; 7:e1. [PMID: 29295809 PMCID: PMC5770577 DOI: 10.2196/resprot.7937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although condoms are effective in reducing the risk of sexually transmitted infections (STIs) and unintended pregnancy, they are still often not used consistently and correctly. Negative impact on sensation and pleasure, ruining the mood, causing problems with maintaining erection, and condom slippage or breakage are some of the reasons given by men explaining why they do not want to use condoms. Although many interventions promoting condom use exist, some of them delivered online are complex and time- and resource-intensive. The Homework Intervention Strategy (eHIS) program, adapted from the existing face-to-face Kinsey Institute Homework Intervention Strategy (KIHIS) program, aims to address these issues by encouraging men to focus on sensation and pleasure when trying different types of condoms and lubricants in a low-pressure situation (on their own, without a partner present). OBJECTIVE The objectives of this study are to assess the feasibility, acceptability, and users' engagement with the eHIS program, its preliminary effectiveness in increasing condom use frequency and consistency, as well as the feasibility of the program's evaluation approach, including choice of measures and participant recruitment and retaining strategies (primary outcomes). Secondary outcomes include condom use experience, condom use attitudes, condom use self-efficacy, condom use errors and problems, and condom fit-and-feel. All of these will be analyzed in the context of participants' demographics, sexual history, and previous condom use. METHODS The study has a pre-post-test, within-subjects design. Men aged 18 to 69 and living in the United Kingdom are recruited through posters, leaflets, social media, and emails. Study participants are asked to complete T1 (baseline) measures before entering the eHIS website. After completing the T1 measures, they can order a free condoms and lubricants kit and have access to the eHIS website for 4 weeks. During that time they are asked to practice using different types of condoms and lubricants on their own in a no-pressure situation. Following T1, participants are asked to complete the T2 and T3 measures at 4 and 10 weeks, respectively. RESULTS Data collection for the study is completed. Data analysis is in progress and is expected to be completed by February 2018. CONCLUSIONS This brief, home-based, self-guided program may lead to increased consistent and correct condom use. Online delivery can make the program an easily accessible and low-cost health promotion intervention, which has the potential to reach a wide and diverse audience. If results of the current study show the program's feasibility and preliminary effectiveness in changing condom use related outcomes, a larger scale randomized controlled trial (RCT) will be conducted. TRIAL REGISTRATION Research Registry: researchregistry2325; http://www.researchregistry.com/browse-the-registry.html# home/registrationdetails/58da6cad1d7ab0314337d076/ (Archived by WebCite at http://www.webcitation.org/6vXs6S9XW).
Collapse
Affiliation(s)
- Marta Glowacka
- Department of Psychology, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Department of Psychology, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | - Nicole Stone
- Department of Psychology, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | - Cynthia A Graham
- Department of Psychology, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
25
|
Wade R, Harper GW, Bauermeister JA. Psychosocial Functioning and Decisional Balance to Use Condoms in a Racially/Ethnically Diverse Sample of Young Gay/Bisexual Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:195-204. [PMID: 28233112 PMCID: PMC5569003 DOI: 10.1007/s10508-016-0912-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/19/2016] [Accepted: 11/25/2016] [Indexed: 06/06/2023]
Abstract
Young gay/bisexual and other men who have sex with men (YGBMSM; ages 18-24) are experiencing an increase in HIV infection rates, particularly if they are Black or Latino. Psychosocial functioning is consistently implicated in HIV risk behaviors; however, less is known about the role of these factors in YGBMSM's decision-making process to use condoms (i.e., decisional balance to use condoms; DBC). We examined whether YGBMSM's psychological functioning was associated differentially with their DBC across racial/ethnic groups. Using data from a cross-sectional web-survey of single YGBMSM (N = 1380; 9.9% Black; 18.6% Latino; 71.5% White), we performed racial/ethnic-specific multivariable regression models to explore the association between DBC and psychological factors (e.g., depression, anxiety), demographics (e.g., age, education, HIV status, prior STI diagnosis), and perceived difficulty implementing safer sex strategies. Black YGBMSM reported lower DBC if they reported higher depression symptoms (β = -.31, p < .05), were HIV-negative (β = -.20, p < .05), and had greater difficulty implementing safer sex strategies (β = -.32, p < .001). Latino participants reported greater DBC to use condoms if they reported greater anxiety symptoms (β = .21, p < .05). White participants reported greater DBC if they were younger (β = -.09, p < .01), did not report a prior STI (β = .10, p < .001), and had fewer difficulties implementing safer sex strategies (β = -.27, p < .001); DBC had no association to psychological well-being among White participants. Psychological factors may be differentially associated with DBC across racial/ethnic group categories. Health promotion initiatives targeting condom use may benefit from culturally tailored interventions that address psychosocial functioning and its role in YGBMSM's condom use decision-making.
Collapse
Affiliation(s)
- Ryan Wade
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - José A Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA.
| |
Collapse
|
26
|
Milhausen RR, McKay A, Graham CA, Sanders SA, Crosby RA, Yarber WL, Wood J. Do Associations Between Pleasure Ratings and Condom Use During Penile-Vaginal Intercourse Vary by Relationship Type?: A Study of Canadian University Students. JOURNAL OF SEX RESEARCH 2018; 55:21-30. [PMID: 28358218 DOI: 10.1080/00224499.2017.1298713] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Research suggests the relationship between pleasure and condom use during penile-vaginal intercourse (PVI) is associated with relationship status. This online study examined pleasure ratings and condom use at last PVI, stratifying by partner type, among a national sample of Canadian university students. Participants were 715 undergraduates (60.7% women, 39.3% men) who reported on their most recent sexual experience. Condom use decreased with level of relationship commitment, whereas ratings of pleasure increased. Overall, participants were more likely to rate their most recent PVI as Very pleasurable when condoms were not used compared to when condoms were used. However, when stratified by partner type, these differences largely disappeared. For women, with one exception, there were no differences in pleasure between PVI with and without condoms across most partner-type categories. Women in committed dating relationships were more likely to report their last PVI as very pleasurable if condoms were not used than women in these same relationships who had used condoms. Across relationship categories, men who did and did not use condoms did not differ in terms of their pleasure ratings. The results of this study suggest relationship context should be taken into account when assessing condom use experiences.
Collapse
Affiliation(s)
- Robin R Milhausen
- a Department of Family Relations and Applied Nutrition, University of Guelph; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention , Indiana University
| | | | - Cynthia A Graham
- c Department of Psychology, University of Southampton; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University ; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - Stephanie A Sanders
- d Department of Gender Studies , Indiana University; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - Richard A Crosby
- e Department of Health Behavior, College of Public Health , University of Kentucky; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - William L Yarber
- f Department of Applied Health Science, Indiana University; Department of Gender Studies , Indiana University; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - Jessica Wood
- g Department of Psychology , University of Guelph
| |
Collapse
|
27
|
Card KG, Lachowsky NJ, Cui Z, Carter A, Armstrong H, Shurgold S, Moore D, Hogg RS, Roth EA. A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:95-106. [PMID: 27987086 PMCID: PMC5474217 DOI: 10.1007/s10508-016-0879-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/16/2016] [Accepted: 10/08/2016] [Indexed: 05/30/2023]
Abstract
Initial research into seroadaptive strategies suggests that, individually, they are potentially effective behavioral methods to reduce risk of HIV transmission. Combining strategies, therefore, has the potential to increase risk reduction. The aim of this study was to determine how gay and bisexual men (GBM) combine strategies. To this end, a total of 774 sexually active GBM, aged ≥16 years, in Metro Vancouver, Canada, were recruited. Grouped by self-reported HIV status, latent class analysis of self-reported condom use, strategic positioning, anal sex avoidance, serosorting, viral-load sorting, and withdrawal were conducted. Multinomial logistical regression identified explanatory variables of class membership (i.e., sensation seeking, treatment optimism, sexual altruism, relationship status, number of partners, anal sex preference). Four latent classes were identified: Condom Users, Multiple Prevention Users, Viral-Load Sorters, and Serosorters. The majority of HIV-negative/unknown men (72 %) and a large proportion of HIV-positive men (42 %) belonged to the Condom Users class. Class membership was associated with age, relationship status, treatment optimism, sexual altruism, sensation seeking, number of recent male anal sex partners, and recent condomless anal sex with a serodiscordant or unknown-status partner. Understanding these distinct patterns allows for tailored interventions addressing GBM's sexual health needs.
Collapse
Affiliation(s)
- Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada.
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Allison Carter
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Heather Armstrong
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Susan Shurgold
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
- Centre for Addiction Research of British Columbia, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
28
|
Cortés AJ. On how role versatility boosts an STI. J Theor Biol 2017; 440:66-69. [PMID: 29273545 DOI: 10.1016/j.jtbi.2017.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
The prevalence of the HIV-1 infection has decayed in the last decades in western heterosexual populations. However, among men who have sex with men (MSM) the prevalence is still high, despite intensive campaigns and treatment programs that keep infected men as undetectable (Beyrer et al. 2012). Promiscuity and condom fatigue (Adam et al. 2005), which are not unique to the MSM community, are making unprotected anal intercourse (UAI) more common and sexually transmitted infections (STIs) presumably harder to track. Yet, MSM communities are peculiar in the sense that men can adopt fixed (insertive or receptive) or versatile (both practices) roles. Some old theoretical work (Wiley & Herschkorn 1989, Van Druten et al. 1992, Trichopoulos et al. 1998) predicted that the transmission of HIV-1 would be enhanced in MSM populations engaged more in role versatility than in role segregation, in which fixed roles are predominantly adopted. These predictions were based on the assumption that the probability of acquisition from unprotected insertive anal (UIA) sex was neglectable. However, as later shown (Vittinghoff et al. 1999, Goodreau et al. 2005), this assumption is inappropriate and HIV-1 may still be acquired via UIA sex. Here I show through a stochastic model that the increase of the HIV-1 prevalence among MSM due to role versatility holds under a stronger assumption of bidirectional virus transmission.
Collapse
Affiliation(s)
- Andrés J Cortés
- Department of Biological and Environmental Sciences, University of Gothenburg, Carl Skottsbergs gata 22B, Gothenburg 41319, Sweden; Colombian Corporation for Agricultural Research (Corpoica), C.I. La Selva, Km 7 Vía Rionegro - Llanogrande, Rionegro, Colombia.
| |
Collapse
|
29
|
Self-Perceived Viral Load and Sexual Risk Behavior Among Known HIV-Positive MSM in San Francisco, 2014. J Acquir Immune Defic Syndr 2017; 75 Suppl 3:S309-S315. [PMID: 28604432 DOI: 10.1097/qai.0000000000001405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Self-perceived viral suppression status among men who have sex with men (MSM) may impact HIV risk transmission behaviors. METHODS We conducted a 2014 cross-sectional survey of MSM in San Francisco and assessed differences in sexual risk behavior among known HIV-positive MSM based on viral suppression of HIV. We collected demographics, self-perceived viral load status, and sexual risk behavior and tested for viral load levels through laboratory assays. Men were categorized in a hierarchical schema of sexual risk behavior categories based on responses to questions regarding recent partners' HIV status, condom use, and sexual positioning. We used Fisher exact tests to assess for differences based on self-perceived viral load status. RESULTS Out of a sample of 96 known HIV-positive men, 59 men self-reported an undetectable HIV viral load and 9 men self-reported a detectable viral load consented to confirmatory laboratory testing. The sample of self-reported undetectable men had gradually larger proportions of higher-risk sexual practices, whereas the sample of detectable men was evenly distributed across sexual practices. This association was not statistically significant (P = 0.91). CONCLUSION Self-perceived viral suppression may influence sexual practices of known HIV-positive MSM, but small sample size, especially within the detectable category, hinders our ability to determine statistical significance. More research is necessary to assess how HIV-positive men account for viral load in sexual decision-making practices, and this research may inform resource allocation and clinical recommendations to maintain the health of MSM populations.
Collapse
|
30
|
Dourado I, MacCarthy S, Reddy M, Calazans G, Gruskin S. Revisiting the use of condoms in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:63-88. [PMID: 26630299 DOI: 10.1590/1809-4503201500050006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 01/27/2015] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION It is known that a single prevention strategy is not enough to control multiple HIV epidemics around the world and in Brazil. However, it is not only necessary to recognize the importance of condoms as part of the policy of HIV/AIDS prevention but also discuss its limits. In this article, we aim to investigate the use of condoms in Brazil, draw critical reflections, and understand how they can once again be highlighted in Brazil's prevention strategy going forward. METHODS A narrative review of literature was conducted using keywords in PubMed. Reports from national surveys that guide the epidemiological and behavioral surveillance of the Brazilian Ministry of Health were also included. RESULTS A total of 40 articles and 3 reports were included in the review and 11 intervention studies to promote the condom use; the main findings were as follows: 1) Despite the increase in national studies on sexual behavior, little attention is given to the role of condom use; 2) There are few studies examining the factors associated with condom use among key populations such as men who have sex with men (MSM), female sex workers (FSW), drug users (DU), and transvestites and transexuals (TT), while substantial studies focus on adolescents and women; 3) Evidence suggests that a combination of interventions is more effective. DISCUSSION new prevention technologies must not lose sight of the critical importance of condoms, and efforts to reintroduce them should focus on the role of pleasure in addition to their potential to minimize the risk of HIV.
Collapse
Affiliation(s)
- Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Sarah MacCarthy
- Program on Global Health and Human Rights, University of Southern California, Los Angeles, CA, USA
| | - Manasa Reddy
- Program on Global Health and Human Rights, University of Southern California, Los Angeles, CA, USA
| | - Gabriela Calazans
- School of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Sofia Gruskin
- Program on Global Health and Human Rights, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
31
|
Neville S, Adams J, Moorley C, Jackson D. The condom imperative in anal sex - one size may not fit all: a qualitative descriptive study of men who have sex with men. J Clin Nurs 2017; 25:3589-3596. [PMID: 27539386 DOI: 10.1111/jocn.13507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore men who have sex with men's views about condom use when having anal intercourse. BACKGROUND Internationally, health promotion campaigns use behavioural change strategies to support men who have sex with men to always use condoms when having anal sex with other men. The health promotion message given to this group is consistent and explicitly stated that 'use a condom every time for anal sex regardless of relationship status'. DESIGN Qualitative analysis of data from a cohort of New Zealand men who have sex with men. METHODS A total of 960 useable questionnaires were completed: 571 online and 389 in hard copy. Qualitative data were analysed using a thematic data analytic process. RESULTS Three themes relating to condom use in men who have sex with men were identified. These are as follows: 'Safer sex is good sex', 'Condom use is good but …' and 'I use condoms sometimes'. CONCLUSIONS The range of responses towards condom use for anal sex in men who have sex with men in our sample reveal this as a complex public health issue, with not all men who have sex with men willing to consistently use condoms. RELEVANCE TO CLINICAL PRACTICE It is important that nurses do not assume that all men who have sex with men are willing to use condoms for anal sex, and should create opportunities for men who have sex with men to raise any concerns about the use of condoms. In this way, nurses can assist in providing information that may help men who have sex with men to make decisions that will minimise risk of contracting infections associated with sexual activity.
Collapse
Affiliation(s)
- Stephen Neville
- Department of Nursing, AUT University, Auckland, New Zealand
| | - Jeffery Adams
- SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
| | - Calvin Moorley
- School of Health & Social Care, London South Bank University, London, UK
| | - Debra Jackson
- Faculty of Health & Life Sciences, Oxford Brookes University, Oxford, UK
| |
Collapse
|
32
|
Otis J, McFadyen A, Haig T, Blais M, Cox J, Brenner B, Rousseau R, Émond G, Roger M, Wainberg M. Beyond Condoms: Risk Reduction Strategies Among Gay, Bisexual, and Other Men Who Have Sex With Men Receiving Rapid HIV Testing in Montreal, Canada. AIDS Behav 2016; 20:2812-2826. [PMID: 26961381 PMCID: PMC5108827 DOI: 10.1007/s10461-016-1344-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) have adapted their sexual practices over the course of the HIV/AIDS epidemic based on available data and knowledge about HIV. This study sought to identify and compare patterns in condom use among gay, bisexual, and other MSM who were tested for HIV at a community-based testing site in Montreal, Canada. Results showed that while study participants use condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also make use of various other strategies such as adjusting to a partner's presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.
Collapse
Affiliation(s)
- Joanne Otis
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
- CIHR Canadian HIV Trials Network, Vancouver, Canada.
| | - Amélie McFadyen
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Thomas Haig
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
- CIHR Canadian HIV Trials Network, Vancouver, Canada
- COCQ-SIDA, Montreal, QC, Canada
| | - Martin Blais
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Joseph Cox
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Bluma Brenner
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Gilbert Émond
- Applied Human Sciences, Concordia University, Montreal, QC, Canada
| | - Michel Roger
- Laboratoire de Biologie Moléculaire, Centre hospitalier de l'université de Montréal, Montreal, QC, Canada
| | - Mark Wainberg
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
33
|
Cook SH, Halkitis PN, Kapadia F. Relationship cognitions and longitudinal trajectories of sexual risk behavior among young gay and bisexual men: The P18 cohort study. J Health Psychol 2016; 23:1884-1894. [PMID: 28810356 DOI: 10.1177/1359105316671187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examines how romantic relationship cognitions are associated with changes of condomless anal sex among emerging adult gay and bisexual men. The sample was drawn from four waves of a prospective cohort study ( N = 598; Mage = 18.2). Results suggest that condomless anal sex increased over the emerging adulthood period. Romantic relationship fear was associated with increased receptive condomless anal sex. Perceptions of greater romantic relationship control increased the likelihood of having insertive and receptive condomless anal sex. Findings suggest that romantic relationship cognitions are important to consider when understanding longitudinal changes in condomless anal sex in this population.
Collapse
|
34
|
Sexual Orientation, Gender Identity and Perceived Source of Infection Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) Recently Diagnosed with HIV and/or STI in Lima, Peru. AIDS Behav 2016; 20:2178-2185. [PMID: 26767533 DOI: 10.1007/s10461-015-1276-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Risk perception and health behaviors result from individual-level factors influenced by specific partnership contexts. We explored individual- and partner-level factors associated with partner-specific perceptions of HIV/STI risk among 372 HIV/STI-positive MSM and transgender women (TW) in Lima, Peru. Generalized estimating equations explored participants' perception of their three most recent partner(s) as a likely source of their HIV/STI diagnosis. Homosexual/gay (PR = 2.07; 95 % CI 1.19-3.61) or transgender (PR = 2.84; 95 % CI 1.48-5.44) partners were more likely to be considered a source of infection than heterosexual partners. Compared to heterosexual respondents, gay and TW respondents were less likely to associate their partner with HIV/STI infection, suggesting a cultural link between gay or TW identity and perceived HIV/STI risk. Our findings demonstrate a need for health promotion messages tailored to high-risk MSM partnerships addressing how perceived HIV/STI risk aligns or conflicts with actual transmission risks in sexual partnerships and networks.
Collapse
|
35
|
Sullivan KM, Dawson Rose C, Phillips JC, Holzemer WL, Webel AR, Nicholas P, Corless IB, Kirksey K, Sanzero Eller L, Voss J, Tyer-Viola L, Portillo C, Johnson MO, Brion J, Sefcik E, Nokes K, Reid P, Rivero-Mendez M, Chen WT. Sexual transmission-risk behaviour among HIV-positive persons: a multisite study using social action theory. J Adv Nurs 2016; 73:162-176. [PMID: 27485796 DOI: 10.1111/jan.13087] [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] [Accepted: 06/06/2016] [Indexed: 12/19/2022]
Abstract
AIM Sexual risk behaviour was explored and described using Social Action Theory. BACKGROUND The sexual transmission of HIV is complex and multi-factorial. Social Action Theory provides a framework for viewing self-regulation of modifiable behaviour such as condom use. Condom use is viewed within the context of social interaction and interdependence. DESIGN Cross-sectional survey. METHODS Self-report questionnaire administered to adults living with HIV/AIDS, recruited from clinics, service organizations and by active outreach, between 2010 - 2011. FINDINGS Having multiple sex partners with inconsistent condom use during a 3-month recall period was associated with being male, younger age, having more years of education,substance use frequency and men having sex with men being a mode of acquiring HIV. In addition, lower self-efficacy for condom use scores were associated with having multiple sex partners and inconsistent condom use. CONCLUSION Social Action Theory provided a framework for organizing data from an international sample of seropositive persons. Interventions for sexually active, younger, HIV positive men who have sex with men, that strengthen perceived efficacy for condom use, and reduce the frequency of substance use, may contribute to reducing HIV-transmission risk.
Collapse
Affiliation(s)
- Kathleen M Sullivan
- University of Hawaii at Manoa School of Nursing and Dental Hygiene, Honolulu, Hawaii, USA
| | - Carol Dawson Rose
- University of California San Francisco School of Nursing, San Francisco, California, USA
| | - J Craig Phillips
- School of Nursing, University of Ottawa School of Nursing, Ottawa, Ontario, Canada
| | | | - Allison R Webel
- Case Western Reserve University School of Nursing, Cleveland, Ohio, USA
| | - Patrice Nicholas
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Inge B Corless
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Kenn Kirksey
- Nursing Strategic Initiatives Harris Health System, Houston, Texas, USA
| | | | - Joachim Voss
- Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Lynda Tyer-Viola
- Baylor College of Medicine and AVP Texas Children's Hospital, Houston, Texas, USA
| | - Carmen Portillo
- University of California San Francisco School of Nursing, San Francisco, California, USA
| | - Mallory O Johnson
- University of California San Francisco School of Nursing, San Francisco, California, USA
| | - John Brion
- Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Elizabeth Sefcik
- Texas A&M University-Corpus Christi, Corpus, Christi, Texas, USA
| | - Kathleen Nokes
- Hunter College, CUNY School of Nursing, New York, New York, USA
| | - Paula Reid
- University of North Carolina at Wilmington, Wilmington, North Carolina, USA
| | | | - Wei-Ti Chen
- Yale University School of Nursing, New Haven, Connecticut, USA
| |
Collapse
|
36
|
Abstract
Living with human immunodeficiency virus (HIV) in the industrialised world has for over a decade been conceptualised as living with a chronic illness. People living with HIV now are amongst the first to live and age with the virus. Drawing on a qualitative longitudinal study in a low-incidence area in a low-incidence country, this paper investigates the nuanced ways that people negotiate this condition. While it has been argued that HIV is a condition like any other chronic disease, our thematic analysis reveals some similarities and particularities around living with the condition. In comparing themselves to others with the condition, high levels of diversity of experience were identified that extended well beyond length of time from diagnosis. In comparing their illness with other illnesses, the location, for example, of their specialist service within a clinic for those with acute sexually transmitted diseases was identified as problematic. The work involved in maintaining a coherent sense of self in the face of existing and shifting challenges as a result of their infection was a second strong theme. The final theme involved flux and flex work in the ways people sought to gain and maintain control over various aspects of their lives. All of these experiences are mediated by place; that is the experience is not the same as that of those who live where there is a much higher incidence of infection. The work involved in negotiating this condition in low-incidence environments deserves more attention, but aspects of these findings are significant in higher incidence contexts as well; in particular, passivity in face of infection as one ages and the potential for medication refusal as a means of maintaining control over life and death.
Collapse
Affiliation(s)
- Lee Thompson
- a Department of Population Health , University of Otago , Christchurch , New Zealand
| | - Gillian Abel
- a Department of Population Health , University of Otago , Christchurch , New Zealand
| |
Collapse
|
37
|
Grace D, Steinberg M, Chown SA, Jollimore J, Parry R, Gilbert M. " … it's almost therapeutic, right? Because it's almost like that session that I never had": gay men's accounts of being a participant in HIV research. AIDS Care 2016; 28:1306-11. [PMID: 27137510 DOI: 10.1080/09540121.2016.1178701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Limited research has explored how gay, bisexual and other men who have sex with men describe the impact of their involvement in HIV and sexual health research. We enrolled 166 gay and bisexual men who tested HIV-negative at a community sexual health clinic in Vancouver, British Columbia, into a year-long mixed methods study. Thirty-three of these participants who reported recent condomless anal intercourse were purposively recruited into an embedded qualitative study. Analysis revealed rich accounts of the self-described, interrelated impacts of study participation: (1) pride in contribution and community involvement (e.g., as a rationale for enrolment and an outcome of participation); (2) how one thinks about sexual behaviours and partnerships (e.g., encouraging reflection on the types and amount of sex they have had; in some cases the methods of quantitative data collection were said to have produced feelings of guilt or shame); and (3) experiencing research as a form of counselling (e.g., qualitative interviews were experienced as having a major therapeutic component to them). Our analysis underscores the importance of researchers being reflexive regarding how study participation in HIV research may impact participants, including unintended emotional and behavioural impacts.
Collapse
Affiliation(s)
- Daniel Grace
- a Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - Malcolm Steinberg
- b Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada
| | - Sarah A Chown
- c British Columbia Centre for Disease Control , Vancouver , Canada
| | | | - Robin Parry
- c British Columbia Centre for Disease Control , Vancouver , Canada
| | - Mark Gilbert
- c British Columbia Centre for Disease Control , Vancouver , Canada.,e Ontario HIV Treatment Network , Toronto , Canada
| |
Collapse
|
38
|
Green AI. Keeping gay and bisexual men safe: The arena of HIV prevention science and praxis. SOCIAL STUDIES OF SCIENCE 2016; 46:210-235. [PMID: 27263237 DOI: 10.1177/0306312715624982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Abstract In this article, I draw from an ongoing ethnographic study of HIV prevention for gay, bisexual, and 'men who have sex with men' to develop an institutional analysis of HIV behavioral intervention science and praxis. I approach this analysis through the lens of the social worlds framework, focusing on the institutional arena in which HIV behavioral interventions are devised and executed. Toward this end, I focus on two fundamental points of contention that lie at the heart of the prevention enterprise and put its social organization in high relief: (1) conceptions of health and lifestyle practices and (2) attributions of expertise. These core contentions reveal less the steady advance of normal science than an arena of actors ensconced in boundary work and jurisdictional struggles over how to engineer behavior change and reduce the scale of the HIV epidemic. Their resolution, I argue, has occurred in a historically contingent process determined by the political economy of the US HIV prevention arena and the differential structural location of its social worlds.
Collapse
|
39
|
Hail-Jares K, Chang RCF, Choi S, Zheng H, He N, Huang ZJ. Intimate-Partner and Client-Initiated Violence among Female Street-Based Sex Workers in China: Does a Support Network Help? PLoS One 2015; 10:e0139161. [PMID: 26413776 PMCID: PMC4586135 DOI: 10.1371/journal.pone.0139161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/08/2015] [Indexed: 12/03/2022] Open
Abstract
Background Globally, female street-based sex workers are vulnerable to gender-based violence. Previous research has shown having a peer social network can reduce sex workers’ risks of victimization. However, mechanisms of how social network impacts violence among female street-based sex workers are still far from clear. Methods Our study was based on data abstracted from a paper-and-pencil survey administered among 218 female street-based sex workers in Shanghai, China. We focused on self-reported client-initiated violence and intimate-partner violence in emotional, physical, and sexual forms. Social networks were characterized by the size and sources of financial and psychosocial support (e.g. family, friends, and peers). Multi-variable logistic regression was used to estimate adjusted odds ratios (AOR) of each type of violence exposure by social network structure after the adjustment of age, education, and years in Shanghai. Results The street-based female sex workers in our study were primarily rural-to-urban migrants (95.7%) with an average age of 41 years old. 24.3% and 62.8% of the sex workers reported intimate-partner violence and client-initiated violence respectively. Lack of financial support, as defined by having only one individual or none in her peer support system to help financially, was significantly associated with self-reported intimate-partner violence (AOR: 2.5; 95% CI: 1.1–5.9). Respondents who reported client-initiated violence, by contrast, were more likely to report lacked psychosocial support from family (AOR: 2.2, 95% CI: 1.0–4.6) and peers (AOR: 5.1, 95% CI: 2.2–11). Conclusion This study is one of the first to systematically analyze the associations between social network and gender-based violence among street-based female sex worker. We reported a high prevalence of both types of gender-based violence and their complex associations with family, friends, and peer support network. Policies with goals to reduce violence against women may apply these findings to leverage social network in the interventions against gender-based violence.
Collapse
Affiliation(s)
- Katie Hail-Jares
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, D.C., United States of America
| | - Ruth C. F. Chang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Sugy Choi
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, D.C., United States of America
| | | | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Z. Jennifer Huang
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, D.C., United States of America
- * E-mail:
| |
Collapse
|
40
|
Pantalone DW, Tomassilli JC, Starks TJ, Golub SA, Parsons JT. Unprotected Anal Intercourse With Casual Male Partners in Urban Gay, Bisexual, and Other Men Who Have Sex With Men. Am J Public Health 2015; 105:103-110. [PMID: 25393176 DOI: 10.2105/ajph.2014.302093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. We investigated trends in, and predictors of, unprotected anal intercourse (UAI) with casual male partners of gay, bisexual, and other men who have sex with men (GBMSM). Methods. We analyzed data from cross-sectional intercept surveys conducted annually (2003-2008) at 2 large lesbian, gay, and bisexual community events in New York City. Survey data covered GBMSM's highest-risk behaviors for HIV acquisition (HIV-negative or unknown status GBMSM, any UAI) and transmission (HIV-positive GBMSM, any serodiscordant unprotected UAI). Results. Across years, 32.3% to 51.5% of the HIV-negative or unknown status men endorsed any UAI, and 36.9% to 52.9% of the HIV-positive men endorsed serodiscordant UAI. We observed a few statistically significant fluctuations in engagement in high-risk behavior. However, these do not appear to constitute meaningful trends. Similarly, in some years, one or another demographic predictor of UAI was significant. Across years, however, no reliable pattern emerged. Conclusions. A significant proportion of urban GBMSM engage in high-risk sex, regardless of serostatus. No consistent demographic predictors emerged, implying a need for broad-based interventions that target all GBMSM.
Collapse
Affiliation(s)
- David W Pantalone
- David W. Pantalone is with the Department of Psychology, University of Massachusetts, Boston, and the Fenway Institute, Fenway Health, Boston, MA. Julia C. Tomassilli is with the Fenway Institute, Fenway Health. Tyrel J. Starks is with Pace University and the Center for HIV/AIDS Educational Studies and Training, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with Hunter College and the Graduate Center, City University of New York. Jeffrey T. Parsons is with the Center for HIV/AIDS Educational Studies and Training, Hunter College, and the Graduate Center, City University of New York
| | | | | | | | | |
Collapse
|
41
|
Cunha RBBE, Gomes R. Os jovens homossexuais masculinos e sua saúde: uma revisão sistemática. ACTA ACUST UNITED AC 2014. [DOI: 10.1590/1807-57622014.0089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Com o objetivo de analisar a literatura acadêmica de abordagem sociocultural acerca da relação entre os temas homossexualidade masculina, homem jovem e saúde, realizou-se uma revisão baseada na análise de conteúdo temática de 37 artigos selecionados, nas bases de dados Medline e Lilacs, entre 2004 e 2013. A escassez de literatura na perspectiva sociocultural apontou para obstáculos e desafios, relacionados à promoção de saúde, que vão desde a qualidade da informação, passando por valores simbólicos inconscientes, até a efetivação de propostas de gestores de saúde. Concluiu-se que a hegemonia heterossexual encontra-se presente nas estruturas inconscientes da construção da homossexualidade, contribuindo para a perpetuação do habitus heteronormativo. Estudos que valorizam o encontro do saber técnico com o conhecimento que cada um produz, referido a seus valores pessoais e culturais, podem servir de subsídio para o maior aprofundamento dessa discussão.
Collapse
|
42
|
Janssen E, Sanders SA, Hill BJ, Amick E, Oversen D, Kvam P, Ingelhart K. Patterns of sexual arousal in young, heterosexual men who experience condom-associated erection problems (CAEP). J Sex Med 2014; 11:2285-91. [PMID: 24787349 DOI: 10.1111/jsm.12548] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Condom-associated erection problems (CAEPs) are reported by a substantial number of young men and are associated with inconsistent and/or incomplete condom use. The underlying mechanisms of CAEP are not well understood, and research examining the possibility that men who report CAEP differ from other men in their sexual responsivity is lacking. AIM This study used psychophysiological methods to examine whether men who report CAEP have a higher threshold for sexual arousal, a stronger need for tactile stimulation, and/or more easily lose their sexual arousal due to neutral distractors or performance-related demands. METHODS A total of 142 young, heterosexual men (53% reporting CAEP) were presented with four 3-minute erotic film clips. Three film clips were combined with one of the following manipulations: (i) distraction; (ii) performance demand; or (iii) vibrotactile stimulation. One erotic film clip was presented with no further instructions or manipulations. MAIN OUTCOME MEASURES Average penile circumference changes during the first, second, and third minute (time) of the erotic film stimuli (condition) were submitted to a mixed-model analysis of variance with condition and time as within-subjects factors and group (CAEP/no-CAEP) as between-subjects factor. RESULTS Significant main effects of condition and time and a significant interaction of group × time were found. No significant interactions involving condition were found. Men who reported CAEP had smaller erectile responses during the first minute, regardless of film condition, than men who reported no CAEP (F(1,141) = 8.64, P < 0.005). CONCLUSION The findings suggest that men with and without CAEP differ in the ease with which they become sexually aroused. Men reporting CAEP needed more time and/or more intense stimulation to become aroused. To our knowledge, this study is the first to use psychophysiological methods to assess sexual responsivity in men who report CAEP.
Collapse
Affiliation(s)
- Erick Janssen
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
| | | | | | | | | | | | | |
Collapse
|
43
|
Sanders SA, Hill BJ, Crosby RA, Janssen E. Correlates of condom-associated erection problems in young, heterosexual men: condom fit, self-efficacy, perceptions, and motivations. AIDS Behav 2014; 18:128-34. [PMID: 23404098 DOI: 10.1007/s10461-013-0422-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Questionnaire data from 479 heterosexual men 18-24 years old were analyzed for correlates of CAEP during application (CAEP-Application) and CAEP during penile-vaginal intercourse (CAEP-PVI). Potential correlates were self-efficacy (condom application, product selection, and maintaining arousal), condom perceptions (condom worry/distraction, negative condom perceptions, concerns about application speed), condom fit, and motivation to use condoms. We conclude that (1) experiencing CAEP may become a repeating cycle, both affecting and being affected by, worry and distraction related to losing erections and maintaining arousal while using a condom (2) poorly fitting condoms may contribute to CAEP, and (3) CAEP may decrease motivation to use condoms.
Collapse
Affiliation(s)
- Stephanie A Sanders
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Morrison Hall 313, Bloomington, IN, 47405, USA
| | | | | | | |
Collapse
|
44
|
Cristian Rangel J, Adam BD. Everyday moral reasoning in the governmentality of HIV risk. SOCIOLOGY OF HEALTH & ILLNESS 2014; 36:60-74. [PMID: 24438226 DOI: 10.1111/1467-9566.12047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Drawing on the sociology of morality, this article analyses the social contexts, discourses and ethno-methods of everyday life that shape real-world decisions of gay men around HIV prevention. Through an analysis of the predominant narratives in an online public forum created for an HIV prevention campaign, this article explores the ways in which homosexually active men engage in everyday moral reasoning and challenge a neoliberal moral order of risk and responsibility. The article concludes that gay and bisexual men engage in forms of practical morality with their sexual partners and imagine larger communities of interest, love, companionship and pleasure. At the same time, they draw heavily from discourses on individual and rational responsibility, as well as narratives of romance and community, that shape forms of moral selfhood. Risk management techniques that are grounded in notions of rational choice and that are insensitive to the emotional worlds that these men inhabit create situations of risk avoidance but also inadvertently open them to new forms of vulnerability.
Collapse
|
45
|
Klein H. Depression and HIV Risk Taking among Men Who Have Sex with Other Men (MSM) and Who Use the Internet to Find Partners for Unprotected Sex. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2013; 18:164-189. [PMID: 26877831 DOI: 10.1080/19359705.2013.834858] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This study examines the prevalence of depression in a sample of MSM who are at high risk for HIV. It examines the relationship between depressive symptomatology and involvement in HIV risk behaviors, and the factors associated with greater depressive symptomatology. METHODS The data come from a national random sample of 332 MSM who used any of 16 websites to identify men with whom they could engage in unprotected sex. Data were collected via telephone interviews. RESULTS Depression was more prevalent in this population (26.7%) than among men in the general population. Depression was not related directly to any of the HIV risk behaviors examined, but it was related to men's attitudes toward condom use, which was the strongest predictor of their involvement in risky behaviors. Five factors were identified as being associated with greater depression: lower educational attainment, greater discrimination based on sexual orientation, greater eroticizing of ejaculatory fluids, experiencing more substance abuse problems, and greater childhood maltreatment. CONCLUSIONS Depression is a consequential problem in this population. Although depression does not appear to be related directly to HIV risk practices in this population, its influence cannot be discounted because of its effects on other key predictors of risk involvement.
Collapse
Affiliation(s)
- Hugh Klein
- Kensington Research Institute, 401 Schuyler Road, Silver Spring, MD 20910,
| |
Collapse
|
46
|
Poon MKL, Pui-Hing Wong J, Sutdhibhasilp N, Ho PTT, Wong B. Sexual practices and sex-seeking behaviours among East and Southeast Asian men who have sex with men in Toronto: Implications for HIV prevention. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2013. [DOI: 10.3138/cjhs.2013.2200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study explored sexual practices and sex-seeking behaviours in a sample of 222 East and Southeast Asian men recruited through two gay venues. Over half of the respondents reported having a current regular partner; the rate of unprotected anal sex with their regular partner was high (45.1%). Among all respondents, 74.8% (166) reported having casual sex with an average of 16 partners in the previous six months; 26.5% of these 166 respondents reported unprotected anal sex with their casual partners. Respondents used multiple venues to seek sex, but bathhouses and the internet were most commonly cited. Bivariate analysis demonstrated that respondents who sought men for sex via both bathhouses and the internet in the past six months were most likely to have had a casual partner, to have had unprotected anal sex with a casual partner, and to have had prior HIV and STI testing. In comparison to respondents who used only bathhouses to seek sex, respondents who used only the internet had fewer casual partners but were more likely to have unprotected anal sex with a casual partner. Given these findings, additional research is needed to further explore the individual and structural factors that shape the condom use behaviour of these sub-populations. HIV prevention efforts must include culturally relevant information about HIV and STI transmission to promote condom use. It is also critical to develop culturally and linguistically appropriate online prevention education for Asian MSM who seek sex primarily through the internet.
Collapse
Affiliation(s)
- Maurice Kwong-Lai Poon
- School of Social Work, York University, Toronto, ON
- Asian Community AIDS Services, Toronto, ON
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
- Asian Community AIDS Services, Toronto, ON
| | | | - Peter Trung-Thu Ho
- Asian Community AIDS Services, Toronto, ON
- Regent Park Community Health Centre, Toronto
| | - Bernard Wong
- School of Social Work, York University, Toronto, ON
| |
Collapse
|
47
|
Bianchi FT, Reisen CA, Gonzales FA, Arroyo JC, Zea MC, Poppen PJ. Sex with sex workers among latino day laborers in Suburban Maryland. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:835-49. [PMID: 23070528 PMCID: PMC4745421 DOI: 10.1007/s10508-012-0010-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 02/04/2012] [Accepted: 05/29/2012] [Indexed: 06/01/2023]
Abstract
Using the structural-environmental conceptual framework, this study employed mixed methods to address the question of whether sex with female sex workers contributes to HIV risk among male immigrant Latino day laborers in suburban Maryland. Because contextual factors can greatly affect HIV risk for both sex workers and their clients, this study investigated the organizational structure of sex work, factors that predicted men's hiring of sex workers, sexual behaviors performed with sex workers, and the use of condoms. Qualitative research was conducted to inform the development of a quantitative survey, but also provided crucial descriptions about the motivations, locations, arrangements, and sexual activities related to sex work. Key informant interviews (N = 10), in-depth interviews with day laborers (N = 10) and Latina female sex workers (N = 4), and two focus groups with day laborers (N = 11) were conducted, and a quantitative survey administered via Audio-enhanced Computer-assisted Self-interviewing (N = 174). Condom use was nearly universal in encounters with female sex workers, thus indicating that the sex workers were not an important source of HIV transmission in this context. Logistic regression was performed to test a model predicting sex with sex workers. Latino day laborers who reported more immigrant stress and who did not have a partner in the U.S. were more likely to have had sex with a sex worker, as were men who reported binge drinking. Structural and social conditions influenced the hiring of sex workers. Further research is warranted to better understand the interrelationships among these circumstances and to inform the development of programs to address them.
Collapse
Affiliation(s)
- Fernanda T Bianchi
- Department of Psychology, George Washington University, 2125 G St. NW, Washington, DC, 20052, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Leuillet P, Cour F, Droupy S. Dysfonctions sexuelles masculines et homosexualité. Prog Urol 2013; 23:727-33. [DOI: 10.1016/j.purol.2013.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
|
49
|
Adams J, McCreanor T, Braun V. Gay men's explanations of health and how to improve it. QUALITATIVE HEALTH RESEARCH 2013; 23:887-899. [PMID: 23558711 DOI: 10.1177/1049732313484196] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Little is known about the health views of gay men. In this article we report on how gay men explained health and the ways they discussed how health for gay men can be improved. We conducted a thematic analysis of data collected from 45 gay men in 11 focus groups and identified that health was mainly explained in individual terms, as were the ways to improve health (personal health care services and health promotion). The second way health was explained drew on social and community factors, with the societal acceptance of gay men being reported as essential for health improvements. These individual and social/community approaches were in tension; overall, the individualized approaches dominated. In line with other theorizing in health, we argue that appropriate policy and service provision to meet the health needs of gay men require greater acknowledgment of the social and community explanations of health and ways of improving health.
Collapse
|
50
|
Klein H. Mental Health Functioning Among Men who Use the Internet Specifically to Find Partners for Unprotected Sex. Ment Illn 2013; 5:e6. [PMID: 25478130 PMCID: PMC4253389 DOI: 10.4081/mi.2013.e6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 03/15/2013] [Indexed: 11/23/2022] Open
Abstract
Previous studies have shown a link between mental health functioning and involvement in HIV risk practices. The present research examines how well one specific group of men who have sex with other men (MSM) fare in terms of their mental health functioning, and then focuses on how mental health functioning relates to HIV risk practices in this population. The study was based on a national random sample of 332 MSM who use the Internet to seek men with whom they can engage in unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. Depression is more common among men in this population than in the adult male population-at-large. All other measures of mental health functioning that were examined (self-esteem, impulsivity, current life satisfaction, optimism about the future) indicated low rates of mental health problem. Contrary to expectations, in nearly all instances, mental health functioning was not related to HIV risk practices. More work needs to be done to understand the causes of depression among these men, and to assess how, if at all, depression relates to risk practices in this population. These findings suggest that factors other than mental health problems must be considered if one wishes to understand HIV risk taking in this population.
Collapse
Affiliation(s)
- Hugh Klein
- Kensington Research Institute, Silver Spring, MD, USA
| |
Collapse
|