Sexual sensation seeking, sexual compulsivity, and high-risk sexual behaviours among gay/bisexual men in Southwest China

Network Analysis of Sexual Sensation Seeking, Internalized Homophobia, and Social Norms Among Men Who Have Sex with Men with Different Sexual Partner Types

Men who have sex with men (MSM) are at disproportionate risk for developing sexually transmitted infections (STIs) such as HIV. Understanding the relationships among factors related to risky sexual behaviors, such as internalized homophobia, sexual sensation seeking, and individual and community norms, among MSM with different sexual partner types may contribute to designing targeted interventions for reducing risky sexual behaviors and STI transmission. We conducted a cross-sectional study recruiting 781 MSM in Sichuan Province, China. All participants were divided into groups with and without sexual partners, groups with regular and casual sexual partners, and groups with only male and both male and female partners in the past 6 months. Network analysis was used to analyze the relationships among dimensions of self-reported sexual sensation seeking, internalized homophobia, and social norms in different groups. Of 781 MSM, 606 (77.6%) had sexual partners in the past 6 months, and among these participants, 429 (70.8%) had casual sexual partners, and 103 (17.0%) had both male and female sexual partners. The complex and intensive relationships between dimensions were mainly observed in networks of MSM with any type of sexual partners, with individual norms (dimension of social norms) presenting strongly negative relationships with fresh feeling (dimension of sexual sensation seeking) and homosexuality morality (dimension of internalized homophobia). One dimension of sexual sensation seeking (i.e., fresh feeling) and two dimensions of internalized homophobia (i.e., homosexuality morality and self-identification) were relatively central variables in most groups, especially for those with casual sexual partners. Our study highlights the role of individual norms in restraining sensation seeking, internalized homophobia, especially among MSM with sexual partners. Intervention targeting these central variables may contribute to reduced risky sexual behaviors and further slow the spread of STIs in MSM.

Internalized homophobia and sexual risk behavior in men who have sex with men: The mediational role of sexual self-concept

Men who have sex with men (MSM) are one of the populations most likely to be infected with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) worldwide. Sexual risk behaviors (SRB) are the main route of HIV transmission. Among the factors associated with SRB, internalized homophobia (rejection of one's sexuality) is a risk factor unique for MSM. However, how this factor influences SRB is not clear. Therefore, the present study attempts to clarify the mechanism of action of the relationship between internalized homophobia on SRB based on the mediating effects of sexual self-concept. A study was conducted with 124 MSM living in Chile over 18 years of age (M = 24.4 and SD = 4.19). Through path analysis, it was observed that internalized homophobia has slight inverse effects on SRBs (multiple sexual partners and sexual activity under the influence of alcohol or drugs) when the sexual self-efficacy dimension acts as a mediating variable. These findings suggest that developing sexually transmitted infections (STIs) and HIV/AIDS prevention campaigns focused on MSM must highlight the development of a healthy sexual self-concept and address self-stigma.

Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

The Moderating Effect of Sexual Sensation Seeking on the Association between Alcohol and Popper Use and Multiple Sexual Partners among Men Who Have Sex with Men in Guangzhou, China

Introduction: This cross sectional study was conducted to explore the moderating effect of sexual sensation seeking (SSS) on the association between alcohol/popper use before sex and multiple sexual partners (MSP) among men who have sex with men (MSM) in Guangzhou, China. Methods: From June 2017 to April 2018, MSM were recruited from a community-based HIV service center in Guangzhou, China; data on sociodemographics, sexual behaviors and SSS were collected. A product term of SSS and alcohol/popper use before sex was included in a multivariate logistic regression model to test the potential moderating effect of SSS on the association between alcohol/popper use before sex and MSP. Results: Among the 500 MSM included, individuals who reported alcohol use and popper use before sex, and MSP in the last six months accounted for 33.80%, 33.40%, and 60.40%, respectively. MSM with high SSS traits accounted for 54.80%. The association between popper use before sex and MSP was moderated by SSS (P for interaction = 0.007). A significant association between popper use before sex and MSP among MSM with low SSS traits (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.06 ∼ 8.67). But not among MSM with high SSS traits (OR = 1.37, 95%CI: 0.77 ∼ 2.43) were observed. However, no moderating effect of SSS on the association between alcohol use before sex and MSP were observed. Conclusion: The moderated analysis indicated that SSS should be taken into consideration when tailoring interventions to prevent popper use before sex to reduce the risk associated with MSP.

Factors Associated with Condom Use in Anal Intercourse Among Spanish Men Who Have Sex with Men: Proposal for an Explanatory Model

Men who have sex with men (MSM) account for more than half of the new HIV diagnoses in Spain. This study aims to carry out a descriptive analysis of the sexual practices and frequency of condom use of MSM and identify the variables that explain inconsistent condom use during anal intercourse. The sample consists of 405 men between 18 and 60 years of age (M = 28.94; SD = 9.35). The results indicate that the percentage of consistent condom use is 72.9% for anal intercourse. Lack of risk perception, high self-esteem, and greater sensation-seeking are risk factors for risky sexual behavior. In contrast, high levels of sexual assertiveness and self-efficacy are protective factors. The proposed model explains between 33.8 and 49.2% of the variance. These findings highlight the importance of designing and implementing condom promotion programs for MSM who engage in anal intercourse with specific sections that consider the acquisition of assertive skills and reduce the risks associated with a perceived invulnerability to HIV.

Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States

BACKGROUND

Compulsive sexual behavior (CSB) is a clinical syndrome that causes significant distress and impairment for many individuals in the United States. Gay men are thought to have a higher prevalence of CSB, and it is associated with many relevant health outcomes including HIV risk behavior.

AIM

To estimate the prevalence and examine demographic correlates of CSB among gay men in the United States.

METHODS

A U.S. national probability sample of 227 gay-identified men were collected as part of the 2015 National Survey of Sexual Health and Behavior (NSSHB).

OUTCOMES

Participants completed the Compulsive Sexual Behavior Inventory (CSBI-13) and demographic measures.

RESULTS

Eighteen participants (7.93%) scored above the CSBI-13 clinical cut point, indicating they would likely meet criteria for clinically significant compulsive sexual behavior. To assess demographic correlates of CSB, demographic variables were entered into a logistic regression. Results of the logistic regression indicated that participant age, education, and religious affiliation were significant predictors of CSB status. Individuals scoring above the cut point were younger on average (M = 39.17; SD = 14.84) than those scoring below the cut point (M = 47.52; SD = 14.62; P = .02). Odds of scoring above the cut point were about six times greater for religiously affiliated participants compared to non-religiously affiliated participants (P = .005), and four times greater for those who had attended college compared to those who had not (P = .03).

CLINICAL IMPLICATIONS

These results indicate the prevalence of CSB in gay men is more modest than previously estimated, and is similar to the general population prevalence estimated in a previous study. The strongest predictor of CSB in this sample was religious affiliation, which underscores the importance of evaluating the role of religiosity in the etiology and/or identification of this clinical syndrome.

STRENGTHS AND LIMITATIONS

These findings are strengthened by the national probability sampling methodology and the use of the empirically validated CSBI-13 cut point. However, this sample was also older and had higher income and educational attainment than the larger population of gay men in the U.S.

CONCLUSION

These results indicate gay men may have a CSB prevalence rate similar to the general population, which contradicts previous research suggesting they are at greater risk for CSB. Gleason N, Finotelli I, Miner MH, et al. Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States. J Sex Med 2021;18:1545-1554.

Association between Psychological Factors and Condom Use with Regular and Nonregular Male Sexual Partners among Chinese MSM: A Quantitative Study Based on the Health Belief Model

Objective

The Chinese men who have sex with men (MSM) population is suffering from a high HIV infection rate owing to unprotected anal sex. The Health Belief Model (HBM) has been proven to be an effective frame associated with behavior maintenance. Based on HBM, we analyzed the beliefs associated with consistent condom use behavior with regular and nonregular partners among MSM to better provide targeted interventions and services.

Methods

A study was conducted in Sichuan Province, China, from November 2018 to April 2019, and 801 eligible participants were recruited by snowball sampling. Sociodemographic characteristics, AIDS-related characteristics, sexual behaviors, condom use behavior, and dimensions of HBM were investigated. Univariate, single multivariate, and summary multivariate models were employed to analyze the factors associated with consistent condom use.

Results

Of all participants, 39.1% and 53.6% had had anal sex with regular and nonregular partners in the last six months, respectively. Only 56.5% of them had used condoms consistently with regular partners, and only 60% of them had used condoms consistently with nonregular partners. When taking consistent condoms use with regular partners as the dependent variable, the dimensions of perceived threats (ORM = 1.28, 95% CI: 1.10, 1.49), perceived barriers (ORM = 0.70, 95% CI: 0.60, 0.82), self-efficacy (ORM = 1.23, 95% CI: 1.14, 1.32), and cues to action (ORM = 1.21, 95% CI: 1.02, 1.43) showed significant associations with the dependent variable. When taking consistent condoms use with nonregular partners as the dependent variable, the dimensions of perceived barriers (ORM = 0.77, 95% CI: 0.67, 0.89), self-efficacy (ORM = 1.22, 95% CI: 1.13, 1.32), and cues to action (ORM = 1.53, 95% CI: 1.30, 1.80) showed significant associations with the dependent variable.

Conclusions

More attention should be focused on how to decrease the obstructive factors of condom use, how to improve the confidence of condom use, and how to layout more cues to action to promote consistent condom use behavior with regular and nonregular partners during anal sex among Chinese MSM.

Associations Between Personality Traits and Patterns of HIV Risk Behaviors Among Young Men Who Have Sex with Men in China

This study aimed to ascertain the patterns of human immunodeficiency virus (HIV) risk behaviors among young men who have sex with men (YMSM) and explore the relationships between personality traits and patterns of HIV risk behaviors. Three hundred and seventy-five YMSM were recruited from March to December 2013, in central China. Latent class analysis (LCA) was utilized to identify underlying subgroups of HIV risk behaviors; multinomial logistic regression was used to examine predictors of HIV risk behaviors patterns. LCA identified four latent classes: low risk (LR), moderate risk (MR), high risk (HR), and drug use (DU). YMSM reporting high levels of sexual sensation seeking (SSS) tended to be classified to the MR class [adjusted odds ratio (aOR) = 2.96, 95% confidence interval (CI) = 1.33-6.57] and HR class (aOR = 13.77, 95% CI = 3.06-61.96) than the LR class. Those with low degrees of self-control were more likely to be in the HR class (aOR = 4.06, 95% CI = 1.11-14.83) and DU class (aOR = 4.64, 95% CI = 1.50-14.32), compared to LR class. These findings highlight the significance of personality traits on predicting HIV risk behaviors. Future HIV interventions should prioritize YMSM with high SSS and low self-control.

Relationship between sexual sensation seeking and condom use among young men who have sex with men in China: testing a moderated mediation model

The present study incorporated a moderated mediation model to explore the role of attitude towards condom use in mediating the link between sexual sensation seeking (SSS) and condom use and whether this indirect link was modified by HIV-related knowledge among Chinese YMSM. Survey data were collected from a cross-sectional study conducted in Wuhan, China and 373 YMSM were recruited. The mediation and moderated mediation modelling analyses were performed with the software SPSS PROCESS macro. Mediation analysis indicated that attitude towards condom use partly mediated the link between SSS and condom use (indict effect = -0.158, P < 0.001). Moderation analysis found HIV-related knowledge acted as a moderator in the relationship between SSS and attitude towards condom use (interact effect = 0.089, P = 0.001). Final moderated mediation analysis demonstrated that the indirect effect from SSS to condom use through attitude towards condom use was moderated by HIV-related knowledge, that is the interaction between HIV-related knowledge and SSS was positively associated with attitude towards condom use (β = 0.101, P < 0.001). Therefore, increased YMSM-specific HIV-related knowledge education programs need to be conducted. Further longitudinal research is required to verify the findings of this study.

Cigarette Smoking and Its Associations with Substance Use and HIV-Related Sexual Risks among Chinese Men Who Have Sex with Men

China has the largest population of male smokers globally. Men who have sex with men (MSM) are at greater risk of cigarette smoking compared to the general population. Limited data are available regarding cigarette smoking and its associations with other health issues among Chinese MSM. Eligible MSM (n = 1100) were recruited from mainland China using an online national cross-sectional survey conducted in 2014-2015. Socio-demographic characteristics, smoking behavior, substance use, homosexual stigma and outness, HIV-related risk behavior, and HIV status were obtained. Logistic regression analyses were performed to evaluate predictors of current cigarette smoking frequency and the co-occurrence of smoking and drug use. Nearly 41% (n = 446) of participants had ever smoked cigarettes; 25% (n = 278) were current frequent smokers; and 13% (n = 138) were current infrequent smokers. Factors associated with a history of smoking included age, employment status, and monthly salary. Risk factors associated with current frequent smoking included self-identification as gay, having female sexual partners, binge drinking, drug use, higher levels of homosexual stigma, and being partially or fully "out" as gay. Adjusted multinomial analysis showed that human immunodeficiency virus (HIV) related risks, including risky sexual behaviors, lack of condom use, and a reported history of sexually transmitted infections (STIs), were associated with co-occurrence of current smoking and drug use. Cigarette smoking rates remain high among MSM in China. Cigarette smoking is associated with binge drinking, drug use, and HIV-related risks in this community. There is a clear opportunity for smoking cessation interventions to be linked with HIV and substance use prevention interventions, thereby addressing multiple health issues simultaneously for the MSM community in China.

Alcohol use and binge drinking among men who have sex with men in China: Prevalence and correlates

BACKGROUND

Both alcohol use/misuse and HIV incidence are increasing among men who have sex with men (MSM) in China. Little is known about predictors of alcohol use/misuse.

METHODS

An online nationwide sample (n = 1100) of MSM from mainland China was recruited between 2014 and 2015. The study objective was to examine the prevalence of a history of alcohol use and frequency of binge drinking in the previous 6 months in this population and assess their relationship with psychological and public health issues.

RESULTS

Nearly 62.1% of respondents reported a history of alcohol use; 30.7% were current infrequent binge drinkers; and 13.6% were current frequent binge drinkers. Adjusted logistic models showed that MSM who reported a history of alcohol use were more likely to report drug use in the previous 6 months (AOR = 1.67); higher levels of internalized homophobia (AOR = 1.49); and partial or full disclosure of their sexual orientation (AOR = 1.46). MSM engaging in current frequent binge drinking were more likely to report female sexual partners (AOR = 2.04) and drug use (AOR = 1.61) in the previous 6 months; higher levels of sexual sensation seeking (AOR = 1.68); and higher levels of homosexual stigma (AOR = 1.69). MSM who reported being unsure of their HIV status were less likely to be current frequent binge drinkers (AOR = 0.46).

CONCLUSIONS

A high prevalence of a history of alcohol use and binge drinking exists among Chinese MSM. Strategies that target alcohol use/misuse in this population are needed.

Psychosociobehavioral characteristics associated with high condomless anal intercourse intention: a comparison of receptive, versatile, and insertive MSM in Taiwan

In Taiwan, men who have sex with men (MSM) continue to be disproportionately affected by HIV, and the main route of HIV transmission is condomless anal intercourse (CAI). This study examined the associations between psychosociobehavioral characteristics and CAI intention among MSM in Taiwan who had ever engaged in anal intercourse with men, and compared the differences across three sexual roles (receptive, versatile, and insertive) using online survey data (N = 563). For all MSM, those that were in a relationship (AOR = 2.55; 95% CI: 1.61-4.03), had three or more steady partners (AOR = 2.58; 95% CI: 1.19-5.58), did not use a condom during last anal intercourse (AOR = 6.81; 95% CI: 4.36-10.63), perceived high HIV risk (AOR = 2.13; 95% CI: 1.26-3.60), and had high sexual sensation seeking (AOR = 2.80; 95% CI: 1.82-4.30) were more likely to have high CAI intention. After stratification, the significant characteristics differed depending on sexual role, except for no condom use during last anal intercourse remaining significant in all models (AOR = 5.09-20.30; 95% CI: 2.49-66.69, depending on sexual role). Tailoring the programs for MSM of different sexual roles may improve the effectiveness of future prevention efforts.

Heterosexual Marital Intention: Effects of Internalized Homophobia, Homosexual Identity, Perceived Family Support, and Disclosure Among Chinese Gay and Bisexual Men

The present study explored the factors that influence the likelihood that 217 Chinese gay/bisexual men will engage in heterosexual marriage, focusing on the Chinese cultural context, in which filial duties to marry, have children, and support one's parents in their old age are taken seriously. Data on heterosexual marital intention (HMI) were examined in relation to demographics, internalized homophobia, homosexual identity formation (HIF), perceived family support, and disclosure. We estimated a multinomial logistic regression model for HMI. Internalized homophobia was a predictor for HMI. Lower levels of HIF and disclosure were found in gay/bisexual men who have married or who intend to marry; and the more family support gay/bisexual men perceived, the more likely they were to enter heterosexual marriages. The findings could help to better evaluate and comprehend the factors leading to heterosexual marriages involving Chinese gay/bisexual men. The social implications of this research are also discussed.

Predictors of Recent HIV Testing Among Chinese Men Who Have Sex with Men: A Barrier Perspective

In China, men who have sex with men (MSM) account for an increasing proportion of new HIV infections. We aim to assess recent HIV testing (in the past 6 months) among Chinese MSM and to identify barriers to testing. A nationwide sample of MSM (n = 1100) from mainland China was recruited. Data on sociodemographics, HIV-related risks, perceived barriers to testing, and testing behaviors were collected. Approximately 30% of MSM had recently undergone HIV testing. With regard to testing, almost half endorsed each of three barriers: did not believe themselves to be at HIV risk, had a fear of being diagnosed HIV positive, and feared their privacy would be violated during testing. Five distinct classes of barriers were identified from the responses. The adjusted multivariable logistic regression model demonstrated that the participants in both the "uncertainty concerning testing sites" and "low risk and privacy violation" classes were less likely to undergo testing than those in the "minimal barrier" class. Men who were unsure of their HIV status were less likely to undergo testing. Furthermore, participants who had multiple male sexual partners and who engaged in substance use over the preceding 6 months were more likely to undergo testing. Distinct subgroups of testing and HIV status varied within the different barrier classifications. Recent HIV testing rates remain low among MSM in China. Barrier factors associated with testing point to the necessity for preventing and controlling HIV, including increasing the privacy of sites or educating MSM on the importance of testing regularly.

Relationship Between Childhood Sexual Abuse and HIV-Related Risks Among Men Who Have Sex with Men: Findings from Mainland China

Men who have sex with men (MSM) carry the burden of HIV infection in China. Outside of China, a history of childhood sexual abuse (CSA) has been associated with HIV-related risks (behavioral, sexual, and mental health outcomes) among MSM. We therefore evaluated the relationship between CSA and these HIV-related risks among MSM in China. Cross-sectional data were collected via a survey from gay websites and social networking applications from MSM in 30 provinces in mainland China during a 3-month period in 2014 and 2015. Overall, 999 screened MSM who responded to questions on CSA were included. Multinomial logistic regression models-adjusted for sociodemographic confounders-showed that men who reported experiencing regular CSA and contact CSA, respectively, were more likely to use substances (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI] 1.39-2.62 and AOR, 1.70; 95% CI 1.25-2.31), had a history of sexually transmitted infections (AOR, 1.81; 95% CI 1.29-2.55 and AOR, 1.65; 95% CI 1.18-2.96), had more male sexual partners (AOR, 1.06; 95% CI 1.04-1.09 and AOR, 1.05; 95% CI 1.03-1.08), engaged in more condomless sex with men (AOR, 1.89; 95% CI 1.39-2.56 and AOR, 1.72; 95% CI 1.29-2.30), and experienced more psychological distress (AOR, 1.05; 95% CI 1.02-1.08 and AOR, 1.05; 95% CI 1.03-1.08). Both frequent and contact forms of CSA were positively associated with HIV-related risks among MSM, suggesting that general CSA prevention strategies and interventions are needed to support this population.

A cross-sectional study of the relationship between sexual compulsivity and unprotected anal intercourse among men who have sex with men in shanghai, China

Background

HIV prevalence among men who have sex with men (MSM) in China is rising rapidly, and unprotected anal intercourse (UAI) is associated with HIV transmission. Recent research has shown that associations between UAI and other factors can differ according to the type of sex partners, including regular partners and casual partners. This study aimed to explore the relationship between sexual compulsivity and UAI according to partner type among MSM in Shanghai, China.

Methods

A cross-sectional study was conducted among 547 MSM from four districts in Shanghai, China. All participants were recruited using snowball sampling. The Sexual Compulsivity Scale was used to evaluate participants’ sexual compulsivity. Multivariable logistic regression was used to identify factors associated with sexual compulsivity and UAI. The mediation effects of substance use before sex on the relationship between sexual compulsivity and UAI were tested through mediation analyses.

Results

After adjusting for sociodemographic variables, sexual compulsivity was associated with overall UAI (adjusted odds ratios [AOR] = 1.039, 95% confidence intervals [CI] = 1.004–1.075), UAI with non-regular sex partners (AOR = 1.089, 95% CI = 1.033–1.148) and UAI with commercial sex partners (AOR = 1.185, 95% CI = 1.042–1.349). No significant association was found between sexual compulsivity and UAI with regular sex partners (AOR = 1.029, 95% CI = 0.984–1.077). Mediation analyses indicated that the relationship between sexual compulsivity and UAI was not mediated by either alcohol use before sex or drug use before sex.

Conclusions

The association between sexual compulsivity and UAI varies depending on the type of UAI partner. Therefore, individuals may engage in different types of UAI for different reasons, and tailored HIV cognitive–behavioral intervention programs are needed.

Co-Occurring Psychosocial Problems and Multiple Sexual Partners among Men Who Have Sex with Men in Shanghai, China: A Syndemic Approach

We aimed to apply syndemic theory to verify the association and reinforcing effects between psychosocial problems and multiple sexual partners (MSP) of men who have sex with men (MSM) in Shanghai, China. A cross-sectional study was conducted among 547 MSM in Shanghai, China using a face-to-face survey. Sociodemographic and psychosocial data were collected, as well as information on MSP and condomless anal sex. In the 6 months prior to the survey, 54.3% of the MSM sample had had MSP. Univariate analysis showed that self-esteem, depression, loneliness, sexual compulsivity, and involuntary subordination (IS) were associated with MSP. Sexual compulsivity (multivariate odds ratio [ORm] = 2.94, 95% CI = 1.76-4.91) and IS (ORm = 1.79, 95% CI = 1.14-2.81) remained significant in multivariate analysis. MSM with five or more psychosocial problems had greater odds of (adjusted odds ratios = 3.06, 95% CI = 1.49-6.25) having MSP in the previous 6 months than the non-syndemic group. Our findings provide preliminary confirmation of the additive relationship of syndemic psychosocial health conditions and MSP among MSM in Shanghai, China. An integrated intervention with special focus on sexual compulsivity and IS is needed.

Vengeance, sexual compulsivity and self-efficacy among men who have sex with men living with HIV

Vengeance is defined as a continuum of thoughts and/or actions ranging from harmless thoughts to destruction or death, due to feelings of hurt or anger, as a result of a perceived personal attack. Studies assessing the association between vengeance and HIV risk behavior are extremely lacking. The primary aims of this study were to examine the associations between vengeance and sexual compulsivity (SC), and self-efficacies (SEs) for condom use, HIV disclosure, and negotiation of safer sex practices. Data were obtained from 266 men who have sex with men (MSM) living with HIV. Simple and multiple linear regression were used to explore the associations between vengeance, SC and SE. After adjusting for sociodemographic and HIV-related factors, there was a negative association between vengeance and SE for HIV disclosure: (most vengeful: β = -1.49; 95% CI: -2.40, -0.58; more vengeful: β = -1.17; 95% CI: -2.12, -0.22; vengeance (continuous: β = -0.03; 95% CI: -0.05, -0.01). Intervention programs geared towards improving SE for HIV disclosure among MSM living with HIV should endeavor to reduce vengeful feelings.

Internalized homophobia, mental health, sexual behaviors, and outness of gay/bisexual men from Southwest China

Background

Social attitudes toward male homosexuality in China so far are still not optimistic. Sexual minorities in China have reported high levels of internalized homophobia.

Methods

This Internet-based study examined the associations among internalized homophobia, mental health, sexual behaviors, and outness among 435 gay/bisexual men in Southwest China from 2014 to 2015. Latent profile analysis, confirmatory factor analysis, univariate logistic regression, and separate multivariate logistic regression analyses were conducted.

Results

This descriptive study found the Internalized Homophobia Scale to be suitable for use in China. The sample demonstrated a high prevalence of internalized homophobia. Latent profile analysis suggested a 2-class solution as optimal, and a high level of internalized homophobia was significantly associated with greater psychological distress (Wald = 6.49, AOR = 1.66), transactional sex during the previous 6 months (Wald = 5.23, AOR = 2.77), more sexual compulsions (Wald = 14.05, AOR = 2.12), and the concealment of sexual identity from others (Wald = 30.70, AOR = 0.30) and parents (Wald = 6.72, AOR = 0.49).

Conclusions

These findings contribute to our understanding of internalized homophobia in China, and highlight the need to decrease gay-related psychological stress/distress and improve public health services.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-017-0530-1) contains supplementary material, which is available to authorized users.