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

What is the global prevalence of depression among men who have sex with men? A systematic review and meta-analysis

BACKGROUND

Depression due to stigma resulting from their sexual identity, isolation, social exclusion, and insufficient access to care and counseling services has become a health problem among men who have sex with men (MSM).

OBJECTIVES

This study aimed to determine the global prevalence of depression among MSM as a systematic review and meta-analysis.

METHODS

This study was a systematic review and meta-analysis performed in five steps of search strategy, screening and selecting articles, data extraction, evaluation of the risk of bias, and meta-analysis. In this study, the determined keywords were searched in the databases of PubMed, Scopus, Embase, and Web of Science from January 1913 to July 2021 to find the initial articles, from which data were extracted according to the set checklist in the data extraction stage. Finally, the studies were included in the present meta-analysis according to the inclusion and exclusion criteria, to be evaluated using the Newcastle Ottawa scale checklist. I Square and Q Cochrane were also used to assess the degree of heterogeneity. The analyses were performed using the random-effects model in STATA 16.

RESULTS

The results showed the quality score of the majority of cross-sectional studies included in the meta-analysis (62 studies) was equal to six or seven (moderate), and five ones had a high-quality score. After combining these studies, the pooled prevalence of depression among MSM in the world was 35% (95% CI 31%-39%, I square; 98.95%, P-value < 0.001). Population subgroup analysis showed the pooled prevalence of depression among MSM living with HIV was 47% (95% CI 39%-55%, I square; 95.76%, P-value < 0.001). Continent subgroup analysis showed the highest pooled prevalence of depression among Asian MSM at 37% (95% CI 31%-43%, I square; 99.07%, P-value < 0.001). Also, in the subgroup analysis of the sampling method, the pooled prevalence in the studies which used the respondent-driven sampling method was equal to 34% (95% CI 25%-43%, I square; 99.32%, P-value < 0.001). Sensitivity analysis revealed the pooled prevalence of depression in studies included in the meta-analysis was near or around the pooled estimate.

CONCLUSION

The pooled prevalence of depression among MSM was almost three times higher than the general male population. Therefore, particular and therapeutic interventions such as screening, and harm reduction programs for mental disorders, especially depression, are suggested to be considered in service packages.

Sexual Behaviors and Factors Associated with Condomless Sexual Practice in Colombian Men Who Have Sex with Men at High Risk of HIV Transmission

Men who have sex with men (MSM) have a disproportionate burden of HIV infection worldwide. In Colombia, the prevalence of HIV in MSM is ~ 43 times higher than in the general population (17% vs. 0.4%). This study determined the sexual behaviors, HIV serostatus, and associated factors with condomless sexual practice with both regular and casual partners in 92 MSM from Medellín, Colombia. The subjects were recruited through a community-based approach, and the data were collected by a structured survey and in-depth interviews. Participants were classified into three groups according to the number of sexual partners in the last three months, to compare the sociodemographic conditions and sexual behaviors. Univariate analysis was described by absolute and relative frequencies; bivariate analysis and multivariate logistic regression were used to compare the groups and to explore the associated factors with condomless sexual practice. The overall HIV estimated prevalence was 4.3%, while the estimated prevalence for MSM with > 10 sexual partners in the last three months was 14.8%. This last group showed higher average age, higher percentage of subjects who have had sex with people living with HIV, and increased frequency of previous sexually transmitted infections. Having condomless sex with casual partners was associated with the number of sexual partners in the last three months. This study demonstrates that Colombian MSM continue to have a high risk of HIV infection/transmission and reinforce the need to implement adequate prevention programs, PrEP and guarantee access to treatment for people living with HIV.

Opposing associations of depression with sexual behaviour: implications for epidemiological investigation among gay, bisexual and other men who have sex with men

OBJECTIVE

The aim of this report is to investigate the nature of the relationship between depression and condomless sex (CLS) among gay, bisexual and other men who have sex with men (GBMSM).

METHODS

Data are from the Antiretrovirals, Sexual Transmission Risk and Attitude (ASTRA) study of people living with HIV and attending one of eight HIV outpatient clinics in England (2011-2012) and the Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study of HIV-negative/unknown status individuals attending one of 20 genitourinary medicine clinics in England (2013-2014). This analysis included GBMSM only. For each study, the prevalence of depressive symptoms (Patient Health Questionnaire-9 score ≥10) was presented according to three categories of sex in the past 3 months (considering anal/vaginal sex with men/women and anal sex with men in separate definitions): (1) no sex, (2) condom-protected sex only and (3) CLS. Multinomial logistic regression with 'condom-protected sex only' as the reference group was used to adjust for age and (for ASTRA participants) time since HIV diagnosis.

RESULTS

There were opposing associations of depression with recent sexual behaviour: the prevalence of depression was higher among those who reported no sex and those who reported CLS, compared with those who reported condom-protected sex only. Among the 2170 HIV-positive GBMSM in ASTRA, considering anal/vaginal sex with men/women, the prevalence of depressive symptoms was 32%, 20% and 28%, respectively, among men reporting no sex (n=783), condom-protected sex only (n=551) and CLS (n=836) (global p<0.001). Among the 1477 HIV-negative GBMSM in AURAH, the prevalence of depressive symptoms was 12%, 8% and 13%, respectively, for no sex (n=137), condom-protected sex only (n=487) and CLS (n=853) (global p=0.017). Patterns were similar after adjustment and when only considering anal sex between men.

CONCLUSIONS

Depression may be linked both to lack of sexual activity and to sexual risk taking. When investigating associations between depression and CLS, it is important to separate out individuals reporting condom-protected sex only from those reporting no sex.

Prevalence and factors associated with psychological distress among key populations in Togo, 2017

OBJECTIVES

Mental health is a largely neglected issue among in Sub-Saharan Africa, especially among key populations at risk for HIV. The aim of this study was to estimate the prevalence of psychological distress (PD) and to assess the factors associated among males who have sex with males (MSM), female sex workers (FSW) and drug users (DU) in Togo in 2017.

STUDY DESIGN

A cross-sectional bio-behavioral study was conducted in August and September 2017 using a respondent-driven sampling (RDS) method, in eight cities in Togo.

METHODS

A standardized questionnaire was used to record sociodemographic characteristics and sexual behaviors. The Alcohol Use Disorders Identification Test (AUDIT) and a subset of questions from the Tobacco Questions for Survey were used to assess alcohol and tobacco consumption respectively. PD was assessed with the Kessler Psychological Distress Scale. A blood sample was taken to test for HIV. Descriptive statistics, univariable and multivariable ordinal regression models were used for analysis.

RESULTS

A total of 2044 key populations including 449 DU, 952 FSW and 643 MSM with a median age of 25 years, interquartile range (IQR) [21-32] were recruited. The overall prevalence of mild PD among the three populations was 19.9% (95%CI = [18.3-21.8]) and was 19.2% (95%CI = [17.5-20.9]) for severe/moderate PD. HIV prevalence was 13.7% (95%CI = [12.2-15.2]). High age (≥ 25 years) [aOR = 1.24 (95% CI: 1.02-1.50)], being HIV positive [aOR = 1.80 (95% CI: 1.31-2.48)] and hazardous alcohol consumption [aOR = 1.52 (95% CI: 1.22-1.87)] were risk factors for PD. Secondary [aOR = 0.52 (95% CI: 0.42-0.64)] or higher [aOR = 0.46 (95% CI: 0.32-0.64)] education levels were protective factors associated with PD. FSW [OR = 0.55 (95% CI: 0.43-0.68)] and MSM [OR = 0.33 (95% CI: 0.24-0.44)] were less likely to report PD compared with DU.

CONCLUSION AND RECOMMENDATIONS

This is the first study conducted among a large, nationally representative sample of key populations in Togo. The prevalence of PD is high among these populations in Togo and was associated to HIV infection. The present study indicates that mental health care must be integrated within health programs in Togo with a special focus to key populations through interventions such as social support groups.

Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire

BACKGROUND

Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature.

OBJECTIVE

We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores.

PARTICIPANTS AND SETTING

192 unique samples consisting of 68,830 individuals.

METHODS

We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis.

RESULTS

We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations.

CONCLUSIONS

These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.

Prevalence and correlates of depressive symptoms among gay, bisexual and other men who have sex with men in the PROUD randomised clinical trial of HIV pre-exposure prophylaxis

OBJECTIVES

The aim of this analysis is to: (i) assess the prevalence of clinically significant depressive symptoms at baseline and follow-up for participants in the PROUD trial of HIV pre-exposure prophylaxis (PrEP), examining changes in prevalence over time and (ii) investigate the association of socioeconomic and psychosocial factors with depression.

METHODS

PROUD was an open label randomised trial evaluating the benefit of PrEP for 544 HIV-negative gay, bisexual and other men who have sex with men (GBMSM) in England. Enrolment was between 2012 and 2014, with at least 2 years follow-up. Prevalence of depression (score ≥10 on Patient Health Questionnaire-9) was assessed and compared across time-points (using McNemar's χ² tests) and between trial arms (using χ² tests). Cross-sectional associations with socioeconomic and psychosocial factors were examined using baseline data in modified Poisson regression models and combined 12 and 24 month follow-up data in generalised estimating equations (GEEs). Prevalence ratios (PRs) were presented as unadjusted PR and adjusted PR (aPR) for age, UK birth, sexual identity, university education, London study clinic site and calendar time (and follow-up time-point in GEEs).

RESULTS

Depression increased significantly from baseline (9.1%; 49/540) to the 12 month (14.4%; 59/410) and 24 month (14.4%; 48/333) follow-ups, possibly explained by underreporting at baseline. The prevalence of depression did not differ by study trial arm, at any time-point. In the baseline analysis, younger age, unemployment and crystal methamphetamine use, was associated with depression. In combined analysis of 12 and 24 month data, measures of intimate partner violence (IPV) (lifetime IPV victimisation aPR 2.57 (95% CI: 1.71 to 3.86)), internalised homophobia (aPR 1.91 (95% CI: 1.29 to 2.83)) and concealment of sexual identity (aPR 1.75 (95% CI: 1.16 to 2.65)), were strongly associated with depression.

CONCLUSIONS

There is a high concomitant burden of psychosocial factors with depression among GBMSM.

TRIAL REGISTRATION NUMBER

ISRCTN (ISRCTN94465371) and ClinicalTrials.gov (NCT02065986).

Effect of a Community-Level HIV Prevention Intervention on Psychosocial Determinants of HIV Risk Behaviors among Young Black Men Who Have Sex with Men (YBMSM)

In contrast to intervention studies that assess psychosocial factors only as mediators or moderators of HIV risk, the present study assessed the effects of an Mpowerment-based community-level intervention on psychosocial determinants (e.g., depressive symptoms, sexual stigma) of HIV risk behavior among young black MSM. Approximately 330 respondents were surveyed annually for 4 years in each of two sites. General linear models examined change across time between the intervention and comparison communities, and participation effects in the intervention site. Social diffusion (spreading information within networks) of safer sex messages (p < 0.01) and comfort with being gay (p < 0.05) increased with time in intervention versus control. Cross-sectionally, intervention participants responded more favorably (p < 0.05) on social diffusion and depressive symptoms, but less favorably (p < 0.01) on sex in difficult situations and attitudes toward condom use. Findings suggest a need to address broader health issues of MSM as well as sexual risk.

The relationship between family acceptance and quality of life and self esteem of PLWH MSM in Medan, North Sumatera, Indonesia

OBJECTIVE

To identify the correlation between family acceptance and quality of life and self-esteem of People Living with HIV Men Who Have Sex With Men (PLWH MSM) in Medan.

METHOD

This cross-sectional study applied a purposive sampling technique and involved 175 PLWH MSM from H. Adam Malik Public Central Hospital, Medan Pringadi Hospital, Padang Bulan, and Teladan Public Health Centers. The research instruments used are the Perceived Acceptance Scale (PAS), WHOQOL-BREF, and the Rosenberg Self-Esteem Scale. This research has passed the ethical test of the Faculty of Nursing Universitas Indonesia with number 157/UN2/F12.D/HKP.02.04/2018.

RESULTS

Bivariate analysis found that family acceptance was related to quality of life and self-esteem (p=0.006, α=0.05; p<0.001, α=0.05). Family acceptance has a positive relation with QOL and self-esteem. These results show that high family acceptance is associated with good QOL and high self-esteem.

CONCLUSIONS

Family acceptance is correlated with quality of life and self-esteem. If family acceptance is promoted by especially nursing, quality of life and self-esteem can play an optimum role in decreasing risky sexual behaviors.

Risk behaviors for HIV infection. A review of emerging trends

HIV infection, acquired with the conscious participation of the recipient, is a complex problem of international concern, especially among men who have sex with men. Behaviors emerge such as bareback (intentionally unprotected anal sex between men) and bugchasing (bareback sex when one participant is HIV+ and the other is not). A group of emerging risk behaviors for HIV infection was characterized. A review of the literature in the MEDLINE, Web of Science and regional SciELO databases was performed. HIV-related search terms such as unprotected sex, barebacking/bareback and bug chasing, were used. Bareback and bug chaser behaviors occur, among other factors, through social homonegativity, ART positive coverage, insufficient prevention campaigns, search for new sensations and attempts to strengthen the relationship with the HIV+ member. Unprotected sex is primarily associated with having HIV/AIDS diagnoses, physical violence due to sexual orientation, viewing homosexual sex sites, and having bought or sold sex. It is necessary to work with individual behaviors that draw individuals close to infection.

The additive effects of depressive symptoms and polysubstance use on HIV risk among gay, bisexual, and other men who have sex with men

INTRODUCTION

Among gay, bisexual, and other men who have sex with men (GBM), collinearity between polysubstance use and mental health concerns has obscured their combined effects on HIV risk with multivariable results often highlighting only one or the other.

METHODS

We used mediation and moderation analyses to examine the effects of polysubstance use and depressive symptoms on high-risk sex (i.e., condomless anal sex with serodiscordant/unknown status partner) in a sample of sexually-active GBM, aged ≥16 years, recruited in Metro Vancouver using respondent driven sampling. Hospital Anxiety and Depression Scale scores assessed mental health. Alcohol Use Disorder Identification Test scores assessed alcohol disorders. Poly-use of multiple drug types (e.g., stimulants, sedatives, opiates, hallucinogens) was assessed over the previous six months.

RESULTS

Among 719 predominantly white (68.0%), gay-identified (80.7%) GBM, alcohol use was not associated with increased prevalence of high-risk sex. Controlling for demographic factors and partner number, an interaction between polysubstance use and depressive symptoms revealed that the combined effects were additively associated with increased odds for high-risk sex. Mediation models showed that polysubstance use partially mediated the relationship between depressive symptoms and high-risk sex.

CONCLUSION

An interaction effect between polysubstance use (defined by using 3 or more substances in the past six months) and depressive symptoms (defined by HADS scores) revealed that the combination of these factors was associated with increased risk for high-risk sex - supporting a syndemic understanding of the production of HIV risk.

Violence and depression among men who have sex with men in Tanzania

BACKGROUND

Men who have sex with men (MSM) continue to be at an increased risk of Violence, HIV transmission and Mental Disorders such as depression on top of many other bio-psycho-socio challenges they face as a result of their sexual orientation.

METHODS

We recruited 345 MSM using a respondent driven sampling technique. Revised Conflict Tactic Scale, PHQ-9 and questions adapted from the TDHS 2010 were used to assess for violence, depression and HIV-risk behaviors respectively. Continuous and categorical variables were analyzed with student's t-test and chi-square test respectively. Logistic regression analyses were performed to assess for predictors of depression and HIV-risk behaviors. All tests were two sided and p < 0.05 was taken as significance level.

RESULTS

Overall, 325 (94.2%) of participants experienced any form of violence, with emotional violence constituting the majority (90.1%), while physical and sexual violence were reported by 254 (73.6%) and 250 (72.5%) of participants respectively. Depressive symptoms were present in 245 (70.0%) and participants who experienced violence had a 3 times increased risk of depressive symptoms compared to their violence-free counterparts, p < 0.001. On the other hand, participants who experienced any form of violence displayed an over 11 times increased rate of depressive symptoms compared to their counterparts who were violence free, p < 0.001. Violence experience was found to be the strongest associated factor for depressive symptoms.

CONCLUSIONS

The rates of violence, depressive symptoms and HIV risk behaviors amongst MSM are astoundingly high thus necessitating extensive interventions. In view of this, deliberate measures to deal with the reported high rates necessitate joint intervention efforts from the policy makers, health providers and community at large.

Sexual Risk-Taking in HIV-Negative Gay and Bisexual Men Increases with Depression: Results from a U.S. National Study

The link between depression and sexual risk-taking has received mixed findings in the literature. The current study analyzed the links between depression and recent condomless anal sex (CAS) with casual partners among 1033 HIV-negative, non-PrEP-using, gay and bisexual men. When CAS was dichotomized as either none or some, depression was not associated with the odds of CAS (with receptive and insertive combined) or insertive CAS only, but was positively associated with the odds of receptive CAS. When CAS was tallied as a count variable of events, depression was positively associated with total CAS, receptive CAS, and insertive CAS. With the addition of a quadratic term for depression, a positive quadratic effect was only found for total CAS and receptive CAS, but not for insertive CAS. These findings highlight the utility of using count data for CAS events and treating CAS separately with regard to receptive and insertive positioning when considering the role of depression among gay and bisexual men.

Clinically significant depressive symptoms and sexual behaviour among men who have sex with men

BACKGROUND

The relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood.

AIMS

To investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex.

METHOD

The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013-2014).

RESULTS

Among 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17-1.74; P=0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20-1.71; P<0.001)), sexually transmitted infection (STI) diagnosis (PR 1.46, 95% CI 1.19-1.79; P<0.001) and post-exposure prophylaxis use in the past year (PR 1.83, 95% CI 1.33-2.50; P<0.001).

CONCLUSIONS

Management of mental health may play a role in HIV and STI prevention.

DECLARATION OF INTEREST

A.N.P. has received payments for presentations made at meetings sponsored by Gilead in spring 2015. N.C.N. has received support for attendance at conferences, speaker fees and payments for attendance at advisory boards from Gilead Sciences, Viiv Healthcare, Janssen Pharmaceuticals and Bristol-Myers Squibb and a research grant from Gilead Sciences. D.A. served on the advisory board for Gilead in January 2016. M.M.G. has had sponsorship to attend conferences by Bristol-Myers Squibb, been on the BioCryst advisory board and run trials for Merck, Gilead, SSAT, BioCryst and Novartis.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

The Prevalence and Correlates of HIV and Undiagnosed Infection among Men Who Have Sex with Men in Hanoi, Vietnam: Findings from a Cross-sectional, Biobehavioral Study

INTRODUCTION

Men who have sex with men (MSM) are a key population for HIV infection in Vietnam, and the use of amphetamine type substances (ATS) is prevalent and possibly increasing in this population. The reported analysis examines the association between ATS use before or during sex and HIV infection among MSM in Hanoi, Vietnam.

METHODS

This cross-sectional study of 210 MSM was conducted in Hanoi, Vietnam, in late 2014. Men tested for HIV and answered questions about demographic characteristics, sexual sensation seeking, depression, belief in HIV prevention strategies, homosexuality-related stigma and discrimination, recent accessing of HIV prevention services, sexual behaviors and ATS, and other drug use behaviors. We performed logistic regression to assess correlates of HIV infection.

RESULTS

HIV prevalence was 6.7% (14/210), and 85.7% (12/14) of HIV-positive men were not aware of their HIV status. Of the 210 participants, 10.5, 2.9, and 3.8% of men had used methamphetamine, amphetamine, and ecstasy before or during sex in the last 3 months. In multivariable analysis, HIV infection was associated with recent sex-related methamphetamine use [adjusted odds ratio (AOR): 5.03, 95% confidence interval (CI): 1.35-18.68], engaging in recent sex work (AOR: 3.55, 95% CI: 1.07-11.75), and homosexuality-related perceived stigma (AOR: 2.32, 95% CI: 0.98-5.47).

CONCLUSION

Findings underscore the importance of integrating methamphetamine use interventions into HIV prevention services and scaling-up of gay-friendly, non-stigmatizing HIV testing services for MSM in Hanoi. We recommend the routine assessment of ATS use and undiagnosed infection in this population.

Correlates of Condom Use Among Substance Using Older Seropositive MSM: Implications for Mental Health Practice

The purpose of this study was to describe the correlates of condom use among a sample of N = 60 substance using seropositive men who have sex with (MSM). The mean age of the study participants was 52 ranging 50-75 years of age. Seventy-percent of study participants reporting smoking marijuana, 62% using cocaine, 25% heroin, 37% alcohol, and 30% amphetamines. Among those reporting substance use, 75% reported it was a hassle to use condoms, 42% indicated pleasure decreased with condom use, 72% indicated safer sex is boring, 72% reported the idea of using condoms is unappealing, 78% reported condoms ruined sex, and 71% said condoms interfered with romance. A multiple logistic regression analysis revealed low self-esteem, relationship status, attitudes towards condom use, and depression predicted condom use χ² = 20.79, df = 6, ρ =.002. The study findings have implications for mental health nursing practice with seropositive African American MSM.

Use of the Internet to Meet Sexual Partners, Sexual Risk Behavior, and Mental Health in Transgender Adults

The purpose of this study was to examine the use of the internet to meet sexual partners among transgender individuals and examine correlates of this use, including sexual risk behavior, discrimination experiences, and mental health. A sample of 166 transgender adults (112 male-to-female transgender women and 54 female-to-male transgender men) were recruited in community venues and anonymously completed measures assessing these variables. Most participants (64.5 %) were HIV-negative, 25.2 % were HIV-positive, and 10.3 % did not know their HIV status. Overall, 33.7 % of participants reported having met a sexual partner over the internet, which did not differ significantly between transgender women and men. Among these individuals, transgender women reported significantly more lifetime internet sexual partners (median = 3) than transgender men (median = 1). Use of the internet to meet sexual partners was associated with lower self-esteem but not with depression, anxiety, somatic distress or discrimination experiences. Among transgender women, use of the internet to meet sexual partners was associated with each of the 11 sexual risk behaviors examined, including having multiple partners, sex under the influence of drugs, number of unprotected anal or vaginal sex acts, and history of commercial sex work. The use of the internet to meet partners was not associated with sexual risk behavior among transgender men (0/11 variables assessed). Although the internet is a common mode of meeting sexual partners among some transgender adults, it may also be a potential venue for prevention interventions targeting transgender individuals at particularly high risk for HIV acquisition.

Semen Arousal: Its Prevalence, Relationship to HIV Risk Practices, and Predictors among Men Using the Internet to Find Male Partners for Unprotected Sex

Purpose

This paper examines the extent to which men who use the Internet to find other men for unprotected sex are aroused by semen. It also looks at the relationship between semen arousal and involvement in HIV risk practices, and the factors associated with higher levels of semen arousal.

Methods

332 men who used any of 16 websites targeting unprotected sex completed 90-minute telephone interviews. Both quantitative and qualitative data were collected. A random sampling strategy was used. Semen arousal was assessed by four questions asking men how much they were turned on by the way that semen smelled, tasted, looked, and felt.

Results

65.1 % of the men found at least one sensory aspect of semen to be "fairly" or "very" arousing, compared to 10.2% being "not very" or "not at all" aroused by all four sensory aspects of semen. Multivariate analysis revealed that semen arousal was related to greater involvement in HIV risk practices, even when the impact of other salient factors such as demographic characteristics, HIV serostatus, and psychological functioning was taken into account. Five factors were found to underlie greater levels of semen arousal: not being African American, self-identification as a sexual "bottom," being better educated, being HIV-positive, and being more depressed.

Conclusions

Being aroused by the sensory aspects of giving or receiving semen is commonplace amongst men in this high-risk population. Semen arousal was related closely to involvement in risk practices, indicating a need for HIV intervention programs to address this phenomenon in this population.