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Tsoumanis A, Vanden Berghe W, Hens N, Van Dijck C. Estimating Partnership Duration among MSM in Belgium-A Modeling Study. Infect Dis Rep 2024; 16:435-447. [PMID: 38804442 PMCID: PMC11130929 DOI: 10.3390/idr16030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Mathematical modeling is widely used for describing infection transmission and evaluating interventions. The lack of reliable social parameters in the literature has been mentioned by many modeling studies, leading to limitations in the validity and interpretation of the results. Using data from the European MSM Internet survey 2017, we developed a network model to describe sex acts among MSM in Belgium. The model simulates daily sex acts among steady, persistent casual and one-off partners in a population of 10,000 MSM, grouped as low- or high-activity by using three different definitions. Model calibration was used to estimate partnership duration and homophily rates to match the distribution of cumulative sex partners over 12 months. We estimated an average duration between 1065 and 1409 days for steady partnerships, 4-6 and 251-299 days for assortative high- and low-activity individuals and 8-13 days for disassortative persistent casual partnerships, respectively, varying across the three definitions. High-quality data on social network and behavioral parameters are scarce in the literature. Our study addresses this lack of information by providing a method to estimate crucial parameters for network specification.
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Affiliation(s)
- Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium; (W.V.B.)
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, 2610 Antwerp, Belgium;
| | - Wim Vanden Berghe
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium; (W.V.B.)
| | - Niel Hens
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, 2610 Antwerp, Belgium;
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium; (W.V.B.)
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Gaither TW, Siapno AED, Kianian R, Vincent N, Williams KC, Piquerias E, Russell MM, Litwin MS. Relationship between pelvic sensations and lifetime exposure to receptive anal intercourse among people with prostates. J Sex Med 2023; 20:1195-1205. [PMID: 37548267 DOI: 10.1093/jsxmed/qdad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Despite the negative stigma on receptive anal intercourse (RAI), this behavior has a positive influence on individuals' sexual and relationship health. No large studies have previously looked at specific sensations experienced during RAI and how these sensations may change with experience. AIM In this study we aimed to quantify commonly reported pelvic sensations during RAI and determine whether their presentation changes with increasing experience of RAI. METHODS An internet survey was conducted on sensations felt during RAI among people with prostates from July 2022-January 2023. The survey content was developed based on a mixed-methods qualitative study and inquired about demographic and sexual histories as well as sensations (pleasure, pain, urinary, and bowel) experienced during RAI. We used descriptive statistics to describe demographic and sexual histories. All data were stratified by lifetime exposure to RAI. OUTCOMES The primary outcomes assessed included the quantification of both the primary sensations experienced during RAI and the associated bother. RESULTS In total, 975 participants completed the survey. The median age was 32 (range 18-78) years. The average age of first participation in RAI was 21 ± 6.6 years. Most respondents were having sex at least once a week (65%). Nine percent of respondents reported fewer than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences. As the number of experiences with RAI increased (from <10 to >500 exposures), the reported frequency of pleasurable sensation increased from 41% to 92% (P < .0001), whereas severe insertional pain and symptoms of bowel urgency decreased from 39% to 13% and from 21% to 6%, respectively (P < .0001). Urinary urgency sensation did not differ by lifetime RAI experience. CLINICAL IMPLICATIONS Lifetime RAI exposure can be readily assessed and correlates not only with pelvic sensation but also many other aspects of sexual health. These results imply that the etiology of dissatisfaction with pleasure or anodyspareunia during RAI may differ by lifetime RAI exposure. STRENGTHS AND LIMITATIONS This is the first study to our knowledge to assess pelvic sensations experienced during RAI among a large sample of individuals. This is a cross-sectional study, and we cannot conclude how pelvic sensations change over time among individuals. Internet-based participants may not be representative of clinical populations. CONCLUSION Lifetime exposure to RAI is positively associated with pleasure and is negatively associated with pain and bowel urgency. Pelvic sensations experienced during RAI appear to be dependent on lifetime RAI exposure history regardless of age.
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Affiliation(s)
- Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Allen E D Siapno
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Reza Kianian
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | | | - Kristen C Williams
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Eduardo Piquerias
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Marcia M Russell
- Department of Surgery, Section of Colorectal Surgery, David Geffen School of Medicine, Los Angeles, CA 90095, United States
- Surgical and Perioperative Careline, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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Gaither TW, Vincent NW, Piqueiras E, Barzallo D, Siapno A, Williams KC, Russell M, Litwin MS. Atlas of the receptive anal sex experience among people with prostates. J Sex Med 2023; 20:126-138. [PMID: 36763914 DOI: 10.1093/jsxmed/qdac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/15/2022] [Accepted: 11/21/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Receptive anal intercourse (RAI) is commonly practiced among individuals of all sexual orientations. However, negative stigmatization by society and health care professionals leads to the underreporting or this practice. AIM We sought to assess and describe the subjective role of the prostate as a pleasure center in participants with diverse RAI experiences. The secondary aim was to describe nonprostatic areas within the anorectal region that produce erotic sensation and/or pain. METHODS The exploratory sequential multimethod study design included focus groups and semistructured interviews with 30 individuals with prostates who had engaged in RAI. We used graphic elicitation of natal male anatomy to enhance visualization and assess participant perspectives. OUTCOMES The main outcome of interest was the identification of anatomic locations of erogenous sensation and pain during RAI. RESULTS Among the participants (median age 38, range 24-77 years), most participants (90%) identified as cisgender male. Three major themes emerged within the motivations for RAI, including (1) deriving intrinsic pleasure, (2) providing both pleasure for a partner and a way to improve intimacy/connection, and (3) an inability to be the insertive partner due to physical or mental challenges. The data suggest that the anorectal region produces a variety of erogenous sensations which participants find pleasurable. Overall, 2 major areas of erogenous sensation occur along the anterior rectal wall and within the anus. Within the context of RAI, 2 distinct categories of pain emerged, including pain with insertion and pain at other times. CLINICAL IMPLICATIONS Understanding where erogenous sensation originates for each individual may predict sexual functioning after various surgical interventions. Timing and location of pain may aid in further characterizing anodyspareunia. STRENGTHS AND LIMITATIONS Our study utilized a sequential design (from focus groups to interviews) with diverse RAI experiences, especially regarding age, geographic location, and prostate pathology. We included individuals of diverse gender identities, but too few to evaluate these groups independently from cisgender men. CONCLUSION People with prostates experience pleasure in multiple areas during RAI. Contrary to some lay literature, the prostate region is not the subjective pleasure center for all individuals. Timing and location of pain during RAI may inform areas for intervention. Providing a language for pleasure and pain during RAI may improve communication between not only sexual partners but also clinicians and patients.
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Affiliation(s)
- Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Eduardo Piqueiras
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Devin Barzallo
- Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Allen Siapno
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Kristen C Williams
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Marcia Russell
- Department of Surgery, Section of Colorectal Surgery, David Geffen School of Medicine, Los Angeles, United States, CA.,Surgical and Perioperative Careline, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States.,School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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Grov C, Westmoreland D, Carneiro PB, Bauermeister JA, Carrico AW. Getting Clear About Rectal Douching Among Men Who Have Sex With Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2911-2920. [PMID: 34590220 PMCID: PMC9753552 DOI: 10.1007/s10508-021-01933-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/26/2020] [Accepted: 01/22/2021] [Indexed: 06/13/2023]
Abstract
Receptive anal sex is the primary means through which HIV is transmitted among men who have sex with men (MSM). Recently, researchers have begun investigating the role that rectal douching may play in amplifying risk for transmission. Yet, there is limited research on the frequency with which MSM douche, the products they use, and how this may vary across sociodemographic characteristics. A U.S. national sample of 4745 MSM completed an online survey that assessed their douching behavior, demographic characteristics, sexual behavior, and their anal sexual positioning (i.e., top, bottom, versatile). Nearly two-thirds (65.8%) had engaged in rectal douching in the last three months. Among those who douched, water was commonly reported (84.2%) and 20.1% reported using commercial enemas (e.g., Fleet), as well as water and soap (15.0%)-numbers exceed 100% as some participants reported more than one. Men who douched reported significantly more receptive and insertive condomless anal sex acts in the prior 3 months. One-in-ten men reported rectal bleeding after douching. Compared to HIV-negative participants who had not taken PrEP, participants had higher odds of reporting douching in the past 3 months if they were HIV-negative and currently on PrEP (AOR = 1.82), HIV-negative and previously used PrEP (AOR = 1.58), and HIV-positive (AOR = 1.83). Douching was common in this sample. Given that douching could amplify risk for HIV transmission, healthcare providers should discuss douching safety with their patients, with a focus on harm reduction (e.g., reduce risk of bleeding, as opposed to abstinence from douching).
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Affiliation(s)
- Christian Grov
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA.
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W. 125th St., 7th Floor mailroom, New York, NY, 10027, USA.
| | - Drew Westmoreland
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | - Pedro B Carneiro
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W. 125th St., 7th Floor mailroom, New York, NY, 10027, USA
| | - Jose A Bauermeister
- Department of Family & Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Molecular Epidemiology of the HIV-1 Subtype B Sub-Epidemic in Bulgaria. Viruses 2020; 12:v12040441. [PMID: 32295123 PMCID: PMC7232140 DOI: 10.3390/v12040441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/30/2022] Open
Abstract
HIV-1 subtype B is the predominant strain in Bulgaria, yet little is known about the molecular epidemiology of these infections, including its origin and transmissibility. We used a phylodynamics approach by combining and analyzing 663 HIV-1 polymerase (pol) sequences collected from persons diagnosed with HIV/AIDS between 1988-2018 and associated epidemiologic data to better understand this sub-epidemic in Bulgaria. Using network analyses at a 1.5% genetic distance threshold (d) we found several large phylogenetic clusters composed mostly of men who have sex with men (MSM) and male heterosexuals (HET). However, at d = 0.5%, used to identify more recent transmission, the largest clusters dissociated to become smaller in size. The majority of female HET and persons with other transmission risks were singletons or pairs in the network. Phylogenetic analysis of the Bulgarian pol sequences with publicly available global sequences showed that subtype B was likely introduced into Bulgaria from multiple countries, including Israel and several European countries. Our findings indicate that subtype B was introduced into Bulgaria multiple times since 1988 and then infections rapidly spread among MSM and non-disclosed MSM. These high-risk behaviors continue to spread subtype B infection in Bulgaria as evidenced by the large clusters at d = 0.5%. Relatively low levels of antiretroviral drug resistance were observed in our study. Prevention strategies should continue to include increased testing and linkage to care and treatment, as well as expanded outreach to the MSM communities.
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