Nonvolitional sex and HIV-related sexual risk behaviours among MSM in the United States

Physical and Sexual Violence and Sexual Behaviors Among Men Who Have Sex with Men in 22 U.S. Cities-National HIV Behavioral Surveillance, 2017

National prevalence of physical and sexual violence and its relationship to sexual behaviors are unknown among men who have sex with men (MSM). We estimated 12-month prevalence of physical and sexual violence and assessed relationships between violence and sexual behaviors among MSM. Data were obtained from National HIV Behavioral Surveillance 2017 that used time-space sampling methods to recruit and interview MSM in 22 U.S. cities. Weighted percentages with 95% confidence intervals (CI) were reported. Adjusted prevalence ratios (aPR) and 95% CIs were calculated using logistic regression with predicted marginal means. Overall, 10.2% (95% CI: 9.3%-11.2%) of MSM experienced physical violence only, 3.2% (95% CI: 2.7%-3.7%) experienced sexual violence only, and 2.3% (95% CI: 1.9%-2.7%) experienced both types of violence, in the past 12 months. Compared to MSM who did not experience violence, those who did reported higher percentages of unemployment, poverty, homelessness, same-sex discrimination, non-injection drug use, and binge drinking. Violence was not independently associated with condomless anal sex among MSM. MSM who experienced both types of violence were more likely than those who did not experience violence to have had four or more male sex partners (aPR=1.18, 95% CI: 1.02-1.37). MSM who experienced both types of violence (aPR=2.49, 95% CI: 1.52-4.09), sexual violence (aPR=2.27, 95% CI: 1.47-3.52), or physical violence (aPR=1.76, 95% CI: 1.27-2.44) were more likely than those who did not experience violence to have had exchange sex. Recent physical violence and sexual violence are common among MSM. Findings highlight the importance of violence screening and suggest the need for tailored interventions that improve the safety and economic security of MSM who experience violence, including those who exchange sex.

Health associations for male survivors of unwanted and non-consensual sex

Literature has established that men with non-consensual sexual experiences exhibit a higher likelihood of engaging in high-risk sexual behaviors; however, previous research does not explore men with unwanted sexual experiences, nor their sexual and general health outcomes. Weighted data from the 2011-2017 National Survey of Family Growth included men aged 18-49 years who ever experienced oral, vaginal, or anal sex by partners of any gender (N = 10,763). The Pearson χ² test compared the sociodemographic of men with or without a history of unwanted or non-consensual sex. Logistic regressions were used to examine the association of this history to sexual health and general health outcomes, while controlling for age, race/ethnicity, and education level. Approximately 1 in 10 (10.3%) American men reported experiencing unwanted or non-consensual sex in their lifetime. Men with these experiences were more likely to rate their health as fair or poor (aOR = 1.5, 95% CI = [1.1, 2.0]) and have difficulty concentrating, remembering, or making decisions due to a physical, mental, or emotional condition (aOR = 2.1, 95% CI = [1.7, 2.7]). Men with forced sex experiences reported higher odds of gonorrhea (aOR = 5.4; 95% CI = [3.0, 10.0]) or chlamydia diagnoses (aOR = 2.5; 95% CI = [1.5, 4.4]) in the past year, and a diagnosis of genital herpes (aOR = 2.7; 95% CI = [1.6, 4.6]), genital warts (aOR = 1.7; 95% CI = [1.0, 5.6]), and syphilis (aOR = 2.4; 95% CI = [1.0, 5.6]) in their lifetime than men who did not report these experiences. The association of sexually transmitted infections and general health outcomes to unwanted and non-consensual sex validates the demand for clinicians to integrate trauma-informed care into their practice with male patients.

Do Sexual Minorities Face Greater Risk for Sexual Harassment, Ever and at School, in Adolescence? : Findings From a 2019 Cross-Sectional Study of U.S. Adults

Bullying of sexual minorities in the United States is common and often begins in middle and high school, yet research that examines sexual harassment of sexual minorities is limited. This study examines whether sexual minorities are more likely than straight people to (a) report sexual harassment and (b) report sexual harassment as adolescents at middle or high school. We analyzed survey data from a cross-sectional study of sexual harassment and assault, conducted with nationally representative samples of adults in 2019 (N = 2,205). Sexual harassment was categorized as non-physically aggressive sexual harassment only (NPSH; e.g., verbal or cyber harassment), physically aggressive sexual harassment (PSH; e.g., stalking, rubbing up against you; with or without NPSH), sexual assault (SA; i.e., forced sex; with or without NPSH or PSH), or no sexual harassment (none). In total, 6% of female and male respondents identified as a sexual minority. A history of sexual harassment or assault was reported by 95.0% of sexual minority women and 80.3% of straight women (p = .001), and by 77.3% of sexual minority men and 41.3% of straight men (p = .001). Multivariable multinomial models demonstrate that sexual minorities were more likely than straight individuals to report NPSH (Adjusted Odds Ratio [AOR] = 2.88, 95% [Confidence Interval] CI = [1.33, 6.20]), PSH (AOR = 4.15, 95% CI: [1.77, 9.77]), and SA (AOR = 5.48, 95% CI = [2.56, 11.73]; reference group: no harassment), as well as to report PSH (AOR = 2.67, 95% CI = [1.30, 5.47]) at school in middle or high school. These abuses demonstrate increased risk for sexual harassment among sexual minorities, including increased risk for physically aggressive sexual harassment when in middle and high school.

Prevalence and Correlates of Sexual Violence Experienced by Young Adult Black Men Who Have Sex with Men

Men who have sex with men (MSM) experience high prevalence of sexual violence (SV), and SV has well-documented effects on health. Research gaps are especially evident for young Black MSM (YBMSM), who experience significant HIV disparities and syndemics, including multiple forms of violence victimization. We examined lifetime prevalence of SV (having been forced or frightened into sexual activity) in a cross-sectional sample of YBMSM (N = 1732), and tested associations of demographic, psychosocial, and structural factors using multivariable regression. YBMSM were recruited between 2013 and 2015 using modified venue-based time-location sampling (e.g., at bars and clubs) in Dallas and Houston, Texas. Approximately 17% of YBMSM experienced any SV in their lifetimes. SV was associated with high school non-completion (OR 1.78; 95% CI 1.15-2.77), lower psychological resilience (OR 0.84; 95% CI 0.71-0.98), lifetime history of homelessness (OR 5.52; 95% CI 3.80-8.02), recent financial hardship (OR 2.16; 95% CI 1.48-3.14), and recent transactional sex (OR 3.87; 95% CI 2.43-6.15). We also examined differences by age of SV onset (childhood versus adulthood). YBMSM with adolescent/emerging adult-onset SV may have been more ambivalent in reporting lifetime SV experience, compared to men with childhood-onset SV, and correlates differed by age of onset. Childhood-onset SV was associated with high school non-completion, lower levels of psychological resilience, history of homelessness, recent financial hardship, and recent transactional sex. Adolescent/emerging adult-onset SV was associated with greater depressive symptoms, history of homelessness, and recent financial hardship. There is a need for multi-level approaches to SV prevention and treatment, including services and supports that are culturally-relevant and responsive to the needs of YBMSM.

Sexual assault reporting amongst users of online sexual health services

Sexual assault (SA) survivors often attend sexual health clinics (SHC) for care relating to their assault. Reported rates of SA amongst SHC attendees can be high. Online sexual health services are becoming increasingly popular. Sexual Health London (SHL) is a large online sexual transmitted infection (STI) screening service. Between 1.1.20– 8.2.20, 0.5% (242/45841) (54% female, 45.6% male) of adults disclosed a recent SA when ordering an online STI testing kit. 79% (192/242) users engaged in a call back discussion initiated by the SHL team: 45% (87/192) users confirmed a SA had occurred and 53% (101/242) users denied an assault (particularly men) stating they had reported this in error. 18% (16/87) users had already reported their SA to the police/sexual assault centre, and one user accepted an onward referral. This study found a low reporting rate of SA amongst SHL users, but despite a high response rate to call backs, >50% cited they reported in error, 25% (22/87) didn’t want to discuss their SA and few accepted onward referrals. Using e-triage to screen for SA followed by service-initiated telephonic support to everyone who discloses, may not be acceptable or offer utility to all. Further evaluation of ways to engage these individuals is required.

Transactional Sex among Men Who Have Sex with Men: Differences by Substance Use and HIV Status

Exchanging money, drugs, and other goods for sex has been associated with sexual risk behaviors and increased STIs/HIV. While female sex work is well described, data on men who exchange sex for money or goods are more limited. This paper examined the prevalence and correlates of transactional sex among young men who have sex with men, especially focusing on substance use and HIV status. We conducted a cohort study of 511 participants recruited between August 2014 and December 2017 in Los Angeles, CA. Eligible participants were: (1) between 18 and 45 years of age; (2) male; and (3) if HIV-negative, reported condomless anal intercourse with a male partner in the past 6 months. By design, half were HIV-positive and half HIV-negative. At baseline and semi-annual follow-up visits, computer-assisted self-interviews were used to collect information on demographics, sexual behaviors including transactional sex which was defined as exchange of money, drugs, or a place to stay for anal intercourse. Laboratory testing was conducted for current STI/HIV status. The average age of participants was 31.4 years with 43% identifying as African American, followed by 36% as Hispanic/Latino. The prevalence of recent transactional sex across 1486 study visits was 17% (n = 255), with 74% of those reporting exchanging sex for drugs. The prevalence of transactional sex was higher among those who reported unstable housing (32 vs. 11%; p value < .01), concurrent sexual partnerships (26 vs. 9%; p value < .01), and transgender sex partners (40 vs. 15%; p value < .01). Those who reported receiving money, drugs, or shelter for sex were also more likely to report giving money, drugs, shelter for sex than men who did not report exchange sex (77 vs. 11%; p value < .01). Based on multivariable analyses after adjusting for age and race/ethnicity, HIV viral load was independently associated with transactional sex [adjusted odds ratio (AOR) = 1.4; 95% confidence interval (CI) 1.1-1.7) per log₁₀ increase]. Additionally, those testing positive for an STI were nearly twice as likely to report transactional sex as compared to those without STIs (AOR = 1.9; 95% CI 1.2-3.5). These findings underscore the relatively high prevalence of transactional sex and its potential role in ongoing HIV transmission among this cohort of high-risk HIV-negative and HIV-positive men who have sex with men.

Understanding the Intersection of Young Age, Mucosal Injury, and HIV Susceptibility

Adolescent boys and girls are disproportionately affected in the current HIV epidemic. Numerous sociobehavioral studies have addressed the indirect drivers surrounding this vulnerability-for example, socioeconomic, geographical locale, and all forms of violence. However, the direct factors that may influence infection, such as the anatomical and physiological maturation of the anogenital tracts of adolescents or the trauma and wound-healing processes of injured mucosal tissue, are understudied and represent a gap within the HIV prevention field. This article reviews the epidemiology of HIV infection and violence in adolescents and the available basic science knowledge attending this research area. More importantly, this review highlights the most critical gaps that need to be addressed to design preventive interventions that are safe and effective for this population, which is key to ending the HIV pandemic.

Migration Stress, Poor Mental Health, and Engagement in Sex with High-Risk Partners: A Mediation Modeling Analysis of Data from Rural-to-Urban Migrants in China

BACKGROUND

There is a growing need for better understanding of mechanisms underpinning the relationship between migration stress and HIV risk behaviors for the development of HIV prevention and control policy.

METHODS

Survey data from a random sample of 1,293 Chinese rural-to-urban migrants were analyzed. Stress was assessed using the Domestic Migration Stress Questionnaire (DMSQ), mental health status was assessed using the Brief Symptoms Inventory (BSI), and having sex with high risk partners was assessed as if ever have had sex with high risk partners (e.g., sex workers, intravenous injection drug users, blood donors, persons infected with HIV, persons with sexually transmitted infection, and same gender partners) in the past year. The proposed relationship was tested using mediation modeling method.

RESULTS

Among the sample, 5.5% reported having had sex with high-risk partners in the past year. Mediation analysis indicated that the relationship between DMSQ scores and having sex with high-risk partners was mediated by BSI (coefficient =0.41, 95% CI [0.21, 0.65]), including its components of somatization (0.32 [0.15, 0.53]), obsessive-compulsive disorder (0.31 [0.07, 0.55]), depression (0.45 [0.23, 0.72]), anxiety (0.41 [0.23, 0.63]), and hostility (0.35 [0.17, 0.56]). Furthermore, the effect was more pronounced in males than in females.

CONCLUSION

The study findings provide new data advancing our understanding of the mechanism of engagement in risky sex, underscoring the need for the HIV prevention policies in China to pay more attention to mental health of the rural-to-urban migrant population.

Barriers to and Facilitators of Help-Seeking Behavior Among Men Who Experience Sexual Violence

Research on sexual violence and related support services access has mainly focused on female victims; there is still a remarkable lack of research on men who experience sexual violence. Research demonstrates that people who both self-identify as men and are members of sexual-orientation minority populations are at higher risk of sexual violence. They are also less likely to either report or seek support services related to such experiences. The present study is an exploratory one aimed at filling the gap in the literature and better understanding how men, both straight and gay as well as cisgender and transgender, conceptualize, understand, and seek help related to sexual violence. A sample of 32 men was recruited on-line and participated in either a one-on-one in-depth interview (N = 19) or one of two focus group discussions (N = 13). All interviews and groups were audiotaped, professionally transcribed and coded using NVivo 9 qualitative software. The present analysis focused on barriers to and facilitators of support service access. Emergent and cross-cutting themes were identified and presented, with an emphasis on understanding what factors may prevent disclosure of a sexual violence experience and facilitate seeking support services and/or professional help. Through this analysis, the research team aims to add knowledge to inform the development of tools to increase service access and receipt, for use by both researchers and service professionals. Although this study contributes to the understanding of the issue of men’s experiences of sexual violence, more research with diverse populations is needed.

Correlates of Forced Sex Among Young Men Who Have Sex With Men in Yangon and Monywa, Myanmar

Forced sex at an early age is associated with a variety of negative factors including increased illness, high-risk sexual and substance-use behaviors, and mental and psychological stress. These sequelae may be compounded for men who have sex with men (MSM), especially young MSM and those with feminine gender identity and expression. This survey examined the prevalence and associations of forced sex among young MSM in two cities in Myanmar. In 2013-2014, surveys using respondent-driven sampling collected data on 200 young MSM in Yangon and 200 in Monywa. One quarter of young MSM in Yangon and 21 % in Monywa reported ever experiencing forced sex. In a multivariable model, having problems with family members and having any MSM friends with many partners had higher odds of experiencing forced sex. Having maternal acceptance of same-sex attraction (compared to acceptance by both parents) and becoming aware of their same-sex attraction at or above the age of 16 had lower odds of experiencing forced sex. Focused research is needed to understand the family and other social dynamics affecting vulnerability to forced sex, as well as specific sexual risks associated with forced sex among young MSM, including HIV acquisition and transmission risks.