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Blondeel K, Mirandola M, Gios L, Folch C, Noestlinger C, Cordioli M, De Sutter P, Temmerman M, Toskin I. Sexual satisfaction, an indicator of sexual health and well-being? Insights from STI/HIV prevention research in European men who have sex with men. BMJ Glob Health 2024; 9:e013285. [PMID: 38789276 PMCID: PMC11129029 DOI: 10.1136/bmjgh-2023-013285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/31/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Although sexual health has been holistically defined to include sexual satisfaction, it has been largely absent in health services and sexual and reproductive health and rights programmes in many parts of the world. We propose sexual satisfaction as a useful indicator, as one of the proxy measures for sexual health and well-being and as a component of well-being in general. METHODS The Sialon II project is a multicentre biological and behavioural cross-sectional community-based survey implemented across 13 European cities during 2013-2014 among men who have sex with men. Sexual satisfaction was explored using one single item: 'How satisfied are you with your sex life?' A multivariable multilevel logistic random-intercept model was estimated to identify factors associated with reporting positive sexual satisfaction versus negative sexual satisfaction. RESULTS Age, the number of partners and self-reported HIV status were not significantly associated with sexual satisfaction in the multivariate model. Participants reporting an insertive role or reported both an insertive and receptive role during the last anal intercourse were more likely to be sexually satisfied, compared with a receptive role. Participants reporting anal intercourse with a condom were more likely to be satisfied than those declaring no anal intercourse in the last 6 months, but no significant association was found compared with anal intercourse without condom. Knowledge of HIV-serostatus concordance with the last sexual partner was positively correlated with sexual satisfaction. Having had sexual intercourse with non-steady partners only in the last 6 months was negatively correlated. The more positive participants perceived their work/school, parents and friends/acquaintances' attitudes towards gay or bisexual persons, the higher the odds they were satisfied with their sexual life. CONCLUSION Using a single item on sexual satisfaction in a bio-behavioural study, our analysis has shown that it is associated with individual, interpersonal and social/structural factors and has proven its usefulness as a sexual health indicator among men who have sex with men.
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Affiliation(s)
- Karel Blondeel
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Cinta Folch
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT) Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Petra De Sutter
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
| | - Marleen Temmerman
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
- Centre of Excellence in Women, Adolescents and Child Health, The Aga Khan University, Nairobi, Kenya
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
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Avallone F, Engler K, Cox J, Hickson F, Lessard D, Bourdon J, Thomas R, Lebouché B. Conceptions of sexual health by gay men living with HIV in serodifferent couples in Montreal, Canada: results from a qualitative analysis. Sex Health 2024; 21:SH23164. [PMID: 38281508 DOI: 10.1071/sh23164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Gay, bisexual, and other men (GBM) who have sex with men living with HIV in serodifferent couples (one partner living with HIV, the other HIV-negative) may encounter unique sexual health challenges. This study aimed to explore their definition of sexual health that could improve service provision. METHODS We interviewed 10 gay-identified men living with HIV from 2017 to 2019 as part of CTNPT013, a study on the sexual health of HIV serodifferent GBM couples conducted at two HIV-specialised clinics in Montreal, Canada. Participants partook in semi-structured interviews on the meaning of sexual health. We performed a content analysis of interview transcripts, coding them according to the 10 dimensions of Robinson's Sexual Health Model. RESULTS Mean age of interviewees was 35.4years (s.d.,10.2; range, 20-53). Every dimension of Robinson's model was spontaneously evoked, except for body image and spirituality. All men indicated intimacy/relationships (e.g. sexual agreements) and sexual health care/safer sex (e.g. HIV management, risk behaviours) as relevant aspects of sexual health. Other dimensions included: positive sexuality (n =7), such as pleasure and enjoyment during sex; talking about sex (n =5), which mainly concerned HIV disclosure; sexual functioning (n =4); challenges to sexual health (n =3), including substance abuse; and culture/sexual identity (n =3). Two participants (n =2) cited masturbation/fantasy. CONCLUSIONS This study emphasises the multi-faceted nature of sexual health for gay men with HIV in serodifferent couples and the pivotal roles of relationships, HIV, risk management (e.g. via health care, knowledge), and positive sexual experiences. These dimensions could be considered in sexual health promotion interventions targeting this population.
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Affiliation(s)
- Francesco Avallone
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada; and Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada; and Chronic Viral Illness Service, Royal Victoria Hospital, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; and Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ford Hickson
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada; and Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; and Chronic Viral Illness Service, Royal Victoria Hospital, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Card KG, Shen T, Barath J, Sang J, Lal A, Moore DM, Lachowsky NJ. Patterns of Event-Level Concurrent Substance Use During Sex Among Gay, Bisexual, and Other Men Who Have Sex with Men in Metro Vancouver. AIDS Behav 2023:10.1007/s10461-023-04036-w. [PMID: 36943600 DOI: 10.1007/s10461-023-04036-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
This study identified patterns of sexualized substance use among gay, bisexual, and other men who have sex with men (gbMSM) and examined associated risk factors for sexually transmitted and blood borne infections (STBBI). Data were from a longitudinal cohort recruited using respondent-driven sampling between Feb-2017 and Feb-2019. Participants reported on events with up to five of their most recent sexual partners. Latent class analysis examined patterns of concurrent substance use 2 h prior to or during sex. Multinomial regression identified demographic, partner-level, and event-level factors associated across 11,877 sexual events reported by 757 participants. Most combinations of substance use were rare, but most drugs were frequently combined with other drugs when they were used prior to or during a sexual event. Six latent classes of concurrent event-level substance use were identified. The referent class (58.8% of events) was characterized by limited use of any drugs. The Common Drug Use class (12.1%) was characterized by use of alcohol, cannabis, and poppers and the Licit Drug Use class (21.6%) was characterized by use of alcohol alone. The Party 'N' Play (PnP) class (2.3%) was characterized by use of crystal methamphetamine GHB, Poppers, and Erectile Drugs; The Multi-use (3.5%) class was characterized by the PnP substances plus alcohol and ecstasy; and the Cannabis + class was characterized by use of Cannabis, Erectile Drugs, and Ecstasy. Relative to the referent class, all other classes were associated with events with more behavioural and network risk factors for STBBIs-highlighting the need for harm reduction interventions for gbMSM who use these drugs.
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
| | - Tian Shen
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jordan Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
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Norman T, Bourne A, Lyons A, Rule J, Power J. Antiretroviral Therapy Use, Viral Detectability and Fear of Onward Transmission Among People Living with HIV in Australia: Changes Between 1997 and 2018. AIDS Behav 2023; 27:591-599. [PMID: 35838861 PMCID: PMC9908629 DOI: 10.1007/s10461-022-03795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/26/2022]
Abstract
This paper examines how antiretroviral therapy (ART) use and fears towards the onward transmission of HIV have changed among people living with HIV (PLHIV) in Australia between 1997 and 2018. Participants were recruited as part of the HIV Futures study, a large cross-sectional survey of PLHIV in Australia, in 1997, 2003, 2012 and 2018 (total n = 3889). ART use, viral load detectability, and fear of onward HIV transmission were compared between years. Predictors of onward transmission fear were assessed among the 2018 subsample. While ART use within our sample decreased between 1997 and 2003, it subsequently increased to 97% in 2018. Self-reported viral load undetectability steadily increased over time, up to 88% in 2018. Notably, fewer PLHIV reported being fearful of transmitting HIV in 2018 compared to all other years. Being unfamiliar with the undetectable = untransmissible health movement, and having a detectable or uncertain viral load at last test, were significant predictors of being fearful of onward HIV transmission. Beyond the immediate medical considerations of HIV treatment, these results suggest that the undetectable = untransmissible movement may play a critical role in attenuating burdens experienced by PLHIV in Australia and that such messaging, in tandem with early and consistent ART use, should remain a salient feature of heath messaging among this population.
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Affiliation(s)
- Thomas Norman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, VIC, 3086, Australia.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, VIC, 3086, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, VIC, 3086, Australia
| | - John Rule
- National Association of People with HIV Australia (NAPWHA), Newtown, Australia
- School of Population Health, University of NSW, Sydney, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, VIC, 3086, Australia
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Parent N, Ferlatte O, Milloy MJ, Fast D, Knight R. The sexualised use of cannabis among young sexual minority men: "I'm actually enjoying this for the first time". CULTURE, HEALTH & SEXUALITY 2021; 23:883-898. [PMID: 32462998 DOI: 10.1080/13691058.2020.1736634] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
The objective of this study was to identify how cannabis use features within the sexual lives of young sexual minority men who use substances, and how this might intersect with features of their contemporary socio-cultural contexts in a setting where non-medical cannabis was recently legalised: Vancouver, Canada. Forty-one sexual minority men ages 15 to 30 years were recruited between January and December 2018 to participate in in-depth, semi-structured 1-2 h interviews about their experiences of using substances (e.g. cannabis) for sex. Drawing on constant comparative analytic techniques, two themes emerged with regards to participants' perceptions of, and experiences with, the sexualised use of cannabis. First, participants described how they used cannabis for sex to increase sexual pleasure and lower inhibitions. Second, participants described using cannabis for sex to reduce feelings of anxiety and shame, and foster intimacy and connection with sexual partners. These findings identify how the sexualised use of cannabis functions as a 'strategic resource' for sexual minority men to deliberately achieve both physiological and psychoactive effects, while concurrently underscoring the extent to which the contexts, patterns and motivations associated with cannabis use for sex parallel those associated with this form of Chemsex.
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Affiliation(s)
- Natasha Parent
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Olivier Ferlatte
- School of Public Health, University of Montreal, Montreal, QC, Canada
| | - M-J Milloy
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Danya Fast
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Rod Knight
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
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Kutner BA, Simoni JM, Aunon FM, Creegan E, Balán IC. How Stigma Toward Anal Sexuality Promotes Concealment and Impedes Health-Seeking Behavior in the U.S. Among Cisgender Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1651-1663. [PMID: 32020349 PMCID: PMC7398831 DOI: 10.1007/s10508-019-01595-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/12/2019] [Accepted: 11/25/2019] [Indexed: 05/23/2023]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) experience alarming HIV disparities alongside sub-optimal engagement in HIV interventions. Among MSM, stigma toward anal sexuality could interfere with engagement in HIV prevention, yet few studies have examined MSM perspectives on anal sex stigma or its health-related sequelae. Guided by theory, we aimed to characterize anal sex stigma, related sexual concerns, and barriers to health seeking, like concealment. We elicited community input by purposively interviewing 10 experts in MSM health and then 25 racially, ethnically, and geographically diverse cisgender MSM. Participants reported experienced, internalized, and anticipated forms of anal sex stigma that inhibited health seeking. Experienced stigma, including direct and observed experiences as well as the absence of sex education and information, contributed to internalized stigma and anticipation of future devaluation. This process produced psychological discomfort and concealment of health-related aspects of anal sexuality, even from potentially supportive sexual partners, social contacts, and health workers. Participants characterized stigma and discomfort with disclosure as normative, pervasive, and detrimental influences on health-seeking behavior both during sex and within healthcare interactions. Omission of information appears to be a particularly salient determinant of sexual behavior, inhibiting prevention of harm, like pain, and leading to adverse health outcomes. The development of measures of anal sex stigma and related sexual concerns, and testing their impact on comfort with disclosure, sexual practices, and engagement in health services could identify modifiable social pathways that contribute to health disparities among MSM, like those seen in the HIV epidemic.
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Affiliation(s)
- Bryan A Kutner
- The HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Frances M Aunon
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Emma Creegan
- School of Public Health, Brown University, Providence, RI, USA
| | - Ivan C Balán
- The HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
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Carlsson-Lalloo E, Rusner M, Berg M, Svedhem V, Mellgren Å. People living with HIV in Sweden report high levels of sexual satisfaction in a registry-based cohort study. AIDS Care 2021; 34:559-567. [PMID: 33793361 DOI: 10.1080/09540121.2021.1909698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sexual satisfaction can be challenging for people living with HIV (PLWH). To investigate self-reported sexual satisfaction in PLWH and its association with HIV-related biomarkers, a retrospective observational cohort study with data on sociodemographic characteristics and changes in PLWH's assessment of their sexual satisfaction over time were retrieved from the Swedish National Quality Assurance Registry (InfCareHIV) where patient-related outcomes are reported annually. PLWH who had assessed self-reported sexual satisfaction 2011-2016 were included. Sexual satisfaction was dichotomized into sexual "satisfaction and dissatisfaction" and associations were analysed. In total, 3798 patients (66% men) answered 8202 questionnaires. Overall, 67% reported sexual satisfaction, with women more satisfied than men (72% vs 64%, p < 0.0001). Sexual satisfaction did not differ between patients on antiretroviral treatment (ART) >6 months whether the viral load was suppressed or not. Overall, the probability of reporting sexual satisfaction increased by 4% annually (p < 0.001). This increase may be explained by evolving knowledge about the minimal risks of sexual HIV transmission when on ART together with Sweden's concomitant revision of legal restrictions. The use of patient-related outcomes in clinical practice is an important tool for facilitating conversations about sexuality in order to promote the health and well-being of PLWH.
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Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Center West, Gothenburg, Sweden
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
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8
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Vasilenko SA, Exten C, Rosenberger JG. Physical and Emotional Satisfaction at First Same-Sex Anal Sex in Young Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1047-1055. [PMID: 32472239 PMCID: PMC7704918 DOI: 10.1007/s10508-020-01738-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Research has focused on adolescents' feelings about their first sexual experiences, but little research has examined this topic in sexual minority adolescents. In this study, we examined how experiencing emotional and physical satisfaction at first same-sex anal sex differed by age of first sex for young gay and bisexual men. We applied the time-varying effect model to data from an Internet survey of men who initiated first sex between ages 14-26 (n = 6401) to examine emotional and physical satisfaction at first same-sex anal sex across continuous age of onset and by partner factors. The majority of men reported satisfaction across all ages; however, satisfaction was generally less likely for men who had first anal sex with a non-relationship partner, an older partner, or a partner they had sex with only once and this was particularly true at earlier ages. Findings suggest that many young gay and bisexual men report satisfaction with their first anal sex and that relationship context can be important in predicting satisfaction, particularly at younger ages.
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Affiliation(s)
- Sara A Vasilenko
- Department of Human Development and Family Science, Syracuse University, 144 White Hall, Syracuse, NY, 13244, USA.
| | - Cara Exten
- College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
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Gios L, Mirandola M, Sherriff N, Toskin I, Blondeel K, Dias S, Staneková D, Folch C, Schink SB, Nöstlinger C, Berghe WV, Naseva E, Alexiev I. Being in the Closet. Correlates of Outness Among MSM in 13 European Cities. JOURNAL OF HOMOSEXUALITY 2021; 68:415-433. [PMID: 31483215 DOI: 10.1080/00918369.2019.1656033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Data for MSM continue to show a high risk of acquiring HIV-STIs. Within this population, outness seems to have an impact on both risk-taking and on health seeking behaviors. The objective of this study was to assess the relationship between socio-demographic, behavioral characteristics, testing behaviors, and outness level among MSM using data from a multi-center bio-behavioral cross-sectional study carried out in 13 EU cities. A multilevel analysis was conducted to identify factors associated with being open ("out") versus not being open ("in"). A total of 4,901 MSM were enrolled in the study and were classified as "out" in 71% of the cases. MSM "out" were more likely to report HIV testing and being reached by HIV prevention programs compared to MSM who were "in." The results confirm the key role of outness in relation to different healthy and risky behavior, ranging from testing to party-drug use.
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Affiliation(s)
- Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton , Brighton, UK
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization , Geneva, Switzerland
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization , Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
| | - Sonia Dias
- Escola Nacional de Saúde Pública Universidade, Universidade NOVA de Lisboa, Centro de Investigação em Saúde Pública , Lisboa, Portugal
| | - Danica Staneková
- NRC for HIV/AIDS, Slovak Medical University , Bratislava, Slovak Republic
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Department Salut, Generalitat de Catalunya/CIBER Epidemiologia y Salud Pública (CIBERESP) , Barcelona, Spain
| | | | - Christiane Nöstlinger
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium
- Faculty of Psychology, University of Vienna , Vienna, Austria
| | - Wim Vanden Berghe
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium
- Scientific Institute of Public Health , Brussels, Belgium
| | - Emilia Naseva
- Faculty of Public Health, Medical University of Sofia , Sofia, Bulgaria
| | - Ivailo Alexiev
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases , Sofia, Bulgaria
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Sexual Desire and Fantasies in the LGBT+ Community: Focus on Lesbian Women and Gay Men. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00263-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abstract
Purpose of Review
The purpose of this review is to summarize the current knowledge around sexual desire, fantasies, and related biopsychosocial factors that may facilitate or obstruct sexual expressions in lesbian women and gay men.
Recent Findings
Sexual desire levels and related problems do not seem significantly different in people who identify as gay or lesbian compared to their heterosexual counterparts. Evidence has shown lesbian women and gay men may have specific desire expressions and biopsychosocial factors influencing their sexual health. This may suggest the importance of deepening the understanding of the unique factors of LGBT+ sexuality and relationships while paying attention to the sociocultural background in which lesbian and gay people grow and develop their identities.
Summary
A lack of specific and unbiased literature on sexual desire and fantasies in gay and lesbian people is reported. Available evidence is controversial and often biased. LG people showed a variety of sexual expressions that are hard to categorize referring to the heteronormative sexual standards that permeate literature and clinical practice. Implications for future research and clinical practice are discussed.
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Smith V, Tasker F. Gay men's chemsex survival stories. Sex Health 2019; 15:116-122. [PMID: 29268074 DOI: 10.1071/sh17122] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/13/2017] [Indexed: 11/23/2022]
Abstract
Background Chemsex (the combined use of drugs and sexual experiences) by men who have sex with men is associated with the transmission of sexually transmissible infections and blood-borne viruses, but psychosocial factors associated with chemsex engagement and remission remain unidentified. In the present study we considered how do gay men self-identify a chemsex problem and remain chemsex free? METHODS Using a life course perspective, the present qualitative interview study examined participants' reflections to discern pathways in and out of chemsex engagement. Six participants (aged ≥18 years) were drawn from a cohort of men who had completed the tailored therapeutic Structured Weekend Antidote Program. Transcripts were analysed using a Labovian narrative analysis framework. RESULTS Each man identified a multiplicity of incidents and feelings that contributed to their engagement in chemsex, and engagement in chemsex was connected to participants' identity development and desire to belong to a gay community. Underlying individual accounts, a common narrative suggested a process through which chemsex journeys were perceived as spiralling from exciting and self-exploratory incidents into an out-of-control, high-risk activity that was isolating and prompted engagement with therapy. Despite seeking therapeutic engagement, participants expressed uncertainty about maintaining a gay future without chemsex. CONCLUSIONS Chemsex was associated with a positive gay identity gain, which explained the ambivalence participants expressed in maintaining a gay future without chemsex despite their awareness of negative consequences. This is significant for understanding both why chemsex pathways may prove attractive and why they may be so difficult to leave.
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Affiliation(s)
- Vivienne Smith
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Fiona Tasker
- Department of Psychological Sciences, Birkbeck University of London, Malet Street, Bloomsbury, London WC1E 7HX, UK
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12
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[Data on the sexual health of providers and clients of sexual services for men who have sex with men in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 60:958-970. [PMID: 28741190 DOI: 10.1007/s00103-017-2589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about the sexual health of male providers and clients of transactional sex. The data of participants of the European MSM Internet Survey (EMIS-DE; N = 50,086) who live in Germany were analysed. The outcomes were testing for and diagnoses of HIV and other sexually transmitted infections (STIs), partner numbers, illicit drug use, and sexual happiness in two populations: (1) men who offered and (2) men who paid for transactional sex in the past 12 months.In the age group of under 30 years (n = 19,138), providers of sexual services (escorts) were compared with non-providers; in the age group of 30 years and above (n = 30,948), we compared men who paid for sexual services with those who did not. We applied univariable and multinomial, multivariable logistic regression analyses in both age groups.Of those under the age of 30, 8% (n = 1529) had been paid for sex in the last 12 months, of which 49% were only paid once or twice. Escorts had lower educational achievements, lived more commonly in large cities, were more often born abroad, self-defined less frequently as gay, and were more frequently single. They reported higher numbers of sex partners, more drug use, and more sexual happiness. Escorts were more frequently tested for HIV and STIs, and among the tested, more diagnoses of HIV and STIs were reported, but those with HIV were less likely to be treated.Among those over 30 years, 11% (n = 3334) had paid for sex, the majority (58%) only once or twice. Payers were older, lived more commonly in large cities, and were more likely to be single, bisexual, or living with a woman. Clients used more illicit drugs, sexual enhancement drugs, and sedatives, but reported less sexual happiness. They were less likely to be tested for HIV and STIs.
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Bourne A, Alba B, Garner A, Spiteri G, Pharris A, Noori T. Use of, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and Central Asia: findings from a 2017 large geosocial networking application survey. Sex Transm Infect 2019; 95:187-192. [PMID: 30612107 PMCID: PMC6580743 DOI: 10.1136/sextrans-2018-053705] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/02/2018] [Accepted: 10/10/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Currently, seven European countries provide HIV pre-exposure prophylaxis (PrEP) through public health services, although there are numerous reports of off-licence use. The objective of this study was to examine current use of PrEP, likelihood of future use and indicators of potential PrEP candidacy among an opportunistic sample of men who have sex with men in Europe and Central Asia. METHODS A survey was sent out in eight languages to users of the Hornet gay networking application in July and August 2017. Descriptive statistics present proportions of PrEP use, while factors associated with PrEP use are examined using logistic and linear regressions. RESULTS Of 12 053 participants whose responses came from 55 European and Central Asian countries, 10 764 (89%) were not living with diagnosed HIV. Among these HIV-negative/untested men, 10.1% (n=1071) were currently taking PrEP or had done so within the previous 3 months. Current or recent PrEP users were significantly more likely to have taken postexposure prophylaxis (adjusted OR (AOR)=16.22 (95% CI 13.53 to 19.45)) or received an STI diagnosis (AOR=4.53 (95% CI 3.77 to 5.44)) in the previous 12 months than those who had not. Most commonly, these men obtained PrEP from a physician (28.1%) or the internet (24.8%), while 33.6% had not disclosed PrEP use to their doctor. Men reporting happiness with their sex life were more likely to have taken PrEP (AOR=1.73 (95% CI 1.59 to 1.89)). Nearly a quarter (21.5%) of those not on PrEP said they were likely to use it in the next 6 months. CONCLUSIONS The majority of men using, or intending to use, PrEP appear to have a risk profile consistent with emerging guidance. A large proportion of these men are accessing PrEP outside of traditional healthcare settings, posing a challenge for routine monitoring.
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Affiliation(s)
- Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Victoria, Australia
| | - Beatrice Alba
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Victoria, Australia
| | - Alex Garner
- Hornet Gay Social Network, San Francisco, California, USA
| | | | | | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
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Pollard A, Nadarzynski T, Llewellyn C. Syndemics of stigma, minority-stress, maladaptive coping, risk environments and littoral spaces among men who have sex with men using chemsex. CULTURE, HEALTH & SEXUALITY 2018; 20:411-427. [PMID: 28741417 DOI: 10.1080/13691058.2017.1350751] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
There has been a steep rise in the use of drugs during sex (chemsex) by some men who have sex with men in economically developed countries, with associated increases in sexual risk for HIV and other STIs. This paper presents data from telephone interviews with 15 men attending sexual health clinics for post-exposure prophylaxis following a chemsex-related risk for HIV and discusses some of the theoretical approaches that have been employed to understand chemsex and inform interventions. Interviews were conducted as part of a larger intervention study, which used an adapted version of motivational Interviewing to explore risk behaviour and support change. Participants conceptualised their chemsex and HIV-related risks in a psycho-social context, highlighting the influences of psycho-socio-cultural challenges of homophobic marginalisation and the 'gay scene' on behaviour. Multiple influences of stigma, marginalisation, minority stress and maladaptive coping (including drug-use) contribute to syndemic 'risk-environments' and 'littoral spaces' in which chemsex and risk behaviours are played out.
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Affiliation(s)
- Alex Pollard
- a Department of Primary Care and Public Health, Brighton & Sussex Medical School , University of Sussex , Brighton , UK
| | - Tom Nadarzynski
- a Department of Primary Care and Public Health, Brighton & Sussex Medical School , University of Sussex , Brighton , UK
| | - Carrie Llewellyn
- a Department of Primary Care and Public Health, Brighton & Sussex Medical School , University of Sussex , Brighton , UK
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Flowers P, Wu O, Lorimer K, Ahmed B, Hesselgreaves H, MacDonald J, Cayless S, Hutchinson S, Elliott L, Sullivan A, Clutterbuck D, Rayment M, McDaid L. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technol Assess 2018; 21:1-164. [PMID: 28145220 DOI: 10.3310/hta21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. OBJECTIVES To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. DATA SOURCES All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. REVIEW METHODS A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. RESULTS Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. LIMITATIONS There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. CONCLUSIONS Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. FUTURE WORK There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. STUDY REGISTRATION The study is registered as PROSPERO CRD42014009500. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Paul Flowers
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Bipasha Ahmed
- GCU London, Glasgow Caledonian University, London, UK
| | - Hannah Hesselgreaves
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Jennifer MacDonald
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Sandi Cayless
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon Hutchinson
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa McDaid
- Chief Scientist Office/Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Clutterbuck D, Asboe D, Barber T, Emerson C, Field N, Gibson S, Hughes G, Jones R, Murchie M, Nori AV, Rayment M, Sullivan A. 2016 United Kingdom national guideline on the sexual health care of men who have sex with men. Int J STD AIDS 2018:956462417746897. [PMID: 29334885 DOI: 10.1177/0956462417746897] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.
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Affiliation(s)
| | - David Asboe
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Tristan Barber
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Nigel Field
- 4 Public Health England, London, UK
- 5 University College London, London, UK
| | | | | | - Rachael Jones
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Achyuta V Nori
- 8 8945 Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - Michael Rayment
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Ann Sullivan
- 9 BASHH CEG, BASHH 2017 Registered Office, Macclesfield, UK
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Shaver J, Sullivan P, Siegler A, de Voux A, Phaswana-Mafuya N, Bekker LG, Baral SD, Wirtz AL, Beyrer C, Brown B, Stephenson R. Comparing Provider and Client Preferences for HIV Prevention Services in South Africa among Men Who Have Sex with Men. J Int Assoc Provid AIDS Care 2017; 16:562-571. [PMID: 29108450 DOI: 10.1177/2325957417736611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Combination prevention efforts are now recommended toward reducing HIV incidence among men who have sex with men (MSM). Understanding the perceptions of both MSM and service providers is critical to informing the development of prevention packages and ultimately improving intervention effectiveness. This study assessed the preferences of MSM and health service providers in the administration of HIV-prevention efforts. Qualitative data were gathered from a series of separate MSM and health care provider focus groups in 2 South African cities. Participants discussed HIV-prevention services and MSM client experiences within South Africa and identified the 3 most important clinic characteristics and 3 most important HIV-prevention services for MSM clients. Priorities indicated by both MSM and health care providers were confidentiality of visit, friendly staff, and condoms, while discrepancies existed between MSM and providers regarding provider consistency and the provision of pre-exposure prophylaxis/post-exposure prophylaxis (PrEP/PEP) and lubricant as prevention methods. Effective interventions must address these discrepancies through the design of intervention and provider training to optimally accommodate MSM.
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Affiliation(s)
- John Shaver
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Patrick Sullivan
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron Siegler
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alex de Voux
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nancy Phaswana-Mafuya
- 3 HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, Port Elizabeth, South Africa.,4 Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Linda-Gail Bekker
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,5 Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stefan D Baral
- 6 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- 6 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- 6 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ben Brown
- 4 Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Rob Stephenson
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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18
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Klein CH, Kuhn T, Huxley D, Kennel J, Withers E, Lomonaco CG. Preliminary Findings of a Technology-Delivered Sexual Health Promotion Program for Black Men Who Have Sex With Men: Quasi-Experimental Outcome Study. JMIR Public Health Surveill 2017; 3:e78. [PMID: 29066422 PMCID: PMC5676034 DOI: 10.2196/publichealth.7933] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/11/2017] [Accepted: 08/09/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) disproportionately affects black men who have sex with men (MSM), yet there are few evidence-based interventions specifically designed for black MSM communities. In response, the authors created Real Talk, a technology-delivered, sexual health program for black MSM. OBJECTIVE The objective of our study was to determine whether Real Talk positively affected risk reduction intentions, disclosure practices, condom use, and overall risk reduction sexual practices. METHODS The study used a quasi-experimental, 2-arm methodology. During the first session, participants completed a baseline assessment, used Real Talk (intervention condition) or reviewed 4 sexual health brochures (the standard of care control condition), and completed a 10-minute user-satisfaction survey. Six months later, participants from both conditions returned to complete the follow-up assessment. RESULTS A total of 226 participants were enrolled in the study, and 144 completed the 6-month follow-up. Real Talk participants were more likely to disagree that they had intended in the last 6 months to bottom without a condom with a partner of unknown status (mean difference=-0.608, P=.02), have anal sex without a condom with a positive man who was on HIV medications (mean difference=-0.471, P=.055), have their partner pull out when bottoming with a partner of unknown HIV status (mean difference=-0.651, P=.03), and pull out when topping a partner of unknown status (mean difference=-0.644, P=.03). Real Talk participants were also significantly more likely to disagree with the statement "I will sometimes lie about my HIV status with people I am going to have sex with" (mean difference=-0.411, P=.04). In terms of attitudes toward HIV prevention, men in the control group were significantly more likely to agree that they had less concern about becoming HIV positive because of the availability of antiretroviral medications (mean difference=0.778, P=.03) and pre-exposure prophylaxis (PReP) (mean difference=0.658, P=.05). There were, however, no significant differences between Real Talk and control participants regarding actual condom use or other risk reduction strategies. CONCLUSIONS Our findings suggest that Real Talk supports engagement on HIV prevention issues. The lack of behavior findings may relate to insufficient study power or the fact that a 2-hour, standalone intervention may be insufficient to motivate behavioral change. In conclusion, we argue that Real Talk's modular format facilitates its utilization within a broader array of prevention activities and may contribute to higher PReP utilization in black MSM communities.
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Affiliation(s)
- Charles H Klein
- Department of Anthropology, Portland State University, Portland, OR, United States
| | - Tamara Kuhn
- dfusion, Oakland, CA, United States.,ETR, Scotts Valley, CA, United States
| | - Danielle Huxley
- Department of Anthropology, Portland State University, Portland, OR, United States
| | - Jamie Kennel
- Department of Emergency Medical Services, Oregon Health & Sciences University, Portland, OR, United States.,Department of Emergency Medical Services, Oregon Institute of Technology, Klamath Falls, OR, United States.,Department of Sociology, Portland State University, Portland, OR, United States
| | - Elizabeth Withers
- Department of Sociology, Portland State University, Portland, OR, United States
| | - Carmela G Lomonaco
- University of California, San Francisco, San Francisco, CA, United States
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Rohleder P, McDermott DT, Cook R. Experience of sexual self-esteem among men living with HIV. J Health Psychol 2016; 22:176-185. [PMID: 26238342 DOI: 10.1177/1359105315597053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Much of the focus on sexual health for people living with HIV has been on promoting safe sex behaviours. However, also important for sexual health is a positive sexual self-esteem. This article reports on an interpretative phenomenological analysis of interviews with seven men about the impact that having HIV has had on their sense of sexual self. Five overarching themes were identified: the 'destruction' of a sexual self; feeling sexually hazardous; sexual inhibition; reclaiming a sexual self and finding a place through sero-sorting. With HIV now being a chronic illness, interventions are required to support people to lead sexually satisfying lives.
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Choukas-Bradley S, Goldberg SK, Widman L, Reese BM, Halpern CT. Demographic and developmental differences in the content and sequence of adolescents' ideal romantic relationship behaviors. J Adolesc 2015; 45:112-26. [PMID: 26431691 PMCID: PMC4674348 DOI: 10.1016/j.adolescence.2015.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 08/12/2015] [Accepted: 08/31/2015] [Indexed: 11/19/2022]
Abstract
This study utilizes data from 18,392 respondents (aged 12-19) in Wave 1 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) to provide a detailed descriptive analysis of U.S. adolescents' desired behaviors in their ideal romantic relationships. Age, gender, and ethnic group differences in the desire for--and preferred sequence of--a set of activities that could occur in a hypothetical romantic relationship were explored within subsets of heterosexual (n = 17,274) and sexual minority adolescents (n = 1118). Non-sexual behaviors were more commonly desired compared to sexual behaviors. The typical desired behavioral sequence was: holding hands, going out alone, telling others they were a couple, kissing, saying "I love you," sexual touching, and finally having sex. Overall, more similarities than differences emerged across groups, with some notable differences in the percentages who desired sexual behaviors. Results provide a nuanced picture of adolescent relationship scripts, with implications for education and prevention.
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Affiliation(s)
| | - Shoshana K Goldberg
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, United States; Carolina Population Center, University of North Carolina at Chapel Hill, United States
| | - Laura Widman
- North Carolina State University, Department of Psychology, United States
| | - Bianka M Reese
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, United States; Carolina Population Center, University of North Carolina at Chapel Hill, United States
| | - Carolyn T Halpern
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, United States; Carolina Population Center, University of North Carolina at Chapel Hill, United States
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Calabrese SK, Rosenberger JG, Schick VR, Novak DS. Pleasure, affection, and love among Black men who have sex with men (MSM) versus MSM of other races: countering dehumanizing stereotypes via cross-race comparisons of reported sexual experience at last sexual event. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:2001-14. [PMID: 25604209 PMCID: PMC4510043 DOI: 10.1007/s10508-014-0405-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/06/2014] [Accepted: 09/18/2014] [Indexed: 05/12/2023]
Abstract
Black men have historically been stereotyped as hedonistic, aggressive, and animalistic in their sexual interactions. This study sought to describe pleasure, affection, and love experienced by Black men who have sex with men (MSM) during their last male-partnered sexual event and to examine differences relative to White, Latino, and Asian MSM. A total of 21,696 (793 Black, 18,905 White, 1,451 Latino, and 547 Asian) U.S. men ages 18-87 (M Age = 39) were recruited from social/sexual networking sites targeting MSM in 2010-2011. Participants reported multiple dimensions of sexual experience (pleasure, affection, and love) occurring at their last male-partnered sexual event, partner relationship, and sociodemographic characteristics. Across relationship categories, a sizeable percentage of Black MSM reported pleasure (72-87 % orgasmed, 57-82 % experienced high subjective pleasure) and affection (70-91 % kissed, 47-90 % cuddled). Love was primarily reported for events involving main partners (felt love for partner: 96 %; felt loved by partner: 97 %; verbalized love to partner: 89 %). Latent class analysis with MSM of all races, adjusting for partner relationship and sociodemographic characteristics, revealed three distinct profiles of sexual experience: affection and love (Class 1); affection in the absence of love (Class 2); and neither affection nor love (Class 3). Pleasure was probable across profiles. Some racial differences in profile probability were present, but no overall pattern emerged. Contrary to Black male stereotypes, Black MSM commonly reported pleasure, affection, and love at their last male-partnered sexual event and did not show a meaningful pattern of difference from other-race MSM in their likelihood of experiencing all three.
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Affiliation(s)
- Sarah K Calabrese
- Yale School of Public Health and Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA,
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