Latent Class Analysis of Polysubstance Use and Sexual Risk Behaviors among Men Who Have Sex with Men Attending Sexual Health Clinics in Mexico City

Men who have sex with men (MSM) are more likely to use drugs and other substances compared to their heterosexual peers. No studies have evaluated patterns of substance use among MSM adults in Mexico. We used latent class analysis (LCA) to identify MSM subgroups with specific substance use patterns and their associations with sexual behaviors. Methods: Data from 1850 adult MSM were collected at HIV clinics in Mexico City between September 2018 and December 2019. The structural equation modeling approach was used to estimate a LC model to identify patterns of substance use by self-report of substance use (i.e., cigarette smoking, alcohol, and drugs). To evaluate LC membership, we included HIV status, condomless anal sex (CAS), and serosorting, while controlling for demographic variables. Results: 30.3% were under the age of 22. Alcohol use in last 30 days (76.2%), binge drinking (29.2%), marijuana (29.4%), sex-drugs (23.9%), stimulants (13.7%), and depressants (6.3%). MSM reported engaging in CAS (55.9%) and serosorting (13.5%) behaviors, and 40% reported being HIV positive. LCA indicated three general categories of MSM substance users: Class 1 (49.0%), Class 2 (29.8%), and Class 3 (20.4%). Members of Class 3 were younger: 23–28 age years (aOR = 1.86) and 29–33 age years (aOR = 1.86), more educated: completed graduate studies (aOR = 1.60), had a high probability of polysubstance use and were more likely to engage in CAS and serosorting. Conclusions: Attempts to detect alcohol and problematic use of substances are needed for MSM followed by culturally competent approaches that address alcohol and drug use disorders.

Prevention challenges with current perceptions of HIV burden among HIV-negative and never-tested men who have sex with men in the Netherlands: a mixed-methods study

INTRODUCTION

As biomedical advances improved HIV treatment, the perceptions of severity and anticipated consequences of HIV could have changed accordingly. This study investigates the current perceptions of severity and anticipated consequences of HIV infection and its association with sexual risk behaviour among HIV-negative and never-tested men who have sex with men (MSM) living in the Netherlands.

METHODS

In-depth interviews with recently diagnosed HIV-positive MSM were used to develop a questionnaire measuring the perceived severity and anticipated consequences of HIV infection. The questionnaire was distributed online between April and July 2019. A structural equation model was constructed to explore the anticipated consequences contributing to the perceived HIV severity and to assess the association between the perceived severity and sexual risk behaviour.

RESULTS

In total, 1,072 HIV-negative and never-tested MSM completed the questionnaire, of whom 28% reported recent sexual risk behaviour. Almost one-quarter of participants (23%) had a low perceived HIV severity, which was associated with more prevalent sexual risk taking (β = -0.07, 95% CI = -0.12/-0.01). In this model, the perceived severity of HIV was more strongly associated with anticipated psychological consequences of HIV (β = 0.34, 95% CI = 0.24 to 0.44) and to a lesser extent with anticipated negative consequences of HIV on sex/relationships (β = 0.28, 95% CI = 0.19 to 0.38) and disclosure-related consequences (β = 0.16, 95% CI = 0.07 to 0.26). Health-related consequences of HIV were not significantly associated with the severity perceptions (β = 0.06, 95% CI = -0.03 to 0.14).

CONCLUSIONS

Anticipated negative social and psychological consequences of HIV mostly contribute to high HIV-severity perceptions in MSM. A smaller subgroup of MSM does not perceive HIV as a serious disease, which is associated with increased sexual risk taking. Efforts to normalize living with HIV are essential but might present a challenge for HIV prevention as it could, for a minority of MSM, decrease the motivation to prevent HIV infection.

Personality among sexually compulsive men who practice intentional unsafe sex in São Paulo, Brazil

INTRODUCTION

There is evidence of an association between the practice of intentional unsafe sex among men who have sex with men (MSM) and sensation seeking and impulsivity. However, other aspects of personality have been less frequently investigated.

AIMS

This study aims to investigate the association between the practice of intentional unsafe sex and personality traits in individuals who sought treatment and met the criteria for compulsive sexual behavior in São Paulo, Brazil.

METHODS

The sample consisted of 69 sexually compulsive MSM. The participants underwent psychiatric evaluation and an interview to define intentional condomless sex and completed self-report instruments.

MAIN OUTCOME MEASURES

The participants completed the following measures: the Temperament and Character Inventory and the Sexual Compulsivity Scale.

RESULTS

Twenty-five participants (36%) reported intentional unsafe sex with casual partners, of whom 84% were gay and 16% bisexual (P<0.05). Fifteen (22%) individuals reported being HIV positive, and 11 (73%) of them practiced intentional unprotected anal intercourse (P<0.05). The mean of sexual compulsivity was associated with men who engaged in intentional unsafe sex (P=0.01). Men who reported intentional unsafe sex scored significantly higher on the novelty seeking temperament dimension (P<0.05) and scored significantly lower on the self-directedness character dimension (P<0.001). However, self-directedness predicted intentional unsafe sex in the multiple logistic regression (P=0.001).

CONCLUSIONS

Sexually compulsive individuals who practiced intentional unsafe sex presented lower self-directedness than the group who did not engage in intentional unsafe sex, which suggests less autonomy regarding life itself. To the best of our knowledge, this is the first study to consider intentional unsafe sex in sexually compulsive men.

Masculinity and Barebacker Identification in Men who have Sex with Men

Purpose:

Barebacking is a term that is used to refer to intentional involvement in unprotected anal sex. This paper examines the relationship between masculinity and self-identification as a barebacker, and how these factors related to HIV risk practices in a sample of men who have sex with other men (MSM).

Method:

As part of the Men4Men Study, a brief Internet-based survey was completed in 2007 with English-speaking MSM aged 18+ who were not involved in a marital/romantic relationship at the time of interview. 886 participants were recruited by placing electronic postings and banner advertisements on Weblogs, social and sexual networking sites, and listservs frequented by MSM.

Results:

A number of factors differentiated men who self-identified as barebackers from those who did not, and barebacking identity was linked with greater involvement in HIV risk practices. Multivariate analysis revealed that having a high level of masculinity was associated with a greater likelihood of self-identifying as a barebacker.

Conclusions:

HIV prevention and intervention efforts targeting MSM ought to address issues of self-identification as a barebacker as well as the extent to which men adhere to a masculine ideology.

Are HIV-negative men who have sex with men and who bareback concerned about HIV infection? Implications for HIV risk reduction interventions

The emergence of barebacking (intentional unprotected anal intercourse in situations where there is risk of HIV infection) among men who have sex with men (MSM) has been partially attributed to a decrease in HIV-related concerns due to improved anti-retroviral treatment. It is important to understand the level of concern these men have regarding HIV infection because it can affect their interest in risk reduction behaviors as well as their possible engagement in risk reduction interventions. As part of a study on MSM who use the Internet to seek sexual partners, 89 ethnic and racially diverse men who reported never having an HIV-positive test result completed an in-depth qualitative interview and a computer-based quantitative assessment. Of the 82 men who were asked about concerns of HIV infection during the qualitative interviews, 30 expressed "significant concern" about acquiring HIV, 42 expressed "moderate concern," and 10 expressed "minimal concern." Themes that emerged across the different levels of concern were their perceptions of the severity of HIV infection, having friends who were HIV positive, and their own vulnerability to HIV infection. However, these themes differed depending on the level of concern. Among the most frequently mentioned approaches to decrease risk of HIV infection, participants mentioned avoiding HIV-positive sex partners, limiting the number of partners with whom they barebacked, and not allowing partners to ejaculate inside their rectum. Findings suggest that many MSM who bareback would be amenable to HIV prevention efforts that do not depend solely on condom use.

Facilitators of barebacking among emergent adult gay and bisexual men: implications for HIV prevention

We undertook a qualitative study to develop a greater understanding of "intentional" unprotected anal intercourse among drug-using gay and bisexual men, also known colloquially as barebacking. In our analysis, we investigated this behavior in a subset of 12 HIV-negative men in the early adulthood stage of life to disentangle factors that functioned as facilitators of barebacking, a behavior that may place these men at risk for HIV infection. Based on thematic analysis of life-history interviews, we delineated 4 main themes associated with barebacking: drug use, the role of responsibility for safer sex, misunderstandings about HIV transmission, and underlying mental health issues. The data suggest that lack of knowledge about HIV transmission is insufficient in explaining risk-taking. Rather, rationalization processes may be a factor in the sexual risk-taking behaviors of young HIV-negative men, and moreover, deep intrapsychic processes (often heightened by concurrent substance use), and the desire to please sexual partners may drive the decision-making of these men. Future intervention strategies must motivate and empower young men to seek support for the states that drive sexual risk-taking.

Predictors of identifying as a barebacker among high-risk New England HIV seronegative men who have sex with men

Studies have found that between 14% and 46% of US men who have sex with men (MSM) consistently report "barebacking" behavior (i.e., intentional unprotected anal intercourse) with other men. This is of public health significance because MSM continue to constitute more than 50% of new HIV infections in the USA. Men who self-identify as barebackers may represent a different and unique subset of MSM with distinct HIV prevention needs. In 2007, 227 HIV seronegative MSM recruited through modified respondent-driven sampling completed an interviewer-administered survey which assessed barebacker identity (i.e., personally identifying with the barebacker scene), demographics, sexual risk behaviors, psychosocial variables, and drug/alcohol use. Bivariate and multivariable logistic regression procedures were used to examine predictors of barebacker identity in relation to HIV risk behavior. Overall, 31% of participants identified as a barebacker. In bivariate analyses, lower education (OR = 1.76; 95% CI = 0.99-3.13; p < 0.05), a current drinking problem (OR = 2.34, 95% CI = 1.29-4.23; p < 0.01), higher levels of HIV treatment optimism (OR = 1.06; 95% CI = 1.01-1.12; p < 0.05), meeting sexual partners at private sex parties (OR = 2.47; 95% CI = 1.28-4.74; p < 0.01) or at bars/cubs (OR = 1.97; 95% CI = 1.10-3.52; p < 0.05), and engaging in serodiscordant unprotected insertive anal sex (OR = 3.42; 95% CI = 1.27-9.21; p < 0.01) significantly predicted barebacker identification compared to those with no barebacker identification. In a multivariable model, barebackers were more likely to screen in for alcohol abuse (adjusted OR = 2.16; 95% CI = 1.09-4.27; p < 0.05) and engage in serodiscordant unprotected insertive anal sex (adjusted OR = 3.17; 95% CI = 1.09-9.20; p < 0.05) compared to their non-barebacker counterparts. No significant differences were found in serodiscordant unprotected receptive anal sex between barebackers and non-barebackers. These findings suggest that barebacker identity is related to intentional HIV sexual risk taking and alcohol abuse. Furthermore, strategic positioning (i.e., engaging in insertive rather than receptive sex) might be associated with barebacker identification and may indicate a harm-reduction strategy being used among some HIV-uninfected MSM to reduce their risk of becoming infected. Additional research is warranted to understand the social identity of barebacking among MSM in order to develop more nuanced prevention strategies.

Is 'bareback' a useful construct in primary HIV-prevention? Definitions, identity and research

The terms bareback and bareback identity are increasingly being used in academic discourse on HIV/AIDS without clear operationalization. Using in-depth, face-to-face interviews with an ethnically diverse sample of 120 HIV-infected and -uninfected men, mainly gay-identifying and recruited online in New York City, this study explored respondents' definitions of bareback sex, the role that intentionality and risk played in those definitions, and whether respondents identified as 'barebackers'. Results showed overall agreement with a basic definition of bareback sex as condomless anal intercourse, but considerable variation on other elements. Any identification as barebacker appeared too loose to be of use from a public health prevention perspective. To help focus HIV-prevention efforts, we propose a re-conceptualization that contextualises risky condomless anal intercourse and distinguishes between behaviours that are intentional and may result in HIV-primary transmission from those that are not.

Men Who Have Sex With Men and Recruit Bareback Sex Partners on the Internet: Implications for STI and HIV Prevention and Client Education

Men who have sex with men (MSM) frequently use Internet-based Web sites to recruit sex partners. Although many MSM users of such sites advocate for safe sex practices in their personal profiles, some users actively recruit sexual partners who wish to participate in anal sexual intercourse without the use of condoms, also known as “bareback” sex. Participating in this sexual practice places both sexual partners at higher risk of HIV transmission. In addition, data indicate this behavior is associated with other high-risk activities such as drug use and communication of other sexually transmitted infections. This article summarizes the literature assessing this phenomenon on the Internet. Specific recommendations are provided for clinicians, health educators, and researchers.

Barebacking, the Internet, and harm reduction: an intercept survey with gay and bisexual men in Los Angeles and New York City

Researchers have suggested that intentional unprotected anal intercourse (UAI) among gay and bisexual men (colloquially called barebacking), is on the rise. Further, they have linked this increase in barebacking to the growth of the Internet as a medium for men to meet sex partners. Data were used from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles collected between 2003 and 2004. In total 1178 men who have sex with men (MSM) responded to questions about the use of the Internet, willingness to have unplanned UAI, intentions toward planned UAI, and "barebacker identity." Compared to nonbarebackers, barebackers spent significantly more time on the Internet looking for sex and looking for dates. Further, HIV-positive barebackers specifically spent the most time online looking for dates. Further analyses of willingness and intentions to have UAI, and the specific sexual behaviors of self-identified barebackers, found evidence of strategic positioning and serosorting, both harm reduction strategies. These data suggest both HIV-positive and HIV-negative barebackers may be engaged in efforts to reduce the risk of HIV transmission when engaged in unprotected sex.