The effect of partner characteristics on HIV infection among African American men who have sex with men in the Young Men's Survey, Los Angeles, 1999-2000

Intergenerational sex and early sexual debut are associated with HIV infection among transgender women in Paraguay

INTRODUCTION

HIV prevalence among transgender women is high worldwide. The objectives of the present study were to estimate the current prevalence of HIV and identify factors associated with high HIV burden among transgender women in Paraguay.

METHODS

Transgender women aged ≥15 years in four regions of Paraguay were recruited by Starfish sampling between February and March 2021.

RESULTS

In total, 322 transgender women were included. Mean age was 31 years (range 15-67), and 102 had positive HIV test results (31.7%, 95% confidence interval [CI] 26.6-37.1). In multivariable analysis, factors associated with HIV infection were age at first intercourse ≤17 years (adjusted odds ratio [aOR] 5.47; 95% CI 1.05-28.42), >10 years difference in age with the last sexual partner (aOR 1.60; 95% CI 1.04-2.46), substance use (mostly cocaine) (aOR 3.00; 95% CI 1.47-6.12), higher risk perception (aOR 3.08; 95% CI 1.53-6.17), not testing for HIV (aOR 1.23; 95% CI 1.09-1.39), and accessed by a peer educator (aOR 3.86; 95% CI 1.77-8.38).

CONCLUSIONS

Sexual debut as a minor and a large age difference with sexual partners are associated with high burden of HIV among transgender women in Paraguay. Our study corroborates the finding of cocaine use during sex as a risk factor for HIV. Prevention programmes must address structural and social vulnerabilities to stem the tragically high burden of HIV among transgender women.

Psychosocial Support, Sexual Health, and HIV Risk among Older Men Who Have Sex with Younger Men

This study examines the extent to which older males are willing to offer psychosocial and sexual health promoting support to their younger male partners, as well as the individual and relationship-level factors associated with this willingness to provide support. In total, 324 men over the age of 45, who currently or previously had younger male sexual partners, completed an anonymous online survey. Results show that participants were most willing to provide emotional support to their younger male partners, followed by health-related encouragement, HIV/STI testing support, and financial support. Of note, HIV positive status and being in a "main partnership" were associated with greater willingness to provide financial support. These results suggest that older men are willing to provide psychosocial and health promotive support to younger male partners, which could be leveraged in targeted interventions to reduce HIV transmission.

Stigma, HIV Risk, and Access to HIV Prevention and Treatment Services Among Men Who have Sex with Men (MSM) in the United States: A Scoping Review

In light of recent advances in HIV prevention and treatment, we reviewed the literature to understand how different types of stigma impact HIV risk; access to HIV prevention, care, and treatment services; and related health outcomes among men who have sex with men (MSM) in the US. We conducted a scoping literature review of observational and qualitative studies that examined stigma and HIV-related outcomes among MSM. Our search identified 5794 studies, of which 47 met the eligibility criteria and were included in the final analysis. The review suggests that stigma remains a formidable barrier to engaging in HIV prevention and treatment among both HIV-negative and HIV-positive MSM. Among the studies of HIV-positive MSM, internalized stigma was related to lower levels of treatment engagement. HIV-positive MSM in the Southern part of the US were also more likely to engage in risky sexual behavior. Perceived health care discrimination was negatively associated with PrEP awareness, particularly among HIV-negative Black MSM. Among young MSM of color, intersectional stigma compounded the social structural barriers to PrEP adherence. Findings indicate that stigma reduction interventions should be implemented in diverse MSM communities to address the disproportionate burden of HIV along with critical gap in the care continuum. Further research should examine how individual types of stigma, including intersectional stigma, affect viral suppression and PrEP uptake and adherence, especially among MSM of color.

Individual and partnership characteristics associated with consistent condom use in a cohort of cisgender men who have sex with men and transgender women in Nigeria

Background

This study reports on the individual and partnership characteristics that influence consistent condom use in cisgender men who have sex with men (MSM) and transgender women (TGW) attending trusted community centers that provide HIV prevention and treatment services in Nigeria.

Methods

Adults assigned male at birth who reported anal sex with male partners who enrolled between March 2013–2019 and had information about at least one male sexual partner were included in these analyses. At enrollment and follow-up visits every 3 months for up to 18 months, participants were administered detailed questionnaires that collected information about demographics, sexual practices, HIV risk behaviors, and characteristics and behaviors of their partners in the previous year (at enrollment) or the preceding 3 to 6-months (at follow-up visits). Logistic regression models with generalized estimating equations were used to assess the odds ratio (OR) and 95% confidence intervals (CI) of individual, partner, and partnership characteristics associated with consistent condom use (CCU). A participant was defined as consistently using condom if they reported always using condoms all the time they had insertive, receptive or both types of anal sex with a male partner.

Results

At the individual level, CCU was positively associated with higher education, disclosure of key population status to a healthcare worker and negatively associated with poor access to condoms. At the partner and partnership level, CCU was associated with partners with higher education (aOR: 1.36; 95% CI: 1.07–1.72), casual relationships (aOR: 1.22; 95% CI: 1.11–1.34) and relationships in which partners encouraged the participant to use condoms with other partners (aOR: 1.14; 95% CI: 1.02–1.28). Relationships in which the partner was married to a woman and/or the partner’s HIV status positive or unknown were negatively associated with CCU.

Conclusions

These findings suggest that individuals in relationships where partners were more open and encouraged safer sex were more likely to consistently use condoms. HIV prevention programs should consider leveraging communication to sexual partners to encourage condom use as this may support condom use with other sexual partners. Given sustained and growing HIV and STI epidemics among MSM and TGW, even with pre-exposure prophylaxis scale-up, it is crucial to continue to study optimal implementation strategies to increase condom use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11275-w.

Sexual and social networks, venue attendance, and HIV risk among young men who have sex with men

OBJECTIVE

This study used a Social network analysis (SNA) approach to describe HIV transmission and venue affiliations among social and sexual networks of young men who have sex with men (YMSM) in Houston, TX.

METHODS

A total of 34 YMSM indices aged 18-23 years and 23 of their network members were interviewed about their social and sexual networks and venues at which they met and spent time.

RESULTS

Participants reported information on 220 friends (mean age = 25.3 years) and 112 sexual partners (mean age = 26.3 years). Participants spent time with friends and sexual partners at similar venues but relied more heavily on social media and dating applications to meet sexual partners. Participants lived in zip codes consistent with high concentrations of HIV positivity. Popularly frequented clubs/gay bars were often 10-20 miles away, also in zip codes with high densities of seropositivity.

CONCLUSION

Both friendship and sexual networks are large, diffuse, and not limited by geography. Participants came from areas with high rates of HIV/AIDS. The venues at which participants recruited sexual partners may present increased opportunities for HIV transmission. HIV prevention interventions should focus on the heightened risk of unknown HIV serostatus.

Collective Avoidance of Social and Health Venues and HIV Racial Inequities: Network Modeling of Venue Avoidance on Venue Affiliation, Social Networks, and HIV Risk

Many younger Black men who have sex with men (YBMSM) are exposed to homonegativity, societal stigma, and racial discrimination in their social environment. This study uses a social network modeling methodology to identify aspects of the social environment that are not often described, that is, the places and spaces or "venues" where YBMSM socialize or where they receive HIV prevention services. In particular, we identify the structural features of avoidance of these venues as an indicator of negative experiences, using bipartite exponential random graph models. Our study theorizes that YBMSM avoid certain venues en masse through information diffusion among social network members. We specify two social mechanisms of collective venue avoidance-(1) homophily (i.e., ego-alter similarity in venue avoidance) and (2) popular opinion leaders (as early adopters)-and test the corresponding hypotheses that (Hypothesis 1) socially connected individuals avoid venues together and that (Hypothesis 2) popular individuals would be more likely to avoid venues. Based on data collected from YBMSM aged 16 to 29 years between 2014 and 2016 in Houston, Texas (N = 227) and Chicago, Illinois (N = 241), results indicate that Hypothesis 1 was supported in both cities but that Hypothesis 2 was supported only in Chicago. The findings suggest that the structural patterns of venue avoidance are different between cities and may inform dissemination of prevention messages and delivery of venue- and social influence-based HIV interventions.

Developing targeted HIV risk predictors for young black men who have sex with men: a two-city comparative study

HIV burden in the United States is geographically and demographically heterogeneous. While efforts over the last few decades have reduced HIV incidence, young black men who have sex with men (YBMSM) account for a significant portion of new HIV diagnoses compared to any other race and age group. The Centers for Disease Control and Prevention has allocated funding to help reduce HIV in the YBMSM community; however, their recommended screening/treatment criteria do not emphasize demographic specificity. To better guide more applicable screening guidelines specifically for YBMSM, we examine demographic, behavioral, sexual network, and biological predictors of HIV status among YBMSM in two demographically distinct cities with high HIV burden in the United States: Chicago, IL and Los Angeles, CA. We perform multivariable logistic regressions to identify predictors of HIV in these populations. We found that having a history of syphilis was the only statistically significant predictor across both cities despite inclusion of other characteristics previously shown to be associated with HIV among YBMSM. Syphilis history could be a powerful HIV risk indicator for YBMSM and, therefore, should be integrated into clinical screening practices for critical biomedical prevention options like HIV pre-exposure prophylaxis.

Discordant Reporting of Partner Labels, HIV Testing and Sexual Behavior Among a Sample of Partnered Men Who have Sex with Men in the US

There is growing evidence that sexual behaviors among male couples are strongly shaped by emotional and quality characteristics of the relationship, and that the labels that men attach to their relationships may indicate how men perceive and engage in risk taking. There has been a lack of attention to how male couples label their relationships, and how discordant understandings of relationship labels may shape HIV risk behavior. Using data from a sample of 804 partnered men who have sex with men, this analysis examines associations between discordant relationship labeling and participation in HIV testing and sexual behavior. Men who labeled their relationship differently from their partners were less likely to have been recently tested for HIV and more likely to engage in sexual risk. The results underscore the need to develop interventions that provide spaces and skills for men to learn how to effectively navigate HIV risks in their relationships.

Social Networks Moderate the Syndemic Effect of Psychosocial and Structural Factors on HIV Risk Among Young Black Transgender Women and Men who have Sex with Men

The interaction between the cumulative effect of psychosocial and structural factors (i.e. syndemic effect) and social networks among young Black transgender women and men who have sex with men (YBTM) remains understudied. A representative cohort of 16-29 year-old YBTM (n = 618) was assessed for syndemic factors [i.e. substance use; community violence; depression; poverty; justice system involvement (JSI)], social network characteristics, condomless anal sex (CAS), group sex (GS), and HIV-infection. The syndemic index significantly increased the odds of CAS, GS, and HIV-infection, and these effects were moderated by network characteristics. Network JSI buffered the effect on CAS, romantic network members buffered the effect on GS, and network age and proportion of family network members buffered the effect on HIV-infection. The proportion of friend network members augmented the effect on GS and HIV-infection. Future research to prevent HIV among YBTM should consider social network approaches that target both structural and psychosocial syndemic factors.

Relationship power and HIV risk among young Black men who have sex with men in the Southern United States

Background The purpose of this study was to examine the impact of relationship power on HIV risk behaviour among young Black men who have sex with men (MSM) in the Southern US.

METHODS

Data from 425 Black/African American males aged 18-29 years who reported recent anal intercourse with a male partner were analysed. Five selected measures of relationship power were tested for correlation and association with protected receptive anal intercourse using contingency tables and logistic regression analysis.

RESULTS

Acts of 100% protected receptive anal intercourse were common (n=277, 65.2%). Men who reported low barriers to condom negotiation were significantly more likely to report protected acts (P<0.001). Men who reported 100% protected acts were less likely to report financial dependence on male sexual partners and serosorting behaviour (12.0% vs 20.7%, P=0.02; 31.5% vs 49.8%, P<0.001 respectively).

CONCLUSION

Future efforts should further examine the role of relationship power in HIV risk among young Black MSM, including the intersection of individual, dyadic and social-structure risks.

Interaction Patterns of Men Who Have Sex With Men on a Geosocial Networking Mobile App in Seven United States Metropolitan Areas: Observational Study

BACKGROUND

The structure of the sexual networks and partnership characteristics of young black men who have sex with men (MSM) may be contributing to their high risk of contracting HIV in the United States. Assortative mixing, which refers to the tendency of individuals to have partners from one's own group, has been proposed as a potential explanation for disparities.

OBJECTIVE

The objective of this study was to identify the age- and race-related search patterns of users of a diverse geosocial networking mobile app in seven metropolitan areas in the United States to understand the disparities in sexually transmitted infection and HIV risk in MSM communities.

METHODS

Data were collected on user behavior between November 2015 and May 2016. Data pertaining to behavior on the app were collected for men who had searched for partners with at least one search parameter narrowed from defaults or used the app to send at least one private chat message and used the app at least once during the study period. Newman assortativity coefficient (R) was calculated from the study data to understand assortativity patterns of men by race. Pearson correlation coefficient was used to assess assortativity patterns by age. Heat maps were used to visualize the relationship between searcher's and candidate's characteristics by age band, race, or age band and race.

RESULTS

From November 2015 through May 2016, there were 2,989,737 searches in all seven metropolitan areas among 122,417 searchers. Assortativity by age was important for looking at the profiles of candidates with correlation coefficients ranging from 0.284 (Birmingham) to 0.523 (San Francisco). Men tended to look at the profiles of candidates that matched their race in a highly assortative manner with R ranging from 0.310 (Birmingham) to 0.566 (Los Angeles). For the initiation of chats, race appeared to be slightly assortative for some groups with R ranging from 0.023 (Birmingham) to 0.305 (Los Angeles). Asian searchers were most assortative in initiating chats with Asian candidates in Boston, Los Angeles, New York, and San Francisco. In Birmingham and Tampa, searchers from all races tended to initiate chats with black candidates.

CONCLUSIONS

Our results indicate that the age preferences of MSM are relatively consistent across cities, that is, younger MSM are more likely to be chatted with and have their profiles viewed compared with older MSM, but the patterns of racial mixing are more variable. Although some generalizations can be made regarding Web-based behaviors across all cities, city-specific usage patterns and trends should be analyzed to create targeted and localized interventions that may make the most difference in the lives of MSM in these areas.

Social Network Support and Decreased Risk of Seroconversion in Black MSM: Results of the BROTHERS (HPTN 061) Study

BACKGROUND AND SETTING

Black men who have sex with men (BMSM) in the United States have disproportionately high HIV infection rates. Social networks have been shown to influence HIV risk behavior; however, little is known about whether they affect the risk of HIV seroconversion. This study uses data from the BROTHERS (HPTN 061) study to test whether contextual factors related to social networks are associated with HIV seroconversion among BMSM.

METHODS

We analyzed data from the BROTHERS study (2009-2011), which examined a multicomponent intervention for BMSM in 6 US cities. We ran a series of Cox regression analyses to examine associations between time-dependent measures of network support (personal/emotional, financial, medical, and social participation) and time to HIV seroconversion. We ran unadjusted models followed by models adjusted for participant age at enrollment and study location.

RESULTS

A total of 1000 BMSM tested HIV negative at baseline and were followed at 6- and 12-month study visits. Twenty-eight men tested HIV positive. In adjusted hazard ratio models, study participants who remained HIV negative had higher proportions of social network members who provided personal/emotional {0.92 [95% confidence interval (CI): 0.85 to 0.99]}, medical [0.92 (95% CI: 0.85 to 0.99)], or social participation [0.91 (95% CI: 0.86 to 0.97)] support.

CONCLUSION

Findings suggest that the increased presence of social network support can be protective against HIV acquisition. Future research should explore the processes that link social network support with sexual and other transmission risk behaviors as a basis to inform HIV prevention efforts.

Sexual Partner Characteristics, Relationship Type, and HIV Risk Among a Community Venue-based Sample of Urban Adolescent and Young Adult Men Who Have Sex with Men

Few studies have examined sexual partnerships and HIV risk in diverse samples of African American/black and Hispanic/Latino adolescent and young adult men who have sex with men (YMSM), a group that have a high burden of HIV in the U.S. A community-venue recruitment approach was used, which identified significant differences in HIV risk by sexual partner type among 1215 YMSM. Those with casual partners had a higher number of sexual partners, had more STIs, and were more likely to engage in transactional sex, to use alcohol, marijuana, or other substances compared with those with main partners only. Among those with female sexual partners, many used condoms "every time" when engaging in vaginal sex with casual partners, but a sizeable proportion "never/rarely" used condoms with their main partners. Our findings demonstrate a need for tailored HIV prevention education and counseling with necessary skills regarding consistent and correct condom use with all sexual partnerships.

An Event-Level Analysis of Condomless Anal Intercourse with a HIV-Discordant or HIV Status-Unknown Partner Among Black Men Who Have Sex with Men from a Multi-site Study

Despite the high HIV incidence and prevalence among black men who have sex with men (BMSM), little research has examined partner characteristics, partner seeking venue, sexual position, substance use, and sexual risk behavior at the sex event-level among BMSM. Using the baseline data from a multi-site study of 807 BMSM stratified by their HIV status, the goal of this study was to conduct a detailed event-level analysis of 1577 male anal sex events to assess the factors associated with condomless anal intercourse (CLAI) with a HIV-discordant or HIV status-unknown partner. We found CLAI with an HIV-discordant or unknown HIV status partner among HIV-negative BMSM was negatively associated with having sex with a main partner, and was positively associated with taking both receptive and insertive sexual positions during sex. As compared to a sex partner met at bar, night club or dance club, HIV-positive BMSM were less likely to engage in CLAI with HIV-discordant and unknown HIV status partner met at party or friend's house or at community organizations. HIV-positive BMSM had lower odds of engaging in CLAI with HIV-discordant and unknown HIV status partner if they had insertive sexual position or both receptive and insertive sexual positions. These results underscore the importance of delineating unique sex event-level factors associated with sexual risk behavior depending on individuals' HIV status. Our findings suggest event-level partner characteristics, sexual position, and partner seeking venues may contribute to disparities in HIV incidence.

Characterizing Geosocial-Networking App Use Among Young Black Men Who Have Sex With Men: A Multi-City Cross-Sectional Survey in the Southern United States

Background

Understanding where and how young black men who have sex with men (YBMSM) in the southern United States meet their sexual partners is germane to understanding the underlying factors contributing to the ongoing HIV transmission in this community. Men who have sex with men (MSM) commonly use geosocial networking apps to meet sexual partners. However, there is a lack of literature exploring geosocial networking app use in this particular population.

Objective

Our aim was to examine the characteristics, preferences, and behaviors of a geographically diverse sample of geosocial networking app-using YBMSM in the southern United States.

Methods

Data were collected from a sample of 75 YBMSM across three cities (Gulfport, Mississippi; Jackson, Mississippi; and New Orleans, Louisiana). Multiple aspects of geosocial networking app use were assessed, including overall app use, age of participant at first app use, specific apps used, reasons for app use, photos presented on apps, logon times and duration, number of messages sent and received, and characteristics of and behaviors with partners met on apps. Survey measures of app-met partner and sexual behavior characteristics assessed at midpoint (Day 7) and completion visits (Day 14) were compared using McNemar’s test or Wilcoxon signed-rank test. In addition, we assessed activity spaces derived from GPS devices that participants wore for 2 weeks.

Results

Of the 70 participants who responded to the overall app-use item, almost three-quarters (53/70, 76%) had ever used geosocial networking apps. Jack’d was the most commonly used geosocial networking app (37/53, 70%), followed by Adam4Adam (22/53, 42%), and Grindr (19/53, 36%). The mean and median number of apps used were 4.3 (SD 2.7) and 4.0 (range 0-13), respectively. Most app-using participants displayed their face on the profile picture (35/52, 67%), whereas fewer displayed their bare legs (2/52, 4%) or bare buttocks (or ass; 2/52, 4%). The mean age at the initiation of app use was 20.1 years (SD 2.78) ranging from 13-26 years. Two-thirds (35/53, 66%) of the sample reported using the apps to “kill time” when bored. A minority (9/53, 17%) reported using the apps to meet people to have sex/hook up with. The vast majority of participants reported meeting black partners for sex. Over two-thirds (36/53, 68%) reported that the HIV status of their app-met partners was negative, and 26% (14/53) reported that they did not know their partner’s HIV status. There was a significant difference in GPS activity spaces between app using YBMSM compared to nonapp using YBMSM (2719.54 km² vs 1855.68 km², P=.011).

Conclusions

Use of geosocial networking apps to meet sexual partners among our sample of YBMSM in the southern United States was common, with a diverse range of app use behaviors being reported. Further research should characterize the association between geosocial networking app use and engagement in sexual behaviors that increase risk for HIV acquisition and transmission. In addition, geosocial networking apps present a promising platform for HIV prevention interventions targeting YBMSM who use these apps.

Age and Age Discordance Associations with Condomless Sex Among Men Who Have Sex with Men

We explored the effect of older partner's age and age difference between partners on condomless sex among men who have sex with men (MSM). We analyzed dyads (n = 1720) from participants (n = 969) in the Sexual Acquisition Transmission of HIV Cooperative Agreement Program. We used modified Poisson regression to model the probability of a sexual encounter's being condomless as a function of older partner's age and age difference between partners adjusting for HIV status, substance use, race/ethnicity, and partner type. We found an interaction between older partner's age and age difference (p < 0.05). Condomless sex decreased with increasing age of the older partner when the age difference was 5-9 years (p = 0.004) or ≥10 years (p = 0.04), but not when <5 years. Condomless sex was less likely among older MSM when there was ≥5 years age difference between partners than <5 years difference. Both age and age discordance affect the likelihood of a sexual encounter between MSM being condomless.

Evaluation of Project RISE, an HIV Prevention Intervention for Black Bisexual Men Using an Ecosystems Approach

Black men who have sex with men and women (MSMW) are among the populations at highest risk for HIV infection. We describe the evaluation of Project RISE, a six-session individual-level intervention developed for black MSMW using an ecosystems approach. A randomized controlled trial was used to test the effect of the intervention on sexual risk outcomes. Eligibility criteria included having both male and female sex partners in the past 12 months. Complete data at 5-month follow-up were collected from 86.7% of the 165 participants. In analyses controlling for HIV status, age, and baseline risk, intervention participants were found to have significantly greater reductions in number of female partners (p < 0.05) and total male and female partners (p < 0.05) at follow-up, compared to the control group. Intervention participants also were significantly more likely to report a reduction in number of sex episodes without a condom with female partners (p < 0.05) and with all partners (p < 0.02) at follow-up, compared to the control group.

Sexual Partner Typologies and the Association Between Drug Use and Sexual Risk Behavior Among Young Men Who Have Sex With Men

Numerous partner and relationship characteristics are associated with sexual risk behavior among young men who have sex with men (YMSM), including being in a serious relationship and having older partners. However, most research in this area is limited by its reliance on variable-centered approaches. Using multilevel latent class analysis, this study identified subgroups of sexual partner types with a particular emphasis on examining whether partner type moderated the association between drug use and condomless anal sex (CAS). Data were utilized from an ongoing cohort study of YMSM (ages 16-29) recruited from previous studies as well as peers and serious partners of existing cohort members. A total of 469 participants reported on 1596 sexual partners in the past 6 months. We identified four distinct sexual partner typologies, which we refer to as: casual, older-online, much older, and serious. Results indicated that rates of CAS were highest for older-online and serious partners. Additionally, there was a positive association between drug use and CAS among a predominantly marijuana using sample, but only for serious partners. While previous research has found that CAS is highest in serious relationships, findings suggest that there may be another type of partnership in which CAS is likely to occur (older partners met online). If confirmed, these results suggest interventions focused on the intersection of marijuana use and CAS may be particularly important among YMSM with serious partners.

The Effect of PrEP on HIV Incidence Among Men Who Have Sex With Men in the Context of Condom Use, Treatment as Prevention, and Seroadaptive Practices

BACKGROUND

HIV preexposure prophylaxis (PrEP) is an effective tool in preventing HIV infection among high-risk men who have sex with men (MSM). It is unknown how effective PrEP is in the context of other implemented HIV prevention strategies, including condom use, seroadaption, and treatment as prevention (TasP). We evaluate the impact of increasing uptake of PrEP in conjunction with established prevention strategies on HIV incidence in a high-risk population of MSM through simulation.

METHODS

Agent-based simulation models representing the sexual behavior of high-risk, urban MSM in the United States over the period of 1 year were used to evaluate the effect of PrEP on HIV infection rates. Simulations included data for 10,000 MSM and compared increasing rates of PrEP uptake under 8 prevention paradigms: no additional strategies, TasP, condom use, seroadaptive behavior, and combinations thereof.

RESULTS

We observed a mean of 103.2 infections per 10,000 MSM in the absence of any prevention method. PrEP uptake at 25% without any additional prevention strategies prevented 30.7% of infections. In the absence of PrEP, TasP, condom use, and seroadaptive behavior independently prevented 27.1%, 48.8%, and 37.7% of infections, respectively, and together prevented 72.2%. The addition of PrEP to the 3 aforementioned prevention methods, at 25% uptake, prevented an additional 5.0% of infections.

CONCLUSIONS

To achieve a 25% reduction in HIV infections by 2020, HIV prevention efforts should focus on significantly scaling up access to PrEP in addition to HIV testing, access to antiretroviral therapy, and promoting condom use.

Are Partner Race and Intimate Partner Violence Associated with Incident and Newly Diagnosed HIV Infection in African-American Men Who Have Sex with Men?

Black gay, bisexual, and other men who have sex with men (BMSM) experience a disparate rate of HIV infections among MSM. Previous analyses have determined that STI coinfection and undiagnosed HIV infection partly explain the disparity. However, few studies have analyzed the impact of partner-level variables on HIV incidence among BMSM. Data were analyzed for BMSM who attended the Los Angeles LGBT Center from August 2011 to July 2015 (n = 1974) to identify risk factors for HIV infection. A multivariable logistic regression was used to analyze predictors for HIV prevalence among all individuals at first test (n = 1974; entire sample). A multivariable survival analysis was used to analyze predictors for HIV incidence (n = 936; repeat tester subset). Condomless receptive anal intercourse at last sex, number of sexual partners in the last 30 days, and intimate partner violence (IPV) were significant partner-level predictors of HIV prevalence and incidence. Individuals who reported IPV had 2.39 times higher odds (CI 1.35-4.23) and 3.33 times higher hazard (CI 1.47-7.55) of seroconverting in the prevalence and incidence models, respectively. Reporting Black partners only was associated with increased HIV prevalence, but a statistically significant association was not found with incidence. IPV is an important correlate of both HIV prevalence and incidence in BMSM. Further studies should explore how IPV affects HIV risk trajectories among BMSM. Given that individuals with IPV history may struggle to negotiate safer sex, IPV also warrants consideration as a qualifying criterion among BMSM for pre-exposure prophylaxis (PrEP).

Drug use Discrimination Predicts Formation of High-Risk Social Networks: Examining Social Pathways of Discrimination

Experiences of discrimination, or social marginalization and ostracism, may lead to the formation of social networks characterized by inequality. For example, those who experience discrimination may be more likely to develop drug use and sexual partnerships with others who are at increased risk for HIV compared to those without experiences of discrimination. This is critical as engaging in risk behaviors with others who are more likely to be HIV positive can increase one's risk of HIV. We used log-binomial regression models to examine the relationship between drug use, racial and incarceration discrimination with changes in the composition of one's risk network among 502 persons who use drugs. We examined both absolute and proportional changes with respect to sex partners, drug use partners, and injecting partners, after accounting for individual risk behaviors. At baseline, participants were predominately male (70%), black or Latino (91%), un-married (85%), and used crack (64%). Among those followed-up (67%), having experienced discrimination due to drug use was significantly related to increases in the absolute number of sex networks and drug networks over time. No types of discrimination were related to changes in the proportion of high-risk network members. Discrimination may increase one's risk of HIV acquisition by leading them to preferentially form risk relationships with higher-risk individuals, thereby perpetuating racial and ethnic inequities in HIV. Future social network studies and behavioral interventions should consider whether social discrimination plays a role in HIV transmission.

Relationship Power Among Same-Sex Male Couples in New York and San Francisco: Laying the Groundwork for Sexual Risk Reduction Interventions Focused on Interpersonal Power

Research is clear that power differentials between women and men shape women's human immunodeficiency virus (HIV) risks; however, little research has attempted to examine power differentials within same-sex male (SSM) couples and whether these influence sexual risk outcomes. To produce the first quantitative scale that measures power in SSM relationships, the current work was a Phase 1 qualitative study that sought to understand domains of relationship power and how power operated in the relationship among 48 Black, White, and interracial (Black-White) SSM couples recruited from San Francisco and New York. Interview domains were focused on definitions of power and perceptions of how power operated in the relationship. Findings revealed that couples described power in three key ways: as power exerted over a partner through decision-making dominance and relationship control; as power to accomplish goals through personal agency; and as couple-level power. In addition, men described ways that decision-making dominance and relationship control could be enacted in the relationship-through structural resources, emotional and sexual influence, and gender norm expectations. We discuss the implications of these findings for sexual risks and HIV care and treatment with SSM couples that are focused on closing gaps in power.

Is Sex with Older Male Partners Associated with Higher Sexual Risk Behavior Among Young Black MSM?

Participants at a sexual health clinic completed a survey with questions regarding sexual risk behavior and partner characteristics. Of 585 participants eligible for analysis, 124 reported generally having older male partners. These participants were significantly more likely to be HIV-infected (p < 0.001), have four or more sex partners as a "bottom" (p = 0.04), have concurrent partners (p = 0.01), and have partners suspected of having an sexually transmitted infection (p = 0.05) than participants without older partners. With analysis restricted to HIV- individuals, risk behaviors did not differ significantly between the groups. HIV- individuals with older partners may be at increased risk of HIV infection due to increased HIV prevalence among older sexual partners and not due to increased risk behaviors with these partners.

Integrating HIV Prevention and Relationship Education for Young Same-Sex Male Couples: A Pilot Trial of the 2GETHER Intervention

Young men who have sex with men are at high risk for HIV, and most new HIV infections occur in serious relationships. This pilot study assessed the feasibility, acceptability and preliminary efficacy of the 2GETHER couples-based HIV prevention and relationship education intervention for young same-sex male couples. We enrolled 57 young male couples (N = 114) into a four-session hybrid group and individual intervention. We assessed acceptability via post-session surveys and exit interviews, and we examined preliminary efficacy at a two week posttest. The vast majority of participants (93%) reported exclusively positive impressions of 2GETHER, and all components received high mean ratings. We observed decreases in HIV risk behavior, increases in information, motivation and behavioral skills related to HIV prevention, and improvement in relationship investment between pretest and posttest. Integrating relationship education and sexual health programming may be an effective way to reduce HIV transmissions in young male couples.

"You just can't trust everybody": the impact of sexual risk, partner type and perceived partner trustworthiness on HIV-status disclosure decisions among HIV-positive black gay and bisexual men

HIV remains an intractable public health concern in the USA, with infection rates notably concentrated among Black gay and bisexual men. Status disclosure by HIV-positive individuals can be an important aspect of risk reduction but doing so poses dilemmas concerning privacy, stigma and self-protection, especially among populations subjected to multiple types of stigmatisation. Understanding the factors related to the disclosure process can help to inform prevention efforts. Using exploratory in-depth interviews, this qualitative study examines the disclosure process among a sample of twenty HIV-positive Black gay and bisexual men (mean age = 40) recruited through a non-profit health centre in a mid-western city in the USA. Data were analysed using a thematic analysis approach with HIV-disclosure as an a priori sensitising concept. Fears of stigma and secondary disclosure within social networks were critical barriers to talking about HIV with sexual partners and disclosure decisions involved a complex process centred on three primary themes: degree of sexual risk, partner type and perceived partner trustworthiness. The unique combinations of these contextual factors resulted in increased or decreased likelihood of disclosure. A conceptual model explicating a potential process by which these contextual factors influence disclosure decisions is presented.

Sex with older partners, condomless anal sex and unrecognized HIV infection among Chinese men who have sex with men

We examined the prevalence of sex with older male partner (SWOMP) and its association with condomless anal intercourse (CAI) with male partners and unrecognized HIV infection among young men who have sex with men (MSM) in Shanghai, China. The analytic sample included 243 MSM who were 18-45 years and HIV negative or of unknown HIV serostatus. Older male partner refers to male sex partner who was at least 10 years older than themselves. Overall, 99 (43.0%) and 50 (20.7%) reported having SWOMP in lifetime and in the last 3 months, respectively. Having any CAI with male partners in the last 3 months was independently associated with SWOMP and sex with stable male partners in the last 3 months. Unrecognized HIV infection was independently associated with being HSV-2 positive and having any CAI with male partners as well as SWOMP in last 3 months. Sex with stable male partner in the last 3 months was also marginally significantly associated with unrecognized infection (p = 0.084). Older partner selection is common among young MSM in China. Prevention programs should incorporate education messages about the HIV risk associated with SWOMP. MSM should be informed that having condomless sex with stable partners may place them at HIV risk.

Racial Differences in Partnership Attributes, Typologies, and Risk Behaviors Among Men Who Have Sex With Men in Atlanta, Georgia

The role of main partnerships in shaping HIV transmission dynamics among men who have sex with men (MSM) has gained recognition in recent studies, but there is little evidence that existing definitions of partnership type are accurate or have consistent meaning for all men. Using data collected from 2011 to 2013 on 693 partnerships described by 193 Black and White MSM in Atlanta, GA, partnership attributes and risk behaviors were examined and compared by race, stratified in two ways: (1) by commonly used definitions of partnerships as "main" or "casual" and (2) by a new data-driven partnership typology identified through latent class analysis (LCA). Racial differences were analyzed using chi-square, Fisher's exact, and Wilcoxon-Mann-Whitney tests. Black participants were less likely to report condomless anal sex (CAS) within partnerships they labeled as main, yet they were also less likely to describe these partnerships as "primary" on a parallel question. In contrast, within strata defined by the LCA-derived typology, most partnership attributes were comparable and the likelihood of CAS was equivalent by race. These findings suggest that classification of partnerships as main or casual does not accurately capture the partnership patterns of MSM, resulting in differential misclassification by race. Future studies and interventions should refine and utilize more evidence-based typologies.

Sexual Networks, Dyadic Characteristics, and HIV Acquisition and Transmission Behaviors Among Black Men Who Have Sex With Men in 6 US Cities

The role of sexual networks in the epidemiology of human immunodeficiency virus (HIV) among black men who have sex with men (MSM) is poorly understood. Using data from 1,306 black MSM in the BROTHERS Study (2009-2010) in the United States, we examined the relationships between multiple sexual dyadic characteristics and serodiscordant/serostatus-unknown condomless sex (SDCS). HIV-infected participants had higher odds of SDCS when having sex at least weekly (odds ratio (OR) = 2.41, 95% confidence interval (CI): 1.37, 4.23) or monthly (OR = 1.94, 95% CI: 1.17, 3.24) versus once to a few times a year. HIV-uninfected participants had higher odds of SDCS with partners met offline at sex-focused venues (OR = 1.79, 95% CI: 1.15, 2.78) versus partners met online. In addition, having sex upon first meeting was associated with higher odds of SDCS (OR = 1.49, 95% CI: 1.21, 1.83) than was not having sex on first meeting, while living/continued communication with sexual partner(s) was associated with lower odds of SDCS (weekly: OR = 0.64, 95% CI: 0.47, 0.85; monthly: OR = 0.60, 95% CI: 0.44, 0.81; yearly: OR = 0.58, 95% CI: 0.39, 0.85) versus discontinued communication. Persons with primary/steady nonprimary partners versus commercial partners had lower odds of SDCS regardless of HIV serostatus. This suggests the need for culturally relevant HIV prevention efforts for black MSM that facilitate communication with sexual partners especially about risk reduction strategies, including preexposure prophylaxis.

Sexual behavior and HIV risk among age-discrepant, same-sex male couples

Research has suggested that men who have sex with men and who have older sexual partners are at increased risk of HIV infection. However, while several studies have explored risk among men in age-discrepant non-primary partnerships, only two have explored age discrepancy and risk in primary same-sex male relationships. We used data from semi-structured in-depth interviews to explore sexual behaviour and HIV risk among 14 Black, white and interracial (Black/white) same-sex male couples with an age difference of 10 or more years. Most couples regularly used condoms, and sexual positioning tended to lead to lower risk for younger partners. Some serodiscordant couples abstained from anal sex, while others used seropositioning to avoid transmission within the relationship. Within some couples, older partners acted as mentors on HIV prevention and broader life lessons. Future studies should further explore the potential risks and benefits of large age differences in same-sex male primary relationships.

The complex contribution of sociodemographics to decision-making power in gay male couples

Relationship power is an important dyadic construct in close relationships that is associated with relationship health and partner's individual health. Understanding what predicts power in heterosexual couples has proven difficult, and even less is known about gay couples. Resource models of power posit that demographic characteristics associated with social status (e.g., age, income) confer power within the relationship, which in turn shapes relationship outcomes. We tested this model in a sample of gay male couples (N = 566 couples) and extended it by examining race and HIV status. Multilevel modeling was used to test associations between demographic bases of power and decision-making power. We also examined relative associations among demographic bases and decision-making power with relationship satisfaction given the literature on power imbalances and overall relationship functioning. Results showed that individual income was positively associated with decision-making power, as was participant's HIV status, with HIV-positive men reporting greater power. Age differences within the relationship interacted with relationship length to predict decision-making power, but not satisfaction. HIV-concordant positive couples were less satisfied than concordant negative couples. Higher power partners were less satisfied than lower power partners. Demographic factors contributing to decision-making power among same-sex male couples appear to share some similarities with heterosexual couples (e.g., income is associated with power) and have unique features (e.g., HIV status influences power). However, these same demographics did not reliably predict relationship satisfaction in the manner that existing power theories suggest. Findings indicate important considerations for theories of power among same-sex male couples. (PsycINFO Database Record

Contributions of Qualitative Research in Informing HIV/AIDS Interventions Targeting Black MSM in the United States

This article presents a systematic review of qualitative studies focusing on human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among Black men who have sex with men (BMSM) in the United States. We reviewed studies that were published between 1980 and 2014. Qualitative methods employed in the studies reviewed include in-depth interviews, focus groups, participant observation, and ethnography. We searched several databases (PubMed, PsychINFO, JSTOR, ERIC, Sociological Abstracts, and Google Scholar) for relevant articles using the following broad terms: "Black men" "Black gay/bisexual" or "Black men who have sex with men," and "qualitative" and/or "ethnography." We include 70 studies in this review. The key themes observed across studies were (1) heterogeneity, (2) layered stigma and intersectionality, (3) risk behaviors, (4) mental health, (5) resilience, and (6) community engagement. The review suggests that sexual behavior and HIV-status disclosure, sexual risk taking, substance use, and psychological well-being were contextually situated. Interventions occurring at multiple levels and within multiple contexts are needed to reduce stigma within the Black community. Similarly, structural interventions targeting religious groups, schools, and health care systems are needed to improve the health outcomes among BMSM. Community engagement and using community-based participatory research methods may facilitate the development and implementation of culturally appropriate HIV/AIDS interventions targeting BMSM.

HIV-transmission-related risk behavior in HIV+ African American men: Exploring biological, psychological, cognitive, and social factors

OBJECTIVES

To identify factors associated with HIV-transmission-related risk behavior among HIV+ African American men.

METHOD

We examined biological, psychological, cognitive, and social factors and recent HIV-transmission-related risk behavior (i.e., needle sharing, unprotected sex, exchange sex) among a sample of HIV+ African American men.

RESULTS

A binary logistic regression showed that individuals under age 50 (OR=4.2), with clinically-elevated masochism scores (OR=3.9) on the Millon Clinical Multiaxial Inventory-III (MCMI-III), current substance abuse/dependence (OR=2.6), and higher sensation-seeking (OR=1.3) were more likely to report recent risk behavior.

CONCLUSIONS

Reducing substance use, addressing self-defeating attitudes, and improving self-control may be avenues for future prevention and intervention research among HIV+ African American men engaging in HIV-transmission-related risk behavior.

Designing a sexual network study of men who have sex with other men: exploring racial and ethnic preferences in study design and methods

Black and Latino gay, bisexual, and other men who have sex with men (MSM) have higher rates of HIV and other sexually transmitted infections (STIs) than their White counterparts. Differences in sexual networks have been hypothesized to play an important role in the observed racial/ethnic disparities in risk. However, concerns about the acceptability and feasibility of conducting sociocentric sexual network studies have left a dearth of data on the structure of sexual networks of MSM. If certain network research procedures are unacceptable among target populations, biases may be introduced. We conducted qualitative interviews and brief surveys with 30 self-identified Black (n = 12), Hispanic/Latino, (n = 9) and White (n = 9) sexually active MSM in the Greater Boston area to assess the acceptability and feasibility of potential procedures for a sociocentric sexual network study. We found that referring recent sexual partners as part of a sociocentric network study was generally acceptable, but racial/ethnic differences emerged regarding specific preferences for how to recruit sexual partners. While the majority of Black participants (7/12) explained that they would not want their name disclosed to sexual partners approached for study participation, most Latino participants (7/9) preferred having the opportunity to inform referrals themselves about the study prior to researchers contacting them, and White participants (8/9) favored having researchers disclose their names when recruiting referrals, emphasizing the importance of transparency. In order to reduce differential rates of research participation, increase scientific validity, and reduce risks of social harm, researchers studying sexual networks among MSM should be aware of these potential differences, engage communities in study design, and provide participants with a variety of options for recruiting their sexual partners.

Community Sexual Bridging Among Heterosexuals at High-Risk of HIV in New York City

Community sexual bridging may influence the socio-geographic distribution of heterosexually transmitted HIV. In a cross-sectional study, heterosexual adults at high-risk of HIV were recruited in New York City (NYC) in 2010 for the Centers for Disease Control and Prevention-sponsored National HIV Behavioral Surveillance system. Eligible participants were interviewed about their HIV risk behaviors and sexual partnerships and tested for HIV. Social network analysis of the geographic location of participants' recent sexual partnerships was used to calculate three sexual bridging measures (non-redundant ties, flow-betweenness and walk-betweenness) for NYC communities (defined as United Hospital Fund neighborhoods), which were plotted against HIV prevalence in each community. The analysis sample comprised 494 participants and 1534 sexual partnerships. Participants were 60.1 % male, 79.6 % non-Hispanic black and 19.6 % Hispanic race/ethnicity; the median age was 40 years (IQR 24-50); 37.7 % had ever been homeless (past 12 months); 16.6 % had ever injected drugs; in the past 12 months 76.7 % used non-injection drugs and 90.1 % engaged in condomless vaginal or anal sex; 9.6 % tested HIV positive (of 481 with positive/negative results). Sexual partnerships were located in 33 (78.6 %) of 42 NYC communities, including 13 "high HIV-spread communities", 7 "hidden bridging communities", 0 "contained high HIV prevalence communities", and 13 "latent HIV bridging communities". Compared with latent HIV bridging communities, the population racial/ethnic composition was more likely (p < 0.0001) to be black or Hispanic in high HIV-spread communities and to be black in hidden bridging communities. High HIV-spread and hidden bridging communities may facilitate the maintenance and spread of heterosexually transmitted HIV in black and Hispanic populations in NYC.

Do Sexual Networks of Men Who Have Sex with Men in New York City Differ by Race/Ethnicity?

The United States HIV epidemic disproportionately affects Black and Hispanic men who have sex with men (MSM). This disparity might be partially explained by differences in social and sexual network structure and composition. A total of 1267 MSM in New York City completed an ACASI survey and egocentric social and sexual network inventory about their sex partners in the past 3 months, and underwent HIV testing. Social and sexual network structure and composition were compared by race/ethnicity of the egos: black, non-Hispanic (N = 365 egos), white, non-Hispanic (N = 466), and Hispanic (N = 436). 21.1% were HIV-positive by HIV testing; 17.2% reported serodiscordant and serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last 3 months. Black MSM were more likely than white and Hispanic MSM to report exclusively having partners of same race/ethnicity. Black and Hispanic MSM had more HIV-positive and unknown status partners than white MSM. White men were more likely to report overlap of social and sex partners than black and Hispanic men. No significant differences by race/ethnicity were found for network size, density, having concurrent partners, or having partners with ≥10 years age difference. Specific network composition characteristics may explain racial/ethnic disparities in HIV infection rates among MSM, including HIV status of sex partners in networks and lack of social support within sexual networks. Network structural characteristics such as size and density do not appear to have such an impact. These data add to our understanding of the complexity of social factors affecting black MSM and Hispanic MSM in the U.S.

Rationale, Design and Methods of the Ecological Study of Sexual Behaviors and HIV/STI among African American Men Who Have Sex with Men in the Southeastern United States (The MARI Study)

BACKGROUND

This paper describes the rationale, design, and methodology of the Ecological Study of Sexual Behaviors and HIV/STI among African American Men Who Have Sex with Men (MSM) in the Southeastern United States (U.S.; known locally simply as the MARI Study).

METHODS

Participants are African American MSM aged 18 years and older residing in the deep South.

RESULTS

Between 2013 and 2015, 800 African American MSM recruited from two study sites (Jackson, MS and Atlanta, GA) will undergo a 1.5-hour examination to obtain anthropometric and blood pressure measures as well as to undergo testing for sexually transmitted infections (STI), including HIV. Intrapersonal, interpersonal, and environmental factors are assessed by audio computer-assisted self-interview survey. Primary outcomes include sexual risk behaviors (e.g., condomless anal sex) and prevalent STIs (HIV, syphilis, gonorrhea, and Chlamydia).

CONCLUSION

The MARI Study will typify the HIV environmental 'riskscape' and provide empirical evidence into novel ecological correlates of HIV risk among African American MSM in the deep South, a population most heavily impacted by HIV. The study's anticipated findings will be of interest to a broad audience and lead to more informed prevention efforts, including effective policies and interventions, that achieve the goals of the updated 2020 U.S. National HIV/AIDS Strategy.

Early HIV Infections Among Men Who Have Sex with Men in Five Cities in the United States

We tested blood samples from men who have sex with men (MSM) to detect early HIV infection. Early HIV included both acute (infected past 30 days) and recent (estimated recency past 240 days). Acute infections were defined as screen immunoassay (IA) negative/NAAT-positive or IA-positive/Multispot-negative/NAAT-positive. Recent infections were defined as avidity index cutoff <30 % on an avidity-based IA and, (1) not reporting antiretroviral therapy use or, (2) HIV RNA >150 copies/mL. Of 937 samples, 26 % (244) were HIV-infected and of these 5 % (12) were early. Of early infections, 2 were acute and 10 recent; most (8/12) were among black MSM. Early infection was associated with last partner of black race [adjusted relative risk (ARR) = 4.6, confidence intervals (CI) 1.2-17.3], receptive anal sex at last sex (ARR = 4.3, CI 1.2-15.0), and daily Internet use to meet partners/friends (ARR = 3.3, CI 1.1-9.7). Expanding prevention and treatment for black MSM will be necessary for reducing incidence in the United States.

Molecular analysis allows inference into HIV transmission among young men who have sex with men in the United States

OBJECTIVE

The objective of this study is to understand the spread of HIV among and between age and racial/ethnic groups of men who engage in male-to-male sexual contact (MSM) in the United States.

DESIGN

An analysis of HIV-1 pol sequences for MSM collected through the US National HIV Surveillance System (NHSS) during 2001-2012.

METHODS

Pairwise genetic distance was calculated to determine potential transmission partners (those with very closely related nucleotide sequences, i.e. distance ≤1.5%). We described race/ethnicity and age of potential transmission partners of MSM.

RESULTS

Of 23 048 MSM with HIV sequences submitted to NHSS during 2000-2012, we identified potential transmission partners for 8880 (39%). Most potential transmission partners were of the same race/ethnicity (78% for blacks/African-Americans, 64% for whites and 49% for Hispanics/Latinos). This assortative mixing was even more pronounced in the youngest age groups. Significantly fewer young black/African-American and Hispanic/Latino MSM had older potential transmission partners than young white MSM.

CONCLUSION

Black/African-American MSM, who are more profoundly affected by HIV, were more likely to have potential HIV transmission partners who were of the same race/ethnicity and similar in age, suggesting that disparities in HIV infections are in large part not due to age-disassortative relationships. Concerted efforts to increase access to preexposure prophylaxis, quality HIV care and effective treatment are needed to interrupt transmission chains among young, black/African-American MSM.

Correlates of Sexual HIV Risk Among African American Men Who Have Sex With Men

OBJECTIVES

We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men (MSM).

METHODS

We recruited social networks composed of 445 Black MSM from 2012 to 2014 in Milwaukee, Wisconsin; Cleveland, Ohio; and Miami Beach, Florida. Participants reported past-3-month sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics.

RESULTS

Condomless anal intercourse outside main concordant partnerships, reported by 34.4% of MSM, was less likely in the case of no alcohol and marijuana use in the past 30 days, and higher risk-reduction behavioral intentions. High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing.

CONCLUSIONS

Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions.

The sexual networks of racially diverse young men who have sex with men

Young men who have sex with men are at increased risk for HIV. Research with older men and high-risk populations suggests that network dynamics may contribute to the spread of infectious disease and HIV, but little is known about the sexual networks of young men who have sex with men. Utilizing a unique dataset, this study presents novel descriptive data about the sexual networks of racially diverse 17- to 23-year-old young men who have sex with men. Additionally, individual, partner, and network characteristics of these young men who have sex with men were examined as potential drivers of HIV, STI, and unprotected intercourse. Results indicated several partner- and network-level factors associated with HIV and associated outcomes.

Drinking Patterns and HIV Risk Behaviors Among Black and Latino Men Who Have Sex Within Los Angeles County

Alcohol, the most widely used substance among men who have sex with men (85%), remains an important factor in HIV research among this high-risk population. However, research on alcohol use among Black and Latino men who have sex with men (BLMSM), a population disproportionately affected by HIV in the United States, is limited and inconclusive. This study explored sociodemographic and HIV risk with daily heavy and low-risk drinking patterns among BLMSM. BLMSM (N = 188) aged 18 to 40 years were recruited through social media, local colleges, heteronormative clubs, private men’s groups, gay establishments, and organized events in Los Angeles County. Participants completed self-administered questionnaires. Fisher’s exact tests revealed significant relationships between drinking patterns and condomless insertive anal intercourse (p = .001), race (p < .001), age (p = .02), and perception of alcohol-related HIV risk (p = .007). The Fisher’s exact tests findings for age held true in the multiple regression model (p = .014). Findings suggest that BLMSM who engage in higher risk drinking also engage in alcohol-related HIV risk. Culturally competent interventions should consider including a combined focus to explore the synergy between risky drinking patterns and HIV risk among BLMSM.

Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities

BACKGROUND

Sexual networks may place U.S. Black men who have sex with men (MSM) at increased HIV risk.

METHODS

Self-reported egocentric sexual network data from the prior six months were collected from 1,349 community-recruited Black MSM in HPTN 061, a multi-component HIV prevention intervention feasibility study. Sexual network composition, size, and density (extent to which members are having sex with one another) were compared by self-reported HIV serostatus and age of the men. GEE models assessed network and other factors associated with having a Black sex partner, having a partner with at least two age category difference (age difference between participant and partner of at least two age group categories), and having serodiscordant/serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last six months.

RESULTS

Over half had exclusively Black partners in the last six months, 46% had a partner of at least two age category difference, 87% had ≤5 partners. Nearly 90% had sex partners who were also part of their social networks. Among HIV-negative men, not having anonymous/exchange/ trade partners and lower density were associated with having a Black partner; larger sexual network size and having non-primary partners were associated with having a partner with at least two age category difference; and having anonymous/exchange/ trade partners was associated with SDUI. Among HIV-positive men, not having non-primary partners was associated with having a Black partner; no sexual network characteristics were associated with having a partner with at least two age category difference and SDUI.

CONCLUSIONS

Black MSM sexual networks were relatively small and often overlapped with the social networks. Sexual risk was associated with having non-primary partners and larger network size. Network interventions that engage the social networks of Black MSM, such as interventions utilizing peer influence, should be developed to address stable partnerships, number of partners, and serostatus disclosure.

Disassortative Age-Mixing Does Not Explain Differences in HIV Prevalence between Young White and Black MSM: Findings from Four Studies

OBJECTIVE

Age disassortativity is one hypothesis for HIV disparities between Black and White MSM. We examined differences in age mixing by race and the effect of partner age difference on the association between race and HIV status.

DESIGN

We used data from four studies of MSM. Participants reported information about recent sexual partners, including age, race, and sexual behavior. Two studies were online with a US sample and two focused on MSM in Atlanta.

METHODS

We computed concordance correlation coefficients (CCCs) by race across strata of partner type, participant HIV status, condom use, and number of partners. We used Wilcoxon rank-sum tests to compare Black and White MSM on partner age differences across five age groups. Finally, we used logistic regression models using race, age, and partner age difference to determine the odds ratio of HIV-positive serostatus.

RESULTS

Of 48 CCC comparisons, Black MSM were more age-disassortative than White MSM in only two. Furthermore, of 20 comparisons of median partner age, Black and White MSM differed in two age groups. One indicated larger age gaps among the Black MSM (18-19). Prevalent HIV infection was associated with race and age. Including partner age difference in the model resulted in a 2% change in the relative odds of infection among Black MSM.

CONCLUSIONS

Partner age disassortativity and partner age differences do not differ by race. Partner age difference offers little predictive value in understanding prevalent HIV infection among Black and White MSM, including diagnosis of HIV-positive status among self-reported HIV-negative individuals.

The Role of Geographic and Network Factors in Racial Disparities in HIV Among Young Men Who have Sex with Men: An Egocentric Network Study

The objective of this study was to characterize and compare individual and sexual network characteristics of Black, White, and Latino young men who have sex with men (YMSM) as potential drivers of racial disparities in HIV. Egocentric network interviews were conducted with 175 diverse YMSM who described 837 sex partners within 167 sexual-active egos. Sexual partner alter attributes were summarized by ego. Descriptives of ego demographics, sexual partner demographics, and network characteristics were calculated by race of the ego and compared. No racial differences were found in individual engagement in HIV risk behaviors or concurrent sexual partnership. Racial differences were found in partner characteristics, including female gender, non-gay sexual orientations, older age, and residence in a high HIV prevalence neighborhood. Racial differences in relationship characteristics included type of relationships (i.e., main partner) and strength of relationships. Network characteristics also showed differences, including sexual network density and assortativity by race. Most racial differences were in the direction of effects that would tend to increase HIV incidence among Black YMSM. These data suggest that racial disparities in HIV may be driven and/or maintained by a combination of racial differences in partner characteristics, assortativity by race, and increased sexual network density, rather than differences in individual's HIV risk behaviors.

Racial/Ethnic Differences in Sexual Network Mixing: A Log-Linear Analysis of HIV Status by Partnership and Sexual Behavior Among Most at-Risk MSM

Mixing patterns within sexual networks have been shown to have an effect on HIV transmission, both within and across groups. This study examined sexual mixing patterns involving HIV-unknown status and risky sexual behavior conditioned on assortative/dissortative mixing by race/ethnicity. The sample used for this study consisted of drug-using male sex workers and their male sex partners. A log-linear analysis of 257 most at-risk MSM and 3,072 sex partners was conducted. The analysis found two significant patterns. HIV-positive most at-risk Black MSM had a strong tendency to have HIV-unknown Black partners (relative risk, RR = 2.91, p < 0.001) and to engage in risky sexual behavior (RR = 2.22, p < 0.001). White most at-risk MSM with unknown HIV status also had a tendency to engage in risky sexual behavior with Whites (RR = 1.72, p < 0.001). The results suggest that interventions that target the most at-risk MSM and their sex partners should account for specific sexual network mixing patterns by HIV status.

The role of sexually explicit material in the sexual development of same-sex-attracted Black adolescent males

Sexually explicit material (SEM) (including Internet, video, and print) may play a key role in the lives of Black same-sex sexually active youth by providing the only information to learn about sexual development. There is limited school- and/or family-based sex education to serve as models for sexual behaviors for Black youth. We describe the role SEM plays in the sexual development of a sample of Black same-sex attracted (SSA) young adolescent males ages 15-19. Adolescents recruited from clinics, social networking sites, and through snowball sampling were invited to participate in a 90-min, semi-structured qualitative interview. Most participants described using SEM prior to their first same-sex sexual experience. Participants described using SEM primarily for sexual development, including learning about sexual organs and function, the mechanics of same-gender sex, and to negotiate one's sexual identity. Secondary functions were to determine readiness for sex; to learn about sexual performance, including understanding sexual roles and responsibilities (e.g., "top" or "bottom"); to introduce sexual performance scripts; and to develop models for how sex should feel (e.g., pleasure and pain). Youth also described engaging in sexual behaviors (including condom non-use and/or swallowing ejaculate) that were modeled on SEM. Comprehensive sexuality education programs should be designed to address the unmet needs of young, Black SSA men, with explicit focus on sexual roles and behaviors that may be inaccurately portrayed and/or involve sexual risk-taking (such as unprotected anal intercourse and swallowing ejaculate) in SEM. This work also calls for development of Internet-based HIV/STI prevention strategies targeting young Black SSA men who may be accessing SEM.

Multilevel risk factors for greater HIV infection of black men who have sex with men in New York City

BACKGROUND

There is a large and disproportionate burden of HIV in black men who have sex with men (MSM) which is not adequately explained by racial/ethnic differences in risk behaviors. However, social factors may account for this disparity in HIV infection. We examine the extent to which both individual risk behaviors and social factors reduce the effect of black race and may account for the disparity in HIV infection of black MSM.

METHODS

In a cross-sectional study in New York City in 2011, MSM were venue sampled, interviewed, and HIV tested. Variables associated (P < 0.10) both with black race and testing HIV positive were analyzed using multivariate logistic regression.

RESULTS

Of 416 participants who were HIV tested and did not self-report being positive, 19.5% were black, 41.1% were Hispanic, 30.5% were white, and 8.9% were of other race/ethnicity. Overall, 8.7% tested positive (24.7% of blacks, 7.6% of Hispanics, 1.0% of whites, and 5.4% of other). The effect of black race versus non-black race/ethnicity with testing HIV positive declined by 49.2%, (crude odds ratio, 6.5 [95% confidence interval, 3.2-13.3] vs. adjusted odds ratio, 3.3 [95% confidence interval, 1.5-7.5]), after adjustment for having a black last sex partner, not having tested for HIV in the past 12 months, Brooklyn residency, and having an annual income less than US$20,000.

CONCLUSIONS

Greater HIV infection risk of black MSM may result from social factors and less frequent HIV testing than from differences in risk behaviors. To reduce the disparity in HIV infection of black MSM, multilevel interventions that both ameliorate social risk factors and increase the frequency of HIV testing are needed.

Future directions in research on sexual minority adolescent mental, behavioral, and sexual health

This article describes current knowledge on sexual, mental, and behavioral health of sexual minority (SM) youth and identifies gaps that would benefit from future research. A translational sciences framework is used to conceptualize the article, discussing findings and gaps along the spectrum from basic research on prevalence and mechanisms, to intervention development and testing, to implementation. Relative to adults, there has been much less research on adolescents and very few studies that had longitudinal follow-up beyond 1 year. Due to historical changes in the social acceptance of the SM community, new cohorts are needed to represent contemporary life experiences and associated health consequences. Important theoretical developments have occurred in conceptualizing mechanisms that drive SM health disparities and mechanistic research is underway, including studies that identify individual and structural risk/protective factors. Research opportunities exist in the utilization of sibling-comparison designs, inclusion of parents, and studying romantic relationships. Methodological innovation is needed in sampling SM populations. There has been less intervention research and approaches should consider natural resiliencies, life-course frameworks, prevention science, multiple levels of influence, and the importance of implementation. Regulatory obstacles are created when ethics boards elect to require parental permission and ethics research is needed. There has been inconsistent inclusion of SM populations in the definition of "health disparity population," which impacts funding and training opportunities. There are incredible opportunities for scholars to make substantial and foundational contributions to help address the health of SM youth, and new funding opportunities to do so.

Reconciling Reality with Fantasy: Exploration of the Sociocultural Factors influencing HIV Transmission among Black Young Men who have Sex with Men (BYMSM) within the House Ball Community: A Chicago Study

Studies involving the House Ball Community (HBC) have found high rates of HIV prevalence and undiagnosed HIV infection, as well as unique social and sexual network-related HIV risk and protective behaviors (Murrill et al., 2008; Sanchez et al., 2010). Efforts to understand culturally-appropriate and effective methods of HIV prevention services within the relatively understudied HBC are scarce (Phillips et al., 2011). This qualitative study, utilizing a Diffusion of Innovation Theoretical framework, aimed to explore social norms regarding HIV and accessibility of HIV prevention services within the HBC. Thirty-seven participants (16 community leaders and 21 youth) engaged in focus group discussions. Participants discussed the perceptions of HIV and stigmatization within the HBC, general and HBC-specific risk factors for HIV transmission, as well as HIV prevention needs and strategies for culturally-appropriate HIV interventions. Findings from this qualitative study highlight both the vulnerability of the HBC to HIV transmission and the corresponding support for HIV prevention interventions.

"I Always Felt I Had to Prove My Manhood": Homosexuality, Masculinity, Gender Role Strain, and HIV Risk Among Young Black Men Who Have Sex With Men

Objectives. We explored gender role strain (GRS) arising from conflict between homosexuality and cultural conceptions of masculinity among young Black men who have sex with men (MSM). Methods. We conducted a categorical analysis (a qualitative, 3-stage, iterative analysis) of data from studies conducted in 2001 to 2006, which interviewed 35 men aged 18 to 24 years in 3 New York cities and Atlanta, Georgia. Results. Participants described rigid, often antihomosexual expectations of masculinity from their families, peers, and communities. Consistent with GRS, this conflict and pressure to conform to these expectations despite their homosexuality led to psychological distress, efforts to camouflage their homosexuality, and strategies to prove their masculinity. Participants believed this conflict and the associated experience of GRS might increase HIV risk through social isolation, poor self-esteem, reduced access to HIV prevention messages, and limited parental-family involvement in sexuality development and early sexual decision-making. Conclusions. Antihomosexual expectations of masculinity isolate young Black MSM during a developmental stage when interpersonal attachments are critical. GRS may influence sexual risk behavior and HIV risk and be an important target for HIV prevention.