HIV status differences in venues where highly sexually active gay and bisexual men meet sex partners: results from a pilot study

Brief Report: Group Sex Among Men Who Have Sex With Men in the Era of PrEP: A Cross-Sectional Study

BACKGROUND

Group sex has been commonly reported among gay and bisexual men who have sex with men (GBMSM); however, there are limited studies on the factors associated with participating in group sex.

SETTING

A cross-sectional study among GBMSM attending a sexual health clinic in Melbourne, Australia.

METHODS

Univariable and multivariable logistic regression were performed to examine the association between GBMSM participating in group sex in the previous 3 months and their demographic characteristics, including age, pre-exposure prophylaxis (PrEP) use, HIV status, any STI (gonorrhea, chlamydia, syphilis) diagnosis on the day, and method of seeking partners.

RESULTS

There were 357 GBMSM who participated in the survey and their mean age was 32.9 years (SD = 10.9). Almost a third (n = 115; 32.2%) had participated in group sex in the previous 3 months. GBMSM who sought sex partners at sex on premises venues (SOPVs) [aOR 5.83; 95% confidence interval (CI): 3.23 to 10.53] had the highest odds of group sex participation after adjusting for other potential confounders. Compared with GBMSM not living with HIV and not taking PrEP, GBMSM taking PrEP had higher odds of group sex participation (aOR 2.09; 95% CI: 1.05 to 4.15), but GBMSM living with HIV did not (aOR 0.93; 95% CI: 0.23 to 3.68).Recent group sex participation was not associated with being diagnosed with any STI (chlamydia, syphilis, or gonorrhea) on the day in the adjusted analyses.

CONCLUSION

PrEP users and MSM attending SOPVs are more likely to participate in group sex. SOPV could be important venues for future public health campaigns.

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.

Is Tinder-Grindr Use Risky? Distinguishing Venue from Individuals' Behavior as Unique Predictors of Sexual Risk

Geosocial networking apps (GSN; e.g., Tinder, Grindr) have rapidly increased in popularity, showing associations with greater sexual risk-taking. This study sought to distinguish between risks associated with intensive partner-seeking (i.e., individuals seeking out casual sex frequently across many venues) and risks associated with specific venues (e.g., GSNs, dating websites, offline activities). Expanding upon a literature predominantly focused on the population of men who have sex with men (MSM), we recruited a broader range of sexual identities. A convenience sample of 3180 participants from the U.S. (18-75 years old, 69% female, 75% Caucasian, 68% heterosexual) completed an anonymous, cross-sectional online survey. Logistic regressions yielded adjusted odds ratios highlighting the unique links between each predictor and sexual risk-taking. MSM/WSW indicators, quantity of partner-seeking and specific venues-particularly GSN use-emerged as robust predictors of sexual risk, increasing the odds of reporting all six outcomes examined: (1) having three or more sex partners in the last year, (2) having hookups in the last 2 months, (3) having hookups involving alcohol or (4) drug use, (5) condomless sexual activity with new partners in the last 2 months, and (6) ever having had a sexually transmitted infection. Although a large portion of risk originated from the proclivities of the individuals seeking casual sex, both online and offline methods of partner-seeking also contributed significant risk, suggesting that specific venues like GSN apps could be used as methods of targeting higher-risk behaviors. The results also highlight the importance of moving beyond MSM when addressing sexual risk.

Genetic Network Analysis to Assess the Risk of Human Immunodeficiency Virus Transmission Among Men Who Have Sex With Men Seeking Partners on the Internet

BACKGROUND

Online partner seeking (OPS) among men who have sex with men (MSM) is associated with increased risk behavior including frequency of unprotected anal intercourse, number of partners, and incidence of sexually transmitted infections (STIs). However, the impact on transmission of human immunodeficiency virus (HIV) is uncertain.

METHODS

MSM diagnosed with acute and early HIV infection were recruited from the Primary Infection Resource Consortium. HIV transmission events in the year following infection were inferred using estimated date of infection combined with genetic network analysis with linked sequences defined as ≤0.015 sequences/site difference in the HIV type 1 (HIV-1) pol coding region. Participants completed a detailed baseline questionnaire including reported methods of meeting sexual partners, including OPS, in the prior 3 months, and regression was performed with inferred transmission as the outcome.

RESULTS

From 147 MSM who completed the questionnaire, there were an associated 20 inferred HIV transmissions. No association with OPS was found (odds ratio, 0.64 [95% confidence interval, .24-1.69]; P = .37), though individuals who reported OPS were more likely to have reported a greater number of partners (P = .003) and prior STIs (P = .002). Geospatial analysis did not indicate that OPS was associated with increased geographical reach of the user (P = .68).

CONCLUSIONS

Individuals reporting OPS did not have increased odds of inferred HIV-1 transmission in the year following infection using genetic linkage analysis despite apparently increased risk behavior. OPS also did not increase the geographic distance between genetically clustered HIV infections, suggesting that individuals mainly use the internet to meet partners in their local region.

The Association between Use of Online Social Networks to Find Sex Partners and Sexually Transmitted Infection Diagnosis among Young Men Who Have Sex with Men and Transgender Women Living with HIV

We conducted a cross-sectional analysis of baseline data from the Adolescent Trials Network for HIV/AIDS Interventions to examine the association between the use of social media sites to find sex partners and recent diagnosis of sexually transmitted infections (STIs) among 13- to 24-year-old men who have sex with men and transgender women living with HIV. We used linear regression to determine the relationship between the number of STIs and the number of social media sites used to find sex partners with each type of sex act included in the analysis. Secondary analyses substituted frequency of social media site use for number of social media sites. Among 741 participants, for every 1 social media account used to find sex partners, there was a 2.53% (95% confidence interval: 0.28-5.54) increase in STIs. This association was mediated through condomless receptive anal intercourse or condomless insertive anal intercourse but not barrierless oral intercourse. Similar but attenuated associations were found when frequency of social media site use was substituted for number of social media sites. Future research should examine innovative interventions on these social media sites with respect for its users.

Prevalence of and Factors Associated with the Use of HIV Serosorting and Other Biomedical Prevention Strategies Among Men Who Have Sex with Men in a US Nationwide Survey

PrEP and treatment-as-prevention (TasP) are biomedical strategies to reduce HIV transmission. Some men who have sex with men (MSM) are combining biomedical strategies with HIV serosorting-termed "biomed matching" when both partners are either on PrEP or TasP, or "biomed sorting" when one partner is using PrEP and the other TasP. Nevertheless, there is limited data on the extent of biomed matching/sorting in large geographically diverse samples. In 2016-2017, 5021 MSM from across the US were surveyed about their HIV status and HIV viral load/PrEP use, as well as that of their recent casual male partners. For each participant, we calculated the proportion of his partners who were (1) HIV-positive and undetectable, (2) HIV-positive and detectable/unknown, (3) HIV unknown/undiscussed, (4) HIV-negative on PrEP, (5) HIV-negative, not on PrEP. In total, 66.6% (n = 3346) of participants were HIV-negative and not on PrEP, 11.9% (n = 599) on PrEP, 14.1% (n = 707) HIV-positive and undetectable, 1.1% (n = 55) HIV-positive and viral load detectable/unknown, and 6.2% (n = 313) HIV unsure/unknown. A participant's own HIV and PrEP status/was significantly associated with that of his partners (all p < 0.001), evincing evidence of both serosorting and biomed matching. Among men on PrEP and those who were HIV-undetectable, there was also some evidence to suggest these participants dually engaged in biomed matching as well as biomed sorting. We found evidence of biomed matching and sorting, which may compound its effectiveness for those using it (i.e., both partners bring biomedical protection). Unintended consequences of biomed matching/sorting include that men not using a biomedical strategy may be less likely to benefit from a partner's use of the strategy-potentially further driving disparities in HIV infections. Public health campaigns might be well served to highlight not only the benefits that biomedical HIV prevention strategies provide for their users (e.g., "being on PrEP protects me from getting HIV"), but also the benefits that a user brings to his partners (e.g., "my use of PrEP means my partners won't get HIV"), and the benefits of being with a partner who is using a biomedical strategy (e.g., "my partner's use of PrEP/TasP protects me from HIV").

HIV transmission and pre-exposure prophylaxis in a high risk MSM population: A simulation study of location-based selection of sexual partners

OBJECTIVE

In France, indications for pre-exposure prophylaxis (PrEP) for HIV prevention are based on individual-level risk factors for HIV infection. However, the risk of HIV infection may also depend on characteristics of sexual partnerships. Here we study how place-based selection of partners change transmission and the overall efficiency of PrEP.

METHODS

We used the PREVAGAY survey of sexual behavior and HIV serostatus in men who have sex with men (MSM) in a Parisian district to look for associations between sexual network characteristics and HIV infection. We then simulated HIV transmission in a high-risk MSM population. We used information about venues visited to meet casual sexual partners (clubs, backrooms or saunas) to define sexual networks. We then simulated HIV transmission in these networks and assessed the impact of PrEP in this population.

RESULTS

In the PREVAGAY study, we found that HIV serostatus changed with the type of venues visited, in addition to other individual risk factors. In simulations, we found similar differences in HIV incidence when the choice of venues visited was not random. The use of PrEP allowed reducing incidence, irrespective of the venues visited by PrEP users. However, with the same amount of PrEP, the number of infections adverted could almost double depending on network structure and venues visited by PrEP users.

CONCLUSION

This study shows that characteristics of the sexual network structure can strongly impact the effectiveness of PrEP interventions. These should be considered further to refine individual risk assessment and maximize the effect of individual-based prevention policies.

The network structure of sex partner meeting places reported by HIV-infected MSM: Opportunities for HIV targeted control

Baltimore, Maryland ranks among U.S. cities with the highest incidence of HIV infection among men who have sex with men (MSM). HIV screening at sex partner meeting places or venues frequented by MSM with new diagnoses and/or high HIV viral load may reduce transmission by identifying and linking infected individuals to care. We investigated venue-based clustering of newly diagnosed MSM to identify high HIV transmission venues. HIV surveillance data from MSM diagnosed between October 2012-June 2014 and reporting ≥1 sex partner meeting place were examined. Venue viral load was defined according to the geometric mean viral load of the cluster of cases that reported the venue and classified as high (>50,000 copies/mL), moderate (1500-50,000 copies/mL), and low (<1500 copies/mL). 143 MSM provided information on ≥1 sex partner meeting place, accounting for 132 unique venues. Twenty-six venues were reported by > 1 MSM; of these, a tightly connected cluster of six moderate viral load sex partner meeting places emerged, representing 66% of reports. Small, dense networks of moderate to high viral load venues may be important for targeted HIV control among MSM.

HIV Research with Men who Have Sex with Men (MSM): Advantages and Challenges of Different Methods for Most Appropriately Targeting a Key Population

The difficulty in accessing hard-to-reach populations as men who have sex with men presents a dilemma for HIV surveillance as their omission from surveillance systems leaves significant gaps in our understanding of HIV/AIDS epidemics. Several methods for recruiting difficult-to-access populations and collecting data on trends of HIV prevalence and behavioural factors for surveillance and research purposes have emerged. This paper aims to critically review different sampling approaches, from chain-referral and venue-based to respondent-driven, time-location and internet sampling methods, focusing on its main advantages and challenges for conducting HIV research among key populations, such as men who have sex with men. The benefits of using these approaches to recruit participants must be weighed against privacy concerns inherent in any social situation or health condition. Nevertheless, the methods discussed in this paper represent some of the best efforts to effectively reach most-at-risk subgroups of men who have sex with men, contributing to obtain unbiased trends of HIV prevalence and HIV-related risk behaviours among this population group.

Cruising Venues as a Context for HIV Risky Behavior Among Men Who Have Sex With Men

We examined differences in sexual risk behaviors, HIV prevalence, and demographic characteristics between men who have sex with men (MSM) who visit different types of venues to meet sexual partners, and identified correlates of high-risk behaviors. A cross-sectional behavioral survey was conducted with a venue-based sample of 1011 MSM in Portugal. Overall, 36.3 % of MSM usually visit cruising venues to meet sexual partners (63.7 % only visit social gay venues). Cruising venues' visitors reported higher HIV prevalence (14.6 % [95 % CI 11-18 %] vs. 5.5 % [95 % CI 4-7 %]). Visiting cruising venues was more likely among those older, reporting high number of male sexual partners, group sex, and unprotected anal sex with a partner whose HIV status was unknown. Cruising venues play an important role in increasing risk of HIV transmission among MSM who frequent them. Venue-focused behavioral interventions that promote healthy sexual behaviors are needed.

Seroadaptive Strategies of Gay & Bisexual Men (GBM) with the Highest Quartile Number of Sexual Partners in Vancouver, Canada

Despite continued research among men with more sexual partners, little information exists on their seroadaptive behavior. Therefore, we examined seroadaptive anal sex strategies among 719 Vancouver gay and bisexual men (GBM) recruited using respondent-driven sampling. We provide descriptive, bivariable, and multivariable adjusted statistics, stratified by HIV status, for the covariates of having ≥7 male anal sex partners in the past 6 months (Population fourth quartile versus <7). Sensitivity Analysis were also performed to assess the robustness of this cut-off. Results suggest that GBM with more sexual partners are more likely to employ seroadaptive strategies than men with fewer partners. These strategies may be used in hopes of offsetting risk, assessing needs for subsequent HIV testing, and balancing personal health with sexual intimacy. Further research is needed to determine the efficacy of these strategies, assess how GBM perceive their efficacy, and understand the social and health impacts of their widespread uptake.

Is Group Sex a Higher-Risk Setting for HIV and Other Sexually Transmitted Infections Compared With Dyadic Sex Among Men Who Have Sex With Men?

BACKGROUND

Group sex has been suggested as a potential high-risk setting for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM). We investigated whether group sex is associated with lower condom use during anal sex and higher proportions of STIs compared with dyadic sex among HIV-negative MSM between 2009 and 2012.

METHODS

Cross-sectional data from 7 data waves of the Amsterdam Cohort Studies were used. The sample consisted of 465 MSM who either reported both group and dyadic sex (at n = 706 visits) or dyadic sex only (at n = 1339 visits) in the preceding 6 months. Logistic regression with generalized estimating equations was used to investigate the association between sexual setting (group vs. dyadic sex), condomless anal sex, and STI.

RESULTS

Group sex was reported at 35% (706/2045) of visits. Condomless sex was more often reported during dyadic than group sex (odds ratio, 3.64 95% confidence interval, 2.57-5.16). Men who had group sex were more likely diagnosed as having gonorrhea compared with men with dyadic sex (odds ratio, 1.71; 95% confidence interval, 1.08-2.97), but this effect was not retained in the multivariate model.

CONCLUSIONS

Results demonstrate within-person differences in sexual behavior during group and dyadic sex among MSM. Men were more likely to use condoms during group sex than during dyadic sex. Thus, for some, group sex may not necessarily be risky for HIV infection compared with dyadic sex. However, group sex may be a higher-risk setting for acquiring STIs other than HIV, such as gonorrhea. Group sex encounters should be recognized as distinct sexual settings with specific risk characteristics that need to be addressed accordingly.

How Different are Men Who Do Not Know Their HIV Status from Those Who Do? Results from an U.S. Online Study of Gay and Bisexual Men

We compared self-described HIV-positive (31.6 %, n = 445), HIV-negative (56.8 %, n = 801), and HIV-unknown (11.6 %, n = 164) gay and bisexual men on sociodemographic and behavioral characteristics. Participants from across the U.S. were enrolled via a popular sexual networking website to complete an online survey. In total, 44.8 % of HIV-negative and HIV-unknown men said they had not been tested for HIV in the CDC-recommended last 6 months. HIV-unknown men significantly differed from HIV-negative and HIV-positive men in sexual behavior and HIV status disclosure patterns. HIV-unknown men were more willing than HIV-negative men to take PrEP; however, HIV-unknown men were significantly less likely than others to have health insurance or a primary care provider. Given the observed differences, researchers should consider analyzing men who are HIV-unknown distinctly from HIV-negative and HIV-positive men.

[Use of psychostimulants in a sexual context: Analysis of cases reported to the French network of Addictovigilance Centers]

The "SLAM" phenomenon is an increasingly popular practice, in Paris and London gay scene, defined by 3 characteristics: injection, sexual party and psychostimulant drugs. The French Medical Agency requested a risk assessment of "SLAM" and more broadly of the use of psychostimulants in a sexual context, by the analysis of complications related to this practice notified to the French Network of Addictovigilance Centers. All cases of complications related to "SLAM" practice, including cases of abuse or dependence, and somatic and psychiatric complications, were analysed. Between January 2008 to December 2013, 51 cases were collected. Users were exclusively men, with a mean age of 40 years, having psychostimulants exposure in a sexual context, mainly in men who have sex with men (MSM) context (100%, n=35). The prevalence of human immunodeficiency virus (HIV) infection was 82% (n=32) with a high level of HIV/hepatitis C virus (HCV) co-infection (50%, n=16). The main psychostimulants reported are synthetic cathinones (89.5%). Cathinones users tended to be polydrug users: 62% also reported use other than psychoactive substances (gamma-butyrolactone [GBL], ketamine, methylenedioxyméthamphetamine [MDMA], lysergic acid diethylamide [LSD]…). The main complications were psychiatric disorders in 50% (psychotic symptoms, agitation, anxiety, suicidal ideas or attempt and forensic problems), acute intoxication in 25% (including 3 deaths), dependence and abuse in 17% and infectious complications in 8% (viral seroconversion). Health professionals as well as users should be aware of the physical (cardiovascular) and behavioural (psychic, fast dependence syndrome) toxicity of cathinones. Risk reduction policy must be targeted to the population of MSM with specific interventions both on risky sexual behavior and substance use.

Is Group Sex a Higher-Risk Setting for HIV and Other Sexually Transmitted Infections Compared With Dyadic Sex Among Men Who Have Sex With Men?

BACKGROUND

Group sex has been suggested as a potential high-risk setting for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM). We investigated whether group sex is associated with lower condom use during anal sex and higher proportions of STIs compared with dyadic sex among HIV-negative MSM between 2009 and 2012.

METHODS

Cross-sectional data from 7 data waves of the Amsterdam Cohort Studies were used. The sample consisted of 465 MSM who either reported both group and dyadic sex (at n = 706 visits) or dyadic sex only (at n = 1339 visits) in the preceding 6 months. Logistic regression with generalized estimating equations was used to investigate the association between sexual setting (group vs. dyadic sex), condomless anal sex, and STI.

RESULTS

Group sex was reported at 35% (706/2045) of visits. Condomless sex was more often reported during dyadic than group sex (odds ratio, 3.64 95% confidence interval, 2.57-5.16). Men who had group sex were more likely diagnosed as having gonorrhea compared with men with dyadic sex (odds ratio, 1.71; 95% confidence interval, 1.08-2.97), but this effect was not retained in the multivariate model.

CONCLUSIONS

Results demonstrate within-person differences in sexual behavior during group and dyadic sex among MSM. Men were more likely to use condoms during group sex than during dyadic sex. Thus, for some, group sex may not necessarily be risky for HIV infection compared with dyadic sex. However, group sex may be a higher-risk setting for acquiring STIs other than HIV, such as gonorrhea. Group sex encounters should be recognized as distinct sexual settings with specific risk characteristics that need to be addressed accordingly.

Social media use and HIV transmission risk behavior among ethnically diverse HIV-positive gay men: results of an online study in three U.S. states

Though Black and Hispanic men who have sex with men (MSM) are at an increased risk for HIV, few HIV risk reduction interventions that target HIV-positive MSM, and even fewer that use technology, have been designed to target these groups. Despite similar rates of social media and technology use across racial/ethnic groups, online engagement of minority MSM for HIV prevention efforts is low. Since minority MSM tend to have less representation in online HIV prevention studies, the goals of this online anonymous study of HIV-positive gay-identified men were to test the feasibility of conducting targeted recruitment by race/ethnicity and sexual orientation, to assess technology and social media use, and to assess global HIV transmission risk. In 2011, an anonymous online survey was conducted among 463 members of an HIV-positive personals website. Emails were sent to a subset of HIV-positive male members who self-identified as gay. While 57 % were White, substantial proportions of participants were Black (20 %) or Hispanic (18 %). Median age was 46 (range 18-79). Men who reported using 3 or more websites or apps to meet sex partners were significantly more likely to report anal intercourse (AOR 4.43, p < .001) and condomless anal sex (CAS) (AOR 2.70, p < .05) in the past 3 months. The only predictor of CAS with HIV-negative or unknown status partners was being under age 30 (AOR 3.38, p < .01). This study helped to inform online targeted recruitment techniques, access to technology and social media use, and sexual risk among a diverse sample of HIV-positive gay men. Efficacy trials of technology-based HIV prevention interventions targeting high-risk minority HIV-positive MSM are warranted.

A systematic review of evidence to inform HIV prevention interventions among men who have sex with men in Europe

An estimated 42% of all newly diagnosed HIV cases in Europe in 2013 were transmitted during sex between men. This review was performed to identify and describe studies evaluating the efficacy and effectiveness of HIV prevention interventions among men who have sex with men (MSM), in relation to implementation data from European settings. A systematic search was performed individually for 24 interventions.Data were extracted from studies including efficacy or implementation data from European settings,appraised for efficacy, implementation and plausibility, and assigned a grade (1-4) according to the Highest Attainable Standard of Evidence (HASTE)framework. Four interventions (condom use, peer outreach,peer-led groups, and using universal coverage of antiretroviral treatment and treatment as prevention)were assigned the highest HASTE grade, 1. Another four interventions were assigned 2a for probable recommendation, including voluntary counseling and testing for HIV, using condom-compatible lubricant,using post-exposure prophylaxis, and individual counselling for MSM living with HIV. In addition, seven interventions were assigned a grade of 2b, for possible recommendation. Encouragingly, 15 interventions were graded to be strongly, probably or possibly recommended.In the relatively resource-rich European setting, there is an opportunity to provide global leadership with regard to the regional scale-up of comprehensive HIV prevention interventions for MSM.

Partners met via sex parties present significantly greater odds for condomless anal sex among MSM: an event-level analysis of venues where male partners are met

One hundred forty-seven men who have sex with men completed time-line follow-back interviews about the venues where they met their male partners (n = 1180 sexual events with first-time partners, <30 days). We ran multivariate models to determine the association between venues and condomless anal sex (CAS). After adjusting for known correlates of CAS, partners met at sex parties presented significantly greater odds for CAS compared with meeting a partner at a gay bar/club (adjusted odds ratio = 0.44), online (adjusted odds ratio = 0.42), bathhouse (adjusted odds ratio = 0.35), or via "other" venues (adjusted odds ratio = 0.35), all P < 0.01. These findings highlight the need to develop innovative HIV/sexually transmitted infection prevention initiatives for men who attend sex parties.

Venues, patrons, and alcohol use dynamics: the creation of a high risk sexual environment

Venue-based HIV prevention interventions, especially in sex on premise venues, can disrupt high-risk sexual networks. However, prior to intervening, it is essential to understand the person-venue dynamics that contribute to HIV risk. As such, we conducted five ethnographic observations at each of six venues where alcohol is sold and sex occurs onsite (2 each porn theaters, sex clubs, and dance clubs) frequented by gay and other men who have sex with men (G&MSM) in the Buenos Aires metropolitan area. Alcohol use, sexual behavior, and person-venue dynamics differed markedly across venue types. In dance clubs, substantial alcohol consumption often preceded visits to the darkroom for sex which, at times, included unprotected anal and vaginal intercourse. Condoms, although available, were not easily accessible. HIV prevention messaging was generally non-existent. These venues are in critical need of interventions to reduce HIV transmission risk.

Place and sexual partnership transition among young American Indian and Alaska native women

Multiple challenges expose American Indian and Alaska Native (AIAN) women to high-risk sexual partnerships and increased risk for HIV/STI. Using a unique sample of sexually-active young AIAN women (n = 129), we examined characteristics of last three partners and whether transitional partnerships were associated with different risk profiles, including where partners met, lived, and had sex. Respondents were more likely to have met their previous or current secondary partner (P2) at a friend's or family setting (versus work or social setting) (AOR = 3.92; 95 % CI 1.31, 11.70). Condom use was less likely when meeting a partner at friend's or family settings (AOR = 0.17; 95 % CI 0.05, 0.59). Sexual intercourse with P2 (compared to P1) usually took place in "riskier" settings such as a car, bar, or outside (AOR = 4.15; 95 % CI 1.59, 10.68). Perceived "safe" places, e.g., friend's or family's house, were identified with risky behaviors; thus, homogeneous messaging campaigns may promote a false sense of safety.

Comparing three cohorts of MSM sampled via sex parties, bars/clubs, and Craigslist.org: implications for researchers and providers

With limited exceptions, few studies have systematically reported on psychosocial and demographic characteristic differences in samples of men who have sex with men (MSM) based on where they were recruited. This study compared three sexually active cohorts of MSM recruited via Craigslist.org (recruited via modified time-space sampling), gay bars and clubs (recruited via time-space sampling), and private sex parties (identified via passive recruitment and listserves), finding mixed results with regard to differences in demographic characteristics, STI history, and psychosocial measures. Men recruited from sex parties were significantly older, reported more symptoms of sexual compulsivity, more likely to be HIV-positive, more likely to report a history of STIs, and more likely to self-identify as a barebacker, than men recruited from the other two venues. In contrast, men from Craigslist.org reported the lowest levels of attachment to the gay and bisexual community and were the least likely to self-identify as gay. Men from bars and clubs were significantly younger, and were more likely to report use of hallucinogens and crack or cocaine. Our findings highlight that the venues in which MSM are recruited have meaningful consequences in terms of the types of individuals who are reached.

Men who have sex with men's attitudes toward using color-coded wristbands to facilitate sexual communication at sex parties

Sex parties are environments where men who have sex with men (MSM) have the opportunity to have sex with multiple partners over a brief period of time. Dim lighting and non-verbal communication are characteristics of sex parties that make sexual communication more challenging. We report on qualitative data from 47 MSM who attended sex parties in New York City. Participants responded to distinct hypothetical scenarios involving the use of color-coded wristbands to communicate (1) condom use preferences, (2) sexual position (e.g., top, bottom) and (3) HIV status at sex parties. The majority had positive-to-neutral attitudes toward color-coded wristbands to indicate (1) condom use preference and (2) sexual position (70.8%, 75.0% HIV-positive; 63.6%, 81.8%, HIV-negative respectively). These men cited that wristbands would facilitate the process of pursuing partners with similar interests while also avoiding the discomforts of verbal communication. In contrast, 41.7% of HIV-positive and 50.0% of HIV-negative men expressed unfavorable attitudes to using wristbands to communicate HIV status. These men cited the potential for HIV-status discrimination as well as suspicions around dishonest disclosure. Although participants were receptive to utilizing color-coded wristbands at sex parties to convey certain information, it may be unfeasible to use wristbands to communicate HIV status.

Gay and bisexual men's use of the Internet: research from the 1990s through 2013

We document the historical and cultural shifts in how gay and bisexual men have used the Internet for sexuality between the 1990s and 2013-including shifting technology as well as research methods to study gay and bisexual men online. Gay and bisexual men have rapidly taken to using the Internet for sexual purposes: for health information seeking, finding sex partners, dating, cybersex, and pornography. Men have adapted to the ever-evolving technological advances that have been made in connecting users to the Internet-from logging on via dial-up modem on a desktop computer to geo-social-sexual networking via handheld devices. In kind, researchers have adapted to the Internet to study gay and bisexual men. Studies have carefully considered the ethics, feasibility, and acceptability of using the Internet to conduct research and interventions. Much of this work has been grounded in models of disease prevention, largely as a result of the ongoing HIV/AIDS epidemic. The need to reduce HIV in this population has been a driving force to develop innovative research and Internet-based intervention methodologies. The Internet, and specifically mobile technology, is an environment gay and bisexual men are using for sexual purposes. These innovative technologies represent powerful resources for researchers to study and provide outreach.

Characteristics of men who have sex with men (MSM) who attend sex parties: results from a national online sample in the USA

OBJECTIVE

To compare three groups of men who have sex with men (MSM)-men who had attended a sex party in the past year (45.2%); men who had been to a sex party more than a year ago (23.3%); and men who had never been to one (31.5%)-on socio-demographic and behavioural characteristics.

METHOD

In spring 2012, 2063 sexually active MSM in the USA were recruited using banner advertising on a sexual networking website to complete an online survey about their sexual behaviour and attendance at sex parties.

RESULTS

A significantly higher proportion of past year attendees were HIV-positive (28.1%), single (31.7%), demonstrated sexual compulsivity symptomology (39.2%), recently used drugs (67.8%), averaged the greatest number of recent male partners (Mdn=15, <90 days), and had greater instances of recent unprotected anal intercourse (UAI) with male partners (median=3, <90 days). Adjusting for covariates, those having been to a sex party in the last year were significantly more likely than others to report UAI. Free lubricant (93.4%) and condoms (81.0%) were the most desirable services/products men wanted at sex parties. More than half of men having been to a sex party expressed interest in free rapid HIV testing at sex parties (52.8%); however, few considered it acceptable to see 'medical providers' (11.7%) and 'peer outreach workers' (9.5%) at sex parties.

CONCLUSIONS

MSM who have attended a sex party in the last year are appropriate candidates for targeted HIV and sexually transmitted infection (STI) prevention. Collaborating with event promoters presents valuable opportunities to provide condoms, lubricant and HIV/STI testing.

Condom use self-efficacy and HIV risk practices among men who use the internet to find male partners for unprotected sex

This research examines the levels of condom use self-efficacy in a population of men who have sex with men who are at great risk for contracting/transmitting HIV. It focuses on the relationship between condom use self-efficacy and risk involvement, and examines the factors associated with greater/lower levels of condom use self-efficacy. The data come from a national sample of men, randomly chosen, who used any of 16 websites specifically to identify other men with whom they could engage in unprotected sex. Data were collected between January 2008 and May 2009 from 332 men, via telephone interviews. Multivariate analyses and structural equation modeling were used to test a conceptual model based on syndemics theory. Overall levels of condom use self-efficacy were fairly high, and self-efficacy was related inversely to involvement in HIV risk practices. Six factors were found to be indicative of levels of condom use self-efficacy: the number of drug problems experienced, sexual role identity as a "bottom," not caring about the HIV serostatus of potential sex partners, experiencing childhood maltreatment, having confidence in HIV-related information provided in other men's online profiles, and level of HIV knowledge. Condom use self-efficacy plays an integral role in HIV risk practices among high-risk men who have sex with men. This is true despite the fact that, overall, condom use self-efficacy levels were fairly high in this population.

HIV risk in group sexual encounters: an event-level analysis from a national online survey of MSM in the U.S

INTRODUCTION

Researchers have investigated group sexual encounters (GSEs) as potential sources for HIV/STI transmission among men who have sex with men (MSM); however, much of this work has focused on organized sex parties.

AIM

To compare behavioral and social characteristics of groups of men who engaged in three types of GSEs: threesomes, spontaneous group sex, and organized sex parties.

METHODS

In 2012, 1,815 U.S.-based MSM completed an online survey.

MAIN OUTCOME MEASURE

We compared men based on their most recent type of GSE: threesome (68.2%), spontaneous group sex (19.7%), or organized sex party (12.1%).

RESULTS

Using multinomial logistic regression, with type of GSE as the dependent variable, MSM who were HIV-positive, used stimulants (cocaine, methamphetamine, crack), consumed five or more alcoholic drinks, and reported receptive unprotected anal intercourse (UAI) during the most recent GSE had significantly higher odds of having had spontaneous group sex as compared to a threesome. MSM who were HIV-positive, not in a relationship, and did not report receptive UAI during the most recent GSE had significantly higher odds of having attended an organized sex party as compared to a threesome. MSM who were in a relationship, had consumed five or more alcoholic drinks, had used stimulants, and reported receptive UAI during the most recent GSE had significantly higher odds of having had spontaneous group sex as compared to an organized sex party. Compared to others, those having engaged in a GSE were more likely to report recent UAI (65% vs. 45%).

CONCLUSIONS

Men having engaged in a GSE were at greater risk for behaviors that transmit HIV and STIs. Unique social and behavioral characteristics inherent to threesomes, spontaneous group sex, and sex parties highlight the need to identify prevention strategies to help those who participate in GSEs reduce their risk for HIV and STI transmission.

Involvement in Specific HIV Risk Practices among Men Who Use the Internet to Find Male Partners for Unprotected Sex

Purpose. Men who have sex with other men (MSM) account for more than one-half of all new HIV infections in the USA. This study reports on the prevalence of a variety of HIV risk behaviors in one specific subpopulation of risk-seeking MSM. Methods. The study was based on a national sample of 332 MSM who use the Internet to find partners for unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. Results. Unprotected oral and anal sex was commonplace among study participants. Men engaged in a large number of other risky behaviors as well, including having had multiple recent sex partners (mean number = 11), simultaneous double-penile penetration of the anus (16%), eating semen out of another man's anus (17%), engaging in multiple-partner sexual encounters (47%), engaging in anonymous sex (51%), and having sex while "under the influence" (52%). Conclusions. HIV intervention and prevention programs need to address numerous behaviors that place MSM at risk for contracting/transmitting HIV. Merely focusing on unprotected anal sex does a disservice to members of this community, who typically engage in many types of behavioral risks, each of which requires addressing if HIV transmission rates are to be reduced.

Exploring the venue's role in risky sexual behavior among gay and bisexual men: an event-level analysis from a national online survey in the U.S

Venue-based characteristics (e.g., alcohol in bars, anonymous chat online, dark/quiet spaces in bathhouses) can impact how men who have sex with men (MSM) negotiate sex and HIV-associated risk behavior. We sought to determine the association between HIV-associated risk factors and the venues where MSM met their most recent new (first-time) male sex partner, using data from a 2004 to 2005 national online anonymous survey of MSM in the U.S. (n = 2,865). Most men (62%) met their partner through the Internet. Among those reporting anal sex during their last encounter (n = 1,550), half had not used a condom. In multivariate modeling, and among men reporting anal sex during their last encounter, venue where partner was met was not significantly associated with unprotected anal intercourse (UAI). Nevertheless, venue was related to other factors that contextualized men's sexual encounters. For example, HIV status disclosure was lowest among men who met their most recent partner in a park, outdoors, or other public place and highest among men who met their most recent partner online. Alcohol use prior to/during the last sexual encounter was highest among men who met their most recent partner in a bathhouse or a bar/club/party/event. These data suggest it is possible to reach men online who seek sex in many different venues, thus potentially broadening the impact of prevention messages delivered in virtual environments. Although not associated with UAI, venues are connected to social-behavioral facets of corresponding sexual encounters, and may be important arenas for differential HIV and STI education, treatment, and prevention.

Association between sex partner meeting venues and sexual risk taking among urban adolescents

PURPOSE

To increase understanding of the association between sexual partner meeting venue types (school, through friends or family, organized groups, public places, or on the street) and sexual risk taking among urban youths.

METHODS

Data were from 17- to 18-year-old youths who reported having had sex (n = 1,656) by the time they participated in the 2008-2009 follow-up of a multicomponent alcohol preventive intervention, Project Northland Chicago. We used logistic regression to assess the association between partner meeting venue and sexual risk taking.

RESULTS

Approximately 20% of Chicago adolescents met their most recent sex partner on the street or in public places. Adolescents who met their partner in a public place, rather than in school, were more likely to report having ≥ 3 years age-discordant partner (women: odds ratio [OR] = 7.7, 95% confidence interval [CI] = 3.3-17.7; men: OR = 2.7, 95% CI = 1.1-6.6], alcohol use before sex (women: OR = 3.4, 95% CI = 1.8-6.5; men: OR = 2.4, 95% CI = 1.3-4.4), casual partner (women: OR = not significant; men: OR = 2.4, 95% CI = 1.3-4.5), anal sex (women: OR = not significant; men: OR = 2.4, 95% CI = 1.2-4.9), and unprotected sex (women: OR = 1.7, 95% CI = 1.0-2.7; men: OR = 1.9, 95% CI = 1.1-3.4). Meeting partners on the street was associated with increased probability of alcohol use before sex (women: OR = 2.2, 95% CI = 1.1-4.3; men: OR = 2.1, 95% CI = 1.0-4.6), age-discordant partnerships among women (OR = 14.2, 95% CI = 6.4-31.4), and casual sex partners among men (OR = 2.5, 95% CI = 1.4-4.8).

CONCLUSIONS

Targeting sexual risk taking with partners selected from public places or the street may improve adolescent HIV preventive interventions.

HIV risk and substance use in men who have sex with men surveyed in bathhouses, bars/clubs, and on Craigslist.org: venue of recruitment matters

There has been little evaluation regarding whether men who have sex with men (MSM) recruited in one type of venue differ in behavioral and demographic characteristics from those recruited in others. We surveyed MSM in gay bars/clubs (n = 199), bathhouses (n = 194), and off Craigslist.org (n = 208). Men in bathhouses reported the greatest average number of partners and were less likely to disclose their HIV status. Among men reporting anal sex; those on Craigslist reported the least condom use. Finally, men surveyed in gay bars/clubs were the youngest of the three and the most likely to be single; they also reported the highest levels of attachment to the gay community and the most frequent alcohol use. Our findings demonstrate the need to tailor HIV prevention efforts to the location in which they are targeted, and for researchers to evaluate if participants differ by recruitment source.

Attitudes about and HIV risk related to the "most common place" MSM meet their sex partners: comparing men from bathhouses, bars/clubs, and Craigslist.org

This study examined attitudes toward the most common place where men who have sex with men (MSM) met their recent male sex partners. In 2009-2010, MSM were surveyed in bars/clubs, bathhouses, and on Craigslist.org . We found strong but differential overlap between venue of recruitment and participants' most common place: 81% of men from Craigslist indicated their most common place was the Internet, 65% of men from bathhouses indicated their most common place was bathhouses, and 47% of men from bars/clubs indicated their most common place was bars/clubs. In general, interest in seeing more information on drugs/alcohol and HIV and interacting with a health outreach worker in participants' most common place ranged from "agree" to "strongly agree." However, men whose most common place was bars/clubs rated these items lowest on average. Rates of unprotected anal intercourse (UAI) were high (43%), thus targeted efforts in bars/clubs, bathhouses, and on the Internet may be ideal venues for reaching high-risk MSM. Although most common place was unrelated to UAI, it was related to factors that contextualize men's encounters (e.g., attitudes toward HIV status disclosure, and perceptions about barebacking, anonymous sex, and alcohol use). Outreach providers should consider these contextualizing aspects as they continue to retool their efforts.

Stigma and sexual compulsivity in a community-based sample of HIV-positive gay and bisexual men

A better exploration of factors associated with sexual compulsivity (SC) among various subpopulations may help to explain its etiology, development, and course, as well as provide implications for treatment. Criticisms of SC highlight the need to have a better understanding of SC that takes into account both behavioral and psychosocial variables such as stigma, particularly stigma related to sexual orientation and HIV status. The purpose of this study was to investigate the association of SC with sexual behavior and stigma in a sample of HIV-positive gay and bisexual men. A cross-sectional, street-intercept method was adapted to survey a sample of 127 HIV-positive gay and bisexual males at two large-scale LGBT community events in the fall of 2008 and spring of 2009. We found that the number of recent male sexual partners (AOR = 1.05) and internalized HIV stigma (AOR = 8.20) were significantly associated with SC symptomology, while internalized homonegativity and interpersonal HIV stigma were not. These findings contradict many prominent criticisms of SC while highlighting the need to better understand the mechanisms related to the development of SC symptomology and the potential role stigma may have for the psychosexual well-being of HIV-positive gay and bisexual men.

Sexual and geographic organisation of men who have sex with men in a large East African city: opportunities for outreach

OBJECTIVES

To describe geographical and dispersion patterns of men who have sex with men (MSM)-related venues in a large East African city and their associations with times, participants and venue type.

METHODS

Mapping of MSM sites in Dar es Salaam was carried out by community research workers who catalogued, observed and reported data on venue sites, formality, times of operation, type of participant, police or vigilante activity, length of operation and the degree to which it is known both in and outside the MSM and gay communities.

RESULTS

There is a large and widely disseminated MSM/gay satellite cultures of at least 98 sites, which has some formal sites, but is largely informal and operates within mixed entertainment environments and at particular times (including some weekend-only locales) across the city. There is a mix of places for sexual contact, largely social venues and sex on location sites. Cruising appears to be limited to open spaces and parks, with no vehicular component and almost no internet component. They are widely disseminated across all suburbs and there is no central location for MSM activities. MSM sex workers (SWs) operate at a third of these sites.

CONCLUSIONS

There is a large number of 'local' MSM contact, social and sex sites and any work with MSM will have to include these less-formal and less-known sites. The widely disseminated nature of the MSM sites, however, also suggests that sexual networks may not be closely linked between sites. The climate of stigma, abuse and potential violence appear to be limiting the development of more formal sites. This pattern is probably typical of other large urban areas in East Africa and perhaps across sub-Saharan Africa (SSA).