How Old Is He Really? The Association Between "Gay Age" and Sexual Behaviors Among Men Who Have Sex With Men

Background:

Men who have sex with men (MSM) are disproportionately impacted by HIV and other sexually transmitted infections (STIs), with sexual behaviors acting as a primary predictor of disease acquisition. Predictors of engagement in specific sexual behaviors may act as key targets for preventive strategies. We hypothesized that time since first engaging in oral or anal sex with another man, or one’s “gay age”, is associated with sexual behavior among MSM.

Methods:

We examined 5,280 MSM, aged 18–40, who were recruited from social and sexual connection websites. We used modified Poisson regression to examine associations between gay age and four sexual behaviors (enema use, group sex, receptive anal intercourse, insertive anal intercourse). We used time-varying effect models (TVEM) to examine how the prevalence of these behaviors varies across gay age.

Results:

In total, 76% of participants reported receptive anal intercourse in the past year and 76% reported insertive anal intercourse. Group sex and enema use in the past year were reported by 39% and 36%, respectively. Modified Poisson and TVEM analyses indicated that prevalence of enema use, group sex, and insertive anal intercourse significantly increased with increasing gay age.

Conclusions:

Gay age may serve as an important marker of engagement in sexual behaviors associated with STI/HIV acquisition among MSM.

Time since first engaging in oral or anal sex with another man may act as a marker of engagement in sexual behaviors associated with STI/HIV transmission among MSM.

Sexual Activities and Changes in Condom Use in Group Sex Events Among Female Sex Workers in Melbourne, Australia

Background

There are few studies investigating group sex among female sex workers (FSWs). This study aimed to examine the typical number of group sex participants, sexual activities and condom use in group sex among FSWs attending a sexual health clinic in Melbourne, Australia.

Methods

We conducted a cross-sectional survey between May 1, 2019 and March 13, 2020 among FSWs in Melbourne. Participants were asked whether they had participated in group sex (sex involving more than two participants) within the past 3 months, the size of the most recent group sex event, sexual activities they engaged in and condom use. It is unknown whether this was a paid or unpaid event in our study.

Results

Of the 247 FSWs surveyed, the mean age was 28.9 years and 51.8% were born in Australia. More than a quarter (27.5%, n = 68) had had group sex in the past 3 months with the number of events ranging from 1 to 10 times. The median size of the group was 3 participants with one man and two women (including the FSW) being the most common combination. Kissing was the most common activity in group sex. Of 58 FSWs who had vaginal sex during group sex, 77.3% (51/58) reported their male partners always used condoms but 13.7% (7/51) of these did not change condoms between women.

Conclusion

This study finds that group sex is common among FSWs. Although condoms are always used during group sex, one in six men did not change their condoms between partners, which may increase STI transmission between partners.

Assembling bodies-without-organs: A poststructuralist analysis of group sex between men

Group sex among men who have sex with men may be understood as a 'radical' practice insofar as it transgresses dominant social discourses around appropriate sexual relations-prioritizing heteronormative, monogamous and risk-averse sex. These practices are generally defined as steeped in risk, most commonly due to the potential for transmitting human immunodeficiency virus and sexually transmitted infections and accompanied by the possibility of legal and social repercussions. Our ethnographic research study explored the desires, practices and contexts of group sex participants (n = 10) within a popular group sex party destination located in the United States. We employ a poststructuralist perspective (utilizing the work of Deleuze and Guattari) to understand group sex events with the pretext that bodies have no inherent ethics, meaning or essence: they are 'bodies without organs'. We identify group sex as a form of boundary play, in which participants pursue new limits to what their bodies can do but within a carefully constructed environment that establishes norms of interaction meant to secure trust and safety between participants. A variety of risk reduction practices are shown to be promoted and honoured within these eventful sexual(ized) spaces. The application of poststructuralist concepts of 'boundary play' and 'bodies without organs' helped to depict the construction and navigation of pleasure, safety and risk among group sex participants.

Group Sex Events Among Cisgender Men Who Have Sex With Men: Cross-Sectional and Longitudinal Survey Study to Explore Participation and Risk-Taking Behaviors

Background

Group sex events (GSEs) are common among cisgender men who have sex with men (MSM), pose a unique risk profile for HIV and sexually transmitted disease (STD) transmission, and may be on the rise, in part because of Web-based networking platforms. However, collecting data on GSEs can be challenging, and many gaps exist in our knowledge about GSE participation among MSM.

Objective

The objective of this study was to develop survey questions addressing aggregate and partner-specific group sex behaviors to measure prevalence of GSEs and associated risks in persons participating in Project Diagnostic Evaluation To Expand Critical Testing Technologies (DETECT), including MSM seeking HIV and STD testing at a public clinic in Seattle, Washington.

Methods

We developed a computer self-assisted survey that included questions about participant demographics, sexual history, and risk behaviors, including group sex, as a part of Project DETECT, a Centers for Disease Control and Prevention–funded study evaluating point-of-care HIV tests. Aggregate and partner-specific questions asked about participation in all GSEs, threesomes, and four-or-more-somes including questions about number and HIV status of sex partners and condom use during the events. To evaluate question performance, we assessed the discrepancies in reporting between the aggregate and partner-specific questions, quantified question refusal rates, and calculated the additional time required to answer the GSE questions. Information about network density (number of partnerships of overlapping duration) was estimated and compared for MSM who did and did not report GSEs.

Results

Among 841 visits by 690 MSM who were asked any group sex survey question, participation in a GSE of any type in the past 3 months was reported at 293 visits (293/841, 34.8%). We found that 9.0% (76/841) of MSM in the sample reported ≥1 four-or-more-some in the partner-specific questions but did not report in the aggregate. The proportion of refusals on any given aggregate GSE-related question ranged from 0% (0/273) to 10.6% (15/141) (median 2.6%) and partner-specific questions ranged from 0% (0/143) to 22% (5/23) (median 3.0%), with questions about four-or-more-somes having the highest proportions of refusals. Completing the aggregate group sex questions added 1 to 2 minutes and the partner-specific questions added an additional 2 to 4 minutes per partner to the total survey length. As expected, the partner-specific GSE questions documented higher density of sexual networks that was not captured by asking about total partner counts and overlap of specific partnerships.

Conclusions

We found that the Project DETECT survey was able to obtain nuanced information about GSEs. The question skip patterns and consistency checks were effective, and survey fatigue was minimal. More research is needed on GSEs, and our survey represents a promising data collection tool to help fill gaps in knowledge about the subject.

Lymphogranuloma venereum (LGV) in men who have sex with men (MSM): a re-emerging problem, Malta, 2018

From 1 January to 30 June 2018, 11 cases of Lymphogranuloma venereum (LGV; all preserved samples (n = 4) genovar L2b) were identified at the Genitourinary Clinic (GUC), Mater Dei Hospital, Msida, Malta. All cases were diagnosed in men who have sex with men (MSM); six participated in three group-sex parties. Here, we describe the outbreak and risk factors associated with LGV diagnoses in MSM in Malta in 2018.

Complex drug use patterns and associated HIV transmission risk behaviors in an Internet sample of U.S. men who have sex with men

Although the relationship between drug use and HIV risk among men who have sex with men (MSM) is well described, relatively few studies have employed empirical methods to assess underlying classes of drug use that may better predict the risk of HIV or sexually transmitted infections (STIs) among MSM. The aim of this study was to determine whether latent class analysis (LCA) would identify underlying drug classes reported prior to sex, as well as predict unprotected anal intercourse (UAI) in the last sexual encounter among MSM. From 2004 to 2005, an anonymous online survey was conducted among 8,717 sexually active MSM recruited from gay-affiliated U.S. websites. LCA clustered participants into six distinct drug use classes based on the specific types and number of drugs used: (1) low/no drug use, (2) recreational drug use, (3) poppers with prescription erectile dysfunction (ED) drug use, (4) poppers with both prescription and non-prescription ED drug use, (5) recreational, club, and ED drug use, and (6) high polydrug use. Compared with men in Class 1, men in the highest drug use class were 4.84 times more likely to report UAI in their last sexual encounter and 3.78 times more likely to report an STI in the past year (both ps < .001). Younger MSM aged 18-29 were significantly more likely to report an STI than men aged 50 and above (p < .001). There is a need to better understand the complex relationship between a diverse set of drugs used among MSM and how polydrug use impacts sexual negotiation over time.

Multi-person sex among a sample of adolescent female urban health clinic patients

Adolescent sexual activity involving three or more people is an emerging public health concern. The goal of this exploratory, cross-sectional study was to describe the prevalence, correlates, and context of multiple-person sex among a sample of adolescent females seeking health care from an urban clinic. Because sex involving multiple people may either be consensual (i.e., "three-ways" or "group sex") or forced (i.e., "gang rape"), we use the term "multi-person sex" (MPS) to encompass these experiences. Subjects were 328 females, ages 14-20 years old, who utilized a Boston-area community- or school-based health clinic between April and December of 2006, and completed an anonymous survey using computer-assisted self-interview software. Overall, 7.3% reported ever having had a MPS experience. Of these, 52% reported ever being pressured to engage in MPS and 43% reported ever being threatened or forced. Condom nonuse by at least one male participant in the most recent MPS was reported by 45%. Controlling for potential demographic confounders, MPS was associated with cigarette smoking (adjusted prevalence ratio [APR], 3.83; 95% confidence interval [CI], 1.56-9.44), sexual initiation prior to age 15 (APR, 2.50; 95% CI, 1.04-5.98), ever being diagnosed with an STI (APR, 2.55; 95% CI, 1.08-6.03), dating violence victimization (APR, 4.43; 95% CI, 1.68-11.69), childhood sexual abuse victimization (APR, 4.30; 95% CI, 1.83-10.07) and past-month pornography exposure (APR, 4.79; 95% CI, 1.91-11.98). Additional study of the perpetration and prevention of adolescent MPS is urgently needed.

"Group sex" parties and other risk patterns: A qualitative study about the perceptions of sexual behaviors and attitudes of adolescents in Soweto, South Africa

This study explored perceptions about sexual behaviors and attitudes of adolescents living in Soweto, Johannesburg, South Africa, from the perspective of parents, counselors and adolescents. A qualitative methodology was applied. Nine focus group discussions (FGDs) were held; three with parents of adolescents, two with counselors who work with adolescents, two with female adolescents aged 16-18 years and two with male adolescents aged 16-18 years. In total, 80 participants were recruited from in and around Soweto. FGDs were guided by a semi-structured interview guide, audio-recorded, transcribed verbatim and translated into English. Data were analyzed using Maxqda, a qualitative software analysis program. There were eight key themes related to adolescent sexuality and perceived attitudes towards relationships. Five themes were common to all participant groupings (parents, counselors and adolescents): (1) dating during adolescence, (2) adolescent females dating older males, (3) condom use amongst adolescents, (4) pregnancy and (5) homosexuality. (6) Sex as a regular and important activity among adolescents and (7) group sex practices among adolescents emerged as themes from adolescent and counselor FGDs. Lastly, (8) the role of the media as an influence on adolescent sexuality was common to adolescent and parent groups. Risky sexual behaviors continue among adolescents, with group sex parties a concerning emergent phenomenon that necessitates further study. HIV, other STIs and pregnancy prevention interventions should address multiple levels of influence to address context-specific influences.