Perceptions about doxycycline post-exposure prophylaxis (Doxy-PEP) as an STI-prevention strategy among gay and bisexual men (GBM) in the United States: Results from a qualitative study

OBJECTIVE

To leverage qualitative data to explore gay and bisexual men's (GBM) perceptions about doxycycline post-exposure prophylaxis (Doxy-PEP). Doxy-PEP is a novel biomedical STI-prevention strategy that helps reduce the risk of acquiring bacterial STIs. Little is known about Doxy-PEP's acceptability in the U.S., nor how best to engage those most vulnerable to STIs in taking up this nascent prevention strategy.

METHOD

Between July and September of 2023, 24 GBM from across the U.S. completed qualitative interviews about their perceptions regarding Doxy-PEP. Interviews were analyzed using a codebook approach to thematic analysis.

RESULTS

Participants were generally interested in using Doxy-PEP, but were concerned about the potential for antibiotic resistance, side-effects, medication interactions to occur, along with stigmatizing discourse around its use. Meanwhile, participants were motivated by the simplicity of Doxy-PEP and the protection it could confer on both an individual and community-level- as well as its potential to reduce STI-related anxiety. Finally, participants desired additional information on Doxy-PEP to address their concerns.

CONCLUSIONS

There is a need for clear guidelines and expanded public health messaging on Doxy-PEP in the U.S.

Examination of Gender Differences in Depression, Relationship Satisfaction, and Problematic Pornography Use Among Romanian Gay Men and Lesbian Women

This study investigates factors influencing the psychological well-being of gay and lesbian individuals in Romania. Participants (N = 172) included 61.6% gay and 38.4% lesbians, currently in relationships, aged between 18 and 62 years (M = 28.28; SD = 9.53). Surveys assessed relationship satisfaction, depression, and problematic pornography use. Significant associations were found among these variables, with gender differences observed. We tested a regression model for problematic pornography use, where depression provided additional explanatory power to the initial model. Age, gender, and depression accounted for 18% of the variance in problematic pornography use. The theoretical and practical implications are discussed.

Problematic alcohol use among gay, bisexual, and other men who have sex with men in Canada: the role of proximal stressors and anxiety

BACKGROUND

Gay, bisexual, and other men who have sex with men (GBM) report high rates of problematic alcohol use, anxiety, and depression. This may, in part, be due to stressors related to their sexual identity (i.e., minority stressors). However, few studies have examined both distal and proximal stressors, as well as the specific psychological mechanisms by which these stressors may be related to alcohol use outcomes, in a representative sample of GBM. We explored the relationship between distal and proximal stressors and alcohol use outcomes, as well as the role of anxiety and depression as potential mediators of these relationships.

METHODS

We analyzed the baseline data of 2,449 GBM from Engage, a cohort study of sexually active GBM recruited using respondent-driven sampling (RDS) in Montreal, Toronto, and Vancouver from February 2017 to August 2019. Using structural equation modeling, we examined the associations between distal minority stressors (i.e., experiences of heterosexist harassment, rejection, and discrimination), proximal minority stressors (i.e., internalized homonegativity, concerns about acceptance, concealment, and lack of affirmation), anxiety and depression, and alcohol consumption and alcohol use problems. RDS-adjusted analyses controlled for age, income, sexual orientation, ethnicity, recruitment city, and HIV serostatus.

RESULTS

There were positive direct associations between distal stress and proximal stress, anxiety, and depression, but not alcohol use outcomes. Proximal stress had a positive direct association with anxiety, depression, and alcohol use problems, but not alcohol consumption. Anxiety was positively associated with alcohol consumption and alcohol use problems. Depression was negatively associated with alcohol consumption but not alcohol use problems. Regarding indirect effects, distal stress was associated with alcohol use outcomes via proximal stress and anxiety, but not via depression.

CONCLUSIONS

We found support for a minority stress model as it relates to alcohol use outcomes among GBM. Findings suggest that proximal minority stress and anxiety differentially impact the problematic alcohol use among GBM who experience heterosexist discrimination. Clinical providers should consider incorporating the treatment of proximal minority stressors and anxiety into existing alcohol interventions for GBM.

Intersexual and Intrasexual Differences in Mate Selection Preferences Among Lesbian Women, Gay Men, and Bisexual Women and Men

Sex differences in mating strategies and partner preferences are well established. However, most research solely focused on heterosexual women and men. We examined the mate selection, marriage, and age preferences of a sample of lesbian women, gay men, and bisexual women and men (LGB) who took part in an online dating survey. Additionally, we analyzed inter- and intrasexual differences in these preferences. A total of 710 participants rated the importance of 82 mate selection criteria and 10 marriage criteria, and they also indicated their age preferences and short-term and long-term relationship orientation. An exploratory factor analysis suggested 11 relevant domains of mate selection in the LGB sample, with sex, age, and long-term relationship orientation being relevant predictors of differences in these domains. We compared the LGB data with data collected from 21,245 heterosexual women and men on the same mate selection criteria. Results showed that the participants' sex was the most important predictor of differences in mate selection and marriage preferences, while intrasexual variables (sexual orientation and relationship orientation) explained only a small part of the variance. We incorporated the results into the current discussion about partner preferences and sexual orientation.

The Experience of Loneliness Among Gay Men in Israel: A Qualitative Study

The aim of this qualitative study is to explore the experience of loneliness among Israeli gay men in their early and mid-adulthood, ages 30-50 (N = 14). The findings demonstrate three main categories of loneliness that study participants experienced: childhood loneliness as an initial experience of gay identity; loneliness in the context of other gay men, via sexual encounters, friendships, and the use of dating apps; and loneliness in the context of heterosexual society. The findings point to the centrality of the experience of loneliness among Israeli gay men in their mid-adulthood years and emphasize how this loneliness is rooted in socio-cultural and political perceptions concerning hetero-normative as well as gay identities.

The Relations Between Self-Warmth, Self-Coldness, Internalized Heterosexism, and Depressive Symptoms Among Sexual Minority Men: A Moderated-Mediation Model

Depression is a prevalent mental health issue for sexual minority men (SMM), with the internalization of sexual identity-based stigma a key risk factor. Self-warmth is a protective factor and self-coldness is a risk factor for depressive symptoms, yet limited research in this area has focused on SMM. In the present study, an international sample of 1,285 gay and 487 bisexual men completed measures of depression, internalized heterosexism, and self-warmth/self-coldness. A multiple linear regression showed that internalized heterosexism explained 0.4% unique variance, self-warmth explained 0.5% unique variance, and self-coldness explained 18.8% unique variance in depressive symptoms. Self-warmth was directly and indirectly related to lower levels of depressive symptoms among SMM. In contrast, self-coldness was directly related to higher levels of depressive symptoms among SMM, and indirectly related to higher levels of depressive symptoms only for gay men. Findings should inform work aiming primarily to reduce self-coldness among SMM, thereby reducing depressive symptoms.

HIV Stress Exchange: Queer Men, Intergenerational Stress, and Intimacy Amidst the Time of HIV

HIV remains a principal inequity for queer men across the United States. Biomedical practices all but dominate interventions, and HIV-related stress persists among queer men. Regarding HIV as discourse is not well represented in prevention and care. This study is a response, then, to this need that seeks to build an HIV-informed model of praxis, entitled HIV Stress Exchange. A Queer Discourse Study was conducted with 20 queer men across two generations, pre-AIDS and post-AIDS. The data included in-depth interviews and material resources participants brought to the conversation. In all, this data speaks to the ways in which HIV is given life in discourse and what meaning it holds in embodied lives. Resultantly, five themes materialized, inclusive of all ages and sero-statuses: HIV provided meaning as in-/validated, un-/voiced, un-/intelligible, holding intimacy/-ies, and being PrEP/-ared. Based on the findings, the conceptual model for HIV Stress Exchange is presented along with an HIV-informed model of practice.

Between two pandemics: Older, gay men's experiences across HIV/AIDS and COVID-19

Pandemics are a component of human life, and have had great bearing on the trajectory of human evolution. Historically, the biomedical aspects of pandemics have been overrepresented, but there is growing recognition of the degree to which pandemics are socially and culturally embedded, highlighting how virus perception is socially and politically informed. Older (50+), gay men represent a population who have experienced two global pandemics in their lifespans: HIV/AIDS and COVID-19. Although governments and health officials largely failed gay men during the HIV/AIDS pandemic, gay men represent an important source of pandemic information and their experiences have much to offer health professionals and policymakers. As such, a small but growing body of literature has compared gay men's experiences amidst the two pandemics. The current study drew on constructivist grounded theory methods to examine how living through the HIV/AIDS pandemic has influenced older gay men's perspectives of COVID-19. Twenty Canadian-based gay men aged 50+ participated in semi-structured interviews via Zoom. Analysis revealed three key processes: (1) uncertainty and the familiarity of loss, (2) witnessing pandemic inequities, and, (3) navigating constantly evolving (mis)information. We highlight the utility of this knowledge to informing future pandemic planning and policies.

Status, sexual capital, and intraminority body stigma in a size-diverse sample of gay men

Gay men are more likely than heterosexual men to experience social pressure based on body weight, shape, and muscularity, which may drive disparities in body image concerns and eating disorders. Utilizing a sample of 1723 gay men living in the United States, the present study examined whether sociodemographic factors (used as proxies for status and sexual capital) and frequency of attending gay-specific establishments or gatherings (community involvement) were associated with gay men's experiences of negative or discriminatory pressures based on body size and shape specifically from other gay men (intraminority body stigma). Experiences of intraminority body stigma were significantly more common among gay men who identified as higher-weight (r = 0.28), less masculine (r = -0.21), less wealthy (r = -0.21), younger (r = -0.21), or people of color (ds = 0.25-0.28). Furthermore, indicators of low status and sexual capital were indirectly associated with less frequent community involvement via more frequent experiences of intraminority body stigma. In addition to frequency, the valence of interactions between gay men should be considered when assessing body image and eating disorder risk in this population. Future research is encouraged to examine intraminority body stigma as an intersectional source of intraminority stress to inform prevention and treatment efforts for gay men.

Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand

Male HIV serodiscordant couples have diverse relationship agreements regarding sex outside the relationship. We examined the relationship agreements as described by 343 male HIV-negative partners in HIV serodiscordant relationships in Australia, Brazil and Thailand participating in a multi-year cohort study. At baseline, 125 (34.1%) HIV-negative partners reported no agreement, 115 (33.5%) had a monogamous agreement, and 103 (37.9%) had an open agreement allowing sex outside the relationship. Relationship agreements were largely stable over time, with 76% of HIV-negative men reporting the same agreement across follow up, while changes were predominantly towards having an open agreement. Behaviour largely matched relationship agreements, and the predictors of breaking an agreement by having condomless anal intercourse (CLAI) with an outside partner were CLAI within the relationship (OR = 3.17, 95%CI: 1.64-6.14, p < 0.001) and PrEP use in the last three months (OR = 3.42, 95%CI: 1.48-7.92, p = 0.004). When considering HIV transmission risk for HIV-negative men in serodiscordant relationships, greater focus needs to be placed on sex that is occurring outside the relationship and the agreements that facilitate this.

Why do queer men experience negative body image? A narrative review and testable stigma model

Queer men (i.e., men who are not heterosexual; sexual minority men) are disproportionately affected by negative body image - they experience greater body dissatisfaction are more likely to develop eating disorders than heterosexual men. While existing literature has examined individual-level predictors of negative body image for queer men, less is known about why queer men as a group are disproportionately affected by negative body image. By synthesising existing theoretical frameworks, research, policy, and media reporting, this narrative review moves towards an understanding of systemic-level negative body image for queer men. Through the lens of hegemonic masculinity, we explain how systemic experiences of stigma work to inform unattainable appearance standards for queer men, and how these standards then contribute to pervasive negative body image concerns among this community. Next, we describe how systemic stigma works to exacerbate negative health outcomes for queer men with body image concerns. Finally, we present a synthesized model of the processes outlined in this review, articulate testable predictions for future studies, and describe practical implications that could be widely employed to improve body image for queer men. Our review is the first to propose a comprehensive explanation of systemic negative body image for queer men.

Collective Sex and Committed Relationships: A Qualitative Exploration of Relationship Desires Among Gay Men Who Attend Sex Clubs

Studies have documented gay men's engagement in collective sex (e.g., group sex in public or commercial environments) but little attention has been paid to these men's relationship desires or agreements. We report on qualitative interviews with 20 gay men who attended private sex clubs in New York City, asking how participants navigated sometimes conflicting desires for collective sex and committed relationships. Participants felt that collective sex was either a) incompatible with relationships, which should be monogamous; b) complementary to a primary non-monogamous relationship; or c) at least as important as relationships. Gay men attending sex clubs attribute different value to collective sex and to committed relationships, and experience different challenges in satisfying their desires for intimacy. Resources could help gay men navigating these apparently conflicting desires and making suitable choices regarding their relationships and/or sexual agreements.

Does Same-Sex Marriage Legalization Make Gay Men Want to Have Children? Findings from a Panel Study in Taiwan

Introduction

This study capitalized on prospective legal change in Taiwan to capture changes in gay men's desires and attitudes toward parenthood as a function of the legalization of same-sex marriage (SSM).

Methods

A panel of 731 gay men (mean age = 26.8 years ± 5.81) completed an online survey between 2019 and 2020, shortly before and 1½ years after the legalization of SSM, to report their parenting desire, marital status, and attitudes toward parenthood and marriage.

Results

This study found that fewer participants in the follow-up survey expressed a parenting desire (59.0% vs. 74.2%), and the perceived importance of parenthood dropped mildly (3.48 to 3.26, Cohen's d = 0.269). Those who expressed a consistent parenting desire attached greater importance to SSM. The perceived importance of SSM was modestly and positively related to the perceived importance of having a child.

Conclusion

Although the decrease in parenting desire and its perceived importance may be attributable to a lack of access to family-building options (e.g., surrogacy and adoption) and the COVID-19 pandemic, our findings illustrate that parenthood might become a next step for some Taiwanese male same-sex couples who married or considered marriage.

Policy Implications

The study findings provide information for policymakers to gauge the possible number of sexual minority men who might want to have a child and consider resource allocation and deliberation on policy changes related to reproduction.

Poverty, Psychological Distress, and Suicidality Among Gay Men and Transgender Women Sex Workers During the Covid-19 Pandemic in Phuket, Thailand

Introduction

Thai gay men and transgender women (GM&TGW) sex workers are more likely to suffer from economic harm since the sex tourism industry in Thailand has been hit hard by the Covid-19 pandemic. They also are more likely to experience poverty and mental health issues subsequent to the pandemic as minority groups in conservative Thai society. While their highly problematic social and economic situation would predict a wide range of psychological issues, little is known about their mental health. Hence, this study examined the prevalence and symptom severity of psychological distress among the group as well as the associations between suicidal ideation, poverty, and psychological distress.

Methods

Two hundred seventy questionnaire responses were collected online via Google forms in Phuket in 2021. Data analysis was conducted using SPSS and Smart-PLS.

Results

Based on the results, most respondents had experienced mild to extremely severe symptoms of psychological distress. However, transgender women sex workers scored higher on depression and anxiety compared to gay men sex workers. This study confirmed the prominent associations between the study variables and the mediation effect of psychological distress.

Conclusions

Poverty resulting from the pandemic imposes a substantial human cost for this vulnerable minority beyond the virus itself as it amplifies mental health problems.

Policy Implications

The findings further extend our awareness of the discriminatory treatment of Thai GM&TGW sex workers and address a gap in Thai law and policy for prohibiting discrimination against them. It is of urgent necessity for Thai public health and tourism policymakers to establish sound support interventions.

Acoustic and Perceptual Characteristics of Mandarin Speech in Gay and Heterosexual Male Speakers

This study investigated acoustic and perceptual characteristics of Mandarin speech produced by gay and heterosexual male speakers. Acoustic analysis of monosyllabic words showed significant differences between the two groups in voice fundamental frequency (F0), F1 of low vowel, and duration of aspiration/frication in consonants. The acoustic patterns on F0, formants, and center of gravity as well as spectral skewness of /s/ differed from those reported for Western languages like American English, which could be interpreted from a sociopsychological point of view based on different acceptability of gay identity in the two societies. The results of a perceptual experiment revealed significant but weak correlations between the acoustic parameters and the score of perceived gayness, which was significantly higher on gay speech than on heterosexual male speech. Although the observed F0 and F1 patterns in Mandarin gay speech were opposite to the stereotype of gayness, gay identity can still be identified to some extent from speech due to the existence of other acoustic cues such as a longer fricative duration, which is not a stereotype of gayness but has been consistently observed in Mandarin and Western languages.

Sexual minority health and allostatic load in the National Health and Nutrition Examination Survey: A systematic scoping review with intersectional implications

Understood largely from a minority stress framework, sexual minorities (SM) are hypothesized to suffer more physical and mental health burdens compared to their heterosexual counterparts. Several studies have used data from the National Health and Nutrition Examination Survey (NHANES) in the United States to assess SM health disparities and the 'wear and tear' of allostatic load. Because findings are generally mixed and sometimes contradictory with sexual minority stress theory, we endeavoured to explore existing NHANES studies of SM health. Our scoping review yielded a comprehensive analysis of all existing published articles (N = 43) that have used the NHANES to assess any outcome regarding SM health and well-being. Our synthesis confirms that SM sub-groups are significantly different from one another and from their heterosexual peers on several key health variables. Surprisingly, gay men appear to have the lowest allostatic load and no differences have yet been identified among women as a function of sexual identity/behavior. The existing literature suggests a need to use the NHANES more broadly and to include more psychosocial variables to better delineate sexual minority stress. This is especially important to consider at a physiological level in allostatic load research that should better include health behaviors available in NHANES and from other available datasets as moderators linking psychosocial exposures (e.g., minority stress) and health outcomes. Suggested future directions are proposed in an intersectional perspective that incorporates interactions among sex, gender, sexual identity/behaviors, race, ethnicity, age cohorts, socioeconomic status, and lived experiences.

Gay Neighborhoods: Can They Be Identified in a Systematic Way Using Latent Class Analysis?

Identifying gay neighborhoods could help in targeting HIV prevention efforts for men who have sex with men. This study's purpose was to identify gay neighborhoods using latent class analysis (LCA). Data at the ZIP code level were drawn from the American Community Survey, website lists of gay bars and neighborhoods, and the Florida Department of Health HIV surveillance system. A two-class model was selected based on fit. About 9% of the ZIP code data was in class two, which was designated as gay neighborhoods. Cohen's kappa coefficient was used to examine agreement between the classification of ZIP codes from LCA and websites. Fair agreement was found (0.2501). Gay neighborhoods could serve as a place to disseminate information about pre-exposure prophylaxis and other methods for HIV prevention. Improved measures, such as the planned question about same-sex spouses for the 2020 US Census, are needed to identify gay neighborhoods in population-level surveys.

"White, Tall, Top, Masculine, Muscular": Narratives of Intracommunity Stigma in Young Sexual Minority Men's Experience on Mobile Apps

What forms of intracommunity stigma do young sexual minority men narrate as they participate in communities through mobile apps? In a content analysis of 32 interviews with a racially diverse sample of young sexual minority men (ages 19-25; 84.4% non-White) from four regions of the USA, a majority of men (62.5%) spontaneously discussed mobile apps (e.g., Grindr, Scruff) when asked about their experience of community more broadly. Men's narratives revealed engagement with intracommunity stigma related to body size, race/ethnicity, gender expression, and sexual position (e.g., bottom). Stigma related to HIV status, substance use, and social class were not spontaneously narrated in response to questions about men's experience in communities. Expressions of stigma were frequently experienced intersectionally, particularly regarding racialized stereotype expectations (e.g., "Asian men are twinks, effeminate"). We discuss the ways in which sexual minority men reproduce dominant ideologies related to racism, misogyny, and masculine body ideals as they engage with one another on mobile apps. To the extent that many young men rely on mobile apps for community connection, their experiences of community might serve to exacerbate, rather than ameliorate, the deleterious impact of stigma.

Trust, Familiarity, Optimism, and Pleasure: Australian Gay Men Accounting for Inconsistent HIV Prevention Practices in the PrEP Era

Despite an increase in the range of effective HIV risk reduction strategies that are available, some gay and bisexual men (GBM) do not use any of them consistently. Understanding why GBM do not always use a protective strategy may help develop more effective responses. Semi-structured interviews with 24 sexually active GBM in Sydney, Australia were conducted and analyzed using thematic analysis. The main characteristics of encounters featuring little or no use of HIV risk reduction strategies were familiarity and trust with partners, pleasure and intoxication, expectations that partners were using HIV pre-exposure prophylaxis or treatment as prevention, and in some cases feelings of inevitability about acquiring HIV. An increase in pleasure and a reduction in anxiety about sex were noted by some GBM who had commenced PrEP. Encouraging GBM to adopt a strategy such as PrEP and to use it consistently may be easier by emphasizing benefits to mental health and the quality of sex and intimacy it can offer. However, even with the increased availability of effective biomedical HIV risk reduction strategies, not all GBM are able to consistently manage HIV risk and some continue to hold optimistic and potentially inaccurate beliefs about sexual partners that may increase HIV risk.

Opting Out: Aging Gays, HIV/AIDS and the Bio-Politics of Queer Viral Time

This paper expands the scope of inquiry into HIV and aging through an ethnographic exploration of a small group of older, long-term (20 or more years) HIV+ gay white men in Toronto who meet fortnightly to discuss and reflect on everyday challenges of living with HIV but do not want to be affiliated with existing HIV/AIDS support organizations. Their discussions reveal a critique of professionalization and biomedical bias in contemporary mainstream Canadian HIV/AIDS discourses and support services, reflecting their shared experiences and memories of the HIV/AIDS epidemic in Canada over many decades. I argue that their frustration with and disengagement from contemporary mainstream HIV/AIDS discourses and support services, based on shared experiences and memories, produces a particular form of "queer viral time," developed through the intersectional dynamics of epidemiological time, gender, age, race and sexual orientation. Queer viral time draws attention to the temporal dimensions of socio-sexual subject formations, social inequalities, and health governance.

Establishing initial validity and factor structure for the muscularity-oriented eating test in gay men

Eating disorders (EDs) affect men at higher rates than previously estimated, with many traditional ED measures likely underestimating the prevalence of eating and exercise-related pathology among males. The development of the Muscularity-Oriented Eating Test (MOET) represents an important advancement in ED assessment, enabling valid and reliable assessment of muscularity-oriented ED pathology among men. The current study sought to provide initial validity of the MOET among gay men. N = 264 gay men, recruited via MTurk, participated in a brief online survey, completing the MOET and other well-validated measures of eating pathology and body image psychopathology. Factor structure, mean, standard deviation, and intercorrelation between measures were assessed. The MOET demonstrated adequate factor structure, similar to that reported in the initial validation sample, and was significantly correlated with other measures of eating and body image psychopathology. The current study suggests initial validity of the MOET for use among gay men. Future research is needed among younger and more diverse samples of SM men, along with evidence of adequate test-retest reliability and absence of differential item functioning among gay men.

Stigma and HIV Concealment Motivation among Gay Men Living with HIV in Finland

This study explored experiences of HIV stigma among gay men in Finland and the impact of these experiences on decision-making concerning HIV status disclosure. Seventeen gay men living with HIV in Finland participated in a qualitative interview study and the data were analyzed using thematic analysis. The results focus on the following themes: (1) "Social support impedes social stigma;" (2) "Social support and the risk of HIV stigma," which describes how the pursuit of social support can expose some individuals to stigma; and (3) "HIV concealment motivation as a coping strategy," focusing on the motivation to conceal one's HIV status from others to avoid stigma. It is necessary to promote awareness and understanding of HIV in Finnish society, to challenge HIV stigma and, crucially, to facilitate access to social support among those diagnosed with HIV. This is likely to have favorable implications for both psychological and public health.

"They Haven't Made a Slot for Us Yet": Conceptualizing the Health Care and Social Service Needs of Older Gay Men Living with HIV in Canada

In this paper, we present the findings of a qualitative study aimed at conceptualizing the service needs of aging gay men living with HIV (GMLH). Our analysis is based on interview data from 16 gay-identified men living with HIV, ages 50 and over. Drawing on a framework of intersectionality, which theoretically accounts for interlocking expressions of marginalization in groups affected by multiple systems of oppression, we highlight the practical, social, and mental health needs of this population, as well as services that could be designed or adapted to address these concerns. We also emphasize the relevance of specialized training for caring professionals serving older GMLH, and articulate the need for initiatives that more fully engage gay men aging with HIV in the development and delivery of services intended for their use.

Socio-behavioral factors related to PrEP non-adherence among gay male PrEP users living in California and New York: A behavioral theory informed approach

One effective preventative measure to reduce the number of new HIV infections is through the uptake of daily oral HIV pre-exposure prophylaxis (PrEP). Although previous clinical trials have proven the effectiveness of on-demand PrEP uptake, daily PrEP uptake is the most popular prevention method among PrEP users and is still recommended by most healthcare professionals and organizations. Informed by the integrative model of behavioral prediction, the current study examined the socio-behavioral factors associated with PrEP non-adherence. The present study conducted a cross-sectional survey of 210 gay male daily PrEP users living in California and New York. The results showed more than two-thirds of the sample indicated that they had skipped taking PrEP within the last 30 days, averaging around four to five missed doses. General attitudes toward desirable and undesirable outcomes, perceived behavioral control, and social-level barriers were associated with daily PrEP uptake non-adherence. The findings highlight providers' role in PrEP adherence and the importance of habit-forming, which can be enhanced by cost-effective strategies and technological innovations.

Discussing parenthood with gay men diagnosed with HIV: a qualitative study of patient and healthcare practitioner perspectives

BACKGROUND

Research on HIV and reproduction has focused largely on women and heterosexual men. This article examines whether it is relevant to address parenthood in HIV care with gay men and what ways of doing so are most appropriate.

METHODS

Qualitative interviews were conducted at four London clinics with 25 men living with HIV, aged 20-45, who did not have children, and 16 HIV clinicians. A thematic analysis identified potential reasons why parenthood was rarely discussed with gay men in HIV care.

RESULTS

Two sets of ideas contributed to a lack of conversations about parenthood: clinicians' ideas about what matters to gay men and men's ideas about what it means to be HIV-positive. Both sets of ideas largely excluded having children, with patients and practitioners similarly unlikely to raise the topic of parenthood in the clinic. Contrary to what clinician commonly assumed, many men expressed interest in receiving more information, highlighting the importance of reassuring people upon diagnosis that it is possible to become parents while living with HIV.

CONCLUSIONS

Parenting desires and intentions were rarely discussed with men in HIV care. Our findings illuminate the potentially beneficial effects of emphasising that having children is a possibility at diagnosis, regardless of patients' gender or sexuality. Conveying this information seems meaningful, not only to men who want to become parents in the future but also to others, as it appears to alleviate fears about mortality and ill health.

Knowledge of and willingness to take pre-exposure prophylaxis among men who have sex with men in Israel

Background

Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) has been found to reduce viral acquisition among HIV-negative MSM. This cross-sectional study was conducted before pre-exposure prophylaxis (PrEP) licensure in Israel, and aimed to compare men who have sex with men (MSM) who had heard of PrEP with those who had not, as well as MSM willing to take PrEP with those who were hesitant or not willing to take PrEP.

Methods

HIV-negative MSM responded anonymously to questionnaires in 2017 regarding their knowledge of and willingness to take PrEP, prior use of PrEP and post-exposure prophylaxis (PEP), and their sexual behaviors.

Results

Among 1705 participants, 1431 (83.9%) had heard about PrEP. They were older and more often reported being Jewish, having an academic degree, self-identifying as gay/bisexual, being tested for HIV in the last year, participating in group sex, using alcohol or drugs before or during sex, and having prior use of PrEP/PEP compared with MSM who had not heard about PrEP. A total of 760 (44.8%) participants indicated that they would consider taking PrEP, 567 (33.5%) maybe would consider taking PrEP, and 367 (21.7%) would not take PrEP. Those who were willing to take PrEP had a lower level of education, were involved in high-risk sexual behaviors, used alcohol or drugs before or during sex, and had previously used PrEP/PEP compared with participants who maybe would consider taking or would not take PrEP. When participants were asked to indicate if they were willing to take PrEP at different potential efficacies and costs, the willingness to using PrEP increased with the potential efficacy of the drug and adversely related to its cost.

Conclusions

PrEP awareness was high, and 44.8% indicated willingness to take PrEP, especially those who reported high-risk sexual behaviors. This supports the current policy in Israel to allow PrEP to MSM who are at high-risk. In order to maintain a high level of PrEP-adherence, physicians should consider structural barriers, such as negative stigma of being promiscuous, lack of perceived HIV-risk, difficulties in accessing clinics or paying for PrEP, inability to follow-up or low tolerability of the medication.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13584-021-00500-x.

Reducing Internalized Homonegativity: Refinement and Replication of an Online Intervention for Gay Men

We refined and replicated an efficacious brief intervention to reduce internalized homonegativity (IH) with a sample of gay and exclusively same-sex attracted men recruited from outside of LGBT community networks using Amazon Mechanical Turk. We sought to 1) determine if levels of IH differed between the original study's community-based sample and our non-community-based sample, 2) examine the efficacy of the replicated intervention, and 3) assess for longitudinal effects of the intervention at a 30-day follow-up. Four hundred eighty-four participants completed either the intervention or a stress management control condition. Mean levels of IH were higher in the current sample compared with the earlier study's community sample. The intervention was efficacious at reducing global IH, reducing personal homonegativity, and increasing gay affirmation. Ninety-six participants completed the follow-up; follow-up results were not significant and may have been affected by high rates of attrition. Implications for research and practice are discussed.

Characteristics of Agreements to have Condomless Anal Intercourse in the Presence of an Undetectable Viral Load Among HIV Serodiscordant Male Couples in Australia, Brazil and Thailand

The use of undetectable viral load (VL) to negotiate condomless anal intercourse (CLAI) in HIV serodiscordant male relationships has become more common as more data regarding the effectiveness of antiretroviral treatments for the prevention of HIV transmission has been described. We examined viral load agreements (VLAs) for condomless sex in the presence of an undetectable VL in 343 HIV serodiscordant male couples in Australia, Brazil and Thailand. Factors associated with having a VLA included having agreements for the HIV-positive partner to report his VL result (p < 0.001), agreeing that VL affects agreements about sexual practice (p < 0.001), the HIV-negative partner's perception of his partner's undetectable VL (p < 0.001), the couple's belief in the efficacy of undetectable VL in preventing HIV transmission (p < 0.001), and the couple engaging in CLAI with each other (p < 0.001). Over time, these agreements became more common although 49.3% of couples in the sample never had a viral load agreement. As these agreements become more common, further education is required to support male couples in using them safely.

Changes in Sexual Behaviour Following PrEP Initiation Among Australian Gay and Bisexual Men in Relationships: Results from a Prospective Observational Study

Few studies have examined changes in sexual behaviour following HIV pre-exposure prophylaxis (PrEP) initiation among gay, bisexual and other men who have sex with men (GBM) in relationships. In a national, online, prospective study of GBM in Australia, we compared sexual behaviours prior to and after PrEP initiation among HIV-negative and unknown-HIV-status men (recruited 2014-2017) not taking PrEP at baseline and who completed at least one six-monthly follow-up by July 2018. Among men in relationships who did not initiate PrEP (n = 339), we compared their most recent survey to their prior one, while among men in relationships who initiated PrEP (n = 81), we compared follow-ups before and after PrEP initiation. Among the 81 PrEP-initiators who were in a relationship both before and after initiation, the proportion reporting their regular partner was on PrEP increased from 8.3 to 44.4% (p < 0.001) and the proportion reporting receptive CLAIC increased from 27.2 to 44.4% (p = 0.009). Overall, men who initiated PrEP were more likely to be in a relationship with a partner on PrEP, and it appeared they started PrEP around the same time. Receptive CLAIC also became more common.

Culture-Specific Form of Stress Based on Sexual Orientation Among Childless Lesbian and Gay Individuals in China: Perceived Difficulties of Future Parenthood

China's long historical and cultural traditions that overemphasize the continuity of the family bloodline have a profound impact on the desire to become parents. Indeed, many Chinese lesbian and gay (LG) individuals want to become parents, despite same-sex parenting being illegal in mainland China. Faced with a conflict between their sexual orientation and desire for parenthood, childless LG individuals in China experience additional stress. However, no empirical study has examined such stress, which has been termed perceived difficulties of future parenthood. The present study aimed to explore the influence of perceived difficulties of future parenthood on mental health and the moderating effect of parenting desire on the relationship between them among 737 childless Chinese LG individuals (216 lesbian women and 521 gay men). A new measure was developed consisting of four dimensions: restricted pathways, social discrimination, uncertain affective ties, and parental opposition. As predicted, perceived difficulties of future parenthood were associated with poorer mental health in the sample. However, the interaction effects between parenting desire and perceived difficulties of future parenthood on mental health were not significant. These findings highlight common existing perceived difficulties about future parenthood in childless LG individuals in China and their negative effects on mental health.

Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men

BACKGROUND

Research on pathways linking stigma with health inequalities affecting sexual minority populations, focused predominantly on exploring the hypothalamic-pituitary-adrenocortical (HPA) dysregulation profiles associated with chronic stress. One of such profiles reflecting a state of increased susceptibility to disease, and not yet studied among sexual minority individuals, is impaired habituation to repeated stress of the same type. In this study we explored whether sexual identity modulates endocrine stress responses and stress responses habituation in healthy heterosexual and gay men. We also explored the associations between perceived sexual minority stigma and cortisol response to stress in the latter group.

METHODS

Gay (N = 49) and heterosexual (N = 40) men, aged 24.4 years, were confronted twice with the Trier Social Stress Test and provided 5 salivary cortisol samples for each of the two testing sessions. A multilevel mixed-effects approach was used to model the cortisol curve throughout the two-day procedure. Habituation to repeated stress was conceptualized as the decrease in the total cortisol levels as well as the change in the cortisol curvilinearity between the first and the second testing session.

RESULTS

Gay participants were characterized by significantly higher cortisol levels throughout both laboratory visits. Their cortisol levels were also predicted by perceived rejection from family due to minority sexual identity, and stigma-related vicarious trauma. Although neither group showed habituation defined as the decrease in cortisol level, the shape of the cortisol curve changed between both visits only in the heterosexual participants.

CONCLUSIONS

Increased cortisol levels observed in gay men are predicted by minority stressors. Combined with non-habituation, the upregulation of the HPA axis may constitute a physiological pathway linking stigma to adverse health outcomes.

Gay men's stress response to a general and a specific social stressor

Gay men show altered psychobiological stress responses and exhibit a higher prevalence of mental disorders than their heterosexual counterparts. Both of these findings are likely due to gay-specific discrimination. Since it has not yet been determined whether gay-specific stress is more noxious than general stress, we tested whether gay men react more strongly to gay-specific socially stressful stimuli than to general socially stressful stimuli. N = 33 self-identified gay men (mean = 26.12 years of age, SD = 5.89), 63.6% of whom were in a relationship with a man, participated in an experimental within-group study, in which they were exposed to the Trier Social Stress Test (TSST) as well as a gay-specific TSST in a randomized order. Salivary cortisol and testosterone were assessed at five time points during the laboratory tests and perceived stress was assessed at four time points. According to psychobiological and perceived stress indices, the participants reacted similarly to a gay-specific and general social stressor. There were no significant differences in the outcomes, either when looking at pre-post-test differences or when comparing the overall stress responses. Given that the response to a gay-specific social stressor was equally pronounced as the one to a general social stressor, programs aiming to decrease minority stress but overlooking general stress are likely to yield only partial improvements in gay men's mental health. Instead, we suggest helping gay men cope with both forms of stress through building social support, assertiveness, and mindfulness skills, as well as decreasing emotional dysregulation.

Minority stress, depression, and cigarette smoking among Chinese gay versus bisexual men: a two-group structural equation model analyses

Background

Literature in the West suggested that bisexual men have a higher smoking rate compared to gay men. Data on patterns of smoking among gay and bisexual men are limited in Eastern Asian countries like China. This study examined the cigarette smoking prevalence for gay versus bisexual men in China and their unique minority stress - smoking pathways.

Methods

Between September 2017 and November 2018, we surveyed a convenience sample of 538 gay men and 138 bisexual men recruited from local sexual minority organizations in four metropolitan cities in China (i.e., Beijing, Wuhan, Nanchang, and Changsha). Measures included sexual orientation, sociodemographics, theory-based minority stressors, depressive symptoms, and past 30-day cigarette smoking. Two-group (gay men vs. bisexual men) structural equation modeling (SEM) was used to test possible distinct mechanisms between theory-based stressors, depressive symptoms, and cigarette smoking among gay men and bisexual men, respectively.

Results

The mean age of participants was 26.51 (SD = 8.41) years old and 76.3% of them had at least a college degree. Bisexual men reported a higher rate of cigarette smoking compared to gay men (39.9% vs. 27.3%). Two-group SEM indicated that the pathways for cigarette smoking were not different between gay and bisexual men. Higher rejection anticipation was associated with greater depressive symptoms (standardized β = 0.32, p < .001), and depressive symptoms were not associated with cigarette smoking.

Conclusions

Minority stress, specifically rejection anticipation, may be critical considerations in addressing depressive symptoms, but not smoking, among both gay and bisexual men in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10888-5.

Mental health symptoms and suicidality in Iranian gay men

BACKGROUND

No published data is currently available on mental health symptoms and suicidality in Iranian gay men - a population facing serious legal threats including capital punishment.

METHODS

The present study provides initial data on this topic by assessing mental health symptoms (SCL-90) and suicidality (BSSI) in N = 213 gay men in Tehran, Iran.

RESULTS

Last-week mental health symptoms were severe in 4.2% of gay men, moderate in 7.5%, minor in 27.7%, and absent in 61.6% of Iranian gay men. Regarding last-week suicidality: 1.9% were highly likely to attempt suicide, 7.5% reported having threatened to commit suicide, 19.7% reported suicidal ideation, and 80.28% revealed no suicidality. Last-week mental health symptoms and last-week suicidality were correlated in gay men to a high degree.

CONCLUSIONS

When descriptively comparing the SCL-90 and BSSI scores with those in the general Iranian population reported in previous studies, gay men reported more serious mental health symptoms, and more suicidal ideation, threats, and attempts. The decriminalization of same-sex sexual encounters and accepting social attitudes towards gay men are needed in Iran to help improve this population's mental health and reduce their suicidality.

Beach body ready? Shredding for summer? A first look at "seasonal body image"

We introduce the term "seasonal body image" to refer to within-person variation in body image that occurs across the Gregorian seasons of Spring, Summer, Autumn, and Winter. Herein, we (i) quantified and visualised seasonal body image and its mechanisms, and (ii) identified individual predictors of seasonal body image. Sexual minority men (N = 823) residing in the Northern Hemisphere (n = 659) and Southern Hemisphere (n = 164) provided cross-sectional data about their experiences of body image phenomena in Spring, Summer, Autumn, and Winter. Most reported seasonal body image (∼70 %). As hypothesised, in Summer we observed peaks for body dissatisfaction alongside peaks in four proposed seasonal body image mechanisms: pressure from media advertisements, pressure from peers on social media, the feeling that one's body is on public display, and appearance comparisons. In Winter, these phenomena were weakest. Effect sizes ranged from small to large (rs = .07-.50) with an average effect size of medium (.38). Seasonal body image was stronger for individuals with greater muscularity dissatisfaction and body fat dissatisfaction, and for higher body-weight and younger individuals. Future research will visualise seasonal body image using a multi-country Twitter database containing several billion tweets spanning multiple calendar years.

Social capital and chemsex initiation in young gay, bisexual, and other men who have sex with men: the pink carpet Y cohort study

Background

Young gay, bisexual, and other men who have sex with men (YMSM) are especially vulnerable to the risks associated with sexualized substance use, or ‘chemsex’. Engaging in chemsex established as a major risk factor for Human Immunodeficiency Virus (HIV) acquisition, and is thus a public health issue of increasing urgency. This paper attempts to explore the association between measures of social capital and patterns of sexualized substance use among a sample of YMSM in Singapore.

Methods

Results of this study were derived from baseline data of the Pink Carpet Y Cohort Study in Singapore, comprising a sample of 570 HIV-negative YMSM aged 18 to 25 years old. Latent class analysis was employed to identify classes with similar patterns of sexualized substance use, and multinomial logistic regression was employed to examine associations between class membership and proxy measures of social capital, including age of sexual debut, bonding and bridging social capital, connectedness to the lesbian, gay, bisexual and transgender community, and outness.

Results

Latent class analysis revealed three classes of YMSM based on their histories of sexualized substance use, which we labelled as ‘alcohol’, ‘poppers’, and ‘chemsex’. Multivariable analyses revealed that participants who were older (aOR = 1.19, p = 0.002) and who identified as gay (aOR = 2.43, p = 0.002) were more likely to be in the poppers class compared to the alcohol class. Participants with a later age of sexual debut were increasingly less likely to be in the poppers (aOR = 0.93, p = 0.039) and chemsex classes (aOR = 0.85, p = 0.018), compared to the alcohol class.

Conclusions

Varying measures of social capital such as an earlier age of exposure to sexual networks may predispose YMSM to greater opportunities for sexualized substance use. Future interventions should target YMSM who become sexually active at an earlier age to reduce the risks associated with sexualized substance use.

Geographic and behavioral differences associated with sexually transmitted infection prevalence among Indian men who have sex with men in Chennai and Mumbai

India has one of the largest numbers of men who have sex with men (MSM) globally; however, geographic data on sexually transmitted infection (STI) prevalence and associations with sexual behavior are limited. Six-hundred and eight MSM in Chennai and Mumbai underwent screening for a behavioral trial and were assessed for bacterial STIs (syphilis, chlamydia, gonorrhea), HIV, and past-month self-reported condomless anal sex (CAS). Mumbai (37.8%) had a greater prevalence of any STI than Chennai (27.6%) (prevalence ratio [PR] = 1.37, 95% CI: 1.09, 1.73). This pattern also emerged for gonorrhea and chlamydia separately but not syphilis. Conversely, Mumbai MSM reported lower rates of CAS (mean = 2.2) compared to Chennai MSM (mean = 14.0) (mean difference = -11.8, 95% CI: -14.6, -9.1). The interaction of city by CAS on any STI prevalence (PR = 2.09, 95% CI: 1.45, 3.01, p < .0001) revealed that in Chennai, higher rates of CAS were not associated with STI prevalence, but in Mumbai they were (PR = 2.49, 95% CI: 1.65, 3.76, p < .0001). The higher prevalence of bacterial STIs but lower frequency of CAS in Mumbai (versus Chennai), along with the significant interaction of CAS with city on STI rates, suggests that there are either differences in disease burden or differences by city with respect to self-reported assessment of CAS. Regardless, the high prevalence rates of untreated STIs and condomless sex among MSM suggest the need for additional prevention intervention efforts for MSM in urban India.

Two sources of autonomy support and depressive symptoms among Chinese gay men: The sequential mediating effect of internalized homonegativity and rumination

BACKGROUND

A high level of depressive symptoms is a universal phenomenon among gay groups. Autonomy support, which refers to supporting an opportunity for others to authentically express themselves and behave consistently with their own beliefs, values and interests, is considered a critical protective factor facilitating the relief of depressive symptoms in gay men. The aim of the current study was to examine the relationships between two sources of autonomy support (from parents and friends) and depressive symptoms in a Chinese context and evaluate the mediating effects of internalized homonegativity and rumination.

METHODS

Altogether, 385 Chinese gay men (mean age = 24.00 years old, standard deviation (SD) = 4.84) who were voluntarily recruited by web-sampling were measured on scales regarding autonomy support, internalized homonegativity, rumination and depressive symptoms.

RESULTS

Autonomy support from both parents and friends were negatively correlated with depressive symptoms among Chinese gay men. Internalized homonegativity and rumination played a sequential mediating role between friends' autonomy support and depressive symptoms, yet this sequential mediation effect was not significant between parental autonomy support and depressive symptoms.

LIMITATIONS

The cross-sectional design limited casual inferences between variables. The effects of domain-specific autonomy support were not involved in this study, and other mediators between autonomy support and depressive symptoms and more sociodemographic variables should be considered.

CONCLUSION

Autonomy support from both parents and friends might be protective factors against depressive symptoms in Chinese gay men. Friends' autonomy support was related to decreased depressive symptoms via lower internalized homonegativity and rumination, while parental autonomy support was related to less depressive symptoms through other possible mechanisms.

Exploring influences on methamphetamine use among Black gay, bisexual and other men who have sex with men in Atlanta: A focus group study

BACKGROUND

Methamphetamine use is a contributor to HIV risk and poor health outcomes among gay, bisexual and other men who have sex with men (GBMSM). There is a paucity of research examining methamphetamine use and its social context specifically among Black GBMSM. We therefore sought to: (1) describe trends in methamphetamine use among Black GBMSM in Atlanta, Georgia, and (2) examine the risk environment (micro-, meso‑ and macro-level factors operating in the political, social, physical, economic, and healthcare environments) that might elevate risk for methamphetamine use in this population.

METHODS

We conducted a qualitative study consisting of eight focus groups with 54 key informants between December 2019 and March 2020. Participants represented community-based and healthcare organizations that work closely with Black GBMSM. Our thematic analysis included an iterative, team coding approach combining deductive and inductive elements.

RESULTS

Participants unanimously agreed that methamphetamine use was increasingly prevalent among Black GBMSM in Atlanta, with many describing a historical arc in which methamphetamine use - previously associated with predominantly white, affluent GBMSM - was now common among younger, lower socioeconomic status Black GBMSM. At the micro-level, participants described contributors to increasing methamphetamine use including use as a sex drug, and the interrelated burdens of stress and mental illness, housing instability, geographic mobility and poverty. At the meso‑level, participants described virtual and physical sex scenes including use of geosocial networking apps that facilitated the spread of methamphetamine use in the Black GBMSM community. At the macro-level, participants described how policies prioritizing other concerns (e.g., HIV, opioids) seemed to limit resources available for methamphetamine prevention and treatment programming.

CONCLUSION

Multi-level environmental influences are working together to elevate risk for methamphetamine use among Black GBMSM in Atlanta, with potential to adversely impact health and well-being and undermine HIV prevention and treatment efforts.

Sexual Dysfunction Among Men Who Have Sex with Men: a Review Article

PURPOSE OF REVIEW

The goal of this review article is to evaluate sexual dysfunction among men who have sex with men (MSM).

RECENT FINDINGS

Men who have sex with men are commonly affected by sexual dysfunction. Often sexual dysfunction in MSM will significantly impact their psychological well-being perhaps even more than their heterosexual counterparts. Despite the frequency and high impact of sexual dysfunction in MSM, access to appropriate care may be limited. It is important for urologists, especially sexual medicine clinicians, to be aware of and comfortable with differences in sexual practices of MSM. Penile pathology in this patient population will negatively affect their quality of life and well-being. Therefore, it is important to properly assess and treat these patients.

Empirical Evaluation of Rainbow Reflections: A Comic Book Anthology on Body Image for Queer Men

Gay, bisexual, and queer (GBQ) men are at higher risk of negative body image. As having a negative body image is related to negative mood, sexual, and health outcomes, identifying and providing community-friendly tools for GBQ men is important. This paper describes the creation and evaluation of Rainbow Reflections, a comic anthology developed to promote awareness of and communication about body image. Rainbow Reflections includes comics from 38 trans- and cis-GBQ artists who drew inspiration from personal narratives based on pre-determined themes in the empirical literature and interactive inserts based on evidence-based practice. To evaluate Rainbow Reflections, 167 trans- and cis-GBQ men completed pre-post measures before/after viewing a selection of comics and responded to an open-ended question about their experience. Overall, participants rated the comic book positively, with a majority (61.1%) indicating that they would recommend the book to a friend. After viewing the comics, participants reported greater comfort with initiating conversations about body image, greater satisfaction with their bodies, and reported higher estimates of how common body image concerns are for queer men. Themes that emerged from open-ended responses included participants reflecting on personal struggles (~ 30%), relating with the stories of others (~ 22%), reflecting on the standards of queer men (~ 18%), recognizing cis-privilege (~ 11%), reflecting on others' struggles (~ 9%), negative feedback about the comics (~ 7%), and balancing masculine and feminine (~ 3%). Results of the study provide preliminary evidence for Rainbow Reflections as an effective community-friendly tool to promote awareness of and communication about body image for GBQ men.

Supernatural Explanatory Models of Health and Illness and HIV Antiretroviral Therapy Use Among Young Men Who Have Sex with Men in China

BACKGROUND

In China, men who have sex with men (MSM) shoulder a disproportionate HIV burden. Early initiation and adherence to HIV antiretroviral therapy (ART) will be critical to reversing the HIV epidemic in China, but ART usage remains suboptimal among MSM diagnosed with HIV. One understudied but potentially important factor underpinning suboptimal ART usage is personal belief in supernatural explanatory models of health and illness (supernatural explanatory models). This study examines associations between beliefs in supernatural explanatory models and ART usage among MSM in China.

METHOD

In 2017, an online survey was distributed nationwide throughout China by gay community-based organizations. Eligible study participants were self-identified MSM between 16 and 30 years old who had tested positive for HIV and who had seen a doctor in the last 2 years. Beliefs in supernatural explanatory models were measured using a three-item scale developed specifically for the Chinese population (range, 3-15).

RESULTS

Of 73 participants, the majority were currently using ART (83.6%) and 42.5% expressed some endorsement of belief in supernatural explanatory models. However, among 21 participants with the strongest belief in supernatural explanatory models, prevalence of current ART usage was 61.9%. Stronger belief in supernatural explanatory models was significantly associated with lower likelihood of current ART usage (adjusted odds ratio = 0.52; 95% confidence interval = 0.13-0.75).

CONCLUSION

Belief in supernatural explanatory models may be a powerful predictor of ART usage among MSM living with HIV in China. Further studies are needed to corroborate these findings and elucidate mechanisms of association.

A Dyadic Perspective on Sexual Agreements Among Same-Sex Male Couples in the United States

Sexual agreements are an important HIV risk reduction strategy enacted by men in male-male partnerships. Greater levels of relationship quality have been associated with sexual agreement formation and adherence. However, current evidence supporting the associations between relationship quality and sexual agreements for male dyads is based primarily on the responses of just one partner. Understanding that relationship quality and decisions about sexual agreements are inherently influenced by both partners, the present analysis uses dyadic-level data to examine the sexual agreements among 199 HIV serodiscordant and seroconcordant male dyads (n = 398 individuals). Specifically, the analysis examines measures of love, trust, and conflict style as they relate to (1) the type of agreement established, (2) concordance in agreement reporting, (3) satisfaction with the agreement, and (4) broken agreements. A discrepancy in love between partners was associated with the type of agreement established, whether they reported the same agreement type, and whether one of the partners reported a broken agreement, but it was not associated with either partner's satisfaction with the agreement. A discrepancy in trust was associated with agreement concordance and agreement breaks, but it was not associated with the type of agreement established or satisfaction with the agreement. Lastly, a discrepancy in conflict style was associated with each of the agreement outcomes. Future research and intervention efforts should focus on understanding the behavioral and communication skills necessary for couples to make successful sexual agreements.

Exploring Diversity in HIV Research in the Sexual Partnerships of Australian Gay and Bisexual Men

Gay and bisexual men engage in a variety of sexual partnerships, but the most common distinction made in HIV research and behavioral surveillance is a binary between "regular" and "casual" partners. The "regular partner" category is often perceived as pertaining to ongoing coupled "boyfriend" relationships, with the literature to date rarely troubling what actually constitutes a "regular partner." Some emerging literature has identified "fuckbuddy" partnerships as a type of regular partnership requiring attention, but it is relatively new and not well understood. Currently, assumptions of the regular partner category do not capture how men perceive and conduct commitment in different sexual partnerships that could also be considered "regular," and the implications this has for HIV prevention. Drawing on in-depth interviews with a sample of 61 Australian gay-identified men, we explore a diversity of partnership types that represent unique ways of enacting commitment. We identify three sexual partnerships: "fuckbuddies," dating, and serial monogamy, each with specific issues for HIV risk and prevention. These partnerships suggest important differences in the way men conceive of and practice intimacy and sex.

Gay-Specific and General Stressors Predict Gay Men's Psychological Functioning Over Time

Gay men experience various stressors, including gay-specific stressors such as discrimination and internalized homonegativity as well as general stressors such as occupational and financial strain. While a robust literature has examined how gay-specific stressors are associated with negative mental health outcomes among gay men, less attention has been paid to the association between general stress and gay men's psychological functioning or to how different types of stressors may interact to affect functioning. The current study sought to address this gap by examining the unique and combined associations between gay-specific external stress (discrimination), gay-specific internal stress (rejection sensitivity, internalized homonegativity, sexual identity concealment), and general stressors (e.g., academic difficulties) and negative affect and alcohol use over time. A total of 147 self-identified gay men living in the greater New York City area participated in a baseline assessment and a 7-week diary study. Univariate and multivariate results revealed that gay-specific external stress, gay-specific internal stress, and general stress were each positively and uniquely associated with higher mean levels of and greater fluctuations in negative affect over time, and general stress was positively associated with greater fluctuations in alcohol use over time. Multiplicative analyses indicated that individuals reporting high levels of stress in multiple domains experienced particularly high mean levels of negative affect. These findings highlight the unique contribution of general stress to gay men's functioning over time and underscore the importance of considering multiple forms of stress (i.e., gay-specific and general stress) and their interactions to better understand gay men's psychological functioning.

Why Do Some Gay Men Identify as "Straight-Acting" and How Is It Related to Well-Being?

Recent literature has described the phenomenon of "straight-acting" gay men: gay men who identify with traditional heteronormative masculinity. The current study examined predictors of "straight-acting" identification in gay men and how identifying as straight-acting relates to well-being. A sample of Australian gay men (N = 966) provided self-report data on two potential predictors of straight-acting identity: self-perceived masculinity and internalized homophobia. A path analysis assessed how these variables related to straight-acting identification. While masculine self-presentation positively predicted well-being and internalized homophobia negatively predicted well-being, straight-acting identification, which positively correlated with both, did not independently predict either psychological distress or physical well-being. Analyses further suggested that internalized homophobia had particularly deleterious effects among gay men who were more feminine. Implications for clinical and public health interventions among gay men are discussed.

Cognitive-Emotional Predictors of Sexual Functioning in Lesbians, Gays, and Heterosexuals

Cognitive-emotional dimensions play a core role in predisposing and maintaining sexual difficulties. This study aimed to assess the role of personality traits, sexual beliefs, cognitive schemas, automatic thoughts and affective states in predicting sexual functioning in a Portuguese sample. A total of 226 lesbian women, 254 heterosexual women, 243 gay men, and 274 heterosexual men completed a web-survey. For each sample, hierarchical regression analyses were conducted, separately. Results indicated that positive affective states and fewer thoughts associated with failure and disengagement during sexual activity act as significant predictors for sexual functioning, in both lesbian and heterosexual women's groups. Specific predictors of better sexual functioning in lesbian women were lower activation of schemas of undesirability and incompetence, and fewer thoughts associated with sexual abuse, body-image and sexual passivity were, whereas particular predictors of better sexual functioning for heterosexual women were erotic thoughts, lower activation of schemas of undesirability and difference/loneliness, and beliefs related to sexual desire as a sin. For men's groups, the best predictor of sexual functioning was the presence of erotic thoughts. Particularly for gay men's group, fewer failure anticipation thoughts were also a predictor of better sexual functioning. Overall, this study supports the core and predictive role of cognitive-emotional dimensions in sexual functioning for lesbian and heterosexual women, as for gay and heterosexual men.

The Health Challenges of Emerging Adult Gay Men: Effecting Change in Health Care

This article focuses on the health and health care challenges experienced by young and emerging adult gay men. Evidence is provided on the extent to which young and emerging adult gay men are disproportionally burdened by multidimensional health disparities, barriers to health care access, and inadequate provider-patient interactions. Recommendations are provided for health care providers and public health officials working with populations of emerging adult gay men that might have the greatest overall impact on improving this population's well-being and access to competent health care by increasing providers' awareness of the unique needs of young and emerging adult gay men.

Which Gay and Bisexual Men Attend Community-Based HIV Testing Services in Australia? An Analysis of Cross-Sectional National Behavioural Surveillance Data

In Australia, HIV testing services have become increasingly available in non-traditional settings such as peer-led, community-based services to expand access and increase uptake of HIV testing among gay and bisexual men (GBM). This study aimed to compare the socio-demographic and behavioural characteristics of GBM whose last HIV test was conducted at a community-based service to GBM whose last test was at a traditional clinical setting. We analysed behavioural surveillance data collected from 5988 participants in seven states and territories in the period 2016-2017. We found that non-HIV-positive GBM who attended community-based services were largely similar to men attending clinic-based settings, particularly in terms of sexual practice and risk of HIV. However, non-HIV-positive GBM who were younger, born in Asia, more socially engaged with other gay men but who had not recently used PrEP were more likely to attend community-based services for their last HIV test. This study points to the successful establishment of community-based HIV testing services in Australia as a way to attract subgroups of GBM at potentially higher risk of HIV.

Incident gonorrhoea and chlamydia among a prospective cohort of men who have sex with men in Kisumu, Kenya

OBJECTIVE

STIs disproportionately affect men who have sex with men (MSM) in sub-Saharan Africa. We identified factors associated with incident Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among MSM in the Anza Mapema cohort study in Kisumu, Kenya.

METHODS

We enrolled 711 MSM who underwent HIV testing and counselling, medical history and examination, and collection of demographic and behavioural information. They also provided urine and rectal swab specimens for CT and NG testing by qualitative PCR at baseline and at months 6 and 12. Separate multivariable Cox regression models identified factors associated with first incident urethral or rectal infection.

RESULTS

Among the 619 men aged 18-54 years included in this analysis, there were 83 first incident urethral CT/NG infections (14.4 cases per 100 person-years (PY)) and 40 first incident rectal infections (6.84 cases per 100 PY), and an overall incidence of 18.0 cases per 100 PY (95% CI 14.8 to 21.8). Most urethral (84%) and rectal (81%) infections were asymptomatic. In the adjusted model, the risk of first incident urethral CT/NG decreased by 4% for each 1-year increase in age and was 41% lower for men who reported their partner used condom at last sexual encounter. Men who were HIV-positive had a 68% less risk of urogenital CT/NG compared with those who were negative. Men who reported being usually receptive or versatile as compared with usually insertive had an 81% increased risk of incident urogenital CT/NG.

CONCLUSION

Our study demonstrated a high incidence of urethral CT/NG infection, with somewhat lower incidence of rectal CT/NG infection, despite repeated testing and treatment, highlighting the need for preventive interventions to decrease the burden of CT/NG among Kenyan MSM. Most infections were asymptomatic, and routine aetiological screening for STIs is recommended.