Prevalence of same-sex behavior and orientation in England: results from a national survey

There are few data sources on the prevalence of same-sex sexual orientation in England.We aimed to measure the prevalence of same-sex orientation and behavior in the English general population and assess the impact of enquiry format on reporting. The Adult Psychiatric Morbidity Survey 2007 used a multi-stage, stratified probability-sampling design (n=7,403). Two questions addressed sexual orientation and sexual partnership and each had two versions. Version A of the sexual orientation question used "homosexual." Version B used "gay or lesbian." Version A of the sexual partnership question required participants who had male and female partners to say which was predominant, while Version B had a midpoint response option: "about equally with men and women." Participants were randomized between versions. Overall, 5.3% of men and 5.6%of women reported they were not entirely heterosexual. The question using "gay or lesbian" elicited higher (though not statistically significant) reporting of non-heterosexual orientation than the question using "homosexual." A significantly larger proportion of men and women (96.0 and 96.1%) reported entirely heterosexual partnerships in response to Version A of the partnership question than in response to Version B (94.0 and 92.9%) where Version B asked specifically about "kissing, touching, intercourse, or any other form of sex." These figures constitute the first national prevalence data on combined sexual orientation and sexual behavior in England, based on a random probability sample of the general population. They demonstrate that people are willing to report their sexual orientation in survey research, but reporting is sensitive to question wording.

Stability and change in sexual orientation identity over a 10-year period in adulthood

We examined reports of sexual orientation identity stability and change over a 10-year period drawing on data from the National Survey of Midlife Development in the United States (MIDUS I and II) and tested for three patterns: (1) heterosexual stability, (2) female sexual fluidity, and (3) bisexual fluidity. Fifty-four percent of the 2,560 participants were female and the average age was approximately 47 years. At Wave 1, 2,494 (97.42%) reported a heterosexual identity, 32 (1.25%) a homosexual identity, and 34 (1.33%) a bisexual identity and somewhat more than 2% reported a different sexual orientation identity at Wave 2. Although some support for each hypothesis was found, initial sexual orientation identity interacted with gender to predict a more complex pattern. For the sample as a whole, heterosexuality was the most stable identity. For women, bisexuality and homosexuality were equally unstable and significantly less stable than heterosexuality, suggesting that sexual orientation identity fluidity is a pattern that applies more to sexual minority women than heterosexual women. For men, heterosexuality and homosexuality were both relatively stable compared to bisexuality, which stood out as a particularly unstable identity. This pattern of results was consistent with previous findings and helps to address methodological limitations of earlier research by showing the characteristics of a population-based sample of heterosexual, homosexual, and bisexual identified men and women over time.

Sexual orientation and substance use among adolescents and young adults

OBJECTIVES

We examined interrelationships among the 3 dimensions of sexual orientation-self-identity, sexual attraction, and sexual experience-and their associations with substance use among adolescents and young adults.

METHODS

To estimate total and net associations of sexual identity, attraction, and experience with use of tobacco, drugs, and alcohol, we applied logistic regression to cross-sectional data from the National Survey of Family Growth Cycle 6.

RESULTS

We found a lack of concordance among the different dimensions of sexual orientation. More youths reported same-gender sexual attraction and same-gender sexual experiences than identified as lesbian, gay, or bisexual. Estimates of substance use prevalence differed significantly by gender and across dimensions of sexual orientation. Sexual experience was the most consistent predictor of substance use. Women and men with no sexual experience had the lowest odds of all forms of substance use; those reporting sexual experience with partners of both genders had the highest odds.

CONCLUSIONS

Our findings indicate that sexual identity was less strongly associated with substance use than sexual experience and attraction were, pointing to the need for more nuanced indicators of sexual orientation in public health studies.

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.

[Prevalence of HIV infection and sexual behaviors with both men and women among currently married men who have sex with men]

OBJECTIVE

To find out the status of HIV infection, sexual behaviors with both men and women as well as condom use among currently married men who have sex with men (MSM) so as to document for HIV intervention targeting this sub-population, in Beijing, Chengdu, Harbin and Zhengzhou cities.

METHODS

"Snowballing" sampling method was used to recruit subjects in four cities. Participants were investigated by anonymous questionnaire containing demographics, sexual orientation, both homosexual and heterosexual behaviors and condom use during the past 6 months. Blood samples from participants were used to test HIV antibodies.

RESULTS

Of the 858 participants for four cities, the average age was 38.3 (SD=9.1) years. 36.7% of them had completed the junior high school or under. The percentage of participants who identified themselves as homosexual, bisexual, and heterosexual or undecided were 40.9%, 54.3% and 4.8%, respectively. The overall HIV prevalence was 8.0%, and among four cities the HIV prevalence in Chengdu was the highest (13.3%). Results from the Multiple logistic regression analysis showed that never used condoms when having anal sex with men during the past 6 months among participants who did not have a city residential card, identifying himself as having homosexual orientation, living in Harbin, having first anal sex experience before 18 years of age the range of OR value was 1.5-2.1. In addition, the factors associated with never using condoms in vaginal sex with women during the past 6 months were as follows: being over 46 years old, not having a city residential card, living in Beijing, identifying himself as heterosexual orientated or with unknown sexual orientation, never using condoms in anal sex with men during the past 6 months, the range of OR value was 1.7-5.9.

CONCLUSION

The prevalence of HIV infection seemed to be quite high among those currently married MSM. High rates of unprotected homosexual and heterosexual behaviors might accelerate the spreading of HIV from currently married MSM to their wives.

A survey of condom use behaviors and HIV/STI prevalence among venue-based money boys in Shenzhen, China

We examined an at-risk population in China, money boys (MBs), to evaluate their potential role for transmitting HIV and sexually transmitted infections (STIs). Data were collected from 418 MBs selected by time-location cluster sampling, using a self-administered computerized questionnaire and testing a small blood sample for HIV/STIs. One-third (32.1%) of participants self-identified as homosexual, 25.4% heterosexual, 33.5% bisexual, and 9.1% uncertain. Consistent condom use by participants was 70-80% with commercial sex partners, 43.9% with girlfriends, and 60-70% with other non-commercial partners. HIV prevalence was 3.3%; syphilis, 10.5%; and HSV-2, 11.0%; overall prevalence for any was 20.3%. Factors significantly associated with HIV/STIs included being minority (OR = 4.82), having only male partners (OR = 1.92), having more male casual partners in the last 6 months (OR = 1.28), being younger at sexual debut (OR = 1.14), and being older (OR = 1.11). This study emphasizes the importance of developing targeted interventions for MBs, particularly those who are homosexual or minority.

Preventive care's forgotten women: life course, sexuality, and sexual health among homosexually and bisexually active women in France

Although studies show that women who have sex with women (WSW) have poorer sexual health and more limited access to health care for gynecological problems than other women, the social processes giving rise to such health differences have not, so far, been explored. These processes may be formed in response to a dominant social norm, which assigns women to a heterosexual and monogamous sexuality. Based on data from a national random survey of sexuality (N = 6,824), enriched by qualitative interviews with WSW (n = 40), this analysis shows that bisexually active women had similar socio-demographic profiles to heterosexually active women, whereas homosexually active women appeared to be more highly educated than other women and less likely to live as couples than bisexually active women. Bisexually active women had more diversified sexual trajectories and sexual networks than other women. Chlamydia prevalence was found to be higher among bisexually active women, and homosexually active women reported fewer medical consultations for gynecological reasons. These analyses highlight the need to deconstruct the binary classification of homosexual versus heterosexual women. Because of constraint by the monogamous heterosexual norm, bisexually active women were less likely to be tested for sexually transmitted infections, and homosexually active women were less likely to have had gynecological follow-ups.

Sex toy use by gay and bisexual men in the United States

Recent studies have documented that vibrators are an important part of the sexual repertoires of both men and women and have demonstrated positive sexual health outcomes among individuals who use such products. However, little is known about the use of other sexual enhancement products, particularly among gay and bisexually identified men. This study sought to document the extent to which gay and bisexually identified men report using sex toys and the sexual and relational situations within which they used them. Data were collected via an internet-based survey from 25,294 gay and bisexually identified men throughout the U.S. recruited from an Internet site popular among men seeking social or sexual interactions with other men. A majority (78.5%) of gay and bisexually identified men reported having used at least one type of sex toy, including dildos (62.1%), non-vibrating cock rings (51.9%), vibrators (49.6%), butt plugs (34.0%), masturbation sleeves (27.9%), and anal beads or balls (19.3%). Among users, toys such as dildos or butt plugs were commonly inserted into one's own anus during masturbation (95.7%, n = 11,781) and insertion into their partners anus (72.0% n = 4,197) during partnered sexual activities. These data suggest that sex toy use is common among gay and bisexual men during both solo and partnered sexual activities and considered by these men as enhancing the quality of their sexual experiences.

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.

The impact of role models on health outcomes for lesbian, gay, bisexual, and transgender youth

PURPOSE

There is little research on the impact of role models on health outcomes for lesbian, gay, bisexual, and transgender (LGBT) youth. This exploratory study describes the presence and availability of LGBT-affirming role models, and examines the relationship between the accessibility of role models and health outcomes among a community-based sample of LGBT youth.

METHODS

A convenience sample of 496 ethnically diverse, 16-24-year-old LGBT youth was recruited to complete a computer-assisted interview, using standardized instruments validated with adolescents. The prevalence and characteristics of role models were described. Differences in subgroup distribution were assessed using Pearson χ(2) test (p < .05). Differences in health outcomes for those with and without role models and the nature of those role models were determined using analysis of covariance models, with post hoc Bonferroni tests to probe significant global findings.

RESULTS

Sixty percent of the participants reported having a role model, with younger participants significantly more likely to report having a role model. A majority of the participants reported having inaccessible role models, especially among younger participants. The presence and accessibility of a role model did not have a significant relationship to binge drinking, drug use, or sexually transmitted infection diagnoses; however, participants with inaccessible role models showed increased psychological distress versus those with accessible or no role models.

CONCLUSIONS

Inaccessible role models may not be sufficient for protecting youth from negative outcomes, and formal mechanisms for connecting LGBT youth with caring adults who can serve as role models, such as mentoring programs, are critical.

Partner characteristics and undiagnosed HIV seropositivity among men who have sex with men only (MSMO) and men who have sex with men and women (MSMW) in Baltimore

This study examined the relationship between HIV risk behaviors, partner characteristics, and undiagnosed seropositivity among men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). BESURE-MSM2 is a venue-based cross-sectional HIV surveillance study conducted among MSM in 2008. Stratified log-binomial regression was used to assess adjusted prevalence ratios of undiagnosed seropositivity among 103 MSMW and 296 MSMO (N = 399). Among MSMO, race/ethnicity, age, having had a sexually transmitted infection, concurrency, and having a black/African American male partner were associated with undiagnosed seropositivity. Among MSMW, having five or more male partners, having a main male partner, and having a main female partner were associated with undiagnosed seropositivity. Our findings underscore the importance of partner characteristics in understanding HIV transmission. HIV programs for men with both male and female partners are needed to address the unique partnership dynamics of MSMW.

Adult body mass index trajectories and sexual orientation: the Nurses' Health Study II

BACKGROUND

Cross-sectional research has documented elevated prevalence of obesity in lesbian and bisexual women relative to heterosexual women, but little is known about disparities in longitudinal patterns in BMI change during adulthood.

PURPOSE

To examine sexual orientation-related disparities in individual BMI trajectories throughout adulthood.

METHODS

Data on BMI, sexual orientation, and sociodemographics were gathered prospectively from 1989 through 2005 from 90,713 U.S. women in the Nurses' Health Study II and examined in 2011 using general growth mixture modeling to identify BMI trajectories from ages 25 to 59 years. Multinomial logistic regression was used to determine whether sexual orientation was associated with BMI trajectory group membership.

RESULTS

Four BMI trajectory groups were identified and labeled based on mean BMI within each group at baseline and final follow-up: Group 1: slow-weight-gain trajectory; Group 2: moderate-weight-gain trajectory; Group 3: rapid-weight-gain trajectory; and Group 4: obese-to-overweight trajectory. Lesbian and bisexual women showed consistently higher odds of membership in Groups 2-4 (adverse-weight-gain trajectories) versus Group 1 (the slow-weight-gain trajectory) relative to heterosexual women.

CONCLUSIONS

Both lesbian and bisexual women were more likely than heterosexual women to experience adverse-weight-gain trajectories in adulthood. New research efforts are needed to understand and eliminate these pronounced disparities.

Sexual, behavioral, and quality of life characteristics of healthy weight, overweight, and obese gay and bisexual men: findings from a prospective cohort study

While there have been attempts to explore the association of obesity and risky sexual behaviors among gay men, findings have been conflicting. Using a prospective cohort of gay and bisexual men residing in Pittsburgh, we performed a semi-parametric, group-based analysis to identify distinct groups of trajectories in body mass index slopes over time from 1999 to 2007 and then correlated these trajectories with a number of psychosocial and behavioral factors, including sexual behaviors. We found many men were either overweight (41.2%) or obese (10.9%) in 1999 and remained stable at these levels over time, in contrast to recent increasing trends in the general population. Correlates of obesity in our study replicated findings from the general population. However, we found no significant association between obesity and sexual risk-taking behaviors, as suggested from several cross-sectional studies of gay men. While there was not a significant association between obesity and sexual risk-taking behaviors, we found high prevalence of overweight and obesity in this population. Gay and bisexual men's health researchers and practitioners need to look beyond HIV and STI prevention and also address a broader range of health concerns important to this population.

Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: a quasi-natural experiment

OBJECTIVES

We sought to determine whether health care use and expenditures among gay and bisexual men were reduced following the enactment of same-sex marriage laws in Massachusetts in 2003.

METHODS

We used quasi-experimental, prospective data from 1211 sexual minority male patients in a community-based health center in Massachusetts.

RESULTS

In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically significant decrease in medical care visits (mean = 5.00 vs mean = 4.67; P = .05; Cohen's d = 0.17), mental health care visits (mean = 24.72 vs mean = 22.20; P = .03; Cohen's d = 0.35), and mental health care costs (mean = $2442.28 vs mean = $2137.38; P = .01; Cohen's d = 0.41), compared with the 12 months before the law change. These effects were not modified by partnership status, indicating that the health effect of same-sex marriage laws was similar for partnered and nonpartnered men.

CONCLUSIONS

Policies that confer protections to same-sex couples may be effective in reducing health care use and costs among sexual minority men.

Support for a fluid-continuum model of sexual orientation: a large-scale Internet study

In a study with 17,785 subjects obtained over the Internet from the United States and 47 other countries, Kinsey's hypothesis that sexual orientation lies on a continuum was supported. Self-identifications of subjects as gay, straight, bisexual, and other corresponded to broad, skewed distributions, suggesting that such terms are misleading for many people. Sexual orientation range-roughly, how much flexibility someone has in expressing sexual orientation-was also measured. The results support a fluid-continuum model of sexual orientation, according to which genetic and environmental factors determine both the size of the sexual orientation range and the point at which an individual's sexual orientation is centered on the continuum.

Sex parties among young gay, bisexual, and other men who have sex with men in New York City: attendance and behavior

Very little information exists with regard to sex party behaviors in young men who have sex with men (YMSM), often defined as men ranging in age from 13 to 29 years. The current analysis examines sex party attendance and behavior in a sample of 540 emergent adult gay, bisexual, and other YMSM in New York City, ages 18-29 years. Findings indicate that 8.7% (n = 47) of the sample had attended a sex party 3 months prior to assessment. Sex party attendees reported that parties included both HIV-positive and HIV-negative men; attendees also reported unprotected sex and limited access to condoms and lubricant. As compared with those who did not attend sex parties, those who did indicated significantly more lifetime and recent (last 3 months) casual sex partners, drug use (both number of different drugs used and total lifetime use), psychosocial burden (history of partner violence and number of arrests), and total syndemic burden (a composite of unprotected anal sex, drug use and psychosocial burden). These results indicate that while only a small percentage of the overall sample attended sex parties, the intersection of both individual risk factors coupled with risk factors engendered within the sex party environment itself has the potential to be a catalyst in the proliferation of the HIV/AIDS epidemic in urban settings. Lastly, given that sex parties are different than other sex environments, commercial and public, with regard to how they are accessed, public health strategies may need to become more tailored in order to reach this potentially highly risky group.

Associations of discrimination and violence with smoking among emerging adults: differences by gender and sexual orientation

INTRODUCTION

Lesbian, gay, and bisexual (i.e., sexual minority) populations have higher smoking prevalence than their heterosexual peers, but there is a lack of empirical study into why such disparities exist. This secondary analysis of data sought to examine associations of discrimination and violence victimization with cigarette smoking within sexual orientation groups.

METHODS

Data from the Fall 2008 and Spring 2009 National College Health Assessments were truncated to respondents of 18-24 years of age (n = 92,470). Since heterosexuals comprised over 90% of respondents, a random 5% subsample of heterosexuals was drawn, creating a total analytic sample of 11,046. Smoking status (i.e., never-, ever-, and current smoker) was regressed on general (e.g., not sexual orientation-specific) measures of past-year victimization and discrimination. To examine within-group differences, two sets of multivariate ordered logistic regression analyses were conducted: one set of models stratified by sexual orientation and another set stratified by gender-by-sexual-orientation groups.

RESULTS

Sexual minorities indicated more experiences of violence victimization and discrimination when compared with their heterosexual counterparts and had nearly twice the current smoking prevalence of heterosexuals. After adjusting for age and race, lesbians/gays who were in physical fights or were physically assaulted had higher proportional odds of being current smokers when compared with their lesbian/gay counterparts who did not experience those stressors.

CONCLUSIONS

When possible, lesbian/gay and bisexual groups should be analyzed separately, as analyses revealed that bisexuals had a higher risk profile than lesbians/gays. Further research is needed with more nuanced measures of smoking (e.g., intensity), as well as examining if victimization may interact with smoking cessation.

Women's sexual orientations and their experiences of sexual assault before and during university

PURPOSE

We sought to examine relationships between women's sexual orientations and their sexual assault experiences before and during university.

METHODS

Self-reported responses on a web-based survey of 5,439 female undergraduates who participated in the Campus Sexual Assault study were analyzed to compare three groups: bisexuals, lesbians, and heterosexuals. Groups were compared in terms of the prevalence of sexual assault before and during university, and the extent to which sexual assault before university predicted sexual assault during university.

FINDINGS

The prevalence of sexual assault before and during university was higher among bisexuals and lesbians compared with heterosexuals (25.4% of bisexuals, 22.4% of lesbians, and 10.7% of heterosexuals were sexually assaulted before university; 24.0% of bisexuals, 17.9% of lesbians, and 13.3% of heterosexuals were sexually assaulted during university). Sexual assault before university was highly predictive of sexual assault during university, especially among non-heterosexuals. Compared with heterosexuals not sexually assaulted before university (the referent group), previously assaulted non-heterosexuals (bisexuals/lesbians) had eight times the odds of sexual assault during university (adjusted odds ratio [AOR] = 8.75), whereas previously assaulted heterosexuals had four times the odds of sexual assault during university (AOR, 4.40). However, there was no difference in the odds of sexual assault during university between non-heterosexuals not sexually assaulted before university and heterosexuals not sexually assaulted before university.

CONCLUSION

Bisexual and lesbian women are more likely than heterosexual women to be sexually assaulted before and during university. Sexual assault before university is linked to sexual assault during university for all women, with this association being especially pronounced among non-heterosexuals.

HIV incidence, risk factors, and motivation for biomedical intervention among gay, bisexual men, and transgender persons in Northern Thailand

Background

HIV prevalence among men who have sex with men (MSM) and transgender (TG) persons is high and increasing in Chiang Mai, northern Thailand.

Objectives

To describe demographic, socioeconomic, sexual behavior and interest in future HIV prevention trials among gay and bisexual MSM and TG presenting for HIV testing (VCT) and pre-screening for the iPrEx pre-exposure chemoprophylaxis trail.

Methods

In 2008–09, MSM/TG participants attending VCT were interviewed and tested for HIV and STI. Univariate and multivariate regression analyses were done to assess associations with HIV infection.

Results

A total of 551 MSM clients (56.1% gay, 25.4% TG, and 18.5% bisexual (BS)) were enrolled. The mean age was 23.9 years. HIV prevalence among MSM overall was 12.9% (71/551); 16.5% among gay men, 9.3% among TG, and 6.9% among BS. Consistent use of condom was low, 33.3% in insertive anal sex and 31.9% in receptive anal sex. Interest in participation was high, 86.3% for PrEP, 69.7% for HIV vaccine trials, but 29.9% for circumcision. HIV was independently associated with being gay identified, aOR 2.8, p = 0.037 and with being aged 25–29, aOR 2.7, p = 0.027. Among repeat testers, HIV incidence was 8.2/100 PY, 95% CI, 3.7/100PY to 18.3/100PY.

Conclusion

HIV risks and rates varied by self-reported sexual orientation and gender identity. HIV was associated with sexual practices, age, and being gay-identified. These are populations are in need of novel prevention strategies and willing to participate in prevention research.

Patterns and correlates of same-sex sexual activity among U.S. teenagers and young adults

CONTEXT

Little is known about the prevalence and correlates of same-sex sexual activity among teenagers and young adults, particularly those who do not identify themselves as gay, lesbian or bisexual. Effective interventions to prevent STDs require accurate understanding of youths' sexual behavior.

METHODS

Descriptive and regression analyses of data from the 2002 National Survey of Family Growth examined patterns and correlates of same-sex sexual activity among a sample of 2,688 never-married, noncohabiting men and women aged 15-21. Same-sex behavior was assessed separately by gender, as well as by heterosexual experience and sexual attraction and identity.

RESULTS

Eleven percent of women and 4% of men reported same-sex sexual experience. Youth who were attracted only to the opposite sex had a decreased likelihood of reporting same-sex activity (rate ratio, 0.1 for each gender), while women and men who identified themselves as homosexual or bisexual had an elevated likelihood of such activity (5.1 and 5.9, respectively). However, among women who were attracted exclusively to men, those who had had heterosexual sex were more than four times as likely as those who had not to have engaged in same-sex activity. Finally, among youth who reported any same-sex attraction, women and men who said they were homosexual or bisexual had an elevated likelihood of having engaged in same-sex behavior (4.7 and 5.6, respectively).

CONCLUSION

A significant proportion of "straight" youth engage in same-sex activity, and so information on risks associated with such behavior should be included in sex education programs and targeted to all youth.

The number of recent sex partners among bisexual men in the United States

CONTEXT

Little is known regarding bisexual men's number of recent sex partners, a risk factor for HIV and other STDs. Furthermore, it is unclear if bisexual men have more partners than heterosexual or homosexual men, and whether partner number varies by measures of sexual behavior, identity and attraction.

METHODS

Sexual orientation-defined separately by sexual behavior during the past year, identity and attraction-was assessed for 3,875 sexually active men aged 15-44 who had participated in the 2002 National Survey of Family Growth. Chi-square and t tests examined differences in background characteristics, behavioral risk factors and number of past-year sex partners by sexual orientation according to each definition. Multivariate ordinary least-squares regression was used to assess predictors of the number of partners.

RESULTS

When sexual identity and attraction were controlled for, behaviorally bisexual men were predicted to have had 3.1 more past-year partners than behaviorally heterosexual men and 2.6 more than behaviorally homosexual men. After controlling for sexual identity and behavior, bisexual-attracted men had had 0.7 fewer partners than homosexual-attracted men. In a model including background characteristics and behavioral risk factors, behaviorally bisexual men were predicted to have had 2.5-2.6 more partners than others. Neither bisexual identity nor bisexual attraction independently predicted the number of recent partners.

CONCLUSION

The way in which bisexuality relates to men's number of recent sex partners depends on how sexual orientation is measured. Interventions to reduce behaviorally bisexual men's number of partners will likely lessen their risk for HIV and other STDs.

PartyIntents: a portal survey to assess gay and bisexual men's risk behaviors at weekend parties

PartyIntents examines whether portal survey methods could be used to anonymously survey gay and bisexual men about HIV-risk behaviors before and after a weekend party-oriented vacation. The study recruited 97% of eligible men and of these 489 participants 47% completed the follow-up assessment. Approximately one half of the men intended to use illegal drugs over the weekend, and almost 20% thought that they might have anal intercourse and not use a condom. The methodology can be applied and provides useful information about HIV risk at these events, though refinements may be needed to increase the follow-up rates.

The spread of HIV in Pakistan: bridging of the epidemic between populations

In the last two decades, ‘concentrated epidemics’ of human immunodeficiency virus (HIV) have established in several high risk groups in Pakistan, including Injecting Drug Users (IDUs) and among men who have sex with men (MSM). To explore the transmission patterns of HIV infection in these major high-risk groups of Pakistan, 76 HIV samples were analyzed from MSM, their female spouses and children, along with 26 samples from a previously studied cohort of IDUs. Phylogenetic analysis of HIV gag gene sequences obtained from these samples indicated a substantial degree of intermixing between the IDU and MSM populations, suggesting a bridging of HIV infection from IDUs, via MSM, to the MSM spouses and children. HIV epidemic in Pakistan is now spreading to the female spouses and offspring of bisexual MSM. HIV control and awareness programs must be refocused to include IDUs, MSM, as well as bisexual MSM, and their spouses and children.

Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12--youth risk behavior surveillance, selected sites, United States, 2001-2009

PROBLEM

Sexual minority youths are youths who identify themselves as gay or lesbian, bisexual, or unsure of their sexual identity or youths who have only had sexual contact with persons of the same sex or with both sexes. Population-based data on the health-risk behaviors practiced by sexual minority youths are needed at the state and local levels to most effectively monitor and ensure the effectiveness of public health interventions designed to address the needs of this population.

REPORTING PERIOD COVERED

January 2001-June 2009.

DESCRIPTION OF SYSTEM

The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, dietary behaviors, physical activity and sedentary behaviors, and weight management) and the prevalence of obesity and asthma among youths and young adults. YRBSS includes state and local school-based Youth Risk Behavior Surveys (YRBSs) conducted by state and local education and health agencies. This report summarizes results from YRBSs conducted during 2001-2009 in seven states and six large urban school districts that included questions on sexual identity (i.e., heterosexual, gay or lesbian, bisexual, or unsure), sex of sexual contacts (i.e., same sex only, opposite sex only, or both sexes), or both of these variables. The surveys were conducted among large population-based samples of public school students in grades 9-12.

RESULTS

Across the nine sites that assessed sexual identity, the prevalence among gay or lesbian students was higher than the prevalence among heterosexual students for a median of 63.8% of all the risk behaviors measured, and the prevalence among bisexual students was higher than the prevalence among heterosexual students for a median of 76.0% of all the risk behaviors measured. In addition, the prevalence among gay or lesbian students was more likely to be higher than (rather than equal to or lower than) the prevalence among heterosexual students for behaviors in seven of the 10 risk behavior categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management). Similarly, the prevalence among bisexual students was more likely to be higher than (rather than equal to or lower than) the prevalence among heterosexual students for behaviors in eight of the 10 risk behavior categories (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management). Across the 12 sites that assessed sex of sexual contacts, the prevalence among students who had sexual contact with both sexes was higher than the prevalence among students who only had sexual contact with the opposite sex for a median of 71.1% of all the risk behaviors measured, and the prevalence among students who only had sexual contact with the same sex was higher than the prevalence among students who only had sexual contact with the opposite sex for a median of 29.7% of all the risk behaviors measured. Furthermore, the prevalence among students who had sexual contact with both sexes was more likely to be higher than (rather than equal to or lower than) the prevalence among students who only had sexual contact with the opposite sex for behaviors in six of the 10 risk behavior categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, and weight management). The prevalence among students who only had sexual contact with the same sex was more likely to be higher than (rather than equal to or lower than) the prevalence among students who only had sexual contact with the opposite sex for behaviors in two risk behavior categories (behaviors related to attempted suicide and weight management).

INTERPRETATIONS

Sexual minority students, particularly gay, lesbian, and bisexual students and students who had sexual contact with both sexes, are more likely to engage in health-risk behaviors than other students.

PUBLIC HEALTH ACTION

Effective state and local public health and school health policies and practices should be developed to help reduce the prevalence of health-risk behaviors and improve health outcomes among sexual minority youths. In addition, more state and local surveys designed to monitor health-risk behaviors and selected health outcomes among population-based samples of students in grades 9-12 should include questions on sexual identity and sex of sexual contacts.