Sexual health behaviors and sexual orientation in a U.S. national sample of college students

Many studies have examined differences in sexual behavior based on sexual orientation with results often indicating that those with same-sex partners engage in higher risk sexual behavior than people with opposite sex partners. However, few of these studies were large, national sample studies that also include those identifying as unsure. To address that gap, this study examined the relationship of sexual orientation and sexual health outcomes in a national sample of U.S. college students. The Fall 2009 American College Health Association-National College Health Assessment was used to examine sexual health related responses from heterosexual, gay, lesbian, bisexual, and unsure students (N = 25,553). Responses related to sexual behavior, safer sex behaviors, prevention and screening behaviors, and diagnosis of sexual health related conditions were examined. The findings indicated that sexual orientation was significantly associated with engaging in sexual behavior in the last 30 days. Sexual orientation was also significantly associated with the number of sexual partners in the previous 12 months, with unsure men having significantly more partners than gay, bisexual and heterosexual men and heterosexual men having significantly less partners than gay, bisexual and unsure men. Bisexual women had significantly more partners than females reporting other sexual orientations. Results examining the associations between sexual orientation and safer sex, prevention behaviors, and screening behaviors were mixed. Implications for practice, including specific programmatic ideas, were discussed.

Health consequences of racist and antigay discrimination for multiple minority adolescents

Individuals who belong to a marginalized group and who perceive discrimination based on that group membership suffer from a variety of poor health outcomes. Many people belong to more than one marginalized group, and much less is known about the influence of multiple forms of discrimination on health outcomes. Drawing on literature describing the influence of multiple stressors, three models of combined forms of discrimination are discussed: additive, prominence, and exacerbation. The current study examined the influence of multiple forms of discrimination in a sample of African American lesbian, gay, or bisexual (LGB) adolescents ages 14-19. Each of the three models of combined stressors were tested to determine which best describes how racist and antigay discrimination combine to predict depressive symptoms, suicidal ideation, and substance use. Participants were included in this analysis if they identified their ethnicity as either African American (n = 156) or African American mixed (n = 120). Mean age was 17.45 years (SD = 1.36). Results revealed both forms of mistreatment were associated with depressive symptoms and suicidal ideation among African American LGB adolescents. Racism was more strongly associated with substance use. Future intervention efforts should be targeted toward reducing discrimination and improving the social context of multiple minority adolescents, and future research with multiple minority individuals should be attuned to the multiple forms of discrimination experienced by these individuals within their environments.

LGBT community, social network characteristics, and smoking behaviors in young sexual minority women

Smoking rates among young sexual minority women (YSMW) are disproportionately high as compared to heterosexual populations. While this disparity has commonly been attributed to the sexual minority stress process, little empirical work has explored what may protect YSMW from high rates of smoking. Using data (N = 471) from a cross-sectional study designed to investigate YSMW's (age 18-24) smoking behaviors and correlates; we explore the relationship of LGBT community connections, YSMW's social network characteristics, and stress to smoking behaviors (i.e., status, frequency, amount). Through this analysis, we find support for LGBT community connection as well as friendships with other sexual minorities as protective in relation to YSMW's smoking behaviors. We discuss the implications of our results, highlighting the need for future longitudinal research and interventions designed to bolster YSMW's connections to the LGBT community and their social networks.

CVD risk among men participating in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2010: differences by sexual minority status

BACKGROUND

Recent research indicates that sexual minority women are at increased risk for cardiovascular disease (CVD) compared with heterosexual women; however, few studies of CVD risk exist for sexual minority men (SMM). This study aimed to determine whether disparities in CVD risk exist for SMM and if CVD risk is consistent across subgroups of SMM.

METHODS

This study utilised publicly available data from the National Health and Nutrition Examination Survey (NHANES), pooled from 2001 to 2010. CVD risk was calculated using the Framingham General CVD Risk Score and operationalised as the ratio of a participant's vascular and chronological age. Differences in this ratio were examined between heterosexual and SMM as a whole, and within subgroups of SMM.

RESULTS

SMM had vascular systems that were, on average, 4% (95% CI -7.5% to -0.4%) younger than their heterosexual counterparts; however, adjustment for education and history of hard drug use rendered this difference statistically insignificant. Analysis of SMM subgroups revealed increased CVD risk for bisexual men and decreased CVD risk for both gay and homosexually experienced heterosexual men when compared with heterosexual men. Differences in CVD risk persisted for only bisexual and homosexually experienced heterosexual men after adjustment for education and history of hard drug use.

CONCLUSIONS

Subgroups of SMM are at increased risk for CVD compared with heterosexual men, and this increased risk cannot be completely attributed to differences in demographic characteristics or negative health behaviours.

Sexual orientation and sexual risk behaviors among male students of a university in southern Thailand

OBJECTIVE

To determine the prevalence of sexual orientation, identify predictors of being homosexual or bisexual (HB), and assess the association of sexual orientation with sexual risk behaviors among university male students in southern Thailand.

MATERIAL AND METHOD

A cross-sectional study was conducted on third year male university students between June 2008 and February 2009 using anonymous self-administered questionnaires.

RESULTS

Among 1,101 eligible students, 1,013 (92%) responded The prevalence of heterosexuality, homosexuality, and bisexuality among respondents were 90.2%, 6.7%, and 3.1%, respectively giving a prevalence of HB of 9.8%. Significant factors predicting HB included having separated parents. Overall lifetime prevalence of men having sex with men (MSM) was 6.3% (2% in heterosexual males and 46.5% among HB males). HB males were more likely to have multiple sex partners and engage in group sex, and less likely to use condoms than were heterosexual males.

CONCLUSION

The prevalence of sexual risk behaviors among these male students, especially HB, was high.

Beyond internalised stigma: daily moralities and subjectivity among self-identified kothis in Karnataka, South India

The Bill and Melinda Gates Foundation has poured a tremendous amount of resources into epidemic prevention in India's high HIV prevalence zones, through their Avahan initiative. These community-centred programmes operate under the assumption that fostering community-based organisational development and empowering the community to take charge of HIV prevention and education will help to transform the wider social inequalities that inhibit access to health services. Focusing on the South Indian state of Karnataka, this paper explores a troubling set of local narratives that, we contend, hold broader implications for future programme planning and implementation. Although confronting stigma and discrimination has become a hallmark in community mobilisation discourse, communities of self-identified kothis (feminine men) who were involved in Avahan programme activities continued to articulate highly negative attitudes about their own sexualities in relation to various spheres of social life. Rather than framing an understanding of these narratives in psychological terms of 'internalized stigma', we draw upon medical anthropological approaches to the study of stigma that emphasise how social, cultural and moral processes create stigmatising conditions in the everyday lives of people. The way stigma continues to manifest itself in the self-perceptions of participants points to an area that warrants critical public health attention.

The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors

PURPOSE

Based on resilience theory, this paper investigates the influence of key health indicators and risk and protective factors on health outcomes (including general health, disability, and depression) among lesbian, gay male, and bisexual (LGB) older adults.

DESIGN AND METHODS

A cross-sectional survey was conducted with LGB older adults, aged 50 and older (N = 2,439). Logistic regressions were conducted to examine the contributions of key health indicators (access to health care and health behaviors), risk factors (lifetime victimization, internalized stigma, and sexual identity concealment), and protective factors (social support and social network size) to health outcomes, when controlling for background characteristics.

RESULTS

The findings revealed that lifetime victimization, financial barriers to health care, obesity, and limited physical activity independently and significantly accounted for poor general health, disability, and depression among LGB older adults. Internalized stigma was also a significant predictor of disability and depression. Social support and social network size served as protective factors, decreasing the odds of poor general health, disability, and depression. Some distinct differences by gender and sexual orientation were also observed.

IMPLICATIONS

High levels of poor general health, disability, and depression among LGB older adults are of major concern. These findings highlight the important role of key risk and protective factors, which significantly influences health outcomes among LGB older adults. Tailored interventions must be developed to address the distinct health issues facing this historically disadvantaged population.

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth

The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mental health with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Referrals for mental health or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Prevention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.

Perceived importance of five different health issues for gay and bisexual men: implications for new directions in health education and prevention

This study assessed the perceived importance of five health issues for gay and bisexual men (N = 660) using time-space sampling in gay bars/clubs and bathhouses in New York City: "HIV & STDs," "Drugs & Alcohol," "Body Image," "Mental Health," and "Smoking." This study compared ratings based on demographic differences, recent substance use, recent sexual risk behavior, and whether or not participants owned a smart device (e.g., "smart" phone, iPad, iPod touch). Contrary to research indicating that gay and bisexual men may be experiencing HIV prevention fatigue, this study identified that HIV and STIs were perceived as most important. Drugs and alcohol and mental health were also rated high, suggesting that providers may be well served to include mental health and drugs and alcohol as part of their comprehensive approach to HIV prevention. A majority of participants (72%) owned a smart device. Smart device owners rated health issues similarly to those who did not, suggesting that such devices may be a useful platform to reach gay and bisexual men for health education and prevention.

Invisible and at risk: STDs among young adult sexual minority women in the United States

CONTEXT

Sexual minority women are not adequately assessed by national STD surveillance systems, and research regarding STD burden in nationally representative samples of such women is rare. Moreover, few studies have assessed STD risk exclusively among young adult women.

METHODS

Wave 4 (2007-2008) data from the National Longitudinal Study of Adolescent Health on 7,296 females aged 24-32 were used to examine the relationship between sexual orientation and receipt of an STD diagnosis in the past year. Multivariate logistic regression analyses used two measures of sexual orientation: sexual identity and gender of sex partners.

RESULTS

Eighty percent of women considered themselves straight; 16% mostly straight; and 4% bisexual, mostly gay or gay. Eighty-five percent had had only male partners, while 7% had had one female partner, and 8% two or more female partners. In unadjusted models, women who identified themselves as mostly straight were more likely than straight women to have had an STD (odds ratio, 1.4); mostly gay or gay women were at lower risk (0.4). Women who had had two or more female partners had a higher STD risk than did women who had had only male partners (1.7). Adjusting for social and demographic characteristics did not substantially alter these results; however, the associations between sexual identity, gender of sex partners and STD diagnosis were eliminated after adjustment for sexual behaviors (e.g., having had anal sex).

CONCLUSIONS

Sexual identity, gender of sex partners and sexual behaviors should be taken into account in assessments of women's STD risk.

Characteristics of a sexual network of behaviorally bisexual men in Vientiane, Lao PDR, 2010

Men who have sex with both men and women (behaviorally bisexual men) may be at increased risk of HIV acquisition and transmission due to risky sexual behaviors. We recruited a sexual network comprised of behaviorally bisexual men and their sexual partners in Vientiane, Lao PDR in 2010 to inform our understanding of the potential for HIV transmission among heterosexual, homosexual, and bisexual networks. Participants completed a sexual behavior questionnaire and referred < 5 sexual partners. A total of 298 people were recruited, including 63 behaviorally bisexual men. Behaviorally bisexual men reported riskier sexual behaviors (number of sexual partners in the previous 12 months and consistent condom use) than behaviorally homosexual and heterosexual men. Using social network diagrammatic representation, heterosexual, homosexual, and bisexual networks are shown to be interlinked. This study demonstrates that behaviorally bisexual men are potential key drivers of HIV epidemics and require a targeted approach to sexual health promotion.

Sexual harassment among young tourists visiting Mediterranean resorts

Despite the known increase in substance use and risky sexual behaviors among young people during holiday periods, issues of sexual harassment (SH) and having sex against one's will (SAW) have not received adequate attention. We implemented a cross-sectional airport-based study to identify experience of SH and SAW in 6,502 British and German holidaymakers aged 16-35 years visiting tourist resorts in Southern Europe (Crete, Cyprus, Italy, Portugal, and Spain) in summer 2009. Across all participants, 8.6 % reported SH during their holiday and 1.5 % reported SAW. Women reported higher levels of SH than heterosexual males. However, gay and bisexual males reported SH levels similar to females and the highest levels of SAW. Of 19 predictor variables tested, ten were independently associated with SH. SH was increased in those who were visitors to Mallorca or Crete, British, younger, female, gay or bisexual, frequently drunk on holiday, cocaine users, and attracted to bars where people get drunk, or where there are opportunities for sex. Among 13 predictor variables tested for SAW, four were significant. SAW reduced in those visiting Cyprus, and was strongly associated with being a gay or bisexual male, using cannabis on holiday and being attracted to bars where there were opportunities for sex. Holiday resorts represent a key location for SH and SAW, especially for holidaymakers who get drunk and use drugs. Preventive programs can raise awareness of the risks of unwanted sexual encounters on holiday and work with the tourist industry and tourist authorities to develop environments where sexual aggression is not tolerated.

Correlates of bisexual behaviors among men who have sex with men in El Salvador

Bisexual behaviors may increase transmission pathways of HIV and sexually transmitted infections (STIs) from a higher prevalence group to lower prevalence groups in El Salvador. In 2008, men who have sex with men (MSM) were recruited in San Salvador and San Miguel using respondent driven sampling. Participants were interviewed and tested for HIV and STIs. Sixteen seeds and 797 MSM participated; 34.9% in San Salvador and 58.8% in San Miguel reported bisexual behavior. Bisexual behavior was associated with drug use (adjusted odds ratio (AOR) = 2.57, 95% CI: 1.30-5.06) and insertive anal sex (AOR = 5.45, 95% CI: 3.01-9.87), and inversely associated with having a stable male partner (AOR = 0.47, 95% CI: 0.26-0.84) and disclosing MSM behavior to family (AOR = 0.41, 95% CI: 0.22-0.75). Bisexual behavior was associated with risk behaviors with male and female partners that may be associated with HIV and STI transmission. Bisexual men displayed a distinct identity calling for tailored interventions.

Repeated changes in reported sexual orientation identity linked to substance use behaviors in youth

PURPOSE

Previous studies have found that sexual minority (e.g., lesbian, gay, bisexual) adolescents are at higher risk of substance use than heterosexuals, but few have examined how changes in sexual orientation over time may relate to substance use. We examined the associations between change in sexual orientation identity and marijuana use, tobacco use, and binge drinking in U.S. youth.

METHODS

Prospective data from 10,515 U.S. youth ages 12-27 years in a longitudinal cohort study were analyzed using sexual orientation identity mobility measure M (frequency of change from 0 [no change] to 1 [change at every wave]) in up to five waves of data. Generalized estimating equations were used to estimate substance use risk ratios and 95% confidence intervals; interactions by sex and age group were assessed.

RESULTS

All substance use behaviors varied significantly by sexual orientation. Sexual minorities were at higher risk for all outcomes, excluding binge drinking in males, and mobility score was positively associated with substance use in most cases (p < .05). The association between mobility and substance use remained significant after adjusting for current sexual orientation and varied by sex and age for selected substance use behaviors. This association had a higher positive magnitude in females than males and in adolescents than young adults.

CONCLUSIONS

In both clinical and research settings it is important to assess history of sexual orientation changes. Changes in reported sexual orientation over time may be as important as current sexual orientation for understanding adolescent substance use risk.

A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth

This short-term prospective study examined general and lesbian, gay, bisexual, and transgender (LGBT)-specific risk and protective factors for suicide attempts in an ethnically diverse sample of LGBT youth (N = 237, 47.7 % male). A structured psychiatric interview assessed clinical depression and conduct disorder symptoms, as well as past and prospective suicide attempts over a 1-year follow-up period (91 % retention). Participants completed questionnaires measuring general risk factors for suicide attempts, including hopelessness, impulsiveness, and perceived social support. They also completed measures of LGBT-specific suicide risk factors, including gender nonconformity, age of first same-sex attraction, and LGBT victimization. Correlation and multivariate regression analyses were conducted to examine the relations between predictors and suicide attempt, and to identify mediators. Of nine variables examined, seven were related to lifetime history of attempted suicide: hopelessness, depression symptoms, conduct disorder symptoms, impulsivity, victimization, age of first same-sex attraction, and low family support. Depressive symptoms and hopelessness mediated the relation between multiple risk and resilience factors and suicide attempts. Suicide attempt history was the strongest predictor of prospective suicide attempts. Participants who previously attempted suicide (31.6 % of the sample) had more than 10 times greater odds of making another attempt in the 1-year follow-up period than were those who had made no previous attempt. These results highlight the need for suicide prevention programs for LGBT youth and suggest the importance of addressing depression and hopelessness as proximal determinants and family support and victimization, which have more distal effects.

Sexual orientation disparities in history of intimate partner violence: results from the California health interview survey

Few studies have examined history of intimate partner violence (IPV) among sexual minorities. We assessed prevalence and predictors of IPV using a probability sample of California residents ages 18 to 70. Lifetime and 1-year IPV prevalence was higher in sexual minorities compared with heterosexuals but this was significant only for bisexual women and gay men. IPV of bisexual women, but not gay men, occurred in a heterosexual relationship. We tested whether the higher prevalence of IPV in gay men and bisexual women was explained by two mental health indicators--psychological distress and binge drinking--but this hypothesis was not supported.

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

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

Navigating condom use and HIV status disclosure with partners met online: a qualitative pilot study with gay and bisexual men from Craigslist.org

We conducted face-to-face semi-structured interviews with 50 men recruited from the New York City men-seeking-men section of Craigslist.org. Participants discussed their favorite venues for meeting sex partners (n = 28 said the Internet), and we focused on these men's responses to probes regarding decisions around condom use and HIV status disclosure with online partners. A majority indicated they set a priori rules for themselves to always use condoms, and they cited the Internet as their favorite venue in part because it helped them sort for like-minded partners. Participants indicated that having in-person conversations around condom use and HIV was often difficult, and that the Internet was a convenient medium to facilitate the process. Notable differences were observed in how HIV-positive and HIV-negative men navigated serostatus disclosure-HIV-negative men were less subtle in starting the conversation. Finally, participants described a common narrative around distrust with online partners, which is one reason why they consistently use condoms. These data suggest that features which allow men to easily indicate, and filter for, condom use preferences should be built into (or maintained on) profile-based sexual networking sites and sexual bulletin board sites.

Sexual orientation and demographic, cultural, and psychological factors associated with the perpetration and victimization of intimate partner violence among Hispanic men

Hispanics are disproportionately affected by intimate partner violence (IPV). Most of the research describing factors associated with intimate partner violence among Hispanics has focused on Hispanic women or Hispanics in heterosexual relationships. The purpose of this study was to explore the relationship among sexual orientation (heterosexual, homosexual, and bisexual), and demographic, cultural, and psychological factors and intimate partner violence among Hispanic men. A cross sectional questionnaire was administered to 160 Hispanic heterosexual men and men who have sex with men. Demographic factors (age, education, and income), acculturation, depressive symptoms, and self-esteem were assessed using standardized instruments. Data was analyzed using ANOVA, and simple and multiple logistical regression. Differences in education, income, and self-esteem were noted across participants identifying as heterosexual, homosexual, and bisexual. Bisexual Hispanic men had almost four times greater odds of reporting the perpetration of IPV than homosexual Hispanic men, even when differences in education, income, and self-esteem were controlled for (AOR = 3.92, 95%CI = 1.11, 14.19). This study suggests the importance of specifically targeting bisexual Hispanic men in IPV research and services.

Sexual behaviors and experiences among behaviorally bisexual men in the midwestern United States

Research examining the sexual behaviors and experiences of behaviorally bisexual men is limited. Most studies focus primarily on highlighting sexual risk behaviors among groups of "men who have sex with men (MSM)" or "gay and bisexual men," which may not be appropriate in terms of behaviorally bisexual men's sexual repertoires with both men and women. This study aimed to assess a broad range of sexual behaviors and associated experiences among bisexual men living in the midwestern United States. An interviewer-administered questionnaire containing items from the National Survey of Sexual Health and Behavior assessed lifetime and recent (i.e., past 6 months and last event) sexual behaviors and experiences with both male and female partners among a diverse sample of 75 behaviorally bisexual men. Responses were quantified and analyzed using descriptive and multivariate statistics. A wide range of sexual behaviors with partners of both genders was found. Vaginal intercourse and oral sex with both men and women were the most commonly reported behaviors. Subjective reports of pleasure, arousal, and sexual function during sexual activity were similar with both male and female sexual partners. Many participants reported using condoms during insertive sexual behaviors with male and female partners, but less during oral sex. Unprotected receptive anal sex was less commonly reported. Overall, participants reported a variety of sexual behaviors and experiences; however, unlike other populations, they shared these with partners of both genders. Results have implications for interventions targeting the sexual behaviors and associated issues among behaviorally bisexual men.

Measurement model exploring a syndemic in emerging adult gay and bisexual men

The current study was designed to develop a better understanding of the nature of the relationships between mental health burden, drug use, and unprotected sexual behavior within a sample of emerging adult gay and bisexual men, ages 18-19 (N = 598) and to test a theory of syndemics using structural equation modeling. Participants were actively recruited from community-based settings and the Internet for participation in a seven-wave cohort study. Data for participant characteristics and mental health were collected via computer-assisted survey, while drug use and unprotected sex behaviors for the month prior to assessment were collected via a calendar-based technique. Using the baseline data, we developed and tested structural equation models for mental health burden, drug use, and unprotected sex and also tested a second-order model for a single syndemic. First-order measurement models for each of the three epidemics were successfully identified using observed data. Tests of a second-order model seeking to explain the three epidemics as a single syndemic fit poorly. However, a second-order construct comprised of mental health burden and drug use fit the data well and was highly associated with the first-order construct of unprotected sex. The findings advance a theory of syndemics and suggest that in order to be maximally effective both HIV prevention and HIV care must be delivered holistically such that sexual risk behaviors are addressed in relation to, and in sync with, the drug use and mental health of the individual.

Targeting HIV prevention messaging to a new generation of gay, bisexual, and other young men who have sex with men

HIV prevention messaging has been shown to reduce or delay high-risk sexual behaviors in young men who have sex with men (YMSM). Since the onset of the HIV/AIDS epidemic, a new generation of YMSM has come of age during an evolution in communication modalities. Because both these communication technologies and this new generation remain understudied, the authors investigated the manner in which YMSM interact with HIV prevention messaging. In particular, the authors examined 6 venues in which YMSM are exposed to, pay attention to, and access HIV prevention information: the Internet, bars/dance clubs, print media, clinics/doctors' offices, community centers/agencies, and educational classes. Data were drawn from a community-based sample of 481 racially and ethnically diverse YMSM from New York City. Significant differences in exposure to HIV prevention messaging venues emerged with respect to age, race/ethnicity, and sexual orientation. Attention paid to HIV prevention messages in various venues differed by age and sexual orientation. Across all venues, multivariate modeling indicated YMSM were more likely to access HIV messaging from the same venues at which they paid attention, with some variability explained by person characteristics (age and perceived family socioeconomic status). This suggests that the one-size-fits-all approach does not hold true, and both the venue and person characteristics must be considered when generating and disseminating HIV prevention messaging.

Sexual identity and drug use harm among high-risk, active substance users

Research shows that sexual minorities are at greater risk for illicit substance use and related harm than their heterosexual counterparts. This study examines a group of active drug users to assess whether sexual identity predicts increased risk of substance use and harm from ecstasy, ketamine, alcohol, marijuana, cocaine and crack. Structured interviews were conducted with participants aged 15 years and older in Vancouver and Victoria, BC, Canada, during 2008-2012. Harm was measured with the World Health Organization's AUDIT and ASSIST tools. Regression analysis controlling for age, gender, education, housing and employment revealed lesbian, gay or bisexual individuals were significantly more likely to have used ecstasy, ketamine and alcohol in the past 30 days compared to heterosexual participants. Inadequate housing increased the likelihood of crack use among both lesbian, gay and bisexuals and heterosexuals, but with considerably higher odds for the lesbian, gay and bisexual group. Lesbian, gay and bisexual participants reported less alcohol harm but greater ecstasy and ketamine harm, the latter two categorised by the ASSIST as amphetamine and hallucinogen harms. Results suggest encouraging harm reduction among sexual minority, high-risk drug users, emphasising ecstasy and ketamine. The impact of stable housing on drug use should also be considered.

Forced sexual experiences as risk factor for self-reported HIV infection among southern African lesbian and bisexual women

Even though women who have sex with women are usually understood to be at no or very low risk for HIV infection, we explored whether lesbian and bisexual women in a geographical area with high HIV prevalence (Southern Africa) get tested for HIV and whether, among those women who get tested, there are women who live with HIV/AIDS. The study was conducted in collaboration with community-based organizations in Botswana, Namibia, South Africa and Zimbabwe. Data were collected via written surveys of women who in the preceding year had had sex with a woman (18 years and older; N = 591). Most participating women identified as lesbian and black. Almost half of the women (47.2%) reported ever having had consensual heterosexual sex. Engagement in transactional sex (lifetime) was reported by 18.6% of all women. Forced sex by men or women was reported by 31.1% of all women. A large proportion of the women reported to ever have been tested for HIV (78.3%); number of lifetime female and male partners was independently associated with having been tested; women who had engaged in transactional sex with women only or with women and men were less likely to have been tested. Self-reported HIV prevalence among tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was having experienced forced sex by men, by women, or by both men and women. Study findings indicate that despite the image of invulnerability, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. Surprisingly, it is not sex with men per se, but rather forced sex that is the important risk factor for self-reported HIV infection among the participating women. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women.

Perceptions of campus climate by sexual minorities

Previous research has indicated that students who identify as lesbian, gay, bisexual, or transgender (LGBT) often have negative experiences on university campuses due to their sexual orientation or gender identity. Direct and indirect experiences contribute to an overall perception of the campus climate. This study used an online survey to assess students' perceptions of campus climate, their experiences confronting bias, support of family members and friends, and whether they had considered leaving campus. Multiple regression analysis indicated that perceptions of poorer campus climate were predicted by greater unfair treatment by instructors, more impact from anti-lesbian, gay, bisexual, transgender, or queer (LGBTQ) bias on friends' and families' emotional support, and having hidden one's LGBT identity from other students. Cluster analyses revealed four groups of participants distinguished by openness about their sexual orientation and negative experiences, with one group appearing to be at risk for poor retention. Results are discussed in terms of the needs of LGBTQ students on campus.

Migration patterns of HIV-1 subtype B virus in Northern Italy

Gene flow analysis is used to identify the migration patterns of viruses within a geographical area and /or in different populations. 883 HIV-1 B subtype pol gene sequences were analyzed. The gene analysis among different geographical areas of the Bergamo district and from different transmission risk groups showed 25% of the observed gene flow was from people living in the north valleys to lowland and 40.5% from a heterosexual risk group to injecting drug users. Injecting drug users seem to be the central link, mercenary sex being the common route of transmission (and gene flow) between this group and both heterosexual and homosexual individuals.

Knowledge of acute human immunodeficiency virus infection among gay and bisexual male college students

OBJECTIVE

To examine human immunodeficiency virus (HIV)-related knowledge, attitudes, and behaviors in at-risk college men who have sex with men (MSM), focusing on knowledge about acute HIV infection (AHI).

PARTICIPANTS AND METHODS

A one-time anonymous survey was administered to college students attending a lesbian, gay, bisexual, transgender, and queer conference in February 2012. This article reports on a study subsample of MSM.

RESULTS

A total of 100 MSM completed the survey. Participants had an average age of 20.4 years. Sixty-six percent reported condom use the last time they had sex. Only 46% had ever heard of symptoms related to AHI. Forty-two percent would likely seek medical care when showing acute symptoms in a setting consistent with AHI.

CONCLUSION

Despite having multiple risk factors for HIV infection, many MSM college students are unaware of AHI. HIV prevention programs should target this population and include information about signs, symptoms, and diagnosis of AHI.

Comparing supports for LGBT aging in rural versus urban areas

Studies of rural populations typically underrepresent lesbian, gay, bisexual, and transgender (LGBT) older adults. This secondary analysis examined data from a nationwide sample of LGBT baby boomers (n = 1201). Geographic differences with respect to self-reported outness, acceptance of sexual identity, social and familial support, and household income were assessed with one-way analyses of variance. Guardedness about one's sexual identity and household asset levels were assessed with chi-square analyses. Rural individuals reported lower levels of outness, guardedness with people including siblings and close friends, and lower levels of household income. Providers should consider strategies for connecting older rural LGBT adults for potential care and support.

Gay men and other men who have sex with men in West Africa: evidence from the field

This paper presents a synthesis of lessons learned from field experiences in HIV prevention, treatment and care services for men who have sex with men in the four contiguous West African countries of the Gambia, Guinea-Bissau, Guinea-Conakry and Senegal. Service provision for men who have sex with men in these countries is contextualised by the epidemiology of HIV, as well as the socio-political environment. These countries share notable commonalities in terms of social structures and culture, though past approaches to the needs of men who have sex with men have varied greatly. This synthesis includes three distinct components. The first focuses on what is known about HIV epidemiology among men who have sex with men in these countries and provides an overview of the data gaps affecting the quality of service provision. The second aspect describes the HIV prevention and treatment services currently available and how organisations and strategies have evolved in their approach to working with men who have sex with men. Finally, an examination of the political and cultural climate highlights socio-cultural factors that enable or impede HIV prevention and treatment efforts for men who have sex with men. The review concludes with a series of recommendations for impactful research, advocacy and service provision to improve the health and human rights context for men who have sex with men in West Africa.

Are anti-LGBT homicides in the United States unique?

An integral issue to the study of bias crimes is how violence targeting lesbian, gay, bisexual, and transgender (LGBT) victims is different from other more common forms of violent crimes. Limitations in official bias crimes data have inhibited our understanding of the relative nature of anti-LGBT crimes. The purpose of this study is to examine the similarities and differences in anti-LGBT homicides and average homicides in the United States between 1990 and 2008. The current study addresses methodological issues by relying on an open-source database of anti-LGBT homicides. This study found that the nature of these homicides is both similar and significantly different from the average homicide. Implications for the ongoing bias crimes discourse are discussed.

HIV risk, substance use, and suicidal behaviors among Asian American lesbian and bisexual women

The authors examined the association between lesbian/bisexual identity and three risky health behaviors (HIV risk, substance use, and suicidal behaviors) in a sample of Asian American women. This cross-sectional study was designed to investigate the prevalence of HIV risk behaviors and mental health functioning among unmarried Chinese, Korean, and Vietnamese women ages 18 to 35 who are children of immigrants (N = 701), using computer-assisted survey interviews (CASI). Approximately one out of five Asian American women in the sample identified themselves as a lesbian and bisexual woman (18%). Overall, Asian American lesbian and bisexual women reported higher proportions of risky health behaviors than did their exclusively heterosexual counterparts. The odds of engaging in HIV risk behaviors, using substances, and experiencing suicidal ideation were two to three times higher for lesbian and bisexual women than for exclusively heterosexual women. These findings suggest that rigorous screening is necessary for identifying women in this lesbian/bisexual subgroup in order to provide them with better assessment and services.

Sexual networks, surveillance, and geographical space during syphilis outbreaks in rural North Carolina

BACKGROUND

Sexually transmitted infections (STIs) spread along sexual networks whose structural characteristics promote transmission that routine surveillance may not capture. Cases who have partners from multiple localities may operate as spatial network bridges, thereby facilitating geographical dissemination. We investigated how surveillance, sexual networks, and spatial bridges relate to each other for syphilis outbreaks in rural counties of North Carolina.

METHODS

We selected from the state health department's surveillance database cases diagnosed with primary, secondary, or early latent syphilis during October 1998 to December 2002 and who resided in central and southeastern North Carolina, along with their sex partners and their social contacts irrespective of infection status. We applied matching algorithms to eliminate duplicate names and create a unique roster of partnerships from which networks were compiled and graphed. Network members were differentiated by disease status and county of residence.

RESULTS

In the county most affected by the outbreak, densely connected networks indicative of STI outbreaks were consistent with increased incidence and a large case load. In other counties, the case loads were low with fluctuating incidence, but network structures suggested the presence of outbreaks. In a county with stable, low incidence and a high number of cases, the networks were sparse and dendritic, indicative of endemic spread. Outbreak counties exhibited densely connected networks within well-defined geographic boundaries and low connectivity between counties; spatial bridges did not seem to facilitate transmission.

CONCLUSIONS

Simple visualization of sexual networks can provide key information to identify communities most in need of resources for outbreak investigation and disease control.

Mediating suicide: print journalism and the categorization of queer youth suicide discourses

This article undertakes textual analysis to examine some of the ways in which knowledge around sexuality-related youth suicide and its causes are produced and made available through news media discourses and news-making processes. Four categories of sexuality-related suicide discourses were identified in news stories and features over the past 20 years: statistical research that makes non-heterosexuality implicit as a cause of suicide; stories about deviancy,guilt, and shame; suicide survivor stories; and bullying/harassment of non-heterosexual persons by individuals in schools and other institutions as suicide cause. Through processes of news production and meaning-making, use of expert opinions of primary definers, experiential accounts, reliance on citations of quantitative data, private accounts given as entertainment, and the newsworthiness of suicide as drama, public knowledge on queer youth suicide is guided by contemporary journalism. In all cases, the underlying relationship between heteronormativity, mental health, depression, and despair were frequently excluded in news journalism on queer youth suicide.

Substance use and mental health disorders among heterosexual identified men and women who have same-sex partners or same-sex attraction: results from the national epidemiological survey on alcohol and related conditions

This study examined sexual orientation discordance, a mismatch between self-reported sexual identity and sexual behavior or sexual attraction, by describing the characteristics, substance use disorders, and mental health risks of heterosexual identified individuals who endorsed this pattern of sexual identification, behavior, and attraction. Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we created three groups based on participants' reported sexual identity and either their sexual behavior or sexual attraction: heterosexual concordant, homosexual concordant, and heterosexual discordant. Bivariate models assessed the relationship of discordant status and demographic correlates, lifetime substance use disorders, and mental health diagnoses. Logistic regression models tested associations between both behavior discordance and attraction discordance and the likelihood of having lifetime disorders of substance use, major depression, and generalized anxiety. Results of this study provided evidence of varying levels of substance use and mental health disorder risk by gender, discordance status, and discordance type. Behavioral discordance was associated with increased risk of mental health and substance use disorder among women (compared to heterosexual concordance). Findings among men were less consistent with heightened risk of alcohol and inhalant use only. Attraction discordance was notably different from behavioral discordance. The odds of substance use and mental health disorders were the same or lower compared with both the heterosexual and homosexual concordance groups. Future research should begin to test theoretical explanations for these differences.

Understanding sexual orientation health disparities in smoking: a population-based analysis

Lesbian, gay, and bisexual populations are at elevated risk for tobacco use compared to their heterosexual peers. However, there is little research examining reasons for this disparity. Drawing on prior literature regarding psychosocial variables associated with both sexual orientation and smoking, the authors tested a path model of risk and protective factors to help explain sexual orientation differences in smoking using data from the Washington State Behavioral Risk Factor Surveillance System from 2003 to 2007. The authors estimated separate models for men and women, comparing lesbians or gays and bisexuals to heterosexuals. Results indicated that the explanatory variables accounted for most of the variance in this relationship, with both risk-enhancing and risk-reducing pathways. Mental health, life dissatisfaction, alcohol use, exposure to tobacco marketing, and single relationship status were risk enhancers for most LGB participants. Health-care access and income level were risk enhancers for bisexual participants only. Neither emotional support nor attitudes and knowledge about tobacco use helped explain the relationship between sexual orientation and smoking. These findings have significant implications for tobacco prevention and control efforts in this high-risk population.

Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals

Most religious environments in the United States do not affirm homosexuality. The authors investigated the relationship between exposure to nonaffirming religious environments and internalized homophobia and mental health in a sample of lesbians, gay men, and bisexuals (LGBs) in New York City. Guided by minority stress theory, the authors hypothesized that exposure to nonaffirming religious settings would lead to higher internalized homophobia, more depressive symptoms, and less psychological well-being. The authors hypothesized that Black and Latino LGBs would be more likely than White LGBs to participate in nonaffirming religious settings and would therefore have higher internalized homophobia than White LGBs. Participants were 355 LGBs recruited through community-based venue sampling and evenly divided among Black, Latino, and White race or ethnic groups and among age groups within each race or ethnic group, as well as between women and men. Results supported the general hypothesis that nonaffirming religion was associated with higher internalized homophobia. There was no main effect of nonaffirming religion on mental health, an unexpected finding discussed in this article. Latinos, but not Blacks, had higher internalized homophobia than Whites, and as predicted, this was mediated by their greater exposure to nonaffirming religion.

Correlates of same-sex attractions and behaviors among self-identified heterosexual university students

Few studies have focused on intragroup variations in sexual orientation and fewer on self-identified heterosexuals with same-sex attractions, fantasies, and/or behaviors. Self-identified heterosexual students at a large public midwestern university (N = 263) completed measures of sexuality and gender, attitudes toward lesbian, gay, and bisexual (LGB) people, religious and political beliefs, emotional well-being, and demographics. The sample included 82 individuals (31%; labeled "H+") who endorsed same-sex attraction, fantasy, and/or behavior and 181 (69%; labeled "H") who did not. Women were more likely to be categorized as H+ than men. H+ participants had more positive attitudes toward lesbians and gay and bisexual men and reported more support for LGB-positive public policies than did H participants. H+ participants reported less literalistic beliefs about religious scripture than did H participants. H and H+ groups did not differ significantly on measures of emotional well-being. Results were discussed in the context of recent literature arguing for a more nuanced and gender-differentiated approach toward assessing sexual orientation, as well as literature on the flexibility of sexual orientation and on heterosexual identity development.

Sex and the community: the implications of neighbourhoods and social networks for sexual risk behaviours among urban gay men

Gay neighbourhoods have historically served as vital places for gay socialising, and gay social networks are important sources of social support. Yet, few studies have examined the influence of these forms of community on sexual health. Informed by theoretical frameworks on neighbourhoods and networks, we employ multi-level modelling to test hypotheses concerning whether gay neighbourhoods and social network factors are associated with five sexual risk behaviours: receptive and insertive unprotected anal intercourse (UAI), barebacking identity, recent internet use for finding sexual partners, and 'Party and Play' (PnP). Our analyses of a community-based sample of gay men in New York City reveal little evidence for the direct effect of gay enclaves on sexual risk with the exception of PnP, which was more likely among gay enclave residents. Having a network composed predominantly of other gay men was associated with insertive UAI, PnP, and internet use for meeting sexual partners. This network type also mediated the association between gay neighbourhoods and higher odds of insertive UAI as well as PnP. Our findings highlight the sexual health implications of two important facets of gay community and, in doing so, indicate the need to better contextualise the sexual health risks faced by gay men.

Rectal self-sampling in non-clinical venues for detection of sexually transmissible infections among behaviourally bisexual men

Rectal sexually transmissible infections are a common health concern for men who have sex with men but little is known about these infections among men who have sex with both men and women. Self-obtained rectal specimens were collected from a diverse sample of behaviourally bisexual men. From a total sample of 75 bisexual men, 58 collected specimens. A relatively high prevalence of rectal Chlamydia trachomatis infection was found. Participants who collected specimens reported overall acceptability and comfort with self-sampling. Future efforts are needed focusing on increasing awareness of and options for rectal sexually transmissible infection testing among bisexual men.

[Mental health of homosexual and bisexual people--role of minority stress]

The results of the researches show that the prevalence of emotional problems among homosexual persons is higher in comparison with the general population. However, homosexual orientation should not be treated as a reason for that, which is stressed by the greatest associations of mental health, basing on research. The question of the causes of increased prevalence of mental disorders among members of the sexual minorities remains without a clear answer. The theory of minority stress seems to be a very interesting explanation. It integrates a variety of risk factors, which may influence the stress level. In the article we try to explain this concept, hoping that it will be useful in understanding the situation of homosexual people.

[Mental health of homosexual and bisexual people--review of research and presentation of phenomenon]

The issues of mental health and psychological well-being of sexual minorities have become one of the ponderable scientific questions in recent years. Not only do they attract the attention of psychiatrists, psychologists or sexologists, but also of public health professionals. It is because psychiatric disorders in sexual minorities are not only the source of individual suffering and dysfunction, but also a big and so far unappreciated social problem. The research results in this field were mostly unreliable in the past, because they were based on the false paradigm, assuming that homosexuality unquestionably belongs in the realms of psychopathology. This became a major selection bias in which researchers tried to draw conclusion upon the mental status of the hole population of homosexual people only from studies of clinical populations. New studies analyse the mental status of this relatively big social group implementing data from epidemiological population-based studies, which allows the more realistic assessment of the problem. In this work we presented new data indicating the elevated risk of psychiatric disorders within the sexual minorities. The problem was discussed in the context of living in the reluctant and hostile environment (minority stress exposure).

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.