Racial differences in same-race partnering and the effects of sexual partnership characteristics on HIV Risk in MSM: a prospective sexual diary study

Prospective Effects of a Syndemic on HIV and STI Incidence and Risk Behaviors in a Cohort of Young Men Who Have Sex with Men

Young men who have sex with men continue to be highly affected by HIV. To improve understanding of the role that multiple co-occurring health issues (i.e., syndemics) play in HIV acquisition, sophisticated modeling methods are needed. The purpose of this study was to use structural equation modeling to understand the structure of the syndemic and to test its longitudinal association with condomless anal sex. Data are from a longitudinal study of 450 YMSM. A primary syndemic component comprised of substance use, violence, and internalizing mental health factors significantly predicted the number of condomless anal sex partners in the full sample. Analyses exploring associations by race/ethnicity found a significant association among White YMSM, but not among Black or Latino YMSM. Higher-order factor modeling suggests these psychosocial factors form a syndemic in all racial/ethnic groups, but the syndemic, as conceptualized here, may be less relevant to racial/ethnic minority YMSM.

High HIV incidence among young black men who have sex with men: constructing a retrospective cohort from a community health programme

OBJECTIVES

We sought to calculate HIV incidence in a retrospective cohort of young (13-29 years old) black men who have sex with men (YBMSM) accessing repeated HIV-antibody testing in a mid-size city in the USA.

METHODS

We aggregated site-specific HIV-antibody testing results from the project's inception among YBMSM who received an initial negative result and accessed at least one additional HIV-antibody test. From these data, we assessed number of seroconversions and person-years and calculated HIV incidence using a mid-P exact test to estimate 95% CIs.

RESULTS

Five seroconversions were documented over 42.3 person-years (the mean age at first onsite test: 19.7 years), resulting in an HIV incidence rate of 11.8% (95% CI 4.3% to 26.2%). The mean age at seroconversion was 20.4 (±3.0) years.

CONCLUSIONS

Even in mid-size cities with low HIV prevalence rates in the general population, HIV incidence among YBMSM may be high. Community-based HIV-antibody testing organisations serving YBMSM should be encouraged and trained to track repeated HIV testing and calculate HIV incidence rates. Increased resources should be deployed to develop and encourage regular HIV testing in community health sites serving YBMSM.

The complex contribution of sociodemographics to decision-making power in gay male couples

Relationship power is an important dyadic construct in close relationships that is associated with relationship health and partner's individual health. Understanding what predicts power in heterosexual couples has proven difficult, and even less is known about gay couples. Resource models of power posit that demographic characteristics associated with social status (e.g., age, income) confer power within the relationship, which in turn shapes relationship outcomes. We tested this model in a sample of gay male couples (N = 566 couples) and extended it by examining race and HIV status. Multilevel modeling was used to test associations between demographic bases of power and decision-making power. We also examined relative associations among demographic bases and decision-making power with relationship satisfaction given the literature on power imbalances and overall relationship functioning. Results showed that individual income was positively associated with decision-making power, as was participant's HIV status, with HIV-positive men reporting greater power. Age differences within the relationship interacted with relationship length to predict decision-making power, but not satisfaction. HIV-concordant positive couples were less satisfied than concordant negative couples. Higher power partners were less satisfied than lower power partners. Demographic factors contributing to decision-making power among same-sex male couples appear to share some similarities with heterosexual couples (e.g., income is associated with power) and have unique features (e.g., HIV status influences power). However, these same demographics did not reliably predict relationship satisfaction in the manner that existing power theories suggest. Findings indicate important considerations for theories of power among same-sex male couples. (PsycINFO Database Record

Influence of concurrency, partner choice, and viral suppression on racial disparity in the prevalence of HIV infected women

In 1992, Watts and May introduced a simple dynamical systems model of the spread of HIV based on disease transmission per partnership including the length of partnership duration. This model allowed for the treatment of concurrent partnerships, although it was hampered by the assumption of an important latent phase which generated a non-autonomous system. Subsequent models including concurrency have been based on networks, Monte Carlo, and stochastic simulations which lose a qualitative understanding of the effects of concurrency. We present a new autonomous deterministic model of the effect of concurrent sexual partnerships that allows for an analytical study of disease transmission. We incorporate the effect of concurrency through the newly derived force of infection term in a mathematical model of the transmission of HIV through sexual contact in a population stratified by sexual behavior and race/ethnicity. The model also includes variations in population mixing (partner choice) and non-uniform Highly Active Anti-Retroviral Treatment (HAART) leading to viral suppression. We use this mathematical model to understand the non-uniform spread of HIV in women who were infected through heterosexual contact. In addition, an analytical study shows the importance of continued condom use in virally suppressed MSM. Numerical simulations of the reproduction number as a function of concurrency, viral suppression level, and mixing show a reservoir of disease present in both heterosexual and MSM populations. Statistical analysis of parameter values show that viral suppression level, mixing and progression to AIDS without viral suppression have a strong correlation (either positive or negative) with the number of HIV positive women. Concurrency and assortative mixing are shown to be essential to reproduce infection levels in women, as reported by 2010 data from the Center for Disease Control (CDC).

The Use of Technology to Advance HIV Prevention for Couples

The majority of HIV prevention studies and programs have targeted individuals or operated at the community level. This has also been the standard approach when incorporating technology (e.g., web-based, smartphones) to help improve HIV prevention efforts. The tides have turned for both approaches: greater attention is now focusing on couple-based HIV prevention and using technology to help improve these efforts for maximizing reach and potential impact. To assess the extent that technology has been used to help advance HIV prevention with couples, a literature review was conducted using four databases and included studies that collected data from 2000 to early 2015. Results from this review suggest that technology has primarily been used to help advance HIV prevention with couples as a tool for (1) recruitment and data collection and (2) intervention development. Challenges and limitations of conducting research (e.g., validity of dyadic data) along with future directions for how technology (e.g., mHealth, wearable sensors) can be used to advance HIV prevention with couples are then discussed. Given the growing and near ubiquitous use of the Internet and smartphones, further efforts in the realm of mHealth (e.g., applications or "apps") and eHealth are needed to develop novel couple-focused HIV-preventive interventions.

Sexual Behavior Varies Between Same-Race and Different-Race Partnerships: A Daily Diary Study of Highly Sexually Active Black, Latino, and White Gay and Bisexual Men

Racial homophily (partnering with those of the same race) has been suggested as contributing to racial disparities in HIV among gay and bisexual men (GBM). Using a daily diary study, we examined racial homophily and its role in anal sexual behaviors in a sample of highly sexually active Black, White, and Latino GBM (N = 294, n = 3107 sexual events). In general, (1) men tended to partner with others of the same race, (2) HIV was more prevalent among men of color, and (3) race acted independent of whether one would engage in behaviors that would put them at highest risk for transmitting HIV (i.e., no main or interaction effects for insertive condomless anal sex (CAS) among HIV-positive men, and no main or interaction effects for receptive CAS among HIV-negative men). There were some main and interactive effects observed for lower risk behaviors (receptive CAS among HIV-positive men and insertive CAS among HIV-negative). Our findings suggest that racial disparities in HIV may be due to a higher exposure frequency (i.e., the frequency with which one comes into contact with a partner where a transmission could occur). However, men were also less likely to have anal sex when having sex with someone of the same race-a finding that works against the premise of higher exposure frequency. Future researchers should examine both racial homophily as well as variation in sexual behavior based on same-race or different-race partnerships.

Findings from within-subjects comparisons of drug use and sexual risk behaviour in men who have sex with men in England

Epidemiological evidence for the encounter-level association between sexualised drug use and unprotected anal intercourse in men who have sex with men is unclear and has not examined men who have sex with men in England. To estimate this association, we compared dyadic sexual encounters within respondents. We used encounter-level data from a longitudinal online survey of men who have sex with men living in England and multilevel models to test univariate and multivariate associations between any respondent or partner drug use, specific respondent drug use, additional situational characteristics and unprotected anal intercourse. Based on 6742 encounters from 2142 men who have sex with men, respondent drug use and respondent use of certain specific drugs were associated with increased unprotected anal intercourse odds. In univariate models, partner drug use was associated with increased unprotected anal intercourse odds, but in multivariate models, only non-specific knowledge of partner drug use was associated with the same. Encounters with non-regular-and-steady partners or that were not HIV-seroconcordant were associated with decreased unprotected anal intercourse odds. This is the first within-subjects comparison of drug use and unprotected anal intercourse conducted on a sample from England, and the largest of its kind. Findings are consistent with other studies, though associations between drug use and unprotected anal intercourse are shaped by social contexts that may change over time.

Does online dating lead to higher sexual risk behaviour? A cross-sectional study among MSM in Amsterdam, the Netherlands

Background

Men having sex with men (MSM) frequently use the Internet to find sex partners. We examined the association between unprotected anal intercourse (UAI) with partners dated online and with partners dated offline (met elsewhere), and examined whether differences can be explained by self-perceived HIV status of the index and knowledge of partnership characteristics.

Methods

MSM were recruited at the Sexually Transmitted Infections Clinic in Amsterdam, in 2008–2009. Participants completed a questionnaire concerning sexual behaviour. Only men reporting both online and offline casual sex partners were included. We assessed the association between online/offline partner dating and UAI, using random-effects logistic regression analysis.

Results

Five hundred seventy-seven men (351 HIV-negative, 153 HIV-positive, and 73 HIV-unaware) reported UAI in 26 % of 878 online, and 23 % of 903 offline casual partnerships. The crude OR of online dating for UAI was 1.36 (95 % CI 1.03–1.81). HIV-positive men were more likely to report UAI than HIV-negative men (49 % vs. 28 % of partnerships). Adjusted for demographic characteristics, online dating had no significant effect on UAI among HIV-negative and HIV status-unaware men, but HIV-positive men were more likely to have UAI with online partners (aOR = 1.65 [95 % CI 1.05–2.57]). After correction for partner and partnership characteristics the effect of online/offline dating on UAI among HIV-positive MSM was reduced and no longer significant.

Conclusions

Online dating was not significantly associated with UAI among HIV-negative MSM. HIV-positive MSM were more likely to practise UAI with partners dated online; however, after correction for partner and partnership characteristics, online partnership acquisition was not associated with a significantly increased risk of UAI.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1637-5) contains supplementary material, which is available to authorized users.

Developmental Change in the Effects of Sexual Partner and Relationship Characteristics on Sexual Risk Behavior in Young Men Who Have Sex with Men

Young men who have sex with men are substantially impacted by HIV/AIDS, and most new infections occur in serious romantic dyads. Young people experience substantial psychosocial and neurocognitive change between adolescence and emerging adulthood which impacts engagement in risk behaviors. We aimed to examine developmental change in the association between sexual partnership characteristics and condomless anal intercourse (CAI). Data were taken from an analytic sample of 114 young adult MSM from a longitudinal study of lesbian, gay, bisexual and transgender youth with 4-year follow-up. Rates of CAI were approximately 12 times higher in serious compared to casual partnerships, but this effect diminished in size over time. Partner age differences and violence were associated with more CAI, and these associations strengthened across development. Characteristics of serious relationships (e.g., power dynamics) were also examined. We discuss the need for HIV prevention strategies that address dyadic influences on CAI during this critical developmental period.

Reconciling Epidemiology and Social Justice in the Public Health Discourse Around the Sexual Networks of Black Men Who Have Sex With Men

Several studies have implicated the sexual networks of Black men who have sex with men (MSM) as facilitating disproportionally high rates of new HIV infections within this community. Although structural disparities place these networks at heightened risk for infection, HIV prevention science continues to describe networks as the cause for HIV disparities, rather than an effect of structures that pattern infection. We explore the historical relationship between public health and Black MSM, arguing that the current articulation of Black MSM networks is too often incomplete and counterproductive. Public health can offer a counternarrative that reconciles epidemiology with the social justice that informs our discipline, and that is required for an effective response to the epidemic among Black MSM.

Do Sexual Networks of Men Who Have Sex with Men in New York City Differ by Race/Ethnicity?

The United States HIV epidemic disproportionately affects Black and Hispanic men who have sex with men (MSM). This disparity might be partially explained by differences in social and sexual network structure and composition. A total of 1267 MSM in New York City completed an ACASI survey and egocentric social and sexual network inventory about their sex partners in the past 3 months, and underwent HIV testing. Social and sexual network structure and composition were compared by race/ethnicity of the egos: black, non-Hispanic (N = 365 egos), white, non-Hispanic (N = 466), and Hispanic (N = 436). 21.1% were HIV-positive by HIV testing; 17.2% reported serodiscordant and serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last 3 months. Black MSM were more likely than white and Hispanic MSM to report exclusively having partners of same race/ethnicity. Black and Hispanic MSM had more HIV-positive and unknown status partners than white MSM. White men were more likely to report overlap of social and sex partners than black and Hispanic men. No significant differences by race/ethnicity were found for network size, density, having concurrent partners, or having partners with ≥10 years age difference. Specific network composition characteristics may explain racial/ethnic disparities in HIV infection rates among MSM, including HIV status of sex partners in networks and lack of social support within sexual networks. Network structural characteristics such as size and density do not appear to have such an impact. These data add to our understanding of the complexity of social factors affecting black MSM and Hispanic MSM in the U.S.

Sexual Behavior and Network Characteristics and Their Association with Bacterial Sexually Transmitted Infections among Black Men Who Have Sex with Men in the United States

Background

Black men who have sex with men (MSM) have a high prevalence of bacterial sexually transmitted infections (STIs), and individual risk behavior does not fully explain the higher prevalence when compared with other MSM. Using the social-ecological framework, we evaluated individual, social and sexual network, and structural factors and their association with prevalent STIs among Black MSM.

Methods

The HIV Prevention Trials Network 061 was a multi-site cohort study designed to determine the feasibility and acceptability of a multi-component intervention for Black MSM in six US cities. Baseline assessments included demographics, risk behavior, and social and sexual network questions collected information about the size, nature and connectedness of their sexual network. Logistic regression was used to estimate the odds of having any prevalent sexually transmitted infection (gonorrhea, chlamydia, or syphilis).

Results

A total of 1,553 Black MSM were enrolled in this study. In multivariate analysis, older age (aOR = 0.57; 95% CI 0.49–0.66, p<0.001) was associated with a lower odds of having a prevalent STI. Compared with reporting one male sexual partner, having 2–3 partners (aOR = 1.74; 95% CI 1.08–2.81, p<0.024) or more than 4 partners (aOR = 2.29; 95% CI 1.43–3.66, p<0.001) was associated with prevalent STIs. Having both Black and non-Black sexual partners (aOR = 0.67; 95% CI 0.45–0.99, p = 0.042) was the only sexual network factor associated with prevalent STIs.

Conclusions

Age and the number and racial composition of sexual partners were associated with prevalent STIs among Black MSM, while other sexual network factors were not. Further studies are needed to evaluate the effects of the individual, network, and structural factors on prevalent STIs among Black MSM to inform combination interventions to reduce STIs among these men.

A Data-Driven Simulation of HIV Spread Among Young Men Who Have Sex With Men: Role of Age and Race Mixing and STIs

OBJECTIVE

Young men who have sex with men (YMSM) in the United States have a high HIV incidence with substantial racial disparities that are poorly understood. We use a data-driven simulation model to understand the impact of network-level mechanisms and sexually transmitted infections on the spread of HIV among YMSM.

METHODS

We designed and parameterized a stochastic agent-based network simulation model using results of a longitudinal cohort study of YMSM in Chicago. Within this model, YMSM formed and dissolved partnerships over time, and partnership types were stratified by length of partnership, sex, and age of the partner. In each partnership, HIV, gonorrhea, and chlamydia could be transmitted. Counterfactual scenarios were run to examine drivers of HIV.

RESULTS

Over a 15-year simulation, the HIV epidemic among YMSM continued to rise, with Latino/white YMSM facing a steeper increase in the HIV burden compared with black YMSM. YMSM in partnerships with older MSM, in particular black YMSM with older black MSM, were at highest risk for HIV, and 1 infection prevented with an older partner would prevent 0.8 additional infections among YMSM. Additionally, racial disparities in HIV were driven by differences in the HIV prevalence of YMSM partners. Finally, of all HIV infections among YMSM, 14.6% were attributable to NG and CT infections.

CONCLUSION

Network-level mechanisms and sexually transmitted infections play a significant role in the spread of HIV and in racial disparities among YMSM. HIV prevention efforts should target YMSM across race, and interventions focusing on YMSM partnerships with older MSM might be highly effective.

Do behavioral scientists really understand HIV-related sexual risk behavior? A systematic review of longitudinal and experimental studies predicting sexual behavior

Behavioral interventions to reduce sexual risk behavior depend on strong health behavior theory. By identifying the psychosocial variables that lead causally to sexual risk, theories provide interventionists with a guide for how to change behavior. However, empirical research is critical to determining whether a particular theory adequately explains sexual risk behavior. A large body of cross-sectional evidence, which has been reviewed elsewhere, supports the notion that certain theory-based constructs (e.g., self-efficacy) are correlates of sexual behavior. However, given the limitations of inferring causality from correlational research, it is essential that we review the evidence from more methodologically rigorous studies (i.e., longitudinal and experimental designs). This systematic review identified 44 longitudinal studies in which investigators attempted to predict sexual risk from psychosocial variables over time. We also found 134 experimental studies (i.e., randomized controlled trials of HIV interventions), but of these only 9 (6.7 %) report the results of mediation analyses that might provide evidence for the validity of health behavior theories in predicting sexual behavior. Results show little convergent support across both types of studies for most traditional, theoretical predictors of sexual behavior. This suggests that the field must expand the body of empirical work that utilizes the most rigorous study designs to test our theoretical assumptions. The inconsistent results of existing research would indicate that current theoretical models of sexual risk behavior are inadequate, and may require expansion or adaptation.

Pleasure, affection, and love among Black men who have sex with men (MSM) versus MSM of other races: countering dehumanizing stereotypes via cross-race comparisons of reported sexual experience at last sexual event

Black men have historically been stereotyped as hedonistic, aggressive, and animalistic in their sexual interactions. This study sought to describe pleasure, affection, and love experienced by Black men who have sex with men (MSM) during their last male-partnered sexual event and to examine differences relative to White, Latino, and Asian MSM. A total of 21,696 (793 Black, 18,905 White, 1,451 Latino, and 547 Asian) U.S. men ages 18-87 (M Age = 39) were recruited from social/sexual networking sites targeting MSM in 2010-2011. Participants reported multiple dimensions of sexual experience (pleasure, affection, and love) occurring at their last male-partnered sexual event, partner relationship, and sociodemographic characteristics. Across relationship categories, a sizeable percentage of Black MSM reported pleasure (72-87  % orgasmed, 57-82 % experienced high subjective pleasure) and affection (70-91 % kissed, 47-90 % cuddled). Love was primarily reported for events involving main partners (felt love for partner: 96 %; felt loved by partner: 97 %; verbalized love to partner: 89 %). Latent class analysis with MSM of all races, adjusting for partner relationship and sociodemographic characteristics, revealed three distinct profiles of sexual experience: affection and love (Class 1); affection in the absence of love (Class 2); and neither affection nor love (Class 3). Pleasure was probable across profiles. Some racial differences in profile probability were present, but no overall pattern emerged. Contrary to Black male stereotypes, Black MSM commonly reported pleasure, affection, and love at their last male-partnered sexual event and did not show a meaningful pattern of difference from other-race MSM in their likelihood of experiencing all three.

Race-based sexual stereotypes and their effects on sexual risk behavior in racially diverse young men who have sex with men

Men who have sex with men (MSM) are disproportionately impacted by the HIV/AIDS epidemic in the United States. The epidemic is not evenly distributed across MSM, and young racial minority MSM experience the highest rate of new infections. Race-based sexual stereotyping is not uncommon among MSM, and it may contribute to the isolation of racial minority sexual networks, which has been found to contribute to increased HIV incidence in Black MSM. The goals of these analyses were to describe the race-based sexual preferences and stereotypes of racially diverse young MSM (YMSM), and to examine whether endorsement of sexual stereotypes was associated with sexual risk behavior when having sex with partners of the stereotyped race. Data were taken from Crew 450, an ongoing longitudinal study of a syndemic of psychosocial health issues linked to HIV among YMSM in Chicago and surrounding areas. Analyses utilized data from three study waves, and longitudinal analyses were conducted with Hierarchical Linear Modeling. YMSM generally endorsed same-race preferences for sexual partners. Black partners were rated highest in displaying stereotypically dominant characteristics and in likelihood of taking the top/insertive sex role, while Latino partners were rated the highest in likelihood of sex being hot and passionate. White partners were rated lowest on each of these domains. Longitudinal analyses found that endorsement of these stereotypes had important implications for the rate of condomless receptive and insertive anal sex with racial minority partners. Findings suggest that sexual stereotypes may contribute to the isolation of racial minority sexual networks.

Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities

BACKGROUND

Sexual networks may place U.S. Black men who have sex with men (MSM) at increased HIV risk.

METHODS

Self-reported egocentric sexual network data from the prior six months were collected from 1,349 community-recruited Black MSM in HPTN 061, a multi-component HIV prevention intervention feasibility study. Sexual network composition, size, and density (extent to which members are having sex with one another) were compared by self-reported HIV serostatus and age of the men. GEE models assessed network and other factors associated with having a Black sex partner, having a partner with at least two age category difference (age difference between participant and partner of at least two age group categories), and having serodiscordant/serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last six months.

RESULTS

Over half had exclusively Black partners in the last six months, 46% had a partner of at least two age category difference, 87% had ≤5 partners. Nearly 90% had sex partners who were also part of their social networks. Among HIV-negative men, not having anonymous/exchange/ trade partners and lower density were associated with having a Black partner; larger sexual network size and having non-primary partners were associated with having a partner with at least two age category difference; and having anonymous/exchange/ trade partners was associated with SDUI. Among HIV-positive men, not having non-primary partners was associated with having a Black partner; no sexual network characteristics were associated with having a partner with at least two age category difference and SDUI.

CONCLUSIONS

Black MSM sexual networks were relatively small and often overlapped with the social networks. Sexual risk was associated with having non-primary partners and larger network size. Network interventions that engage the social networks of Black MSM, such as interventions utilizing peer influence, should be developed to address stable partnerships, number of partners, and serostatus disclosure.

Racial/Ethnic Differences in the Association between Arrest and Unprotected Anal Sex among Young Men Who Have Sex with Men: The P18 Cohort Study

This analysis aimed to determine whether the relationship between a history of arrest and unprotected anal sex (UAS) is the same for Black/Latino gay, bisexual, and other young men who have sex with men (YMSM) as compared to White/Asian/Pacific Islander (API) YMSM in New York City (NYC). Baseline audio-computer-assisted self-interview (ACASI) and interviewer-administered survey data from a sample of 576 YMSM aged 18-19 years old who self-reported being HIV-negative were analyzed. Data included history of arrest and incarceration as well as UAS in the past 30 days. Race/ethnicity was an effect modifier of the association between arrest and UAS among YMSM: White/API YMSM with a lifetime arrest history were more than three times as likely to report UAS, and Black/Latino YMSM with a lifetime history of arrest were approximately 70 % less likely to report UAS as compared with White/API YMSM with no reported arrest history. Race/ethnicity may modify the relationship between arrest and sexual risk behavior because the etiology of arrest differs by race, as partially evidenced by racial/ethnic disparities in police stop, arrest, and incarceration rates in NYC. Arrest could not only be an indicator of risky behavior for White/API YMSM but also an indicator of discrimination for Black/Latino YMSM. Further research is needed to assess whether the differential associations observed here vis-à-vis race/ethnicity are robust across different populations and different health outcomes.

Non-Parental Adults in the Social and Risk Behavior Networks of Sexual Minority Male Youth

The presence of non-parental adults (NPAs), or adults outside of caregivers (e.g., extended family, natural mentors), in the lives of adolescents and emerging adults has received a rapidly expanding amount of empirical attention in the last decade. Sexual minority male youth (SMMY) face disproportionate risks of abuse and victimization in relationships with parents and peers. Yet, despite the fact that this group, therefore, may be both potentially vulnerable to negative interpersonal influences but also poised to benefit from additional relationships, NPA involvement in the lives of SMMY is currently not well understood in the extant literature. This study sought to examine and characterize the involvement of NPAs in the social and risk networks of SMMY (n = 175; 54% African American, 21% Hispanic/Latino, 14% Caucasian; ages 17-23). Most SMMY identified at least one NPA, such as friends and grandparents, in their networks. Three categories of relationships were identified, Strictly Social, which only involved social interactions; Complex, which were both social and involved substance use and/or sexual activity; and Risky, which purely consisted of substance use or sexual activity. Relationships were rated as emotionally "closer" among ethnic minority SMMY, although, racial/ethnic similarity between SMMY and NPAs was not associated with relationship closeness. In addition, relationships involving female and heterosexual NPAs were also rated as stronger. These findings suggest the potential usefulness of considering multiple types of relationships between SMMY and NPAs when designing intervention and prevention efforts. Moreover, African American and Latino SMMY, who represent the most vulnerable sub-groups of SMMY in terms of HIV-risk, may be particularly poised to benefit from positive NPA relationships.

Disassortative Age-Mixing Does Not Explain Differences in HIV Prevalence between Young White and Black MSM: Findings from Four Studies

OBJECTIVE

Age disassortativity is one hypothesis for HIV disparities between Black and White MSM. We examined differences in age mixing by race and the effect of partner age difference on the association between race and HIV status.

DESIGN

We used data from four studies of MSM. Participants reported information about recent sexual partners, including age, race, and sexual behavior. Two studies were online with a US sample and two focused on MSM in Atlanta.

METHODS

We computed concordance correlation coefficients (CCCs) by race across strata of partner type, participant HIV status, condom use, and number of partners. We used Wilcoxon rank-sum tests to compare Black and White MSM on partner age differences across five age groups. Finally, we used logistic regression models using race, age, and partner age difference to determine the odds ratio of HIV-positive serostatus.

RESULTS

Of 48 CCC comparisons, Black MSM were more age-disassortative than White MSM in only two. Furthermore, of 20 comparisons of median partner age, Black and White MSM differed in two age groups. One indicated larger age gaps among the Black MSM (18-19). Prevalent HIV infection was associated with race and age. Including partner age difference in the model resulted in a 2% change in the relative odds of infection among Black MSM.

CONCLUSIONS

Partner age disassortativity and partner age differences do not differ by race. Partner age difference offers little predictive value in understanding prevalent HIV infection among Black and White MSM, including diagnosis of HIV-positive status among self-reported HIV-negative individuals.

Attitudes Toward HIV Voluntary Counseling and Testing (VCT) Among African American Men Who Have Sex With Men: Concerns Underlying Reluctance to Test

Contemporary antiretroviral therapy (ART) can produce viral suppression of HIV, maintain health, and prevent onward HIV transmission from infected persons to their sexual partners, giving rise to the concept of treatment as prevention. Successful implementation of test-and-treat strategies rests on the early detection of HIV infection through voluntary counseling and testing (VCT) followed by entry and retention in care, ART initiation and adherence, and subsequent viral suppression. In the United States, African American men who have sex with men (MSM) bear a disproportionate burden of HIV and have high rates of undetected and untreated HIV infection. However, little research has examined racial minority MSM's views about HIV testing. In this study, in-depth interviews were conducted with 96 key informants knowledgeable about racial minority MSM as well as 100 African American MSM community members in Milwaukee, Cleveland, and Miami. Most men in the sample were aware of the availability of testing and knew testing locations, but many voiced great personal ambivalence about being tested, feared knowing their HIV status, expressed concern about stigma and loss of confidentiality, and held beliefs indicative of medical mistrust. Participants did not spontaneously cite benefits of being tested, risk reduction behavior changes made as a consequence of testing, nor the benefits of testing to get early medical care for HIV infection. There is a gap between the public health field's perception of testing benefits and the beliefs about testing held by racial minority MSM in this sample. To increase the desired outcomes from VCT for minority MSM, VCT promotion should address the concerns of African American MSM and underscore the benefits of early entry into medical care.

The Role of Geographic and Network Factors in Racial Disparities in HIV Among Young Men Who have Sex with Men: An Egocentric Network Study

The objective of this study was to characterize and compare individual and sexual network characteristics of Black, White, and Latino young men who have sex with men (YMSM) as potential drivers of racial disparities in HIV. Egocentric network interviews were conducted with 175 diverse YMSM who described 837 sex partners within 167 sexual-active egos. Sexual partner alter attributes were summarized by ego. Descriptives of ego demographics, sexual partner demographics, and network characteristics were calculated by race of the ego and compared. No racial differences were found in individual engagement in HIV risk behaviors or concurrent sexual partnership. Racial differences were found in partner characteristics, including female gender, non-gay sexual orientations, older age, and residence in a high HIV prevalence neighborhood. Racial differences in relationship characteristics included type of relationships (i.e., main partner) and strength of relationships. Network characteristics also showed differences, including sexual network density and assortativity by race. Most racial differences were in the direction of effects that would tend to increase HIV incidence among Black YMSM. These data suggest that racial disparities in HIV may be driven and/or maintained by a combination of racial differences in partner characteristics, assortativity by race, and increased sexual network density, rather than differences in individual's HIV risk behaviors.

Individual-Level and Partner-Level Predictors of Newly Diagnosed HIV Infection Among Black and White Men Who Have Sex with Men in Baltimore, MD

Black MSM continue to be the group most disproportionately impacted by HIV in the United States. This study assesses the relationship between partner-level and respondent-level characteristics and newly diagnosed HIV infection among a sample of MSM. Ego-centric data were gathered using venue-based time-space sampling on 335 men who reported on a total of 831 male anal sex partners. In multivariate analyses, age of partner, HIV status of partner, and respondent having had an STD in the past twelve months were associated with a newly diagnosed HIV infection among black MSM. Efforts for black MSM are needed that aim to increase HIV and STD testing, foster open communication between partners about HIV status, and address social determinants of health.

An application of propensity score weighting to quantify the causal effect of rectal sexually transmitted infections on incident HIV among men who have sex with men

Background

Exploring causal associations in HIV research requires careful consideration of numerous epidemiologic limitations. First, a primary cause of HIV, unprotected anal intercourse (UAI), is time-varying and, if it is also associated with an exposure of interest, may be on a confounding path. Second, HIV is a rare outcome, even in high-risk populations. Finally, for most causal, non-preventive exposures, a randomized trial is impossible. In order to address these limitations and provide a practical illustration of efficient statistical control via propensity-score weighting, we examine the causal association between rectal STI and HIV acquisition in the InvolveMENt study, a cohort of Atlanta-area men who have sex with men (MSM). We hypothesized that, after controlling for potentially confounding behavioral and demographic factors, the significant STI-HIV association would attenuate, but yield an estimate of the causal effect.

Methods

The exposure of interest was incident rectal gonorrhea or chlamydia infection; the outcome was incident HIV infection. To adjust for behavioral confounding, while accounting for limited HIV infections, we used an inverse probability of treatment weighted (IPTW) Cox proportional hazards (PH) model for incident HIV. Weights were derived from propensity score modeling of the probability of incident rectal STI as a function of potential confounders, including UAI in the interval of rectal STI acquisition/censoring.

Results

Of 556 HIV-negative MSM at baseline, 552 (99%) men were included in this analysis. 79 men were diagnosed with an incident rectal STI and 26 with HIV. 6 HIV-infected men were previously diagnosed with a rectal STI. In unadjusted analysis, incident rectal STI was significantly associated with subsequent incident HIV (HR (95%CI): 3.6 (1.4-9.2)). In the final weighted and adjusted model, the association was attenuated and more precise (HR (95% CI): 2.7 (1.2-6.4)).

Conclusions

We found that, controlling for time-varying risk behaviors and time-invariant demographic factors, diagnosis with HIV was significantly associated with prior diagnosis of rectal CT or GC. Our analysis lends support to the causal effect of incident rectal STI on HIV diagnosis and provides a framework for similar analyses of HIV incidence.

Electronic supplementary material

The online version of this article (doi:10.1186/s12874-015-0017-y) contains supplementary material, which is available to authorized users.

Future directions in research on sexual minority adolescent mental, behavioral, and sexual health

This article describes current knowledge on sexual, mental, and behavioral health of sexual minority (SM) youth and identifies gaps that would benefit from future research. A translational sciences framework is used to conceptualize the article, discussing findings and gaps along the spectrum from basic research on prevalence and mechanisms, to intervention development and testing, to implementation. Relative to adults, there has been much less research on adolescents and very few studies that had longitudinal follow-up beyond 1 year. Due to historical changes in the social acceptance of the SM community, new cohorts are needed to represent contemporary life experiences and associated health consequences. Important theoretical developments have occurred in conceptualizing mechanisms that drive SM health disparities and mechanistic research is underway, including studies that identify individual and structural risk/protective factors. Research opportunities exist in the utilization of sibling-comparison designs, inclusion of parents, and studying romantic relationships. Methodological innovation is needed in sampling SM populations. There has been less intervention research and approaches should consider natural resiliencies, life-course frameworks, prevention science, multiple levels of influence, and the importance of implementation. Regulatory obstacles are created when ethics boards elect to require parental permission and ethics research is needed. There has been inconsistent inclusion of SM populations in the definition of "health disparity population," which impacts funding and training opportunities. There are incredible opportunities for scholars to make substantial and foundational contributions to help address the health of SM youth, and new funding opportunities to do so.

Methods for Collection of Participant-aided Sociograms for the Study of Social, Sexual and Substance-using Networks Among Young Men Who Have Sex with Men

In this study, we adapted and tested a participant-aided sociogram approach for the study of the social, sexual, and substance use networks of young men who have sex with men (YMSM); a population of increasing and disproportionate risk of HIV infection. We used a combination of two interviewer-administered procedures: completion of a pre-numbered list form to enumerate alters and to capture alter attributes; and a participant-aided sociogram to capture respondent report of interactions between alters on an erasable whiteboard. We followed the collection of alter interactions via the sociogram with a traditional matrix-based tie elicitation approach for a sub-sample of respondents for comparison purposes. Digital photographs of each network drawn on the whiteboard serve as the raw data for entry into a database in which group interactions are stored. Visual feedback of the network was created at the point of data entry, using NetDraw network visualization software for comparison to the network structure elicited via the sociogram. In a sample of 175 YMSM, we found this approach to be feasible and reliable, with high rates of participation among those eligible for the study and substantial agreement between the participant-aided sociogram in comparison to a traditional matrix-based approach. We believe that key strengths of this approach are the engagement and maintenance of participant attention and reduction of participant burden for alter tie elicitation. A key weakness is the challenge of entry of interview-based list form and sociogram data into the database. Our experience suggests that this approach to data collection is feasible and particularly appropriate for an adolescent and young adult population. This builds on and advances visualization-based approaches to social network data collection.

Social networks, sexual networks and HIV risk in men who have sex with men

Worldwide, men who have sex with men (MSM) remain one of the most HIV-vulnerable community populations. A global public health priority is developing new methods of reaching MSM, understanding HIV transmission patterns, and intervening to reduce their risk. Increased attention is being given to the role that MSM networks play in HIV epidemiology. This review of MSM network research studies demonstrates that: (1) Members of the same social network often share similar norms, attitudes, and HIV risk behavior levels; (2) Network interventions are feasible and powerful for reducing unprotected sex and potentially for increasing HIV testing uptake; (3) HIV vulnerability among African American MSM increases when an individual enters a high-risk sexual network characterized by high density and racial homogeneity; and (4) Networks are primary sources of social support for MSM, particularly for those living with HIV, with greater support predicting higher care uptake and adherence.

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

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

Diaries for observation or intervention of health behaviors: factors that predict reactivity in a sexual diary study of men who have sex with men

BACKGROUND

Behavioral diaries for observation of health-related behaviors assume absence of reactivity (i.e., change in behavior resulting from observation), while self-monitoring diaries maximize reactivity for behavior change. Little is known about when and for whom behavioral diary studies become self-monitoring interventions.

PURPOSE

This study evaluated the moderating effects of social cognitive variables on reactivity in sexual risk behavior and risk appraisals in a diary study of men who have sex with men (MSM).

METHODS

One hundred forty-three MSM completed weekly online sexual diaries for 3 months. Analyses were conducted with hierarchical linear modeling.

RESULTS

There was no evidence of reactivity for the sample as a whole. Social cognitive variables (e.g., risk reduction motivation, condom use intentions, and social norms) moderated reactivity in study outcomes. For example, more highly motivated MSM experienced declines in serodiscordant unprotected anal intercourse over time.

CONCLUSIONS

Effectiveness of behavioral self-monitoring strategies may vary depending on social cognitive domains.

The use of web-based diaries in sexual risk behaviour research: a systematic review

BACKGROUND

An increasing number of studies have used the diary method, which provides quantitative event-level data about sexual encounters. Diaries are an attractive tool for sexual behaviour research, yet little is known about the range of uses, methodological issues and best practices associated with this technology.

OBJECTIVES

To conduct a systematic review of the literature regarding the use of web-based diaries in sexual risk behaviour studies.

DESIGN

Systematic review.

DATA SOURCES

Five bibliographical databases, supplemented by references from previous reviews.

METHODS

Eligible studies were published in English before August 2013, used the internet to transmit data from collection device to study staff, and measured behaviours affecting HIV or sexually transmitted infection transmission risk. The primary author conducted an initial screen to eliminate irrelevant articles. Both authors conducted full-text reviews to determine final articles. We abstracted data on diary methodology, validity and reactivity (behaviour change caused by diary completion).

RESULTS

Twenty-three articles representing 15 studies were identified. Most diaries were collected daily for 1 month via websites, and completion was generally high (>80%). Compensation varied by study and was not associated with completion. Studies comparing diary with retrospective survey data demonstrated evidence of over-reporting on retrospective tools, except for the least frequent behaviours. Most studies that assessed reactivity as a result of diary completion demonstrated some change in behaviour associated with frequent monitoring.

CONCLUSIONS

Web-based diaries are an effective means of studying sexual risk behaviour. More uniform reporting and further research on the extent of reactivity are needed.

The effects of sexual partnership and relationship characteristics on three sexual risk variables in young men who have sex with men

Young men who have sex with men (YMSM) in the United States are experiencing an alarming increase in HIV incidence. Recent evidence suggests that the majority of new HIV infections in YMSM occur in the context of serious relationships, which underscores the importance of examining predictors of sexual risk behavior in the context of sexual partnerships, including relationship type, sexual partner characteristics, and relationship dynamics. The current study aimed to evaluate relationship and sexual partnership influences on sexual risk behavior in YMSM, including differentiating between multiple sexual risk variables (i.e., any unprotected anal or vaginal intercourse, unprotected insertive anal or vaginal intercourse, and unprotected receptive anal intercourse). More serious/familiar partnerships were associated with more sexual risk across all three risk variables, while wanting a relationship to last was protective against risk across all three risk variables. Some variables were differentially linked to unprotected insertive sex (partner gender) or unprotected receptive sex (partner age, partner race, believing a partner was having sex with others, and partners repeated across waves). Sexual risk behavior in YMSM is inconsistent across sexual partnerships and appears to be determined in no small part by sexual partner characteristics, relationship dynamics, and sexual role (i.e., insertive or receptive partner). These influences are critical in understanding sexual risk in YMSM and provide important targets for intervention.

Methods for the design and analysis of relationship and partner effects on sexual health

Sexual intercourse involves two people and many aspects of sexual health are influenced by, if not dependent on, interpersonal processes. Yet, the majority of sexual health research involves the study of individuals. The collection and analysis of dyadic data present additional complexities compared to the study of individuals. The aim of this article was to describe methods for the study of dyadic processes related to sexual health. One-sided designs, including the PLM, involve a single individual reporting on the characteristics of multiple romantic or sexual relationships and the associations of these factors with sexual health outcomes are then estimated. This approach has been used to study how relationship factors, such as if the relationship is serious or casual, are associated with engagement in HIV risk behaviors. Such data can be collected cross-sectionally, longitudinally or through the use of diaries. Two-sided designs, including the actor-partner interdependence model, are used when data are obtained from both members of the dyad. The goal of such approaches is to disentangle intra- and inter-personal effects on outcomes (e.g., the ages of an individual and his partner may influence sexual frequency). In distinguishable datasets, there is some variable that allows the analyst to differentiate between partners within dyads, such as HIV status in a serodiscordant couple. When analyzing data from these dyads, effects can be assigned to specific types of partners. In exchangeable dyadic datasets, no variable is present that distinguishes between couple members across all dyads. Extensions of these approaches are described.

Associations between perceived characteristics of the peer social network involving significant others and risk of HIV transmission among men who have sex with men in China

The HIV epidemic among men who have sex with men (MSM) in China is severe. Peer can induce risky and preventive behaviors among MSM. We interviewed 220 MSM who had at least one significant other who was a peer MSM (SOPM). Interviews were conducted at two gay venues in Suzhou, China, which reported five HIV-related outcomes: HIV (8.2 %), syphilis (16.4 %), self-reported sexually transmitted infection symptoms (14.6 %), unprotected anal intercourse (UAI; 58.6 %) and having had taken up HIV testing (40.4 %). Adjusting for significant background variables, participants' perceived characteristics of the social network of SOPM, such as practicing risk behavior (e.g. UAI) or preventive behaviors (e.g. HIV antibody testing), or possessing HIV-related perceptions (e.g. dislike in condom use), were significantly associated with some of the five aforementioned outcomes (p < 0.05). Peer education and peer-based interventions involving significant others are hence potentially important in HIV prevention targeting MSM. Future pilot intervention studies are warranted.

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

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

Intimacy, monogamy, and condom problems drive unprotected sex among young men in serious relationships with other men: a mixed methods dyadic study

This mixed methods study aimed to examine partner and relationship characteristics associated with HIV risk among young men who have sex with men (YMSM). A sub-sample of YMSM (18-25 years) who were involved in serious relationships with other men were recruited from two on-going longitudinal studies, Project Q2 and Crew450 (N = 20 couples). The mean age of the dyadic sample was 22.5 years (SD = 5.33, range 18-46 years) and participants were racially and ethnically diverse, with the largest percentage of the sample identifying as African American (47.5 %), followed by Hispanic (20 %). Participants completed individual self-report measures using computer-assisted self-interview technology and engaged in couples-based interviews. Mixed methods analyses indicated three global reasons for unprotected sex among YMSM in serious relationships: (1) the desire to achieve emotional intimacy; (2) the perception of being in a monogamous relationship; and (3) the difficulties associated with accessing and/or using condoms. Couples' decision-making processes, including decisions made "in the heat of the moment," have implications for HIV prevention interventions.

Intergenerational sex as a risk factor for HIV among young men who have sex with men: a scoping review

An emerging body of evidence suggests that intergenerational sexual partnerships may increase risk of HIV acquisition among young men who have sex with men (YMSM). However, no studies have comprehensively evaluated literature in this area. We applied a scoping review methodology to explore the relationships between age mixing, HIV risk behavior, and HIV seroconversion among YMSM. This study identified several individual, micro-, and meso-system factors influencing HIV risk among YMSM in the context of intergenerational relationships: childhood maltreatment, coming of age and sexual identity, and substance use (individual-level factors); family and social support, partner characteristics, intimate partner violence, connectedness to gay community (micro-system factors); and race/ethnicity, economic disparity, and use of the Internet (meso-system factors). These thematic groups can be used to frame future research on the role of age-discrepant relationships on HIV risk among YMSM, and to enhance public health HIV education and prevention strategies targeting this vulnerable population.

Cognitive influences on sexual risk and risk appraisals in men who have sex with men

Men who have sex with men (MSM) account for more than half of new HIV infections each year. Previous research has linked cognitive variables from the Information, Motivational and Behavioral Skills (IMB) Model to sexual risk behavior, but cognitions may additionally influence risk appraisals of sexual encounters and subsequently potentiate sexual risk. The aim of this study was to use prospective event-level data to examine the direct influence of cognitive variables on sexual risk in MSM, as well as the moderating effects of these variables on the association between unprotected anal intercourse (UAI) and risk appraisals of these encounters. One hundred forty-three ethnically diverse MSM were enrolled in a 3-month online diary study of sexual behavior. Each week participants reported on specific sexual behaviors that occurred during each of up to three sexual encounters, including type of sexual behavior, condom use, and perceived risk for acquiring HIV during the encounter. All analyses were conducted with Hierarchical Linear Modeling. Condom use self-efficacy was the only cognitive variable that was directly associated with UAI. However, both HIV knowledge and social norms of condom use contributed to accuracy of risk appraisals. Conversely, MSM who were highly motivated to become/stay safer downplayed the risk associated with their unprotected sexual encounters. Cognitive variables play an important role in influencing sexual risk in MSM both directly and indirectly via risk appraisals. Addressing these cognitive processes in HIV prevention interventions may help to increase the likelihood of condom use and the accuracy of risk appraisals.

Moderating effect of age on the association between alcohol use and sexual risk in MSM: evidence for elevated risk among younger MSM

Men who have sex with men (MSM) are substantially impacted by HIV/AIDS in the United States. Alcohol use is frequently studied as a predictor of sexual risk in MSM, but findings for this association have been mixed. Developmental differences in this effect may help to explain equivocal findings. 143 MSM (analytic sample 137) ages 16-40 completed weekly diaries of sexual encounters and associated situational factors for 12 weeks. Analyses were conducted with Hierarchical Linear Modeling. Alcohol use before sex was not associated with sexual risk across all participants. Participant age moderated this effect; alcohol use before sex was associated with increased odds of sexual risk in younger MSM only. These analyses expand on previous findings by utilizing a wider age range than most prior studies and adjusting for the effects of several theoretically-selected covariates. Young MSM are an important group to target for addressing alcohol use in the context of sexual behavior.