The continuing HIV epidemic among men who have sex with men

A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women

OBJECTIVE

Men who have sex with men (MSM) have higher rates of HIV and other sexually transmitted infections than women and heterosexual men. This elevated risk persists across age groups and reflects biological and behavioral factors; yet, there have been few direct comparisons of sexual behavior patterns between these populations.

METHODS

We compared sexual behavior patterns of MSM and male and female heterosexuals aged 18-39 using 4 population-based random digit dialing surveys. A 1996-1998 survey in 4 US cities and 2 Seattle surveys (2003 and 2006) provided estimates for MSM; a 2003-2004 Seattle survey provided data about heterosexual men and women.

RESULTS

Sexual debut occurred earlier among MSM than heterosexuals. MSM reported longer cumulative lifetime periods of new partner acquisition than heterosexuals and a more gradual decline in new partnership formation with age. Among MSM, 86% of 18- to 24-year-olds and 72% of 35- to 39-year-olds formed a new partnership during the previous year, compared with 56% of heterosexual men and 34% of women at 18-24 years, and 21% and 10%, respectively, at 35-39 years. MSM were also more likely to choose partners >5 years older and were 2-3 times as likely as heterosexuals to report recent concurrent partnerships. MSM reported more consistent condom use during anal sex than heterosexuals reported during vaginal sex.

CONCLUSIONS

MSM have longer periods of partnership acquisition, a higher prevalence of partnership concurrency, and more age disassortative mixing than heterosexuals. These factors likely help to explain higher HIV/sexually transmitted infections rates among MSM, despite higher levels of condom use.

Psychological processes and stimulant use among men who have sex with men

BACKGROUND

Prior research established that psychological factors are associated with the frequency of stimulant (i.e., cocaine, crack, and methamphetamine) use among substance-using men who have sex with men (MSM). The present investigation examined whether and how psychological factors are associated with engagement in any stimulant use in the broader population of MSM.

METHODS

A probability sample of 879 MSM residing in San Francisco was obtained using random digit dialing from May of 2002 through January of 2003. Of these, 711 participants (81%) completed a mail-in questionnaire that assessed psychological factors and substance use. After accounting for demographic factors, a multiple logistic regression analysis examined correlates of any self-reported stimulant use during the past 6 months. Path analyses examined if the use of alcohol or other substances to avoid negative mood states (i.e., substance use coping) mediated the associations of sexual compulsivity and depressed mood with stimulant use.

RESULTS

Younger age (adjusted OR [AOR]=0.58; 95% CI=0.47-0.70), HIV-positive serostatus (AOR=2.55; 95% CI=1.61-4.04), greater depressed mood (AOR=1.26; 95% CI=1.05-1.52) and higher sexual compulsivity (AOR=1.46; 95% CI=1.18-1.80) were independently associated with increased odds of stimulant use. Substance use coping partially mediated the associations of sexual compulsivity (β(indirect)=0.11, p<.001) and depressed mood (β(indirect)=0.13, p<.001) with stimulant use.

CONCLUSIONS

Clinical research is needed to examine if interventions targeting sexual compulsivity and emotion regulation reduce stimulant use among MSM.

High and persistent HIV seroincidence in men who have sex with men across 47 U.S. cities

OBJECTIVE

To provide HIV seroincidence data among men who have sex with men (MSM) in the United States and to identify predictive factors for seroconversion.

METHODS

From 1998-2002, 4684 high-risk MSM, age 18-60 years, participated in a randomized, placebo-controlled HIV vaccine efficacy trial at 56 U.S. clinical trial sites. Demographics, behavioral data, and HIV status were assessed at baseline and 6 month intervals. Since no overall vaccine efficacy was detected, data were combined from both trial arms to calculate HIV incidence based on person-years (py) of follow-up. Predictors of seroconversion, adjusted hazards ratio (aHR), were evaluated using a Cox proportional hazard model with time-varying covariates.

RESULTS

Overall, HIV incidence was 2.7/100 py and was relatively uniform across study sites and study years. HIV incidence was highest among young men and men reporting unprotected sex, recreational drug use, and a history of a sexually transmitted infection. Independent predictors of HIV seroconversion included: age 18-30 years (aHR = 2.4; 95% CI 1.4,4.0), having >10 partners (aHR = 2.4; 95% CI 1.7,3.3), having a known HIV-positive male sex partner (aHR = 1.6; 95% CI 1.2, 2.0), unprotected anal intercourse with HIV positive/unknown male partners (aHR = 1.7; 95% CI 1.3, 2.3), and amphetamine (aHR = 1.6; 95% CI 1.1, 2.1) and popper (aHR = 1.7; 95% CI 1.3, 2.2) use.

CONCLUSIONS

HIV seroincidence was high among MSM despite repeated HIV counseling and reported declines in sexual risk behaviors. Continuing development of new HIV prevention strategies and intensification of existing efforts will be necessary to reduce the rate of new HIV infections, especially among young men.

HIV and club drugs in emerging adulthood

PURPOSE OF REVIEW

To evaluate the incidence of club drug use in pediatric patients, especially those aged 13-25, and how it relates to the spread of HIV.

RECENT FINDINGS

Transmission of HIV among younger patients has become largely associated with risky sexual behaviors, as the rate of transmission from vertical infection and intravenous drug use has decreased. Use of club drugs in emerging adult populations contributes to the HIV epidemic through a combination of decreased inhibitions as well as physiological effects that increase high-risk sexual practices. Robust data exists linking the use of club drugs by the men who have sex with men population with spread of HIV, but this data in other at-risk populations (e.g. African Americans) is not as robust. Additional research is needed to identify the rates of transmission among adolescents and emerging adults, as well as knowledge, attitudes, beliefs, and practices that affect HIV transmission in this population.

SUMMARY

Use of club drugs by adolescents and emerging adults contributes to the current rate of HIV transmission among this age group.

Prevalence, genotype diversity and determinants of anal HPV infection in HIV-uninfected men having sex with men

BACKGROUND

Anal human papillomavirus (HPV) infection is very common in men having sex with men (MSM), but the available data on its burden and characteristics mainly concern HIV-infected individuals.

OBJECTIVES

This study aimed to assess the prevalence, spectrum of genotypes, and determinants of the anal HPV infection in metropolitan HIV-1 uninfected MSM.

STUDY DESIGN

A cohort of 258 MSM (median age 32 years, IQR 26-39) enrolled at an STI Clinic was screened for anal HPV infection using a highly sensitive PCR-based genotyping method. Medical history and behavioral data were collected.

RESULTS

Overall, 74.8% of the MSM were HPV-positive, with 56.2% of the participants being infected by high-risk (HR) types. A multiple infection was detected in 65.3% of the HPV-positive MSM, with up to 10 different HPV types detected in the same sample. A broad spectrum of infecting HPV types was observed, with 36 different types found overall and HPV16 representing the most common type (17.8%). The lifetime and recent number of sexual partners as well as having receptive anal sex were significantly associated with the anal HPV infection, confirming the role of sexual behavior in risk of HPV infection. However, neither younger age at first intercourse nor inconsistent use of condom was significantly associated with the infection.

CONCLUSIONS

The present findings highlight the need to create a more significant awareness about the risk of anal HPV infection among HIV-uninfected MSM and warrant the investigation of possible anal intraepithelial lesions, particularly in view of the increasing anal cancer incidence in high-risk populations.

'I've had unsafe sex so many times why bother being safe now?': the role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men

BACKGROUND

American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission.

PURPOSE

This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM.

METHODS

AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed.

RESULTS

Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both.

CONCLUSIONS

Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.

A comparison of the social and sexual networks of crack-using and non-crack using African American men who have sex with men

The role of crack cocaine in accelerating the HIV epidemic among heterosexual populations has been well documented. Little is known about crack use as an HIV risk factor among African American men who have sex with men (AA MSM), a group disproportionately infected with HIV. We sought to compare the social and sexual network characteristics of crack-using and non-crack using AA MSM in Baltimore, MD, USA and to examine associations of crack use with sexual risk. Participants were recruited using street-based and internet-based outreach, printed advertisements, word of mouth. Inclusion criteria were being aged 18 years or older, African American or of black race/ethnicity, and have self-reported sex with another male in the prior 90 days. Crack use was operationalized as self-report of crack in the prior 90 days. Logistic regression was used to identify variables that were independently associated with crack use. Of 230 enrolled AA MSM, 37% (n = 84) reported crack use. The sexual networks of crack-using AA MSM were composed of a greater number of HIV-positive sex partners, exchange partners, and partners who were both sex and drug partners and fewer networks with whom they always use condoms as compared to non-crack using AA MSM. Crack use was independently associated with increased odds of bisexual identity and networks with a greater number of exchange partners, overlap of drug and sex partners, and lesser condom use. Results of this study highlight sexual network characteristics of crack-smoking AA MSM that may promote transmission of HIV. HIV interventions are needed that are tailored to address the social context of crack-smoking AA MSM risk behaviors.

Use of respondent driven sampling (RDS) generates a very diverse sample of men who have sex with men (MSM) in Buenos Aires, Argentina

Background

Prior research focusing on men who have sex with men (MSM) conducted in Buenos Aires, Argentina, used convenience samples that included mainly gay identified men. To increase MSM sample representativeness, we used Respondent Driven Sampling (RDS) for the first time in Argentina. Using RDS, under certain specified conditions, the observed estimates for the percentage of the population with a specific trait are asymptotically unbiased. We describe, the diversity of the recruited sample, from the point of view of sexual orientation, and contrast the different subgroups in terms of their HIV sexual risk behavior.

Methodology

500 MSM were recruited using RDS. Behavioral data were collected through face-to-face interviews and Web-based CASI.

Conclusion

In contrast with prior studies, RDS generated a very diverse sample of MSM from a sexual identity perspective. Only 24.5% of participants identified as gay; 36.2% identified as bisexual, 21.9% as heterosexual, and 17.4% were grouped as “other.” Gay and non-gay identified MSM differed significantly in their sexual behavior, the former having higher numbers of partners, more frequent sexual contacts and less frequency of condom use. One third of the men (gay, 3%; bisexual, 34%, heterosexual, 51%; other, 49%) reported having had sex with men, women and transvestites in the two months prior to the interview. This population requires further study and, potentially, HIV prevention strategies tailored to such diversity of partnerships. Our results highlight the potential effectiveness of using RDS to reach non-gay identified MSM. They also present lessons learned in the implementation of RDS to recruit MSM concerning both the importance and limitations of formative work, the need to tailor incentives to circumstances of the less affluent potential participants, the need to prevent masking, and the challenge of assessing network size.

What is the potential for bisexual men in China to act as a bridge of HIV transmission to the female population? Behavioural evidence from a systematic review and meta-analysis

Background

HIV prevalence among men who have sex with men (MSM) in China has rapidly increased in recent years. It is suggested that MSM could be a potential bridge of HIV transmission to the general female population. We investigated the bisexual behaviour of MSM in China through systematic review and meta-analysis.

Methods

We conducted a systematic review and meta-analyses on published peer-reviewed Chinese and English literature during 2001-2010 according to the PRISMA guidelines. Marital status and sexual behavioural indicators of MSM were presented graphically using forest plots. The pooled effect rates with 95% confidence intervals were also calculated. Meta-regression analyses were performed to examine the factors associated with high heterogeneities across the studies.

Results

Forty-three eligible articles (11 in English and 32 in Chinese) were identified. Our results showed that 17.0% (95% CI: 15.1-19.1%) of MSM in China are currently married to a woman and 26.3% (95% CI: 23.6-29.1%) of MSM had female sexual partners in the last six months. The pooled estimates for condom use rate between MSM and female sex partners was 41.4% (95% CI: 35.5-47.5%) at the last sex act; and 25.6% (95% CI: 23.0-28.4%) in the last six months. The consistent condom use rates with regular, non-commercial, casual and commercial female sex partners in the last six months were 23.3% (95% CI: 11.25-42.1%), 39.0% (95% CI: 28.8-50.3%) and 55.8% (95% CI: 41.4-69.4%), respectively.

Conclusions

A substantial proportion of Chinese MSM is currently married or had sexual relations with a female in the past six months. In addition, low condom usage was common between married MSM and their wives, hence posing a higher risk of transmitting HIV. Harm-reduction programs targeting married MSM and their female partners are necessary to curb the further spread of HIV infection to the general female population.

What is the potential for bisexual men in China to act as a bridge of HIV transmission to the female population? Behavioural evidence from a systematic review and meta-analysis

Background

HIV prevalence among men who have sex with men (MSM) in China has rapidly increased in recent years. It is suggested that MSM could be a potential bridge of HIV transmission to the general female population. We investigated the bisexual behaviour of MSM in China through systematic review and meta-analysis.

Methods

We conducted a systematic review and meta-analyses on published peer-reviewed Chinese and English literature during 2001-2010 according to the PRISMA guidelines. Marital status and sexual behavioural indicators of MSM were presented graphically using forest plots. The pooled effect rates with 95% confidence intervals were also calculated. Meta-regression analyses were performed to examine the factors associated with high heterogeneities across the studies.

Results

Forty-three eligible articles (11 in English and 32 in Chinese) were identified. Our results showed that 17.0% (95% CI: 15.1-19.1%) of MSM in China are currently married to a woman and 26.3% (95% CI: 23.6-29.1%) of MSM had female sexual partners in the last six months. The pooled estimates for condom use rate between MSM and female sex partners was 41.4% (95% CI: 35.5-47.5%) at the last sex act; and 25.6% (95% CI: 23.0-28.4%) in the last six months. The consistent condom use rates with regular, non-commercial, casual and commercial female sex partners in the last six months were 23.3% (95% CI: 11.25-42.1%), 39.0% (95% CI: 28.8-50.3%) and 55.8% (95% CI: 41.4-69.4%), respectively.

Conclusions

A substantial proportion of Chinese MSM is currently married or had sexual relations with a female in the past six months. In addition, low condom usage was common between married MSM and their wives, hence posing a higher risk of transmitting HIV. Harm-reduction programs targeting married MSM and their female partners are necessary to curb the further spread of HIV infection to the general female population.

Provision of HIV counseling and testing services at five community-based organizations among young men of color who have sex with men

In the context of monitoring and improving CDC-funded HIV prevention programs, we describe HIV tests and infections, provision of results, previous HIV tests, and risk behaviors for young (aged 13-29) men of color who have sex with men who received HIV tests at five community-based organizations. Of 1,723 tests provided, 2.1% were positive and 75.7% of positives were previously unaware of their infection. The highest positivity rate was among men aged 25-29 (4.7%). Thirty-four percent of tests were provided to men who were tested for the first time. Over half the tests (53.2%) were provided to men who reported sex with a person of unknown HIV status, and 34% to men who reported sex with an anonymous partner. Continued and more focused prevention efforts are needed to reach and test young men of color who have sex with men and to identify previously undiagnosed HIV infections among this target population.

Statewide estimation of racial/ethnic populations of men who have sex with men in the U.S

OBJECTIVES

Men who have sex with men (MSM) bear the greatest burden of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in every state in the U.S., but their populations are poorly defined. We estimated and compared populations of MSM in 2007 by region, state, and race/ethnicity.

METHODS

We averaged findings from two statistical models we had previously developed to estimate the total state-specific percentage and number of males who were MSM. The models were based, respectively, on state-specific rural/ suburban/urban characteristics and an index using state-specific household census data on same-sex male unmarried partners. A third model, based on racial/ethnic ratios from a nationally representative behavioral survey, partitioned these statewide numbers by race/ethnicity.

RESULTS

Of an estimated 7.1 million MSM residing in the U.S. in 2007, 71.4% (5.1 million) were white, 15.9% (1.1 million) were Hispanic, 8.9% (635,000) were black, 2.7% (191,000) were Asian, 0.4% (26,000) were American Indian/Alaska Native, 0.1% (6,000) were Native Hawaiian/other Pacific Islander, and 0.6% (41,000) were of multiple/unknown race/ethnicity. The overall U.S. percentage of males who were MSM (6.4%) varied from 3.3% in South Dakota to 13.2% in the District of Columbia, which we treated as a state. Estimated numbers of MSM ranged from 9,612 in Wyoming to 1,104,805 in California.

CONCLUSIONS

Plausible estimates of MSM populations by state and race/ethnicity can inform and guide HIV/AIDS surveillance, allocation of resources, and advocacy. They can help in the planning, implementation, and evaluation of HIV prevention programs and other services. Using MSM numbers as denominators, estimates of population-based MSM HIV incidence, prevalence, and mortality rates could help clarify national and state-level epidemic dynamics. Until corroborated by other modeling and/or empirical research, these estimates should be used with caution.

Stable sexual risk behavior in a rapidly changing risk environment: findings from population-based surveys of men who have sex with men in Seattle, Washington, 2003-2006

We assessed trends in behavioral risk for HIV infection among men who have sex with men (MSM). Seattle MSM participated in random digit dial telephone surveys in 2003 (n = 400) and 2006 (n = 400). Fourteen percent in 2003 and 9% in 2006 reported unprotected anal intercourse with a partner of different or unknown HIV status (non-concordant UAI; odds ratio [OR] = 0.7; 95% confidence interval [CI]: 0.5, 1.2). Compared to participants in 2003, participants in 2006 met a greater proportion of their anal sex partners through the Internet (OR = 2.0; 95% CI: 1.2, 3.1). Although the proportion of anal sex partnerships formed online increased between 2003 and 2006, Internet partnerships were not more risky than those initiated elsewhere. While the emergence of the Internet as a venue through which men meet partners demonstrates that sexual risk among MSM remains highly dynamic, our findings suggest that sexual risk behavior among MSM is currently stable.

Sex parties among urban MSM: an emerging culture and HIV risk environment

Private sex parties are an emerging risk environment for HIV among men who have sex with men (MSM). In 2009, 103 participants who reported attending at least one sex party in Massachusetts in the prior 12 months completed an in-depth, interviewer-administered quantitative assessment. Multivariable logistic regression analyses were conducted to examine associations with having engaged in one or more serodiscordant unprotected anal sex (SDUAS) acts at the most recent sex party attended. Nearly one-third (32%) of the sample reported engaging in SDUAS at the most recent sex party attended. Adjusting for age, race/ethnicity, and educational attainment, variables associated with an increased odds of engaging in SDUAS at the most recent sex party were: total number of unprotected anal receptive sex acts at sex parties in the past 12 months, self-perception of being at-risk for transmitting or acquiring HIV, and sexual sensation seeking. Examined in the same model, if condoms were provided/available at the most recent sex party attended, participants were at a decreased odds of engaging in SDUAS at that sex party. The majority (80%) expressed an interest in HIV prevention activities for MSM who attend sex parties. HIV prevention interventions are needed to reach MSM who attend sex parties and should take into account individual and contextual factors that may contribute to sexual risk. Environmental factors in the sex party setting, in particular the presence and availability of condoms, may potentially mitigate individual-level factors such as unprotected anal sex.

Mental health among Israeli homosexual adolescents and young adults

This study examines the mental health status of Israeli homosexuals in adolescence and early adulthood in comparison to heterosexual controls. We compared 219 homosexuals (136 gay men and 83 lesbian women) with 219 individually matched heterosexuals on indices of depression and subjective well being. In line with the study hypothesis, the results indicated that the homosexual participants reported more depressive symptoms and more negative affect than matched heterosexuals. However, the homosexuals were also found to report a higher level of positive affect. This study suggests that co-activated systems of negative and positive emotions facilitate adaptation among young homosexuals.

Sampling methods used in developed countries for behavioural surveillance among men who have sex with men

The aim of this review was to develop an overview of the sampling methods used in developed countries for behavioural surveillance among men who have sex with men. We abstracted information from peer-reviewed and non-peer-reviewed publications and, when needed, contacted first authors and surveillance authorities. Out of the 40 developed countries, 26 surveillance systems were identified in 23 countries. These surveillance systems made use of one or a combination of: venue-based sampling (n = 16); web-based sampling (n = 11); gay press/mail-out (n = 8); or respondent-driven sampling (n = 4). Differences in the sampling methods used were found by year of implementation and by region. More information is needed to better assess the strengths and limitations of the range of sampling methods. There was substantial variation in the way sampling methods were applied, most especially in venue-based sampling. To improve the ability to compare indicators across countries, key elements of the sampling methods should be standardized.

The role of peer support on condom use among Black and Latino MSM in three urban areas

This article examines the sociodemographic/behavioral variables associated with low peer support of condom use and the relation between low peer support of condom use and unprotected anal sex for Black and Latino MSM in cities heavily impacted by the HIV/AIDS epidemic. Our findings indicate that perceived low peer support of condom use is associated with increased odds of recent unprotected anal intercourse (UAI) among Black and Latino MSM, regardless of male partner type. Although many participants reported having high peer support of condom use, this analysis highlights a considerable subgroup of Black and Latino MSM, 21% and 30%, respectively, who report low peer support of condoms. Given the prevalence of low peer support of condom use and its association with UAI in these highly impacted MSM populations, we recommend future intervention work that draws upon Black and Latino MSM's peer and social network members to reduce HIV risk behaviors.

HIV testing among bisexual men in the United States

Little is known about HIV testing among bisexual men in the United States. Existing studies lack adequate representation, multivariate analytical strategies, and measurement of bisexuality indicators. To address these limitations, this study used the National Survey of Family Growth (N = 3,875). Sexual behavior and identity measures compared bisexual and other men along HIV testing history, reasons for testing, and recency of testing. Multivariate analyses adjusted for sociodemographic and risk factors that covary with testing. Bisexually active men were significantly less likely than homosexually active men to ever test, and they tested less often to know their HIV serostatuses. Bisexual identification decreased the odds of testing among bisexually active men but not others. Findings suggest that bisexual behavior and identity interact to decrease men's likelihoods of HIV testing. Interventions must recognize the potentially mediating roles of bisexual identity and behavior as well as risk factors that increase bisexual men's susceptibility to HIV infection.

Stigma and sexual health risk in HIV-positive African American young men who have sex with men

Understanding the multiple forms of stigma experienced by young HIV-positive African American men who have sex with men and how they relate to sexual risk behaviors is essential to design effective HIV prevention programs. This study of 40 African American young MSM found that 90% of those surveyed experienced sexual minority stigma, 88% experienced HIV stigma, and 78% experienced dual stigma. Sexual minority stigma was characterized by experiences of social avoidance, and HIV stigma, by shame. Individuals with high HIV stigma were significantly more likely to engage in unprotected sex while high or intoxicated. Associations between stigma and sexual practices were examined; youth endorsing higher levels of sexual minority stigma engaged in less insertive anal intercourse. Individuals endorsing more HIV stigma reported more receptive anal intercourse. These findings support the development of stigma-informed secondary prevention interventions for African American HIV-positive young MSM.

Analyzing HIV/AIDS and Alcohol and Other Drug Use as a Social Problem

Most prevention and intervention activities directed toward HIV/AIDS and alcohol and other drug use separately as well as the combining of the two (e.g., those who are both HIV/AIDS and using alcohol and other drugs) comes in the form of specific, individualized therapies without consideration of social influences that may have a greater impact on this population. Approaching this social problem from the narrowed view of individualized, mi-cro solutions disregards the larger social conditions that affect or perhaps even are at the root of the problem. This paper analyzes the social problem of HIV/AIDS and alcohol and other drug abuse using three sociological perspectives-social construction theory, ethnomethodology, and conflict theory-informing the reader of the broader influences accompanying this problem.

Sexual risk behavior and drug use in two Chicago samples of men who have sex with men: 1997 vs. 2002

Employing data from two Chicago-based household probability samples of men who have sex with men (MSM) implemented 5 years apart (the "UMHS 1997" and the "2002 MSM supplement" studies), we evaluated changes in risk behavior as well as the potential viability of two alternative perspectives for explaining these changes--risk management and safe-sex norm abandonment. We found significantly increased rates of unprotected insertive and receptive anal intercourse in the 2002 study. Sixty-eight percent of UMHS men reported having sex with partners having HIV positive or unknown status, compared with 38% of the MSM supplement men (p < .0001). Serosorting mediated and moderated the most extreme forms of risk behavior. Positive statistical associations between drug use and unprotected sex were stronger in the UMHS sample than in the MSM supplement. Findings suggesting that "risk management" strategies have shaped MSM behavior as it emerged in the early part of this decade have considerable implications for HIV prevention strategies.

Risk behaviors and psychosocial stressors in the new york city house ball community: a comparison of men and transgender women who have sex with men

The New York City House Ball community consists of social networks of racial/ethnic minority gay, lesbian or bisexual men and women, and transgender persons. HIV seroprevalence and interview data were obtained from a sample of community members to identify statistical differences in HIV prevalence, risk behavior, and psychosocial stressors between men who have sex with men (MSM) and transgender women. Of 301 MSM and 60 transgender women, 20% were HIV-infected and 73% were unaware of their infection, but rates did not differ by gender. Risk behavior and stressors were common in both groups, but transgender women were more likely to report exchange sex, stigmatization, and stressful life events. High rates of risk behavior and HIV in this special community warrant relevant HIV testing and prevention services. Transgender women in the community may be at even greater risk for HIV infection due to behaviors compounded by substantial psychosocial stressors.

Deconstructing the complexity of substance use among young men who have sex with men (YMSM) by optimizing the role of qualitative strategies in a mixed methods study

Qualitative data can be a powerful tool in developing interventions for substance use and other HIV-risk behaviors. Mixed methods design offers researchers the ability to obtain data that provides both breadth and depth to their research questions. However, the integration of qualitative data in mixed methods research has been limited. This paper describes the qualitative study design of the Healthy Young Men's Study, a longitudinal mixed method study with an ethnically diverse cohort of young men who have sex with men (YMSM) (N = 526) in Los Angeles. Integral to this discussion is how a mixed methods study can address common challenges such as sampling, representation and integration of both datasets.

Characteristics of research-related HIV testing programmes contribute to detection of more HIV infections

HIV prevalence estimates from bathhouse testing programmes differ widely, ranging from 3% to 11%. The observed difference may be a consequence of whether the programme was part of a research project or a community-based programme. A research-funded testing programme was offered at a bathhouse between May 2001 and December 2002. A local community-based organization began a testing programme in July 2006 at the same bathhouse; the data for this analysis cover the period July 2006 through December 2007. County-wide HIV prevalence estimates were available across the two time periods (i.e. 2001-2002 and 2006-2007). The research-funded testing programme recruited fewer men but identified more positive individuals (10.7% of those testing in the research programme) than were identified among men who tested in the area clinics (3.8% of those men who have sex with men [MSM] testing throughout the county in the same time period). However, the community-based testing programme identified about the same proportion of positive MSM (2.6%) as county clinics (2.7%) in the same time period. In conclusion, results confirmed that even in the same venue, a community-based HIV testing programme identified a similar proportion of positive MSM as the area clinics; however, the research-funded programme identified appreciably more. Incentives may contribute to the difference.

Sexual seroadaptation: lessons for prevention and sex research from a cohort of HIV-positive men who have sex with men

Background

Surveillance data on sexually transmitted infections (STIs) and behavioral characteristics identified in studies of the risk of seroconversion are often used as to track sexual behaviors that spread HIV. However, such analyses can be confounded by “seroadaptation”—the restriction of unprotected anal intercourse (UAI), especially unprotected insertive UAI, to seroconcordant partnerships.

Methods

We utilized sexual network methodology and repeated-measures statistics to test the hypothesis that seroadaptive strategies reduce the risk of HIV transmission despite numerous partnerships and frequent UAI.

Principal Findings

In a prospective cohort study of HIV superinfection including 168 HIV-positive men who have sex with men (MSM), we found extensive seroadaptation. UAI was 15.5 times more likely to occur with a positive partner than a negative one (95% confidence interval [CI], 9.1–26.4). Receptive UAI was 4.3 times more likely in seroconcordant partnerships than with negative partners (95% CI, 2.8–6.6), but insertive UAI was 13.6 times more likely with positives (95% CI, 7.2–25.6). Our estimates suggest that seroadaptation reduced HIV transmissions by 98%.

Conclusion

Potentially effective HIV prevention strategies, such as seroadaptation, have evolved in communities of MSM before they have been recognized in research or discussed in the public health forum. Thus, to be informative, studies of HIV risk must be designed to assess seroadaptive behaviors rather than be limited to individual characteristics, unprotected intercourse, and numbers of partners. STI surveillance is not an effective indicator of trends in HIV incidence where there are strong patterns of seroadaptation.

Measuring sexual risk for HIV: a Rasch scaling approach

In this study, we developed an HIV transmission risk scale and examined its psychometric properties using data on sexual behavior obtained from a probability sample of adult men who have sex with men living in Chicago. We used Messick's (Am Psychol 50:741-749, 1995) conceptualization of unified validity theory to organize the psychometric properties of data. Evidence related to scale content was investigated via Rasch item fit statistics, point-measure correlations, and expert evaluation. The substantive aspect of validity was addressed by interpreting the meaningfulness of the item difficulty hierarchy (continuum of risky behaviors) and assessment of person fit. The structural aspect of validity was assessed using Rasch item fit statistics, principal component analysis of standardized residuals, and other residual analyses. The generalizability aspect of validity was investigated via internal consistency reliability estimates for both items and persons, and aspects of external validity were addressed by examining between-group differences with respect to levels of risky behavior. Applications and suggested future studies are discussed.

Drug use, high-risk sex behaviors, and increased risk for recent HIV infection among men who have sex with men in Chicago and Los Angeles

We examined how drugs, high-risk sexual behaviors, and socio-demographic variables are associated with recent HIV infection among men who have sex with men (MSM) in a case-control study. Interviewers collected risk factor data among 111 cases with recent HIV infection, and 333 HIV-negative controls from Chicago and Los Angeles. Compared with controls, cases had more unprotected anal intercourse (UAI) with both HIV-positive and HIV-negative partners. MSM with lower income or prior sexually transmitted infections (STI) were more likely to be recently HIV infected. Substances associated with UAI included amyl nitrate ("poppers"), methamphetamine, Viagra (or similar PDE-5 inhibitors), ketamine, and gamma hydroxybutyrate (GHB). Cases more frequently used Viagra, poppers, and methamphetamine during UAI compared with controls. In multivariate analysis, income, UAI with HIV-positive partners, Viagra, and poppers remained associated with recent HIV seroconversion. Better methods are needed to prevent HIV among MSM who engage in high-risk sex with concurrent drug use.

"There's no pamphlet for the kind of sex I have": HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men

Preliminary evidence has suggested that some transgender men who have sex with nontransgender men ("trans MSM") may be at risk for HIV and sexually transmitted infections and that their prevention needs are not being met. Quantitative (n =45) and qualitative (n =15) interviews explored risk behaviors, protective strategies, and perceptions of the impact of transgender identity on sexual decision making among trans MSM. A majority of the participants reported inconsistent condom use during receptive vaginal and anal sex with nontrans male partners; HIV prevalence was 2.2%. Risk factors included barriers to sexual negotiation such as unequal power dynamics, low self-esteem, and need for gender identity affirmation. Protective strategies included meeting and negotiating with potential partners online. Results of this study provide initial evidence that current risk behaviors could lead to rising HIV prevalence rates among trans MSM. Prevention programs must tailor services to include issues unique to trans MSM and their nontrans male partners.

Behavioral mechanisms in HIV epidemiology and prevention: past, present, and future roles

In the 1980s, behavioral variations across geographically and socially defined populations were the central focus of AIDS research, and behavior change was seen as the primary means of controlling HIV epidemics. Today, biological mechanisms--especially other sexually transmitted infections, antiretroviral therapy, and male circumcision--predominate in HIV epidemiology and prevention. We describe several reasons for this shift in emphasis. Although the shift is understandable, we argue for a sustained focus on behavioral mechanisms in HIV research in order to realize the theoretical promise of interventions targeting the biological aspects of HIV risk. We also provide evidence to suggest that large reductions in HIV prevalence may be accomplished by small changes in behavior. Moreover, we contend that behavioral mechanisms will find their proper place in HIV epidemiology and prevention only when investigators adopt a conceptual model that treats prevalence as a determinant as well as an outcome of behavior and that explicitly recognizes the dynamic interdependence between behavior and other epidemiological and demographic parameters.

Estimating populations of men who have sex with men in the southern United States

Population estimates of men who have sex with men (MSM) by state and race/ethnicity are lacking, hampering effective HIV epidemic monitoring and targeting of outreach and prevention efforts. We created three models to estimate the proportion and number of adult males who are MSM in 17 southern states. Model A used state-specific census data stratified by rural/suburban/urban area and national estimates of the percentage MSM in corresponding areas. Model B used a national estimate of the percentage MSM and state-specific household census data. Model C partitioned the statewide estimates by race/ethnicity. Statewide Models A and B estimates of the percentages MSM were strongly correlated (r = 0.74; r-squared = 0.55; p < 0.001) and had similar means (5.82% and 5.88%, respectively) and medians (5.5% and 5.2%, respectively). The estimated percentage MSM in the South was 6.0% (range 3.6-13.2%; median, 5.4%). The combined estimated number of MSM was 2.4 million, including 1,656,500 (69%) whites, 339,400 (14%) blacks, 368,800 (15%) Hispanics, 34,600 (1.4%) Asian/Pacific Islanders, 7,700 (0.3%) American Indians/Alaska Natives, and 11,000 (0.5%) others. The estimates showed considerable variability in state-specific racial/ethnic percentages MSM. MSM population estimates enable better assessment of community vulnerability, HIV/AIDS surveillance, and allocation of resources. Data availability and computational ease of our models suggest other states could similarly estimate their MSM populations.

Race-based sexual stereotyping and sexual partnering among men who use the internet to identify other men for bareback sex

This qualitative study used sexual scripting theory to explore sexual stereotyping and sexual partnering practices among a racially diverse sample of men who use the Internet to engage in "bareback" sex with other men. The sample included 81 (73%) HIV-negative and 30 (27%) HIV-positive men who were recruited on Web sites where men seek other men to have bareback sex. Participants completed a semi-structured interview that included topics on their racial identification, their sexual experiences tied to race, and their experiences having sex with men of different racial groups. The findings suggested that a variety of race-based sexual stereotypes were used by participants. Sexual stereotyping appeared to directly and indirectly affect the sexual partnering decisions of participants. Sexual scripts may reinforce and facilitate race-based sexual stereotyping, and this behavior may structure sexual networks.

Men who have sex with men: racial/ethnic disparities in estimated HIV/AIDS prevalence at the state and county level, Florida

Population-based HIV/AIDS prevalence estimates among men who have sex with men (MSM) have been unavailable, but have implications for effective prevention efforts. Prevalent (living) Florida HIV/AIDS cases reported through 2006 (numerators) were stratified by race/ethnicity and HIV exposure category. Based on previous research, MSM populations were posited as 4-10% of all males aged > or =13 years in each subgroup (denominators). At the estimated lower and upper plausible bounds, respectively, HIV/AIDS prevalence per 100,000 MSM was significantly higher among black (8,292.6-20,731.4); Hispanic (5,599.5-13,998.7); and Asian/Pacific Islander, American Indian or multi-racial (4,942.6-12,356.8) MSM than among white MSM (3,444.9-8,612.3). HIV/AIDS prevalence among all MSM was 13.8-36.9 times that among all other males. Across 19 high-morbidity counties, MSM HIV/AIDS prevalence was highest among those in the most populous counties and highest among blacks. This methodology, adaptable by other states, facilitates calculation of plausible MSM HIV/AIDS prevalence to guide HIV prevention/care community planners and MSM.

Alcohol use and risk of HIV infection among men who have sex with men

In the United States, men who have sex with men (MSM) currently represent more than 50% of those living with HIV and over 70% of HIV+ men (CDC 2007, http://www.cdc.gov/hiv/topics/msm/resources/factsheets/pdf/msm.pdf ). Male-to-male sexual contact has been identified as the predominant route of transmission among this sub-group, which underscores the need for research that targets risk factors associated with risky sex-related HIV acquisition. Along these lines, research has shown that one potentially important predictor variable for risky sex among MSM is alcohol use. The major aim of this paper is to review and integrate empirical evidence on the association of alcohol use and risky sex among MSM. A summary of the quantitative research is provided first, followed by a critique of the reviewed literature, a discussion of the consistency of the existing empirical evidence with predictions of current theories, and finally, recommendations for future research designed to evaluate alcohol-related sexual risk in MSM.

Use of a rapid HIV home test to screen sexual partners: an evaluation of its possible use and relative risk

We estimated the HIV risk reduction that could be attained by using a rapid HIV home test (HT) to screen sexual partners versus using condoms in different proportions of anal intercourse (AI) occasions among men who have sex with men (MSM). Special attention was paid to the role of the window period during which infected cases go undetected. Our results show that if MSM engage in AI without condoms following a non-reactive HT result, they have lower chances of becoming infected by someone still in the window period than by following heuristics and using condoms inconsistently. For MSM who do not use condoms, use of HT as a screening device may be a useful risk reduction strategy. This advantage increases with higher HIV population prevalence. With higher HIV incidence, this strategy will not provide any advantage if condoms are used in as little as one out of four occasions.

Drug use and high-risk sexual behaviors among african american men who have sex with men and men who have sex with women

OBJECTIVES

We investigated covariates related to risky sexual behaviors among young African American men enrolled at historically Black colleges and universities (HBCUs).

METHODS

Analyses were based on data gathered from 1837 male freshmen enrolled at 34 HBCUs who participated in the 2001 HBCU Substance Use Survey. The covariates of risky sexual behavior assessed included condom nonuse, engaging in sexual activity with multiple partners, and history of a sexually transmitted disease.

RESULTS

Young Black men who had sex with men were more likely to engage in risky sexual behaviors than were young men who had sex with women. Two additional factors, early onset of sexual activity and consumption of alcohol or drugs before sexual activity, were independently associated with modestly higher odds of sexual risk behaviors.

CONCLUSIONS

Services focusing on prevention of sexually transmitted diseases should be provided to all male college students, regardless of the gender of their sexual partners. Such a general approach should also address drug and alcohol use before sexual activity.

Sociodemographic, sexual, and HIV and other sexually transmitted disease risk profiles of nonhomosexual-identified men who have sex with men

I examined sociodemographic, sexual, and HIV and other sexually transmitted disease risk differences among homosexual- and nonhomosexual-identified men who have sex with men (MSM) in the United States. Non-Mexican Latino ethnicity, marriage or cohabitation, religiosity, and incarceration history were positively associated with being nonhomosexual identified. Being nonhomosexual identified was associated with some risk (e.g., more sexual intercourse while intoxicated) and protective (e.g., fewer male partners) behaviors. Probabilistic sampling strategies may be useful in future research and intervention efforts.

Childhood sexual abuse and the sociocultural context of sexual risk among adult Latino gay and bisexual men

OBJECTIVES

We sought to examine the relationships among childhood sexual abuse, social discrimination, psychological distress, and HIV-risk among Latino gay and bisexual men in the United States.

METHODS

Data were from a probability sample of 912 men from Miami, FL; Los Angeles, CA; and New York, NY. We used logistic regression and path analyses to examine direct and indirect effects of childhood sexual abuse on psychological distress and sexual risk behavior.

RESULTS

We found a 15.8% (95% confidence interval = 12.3%, 19.2%) prevalence of childhood sexual abuse. Not having sex before age 16 years and having consensual sex before age 16 years did not differ from each other in predicting any of the outcomes of interest. Forced sex was associated with a significantly increased risk for all outcomes. A path analyses yielded direct effects of childhood sexual abuse and exposure to homophobia during childhood and during adulthood on psychological distress and indirect effects on risky sexual behavior.

CONCLUSIONS

HIV-risk patterns among Latino gay and bisexual men are related to childhood sexual abuse and a social context of discrimination, which combined lead to symptoms of psychological distress and participation in risky sexual situations that increase risky sexual behaviors associated with HIV acquisition.

Sexually transmitted infections and HIV prevalence among incarcerated men who have sex with men, 2000-2005

OBJECTIVE

: Screening incarcerated populations, particularly men who have sex with men (MSM), for the identification, treatment, and prevention of sexually transmitted infections (STI) and HIV provides an effective way to access a hard-to-reach, high-risk population.

GOAL

: To describe findings from a screening program designed to identify STIs and HIV among incarcerated MSM.

STUDY DESIGN

: The Los Angeles County Sexually Transmitted Disease Program implemented a voluntary HIV and STI screening program in the segregated MSM unit of the Los Angeles County Men's Jail in March 2000. This analysis reports on data collected through December 2005.

RESULTS

: Between March 2000 and December 2005, a total of 7004 inmates participated in the screening program. The overall positivity rate for chlamydia was 3.1% (127 of 4157) and 1.7% (69 of 4106) for gonorrhea. In addition, early syphilis was identified in 1.6% of inmates (95 of 6008) and the overall prevalence of HIV was 13.4% (625 of 4658). The level of repeat testing was relatively high with 15% (1048) of inmates repeatedly incarcerated and screened for STIs over the 5-year period. Although the seroprevalence of HIV was not significantly different between repeaters and nonrepeaters, 33 inmates were HIV seropositive after having tested negative at prior bookings, resulting in an HIV incidence of 1.9%.

CONCLUSIONS

: Screening incarcerated MSM in Los Angeles revealed a high prevalence of STI and HIV infection. These inmates not only represent a high-risk group, but also a unique opportunity for the identification, treatment, and counseling of this hard-to-reach, high-risk population.

Single by choice? Assessing and understanding voluntary singlehood among mature gay men

This study investigated what it means for mature gay men to be voluntary single from the perspective of both assessment and subjective experience. A convenience sample of 94 self-identified single gay men from a large midwestern city, ages 35 and over, completed a structured questionnaire that included the 15-item Adaptation to Single Status Measure. Twenty of these men also participated in semi-structured life-history interviews. Descriptive, item, and scale analyses indicated a discrepancy between the perception of oneself as "single by choice" and acceptance of and satisfaction with single status. Qualitative data indicated that voluntary singlehood is neither a salient identity nor an expression of primary control; rather, it is an idiosyncratic "narrative strategy" and a form of secondary control that preserves ego integrity. These findings are discussed with respect to their implications for the creation and maintenance of healthy, happy, single lifestyles and communities.

Gay-related development, early abuse and adult health outcomes among gay males

This study examined relationships between timing of gay-related developmental milestones, early abuse, and emergence of poor health outcomes in adulthood among 1,383 gay/bisexual men in the Urban Men's Health Study. Latent Profile Analysis grouped participants as developing early, middle or late based on the achievement of four phenomena including age of first awareness of same-sex sexual attractions and disclosure of sexual orientation. Participants who developed early were more likely, compared to others, to experience forced sex and gay-related harassment before adulthood. They were more likely to be HIV seropositive and experience gay-related victimization, partner abuse and depression during adulthood. Early forced-sex, gay-related harassment and physical abuse were associated with several negative health outcomes in adulthood including HIV infection, partner abuse, and depression. This analysis suggests that the experience of homophobic attacks against young gay/bisexual male youth helps to explain heightened rates of serious health problems among adult gay men.

Mediators of childhood sexual abuse and high-risk sex among men-who-have-sex-with-men

OBJECTIVE

Mediators of childhood sexual abuse (CSA) and HIV risk behavior were examined for men-who-have-sex-with-men (MSM).

METHOD

Data from a dual frame survey of urban MSM (N=1078) provided prevalence estimates of CSA, and a test of two latent variable models (defined by partner type) of CSA-risk behavior mediators.

RESULTS

A 20% prevalence of CSA was reported. For MSM in secondary sexual relationships, our modeling work identified two over-arching but inter-related pathways (e.g., both pathways include effects on interpersonal skills) linking CSA and high-risk behavior: (1) CSA-Motivation-Scripts-Skills-Risk Behavior; and (2) CSA-Motivation-Coping-Risk Appraisal-Skills-Risk Behavior. For men in primary relationships, there was one over-arching pathway including CSA-Motivation-Coping-Risk Appraisal-Risk Behavior processes. Exploratory analyses indicated that men with a history of CSA in only primary relationships versus only secondary relationships had, for example, fewer motivational problems, and better coping and interpersonal skills.

CONCLUSIONS

CSA contributes to the ongoing HIV epidemic among MSM by distorting or undermining critical motivational, coping, and interpersonal factors that, in turn, influence adult sexual risk behavior. Further, the type of adult relationships men engage in serve as markers for adult CSA-related problems. The findings are discussed in the context of current theory and HIV prevention strategies.

PRACTICE IMPLICATIONS

Direct extrapolation from our findings to practice is limited. However, there are general implications that may be drawn. First, the complex challenges faced by men with severe CSA experiences may limit the effectiveness of typical short-term HIV risk reduction programs; more intensive treatment maybe needed. Secondly, Clinical Psychologists and Psychiatrists with MSM patients with CSA histories should, if not already, routinely consider issues of sexual health; patterns and types of sexual partners may be useful markers for identifying more problematic cases. Lastly, public service messages directed at destigmatizing CSA for MSM may increase use of health and mental health services.

Researching special populations: retention of Latino gay and bisexual men and transgender persons in longitudinal health research

Few studies have sought to assess predictors of retention of racial/ethnic or sexual minorities in longitudinal health research. The purpose of this study is to investigate predictors of retention of Latino gay and bisexual men and transgender (GBT) research participants after the baseline interview. Data come from a sample of 643 Latino GBT individuals in two cities (Chicago and San Francisco). We assessed potential predictors of retention (operationalized as successful re-contact) using binary logistic regression of retention on five factors (sociodemographic/health, residential stability, acculturation/attachment to the United States, gay community attachment/stigmatization and research process/design). Our overall follow-up rate was 83 and 80% at 3 and 6 months, respectively. We found that traditional factors (e.g. education, income) were not associated with retention among Latino GBT. The strongest predictors of successful retention were the number of pieces of contact information provided by participants and city of residence (San Francisco). Furthermore, successful methods of contact (i.e. telephone, email) varied by city. We conclude that a largely immigrant urban population of Latino GBT individuals can be successfully followed in longitudinal research. The strong relationship between study design variables and successful retention indicates that collection of thorough contact information is vital to successful follow-up with this population.

Medical Treatment for Men Who Have Sex With Men and Are Living With HIV/AIDS

This study focuses on a sample of men who have sex with men (MSM) living with HIV/AIDS in a south Florida community. The study uses a mixed-method, quantitative, and qualitative research design. The purpose of the study was to identify individual and service system characteristics that impact access, retention, and adherence to an HIV/AIDS medical treatment regimen. The study identified many men who were not likely to seek treatment after their initial HIV/AIDS diagnosis. Compared with the general population living with HIV/AIDS in the same south Florida community many of these men were less likely to maintain a regimen of medical care for their HIV/AIDS. The study indicated that the following issues affected medical treatment and treatment adherence: treatment readiness, presence of support networks, availability of “MSM-friendly” health providers, and the cultural competency of substance abuse providers.

HIV prevention services received at health care and HIV test providers by young men who have sex with men: an examination of racial disparities

We investigated whether there were racial/ethnic differences among young men who have sex with men (MSM) in their use of, perceived importance of, receipt of, and satisfaction with HIV prevention services received at health care providers (HCP) and HIV test providers (HTP) that explain racial disparities in HIV prevalence. Young men, aged 23 to 29 years, were interviewed and tested for HIV at randomly sampled MSM-identified venues in six U.S. cities from 1998 through 2000. Analyses were restricted to five U.S. cities that enrolled 50 or more black or Hispanic MSM. Among the 2,424 MSM enrolled, 1,522 (63%) reported using a HCP, and 1,268 (52%) reported having had an HIV test in the year prior to our interview. No racial/ethnic differences were found in using a HCP or testing for HIV. Compared with white MSM, black and Hispanic MSM were more likely to believe that HIV prevention services are important [respectively, AOR, 95% confidence interval (CI): 3.0, 1.97 to 4.51 and AOR, 95% CI: 2.7, 1.89 to 3.79], and were more likely to receive prevention services at their HCP (AOR, 95% CI: 2.5, 1.72 to 3.71 and AOR, 95% CI: 1.7, 1.18 to 2.41) and as likely to receive counseling services at their HTP. Blacks were more likely to be satisfied with the prevention services received at their HCP (AOR, 95% CI: 1.7, 1.14 to 2.65). Compared to white MSM, black and Hispanic MSM had equal or greater use of, perceived importance of, receipt of, and satisfaction with HIV prevention services. Differential experience with HIV prevention services does not explain the higher HIV prevalence among black and Hispanic MSM.

Validity of self-reported substance use in men who have sex with men: comparisons with a general population sample

PURPOSE

To understand the validity of self-reported recent drug use in men who have sex with men (MSM).

METHODS

We obtained a probability sample of Chicago men who have sex with men (MSM; n=216) and administered urine and saliva drug testing after a self-administered interview. Analyses examined participation in drug testing, the agreement between self-reported past month drug use and drug test results, correlates of underreporting, and the relative utility of drug testing versus self-reports in identifying recent marijuana and cocaine use. For marijuana and cocaine, findings were compared with those obtained from a general population sample of men (n=241).

RESULTS

More than three quarters of the participants in both samples provided at least one specimen for drug testing. Self reports in both samples showed a high degree of correspondence with drug tests for marijuana but not for cocaine. Sensitivity for cocaine use reporting was 60% for the MSM sample and 40% for the general-population men. Conditional kappa and sensitivity statistics for marijuana, cocaine, 3,4 methylenedioxymethamphetamine (i.e., MDMA, "ecstacy"), and methamphetamine suggested that self reports among MSM are provided with a high degree of validity. Underreporting was a correlate of social class (education, income, and employment) in the general population but not in the MSM sample. The utility of drug testing was dependent on social class in the general population sample.

CONCLUSIONS

Drug testing is feasible in epidemiological surveys of drug use. Self reports among MSM are at least as valid as those provided by a general population sample of men. In some instances (e.g., cocaine use), they may actually be of higher quality. Although the findings support the merit of epidemiological studies of MSM drug use that have relied completely on self-reporting, drug tests may be useful for clarifying club drug ingestion patterns.

Sexual risk behavior has decreased among men who have sex with men in Los Angeles but remains greater than that among heterosexual men and women

We examined changes and correlates of sexual risk behavior of men who have sex with men (MSM) compared with heterosexual men and women over three time periods. Data from the 1997, 1999, and 2003 Los Angeles County Health Surveys, a population-based telephone survey, were analyzed to examine the association of sociodemographic and health-related factors with sexual risk behaviors among the three groups. In each time period, MSM reported a significantly greater percentage of sexual risk (i.e., both inconsistent condom use and multiple sex partners in the past 12 months) compared with heterosexual men and women. Multivariate analyses indicated that MSM and heterosexual men reported greater sexual risk than heterosexual women. Respondents who were younger, U.S. born, reported heavy alcohol consumption, or had been tested for HIV in the past 24 months were more likely to report sexual risk behavior. The findings suggest the need for continued targeted prevention for MSM and prevention efforts for segments of the general population at elevated risk for HIV.