Body Image and Condomless Anal Sex Among Sexual Minority Men Living with HIV

Body Image and Its Associated Factors among People Living with HIV: A Comprehensive Systematic Review and implications for integrated care

Objectives

People living with HIV (PLWH) face unique psychosocial challenges due to both infection and antiretroviral therapy (ART), one of which is body image disruption. Yet, a comprehensive synthesis of existing research on body image among PLWH is lacking. This study systematically reviewed relevant studies to explore body image issues, identify associated factors, and describe assessment methods and interventions targeting body image in this population.

Methods

Guided by the PRISMA, a thorough search of PsycINFO, PubMed, Embase, and Web of Science was conducted in January 2024, including empirical studies considering Body Image among PLWH published in peer-reviewed English journals, using search terms relevant to HIV and Body image. To include the latest articles, we conducted another round of searches in November 2024. NIH Study Quality Assessment Tools were used to assess the quality of the included studies, and a narrative synthesis was conducted to identify common themes, including definitions of body image, associated factors, measurement instruments, and interventions targeting body image among PLWH.

Results

From 2197 publications, 26 studies from 2004 to 2024 met the inclusion criteria, comprising a sample of 4095 PLWH aged 8 to 65 from different countries. Most of the studies were cross-sectional in design and varied in focus. Findings reveal that body image issues are prevalent among PLWH. The majority of studies demonstrated an association between negative body image and psychological comorbidities, including depression, anxiety, social withdrawal, and substance use. Body image dissatisfaction was also associated with physical health factors such as lipodystrophy. BMI measures reported in twelve studies indicated that BMI tends to increase with age in PLWH. Sixteen distinct body image measurement tools were used across studies. CBT-BISC was the only target intervention that showed effectiveness in mitigating body image disturbance and improving ART adherence among PLWH.

Conclusion

Body image issues represent a critical but often overlooked component of the biopsychosocial challenges faced by PLWH. This is the first comprehensive literature review to exclusively consider body image, associated factors, measurements, and target interventions among PLWH, which highlighted the need for comprehensive, culturally sensitive interventions that address both the physical and psychological dimensions of body image concerns.

Exploring the Relationships Between Body Image, Sexual Well-Being, and Community Connectedness among Gay, Bisexual and Queer+ Men

Sexual minority (SM) men are more likely than heterosexual men to experience body dissatisfaction due to prevailing body ideals (e.g. lean and muscular) within the SM community. Negative body image can have harmful effects on well-being, and, by extension, sexual well-being. The current study aimed to investigate whether SM men's minority identification and LGBTQ+ community connectedness moderates the relationship between drives for muscularity and sexual anxiety. To address this aim, 298 Australian-residing SM men completed an online survey that examined drive for muscularity, sexual anxiety, and connectedness or identification with the LGBTQ+ and SM-specific communities. As hypothesized, the results showed a positive relationship between drive for muscularity and sexual anxiety. Additionally, LGBTQ+ community connectedness, but importantly not SM identification, was found to moderate this relationship, showing a positive association only when connection was at low or average levels. These results highlight the beneficial effects that LGBTQ+ community connection can have for SM men, such as protecting them against the harmful impacts of poor body image on sexual well-being. These results also provide preliminary insights into the need to expand the understandings of bodily diversity, and diversity of sexual well-being experiences, among SM men less connected to the broader LGBTQ+ community.

Body image among people living with HIV: A systematic review and narrative synthesis

OBJECTIVES

The aim of this systematic review was to analyse, synthesise and review existing research on body image among people living with HIV (PLWH). Specifically, the review investigated the relationship of body image with sociodemographic and clinical variables and psychological correlates among PLWH.

METHOD

A comprehensive literature search was conducted using Web of Science, PsycARTICLES, MedLine, ProQuest and Scopus databases and yielded a total of 699 abstracts. The inclusion criteria encompassed quantitative and peer-reviewed articles published in English devoted to HIV/AIDS adult patients, with validated measurements of body image operationalized explicitly as an outcome variable.

RESULTS

A total of 17 articles were accepted for systematic review and analysis. The quality of the studies was evaluated using STROBE guidelines for observational studies. The findings revealed that body image disturbances are common among PLWH and are influenced by factors such as lipodystrophy, depression, anxiety, self-efficacy in health behaviours, social support, stigma and quality of life. Higher body image disturbance was also linked to poorer adherence to antiretroviral therapy (ART) and increased HIV sexual transmission risk behaviours.

CONCLUSIONS

Body image is a crucial aspect of the psychosocial functioning of PLWH. Despite medical advancements, PLWH continue to face significant body image disturbances that impact their quality of life. Future research should focus on longitudinal studies, diverse geographical contexts and interventions aimed at improving body image among this population. Addressing body image concerns through psychosocial support and therapeutic interventions can potentially enhance the overall well-being and health outcomes of PLWH.

Body Image Perceptions and Visualization of Vietnamese Men Who Have Sex with Men (MSM)

Research on body image among men who have sex with men (MSM) has predominantly been approached with the assumption that all MSM conform to a culturally preferred body, and have a high risk of body image concerns leading to risky behaviors and negative health outcomes. Scholars have called for a more nuanced understanding of how MSM engage with their body images. In response, we conducted 30 semi-structured interviews with Vietnamese MSM to explore their perceptions and feelings of their bodies, including their current body, idealized body, and sexually desired body. Inductive thematic analysis was utilized. The findings highlight the diversity and complexity in Vietnamese MSM's perceptions and feelings about their bodies, which Western measurements of body image and body dissatisfaction might not fully capture. The participants also acknowledge the pressure of physical appearance; however, they do not always conform to the dominant body ideals and have a high risk of body dissatisfaction. We conclude with a call for reframing the approach to gay and bisexual men's body image to understand better how they navigate complex pressures and make sense of their body image instead of assuming they are at risk of body dissatisfaction.

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

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

Online Sexual Health Information Seeking Patterns Differentiated by Social Location and Physical Location among Gay and Bisexual Men in Ontario, Canada

Objective

This research aimed to understand the varying needs of diverse gay and bisexual men (GBM) in relation to online sexual health information-seeking dependent upon differing social sociodemographic variables and geographic location.

Methods

A total of 1802 GBM in Ontario participated in this study. Multivariable regressions were conducted to analyze differences in information-seeking based on ethnicity group, HIV status, recent sexual behavior and regionality (urban and rural location).

Results

There were significant differences in online sexual health information-seeking content based on these demographic variables.

Conclusions

Implications for sexual health outreach and service provision for diverse GBM are discussed as well.

Gay Community Involvement and Condomless Anal Sex Among Sexual Minority Men in the USA

Sexual minority men (SMM) remain disproportionately burdened by sexually transmitted infections. Although gay community involvement has been theorized to be protective against many negative health outcomes, research examining the association between community involvement and condomless anal sex (CAS) has yielded conflicting results. The current study, conducted between 2018-2020, examined whether the importance one places on various aspects of community involvement was associated with CAS among a sample of young adult SMM aged 18-34 years with body image concerns (N = 180). Gay community involvement was measured using the Importance of Gay Community Scale, and the results of an exploratory factor analysis indicated the presence of two factors: "social activism" and "going out/nightlife." A zero-inflated Poisson regression was conducted to examine the association between gay "social activism," "going out/nightlife," and their interaction with the number of CAS partners. Upon examining a significant interaction, "social activism" had a protective effect against CAS at low levels of "going out/nightlife," but this effect was non-significant at higher levels. These results suggest that encouraging gay community involvement through activism could be effective at reducing CAS and addressing the health disparity that exists within this population.

Demographic and sociocultural predictors of sexuality-related body image and sexual frequency: The U.S. Body Project I

Body image is a critical component of an individual's sexual experiences. This makes it critical to identify demographic and sociocultural correlates of sexuality-related body image: the subjective feelings, cognitions, and evaluations related to one's body in the context of sexual experience. We examined how sexuality-related body image differed by gender, sexual orientation, race, age, and BMI. Four items assessing sexuality-related body image were completed by 11,620 U.S. adults: self-perceived sex appeal of their body, nude appearance satisfaction, and the extent to which they believed that body image positively or negatively affected their sexual enjoyment and feelings of sexual acceptability as a partner. Men reported slightly less nude appearance dissatisfaction and fewer negative effects of body image on sexual enjoyment and sexual acceptability than women, but did not differ in reported sex appeal. Poorer sexuality-related body image was reported by people with higher BMIs, not in relationships, who had sex less frequently, among White compared to Black women and men, and among gay compared to heterosexual men. Data also revealed a subgroup of respondents who reported that their body image had a positive impact on their sex lives. The findings highlight a need for interventions addressing sexuality-related body image.

Associations among romantic and sexual partner history and muscle dysmorphia symptoms, disordered eating, and appearance- and performance-enhancing drugs and supplement use among cisgender gay men

This study examined relationship status (e.g., single versus not single) and number of sexual partners in relation to muscularity- and disordered eating-related attitudes and behaviors among 1090 cisgender gay men enrolled in The PRIDE Study in 2018. Participants completed measures assessing muscle dysmorphia (MD) symptoms, disordered eating attitudes and behaviors, and appearance- and performance-enhancing drug or supplement (APEDS) use. In linear regression models adjusting for theoretically relevant covariates, neither relationship status nor number of past-month sexual partners was associated with disordered eating attitudes. In terms of MD symptoms, single (versus not single) relationship status was associated with greater appearance intolerance, and a greater number of sexual partners was associated with greater drive for size and functional impairment. In adjusted logistic regression models, a greater number of past-month sexual partners was associated with use of anabolic-androgenic steroids, synthetic performance-enhancing substances, protein supplements, and creatine supplements, as well as greater likelihood of engaging in compelled/driven exercise. Across all associations, effect sizes were generally small. Overall, results support that inquiring about sexual partners may have utility in evaluating risk for muscularity-oriented attitudes and behaviors among cisgender gay men. Future work will need to replicate these findings, particularly in more diverse samples.

Body Image and Sexual Behavior Among Adult Men Who "Hook Up"

Understanding the psychosocial variables associated with sexual behavior is critical, particularly among high-risk individuals such as those who hook-up. It is possible body image is one of these variables. The current study aimed to examine the relationship between body appreciation and body image self-consciousness and three sexual health-related behaviors: 1) condom usage, 2) HIV screening, and 3) STI screening among a sample of adult men who have hooked up at least once in the past month (n = 243). We found that higher levels of body appreciation were related to being less likely to use condoms and higher levels of body image self-consciousness were related to being less likely to be screened for HIV and STIs. The conflicting results suggest additional research is warranted.

Who is at risk? Gendered psychological correlates in Italian students’ sexual risk profiles

Recent research has shown that sexual risk behaviours are rising substantially among Italian youth, but this evidence is still undervalued in public discussion. Adopting a multidimensional perspective for sexual risk and addressing gender differences, the present study investigates if and how some individuals’ psychological characteristics—namely body satisfaction, self-esteem and body sensation-seeking—are associated with unsafe and risky sexual behaviours of Italian emerging adults. We exploited the survey SELFY—Sexual and Emotional LiFe of Youths—conducted in 2017 in Italy. Several key points may be highlighted from our study. First, we identify two clusters characterized by high sexual risk-taking behaviours, which include one third of our sample, a non-negligible proportion. Second, we prove that women are generally less inclined to adopt risk-taking behaviours in sexual life. Third, our findings show that body satisfaction, self-esteem and sensation seeking are differently linked to sexual risk taking among women and men. Body satisfaction is associated with a higher probability of adopting risky and promiscuous sexual behaviours among men, while the relationship is not significant among women. Sensation seeking shows a certain relevance in defining sexual risk profiles, especially for men. Overall, our research suggests that body image and self-worth could be relevant areas of intervention for sexual health programs targeting emerging Italian adults. Notably, communication and education strategies on these issues should be differentiated for women and men.

Body image and condomless anal sex among Young Latino sexual minority men

OBJECTIVE

To investigate body image and condomless anal sex (CAS) among young Latino sexual minority men (SMM)-a population with health disparities in HIV and body image concerns.

METHODS

Participants were 151 young Latino SMM from the San Diego area who were HIV-negative or unknown. Participants completed a questionnaire online in either English or Spanish, which included body image and sexual behavior items. A binary CAS variable was created based on the number of CAS partners reported (0 vs 1 + over past 3 months). A logistic regression was conducted with body dissatisfaction, appearance investment, and their interaction term entered as predictor variables and CAS as the outcome.

RESULTS

Of 151 participants, 54 (35.8%) reported no CAS in the past 3 months. Appearance investment, but not body dissatisfaction, was associated with higher odds of CAS. However, a significant interaction indicated that body dissatisfaction was associated with higher odds of CAS when appearance investment was high.

CONCLUSIONS

Young Latino SMM who are highly invested in, and dissatisfied with, their appearance may be at significantly increased risk for acquiring HIV through elevated odds of CAS. Reducing appearance concerns in this population may lead to reductions in HIV risk behaviors.