Romantic ideation, partner-seeking, and HIV risk among young gay and bisexual men

A Suicide Prevention Intervention for Emerging Adult Sexual and Gender Minority Groups: Protocol for a Pilot Hybrid Effectiveness Randomized Controlled Trial

BACKGROUND

Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (age 18-24 years). However, suicide prevention strategies tailored for emerging adult sexual and gender minority (EA-SGM) groups are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing the risk for suicide in the general population, but it is unclear how best to support EA-SGM groups in their use of a safety plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide [STARS]) builds on content from an existing life skills mobile app for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM groups, namely, positive affect, discrimination, and social disconnection. The mobile app is delivered to participants randomized to STARS alongside 6 peer mentoring sessions to support the use of the safety plan and other life skills from the app to ultimately reduce suicide risk.

OBJECTIVE

We will pilot-test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intention to use SPI and overcome obstacles to its use. EA-SGM groups will be randomized to receive either SPI alone or STARS and will be assessed for 6 months.

METHODS

Guided by the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, we will recruit and enroll a racially and ethnically diverse sample of 60 EA-SGM individuals reporting past-month suicidal ideation. Using a type-1 effectiveness-implementation hybrid design, participants will be randomized to receive SPI (control arm) or to receive SPI alongside STARS (intervention arm). We will follow the participants for 6 months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants' willingness and adoption of SPI and STARS and staff's experiences with delivering the program.

RESULTS

Study activities began in September 2021 and are ongoing. The study was approved by the institutional review board of the University of Pennsylvania (protocol number 849500). Study recruitment began on October 14, 2022.

CONCLUSIONS

This project will be among the first tailored, mobile-based interventions for EA-SGM groups at risk for suicide. This project is responsive to the documented gaps for this population: approaches that address chosen family, focus on a life-course perspective, web approaches, and focus on health equity and provision of additional services relevant to sexual and gender minority youth.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05018143; https://classic.clinicaltrials.gov/ct2/show/NCT05018143.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48177.

Expectations and beliefs: How single young gay, bisexual and other men who have sex with men envision romantic relationships

We developed measures of relational beliefs and expectations among single young gay and bisexual men (YGBM). Data come from an online cross-sectional study YGBM, which ran from July 2012 until January 2013. There were 50 items on relational beliefs and 25 items on relational expectations. We used random split samples and a priori analysis to group items together and applied principal axis factoring with varimax orthogonal rotation. We had a total N = 1582 in our analytical sample and identified six constructs of relational expectations (restrictions, negative break up, masculine and gender norms, optimism, cheating, immediacy) and two constructs of relational beliefs (sex beliefs, equality). Our findings highlight specific relational cognitions among YGBM and offer insight into the beliefs and expectations that may inform their relationships. Findings may be useful for health professionals to help YGBM reflect and understand the health implications of their beliefs and expectations about same-sex relationships to promote healthy decision-making as they seek future partners.

A Prospective Study of Predictors and Consequences of Hooking Up for Sexual Minority Women

Hooking up, which refers to a sexual encounter (ranging from kissing to penetrative sex) between individuals who are not in a committed relationship, is an increasingly normative form of sexual exploration among emerging adults. Past research has focused on hookups within a heteronormative context, and some of this work has examined hookups as a way to cope with distress. Building on this work, we examined the role of hookups as a means for lesbian and bisexual women to cope with minority stress through increasing connection and engagement with the LGBTQ (lesbian/gay/bisexual/transgender/queer or questioning) community. A nationally recruited sample of 520 lesbian and bisexual women ages 18 to 25 years completed questionnaires regarding their hookup behaviors as part of a longitudinal study. Childhood sexual abuse, posttraumatic stress symptoms, alcohol use, minority stress, and involvement and connectedness with the LGBTQ community were also assessed. First, regression analyses were used to examine baseline predictors of hookup behaviors reported at a 12-month follow-up. Findings revealed that alcohol use was associated with a greater likelihood of any subsequent hookups, and individuals reporting more minority stress subsequently hooked up with more partners. Second, hookup behaviors at 12 months were examined as predictors of outcomes at a 24-month follow-up, after controlling for baseline variables. Findings revealed that hookup behaviors were associated with reduced minority stress as well as increased involvement with and connectedness to the LGBTQ community, suggesting hookups may serve a protective function. Overall, findings support the notion that, for sexual minority women, hookups may operate as a means of coping and connection.

Developmental Barriers to Couples' HIV Testing and Counseling Among Adolescent Sexual Minority Males: A Dyadic Socio-ecological Perspective

Couples HIV Testing and Counseling (CHTC) is now a standard of care for partnered sexual minority men. While adolescent sexual minority men (ASMM; ages 15-19) face disproportionate HIV risk, the emergent nature of relationships and communication skills may present challenges to accessing and engaging in CHTC. This study utilized qualitative data from 28 ASMM recruited in 4 urban centers in the USA during the formative stage of Adolescent Trials Network study ATN-156. Participants were cis-male, HIV-negative, and in a relationship with a similarly-aged cis-male partner. Thematic analysis indicated low and high levels of commitment were barriers to CHTC. Concerns about caregiver attitudes towards HIV testing were salient. Adolescents' perception of structural barriers highlighted reliance on caregiver resources, which limited access to sexual health services. Prevention programming must address structural barriers to access encountered by adolescents. ASMM in relationships may benefit from programming that includes options for individual and dyadic participation.

Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial

BACKGROUND

Stigma and discrimination related to sexuality, race, ethnicity, and HIV status negatively impact HIV testing, engagement in care, and consistent viral suppression (VS) among young Black and Latinx men who have sex with men and transgender women who have sex with men (YBLMT). Few interventions address the effects of intersectional stigma among youth living with HIV and those at risk for HIV within the same virtual space.

OBJECTIVE

Building on the success of the HealthMpowerment (HMP) mobile health (mHealth) intervention (HMP 1.0) and with the input of a youth advisory board, HMP 2.0 is an app-based intervention that promotes user-generated content and social support to reduce intersectional stigma and improve HIV-related outcomes among YBLMT. The primary objective of this study is to test whether participants randomized to HMP 2.0 report improvement in HIV prevention and care continuum outcomes compared with an information-only control arm. We will also explore whether participant engagement, as measured by paradata (data collected as users interact with an mHealth intervention, eg, time spent using the intervention), mediates stigma- and HIV care-related outcomes. Finally, we will assess whether changes in intersectional stigma and improvements in HIV care continuum outcomes vary across different types of social networks formed within the intervention study arms.

METHODS

We will enroll 1050 YBLMT aged 15 to 29 years affected by HIV across the United States. Using an HIV-status stratified, randomized trial design, participants will be randomly assigned to 1 of the 3 app-based conditions (information-only app-based control arm, a researcher-created network arm of HMP 2.0, or a peer-referred network arm of HMP 2.0). Behavioral assessments will occur at baseline, 3, 6, 9, and 12 months. For participants living with HIV, self-collected biomarkers (viral load) are scheduled for baseline, 6, and 12 months. For HIV-negative participants, up to 3 HIV self-testing kits will be available during the study period.

RESULTS

Research activities began in September 2018 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #829805) with institutional reliance agreements with the University of North Carolina at Chapel Hill, Duke University, and SUNY Downstate Health Sciences University. Study recruitment began on July 20, 2020. A total of 205 participants have been enrolled as of November 20, 2020.

CONCLUSIONS

Among a large sample of US-based YBLMT, this study will assess whether HMP 2.0, an app-based intervention designed to ameliorate stigma and its negative sequelae, can increase routine HIV testing among HIV-negative participants and consistent VS among participants living with HIV. If efficacious and brought to scale, this intervention has the potential to significantly impact the disproportionate burden of HIV among YBLMT in the United States.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03678181; https://clinicaltrials.gov/ct2/show/study/NCT03678181.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/24043.

Exploring Diversity in HIV Research in the Sexual Partnerships of Australian Gay and Bisexual Men

Gay and bisexual men engage in a variety of sexual partnerships, but the most common distinction made in HIV research and behavioral surveillance is a binary between "regular" and "casual" partners. The "regular partner" category is often perceived as pertaining to ongoing coupled "boyfriend" relationships, with the literature to date rarely troubling what actually constitutes a "regular partner." Some emerging literature has identified "fuckbuddy" partnerships as a type of regular partnership requiring attention, but it is relatively new and not well understood. Currently, assumptions of the regular partner category do not capture how men perceive and conduct commitment in different sexual partnerships that could also be considered "regular," and the implications this has for HIV prevention. Drawing on in-depth interviews with a sample of 61 Australian gay-identified men, we explore a diversity of partnership types that represent unique ways of enacting commitment. We identify three sexual partnerships: "fuckbuddies," dating, and serial monogamy, each with specific issues for HIV risk and prevention. These partnerships suggest important differences in the way men conceive of and practice intimacy and sex.

Racialized Sexual Discrimination (RSD) in the Age of Online Sexual Networking: Are Young Black Gay/Bisexual Men (YBGBM) at Elevated Risk for Adverse Psychological Health?

Young Black gay/bisexual men (YBGBM) are a highly marginalized population across multiple health outcomes. Most research on YBGBM health has focused on HIV/sexual health, but there is a demonstrable need for research examining racism and psychosocial functioning among this population. Racialized Sexual Discrimination (RSD), also known as sexual racism, is an important but under-investigated phenomenon that may have implications for the psychological health and well-being of YBGBM. This paper provides an overview of empirical research on RSD as experienced by gay/bisexual men of color in online partner-seeking venues. First, the researchers discuss how racialized experiences are a documented online phenomenon, with a variety of manifestations, and identify the potential effects that this phenomenon may have on the psychosocial health of YBGBM, and gay/bisexual men of color as a whole. Second, the researchers synthesize the RSD literature with a broader literature examining psychological well-being across race and sexual orientation. Third, the researchers present a theoretically grounded conceptual model detailing the pathways between RSD and psychological well-being using a stress and coping framework. The paper concludes with recommendations for future research on this topic, including scale development and hypothesis testing.

Mobile Dating, Relational Communication, and Motivations for AIDS Risk Reduction among Chinese MSM College Students

While the wide popularity of mobile dating has greatly emancipated men who have sex with men (MSM) from heterosexual orthodoxy, concerns have arisen as to whether an increase in dating opportunities will bring about more HIV infections to this group. Based on in-depth interviews, a relational communication study on mobile dating among Chinese MSM college students revealed that various practices, including partner filtering and trust building, were somewhat motivated to alleviate HIV risk. However, these practices also incurred controversies in this group because of their paradoxical implications for safer sex. By interpreting attitudes toward these practices as relational motivations for AIDS risk reduction in a cross-sectional study, the negative predictive effects of the two motivations, specifically deferring to intragroup hierarchies for partner filtering and HIV risk judgment and relying on trust building for HIV risk coping, on the self-efficacy for safer sex were confirmed. These effects were moderated by the levels of identification with family values. Therefore, health promotion targeting this group should warn of the intrinsic dilemmas of these practices and should respond to "negative nurtures" in cultural values.

Acceptability and Preliminary Efficacy of an Online HIV Prevention Intervention for Single Young Men Who Have Sex with Men Seeking Partners Online: The myDEx Project

Prevention of new cases of HIV among young gay, bisexual and other men who have sex with men (YGBMSM; ages 18-24) remains a priority. We developed and pilot tested an online intervention (myDEx) using a pilot randomized trial design with 180 online-recruited single YGBMSM who reported recent unprotected anal intercourse, self-reporting as HIV negative or status-unaware, and who met sexual partners through online dating applications. myDEx participants reported higher overall satisfaction (d = 0.46) and willingness to recommend the intervention to friends (d = 0.48) than controls. myDEx participants were less likely to report foregoing condoms to achieve an emotional connection with a partner (d =0 .43), and more likely to report greater emotional regulation during their partner-seeking behaviors (d = 0.44). myDEx participants reported fewer partners with whom they had condomless receptive anal sex (d = 0.48). Our pilot results demonstrate the potential of the myDEx intervention, suggesting that a larger efficacy trial may be warranted in the future.

"Stay strong! keep ya head up! move on! it gets better!!!!": resilience processes in the healthMpowerment online intervention of young black gay, bisexual and other men who have sex with men

Overlapping stigmas related to sexual minority-, race/ethnicity-, and HIV-status pose barriers to HIV prevention and care and the creation of supportive social networks for young, Black, gay, bisexual, and other men who have sex with men (GBMSM). A risk-based approach to addressing the HIV epidemic focuses on what is lacking and reinforces negative stereotypes about already-marginalized populations. In contrast, a strengths-based approach builds on Black GBMSM’s existing strengths, recognizing the remarkable ways in which they are overcoming barriers to HIV prevention and care. HealthMpowerment (HMP) is an online, mobile phone optimized intervention that aimed to reduce condomless anal intercourse and foster community among young Black GBMSM (age 18–30). Applying a resilience framework, we analyzed 322 conversations contributed by 48 HMP participants (22/48 living with HIV) on the intervention website. These conversations provided a unique opportunity to observe and analyze dynamic, interpersonal resilience processes shared in response to stigma, discrimination, and life challenges experienced by young Black GBMSM. We utilized an existing framework with four resilience processes and identified new subthemes that were displayed in these online interactions: (1) Exchanging social support occurred through sharing emotional and informational support. (2) Engaging in health-promoting cognitive processes appeared as reframing, self-acceptance, endorsing a positive outlook, and agency and taking responsibility for outcomes. (3) Enacting healthy behavioral practices clustered into modeling sex-positive norms, reducing the risk of acquiring or transmitting HIV, and living well with HIV. (4) Finally, empowering other gay and bisexual youth occurred through role modeling, promoting self-advocacy, and providing encouragement. Future online interventions could advance strengths-based approaches within HIV prevention and care by intentionally building on Black GBMSM’s existing resilience processes. The accessibility and anonymity of online spaces may provide a particularly powerful intervention modality for amplifying resilience among young Black GBMSM.

Gay and Bisexual Men's Perceptions of HIV Risk in Various Relationships

Men who have sex with men (MSM) bear a disproportionate burden of HIV incidence in the United States. Previous study of sexual decision-making and HIV risk among MSM has not accounted for relationship dynamics. Further research must examine this connection between relationship dynamics and sexual decision-making, especially regarding condomless anal intercourse. This study analyzes data gathered from gay and bisexual men regarding their sexual partners and sexual decision-making over a 10-week period through personal relationship diaries (PRDs) and a follow-up in-depth interview (IDI). Through coding and extraction of relationship dynamics, key patterns of participants' sexual decision-making processes were examined based on relationship type, which was categorized by commitment, formality, and sexual agreement. Participants' sexual relationships can be divided into five categories: (a) Uncommitted, one time, (b) Uncommitted, ongoing, (c) Transitioning or unknown commitment, (d) Committed, nonmonogamous, and (e) Committed, monogamous. These five categories correspond to patterns in sexual decision making and consequent sexual risk-taking behaviors. Each of these influence HIV risk within male-male sexual encounters in a particular manner, and understanding these is important for appropriately tailored HIV prevention interventions for MSM. Recommendations are included for interventions seeking to address HIV risk across a wide variety of MSM sexual relationships.

Who counts as family? Family typologies, family support, and family undermining among young adult gay and bisexual men

Gay and bisexual men may form chosen families in addition to or in place of families of origin. However, the characteristics of these diverse families remain largely unexamined in the quantitative literature. The purpose of this study was to develop a family typology based on responses from a racially and ethnically diverse sample of young adult gay and bisexual men (YGBM) recruited from the Detroit Metropolitan Area (N=350; 18-29 years old). To explore the role of family, we then examined family social support and social undermining in relation to YGBM psychological distress within different family types. A series of multivariate regressions were used to examine associations between family social support and social undermining with depression and anxiety outcomes. The majority (88%) of YGBM included family of origin in their definitions of family and 63% indicated having chosen families. Associations between family social processes and psychological outcomes varied by type of family, suggesting that family composition shapes how perceptions of support and undermining relate to experiencing symptoms of depression and anxiety. Chosen families play a prominent role in the lives of YGBM and should not be overlooked in family research. Findings also highlight the importance of examining co-occurring family social support and social stress processes to further address psychological distress symptoms among YGBM.

Dyadic Qualitative Analysis of Condom Use Scripts Among Emerging Adult Gay Male Couples

Sexual risk reduction among gay male couples has received increasing attention in light of evidence that primary partners account for many-and possibly most-new HIV infections. This study examined the content of condom use scripts in interviews conducted with both members of 17 HIV-negative gay male couples. In each couple, at least one partner was an emerging adult (aged 18 to 29). Three scripts were identified: romantic love, unanticipated condomless anal intercourse (CAI), and negotiated safety. Scripts varied in their emphasis on emotional factors versus HIV risk reduction, the salience of sexual agreements, and the presence of an explicit communication goal. Results indicated that condom use may vary for couples as a result of script content and from the fluid adoption of scripts across contexts. Results highlighted potential tensions between emotional closeness and HIV prevention. Condom use cessation and sexual agreements-a potential mechanism for HIV risk reduction-may also serve as expressions of intimacy. This implies interventions that facilitate direct communication about sexual and relational goals-as well as those that expand couples' repertoires for expressing emotional closeness-may enhance sexual health for gay couples, particularly during the period of emerging adulthood.

Young Black Gay/Bisexual and Other Men Who Have Sex With Men: A Review and Content Analysis of Health-Focused Research Between 1988 and 2013

Black young gay, bisexual, and other men who have sex with men (YGBMSM) are at high risk for negative health outcomes, though this population is underrepresented in the health literature. An extensive literature review and content analysis of health-related peer-reviewed articles (1988-2013) was conducted that targeted Black YGBMSM, examining five content areas: sexual health, health care, substance use, psychosocial functioning, and sociostructural factors. A coding sheet was created to collect information on all content areas and related subtopics and computed descriptive statistics. Out of 54 articles, most were published after 2004 ( N = 49; 90.7%) and addressed some aspect of sexual health ( N = 50; 92.6%). Few articles included content on psychosocial functioning, including bullying/harassment, suicide, and racial/ethnic identity. Data on health care delivery/receipt and health insurance were underrepresented; tobacco use and substance abuse were seldom addressed. Important sociostructural factors, including sexual networks and race-based discrimination, were poorly represented. Last, there was a noteworthy deficit of qualitative studies and research exploring intersectional identity and health. This review concludes that studies on Black YGBMSM health places sex at the forefront to the neglect of other critical health domains. More research is needed on the diverse health issues of a vulnerable and underexamined population.

Development of a Tailored HIV Prevention Intervention for Single Young Men Who Have Sex With Men Who Meet Partners Online: Protocol for the myDEx Project

Background

New cases of human immunodeficiency virus (HIV) among young men who have sex with men (YMSM), aged 18 to 24, underscore the importance of developmentally-informed HIV programs for YMSM. We developed an online intervention focused on risk reduction strategies across different sexual partner types. Intervention activities focus on assisting YMSM reflect on their partner-seeking behaviors, develop sexual decision-making rules to reduce their HIV risks, and consider the adoption of HIV prevention behaviors.

Objective

This pilot, randomized controlled trial (RCT) aims to examine the feasibility, acceptability, and preliminary efficacy of a tailored, Web-based HIV prevention intervention for single YMSM.

Methods

We designed a prospective RCT of online-recruited cis-gender men (N=180) who reported recent unprotected anal intercourse, self-report as HIV negative or are unaware of their HIV status, and meet sexual partners through online dating apps. Individuals in the control arm receive an attention-control condition that includes HIV/sexually transmitted infection (STI) information currently available on sex education websites. Individuals in the intervention arm receive a 6-session Web-based program tailored on their demographic information, partner-seeking behaviors and relationship desires, and prior sexual attitudes and behaviors. This tailored content will match HIV prevention messages and safer sex skills with YMSM’s outcome expectancies when meeting new partners and thereby help them consider how to integrate safer sex practices into different partner types. Study assessments are taken at baseline, 30-, 60-, and 90-day follow-ups. Intervention acceptability and preliminary efficacy will be explored in sexual risk behaviors and HIV/STI testing.

Results

The RCT launched in November 2016 and is ongoing. To date, 180 eligible individuals have been enrolled, consented, and randomized. Of the 120 individuals in the intervention arm, 51.7% (62/120) identify as non-Hispanic white and half of the control arm identifies as non-Hispanic white. There were no differences observed by arm for race and/or ethnicity, age, or sexual orientation.

Conclusions

Although there are in-person evidence-based interventions with proven efficacy for YMSM, few HIV/STI prevention interventions delivered online exist. Online interventions may ease access to comprehensive HIV/STI education among YMSM and allow personalized content to be delivered. The online intervention that we developed, myDEx, aims to alleviate the gaps within HIV prevention for YMSM by utilizing tailored, Web-based content with the goal of developing skills for same-sex dating and relationship building, while reducing their risks for HIV/STI.

Trial Registration

ClinicalTrials.gov NCT02842060; https://clinicaltrials.gov/ct2/show/NCT02842060 (Archived by WebCite at http://www.webcitation.org/6rcJdxF9v)

Young African American Male-Male Relationships: Experiences, Expectations, and Condom Use

HIV disproportionately impacts young African American men who have sex with men (MSM). In this study, we sought to understand how previous relationship experiences and expectations for romantic relationships influence condom use among young African American MSM. Twenty African American MSM age 16 to 24 years completed a semi-structured interview and questionnaire on sexual experiences, romantic relationships, and sexual behavior. We identified three major themes characterizing romantic male-male relationships: (1) partner selection, (2) relationship ideals and expectations, and (3) relationship rules for condom use. Our findings indicate that young African American MSM rely on previous relationship experiences and desires for romantic relationships to determine condom use in subsequent relationships. Participants revealed that their previous relationship experiences and desires are often in conflict with their descriptions of their ideal romantic relationships, and subsequently influences their condom use. Our findings fill a gap in the literature describing male-male romantic relationships and condom use among young African American MSM.

Going social: Success in online recruitment of men who have sex with men for prevention HIV vaccine research

OBJECTIVE

To compare the use of four different social media sites to recruit men who have sex with men (MSM) and transgender women to a phase 2b HIV prevention vaccine trial, HVTN 505.

DESIGN

Retrospective, observational study.

METHODS

The University of Pennsylvania HIV Vaccine Trials Unit (Penn HVTU) employed street outreach and online recruitment methods to recruit participants for HVTN 505 using a combination of national recruitment images/messages with Philadelphia-specific language and imagery. We compared the efficiency (number of enrolled participants per number of completed phone screens) and effectiveness (number of enrolled participants per time interval employed) of each strategy, as well as the demographics and risk behaviors of the populations.

RESULTS

Online recruitment strategies populated 37% (71/191) of trial participants at our site. Among the four social media strategies employed, 45.1% (32/71) were enrolled through Facebook, 16.9% (12/71) through Craigslist, 15.5% (11/71) through a web-based marketing company (WBMC), and 22.5% (16/71) via GRINDR. The number of participants enrolled per month of strategy and the months the strategy was employed were Facebook - 32(33months), Craigslist - 12(33months), WBMC - 11(6months), and GRINDR - 16(0.56months). In-person and online recruitment strategies yielded participants of similar demographics and levels of risk behavior.

CONCLUSION

Use of several social media recruitment modalities produced large numbers of MSM engaging in high risk behavior and willing to participate in an HIV prevention vaccine trial. In comparison to other social media and online strategies, recruitment via GRINDR was the most effective.

'He's still with these girls': exploring perceptions of HIV risk among men with behaviourally bisexual male partners

Recent studies have called for more nuanced research into the relationships between behaviourally bisexual men and their sexual partners. To address this, we conducted a longitudinal qualitative study with self-identifying gay men; participants took part in timeline-based interviews and relationship diaries. We conducted a thematic analysis of verbatim transcripts to understand how relationship motivations, emotions and relationship dynamics influenced perceptions of HIV risk with behaviourally bisexual male partners. Participants described how partnership types (main and casual) and relationship dimensions (exclusivity, commitment, emotional attachment and relationship designation) strongly influenced perceptions of HIV risk and shaped their decisions to choose behaviourally bisexual male sex partners. Results reveal the crucial role relationship dynamics play in the shaping of HIV risk perceptions, sexual decision-making and HIV risk between partners, and provide potential insight on how to message HIV risk to gay men and their behaviourally bisexual male partners. It is imperative that HIV prevention is able to message key concepts of risk, decision-making and partner negotiation in a way that does not act to stereotype or create stigma against behaviourally bisexual men and their male partners.

Relationship cognitions and longitudinal trajectories of sexual risk behavior among young gay and bisexual men: The P18 cohort study

This study examines how romantic relationship cognitions are associated with changes of condomless anal sex among emerging adult gay and bisexual men. The sample was drawn from four waves of a prospective cohort study ( N = 598; M_age = 18.2). Results suggest that condomless anal sex increased over the emerging adulthood period. Romantic relationship fear was associated with increased receptive condomless anal sex. Perceptions of greater romantic relationship control increased the likelihood of having insertive and receptive condomless anal sex. Findings suggest that romantic relationship cognitions are important to consider when understanding longitudinal changes in condomless anal sex in this population.

Factors Associated With Emotional Satisfaction During First Anal Intercourse in a Sample of YMSM

We sought to determine, in a sample of 2,813 HIV seronegative young men who had sex with other men age 18-24, whether physical satisfaction would explain emotional satisfaction during first anal intercourse and whether emotional satisfaction would impact having sex with a partner a second time. Emotional satisfaction was explained mostly by physical satisfaction during the event, but partner type also had direct impact on emotional satisfaction. Our findings suggest that first anal intercourse experiences in young men are both emotionally and physically satisfying and may impact subsequent sexual behavior and partner decision-making.

Individual-level protective factors for sexual health outcomes among sexual minority youth: a systematic review of the literature

Although factors associated with negative sexual health outcomes among sexual minority youth (SMY) have been well documented, protective factors have been less studied. This review summarises the current state of science on individual-level protective factors for SMY and identifies gaps to inform future research. A systematic search of non-intervention, empirical peer-reviewed research was conducted. Articles that examined an a priori-identified individual-level protective factor and at least one sexual health outcome in a sample or subsample of SMY aged 10-24 years in Western, industrialised countries were eligible for inclusion. A total of 21 articles that reported data from 13 unique studies met inclusion criteria. Only two studies described findings for young sexual minority women and thus the literature synthesis was limited to studies reporting on young men who have sex with men (YMSM) in the USA. A total of 11 individual-level protective factors were examined. Subjective peer norms and attitudes about condom use were repeatedly protective in cross-sectional analyses. Findings related to self-efficacy, self-esteem and clear and positive identity were more mixed. The findings of this review suggest that attitudes and subjective peer norms related to condom use are promising intervention targets for YMSM. There is a need, however, for longitudinal research to confirm these protective effects and to consider them among other SMY. Moreover, protective factors related to skills and competencies have been insufficiently studied among SMY. Addressing these gaps will help develop a robust body of evidence to inform interventions.

Sexual Partner Typologies Among Single Young Men Who Have Sex with Men

Using data from a sample of single young men who have sex with men (N = 1,359, ages 18-24, 65 % White, 93 % gay), we examined whether the number of unprotected anal intercourse (UAI) partners with differed across relationship typologies (e.g., friends with benefits, hookups, romantic interests). We then examined how safer sex self-efficacy, decisional balance to forego condoms, ideal relationship attributes (i.e., intimacy, passion and commitment), and limerence were associated with UAI. Different partner types were associated with greater UAI partners; single partner types were associated with fewer UAI partners, irrespective of how they were categorized. UAI partners was associated with decisional balance (OR = 1.89, p < 0.001), passion ideation (OR = 1.38, p < 0.001), and difficulty negotiating safer sex with romantic partners (OR = 1.16, p < 0.001). Odds of UAI partners decreased with higher scores of commitment ideation (OR = 0.91, p < 0.05) and difficulty negotiating safer sex with casual partners (OR = 0.96, p < 0.05). We discuss the importance of acknowledging how different sexual partnerships, alongside its motivational correlates, influence UAI risk in order to inform HIV-prevention interventions.

Patterns of client behavior with their most recent male escort: an application of latent class analysis

Research examining interactions between male escorts and clients has relied heavily on data from escorts, men working on the street, and behavioral data aggregated over time. In the current study, 495 clients of male escorts answered questions about sexual behavior with their last hire. Latent class analysis identified four client sets based on these variables. The largest (n = 200, 40.4 %, labeled Typical Escort Encounter) included men endorsing behavior prior research found typical of paid encounters (e.g., oral sex and kissing). The second largest class (n = 157, 31.7 %, Typical Escort Encounter + Erotic Touching) included men reporting similar behaviors, but with greater variety along a spectrum of touching (e.g., mutual masturbation and body worship). Those classed BD/SM and Kink (n = 76, 15.4 %) reported activity along the kink spectrum (BD/SM and role play). Finally, men classed Erotic Massage Encounters (n = 58, 11.7 %) primarily engaged in erotic touch. Clients reporting condomless anal sex were in the minority (12.2 % overall). Escorts who engage in anal sex with clients might be appropriate to train in HIV prevention and other harm reduction practices-adopting the perspective of "sex workers as sex educators."

How statewide LGB policies go from ‘‘under our skin’’ to ‘‘into our hearts’’: fatherhood aspirations and psychological well-being among emerging adult sexual minority men

Researchers have noted increasingly the public health importance of addressing discriminatory policies towards lesbian, gay, and bisexual (LGB) populations. At present, however, we know little about the mechanisms through which policies affect LGB populations’ psychological well-being; in other words, how do policies get under our skin? Using data from a study of sexual minority young men (N = 1,487; M = 20.80 (SD = 1.93); 65% White; 92% gay), we examined whether statewide bans (e.g., same-sex marriage, adoption) moderated the relationship between fatherhood aspirations and psychological well-being. Fatherhood aspirations were associated with lower depressive symptoms and higher self-esteem scores among participants living in states without discriminatory policies. In states with marriage equality bans, fatherhood aspirations were associated with higher depressive symptoms and lower self-esteem scores, respectively. Fatherhood aspirations were associated negatively with self-esteem in states banning same-sex and second parent adoptions, respectively. Our findings underscore the importance of recognizing how anti-equality LGB policies may influence the psychosocial development of sexual minority men.

PrEP awareness and perceived barriers among single young men who have sex with men

Pre-exposure prophylaxis (PrEP) has the potential to help reduce new HIV infections among young men who have sex with men (YMSM). Using a cross-sectional survey of YMSM (N=1,507; ages 18-24), we gauged YMSM's PrEP awareness and PrEP-related beliefs regarding side effects, accessibility, and affordability. Overall, 27% of the sample had heard about PrEP; 1% reported ever using PrEP prior to sex. In a multivariate logistic regression, we found that YMSM were more likely to have heard about PrEP if they were older, more educated, were residentially unstable in the prior 30 days, had insurance, or reported having at least one sexually transmitted infection in their lifetime. We found no differences by race/ethnicity, history of incarceration, or recent sexual risk behavior. In multivariate linear regression models, Black and Latino YMSM were more likely than Whites to state they would not use PrEP because of side effect concerns. YMSM were more likely to indicate that they would not be able to afford PrEP if they did not have insurance or if they had a prior sexually transmitted infection, PrEP rollout may be hindered due to lack of awareness, as well as perceived barriers regarding its use. We propose strategies to maximize equity in PrEP awareness and access if it is to be scaled up among YMSM.

Os jovens homossexuais masculinos e sua saúde: uma revisão sistemática

Com o objetivo de analisar a literatura acadêmica de abordagem sociocultural acerca da relação entre os temas homossexualidade masculina, homem jovem e saúde, realizou-se uma revisão baseada na análise de conteúdo temática de 37 artigos selecionados, nas bases de dados Medline e Lilacs, entre 2004 e 2013. A escassez de literatura na perspectiva sociocultural apontou para obstáculos e desafios, relacionados à promoção de saúde, que vão desde a qualidade da informação, passando por valores simbólicos inconscientes, até a efetivação de propostas de gestores de saúde. Concluiu-se que a hegemonia heterossexual encontra-se presente nas estruturas inconscientes da construção da homossexualidade, contribuindo para a perpetuação do habitus heteronormativo. Estudos que valorizam o encontro do saber técnico com o conhecimento que cada um produz, referido a seus valores pessoais e culturais, podem servir de subsídio para o maior aprofundamento dessa discussão.

Sexting among young men who have sex with men: results from a national survey

PURPOSE

We know little about the prevalence of sexting behavior among young men who have sex with men (YMSM) or its association with their sexual behaviors.

METHODS

To address these gaps, we used data from an online study examining the partner-seeking behaviors of single YMSM (N = 1,502; ages 18-24 years) in the United States. Most participants (87.5%) reported sexting, with 75.7% of the sample reporting having sent and received a sext.

RESULTS

Sexting was more frequent among sexually active YMSM, with YMSM who had sent and received a sext being more likely to report insertive anal intercourse, with and without condoms, than those who had not sexted. We found no association between sexting and receptive anal intercourse.

CONCLUSIONS

Our findings suggest that sexting may vary by YMSM's sexual roles. We discuss our findings with attention to their implications for sexual health promotion.

Acceptability of smartphone application-based HIV prevention among young men who have sex with men

Young men who have sex with men (YMSM) are increasingly using mobile smartphone applications ("apps"), such as Grindr, to meet sex partners. A probability sample of 195 Grindr-using YMSM in Southern California were administered an anonymous online survey to assess patterns of and motivations for Grindr use in order to inform development and tailoring of smartphone-based HIV prevention for YMSM. The number one reason for using Grindr (29 %) was to meet "hook ups." Among those participants who used both Grindr and online dating sites, a statistically significantly greater percentage used online dating sites for "hook ups" (42 %) compared to Grindr (30 %). Seventy percent of YMSM expressed a willingness to participate in a smartphone app-based HIV prevention program. Development and testing of smartphone apps for HIV prevention delivery has the potential to engage YMSM in HIV prevention programming, which can be tailored based on use patterns and motivations for use.

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.

PrEP awareness and perceived barriers among single young men who have sex with men

Pre-exposure prophylaxis (PrEP) has the potential to help reduce new HIV infections among young men who have sex with men (YMSM). Using a cross-sectional survey of YMSM (N=1,507; ages 18-24), we gauged YMSM's PrEP awareness and PrEP-related beliefs regarding side effects, accessibility, and affordability. Overall, 27% of the sample had heard about PrEP; 1% reported ever using PrEP prior to sex. In a multivariate logistic regression, we found that YMSM were more likely to have heard about PrEP if they were older, more educated, were residentially unstable in the prior 30 days, had insurance, or reported having at least one sexually transmitted infection in their lifetime. We found no differences by race/ethnicity, history of incarceration, or recent sexual risk behavior. In multivariate linear regression models, Black and Latino YMSM were more likely than Whites to state they would not use PrEP because of side effect concerns. YMSM were more likely to indicate that they would not be able to afford PrEP if they did not have insurance or if they had a prior sexually transmitted infection, PrEP rollout may be hindered due to lack of awareness, as well as perceived barriers regarding its use. We propose strategies to maximize equity in PrEP awareness and access if it is to be scaled up among YMSM.

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

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

Spectrums of love: examining the relationship between romantic motivations and sexual risk among young gay and bisexual men

We examined the association between HIV/AIDS risk behaviors and romantic feelings among single, young gay and bisexual men (YGBM). Romantic feelings may have positive (romantic ideation) and negative (romantic obsession) connotations. Consequently, we hypothesized that YGBM would report greater risks if they reported having obsessive thoughts about their relationship desires; conversely, we hypothesized that YGBM who envision a romantic relationship would report fewer unprotected partners. Using cross-sectional data from a study examining YGBM's online dating experiences (N = 376; ages 18-24), we found a positive association between romantic obsession and number of partners for unprotected receptive (URAI) and insertive (UIAI) anal intercourse. Conversely, we found a negative association between romantic ideation and number of partners for URAI and UIAI. Is love risky or protective? Our results indicate support for both perspectives. We discuss the implications of our findings, highlighting the importance of addressing romantic pursuits into existing HIV prevention interventions for YGBM.

Measuring Love: Sexual Minority Male Youths' Ideal Romantic Characteristics

Research examining how sexual minorities characterize love within same-sex relationships is scarce. In this study, we examined the validity of Sternberg's Triangular Theory of Love in a sample of sexual minority male youth (N = 447). To test the adequacy of the theory for our population, we examined the psychometric properties of the Triadic Love Scale (TLS) and tested whether the three underlying constructs of the theory (Intimacy, Passion, and Commitment) emerged when participants were asked to consider their ideal relationship with another man. Using confirmatory factor analysis (CFA), we found support for the three-factor solution to characterize sexual minority male youths' ideal romantic relationship, after minimizing item cross-loadings and adapting the content of the Passion subscale. We discuss the implications of our findings regarding the measurement of the TLS among sexual minority male youth and propose ways to enhance its measurement in future research.