Viewing pornography depicting unprotected anal intercourse: are there implications for HIV prevention among men who have sex with men?

Associations Between Pornography Use Through Different Media and Sexual and Relationship Satisfaction Among Cohabiting Couples

Pornography can be used through multiple media and its associations with couples' relationship and sexual satisfaction are mixed. The aims of this study were to examine the proportion of use of different pornographic media (i.e., videos, pictures, audio material, and written material), including different contents (i.e., sexual activities and nudity), gender-based differences in the frequency of use of these media, and the associations between an individual's frequency of use of different pornographic media and their own and their partner's sexual and relationship satisfaction, considering potential gender differences. A sample of 706 adult couples (1368 participants; Mage = 32.19 years) completed online self-report questionnaires. Results of actor-partner interdependence models indicated that video use was associated with lower relationship and sexual satisfaction, and partners' lower sexual satisfaction. Picture use was associated with lower relationship satisfaction and partners' lower sexual satisfaction. Written material use was associated with lower sexual satisfaction. Cisgender women's audio use was associated with their own higher sexual satisfaction, whereas cisgender men's audio use was associated with their partner's lower sexual satisfaction. These findings suggest different associations with sexual and relationship satisfaction depending on the pornographic media.

Sexual Behaviors and Aggression in Gay Pornography

Previous studies have suggested a substantial number of men who have sex with men (MSM) have consumed and used pornography to learn about same-sex sexual behaviors. Yet, past research has focused almost exclusively on condom-use in the category of Gay pornography and ignored the types of sexual behaviors and aggression depicted within the content. This study examined aggression and sexual behaviors depicted in Gay online pornography (N = 415). We found fellatio and anal sex were the most common behaviors, occurring in roughly two-thirds of scenes, while kissing occurred in less than a third of scenes. Additionally, sexual aggression occurred in 31% of scenes, with spanking being the most common, occurring in 20% of scenes. Anal sex and forced fellatio were found to be predictors of physical aggression. These findings point to normalization of aggression and narrow sexual behaviors in Gay pornography, which may have implications for MSM's norm perceptions related to sexuality.

Sexually Explicit Internet Media Consumption and Sexual Risk Behaviors Among Chinese Male Sexual Minorities: The Moderating Role of Perceived Realism

Western research has suggested that viewing sexually explicit internet media (SEIM) may result in sexual risk behaviors (SRBs) among gay, bisexual, and other men who have sex with men. This study explored the relationship between SEIM consumption and SRBs and whether perceived realism could moderate this relationship among Chinese male sexual minorities. We assessed SEIM consumption from two aspects: consumption frequency and preference for specific content (condomless and group sex). This study recruited 360 participants from various online channels. Consistent with the sexual script acquisition, activation, application model (₃AM), we found that both SEIM consumption frequency and content preference were related to SRBs, and that perceived realism moderated the relationship between SEIM consumption and SRBs. Preference for group sex SEIM was significantly associated with an increased likelihood of casual sex when perceived realism was higher. SEIM use frequency was significantly associated with an increased likelihood of unprotected anal intercourse when perceived realism was higher. These findings may be used to promote HIV prevention, which necessitates joint effort from multiple stakeholders.

The Young Men and Media Study: A Pilot Randomized Controlled Trial of a Community-Informed, Online HIV Prevention Intervention for 14-17-Year-Old Sexual Minority Males

The Young Men and Media study developed and pilot tested a community-informed, online HIV prevention program for adolescent sexual minority males (ASMM) in the United States. The developed intervention uses nine interactive modules to increase sexual health knowledge, promote critical examination of pornography, and decrease sexual risk among ASMM. Participants (N = 154, age 14-17 years) were recruited online in Spring 2020 and randomized to the intervention (n = 77) or other existing HIV websites (n = 77). Of the 65 intervention participants who logged in to the website, most completed all nine modules and found the content useful (average module score 4.3 out of 5 stars). The intervention also showed improved HIV/STI knowledge, increased pornography knowledge, and reduced beliefs that pornography is an accurate depiction of male-male sex. Results indicate that the Young Men and Media intervention is feasible, acceptable, and may positively impact sexual health outcomes.

Factors associated with unprotected sex in people who consume sexually explicit media

OBJECTIVE

To analyze the factors associated with sex without the use of condoms in consumers of sexually explicit media (SEM).

METHODS

Cross-sectional study, with a sample of 172 participants selected and collected through social media. To assess the predictors of unprotected sexual practices, the Poisson regression model was used. Values were expressed as a robust prevalence ratio (PR) with their respective confidence intervals.

RESULTS

There was a statistically significant association between, the use of condoms and the type of scenes that the participants prefer (p = 0.03), the preference for films with scenes involving unprotected sex or even those that do not care about protection (p = 0.02), the type of pornography watched influencing sexual relations (p = 0.017), and the number of scenes seen per week (p = 0.05).

CONCLUSIONS

The lack of condom use was associated with the access to erotic scenes.

Sexually Explicit Online Media Use and Sexual Behavior among Sexual Minority Men in Portugal

Introduction: This study aimed to describe sexually explicit online media (SEOM) use among men who have sex with men (MSM) in Portugal and to examine any associations between exposure to SEOM depicting unprotected anal intercourse and engaging in unprotected anal sex. Methods: This study recruited 1577 MSM living in Portugal with Internet access, who ranged in age from 18 to 74 years old (M_age = 35.69, SD_age = 11.16). Participants were recruited via websites, e-mail and social media. 67.3% (n = 1061) of sample participants self-identified as gay, and 32.7% (n = 516) claimed to be bisexual. The survey included four categories of questions/measurements, encompassing demographic information, SEOM use, explicit imagery of protected/unprotected anal sex and sexual behavior. Results: The study results suggest that Portuguese MSM frequently use SEOM and that they possess a stated preference for SEOM displaying unprotected anal sex. Furthermore, this study’s findings indicate that self-identified gay men more frequently engage in unprotected sex than self-identified bisexual men. Finally, the study revealed that a preference for viewing SEOM displaying unprotected sex and higher levels of arousal attributed to direct SEOM exposure are significant predictors of having receptive anal sex without condoms.

Effects of Pornography Use and Demographic Parameters on Sexual Response during Masturbation and Partnered Sex in Women

The effect of pornography on sexual response is understudied, particularly among women. A multinational, community-based sample of 2433 women at least 18 years of age completed a 42-item, opt-in questionnaire collecting information on demographic and sexual history characteristics, use of pornography during masturbation, frequency of pornography use, and sexual response parameters. Pornography use and average frequency were compared across demographic variables. We also examined how pornography frequency predicted differences in self-reported arousal difficulty; orgasmic difficulty, latency, and pleasure; and the percent of sexual activities ending in orgasm during both masturbation and partnered sex. On average, women using pornography were younger, and reported more interest in sex. Pornography frequency differed significantly by menopausal status, sexual orientation, anxiety/depression status, number of sexual partners, and origin of data collection. During masturbation, more frequent pornography use predicted lower arousal difficulty and orgasmic difficulty, greater pleasure, and a higher percentage of masturbatory events leading to orgasm. Frequency of pornography use predicted only lower arousal difficulty and longer orgasmic latencies during partnered sex, having no effect on the other outcome variables. Pornography use frequency did not predict overall relationship satisfaction or sexual relationship satisfaction. Overall, more frequent pornography use was generally associated with more favorable sexual response outcomes during masturbation, while not affecting most partnered sex parameters. Several demographic and relationship covariates appear to more consistently and strongly predict orgasmic problems during partnered sexual activity than pornography use.

Sexually Explicit Media Use Among 14-17-Year-Old Sexual Minority Males in the U.S

Adolescent sexual minority males (ASMM; < 18 years old) do not typically receive sexual education that addresses male-male relationships from traditional sources (i.e., school, parents). Therefore, many rely on sexually explicit online media (SEOM; i.e., pornography) to find sexual health information. The current study describes SEOM use by ASMM in the U.S. and examined the association between exposure to condomless anal sex (CAS) in SEOM and engagement in CAS. In 2017, ASMM (N = 206; M age = 16, range: 14-17; 51% racial/ethnic minorities) from across the U.S. completed an online sexual health survey, including questions about SEOM use and sexual behaviors. Most (86%) reported that they had viewed SEOM. Engagement with SEOM was frequent (86% reported viewing ≥ one time per week) and lengthy (70% reported viewing for ≥ 15 min per session). Youth perceived that SEOM influenced how they, and other ASMM, think and behave sexually. Further, exposure to risky sexual behavior in SEOM appeared to be associated with youths' dyadic sexual behavior. To support the healthy sexual development of ASMM, it is important to acknowledge the near-universal use of SEOM by ASMM, to identify ways to maximize its potential value, and to minimize potential harms.

Bareback Sexually Explicit Media Consumption and Men Who Have Sex with Men's Responses to Sexual Partners Who Prefer Anal Intercourse With or Without Condoms

This study investigated whether "bareback" (i.e., condomless) sexually explicit media (SEM) consumption is differentially associated with men who have sex with men's (MSM) concerns about, and willingness to have, condomless anal intercourse (CAI) versus anal intercourse with condoms. Participants were 659 Australian MSM who all reported their bareback SEM consumption and read a vignette in which they were propositioned for sex by a hypothetical male target. Participants were randomly assigned to one of four vignettes, in which the target exclusively preferred either CAI or anal intercourse with condoms, and either did or did not disclose that they took pre-exposure prophylaxis (PrEP). Perceived partner attractiveness was also measured as a potential moderator. Greater bareback SEM consumption was associated with reduced concerns about, and intentions to have, sex with a target who exclusively preferred CAI. Bareback SEM consumption, however, was not related to concerns about, or intentions to have, sex with a target who exclusively preferred anal intercourse with condoms. PrEP disclosure was not causally related to either concern about having, or intentions to have, sex with the target, nor did it moderate the relationship between bareback SEM consumption and these outcomes. Perceived partner attractiveness moderated the effect of bareback SEM consumption on general sexual intentions, such that bareback SEM was only associated with greater intentions to have sex when the partner was perceived to be highly attractive.

Measuring exposure to sexually explicit media among young men who have sex with men: a pilot study

Background Sexually explicit media (SEM) consumption may contribute to sexual risk-taking among young men who have sex with men (YMSM).

METHODS

The prevalence and frequency of SEM consumption as well as associations with contextual and sexual risk characteristics among 61 YMSM were estimated.

RESULTS

All participants (n=61, 100%) reported viewing SEM; 45 (74%) in the past week. There were no significant associations between viewing SEM in the past week and measured characteristics.

CONCLUSION

SEM use among YMSM is extremely common. Future research should clarify potential relations between SEM and sexual risk-taking with larger samples of YMSM and specific measures, including SEM content and amount.

[Use of online sexual material and safe sex in men who have sex with men]

INTRODUCTION

Sexual material online has represented, from its origins, an important role in the life of men who have sex with men. Internet, which has become a vehicle without restriction for its access, has favored an increase in the use of this material, and has had an impact on the sexual behavior of these men.

OBJECTIVE

To determine if the use of online sexual material influences safe sexual behavior in men who have sex with men.

MATERIAL AND METHOD

An analytical observational study was conducted, with a sample of 251 men who have sex with men from a city in northeastern Mexico. The respondent driven sampling was used, an ad hoc sociodemographic and sexuality data questionnaire was applied, and a questionnaire to measure the use of online sexual material and questionnaire on safe sexual behavior.

RESULTS

The simple linear regression model shows that the use of online sexual material negatively influences safe sexual behavior (R²=0.062; F_[1,249]=16.937; p<0.01).

CONCLUSIONS

The findings provide the guideline to continue with studies in the investigation of said sociocultural variable and its consideration is proposed in the programs focused on the prevention of HIV in this population.

Determinants of HIV Incidence Disparities Among Young and Older Men Who Have Sex with Men in the United States

This study sought to determine why young men who have sex with men (MSM) have higher HIV incidence rates than older MSM in the United States. We developed hypotheses that may explain this disparity. Data came from peer-reviewed studies published during 1996-2016. We compared young and older MSM with respect to behavioral, clinical, psychosocial, and structural factors that promote HIV vulnerability. Compared with older MSM, young MSM were more likely to have HIV-discordant condomless receptive intercourse. Young MSM also were more likely to have "any" sexually transmitted infection and gonorrhea. Among HIV-positive MSM, young MSM were less likely to be virally suppressed, use antiretroviral therapy, and be aware of their infection. Moreover, young MSM were more likely than older MSM to experience depression, polysubstance use, low income, decreased health care access, and early ages of sexual expression. These factors likely converge to exacerbate age-associated HIV incidence disparities among MSM.

Viewing Sexually Explicit Media and Its Association with Mental Health Among Gay and Bisexual Men Across the U.S

Gay and bisexual men (GBM) have reported viewing significantly more sexually explicit media (SEM) than heterosexual men. There is evidence that viewing greater amounts of SEM may result in more negative body attitude and negative affect. However, no studies have examined these variables within the same model. A national sample of 1071 HIV-negative GBM in the U.S. participating in a larger study completed an online survey, which included measures of SEM consumption, male body attitudes, anxiety, and depression. Participants reported viewing 3 h of SEM per week, on average, and 96% of participants reported recently viewing at least some SEM. Greater consumption of SEM was directly related to more negative body attitude and both depressive and anxious symptomology. There was also a significant indirect effect of SEM consumption on depressive and anxious symptomology through body attitude. These findings highlight the relevance of both SEM on body image and negative affect along with the role body image plays in anxiety and depression outcomes for GBM. They also indicate a potential role for body image in explaining the co-occurrence of SEM consumption and negative affect. For interventions looking to alleviate negative affect for GBM, it may be important to address SEM consumption and body image as they are shown to be associated with both anxious and depressive symptomology.

If You Film It Will They Watch? Factors Associated with Willingness to View Safer Sex Messaging in Internet-Based Sexually Explicit Media

Research on the association between viewing condomless sex in sexually explicit media (SEM) and engaging in risk behavior suggests the need for SEM-based safer sex messaging (e.g., PrEP, condom use), though few studies have considered viewer willingness to watch SEM containing HIV/STI prevention messages. Online survey data from a racially diverse sample of 859 men and women were used to investigate factors associated with willingness to watch SEM with safer sex messaging. Analyses were conducted separately for three groups: heterosexual men and other men who only report sex with women, heterosexual women and other women who only report sex with men, and gay, bisexual, and other men who have sex with men. All three groups expressed some willingness to view safer sex messages in SEM and a majority viewed the SEM industry as having some responsibility to provide this type of messaging. Factors associated with greater willingness varied across the three groups. These findings have implications for the design and implementation of safer sex messaging in SEM.

Sexually Explicit Media and Condomless Anal Sex Among Gay and Bisexual Men

Gay and bisexual men (GBM) have reported viewing significantly more sexually explicit media (SEM) than heterosexual men. There is some evidence that SEM depicting bareback anal sex may be linked to engagement in condomless anal sex (CAS) and thus HIV/STI transmission among GBM. A nationwide sample of HIV-negative GBM in the U.S. completed an online survey that included measures on SEM consumption (both overall frequency and percentage viewed depicting bareback sex) and reported on CAS in the past 3 months. Data showed that there was no main effect for the frequency of SEM watched in association on either the number of CAS acts with casual partners or the probability of engaging in CAS during a casual sex event. However, there was an interaction between amount of SEM consumed and percentage of bareback SEM consumed on both outcomes, such that men who reported both a high frequency of SEM consumption and a high percentage of their SEM being bareback reported the highest levels of risk behavior. These findings highlight the role that barebacking depicted in SEM may play in the normalization of sexual risk behaviors for GBM. Interventions looking to target the role SEM may play in the lives of GBM should examine what variables may help to mediate associations between viewing SEM and engaging in risk behavior.

Hypersexuality: A Critical Review and Introduction to the "Sexhavior Cycle"

An empirical review of hypersexuality is timely as "compulsive sexual behavior" is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one's sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the "sexhavior cycle of hypersexuality" to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one's sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as gambling), although some presentations of the condition appear to be symptomatic of a heterogeneous psychological problem that requires treatment.

Sexually Explicit Online Media, Body Satisfaction, and Partner Expectations Among Men who have Sex with Men: a Qualitative Study

Limited research has investigated the perceived influence of sexually explicit online media (SEOM) on body satisfaction and partner expectations of men who have sex with men (MSM). Semi-structured qualitative interviews were conducted with 16 MSM, covering the perceived influence of MSM-specific SEOM. All nine men who broached the topics of body satisfaction and partner expectations reported that MSM-specific SEOM set unreasonably high physical appearance expectations for themselves and/or their potential partners. Although MSM-specific SEOM might be negatively affecting body satisfaction and partner expectations among MSM, its ubiquity may make it a useful tool to support body positivity.

Sexually Explicit Media Use by Sexual Identity: A Comparative Analysis of Gay, Bisexual, and Heterosexual Men in the United States

Advances in production and distribution of sexually explicit media (SEM) online have resulted in widespread use among men. Limited research has compared contexts of use and behaviors viewed in Internet SEM by sexual identity. The current study examined differences in recent SEM use (past 6 months) by sexual identity among an ethnically diverse sample of 821 men who completed an online survey in 2015. Both gay and bisexual men reported significantly more frequent use of Internet SEM compared to heterosexual men. Although most participants reported viewing SEM at home (on a computer, tablet, or smartphone), significantly more gay men reported SEM use at a sex party or commercial sex venue than either heterosexual or bisexual men. Sexual identity predicted viewing of high-risk and protective behaviors in separate logistic regression models. Specifically, compared to heterosexual men, gay and bisexual men had increased odds of viewing condomless anal sex (gay OR 5.20, 95 % CI 3.35-8.09; bisexual OR 3.99, 95 % CI 2.24-7.10) and anal sex with a condom (gay OR 3.93, 95 % CI 2.64-5.83; bisexual OR 4.59, 95 % CI 2.78-7.57). Compared to gay men, heterosexual and bisexual men had increased odds of viewing condomless vaginal sex (heterosexual OR 27.08, 95 % CI 15.25-48.07; bisexual OR 5.59, 95 % CI 3.81-8.21) and vaginal sex with a condom (heterosexual OR 7.90, 95 % CI 5.19-12.03; bisexual OR 4.97, 95 % CI 3.32-7.44). There was also evidence of identity discrepant SEM viewing as 20.7 % of heterosexual-identified men reported viewing male same-sex behavior and 55.0 % of gay-identified men reported viewing heterosexual behavior. Findings suggest the importance of assessing SEM use across media types and contexts and have implications for research to address the potential influence of SEM on sexual behavior (e.g., investigate associations between viewing condomless vaginal sex and engaging in high-risk encounters with female partners).

Preferences for Condomless Sex in Sexually Explicit Media Among Black/African American Men Who Have Sex with Men: Implications for HIV Prevention

Accumulating evidence suggests that viewing sexually explicit media (SEM; i.e., pornography) may be related to the sexual behaviors of men who have sex with men (MSM). Furthermore, stereotypical depictions of Black/African American MSM engaging in sexual risk behaviors in SEM may serve to normalize condomless sex, reinforce low peer norms around condom use, and facilitate HIV risk taking among Black/African American MSM. Despite this evidence, very little is known about the correlates of SEM consumption among Black/African American MSM, including HIV risk behaviors and their relation to preferences for viewing condomless sex in SEM. Participants were 653 HIV-seronegative Black-identified MSM ages 18-62 (M 33.58, SD 11.01) who completed a cross-sectional survey as a part of a HIV prevention trial in Atlanta, Georgia. Over three-quarters of the men (n = 514) reported a preference for condomless sex in SEM. In multivariate models, engaging in serodiscordant condomless sex was not significantly associated with preferences for condomless sex in SEM; however, men who self-identified as bisexual, engaged in transactional sex, and reported greater agreement with sexual risk cognitions (i.e., heat-of-the-moment thoughts about condom use) had significantly greater odds of reporting a preference for condomless sex in SEM. Study findings highlight the need for future research exploring the role of SEM in the sexual health of Black/African American MSM, including the extent to which SEM exposure alters norms and expectations about sexual behaviors among Black/African American MSM and how this might be addressed in HIV prevention programs.

The condom imperative in anal sex - one size may not fit all: a qualitative descriptive study of men who have sex with men

AIMS AND OBJECTIVES

To explore men who have sex with men's views about condom use when having anal intercourse.

BACKGROUND

Internationally, health promotion campaigns use behavioural change strategies to support men who have sex with men to always use condoms when having anal sex with other men. The health promotion message given to this group is consistent and explicitly stated that 'use a condom every time for anal sex regardless of relationship status'.

DESIGN

Qualitative analysis of data from a cohort of New Zealand men who have sex with men.

METHODS

A total of 960 useable questionnaires were completed: 571 online and 389 in hard copy. Qualitative data were analysed using a thematic data analytic process.

RESULTS

Three themes relating to condom use in men who have sex with men were identified. These are as follows: 'Safer sex is good sex', 'Condom use is good but …' and 'I use condoms sometimes'.

CONCLUSIONS

The range of responses towards condom use for anal sex in men who have sex with men in our sample reveal this as a complex public health issue, with not all men who have sex with men willing to consistently use condoms.

RELEVANCE TO CLINICAL PRACTICE

It is important that nurses do not assume that all men who have sex with men are willing to use condoms for anal sex, and should create opportunities for men who have sex with men to raise any concerns about the use of condoms. In this way, nurses can assist in providing information that may help men who have sex with men to make decisions that will minimise risk of contracting infections associated with sexual activity.

The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China

INTRODUCTION

Previous studies have indicated that viewing sexually explicit media (SEM) might be associated with sexual risk behaviors in men who have sex with men (MSM). However, most prior research has not explored this association cross-culturally or the potential influence that important covariates might have on the association.

AIM

To explore the association between self-reports of viewing SEM depicting various sexual risk behaviors and engagement in sexual risk behaviors after controlling for relevant covariates in MSM in China.

METHODS

Three hundred fourteen Chinese MSM participated in a web-based survey.

MAIN OUTCOME MEASURES

SEM consumption, sexual risk behavior, and measurements of covariates.

RESULTS

SEM consumption was frequent in MSM in China. Viewing a larger proportion of SEM depicting sexual risk behaviors was associated with a larger number of regular partners with whom MSM reported engaging in sexual risk behaviors, but not with the number of casual partners, after controlling for covariates. HIV-related knowledge and seeking male sex partners were associated with the number of regular partners with whom MSM had engaged in sexual risk behaviors. Seeking sexual sensation, HIV-related knowledge, and seeking male sex partners were associated with the number of casual partners with whom MSM had engaged in sexual risk behaviors.

CONCLUSION

Future research exploring the relation between SEM use and sexual health risk behaviors should consider theoretically important psychological and behavioral covariates. Xu Y, Zheng Y, Rahman Q. The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China. J Sex Med 2017;14:357-365.

Sexual Debut and HIV-Related Sexual Risk-Taking by Birth Cohort Among Men Who Have Sex with Men in the United States

Age-discordant and earlier sexual debut are risk factors for HIV among men who have sex with men (MSM). Despite differences in the sociopolitical landscape over time, there are no studies sampling participants from the United States that have examined the role of birth cohort in relations between sexual debut characteristics and sexual risk among MSM. We assessed sexual debut patterns and associations with sexual risk-taking in 812 adult MSM stratified by ten-year birth cohorts (i.e., before 1970, 1970-1979, 1980-1989, after 1990). Sexual debut characteristics differed by birth cohort. In multivariate models controlling for birth cohort, both younger age of sexual debut and younger age of anal sex debut were associated with an increased likelihood of condomless sex. Men born in the 1990s had increased odds of engaging in sexual risk regardless of sexual debut characteristics. Sexual risk reduction interventions tailored to the unique needs of young MSM are encouraged.

Consumption of Pornography, Perceived Peer Norms, and Condomless Sex

Sexual scripts in pornography rarely include condoms. Many U.S. college students consume pornography and have unprotected sex. Yet no study appears to have investigated whether pornography consumption is correlated with having unprotected sex among U.S. college students. This article reports results from two studies of pornography consumption and condomless sex among U.S. college students. Pornography consumption was directly associated with a higher likelihood of condomless sex in study 1. This finding was replicated in study 2. Study 2 also explored whether perceptions of peers' use of condoms partially mediates the association between pornography consumption and condomless sex. Pornography consumption was associated with lower estimations of peers' condom use, and lower estimations of peers' condom use were associated with personally engaging in condomless sex.

A New Measure of the Perceived Influence of Sexually Explicit Online Media on the Sexual Behaviors of Men Who Have Sex With Men

Men who have sex with men (MSM) frequently consume sexually explicit online media (SEOM), yet little is known about its influence on their sexual behaviors. We describe a sequence of four studies to develop and psychometrically validate a measure of the perceived influence of sexually explicit online media (PI-SEOM) on the sexual behaviors of MSM. Study 1 involved qualitative interviews (N = 28) and a quantitative survey (N = 100) to develop a preliminary measure. Using an Internet sample of MSM (N = 1,170), we assessed its factor structure and reliability in Studies 2 and 3 as well as convergent validity and associations with HIV-related sexual risk in Study 4. Based on findings the measure was divided into two subscales: influences on (1) self and (2) other MSM. Factor analyses confirmed a two-factor model for each subscale, measuring perceived influences on (a) general sexual scripts and (b) condomless sex scripts. Survey results indicated that the more men perceived SEOM influencing their own condomless sex scripts, the more likely they were to report engaging in sexual risk behaviors. The developed measure holds promise for assessing the influence of SEOM on the sexual behaviors of MSM and may prove useful for HIV-prevention research.

Viewing of Internet-Based Sexually Explicit Media as a Risk Factor for Condomless Anal Sex among Men Who Have Sex with Men in Four U.S. Cities

The last decade has seen a dramatic increase in the availability of sexually explicit media (SEM) on the Internet. Men who have sex with men (MSM) report near universal use of SEM. However, this widespread use of SEM among MSM may contribute to more condomless anal sex. To examine the association of viewing SEM on the Internet and the number of condomless anal sex encounters among MSM, in 2012, an online survey was conducted of 265 MSM from New York, Philadelphia, Baltimore, or Washington D.C. who reported viewing SEM online in the past 3 months. Analyses were performed using negative binomial regression. Nearly all men reported viewing SEM featuring anal sex with (91%) or without (92%) condoms in the past 3 months. Neither viewing more hours of SEM per week or compulsively viewing SEM were associated with more condomless anal sex encounters. Rather, viewing a greater proportion of SEM containing condomless anal sex was associated with engaging in more condomless anal encounters (IRR = 1.25), while viewing a greater proportion of SEM containing anal sex where condoms were used was associated with fewer condomless anal sex encounters (IRR = 0.62). MSM reported that viewing SEM caused changes in their sexual fantasies, desires, and behaviors. These findings provide important insights for health policy and the design of interventions addressing SEM and condomless sex among MSM. The findings suggest that condom use by SEM performers may benefit not only actor health, but also have health implications for SEM viewers.

Relative Risk for HIV Infection Among Men Who Have Sex with Men Engaging in Different Roles in Anal Sex: A Systematic Review and Meta-analysis on Global Data

We systematically reviewed and meta-analyzed global data on the relative risk for HIV infection among men who have sex with men (MSM) engaging in different roles in anal sex. MSM engaging in receptive anal sex only (MRAI) and MSM engaging in both insertive and receptive anal sex (MIRAI) were 6.9 (95 % CI 5.5-8.6) and 4.3 (95 % CI 3.6-5.3) times more likely to have prevalent HIV compared to MSM engaging in insertive anal sex only (MIAI) in 1981-1985. These figures were 1.8 (95 % CI 1.6-2.0) and 2.2 (95 % CI 2.0-2.4) in 1986-2010. Overall, MRAI and MIRAI were 6.2 (95 % CI 3.3-11.8) and 6.6 (95 % CI 3.8-11.7) times more likely to develop incident HIV infection compared to MIAI. MRAI are at higher risk for HIV infection compared to MIAI. HIV prevalence among men engaging in all roles in anal sex is high enough that all MSM should be aware of potential risk.

Sexually explicit racialised media targeting men who have sex with men online: a content analysis of high-risk behaviour depicted in online advertisements

Sexually explicit media may perpetuate racial and sexual norms among men who have sex with men. While men may be exposed to sexually explicit media in the online settings where they seek sex with other men, no studies to our knowledge have explored the relationship between the racial and sexual content of advertisements appearing in these spaces. In 2011, using a detailed codebook, 217 sexually explicit advertisements on a male sex-seeking website were coded for themes, actor characteristics and sexual acts depicted. Multivariable logistic regression models examined the association between skin colour, theme, sexual acts and condomless sex acts. Nearly half (45%) featured a 'thug' theme (a style emphasising Black masculinity/hip-hop culture), 21% featured a college theme and 44% featured condomless sex. Advertisements featuring only Black men, advertisements featuring Black men with men of other skin tones and advertisements depicting a thug theme were positively associated with depictions of condomless sex. Online sexually explicit advertisements featuring Black themes and actors more frequently depicted condomless sex than advertisements with White men alone. Future research should examine whether depictions of Black men engaging in condomless sex in online advertisements influence the sexual norms and cognitions of Black men who have sex with men and their partners.

The role of sexually explicit material in the sexual development of same-sex-attracted Black adolescent males

Sexually explicit material (SEM) (including Internet, video, and print) may play a key role in the lives of Black same-sex sexually active youth by providing the only information to learn about sexual development. There is limited school- and/or family-based sex education to serve as models for sexual behaviors for Black youth. We describe the role SEM plays in the sexual development of a sample of Black same-sex attracted (SSA) young adolescent males ages 15-19. Adolescents recruited from clinics, social networking sites, and through snowball sampling were invited to participate in a 90-min, semi-structured qualitative interview. Most participants described using SEM prior to their first same-sex sexual experience. Participants described using SEM primarily for sexual development, including learning about sexual organs and function, the mechanics of same-gender sex, and to negotiate one's sexual identity. Secondary functions were to determine readiness for sex; to learn about sexual performance, including understanding sexual roles and responsibilities (e.g., "top" or "bottom"); to introduce sexual performance scripts; and to develop models for how sex should feel (e.g., pleasure and pain). Youth also described engaging in sexual behaviors (including condom non-use and/or swallowing ejaculate) that were modeled on SEM. Comprehensive sexuality education programs should be designed to address the unmet needs of young, Black SSA men, with explicit focus on sexual roles and behaviors that may be inaccurately portrayed and/or involve sexual risk-taking (such as unprotected anal intercourse and swallowing ejaculate) in SEM. This work also calls for development of Internet-based HIV/STI prevention strategies targeting young Black SSA men who may be accessing SEM.

Examining the relationship between use of sexually explicit media and sexual risk behavior in a sample of men who have sex with men in Norway

The purpose of this study was to investigate consumption patterns of gay-oriented sexually explicit media (SEM) among men who have sex with men (MSM) in Norway, with a particular emphasis on a possible relationship between gay SEM consumption and HIV risk behavior. Participants included 529 MSM living in Norway recruited online to complete a SEM consumption and sexual risk survey. Of the 507 participants who responded to the all items measuring exposure to SEM, 19% reported unprotected anal intercourse with a casual partner (UAI) in last 90 days, and 14% reported having had sero-discordant UAI. Among those with UAI experience, 23% reported receptive anal intercourse (R-UAI) and 37% reported insertive anal intercourse (I-UAI). SEM consumption was found to be significantly associated with sexual risk behaviors. Participants with increased consumption of bareback SEM reported higher odds of UAI and I-UAI after adjusting for other factors using multivariable statistics. MSM who started using SEM at a later age reported lower odds of UAI and I-UAI than MSM who started earlier. Future research should aim at understanding how MSM develop and maintain SEM preferences and the relationship between developmental and maintenance factors and HIV sexual risk behavior.

Typologies of sexually explicit media use among MSM: An application of latent class analysis

The viewing of sexually explicit media (SEM) is widespread, especially among men, and research linking SEM viewing and sexual behavior has shown a variety of results, some positive (e.g., sexuality education) and some negative (e.g., poorer body image). These results might be due to limitations in measuring SEM consumption, particularly around typology. The goal of the current study was to examine potential patterns of SEM viewing activities. Using data from an online survey of men who have sex with men (MSM), we conducted latent class analyses of 15 SEM activities. Results suggested a three-class solution. The most prevalent class included over 60% of men and was characterized by viewing primarily safer-sex or conventional behaviors. The second class included 32% of men and had a similar albeit amplified pattern of viewing. The final class included just 7% of men and was marked by high levels of viewing of all activities, including fetish and kink. Compared to the conventional or safer-sex class, the other classes had lower internalized homonegativity, lower condom use self-efficacy, and higher SEM consumption or dose. Implications for HIV prevention, sexuality research and the SEM industry are discussed.

Association between pornography use and sexual risk behaviors in adult consumers: a systematic review

The purpose of this review was to determine whether an association exists between sexual risk behaviors and pornography consumption. Consumption of pornography is common, yet research examining its link with sexual risk behaviors is in its infancy. Indicators of sexual risk behavior, including unsafe sex practices and a higher number of sexual partners, have been linked to poor health outcomes. A systematic literature search was performed using Medline, PsycINFO, Web of Knowledge, Pubmed, and CINAHL. Studies were included if they assessed the association between pornography use and indicators of sexual risk behaviors in an adult population. A total of 17 were included in the review, and all were assessed for research standards using the Quality Index Scale. For both Internet pornography and general pornography, links with greater unsafe sex practices and number of sexual partners were identified. Limitations of the literature, including low external validity and poor study design, restrict the generalizability of the findings. Accordingly, replication and more rigorous methods are recommended for future research.

Normal, Problematic and Compulsive Consumption of Sexually Explicit Media: Clinical Findings using the Compulsive Pornography Consumption (CPC) Scale among Men who have Sex with Men

To assess problematic sexually explicit media (SEM) consumption, and to identify clinically meaningful cut-off points, we examined clinical correlates using the new Compulsive Pornography Consumption (CPC) scale among 1165 participating MSM. Building on scale practices in measuring compulsive sexual behavior, two cut-off points were identified. While most (76-80%) MSM do not report compulsive symptoms, about 16-20% report levels of problematic SEM consumption, including 7% with extreme scores consistent with DSM criteria for compulsive disorders. Demographic, sexual, and HIV risk differences were identified between the three groups. Researchers and clinicians are encouraged to consider using the CPC scale for comprehensive assessment of compulsive sexual behavior.

A Brief Scale to Measure Problematic Sexually Explicit Media Consumption: Psychometric Properties of the Compulsive Pornography Consumption (CPC) Scale among Men who have Sex with Men

Although the phenomenon of hypersexuality has been described in the literature, and scales of compulsive sexual behavior have been published, the existing measures do not assess compulsive sexually explicit media (SEM) consumption. This study tested the psychometric properties of a new scale, the Compulsive Pornography Consumption (CPC). Exploratory and confirmatory factor analyses results showed good psychometric performance of a five item two factor preoccupation-compulsivity solution. As hypothesized, the scale correlates positively with compulsive sexual behavior, internalized homonegativity, and negatively with sexual self-esteem. The scale will enable researchers to investigate the etiologic factors of compulsive SEM use, and enable clinicians to assess problematic consumption.

Compulsive use of Internet-based sexually explicit media: Adaptation and validation of the Compulsive Internet Use Scale (CIUS)

Despite evidence that viewing sexually explicit media (SEM) may contribute to greater numbers of sexual partners, sexual risk taking, greater interest in group sex, and lower self-esteem among men who have sex with men (MSM), research has not addressed compulsive use of Internet-based SEM due to the lack of a validated measure for this population. This report investigates the psychometric properties of the 14-item Compulsive Internet Use Scale (CIUS; Meerkerk, van den Eijnden, Vermulst, & Garretsen, 2009) adapted to assess the severity of compulsive Internet SEM use. A total of 265 Internet SEM-viewing MSM participated in an online survey about their SEM preferences, viewing habits, and recent sexual behaviors. A principal components analysis revealed a single-component, 13-item scale to adequately assess the cognitive, emotional, and behavioral aspects of this phenomenon, with a high internal consistency (α=.92). Greater compulsive use of Internet SEM was positively correlated with several relevant variables including boredom, sexual frustration, time spent viewing Internet SEM, and number of recent male sexual partners. The results offer preliminary evidence for the reliability and validity of using an adapted version of the CIUS to understand compulsive Internet SEM use, and allow for more research into the potential negative consequences of compulsive SEM use.

Sexually explicit online media and sexual risk among men who have sex with men in the United States

This study aimed to describe sexually explicit online media (SEOM) consumption among men who have sex with men (MSM) in the United States and examine associations between exposure to unprotected anal intercourse (UAI) in SEOM and engagement in both UAI and serodiscordant UAI. MSM in the U.S. who accessed a men-seeking-men website in the past year (N = 1,170) were recruited online for a cross-sectional, Internet-based survey of sexual risk and SEOM consumption. In the 3 months prior to interview, more than half (57 %) of the men reported viewing SEOM one or more times per day and almost half (45 %) reported that at least half of the SEOM they viewed portrayed UAI. Compared to participants who reported that 0-24 % of the SEOM they viewed showed UAI, participants who reported that 25-49, 50-74, or 75-100 % of the SEOM they viewed portrayed UAI had progressively increasing odds of engaging in UAI and serodiscordant UAI in the past 3 months. As SEOM has become more ubiquitous and accessible, research should examine causal relations between SEOM consumption and sexual risk-taking among MSM as well as ways to use SEOM for HIV prevention.

Sexually explicit media on the internet: a content analysis of sexual behaviors, risk, and media characteristics in gay male adult videos

Recent research suggests that viewing sexually explicit media (SEM), i.e., adult videos, may influence sexual risk taking among men who have sex with men. Despite this evidence, very little is known about the content of gay male SEM on the Internet, including the prevalence of sexual risk behaviors and their relation to video- and performer-characteristics, viewing frequency, and favorability. The current study content analyzed 302 sexually explicit videos featuring male same-sex performers that were posted to five highly trafficked adult-oriented websites. Findings revealed that gay male SEM on the Internet features a variety of conventional and nonconventional sexual behaviors. There was a substantial prevalence of unprotected anal intercourse (UAI) (34 %) and was virtually the same as the prevalence of anal sex with a condom (36 %). The presence of UAI was not associated with video length, amateur production, number of video views, favorability, or website source. However, the presence of other potentially high-risk behaviors (e.g., ejaculation in the mouth, and ejaculation on/in/rubbed into the anus) was associated with longer videos, more views, and group sex videos (three or more performers). The findings of high levels of sexual risk behavior and the fact that there was virtually no difference in the prevalence of anal sex with and without a condom in gay male SEM have important implications for HIV prevention efforts, future research on the role of SEM on sexual risk taking, and public health policy.

The relationship between use of sexually explicit media and sexual risk behavior in men who have sex with men: exploring the mediating effects of sexual self-esteem and condom use self-efficacy

This study tests the following three hypotheses: 1) there is a direct association between consumption of sexually explicit media (SEM) depicting non-condom use and STI-related sexual risk behavior among men who have sex with men (MSM), 2) The association between SEM consumption and STI-related sexual risk behavior is mediated by men's sexual self-esteem, and 3) the relationship between SEM consumption and sexual risk behavior is mediated by condom use self-efficacy. A cross-sectional, Internet-based survey on exposure to SEM and sexual behavior of 1,391 MSM in the USA was conducted in 2011. The results confirmed hypothesis 1 and 3 while hypothesis 2 was rejected. Accordingly, a significant association between the use of SEM picturing condom use and STI related sexual risk behavior among MSM was found. Likewise, we found that the association between the use of SEM and sexual risk behavior was mediated by condom use self-efficacy in an indirect path. However, SEM did not influence sexual risk behavior via sexual self-esteem. To promote STI prevention, the actors in SEM may be used as role models in managing condom use in sexual contexts.

[Sexually transmitted diseases and other risks in the adult film industry]

The adult film industry nowadays represents a legal multi-billion dollar business. The main health risks of adult performers are well known. They mainly include the transmission of sexually transmitted diseases such as HIV, hepatitis, gonorrhoea, Chlamydia, herpes and papillomavirus. However, despite regular follow-up, the frequency of STD remains significant in this high-risk population since a large part of the industry continues to reject systematic use of condoms. Besides, performers are also exposed to other physical and mental health issues often not known to the public. This article provides a comprehensive review of what is known about STD and other risks among the community of performers in the adult film industry.