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Casey EA, Willey-Sthapit C, Hoxmeier JC, Carlson J. Patterns of Gender Equitable Attitudes and Behaviors Among Young Men: Relationships With Violence Perpetration and Masculinity Ideologies. Violence Against Women 2024; 30:2174-2199. [PMID: 36788416 DOI: 10.1177/10778012231153359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This study used latent profile analysis with data from 481 U.S. men to examine patterns of men's attitudes toward gender equity and their engagement in gender-equitable (GE) behaviors. Five resulting profiles included groups with (a) high endorsement of both GE attitudes and behaviors, (b) low endorsement of both, (c) mid-range endorsement of both, (d) strong endorsement of GE attitudes, but low engagement in action, and (e) low endorsement of GE attitudes but high participation in GE behavior. Worryingly, this last group reported higher rates of violence perpetration than other groups, while simultaneously reporting higher rates of participation in gender-based violence prevention actions.
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Affiliation(s)
- Erin A Casey
- School of Social Work and Criminal Justice, University of Washington, Tacoma, Tacoma, WA, USA
| | | | - Jill C Hoxmeier
- Department of Health Sciences, Central Washington University, Ellensburg, WA, USA
| | - Juliana Carlson
- School of Social Welfare, University of Kansas, Lawrence, KS, USA
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Gauthier-Duchesne A, Hébert M, Blais M, Wekerle C. Differential Profiles of Sexually Abused Adolescent Boys. JOURNAL OF CHILD SEXUAL ABUSE 2023; 32:655-673. [PMID: 37335029 DOI: 10.1080/10538712.2023.2226652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 04/03/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
Victims of child sexual abuse (CSA) are a heterogeneous population. Several characteristics may influence the outcomes associated with this adverse childhood experience, including personal (e.g. age) and CSA characteristics (e.g. relationship to the perpetrator). This study relied on a person-centered approach to account for this heterogeneity and focused on adolescent boys, an understudied population. Data were drawn from a representative sample of high school students aged 14 to 18 years old in Quebec, Canada. A total of 3.9% (n = 138) of boys reported CSA. Various CSA characteristics (severity, relationship to the perpetrator, and number of events) were used as indicators to derive classes. A four-class solution emerged from the latent class analysis: CSA in a sports context (6%), intrafamilial CSA (8%), extrafamilial CSA (52%) and multiple CSA (34%). The multiple CSA profile included boys who were sexually abused in multiple situations by different perpetrators and who were victims of acts involving penetration. The exploration of correlates associated with class membership revealed that adolescent boys included in the multiple CSA profile were distinguished by higher rates of delinquent behaviors and alcohol and drug use. They were more likely than members of other latent classes to belong to sexual minorities. This exploratory study sheds light on sexually victimized adolescent boys and the deleterious consequences that may affect them, particularly boys who have experienced multiple CSA events. We conclude that prevention efforts should focus on the demystification of sexual trauma among boys and on using trauma-informed care approaches for adolescent externalizing behaviors.
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Affiliation(s)
| | - Martine Hébert
- Université du Québec à Montréal, Montréal, Québec, Canada
| | - Martin Blais
- Université du Québec à Montréal, Montréal, Québec, Canada
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Reyes HLM, Maman S, Kajula L, Mulawa M. Intimate partner violence perpetration and sexual risk behaviour: Identifying shared determinants among young men in Tanzania. Glob Public Health 2022; 17:2792-2806. [PMID: 35129086 PMCID: PMC9356116 DOI: 10.1080/17441692.2022.2032257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
In this study we examined factors that predict involvement in different patterns of sexual risk behavior and IPV perpetration among young men in Tanzania (n = 979), with a focus on identifying factors that distinguish men who engage in both behaviours from those who do not. Risk factors were drawn from three domains thought to be upstream drivers of both IPV and sexual risk: poverty, adverse childhood experiences, and inequitable gender norms. A three-step latent class analysis was used to assess whether and how factors from each domain distinguished subgroups of men whose behaviour patterns were characterised as comorbid (involvement in IPV and sexual risk behaviour), IPV-only, sexual risk only, and normative (low risk). Consistent with expectations, greater food insecurity, adverse childhood experiences, and inequitable gender norms related to violence and sexual behaviour predicted increased risk of membership in the comorbid group compared to other sub-groups. Findings support the promise of integrated prevention programmes targeting the common causes of IPV perpetration and sexual risk behaviour.
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Affiliation(s)
- H. Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440
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Nielson MG, Ward LM, Seabrook RC, Giaccardi S. The Roots and Fruits of Masculinity: Social Antecedents and Sexual Relationship Consequences of Young Men's Adherence to Masculine Norms. JOURNAL OF SEX RESEARCH 2022; 59:897-910. [PMID: 35316111 DOI: 10.1080/00224499.2022.2049188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
On a longitudinal sample of 181 emerging adult men (Mage = 19.36, SDage = 1.48), we analyzed how diverse socializing agents (fathers, male peers, magazines, music videos, TV dramas, and TV sitcoms) related to adherence to masculine norms, and how norm adherence related to men's interpersonal sexual cognitions and behaviors (romantic relationship self-efficacy, sexual self-esteem, and alcohol-primed sexual encounters). We found that male peers, magazines, and music videos related to masculine norm adherence one year later, and that norm adherence predicted increased alcohol-primed sexual encounters. We followed this up with analyses investigating the role of specific masculine norms and found unique socialization and outcome paths for different masculine norms. For example, analyses indicated that male peers were positively related to norms of winning, power over women, playboy attitudes, and risk-taking, and that playboy attitudes, risk-taking, emotional control, and self-reliance predicted lower levels of romantic relationship self-efficacy. Interestingly, sitcom viewing related to lower adherence to masculine norms including heterosexual presentation and having power over women. Findings identify the unique influence of male peers, magazines, and music videos on young men's sexual cognitions and behaviors and highlight how combining different socialization agents in one model is key to identifying these unique patterns of socialization and their consequences.
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Affiliation(s)
| | | | | | - Soraya Giaccardi
- Annenberg School for Communication and Journalism, University of Southern California
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Casey EA, Ihrig A, Roman M, Hoxmeier JC, Carlson J, Greer K. Life Course and Socioecological Influences on Gender-Equitable Attitudes Among Men: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:764-777. [PMID: 33267742 DOI: 10.1177/1524838020977140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Emerging research suggests that holding gender-equitable attitudes (GEA) is associated with decreased risk of gender-based violence perpetration and increased willingness to engage in violence preventative actions among men. GEA, defined here as support for political, economic, and social equity across gender in both public and private spheres, may therefore constitute a protective factor against perpetration and a promotive factor in fostering healthy relationships and communities. Forces that shape GEA throughout boys' and young men's lives are less well articulated. The purpose of this exploratory, scoping review was to synthesize cross-disciplinary research to distill life-course influences on the development of GEA among men. Three databases and Google Scholar were searched to locate peer-reviewed studies that empirically examined GEA as an outcome of childhood, adolescent, or young adulthood factors. Sixty-nine articles were located that, collectively, used data from 97 different countries and identified 22 potential life-course influences on men's GEA. Across studies, facilitators of equitable attitudes included higher levels of education, exposure to gender transformative prevention programming, and having parents who held, modeled, and communicated gender-equitable beliefs. Hindrances to equitable attitudes included but were not limited to religiosity, the transition to fatherhood, and having mostly male peer groups. Findings suggest that opportunities to foster equitable attitudes exist across the life course and both inside and outside of formal prevention or education interventions.
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Affiliation(s)
- Erin A Casey
- School of Social Work and Criminal Justice, University of Washington, Tacoma, WA, USA
| | - Anna Ihrig
- School of Social Work and Criminal Justice, University of Washington, Tacoma, WA, USA
| | - Melinda Roman
- School of Social Work and Criminal Justice, University of Washington, Tacoma, WA, USA
| | - Jill C Hoxmeier
- Department of Health Sciences, Central Washington University, Ellensburg, WA, USA
| | - Juliana Carlson
- School of Social Welfare, University of Kansas, Lawrence, KS, USA
| | - Kelsey Greer
- School of Social Work and Criminal Justice, University of Washington, Tacoma, WA, USA
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McNaughton Reyes HL, Maman S, Kajula LJ, Mulawa M. The Intersection of Intimate Partner Violence Perpetration and Sexual Risk Behavior Among Young Men in Tanzania: A Latent Class Analysis of Patterns and Outcomes. AIDS Behav 2022; 26:512-522. [PMID: 34342741 PMCID: PMC8810910 DOI: 10.1007/s10461-021-03407-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 02/03/2023]
Abstract
Few studies of intimate partner violence (IPV) perpetration and sexual risk behavior among men have examined how multiple dimensions of these behaviors intersect in ways that may uniquely elevate health risks. The current study used latent class analysis to: (1) identify distinct patterns of IPV and sexual risk behavior in a sample of Tanzanian men (n = 985) and (2) examine associations between identified patterns and health outcomes. Four classes were identified: normative (64% of the sample), IPV only (14%), sexual risk only (13%), and comorbid IPV/sexual risk (5%). Compared to men in the normative subgroup, men in the comorbid group had significantly higher odds of STI infection, higher perceived HIV risk, and greater odds of substance use. Findings provide evidence that engaging in IPV and multiple sexual partnerships (i.e., a comorbid pattern) denotes elevated health risks across a range of indicators, suggesting the importance of targeted treatment and prevention efforts for men in this subgroup.
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Affiliation(s)
- H Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA.
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
| | | | - Marta Mulawa
- School of Nursing, Duke University, Durham, NC, USA
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Jewkes R, Jordaan E, Myrttinen H, Gibbs A. Masculinities and violence: using latent class analysis to investigate the origins and correlates of differences between men in the cross-sectional UN Multi-country Study on men and violence in Asia and the Pacific. J Glob Health 2021; 10:020439. [PMID: 33437463 PMCID: PMC7774029 DOI: 10.7189/jogh.10.020439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Multiple masculinities have been explicated through latent class analysis (LCA) in South Africa, and a question arises as to whether men can be similarly grouped by their behaviour in very different cultural contexts, and whether an analysis would point to similar origins to men’s use of violence against women. The UN Multi-country Study on Men and Violence in Asia and the Pacific’s data set enabled this question to be explored. Methods In nine sites in six countries, data were collected from one man (18-49 years) interviewed in each of a random sample of households. Using LCA, we categorised men based on their probability of having engaged in 10 acts of violence against women or other illegal or sexually risky behaviour. We present multinomial logistic regression models of factors associated with class membership and associated childhood and trauma experiences. Results The LCA model with 5 classes fitted best: the largest class (59.5% of men) had the lowest probabilities of engagement in the class-defining acts; men in the second (21.2%) were otherwise law abiding and not sexually risky, but very violent towards partners; men in the third (7.9%) had the highest probability of engagement in all violent and illegal behaviour; men in the fourth (7.8%) demonstrated behaviour at the nexus of sex and power including rape and transacted sex; and men in the fifth (3.6%), engaged in anti-social behaviour, but were less violent towards women and sexually risky. Assignment to more violent classes was associated with poverty, substance abuse and depression, and more gender inequitable attitudes and practices. Child abuse, neglect and bullying were associated with being in the more violent classes. Neither men’s domestic practices nor their fathers’ presence in their childhood were associated with class. Conclusions Closely paralleling the South African findings, we have highlighted the childhood origins of men’s violent and anti-social behaviour, as well as the interrelationships with men’s mental health, poverty and misogyny, showing that these (intersectional) developmental processes transcend culture and setting. We need to prevent children’s exposure to violence, and in gender transformative work with men, recognise and address past and present psychological distress stemming from trauma experience.
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Affiliation(s)
- Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Henri Myrttinen
- Gender Associations International Consulting, Berlin, Germany
| | - Andrew Gibbs
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Casey EA, Masters NT, Beadnell B. Social Norms: Are Sexually Aggressive Men More Likely to Misperceive Other Men's Sexual Desires and Behavior? JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2020; 29:917-935. [PMID: 33716494 PMCID: PMC7954127 DOI: 10.1080/10926771.2019.1711278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/30/2019] [Accepted: 12/15/2019] [Indexed: 06/12/2023]
Abstract
Separate lines of research show that men overestimate the extent of male peers' sexual activity, and independently, that sexually aggressive men believe that other men approve of coercive behavior. This study examined the intersection of these lines of inquiry, testing whether the degree of male participants' misperception of other men's sexual behavior differs as a function of perpetrator status. In a national sample, we presented heterosexually active men (n=497) with sexual scenarios varying in sexual acts, partner types, and circumstances. Results showed that participants significantly overestimated the typicality of all types of sexual situations for other men. Participants also misjudged the desirability of scenarios consistent with a traditional masculinity sexual script to other men; these scenarios reflected an adversarial perspective on relationships and an impersonal approach to sexuality - a known risk factor for sexual aggression. Further, sexually aggressive men overestimated the desirability of these traditional masculinity scenarios to a greater extent than non-aggressive peers. Findings suggest that interventions that provide accurate knowledge about social norms, or "typical" sexual desires and behaviors among other men, may reduce pressure to live up to perceived but perhaps inaccurate masculine ideals, as well as reduce social norm-related risks for sexually aggressive behavior.
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Iwamoto DK, Brady J, Kaya A, Park A. Masculinity and Depression: A Longitudinal Investigation of Multidimensional Masculine Norms Among College Men. Am J Mens Health 2018; 12:1873-1881. [PMID: 29973104 PMCID: PMC6199432 DOI: 10.1177/1557988318785549] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/10/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022] Open
Abstract
The transition from high school to college represents a pivotal developmental period that may result in significant maladjustment for first-year college men. Men may feel pressured to "prove" their masculinity by engaging in traditional masculine behaviors that could be negative for their overall well-being. Although adherence to multidimensional masculine norms has been associated with poorer mental health, no studies have examined the role of masculine norms on prospective depressive symptoms among first-year college men. Examining college men's adherence to multidimensional masculine norms longitudinally can offer a promising theoretical framework to explain within-group variability in depression symptomatology. The sample included 322 men from the Mid-Atlantic region of the United States. Masculine norms were assessed during the beginning of their first year of college. Depressive symptomatology was assessed 6 months after the first wave of data collection. Masculine norms were positively and negatively related to prospective depression scores, such that men who endorsed the masculine norms of Self-Reliance, Playboy (i.e., desire to have multiple sexual partners), and Violence, had heightened risk, whereas men who endorsed Winning and Power Over Women were less likely to report depressive symptomatology. Distinct masculine norms appear to confer risk for depression while other norms appear to be protective. This study was the first to examine the role of multidimensional masculine norms on prospective depressive symptomatology among college men. The results suggest that practitioners working with men should consider assessing their clients' adherence to distinct masculine norms and explore how these might be impacting their current mental health.
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Affiliation(s)
- Derek K. Iwamoto
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | | | - Aylin Kaya
- University of Maryland, College Park, MD, USA
| | - Athena Park
- University of Maryland, College Park, MD, USA
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Bay-Cheng LY, Bruns AE, Maguin E. Agents, Virgins, Sluts, and Losers: The Sexual Typecasting of Young Heterosexual Women. SEX ROLES 2018. [DOI: 10.1007/s11199-018-0907-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Willie TC, Khondkaryan E, Callands T, Kershaw T. "Think Like a Man": How Sexual Cultural Scripting and Masculinity Influence Changes in Men's Use of Intimate Partner Violence. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:240-250. [PMID: 29377159 PMCID: PMC5837937 DOI: 10.1002/ajcp.12224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of the study was to (a) explore the relationship between sexual cultural scripting and traditional masculine norms on changes in intimate partner violence (IPV) perpetration, and (b) examine traditional masculine norms as an effect modifier among young heterosexual men. This study is a secondary data analysis of a prospective cohort study of 119 young heterosexual men who were followed for 6 months. The adjusted logistic regression results revealed that sexual cultural scripting norms were associated with an increased odds of emotional IPV perpetration and traditional masculine norms were associated with an increased odds of physical IPV perpetration in the past 6 months. There were no significant interaction effects between sexual cultural scripting and traditional masculine norms on IPV perpetration. These findings suggest that socially constructed norms and beliefs surrounding masculinity, femininity, and how women and men interact in sexual relationships are important constructs for understanding the etiology of young men's use of violence against a female partner. While primary IPV interventions targeting young men do address masculinity, sexual cultural scripting is an additional concept that should also be addressed.
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Affiliation(s)
- Tiara C Willie
- School of Public Health, Yale University, New Haven, CT, USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | | | - Tamora Callands
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace Kershaw
- School of Public Health, Yale University, New Haven, CT, USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
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Card KG, Lachowsky NJ, Cui Z, Carter A, Armstrong H, Shurgold S, Moore D, Hogg RS, Roth EA. A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:95-106. [PMID: 27987086 PMCID: PMC5474217 DOI: 10.1007/s10508-016-0879-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/16/2016] [Accepted: 10/08/2016] [Indexed: 05/30/2023]
Abstract
Initial research into seroadaptive strategies suggests that, individually, they are potentially effective behavioral methods to reduce risk of HIV transmission. Combining strategies, therefore, has the potential to increase risk reduction. The aim of this study was to determine how gay and bisexual men (GBM) combine strategies. To this end, a total of 774 sexually active GBM, aged ≥16 years, in Metro Vancouver, Canada, were recruited. Grouped by self-reported HIV status, latent class analysis of self-reported condom use, strategic positioning, anal sex avoidance, serosorting, viral-load sorting, and withdrawal were conducted. Multinomial logistical regression identified explanatory variables of class membership (i.e., sensation seeking, treatment optimism, sexual altruism, relationship status, number of partners, anal sex preference). Four latent classes were identified: Condom Users, Multiple Prevention Users, Viral-Load Sorters, and Serosorters. The majority of HIV-negative/unknown men (72 %) and a large proportion of HIV-positive men (42 %) belonged to the Condom Users class. Class membership was associated with age, relationship status, treatment optimism, sexual altruism, sensation seeking, number of recent male anal sex partners, and recent condomless anal sex with a serodiscordant or unknown-status partner. Understanding these distinct patterns allows for tailored interventions addressing GBM's sexual health needs.
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Affiliation(s)
- Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada.
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Allison Carter
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Heather Armstrong
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Susan Shurgold
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Science, Simon Fraser University, Vancouver, BC, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, BC, Canada
- Centre for Addiction Research of British Columbia, University of Victoria, Victoria, BC, Canada
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