B. R. Simon Rosser

Sexual Risk Taking Among Young Internet-Using Men Who Have Sex With Men

OBJECTIVES We examined the characteristics of young Internet-using men who have sex with men (MSM) and risks associated with seeking sex online, offline, or through both strategies. METHODS Data were obtained from MSM aged 18 to 24 years who completed a 45-minute online survey regarding sex and Internet use in the preceding 3 months. RESULTS Significantly more Internet-using MSM who had met sexual partners both online and offline (43%) reported unprotected anal intercourse than did those who had met sexual partners exclusively online (29%) or offline (34%). MSM who met sexual partners exclusively offline reported the fewest partners but the greatest proportion of partnerships involving unprotected anal intercourse (49%). Meeting sexual partners both online and offline (odds ratio [OR]=3.38-58.42) and being drunk (OR=1.57) or high (OR=2.24) increased the odds of having more sexual partners. The same factors increased the odds of having unprotected anal intercourse (online and offline sexual partners, OR=1.60; being drunk, OR=1.43; being high, OR=1.61). CONCLUSIONS Risky sexual behavior was prevalent among all of the study subgroups. Our findings suggest that online sex seeking is associated with greater numbers of sexual partners but neither promotes nor discourages unprotected anal intercourse. Regardless of where sexual partners met, being drunk and high were significant risks for unprotected anal intercourse.

The relationship between homosexuality, internalized homo-negativity, and mental health in men who have sex with men

ABSTRACT Whether homosexuality or internalized homo-negativity is the critical variable affecting the mental health of men who have sex with men has long been debated. As part of a larger study, 422 Midwestern homosexual men completed questionnaires examining degree of homosexuality, internalized homo-negativity, and depression. Logistic regression modeling identified internalized homo-negativity, but not degree of homosexuality, as significantly associated with greater adjustment depression (OR = 1.5), major depression (OR = 2.6), dysthymia (OR = 1.5), and likelihood of being in therapy (OR = 1.4). Internalized homo-negativity was also negatively associated with overall sexual health, psychosexual maturation, comfort with sexual orientation, “outness,” and peer socialization. Internalized homo-negativity, not homosexuality, appears associated with negative health outcomes. Providers should promote sexual health and avoid interventions that reinforce internalized homo-negativity.

The Story of Subject Naught: A Cautionary but Optimistic Tale of Internet Survey Research

In a web-based, sexual behavior risk study using a rigorous response validation protocol, we identified 124 invalid responses out of 1,150 total (11% rejection). Nearly all of these (119) were due to repeat survey submissions from the same participants, and 65 of them came from a single participant. This brief describes how we were able to detect these repeat submissions using the validation protocol, and highlights the importance of using both automated and manual validation techniques

Reducing HIV risk behavior of men who have sex with men through persuasive computing: Results of the Men's INTernet Study-II

Objective:The primary objective of this study was to develop and test a highly interactive Internet-based HIV prevention intervention for men who have sex with men (MSM). MSM remain the group at highest risk for HIV/AIDS in the United States and similar countries. As the Internet becomes popular for seeking sex, online interventions to reduce sexual risk are critical. Given previous studies, a secondary objective was to demonstrate that good retention is possible in online trials. Design:A randomized controlled trial with 3-month, 6-month, 9-month, and 12-month follow-up design was employed. Methods:In 2008, 650 participants were randomized to an online, interactive sexual risk reduction intervention or to a waitlist null control. Results:Retention was 76–89% over 12 months. At 3-month follow-up, results showed a 16% reduction in reported unprotected anal intercourse risk among those in the treatment condition versus control [95% confidence interval (95% CI) of rate ratio: 0.70–1.01]. No meaningful differences were observed at 12-month follow-up. Conclusion:Internet-based, persuasive computing programs hold promise as an effective new approach to HIV prevention for MSM, at least in the short term. Further, online trials can be conducted with acceptable retention provided strong retention protocols are employed. Four directions for future research are identified.

Are gay communities dying or just in transition? Results from an international consultation examining possible structural change in gay communities

Abstract This study sought to identify how urban gay communities are undergoing structural change, reasons for that change, and implications for HIV prevention planning. Key informants (N=29) at the AIDS Impact Conference from 17 cities in 14 countries completed surveys and participated in a facilitated structured dialog about if gay communities are changing, and if so, how they are changing. In all cities, the virtual gay community was identified as currently larger than the offline physical community. Most cities identified that while the gay population in their cities appeared stable or growing, the gay community appeared in decline. Measures included greater integration of heterosexuals into historically gay-identified neighborhoods and movement of gay persons into suburbs, decreased number of gay bars/clubs, less attendance at gay events, less volunteerism in gay or HIV/AIDS organizations, and the overall declining visibility of gay communities. Participants attributed structural change to multiple factors including gay neighborhood gentrification, achievement of civil rights, less discrimination, a vibrant virtual community, and changes in drug use. Consistent with social assimilation, gay infrastructure, visibility, and community identification appears to be decreasing across cities. HIV prevention planning, interventions, treatment services, and policies need to be re-conceptualized for MSM in the future. Four recommendations for future HIV prevention and research are detailed.

History of childhood sexual abuse and unsafe anal intercourse in a 6-city study of HIV-positive men who have sex with men.

OBJECTIVES We assessed rates of childhood sexual abuse and its demographic and mental health correlates among HIV-positive men who reported unsafe anal intercourse with other men in the past year. METHODS We conducted a cross-sectional analysis of baseline data from 593 HIV-positive men who have sex with men enrolled in the Positive Connections intervention. RESULTS Childhood sexual abuse was reported by 47% of participants; 32% reported frequency as often or sometimes. Men reporting abuse were more likely to be Latino (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.6, 4.2; P < .001) or African American (OR = 1.8; 95% CI = 1.2, 2.7; P = .005) than White. Among those who were abused, more frequent abuse was associated with more sexual contacts (for each, rate ratio [RR] = 1.3; P < .001) and unsafe anal intercourse (often, RR = 1.5; sometimes, RR = 2.0; P < .001) compared with men who were not abused. CONCLUSIONS History of childhood sexual abuse is highly prevalent among HIV-positive men who engage in risky sexual behavior with other men and appears to be more common among men of color. Our findings suggest that abuse is associated with a significantly increased risk of sexually transmitted infections.

Sexual difficulties, concerns, and satisfaction in homosexual men: An empirical study with implications for HIV prevention

Minimal research has investigated the prevalence of sexual disorders in homosexual men. We examined sexual performance concerns, problems, and satisfaction in a convenience sample of 197 homosexual men who attended a health seminar. Sexual dysfunction and sexual concerns were found to be common problems. Almost all men reported some sexual difficulty over their lifetime, and more than half reported a current sexual difficulty. A further 25% of the sampled men identified other sexual concerns as well. Despite these figures, most participants-whether single, dating, or in a relationship-reported average to above-average sexual satisfaction. Correlates of sexual satisfaction included more liberal attitudes toward human sexuality, greater comfort with mens sexual attractions to other men, lower levels of internalized homophobia, and greater satisfaction with ones relationship status. Painful receptive anal intercourse appeared to be a common, yet previously underacknowledged, difficulty. Almost half of the respondents described HIV/AIDS as having a negative impact on their sexual functioning, with most reporting an increase in fear of sex as the major negative outcome.

Revision, Criterion Validity, and Multigroup Assessment of the Reactions to Homosexuality Scale

Internalized homonegativity encompasses negative attitudes toward ones own sexual orientation and is associated with negative mental and physical health outcomes. The Reactions to Homosexuality Scale (Ross & Rosser, 1996), an instrument used to measure internalized homonegativity, has been criticized for including content irrelevant to the construct of internalized homonegativity. We revised the scale using exploratory and confirmatory factor analyses and identified a 7-item, 3-factor reduced version that demonstrated measurement invariance across racial/ethnic categorizations and between English and Spanish versions. We also investigated criterion validity by estimating correlations with hypothesized outcomes associated with outness, relationship status, sexual orientation, and gay community affiliation. The evidence of measurement invariance suggests that this scale is appropriate for pluralistic treatment or study groups.

The Future of Internet-Based HIV Prevention: A Report on Key Findings from the Men’s INTernet (MINTS-I, II) Sex Studies

The Internet and other new media have changed how men who have sex with men (MSM) find and interact with sexual partners. This social phenomenon, paired with growing evidence that use of the Internet increases MSM’s risk for HIV infection, makes it crucial that innovative technology-based HIV prevention interventions are developed for this population. In this commentary we explain why technology-based HIV prevention interventions are urgently needed; we then highlight findings from some of the first Internet-based HIV prevention for MSM studies that show the potential for future interventions; we next discuss ways for interventionists to conceptualize new media as a tool for HIV prevention; and finally we discuss emerging trends for technology-based HIV-prevention research.

Compulsive Sexual Behavior and Risk for Unsafe Sex Among Internet Using Men Who Have Sex with Men

The present study explored the relationship between compulsive sexual behavior (CSB) and unprotected anal intercourse (UAI) for men who have sex with men (MSM) across a number of ethnic/racial groups and who used the Internet to seek sexual partners. A sample of 2,716 MSM (512 Asian, 445 Black, 683 Latino, 348 Other, 728 White) completed on online survey that collected information about their sexual behaviors with partners met online and offline. The survey also included the Compulsive Sexual Behavior Inventory (CSBI). Consistent with the notion that CSB is a stable trait, higher scores on the CSBI were associated with greater odds for engaging in UAI, regardless of the context in which sex partners were met (online or offline). Differences in median CSB scores were generally similar across racial and ethnic groups. The median CSB score was significantly higher for HIV-positive participants than for HIV-negative participants. HIV-prevention interventions are needed among MSM, but should take into account that some may be resistant to risk reduction strategies because of CSB.