Christian Grov

A Social-Cognitive Analysis of How Young Men Become Involved in Male Escorting

This study employed a social-cognitive theoretical perspective to assess the interactions of behavioral, cognitive, and situational factors to understand better how young male sex workers (MSWs) entered the sex trade industry. As part of a larger project examining male escorts working for a single agency, MSWs (n = 38) were interviewed about their work and personal lives. Interviews were transcribed and analyzed thematically. As predicted by a social-cognitive perspective, results supported reciprocal influences of behavior and environment, environment and cognition, and behavior and cognition. MSWs developed more self-efficacy around sex work behaviors and more positive outcome expectations with experience; moral conflict and lack of attraction to clients limited MSWs’ self-efficacy. Key variables for sex work appeared to be cognitive in nature—mostly represented by a decreased commitment to normative social/sexual values, the specific nature of which may have varied by sexual orientation. Findings support the contention that social-cognitive theory can effectively model entry of young men into sex work. Social-cognitive theory provides a broad umbrella underneath which various explanations for male sex work can be gathered.

Characteristics Associated With Urethral and Rectal Gonorrhea and Chlamydia Diagnoses in a US National Sample of Gay and Bisexual Men: Results From the One Thousand Strong Panel.

Background Gay and bisexual men are at elevated risk for Neisseria gonorrhoeae and Chlamydia trachomatis (GC/CT). Rectal GC/CT symptoms may be less obvious than urethral, increasing opportunities for undiagnosed rectal GC/CT. Methods A US national sample of 1071 gay and bisexual men completed urethral and rectal GC/CT testing and an online survey. Results In total, 6.2% were GC/CT positive (5.3% rectal, 1.7% urethral). We calculated adjusted (for education, race, age, relationship status, having health insurance, and income) odds ratios for factors associated with rectal and urethral GC/CT diagnoses. Age was inversely associated with urethral and rectal GC/CT. Compared with white men, Latinos had significantly greater odds of rectal GC/CT. Among men who reported anal sex, those reporting only insertive sex had lower odds of rectal GC/CT than did men who reported both insertive and receptive. There was a positive association between rectal GC/CT and number of male partners (<12 months), the number of anal receptive acts, receptive condomless anal sex (CAS) acts, and insertive CAS acts. Compared with those who had engaged in both insertive and receptive anal sex, those who engaged in only receptive anal sex had lower odds of urethral GC/CT. The number of male partners (<12 months) was associated with increased odds of urethral GC/CT. Conclusions Rectal GC/CT was more common than urethral and associated with some demographic and behavioral characteristics. Our finding that insertive CAS acts was associated with rectal GC/CT highlights that providers should screen patients for GC/CT via a full range of transmission routes, lest GC/CT go undiagnosed.

Why I Quit Pre-Exposure Prophylaxis (PrEP)? A Mixed-Method Study Exploring Reasons for PrEP Discontinuation and Potential Re-initiation Among Gay and Bisexual Men

Literature concerning pre-exposure prophylaxis (PrEP) among gay and bisexual identifying men (GBM) has explored facilitators and barriers to uptake and adherence. Far less reported are the reasons why GBM discontinue PrEP use. A national sample of 1071 GBM completed surveys about PrEP use and discontinuation. Participants who were still taking PrEP the 24-month follow up were compared to those that had stopped. Eighteen percent (nxa0=xa031) of GBM who reported ever using PrEP discontinued use. Younger (AORxa0=xa00.96; 95% CI 0.92–1.00), and unemployed (AORxa0=xa04.58; 95% CI 1.43–14.70) GBM were more likely to discontinue PrEP than their counterparts. Those that discontinued provided details on why via a free response question. The most common reasons for discontinuation were lower perceived HIV risk (50%) and cost/insurance (30%). Reasons for potential re-initiation included higher-risk sexual activities and changes to structural related barriers. More research is needed to inform interventions on how GBM can continue taking PrEP during changes to employment that effect insurance coverage and cost.ResumenLa literatura sobre la Profilaxis Pre-Exposición (PrEP) entre hombres que se auto identifican como gay y bisexuales (HGB) ha explorado facilitadores y barreras al uso y la adherencia a la PrEP. Mucho menos reportadas son las razones por las cuales HGB discontinúan el uso de la PrEP. Una muestra nacional de 1071 HGB completó encuestas sobre el uso y la discontinuación de la PrEP. Participantes que todavía estaban tomando PrEP durante su seguimiento a los 24 meses fueron comparados con aquellos que habían dejado de usarla. HGB más jóvenes (AORxa0=xa00.96; 95% C.I.xa0=xa00.92-1.00) y desempleados (AORxa0=xa04.58; 95% C.I.xa0=xa01.43-14.70) tuvieron una probabilidad más alta de discontinuar la PrEP que sus homólogos. Aquellos que la discontinuaron proveyeron detalles sobre el por qué a través de un cuestionario de repuesta libre. Las razones más comúnmente citada para la discontinuación fueron: bajo riesgo percibido de contraer VIH (50%) y costo/seguro de salud (30%). Razones para potencialmente reiniciarla incluyeron actividades sexuales de más alto riesgo y cambios en las barreras estructurales relacionadas. Mas investigación es necesaria para informar intervenciones sobre cómo los HGB pueden continuar tomando PrEP durante periodos de cambio en el empleo que afectan la cobertura de salud y su costo.

Measuring Sexual Orientation: A Review and Critique of U.S. Data Collection Efforts and Implications for Health Policy

The U.S. Department of Health and Human Services’ (HHS) Healthy People 2020 goals sought to improve health outcomes among sexual minorities; HHS acknowledged that a dearth of sexual orientation items in federal and state health surveys obscured a broad understanding of sexual minority–related health disparities. The HHS 2011 data progression plan aimed to advance sexual orientation data collection efforts at the national level. Sexual orientation is a complex, multidimensional construct often composed of sexual identity, sexual attraction, and sexual behavior, thus posing challenges to its quantitative and practical measurement and analysis. In this review, we (a) present existing sexual orientation constructs; (b) evaluate current HHS sexual orientation data collection efforts; (c) review post-2011 data progression plan research on sexual minority health disparities, drawing on HHS survey data; (d) highlight the importance of and (e) identify obstacles to multidimensional sexual orientation measurement and analysis; and (f) discuss methods for multidimensional sexual orientation analysis and propose a matrix for addressing discordance/branchedness within these analyses. Multidimensional sexual orientation data collection and analysis would elucidate sexual minority–related health disparities, guide related health policies, and enhance population-based estimates of sexual minority individuals to steer health care practices.

Prospective Measurement of Daily Health Behaviors: Modeling Temporal Patterns in Missing Data, Sexual Behavior, and Substance Use in an Online Daily Diary Study of Gay and Bisexual Men.

Daily diary and other intensive longitudinal methods are increasingly being used to investigate fluctuations in psychological and behavioral processes. To inform the development of this methodology, we sought to explore predictors of and patterns in diary compliance and behavioral reports. We used multilevel modeling to analyze data from an online daily diary study of 371 gay and bisexual men focused on sexual behavior and substance use. We found that greater education and olderxa0age as well as lower frequency of substance use were associated with higher compliance. Using polynomial and trigonometric functions, we found evidence for circaseptan patterns in compliance, sexual behavior, and substance use, as well as linear declines in compliance and behavior over time. The results suggest potential sources of non-random patterns of missing data and suggest that trigonometric terms provide a similar but more parsimonious investigation of circaseptan rhythms than do third-order polynomial terms.

Will Gay and Bisexual Men Taking Oral Pre-exposure Prophylaxis (PrEP) Switch to Long-Acting Injectable PrEP Should It Become Available?

Oral pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV transmission risk and is CDC recommended for many gay, bisexual, and other men who have sex with men (GBM). We sought to investigate awareness of and preference for using long-acting injectable PrEP (LAI-PrEP) among GBM currently taking oral PrEP (nxa0=xa0104), and identify their concerns. About half of GBM had heard of LAI-PrEP, and 30.8% specifically preferred LAI-PrEP. GBM with more concerns about the level of protection and drug half-life of LAI-PrEP had lower odds of preferring LAI-PrEP. Given that daily pill adherence is a challenge for some on PrEP, it is important to investigate the degree to which those on PrEP might consider LAI-PrEP as an alternative.ResumenLa Profilaxis pre-Exposición (PrEP) es altamente efectiva en reducir el riesgo de transmisión del VIH y la es recomendada por los Centros de Control y Prevención de Enfermedades (CDC, por su sigla en inglés) para hombres homosexuales, bisexuales, y otros hombres que tienen relaciones sexuales con hombres (HGB). Buscamos investigar el grado de conciencia sobre y la preferencia por usar la PrEP inyectable de acción prolongada (LAI-PrEP, por su sigla en inglés) entre HGB que están actualmente tomando la PrEP oralmente (nxa0=xa0104), e identificar sus preocupaciones al respecto. Aproximadamente la mitad de los HGB había oído sobre la LAI-PrEP (LAI-PrEP, por su sigla en inglés) y el 30.8% prefirió específicamente la LAI-PrEP. HGB con más preocupación sobre el nivel de protección y la vida-media de la LAI-PrEP tuvieron menor probabilidad de preferir la LAI-PrEP. Dado que la adherencia al tratamiento con un medicamento diario es un desafío para algunas personas que toman la PrEP, es importante investigar hasta qué punto las personas que toman la PrEP considerarían la LAI-PrEP como una alternativa.

Level of ‘outness’ and pornography use among men who have sex with men: results from an online survey

Higher levels of ‘outness’ – a fundamental experience of people who experience same-sex attraction or engage in same-sex relationships – have been associated with increased community engagement, improved self-worth and relationship satisfaction. Pornography viewing is common among men who have sex with men (MSM), and may be associated with outness. Current literature lacks analyses of outness and pornography viewing among MSM. In data taken from a 2009 online survey 1995 MSM participants reported accessing pornography via the Internet (58.8%), video/digital versatile disc (32.3%) and magazines (10.4%). Viewing of pornography portraying only safer sex encounters (oral sex, mutual masturbation and/or anal sex with condoms) was reported by 49.4%; 4.5% reported exclusively viewing high-risk sex (anal sex without condoms with/without oral sex or mutual masturbation); and 46.1% reported viewing both safer sex and high-risk pornography. In multivariable modelling – compared to the other two groups – men who watched only safer sex pornography were more likely to report being single, HIV negative, a lower degree of outness and to indicate their sex life resembled pornography. Self-identifying as gay was not associated with type of pornography watched. These findings highlight the need to incorporate level of outness when analysing pornography-viewing behaviours among MSM, as outness may be associated with different viewing habits.

Social–Emotional Aspects of Male Escorting: Experiences of Men Working for an Agency

Social situations and emotional correlates associated with male sex work have not been well documented. Most of the research in this area focuses on sexual activity with little mention of other aspects of the job. Yet, research with female sex workers finds significant social and emotional components to sex work. The current study focused on how male sex workers (MSWs) perceived and adapted to the social–emotional aspects of their job. As part of a larger project examining MSWs working for a single escort agency, 40 men (M age, 22.3xa0years, 75xa0% Caucasian) located in the mid-Atlantic U.S. participated in semi-structured interviews. The agency owner was also interviewed. Participants reported a range of social and emotional factors regarding sex work and employed a variety of strategies to provide good customer service and adapt to negative experiences. For most, social support was inhibited due to fear of stigmatization that might result if participants disclosed sex work to significant others outside the agency. Instead, interactions within the agency provided core work-related social support for most MSWs. Emotional and relational tasks inherent to escort work grew easier with experience and negativity about the job declined. Our data suggested that socially connected individuals seemed to be more satisfied with sex work. Social and emotional requirements represented a significant but unanticipated component of male sex work to which escorts actively adapted. Escorting may be similar to other service occupations in terms of the social–emotional situations and skills involved.

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 3xa0h 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.

Gay Men's Perspectives on HIV Prevention and Treatment in Berlin, Germany: Lessons for Policy and Prevention

ABSTRACT Qualitative data from interviews with gay men in Berlin, Germany were used to identify challenges facing HIV prevention and treatment as well as opportunities to improve them. In 2015, 20 self-identified gay men in Berlin—who had all received HIV prevention services and/or treatment (broadly defined)—participated in 1-on-1 qualitative interviews (30–75 min long). Ages ranged from 24 to 54, 35% self-identified as HIV-positive, and the remainder as HIV-negative. With regard to challenges to HIV prevention, participants highlighted (a) an already high HIV burden among gay men in Berlin and thus a need for doing prevention with positives (test-and-treat, and treatment as prevention); (b) the lack of a universal free condom distribution program; and (c) relaxed attitudes around the seriousness of HIV as a result of HIV treatment optimism. Participants highlighted that although condoms are an effective HIV prevention strategy (and thus certainly an area for focus), HIV prevention campaigns would benefit from updates with regard to embracing a diverse range of biological and behavioral prevention strategies, as well as expanded methods for making access to postexposure prophylaxis and free rapid HIV-antibody testing. This study informs HIV prevention approaches in Berlin, Germany as well as other urban centers where MSM are disproportionally affected by the HIV epidemic.