Christopher W. Blackwell

Men who have sex with men and recruit bareback sex partners on the internet: implications for STI and HIV prevention and client education.

Men who have sex with men (MSM) frequently use Internet-based Web sites to recruit sex partners. Although many MSM users of such sites advocate for safe sex practices in their personal profiles, some users actively recruit sexual partners who wish to participate in anal sexual intercourse without the use of condoms, also known as “bareback” sex. Participating in this sexual practice places both sexual partners at higher risk of HIV transmission. In addition, data indicate this behavior is associated with other high-risk activities such as drug use and communication of other sexually transmitted infections. This article summarizes the literature assessing this phenomenon on the Internet. Specific recommendations are provided for clinicians, health educators, and researchers.

Human Papillomavirus and Anorectal Carcinoma Knowledge in Men Who Have Sex With Men

&NA; Human papillomavirus (HPV) infection is a precursor to the development of anorectal carcinoma. Studies have indicated that men who have sex with men (MSM) have significantly higher rates of HPV and HIV than their heterosexual counterparts and are at greater risk for anorectal carcinoma. This article presents findings from a descriptive study to assess knowledge of HPV, anorectal carcinoma, and anorectal screening in a sample of MSM in Orlando, FL. The 89 participants demonstrated knowledge deficits. The average score on knowledge items was only 38% correct. Of the 49 participants who had heard of anal Papanicolau (Pap) smears, only 5 (10.2%) discussed screening with a physician, while 8 (16.3%) had discussed it with a nurse, and 16 (32.7%) with another health care professional. Findings support the need for community outreach efforts to promote knowledge and the need for discussion with providers regarding HPV and anorectal carcinoma in this vulnerable population.

The Relationship Among Population Size, Requests for Bareback Sex, and HIV Serostatus in Men Who Have Sex With Men Using the Internet to Meet Sexual Partners

Recent research has indicated the use of the Internet to meet sexual partners among men who have sex with men (MSM) is increasing. This medium also serves as a major source for social and sexual networking among MSM who live in more rural areas. In addition, data suggest the use of the Internet to initiate sexual relationships among this population may increase the risk of transmission of sexually transmitted infections, including HIV. The purpose of this study was to examine differences between self-reported HIV serostatus and requests for condomless bareback (BB) sex among a sample of Florida MSM (n = 483) using a popular Internet sexual networking site to meet sexual partners. Specifically, these variables were assessed in relation to population size among the sites seven geographic regions within the state. Findings indicated an overall statistically significant relationship among requests for BB sex and self-reported HIV serostatus. However, there was not a significant relationship among these variables and geographic region. Thus, although previous data have emphasized the importance of different HIV prevention strategies among rural versus urban MSM, there may not be major differences in HIV serostatus and requests for unsafe sexual practices among these men who use the Internet to meet sexual partners in comparison to MSM in more populated areas.

Serosorting Sexual Partners by Gay and Bisexual Men to Prevent HIV Infection: Implications for Public Health Clinicians.

The most recent Centers for Disease Control and Prevention epidemiological statistics in the United States demonstrate that gay and bisexual men are at most risk for acquiring new HIV infections. While public health campaigns aimed at gay and bisexual males have resulted in improved HIV screening and greater awareness of the need for safer sex practices, barebacking has become a practice of increasing incidence. This act carries the highest risk of HIV transmission and acquisition; and data suggest HIV disease burden is higher among ethnic minorities. Serosorting-purposely seeking HIV serocordant partners--to help lower risk of HIV infection is common. While this can be a positive step in preventing the spread of HIV, it carries serious threats that must be acknowledged. The purpose of this article was to explore the positive and negative aspects of serosorting in the prevention of HIV, describe ways in which health care providers can approach the topic with clients, provide clinical practice implications, and suggest some direction for future research.

Requests for Safer Sex Among Men Who Have Sex with Men Who Use the Internet to Initiate Sexual Relationships: Implications for Healthcare Providers

ABSTRACT The number of men who have sex with men (MSM) who are using the Internet to initiate sexual relationships is increasing. Research suggests these men might have a higher likelihood of participation in high-risk sexual activities that might place them at greater risk for transmission of sexually-transmitted infections, including HIV. Although a few research studies have assessed higher risk behaviors among this population, studies have not typically focused on safer sex practices. This article presents findings from an original research study designed to assess both high-risk and safer-sex requests among MSM within a sample from Florida (n = 483) who use a popular Internet social networking site to initiate sexual relationships. Although the findings indicated a majority of MSM did not specifically request safe sex only within their profiles, its prevalence was higher in men with a reported negative HIV serostatus. This suggests some HIV-negative MSM are possibly participating in sexually-protectiv...

Vaccination guidelines for gay and bisexual men.

While gay and bisexual men should be vaccinated according to the most recent guidelines, this population also has needs that extend beyond those guidelines. This article explores current vaccination recommendations for gay and bisexual men and provides strategies to reduce barriers to vaccination in this population.

Assessment and treatment of depression in gay and bisexual men in emergency settings.

Gay and bisexual men are at higher risk for certain mental health disorders, including anxiety, depression, and suicide. These individuals often present to emergency settings in need of evaluation and treatment. Despite the utilization of emergency mental health services by this population, clinicians are often underprepared in responding to their unique needs. This article discusses depression in gay and bisexual men and provides an evidence-based approach in treating these men in emergency settings. Directives for future research and advanced practice nursing education are also presented.

Risk for a Price: Sexual Activity Solicitations in Online Male Sex Worker Profiles

ABSTRACT The use of social- and sexual networking-based Web sites designed to provide easy and more anonymous access to sexual partners is rising. The popularity of the use of Web sites by male sex workers to promote their services and find clients is also rising. To date, very little inquiry has been devoted to studying the sexual behaviors solicited within online advertisement profiles of male sex workers and men who have sex with men. This study utilized a widely used popular Internet site designed to advertise to clients and gathered demographic, advertised sexual and nonsexual behaviors, pricing, and safety risk category data from profiles within the state of Florida (n = 163). Pearson chi-square analyses indicated that location and several sexual behaviors were significantly related to how often the men reported the degree to which they had safer sex with clients. These findings suggest some male sex workers do not consistently maintain safer-sex behaviors and that some of these men are engaging in sexual activity while under the influence of drugs. Future recommendations support the need for effective public health outreach that emphasizes the importance of safer sexual decision making.

Certification and education as determinants of nurse practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States

Purpose and background In 2008, a consortium of advanced practice nursing organizations authored the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. The documents aim is to provide guidance for states to adopt uniformity in the regulation of advanced practice registered nurse roles. Despite a target date to complete that work by 2015, there remains an extensive amount of variation in how states define the scope of practice (SOP) for nurse practitioners (NPs). Data sources Based on the National Council of State Boards of Nursing online database, state (N = 51 [includes the District of Columbia]) NP practice acts and/or rules and regulations documents were examined for language describing SOP for NPs consistent with the language of the advanced practice registered nurse (APRN) Consensus Model. Conclusions Results indicated that 18 states and the District of Columbia (37%) had specific regulations defining NP SOP by certification and/or educational preparation while 23 (45%) did not. The remaining nine states (18%) had SOP regulations that were interpreted as being ambiguous in relation to certification and/or educational preparation. Implications for practice The findings suggest much work is needed to ensure NP SOP accurately reflects NP board-certification and graduate educational preparation.Purpose and background:In 2008, a consortium of advanced practice nursing organizations authored the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. The documents aim is to provide guidance for states to adopt uniformity in the regulation of advanced practice registered nurse roles. Despite a target date to complete that work by 2015, there remains an extensive amount of variation in how states define the scope of practice (SOP) for nurse practitioners (NPs). Data sources:Based on the National Council of State Boards of Nursing online database, state (N = 51 [includes the District of Columbia]) NP practice acts and/or rules and regulations documents were examined for language describing SOP for NPs consistent with the language of the advanced practice registered nurse (APRN) Consensus Model. Conclusions:Results indicated that 18 states and the District of Columbia (37%) had specific regulations defining NP SOP by certification and/or educational preparation while 23 (45%) did not. The remaining nine states (18%) had SOP regulations that were interpreted as being ambiguous in relation to certification and/or educational preparation. Implications for practice:The findings suggest much work is needed to ensure NP SOP accurately reflects NP board‐certification and graduate educational preparation.

Preexposure prophylaxis: An emerging clinical approach to preventing HIV in high-risk adults.

The HIV antiretroviral drug emtricitabine/tenofovir disoproxil fumarate (Truvada) was recently approved as preexposure prophylaxis (PrEP) therapy for adults at high risk for sexually acquired HIV infection. This article reviews the data supporting the efficacy of PrEP, and provides other relevant data regarding the implementation of PrEP.