David A. Moskowitz

Tops, bottoms and versatiles

Amongst gay men, the self-label – top, bottom or versatile – reflects the sexual role preference during anal intercourse. This study explored whether this label could predict preferences for other sexual behaviors and the roles within those behaviors. First, the accuracy of the sexual self-label was tested. We confirmed that tops strongly preferred insertive anal intercourse; bottoms, receptive anal intercourse; and versatiles, both behaviors. Further tests showed that sexual self-label was indeed correlated with corresponding roles within sexual behaviors aside from intercourse, e.g. insertive urination or receptive fisting. About 75% of these sexual behaviors followed posited trends: tops being insertive; bottoms, receptive; and versatiles, between the two. Finally, within groups, tops were found to strongly prefer playing insertive rather than receptive roles; bottoms strongly prefer playing receptive to insertive roles; and versatiles were found to have an equal preference for playing both.

Relationship Factors Associated with Gay Male Couples’ Concordance on Aspects of Their Sexual Agreements: Establishment, Type, and Adherence

Factors associated with gay male couples’ concordance on aspects of sexual agreements remain understudied. The present study examined which relationship factors, self-reports of UAI, and patterns of HIV testing may be associated with men who were concordant about having a sexual agreement, the same type of sexual agreement, and adhering to their sexual agreement with their main partner. Various recruitment strategies were used to collect dyadic data from 142 gay male couples. Concordance on aspects of sexual agreements varied within the sample. Results indicated that relationship satisfaction was significantly associated with couples who were concordant about having and adhering to their sexual agreement. Predictability and faith of trusting a partner, and value in one’s sexual agreement were also positively associated with couples’ adhering to their sexual agreement. More research is needed to better understand how relationship dynamics, including sexual agreements, affect HIV risk among gay male couples in the U.S.ResumenFactores asociados a concordancia de aspectos en acuerdos sexuales entre parejas gay no han sido suficientemente investigados. Este estudio examina factores de relación de pareja, auto-reportes de sexo anal desprotegido y patrones de pruebas de VIH que pueden estar asociados a concordancia en tener un acuerdo sexual, el tipo de acuerdo, y adherencia al acuerdo con su pareja principal. Se usaron varias estrategias de reclutamiento para recoger data diádica en 142 parejas de hombres gay. Concordancia en aspectos de acuerdos sexuales variaron en esta muestra. Los resultados indican que satisfacción con la relación está asociado a concordancia en tener y adherirse al acuerdo sexual. Predecibilidad y fe en la confiabilidad de la pareja y valorización del acuerdo están positivamente asociados a adherencia al acuerdo sexual. Más investigación es necesaria para entender como las dinámicas de relación, incluyendo acuerdos sexuales, afectan el riesgo de VIH en parejas gay en los EE.UU.

The influence of physical body traits and masculinity on anal sex roles in gay and bisexual men.

Sociological, psychological, and public health studies document that many gay and bisexual men may self-label by their anal penetrative role (i.e., bottom or exclusively receptive; top or exclusively insertive; or versatile, both receptive and insertive during anal intercourse). Yet, what orients men to think of themselves as tops, bottoms or versatiles is poorly understood. We surveyed 429 men engaging in same-sex anal intercourse to investigate the degree to which anal penetrative self-identity was concordant with actual penetrative behavior. Additionally, the roles of masculinity and physical body traits (e.g., penis size, muscularity, height, hairiness, and weight) were tested as correlates of anal penetrative identity and identity-behavior concordance. Tops and bottoms showed a high degree of concordance between identity and enacted behavior; however, only half of versatiles reported concordant identity and behavior (i.e., wanting to be versatile and actually reporting versatile behavior). Generally, tops reported larger penises than bottoms. They also reported being comparatively more masculine than bottoms. Versatiles fell somewhat between the tops and bottoms on these traits. Of the six independent variables, penis size and masculinity were the only two factors to influence concordance or discordance between identity and penetrative behavior. Our study suggests that the correlates of gay men’s sexual self-labels may depend on objective traits in addition to the subjective pleasure associated with receptive or insertive anal intercourse.

PowerON: the use of instant message counseling and the Internet to facilitate HIV/STD education and prevention.

OBJECTIVE In recent years, Internet-based or online counseling has emerged as an effective way to assess psychological disorders and discuss destructive behaviors with individuals or groups of individuals. This study explores the application of online counseling to HIV/STD risk-taking behavior among men who have sex with men (MSM). METHODS PowerON, an organization that provides sexual health information to MSM exclusively online, used instant message technology to counsel MSM in real time through computer-mediated means. A sample of 279 transcripts of instant message exchanges between PowerON counselors and Gay.com users were recorded and qualitatively analyzed. RESULTS Approximately 43% of the instant message sessions discussed information about HIV/STD testing. Risk-taking behaviors were addressed in 39% of the sessions. Information about HIV/STDs and general counseling were given in 23% and 18% of the counseling sessions, respectively. CONCLUSION The data showed these instant message sessions to be a potentially feasible forum for HIV/STD counseling. PRACTICE IMPLICATIONS Information ordinarily disseminated at health clinics could be successfully distributed through the Internet to MSM.

Heterosexual Attitudes Toward Same-Sex Marriage

Negative attitudes of heterosexual people toward same-sex marriage relate to the degree to which they are homophobic. However, it has been understudied whether there exists a gender difference in this association. Our results indicated that homophobia was the best predictor of attitudes toward gay male and lesbian marriage, and this was equally true for both heterosexual men and women. However, the attitudinal difference between gay male and lesbian marriage was related to homophobia in men but not in women. That is, for men only, being less homophobic toward lesbians than toward gay men was associated with favoring lesbian over gay men marriage. Considering these results, the role of gender in attitudes toward same-sex marriage seems to be as an important moderator of homophobia.

“GWM Looking for Sex—SERIOUS ONLY”: The Interplay of Sexual Ad Placement Frequency and Success on the Sexual Health of “Men Seeking Men” on Craigslist

Over the past few years, researchers have begun to explore the use of the personals section on Craigslist.org as it applies to the sexual behaviors and partner accrual of men who have sex with men (MSM). Yet, the exact ramifications of such a free sexual advertisement service on MSMs sexual health and sexual risk-taking behaviors are just being documented. As such, we surveyed 535 men by responding to their sexual ads placed on Craigslist.org to assess their sexual health and sexual health behaviors. Using Self-Efficacy Theory as our foundation, we posited that MSM who placed more ads and reported more success from these ads would also report more negative health behaviors (e.g., lowered condom use) and sexually transmitted diseases. Testing confirmed this hypothesis. This study has two important implications. (1) The behavior of Internet cruising, on its own, insufficiently impacted MSM health. It was the interaction of number of ads (self-efficacy) and the success of those ads (outcome-efficacy) that ultimately contributed to negative health behaviors. (2) MSM may have had different intentions for cruising. The anti-theoretical tendency for some men to continually place high numbers of ads while also reporting very low success suggested that the outcome of merely placing the ads might be sufficiently erotic for some men.

The Ultimate High: Sexual Addiction and the Bug Chasing Phenomenon

This study sought to explain the existence of a controversial subculture of gay men, a group whose main attribute is an active desire to voluntarily contract HIV. The following research reasons “bug chasing” as being symptomatic of sexual addiction. A quasi-randomized survey of personal advertisements of HIV-negative bug chasers and barebackers—gay men who intentionally eschew condom use without the desire to seroconvert—revealed that chasers were: (a) considerably different from their barebacker counterparts regarding paraphiliac activities, and (b) significantly more likely than barebackers to rank higher on behavioral and psychological measures of sexual addiction.

The Role of Media and the Internet on Vaccine Adverse Event Reporting: A Case Study of Human Papillomavirus Vaccination

PURPOSE This study aimed to determine the temporal association of print media coverage and Internet search activity with adverse events reports associated with the human papillomavirus vaccine Gardasil (HPV4) and the meningitis vaccine Menactra (MNQ) among United States adolescents. METHODS We used moderated linear regression to test the relationships between print media reports in top circulating newspapers, Internet search activity, and reports to the Vaccine Adverse Event Reporting System (VAERS) for HPV4 and MNQ during the first 2.5 years after Food and Drug Administration approval. RESULTS Compared with MNQ, HPV4 had more coverage in the print media and Internet search activity, which corresponded with the frequency of VAERS reports. In February 2007, we observed a spike in print media for HPV4. Although media coverage waned, Internet search activity remained stable and predicted the rise in HPV4-associated VAERS reports. CONCLUSIONS We demonstrate that media coverage and Internet search activity, in particular, may promote increased adverse event reporting. Public health officials who have long recognized the importance of proactive engagement with news media must now consider strategies for meaningful participation in Internet discussions.

The existence of a bug chasing subculture.

This study attempted to authenticate the existence of a controversial subculture of gay men, the ‘bug chasers’, whose main attribute is an active desire to voluntarily contract the human immunodeficiency virus (HIV), and examine the tenacity with which this subculture actually searches for seroconversion. Using a quasi‐randomized survey of personal profiles, bug chasers were compared against barebackers, a culture of gay men that practice intentional unprotected anal intercourse. Bug chasers were authenticated as an observable subculture of barebackers where most reported apathy to the serostatus of their partner or an active want of a serodiscordant partner, and a preference towards practicing unprotected anal intercourse. As anticipated, two subgroups with varying tenacities were found within the sample of bug chasers. Apathetic chasers were found only to be in search of partners with sero‐ambiguous status. Ardent chasers were found only to be in search of certifiably serodiscordant partners.

The cumulative effects of medication use, drug use, and smoking on erectile dysfunction among men who have sex with men.

INTRODUCTION Erectile dysfunction (ED) is highly prevalent among human immunodeficiency virus-seropositive (HIV+) men who have sex with men (MSM). There is a need for additional research to determine the correlates of HIV+ and HIV-seronegative (HIV-) MSM, especially regarding nonantiretroviral medication use. AIMS This study examined the prevalence of ED and the sociodemographic, medical conditions, medication use, and substance use correlates of ED among HIV+ and HIV- MSM. METHODS A modified version of the International Index of Erectile Function (IIEF) for MSM was self-administered by participants enrolled in the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural and treated histories of HIV infection among MSM in the United States. The study sample included 1,340 participants, including 612 HIV+ and 728 HIV- men. Poisson regression with robust error variance was used to estimate prevalence ratios of ED in multivariable models in combined (HIV+/-) and separate analyses. MAIN OUTCOME MEASURE ED was determined by the summed scores of a modified version of the IIEF validated among MSM. RESULTS Twenty-one percent of HIV+ MSM and 16% of HIV- MSM reported ED. Being >55 years of age, black race, cumulative pack years of smoking, cumulative antihypertensive use, and cumulative antidepressant use had significant positive associations with the prevalence of ED in the total sample. Among HIV+ men, duration of antihypertensive use and antidepressant use were significantly associated with increasing prevalence of ED. Among HIV- men, being >55 years of age, black race, and cigarette smoking duration were associated with increased prevalence of ED. CONCLUSION Predictors of ED may differ by HIV status. Although smoking cessation and effective medication management may be important as possible treatment strategies for ED among all MSM, there may be a burden on sexual functioning produced by non-HIV medications for HIV+ men.