David W. Seal

HIV prevention with young men who have sex with men: What young men themselves say is needed

Young men who have sex with men (YMSM), and particularly ethnic minority YMSM, experience high incidence HIV infection due to continued patterns of high-risk sexual behaviour. The intent of this research was to systematically solicit input and recommendations from YMSM themselves concerning the kinds of HIV prevention programmes that would best meet their needs and would address risk issues they believed are critical. In-depth qualitative interviews were conducted with a sample of 72 purposively selected YMSM to identify necessary components of HIV prevention targeting YMSM. Respondents noted a need for comprehensive HIV prevention programmes that addressed issues related to dating and intimacy, sexuality and arousal, drugs and alcohol, self-esteem and self-worth, abuse and coercion, and sexual identity. Respondents emphasized the importance of keeping programmes confidential, fun, comfortable, accepting and open to all YMSM regardless of sexual identity. Identified community resource needs included safe havens for youth, more peer educators and older MSM mentors, increased school-based sexuality education, and greater support from the society at large as well as from churches, the gay community and communities of Color. Implications of these findings for HIV prevention are discussed.

HIV Sexual Risk Reduction Interventions With Heterosexual Men: The Forgotten Group

This paper reviews published evaluations (through fall 1998) of HIV sexual risk reduction programs conducted in the United States that have targeted adult heterosexual men. The review was limited to studies that provided a male-specific analysis of intervention effects on sexual risk behavior. Fifteen of 20 peer-reviewed studies meeting inclusion criteria demonstrated that HIV sexual risk reduction programs can be effective in reducing mens heterosexual risk behavior, although effect sizes were usually modest. Outcomes varied and included biological markers and self-reported behavior. No clear pattern distinguished effective from ineffective interventions. All intervention types (information-only; condom skills/distribution; behavioral skills–focused; HIV counseling and testing; individual risk counseling; street outreach) showed some efficacy, and there were no discernable differences by targeted population. Both group and individual delivery formats were effective. The review includes a methodologic critique, identifies research gaps, and provides recommendations for future research efforts with heterosexually active men.

Relationship Factors Associated with HIV Risk Among a Sample of Gay Male Couples

More HIV prevention research is needed to better understand how relationship factors may affect sexual risk behaviors among gay male couples. Our cross-sectional study collected dyadic data from 144 gay male couples to examine which relationship factors and characteristics were associated with men having UAI with a secondary sex partner. We targeted male couples by using a variety of recruitment strategies. Multilevel random-effects logistic regression modeling was used to examine which factors were predictive of men in gay couples who had UAI with a secondary sex partner. Analyses revealed that men were less likely to have had UAI with a secondary sex partner if they reported being in a strictly monogamous relationship, receiving an HIV test within the previous 3 months, and being committed to their sexual agreement. Future HIV prevention interventions must consider how relationship factors may influence sexual risk behaviors among gay male couples.ResumenMas investigación de prevención de VIH es necesario para entender mejor como los factores de relaciones de pareja pueden afectar los comportamientos de riesgo sexual en parejas de hombres gay. Nuestro estudio de diseño transversal recogió datos diádicos en una muestra de 144 parejas gay para examinar que factores y características de relación de pareja están asociadas con hombres gay teniendo sexo anal desprotegido con parejas secundaria. Nosotros encontramos parejas de hombres gay usando varias estrategias de reclutamiento. Modelaje con una regresión logística a multinivel para efectos al azar fue usado para examinar los factores que predicen los hombres en relaciones de pareja gay que tienen sexo anal desprotegido con una pareja sexual secundaria. El análisis revelo que era menos probable que los hombres tuvieran sexo anal desprotegido con parejas sexuales secundarias si ellos reportaban ser estrictamente monógamos en sus relaciones de pareja, haber recibido una prueba de VIH en los últimos tres meses o estar comprometidos al acuerdo sexual con su pareja principal. Futuras intervenciones para la prevención de VIH deben considerar la forma en que factores de pareja pueden influir el comportamiento de riesgo sexual en parejas de hombres gay.

The Female Condom: What We Have Learned Thus Far

High rates of sexually transmitted diseases (STDs), including HIV, and unplanned pregnancies persist in the United States. Women are more likely than men to be infected with an STD and to bear the burdens associated with unplanned pregnancies and with STD-associated complications. Condom use is advocated for sexually active individuals. However, for some persons condom use remains infrequent and inconsistent; this is particularly true for women, who may face substantial barriers (e.g., partner aggression) to enacting consistent condom use. The female condom is the only female-controlled barrier method currently available to protect women from STDs and unplanned pregnancies. In this paper, we review and summarize the literature on the female condom with regard to efficacy, use-effectiveness, and acceptability among potential and current users. In addition, we identify gaps in the literature and suggest paths for future research.

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.

Gender roles and HIV sexual risk vulnerability of Roma (Gypsies) men and women in Bulgaria and Hungary: an ethnographic study

Roma, the largest ethnic minority group in Central and Eastern Europe, have cultures that are traditional, often closed, and autonomous of majority populations. Roma communities are characterized by pervasive social health problems, widespread poverty, limited educational opportunities, and discrimination. Although some evidence suggests high levels of HIV sexual risk behaviour among Roma, little is known about the cultural and social context in which risk behaviour occurs. In-depth interviews were used to elicit detailed information about types of sexual partnerships and sexual risk behaviour practices occurring in them, use and perception of protection, knowledge and beliefs about AIDS and STDs, and sexual communication patterns in a sample of 42 men and women aged 18–52 living in Roma community settlements in Bulgaria and Hungary. Analysis of the interview data revealed that men have great sexual freedom before and during marriage, engage in a wide range of unprotected practices with primary and multiple outside partners, and have much more relationship power and control. In contrast, women are expected to maintain virginity before marriage and then sexual exclusivity to their husbands. Condom use is not normative and is mainly perceived as a form of contraception. Although awareness of AIDS was common, it was generally not perceived as a personal threat. Misconceptions about how HIV is transmitted are widespread, and women – in particular – had very little knowledge about STDs, HIV transmission, and protective steps. There is an urgent need for the development of HIV prevention programs culturally sensitive to Roma populations in Eastern Europe, where HIV rates are rapidly rising.

HIV and STD risk behavior among 18- to 25-year-old men released from U.S. prisons: provider perspectives.

Ninety-seven service providers, representing 83 agencies, were interviewed about sexual and drug use HIV/STD risk behaviors and their determinants among young men who have been released from prison. Providers believed that men frequently practiced sexual risk behavior, often in conjunction with substance use. Individual determinants of risk behavior primarily focused on “making up for lost time,” being a man, degree of HIV/STD knowledge and vulnerability, desire to escape, and future orientation. Peers, partners, and family were portrayed as strong interpersonal influences on risk behavior, both positively and negatively. The dominant contextual determinant of risk behavior was the co-occurrence of sex and drug use. Structural determinants of reduced risk included stable housing, economic sufficiency, and positive community support for safer behavior (e.g., drug treatment access, needle exchange). The findings highlight the need for comprehensive, transitional case management for young men as they reintegrate into the community, including HIV/STD prevention.

A Qualitative Study of Substance Use and Sexual Behavior Among 18- to 29-Year-Old Men While Incarcerated in the United States

The article describes men’s perceptions of and experience with substance use and sexual behavior during incarceration. Grounded theory content analyses were performed on qualitative interviews conducted with 80 men, aged 18 to 29, in four U.S. states. Participants believed that drugs were easily available in prison. Half reported using substances, primarily marijuana or alcohol, while incarcerated. Key themes included the role of correctional personnel in the flow of substances in prison and the economic significance of substance traffic king. With regard to sexual behavior, most men acknowledged that it occurred but were hesitant to talk in-depth about it. There was a strong belief in “don’t look, don’t tell,” and sex in prison was often associated with homo sexual behavior or identity. Sex during incarceration was reported by 12 men, mostly with female partners. Participants were pessimistic about HIV/STD/hepatitis prevention efforts inside correctional facilities. These findings highlight the need for risk reduction programs for incarcerated men.

Levels and Predictors of Sexual HIV Risk in Social Networks of Men who Have Sex with Men in the Midwest

Past studies have primarily focused on individual-level factors influencing the HIV risk practices of gay or bisexual men. The role of ones social network has been less explored. This study identified 75 indexes in venues frequented by men who have sex with men and then recruited all willing persons named as members of each indexs egocentric social network. Two hundred fifty-five unique network members completed assessments of risk-related characteristics and also sociometric measures that were used to identify the influence leader of each network. White and African American networks were composed primarily of men of the same race. Over 70% of men reported recent casual sexual partners. About one fourth of men engaged in unprotected anal intercourse (UAI) with a casual partner or with multiple partners in the past 3 months. The social network to which a man belonged, weaker risk reduction intentions, and greater substance use independently predicted a range of high-risk sexual behaviors. There were modest but significant correlations between the risk-related characteristics of network members and network leaders. Social network-level approaches are feasible for reaching hidden subgroups of MSM at high risk for contracting HIV.

Dilemmas in Conducting Qualitative Sex Research in Applied Field Settings

Although resources are available to inform researchers of the many technical skills necessary to conduct qualitative research, individuals working in applied field settings often encounter ethical, moral, and sociopolitical dilemmas that cannot be resolved through the application of technical skills. The purpose of this article is to present examples of dilemmas faced by qualitative research methodologists studying sexual behavior in applied field settings. Possible solutions to these dilemmas are discussed within a theoretical and conceptual frame work. The examples and discussion are organized around four broad topic areas: informed consent, privacy, confidentiality, and personal relationships.