Iván C. Balán

Race-Based Sexual Stereotyping and Sexual Partnering Among Men Who Use the Internet to Identify Other Men for Bareback Sex

This qualitative study used sexual scripting theory to explore sexual stereotyping and sexual partnering practices among a racially diverse sample of men who use the Internet to engage in “bareback” sex with other men. The sample included 81 (73%) HIV-negative and 30 (27%) HIV-positive men who were recruited on Web sites where men seek other men to have bareback sex. Participants completed a semi-structured interview that included topics on their racial identification, their sexual experiences tied to race, and their experiences having sex with men of different racial groups. The findings suggested that a variety of race-based sexual stereotypes were used by participants. Sexual stereotyping appeared to directly and indirectly affect the sexual partnering decisions of participants. Sexual scripts may reinforce and facilitate race-based sexual stereotyping, and this behavior may structure sexual networks.

Knowledge and acceptability of alternative HIV prevention bio-medical products among MSM who bareback.

Abstract Condom use is the best available strategy to prevent HIV infection during sexual intercourse. However, since many people choose not to use condoms in circumstances in which HIV risk exists, alternatives to condom use for HIV prevention are needed. Currently there are several alternative bio-medical HIV-prevention products in different stages of development: microbicides, vaccines, post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). Seventy-two men who have sex with men (MSM) who took part in a study on Internet use and intentional condomless anal intercourse were asked about these four products during a semi-structured interview. The questions explored knowledge and acceptability of all the products and willingness to participate in microbicide and vaccine trials. Qualitative analysis of the data suggests that these men had virtually no knowledge of PrEP, very limited knowledge of microbicides, some information about PEP and considerably more knowledge about vaccines. Reactions towards the products were generally positive except for PrEP, for which reactions were polarized as either enthusiastic or negative. With the exception of PrEP, many men expressed willingness to use the products in the future. Most men would be willing to participate in trials for microbicides and vaccines if given basic reassurances. Concerns over negative side effects and preoccupation with possible infection were some of the motives given for non-willingness to participate in a vaccine trial. These results should inform the development of future trials of biomedical prevention products.

Will Gay and Bisexually Active Men at High Risk of Infection Use Over-the-Counter Rapid HIV Tests to Screen Sexual Partners?

The Food and Drug Administration may license OraQuick™, a rapid HIV test, for over-the-counter (OTC) sale. This study investigated whether HIV-uninfected, non-monogamous, gay and bisexual men who never or rarely use condoms would use the test with partners as a harm-reduction approach. Sixty participants responded to two computer-assisted self-interviews, underwent an in-depth interview, and chose whether to test themselves with OraQuick. Over 80% of the men said they would use the kit to test sexual partners or themselves if it became available OTC. Most participants understood that antibody tests have a window period in which the virus is undetectable, yet saw advantages to using the test to screen partners; 74% tested themselves in our offices. Participants offered several possible strategies to introduce the home-test idea to partners, frequently endorsed mutual testing, and highlighted that home testing could stimulate greater honesty in serostatus disclosure. Participants drew distinctions between testing regular versus occasional partners. Non-monogamous men who have sex with men, who never or rarely use condoms, may nevertheless seek to avoid HIV. Technologies that do not interfere with sexual pleasure are likely to be used when available. Studies are needed to evaluate the advantages and disadvantages of using OTC rapid HIV tests as one additional harm-reduction tool.

A randomized controlled trial to test an HIV-prevention intervention for Latino gay and bisexual men: lessons learned.

At the time of this writing, no randomized controlled trial (RCT) of an intervention to reduce unsafe sex among Latino gay and bisexual men (LGBM) had been published. We report the results of an RCT conducted in New York City in which 180 LGBM were assigned either to an intervention developed specifically for this population or to a wait-list control group. The intervention was based on empowerment theory and used factors identified in prior research as determinants of unsafe sex. By eligibility criteria, all men had engaged in unprotected anal intercourse (UAI) within two months of the baseline assessment. At first (two months) and second (six months later) follow-up assessments, approximately half of the men in the experimental group reported no UAI. Yet, a similar proportion of the control group also reported no UAI. Baseline data indicate that although the men had been the subject of social oppression and sexual prejudice (homophobia), they did not feel disempowered, externally controlled or fatalistic, and they reported self-efficacy and intentionality to enact safer sex. Lessons learned are discussed, as well as notes of caution for future research employing a similar conceptual framework.

Sexual Pleasure and Intimacy Among Men Who Engage in “Bareback Sex”

An ethnically diverse sample of 120 mostly gay-identified men who engaged in “bareback” intercourse was recruited via the Internet in New York City. By study design three quarters of participants were HIV-uninfected and engaged in condomless receptive anal intercourse. In the course of face-to-face in-depth interviews, participants were asked what led them to have their first bareback experience as well as to continue with the behavior. Qualitative analysis identified the pivotal role that sexual pleasure and intimacy have in this population and how drives for sexual satisfaction, adventure, intimacy, and love overpower health concerns and condom use recommendations. Men interested in bareback sex use a variety of defense mechanisms to account for, justify, and exonerate their behavior. HIV-prevention interventions have paid insufficient attention to libidinal drives, a crucial element of psychological functioning.

HIV and Other Sexually Transmitted Infections among Men Who Have Sex with Men Recruited by RDS in Buenos Aires, Argentina: High HIV and HPV Infection

Background The aim of this study was to estimate the prevalence of HIV and other STIs, among MSM from Buenos Aires (2007–2009). Methods Responding Driven Sampling was used for recruitment of MSM. Participants completed a structured web-based survey and provided biological samples. Results A total of 496 MSM were studied for HIV, HBV, HCV, and T pallidum infections. Chlamydia and HPV diagnoses were only performed in 98 and 109 participants, respectively. Prevalence of HIV was 17.3%, HBV 22.9%, HCV 7.5%, T pallidum 20.5%, HPV 83.5%, and C trachomatis 1.7%. In the year prior to the evaluation, 71% of the participants had had sex with men and/or trans and women (MMW) while 29% had not had sex with women (MM). Comparing MM to MMW, prevalence of HIV (30.7% vs. 11.9%, p<0.001), HBV (36.4% vs. 17.8%, p<0.001), T pallidum (32.1% vs. 15.7%, p<0.001), and HPV (88.3% vs. 70.4%, p = 0.039) were significantly higher among MM, whereas no significant differences were found for HCV and C trachomatis. The MM group had also significantly higher HIV incidence (5.60 vs. 4.28 per 100 persons-year, p = 0.032). HPV genotypes 16, 6, and 11 were the most frequently found; 40.7% of the MSM had more than one genotype and one high risk genotype was detected in 43.6% of participants. Conclusions Both MM and MMW are at high risk of infection for HIV and other STIs. Rates of HIV, HBV, T pallidum and HPV infections are higher in the MM group.

Use of Respondent Driven Sampling (RDS) Generates a Very Diverse Sample of Men Who Have Sex with Men (MSM) in Buenos Aires, Argentina

Background Prior research focusing on men who have sex with men (MSM) conducted in Buenos Aires, Argentina, used convenience samples that included mainly gay identified men. To increase MSM sample representativeness, we used Respondent Driven Sampling (RDS) for the first time in Argentina. Using RDS, under certain specified conditions, the observed estimates for the percentage of the population with a specific trait are asymptotically unbiased. We describe, the diversity of the recruited sample, from the point of view of sexual orientation, and contrast the different subgroups in terms of their HIV sexual risk behavior. Methodology 500 MSM were recruited using RDS. Behavioral data were collected through face-to-face interviews and Web-based CASI. Conclusion In contrast with prior studies, RDS generated a very diverse sample of MSM from a sexual identity perspective. Only 24.5% of participants identified as gay; 36.2% identified as bisexual, 21.9% as heterosexual, and 17.4% were grouped as “other.” Gay and non-gay identified MSM differed significantly in their sexual behavior, the former having higher numbers of partners, more frequent sexual contacts and less frequency of condom use. One third of the men (gay, 3%; bisexual, 34%, heterosexual, 51%; other, 49%) reported having had sex with men, women and transvestites in the two months prior to the interview. This population requires further study and, potentially, HIV prevention strategies tailored to such diversity of partnerships. Our results highlight the potential effectiveness of using RDS to reach non-gay identified MSM. They also present lessons learned in the implementation of RDS to recruit MSM concerning both the importance and limitations of formative work, the need to tailor incentives to circumstances of the less affluent potential participants, the need to prevent masking, and the challenge of assessing network size.

Relationship between psychiatric disorders and sexually transmitted diseases in a nationally representative sample

OBJECTIVE Sexually transmitted diseases (STDs) are a significant public health concern. Numerous internalizing and externalizing psychiatric disorders have been found to be related to STD risk. However, to date, no studies have examined several psychiatric disorders simultaneously to account for STD risk. Given that psychiatric disorders often co-occur and can be explained by a limited number of latent dimensions of psychopathology, it is important to examine whether the relationship between STDs and psychiatric disorders is best explained by broad dimensions of psychopathology. METHODS The current study examined the associations between a range of Axis I and II psychiatric disorders at baseline and rates of STDs at a three-year follow-up in a large, nationally representative sample of adults in the United States (n=34,434). A confirmatory factor analysis (CFA) was conducted to fit three factors, two internalizing and one externalizing. Structural equation modeling (SEM) was used to assess the relationships between and among the factors and STD status and to test for mediation. RESULTS In bivariate analyses, most Axis I and Axis II disorders were associated with STD diagnosis at Wave 2, whereas the results of the structural model showed that only the externalizing factor was significantly associated with STD diagnosis at Wave 2. Further, the externalizing factor mediated the relationship between one of the internalizing factors and STD diagnosis. CONCLUSION Findings suggest the unique contribution of externalizing psychopathology to STD risk and the importance of examining latent dimensions of disorders when understanding this relationship between psychiatric disorders and STDs.

Attitude and Behavior Changes Among Gay and Bisexual Men After Use of Rapid Home HIV Tests to Screen Sexual Partners

Abstract HIV testing can now be self-administered outside clinical settings through the purchase of home testing (HT) kits. Individuals also can use the kits to perform a test on a potential sexual partner prior to intercourse. We provided a 3-month supply of HT kits to men who reported multiple male partners and little or no condom use for anal intercourse. Participants used the test kits with partners in over 100 occasions. At the end of the study, approximately half of the participants described shifts in their attitudes and/or behaviors related to sexual risk. Reported changes included increased awareness of risk, increased discussion of STI/HIV safety measures, changes in partner choice and heightened consciousness of partner thinking. Easy access to HT kits may be a risk-reduction strategy for men with a high risk profile because their regular use could have an impact beyond the specific sexual encounter.ResumenActualmente, las personas pueden comprar libremente la prueba para el VIH y auto-administrársela fuera del ámbito clínico. Asimismo, pueden ofrecer la prueba a una pareja potencial antes de tener relaciones sexuales. En un estudio, hombres que declararon tener múltiples parejas masculinas y escaso uso de condones para el coito anal, recibieron una cantidad de kits durante tres meses. Los kits fueron utilizados con parejas en más de 100 ocasiones. Al final del estudio, aproximadamente la mitad de los participantes describieron cambios en sus actitudes y/o conductas relacionadas al riesgo sexual. Los cambios relatados incluyeron: mayor conciencia del riesgo, discusiones más frecuentes de medidas de seguridad para evitar infecciones, alteraciones en el tipo de pareja buscada y mayor conciencia de los pensamientos de las parejas. Facilitar el acceso a las pruebas para el VIH puede ser una estrategia preventiva prometedora para hombres con un perfil de riesgo alto, ya que su uso regular puede tener un impacto más allá del encuentro sexual específico.

Anticipated and Actual Reactions to Receiving HIV Positive Results Through Self-Testing Among Gay and Bisexual Men

We explored anticipated and actual reactions to receiving HIV positive results through self-testing with a diverse group of 84 gay and bisexual men in New York City. Grounded Theory was used to investigate these reactions in a two-phase study, one hypothetical, followed by a practical phase in which self-tests were distributed and used. Three major themes emerged when participants were asked about their anticipated reactions to an HIV positive self-test result: managing emotional distress, obtaining HIV medical care, and postponing sexual activity. When participants were asked about their anticipated reactions to a partner’s HIV positive self-test result, five themes emerged: provide emotional support; refrain from engaging in sex with casual partner; avoid high-risk sexual activity with both main and casual partners; seek medical services; and obtain a confirmatory test result. Although none of the participants tested positive, seven of their partners did. Participants provided emotional support and linked their partners to support services. The availability of HIV self-testing kits offers potential opportunities to tackle HIV infection among individuals with high-risk practices.ResumenExploramos las reacciones anticipadas y que ocurrieron al recibir un resultado de VIH positivo con el uso de la prueba de auto test de VIH en un grupo diverso de 84 hombres gay y bisexuales en la ciudad de Nueva York. Usamos la Teoría Fundamental para investigar estas reacciones en un estudio de dos fases, una fase hipotética, y la otra práctica en la cual las pruebas de auto test de VIH fueron distribuidas y usadas. Tres temas generales surgieron cuando le preguntamos a los participantes acerca de cómo ellos reaccionarían a un resultado positivo como resultado del uso de la prueba de auto test de VIH: brindar apoyo emocional, buscar atención médica para el VIH, y evitar la actividad sexual. En cuanto a sus reacciones en caso de que su pareja recibiera un resultado positivo, hubo cinco temas: brindar apoyo emocional; evitar la actividad sexual riesgosa con la pareja casual; participar en actividades sexuales no riesgosas con la pareja principal y casual; conectar a la pareja con servicios médicos; y el deseo de obtener una prueba confirmatoria para el VIH. Aunque ninguno de los participantes resultó ser positivo, siete de sus parejas sí recibieron resultados positivos. Los participantes que se encontraron en esta situación hablaron de cómo brindar apoyo emocional y conectar a la pareja con servicios de apoyo. La disponibilidad de la prueba casera ofrece oportunidades para abordar la infección del HIV en individuos con prácticas de alto riesgo.