José A. Bauermeister

Sexting Among Young Adults

PURPOSE Sexting has stirred debate over its legality and safety, but few researchers have documented the relationship between sexting and health. We describe the sexting behavior of young adults in the United States, and examine its association with sexual behavior and psychological well-being. METHODS Using an adapted Web version of respondent-driven sampling, we recruited a sample of U.S. young adults (aged 18-24 years, N = 3,447). We examined participant sexting behavior using four categories of sexting: (1) nonsexters, (2) receivers, (3) senders, and (4) two-way sexters. We then assessed the relationships between sexting categories and sociodemographic characteristics, sexual behavior, and psychological well-being. RESULTS More than half (57%) of the respondents were nonsexters, 28.2% were two-way sexters, 12.6% were receivers, and 2% were senders. Male respondents were more likely to be receivers than their female counterparts. Sexually active respondents were more likely to be two-way sexters than non-sexually active ones. Among participants who were sexually active in the past 30 days, we found no differences across sexting groups in the number of sexual partners or the number of unprotected sex partners in the past 30 days. We also found no relationship between sexting and psychological well-being. CONCLUSIONS Our results suggest that sexting is not related to sexual risk behavior or psychological well-being. We discuss the findings of this study and propose directions for further research on sexting.

Gay and Bisexual Men's Use of the Internet: Research from the 1990s through 2013

We document the historical and cultural shifts in how gay and bisexual men have used the Internet for sexuality between the 1990s and 2013—including shifting technology as well as research methods to study gay and bisexual men online. Gay and bisexual men have rapidly taken to using the Internet for sexual purposes: for health information seeking, finding sex partners, dating, cybersex, and pornography. Men have adapted to the ever-evolving technological advances that have been made in connecting users to the Internet—from logging on via dial-up modem on a desktop computer to geo-social-sexual networking via handheld devices. In kind, researchers have adapted to the Internet to study gay and bisexual men. Studies have carefully considered the ethics, feasibility, and acceptability of using the Internet to conduct research and interventions. Much of this work has been grounded in models of disease prevention, largely as a result of the ongoing HIV/AIDS epidemic. The need to reduce HIV in this population has been a driving force to develop innovative research and Internet-based intervention methodologies. The Internet, and specifically mobile technology, is an environment gay and bisexual men are using for sexual purposes. These innovative technologies represent powerful resources for researchers to study and provide outreach.

Barebacking: Intentional Condomless Anal Sex in HIV-Risk Contexts. Reasons for and Against It

ABSTRACT Intentional condomless anal sex in HIV-risk contexts (“barebacking”) has been heatedly debated in gay circles, the gay media, and, to a lesser degree, the mainstream media. Yet it has received little attention in the scientific literature. In order to better understand the reasons behind this behavior, we conducted a content analysis of messages posted on an Internet message board following http://www.Gay.coms decision to close a company-sponsored bareback chat room. Individuals posting messages self-identified in their online profiles as being mostly White/ European gay men residing in the US, with an average age of 35 years. Out of 130 messages, 62 (48%) were pro-barebacking, 55 (42%) were against barebacking, and 13 (10%) referred to other topics. The content analysis of the messages showed that both those in favor of and against barebacking felt well-informed about HIV/AIDS and the risks of HIV transmission. Those in favor considered condomless sex more enjoyable than sex with condoms (both in actual experience and in erotic imagery), felt that condomless sex conferred a sense of freedom, minimized the risks involved in barebacking (assuming that practitioners were already HIV infected and that the risk of superinfection was small), and ultimately believed that barebacking was a personal decision and responsibility. Those against barebacking believed the behavior was dangerous, advocated for condom use and personal and social responsibility, and felt barebackers needed to be sensitized to the burdens of HIV disease. Implications of these results are discussed, pointing out the need for further scientific inquiry in this area.

A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care

AbstracteHealth, mHealth and “Web 2.0” social media strategies can effectively reach and engage key populations in HIV prevention across the testing, treatment, and care continuum. To assess how these tools are currently being used within the field of HIV prevention and care, we systematically reviewed recent (2013–2014) published literature, conference abstracts, and funded research. Our searches identified 23 published intervention studies and 32 funded projects underway. In this synthesis we describe the technology modes applied and the stages of the HIV care cascade addressed, including both primary and secondary prevention activities. Overall trends include use of new tools including social networking sites, provision of real-time assessment and feedback, gamification and virtual reality. While there has been increasing attention to use of technology to address the care continuum, gaps remain around linkage to care, retention in care, and initiation of antiretroviral therapy.

Minimal Awareness and Stalled Uptake of Pre-Exposure Prophylaxis (PrEP) Among at Risk, HIV-Negative, Black Men Who Have Sex with Men

In the United States, rates of HIV infection are highest among black men who have sex with men (BMSM). Pre-exposure prophylaxis (PrEP) is a highly effective form of HIV prevention, but the uptake of this strategy has been slow since FDA approval in 2012, and it is unknown whether information about PrEP is reaching BMSM. Four hundred and thirty-six BMSM in Atlanta, GA were surveyed from January 2012 (6 months prior to PrEP approval) to March 2014 (20 months after approval). Analyses revealed no association between date of survey assessment and awareness of PrEP (20.5% were aware of PrEP before approval and 23.4% were aware after approval; OR=0.99 [0.98-1.02], p=0.952). In a multivariate model, BMSM unaware of PrEP reported lower rates of HIV testing knowledge, fewer experiences with HIV testing, and higher rates of transactional sex than BMSM who were aware of PrEP. Our findings suggest that there is limited understanding of PrEP and that there is considerable groundwork that needs to be achieved in order to reap the full benefits of PrEP. The current findings call attention to the need to both prioritize and better understand how to strengthen the bridge between medical advances and community uptake.

Data Quality in web-based HIV/AIDS research: Handling Invalid and Suspicious Data.

Invalid data may compromise data quality. We examined how decisions made to handle these data may affect the relationship between Internet use and HIV risk behaviors in a sample of young men who have sex with men (YMSM). We recorded 548 entries during the 3-month period and created six analytic groups (i.e., full sample, entries initially tagged as valid, suspicious entries, valid cases mislabeled as suspicious, fraudulent data, and total valid cases) using data quality decisions. We compared these groups on the sample’s composition and their bivariate relationships. Forty-one cases were marked as invalid, affecting the statistical precision of our estimates but not the relationships between variables. Sixty-two additional cases were flagged as suspicious entries and found to contribute to the sample’s diversity and observed relationships. Using our final analytic sample, we found that very conservative criteria regarding data exclusion may prevent researchers from observing true associations. We discuss the implications of data quality decisions and its implications for the design of future HIV/AIDS web surveys.Invalid data may compromise data quality. We examined how decisions taken to handle these data may affect the relationship between Internet use and HIV risk behaviors in a sample of young men who have sex with men (YMSM). We recorded 548 entries during the three-month period, and created 6 analytic groups (i.e., full sample, entries initially tagged as valid, suspicious entries, valid cases mislabeled as suspicious, fraudulent data, and total valid cases) using data quality decisions. We compared these groups on the samples composition and their bivariate relationships. Forty-one cases were marked as invalid, affecting the statistical precision of our estimates but not the relationships between variables. Sixty-two additional cases were flagged as suspicious entries and found to contribute to the samples diversity and observed relationships. Using our final analytic sample (N = 447; M = 21.48 years old, SD = 1.98), we found that very conservative criteria regarding data exclusion may prevent researchers from observing true associations. We discuss the implications of data quality decisions and its implications for the design of future HIV/AIDS web-surveys.

The Intersection of Youth, Technology, and New Media with Sexual Health: Moving the Research Agenda Forward

Youth bear a significant proportion of the sexually transmitted infection (STI)/HIV burden in the United States, CDC, 2010. Available at: http://www.cdc.gov/std/stats09/default.htm, with rates of some STIs increasing among youth of color and young men who have sex with men. Technology use among youth also continues to increase. The ubiquitous nature of technology use among youth offers a multitude of opportunities to promote youth sexual health and to prevent disease transmission and unplanned pregnancies. To date, there have been a handful of peer-reviewed articles published regarding the feasibility, acceptability, and effectiveness of using new media and technology for sexual health promotion. Despite recent publications, there is still a real need for high-quality research to understand the impact of different forms of new media use on youth sexual health, as well as to determine the best ways to harness technology to promote safer sex behaviors, both for the short- and long-term. In March 2011, Internet Sexuality Information Services (ISIS), National Institute of Mental Health (NIMH), and the Ford Foundation convened a meeting of scientists and technology experts to discuss how to effectively conduct sexual health promotion research using new forms of technology. The meeting was structured to cover the following topic areas: (i) research-community partnerships, (ii) institutional review board and ethical issues, (iii) theoretical frameworks, (iv) intervention approaches, (v) recruitment methods, and (vi) assessing impact. Presentations included case studies of successful technology-based HIV/STI prevention interventions for youth, which led to broader discussions on how to conduct research in this area. This article summarizes the meeting proceedings, highlights key points, offers recommendations, and outlines future directions.

Do Parents and Peers Matter? A Prospective Socio-Ecological Examination of Substance Use and Sexual Risk among African American Youth.

We examined the direct contribution of parent and peer risk and promotive factors on youth condom use trajectories, in addition to the indirect influence of these factors via youths substance use over four years in a sample of urban, African American youth (N=679; 51% female; M=14.86 years; SD=0.65). Growth curve modeling was used to estimate changes in substance use and sexual risk across adolescence and test their association with parent and peer factors. Parent and peer risk factors were strongly associated with increasing substance use as youth aged. Substance use and condom use were interrelated. Parent and peer risk factors were indirectly associated with youth condom use; parent and peer promotive factors were directly associated with condom use, after accounting for substance use. Findings suggest the value of considering multiple influences on youth risk behavior.

PrEP Awareness and Perceived Barriers Among Single Young Men who have Sex with Men

Pre-exposure prophylaxis (PrEP) has the potential to help reduce new HIV infections among young men who have sex with men (YMSM). Using a cross-sectional survey of YMSM (N=1,507; ages 18-24), we gauged YMSMs PrEP awareness and PrEP-related beliefs regarding side effects, accessibility, and affordability. Overall, 27% of the sample had heard about PrEP; 1% reported ever using PrEP prior to sex. In a multivariate logistic regression, we found that YMSM were more likely to have heard about PrEP if they were older, more educated, were residentially unstable in the prior 30 days, had insurance, or reported having at least one sexually transmitted infection in their lifetime. We found no differences by race/ethnicity, history of incarceration, or recent sexual risk behavior. In multivariate linear regression models, Black and Latino YMSM were more likely than Whites to state they would not use PrEP because of side effect concerns. YMSM were more likely to indicate that they would not be able to afford PrEP if they did not have insurance or if they had a prior sexually transmitted infection, PrEP rollout may be hindered due to lack of awareness, as well as perceived barriers regarding its use. We propose strategies to maximize equity in PrEP awareness and access if it is to be scaled up among YMSM.

Assessing motivations to engage in intentional condomless anal intercourse in HIV risk contexts ("Bareback Sex") among men who have sex with men.

Although condom use is an effective barrier against HIV transmission, some men who have sex with men (MSM) engage in bareback sex (unprotected anal sex in risky contexts) and increase their risk for HIV (re)infection. Understanding MSMs decision to bareback (vis-à-vis condom use) is essential to develop effective HIV/AIDS prevention programs for this population. An ethnically diverse sample of men who bareback (n = 120) was recruited exclusively on the Internet and stratified to include two thirds who reported both unprotected receptive anal intercourse (URAI) and being HIV uninfected. We used exploratory factor analysis to explore the domains within the Decisional Balance to Bareback (DBB) scale, and test the association between DBB and risky sexual behaviors. HIV-positive MSM (n = 31) reported higher costs/losses associated with condom use than HIV-negative men (n = 89). We found two underlying factors in the DBB scale: a Coping with Social Vulnerabilities subscale (eight items; alpha = .89) and a Pleasure and Emotional Connection subscale (five items; alpha = .92). We found a positive association between DBB (i.e. greater gains associated with bareback sex) and URAI occasions, number of partners, and having one or more sero-discordant partners in the past 3 months. We conclude that because MSM may avoid using condoms in order to cope with psychosocial vulnerabilities and create intimacy with other MSM, this population could benefit from alternatives to condoms such as pre/post exposure prophylaxis and rectal microbicides.