Juline A. Koken

Experiences of familial acceptance-rejection among transwomen of color.

Because of the stigma associated with transgenderism, many transwomen (biological males who identify as female or transgender) experience rejection or abuse at the hands of their parents and primary caregivers as children and adolescents. The Parental Acceptance-Rejection (PAR) theory indicates that a childs experience of rejection may have a significant impact on their adult lives. The purpose of this study was to conduct a qualitative analysis of adult transwomen of colors experiences with caregivers, guided by PAR theory. Twenty transwomen of color completed semi-structured interviews exploring the reaction of their parents and primary caregivers to their gender. While many participants reported that at least one parent or close family member responded with warmth and acceptance, the majority confronted hostility and aggression; reports of neglect and undifferentiated rejection were also common. Many transwomen were forced out of their homes as adolescents or chose to leave, increasing their risk of homelessness, poverty, and associated negative sequelae. Future research is needed to explore how families come to terms with having a transgender child and how best to promote acceptance of such children.

The use of the Internet by gay and bisexual male escorts: sex workers as sex educators

While prior studies have targeted street-based male sex workers as potential vectors of disease transmission, the number of men who work independently through Internet chat-rooms and other online endeavors has steadily increased. It is likely that these men differ substantially from their street-based counterparts in terms of sexual risk behaviors with their clients. The purpose of this study was to explore the ways in which the Internet has impacted the work of male escorts and their sexual practices with clients. Semi-structured qualitative interviews and quantitative surveys were administered to 46 such men. Less than half the men reported unprotected anal sex with clients. The qualitative data lend support to this finding, in that the majority talked about refusing any unsafe sex with clients, and many reported taking the extra step of educating their clients about the dangers of risky sex. Some of the escorts described the methods used to incorporate safer sex practices into sessions with their clients. Internet-based male escorts can play an important role as potential sex educators on the front lines of the fight against HIV and other sexually transmitted infections.

Factors related to childhood sexual abuse among gay/bisexual male Internet escorts

ABSTRACT This exploratory investigation examined the relationship between childhood sexual abuse (CSA) and related psychosocial characteristics and sexual behaviors among 46 gay/bisexual male escorts who advertise via the Internet. More than a quarter of men (28.3%) reported some history of CSA. Men reporting CSA were more likely to be from an ethnic minority group, identify as bisexual, have a primary male partner, and were less likely to identify an anal receptive (“bottom”) sexual role preference. Men with a history of CSA were more likely to report unprotected sex with work-related partners, increased internalized homophobia, and decreased adolescent isolation. Interventions designed for male escorts with a history of CSA should emphasize safer sex strategies with work partners and reducing internalized homophobia.

Perspectives on substance use and disclosure among behaviorally bisexual black men with female primary partners.

Black men who have sex with men and women (MSMW) are believed to be a bridge to HIV infection among heterosexual Black women, and substance use can increase the risk of infection among men. However, empirical evidence on the social context of MSMWs sexual behavior and substance use is needed. This study examines the perspectives of Black MSMW with female primary partners on the role of substance use in their sexual encounters with men and their reasons for disclosing or not disclosing this behavior to their female partners. Findings can inform culturally relevant HIV prevention interventions for this population.

A feasibility study of motivational interviewing for health risk behaviors among thai youth living with HIV

hailandisamongthefewless-developedcountrieswith successful HIV prevention among segments ofthe population (National AIDS Prevention andAlleviation Committee, 2010). However, the successof HIV prevention among Thai adolescents andyoung adults has been questionable. The highestpercentage of Thai persons with AIDS remain inthe age group of 25–34 years, indicating that thetime of greatest HIV acquisition has occurred inadolescence and young adulthood (Thai WorkingGroup on HIV/AIDS, 2010). Most Thai youth livingwith HIV (TYLH) acquire HIV through sexualcontact (National AIDS Prevention and AlleviationCommittee, 2010). In a study of TYLH, only half re-ported consistent condom use in the previous 30 days(Rongkavilit et al., 2007); therefore, secondaryprevention targeting sexual risk behaviors in TYLHare needed.Behavioral intervention research targeting youthwith HIV in less-developed countries remains non-existent. An intervention that is brief, culturallyacceptable, and can increase young people’s intrinsicmotivation to reduce risk behaviors and maintainthese changes over time is critically neededfor this setting. Motivational interviewing (MI),an empirically supported behavioral counselingapproach, targets an individual’s intrinsic motivationfor change by exploring and resolving ambivalenceabout behavior change while supporting theindividual’s self-efficacy and autonomy for makingchanges. The MI approach can impact the informa-tion, motivation, and behavioral skills necessary toachieve a behavior change according to theInformation-Motivation-Behavioral Skills model(Fisher & Fisher, 1992). MI has been successfully

Male Clients of Male Escorts: Satisfaction, Sexual Behavior, and Demographic Characteristics

Few studies have examined male clients who pay for sex with male escorts. In 2012, clients (n = 495) completed an online survey about their most recent hire. Most clients were White/Caucasian (87.7%), HIV negative (89.5%), employed full time (71.1%), single (58.6%), with a mean age of 54. Three-quarters of clients were gay identified, 18% bisexual, and 4% heterosexual. The median rate paid to escorts was

A Cross-Cultural Three-Step Process Model for Assessing Motivational Interviewing Treatment Fidelity in Thailand

250 per hour with a modal appointment time of 1 to 2 hours (41.6%). Oral sex was common (80% gave, 69% received), 30% reported anal insertive sex, and 34% reported anal receptive sex. In total, few (12%) reported unprotected anal sex. Satisfaction with encounters was high. Receptive unprotected anal intercourse was associated with greater satisfaction in bivariate analyses but not in multivariable analyses. In a multivariable model, having receptive anal sex (whether protected or not) and rating the financial cost of the encounter as “worth it” were significantly associated with greater satisfaction. This study contributes to a scarce literature regarding clients of male sex workers and, in particular, provides information on the characteristics of men hiring men for sexual services, behavioral event-level data about their encounters, and analysis of factors directly associated with client satisfaction.

The Experience of Stigma in the Lives of Male Internet Escorts

The provision of culturally relevant yet evidence-based interventions has become crucial to global HIV prevention and treatment efforts. In Thailand, where treatment for HIV has become widely available, medication adherence and risk behaviors remain an issue for Thai youth living with HIV. Previous research on motivational interviewing (MI) has proven effective in promoting medication adherence and HIV risk reduction in the United States. However, to test the efficacy of MI in the Thai context a feasible method for monitoring treatment fidelity must be implemented. This article describes a collaborative three-step process model for implementing the MI Treatment Integrity (MITI) across cultures while identifying linguistic issues that the English-originated MITI was not designed to detect as part of a larger intervention for Thai youth living with HIV. Step 1 describes the training of the Thai MITI coder, Step 2 describes identifying cultural and linguistic issues unique to the Thai context, and Step 3 describes an MITI booster training and incorporation of the MITI feedback into supervision and team discussion. Throughout the process the research team collaborated to implement the MITI while creating additional ways to evaluate in-session processes that the MITI is not designed to detect. The feasibility of using the MITI as a measure of treatment fidelity for MI delivered in the Thai linguistic and cultural context is discussed.