Martin J. Downing

Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally bisexual men.

OBJECTIVE Although bisexual men report lower levels of mental health relative to gay men, few studies have examined the factors that contribute to bisexual mens mental health. Bisexual men are less likely to disclose, and more likely to conceal (i.e., a desire to hide), their sexual orientation than gay men. Theory suggests that this may adversely impact their mental health. This report examined the factors associated with disclosure and with concealment of sexual orientation, the association of disclosure and concealment with mental health, and the potential mediators (i.e., internalized homophobia, social support) of this association with mental health. METHOD An ethnically diverse sample of 203 non-gay-identified, behaviorally bisexual men who do not disclose their same-sex behavior to their female partners were recruited in New York City to complete a single set of self-report measures. RESULTS Concealment was associated with higher income, a heterosexual identification, living with a wife or girlfriend, more frequent sex with women, and less frequent sex with men. Greater concealment, but not disclosure to friends and family, was significantly associated with lower levels of mental health. Multiple mediation analyses revealed that both internalized homophobia and general emotional support significantly mediated the association between concealment and mental health. CONCLUSIONS The findings demonstrate that concealment and disclosure are independent constructs among bisexual men. Further, they suggest that interventions addressing concerns about concealment, emotional support, and internalized homophobia may be more beneficial for increasing the mental health of bisexual men than those focused on promoting disclosure.

Using the Internet in Pursuit of Public Sexual Encounters Is Frequency of Use Associated With Risk Behavior Among MSM

The current study investigated a subgroup of 112 men who have sex with men who use the Internet in search of partners for sex venue encounters to understand what types of venues they frequent and whether their behaviors are associated with an increased risk of HIV/STI transmission. An initial cluster analysis revealed two patterns of Internet use—low and high frequency—among these men. Although frequency of Internet use to find partners for venue encounters did not cluster with venue attendance, there was a trend among high-frequency Internet users to attend gyms, public bathrooms, and sex clubs more than low-frequency users. Furthermore, high-frequency users attended more venues, preferred venues where multiple partners can be found, and were marginally more likely to engage in unprotected anal sex across venues compared with low-frequency users. Knowing that some venue users initiate venue encounters on the Internet may be useful in targeting appropriate HIV/STI interventions.

Socially-Integrated Transdisciplinary HIV Prevention

Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make “treatment as prevention” more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.ResumenLas ideas actuales sobre prevención del VIH incluyen una mezcla de intervenciones biomédicas primariamente -, intervenciones socio-mecánicas tales como la distribución de jeringas estériles y preservativos e intervenciones conductuales. Este artículo presenta un marco transdisciplinario y socialmente integrado para la prevención del VIH que puede mejorar los esfuerzos de prevención actuales. En primer lugar, se describe un proyecto de intervención transdisciplinario socialmente integrado: Proyecto de Intervención para Reducción de Transmisión. Nos centramos en cómo los aspectos sociales de la intervención integran sus componentes en todas las disciplinas y los procesos en diferentes niveles de análisis. A continuación, presentamos las perspectivas socialmente integradas sobre cómo mejorar los procesos de tratamiento antirretroviral combinado (TARC) a nivel de la población con el fin de resolver los problemas de cascada de tratamiento y hacer “tratamiento como prevención” más eficaz. Finalmente, se discuten algunos problemas pendientes en la descrita intervención transdisciplinaria en la esperanza de que otros investigadores y agentes de salud pública desarrollen otras intervenciones socialmente integradas para el VIH y otras enfermedades.

Reasons for Non-Disclosure of Sexual Orientation Among Behaviorally Bisexual Men: Non-Disclosure as Stigma Management

AbstractAlthough bisexual men are known to be less likely to disclose their sexual orientation to others than gay men, the reasons why bisexual men choose or feel unable to disclose have received minimal research attention. To examine the reasons behaviorally bisexual men offer for not disclosing to their friends, family, and female partners, in-depth interviews were conducted with an ethnically diverse sample of 203 men who had not disclosed their same-sex behavior to their female sexual partners in New York City. Men were recruited from multiple venues and online sources using a targeted sampling approach. Transcripts were thematically analyzed using Atlas.ti software. Contrary to the theory that non-disclosure is due to uncertainty about one’s sexual identity, the reasons offered for non-disclosure revealed that it was largely a method to avoid stigmatizing reactions from others. Men reported a number of specific reasons for non-disclosure, including (1) anticipation of negative emotional reactions; (2) anticipation of negative changes in relationships; (3) belief that others held stigmatizing attitudes toward homosexuality; (4) prior experience with negative reactions to disclosure; (5) wanting to maintain others’ perceptions of him; (6) fear that those told would disclose to additional people; and (7) fear of rejection due to culture or religion. These findings provide insights into the reasons why many behaviorally bisexual men choose not to disclose, potential reasons why bisexual and gay men differ in the extent to which they disclose, and potential reasons why some bisexual men report greater emotional distress than gay men. Further, they suggest that greater attention needs to be placed on addressing the stigmatizing contexts that confront bisexual men and providing them with strategies to manage stigma.

Drug Use, Sexual Risk, and Syndemic Production Among Men Who Have Sex With Men Who Engage in Group Sexual Encounters.

OBJECTIVES We surveyed men who have sex with men (MSM) to determine whether sexual risk behaviors, recent drug use, and other psychosocial problems differed between men who engaged in one-on-one and group sexual encounters. METHODS We conducted an Internet-based cross-sectional survey of 7158 MSM aged 18 years or older in the United States recruited from a gay-oriented sexual networking Web site in 2008. Among MSM who engaged in group sexual encounters, we compared their past-60-day sexual behaviors in one-on-one encounters and group sexual encounters. We also compared risk profiles and syndemic production between men who did and did not participate in group sex. RESULTS Men reporting a group-sex encounter had significantly higher polydrug use and sexual risk than did the men not reporting group sex in the past 60 days. The odds of engaging in group sex with 4 or more sexual partners significantly increased with the number of psychosocial problems, supporting evidence of syndemic production. CONCLUSIONS We identified a particularly high-risk subgroup in the MSM population with considerable psychosocial problems that may be reached online. Research is needed on how to engage these high-risk men in combination prevention interventions.

Sexual Risk Behaviors with Female and Male Partners Met in Different Sexual Venues Among Non-Gay-Identified, Non-Disclosing MSMW.

ABSTRACT Despite considerable interest in the sexual behavior of nondisclosing men who have sex with men and women (MSMW), little is known about where they meet their male and female partners and whether their sexual risk behavior differs with partners met in different sexual venues (e.g., bars, Internet, parks). These issues were examined among 46 non-gay-identified MSMW who had not disclosed their same-sex behavior to female partners (i.e., men on the “down low”). The prevalence of unprotected vaginal sex was nearly identical with women met in bars/clubs as with women met through friends, work, or the neighborhood. In contrast, the prevalence of unprotected anal sex was higher with male partners met on the Internet, in bars/clubs, and through friends/work/neighborhood compared with partners met in parks/restrooms or gyms. This is largely due to MSMW avoiding anal sex in parks, restrooms, and gyms in favor of oral sex. These findings provide important insights into the role of venues on sexual risk and the locations where risk reduction interventions for MSMW may be provided.

Sexual Venue Selection and Strategies for Concealment of Same-Sex Behavior Among Non-Disclosing Men Who Have Sex with Men and Women

In order to conceal their same-sex behavior, men who have sex with men and women (MSMW) who do not disclose their same-sex behavior to female partners must be cautious in their attempts to find potential male partners. This study interviewed 46 non-gay-identified, non-disclosing MSMW to identify the venues where they meet male sexual partners and the strategies they use to reduce the likelihood of discovery when at such venues. Most (74%) reported meeting a male partner in a sexual venue (e.g., bar or club, park) in the past year. Strategies to reduce the risk of discovery while seeking male partners included: a) avoiding certain venues, b) attending venues away from home, c) meeting partners on the Internet, d) preferring venues that have potential nonsexual uses, e) having sex at the partners place, and f) limiting their onsite sexual activities. These findings provide insight into the coping strategies these men use to manage the conflicting needs to conceal their behavior and meet sexual partners.

Compulsive use of Internet-based sexually explicit media: adaptation and validation of the Compulsive Internet Use Scale (CIUS)

Despite evidence that viewing sexually explicit media (SEM) may contribute to greater numbers of sexual partners, sexual risk taking, greater interest in group sex, and lower self-esteem among men who have sex with men (MSM), research has not addressed compulsive use of Internet-based SEM due to the lack of a validated measure for this population. This report investigates the psychometric properties of the 14-item Compulsive Internet Use Scale (CIUS; Meerkerk, van den Eijnden, Vermulst, & Garretsen, 2009) adapted to assess the severity of compulsive Internet SEM use. A total of 265 Internet SEM-viewing MSM participated in an online survey about their SEM preferences, viewing habits, and recent sexual behaviors. A principal components analysis revealed a single-component, 13-item scale to adequately assess the cognitive, emotional, and behavioral aspects of this phenomenon, with a high internal consistency (α=.92). Greater compulsive use of Internet SEM was positively correlated with several relevant variables including boredom, sexual frustration, time spent viewing Internet SEM, and number of recent male sexual partners. The results offer preliminary evidence for the reliability and validity of using an adapted version of the CIUS to understand compulsive Internet SEM use, and allow for more research into the potential negative consequences of compulsive SEM use.

Childhood sexual experiences among substance-using non-gay identified Black men who have sex with men and women

This study explored potential variations in childhood sexual abuse (CSA) by examining qualitative accounts of first sexual experiences among non-disclosing, non-gay identified Black men who have sex with men and women (MSMW). We analyzed data from semi-structured qualitative interviews with 33 MSMW who described first sexual experiences with male and female partners. Thematic analysis revealed four patterns of first sexual experiences including: unwanted sexual experiences with a male or female consistent with definitions of childhood sexual abuse; consensual sex with an older male or female; bodily exploration with another male or female child; and consensual sex with a peer-age female. Most of the experiences described by participants as consensual with an older male or female, however, met criteria for childhood sexual abuse found in the extant literature. Several men discussed childhood sexual experiences (CSE) relative to their experiences with alcohol, drugs, and same-sex behavior as adults. Findings suggest that the relationship between CSE and risk-taking behavior may be shaped by whether men perceive their experiences as abusive or consensual, and have implications for researchers, treatment providers and counselors.

Engagement in care, psychological distress, and resilience are associated with sleep quality among HIV-positive gay, bisexual, and other men who have sex with men

OBJECTIVES We investigated risk and protective factors associated with sleep quality among a national sample of HIV-positive gay, bisexual, and other men who have sex with men (GBMSM). DESIGN This study reports on findings from both an eligibility survey and baseline assessment for an online HIV risk reduction intervention. PARTICIPANTS There were 16,466 completed eligibility surveys. A total of 1,205 eligible men completed a baseline assessment after consenting to participate in the intervention. MEASUREMENTS AND RESULTS Among participants with a completed eligibility survey, men with an HIV-positive status had significantly worse sleep quality and more frequent use of sleep medications during the past month than HIV-negative men. Within the intervention sample (n = 1,205 HIV-positive participants), men with symptoms of anxiety (Adjusted odds ratio [AOR]=2.80; 95% confidence interval [CI]: 1.93-4.06) and depression (AOR=1.66; CI: 1.14-2.43), and who reported a detectable viral load in the past six months (AOR=1.57; CI: 1.06-2.33) had increased odds of poor sleep quality after controlling for demographic characteristics, socioeconomic status, ART use and adherence, substance use, and CD4 count. However, men with greater perceived resilience had decreased odds of reporting poor sleep quality during the past month (AOR=0.68; CI: 0.51-0.89). CONCLUSIONS Findings from this online study call for more attention to the role of sleep in immune system functioning and engagement in HIV care. Results further suggest a need to design and test culturally-appropriate sleep health interventions for GBMSM living with HIV that promote protective factors and target particular behavioral changes (i.e., stress reduction, substance use).