Matt G. Mutchler

Psychosocial correlates of unprotected sex without disclosure of HIV-positivity among African-American, Latino, and White men who have sex with men and women.

African-American, Latino, and White men who have sex with men and women (MSMW) may be a bridge of HIV transmission from men to women. Very little research has directly compared culturally specific correlates of the likelihood of unprotected sex among MSMW. The present study examined psychosocial correlates of unprotected sex without disclosure of HIV status with male and female partners among 50 African American, 50 Latino, and 50 White HIV-positive MSMW recruited from AIDS service organizations in Los Angeles County. Multivariate logistic regressions were conducted to examine relationships of race/ethnicity and psychosocial variables (e.g., condom attitudes, self-efficacy for HIV disclosure, sexual identification) to unprotected sex without disclosure of HIV status, for male and female partners separately. For female partners, different effects emerged by race/ethnicity. Among African-Americans, less exclusively homosexual identification and low self-efficacy for disclosure of HIV status to female partners were associated with unprotected sex without disclosure; among Latinos, less exclusively homosexual identification and negative attitudes about condoms were significant. Participants who were more exclusively homosexually identified, who held less positive condom attitudes, and who had low self-efficacy for disclosure to female partners were more likely to have unprotected sex without disclosure of HIV status to male partners. Culturally tailored community-level interventions may help to raise awareness about HIV and bisexuality, and decrease HIV and sexual orientation stigma, thereby increasing African-American and Latino MSMW’s comfort in communicating with their female partners about sexuality, HIV and condoms. Addressing norms for condom use and disclosure between male partners is recommended, especially for homosexually identified MSMW.

Young Gay Men's Stories in the States: Scripts, Sex, and Safety in the Time of AIDS

Surprisingly little is known about how young gay men structure their sexual behavior in the era of AIDS. This research examines the sexual stories told by 30 White and Latino gay men between the ages of 18 and 24 based on data collected from semistructured interviews. Four dominant sexual scripts (romantic love, erotic adventures, safer sex, and sexual coercion) frame their sexual experiences. These stories illustrate how gay male youth use and adapt gendered sexual scripts encountered in particular social, cultural, and situational contexts. The author examines how interpersonal dynamics, social contexts, and masculinities shape and constrain their sexual experiences. The findings suggest new approaches to studying sexualities based on wedding sexual scripts and queer and gender theories, and accounting for agency and constraint. Directions for HIV-prevention policy-making in light of these newly revealed sexualities conclude this article.

Sex drugs, peer connections, and HIV: Use and risk among African American, Latino, and Multiracial young men who have sex with men (YMSM) in Los Angeles and New York

African-American and Latino young men who have sex with men (YMSM) are at high risk for HIV infection. We administered brief intercept surveys (N = 416) at 18 black and Latino gay pride events in Los Angeles and New York in 2006 and 2007. Ordinal logistic regressions were used to model the effects of substance use during sex, peer connectedness, relationship status, and homelessness on condom use. Alcohol use, crystal use, homelessness, and having a primary relationship partner were negatively associated with condom use, while peer connectedness and marijuana use during sex were positively associated with condom use. Implications for service providers and future research are discussed.

The Effect of Partner Sex: Nondisclosure of HIV Status to Male and Female Partners Among Men who Have Sex with Men and Women (MSMW)

A common concern within HIV prevention is that HIV positive MSMW do not disclose their HIV status to female partners who are thus at increased risk for HIV infection. The present study uses unique data to examine whether MSMW disclose more often to male rather than female partners. Data were collected on most recent male and/or female primary partner and four most recent casual partners from 150 MSMW (50 African American, 50 Latino, 50 White). MSMW reported on 590 partners (31% female; 69% male). Disclosure was coded as disclosure before sex, disclosure after sex, or nondisclosure. A series of multinomial logistic regressions with partners clustered within respondents were conducted to evaluate effects of respondent characteristics and partner characteristics on timing of disclosure. In bivariate and multivariate analyses there were no significant differences in odds of disclosure to male and female partners before or after sex. Although MSMW were substantially less likely to disclose to HIV negative partners before sex compared to HIV positive partners regardless of sex, when we fully interacted the multivariate model by partner sex, the odds of disclosure to HIV negative male partners compared to HIV positive male partners before sex were significantly higher than the odds of disclosure to HIV negative female partners compared to HIV positive female partners. Patterns of mutual nondisclosure and nonreciprocal disclosure were observed with both primary and casual partners. The paper makes additional methodological contributions to the measurement and analysis of disclosure.

Safer Sex Stories Told by Young Gay Men: Building on Resiliency Through Gay-Boy Talk

ABSTRACT Most research about HIV among gay youth focuses on HIV risk behaviors. Many of the studies of gay youth are also driven by a deficit model of development. Scholars have argued that such deficit models may be contributing to their stigmatization while ignoring their resiliency. This article focuses attention on a subset of the sexual stories told by young gay men as part of the Sexual Stores Project. The twenty Anglo and twenty Latino young gay men, ages 18–24, were drawn using a snowball sampling procedure within each ethnic group. Analyses of these semi-structured interviews allow for examinations of these young gay mens safe sex accounts and their experiences in sex education at school. Recommendations for meaningful and relevant HIV prevention sex education guided by “Gay-boy” talk are provided.

“Becoming Bold”: Alcohol Use and Sexual Exploration among Black and Latino Young Men Who Have Sex with Men (YMSM)

Alcohol use is correlated with unprotected sex, which may place young men who have sex with men (YMSM) who use alcohol with sex at increased risk for contracting HIV. However, little is known about how this link develops. This study used qualitative interviews to explore how alcohol became associated with sex and sexual risk among YMSM. We purposively sampled 20 Black and 20 Latino YMSM (N = 40), ages 21 to 24, who used substances (alcohol, marijuana, and crystal methamphetamine) with sex. Interviews focused on participants’ personal histories to trace how these associations developed for each individual. Drawing on sexual script, emotion regulation, and alcohol expectancy theories, analyses followed a modified grounded theory approach. Participants stated that alcohol enabled them to engage in sexual behaviors with men that they wanted to try, allowing them to be more “bold,” overcome stigma about homosexuality, and feel increased comfort with their sexual desires and identities. The use of alcohol during sex was helpful to some of the participants but could also lead to sexual risk behaviors. Intervention programs seeking to reduce alcohol misuse and sexual risk should take into account how YMSM conceptualize associations between alcohol and sex. These programs may be more effective if they provide support for sexual identity exploration.

Commercial lubricant use among HIV-negative men who have sex with men in Los Angeles: implications for the development of rectal microbicides for HIV prevention

To inform the development and assess potential use of rectal microbicide gels for HIV prevention among men who have sex with men (MSM), we examined the dynamics and contexts of commercial lubricant use during receptive anal intercourse (RAI) within this population. From 2007 to 2010, 168 HIV-negative MSM living in Los Angeles who practice RAI completed computer-assisted self-interviews, which collected information on their last sexual event with ≤3 recent partners, at baseline, three months, and one-year study visits. Logistic generalized linear mixed models were used to identify individual- and sexual event-level characteristics associated with commercial lubricant use during RAI at the last sexual event within 421 partnerships reported by participants over the course of follow-up. During RAI at their last sexual event, 57% of partnerships used a condom and 69% used commercial lubricant. Among partnerships that used commercial lubricant, 56% reported lubricant application by both members of the partnership, 66% first applied lubricant during sex, but before penetration, and 98% applied lubricant at multiple locations. The relationship between substance use and commercial lubricant use varied by condom use (interaction p-value = 0.01). Substance use was positively associated with commercial lubricant use within partnerships that did not use condoms during RAI at their last sexual event (adjusted odds ratio [AOR] = 4.47, 95% confidence interval [CI]: 1.63–12.28), but no association was observed within partnerships that did use condoms (AOR = 0.66, 95% CI: 0.23–1.85). Commercial lubricant use during RAI was also positively associated with reporting more sexual partners (AOR = 1.18, 95% CI: 1.05–1.31), while older age (units = 5 years; AOR = 0.75, 95% CI: 0.61–0.94), homelessness (past year; AOR = 0.32, 95% CI: 0.13–0.76), and having sex with an older (>10 years) partner (AOR = 0.37, 95% CI: 0.14–0.95) were negatively associated with commercial lubricant use. These factors should be considered in the development of rectal microbicide gels to enhance their acceptability and use among MSM.

Community HIV Treatment Advocacy Programs May Support Treatment Adherence

Treatment advocacy (TA) programs, based in AIDS service organizations and clinics, aim to engage clients into care and support antiretroviral treatment (ART) adherence through client-centered counseling; advocate for patients with providers; and provide social service referrals. Systematic evaluations of TA are lacking. We conducted a non-randomized evaluation examining relationships of TA participation to adherence, care engagement, social services utilization, unmet needs, patient self-advocacy, and adherence self-efficacy among 121 HIV-positive clients (36 in TA, 85 not in TA; 87% male, 34% African American, 31% White, 19% Latino). In multivariate models, TA participants (vs. non-TA participants) showed higher electronically monitored [85.3% vs. 70.7% of doses taken; b(SE) = 13.16(5.55), p < .05] and self-reported [91.1% vs. 75.0%; b(SE) = 11.60(5.65), p < .05] adherence; utilized more social service programs [Ms = 5.2 vs. 3.4; b(SE) = 1.97(0.48), p < .0001]; and had fewer unmet social-service needs [Ms = 1.8 vs. 2.7; b(SE) = -1.06(0.48), p < .05]. Findings suggest the need for a randomized controlled trial of TA.

'Their type of drugs': perceptions of substance use, sex and social boundaries among young African American and Latino gay and bisexual men.

Studies of sexuality have increasingly shifted their attention towards understanding the social contexts that inform and organise sexual behaviour. Building on this work, we examine how substance use and sex are socially organised and meaningful activities for young African American and Latino gay and bisexual men who use substances with sex. Drawing on 30 qualitative interviews in Los Angeles and New York, we identify the ways in which social boundaries inform substance use among these young men. We find that many of them view the gay and racial/ethnic communities they belong to as differentiated by patterns of substance use. Further, they see these communities as actively constructing group boundaries through substance use, sanctioning the use of particular substances while simultaneously discouraging the use or discussion of others. For these young men, racial/ethnic and gay communities provide salient contexts in which the use of certain substances and not others is socially meaningful. Findings demonstrate the important and heretofore unrecognised ways that perceived social boundaries inform these young mens use of substances. As both protective and marginalising influences, perceptions of communities and social identities have real consequences for the sexual health of young African American and Latino gay and bisexual men.

Dude, You're Such a Slut! Barriers and Facilitators of Sexual Communication Among Young Gay Men and Their Best Friends.

Conversations with friends are a crucial source of information about sexuality for young gay men, and a key way that sexual health norms are shared during emerging adulthood. However, friends can only provide this support if they are able to talk openly about sexuality. We explored this issue through qualitative interviews with an ethnically diverse sample of young gay men and their best friends. Using theories of sexual scripts, stigma, and emerging adulthood, we examined how conversations about sex could be obstructed or facilitated by several key factors, including judgmentalism, comfort/discomfort, and receptivity. Gay male friends sometimes spoke about unprotected sex in judgmental ways (e.g., calling a friend “slut” or “whore” for having sex without condoms). In some cases, this language could be used playfully, while in others it had the effect of shaming a friend and obstructing further communication about sexual risk. Female friends were rarely openly judgmental, but often felt uncomfortable talking about gay male sexuality, which could render this topic taboo. Sexual communication was facilitated most effectively when friends encouraged it through humor or supportive questioning. Drawing on these findings, we show how judgmentalism and discomfort may generate sexual scripts with contradictory norms, and potentially obstruct support from friends around sexual exploration during a period of life when it may be most developmentally important.