Robert W. Moeller

Individual, psychosocial, and social correlates of unprotected anal intercourse in a new generation of young men who have sex with men in New York City.

OBJECTIVES We examined associations of individual, psychosocial, and social factors with unprotected anal intercourse (UAI) among young men who have sex with men in New York City. METHODS Using baseline assessment data from 592 young men who have sex with men participating in an ongoing prospective cohort study, we conducted multivariable logistic regression analyses to examine the associations between covariates and likelihood of recently engaging in UAI with same-sex partners. RESULTS Nineteen percent reported recent UAI with a same-sex partner. In multivariable models, being in a current relationship with another man (adjusted odds ratio [AOR] = 4.87), an arrest history (AOR = 2.01), greater residential instability (AOR = 1.75), and unstable housing or homelessness (AOR = 3.10) was associated with recent UAI. Although high levels of gay community affinity and low internalized homophobia were associated with engaging in UAI in bivariate analyses, these associations did not persist in multivariable analyses. CONCLUSIONS Associations of psychosocial and socially produced conditions with UAI among a new generation of young men who have sex with men warrant that HIV prevention programs and policies address structural factors that predispose sexual risk behaviors.

Substance Use in the MSM Population of New York City during the Era of HIV/AIDS

This literature review considers the historical significance, emergence of, and interplay between the HIV and illicit drug use epidemics among gay, bisexual, and other men who have sex with men (MSM) in New York City (NYC). The continual rise in HIV infections in recent years among MSM, particularly among young MSM (YMSM), commands a need for the examination of the effectiveness of current HIV prevention strategies and a more comprehensive understanding of the complex biopsychosocial influences that place YMSM at risk. A chronological perspective of both the HIV and illicit drug use epidemics affecting NYC MSM is presented, followed by a review of the existing research on the synergistic relation between the two. Special consideration is given to the patterns and interconnectivity between HIV, substance use, and housing instability specific to YMSM, as they represent the demographic currently at greatest risk for HIV transmission in NYC. Thereafter, an overview of treatment research is provided. We conclude by offering recommendations for future research and best practices as we move forward in an attempt to reduce the incidence of HIV transmission.

High interest in a long-acting injectable formulation of pre-exposure prophylaxis for HIV in young men who have sex with men in NYC: a P18 cohort substudy.

Objective In the context of continued high rates of condomless anal intercourse and HIV-1 infection, young men who have sex with men (YMSM) need additional effective and desirable HIV prevention tools. This study reports on the willingness of a racially-ethnically diverse cohort of YMSM to use a new biomedical prevention approach, a long-acting injectable pre-exposure prophylaxis (LAI-PrEP) agent. Methods A cross-sectional study conducted between June-August 2013 recruited participants from an ongoing cohort study of YMSM in NYC. Participants included 197 YMSM, of whom 72.6% (n = 143) identified as men of color. Two outcomes were measured through computer-assisted self-interviews: 1) willingness to use long-acting injectable PrEP and 2) preference for route of administration of PrEP. In addition, concerns about perceived impacts of PrEP on health and risk behavior, access to health services, and stigma were investigated. Results Over 80% (n = 159/197, p<0.001) of participants stated they would be willing to use LAI-PrEP. With regards to preference for mode of delivery 79.2% (n = 156/197, p<0.001) stated they would prefer an injection administered every three months over a daily pill or neither one. Conclusions This study is the first to explore acceptability of LAI-PrEP in the US. A significant majority of participants expressed willingness to use LAI and the majority preferred LAI-PrEP. LAI-PrEP holds great promise in that it could circumvent the adherence challenges associated with daily dosing, especially if nested within appropriate psycho-behavioral support. Medical providers whose patients include YMSM at high risk for HIV infection should note the positive attitudes toward PrEP, and specifically LAI-PrEP.

Sexual Behaviors of Adolescent Emerging and Young Adult Men Who Have Sex With Men Ages 13-29 in New York City

Content: HIV infections among young men who have sex with men (YMSM), ages 13-29 in New York City have been steadily increasing over the last decade. Objective: To document the sexual onset and behavior of YMSM as a means for informing the development of new HIV prevention messaging. Design: Cross-sectional study. Participants: Five hundred fifty-eight YMSM, with more than 60% racial/ethnic minorities. Results: Young adults (25-29 years) reported a greater number of lifetime sexual partners, but the adolescents (13-17 years) and emerging adults (18-24 years) reported having their first sexual encounter with another man at a younger age. Black and Latino men first engaged in various sexual behaviors, including receptive anal intercourse, at a younger age than either Asian/Pacific Islander or white men, and were more likely to report an HIV-seropositive status. Across race/ethnicity, YMSM reported an equivalent number of recent male sex partners and selected both main and casual partners who were age and race/ethnicity matches. During the most recent sexual encounter with a casual male partner, black men were more likely than white men to have had unprotected receptive anal intercourse, whereas white men were more likely to report unprotected oral sex. Black YMSM reported more recent female partners than all other groups. Conclusions: Black and Latino YMSM may be at increased risk for seroconversion because they tend to start having sex with other men at a younger age than their white and Asian/Pacific Islander peers and because they engage in unprotected sexual behaviors with men of concordant race/ethnicity and of a similar age where levels of viremia may be more elevated but not because of the sheer number of sexual partners.

Sexual Practices of Gay, Bisexual, and Other Nonidentified MSM Attending New York City Gyms: Patterns of Serosorting, Strategic Positioning, and Context Selection

This descriptive paper characterizes the sexual behaviors of a diverse sample (N = 311) of gay, bisexual, and other nonidentified men who have sex with men (MSM) who regularly attended gyms in New York City. Approximately 50% of the sample indicated sex with primary male partners, while 88% of the men had sexual relations with male casual partners in the 6 months prior to assessment. The participants met their casual partners in a variety of different venues, including the Internet. Differences were noted along key demographic factors with regard to the contexts in which men met their partners. The data indicate that the men use serosorting, strategic positioning, and contexts in which they meet other men, to influence choices concerning sexual partners and practices as a form of health protection. It is proposed that these patterns of sexual behavior are representative of the totality of the lives of gay, bisexual, and other MSM, because despite engaging in gym behaviors, which might be considered health promoting, these men are simultaneously taking risks. Such findings point to varying motivations as to why gay, bisexual, and other MSM actually attend the gym.

Alcohol Use Among Young Men Who Have Sex With Men

This study reveals associations between alcohol use and demographic variables, as well as the relation between alcohol use and sexual activity, using episodic data. Data were obtained during summer and fall from a sample of 558 gay, bisexual, and other young men who have sex with men (YMSM), ages of 13–29 years in New York City. Recruitment strategies targeted potential participants at gay-related venues and public spaces often frequented by YMSM. Alcohol use varied by race/ethnicity, with White YMSM consuming significantly more alcohol than other races/ethnicities. Participants over the age of 21 drank significantly more alcohol than participants ages 13–20. Alcohol use was not found to be associated with sexual risk-taking activity. Our findings are enriched by a large, diverse sample of urban YMSM. Study limitations are noted.

Methamphetamine Use among Gay, Bisexual and Non-identified Men-Who-Have-Sex-with-Men An Analysis of Daily Patterns

This study sought to understand the patterns, methods of administration and contexts for methamphetamine use (MA) in a sample of racially diverse men who have sex with men (MSM). Inclusion into the study required participants to be classified as clinically dependent on MA, but indicate no other illicit substance use. Use was assessed using Timeline Followback for a period of 30 days. Of the 900 assessed days, MA use was reported on 217. Participants reported an average of seven days of use, with the majority of use occurring on the weekend. The weekend usage pattern suggests an incorporation of drugs into the lives of gay men as a means of socialization and recreation.

Cigarette Smoking as Part of a Syndemic among Young Men Who Have Sex with Men Ages 13–29 in New York City

The prevalence of cigarette smoking among young men who have sex with men (YMSM) is significantly higher than among their heterosexual peers. We undertook an analysis to examine cigarette smoking in relation to demographic factors and other risk behaviors among 580 YMSM, ages 13–29, in New York City. Cross-sectional data were collected as part of larger study of risk behaviors using palm devices and targeted active recruitment strategies across all five boroughs of the city. Multivariate modeling suggests that Asian or Pacific Islander and White YMSM are more likely to report cigarette smoking than other racial and ethnic groups, as are men reporting a middle class socioeconomic status. In addition, smoking was related to the likelihood of using a variety of illicit substances, as well as alcohol and pharmaceuticals without a prescription, during the period of assessment. YMSM who smoke cigarettes reported a greater number of casual sex partners and a greater number of transactional sex partners than non-smokers. Episodic analysis of sexual behaviors with casual partners indicated that smokers were more likely to engage in illicit drug and alcohol use immediately before or during sex than did non-smokers. These findings are understood as part of a larger syndemic among YMSM, and suggest that smoking prevention and cessation programs should be embedded as part of larger more holistic health and wellness programs targeting YMSM.

The Interplay of Syndemic Production and Serosorting in Drug-Using Gay and Bisexual Men

The relationships between mental health, substance use, and sexual behaviors among gay and bisexual men in a sample of 450 club drug-using men from New York City were examined using syndemics theory. Risk scores for each participant were based on variables measuring substance use and mental health burden. Participants with higher risk scores were significantly more likely to engage in risk behaviors. Risk taking was also explained by serosorting, suggesting that syndemics theory in and of itself, while significant in explaining risk, is not sufficient. These findings suggest we need to understand the interplay between social, emotional, and cognitive factors to understand sexual risk taking.

Levels of methamphetamine use and addiction among gay, bisexual, and other men who have sex with men

Methamphetamine (MA) and poly-drug use among gay, bisexual, and other men who have sex with men (MSM) may be linked to risky sexual behaviors and the subsequent transmission of the human immunodeficiency virus. The goal of this analysis was to examine, quantify, and describe lifetime use of MA as well as MA use in the past year in relation to other substances by means of a standardized diagnostic tool, and along key socio-demographic variables. Data for this analysis were gathered from the screening assessment of a larger cross-sectional study examining MA use and psychosocial states in a sample of 215 MSM in New York City. Based on criteria set forth by the Mini International Neuropsychiatric Inventory, clinical dependence to MA was shown in 78% of participants. Of this group, over 70% were codependent on other substances, including cocaine and Ecstasy. Further, 95% of Black MSM reported MA use in the past year, of which 97% were classified as dependent. These findings suggest that MA continues to be used at significant rates among MSM and often in conjunction with other substances, and is increasingly used and abused by ethnic and racial minority MSM. Findings suggest the need for programs to address multiple drug dependence and in relation to co-occurring health problems.