Stuart Michaels

Prevalence and Social Distribution of Men Who Have Sex with Men: United States and Its Urban Centers

Prevalence data on the social distribution and AIDS‐related risk behavior of men who have sex with men are presented from two national probability surveys [General Social Survey (GSS) and National Health and Social Life Survey (NHSLS)] and a probability survey of urban centers in the U.S. [National AIDS Behavioral Surveys (NABS)]. Men residing in large cities, the highly educated, and Whites were more likely to report sex with men. In the urban sample (NABS), one third reported sex with women. In addition, minority men were more likely to report sex with men and women. More than half of the men with an HIV risk factor reported consistent condom use. The surveys were based on two different modes of interviewing (self‐administered and telephone), conducted independently of each other and by different organizations. The prevalence estimates from these surveys are consistent with each other and with other population‐based surveys in the United States and Europe. We discuss these data in light of the ongoing d...

Family network proportion and HIV risk among Black men who have sex with men

Objectives:Black men who have sex with men (BMSM) have the highest rates of HIV in the United States. Despite increased attention to social and sexual networks as a framework for biomedical intervention, the role of family in these networks and their relationship to HIV prevention have received limited attention. Methods:A network sample (N = 380) of BMSM (n = 204) and their family members (n = 176) was generated through respondent-driven sampling of BMSM and elicitation of their personal networks. The proportion of personal network members who were family was calculated, and the weighted logistic regression was used to assess the relationship between this proportion and unprotected anal intercourse, sex-drug use (SDU), and group sex (GS), as well as intravention efforts to discourage these risk behaviors among their MSM social networks. Results:45.3% of respondents listed at least 1 family member in their close personal network. Greater family network proportion (having 2 or more family members in the close network) was associated with less SDU [adjusted odds ratio (AOR) 0.38, 95% CI: 0.17 to 0.87] and participation in GS (AOR 0.25, 95% CI: 0.10 to 0.67). For intravention, BMSM with greater family proportion were more likely to discourage GS (AOR 3.83, 95% CI: 1.56 to 9.43) and SDU (AOR 2.18, 95% CI: 1.35 to 3.54) among their MSM friend network. Moreover, increased male family network proportion was associated with lower HIV risk and greater intravention than increased female network proportion. Conclusions:Nearly half of BMSM have a close family member with whom they share personal information. Combination prevention interventions might be made more potent if this often overlooked component of personal networks was incorporated.

Preexposure Prophylaxis Awareness and Use in a Population-Based Sample of Young Black Men Who Have Sex With Men

Preexposure Prophylaxis Awareness and Use in a Population-Based Sample of Young Black Men Who Have Sex With Men In the United States, reducing new human immunodeficiency virus (HIV) infections will require a determined focus on primary HIV prevention among young black men who have sex with men (YBMSM), the only group in the United States where HIV incidence has increased over the past decade.1 Through 2011, effective clinic-based HIV prevention interventions that target YBMSM have been virtually nonexistent.2 In 2012, the US Food and Drug Administration approved a preexposure prophylaxis (PrEP) consisting of daily oral tenofovir disoproxil fumarate and emtricitabine. This PrEP has an estimated effectiveness of over 90%3 and, therefore, an HIV prevention effect potential for several domestic HIV epicenters.4

Conceptualization and measurement of homosexuality in sex surveys: a critical review

This article reviews major national population sex surveys that have asked questions about homosexuality focusing on conceptual and methodological issues, including the definitions of sex, the measured aspects of homosexuality, sampling and interviewing technique, and questionnaire design. Reported rates of major measures of same-sex attraction, behavior, partners, and sexual identity from surveys are also presented and compared. The study of homosexuality in surveys has been shaped by the research traditions and questions ranging from sexology to the epidemiology of HIV/AIDS. Sexual behavior has been a central topic at least since Kinsey. Issues of sexual attraction and/or orientation and sexual identity have emerged more recently. Differences in the treatment of men and women in the design and analysis of surveys as well as in the reported rates in different surveys, in different countries and time periods are also presented and discussed. We point out the importance of the consideration of both methodological and social change issues in assessing such differences.

HIV health center affiliation networks of Black Men Who Have Sex with Men: Disentangling fragmented patterns of HIV prevention service utilization

Background: In the United States, black men who have sex with men (BMSM) are at highest risk for HIV infection and are at high risk for limited health service utilization. We describe HIV health center (HHC) affiliation network patterns and their potential determinants among urban BMSM. Methods: The Mens Assessment of Social and Risk Network instrument was used to elicit HHC utilization, as reported by study respondents recruited through respondent-driven sampling. In 2010, 204 BMSM were systematically recruited from diverse venues in Chicago, IL. A 2-mode data set was constructed that included study participants and 9 diverse HHCs. Associations between individual-level characteristics and HHC utilization were analyzed using Multiple Regression Quadratic Assignment Procedure. Visualization analyses included computation of HHC centrality and faction membership. Results: High utilization of HHCs (45.9%–70.3%) was evident among BMSM, 44.4% who were HIV infected. Multiple Regression Quadratic Assignment Procedure revealed that age, social network size, and HIV status were associated with HHC affiliation patterns (coeff., 0.13–0.27; all P < 0.05). With the exception of one HHC, HHCs offering HIV prevention services to HIV-infected participants occupied peripheral positions within the network of health centers. High-risk HIV-uninfected participants affiliated most with an HHC that offers only treatment services. Conclusions: Subcategories of BMSM in this sample affiliated with HHCs that may not provide appropriate HIV prevention services. Using 2-mode data, public health authorities may be better able to match prevention services to BMSM need; in particular, HIV prevention services for high-risk HIV-uninfected men and HIV “prevention for positives” services for HIV-infected men.

Marijuana Use Among Young Black Men Who Have Sex With Men and the HIV Care Continuum: Findings From the uConnect Cohort

ABSTRACT Background: Young Black men who have sex with men (YBMSM) are at highest risk for HIV seroconversion in the United States. Successful movement through the HIV care continuum is an important intervention for limiting onwards HIV transmission. Objective: Little data exists on how substances most commonly used by YBMSM, such as marijuana, are related to the HIV continuum, which represents the primary aim of this study. Methods: A cohort of YBMSM (n = 618) was generated through respondent-driven sampling. Frequency of marijuana use and marijuana use as a sex-drug were assessed across the HIV care continuum using weighted logistic regression models. Results: Study participants reported more intermittent marijuana use (n = 254, 56.2%) compared to heavy use (n = 198, 43.8%). Our sample contained 212 (34.3%) HIV seropositive participants of which 52 (24.5%) were unaware of their HIV positive status. Study participants who were heavy marijuana users were more likely to be unaware of their HIV seropositive status (AOR: 4.18; 95% CI 1.26, 13.89). All other stages in the care continuum demonstrated no significant differences between those who use marijuana intermittently or heavily or as a sex-drug and nonusers. Conclusions: YBMSM who used marijuana heavily were more likely to be HIV-positive unaware than those who never used marijuana. Findings were inconclusive regarding the relationships between marijuana use and other HIV care continuum metrics. However, knowledge of ones’ HIV status is a critical requirement for engaging in care and may have implications for onwards HIV transmission.

Social-structural properties and HIV prevention among young men who have sex with men in the ballroom house and independent gay family communities.

The endogenous social support systems of young Black men who have sex with men (YBMSM), like surrogate families and social networks, are considered crucial assets for HIV prevention in this population. Yet, the extent to which these social systems foster sexual health protections or risks remains unclear. We examine the networked patterns of membership in ballroom houses and independent gay families, both Black gay subcultures in the United States, and how these memberships are related to HIV protective and risk traits of members. Drawing from a population-based sample of 618 YBMSM living in Chicago between June 2013 and July 2014, we observe a suite of protective and risk traits and perform bivariate analyses to assess each of their associations with being a member of a house or family. We then present an analysis of the homophilous and heterophilous mixing on these traits that structures the patterns of house and family affiliations among members. The bivariate analyses show that members of the house and family communities were more likely than non-members to report protective traits like being aware of PrEP, having health coverage, having a primary care doctor, and discouraging sex drug use among peers. However, members were also more likely to engage in the use of sex drugs. With respect to how these traits inform specific house/family affiliations, results show that members who had a recent HIV test, who were PrEP aware, or who engaged in exchange sex were more likely to belong to the same house or family, while HIV positive individuals were less likely to cluster within houses or families. These findings provide insights regarding the strengths and vulnerabilities of the house and gay family communities that can inform more culturally specific interventions that build on the existing human and social capital in this milieu.

Evaluation of sexual networks as a cause for disparate HIV prevalence between blacks and whites: more questions than answers.

Gray et al. [1] underestimate the true contribution to overall HIV incidence from serodiscordant couples in two ways. First, they focus only on study participants identified as both married and serodiscordant. Yet approximately one-third of married couples had a partner of unknown HIV status (36 and 33% in the preand postantiretroviral therapy (ART) intervals, respectively). It is likely that some of these couples were in fact HIV serodiscordant. Likewise, among those who were not currently married, some were likely in long-term serodiscordant relationships. Thus, the number of infections that occurred among serodiscordant couples is unknown but likely higher than could be reported with the available data.

Criminal justice involvement history is associated with better HIV care continuum metrics among a population-based sample of young black MSM.

Objective: To examine how history of criminal justice involvement (CJI) is related to HIV care continuum metrics among young black MSM 16–29 years of age. Design: Population-based survey. Methods: From 2013 to 2014, a representative sample of young black MSM was generated using respondent-driven sampling (RDS) in Chicago (n = 618). HIV antibody/antigen and RNA testing were performed using dry blood spots. Factors assessed in the care continuum included HIV testing, HIV diagnosis, linkage to care within 6 months, retention in care, adherence to antiretrovirals, and viral suppression. RDS-weighted regression models examined the associations between history of CJI, including frequency of CJI and durations of stay and each of the continuum metrics. Results: A final analytic sample of 618 participants was generated through RDS chains of up to 13 waves in length and with a mean of 2.1 recruits per participant. At enrollment, 40.8% had prior history of CJI and 34.6% were HIV seropositive. Of persons reporting HIV seropositive status, 58.4% were linked to care, 40.2% were retained in care, 32.2% were adherent to antiretrovirals, and 24.3% were virally suppressed. Any CJI history was associated with the overall care continuum (adjusted odds ratio = 2.35; 95% confidence interval 1.13–4.88) and was most associated with increased retention in care [adjusted odds ratio = 3.72 (1.77–7.84)]. Having one CJI experience and detention for only 1 day was associated with better retention in care compared with no or more frequent CJI. Conclusion: Those with a previous history of CJI were more successful in achieving most HIV care continuum metrics. Frequent and cycling CJI, however, was detrimental to HIV care.

Sexual Behavior and Practices: Data and Measurement

Sexuality is a broad and complex topic which has been studied from a variety of perspectives and disciplines, including its own discipline of “sexology.” Even when interest is confined to sexual behavior, research approaches can range from the biological sciences to the social sciences and the humanities and from the laboratory to the cultural and historical. Sexuality is also a particularly sensitive and emotionally charged topic that evokes a wide range of strong reactions including political, moral, ethical, and religious responses. Even in the area of empirical scientific research, it is difficult to escape the “specialness” of sexuality. This is what Rubin 1984 referred to as the “fallacy of misplaced scale,” referencing Sontag who pointed out that “everything pertaining to sex has been a ‘special case’ in our culture” (Sontag 1969: 46). It is often difficult to maintain a level of objectivity and scale when thinking of sex. This has made it particularly difficult to conduct research directly about sexuality.