Syed W. Noor

The relationship between use of sexually explicit media and sexual risk behavior in men who have sex with men: exploring the mediating effects of sexual self-esteem and condom use self-efficacy

ABSTRACT Objectives: This study tests the following 3 hypotheses: (1) there is a direct association between consumption of sexually explicit media (SEM) depicting non-condom use and sexually transmitted infection (STI)-related sexual risk behavior among men who have sex with men (MSM); (2) the association between SEM consumption and STI-related sexual risk behavior is mediated by mens sexual self-esteem; and (3) the relationship between SEM consumption and sexual risk behavior is mediated by condom use self-efficacy. Methods: A cross-sectional, Internet-based survey on exposure to SEM and sexual behavior of 1,391 MSM in the United States was conducted in 2011. Results: The results confirmed Hypotheses 1 and 3, while Hypothesis 2 was rejected. Accordingly, a significant association between the use of SEM picturing condom use and STI-related sexual risk behavior among MSM was found. Likewise, we found that the association between the use of SEM and sexual risk behavior was mediated by condom use self-efficacy in an indirect path. However, SEM did not influence sexual risk behavior via sexual self-esteem. Conclusions: To promote STI prevention, the actors in SEM may be used as role models in managing condom use in sexual contexts.

Normal, Problematic, and Compulsive Consumption of Sexually Explicit Media: Clinical Findings Using the Compulsive Pornography Consumption (CPC) Scale Among Men Who Have Sex With Men

To assess problematic sexually explicit media (SEM) consumption, and to identify clinically meaningful cut-off points, we examined clinical correlates using the new Compulsive Pornography Consumption (CPC) scale among 1,165 participating men who have sex with (MSM). Building on scale practices in measuring compulsive sexual behavior, 2 cut-off points were identified. While most (76–80%) MSM do not report compulsive symptoms, about 16–20% report levels of problematic SEM consumption, including 7% with extreme scores consistent with DSM criteria for compulsive disorders. Demographic, sexual, and HIV risk differences were identified between the 3 groups. Researchers and clinicians are encouraged to consider using the CPC scale for comprehensive assessment of compulsive sexual behavior.

A Brief Scale to Measure Problematic Sexually Explicit Media Consumption: Psychometric Properties of the Compulsive Pornography Consumption (CPC) Scale Among Men Who Have Sex With Men

Although the phenomenon of hypersexuality has been described in the literature, and scales of compulsive sexual behavior have been published, the existing measures do not assess compulsive sexually explicit media (SEM) consumption. This study tested the psychometric properties of a new scale, the Compulsive Pornography Consumption (CPC). Exploratory and confirmatory factor analyses results showed good psychometric performance of a 5 item, 2 factor preoccupation-compulsivity solution. As hypothesized, the scale correlates positively with compulsive sexual behavior, internalized homonegativity, and negatively with sexual self-esteem. The scale will enable researchers to investigate the etiologic factors of compulsive SEM use, and enable clinicians to assess problematic consumption.

Does Sexually Explicit Media (SEM) affect me? Assessing first-person effects of SEM consumption among Norwegian men who have sex with men

Using a self-selected online sample of 448 Norwegian men who have sex with men (MSM) and a cross-sectional design, the present study investigated first-person effects of sexually explicit media (SEM) consumption on sexual knowledge, enjoyment of and interest in sex, attitudes towards sex and understanding of one’s sexual orientation. First-person effects refer to self-perceived and self-reported effects of SEM consumption as experienced by the consumer. In addition, the study examined and provided a thorough validation of the psychometric properties of the seven-item Pornography Consumption Effect Scale (PCES). The study found that 93% of MSM reported small-to-large positive effects from their SEM consumption on their sexual knowledge, enjoyment of and interest in sex, attitudes towards sex and understanding of their sexual orientation. Only 7% reported any negative effects from their SEM consumption on these outcomes. Furthermore, the psychometric properties of the revised version of the PCES were found to be very satisfactory. The results of the study indicate that SEM consumption among MSM may play a positive role in MSM’s sexuality by enhancing their sex life, being a major source of sexual information, providing a recreational sexual outlet and offering confirmation of one’s sexual orientation.

Recruitment strategies of methamphetamine-using men who have sex with men into an online survey

Abstract Recruiting hidden populations into online research remains challenging. In this manuscript, we report lessons learned from our efforts to recruit methamphetamine-using men who have sex with men. Between July and October 2012, we implemented a four-phase recruitment strategy to enroll a total of 343 methamphetamine-using MSM into an online survey about recent substance use, sexual behavior, and various psychosocial measures. The four phases were implemented sequentially. During phase one, we placed advertisements on mobile applications, and during phase two, we placed advertisements on traditional websites formatted for browsers. During phase three, we used e-mail to initiate snowball recruitment, and during phase four, we used social media for snowball recruitment. Advertisements on mobile devices and websites formatted for browsers proved to be expensive options and resulted in few eligible participants. Our attempts to initiate a snowball through e-mail also proved unsuccessful. The majority (n = 320) of observations in our final dataset came from our use of social media. However, participant fraud was a concern, requiring us to implement a strong participant verification protocol. For maximum recruitment and cost-effectiveness, researchers should use social media for recruitment provided they employ strong participant verification protocols.

Scenes as Micro-Cultures: Examining Heterogeneity of HIV Risk Behavior Among Gay, Bisexual, and Other Men Who Have Sex with Men in Toronto, Canada

Using latent class analysis (LCA), we examined patterns of participation in multiple scenes, how sexual risk practices vary by scene, and psychosocial factors associated with these patterns among 470 gay, bisexual, and other men who have sex with men (GBM) recruited from Toronto. We calculated posterior probability of being in a class from participation in nine separate scenes. We used Entropy, the Bayesian information criterion and the Lo–Mendel–Rubin likelihood ratio test to identify the best fit model. Fit indices suggested a four-class solution. Half (50%) of the GBM reported no or minimal participation in any scene, 28% reported participating in the dance club scene, 16% reported participating in the BDSM, bear, and leather scenes, and 6% reported participating in circuit, party and play, and sex party scenes. Compared to GBM who did not participate in scenes, GBM participating in the BDSM-Bear-Leather scene were more likely to be older, white, to report higher sexual self-esteem, and to engage in condomless anal sex; Party and Play scene members were more likely to be of Asian origin, and to use drugs before and during sex, whereas Dance Club scene members were more likely to be younger and to report lower self-esteem but higher hope. LCA allowed us to identify distinct social niches or micro-cultures and factors characterizing these micro-cultures. GBM differ in their risk for HIV and STIs according to characteristics associated with participation in distinct micro-cultures associated with scenes. Tailored interventions may be needed that focus on reducing HIV risk and promoting sexual health in specific contexts such as the BDSM-Bear-Leather and Party and Play.

Substance-use and sexual harm reduction strategies of methamphetamine-using men who have sex with men and inject drugs

Research indicates that men who have sex with men (MSM), use methamphetamine, and inject drugs are at high risk of HIV infection and they employ multiple harm reduction strategies simultaneously to reduce that risk. In this study, we identified substances most commonly injected and harm reduction strategies most often employed by methamphetamine-using MSM, used latent class analysis (LCA) to identify patterns of harm reduction strategies, and differentiated MSM within each class by individual characteristics. We analyzed data from 284 participants who completed an online cross-sectional survey. Commonly injected substances were methamphetamine (93.70%), gamma-hydroxybutyrate/gamma-butyrolactone (41.55%), flunitrazepam (40.49%), and cocaine (35.56%). The substance-use strategies most often used were avoidance of sharing needles (85.92%) and use of bleach to clean drug paraphernalia (64.08%). The sexual strategy most often used was avoidance of condomless anal intercourse (CAS) while using drugs (77.11%). Using an LCA approach, we identified three classes distinguishable by age, race/ethnicity, and outness. One class (19%) employed lay strategies to reduce harm: they avoided sharing drug preparation equipment, serosorted when sharing needles and equipment or having CAS, and practiced withdrawal when having CAS. The largest class (53%) combined sexual and substance-use strategies: they avoided sharing needles, used bleach to clean needles and equipment, avoided CAS when using drugs, and used extra lubricant when having CAS. The remaining class (28%) employed only substance-use rather than sexual strategies. More MSM of color were in the substance-use class, and more young, non-Hispanic White men were in the lay class. The low utilization of sexual strategies by younger, non-Hispanic White men in the lay class is concerning as they are just as likely as older, non-Hispanic White men in the combined class to have CAS with multiple male partners. Interventionists should consider these differences when developing interventions tailored to methamphetamine-using MSM.

Drug and sexual HIV risk behaviours related to knowledge of HIV serostatus among injection drug users in Houston, Texas

This study examines the association between drug and sexual HIV risk behaviours and knowledge of HIV serostatus among a sample of injection drug users, recruited into the 2009 National HIV Behavioral Surveillance project. We calculated prevalence ratios and associated 95% confidence intervals of reporting a given risk behaviour comparing injection drug users unaware of their serostatus and HIV-negative to HIV-positive injection drug users. Of 523 participants, 21% were unaware of their HIV serostatus. The three groups were not different from each other in terms of drug-use behaviours; however, injection drug users unaware of their HIV serostatus were 33% more likely to report having more than three sexual partners in the past 12 months and 45% more likely to report having unprotected sex compared to HIV-positive injection drug users. We observed markedly higher prevalence of sexual risk behaviours among injection drug users unaware of their serostatus, but drug-use risk behaviours were similar across the groups.

Clustered drug and sexual HIV risk among a sample of middle-aged injection drug users, Houston, Texas

Recent studies have reported a clustered pattern of high-risk drug using and sexual behaviors among younger injection drug users (IDUs), however, no studies have looked at this clustering pattern in relatively older IDUs. This analysis examines the interplay and overlap of drug and sexual HIV risk among a sample of middle-aged, long-term IDUs in Houston, Texas. Our study includes 452 eligible IDUs, recruited into the 2009 National HIV Behavioral Surveillance project. Four separate multiple logistic regression models were built to examine the odds of reporting a given risk behavior. We constructed the most parsimonious multiple logistic regression model using a manual backward stepwise process. Participants were mostly male, older (mean age: 49.5±6.63), and nonHispanic Black. Prevalence of receptive needle sharing as well as having multiple sex partners and having unprotected sex with a partner in exchange for money, drugs, or other things at last sex were high. Unsafe injecting practices were associated with high-risk sexual behaviors. IDUs, who used a needle after someone else had injected with it had higher odds of having more than three sex partners (odds ratio (OR) = 2.10, 95% confidence interval (CI): 1.40–3.12) in last year and who shared drug preparation equipment had higher odds of having unprotected sex with an exchange partner (OR = 3.89, 95% CI: 1.66–9.09) at last sex. Additionally, homelessness was associated with unsafe injecting practices but not with high-risk sexual behaviors. Our results show that a majority of the sample IDUs are practicing sexual as well as drug-using HIV risk behaviors. The observed clustering pattern of drug and sexual risk behavior among this middle-aged population is alarming and deserve attention of HIV policy-makers and planners.

Examining the relationship between use of sexually explicit media and sexual risk behavior in a sample of men who have sex with men in Norway

The purpose of this study was to investigate consumption patterns of gay-oriented sexually explicit media (SEM) among men who have sex with men (MSM) in Norway, with a particular emphasis on a possible relationship between gay SEM consumption and HIV risk behavior. Participants included 529 MSM living in Norway recruited online to complete a SEM consumption and sexual risk survey. Of the 507 participants who responded to the all items measuring exposure to SEM, 19% reported unprotected anal intercourse with a casual partner (UAI) in last 90 days, and 14% reported having had sero-discordant UAI. Among those with UAI experience, 23% reported receptive anal intercourse (R-UAI) and 37% reported insertive anal intercourse (I-UAI). SEM consumption was found to be significantly associated with sexual risk behaviors. Participants with increased consumption of bareback SEM reported higher odds of UAI and I-UAI after adjusting for other factors using multivariable statistics. MSM who started using SEM at a later age reported lower odds of UAI and I-UAI than MSM who started earlier. Future research should aim at understanding how MSM develop and maintain SEM preferences and the relationship between developmental and maintenance factors and HIV sexual risk behavior.