"We Might Get Some Free Beers": Experience and Motivation for Transactional Sex among Behaviorally Bisexual Men in Vientiane, Laos

People engaging in transactional sex are considered a key population for HIV prevention. Prior quantitative surveys demonstrated that behaviorally bisexual men in Vientiane, Laos commonly transact sex. 

In 2013, we conducted a qualitative study to explore behaviorally bisexual men's experience, motivations, and perceptions related to transactional sex in Vientiane. Behaviorally bisexual men were recruited from bars, nightclubs, and dormitories for five focus group discussions (FGDs) and 11 in-depth interviews (n = 31). Additionally, young women were recruited from a university, garment factory, and nightclub for four FGDs (n = 22). Transcripts were translated and thematically coded. 

Bisexual male participants most commonly described being paid for sex by male-to-female transgender people and buying sex from women. Both male and female participants reported that older, single women pay younger men for sex. Negotiation and direction of sexual transactions are influenced by age, attraction, and wealth. Common motivations for selling sex included the need for money to support family or fund school fees, material gain, or physical pleasure. Transactional sex was often opportunistic. Some behaviorally bisexual men reported selling sex in order to pay another more desirable sex partner or to buy gifts for their regular sex partner. Participants perceived high risk associated with intercourse with female sex workers but not with other transactional sex partners. 

Health interventions are needed to improve knowledge, risk perception, and health behaviors, but must recognize the diversity of transactional sex in Vientiane. Both physical and virtual settings may be appropriate for reaching behaviorally bisexual men and their partners.

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By:  Bowring AL1,2, Pasomsouk N3, Hughes C4, van Gemert C5,6, Higgs P5,7, Sychareun V8, Hellard M5,6, Power R6,4,9.

• 1Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia. annab@burnet.edu.au.
• 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. annab@burnet.edu.au.
• 3Burnet Institute, Vientiane, Lao PDR.
• 4Centre for International Health, Burnet Institute, Melbourne, Australia.
• 5Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC, 3004, Australia.
• 6Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
• 7Faculty of Health Sciences, National Drug Research Institute, Curtin University, Fitzroy, Melbourne, Australia.
• 8Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR.
• 9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
• Arch Sex Behav. 2016 Mar 23.  

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Risk Factors Associated with HIV among Men Who Have Sex With Men (MSM) in Ecuador

The Joint United Nations Program on HIV/AIDS estimates that between 0.3% and 0.7% of adults aged 15 to 49 years were living with HIV in Ecuador in 2013. However, very little is known about the HIV prevalence rate among men who have sex with men (MSM) in that country. 

A cross-sectional survey was conducted to investigate the knowledge, attitudes, and practices regarding HIV/AIDS as well as to estimate the prevalence of HIV among MSM in one of the cities with high HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 307 adult MSM. 

An HIV prevalence of 10% was observed. Knowledge about HIV was high; 91% of participants could identify how HIV is transmitted. Although consistent condom use for anal sex was relatively high (89%) among participants who reported having pay-for-service clients, only 64% reported using a condom during oral sex with a client. Participants who had multiple male sexual partners (i.e., their stable male partners plus other partner[s]) had 3.7 times higher odds of testing positive for HIV compared with those who did not. They also had reduced odds of condom use. Participants who were forced to have anal receptive sex had 3 times higher odds of testing positive for HIV. 

Despite the finding that participants exhibited high knowledge about HIV/AIDS, a high prevalence rate of HIV was observed, which warrants targeted behavioral interventions. These data are consistent with MSM being one of the highest at-risk population groups for HIV in this region of Ecuador.

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By:  Hernandez I1, Reina-Ortiz M2, Johnson A3, Rosas C4, Sharma V3, Teran S4, Naik E3, Salihu HM5, Teran E6, Izurieta R3.

• 1Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
• 2University of South Florida, Tampa, FL, USA Fundación Raíces, Esmeraldas, Ecuador.
• 3University of South Florida, Tampa, FL, USA.
• 4Universidad San Francisco de Quito, Quito, Ecuador.
• 5Baylor College of Medicine, Houston, TX, USA.
• 6Universidad San Francisco de Quito, Quito, Ecuador eteran@usfq.edu.ec.
• Am J Mens Health. 2016 May 8. pii: 1557988316646757 

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Sexual Positioning among Men Who Have Sex with Men: A Narrative Review

Sexual positioning practices among men who have sex with men (MSM) have not received a thorough discussion in the MSM and HIV literature, given that risks for acquiring or transmitting HIV and STIs via condomless anal sex vary according to sexual positioning. MSM bear a disproportionate burden of HIV compared to the general population in the United States; surveillance efforts suggest that HIV and STIs are increasing among domestic and international populations of MSM. 

We conducted a narrative review, using a targeted literature search strategy, as an initial effort to explore processes through which sexual positioning practices may contribute to HIV/STI transmission. Peer-reviewed articles were eligible for inclusion if they contained a measure of sexual positioning identity and/or behavior (i.e., "top", "bottom," etc.) or sexual positioning behavior (receptive anal intercourse or insertive anal intercourse), or assessed the relationship between sexual positioning identity withHIV risk, anal sex practice, masculinity, power, partner type, or HIV status. 

A total of 23 articles met our inclusion criteria. This review highlights dynamic psychosocial processes likely underlying sexual decision making related to sexual positioning identity and practices among MSM and MSM who have sex with women (MSMW), and ways these contexts may influence HIV/STI risk. 

Despite limited focus in the extant literature, this review notes the important role the contextual factors (masculinity stereotypes, power, partner type, and HIV status) likely to play in influencing sexual positioning identity and practices. Through this review we offer an initial synthesis of the literature describing sexual positioning identities and practices and conceptual model to provide insight into important areas of study through future research.

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By:  Dangerfield DT 2nd1, Smith LR2, Williams J3, Unger J3, Bluthenthal R3.

• 1Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA. ddangerf@usc.edu.
• 2Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA.
• 3Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA.
• Arch Sex Behav. 2016 May 13. 

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Correlates of Sexual Violence among Men Who Have Sex with Men in Tijuana, Mexico

Sexual violence among men who have sex with men (MSM) is prevalent in developing countries and is associated with increased HIV/STI risk. Despite high HIV prevalence (20 %) among MSM in Tijuana, Mexico, little attention has been paid to the occurrence of sexual violence in this high-risk group. 

The present study used a syndemic conditions framework to examine correlates of sexual violence victimization in a sample of 201 MSM surveyed in Tijuana, Mexico during 2012 and 2013. Participants were recruited through respondent-driven sampling and underwent a 2-h baseline interview and testing for HIV and syphilis. Sexual violence was defined as any incident during the past year in which the participant had been raped, sexually molested, or sexually harassed. 

The majority of participants self-identified as gay or bisexual, had never married, were employed, and had a high school education or greater. The average age was 29.7 years. Thirty-nine percent reported sexual violence in the past year. A hierarchical multiple linear regression model predicting more experiences of sexual violence was tested. In a final model, a higher number of experiences of sexual violence was associated with a history of childhood sexual abuse, more adult experiences of homophobia, more depression and hostility symptoms, and not living with a spouse or steady partner. 

The findings from this study support a model of co-occurring psychosocial factors that increase the likelihood of sexual violence experiences among MSM. Multi-level approaches to the prevention of childhood and adult experiences of sexual violence and homophobia are needed to avert the development of adverse mental and physical health outcomes associated with sexual violence victimization.

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By:  Semple SJ1, Stockman JK2, Goodman-Meza D3, Pitpitan EV2, Strathdee SA2, Chavarin CV1, Rangel G4, Torres K5, Patterson TL6.

• 1Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
• 2Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
• 3Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
• 4US-Mexico Border Health Commission, Tijuana, Mexico.
• 5Agencia Familiar Binacional, A.C., Tijuana, Mexico.
• 6Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA. tpatterson@ucsd.edu. 
• Arch Sex Behav. 2016 May 13. 

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Availability and Quality of Size Estimations of Female Sex Workers, Men Who Have Sex with Men, People Who Inject Drugs and Transgender Women in Low- and Middle-Income Countries

Objective

To assess the availability and quality of population size estimations of female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women.

Methods

Size estimation data since 2010 were retrieved from global reporting databases, Global Fund grant application documents, and the peer-reviewed and grey literature. Overall quality and availability were assessed against a defined set of criteria, including estimation methods, geographic coverage, and extrapolation approaches. Estimates were compositely categorized into ‘nationally adequate’, ‘nationally inadequate but locally adequate’, ‘documented but inadequate methods’, ‘undocumented or untimely’ and ‘no data.’

Findings

Of 140 countries assessed, 41 did not report any estimates since 2010. Among 99 countries with at least one estimate, 38 were categorized as having nationally adequate estimates and 30 as having nationally inadequate but locally adequate estimates. Multiplier, capture-recapture, census and enumeration, and programmatic mapping were the most commonly used methods. Most countries relied on only one estimate for a given population while about half of all reports included national estimates. A variety of approaches were applied to extrapolate from sites-level numbers to national estimates in two-thirds of countries.

Conclusions

Size estimates for FSW, MSM, PWID and transgender women are increasingly available but quality varies widely. The different approaches present challenges for data use in design, implementation and evaluation of programs for these populations in half of the countries assessed. Guidance should be further developed to recommend: a) applying multiple estimation methods; b) estimating size for a minimum number of sites; and, c) documenting extrapolation approaches.

Below:  Categorization of population size estimates of female sex workers, men who have sex with men, people who inject drugs, and transgender women in low- and middle-income countries, 2010–2014

Full article at:   http://goo.gl/wG4uNP

By:  

Keith Sabin, Sonia Arias Garcia 
Strategic Information and Evaluation Department, the Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland

Jinkou Zhao, Yaou Sheng, Annette Reinisch 

Technical Advice and Partnerships Department, The Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

Jinkou Zhao

Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China

Jesus Maria Garcia Calleja 

Department of HIV/AIDS, World Health Organization, Geneva, Switzerland

Ryuichi Komatsu 

Technical Evaluation Reference Group Support Team, The Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

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Intimate partner violence and condom negotiation efficacy among gay and bisexual men in Atlanta

Background:

The experience of intimate partner violence (IPV) has been shown to decrease condom negotiation efficacy among women; however, studies of this association among gay and bisexual men (GBM) are lacking.

Methods:

A venue-recruited sample of 745 GBM was recruited in Atlanta, GA, USA in 2012-13. Participants self-completed a survey including questions on recent (previous 12 month) experience and perpetration of IPV using the IPV-GBM Scale. Multivariate regression analysis examined the association between reporting low condom negotiation efficacy with the respondent's most recent sex partner (19.2% of respondents) and recent experience of IPV with the same or another partner.

Results:

Nearly half the sample (49.1%) reported recent receipt of IPV, although prevalence varied considerably across the forms of IPV. GBM who reported recent IPV experience were significantly less likely to report having felt able to negotiate condom use.

Conclusions:

These findings suggest that IPV may be a significant risk factor for HIV acquisition and transmission among GBM.

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By:  Rob Stephenson A B D, Ryan Freeland B and Catherine Finneran C 

A Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48104, USA. B The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI 48104, USA. C Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA 30322, USA. D Corresponding author. Email: rbsteph@umich.edu 

Sex Health. 2016 Apr 28. doi: 10.1071/SH15212. 

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A Pilot Trial of a Sexual Health Counseling Intervention for HIV-Positive Gay and Bisexual Men Who Report Anal Sex without Condoms

BACKGROUND:

Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior.

METHOD:

HIV-positive (HIV+) peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors.

RESULTS:

There was a significant reduction in condomless anal sex (CAS) with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity.

CONCLUSIONS:

The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men.

Below:  CONSORT diagram

Full article at:   http://goo.gl/A6MtFI

By:  Hart TA1,2, Stratton N1, Coleman TA1, Wilson HA1, Simpson SH3, Julien RE3, Hoe D4, Leahy B4, Maxwell J3, Adam BD5,6.

• 1Department of Psychology, Ryerson University, Toronto, Ontario, Canada.
• 2Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
• 3AIDS Committee of Toronto, Toronto, Ontario, Canada.
• 4Poz Prevention Working Group, Gay Men's Sexual Health Alliance, Toronto, Ontario, Canada.
• 5Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Ontario, Canada.
• 6Ontario HIV Treatment Network, Toronto, Ontario, Canada. 

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Frequency of HIV Testing among Gay & Bisexual Men in the UK: Implications for HIV Prevention

OBJECTIVES:

The aim of the study was to explore HIV testing frequency among UK men who have sex with men (MSM) in order to direct intervention development.

METHODS:

Cross-sectional surveys were completed by 2409 MSM in Edinburgh, Glasgow and London in 2011 and a Scotland-wide online survey was carried out in 2012/13. The frequency of HIV testing in the last 2 years was measured.

RESULTS:

Overall, 21.2% of respondents reported at least four HIV tests and 33.7% reported two or three tests in the last 2 years, so we estimate that 54.9% test annually. Men reporting at least four HIV tests were younger and less likely to be surveyed in London. They were more likely to report higher numbers of sexual and anal intercourse partners, but not "higher risk" unprotected anal intercourse (UAI) with at least two partners, casual partners and/or unknown/discordant status partners in the previous 12 months. Only 26.7% (238 of 893) of men reporting higher risk UAI reported at least four tests. Among all testers (n = 2009), 56.7% tested as part of a regular sexual health check and 35.5% tested following a risk event. Differences were observed between surveys, and those testing in response to a risk event were more likely to report higher risk UAI.

CONCLUSIONS:

Guidelines recommend that all MSM test annually and those at "higher risk" test more frequently, but our findings suggest neither recommendation is being met. Additional efforts are required to increase testing frequency and harness the opportunities provided by biomedical HIV prevention. Regional, demographic and behavioural differences and variations in the risk profiles of testers suggest that it is unlikely that a "one size fits all" approach to increasing the frequency of testing will be successful.

Full article at:   http://goo.gl/7F0D3O

By:  McDaid LM1, Aghaizu A2, Frankis J3, Riddell J1, Nardone A2, Mercey D4, Johnson AM4, Hart GJ4, Flowers P3.

• 1MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
• 2Public Health England, London, UK.
• 3Glasgow Caledonian University, Glasgow, UK.
• 4University College London, London, UK. 
• HIV Med. 2016 Mar 15. doi: 10.1111/hiv.12373.

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Providing HIV-Related Services in China for Men Who Have Sex with Men

Problem

In China, human immunodeficiency virus (HIV) care provided by community-based organizations and the public sector are not well integrated.

Approach

A community-based organization and experts from the Guangzhou Center for Disease Control and Prevention developed internet-based services for men who have sex with men, in Guangzhou, China. The internet services were linked to clinical services offering HIV testing and care.

Local setting

The expanding HIV epidemic among men who have sex with men is a public health problem in China. HIV control and prevention measures are implemented primarily through the public system. Only a limited number of community organizations are involved in providing HIV services.

Relevant changes

The programme integrated community and public sector HIV services including health education, online HIV risk assessment, on-site HIV counselling and testing, partner notification, psychosocial care and support, counting of CD4+ T-lymphocytes and treatment guidance.

Lessons learnt

The internet can facilitate HIV prevention among a subset of men who have sex with men by enhancing awareness, service uptake, retention in care and adherence to treatment. Collaboration between the public sector and the community group promoted acceptance by the target population. Task sharing by community groups can increase access of this high-risk group to available HIV-related services.

Below:  HIV testing of men who have sex with men through a project linking internet-based HIV services to testing, in Guangzhou, China, 2008–2013

Full article at:  http://goo.gl/K7wbD6

By:  Weibin Cheng,^a Yanshan Cai,^a Weiming Tang,^b Fei Zhong,^a Gang Meng,^c Jing Gu,^d Chun Hao,^d Zhigang Han,^a Jingyan Li,^c Aritra Das,^e Jinkou Zhao,^f Huifang Xu,^a Joseph D Tucker,^b and Ming Wang^a

^aDepartment of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Jiahe, Guangzhou, Guangdong,510440, China.

^bUniversity of North Carolina Project-China, Guangzhou, China.

^cLingnan Partners Community Support Center (GZTZ.ORG), Guangzhou, China.

^dSchool of Public Health, Sun Yat-sen University, Guangzhou, China.

^eFielding School of Public Health, University of California Los Angeles, Los Angeles, United States of America.

^fGlobal Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.

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'HIV and work don't go together': Employment as a social determinant of HIV outcomes among men who have sex with men and transgender women in the Dominican Republic

Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in the Dominican Republic. Little is known about their experiences living with HIV as a chronic condition. 

We explored employment as a social determinant of well-being with HIV. We conducted 42 qualitative in-depth interviews with MSM (n = 16) and transgender women (n = 5) living with HIV; each participant completed 2 interviews to facilitate depth and iterative analysis. We used narrative analysis and systematic coding to identify salient themes related to employment and the HIV experience and developed a conceptual model of the pathways between HIV stigma, unemployment, and HIV outcomes. Early life experiences, including rejection from families and school, resulted in limited work opportunities, especially among transgender women. Following HIV diagnosis, participants across all socio-economic levels lost jobs and/or were unable to get jobs due to illegal HIV testing and HIV stigma and discrimination. Not being able to work impacted mental health, engagement in HIV care, and overall well-being. 

We conclude that lack of employment is a salient concern among MSM and transgender women living with HIV. Holistic, multi-level programmes that address illegal HIV testing and discriminatory hiring practices are urgently needed to facilitate engagement in care and long-term well-being.

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By:  Barrington C1, Acevedo R2, Donastorg Y3, Perez M3, Kerrigan D4.

• 1 Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
• 2 Consejo Nacional para el VIH y el SIDA , Santo Domingo , Dominican Republic.
• 3 HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugía de Piel Dr. Huberto Bogaert Díaz , Santo Domingo , Dominican Republic.
• 4 Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA. 
• Glob Public Health. 2016 Mar 21:1-16. 

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