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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Status & Influencing Factors of Rush Poppers Use & HIV Infection among Men Who Have Sex with Men in Changsha

OBJECTIVE:

To explore the relationship between use of rush poppers and HIV infection, and associated factors among men who have sex with men in Changsha.

METHODS:

A cross-sectional study was conducted in Changsha from April to December, 2014. Men who have sex with men who came for HIV counseling and testing services were invited to fill out a survey. A total of 608 MSM were finally recruited. The survey included socio-demographic characteristics, sexual roles, sexual behaviors in last 6 months and rush poppers use, HIV infection among MSM. After finishing the questionnaire, 5 ml blood was also drawn for HIV testing. Chi-square test or Fisher probabilities was used to compare usage of rush poppers and HIV antibody positive rate among MSM who had different characteristics and sexual behaviors. Multi-factor unconditioned logistic regression model was used to explore related factors about rush poppers use and HIV infection of MSM.

RESULTS:

Among 608 MSM, 29.8% (181) said they ever used rush poppers, and 13.3% (81 cases) were HIV positive. Among MSM who ever used rush poppers, 18.8% (34/181) were HIV positive; While among those who never used rush poppers, 10.5% (45/427) were HIV positive (χ(2)=7.65,P=0.006). Compared with MSM who had no For One Night sex in the last 6 months,OR (95%CI) value of MSM who had 6-10 times For One Night sexes in last 6 months to use rush poppers was 4.32 (1.77-10.57). Compared with MSM who self-identified as top,OR (95%CI) value of MSM who self-identified as bottom or versatile using rush poppers were 2.99 (1.53-5.86), or 3.60 (2.13-6.09). Compared with MSM who self-identified as top, OR (95%CI) value of MSM who self-identified as bottom or versatile to infect HIV were 3.19 (1.35-7.58), or 2.33 (1.12-4.85). Compared with MSM who used condoms at every anal sex,OR (95%CI) value of MSM who used condoms sometimes or never used to infect HIV were 1.93 (1.12-3.35) or 1.87 (0.64-5.50). Compared with MSM who never used rush poppers,OR (95%CI) value of MSM who ever used rush poppers to infect HIV was 1.88 (1.12-3.16).

CONCLUSION:

A large percentage of MSM population in Changsha used rush poppers, and HIV antibody positive rate among MSM was high. MSM who had more frequencies of For One Night sexes, self-identified as bottom or versatile were more likely to use rush poppers and more susceptible to HIV infection. In addition, MSM who had low frequency of condom use in the last 6 months in anal intercourse were more likely to infect HIV.

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By:  Lei YX1, Wang HH, Xiao XL, Chen J, Li XH.

• 1Xiangya School of Nursing, Central South University, Changsha 410013, China. 
• Zhonghua Yu Fang Yi Xue Za Zhi. 2016 Feb 6;50(2):148-52. doi: 10.3760/cma.j.issn.0253-9624.2016.02.009.

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"I provide the pleasure, I control it": Sexual Pleasure & "Bottom" Identity Constructs amongst Gay Youth in a Stepping Stones Workshop

This paper explores the meanings attached to gay sexuality through the self-labelling practices of a group of young gay-identified students in focus group and individual interviews in Johannesburg, South Africa. These meanings include constructs of the dynamics surrounding safe sex negotiation and risk related to "top-bottom" subject positioning as well as the erotics of power and desire that are imbued in these practices and positioning. 

Using performativity theory as a theoretical tool of analysis, I argue that constructs of "top-bottom" subjectivities can be seen to meet certain erotic needs for LGBTI youth, including reasons related to physical safety for LGBTI people living in dangerous spaces. The performance of "bottom" identities in sexual intimacy and behaviour is further deployed in the expression and performance of power that the participants construct as erotic. 

The implications for sexual health intervention include understanding the gendered performance influences of sexual behaviour including safe sex, exploring creative ways that practices of sexual health can be engaged with this population group in a way that accommodates the erotic pleasure interfaced with sexual identity identifications and performances of "bottom" identities.

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By:   Kiguwa P¹.

¹Senior Lecturer, Department of Psychology, University of the Witwatersrand, South Africa. Electronic address: Peace.Kiguwa@wits.ac.za.

Reprod Health Matters. 2015 Nov;23(46):117-26. doi: 10.1016/j.rhm.2015.11.016. Epub 2015 Dec 17. 

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Ask a Homo: What’s the deal with tops and bottoms? (mildly NSFW)

Via:  http://goo.gl/hD88rW  By:  https://twitter.com/jbryanlowder

Experimentals, Bottoms, Risk-Reducers & Clubbers: Exploring Diverse Sexual Practice in an Internet-Active High-Risk Behaviour Group of Men Who Have Sex with Men in Sweden

This study aimed to identify sub-groups of men who have sex with men at high risk of HIV infection. Data from the Swedish MSM2013 survey were analysed with a focus on respondents (n = 714) who reported having had unprotected anal intercourse with male casual partner(s) in the past 12 months. 

Weighted Latent Class Analysis with covariates and distal outcomes was conducted to identify sub-groups of men sharing the same sexual practice characteristics. Four latent classes emerged: experimentals, bottoms, risk-reducers and clubbers. 

Experimentals appeared to differ most from the other classes. They had extensive experience of barebacking, the use of poppers and fisting. Higher number of casual male sex partners and reporting having HIV were predictors for belonging to experimentals. 

No evidence for an association between self-rated HIV prevention knowledge and taking less part in risky practices was found. Hence, knowledge-intensive interventions may not be the best fit for reducing HIV transmission. 

This diversity of men based on similar sexual practice patterns should be taken into account when designing future HIV prevention interventions.

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By:  Persson KI1,2, Tikkanen R3, Bergström J4, Berglund T5, Thorson A1, Forsberg BC1.

• 1 Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.
• 2 Department of Knowledge Development, Unit for Health and Sexuality , Public Health Agency of Sweden , Solna , Sweden.
• 3 Department of Social Work , University of Gothenburg , Göteborg , Sweden.
• 4 Department of Monitoring and Evaluation, Unit for Statistics and Surveillance , Public Health Agency of Sweden , Solna , Sweden.
• 5 Department of Monitoring and Evaluation, Unit for Epidemiology and Health Economics , Public Health Agency of Sweden , Solna , Sweden.

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