Heterosexual Young Adults' Interest, Attitudes, and Experiences Related to Mixed-Gender, Multi-Person Sex

There has been little research on threesomes, a form of multi-person sex that involves sexual activity with two other people simultaneously. Therefore, we examined young adults' attitudes toward, interest in, and experiences with one form of threesome, mixed-gender threesomes (MGTs), defined as sexual activity involving three people where at least one member of each gender is present. 

Participants were 274 (202 women, 72 men) heterosexual young adults who completed an online survey. Overall, 13 % of participants (24 % of men and 8 % of women) reported experience and 64 % reported some interest in engaging in an MGT. However, the overall level of interest was quite low and varied according to contextual variables (i.e., what other persons were involved). 

Men's interest remained unaffected by third person status as long as the MGT involved familiar others (friends and acquaintances) rather than strangers, whereas women preferred familiar others only for MGTs with which they were the third person, not for those involving a romantic partner. 

Participants also reported fairly neutral attitudes toward MGTs. Compared to the women, the men reported significantly more positive attitudes and greater interest, and were more likely to report MGT experience. In addition, attitudes, interest, and experience were all positively associated with each other. 

Taken together, these results suggest that young people are not judgmental about others engaging in MGTs but are not highly motivated to do so themselves. Implications for researchers and sexual health educators are discussed.

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By:  Thompson AE1, Byers ES2.

• 1Department of Psychology, University of Wisconsin Oshkosh, 800 Algoma Blvd., Oshkosh, WI, 54901, USA. thompsae@uwosh.edu.
• 2Department of Psychology, University of New Brunswick, POB 4400, Fredericton, NB, E3B 3A1, Canada. 
• Arch Sex Behav. 2016 Mar 4. 

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Beyond Anal Sex: Sexual Practices of Men Who Have Sex with Men and Associations with HIV and Other Sexually Transmitted Infections

INTRODUCTION:

Unprotected anal intercourse is often used as a single indicator of risky behavior in men who have sex with men (MSM), yet MSM engage in a variety of behaviors that have unknown associations with sexually transmitted infection (STI) and HIV.

AIM:

To assess the prevalence of a wide range of sexual behaviors and their associations with prevalent STI and HIV.

METHODS:

We used a standardized, self-administered survey to collect behavioral data for this cross-sectional study of 235 MSM seeking care in a public clinic for sexually transmitted diseases.

MEAN OUTCOME MEASURES:

Using modified Poisson regression, we generated unadjusted and adjusted prevalence ratios (PRs) to characterize associations between recent participation in each behavior and prevalent STI and HIV.

RESULTS:

Participants' median age was 26 years. One third (35%) were positive for STI. STI prevalence was significantly associated with using sex slings, felching, group sex, fisting, anonymous sex, and sex toys. HIV prevalence was 17% and was significantly associated with fisting, felching, enemas, and group sex.

CONCLUSION:

Multiple behaviors were significantly associated with prevalent STI and HIV in adjusted analyses. To provide a more comprehensive understanding of sexual risk in MSM, prospective studies are needed to examine whether these behaviors are causally associated with HIV and STI acquisition.

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By:  Rice CE1, Maierhofer C2, Fields KS3, Ervin M3, Lanza ST4, Turner AN2.

• 1Department of Biobehavioral Health, The Methodology Center (https://methodology.psu.edu/), College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA. Electronic address: cer5374@psu.edu.
• 2Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA.
• 3Sexual Health Clinic, Columbus Public Health, Columbus, OH, USA.
• 4Department of Biobehavioral Health, The Methodology Center, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA. 
• J Sex Med. 2016 Feb 4. pii: S1743-6095(16)00074-6. doi: 10.1016/j.jsxm.2016.01.001.

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Is Group Sex a Higher-Risk Setting for HIV and Other Sexually Transmitted Infections Compared with Dyadic Sex among Men Who Have Sex with Men?

BACKGROUND:

Group sex has been suggested as a potential high-risk setting for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM). We investigated whether group sex is associated with lower condom use during anal sex and higher proportions of STIs compared with dyadic sex among HIV-negative MSM between 2009 and 2012.

METHODS:

Cross-sectional data from 7 data waves of the Amsterdam Cohort Studies were used. The sample consisted of 465 MSM who either reported both group and dyadic sex (at n = 706 visits) or dyadic sex only (at n = 1339 visits) in the preceding 6 months. Logistic regression with generalized estimating equations was used to investigate the association between sexual setting (group vs. dyadic sex), condomless anal sex, and STI.

RESULTS:

Group sex was reported at 35% (706/2045) of visits. Condomless sex was more often reported during dyadic than group sex (odds ratio, 3.64 95% confidence interval, 2.57-5.16). Men who had group sex were more likely diagnosed as having gonorrhea compared with men with dyadic sex (odds ratio, 1.71; 95% confidence interval, 1.08-2.97), but this effect was not retained in the multivariate model.

CONCLUSIONS:

Results demonstrate within-person differences in sexual behavior during group and dyadic sex among MSM. Men were more likely to use condoms during group sex than during dyadic sex. Thus, for some, group sex may not necessarily be risky for HIV infection compared with dyadic sex. However, group sex may be a higher-risk setting for acquiring STIs other than HIV, such as gonorrhea. Group sex encounters should be recognized as distinct sexual settings with specific risk characteristics that need to be addressed accordingly.

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By:  van den Boom W1, Davidovich U, Heuker J, Lambers F, Prins M, Sandfort T, Stolte IG.

• 1From the *Department of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, Amsterdam, the Netherlands; †Department of Infectious Diseases, Tropical Medicine and AIDS, CINIMA, Academic Medical Center, Amsterdam, the Netherlands; and ‡HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY. 

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Sexual Behaviours, Sex Toy & Sexual Safety Methods Reported by Women Who Have Sex with Women & Men

Background: 
Relative to women who engage in sex with exclusively men or women, women who have sex with women and men (WSWM) are more likely to report a history of sexually transmissible infections. Knowledge of the diversity and specificity of the sexual behaviours in which they engage may provide insight into the behavioural modes of infection. The present study sought to document a range of behaviours including concurrent multi-person sexual activity (e.g. orgy, threesome), anal sexual activity and sex toy use. Barrier use methods during specific behaviours were also assessed. 

Methods: Eighty women who reported recent genital contact with at least one man and one woman were recruited via targeted Internet, venue-based and snowball sampling methods. Consenting participants were directed to an online survey. During an in-person timeline follow-back interview (the SEQUENCE© calendar method), a subset of participants (n = 53) provided detailed sexual behaviour data for each sexual partner over the previous 12 months. 

Results: Almost three-quarters of the sample reported at least one concurrent multi-person sexual activity. Nearly two-thirds of participants reported engaging in sexual behaviour that involved their own (66.7%) or their partner's (49.4%) anus in the past year. Barrier use for sexual behaviours other than penile-vaginal intercourse was uncommon. Behaviours and safety strategies were similar with men and women regardless of partner gender. 

Conclusions: The sexual repertoires reported by participants in this study were diverse. Understanding the range of diverse sexual behaviours of the participants may enable the construction of tailored recommendations for sexual health maintenance among WSWM.

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By:   Vanessa Schick A E, Brian Dodge B, Barbara Van Der Pol C, Aleta Baldwin B and J. Dennis Fortenberry D 

A University of Texas Health Science Center at Houston, Division of Management, Policy, and Community Health, School of Public Health, 1200 Pressler Street, Rm E-917, Houston, TX 77030, USA. 

B Indiana University - Bloomington, Center for Sexual Health Promotion, 1025 E.7th Street SPH 116, Bloomington, IN 47405, USA. 

C University of Alabama at Birmingham, Division of Infectious Diseases, 1900 University Boulevard, Birmingham, AL 35294, USA. 

D Indiana University School of Medicine, Division of Adolescent Medicine, 410 West 10th Street, Indianapolis, IN 46202, USA. 

E Corresponding author. Email: Vanessa.Schick@uth.tmc.edu 

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Event-Level Analysis of Anal Sex Roles and Sex Drug Use among Gay & Bisexual Men in Vancouver, British Columbia, Canada

This study analyzed event-level partnership data from a computer-assisted survey of 719 gay and bisexual men (GBM) enrolled in the Momentum Health Study to delineate potential linkages between anal sex roles and the so-called “sex drugs,” i.e., erectile dysfunction drugs (EDD), poppers, and crystal methamphetamine. 

Univariable and multivariable analyses using generalized linear mixed models with logit link function with sexual encounters (n = 2514) as the unit of analysis tested four hypotheses: 

1. EDD are significantly associated with insertive anal sex roles, 
2. poppers are significantly associated with receptive anal sex, 
3. both poppers and EDD are significantly associated with anal sexual versatility, and 
4. crystal methamphetamine is significantly associated with all anal sex roles. 

Data for survey respondents and their sexual partners allowed testing these hypotheses for both anal sex partners in the same encounter. Multivariable results supported the first three hypotheses. Crystal methamphetamine was significantly associated with all anal sex roles in the univariable models, but not significant in any multivariable ones. Other multivariable significant variables included attending group sex events, venue where first met, and self-described sexual orientation. 

Results indicate that GBM sex-drug use behavior features rational decision-making strategies linked to anal sex roles. They also suggest that more research on anal sex roles, particularly versatility, is needed, and that sexual behavior research can benefit from partnership analysis.

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By: Rich AJ1, Lachowsky NJ1,2, Cui Z1, Sereda P1, Lal A1, Moore DM1,2, Hogg RS1,3, Roth EA4,5.

• 1BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
• 2Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
• 3Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
• 4Department of Anthropology, Centre for Addictions Research of British Columbia, University of Victoria, Victoria, BC, Canada. ericroth@uvic.ca.
• 5Centre for Addictions Research of British Columbia, University of Victoria, P.O. Box 3050 STN CSC, Victoria, BC, V8W 3P5, Canada. ericroth@uvic.ca.  

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Group Sex and Prevalent Sexually Transmitted Infections among Men Who Have Sex with Men

We evaluated the direct relation between group sex and prevalent sexually transmitted infections (STI) in a cross-sectional study of men who have sex with men (MSM) presenting at an urban STI clinic in the Midwestern US. 

Among 231 men who enrolled and reported that they have sex with men, we collected behavioral data using a combination of interviewer and self-administered surveys and extracted STI data from electronic health records. We used modified Poisson regression to examine the unadjusted and adjusted associations between group sex participation and prevalent STI. 

• One-quarter of participants reported group sex participation in the last 3 months. 
• 18% of participants had gonorrhea and 19% had chlamydial infection. 
• Men who reported recent group sex were more likely
• to be HIV-positive, 
• to report recent drug use, and 
• to report unprotected receptive anal intercourse in the past 3 months. 
• After adjustment for age, race, and recent drug use, recent participation in group sex was associated with prevalent gonorrhea infection but not chlamydia infection. 

We performed a sensitivity analysis in which we also adjusted for unprotected receptive anal intercourse and the results were not substantively changed. 

In summary, participation in group sex in the past 3 months was associated with a more than twofold increased prevalence of gonorrhea, but not with chlamydia. These findings support group sex participation as a potential contributor to increased STI prevalence.

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By: Rice CE1, Lynch CD2, Norris AH3,4, Davis JA4, Fields KS5, Ervin M5, Turner AN3,4.

• 1Division of Epidemiology, College of Public Health, The Ohio State University, N1144 Doan Hall, 410 West 10th Ave., Columbus, OH, 43210, USA
• 2Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, USA.
• 3Division of Epidemiology, College of Public Health, The Ohio State University, N1144 Doan Hall, 410 West 10th Ave., Columbus, OH, 43210, USA.
• 4Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA.
• 5Sexual Health Clinic, Columbus Public Health, Columbus, OH, USA.

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Marijuana Use as a Sex-Drug is Associated with HIV Risk among Black MSM and Their Network

Black men who have sex with men (BMSM) are highest risk for HIV seroconversion in the United States. Little attention has been paid to marijuana use among BMSM and potential for HIV risk. 

A sample of 202 BMSM was generated through respondent driven sampling. The relationship between differential marijuana use and both HIV risk behavior and social network factors were examined using weighted logistic regression. 

Of the BMSM in this sample 

• 60.4% use marijuana in general and 
• 20.8% use marijuana as sex-drug. 
• General marijuana use was significantly associated with participation in group sex 
• while marijuana use as a sex drug was significantly associated with both participation in condomless sex and group sex. 
• Respondents with a moderate or high perception of network members who use marijuana were more likely to use marijuana both in general and as a sex-drug. 
• Network member marijuana use, while not associated with risk behaviors, 
• is associated with individual marijuana use and 
• individual marijuana use in the context of sex is associated with risk practices. 

Targeting interventions towards individuals and their respective networks that use marijuana as a sex drug may reduce HIV risk.

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By: Morgan E1, Skaathun B1, Michaels S2, Young L3, Khanna A3, Friedman SR4, Davis B3, Pitrak D3, Schneider J5,6,7; UConnect Study Team.

• 1Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
• 2NORC at the University of Chicago, University of Chicago, Chicago, IL, USA.
• 3Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.
• 4National Development and Research Institutes, New York, NY, USA.
• 5Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
• 6NORC at the University of Chicago, University of Chicago, Chicago, IL, USA.
• 7Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.

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Characteristics Associated with Group Sex Participation among Men & Women in the Club Drug Scene

This study examined the demographics, substance use and sexual risk behaviours associated with group sex (GS) participation among a sample of club drug users (n = 498) in Miami. 

Men and women reported histories of GS. Group sex participation among men and women was associated with heroin and injection drug use, trading or selling sex, and sex while high, compared with no GS participation. Moreover, among men, GS was associated with buying sex and sex with an injection drug user; among women, GS was associated with substance dependence, a history of sexually transmissible infections and crack cocaine use, compared with no GS participation.

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By: Buttram ME, Kurtz SP.
Center For Applied Research on Substance Use and Health Disparities, 2 NE 40th Street, Suite 404 Miami, FL 33137, USA. 

Engagement in Group Sex among Geosocial Networking Mobile Application-Using Men Who Have Sex with Men

Background: Men who have sex with men (MSM) remain the group most affected by the HIV epidemic in the United States. At least one-quarter of MSM report engagement in group sex events (GSEs), which can pose a risk for HIV transmission and acquisition. In this study, identification of event-level correlates of sexual and drug use behaviours at GSEs was sought to better inform prevention activities. 

Methods: For this study, participants were recruited via banner and pop-up advertisements placed on a geosocial networking mobile phone application that MSM use to meet men.

Results: Of the 1997 individuals who completed the study screener, 36.0% reported participating in at least one GSE in the prior year. In multivariable logistic regression analysis, attendance at a GSE in the past year was significantly associated with older age, full/part time employment and being HIV positive. Of the men who attended a GSE, more than half reported condomless anal sex (CAS) with at least one of their partners (insertive: 57.7%; receptive: 56.3%). MSM who indicated drug use had significantly higher odds of having insertive CAS [odds ratio (OR) = 2.45; 95% confidence interval (CI): 1.37–4.39] and receptive CAS (OR = 3.60; 95% CI: 1.96–6.63) at their last GSE. 

Conclusions:The high prevalence of HIV-positive MSM engaging in group sex, coupled with their greater odds of CAS, poses a significant risk for HIV/STI transmission within the group sex setting. More research is needed to determine patterns of condom use at these events and whether seroadaptive behaviours are driving CAS.