"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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Alcohol use, risky sexual behavior, and condom possession among bar patrons

HIGHLIGHTS

• Bar patrons' intentions to engage in unsafe sex varied by sex and BrAC.
• Significant predictors of condom possession were gender, race, age and BrAC level.

PURPOSE:

The current study seeks to: 1) assess the relationship between alcohol consumption and intentions to engage in unprotected sex in an uncontrolled environment, and 2) to identify if covariates (race, age, sex, breath alcohol content (BrAC), intentions to engage in sex, hazardous drinking rates) are significant predictors of condom possession during time of uncontrolled alcohol consumption.

METHODS:

Data were collected from 917 bar patrons to assess alcohol use using the Alcohol Use Disorders Identification Test (AUDIT-C), BrAC levels, intentions to engage in risky sex, and condom possession. Correlational analysis and hierarchical binary logistic regression was conducted using SPSS.

RESULTS:

Correlational analyses indicated a negative relationship between AUDIT-C scores (r=-0.115, p=0.001), BrAC (r=-0.08, p=0.015), and intentions to use a condom. Over 70% of participants intended to use a condom if they engaged in sex; however, only 28.4% had a condom to use. The regression analysis indicated the predictive model (χ²=114.5, df=8, p<0.001) was statistically significant, and correctly classified 72.9% of those in possession of a condom.

CONCLUSIONS:

Alcohol consumption was associated with intentions to have unprotected sex; however, intentions to engage in protected sex and condom possession were higher for males and those with higher BrAC levels.

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By:  Chaney BH1, Vail-Smith K2, Martin RJ3, Cremeens-Matthews J4.

• 1East Carolina University, Department of Health Education & Promotion, 3105 Carol G. Belk Building, Greenville, NC 27858, United States. Electronic address: chaneye@ecu.edu.
• 2East Carolina University, Department of Health Education & Promotion, 3208 Carol G. Belk Building, Greenville, NC 27858, United States. Electronic address: vailsmithk@ecu.edu.
• 3East Carolina University, Department of Health Education & Promotion, 2206 Carol G. Belk Building, Greenville, NC 27858, United States. Electronic address: martinry@ecu.edu.
• 4East Carolina University, Department of Health Education & Promotion, 2302 Carol G. Belk Building, Greenville, NC 27858, United States. Electronic address: cremeensj@ecu.edu. 
• Addict Behav. 2016 Apr 6;60:32-36. doi: 10.1016/j.addbeh.2016.03.035.

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Time-Site Survey of Substance Use, Sexual Behaviours, and HIV-Testing Practices among Women Attending Social Venues in Prague

AIM:

The rates of HIV acquired through heterosexual contact are increasing in the Czech Republic. This study explored potential HIV risk associations with alcohol, illicit drugs and sexual behaviors among adults from a community-based sample attending gay- and non-gay venues in Prague.

METHODS:

Women attending bars, cafes and beer gardens in central Prague responded to the self-administered, time-site survey. Alcohol use was measured by the AUDIT-C and CAGE questionnaires. Sexual network structuring identified number, gender and coital frequency with current and recent sexual partners. Statistical analysis included central tendency, chi-square and logistic regression. Female participants (n=124) ranged from 18 to 67 years of age (mean 29 years); 25% self-identified as non-heterosexual.

RESULTS:

We found alcohol to be the preferred drug of choice. Younger heterosexual women with new and casual sexual partners were more likely to use alcohol excessively. Women with children reported the least alcohol use. Sixty percent of the sample had never used condoms; condom-use was associated with longer relationship duration and discussions about HIV status with a sexual partner; non-use tended to occur among unmarried women with multiple male partners in short, serial sexual relationships. Women who sought HIV testing tended to be younger and more self-identified as non-heterosexual. Protective practices were rarely reported even when HIV transmission increases via heterosexual sexual partnering.

CONCLUSION:

Further research is recommended regarding cultural and contextual influences on HIV risk behaviors among Czech women.

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By:  Stemmler SM1,2, Hall TM1, Prokopík P3, Shoptaw S1.

• 1Center for Behavioral and Addiction Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
• 2California State University, Dominguez Hills, Carson, CA, United States.
• 3Charles University, Prague, Czech Republic.
• Cent Eur J Public Health. 2015 Jun;23(2):135-141. 

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Comparison of Drugs Used by Nightclub Patrons & Criminal Offenders in Oslo, Norway

The aim of this study was to investigate psychoactive drug use among nightclub patrons by analysing samples of oral fluid and compare with findings in blood samples from criminal suspects. 

We hypothesized that the profile of illicit drug use among nightclub patrons is different from what we observe in those forensic cases. Research stations were established outside nine popular nightclubs with different profiles and patron-characteristics in downtown Oslo. Data and sample collection was conducted on Fridays and Saturdays in March and May 2014. Individuals and groups who entered defined recruitment zones from 23:00 to 03:30 were invited to participate in this voluntary and anonymous study. Oral fluid was collected using the Intercept Oral Fluid Sampling Device. Methanol was added to increase the recovery of cannabinoids from the device. Sample preparation was performed using liquid-liquid extraction with ethyl acetate/heptane (4:1) after adding internal standards, ammonium carbonate buffer pH 9.3 and Triton X100. The first 80 samples were analysed for 122 substances, which included psychoactive medicinal drugs, classical illicit drugs and new psychoactive substances (NPS). Based on the findings and discussions with police and customs authorities, the remaining oral fluid samples were analysed for 46 substances. 

Among the 500 samples collected during the study period, we found illicit drugs in 25.4% and medicinal drugs in 4.2% of the samples. The most prevalent substances were: cocaine 14.6%, THC 12.4%, amphetamine/methamphetamine 2.8%, diazepam 1.2% and clonazepam 1.0%. Various NPS were found in 1.4% of the samples. 

The prevalence of drugs in blood samples from criminal suspects were for cocaine 3.4%, THC 34.7%, amphetamine/methamphetamine 37.0%, diazepam 12.0%, and clonazepam 29.3%. Multi-drug use was more common among criminal suspects (41.3%) than among club patrons (6.8%). 

The results showed that the drug use pattern among nightclub patrons was substantially different from the drug use pattern manifested by individuals apprehended by the police suspected for criminal conduct.

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By:  Gjerde H1, Nordfjærn T2, Bretteville-Jensen AL2, Edland-Gryt M2, Furuhaugen H3, Karinen R3, Øiestad EL3.

• 1Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, NO-0403 Oslo, Norway. Electronic address: hallvard.gjerde@fhi.no.
• 2Norwegian Institute for Alcohol and Drug Research (SIRUS), PO Box 565, Sentrum, NO-0105 Oslo, Norway.
• 3Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, NO-0403 Oslo, Norway. 
• Forensic Sci Int. 2015 Dec 30;265:1-5. doi: 10.1016/j.forsciint.2015.12.029

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Partner Meeting Contexts and Risky Behavior in College Students' Other-Sex and Same-Sex Hookups

We analyzed a sample of 12,065 hookup encounters among college students at 22 colleges and universities in the Online College Social Life Survey (OCSLS) to explore how partner meeting locales may influence college students' risky behavior when hookup partners are met in those contexts. 

For other-sex encounters, meeting in bars or at parties, through common interest groups or history, and (for women) at dormitories was associated with binge drinking during encounters, while meeting online and (for women) in public was associated with reduced binge drinking during encounters. Unprotected sex during other-sex encounters was more common when partners were met in public and less common with partners met in dormitories. 

Binge drinking and marijuana use during or just prior to encounters was associated with an increased risk of unprotected sex and other substance use. Marijuana use and unprotected sex during encounters was more common when students knew their hookup partner better or had hooked up with the partner before, while binge drinking was associated with hooking up with less familiar partners. 

Associations of meeting contexts with behavior were explained by the locale's association with institutional and personal trust, social scripts, and selection into certain contexts by students with a risk-taking personality.

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By:  Kuperberg A1, Padgett JE2.

• 1 Department of Sociology , The University of North Carolina at Greensboro.
• 2 Department of Sociology , University of South Carolina. 
• J Sex Res. 2016 Jan 26:1-18.

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Polydrug Use among Nightclub Patrons in a Megacity: A Latent Class Analysis

Highlights

• Three groups of drug users were found in São Paulo nightclubs.
• It is more likely to find high level polydrug users in electronic or hip-hop nightclubs.
• Frequency of attendance, gender and age are associate to the two polydrug groups.
• Binge drinking was a predominant behaviour in all groups.

Abstract

Background

Nightclubs are places with a high prevalence of binge drinking and illicit drug use. The aim of this study was to evaluate the characteristics of polydrug use, including licit and illicit drugs, among 2420 nightclub patrons in a probabilistic sample in the city of São Paulo, Brazil,

Methods

The study was conducted in 2013. A latent class analysis (LCA) of polydrug use, accounting for binge drinking (BD) and other drug use (cannabis, cocaine, ecstasy, tobacco, ketamine, inhalants and hallucinogens) in the past 12 months was performed using Mplus. Multinomial logistic regression was used to evaluate latent class associations with sociodemographic characteristics and variables that characterise type of nightclub and frequency of attendance.

Findings

A three-class LCA model best described polydrug use patterns. We found a “no polydrug use” class (55%), a “moderate polydrug use” class (35%) and a “high level polydrug use” class (10%). Compared to “no polydrug use”, patrons in the two “polydrug use classes” were more likely to be men, young adults (<34 years), have attended nightclubs three times or more per month and have attended hip-hop and rock music nightclubs. Patrons in the “high level polydrug use” class were more likely to attend electronic (aOR = 9.9, 95% CI: 5.4–8.1, p < 0.001) and hip-hop music nightclubs (aOR = 10.1, 95% CI: 6.2–16.5, p < 0.001).

Conclusion

LCA is a useful method to identify groups of polydrug users among nightclub patrons. The three groups identified represented the diversity of patrons of São Paulo nightclubs. Frequency of attendance and the nightclub's musical style were highly correlated with polydrug use.

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By:  Adriana Sañudo^,, Solange Andreoni^a Zila M. Sanchez^b, , 

^a Department of Preventive Medicine, Section of Biostatistics, Universidade Federal de Sao Paulo, Rua Botucatu, 740, São Paulo, SP, Brazil

^b Department of Preventive Medicine, Section of Epidemiology, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, SP, Brazil

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HIV Test Uptake among MSM in China: Implications for Enhanced HIV Test Promotion Campaigns among Key Populations

Despite global efforts to increase HIV test uptake among men who have sex with men (MSM), social stigma and negative attitudes toward homosexuality hinder the effectiveness of traditional test promotion campaigns. Increasing HIV test uptake requires greater understanding of the conditions that facilitate decisions to get tested. 

We conducted an online survey hosted by two of the most highly frequented MSM web portals in China. A generalised ordered logistic regression analysis was conducted to determine factors associated with HIV testing behaviour. Compared to men who had never tested for HIV, men who had tested in the past year were more likely to have never engaged in sex with women, have multiple male sex partners in the past 3 months and have disclosed their sexual orientation to others. MSM found testing at local Chinese Centers for Disease Control and Prevention (80.7%), gay men's community-based organisations (80.2%) and public hospitals (70.9%) to be acceptable, while saunas (50.5%) and gay bars (41.8%) were found to be unacceptable testing venues. 

Our study shows that MSM in China prefer to test at venues that guarantee confidentiality, quality and quick results. Our study also suggests that self-testing may be a feasible approach to increase test uptake.

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By:  Han L1,2, Wei C3, Muessig KE1,4, Bien CH1,5, Meng G6, Emch ME7, Tucker JD1,8.

• 1 University of North Carolina Project - China , Guangzhou , People's Republic of China.
• 2 Department of Biostatistics, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
• 3 Department of Epidemiology and Biostatistics & Global Health Sciences , University of California - San Francisco , San Francisco , CA , USA.
• 4 Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
• 5 Icahn School of Medicine at Mount Sinai , New York , NY , USA.
• 6 Guangtong - Lingnan MSM Community Support Center , Guangzhou , People's Republic of China.
• 7 Department of Geography , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
• 8 School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
• Glob Public Health. 2016 Jan 19:1-14.  

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High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda

The aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. 

Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. 

At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). 

Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. 

This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa.

Full article at:   http://goo.gl/yT7hIa

By:  Weiss HA1, Vandepitte J2, Bukenya JN3, Mayanja Y4, Nakubulwa S5, Kamali A6, Seeley J7,8, Grosskurth H9.

• 1MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene &amp; Tropical Medicine, London WC1E 7HT, UK. helen.weiss@lshtm.ac.uk.
• 2Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. jvdpitte@hotmail.co.uk.
• 3Department of Community Health and Behavioral Sciences, School of Public Health, Colleges of Health Sciences, Makerere University, Kampala, Uganda. jbukenya@musph.ac.ug.
• 4Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. yunia.mayanja@mrcuganda.org.
• 5Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. Susan.nakubulwa@mrcuganda.org.
• 6Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. anatoli.kamali@mrcuganda.org.
• 7Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. janet.seeley@lshtm.ac.uk.
• 8Department of Global Health and Development, London School of Hygiene &amp; Tropical Medicine, London WC1E 9RE, UK. janet.seeley@lshtm.ac.uk.
• 9MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene &amp; Tropical Medicine, London WC1E 7HT, UK. heiner.grosskurth@lshtm.ac.uk. 
• Int J Environ Res Public Health. 2016 Jan 22;13(2). pii: E153. doi: 10.3390/ijerph13020153.

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Determinants of Heterosexual Adolescents Having Sex with Female Sex Workers in Singapore

OBJECTIVES:

We assessed the proportion of and socio-ecological factors associated with ever having had sex with female sex workers (FSWs) among heterosexual adolescents. We also described the characteristics of the adolescents who reported inconsistent condom use with FSWs.

METHODS:

This is a cross-sectional study (response rate: 73%) of 300 heterosexually active male adolescents of 16 to 19 years attending a national STI clinic in Singapore between 2009 and 2014. We assessed the ecological factors (individual, parental, peer, school and medial influences) and sexual risk behaviors using a self-reported questionnaire. Poisson regression was used to obtain the adjusted prevalence ratios (aPR) and confidence intervals (CI).

RESULTS:

The proportion of heterosexual male adolescents who had ever had sex with FSWs was 39%. Multivariate analysis showed that significant factors associated with ever having had sex with FSWs were sex initiation before 16 years old (aPR 1.79 CI: 1.30-2.46), never had a sexually active girlfriend (aPR 1.75 CI 1.28-2.38), reported lower self-esteem score (aPR 0.96 CI: 0.93-0.98), higher rebelliousness score (aPR 1.03 CI: 1.00-1.07) and more frequent viewing of pornography (aPR 1.47 CI: 1.04-2.09). Lifetime inconsistent condom use with FSWs was 30%.

CONCLUSIONS:

A significant proportion of heterosexual male adolescents attending the public STI clinic had ever had sex with FSWs. A targeted intervention that addresses different levels of influence to this behavior is needed. This is even more so because a considerable proportion of adolescents reported inconsistent condom use with FSWs, who may serve as a bridge of STI transmission to the community. National surveys on adolescent health should include the assessment of frequency of commercial sex visits and condom use with FSWs for long-term monitoring and surveillance.

Below:  Percentage of sexually active adolescents aged 16–19 years who used condom inconsistently with female sex workers in the past year by country of female sex workers

Below:  Percentage of sexually active adolescents aged 16–19 years who used condom inconsistently with female sex workers in the past year by type of female sex workers

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

By:  Ng JY¹, Wong ML¹.

¹Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.

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Men's Behavior Predicts Women's Risks for HIV/AIDS: Multilevel Analysis of Alcohol-Serving Venues in South Africa

South Africa has among the highest rates of HIV infection in the world, with women disproportionately affected. Alcohol-serving venues, where alcohol use and sexual risk often intersect, play an important role in HIV risk. Previous studies indicate alcohol use and gender inequity as drivers of this epidemic, yet these factors have largely been examined using person-level predictors. 

We sought to advance upon this literature by examining venue-level predictors, namely men's gender attitudes, alcohol, and sex behavior, to predict women's risks for HIV. We recruited a cohort of 554 women from 12 alcohol venues (6 primarily Black African, and 6 primarily Coloured [i.e., mixed race] venues) in Cape Town, who were followed for 1 year across four time points. 

In each of these venues, men's (N = 2216) attitudes, alcohol use, and sexual behaviors were also assessed. Men's attitudes and behaviors at the venue level were modeled using multilevel modeling to predict women's unprotected sex over time. We stratified analyses by venue race. 

As predicted, venue-level characteristics were significantly associated with women's unprotected sex. Stratified results varied between Black and Coloured venues. Among Black venues where men reported drinking alcohol more frequently, and among Coloured venues where men reported meeting sex partners more frequently, women reported more unprotected sex. 

This study adds to the growing literature on venues, context, and HIV risk. The results demonstrate that men's behavior at alcohol drinking venues relate to women's risks for HIV. This novel finding suggests a need for social-structural interventions that target both men and women to reduce women's risks.

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By:  Pitpitan EV1,2,3, Kalichman SC4,5, Eaton LA6, Sikkema KJ7, Watt MH7, Skinner D8, Pieterse D8.

• 1Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA. epitpitan@ucsd.edu.
• 2Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA. epitpitan@ucsd.edu.
• 3Department of Psychology, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT, 06269-1020, USA. epitpitan@ucsd.edu.
• 4Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA. seth.k@uconn.edu.
• 5Department of Psychology, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT, 06269-1020, USA. seth.k@uconn.edu.
• 6Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA.
• 7Duke University, Trinity, NC, USA.
• 8Stellenbosch University, Stellenbosch, South Africa. 
• Prev Sci. 2016 Jan 15.

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