Exchange Sex and HIV Infection among Men Who Have Sex with Men: 20 US Cities, 2011

This study assessed the prevalence of exchanging sex for money or drugs among men who have sex with men (MSM) in the 2011 US National HIV Behavioral Surveillance system. Prevalence of HIV, being HIV-positive but unaware (HIV-positive-unaware), risk behaviors and use of services were compared between MSM who did and did not receive money or drugs from one or more casual male partners in exchange for oral or anal sex in the past 12 months. 

Among 8411 MSM, 7.0 % exchanged sex. MSM who exchanged sex were more likely to be non-Hispanic black, live in poverty, have injected drugs, have multiple condomless anal sex partners, be HIV-positive and be HIV-positive-unaware. 

In multivariable analysis, exchange sex was associated with being HIV-positive-unaware (aPR 1.34, 95 % CI 1.05-1.69) after adjusting for race/ethnicity, age, education, poverty, and injecting drugs. 

MSM who exchange sex represent an important group to reach with HIV prevention, testing, and care services as they were more likely to report behavioral risk factors that put them at risk of HIV.

Purchase full article at:  http://goo.gl/ptrrEk

By: M Nerlander L^1,2, Hess KL³, Sionean C³, E Rose C³, Thorson A⁴, Broz D³, Paz-Bailey G³.

¹Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E46, Atlanta, GA, 30329, USA. vif7@cdc.gov.

²Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. vif7@cdc.gov.

³Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E46, Atlanta, GA, 30329, USA.

⁴Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

AIDS Behav. 2016 Jun 15. [Epub ahead of print]

  

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Race Is Associated with Sexual Behaviors and Modifies the Effect of Age on Human Papillomavirus Serostatus among Perimenopausal Women

BACKGROUND:

Human papillomavirus (HPV) causes oropharyngeal and cervical cancers. Oropharyngeal cancer primarily affects whites, but cervical cancer is more common among blacks. Reasons for this distinct epidemiology are unclear.

METHODS:

Serum was collected from women aged 35 to 60 years in the HPV in Perimenopause cohort and evaluated for antibodies to 8 HPV types. Demographic and behavioral data were collected by telephone questionnaire. Associations between sexual behaviors, race, age, HPV serostatus, and strength of serologic response to HPV were evaluated.

RESULTS:

There were 781 women in this analysis, including 620 white (79%) and 161 (21%) black women. Whites were less likely to report 5+ vaginal sex partners (prevalence ratio [PR], 0.86; 95% confidence interval [CI], 0.77-0.97), but more likely to report 5+ oral sex partners (PR, 2.38; 95% CI, 1.62-3.49) compared with blacks. Seropositivity to most individual HPV types and at least 3 types was significantly lower in whites than in blacks (PR, 0.62; 95% CI, 0.47-0.80). Human papillomavirus seropositivity was independently associated with younger age among blacks, but with sexual exposures among whites. Furthermore, strength of serologic response to most HPV types significantly decreased with older age among blacks, but not among whites.

CONCLUSIONS:

Racial differences in immune markers of HPV exposure and the epidemiology of HPV-related cancers may be linked to differences in patterns of sexual behaviors.

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By:  Rettig EM1, Fakhry C, Rositch AF, Burke AE, Chang K, Silver MI, Viscidi R, Gravitt P.

• 1From the *Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of ‡Gynecology and Obstetrics and §Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; and ¶Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM.
• Sex Transm Dis. 2016 Apr;43(4):231-7. doi: 10.1097/OLQ.0000000000000426. 

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Sex with Sex Workers among Latino Day Laborers in Suburban Maryland

Using the structural-environmental conceptual framework, this study employed mixed methods to address the question of whether sex with female sex workers contributes to HIV risk among male immigrant Latino day laborers in suburban Maryland. Because contextual factors can greatly affect HIV risk for both sex workers and their clients, this study investigated the organizational structure of sex work, factors that predicted men’s hiring of sex workers, sexual behaviors performed with sex workers, and the use of condoms. 

Qualitative research was conducted to inform the development of a quantitative survey, but also provided crucial descriptions about the motivations, locations, arrangements, and sexual activities related to sex work. Key informant interviews (N= 10), in-depth interviews with day laborers (N= 10) and Latina female sex workers (N = 4), and two focus groups with day laborers (N= 11) were conducted, and a quantitative survey administered via Audio-enhanced Computer-assisted Self-interviewing (N = 174). 

Condom use was nearly universal in encounters with female sex workers, thus indicating that the sex workers were not an important source of HIV transmission in this context. Logistic regression was performed to test a model predicting sex with sex workers. Latino day laborers who reported more immigrant stress and who did not have a partner in the U.S. were more likely to have had sex with a sex worker, as were men who reported binge drinking. Structural and social conditions influenced the hiring of sex workers. 

Further research is warranted to better understand the interrelationships among these circumstances and to inform the development of programs to address them.

Experiences of Latino day laborers with sex workers

	Percent
Ways men find sex workers (N= 174)
Sex workers give out business cards	59.2
Friends tell each other	50.6
Pimp approaches potential clients	33.3
Internet	18.4
Sex workers are in public places (e.g., street corner)	14.9
Locations where men have sex with sex workers (N= 174)
House or apartment (“delivery”)	58.1
Brothel (“casa de sitas”)	36.8
Hotel or motel	28.7
Street, car, or park	19.0
Bar, discotheque, restaurant	16.7
Reasons participants had sex with sex workers (N= 52)
Lack of companionship	65.4
Relief from sexual urges	55.8
No commitment	51.9
Only sex available	40.4
Fun and pleasure	36.5
Distraction from problems	17.3
Sexual behaviors participants performed with sex workers (N= 52)
Vaginal intercourse	76.9
Oral sex on the participant	59.6
Manual stimulation of penis	34.6
Anal intercourse	9.6
Oral sex on the woman	3.9

Note: Participants could select more than one response option

Full article at:   http://goo.gl/YzCU35

By:  Fernanda T. Bianchi, Carol A. Reisen, Felisa A. Gonzales, Juan C. Arroyo, Maria Cecilia Zea, and Paul J. Poppen

Department of Psychology, George Washington University, 2125 G St. NW, Washington, DC 20052, USA

Corresponding author.

Fernanda T. Bianchi: ude.uwg@ihcnaibf

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Risky Sexual Behaviors among Sexually Active First-Year Students Matriculating at a Historically Black College: Is A Positive Self-Image An Instigator?

A sample of 498 sexually active first-year students matriculating at a historically Black college in North Carolina was used to determine correlates of risky sexual behaviors. 

In an Ordinary Least Squares regression, the self-esteem element "I take a positive attitude toward myself", non-condom use because of partner issues and being drunk or high, oral sex, anal sex, and bisexuality all increased the number of these behaviors. Higher scores on the condom usage scale were found to decrease the number of risky sexual behaviors. Illicit drug use was an underpinning of the surprisingly positive relationship between positive self-image and risky sexual behaviors. 

It was concluded that school-based social workers, mental health care professionals, and community-based prevention providers can play a critical role in the training of peer facilitators, development, and supervision of peer-driven risk-reduction programs to address the complex interplay among self-esteem, sex, and substances.

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By:  Ellis WL1.

• 1 Social Work Program , Livingstone College , Salisbury , North Carolina , USA. 
• Soc Work Health Care. 2016 Feb 11:1-19.

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Oral Sex, Young People, and Gendered Narratives of Reciprocity

Young people in many countries report gender differences in giving and receiving oral sex, yet examination of young people’s own perspectives on gender dynamics in oral heterosex are relatively rare. 

We explored the constructs and discourses 16- to 18-year-old men and women in England used in their accounts of oral sex during in-depth interviews. Two contrasting constructs were in circulation in the accounts: on one hand, oral sex on men and women was narrated as equivalent, while on the other, oral sex on women was seen as “a bigger deal” than oral sex on men. 

Young men and women used a “give and take” discourse, which constructed the mutual exchange of oral sex as “fair.” Appeals to an ethic of reciprocity in oral sex enabled women to present themselves as demanding equality in their sexual interactions, and men as supporting mutuality. 

However, we show how these ostensibly positive discourses about equality also worked in narratives to obscure women’s constrained agency and work with respect to giving oral sex.

...The notion that oral-vulva contact was more costly was also evident in young women’s accounts, which included two related ideas: first, that it was “easier” for women to give oral sex than for men; and second, that it was easier for men to receive oral sex and, crucially, to enjoy receiving it than it was for women:

I think anything to a girl, the way girls talk about it, is more of a big deal than it would be to a boy. […] I think you’d be more likely to give a blow job because licking out, again, like … girls have a lot of insecurities […] like I said about [pubic] hair and things like that because, ’cause in school boys made such a big deal about things like that. And […] yeah, I think … I think it’s more of a big deal for a girl to, like, be licked out. (Pippa, 16-year-old woman, southwest)

I think all males really like it being done to them but, um, like, it’s … a lot of girls say, like, the same, it’s just … they don’t really like it. They feel uncomfortable.

What are the general concerns about it do you think, when you say people feel uncomfortable?

Um … I don’t know. I think it’s sort of the same thing that you’re not really doing anything; it’s sort of being done to you. I don’t like that, and yeah, I just, I dunno … I guess it’s like, generally an area you’re not very confident, but, well, I’m not. (Becky, 17-year-old woman, north)...

  

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

By:  Ruth Lewis^ab & Cicely Marston^b*

• ^a Department of Sociology, University of the Pacific, and Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
• ^b Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine 

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A Comparison of Actual and Perceived Sexual Risk among Older Adults

Sexual risk among older adults (OAs) is prevalent, though little is known about the accuracy of sexual risk perceptions. Thus, the aim was to determine the accuracy of sexual risk perceptions among OAs by examining concordance between self-reported sexual risk behaviors and perceived risk. Data on OAs aged 50 to 92 were collected via Amazon.com's Mechanical Turk. 

Frequency of sexual risk behaviors (past six months) were reported along with perceived risk, namely, sexually transmitted infection (STI) susceptibility. Accuracy categories (accurate, underestimated, overestimated) were established based on dis/concordance between risk levels (low, moderate, high) and perceived risk (not susceptible, somewhat susceptible, very susceptible). Approximately half of the sample reported engaging in vaginal (49%) and/or oral sex (43%) without a condom in the past six months. However, approximately two-thirds of the sample indicated they were "not susceptible" to STIs. 

No relationship was found between risk behaviors and risk perceptions, and approximately half (48.1%) of OAs in the sample underestimated their risk. Accuracy was found to decrease as sexual risk level increased, with 93.1% of high-risk OAs underestimating their risk. Several sexual risk behaviors are prevalent among OAs, particularly men. However, perception of risk is often inaccurate and warrants attention.

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By:  Syme ML1, Cohn TJ2, Barnack-Tavlaris J3.

• 1 Center on Aging , Kansas State University.
• 2 Department of Psychology , Radford University.
• 3 Department of Psychology , The College of New Jersey. 

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The Road Less Travelled: Exploring Gay and Bisexual Men's Explanations of 'Uncommon' Routes of HIV Transmission

Although there are practices other than condomless anal intercourse that may result in HIV transmission among gay and bisexual men, very little is known about these 'uncommon' transmission explanations. 

To address this topic, the free text survey responses from 465 HIV positive gay men in Australia were thematically analysed; 123 participants offered uncommon explanations for their seroconversion. Men described several sexual acts they believed led to infection, categorised as adventurous sex (e.g., fisting) and foreplay (e.g., oral sex). Participants also identified mediating factors associated with their seroconversion, either internal (e.g., cum/pre-cum) or external (e.g., sores, illness) to sex. Finally, contextual forces associated with infection were also explored, namely physical spaces (e.g., sex on premises venues) or mental states (e.g., depression). 

While some uncommon explanations are unlikely to have resulted in HIV transmission, these accounts reveal the diverse and intersecting ways that men attempt to make sense of their seroconversion.

Purchase full article at:   http://goo.gl/PN58PY

By:  Callander D^1,2, Prestage G^3,4, Ellard J⁴, Triffitt K³, Brown G⁴, Down I³.

¹Kirby Institute for Infection and Immunity in Society, UNSW Australia, Level 6 Wallace Wurth Building, Sydney, NSW, 2052, Australia. d.callander@unsw.edu.au.

²Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia. d.callander@unsw.edu.au.

³Kirby Institute for Infection and Immunity in Society, UNSW Australia, Level 6 Wallace Wurth Building, Sydney, NSW, 2052, Australia.

⁴Australian Research Centre in Sex, Health and Society, UNSW Australia, Sydney, NSW, Australia.

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Condom Use, Sexual Risk, and Self-Reported STI in a Sample of Older Male Clients of Heterosexual Prostitution in the United States

While there is evidence of increasing rates of sexually transmitted infections (STIs) among older men in the United States, there has been little research on older male clients of female sex providers. The purpose of the current study was to understand the sexual risk behaviors and psychosocial correlates among older men hiring sex providers through provider review websites and discussion boards. 

A convenience sample of 208 male clients ages 60 to 84 completed online surveys about their sexual behavior and psychosocial factors. Participants indicated the most common sexual activities with providers in the past 12 months were 

• receiving condomless fellatio (33.7%) and 
• having penile-vaginal intercourse with a condom (31.7%). 

Although condomless penile-vaginal sex with a provider in the past 12 months was only reported by 2.9%, about half (51%) of the respondents indicated that they had experienced this at least once during their lifetime. This was associated with a preference for providers who do not require condoms, having been previously diagnosed with an STI, and perceiving one's HIV risk to be higher, as well as advancing age and having more emotional relationships with providers. 

Findings demonstrate the need for general and sexual health care practitioners to openly discuss protective measures and strategies for avoiding STIs among their older-to-elderly male patients.

Full article at:   http://goo.gl/koE4fr

By:  Milrod C, Monto M1.

• 1University of Portland (http://www.up.edu/), OR, USA. 
• 
  
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Exploring Associations between Exposure to Sexy Online Self-Presentations & Adolescents' Sexual Attitudes & Behavior

Previous research suggests that adolescents' social network site use is related to their sexual development. However, the associations between adolescents' exposure to sexy self-presentations of others on social network sites and their sexual attitudes and experience have not yet been empirically supported. 

This study investigated reciprocal longitudinal relationships between adolescents' exposure to others' sexy self-presentations on social network sites and their sexual attitudes (i.e., sexual objectification of girls and instrumental attitudes towards sex) and sexual experience. 

We further tested whether these associations depended on adolescents' age and gender. Results from a representative two-wave panel study among 1,636 Dutch adolescents (aged 13-17, 51.5 % female) showed that exposure to sexy online self-presentations of others predicted changes in adolescents' experience with oral sex and intercourse 6 months later, but did not influence their sexual attitudes. Adolescents' instrumental attitudes towards sex, in turn, did predict their exposure to others' sexy online self-presentations. Sexual objectification increased such exposure for younger adolescents, but decreased exposure for older adolescents. In addition, adolescents' experience with genital touching as well as oral sex (only for adolescents aged 13-15) predicted their exposure to sexy self-presentations of others. 

These findings tentatively suggest that the influence on adolescents' sexual attitudes previously found for sexual media content may not hold for sexy self-presentations on social network sites. However, exposure to sexy self-presentations on social network sites is motivated by adolescents' sexual attitudes and behavior, especially among young adolescents.

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By:   van Oosten JM1, Peter J, Boot I.

• 1Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Postbus 15791, 1001 NG, Amsterdam, The Netherlands, j.m.f.vanoosten@uva.nl. 
• J Youth Adolesc. 2015 May;44(5):1078-91. doi: 10.1007/s10964-014-0194-8. Epub 2014 Oct 7.

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Vaginal and Oral Sex Initiation Timing: A Focus on Gender and Race/Ethnicity

OBJECTIVES:

Most previous studies on sexual initiation timing have examined its effects on a variety of subsequent outcomes without first examining the correlates and predictors of these timing categories. Studies that do exist often do not utilize samples through young adulthood, leading to a misclassified set of sexual timing categories. In addition, the literature does not adequately address the issues of oral sex timing. Therefore, the objectives of this study were 1) to explore age-cutoffs that mark the "normative" and "non-normative" entry into vaginal and oral sex among young women and men in the U.S., creating sexual four sexual initiation timing categories - "early," "normative," "late," and "inexperienced," and; 2) to examine the association between race/ethnicity and sexual initiation timing by gender.

METHODS:

The National Longitudinal Study of Adolescent to Adult Health (Add Health) was used in both descriptive and multivariate contexts to determine the net association of gender and race/ethnicity with vaginal and oral sex initiation timing.

RESULTS:

Age-cutoffs for vaginal sex timing were similar for women and men, yet differed by gender for oral sex timing. Women were more likely than men to initiate vaginal sex (20% vs. 18%) and oral sex (19% vs. 16%) at an early age and less likely than men to initiate these behaviors at a late age (18% vs. 19% for vaginal sex, and 15% vs. 16% for oral sex). Although most respondents initiated these two behaviors by young adulthood, a considerable proportion remained inexperienced, with men more likely than women to report inexperience with vaginal sex (7% vs. 5%), and women more likely than men to report abstaining from oral sex (8% vs. 6%). Race/ethnic differences in sexual initiation timing remained robust in the face of controls for both women and men.

CONCLUSIONS:

Understanding the timing at which adolescents and young adults transition to first vaginal and first oral sex is critical for sex education curriculum and policy makers.

Below:  Weighted Percentages of Sexual Initiation Timing by Gender and Race/Ethnicity

Full article at:   http://goo.gl/1P7DdJ

By:   Giuseppina Valle Holway, Ph.D

Author Contact: Giuseppina Valle, Ph.D, Postdoctoral Fellow, Population Research Center, The University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX 78712-1699, Phone: 585-506-6557, Email: ude.saxetu.crp@ellavg

Int J Sex Health. 2015 Jul 1; 27(3): 351–367. Published online 2015 Mar 9. doi:  10.1080/19317611.2015.1014954 

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Risky Sexual Networks & Concentrated HIV Epidemics among Men Who Have Sex with Men in Wenzhou, China

Background

The high and continually increasing prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases among men who have sex with men (MSM) in China underscores the critical importance of examining the exact sexual networks that result in HIV transmission, as well as HIV infection, using powerful sampling methods, such as respondent-driven sampling (RDS), to improve the sexual health of this population.

Methods

Using RDS, a cross-sectional study was conducted among MSM in Wenzhou, Zhejiang province, China from December 2013 to June 2014. The type of sex, numbers of anal sex partners, male oral sex partners and vaginal sex partners, condom use during each type of sex over the previous 6 months, prevention behaviors, risk perception, and the burdens of HIV and syphilis were investigated and analyzed.

Results

Of 424 MSM, a great number of them did anal sex, male oral sex, and vaginal sex during the previous 6 months, and weighted estimates for the prevalence that MSM did not conduct these sexual behaviors were 11.2 % (95 % confidence interval [CI] =6.7–16.50 %), 20.3 % (95 % CI = 15.2–27.1 %), and 58.9 % (95 % CI = 52.1–65.8 %), respectively. Multiple sexual partners, engaging in regular, casual and commercial sex, and lack of condom use during all types of sex were common among MSM. The estimated HIV and syphilis prevalences were 22.8 % (95 % CI = 16.9–28.5 %) and 9.7 % (95 % CI = 6.4–13.6 %), respectively. Of the participants, 53.5 % (95 % CI = 45.3–60.2 %) received HIV-related interventions during the previous year, 48.1 % (95 % CI = 39.7–55.1 %) had never been tested for HIV, and only 14.1 % (95 % CI =10.1–19.2 %) perceived a risk of contracting HIV. Multiple logistic regression analysis revealed that age over 44 years (adjusted odds ratio [AOR] = 3.60, 95 % CI = 1.34–9.64), a monthly income of 3001–4000 yuan (approximately 470–630 US$) (AOR = 1.96, 95 % CI = 1.67–3.60), multiple anal sex partners (AOR = 1.93, 95 % CI = 1.15–3.24), awareness of the possibility of contracting HIV (AOR = 3.18, 95 % CI = 1.56–6.48), and current syphilis infection (AOR = 3.01, 95 % CI = 1.44–6.29) were predictors of HIV infection.

Conclusions

HIV transmission has become highly prevalent and will likely become more prevalent among MSM and their female partners if these risky sexual networks persist. Our findings call for urgent and effective interventions to prevent the rapid transmission of HIV among MSM in Wenzhou.

Below:  Estimated proportion of condom use during the previous half year. A1 = Anal sex with a regular partner (N = 226). A2 = Anal sex with a casual partner (N = 281). A3 = Anal sex with a sex worker (N = 28). A4 = Anal sex with group partners (N = 18). A5 = Anal sex after drinking alcohol (N = 42) A6 = Anal sex after using drugs (N = 18). O1 = Oral sex with a regular partner (N = 190). O2 = Oral sex with a casual partner (N = 250). O3 = Oral sex with a sex worker (N = 19). V1 = Vaginal sex with a regular female partner (N = 115). V2 = Vaginal sex with a casual female partner (N = 42). V3 = Vaginal sex with a female sex worker (N = 28).

Full article at:   http://goo.gl/GH7G2O

By:   Qiaoqin Ma¹, Shidian Zeng², Shichang Xia^1*, Xiaohong Pan¹, Dayong Wang², Haishen Zhu³, Hui Wang¹, Tingting Jiang¹, Lin He¹, Dongshe Zhao³ and Zhihang Peng⁴

¹Department of HIV/STD Control, Center for Disease Control and Prevention of Zhejiang Province, No.3399, Binsheng Road, Hangzhou 310051, People’s Republic of China

²Center for Disease Control and Prevention of Wenzhou Municipality, Wenzhou 3250051, People’s Republic of China

³Center for Disease Control and Prevention of Lucheng District, Wenzhou 325001, People’s Republic of China

⁴Nanjing Medical University School of Public Health, Nanjing 211166, People’s Republic of China

 

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