Engagement in group sex among geosocial networking (GSN) mobile application-using men who have sex with men (MSM)

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, we sought to identify event-level correlates of sexual and drug use behaviors at GSEs to better inform prevention activities. Methods: For this study, we recruited participants via banner and pop-up advertisements placed on a geosocial networking mobile phone application for MSM to meet. Results: Of the 1,997 individuals who completed the study screener, 36.0% reported participating in at least one GSE in the prior year. In multivariable logistic regression, 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 behaviors are driving CAS

How different are men who do not know their HIV status from those who do? Results from an U.S. online study of gay and bisexual men

We compared self-described HIV-positive (31.6%, n=445), HIV-negative (56.8%, n=801), and HIV-unknown (11.6%, n=164) gay and bisexual men (GBM) on sociodemographic and behavioral characteristics. Participants from across the U.S. were enrolled via a popular sexual networking website to complete an online survey. In total, 44.8% of HIV-negative and HIV-unknown men said they had not been tested for HIV in the CDC-recommended last 6 months. HIV-unknown men significantly differed from HIV-negative and HIV-positive men in sexual behavior and HIV status disclosure patterns. HIV-unknown men were more willing than HIV-negative men to take PrEP; however, HIV-unknown men were significantly less likely than others to have health insurance or a primary care provider. Given the observed differences, researchers should consider analyzing men who are HIV-unknown distinctly from HIV-negative and HIV-positive men

Familiarity with and preferences for oral and long-acting injectable HIV pre-exposure prophylaxis (PrEP) in a national sample of gay and bisexual men in the U.S.

Objectives: We sought to determine preferences for oral versus long-acting injectable (LAI) PrEP among gay and bisexual men (GBM). Methods: We surveyed a national U.S. sample of 1,071 GBM about forms of PrEP. Results: Overall, 46.0% preferred LAI, 14.3% oral, 21.7% whichever was most effective, 10.1% had no preference, and 7.8% would not take PrEP. There were no differences in PrEP preferences by race/ethnicity, income, region of residence, or relationship status. Those unwilling to take PrEP were significantly older than those who preferred LAI PrEP and those who would take either. Those who preferred the most effective form were younger, had less education, and reported more recent club drug use. Those who reported condomless anal sex and those who thought they were good PrEP candidates were more willing to take PrEP. Long-term health and side effects were of the greatest concern for both LAI and oral PrEP. Conclusions: The availability of LAI PrEP has the potential to increase uptake among GBM. The results of ongoing clinical trials of LAI PrEP will need to demonstrate similar or greater efficacy as daily Truvada for uptake to be maximized

Social Media Use and HIV Transmission Risk Behavior Among Ethnically Diverse HIV-Positive Gay Men: Results of an Online Study in Three U.S. States

Though Black and Hispanic men who have sex with men (MSM) are at an increased risk for HIV, few HIV risk reduction interventions that target HIV-positive MSM, and even fewer that use technology, have been designed to target these groups. Despite similar rates of social media and technology use across racial/ethnic groups, online engagement of minority MSM for HIV prevention efforts is low. Since minority MSM tend to have less representation in online HIV prevention studies, the goals of this online anonymous study of HIV-positive gay-identified men were to test the feasibility of conducting targeted recruitment by race/ethnicity and sexual orientation, to assess technology and social media use,and to assess global HIV transmission risk. In 2011,an anonymous online survey was conducted among 463 members of an HIV-positive personals website. Emails were sent to a subset of HIV-positive male members who self- identified as gay. While 57% were White, substantial proportions of participants were Black (20%) or Hispanic (18 %). Median age was 46 (range 18–79). Men who reported using 3 or more websites or apps to meet sex partners were significantly more likely to report anal intercourse (AOR 4.43, p\.001) and condomless anal sex (CAS) (AOR 2.70, p\.05) in the past 3 months. The only predictor of CAS with HIV-negative or unknown status partners was being under age 30 (AOR3.38, p\ .01). This study helped to inform online targeted recruitment techniques, access to technology and social media use, and sexual risk among a diverse sample of HIV-positive gay men. Efficacy trials of technology-based HIV prevention interventions targeting high-risk minority HIV-positive MSM are warranted

Sexual behavior varies between same-race and different-race partnerships: A daily diary study of highly sexually active Black, Latino, and White gay and bisexual men

Background. Gay and bisexual men (GBM) are at elevated risk for gonorrhea and chlamydia trachomatis (GC/CT). Rectal GC/CT symptoms may be less obvious than urethral, increasing opportunities for undiagnosed rectal GC/CT. Method. A U.S. national sample of 1,071 GBM completed urethral and rectal GC/CT testing and an online survey. Results. In total, 6.2% were GC/CT positive (5.3% rectal, 1.7% urethral). We calculated adjusted (for education, race, age, relationship status, having health insurance, and income) odds ratios for factors associated with rectal and urethral GC/CT diagnoses. Age was inversely associated with urethral and rectal GC/CT. Compared to White men, Latinos had significantly greater odds of rectal GC/CT. Among men who reported anal sex, those reporting only insertive sex had lower odds of rectal GC/CT than men who reported both insertive and receptive. There was a positive association between rectal GC/CT and number of male partners (\u3c12 \u3emonths), the number of anal receptive acts, receptive condomless anal sex (CAS) acts, and insertive CAS acts. Compared to those who had engaged in both insertive and receptive anal sex, those who engaged in only receptive anal sex had lower odds of urethral GC/CT. The number of male partners (\u3c12 \u3emonths) was associated with increased odds of urethral GC/CT. Conclusion. Rectal GC/CT was more common than urethral and associated with some demographic and behavioral characteristics. Our finding that insertive CAS acts was associated with rectal GC/CT highlights that providers should screen patients for GC/CT via a full range of transmission routes, lest GC/CT go undiagnosed

Community Reactions to Campaigns Addressing Crystal Methamphetamine Use Among Gay and Bisexual Men In New York City

Crystal methamphetamine (aka “crystal meth”) use with high-risk sex has become an emerging health problem for gay and bisexual men in New York City since the late 1990s. Public health campaigns were eventually developed to encourage gay and bisexual men to avoid or reconsider using crystal meth. Reactions to three campaigns were measured with a cross-sectional survey administered in 2004. Among an ethnically-diverse sample of 971 gay and bisexual men, 61.8% reported seeing the campaigns. Those who reported ever using crystal meth, recent use, and recent use with sex were significantly more likely to have seen the campaigns. In general, white men, HIV-negative men, and men not currently using crystal meth responded more positively to the campaigns than their counterparts; yet, more men of color reported having discussions with partners and friends about their crystal use as a result of these campaigns. Implications for researchers and practitioners are discussed

Changes in familiarity with and willingness to take PrEP in a longitudinal study of highly sexually active gay and bisexual men

PURPOSE: For gay and bisexual men (GBM), research suggests that familiarity with Pre-Exposure Prophylaxis (PrEP) has been increasing since being approved by the U.S. FDA in 2012. However, it is less clear how willingness to start using PrEP has changed over time. Likewise, some have expressed concerns regarding the potential for risk compensation (i.e., reduced condom use) were one to start PrEP; however, again, it is unclear how these may have been changing over time. METHODS: We conducted baseline and 12 month assessments with 158 highly sexually active HIV-negative GBM in NYC who were assessed between 2011 and 2014. We examined change over time both between participants (based on when they entered the study), as well as within each participant (over the 12 months of his involvement). RESULTS: Familiarity with PrEP increased over time (both between and within participants); however, willingness to take PrEP did not change (neither between nor within participants). Few men believed taking PrEP would cause their condomless anal sex (CAS) to increase and this did not change over time. However, a majority believed PrEP would increase temptation for CAS, and this did not change over time within participants. Sexual compulsivity (SC) symptomology was associated with higher willingness to take PrEP and perceiving that PrEP would increase one’s temptations for CAS. Furthermore, recent CAS was associated with greater willingness to take PrEP, a perception that PrEP would increase one’s likelihood to engage in CAS, and a perception that being on PrEP would increase one’s temptation for CAS. CONCLUSIONS: Participants became more familiar with PrEP over time; however, willingness to start PrEP did not change, and this may serve as an opportunity for providers to 3 discuss PrEP with their patients. Higher risk men were interested in PrEP and pre-existing patterns of sexual behavior may be the primary determinant of CAS while on PrEP

Differences in substance use, sexual behavior, and demographic factors by level of outness to friends and family about being a male-for-male escort

Male sex work (i.e., escorting) is a stigmatized profession and men in the sex industry may hide their involvement to avoid negative social consequences. There is limited research comparing men who are out about being an escort to their friends and/or family with those out to neither friends nor family. Data were taken from a 2013 online study of male escorts who were categorized into three groups based on outness patterns—friends only (48.9%, n = 193), friends and family (26.6%, n = 105), or neither friends nor family (23.5%, n = 93)—and compared on demographic and behavioral variables. We hypothesized that men out to neither friends nor family would perform poorer across indicators of health and wellbeing due to the lack of social support that can come from friends and family. However, with the exception of reporting lower satisfaction and pay from their last male client, this hypothesis was unsupported. Outness patterns were largely unassociated with social and sexual behaviors with the last male client, and the majority eschewed condomless anal sex with their last male client, suggesting escorts—regardless of how out they are to friends and family—could navigate safer sex behaviors with their clients. Outness was associated with substance use (\u3c 12 months) and substance use with their last male client—men out to friends and family were, for the most part, the most likely to have used substances. Men out to friends and family were significantly more likely than others to have been escorting for greater than five years as well as escorting full-time. Interventions for escorts that address substance use and sexual risk behaviors that incorporate supportive friend and family social networks may be an important area for future research

Daily Minority Stress and Affect among Gay and Bisexual Men: A 30-day Diary Study

Background. This study examined the time-variant association between daily minority stress and daily affect among gay and bisexual men. Tests of time-lagged associations allow for a stronger causal examination of minority stress-affect associations compared with static assessments. Multilevel modeling allows for comparison of associations between minority stress and daily affect when minority stress is modeled as a between-person factor and a within-person time-fluctuating state. Methods. 371 gay and bisexual men in New York City completed a 30-day daily diary, recording daily experiences of minority stress and positive affect (PA), negative affect (NA), and anxious affect (AA). Multilevel analyses examined associations between minority stress and affect in both same-day and time-lagged analyses, with minority stress assessed as both a between-person factor and a within-person state. Results. Daily minority stress, modeled as both a between-person and within-person construct, significantly predicted lower PA and higher NA and AA. Daily minority stress also predicted lower subsequent-day PA and higher subsequent-day NA and AA. Limitations. Self-report assessments and the unique sample may limit generalizability of this study. Conclusions. The time-variant association between sexual minority stress and affect found here substantiates the basic tenet of minority stress theory with a fine-grained analysis of gay and bisexual men’s daily experience. Time-lagged effects suggest a potentially causal pathway between minority stress as a social determinant of mood and anxiety disorder symptoms among gay and bisexual men. When modeled as both a between-person factor and within-person state, minority stress demonstrated expected patterns with affect

Craigslist as a Source for Illicit Drugs: A Case Report and Review of the Literature

Introduction: Online drug markets and social media are facilitating the spread of information and sale of illicit substances. Online sites, such as Craigslist and Bluelight, underscore an emerging shift in contemporary drug consumerism. Case Descriptions: We report on two cases. Case 1 is a 42-year-old male with a history of heroin-use disorder, presented for an initial visit to an office-based buprenorphine program, and reported having acquired heroin from Craigslist. Despite several harrowing experiences, Craigslist remained Patient 1’s primary method of purchasing heroin during a 14-month period. Craigslist ads also redirected the patient to the web site Bluelight, which facilitated access to updated information on open-air drug markets in New York City. Case 2 is a 23-year-old male, who was admitted to inpatient detoxification and utilized the site for the sale of heroin in order to fund his own use of heroin. He sold heroin via Craigslist for 1 year until his arrest, noting undeterred advertising and largely uncomplicated transactions. He secured largely professionals buyers that purchased a steady quantity of heroin over extended periods of time. Discussion: Online drug marketplaces offer platforms to extend public health surveillance, harm reduction, and treatment entry strategies for internet users with substance-use disorders