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PubMed2004

Recent trends in diagnoses of HIV and other sexually transmitted infections in England and Wales among men who have sex with men.

OBJECTIVES: To examine trends in rates of diagnoses of HIV and other sexually transmitted infections (STIs) in men who have sex with men (MSM) in England and Wales between 1997 and 2002. METHODS: Estimates of the MSM population living in England and Wales, London and the rest of England and Wales were applied to surveillance data, providing rates of diagnoses of HIV and STIs and age group specific rates for HIV and uncomplicated gonorrhoea. RESULTS: Between 1997 and 2002, rates of diagnoses of HIV and acute STIs in MSM increased substantially. Rates in London were higher than elsewhere. Rises in acute STIs were similar throughout England and Wales, except for uncomplicated gonorrhoea and infectious syphilis, with greater increases outside London. Rates of gonorrhoea diagnoses doubled between 1999 and 2001 (661/100,000, 1271/100,000, p<0.001) in England and Wales followed by a slight decline to 1210/100,000 (p=0.03) in 2002-primarily the result of a decline in diagnoses among men aged 25-34 (1340/100,000, 1128/100,000, p<0.001) and 35-44 (924/100,000, 863/100,000, p=0.03) in London. HIV was the third most common STI diagnosed in MSM in England and Wales and the second in London, with the highest rate (1286/100,000) found among men aged 35-44 in London in 2002. CONCLUSIONS: Rates of diagnosis of HIV and other STIs have increased substantially among MSM in England and Wales. Increases show heterogeneity by infection, geography, and age over time. Rates in London were twice those seen elsewhere, with greatest changes over time. The observed changes reflect concomitant increases in high risk behaviour documented in behavioural surveillance survey programmes.

Adolescent↗
PubMed2006

Evidence of heterosexual bridging among syphilis-positive men who have sex with men.

OBJECTIVE: To explore whether heterosexual bridging among syphilis-positive men who have sex with men (MSM) contributes to increased infection rates among adolescent women in Baltimore City, Maryland. METHODS: Interview data for patients with primary, secondary and early-latent syphilis from January 2001 to July 2005 were linked with their corresponding field records for named exposed contacts to assess prevalence of male bisexual activity and risk profiles of potential male bisexual bridgers and their female sex partners. RESULTS: None of the women with syphilis reported having known heterosexual relationships with a bisexual man. However, 3.9% and 11.0% of the male sex partners of adolescent females and women aged >25 years with syphilis, respectively, self-reported as MSM or named male sex partners. Likewise, 10.3% of syphilis-positive MSM named female sex partners and 3.0% of syphilis-positive men who did not self-identify as MSM named both male and female sex partners. CONCLUSIONS: Sexual network links exist between syphilis-positive MSM and heterosexual women, but the extent of bisexual behaviour among men is not detectable by self-identification and disclosure to female sex partners.

Adolescent↗
PubMed2006

Chlamydia trachomatis and Neisseria gonorrhoeae infection and the sexual behaviour of men who have sex with men.

BACKGROUND: Rates of bacterial sexually transmitted infections (STIs) continue to rise among men who have sex with men (MSM) in the UK. OBJECTIVE: To evaluate factors associated with Chlamydia trachomatis and Neisseria gonorrhoeae among MSM attending a genitourinary medicine clinic in inner London. STUDY DESIGN: 599 MSM undergoing testing for STIs were recruited. Specimens for ligase chain reaction (LCR), strand displacement amplification (SDA) assay and culture were collected from the pharynx, urethra and rectum for the detection of C trachomatis and N gonorrhoeae. Details regarding demographics, symptoms, signs and sexual behaviour were recorded. Associations of these factors with each infection were tested, adjusting for other risk factors. RESULTS: The prevalence of C trachomatis and N gonorrhoeae was 11.0% and 16.0%, respectively. LCR and SDA performed well for the detection of C trachomatis and N gonorrhoeae from urethra and rectum. Using either method, compared with our current testing policy, over 18% of those with C trachomatis and N gonorrhoeae would not have had their infection diagnosed or treated. Age, sexual behaviour, urethral and rectal symptoms and signs were strongly associated with both infections. A total of 33.7% of men reported at least one episode of unprotected anal intercourse in the previous month. Men reporting multiple episodes were markedly more likely to be HIV positive. CONCLUSION: The prevalence of infection, rates of partner acquisition and unprotected anal intercourse reported among these MSM are alarming. Improved detection of C trachomatis and N gonorrhoeae using nucleic acid amplification tests has major public health implications for STI and possibly HIV transmission in this population.

Adolescent↗
PubMed2002

Prevalence of chlamydia and gonorrhoea among a population of men who have sex with men.

OBJECTIVES: Few data are available on the prevalence of sexually transmitted diseases (STDs) in men who have sex with men (MSM), making it difficult to develop STD screening guidelines for this population. The objective of the study was to determine the prevalence of urethral infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae within a large, community based population of MSM, and to assess the feasibility of rectal screening in this population. METHODS: This was a cross sectional study of 566 MSM, who were predominantly middle aged, white, asymptomatic, and engaged in sex with multiple partners. All provided a urine sample to screen for chlamydial and gonorrhoea infections using a PCR assay; rectal screening was performed on 48 participants. RESULTS: Urethral C. trachomatis infections were detected in 1/566 participants (prevalence 0.2%, 95% CI 0.004% to 1.0%), and rectal C. trachomatis infections were detected in 2/48 men (prevalence 4.2%, 95% CI 0.5% to 14.2%). No gonorrhoea infections were detected, and none of the 117 HIV positive men had either infection. CONCLUSIONS: Chlamydial and gonorrhoea infections were uncommon in this sample of MSM, even among those with multiple sexual partners or HIV infection. These data call into question recommendations to screen all MSM based on their individual sexual behaviours or HIV. Additional data are needed on the prevalence of these infections in MSM from different settings.

Adult↗
PubMed2000

Finding the "community" in community-level HIV/AIDS interventions: formative research with young African American men who have sex with men.

Data from 76 qualitative interviews with 18- to 29-year-old African American men who have sex with men (MSM) in Chicago and Atlanta were examined to identify perceptions of "community" and components of a community-level HIV/AIDS intervention. Many men reported feeling marginal to African American and gay White communities because of perceived homophobia and racism. Those who reported feeling part of gay African American communities characterized communities in terms of settings, social structures, and functions, including social support, socialization, and mobility. Despite these positive functions, divisions among groups of MSM, lack of settings for nonsexual interaction with other MSM, lack of leadership, and negative attitudes toward homosexuality may make it difficult for men to participate in activities to alter community contexts that influence behavior. Rather, changing norms, increasing social support, and community building should be part of initial community-level interventions. Community building might identify leaders, create new settings, and create opportunities for dialogue between MSM and African American community groups to address negative perceptions of homosexuality.

Adolescent↗
PubMed1976

Gonadotropin and testosterone measurements after estrogen administration to adult men, prepubertal and pubertal boys, and men with hypogonadotropism: evidence for maturation of positive feedback in the male.

Nineteen male subjects were fiven five daily injections of 17beta-estradiol and circulating levels of estradiol (E2), testerone (T), and gonadotropins were determined by radioimmunoassay before, during, and after the steroid course. Peak levels of E2 attained during the 5 days of treatment ranged from 173-577 pg/ml. Four of seven normal adult men and one castrate man demonstrated suppression of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) with a subsequent rise in LH (positive feedback) while E2 levels remained elevated. A rise in T was associated with the LH increment in the four normal men. Nine pre-, early, or midpubertal boys and two men with hypogonadotropic hypogonadism displayed only gonadotropin suppression after E2 administration. The difference in LH response to estrogen (i.e., positive feedback) between the adult men with normal or elevated gonadotropin levels as compared with the endocrinologically normal boys is significant (P less than 0.01).

Adolescent↗
PubMed1990

Sexual function in married men with Parkinson's disease compared to married men with arthritis.

We evaluated the sexual function of 41 married men with Parkinson's disease (PD) and its relation to age, severity of PD, and depression. We used a group of 29 married men with arthritis for comparison. Total sexual functioning and categories of desire, arousal, orgasm, and satisfaction did not differ significantly between patients with PD and arthritis. For both PD and arthritis, increased age, severity of illness, and depression were associated with reduced sexual function. These results suggest that sexual dysfunction is common in married men with PD, but no more so than in men with another chronic illness that does not involve the nervous system.

Adult↗
PubMed2005

Hepatitis B vaccination of men who have sex with men: experience with an accelerated course of vaccination in a genitourinary medicine clinic.

An accelerated course of hepatitis B vaccination was offered to men who had sex with men attending a genitourinary medicine clinic. The uptake and completion rates of the vaccine between 1 November 2002 and 28 February 2004 were compared with data for 1994. The uptake of vaccine was significantly higher during the former audit period than the latter (310 [98%] of 315 versus 146 [74%]). There was, however, no significant difference in completion rates between the two audit periods: 220 (73%) of the 302 men who initiated the accelerated schedule, compared with 118 (81%) of the 146 men who completed the standard course in 1994. Innovative means of ensuring completion of vaccination are needed.

Adult↗
PubMed2006

HIV risk behaviour patterns, predictors, and sexually transmitted disease prevalence in the social networks of young men who have sex with men in St Petersburg, Russia.

HIV seroconversions and sexually transmitted diseases (STDs) are often clustered in social networks within community populations. The present study was carried out among men who have sex with men in Russia, where a major HIV epidemic is unfolding, and where social networks have played a historically important role. In all, 38 social networks were recruited into the study, and members of all networks (n = 187) completed risk behaviour assessments and were tested for STDs. About 17% of participants had STDs, and 10% of men had syphilis. Over 64% of men had recent unprotected anal intercourse (UAI), including 51% who did so with main partners, 30% who did so with casual partners, and 32% who had UAI with multiple male partners. The strongest predictor of all risk behaviour indicators and STDs was the social network, to which an individual belonged, supplemented by peer norm perceptions and intentions to practise safer sex. There was a high level of correspondence in behaviour between the social leader of a network and its other members. Social networks should be directly targeted in HIV prevention efforts.

Adult↗
PubMed1999

HIV-associated risk factors among young Canadian Aboriginal and non-Aboriginal men who have sex with men.

Young Aboriginal men face marginalization distinct in cause but similar in pattern to those seen among men who have sex with men (MSM) and may be at increased risk for HIV infection. We compared sociodemographic characteristics and risk taking behaviours associated with HIV infection among MSM of Aboriginal and non-Aboriginal descent. Data for this comparison were gathered from baseline questionnaires completed by participants in a cohort study of young MSM. Data collection included: demographic characteristics such as age, length of time residing in the Vancouver region, housing, employment, income and income sources; mental health and personal support; instances of forced sex and sex trade participation and; sexual practices with regular and casual male sex partners. Data were available for 57 Aboriginal and 624 non-Aboriginal MSM. Aboriginal MSM were significantly less likely to be employed, more likely to live in unstable housing, to have incomes of <$10,000 and to receive income assistance than non-Aboriginals (all P<0.01). Aboriginals also had higher depression scores (P<0.01), were more likely to report non-consensual sex (P=0.03), sexual abuse during childhood (P=0.04) and having been paid for sex (P<0.01). In the past year they were no more likely to have had sex with a male partner they knew to be HIV positive, to have had more than 50 male partners or to have unprotected anal insertive or receptive intercourse with their male partners (all P>0.05). Our data indicate that among MSM, Aboriginal men are at increased risk of antecedent risk factors for HIV infection including sexual abuse, poverty, poor mental health and involvement in the sex trade.

Adolescent↗
PubMed2002

Sexual orientation identification of men who have sex with men in public settings in Canada.

The present study attempts to determine how men who have sex with men (MSM) identify in terms of their sexual orientation. The sexual identity of MSM has important implications for the spread of HIV. The literature suggests that gay or bisexual identifying MSM are more likely to practice safer sex than heterosexually-identified MSM. A significant number of the MSM in public settings, such as parks, are believed to be heterosexual identifying. MSM in bathhouses are presumed to be gay or bisexual identifying. Parks have been the focus of safer sex outreach efforts targeted towards heterosexually-identified MSM. Sexual orientation self-identification was ascertained from park and bathhouse users via one-on-one interactions with outreach workers from 1996 to 1998. Chi-square analysis revealed no significant difference in the expressed sexual orientation of bath and park users, with both populations consisting mostly of gay-identified men. Heterosexually-identified MSM are not found in significant numbers in public settings. The current micro educational approach used to target these men may not be cost-effective. Alternative strategies are discussed.

Adult↗
PubMed2003

Age and race mixing patterns of sexual partnerships among Asian men who have sex with men: implications for HIV transmission and prevention.

Recent studies of U.S. men who have sex with men (MSM) have reported high rates of unprotected anal intercourse but low rates of HIV infection among Asian and Pacific Islander (API) men. We investigated this discrepancy by examining the characteristics of sexual partnerships among API MSM. Multivariate logistic regression analyses found that having an API partner was related to having unprotected anal intercourse after controlling for respondent's age, number of sexual partners, and partner type. Having an API partner and a younger partner were related to respondent reports of unprotected insertive anal intercourse. However, a partner's race and age did not predict unprotected receptive anal intercourse. Study findings suggest that HIV prevalence among API MSM may have remained relatively low because higher risk sexual practices occur more frequently within a lower risk API group compared with higher risk non-API groups. However, because the possibility for the rise of HV infection in this population still exists if HIV spreads from older to younger men, HIV prevention efforts must target partner characteristics to maintain low HIV prevalence among API MSM.

Adult↗
PubMed2004

HIV, STIs, and sexual behaviors among men who have sex with men in Phnom Penh, Cambodia.

A probability sample of 206 men who have sex with men from 16 sites in Phnom Penh were surveyed about sexual behaviors and tested for HIV and sexually transmitted infections (STIs). HIV and syphilis prevalence was 14.4% and 5.5%, respectively. Out of the total sample, 81% reported anal sex with any male partners in the past 6 months, and 61.2% reported having had vaginal sex. In the past 6 months, 82.8% of the sample reported having male partners who paid them to have sex. Self-reported sexual orientation did not match well with self-reported sexual behavior. Significant risk factors for HIV infection were anal sex with multiple partners, unprotected vaginal sex with commercial female partners in the past month, and any STI. Complex sexual networks indicate that men who have sex with men act as a bridge between higher and lower HIV prevalence populations. Better prevention efforts structured around behaviors rather than sexual identities are needed.

Adult↗
PubMed2004

The influence of stigma on the sexual risk behavior of rural men who have sex with men.

Research investigating predictors of risky sexual behavior of rural MSM is sparse, even though the prevalence of HIV in rural areas has increased. This study explored two sets of predictors of 93 rural MSM's levels of risky sexual behavior: mental health variables and stigma emanating from men's family members, health care professionals, and people in the rural communities in which they live. Over 47% of the men were found to be at modified high to high risk. Logistic regression using a continuation logit model was used to test the relationship of the predictor variables and the four levels of risk. Findings indicate that self-esteem was predictive of the highest sexual risk behavior but not lower levels of risk. Stigma was predictive of modified high sexual risk when compared to low and no risk categories. No variables differentiated men at low risk from men at no risk.

Adolescent↗
PubMed2004

Characteristics of latino men who have sex with men on the internet who complete and drop out of an internet-based sexual behavior survey.

To identify biases and threats to validity of Internet survey data collection on HIV-related risk behaviors, we studied 1,546 Latino men who have sex with men on the Internet recruited through banner impressions on a leading national gay Internet site. The study could be completed in English or Spanish. Of those commencing, 33.6% dropped out before completing the 450-field questionnaire. None of the linguistic variables (level of use of Spanish or English) predicted dropout. However, dropouts were more likely to identify as Puerto Rican or Black, to reject the $20 compensation or offer it to a charity, to not have met men for sex on the Internet, to identify as bisexual or heterosexual, and to use Web sites or personal ads for contact and to use the Internet less at home than those who completed the study. Men in seroconcordant monogamous relationships and those who had not met a man for sex on the Internet were also more likely to drop out. These data suggest that there are no linguistic and few demographic and Internet use variables that are associated with dropout. Issues of compensation and respondent characteristics that make it likely that there will be a large number of inapplicable data fields in the questionnaire appear to be significant predictors of dropout. Although there were many data missing, the dropouts did not appear to be at greater HIV-associated risk than the completers. The fact that there appear to be few systematic demographic or Internet use biases in dropouts suggests that the completers do not represent a seriously skewed sample of those Latinos who commence the Internet survey.

Analysis of Variance↗
PubMed2005

Need fulfillment in the sexual relationships of HIV-infected men who have sex with men.

This article explores the associations among sexual need fulfillment, partner selection, and risky sexual behavior, using a functional/motivational perspective. The authors suggest that sexual needs influence partner selection (e.g., steady versus nonsteady), and engaging in UAI is influenced by sexual needs and partner selection. A sample of 108 HIV-positive gay men completed measures of sexual frequency, sexual risk-taking behaviors, and sexual need fulfillment. Results indicated support for both objectives. These men were more likely to choose a steady partner when they possessed greater relationship needs, whereas while men with higher substitution and pleasure needs were more likely to select nonsteady partners. In addition, only men who reported greater substitution needs were more likely to engage in UAI. The results suggest that certain sexual needs influence partner selection, but that sexual needs also influence what activities occur in the encounter.

Adult↗
PubMed2006

Lack of HIV testing and awareness of HIV infection among men who have sex with men, Beijing, China.

In China, men who have sex with men (MSM) are at high risk for HIV. However, little is known about their HIV testing behavior. From September 2001 to January 2002, we recruited 482 men through social networks and MSM venues. We conducted HIV testing and counseling, and anonymous, standardized face-to-face interviews. Eighty-two percent of participants had never tested for HIV before the study. The most common reasons for not testing were perceived low risk of HIV infection (72%), not knowing the location of test sites (56%), fear of positive test results (54%), fear of people learning about his homosexuality (47%), and fear of breach of confidentiality about test results (47%). We identified five statistically significant independent correlates of having been tested for HIV: being older, having a college degree, being more "out" (disclosing MSM activities to people), being recruited through social networks, and having a lifetime history of sexually transmitted diseases. Of 15 participants (3.1%) who tested positive for HIV in our study, 14 (93%) did not know their status before being tested in the study. The prevalence of HIV testing among MSM in Beijing is low; almost all HIV-positive men in our study were unaware of their infection. Our findings suggest an urgent need to promote HIV testing among MSM in Beijing.

Adolescent↗
PubMed2006

Cybercartography of popular internet sites used by New York City men who have sex with men interested in bareback sex.

A systematic method was used to elicit the names of the six most popular free Internet sites used by gay men and other men who have sex with men in New York City, to meet partners for "bareback" sex. An analysis of the sites characteristics shows that men can use mainstream Internet sites, gay-specific sites, and sex-focused sites free of charge to search for bareback sex partners, selecting by location, physical attributes, sexual mode, HIV-serostatus, and other characteristics. Many individuals use these sites, producing the impression that bareback sex is not an oddity confined to just a few. The official language of the bareback sites associates bareback sex with masculinity and courage, prioritizing pleasure, freedom, choice, and intimacy over HIV-transmission prevention. The sites facilitate sexual experimentation and the expansion of bareback networks. Although some consider bareback sex to represent a failure of HIV prevention, this study suggests that harm reduction strategies may be viable within bareback networks.

Adult↗