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PubMed2005

Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya.

Numerous epidemiologic studies report significant associations between lack of male circumcision and HIV-1 infection, leading some to suggest that male circumcision be added to the limited armamentarium of HIV prevention strategies in areas where HIV prevalence is high and the mode of transmission is primarily heterosexual. This cross-sectional survey of 107 men and 110 women in Nyanza Province, Kenya, assesses the attitudes, beliefs, and predictors of circumcision preference among men and women in a traditionally non-circumcising region. Sixty per cent (n=64) of uncircumcised men and 69% (n=68) of women who had uncircumcised regular partners reported that they would prefer to be circumcised or their partners to be circumcised. Men's circumcision preference was associated with the belief that it is easier for uncircumcised men to get penile cancer, sexually transmitted diseases, and HIV/AIDS, and that circumcised men have more feeling in their penises, enjoy sex more, and confer more pleasure to their partners. Women with nine or more years of school were more likely to prefer circumcised partners. Men who preferred to remain uncircumcised were concerned about the pain and cost of the procedure, and pain was a significant deterrent for women to agree to circumcision for their sons. If clinical trials prove circumcision to be efficacious in reducing risk of HIV infection, it is likely that the procedure will be sought by a significant proportion of the population, especially if it is affordable and minimally painful.

Adolescent↗
PubMed1997

Younger versus older gay men: risks, pleasures and dangers of anal sex.

This study reports on the practice and the pleasure and danger perceptions of protected and unprotected anal sex of young adult gay men (< or = 30) and older gay men (30+). It is assumed that, if prevention efforts were successful, younger gay men-sexually socialized during the AIDS era-should have more favourable perceptions of anal sex with a condom. Data from a cohort of gay men in Flanders, Belgium (1993, n = 553) are used in this analysis. The results indicate that younger gay men do not differ from older gay men in the riskiness/safety of their actual sexual behaviour. However, younger men hold different valuations regarding anal sex. They report a higher appraisal for both insertive and receptive anal sex with a condom. The perceived safety of protected anal sex is also higher among the younger men. We also found that younger men with a steady partner report more gratification from insertive anal sex with a condom than do older partnered men. We interpret these findings as evidence of the effectiveness of HIV prevention efforts.

Adolescent↗
PubMed2005

Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation.

OBJECTIVE: This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk. METHOD: The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques. RESULTS: City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco. CONCLUSION: Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

Adult↗
PubMed2006

Unprotected sex with multiple partners: implications for HIV prevention among young men with a history of incarceration.

OBJECTIVES: The objectives of this study were to describe preincarceration risk behaviors of young men and identify correlates of unprotected sex with multiple partners during the 3 months before incarceration. STUDY: Data on preincarceration risk behaviors were obtained from 550 men, aged 18 to 29 years, in state prisons in California, Mississippi, Rhode Island, and Wisconsin. Correlates of unprotected sex with multiple partners were determined by logistic regression. RESULTS: Of 550 participants, 71% had multiple sex partners, 65.1% had sex with a partner they perceived as risky, and 45.3% engaged in unprotected sex with multiple partners. Men who drank heavily (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.11-2.54) or who had a risky partner (OR, 3.90; 95% CI, 2.60-5.85) were more likely to report unprotected sex with multiple partners. Men who attended religious gatherings (OR, 0.66; 95% CI, 0.46-0.96) or lived in stable housing (OR, 0.69; 95% CI, 0.48-1.00) were less likely to report unprotected sex with multiple partners. CONCLUSIONS: Most participants engaged in behaviors that could result in a sexually transmitted disease, including HIV. Prevention programs should address the relationship between heavy alcohol use and risky sexual behavior. Discharge planning should address housing needs. Faith-based community organizations may play an important role for some young men in their transition to the community.

Adolescent↗
PubMed2004

Sexual risk reduction in a cohort of injecting drug users in Bangkok, Thailand.

OBJECTIVE: Interventions to reduce sexual risk behavior among injecting drug users (IDUs) have generally had very modest effects, but almost all such interventions have been conducted within short time frames. This study assessed whether long-term participation in interventions to reduce sexual risk behavior was associated with reduced sexual risk behavior. METHODS: A total of 806 IDUs participated in the Bangkok HIV Vaccine Trial Preparatory Cohort Study from 1995-1998 and remained in the study for at least 4 follow-up visits (approximately 16 months). Participants received HIV counseling and testing every 4 months and free condoms were provided. Structured interviews including questions on sexual behavior were administered every 4 months. RESULTS: Approximately 40% of participants reported engaging in unprotected sex (vaginal intercourse without always using a condom) with a regular partner at each study visit, without any decline over time in this behavior. There were declines in the proportions of participants reporting unprotected sex with casual partners and with paid partners (men only) over time, but the declines were confined to the early period of the study. Unprotected sex with casual partners was associated with amphetamine use. Condom use increased substantially among participants who seroconverted for HIV during the study. CONCLUSIONS: Interventions to reduce sexual risk behavior among HIV-seronegative IDUs over extended periods were no more likely to be effective than shorter interventions. New programs are needed to reduce sexual risk behavior among amphetamine users and among IDUs who are currently seronegative but are engaging in injection risk behaviors and in unprotected sex with regular partners.

Adult↗
PubMed1995

Predictors of unprotected male-to-male anal intercourse with casual partners in a national sample.

The focus of the paper is the predictors of unprotected anal intercourse with casual partners among a national Australian sample of homosexually active men. We interviewed by telephone 2583 homosexually active men (sex with a man within the last five years) about their sexual practice, type of sexual partners, human immunodeficiency virus (HIV) test status, attachment to the gay community, knowledge of HIV and acquired immune deficiency syndrome (AIDS) and a range of demographic variables. Logistic regression analyses were used to distinguish men who practised unprotected anal intercourse with casual partners from those who practised safe sex with casual partners. Men who practised unprotected anal intercourse with casual partners were less likely to have a regular male sexual partner than men who practised safe sex with their casual partners. They were less likely to be tertiary educated, more likely to be employed in trade and manual occupations and to live in Tasmania and the Northern Territory. They were less likely to be culturally or politically attached to the gay community. Knowledge of HIV/AIDS also distinguished the men: men with an accurate knowledge of HIV transmission were less likely to engage in unprotected anal intercourse with their casual partners. Several other variables, including age and HIV test status, did not distinguish those who practised safe sex with casual partners from those who practised unprotected anal intercourse with casual partners.

Australia↗
PubMed2005

How condom use, number of receptive anal intercourse partners and history of external genital warts predict risk for external anal warts.

Few analytic opportunities have allowed us to evaluate the role that specific sexual acts and male latex condoms play in the acquisition of external anal warts (EAW) using longitudinal data. The acquisition of EAWs occurs from epithelial contact with other HPV-infected surfaces, and hence is dependent upon sexual behaviour. Our objectives were to classify the relative importance of condom use, receptive anal intercourse (RAI) and prior history of EGWs on acquisition of EAWs. The observational Multicenter AIDS Cohort Study followed 2925 men over nine semiannual study visits for behavioural and physical examinations with laboratory testing. The main outcome measure was the occurrence of examiner-diagnosed EAWs in a homosexual population. EAWs were diagnosed among 10% of men studied across 22,157 visits reviewed for this study. Men with history of EGWs were more likely than those previously unaffected to have developed EAWs (cOR = 2.4 (2.0, 2.9)), as were men who reported multiple anoreceptive intercourse partners (e.g., compared with men who reported no RAI partners, men with 1, 2-5, > or = 6 RAI partners had crude risk ratios 1.0 (0.8, 1.3), 1.6 (1.2, 2.1), 3.9 (2.7, 5.8), respectively). These relations persisted after other demographic and sexual risk factors were controlled for in the analyses. Consistent condom usage showed no protective effect for EAWs in our crude or adjusted analyses. Patient education messages should be tailored to reflect our uncertainty about the protective nature of condoms for the development of anal warts, but to continue to assert the protective effects of a limited lifetime number of sexual partners and the heightened risk for wart recurrence once infected.

Anus Diseases↗
PubMed1997

Syphilis in injecting drug users: clues for high-risk sexual behaviour in female IDUs.

The objective was to measure the gender-specific differences for syphilis and for the sexual transmission of human immunodeficiency virus (HIV) in a cross-sectional analysis of injecting drug users (IDUs) admitted to detoxification between February 1987 and January 1990. HIV was determined by enzyme-linked immunosorbent assay (ELISA) and confirmed with Western blot. For syphilis reactive samples to a rapid plasma reagent (RPR) were confirmed with treponemal tests (FTA-ABS or MHA-TP). Of the 386 heterosexual IDUs, 68% were HIV-positive and 4.7% had serologic syphilis (RPR and FTA-ABS or MHA-TP positive). Syphilis was higher in women (12%) than in men (3%), and women reported a significantly (P < 0.001) higher number of sex partners. Men had an IDU as a sex partner more often than women did (P = 0.001). Serologic syphilis in women was associated with having had more than one sexual partner in the previous year (P = 0.028) but this association was not present in men. HIV infection was not associated with syphilis in male IDUs. However, HIV was present in all women with syphilis that reported more than one partner.

Adolescent↗
PubMed2003

Correlates of sexual risk behaviors among HIV-positive men who have sex with men.

This study examines correlates of unprotected sexual risk practices of an ethnically diverse sample of HIV-seropositive men who have sex with men (MSM) from the New York City and San Francisco metropolitan areas. Participants completed a self-report survey that assessed sexual risk behaviors and potential correlates. A total of 367 men reported sex with a casual male partner in the previous 3 months. Participants were divided into three groups based on level of HIV-transmission risk with HIV negative or unknown-status partners: no unprotected anal sex (58.9%), unprotected receptive anal sex only (14.2%), and unprotected insertive anal sex (22.6%). Multivariate logistic regression analyses indicated that men reporting unprotected anal insertive sex perceived less responsibility to protect their partners from HIV. Men reporting no unprotected anal sex also reported less use of nitrate inhalants, lower temptation for unsafe sex, and fewer HIV-negative and unknown-status partners. Men reporting unprotected receptive anal sex were less anxious than the other two groups but also reported greater depression than those not reporting unprotected anal sex and greater loneliness than those reporting unprotected anal insertive sex. Implications for interventions with HIV-positive MSM are presented.

Adolescent↗
PubMedDate not supplied

Levels of sexual activity among adolescent males in the United States.

Although three-fifths of adolescent males aged 15-19 say they have had sexual intercourse, analyses of data from the 1988 National Survey of Adolescent Males indicate that their level of sexual activity is relatively moderate. The data show that among sexually experienced young men the mean number of partners in the last 12 months is 1.9, and the mean frequency of intercourse in the last four weeks is 2.7 times. Black males have had more partners than white or Hispanic males; however, after the number of years since first intercourse are controlled for, these differences disappear. On average, sexually experienced youth spent six out of the last 12 months with no sexual partner, and only 21 percent of sexually active males had more than one partner in any month in the last year. Comparisons with 1979 data suggest that proportionately more adolescents were sexually experienced in 1988, but fewer non-black males had first intercourse before their 15th birthday. The number of partners since first intercourse and in the past four weeks appears to have decreased, as has the frequency of intercourse in the last four weeks.

Adolescent↗
PubMed1995

A double-blind crossover trial of clomipramine for rapid ejaculation in 15 couples.

BACKGROUND: The purpose of this study was to assess the sexual and psychosocial efficacy of clomipramine for rapid ejaculation. METHODS: Fifteen physically healthy, self-selected couples (men had a mean age of 38 years) who met six eligibility criteria and did not meet five exclusion criteria participated in a variable-length, repeated measures, randomized, double-blind, placebo-controlled crossover study with a 2-month follow-up period. Sexual and psychosocial assessments were conducted at baseline, after placebo, after 25 mg/day of clomipramine, after 50 mg/day of clomipramine, and at the 2-month follow-up point. The major outcome measures included stopwatch timing of ejaculation latencies, modified Case Western Reserve University Sexual Function Questionnaire, Symptom Checklist-90-R, Dyadic Adjustment Scale, State-Trait Anxiety Inventory, and the Harder Self-Esteem Inventory. RESULTS: Baseline mean ejaculatory latency was 81 seconds; 25 mg/day of clomipramine increased it to 202 seconds and 50 mg/day of clomipramine to 419 seconds. This resulted in significantly greater sexual satisfaction scores for men and their partners (men, p < .001; women, p < .05), improvements in partner coital orgasmic attainment, and greater relationship and emotional satisfaction for the men. Withdrawal of the drug caused ejaculatory latencies to return to baseline. CONCLUSION: Clomipramine appears to be effective in significantly lengthening ejaculatory latencies and increasing sexual and relationship satisfaction. It can be a cost-effective chronic therapy for selected patients. These impressive results should not be expected in a less carefully screened population of men concerned about the timing of their orgasm during intercourse.

Adult↗
PubMed1994

Attitudes, knowledge, and behavior regarding condom use in urban black adolescent males.

This study was conducted to determine male adolescent behavior, attitudes, and knowledge concerning the use of condoms. Subjects were 241 sexually active black adolescent males attending an inner-city adolescent medicine clinic who were surveyed using a structured interview technique. Factors associated with condom use included higher grade level, > or = 2 sexual partners in the past six months, communication about contraception with sexual partner(s), desire for sexually transmitted disease (STD) prevention when contracepting, and parental suggestion to use condoms. Variables not associated with condom use included older age, minimal level of knowledge about condom use, history of having impregnated a partner or of having contracted an STD, desire for pregnancy prevention, suggestion by friends to use condoms, or partner dissatisfaction with condoms. Using multivariate logistic regression analysis, the following variables in combination were able to correctly classify respondents as condom users or nonusers in 74% of cases: higher knowledge score, reported communication about contraception with one's partner(s), > or = 2 partners in the past six months, and higher socioeconomic status. These findings suggest that, for the study population, interventions directed toward improving knowledge about condoms, school achievement, and communication with parents and partners may be effective in increasing condom use.

Adolescent↗