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Data from Medical Monitoring Project was used to determine if partner type is associated with condomless anal sex (CAS) and insertive condomless anal sex (ICAS) among HIV-positive men who have sex with men. Participants reported HIV status and PrEP use of up to five anal sex partners. Partner type was categorized as HIV-positive, HIV status unknown, HIV-negative on PrEP or HIV-negative not on PrEP. To account for correlation of multiple observations per participant, generalized estimating equations were used to calculate adjusted prevalence ratios and 95% confidence intervals of CAS and ICAS. Condom use during anal sex and insertive anal sex varied based on partner type. There was a higher prevalence of CAS and ICAS in partnerships with HIV-positive partners or HIV-negative partners on PrEP compared to HIV-negative partners not on PrEP.

The purpose of this study was to understand how bear identity influenced condom use during the last anal sex event. Participants were recruited to complete an online, anonymous self-report survey through bear-related sexual and social networking websites. A total of 1,080 men who identified as gay or bisexual and as a member of the bear community and were 18 years or older completed the survey. Overall, fewer than a third of men reported condom use during the most recent receptive (28%) and insertive (30%) anal sex event. Men in bear concordant pairings were less likely to use a condom during receptive and insertive anal sex compared to those is discordant pairings (p < .05). Findings suggest that bear identity concordance influences condom use during anal sex after accounting for an individual's relationship to their most recent partner as well as other confounding variables.

The lack of data on condom and lubricant use among African men who have sex with men (MSM) hinders prevention efforts. We describe use, knowledge, and access to lubricants in Dar es Salaam and Tanga, Tanzania. Data were collected in 2012 and 2013 from a cross-sectional survey of 200 MSM in Dar es Salaam and 100 MSM in Tanga, Tanzania. The most common reason for not using condoms was dislike of condoms. Two-thirds of the men reported always using a lubricant for anal sex. Results showed that: fewer men who have sex with both men and women (MSMW) know about lubricants; more MSM look for, have difficulty finding, and find lubricants to be expensive; and MSM use lubricants to facilitate penetration. MSMW commonly receive their lubricants from their sexual partner, while MSM got them from friends and pharmacies. HIV-negative MSM used lubricants to facilitate penetration and reduce pain. HIV-positive MSM are likely to get their lubricants from pharmacies or friends. MSMW use Vaseline® significantly more than MSM as a lubricant. Results suggest that HIV prevention knowledge among MSM is greater, so HIV prevention efforts should emphasise carrying water-based lubricant among MSMW. Consequently, there is an opportunity to co-market condoms and water-based lubricants., (© The Author(s) 2016.)

Aims and Objectives: To explore men who have sex with men's views about condom use when having anal intercourse., Background: Internationally, health promotion campaigns use behavioural change strategies to support men who have sex with men to always use condoms when having anal sex with other men. The health promotion message given to this group is consistent and explicitly stated that 'use a condom every time for anal sex regardless of relationship status'., Design: Qualitative analysis of data from a cohort of New Zealand men who have sex with men., Methods: A total of 960 useable questionnaires were completed: 571 online and 389 in hard copy. Qualitative data were analysed using a thematic data analytic process., Results: Three themes relating to condom use in men who have sex with men were identified. These are as follows: 'Safer sex is good sex', 'Condom use is good but …' and 'I use condoms sometimes'., Conclusions: The range of responses towards condom use for anal sex in men who have sex with men in our sample reveal this as a complex public health issue, with not all men who have sex with men willing to consistently use condoms., Relevance to Clinical Practice: It is important that nurses do not assume that all men who have sex with men are willing to use condoms for anal sex, and should create opportunities for men who have sex with men to raise any concerns about the use of condoms. In this way, nurses can assist in providing information that may help men who have sex with men to make decisions that will minimise risk of contracting infections associated with sexual activity., (© 2016 John Wiley & Sons Ltd.)

Introduction: Heterosexual anal intercourse (HAI) is common among U.S. women. Receptive anal intercourse is a known risk factor for HIV, yet there is a paucity of data on HAI frequency and distribution in the United States. Condom use is lower with HAI vs. vaginal intercourse, but little is known regarding of correlates of HAI with and without condoms., Aims: The aims of this study were to describe recent (past 12 months) and lifetime HAI among sexually active reproductive-aged U.S. women, and to characterize women who engage in HAI with and without condoms., Methods: We analyzed a sample of 10,463 heterosexually active women aged 15-44 years for whom anal intercourse data were available in the 2006-2010 National Survey of Family Growth., Main Outcome Measures: Weighted bivariate and multivariable analyses were used to determine HAI prevalence and correlates. Primary outcomes were lifetime HAI, recent (last 12 months) HAI, and condom use at last HAI., Results: In our sample, 13.2% of women had engaged in recent HAI and 36.3% in lifetime HAI. Women of all racial and ethnic backgrounds and religions reported recent anal intercourse. Condom use was more common at last vaginal intercourse than at last anal intercourse (28% vs. 16.4%, P < 0.001). In multivariable analysis, correlates of recent HAI included: less frequent church attendance, younger age at first intercourse, multiple sexual partners, history of oral intercourse, history of unintended pregnancy, and treatment for sexually transmitted infections (all P < 0.05). Correlates of lifetime HAI were similar, with the addition of older age, higher education, higher income, and history of drug use (all P < 0.05)., Conclusion: Women of all ages and ethnicities engage in HAI, at rates higher than providers might realize. Condom use is significantly lower for HAI vs. vaginal intercourse, putting these women at risk for acquisition of sexually transmitted infections., (© 2015 International Society for Sexual Medicine.)

In an earlier study, we found that sexual risk-taking in gay men was reduced by getting them to evaluate the self-justifications for having unsafe sex which they had used on a specific occasion when they 'slipped up' (broke their safe sex rules by having unprotected anal intercourse). This study investigated whether the earlier finding occurred simply because recalling vividly a specific encounter in which a slip-up took place brought the men's risk-taking home to them very strongly and whether the intervention would still work if translated into posters suitable for the mass media. Gay men (n=92) who had slipped up kept diaries of their sexual behaviour for 16 weeks. After 4 weeks, they were allocated to one of 3 conditions: Specific Encounter (detailed reconstruction of a slip-up, but without any questions about self-justifications); Posters (examination of posters, specially designed for the study, that focused on self-justifications); and Control (no intervention). All 3 groups slipped up to the same extent in the post-intervention period. The results for the Specific Encounter group indicate that the earlier finding is not attributable to the alternative explanation above, while those for the Posters group suggest the importance of ensuring personal 'ownership' of the self-justifications presented. Implications for AIDS education are discussed.

The performance of condoms in actual use has been poorly researched in the past, especially in comparing condoms that met different quality control standards as indicated by laboratory testing. The present study used a double-blind crossover design to compare the performance of 2 types of condoms in actual use; one that met the Australian and International Organization for Standardization (ISO) standards for condom quality and one that met the more stringent Swiss Quality Seal requirements. Ninety-two men recruited from Metropolitan Melbourne completed a self-report diary sheet after each condom was used which assessed the performance of the condom and the conditions under which it was used. From a total of 1917 condom uses, there was an overall breakage risk of 2.7%. The breakage risk ratio (Australian/ISO:Swiss) for all types of use was 1.16 (95% confidence interval 0.68-1.99). When subanalyses by method of entry were performed, the condoms meeting the Swiss standard appeared to fare better than the Australian/ ISO standards for anal sex (RR = 4.84, 95% CI 1.07-21.8, P = 0.022), while the opposite was the case for vaginal sex (RR = 0.74, 95% CI 0.35-1.53, P = 0.41). The result for anal use was statistically significant at the 5% level, despite being based on fewer condom trials than that for vaginal use, but this result needs to be replicated. Although the participants appeared representative of the general male population in Melbourne in the age bracket 18-46 years, there was a significant history of condom usage reported. This may have influenced the risk of breakage.

Background: To analyse the relation between number of sexual partners, selected sexual habits and the risk of human immunodeficiency virus (HIV) infection., Methods: We conducted a case-control study nested in a cross-sectional survey conducted among subjects attending sexually transmitted diseases (STD) clinics in Northern Italy. Eligible for the study were 1711 subjects (1259 males, 452 females) who referred themselves for the first time between September 1988 and March 1993 to three STD clinics in Northern Italy for suspected STD or STD treatment. A total of 145 subjects (113 males and 32 females) were HIV positive., Results: In comparison with subjects reporting no or one sexual partner over the 3 years before the interview, the estimated odds ratios (OR) of HIV serum positivity were 1.2 (95% confidence interval [CI]: 0.6-2.3), 0.8 (95% CI: 0.4-1.8) and 0.3 (95% CI: 0.4-2.5) in subjects reporting 2-3, 4-5, and > or = 6 partners, respectively. The results were similar considering separately males and females and in men reporting only homosexual partners. Regular condom use decreased the risk of HIV infection: in comparison with subjects reporting no or occasional use of condoms, the OR of HIV infection was 0.5 (95% CI: 0.4-0.8) for regular users. Considering men only, compared with men with no homosexual intercourse, the OR of HIV infection was 2.3 (95% CI: 1.4-3.9) in those reporting bisexual intercourse and 2.2 (95% CI: 1.2-4.2) in men reporting only homosexual intercourse (among homosexuals). There was no relation between HIV infection risk and receptive anal sex., Conclusions: The risk of HIV infection does not increase linearly with the number of sexual partners in this population. This is reasonable, as the prevalence of HIV infection in this population is essentially determined by drug use. Caution is needed in the interpretation of these results since the analysis of role of number of sexual partners in male intravenous drug users is impaired by low statistical power.

In an evaluation of the breakage rate of a thicker condom when used for anal intercourse, one hundred and eight gay men volunteered to use condoms which were 30% thicker than standard condoms. Of the 772 condoms used, 14 broke during anal sex, representing a breakage rate of 1.8%. When one subject was removed from the sample because of inappropriate use of the condom, the overall breakage rate was 1.6%. This compares favorably with the breakage rates reported for condom use during anal sex in other investigations, and is similar to the breakage rate for condom use during vaginal intercourse.

Twenty-seven male prostitutes were interviewed extensively about their work and considerations relating to safe sex with clients. Important differences were found between street prostitutes and those working at home. Street-workers were more likely to be using hard drugs, to have a heterosexual preference, to have no other occupation, to have more clients, but less steady ones, and to have a more negative working attitude. Sexual techniques most often practised were manual and oral contact; however, most prostitutes also practised either insertive or receptive anal intercourse. Homosexual male prostitutes reported more receptive anal intercourse than did their heterosexual male colleagues; but no such differences were found in insertive anal intercourse. Prostitutes were most likely to have had anal intercourse with steady clients, with clients whom they trusted regarding condom use, or with clients they felt sexually attracted to; and also when in dire need of drugs. Of those who had practised anal intercourse in the previous year, a minority had not consistently used condoms. The same factors that encourage anal intercourse also appear conducive to unprotected intercourse.

Condom use was studied for 421 sexually active, minority male adolescents who were currently in jail in New York City. Over three-quarters of the youths were users of alcohol and marijuana and about one-quarter were users of cocaine or crack, but drug injectors were rare. In the six months before arrest they had multiple sexual partners and about one-third had engaged in anal intercourse. Inconsistent condom use was the norm, with 17% reporting that they never used condoms and only 15% reporting that they used condoms every time for insertive sex. In multivariate analysis, more frequent condom use was independently predicted by gay/bisexual preference, greater acceptability and accessibility of condoms, partners' receptivity to use, self-initiation of use, and self-efficacy of avoiding AIDS. Condoms were used less frequently with steady than with causual partners, and rarely for anal or oral sex. AIDS prevention curricula addressing these factors should be delivered to high risk adolescents while they are temporarily accessible in jail.

How the withdrawal of social support associated with the coming out of gay men influences AIDS-related sexual risk-taking among Flemish (Belgian) gay men is analyzed. Recruited via key persons, the 379 gay men in this nonclinical cohort completed a lengthy, computerized questionnaire dealing with diverse aspects of gay life and culture. Independent variables include demographic characteristics, AIDS knowledge, coming-out histories, six social support dimensions, and personal resources. The dependent variables were insertive and receptive anal intercourse with and without a condom. Stepwise regression explained, respectively, 41.2, 38.4, 18.4, and 14.2% of the variance. Absence of appraisal (the view that others approve of the way one does things or feels about things) led to higher frequencies of insertive anal sex (both with and without a condom). The experience of emotional conflict lowered the use of condoms by the insertive partner in anal intercourse. Disapproval by significant others of being gay also led to higher levels of receptive anal intercourse without a condom. Subjects with a high belief in mastery had higher frequencies of risk-taking, suggesting that the combination of the experience of negative reactions and high mastery lead to greater involvement in risky sexual behavior. Findings are interpreted within the theoretical framework of the coming-out process and gay identity formation.

Sexual health and well-being are important components of overall well-being and quality of life. Yet, little is known about autistic persons' self-reported sexual health and well-being in Canada. In the current study, 3,551 youth aged 16–24 from across Canada were surveyed, including 419 youth who reported an autism diagnosis or self-identified as autistic. We examined demographic and sexual health data from autistic youth and assessed differences/similarities with non-autistic youth on key indicators. A significantly greater percentage of autistic youth reported a transgender identity (22.5% vs. 1.9%), an asexual identity (7.0% vs. 2.7%), and an LGBQ+ sexual orientation (55.6% vs. 22.3%), compared to non-autistic youth. Autistic youth were just as likely as non-autistic youth to value sexual pleasure. On average, autistic youth rated their sexual health as "good," and many were happy with their sexual lives. Half were in a committed relationship, and autistic youth in relationships were generally sexually and emotionally satisfied in their relationships. Many had engaged in partnered sexual behaviours (e.g., touching genitals, oral sex, penis–vagina sex), with a higher percentage of autistic youth reporting that they had ever had penis–anal sex (30.8% vs. 22.6%). Autistic youth and non-autistic youth reported similar condom/barrier use for most sexual behaviours. The implications of these findings for sexual health promotion with autistic youth are discussed. [ABSTRACT FROM AUTHOR]

This study aimed to characterize the epidemiological aspects of PrEP use and barriers to accessing this prophylaxis. This cross-sectional study was conducted between January 2021 and April 2022, encompassing 140 PrEP users treated at the Testing and Counseling Center (CTA) in Campo Grande, Mato Grosso do Sul. Data on sociodemographic characteristics and factors associated with PrEP discontinuation were obtained using a standardized questionnaire. Most PrEP users were cisgender men (92.00%), predominantly white (51.00%), over 30 years of age (56.50%), homosexual-oriented (76.50%), and had a minimum of 12 years of education (77.50%). Approximately 60.00% admitted to inconsistent condom use in recent sexual encounters, primarily involving anal intercourse. Approximately 88.00% perceived themselves as at risk of contracting STIs in the upcoming year. Regarding new presentation forms, 54.00% indicated a willingness to use "on-demand PrEP," and 92.00% expressed interest in using "injectable PrEP." After 6 months of follow-up, 43.60% (95.00% CI: 35.50–52.00) discontinued PrEP use, primarily due to changes in sexual behavior (38.30%) and difficulties accessing healthcare services (21.28%). This study underscores the need to involve diverse key populations and highlights the significance of PrEP as an ongoing monitoring strategy for HIV/STI prevention in addition to the importance of incorporating new formulations such as daily oral PrEP into the Brazilian National Health System (SUS). [ABSTRACT FROM AUTHOR]

Minority stressors have been linked to HIV risk behaviors among gay, bisexual, queer, and other men who have sex with men (MSM). Committed partnerships are a key context for new HIV infections and coping with minority stress among MSM, but very little work has tested the minority stress-HIV risk link among male couples, and little is known about how processes within one's relationship may exacerbate or buffer this association. The present study examined links between minority stress (i.e., internalized stigma, microaggressions) and HIV transmission risk behaviors (i.e., condomless anal sex with outside partners, breaks in relationship agreements) among male couples, as well as relationship-based moderators (i.e., social support, dyadic coping) of these associations. An analytic sample of male couples from a large cohort study (analytic N = 410 individuals, 205 dyads) completed self-report measures of minority stress, relationship-based moderators, and HIV transmission risk behaviors which were submitted to moderated actor-partner interdependence models (APIMs). In many cases, coping with stress with one's partner buffered the minority stress-HIV transmission link risk. However, findings also suggested situations in which partners may overburden one another with coping, thus exacerbating HIV-related risk behaviors. [ABSTRACT FROM AUTHOR]

Club drug use—including 3,4-Methylenedioxymethamphetamine, ketamine, crack/cocaine, hallucinogens, gamma hydroxybutyrate, volatile nitrites, and methamphetamine—has been linked to sexual risk behaviors among MSM. Few studies examine how the use of club drugs and the association between club drug use during sex and sexual risk may differ by race/ethnicity. Using data from a cross-sectional study among alcohol-using MSM in San Francisco (n = 252), we examined the associations between the interaction of race/ethnicity and club drug use during sex, and the following behavioral outcomes: any condomless anal intercourse (CAI), insertive CAI, receptive CAI, and any serodiscordant sex in the past six months. All models controlled for income, HIV status, relationship status, age, and current use of a biomedical HIV prevention tool (i.e., Pre-Exposure Prophylaxis [PrEP] or antiretroviral therapy). There were significant racial differences in club drug use (p < 0.001) and club drug use during sex (p = 0.01). Asian/Pacific Islander (API) and Latino participants reported using club drugs the most at 78.8% and 79%, respectively. Among users of club drugs, club drug use during sex was most common among Black (100%), and Latino MSM (93%). Significant interactions between race/ethnicity and club drug use during sex were observed for CAI (p = 0.02), insertive CAI (p = 0.01), and receptive CAI (p = 0.01). API participants who used club drug during sex had higher odds of reporting CAI (aOR = 15.27, CI = 1.50–155.34), insertive CAI (aOR = 21.11, CI = 2.04–218.10), and receptive CAI (aOR = 21.11, CI = 2.04–218.10). Given the differing rates of club drug use during sex by race/ethnicity and the role race/ethnicity plays in modifying the relationships between club drug use during sex and sexual risk behaviors, culturally-tailored interventions may be needed to address the needs of ethnically-diverse, club drug-using MSM. [ABSTRACT FROM AUTHOR]

This study measures changes in condomless anal sex (CAS) among HIV-negative men who have sex with men (MSM) who are not taking pre-exposure prophylaxis (PrEP). It considers the 2014–2019 cycles of the American Men's Internet Survey, a serial, cross-sectional web-based survey of US cisgender MSM aged ≥ 15 years, in which ~ 10% of each year's sample is drawn from the previous year. Among those surveyed for 2 years who remained HIV-negative and off PrEP, reports of having any CAS and of CAS partner number were compared across years. We disaggregated by partner HIV status, and considered demographic predictors. The overall population saw a significant 2.2 percentage-point (pp) increase in reports of any CAS year-over-year. Sub-populations with the largest year-on-year increases were 15–24-year-olds (5.0-pp) and Hispanic respondents (5.1-pp), with interaction (young Hispanic respondents = 12.8-pp). On the relative scale, these numbers correspond to 3.2%, 7.2%, 7.3% and 18.7%, respectively. Absolute increases were concentrated among partners reported as HIV-negative. Multivariable analyses for CAS initiation found effects concentrated among Hispanic and White youth and residents of fringe counties of large metropolitan areas. CAS partner number increases were similarly predicted by Hispanic identity and young age. Although condom use remains more common than PrEP use, increasing CAS among MSM not on PrEP suggests potential new HIV transmission pathways. Concentration of increases among 18–24-year-old MSM portends future increases in the proportion of newly diagnosed HIV that occur among youth. Concentration among young Hispanic MSM will likely expand existing disparities. Although reducing barriers to PrEP remains vital, condom promotion for MSM remains a key public health practice and appears to be missing key audiences. LGBTQ+-inclusive sex education is one avenue for enhancing these efforts. [ABSTRACT FROM AUTHOR]

To prevent hepatitis C virus (HCV) reinfection, within the Swiss HCVree Trial, a preventive risk reduction intervention was implemented alongside curative treatment. Formative qualitative research identified three response patterns to the intervention. This mixed-methods study's aim was to cross-validate group differences in (a) the content of sexual risk reduction goals set during intervention and (b) the extent of their behavioural change in condomless anal intercourse with non-steady partners (nsCAI), sexualised and intravenous drug use at start and six-month post-intervention. Qualitative thematic analysis was used to summarise goal setting domains. Quantitative descriptive analysis was used to evaluate group differences based on assumptions of the group descriptions. Results largely confirmed assumptions on inter-group response differences in goal setting and behaviour: as expected group 1 Avoid risks showed the lowest HCV risk profile with changes in nsCAI. Group 2 Minimize-risks and Group 3 Accept-risks showed unchanged nsCAI. Group 3 had the highest HCV risk profile. Differences in their goal preferences (1: condom use; 2 reduction blood exposure; 3 safer dating) highlight diversity in attitudes to behavioural change. Our results improve understanding of variability in intervention responses such as changes in attitudes and behaviour. This provides evidence for intervention tailoring and outcome measurement. [ABSTRACT FROM AUTHOR]

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Background: This study conducted a survey of men who have sex with men (MSM) in Maanshan City of Anhui Province to assess the risk behaviors related to human immunodeficiency virus (HIV) infection. Methods: A cross-sectional survey was conducted from June 2016 to June 2019. The MSM were recruited by a peer-driven sampling method. A face-to-face interview with anonymous questionnaire was used for data collection. The information collected by the survey was summarized and epidemiology described the basic characteristics of MSM, and then the related factors were statistically analyzed. Results: A total of 934 MSM were recruited with a average age was 30.5 (SD = 8.90) years old, including 816 (87.4%) HIV negative participants and 118 (12.6%) HIV positive ones. This study showed that freelancer (OR = 4.02, 95% CI: 1.96–8.23), scope of sexual partners distribution (OR = 1.78, 95% CI: 1.36–2.33), number of male sexual partners (OR = 2.11, 95% CI: 1.47–3.02), role of anal sex with men was receptive (OR = 2.54, 95% CI: 1.25–5.13) and versatile (OR = 2.34, 95% CI: 1.31–4.19) and non-steady sex partners (OR = 2.14, 95% CI: 1.56–2.93) were risk factors for HIV infection, while monthly income (OR = 0.68, 95% CI: 0.57–0.82), education level (OR = 0.79, 95% CI: 0.66–0.95), frequency of condom use (OR = 0.53, 95% CI: 0.35–0.81) and number of oral sex partners (OR = 0.35, 95% CI: 0.24–0.51) in the past 6 months were protective factors for HIV infection. Conclusion: Risk behaviors were common in MSM, and urgent need for targeted and comprehensive interventions to reduce risky sexual behaviour and to prevent HIV infection in MSM. [ABSTRACT FROM AUTHOR]

In Lima, Peru, men who have sex with men (MSM) and transgender women (TW) are disproportionately affected by HIV. Patterns of sexual behavior vary by sexual partner type, which has implications for HIV prevention intervention design. We examine correlates of sex and condomless anal intercourse (CAI) with each of four types of partners among HIV-negative MSM and TW in Lima who completed monthly questionnaires about partnership types and CAI. Odds ratios were calculated using generalized estimating equations to identify correlates of being in different types of partnerships and CAI within those partnerships. Among 1,831 MSM and TW with over 14,792 study visits, CAI was most reported with main partners, followed by casual partners, one-time partners, and clients. Presence of an alcohol use disorder (AUD) significantly increased the odds of CAI with all types of partners (main: OR 1.36 (95% CI 1.17-1.57); casual: 1.49 (1.27-1.75); one-time: 1.45 (1.22-1.72); client 1.52 (1.12-2.08)); recent alcohol use increased odds of CAI with main partners. Having one main partner decreased the odds of being in casual and one-time partnerships and of CAI in all types of partnerships. Interventions targeting AUDs and individuals with multiple sexual contacts could reduce CAI and HIV risk in this population. The Sabes study was registered in March 2013 with the National Institutes of Health at ClinicalTrials.gov (identifier: NCT01815580). [ABSTRACT FROM AUTHOR]

Most new HIV diagnoses in the US occur among sexual minority men (SMM). The majority (69%) of new HIV diagnoses among US SMM are due to transmission from main sex partners. We identified multilevel correlates of unprotected anal intercourse (UAI; condomless anal intercourse while not using a biomedical strategy) among SMM couples using the Actor Partner Interdependence Model (APIM). Participants were US SMM over 18 years, with a primary male partner > 6 months. Couples were recruited online from April 2016 until June 2017 and interviewed using self-administered computer-assisted surveys. We used a series of APIM regressions to assess multilevel associations with UAI. We also tested the moderating role of an individual's binge drinking on the relationship between HIV status similarity and UAI. Among 798 participants (n = 411 couples), 61% reported UAI in the past 6 months. Binge drinking (52%) and physical intimate partner violence (IPV; 34%) were considerably high within our sample. Actor's binge drinking, reporting experiencing and/or perpetrating physical IPV, and partner's trust were positively associated with UAI. Actor having other sexual partner(s), using illegal drugs (not marijuana), and length of relationship were negatively associated with UAI. Binge drinking positively moderated UAI among HIV serostatus similar partners. HIV prevention programming should integrate components on IPV and binge drinking reduction- especially among HIV serostatus similar couples. [ABSTRACT FROM AUTHOR]

We investigated the determinants of daily PrEP use and coverage of condomless anal sex (CAS) by PrEP among men who have sex with men in Wales, UK. We measured PrEP use by electronic monitors and CAS by secure online surveys. We defined PrEP use based on daily medication cap openings and coverage as CAS episodes preceded by ≥ 3 days of PrEP use and followed by ≥ 2 days of PrEP use. We included 57 participants (5463 observations). An STI diagnosis was associated with lower PrEP use but also lower PrEP coverage. Older adults had higher PrEP use. A belief that other PrEP users took PrEP as prescribed was associated with lower PrEP coverage. An STI diagnosis is an important cue for an intervention, reflecting episodes of high-risk sexual behaviour and low PrEP coverage. Other results provide a basis for the development of an evidence-informed intervention for promoting coverage of PrEP. [ABSTRACT FROM AUTHOR]

Objectives: To determine the impact of fraternity and sorority membership on condom use during sex. Methods: Utilizing data from The American College Health Association (ACHA) National College Health Assessment from 2016-2018, we estimated a linear probability, logistic, and instrumental variable model to determine the relationship between fraternity and sorority membership and the frequency of condom use during sex. Results: Compared to non-fraternity members, fraternity members experience an increase in sex without a condom for both oral sex (13.5%, 95% ci= 0.048, 0.221) and anal sex (28.5%, 95% ci= 0.174, 0.396). Compared to non-sorority members, sorority members are more likely to engage in oral sex without a condom. This result is not robust to single sorority members. Conclusions: Fraternity membership increases the probability of risky oral and anal sex. Policy Implications: The reduced use of condoms has implications on sexual health including an increased risk of contracting or spreading sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Objective: to analyze the factors associated with inconsistent use of male condoms among HIV-negative men who have sex with other men. Method: a cross-sectional, analytical and nationwide study conducted online in all the Brazilian regions in 2020, via networks and in dating websites. Inconsistent condom use was defined as occasional use or as never using it. Descriptive statistical analyses were performed, as well as association and binary logistic regression tests. Results: inconsistent condom use was reported by 1,222 (85%) of all 1,438 participants. The "homosexuals" (ORAdj: 2.03; 95% CI: 1.14-3.59; p=0.016), "having a fixed partner" (ORAdj: 2.19; 95% CI: 1.55-3.09; p<0.001), "oral sex" (ORAdj: 2.41; 95% CI: 1.31-4.43; p=0.005), "insertive anal" (ORAdj: 1.98; 95% CI: 1.10-3.58; p=0.023) and "STI diagnosis" (ORAdj: 1.59; 95% CI: 1.13-2.24; p=0.007) variables were independently associated with inconsistent use of male condoms. The "receiving advice on HIV test from a friend" (ORAdj: 0.71; 95% CI: 0.52-0.96; p=0.028) and "sex worker" (ORAdj: 0.26; 95% CI: 0.11-0.60; p=0.002) variables were protective factors. Conclusion: the variables under study pointed to a strong relationship between steady partners and increased trust and low adherence to condom use, corroborating other studies. [ABSTRACT FROM AUTHOR]

National prevalence of physical and sexual violence and its relationship to sexual behaviors are unknown among men who have sex with men (MSM). We estimated 12-month prevalence of physical and sexual violence and assessed relationships between violence and sexual behaviors among MSM. Data were obtained from National HIV Behavioral Surveillance 2017 that used time-space sampling methods to recruit and interview MSM in 22 U.S. cities. Weighted percentages with 95% confidence intervals (CI) were reported. Adjusted prevalence ratios (aPR) and 95% CIs were calculated using logistic regression with predicted marginal means. Overall, 10.2% (95% CI: 9.3%–11.2%) of MSM experienced physical violence only, 3.2% (95% CI: 2.7%–3.7%) experienced sexual violence only, and 2.3% (95% CI: 1.9%–2.7%) experienced both types of violence, in the past 12 months. Compared to MSM who did not experience violence, those who did reported higher percentages of unemployment, poverty, homelessness, same-sex discrimination, non-injection drug use, and binge drinking. Violence was not independently associated with condomless anal sex among MSM. MSM who experienced both types of violence were more likely than those who did not experience violence to have had four or more male sex partners (aPR=1.18, 95% CI: 1.02–1.37). MSM who experienced both types of violence (aPR=2.49, 95% CI: 1.52–4.09), sexual violence (aPR=2.27, 95% CI: 1.47–3.52), or physical violence (aPR=1.76, 95% CI: 1.27–2.44) were more likely than those who did not experience violence to have had exchange sex. Recent physical violence and sexual violence are common among MSM. Findings highlight the importance of violence screening and suggest the need for tailored interventions that improve the safety and economic security of MSM who experience violence, including those who exchange sex. [ABSTRACT FROM AUTHOR]

Sexual transmission accounts for the majority of new HIV infections in Iran. More than 80% of HIV-positive persons are sexually active, and nearly 68% reported never using a condom. The present RCT study was conducted on a group of HIV-positive women using internet-based motivational interviewing. The participants, including 100 HIV-positive women, were randomly assigned to an intervention or control group. The intervention group received five weekly internet-based group motivational interviewing sessions focused on reducing risky behaviors, and the control group received routine care. Follow-ups occurred one month and three months after the end of the intervention. The participants completed demographic information, sexual behaviors, HIV knowledge, condom negotiation skills, and HIV-specific perceived social support scales before, one month, and three months after the intervention. Motivational interviewing was effective in improving knowledge about HIV/AIDS, condom negotiation skills, and HIV-specific perceived social support in the intervention group compared to controls. The intervention significantly increased using condoms in vaginal or anal intercourse in the last three months. Still, it was not effective at consistent condom use in all vaginal and anal sex. Further investigation or a larger RCT needs to confirm the using tele-counseling for women living with HIV. [ABSTRACT FROM AUTHOR]

HIV prevalence is high among transgender women, but little is known about cisgender men who have sex with transgender women (MSTW). The objective of this study was to investigate characteristics and behavior of MSTW compared to transgender women and men who have sex with men (MSM) using a modified respondent-driven sampling design. Seed participants completed a survey and invited up to three sex partners. Forward recruitment continued in waves through the referral of sex partners. Cross-sectional data were assessed using mixed effects models. From February to July 2018, 479 participants in Lima, Peru enrolled (n = 199 transgender women, n = 196 MSTW, and n = 45 MSM). MSTW behavior and identity differed significantly from that of transgender women and MSM. MSTW primarily identified as bisexual (69%) or heterosexual (15%) and only 6% reported male partners. Insertive condomless anal intercourse was reported by 61% of MSTW; 46% did not know their HIV serostatus. Compared to MSTW without male partners, those with recent male partners were more likely to sell sex (OR 15.7, 95% CI 4.1–60.5), and report condomless receptive anal intercourse (OR 89.0, 95% CI 19.1–414.8). This evidence suggests that MSTW are a distinct population from MSM, and highlights the critical need to include MSTW in HIV research and interventions. [ABSTRACT FROM AUTHOR]

Objectives: Accumulating evidence suggests that there may be differences in sexual behaviors, condom use, and HIV prevention service utilization (e.g., HIV testing, PrEP use) between gay and bisexual men, but this remains under-explored, especially among gay and bisexual men in China. Methods: We surveyed 4,142 gay and bisexual men on a geosocial networking app in China. Results: In adjusted model, bisexual men were less likely to have received HIV testing in their lifetime (AOR =.62, 95% CI [.53,.72]) or to have received a recent HIV test (AOR =.78, 95% CI [.68,.90]). Conversely, among those who reported having had anal sex in the past six months, bisexual men were more likely to report consistent condom use than gay men (OR = 1.38, 95% CI [1.17, 1.62]). Compared with gay men, bisexual men were significantly less likely to be aware of PrEP (AOR =.62, 95% CI [.52,.74]) and significantly less willing to use PrEP (AOR =.58, 95% CI [.46,.73]). Conclusions: Tailored HIV prevention interventions are needed to address bisexual men's needs in the context of the unique sociocultural influences on sexual behavior in China. [ABSTRACT FROM AUTHOR]

Travelers may adapt HIV risk-reduction practices based on perceived destination-specific norms. We examined the association between perceived condom norms and condomless anal sex (CAS) during international and domestic travel and in the home environment among men who have sex with men. Men who traveled internationally in the past 12 months were recruited by respondent-driven sampling (N = 501). Not knowing destination-specific condom norms was significantly associated with less CAS during international travel and in the home environment but not during domestic travel. Perceiving home environment condom norms to expect use of condoms was significantly associated with less CAS during domestic but not international travel. Men were less likely to engage in CAS during international travel when destination-specific condom norms were unknown. Unfamiliarity with the environment and culture may influence some men to refrain from higher-risk behaviors. During domestic travel, some men appeared to apply home environment condom norms, which may be erroneous in some situations and pose an HIV risk. [ABSTRACT FROM AUTHOR]

Despite the increased use of geosocial networking applications for finding sexual partners among young men who have sex with men (YMSM), few studies have examined the intricate patterns of online dating behaviors. In order to advance understanding of online dating patterns among YMSM, various factors, including how frequently and how much time is spent within partner-seeking sites, need to be examined concurrently. Therefore, we used latent profile analysis to identify online dating patterns and logistic regressions to examine their associations with sexual behaviors and relationship characteristics among single YMSM (N = 180; ages 18–24). We found three online dating patterns: discouraged users (N = 93, 52%), date seekers (N = 67, 37%), and instant lovers (N = 20, 11%). Discouraged users were less likely to seek sexual sensational activities, while date seekers were more likely to seek sexual sensational activities. Moreover, instant lovers were less likely to pursue committed romantic relationships, while they reported a higher number of condomless anal intercourse. Given that online dating patterns are not homogeneous, HIV prevention interventions may benefit from tailored approaches based on YMSM's different online dating profiles. [ABSTRACT FROM AUTHOR]

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Familism may play an important role in HIV risk behaviors among men who have sex with men (MSM) living in a collectivist culture. This study examined a hypothesized path from familism, stressful life events (i.e., adverse childhood experiences, intimate partner violence, and sexuality-related discriminatory experiences), and coping strategies to condomless anal sex (CAS) among Taiwanese MSM. Participants were 1,000 MSM (mean age = 28.5 years) recruited through five community-based organizations. Structural equation modeling using bootstrapping with 3,000 iterations evaluated the mediating effects of 14 coping strategies. We found a pathway from familism to CAS through stressful life events and substance use coping. The protective effects of familism on stressful life events and CAS suggest that integrating components of family support and family connection into HIV prevention and education programs may increase the effectiveness of these programs in reducing HIV risk behaviors and dysfunctional coping strategies among MSM in Taiwan. [ABSTRACT FROM AUTHOR]

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Background: We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS.Methods: We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years).Results: For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03).Conclusion: Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the influence of bareback sexually explicit media (SEM) consumption on anal sex without a condom by men who have sex with men (MSM). To this end, a page was created on the Facebook® social network with a link that directed interested parties to a questionnaire. Cisgender men, aged 18 years and over, who had sex with other men in the last 12 months, were included. Data were collected in 2017 and analyzed using univariate and bivariate inferential statistics and multivariate logistic regression. A total of 2,248 MSM participated in the research, with a mean age of 24.4 years and a mean number of 3.9 partners in the last 30 days. Having multiple sexual partners (ORa: 9.4; 95% CI 3.9-22.4), preferring movies with bareback scenes (ORa: 2.6; 95% CI 1.5-4.6), considering this practice a fetish and realizing it (ORa: 3.52; 95% CI 2.3-5.4), having casual partnerships (ORa: 1.8; 95% CI 1.5-1.9) and being aware of the partner’s negative serological status for HIV (ORa: 1.4; 95% CI 1.1-2.3) were factors that increased the likelihood of engaging in anal sex without a condom. Thus, we found an association between the consumption of bareback SEM and sex without a condom among MSM. [ABSTRACT FROM AUTHOR]

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Over the last decade, syphilis diagnoses among men-who-have-sex-with-men (MSM) have strongly increased in Europe. Understanding the drivers of the ongoing epidemic may aid to curb transmissions. In order to identify the drivers of syphilis transmission in MSM in Switzerland between 2006 and 2017 as well as the effect of potential interventions, we set up an epidemiological model stratified by syphilis stage, HIV-diagnosis, and behavioral factors to account for syphilis infectiousness and risk for transmission. In the main model, we used 'reported non-steady partners' (nsP) as the main proxy for sexual risk. We parameterized the model using data from the Swiss HIV Cohort Study, Swiss Voluntary Counselling and Testing center, cross-sectional surveys among the Swiss MSM population, and published syphilis notifications from the Federal Office of Public Health. The main model reproduced the increase in syphilis diagnoses from 168 cases in 2006 to 418 cases in 2017. It estimated that between 2006 and 2017, MSM with HIV diagnosis had 45.9 times the median syphilis incidence of MSM without HIV diagnosis. Defining risk as condomless anal intercourse with nsP decreased model accuracy (sum of squared weighted residuals, 378.8 vs. 148.3). Counterfactual scenarios suggested that increasing screening of MSM without HIV diagnosis and with nsP from once every two years to twice per year may reduce syphilis incidence (at most 12.8% reduction by 2017). Whereas, increasing screening among MSM with HIV diagnosis and with nsP from once per year to twice per year may substantially reduce syphilis incidence over time (at least 63.5% reduction by 2017). The model suggests that reporting nsP regardless of condom use is suitable for risk stratification when modelling syphilis transmission. More frequent screening of MSM with HIV diagnosis, particularly those with nsP may aid to curb syphilis transmission. Author summary: Syphilis, one of the most common sexually transmitted infections, remains a major public health problem. Over the last decade, a rising number of diagnoses especially in men-who-have-sex-with-men (MSM) was observed in Western Europe and Northern America. In Switzerland, the number of syphilis diagnoses in MSM tripled between 2006 and 2017. In this study, we used a mathematical model to assess the drivers of this increase among MSM in Switzerland. Our model could reproduce the increase in syphilis diagnoses in both MSM with and without HIV diagnosis between 2006 and 2017. Based on this model we found that MSM with HIV diagnosis have an over 45 times higher syphilis incidence than MSM without HIV diagnosis. Furthermore, we found that reported sex with non-steady partners is a useful proxy of behavioral risk. Considering counterfactual scenarios, we showed that increasing the screening frequency for syphilis among MSM with HIV diagnosis and with non-steady partners from once a year to twice per year can reduce syphilis incidence by 63.5% to 99.2%. [ABSTRACT FROM AUTHOR]

We examined reporting agreement of oral, vaginal, and anal sex in adolescents and young adults living with perinatally-acquired HIV and those perinatally HIV-exposed and uninfected in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (AMP) and AMP Up studies. Agreement between fixed constructs (e.g., age at first sex) and prevalence of logical inconsistencies (e.g., reclaimed virginity status) over time were assessed. Internal consistency was also examined using an attention check question and questions regarding condom use in the prior three months. Those who reported having anal sex in adolescence had a higher proportion of inconsistent responses compared to vaginal and oral sex measures. At their most recent survey, 84% of young adults correctly answered an attention check question and 74% agreed within the survey on condom use in the prior three months. In bivariate analyses, HIV status was not associated with responding inconsistently. Increased time between surveys, male sex, and younger age at first survey were associated with multiple measures of inconsistency over time, while lower cognitive scores, having less than a high school diploma, and negatively answering post-survey acceptability questions were associated with incorrectly answering an attention check question. [ABSTRACT FROM AUTHOR]

Most studies of heterosexual sex risk practices have focused on condomless vaginal sex despite evidence that condomless anal sex has a significantly higher risk of HIV transmission. The present study focused on male clients' anal sex practices with female sex workers (FSWs) in Tijuana, Mexico, where an HIV epidemic is growing among high-risk groups. Logistic regression analyses were used to identify psychosocial and behavioral correlates of anal sex among male clients. Our sample of HIV-negative men (N = 400) was predominantly Latino (87.5 %), born in Mexico (78.8 %), never married (36.8 %) or in a regular or common-law marriage (31.5 %), and employed (62.8 %), with an average age and education of 37.8 and 9.2 years, respectively. Eighty-nine percent identified as heterosexual and 11 % as bisexual. By design, 50 % of the sample resided in Tijuana and the other 50 % in San Diego County. Nearly half (49 %) reported at least one incident of anal sex with a FSW in Tijuana in the past 4 months; of those participants, 85 % reported that one or more of their anal sex acts with FSWs had been without a condom. In a multivariate model, anal sex with a FSW in the past 4 months was associated with bisexual identification, methamphetamine use with FSWs, repeat visits to the same FSW, higher scores on perceived stigma about being a client of FSWs, and sexual compulsivity. Prevention programs are needed that address the behavioral and psychosocial correlates of heterosexual anal sex in order to reduce HIV/STI transmission risk among male clients, FSWs, and their sexual network members.

Background: This study determined the association between mental health and risky oral health and sexual health behaviours. Methods: A household cross-sectional survey was conducted in Ile-Ife, Nigeria between December 2019 and January 2020. Data were collected from 10 to 19-year-old on the sociodemographic profile (age, sex at birth and socioeconomic status); mental health problems (psychological distress, depressive symptoms and suicidal ideation); and mental (smoking habit, consumption of alcohol, use of psychoactive substances), sexual (history of vaginal or anal sexual intercourse; transactional sex, multiple sex partners, use of condom at last sexual intercourse) and oral (frequency of daily tooth brushing, daily frequency of consumption of refined carbohydrate in-between-meals, frequency of use of dental floss, history of dental service utilization in the last 12 months and dental anxiety) health risk factors. Binary logistic regression analysis was conducted to determine the association between risky oral (neglecting to brush twice daily and frequent consumption of refined carbohydrates in-between-meals), and sexual (neglecting to use condoms during the last sex act and having multiple sex partners) health behaviours as outcome variables, and mental health status as the explanatory variables. An ordinal logistic regression model was also developed where the outcome variable was the number of risky health behaviours. The models were adjusted for the socio-demographic variables and history of dental service utilisation in the last 12 months of the survey. Results: High psychological distress was significantly associated with lower odds of frequent consumption of refined carbohydrates in-between-meals (AOR = 0.32; 95%CI 0.23, 0.47), and having multiple sex partners (AOR = 0.10; 95%CI 0.02, 0.57); but higher odds of having a higher number of risky behaviours (AOR = 3.04; 95%CI 2.13, 4.33). Having depressive symptoms was significantly associated with higher odds of neglecting to use condom at the last sexual intercourse (AOR = 7.20; 95%CI 1.94, 26.76) and having multiple partners (AOR = 95.43; 95%CI 24.55, 370.90). Suicidal ideation was significantly associated with lower odds of neglecting to use condom at the last sexual intercourse (AOR = 0.00; 95%CI 0.00, 0.00) and having multiple sex partners (AOR = 0.00; 95%CI 0.00, 0.00). Conclusion: The associations between psychological distress and oral and sexual health risk behaviours in adolescents seem complex and need to be studied further. [ABSTRACT FROM AUTHOR]

Aims and objectives: To locate and summarise existing literature regarding safer sex practices specific to heterosexual anal intercourse and identify promising health promotion strategies. Background: Much of the literature regarding anal intercourse and safer sex is related to men who have sex with men. However, some studies suggest there are more women than men engaging in unprotected receptive anal intercourse. The risks associated with this sexual practice have been well documented, although many healthcare providers fail to ask about anal intercourse while addressing safer sex in the heterosexual population. Design: The study was based on Arksey and O'Malley's 2005 five‐step methodology. Methods: A search was conducted of MEDLINE; CINAHL; PsycInfo; Cochrane; and PubMed. Databases were searched from 1990–2020. The 72 studies selected were classified according to their main area of focus. A grey literature search was also included. This scientific submission has been assessed for accuracy and completeness using the PRISMA‐ScR guideline criteria (File S1). Results: The literature in this area is heterogeneous in terms of method and topic. Prevalence and incidence (n = 26) in addition to sexually transmitted infection risks (n = 26) related to heterosexual anal intercourse are well understood. However, there is limited information on condom use (n = 6), factors that influence heterosexual anal intercourse (n = 10) and health promotion strategies for this population and practice (n = 4). Two websites that mentioned heterosexual anal intercourse risk reduction activities were included. Conclusions: Although heterosexual anal intercourse appears to be an increasingly common sexual practice, very little is known about health promotion strategies nurses might use for encouraging safer sex in this population. Relevance to clinical practice: Increased awareness of the prevalence and risks of heterosexual anal intercourse could enhance nurses' harm reduction strategies. Screening for sexually transmitted infections may be based on incorrect assumptions about sexual practices or due to stigma linked with anal intercourse. Reducing unprotected heterosexual anal intercourse will reduce sexually transmitted infections and their long‐term sequelae. [ABSTRACT FROM AUTHOR]

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Online partner-seeking among adolescent sexual minority males (ASMM) has been associated with condomless anal sex. Two hypotheses may explain this association: that online venues facilitate HIV transmission risk behavior more than offline venues (accentuation), or that individuals who tend to engage in these behaviors are more likely to seek partners online (self-selection). We examined these hypotheses in 700 13–18 year-old ASMM who completed the baseline survey of an effectiveness trial of an HIV prevention program in 2018–2020. The survey assessed demographic, sexual, and venue characteristics of male anal sex partnerships in the past 3 months. Many participants (83%) reported ≥ 1 online-met partner; most were met via sexual networking applications and were older than offline-met partners. Having met partners online, but not whether a particular partner was met online, was associated with greater odds of receptive condomless sex. Findings support the self-selection hypothesis, which has implications for HIV prevention in ASMM. [ABSTRACT FROM AUTHOR]

HIV risk perception plays a crucial role in the uptake of preventive strategies. We investigated how risk perception and its determinants changed between 1999 and 2018 in an open, prospective cohort of 1323 HIV-negative men who have sex with men (MSM). Risk perception, defined as the perceived likelihood of acquiring HIV in the past 6 months, changed over time: being relatively lower in 2008–2011, higher in 2012–2016, and again lower in 2017–2018. Irrespective of calendar year, condomless anal intercourse (AI) with casual partners and high numbers of partners were associated with higher risk perception. In 2017–2018, condomless receptive AI with a partner living with HIV was no longer associated with risk perception, while PrEP use and condomless AI with a steady partner were associated with lower risk perception. We showed that risk perception has fluctuated among MSM in the past 20 years. The Undetectable equals Untransmittable statement and PrEP coincided with lower perceived risk. [ABSTRACT FROM AUTHOR]

We examine condom failure and use error experienced by high school youth in two regions of the United States. Data are from a baseline survey of a randomized controlled trial to evaluate FLASH, a sexual health education curriculum for high school students. Participants were 1,597 ninth- or 10th-grade students in health class who had parental consent and who assented to participate in the study. This study examines condom use behavior among students who reported vaginal or anal sex at baseline. Of the 222 participants who reported having vaginal or anal sex in the 3 months prior to baseline survey, 180 of them reported using a condom at least once. Of these youth, 70.6% reported that they did not squeeze the tip of the condom before sex, 25.0% of youth reported that they did not roll the condom all the way down to the base of the penis, and 49.4% reported that they did not hold the base of the penis when pulling out; 36.9% reported experiencing condom breakage or slippage. The frequency of condom error and/or failure reported by young adolescents in this study indicates a need for further education on potential condom use errors with an emphasis on the correct steps for using a condom to prevent condom failure. High rates of error and failure suggest an opportunity for educators to tailor preexisting condom use interventions to further reinforce the skills necessary for effective condom use and to educate on what to do in the event of condom failure. [ABSTRACT FROM AUTHOR]

Background We examined links among face visibility on dating-profile pictures, self-perceived attractiveness, condom use self-efficacy, and unprotected receptive anal intercourse (URAI) in 223 young men who have sex with men (YMSM; ages 18-24 years) using online dating applications (e.g. Grindr).Methods: Participants reported their face visibility on their main dating-profile picture, attractiveness, condom use self-efficacy, and frequency of URAI in the past 3 months. Number of casual sex partners and pre-exposure prophylaxis (PrEP) use were statistically controlled in all analyses.Results: Using a mediated moderation model, we found that a significant attractiveness-by-face-visibility interaction for URAI was fully mediated by condom use self-efficacy. Specifically, lower face visibility on profile pictures related to lower condom use self-efficacy, which in turn related to higher URAI, but only among highly attractive YMSM.Conclusions: Our findings suggest that attractive YMSM who show less-visible faces on their dating profiles could be at particularly high risk for sexually transmissible infections. This study has potentially important clinical implications because dating applications have become one of the most common ways for YMSM to find sexual partners. [ABSTRACT FROM AUTHOR]

We sought to examine how condom use was differentially reasoned by gay, bisexual and other men who have sex with other men (GBM) in Ontario, Canada. Data were derived from a community-based study of GBM who completed an anonymous online questionnaire in 2014. Participants qualitatively described reasons a condom was used or not at their most recent anal sex event. Qualitative responses were thematically coded non-exclusively and associations with event-level and individual-level factors were determined quantitatively using manual backward stepwise multivariable logistic regression. Among 1,830 participants, 1,460 (79.8%) reported a recent anal sex event, during which 884 (60.6%) used condoms. Reasons for condom use included protection/safety (82.4%), norms (30.5%), and combination prevention (6.2%). Reasons for non-use were intentional (43.1%), trust (27.6%), unintentional (25.7%), and other strategies (19.6%). Event-level substance use was associated with all non-use reasons: e.g., more likely to be unintentional, less likely to be trust. Condom non-use with online-met partners was associated with more intentional and unintentional reasons and less trust reasons. Non-white and bisexual GBM were less likely to explain condom use as a norm. Participant-partner HIV status was an important predictor across most condom use and non-use reasons: e.g., sero-different partnerships were more likely to reason condom use as combination prevention and condom non-use as trust, unknown status partnerships were more likely to reason non-use as unintentional. Condom use among GBM is a multi-faceted practice, especially with increasing antiretroviral-based HIV prevention. Future interventions must adapt to changing GBM (sub-)cultures with targeted, differentiated, culturally-appropriate, and sustained interventions. [ABSTRACT FROM AUTHOR]