[show abstract][hide abstract] ABSTRACT: Cognitive appraisals about sex may represent an important component of the maintenance and treatment of hypersexuality, but they are not currently represented in conceptual models of hypersexuality. Therefore, we validated a measure of maladaptive cognitions about sex and examined its unique ability to predict hypersexuality. Qualitative interviews with a pilot sample of 60 highly sexually active gay and bisexual men and expert review of items yielded a pool of 17 items regarding maladaptive cognitions about sex. A separate sample of 202 highly sexually active gay and bisexual men completed measures of sexual inhibition and excitation, impulsivity, emotional dysregulation, depression and anxiety, sexual compulsivity, and a measure of problematic hypersexuality. Factor analysis confirmed the presence of three subscales: perceived sexual needs, sexual costs, and sexual control efficacy. Structural equation modeling results were consistent with a cognitive model of hypersexuality whereby magnifying the necessity of sex and disqualifying the benefits of sex partially predicted minimized self-efficacy for controlling one's sexual behavior, all of which predicted problematic hypersexuality. In multivariate logistic regression, disqualifying the benefits of sex predicted unique variance in hypersexuality, even after adjusting for the role of core constructs of existing research on hypersexuality, AOR = 1.78, 95 % CI 1.02, 3.10. Results suggest the utility of a cognitive approach for better understanding hypersexuality and the importance of developing treatment approaches that encourage adaptive appraisals regarding the outcomes of sex and one's ability to control his sexual behavior.
Archives of Sexual Behavior 02/2014; · 3.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: Main partnerships represent one context in which HIV transmission may occur that has been insufficiently addressed to date for gay and bisexual men, but few studies have focused on the acceptability of couples-based voluntary HIV counseling and testing (CVCT) for male couples in the U.S. Our aim in this study was to explore the acceptability of CVCT among a national U.S. sample of 1,532 gay and bisexual men surveyed online using a sexual networking site. We examined the role of demographic (i.e., geographic region, age, relationship status, sexual orientation, race/ethnicity) and HIV risk (i.e., substance use, number of sexual partners, unprotected anal intercourse, sexual role identity, and sexual compulsivity) factors that may be associated with CVCT among the full sample and among partnered men separately. We found that single men expressed higher interest in CVCT than partnered men and that greater age was more strongly associated with lower interest in CVCT for partnered men than for single men. The intersection of sexual orientation and race/ethnicity was also significantly associated with CVCT interest, with a higher proportion of Black bisexual men being interested than White bisexual men. These findings suggest that the uptake of CVCT may be less impacted by HIV risk factors than by demographic factors and that young gay and bisexual men of color-for whom rates of HIV continue to rise-may be the group with the highest levels of interest in CVCT.
Archives of Sexual Behavior 11/2013; · 3.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: To compare three groups of men who have sex with men (MSM)-men who had attended a sex party in the past year (45.2%); men who had been to a sex party more than a year ago (23.3%); and men who had never been to one (31.5%)-on socio-demographic and behavioural characteristics.
In spring 2012, 2063 sexually active MSM in the USA were recruited using banner advertising on a sexual networking website to complete an online survey about their sexual behaviour and attendance at sex parties.
A significantly higher proportion of past year attendees were HIV-positive (28.1%), single (31.7%), demonstrated sexual compulsivity symptomology (39.2%), recently used drugs (67.8%), averaged the greatest number of recent male partners (Mdn=15, <90 days), and had greater instances of recent unprotected anal intercourse (UAI) with male partners (median=3, <90 days). Adjusting for covariates, those having been to a sex party in the last year were significantly more likely than others to report UAI. Free lubricant (93.4%) and condoms (81.0%) were the most desirable services/products men wanted at sex parties. More than half of men having been to a sex party expressed interest in free rapid HIV testing at sex parties (52.8%); however, few considered it acceptable to see 'medical providers' (11.7%) and 'peer outreach workers' (9.5%) at sex parties.
MSM who have attended a sex party in the last year are appropriate candidates for targeted HIV and sexually transmitted infection (STI) prevention. Collaborating with event promoters presents valuable opportunities to provide condoms, lubricant and HIV/STI testing.
[show abstract][hide abstract] ABSTRACT: Rates of HIV infection continue to rise for men who have sex with men (MSM), and may be partially due to lack of testing among groups at risk for HIV. Mobile applications have demonstrated promise to identify at-risk MSM, though more research is needed to address testing patterns among this population. We conducted an online survey of 1,351 MSM in the New York City (NYC) area recruited from Grindr and analyzed predictors of lifetime and past-year testing using Pearson's chi-squared statistic, Fisher's exact tests, and logistic regression. A majority (90 %) of men had been tested within their lifetimes, and most (71 %) had been tested within the prior year. Among those who had never been tested (n = 135), one-third had engaged in unprotected anal intercourse (UAI) in the prior 3 months and nearly one-third identified themselves as HIV-negative rather than unknown. Older age, reporting an HIV-negative (versus unknown) status, and recent UAI were independently associated with lifetime testing. Greater proportions of men who had recently engaged in UAI reported testing within the past year compared with those who had not engaged in UAI. Overall, rates of testing among MSM in this sample exceeded those of the general population, including the general population in NYC. A greater proportion of this sample had never tested compared to a population-based sample of NYC MSM, though a higher percentage had also tested in the past year. This study demonstrated that 1 in 10 NYC men using Grindr and 1 in 5 who were 18-24 years of age had never received an HIV test in their lives. Using the existing infrastructure and popularity of mobile technology such as Grindr to identify and link men to information regarding HIV testing may be a useful strategy for prevention.
[show abstract][hide abstract] ABSTRACT: Few studies have examined male clients who pay for sex with male escorts. In 2012, clients (n = 495) completed an online survey about their most recent hire. Most clients were White/Caucasian (87.7%), HIV negative (89.5%), employed full time (71.1%), single (58.6%), with a mean age of 54. Three-quarters of clients were gay identified, 18% bisexual, and 4% heterosexual. The median rate paid to escorts was $250 per hour with a modal appointment time of 1 to 2 hours (41.6%). Oral sex was common (80% gave, 69% received), 30% reported anal insertive sex, and 34% reported anal receptive sex. In total, few (12%) reported unprotected anal sex. Satisfaction with encounters was high. Receptive unprotected anal intercourse was associated with greater satisfaction in bivariate analyses but not in multivariable analyses. In a multivariable model, having receptive anal sex (whether protected or not) and rating the financial cost of the encounter as "worth it" were significantly associated with greater satisfaction. This study contributes to a scarce literature regarding clients of male sex workers and, in particular, provides information on the characteristics of men hiring men for sexual services, behavioral event-level data about their encounters, and analysis of factors directly associated with client satisfaction.
The Journal of Sex Research 08/2013; · 2.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: Researchers have investigated group sexual encounters (GSEs) as potential sources for HIV/STI transmission among men who have sex with men (MSM); however, much of this work has focused on organized sex parties.
To compare behavioral and social characteristics of groups of men who engaged in three types of GSEs: threesomes, spontaneous group sex, and organized sex parties.
In 2012, 1,815 U.S.-based MSM completed an online survey.
We compared men based on their most recent type of GSE: threesome (68.2%), spontaneous group sex (19.7%), or organized sex party (12.1%).
Using multinomial logistic regression, with type of GSE as the dependent variable, MSM who were HIV-positive, used stimulants (cocaine, methamphetamine, crack), consumed five or more alcoholic drinks, and reported receptive unprotected anal intercourse (UAI) during the most recent GSE had significantly higher odds of having had spontaneous group sex as compared to a threesome. MSM who were HIV-positive, not in a relationship, and did not report receptive UAI during the most recent GSE had significantly higher odds of having attended an organized sex party as compared to a threesome. MSM who were in a relationship, had consumed five or more alcoholic drinks, had used stimulants, and reported receptive UAI during the most recent GSE had significantly higher odds of having had spontaneous group sex as compared to an organized sex party. Compared to others, those having engaged in a GSE were more likely to report recent UAI (65% vs. 45%).
Men having engaged in a GSE were at greater risk for behaviors that transmit HIV and STIs. Unique social and behavioral characteristics inherent to threesomes, spontaneous group sex, and sex parties highlight the need to identify prevention strategies to help those who participate in GSEs reduce their risk for HIV and STI transmission. Grov C, Rendina HJ, Ventuneac A, and Parsons JT. HIV risk in group sexual encounters: An event-level analysis from a national online survey of MSM in the U.S. J Sex Med **;**:**-**.
Journal of Sexual Medicine 06/2013; · 3.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: INTRODUCTION: The Hypersexual Disorder Screening Inventory (HDSI) was designed as an instrument for the screening of hypersexuality by the American Psychiatric Association's taskforce for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. AIM: Our study sought to conduct a psychometric analysis of the HDSI, including an investigation of its underlying structure and reliability utilizing item response theory (IRT) modeling, and an examination of its polythetic scoring criteria in comparison to a standard dimensionally based cutoff score. METHODS: We examined a diverse group of 202 highly sexually active gay and bisexual men in New York City. We conducted psychometric analyses of the HDSI, including both confirmatory factor analysis of its structure and IRT analysis of the item and scale reliabilities. MAIN OUTCOME MEASURES: We utilized the HDSI. RESULTS: The HDSI adequately fit a single-factor solution, although there was evidence that two of the items may measure a second factor that taps into sex as a form of coping. The scale showed evidence of strong reliability across much of the continuum of hypersexuality, and results suggested that, in addition to the proposed polythetic scoring criteria, a cutoff score of 20 on the severity index might be used for preliminary classification of HD. CONCLUSION: The HDSI was found to be highly reliable, and results suggested that a unidimensional, quantitative conception of hypersexuality with a clinically relevant cutoff score may be more appropriate than a qualitative syndrome comprised of multiple distinct clusters of problems. However, we also found preliminary evidence that three clusters of symptoms may constitute an HD syndrome as opposed to the two clusters initially proposed. Future research is needed to determine which of these issues are characteristic of the hypersexuality and HD constructs themselves and which are more likely to be methodological artifacts of the HDSI.
Journal of Sexual Medicine 03/2013; · 3.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: We conducted face-to-face semi-structured interviews with 50 men recruited from the New York City men-seeking-men section of Craigslist.org . Participants discussed their favorite venues for meeting sex partners (n = 28 said the Internet), and we focused on these men's responses to probes regarding decisions around condom use and HIV status disclosure with online partners. A majority indicated they set a priori rules for themselves to always use condoms, and they cited the Internet as their favorite venue in part because it helped them sort for like-minded partners. Participants indicated that having in-person conversations around condom use and HIV was often difficult, and that the Internet was a convenient medium to facilitate the process. Notable differences were observed in how HIV-positive and HIV-negative men navigated serostatus disclosure-HIV-negative men were less subtle in starting the conversation. Finally, participants described a common narrative around distrust with online partners, which is one reason why they consistently use condoms. These data suggest that features which allow men to easily indicate, and filter for, condom use preferences should be built into (or maintained on) profile-based sexual networking sites and sexual bulletin board sites.
AIDS education and prevention: official publication of the International Society for AIDS Education 02/2013; 25(1):72-85. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective: The present study examined the role of sexual compulsivity (SC) in four aspects of interpersonal functioning relevant to main partnerships-sexual satisfaction, sexual communication, the presence of weekly sexual activity with main partner, and the number of recent casual male sex partners (i.e., outside of the relationship) with whom participants had unprotected anal intercourse (UAI). Method: Data were collected using a street-intercept strategy from both members of 172 gay male couples (N = 344 individuals) attending gay-community events together. SC was measured using the Sexual Compulsivity Scale; sexual satisfaction using a modified version of the Sexual Functioning Inventory (SFI); and sexual communication using a shortened version of the Dyadic Sexual Communication (DSC) Scale. Results: Men high on SC were as likely to be partnered with men low on SC as they were to be partnered with others having high levels of SC. SC was negatively associated with sexual satisfaction and sexual communication. Individuals with higher SC scores and those whose partners had higher SC scores engaged in UAI with a greater number of male partners outside their relationship. SC was unrelated to frequency of sex with main partners. Conclusion: SC was associated with lower sexual relationship quality and increased potential for human immunodeficiency virus (HIV) transmission from a casual partner and subsequent transmission to (or reinfection with) a primary partner. Couples interventions for SC may be relevant to individual and public health. They provide a platform to practice communication skills, identify preferred sexual activities, and negotiate sexual safety. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
[show abstract][hide abstract] ABSTRACT: This study assessed the perceived importance of five health issues for gay and bisexual men (N = 660) using time-space sampling in gay bars/clubs and bathhouses in New York City: "HIV & STDs," "Drugs & Alcohol," "Body Image," "Mental Health," and "Smoking." This study compared ratings based on demographic differences, recent substance use, recent sexual risk behavior, and whether or not participants owned a smart device (e.g., "smart" phone, iPad, iPod touch). Contrary to research indicating that gay and bisexual men may be experiencing HIV prevention fatigue, this study identified that HIV and STIs were perceived as most important. Drugs and alcohol and mental health were also rated high, suggesting that providers may be well served to include mental health and drugs and alcohol as part of their comprehensive approach to HIV prevention. A majority of participants (72%) owned a smart device. Smart device owners rated health issues similarly to those who did not, suggesting that such devices may be a useful platform to reach gay and bisexual men for health education and prevention.
American journal of men's health 10/2012; · 1.15 Impact Factor
[show abstract][hide abstract] ABSTRACT: We adapted time-space sampling to enroll men who have sex with men (MSM) off Craigslist.org for face-to-face interviews. Men responding to our ads (n = 322) were instructed to either complete an online pre-screening survey (to determine preliminary eligibility) or call our office directly. Of those taking further initiative to enroll, 29 % (n = 41) called directly and 71 % (n = 101) opted to first complete the online survey. Participants scheduled via online pre-screening were more likely to present for their face-to-face assessment than men deemed eligible directly via phone screening (72.3 vs. 47.1 %). Online pre-screening was a useful tool to offer potential participants when recruiting on Craigslist and improved study enrollment. RESUMEN: Hemos adaptado un muestreo de "time-space" con el propósito de inscribir a hombres que tienen sexo con hombres (HSH) usando Craigslist.org, para hacer entrevistas en persona. Los hombres que respondieron a nuestros anuncios (n = 322) fueron instruidos a completar una encuesta por internet, que ayudaría a determinar la elegibilidad preliminar, o llamar directamente a nuestra oficina. De los que tomaron la iniciativa de inscribirse, 29 % (n = 41) nos llamaron directamente y 71 % (n = 101) decidieron en completar la encuesta por internet. Los participantes programados para una cita usando la encuesta por internet fueron más propensos a presentarse para su entrevista en persona que los hombres considerados elegibles directamente por la entrevista de teléfono (72,3 vs 47,1 %). Usando la encuesta por internet fue una herramienta útil de ofrecer a los posibles participantes al reclutar por Craigslist.org y también fue algo que aumento inscripción a esta investigación.
[show abstract][hide abstract] ABSTRACT: Relationship arrangements about sex with outside partners are common among gay couples, and meaningful distinctions in psychological and behavioral health correlates have been found among nonmonogamous agreement types. The goal of this study was to investigate the relationship between sexual agreements and partners' sexual relationship quality. Data were collected from both members of 161 gay male couples (n = 322 individuals). Couples were categorized as monogamous (52.8%), open (13.0%), monogamish (14.9%), and discrepant (19.3%). We used the actor-partner interdependence model (APIM) to assess associations of relationship arrangement with four aspects of sexual relationship quality: sexual satisfaction, sexual communication, sexual jealousy, and the occurrence of at-least weekly sex between main partners. We found that sexual arrangements were not associated with sexual satisfaction, communication, or frequency. However, monogamous men reported significantly higher levels of sexual jealousy. Our findings indicate that gay men engage in a range of relationship agreements, and nonmonogamous agreements are associated with levels of sexual relationship quality equivalent to monogamous agreements. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Journal of Family Psychology 08/2012; 26(5):669-77. · 1.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study employed a social-cognitive theoretical perspective to assess the interactions of behavioral, cognitive, and situational factors to understand better how young male sex workers (MSWs) entered the sex trade industry. As part of a larger project examining male escorts working for a single agency, MSWs (n = 38) were interviewed about their work and personal lives. Interviews were transcribed and analyzed thematically. As predicted by a social-cognitive perspective, results supported reciprocal influences of behavior and environment, environment and cognition, and behavior and cognition. MSWs developed more self-efficacy around sex work behaviors and more positive outcome expectations with experience; moral conflict and lack of attraction to clients limited MSWs' self-efficacy. Key variables for sex work appeared to be cognitive in nature-mostly represented by a decreased commitment to normative social/sexual values, the specific nature of which may have varied by sexual orientation. Findings support the contention that social-cognitive theory can effectively model entry of young men into sex work. Social-cognitive theory provides a broad umbrella underneath which various explanations for male sex work can be gathered.
The Journal of Sex Research 08/2012; · 2.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: The authors used latent class analysis to investigate rules guiding nonmonogamy in partnered gay and bisexual men. Data are from a 2010 survey (N = 463) from which those in relationships (n = 191) were analyzed. More than half (56%) were nonmonogamous, and these men responded to 13 rules about sex outside of their relationship. The safe anonymous sex group (34%) included men who indicated that they must use condoms for anal sex and not have sex with people they know. The communication mandate group (19%) included men who indicated that they must talk about outside partners before sex occurs, disclose their relationship status to outside partners, and use condoms for anal sex. The play together group (9%) included men who indicated that they must play with others as a couple, not have anal sex with outside partners, and not spend the night with outside partners. Those in the no salient rule group (37%) were individuals who did not endorse a clear set of rules. These 4 groups (and compared with monogamous men) differed in age, agreement formality and flexibility, relationship satisfaction, and whether anal sex recently occurred with casual partners. This study provides a novel approach for understanding nonmonogamous same-sex relationships and highlights their complexity.
Journal of Sex and Marital Therapy 05/2012; · 1.27 Impact Factor
[show abstract][hide abstract] ABSTRACT: As researchers and community-based providers continue to encourage latex condom use as a chief strategy to prevent HIV transmission among men who have sex with men, research is needed to better explore the intersecting associations among penis size (length and circumference), condom feel, ease of finding condoms, recent experience of condom failure (breakage and slippage), and unprotected anal sex. Data were taken from a 2010 community-based survey of self-identified gay and bisexual men in New York City (n = 463). More than half (51.4 %) reported penile length as 6-8 in. long (15-20 cm) and 31.5 % reported penile circumference as 4-6 in. around (10-15 cm). Variation in self-reported penile dimensions was significantly associated with men's attitudes toward the typical/average condom, difficulty finding condoms that fit, and the experience of condom breakage. Men who had engaged in recent unprotected insertive anal intercourse reported significantly higher values for both penile length and circumference, and these men were significantly more likely to report that the average/typical condom was "too tight." Most men had measured their length (86.2 %) and/or circumference (68.9 %), suggesting that penile measurement might be a common and acceptable practice among gay and bisexual men. As HIV and STI prevention providers continue to serve as leading distributers of free condoms, these findings further highlight the need for condom availability to be in a variety of sizes. Improving condom fit and attitudes toward condoms may also improve condom use and minimize condom slippage and breakage.
Archives of Sexual Behavior 05/2012; · 3.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examined attitudes toward the most common place where men who have sex with men (MSM) met their recent male sex partners. In 2009-2010, MSM were surveyed in bars/clubs, bathhouses, and on Craigslist.org . We found strong but differential overlap between venue of recruitment and participants' most common place: 81% of men from Craigslist indicated their most common place was the Internet, 65% of men from bathhouses indicated their most common place was bathhouses, and 47% of men from bars/clubs indicated their most common place was bars/clubs. In general, interest in seeing more information on drugs/alcohol and HIV and interacting with a health outreach worker in participants' most common place ranged from "agree" to "strongly agree." However, men whose most common place was bars/clubs rated these items lowest on average. Rates of unprotected anal intercourse (UAI) were high (43%), thus targeted efforts in bars/clubs, bathhouses, and on the Internet may be ideal venues for reaching high-risk MSM. Although most common place was unrelated to UAI, it was related to factors that contextualize men's encounters (e.g., attitudes toward HIV status disclosure, and perceptions about barebacking, anonymous sex, and alcohol use). Outreach providers should consider these contextualizing aspects as they continue to retool their efforts.
AIDS education and prevention: official publication of the International Society for AIDS Education 04/2012; 24(2):102-16. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: Researchers have documented the psychological and physical health benefits of being in a relationship among heterosexuals, although there has been limited research to examine such benefits among gay and bisexual men. Gay and bisexual men demonstrate considerable variety in the nature of their relationships, particularly in terms of the degree to which they are monogamous. In order to better understand the psychological and behavioral impact of same-sex relationships on the health of gay and bisexual men, demographic characteristics, psychological factors, sexual behavior, and substance use data were examined in a sample of 819 gay and bisexual men who self-identified as single (n = 503) or were classified as being in monogamous (n = 182), open (n = 71) or monogamish (n = 63) relationships. Monogamish relationships were those in which both men have agreed that any sexual activity with casual partners must happen when both members of the couple are present and involved (e.g., "threeways" or group sex). Findings indicated that being in a same-sex relationship had health benefits compared to being single among gay and bisexual men. Men in monogamous relationships reported the least amount of substance use compared to all other groups, and less substance use during sex than single men or men in open relationships. Men in monogamish relationships demonstrated psychological and sexual health benefits relative to single men and men in open relationships. Gay and bisexual men in monogamish relationships more closely resembled those in monogamous relationships, in terms of psychological and sexual health benefits, rather than men in open relationships, suggesting that varying forms of non-monogamy should be explored for their relevance to health behaviors.
Archives of Sexual Behavior 12/2011; · 3.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: We evaluated whether sexual compulsivity fits into a syndemic framework, in which sexual compulsivity is one of a number of co-occurring psychosocial health problems that increase HIV risk among men who have sex with men (MSM).
In 2003 and 2004, we conducted an anonymous cross-sectional survey of MSM in New York City (n = 669) by approaching attendees at gay, lesbian, and bisexual community events. We analyzed data by bivariate and multivariate logistic regression.
We found strong positive interrelationships among syndemic factors including sexual compulsivity, depression, childhood sexual abuse, intimate partner violence, and polydrug use. In bivariate analyses, all syndemic health problems except for childhood sexual abuse were positively related to HIV seropositivity and high-risk sexual behavior. Our multivariate models revealed an array of interrelationships among psychosocial health problems. We found amplified effects of these problems on HIV seropositivity and on the likelihood of engaging in high-risk sexual behavior.
Our findings support the conclusion that sexual compulsivity is a component of a syndemic framework for HIV risk among MSM. HIV prevention interventions should consider the overlapping and compounding effects of psychosocial problems, including sexual compulsivity.
American Journal of Public Health 11/2011; 102(1):156-62. · 3.93 Impact Factor