Anti-LGBT and Anti-immigrant Structural Stigma: An Intersectional Analysis of Sexual Minority Men's HIV Risk When Migrating to or Within Europe.

OBJECTIVE: Gay, bisexual, and other men who have sex with men (MSM) might be particularly likely to migrate to experience freedoms unavailable in their home countries. Structural stigma (eg, laws and policies promoting the unequal treatment of oppressed populations) in MSM migrants' sending and receiving countries represent potential barriers to HIV prevention among this intersectional population. This study represents the first investigation of structural determinants of HIV risk in a large, geographically diverse sample of MSM migrants. DESIGN: The 2010 European MSM Internet Survey (n = 23,371 migrants) was administered across 38 European countries. METHODS: Structural stigma was assessed using (1) national laws and policies promoting unequal treatment of sexual minorities across 181 countries worldwide and (2) national attitudes against immigrants in the 38 receiving countries. We also assessed linguistic status, time since migrating, and 5 HIV-prevention outcomes. RESULTS: Structural stigma toward sexual minorities (in sending and receiving countries) and toward immigrants (in receiving countries) was associated with a lack of HIV-prevention knowledge, service coverage, and precautionary behaviors among MSM migrants. Linguistic status and time since migrating moderated some associations between structural stigma and lack of HIV prevention. CONCLUSIONS: Structural stigma toward MSM and immigrants represents a modifiable structural determinant of the global HIV epidemic.

Alto consumo de drogas recreativas y conductas sexuales de riesgo en hombres que tienen relaciones sexuales con hombres / High prevalence of drug consumption and sexual risk behaviors in men who have sex with men

Fundamento y objetivo: Describir el patrón de uso de drogas en hombres que tienen relaciones sexuales con hombres (HSH) residentes en España y su asociación con las prácticas de riesgo sexual. Material y método: La Encuesta Europea por Internet para HSH se implementó en 2010 en 38 países europeos y recogió información sociodemográfica y sobre conducta y salud sexual, entre otras. Mediante modelos de regresión logística multivariante se evaluó la asociación entre la variable penetración anal desprotegida (PANP) con parejas ocasionales y el consumo de drogas. Resultados: Entre los 13.111 HSH encuestados, el cannabis fue la droga consumida con más frecuencia en los últimos 12 meses (30,1%), seguido del popper (28,4%) y la cocaína (18,7%). Los modelos de regresión logística ajustados mostraron un riesgo de PANP de 1,5 entre los consumidores de drogas en relación con los que no las habían consumido. El 2,5% de los HSH se había inyectado drogas alguna vez en la vida, y el 1,4%, en los últimos 12 meses. La prevalencia de PANP con parejas ocasionales (53,4%), de infección por el virus de la inmunodeficiencia humana (VIH) (23%), de hepatitis C (8,2%) y de infecciones de transmisión sexual (ITS) (15,8%) fue superior en HSH inyectores con respecto al resto de los participantes (p < 0,05). Conclusiones: Se confirma una elevada prevalencia de consumo de drogas en HSH y su asociación con las conductas sexuales de riesgo. Aunque el uso de la vía inyectada en HSH es minoritario, el subgrupo de HSH inyectores presenta una mayor prevalencia de conductas sexuales de riesgo, VIH, hepatitis C y otras ITS (AU)

Basis and objective: To describe the pattern of drug use among men who have sex with men (MSM) living in Spain and its association with sexual risk practices. Material and method. The European MSM Internet Survey was implemented in 2010 in 38 European countries on websites for MSM and collected data on sociodemographics, sexual behavior, and other sexual health variables. The association between unprotected anal intercourse (UAI) with casual partners and drug consumption was evaluated using multivariate logistic regression models. Results: Among the 13,111 participants, most consumed drugs were cannabis (30.1%), popper (28.4%) and cocaine (18.7%). The risk of UAI with casual partners was 1.5 among those who had used drugs in relation to the other participants. The proportion of MSM who had injected drugs at least once in life was 2.5%, and 1.4% in the last 12 months. The prevalence of UAI with casual partners (53.4%), human immunodeficiency virus (HIV) (23%), hepatitis C (8.2%) and sexually transmitted infections (STI) (15.8%) was higher in MSM injectors related to those who had not used injected drugs (P < .05). Conclusions: The results of this study confirm a high prevalence of drug use in MSM and their relationship to sexual risk behavior. Although the use of injected drugs in MSM is a minority, this group reported a higher level of sexual risk behaviors, self-reported HIV, hepatitis C and other STI (AU)

Use of new technologies to notify possible contagion of sexually-transmitted infections among men / Uso de las nuevas tecnologías para la notificación del posible contagio de infecciones de transmisión sexual entre hombres

Background: Among men who have sex with men (MSM), the association between searching for sexual partners’ on the Internet and increased risk of sexually transmitted infections (STIs)/HIV infection, together with current low levels of partner notification (PN), justifies a study to explore the intention to use new communication technologies for PN in Spain. Methods: Two cross-sectional surveys were performed: the first was administered online to visitors to web pages where the survey was advertised; the second was administered on paper to patients attending an STI Unit and centres similar to Community-Based Voluntary Counselling and Testing centres. Results: The study population comprised 1578 Spanish residents (median age, 34 years [range: 18 to 74]); 84% lived in urban areas, and 69% reported searching for sexual partners on the Internet. Thirty-seven per cent would be willing to use a website for PN, 26% did not know if they would use one, and 37% would not want to use one. The main reasons for not intending to notify STI/HIV were 'shame or fear' (stable partner) and 'not knowing how to contact them' (casual partner). The preferred method of notification was face to face (73%) for both stable and casual partners, although using new technologies (Short Messaging System, e-mail, web page, phone applications) was widely accepted for notifying casual partners. Conclusions: Fighting stigma and promoting alternative methods of PN among MSM and health professionals through new technologies could increase the frequency of PN. This approach will improve early detection and reduce transmission in Spain (AU)

Antecedentes: Entre los hombres que tienen sexo con hombres, la asociación entre buscar parejas por internet y el incremento de riesgo para presentar una Infección de Transmisión Sexual (ITS), junto con la baja frecuencia de la práctica de la notificación a las parejas sexuales expuestas a un infectado justifican explorar la intención de uso de las nuevas tecnologías para facilitar dicha notificación en España. Métodos: Se han utilizado dos estudios transversales: el primero, administrado 'online' a los visitantes de páginas web donde se publicitaba la encuesta; el segundo, administrado en formato papel en una Unidad Especializada de Atención a las ITS y otros centros similares a los de soporte y realización de pruebas. Resultados: Participaron 1578 personas residentes en España, mediana de edad 34 años (Rango: 18- 74); 84% de áreas urbanas, 69% buscaron parejas sexuales en internet. Un treinta y siete por ciento utilizarían un página web si estuviera disponible, un 26% no sabían si lo harían y otro 37% no la utilizarían. Las razones principales para no tener la intención de notificar de ITS/VIH a una pareja estable fueron: 'miedo o vergüenza'; a una pareja ocasional: 'no saber cómo contactarla'. El método preferido para notificar fue el 'cara a cara o por teléfono' (73%), tanto en caso de pareja estable como ocasional. El uso de nuevas tecnologías (SMS, e-mail, web page, aplicaciones de teléfono) fue más aceptado en caso de pareja ocasional. Conclusiones: La lucha contra el estigma y la promoción del uso de nuevas tecnologías para la notificación a las parejas sexuales, entre los hombres que tienen sexo con hombres (HSH) y por parte de los profesionales de la salud, pueden aumentar la notificación, con los beneficios esperados de una más temprana detección de casos y una reducción de la transmisión en España (AU)

Use of new technologies to notify possible contagion of sexually-transmitted infections among men.

BACKGROUND: Among men who have sex with men (MSM), the association between searching for sexual partners' on the Internet and increased risk of sexually transmitted infections (STIs)/HIV infection, together with current low levels of partner notification (PN), justifies a study to explore the intention to use new communication technologies for PN in Spain. METHODS: Two cross-sectional surveys were performed: the first was administered online to visitors to web pages where the survey was advertised; the second was administered on paper to patients attending an STI Unit and centres similar to Community-Based Voluntary Counselling and Testing centres. RESULTS: The study population comprised 1578 Spanish residents (median age, 34 years [range: 18 to 74]); 84% lived in urban areas, and 69% reported searching for sexual partners on the Internet. Thirty-seven per cent would be willing to use a website for PN, 26% did not know if they would use one, and 37% would not want to use one. The main reasons for not intending to notify STI/HIV were "shame or fear" (stable partner) and "not knowing how to contact them" (casual partner). The preferred method of notification was face to face (73%) for both stable and casual partners, although using new technologies (Short Messaging System, e-mail, web page, phone applications) was widely accepted for notifying casual partners. CONCLUSIONS: Fighting stigma and promoting alternative methods of PN among MSM and health professionals through new technologies could increase the frequency of PN. This approach will improve early detection and reduce transmission in Spain.

[High prevalence of drug consumption and sexual risk behaviors in men who have sex with men]. / Alto consumo de drogas recreativas y conductas sexuales de riesgo en hombres que tienen relaciones sexuales con hombres.

BASIS AND OBJECTIVE: To describe the pattern of drug use among men who have sex with men (MSM) living in Spain and its association with sexual risk practices. MATERIAL AND METHOD: The European MSM Internet Survey was implemented in 2010 in 38 European countries on websites for MSM and collected data on sociodemographics, sexual behavior, and other sexual health variables. The association between unprotected anal intercourse (UAI) with casual partners and drug consumption was evaluated using multivariate logistic regression models. RESULTS: Among the 13,111 participants, most consumed drugs were cannabis (30.1%), popper (28.4%) and cocaine (18.7%). The risk of UAI with casual partners was 1.5 among those who had used drugs in relation to the other participants. The proportion of MSM who had injected drugs at least once in life was 2.5%, and 1.4% in the last 12 months. The prevalence of UAI with casual partners (53.4%), human immunodeficiency virus (HIV) (23%), hepatitis C (8.2%) and sexually transmitted infections (STI) (15.8%) was higher in MSM injectors related to those who had not used injected drugs (P<.05). CONCLUSIONS: The results of this study confirm a high prevalence of drug use in MSM and their relationship to sexual risk behavior. Although the use of injected drugs in MSM is a minority, this group reported a higher level of sexual risk behaviors, self-reported HIV, hepatitis C and other STI.

Hepatitis C virus infection and its relationship to certain sexual practices in men-who-have-sex-with-men in Spain: results from the European MSM internet survey (EMIS).

OBJECTIVES: To compare sexual practices and risk behaviours between MSM who were first diagnosed with hepatitis C (HCV) in the previous 12 months and those who were never diagnosed; and, to identify factors associated with a diagnosis of HCV. METHODS: The European-MSM-Internet-Survey (EMIS) was implemented for 3 months during 2010, mainly on websites for MSM. Data on socio-demographic characteristics, sexual behaviour, drug use, STI history, and other sexual health variables were collected. The Chi-square test and logistic regression analysis were used to analyse the data. RESULTS: Data from 13,111 respondents were analysed. The proportion of MSM who had ever been diagnosed with HCV infection was 1.9% (n=250), and of those currently infected with the virus was 0.6% (n=78). The percentage of those first diagnosed in the last 12 months was 0.4% (n=46), of whom 70% were HIV-negative and 22% had HIV coinfection. Having a first diagnosis of HCV in the last 12 months was more common among HIV-positive than among HIV-negative MSM (0.9% vs 0.4%) and among MSM born abroad than among Spanish-born (0.7% vs 0.3%). MSM diagnosed with HCV in the last 12 months were more likely to have had: more than 10 sexual partners, sex abroad, receptive anal intercourse, insertive/receptive fisting, and unprotected anal intercourse with non-steady partners of unknown or discordant HIV-status. Likewise, they reported more frequent visits to sex-focused venues, higher drug use, as well as a higher proportion of STI diagnosis. In the multivariate model, visiting a public sex-focused venue, practicing receptive fisting, using erection enhancing medication and having a diagnosis of syphilis were independently associated with a first diagnosis of HCV in the last 12 months. CONCLUSIONS: HCV infection does not seem to be restricted to HIV-infected MSM. Certain sexual behaviour (fisting, visiting sex-focused venues), drug use, and ulcerative STI seem to be associated with a diagnosis of HCV.

Conductas sexuales de alto riesgo en hombres que tienen relaciones sexuales con hombres según tipo de pareja sexual / High-risk sexual behaviour by partner type among men who have sex with men

OBJETIVO: Identificar los factores asociados a las prácticas sexuales de alto riesgo en hombres que tienen relaciones sexuales con hombres (HSH) en España. Métodos Encuesta online realizada en 2010 sobre conductas sexuales y necesidades de prevención del VIH/ITS, entre otros. La práctica de la penetración anal no protegida (PANP) con parejas con estado serológico al VIH desconocido o discordante en el último año se consideró como de alto riesgo. Resultados De los 13.111 participantes, el 49,4% habían tenido relaciones sexuales con parejas estables (PE) y el 73,4% con parejas ocasionales (PO) en los últimos 12 meses, siendo la PANP de alto riesgo del 25,4 y el 29,4%, respectivamente. Entre los factores asociados a la PANP de alto riesgo con PE destacaron: residir en poblaciones < 500.000 habitantes (OR = 1,42 < 100.000 habitantes), declarar que casi nadie de su entorno conocía su orientación sexual (OR = 1,42) y ser VIH positivo con carga viral indetectable siempre que se presentara un nivel de conocimientos sobre el VIH/ITS elevado (OR = 3,18). Con las PO destacaron: un mayor número de parejas (OR = 4,31 > 50 parejas), haber consumido drogas para sexo (OR = 1,33) y drogas de ocio (OR = 1,19), presentar un nivel de conocimientos sobre el VIH/ITS medio (OR = 1,82) o bajo (OR = 1,33), y ser VIH positivo (OR = 1,56).Conclusiones Entre los HSH la prevalencia de conductas sexuales de alto riesgo es alta, tanto con la PE como con las PO. Los factores asociados a la PANP de alto riesgo varían según el tipo de pareja sexual (p. ej., tener el VIH con una carga viral indetectable), factores que tienen que considerarse para plantear estrategias de prevención primaria y secundaria

OBJECTIVE: To identify factors associated with high risk sexual practices among men who have sex with men (MSM) in Spain. METHODS: An online survey was conducted in 2010, which included, among others, questions on HIV/STI sexual behaviours and prevention needs. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status in the past year was defined as a high risk sexual behaviour. RESULTS: Of the 13,111 participants, 49.4% had had sex with steady partners (SP) and 73.4% with non-steady partners (NSP) in the last 12months; and the prevalence of high risk UAI was 25.4% and 29.4%, respectively. Factors associated with high risk UAI with SP were: living in a city of less than 500,000 inhabitants (OR=1.42 <100,000 inhabitants), being out to no-one or only a few people (OR=1.42), and being HIV-positive with undetectable viral load among those with a high level of HIV/STI knowledge (OR = 3.18). Factors associated with high risk UAI with NSP were mainly: having a higher number of sexual partners (OR = 4.31 >50 partners), having used drugs for sex (OR = 1.33), and at parties (OR = 1.19), having a medium (OR = 1.82) or low (OR = 1.33) level of HIV/STI knowledge, and being HIV-positive (OR = 1.56). CONCLUSIONS: Among MSM, the prevalence of high risk sexual practices is high with both SP and NSP. Factors associated with high risk UAI vary by type of sexual partner (e.g., having HIV with an undetectable viral load). These must be taken into account when planning strategies for primary and secondary prevention

[High-risk sexual behaviour by partner type among men who have sex with men]. / Conductas sexuales de alto riesgo en hombres que tienen relaciones sexuales con hombres según tipo de pareja sexual.

OBJECTIVE: To identify factors associated with high risk sexual practices among men who have sex with men (MSM) in Spain. METHODS: An online survey was conducted in 2010, which included, among others, questions on HIV/STI sexual behaviours and prevention needs. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status in the past year was defined as a high risk sexual behaviour. RESULTS: Of the 13,111 participants, 49.4% had had sex with steady partners (SP) and 73.4% with non-steady partners (NSP) in the last 12months; and the prevalence of high risk UAI was 25.4% and 29.4%, respectively. Factors associated with high risk UAI with SP were: living in a city of less than 500,000 inhabitants (OR=1.42 <100,000 inhabitants), being out to no-one or only a few people (OR=1.42), and being HIV-positive with undetectable viral load among those with a high level of HIV/STI knowledge (OR=3.18). Factors associated with high risk UAI with NSP were mainly: having a higher number of sexual partners (OR=4.31 >50 partners), having used drugs for sex (OR=1.33), and at parties (OR=1.19), having a medium (OR=1.82) or low (OR=1.33) level of HIV/STI knowledge, and being HIV-positive (OR=1.56). CONCLUSIONS: Among MSM, the prevalence of high risk sexual practices is high with both SP and NSP. Factors associated with high risk UAI vary by type of sexual partner (e.g., having HIV with an undetectable viral load). These must be taken into account when planning strategies for primary and secondary prevention.

[Discourses on sexual responsibility in a group of HIV-positive MSM in Spain]. / Discursos sobre la responsabilidad sexual en hombres VIH-positivos que tienen sexo con hombres.

BACKGROUND: High rates of sexual risk behaviours are being reported among HIV-positive MSM which raises the question about the ideas of sexual responsibility that exist in this population to prevent the transmission and/or re-infection of HIV and other STIs. This study sought to understand the discourses on sexual care and responsibility in men living with HIV who have sex with men. METHODS: A qualitative study was carried out with 78 men (aged 27-65): 35 individual interviews and 43 in five discussion groups, in the cities of Barcelona, Madrid and Palma de Mallorca, between 2007 and 2008. The selection criterion was that eighteen months had passed after a HIV diagnosis was established. The grounded theory approach was used to analyze the data. RESULTS: Three distinct discourses about sexual responsibility were observed: (1) sole responsibility: it is the HIV-positive man who should protect himself in order to protect others. This discourse is based on an ethical position (altruistic), in which the duty and obligation to protect others is a priority; (2) shared responsibility: both parties agree and/or consent to high risk sexual practices although those who tend to use this discourse, in practice, ultimately assume full responsibility, and (3) individual responsibility: each person is responsible for himself, although the type of emotional bond with others may affect the decision to protect only oneself (there is some commitment to protect a sexual partner when something is felt for that person). CONCLUSIONS: The sexual care behaviour among HIV-positive MSM was determined by three discourses. Those discourses were influenced by various factors: moral conscience, sexual context, type of sexual partner and disclosure of HIV status.

Discursos sobre la responsabilidad sexual en hombres Vih-positivos que tienen sexo con hombres / Discourses on sexual responsibility in a group of HIV-positive MSM in Spain

Fundamentos: Entre los hombres VIH-positivos que tienen sexo con hombres (HSH VIH-positivos) se vienen reportando elevadas tasas de prácticas sexuales de riesgo, lo que lleva a preguntarnos sobre las ideas del cuidado sexual que existen en este colectivo para evitar la transmisión y/o reinfección del VIH y otras ITS. Este estudio buscó comprender los discursos que sobre la responsabilidad sexual tienen estos hombres. Método: Se realizó un estudio cualitativo. Participaron 78 hombres (27-65 años), 35 en entrevistas individuales y 43 en cinco grupos de discusión, en las ciudades de Barcelona, Madrid y Palma de Mallorca, entre 2007 y 2008. Se estableció como criterio de selección que hubieran transcurrido 18 meses desde el diagnóstico del VIH. El enfoque utilizado para analizar los datos fue la Teoría Fundamentada. Resultados: Entre los participantes se diferenciaron tres tipos de discurso respecto a la responsabilidad sexual: (1) Responsabilidad única: el sujeto seropositivo es el que debe cuidarse para cuidar a otros. Se fundamenta en un posicionamiento ético (altruista) en el que el deber y la obligación por proteger a los otros está por encima de todo. (2) Responsabilidad compartida: ambas partes deciden y/o consienten tener una relación sexual de riesgo aunque los que esgrimen este discurso en la práctica terminen asumiendo toda la carga de la responsabilidad. Y (3) Responsabilidad individual: cada uno vela por el cuidado de sí mismo, aunque el tipo de vínculo emocional con otras personas podría afectar la decisión de cuidarse o no (existe algún tipo de compromiso de proteger a alguien cuando se siente algo por esa persona). Conclusiones: La conducta de cuidado sexual de los HSH VIH-positivos estuvo orientaba en base a los tres discursos sobre la responsabilidad. Estos discursos estuvieron influenciados por diversos factores: conciencia moral, el contexto sexual, el tipo de pareja sexual y el revelamiento del seroestatus(AU)

Background: High rates of sexual risk behaviours are being reported among HIV-positive MSM which raises the question about the ideas of sexual responsibility that exist in this population to prevent the transmission and/or re-infection of HIV and other STIs. This study sought to understand the discourses on sexual care and responsibility in men living with HIV who have sex with men. Methods: A qualitative study was carried out with 78 men (aged 27-65): 35 individual interviews and 43 in five discussion groups, in the cities of Barcelona, Madrid and Palma de Mallorca, between 2007 and 2008. The selection criterion was that eighteen months had passed after a HIV diagnosis was established. The grounded theory approach was used to analyze the data. Results: Three distinct discourses about sexual responsibility were observed: (1) sole responsibility: it is the HIV-positive man who should protect himself in order to protect others. This discourse is based on an ethical position (altruistic), in which the duty and obligation to protect others is a priority; (2) shared responsibility: both parties agree and/or consent to high risk sexual practices although those who tend to use this discourse, in practice, ultimately assume full responsibility, and (3) individual responsibility: each person is responsible for himself, although the type of emotional bond with others may affect the decision to protect only oneself (there is some commitment to protect a sexual partner when something is felt for that person). Conclusions: The sexual care behaviour among HIV-positive MSM was determined by three discourses. Those discourses were influenced by various factors: moral conscience, sexual context, type of sexual partner and disclosure of HIV status(AU)

Actitudes hacia los programas de prevención on-line del VIH y las ITS, y perfil de los usuarios de Internet en los hombres que tienen sexo con hombres / Attitudes toward online HIV/sexually-transmitted infection prevention programs and Internet user profiles among men who have sex with men

Objetivos Describir las actitudes de los hombres que tienen sexo con hombres hacia los programas de prevención on-line del virus de la inmunodeficiencia humana (VIH) y de las infecciones de transmisión sexual (ITS), e identificar y caracterizar perfiles de usuarios con respecto a sus actitudes hacia estos programas de prevención. Método Encuesta aplicada en lugares/locales de ambiente gay o a través de Internet contestada por 2044 participantes de Madrid, Barcelona, Bilbao y San Sebastián. La encuesta investigó, además de variables sociodemográficas, conductas sexuales y otras variables asociadas a riesgo de infección por el VIH, las actitudes hacia los programas de prevención on-line. El análisis estadístico incluyó análisis factorial y análisis de clusters no jerárquicos. Resultados La mayoría de los hombres tuvieron actitudes favorables hacia los programas de prevención on-line del VIH y las ITS. El análisis factorial reveló dos factores: prevención on-line orientada a la interacción y prevención on-line orientada a la información. A partir de estos factores se determinaron tres perfiles de usuarios: usuarios orientados hacia la prevención on-line informativa e interactiva (53,5%), usuarios orientados hacia la prevención on-line interactiva (25,9%) y usuarios no orientados hacia la prevención on-line (20,7%). Al caracterizar estos perfiles, observamos una presencia significativa de hombres que no están interesados en la prevención on-line entre aquellos con menor nivel de estudios, bisexuales y VIH positivos. Inversamente, los más receptivos a la prevención on-line eran (..) (AU)

Objectives To describe the attitudes of men who have sex with men (MSM) toward online HIV/sexually-transmitted infection (STI) prevention programs and to identify and characterize user profiles with regard to their attitudes toward online prevention programs. Method A survey in gay venues or via the internet was completed by 2,044 participants from Madrid, Barcelona, Bilbao and San Sebastián (Spain). The survey explored socio-demographic variables, sexual behavior and other risk behaviors associated with HIV infection, as well as attitudes toward online prevention programs. The statistical analysis included factor analysis and non-hierarchical cluster analysis. Results Most MSM had positive attitudes towards online HIV/STI prevention programs. Factor analysis revealed two factors: online prevention aimed at interaction and online prevention aimed at information. Based on these factors, three user profiles were identified: users oriented toward informative and interactive online prevention (53.5%), users oriented toward interactive online prevention (25.9%) and users were not oriented toward online prevention (20.7%). On characterizing these profiles, we observed a significant presence of men who were not (..) (AU)

[Attitudes toward online HIV/sexually-transmitted infection prevention programs and Internet user profiles among men who have sex with men]. / Actitudes hacia los programas de prevención on-line del VIH y las ITS, y perfil de los usuarios de Internet en los hombres que tienen sexo con hombres.

OBJECTIVES: To describe the attitudes of men who have sex with men (MSM) toward online HIV/sexually-transmitted infection (STI) prevention programs and to identify and characterize user profiles with regard to their attitudes toward online prevention programs. METHOD: A survey in gay venues or via the internet was completed by 2,044 participants from Madrid, Barcelona, Bilbao and San Sebastián (Spain). The survey explored socio-demographic variables, sexual behavior and other risk behaviors associated with HIV infection, as well as attitudes toward online prevention programs. The statistical analysis included factor analysis and non-hierarchical cluster analysis. RESULTS: Most MSM had positive attitudes towards online HIV/STI prevention programs. Factor analysis revealed two factors: online prevention aimed at interaction and online prevention aimed at information. Based on these factors, three user profiles were identified: users oriented toward informative and interactive online prevention (53.5%), users oriented toward interactive online prevention (25.9%) and users were not oriented toward online prevention (20.7%). On characterizing these profiles, we observed a significant presence of men who were not interested in online prevention among those with a lower educational level, bisexual men and HIV-positive men. Conversely, those most receptive to online prevention were men self-identified as gay, those with a bachelors degree, those who had been tested for HIV and those who were HIV-negative. CONCLUSION: The internet can facilitate sexual health promotion among MSM. Characterization of user profiles offers the possibility of segmenting prevention programs and of combining online and offline strategies.

Hombres jóvenes que tienen sexo con hombres: ¿un colectivo en alto riesgo para la infección por el VIH? / Young men who have sex with men: a group at high risk for HIV infection?

Objetivos Comparar las variables asociadas al riesgo de infección por el VIH entre los hombres ≤25 años (jóvenes) y >25 años de edad que tienen sexo con hombres, y determinar las variables asociadas a la penetración anal sin condón de los hombres jóvenes con parejas sexuales ocasionales. Método Durante 1 mes, 485 participantes ≤25 años y 1.470 >25 años completaron una encuesta impresa aplicada en lugares de ambiente o a través de Internet en Madrid, Barcelona, Bilbao y San Sebastián. La encuesta investigó conductas sexuales de los últimos 3 meses según las parejas sexuales conocidas en lugares de ambiente y por Internet. Resultados No se encontraron diferencias significativas entre los hombres ≤25 años y >25 años con respecto a la penetración anal sin condón con parejas sexuales conocidas en lugares de ambiente (23% frente a 30%, p>0,05) o en Internet (29% frente a 30%, p>0,05), al uso del condón en la última penetración anal y a haber tenido una infección de transmisión sexual en el último año (19% frente a 23%, p>0,05). Sin embargo, los encuestados >25 años tuvieron un número promedio mayor de parejas sexuales conocidas en lugares de ambiente (9,2 frente a 7, p<0,05) y en Internet (8,9 frente a 6,4, p<0,05), consumieron alguna droga cuando tuvieron penetración anal sin condón (68% frente a 55%, p<0,05, con parejas conocidas en Internet; y 73% frente a 55%, p<0,05, con parejas conocidas en lugares de ambiente) y presentaban una mayor prevalencia del (..) (AU)

Objectives To compare variables associated with the risk of HIV among men ≤25 years old who have sex with men (YMSM) and those >25 years old, and to determine the variables associated with unprotected anal intercourse (UAI) in YMSM with casual sexual partners. Method For 1 month, 485 participants ≤25 years old and 1,470 aged >25 years old completed a pen-and-paper survey carried out in gay venues (GV) or via the Internet in Madrid, Barcelona, Bilbao and San Sebastián (Spain). The survey investigated sexual behaviors in the past 3 months according to whether the men met sexual partners in GV (SPGV) or on the Internet (SPI).Results No significant differences were found between YMSM and those >25 years old with respect to UAI with SPGV (23% vs. 30%, p>0.05) and SPI (29% vs. 30%, p>0.05), condom use in the last anal intercourse and having had a sexually-transmitted infection (STI) in the last year (19% vs. 23%, p>0.05). However, respondents>25 years old had a higher average number of SPGV (9.2 vs. 7, p<0.05) and SPI (8.9 vs. 6.4, p<0.05), were more likely to have used drugs while having UAI (68% vs. 55%, p<0.05, with SPI, and 73% vs. 55%, p<0.05, with SPGV) and had a higher prevalence of HIV (11% vs. 4%, p<0.05). When exploring other variables, we found that YMSM more frequently had receptive UAI with SPI (73% vs. 57%, p<0.05), had less time to be in a stable relationship, and their sexual partner more frequently convinced them to have UAI (8% vs. 0%, p<0.05). In multivariate analysis, UAI in YMSM with casual sexual partners was not associated with any of the variables. Conclusions YMSM do not constitute a group at increased risk of HIV/STI infection compared with respondents >25 years old. However, there are some variables could contribute to vulnerability in this group (AU)

[Young men who have sex with men: a group at high risk for HIV infection?]. / Hombres jóvenes que tienen sexo con hombres: ¿un colectivo en alto riesgo para la infección por el VIH?

OBJECTIVES: To compare variables associated with the risk of HIV among men ≤ 25 years old who have sex with men (YMSM) and those >25 years old, and to determine the variables associated with unprotected anal intercourse (UAI) in YMSM with casual sexual partners. METHOD: For 1 month, 485 participants ≤ 25 years old and 1,470 aged >25 years old completed a pen-and-paper survey carried out in gay venues (GV) or via the Internet in Madrid, Barcelona, Bilbao and San Sebastián (Spain). The survey investigated sexual behaviors in the past 3 months according to whether the men met sexual partners in GV (SPGV) or on the Internet (SPI). RESULTS: No significant differences were found between YMSM and those >25 years old with respect to UAI with SPGV (23% vs. 30%, p>0.05) and SPI (29% vs. 30%, p>0.05), condom use in the last anal intercourse and having had a sexually-transmitted infection (STI) in the last year (19% vs. 23%, p>0.05). However, respondents>25 years old had a higher average number of SPGV (9.2 vs. 7, p<0.05) and SPI (8.9 vs. 6.4, p<0.05), were more likely to have used drugs while having UAI (68% vs. 55%, p<0.05, with SPI, and 73% vs. 55%, p<0.05, with SPGV) and had a higher prevalence of HIV (11% vs. 4%, p<0.05). When exploring other variables, we found that YMSM more frequently had receptive UAI with SPI (73% vs. 57%, p<0.05), had less time to be in a stable relationship, and their sexual partner more frequently convinced them to have UAI (8% vs. 0%, p<0.05). In multivariate analysis, UAI in YMSM with casual sexual partners was not associated with any of the variables. CONCLUSIONS: YMSM do not constitute a group at increased risk of HIV/STI infection compared with respondents >25 years old. However, there are some variables could contribute to vulnerability in this group.

Internet y riesgo sexual en hombres que tienen sexo con hombres / Internet and sexual risk in men who have sex with men

Objetivo1) Comparar las características sociodemográficas, el uso de Internet para buscar sexo y la conducta sexual entre hombres que tienen sexo con hombres encuestados en lugares de ambiente y encuestados por Internet, y 2) determinar las variables asociadas a la penetración anal sin condón con parejas sexuales conocidas por Internet.MétodoDurante un mes, 804 hombres que tienen sexo con hombres completaron una encuesta impresa aplicada en lugares de ambiente, y 1.240 lo hicieron por Internet, en Madrid, Barcelona y Bilbao/San Sebastián.ResultadosAmbas muestras presentan características sociodemográficas diferentes. Comparando los hombres encuestados en lugares de ambiente con los encuestados on-line, encontramos una mayor proporción de encuestados on-line que usaron Internet para buscar parejas sexuales (81% frente a 65%, p<0,05), practicaron la penetración anal sin condón con parejas ocasionales conocidas por Internet (31% frente a 27%, p>0,05), tuvieron penetración anal sin condón de manera intencionada (81% frente a 65%, p <0,05), no sabían su estado serológico respecto al virus de la inmunodeficiencia humana (VIH) (35% frente a 28%, p<0,05), consumieron alguna droga cuando tuvieron penetración anal sin condón (68% frente a 55%, p<0,05) y han tenido alguna infección de transmisión sexual en el último año (24% frente a 20%, p <0,05). En el análisis multivariado, la penetración anal sin condón con parejas sexuales conocidas por Internet estuvo asociada con tener más de 20 parejas sexuales (odss ratio [OR]: 1,528; intervalo de confianza del 95% [IC95%]: 1,024–2,282; p=0,038), consumir drogas antes o durante la penetración anal sin condón (OR: 1,962; IC95%: 1,478–2,604; p=0,000)(..) (AU)

Objective1) To compare sociodemographic characteristics, Internet use to seek sexual partners, and sexual behavior in two samples of men who have sex with men: one sample that was surveyed on-line and another that was interviewed in gay venues. 2) To determine the variables associated with unprotected anal intercourse with sexual partners met on-line.MethodsFor 1 month, 804 men who have sex with men completed a pen-and-paper survey in gay venues and 1,240 completed a web survey in Madrid, Barcelona and Bilbao/San Sebastián (Spain).ResultsThe sociodemographic characteristics differed in the two samples. Compared with men who have sex with men surveyed off-line, a higher proportion of those surveyed on-line used the Internet to meet sexual partners (81% vs. 65%, p<0.05), had unprotected anal intercourse with sexual partners met on-line (31% vs. 27%, p>0.05), had intentionally practised unprotected anal intercourse (81% vs. 65%, p<0.05), did not know their HIV status (35% vs. 28%, p<0.05), used drugs when they practised unprotected anal intercourse (68% vs. 55%, p<0.05) and had had a sexually transmitted infection in the previous year (24% vs. 20%, p<0.05). In the multivariate analysis, unprotected anal intercourse with sexual partners met on-line was associated with having more than 20 sexual partners (odds ratio [OR]: 1.528; 95% confidence interval [95%CI]: 1.024–2.282; p=0.038), using drugs before/during sexual relations (OR: 1.962; 95% CI: 1.478–2.604; p=0.000), having had a sexually transmitted infection in the previous year (OR: 2.042; 95% CI: 1.535–2.716; p=0.000) and being HIV-positive (OR: 2.124; 95% CI: 1.355–3.330; p=0.001), amongst other factors.ConclusionsAlthough the prevalence of unprotected anal intercourse was similar in the two samples, certain variables could explain why the men who have sex with men surveyed on-line had a greater risk of sexually transmitted infections than those surveyed off-line(..) (AU)

[Internet and sexual risk in men who have sex with men]. / Internet y riesgo sexual en hombres que tienen sexo con hombres.

OBJECTIVE: 1) To compare sociodemographic characteristics, Internet use to seek sexual partners, and sexual behavior in two samples of men who have sex with men: one sample that was surveyed on-line and another that was interviewed in gay venues. 2) To determine the variables associated with unprotected anal intercourse with sexual partners met on-line. METHODS: For 1 month, 804 men who have sex with men completed a pen-and-paper survey in gay venues and 1,240 completed a web survey in Madrid, Barcelona and Bilbao/San Sebastián (Spain). RESULTS: The sociodemographic characteristics differed in the two samples. Compared with men who have sex with men surveyed off-line, a higher proportion of those surveyed on-line used the Internet to meet sexual partners (81% vs. 65%, p<0.05), had unprotected anal intercourse with sexual partners met on-line (31% vs. 27%, p>0.05), had intentionally practised unprotected anal intercourse (81% vs. 65%, p<0.05), did not know their HIV status (35% vs. 28%, p<0.05), used drugs when they practised unprotected anal intercourse (68% vs. 55%, p<0.05) and had had a sexually transmitted infection in the previous year (24% vs. 20%, p<0.05). In the multivariate analysis, unprotected anal intercourse with sexual partners met on-line was associated with having more than 20 sexual partners (odds ratio [OR]: 1.528; 95% confidence interval [95%CI]: 1.024-2.282; p=0.038), using drugs before/during sexual relations (OR: 1.962; 95% CI: 1.478-2.604; p=0.000), having had a sexually transmitted infection in the previous year (OR: 2.042; 95% CI: 1.535-2.716; p=0.000) and being HIV-positive (OR: 2.124; 95% CI: 1.355-3.330; p=0.001), amongst other factors. CONCLUSIONS: Although the prevalence of unprotected anal intercourse was similar in the two samples, certain variables could explain why the men who have sex with men surveyed on-line had a greater risk of sexually transmitted infections than those surveyed off-line.

Reproductive health and healthcare among sex workers in Escuintla, Guatemala.

This study examines understandings of sexual and reproductive health and healthcare, and perceptions of health services among women who regularly or occasionally sell or transact sex in Escuintla, Guatemala. Using an approach informed by grounded theory, 35 individual interviews were analysed. Results suggest that sex workers face multiple forms of vulnerability due to their level of education, economic situation and unequal gender relations. Many feel dissatisfied with the quality of health services received, specifically with the lack of medicines, poor personal treatment by health workers and scanty information. Condoms were widely acknowledged as the means of preventing STI/HIV; however, many of the women do not use them with regular clients and regular partners. An effective STI/HIV-prevention strategy that addresses sex workers' circumstances and needs, requires a comprehensive approach, which includes a combination of individual and community-based interventions. These interventions must involve clients, sex establishment owners and health personnel.

Compensated Sex and Sexual Risk: Sexual, Social and Economic Interactions between Homosexually- and Heterosexually-Identified Men of Low Income in Two Cities of Peru.

This study describes the complex dynamics of the sexual, economic and social interactions between a group of feminized homosexual men and men who have sex with men and self-identify as heterosexual ('mostaceros'), in lower-income peripheral urban areas of Lima and Trujillo, Peru. The study examined sexual risk between these two groups of men, and the significance of the economic exchanges involved in their sexual interactions. Using a Grounded Theory approach, 23 individual interviews and 7 focus groups were analyzed. The results reveal that cultural, economic and gender factors mold sexual and social relations among a group of men who have sex with men in Peru. Compensated sex is part of the behaviors of these men, reflecting a complicated construction of sexuality based on traditional conceptions of gender roles, sexual identity and masculinity. Several factors (e.g. difficulty in negotiating condom use, low self-esteem, low risk perception, alcohol and drug consumption), in the context of compensated sex, play a role in risk-taking for HIV infection.

["Sex buddies": a high risk behavior for contracting HIV among homo/bisexual men]. / Amigos con derecho a roce: una oportunidad para contraer la infección por el virus de la inmunodeficiencia humana en hombres homo/bixesuales con prácticas sexuales de alto riesgo.

OBJECTIVE: Despite prevention efforts, the prevalence of unprotected anal intercourse (UAI) remains substantial among men who have sex with men (MSM). This study describes and analyzes how a group of MSM manages sexual risk with sexual partners. METHOD: Qualitative study by means in-depth, semi-structured interviews with 20 MSM, aged 21 to 40 years old, who had had at least one episode of UAI within the previous 3 months. A grounded theory approach was used to understand sexual risk management with sexual partners as seen by the MSM interviewed. RESULTS: Most MSM were involved in UAI when they established relationships with <> as a way to balance their need for sexual expression with their need for sexual security. In these relationships, the partner's serostatus was assessed on the basis of trust and the assumption of sharing the same serologic status. CONCLUSIONS: Subjective evaluations (e.g. trust, intuition) played a key role in the decision to engage in UAI with <> without precise knowledge of their HIV serostatus. Future approaches need to include the role of subjectivity in making decisions related to risk management and the specific contexts (e.g. type of sexual partner) in which UAI takes place.