Examining the Fraternal Birth Order Effect and Sexual Orientation: Insights from an East European Population.

The development of human sexual orientation remains a complex and multifaceted subject. It is often studied but its origins continue to elude us. In this preregistered study, our primary objective was to demonstrate the fraternal birth order effect (FBOE), which assumes a higher prevalence of older brothers in gay men than in their straight counterparts and which has also been recently recorded in lesbian women. Our second aim was to explore any potential impact of the FBOE on anal-erotic role orientation (AERO), both in gay and straight men. Our study sample included 693 gay men, 843 straight men, 265 lesbian women, and 331 straight women from Czechia and Slovakia. Employing a conventionally parameterized logistic regression model, we substantiated the FBOE among both gay men (OR = 1.35 for maternal older brothers) and lesbian women (OR = 1.71). These outcomes were confirmed by a more nuanced parameterization recently proposed by Blanchard (2022). Nonmaternal older brothers did not exhibit a significant influence on their younger brothers' sexual orientation. Contrary to some earlier reports, however, our data did not establish the FBOE as exclusive to gay men with the receptive AERO. Furthermore, our observations indicated a lower offspring count for mothers of gay men compared to mothers of straight men. Emphasizing the positive FBOE outcomes, we acknowledge the need for caution regarding the various options that can be used to estimate the familial influences on sexual orientation.

Comparison of the burden of self-reported bacterial sexually transmitted infections among men having sex with men across 68 countries on four continents.

BACKGROUND: Men who have sex with men (MSM) are in general more vulnerable to sexually transmitted infections (STIs) than the heterosexual men population. However, surveillance data on STI diagnoses lack comparability across countries due to differential identification of MSM, diagnostic standards and methods, and screening guidelines for asymptomatic infections. METHODS: We compared self-reported overall diagnostic rates for syphilis, gonorrhea, and chlamydia infections, and diagnostic rates for infections that were classified to be symptomatic in the previous 12 months from two online surveys. They had a shared methodology, were conducted in 68 countries across four continents between October 2017 and May 2018 and had 202,013 participants. RESULTS: Using multivariable multilevel regression analysis, we identified age, settlement size, number of sexual partners, condom use for anal intercourse, testing frequency, sampling rectal mucosa for extragenital testing, HIV diagnosis, and pre-exposure prophylaxis use as individual-level explanatory variables. The national proportions of respondents screened and diagnosed who notified some or all of their sexual partners were used as country-level explanatory variables. Combined, these factors helped to explain differences in self-reported diagnosis rates between countries. The following differences were not explained by the above factors: self-reported syphilis diagnoses were higher in Latin America compared with Europe, Canada, Israel, Lebanon, and the Philippines (aORs 2.30 - 3.71 for symptomatic syphilis compared to Central-West Europe); self-reported gonorrhea diagnoses were lower in Eastern Europe and in Latin America compared with all other regions (aORs 0.17-0.55 and 0.34 - 0.62 for symptomatic gonorrhea compared to Central-West Europe); and self-reported chlamydia diagnoses were lower in Central East and Southeast Europe, South and Central America, and the Philippines (aORs 0.25 - 0.39 for symptomatic chlamydia for Latin American subregions compared to Central West Europe). CONCLUSIONS: Possible reasons for differences in self-reported STI diagnosis prevalence likely include different background prevalence for syphilis and syndromic management without proper diagnosis, and different diagnostic approaches for gonorrhea and chlamydia.

Sexual practices and the risk of Hepatitis A in men who have sex with men in Spain.

AIM: To determine the frequency of and identify risk factors associated with sexual practices leading to hepatitis A infection in the population of men who have sex with men in Spain. BACKGROUND: The increased incidence of hepatitis A as a result of sexual contact among this population is a public health concern and a challenge in controlling sexually transmitted infections. METHODS: This cross-sectional, online survey-based study included 881 men who have sex with men. Unprotected oro-anal and insertive-anal sex are considered to be unsafe sexual practices associated with hepatitis A infection. RESULTS: Of all respondents, 83.4% engaged in insertive-anal sex and 71.3% in unprotected oro-anal sex during the previous 12 months. An association was found with sociodemographic factors [living alone (OR = 2; 95%CI = 1.13-3.35)] and contextual factors of sexual behaviour [previous diagnosis of sexually transmitted infection(s) (OR = 1.74; 95%CI = 1.15-2.61) and participating in 'chemsex' (OR = 5.15; 95%CI = 1.05-25.15)]. CONCLUSION: The frequency of unsafe sexual practices associated with hepatitis A among men who have sex with men in Spain is high. Interventions based on sociodemographic and contextual factors of sexual behaviour should be implemented. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should update and incorporate the support needs of men who have sex with men and take advantage of the opportunity to implement harm reduction strategies.

Quantifying Sexual Constitution: Abraham Myerson's Endocrine Study of Male Homosexuality, 1938-1942.

Using the new medical science of endocrinology, scientific sex researchers in the 1920s and 1930s began studying sex hormone excretion as a means to search for the biological basis of human sexuality. One of these researchers was Abraham Myerson, a leading psychiatrist and researcher from Boston who conducted a series of innovative endocrine experiments between 1938 and 1942 in an effort to establish a relationship between sex hormone excretion patterns and homosexuality in men. While prevailing cultural models of heteronormativity identified male homosexuality as an abnormal case of biological femininity in men, Myerson's framework and experimental research transcended this limiting duality of sexual biology. Adopting the theory of bisexuality, he argued that all men possessed a natural variability of masculine and feminine traits in their biological, social, and sexual characteristics, and that the disparity among these traits could be quantified and understood using sex hormones. In reconstructing Myerson's research methods and data analysis, this paper uncovers how he established a distinctive diagnostic method and classification system for male homosexuality and illuminates how he conceptualized and categorized male sexuality as quantifiable and independent of personality.

On the Mathematics of the Fraternal Birth Order Effect and the Genetics of Homosexuality.

Mathematicians have always been attracted to the field of genetics. The mathematical aspects of research on homosexuality are especially interesting. Certain studies show that male homosexuality may have a genetic component that is correlated with female fertility. Other studies show the existence of the fraternal birth order effect, that is, the correlation of homosexuality with the number of older brothers. This article is devoted to the mathematical aspects of how these two phenomena are interconnected. In particular, we show that the fraternal birth order effect implies a correlation between homosexuality and maternal fecundity. Vice versa, we show that the correlation between homosexuality and female fecundity implies the increase in the probability of the younger brothers being homosexual.

Frequent Transmission of Gonorrhea in Men Who Have Sex with Men.

The rate of gonorrhea is much higher in men who have sex with men than in heterosexuals. Because of unique behavioral characteristics, asymptomatic sites of infection, mainly the pharynx, are principal drivers of gonorrhea prevalence in men who have sex with men. On the basis of this observation, we call for interventions.

Physical health inequalities among gay and bisexual men in England: a large community-based cross-sectional survey.

Background: Gay and bisexual men experience a disproportionate burden of ill health compared with the general male population. However, little is known regarding health inequalities that exist within this group. We describe five key physical health indicators and their variation across common axes of inequality. Methods: Community-based opportunistic sampling recruited 5799 gay and bisexual men to a self-completion Internet survey. Respondents provided data relating to their height, weight, physical activity and substance use (tobacco, alcohol, illicit drugs). Responses were compared across seven demographic characteristics. Results: Indicators of problematic health behaviour were concentrated within different groups and inequalities were rarely observed in the same direction. Older men were more likely to be overweight and drink alcohol frequently but less likely to smoke or use illicit drugs. Men of Asian ethnicity were more likely to exercise infrequently but less likely to smoke. Men living in London were more likely to smoke and use illicit drugs but less likely to be overweight. However, lower education was associated with being overweight, frequent alcohol, low exercise and smoking. Conclusion: There is evidence of significant demographic variation in physical health-related behaviours among gay and bisexual men, and men with lower levels of education are consistently in greater need.

Correlates of a Single-Item Indicator Versus a Multi-Item Scale of Outness About Same-Sex Attraction.

In this study, we investigated if a single-item indicator measured the degree to which people were open about their same-sex attraction ("out") as accurately as a multi-item scale. For the multi-item scale, we used the Outness Inventory, which includes three subscales: family, world, and religion. We examined correlations between the single- and multi-item measures; between the single-item indicator and the subscales of the multi-item scale; and between the measures and internalized homonegativity, social attitudes towards homosexuality, and depressive symptoms. In addition, we calculated Tjur's R (2) as a measure of predictive power of the single-item indicator, multi-item scale, and subscales of the multi-item scale in predicting two health-related outcomes: depressive symptoms and condomless anal sex with multiple partners. There was a strong correlation between the single- and multi-item measures (r = 0.73). Furthermore, there were strong correlations between the single-item indicator and each subscale of the multi-item scale: family (r = 0.70), world (r = 0.77), and religion (r = 0.50). In addition, the correlations between the single-item indicator and internalized homonegativity (r = -0.63), social attitudes towards homosexuality (r = -0.38), and depression (r = -0.14) were higher than those between the multi-item scale and internalized homonegativity (r = -0.55), social attitudes towards homosexuality (r = -0.21), and depression (r = -0.13). Contrary to the premise that multi-item measures are superior to single-item measures, our collective findings indicate that the single-item indicator of outness performs better than the multi-item scale of outness.

Geosocial Networking App Use Among Men Who Have Sex With Men in Serious Romantic Relationships.

Geosocial networking (GSN) mobile phone applications ("apps") are used frequently among men who have sex with men (MSM) to socialize and meet sexual partners. Though GSN apps are used by some MSM in partnered relationships, little is known about how the use of GSN apps among MSM in serious romantic relationships can influence couples' sexual and relationship health. MSM in serious relationships (N = 323; M age = 40 years) were recruited through a popular GSN app for MSM. Participants completed open-ended items regarding the costs and benefits of app use to their relationships, discussions of app use with their partners, and preferences for relationship education related to app use. Reported benefits of app use included improving sex and communication with one's primary partner and fulfilling unmet sexual needs. Although approximately half had not discussed app use with their partners, citing app use as a "non-issue," many cited various drawbacks to app use, including jealousy and being a distraction from the relationship. Few described sexual health concerns as a drawback to meeting partners through apps. Regarding relationship education preferences, most wanted help with general communication skills and how to express one's sexual needs to a partner. Although GSN app use can enhance relationships and sex among partnered MSM, unclear communication about app use may contribute to negative relationship outcomes and could prevent partners from having sexual needs met. Relationship and sexual health education programs for male couples should consider addressing social media and technology use in their curricula.

[Use of psychostimulants in a sexual context: Analysis of cases reported to the French network of Addictovigilance Centers]. / Usage de psychostimulants dans un contexte sexuel : analyse des cas rapportés au Réseau français des centres d'addictovigilance. Évaluation des risques liés à la pratique du SLAM.

The "SLAM" phenomenon is an increasingly popular practice, in Paris and London gay scene, defined by 3 characteristics: injection, sexual party and psychostimulant drugs. The French Medical Agency requested a risk assessment of "SLAM" and more broadly of the use of psychostimulants in a sexual context, by the analysis of complications related to this practice notified to the French Network of Addictovigilance Centers. All cases of complications related to "SLAM" practice, including cases of abuse or dependence, and somatic and psychiatric complications, were analysed. Between January 2008 to December 2013, 51 cases were collected. Users were exclusively men, with a mean age of 40 years, having psychostimulants exposure in a sexual context, mainly in men who have sex with men (MSM) context (100%, n=35). The prevalence of human immunodeficiency virus (HIV) infection was 82% (n=32) with a high level of HIV/hepatitis C virus (HCV) co-infection (50%, n=16). The main psychostimulants reported are synthetic cathinones (89.5%). Cathinones users tended to be polydrug users: 62% also reported use other than psychoactive substances (gamma-butyrolactone [GBL], ketamine, methylenedioxyméthamphetamine [MDMA], lysergic acid diethylamide [LSD]…). The main complications were psychiatric disorders in 50% (psychotic symptoms, agitation, anxiety, suicidal ideas or attempt and forensic problems), acute intoxication in 25% (including 3 deaths), dependence and abuse in 17% and infectious complications in 8% (viral seroconversion). Health professionals as well as users should be aware of the physical (cardiovascular) and behavioural (psychic, fast dependence syndrome) toxicity of cathinones. Risk reduction policy must be targeted to the population of MSM with specific interventions both on risky sexual behavior and substance use.

Sexual identity stigma and social support among men who have sex with men in Lesotho: a qualitative analysis.

Men who have sex with men (MSM) face sexual identity stigma in many settings, which can increase risk for HIV by limiting access to care. This paper examines the roles of social support, sexual identity stigma, and sexual identity disclosure among MSM in Lesotho, a lower-middle income country within South Africa. Qualitative data were collected from 23 in-depth interview and six focus group participants and content analysis was performed to extract themes. Four primary themes emerged: 1) Verbal abuse from the broader community is a major challenge faced by MSM in Lesotho, 2) participants who were open about their sexual identity experienced greater stigma but were more self-sufficient and had higher self-confidence, 3) relationships between MSM tend to be conducted in secrecy, which can be associated with unhealthy relationships between male couples and higher risk sexual practices, and 4) MSM community organisations provide significant social and emotional support. Friends and family members from outside the MSM community also offer social support, but this support cannot be utilised by MSM until the risk of disclosing their sexual identity is reduced. Greater acceptance of same-sex practices would likely result in more open, healthy relationships and greater access to social support for MSM.

Characteristics of men who have sex with men in southern Africa who seek sex online: a cross-sectional study.

BACKGROUND: Use of the Internet for finding sexual partners is increasing, particularly among men who have sex with men (MSM). In particular, MSM who seek sex online are an important group to target for human immunodeficiency virus (HIV)/sexually transmitted infection (STI) interventions because they tend to have elevated levels of sexual risk behavior and because the Internet itself may serve as a promising intervention delivery mechanism. However, few studies have examined the correlates of online sexual partner seeking among MSM in sub-Saharan Africa. OBJECTIVE: These analyses aim to describe the prevalence of using the Internet to find new male sexual partners among MSM in two southern African countries. In addition, these analyses examine the sociodemographic characteristics, experiences of discrimination and stigma, mental health and substance use characteristics, and HIV-related knowledge, attitudes, and behaviors among MSM associated with meeting sex partners online. METHODS: MSM were enrolled into a cross-sectional study across two sites in Lesotho (N=530), and one in Swaziland (N=322) using respondent-driven sampling. Participants completed a survey and HIV testing. Data were analyzed using bivariate and multivariable logistic regression models to determine which factors were associated with using the Internet to meet sex partners among MSM. RESULTS: The prevalence of online sex-seeking was high, with 39.4% (209/530) of MSM in Lesotho and 43.8% (141/322) of MSM in Swaziland reporting meeting a new male sexual partner online. In the multivariable analysis, younger age (adjusted odds ratio [aOR] 0.37, 95% confidence interval [CI] 0.27-0.50 per 5 years in Lesotho; aOR 0.68, 95% CI 0.49-0.93 in Swaziland), having more than a high school education (aOR 18.2, 95% CI 7.09-46.62 in Lesotho; aOR 4.23, 95% CI 2.07-8.63 in Swaziland), feeling scared to walk around in public places (aOR 1.89, 95% CI 1.00-3.56 in Lesotho; aOR 2.06, 95% CI 1.23-3.46 in Swaziland), and higher numbers of male anal sex partners within the past 12 months (aOR 1.27, 95% CI 1.01-1.59 per 5 partners in Lesotho; aOR 2.98, 95% CI 1.51-5.89 in Swaziland) were significantly associated with meeting sex partners online in both countries. Additional country-specific associations included increasing knowledge about HIV transmission, feeling afraid to seek health care services, thinking that family members gossiped, and having a prevalent HIV infection among MSM in Lesotho. CONCLUSIONS: Overall, a high proportion of MSM in Lesotho and Swaziland reported meeting male sex partners online, as in other parts of the world. The information in this study can be used to tailor interventions or to suggest modes of delivery of HIV prevention messaging to these MSM, who represent a young and highly stigmatized group. These data suggest that further research assessing the feasibility and acceptability of online interventions will be increasingly critical to addressing the HIV epidemic among MSM across sub-Saharan Africa.

Initial design of culturally informed behavioral intervention technologies: developing an mHealth intervention for young sexual minority men with generalized anxiety disorder and major depression.

BACKGROUND: To our knowledge, there is no well-articulated process for the design of culturally informed behavioral intervention technologies. OBJECTIVE: This paper describes the early stages of such a process, illustrated by the methodology for the ongoing development of a behavioral intervention technology targeting generalized anxiety disorder and major depression among young sexual minority men. METHODS: We integrated instructional design for Internet behavioral intervention technologies with greater detail on information sources that can identify user needs in understudied populations, as well as advances in the understanding of technology-specific behavioral intervention technology dimensions that may need to be culturally tailored. RESULTS: General psychological theory describing how to effect change in the clinical target is first integrated with theory describing potentially malleable factors that help explain the clinical problem within the population. Additional information sources are then used to (1) evaluate the theory, (2) identify population-specific factors that may affect users' ability to relate to and benefit from the behavioral intervention technology, and (3) establish specific skills, attitudes, knowledge, etc, required to change malleable factors posited in the theory. User needs result from synthesis of this information. Product requirements are then generated through application of the user needs to specific behavioral intervention technology dimensions (eg, technology platform). We provide examples of considerations relevant to each stage of this process and how they were applied. CONCLUSIONS: This process can guide the initial design of other culturally informed behavioral intervention technologies. This first attempt to create a systematic design process can spur development of guidelines for design of behavioral intervention technologies aimed to reduce health disparities.

Topology of the Closet.

Despite the closet's centrality to queer culture and theory, the metaphor's various meanings have yet to be disaggregated and defined. Following Eve Kosofsky Sedgwick's identification of the closet with a "crisis of homo/heterosexual definition, indicatively male, dating from the end of the nineteenth century," the present article uses an array of late-Victorian sources-especially The Memoirs of John Addington Symonds and Teleny, a pornographic novel sometimes attributed to Oscar Wilde-to describe and distinguish: (1) so-called latent homosexuality ("the unconscious closet"); (2) deliberate strategies of suppression, abstention, and reformation ("the conscious closet"); (3) clandestine pursuits of gay sex and sociability ("the double life"); and (4) performances of a heterosexual persona ("the mask"). This article's sources further attest to the late-Victorian advent of "closet consciousness"-a recognition among certain homosexually-inclined men that the closet's multiple modalities, for all their variety, are phenomenologically and ideologically linked.

The relationship between acceptance of illness and quality of life among men who have sex with men living with human immunodeficiency virus: A cross-sectional study.

Objectives: To explore the relationship between acceptance of illness and quality of life (QOL), and factors associated with acceptance of illness among men who have sex with men (MSM) living with human immunodeficiency virus (HIV). Methods: Three hundred and one MSM were recruited from an HIV clinic between August and December 2018. The battery of measurements consisted of the Acceptance of Illness Scale, World Health Organization Quality of Life Questionnaire for HIV brief version, HIV Cognitive Appraisal Scale and a self-designed questionnaire used to collect general information. Pearson correlation test was used to examine the relationship between acceptance of illness and QOL. Univariate and multivariate ordinal logistic regression analyses were used to examine whether the general data (demographic and HIV-related clinical data) and HIV cognitive appraisal were associated with acceptance of illness levels. Results: Descriptive analysis showed the acceptance level among MSM living with HIV was moderate (Mean = 26.29, SD = 5.28). Those with a better acceptance of illness had a better QOL (r = 0.69, P < 0.01). In the multivariate ordinal logistic regression model, education level, threat appraisals (OR:1.09; 95%CI [1.06-1.13]), and controllability appraisals (OR: 0.82; 95%CI [0.71-0.94]) were significantly associated with acceptance of illness. Conclusions: Results showed acceptance level was moderate and had a positive correlation with QOL. High level of education, low threat appraisals and high controllability appraisals were related to high illness acceptance. This finding highlights the importance of focusing on HIV-infected MSM with low education and on their perceptions of threat and controllability about HIV-related issues when designing interventions to promote illness acceptance in this vulnerable population.

To What Extent are Prenatal Androgens Involved in the Development of Male Homosexuality in Humans?

Endocrine variations, including possibly reduced exposure to androgens, may contribute to the development of male homosexuality, with animal models demonstrating same-sex mate preference with altered exposure during prenatal or early postnatal development. As similar studies in humans are impossible, indirect physical and cognitive measures of androgen exposure are used. Some studies suggest that physical measures affected by prenatal androgens, including the index-to-ring finger ratio, growth indices, and facial structure, are more "feminine" in gay men. Gay men also exhibit significant childhood gender non-conformity and a "feminized" anatomical and functional brain pattern in sexual arousal, as well as domains such as language, visuospatial skills and hemispheric relationships. However, many of these results are equivocal and may be confounded by other factors. Research has also been hampered by inconsistencies in the reporting of sexual orientation and the potentially unrepresentative populations of gay men studied, while additional complexities pertaining to gender conformity and sexual role may also influence results.

The Interactions Among Sexual Orientation, Masculine and Feminine Gender Role Orientation, and Facets of Sociosexuality in Young Heterosexual and Homosexual Men.

The present study investigated the functional relationships among sexual orientation, masculine and feminine gender role orientation, and sociosexual orientation in 282 heterosexual and 282 homosexual young men. Homosexual men reported significantly more pronounced sociosexual behavior (d = 0.65) and desire (d = 0.31). Furthermore, homosexual men were characterized by lower masculine (d =-0.26) and higher feminine (d = 0.38) gender role orientation. Latent variable analyses revealed that homosexual men as well as more masculine men, irrespective of their sexual orientation, had more uncommitted sexual relations and more unrestricted sociosexual attitudes. A similar pattern could be identified for sociosexual desire. While homosexual men were more unrestricted in their sociosexual desire, this also held for more feminine men in general. Overall, findings indicated that homosexual orientation is positively associated with sociosexual orientation. In addition, masculine/feminine gender role orientations exert differential influences on the three facets of sociosexuality independent of sexual orientation.

Perceived risk and decisional balance to HIV testing in men who have sex with men from Monterrey, Mexico. / Riesgo percibido y balance decisional hacia la prueba del VIH en hombres que tienen sexo con hombres de Monterrey, México.

The perceived risk to HIV and the decisional balance (pros and cons) towards HIV testing are fundamental aspects for understanding the motivation of men who have sex with men to engage in behaviours that reduce or increase the risk of infection with the virus. OBJECTIVES: To describe the perceived risk of HIV and the decisional balance towards HIV testing and determine the association between perceived risk and the decisional balance towards HIV testing of men who have sex with men. METHOD: Descriptive correlational design, we used respondent-driven sampling, with which we recruited 202 men who have sex with men. RESULTS: Mean age of 27.79 (SD=8.13), 66.3% reported low perceived risk to HIV. The most significant pros were: "If I had HIV I would not want to infect anyone else" (95%) and "I would like to be sure I did not have HIV to tell my sexual partner" (90.6%). The most significant cons were: "I am afraid of the needle used for the HIV test" (53%), "people could reject me if they had HIV" (78.7%). Finally, there was a correlation between the perceived risk and the decisional balance towards HIV testing (rs=.759, p<.001). CONCLUSIONS: Given such data, in future interventions it is important to consider information about the importance of HIV testing on a regular basis, as well as actions to increase the perception of vulnerability to HIV in this population.

Measuring Sexual Behavior Stigma to Inform Effective HIV Prevention and Treatment Programs for Key Populations.

BACKGROUND: The levels of coverage of human immunodeficiency virus (HIV) treatment and prevention services needed to change the trajectory of the HIV epidemic among key populations, including gay men and other men who have sex with men (MSM) and sex workers, have consistently been shown to be limited by stigma. OBJECTIVE: The aim of this study was to propose an agenda for the goals and approaches of a sexual behavior stigma surveillance effort for key populations, with a focus on collecting surveillance data from 4 groups: (1) members of key population groups themselves (regardless of HIV status), (2) people living with HIV (PLHIV) who are also members of key populations, (3) members of nonkey populations, and (4) health workers. METHODS: We discuss strengths and weaknesses of measuring multiple different types of stigma including perceived, anticipated, experienced, perpetrated, internalized, and intersecting stigma as measured among key populations themselves, as well as attitudes or beliefs about key populations as measured among other groups. RESULTS: With the increasing recognition of the importance of stigma, consistent and validated stigma metrics for key populations are needed to monitor trends and guide immediate action. Evidence-based stigma interventions may ultimately be the key to overcoming the barriers to coverage and retention in life-saving antiretroviral-based HIV prevention and treatment programs for key populations. CONCLUSIONS: Moving forward necessitates the integration of validated stigma scales in routine HIV surveillance efforts, as well as HIV epidemiologic and intervention studies focused on key populations, as a means of tracking progress toward a more efficient and impactful HIV response.