AIDS and Behavior

, Volume 17, Issue 3, pp 889–899 | Cite as

Correlates of Unprotected Vaginal or Anal Intercourse with Women Among Substance-Using Men Who Have Sex with Men

  • Emily Greene
  • Victoria Frye
  • Gordon Mansergh
  • Grant N. Colfax
  • Sharon M. Hudson
  • Stephen A. Flores
  • Donald R. Hoover
  • Sebastian Bonner
  • Beryl A. Koblin
Original Paper

Abstract

The role men who have sex with men and women (MSMW) play in heterosexual HIV transmission is not well understood. We analyzed baseline data from Project MIX, a behavioral intervention study of substance-using men who have sex with men (MSM), and identified correlates of unprotected vaginal intercourse, anal intercourse, or both with women (UVAI). Approximately 10 % (n = 194) of the men reported vaginal sex, anal sex, or both with a woman; of these substance-using MSMW, 66 % (129) reported UVAI. Among substance-using MSMW, multivariate analyses found unemployment relative to full/part-time employment (OR = 2.28; 95 % CI 1.01, 5.17), having a primary female partner relative to no primary female partner (OR = 3.44; CI 1.4, 8.46), and higher levels of treatment optimism (OR = 1.73; 95 % CI 1.18, 2.54) increased odds of UVAI. Strong feelings of connection to a same-race gay community (OR = 0.71; 95 % CI 0.56, 0.91) and Viagra use (OR = 0.31; 95 % CI 0.10, 0.95) decreased odds of UVAI. This work suggests that although the proportion of substance-using MSM who also have sex with women is low, these men engage in unprotected sex with women, particularly with primary female partners. This work highlights the need for further research with the substance using MSMW population to inform HIV prevention interventions specifically for MSMW.

Keywords

Bisexual Heterosexual HIV MSMW Condom usage 

Notes

Acknowledgments

This study was supported by cooperative agreements from the Division of HIV/AIDS Prevention, CDC award numbers: U65/CCU522209 (Chicago), U65/CCU922215 (Los Angeles), U65/CCU222309 (New York), U65/CCU922213 (San Francisco), and K01-DA-020774 (Frye). We would like to thank all participants and project support staff for their important contributions to this study. In addition to the authors listed, the Project MIX study group includes staff from the Centers for Disease Control and Prevention (CDC) (D. Purcell, R. Taylor, P. Spikes), Chicago (J. Hopwood, N. Martin, D. Jimenez, C. Powers, P. Rodriguez), Los Angeles (B. Gatson, J. Copeland, L. Fernandez), New York (K. Curtis, K. Goodman, J. Bonelli), and San Francisco (T. Matheson, R. Guzman).

References

  1. 1.
    Centers for Disease Control and Prevention. HIV/AIDS surveillance report, 2010. vol. 22. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2012.Google Scholar
  2. 2.
    Prabhu R, Owen CL, Folger K, McFarland W. The bisexual bridge revisited: sexual risk behavior among men who have sex with men and women, San Francisco, 1998–2003. AIDS. 2004;18(11):1604–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Williams CT, Mackesy-Amiti ME, McKirnan DJ, Oullet LJ. Differences in sexual identity, risk practices, and sex partners between bisexual men and other men among a low-income drug-using sample. J Urban Health. 2009;86(Suppl 1):93–106.PubMedCrossRefGoogle Scholar
  4. 4.
    Zule WA, Bobashev GV, Wechsberg WM, Costenbader EC, Coomes CM. Behaviorally bisexual men and the risk behaviors with men and women. J Urban Health. 2009;86(Suppl 1):48–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Malebranche DJ. Bisexually active Black men in the United States and HIV: acknowledging more than the “Down Low”. Arch Sex Behav. 2008;37(5):810–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Siegel K, Scrimshaw EW, Lekas HM, Parsons JT. Sexual behaviors of non-gay identified non-disclosing men who have sex with men and women. Arch Sex Behav. 2008;37(5):720–35.PubMedCrossRefGoogle Scholar
  7. 7.
    Chu SY, Peterman TA, Doll LS, Buehler JW, Curran JW. AIDS in bisexual men in the United States: epidemiology and transmission to women. Am J Public Health. 1992;82(2):220–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Ekstrand ML, Coates TJ, Guydish JR, Hauck WW, Collette L, Hulley SB. Are bisexually identified men in San Francisco a common vector for spreading HIV infection to women? Am J Public Health. 1994;84(6):915–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Stokes J, McKirnan DJ, Doll L, Burzette RG. Female partners of bisexual men: what they don’t know might hurt them. Psychol Women Q. 1996;20(2):267–84.CrossRefGoogle Scholar
  10. 10.
    Kahn JG, Gurvey J, Pollack LM, Binson D, Catania JA. How many HIV infections cross the bisexual bridge? An estimate from the United States. AIDS. 1997;11(8):1031–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Wood RW, Krueger LE, Pearlman TC, Goldbaum G. HIV transmission: women’s risk from bisexual men. Am J Public Health. 1993;83(12):1757–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Worth H. The myth of the bisexual infector. J Bisex. 2003;3(2):69–88.CrossRefGoogle Scholar
  13. 13.
    Hightow LB, Leone PA, Macdonald PD, McCoy SI, Sampson LA, Kaplan AH. Men who have sex with men and women: a unique risk group for HIV transmission on North Carolina College campuses. Sex Transm Dis. 2006;33(10):585–93.PubMedCrossRefGoogle Scholar
  14. 14.
    Adimora AA, Fullilove RE. Men who have sex with men and women: pieces of the U.S. HIV epidemic puzzle. Sex Transm Dis. 2006;33(10):596–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Montgomery JP, Mokotoff ED, Gentry AC, Blair JM. The extent of bisexual behavior in HIV-infected men and implications for transmission to their female partners. AIDS Care. 2003;15(6):829–32.PubMedCrossRefGoogle Scholar
  16. 16.
    Dodge B, Jeffries JW IV, Sandfort TG. Beyond the down low: sexual risk, protection, and disclosure among at-risk black men who have sex with both men and women. Arch Sex Behav. 2008;37(5):683–96.PubMedCrossRefGoogle Scholar
  17. 17.
    Knight KR, Shade SB, Purcell DW, et al. Sexual transmission risk behavior reported among behaviorally bisexual HIV-positive injection drug-using men. JAIDS. 2007;46(Suppl 2):S80–7.PubMedGoogle Scholar
  18. 18.
    Spikes PS, Purcell DW, Williams K, Chen Y, Ding H. Sexual risk behaviors among HIV-positive black men who have sex with women, with men, or with men and women: implications for intervention development. Am J Public Health. 2009;99(6):1072–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Lauby JL, Millet GA, LaPollo AB, Bond L, Merrill CS, Marks G. Sexual risk behaviors of HIV-Positive, HIV-negative, and serostatus unknown Black men who have sex with men and women. Arch Sex Behav. 2008;37(5):708–19.PubMedCrossRefGoogle Scholar
  20. 20.
    Wheeler DP, Lauby JL, Liu KL, Van Sluytman LG, Murill C. A comparative analysis of sexual risk characteristics of Black men who have sex with men or with men and women. Arch Sex Behav. 2008;37(5):697–707.PubMedCrossRefGoogle Scholar
  21. 21.
    Nakamura N, Semple SJ, Strathdee SA, Patterson TL. HIV risk profiles among HIV-positive, methamphetamine-using men who have sex with both men and women. Arch Sex Behav. 2011;40(4):793–801.PubMedCrossRefGoogle Scholar
  22. 22.
    McKay T, Mutchler MG. The effect of partner sex: nondisclosure of HIV status to male and female partners among men who have sex with men and women (MSMW). AIDS Behav. 2011;15(6):1140–52.PubMedCrossRefGoogle Scholar
  23. 23.
    Gorbach PM, Murphy R, Weiss RE, Hucks-Ortiz C, Shoptaw S. Bridging sexual boundaries: men who have sex with men and women in a street-based sample in Los Angeles. J Urban Health. 2009;86(Suppl. 1):63–76.PubMedCrossRefGoogle Scholar
  24. 24.
    Shoptaw S, Weiss RE, Munjas B, Hucks-Ortiz C, et al. Homonegativity, substance use, sexual risk behaviors, and HIV status in poor and ethnic men who have sex with men in Los Angeles. J Urban Health. 2009;86(Suppl 1):77–92.PubMedCrossRefGoogle Scholar
  25. 25.
    Mansergh G, Koblin BA, McKirnan DJ, et al. An intervention to reduce HIV risk behavior of substance-using men who have sex with men: a two-group randomized trial with a nonrandomized third group. PloS Med. 2010;7(8):e1000329.PubMedCrossRefGoogle Scholar
  26. 26.
    Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRefGoogle Scholar
  27. 27.
    Santor SA, Coyne JC. Shortening the CES-D to improve its ability to detect cases of depression. Psychol Assess. 1997;9(3):233–43.CrossRefGoogle Scholar
  28. 28.
    Derogatis LR. Brief symptom inventory. Baltimore: Clinical Psychometric Research; 1975.Google Scholar
  29. 29.
    Derogatis LR, Melisaratos N. The brief symptom inventory: an introductory report. Psychol Med. 1983;13(3):595–605.PubMedCrossRefGoogle Scholar
  30. 30.
    Bell A, Weinburg M, Hammersmith S. Sexual preference: it’s development in men and women. Bloomington: Indiana University Press; 1981.Google Scholar
  31. 31.
    McKirnan DJ, Stokes JP, Doll L, Burzette R. Bisexually active men: social characteristics and sexual behavior. J Sex Res. 1995;32(1):65–76.CrossRefGoogle Scholar
  32. 32.
    Huebner DM, Rebchook GM, Kegeles SM. A longitudinal study of the association between treatment optimism and sexual risk behavior in young gay and bisexual men. J Acquir Immune Defic Syndr. 2004;37:1514–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Wulfert E, Wan CK. safer sex intentions and condom use viewed from a health relief, reasoned action, and social cognitive perspective. J Sex Res. 1995;32(4):299–311.CrossRefGoogle Scholar
  34. 34.
    O’Leary A, Purcell DW, Remien RH, Fisher HE, Spikes PS. Characteristics of bisexually active men in the Seropositive Urban Mens’ Study (SUMS). AIDS Care. 2007;19(7):940–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Millet GM, Malebranche D, Mason B, Spikes P. Focusing “down low”: bisexual black men HIV risk, and heterosexual transmission. J Natl Med Assoc. 2005;97(7 Suppl):52S–9S.Google Scholar
  36. 36.
    Williams JK, Wyatt GE, Resell J, Peterson J, Asuan-O’Brien A. Psychosocial issues among gay- and non-gay-identifying HIV-seropositive African American and Latino MSM. Cultur Divers Ethnic Minor Psychol. 2004;10(3):268–86.PubMedCrossRefGoogle Scholar
  37. 37.
    Dilley J, Woods W, McFarland W. Are advances in treatment changing views about high-risk sex? N Engl J Med. 1997;337(7):501–2.PubMedCrossRefGoogle Scholar
  38. 38.
    Sullivan PS, Drake AJ, Sanchez TH. Prevalence of treatment optimism-related risk behavior and associated factors among men who have sex with men in 11 states, 2000–2001. AIDS Behav. 2007;11(1):123–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Vanable PA, Ostrow DG, McKirnan DJ, Taywditep KJ, Hope BA. Impact of combination therapies on HIV-risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychol. 2000;19(2):134–45.PubMedCrossRefGoogle Scholar
  40. 40.
    Stolte IG, Dukers NH, Geskas RB, Cortinho RA, de Wit JB. Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study. AIDS. 2004;18(2):303–9.PubMedCrossRefGoogle Scholar
  41. 41.
    O’Donnell L, Agronick G, San Doval A, Duran R, Myint-U A, Stueve A. Ethnic and gay community attachments and sexual risk behaviors among urban Latino young men who have sex with men. AIDS Educ Prev. 2002;14(6):457–71.PubMedCrossRefGoogle Scholar
  42. 42.
    Metzger DS, Koblin B, Turner C, et al. Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies. Am J Epidemiol. 2000;152(2):99–106.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Emily Greene
    • 1
    • 2
  • Victoria Frye
    • 1
    • 3
  • Gordon Mansergh
    • 4
  • Grant N. Colfax
    • 5
  • Sharon M. Hudson
    • 6
  • Stephen A. Flores
    • 4
  • Donald R. Hoover
    • 7
  • Sebastian Bonner
    • 8
  • Beryl A. Koblin
    • 9
  1. 1.Laboratory of Social and Behavioral SciencesLindsley F. Kimball Research Institute, New York Blood CenterNew YorkUSA
  2. 2.Department of EpidemiologyMailman School of Public Health, Columbia UniversityNew YorkUSA
  3. 3.Department of Sociomedical SciencesMailman School of Public Health, Columbia UniversityNew YorkUSA
  4. 4.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  5. 5.San Francisco Department of Public HealthSan FranciscoUSA
  6. 6.Health Research AssociationLos AngelesUSA
  7. 7.Department of Statistics and Biostatistics and Institute for Health Care Policy and Aging ResearchRutgers University, The State University of New JerseyPiscatawayUSA
  8. 8.Independent ConsultantNew YorkUSA
  9. 9.Laboratory of Infectious Disease PreventionLindsley F. Kimball Research Institute, New York Blood CenterNew YorkUSA

Personalised recommendations