Abstract
Young men who have sex with men (MSM) are disproportionately affected by HIV, but it remains unclear whether there are differences in HIV risk behaviors between self-identified gay and bisexual young men. To address this, the current study examined differences in condomless sex and substance use before sex with male partners between self-identified gay and bisexual young men who are HIV-negative. Additionally, we examined differences in HIV risk behaviors with male versus female partners among the bisexual men. We used four waves of data spanning 24 months from a cohort of young MSM ages 16–29. At each wave, participants reported on up to four partners, allowing us to examine within-person associations. Compared to gay men, bisexual men reported more insertive condomless anal sex (CAS) with casual partners, they were more likely to report marijuana use before sex, and they were less likely to report lifetime HIV testing and PrEP use. Alcohol and marijuana use before sex were associated with CAS for both gay and bisexual men, but the association between marijuana use and insertive CAS was stronger for bisexual men. Bisexual men reported more condomless sex with female partners compared to male partners, but this was not significant after accounting for alcohol and marijuana use. Bisexual men were more likely to report alcohol and marijuana use with female partners compared to male partners, but both alcohol and marijuana use were associated with condomless sex regardless of partner gender. Findings support the need for tailored HIV prevention for self-identified bisexual men to address their lack of preventive behaviors, their increased engagement in certain risk behaviors with male partners, and their engagement in risk behaviors with female partners.
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References
Agronick, G., O’Donnell, L., Stueve, A., Doval, A. S., Duran, R., & Vargo, S. (2004). Sexual behaviors and risks among bisexually- and gay-identified young Latino men. AIDS and Behavior, 8(2), 185–197. https://doi.org/10.1023/B:AIBE.0000030249.11679.d0.
Arnett, J. J. (2000). Emerging adulthood. A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003-066X.55.5.469.
Balsam, K. F., & Mohr, J. J. (2007). Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults. Journal of Counseling Psychology, 54, 306–319.
Baral, S. D., Poteat, T., Stromdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. Lancet Infectious Diseases, 13(3), 214–222. https://doi.org/10.1016/S1473-3099(12)70315-8.
Bauer, G. R., & Brennan, D. J. (2013). The problem with “behavioral bisexuality”: Assessing sexual orientation in survey research. Journal of Bisexuality, 13, 148–165.
Carliner, H., Mauro, P. M., Brown, Q. L., Shmulewitz, D., Rahim-Juwel, R., Sarvet, A. L., … Hasin, D. S. (2017). The widening gender gap in marijuana use prevalence in the U.S. during a period of economic change, 2002–2014. Drug and Alcohol Dependence, 170, 51–58. https://doi.org/10.1016/j.drugalcdep.2016.10.042.
CDC. (2015). HIV among gay and bisexual men. Retrieved from http://www.cdc.gov/hiv/group/msm/index.html.
CDC. (2016). HIV Surveillance Report, 2015. Retrieved from http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.
Cooper, M. L. (2010). Toward a person × situation model of sexual risk-taking behaviors: Illuminating the conditional effects of traits across sexual situations and relationship contexts. Journal of Personality and Social Psychology, 98(2), 319–341. https://doi.org/10.1037/a0017785.
Cox, N., Vanden Berghe, W., Dewaele, A., & Vincke, J. (2010). Acculturation strategies and mental health in gay, lesbian, and bisexual youth. Journal of Youth and Adolescence, 39(10), 1199–1210. https://doi.org/10.1007/s10964-009-9435-7.
Delker, E., Brown, Q., & Hasin, D. S. (2016). Alcohol consumption in demographic subpopulations: An epidemiologic overview. Alcohol Research, 38(1), 7–15.
Dodge, B., Jeffries, W. L., & Sandfort, T. G. (2008). Beyond the down low: Sexual risk, protection, and disclosure among at-risk Black men who have sex with both men and women (MSMW). Archives of Sexual Behavior, 37(5), 683–696. https://doi.org/10.1007/s10508-008-9356-7.
Dodge, B., Schnarrs, P. W., Goncalves, G., Malebranche, D., Martinez, O., Reece, M., … Fortenberry, J. D. (2012a). The significance of privacy and trust in providing health-related services to behaviorally bisexual men in the United States. AIDS Education and Prevention, 24(3), 242–256. https://doi.org/10.1521/aeap.2012.24.3.242.
Dodge, B., Schnarrs, P. W., Reece, M., Martinez, O., Goncalves, G., Malebranche, D., … Fortenberry, J. D. (2013). Sexual behaviors and experiences among behaviorally bisexual men in the midwestern United States. Archives of Sexual Behavior, 42(2), 247–256. https://doi.org/10.1007/s10508-011-9878-2.
Dodge, B., Van Der Pol, B., Reece, M., Malebranche, D., Martinez, O., Goncalves, G., … Fortenberry, J. D. (2012b). Rectal self-sampling in non-clinical venues for detection of sexually transmissible infections among behaviourally bisexual men. Sexual Health, 9(2), 190–191. https://doi.org/10.1071/sh11068.
Doll, L. S., & Beeker, C. (1996). Male bisexual behavior and HIV risk in the United States: Synthesis of research with implications for behavioral interventions. AIDS Education and Prevention, 8(3), 205–225.
Doll, L., Myers, T., Kennedy, M., & Allman, D. (1997). Bisexuality and HIV risk: Experiences in Canada and the United States. Annual Review of Sex Research, 8, 102–147.
Doll, L. S., Petersen, L. R., White, C. R., Johnson, E. S., Ward, J. W., & The Blood Donor Study Group. (1992). Homosexually and nonhomosexually identified men who have sex with men: A behavioral comparison. Journal of Sex Research, 29, 1–14.
Drumright, L. N., Patterson, T. L., & Strathdee, S. A. (2006). Club drugs as causal risk factors for HIV acquisition among men who have sex with men: A review. Substance Use and Misuse, 41(10–12), 1551–1601. https://doi.org/10.1080/10826080600847894.
Duncan, S. C., Duncan, T. E., & Hops, H. (1996). Analysis of longitudinal data within accelerated longitudinal designs. Psychological Methods, 1, 236–248.
Dunlap, A. (2016). Changes in coming out milestones across five age cohorts. Journal of Gay & Lesbian Social Services, 28, 20–38.
Eady, A., Dobinson, C., & Ross, L. E. (2011). Bisexual people’s experiences with mental health services: A qualitative investigation. Community Mental Health Journal, 47(4), 378–389. https://doi.org/10.1007/s10597-010-9329-x.
Everett, B. G., Schnarrs, P. W., Rosario, M., Garofalo, R., & Mustanski, B. (2014). Sexual orientation disparities in sexually transmitted infection risk behaviors and risk determinants among sexually active adolescent males: Results from a school-based sample. American Journal of Public Health, 104(6), 1107–1112. https://doi.org/10.2105/AJPH.2013.301759.
Feinstein, B. A., & Dyar, C. (2017). Bisexuality, minority stress, and health. Current Sexual Health Reports, 9, 42–49.
Feinstein, B. A., Dyar, C., & London, B. (2017). Are outness and community involvement risk or protective factors for alcohol and drug abuse among sexual minority women? Archives of Sexual Behavior, 46, 1411–1423.
Feinstein, B. A., & Newcomb, M. E. (2016). The role of substance use motives in the associations between minority stressors and substance use problems among young men who have sex with men. Psychology of Sexual Orientation and Gender Diversity, 3(3), 357–366. https://doi.org/10.1037/sgd0000185.
Friedman, M. R., Wei, C., Klem, M. L., Silvestre, A. J., Markovic, N., & Stall, R. (2014). HIV infection and sexual risk among men who have sex with men and women (MSMW): A systematic review and meta-analysis. PLoS ONE, 9(1), e87139. https://doi.org/10.1371/journal.pone.0087139.
Grant, B. F., Dawson, D. A., Stinson, F. S., Chou, S. P., Dufour, M. C., & Pickering, R. P. (2004). The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug and Alcohol Dependence, 74(3), 223–234. https://doi.org/10.1016/j.drugalcdep.2004.02.004.
Grov, C., Rendina, H. J., Jimenez, R., & Parsons, J. T. (2016). Using online settings to identify gay and bisexual men willing to take or with experience taking PrEP: Implications for researchers and providers. AIDS Education and Prevention, 28(5), 378–392. https://doi.org/10.1521/aeap.2016.28.5.378.
Harawa, N. T., Williams, J. K., Ramamurthi, H. C., Manago, C., Avina, S., & Jones, M. (2008). Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men. Archives of Sexual Behavior, 37(5), 748–762. https://doi.org/10.1007/s10508-008-9361-x.
Herbst, J. H., Jacobs, E. D., Finlayson, T. J., McKleroy, V. S., Neumann, M. S., Crepaz, N., & HIV/AIDS Prevention Research Synthesis Team. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS and Behavior, 12(1), 1–17. https://doi.org/10.1007/s10461-007-9299-3.
Hergenrather, K. C., Emmanuel, D., Durant, S., & Rhodes, S. D. (2016). Enhancing HIV prevention among young men who have sex with men: A systematic review of HIV behavioral interventions for young gay and bisexual men. AIDS Education and Prevention, 28(3), 252–271. https://doi.org/10.1521/aeap.2016.28.3.252.
Herrick, A. L., Marshal, M. P., Smith, H. A., Sucato, G., & Stall, R. D. (2011). Sex while intoxicated: A meta-analysis comparing heterosexual and sexual minority youth. Journal of Adolescent Health, 48(3), 306–309. https://doi.org/10.1016/j.jadohealth.2010.07.008.
Hogan, B., Melville, J. R., Philips, G. L., 2nd, Janulis, P., Contractor, N., Mustanski, B. S., & Birkett, M. (2016). Evaluating the paper-to-screen translation of participant-aided sociograms with high-risk participants. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 2016, 5360–5371. https://doi.org/10.1145/2858036.2858368.
Hubach, R. D., Dodge, B., Goncalves, G., Malebranche, D., Reece, M., Van Der Pol, B., … Fortenberry, J. D. (2014). Gender matters: Condom use and nonuse among behaviorally bisexual men. Archives of Sexual Behavior, 43(4), 707–717. https://doi.org/10.1007/s10508-013-0147-4.
Janulis, P., Feinstein, B. A., Phillips, G., Newcomb, M. E., Birkett, M., & Mustanski, B. (2018). Sexual partner typologies and the association between drug use and sexual risk behavior among young men who have sex with men. Archives of Sexual Behavior, 47, 259–271.
Jeffries, W. L. (2010). HIV testing among bisexual men in the United States. AIDS Education and Prevention, 22(4), 356–370. https://doi.org/10.1521/aeap.2010.22.4.356.
Jeffries, W. L. (2014). Beyond the bisexual bridge: Sexual health among U.S. men who have sex with men and women. American Journal of Preventive Medicine, 47(3), 320–329. https://doi.org/10.1016/j.amepre.2014.05.002.
Jeffries, W. L., & Dodge, B. (2007). Male bisexuality and condom use at last sexual encounter: Results from a national survey. Journal of Sex Research, 44(3), 278–289.
Jessor, R. (1992). Risk behavior in adolescence: A psychosocial framework for understanding and action. Developmental Review, 12(4), 374–390.
Jin, F. Y., Prestage, G., Law, M. G., Kippax, S., Van de Ven, P., Rawsthorne, P., … Grulich, A. E. (2002). Predictors of recent HIV testing in homosexual men in Australia. HIV Medicine, 3(4), 271–276.
Kennedy, M., & Doll, L. S. (2001). Male bisexuality and HIV risk. Journal of Bisexuality, 1, 111–135.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593.
Lachowsky, N. J., Saxton, P. J., Hughes, A. J., Dickson, N. P., Summerlee, A. J., Milhausen, R. R., & Dewey, C. E. (2015). Younger gay and bisexual men’s condom use with main regular sexual partner in New Zealand. AIDS Education and Prevention, 27(3), 257–274. https://doi.org/10.1521/aeap.2015.27.3.257.
Lever, J., Kanouse, D. E., Rogers, W. H., Carson, S., & Hertz, R. (1992). Behavior patterns and sexual identity of bisexual males. Journal of Sex Research, 29, 141–167.
Magnusson, A., Skaug, H., Nielsen, A., Berg, C., Kristensen, K., Maechler, M., … Brooks, M. (2016). glmmTMB: Generalized linear mixed models using template model builder. Retrieved from https://github.com/glmmTMB/.
Malebranche, D. J., Arriola, K. J., Jenkins, T. R., Dauria, E., & Patel, S. N. (2010). Exploring the “bisexual bridge”: A qualitative study of risk behavior and disclosure of same-sex behavior among black bisexual men. American Journal of Public Health, 100(1), 159–164. https://doi.org/10.2105/AJPH.2008.158725.
Martinez, O., Dodge, B., Goncalves, G., Schnarrs, P., Munoz-Laboy, M., Reece, M., … Fortenberry, J. D. (2012). Sexual behaviors and experiences among behaviorally bisexual Latino men in the midwestern United States: Implications for sexual health interventions. Journal of Bisexuality, 12(2), 283–310. https://doi.org/10.1080/15299716.2012.674865.
Martos, A., Nezhad, S., & Meyer, I. H. (2015). Variations in sexual identity milestones among lesbians, gay men and bisexuals. Sexuality Research and Social Policy, 12(1), 24–33. https://doi.org/10.1007/s13178-014-0167-4.
McKechnie, M. L., Bavinton, B. R., & Zablotska, I. B. (2013). Understanding of norms regarding sexual practices among gay men: Literature review. AIDS and Behavior, 17(4), 1245–1254. https://doi.org/10.1007/s10461-012-0309-8.
Munoz-Laboy, M., & Dodge, B. (2007). Bisexual Latino men and HIV and sexually transmitted infections risk: An exploratory analysis. American Journal of Public Health, 97(6), 1102–1106. https://doi.org/10.2105/AJPH.2005.078345.
Mustanski, B. (2011). Ethical and regulatory issues with conducting sexuality research with LGBT adolescents: A call to action for a scientifically informed approach. Archives of Sexual Behavior, 40, 673–686. https://doi.org/10.1007/s10508-011-9745-1.
Mustanski, B., Kuper, L., & Greene, G. J. (2014a). Development of sexual orientation and identity. In D. L. Tolman & L. M. Diamond (Eds.), Handbook of sexuality and psychology (pp. 597–628). Washington, DC: American Psychological Association.
Mustanski, B., Newcomb, M. E., & Clerkin, E. M. (2011a). Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychology, 30(5), 597–605. https://doi.org/10.1037/a0023858.
Mustanski, B. S., Newcomb, M., Du Bois, S. N., Garcia, S. C., & Grov, C. (2011b). HIV in young men who have sex with men: A review of epidemiology, risk and protective factors, and interventions. Journal of Sex Research, 48(2–3), 218–253. https://doi.org/10.1080/00224499.2011.558645.
Mustanski, B., Ryan, D. T., & Garofalo, R. (2014b). Associations of sexually transmitted infections with condom problems among young men who have sex with men. Sexually Transmitted Diseases, 41(7), 427–432. https://doi.org/10.1097/OLQ.0000000000000150.
Mustanski, B., Starks, T., & Newcomb, M. E. (2014c). Methods for the design and analysis of relationship and partner effects on sexual health. Archives of Sexual Behavior, 43(1), 21–33. https://doi.org/10.1007/s10508-013-0215-9.
Mustanski, B., Swann, G., Newcomb, M. E., & Prachand, N. (2017). Effects of parental monitoring and knowledge on substance use and HIV risk behaviors among young men who have sex with men: Results from three studies. AIDS and Behavior, 21, 2046–2058.
Newcomb, M. E., & Mustanski, B. (2013). Racial differences in same-race partnering and the effects of sexual partnership characteristics on HIV Risk in MSM: A prospective sexual diary study. Journal of Acquired Immune Deficiency Syndromes, 62(3), 329–333. https://doi.org/10.1097/QAI.0b013e31827e5f8c.
Newcomb, M. E., Ryan, D. T., Greene, G. J., Garofalo, R., & Mustanski, B. (2014). Prevalence and patterns of smoking, alcohol use, and illicit drug use in young men who have sex with men. Drug and Alcohol Dependence, 141, 65–71. https://doi.org/10.1016/j.drugalcdep.2014.05.005.
Ontario Public Health Association. (2003). Improving the access and quality of public health services for bisexuals. Toronto, ON: Author.
Ott, M. Q., Wypij, D., Corliss, H. L., Rosario, M., Reisner, S. L., Gordon, A. R., & Austin, S. B. (2013). Repeated changes in reported sexual orientation identity linked to substance use behaviors in youth. Journal of Adolescent Health, 52(4), 465–472. https://doi.org/10.1016/j.jadohealth.2012.08.004.
Page, E. H. (2004). Mental health services experiences of bisexual women and bisexual men: An empirical study. Journal of Bisexuality, 4, 137–160.
Parsons, J. T., Siegel, A. W., & Cousins, J. H. (1997). Late adolescent risk-taking: Effects of perceived benefits and perceived risks on behavioral intentions and behavioral change. Journal of Adolescence, 20(4), 381–392. https://doi.org/10.1006/jado.1997.0094.
R Core Team. (2017). R: A language and environment for statistical computing. Retrieved from https://www.R-project.org/.
Ross, L. E., Dobinson, C., & Eady, A. (2010). Perceived determinants of mental health for bisexual people: A qualitative examination. American Journal of Public Health, 100(3), 496–502. https://doi.org/10.2105/AJPH.2008.156307.
Siegel, A. W., Cuccaro, P., Parsons, J. T., Wall, J., & Weinberg, A. D. (1993). Adolescents’ thinking about emotions and risk-taking. In J. M. Puckett & H. W. Reese (Eds.), Mechanisms of everyday cognition (pp. 155–175). Hillsdale, NJ: Lawrence Erlbaum Associates.
Simons, J., Correia, C. J., & Carey, K. B. (2000). A comparison of motives for marijuana and alcohol use among experienced users. Addictive Behaviors, 25(1), 153–160.
Stokes, J. P., McKirnan, D., & Burzette, R. (1993). Sexual behavior, condom use, disclosure of sexuality, and stability of sexual orientation in bisexual men. Journal of Sex Research, 30, 203–213.
Stokes, J. P., Vanable, P., & McKirnan, D. J. (1997). Comparing gay and bisexual men on sexual behavior, condom use, and psychosocial variables related to HIV/AIDS. Archives of Sexual Behavior, 26(4), 383–397.
Swann, G., Newcomb, M. E., & Mustanski, B. (2018). Validation of the HIV Risk Assessment of Sexual Partnerships (H-RASP): Comparison to a 2-month prospective diary study. Archives of Sexual Behavior, 47, 121–131.
Thompson, R. G., Eaton, N. R., Hu, M. C., Grant, B. F., & Hasin, D. S. (2014). Regularly drinking alcohol before sex in the United States: Effects of relationship status and alcohol use disorders. Drug and Alcohol Dependence, 141, 167–170. https://doi.org/10.1016/j.drugalcdep.2014.05.021.
Vosburgh, H. W., Mansergh, G., Sullivan, P. S., & Purcell, D. W. (2012). A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS and Behavior, 16(6), 1394–1410. https://doi.org/10.1007/s10461-011-0131-8.
Young, R. M., & Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American Journal of Public Health, 95(7), 1144–1149. https://doi.org/10.2105/ajph.2004.046714.
Funding
This research was supported by a grant from the National Institute on Drug Abuse (U01DA036939; PI: Mustanski). Brian A. Feinstein was also supported by a grant from the National Institute on Drug Abuse (F32DA042708). We acknowledge the research infrastructure provided by the NIH-funded Third Coast Center for AIDS Research (CFAR) (P30 AI117943) and the NIH-funded Northwestern University Clinical and Translational Sciences Institute (UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
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Feinstein, B.A., Moran, K.O., Newcomb, M.E. et al. Differences in HIV Risk Behaviors Between Self-Identified Gay and Bisexual Young Men Who are HIV-Negative. Arch Sex Behav 48, 261–275 (2019). https://doi.org/10.1007/s10508-018-1148-0
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DOI: https://doi.org/10.1007/s10508-018-1148-0