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Sexual positioning practices among men who have sex with men (MSM) have not received a thorough discussion in the MSM and HIV literature, given that risks for acquiring or transmitting HIV and STIs via condomless anal sex vary according to sexual positioning. MSM bear a disproportionate burden of HIV compared to the general population in the United States; surveillance efforts suggest that HIV and STIs are increasing among domestic and international populations of MSM. We conducted a narrative review, using a targeted literature search strategy, as an initial effort to explore processes through which sexual positioning practices may contribute to HIV/STI transmission. Peer-reviewed articles were eligible for inclusion if they contained a measure of sexual positioning identity and/or behavior (i.e., “top”, “bottom,” etc.) or sexual positioning behavior (receptive anal intercourse or insertive anal intercourse), or assessed the relationship between sexual positioning identity with HIV risk, anal sex practice, masculinity, power, partner type, or HIV status. A total of 23 articles met our inclusion criteria. This review highlights dynamic psychosocial processes likely underlying sexual decision making related to sexual positioning identity and practices among MSM and MSM who have sex with women (MSMW), and ways these contexts may influence HIV/STI risk. Despite limited focus in the extant literature, this review notes the important role the contextual factors (masculinity stereotypes, power, partner type, and HIV status) likely to play in influencing sexual positioning identity and practices. Through this review we offer an initial synthesis of the literature describing sexual positioning identities and practices and conceptual model to provide insight into important areas of study through future research.

Men who have sex with men (MSM) are disproportionately impacted by HIV in the United States, and substance use and compulsive sexual behavior (CSB) are contributors to HIV risk behavior. This study sought to examine the direct and interactive effects of concurrent substance use and CSB on condomless anal sex (CAS) in a community sample of MSM (N = 200) utilizing a 90-day timeline follow-back assessment. Results indicated CSB did not directly increase risk for CAS when controlling for substance use and age. There was limited evidence for a direct effect of concurrent alcohol use on CAS, and no evidence for an interaction effect with CSB. The relationship between concurrent drug use and CAS was moderated by CSB, such that concurrent drug use was positively associated with CAS for those who screened positive for CSB, while the association was non-significant for those who screened negative. Implications and limitations of these findings are discussed.

Among men who have sex with men (MSM), those who also engage in the exchange of sex for money, drugs, shelter or other material goods (i.e., male sex workers-MSWs) have been found to have higher rates of condomless anal sex (CAS), HIV, and STIs than MSM who do not engage in exchange sex. To gain a better understanding of the factors that influence MSWs’ engagement in CAS with male clients, we analyzed qualitative interview data from a diverse sample of 141 MSWs from 8 U.S. cities who met clients primarily through hookup or dating apps/websites and who reported having condomless anal sex with at least one of their exchange sex partners in the prior three months. While high client demand and financial incentives were the most frequently mentioned reasons for engaging in CAS with clients, other factors including drug and alcohol use, attraction to the client, the heat of the moment, concerns about sexual performance, and reliance on pre-exposure prophylaxis (PrEP) were also important. Participants who engaged in CAS generally felt that due to client characteristics or mitigating steps they had taken themselves, their chance of acquiring HIV/STIs was acceptably low. Hookup or dating apps/websites have provided an additional and increasingly popular venue for exchange sex to be arranged. These platforms also offer an opportunity for HIV/STI prevention through interventions and tailored messages delivered through these venues that address the motivations, misconceptions and/or situational factors that may lead to CAS.

Among the many effective prevention strategies, frequent HIV testing continues to be promoted to reduce the risk of HIV transmission among sexual minority men (SMM). Testing negative for HIV can result in varied reactions that influence subsequent HIV transmission behaviors, yet the extant research has primarily been conducted in English. The current study examined measurement invariance of a Spanish-translated Inventory of Reactions to Testing HIV Negative (IRTHN). The study also examined whether the IRTHN was associated with subsequent condomless anal sex. Data were drawn from 2,170 Latinx SMM subsample of the UNITE Cohort Study. We conducted a multigroup confirmatory factor analysis to test for measurement invariance between participants who opted to take the survey in English (n = 2,024) and those who opted to take it in Spanish (n = 128). We also examined if the IRTHN is associated with subsequent CAS. The results were suggestive of partial invariance. The subscales of Luck and Invulernability were associated with CAS at the 12-month follow-up. Practice and research-based implications are discussed.

Men who have sex with men (MSM) continue to constitute the majority of HIV incidence in Taiwan. This study examined the associations between five co-occurring psychosocial health conditions (PHCs)–childhood physical abuse (CPA), childhood sexual abuse (CSA), intimate partner violence (IPV), internalized homophobia (IH), and methamphetamine use (MU), and two outcomes (HIV infection and condomless anal sex) among a community sample of 1,000 Taiwanese MSM (mean age 28.5 years). Compared to MSM who had never experienced any PHC, MSM with one or more PHCs had greater than twofold higher odds of being HIV-positive, and those with three or more PHCs had twofold higher odds of having condomless anal sex. Interactive effects on HIV infection were identified from CPA + CSA + MU and CPA + IPV + MU. An interactive effect on condomless anal sex was detected between IH and MU. In order to control the escalating HIV epidemic among MSM in Taiwan, interventions are needed to address syndemic psychosocial health conditions.

The majority of new HIV infections in the US occur among sexual minority men (SMM) with older adolescent and emerging adult SMM at the highest risk. Those in relationships face unique HIV prevention challenges. Existing sexual HIV transmission risk interventions for male couples often encounter implementation challenges and engaging younger SMM early in relationships may be particularly difficult. This pilot randomized controlled trial evaluated the acceptibility and feasibility of We Test HIV testing – a behavioral health intervention tailored for younger SMM in realtionships – and generated preliminary estimates of effect size. The intervention comprises two adjunct moduls – video-based communication skills training as well as communication goal setting and planning – delivered in conjunction with routine HIV testing and counseling in individual or dyadic formats. A sample of 69 SMM aged 17 to 24 were recruited online. Following baseline assessment, youth were randomized to receive either the experimental, We Test, intervention or routine HIV testing (the control condition). Follow-up assessments were completed 3 and 6 months post-baseline. Results suggested the study was feasible and the individually delivered format was acceptible. We Test HIV testing was associated with significant improvements in communication skills. In addition, youth who remained in a relationship experienced an increase in communal coping to reduce HIV infection risk and relationship power. While groups did not differ with respect to condomless anal sex with casual partners, these psycho-social constructs (communication, communal coping with HIV prevention, and relationship power) may serve as mediators of intervention effects on sexual risk reduction in a larger study.

We conducted a series of studies to validate a new scale of stigma toward anal sex, culturally tailored to cisgender men who have sex with men (MSM). In Study 1 we conducted in-depth interviews (N = 35) to generate items. In Study 2, we reduced the item pool through an online survey (N = 268), testing scale performance, dimensionality, and convergent and discriminant validity. For Study 3, we recruited another online sample (N = 1605), randomized to exploratory or confirmatory factor analyses to finalize item reduction, then assessed validity among sexually active MSM (n = 1263). Final subscales encompassed self-stigma (6 items, Cronbach’s α = .72), provider stigma (5 items, Cronbach’s α = .79), and omission of information (6 items, Cronbach’s α = .73; full 3-factor scale = .80). We developed a 17-item measure, grounded in the lived experience of cisgender MSM. Future work should examine associations with health-seeking behavior.

Gay and bisexual men (GBM) have reported viewing significantly more sexually explicit media (SEM) than heterosexual men. There is some evidence that SEM depicting bareback anal sex may be linked to engagement in condomless anal sex (CAS) and thus HIV/STI transmission among GBM. A nationwide sample of HIV-negative GBM in the U.S. completed an online survey that included measures on SEM consumption (both overall frequency and percentage viewed depicting bareback sex) and reported on CAS in the past 3 months. Data showed that there was no main effect for the frequency of SEM watched in association on either the number of CAS acts with casual partners or the probability of engaging in CAS during a casual sex event. However, there was an interaction between amount of SEM consumed and percentage of bareback SEM consumed on both outcomes, such that men who reported both a high frequency of SEM consumption and a high percentage of their SEM being bareback reported the highest levels of risk behavior. These findings highlight the role that barebacking depicted in SEM may play in the normalization of sexual risk behaviors for GBM. Interventions looking to target the role SEM may play in the lives of GBM should examine what variables may help to mediate associations between viewing SEM and engaging in risk behavior.

We assessed how egocentric (i.e., self-generated descriptions of a person’s social contacts) network structure and composition corresponded with reported instances of condomless receptive and insertive anal intercourse with men who were reportedly HIV-infected or of unknown HIV serostatus in a sample of black men who have sex with men (MSM) in six U.S. cities. Ratings showing a higher percentage of network members who provided social participation and medical support were positively associated with reporting condomless sex. There were also significant positive associations between stimulant use and condomless insertive and receptive anal sex. Future research should examine the social processes that underlie these associations and explore ways that social support can affect HIV prevention efforts for black MSM.

This study was conducted among predominately African American/Black women, aged 18–29, in Northeast cities with high HIV prevalence. Demographic, behavioral, and partner characteristics associated with condomless vaginal and anal sex acts with high-risk partners (CVS-HRP and CAS-HRP) and with HIV testing were explored. The high-risk sample was largely recruited online. Of 4972 women screened, 2254 (45.3%) were high-risk for HIV acquisition; 2214 were included. Bivariate and stepwise multivariate logistic regression models were fit. After adjusting for other factors, sex risk behavior did not differ by race and ethnicity. CAS-HRP was associated with believing condoms don’t reduce HIV risk and with several high-risk behaviors, including; alcohol use, multiple partners, and sex with men who had sex with men, but, not with HIV testing. Half the sample had condomless sex with partners who never HIV tested and were themselves three times as likely to have never tested. These results point to the ongoing need for effective prevention strategies among at-risk heterosexual women.