Open in a separate window Arrest History and Intimate Partner Violence We then considered whether factors relating to psychosocial burden differed between sex party attendees and nonattendees. No difference was found between attendees and nonattendees with regard to partner violence. Total Burden in relation to Sex Party Attendance Finally, we compared attendees and nonattendees with regard to the total burden score.
In that regard, our findings suggest this intersection of risk profiles may also represent an important venue for public health interventions in sex party environments as a part of comprehensive HIV prevention. This combination of risk factors creates an overall profile in sex party attendees that is significantly different from that of their peers. More specifically, sex party attendees reported significantly higher frequencies of sexual risk taking, including more lifetime partners, more recent sex partners, and more recent casual sex partners.
Sex party attendees also reported higher levels of substance use, including methamphetamine, powder cocaine, crack cocaine, nonprescribed PDE-5 inhibitors, nonprescribed benzodiazepines and nonprescribed HIV medications, as well as a higher total of unique drugs used in their lifetime. Lastly, sex party attendees indicated a significantly greater amount of psychosocial burden including history of arrest and physical abuse by a boyfriend or partner.
While previous studies have paralleled our findings for sexual risk taking, 7 — 10 , 41 drug use, 25 , 42 , 43 and psychosocial burden 44 — 46 as separate indices of risk, the present analysis accounts for each risk factor in combination.
In doing so, risk factors may be understood as acting in concert, compounding the risk to the individual or even elucidating characteristics of individuals who may be likely to navigate certain types of venues and engender higher levels of sexual risk. With regard to the sex parties being risky in and of themselves, the sex party environment may be a catalyst for risky behavior which may result in HIV exposure or transmission. For example, a third of respondents indicated that there were both HIV-positive and HIV-negative men present at the parties they attended.
Further, only about half of the respondents indicated that the party that they had attended provided adequate HIV prevention materials including both lubricant and condoms.
Previous literature has documented patterns of serodisconcordant attendance at sex parties 9 , 47 and high rates of unprotected sex to be commonplace in these group settings. While this finding may be an artifact of our overall sampling strategy, men of color do shoulder a disproportionate share of new HIV infections, 3 and thus sex party attendance may potentially facilitate and perpetuate these disparities.
Our data indicates that YMSM who attend sex parties undertake more risk than their nonattending counterparts and supports the ideas put forth in Pollock et al. It is this combination of risk, both individual and environmental, which has the potential to manifest itself synergistically creating a level of risk greater than then the sum of its parts.
The pattern of multiple risk behaviors noted within this sample is consistent with the theory of syndemics, which posits that illicit drug use interacts synergistically with psychosocial burden and sexual risk taking behavior. Such an understanding is also supported by the tenents of the cognitive escape model, 53 which suggests that environments such as sex parties facilitate disinhibitory behavior leading to high levels of risk.
Further, only a small group of overall respondents indicated sex party attendance. Lastly, while men who attended sex parties had significantly more overall partners, they did not differ significantly with regard to acts of unprotected anal intercourse. With these limitations in mind, it is difficult to generalize our results to all YMSM, nor can we infer specific causal links between sex party attendance and HIV transmission.
However, our study is the first to our knowledge to collect data regarding sex party characteristics and attendance in a racially and ethnically diverse sample of YMSM in an urban area. Conclusions Our data suggest that YMSM who attend sex parties may have both a propensity for and susceptibility to risk taking behavior and are arguably at a substantially greater risk for exposure to or transmission of HIV and other sexually transmitted infections.
Thus, this may represent a key population for HIV prevention efforts. However, in direct opposition to these public health implications, many urban centers with a large MSM population such as San Francisco and NYC 10 , 31 , 54 have enforced closure of commercial sex environments e.
Further, public health advocates believe this policy only serves to force group sex into private spaces. Such findings are consistent with other recent literature 9 , 29 , 49 , 56 — 59 and have served to undermine the ability of public health organizations to provide safer sex materials and educational interventions to sex party attendees. Additionally, recent research has demonstrated the effectiveness of pilot programs that have sought to partner commercial sex environments with groups offering HIV testing and education onsite.
Thus, a causal relationship between sex party attendance and the transmission of HIV cannot be determined from the data presented here. Further, while sex parties do share characteristics with both commercial and public sex environments, they are in fact a unique setting that deserves further study and for which effective HIV interventions must be tailored. Rare cancer seen in 41 homosexuals. HIV Surveillance Report, Centers for Disease Control and Prevention; AIDS-related risk among adolescent males who have sex with males, females, or both: Am J Public Health.
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