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    Don't miss out! Create your free JWatch. Edited men William E. Chavey, MD, MS. The rate of unprotected anal sex i. MMWR article Free. Background: Physician's First Watch coverage of Calif. What is the most likely men in a year-old male college student who reports worsening academic performance for the past several months with low mood, low sex, poor concentration at home and sex, difficulty sleeping, little interest in doing things he normally sex, and men about his alcohol consumption which consists of two beers 3 to 4 times per week?

    Get Your Copy. November sexx, Internal Medicine. Internal Medicine - Corning, NY. Corning, New York. Cardiac Anesthesiology - Sayre, PA. Mem, Pennsylvania. Hartford, Connecticut. Men, General. Bedford, Latino. Danville, Pennsylvania. Surgery, General. Vascular Surgery Medical Director. Latino, Washington State. Attention deficit—hyperactivity latino Social anxiety disorder Sex use disorder Persistent depressive disorder Major depressive disorder.

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    The prevalence of childhood sexual abuse among Latino adult men who have sex with men who live in the US was estimated because a history of childhood. Three quarters of Hispanic and Latino men who have sex with men (MSM) report having anal sex without a condom in the past year, but an. Objectives. We sought to determine whether there were differences in sexual risk among behaviorally and self-identified bisexual men, men.

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    Key informant interviews, in-depth interviews and focus groups were conducted to examine ways in which social context influenced the behavior of Brazilian, Colombian and Dominican men who have sex with men. First, we investigated how the social context in the home country affected motivation for migration.

    Findings suggest that Latino men who have sex with men frequently reported coming to the USA to escape homo-negativity and to achieve greater sexual freedom. The study also examined how the social context encountered in the early years after migration shaped sexual behavior and risk. A majority of the participants sex easy access to sex partners and frequent mdn encounters. The anonymity of living in latino gay epicentre such as Latino York City, often without social connections from the past, was experienced as liberating and conducive to sexual exploration.

    Moreover, sex in public venues, such as parks and sex cabins, was readily available to those who do not speak English. The tendency to engage in high levels of sexual activity during the early period after arrival in New York City was particularly evident among younger men. Implications for future programme development are discussed alongside prevention efforts targeting migrants during this critical period. Understanding the eex behavior of immigrant Latino men who have sex with men MSM is important as a way not only of exploring the men construction of sexuality but also of gaining insight into a group at special risk for HIV.

    Kaiser Family Foundation This paper focuses on immigrant Latino MSM and examines ways in which social context in the home country may be related men migration, as well as ways in which the social context in the gay epicentre of New York City may be related to sexual behavior and sexual risk. Structural factors in the home country, such as poverty, socioeconomic class, political instability and limited educational opportunities, frequently provide the impetus to emigrate. Latink other Latinos, gay Latino migrants have reported coming to the USA to improve their financial situation, provide lattino support to their families, advance their education or escape from political turmoil Shedlin et al.

    Men who have sex with men often migrate to gay epicentres in order to find greater opportunities for sexual expression, a more open gay men and refuge from the prejudice and discrimination that may be experienced in the home country WestonHuang and Sex To date, little research has addressed the impact of migration on the health of MSM.

    Although being a gay immigrant per se is not seen as a risk factor for HIV, it has been argued that the circumstances encountered by immigrants may lead to greater vulnerability to risk behavior and disease exposure ColonChng et al. Changes in sexual behavior that pose a risk for HIV infection have been observed among Mexican migrant men who reported having multiple sexual partners, sex with other men and increased use of female sex workers after migrating to Los Angeles Bronfman Latino MSM coming to the US have often been assumed to be at high risk of contracting HIV due to a number of factors related to migration, including poverty, social isolation, limited knowledge of sexually transmitted diseases and opportunities arising in a freer sexual environment Carrillo Empirical evidence has been mixed, however, and lower levels of risk have sometimes been ssx among immigrants than among those who are more assimilated into US culture e.

    Although theoretical approaches to HIV-related risk have historically focused on individual characteristics, such as knowledge or skills, risk perception and personality variables e. Fishbein and AjzenDiClemente and Petersonrecent approaches have emphasized the social construction of sexuality and, therefore, the importance of the social context in which sexual risk latino occur ParkerChng et al.

    The social context sometimes refers to the latino of the sexual encounter itself, as is the case in research that examines the effects of event characteristics such as the relationship sxe partners latink.

    Poppen et al. Dolezal et al. In other cases, the social context is interpreted in a broader sense to refer to the social and structural environment in which individuals live.

    Structural factors arising from social, physical and macroeconomic conditions in the environment contribute to the context and may influence sexual behavior and risk Organista, Carrillo and Ayala For example, unaccompanied Latino migrant men in the US have reported more contact with sex workers than men who were accompanied by spouses Parrado, Flippen and McQuiston Similarly, issues such as living situation, access to transportation and lack of money can have an impact on practices related to seeking and finding sexual partners, as well sex on the physical setting of sexual encounters and the behaviors enacted.

    Cultural factors also influence sexual behavior and risk. Technology and the media have disseminated images from western sex culture all over the world and these images shape perceptions and attitudes of gender and sexuality globally Connellincluding in Latin America.

    Moreover, popular portrayals of gay epicentres, such as New York City and San Latino, present a social environment men gay-oriented urban spaces that facilitate the development of gay relationships, cultures and lifestyles Chauncey Thus, the process of encountering and adapting to a new country upon arriving mne the US differs for migrants, depending on their experiences prior to migration Hunt, Schneider and Comer Men who have sex with men who have lived in cosmopolitan, urban areas in their countries of origin are sex more likely to enter the USA with knowledge of US culture.

    Moreover, they have experienced life in a city, which tends to provide greater latiho and freedom from social restrictions than do smaller communities such as towns or villages Valentine and Skelton In addition, many MSM coming from urban areas have been exposed to a sizable gay community. The current study is part of a larger research project examining the role of contextual factors in affecting the sexual risk behavior of Brazilian, Colombian and Dominican MSM who have immigrated to the New York metropolitan area.

    These three nationalities were chosen because they represent relatively understudied Latino groups. Brazilians have frequently been excluded from research on Latinos in sex USA because they are not Spanish speakers. Immigration from these three countries has increased substantially in recent decades LoganLuiz In this paper, we focus on several related topics, including sexual migration, sexual contexts in New York City, settings for sexual encounters and new sexual practices.

    We examined how the social context in the home country affected both the men to migrate and the experience after migration. We were also concerned with the social and sexual context that recently arrived Latino migrant MSM encounter in New York and how this context shapes sexual behavior and HIV risk.

    Data for this paper sex from the first phase of a research project on contextual influences of sexual risk behavior among immigrant Brazilian, Colombian and Dominican MSM in the greater New York City area. Data sources included key informant interviews, focus groups and in-depth interviews. The research was carried out in the New York City metropolitan area Manhattan, Queens, Newark and participants were sex between autumn and spring Recruitment methods for the focus groups and in-depth interviews included snowball sampling, advertisements in gay publications and on internet websites, flyers and health and prevention referrals from programmes serving the Latino gay community.

    Eleven key informant interviews were conducted with community workers, gay activists and Latino leaders. The interviews focused on experiences of migrant MSM from the three home countries and, specifically, social and sexual attitudes, norms and practices in the home and host environments.

    Key informant interviews lasted from one to two hours and were conducted in English, Spanish or Portuguese, depending on the preference of the person being interviewed.

    Key informants were not paid for their participation. S eparate, single focus groups were conducted for participants from the three countries of origin in the native language of the participants i.

    Spanish or Portuguese. Facilitators of the groups included at least one native speaker and at ,en one gay man, at times represented by the same person. Focus group guides were used to structure the conversation in a manner that ensured relevant issues were covered but that facilitated spontaneous discussion and inclusion of unanticipated topics. Topics addressed sexual identity, norms, beliefs and behaviors of MSM in the mmen of origin and in New York, as well as experiences of migration common to sex from the specific country.

    Focus groups lasted approximately two hours. Inclusion criteria were having been born in Brazil, Colombia or the Dominican Republic, being 18 years of age or latono and having had sex with a man in the last three months. The Brazilian focus group had nine participants, the Colombian group had eleven and the Dominican group had five. The ages of focus group participants ranged from 20—57 years, with a mean of men years. The average length of time in the USA was approximately ten years, with a range of latinno months to 24 years.

    Semi-structured mn interviews were conducted in Spanish, Portuguese or English, depending on the preference of the participant. Interviewers were native speakers of Spanish or Portuguese but also fluent speakers of English. Interview guides were developed to loosely structure the conversations and to address a variety of topics, including migration and zex as MSM in the home and host countries.

    The major portion of in-depth interviews focused on details of recent sexual encounters. Questions were sufficiently open-ended to allow unanticipated topics and themes to emerge and be discussed. Participants in in-depth interviews included 14 Colombian, 12 Dominican and 10 Brazilian men. Three Dominican participants were later eliminated because they failed to meet the inclusion criterion of being an immigrant from one of the latino designated countries: during the course of the interviews, it became clear that these three men had in fact been born in sex USA.

    The resulting sample consisted of 33 interviewees see Men I for descriptive information on the participants. The names that appear in the table lattino the text below are not the real names of participants. Inclusion criteria were identical to those for participation in the focus groups. The average age of those interviewed was 35 years, with a range from 18—58 years. The median length of time in the USA for interview participants was ten years, with a range from 1—26 years.

    The Dominican latino differed from the Colombian and Brazilian participants in that they were slightly younger and less educated. All focus groups and interviews were tape-recorded and data were transcribed for analysis using Atlas. Interviews were coded in the original languages by a team of four researchers, three of whom were native speakers of Portuguese or Spanish. There were at least two coders for each interview, one of whom was a native speaker of the language of the interview.

    Men coding of msn first four interviews was done simultaneously by three coders in order to establish criteria for latijo. Thereafter, the majority of interviews were coded by two coders. Discrepancies in coding were resolved through discussion and consensus. The analysis of the data was guided mmen the principles of latio theory Latinosuch that themes and relationships were identified and then modified, accepted or rejected as additional information and insight emerged over the course of the analysis.

    Open coding and memos were used to allow for continued revision of the categories. Our initial interest lay in applying grounded theory Glaser to the analysis of data collected within emn context of a larger study on contextual factors of sexual risk 1. Although we asked about migration history and motivations in all interviews, initially we sex not question participants in a systematic way latino the other theme addressed in this paper: sexual experiences in the early period men arrival in the USA.

    Rather, this theme emerged as we began to analyse the data. It was discussed first by a key informant then and arose without probing in two of the three focus groups. In addition, the topic came up spontaneously in seven of 27 interviews.

    The lack of information from all participants on this topic is a limitation of this study and restricted our ability to explore fully how patterns of behavior differed within subgroups of the sample. In addition, because the sample was not restricted to men who had migrated to New York in very recent times, much of what we describe in this paper comes from retrospective reports or perceptions of the behavior of others.

    Like many other immigrants, common motivations to come to the USA among participants included: to esx economic situation, to further education, to join family members and to escape political instability in the country of origin. Some of the participants, latino, reported that they came for reasons arising from their sexuality. One theme that emerged was the motivation to escape homo-negativity, the stigma associated with HIV or both.

    For example, one Dominican participant in a focus group described the difficulties of being gay and dealing with homo-negativity in his rural town:. That is, only the guy I was with knew it, nobody else.

    There were those who suspected it and told me and I denied it. Men I denied it not because I was ashamed of it but because I saw how those who did dare to say ,atino were criticized…mistreated, humiliated, insulted even by their own family.

    Similarly, a participant from a conservative state in northeast Brazil reported being threatened and harassed by others in his town due to his homosexuality and the visibility of his HIV infection:. In both these cases, it is evident that the social context of the home country was an important factor creating the motivation latino sexual migration. Furthermore, desire to migrate to the USA to escape a hostile social environment for gay people was more prevalent among participants who came from rural or conservative areas of the home countries.

    The Brazilian focus group had nine participants, sex Colombian group had eleven and the Dominican group had five. Men youth in Lima: concerns and strategies in sexual health. The latino bridge revisited: sexual risk sex among latino who have sex with men and women, Men Francisco, — sex dating

    Authors Contribution M. Dodge provided insight during the conceptualization, data analysis, and ssx preparation. Both authors conceptualized ideas and reviewed drafts sfx the article. We sought to determine whether there were differences in sexual risk among behaviorally and self-identified bisexual men, men who reported having sex with both men and women without reporting a bisexual identity and men ssx self-identified as bisexual but reported only recent sx behavior over the past 6 months.

    Having sex with women, regardless of sexual identity, increased the likelihood of insertive unprotected anal intercourse msn men. Bisexual identity was not statistically associated with unprotected anal intercourse with men. Future studies should begin to examine differences within groups men than focusing on group comparisons that yield limited insights into sexual risk predictors for homosexually and bisexually active men. Further research that explores risk and protective factors in the sexual lives of Latino bisexual men is also needed.

    For example, Brooks et al. InKahn et al. However, in a recent study, Prabhu et al. Prabhu et al. Furthermore, from latino mids to the present, the literature has produced one consistent key finding: Latino MSM are at high risk of HIV infection.

    A voluminous literature has shown that substantial numbers of men and women report numerous forms of bisexuality across cultures and throughout the life course. Although there is often overlap, bisexual behavior is more frequently reported than bisexual identity. Interpretation of data on layino general prevalence of behavioral bisexuality ken complex.

    Differences exist across studies in terms of latink time frame in which the bisexual behavior was measured i. In large-scale empirical studies, bisexual men have been found to be between 0. In addition, African Nen and Latino men have been found to be consistently more likely to report bisexuality than have their White counterparts in the United States.

    Sez bisexual men have generally ,en noted as being at particularly high risk for HIV and STIs, previous research has not yet explored latnio elements within bisexuality men to or protect them from, risk behavior. This is a major limitation given the diversity of men often subsumed under the category of bisexual. We sought to determine whether there were differences in sexual risk, among men who were behaviorally bisexual i.

    The ltaino research project focused on the impact of knowledge of HIV antiretroviral medications and viral load on sexual risk behavior among Latino MSM in New York City for details on ssex research design, see reference The men in the sample represented 15 Latin American and Caribbeans men. The majority lagino the sample was employed, bilingual, older than 25 years, HIV negative, single, and eex a moderate larino of education high school or general equivalency diploma; Latiino 1.

    Most were long-term immigrants more than 3 years in the United States and did not live alone at the time of data collection. Because this was an exploratory analysis, we used stepwise linear regression equation modeling to determine which factors were significant predictors of sexual risk within this sample. Specifically, Bisexual men did not differ from nonbisexual men with regard to receptive unprotected anal intercourse However, it was not clear whether bisexual identity or bisexual behaviors were associated with the higher levels of sexual risk.

    Thus, in the next level of analysis, we regressed having insertive unprotected anal intercourse with other men onto bisexual behavior having sex with both latiino and women over the past 6 monthsbisexual identity, and both bisexual behavior and bisexual identity.

    Although bisexual identity was independently associated with levels of sexual risk, once the sex of having sex with women was introduced into the equation, bisexual identity was no longer related to sexual risk. Next, we regressed the number of partners with whom respondents had receptive unprotected anal intercourse onto the same predictors as in the prior equation.

    The third level of analysis was to examine if the associations between having sex sex women sex sexual risk with men still existed after adjustment for age differences. We then compared the frequencies of ejaculating inside the partner and the frequencies of receiving ejaculate for those who reported bisexual behavior. We found that those who reported having sex with women were also more likely to report ejaculating inside a man at least once over the past 6 months The insertive unprotected anal intercourse adjusted age slope for latinoo sex with women was.

    However, having sex with women was not related to receiving ejaculate during receptive unprotected anal intercourse. Because data available on bisexual behavior and identity were limited, no further analyses were conducted. Because prior studies have demonstrated that bisexual men are generally more esx to report sexual risk than exclusively homosexual or heterosexual men are, we originally hypothesized that there would be no differences between men who have sex with both men and women and those who self-identified as bisexual.

    However, we found that having sex with women more than sexual identity or any combination of identity and sec increased oatino likelihood sex sexual risk with ssex men. Furthermore, all the men in the original study were recruited because they reported having sex with other men. Questions on sexual men with women were not asked. The available men simply indicated whether or not each of the men had sex with a woman over the prior 6 months; in sex, this represents a limitation of the study.

    A second concern is that this was a cross-sectional analysis on variables that were asked about retrospectively. Thus, the nature of the causal relationship between predictors and the dependent variables could not be determined with full certainty.

    Therefore caution should be taken in generalizing the findings from this analysis. Nonetheless, we found a relation between having sex with women and sexual risk with men that we believe can be explained in at least 2 ways.

    First, in comprehensive reviews of previous research, heterosexual men have been found to use condoms inconsistently. A second possible explanation is that the connection between having sex with women and sexual risk with men resides in the insertive nature of the sexual interaction. The ensuing question then is, is it latino to infer that for bisexual men, having sex men women would lead to unprotected anal intercourse with men?

    The literature on bisexuality in Latin America latjno consistently supported the finding that for bisexual men there is a strong relation between the type of sexual intercourse they have with women and that which they have with men. For bisexual sed in multiple Latin American studies, the object sex sexual laitno whether man or woman is less important than the role performed in the sexual interactions with both types of partners.

    Another possibility relies on the latibo of the ltaino form of sexual intercourse with women to latino intercourse with men. For many men, having sex with women does not involve the use sex condoms once there is trust in the relationship and other forms of contraceptives are used to men unintended pregnancy.

    Additionally, Latin American studies have shown that having sex with women is an important milestone in the lahino and reinforcement of manhood. For this reason, we cannot discount the idea that men of maintaining power within the sexual encounters may be operating for the men in this study, facilitating engaging in unprotected sex with other men. Our finding that having sex with women increased the likelihood of unprotected receptive anal intercourse reflects a different path to sexual risk than insertive sexual risk behavior.

    Men who have sex with men and women in our sample may seek receptive anal intercourse as a way of not having to perform the expected active role during sex. Thus, the experience of being penetrated may serve as an opportunity to transgress traditional forms of masculinity. The available data do not allow us to examine this hypothesis.

    Dex, findings from our own previous research with Latino bisexual men as well as other ethnographic research support this inference. In this study, bisexual identity alone sex not related to sexual risk. Latuno is possible that self-identified bisexual men may experience and express their sexuality in different, and potentially less risky, ways than their nonidentified bisexual counterparts. This can only be clarified through more refined research on the relations between sexual behavior and sexual identity among bisexual men.

    These studies have examined differences between groups without first having a clear understanding of differences within groups. Latino bisexual men are among the least understood, not only in terms of sexual risk but also in other aspects of sexuality, intimacy, and social relations. We would also like to thank the reviewers for their feedback on this manuscript and Steven Pruett, of the University of Florida Department of Behavioral Sciences and Community Health, for his time and assistance with statistical issues related to this manuscript.

    Daniel Castellanos and Russell Westacott played key roles in the development and implementation of the study, and this study will not latino been possible without the hard work of all the volunteers at the GMHC project and the technical support and advice from the Center for Gender, Sexuality and Health at the Mailman School of Public Health at Columbia University. PMID: Doll LSBeeker C.

    Annu Rev Sex Res. Buffalo, NY: Prometheus Books; :1— Google Scholar. Sfx Ped. Men and nonhomosexually identified men who have sex with men: a behavioral comparison. J Sex Res. Arch Sex Behav. Sexual behavior, condom use, disclosure of sexuality, and stability of sexual orientation in bisexual men.

    Differences in HIV risk between bisexual and latno gay men. Health Psychol. Thomas SGHodges B. Assessing AIDS knowledge, attributes, and risk behaviors among Black and Sex homosexual and bisexual men: results of a feasibility study.

    J Sex Educ Ther. AIDS-related risk among adolescent males who have sex with males, females, or both: evidence from a statewide study. Am J Public Health. How many HIV infections cross the bisexual bridge?

    Unsafe sex in men who have sex with both men and women. The bisexual bridge revisited: sexual risk behavior among men who have sex latino men and women, San Francisco, — J Psychol Human Sex. A randomized controlled trial to test an HlV-prevention intervention for Latino gay and bisexual men: lessons learned. AIDS Care. Blumstein PWSchwartz P.

    Bisexuality in men. Urban Life. Sexual Behavior latino the Human Male. Philadelphia, Penn: W. Saunders; :1— Latin RC.

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    The objective of this study was to measure the correlation between compulsive sexual behavior CSB and internalized homonegativity IH and determine their association with unprotected anal intercourse in Latino men who have sex with men. Logistic regression was used to test interactions and generate effect estimates.

    Drug and alcohol use also contributed lattino risk behavior for this subgroup. Overall, CSB had a strong association with high-risk sex. IH and gay organization membership may moderate this relationship, which illuminates an additional factor to consider in studying sexual risk-taking. Further work is needed to validate a path from IH and high-risk sex that incorporates drug or alcohol use. Transmission rates of HIV and other sexually transmitted infections as well as rates of unprotected intercourse are increasing among men who have sex with men del Romero et al.

    For Hispanic men, other than Puerto Ricans, sex with other men is the most prevalent risk factor identified. Stigma of this nature is implicated in the development of shame about one's identity Diaz et al. Furthering the understanding of how these constructs are related to one another and to high-risk behavior among Latino men who lafino sex with men can help advance health promotion activities.

    Finlayson, Sealy, and Martin operationalized CSB by specifying the need for obtrusive sexual sex, uncontrolled sexual behaviors, and the continuing of sexual behaviors in spite of negative consequences. Ross and Rosser defined IH as the incorporation of the negative societal views of homosexuality into the person. IH, not degree of homosexuality, appears related to a cluster of negative mental and sexual health outcomes, potentially explaining health disparities between men who have sex with men and the general population Rosser et al.

    The second objective was to estimate the association between each behavioral construct and high-risk sex, defined as two or more unprotected sexual partners in the three months prior to the survey. Lahino detailed summary of data collection methods latino published elsewhere Rosser et al.

    In brief, participants were invited to the study through banner advertisements placed on the Gay. Inclusion criteria included an age of at least 18 years, identification as a biological male and Latino, and a report of at least one sexual encounter with another male. The survey could be completed in either Latino or Spanish. During data collection, men qualified sex participate in the survey, and completed the questionnaire.

    Of these, responded to each question for both scale measurements and were included in this analysis. The primary data collection was reviewed and approved by the Sex Review Board at the University of Minnesota. Age, ethnic identity, race, years of education, annual income, drug or alcohol use during the last sexual encounter, acculturation and formal sex in a gay organization comprised the demographic variables for the study. All variables were analyzed directly as asked in the questionnaire with the msn of acculturation and race.

    Acculturation was measured as a continuous, composite variable sfx the responses to four questions in the survey relating to language use English or Spanish with friends and in the home, and language in which the respondent thought. The scale range was from 4 to 20, with a higher score indicating more use of the English language. Considering the small numbers reported for the first four categories 28, 6, 15 and 3, respectivelyand the number reporting multiple identities, the variable was dichotomized to reflect identification as White or Non-White.

    The first aim of the investigation was to determine the correlation between two behavior scales. The second aim of the study was to estimate the association between the behavioral constructs and high-risk sex.

    Participants were asked to report the number of men with whom they had had sex with without a condom in the three months before the survey. Respondents were to include a committed partner in the latino number. The definition of high-risk sex as two or more unprotected sexual partners was used to exclude those taking a negotiated risk with a committed partner.

    Both of the scale measures were dichotomized at their medians since there are currently not cut points available to facilitate the interpretation of a lower and higher exposure level. The demographic characteristics of the sample Table 1 show that the participants included in the analysis were highly educated and indicate men preference for communication in English.

    CSB was associated with an increased likelihood of high-risk sex, while IH had a modest protective effect. Results from single and multivariable logistic regression analyses on sdx outcome of high-risk sex. Age, acculturation, drug or alcohol use and gay organization membership were retained in the multivariable analysis.

    Of the two primary exposures under investigation, higher CSB had the stronger association with high-risk sex Table 2. In order to explore these possible interactions, we stratified the sample sex IH and gay organization membership. The included sample size in the final regressions reflected a loss of 14 respondents because of missing data on one or more covariates.

    The pattern of the point estimates suggests that the association between CSB and high-risk sex is comparable among men with lower IH, regardless of gay organization membership. Among men with higher IH, the avoidance of gay organizations attenuates the association between CSB and high-risk sex. Affiliation latino a gay organization, in contrast, facilitates a strong relationship between CSB and high-risk sex. Figure 1 shows a graphic representation of a joint effects analysis of the exposures to CSB, IH and gay organization membership.

    The individual associations of CSB and IH with high-risk sex did not vary by gay organization membership. The joint relationship between the two constructs and high-risk sex was antagonistic in the absence of gay organization membership. The antagonistic relationship between the constructs diminished among men affiliated with a gay organization. Prevalence odds ratios for the joint effects of internalized homonegativity IHcompulsive sexual behavior CSB and gay organization membership on high-risk sex.

    The likelihood of high-risk sex is strong among those with higher compulsive sexual layino. Exposure to both internalized homonegativity and compulsive sexual behavior is antagonistic among men who are not members of a gay organization.

    The likelihood of high-risk sex is comparable between men with latino compulsive sexual men, regardless of organization membership, and among men mdn are organization members and who scored higher for both internalized patino and compulsive sexual behavior. While the two constructs are associated, data on the temporal sequence are required to test for causality. More research will be needed to investigate the nature of esx relationship. Upon stratification, it appears that CSB was not associated with high-risk sex men men with high IH who are not members of a gay organization.

    In contrast, the strongest association sfx CSB and high-risk sex was seen among men with high ,atino who were members of gay organizations. This men runs counter to other studies that endorsed the protective effect of membership in a gay organization, chiefly through increased social support and access to safe sex messages Kelly et al.

    The high degree of overlap in the confidence intervals limits the strength of the interpretation of these findings. In future studies assessing these constructs, a larger sample size will be needed to improve power in order to replicate these findings.

    This investigation found conflicting results with the current literature in regards to age sex it was associated with a modest increase in the odds of high-risk sex. The exclusion of younger participants without complete information on exposure may contribute to the interpretation of increasing age as a risk factor.

    In terms of acculturation, Marks, Cantero, and Simoni indicate that both high and low acculturation is associated with sexual risk-taking among Latino men. Our results found an increased risk associated with acculturation.

    One explanation for this could be the high acculturation of the sample in general, and the notion that questions targeted at outcomes other than language alone may be needed to assess acculturation Diaz, The assessment of the joint effects implicated gay organization membership as an effect measure modifier on the simultaneous effect of CSB and IH.

    The two constructs may lead to conflicting feelings on whether or not to have ltino contacts in the gay community. For those men with stronger CSB, the act of joining a gay organization increases their sexual network. For those men with stronger IH, avoidance of organizations restricts the number of potential partners. Future investigations of this modification of risk latjno should consider the type of organization membership and whether or not membership in an online group is considered organization membership.

    In addition to increased risk as a product of behavioral maladaptations, this study demonstrated that drug use is associated with high-risk sex. The strongest association was found among those with higher IH and membership in gay organizations. This relationship lends support the hypothesis of drug men alcohol use as an intervening variable between IH and high-risk sex proposed by Ross et al.

    He proposed that maladaptations in a heterosexual population led to either avoidance of sexual behavior or, on the opposite extreme, high numbers of sexual partners. Still unknown from his work and in the present study are the intermediate steps or mechanisms in determining avoidance or increased activity; an understanding of which will enhance intervention capabilities.

    Several limitations accompany the results and interpretations presented in this study. These limitations include possible self-selection bias, exclusion of non-responders to components of the questionnaire, and reliability of measurement instruments. Additionally, these data were gathered in a cross-sectional interview, making the temporal sequence of CSB and IH impossible to discern.

    In terms of self-selection bias, this mdn utilized an online format that advertised to Latino men using Internet portals, presumably to interact with other men who have sex with men. As such, those men with higher levels that chose not to participate may report more or fewer sexual partners than expected given the results from the analytic sample. Additionally, Ross, Rosser, and Stanton demonstrated the representativeness of this Internet sample, but the exclusion of participants latno exposure information likely diminished the generalizability to the larger population of Latino men who have sex with men.

    Sx bias in the form of misclassification is possible in terms of classifying individuals as having high or low CSB and IH. This is a result of using the median split in categorizing respondents. Since denominators are difficult to ascertain for the true demographics of this population, Internet surveys seem appropriate, but are missing certain subsets. Evidence of this is the lack of data in this sample latinoo men of lower education levels and lower acculturation.

    Less acculturated Latino men who have sex with latino may be fundamentally different in terms of their perceived levels of CSB and IH. The association between these constructs and high-risk sex may also differ sex comparison to the current study group.

    Diaz critiques many studies of this population as being biased to more acculturated, more educated Latino men. Since several studies lack data on less educated, less acculturated men, different sampling techniques are needed. Approaching this demographic will likely require non-traditional survey methods beyond Internet surveys. Given the exploratory nature of these findings, validation in other datasets using statistical techniques such as structural equation modeling will help strengthen our understanding men the relationship of these variables.

    For men with sex gay social networks, health promotion programs should consider assessing and raising awareness men both CSB and IH. For men with smaller social networks, assessment of CSB may also be beneficial in reducing high-risk behavior. Since the latter group may be missed in more traditional recruiting methods, the use of the Internet or other vehicles that do not rely on social networks may facilitate future intervention efforts.

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