Friday, November 28, 2008

Differences Between Black Men Who Have Sex with Men and Black Men Who Have Sex with Both Women and Men

The previous blog entry discussed the first article in a special section of the recent issue of the Archives of Sexual Behavior. The journal presents a number of articles devoted to the issues and complexities involved in Black male bisexuality and its connection with risk. As was noted previously, very little scientific research exists regarding the topic.

One article in this series by Darrell Wheeler and his colleagues compared Black men who have sex with both men and women (MSMW) to Black men who have sex only with men (MSM). The authors did not categorize the men in the study in terms of whether they identify as gay or bisexual, but rather only in terms of the types of sexual behaviors in which they engage. This is because of the complexity of the way in which people apply sexual identity labels to themselves; individuals may engage in behavior that is inconsistent with the label they ascribe to themselves without the behavior affecting the way they view themselves. Specifically, in this case, men may engage in sexual behavior with other men, but view themselves as largely or completely heterosexual. Furthermore, the authors were concerned about the occurrence of risky sexual behavior, such as unprotected penile-anal and penile-vaginal intercourse; this of course is sexual behavior in which a condom is not used, which dramatically increases the risk of infection by a sexually transmitted disease. Consequently, they instead identified men in terms of the sex of their partners and also asked them about the frequency of engaging in anal or vaginal sex when not using a condom.

The study involved a very large number of participants, 1154 men from New York City and Philadelphia; 822 of the men actually met the criteria for inclusion in the study. Of these, 226 were men who have sex with women and men, while 596 were men who have sex with men. They were recruited through a procedure called respondent-driven sampling, a strategy to overcome the challenge of locating men who engage in sexual behavior with other men (contrary to stereotypes, it is not possible to accurately identify such men based on easily observable characteristics). In the respondent driven procedure, an initial set of men who engaged in sex with other men was located through community organizations; these men were paid $15 for each eligible individual they recruited for the study, up to a maximum of three individuals. Those who participated were then paid to recruit up to three other men to participate. The process continued until the researchers obtained the targeted number of participants.

The results of the study were that men who have sex with men (MSM) were more likely to be at risk for HIV infection, to be HIV-positive based on tests conducted for this study, but to be unaware that they had been infected compared to men who have sex with both women and men (MSMW). The men who have sex with men were more likely to report that they had engaged in unprotected sex in which their partner inserted his penis in their anus (unprotected receptive anal intercourse). No difference was found between the two groups in inserting one’s penis in a partner’s anus (insertive anal intercourse). The findings for receptive and insertive anal intercourse have been found in other studies that have not focused exclusively on Black men. The authors propose that MSMW and MSM are equally willing to accept the risk associated with insertive anal intercourse because it involves less risk, but that the greater risk associated with receptive anal intercourse causes MSMW to be less willing to be receptive during anal intercourse.

Important differences were found between the two groups in terms of their economic well-being, with MSMW having lower income, less education, and more likely to be unemployed than MSM. MSMW were also more likely to have engaged in recent exchange sex, having anal sex with a casual partner for money, drugs, a place to stay, or to get other resources they needed. They were also more likely to report recent substance use, being arrested two or more times in their lives, and supporting more than one person with their income. This suggests that men who have sex with both women and men may tend to engage in anal intercourse for economic reasons, because they need money to support themselves and others or to obtain drugs or alcohol. In fact, the strongest factor related to engaging in either receptive or insertive anal intercourse common to both MSMW and MSM was engaging in exchange sex.

The next most influential factor related to engaging unprotected anal intercourse for both groups of men was having a gay identity, that is explicitly labeling themselves as being gay or homosexual. Gay identified men were more likely to engage in unprotected receptive anal sex, as the authors state “the riskiest behavior associated with HIV infection” (p. 705). Sexual orientation identity did not relate to the tendency to engage in unprotected insertive anal intercourse, again possibly because it is relatively less risky than receptive sex.

As it turned out, the majority of men reported sexual orientation identities that matched the types of sexual behavior in which they engaged. That is, most men in the group labeled MSMW identified as bisexual and most men in the MSM group identified as gay. Nonetheless, substantial proportions of men in the MSMW group identified as heterosexual (24%) and substantial proportions of MSM identified as bisexual (25%). These results strengthen the generally accepted conclusion among scientists that sexual orientation identity is not extremely accurate in understanding the types of sexual behavior in which individuals may engage.

Wheeler, D. P., Lauby, J. L., Liu, K., Van Sluytman, L. G., & Murrill, C. (2008). A comparative analysis of sexual risk characteristics of Black men who have sex with men or with men and women. Archives of Sexual Behavior, 37, 697-707.

Tuesday, October 14, 2008

Dangerous Liaisons: How Accurate is the Idea of “the Down Low”?

Oprah Winfrey “stunned America” with the “shocking” exposé of Black men on “the down low” in her April 16, 2004 show, ‘‘A Secret World of Sex: Living on the ‘Down Low’’’ (Sandfort & Dodge, 2008). Or so it would seem, in her program highlighting the now well known, and somewhat controversial, book by J. L. King, On the Down Low: A Journey into the Lives of “Straight” Black Men Who Sleep with Men. (Quotations from this book are presented in my sexuality textbook on page 208.) In what can only be called a quantum leap, Oprah accelerated the popularization of the term, “down low,” in a way that only she could do as such a monumental media personality. The “down low” is the situation of a Black man, in this case, living and identifying as a straight man with a wife and family, while at the same time secretly engaging in sex and having intimate relationships with men.

In fact, King’s book was not the profound revelation that it was promoted to be by the Oprah Winfrey Show. The New York Times Magazine had published an article the previous year documenting an extensive examination of a secretive organized culture comprising primarily Black men who lived ostensibly as straight men. Several novels almost 10 years before this had also described the experience of Black male bisexuality (Sandfort & Dodge, 2008).

In the lead article of a special section of the Archives of Sexual Behavior, Theo Sandfort and Brian Dodge identify a number of conceptual difficulties with the notion of “the down low.” To begin with, a clear, stable definition of the phenomenon has not been advanced. The idea of “the down low” was originated in African-American culture to refer to any type of behavior an individual hides from others. By the 1990s, the term was used in rhythm and blues lyrics to refer to male infidelity. The more recent use of the term is a limited version of the earlier meaning. A change in its meaning also occurred when men began to use “down low” in reference to their identity, an aspect of their life that defines who they are.

Furthermore, the secretive, deceptive meaning associated with “down low” is yet another instance of the historical tendency to demonize not only sexuality in general, but specifically Black male sexuality (Sandfort & Dodge, 2008). Black male sexuality has been conceived in extremely negative terms throughout U.S. history, as animalistic and dangerous, since the days of slavery. Linking it to bisexuality, especially situations involving secretive affairs that put one’s spouse at risk for sexually transmitted disease and death, amplifies its dangerousness tremendously.

Yet, discussions of bisexuality in earlier times and involving other ethnic groups have not been treated with the same sinister reputation. In 1974, Newsweek created a sensation with an article “exposing” the “new bisexual chic.” Bisexuality was cast as the trendy, classy new pop phenomenon indulged in by celebrities and supermodels. Likewise, Latino bisexual men were not initially swept up in the highly negative perspective regarding the “down low;” this is despite research 20 years ago documenting the presence of surreptitious male-male sexual behavior among men who viewed themselves as heterosexual. Even Latino men, however, became linked with the idea of dangerous liaisons after the onset of the HIV/AIDS epidemic (Sandfort & Dodge, 2008).

Paraphrasing Sandfort and Dodge (2008), the concept of “the down low” became a handy, commonsensical explanation for the surge in HIV infections within African American populations. It is the great villain that made sense as the culprit because of its link to sexuality. Sexuality remains an issue about which much of our culture is still not comfortable, and that conjures feelings of anxiety, sinfulness, and even guilt and remorse. In their own words, “Although Down Low men seem useful scapegoats for the disproportionally high prevalence rates of HIV among Black women, any direct empirical evidence regarding the role of the Down Low phenomenon in the HIV epidemic among African Americans is lacking” (p. 676).

In fact, very little research is available to understand the issues and complexities involved in Black male bisexuality and its connection with risk. The special section of the Archives of Sexual Behavior presents a number of articles devoted exactly to these issues. Look for additional entries in this blog on the results of the studies presented in these articles.

Sandfort, T. G. M., & Dodge, B. (2008). ‘‘...And then there was the Down Low’’: Introduction to Black and Latino male bisexualities. Archives of Sexual Behavior, 37, 675-682.

Wednesday, August 6, 2008

Sex in Cyber World Becomes Sex in the Real World

In the previous post, I discussed a recently published study by Julie M. Albright regarding the cybersex patterns of a large sample of Americans. In addition to asking respondents about whether they had viewed erotic images and videos online and the effect it had on them, the survey also asked whether they had discussed sexual topics online, whether they met someone in person, and whether they had sought a long-term romantic relationship with someone they met online.

Majorities of both women (55%) and men (58%) in the study reported that they had logged on to a personals site at least once. Slightly lower proportions–43% of women and 46% of men–had actually created a profile with a photo of themselves on such a site. Large proportions of individuals who had never been married (53%) or who were divorced (59%) had created a profile with a photo. Possibly somewhat surprisingly, 27% of married individuals had done so as well. This means that over a quarter of married people had gone online to advertise their attributes to others who are interested in meeting someone for a romantic or sexual relationship.

Moreover, 63% of married people in the survey reported that they had communicated by e-mail with at least one person they met on the personals website. An equal proportion (63%) had actually met at least one individual in person. Taking into account the marital status of individuals, 76% of never-married and 82% of divorced respondents had met at least one cyber partner in person. Furthermore, 36% of married respondents indicated that they had met one cyber partner in person, while approximately 30% had met two or more individuals in person. Women reported e-mailing and meeting more people in person than did men.

You might wonder about the motivations for communicating with people online or meeting them in person. Women and men were not different in terms of reporting that they were just curious or just browsing. Married people were half as likely as those who had never been married to indicate that they were simply curious or were just browsing as the reason for logging on to a personals site. Divorced and never-married individuals reported this reason in about the same higher proportions compared to married individuals. In contrast, never-married individuals were two times more likely to say that they visited these websites to engage in sexual chat than were married or divorced people. So, if they were neither simply curious nor interested in sexual chat in the case of married respondents, what were married people interested in? Both married and divorced people were four times more likely to say they wanted to “date for fun” than were never-married individuals.

What did individuals end up doing as a result of visiting personals websites? Actually, relatively small proportions of the survey participants actually connected with their cyber partners: 17% of women and 11% of men went on a date as a result of their online visits, 15% of women and 14% of men engaged in casual sex with someone they met online, 7% of women and 5% of men had a discreet affair, and 12% of women and 4% of men became involved in a committed relationship.

On a final note, who do you think was more likely to seek a serious romantic relationship by visiting sexually oriented personals sites, single people or divorced people? Believe it or not, married heterosexual individuals were five and a half times as likely to be on the hunt for a serious relationship compared to singles; they were also more likely to go on a date with someone they had met on a sex-related website. Moreover, divorced individuals were three and half times more likely than never-married individuals to want a serious relationship.

What is Albright’s interpretation of this rather surprising finding? “Perhaps people already married or in committed relationships are unhappy and are ‘testing the waters’ to see if an attractive other would respond to them online, allowing them to transition out of the marriage” (p. 184). In other words, people who are unhappy in their marriage may be trying to find a romantic partner to replace their spouse if they decide to leave the marriage, or to give them a substantial reason to finally get out. One point to keep in mind, however, is that the married individuals were probably dissatisfied in the relationship already and, even without the internet, would have been searching for romantic and sexual partners in other ways.

Albright, J. M. (2008). Sex in America online: An exploration of sex, marital status, and sexual identity in Internet sex seeking and its impacts. Journal of Sex Research, 45, 175-186.

Tuesday, August 5, 2008

Sex in Cyber World

Some of you out there in Cyber World may have a burning question or two about the effect of viewing erotic images and videos online, visiting websites devoted to dating or sexual hookups, or messaging online in an erotic, titillating way with some secret, cyber sex partner. The questions that a number of people seem to have (if I can take a little literary license here) are: Does the internet lead to the horrific, debilitating downfall of many a good woman and man, as well as the devastating ruination of untold numbers of relationships? Or, is Cyber World the great exotic, enchanting hideaway e-resort or lavish luxury virtual cruise where individuals can mingle and cavort electronically, allowing them to meet the men or women of their dreams and live a life of fulfillment and delight that they wouldn’t be able to live without the internet?

Of course, these two questions are phrased in an exaggerated, hyperbolic way, like you might find in some over-the-top sensational popular magazine. Yet, I have heard some individuals refer to the viewing of erotica online and cruising the internet as absolutely and necessarily corrupting and dangerous. Like many extremist viewpoints on various issues, this doomsday perspective is not universally supported by empirical evidence. Nonetheless, even some scientific researchers focus exclusively on the adverse effects of sexually oriented online behaviors, or cybersex.

An article recently published in the Journal of Sex Research by Julie M. Albright provides new information regarding the cybersex patterns of a large group of Americans. It does not address the long-term effects of such experience, but few, if any, studies do. Professor Albright, a sociologist at the University of Southern California, analyzed data obtained by Elle Magazine and MSNBC.com in their Cybersex Survey available at the MSNBC.com website in 2004. Respondents to the survey were recruited by announcements in the Elle Magazine, on Elle.com, and on MSNBC.com. The way that the survey was conducted has both disadvantages and advantages. The downside is that people who participated were those who heard about the study and volunteered on their own; consequently, they selected themselves, rather than being randomly selected by a scientist so that we can have greater confidence that the group is an accurate reflection of the population of people who use the internet for sexual reasons. A tremendous strength of the study is that 15,246 people responded to the survey. However, 75% were men, and we have no way of knowing if that is an accurate proportion for this population.

One important issue that was addressed in this analysis was whether individuals who use the internet for sexual reasons are prone to be compulsive in their sex-seeking behaviors, one of the suspected outcomes of cybersex. Professor Albright found that only 2% of respondents spent more than 11 hours per week in internet sex-seeking behaviors, the amount identified by a previous researcher as excessive. Women were as likely as men to be in this group. The low rate means that it is unlikely that sexually oriented cyber behavior automatically leads to compulsive behavior; in fact, this outcome is very unlikely. Single individuals and gay, lesbian, or bisexual individuals were more likely to spend this extreme number of hours on cybersex compared to married and heterosexual individuals (although, again, the proportions were very small).

In fact, certain proportions of individuals indicate that they experience positive outcomes from their online experiences, although women and men appear to get somewhat different types of benefits. Women reported greater levels of chatting online about sex, possibly creating more of a “relational context,” as Albright calls it, to their internet experiences. In keeping with the relationship focus, women indicated to a slightly greater extent than men that they were more open to trying new situations and behavior as a result of viewing erotica (26% of women, 24% of men), and that it was easier to talk about what they want sexually as a result of their online experience (26% of women, 23% of men). They also were slightly more likely to employ the strategy of viewing erotic images and videos with their partner as a way to heighten sexual arousal for them (19% of women, 16% of men).

Men, in contrast, indicated to a greater extent that they viewed erotic images and videos online (75% did so) than did women (41%). Men were only very slightly more likely to view the erotica alone to increase their own sexual arousal, 16% of men compared to 14% of women. This type of viewing may have involved masturbation.

Participants in the survey also reported on whether they had experienced several negative outcomes. Smaller proportions of individuals indicated that they had experienced negative outcomes than indicated that they had experienced positive outcomes. The greatest proportion was 15% of women reporting that they had felt pressure to engage in sexual behaviors they had seen online; only 2% of men reported feeling this pressure. Slightly more women (12%) indicated that their viewing of erotica had resulted in them engaging in sex with their partner less often compared to men (9%). Although relatively rare overall, somewhat greater proportions of women (9%) felt that their partner was more critical of them as a result of viewing erotica than were men (2%). In contrast, greater proportions of men (9%) reported that they themselves were more critical of their partner as a result of erotica compared to women (2%). Again, the negative effect on views of one’s partner was relatively infrequent.

More will be said in the next blog entry about actually seeking out sexual partners online to meet in person. However, the results of this survey suggest that, with respect to viewing erotic images and videos, larger proportions of both women and men report positive outcomes than negative ones. A compulsive pattern of online sexually oriented behavior is indeed extremely rare.

Albright, J. M. (2008). Sex in America online: An exploration of sex, marital status, and sexual identity in Internet sex seeking and its impacts. Journal of Sex Research, 45, 175-186.

Tuesday, March 4, 2008

“I’ve Never Done This Before” and “Was It As Good For You As It Was For Me?!” Sex, Lies, and Whatever It Takes

Can you believe your sexual partner when he or she tells you that you are the first, and the one and only? Can you really be sure when your partner seems as if they have just experienced the most earth-shattering orgasm during sex with you? Maybe, but don’t be too sure.

Research indicates that 85% of individuals have lied to their relationship partner regarding their involvement with some other person, such as having engaged in sex with someone outside of the relationship (Saxe, 1991). In fact, 92% of college students acknowledge that they have lied at least once to a partner. The most common “mistruths” concern the number of people with whom one has previously had sex (31% say they have not told the truth about that issue; “One or two others? Yeah, okay . . . we’ll go with that number”), having experienced an orgasm (26%), commending one’s partner as the best ever (18%), assuring the partner that the sex was good (18%), telling the partner they love him or her (17%), or claiming to be a virgin (8%; Knox, Schacht, Holt, & Turner, 1993). Beyond these issues, substantial proportions of individuals infected with HIV do not inform their primary partner of their status (12 to 33%; Sullivan, 2005), 38% of those with genital herpes do not (Green et al., 2003), and 69% of those with human papillomavirus (HPV) do not (Keller, Von Sadovsky, Pankratz, & Hermsen, 2000).

Maybe it isn’t extremely surprising, but people will also actually lie so that a potential partner will have sex with them. Over a third of men and a tenth of women have reported that they lied to a partner so that they would have sex with them (Cochran & Mays, 1990).

Recent research by William Marelich and his colleagues (Marelich, Lundquist, Painter, & Mechanic, 2008) found that sexual lies or deceptions, according to statistical analyses, fall into three categories: blatant deception, self-serving deception, and deception to avoid confrontation. Examples of blatant deception include telling “. . . someone ‘I love you’ but really didn’t just to have sex with them” and “had sex with someone just so you could tell your friends about it.” Self-serving lies include “had sex with someone to get resources from them (e.g., money, clothes, companionship)” and “had sex with someone so you would have someone to sleep next to.” Deception to avoid confrontation consists of, among other examples, “had sex even though you didn’t want to” and “had sex with someone in order to maintain your relationship with them.”

In this study, the most frequent type of deception was avoiding confrontation, with 51% of study respondents indicating that they have had sex with someone because they wanted to please their partner. Also, individuals had sex with someone even though they didn’t want to (27%), although this item does not really indicate the reason they had sex even though they didn’t want to. Women were more likely to report having engaged in these relationship maintaining strategies, most likely intended to avoid disappointing their partner and sidestepping situations that might destablilize and threaten relationships. In contrast, men were more likely to engage in blatant types of deception, aimed at getting a partner to engage in sex with them. Women and men, however, were not different in their tendency to employ self-serving deception strategies; this type of strategy is consistent with the social exchange view of interpersonal relationships discussed in Chapters 9 and 10 of the textbook.

Cochran, S. D., & Mays, V. M. (1990). Sex, lies, and HIV. New England Journal of Medicine, 322, 774-775.
Green, J., Ferrier, S., Kocsis, A., Shadrick, J., Ukoumunne, O. C., Murphy, S., & Hetherton, J. (2003). Determinants of disclosure of genital herpes to partners. Sexually Transmitted Infections, 79, 42-44.
Keller, M. L., Von Sadovsky, V., Pankratz, B., & Hermsen, J. (2000). Self-disclusure of HPV infection to sexual partners. Western Journal of Nursing Research, 22, 285-302.
Knox, D., Schacht, C., Holt, J., & Turner, J. (1993). Sexual lies among university students. College Student Journal, 27, 269-272.
Marelich, W. D., Lundquist, J., Painter, K., & Mechanic, M. B. (2008). Sexual deception as a social-exchange process: Development of a behavior-based sexual deception scale. Journal of Sex Research, 45, 27-35.
Saxe, L. (1991). Lying: Thoughts of an applied social psychologist. American Psychologist, 46, 409-415.
Sullivan, K. M. (2005). Male self-disclosure of HIV-positive serostatus to sex partners: A review of the literature. Journal of the Association of Nurses in AIDS Care, 16, 33-47.

Saturday, February 2, 2008

Should Boys Be Vaccinated Against HPV Infection?

Human papillomavirus (HPV) infection is the leading cause of cervical cancer among women today. However, research published February 1, 2008 indicates that HPV is also the leading cause of cancer of the tonsils, lower tongue, and upper throat (Chaturvedi, Engels, Anderson, & Gillison, 2008). The rates of HPV-related oral cancer have increased consistently in men from 1973 to 2004, such that it is now as prevalent as oral cancer caused by tobacco and alcohol. Approximately, 5600 cases annually may be attributed to infection with HPV. The increasing prevalence of HPV-related oral cancer in men may be due to the increasing frequency of oral-genital sex, in addition to the decreasing rates of tobacco use. HPV-related oral cancer has actually declined in the same time period for women.

Currently, a vaccine to prevent HPV infection, produced by Merck & Company, Inc., is only authorized by the federal government to be administered to girls, because early research focused on the risk of cervical cancer in women. However, the recent research suggests an additional reason that HPV vaccination should begin for boys as well. In fact, Merck plans to seek federal authorization for boys in the near future. In addition to oral cancer, HPV infection is also linked to increased risk for genital warts, penile cancer, and anal cancer. The recent research by Merck has only focused on the latter types of cancer, not oral cancer (Stobbe, February 1, 2008).

All of these findings lend support to arguments that boys should be vaccinated at early ages, along with girls. The vaccine is more effective if it is administered prior to HPV infection, which is the rationale for vaccinating individuals at an early age before they have first engaged in sexual behavior. Initially, the proposal to vaccinate boys was based on concern about reducing the spread of HPV to women because of its role in increasing risk of cervical cancer. With evidence indicating that HPV is associated with higher levels of oral, penile, and anal cancer among men, the vaccination of boys against HPV infection is even more compelling.

The proposal to vaccinate young girls, however, has already inflamed a good deal of controversy in a number of states and communities around the U.S. It is likely that the movement to vaccinate boys will meet with the same type of disapproval by some people.

What is your view about the issue of vaccinating girls and boys for HPV infection? Why do you suppose some people are upset about the prospect? Is it more important to protect individuals from factors known to cause cancer, or to avoid the issue because it is related to sexual behavior?

Chaturvedi, A. K., Engels, E. A., Anderson, W. F., & Gillison, M. L. (2008). Incidence trends for Human Papillomavirus–related and –unrelated oral squamous cell carcinomas in the United States. Journal of Clinical Oncology, 26, 612–619.

Stobbe, M. (February 1, 2008). HPV causing more oral cancer in men. Retrieved February 2, 2008, from http://ap.google.com/article/ALeqM5ip7PfN_mm2RrKX-AyRKDX9FNzzNwD8UHQ3KG0