Increasing hepatitis A immunity in men who have sex with men in Sydney, 1996–2012

We examined the hepatitis A virus status of all MSM seen at a large sexual health clinic in inner Sydney between 1996 and 2012. Overall, the proportion of MSM susceptible to hepatitis A decreased from 68.1% in 1996 to 36.2% in 2012; most of this reduction was attributable to vaccination.     

Why include men? Establishing sexual health clinics for men in rural Bangladesh

Subsequent to recommendations from the 1994 United Nations International Conference on Population and Development, and given recent findings outlining the links between control of sexually transmitted infections (STIs) and a reduction in HIV incidence, many countries are now seeking to establish STI control programmes. In many cases this is through a policy of providing comprehensive reproductive health care through the maternal and child health/family planning (MCH-FP) system. This involves management of all reproductive tract infections including STIs. This paper demonstrates how such an approach may miss one of the largest target groups--men. In general, men are at higher risk of initially contracting STIs, but, once infected, their clinical management is usually simpler than treating equivalent infections in women. It is argued that these two factors alone make the inclusion of men in STI control programmes critical. The paper outlines the experiences of one programme in rural Bangladesh in establishing sexual health clinics for men within the existing service structure. In response to client demand, the clinics moved beyond simple STI care towards provision of comprehensive sexual health services. Finally, the paper argues that whilst including men in sexual health programmes should never be at the expense of providing services for women, excluding them from service provision may make the objectives of STI control programmes unattainable.     

Heteronormativity and ‘troubled’ masculinities among men who have sex with men in Addis Ababa

In most societies, heterosexuality is the dominant way of expressing sexuality and masculinity and those men outside of it are stigmatised and discriminated against. This paper explores the sexual lives of men who have sex with men and the personal and social conflicts that arise as they attempt to both live up to societal expectations and manage their sexual desires. It critically explores how an overriding heteronormativity structures and influences men's perception and understanding of sexuality and masculinity/femininity. The paper draws on data from 24 in-depth/life history interviews, one focus group discussion and ethnographic observation conducted between July 2006 and June 2007. The study reveals that powerful and dominating beliefs about heteronormativity and masculinity result in men who have sex with men dealing with a number of issues of personal conflict and contradiction resulting in uncertainty, resentment, ambivalence, worry and discomfort. Heteronormativity or the expectations of parents, community and society at large is far more influential on the sexuality of men who have sex with men than their own individual desires and needs. The paper concludes that there is little room for individuality for Ethiopian men who have sex with men with their sexual bodies ‘belonging’ to parents, families and to society at large.     

Getting men in the room: perceptions of effective strategies to initiate men’s involvement in gender-based violence prevention in a global sample

Abstract

As engaging men in gender-based violence prevention efforts becomes an increasingly institutionalised component of gender equity work globally, clarity is needed about the strategies that best initiate male-identified individuals’ involvement in these efforts. The purpose of this study was to examine the perceived relevance and effectiveness of men’s engagement strategies from the perspective of men around the world who have organised or attended gender-based violence prevention events. Participants responded to an online survey (available in English, French and Spanish) and rated the effectiveness of 15 discrete engagement strategies derived from earlier qualitative work. Participants also provided suggestions regarding strategies in open-ended comments. Listed strategies cut across the social ecological spectrum and represented both venues in which to reach men, and the content of violence prevention messaging. Results suggest that all strategies, on average, were perceived as effective across regions of the world, with strategies that tailor messaging to topics of particular concern to men (such as fatherhood and healthy relationships) rated most highly. Open-ended comments also surfaced tensions, particularly related to the role of a gender analysis in initial men’s engagement efforts. Findings suggest the promise of cross-regional adaptation and information sharing regarding successful approaches to initiating men’s anti-violence involvement.     

What role can gender-transformative programming for men play in increasing men’s HIV testing and engagement in HIV care and treatment in South Africa?

Men are less likely than women to test for HIV and engage in HIV care and treatment. We conducted in-depth interviews with men participating in One Man Can (OMC) – a rights-based gender equality and health programme intervention conducted in rural Limpopo and Eastern Cape, South Africa – to explore masculinity-related barriers to HIV testing/care/treatment and how participation in OMC impacted on these. Men who participated in OMC reported an increased capability to overcome masculinity-related barriers to testing/care/treatment. They also reported increased ability to express vulnerability and discuss HIV openly with others, which led to greater willingness to be tested for HIV and receive HIV care and treatment for those who were living with HIV. Interventions that challenge masculine norms and promote gender equality (i.e. gender-transformative interventions) represent a promising new approach to address men’s barriers to testing, care and treatment.     

HIV prevention and men who have sex with women and men in México: findings from a qualitative study with HIV-positive men

Unprotected sex between men is the major risk factor for HIV infection in México and many other Latin American countries. There is a substantial body of literature demonstrating that the relationship between sexual identity and sexual practice is not binary or causal -- men who have sex with other men do not necessarily perceive themselves as gay -- and there is increasing interest in HIV prevention with men who have sex with both men and women. In México, HIV prevention with men who have sex with women and men and who are not socially affiliated or identified with gay men is lacking. This paper explores the sexual histories and HIV-risk perception of HIV-positive Mexican men who indicated that they have sex with women in a screening interview and then in the context of an in-depth interview also reported having had sex with men. We consider the sexual practices and sexual and social identities of these men, examining their explanations for having sex with other men, the strategies used to affirm their masculinity, the management of their sexual identity in their social networks, HIV-risk perception before diagnosis and sexual practices after diagnosis. Recommendations are made to improve HIV prevention for men who have sex with men as well as women and who do not assume a gay or bisexual identity.     

Is screening for anal cancer warranted in homosexual men?

Some investigators have proposed screening homosexual men for anal cancer and its probable precursor, high grade anal intraepithelial neoplasia (AIN). Using widely accepted criteria for the introduction of screening programmes, this paper reviews the current evidence for screening for this condition in this high risk population and highlights areas where additional research is required. While it is accepted that the incidence of anal cancer is at least 20 times higher in homosexual men than the general population, the natural history of anal cancer and its precise relationship with AIN is not clearly understood. Anal intraepithelial neoplasia is a very highly prevalent disease among homosexual men, but little is known about what predicts progression to invasive disease. The screening tests, exfoliate cytology and high resolution anoscopy, have a sensitivity of between 45 and 70%. Treatment options for AIN are limited by morbidity and high recurrence rates and there are no randomised controlled trials studying the efficacy of therapeutic agents or surgery for high grade AIN, although immunotherapies show very early promise. Theoretically, early detection may lead to better treatment outcomes. Studies of the potential negative consequences of screening programmes on the homosexual population are needed. The currently available data does not support the implementation of a screening programme for AIN and anal cancer in homosexual men in Australia.     

HIV prevention and men who have sex with women and men in México: Findings from a qualitative study with HIV‐positive men

Unprotected sex between men is the major risk factor for HIV infection in México and many other Latin American countries. There is a substantial body of literature demonstrating that the relationship between sexual identity and sexual practice is not binary or causal — men who have sex with other men do not necessarily perceive themselves as gay — and there is increasing interest in HIV prevention with men who have sex with both men and women. In México, HIV prevention with men who have sex with women and men and who are not socially affiliated or identified with gay men is lacking. This paper explores the sexual histories and HIV‐risk perception of HIV‐positive Mexican men who indicated that they have sex with women in a screening interview and then in the context of an in‐depth interview also reported having had sex with men. We consider the sexual practices and sexual and social identities of these men, examining their explanations for having sex with other men, the strategies used to affirm their masculinity, the management of their sexual identity in their social networks, HIV‐risk perception before diagnosis and sexual practices after diagnosis. Recommendations are made to improve HIV prevention for men who have sex with men as well as women and who do not assume a gay or bisexual identity.     

Clinical inquiries. Does anal cancer screening reduce morbidity and mortality in men who have sex with men?

It's unclear whether anal cancer screening benefits men who have sex with men because high-quality studies on this subject are lacking. In the absence of high-quality data, anal pap smears aren't recommended for routine screening of men who have sex with men (strength of recommendation: C, expert opinion).     

Depression and osteoporosis in men: association or casual link?

The longer life expectancy of women than that of men and, therefore, the longer exposure to fracture risk has, at least partially, led to neglect of osteoporosis in men. Recently, unipolar depression, which is 2 times more frequent in women than in men, has been linked to osteoporosis. However, it is quite possible that this diagnosis may escape detection in men because of a different behavioral phenotype between the genders. A potential mechanism of bone loss in depression has been proposed, involving concurrent activation of the hypothalamo-pituitary-adrenal and sympatho-adrenal axes, suppression of the gonadal and somatotrophic axes, and high interleukin-6 and low leptin levels. We suggest that similar neurohormonal changes may cause osteoporosis in men.     

Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America,Western Europe,and Australia, 2000–2014

PurposeThe aim of the article was to investigate recent trends in human immunodeficiency virus (HIV) diagnosis rates among men who have sex with men (MSM) in high-income countries in North America, Western Europe, and Australia.MethodsData on annual rates of HIV diagnoses among MSM aged 15 to 65 years from 2000 to 2014 were collected from 13 high-income countries. Joinpoint regression software was used to empirically determine country-specific trend periods. Trends in HIV diagnosis rates and in the proportion of diagnoses occurring in young MSM aged 15 to 24 years were analyzed using Poisson regression and log-binomial regression, respectively.ResultsSix countries experienced an increasing trend from 2000 to 2007-08 followed by either a stable or declining trend through 2014. Five countries had recently increasing trends, and two countries had one stable trend from 2000 to 2014. All 13 countries experienced increases in the proportion of diagnoses occurring in young MSM.ConclusionsSince 2008, half of the 13 high-income countries examined experienced stable or decreasing trends. Still, some countries continue to experience increasing HIV trends, and young MSM are increasingly represented among new diagnoses. Efforts to support early sexual health promotion, reduce barriers to pre-exposure prophylaxis, and improve care engagement for young MSM are critical to addressing current HIV trends.     

HIV prevention using the operative group approach among men who have sex with men in São Paulo, Brazil

This study aimed to evaluate the operative group as a preventive approach among men who have sex with men that use two public health services in the city of S?o Paulo, Brazil. One hundred volunteers were randomly allocated to two groups (intervention and control, with 50 each). All participants answered questionnaires in two phases: before the intervention and six months after its conclusion. Effect was measured by comparing the groups for the following outcomes: median number of anal sex acts without condoms and responses from the participants to questions about HIV infection. 69 participants completed the study (34 in the prevention group and 35 in the control group). Analysis showed a decrease in the number of unprotected anal sex acts (p = 0.029) and an increase in the number of answers favoring prevention in the intervention group. The results indicate that the study group was responsive to a safer sex operative group intervention. Further research is necessary to evaluate the feasibility of this prevention approach as a public health strategy, including other social groups.     

Homosexuality,seropositivity, and family obligations: Perspectives of HIV‐infected men who have sex with men in China

The HIV epidemic has had major impact on men who have sex with men in China. Most current studies view male‐to‐male sex as a behavioural dimension or variable affecting HIV infection, paying little attention to the socio‐cultural meanings of homosexuality and their impacts on men's experiences with HIV/AIDS. This oversight has impeded understanding of the health practices of this population. Based on a qualitative study of experiences of Chinese people living with HIV/AIDS, this paper explores the complex processes in which men who have sex with men struggle and negotiate with their sexuality, family obligations, and this disease. To facilitate Chinese men who have sex with men in responding effectively to HIV and AIDS, researchers and practitioners should take into account a wide range of contextual factors including desired gender roles, family obligations, homophobia, and HIV‐related stigma that contribute to current constructions of ‘homosexuality’ in China.

Résumé

En Chine, l'épidémie de sida a eu un impact majeur sur les hommes qui ont des rapports sexuels avec des hommes. Actuellement, la plupart des recherches envisagent les rapports sexuels entre hommes comme une dimension ou une variable comportementale qui a des conséquences sur l'épidémie, en prêtant peu d'attention aux significations socio‐culturelles de l'homosexualité et à leur impact sur les expériences des hommes vivant avec le VIH/sida. Cette négligence entrave la compréhension des pratiques de santé dans cette population et l'élaboration d'interventions qui lui soient plus spécifiques. En se basant sur une étude qualitative des expériences des Chinois vivant avec le VIH/sida, cet article explore les processus complexes selon lesquels les hommes qui ont des rapports avec des hommes luttent et négocient avec leur sexualité, leurs obligations familiales et cette maladie. Pour aider les hommes qui ont des rapports avec des hommes à apporter des réponses efficaces au VIH/sida, les chercheurs et les praticiens devraient prendre en considération un large éventail de facteurs contextuels comprenant les rôles de genre désirés, les obligations familiales, l'homophobie et le stigma dÛ au VIH, qui contribuent aux constructions actuelles de «l'homosexualité» en Chine.

Resumen

La epidemia del sida ha tenido un fuerte impacto en los hombres que tienen relaciones homosexuales en China. En la mayoría de estudios actuales se consideran las relaciones homosexuales como una dimensión de conducta o variable que afecta a la infección del VIH. Se presta poca atención a los significados socioculturales de la homosexualidad y al impacto que tiene en las experiencias de los hombres afectados con el VIH/sida. Esta negligencia ha impedido conocer las practicas sanitarias en esta población y la posibilidad de desarrollar intervenciones más sensibles. A partir de un estudio cualitativo sobre las experiencias de chinos afectados con el VIH/sida, en este artículo se exploran los complejos procesos en que los hombres con relaciones heterosexuales negocian y luchan por su sexualidad, las obligaciones familiares y la enfermedad. Para ofrecer una respuesta eficaz al VIH y el sida a esta población con relaciones homosexuales, los investigadores y profesionales de la salud deberían tener en cuenta toda una serie de factores contextuales, por ejemplo los roles sexuales deseados, las obligaciones familiares, la homofobia y el estigma relacionado con el VIH que contribuyen a crear el concepto actual de la ‘homosexualidad’ en China.     

Power absorption in women and men exposed to hand–arm vibration

OBJECTIVES: The aim of the study was to determine whether there are gender differences as regards the quantity of absorbed power, i.e., vibration absorption per unit of time, during exposure to vibration from a specially constructed handle. METHODS: The study was conducted on 24 subjects (12 female and 12 male). The experiments were performed with exposure in two vibration directions, X(h), and Z(h), and with two vibration levels, 3 and 6 m/s(2). RESULTS: The male subjects had significantly higher power absorption during exposure to vibrations in the Z(h) direction at the vibration level of 6 m/s(2) than did the female subjects. When adjusted for anthropometrical measurements the difference did not remain significant. Higher vibration levels resulted in significantly higher absorption of power for both X(h) and Z(h) directions. The absorption was significantly higher in the Z(h) direction than in the X(h) direction. CONCLUSIONS: No gender difference in power absorption was shown.