Gay and bisexual Latino men's sexual health and behaviors: a national online sample.
Article Type: Report
Subject: Sexually transmitted diseases (Demographic aspects)
Sexually transmitted diseases (Risk factors)
Sexually transmitted diseases (Statistics)
Sex (Research)
HIV (Viruses) (Demographic aspects)
HIV (Viruses) (Risk factors)
HIV (Viruses) (Statistics)
Men (Health aspects)
Men (Research)
Authors: Schnarrs, Phillip W.
Rosenberger, Joshua G.
Schick, Vanessa R.
Novak, David S.
Herbenick, Debby
Reece, Michael
Pub Date: 03/22/2012
Publication: Name: International Journal of Men's Health Publisher: Men's Studies Press Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 Men's Studies Press ISSN: 1532-6306
Issue: Date: Spring, 2012 Source Volume: 11 Source Issue: 1
Topic: Event Code: 680 Labor Distribution by Employer; 310 Science & research Canadian Subject Form: Sexual behaviour
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 295171079
Full Text: Latino men represent a quickly growing segment of the U.S. population. As such, it is important to document the health of these individuals. Data were collected from one of the largest gay networking Web sites in the U.S. Using multivariate logistic regression relationships between participant characteristics and sexual health outcomes and behaviors were examined. The sample included 1,880 Latino men self-identifying as gay (83.7%) and bisexual (16.3%). Findings suggest the majority of men had not tested positive for any STD (86.8-92.0%) or H1V (79.9%), however overall STD testing was low (33.9%) compared to HIV testing (55.6%) during the previous year. Additionally, education level, employment, sexual orientation, and relationship status significantly influenced a variety of sexual behaviors and sexual health outcomes.

Keywords: Latino men, HIV, sexual behavior, online research, men who have sex with men (MSM)

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As the United States becomes increasingly diverse it is important to understand the complexities of race and ethnicity in relation to health outcomes and how these identities intersect with other demographic characteristics such as educational attainment, age, and location. Previous research has established that Latinos have become the largest ethnic minority in the U.S., with one out of eight individuals in the United States self-identifying as of Hispanic origin (Vidal de Haymes & Kilty, 2007; U.S. Census Bureau, 2003) Additionally, the most recent census data has shown that individuals identifying as Hispanic or Latino made up 16.3% of the US population surpassing all other racial and ethnic minority groups (U.S. Census Bureau, 2010).

Studies have examined various aspects of Latino men's sexual lives including traditional gender and sexual norm socialization in which men and women have differing experiences based upon cultural beliefs surrounding the roles of men and women within Latino culture (Raffaelli & Ontai, 2004). Most research to date has focused on understanding Latino men's sexuality through a gendered lens because of cultural beliefs surrounding manhood and sexual behavior among this group, specifically exploring aspects related to machismo, sexual risk taking and intimate partner violence (Asencio, 1999).

Fewer studies have investigated sexual behaviors among Latino gay and bisexual men, with the majority focusing on sexual position taking by Latino men based upon perceived masculinity of sexual partners (Carballo-Di6guez, Dolezal, Nieves, Diaz, Decena, & Balan, 2004). Jefferies (2007) found that Latino men, excluding Mexican men, had an increased likelihood of having engaged in anal sex compared to non-Latino men, as well as preferring the insertive role during oral sex and during anal sex. Mexican men, in the same study, were more likely than other self-identified Latino men to be the receptive partner during anal sex. Several studies around sexual role position among Latino gay and bisexual men have suggested that role segregation (i.e., insertive or receptive role during sex) is highly prevalent among this group due to cultural notions of active and passive roles (Carrier & Mangana, 1991; Munoz-Laboy, 2004) in the United States.

While these studies are an important first step into understanding Latino gay and bisexual men, more investigation into the sexual lives of this group is needed to present a clearer image of their sexual behaviors. This study sought to document Latino gay and bisexual men's sexual behaviors with other men and their associations with health outcomes.

METHOD

Participants and Procedure

Participants resided in all 50 United States with the largest percentages of men reporting their home state as Texas (n = 266, 14.1%), California (n = 211, 11.2%), Florida (n = 169, 9.0%) and New York (n = 157, 8.4%). The states with the fewest participants included: Wyoming (n = 1,0.1%) Kentucky (n = 1,0.1%), North Dakota (n = 2, 0.1%) and Vermont (n = 2, 0.1%). The mean age of the sample was 33.29 (SD = 11.27), most had attended at least some college (n = 1,310, 84.4%), and were employed full-time (n = 1,125, 70.3%). The majority identified as homosexual/gay (n = 1,310, 81.9%) with the remaining indicating they were bisexual (n = 306, 16.3%). Most men indicated they were not currently dating anyone (n = 815, 50.9%), and were sexually active, but not in a sexual relationship (n = 745, 46.6%). Participant characteristics are summarized in Table 1.

The study was conducted in partnership with one of the largest online social and sexual networking internet sites for men who have sex with men. An electronic message was sent to all users of the website briefly summarizing the study and its incentives, and providing a link directing them to the study website. The recruitment message remained in each individual's electronic mailbox for a period of 7 days, after which time any unopened emails were automatically removed. A total of 127,489 individuals opened the recruitment email and 34.1% of these men clicked on the link to the study website. Of those viewing the study information and consent form, 60.4% consented to and subsequently participated in the study. Data presented in this article are limited to the 1,880 men who identified themselves as Latino and gay or bisexual. All study protocols were reviewed and approved by Institutional Review Board at the academic institution of the first author.

Measures

Sociodemographics. Measures included those related to a participant's age, gender (male, female, transgender male to female, transgender female to male), sexual orientation, race/ethnicity, level of education completed, U.S. state of residence, and employment status. Participants also responded to items related to relationship status (married, partnered, divorced, widower, single, and other); whether they were currently dating someone or in a relationship (in a relationship with the same person longer than 6 months, 3-6 months, less than 6 months, dating more than one person, or not dating anyone), and whether they were currently in a sexual relationship (with one person, more than one person, sexually active but don't consider myself in a sexual relationship, or currently not sexually active).

Health status. Measures included those related to physical and mental quality of life using the 4-item Healthy Days Core Module from the CDC health-related quality of life measure (HRQOL-4) (CDC, 2000a), a widely validated set of survey measures used to assess a person's sense of well-being, during the past 30 days, through four items (Ahluwalia, Holtzman, Mack, & Mokdad, 2003; Andresen, Catlin, Wyrwich, & Jackson-Thompson, 2003; CDC, 1998, 2000b, 2001; Moriarty, Zack, & Kobau, 2003). In addition, we assessed history of participation in self- (genital and testicular self-exams) and provider-administered (general physical exam) exams.

Sexual behaviors. Participants were asked to indicate whether or not they had engaged in specific sexual behaviors with both women and men within the past month, past three months, past year, more than a year ago, or never. Behaviors included masturbation, receptive anal intercourse, insertive anal intercourse, insertive vaginal intercourse, performing oral sex, and receiving oral sex. For behaviors reported within the past year, participants were asked to indicate how frequently they had engaged in each. Response options included "a few times per year," "about once per month," "a few times per month," "about once per week," "2-3 times per week," "almost every day," and "more than once per day." Measures used were consistent with those used in a recent nationally representative study of sexual behavior in the United States (Herbenick, Reece, Schick, Sanders, Dodge & Fortenberry, 2010). Additionally, to assess unprotected behaviors, participants were asked to indicate the numbers of times they used a condom during the past ten times they engaged in receptive anal intercourse, insertive anal intercourse, and vaginal intercourse (Reece, Herbenick, Sanders, Schick, Dodge, & Fortenberry, 2010).

Data Analysis

PASW version 19.0 (Chicago, IL, USA) was used to conduct all analyses. Descriptive statistics were used to examine the participant demographic characteristics, health status, and sexual behaviors. A multivariate logistic regression model was used to test the relationship between participant characteristics and health-related outcomes, sexual health-related screenings, and sexual behaviors.

RESULTS

Health Status, Screening, and Diagnosis

Overall the sample was healthy with most participants self-reporting their health to be "very good" (n = 775,43.2%), "excellent" (n = 587, 32.7%), or "good" (n = 369, 20.6%). The mean number of days the participants reported physical and mental health concerns was 5.07 (SD = 7.06), and 7.71 (SD = 7.52) respectively, and reported on average, 5.90 (SD = 6.5) days of limited activity due to illness which is well below the CDC (2003) guidelines defining "good" health (under 14 days). Just over half of men (50.1%) had performed a testicular self-exam and 68% (n = 1,278) had visited a provider for a physical exam within the past year. Over half of participants had received an HIV test within the past year (55.6%), however screening for other STDs during that same time period was lower with only 33.9% reporting having been tested. When asked to report confirmed diagnosis of STD in the past two years the majority indicated they had not tested positive for Syphilis (n = 1,389, 86.8%), Gonorrhea (n = 1,664, 93.4%), Chlamydia (n = 1,681,94.4%), HPV (n = 1,675, 94.3%), or Herpes (n = 1,635,92%) in the previous two years. HIV was the most prevalent (n = 235, 14.7%) occurring sexually related illness among the sample. Table 2 summarizes these findings.

Condom Use

Participants were asked to report the number of times they had used a condom during the last ten occurrences of specific sexual behaviors. On average men reported using condoms more often when they were the receptive partner in anal intercourse ([bar.x] = 6.38, SD = 145) than when they were the insertive partner in both anal intercourse with a male partner ([bar.x] = 6.27, 1.45) and vaginal intercourse ([bar.x] = 5.6, SD = 1.58).

Sexual Behaviors

Participants were asked to indicate whether or not they had participated in a range of sexual behaviors and to indicate the recency and past year frequency of these behaviors. Table 4 provides a summary of men's reports of participation in these behaviors within their life time, and Table 5 provides a more detailed summary of the recency of men's participation in these behaviors. Table 6 provides a summary of the reported frequency of men's participation in these sexual behaviors during the past year.

Solo and partnered masturbation. Masturbation alone was the most common sexual activity among participants. The vast majority of men stated they had masturbated alone (n = 1,753, 99.83%), with 97.2% (n = 1,707) indicating masturbation within the past month. Nearly all participants (88.5%) reported engaging in solo masturbation at least weekly, with the frequency of masturbation including more than once a day (n = 246, 14.1%), almost daily (n = 673, 38.6%), two or three times per week (n = 481,27.6%), and about once a week (n = 143, 8.2%). Similarly, most men (95.6%) indicated they had masturbated with a partner during their lifetime, with over a third (n = 70.6%) of participants indicating they had done so within the past month.

Sexual activity with men. The majority of men (n = 1,737, 98.8%) reported that they had inserted their penis into another man's mouth during their lifetime with most men (n = 1,369, 77.9%) indicating they had done this in the past month. The second most common behavior (n = 1,714, 97.6%) over the lifetime was inserting another man's penis into their mouth with most (n = 1,315, 74.8%) having done this in the past month. Of those reporting having had inserted their penis into another man's anus during their lifetime (n = 1,636, 94.3%) 52.6% (n = 984) reported having done so within the past month. Of those indicating they had inserted their penis into another man's anus during the past year (n = 1,415), 31.4% reported having done this a few times (n = 445) during this time period. Similar to the rates of insertive anal intercourse 91.1% (n = 1,597) of men had engaged in lifetime receptive intercourse, with 49.5% (n = 867) having done so in the past month and most (n = 1,329, 75.8%) reporting participating in this behavior a few times during the past year. Of those indicating participant anal sex the majority of men (68.9%, n = 1,241) had been both the insertive and receptive partner during anal sex in the past year with half (50.4%, n = 620) having done this is the past 30 days.

Participant Characteristics and Health

Sexual orientation and relationship status were significant predictors of STD testing and sexual orientation, employment status, and age were significantly associated with HIV testing. Men who identified as bisexual were more likely to have had an STD screening the past year (OR = 1.34, CI = 1.04-1.74) compared to their gay identified counterparts. Participants responding they were currently in a relationship with more than one person were less likely (OR = 0.58, CI = 0.36-0.93) to have been screened for STI compared to those in a relationship for more than five years with only one person. Men who self-identified as bisexual (OR = 0.44, CI = 0.29-0.66) and unemployed (OR = 0.51, CI = 0.27-0.98) were less likely to have been tested for HIV during the past year. Finally, older men were more likely to have had an HIV test during the past year compared to younger men (OR = 1.08, CI = 1.04-1.10).

Bisexual men were less likely to have been diagnosed with an STD or HIV (OR = 0.44, CI = 0.29-0.66) during the past year. Predictors of having been diagnosed with HIV included sexual orientation, age, and employment status. Additionally, men who were older (OR = 1.08, CI = 1.06-1.10) and indicated they were unemployed (OR = 2.14, CI = 1.24-3.70) were more likely to have been diagnosed with HIV.

Participant Characteristics and Sexual Behavior

Sexual orientation and relationship status were significant predictors of partnered masturbation. Men who identified as bisexual (OR = 0.44, CI = 0.29-0.66) were less likely to have masturbated with a sexual partner, while those who were single were more likely to have masturbated with a sexual partner. In terms of oral sex, men who indicated they were bisexual and currently unemployed were less likely to receive (OR = 0.52, CI = 0.31-0.88; OR = 0.24, CI = 0.13-0.46, respectively) or perform (OR = 0.44, CI = 0.282-0.685, OR = 0.48, CI = 0.24-0.94, respectively) oral sex on a male partner. Additionally, participants indicating they were not currently in a relationship were less likely to perform oral sex (OR = 0.40, CI = 0.20-0.78).

With regards to anal sex, those who were more likely to be the insertive partner were in a relationship for one to five years (OR = 2.62, CI= 01.50-4.58) or six months to a year (OR = 3.90, CI = 1.16-13.13) with only one person. Men who indicated being in a relationship for one to five years (OR = 1.64, CI = 0.29-0.66) or that they were currently dating more than one person (OR = 1.93, CI = 1.03-3.61) were more likely to be the anal receptive partner. Additionally, men with a professional level of education were less likely (OR = 0.55, CI = 0.32-0.96) than those without a college level of education to be the receptive partner.

DISCUSSION

Overall the sample was healthy, with most men reporting their health to be good, a low number of STD diagnosis in the previous 2 years, and almost all men had been tested for HIV at some point during their lives. Similar numbers of men indicated having had a STD and HIV test during the past year, suggesting this group is conscious of their sexual health needs with regards to testing behavior. However, almost half (44.4%) had not been screened for HIV and nearly two-thirds (61.6%) had not received an STD in the past year, highlighting that public health messages regarding testing, especially for STDs, are perhaps not effectively reaching this group in its entirety. While these data do suggest that condoms were not always used during the past 10 sexual experiences overall use was relatively high. Further, instances of condom non-use may not be warranted, to some degree, if sexual activity was occurring with a primary partner whose STD and HIV status was known, hence minimizing the level of risk for disease transmission.

Bisexual men were less likely to have been diagnosed with an STD or HIV during the previous two years and more likely to have been screened for STDs during the past year compared to their gay counterparts. Why bisexual men were more likely to be screened for STDs is beyond the scope of this paper, but it may be related to sexual activity outside of primary relationships and concern for primary partners. Further, this may be an outcome of STDs being perceived as less harmful compared to HIV by a group that has historically received messages about the importance of HIV testing, but not necessarily receiving these same messages about STD screening to the same degree.

Participants reported on average between 5.07-7.71 days in which they had experienced decreased physical or mental health or decreased activity as a result of poor health. Although this number is well below the 14 day cut off by CDC for clinical depression, it remains higher than the number of days found in similar men of Caucasian ethnicity (Rosenberger, et. al, In Press). These findings suggest that perhaps issues of being doubly stigmatized as both an ethnic and sexual minority may have implications for the health status of this population. Further research should continue explore the ways in which social issues surrounding ethnic minority status influence the health status of gay and bisexual men and what affect this has on sexual behaviors.

In terms of behavior, receiving or performing oral sex were both influenced by sexual orientation and jobs status with bisexual men and those unemployed and not looking for work being less likely to participate in either behavior. Self-identified bisexual men were also significantly less likely to report being the receptive partner during anal sex. Both of these finding may be an outcome of decreased interactions with potential male sexual partners for both groups. However, the lack of significant findings concerning bisexual men as insertive partners suggests that bisexual men may be perceived as more masculine therefore more likely to take on the active role during anal sex. As suggested by Carballo-Dieguez et al. (2004) men who perceived themselves as less masculine than their sexual partners were more inclined to take on a passive role. Additionally, men who were not in a relationship were less likely than those in a relationship for more than five years to be the receptive partner during anal intercourse. This same group was not significantly less likely to be the insertive partner during sex suggesting that those not currently in a relationship may avoid taking the receptive role during anal intercourse as a protective behavior against HIV, as this role may be perceived as higher risk compared to being the insertive partner outside the context of a relationship. Older men and those with a professional level of education (i.e., Ph.D., M.D., J.D.) were less likely to be the receptive partner during anal sex. Further, men who were unemployed and not looking for work were less likely to be the insertive partner. These findings suggest that social status may be influence sexual positioning with individuals holding a higher status in a sexual interaction being the insertive partner. Older, more educated, and employed men may be perceived as being masculine, as suggested by Carballo-Dieguez et al. (2004), compared to those who are younger, less educated and not employed. Additionally, older men may be seen as having more sexual experience influencing their ability to take an insertive role. Further, younger men may have less opportunity to engage in sexual activity influencing receptive behavior patterns, however this is unlikely because of the lack of significant findings in terms of insertive behaviors.

Unlike previous studies examining role position during sexual activity this sample was highly versatile, suggesting that role segregation may not be as important to this group and that sexual role position as suggested by Carballo-Dieguez et al. (2004), may be an outcome of context and perceptions concerning the identity of a sexual partner. In other words, sexual role position may be influenced by perceived partner characteristics such as masculinity. However, this finding should be taken along with its limitations because we do not know the extent of time this sample had been living in the US and we did not inquire about perceptions of sexual partners.

Finally, these data should be considered in terms of limits inherent in the study design. The sample was not representative of the general population, despite its size, and participants were recruited through a website that might appeal to people who are more sexually conscious, however, challenges exist with establishing truly nationally representative samples of gay and bisexual Latino men. Because the sample was entirely internet-based, we acknowledge the potential for our data to not be generalizable to all gay or bisexual Latino men in the U.S., particularly those that are less educated or lack access to online technology.

Conclusions

Findings suggest that social position (i.e., educational attainment, employment, and age) self-identified sexual orientation, and relationship status may influence whether or not Latino gay and bisexual men participate in a variety of sexual behaviors. Further, as documented in previous studies (Carballo-Dieguez et al., 2004), the high level of versatility in this sample suggests that perception of a sexual partner may influence sexual decision making. For example, Carballo-Dieguez et al. found that perceived masculinity of a partner influenced whether men would take a passive or active role. In other words, this research found that men who perceived their partners to me more masculine then they perceived themselves would be more likely to take on the passive role or the active role if they perceived their partner to be less masculine. This study extends this through suggesting that those with higher social positions being more likely to take on active roles. Future studies need to further examine this to understand power dynamics and sexual role positioning between varying social positions of sexual partners to understand the ways in which perceived social position (beyond masculinity) influence sexual position taking. While cultural notions surrounding insertive and receptive behaviors may still hold true (e.g. the more masculine man takes the insertive role), participants in this study reported diverse anal sex behaviors, with men engaging in anal intercourse as both the insertive and receptive sexual partner.

Overall, STI and HIV for this sample were low compared to US National Averages (CDC, 2010) however this maybe more of an outcome of rates of testing compared to actual low diagnoses. While over half of individuals had be tested for HIV there exists a disconnect between HIV testing and STD testing. This may indicate that because of public health's emphasis on HIV among gay and bisexual men the importance of STD testing may not be as apparent to this group. Additionally, this could indicate that individuals perceive HIV as more threatening to their health and are therefore more likely to be tested or may only be tested when symptoms of STDs are present. Whatever the case it is important to understand why as a group more than half of individuals are being tested for HIV within the past year, but far less are being tested for STDs which could potential put them at risk for HIV infection.

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Rosenberger, J.G., Schick, V., Herbenick, D., Novak, D., & Reece, M. (2011). Sex toy use by gay and bisexual men in the United States. Archives of Sexual Behaviors. DOI: 10.1007/s10508010-9716-y.

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PHILLIP W. SCHNARRS, Ph.D. (1), JOSHUA G. ROSENBERGER, Ph.D., MPH (2), VANESSA R. SCHICK, Ph.D (1), DAVID S. NOVAK, MSW (3), DEBBY HERBENICK, Ph.D., MPH (1), and MICHAEL REECE, Ph.D., MPH (1)

(1) Center for Sexual Health Promotion, Indiana University.

(2) Department of Global & Community Health, George Mason University.

(3) Online Buddies Inc.

Correspondence concerning this article should be addressed to Joshua G. Rosenberger, Department of Global & Community Health, George Mason University, MS: 5B7, 4400 University Drive, Fairfax, VA 22030. Email: jrosen10@gmu.edu.
Table 1
Participant Characteristics

                                              n      %

Age (n = 1,861)
  18-24                                       446   24.0
  25-29                                       335   18.0
  30-39                                       547   29.4
  40-49                                       406   21.8
  50-59                                       108    5.8
  60+                                          19    1.1
Relationship Status (n = 1,869)
  Longer than five years with one person      260   16.3
  One to five years with one person           228   14.3
  Six months to a year with one person         51    3.2
  Three to six months with one person          51    3.2
  Less than three months with one person       55    3.4
  Currently dating more than one person       133    8.3
  No currently dating anyone                  815   50.9
Sexual Orientation (n = 1880)
  Homosexual                                 1574   83.7
  Bisexual                                    306   16.3
Education (n = 1874)
  Did not graduate highschool                  24    1.3
  High school graduate/ GED                   265   14.1
  Some college/Associate's                    712   38
  Bachelor's                                  551   29.4
  Master's                                    205   10.9
  Professional (i.e., MD, PhD)                102    5.4
  Other                                        15    0.8
Employment Status (n = 1860)
  Full-time (35+ hours/week)                 1304   70.3
  Part-time                                   249   12.9
  Unemployed, looking for work                205   10.7
  Unemployed, not looking for work            102    5.3

Table 2
Sexual Health Status (n = 1600)

                                            n      $

Performed testicular self-exam past year
  No                                        729   45.6
  Yes                                       801   50.1
  No response                                70    4.4
STD test in the past year
  No                                        985   61.6
  Yes                                       543   33.9
  No response                                72    4.5
Syphilis diagnosis past two years
  No                                       1389   86.8
  Yes                                       115    7.2
  No response                                96    6
Gonorrhea diagnosis past two years
  No                                       1414   88.4
  Yes                                        90    5.6
  No response                                96    6
Chlamydia diagnosis past two years
  No                                       1432   89.2
  Yes                                        72    4.5
  No response                               108    6.8
Herpes diagnosis past two years
  No                                       1393   87.1
  Yes                                        99    6.2
  No response                               108    6.8
Ever been tested for HIV
  No                                        141    8.8
  Yes, over a year ago                      494   30.9
  Yes, within the past year                 889   55.6
  No response                                79    4.7
Ever been diagnosis with HIV
  No                                       1279   79.9
  Yes                                       235   14.7
  No response                                86    5.4

Table 3
Recency of Sexual Behaviors

                                           n      %

Masturbated alone (n = 1756)
  Done in the past month                  1707   97.2
  Done in the past three months             29    1.7
  Done in the past year                      8    0.5
  Done more than a year ago                  9    0.5
  Never done this                            3    0.2

Masturbated with another person (n = 1752)
  Done in the past month                  1237   70.6
  Done in the past three months            229   13.1
  Done in the past year                    121    6.9
  Done more than a year ago                 88    5
  Never done this                           77    4.4

Inserted penis into another man's anus (n = 1751)
  Done in the past month                   984   56.2
  Done in the past three months            231   13.2
  Done in the past year                    200   11.4
  Done more than a year ago                221   12.6
  Never done this                          115    6.6

Had penis inserted into anus (n = 1753)
  Done in the past month                   867   49.5
  Done in the past three months            249   14.2
  Done in the past year                    225   12.8
  Done more than a year ago                256   14.6
  Never done this                          156    8.9

Inserted penis into another man's mouth (n = 1758)
  Done in the past month                  1369   77.9
  Done in the past three months            202   11.5
  Done in the past year                     95    5.4
  Done more than a year ago                 71    4
  Never done this                           21    1.2

Had another man's penis in my mouth (n = 1757)
  Done in the past month                  1315   74.8
  Done in the past three months            206   11.7
  Done in the past year                    115    6.5
  Done more than a year ago                 78    4.4
  Never done this                           43    2.4

Inserted penis into a woman's vagina (n = 1705)
  Done in the past month                    96    5.1
  Done in the past three months             27    1.4
  Done in the past year                     57    3
  Done more than a year ago                503   29.5
  Never done this                         1022   59.9

Inserted penis into a woman's anus (n = 1691)
  Done in the past month                    31    1.8
  Done in the past three months             10    0.6
  Done in the past year                     27    1.6
  Done more than a year ago                218   12.9
  Never done this                         1405   83.1

Inserted penis into woman's mouth (n = 1703)
  Done in the past month                    79    4.6
  Done in the past three months             32    1.9
  Done in the past year                     54    3.2
  Done more than a year ago                473   27.8
  Never done this                         1065   62.5

Put mouth or tongue on a woman's vagina (n = 1700)
  Done in the past month                    71    4.2
  Done in the past three months             28    1.6
  Done in the past year                     54    3.2
  Done more than a year ago                402   23.6
  Never done this                         1145   67.4

Table 4
Frequency of Sexual Behaviors During the Past Year

                                             A few times  About once
                                              per year     a month

                                              n     %      n     %

Masturbated alone (1744)                      43    2.5    33    1.9
Inserted penis into a man's anus (1415)      445   31.4   249   17.6
Inserted a penis into my anus (1329)         502   37.8   234   17.6
Inserted penis into a woman's vagina (168)    73   43.5    30   17.9

                                             A few time   About once
                                              per week     a week

                                              n     %      n     %

Masturbated alone (1744)                     125    7.2   143    8.2
Inserted penis into a man's anus (1415)      363   25.7   163   11.5
Inserted a penis into my anus (1329)         306   23     129    9.7
Inserted penis into a woman's vagina (168)    27   16.1    16    9.5

                                             2-3 times      Almost
                                              per week     everyday

                                              n     %      n     %

Masturbated alone (1744)                     481   27.6   673   38.6
Inserted penis into a man's anus (1415)      161   11.4    29    2
Inserted a penis into my anus (1329)         129    9.7    26    2
Inserted penis into a woman's vagina (168)    18   10.7     4    2.4

                                             More than
                                              once a day

                                              n     %

Masturbated alone (1744)                     246   14.1
Inserted penis into a man's anus (1415)        5    0.3
Inserted a penis into my anus (1329)           3    0.2
Inserted penis into a woman's vagina (168)     0    0

Table 5
Odds Ratio of Sexual Health-Related Outcomes & Testing by
Participant Characteristics

                                           STD diagnosis past 2 years

                                                OR        CI (95%)

Age                                            1.00     (0.92-1.01)
  Sexual Orientation
  Homosexual (Ref)
  Bisexual                                     0.63 *   (0.43-0.90)

Relationship Status
  Longer than five years with one person
    (Ref)
  One to five years with one person            1.11     (0.69-1.78)
  Six months to a year with one person         1.34     (0.64-2.78)
  Three to six months with one person          1.33     (0.61-2.90)
  Less than three months with one person       1.80     (0.90-3.59)
  Currently dating more than one person        0.69     (0.38-1.28)
  No currently dating anyone                   1.11     (0.77-1.62)

Education
  Less than college (ref)
  Some college/Associate's                     1.37     (0.93-2.01)
  Bachelor's                                   1.40     (0.93-2.11)
  Master's                                     1.25     (0.75-2.08)
  Professional (i.e., MD, PhD)                 1.13     (0.59-2.17)

Employment Status
  Full-time (35+ hours/week) (ref)
  Part-time                                    1.35     (0.95-1.93)
  Unemployed, looking for work                 1.43     (0.99-2.06)
  Unemployed, not looking for work             0.84     (0.47-1.49)

                                             Positive HIV Diagnosis

                                                OR         CI (95%)

Age                                            1.08 ***   (1.06-1.09)
  Sexual Orientation
  Homosexual (Ref)
  Bisexual                                     0.20 ***   (0.12-0.36)

Relationship Status
  Longer than five years with one person
    (Ref)
  One to five years with one person            1.07       (0.66-1.74)
  Six months to a year with one person         0.74       (0.32-1.73)
  Three to six months with one person          0.94       (0.38-2.32)
  Less than three months with one person       0.60       (0.23-1.57)
  Currently dating more than one person        1.00       (0.55-1.80)
  No currently dating anyone                   0.76       (0.52-1.11)

Education
  Less than college (ref)
  Some college/Associate's                     0.91       (0.59-1.40)
  Bachelor's                                   0.77       (0.49-1.21)
  Master's                                     0.67       (0.39-1.17)
  Professional (i.e., MD, PhD)                 0.46 *     (0.22-0.96)

Employment Status
  Full-time (35+ hours/week) (ref)
  Part-time                                    1.40       (0.91-2.17)
  Unemployed, looking for work                 1.48       (0.96-2.28)
  Unemployed, not looking for work             2.14 **    (1.23-3.70)

                                            STD test in the past year

                                                OR       CI (95%)

Age                                            0.99     (1.04-1.10)
  Sexual Orientation
  Homosexual (Ref)
  Bisexual                                     1.34 *   (1.04-1.74)

Relationship Status
  Longer than five years with one person
    (Ref)
  One to five years with one person            0.75     (0.77-3.40)
  Six months to a year with one person         0.57     (0.27-2.51)
  Three to six months with one person          0.67     (0.52-9.46)
  Less than three months with one person       1.02     (0.16-1.18)
  Currently dating more than one person        0.58 **  (0.36-1.69)
  No currently dating anyone                   0.96     (0.43-1.28)

Education
  Less than college (ref)
  Some college/Associate's                     0.84     (0.58-1.47)
  Bachelor's                                   0.86     (0.66-1.77)
  Master's                                     0.72     (0.64-2.65)
  Professional (i.e., MD, PhD)                 1.06     (0.39-2.12)

Employment Status
  Full-time (35+ hours/week) (ref)
  Part-time                                    0.99     (0.76-1.98)
  Unemployed, looking for work                 1.08     (0.48-1.32)
  Unemployed, not looking for work             1.49     (0.27-0.99)

                                             HIV test in the past year

                                                OR          CI (95%)

Age                                            1.08 ***   (0.98-1.00)
  Sexual Orientation
  Homosexual (Ref)
  Bisexual                                     0.44 ***   (0.29-0.66)

Relationship Status
  Longer than five years with one person
    (Ref)
  One to five years with one person            1.62       (0.51-1.10)
  Six months to a year with one person         0.82       (0.29-1.12)
  Three to six months with one person          2.22       (0.33-1.33)
  Less than three months with one person       0.44       (0.56-1.85)
  Currently dating more than one person        0.78       (0.36-0.92)
  No currently dating anyone                   0.74       (0.71-1.29)

Education
  Less than college (ref)
  Some college/Associate's                     0.92       (0.62-1.12)
  Bachelor's                                   1.08       (0.63-1.18)
  Master's                                     1.30       (0.50-1.07)
  Professional (i.e., MD, PhD)                 0.90       (0.65-1.74)

Employment Status
  Full-time (35+ hours/week) (ref)
  Part-time                                    1.23       (0.73-1.34)
  Unemployed, looking for work                 0.80       (0.79-1.48)
  Unemployed, not looking for work             0.51 **    (0.98-2.26)

* p[less than or equal to]0.05, ** p[less than or equal
to]0.01, *** p[less than or equal to]0.001

Table 6
Odds Ratio of Sexual Behaviors by Participant Characteristics

                                            Mutual masturbation

                                              OR        CI (95%)

Age                                        0.98       (0.96-0.99)

Sexual Orientation
  Homosexual (Ref)
  Bisexual                                 0.40 ***   (0.27-0.58)

Relationship Status
  Longer than five years with one person
    (Ref)
  One to five years with one person        2.08       (0.89-4.86)
  Six months to a year with one person     0.83       (0.27-2.59)
  Three to six months with one person      1.05       (0.29-3.79)
  Less than three months with one person   2.26       (0.50-10.1)
  Currently dating more than one person    1.89       (0.69-5.20)
  No currently dating anyone               0.54 *     (0.32-0.90)

Education
  Less than college (ref)
  Some college/Associate's                 0.60       (0.35-1.03)
  Bachelor's                               0.84       (0.47-1.50)
  Master's                                 1.09       (0.52-2.29)
  Professional (i.e., MD, PhD)             0.58       (0.26-1.33)

Employment Status
  Full-time (35+ hours/week) (ref)
  Part-time                                0.76       (0.47-1.22)
  Unemployed, looking for work             0.89       (0.52-1.51)
  Unemployed, not looking for work         0.60       (0.31-1.16)

                                           Anal insertive partner

                                              OR        CI (95%)

Age                                        1.00       (0.98-1.01)

Sexual Orientation
  Homosexual (Ref)
  Bisexual                                 0.74       (0.54-1.02)

Relationship Status
  Longer than five years with one person
    (Ref)
  One to five years with one person        2.62 ***   (1.50-4.58)
  Six months to a year with one person     3.90 *     (1.16-13.1)
  Three to six months with one person      0.96       (0.44-2.08)
  Less than three months with one person   1.77       (0.78-4.03)
  Currently dating more than one person    1.62       (0.88-2.96)
  No currently dating anyone               0.90       (0.63-1.29)

Education
  Less than college (ref)
  Some college/Associate's                 0.90       (0.62-1.30)
  Bachelor's                               1.11       (0.74-1.65)
  Master's                                 1.15       (0.69-1.92)
  Professional (i.e., MD, PhD)             0.75       (0.41-1.38)

Employment Status
  Full-time (35+ hours/week) (ref)
  Part-time                                1.11       (0.76-1.63)
  Unemployed, looking for work             1.11       (0.74-1.67)
  Unemployed, not looking for work         0.60 *     (0.37-0.98)

                                           Anal receptive partner

                                              OR        CI (95%)

Age                                        0.97 ***   (0.96-0.99)

Sexual Orientation
  Homosexual (Ref)
  Bisexual                                 0.46 ***   (0.34-0.61)

Relationship Status
  Longer than five years with one person
    (Ref)
  One to five years with one person        1.64 *     (1.00-2.70)
  Six months to a year with one person     0.66       (0.32-1.37)
  Three to six months with one person      0.81       (0.38-1.73)
  Less than three months with one person   1.57       (0.69-3.59)
  Currently dating more than one person    1.93 *     (1.03-3.61)
  No currently dating anyone               0.66 *     (0.46-0.93)

Education
  Less than college (ref)
  Some college/Associate's                 1.11       (0.77-1.59)
  Bachelor's                               0.93       (0.64-1.35)
  Master's                                 0.92       (0.58-1.46)
  Professional (i.e., MD, PhD)             0.55 *     (0.32-0.96)

Employment Status
  Full-time (35+ hours/week) (ref)
  Part-time                                1.07       (0.74-1.55)
  Unemployed, looking for work             0.93       (0.64-1.34)
  Unemployed, not looking for work         0.92       (0.55-1.54)

                                           Received oral sex

                                              OR        CI (95%)

Age                                        0.98       (0.96-1.00)

Sexual Orientation
  Homosexual (Ref)
  Bisexual                                 0.52 *     (0.31-0.88)

Relationship Status
  Longer than five years with one person
    (Ref)
  One to five years with one person        4.50       (0.97-20.8)
  Six months to a year with one person     (1)        (1)
  Three to six months with one person      0.90       (0.19-4.31)
  Less than three months with one person   3.01       (0.37-24.6)
  Currently dating more than one person    (2)        (2)
  No currently dating anyone               0.49       (0.25-0.96)

Education
  Less than college (ref)
  Some college/Associate's                 0.98       (0.52-1.85)
  Bachelor's                               1.20       (0.60-2.38)
  Master's                                 1.66       (0.64-4.31)
  Professional (i.e., MD, PhD)             0.99       (0.33-2.98)

Employment Status
  Full-time (35+ hours/week) (ref)
  Part-time                                1.10       (0.54-2.26)
  Unemployed, looking for work             1.05       (0.50-2.20)
  Unemployed, not looking for work         0.24 ***   (0.13-0.46)

                                           Performed oral sex

                                              OR        CI (95%)

Age                                        0.98       (0.97-1.00)

Sexual Orientation
  Homosexual (Ref)
  Bisexual                                 0.44 ***   (0.28-0.69)

Relationship Status
  Longer than five years with one person
    (Ref)
  One to five years with one person        0.84       (0.35-2.05)
  Six months to a year with one person     0.56       (0.15-2.14)
  Three to six months with one person      0.63       (0.17-2.42)
  Less than three months with one person   2.67       (0.33-21.6)
  Currently dating more than one person    4.97       (0.63-39.2)
  No currently dating anyone               0.40 *     (0.20-0.78)

Education
  Less than college (ref)
  Some college/Associate's                 1.34       (0.93-2.75)
  Bachelor's                               1.41       (0.77-2.36)
  Master's                                 1.38       (0.68-2.94)
  Professional (i.e., MD, PhD)             0.48       (0.52-3.65)

Employment Status
  Full-time (35+ hours/week) (ref)
  Part-time                                1.47       (0.75-2.88)
  Unemployed, looking for work             1.00       (0.54-1.84)
  Unemployed, not looking for work         0.48 *     (0.24-0.94)

* p[less than or equal to]0.05, ** p[less than or equal to]0.01,
*** p[less than or equal to]0.001

(1) Confidence intervals were omitted because no respondents
indicated being in a relationship for six months to a year and
not receiving oral sex.

(2) Confidence intervals were omitted because no respondents
indicated they were currently dating more than one person and not
receiving oral sex.
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.