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Differences by Race/ethnicity and Partner Gender in Safer Sex Strategies and Stigma among HIV+ MSMW
Unformatted Document Text:  Mutchler et al., ASA 2005 1 INTRODUCTION HIV positive (HIV+) men who have sex with men and women (MSMW) constitute a unique high-risk population that has been largely ignored in HIV/AIDS research. One of the major reasons for this prevailing trend is that MSMW are often grouped together with men who have sex with men (MSM) in terms of HIV risk prevention efforts 1,2,3,4 . As a consequence, information regarding HIV risk behaviors and predictors of unprotected sex among MSMW is scarce. Even less is known about MSMW who are HIV+ despite a growing body of work that focuses on the HIV prevention needs of HIV+ individuals 2,4,5,6,7 . Moreover, the female sexual partners of HIV+ MSMW may be particularly vulnerable since misconceptions about HIV/AIDS as a gay disease continue to persist. We use the term MSMW for three important reasons: (1) HIV is transmitted by specific behaviors (not identities), (2) such behaviors are not necessarily linked to an identity such as bisexuality, and (3) behaviorally bisexual African- American and Latino men may be particularly reluctant to identify as bisexual due to cultural pressures and complex constructions of sexual scripts in their communities 8,9,10,11,12,13,14,15,16 . Due to recent epidemiological trends, there is a continued need to target MSMW 17 . Past research indicates that the proportion of MSMW has increased in national and local (Los Angeles County) AIDS surveillance reports 18 , 19 . A few important studies examine HIV+ MSMW apart from MSM 5, 9, 18, 20,21 and report unprotected anal and vaginal intercourse (UAVI) among HIV+ MSMW, but none report predictors of sexual risk for HIV+ MSMW. These studies also indicate that there are significant demographic and behavioral differences between MSMW and MSM that warrant closer examination of HIV+ MSMW as a unique population. In terms of ethnic distribution, research indicates that African Americans and Latinos self-report higher percentages of bisexual behaviors. Montgomery and associates 22 found that the proportion of MSM who reported having sex with women varied by race: 34% of black MSM, 26% of Hispanic MSM and 13% of white MSM. Chu and colleagues 18 reported that more African American (41%) and Hispanic men (31%) reported bisexual behavior than white men (21%). Moreover, the AIDS rate due to sex with a bisexual man was three and five times higher among Hispanic and black women, respectively, than among white women. These findings illustrate the importance of assessing the sexual

Authors: Mutchler, Matt., colemon, leonardo., Neith, Katie. and Davtyan, Mariam.
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Mutchler et al., ASA 2005
1
INTRODUCTION
HIV positive (HIV+) men who have sex with men and women (MSMW) constitute a unique
high-risk population that has been largely ignored in HIV/AIDS research. One of the major reasons for
this prevailing trend is that MSMW are often grouped together with men who have sex with men (MSM)
in terms of HIV risk prevention efforts
1,2,3,4
. As a consequence, information regarding HIV risk
behaviors and predictors of unprotected sex among MSMW is scarce. Even less is known about MSMW
who are HIV+ despite a growing body of work that focuses on the HIV prevention needs of HIV+
individuals
2,4,5,6,7
. Moreover, the female sexual partners of HIV+ MSMW may be particularly vulnerable
since misconceptions about HIV/AIDS as a gay disease continue to persist. We use the term MSMW for
three important reasons: (1) HIV is transmitted by specific behaviors (not identities), (2) such behaviors
are not necessarily linked to an identity such as bisexuality, and (3) behaviorally bisexual African-
American and Latino men may be particularly reluctant to identify as bisexual due to cultural pressures
and complex constructions of sexual scripts in their communities
8,9,10,11,12,13,14,15,16
.
Due to recent epidemiological trends, there is a continued need to target MSMW
17
. Past research
indicates that the proportion of MSMW has increased in national and local (Los Angeles County) AIDS
surveillance reports
18
,
19
. A few important studies examine HIV+ MSMW apart from MSM
5, 9, 18, 20,21
and
report unprotected anal and vaginal intercourse (UAVI) among HIV+ MSMW, but none report predictors
of sexual risk for HIV+ MSMW. These studies also indicate that there are significant demographic and
behavioral differences between MSMW and MSM that warrant closer examination of HIV+ MSMW as a
unique population. In terms of ethnic distribution, research indicates that African Americans and Latinos
self-report higher percentages of bisexual behaviors. Montgomery and associates
22
found that the
proportion of MSM who reported having sex with women varied by race: 34% of black MSM, 26% of
Hispanic MSM and 13% of white MSM. Chu and colleagues
18
reported that more African American
(41%) and Hispanic men (31%) reported bisexual behavior than white men (21%). Moreover, the AIDS
rate due to sex with a bisexual man was three and five times higher among Hispanic and black women,
respectively, than among white women. These findings illustrate the importance of assessing the sexual


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