IntrodudionIn the United States, the norm of sexual monogamy asserts considerable influence on relationships ranging from state-sanctioned marriages to less formal dating relationships. For married couples, the norm of sexual monogamy holds considerable sway at the attitudinal level,' but behavioral adherence to this norm is less rigid. An estimated 26% to 50% of men and 21% to 38% of women have reported at least one lifetime occurrence of extramarital sex. cases (total unweighted n = 8263, married n = 3197; response rate = 65%), and a special Hispanic urban sample (total unweighted n = 4511, married n = 2343; cooperation rate = 79%) (for demographics, see Table 1).Extramarital sex was defined as having more than one partner during the year prior to the survey based on the following question: "Over the past 12 months, how many different people have you had either vaginal or anal intercourse with?" (0.2% nonresponse across samples). Since types of sexual partners were not ascertained, some respondents who had only one sexual partner, but whose partner was not their spouse, may have been misclassified as maritally monogamous. Also, those who changed during the 12-month reporting period from marital monogamy to nonmonogamy following divorce or the death of their spouse could not be distinguished from those who were married and nonmonogamous in tandem. We focused on condom use during all acts of vaginal intercourse over the previous 6 months since all extramarital sex respondents were having vaginal intercourse. Six-month estimates of sexual behavior have been shown to have good reliability and validity.843 Condom use was categorized into three groups: never (0%), sometimes (1% to 99%), and always (100%).To examine the correlates of extramarital sex, we restricted our analysis to married 18-to 49-year-olds since this age group allowed us to use both the urban sample and the large

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). We investigated sexual risk, risk perception, HIV and condom knowledge, and utilization of prevention services in the first large sample of MSM recruited in Beijing. Four hundred eighty-two MSM were sampled from September 2001 to January 2002. Forty-nine percent of participants reported unprotected anal intercourse with men during the previous 6 months. However, only 15% perceived they are at risk for HIV and many had misconceptions about HIV transmission routes and limited knowledge about condoms. Less than one quarter obtained free condoms (24%) and condom lubricants (19%) in the past 2 years. Multiple logistic regression analysis showed that unprotected insertive anal intercourse was associated with not having a Beijing residence card, having six or more male sexual partners, not having sex with women, having a lifetime history of sexually transmitted diseases (STDs), and having never tested for HIV. Unprotected receptive anal intercourse was independently associated with having six or more male sexual partners, not having sex with women, having a lifetime history of STDs, having never tested for HIV, and having less exposure to HIV prevention services. In addition, 28% reported having sex with both men and women during the previous 6 months, and 11% had unprotected intercourse with both men and women. This finding suggests that MSM are a potential bridge of HIV transmission to heterosexual women (or vice versa) and that addressing the HIV prevention needs of MSM may benefit the wider population.

Objectives We examined the associations between specific types and sources of discrimination and mental health outcomes among U.S. racial/ethnic minority men who have sex with men (MSM) and how these associations vary by race/ethnicity. Methods A chain-referral sample of 403 African American, 393 Asian and Pacific Islander (API), and 400 Latino MSM recruited in Los Angeles County, CA completed a standardized questionnaire. Results Past-year experiences of racism within the general community and perceived homophobia among heterosexual friends were positively associated with depression and anxiety. Past-year homophobia experienced within the general community was also positively associated with anxiety. These statistically significant associations did not vary across racial/ethnic groups. The positive association of perceived racism within the gay community with anxiety differed by race/ethnicity, and was statistically significant only for APIs. Perceived homophobia within the family was not associated with either depression or anxiety. Conclusions Higher levels of experiences of discrimination were associated with psychological distress among MSM of color. However, specific types and sources of discrimination were differentially linked to negative mental health outcomes among African American, API, and Latino MSM.

These findings, in combination with findings supporting the efficacy and cost-effectiveness of HIV VCT, support the dissemination of HIV VCT with appropriate support services in developing countries.

Objectives-Evaluate the efficacy of skills training designed to increase female condom use among women.Methods-A randomized trial of 409 women, recruited from family planning clinics in northern California, randomly assigned to the experimental 4-session female condom skills training intervention or the comparison 4-session women's general health promotion intervention. Participants received condom use instructions at baseline and male and female condoms during the study. They completed audio computer-assisted self-interviews at baseline, 3, and 6 months.Results-At 3 and 6 months, women in the experimental group were more likely than those in the comparison group to have used the female condom at least once in the prior 3 months. The increase in the percentage of sex acts protected by female condoms from baseline to the 6-month follow-up was greater for the experimental group. The percentage of sex acts protected by any condom was higher in the experimental group at 6 months. There were no group differences in male condom use.Conclusions-Outcomes suggest that skills training can increase female condom use and protected sex acts without reducing male condom use among women.

Despite widespread recognition that experiences of social discrimination can lead to poor physical and mental health outcomes for members of minority groups, little is known about how U.S. ethnic minority men who have sex with men (MSM) manage their experiences of racism and homophobia. We conducted six focus group discussions (n=50) and 35 in-depth interviews with African American, Latino, and Asian or Pacific Islander MSM (aged 18+) recruited in Los Angeles, CA. This process revealed five strategies that MSM of color employed in order to mitigate the impact of racism and homophobia. To minimize opportunities for stigmatization, men used (1) concealment of homosexuality and (2) disassociation from social settings associated with stigmatization. To minimize the impact of experienced stigma, men (3) dismissed the stigmatization and (4) drew strength and comfort from external sources. Men also actively countered stigmatization by (5) direct confrontation. More research is needed to understand the efficacy of these coping strategies in mitigating negative health consequences of stigmatization and discrimination.

Significant associations were found between network characteristics and syphilis infection and unprotected sex. Network-based interventions should be developed to reduce this HIV risk among MSM in China.

Previous research has documented the deleterious impact of homosexuality stigma on HIV sexual risk behavior among men who have sex with men (MSM) and the vulnerability of this group in China for HIV acquisition. Factor analysis of 10 survey items from 477 MSM from Shanghai yielded two factors: Perceived stigma assessed participants' impressions of the degree of societal stigmatization of homosexuals whereas enacted stigma measured direct personal experiences of stigmatizing behaviors. Enacted stigma exhibited satisfactory internal reliability and was associated with HIV sexual risk behavior. Further research is needed to refine perceived and other stigma constructs for Chinese MSM.