Sexual Positioning Among Men Who Have Sex With Men: A Narrative Review

Abstract

Sexual positioning practices among men who have sex with men (MSM) have not received a thorough discussion in the MSM and HIV literature, given that risks for acquiring or transmitting HIV and STIs via condomless anal sex vary according to sexual positioning. MSM bear a disproportionate burden of HIV compared to the general population in the United States; surveillance efforts suggest that HIV and STIs are increasing among domestic and international populations of MSM. We conducted a narrative review, using a targeted literature search strategy, as an initial effort to explore processes through which sexual positioning practices may contribute to HIV/STI transmission. Peer-reviewed articles were eligible for inclusion if they contained a measure of sexual positioning identity and/or behavior (i.e. “top,” “bottom,” etc.) or sexual positioning behavior (receptive anal intercourse [RAI] or insertive anal intercourse [IAI]), or assessed the relationship between sexual positioning identity with HIV risk, anal sex practice, masculinity, power, partner type, or HIV status. A total of 23 articles met our inclusion criteria. This review highlights dynamic psycho-social processes likely underlying sexual decision-making related to sexual positioning identity and practices among MSM and MSM who have sex with women (MSMW), and ways these contexts may influence HIV/STI risk. Despite limited focus in the extant literature, this review notes the important role contextual factors (masculinity stereotypes, power, partner type, and HIV status) likely play in influencing sexual positioning identity and practices. Through this review we offer an initial synthesis of the literature describing sexual positioning identities and practices and conceptual model to provide insight into important areas of study through future research.

Subsequent Sexual Risks Among Men Who Have Sex with Men May Differ by Sex of First Partner and Age at Sexual Debut: A Cross-Sectional Study in Beijing, China

“…The self-labeling and anal sex role preference is an important identity among both MSM and MSMW; early patterns and preferences may be influenced by early partner characteristics (e.g., first sexual encounter with a male or a female), and be associated with psychosexual preferences of specific male-to-male anal sex roles, influencing different HIV/STI risk exposures (e.g., receptive anal sex riskier than insertive) [30–32]. Complex prospective studies of youth and young adults would be needed to assess whether the sex of the first partner has a predisposing influence on subsequent sexual positioning and practice preference, or in turn, whether this choice merely reflects these early preferences without influencing them.…”

Age Cohort Differences in Sexual Behaviors Among Black Men Who Have Sex With Men and Women

“…Behavioral risk HIV and STIs within a sexual encounter (i.e., sexual positioning, serosorting, condom use) among BMSM may also be relative and contextual based upon age, HIV status, partner type, and partner gender (Dangerfield II, Smith, Williams, Unger, & Bluthenthal, 2016). Still, all of these developmental and situational/sexual contexts are nested within larger historical contexts that provide varying risk environments for HIV infection (Dangerfield, Smith, Anderson, et al, 2017; Dangerfield, Smith, Williams, et al, 2017; Elder Jr., 1996; Rhodes, 2002). Specifically, the changing nature of the AIDS epidemic due to increasing prevention options may create varying perceptions of risk for different cohorts of BMSM (Brooks et al, 2011; Dangerfield II, Smith, Anderson, et al, 2017; Hoff et al, 2015; Venkatesh et al, 2010).…”

Examining the Sexual Health Consequences of Alcohol Consumption Among Black Gay and Bisexual Men

“…While sexual position is often an important factor in motivating condom use among MSM (Newcomb et al., ), men in the current study did not appear to make such distinctions. It should be noted that the current study operationalized sexual position as based on behavior (i.e., engaging in receptive anal sex, insertive anal sex, or both) and not identity as “bottom,” “top,” or “versatile.” Sexual decision making and use of protective sexual behaviors may vary given sexual position, identity associated with sexual position, and whether there is discrepancy between the preferred position and stated identity (Dangerfield et al., ). Therefore, future investigations of identity as well as behavior may provide further characterization to the association between alcohol consumption and condom use.…”