Stuart Michaels, Academic Research Centers, NORC Sexual Behavior & Sexual Identity among Men who have Sex with Men (MSM)

HIV disproportionately affects MSM. This has been true since the beginning of the epidemic and continues to today. MSM are the only risk group with increasing numbers of new infections. MSM make up about half of all persons in the U.S. living with HIV. In 2009 they accounted for 61% of new infections And Black MSM are disproportionately affected. In 2009, black men who have sex with men (MSM) represented an estimated 73% of new infections among all black men, and 37% among all MSM. More new HIV infections occurred among young black MSM (aged 13– 29) than any other age and racial group of MSM. New HIV infections among young black MSM increased by 48% from 2006–2009. Footer Information Here 2 Background

Footer Information Here HIV new infection by most affect groups (2009) 3

Most HIV research uses community based sampling methods to study high risk population such as MSM. Examples: Recruiting through bars, associations, cruising sites, gay pride parades, clinic population, internet sites, snow-ball sampling Recent more sophisticated versions of community based sampling: Time –venue sampling Respondent Driven Sampling Participants are presumed to be gay/MSM, but It is difficult or impossible to generalize finding beyond the sample of persons sampled. Footer Information Here Sampling for studies of MSM 4

Can we leverage the relatively recent existence of data from large national surveys of the U.S. population that include questions about sexual behavior and identity to help us better understand social contextual factors that drive the HIV/AIDS epidemic? Use population estimates of prevalence of MSM in the U.S. to contextualize community based research findings, e.g., recent CDC article on Purcell et al “Estimating Population Size of MSM to Obtain HIV Rates” Use representative samples to learn more about the relationship between behavior, identity, and attraction to help us understand the behavioral category, MSM and it’s social meaning. Footer Information Here Question 5

Data Source: NSFG Data National Survey of Family Growth (NSFG) 2002 and , U.S. men and women Total N = 35,253 of which 15,331 men White Black Hispanic Other Total 8,049 2,784 3, Sexual orientation measures: Behavior: Sex of sex partners ever and past 12 months Identity: Gay/homosexual, bisexual, straight/heterosexual Attraction: exclusive opposite sex, mostly opposite sex, equal attraction to both, mostly or only same-sex Questions asked using Audio-Computer Assisted Self Interview (ACASI) 6

Sexual Orientation as a multi-dimensional construct: Sexual Behavior, Attraction, & Identity 7 MSM Gay/Bisexual

Footer Information Here 8 Population Estimates of Same-Sex Behavior, Identity and Attraction, U.S. Men

Footer Information Here 9 Same-Sex Behavior by Sexual Identity

Footer Information Here 10 Recent Same Sex Partner by Identity

11

Footer Information Here 12 Black men For 7% Black men who report any same sex behavior, attraction, or identity our of a total of 2,640

First steps in trying to use population survey data and a multi-dimensional approach to sexuality/sexual orientation to think about composition and characteristics of MSM population Population survey approach does not select subjects based on the identification with or participation in “gay” worlds or same-sex behavior Less racial/ethnic differences among non-heterosexual men in survey than popular notions such as “down low” tend to suggest Footer Information Here 13 Discussion

Need more theoretical and empirical work (qualitative as well as quantitative) to better understand personal and social meaning of sexual behavior and risk. How does social context (institutions, social networks) affect “sexual identity”? Better understanding of meaning and social context should help to inform prevention and interventions Footer Information Here 14 Going forward

Thank You!