Date of Award

1-1-2013

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Lucy Annag

Abstract

Men who have sex with men (MSM), especially in the southeastern US are disproportionately impacted by the HIV/AIDS epidemic. Young MSM and African American MSM are particularly burdened accounting for a greater proportion of HIV/AIDS diagnoses. Factors such as risky sexual behavior, perception of sexual risk, ignorance about HIV sero-status, internalized homonegativity/homophobia (IH), stigma, and alcohol and illegal drug use have been advanced as reasons for this disproportionate burden. HIV/AIDS prevention efforts aimed at stemming the epidemic among MSM have focused on locations where MSM meet other men for sex such as parks, beaches, bathhouses, adult book stores, clubs, and bars. However, in recent years, the Internet has emerged as a venue where MSM also meet other men for sex. This has prompted research studies examining the correlates of Internet sex seeking behavior among MSM. A review of these research studies show that most of them were conducted in regions other than the southeastern US, and on predominantly homogenous samples of MSM, usually older, White MSM. Furthermore, these studies have produced contradictory findings and focused almost exclusively on sexual risk. The paucity of studies conducted in the southeastern US focusing on a diverse sample of young MSM (18-29 years) provided the basis for the current research study. The overall goal of this study was to investigate the relationship between IH, risky sexual behavior, health protective sexual communication, perception of partners' sexual risk, and Internet sex seeking behavior among young MSM. Additionally this study examined the influence of race on these relationships. The study design was cross-sectional recruiting MSM from North Carolina, South Carolina, Georgia, Alabama, Florida, and Tennessee. Participants were recruited online and offline. Online participants completed an electronic survey while offline participants completed a pencil and paper survey. Two hundred and sixty seven participants were recruited but four participants were dropped because they failed to meet the study's inclusion criteria, resulting in a sample size of 263. Analysis was done using the Statistical Program for the Social Sciences (SPSS) version 21 and Mplus version 7. Descriptive statistics and a path analysis were conducted. Results of the analyses showed a high prevalence of Internet sex seeking behavior and risky sexual behavior respondents. Also, IH was not associated with Internet sex seeking behavior though African American MSM reported significantly higher levels of IH than White MSM. African American MSM who sought sex online reported a greater perception of partners' sexual risk than White MSM who sought sex online but were less likely to engage in health protective sexual communication relative to White MSM. Per sexual risk, African American MSM who sought sex online were more likely to engage in unprotected anal intercourse (UAI) than White MSM and MSM who sought sex online were more likely to engage in casual sex and report a history of sexually transmitted infection (STI) than MSM who sought sex offline. These findings support the need for more aggressive sexual health interventions that include equipping MSM with the tools and self-efficacy to navigate these virtual communities and understand the sexual risk associated with it. They also lend support to the use of the Internet and other mobile platforms as a tool for HIV/AIDS prevention interventions while presenting a new focus for interventions that target African American MSM.

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