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Try out PMC Labs and tell us what you think. Learn More. An emerging body of evidence suggests that intergenerational sexual partnerships may increase risk of HIV acquisition among young men who have sex with men YMSM.
However, no studies have comprehensively evaluated literature in this area. These thematic groups can be used to frame future research on the role of age-discrepant relationships on HIV risk among YMSM, and to enhance public health HIV education and prevention strategies targeting this vulnerable population. The of men who have sex with men MSM living with HIV continues to increase around the world [ 1 ], despite advances in combination prevention strategies, including the expanding use of highly active antiretroviral therapy ART [ 2 ].
Slightly different patterns of HIV incidence have emerged in other settings. Collectively, these studies suggest that trends in HIV incidence among YMSM are context-specific, and highlight the need to better characterize risk factors influencing HIV incidence in this population. Unprotected anal intercourse UAIspecifically receptive intercourse, is considered to be the primary direct risk factor for HIV acquisition among MSM due to its high per-act transmission probability [ 1 ].
However, evidence supporting this hypothesis is conflicting. A population-based study of MSM in California found that younger age was ificantly associated with engagement in sero-discordant UAI [ 15 ]. In contrast, other studies have found no difference in sexual risk-taking behavior between Seeking sex in Brandon al and older MSM [ 17 — 1810 ]. A recent study involving 5, MSM across three cities in Australia found no association between age and likelihood of risky sex [ 19 ]. Intergenerational sexual relationships are commonly reported among MSM, and are a function of both partnership selection and age distribution of the MSM community [ 22 ].
Notably, a study involving YMSM in San Francisco found that having exclusively older sexual partners was associated with five times greater odds of HIV infection [ 27 ]. A study involving 1, MSM across 4 cities in China found that having a partner at least 10 years older was independently associated with a two-fold increased risk of HIV infection [ 29 ].
Finally, a recent longitudinal study involving 1, HIV-negative MSM in Australia found that individuals who reported having a few, and half to most, of their partners being much older in age were 2. However, some findings are not consistent with this literature. In order to inform future research directions and improved HIV prevention interventions for YMSM, this study sought to explore the relationships between age-mixing, HIV risk Seeking sex in Brandon al, and seroconversion in this population.
This study employed a scoping review methodology [ 31 ], which aims to map key concepts regarding a proposed research area to its main sources of evidence and salient thematic. Abstracts were considered eligible for review if they included all three core themes. Manual reviews of reference lists were also performed. In line with the scoping review methodology, the data extraction and analysis process involved compiling relevant findings into narrative descriptions and summarizing key findings in thematic [ 31 ].
We categorized findings based on an ecological theory of development by Bronfenbrenner which understands child development as directly and indirectly influenced by multiple environmental systems [ 33 ]. We selected this model on the basis that has been ly used to frame and interpret prevention research among youth populations [ 34 ], and has been specifically adapted by Mustanski et al. Our review of electronic databases and key journals identified an initial pool of 2, manuscripts.
Screening of abstracts led to elimination of 2, articles were excluded on the basis that they did not meet review inclusion criteria described above. Full texts of manuscripts were downloaded and reviewed in duplicate by the research team. MSM have reported high levels of childhood maltreatment, which has been associated with high risk sexual behaviors and HIV infection among adult MSM [ 36 ].
Studies examining these relationships have focused largely on the effect of childhood sexual abuse CSAand have identified ificant associations between CSA and: unprotected anal intercourse [ 37 — 42 ], transactional sex [ 3740 ], greater of partners [ 43 ], frequent casual sex [ 394044 — 46 ] and HIV-positive serostatus [ 3739 — 41Seeking sex in Brandon al48 ].
This trend has also been observed among YMSM; however, evidence is more limited. In a study of YMSM, men reporting a history of nonconsensual sex were ificantly more likely to have recently had UAI with casual partners [ 49 ]. In a study involving MSM in Brazil, early childhood sexual experience with older men were recalled as both positive and negative experiences, and typically perceived as abuse only when pain was involved [ 43 ]. We did not uncover any studies that specifically evaluated the relationships between childhood sexual maltreatment, HIV risk and intergenerational relationships among YMSM.
The high prevalence of childhood abuse, its association with HIV risk and seroconversion, and lack of research in the context of intergenerational relationships among YMSM point towards an important area for future research. For example, MSM who report having first anal intercourse at age 16 years or younger have been found to be more than twice as likely to have had UAI and over 10 sexual partners in the past year [ 5354 ], and to have engaged in transactional sex [ 55 ]. In qualitative interviews, for example, YMSM reporting first sexual debut with older partners have reported feelings of captivation by their older partner [ 60 ].
Studies suggest that the prevalence of heavy drug and alcohol use including polydrug use among YMSM is high. Several studies have highlighted both global and event-specific associations between substance use and sexual risk among YMSM [ 63 — 68 ]. Studies examining event-specific encounters have also found positive associations between substance use directly prior to sex and reduced odds of condom use [ 64657071 ].
In the context of intergenerational sex, these patterns may be compounded by inherent power dynamics and age-specific patterns of drug utilization [ 1664 ].
Given the high prevalence of substance use among YMSM, the relationship of substance use to risky sex, and the role of substance use in intergenerational sexual experiences, continued research is warranted. In particular, there is a need for further research to unpack the differential impacts of distinct types of substances on sexual risk behavior among YMSM in the context of age-discrepant relationships.
An ongoing area of research is the role of social and family support on sexual risk behavior among YMSM. A recent systematic review of 31 studies involving lesbian, gay and bisexual youth found that the vast majority experience negative parental influence [ 73 ]. Studies have additionally reported an association between family rejection and victimization among YMSM who come out, and engagement in sexual risk behavior [ 7374 ].
In a study involving self-identified lesbian, gay, and bisexual young adults in San Francisco, the experience of family rejection during adolescence was associated with 3. For YMSM experiencing family rejection and victimization, intergenerational sexual relations may act as surrogates for emotional and structural support, which may positively or negatively influence HIV risk behaviors. YMSM have reported being attracted to older partners because of the maturity, stability and decisiveness they offer [ 75 ], as well as emotional support, particularly when emotional support from family is lacking [ 60 ].
We were unable to identify any studies that specifically explored the relationship between family support, intergenerational relationships, and HIV risk among YMSM, pointing towards the need for further research in this area. With the exception of one study [ 76 ], research has consistently uncovered an increased likelihood of engaging in UAI among YMSM in committed or serious partnerships, compared to casual ones [ 828677577 — 79 ].
In a recent study of YMSM, being in a serious relationship was associated with an almost eight-fold increase in the rate of UAI [ 81 ]. Several explanations have been provided for these observations, including the fact that YMSM in primary partnerships report high levels of trust and familiarity with each other, agree on conditions of safer sex strategies, and share a perception that condoms reduce intimacy [ 8283 ]. The belief that primary partnerships are low-risk may be further enhanced by an assumption that a partner is HIV-negative, which has been reported by some YMSM [ 84 ].
YMSM have reported intentionally seeking out age-discrepant sexual partners because of the perceived relationship stability associated with older men [ 60 ]. However, young men in stable relationships with older men have also reported experiencing sexual coercion and forced UAI, highlighting the vulnerability of younger men in this relationship dynamic [ 85 ].
More research is required to investigate the specific contexts and power dynamics implicit in age-discrepant relationships that are associated with engagement in HIV risk among YMSM. Our review revealed a paucity of studies that have examined the prevalence of and HIV risk within intergenerational, serodiscordant relationships among MSM. A study by Hurt et al. Given that HIV prevalence among MSM increases with age [ 21 ], the risk of HIV acquisition among younger MSM in relationships with older, serodiscordant partners is likely substantial and requires further investigation.
Studies suggest that YMSM may be at increased risk of experiencing emotional or physical violence from sexual partners [ 86 ]. A history of intimate partner violence has also been associated with increased odds of risky sex [ 87 ] and HIV seropositivity [ 88 ] among YMSM.
A study involving YMSM aged 15—22 years in New York found that men reporting a history of threats and violence by family or partners had approximately twice the odds of reporting recent UAI, compared to men reporting no history of violence [ 89 ]. Our review yielded no studies have evaluated whether violence experienced by YMSM is related to having a partner of an older age. Research overwhelmingly support the notion that patterns of intimate partner violence are transmitted across generations, such that people who have observed inter-parental violence in childhood have a strong likelihood of enact the same behaviors as adults [ 90 ].
In addition to psychological power dynamics implicit in inter-generational relationships and HIV risk, YMSM engaged in sexual relations with older partners that have a history of inter-parental violence may be particularly at HIV risks associated with intimate partner violence. Collectively, the high burden of intimate partner violence among YMSMS, associated HIV risks, and power differential implicit in age-discrepant relationships point towards an important area for future research.
Research suggests that being connected to a gay community is associated with heightened access to HIV prevention, education and care services [ 35 ]. YMSM engaged in intergenerational relationships may have increased connectedness to the gay community by virtue of the fact that older MSM have been part of the community for a longer period of time, and the impact of these connections may be protective or encourage HIV risk. We did not find any studies that specifically explored the relationship between connectedness to the gay community, intergenerational relationships, and HIV risk, highlighting a critical area for further investigation.
Future studies are necessary to untangle whether participation in gay community acts as a risk or protective factor for YMSM in intergenerational relationships. Disparities in HIV prevalence between ethnic groups are not explained by individual sexual risk behaviors alone; a review of 53 studies found no difference in UAI, commercial sex work, sex with a known HIV-positive partner, or HIV testing history by ethnicity [ 93 ]. Further research is needed in other settings to understand to what extent these associations may apply in other YMSM communities.
Research has uncovered an association between low levels of education Seeking sex in Brandon al socio-economic status among YMSM and risky sexual Seeking sex in Brandon al [ ].
Interviews with YMSM found that men were attracted to older partners because of the perceived financial stability and success of older men and out of desire to exchange sex for money or goods [ 60 ]. In a study involving MSM aged 8—24 years in Baltimore, a greater of older partners were found among young men who reported exchanging sex for money [ ].
However, the perceived economic benefits of intergenerational relationships among YMSM may be outweighed by the negative effects of power inequalities [ 60 ]. Young MSM have reported coercion into unwanted sex by older partners which is exacerbated by imbalances in economic power [ 85 ].
Further research is needed to identify the extent to which economic disparity and dependency of YMSM on older sexual partners may influence their decision-making regarding sexual risk behavior. studies have reported high levels of Internet use among YMSM to meet sexual partners , and the Internet has also been shown to be an important mechanism for YMSM to find their first sexual partner [ ].
A cross-sectional study involving YMSM found that men using the Internet to meet sexual partners are more likely to engage in risky sexual behavior at sex clubs and bathhouses [ ].
Several studies also suggest that YMSM intentionally use the Internet or chat rooms to seek out older sexual partners [ 60, ]. We identified a growing body of evidence regarding the association between intergenerational sex and HIV risk and seroconversion among YMSM. This scoping review identified individual-level, micro- and meso-system factors that may influence HIV risk behavior in the context of intergenerational sexual relationships, and identified promising avenues for future research.
Findings from this review also support the need for age-specific public health HIV education and prevention strategies. While interventions aimed at addressing sexual networks, such as sexual preferences by age and ethnicity are likely not feasible [ 94 ],our findings suggest that YMSM may benefit from enhanced public health messaging about HIV risks inherent in intergenerational relationships. However, HIV prevention messaging regarding HIV risks associated with intergenerational sex may be integrated into different types of interventions, including school-based sexual education regarding sexual health and identity formation, family-based HIV preventions programs, Web-based and community-based outreach services.
Robert S. Julio S. Brandon D. Marshall is supported by a Richard B. Salomon Award from Brown University. Viviane D. National Center for Biotechnology InformationU. Author manuscript; available in PMC Jan RothPhD, 4 Viviane D. LimaPhD, 1, 5 Julio S. HoggPhD 1, 3. Eric A. Author information Copyright and information Disclaimer.
Aranka Anema: ac. Marshall: ude. Roth: ac. Lima: ac. Montaner: ac. Hogg: ac. Corresponding Author: Dr. Copyright notice. See other articles in PMC that cite the published article. Abstract An emerging body of evidence suggests that intergenerational sexual partnerships may increase risk of HIV acquisition among young men who have sex with men YMSM.
METHODS Search strategy This study employed a scoping review methodology [ 31 ], which aims to map key concepts regarding a proposed research area to its main sources of evidence and salient thematic. Open in a separate window. Substance Use Studies suggest that the prevalence of heavy drug and alcohol use including polydrug use among YMSM is high.
Partner Characteristics With the exception of one study [ 76 ], research has consistently uncovered an increased likelihood of engaging in UAI among YMSM in committed or serious partnerships, compared to casual ones [ 828677577 — 79 ]. Intimate Partner Violence Studies suggest that YMSM may be Seeking sex in Brandon al increased risk of experiencing emotional or physical violence from sexual partners [ 86 ]. Connectedness to Gay Community Research suggests that being connected to a gay community is associated with heightened access to HIV prevention, education and care services [ 35 ].
Economic Disparity Research has uncovered an association between low levels of education and socio-economic status among YMSM and Seeking sex in Brandon al sexual behavior [ ]. Internet Use studies have reported high levels of Internet use among YMSM to meet sexual partners , and the Internet has also been shown to be an important mechanism for YMSM to find their first sexual partner [ ]. Acknowledgments Drs. References 1. The Lancet. Cohen J. Breakthrough of the year. HIV treatment as prevention.Seeking sex in Brandon al
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