Background: Men who have sex with men (MSM) are heterogeneous with respect to sexual behavior. We examined differences in sexual risk behaviors and HIV protective behaviors between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). Among MSMW, we also examined associations between partner gender and disclosure of same-sex attraction to sexual risk behaviors. Methods: Data for this analysis were from MSM who participated in National HIV Behavioral Surveillance (NHBS) in 2011 and 2014. Prevalence differences comparing MSMW and MSMO were calculated for demographics and behaviors. Adjusted prevalence ratios comparing MSMW to MSMO were calculated for the outcomes condomless sex, exchange sex, testing for HIV, and disclosure of same-sex behavior. Results: MSMW were less likely than MSMO to have condomless sex with male partners (aPR 0.77; 95%CI 0.73-0.80), to have been diagnosed with another STD (aPR 0.83; 95%CI 0.73-0.95), and to disclose their same-sex behavior to healthcare providers (aPR 0.72; 95%CI 0.69-0.76). However, MSMW were more likely than MSMO to engage in exchange sex (aPR 2.43; 95%CI 2.17-2.72) and to have ever injected drugs (aPR 2.00; 95%CI 1.76-2.28) Conclusions: MSMW have distinctive sexual risk behaviors and could benefit from tailored interventions to reduce the prevalence of HIV in this population.

The purpose of this study was to investigate the relationships among cultural/spiritual beliefs, risk behaviors, and disclosure among Hispanic/Latino men who have sex with men and women (MSMW). Minority men who have sex with men are disproportionately affected by HIV, in particular MSM who are Hispanic/Latino or African American. Limited research is available on the link between Hispanic/Latino MSMW, their cultural/spiritual beliefs, risk behavior, and disclosure about risk behaviors to friends and family. The data were obtained from the SJS Project, which used survey methods to gather data on participants from all 50 states and Puerto Rico. Among the participants in this project, 354 indicated that Hispanic/Latino was their only race/ethnicity, 264 identified as gay (MSM), 23 identified as bisexual (MSMW) and 67 identified as some other sexuality, and thus were not included in the analysis. Chi-square analysis and multiple linear regression were used to analyze the data and test the hypotheses. Among the bisexual group, the results showed no relationship between the independent variable, cultural/spiritual beliefs, and the dependent variable, disclosure. Among the gay group, the results showed a moderate relationship on one item of the independent variable, cultural/spiritual belief, and one item of the dependent variable, self-disclosure. Thus there is a relationship between disclosing to friends, family and the neighborhood and feeling supported by family among the gay group. It is expected that these findings will inform public health practitioners who have an interest in creating and implementing HIV prevention programs geared toward the Hispanic/Latino members of the LGBT community and Hispanics/Latinos.

Our understanding of humoral immune response to human papillomavirus (HPV) infection has been mainly derived from studies in women. Very little is known about humoral immune response to HPV in men. There is also a growing interest in understanding the burden of HPV exposure in the subgroups of the male population, including men who have sex with women (MSW), men who have sex with men (MSM) and men who have sex with both men and women (MSMW). This dissertation was undertaken to understand and characterize humoral immune response, measured by detectable serum antibody IgG, to HPV 6, 11, 16 and 18 infection, to estimates seroprevalence of HPV 6, 11, 16 and 18, to determine the associations of sociodemographic and sexual behavioral factors with seroprevalence of individual HPV types, and to evaluate the role of serum antibodies in the subsequent acquisition of infection with the same HPV type, genetically related and un-related HPV types. Three studies that compose of this dissertation were conducted within the framework of two longitudinal studies of HPV infection in men: a single-site natural history study of male residents of Tucson, Arizona (the 1st study: N=285); and a multinational natural history study of healthy men residing in São Paulo, Brazil, Cuernavaca, Mexico, and Tampa, Florida (the 2nd study: N=1477; the 3rd study: N=2187). Men were recruited using similar eligibility criteria in both natural history studies and followed every 6 months for a maximum of 18 months in the single-site study and 48 months in the multi-national study. HPV DNA status was assessed using the PGMY09/11 L1 consensus primer system and the Linear Array HPV Genotyping Protocol. Testing of serum antibodies to HPV 6, 11, 16 and 18 was performed with virus-like particle-based ELISA assays. Data from our studies indicate that exposure to HPV 6, 11, 16 and 18, the four HPV types targeted in the currently license HPV vaccines, is common. Of 285 male residents of Tucson, Arizona, 28.8% of them were seropositive to HPV 16 and/or 18 at study entry. Similarly, approximately one third of 1477 participants of the multi-national male HPV natural history study were seropositive to at least one vaccine HPV type, with the percentage of 21.8% in U.S. site, 33.4% in Mexico site, and 49.1% in Brazil site. It is also noted that seroprevalence of individual vaccine HPV types is greatly elevated among men of different sexual practices. Seroprevalence of HPV 6, 11, 16 and/or 18 was twice as high among MSM and MSMW compared to MSW. Likewise, seroprevalence of individual HPV types was two fold or higher among MSW and MSMW. Our findings suggest that the predominant predictors of seropositivity to HPV 6, 11, 16 and 18 are age and same-sex sexual behaviors. Seroprevalence increased with age among young-to-middle-aged men with significant upward age trends observed for HPV 11, 16 and 18. MSM, compared to MSW, more likely to be seropositive to HPV 16 or 18. Similarly, men who practiced same-sex anal sex, compared to those who did not, were significantly more likely to be seropositive to HPV 6, 11, 16 and 18, respectively. Among 276 men free of HPV 16 at enrollment in Tucson, We did not detect statistically significant associations between the baseline serum antibodies to HPV 16 and/or 18 and subsequent risk of infection with homogeneous HPV types or related-HPV types. Of 2187 men residing in three countries who tested HPV 16 negative at enrollment, the risk of subsequent HPV 16 infection was not associated with enrollment HPV 16 serum antibodies status. Our data provide important estimates of population exposure to vaccine HPV types for future studies modeling potential vaccine impact and vaccine cost effectiveness in men. Our findings also support strategic vaccination of males as an effective preventive measure for HPV-related diseases and cancers in men and their sex partners, men and women alike.