Eric W. Schrimshaw, Ph.D. - US grants

DESCRIPTION (provided by applicant): Smartphone technologies (i.e., cellular telephones, such as the iPhone, Android phones, and newer generation Blackberry phones), have provided a new venue for sexual partnering among men who have sex with men (MSM). Indeed, there are a rapidly growing number of smartphone applications designed to facilitate sexual partnering among MSM. Although all smartphones can access Internet sites for sexual partnering, smartphone applications designed for sexual partnering go a step further by utilizing the Global Positioning System (GPS) technology built into smartphones to help MSM identify potential partners who are geographically closest to their current position. As such, these technologies may have accelerated the rate with which men can meet and connect with sexual partners over that of the traditional Internet. Furthermore, given the expediency with which men are able to arrange sexual encounters using these applications, there is cause to question if, when, and how sexual negotiation and serostatus disclosure occurs. The overall study goal is to understand how sexual risk behaviors among MSM may be facilitated by the nature of GPS-enabled smartphone applications, the way they are used, and the process by which sexual partnering occurs via smartphone applications. We will conduct in-depth qualitative interviews with 60 MSM (20 African American, 20 Latino, 20 White; 25% of whom are HIV-positive) who have utilized smartphone applications to meet sexual partners in the past 3 months. For each of the aims below, while our focus is on smartphone use, we will also collect information on their use of Internet partnering sites to use as a context for comparison and identify what might be unique to smartphone usage. The study aims are: 1. Examine how and why smartphone applications are used for sexual partnering, the situations and locations in which they are used, in order to gain insights into how these use patterns might contribute to sexual risk behaviors. 2. Investigate the process by which MSM use smartphone applications to find sexual partners (i.e., who they look for, how they present themselves, how they communicate, extent of safer sex negotiation,and disclosure) to gain insights into how this process may contribute to sexual risk behaviors. 3. Investigate the sexual and emotional states (e.g., more/less urgency, arousal, impulsivity) that MSM experience when seeking or meeting sexual partners using smartphone applications and gain insights into how these states may contribute to sexual risk behaviors. 4. Examine the perceived need and acceptability of a smartphone delivered intervention and assess what MSM perceive as needed components for a smartphone-based sexual risk reduction intervention. PUBLIC HEALTH RELEVANCE: Smartphone technologies (such as the iPhone, Android phones, and newer generation Blackberry phones), have provided a new venue for sexual partnering among men who have sex with men (MSM). Smartphone applications designed for sexual partnering utilize GPS technology built into smartphones to help MSM identify potential partners who are geographically closest to their current position. As such, these technologies may have accelerated the rate with which men can meet and connect with sexual partners over that of the traditional Internet. To understand how sexual risk behaviors among MSM may be facilitated by the nature of GPS-enabled smartphone applications, we will conduct in-depth qualitative interviews with 60 MSM (20 African American, 20 Latino, 20 White; 25% of whom are HIV-positive) who have utilized smartphone applications to meet sexual partners in the past 3 months.

? DESCRIPTION (provided by applicant): Despite considerable attention to the sexual health of young men who have sex with men (YMSM), new HIV and STD infections are rapidly increasing among this population. A critical aspect of sexual behavior among YMSM is the process of sexual socialization - the process by which individuals gain knowledge, attitudes, and norms about sexuality, sexual behavior, and sexual risk. Sexual scripts theory provides a framework to understand the sexual socialization process, specifically how individuals receive cultural scenarios from external sources (cultural scripts), interpret them (intrapsychic scripts), and enact them with sexual partners (interpersonal scripts). To understand this phenomenon and inform the development of, and improve existing, interventions for YMSM, the proposed study will conduct mixed-methods interviews with an ethnically diverse sample of 160 urban YMSM (33% Black, 33% Latino, 33% White; of whom 50% within each racial/ethnic group will be ages 16-20 and 50% will be ages 21-25). Aim 1. Examine the content of cultural scenarios that YMSM are exposed to, from different sources, about when/what age they should have sex, who are acceptable partners, the frequency and types of sexual (risk) behaviors that are appropriate, and the role of substance use in sexual interactions. Aim 2. Examine the processes by which YMSM interpret, resolve discrepancies between, and enact these cultural scenarios into sexual behaviors, including the process by which scripts are reappraised and enacted differently over time (e.g., due to maturation, new relationship contexts, exposure to new cultural scenarios). Aim 3. Examine how the content and sources of cultural scenarios to which YMSM are exposed and their interpretation, enactment, and reappraisal of these scripts over time, differ by selected participant characteristics; and how these differences in scripts serve to explain differences in sexual risk behaviors. Aim 4: Investigate the views of YMSM regarding the need for, desired content of, and method of delivery for sexual education and HIV prevention interventions for YMSM.

Summary For men who have sex with men (MSM) who engage in exchange sex (i.e., offering sex in exchange for money, drugs, shelter, or goods), gay hookup apps and websites have become a common venue for meeting clients. Further, it has been argued that these new technologies have made male sex work safer, more anonymous and normalized in the gay community, thus likely diversifying and expanding the number of MSM who participate in exchange sex. However, this population of MSM is currently not well characterized or understood from a public health perspective. The goal of the study is to investigate a very under-studied population?MSM who use hookup apps/websites to find clients for exchange sex. The proposed research will be extremely valuable in better characterizing this population and its sexual practices, risk behavior, and risk reduction strategies. We will also examine participants? HIV and STI testing behavior and their attitudes toward PrEP. Because exchange sex is most prevalent among Black, Hispanic, and White MSM ages 18?45, we will conduct in-depth qualitative interviews with an ethnically diverse sample of 180 HIV-uninfected MSM (60 Black, 60 Latino, and 60 White participants, half of them ages 18?29 and half 30?45). To better understand the factors associated with sexual risk taking among men who engage in exchange sex, half of the men in each age and racial/ethnic group will have only had protected sex (either consistent condom use or consistent use of PrEP) and half will have had unprotected anal sex (condomless sex without taking PrEP) with their clients in the prior three months. The study aims are: 1. To investigate participants? pathways into exchange sex, how they use hookup apps/websites to find and negotiate with clients, and how they evaluate the worth of different acts and partners. 2. To investigate the heuristics and risk-reduction strategies?including PrEP and HIV and STI testing?participants use to try to manage the risks of becoming HIV infected and their reasons for their choices. 3. To investigate what types of HIV/STI and sexual health interventions participants would find useful, how they would like these delivered, and then, use findings to develop a provisional intervention to reduce sexual-risk behavior among MSM who use hookup apps/websites to find clients for exchange sex.

PROJECT SUMMARY Young lesbian, bisexual, and other women who love women (YLBWLW) are more likely to report considering and attempting suicide than their heterosexual female peers, or gay/bisexual male peers. However, most researchers combine lesbians/bisexual women with other sexual minorities, resulting in a paucity of research specific to YLBWLW, and even fewer have examined potential differences between YLBWLW. Further, within the scant protective factor research, YLBWLW are severely under-represented, and no studies have examined relationships between individual identity protective factors or interpersonal social connectedness protective factors specific to YLBWLW and their suicide risk. Another important area of study in suicide research with YLBWLW involves understanding how developmental transition periods (e.g., into high school, college, or the workforce) affect suicide risk since developmental transitions can result in a major loss of social connections that serve as protective factors against minority stress and suicide ideation. To address gaps in the research, we will pursue the following specific aims: (1) Examine the moderating effects of individual and interpersonal sexual identity-specific protective factors on theoretical pathways of risk for suicide ideation among YLBWLW; (2) Test developmental transition periods as a multi-level moderator within the theoretical model; and (3) Explore in-depth the effects of changes in social connections over time, especially during transition periods, on suicide risk. The sample will include a nationwide sample of 780 racially and ethnically diverse YLBWLW aged 14 to 30 recruited through social media platforms. Participants will complete an online survey every three months over an 18-month period. We will address Aim 1 by performing stratified latent variable moderated mediation analyses for YLBWLW separately to test and compare the following hypotheses: a) individual protective factors (identity centrality, authenticity, and affirmation) will moderate the risk relationship of minority stress on entrapment; and b) interpersonal social connectedness factors (social inclusion/belonging, lesbian/bisexual community involvement, social support) will moderate (weaken) the risk conferred by experiences of entrapment on suicide ideation. For Aim 2, we hypothesize that a) compared to those not going through transitions, those going through a transition will experience increased feelings of stress and entrapment; and b) social connectedness and positive identity factors will moderate associations between stress, entrapment, and suicide ideation. Aim 3 will involve conducting individual interviews with a subsample of 70 participants going through a developmental transition and reporting some suicide ideation to glean insights into YLBWLW?s experiences of these transitions and aspects of social connection that were most helpful in reducing their distress. The impact of this research involves identifying modifiable individual identity- and interpersonal social connectedness-level protective factors that will guide suicide prevention efforts across different levels of influence to promote mental health and reduce deaths by suicide among YLBWLW.