American Journal of Men's Health recent issues

Epidemiology as the Foundation for Population and Men's Health

Porche, D. J. — Sun, 22 Nov 2009 21:14:11 PST

Expanding Hegemonic Masculinity: The Use of Irony in Young Men's Stories About Romantic Experiences

Korobov, N. — Sun, 22 Nov 2009 21:14:11 PST

This study examines the use of irony in young men’s stories about romantic and sexual experiences. Because romantic experiences are central in the constitution of a heterosexual self, and because they are increasingly formulated in relation to traditional masculine norms and the simultaneous avowal and disavowal of effeminacy, they reveal an oscillation between complicity and resistance to hegemonic masculine norms. This oscillation is explored in stories about promiscuity, seduction, and vulnerability. Critical discursive analyses reveal how young men discursively pivot between complicity and resistance to traditional masculine norms, how this oscillation functions in the accomplishment of their romantic identities, how a sense of conventional masculinity is reclaimed, and what these processes reveal about the shifting nature of hegemonic masculinity in contemporary culture.

Masculinity and the Body: How African American and White Men Experience Cancer Screening Exams Involving the Rectum

Sun, 22 Nov 2009 21:14:11 PST

Past research on prostate and colorectal cancer disparities finds that barriers to screening, such as embarrassment and offensiveness, are often reported. Yet none of this literature investigates why. This study uses masculinity and health theory to examine how men experience two common screenings: digital rectal exams (DREs) and colonoscopies. In-depth interviews were conducted with 64 African American and White men from diverse backgrounds, aged 40 to 64, from North Carolina. Regardless of race or education, men experienced DREs more negatively than colonoscopies because penetration with a finger was associated with a gay sexual act. Some men disliked colonoscopies, however, because they associated any penetration as an affront to their masculinity. Because beliefs did not differ by race, future research should focus on structural issues to examine why disparities persist with prostate and colorectal cancer. Recommendations are provided for educational programs and physicians to improve men’s experiences with exams that involve the rectum.

African American Men's Perceptions of Power in Intimate Relationships

Senn, T. E., Carey, M. P., Vanable, P. A., Seward, D. X. — Sun, 22 Nov 2009 21:14:11 PST

Power in intimate relationships is an important predictor of sexual risk behavior. The purpose of this study was to better understand African American men’s perceptions of interpersonal power. A total of 20 African American men participated in focus groups to elicit their perceptions of power in intimate relationships; their responses were analyzed using grounded theory. From this analysis, a conceptual framework was developed that, among African American men, power in relationships was largely determined by the contribution of financial resources, and/or withholding sex. These findings were then considered in light of existing social—psychological theories of power in relationships. Future research should consider how to incorporate this understanding of interpersonal power into current theories of sexual risk behavior in order to develop more effective HIV risk reduction programs.

Medical Treatment for Men Who Have Sex With Men and Are Living With HIV/AIDS

Beckerman, A., Fontana, L. — Sun, 22 Nov 2009 21:14:11 PST

This study focuses on a sample of men who have sex with men (MSM) living with HIV/AIDS in a south Florida community. The study uses a mixed-method, quantitative, and qualitative research design. The purpose of the study was to identify individual and service system characteristics that impact access, retention, and adherence to an HIV/AIDS medical treatment regimen. The study identified many men who were not likely to seek treatment after their initial HIV/AIDS diagnosis. Compared with the general population living with HIV/AIDS in the same south Florida community many of these men were less likely to maintain a regimen of medical care for their HIV/AIDS. The study indicated that the following issues affected medical treatment and treatment adherence: treatment readiness, presence of support networks, availability of "MSM-friendly" health providers, and the cultural competency of substance abuse providers.

Penile Fracture Following Husband Abuse: A Case Report

Dienye, P. O., Jebbin, N. J., Gbeneol, P. K. — Sun, 22 Nov 2009 21:14:11 PST

The case of a 35-year-old fisherman who presented in a rural clinic with a sudden onset of painful penile swelling affecting the left lateral side with associated rapid detumescence is reported. He had tried to coerce his wife to a sexual intercourse when she forcefully bent his penis. He was initially managed with cold applications, oral diclofenac potassium, chymoral, and splinting of the penis and then referred to the urological services of a teaching hospital. He defaulted only to re-present about 2 weeks later with some improvement in his symptoms. Further advice to see the urologist was also rebuffed on financial grounds. When he reported about 1 month later, he was assessed to have grade 3 erectile dysfunction. In conclusion, penile fracture is a rare condition which follows unphysiological bending of the tumescent penis during sexual intercourse or masturbation. That following husband abuse is rarer. The sequelae can be devastating.

Domestic Violence Against Men in Primary Care in Nigeria

Dienye, P. O., Gbeneol, P. K. — Sun, 22 Nov 2009 21:14:11 PST

Domestic violence against men is rare in Nigeria. This study was aimed at assessing the prevalence of domestic violence against men, the sociodemographic characteristics of victims, and the pattern of injury sustained in a primary care setting. This was a retrospective study over a period of 5 years in which all the medical records of patients were retrieved and information on domestic violence extracted from them and transferred to a data sheet. Those whose records were grossly deficient were excluded from the study. A total of 220,000 patients were seen of which 48 (22 per 100,000) were victims of domestic violence. There were only five married male victims with a prevalence of 0.0023%. The injuries observed were scratches, bruises, welts, and scalds. The primary care physician needs a high index of suspicion to be able to detect it.

A Computer-Tailored Intervention to Promote Informed Decision Making for Prostate Cancer Screening Among African American Men

Allen, J. D., Mohllajee, A. P., Shelton, R. C., Drake, B. F., Mars, D. R. — Sun, 22 Nov 2009 21:14:11 PST

African American men experience a disproportionate burden of prostate cancer (CaP) morbidity and mortality. National screening guidelines advise men to make individualized screening decisions through a process termed informed decision making (IDM). In this pilot study, a computer-tailored decision-aid designed to promote IDM was evaluated using a pre-/posttest design. African American men aged 40 years and older were recruited from a variety of community settings ( n = 108). At pretest, 43% of men reported having made a screening decision; at posttest 47% reported this to be the case (p = .39). Significant improvements were observed between pre- and posttest on scores of knowledge, decision self-efficacy, and decisional conflict. Men were also more likely to want an active role in decision making after using the tool. These results suggest that use of a computer-tailored decision aid is a promising strategy to promote IDM for CaP screening among African American men.

Helping Young Men Thrive: Positive Youth Development and Men's Health

Vo, D. X., Park, M. J. — Sun, 22 Nov 2009 21:14:11 PST

Positive youth development (PYD) is a strong and growing field that complements the traditional problem-focused view of youth, and describes and promotes the healthy development and positive outcomes of young people. The PYD perspective can be applied in clinical and community intervention settings. Frameworks such as the "Five Cs" and the Search Institute’s developmental assets model have guided researchers and practitioners in better understanding the process of PYD and the effectiveness of community interventions to promote PYD. The PYD literature lacks a coherent guiding framework to describe gender differences in positive development, which in turn could guide community and clinical interventions designed to help young men thrive.

Information for Authors

Sun, 22 Nov 2009 21:14:11 PST

The Health Care Reform Agenda

Porche, D. J. — Thu, 03 Sep 2009 00:36:05 PDT

Stemming the Tide of Suicide in Older White Men: A Call to Action

Schmutte, T., O'Connell, M., Weiland, M., Lawless, S., Davidson, L. — Thu, 03 Sep 2009 00:36:05 PDT

Preventing suicide has been identified as a national priority by recent commissions in the United States. Despite increased awareness of suicide as a public health problem, suicide in older adults remains a neglected topic in prevention strategies and research. This is especially true regarding elderly White men, who in terms of suicide rates have represented the most at-risk age group for the past half century. In light of the unprecedented aging of the United States as the baby boom generation enters late adulthood, suicide prevention initiatives that focus on aging males are needed to prevent a national crisis in geriatric mental health. This article provides a brief review of the perennially under-recognized reality of suicide in older men and prevention strategies that, if implemented, might help stem this rising tide of suicide in this vulnerable population.

Correlates of Dietary Intake Among Men Involved in the MAN for Health Study

Thu, 03 Sep 2009 00:36:05 PDT

The clustering of diet and other lifestyle behaviors and their psychosocial correlates were examined among 455 Latino and African American men in the U.S. Southeast. Men were recruited by male community health workers and surveys were self-administered in a group format. Latino men were younger, less educated, and more likely to be employed than African American men and reported a lower household income and larger household size. Fruit and vegetable consumption was associated with physical activity (p ≤ .001). A more positive attitude toward health was associated with meeting vegetable dietary guidelines (p ≤ .05) and consuming fast food less frequently (p ≤ .01). Active coping was associated with meeting fruit and vegetable dietary guidelines (p ≤ .01 and p ≤ .001, respectively), and avoidant coping was associated with greater fast-food consumption (p ≤ .001). Latino fast-food consumption was associated with binge drinking (p ≤ .001). This research provides evidence for tailoring dietary intervention for men of color.

Religious Involvement and Prostate Cancer Screening Behaviors Among Southeastern African American Men

Holt, C. L., Wynn, T. A., Darrington, J. — Thu, 03 Sep 2009 00:36:05 PDT

This study examined the relationship between religious involvement and prostate cancer screening behavior among a probability sample of 199 African American men. Religious involvement was assessed by telephone via a multidimensional instrument. Engaging in religious behaviors was predictive of reporting a digital rectal examination (DRE) within the past year. Religious beliefs and behaviors were predictive of behavioral intention for DRE in the next 6 months. Religious behaviors were predictive of reporting an appointment for a DRE in the next 6 months. All analyses were controlled for age, education, and marital status. None of the predictions were significant for prostate-specific antigen testing. Understanding the role of religious involvement in cancer beliefs and screening is important. Such knowledge can inform educational interventions for this group, which is disproportionately affected by prostate cancer.

High Risk Community--Men's Perceptions of Black Infant Mortality: A Qualitative Inquiry

Thu, 03 Sep 2009 00:36:05 PDT

Infant mortality has been identified as a key public health concern in the United States. Although infant mortality rates (IMRs) in the United States have declined during the past 10 years, the rates among Blacks are more than two times higher as compared with other racial and ethnic groups. This study used focus groups to explore Black men’s awareness and perceptions of the rising IMR in their community. Twenty-five men participated in an initial and follow-up focus group, which revealed that men had limited awareness of infant mortality, reduced sense of personal responsibility for pregnancy outcomes, and perceptions that stress, the age of the mother, and the health care system were responsible for poor birth outcomes. The role of the community and possible interventions to involve and educate men were also explored.

Young Men's Vulnerability in Constituting Hegemonic Masculinity in Sexual Relations

Hyde, A., Drennan, J., Howlett, E., Brady, D. — Thu, 03 Sep 2009 00:36:05 PDT

This article reports on a qualitative analysis of the accounts of young men on their experiences of heterosexual encounters. Based on data collected in Ireland using 17 focus groups with 124 young men aged between 14 and 19 years (a subsection of a wider study), the manner in which intricate peer group mechanisms acted as surveillance strategies in regulating the young men toward presenting themselves in ways consistent with hegemonic manifestations of masculinity is explored. However, there were also elements of resistance to such a culture in the way in which sexual pleasure for some young men was derived relationally through giving pleasure rather than merely through mechanical, emotionally detached sexual acts that characterize hegemonic masculinity. In emphasizing male vulnerabilities such as uncertainty, fear, and rejection in the realm of sexuality, it is proposed that one must not lose sight of the broader context of male sexual dominance for which, as data indicate, men themselves pay a price.

Drugs, Incarceration, and HIV/AIDS Among African American Men: A Critical Literature Review and Call to Action

Lichtenstein, B. — Thu, 03 Sep 2009 00:36:05 PDT

Incarceration and HIV/AIDS disproportionately affect African American men compared to the U.S. population as a whole. Disparities in relation to crime and HIV/AIDS for Black men suggest that these phenomena have elements in common, particularly given the mediating role of illicit drug use or drug activities in both cases. A socioecological exploration of how and why these twin epidemics intersect (and the role of drug-related activities as mediating variables) is needed illicit drug use or to address the impact of these epidemics on the health and well-being of communities of color. This article critically reviews relevant articles, research reports, and official statistics, as well as conceptual frames of reference for information on the socioecological synergies between crime, drugs, and HIV/AIDS. The article recommends five calls for action for policies to mitigate the cumulative negative effects of these epidemics and for interventions to enhance the life chances of at-risk Black men.

Marijuana: Use Among Young Males and Health Outcomes

Pujazon-Zazik, M., Park, M. J. — Thu, 03 Sep 2009 00:36:05 PDT

Marijuana is the most commonly used illicit drug by adolescents and young adults, with more males than females reporting marijuana use. The adolescent and young adult years represent a critical period for interventions to prevent marijuana use and abuse. This article reviews relevant literature, including trends in young males’ marijuana use and health effects of marijuana use. By most measures, there has been little net change in marijuana use among 12th graders and young adults since the 1990s. Despite males’ greater use, little research has examined gender differences in areas such as metabolism of marijuana and long-term impact of marijuana use. In many areas, including dental health, fertility, and respiratory function, research is either sparse or has yielded conflicting results. Similarly, research on marijuana’s carcinogenic effects has yielded conflicting results; however, a small but consistent literature indicates that marijuana use is linked to cancers unique to males. A stronger literature has identified an association between marijuana use and psychiatric problems. Clinical and program interventions for adolescents have potential to prevent marijuana use, as well as screen for and treat marijuana abuse. Improved research is needed, such as research with greater consistency in defining levels of use and greater emphasis on gender differences. Such research would help clinical and program interventions focus on those most at risk for adverse outcomes.

Men's Health: Building the Science

Porche, D. J. — Thu, 14 May 2009 23:02:19 PDT

Fathers' Experience of Social Support After the Death of a Child

Aho, A. L., Tarkka, M.-T., Astedt-Kurki, P., Kaunonen, M. — Thu, 14 May 2009 23:02:19 PDT

The aims of this study were to describe fathers' social networks and their experience of social support after the death of a child. The sample consisted of 8 fathers who had lost a child under the age of 3. The data were collected with open-ended questions and interviews. Data analysis used qualitative content analysis. The fathers' social support networks varied over time and between fathers. The support networks included either just the spouse or the spouse and other people. Social relationships broke down and new relationships formed in their place. The fathers experienced social isolation but also deliberately isolated themselves from human relationships. The support the fathers received was felt to be both positive and negative. Peer support was only positive. Support from professionals was reported to be important but was also criticized. In particular better family care, informal support, and systematic support after leaving the hospital were expected.

Age at First Birth and Fathers' Subsequent Health: Evidence From Sibling and Twin Models

Pudrovska, T., Carr, D. — Thu, 14 May 2009 23:02:19 PDT

Using a sample of 540 siblings and twins from the National Survey of Midlife Development in the United States, this study examines the relationship between the age at which men become biological fathers and their subsequent health. The analysis includes both between-family models that treat brothers as independent observations and within-family models that account for unobserved genetic and early-life environmental endowments shared by brothers within families. Findings indicate that age at first birth has a positive, linear effect on men's health, and this relationship is not explained by the confounding influences of unobserved early-life characteristics. However, the effect of age at first birth on fathers' health is explained by men's socioeconomic and family statuses. Whereas most research linking birth timing to specific diseases focuses narrowly on biological mechanisms among mothers, this study demonstrates the importance of reproductive decisions for men's health and well-being.

"Maybe It Could Be a Heart Attack . . . But I'm Only 31": Young Men's Lived Experience of Myocardial Infarction--An Exploratory Study

Allison, M., Campbell, C. — Thu, 14 May 2009 23:02:19 PDT

This study examines the lived experience of myocardial infarction (MI) in younger men. Seven men, aged between 32 and 58, all of whom had suffered MI within the previous 12 months, were interviewed. Thematic analysis of the interview transcripts revealed four main themes. The themes were "disillusionment with life," "tension and stress," "keeping up appearances," and "invincibility." Collectively the four themes reflected the complexities, subtleties, and consensus of the experiences of these younger men who have survived MI. This study reveals that the individuals within the authors' sample appear to allude to the ideal or hegemonic form of masculine identity. Utilization of a qualitative approach with this younger male sample has enabled the authors to elicit the defining features of their experience as identified by themselves. Implications for these findings are discussed.

Experiences of Living in a Disrupted Situation as Partner to a Man With Testicular Cancer

Sanden, I., Soderhamn, O. — Thu, 14 May 2009 23:02:19 PDT

New knowledge has been gained about how close relatives reorient themselves and handle their life situation when facing close relatives' illness. The aim of this study was to describe and elucidate narrated experiences of living in a disrupted situation as partner to a patient with testicular cancer. A qualitative single-case design with a conversational interview using a semistructured guide with open-ended questions was implemented. A young woman whose partner had testicular cancer with metastases was interviewed. Narrative analysis of the data with focus on corporeality, spatiality, temporality, and communality revealed three themes that reflected the woman's concerns in different existential dimensions: the limitless self-care, the restricted space, and the shortness of time. The findings may facilitate caregivers' awareness of actual and potential self-care demands of both patients and significant others and can be used in developing structured strategies in helping close relatives to cope and manage as caregivers.

A Dilemma in Male Engagement in Preventive Services: Adolescent Males' Knowledge and Attitudes Toward Testicular Cancer and Testicular Self-Exam

Cronholm, P. F., Mao, J. J., Nguyen, G. T., Paris, R. T. — Thu, 14 May 2009 23:02:19 PDT

The objective of this study was to determine the knowledge and attitudes toward testicular cancer (TC) and testicular self-exam (TSE) among adolescent males. To assess adolescent male perspectives, a cross-sectional study was conducted in a convenience sample of 203 male high school students. Among the study participants, 139 (68.5%) correctly identified the age group when TC most commonly occurs, and 74 (36.5%) believed that TSE should be performed monthly. In a logistic regression model, students who have never heard of TSE were more likely to report intention to delay health care seeking with symptoms of testicular cancer (odds ratio, 2.83; 95% confidence interval, 1.33-6.05; p = .007). The participants demonstrated significant awareness of TC. Given the tension between current recommendations against screening for TC and the potential benefits of engaging men in preventive health care utilization, it remains unclear how awareness of TC and TSE will affect the health-seeking and preventive care of men.

Hepatitis Vaccination and Infection Among Gay, Bisexual, and Other Men Who Have Sex with Men who Attend Gyms in New York City

Siconolfi, D. E., Halkitis, P. N., Rogers, M. E. — Thu, 14 May 2009 23:02:19 PDT

The authors examined hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination rates, hepatitis infection, and health care access in a gym-attending sample of 311 gay, bisexual, and other men who have sex with men (MSM) in New York City. Overall, 69% reported having been vaccinated for HAV and 70% reported having been vaccinated for HBV. Multivariate models were used to identify predictors of HAV and HBV vaccination, and younger men, HIV-positive men, and men who had access to a doctor or clinic were more likely to be vaccinated than older men, HIVnegative men, and men without access to a doctor or clinic. Men with health insurance coverage were more likely to have received HBV vaccination than men without coverage. Findings indicate that there is still a significant proportion of unvaccinated men in our sample.

"HIV Is Still Real": Perceptions of HIV Testing and HIV Prevention Among Black Men Who Have Sex With Men in New York City

Nanin, J., Osubu, T., Walker, J., Powell, B., Powell, D., Parsons, J. — Thu, 14 May 2009 23:02:19 PDT

Rising HIV infection rates have been recently occurring among Black men who have sex with men (BMSM) in the United States. As a result, promoting HIV testing among members of this population is now considered a priority among local and federal health officials. A study was conducted to explore concerns about HIV testing among BMSM in New York City. In early 2006, data were gathered from focus groups with 29 BMSM. Discussions revealed factors affecting HIV testing, including stigma, sexuality, religion, race, and class, emphasizing responsibility, testing concerns, and media influences, among others. Recommendations were submitted to New York City health officials to inform HIV testing and prevention efforts.

Traditional Masculinity and African American Men's Health-Related Attitudes and Behaviors

Wade, J. C. — Thu, 14 May 2009 23:02:19 PDT

This study investigates aspects of masculinity that may relate to African American men's health-related attitudes and behaviors. Two hundred and eight men completed measures of traditional masculinity ideology and health-related attitudes and behaviors. Results indicated that after accounting for participants' age, education, income, and employment status, traditional masculinity norms of self-reliance and aggression were associated with behaviors conducive to personal wellness and certain health-related psychological tendencies. Restrictive emotionality was associated with anxiety about one's health and the belief that one's health status is outside of one's personal control. Implications of the findings for the health-related attitudes and behaviors of African American men are discussed.

Success with Men's Educational Group Appointments (MEGA): Subjective Improvements in Patient Education

Campbell, B. B., Shah, S., Gosselin, D. — Thu, 14 May 2009 23:02:19 PDT

Men have a higher age-adjusted death rate from many of the leading causes of death, compared with women. Avoidance of health care and unhealthy behavior contribute to premature death among men. The Lahey Clinic recently initiated a program, the Men's Educational Group Appointment (MEGA), which capitalizes on the potential benefits of group dynamics in an effort to educate men about preventative health. We hypothesized that putting men into a group setting for the educational portion of the visit would improve information exchange and patient learning. During 12 months, 261 men between the ages of 22 and 67 were evaluated. A survey designed to address both patient satisfaction and patients' perceptions regarding how much they learned was administered to all patients following the MEGA session. We identified high patient satisfaction with the MEGA model. This study illustrates the potential utility of the group model for improving patient education regarding health maintenance among men.

Men's Health: Integration Into the National Health Care Policy Agenda

Porche, D. J. — Wed, 11 Feb 2009 09:50:24 PST

African American Men's Perceptions of Factors Influencing Health-Information Seeking

Sanders Thompson, V. L., Talley, M., Caito, N., Kreuter, M. — Wed, 11 Feb 2009 09:50:25 PST

The lack of health information is one of several factors implicated in the poor health status of African American men. Although a growing body of research delineates the obstacles to African Americans' engagement in preventive health behaviors, relatively little is known about the barriers that adversely affect men's involvement in health-information seeking. This article presents qualitative data on African American men's information seeking through an analysis of focus group data. Three research questions are addressed: (a) What health-information concerns and needs do African American men have? (b) How do African American men describe their efforts to obtain health information? and (c) What factors facilitate or inhibit health-information seeking by African American men? The implications of the data and suggestions for future research are provided.

The Lived Experience of Informal African American Male Caregivers

Weinland, J. A. — Wed, 11 Feb 2009 09:50:25 PST

Informal caregivers play a major role in providing care to loved ones within the home and demands for dependent care are likely to increase. Informal caregivers are likely to continue to be responsible for the majority of care for loved ones living well into late stages of life. This article describes the lived experience of African American men providing care to a relative within the home and explores their definition of caregiver distress. The phenomenological study was conducted using face-to-face interviews with 10 Christian African American men. Demographic data about the caregiver and the care recipient were collected. Common themes included: commitment, support (family support and formal health-related support), spirituality, and caregiver burden (stress, time strain and financial strain). Implications include the need for health care providers to expand their knowledge related to the diversity of caregivers and to use culturally relevant comprehensive assessments of caregivers and recipients, discharge planning tools, and community resources.

Situational, Psychosocial, and Physical Health--Related Correlates of HIV/AIDS Risk Behaviors in Homeless Men

Stein, J. A., Nyamathi, A. M., Zane, J. I. — Wed, 11 Feb 2009 09:50:25 PST

A biopsychosocial perspective is employed to assess associations among situational and psychosocial variables related to health, health care, and HIV/AIDS risk behaviors among 479 homeless men (aged 18-64 years). Poor health was not significantly associated with sexual risk behaviors and was only modestly associated with injection drug use (IDU). Health care was not significantly associated with sexual risk behavior or IDU. HIV/AIDS risk behaviors were highly associated with homelessness severity and posttraumatic stress disorder. IDU was significantly associated with greater emotional distress and was more likely among younger men and among White men. Sexual risk behavior was more frequent among those who had particularly poor-quality housing such as living on the street or in abandoned buildings. Because interactions with the medical community are limited and not associated with HIV/AIDS risk, outreach in areas in which homeless men congregate, mental health and substance abuse treatment, and permanent supportive housing may help reduce HIV risk among homeless men more effectively.

Challenging Roles: Insights Into Issues for Men Caring for Family Members With Mental Illness

Fraser, C., Warr, D. J. — Wed, 11 Feb 2009 09:50:25 PST

Assumptions informing expectations of caring may not reflect the diversity of circumstances in which informal care is provided, and scant attention has been given to the experiences of men providing care to family members. This study reports on qualitative findings from a study that explored these issues among rural men caring for partners or children with a range of mental illnesses. The findings suggest that the primary relationship between carers and care recipients influences the ways in which the men understand and practice their caring roles. Fathers consistently described proactive approaches to caring and were strongly focused on managing the illness condition. There was some complementarity between parenting and caring roles that is likely to explain why they reported a high use of, and satisfaction with, mental health services. Husbands tended to take reactive approaches to caring in which they were more concerned with managing situations that were associated with their partners' illnesses. Husbands reported limited contact with treatment and support services and perceived them as inappropriate to their circumstances. All of the men were presented with complex tensions in their caring roles, and the men's accounts of caring that are presented offer useful insight into the contexts in which men are increasingly taking on caring roles in families and inform efforts to support men in this capacity.

Where MSM Have Their First HIV Test: Differences by Race, Income, and Sexual Identity

Lauby, J. L., Milnamow, M. — Wed, 11 Feb 2009 09:50:25 PST

To inform initiatives to increase HIV testing in nontraditional locations, this study examined locations where men who have sex with men (MSM) get their first HIV test and identified population segments with different test location patterns. Interviews were conducted with 451 MSM systematically recruited from 65 venues in Philadelphia. Of 408 men ever tested for HIV, 29% took their first test in a clinic or hospital, 23% in a doctor's office, 30% at an HIV organization, and 19% in a high-risk setting, including prison, shelter, or drug treatment facility. More than half (58.5%) had their most recent test in the same type of location as their first test. Men tested at HIV organizations were the most likely to receive information about HIV prevention. Low-income Black MSM were less likely to be tested at medical settings or HIV organizations. Segmentation analysis revealed other differences in testing locations by income, race/ethnicity, and sexual identity.

Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa

Bankole, A., Singh, S., Hussain, R., Oestreicher, G. — Wed, 11 Feb 2009 09:50:25 PST

The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.

Can Routine Neonatal Circumcision Help Prevent Human Immunodeficiency Virus Transmission in the United States?

Xiao Xu, , Patel, D. A., Dalton, V. K., Pearlman, M. D., Johnson, T. R. B. — Wed, 11 Feb 2009 09:50:25 PST

Primary prevention of human immunodeficiency virus (HIV) continues to pose an important challenge in the United States. Recent clinical trials conducted in Kenya, South Africa, and Uganda have demonstrated considerable benefit of male circumcision in reducing HIV seroincidence in males. These results have ignited debate over the appropriateness of implementing routine provision of neonatal circumcision in the United States for HIV prevention. This article discusses major contextual differences between the United States and the three African countries where the clinical trials were conducted, and cautions that the applicability of the scientific data from Africa to this country must be carefully considered before rational policy recommendations regarding routine neonatal circumcision can be made as a strategy to prevent the spread of HIV in the United States.