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Concept: Anal sex

56

Recently, the world has experienced a rapidly escalating outbreak of infectious syphilis primarily affecting men who have sex with men (MSM); many are taking highly active antiretroviral therapy (HAART) for HIV-1 infection. The prevailing hypothesis is that HAART availability and effectiveness have led to the perception among both individuals who are HIV-1 infected and those who are uninfected that HIV-1 transmission has become much less likely, and the effects of HIV-1 infection less deadly. This is expected to result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 STDs, including gonorrhoea, chlamydia and syphilis. However, syphilis incidence has increased more rapidly than other STDs. We hypothesise that HAART downregulates the innate and acquired immune responses to Treponema pallidum and that this biological explanation plays an important role in the syphilis epidemic.

Concepts: Antiretroviral drug, HIV, AIDS, Immune system, Epidemiology, Chlamydia infection, Syphilis, Anal sex

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The Italian society of colo-rectal surgery (SICCR) is dedicated to improving the study, prevention and management of the diseases of the colon, rectum and anus. One of the aims of the society is to establish guidelines to the treatment of these diseases. These guidelines are based on the international literature and on the best available evidence. Clinical practice guidelines are one of the most important instruments to provide therapeutic decision-making support, based on the best scientific evidence available at the time. Guidelines are advisory and not prescriptive, susceptible to continual variations secondary to innovations and new scientific evidence. These guidelines are a guide for all colo-rectal surgeons and physicians who approach anal cancer.

Concepts: Scientific method, Medicine, Cancer, Human papillomavirus, Physician, Anal cancer, Rectum, Anal sex

8

Rectal microbicides are needed to reduce the risk of HIV acquisition associated with unprotected receptive anal intercourse. The MTN-007 study was designed to assess the safety (general and mucosal), adherence, and acceptability of a new reduced glycerin formulation of tenofovir 1% gel.

Concepts: Iron, Rectum, Anal sex, Potassium permanganate

6

Squamous cell carcinomas of the anus and anal canal represent a model of a cancer and perhaps the first where level 1 evidence supported primary chemoradiotherapy (CRT) in treating locoregional disease with curative intent. The majority of tumours are associated with infection with oncogenic subtypes of human papilloma virus and this plays a significant role in their sensitivity to treatment. However, not all tumours are cured with CRT and there remain opportunities to improve outcomes in terms of oncological control and also reducing late toxicities. Understanding the biology of ASCC promises to allow a more personalised approach to treatment, with the development and validation of a range of biomarkers and associated techniques that are the focus of this review.British Journal of Cancer advance online publication, 6 December 2016; doi:10.1038/bjc.2016.398 www.bjcancer.com.

Concepts: Cancer, Disease, Oncology, Human papillomavirus, Lung cancer, Anal cancer, Squamous cell carcinoma, Anal sex

6

The aim of this study was to assess the prevalence and associations between anal intercourse and fecal incontinence.

Concepts: Fecal incontinence, Anal sex

3

The Army implemented a comprehensive HIV characterization program in 2012 following repeal of the Don’t Ask, Don’t Tell (DADT) policy banning openly homosexual individuals from serving in the United States military. Program staff administered a standardized case report form (CRF) to soldiers newly-diagnosed with HIV from 2012 to 2014 in compliance with new program requirements. The CRF documented socio-demographic, sexual and other risk behavior information elicited from Army regulation-mandated epidemiologic interviews at initial HIV notification. A majority of HIV-infected soldiers were male and of black/African American racial origin. In the HIV risk period, male soldiers commonly reported male-male sexual contact, civilian partners, online partner-seeking, unprotected anal sex, and expressed surprise at having a positive HIV result. DADT repeal allows for risk screening and reduction interventions targeting a newly-identifiable risk category in the Army. At risk populations need to be identified and assessed for possible unmet health needs.This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial No Derivatives 3.0 License, which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Concepts: Sexual intercourse, United States, United States Army, Homosexuality, Anal sex, Men who have sex with men, Creative Commons, United States armed forces

3

Preferences for anal sex roles (top/bottom) are an important aspect of gay male identity, but scholars have only recently begun to explore the factors that covary with these preferences. Here, we argue that the gendered nature of both racial stereotypes (i.e., Black men are masculine, Asian men are feminine) and sexual role stereotypes (i.e., tops are masculine, bottoms are feminine) link the categories Asian/bottom and the categories Black/top. We provide empirical evidence for these claims at three levels of analysis: At the cultural level based upon gay men’s stereotypic beliefs about others (Study 1), at the interpersonal level based upon gay men’s perceptions of others' sexual role preferences (Study 2), and at the intrapersonal level based upon racially diverse men’s self-reported sexual roles on a public hookup website (Study 3). These studies offer the first systematic evidence of linkages between race categories and sexual roles in gay male communities.

Concepts: Gender, Gender role, Race, Gender identity, Man, Masculinity, Homosexuality, Anal sex

3

Objective: Research has suggested a weak association between depression and sexual risk behavior in men who have sex with men (MSM). The purpose of this study was to investigate the relationship between within-person fluctuations in depression and well-being and episodes of sexual risk-taking among HIV-positive MSM. Methods: One hundred six sexually active HIV-positive MSM living in New York City completed a structured weekly survey over 6 weeks. In Weeks 1, 3, and 5, they responded to items assessing their sexual behavior, depression, and well-being in the prior week. Multilevel logistic regression analyses were conducted to explore the relationship between changes in levels of depression and well-being, and episodes of unprotected anal intercourse (UAI). Results: Within-person deviations from participants' average levels of depression and well-being were associated with the probability of risk. The probability of a risk episode was higher in weeks when depression was higher than participants' average levels (any UAI episode: odd ratio [OR] = 1.71, 95% confidence interval [CI] [1.00, 2.90], p < .05; serodiscordant UAI episode: OR = 2.49, 95% CI [1.31, 4.73], p < .05). The probability of a risk episode was lower in weeks when well-being was higher than participants' average levels (any UAI: OR = 0.40, 95% CI [0.22, 0.74], p < .05; serodiscordant UAI: OR = 0.42, 95% CI [0.22, 0.81], p < .05). Between-person differences in depression and well-being were not associated with risk episodes (ps > .05). Conclusion: This study is among the first to examine the association of within-person changes in depression and well-being with sexual risk behavior in a diverse sample. It contributes new evidence to literature exploring the relationship between depression and sexual risk. Future research should employ longitudinal designs to explore pathways linking within-person changes in depression with risk behavior. (PsycINFO Database Record © 2014 APA, all rights reserved).

Concepts: HIV, Regression analysis, Sexual intercourse, Risk, Human sexual behavior, Human sexuality, Sodomy, Anal sex

2

Preexposure prophylaxis has transformed HIV prevention, becoming widespread in communities of gay and bisexual men in the developed world in a short time. There is a broad concern that preexposure prophylaxis will discourage condom use among gay men (i.e., “risk compensation”). This commentary argues for broadening the focus on gay men’s health beyond sexual health to address the holistic health and well-being of gay men. Gay men may benefit from being offered candid, nonjudgmental health promotion/HIV prevention messages not requiring condom use for anal sex. Lessons can be drawn from the family planning movement, which has undergone a similar shift in focus. The principle of patient centeredness supports such a shift in gay men’s health toward the goal of providing men with the knowledge to evaluate various prevention approaches according to the specifics of their life circumstances and health needs. Bringing more nuance to discussions of sexual risk and sexual pleasure could facilitate more universally healthy attitudes regarding sex among gay men, in turn enabling healthier decisions more compatible with men’s own values and preferences.

Concepts: Family planning, Health, Reproductive health, Condom, Homosexuality, Bisexuality, Anal sex, Men who have sex with men

2

Apart from penile-anal intercourse, other anal sexual practices (rimming, fingering and saliva use as a lubricant for anal sex) are common among men who have sex with men (MSM). The aim of this study is to evaluate whether these anal sexual practices are risk factors for rectal gonorrhoea in MSM.

Concepts: Sexual intercourse, Epidemiology, Oral sex, Human sexual behavior, Chlamydia infection, Homosexuality, Sodomy, Anal sex