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Sexual Health, 2015, 12, 467–468 http://dx.doi.org/10.1071/SH15086

Letter

Body image and sexually transmissible infection prevalence among men who have sex with men Cara E. Rice A,E, Alison H. Norris A,B, John A. Davis B, Courtney D. Lynch C, Karen S. Fields D, Melissa Ervin D and Abigail Norris Turner A,B A

Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA. B Division of Infectious Diseases, College of Medicine, The Ohio State University, 410 W. 10th Avenue, Columbus, OH 43210, USA. C Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA. D Sexual Health Clinic, Columbus Public Health, 240 Parsons Avenue, Columbus, OH 43215, USA. E Corresponding author. Email: [email protected]

Abstract. Compared with men who have sex with women, some evidence suggests that men who have sex with men (MSM) have increased prevalence of body image dissatisfaction. MSM also have a higher prevalence of sexually transmissible infections (STIs) than other population groups. As part of a cross-sectional study, body image among 104 MSM using the standardised, validated Male Body Attitudes Scale was assessed. Associations between body image and prevalent STI were examined. Body image was not associated with prevalent STI in unadjusted [prevalence ratio (PR): 1.14, 95% confidence interval (CI): 0.86–1.52] or adjusted analyses (PR: 1.17, 95% CI: 0.89–1.53). Received 2 October 2014, accepted 4 May 2015, published online 20 July 2015

Sexually transmissible infections (STIs)1 and body image dissatisfaction2–7 both disproportionately impact men who have sex with men (MSM). Some studies have examined the link between body image and risky sexual behaviour among MSM, yielding mixed results; positive body image has been associated with both increases8,9 and decreases10 in risky behaviour. Negative (e.g. poor) body image has also been associated with risky behaviour.11 To the best of our knowledge, no research has examined the direct relationship between body image and biologically confirmed STI. We utilised data from a cross-sectional study of MSM seeking care at a public sexual health clinic (SHC). To be eligible for the parent study, men were 18 years or older and reported anal intercourse with another man within the past year. After providing informed consent, participants completed a self-administered questionnaire capturing behaviour and body image data. We measured body image using the 6-point Male Body Attitudes Scale (MBAS). Higher MBAS scores indicate poorer body image.12 All men underwent testing for HIV, syphilis, gonorrhoea and chlamydia. Statistical analyses were conducted using SAS (Version 9.3.1; Cary, NC, USA). Participants were classified as being STI-positive if they tested positive for primary or secondary syphilis, gonorrhoea or chlamydia. We evaluated the association between body image and STI prevalence using unadjusted and Journal compilation  CSIRO 2015

adjusted modified Poisson regression models,13 specifying continuous MBAS score as the exposure and a composite STI variable (any prevalent STI vs none) as the outcome. We adjusted for HIV status, age, race and relationship status. Of the 235 men enrolled in the parent study, 104 men completed the MBAS and were included in this analysis. Participants were 18–66 years of age (median: 26 years) and 53% were white. Nineteen per cent (n = 20) were HIV positive and 32% (n = 33) were STI positive. The MBAS scores ranged from 1.00 to 5.38, with a median of 2.83 [interquartile range (IQR): 2.06–3.42]. MBAS scores did not differ significantly by age, race, education, employment status or sexual orientation. Body image was significantly poorer with increasing body mass index (BMI) (MBAS of 2.67 vs 2.95 for normal vs overweight BMI, P = 0.03) and among men without a committed partner (MBAS of 2.67 vs 2.88 for men with vs without a partner, P = 0.03). Body image did not differ significantly by HIV status. The median MBAS score was very similar among MSM with prevalent STI (2.88) vs men without prevalent STI (2.83, P = 0.56). Similarly, in the unadjusted regression model, we observed no significant association between MBAS score and prevalent STI [prevalence ratio (PR): 1.14, 95% confidence interval (CI): 0.86–1.52]. Adjustment for HIV status, relationship status, race and age did not meaningfully change www.publish.csiro.au/journals/sh

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Table 1. Unadjusted and adjusted associations between body image and prevalent STI CI, confidence interval; MBAS, Male Body Attitudes Scale; PR, prevalence ratio; STI, sexually transmissible infection

MBAS score (body image) A

Unadjusted PR (95% CI)

AdjustedA PR (95% CI)

1.14 (0.86–1.52)

1.17 (0.89–1.53)

Adjusted for HIV status, relationship status, race and age.

the association (PR: 1.17, 95% CI: 0.89–1.53) (Table 1). We also found no association between body image and risky sexual behaviour (data not shown). This analysis makes a novel contribution to the current literature on MSM, body image and STI. While previous research suggested that body image was associated with risky sexual behaviours and thus indirectly with STI, no existing study had measured STI status. In other areas of sexual research, selfreported behavioural measures often do not correlate with biological STI status.14,15 Our work is further strengthened by use of the MBAS, which was developed for men, has excellent psychometric properties12 and displayed strong factorial validity in a confirmatory analysis in gay men.16 Our study also has important weaknesses, including the small sample size and the cross-sectional design. In summary, we found no significant association between body image and prevalent STI, suggesting that poor body image may not be an appropriate target for public health interventions focussed on reducing STI prevalence. Conflicts of interest None declared. Acknowledgements This project received support from the Ohio State University Center for Clinical and Translational Science (OSU CCTS). The OSU CCTS is supported by the National Center for Research Resources, Grant UL1RR025755, and is now at the National Center for Advancing Translational Sciences, Grant 8UL1TR000090–05. The work was also supported by the Alumni Grant for Graduate Research and Scholarship (CR) and The Ohio State University Presidential Fellowship (CR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. The funding sources had no role in data collection, data analysis, data interpretation, writing of this report or the decision to publish this manuscript. The authors thank Mysheika Williams Roberts, Jose Bazan and the Division of Infectious Diseases at The Wexner Medical Center at Ohio State University for their support of this project. The authors also thank the clinicians from Columbus Public Health Sexual Health Clinic and study volunteers (Alexandra Medoro, Aliza Spaeth-Cook, Angela Palmer-Wackerly, Chelsea Muyskens, Courtney Maierhofer, Julie Anderson, Laura Drew, Samantha Lahey and Tiffany Wang) for their assistance with data collection.

References 1 Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2010. Atlanta: U.S. Department of Health and Human Services; 2011. 2 Morrison MA, Morrison TG, Sager CL. Does body satisfaction differ between gay men and lesbian women and heterosexual men and women? A meta-analytic review. Body Image 2004; 1: 127–38. doi:10.1016/j.bodyim.2004.01.002 3 Siever MD. Sexual orientation and gender as factors in socioculturally acquired vulnerability to body dissatisfaction and eating disorders. J Consult Clin Psychol 1994; 62: 252–60. doi:10.1037/0022-006X. 62.2.252 4 Brand PA, Rothblum ED, Solomon LJ. A comparison of lesbians, gay men, and heterosexuals on weight and restrained eating. Int J Eat Disord 1992; 11: 253–9. doi:10.1002/1098-108X(199204)11:33.0.CO;2-J 5 Schneider JA, OLeary A, Jenkins SR. Gender, sexual orientation, and disordered eating. Psychol Health 1995; 10: 113–28. doi:10.1080/ 08870449508401942 6 McCreary DR, Hildebrandt TB, Heinberg LJ, Boroughs M, Thompson JK. A review of body image influences on men’s fitness goals and supplement use. Am J Men Health 2007; 1: 307–16. doi:10.1177/ 1557988306309408 7 Peplau LA, Frederick DA, Yee C, Maisel N, Lever J, Ghavami N. Body image satisfaction in heterosexual, gay, and lesbian adults. Arch Sex Behav 2009; 38: 713–25. doi:10.1007/s10508-008-9378-1 8 Kraft C, Robinson BE, Nordstrom DL, Bockting WO, Rosser BRS. Obesity, body image, and unsafe sex in men who have sex with men. Arch Sex Behav 2006; 35: 587–95. doi:10.1007/s10508-006-9059-x 9 Meanley S, Hickok A, Johns MM, Pingel ES, Bauermeister JA. Body mass index, body esteem, and unprotected receptive anal intercourse among young men who have sex with men who seek partners online. Arch Sex Behav 2014; 43: 735–44. doi:10.1007/s10508-013-0159-0 10 Allensworth-Davies D, Welles SL, Hellerstedt WL, Ross MW. Body image, body satisfaction, and unsafe anal intercourse among men who have sex with men. J Sex Res 2008; 45: 49–56. doi:10.1080/ 00224490701808142 11 Wilton L. A preliminary study of body image and HIV sexual risk behavior in black gay and bisexual men: implications for HIV prevention. J Gay Lesbian Soc Serv 2009; 21: 309–25. doi:10.1080/ 10538720802497829 12 Tylka TL, Bergeron D, Schwartz JP. Development and psychometric evaluation of the Male Body Attitudes Scale (MBAS). Body Image 2005; 2: 161–75. doi:10.1016/j.bodyim.2005.03.001 13 Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159: 702–6. doi:10.1093/aje/ kwh090 14 Zenilman JM, Weisman CS, Rompalo AM, Ellish N, Upchurch D, Hook E III, Celentano D. Condom use to prevent incident STDs: the validity of self-reported condom use. Sex Transm Dis 1995; 22: 15–21. doi:10.1097/00007435-199501000-00003 15 Schachter J. Biologic versus behavioral endpoints–the duet continues. Sex Transm Dis 2000; 27: 456–7. doi:10.1097/00007435-20000900000006 16 Blashill AJ, Vander Wal JS. The Male Body Attitudes Scale: a confirmatory factor analysis with a sample of gay men. Body Image 2009; 6: 322–5. doi:10.1016/j.bodyim.2009.07.004

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Body image and sexually transmissible infection prevalence among men who have sex with men.

Compared with men who have sex with women, some evidence suggests that men who have sex with men (MSM) have increased prevalence of body image dissati...
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