In this review, we document the historical and cultural shifts in how gay and bisexual men have used the Internet for sexuality between the 1990s and 2013. Over that time, gay and bisexual men have rapidly taken to using the Internet for sexual purposes: sexual health information seeking, finding sex partners, dating, cybersex, and pornography. Gay and bisexual men have adapted to the ever-evolving technological advances that have been made in connecting users to the Internet—from logging into the World Wide Web via dial-up modem on a desktop computer to geo-social and sexual networking via a handheld device. In kind, researchers too have adapted to the Internet to study gay and bisexual men, though not at the same rapid pace at which technology (and its users) have advanced. Studies have carefully considered the ethics, feasibility, and acceptability of using the Internet to conduct research and interventions with gay and bisexual men. Much of this work has been grounded in models of disease prevention, largely as a result of the ongoing HIV/AIDS epidemic. The urgent need to reduce HIV in this population has been a driving force to develop innovative research and Internet-based intervention methodologies. Moving forward, a more holistic understanding of gay and bisexual men's sexual behavior might be warranted to address continued HIV and STI disparities. The Internet, and specifically mobile technology, is an environment gay and bisexual men are using for sexual purposes. These innovative technologies represent powerful resources for researchers to study and provide rapidly evolving outreach to gay and bisexual men.

BackgroundIn 2010, the iPrEx trial demonstrated that oral antiretroviral pre-exposure prophylaxis (PrEP) reduced the risk of HIV acquisition among high-risk men who have sex with men (MSM). The impact of iPrEx on PrEP knowledge and actual use among at-risk MSM is unknown. Online surveys were conducted to assess PrEP awareness, interest and experience among at-risk MSM before and after iPrEx, and to determine demographic and behavioral factors associated with these measures.Methods and FindingsCross-sectional, national, internet-based surveys were administered to U.S. based members of the most popular American MSM social networking site 2 months before (n = 398) and 1 month after (n = 4 558) publication of iPrEx results. Comparisons were made between these samples with regards to PrEP knowledge, interest, and experience. Data were collected on demographics, sexual risk, and experience with post-exposure prophylaxis (PEP). Regression analyses were performed to identify factors associated with PrEP awareness, interest, and experience post-iPrEx. Most participants were white, educated, and indicated high-risk sexual behaviors. Awareness of PrEP was limited pre- and post-iPrEx (13% vs. 19%), whereas interest levels after being provided with a description of PrEP remained high (76% vs. 79%). PrEP use remained uncommon (0.7% vs. 0.9%). PrEP use was associated with PEP awareness (OR 7.46; CI 1.52–36.6) and PEP experience (OR 34.2; CI 13.3–88.4). PrEP interest was associated with older age (OR 1.01; CI 1.00–1.02), unprotected anal intercourse with ≥1 male partner in the prior 3 months (OR 1.40; CI 1.10–1.77), and perceiving oneself at increased risk for HIV acquisition (OR 1.20; CI 1.13–1.27).ConclusionsAmong MSM engaged in online networking, awareness of PrEP was limited 1 month after the iPrEx data were released. Utilization was low, although some MSM who reported high-risk behaviors were interested in using PrEP. Studies are needed to understand barriers to PrEP utilization by at-risk MSM.

Background-Spinal cord stimulation (SCS) reduces the incidence of ventricular tachyarrhythmias in experimental models. This study investigated the effects of long-term SCS on ventricular function in a postinfarction canine heart failure model. Methods and Results-In stage 1, dogs underwent implantable cardioverter-defibrillator implantation and embolization of the left anterior descending artery followed by right ventricular pacing (240 ppm) for 3 weeks to produce heart failure. In stage 2, 28 surviving animals were assigned to the SCS (delivered at the T4/T5 spinal region for 2 hours 3 times a day), medicine (MED; carvedilol therapy at 12.5 mg PO BID), or control (CTRL; no therapy) group for the initial phase 1 study. In a subsequent phase 2 study, 32 stage 1 survivors were equally randomized to the SCS, MEDS (carvedilol plus ramipril 2.5 mg PO QD), SCS plus MEDS (concurrent therapy), or CTRL group. Animals were monitored for 5 weeks (phase 1) or 10 weeks (phase 2). In stage 3, all phase 1 animals underwent circumflex artery balloon occlusion for 1 hour. In the SCS group, left ventricular ejection fraction was 65Ϯ5% at baseline, 17Ϯ3% at the end of stage 1, and 47Ϯ7% at the end of stage 2. In the MED group, left ventricular ejection fraction was 61Ϯ4% at baseline, 18Ϯ3% at the end of stage 1, and 34Ϯ4% at the end of stage 2. In the CTRL group, left ventricular ejection fraction was 64Ϯ5% at baseline, 19Ϯ5% at the end of stage 1, and 28Ϯ3% at the end of stage 2. Left ventricular ejection fraction was significantly improved in the SCS compared with the MED and CTRL groups (PϽ0.001 for both). The mean number of spontaneous nonsustained ventricular tachyarrhythmias during stage 2 and the occurrence of ischemic ventricular tachyarrhythmias during stage 3 also were significantly decreased in the SCS (27Ϯ17 and 27%, respectively; PϽ0.03) and MED (58Ϯ42 and 33%; PϽ0.05) versus CTRL (88Ϯ52 and 76%) group. After 10 weeks in the phase 2 studies, the greatest recovery in ejection fraction was noted in the SCS (52Ϯ5%) and SCSϩMEDS (46Ϯ4%) groups compared with the MEDS (38Ϯ2%) and CTRL (31Ϯ4%) groups. Conclusion-SCS

Introduction Recent nationally representative studies documenting event-level sexual behavior have included samples that are predominantly heterosexual, resulting in limited information on the sexual repertoire of gay and bisexually identified men. Aim This study sought to document the sexual behaviors that gay and bisexually identified men report during their most recent male-partnered sexual event and to describe the situational characteristics and participants' evaluation of these events. Methods Via an internet-based survey, data were collected from 24,787 gay and bisexually identified men (ages 18–87 years) from 50 US states and the District of Columbia. Main Outcome Measures Measures included items related to sociodemographics, recent sexual behavior history, situational characteristics, orgasm, and ratings of arousal and pleasure. Results Participants' mean age was 39.2 years; ethnicities included white (84.6%), Latino (6.4%), and African American (3.6%); and most men (79.9%) identified as homosexual. The most commonly reported behavior was kissing a partner on the mouth (74.5%), followed by oral sex (72.7%), and partnered masturbation (68.4%). Anal intercourse occurred among less than half of participants (37.2%) and was most common among men ages 18–24 (42.7%). Sex was most likely to occur in the participant's home (46.8%), with less frequently reported locations including hotels (7.4%) and public spaces (3.1%). The number of behaviors engaged in during last sexual event varied with most (63.2%) including 5–9 different sexual behaviors. Conclusions These data provide one of the first examinations of sexual behaviors during the most recent male-partnered sexual event among gay and bisexually identified men in the United States. Findings from this study suggest that gay and bisexually identified men have a diverse sexual repertoire and that partnered sexual behaviors are not limited solely to acts of penile insertion.