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Both RAI and IAI, as sexual positioning practices, can facilitate HIV acquisition and transmission among MSM. Data further show that STIs potentiate HIV acquisition and transmission ( Dallabetta & Neilsen, 2005 Frye et al., 2009 Malott et al., 2013). Similarly, gonorrhea cases among MSM increased 14% compared to the cases among men who have sex with women only that remained stable and the proportion of cases among women that declined 13% ( Kidd, Stenger, Kirkcaldy, Llata, & Weinstock, 2015). In 2013, gay and bisexual men in the United States accounted for 81% of estimated HIV diagnoses among all males aged 13 years and older and 65% of the estimated diagnoses among all HIV diagnoses that year ( CDC 2015). MSM bear a disproportionate burden of HIV and STIs compared to the general population in the United States ( CDC, 2010 Scott et al., 2014), for whom rates of HIV and STIs continue to increase among domestic and international MSM populations ( Beyrer et al., 2012 CDC, 2010 Prejean et al., 2011 van Griensven, de Lind van Wijngaarden, Baral, & Grulich, 2009). A greater understanding of the dynamics underlying sexual positioning practices and the ways these dynamics may contribute to HIV and other STIs is needed (Baggaley, White, & Boily, 2010 Centers for Disease Control and Prevention (CDC), 2014a, 2014b).
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Specifically, men who participate in receptive anal intercourse (RAI) are more likely to acquire HIV and rectal STIs compared to men who only participate in insertive anal intercourse (IAI) (Coates et al., 1988 Kent et al., 2005). Risks for acquiring or transmitting HIV and sexually transmitted infections (STIs) via condomless anal sex vary according to sexual positioning. Sexual positioning practices among men who have sex with men (MSM) have not received a thorough discussion in the MSM and HIV literature. Through this review we offer an initial synthesis of the literature describing sexual positioning identities and practices and conceptual model to provide insight into important areas of study through future research. Despite limited focus in the extant literature, this review notes the important role contextual factors (masculinity stereotypes, power, partner type, and HIV status) likely play in influencing sexual positioning identity and practices. This review highlights dynamic psycho-social processes likely underlying sexual decision-making related to sexual positioning identity and practices among MSM and MSM who have sex with women (MSMW), and ways these contexts may influence HIV/STI risk. A total of 23 articles met our inclusion criteria. “top,” “bottom,” etc.) or sexual positioning behavior (receptive anal intercourse or insertive anal intercourse ), or assessed the relationship between sexual positioning identity with HIV risk, anal sex practice, masculinity, power, partner type, or HIV status. Peer-reviewed articles were eligible for inclusion if they contained a measure of sexual positioning identity and/or behavior (i.e. We conducted a narrative review, using a targeted literature search strategy, as an initial effort to explore processes through which sexual positioning practices may contribute to HIV/STI transmission. MSM bear a disproportionate burden of HIV compared to the general population in the United States surveillance efforts suggest that HIV and STIs are increasing among domestic and international populations of MSM. Sexual positioning practices among men who have sex with men (MSM) have not received a thorough discussion in the MSM and HIV literature, given that risks for acquiring or transmitting HIV and STIs via condomless anal sex vary according to sexual positioning.