Sexual Behavior Among Hiv-Positive Men Who have Sex with Men: What's in a Label‪?‬

The Seropositive Urban Men's Study Team The sexual practices of men who have sex with men (MSM) have been the subject of many studies since the emergence of the human immunodeficiency virus (HIV) epidemic (Stall, Hays, Waldo, Ekstrand, & McFarland, 2000; Wolitski, Valdisseri, Denning, & Levine, 2001). These studies extensively document the prevalence of specific sexual practices but provide little insight into MSM's identification with, and preference for, specific roles during sexual intercourse. Among MSM, distinctions are commonly made regarding preferences for insertive or receptive intercourse (Wegesin & Meyer-Bahlburg, 2000). Three major self-labels are typically specified: "top," meaning one who prefers the insertive role, "bottom," meaning one who prefers the receptive role (Sanderson, 1994), and "versatile," meaning one who engages in both behaviors without strong preferences for one or the other. Despite the potential utility for those who design HIV prevention programs of knowing how MSM self-label regarding their typical sexual behavior, the use of such self-labels and their relation to HIV transmission behavior and psychological adjustment have received little attention in the literature.