Top/Bottom Self-Label, Anal Sex Practices, HIV Risk and Gender Role Identity in Gay Men in New York City

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Abstract
Within the gay community, labeling oneself as a “top” or as a “bottom” communicates preferences for insertive or receptive sexual practices. The use of these terms and their relevance to the HIV/AIDS pandemic have received little attention in the scientific literature. The current exploratory study examines both qualitatively and quantitatively the use of top/bottom self-labels and their relation to gender role identity, sexual behavior, and HIV risk. Results revealed that nearly half of the 84 participating men used a self-label to describe their genitoerotic preferences. However, the rate of self-labeling decreased significantly over the five-year study period. Results also revealed that self-label corresponded to anal sex practices, such that tops engaged in more insertive anal sex than bottoms, and bottoms in more receptive anal sex than tops. Further, top/bottom labelers were more dichotomous in their anal sex practices than men who did not use a label. Labeling was also related to HIV statu...