Yet when these participants outlined the power distribution associated with sexual roles during anal sex, it did not always mirror those assumed by heterosexual gender roles ( Kippax & Smith, 2001). Some participants spoke of the receptive partner as possessing effeminate characteristics, linking the preference for anal receptivity to the hegemonic feminine personality traits assigned to heterosexual women by traditional gender roles (i.e., the vaginally receptive partner). The couples gave descriptions heavily steeped in assumptions about the overlap between sexual positioning and gender roles. In a formative study with male couples, Kippax and Smith (2001) asked participants to characterize men who performed as tops and men who performed as bottoms. Normative language around sexual positioning commonly refers to the insertive partner during anal sex as the “top” and the receptive partner as the “bottom.” While these terms describe anal sex behaviors, there is evidence to suggest that MSM may also associate these terms with gender roles. Examinations of the decision-making around sexual positioning among adult MSM have yielded some important insights into the explicit and understood ways in which gender roles inform negotiations during anal sex. Gender Roles and Sexual Positioning among MSMĮarly research indicates that knowledge of gender roles is present within MSM’s conceptions around anal sex dynamics. In order to bolster HIV prevention efforts in the face of the growing HIV epidemic among YMSM, we examine how gendered ideologies regarding sexual positioning influence sexual decision-making among YMSM, and reflect on the usefulness of a gender framework in working with YMSM. Yet explorations of how performances of gender may (or may not) shape young men who have sex with men’s (YMSM) sexual decision-making remain in their infancy, despite the fact that YMSM are at the forefront of the HIV epidemic in the US-male–to-male sexual contact accounts for a majority of new HIV cases (e.g., 56% of new infections in 2009), and the most dramatic increases in new infections occurring among MSM between the ages of 13-24 ( CDC, 2011). In heterosexual transmission, power imbalances in sexual negotiation derived from restrictive male and female gender roles are frequently implicated in women’s heightened vulnerability to HIV/ AIDS (MacPhail, Williams, & Campbell, 2002 Rosenthal & Levy, 2010 Wingood & DiClemente, 2002). Subsequently, a large body of health and science literature explores the social forces that may exacerbate a receptive sexual partner’s biological level of risk for HIV (MacPhail, Williams, & Campbell, 2002 Rosenthal & Levy, 2010 Wingood & DiClemente, 2002). HIV prevention researchers have long acknowledged the heightened risk of HIV transmission for sexually receptive partners ( Kingsley et al., 1987).