HIV risks among women who are married to men who have sex with men in India: a qualitative investigation

In countries such as India, men who have same-sex partnerships may marry women due to cultural pressures regardless of their sexual desires and preferences. The wives of such men may be at risk for HIV but limited existing research addresses this issue. This qualitative study used in-depth interviews to investigate HIV-related risk among married men who have sex with men (n = 34) and women who were aware of their husband’s same-sex behaviour (n = 13) from six research sites in five states and a Union Territory in India: Delhi (Delhi), Visakhapatnam (Andhra Pradesh), Hyderabad (Telangana), Bengaluru (Karnataka), Chennai and Madurai (Tamil Nadu). Thematic analysis revealed that wives of men who have sex with men were at risk for HIV from their husbands’ sexual practices, which are often hidden to avoid the potential consequences of stigmatisation, as well as from gender-based inequities that make husbands the primary decision-makers about sex and condom use, even when wives are aware of their husband’s same-sex behaviour. Innovative interventions are needed to address HIV-related risk in couples where wives remain unaware of their husband’s same-sex behaviour, and for wives who are aware but remain within these marriages.     

Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso

Purpose

The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities.

绵阳市年轻男男性行为者自杀意念及关联因素分析

目的了解年轻男男性行为者(YMSM)自杀意念现状,分析关联因素。方法以四川省绵阳市15～24周岁男男性行为者为对象,用滚雪球抽样法进行招募调查和血清学检测。关联因素单因素分析用χ2检验,多因素分析用非条件logistic回归。结果共合格调查350人,20. 0%产生过自杀意念,主要为情感因素占45. 7%; 6. 6%实施过自杀。是否有过自杀意念艾滋病病毒(HIV)感染率分别为14. 3%、7. 9%(χ~2=2. 753,P=0. 097)。多因素分析结果:经历性虐待(OR=8. 748)、因性取向受过伤害(OR=2. 529)、性取向自我态度负向(OR=3. 164)、公开性取向受到家人冷落(OR=22. 727)、近6个月商业性行为(OR=4. 630)是YMSM自杀意念的危险因素。结论 YMSM自杀意念发生率高,性虐待及社会、家庭和自我歧视影响明显,增大HIV感染潜在风险。减少歧视性环境和增强未成年人保护,是YMSM自杀危机干预的重要内容。     

Differences in substance use and sexual partnering between men who have sex with men,men who have sex with men and women and transgender women

Men who have sex with men (MSM), men who have sex with men and women (MSM/W) and transgender women (TGW) remain the populations most severely and disproportionately impacted upon by HIV in Los Angeles County. Baseline data from community-based HIV-prevention programmes serving these populations were analysed to explore differences in demographic characteristics, substance use and sexual partnering between the three groups. Despite high HIV prevalence overall (MSM 34.7% versus MSM/W 16.1% versus TGW 21.9%, p < .001), there were striking differences in risk behaviours. Higher rates of homelessness were reported by MSM/W compared to MSM and TGW. Lower rates of education and less substance use were reported by TGW (62.2%), compared to MSM (79.7%) and MSM/W (92.6%). A much higher number of male sexual exchange partners were reported by TGW (MSM 1.04 [SD = 4.8] versus MSM/W 1.54 [SD = 10.3] versus TGW 12.37 [SD = 23.9], p < .001). Findings support the need for HIV-prevention interventions that specifically address the unique risk patterns among each population in order to curb HIV acquisition and transmission.     

Syndemics of depression,alcohol use,and victimisation,and their association with HIV-related sexual risk among men who have sex with men and transgender women in India

We examined the presence and co-occurrence of psychosocial health conditions (depression, frequent alcohol use, and victimisation) among men who have sex with men (MSM) and transgender (TG) women in India, and their cumulative association with sexual risk. A survey questionnaire was administered among a convenience sample of 600 participants (MSM?=?300; TG women?=?300) recruited through six non-governmental organisations in four states. Prevalences of the number of psychosocial health conditions among MSM were: none?=?31.3%, one?=?43%, two?=?20%, and three?=?5.7%; and among TG women: none?=?9%; one?=?35.33%, two?=?38.33%, and three?=?17.33%. In bivariate and multivariate models, these conditions were positively and additively related to sexual risk, providing evidence for a syndemic of psychosocial health conditions among MSM and TG women and their synergistic effect on sexual risk. In addition to the number of syndemic conditions, resilient coping and social support were significant predictors of sexual risk among MSM and TG women, respectively. HIV preventive interventions in India should screen for and address co-occurring psychosocial health conditions – experiences of violence, mental health issues, and alcohol use – among MSM and TG women.     

重庆市男男性行为者网络交友HIV感染情况

目的了解重庆市男男性行为者(MSM) 网络交友状况及人类免疫缺陷病毒(HIV)感染情况,为有效干预MSM HIV感染提供依据。方法对重庆市206名MSM进行结构式访问与问卷调查,对半年内未进行HIV检测者进行实验室筛查,分析MSM人口社会学特征及HIV感染的影响因素。结果206名MSM平均年龄（22.08±1.81）岁,大专及以上文化程度137名（66.50%）,HIV感染率为21.36%（44/206）。MSM无固定性伴侣者HIV感染率高于有固定性伴侣者;MSM性伴数量越多,HIV感染风险越大;与不熟悉或陌生的人发生性行为HIV感染率高于与熟悉的性伴;性行为中安全套使用率越高,HIV感染率越低,各组比较,差异均有统计学意义(均P＜0.05)。不同文化程度的MSM安全套使用情况比较,差异有统计学意义(P＜0.05)。结论该市MSM HIV感染率较高,建议加强健康教育宣传、同伴网络教育与行为干预,减少联结MSM网体之间的桥梁人群,建立同性恋社会支持体系,降低MSM HIV感染风险。     

男男性行为人群HIV/AIDS性伴感染状况和溯源效率相关因素研究

目的 了解MSM HIV/AIDS的性伴感染状况和溯源效率的相关因素。方法 采用横断面调查方法,2018-2020年在宁波市对MSM HIV/AIDS开展性伴调查和HIV检测,并用限制性抗原亲和力酶联免疫法判定是否新发感染。分类资料采用χ²检验,采用多因素logistic回归分析溯源效率的相关因素。结果 共调查374例新确证MSM HIV/AIDS,动员479例性伴进行调查和HIV检测,性伴HIV阳性率为15.7%（75/479,95%CI：12.4%~18.9%）,其中新发感染者性伴HIV阳性率为31.8%（21/66,95%CI：20.3%~43.4%）。新发感染者的性伴HIV阳性者中新发现阳性性伴的比例（76.2%）高于长期感染者（48.1%）,差异有统计学意义（P=0.028）。多因素logistic回归分析结果显示,36~45岁年龄组（与18~25岁年龄组相比,OR=3.973,95%CI：1.364~11.569）、HIV主动检测（与HIV被动检测相比,OR=1.896,95%CI：1.083~3.319）、新发感染者（与长期感染者相比,OR=3.733,95%CI：1.844~7.556）的溯源效率更高。结论 MSM HIV/AIDS性伴HIV阳性率高,其中新发感染者和HIV主动检测发现的感染者性伴溯源效率较高。建议加强MSM HIV/AIDS溯源调查,重点关注艾滋病自愿咨询与检测门诊新确证的MSM HIV/AIDS。     

Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Northeastern Brazil

Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants’ knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants’ opinions about PrEP’s contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil’s civil society movement, may enhance the public health effort to expand access to PrEP in Brazil.     

有导致出血的性施虐一受虐行为的男男性行为者行为特征研究

目的 探讨有导致出血的性施虐-受虐行为的男男性行为者(MSM)的行为特征,并分析与HIV/AIDS高危行为等之间关系.方法 采用改良型"滚雪球"抽样法(定向抽样法)进行横断面调查.从MSM有效问卷中获取有导致出血的性施虐-受虐行为者,并在无此行为者中选取比较组进行研究,采用SPSS 13.0软件进行统计分析.结果 有导致出血的性施虐-受虐行为组累计同性性伴数(M=20)、肛交(M=10)、口交(M=10)、手交(M=15)同性性伴数及近6个月同性性伴数(M=4)、肛交(M=3)、手交(M=3)同性性伴数均高于或显著高于比较组.有导致出血的性施虐-受虐行为组近6个月性交中安全套曾破裂或滑脱(22.6%)、曾罹患性传播感染(28.0%)、曾参与群交(34.8%)、近6个月曾在MSM活动场所与陌生同性性交(62.2%)、有过主动或被动的吻肛(64.0%)、拳交(18.9%)、指交行为(66.7%)、性交过程中曾出血(58.3%)、首次性交对象为未成年人(33.8%)、曾有过强烈自杀念头(33.3%)及自杀未遂行为(23.6%)的百分率,均高于或显著高于比较组.结论 有导致出血的性施虐-受虐行为的MSM与HW/AIDS相关的高危行为,显著多于无此行为者,该人群是在健康干预工作中需特殊关注的亚人群.     

基于结构方程模型的男男性行为人群HIV检测行为影响因素研究

目的 分析MSM人群HIV检测行为的影响因素,为制定促进该人群检测HIV的干预措施提供依据。方法 2018年4-6月,通过滚雪球的方法在江苏省无锡市招募MSM研究对象。采取面对面问卷调查的方式,收集研究对象的人口学信息、性行为特征、接受干预服务情况、心理状态和HIV检测情况等。利用结构方程模型对数据进行拟合并对拟合后的模型进行修正,分析各变量间的关系和影响程度。结果 共招募研究对象MSM 410人,认为自己有必要检测HIV占72.9%（299/410）,最近1年HIV检测占69.0%（283/410）。修正后的结构方程模型拟合较好,拟合指数主要结果分别为近似误差均方根（RMSEA）=0.065、规范拟合指数（NFI）=0.946、相对拟合指数（RFI）=0.922、Tucker-Lewis指数（TLI）=0.968、比较拟合指数（CFI）=0.952。模型拟合结果显示,对MSM人群HIV检测行为标准化总效应最高的变量为干预服务,路径系数为0.57;而在干预服务中,HIV检测提醒的因子载荷最大,为0.88。心理状态评分对MSM人群HIV检测行为的标准化总效应呈负向关系,路径系数为-0.33。结论 MSM人群HIV检测意识和检测率有待进一步提高,在采取有效措施促进MSM进行检测的同时,应关注MSM人群心理健康问题。     

扬州市广陵区男男性行为人群艾滋病感染状况与主要危险行为研究

目的：了解广陵区男男性行为人群（MSM）的艾滋病／性传播疾病的感染状况与主要危险行为。方法：2008年5月至2009年6月通过志愿者招募和网络招募,对符合要求的愿意接受调查的男男性行为人群开展面对面的问卷调查和HIV抗体、梅毒抗体检测,数据用SPSS13．0软件进行分析。结果：共调查750例对象,平均年龄33．47岁;婚姻状况以已婚／同居占52．80％;以外地户籍流入本地者为多,占62．07％;艾滋病防治知识知晓率达84．2％;主要通过浴室和互联网途径寻找男性性伴,占64．53％;平均首次性行为年龄为21．56±5．40岁、首次男性性行为年龄为26．50±8．87岁;有50．55％的调查对象自述半年内与男性肛交时未坚持使用安全套,有31．64％的调查对象自述最近一次与男性肛交时未使用安全套;最近半年与女性有性接触者占53．96％,其中仅有20．94％的人坚持使用安全套,最近一次性行为中安全套使用率仅有29．66％;抗-HIV阳性率为9．33％,梅毒抗体阳性率为22．80％;其中梅毒抗体阳性者的HIV感染率高于阴性者（χ2=19．39,P〈0．005）;年龄〉30岁、近半年男性性伴≥2个者,HIV感染率高于年龄≤30岁、近半年男性性伴≤1个者（χ2=5．61,P〈0．05,χ2=3．84,P〈0．05）。结论：广陵区男男性行为人群HIV及梅毒感染率较高,需进一步在该人群中开展高危行为干预工作,同时要积极发挥同伴宣传教育的作用,让MSM把健康作为自身重要需求之一,自觉改变自己的高危行为。     

Differences in substance use and sexual partnering between men who have sex with men, men who have sex with men and women and transgender women

Men who have sex with men (MSM), men who have sex with men and women (MSM/W) and transgender women (TGW) remain the populations most severely and disproportionately impacted upon by HIV in Los Angeles County. Baseline data from community-based HIV-prevention programmes serving these populations were analysed to explore differences in demographic characteristics, substance use and sexual partnering between the three groups. Despite high HIV prevalence overall (MSM 34.7% versus MSM/W 16.1% versus TGW 21.9%, p < .001), there were striking differences in risk behaviours. Higher rates of homelessness were reported by MSM/W compared to MSM and TGW. Lower rates of education and less substance use were reported by TGW (62.2%), compared to MSM (79.7%) and MSM/W (92.6%). A much higher number of male sexual exchange partners were reported by TGW (MSM 1.04 [SD = 4.8] versus MSM/W 1.54 [SD = 10.3] versus TGW 12.37 [SD = 23.9], p < .001). Findings support the need for HIV-prevention interventions that specifically address the unique risk patterns among each population in order to curb HIV acquisition and transmission.     

Sexual diversity among black men who have sex with men in an inner-city community

Dramatic increases in HIV-incidence rates have been documented for Black men who have sex with men (MSM). Moreover, MSM has become a more visible HIV-transmission route in the Black community, in part due to public interest in the “down low” (i.e., “straight” men who also have sex with men). Interviews were conducted with 21 Black MSM in central Brooklyn, New York City, in efforts to understand the diversity of MSM experience in a low income, high HIV-prevalence community. Two thirds of the men identified as either heterosexual (43%) or bisexual (24%) and 15 (71%) MSM reported recent sex with women. Conformity to masculine social role expectations made it difficult to identify sex partners in the community; therefore, men relied on private sex clubs and the Internet. The findings suggest that stigma surrounding both HIV and homosexuality may effectively insure that nonheterosexual preferences and practices remain hidden in the Black community. A focus on sexual orientation and bisexuality has obscured the issue of race in the HIV/AIDS epidemic among Black MSM. In the long term, public health promotion and HIV prevention will require greater tolerance and acceptance of sexual diversity in the Black community.     

Characteristics of recently arrived Asian men who have sex with men diagnosed with HIV through sexual health services in Melbourne and Sydney

Objectives: Asian men who have sex with men (MSM) who have recently arrived in Australia are an emergent risk group for HIV; however, little is known about how they compare to Australian MSM diagnosed with HIV. This study compared the characteristics of these two groups. Methods: A retrospective, cross‐sectional study of MSM diagnosed with HIV between January 2014 and October 2017 in Melbourne and Sydney public sexual health clinics. Asian MSM were those who had arrived in Australia within 4 years of diagnosis. Results: Among 111 Asian men, 75% spoke a language other than English, 88% did not have Medicare and 61% were international students. Compared with Australian men (n=209), Asian men reported fewer male sexual partners within 12 months (median 4 versus 10, p<0.001), were less likely to have tested for HIV previously (71% versus 89%, p<0.001) and had a lower median CD4 count (326 versus 520, p<0.001). Among Asian men, HIV subtype CRF01‐AE was more common (55% versus 16%, p<0.001) and subtype B less common (29% versus 73%, p<0.001). Conclusions: Asian MSM diagnosed with HIV reported lower risk and had more advanced HIV. Implications for public health: HIV testing and preventative interventions supporting international students are required.     

Unhealthy environments,unhealthy consequences: Experienced homonegativity and HIV infection risk among young men who have sex with men

Unfavourable social environments can negatively affect the health of gay, bisexual, and other men who have sex with men (MSM). We described how experienced homonegativity – negative perceptions and treatment that MSM encounter due to their sexual orientations – can increase HIV vulnerability among young MSM. Participants (n?=?44) were young MSM diagnosed with HIV infection during January 2006–June 2009. All participants completed questionnaires that assessed experienced homonegativity and related factors (e.g. internalised homonegativity). We focus this analysis on qualitative interviews in which a subset of participants (n?=?28) described factors that they perceived to have placed them at risk for HIV infection. Inductive content analysis identified themes within qualitative interviews, and we determined the prevalence of homonegativity and related factors using questionnaires. In qualitative interviews, participants reported that young MSM commonly experienced homonegativity. They described how homonegativity generated internalised homonegativity, HIV stigma, silence around homosexuality, and forced housing displacement. These factors could promote HIV risk. Homonegative experiences were more common among young Black (vs. non-Black) MSM who completed questionnaires. Results illustrate multiple pathways through which experienced homonegativity may increase HIV vulnerability among young MSM. Interventions that target homonegativity might help to reduce the burden of HIV within this population.     

中山市男男性行为人群的艾滋病感染状况及影响因素分析

目的了解中山市男男性行为人群（menwhohavesexwithnell，MSM）HIV感染率及其影响因素。方法2010年，采用同伴推动抽样法（respondent—drivensampling，RDS）招募在中山市生活或工作的、年龄在18岁以上、自我报告最近1年有过男男性行为（口交或肛交）的MSM进行面对面的问卷调查。调查内容包括人口学特征、艾滋病相关知识、艾滋病相关行为和流动性等；采集血样进行人类免疫缺陷病毒（HIV）、丙型肝炎病毒（HCV）和梅毒抗体检测；利用RDS分析软件（RDSAT）进行权重处理和双变量分析，多因素逐步非条件logistic回归分析艾滋病感染的影响因素。结果8名种子经过10周共招募127名下线。135名MSM中，平均年龄（28．24-6．9）岁。RDSAT校正后，未婚、外省户籍、高中及以上学历构成比分别为77．9％、63．9％和75．0％：艾滋病校正知晓率为91．3％；89．0％的MSM最近6个月与同性发生过肛交，其中53．6％每次使用安全套；20．7％的MSM自我报告最近6个月发生过异性性行为。血清学检测结果HIV抗体阳性18例（13．3％），HCV抗体阳性2例（1．5％），梅毒TRUST阳性11例（8．1％），经RDSAT校正后，中山市MSMHIV、HCV和梅毒TRUST阳性率分别为15．1％（95％叫：7．3％～25．6％）、3．0％（95％CI：0～4．2％）和8．9％（95％C／：3．3％～17．5％）。多因素logistic回归模型提示，最近6个月肛交非每次使用安全套（OR=10．19，95％CI：2．14～48．67）、最近1年未做过HIV检测（OR=15．09，95％CI：1．88～120．98）是HIV感染的危险因素。结论中山市受调查的MSMHIV感染率较高，高危行为普遍存在，亟需采取针对性的干预措施。     

HIV自检模式在男男性行为者中的成本效果分析

目的 分析珠海市MSM中HIV自我检测（HIVST）模式和现场HIV快速检测（HIV-RDT）模式的成本效果和支付意愿,为政府合理配置卫生资源提供参考依据。方法 以卫生服务提供者的视角,收集珠海市在2019年1-9月MSM参与两种HIV检测模式的成本投入和效果产出,采用TreeAge Pro 2019软件构建10 000名MSM队列决策树模型,测算成本效果比（CER）和增量成本效果比（ICER）,以敏感性分析模型中各参数的不确定性,绘制成本效果可支付曲线评价策略的可支付性。结果 珠海市男同社会组织通过互联网+社交媒体动员参与HIVST和现场HIV-RDT的MSM人次数为2 303 vs.816,发现HIV筛查阳性者人数为33 vs.35,筛查阳性率为1.7% vs.4.3%。每筛查1例的成本为60.45元vs.240.43元,每发现1例筛查阳性的成本为4 218元vs.5 606元。决策树模型运行结果显示,每检测1例MSM的平均费用为44.67元vs.148.42元,ICER为负值。当发现1例HIV筛查阳性支付意愿低于6 528元时,HIVST更具成本效果的选择;当投入高于该阈值时,现场HIV-RDT是更具成本效果的选择。结论 珠海市现行的HIVST模式是具有经济学价值的公共卫生项目,决策者应加大社会组织扶持力度,推广HIVST在MSM中的应用。     

采用BED-CEIA法估算男男性行为人群HIV-1新发感染率

目的监测黑龙江省2011年男男性行为人群中艾滋病病毒(HIV)新近感染状况并计算其HIV-1新发感染率。方法收集黑龙江省2011年5个男男性行为人群哨点监测样本共计2 004份,采用酶联免疫和蛋白印迹方法检测出HIV抗体阳性样本,应用BED HIV-1捕获酶联法(BED-CEIA)对这些HIV抗体阳性样本进行检测,得出其新近感染所占比例,进而估算该人群的HIV-1年新发感染率。结果应用BED-CEIA方法共检测样本61份,其中30份为新近感染。计算得到2012年黑龙江省MSM人群HIV-1年新发感染率为3.41%(95%CI:2.19%～4.64%)。结论 2011年黑龙江省男男性行为人群监测哨点发现HIV感染者中约半数为新发感染,男男性行为人群艾滋病疫情态势不容乐观,应对该人群开展HIV-1新发感染连续监测。     

Public health challenges of the emerging HIV epidemic among men who have sex with men in China

A large-scale national survey was conducted in 2008 across 61 cities throughout China, covering over 18,000 men who have sex with men (MSM). The prevalence of human immunodeficiency virus (HIV) was 4.9% and incidence ranged from 2.6 to 5.4 per 100 person-years. The prevalence of sexually transmitted diseases ranged from 2.0% to 29.9% among MSM in different parts of China. Syphilis status, recruitment of sexual partners mainly from gay saunas, duration of MSM experience, and unprotected sex with regular male sex partners and multiple male sex partners predicted HIV seroconversion. The prevalence of consistent condom use was low during anal sex, ranging from 29.4% to 37.3%. Within this context, this paper considers the factors surrounding HIV prevention activity, and identifies a number of public health challenges which need to be considered if optimum outcomes are to be achieved. HIV prevention targeting MSM is a delayed response. The high risk associated with gay saunas and the need for steady condom supply at these venues needs urgent consideration. In addition, approximately one-third of MSM in China reported bisexual behavior, which may be attributed to sociocultural reasons and stigma against MSM. Female sex partners of MSM are seldom aware of their exposure to high risk of HIV transmission. Finally, the primitive nature of non-government organizations for HIV prevention and issues around their sustainability pose another serious challenge for the future of HIV prevention campaigns targeting MSM in China.     

男男性行为者艾滋病风险认识与知识和高危性行为关联性

目的 了解男男性行为者(MSM)艾滋病风险认识现状,分析其与知识及高危性行为的关联性。方法 在四川省绵阳市采用滚雪球抽样法抽取MSM,对MSM进行艾滋同风险认识、艾滋病知识及性行为等调查并抽取静脉血进行HIV-抗体和TP-抗体检测,采用描述流行病学分析方法对结果进行分析,并采用多因素非条件logistic回归模型进行风险认识与知识、高危性行为关联性分析。结果 回收有效问卷1 226份,MSM平均年龄 (27.5 ± 9.0)岁,高中及以上占87.9%(1 078/1 226),未婚占81.1%(994/1 226)。艾滋病知识知晓率为97.4%(1 194/1 226),近6个月肛交有保护占71.4%(802/1 123),有风险认识占94.6%(1 160/1 226)。多因素分析结果显示,相对于无风险认识者,知晓艾滋病知识 (OR_a=18.951,95%CI:6.813~52.720)、近6个月肛交有保护(OR_a=1.821,95%CI:1.074~3.262)者有风险认识概率更高。结论 MSM具一定风险认识,风险认识与知识及高危性行为相关,知识对风险认识、风险认识对行为的促进作用明显。