Behavioural predictors of subsequent hepatitis C diagnosis in a UK clinic sample of HIV positive men who have sex with men

OBJECTIVE: To explore the associations between self reported high risk sexual behaviours and subsequent diagnosis with hepatitis C virus (HCV) infection. METHODS: The Sex, Health and Anti-Retrovirals Project (SHARP) was a cross sectional study of sexual behaviour in HIV positive, men who have sex with men (MSM) attending a London outpatient clinic. From July 1999 to August 2000 participants completed a computer assisted self interview questionnaire (CASI) on recent sexual behaviour, recreational drug use, and detailed reporting of the last two sexual episodes involving different partners. Results were combined with routine clinic data and subsequent testing for HCV up to 21 April 2005. A new HCV diagnosis was defined as anti-HCV antibody seroconversion or positive HCV RNA following a previous negative. Incident rate ratios (IRR) were calculated using Poisson regression in Stata (version 9). Men contributed time at risk from interview until either their diagnosis or their last negative test result. RESULTS: Of the 422 men who completed questionnaires, 308 (73%) had sufficient clinical and HCV testing data available for analysis. Incident HCV infection was identified in 11 men. Unprotected anal intercourse, more than 30 sex partners in the past year, higher numbers of new anal sex partners, rimming (oro-anal sex), fisting, use of sex toys, and intranasal recreational drug use were associated with HCV. In multivariate analysis only fisting remained associated with HCV (adjusted IRR 6.27, p = 0.005). CONCLUSIONS: In this study of HIV positive MSM, fisting is strongly associated with HCV infection. Where individuals report high risk sexual behaviours, clinicians should offer appropriate testing for HCV infection.     

HIV serodiscordant sex partners and the prevalence of human herpesvirus 8 infection among HIV negative men who have sex with men: baseline data from the EXPLORE Study

OBJECTIVES: Human herpesvirus 8 (HHV-8) infection is common among men who have sex with men (MSM), especially those infected with HIV, and is frequently detected in saliva. We sought to determine whether oral or anogenital contact with HIV discordant, or unknown serostatus sexual partners is associated with HHV-8 seroprevalence among HIV negative MSM. METHODS: HIV negative MSM participating in a behavioural intervention trial for the prevention of HIV infection (the EXPLORE study) were recruited from the Seattle and Denver areas for participation in this cross sectional study. Participants completed detailed questionnaires regarding sexual behaviour, focusing on activities with possible exposure to the oropharynx. Serum samples from study enrollment were tested for the presence of HHV-8 antibodies using whole virus enzyme immunoassay and immunofluorescence assay to latent and lytic proteins. RESULTS: 198/819 MSM (24.3%) were HHV-8 antibody positive. Exposure to saliva with HIV positive and HIV unknown serostatus sex partners was reported by 83% and 90% of all men, respectively. In a multivariate model, reporting more than the median number of lifetime sex partners (OR 2.2, p = 0.03) or lifetime sex partners of unknown HIV status (OR 1.7, p = 0.03), and the performance of oro-anal sex ("rimming") on partners whose HIV status is unknown (OR 2.7, p = 0.04) were independently associated with HHV-8 infection. CONCLUSIONS: The oropharynx may be an important anatomical site in HHV-8 acquisition, and contact with HIV serodiscordant or unknown sex partners is associated with higher HHV-8 seroprevalence among HIV negative MSM.     

Correlates of recent unprotected anal sex among men having sex with men attending a large sex resort in the South

BACKGROUND: Published studies have not investigated sexually transmitted disease-associated risk behaviors among men who have sex with men (MSM) attending U.S. sex resorts. GOAL: We conducted an exploratory study to identify demographic and behavioral correlates of recently engaging in unprotected anal sex (UAS) among MSM attending a sex resort in the southern United States. STUDY DESIGN: A cross-sectional survey of 150 men. RESULTS: In multivariate analyses, men were more likely to practice risky sex if they also recently engaged in the practices of having group sex (adjusted odds ratio [AOR], 3.0), rimming (AOR, 2.0), or if they used public restrooms to meet potential sex partners (AOR, 2.6). UAS was also more likely among men vaccinated against hepatitis B (AOR, 1.9). Men who reported having primary partners and men who reported being HIV-positive were no less likely than other men in the sample to report recent UAS. CONCLUSION: Sex resorts can be an important venue for sexually transmitted disease and HIV prevention among MSM. Tailored prevention messages could be warranted for men who report group sex, rimming, meeting partners in public restrooms, or being vaccinated against hepatitis B.     

Risk factors leading to Cryptosporidium infection in men who have sex with men

OBJECTIVES: Cryptosporidiosis is a devastating illness in people with HIV/AIDS yet there have been no analytical epidemiological studies measuring risk factors leading to cryptosporidiosis in men who have sex with men (MSM). The objective of this study was to measure the risk factors for exposure to Cryptosporidium among MSM. METHODS: The study was a case-control design. It recruited MSM who had laboratory confirmed Cryptosporidium infection between 1997 and 2000. Participants answered a questionnaire about potential risk factors leading to exposure to Cryptosporidium. RESULTS: 10 cases and 24 controls were recruited. Men having more than one sexual partner in the past month were more likely to have had Cryptosporidium diarrhoea p=0.034 (OR 6.67, CI (1.15 to 38.60). Insertive anal sex (p=0.059) and attending a sex venue one or more times (p=0.059) also increased the odds of having cryptosporidiosis. CONCLUSION: The study results suggest that sexual behaviour is a significant risk factor for cryptosporidial diarrhoea in MSM. The results will be used to inform risk groups about behaviours that may put them at increased risk of cryptosporidial diarrhoea.     

Differences in HIV risk behaviors among black and white men who have sex with men

OBJECTIVES: Surveillance findings consistently indicate that black men who have sex with men (MSM) experience a disproportionate burden of HIV/AIDS compared with white MSM. This study tested the hypothesis that black MSM engage in greater levels of HIV risk behaviors than white MSM and sought to determine if self-reported HIV serostatus moderated any of the observed differences. METHODS: A cross-sectional study of MSM was conducted by recruiting men from gay-identified venues in a large metropolitan area of the southern United States. Data were collected by face-to-face interview. RESULTS: The hypothesis was only supported for one measure of HIV risk behavior: The average number of main (steady) sex partners in the past year was significantly greater among black men (P < 0.0001). However, black and white MSM did not significantly differ in unprotected sex with serodiscordant partners. Racial differences in sexual risk behavior were found only for HIV-negative men and indicated greater protective behavior for black men. DISCUSSION: These findings suggest that fewer black MSM, compared with white MSM, engage in HIV sexual risk behaviors but only among HIV-negative men. Identifying the epidemiologic dynamics driving HIV infection among black MSM that go beyond individual-level risk behaviors may be warranted.     

Commercial sex venues: a closer look at their impact on the syphilis and HIV epidemics among men who have sex with men

OBJECTIVE: To provide insight into the role of commercial sex venues in the spread of syphilis and HIV among men who have sex with men (MSM). Study: A cross sectional study of 1351 MSM who were diagnosed with early syphilis who did and did not encounter sexual partners at commercial sex venues. RESULTS: Overall, 26% MSM diagnosed with syphilis had sexual encounters at commercial sex venues. Of these, 74% were HIV positive, 94% reported anonymous sex, and 66% did not use a condom. Compared to those who did not have a sexual encounter at these venues, they were twice as likely to be HIV positive (OR = 1.91, 95% CI 1.36 to 2.68), six times more likely to have anonymous sex (OR = 6.18, 95% CI 3.37 to 11.32), twice as likely not to use condom (OR = 2.02, 95% CI 1.71 to 2.38), and twice as likely to use non-injecting drugs (OR = 1.65, 95% CI 1.21 to 2.37). CONCLUSIONS: MSM diagnosed with syphilis who frequent commercial sex venues are engaging in high risk behaviours for syphilis and HIV transmission and acquisition. Thus commercial sex venues are one of the focal points of syphilis and HIV transmission and acquisition.     

深圳市男男性接触人群梅毒合并HIV感染状况及其危险因素分析

目的：了解深圳市近6个月内发生过同性临时性行为的MSM人群梅毒合并HIV感染状况及其相关影响因素。方法：运用滚雪球法和同伴推动抽样法招募MSM进行问卷调查和血清学检测,采用χ2检验和Logistic回归分析梅毒HIV合并感染的相关影响因素。结果：共调查434例MSM,梅毒和HIV感染率分别为16.4%和12.2%,梅毒合并HIV感染率为7.3%。年龄越大（OR=4.0,P=0.0007）、高中/中专文化者（OR=6.5,P=0.0081）、性角色以被动方为主者（OR=12.1,P=0.0017）、多个同性肛交性伴者（OR=1.5,P=0.0455）、不能坚持每次使用安全套者（OR=2.9,P=0.0236）,其梅毒合并HIV感染风险越高。结论：需要采取更大努力来应对该人群的梅毒和HIV双重感染问题。     

HIV, sexual risk, and ethnicity among men in England who have sex with men

OBJECTIVES: To examine ethnic group differences in HIV testing history and sexual HIV risk behaviours that may account for such differences, among men in England who have sex with men (MSM), in order to inform HIV prevention planning priorities. METHODS: A self completion survey in the summer of 2001 was carried out in collaboration with community based health promoters. Three recruitment methods were used: "gay pride" festivals, health promoter distributed leaflets, internet version advertised with gay service providers. The leaflet was produced with an alternative cover for targeted recruitment of black men. RESULTS: In a sample of 13,369 MSM living in England, 17.0% were from minority ethnic groups and 5.4% had tested HIV positive. Compared to the white British majority, Asian men were 0.32 times as likely to be living with diagnosed HIV infection, while black men were 2.06 times as likely to be doing so. Among men who had not tested HIV positive, Asian men were less likely to have sex with a known HIV positive partner, while black men were more likely to have insertive unprotected anal intercourse both with a partner they knew to be HIV positive and with a partner whose HIV status they did not know. CONCLUSIONS: Among MSM in England, HIV prevalence is higher among black men and lower among Asian men compared with the white British majority. Increased sexual HIV risk behaviour, especially exposure during insertive anal intercourse, accounts for some of this difference. HIV prevention programmes for MSM and African people should both prioritise black MSM.     

HIV related behaviours and attitudes among Chinese men who have sex with men in Hong Kong: a population based study

OBJECTIVE: This study was conducted in order to determine the prevalence of men having sex with men (MSM) and their HIV related behaviours and attitudes among Chinese men in Hong Kong. METHODS: A large scale, random, population based, anonymous telephone survey of 14 963 men between the ages of 18-60 was conducted. The overall response rate was approximately 57%. RESULTS: Of the respondents, 4.6% had ever engaged in MSM activity. In the 6 months preceding the survey, 2.0% had engaged in MSM behaviours (active MSM) and 0.5% reported having engaged in anal sex MSM behaviours. Among anal sex MSM, consistent condom use was 42.9% with male non-commercial sex partners and even lower with male commercial sex partners (35.7%). Approximately 11% of anal sex MSM and 4.1% of the non-anal sex MSM had contracted an STD in the last 6 months. The prevalence of HIV testing was only 20.6% among anal sex MSM and 11.9% among non-anal sex MSM. CONCLUSIONS: Active MSM in Hong Kong are at high risk of HIV infection. The belief of low vulnerability to HIV is prevalent among active MSM in Hong Kong with only 2.0% believing that their chances of HIV infection as being "very likely."     

Refocusing health promotion for syphilis prevention: results of a case-control study of men who have sex with men on England's south coast

BACKGROUND: Prevention interventions have had little impact on syphilis outbreaks among men who have sex with men (MSM) and diagnosis rates continue to rise rapidly. Detailed studies of the determinants of syphilis transmission are needed to inform new prevention interventions. OBJECTIVE: To investigate factors associated with recent syphilis diagnosis and recommend strategies for improved prevention interventions. METHODS: A case-control study of MSM attending genitourinary medicine (GUM) and HIV outpatient clinics. Cases were MSM testing positive for early syphilis, based on either laboratory or microscopy results, with those testing negative being controls. All participants completed the same anonymous questionnaire covering demographics, lifestyle, sexual behaviour, and sexual partnerships. RESULTS: 50 cases and 108 controls returned questionnaires. Syphilis diagnosis was significantly associated with sexually transmitted infection history, recent recreational drug use, receptive anal sex practices, but not insertive ones, higher numbers of oral sex partners, but not specific oral sex practices. Overall, there were no differences between HIV positive and HIV negative/untested men in reporting of sexual behaviours or partnership combinations. The use of public sex settings (backrooms, saunas, "cruising grounds," etc) was reported by 68% of all participants and not significantly associated with syphilis diagnosis. CONCLUSIONS: Many key behavioural and partnership risk factors for syphilis are also risk behaviours for HIV transmission and point to the need for integrated strategies that tackle the two infections together. Simplified procedures for syphilis screening should be available in GUM clinical settings, along with targeted community outreach prevention interventions.     

Prevalence of chlamydia and gonorrhoea among a population of men who have sex with men

OBJECTIVES: Few data are available on the prevalence of sexually transmitted diseases (STDs) in men who have sex with men (MSM), making it difficult to develop STD screening guidelines for this population. The objective of the study was to determine the prevalence of urethral infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae within a large, community based population of MSM, and to assess the feasibility of rectal screening in this population. METHODS: This was a cross sectional study of 566 MSM, who were predominantly middle aged, white, asymptomatic, and engaged in sex with multiple partners. All provided a urine sample to screen for chlamydial and gonorrhoea infections using a PCR assay; rectal screening was performed on 48 participants. RESULTS: Urethral C. trachomatis infections were detected in 1/566 participants (prevalence 0.2%, 95% CI 0.004% to 1.0%), and rectal C. trachomatis infections were detected in 2/48 men (prevalence 4.2%, 95% CI 0.5% to 14.2%). No gonorrhoea infections were detected, and none of the 117 HIV positive men had either infection. CONCLUSIONS: Chlamydial and gonorrhoea infections were uncommon in this sample of MSM, even among those with multiple sexual partners or HIV infection. These data call into question recommendations to screen all MSM based on their individual sexual behaviours or HIV. Additional data are needed on the prevalence of these infections in MSM from different settings.     

Determinants of HIV seroconversion among men who have sex with men living in a low HIV incidence population in the era of highly active antiretroviral therapies

OBJECTIVE: To estimate human immunodeficiency virus (HIV) incidence and associated risk factors among men who have sex with men (MSM) participating in the Omega Cohort Study in Montreal, 1996-2003. METHODS: Longitudinal study of 1587 MSM seronegative at baseline with > or =1 six-month follow-up visit. Multivariate Cox regression with time-dependent variables was used for data analysis. RESULTS: HIV incidence was 0.62 per 100 person-years (95% confidence interval: 0.41-0.84). In multivariate analyses compared with subjects not reporting any anal sex with serodiscordant or casual partners, those reporting anal sex with such partners (all P values <0.05), whether consistently protected [hazard ratio (HR) = 3.4], or unprotected exclusively receptive (HR = 12.0), exclusively insertive (HR = 4.7), or both receptive and insertive (HR = 8.3), were at increased risk of seroconversion. Sexual behaviors with seroconcordant regular partners were not associated with seroconversion. CONCLUSION: These results observed in a cohort of MSM with low HIV incidence provide new insights regarding the debate about harm-reduction strategies to prevent sexual HIV transmission.     

Correlates of Internet use to meet sex partners among men who have sex with men diagnosed with early syphilis in Los Angeles County

OBJECTIVE: The objective of this study was to evaluate use of the Internet to solicit sex partners by men who have sex with men (MSM) who were diagnosed with early syphilis infection. STUDY: Field interview records for syphilis patients were reviewed for factors associated with Internet use. RESULTS: Internet users were more likely to be of white race (prevalence ratio [PR], 1.6; 95% confidence interval [CI], 1.4-1.8), to report anal insertive sex (PR, 1.1; 95% CI, 1.1-1.2), sex with anonymous partners (PR, 1.2; 95% CI, 1.1-1.3), intravenous drug use (PR, 2.7; 95% CI, 1.1-6.7), and nonintravenous drug use (PR, 1.4; 95% CI, 1.1-1.8). Controlling for race and sexual risk behaviors, white race (odds ratio [OR], 2.8; 95% CI, 1.8-4.6), having anonymous sex partners (OR, 3.4; 95% CI, 1.6-7.0), and nonintravenous drug use (OR, 1.6; 95% CI, 1.1-2.6) were associated with meeting sex partners through the Internet. CONCLUSIONS: Effective sexually transmitted disease risk reduction interventions using the Internet are needed to reach Internet-using, sex-seeking MSM populations engaging in high-risk behaviors.     

Internet use and risk behaviours: an online survey of visitors to three gay websites in China

Objectives

To describe the risk behaviours of visitors to gay websites and to explore the role of the internet in the HIV transmission among the Chinese men who have sex with men (MSM).

Methods

Between May and August 2006, visitors of three Chinese gay websites were invited to complete an online questionnaire about the use of the internet and risk sexual behaviours.

Results

The median age of the online sample was 25 years old (range 18 to 64). Over three‐quarters (77.6%) had an education of college or higher. Less than 44% of the online sample reported little or no risk for HIV transmission. These men had either had no anal intercourse (28.0%) or had always used a condom for anal intercourse (15.8%). Although only about half of the participants reported that their main purpose of visiting the gay websites was to look for sexual partners, most participants (86.1%) had used the internet to seek partners. Compared with men seeking sexual partners only on the internet, men seeking partners both in traditional gay venues and on the internet were older, less likely to be students and more likely to have unprotected anal intercourse, more than six sexual partners in the past 6 months and commercial sex behaviours.

Conclusion

The users of the gay websites are relatively young and well educated, and highly vulnerable to HIV/AIDS, given their low prevalence of consistent condom use and multiple‐risk sexual behaviours. Effective intervention programmes should be implemented and strengthened in China, especially for those who seek sexual partners both on the internet and in traditional gay venues.

Key messages

• At present, the internet MSM users in China may represent a young and well‐educated group of MSM
• As a new meeting ground, the internet has become an emerging risk environment for HIV/AIDS transmission for the Chinese MSM population
• MSM who seek sex both on the internet and in traditional gay venues are at significantly higher risk for HIV infection than those seeking sex on the internet only or in other ways

The world wide web has become a widely used meeting place for facilitating sex networking among men who have sex with men (MSM) in developed countries.^1,2,3 Its anonymous nature and relatively confidential environment maintain men''s privacy. The numerous users make men easily find other men for sexual and social contacts.³ While the internet enhances sex‐seeking efficiency, it may also place MSM at high risk for HIV/STI. The increasing number of studies conducted in developed countries have demonstrated that MSM who seek sexual partners on the internet are more likely to have unprotected anal intercourse (UAI) and more sexual partners and to have a history of STD.^4,5,6,7 However, no studies have been conducted in China—the largest developing country in the world—to explore sex‐seeking behaviours and the use of the internet among this specific group.China is facing an emerging HIV epidemic among MSM. Although limited data show that HIV prevalence among this group remains at a relatively low level—for example, it was 3.1% in Beijing,⁸ 1.7% in Guangdong (Southern China) and 1.2% in Shenyang (northern China)⁹—high‐risk behaviours such as UAI and multiple sexual partners and deficiency of HIV preventive knowledge place the Chinese MSM at high risk for HIV infection.^10,11,12 Evidence also demonstrates that Chinese gay men are avid users of the internet. In 2001, for instance, there were more than 250 Chinese websites dedicated to gays, lesbians and bisexual people (gay websites).¹³ By the end of 2004, the number of people accessing broadband connections increased to 94 million.¹⁴ In addition, it has been reported that there are approximately 10–20 million gay men in China, accounting for 2–4% of the adult male population.¹⁵ The unique nature of the internet may attract more Chinese MSM to choose the internet to socialise and seek sex in addition to or instead of traditional gay venues, as homosexuals in China are still under huge cultural pressure from the society and family.¹⁶ A number of questions associated with the gay websites in China need to be answered. Who are using the gay websites? What and why are they using the gay websites? Are the gay websites users vulnerable to HIV infection? Are those MSM who seek sexual partners on the internet at higher risk for HIV than those who seek sexual partners from traditional gay venues and in other ways? The purpose of this project was to explore the characteristics of Chinese gay websites users and their risk behaviours in the use of gay websites for sexual purposes, and then to provide evidence for developing possible HIV/AIDS surveillance and intervention strategies in the internet era.     

Methamphetamine and sildenafil (Viagra) use are linked to unprotected receptive and insertive anal sex, respectively, in a sample of men who have sex with men

OBJECTIVES: There is evidence that methamphetamine and sildenafil (Viagra) use are associated with sexual risk behaviour among men who have sex with men (MSM). We investigated the association of methamphetamine, sildenafil, and other substance use with unprotected receptive and insertive anal sex among MSM by conducting an encounter specific analysis. METHODS: Data were from a cross sectional, community based survey of MSM in San Francisco regarding behaviour during their most recent anal sex encounter. Mulitvariate regression analysed independent associations of specific substance use and demographic variables with unprotected anal sex behaviours. RESULTS: The sample (n = 388) was diverse in race/ethnicity, age, income, education, HIV status, and homosexual/bisexual identification. More than half (53%) reported unprotected anal sex, including insertive (29%) and receptive (37%) during their most recent anal sex encounter; 12% reported unprotected insertive and 17% reported unprotected receptive anal sex with an HIV discordant or unknown partner. Methamphetamine was used by 15% and sildenafil was used by 6% of the men before or during the encounter; 2% used both drugs. In multivariate analysis controlling for demographic factors and other substance use, methamphetamine use was associated with unprotected receptive (odds ratio (OR), 2.03; 95% confidence interval (CI), 1.09 to 3.76) and sildenafil use was associated with unprotected insertive (OR, 6.51; CI, 2.46 to 17.24) anal sex. Effects were stronger with HIV discordant or unknown sex partners specifically. CONCLUSION: Encounter specific associations of methamphetamine and sildenafil use with unprotected receptive and insertive anal sex, respectively, indicate the importance of assessment specificity and tailoring risk reduction efforts to address certain drugs and sexual behavioural roles among MSM.     

Men who have sex with men in Great Britain: comparison of a self-selected internet sample with a national probability sample

OBJECTIVES: To compare the characteristics of a self-selected, convenience sample of men who have sex with men (MSM) recruited through the internet with MSM drawn from a national probability survey in Great Britain. METHODS: The internet sample (n = 2065) was recruited through two popular websites for homosexual men in Great Britain in May and June 2003. This sample was compared with MSM (n = 117) from the National Survey of Sexual Attitudes and Lifestyles (Natsal), a probability sample survey of adults resident in Great Britain conducted between May 1999 and February 2001. RESULTS: No significant differences were observed between the samples on a range of sociodemographic and behavioural variables (p>0.05). However, men from the internet sample were younger (p<0.001) and more likely to be students (p = 0.001), but less likely to live in London (p = 0.001) or report good health (p = 0.014). Although both samples were equally likely to report testing for HIV, men from the internet sample were more likely to report a sexually transmitted infection in the past year (16.9% v 4.8%, adjusted odds ratio 4.14, 95% CI 1.76 to 9.74; p = 0.001), anal intercourse (76.9% v 63.3%; p = 0.001) and unprotected anal intercourse in the past 3 months (45% v 36.6%; p = 0.064). CONCLUSIONS: The internet provides a means of recruiting a self-selected, convenience sample of MSM whose social and demographic characteristics are broadly similar to those of MSM drawn from a national probability survey. However, estimates of high-risk sexual behaviour based on internet convenience samples are likely to overestimate levels of sexual risk behaviour in the wider MSM population.     

Relationship between syphilis and HIV infections among men who have sex with men in Beijing, China

BACKGROUND: Little is known about risk of HIV and other STDs among men who have sex with men (MSM) in China. OBJECTIVE: To survey the prevalence and risk factors of HIV and syphilis and evaluate correlation of two infections among MSM in the Chinese capital city. METHODS: A community-based sample of 526 MSM was recruited in 2005 through Internet advertising, community outreach, and peer referring. Interviewer-administered interviews were conducted to collect information on demographics and sexual and other risk behaviors, and blood samples were collected to test for syphilis and HIV infections. RESULTS: Seventeen (3.2%) participants were HIV seropositive and 59 (11.2%) syphilis seropositive. Sixty-four percent of participants were migrants who did not have Beijing residence. Forty percent had >10 lifetime male sex partners and 28.8% reported having ever had sex with women. Consistent condom use with primary male sex partners ranged from 21% to 24%, with nonprimary male sex partners from 35% to 42%, and with female partners around 33%. Illicit drug use was not common; only 2.5% reported using Ecstasy or ketamine in the past 6 months. Multivariate logistic regression analyses demonstrated that >10 lifetime male sex partners were independently associated with seropositivity of both syphilis (OR, 1.9; 95% CI, 1.1-3.4) and HIV (OR, 4.3; 95% CI, 1.4-13.6). In addition, HIV infection is significantly associated with syphilis seropositivity (OR, 3.8; 95% CI, 1.3-10.8). CONCLUSIONS: High mobility, multiple sexual partners, and high prevalence of unprotected sex behaviors and syphilis infection suggest a potential rapid spread of HIV in Chinese MSM.     

HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia

OBJECTIVES: To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links between these men and broader heterosexual populations. METHODS: Anonymous, cross sectional surveys among community recruited transgender and male sex workers and self recognised men who have sex with men (MSM) were undertaken in mid-2002 in Jakarta, Indonesia. Places where transgender and male sex workers sell sex and where men go to meet non-commercial male sex partners were mapped. Probability samples were selected for the sex worker populations, while a mixed probability and convenience sample was drawn for self recognised MSM. Blood was drawn for HIV and syphilis serology and community interviewers administered a standardised questionnaire. RESULTS: HIV prevalence was 22% among transgender sex workers, 3.6% among male sex workers, and 2.5% among self recognised MSM, and syphilis prevalence was 19.3%, 2.0% and 1.1% respectively. 59.3% of transgender sex workers and 64.8% of male sex workers reported recent unprotected anal intercourse with clients, and 53.1% of other MSM reported unprotected anal sex with male partners. Some 54.4% of male sex workers and 18.3% of other MSM reported female partners in the preceding year. CONCLUSION: HIV has reached substantial levels among transgender sex workers, and is not negligible in other MSM groups. Risk behaviour is high in all subpopulations, and bisexual behaviour is common, meaning the threat of a wider epidemic is substantial. Prevention programmes targeting male-male sex are needed to reduce this threat.     

The effect of venue sampling on estimates of HIV prevalence and sexual risk behaviors in men who have sex with men

OBJECTIVE: The objective of this study was to investigate differences in HIV prevalence and sexual risk behaviors among men who have sex with men (MSM) according to their gay venue visit patterns. METHODS: In a cross-sectional survey, a population-based sample of men aged 18 to 64 years who self-identified as gay or bisexual were interviewed by telephone regarding their sexual behaviors, HIV serostatus, and gay venue visit patterns. RESULTS: A total of 398 men were recruited for the study. The results showed that frequent gay venue visitors were more likely to engage in high-risk sexual behaviors. Among gay venue attendees who visited different types of gay venues, men who visited sex clubs/bathhouses reported the highest rates of 5 or more male sexual partners and unprotected anal intercourse (UAI) with secondary partners (62.6% and 34.6%, respectively), gay bar/club attendees and cruisers reported higher rates of having sex with women (8.5% and 14.8%, respectively), and circuit party attendees reported the highest HIV prevalence (40.4%) and serodiscordant UAI (30.2%). CONCLUSIONS: MSM who visited different types of gay venues and with varied visit frequency showed marked differences in sexual risk behaviors, and the differences suggest the importance of weighting procedure to obtain unbiased estimates in venue-based studies.