男男性接触者性病就医意向调查分析

目的 了解男男性接触者（MSM）目前的就医选择及对就医环境、医生的需求，为改善医疗服务、促进其正确求医行为提供依据。方法 采用问卷调查形式对昆明市76名MSM进行调查。结果 43.8％的MSM在性病就医时首先选择皮肤病性病专科医院，27．4％选择综合医院的相关科室，12．3％选择个体诊所。63．5％希望是男医生接诊，32．4％无所谓。在就医环境处理等许多方面，MSM与其他人群相比并无特别的需求。结论 对MSM开展性病诊疗服务时，需要医生对该人群有一个正确的了解，采用不评判、不歧视态度，创造宽松的就医环境，同时为其提供保密的、良好的、规范和富有责任心的服务是非常重要的。     

成都地区男男性行为者的性病就医意向调查

目的促进男男性行为者的正确就医行为。方法以匿名问卷的方式开展性病就医意向调查。结果70名接受调查者平均年龄26．6岁，以青壮年为主，且文化程度较高。患了性病后60例(85．7％)表示愿意去正规医院和皮肤性病专科医院就诊，42例(60．0％)对医院所处的地理位置不介意，44例(62．9％)希望男医生接诊，希望得到全面认真的检查和治疗，69例(98．6％)赞成提供转介卡进行性病转介服务的设想。结论本次调查对今后在男男性行为人群中开展针对性的性病医疗服务，促进正确的就医行为提供了依据。     

济南市男男性行为人群的特征和高危行为分析

目的对济南市男男性行为人群（MSM）的行为特征和高危行为进行分析，为制定防治政策提供依据。方法2008年4—6月，使用同伴推动抽样法，在济南市开展MSM人群的流行病学调查，使用RDSATT软件进行统计分析。结果调查500名MSM，平均年龄29．6岁，高中及以下学历占52．6％，未婚者、流动人口居多。涉及多种职业，其中农民工占13．8％。发生首次性行为平均年龄20．8岁，第一个性伴多为男性。性交方式主要为口交和肛交。近6个月平均性伴数4．5个，近一半为约会情人或一夜情。有12．4％的人有过商业性行为，且80．8％的人在商业性行为时从不使用安全套。有34．7％的人近6个月与异性发生过性行为。结论济南市MSM人群危险性行为普遍存在，农民T中的MSM值得关注。通过异性性传播的危险犹存，应继续在该人群中开展健康教育与行为干预。     

中国MSM艾滋病性病干预中的现象与思考

2007年我国新发艾滋病病毒（HIV）感染者约5万（4万～6万）人,其中异性性传播占44．7％,男男性传播占12．2％,注射吸毒传播占42．0％,母婴传播占1．1％。中国的艾滋病从经血传播向性接触传播为主转变。国内对男男性行为者（men who have sex with men,MSM）的调查数据显示,目前MSM人群HIV感染率在1％～4％ 。作为社会群体的MSM群体已经不得不面对来自艾滋病的威胁,     

采用同伴推动抽样法进行男男性接触人群HIV／STD流行病学调查的探索

目的探索同伴推动抽样法（Respondent driven sampling，RDS）在我国男男性接触（MSM）人群调查的可行性。方法使用RDS对北京市MSM进行抽样调查及血清学检测，了解他们艾滋病病毒（HIV）、性病感染状况及行为特点；采用RDSAT软件进行统计分析，NETDRAW和EXCEL作图。结果共征募MSM　325人，其中35岁以下占90．5％，未婚占83．0％（95％CI：76．4～88．9），外地户籍为61．9％（95％CI：54．0～70．1）；HIV感染率为0．4％（95％CI：0．1～0．5），梅毒抗体阳性率为13．7％（95％CI：9．1～19．0），梅毒RPR阳性率6．0％（95％CI：3.8～8．7）；56．2％（95％CI：50．0～65．0）为男性性取向，88．9％首次性行为年龄≤24岁，56．3％（95％CI：49．5～64．0）半年内有≥2个性伴，近6个月无保护插入性肛交为51.8％（95％CI：44．0～59．4），无保护被插入性肛交为44．8％（95％CI：37．2～52．3）。结论RDS简便易行，无需过多凋查员投入前期准备工作，实为开展隐匿人群调查的行之有效的方法之一。北京市MSM人群HIV感染率可能处于低水平．但存在HIV行隐患。     

2005年云南省疟疾监测点疟疾流行特征调查分析

目的了解云南省疟疾流行特征。方法采用调查表进行疟疾患者个案调查。结果人群特征：男性、农民、小学文化是风险人群。感染特征：当地感染病例占77．01％，外地感染病例占5．37％，国外感染病例占17．61％。发病特征：间日疟占74．30％，恶性疟占25．70％；轻型病例占97．90％，重型病例占2．10％；初发病例占74．10％，复发病例占25．90％。就医特征：平均就医时间4．15d；首选医院：村卫生所占61．50％。诊断方式：实验室诊断占53．40％，临床诊断占24．20％，药物试治有效占21．50％。行为特征：使用蚊帐率38．20％，有露宿习惯者占14．30％。治疗特征：口服药治疗占69．16％，肌肉注射24．25％；肌肉注射加口服治疗占6．59％，使用正规处方率为64．67％，非正规处方率为35．33％。结论防治措施有很大的改进空间，通过卫生宣教和培训，加强风险人群和有出国打工行为者的管理，提高村民的及时就医和自我防护能力，提高村医的正规治疗率，减少复发，改善抗疟环境，降低发病，控制疟疾。     

2012年四川省艾滋病高危人群哨点监测结果分析

目的了解四川省艾滋病病毒（HIV）感染高危人群中,艾滋病的流行现状及其相关行为特征,为四川省艾滋病防治策略的制定与干预工作的开展提供科学依据。方法采用连续抽样法调查,对暗娼（FSW）、吸毒人群（DUS）、男男性行为人群（MSM）、性病门诊男性就诊者（Male STD）进行问卷调查和血清学检测。结果2012年4类高危人群共监测40091人,FSW、DUS、MSM、Male STD的HIV阳性检出率分别为0．4％、5．4％、11．1％、0．7％。2009—2012年,DUSHIV阳性检出率呈逐年下降趋势（Х^2=43．26,P〈0．001）,但总体仍在相对较高水平;其余高危人群未见下降趋势,MSM仍维持在较高水平（9．7％～11．5％）,FSW（0．3％～0．6％）、Male STD（0．6％～0．7％）则在较低水平波动。FSW最近1个月商业性行为时坚持使用安全套比例为71．6％,DUS最近1个月共用针具比例为23．6％,MSM最近6个月同性肛交时坚持使用安全套的比例为37．4％。结论MSM与DUS人群的HIV阳性检出率处于较高水平,各人群的HIV感染危险因素广泛存在,四川省艾滋病疫情流行态势依然严峻,预防干预工作不容忽视。     

东莞市MSM高危行为特征及HIV感染状况

目的了解东莞市男男性行为人群（MSM）的高危行为特征,艾滋病病毒（HIV）感染情况及影响因素,为在该人群中开展防控措施提供依据。方法利用2010—2012年东莞市MSM哨点监测数据,对MSM的人口学特征、行为学特征、性病症状、接受干预服务、HIV和梅毒感染水平等进行分析。结果共调查MSM984人,平均年龄为（30．36±6．71）岁;最近6个月发生过同性、异性性行为的比例分别为73．37％和37．5％,与同性、异性发生性行为时坚持使用安全套的比例分别为48．89％和29．27％。近1年有性病相关症状的MSM的比例为6．81％,接受过于预服务的比例为59．04％。HIV和梅毒抗体阳性率分别为14．23％和15．35％,其中2010—2012年HIV阳性率分别为10．5％、11．33％和22．91％。多因素Logistic回归分析结果表明：艾滋病知识知晓和接受过干预服务与最近6个月同性性行为时坚持使用安全套的关系有统计学意义（P〈0．05）;梅毒抗体阳性、近1年有性病相关症状、年龄在≥40岁、样本来源等因素,与HIV感染的关系有统计学意义（P〈0．05）。结论东莞市MSM的HIV感染率高,且上升趋势明显,迫切需要加强行为干预,防止艾滋病向一般人群蔓延。     

北京市部分男男性接触者STD/AIDS知识、态度、信念、行为调查

目的 了解北京市男男性接触者（MSM）关于性传播疾病／艾滋病（STD／AIDS）的知识、态度、信念、行为情况，为在该人群中开展有针对性的干预工作提供依据。方法 经过培训的访谈员对符合条件的MSM进行一对一的访谈，并留取唾液样本进行艾滋病病毒Ⅰ型抗体（抗-HIV-1）检测。结果 共有481名MSM接受了调查。北京市MSM具有一定的STD／AIDS知识，64．1％的被调查者同时与女性有性接触。近6个月与女性发生阴道交和肛交时每次使用安全套率为27．6％和36．4％，与男性进行肛交或接受肛交时每次使用安全套率为40．1％和38．4％。21％的被调查者自诉患过STD，唾液检测抗-HIV-1阳性率为3．1％。结论 北京市MSM人群中存在着STD／AIDS流行，并有向普通人群扩散的潜在危险。     

"序贯粪隐血大肠肿瘤筛检方案"应用价值的再探讨

目的 通过自然人群大肠肿瘤普查了解近年北京市大肠癌发病情况，进一步探讨“序贯粪便隐血大肠癌筛检方案”的有效性和可行性。方法 选定15家医院医疗责任区内48100自然人群为本次普查靶人群。对其中30岁以上的社区或企业职工26827人进行普查登记，并连续进行3d序贯粪隐血检查。隐血阳性者接受结肠镜检查。符合高危条件者，全部接受隐血和肠镜检查。结果 预计普查人为26827人，实际普查人数为19852人，普查率为74％。男女比例为1．05：1。中位年龄50岁。序贯粪隐血阳性率为5．6％，检出大肠癌12例，其中DukesA期4例，B期7例，C期1例。Dukes A B共11例，占全部检出癌的91．66％。40岁以下人群未检出大肠癌，50岁以上人群中，检出大肠癌的比例随年龄升高而逐渐增加。高危人群中检出2例大肠癌，占该人群的0．28％，一般危险人群中检出10例大肠癌，占该人群的0．05％。结论 普查靶人群的大肠癌患病率为36．57／10^5，提示北京市城区有较高的患病率。采用“序贯粪隐血筛检方案”检出了91．66％的早期和较早期癌。提示该方案的有效性和可行性。高危人群和50岁以上的一般危险人群为大肠癌的重点普查对象。     

Donor deferral policies for men who have sex with men: past,present and future

We review the history and evolution of blood donor criteria for men who have sex with men (MSM). Deferral policies in many jurisdictions, including Australia, New Zealand, Canada, the United States, Brazil and many western European countries are based on a period of abstinence from MSM, often of 12 months duration. Several countries (Italy, Spain and Portugal) defer donors based on sexual behaviours considered to be at high risk, regardless of whether the partner is same sex or opposite sex. Compliance is a key determinant in the efficacy of any deferral policy. We summarize research themes and strategies discussed at a January 2017 meeting held in Toronto, Canada, to provide an evidence basis for future policy changes.     

Improving HIV medical care engagement by attending to status disclosure and social support

ABSTRACT

Expeditious linkage and consistent engagement in medical care is important for people with HIV’s (PWH) health. One theory on fostering linkage and engagement involves HIV status disclosure to mobilize social support. To assess disclosure and social support’s association with linkage and engagement, we conducted a qualitative study sampling black and Latino men who have sex with men (MSM of color) in the U.S. Participants' narratives presented mixed results. For instance, several participants who reported delaying, inconsistent access, or detachment from care also reported disclosing for support purposes, yet sporadic engagement suggests that their disclosure or any subsequent social support have not assisted. The findings contribute to the literature that questions disclosure and social support’s influence on care engagement, especially when decontextualized from circumstances and intentions. Our findings suggest the mechanics of disclosure and social support require planned implementation if intending to affect outcomes, especially among MSM of color. From the findings, we explore steps that may bolster interventions seeking to anchor medical care engagement.     

Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US*

Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N?=?532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs?>?6), multiple sex partnerships (AORs?>?1.8), and condomless sex in the context of substance use (AORs?>?3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release.     

Are we on the precipice of a new epidemic? Risk for hepatitis C among HIV-negative men-, trans women-, and trans men- who have sex with men in the United States

ABSTRACT

Emerging data from Europe have documented increases in diagnoses of acute hepatitis C virus (HCV) infection among HIV-negative men who have sex with men. We investigated risk factors for HCV and their correlates in the Together 5000 study, a U.S. national cohort study of HIV-negative men (n?=?6089), transgender women (n?=?40), and transgender men (n?=?42) who have sex with men. We used bivariate and multivariable analyses to determine demographic and behavioral factors associated with high risk for acute HCV infection (using the HCV-MOSAIC risk indicator with a score?≥?2.0). Mean HCV risk score was 1.38 (SD?=?1.09) and 27.3% of participants had HCV risk scores?≥?2.0. In multivariable modeling, being cisgender male (vs. not) was associated with having a lower HCV-MOSAIC risk score. Meanwhile, being white, having been incarcerated, prior use of HIV pre- or post-exposure prophylaxis, having ever been tested for HIV, and recent methamphetamine use were associated with high risk for HCV. More than one-in-four participants exceeded the threshold score for HCV risk. Those with high HCV-MOSAIC risk scores were more likely to have been in settings where they could be tested for acute HCV (i.e., HIV testing, PrEP care, PEP care, incarceration), suggesting opportunities to engage them in HCV screening, prevention, and treatment.     

Associations between sexual partner number and HIV risk behaviors: implications for HIV prevention efforts in a Treatment as Prevention (TasP) environment

Previous research indicates that gay and bisexual men (GBM) have significantly more sexual partners than same-aged heterosexual men and women. As a result, some HIV intervention programs have focused on partner reduction. However, new research findings question the relevance of sexual partner number as a sexual risk measure for GBM given Treatment as Prevention (TasP) programs and new seroadaptive strategies which have led to lower GBM community viral load and new HIV prevention behaviors. To assess if sexual partner number continues to remain an important measure of sexual risk for GBM living in a city that actively promotes TasP as provincial policy, we analysed cross-sectional data from 719 GBM recruited through respondent-driven sampling in Vancouver, Canada. Multivariable negative binomial regression analysis showed that partner number was significantly associated with previously identified HIV risk factors including condomless anal intercourse with serodiscordant and/or unknown serostatus partners, using sex toys, attending group sex events, receiving money for sex, and sex drug use. These results indicate that sexual partner number remains an important proximate HIV risk measure. However, more nuanced measures of HIV treatment status and greater understanding of the possible causes of increased partner number among GBM are needed.     

Hepatitis A occurrence and outbreaks in Europe over the past two decades: A systematic review

Hepatitis A (HA) is a vaccine-preventable liver disease with >170 million new cases occurring yearly. In recent outbreaks in the USA, hospitalization and case-fatality ratios were >60% and ~1%, respectively. In Europe, endemicity persists and outbreaks continue to occur. We performed a systematic literature review to understand the changes in HA occurrence in Europe over the past two decades. PubMed and Embase were systematically searched for peer-reviewed articles published between 1 January 2001 and 14 April 2021 using terms covering HA, 11 selected European countries, outbreaks, outcomes and HA virus circulation. Here, we focus on HA occurrence and outbreaks in the five countries with the largest population and the most comprehensive vaccination recommendations: France, Germany, Italy, Spain and the UK; 118 reports included data for these five European countries. Notification rates (≤9.7/100,000 population) and percentages of men among cases (≤83.0%) peaked in 2017. The number of person-to-person-transmitted cases and outbreaks decreased in children but increased in other risk groups, such as men who have sex with men (MSM). Sexually transmitted outbreaks in MSM clustered around 2017. Travel-related outbreaks were few; the proportion of travel-related cases decreased during the past two decades, while the number of domestic cases increased. Despite the existing risk-based vaccination recommendations, HA transmission shifted in proportions from travelers and children to other risk groups, such as MSM and older age groups. Because a substantial proportion of the European population is susceptible to HA, adherence to existing recommendations should be monitored more closely, and enhanced vaccination strategies should be considered.     

Partner Awareness of the Serostatus of HIV-Seropositive Men Who Have Sex With Men: Impact on Unprotected Sexual Behavior

Prior research has provided conflicting evidence about the association between partner awareness of an HIV-seropositive persons serostatus and HIV transmission behavior via unprotected intercourse. The current study examined partner awareness of participant HIV-seropositive status and sexual behavior in a multiethnic sample of HIV-seropositive men who have sex with men. Most HIV-seropositive men reported that their primary partners are aware, and most reported that at least some non-primary partners are aware the participant was HIV-seropositive before first having sex. Partner awareness of participant HIV-serostatus was related to unprotected sexual behavior during the past 3 months in a non-linear fashion, as men with partners who were inconsistently aware had higher rates of unprotected receptive anal intercourse than men with partners who were consistently aware or consistently unaware. Men with partners who were inconsistently aware also had higher rates of insertive oral intercourse than men with partners who were consistently aware. However, there were no differences in HIV transmission risk behavior between men with partners who were consistently aware and men with partners who were consistently unaware a participant was HIV-seropositive.     

Evaluation of an HIV Prevention Intervention for Men Who Have Sex with Men at Cruising Areas in the Netherlands

This study collected data from 362 men who had sex with men at cruising areas in the Netherlands, and measured characteristics of respondents, sexual risk behavior, and risk perceptions. Furthermore, the study assessed whether outreach activities at cruising areas promote safe sex behavior. Almost one in five respondents reported having sex with both men and women, and 18.5% of respondents reported sexual risk behavior at cruising areas. Men who had a conversation about safe sex with a volunteer used condoms more consistently than men who had not spoken with a volunteer. Finally, it was found that behaviorally bisexual men used condoms less frequently at cruising areas. The relatively high levels of risk-taking sex stress the importance of HIV prevention at cruising areas. Furthermore, special attention could be given to cruising area visitors who have sex with both men and women, because they report higher levels of risk behavior and have less access to safer sex information regarding homosexual behavior.