Risky sexual behaviors associated with recreational drug use among men who have sex with men in an international resort area: Challenges and opportunities

South Florida is home to a highly transient population of approximately 145,000 men who have sex with men (MSM) and annually hosts over 1.8 million gay and bisexual visitors. To develop more effective interventions for HIV/sexually transmitted infections (STI) prevention in this setting, we conducted a cross-sectional study of recreational drug use and risky sexual behaviors among MSM. A standardized, selfadministered questionnaire, reviewed and approved by a university Institutional Review Board, was offered to men 18 years of age and older who reported ever having sex with a man. Men were approached on weekends in five diverse locations in Miami-Dade County and five in Broward County in winter 2004. An honorarium of $10 was offered to those who completed and returned a questionnaire. Of 407 participants, 115 men (28%) lived in Miami-Dade, 147 (36%) lived in Broward, 46 (11%) lived in another county in south Florida, and 99 (24%) lived elsewhere. Overall, 32% reported using one or more “club drugs” in the past year. Club drug use was highly associated with unprotected anal intercourse (UAI) (P<.001). MSM residing outside of south Florida were more likely than local residents to report using cocaine and ketamine and engaging in unprotected receptive anal intercourse (URAI) in the past month (P=.03). Tourists may be even more likely than residents to engage in risky sexual behaviors and use certain recreational drugs. Interventions must be developed, implemented, and evaluated that take into account the unique characteristics of international resort areas. An earlier version was presented in Miami Beach on August 27, 2004, at the conference, “Opportunities, Challenges, and Successes of International Research,” cosponsored by the Drug Abuse and AIDS Research Center (DAARC) of the University of Miami and the National Institute on Drug Abuse (NIDA). Drs. Darrow, Biersteker, Geiss, Chevalier, Clark, Marrero, Mills, and Obiaja are with the Robert R. Stempel School of Public Health, Florida International University, Miami, Florida. Ana Adasme, Lenworth Anglin, Veronica Francis, Lynda Humaran, Maria Norasco-Warren, Lisa Quammie, and Nalinie Samlal also contributed to this report.     

HIV/AIDS Patients Who Move to Urban Florida Counties Following a Diagnosis of HIV: Predictors and Implications for HIV Prevention

We characterized patients at publicly funded HIV/AIDS patient treatment sites who moved (“migrated”) post-diagnosis of HIV to five urban Florida counties, by geographic, demographic, socioeconomic and risk variables. Each patient who came for services at the sites in a 2–3 week sampling period was asked to complete a brief, self-administered questionnaire. We compared migrant with non-migrant patients to disclose characteristics predictive of migration and help plan for continuity of HIV care, future funding, and HIV prevention. Overall, 25% (range by site, 20%–38%) of the 1,286 patients in the study migrated to the counties from a non-contiguous Florida county, another state, or another country. In a multivariate model comparing interstate migrants with non-migrants, white and Hispanic race/ethnicity, age 9–29 years at first HIV diagnosis compared with older age, increasing education, highest current income and exposure category (men having sex with men and injection drug users) were independently associated with migration (all p < 0.05). In a similar model for international migrants, the independently associated variables included Hispanic ethnicity, education, and younger age at first HIV diagnosis. Although migrating can bring benefits to a patient such as improved access to health care or a new employment opportunity, it is stressful because it can result in changes in a person’s social network, employment, and health care providers. Thus, moving could create unique patient needs concerning medication adherence, risk-taking, and other psychosocial needs. Given the high percentage of migrants in these urban Florida county clinics, these needs should be further examined and addressed. Lieb is with the Florida Department of Health, Bureau of HIV/AIDS, Tallahassee, FL, USA; Trepka is with the Stempel School of Public Health, Florida International University, Miami, FL, USA; Liberti, Cohen, and Romero are with the Florida Department of Health, Tallahassee, FL, USA.     

Estimation of HIV Prevalence,Risk Factors,and Testing Frequency among Sexually Active Men Who Have Sex with Men,Aged 18–64 Years—New York City, 2002

Population-based estimates of human immunodeficiency virus (HIV) prevalence and risk behaviors among men who have sex with men (MSM) are valuable for HIV prevention planning but not widely available, especially at the local level. We combined two population-based data sources to estimate prevalence of diagnosed HIV infection, HIV-associated risk-behaviors, and HIV testing patterns among sexually active MSM in New York City (NYC). HIV/AIDS surveillance data were used to determine the number of living males reporting a history of sex with men who had been diagnosed in NYC with HIV infection through 2002 (23% of HIV-infected males did not have HIV transmission risk information available). Sexual behavior data from a cross-sectional telephone survey were used to estimate the number of sexually active MSM in NYC in 2002. Prevalence of diagnosed HIV infection was estimated using the ratio of HIV-infected MSM to sexually active MSM. The estimated base prevalence of diagnosed HIV infection was 8.4% overall (95% confidence interval [CI] = 7.5–9.6). Diagnosed HIV prevalence was highest among MSM who were non-Hispanic black (12.6%, 95% CI = 9.8–17.6), aged 35–44 (12.6%, 95% CI = 10.4–15.9), or 45–54 years (13.1%, 95% CI = 10.2–18.3), and residents of Manhattan (17.7%, 95% CI = 14.5–22.8). Overall, 37% (95% CI = 32–43%) of MSM reported using a condom at last sex, and 34% (95% CI = 28–39%) reported being tested for HIV in the past year. Estimates derived through sensitivity analyses (assigning a range of HIV-infected males with no reported risk information as MSM) yielded higher diagnosed HIV prevalence estimates (11.0–13.2%). Accounting for additional undiagnosed HIV-infected MSM yielded even higher prevalence estimates. The high prevalence of diagnosed HIV among sexually active MSM in NYC is likely due to a combination of high incidence over the course of the epidemic and prolonged survival in the era of highly active antiretroviral therapy. Despite high HIV prevalence in this population, condom use and HIV testing are low. Combining complementary population-based data sources can provide critical HIV-related information to guide prevention efforts. Individual counseling and education interventions should focus on increasing condom use and encouraging safer sex practices among all sexually active MSM, particularly those groups with low levels of condom use and multiple sex partners At the time this work was conducted, Manning and Marx were with the Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA; Thorpe, Ramaswamy, Hajat, Marx, Karpati, Mostashari, and Pfeiffer are with the New York City Department of Health and Mental Hygiene, New York, NY, USA; Nash is with the Department of Epidemiology and International Center for AIDS Care and Treatment Programs, Columbia Mailman School of Public Health, New York, NY, USA; Manning is with the Massachusetts Department of Public Health, Bureau of Family and Community Health, Boston, MA, USA.     

Estimating the Number of Men Who Have Sex with Men by Race/Ethnicity at the County Level in Texas

This analysis presents a method for estimating the population of men who have sex with men (MSM) at the county and metropolitan area level in Texas. Surveillance data consistently demonstrate that MSM experience a high burden of HIV and other sexually transmitted infections (STIs). Numerous studies have shown that MSM are also vulnerable to many other health concerns such as suicide, substance abuse, domestic violence and assault, homelessness, and mental illness. However, compilation of rates of HIV, STIs, and other health issues is dependent on estimation of population denominators. In the absence of systematic, consistent, and direct assessment of sexual orientation and gender identity in national surveys, it is difficult to estimate the size of at-risk populations. Previous estimates at the national and state level have been calculated using varied methodologies. However, to date, statewide estimates at the county level have only been produced for the state of Florida. County-level and metropolitan area estimates of MSM population were produced using three modified models developed by Lieb et al. These models used data on population and same-sex households from the US Census, along with estimates of sexual behavior from the National Survey on Family Growth. These models produce an estimate of 599,683 MSM in Texas (6.4 % of the adult male population). Metropolitan areas with the highest percentage of MSM population include Dallas and Austin (10.3 and 9.8 %, respectively). County-level estimates of MSM population range from 1.0 to 12.9 %. These local estimates are critical to targeting vulnerable populations and effective allocation of resources for prevention and treatment programs.     

Estimating Populations of Men Who Have Sex with Men in the Southern United States

Population estimates of men who have sex with men (MSM) by state and race/ethnicity are lacking, hampering effective HIV epidemic monitoring and targeting of outreach and prevention efforts. We created three models to estimate the proportion and number of adult males who are MSM in 17 southern states. Model A used state-specific census data stratified by rural/suburban/urban area and national estimates of the percentage MSM in corresponding areas. Model B used a national estimate of the percentage MSM and state-specific household census data. Model C partitioned the statewide estimates by race/ethnicity. Statewide Models A and B estimates of the percentages MSM were strongly correlated (r = 0.74; r-squared = 0.55; p < 0.001) and had similar means (5.82% and 5.88%, respectively) and medians (5.5% and 5.2%, respectively). The estimated percentage MSM in the South was 6.0% (range 3.6–13.2%; median, 5.4%). The combined estimated number of MSM was 2.4 million, including 1,656,500 (69%) whites, 339,400 (14%) blacks, 368,800 (15%) Hispanics, 34,600 (1.4%) Asian/Pacific Islanders, 7,700 (0.3%) American Indians/Alaska Natives, and 11,000 (0.5%) others. The estimates showed considerable variability in state-specific racial/ethnic percentages MSM. MSM population estimates enable better assessment of community vulnerability, HIV/AIDS surveillance, and allocation of resources. Data availability and computational ease of our models suggest other states could similarly estimate their MSM populations.     

Attitudes about combination HIV therapies: The next generation of gay men at risk

This study examined awareness of and attitudes about highly active antiret-roviral therapies (HAARTs) among adolescent and young men who have sex with men (MSM). As part of the multisite Young Men’s Survey, 813 MSM aged 15–22 years who attended public venues in two cities were questioned about HAART in 1997–1998. Overall, 45.1% had heard of HAART, 61.6% in Seattle, Washington, and 35.0% in New York City. MSM in New York City who were the youngest, men of color, men who were human immunodeficiency virus (HIV) antibody negative, and men who resided in New Jersey were significantly less likely to be aware of HAART. Attitudes about HAART were not associated with sexual risk behaviors. Prevention efforts among young MSM should focus on other determinants of risk, but also include information on the changing nature of HIV therapies. Presented in part at the 1999 National HIV Prevention Conference, Atlanta, Georgia, August 29–September 1, 1999.     

中国男男性行为者艾滋病感染情况及干预工作进展

目的了解浙江省台州市2010—2017年艾滋病哨点监测对象中,50岁以上男男性行为者(MSM)的HIV感染状况及行为特征,分析其相关因素,为制定针对性干预策略提供依据。方法利用台州市2010—2017年MSM哨点监测资料,分析50岁以上者的人口学特征、艾滋病知识知晓情况、性行为特征, 并通过多因素回归分析HIV感染状况及相关因素。结果2010—2017年,共调查334名50岁以上的MSM,HIV阳性率为14.1%。334人的平均年龄为(59.6±7.2)岁,初中及以下学历者占76.0%,艾滋病知识知晓率为85.6%。其中,最近6个月与同性发生肛交性行为的占78.7%,每次都用安全套的比例为30.4%;最近6个月与同性发生商业性行为的占4.8%,与异性发生性行为的占37.1%。多因素分析显示,梅毒阳性是HIV感染的危险因素(OR=2.81,95%CI为1.14~6.89),知晓艾滋病相关知识是HIV感染的保护因素(OR=0.37,95%CI为0.15~0.94)。结论台州市50岁以上MSM的HIV阳性率较高,高危行为广泛存在,应加强对该人群动态HIV监测和高危行为干预,减少不安全性行为。     

新疆乌鲁木齐市男男性行为人群HIV传播动力学的预测和分析

目的建立人类免疫缺陷病毒(HIV)感染传播动力学模型,评估男男性行为(MSM)人群HIV感染状况,并预测未来十年新疆乌鲁木齐市MSM人群HIV的流行趋势,为制定合适的防控措施提供定量依据。方法利用新疆乌鲁木齐市2009—2017年MSM人群HIV的监测数据,建立HIV传播的动力学模型。通过模型分析得到决定疾病传播与否的基本再生数R0,并用收集和估计的参数对模型进行数值模拟,分析乌鲁木齐市MSM人群HIV的流行状况。结果建立的MSM人群HIV的传播动力学模型拟合效果合理[平均绝对百分比误差(MAPE)=10.89%,均方根百分比误差(RMSPE)=25.74%],基本再生数R0≈0.2616(95%CI:0.2394～0.9299),该模型预测2027年乌鲁木齐市MSM人群HIV的阳性率下降至2%。参数敏感性分析发现,由低危易感者发展成为高危易感者的比例、由HIV感染者发展成为艾滋病患者的比例和高危易感者发展成为低危易感者的比例是影响MSM人群HIV流行的主要因素。结论乌鲁木齐市MSM人群HIV感染呈现持续流行,相关部门应加强对MSM人群的防控,推广安全套的使用,加强宣传教育等综合性干预措施,控制MSM人群HIV的流行。     

The continuing HIV epidemic among men who have sex with men

OBJECTIVES: This study characterized the AIDS epidemic among urban men who have sex with men (MSM). METHODS: A probability sample of MSM was obtained in 1997 (n = 2881; 18 years and older) from New York, Los Angeles, Chicago, and San Francisco, and HIV status was determined through self-report and biological measures. RESULTS: HIV prevalence was 17% (95% confidence interval = 15%, 19%) overall, with extremely high levels in African Americans (29%), MSM who used injection drugs (40%), "ultraheavy" noninjection drug users (32%), and less educated men (< high school, 37%). City-level HIV differences were non-significant once these other factors were controlled for. In comparing the present findings with historical data based on public records and modeling, HIV prevalence appears to have declined as a result of high mortality (69%) and stable, but high, incidence rates (1%-2%). CONCLUSIONS: Although the findings suggest that HIV prevalence has declined significantly from the mid-1980s, current levels among urban MSM in the United States approximate those of sub-Saharan countries (e.g., 14%-25%) and are extremely high in many population subsegments. Despite years of progress, the AIDS epidemic continues unabated among subsegments of the MSM community.     

重庆市男男性接触者艾滋病病毒感染率及其影响因素

目的 了解重庆市男男性接触人群(MSM)艾滋病病毒(HIV)感染率及其影响因素.方法 2007年7-9月在重庆市渝中区、九龙坡区和沙坪坝区通过滚雪球方式招募1044名MSM进行面对面的问卷调查,以HIV感染状况为应变量,人口学特征、艾滋病防治知识知晓水平、性行为状况、接受干预服务、梅毒感染状况等为自变量进行逐步向前法的logistic回归分析与HIV感染相关的因素.结果 调查的1044名MSM中,艾滋病防治知识知晓率高(89.5%),近6个月与男性发生无保护性的肛交比例为63.8%;梅毒感染率为8.5%(89/1044),HIV感染率为12.5%(131/1044).多因素回归分析发现,年龄较大(OR=1.69,95%CI:1.13～2.52)、文化程度在初中以下(OR=1.89,95%CI:1.17～3.05)、首次性行为年龄在18岁以下(OR=3.11,95%CI:1.20～8.02)、近6个月男性性伴数在10个以上(OR=2.24,95%CI:1.24～4.02)、近6个月与女性有性行为史(OR=2.40,95%CI:1.64～3.51)和梅毒感染(OR=4.52,95%CI:2.77～7.38)是HIV感染的独立危险因素.结论 MSM人群无保护性性行为发生率、梅毒和HIV感染率均高.     

北京2013年男男性行为人群基数评估

目的 估计北京市男男性行为人群(MSM)基数, 为制定北京市MSM人群艾滋病预防干预措施及合理配置卫生资源提供参考依据。方法 采用两阶段抽样, 对北京市男同活动场所、艾滋病自愿咨询检测(VCT)门诊所和男同网站的MSM进行问卷调查以获取相关数据, 通过三来源获取再获取法(CMR)估计北京MSM人群基数。结果 北京市MSM人群基数估计为78 283人, 标准差为7 682人(95%CI=63 226~93 340)。结论 首次采用三来源CMR法, 对北京市MSM人群基数作出科学估计。     

珠三角地区2009－2013年男男性行为者HIV感染率及其影响因素分析

目的 了解珠三角地区MSM的HIV感染状况及其影响因素。方法 2009－2013年采用全国MSM哨点监测方案调查该地区内6市MSM的HIV感染率,并分析影响因素。结果 2009－2013年珠三角地区6市共调查MSM 8 770例,HIV感染率分别为4.7%、9.7%、10.6%、12.9%和11.4%,呈上升趋势。MSM中危险行为较为普遍,最近6个月肛交每次使用安全套的比例为46.3%。年龄较大、外省籍、不坚持使用安全套、1年内被诊断患过性病及1年内未接受过艾滋病相关干预服务,是该人群感染HIV的危险因素。结论 珠三角地区MSM中HIV传播危险行为较为普遍,HIV感染率呈逐年上升趋势。     

上海市虹口区2010—2015年VCT门诊男男性行为者艾滋病流行病学特征分析

目的 了解上海市虹口区疾病预防控制中心艾滋病自愿咨询检测（VCT）门诊男男性行为者（MSM）的基本情况和艾滋病病毒（HIV）感染的流行病学特征。方法 对虹口区VCT门诊2010—2015年MSM咨询、检测数据进行分析,数据下载自\     

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。     

The Miami,Florida, Young Men’s Survey: HIV prevalence and risk behaviors among urban young men who have sex with men who have ever runaway

Youth in urban areas with a history of running away from home often have special needs. Importantly, risk factors for HIV/AIDS might be associated with such a history. We assessed the association between having a history of running away from home and the occurrence of HIV infection and risk behavior among young men who have sex with men (YMSM), aged 15–22 years. A cross-sectional epidemiologic and behavioral survey was conducted between 1995 and 1996 in Miami, Florida, as part of a national Young Men’s Survey. Of 488 YMSM, the prevalence of HIV infection among those with a history of running away from home was 10.5% (adjusted odds ratio=3.4; 95% Cl 1.5–7.8). YMSM who had ever run away were more likely to be HIV infected, be out of school, and have ever had vaginal or anal sex with females, been forced to have sex, injected drugs, and used needles for self-tattooing or body piercing. The prevalence of HIV infection and associated risk behaviors among runaways was high, highlighting the ongoing need for prevention and social support services for youth with a history of running away from home.     

If You Are Not Counted,You Don’t Count: Estimating the Number of African-American Men Who Have Sex with Men in San Francisco Using a Novel Bayesian Approach

African-American men who have sex with men (AA MSM) have been disproportionately infected with and affected by HIV and other STIs in San Francisco and the USA. The true scope and scale of the HIV epidemic in this population has not been quantified, in part because the size of this population remains unknown. We used the successive sampling population size estimation (SS-PSE) method, a new Bayesian approach to population size estimation that incorporates network size data routinely collected in respondent-driven sampling (RDS) studies, to estimate the number of AA MSM in San Francisco. This method was applied to data from a 2009 RDS study of AA MSM. An estimate from a separate study of local AA MSM was used to model the prior distribution of the population size. Two-hundred and fifty-six AA MSM were included in the RDS survey. The estimated population size was 4917 (95 % CI 1267–28,771), using a flat prior estimated 1882 (95 % CI 919–2463) as a lower acceptable bound, and a large prior estimated 6762 (95 % CI 1994–13,863) as an acceptable upper bound. Point estimates from the SS-PSE were consistent with estimates from multiplier methods using external data. The SS-PSE method is easily integrated into RDS studies and therefore provides a simple and appealing tool to rapidly produce estimates of the size of key populations otherwise difficult to reach and enumerate.     

江苏省男男性行为者HIV新发感染状况及影响因素研究

目的了解江苏省男男性行为者（menwhohavesexwithmen,MSM）HIV新发感染状况及影响因素。方法2011年在江苏省8个地级市招募MSM,并进行问卷调查及实验室检测,应用BEDHIV一1IgG捕获酶免疫（BED-CEIA）法检出其中的新发感染者,以HIV阴性MSM为对照,采用多因素Logistic回归模型分析HIV新发感染的影响因素。结果共招募2432名MSM,HIV新发感染率为4．67％（95％CI：3．44％～5．89％）,HIV阴性和新发感染者之间在户籍省、文化程度、最近6个月是否与同性发生肛交、最近1次同性肛交是否使用安全套、最近6个月同性肛交安全套使用率及是否正在感染梅毒等变量上差异有统计学意义（均有P〈0．05）,多因素分析外省籍、文化程度低、最近1次同性肛交未使用安全套及正在感染梅毒是MSM人群HIV新发感染的主要危险因素。结论江苏省MSM人群中HIV新发感染率较高,提示HIV在该人群中正快速传播,必须加大防控力度;影响新发感染的主要因素仍为无保护性肛交及正在感染梅毒等。     

男男性行为者未参加艾滋病抗体检测因素调查

目的 了解男男性行为人群(MSM)未参加艾滋病抗体检测的原因,为行为干预提供依据.方法 在南京市使用滚雪球法进行问卷调查,了解MSM人口学、高危行为特征,分析未参加艾滋病抗体检测的原因.结果 共调查766名MSM,有76.0％最近一年未参加艾滋病抗体检测.其HIV感染率为3.92％,梅毒感染率为10.97％;多因素Logistic回归分析显示:年龄＞20岁、最近一年进行性病检查治疗和接受过性病艾滋病宣传与未进行艾滋病抗体检测有统计学关联.结论 南京市MSM人群HIV检测率低,急需探索MSM检测咨询、后续服务等管理模式,提高MSM人群艾滋病抗体检测率.     

我国男男性行为人群HIV自我检测及相关因素研究进展

HIV检测是艾滋病防控工作的第一步, 我国MSM的HIV感染率高, 检测率低。HIV自我检测(HIV自检)为MSM提供了一个新的选择, 对扩大HIV检测在该人群中的覆盖面具有重要作用。本文综述了我国MSM的HIV自检及相关因素, 为HIV自检在该人群中的推广提供依据。     

临海市男男性行为HIV感染者干预效果评估

目的 了解对男男性行为HIV感染者（MSM感染者）的干预效果,为有针对性的随访管理提供参考。方法 通过全国艾滋病综合防治数据信息系统,将现住址为\