HIV Prevalence and Correlates of Unprotected Anal Intercourse Among Men Who Have Sex with Men, Jinan, China

China’s HIV epidemic may be shifting towards predominantly sexual transmission and emerging data point to potential increases in HIV prevalence among men who have sex with men (MSM). There is particular need to assess the extent of risk behavior among MSM outside of China’s most cosmopolitan cities. We conducted a respondent-driven sampling survey (N = 428) to measure HIV seroprevalence and risk behavior among MSM in Jinan, China, the provincial capital of Shandong. HIV prevalence was 0.5% (95% confidence interval [CI] 0.1–1.0). Unprotected anal intercourse (UAI) in the last 6 months (reported by 61.4%) was associated with buying or selling sex to a man in the last 6 months, syphilis infection, multiple partners in the last month, low HIV knowledge and migrant status. No participant had previously tested for HIV. Risk for HIV transmission is widespread among MSM throughout China; basic prevention programs are urgently needed.     

Correlates of Unprotected Vaginal or Anal Intercourse with Women Among Substance-Using Men Who Have Sex with Men

The role men who have sex with men and women (MSMW) play in heterosexual HIV transmission is not well understood. We analyzed baseline data from Project MIX, a behavioral intervention study of substance-using men who have sex with men (MSM), and identified correlates of unprotected vaginal intercourse, anal intercourse, or both with women (UVAI). Approximately 10 % (n = 194) of the men reported vaginal sex, anal sex, or both with a woman; of these substance-using MSMW, 66 % (129) reported UVAI. Among substance-using MSMW, multivariate analyses found unemployment relative to full/part-time employment (OR = 2.28; 95 % CI 1.01, 5.17), having a primary female partner relative to no primary female partner (OR = 3.44; CI 1.4, 8.46), and higher levels of treatment optimism (OR = 1.73; 95 % CI 1.18, 2.54) increased odds of UVAI. Strong feelings of connection to a same-race gay community (OR = 0.71; 95 % CI 0.56, 0.91) and Viagra use (OR = 0.31; 95 % CI 0.10, 0.95) decreased odds of UVAI. This work suggests that although the proportion of substance-using MSM who also have sex with women is low, these men engage in unprotected sex with women, particularly with primary female partners. This work highlights the need for further research with the substance using MSMW population to inform HIV prevention interventions specifically for MSMW.     

Prospective Predictors of Unprotected Anal Intercourse Among HIV-Seropositive Men Who Have Sex with Men Initiating Antiretroviral Therapy

Contemporary HIV prevention efforts are increasingly focused on those already living with HIV/AIDS (i.e., “prevention with positives”). Key to these initiatives is research identifying the most risky behavioral targets. Using a longitudinal design, we examined socio-demographic and psychosocial factors that prospectively predicted unprotected anal intercourse (UAI) in a sample of 134 HIV-seropositive men who have sex with men (MSM) initiating, changing, or re-starting an antiretroviral therapy regimen as part of a behavioral intervention study. Computer-based questionnaires were given at baseline and 6 months. In a sequential logistic regression, baseline measures of UAI (step 1), socio-demographic factors such as Latino ethnicity (step 2), and psychosocial factors such as crystal methamphetamine use, greater life stress, and lower trait anxiety (step 3) were predictors of UAI at 6 months. Problem drinking was not a significant predictor. Prevention efforts among MSM living with HIV/AIDS might focus on multiple psychosocial targets, like decreasing their crystal methamphetamine use and teaching coping skills to deal with life stress.     

Unprotected Receptive Anal Intercourse Among Men Who have Sex with Men in Brazil

The aim of this study was to assess factors associated with unprotected receptive anal intercourse (URAI) in a sample of MSM recruited by respondent driven sampling in Brazil. Among 3,449 participants, 36.5 % reported URAI. Final logistic model indicated that living with a male partner, illicit drug use, having stable partnership, having sex with men only, having few friends encouraging condom use, and high self-perceived risk for HIV infection were characteristics independently associated with URAI. Intervention strategies should focus on the role of anal sex practices on HIV transmission, address illicit drug use, stigma and expansion of HIV testing and care.     

Correlates of Serodiscordant Condomless Anal Intercourse Among Virologically Detectable HIV-Positive Young Men Who Have Sex with Men

Sexual transmission risk occurs in the context of serodiscordant condomless anal intercourse (CAI) where the seropositive partner is virologically detectable (VL+) and/or seronegative partner is not on PrEP. We analyzed correlates of serodiscordant CAI among 688 VL+ young men who have sex with men (YMSM). In multivariable analyses, serodiscordant CAI was associated with a receiving a HIV diagnosis in the past 6 months, greater depressive symptoms, and cocaine use during the past 90 days. Although HIV+ YMSM currently experience disparities across the continuum of care, those new to care may need support adopting risk reduction strategies with their sexual partners.     

Financial Hardship,Condomless Anal Intercourse and HIV Risk Among Men Who Have Sex with Men

The objective of this study was to examine the association between financial hardship, condomless anal intercourse and HIV risk among a sample of men who have sex with men (MSM). Users of a popular geosocial networking application in Paris were shown an advertisement with text encouraging them to complete a anonymous web-based survey (n = 580). In adjusted multivariate models, high financial hardship (compared to low financial hardship) was associated with engagement in condomless anal intercourse (aRR 1.28; 95% CI 1.08–1.52), engagement in condomless receptive anal intercourse (aRR 1.34; 95% CI 1.07–1.67), engagement in condomless insertive anal intercourse (aRR 1.30; 95% CI 1.01–1.67), engagement in transactional sex (aRR 2.36; 95% CI 1.47–3.79) and infection with non-HIV STIs (aRR 1.50; 95% CI 1.07–2.10). This study suggests that interventions to reduce financial hardships (e.g., income-based strategies to ensure meeting of basic necessities) could decrease sexual risk behaviors in MSM.     

Factors Associated with Unprotected Anal Intercourse Among Men Who Have Sex with Men: Results from a Respondent Driven Sampling Survey in Nanjing, China, 2008

Unprotected anal intercourse (UAI) is a well-documented risk factor for acquiring HIV, but not well-studied in China. We studied demographic and behavioral correlates for UAI among men who have sex with men (MSM) in a respondent-driven-sampling (RDS) survey in Nanjing, China. Four hundred and thirty MSM (including ten seeds) participated in this study, rendering an adjusted rate of UAI as 62.3 % (95 % CI 56.4–68.4 %). Adjusted HIV and syphilis prevalence rates were 6.6 % (95 % CI 3.0–10.4) and 12.6 % (95 % CI 8.1–18.3), respectively. HIV- and syphilis-positive cases were more likely to have engaged in UAI. Being unwilling to use condoms, meeting partners in non-conventional venues, having multiple male sex-partners in the past 6 months, having sex with regular and casual male partners in the past 6 months, and consumption of alcohol before sex were all positively associated with UAI. Based on the observed high prevalence of UAI among MSM in Nanjing, we can conclude that implementation of strategies to motivate MSM with high-risk behaviors to use condoms is urgently required in Nanjing.     

Factors Associated with Unprotected Receptive Anal Intercourse with Internal Ejaculation Among Men Who Have Sex with Men in a Large Internet Sample from Asia

We examined socio-demographic and behavioral characteristics of men who have sex with men (MSM) residing in Asia and correlates of unprotected receptive intercourse with Internet ejaculation (URAIE). Asia Internet MSM Sex Survey, a behavioral survey of MSM in Asia was conducted from 1 January to 28 February 2010. Data analysis was limited to participants aged 18 or above, biological male, and had one regular or casual sex partner in the past 6 months (n?=?10,413). Pearson's Chi-square test, t test and logistic regression were used to examine the correlates of URAIE in the past 6 months, the highest risk sexual behavior sampled. Of 7311 participants who had receptive anal intercourse, 47.5?% had URAIE, which was associated with the following attributes: less than high-school education and pre-college education compared to university (AOR?=?1.53, 95?% CI: 1.28, 1.83; AOR?=?1.22, CI: 1.08, 1.37), being in the heterosexual marriage (AOR?=?1.35, CI: 1.18, 1.56), having regular partners or both regular and casual partners compared to having casual partners (AOR?=?2.85, CI: 2.48, 3.27; AOR?=?2.32, CI: 2.06, 2.62), HIV-positive compared to HIV-negative status (AOR?=?1.39, 95?% CI: 1.08, 1.81), higher perception of HIV risk (AOR?=?1.62, CI: 1.34, 1.95), use of recreational drug before sex (AOR?=?1.30, CI: 1.14, 1.49), and use of the Internet as the main way to seek sex partners (AOR?=?1.21, CI: 1.08, 1.36). MSM from certain Asian countries reported alarming rates of URAIE. The internet can be used as a platform for HIV surveillance and intervention.     

Socialization Patterns and Their Associations with Unprotected Anal Intercourse,HIV, and Syphilis Among High-Risk Men Who Have Sex with Men and Transgender Women in Peru

The association of socialization patterns with unprotected anal intercourse (UAI) and HIV/STI prevalence remains underexplored in men who have sex with men (MSM) and transgender women (TW) in developing country settings. We evaluated the correlation of UAI, HIV, and syphilis with MSM/TW venue attendance and social network size among high-risk MSM and TW in Peru according to self-reported sexual identity. Frequency of venue attendance and MSM/TW social network size were lowest among heterosexual MSM and highest among TW respondents. Attendance (frequent or occasional) at MSM/TW venues was associated with increased odds of insertive UAI among heterosexual participants. Frequent venue attendance was associated with increased odds of receptive UAI among gay/homosexual, bisexual, and TW participants. Further investigation of the differing socialization patterns and associations with HIV/STI transmission within subgroups of Peruvian MSM and TW will enable more effective prevention interventions for these populations.     

Correlates of Unprotected Receptive Anal Intercourse Among Gay and Bisexual Men: Kampala, Uganda

We conducted a respondent-driven sampling survey (N = 215) to characterize correlates of risk for HIV infection among gay and bisexual men in Kampala, Uganda. We used RDSAT software to produce population estimates for measures and created exportable weights for multivariable analysis. Overall, 60.5% of gay/bi men identify as gay and 39.5% as bisexual; 91.6% are Ugandans. Unprotected receptive anal intercourse (URAI) was associated with identifying as gay, being younger and having had an HIV test in the past 6 months. Perceptions of being low risk to acquire or transmit HIV infection were paradoxically associated with higher likelihood of URAI. Programs to address risk of HIV infection among gay and bisexual men in Kampala need to address perceptions of risk among gay identified men.     

Rising HIV Prevalence Among Married and Unmarried Among Men Who Have Sex with Men: Jinan, China

We report on two waves of bio-behavioral surveillance of MSM in Jinan, Shandong Province, China. HIV prevalence rose from 0.05% in 2007 to 3.1% in 2008. Differences in the two waves of surveys were noted, particularly with respect to marital status, requiring stratified analysis. In multivariable analysis, unmarried, homosexually identified MSM who do not have female sex partners have a greater than sixfold greater chance of being infected with HIV compared to married, non-homosexually identified MSM who do have female partners. Carefully targeted and population-specific messages will be needed for homosexually identified and non-identified MSM in China.     

Prevalence and Correlates of HIV Infection and Unrecognized HIV Status Among Men Who Have Sex with Men and Women in Chengdu and Guangzhou, China

To know the status of HIV infection and the correlates for HIV infection among MSMW in China. This research examined the risks for HIV in 600 MSMW in Chengdu and Guangzhou, China. Participants completed a structured behavioral risk survey and were tested for HIV status. Overall, 26.2 % (n = 157) of the sample were HIV-positive, and 7 % (n = 41) were newly diagnosed and previously unaware of their HIV-positive status. Independent correlates of new HIV infection were Chengdu residence, being currently married, and sometimes using condoms during anal intercourse. Compared with previously diagnosed participants, newly diagnosed participants were more likely to have unprotected sex in the anal and vaginal sexes. Given the high risk for HIV in MSMW in these Chinese cities, public health interventions are needed to promote frequent HIV testing and to address sexual risk behaviors with both male and female partners.     

Individual-Level,Partnership-Level,and Sexual Event-Level Predictors of Condom Use During Receptive Anal Intercourse Among HIV-Negative Men Who Have Sex with Men in Los Angeles

We examined individual-level, partnership-level, and sexual event-level factors associated with condom use during receptive anal intercourse (RAI) among 163 low-income, racially/ethnically diverse, HIV-negative men who have sex with men (MSM) in Los Angeles (2007–2010). At baseline, 3-month, and 12-month visits, computer-assisted self-interviews collected information on ≤3 recent male partners and the last sexual event with those partners. Factors associated with condom use during RAI at the last sexual event were identified using logistic generalized linear mixed models. Condom use during RAI was negatively associated with reporting ≥ high school education (adjusted odds ratio [AOR] = 0.32, 95 % confidence interval [CI] 0.11–0.96) and methamphetamine use, specifically during RAI events with non-main partners (AOR = 0.20, 95 % CI 0.07–0.53) and those that included lubricant use (AOR = 0.20, 95 % CI 0.08–0.53). Condom use during RAI varies according to individual-level, partnership-level, and sexual event-level factors that should be considered in the development of risk reduction strategies for this population.     

Predictors of Unprotected Anal Intercourse Among HIV-Positive Latino Gay and Bisexual Men

This study examined sexual behaviors in a sample of 155 HIV-positive Latino gay and bisexual men. Nearly half the sample had engaged in unprotected anal intercourse in the past 12 months; unprotected anal intercourse was more likely when the partner was also HIV-positive. Separate regression models predicted the number of receptive and insertive partners for unprotected anal intercourse. Participants reported both more unprotected insertive and receptive partners if they had sex under the influence of alcohol or drugs. Older participants and those with lower levels of Latino acculturation reported having more partners with whom they took the receptive role during unprotected anal intercourse, whereas those with higher levels of depression reported having more partners with whom they took the insertive role. Hierarchical set logistic regression revealed that the dyadic variable of seroconcordance added to the prediction of unprotected anal sex with the most recent male partner, beyond the individual characteristics. Results show the importance of examining both individual and dyadic characteristics in the study of sexual behavior.     

Prevalence of Sexually Transmitted Infections Among Men Who Have Sex with Men in Zagreb, Croatia

We used respondent-driven sampling among men who have sex with men (MSM) in Zagreb, Croatia in 2006 to investigate the prevalence of HIV, other sexually transmitted infections and sexual behaviours. We recruited 360 MSM. HIV infection was diagnosed in 4.5%. The seroprevalence of antibodies to viral pathogens was: herpes simplex virus type-2, 9.4%; hepatitis A, 14.2%; hepatitis C, 3.0%. Eighty percent of participants were susceptible to HBV infection (HBs antigen negative, and no antibodies to HBs and HBc antigen). Syphilis seroprevalence was 10.6%. Prevalence of Chlamydia and gonorrhoea was 9.0%, and 13.2%, respectively. Results indicate the need for interventions to diagnose, treat and prevent sexually transmitted infections among this population.     

Types of Female Partners Reported by Black Men Who Have Sex with Men and Women (MSMW) and Associations with Intercourse Frequency,Unprotected Sex and HIV and STI Prevalence

We used baseline data from a study of Black MSM/MSMW in 6 US cities to examine the association of female partnership types with disease prevalence and sexual behaviors among the 555 MSMW participants. MSMW reported more than three times as many total and unprotected sex acts with each primary as they did with each non-primary female partner. We compared MSMW whose recent female partners were: (1) all primary (“PF only”, n = 156), (2) both primary and non-primary (“PF & NPF”, n = 186), and (3) all non-primary (“NPF only”, n = 213). HIV/STI prevalence did not differ significantly across groups but sexual behaviors did. The PF only group had the fewest male partners and was the most likely to have only primary male partners; the PF & NPF group was the most likely to have transgender partners. PF & NPF men reported the most sex acts (total and unprotected) with females; NPF only men reported the fewest. Implications for HIV risk and prevention are discussed.     

Casual Sexual Encounters Among Gay Men: Familiarity,Trust and Unprotected Anal Intercourse

Familiarity with and a history of prior sex with casual partners is associated with unprotected anal intercourse and may increase the risk of HIV transmission among gay men. Using data from the Sydney Gay Community Periodic Survey 2007, we explored the relationship between familiarity and unprotected anal intercourse with the last casual partner (UAI-LC). 51% of the men knew their last casual partner and 49% had previously had sex with him. Men were more inclined to engage in UAI-LC if they had previously had sex with this partner. HIV-negative men were more likely to have UAI-LC with a more familiar partner independent of his serostatus. Familiarity with and a previous history of sex between casual partners may result in a false sense of trust and may increase the risk of HIV transmission. HIV prevention services should address this issue and develop programs to improve men’s skills in negotiating safer sex.     

Experiences of Social Discrimination Among Men Who Have Sex with Men in Shanghai,China

In China, men who have sex with men (MSM) are at increasingly high risk for HIV. However, prevention efforts targeting this population may be hindered because of the stigma associated with homosexuality in traditional Chinese culture. We conducted qualitative interviews with 30 MSM in Shanghai to better understand the types and sources of stigma and discrimination and how MSM respond to them. The stigma associated with homosexuality can be traced back to four culturally based factors: social status and relationships, the value of family, perceptions of immorality and abnormality, and gender stereotypes of masculinity. In particular, the centrality of the family and the importance of maintaining key relationships caused stress and anxiety, contributing to more frequent encounters with felt stigma. In response, MSM often evaded the scrutiny of family members through various tactics, even prompting some to leave their rural homes. Implications of these findings on HIV/AIDS prevention are discussed.