Men who have sex with men in Kisumu,Kenya: support group membership and knowledge of HIV-risk factors

Men who have sex with men are an important yet marginalised population for HIV prevention in Africa. We conducted a two-phase study (individual qualitative interviews and a survey) of men who have sex with men, aged 18–34 years of age and living in Kisumu, Kenya. Approximately half (27/51) of survey respondents reported belonging to a support group. The odds of belonging to support groups were greater for older men (aged 24–34 versus 18–23 years [OR = 5.20; 95%CI = 1.27–26.66]). More than two-thirds (68.6%) of survey respondents were categorised as having high knowledge of HIV-risk factors. Most respondents (94.1%) correctly reported lack of condom use during vaginal sex as a risk factor for HIV, but slightly fewer (82.4%) recognised lack of condom use during anal sex as an HIV risk factor. Among the 15 interviewees, the following were included as greatest needs: health information (n = 5), safe lubricants (n = 5), condoms (n = 4), healthcare facility or men-who-have-sex-with-men-friendly health services (n = 3) and advocacy (n = 2). Kenyan men who have sex with men have developed support groups and have unmet needs for information, lubricants and condoms and services. Partnering with support groups offers an opportunity for organisations to reach men who have sex with men with accurate health information, provision of safe sexual lubricants, condoms and other health and social services.     

How intersectional constructions of sexuality,culture, and masculinity shape identities and sexual decision-making among men who have sex with men in coastal Kenya

Men who have sex with men are increasingly recognised as one of the most vulnerable HIV risk groups in Kenya. Sex between men is highly stigmatised in Kenya, and efforts to provide sexual health services to men who have sex with men require a deeper understanding of their lived experiences; this includes how such men in Kenya construct their sexual identities and how these constructions affect sexual decision-making. Adult self-identified men who have sex with men (n = 26) in Malindi, Kenya, participated in individual interviews to examine sociocultural processes influencing sexual identity construction and decision-making. Four key themes were identified: (1) tensions between perceptions of ‘homosexuality’ versus being ‘African’, (2) gender-stereotyped beliefs about sexual positioning, (3) socioeconomic status and limitations to personal agency and (4) objectification and commodification of non-normative sexualities. Findings from this analysis emphasise the need to conceive of same-sex sexuality and HIV risk as context-dependent social phenomena. Multiple sociocultural axes were found to converge and shape sexual identity and sexual decision-making among this population. These axes and their interactive effects should be considered in the design of future interventions and other public health programmes for men who have sex with men in this region.     

The sexual experiences of Latino men who have sex with men who migrated to a gay epicentre in the USA

Key informant interviews, in‐depth interviews and focus groups were conducted to examine ways in which social context influenced the behavior of Brazilian, Colombian and Dominican men who have sex with men. First, we investigated how the social context in the home country affected motivation for migration. Findings suggest that Latino men who have sex with men frequently reported coming to the USA to escape homo‐negativity and to achieve greater sexual freedom. The study also examined how the social context encountered in the early years after migration shaped sexual behavior and risk. A majority of the participants reported easy access to sex partners and frequent sexual encounters. The anonymity of living in a gay epicentre such as New York City, often without social connections from the past, was experienced as liberating and conducive to sexual exploration. Moreover, sex in public venues, such as parks and sex cabins, was readily available to those who do not speak English. The tendency to engage in high levels of sexual activity during the early period after arrival in New York City was particularly evident among younger men. Implications for future programme development are discussed alongside prevention efforts targeting migrants during this critical period.     

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.     

性感觉寻求与青少年男男性行为人群危险性行为的关系

目的 研究25岁及以下青少年男男性行为人群(YMSM)性感觉寻求与其艾滋病相关危险性行为的关系。方法 于2013年5-11月通过互联网宣传、外展活动以及例行的艾滋病自愿咨询检测服务招募403名YMSM, 采用匿名问卷调查, 回收375份(93.05%)有效问卷。结果 YMSM中有37.9%首次同性性行为未使用安全套, 最近6个月有55.7%发生多性伴行为, 51.7%有“419”(一夜情)行为, 5.6%有群交行为。性感觉寻求与首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为呈正相关(偏相关系数分别为0.247、0.218、0.296、0.252)。分别以首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为作为因变量进行logistic回归分析, 结果显示性感觉寻求高者更有可能发生以上危险性行为。结论 青少年性感觉寻求水平对危险性行为有影响, 应加强基于人群性感觉寻求分析的艾滋病相关知识及行为教育, 强化艾滋病相关危险性行为的风险意识, 从而更有效开展YMSM艾滋病干预。     

中小城市男男性接触者安全套使用状况分析

目的 了解中小城市男男性接触者（MSM）安全套使用情况及影响因素。方法 用方便抽样法和雪球抽样法选取对象，用《同志心理与行为问卷》进行调查。结果 在调查147名MSM中，与不同类别性伴发生性行为时，每次均使用安全套者低于8％，从不使用者超过60％，付费与不付费性伴间安全套使用率有明显差异；艾滋病预防知识掌握程度和对人类免疫缺陷病毒（HIV）感染的风险意识高低会影响安全套的使用；年龄、性别、文化程度、婚姻状况、心理压力、艾滋病传播知识等因素与安全套使用率无关；不使用安全套最主要的原因是自己不喜欢使用，其次为性伴不同意使用。结论 在中小城市的MSM中开展艾滋病干预势在必行。     

The role of patient–provider sexual health communication in understanding the uptake of HIV prevention services among Black men who have sex with men

We examined factors that may be associated with whether Black men who have sex with men a) disclose their sexual orientation to healthcare providers, and b) discuss their sexual health with healthcare providers to inform interventions to improve HIV prevention efforts and reduce HIV incidence rates among Black men who have sex with men. During 2011–2012, we conducted semi-structured individual in-depth interviews with Black men who have sex with men in New York City. Interviews were audio recorded. We examined transcribed responses for main themes using a qualitative exploratory approach followed by computer-assisted thematic analyses. Twenty-nine men participated. The median age was 25.3 years; 41% (n = 12) earned an annual income of < US$10,000; 72% (n = 21) had a college degree; 86% (n = 25) reported being single; 69% (n = 20) self-identified as gay or homosexual. We identified three main themes affecting whether the men discussed their sexual orientation and sexual health with healthcare providers: 1) comfort discussing sexual health needs; 2) health literacy; and 3) trust. Identifying strategies for improved comfort, health literacy and trust between Black men who have sex with men and healthcare providers may be an important strategy for increasing sexual health patient–provider communications, increasing opportunities for HIV prevention including testing and reducing HIV-related health disparities.     

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.     

Experimentals,bottoms, risk-reducers and clubbers: exploring diverse sexual practice in an Internet-active high-risk behaviour group of men who have sex with men in Sweden

This study aimed to identify sub-groups of men who have sex with men at high risk of HIV infection. Data from the Swedish MSM2013 survey were analysed with a focus on respondents (n = 714) who reported having had unprotected anal intercourse with male casual partner(s) in the past 12 months. Weighted Latent Class Analysis with covariates and distal outcomes was conducted to identify sub-groups of men sharing the same sexual practice characteristics. Four latent classes emerged: experimentals, bottoms, risk-reducers and clubbers. Experimentals appeared to differ most from the other classes. They had extensive experience of barebacking, the use of poppers and fisting. Higher number of casual male sex partners and reporting having HIV were predictors for belonging to experimentals. No evidence for an association between self-rated HIV prevention knowledge and taking less part in risky practices was found. Hence, knowledge-intensive interventions may not be the best fit for reducing HIV transmission. This diversity of men based on similar sexual practice patterns should be taken into account when designing future HIV prevention interventions.     

武汉市年轻男男性行为者偶遇性行为及相关因素分析

目的 了解年轻男男性行为人群（YMSM）偶遇性行为及相关危险行为状况,并分析影响偶遇性行为的因素,为降低该人群感染和传播艾滋病的风险提出针对性的措施。方法 2013年5－11月在武汉市通过互联网宣传、外展活动的组织以及艾滋病自愿咨询检测服务招募年龄≤25岁的YMSM参加匿名式问卷调查,招募403名YMSM,收集其人口学、性行为等相关信息,分析YMSM偶遇性行为的相关因素。结果 实际调查398名YMSM中,48.99%（195/398）报告最近6个月发生过偶遇性行为。与未报告偶遇性行为的YMSM比较,报告偶遇性行为的YMSM肛交、口交坚持使用安全套的比例均较低［34.29%（60/175）比49.08%（80/163）（χ²=7.61,P=0.01）、38.85%（61/157）比28.65%（49/171）（χ²=3.82,P=0.05）］。报告偶遇性行为的YMSM中,多性伴的比例高于未报告偶遇性行为的YMSM［76.80%（149/194）比33.15%（60/181）（χ²=77.36,P<0.01）］。多因素logistic回归分析显示,经常使用互联网、存在吸毒行为是YMSM发生偶遇性行为的影响因素（OR=4.89,95% CI：1.90～12.54;OR=2.72,95% CI：1.60～4.63）。结论 YMSM有过偶遇性行为者更容易发生无保护性行为和多性伴等高危行为,应加强互联网针对YMSM的行为干预。     

Immigrant Latino men in rural communities in the Northwest: social environment and HIV/STI risk

This study explored how migration-related socio-cultural and environmental factors interact to render immigrant Latino men residing in rural Oregon at increased risk for HIV/STI. More specifically, the paper describes the socio-demographic characteristics and sexual risk profile of immigrant Latino men and characterises the physical and socio-cultural contexts in which they reside. In-depth interviews were conducted with 49 men who newly immigrated to the USA and had recently engaged in sexual intercourse with women. Content analysis indicated that job instability and seasonal/industry restrictions resulted in frequent changes in employment and living situations, and one-third of respondents reported having no one to turn to when in need. Over two-fifths had ever had sex with a sex worker, with almost a quarter reporting sex with a sex worker in the past three months. In addition, over half of the men reported that they never, or inconsistently, used condoms. Although respect for wives/girlfriends was valued, loneliness, sexual experimentation and inherent sexual needs were cited as reasons that men have sex outside their primary relationships. Our data support the convergence of risky environments and migration-driven factors in exacerbating STI prevalence and the HIV epidemic among Latino immigrant men residing in the Northwest.     

Sexual stigma,psychological well-being and social engagement among men who have sex with men in Beirut,Lebanon

This qualitative study sought to explore sexual identity development among men who have sex with men in Beirut, Lebanon; the stigma experienced by these men; and how their psychological well-being and social engagement are shaped by how they cope with this stigma. Semi-structured interviews were conducted with 31 men who have sex with men and content analysis was used to identify emergent themes. While many men reported feeling very comfortable with their sexual orientation and had disclosed their sexual orientation to family, most men struggled at least somewhat with their sexuality, often because of perceived stigma from others and internal religious conflict about the immorality of homosexuality. Most participants described experiencing verbal harassment or ridicule or being treated as different or lesser than in social relationships with friends or family. Mechanisms for coping with stigma included social avoidance (trying to pass as heterosexual and limiting interaction with men who have sex with men to the internet) or withdrawal from relationships in an attempt to limit exposure to stigma. Findings suggest that effective coping with both internal and external sexual stigma is central to the psychological well-being and social engagement of men who have sex with men in Beirut, much as has been found in Western gay communities.     

Sexual HIV risk among gay,bisexual and queer transgender men: findings from interviews in Vancouver,Canada

Abstract

Gay, bisexual, queer and other men who have sex with men are disproportionately affected by HIV in Canada. While up to 63% of transgender men identify as gay, bisexual or queer and report a variety of HIV sexual risk behaviours, transgender men are often overlooked within epidemiological HIV surveillance and research. While a growing body of research has begun to examine sexual risk for transgender gay, bisexual and queer men, most studies have been conducted in the USA. This study explored sexual HIV risk for this population in the Canadian context, specifically in British Columbia, in an environment of publically funded universal access to healthcare, including HIV testing and treatment. We conducted interviews with 11 gay, bisexual and queer transgender men. Participants’ narratives suggest that HIV risk for these transgender men is shaped by a diversity of sexual behaviours, including inconsistent condom use, seeking partners online for greater safety and accessing HIV/STI testing and other healthcare services despite facing transition-related barriers. Public health prevention and health education must recognise the presence of transgender men and ensure health services and broader population health promotion meet the unique sexual health needs of this sub-population of gay, bisexual and queer men.     

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.     

The Internet profiles of men who have sex with men within bareback websites

The Internet has become a venue for men who have sex with men to search for sexual partners. Some of these men intentionally seek unprotected anal intercourse with other men (‘bareback’ sex). This paper focuses on the creation, use, and content of Internet personal profiles of men who have sex with men in the greater New York City metropolitan area who use bareback sites for sexual networking. We used a mixed-methods approach to examine data from a cybercartography of Internet sites conducted during the first phase of the research (199 personal profiles) and from in-depth interviews conducted during its second phase (120 men who have sex with men who sought partners online for bareback sex). Results indicate that men generally followed offline stereotypical patterns in their online profiles. However, men who disclosed being HIV-positive were more likely to include face and head pictures. Overall, the images they used were heavily sexualised in accordance with group norms perceived and reinforced by the websites' design and imagery. Bottom-identified men tended to be more explicit in the exposition of their sexual and drug use interests online. This paper highlights how certain virtual and social performances play upon and reinforce other, in the flesh, performances.     

深圳市男男性行为人群相关高危行为干预及其影响因素研究

目的 了解深圳市男男性行为者(MSM)安全套使用及其相关影响因素.方法 2009年8-11月招募深圳市同性恋聚集地的同性接触人群作为访谈对象,采用统一调查表进行问卷调查.对调查的273名MSM进行人口学和行为特征分析;以近6个月发生性行为时不能坚持每次使用安全套的行为为应变量,而各类影响因素为自变量进行logistic回归分析.结果 调查对象来自全国各地,绝大部分为青壮年,平均年龄27.9岁,以未婚居多,文化程度较高,但对艾滋病知识缺乏;安全套使用率低,过去1年每次性行为均使用安全套的比例为20.5%;与同性发生性行为不使用安全套的原因主要是对方为"稳定的性伴和爱人"、"年轻,看起来没病"、"没有滥交".结论 深圳市MSM危险性行为普遍存在,安全套使用情况和影响因素各不相同,艾滋病极有可能在该人群中流行.

Abstract：

Objective To learn the condom-use and it's associated factors among men who have sex with men(MSM)in Shenzhen,so as to provide scientific basis for the development of prevention and control program.Methods Cross-sectional survey was conducted with standardized questionnaire used on individual case.Associated factors with behavior of not persistent condom use were analyzed,using logistic regression method as dependent variable and associated factors with behaviors as independent variables.Results Most of the MSM were young,with average age as 27.9.coming from 26 provinces of China.Only 20.5 percent of the participants were persistently using condoms every time with their sex partners in the past year. The main reasons of not constantly using condom with their male sex partners were having fixed partners,being young,healthy and being faithful.Conclusion High risk sexual behaviors and the low rate of condom-use among MSM might serve as potential risks for HIV epidemics.Data on the rate of condom use and the influencing factors among MSM varied for different sexual partners,suggested that targeted prevention measures should be conducted.     

我国24个城市男男性行为者HIV暴露前预防用药现状及相关因素分析

目的了解我国MSM对HIV暴露前预防(PrEP)的认知和用药现状及影响因素。方法 2021年8月25日至9月5日通过男性社交平台Blued 7.5软件在我国24个城市招募MSM 2 447人参与线上问卷调查, 调查内容包括社会人口学、PrEP知晓和用药与高危性行为等信息。采用三分类二水平logistic回归分析MSM的PrEP用药相关因素。采用SPSS 24.0和SAS 9.4软件进行统计学分析。结果在MSM研究对象2 447人中, 听说过PrEP者1 712人(69.96%), 曾用药者437人(17.86%), 正在用药者274人(11.20%), 停用者163人(6.66%);437人曾用药者多数采用了按需用药方式, 用药方案采用替诺福韦+恩曲他滨的占61.88%(388/627), 人均用量为1.12片/周, 获取药物以互联网为主, 选择药物更关注PrEP用药的预防效果;163人停药最常见原因是认为没有HIV感染的风险。logistic回归分析结果显示, MSM中PrEP用药与年龄、月均收入、最近1年发生无保护肛交、最近1年使用助性剂和被诊断出患有性病等因素存在统计学关联, 其...     

The other side of the bridge: exploring the sexual relationships of men who have sex with men and their female partners in Mumbai,India

Behaviourally bisexual men have been identified as a ‘bridge’ population of HIV transmission to heterosexual women in India. Little is known about the sexual relationships that these men have with their female sex partners. The primary objective of this study was to explore the sexual practices and relationship dynamics between married and unmarried behaviourally bisexual men and their female sex partners in Mumbai, India. In 2009, semi-structured qualitative interviews were conducted with 32 men who reported sex with men and women. Participants discussed a variety of sexual practices and arrangements with female sex partners. Irrespective of marital status and sexual identity, many said that they had satisfying sexual experiences and feelings of affection for female sex partners. However, sexual incompatibility between married partners was also reported. Explanations of bisexual concurrency were discussed in terms of both sexual satisfaction and sexual preference. Self-perceived HIV risk related to same-sex sexual behaviour motivated many men to use condoms with female partners. Expectations of unprotected marital sex and perceptions of partner risk were barriers to condom use. HIV-prevention programmes for this population may benefit from tailored risk-reduction counselling that attends to the variations of these sexual and social relationship dynamics.