Factors associated with self-reported unprotected anal intercourse among men who have sex with men in Changsha city of Hunan province,China

Men who have sex with men (MSM) in China are highly susceptible to HIV infection and HIV prevalence among Chinese MSM is rapidly increasing in recent years. Unprotected anal intercourse (UAI) is a major contributing factor of HIV transmission. This study aims to identify factors associated with UAI among MSM in Changsha city, China. A cross-sectional survey was conducted among 642 MSM in Changsha city from July 2009 to June 2011 via a venue-based sampling method. Data on socio-demographic characteristics, sexual behaviours and utilisation of HIV/AIDS services were collected to determine the associates of UAI in MSM. Among the 642 MSM, 184 (28.7%) reported having UAI with male partners at the last sexual episode. UAI was associated with the venues where MSM met other MSM, and having unprotected sex with female partners at last the sexual episode and in the past six months. In addition, UAI was significant associated with not being exposed to HIV interventions, including free condom, lubricant, HIV testing and counselling, and peer education. MSM who have UAI practice are more likely to have unprotected sex with female; hence, potentially bridging HIV to the general female population. Specific harm-reduction programmes are shown to have significant impacts in reducing UAI and should be scaled up among MSM in China.     

Engagement in HIV care and sexual transmission risk behavior among men who have sex with men using online social/sexual networking in Latin America

HIV/AIDS in Latin America is concentrated among men who have sex with men (MSM). However, accurate estimates of engagement in HIV care in this population can be difficult to ascertain because many do not self-identify as MSM. Given evidence of decreased HIV transmissibility in the context of antiretroviral therapy (ART) adherence, identifying individuals not in care who are engaging in HIV transmission risk behavior is crucial for secondary prevention. Primary aims of this study were to examine engagement in care from testing to ART adherence among MSM using online social/sexual networking across Latin America, and whether individuals not in care at each step reported greater sexual transmission risk behavior than those in care. In the overall sample (n = 28,779), approximately 75% reported ever being tested for HIV, and 9% reported having received an HIV diagnosis. Among known HIV-infected individuals, 20% reported not being in care, 30% reported not taking ART, and 55% reported less than 100% ART adherence. Over one-third of HIV-infected individuals reported sexual HIV transmission risk behavior, defined as unprotected anal intercourse (UAI) with a male partner of different/unknown HIV serostatus in the past three months. HIV-infected individuals not engaged in care more often reported UAI compared to those in care (OR = 1.29; 95% CI = 1.01–1.66). Although not statistically significant, HIV-infected individuals not on ART more often reported UAI compared to those on ART (OR = 1.18; 95% CI = 0.94–1.47). Individuals who reported less than 100% ART adherence more often reported UAI compared to individuals with 100% adherence (OR = 1.55; 95% CI = 1.26–1.90). Findings demonstrate that a substantial portion of HIV-infected MSM in Latin America who are likely not virologically suppressed from lack of ART use or adherence report sexual HIV transmission risk. Tailoring secondary HIV prevention for MSM in Latin America who are not in HIV care or adherent to ART may be warranted.     

Predictors of unprotected sex among men who have sex with men in Beijing, China

To estimate the prevalence of HIV and syphilis and to assess the predictors of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in Beijing, a community-based survey recruited MSM in 2005 through internet advertisement, community outreach, and peer referral. Demographic, sexual, and HIV risk behavioral information were collected. Serospecimens were tested for HIV and syphilis infections. Of the 526 participants, 3.2% were HIV-positive, 11.2% syphilis-positive, 50% and 43.3% had UAI with regular and casual sex partners, respectively. Participants practicing UAI with regular male partners were independently associated with lower monthly income (adjusted odds ratio-AOR, 1.7; 95% CI, 1.0-3.0) and encountering male sex partners at bathhouses, public washrooms, and parks (AOR, 2.2; 95% CI, 1.0-4.9). Participants practicing UAI with casual male partners were associated with encountering male sex partners at bathhouses, publics washrooms, and park (AOR, 3.0; 95% CI, 1.8-5.2) and more male sex partners having receptive anal intercourse (AOR, 1.8; 95% CI, 1.1-2.9), and was inversely associated with receiving money for sex with men (AOR, 0.3; 95% CI, 0.2-0.7). Professional male sex workers were less likely to practice UAI in Beijing, suggesting the benefits of educational outreach to date. Further education, condom promotion, and prevention of sexually transmitted infections should be intensified urgently to combat the rising HIV epidemic among MSM in Beijing.     

High levels of bisexual behavior and factors associated with bisexual behavior among men having sex with men (MSM) in Nigeria

Nigerian men who have sex with men (MSM) have a high burden of HIV infection and are known to engage in bisexual behavior. This study presents the first data on characteristics and correlates of Nigerian men having sex with men and women (MSMW) in three Nigerian cities. Five hundred and fifty-seven MSM who engaged in anal sex with men completed a behavioral survey; 48.1% of these MSM also engaged in sex with women in the previous 2 months. MSMW displayed high levels of risky sexual behavior with female sex partners; casual (56.0%) and multiple female partners were common (69.0%) and 66.0% had unprotected vaginal sex. As much as 45.1% MSMW had anal sex with female partners of which 74.0% did not use protection in the 2 months prior. In bivariate analyses, bisexual behavior was associated (p<0.05) with being married or living with a women (OR 5.0, 95% CI = 2.6–9.4), less education (OR 2.0, 95% CI = 1.4–3.0), bisexual/straight identity (OR 2.3, 95% CI = 1.6–3.2), being an insertive partner (OR 3.0, 95% CI = 1.9–4.5), being HIV-negative (OR 1.6, 95% CI = 1.1–2.5), living in Lagos (OR 2.3, 95% CI = 1.7–2.2), being Muslim (OR 1.7, 95% CI = 1.1–2.5), and being away from home (OR 1.5, 95% CI = 1.0–2.1). In the multivariate model, being married to or living with a woman (AOR = 5.1; 95% CI = 2.5–10.3), bisexual/straight identity (AOR = 2.2; 95% CIs = 1.5–3.3), being an insertive partner (AOR = 3.0; 95% CI = 1.9–4.9), being away from home (AOR = 1.6; 95% CI = 1.1–2.3) and living in Lagos (AOR = 1.7; 95% CI = 1.0–2.8) remained significant (p< 0.05). High levels of bisexual behavior exist among Nigerian MSM, and these men engage in risky sexual behaviors with both male and female sex partners. While decriminalization of same-sex behavior in Nigeria will promote access to HIV prevention programs, current MSM interventions must incorporate information on safe sex with both male and female sex partners.     

Ethnicity and HIV vulnerabilities among men who have sex with men in China

Ethnic affiliation can define sociocultural boundaries and contribute to the HIV vulnerabilities faced by men who have sex with men (MSM). This study investigated the influence of ethnic affiliation on HIV vulnerabilities among MSM in North China. Our study analyzed a cross-sectional survey of MSM (n?=?398) in two major North China cities. We examined associations between ethnic affiliation and (a) HIV status, (b) sexual behaviors and experiences, and (c) substance use. Compared to ethnic majority Han MSM: MSM belonging to ethnic minority groups of South China had significantly greater odds of HIV infection (AOR: 7.40; 95% CI: 2.33–23.47) and experience of forced sex (AOR: 3.27; 95% CI: 1.12–9.52). Compared to ethnic majority Han MSM, Ethnic Hui MSM had significantly lower odds of condomless anal sex (AOR: 0.41; 95% CI: 0.21–0.82) and significantly greater odds of circumcision (AOR: 2.62; 95% CI: 1.24–5.51). HIV prevalence and riskier sexual behaviors among MSM in China appear to vary significantly by ethnic affiliation. Current epidemiological practices of aggregating all ethnic minority groups in China into a single category may be masking important interethnic differences in HIV risk, and precluding opportunities for more culturally appropriate interventions.     

Psychosociobehavioral characteristics associated with high condomless anal intercourse intention: a comparison of receptive,versatile, and insertive MSM in Taiwan

ABSTRACT

In Taiwan, men who have sex with men (MSM) continue to be disproportionately affected by HIV, and the main route of HIV transmission is condomless anal intercourse (CAI). This study examined the associations between psychosociobehavioral characteristics and CAI intention among MSM in Taiwan who had ever engaged in anal intercourse with men, and compared the differences across three sexual roles (receptive, versatile, and insertive) using online survey data (N?=?563). For all MSM, those that were in a relationship (AOR?=?2.55; 95% CI: 1.61–4.03), had three or more steady partners (AOR?=?2.58; 95% CI: 1.19–5.58), did not use a condom during last anal intercourse (AOR?=?6.81; 95% CI: 4.36–10.63), perceived high HIV risk (AOR?=?2.13; 95% CI: 1.26–3.60), and had high sexual sensation seeking (AOR?=?2.80; 95% CI: 1.82–4.30) were more likely to have high CAI intention. After stratification, the significant characteristics differed depending on sexual role, except for no condom use during last anal intercourse remaining significant in all models (AOR?=?5.09–20.30; 95% CI: 2.49–66.69, depending on sexual role). Tailoring the programs for MSM of different sexual roles may improve the effectiveness of future prevention efforts.     

Prevalence and correlates of willingness to participate in a rectal microbicide trial among men who have sex with men in Bangkok

Rectal microbicides (RMs) hold promise as a HIV prevention method to reduce transmission among men who have sex with men (MSM). To assess RM trial feasibility in Bangkok, we measured prevalence and correlates of willingness to participate among Thai MSM observational cohort participants. Between April 2006 and December 2010, 1744 MSM enrolled in the Bangkok MSM Cohort Study; at 12 months, RM trial participation willingness was measured. We evaluated correlates of RM trial participation willingness using logistic regression analysis. Participants completing the 12-month visit (81.4%, n = 1419) had a mean age of 27.3 years (SD = 6.1), and 65.5% and 86.1% reported having a steady partner or anal intercourse (AI) in the past four months, respectively. Most (79.1%, n = 1123) participants reported willingness to participate in an RM trial, which, in multivariable analysis, was independently associated with insertive only (adjusted odds ratio [AOR] = 3.25, 95% CI: 1.82–5.81) or receptive/versatile role AI (AOR = 3.07, 95% CI: 1.88–5.01), and being paid for sex (AOR = 12.15, 95% CI: 1.67–88.21) in the past four months, and believing that people with AIDS look sick (AOR = 1.92, 95% CI: 1.23–2.98). Of hypothetical RM trial features to increase enrollment likelihood, the most (91.1%) compelling was that the study be approved by the Thai ethics committee, followed by the study site offering evening hours (88.9%). Reasons not to participate were not wanting a rectal examination (29.5%) or fluid collected from the penis or anus (24.6%) and not wanting the placebo (23.0%). RM trial participation willingness was high, particularly for those with greater HIV acquisition risk, within this Thai MSM cohort, suggesting feasibility of an RM trial. Addressing potential barriers to trial entry may be useful in educational materials to optimize recruitment.     

Discussions of viral load in negotiating sexual episodes with primary and casual partners among men who have sex with men

Recent studies suggest that people living with HIV with lower viral load are at reduced risk for transmitting HIV to their sexual partners. As information about the association between viral load and risk for HIV transmission disseminates throughout high-risk communities, viral load discussions may be used more often as a risk reduction strategy. The overall purpose of this study was to determine the frequency of viral load discussions and unprotected anal intercourse (UAI) in primary and casual sexual partnerships among men who have sex with men (MSM). An online survey was completed by 326 MSM (82% Caucasian, 62% college educated, 7% HIV-positive or thought they were HIV positive) in January 2011. Results showed that viral load discussions occurred in 93% of primary partnerships in which at least one partner was HIV-positive; UAI was reported with 46% of all primary partners and 25% of serodiscordant primary partners with whom viral load was discussed. Viral load discussions occurred in 53% of the three recent sexual episodes with casual sex partners with whom participants had either sex with once or had sex with multiple times in the past three months. UAI was more common in sexual encounters with casual sex partners when viral load was not discussed than when viral load was discussed (75% v. 56% of encounters). The finding that casual sexual episodes that did not include viral load discussions had a higher percentage of UAI than those that did include viral load discussions suggests either that men who do not discuss viral load may be higher risk-takers than men who do, or that the former are less adept at negotiating safer sex with casual sex partners than men who do discuss viral load. More research is needed to understand the role of viral load discussions in negotiating sexual activities among MSM.     

Commercial lubricant use among HIV-negative men who have sex with men in Los Angeles: implications for the development of rectal microbicides for HIV prevention

To inform the development and assess potential use of rectal microbicide gels for HIV prevention among men who have sex with men (MSM), we examined the dynamics and contexts of commercial lubricant use during receptive anal intercourse (RAI) within this population. From 2007 to 2010, 168 HIV-negative MSM living in Los Angeles who practice RAI completed computer-assisted self-interviews, which collected information on their last sexual event with ≤3 recent partners, at baseline, three months, and one-year study visits. Logistic generalized linear mixed models were used to identify individual- and sexual event-level characteristics associated with commercial lubricant use during RAI at the last sexual event within 421 partnerships reported by participants over the course of follow-up. During RAI at their last sexual event, 57% of partnerships used a condom and 69% used commercial lubricant. Among partnerships that used commercial lubricant, 56% reported lubricant application by both members of the partnership, 66% first applied lubricant during sex, but before penetration, and 98% applied lubricant at multiple locations. The relationship between substance use and commercial lubricant use varied by condom use (interaction p-value = 0.01). Substance use was positively associated with commercial lubricant use within partnerships that did not use condoms during RAI at their last sexual event (adjusted odds ratio [AOR] = 4.47, 95% confidence interval [CI]: 1.63–12.28), but no association was observed within partnerships that did use condoms (AOR = 0.66, 95% CI: 0.23–1.85). Commercial lubricant use during RAI was also positively associated with reporting more sexual partners (AOR = 1.18, 95% CI: 1.05–1.31), while older age (units = 5 years; AOR = 0.75, 95% CI: 0.61–0.94), homelessness (past year; AOR = 0.32, 95% CI: 0.13–0.76), and having sex with an older (>10 years) partner (AOR = 0.37, 95% CI: 0.14–0.95) were negatively associated with commercial lubricant use. These factors should be considered in the development of rectal microbicide gels to enhance their acceptability and use among MSM.     

Perceived HIV risk,actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto,Canada

Pre-exposure prophylaxis (PrEP) reduces HIV acquisition. Our goal was to determine the willingness of men who have sex with men (MSM) to take PrEP given perceived and actual HIV risk. HIV-negative MSM were recruited from September 2010 to June 2012 and asked about PrEP willingness and perceived HIV risk. Actual sexual HIV risk was measured by three condom-use components generated through principal components analysis. General HIV risk was measured using the HIV Incidence Risk Index for MSM (HIRI-MSM). Model 1 measured PrEP willingness given perceived and actual sexual HIV risk. Model 2 included actual HIV sexual risk, perceived HIV risk and general HIV risk. Model 3 removed actual sexual HIV risk. We recruited 150 HIV-negative MSM. About 55% were willing to take PrEP. Reasons for PrEP unwillingness were: low perceived risk (64%), side-effect concerns (44%), daily pill burden (16%) and efficacy concerns (4%). Model 1: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 27.11, 95% CI 1.33–554.43) after adjusting for perceived risk, which was not significantly associated with PrEP willingness (OR 4.79, 95% CI 0.72–31.96). Model 2: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 29.85, 95% CI 1.39–640.53) after adjusting for perceived and general HIV risk, neither of which was significantly associated with PrEP willingness (OR 5.07, 95% CI 0.73–35.09) and (OR 1.58, 95% CI 0.37–6.79), respectively. Model 3: After removing actual sexual HIV risk, MSM with high compared to low perceived risk were more willing to use PrEP (OR 6.85, 95% CI 1.23–38.05), and the HIRI-MSM general risk index was not associated with PrEP willingness (OR 1.87, 95% CI 0.54–6.54). Therefore, actual sexual HIV risk was the best predictor of PrEP willingness and general HIV risk did not inform PrEP willingness.     

Sexualized drug use (‘chemsex’) and high‐risk sexual behaviours in HIV‐positive men who have sex with men

Objectives

The incidence of sexually transmitted infections (STIs) and HIV infection remains high in gay, bisexual, and other men who have sex with men (MSM) in the UK, and sexualized drug use (“chemsex”) and injecting drug use (“slamsex”) may play a part in this. We aimed to characterize HIV‐positive MSM engaging in chemsex/slamsex and to assess the associations with self‐reported STI diagnoses and sexual behaviours.

Methods

Data from a 2014 survey of people attending HIV clinics in England and Wales were linked to clinical data from national HIV surveillance records and weighted to be nationally representative. Multivariable logistic regression assessed the associations of chemsex and slamsex with self‐reported unprotected anal intercourse (UAI), serodiscordant UAI (sdUAI) (i.e. UAI with an HIV‐negative or unknown HIV status partner), sdUAI with a detectable viral load (>50 HIV‐1 RNA copies/mL), hepatitis C, and bacterial STIs.

Results

In the previous year, 29.5% of 392 sexually active participants engaged in chemsex, and 10.1% in slamsex. Chemsex was significantly associated with increased odds of UAI [adjusted odds ratio (AOR) 5.73; P < 0.001], sdUAI (AOR 2.34; P < 0.05), sdUAI with a detectable viral load (AOR 3.86; P < 0.01), hepatitis C (AOR 6.58; P < 0.01), and bacterial STI diagnosis (AOR 2.65; P < 0.01). Slamsex was associated with increased odds of UAI (AOR 6.11; P < 0.05), hepatitis C (AOR 9.39; P < 0.001), and bacterial STI diagnosis (AOR 6.11; P < 0.001).

Conclusions

Three in ten sexually active HIV‐positive MSM engaged in chemsex in the past year, which was positively associated with self‐reported depression/anxiety, smoking, nonsexual drug use, risky sexual behaviours, STIs, and hepatitis C. Chemsex may therefore play a role in the ongoing HIV and STI epidemics in the UK.     

Behavioral intention to take up different types of HIV testing among men who have sex with men who were never-testers in Hong Kong

Human immunodeficiency virus (HIV) testing is an important global prevention strategy but underutilized by local men who have sex with men (MSM). This study investigated the prevalence of behavioral intention to take up HIV testing (specific or any type), in the next six months among MSM who had not been tested for HIV in the last three years (never-testers) in Hong Kong. The data was based on 141 never-testers of 430 MSM who completed the anonymous baseline telephone survey of an ongoing randomized controlled trial from January 2015 to August 2015. Only 17.7% of them showed strong intention to take up any type of HIV testing in the next six months. Adjusted analysis showed that perceived benefit of HIV testing (adjusted odds ratio [AOR]: 1.29, 95% confidence interval [CI]: 1.01, 1.66), perceived psychological barriers of HIV testing (AOR: 0.85, 95%CI: 0.73, 1.00), and perceived self-efficacy in taking up HIV testing (AOR: 1.28, 95%CI: 1.07, 1.52) were significantly associated with behavioral intention to take up any HIV testing. Perceived cue to action from non-governmental organization staff was positively associated with a marginal p-value of 0.077 (AOR: 2.37, 95%CI: 0.97, 5.77). It is warranted to strengthen perceived benefit, remove psychological barriers, and increase perceived self-efficacy related to HIV testing. Innovative and effective health promotions are greatly needed to increase HIV testing coverage among never-testers.     

Healthcare-related stigma among men who have sex with men and transgender women in sub-Saharan Africa participating in HIV Prevention Trials Network (HPTN) 075 study

ABSTRACT

The inability to access health services when needed is a critical barrier to HIV prevention, treatment and care among men who have sex with men (MSM) and transgender women (TGW). Using data collected in HPTN 075, we explored factors associated with any experienced healthcare-related stigma. HPTN 075 was a cohort study to assess the feasibility of recruiting and retaining MSM and TGW in clinical trials in sub-Saharan Africa. Of 401 MSM and TGW enrolled at four sites (Kisumu, Kenya; Blantyre, Malawi; Cape Town, Soweto, South Africa) 397 contributed to the analysis (79.9% cis-gender and 20.1% TGW). Of these, (45.3%; 180/397) reported one or more of healthcare-related stigma experiences. Most frequently reported experiences included fear to seek healthcare services (36.3%) and avoiding seeking such services because of the discovery of MSM status (29.2%). Few men and TGW (2.5%) reported having been denied health services because of having sex with men. In multivariable analysis, more participants in Soweto [adjusted odds ratio (AOR)?=?2.60] and fewer participants in Blantyre (AOR?=?0.27) reported any healthcare-related stigma experiences, in comparison to participants in Kisumu. MSM and TGW that did not have a supportive gay community to rely on were more likely to report any healthcare-related stigma experiences (AOR?=?1.46), whereas MSM and TGW who reported high social support and who never had engaged in transactional sex were less likely to report such experiences (AOR?=?0.76 and AOR?=?0.43, respectively). Our results suggest that encouraging support groups for MSM and TGW as well as training and sensitizing healthcare staff, and the general community, on MSM and TGW health issues and cultural competence may reduce stigma, improve access to healthcare, which could ultimately reduce HIV transmission.     

Prevalence of unprotected anal intercourse and associated factors among male students who have sex with men in Qingdao,China: A cross-sectional study

The significant rise of human immunodeficiency virus (HIV) epidemic among young students has become a new feature of acquired immune deficiency syndrome in China, and unprotected anal intercourse (UAI) among male students who have sex with men (SMSM) played a central role in this process. The aim of this study was to investigate the prevalence of UAI, as well as analyze the factors associated with UAI among SMSM in Qingdao, China. From May 2021 to April 2022, men who aged 15 to 30, studied in a high school or college in Qingdao and had anal sex with men in the past 6 months were recruited through snowball method relying on the nongovernmental organization. An anonymous electronic questionnaire was administrated to collect information on socio-demographic characteristics, sexual behaviors, substance use before sex, HIV prevention services and self-esteem. Univariate and multivariate logistic regressions were used to assess factors related to UAI. Among the 341 SMSM included in the study, 40.5% engaged in UAI in the past 6 months. Being migrants from other provinces [odds ratios (OR) = 2.04, 95% confidence intervals (CI): 1.10–3.78], failing to use condoms for the first anal intercourse (OR = 3.38, 95% CI: 1.85–6.18), drinking alcohol before sex (OR = 2.31, 95% CI: 1.25–4.28) and being low level self-esteem (OR = 1.77, 95% CI: 1.09–2.87) were positively associated with UAI. SMSM who had homosexual intercourse more than once a week (OR = 1.76, 95% CI: 1.03–3.00) or had multiple male sex partners (OR = 1.99, 95% CI: 1.20–3.30) were more likely to engage in UAI. Received peer education in the past 12 months (OR = 0.48, 95% CI: 0.27–0.86) was associated with lower odds of UAI. The situation of UAI among SMSM in Qingdao was a public health issue of concern. It is necessary to take targeted measures, such as focusing on first-time sex, advancing sexual health education, expanding peer education, implementing alcohol use screening and maintaining the self-esteem of SMSM, so as to reduce the occurrence of high-risk behaviors among SMSM and curb the spread of HIV on campus.     

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.     

Factors associated with recency of HIV testing amongst men residing in Scotland who have sex with men

Rates of HIV testing are increasing among men who have sex with men (MSM) in Scotland and the UK. However, it remains vital to encourage MSM to test for HIV. The aim of the current study was to determine which factors discriminated among three groups of MSM: those tested for HIV within the previous year, those who had tested over one year previously, and those who had never tested. Cross-sectional data were collected using self-report, anonymous questionnaires from MSM frequenting gay venues in Glasgow, Scotland, during July 2010 (N = 822, response rate 62.6%). Those who identified themselves as HIV positive (n = 38), did not normally reside in Scotland (n = 88), and did not provide information on HIV testing (n = 13), were excluded (139 excluded, leaving N = 683). Around 57% (n = 391) had tested for HIV within the previous year, 23% (n = 155) had tested over one year previously and 20% (n = 137) had never tested. Compared with those tested within the previous year, those tested over one year previously and those never tested had greater fear of a positive-HIV test result, a weaker norm for HIV testing, and were more likely to have had no anal sex partners at all within the previous year. Those tested over one year previously were significantly older than both other groups (who were more likely to be under 25 years of age). Unprotected anal intercourse (UAI) did not discriminate among the HIV testing groups. The results highlight the need to promote HIV testing in Scotland among those under 25 years and over 45 years, those with high fear of testing, and those whose sexual behaviour puts them at risk. Interventions to increase HIV testing should promote positive norms and challenge the fear of a positive result.     

An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men

Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β?=??0.36; 95% CI: ?0.69, ?0.02; p?=?0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β?=??0.95; 95% CI: ?1.44, ?0.46; p?<?0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β?=??0.87; 95% CI: ?1.38, ?0.36; p?=?0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β?=?0.25; 95% CI: 0.16, 0.34; p?<?0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.     

Risks for HIV infection among gay, bisexual, and other men who have sex with men in Moscow and St. Petersburg, Russia

The majority of early cases of HIV in Russia were among men who have sex with men (MSM). Despite this and the current resurgence of HIV among MSM globally, little systematic work has been done to assess current HIV risks. We conducted a rapid assessment of HIV and associated risk behaviors among MSM in Russia. An anonymous, cross-sectional study was performed among MSM in Moscow and St. Petersburg (January 2008). Participants were enrolled by local NGO partners via peer-recruitment, underwent a brief behavioral survey, and were offered rapid, oral HIV screening. Factors associated with HIV infection were assessed using logistic regression. A total of 401 participants were enrolled. HIV prevalence was comparable in the two cities (6.0% in Moscow, 5.5% in St. Petersburg). Approximately half (49.3%) were under age 25, 75.1% of all men reported unprotected anal intercourse (UAI), and 21.5% reported engaging in unprotected exchange sex in the prior 12 months. HIV infection was the highest (7.7%) among the youngest MSM, those aged 18-22 years. Never having tested for HIV (AOR=6.2; 95% CI: 1.8, 21.9) and ever injecting drugs (AOR=11.3; 95% CI: 2.6, 50.4) were independently associated with HIV infection. We found significant overall HIV prevalence among MSM in Moscow and St. Petersburg, particularly among the youngest men. The majority of men reported ongoing high-risk behaviors, indicating the potential for further spread. HIV prevention efforts need to specifically focus on urban MSM in Russia, encourage testing, and target injection risks to address this epidemic.     

Being high and taking sexual risks: findings from a multisite survey of urban young men who have sex with men.

Adolescent and young adult males who have sex with men (MSM) remain at high risk of HIV infection. Many sexual risk factors have been identified, yet the role of substance use remains controversial. We assess the extent to which urban young MSM report being "high" on drugs or alcohol during sex and the association between being "high" and unprotected anal intercourse (UAI). During summer 2000, 3,075 MSM aged 15-25 years completed a 20-minute interview for the Community Intervention Trial for Youth Project. Participants were asked about their last sexual contact with main and nonmain partners, including whether they were "high on drugs or alcohol." 18.6% of MSM with a main partner reported being high during their last sexual encounter; 25.0% reported UAI. Among men with a nonmain partner, 29.3% reported being high, and 12.3% reported UAI. Being high was associated with unprotected receptive anal intercourse with nonmain partners (odds ratio = 1.66, p = .02). HIV prevention should include messages about the potential dangers of drinking and drug use in situations where sexual encounters with nonmain partners may occur.     

Homophobic stigma,depression, self-efficacy and unprotected anal intercourse for peri-urban township men who have sex with men in Cape Town,South Africa: a cross-sectional association model

While research now highlights that men who have sex with men (MSM) in places such as South Africa are at particular risk of HIV infection, left relatively unexplored are potential relationships between one of the most pressing social issues affecting peri-urban MSM – namely homophobic stigma – and sexual risk-taking behaviour. Drawing on research from the Ukwazana baseline study of 316 township MSM in Cape Town we examine how homophobic stigma relates to psychosocial factors such as depression and self-efficacy and the risk activity of unprotected anal intercourse (UAI). By deploying cross-sectional association models, we examine a series of relationships between these variables and offer evidence to suggest that HIV prevention programmes aimed at sexual minority groups should be mindful of potentially complex relationships between social stigmas such as homophobia and sexual risk-taking behaviour.