Differences in HIV risk behaviors among black and white men who have sex with men

OBJECTIVES: Surveillance findings consistently indicate that black men who have sex with men (MSM) experience a disproportionate burden of HIV/AIDS compared with white MSM. This study tested the hypothesis that black MSM engage in greater levels of HIV risk behaviors than white MSM and sought to determine if self-reported HIV serostatus moderated any of the observed differences. METHODS: A cross-sectional study of MSM was conducted by recruiting men from gay-identified venues in a large metropolitan area of the southern United States. Data were collected by face-to-face interview. RESULTS: The hypothesis was only supported for one measure of HIV risk behavior: The average number of main (steady) sex partners in the past year was significantly greater among black men (P < 0.0001). However, black and white MSM did not significantly differ in unprotected sex with serodiscordant partners. Racial differences in sexual risk behavior were found only for HIV-negative men and indicated greater protective behavior for black men. DISCUSSION: These findings suggest that fewer black MSM, compared with white MSM, engage in HIV sexual risk behaviors but only among HIV-negative men. Identifying the epidemiologic dynamics driving HIV infection among black MSM that go beyond individual-level risk behaviors may be warranted.     

Substance use, medications for sexual facilitation, and sexual risk behavior among traveling men who have sex with men

OBJECTIVES: The objective of the study was to examine correlates of sexual risk behavior among men who have sex with men (MSM) traveling for leisure. STUDY DESIGN: MSM (N = 304) visiting popular tourist areas completed a brief survey assessing sexual behavior and substances used while on vacation, including the use of erectile dysfunction medications (e.g., Viagra). RESULTS: Forty-seven percent of the respondents were sexually active during their vacation, with a mean of 1.33 unprotected anal sex acts during their brief stay (mean = 3.6 days). More than half of the sexually active men reported sex with a partner of unknown HIV status. Individuals reporting substance use or taking erectile dysfunction medications reported higher rates of sexual risk behaviors. CONCLUSION: Many MSM travelers report behaviors that may put their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors among MSM tourists are needed.     

Epidemiology of HIV among black and minority ethnic men who have sex with men in England and Wales

OBJECTIVES: To examine the epidemiology of HIV among black and minority ethnic (BME) men who have sex with men (MSM) in England and Wales (E&W). METHODS: Ethnicity data from two national HIV/AIDS surveillance systems were reviewed (1997-2002 inclusive), providing information on new HIV diagnoses and those accessing NHS HIV treatment and care services. In addition, undiagnosed HIV prevalence among MSM attending 14 genitourinary medicine (GUM) clinics participating in the Unlinked Anonymous Prevalence Monitoring Programme and having routine syphilis serology was examined by world region of birth. RESULTS: Between 1997 and 2002, 1040 BME MSM were newly diagnosed with HIV in E&W, representing 12% of all new diagnoses reported among MSM. Of the 1040 BME MSM, 27% were black Caribbean, 12% black African, 10% black other, 8% Indian/Pakistani/Bangladeshi, and 44% other/mixed. Where reported (n = 395), 58% of BME MSM were probably infected in the United Kingdom. An estimated 7.4% (approximate 95% CI: 4.4% to 12.5%) of BME MSM aged 16-44 in E&W were living with diagnosed HIV in 2002 compared with 3.2% (approximate 95% CI: 2.6% to 3.9%) of white MSM (p<0.001). Of Caribbean born MSM attending GUM clinics between 1997 and 2002, the proportion with undiagnosed HIV infection was 15.8% (95% CI: 11.7% to 20.8%), while among MSM born in other regions it remained below 6.0%. CONCLUSIONS: Between 1997-2002, BME MSM accounted for just over one in 10 new HIV diagnoses among MSM in E & W; more than half probably acquired their infection in the United Kingdom. In 2002, the proportion of BME MSM living with diagnosed HIV in E&W was significantly higher than white MSM. Undiagnosed HIV prevalence in Caribbean born MSM was high. These data confirm the need to remain alert to the sexual health needs and evolving epidemiology of HIV among BME MSM in E&W.     

Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men

OBJECTIVES: To estimate the percentage of men who have sex with men (MSM) who have used the Internet to look for sex partners and to examine the prevalence of risky sex among MSM who have and have not sought partners online. METHODS: Meta-analyses were conducted on findings from published English-language studies. High-risk sex was self-reported unprotected anal intercourse (UAI). Analyses were stratified by method of study recruitment (online versus offline venues) and participants' human immunodeficiency virus (HIV) status. RESULTS: In studies that recruited MSM offline, a weighted mean, based on 15 findings, indicated that 40% (95% confidence interval [CI], 35.2%-45.2%) of MSM had used the Internet to look for sex partners. In 3 findings from offline studies that stratified by participant HIV status, the weighted-mean percentage was higher among HIV-positive (49.6%; 95% CI, 44.9%-54.3%) than HIV-negative/unknown MSM (41.2%; 95% CI, 36.8%-45.6%). UAI with male sex partners was more likely among MSM who sought partners online than MSM who did not (odds ratio, 1.68; 95% CI, 1.18-2.40; k = 11). This group difference was observed for UAI with HIV-serodiscordant as well as HIV-seroconcordant partners, particularly among HIV-positive study participants. HIV-serodiscordant UAI was not more prevalent with partners met online than offline. CONCLUSIONS: A substantial percentage of MSM use the Internet to look for sex partners, and those who do are more likely to engage in unprotected sex. Additional research is needed to determine whether the Internet may increase risk behavior beyond that which occurs when men meet partners at offline venues.     

Associations between substance use and sexual risk among very young men who have sex with men

OBJECTIVE: To determine if an association exists in young men who have sex with men (MSM) between being under the influence of alcohol or drugs during sex and participation in sexual behaviors which increase the risk of human immunodeficiency virus (HIV). STUDY DESIGN: A total of 3492 young MSM were interviewed through the Young Men's Survey, an anonymous, cross-sectional, multisite, venue-based survey conducted from 1994 through 1998 at 194 public venues frequented by MSM aged 15 to 22 years in 7 US cities. RESULTS: The majority of young MSM reported both receptive and insertive anal intercourse, and of these, approximately half reported not using condoms. Report of unprotected receptive anal intercourse at least once in the prior 6 months was associated with being under the influence of alcohol (adjusted odds ratio [AOR]=1.5; 95% confidence interval [CI]=1.2-1.8), cocaine (AOR=1.6; 95% CI=1.1-2.2), amphetamines (AOR=1.5; 95% CI=1.1-2.0) or marijuana during sex (AOR=1.3; 95% CI=1.1-1.6). Report of unprotected insertive anal intercourse at least once in the prior 6 months was associated with being under the influence of alcohol (AOR=1.2; 95% CI=1.0-1.5), cocaine (AOR=1.5; 95% CI=1.1-2.0) or amphetamines (AOR=1.9; 95% CI=1.4-2.6). CONCLUSIONS: HIV prevention strategies for young MSM need to incorporate substance use risk reduction.     

深圳市男男性接触人群梅毒合并HIV感染状况及其危险因素分析

目的：了解深圳市近6个月内发生过同性临时性行为的MSM人群梅毒合并HIV感染状况及其相关影响因素。方法：运用滚雪球法和同伴推动抽样法招募MSM进行问卷调查和血清学检测,采用χ2检验和Logistic回归分析梅毒HIV合并感染的相关影响因素。结果：共调查434例MSM,梅毒和HIV感染率分别为16.4%和12.2%,梅毒合并HIV感染率为7.3%。年龄越大（OR=4.0,P=0.0007）、高中/中专文化者（OR=6.5,P=0.0081）、性角色以被动方为主者（OR=12.1,P=0.0017）、多个同性肛交性伴者（OR=1.5,P=0.0455）、不能坚持每次使用安全套者（OR=2.9,P=0.0236）,其梅毒合并HIV感染风险越高。结论：需要采取更大努力来应对该人群的梅毒和HIV双重感染问题。     

Commercial sex work and risk of HIV infection among young drug-injecting men who have sex with men in San Francisco

OBJECTIVE: The objective of this study was to investigate the relationship between sex work and HIV infection among young injection drug-using men who have sex with men (MSM-IDU). STUDY DESIGN: This study was a cross-sectional analysis of behavioral and serologic data collected from 227 street-recruited MSM-IDU in San Francisco, California, between January 2000 and November 2001. RESULTS: Sixty-eight percent of participants reported being paid by another man for sex. HIV prevalence was 12% (95% confidence interval, 8-16%); 42% of seropositive participants were unaware of their infection. HIV was independently associated with higher number of paying male partners and history of gonorrhea and inversely associated with number of female partners, education, and syringe-sharing. Consistent condom use overall was 41%, but varied significantly by type of partner. CONCLUSIONS: Among MSM-IDU in San Francisco, sex work with men is strongly associated with HIV infection and the prevalence of condom use is low. HIV prevention among MSM-IDU must be tailored to address the excess risk associated with sex work.     

HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia

OBJECTIVES: To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links between these men and broader heterosexual populations. METHODS: Anonymous, cross sectional surveys among community recruited transgender and male sex workers and self recognised men who have sex with men (MSM) were undertaken in mid-2002 in Jakarta, Indonesia. Places where transgender and male sex workers sell sex and where men go to meet non-commercial male sex partners were mapped. Probability samples were selected for the sex worker populations, while a mixed probability and convenience sample was drawn for self recognised MSM. Blood was drawn for HIV and syphilis serology and community interviewers administered a standardised questionnaire. RESULTS: HIV prevalence was 22% among transgender sex workers, 3.6% among male sex workers, and 2.5% among self recognised MSM, and syphilis prevalence was 19.3%, 2.0% and 1.1% respectively. 59.3% of transgender sex workers and 64.8% of male sex workers reported recent unprotected anal intercourse with clients, and 53.1% of other MSM reported unprotected anal sex with male partners. Some 54.4% of male sex workers and 18.3% of other MSM reported female partners in the preceding year. CONCLUSION: HIV has reached substantial levels among transgender sex workers, and is not negligible in other MSM groups. Risk behaviour is high in all subpopulations, and bisexual behaviour is common, meaning the threat of a wider epidemic is substantial. Prevention programmes targeting male-male sex are needed to reduce this threat.     

Recent HIV testing among young men who have sex with men: correlates, contexts, and HIV seroconversion

OBJECTIVES: We evaluated the correlates and contexts of HIV testing within the past year, subsequent risk reduction, and HIV seroconversion among young men who have sex with men (MSM). METHODS: Young men aged 23 to 29 years were approached, interviewed, counseled, and tested for HIV at 181 randomly sampled MSM-identified venues in six U.S. cities from 1998 through 2000. Analyses were restricted to 2,797 MSM who reported never testing HIV-positive. RESULTS: Of the 2,797 MSM, 1,281 (46%) either never previously tested or had not tested in the past year (never/remote testers); 1,516 (54%) had tested in the past year (recent testers); and 271 (10%) tested HIV-positive as part of the study. Of 1,885 recent sex partners reported by HIV-infected participants, 68% were partners of never/remote testers. Of recent testers, 50% tested anonymously, 51% tested because of specific risks, 59% were counseled, 47% reported reducing their risks after testing, and 8% tested HIV-positive (percent HIV-infected by race: blacks, 24%; Hispanics, 6%; whites, 4%; Asians, 1%). CONCLUSION: Nearly half of young MSM participants had not tested in the past year and HIV-infected never/remote testers accounted for approximately two thirds of recent partners potentially exposed to HIV. Of those who had tested recently, many MSM, especially those who are black, had already acquired HIV. To reduce HIV transmission and facilitate early diagnosis and entry into care, increased HIV testing among young at-risk MSM in the United States, especially those who are black, is needed.     

Relationship between syphilis and HIV infections among men who have sex with men in Beijing, China

BACKGROUND: Little is known about risk of HIV and other STDs among men who have sex with men (MSM) in China. OBJECTIVE: To survey the prevalence and risk factors of HIV and syphilis and evaluate correlation of two infections among MSM in the Chinese capital city. METHODS: A community-based sample of 526 MSM was recruited in 2005 through Internet advertising, community outreach, and peer referring. Interviewer-administered interviews were conducted to collect information on demographics and sexual and other risk behaviors, and blood samples were collected to test for syphilis and HIV infections. RESULTS: Seventeen (3.2%) participants were HIV seropositive and 59 (11.2%) syphilis seropositive. Sixty-four percent of participants were migrants who did not have Beijing residence. Forty percent had >10 lifetime male sex partners and 28.8% reported having ever had sex with women. Consistent condom use with primary male sex partners ranged from 21% to 24%, with nonprimary male sex partners from 35% to 42%, and with female partners around 33%. Illicit drug use was not common; only 2.5% reported using Ecstasy or ketamine in the past 6 months. Multivariate logistic regression analyses demonstrated that >10 lifetime male sex partners were independently associated with seropositivity of both syphilis (OR, 1.9; 95% CI, 1.1-3.4) and HIV (OR, 4.3; 95% CI, 1.4-13.6). In addition, HIV infection is significantly associated with syphilis seropositivity (OR, 3.8; 95% CI, 1.3-10.8). CONCLUSIONS: High mobility, multiple sexual partners, and high prevalence of unprotected sex behaviors and syphilis infection suggest a potential rapid spread of HIV in Chinese MSM.     

The effect of venue sampling on estimates of HIV prevalence and sexual risk behaviors in men who have sex with men

OBJECTIVE: The objective of this study was to investigate differences in HIV prevalence and sexual risk behaviors among men who have sex with men (MSM) according to their gay venue visit patterns. METHODS: In a cross-sectional survey, a population-based sample of men aged 18 to 64 years who self-identified as gay or bisexual were interviewed by telephone regarding their sexual behaviors, HIV serostatus, and gay venue visit patterns. RESULTS: A total of 398 men were recruited for the study. The results showed that frequent gay venue visitors were more likely to engage in high-risk sexual behaviors. Among gay venue attendees who visited different types of gay venues, men who visited sex clubs/bathhouses reported the highest rates of 5 or more male sexual partners and unprotected anal intercourse (UAI) with secondary partners (62.6% and 34.6%, respectively), gay bar/club attendees and cruisers reported higher rates of having sex with women (8.5% and 14.8%, respectively), and circuit party attendees reported the highest HIV prevalence (40.4%) and serodiscordant UAI (30.2%). CONCLUSIONS: MSM who visited different types of gay venues and with varied visit frequency showed marked differences in sexual risk behaviors, and the differences suggest the importance of weighting procedure to obtain unbiased estimates in venue-based studies.     

Recent trends in diagnoses of HIV and other sexually transmitted infections in England and Wales among men who have sex with men

OBJECTIVES: To examine trends in rates of diagnoses of HIV and other sexually transmitted infections (STIs) in men who have sex with men (MSM) in England and Wales between 1997 and 2002. METHODS: Estimates of the MSM population living in England and Wales, London and the rest of England and Wales were applied to surveillance data, providing rates of diagnoses of HIV and STIs and age group specific rates for HIV and uncomplicated gonorrhoea. RESULTS: Between 1997 and 2002, rates of diagnoses of HIV and acute STIs in MSM increased substantially. Rates in London were higher than elsewhere. Rises in acute STIs were similar throughout England and Wales, except for uncomplicated gonorrhoea and infectious syphilis, with greater increases outside London. Rates of gonorrhoea diagnoses doubled between 1999 and 2001 (661/100,000, 1271/100,000, p<0.001) in England and Wales followed by a slight decline to 1210/100,000 (p=0.03) in 2002-primarily the result of a decline in diagnoses among men aged 25-34 (1340/100,000, 1128/100,000, p<0.001) and 35-44 (924/100,000, 863/100,000, p=0.03) in London. HIV was the third most common STI diagnosed in MSM in England and Wales and the second in London, with the highest rate (1286/100,000) found among men aged 35-44 in London in 2002. CONCLUSIONS: Rates of diagnosis of HIV and other STIs have increased substantially among MSM in England and Wales. Increases show heterogeneity by infection, geography, and age over time. Rates in London were twice those seen elsewhere, with greatest changes over time. The observed changes reflect concomitant increases in high risk behaviour documented in behavioural surveillance survey programmes.     

固定性伴是男男性行为者的女性之相关生活、态度和认知

目的：探讨固定性伴是男男性行为者（MSM）的女性之相关生活、态度和认知,从当事人角度了解该群体面对的挑战。方法：主要依托固定性伴是MSM的女性所创办的同妻网站进行动员,调查对象限定为其固定性伴是MSM的在婚、已离异或尚未结婚的女性。针对不同亚人群共设计出三套问卷。数据收集通过互联网调查软件“问卷星”进行。结果：有效样本144例,在婚组100人,离异组33人,未婚组11人。与MSM固定性伴在经济上是“AA制”者约3/5。有婚史者认为MSM结婚的最重要原因是亲长要求,用婚姻来证明其“正常”。在知道（对方是MSM）真相前,MSM对固定性伴仅1/4有过主动亲吻行为,性交时3/10喜欢爱抚女性乳房。有婚史者中多数人通过MSM的移动互联网活动发现真相,约1/6直接发现MSM与其他男性的性交往;结婚3年后才知道真相者约2/5,在女方说出真相时,对方承认者不足3/10,MSM婚后主动说出真相者不足1/11。知道真相后她们几乎都曾试图尽多了解MSM固定性伴,少数人甚至雇用私家侦探。在婚组中与MSM有子女者3/4,已分居者约1/4;尚未离异的最重要原因首先是顾忌到子女和财产分配,认为自己生活（较）幸福者仅1/12。离异组中女方提出离异者9/10,通过法院离婚近1/10;女方“净身出户”或仅得到很少财产者占3/5;离异前的最大顾虑是对子女、自己和亲长的影响;离异的最重要原因是认为自己有权利寻找幸福婚姻和夫妻性生活严重不和谐。有婚史者在婚期间有过婚外性伴者3/10,其原因首先是解决性饥渴,恢复自信心和宣泄对MSM固定性伴的不满。该女性群体在为性伴侣状况苦恼时普遍得到过帮助,但最重要的帮助者通常是互联网上的“同妻”、亲人和女友,她们希望获得心理专家、法律专家和艾滋病性病专家帮助。她们中知道同性爱是正常     

男男性行为性病患者性行为特征分析

目的: 分析近一年曾患性传播感染(STI)的男男性行为者(men who have sex with men, MSM)性行为特征及感染STI的影响因素.方法: 对近一年曾患STI者的性行为及STI相关因素进行分析,并与未患STI者进行比较.结果: 近一年曾患STI的MSM同性性伴数、与同性性伴间的高危行为、网络寻找性伴并与网友发生性行为等方面均高于对照组.多因素分析,从事男男性工作和性交时出血与近一年患STI关系密切.结论: 应继续加强对MSM人群进行安全性行为健康教育,以降低STI和HIV感染风险.     

广州市520名男男性行为者HIV感染情况及影响因素分析

目的:了解广州市男男性行为者(MSM)的艾滋病知识、高危行为以及艾滋病、梅毒感染情况及影响因素,为针对性开展MSM人群艾滋病防治工作提供依据。方法:面对面问卷调查520名MSM人群的艾滋病知识、行为情况,并进行艾滋病、梅毒血清学检测。结果:艾滋病知识知晓率为90.19%(469/520);HIV抗体阳性率为9.23%(48/520),梅毒阳性检出率为5.77%(30/520);最近六个月同性肛交性行为时每次均用安全套比例为53.81%(240/446);多因素logistic回归分析结果显示,感染了性病[OR=3.333,95%CI:(1.146~9.696)]、最近六个月与同性发生肛交性行为使用安全套的频率较少[OR=3.460,95%CI:(1.770~6.763)]是HIV感染的危险因素(P0.05)。结论:广州市MSM人群艾滋病知识知晓率高、安全套使用率低、知行分离严重,艾滋病、梅毒感染率高,应加强有效的干预检测和性病诊治。