eHealth Interventions to Address HIV and Other Sexually Transmitted Infections,Sexual Risk Behavior,Substance Use,and Mental Ill-health in Men Who Have Sex With Men: Systematic Review and Meta-analysis

BackgroundMen who have sex with men experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behavior, substance use, and mental ill-health. These experiences are interrelated, and these interrelations are potentiated by structural conditions of discrimination, stigma, and unequal access to appropriate health services, and they magnify each other and have intersecting causal pathways, worsening both risk for each condition and risk for the negative sequelae of each condition. eHealth interventions could address these issues simultaneously and thus have wide-ranging and greater effects than would be for any 1 outcome alone.ObjectiveWe systematically reviewed the evidence for the effectiveness of eHealth interventions in addressing these outcomes separately or together.MethodsWe searched 19 databases for randomized trials of interactive or noninteractive eHealth interventions delivered via mobile phone apps, internet, or other electronic media to populations consisting entirely or principally of men who have sex with men to prevent HIV, STIs, sexual risk behavior, alcohol and drug use, or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible by using random effects and robust variance estimation, and assessed the certainty of our findings (closeness of the estimated effect to the true effect) by using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).ResultsWe included 14 trials, of which 13 included active versus control comparisons; none reported mental health outcomes, and all drew from 12 months or less of follow-up postintervention. Findings for STIs drew on low numbers of studies and did not suggest consistent short-term (<3 months postintervention; d=0.17, 95% CI –0.18 to 0.52; I²=0%; 2 studies) or midterm (3-12 months postintervention, no meta-analysis, 1 study) evidence of effectiveness. Eight studies considering sexual risk behavior outcomes suggested a short-term, nonsignificant reduction (d=–0.14, 95% CI –0.30 to 0.03) with very low certainty, but 6 studies reporting midterm follow-ups suggested a significant impact on reducing sexual risk behavior (d=–0.12, 95% CI –0.19 to –0.05) with low certainty. Meta-analyses could not be undertaken for alcohol and drug use (2 heterogeneous studies) or for HIV infections (1 study for each of short-term or midterm follow-up), and alcohol outcomes alone were not captured in the included studies. Certainty was graded as low to very low for most outcomes, including all meta-analyses.ConclusionsTo create a comprehensive eHealth intervention that targets multiple outcomes, intervention evaluations should seek to generalize both mechanisms and components that are successfully used to achieve change in 1 outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behavior are needed before development and evaluation of a joined-up intervention.     

四类场所男性双性性行为者艾滋病、梅毒检测及性行为特征分析

目的研究不同场所男性双向性性行为者性行为特征。方法选择男男性行为者（men who have sex with men,MSM）聚集的浴池、酒吧、公园、会所为目标场所,采用分层整群抽样方法,抽取473名兼有异性性行为的 MSM开展匿名问卷调查,同时进行艾滋病和梅毒血清学检测。对社区志愿者组织（CBO）关键人物及场所业主开展深度访谈。结果473名 MSM 中,“1暠（扮演“丈夫暠者）占38.56%,“0.5暠（可扮演“丈夫暠或“妻子暠者）占45.53%,“0暠（扮演“妻子暠者）占15.90%,酒吧和会所中“0暠和“1暠占比较大,浴池和公园中“1暠占比较大;最近半年与女性发生过性行为的共占37.58%,公园和浴池中的占比高于酒吧和会所;有“滥交暠经历的共占66.23%,按占比高低排序为：浴池、公园、会所、酒吧;每次性行为时均使用安全套的共占37.93%,活动于公园的最低;HIV 抗体和梅毒血清学检测阳性率分别为4.44%和20.93%,浴池和公园的 MSM 感染率均较高。结论在针对 MSM 的艾滋病行为干预工作中,应将浴池和公园作为场所干预的重点。     

Increase in Sexually Transmitted Infections among Men Who Have Sex with Men,England, 2014

Surveillance data from sexual health clinics indicate recent increases in sexually transmitted infections, particularly among men who have sex with men. The largest annual increase in syphilis diagnoses in a decade was reported in 2014. Less condom use may be the primary reason for these increases.     

Health Care Access and Utilization among Women Who Have Sex with Women: Sexual Behavior and Identity

Past research has shown that women who either have sex with women or who identify as lesbian access less preventive health care than other women. However, previous studies have generally relied on convenience samples and have not examined the multiple associations of sexual identity, behavior and health care access/utilization. Unlike other studies, we used a multi-lingual population-based survey in New York City to examine the use of Pap tests and mammograms, as well as health care coverage and the use of primary care providers, among women who have sex with women and by sexual identity status. We found that women who had sex with women (WSW) were less likely to have had a Pap test in the past 3 years (66 vs. 80%, p<0.0001) or a mammogram in the past 2 years (53 vs. 73%, p=0.0009) than other women. After adjusting for health insurance coverage and other factors, WSW were ten times [adjusted odds ratio (AOR), 9.8, 95% confidence interval (CI), 4.2, 22.9] and four times (AOR, 4.0, 95% CI 1.3, 12.0) more likely than non-WSW to not have received a timely Pap test or mammogram, respectively. Women whose behavior and identity were concordant were more likely to access Pap tests and mammograms than those whose behavior and identity were discordant. For example, WSW who identified as lesbians were more likely to have received timely Pap tests (97 vs. 48%, p<0.0001) and mammograms (86 vs. 42%, p=0.0007) than those who identified as heterosexual. Given the current screening recommendations for Pap tests and mammograms, provider counseling and public health messages should be inclusive of women who have sex with women, including those who have sex with women but identify as heterosexual.Kerker and Thorpe are with the NYC Department of Health and Mental Hygiene, Division of Epidemiology, New York, NY, USA; Mostashari is with the NYC Department of Health and Mental Hygiene, Division of Health Care Access and Improvement, 225 Broadway, 23rd fl, rm 10, #10, New York, NY 10007, USA.     

2011年武汉市汉阳区男男同性恋人群艾滋病相关知识、性行为特征及艾滋病病毒感染状况调查

[目的]了解武汉市汉阳区男男同性恋人群(MSM)高危行为特征及艾滋病病毒感染状况,为开展针对该人群的艾滋病预防工作提供依据。[方法]2011年4～9月,通过滚雪球的方式招募武汉市汉阳区MSM人群502人进行问卷调查,并检测艾滋病病毒抗体和梅毒抗体。[结果]调查502人,艾滋病相关知识总知晓率为40.84%。最近6个月有61.75%的人与男性发生过肛交性行为,与男性发生肛交性行为时有25.16%每次都使用安全套;最近6个月有31.67%的人与女性发生过性行为,与女性发生性行为时每次使用安全套的比例为9.43%。7.57%的调查对象承认在最近一年出现过性病相关症状,其中选择到专科医院就诊的占26.32%。艾滋病病毒、梅毒感染率分别为3.19%和15.74%。[结论]武汉市汉阳区男男同性恋人群之间危险行为普遍存在,艾滋病性病感染率高。     

Knowledge,Attitudes, and Sexual Behaviors in HIV/AIDS and Predictors Affecting Condom Use among Men Who Have Sex with Men in South Korea

ObjectivesIn South Korea, men who have sex with men (MSM) are rather understudied, but are known to be at high risk for human immunodeficiency virus infection (HIV)/acquired immunodeficiency syndrome (AIDS). This study was to access HIV/AIDS knowledge, attitudes, and risk behaviors, and to identify the factors of condom use in HIV prevention.MethodsWe recruited 1070 MSM in Korea, using the Internet to maximize the confidentiality of the MSM.ResultsThe prevalence of self-reported and sexually transmitted infections and HIV in the total sample was 10.7% and 2.7%, respectively. Factual knowledge and phobias regarding HIV/AIDS and self-efficacy were relatively high among the MSM. After controlling for age, education, marital status, and sexual identity, predictors of condom use at most recent anal sex included knowledge (OR = 1.25; p < 0.0001); self-efficacy (OR = 1.33; p = 0.02), additionally, having HIV testing (OR = 1.45; p = 0.02); and having a regular partner (OR = 0.53; p < 0.0001) were also positively associated with condom use.ConclusionThe intervention programs for MSM in Korea may need to take the idiosyncratic societal and cultural pressures of the region into consideration in order to reduce infection risk.     

Binge Drinking among Men Who Have Sex with Men and Transgender Women in San Salvador: Correlates and Sexual Health Implications

High rates of heavy alcohol use among men who have sex with men (MSM) and transgender women (TW) have been linked to increased vulnerability for HIV and poor mental health. While theories explaining elevated drinking levels among sexual minorities have been forwarded, few investigations have assessed the potential pathways using empirical data, particularly with an explicit focus on self-stigma and among MSM and TW in low- and middle-income countries. This study examined the relationship between stigma-related stress (specifically, self-stigma and concealment of one’s sexual orientation) and binge drinking in a sample of MSM and TW (n = 670) in San Salvador, El Salvador, recruited using respondent-driven sampling. Levels of alcohol consumption among participants were high: only 39 % of the sample did not drink alcohol or did not binge drink, while 34 % engaged in binge drinking at least weekly. Among MSM, high self-stigma was associated with binge drinking at least weekly (adjusted relative risk ratio (aRRR) = 2.1, p < 0.05). No such relationship was found with less than weekly binge drinking. Among both MSM and TW, having a female partner was associated with binge drinking less than weekly (aRRR = 3.3, p < 0.05) and binge drinking at least weekly (aRRR = 3.4, p < 0.05), while disclosure of sexual orientation to multiple types of people was associated with binge drinking less than weekly (aRRR = 2.9 for disclosure to one–two types of people, p < 0.01; aRRR = 4.0 for disclosure to three–nine types of people, p < 0.01). No such relationship was found with at least weekly binge drinking. Binge drinking at least weekly was marginally associated with a number of sexual health outcomes, including high number of lifetime partners (adjusted odds ratio (aOR) = 1.7, p < 0.10), inconsistent condom use with a non-regular partner (aOR = 0.5, p < 0.10), and decreased intention to test for HIV in the next 12 months (aOR = 0.6, p < 0.10). With the exception of inconsistent condom use with a non-regular partner (aOR = 0.4, p < 0.05), binge drinking less than weekly was not associated with increased sexual risk behavior and was actually associated with increased intention to test for HIV in the next 12 months (aOR = 2.8, p < 0.01). These findings support multiple pathways linking stigma-related stress to alcohol use. Specifically, those with high self-stigma and identity concealment may be using alcohol as a maladaptive coping and emotion regulation strategy, while those who have disclosed their sexual orientation to multiple types of people may be more engaged with the sexual minority community, likely in bars and other venues where permissive norms for alcohol use prevail. That this frequency of binge drinking does not appear to be associated with increased sexual risk behavior (and may even be associated with increased intention to test for HIV in the next 12 months) lends further support to the suggestion that these individuals with healthy concepts of the self (as indicated by high levels of disclosure and low levels of risky sexual behavior) may engage in binge drinking because of the influence of the social environment. Further research is needed to establish the pathways linking stigma-related stress to heavy alcohol use so that points of intervention can be identified.     

2008年济南市部分男男性行为人群艾滋病相关知识、性行为特征及HIV和梅毒感染状况调查

[目的]了解济南市男男性行为人群(MSM)的性行为特征、艾滋病及梅毒感染状况。[方法]2008年10~12月,对在济南市疾病预防控制中心自愿接受艾滋病咨询的男男性行为人群进行匿名问卷调查和艾滋病病毒抗体、梅毒抗体检测。[结果]调查542人,艾滋病相关知识知晓率为84.51%。最近1年接受过有关预防艾滋病服务的占55.97%;相关知识信息的主要来源为网络(占64.66%)、电视(占43.46%)、免费宣传材料(占42.93%)、报刊(占41.62%);65.93%的人通过网络寻找性伴;24.56%的人同时与女性有性行为,最近半年内平均性伴数为4.23±8.08人;68.35%的人最近6个月与男性性伴发生肛交性行为时未能每次都使用安全套。HIV抗体阳性检出率为1.55%,梅毒抗体抗体阳性检出率为5.31%。[结论]MSM人群艾滋病相关知识知晓率较高,但普遍存在高危性行为。     

Gaps in sexual health research about women who have sex with women. A scoping review

ObjectiveTo know the characteristics of the studies that have paid attention to women who have sex with women (WSW) and to identify possible gaps in the interest of comprehensive sexual health in WSW.MethodA scoping review on sexual health on WSW was conducted from 2000 to 2019. Papers with lack of focus on sexual health on WSW were excluded and a web tool was used to guarantee blindness. Information was extracted on the key characteristics of the studies and the quality of the evidence. The sexual health categories were comprehensive sexual health, specification of sexual practices in WSW, and recommendations provided.Results39 studies were included, mostly cross-sectional. The gaps identified were the lack of evidence on sexual health, confusion about sexual orientation and sexual practices, lack of specific interest in comprehensive sexual health and the life cycle approach. Recommendations focused on WSW self-care; interventions aimed at clinical practice, research, education and prevention; and contributions of a feminist approach on sexual health of WSW.ConclusionsThere are several gaps about in the knowledge about sexual health among WSW. Self-care improvement and specific strategies addressed to the unique characteristics of these women and their different and specific situation and health determinants are highlighted.