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.     

Prevalence and Correlates of Unprotected Anal Intercourse Among Hong Kong Men Who Have Sex with Men Traveling to Shenzhen, China

In China, the HIV prevalence among men who have sex with men (MSM) has been increasing sharply. A total of 195 Hong Kong MSM having had sex with men in Shenzhen, a mainland China city separated from Hong Kong by a border, were recruited from some randomly selected gay venues in Shenzhen. Participants were face-to-face and anonymously interviewed. The results showed that in the last six months, respectively 62.1, 84.6, and 31.3 % of the participants from Hong Kong had had sex with commercial sex partners (CSP), non-regular partners (NRP) and regular partners (RP) in Shenzhen. The prevalence of unprotected anal intercourse (UAI) with these three types of sex partners was respectively 29.8, 27.9, and 78.7 %. Factors associated with UAI with any MSM in Shenzhen in the last six months included perceived chances of contracting HIV, perceived non-availability of condoms, giving money/gifts to Shenzhen MSM sex partners, and perception that MSM partners in Shenzhen would not always insist on condom use (multivariate OR = 2.9–13.90, p < 0.05), whilst factors of inverse associations included university education, having had sex with NRP but not with CSP and RP in Shenzhen and self-efficacy of insisting on condom use (multivariate OR = 0.04–0.22, p < 0.05). In sum, the prevalence of having multiple types of male sex partners and UAI was high. This was especially true when anal sex with RP was involved. Cross-border HIV prevention is greatly warranted. It should ensure condom availability and modify perceptions toward UAI.     

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.     

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.     

Gender Differences in Heterosexual Anal Sex Practices Among Women and Men in Substance Abuse Treatment

Heterosexual anal intercourse (HAI) is an understudied risk behavior among women and men in substance abuse treatment. Rates of HAI for women (n = 441) and men (n = 539) were identified for any, main and casual partners. More men (32.8 %) than women (27.1 %) reported engaging in HAI in the previous 90 days. These rates are higher than those reported for both men (6.0–15.9 %) and women (3.5–13.0 %) ages 25–59 in the National Survey of Sexual Health and Behavior. Men were significantly more likely to report HAI with their casual partners (34.1 %) than women (16.7 %). In a logistic regression model generated to identify associations between HAI and variables previously shown to be related to high risk sexual behavior, being younger, bisexual, and White were significantly associated with HAI. For men, having more sex partners was also a significant correlate. HAI is a logical target for increased focus in HIV prevention interventions.     

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.     

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.     

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.     

Correlates of Anal Intercourse Vary by Partner Type Among Substance-Using Women: Baseline Data from the UNITY Study

Data are limited about anal intercourse among women at risk of HIV infection. HIV-negative non-injection drug using women at sexual risk (N = 404) were recruited. At baseline, 41.7% reported anal intercourse in the prior 3 months; of these, 88.2% reported unprotected anal intercourse (UAI). Factors associated with UAI varied by partner type: UAI with a steady partner was associated with younger age, depressive symptoms, and experience of battering; UAI with casual partners was associated with younger age, cocaine use and negative outcome expectancies for condom use; UAI with exchange partners was associated with cocaine use, negative outcome expectancies for condom use and depressive symptoms. Younger women were more likely to report unprotected anal intercourse if they did not use birth control. Specific counseling messages are needed to identify and address this risk and associated factors, including partner relationships, substance use, birth control, mental health issues and domestic violence.     

Heterosexual Anal Sex Among Female Drug Users: U.S. National Compared to Local Long Beach, California Data

Receptive anal sex is a well-studied Human Immunodeficiency Virus (HIV) high-risk behavior among gay and bisexual men, yet previous research indicates that more women than men may be at risk from heterosexual anal sex (HAS). 1991-1996 data from the National Institute on Drug Abuse (NIDA) Cooperative Agreement (CA) were analyzed to model risk for women who reported having had HAS in the 30 days prior to interview. This model was then tested on recent data (2001-2006) collected on women in Long Beach, California. The multivariate model predicting anal sex in the NIDA CA dataset included sex trading; risk perception for HIV; ever had gonorrhea; sex while high; and drugs used in the last 30 days. African American race/ethnicity and older age were inversely associated with HAS. Risk factors common to both samples of women were number of days used amphetamine in the last month and risk perception for HIV.     

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.     

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.     

The Impact of Stressful Life Events on Unprotected Anal Intercourse Among Gay and Bisexual Men

We investigated the hypothesis that gay and bisexual men experiencing stressful life events are more likely to engage in risky sexual behavior. Data were from a cohort study of 155 HIV-positive and 207 HIV-negative men in Ontario, Canada (1998–2007). We quantified the relation between stressful life events and unprotected anal intercourse with a non-regular partner. In the past 6 months, 19% reported unprotected intercourse (HIV+: 28%; HIV−: 13%) and 58% reported one or more stressful life events (HIV+: 64%; HIV−: 55%). Among HIV-negative men, the odds of unprotected intercourse increased by 1.15 for each additional event (95%CI 1.06, 1.24). Among HIV-positive men, those who reported the event “problems due to alcohol or drugs” were 1.80 (95%CI 1.27, 2.56) times more likely to report unprotected intercourse. Interventions to assist men to cope with stress may help to prevent population spread of HIV and improve overall health.     

Partner-Level Factors Associated with Insertive and Receptive Condomless Anal Intercourse Among Transgender Women in Lima,Peru

Condomless anal intercourse among transgender women (TW) in Peru has been shown to vary by the type of partner involved (e.g. primary vs. casual vs. transactional sex partner), but no previous studies have explored variations in partner-level patterns of condom use according to type of anal intercourse. We evaluated the relationship between partnership characteristics and condom use during insertive (IAI) versus receptive anal intercourse (RAI) among TW with recent, non-female partners. Condomless IAI was more common with transactional and casual sex partners and by TW who self-reported HIV-uninfected serostatus (p < 0.05), alcohol use disorders, or substance use before sex. Condomless RAI was more common with primary partners and by TW who described their HIV serostatus as unknown (p < 0.05). Examining partner-level differences between condomless IAI and RAI reveals distinct patterns of HIV/STI risk among TW, suggesting a need for HIV prevention strategies tailored to the specific contexts of partners, practices, and networks.     

Increases in Unprotected Anal Intercourse with Serodiscordant Casual Partners Among HIV-Negative Gay Men in Sydney

Prevalence of unprotected anal intercourse between casual male partners (UAIC) has been increasing worldwide. We explored trends in serodiscordant UAIC and the associated factors among gay men in Sydney. Proportions of HIV-positive and negative men with serodiscordant casual partners increased during 2003–2006. Prevalence of serodiscordant UAIC increased among HIV-negative men. Age, number of partners, seeking partners online, drug use and esoteric practices were associated with serodiscordant UAIC. Increases in serodiscordant UAIC may be related to growing disclosure. These findings do not indicate a core group of high-risk men. More research is needed about the context in which serodiscordant UAIC happens. Contributors: Iryna B. Zablotska and June Crawford contributed to formulating the research issue and design of this analysis, assumed principal responsibility for data collection, analysis and preparation of the paper. John Imrie, Garrett Prestage, Fengyi Jin, Andrew Grulich and Susan Kippax contributed to this paper at different stages of study design, data collection and analysis, and assisted with the interpretation of the results and the preparation of the paper. All authors have seen and approved the final version of this paper.     

Alcohol Use, Anal Sex, and Other Risky Sexual Behaviors Among HIV-Infected Women and Men

Effective sexual risk reduction strategies for HIV-infected individuals require an understanding of alcohol’s influence on specific sexual behaviors. We conducted audio-computer-assisted-self-interviews on 910 patients from two HIV primary care programs. The association between alcohol use and risky sexual behaviors was examined using multivariable logistic regression adjusting for age, education, race/ethnicity and drug use. Frequent/binge drinking was associated with engaging in anal sex and having multiple sex partners among women, engaging in insertive anal sex among gay/bisexual men, and was unrelated to risky sexual behaviors among heterosexual men. Infrequent drinkers did not differ in sexual risk behaviors from abstainers among women or men. Finally, there was no interaction effect between race/ethnicity and alcohol use on the association with sexual risk behaviors. The study has yielded important new findings in several key areas with high relevance to HIV care. Results underscore the importance of routinely screening for alcohol use and risky sexual behaviors in HIV primary care.     

HIV Prevalence and Associated Factors Among Men Who have Sex with Men (MSM) in New Jersey,U.S., 2017

AIDS and Behavior - This study assessed the HIV prevalence among MSM in the greater Newark New Jersey area including Essex, Hudson, Morris and Union Counties and examined correlates of HIV...     

Receipt and Perpetration of Intimate Partner Violence and Condomless Anal Intercourse Among Gay and Bisexual Men in Atlanta

Intimate partner violence (IPV) rates are disproportionately high among sexual minority populations, with increasing evident that gay men experience IPV at the same rates as heterosexual women. This study examines the relationship between self-reported condomless anal intercourse (CAI) and IPV among a sample of 750 gay and bisexual men. Participants answered questions regarding recent receipt and perpetration of IPV using the IPV-GBM Scale (Cronbach Alpha 0.90). Of the sample, 46.1% reported recent receipt of any type of IPV and 33.6% reported recent perpetration of any type of IPV. Overall, 55.1% of participants reported CAI at last sex. Significant associations were determined between several forms of IPV and increased odds of reporting CAI at last sex. These findings suggest that IPV may be a risk factor for CAI among men who have sex with men, and highlight the need to understand the IPV prevention and care needs of this population.