HIV infection and risk behaviours among young gay and bisexual men in Vancouver

BACKGROUND: Young gay and bisexual men may perceive that the consequences of HIV infection have dramatically improved with the availability of highly active antiretroviral therapy. We therefore sought to identify trends in HIV infection rates and associated risk behaviours among young gay and bisexual men in Vancouver. METHODS: Prospective cohort study involving gay and bisexual men aged 18-30 years who had not previously tested HIV positive. Subjects were recruited through physicians, clinics and community outreach in Vancouver. Annually participants were tested for HIV antibodies and asked to complete a self-administered questionnaire pertaining to sociodemographic characteristics, sexual behaviours and substance use. Prevalence of HIV infection and risk behaviours were determined for eligible participants who completed a baseline questionnaire and HIV testing as of May 1998. The primary outcome was the proportion of men who reported having protected sex during the year before enrollment and who reported any episode of unprotected sex by the time of the first follow-up visit. RESULTS: A total of 681 men completed a baseline questionnaire and HIV testing as of May 1998. The median duration between baseline and the first follow-up visit was 14 months. The median age was 25 years. Most of the subjects were white and of high socioeconomic status. The majority (549 [80.6%]) reported having sex only with men; 81 (11.9%) reported bisexual activity. Of the 503 men who had one or more regular male partners, 245 (48.7%) reported at least one episode of unprotected anal sex in the year before enrollment; the corresponding number among the 537 who had one or more casual male partners was 140 (26.1%). The prevalence and incidence of HIV seropositivity were 1.8% (95% confidence interval [CI] 0.8%-2.8%) and 1.7 per 100 person-years [95% CI 0.7-2.7], respectively. Fifty-two (26.5%) of the 196 and 55 (29.7%) of the 185 men with regular partners who reported having practiced protected insertive and receptive anal sex in the year before the baseline visit reported engaging in these activities without a condom at the follow-up visit; the corresponding numbers among the 232 and 242 men with causal partners who had practiced protected insertive and receptive anal sex before the baseline visit were 43 (15.5%) and 26 (9.4%) respectively at follow-up. INTERPRETATION: The incidence of HIV infection is unacceptably high among this cohort of young gay and bisexual men. Preliminary results suggest a disturbing trend toward increasing levels of unprotected anal intercourse.     

High-risk STD/HIV behavior among college students

The current sexually transmitted disease (STD) epidemic in adolescents has led to concern about the potential for spread of the human immunodeficiency virus (HIV). In 1988, a total of 5514 students in first-year community college and university classrooms across Canada were surveyed to assess STD/HIV-related knowledge, attitudes, and risk behavior. The students' mean age was 19.7 years; the male-to-female ratio was 1:1.4. Students knew more about HIV/acquired immunodeficiency syndrome than other STDs. Of the 74.3% of the men and 68.9% of the women who were coitally active, 14.3% of the men and 18.6% of the women had participated in anal intercourse and 5.5% reported a previous STD. Only 24.8% of the men and 15.6% of the women always used a condom during sexual intercourse. Among the 21.3% of the men and 8.6% of the women with 10 or more partners, regular condom use was reported in only 21% and 7.5%, respectively. In this subgroup, anal intercourse was practiced by 26.9% of the men and 34.8% of the women, and previous STD was reported by 10.6% and 24.2%, respectively. Factors associated with not using a condom included number of sexual partners, embarrassment about condom purchase, difficulty discussing condom use with a partner, use of oral contraceptives, insufficient knowledge of HIV/STDs, and the belief that condoms interfere with sexual pleasure. These factors are potentially amenable to change. Effective, behaviorally focused educational programs are needed to improve condom use and reduce STD/HIV risk.     

Sexual practices and condom usage in a cohort of homosexual men in relation to human immunodeficiency virus status

Between January 1, and October 31, 1987, 420 homosexual men who participated in a cohort study of infection with the human immunodeficiency virus (HIV) completed a questionnaire that examined their sexual practices during the previous six months. Of the subjects, 205 (48.8%) men were HIV-seropositive and 215 (51.2%) men were HIV-seronegative. Although there was an appreciable level of condom usage in both groups, 13.5% of the HIV-seronegative men had engaged in unprotected receptive anal intercourse and 6.3% of the HIV-seropositive men had engaged in unprotected insertive anal intercourse. Condom breakage was reported on approximately 6% of occasions by a minority of subjects. Among subjects who were in a relationship with a regular male sexual partner, the most commonly reported sexual practices were deep kissing, mutual masturbation and receptive oral intercourse without ejaculation. No HIV-seronegative man engaged in unprotected receptive and/or insertive anal intercourse, receptive oral intercourse with ejaculation or receptive and/or insertive "fisting" with a regular partner who was HIV-seropositive. No HIV-seropositive man engaged in unprotected insertive anal intercourse to ejaculation with an HIV-seronegative partner, although they did so with partners who were HIV-seropositive or of unknown status. On multivariate analyses the subject's antibody status was found to be associated with receptive anal intercourse with a condom (P = 0.007) and mutual masturbation (P = 0.001), with HIV-seronegative men being more likely to practise either; no significant independent effect was associated with the partner's antibody status. These findings provide important information on the types and levels of sexual practices in a group of homosexual men after the recognition of the acquired immunodeficiency syndrome in this country.     

深圳市502例男男性行为者HIV/梅毒感染调查

目的了解深圳市男男性行为者（Menwhohavesexwithmen,MsM）H1v／梅毒感染情况及高危行为特征,为今后有针对性地实施有效干预措施提供科学依据。方法知情同意原则下,收集深圳市2012年MSM人群HIW梅毒监测资料,进行单因素和多因素Logistic回归分析。结果共502例接受自愿咨询检测,42．6％性角色以主动为主,25．5％以被动为主,30．1％二者兼有,1．8％极少肛交或多口交;半年内68．3％肛交性伴数≥2个,65．3％口交性伴数t〉2个;40．9％半年内肛交时每次使用安全套,3．6％半年内口交时每次使用安全套,44．5％半年内与女性性交时每次使用安全套。梅毒感染率为18．3％,HIV感染率为9．8％,梅毒合并HIV感染率为5．0％;多因素Logistic回归分析结果表明：性角色、肛交性伴数是MSM人群感染HIV的影响因素,HIV主动检测史、性角色、做过男男性工作者是MSM人群感染梅毒的影响因素。结论深圳市MSM人群HIV感染率仍呈上升趋势,应加强健康教育和行为干预工作,以有效阻断HIV传播。     

男-男性行为者的行为特征分析

目的 通过对男-男性行为者(men who have sex with men,MSM)行为监测,了解该群体与艾滋病相关的行为特征,为评估艾滋病在该人群的流行趋势提供依据。方法 2003年9月至12月,同时在成都和南充两市进行监测,采用专门设计的问卷收集行为资料,采用方便样本法和“滚雪球”法,从5类MSM最常活动的场所中抽取调查对象。结果 大部分MSM的性伴类型为男性性伴,最常见的性行为方式是肛交、口交和相互手淫。多性伴情况普遍存在,肛交和口交的性伴数中位数分别为4．4人和4．2人。近6个月性活动中,有491人(84．7％)与男性性伴发生过肛交,其中与不付费的固定和非固定性伴发生肛交的比例分别是68．6％和66．2％,明显高于与商业性性伴肛交的比例(20．4％)。与不付费固定和非固定、以及付费性伴肛交时坚持使用安全套的比例分别为15．8％、16．3％和32．3％。MSM中最近1年曾经有过毒品注射的人为1．9％,曾经自愿检测过HIV的人为18．3％。结论 MSM群体中HIV传播的危险行为是广泛存在的,这些行为包括多性伴、无保护肛交、商业性性活动、以及注射吸毒行为等。     

The Internet as a newly emerging risk environment for sexually transmitted diseases

CONTEXT: Transmission of sexually transmitted diseases (STDs) such as human immunodeficiency virus (HIV) infection is associated with unprotected sex among multiple anonymous sex partners. The role of the Internet in risk of STDs is not known. OBJECTIVE: To compare risk of STD transmission for persons who seek sex partners on the Internet with risk for persons not seeking sex partners on the Internet. DESIGN: Cross-sectional survey conducted September 1999 through April 2000. SETTING AND PARTICIPANTS: A total of 856 clients of the Denver Public Health HIV Counseling and Testing Site in Colorado. MAIN OUTCOME MEASURES: Self-report of logging on to the Internet with the intention of finding sex partners; having sex with partners who were originally contacted via the Internet; number of such partners and use of condoms with them; and time since last sexual contact with Internet partners, linked to HIV risk assessment and test records. RESULTS: Of the 856 clients, most were white (77. 8%), men (69.2%), heterosexual (65.3%), and aged 20 to 50 years (84. 1%). Of those, 135 (15.8%) had sought sex partners on the Internet, and 88 (65.2%) of these reported having sex with a partner initially met via the Internet. Of those with Internet partners, 34 (38.7%) had 4 or more such partners, with 62 (71.2%) of contacts occurring within 6 months prior to the client's HIV test. Internet sex seekers were more likely to be men (P<.001) and homosexual (P<.001) than those not seeking sex via the Internet. Internet sex seekers reported more previous STDs (P =.02); more partners (P<.001); more anal sex (P<.001); and more sexual exposure to men (P<.001), men who have sex with men (P<.001), and partners known to be HIV positive (P<.001) than those not seeking sex via the Internet. CONCLUSIONS: Seeking sex partners via the Internet was a relatively common practice in this sample of persons seeking HIV testing and counseling (representative of neither Denver nor the overall US population). Clients who seek sex using the Internet appear to be at greater risk for STDs than clients who do not seek sex on the Internet. JAMA. 2000;284:443-446     

Sexual attitudes and practices of selected groups in Northern Ireland since the emergence of AIDS.

One hundred and seventeen heterosexual males and females attending a sexually transmitted disease clinic and 57 homosexual males from a local "gay" club were asked to complete a questionnaire regarding their attitudes and sexual practices since the emergence of AIDS. The results show a trend towards increasing partner change rate among heterosexual males. There has been an increase in the practice of insertive anal intercourse by homosexual men with Northern Ireland contacts but no corresponding increase with contacts outside Northern Ireland. The practice of receptive anal intercourse has remained constant. Significant differences in attitudes between homosexual and heterosexual males were expressed with regard to testing of 'at risk groups' (p less than 0.001), in the uptake of testing (p less than 0.01), and in attitudes to sexual practices if they themselves became HIV positive. There was a low level of anxiety amongst heterosexuals regarding risk of HIV infection in the future. Less than 50% of the heterosexual patients attending this clinic use condoms, though more claim to intend to use them in future.     

北京市MSMHIV和梅毒感染号性行为影响因素调查

目的了解北京市男男性行为者（Mellwhohavesexwithmen,MSM）与固定和临时男性性伴无保护性肛交的情况及其影响因素。方法于2008年3月巧月,在北京市招募MSM进行问卷访谈,了解其社会人口学、高危行为特征,以及心理状况,并采集血样进行HIV抗体、梅毒抗体、HBsAg和HCV抗体检测。结果共调查550名MSM。近1个月分别有86人（15．6％）和62人（11.3％）与固定和临时男性性伴发生无保护性肛交。多因素logisfic回归分析结果显示。大学本科及以上文化程度（OR=1．70,95％CI：1．06-2．72）和近3个月与男性性伴同居（OR=2．41,95％CI：1．45-4．02）是MSM与固定男性性伴无保护性肛交的影响因素,近3个月男性性伴数≥10人（OR=4．11;95％CI：2．04～8．30）和近1个月感到悲伤（OR=1．82;95％CI：1．04—3．18）是MSM与临时男性性伴无保护性肛交的影响因素。结论北京市MSM无保护性肛交现象较为普遍,HIV和梅毒感染率高,应采取宣传教育、安全套推广等措施以控制HIV等性传播疾病的流行。     

深圳市2011年MSM高危行为特征及梅毒/HIV感染调查

目的了解深圳市男男性行为者高危行为特征及梅毒/HIV感染情况,为今后有针对性地实施有效干预措施提供科学依据。方法知情同意原则下,2011年对深圳市MSM进行问卷调查及抽血检测。结果共762例接受自愿咨询检测,梅毒感染率为17.8%,HIV感染率为7.1%,梅毒合并HIV感染率为3.8%;45.8%性角色以主动为主,23.8%以被动为主,29.5%二者兼有,0.9%很少肛交或多口交;半年内70.8%肛交性伴数≥2个,64.4%口交性伴数≥2个;37.1%半年内肛交时每次使用安全套,4.0%半年内口交时每次使用安全套,27.1%半年内与女性性交时每次使用安全套。结论深圳市MSM人群不安全性行为普遍存在,是梅毒/HIV传播的桥梁人群。     

合肥市青年男男性行为者梅毒和HIV感染状况分析

目的了解合肥市青年男男性行为者(MSM)梅毒和HIV感染状况以及相关的因素,为对该人群进行梅毒与HIV预防干预提供依据。方法采用应答者驱动招募、关键知情人介绍及在MSM网站上发布广告三种方法招募年轻的男男性行为者,进行匿名问卷调查与HIV和梅毒血清学检测。结果202名调查对象平均年龄为20.7岁,大学及以上学历占66.9%,在校学生为62.4%,63.4%的人自认为是同性性取向,26.7%的人自认为是双性性取向。HIV感染率为1.0%,RPR阳性率为7.0%,TPPA阳性率为13.1%。单因素2检验表明,曾进行过HIV检测、一生中肛交同性性伴4个以上与梅毒感染相关,2值分别为10.944与7.696(均P<0.01)。结论年轻的男男性行为者中梅毒感染情况严重,HIV在该人群中流行条件已经具备,急需在该人群中开展性病艾滋病的高危行为干预,尤其要加强大、中学校学生性病艾滋病知识宣传和健康教育。     

HTLV-III/LAV antibody and immune status of household contacts and sexual partners of persons with hemophilia

We evaluated the human T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) antibody and immune status of 88 persons living with and/or sexual partners of 43 hemophiliacs, 12 of whom had AIDS, five of whom had AIDS-related complex (ARC), 17 of whom were clinically well but HTLV-III/LAV antibody positive, and nine of whom were well and HTLV-III/LAV antibody negative. No nonhemophilic household contacts (0/50) of healthy hemophiliacs were HTLV-III/LAV antibody positive; two of 33 nonhemophilic AIDS/ARC contacts were positive. One was a spouse and one a sexual partner of a hemophiliac. One of these antibody-positive contacts herself had AIDS, and one had ARC. Antibody-negative, nonhemophilic contacts of AIDS/ARC and of antibody-positive hemophiliacs had significantly lower numbers of lymphocytes, T helper lymphocytes, and T suppressor lymphocytes than did contacts of antibody-negative hemophiliacs. We conclude that risk of HTLV-III/LAV transmission may exist for spouses and/or sexual contacts of hemophiliacs with AIDS/ARC, but we cannot now determine the risk for contacts of asymptomatic hemophiliacs.     

武汉市同性恋酒吧男男性接触者HIV高危行为的现况调查

目的:描述武汉市男男性接触者HIV高危行为的现状,探讨其影响因素。方法:在武汉市同性恋酒吧对96名男男性接触者进行问卷调查。结果:调查对象中21-30岁年龄段者占41.7%,高中及以上学历者占95.8%,职业以学生、企业职员和公务员为主;50.0%曾与一个女性有过性交,13.5%与1名以上的女性有过性交;44.8%第一次发生男男性关系的年龄在16-18岁。全部调查对象在过去的6个月中有过同性性行为,其中77.1%有过口交行为,87.5%有过肛交行为。结论:武汉市男男性接触者中的HIV相关行为存在高度的危险性。     

Sexual transmission efficiency of hepatitis B virus and human immunodeficiency virus among homosexual men

The relative sexual transmission efficiency of hepatitis B virus (HBV) and human immunodeficiency virus type 1 (HIV-1) was investigated by a prospective study of homosexual men in Pittsburgh, Pa, from the Multicenter AIDS Cohort Study. During the 30-month follow-up, 19.8% and 7.8% of the initially seronegative HBV and HIV-1 groups were estimated to seroconvert to HBV and HIV-1, respectively. The significantly higher cumulative HBV seroconversion rate occurred despite a much lower prevalence of hepatitis B carriers (7% were hepatitis B surface antigen positive) compared with HIV-1 carriers (22% were HIV-1 antibody positive). The sexual exposure profile of HBV and HIV-1 seroconverters was similar during the 6 months prior to seroconversion, supporting the link between anal intercourse and acquisition of either infection. However, insertive, not receptive, anal intercourse was the major risk factor identified for HBV seroconversion, suggesting that transurethral exposure is an important mode of transmission. These data suggest that HBV is transmitted 8.6-fold more efficiently than HIV-1 among homosexual men studied and underscore the benefits of both HBV immunization and use of condoms during intercourse to prevent HBV infection.     

深圳市男男性行为者艾滋病知晓率及异性性行为特征调查

目的了解男男性行为者艾滋病知晓率及异性性行为特征,为有针对性地制定干预措施提供参考依据。方法成立彩虹工作组,开展外展服务,知情同意原则下,填写调查问卷。结果共调查458例,双性恋占42．6％;艾滋病知识知晓率低,风险感知认识薄弱;最近一年曾经和女性发生性行为的比例达26．6％,和自己的配偶或固定女友发生性行为时,多数不用或从来不用安全套的比例较高,与之相反,和不固定非商业性女性或女性性工作者发生性行为时,每次用或多数用安全套的比例较高。结论相当比例的男男性行为者具有双性性行为,起着HIV传播的桥梁作用,应加强健康教育和行为干预。     

性病门诊男男同性恋者艾滋病知识知晓率和性行为调查

目的：对性病门诊就诊的男男同性恋的性行为方式、安全套使用情况、艾滋病相关知识掌握情况等进行问卷调查,以了解该人群的行为特征,为制定相应的健康教育及行为干预提供科学的依据。方法：2009年1月至12月在多家综合医院性病门诊采用自行设计调查问卷对200名就诊MSM（men who have sex with men,男男同性恋）的人口学特征、性行为方式、安全套使用情况、HIV相关知识的掌握程度等进行匿名式问卷调查。结果：被调查者年龄（26.7±8.9）岁,近1年来有121人（62.6%）被确诊过性病。近6个月来,同性性伴侣数为（9.2±4.8）人,102人有异性性伴侣（52.8%）。与同性性交时,123人有肛交行为（63.7%）,117人有口交行为（60.6%）。与异性性交时,92人有阴道交(90.2%), 37人有肛交行为（36.2%）,59人有口交行为（57.8%）。经卡方检验,同性性行为和异性性行为的行构成有统计学差异（P＜0.01）。不同性行为方式安全套使用频率有统计学差异（χ2=188.396, P<0.001）。而人免疫缺陷病毒（human immunodeficiency virus,HIV）相关知识与安全套使用情况分析发现除异性肛交安全套使用与HIV知识得分有线性关系外,其他性行为方式的安全套使用与HIV 知识得分间无线性相关关系。结论：被调查对象艾滋病知识知晓率较高,能够主动通过多种途径获得艾滋病知识,但其HIV相关知识掌握程度与安全套使用频率无明显相关性。MSM在与异性性交时无保护性行为比例高。如何对性病门诊的MSM采取更为有效的方式进行干预以减少其高危性行为值得思考。     

2006-2009年重庆市男男性行为人群HIV感染者情况分析

目的 了解男男性行为人群(man who have sex with men,MSM)人群中HIV感染者的特征及艾滋病相关因素的变化趋势,为MSM人群干预提供针对性的建议.方法 对2006-2009年4次横断面调查发现的HIV感染者的资料进行统计分析,比较趋势变化.结果 2006-2009年发现的HIV感染者呈现低龄化...     

男男性行为者不同性角色HIV/梅毒感染及与相关行为特征的关系研究简

目的了解男男性行为者（MSM）性角色及不同角色艾滋病病毒（HIV）／梅毒感染和相关行为特征。方法对2009年建立的MSM人群开放性研究队列在2010年随访调查基础上进行随访调查,不足基线调查样本部分,采用滚雪球采样法招募补足,应用自行设计制作的调查表,由专门人员面对面进行相关行为学和血清学的匿名调查。结果在有效调查的402例中,0号115例（28．6％）,1号92例（22．9％）,0．5号195例（48．5％）。不同性角色人口学及行为特征关联性的多因素分析,存在独立的统计学／边缘统计学关联的变量：1号与0号相比,年龄、职业、认识当地MSM朋友数、近6月性伴数、同时有过2个及以上固定性伴、习惯携带安全套（P〈0．05或0．05〈P％0．10）;0．5号与0号相比,年龄、职业、近6月无保护性男性肛交、习惯携带安全套;1号与0．5号相比,收入、近6月无保护性男性肛交、同时有2个及以上固定性伴（P〈0．05或0．05〈P〈0．10）。年龄较小、学生／教师／干部职员、认识当地MSM朋友数较多、近6月性伴数较多、不习惯携带安全套的比例0号较多;中低收入、体力劳动、近6月有无保护性男性肛交0．5号比例较高,同时有2个及以上固定性伴者1号较高。生物学检测结果,0号、1号、0．5号HIV累计发病率分别为6．3％、0、7．6％（似然比x2=7．390,P=0．025）,梅毒累计发病率分别为8．0％、2．3％、3．5％（x2=1．985,P=0．371）。结论不同性角色具有不同的人口学、社会网络、性行为特征和HIV感染风险,在艾滋病防治中应针对性开展干预活动。     

男男性接触者艾滋病感染危险因素调查

目的 了解深圳市男男性接触者的艾滋病高危行为厦相关情况。为实施有效的干预措施和制定预防控制对策提供信息和依据。方法 采用匿名问卷形式进行横断面调查和血标本采集。结果 （1）调查对象以青壮年为主，多数人对自己的患病机会认识不足，在安全套使用上存在看认识和行为分离的现象；广泛存在双性性行为和多性件现象。持续使用安全套比例低，肛交行为普遍。（2）梅毒感染率为12．3％；HIV感染率为1．75％。结论 深圳的MSM已经具备了艾滋病流行的条件，应全面深入进行行为干预。以阻断AIDS的二代传播。     

Sex Workers' Sexual Health and Peer Education Project in Goroka, Eastern Highlands Province, Papua New Guinea

We conducted a survey among female sex workers in Goroka, Eastern Highlands Province, Papua New Guinea to evaluate the frequency of sexually transmitted disease (STD) symptoms they suffered, their STD and HIV (human immunodeficiency virus) transmission knowledge and health-seeking behaviours, the forms that their HIV risk perception took, and the types and quantities of educational resources to which they had access and in fact used. This survey was a part of a larger study of sex workers that was carried out in two other cities, Lae, the capital of Morobe Province, and Port Moresby, the nation's capital. We interviewed 190 self-identified female sex workers who had been recruited between January 1999 and October 1999 through peer-mediated contacts. In an average one-week period, the women had intercourse with two customers, two to three times, and one boyfriend once or twice. In the surveyed group, 83% of the women had a history of symptomatic STDs and 73% had gone to an STD clinic for treatment. Of the women who used condoms at all, 7% used them each time they had sex with clients, but only 3% used them each time they had sex with steady partners. The remaining 93% of the women used condoms on some occasions or not at all. Most women (72%) knew about male-female transmission of HIV, but fewer cited other sexual and non-sexual modes of transmission. The majority of the women (71%) felt that they were of low or unknown risk of acquiring HIV infection. When asked where or to whom they would go when concerned about AIDS (acquired immune deficiency syndrome) or STDs, most women (93%) said that they would go to a health care provider. Evaluating the sex workers' understanding of STDs and HIV has been essential in designing education and intervention projects so as better to address the future morbidity and mortality associated with STDs and AIDS.     

MSM人群艾滋病相关KAP调查

目的调查男男性接触者（MSM）艾滋病（AIDS）相关知识态度及高危行为，为针对性地开展MSM人群AJDs防治工作提供依据。方法对山东省济宁市市中区MSM进行不记名问卷调查，所得数据进行统计学分析。结果调查对象年龄中位数为25岁，49．5％的人认为与一个未感染艾滋病病毒的性伴发生性行为能降低艾滋病病毒传播的危险。最近6个月，平均男性性伴数为（6．7±4．4）个。最近一次与男性发生肛交性行为时使用安全套的比例为50．6％。结论MSM人群艾滋病知识还有不足，存在艾滋病传播的高危性行为，应该加强健康教育和行为干预，从而有效的防制MsM人群AIDS的快速蔓延。