Correlates of sexual risk behaviors among HIV-positive men who have sex with men.

This study examines correlates of unprotected sexual risk practices of an ethnically diverse sample of HIV-seropositive men who have sex with men (MSM) from the New York City and San Francisco metropolitan areas. Participants completed a self-report survey that assessed sexual risk behaviors and potential correlates. A total of 367 men reported sex with a casual male partner in the previous 3 months. Participants were divided into three groups based on level of HIV-transmission risk with HIV negative or unknown-status partners: no unprotected anal sex (58.9%), unprotected receptive anal sex only (14.2%), and unprotected insertive anal sex (22.6%). Multivariate logistic regression analyses indicated that men reporting unprotected anal insertive sex perceived less responsibility to protect their partners from HIV. Men reporting no unprotected anal sex also reported less use of nitrate inhalants, lower temptation for unsafe sex, and fewer HIV-negative and unknown-status partners. Men reporting unprotected receptive anal sex were less anxious than the other two groups but also reported greater depression than those not reporting unprotected anal sex and greater loneliness than those reporting unprotected anal insertive sex. Implications for interventions with HIV-positive MSM are presented.     

HIV treatment optimism and sexual risk behaviors among HIV positive African American men who have sex with men

The association between HIV treatment optimism--beliefs about susceptibility to transmit HIV, motivation to use condoms, and severity of HIV--and sexual risk behavior was examined among HIV-positive African American men who have sex with men (MSM). Participants were 174 men recruited in four major metropolitan areas of the United States to participate in a weekend HIV risk reduction intervention. Baseline results revealed that beliefs in less susceptibility to transmit HIV and less motivation to use condoms were significantly associated with more unprotected anal intercourse among serodiscordant casual partners. Less motivation to use condoms also predicted more unprotected insertive and receptive anal sex and was more important than susceptibility beliefs in predicting these behaviors. Suggestions are offered of ways to better inform HIV-positive African American MSM about their misperceptions about HIV treatment and how their level of optimism about HIV treatment may diminish or encourage condom use.     

Risk factors for HIV infection among men who have sex with men

OBJECTIVES: Risk factors for HIV acquisition were examined in a recent cohort of men who have sex with men (MSM). DESIGN: A longitudinal analysis of 4295 HIV-negative MSM enrolled in a randomized behavioral intervention trial conducted in six US cities. METHODS: MSM were enrolled and assessed for HIV infection and risk behaviors semi-annually, up to 48 months. RESULTS: In multivariate analysis, men reporting four or more male sex partners, unprotected receptive anal intercourse with any HIV serostatus partners and unprotected insertive anal intercourse with HIV-positive partners were at increased risk of HIV infection, as were those reporting amphetamine or heavy alcohol use and alcohol or drug use before sex. Some depression symptoms and occurrence of gonorrhea also were independently associated with HIV infection. The attributable fractions of high number of male partners, use of alcohol or drugs before sex, and unprotected receptive anal intercourse with unknown status partners and the same with presumed negative partners accounted for 32.3, 29.0, 28.4 and 21.6% of infections, respectively. CONCLUSIONS: The challenge is to develop strategies to identify men in need. Interventions are needed to help men reduce their number of sexual partners, occurrences of unprotected anal intercourse, alcohol or drug use before sex and address other mental health issues.     

东北某地男同性恋者性行为及HIV感染流行病学研究

目的 了解男同性恋者HIV感染的流行状况及潜在危险因素。方法 采用匿名横断面调查设计,对进出酒吧的男同性恋者进行问卷调查,并收集尿液进行HIV抗体检测。结果 共收集尿液标本153份,其中2例经尿ELISA初筛及尿WB确认试剂检测均为阳性,HIV感染率为1.31％。首次性行为年龄中位数为18岁。所有调查对象均与男性发生过性行为,67.1％的调查对象既与男性又与女性发生过性行为。89.9％（18/208）的调查对象在半年内有肛交性行为,无保护肛交性行为的发生率为 84.5％。79.8％在近半年内肛交时曾主动插入过对方,58.7％曾接受过对方插入。31.9％的调查对象有性病史。多因素分析显示有性病史者肛交时安全套使用率显著低于无性病史者,OR值为13.5,95％CI为1.75～103.50。结论 同性恋人群中已经有较高的HIV感染率,并且艾滋病相关的危险行为普遍存在,如不采取有效措施加强控制,艾滋病极有可能在同性恋人群中广泛流行。     

High levels of unprotected sex with men and women among men who have sex with men: a potential bridge of HIV transmission in Beijing, China.

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). We investigated sexual risk, risk perception, HIV and condom knowledge, and utilization of prevention services in the first large sample of MSM recruited in Beijing. Four hundred eighty-two MSM were sampled from September 2001 to January 2002. Forty-nine percent of participants reported unprotected anal intercourse with men during the previous 6 months. However, only 15% perceived they are at risk for HIV and many had misconceptions about HIV transmission routes and limited knowledge about condoms. Less than one quarter obtained free condoms (24%) and condom lubricants (19%) in the past 2 years. Multiple logistic regression analysis showed that unprotected insertive anal intercourse was associated with not having a Beijing residence card, having six or more male sexual partners, not having sex with women, having a lifetime history of sexually transmitted diseases (STDs), and having never tested for HIV. Unprotected receptive anal intercourse was independently associated with having six or more male sexual partners, not having sex with women, having a lifetime history of STDs, having never tested for HIV, and having less exposure to HIV prevention services. In addition, 28% reported having sex with both men and women during the previous 6 months, and 11% had unprotected intercourse with both men and women. This finding suggests that MSM are a potential bridge of HIV transmission to heterosexual women (or vice versa) and that addressing the HIV prevention needs of MSM may benefit the wider population.     

The pleasure principle: the effect of perceived pleasure loss associated with condoms on unprotected anal intercourse among immigrant Latino men who have sex with men

Sexual pleasure has been identified as an important consideration in decision-making surrounding condom use. We examined the impact of perceived pleasure loss associated with condom use on recent history of insertive and receptive unprotected anal intercourse (UAI) among Latino men who have sex with men (MSM) living in the United States. A total of 482 Dominican, Colombian, and Brazilian immigrant MSM were surveyed regarding sexual attitudes and practices via computer-assisted self-interviewing technology with audio enhancement (ACASI). Participants rated the pleasure they derived from protected and unprotected anal intercourse in each position (insertive and receptive) and also reported their HIV status, relationship status, and recent sexual history. Men who had engaged in both positions, with and without condoms (n=268), perceived a greater pleasure loss associated with condoms during anal intercourse in the insertive versus receptive position. Logistic regression analyses controlling for HIV status, relationship status, and age revealed that men who perceived greater pleasure loss from condoms were more likely to have engaged in UAI over the past 3 months (n[insertive]=297; n[receptive]=284). Findings indicate that the pleasure loss associated with condoms may be a key deterrent for their use in either sex position among Latino MSM. Therefore, pleasure needs to be prioritized in the development of condoms and other sexual safety measures as well as in the promotion of their use.     

In a minority of gay men,sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex

The aim of this analysis was to examine gay men's sexual risk practice to determine patterns of risk management. Ten cross-sectional surveys of gay men were conducted six-monthly from February 1996 to August 2000 at Sydney gay community social, sex-on-premises and sexual health sites (average n = 827). Every February during this period, five identical surveys were conducted at the annual Gay and Lesbian Mardi Gras Fair Day (average n = 1178). Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with a serodiscordant regular partner, there was a clear pattern of sexual positioning. Few regular couples were both receptive and insertive. Most HIV-positive men were receptive and most HIV-negative men were insertive. Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with casual partners, there was also a pattern of sexual positioning. Whereas many casual couples were both receptive and insertive (especially those involving HIV-positive respondents), among the remainder HIV-positive men tended to be receptive and HIV-negative men tended to be insertive. These patterns of HIV-positive/receptive and HIV-negative/insertive suggest strategic risk reduction positionings rather than mere sexual preferences among a minority of gay men. If so, they point not to complacency but to an ever more complex domain of HIV prevention.     

A new meeting place: chatting on the Internet, e-dating and sexual risk behaviour among Dutch men who have sex with men

OBJECTIVE: To describe the process of Internet chatting, and subsequent dating and sexual (risk) behaviour among Dutch men who have sex with men (MSM), and to compare the demographic profile of the Internet sample with a traditional Dutch MSM sample. DESIGN: A self-selected anonymous Internet sample. METHODS: Enrolment via a prominent gay chat room. Potential respondents were asked to complete an online questionnaire about chatting and dating, and sexual (risk) behaviour with their last date via chatting (e-date). In 26 days, 5302 questionnaires were returned. Of these, 4984 were evaluated as reliable and were used in the analyses. RESULTS: Eighty-two per cent chatted at least once a week, 88% had ever dated through chatting, and of these 89% had had sex with one or more e-dates. With respect to the last e-date, almost 50% had had anal sex with their last e-date, and 15% reported unprotected anal sex. Especially among HIV-positive men, a high percentage of unprotected anal sex was reported (39%). After correcting for the disclosure of HIV status, this percentage remained twice as high compared with HIV-negative and never-tested men (28 versus 14%). Compared with a traditional MSM sample, the Internet sample was significantly younger, and comprised more non-Dutch and bisexual men, whereas the level of sexual risk behaviour with casual partners was comparable. CONCLUSION: The Internet is a popular new meeting place for MSM, and attracts men with a different demographic profile. The level of risk behaviour warrants that opportunities for interventions on the Internet are explored, with special attention to HIV-positive chatters.     

MSM中HIV阳性者性行为特征及其影响因素的研究进展

男男性行为人群(Men who have sex with men,MSM)艾滋病病毒(Human immunodeficiency virus,HIV)阳性者的性行为和心理特征,与一般的MSM有显著差异,他们的不安全性行为仍然广泛存在,但更倾向于寻找阳性性伴,并选择被动肛交方式来"自我降低传播风险"。针对这一群体的特点,艾滋病防控重点,应该重在阻止二代传播,提高感染者生活质量。     

HIV risk behaviour among gay and bisexual men in Budapest, Hungary

HIV is a growing public health threat in Central and Eastern Europe. In Hungary and a number of other countries, men who have sex with men (MSM) account for a high proportion of HIV infections. However, there has been very little systematic study of the sexual risk practices and characteristics of MSM in this region. This study surveyed 469 MSM recruited in Budapest gay community venues in June 2001. Half the men (50%) engaged in unprotected anal intercourse (UAI) in the past 3 months. Of these, 40% of men's insertive and 50% of their receptive acts were unprotected, and 25% had multiple AI partners in the past 3 months. 17% of MSM exchanged sex for money, 26% had female partners in the past year, and condoms were used in only 23% of their vaginal intercourse occasions. Multivariate analyses showed that high-risk behaviour was predicted by not having condoms available when needed, weak risk reduction intentions, negative attitudes toward safer sex, being in a steady relationship, and having a bisexual orientation. Community-based HIV prevention programmes focused on the needs of gay or bisexual men in Central and Eastern Europe are urgently needed.     

HIV testing and sexual risks among migrant men who have sex with men: findings from a large cross-sectional study in Beijing,China

Despite the exacerbating HIV transmission among migrant men who have sex with men (MSM) in China, few epidemiological studies explore their HIV testing/risk profiles. We sought to explore sociodemographic/behavioral correlates of HIV/syphilis and HIV testing among migrant MSM. A study was conducted among 3,588 HIV-uninfected MSM. Participants were recruited via short message services, peer referral, web-advertisement and community outreach. HIV/syphilis infections were lab-confirmed. Migrant MSM were more likely to be HIV-infected compared to local MSM. Among 2,699 migrant MSM, HIV testing was associated with older age, living longer in Beijing, having ≥10 lifetime male sexual partners (LMSPs), having insertive anal sex; while being unemployed/retired and having condomless receptive anal sex (CRAS) were associated with a lower odds of HIV testing. Being married, living longer in Beijing, ever testing for HIV and having sex with women were associated with lower HIV odds; while being unemployed/retired, having higher HIV perception, having ≥ 10 LMSPs and having CRAS were associated a higher HIV odds. Increased likelihood of syphilis was associated with older age, being employed, higher HIV perception, having ≥10 LMSPs and having CRAS. Our study provides implications for targeted interventions to tackle HIV/STI risks and improve HIV testing among migrant Chinese MSM.     

Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men

OBJECTIVE: To determine whether attitudes towards highly active antiretroviral therapy (HAART) are associated with unprotected anal sex among sexually active homosexual men. DESIGN: Cross-sectional study nested within an ongoing prospective cohort study. SETTING: Multicenter AIDS Cohort Study, from April through September 1999. PARTICIPANTS: Five-hundred and forty-seven homosexual men reporting anal sex (218 HIV-negative and 329 HIV-positive) during study interviews in 1999, including a 20-item validated scale on attitudes toward HAART and HIV risk behaviors (e.g., 'Because of HAART, I am less concerned about becoming HIV-infected or infecting someone'), and safer sex fatigue (e.g., 'I am tired of always having safer sex'). MAIN OUTCOME MEASURES: Self-reported unprotected receptive anal sex (RAS) and insertive anal sex (IAS) in the prior 6 months. RESULTS: More than 50% of HIV-negative and HIV-positive men who reported having anal sex also reported recent unprotected RAS and/or IAS. HIV-negative men who most agreed that HAART reduced concern about becoming infected were more likely to report unprotected RAS compared to other HIV-negative men [adjusted odds ratio (AOR), 3.31; 95% confidence interval (CI), 1.27-8.62]. Moreover, HIV-positive men with greatest reduced concern due to HAART or safer sex fatigue were more likely to report unprotected IAS (AOR, 6.05; 95% CI, 2.24-16.63 and AOR, 4.57; 95% CI, 1.70-12.24, respectively) compared to other HIV-positive men. CONCLUSIONS: Among sexually active homosexual men, lessened concern about HIV transmission due to HAART was strongly associated with sexual risk taking, as was safer sex fatigue among HIV-positive men. Prevention programs should take into account underlying attitudes for unprotected sex in the era of HAART among both HIV-infected and uninfected men.     

Factors associated with sexual problems in HIV-positive gay men

Our objective was to determine factors associated with sexual problems in a sample of HIV-seropositive gay male clinic patients. Using a cross-sectional survey design a volunteer sample of 78 outpatient HIV-seropositive gay male service users completed a self-report questionnaire. This examined sexual problems, their perceived causes and associated factors including demographics, health status, sexual behaviour, self-justifications for sexual risk-taking and mood state (Hospital Anxiety and Depression Scale). Fifty (69%) of 78 HIV-positive gay men reported one or more sexual problems. Erectile dysfunction (ED) was reported by 38% rising to 51% in the context of trying to use condoms. Loss of interest in sex was reported by 41% and 24% experienced delayed ejaculation. The presence of sexual problems affected condom use in that 33 (90%) of the 37 gay men who had ED associated with condom use were inconsistent condom users in insertive sex compared to 28% of those not having this type of ED (P < 0.001). The presence of ED did not reduce the frequency of anal intercourse but those with ED associated with condoms were significantly more likely to have had receptive anal sex in the past three months (62%) compared to men without ED with condoms (38%) (P = 0.05). Risk cognitions such as wanting to lose oneself in sex, leaving responsibility for condom use to the active partner and perceptions that condoms interfere with pleasure were significantly more likely to be endorsed by those who report ED with condoms. Other factors associated with sexual problems included low T-cell counts (i.e. < 200). Psychological explanations were the most frequently cited causes of sexual problems, whether alone or in interaction with HIV disease itself, and combination therapy. A high incidence of sexual problems was found amongst this sample of HIV-positive gay men. Untreated sexual dysfunctions may contribute to sexual risk-taking and therefore HIV clinics need to address both issues. Further research is required to better understand the role of psychological factors, HIV disease itself and combination therapy in the incidence and treatment of sexual problems.     

Seroadaptation in a Sample of Very Poor Los Angeles Area Men Who Have Sex with Men

Data from 635 very poor men who have sex with men (MSM) were used to identify seroadaptation with 1,102 male partners reported between 2005 and 2007 in Los Angeles as part of the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program. The mean age of the sample was 41.7 years; 53 % had experienced homelessness in the past year. Condoms were reported in 51 % of sexual events involving anal intercourse. HIV seroconcordance was reported in 41 % of sexual partnerships among HIV-positive participants. HIV-positive men were more likely to have oral-only or unprotected receptive anal intercourse and less likely to have unprotected insertive anal intercourse with HIV-negative or unknown partners compared to HIV-positive partners. Even in the face of poverty, HIV-positive MSM report mitigating risks of HIV-transmission though seroadaptation in the context of modest rates of condom use.     

Urine-based asymptomatic urethral gonorrhea and chlamydia screening and sexual risk-taking behavior in men who have sex with men in greater Boston

To assess the prevalence of asymptomatic urethral gonorrhea and chlamydia men who have sex with men (MSM) living in greater Boston, 206 men attending routine medical appointments consented to urine-based chlamydia and gonorrhea screening using urine LCR amplification. Of those screened, 201 patients also completed a seven-question survey to assess sexual risk behaviors associated with urethral sexually transmitted infections. Less than 1% of the asymptomatic patients screened tested positive for urethral chlamydia; none tested positive for urethral gonorrhea. Forty-eight percent reported multiple sexual partners in the 30 days prior to screening, with HIV-infected patients reporting fewer partners and less unprotected insertive anal sex than HIV-uninfected patients. Almost 25% of patients screened used the Internet in the 30 days prior to screening to find a sexual partner. Internet use was associated with increased numbers of sexual partners in the 30 days prior to screening. Findings suggest that asymptomatic urethral chlamydia and gonorrhea may be uncommon in MSM living in the greater Boston area and that the recent rise in the prevalence of sexually transmitted infections may not be due to untreated asymptomatic infections. Increased awareness of STD symptoms among patients and medical providers is critical to timely diagnosis and treatment of STDs in MSM.     

八城市男男性行为人群不同性角色高危行为及HIV梅毒 生殖器疱疹感染状况分析

目的了解中国八个城市男男性行为人群(MSM)中,不同性角色的人口学、性行为特点,以及艾滋病病毒(HIV)、梅毒、Ⅱ型生殖器单纯疱疹(HSV-2)的感染状况,分析其影响因素,为开展针对性的干预活动提供信息。方法采用分类滚雪球法招募MSM,使用统一的问卷调查人口学、行为学信息,并采集静脉血液进行血清学检测。采用χ2检验对比不同性角色的一般情况、性行为特征以及HIV、梅毒、HSV-2感染率,使用SPSS Statistics进行统计学分析。结果共调查MSM 3 509人,其中262人过去6个月未发生过肛交性行为,20人未回答性角色情况,实际将符合条件的3 227名MSM纳入分析。按过去6个月肛交中性行为角色分为3组,仅有主动插入行为(简称1号);仅有被动插入行为(简称0号);既有主动插入,又有被动插入行为(简称0.5号)。1号组983人(30.5%),0号组621人(19.2%),0.5号组1 623人(50.3%)。三组在最近6个月的男性性伴人数、安全套使用频率、与男性买卖性史、与女性有性交史上差异有统计学意义(P<0.01)。在最近一次肛交安全套使用率、毒品使用史、包皮环切史方面,三组间差异无统计学意义(P=0.413,P=0.348,P=0.105)。0号组HIV感染率为12.2%(95%CI:9.7%～14.8%),0.5号组10.3%(95%CI:8.8%～11.8%),1号组最低为4.4%(95%CI:3.1%～5.7%),三组间差异有统计学意义(P<0.001)。梅毒的感染率1号、0.5号、0号三组比较接近(10.0%、10.6%、10.9%),差异无统计学意义(P=0.279)。HSV-2感染率0号组最低(8.1%),1号组居中(10.5%),0.5号组最高(11.8%),三组的差异有统计学意义(P=0.038)。结论 MSM不同性角色人群在行为学特征上的差异,使其在感染性病艾滋病的风险上不同,应根据各自的特点,开展针对性的干预措施。     

Bisexual and Bidirectional: Assessing the Potential for HIV Bridging in Mozambique

African men who have sex with men (MSM) frequently, and often concurrently, have female partners, raising concerns about HIV sexual bridging. We explored potential HIV transmission in Mozambique from and to female partners of MSM focusing on preferred anal sex role and circumcision status. Data collected in a respondent-driven sampling study of MSM in 2011 in Maputo and Beira. Men who had oral or anal sex with other men 12 months prior completed a questionnaire and consented for HIV testing. Statistical analysis explored demographic/risk characteristics and associations among circumcision status, anal sex with men, sexual positions during anal sex with men and vaginal or anal sex with women. We identified 326 MSM in Maputo and 237 in Beira with both male and female partners 3 months before the study. Of these, 20.8% in Maputo and 36.0% in Beira had any receptive anal sex with men 12 months prior, including 895 unprotected sexual acts with males in Maputo and 692 in Beira. Uncircumcised and exclusively insertive males, 27.7% of the sample in Maputo and 33.6% in Beira, had the most unprotected sex with females: 1159 total acts in Maputo and 600 in Beira. Sexual bridging between MSM and women likely varies geographically and is probably bi-directional, occurring within a generalized epidemic where HIV prevalence is higher among reproductive-age women than MSM. Prevention strategies emphasizing correct and consistent condom use for all partners and circumcision for bisexual men should be considered.     

HIV risk among men who have sex with men who have experienced childhood sexual abuse: systematic review and meta-analysis

Previous research has indicated a high prevalence of childhood sexual abuse (CSA) among men who have sex with men (MSM) in the United States, and has suggested that CSA history is a risk factor for HIV infection in MSM. We conducted a systematic review to identify, synthesize, meta-analyze, and critique the current state of relevant literature. Systematic review methodology was utilized to identify 12 studies that compared MSM with a history of CSA to MSM without a history of CSA on HIV risk indicators including HIV serostatus, sexually transmitted infections (STIs), sexual behaviors, and illicit drug use. Overall, 27.3% (n = 4,263) of the MSM in all included studies (n = 15,622) reported a CSA history. Across the studies that used probabilistic sampling (n = 8,240), the estimated prevalence of CSA was 21.8% (n = 1,800). Meta-analysis indicated that MSM with CSA history were more likely to be HIV positive [odds ratio (OR) = 1.54; 95% confidence interval (CI) = 1.22-1.95)] and to engage in recent unprotected anal intercourse (OR = 1.85, 95% CI = 1.36-2.51). Studies also indicated that MSM with a history of CSA were more likely to report frequent casual male partners, substance use, and sex while under the influence of alcohol or other drugs. Trends across studies indicated a need for interventions to assess CSA history and address effects of CSA on sexual risk behavior of MSM. Inconsistencies across studies indicated a need to reach consensus among researchers and providers in defining CSA.     

Alcohol and Sexual HIV Risk Behavior Among Problem Drinking Men Who Have Sex With Men: An Event Level Analysis of Timeline Followback Data

While heavy drinking among men who have sex with men (MSM) has been shown to be associated with an increase in sexual risk taking, a temporal relationship between drinking and an increase in subsequent HIV risk behaviors among adult samples has been less obvious. This study used an event level analysis to examine this relationship among HIV negative problem drinking MSM. Within subjects analyses show a higher probability of unprotected anal intercourse after drinking. Post-hoc analyses of within subjects data indicate that drinking increases risk taking when engaging in receptive anal intercourse but not for insertive anal intercourse. Findings from this study support evidence that drinking is a factor that increases risk taking among HIV negative problem drinking MSM, particularly for receptive anal intercourse.     

Risk behaviour and HIV prevalence among men who have sex with men in a multiethnic society: a venue-based study in Kuala Lumpur, Malaysia

This research aimed to determine HIV prevalence, risk behaviour and knowledge of transmission methods among men who have sex with men (MSM) in Kuala Lumpur, Malaysia. Venue-day-time sampling (VDTS) was applied to identify venues where men congregate to solicit sex from other men. Participants recruited from clubs, massage parlours, saunas and one park self-completed a computerized behavioural questionnaire, were administered an oral rapid HIV test and given the opportunity to return later to receive full counselling and learn their HIV status. A total of 517 men were enrolled into the study. The majority were Malays (47.0%) and Chinese (43.7%). Twenty tested HIV positive (3.9%). Significant predictors of HIV infection included having unprotected anal sex with a casual partner (44.9% of participants, odds ratio [OR] = 2.99; 95% confidence interval [CI] 1.13-7.90; P = 0.027), having unprotected receptive anal sex (27.9%, OR = 2.71; 95% CI 1.10-6.54; P = 0.030) and having group sex (33.3%, OR = 3.95; 95% CI 1.55-10.09; P = 0.004). One in five participants (20.1% and 19.5%) did not believe that HIV could be transmitted through insertive or receptive anal sex, respectively. Risk behaviour is high and knowledge of HIV transmission methods was low among MSM in Kuala Lumpur. Future prevention efforts should focus on providing risk reduction education to this community.