HIV-testing behavior among young migrant men who have sex with men (MSM) in Beijing, China

Previous studies suggested a rapid increase of HIV prevalence among men who have sex with men (MSM) in China in recent years, from 0.4% in 2004 to 5.8% in 2006. However, some MSM had never been tested for HIV. In order to expand the accessibility to HIV testing, understanding HIV-testing behavior and barriers among MSM is important. Using data collected from 307 young migrant MSM (aged 18-29 years) in 2009 in Beijing, we aimed to identify psychological and structural barriers to HIV testing. MSM were recruited through peer outreach, informal social networks, Internet outreach, and venue-based outreach. Participants completed a confidential self-administered questionnaire. Results show that about 72% of MSM ever had an HIV test. Logistic regression analysis indicated that the HIV-testing behavior was associated with sexual risk behaviors (e.g., multiple sexual partners and inconsistent condom use for anal sex) and history of sexually transmitted diseases. Eighty four MSM (28%) who never had an HIV test reported that the psychological barriers mainly were perceived low risk of HIV infection and fears of being stigmatized. The structural barriers reported inconvenience of doing test and lack of confidentiality. Future HIV prevention programs should be strengthened among MSM to increase their awareness of HIV risk. Efforts are needed to increase access to quality and confidential HIV testing among MSM and reduce stigma against MSM.     

Bisexual behavior and infection with HIV and syphilis among men who have sex with men along the east coast of China

This study examined the correlates of bisexual behavior and infection with HIV/syphilis among men who have sex with men only (MSM-only) and those who have sex with both men and women (MSMW) in Shandong, China. Cross-sectional surveys probed sociodemographic information, sexual and drug use behaviors, knowledge, and use of prevention services; blood samples were tested for HIV/syphilis status. Of 2996 participants, 39.5% acknowledged being MSMW; 60.5% being MSM-only; 2.5% were HIV-infected with similar rates for MSMW (2.5%) and MSM-only (2.6%); 5.5% syphilis-infected with comparable rates for MSMW (5.6%) and MSM-only (5.5%). In multivariable models, MSMW were more likely than MSM-only to be older, local residents, recruited from outdoor cruising area, drug users, and less likely to have used a condom during last anal sex with a male partner. HIV-infected MSMW were more likely to have syphilis and other sexually transmitted diseases (STDs) and less likely to have received peer education. HIV-infected MSM-only were more likely to be older, nonlocal residents, and have syphilis and other STDs. MSMW with syphilis were more likely to be recruited from Jinan, Qingdao, and Zibo (versus Yantai), infected with HIV, and less likely to have received lubricant promotion. MSM-only with syphilis were more likely to be recruited from Jinan and Qingdao (versus Yantai), drug users, infected with HIV, and have had sex with male partners in the past 6 months. High prevalence of bisexual behavior and HIV/other STDs with common unprotected sex and multiple sexual partners among Shandong's gay community revealed in this study highlighted the importance of bisexuals as a potential epidemiologic bridge. Further research is needed to investigate the impact of bisexual behaviors on population transmission.     

Space: the new frontier in HIV prevention for young men who have sex with men.

Young men who have sex with men (MSM) in urban areas of the United States continue to be vulnerable to HIV infection. Qualitative data collected with participants in a community level HIV intervention in West Hollywood and Orange County, California, suggest that space -- both actual physical space and the concept of having space -- should be an integral part of an HIV prevention intervention for young MSM. Having such spaces appears to contribute to youth sense of empowerment and efficacy and foster community building, all important components of an effective HIV prevention. Data were drawn from a qualitative research sample of 73. Through narratives, young men describe specific characteristics of the space necessary for effective HIV intervention, including mentoring and supportive staff, tolerant and like-minded peers, information exchange, opportunities for strengthening self-esteem, and a sense of collaborative community invested in social change.     

Social and structural risks for HIV among migrant and immigrant men who have sex with men in Moscow,Russia: Implications for prevention

Moscow has a large population of immigrants and migrants from across the Former Soviet Union. Little is studied about men who have sex with men (MSM) within these groups. Qualitative research methods were used to explore identities, practices, and factors affecting HIV prevention and risks among immigrant/migrant MSM in Moscow. Nine interviews and three focus group discussions were conducted between April–June 2010 with immigrant/migrant MSM, analyzed as a subset of a larger population of MSM who participated in qualitative research (n=121). Participants were purposively selected men who reported same sex practices (last 12 months). Migrants were men residing in Moscow but from other Russian regions and immigrants from countries outside of Russia. A socioecological framework was used to describe distal to proximal factors that influenced risks for HIV acquisition. MSM ranged from heterosexual to gay-identified. Stigma and violence related to homophobia in homelands and concerns about xenophobia and distrust of migrants in Moscow were emerged as key themes. Participants reported greater sexual freedom in Moscow but feared relatives in homelands would learn of behaviors in Moscow, often avoiding members of their own ethnicity in Moscow. Internalized homophobia was prevalent and linked to traditional sexual views. Sexual risks included sex work, high numbers of partners, and inconsistent condom use. Avoidance of HIV testing or purchasing false results was related to reporting requirements in Russia, which may bar entry or expel those testing positive. HIV prevention for MSM should consider immigrant/migrant populations, the range of sexual identities, and risk factors among these men. The willingness of some men to socialize with immigrants/migrants of other countries may provide opportunities for peer-based prevention approaches. Immigrants/migrants comprised important proportions of the MSM population, yet are rarely acknowledged in research. Understanding their risks and how to reach them may improve the overall impact of prevention for MSM and adults in Russia.     

Binge use of methamphetamine among HIV-positive men who have sex with men: pilot data and HIV prevention implications.

This study compared the social and behavioral characteristics of binge users and nonbinge users of methamphetamine (meth) in a sample of 90 HIV-positive men who have sex with men. Forty-one participants (46%) self-identified as a binge user. Meth binges ranged from 2 to 33 days (mean = 5.6), and average consumption was 3.1 grams. Binge users were significantly more likely than nonbinge users to be ethnic minority and to have lower education. The two groups did not differ in terms of the total amount of meth used in the past 30 days; however, binge users reported significantly more social difficulties, more mental and physical health problems, and more sexual risk behaviors as compared with nonbinge users. The findings are discussed in relation to drug treatment approaches and the development of behavioral interventions.     

Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men.

Psychological depression has been identified as a condition that may influence HIV risk behavior among injection drug users (IDUs) and men who have sex with men (MSM). In two Seattle studies, 1,228 IDUs and 429 young MSM completed the Center for Epidemiologic Studies Depression Scale (CES-D); the relationship between depression and injection and sexual risk behavior was assessed using logistic regression analysis. Forty-seven percent of IDUs had CES-D scores > or = 23; a high score was significantly related to injection with a syringe used by another IDU (adjusted odds ratio 1.4) but not other injection risk behavior. Among MSM, CES-D scores > or = 16 were related to reporting 3 or more sex partners in the last 6 months but not to other sexual risk behavior. This analysis suggests that psychological depression may influence certain HIV risk behavior in young MSM and IDUs, and that interventions addressing depression may be indicated.     

HIV risk and prevention among men who have sex with men in rural South Africa

Rural South African men who have sex with men (MSM) are likely to be underserved in terms of access to relevant healthcare and HIV prevention services. While research in urban and peri-urban MSM populations has identified a range of factors affecting HIV risk in South African MSM, very little research is available that examines HIV risk and prevention in rural MSM populations. This exploratory study begins to address this lack by assessing perceptions of HIV risk among MSM in rural Limpopo province. Using thematic analysis of interview and discussion data, two overarching global themes that encapsulated participants’ understandings of HIV risk and the HIV risk environment in their communities were developed. In the first theme, “community experience and the rural social environment”, factors affecting HIV risk within the broad risk environment were discussed. These included perceptions of traditional value systems and communities as homophobic; jealousy and competition between MSM; and the role of social media as a means of meeting other MSM. The second global theme, “HIV/AIDS knowledge, risk and experience”, focused on factors more immediately affecting HIV transmission risk. These included: high levels of knowledge of heterosexual HIV risk, but limited knowledge of MSM-specific risk; inconsistent condom and lubricant use; difficulties in negotiating condom and lubricant use due to uneven power dynamics in relationships; competition for sexual partners; multiple concurrent sexual partnerships; and transactional sex. These exploratory results suggest that rural South African MSM, like their urban and peri-urban counterparts, are at high risk of contracting HIV, and that there is a need for more in-depth research into the interactions between the rural context and the specific HIV risk knowledge and behaviours that affect HIV risk in this population.     

Correlates of high-risk sexual behavior among young men who have sex with men.

Data from a sample (n = 154) of young men who have sex with men (YMSM), aged 13-21, residing in five mid-sized cities in the midwestern United States were used to test the hypothesis that personality variables (impulsive decision making, sensation seeking, anxiety/depression, internalized homophobia) contribute uniquely to the prediction of unprotected anal sex beyond what is accounted for by other high-risk behaviors (i.e., substance use and number of sex partners) and partner status (having a dating partner). Results of hierarchical regression analyses indicated that number of reported anal sex partners and partner status were positively associated with self-reported frequency of unprotected anal sex. Beyond these factors, impulsive decision making significantly contributed to the predictive model. These findings indicate that designing effective prevention programming for YMSM should take into consideration relationship status and the impulsiveness of sexual decision making among members of the target group.     

Peer referral for HIV case-finding among men who have sex with men

OBJECTIVE: To evaluate the effectiveness and cost-effectiveness of a health department-based peer referral program for identifying previously undiagnosed cases of HIV among men who have sex with men (MSM). DESIGN AND METHODS: Between 2002 and 2005, 283 MSM peer recruiters were enrolled in a public health program in King County, Washington, USA. Peer recruiters were enrolled from a sexually transmitted disease (STD) clinic, an HIV clinic, via media advertisements and through collaboration with community-based organizations (CBO). The peer recruiters underwent a brief training and were then paid US$ 20 for each peer they referred to be tested for HIV, STD and viral hepatitis. Peers were paid US$ 20 for being tested. The main outcome measure was the number of new cases of HIV identified and cost per case of HIV identified. RESULTS: Recruiters referred 498 peers for HIV, STD and hepatitis testing. Among 438 peers not previously diagnosed with HIV, 22 (5%) were HIV positive, of whom 18 received their HIV test results. Other infections were variably prevalent among tested peers: gonorrhea [23/307 (8%)], chlamydia [6/285 (2%)], syphilis [1/445 (0.2%)], hepatitis C [61/198 (31%)], surface antigen positive hepatitis B [8/314 (3%)]. Excluding the costs of testing for viral hepatitis and STDs other than HIV, the cost per new HIV case identified was US$ 4929. During the same period, the cost per new case of HIV detected through bathhouse-based HIV testing and through the county's largest CBO-based HIV testing program were US$ 8250 and US$ 11 481, respectively. CONCLUSIONS: Peer referral is an effective means of identifying new cases of HIV among MSM.     

Evaluation of a social network HIV prevention intervention program for young men who have sex with men in Russia and Bulgaria.

HIV prevention, by intervening within social networks, is potentially important but highly understudied. Approaches that systematically identify, train, and enlist known social influence leaders to advise members of their own networks in risk reduction constitute ways to reach hidden population segments, persons who are distrustful of authorities but trust their peers, and those who cannot be reached through traditional professionally delivered counseling. This article illustrates and provides evaluation data on a program that recruited 14 intact social networks of young men who have sex with men (YMSM) in St. Petersburg, Russia, and Sofia, Bulgaria. Sociometric measures were used to identify the social leader of each network, and baseline risk assessment measures were administered to all members of each social network. The sociometrically determined leaders then attended a six-session group program that provided training and guidance in how to carry out theory-based and tailored HIV prevention conversations with members of their own social networks. Four months after leaders completed the program, all network members were readministered risk assessment measures. Pre- to postintervention data revealed that the program produced: (1) increases in the level and comfort with which network members talked about AIDS prevention topics in their daily conversations; (2) increased network-level AIDS risk reduction knowledge and improved risk reduction norm perceptions, attitudes, behavioral intentions, and self-efficacy; and (3) increased condom use levels among network members. Although not a controlled, randomized trial, these program evaluation findings strongly support the feasibility of social network-level HIV prevention approaches.     

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.     

Missed opportunities for HIV testing in health care settings among young African American men who have sex with men: implications for the HIV epidemic

Limited health care access and missed opportunities for HIV and other sexually transmitted infection (STI) education and testing in health care settings may contribute to risk of HIV infection. In 2008, we conducted a case-control study of African American men who have sex with men (MSM) in a southeastern city (Jackson, Mississippi) with an increase in numbers of newly reported HIV cases. Our aims were to evaluate associations between health care and HIV infection and to identify missed opportunities for HIV/STI testing. We queried 40 potential HIV-infected cases and 936 potential HIV-uninfected controls for participation in this study. Study enrollees included HIV-infected cases (n=30) and HIV-uninfected controls (n=95) who consented to participate and responded to a self-administered computerized survey about sexual risk behaviors and health care utilization. We used bivariate analysis and logistic regression to test for associations between potential risk factors and HIV infection. Cases were more likely than controls to lack health insurance (odds ratio [OR]=2.5; 95% confidence interval [CI]=1.1-5.7), lack a primary care provider (OR=6.3; CI=2.3-16.8), and to not have received advice about HIV or STI testing or prevention (OR=5.4; CI=1.3-21.5) or disclose their sexual identity (OR=7.0; CI=1.6-29.2) to a health care provider. In multivariate analysis, lacking a primary health care provider (adjusted odds ratio [AOR]=4.5; CI=1.4-14.7) and not disclosing sexual identity to a health care provider (AOR=8.6; CI=1.8-40.0) were independent risk factors for HIV infection among African American MSM. HIV prevention interventions for African American MSM should address access to primary health care providers for HIV/STI prevention and testing services and the need for increased discussions about sexual health, sexual identity, and sexual behaviors between providers and patients in an effort to reduce HIV incidence and HIV-related health disparities.     

Communication technology use and mHealth acceptance among HIV-infected men who have sex with men in Peru: implications for HIV prevention and treatment

The HIV epidemic in Peru is concentrated among men who have sex with men (MSM). Given that MSM have been documented as early adopters of emerging technology, we examined communication technology access and utilization, and mobile health (mHealth) acceptance among Peruvian MSM and transgender women (TGW) in order to gauge opportunities for mHealth-enabled HIV interventions. A convenience sample of 359 HIV-infected MSM and TGW recruited from three sites in Lima, Peru completed standardized assessments of alcohol use disorders (AUDs), risky sexual behavior, and antiretroviral therapy (ART) adherence along with self-constructed measures of communication technology access and utilization, and mHealth acceptance. Most participants (86%) had daily access to any cell phone, including smartphones (30%). The most frequent communication activities were receiving and making calls, and receiving and sending text messages using cell phones. On a 5-point Likert scale, participants expressed interest in using mHealth for medication reminders (M = 3.21, SD = 1.32) and engaging in anonymous online interactions with health professionals to discuss HIV-related issues (M = 3.56, SD = 1.33). Importantly, no significant differences were found in communication technology use and mHealth acceptance among participants with AUDs, depression, and suboptimal ART adherence, all of which are associated with poor HIV treatment outcomes. Findings show support for implementing mHealth-based intervention strategies using cell phones to assess and reduce HIV-risk behaviors among HIV-infected MSM and TGW.     

High prevalence of stigma-related abuse among a sample of men who have sex with men in Tanzania: implications for HIV prevention

In sub-Saharan Africa, the prevalence of stigma-related abuse and violence among men who have sex with men (MSM) and its potential impact on the HIV/AIDS epidemic is unknown. This study estimated the prevalence and source of violence and abuse among a sample of MSM in Tanzania and characterized the association between levels of violence and sexual and mental health variables. Data were taken from a larger study of 200 MSM in Tanzania. Frequency tabulations, bivariate analysis, and logistic regression were performed to describe the prevalence and source of abuse and to determine the association between levels of violence and sexual demographics and mental health variables. The MSM sample for this study was young (median age 23), somewhat educated with the majority having attained secondary school (80%) and mostly employed (60%). Verbal (48.5%) and moral (32.5%) abuses were the most predominant types of abuse among the sample and were mostly from people in the street and neighbors. Sexual abuse (30%) was mostly from partners, and physical violence (29.5%) was largely from people in the street. Participants in the high-violence level group had a significantly greater number of sexual partners, depression scores, and internalized homonegativity (IH) scores. IH predicted HIV infection and verbal abuse predicted IH.There is a need for an increased awareness of violence and abuse faced by MSM in Tanzania, as well as effective programs to specifically target the issue of violence among MSM, and its implication for mental health and for risky sexual behaviors and HIV transmission.     

北京市年轻MSM人群HIV感染情况调查

目的了解年轻男男性行为人群（MSM）艾滋病病毒（HIV）感染情况及其影响因素。方法分别于2009-2011年,采用应答驱动抽样方法（RDS）,在北京市18～25岁年轻MSM中开展横断面调查,采用计算机辅助问卷,调查内容包括社会人口学、性行为特征、HIV检测和对安全性行为的认知等。结果在474名调查对象中,HIV感染率为7.4%,其中2009年、2010年和2011年的感染率分别为6.4%、8.4%和7.5%。多因素Logistic回归分析结果显示,HIV感染的影响因素为：自报HIV感染状况正确[比值比（OR）=0.06,95%可信区间（CI）：0.02～0.18]、对安全性行为的认知高（OR=0.44,95%CI：0.20～0.98）、近1年有过性病症状（OR=6.78,95%CI：1.92～23.95）和梅毒抗体阳性（OR=4.19,95%CI：1.49～11.80）。对安全性行为的认知量表内部一致性检验克朗巴赫系数为0.92。结论应促进对安全性行为的认知和性病的预防和治疗,以遏制HIV在年轻MSM中的快速传播。     

利用互联网对男男性行为人群进行艾滋病防治干预的可行性研究

目的了解互联网对男男性行为人群(MSM)艾滋病相关知识、行为及检测情况的影响,探索利用互联网进行MSM艾滋病防治干预的可行性。方法 2009年7-9月,采用同伴推动抽样方法共招募477名MSM进行面对面问卷调查,所得资料用SPSS软件进行数据分析和处理。结果网络为主型MSM和非网络为主型MSM在婚姻状况(χ2=8.696,P=0.027)、文化程度(χ2=8.303,P=0.016)、户籍(χ2=13.252,P=0.001)方面的分布差异有统计学意义;艾滋病防治知识知晓率,网络为主型为91.4%(318/348),非网络为主型为82.9%(102/123),网络为主型更高(χ2=6.724,P=0.010);最近六个月同性性伴数,网络为主型平均为(2.91±3.45)人,非网络为主型平均为(4.52±6.75)人,两组比较差异有统计学意义(t=-2.286,P=0.024,χ2=9.932,P=0.019);最近六个月与同性发生插入性行为坚持每次使用安全套的,网络为主型有34.9%(107/307),非网络为主型有33.0%(35/106)。结论互联网对MSM的艾滋病相关知识、行为有正面影响,应重视和加强利用互联网对MSM开展艾滋病防治干预工作。     

Bias-motivated bullying and psychosocial problems: Implications for HIV risk behaviors among young men who have sex with men

The present study aimed to determine whether the experience of bias-motivated bullying was associated with behaviors known to increase the risk of HIV infection among young men who have sex with men (YMSM) aged 18–29, and to assess whether the psychosocial problems moderated this relationship. Using an Internet-based direct marketing approach in sampling, we recruited 545 YMSM residing in the USA to complete an online questionnaire. Multiple linear regression analyses tested three regression models where we controlled for sociodemographics. The first model indicated that bullying during high school was associated with unprotected receptive anal intercourse within the past 12 months, while the second model indicated that bullying after high school was associated with engaging in anal intercourse while under the influence of drugs or alcohol in the past 12 months. In the final regression model, our composite measure of HIV risk behavior was found to be associated with lifetime verbal harassment. None of the psychosocial problems measured in this study – depression, low self-esteem, and internalized homonegativity – moderated any of the associations between bias-motivated bullying victimization and HIV risk behaviors in our regression models. Still, these findings provide novel evidence that bullying prevention programs in schools and communities should be included in comprehensive approaches to HIV prevention among YMSM.     

An HIV intervention tailored for black young men who have sex with men in the House Ball Community

Black young men who have sex with men (BYMSM) are the group most disproportionately impacted by HIV in the USA and most in need of efficacious interventions to address community-level factors that increase their vulnerability to HIV. The House Ball Community (HBC) is a distinct social network within the larger BYMSM community that may be particularly vulnerable to social norms and stigma around HIV. This study tailored an evidence-based, community-level popular opinion leader (OL) intervention for use within the HBC. The intervention, called Promoting Ovahness through Safer Sex Education (POSSE), was then piloted to evaluate feasibility, acceptability, and preliminary efficacy. Recruiting OLs from the community and training them to deliver risk reduction messages were found to be feasible and highly acceptable. Community-level surveys (n = 406) were completed over five waves of data collection. Overall exposure to the intervention increased across waves. Statistically significant (p < .05) declines were observed for multiple sexual partners, condomless anal intercourse with any male partners, and with male partners of unknown HIV status. HIV stigma declined as well, but the trend was not statistically significant.     

性网络与男男性行为人群的HIV传播

性网络是男男性行为人群(MSM)经性途径传播艾滋病病毒(HIV)的直接通道。网络分析方法可揭示性网络构成与个体感染HIV风险及与群体中HIV传播的动力学关系。为深入探讨MSM HIV传播风险,为预防干预定位提供信息,该文对性网络与MSMHIV传播关系的研究现况做一简要概述。