HIV vulnerabilities and coercive sex at same-sex sexual debut among men who have sex with men in Beijing,China

Few studies have examined coercive sex and HIV vulnerabilities among men who have sex with men (MSM) in China. The present study seeks to compare individual characteristics between MSM who did and did not experience coercive sex at their MSM sexual debut and to identify HIV risk factors correlated with coercive sex at MSM sexual debut. In 2007, we recruited 167 MSM in Beijing, China by peer-referred social network sampling. Each participant then completed self-administered questionnaires regarding their sexual experiences and practices. Results show that 14% of participants reported coercive sex at MSM sexual debut, of whom 48% reported recent unprotected anal intercourse (UAI). Coercive sex at MSM sexual debut was significantly associated with UAI [adjusted odds ratio (AOR): 5.38, 95% confidence interval: 1.95–14.87] and lifetime number of male sex partners (AOR: 7.25, 95% CI: 2.39–22.01). Coercive sex is harming MSM in China and should be immediately addressed by researchers, public health officials, and MSM community stakeholders.     

Risk Factors for Syphilis and Prevalence of HIV, Hepatitis B and C among Men Who Have Sex with Men in Beijing, China: Implications for HIV Prevention

To examine the correlates for syphilis and the prevalence for HIV, hepatitis B, hepatitis C among men-who-have-sex-with-men (MSM) in Beijing, China. A total of 541 MSM was recruited using peer-referral, community outreach, and Internet. Questionnaire-based interviews provided information including, demographics, sexual and other risk behaviors. HIV prevalence was 4.8%, syphilis 19.8%, HCV 0.4% and HBsAg 6.5%. The median number of lifetime male sex partners was ten. In the past 3 months, 20.7% drank alcohol ≥1 times per week. In the past month, 21.3 and 14.6% had unprotected anal intercourse with regular and casual male sex partners, respectively. Syphilis infection was associated with less education, alcohol use, finding male sex partners through bathhouses/public washrooms/parks, and diagnoses of sexual transmitted diseases (STDs). Syphilis is now epidemic among Beijing’s MSM. Prevention efforts are urgent as HIV prevalence is already near 5%. Education, condom promotion, STD control, and alcohol-related intervention are needed urgently.     

Attitudes about and HIV risk related to the "most common place" MSM meet their sex partners: comparing men from bathhouses, bars/clubs, and Craigslist.org

This study examined attitudes toward the most common place where men who have sex with men (MSM) met their recent male sex partners. In 2009-2010, MSM were surveyed in bars/clubs, bathhouses, and on Craigslist.org . We found strong but differential overlap between venue of recruitment and participants' most common place: 81% of men from Craigslist indicated their most common place was the Internet, 65% of men from bathhouses indicated their most common place was bathhouses, and 47% of men from bars/clubs indicated their most common place was bars/clubs. In general, interest in seeing more information on drugs/alcohol and HIV and interacting with a health outreach worker in participants' most common place ranged from "agree" to "strongly agree." However, men whose most common place was bars/clubs rated these items lowest on average. Rates of unprotected anal intercourse (UAI) were high (43%), thus targeted efforts in bars/clubs, bathhouses, and on the Internet may be ideal venues for reaching high-risk MSM. Although most common place was unrelated to UAI, it was related to factors that contextualize men's encounters (e.g., attitudes toward HIV status disclosure, and perceptions about barebacking, anonymous sex, and alcohol use). Outreach providers should consider these contextualizing aspects as they continue to retool their efforts.     

HIV trends and related risk factors among men having sex with men in mainland China: findings from a systematic literature review

The purpose of this study was to assess trends in the HIV epidemic and risk factors for HIV infection among men having sex with men (MSM) in mainland China. A literature review was conducted. Data from studies regarding HIV prevalence, syphilis infection and risk behavior, were pooled into three chronological stages. The independent correlates of HIV infection were gathered in order to guide the development of future interventions. HIV prevalences were 2.5% (95%CI 1.8-3.7), 1.8% (95%CI 1.1-2.9) and 3.3% (95%CI 2.0-5.3) before 2004, during 2004 to 2005 and 2006 to 2007, respectively. About two-thirds of MSM had multiple male sex partners during the previous six months (P6M), and more than one third of MSM engaged in unprotected anal intercourse (UAI) during last sex. Only UAI among commercial sex workers declined significantly. More than one quarter of MSM had female partners in P6M and the proportion having multiple female partners declined. The rates of unprotected vaginal sex had a downward trend. The prevalence of injecting drug use was low and remained the same. The number of lifetime male sexual partners and the frequency of anal sex in P6M were independently associated with HIV infection; UAI was correlated to the number of male partners, buying sex from males, being part of a mobile population, prior HIV testing and having a prior sexually transmitted disease (STD). We conclude intervention programs targeting UAI and multiple partners are urgently needed to control the HIV epidemic among MSM in mainland China.     

Factors Associated with Unprotected Anal Intercourse Among Men Who Have Sex with Men: Results from a Respondent Driven Sampling Survey in Nanjing, China, 2008

Unprotected anal intercourse (UAI) is a well-documented risk factor for acquiring HIV, but not well-studied in China. We studied demographic and behavioral correlates for UAI among men who have sex with men (MSM) in a respondent-driven-sampling (RDS) survey in Nanjing, China. Four hundred and thirty MSM (including ten seeds) participated in this study, rendering an adjusted rate of UAI as 62.3 % (95 % CI 56.4–68.4 %). Adjusted HIV and syphilis prevalence rates were 6.6 % (95 % CI 3.0–10.4) and 12.6 % (95 % CI 8.1–18.3), respectively. HIV- and syphilis-positive cases were more likely to have engaged in UAI. Being unwilling to use condoms, meeting partners in non-conventional venues, having multiple male sex-partners in the past 6 months, having sex with regular and casual male partners in the past 6 months, and consumption of alcohol before sex were all positively associated with UAI. Based on the observed high prevalence of UAI among MSM in Nanjing, we can conclude that implementation of strategies to motivate MSM with high-risk behaviors to use condoms is urgently required in Nanjing.     

Risks for HIV infection among gay, bisexual, and other men who have sex with men in Moscow and St. Petersburg, Russia

The majority of early cases of HIV in Russia were among men who have sex with men (MSM). Despite this and the current resurgence of HIV among MSM globally, little systematic work has been done to assess current HIV risks. We conducted a rapid assessment of HIV and associated risk behaviors among MSM in Russia. An anonymous, cross-sectional study was performed among MSM in Moscow and St. Petersburg (January 2008). Participants were enrolled by local NGO partners via peer-recruitment, underwent a brief behavioral survey, and were offered rapid, oral HIV screening. Factors associated with HIV infection were assessed using logistic regression. A total of 401 participants were enrolled. HIV prevalence was comparable in the two cities (6.0% in Moscow, 5.5% in St. Petersburg). Approximately half (49.3%) were under age 25, 75.1% of all men reported unprotected anal intercourse (UAI), and 21.5% reported engaging in unprotected exchange sex in the prior 12 months. HIV infection was the highest (7.7%) among the youngest MSM, those aged 18-22 years. Never having tested for HIV (AOR=6.2; 95% CI: 1.8, 21.9) and ever injecting drugs (AOR=11.3; 95% CI: 2.6, 50.4) were independently associated with HIV infection. We found significant overall HIV prevalence among MSM in Moscow and St. Petersburg, particularly among the youngest men. The majority of men reported ongoing high-risk behaviors, indicating the potential for further spread. HIV prevention efforts need to specifically focus on urban MSM in Russia, encourage testing, and target injection risks to address this epidemic.     

Factors associated with unprotected sexual intercourse with steady male, casual male, and female partners among men who have sex with men in Barcelona, Spain.

To increase understanding of the HIV epidemic among MSM in Barcelona, anonymous questionnaires were completed by 640 MSM recruited in the city in 2002. The prevalence of unprotected anal intercourse (UAI) with casual male partners in the prior 12 months was higher among self-reported HIV-positive men (confirmed through saliva testing) than among men who were HIV-negative or of unknown serostatus (35% vs. 20%, p < .01). The prevalence of UAI with steady male partners was substantially lower among HIV-positive men than other men (28% vs. 60%, p < .01). In multivariate analyses, UAI with casual partners was more likely among HIV-positive individuals; those who used drugs before sex; perceived less acceptance of their sexual orientation by family, friends, or coworkers; and were less concerned about HIV prevention because of antiretroviral therapy (ART). UAI with steady partners was more likely among HIV-negative men with seroconcordant partners, those living with a partner, and men less concerned about HIV prevention because of ART. Findings indicate a need for prevention programs targeting HIV-positive MSM in Barcelona. Attention to substance use and attitudes about HIV prevention are needed for MSM in general.     

Risk factors of syphilis co-infection among HIV-infected men who have sex with men in Tel-Aviv,Israel

Syphilis incidence in Israel and other industrialized countries has increased in the past decade, mainly among men who have sex with men (MSM) who were co-infected with HIV. This study aimed to assess the demographic characteristics and behavioral risk factors for syphilis infection among HIV-infected MSM in the Tel-Aviv region, Israel. This cross-sectional study compared HIV-infected MSM who were co-infected with syphilis since 2005 with HIV-infected MSM without syphilis, using an anonymous self-administered questionnaire distributed at the AIDS treatment clinic in central Israel in 2016. This study included 75 HIV-infected MSM who were diagnosed with syphilis after their HIV diagnosis and 99 HIV-infected MSM without syphilis. Variables associated with syphilis infection included inadequate adherence to antiretroviral therapy (ART) (OR?=?1.8 [1.2–2.4]), frequent unprotected receptive anal intercourse (UAI) with casual sex partners (OR?=?2.2 [1.5–8.2]), especially with HIV-infected partner (OR?=?3.2 [1.1–7.9]).

In conclusion, HIV and syphilis co-infection were associated with frequent UAI with casual sex partners, inadequate adherence to ART and limited partner notification. In order to minimize syphilis transmission among HIV-infected MSM, AIDS clinics should encourage HIV-infected MSM to use condoms, ensure that patients perform periodic syphilis serology testing and improve partner notifications.     

Methamphetamine use and sexual risk behaviours among men who have sex with men diagnosed with early syphilis in Los Angeles County

Methamphetamine use has been associated with risky sexual behaviour and sexually transmitted disease (STD)/HIV transmission among men who have sex with men (MSM). Field interview records for MSM early syphilis (ES) patients were reviewed for factors associated with methamphetamine use during January 2001 through December 2004. There were a total of 2915 ES cases reported during the study period. Of these, 1904 (65%) were MSM. Of these MSM, 167 reported methamphetamine use. Methamphetamine use was associated with having multiple sex partners (prevalence ratios [PR] 1.8, 95% confidence interval [CI] 1.4-2.4), not using condoms (PR 2.0, 95% CI 1.3-2.5), having anonymous sex partners (PR 1.1 95% CI 1.03-1.2), history of recent incarceration (PR 5.4, 95% CI 3.3-8.7), and meeting sex partners via the Internet (PR 1.6, 95% CI 1.3-2.1), at bathhouses (PR 1.6, 95% CI 1.2-2.0) and on the streets (PR 2.6, 95% CI 1.7-4.0). In multivariate analysis having multiple sex partners, not using condoms, recent incarceration and meeting sex partners at bathhouses were significantly associated with methamphetamine use. In conclusion, effective STD risk reduction interventions targeting MSM methamphetamine users are needed to curb risky sexual behaviour.     

Discussions of viral load in negotiating sexual episodes with primary and casual partners among men who have sex with men

Recent studies suggest that people living with HIV with lower viral load are at reduced risk for transmitting HIV to their sexual partners. As information about the association between viral load and risk for HIV transmission disseminates throughout high-risk communities, viral load discussions may be used more often as a risk reduction strategy. The overall purpose of this study was to determine the frequency of viral load discussions and unprotected anal intercourse (UAI) in primary and casual sexual partnerships among men who have sex with men (MSM). An online survey was completed by 326 MSM (82% Caucasian, 62% college educated, 7% HIV-positive or thought they were HIV positive) in January 2011. Results showed that viral load discussions occurred in 93% of primary partnerships in which at least one partner was HIV-positive; UAI was reported with 46% of all primary partners and 25% of serodiscordant primary partners with whom viral load was discussed. Viral load discussions occurred in 53% of the three recent sexual episodes with casual sex partners with whom participants had either sex with once or had sex with multiple times in the past three months. UAI was more common in sexual encounters with casual sex partners when viral load was not discussed than when viral load was discussed (75% v. 56% of encounters). The finding that casual sexual episodes that did not include viral load discussions had a higher percentage of UAI than those that did include viral load discussions suggests either that men who do not discuss viral load may be higher risk-takers than men who do, or that the former are less adept at negotiating safer sex with casual sex partners than men who do discuss viral load. More research is needed to understand the role of viral load discussions in negotiating sexual activities among MSM.     

High levels of bisexual behavior and factors associated with bisexual behavior among men having sex with men (MSM) in Nigeria

Nigerian men who have sex with men (MSM) have a high burden of HIV infection and are known to engage in bisexual behavior. This study presents the first data on characteristics and correlates of Nigerian men having sex with men and women (MSMW) in three Nigerian cities. Five hundred and fifty-seven MSM who engaged in anal sex with men completed a behavioral survey; 48.1% of these MSM also engaged in sex with women in the previous 2 months. MSMW displayed high levels of risky sexual behavior with female sex partners; casual (56.0%) and multiple female partners were common (69.0%) and 66.0% had unprotected vaginal sex. As much as 45.1% MSMW had anal sex with female partners of which 74.0% did not use protection in the 2 months prior. In bivariate analyses, bisexual behavior was associated (p<0.05) with being married or living with a women (OR 5.0, 95% CI = 2.6–9.4), less education (OR 2.0, 95% CI = 1.4–3.0), bisexual/straight identity (OR 2.3, 95% CI = 1.6–3.2), being an insertive partner (OR 3.0, 95% CI = 1.9–4.5), being HIV-negative (OR 1.6, 95% CI = 1.1–2.5), living in Lagos (OR 2.3, 95% CI = 1.7–2.2), being Muslim (OR 1.7, 95% CI = 1.1–2.5), and being away from home (OR 1.5, 95% CI = 1.0–2.1). In the multivariate model, being married to or living with a woman (AOR = 5.1; 95% CI = 2.5–10.3), bisexual/straight identity (AOR = 2.2; 95% CIs = 1.5–3.3), being an insertive partner (AOR = 3.0; 95% CI = 1.9–4.9), being away from home (AOR = 1.6; 95% CI = 1.1–2.3) and living in Lagos (AOR = 1.7; 95% CI = 1.0–2.8) remained significant (p< 0.05). High levels of bisexual behavior exist among Nigerian MSM, and these men engage in risky sexual behaviors with both male and female sex partners. While decriminalization of same-sex behavior in Nigeria will promote access to HIV prevention programs, current MSM interventions must incorporate information on safe sex with both male and female sex partners.     

Factors associated with self-reported unprotected anal intercourse among men who have sex with men in Changsha city of Hunan province,China

Men who have sex with men (MSM) in China are highly susceptible to HIV infection and HIV prevalence among Chinese MSM is rapidly increasing in recent years. Unprotected anal intercourse (UAI) is a major contributing factor of HIV transmission. This study aims to identify factors associated with UAI among MSM in Changsha city, China. A cross-sectional survey was conducted among 642 MSM in Changsha city from July 2009 to June 2011 via a venue-based sampling method. Data on socio-demographic characteristics, sexual behaviours and utilisation of HIV/AIDS services were collected to determine the associates of UAI in MSM. Among the 642 MSM, 184 (28.7%) reported having UAI with male partners at the last sexual episode. UAI was associated with the venues where MSM met other MSM, and having unprotected sex with female partners at last the sexual episode and in the past six months. In addition, UAI was significant associated with not being exposed to HIV interventions, including free condom, lubricant, HIV testing and counselling, and peer education. MSM who have UAI practice are more likely to have unprotected sex with female; hence, potentially bridging HIV to the general female population. Specific harm-reduction programmes are shown to have significant impacts in reducing UAI and should be scaled up among MSM in China.     

Factors Associated with Unprotected Receptive Anal Intercourse with Internal Ejaculation Among Men Who Have Sex with Men in a Large Internet Sample from Asia

We examined socio-demographic and behavioral characteristics of men who have sex with men (MSM) residing in Asia and correlates of unprotected receptive intercourse with Internet ejaculation (URAIE). Asia Internet MSM Sex Survey, a behavioral survey of MSM in Asia was conducted from 1 January to 28 February 2010. Data analysis was limited to participants aged 18 or above, biological male, and had one regular or casual sex partner in the past 6 months (n?=?10,413). Pearson's Chi-square test, t test and logistic regression were used to examine the correlates of URAIE in the past 6 months, the highest risk sexual behavior sampled. Of 7311 participants who had receptive anal intercourse, 47.5?% had URAIE, which was associated with the following attributes: less than high-school education and pre-college education compared to university (AOR?=?1.53, 95?% CI: 1.28, 1.83; AOR?=?1.22, CI: 1.08, 1.37), being in the heterosexual marriage (AOR?=?1.35, CI: 1.18, 1.56), having regular partners or both regular and casual partners compared to having casual partners (AOR?=?2.85, CI: 2.48, 3.27; AOR?=?2.32, CI: 2.06, 2.62), HIV-positive compared to HIV-negative status (AOR?=?1.39, 95?% CI: 1.08, 1.81), higher perception of HIV risk (AOR?=?1.62, CI: 1.34, 1.95), use of recreational drug before sex (AOR?=?1.30, CI: 1.14, 1.49), and use of the Internet as the main way to seek sex partners (AOR?=?1.21, CI: 1.08, 1.36). MSM from certain Asian countries reported alarming rates of URAIE. The internet can be used as a platform for HIV surveillance and intervention.     

Associations of current marital status and living arrangements with HIV and syphilis risk: findings from a community-based sample of men who have sex with men in China

Chinese men who have sex with men (MSM) are disproportionally affected by HIV and sexually transmitted infections (STIs), but little is known about the role of current marital status and living arrangements in shaping their HIV/syphilis risk. A cross-sectional study was conducted among MSM in Beijing, China to assess their sociodemographic/behavioral characteristics between married and single MSM, and test the hypothesis that currently married MSM have a lower odds of being HIV- and/or syphilis-infected. Participants were recruited via short message services, peer referral, internet, and community outreach. Data collection was based on a questionnaire survey and self-report. Infection status was lab-confirmed. Multivariable logistic regression modeling was used to assess the association of marital status and living arrangement with HIV/syphilis risk. Of the 3588 MSM, infection prevalence was high (HIV?=?12.7%; syphilis?=?7.5%). Compared to single MSM living with their boyfriends or male sex partners, single/alone MSM and married MSM living with wives were less likely to practice condomless insertive (CIAI) or receptive (CRAI) anal intercourse with men; while married MSM living with boyfriends or male sex partner were more likely to practice CIAI and CRAI, and married MSM were more likely to practice condomless vaginal sex. Compared to men living with boyfriends/sexual partners, significantly reduced odds of being HIV-positive were seen among married MSM who were living alone (aOR: 0.52; 95%CI: 0.28, 0.94) or living with their wives (aOR: 0.53; 95%CI: 0.31, 0.89). Similarly, single MSM living alone (aOR: 0.67; 95%CI: 0.48, 0.95) and married MSM living with their wives were comparatively less likely to be syphilis-infected (aOR: 0.43; 95%CI: 0.23, 0.79). Future efforts should consider characteristics of marital status and living arrangements for designing subgroup-specific risk reduction strategies among Chinese MSM.     

Serosorting and sexual risk behaviour according to different casual partnership types among MSM: the study of one-night stands and sex buddies

Among HIV-negative men who have sex with men (MSM), any incident of unprotected anal intercourse (UAI) between casual partners is usually regarded as risky for HIV transmission. However, men are increasingly using knowledge of their casual partner's HIV-status to reduce HIV risk during UAI (i.e., serosorting). Since familiarity between casual partners may lead to higher levels of UAI and serosorting, we examined how often men have UAI and practice serosorting with three types of casual partnerships that differ in their degree of familiarity. We included 240 HIV-negative men of the Amsterdam Cohort Study among MSM. We distinguished three types of casual partnerships: one-night stand ("met by chance and had sex only once"); multiple-time casual partner ("met and had sex with several times") and the "regular" casual partner ("sex buddy"). Serosorting was defined as UAI with an HIV-concordant partner. Generalised estimating equations analyses were used to examine the association between type of casual partnership and sexual risk behaviour. Analyses revealed that men with a sex buddy were more likely to have UAI than men with a one-night stand (OR [95%CI] 2.39 [1.39-4.09]). However, men with a sex buddy were also more likely to practice serosorting than men with a one-night stand (OR [95%CI] 5.20 [1.20-22.52]). Men with a sex buddy had more UAI but also reported more serosorting than men with a one-night stand. As a result, the proportion of UAI without serosorting is lower for men with a sex buddy, and therefore men might have less UAI at risk for HIV with this partner type. However, the protective value of serosorting with a sex buddy against HIV transmission needs to be further established. At this time, we suggest that a distinction between the one-night stand and the sex buddy should be incorporated in future studies as men behave significantly different with the two partner types.     

Association between risk of acquiring HIV and beliefs and perceptions about the lived experience of HIV/AIDS among HIV-negative or untested men who have sex with men

The study aim was to assess whether the sexual behaviour of HIV-negative or untested men who have sex with men (MSM) was related to their perceptions of what it is like to live with HIV/AIDS, their beliefs or their attitudes to highly active antiretroviral treatments. Any unprotected anal intercourse (UAI) with casual partners was used as the sexual-risk indicator. The study enrolled 261 MSM. There were no significant differences between beliefs, attitudes and perceptions about HIV/AIDS, knowledge of post-exposure prophylaxis (PEP) or exposure to the HIV/AIDS epidemic among those who had had UAI with casual partners and those that had not (P>0.12). Those who considered that low levels of viral load and withdrawing before ejaculation reduced the risk of HIV transmission were significantly more likely to have had UAI with a casual partner (P=0.03). Only a minority of MSM engaging in UAI were optimistic about antiretroviral therapy. The study participants were in general pessimistic about life with HIV/AIDS despite their risk-taking sexual behaviour.     

HIV, syphilis infection, and risky sexual behaviors among male university students who have sex with men in Beijing, China: a cross-sectional study

Young male university students who have sex with men are at high risk of HIV and sexually transmitted infections (STIs). We conducted a cross-sectional survey to assess the prevalence of risky sexual behaviors, HIV, and syphilis among male university students who have sex with men in Beijing, China; and to identify risk factors for unprotected anal intercourse (UAI). Among 157 study participants, HIV and syphilis prevalence were 2.5% and 7.0%, respectively. We found a high prevalence of UAI in our study population. Multiple logistic regression analysis revealed two significant predictors of UAI: believing it is not necessary to use a condom with a regular sex partner and not feeling anxious about being gay. Not using a condom during first sexual experience with a man was a marginally significant predictor of UAI. Male university students who have sex with men are especially vulnerable to HIV and STIs. Intensified education and HIV testing programs are needed to reduce risk in this population.     

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。     

Psychosociobehavioral characteristics associated with high condomless anal intercourse intention: a comparison of receptive,versatile, and insertive MSM in Taiwan

ABSTRACT

In Taiwan, men who have sex with men (MSM) continue to be disproportionately affected by HIV, and the main route of HIV transmission is condomless anal intercourse (CAI). This study examined the associations between psychosociobehavioral characteristics and CAI intention among MSM in Taiwan who had ever engaged in anal intercourse with men, and compared the differences across three sexual roles (receptive, versatile, and insertive) using online survey data (N?=?563). For all MSM, those that were in a relationship (AOR?=?2.55; 95% CI: 1.61–4.03), had three or more steady partners (AOR?=?2.58; 95% CI: 1.19–5.58), did not use a condom during last anal intercourse (AOR?=?6.81; 95% CI: 4.36–10.63), perceived high HIV risk (AOR?=?2.13; 95% CI: 1.26–3.60), and had high sexual sensation seeking (AOR?=?2.80; 95% CI: 1.82–4.30) were more likely to have high CAI intention. After stratification, the significant characteristics differed depending on sexual role, except for no condom use during last anal intercourse remaining significant in all models (AOR?=?5.09–20.30; 95% CI: 2.49–66.69, depending on sexual role). Tailoring the programs for MSM of different sexual roles may improve the effectiveness of future prevention efforts.     

HIV Disclosure and Sexual Transmission Behaviors among an Internet Sample of HIV-positive Men Who Have Sex with Men in Asia: Implications for Prevention with Positives

The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR?=?37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR?=?1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1 and 5?years ago (AOR?=?2.23, 95% CI: 1.05, 4.74), and not knowing one's viral load (AOR?=?2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men.