Importance of sex partner HIV status in HIV risk assessment among men who have sex with men

Clinical HIV risk assessments have not typically integrated questions about sex partners' HIV status with questions about condom use and type of sex. Since 2001, we have asked all men who have sex with men (MSM) evaluated in an urban sexually transmitted disease (STD) clinic how often in the preceding 12 months they used condoms for anal sex with partners who were HIV-positive, HIV-negative, and of unknown HIV status. Overall, MSM displayed a pattern of assortative mixing by HIV status, particularly for unprotected anal intercourse (UAI). Nevertheless, 433 (27%) of 1580 MSM who denied knowing they were HIV-positive and 93 (43%) of 217 HIV-positive MSM reported having UAI with a partner of opposite or unknown HIV status. Among men who denied previously knowing they were HIV-positive, 24 (9.6%) of 251 MSM who reported having UAI with an HIV-positive partner or partner of unknown HIV status compared with 11 (1.7%) of 620 MSM who denied such exposure tested HIV-positive (odds ratio=5.8, 95% confidence interval: 2.8-12.1). UAI with an HIV-positive partner or partner with unknown HIV status was 69% sensitive and 73% specific in identifying men with previously undiagnosed HIV infection; UAI regardless of partner HIV status was 80% sensitive but only 45% specific. The positive predictive value was highest for risk assessments that included partner HIV status. Integrating questions about anal sex partner HIV status and condom use identifies MSM at greatest risk for HIV acquisition and transmission. These risk criteria might be effectively used to triage MSM into more intensive prevention interventions.     

HIV infection and associated risks among young men who have sex with men in a Florida resort community

OBJECTIVE: Several recent studies have reported high rates of sexual risk-taking and HIV infection among young men who have sex with men (MSM). Most of these studies used samples of convenience. The authors obtained population-based data on young MSM living in South Beach (Miami Beach, Florida), a resort community where some of the highest AIDS rates in the United States have been reported. METHODS: A household probability sample was drawn to survey unmarried 18- to 29-year-old MSM living in South Beach. Subjects were interviewed, completed self-administered questionnaires, and provided oral specimens for HIV antibody testing. RESULTS: From the 2,622 screened residential units, 100 mostly white and Hispanic MSM (92.6% of eligible participants) were enrolled in the study. Fifteen percent of the sample tested positive for antibodies to HIV. White and Hispanic MSM had similar rates. Forty-five percent of the sample reported engaging in unprotected anal intercourse (UAI) in the prior 12 months, and 31% reported UAI with a nonprimary partner. The estimated annual incidence of HIV infection was 6.3%. CONCLUSION: The high prevalences of UAI and HIV infection in South Beach attest to a previously undocumented public health concern. The extremely high estimated incidence for young MSM in South Beach highlights the urgent need for more effective risk-reduction interventions and further epidemiological research on resort areas.     

Sexual risk behavior among HIV-positive men who have sex with men: a literature review

OBJECTIVE: To review research on sexual risk behavior among HIV-positive men who have sex with men (MSM) after the year 2000. METHOD: The review included 53 published studies that reported on unprotected anal intercourse (UAI) in cross-sectional and longitudinal surveys of HIV-positive MSM and MSM of mixed HIV status. RESULTS: The findings indicate high levels of UAI among HIV-positive MSM, particularly with HIV-negative or HIV status unknown partners. In studies of MSM of mixed HIV status, we found that the rate of UAI among HIV-positive MSM was much higher than that of HIV-negative MSM. Furthermore, the prevalence of UAI among HIV-positive MSM has increased in recent years. CONCLUSION: Although studies indicate that HIV-positive MSM have adopted risk reduction strategies, roughly two in five HIV-positive MSM continue to engage in UAI, which represents a risk for continued HIV and STI (sexually transmitted infection) transmission. PRACTICE IMPLICATIONS: Prevention efforts targeting HIV-positive MSM to assist them in adopting and maintaining safer sexual behaviors need to be intensified.     

Condom use rather than serosorting explains differences in HIV incidence among men who have sex with men

BACKGROUND: HIV incidence is high and increasing among men who have sex with men (MSM) attending the Sexually Transmitted Infection (STI) Outpatient Clinic in Amsterdam but remains low among MSM in the Amsterdam Cohort Studies (ACS). We studied whether sexual behaviors in these 2 groups are consistent with serosorting and if serosorting explains the difference in HIV incidence. METHODS: In 2004 to 2006, a survey of sexual behaviors and HIV status regarding up to 4 traceable partners in the prior 6 months was performed in MSM attending the STI Outpatient Clinic (high-risk) and in MSM in the ACS (lower risk). Moreover, pooled information was collected on anonymous partners. We used logistic regression to test whether sexual behaviors are consistent with serosorting and to test whether risk group is associated with having concordant traceable partners among men reporting unprotected anal intercourse (UAI). RESULTS: We included 513 MSM (54% lower risk and 75% HIV-negative). Lower risk and high-risk MSM with concordant traceable partners were more likely to have UAI than MSM with discordant partners or partners of unknown HIV status (P < 0.001). Risk group was not associated with having concordant UAI. Compared with lower risk MSM, however, high-risk MSM frequently had UAI with nonconcordant traceable partners and with anonymous partners. CONCLUSIONS: Sexual risk behaviors with traceable partners are consistent with serosorting. Nonetheless, the higher level of UAI with anonymous or nonconcordant traceable partners more likely explains the increasing HIV incidence seen among STI Outpatient Clinic attendees than a difference in serosorting behavior.     

Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men,San Francisco

BACKGROUND: Increasing trends in high-risk sexual behavior are noted among men who have sex with men (MSM) worldwide. Less information is available on unprotected sex between persons of different HIV serostatus. METHODS: From 1999 through 2001, volunteers of a community-based organization conducted interviews of 10,579 MSM at gay-oriented venues in San Francisco and in neighborhoods with high-volume MSM pedestrian traffic. The questionnaire recorded demographic and risk behavior information, including self-reported and partners' HIV serostatus. RESULTS: Potentially serodiscordant unprotected anal intercourse (UAI) with at least 2 anal sex partners was reported by 12.7% and increased from 11.0% in 1999 to 16.2% in 2001. Stratifying by self-reported HIV serostatus, 20.8% of HIV-positive respondents, 12.1% of HIV-negative respondents, and 13.4% of MSM who did not know or report their own HIV serostatus had potentially serodiscordant UAI. Older MSM of white race were more likely to report potentially serodiscordant UAI among HIV-positive respondents, whereas younger MSM of white race were more likely to report potentially serodiscordant UAI among HIV-negative respondents. Among those with unknown HIV serostatus, MSM of color were more likely to engage in potentially serodiscordant UAI. CONCLUSION: Recent increases in UAI among MSM in San Francisco are not only the result of increases in UAI between persons of the same HIV serostatus. Prevention messages must address disclosure of HIV serostatus to sexual partners specifically tailored to groups according to age, community, and HIV serostatus.     

Repeat HIV testing, risk behaviors, and HIV seroconversion among young men who have sex with men: a call to monitor and improve the practice of prevention.

OBJECTIVES: We compared recent risk behaviors and HIV seroconversion among young men who have sex with men (MSM) who were first-time, infrequent, and repeat HIV testers. METHODS: Male adolescents and young men aged 15 to 22 years were randomly sampled, interviewed, counseled, and tested for HIV at 194 gay-identified venues in seven U.S. cities from 1994 through 1998. Analyses were restricted to MSM who reported having never tested or last tested HIV-negative. RESULTS: Of 3430 participants, 36% tested for the first time, 39% had tested infrequently (one or two times), and 26% had tested repeatedly (> or = three times). Compared with first-time testers, repeat testers were more likely to report recent risk behaviors and to acquire HIV (7% versus 4%). Over 75% of repeat testers who seroconverted acquired HIV within 1 year of their last test. Compared with repeat testers, first-time testers reported similar use of health care but delayed testing for nearly 2 additional years after initiating risk. CONCLUSIONS: Many young MSM soon acquire HIV after repeated use of HIV counseling and testing services. Providers must strengthen practices to identify, counsel, and test young MSM and provide enhanced behavioral interventions for those with persistent risks.     

Unprotected sex, underestimated risk, undiagnosed HIV and sexually transmitted diseases among men who have sex with men accessing testing services in a New England bathhouse

American men who have sex with men (MSM) continue to have increased rates of HIV and sexually transmitted diseases (STD). Between 2004 and 2010, 1155 MSM were tested for HIV and/or STDs at Providence, RI bathhouse. The prevalence of HIV was 2.3%; syphilis, 2.0%; urethral gonorrhea, 0.1%; urethral chlamydia, 1.3%; 2.2% of the men had hepatitis C antibodies. Although 43.2% of the men engaged in unprotected anal intercourse in the prior 2 months, the majority of the men thought that their behaviors did not put them at increased risk for HIV or STDs. Multivariate analyses found that men who engaged in unprotected anal intercourse were more likely to have had sex with unknown status or HIV-infected partners; have sex although under the influence of drugs; tended to find partners on the internet; and were more likely to have a primary male partner. Men who were newly diagnosed with HIV or syphilis tended to be older than 30 years; had sex with an HIV-infected partner; had a prior STD diagnosis; and met partners on the internet. For 10.5% of the men, bathhouse testing was the first time that they had ever been screened for HIV. Of 24 men who were newly diagnosed with HIV infection, only 1 was not successfully linked to care. These data suggest that offering HIV and STD testing in a bathhouse setting is effective in attracting MSM who are at increased risk for HIV and/or STD acquisition or transmission.     

Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection

OBJECTIVES: To examine within-subjects and combined between- and within-subjects associations between substance use and unprotected anal intercourse (UAI) among men who have sex with men (MSM) with recent HIV infection. METHODS: One hundred ninety-four MSM who were recently infected with HIV completed a computer-assisted questionnaire regarding sexual behaviors and substance use with their last 3 partners. Associations between UAI and substance use were assessed using conditional logistic regression (CLR) to assess associations among the 116 MSM reporting UAI with some but not all partners and generalized linear mixed effects models (GLMMs) to examine a combination of within- and between-subjects associations in the entire sample (N = 194). RESULTS: In multivariate CLR models and GLMMs, UAI was associated with the use of methamphetamine (odds ratio [OR] = 4.9 and OR = 3.5, respectively), marijuana (OR = 4.0 and OR = 2.2, respectively) and erectile dysfunction medications (EDMs) when used with a main partner (OR = 13.8 and OR = 10.1, respectively). CONCLUSIONS: Results indicate that a direct association may exist between specific substances and UAI and provide evidence that the use of methamphetamine and EDMs may contribute to HIV transmission.     

A comparison of on-line and off-line sexual risk in men who have sex with men: an event-based on-line survey

OBJECTIVE: To assess whether men who have sex with men (MSM) are more likely to report unprotected anal intercourse (UAI) with partners met on-line compared with those met off-line. METHODS: A total of 6122 individuals consented to participate in an anonymous behavioral survey on-line. This event-based analysis is limited to the 1683 men from the United States and Canada who had sex in the 3 months before the study and reported that their last sexual encounter included a new or casual male partner or partners. Prevalence and predictors of UAI were analyzed separately for the 386 men reporting more than 1 partner (multiple) and the 1297 men reporting only 1 (single) partner in their last encounter. RESULTS: Of the 1683 MSM recruited on-line, 51% met their partner(s) in their last sexual encounter on-line and 23% reported UAI. No difference in risk for UAI was found for partners met on-line versus off-line in the bivariate or multivariate analyses. In a multivariate analysis of men with multiple-partner encounters, UAI was significantly associated with being HIV-seropositive (adjusted odds ratio [OR] = 2.87; P = 0.02) in a model that included age; education; whether partners were met on-line or off-line; and use of crystal methamphetamine, sildenafil, or alcohol before sex. Using the same model, significant predictors of UAI in men reporting a single-partner encounter were use of crystal methamphetamine (adjusted OR = 5.67; P = 0.001) and no college degree (adjusted OR = 1.63; P = 0.01). CONCLUSIONS: MSM recruited on-line who reported a new or casual sex partner(s) in the prior 3 months are at considerable risk of HIV or other sexually transmitted infections, but they are equally likely to report UAI whether sex partners were met on-line or off-line. The Internet may be an ideal venue for reaching high-risk MSM.     

HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States

Determining rates of HIV transmission risk behavior among HIV-positive individuals is a public health priority, especially as infected persons live longer because of improved medical treatments. Few studies have assessed the potential for transmission to the partners of HIV-positive persons who engage in high-risk activities. A total of 3723 HIV-infected persons (1918 men who have sex with men [MSM], 978 women, and 827 heterosexual men) were interviewed in clinics and community-based agencies in Los Angeles, Milwaukee, New York City, and San Francisco from June 2000 to January 2002 regarding sexual and drug use behaviors that confer risk for transmitting HIV. Less than one quarter of women and heterosexual men had 2 or more sexual partners, whereas 59% of MSM reported having multiple partners. Most unprotected vaginal and anal sexual activity took place in the context of relationships with other HIV-positive individuals. Approximately 19% of women, 15.6% of MSM, and 13.1% of heterosexual men engaged in unprotected vaginal or anal intercourse with partners who were HIV-negative or whose serostatus was unknown. The majority of sexually active participants disclosed their serostatus to all partners with whom they engaged in unprotected intercourse. An estimated 30.4 new infections (79.7% as a result of sexual interactions with MSM) would be expected among the sex partners of study participants during the 3-month reporting period. Eighteen percent of 304 participants who injected drugs in the past 3 months reported lending their used injection equipment to others. In addition to the more traditional approaches of HIV test counseling and of focusing on persons not infected, intensive prevention programs for persons with HIV infection are needed to stem the future spread of the virus.     

Use of the serologic testing algorithm for recent HIV seroconversion (STARHS) to identify recently acquired HIV infections in men with early syphilis in Los Angeles County

BACKGROUND: Syphilis outbreaks among men who have sex with men (MSM) in the United States, many of whom are HIV infected, have prompted increased concern for HIV transmission. METHODS: To identify whether men are acquiring HIV concomitantly or within the critical period of syphilis infection, banked Treponema pallidum particle agglutination-positive serum specimens from men with early syphilis infection were screened for HIV-1 antibody. Samples that were positive for HIV antibody were then tested with a less sensitive (LS) HIV-1 antibody enzyme immunoassay (serologic testing algorithm for recent HIV seroconversion [STARHS]) to identify HIV infections that occurred on average within the previous 6 months. RESULTS: Of the 212 specimens banked from men with early syphilis, 74 (35%) were HIV-positive. Of these, 15 tested non-reactive by the LS assay. Twelve of these 15 were considered to be recent infections by the LS assay and testing history. Eleven (92%) of the recent infections were among MSM. One man had primary syphilis, 6 (50%) had secondary syphilis, and 5 (42%) had early latent syphilis. Eight men (67%) reported sex with anonymous partners, and 3 (25%) reported consistent condom use. The estimated HIV incidence was 17% per year (95% confidence interval [CI]: 12%-22%) among all men with early syphilis, and it was 26% per year (95% CI: 91%-33%) among MSM. CONCLUSIONS: Syphilis epidemics in MSM may be contributing to HIV incidence in this population. The STARHS can be applied as a surveillance tool to assess HIV incidence in various at-risk populations, but further studies are necessary for validation.     

Triple jeopardy: targeting older men of color who have sex with men

This article presents selected findings from a needs assessment conducted for a community-based organization in Chicago that targeted black and Latino men 50 years and older who have sex with men (MSM). A convenience sample of 110 self-identified minority MSM was recruited through agency sources and administered a 73-question survey. Most men surveyed (>90%) reported sex with other men, with 20% reporting unprotected receptive anal sex and most reporting drug use in conjunction with sex. The data showed varying sexual self-identification, with 45% identified as either bisexual or mostly or completely straight and a substantial proportion (36%) reporting sexual activity with women. A large percentage disclosed being relatively secretive about their same-sex behaviors to others, however, and ranked homosexual-related and HIV-related stigma high. Most men (74%) perceived themselves to be at minimal risk for contracting HIV infection, and 50% ranked their level of worry about contracting HIV infection as low. Noteworthy among the findings were the linked variables of age and race, revealing that older minority MSM may be at elevated risk because they are sexually active, often have multiple partners, and include drug use as part of their sexual episodes. Race and age also may play an important role in determining patterns of sexual identity formation, whether older minority MSM disclose same-sex practices to others or perceive gay-related or HIV-related stigmatization. Implications of these data for interventions targeting older minority MSM suggest the need for culturally sensitive and specific dissemination of basic HIV prevention information and promotion of HIV testing.     

HIV knowledge and risk factors among men who have sex with men in Ho Chi Minh City,Vietnam

OBJECTIVES: To describe health risk behavior, knowledge, and attitudes about HIV/AIDS and its prevention in men who have sex with men (MSM) in Ho Chi Minh City (HCMC), Vietnam. METHODS: A cross-sectional survey of 219 MSM using a standardized questionnaire. RESULTS: Men who have sex with men were easy to locate and willing to answer detailed questions about their sexual behavior. Self-identified sexual orientation was 67% homosexual, 31% bisexual, and 1.4% heterosexual. High-risk sexual behavior was common. The mean number of sexual partners was 3.3 in the previous month and 14.8 in the previous year. Only 32% used condoms during their last intercourse, and only 40% used a condom when their last intercourse included anal sex. Eighty-one percent reported sex with nonregular male partners, and 22% also had sex with women in the past year. Drug use other than alcohol was rare. Most correctly identified high-risk sexual behavior and body fluids that could transmit HIV; however, only about half knew that someone who appeared healthy could transmit HIV or that there was no cure for AIDS. Self-rated risk for HIV was very low, and fewer than one third believed that homosexuals in Vietnam are at increased risk for HIV. CONCLUSION: Men who have sex with men in HCMC are at high risk for HIV. Knowledge about HIV transmission and prevention could be improved. Education and interventions specifically aimed at MSM are needed, because education targeted at the general population may not reach MSM or influence their behavior.     

High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India

OBJECTIVE: To estimate HIV and sexually transmitted disease (STD) prevalence and behavioral risk characteristics of men who have sex with men (MSM) in Chennai, India. METHODS: A cross-sectional population-based random sample survey was conducted in 2001. Randomly selected residents of 30 slums in Chennai were interviewed for behavioral risk factors through face-to-face interviews. Sera and urine were examined for syphilis, HIV-1, gonorrhea, and chlamydia. Logistic regression analyses were used to assess associations between MSM status and HIV infection and to identify risk characteristics of MSM. RESULTS: Of 774 men, 46 reported (5.9%) sex with other men. MSM were more likely to be seropositive for HIV (odds ratio [OR] = 8.57; 95% confidence interval [CI]: 1.83, 40.23) and were more likely to have a history of STD (OR = 2.66; 95% CI: 1.18, 6.02) than non-MSM. Men who used illicit drugs in past 3 months (adjusted odds ratio [AOR] = 4.01; 95% CI: 1.92, 8.41), ever exchanged money for sex (AOR = 3.93; 95% CI: 1.97, 7.84), or were ever tested for HIV (AOR = 3.72; 95% CI: 1.34, 10.34) were significantly more likely to report sex with men. CONCLUSIONS: MSM in Chennai slums are at high risk for HIV. HIV prevention strategies aimed at changing unsafe drug and sexual practices should target the general population of men, with specific attention to areas with high rates of MSM.     

Changing sexual behavior among gay male repeat testers for HIV: a randomized,controlled trial of a single-session intervention

CONTEXT: High-risk sexual behavior is increasingly prevalent among men who have sex with men (MSM) and among men with a history of repeat testing for HIV. OBJECTIVES: The study assessed whether one counseling intervention session focusing on self-justifications (thoughts, attitudes, or beliefs that allow the participant to engage in high-risk sexual behaviors) at most recent unprotected anal intercourse (UAI) is effective in reducing future high-risk behaviors among HIV-negative men. DESIGN, SETTING, AND PARTICIPANTS: A randomized, controlled, counseling intervention trial was conducted at an anonymous testing site in San Francisco, California, between May 1997 and January 2000. Participants were 248 MSM with a history of at least one previous negative HIV test result and self-reported UAI (receptive or insertive) in the previous 12 months with partners of unknown or discordant HIV status. Two intervention groups received standard HIV test counseling plus a cognitive-behavioral intervention, and two control groups received only standard HIV test counseling. Follow-up evaluation was at 6 and 12 months. MAIN OUTCOME MEASURE: Number of episodes of UAI with nonprimary partners (of unknown or discordant HIV status) in the 90 days preceding the interview was measured via self-report during face-to-face interview. RESULTS: A novel counseling intervention focusing on self-justifications significantly decreased the proportion of participants reporting UAI with nonprimary partners of unknown or discordant HIV status at 6 and 12 months (from 66% to 21% at 6 months and to 26% at 12 months, p =.002; p <.001) as compared with a control group when added to standard client-centered HIV counseling and testing. CONCLUSIONS: A specific, single-session counseling intervention focusing on a reevaluation of a person's self-justifications operant during a recent occasion of high-risk behavior may prove useful in decreasing individual risk behavior and thus limiting community-level HIV transmission.     

Partner-specific sexual behavioral differences between phase 3 HIV vaccine efficacy trial participants and controls: Project VISION

OBJECTIVE: To assess and compare sexual behaviors using partner-specific data between HIV-negative men who have sex with men (MSM) recruited for an HIV vaccine efficacy trial and a control group. METHODS: HIV-negative MSM from an HIV vaccine trial (n = 525) and controls (n = 732) were recruited by similar strategies and interviewed about behaviors with the 3 most recent partners in the past 6 months, obtained by audio computer-assisted self-interview (A-CASI). RESULTS: Vaccine trial participants were more likely than controls to report an HIV-positive partner (24.7% and 14.1%, respectively) or an HIV-positive primary partner (16.1% and 6.8%, respectively) and were less likely to report occasional or single-time partners of unknown HIV status (51.6% and 63.2%, respectively; P < 0.05 for each comparison). Vaccine trial participants more often reported receptive unprotected anal intercourse (UAI) during their last sexual encounter with an HIV-positive partner (adjusted odds ratio [OR] = 2.7, 95% confidence interval [CI]: 1.0 to 7.9). Most believed their HIV-positive partners were receiving antiretroviral treatment (ART), however, and after adjustment for perceived ART use, the association between vaccine study participation and receptive UAI with an HIV-positive partner was not significant. CONCLUSIONS: High-risk sexual behavior was reported by many VAX004 participants and controls. Differences between vaccine trial and control participants in the highest risk per contact behavior, receptive UAI with HIV-positive partners, was partly accounted for by perceived ART use. Partner level data are useful in refining risk assessment, which is important in the evaluation of HIV vaccine and other prevention trials.     

The influence of social and sexual networks in the spread of HIV and syphilis among men who have sex with men in Shanghai, China

OBJECTIVES: To analyze characteristics of social and sexual networks and their role as risk factors for HIV and syphilis among men who have sex with men (MSM) in Shanghai, China. DESIGN:: A cross-sectional study. METHODS: We recruited 477 participants using a snowball sampling method. We administered a face-to-face questionnaire and provided testing and counseling for HIV and syphilis. RESULTS: The prevalences of HIV and markers for syphilis were 1.47% (95% confidence interval [CI]: 0.59 to 3.01) and 13.47% (95% CI: 10.53 to 16.88), respectively. The independent factors associated with lower risk for syphilis infection were having a contact network, overlap of social and sexual networks, meeting other MSM at the gym or through the Internet, having 3 to 5 lifetime male anal sex partners, and having a female steady sex partner. A larger male sexual network size, having been married, being more knowledgeable about HIV, having 6 or more lifetime male anal sex partners, and having steady male or female sex partners were independently associated with having unprotected anal or vaginal intercourse. CONCLUSIONS: Significant associations were found between network characteristics and syphilis infection and unprotected sex. Network-based interventions should be developed to reduce this HIV risk among MSM in China.     

Racial disparities in HIV incidence among young men who have sex with men: the Baltimore Young Men's Survey

Recent reports have demonstrated racial disparities in the prevalence of HIV infection among men who have sex with men (MSM). The objectives of this study are to investigate whether racial disparities exist in HIV incidence among young MSM in Baltimore, MD and to examine potential explanations for differences. Data were collected by the Baltimore Young Men's Survey, a cross-sectional venue-based survey (1996 to 2000) enrolling MSM aged 15 to 29 years. HIV incidence was ascertained using the serologic testing algorithm for recent HIV seroconversion. HIV incidence was 4.2% per year (95% confidence interval [CI]: 1.2 to 10.5) among 843 participants. There were substantial racial differences in HIV incidence, ranging from 0 among Hispanics to 11.0% per year (95% CI: 5.5 to 19.7) among non-Hispanic blacks. In multivariate analysis, among MSM at risk for HIV acquisition, race was not associated with unprotected anal intercourse. Independent risks included having more than 4 recent male sexual partners (adjusted odds ratio [AOR] = 1.6, 95% CI: 1.0 to 2.4) and being under the influence of drugs while having sex (AOR = 1.6, 95% CI: 1.1 to 2.3). Non-Hispanic blacks were no more likely than non-Hispanic whites to report these risk behaviors. Possible alternative explanations for the observed racial disparities in HIV incidence and implications for prevention are explored.     

Prevalence and risk factors of HIV and syphilis,and knowledge and risk behaviors related to HIV/AIDS among men who have sex with men in Chongqing,China

High HIV prevalence and incidence burdens have been reported in men who have sex with men (MSM) in Chongqing, China. We aimed to estimate the prevalence of HIV and other sexually transmitted infections (STIs), to appraise the knowledge and risk behaviors related to HIV/AIDS among MSM, and to analyze the possible causes of deviation between behavior and knowledge to make better strategies. We recruited 617 MSM from February to July in 2008 by using a respondent-driven sampling (RDS) method in Chongqing, China. Through the collection of questionnaire-based data and biological testing results from all objects, we launched a cross-sectional survey. STATA/SE was used for data analysis by frequency, ANOVA, rank sum test and logistic regression models. MSM with syphilis (OR=4.16, 95%CI: 2.35-7.33, P<0.0001) were more likely to be HIV infected. Being a company employee (OR=3.64, 95%CI: 1.22-10.08, P<0.0001) and having bought male for sex (OR=3.52, 95%CI: 1.10-11.32, P < 0.034) were associated with a higher probability of syphilis. MSM with younger age, higher education and greater monthly income had a higher mean knowledge score. MSM who had HIV testing had a higher mean knowledge score than those who never had. Students, venues for finding sex partners by Internet and homosexuals in MSM had a higher mean knowledge score compared to other occupations, venues for finding sex partners and sexual orientation. There is an urgent need for delivery of barrier and biomedical interventions with coordinated behavioral and structural strategies to improve the effect of HIV interventions among MSM.