HIV testing patterns and unrecognized HIV infection among young Asian and Pacific Islander men who have sex with men in San Francisco.

The HIV epidemic is rising in Asian and Pacific Islander men who have sex with men (API MSM), who are often first diagnosed with HIV at a late stage of disease. We investigated the HIV testing patterns, correlates of prior testing, and awareness of HIV infection of 495 API MSM aged 18-29 years recruited from venues in San Francisco, using standardized face-to-face interviews. One quarter of participants had never tested for HIV, citing reasons such as perceived low risk, fear of results, and fear of needles. Older age, gay sexual orientation, history of sexually transmitted disease, higher lifetime number of sexual partners, and higher acculturation were significantly and independently associated with prior testing. Thirteen (2.6%) tested HIV-positive, of whom eight were unaware of their infection, five perceived themselves to be at low risk for HIV, and five reported recent UAI. These findings underscore the need to increase access to culturally appropriate and targeted HIV testing and to change perceptions of risk in this population.     

HIV testing trends and correlates among young Asian and Pacific Islander men who have sex with men in two U.S. cities.

We sought to determine the prevalence, trends, and correlates of recent HIV testing (within the past year) among young Asian and Pacific Islander men who have sex with men (API MSM) in two U.S. cities. We conducted serial, cross-sectional, interviewer-administered surveys of 908 API MSM aged 15-25 years, sampled from randomly selected MSM-identified venues annually from 1999 to 2002. The prevalence of recent testing increased from 63% to 71% between the first and fourth year. Recent testing was most significantly associated with ethnicity and with knowledge of testing sites to which respondents felt comfortable going. Other correlates of recent testing included gay identity, comfort with sexual and API identity, having a main partner, social support, and recent unprotected anal intercourse. API MSM who had ever traded sex for material goods or shelter were as likely to have tested recently. HIV prevention campaigns should increase the awareness and availability of culturally appropriate testing sites and urge more frequent testing by young API MSM.     

Substance use, substance choice, and unprotected anal intercourse among young Asian American and Pacific Islander men who have sex with men.

Substance use has been shown to be an important factor associated with having unprotected anal intercourse (UAI) among Asian and Pacific Islander (API) men who have sex with men (MSM). However, little is known about which substances are used in conjunction with sexual activity and whether having UAI varies by substance choice in this population. From January 2000 to September 2001, we sampled API MSM aged 18-29 years from 30 gay-identified venues in San Francisco, California, and interviewed 496 API men face-to-face using a standardized questionnaire. Overall, 47% of the sample reported UAI in the past 6 months. During the same time period, 32% and 34% reported being "high" or "buzzed" on alcohol and drugs during sex, respectively. The most common drugs used in conjunction with sex were methylenedioxymethamphetamine ("ecstasy"; 19%), followed by marijuana (14%), inhalant nitrites ("poppers"; 11%), and crystal methamphetamine ("crystal"; 10%). In a multivariate model, we observed associations between UAI and being high or buzzed on ecstasy (odds ratio [OR] = 2.62; 95% confidence interval [CI] = 1.37, 5.02) and poppers during sex (OR = 3.29; 95% CI = 1.50, 7.25). However, being high or buzzed on alcohol, marijuana, gamma-hydroxybutyrate (GHB), and crystal methamphetamine during sex had no association with UAI. One third of sampled young API MSM used drugs or alcohol during sex. The co-occurrence of ecstasy and popper use and unprotected sex underscores the need to develop HIV prevention programs focusing on particular drugs.     

HIV-associated risk factors among young Canadian Aboriginal and non-Aboriginal men who have sex with men.

Young Aboriginal men face marginalization distinct in cause but similar in pattern to those seen among men who have sex with men (MSM) and may be at increased risk for HIV infection. We compared sociodemographic characteristics and risk taking behaviours associated with HIV infection among MSM of Aboriginal and non-Aboriginal descent. Data for this comparison were gathered from baseline questionnaires completed by participants in a cohort study of young MSM. Data collection included: demographic characteristics such as age, length of time residing in the Vancouver region, housing, employment, income and income sources; mental health and personal support; instances of forced sex and sex trade participation and; sexual practices with regular and casual male sex partners. Data were available for 57 Aboriginal and 624 non-Aboriginal MSM. Aboriginal MSM were significantly less likely to be employed, more likely to live in unstable housing, to have incomes of <$10,000 and to receive income assistance than non-Aboriginals (all P<0.01). Aboriginals also had higher depression scores (P<0.01), were more likely to report non-consensual sex (P=0.03), sexual abuse during childhood (P=0.04) and having been paid for sex (P<0.01). In the past year they were no more likely to have had sex with a male partner they knew to be HIV positive, to have had more than 50 male partners or to have unprotected anal insertive or receptive intercourse with their male partners (all P>0.05). Our data indicate that among MSM, Aboriginal men are at increased risk of antecedent risk factors for HIV infection including sexual abuse, poverty, poor mental health and involvement in the sex trade.     

Violence and HIV-related risk among young men who have sex with men

Limited research has been conducted on threats or violence by family members and sexual partners against young men who have sex with men (MSM). Young MSM, aged 15-22 years, who attended public venues in New York City were enrolled in an anonymous, cross-sectional HIV seroprevalence and risk-behavior study. About two-thirds (68%) of the young MSM reported ever experiencing threats or violence from either family or partners and 25% reported threats or violence by both family and partners. In multivariate analysis, threats or violence by partners was significantly associated with older age, a history of forced sex and a history of running away from home. Recent unprotected anal sex and club drug use were significantly associated with a history of threats or violence by both family and partners. HIV prevention interventions need to include multiple factors that may have an impact on risk, including substance use and abuse, anti-violence and other mental-health issues.     

Correlates of sexual, ethnic, and dual identity: a study of young Asian and Pacific Islander men who have sex with men

Having a positive attitude toward one's own sexual and ethnic identity can improve psychological well-being and self-efficacy and may reduce vulnerability to HIV infection. We sought to understand factors associated with having greater self-worth about being Asian and Pacific Islander (API), being gay/bisexual, and being both gay/bisexual and API (dual identity). We conducted serial, cross-sectional surveys of 763 API men who have sex with men (MSM) annually from 1999 to 2002 in San Diego, California and Seattle, Washington. We found (a) sexual and ethnic identity were intertwined and mutually influential; (b) a positive attitude toward sexual identity was associated with higher socioeconomic status, greater social support, and self-identified homosexual orientation (as opposed to "straight/undecided"); (c) a positive dual identity was associated with higher socioeconomic status, greater social support, and levels of acculturation (being United States born and speaking English and another language equally); and (d) a positive sexual identity and dual identity were associated with HIV testing. The findings suggest that targeted programs should address cultural issues at the intersection of sexual and ethnic identity, promote social support and self-acceptance around homosexual identity, and help MSM build a positive sense of self to foster their self-esteem and HIV prevention self-efficacy.     

Sexual risk behaviors among apps-using young men who have sex with men in Hong Kong

This study is among the first to examine the sexual risk behaviors and attendant factors of young men who have sex with men (YMSM) in Hong Kong using location-aware gay social networking mobile applications (“gay apps”). Among the 213 YMSM (M_age?=?21.52, SD?=?2.29 years, range 17–25) who reported their recent (past six months) sexual history with male partners and gay apps use, inconsistent condom use (ICU) during anal sex was fairly common (60.2% regular partners, 45.8% non-regular partners). One-fifth of the sample reported condomless internal ejaculation (CIE) during anal sex (19.3% insertive, 19.8% receptive). Frequent “Grindr” and “Jack'd” users were less likely to report anal sex, and hence ICU, with regular [adjusted odds ratio (AOR)?=?0.72] and non-regular (AOR?=?0.62) partners, respectively. Sexual partnering via apps doubled the odds of ICU with both regular (AOR?=?1.99) and non-regular (AOR?=?2.17) partners. The odds of ICU with regular partners also increased with relationship status (AOR?=?2.86 exclusive, AOR?=?3.23 non-exclusive) but reduced for those who never had STI/HIV testing (AOR?=?0.27). With non-regular partners, YMSM's likelihood of ICU increased with more recent partners (AOR?=?3.25) and drug use (AOR?=?3.79), but reduced with group sex (AOR?=?0.15). The odds of receptive CIE increased with alcohol consumption (AOR?=?4.04), non-exclusive relationship (AOR?=?4.10), and more recent partners (AOR?=?2.47), but reduced with group sex (AOR?=?0.15) and older age (AOR?=?0.84). For insertive CIE, the odds increased with bisexual YMSM (AOR?=?2.89), exclusive relationship (AOR?=?3.97), and longtime apps-use (AOR?=?1.81). The findings identify meaningful differences among YMSM app-users that inform sexual health intervention and suggest attention on alcohol or drug use during sex and condomless sex with non-exclusive regular partners.     

沈阳市男男性行为人群HIV感染率及其影响因素分析

目的了解沈阳市男男性行为人群（MSM）艾滋病病毒（HIV）感染率及其影响因素,进一步做好MSM的艾滋病防治工作。方法采用同伴推动法（RDS）招募900名MSM,由经过专业培训的调查员进行面对面的问卷调查,主要内容包括社会人口学特征、艾滋病知识知晓水平、性行为状况、接受干预服务情况和HIV/梅毒感染状况,并抽取静脉血检测HIV及梅毒,对影响HIV感染的相关因素进行χ2检验。结果调查了900名MSM,艾滋病知识知晓率达到91.3%。86.9%的调查对象最近6个月有同性肛交性行为,最近6个月与男性发生肛交性行为时每次都使用安全套的比例为57.5%。HIV感染率为9.3%,梅毒感染率为11.0%。分析显示,年龄较大、文化程度在初中及以下、最近6个月与男性发生肛交性行为时未坚持使用安全套、梅毒感染是感染HIV的危险因素。结论 MSM人群高危性行为发生率、HIV和梅毒感染率均高,可能成为当前HIV流行的重要人群和重要因素,应采取积极有效的宣传教育和行为干预活动。     

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。     

Heterogeneity of risk among African-American men who have sex with men

The objective of this study was to examine the social mixing and sexual risk taking of African-American men who have sex with men (AAMSM). The design was a cross-sectional survey with targeted, ethnographically informed recruitment of respondents (n = 95), and subsequent recruitment of their network partners (n = 63). We ascertained current demographics, occupation, peer norms for sexual activity, community involvement, and information about members of their social and sexual network. Risk level was categorized by the frequency of anal sex and the consistency of condom use for anal sex. Twenty-nine of 158 (18.4%) persons were classified as being at high risk (any anal intercourse in the past three months with less than 100% condom use); 79 of 158 (50%) were at medium risk (any anal intercourse in the past three months with 100% condom use reported), and 50 (31.7%) were at low risk (no reported anal intercourse). The risk groups were similar with regard to perception of behavioural and community norms. White-collar workers associated predominantly with each other and other groups mixing preferentially with white-collar workers. Clustering within contact networks (the extent to which partners to a respondent know each other) was high for all risk groups (approximately 0.4-0.5), indicating dense, interactive networks. In conclusion, this study group demonstrates a greater degree of social mixing and heterogeneity than is commonly assumed for AAMSM. At least some portion of AAMSM has internalized public health messages about safer sexual activity. Intervention programmes should avoid the pitfalls of assumed homogeneity.     

A longitudinal examination of factors associated with social support satisfaction among HIV-positive young Black men who have sex with men

This study examined the long-term predictors of social support satisfaction among HIV-positive young Black men who have sex with men (YBMSM). Data were collected across three waves between October 2012 and November 2014 as part of the baseline assessment from Project nGage, a preliminary efficacy randomized control study examining the role of social support in improving HIV care among YBMSM. The sample included 92 YBMSM aged 18–29. Major results controlling for age, education and intervention effects indicated that psychological health, social network size, and education at baseline predicted differences in social support satisfaction at Wave 3, with no significant effects based on length of HIV diagnosis. Therefore, interventions that are intended to promote the quality of life for YBMSM and their engagement and retention in HIV care must focus on their psychological health concerns and network size.     

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.     

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.     

男男性行为人群队列保持的影响因素研究

目的探讨男男性行为人群(MSM)艾滋病病毒(HIV)血清学阳转的前瞻性队列保持影响因素。方法 2009年3-10月,在重庆市采用分类滚雪球的方法,招募HIV抗体检测阴性的MSM,2010年3月和9月分别进行两次随访调查,随访联系以移动电话和网络聊天工具通知为主,并在随访联系中逐一调查研究对象的失访情况。分析研究对象的社会人口学和行为学特征,以及对队列保持的影响。结果基线进入队列的453名MSM,有299人至少参加了一次随访,随访率为66.0%。单因素和多因素分析显示,年龄>25岁、本市居住时间>1年、近1年做过艾滋病检测与近6个月发生无保护男男肛交性行为和较高的保持率密切相关(P<0.05)。结论低年龄段、本地居住时间较短、近1年未做过艾滋病检测、近6个月未发生无保护男男肛交性行为的MSM,相比之下更不易保持在队列中,需要在MSM队列研究时引起注意。     

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.     

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.     

深圳市男男性行为人群不安全性行为状况及其影响因素

目的了解深圳市男男性行为人群(MSM)不安全性行为状况及其影响因素,为开展有针对性的干预工作提供建议。方法通过滚雪球的方式招募MSM,在知情同意保密原则下,对近半年有过男男性行为的450名MSM进行匿名自填问卷调查,并通过CAPI指纹系统对被调查者进行查重。结果此次被调查的MSM艾滋病知识知晓率较高,除"蚊虫叮咬会不会传播艾滋病病毒"这一项知晓率只有63.78%,其他几项知晓率均高于80.00%。近半年与男性发生性行为的平均性伴数为(5.02±1.23)个,18.67%的人有过异性性行为。经多因素Logistic回归分析发现,文化程度低(OR=0.740,P=0.0194)、第一个性伴为男性(OR=1.706,P=0.0097)为不安全性行为的危险因素。结论深圳市MSM人群呈现明显的知识和行为分离,应探索更有效的干预方法,减少其性伴数和提高安全套使用率。     

Ethnic and gay community attachments and sexual risk behaviors among urban Latino young men who have sex with men.

Culturally relevant prevention programs are required to reduce HIV risk exposure of Latino young men who have sex with men (YMSM). As part of Hermanos Jóvenes, 465 Latino YMSM were surveyed at community venues of New York City outside the gay-identified area of lower Manhattan. We examined factors that influence ethnic and gay community attachments; the association between community attachments and social support in sexual matters; and the relationship between levels of attachment, social support in sexual matters, and sexual risk behaviors. Sixty-eight percent felt closely connected to their ethnic community; about 34% were highly attached to both neighborhood and New York City gay communities. Greater social support in sexual matters was associated with ethnic and gay community attachments. Latino YMSM connected to their ethnic community were about 40% less likely to report recent unprotected anal intercourse (UAI) with a male partner, and 60% less likely to have engaged in UAI during the last sexual contact with a nonmain male partner. Gay community attachment was not significantly related to risk behaviors. Findings point to the importance of ethnic ties and involving ethnic community organizations in HIV prevention efforts.     

Depression and anxiety among HIV-positive men who have sex with men and men who have sex with women in China

ABSTRACT

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). Minority stress theory posits that marginalized populations experience additional stress, which influences experiences of psychological distress and health outcomes. This study aimed to understand psychological distress of MSM relative to men who have sex with women (MSW) in an urban Chinese setting. Cross-sectional survey data were collected from 162 HIV-positive Chinese men receiving HIV treatment at Beijing’s Ditan Hospital. Multiple linear regression with imputation was used to identify correlates of psychological distress. Relative to MSW, MSM were younger, more educated, and less likely to be in a relationship or have children. While both groups reported clinically elevated levels of depression and anxiety, sexual behavior was not associated with either outcome. Higher endorsement of depression symptomology was associated with worse reported physical health (β?=??1.37, p?<?.05) and greater endorsement of maladaptive coping (β?=?2.39, p?<?.05), whereas higher endorsement of anxiety symptomology was associated with greater endorsement of adaptive coping (β?=?0.78, p?<?.05), diminished physical health (β?=??0.86, p?<?.05), and a high school or greater level of education (β?=?4.13, p?<?.05). These findings suggest that interventions targeting coping strategies may address psychological distress among HIV-positive Chinese men.