Gay Asian men in San Francisco follow the international trend: increases in rates of unprotected anal intercourse and sexually transmitted diseases, 1999-2002.

Worldwide, studies of men who have sex with men (MSM) report increases in HIV risk-related behavior. Less is known about trends within minority subpopulations of MSM, particularly those of Asian and Pacific Islander (A&PI) ethnicity. A&PI MSM are underrepresented among AIDS cases (2.7%) with respect to their estimated makeup in the gay community of San Francisco (4.5%). However, recent trends in unprotected anal intercourse (UAI) and sexually transmitted diseases suggest a reversal in the relative risk for HIV among A&PI MSM compared with White MSM. Starting from lower levels in 1999, UAI with multiple partners, UAI with multiple partners of unknown HIV serostatus, the incidence of male rectal gonorrhea, and the incidence of early syphilis among A&PI MSM surpassed levels among White MSM by 2002. A window of opportunity to prevent further spread of HIV among A&PI MSM may be closing.     

Using Social Networks to Reach Black MSM for HIV Testing and Linkage to Care

Black men who have sex with men (MSM) are disproportionately affected by HIV infection. Black MSM in San Francisco may have higher rates of unrecognized HIV infections. Increased HIV testing among Black MSM may reduce the numbers of unrecognized infections, inform more men of their status and thus reduce the potential for ongoing transmissions. Social network HIV testing programs have focused on asking HIV-positive and/or high-risk negative men to recruit their social or sexual contacts. We used a network approach to deliver HIV testing to Black MSM in San Francisco and collected risk assessment data. Participants were asked to recruit any of their social contacts who were also Black MSM. Recruitment by risk level and HIV status was heterogeneous. HIV infection among this population is associated with older age, having a high school education or higher and currently being homeless. Fully 23% of HIV positive Black MSM are unaware of their infection. Only a third of unrecognized infections were recruited by a known HIV-positive participant. Linkage to care was a challenge and underscores the need for comprehensive systems and support to link Black MSM to care and treatment.     

The bisexual bridge revisited: sexual risk behavior among men who have sex with men and women, San Francisco, 1998-2003

From 1998 to 2003 in San Francisco, unprotected anal intercourse (UAI) with one or more partner of unknown HIV serostatus (potentially serodiscordant UAI) increased among bisexual men who have sex with men (MSM) in parallel and in magnitude compared with other MSM. Potentially serodiscordant UAI and unprotected vaginal intercourse increased from 1998 to 2001 then decreased from 2001 to 2003. Although elements of a 'bisexual bridge' are present, we note an encouraging decrease in risk from 2001 to 2003.     

Examining progress toward the UNAIDS 90-90-90 framework among men who have sex with men,San Francisco, 2014

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has published treatment goals toward ending the HIV epidemic. The worldwide goals are 90% of HIV-infected individuals diagnosed, 90% of those diagnosed taking anti-retroviral treatment and 90% of those on anti-retroviral treatment virally suppressed. In light of the UNAIDS goals and that five years have passed since the adoption of early HIV treatment, we examined the progress toward the 90-90-90 indicators among men who have sex with men (MSM) in San Francisco in 2014. Our data suggest that overall MSM have not yet reached the 90-90-90 goals. Our data also suggest that Black and Latino MSM are further from the goals than White MSM.     

Syphilis in Denmark-Outbreak among MSM in Copenhagen, 2003-2004

Denmark is currently experiencing an outbreak of syphilis that began in 2003 and has continued in 2004. Data from the national surveillance system show that most cases are in men who have sex with men (MSM), and that a large proportion of these patients are also HIV positive. The proportion of known HIV positive cases in MSM notified with syphilis during the outbreak has, however, not been significantly different from previous years. The majority of cases were reported from Copenhagen municipality, and 70% of the cases were acquired domestically. The outbreak does not seem to be affecting the age group under 20 years. We speculate that most of the MSM found with both syphilis and HIV were already HIV positive when they acquired syphilis infection.     

Breaking Down the Siloes: Developing Effective Multidisciplinary HIV Research Teams

Among men who have sex with men (MSM), sexual compulsivity is associated with overlapping psychosocial and behavioral health problems. Because difficulties with emotion regulation are thought to be one important feature, this study examined whether affective states and traumatic stress symptoms were independently associated with key dimensions of sexual compulsivity. Data were collected in San Francisco for the Urban Men’s Health Study-2002 from May 24, 2002 to January 19, 2003. In total, 711 MSM recruited via probability-based sampling completed a mail-in questionnaire that assessed psychological factors and substance use. Dissociation related to traumatic stress and any stimulant use in the past 6 months were independently associated with more frequent sexual thoughts or urges. Increased anger and HIV-positive serostatus were independently associated with a greater perception that sexual behavior is difficult to control. Clinical research is needed to examine if interventions targeting emotion regulation and traumatic stress can boost the effectiveness of HIV prevention efforts among MSM who experience difficulties related to managing sexual behaviors.     

An outbreak of syphilis in Oslo

During 1999 and 2000, an outbreak of syphilis occurred in Norway: 93 cases were reported to the National Institute of Public Health. This report summarizes a retrospective investigation of the medical records of 60 patients with primary, secondary and early latent syphilis treated during 1999-2000 at the Department of STD at the Ullev?l University Hospital in Oslo. Five women and 55 men were treated, mean age 38.6 and 44.9 years, respectively. Of the 60 cases, 14 (23.3%) had primary, 39 (65.0) secondary and seven (11.7%) early latent syphilis. Men who have sex with men (MSM) constituted 78.2% (43/55) of the male patients. Transmission among MSM was related to casual sexual contacts in bathhouses in Oslo. Two cases occurred among men with previously diagnosed HIV infection. Two new cases of HIV were reported. Condom use was inconsistent, and seldom used for oral sex.     

Incidence of the acquired immunodeficiency syndrome in San Francisco, 1980-1983

Incidence data for the acquired immunodeficiency syndrome (AIDS) are presented on the basis of a surveillance file maintained by the San Francisco Bureau of Communicable Disease Control. The incidence of AIDS among residents of San Francisco rose steadily from the first case diagnosed in the last quarter of 1980 through the last quarter of 1983. New cases were diagnosed at a rate of 25 per month in the last quarter of 1983. Reported incidence declined in mid-1983, but the decline was probably a case-finding artifact. Smoothed incidence rates show a steady progressive rise, which is approximated equally well by quadratic or exponential curves. Among the patients diagnosed in San Francisco, 99% were homosexual or bisexual men. The cumulative incidence rate among homosexual or bisexual men was estimated to be 770 per 100,000 in the last quarter of 1983. The incidence rate of AIDS increased with age, and the increase was greater than that found with other sexually transmitted diseases. The difference in the age distributions between cases of AIDS and syphilis suggests either that susceptibility to AIDS increases with age or that the average latency associated with AIDS is longer than previously thought.     

Amphetamine use is associated with increased HIV incidence among men who have sex with men in San Francisco

We examined the association between amphetamine use and HIV incidence for 2991 men who have sex with men (MSM) who tested anonymously for HIV in San Francisco. HIV incidence among 290 amphetamine users was 6.3% per year (95% CI 1.9-10.6%), compared with 2.1% per year (95% CI 1.3-2.9%) among 2701 non-users (RR 3.0, 95% CI 1.4-6.5). HIV prevention programmes in San Francisco should include efforts to reduce amphetamine use and associated high-risk sexual behaviors.     

The public health response to the re-emergence of syphilis in Wales, UK

During the 1990s, cases of infectious syphilis were uncommon in Wales. In 2002, an outbreak occurred in a sexual network of men who have sex with men (MSM) attending a sauna. A multidisciplinary outbreak control team was convened to raise awareness of the outbreak among MSM and health professionals, assess the extent of outbreak, and initiate surveillance measures. It is likely that early intensive control efforts dampened the epidemic curve. However, since 2006 the number of cases has increased steadily to a peak of four cases per 100,000 population in 2008. The majority of cases continue to occur in MSM (81% in 2009) and in those attending genitourinary (GU) medicine clinics in south east Wales (76%). Traditional sexual networks such as saunas, bars/clubs and cruising grounds remain frequently reported, but Internet-based networks are assuming increasing importance. Public health interventions have been sustained, using traditional partner notification, health promotion initiatives, and more innovative Internet network tracing methods.     

Same race and older partner selection may explain higher HIV prevalence among black men who have sex with men

In a community-based survey in San Francisco, black men who have sex with men (MSM) had higher rates of same-race/ethnicity sexual partnerships and partners 10 or more years older compared with other MSM. Differences in sexual networks may explain why black MSM have higher HIV prevalence than other MSM despite lower levels of risk behavior.     

青岛地区MSM中HIV/梅毒及尖锐湿疣的感染情况

目的了解青岛地区男男性行为人群（MSM）艾滋病病毒（HIV）/梅毒及尖锐湿疣的感染情况。方法利用中盖项目支持平台,对前来接受干预检测的MSM进行相关查体及实验室检查。结果 687名MSM共检出尖锐湿疣41例,检出率为5.97%;梅毒89例,检出率为12.95%;HIV 8例,检出率1.16%。8例HIV阳性患者中,3例合并CA,4例合并梅毒;2例CA患者同时伴有HIV、梅毒阳性;89例梅毒阳性患者中,19例合并CA。结论 MSM中HIV、梅毒及尖锐湿疣感染情况严重,提示临床医生在对MSM的梅毒、尖锐湿疣患者诊治的同时,应注重HIV的检测。     

Syphilis surveillance and epidemiology in the United Kingdom

The aim of this article is to describe trends in infectious syphilis in the UK, and specifically the epidemiology of the London syphilis outbreak, the largest in the UK to date. Analysis of routine surveillance data from genitourinary medicine (GUM) clinics was performed as well as data collection through enhanced surveillance systems. There have been substantial increases in diagnoses of infectious syphilis between 1998 and 2003, with a 25-fold increase seen in men who have sex with men (MSM) (from 43 to 1028 diagnoses); 6-fold (138 to 860) in heterosexual men and 3-fold (112 to 338) in women. The national rise in syphilis was driven by a series of local outbreaks, the first of which occurred in 1997. To date, 1910 cases have been reported in the London outbreak, first detected in April 2001. High rates of HIV co-infection were seen among MSM, with MSM likely to be of white ethnicity and born in the UK. In contrast, heterosexuals were more likely to be of black ethnicity and born outside the UK. Most syphilis infections were acquired in London. MSM bear the brunt of the national resurgence in infectious syphilis. Substantial rises in male heterosexual cases has resulted in a divergence between male heterosexual and female cases, which now requires further investigation.     

The Internet, HIV serosorting and transmission risk among men who have sex with men, San Francisco

In a community-based, time-location sampling survey in San Francisco, Internet-met partners were not more likely to be HIV seroconcordant among HIV-negative and HIV-positive men who have sex with men (MSM) compared with partners met at bars and dance clubs. In addition, HIV-negative MSM were more likely to have unprotected anal intercourse with potentially serodiscordant partners met on the Internet compared with those met at bars and dance clubs (adjusted OR 1.5, 95% CI 1.1-2.0, P = 0.01).     

Internet-based site-specific interventions for syphilis prevention among gay and bisexual men

Recent increases in syphilis in gay men in urban areas in the US and Europe have been associated with men meeting new sex partners on the Internet in chat-rooms and at websites that facilitate partner meeting. In response to the syphilis epidemic in San Francisco, the San Francisco Department of Public Health partnered with a community-based organization, Internet Sexuality Information Services, Inc., to develop, implement and evaluate a broad range of innovative Internet-based prevention interventions including the creation of a website, individual online outreach, banner advertisements, chats, an educational site, message boards, warnings and an online syphilis testing program. This paper documents the varied success of these interventions with process measures and calls for greater emphasis on impact measures in the evaluation of these types of intervention.     

Racial Mixing and HIV Risk Among Men Who Have Sex with Men

We conducted a cross-sectional survey of MSM using a time-location-sampling design in San Francisco during 2007–2008. The investigation focused on the selection of sexual partners, partner preferences, perceptions of HIV risk, and social mixing with respect to race/ethnicity. The sample of 1,142 MSM was 56% White, 22% Latino, 14% Asian, and 9% Black and reported on 3,532 sexual partnerships. Black MSM had a significant, three-fold higher level of same race sexual partnering than would be expected by chance alone (i.e., in the absence of selective forces with respect to race among partners). Black MSM were reported as the least preferred as sexual partners, believed at higher risk for HIV, counted less often among friends, were considered hardest to meet, and perceived as less welcome at the common venues that cater to gay men in San Francisco by other MSM. Our findings support the hypothesis that the sexual networks of Black MSM, constrained by the preferences and attitudes of non-Blacks and the social environment, are pushed to be more highly interconnected than other groups with the potential consequence of more rapid spread of HIV and a higher sustained prevalence of infection. The racial disparity in HIV observed for more than a decade will not disappear until the challenges posed by a legacy of racism towards Blacks in the US are addressed.     

STI surveillance by a sentinel network of physicians in Belgium

The STI sentinel surveillance network by physicians in Belgium started in 2000. During 4 months a year, from October until January, STI patients were registered using a standardized protocol. The main goal is to determine STI incidence trends by comparing the results of the analyses using the data of the physicians that registered in all registration periods (Oct. 2000-Jan. 2001; Oct. 2001-Jan. 2002; Oct. 2002-Jan. 2003; Oct. 2003-Jan. 2004). Between the registration periods 2000-2001 and 2002-2003, there was a significant increase in the number of syphilis diagnoses (p<0.01), largely attributable to infections in men who have sex with men (MSM). A high proportion of MSM with syphilis were HIV positive. 83% of HIV positive MSM were already aware of their HIV positive status. The proportion of STI patients with HIV co-infection increased significantly throughout the different periods (from 7.4% in 2000-2001 to 18.1% in 2003-2004; p<0.01). These findings emphasize the importance of the proposal of a HIV test in a STI patient and call for intensification of prevention measures, particularly in MSM and people living with HIV.     

Recent syphilis trends in Belgium and enhancement of STI surveillance systems

Over the past five years, a series of syphilis outbreaks mainly occurring among gay men have been observed in Europe. One of these outbreaks was reported in the city of Antwerp, Belgium, during the first quarter of 2001. This outbreak is still ongoing in 2004. Furthermore, active syphilis diagnoses reported by the Sentinel Laboratory Network rose by 89% in the country during the fourth quarter of 2003. An increase in Brussels was also observed during the same quarter (+300%; 24 cases reported). Overall, the sentinel network of clinicians reported that 93.4% of patients were male; among them, 79.9% were men having sex with men (MSM). The overall proportion of patients co-infected with HIV was 50.5% (MSM: 58.6%; male heterosexuals: 23.8%; females: 8.3%); 76.1% of co-infected patients were already aware of their HIV infection at the time they were diagnosed with syphilis.     

International travel among HIV-positive and HIV-negative men who have sex with men, San Francisco, USA

We measured the prevalence of international travel, the demographic and risk profile of international travellers and risk and preventive behaviours of travellers among HIV-negative and HIV-positive men who have sex with men (MSM), based in San Francisco, CA, USA, through the addition of questions to the local implementation of the National HIV Behavioral Surveillance survey in 2008. Of 270 MSM participating in the survey, slightly more than one-quarter (26.3%) had travelled internationally in the last year. Those with a history of international travel were more likely to be foreign born, of a higher socioeconomic status and HIV uninfected. Of eight HIV-positive MSM who travelled internationally (11.3% of HIV-positive MSM), all were on antiretroviral therapy and only three recalled being vaccinated for hepatitis A and B. Human papillomavirus infection was also higher among international travellers. Travel health services must be improved to address special needs of this population of international travellers.     

San Franciscan MSM have similar types and numbers of partnerships with men inside San Francisco and outside San Francisco, 2011

Sexual networks among men who have sex with men (MSM) across health jurisdictions may play a role in HIV transmission and acquisition. Levels of HIV prevention activities may be different across health jurisdictions leading to differential risk for HIV transmission with partners in and outside of San Francisco (SF). We examined MSM sexual partnerships within and outside SF. Data were collected during the 2011 National HIV Behavioral Surveillance MSM data collection cycle. Participants were asked to report characteristics of and sexual behaviors with up to five most recent sexual partners. Restricting our analysis to sexually active San Franciscans (n?=?329 MSM reporting 927 partnerships), we found that SF MSM have similar numbers of partnerships (SF mean?=?1.3, non-SF mean?=?1.2) and levels of risk behavior with men within and outside SF. With the current intensity of HIV prevention occurring in SF additional strategies may be needed to address the fact that SF MSM have many sexual connections to men in other health jurisdictions where HIV prevention may not be similar to those in SF.