Association of herpes simplex virus type 2 infection and syphilis with human immunodeficiency virus infection among men who have sex with men in Peru

BACKGROUND: We evaluated associations between human immunodeficiency virus (HIV) infection, herpes simplex virus type 2 (HSV-2) infection, and syphilis among men who have sex with men (MSM) in Peru. METHODS: A surveillance survey of 3280 MSM was conducted; sexual behavior was assessed with a structured computer-assisted self-interview, and serum antibody testing was performed for HIV, HSV-2, and Treponema pallidum. RESULTS: HIV, HSV-2, and syphilis seroprevalences of 13.9%, 46.3%, and 13.4% were detected, respectively. HSV-2 seroprevalence was twice as high in HIV-infected subjects (80.5%) than it was in HIV-uninfected subjects (40.8%) (P < .01), and HSV-2 seropositivity (adjusted odds ratio [AOR], 5.66) was found to be strongly associated with HIV infection. In addition, homosexual self-definition (AOR, 3.12), exchange of sex for money (AOR, 1.61), unprotected sex (no condom) (AOR, 2.81), history of sex work (AOR, 1.89), oral receptive sex (AOR, 1.43), and cocaine use before/during sex (AOR, 2.53) within the preceding 6 months, as well as such sexually transmitted infections (STIs) and STI syndromes as proctitis (AOR, 2.80), genital ulcer disease (GUD) (AOR, 2.06), prior syphilis (AOR, 2.64), genital warts (AOR, 1.70), and self-reported STIs within the preceding 6 months (AOR, 1.61), were also found to be significant predictors of HIV infection. CONCLUSIONS: We found a strong association between HSV-2 seropositivity and HIV infection. Intervention measures against GUD due to HSV-2 infection and syphilis, such as routine testing, early detection, HSV-2 suppressive treatment, and condom distribution, need to be enhanced as part of STI prevention strategies at a national level to effectively reduce HIV infection among MSM in Peru.     

Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors

OBJECTIVE: To identify factors that contribute to the racial disparity in HIV prevalence between black and white men who have sex with men (MSM) in the United States. METHODS: A comprehensive literature search of electronic databases, online bibliographies, and publication reference lists yielded 53 quantitative studies of MSM published between 1980 and 2006 that stratified HIV risk behaviors by race. Meta-analyses were performed to compare HIV risks between black and white MSM across studies. RESULTS: Compared with white MSM, black MSM reported less overall substance use [odds ratio (OR), 0.71; 95% confidence interval (CI), 0.53-0.97], fewer sex partners (OR, 0.64; 95% CI, 0.45-0.92), less gay identity (OR, 0.29; 95% CI, 0.17-0.48), and less disclosure of same sex behavior (OR, 0.42; 95% CI, 0.30-0.60). HIV-positive black MSM were less likely than HIV-positive white MSM to report taking antiretroviral medications (OR, 0.43; 95% CI, 0.30-0.61). Sexually transmitted diseases were significantly greater among black MSM than white MSM (OR, 1.64; 95% CI, 1.07-2.53). There were no statistically significant differences by race in reported unprotected anal intercourse, commercial sex work, sex with a known HIV-positive partner, or HIV testing history. CONCLUSIONS: Behavioral risk factors for HIV infection do not explain elevated HIV rates among black MSM. Continued emphasis on risk behaviors will have only limited impact on the disproportionate rates of HIV infection among black MSM. Future research should focus on the contribution of other factors, such as social networks, to explain racial disparities in HIV infection rates.     

HIV testing, perceived vulnerability and correlates of HIV sexual risk behaviours of Latino and African American young male gang members

This study examined HIV testing behaviours, perceived vulnerability to HIV and correlates of sexual risk behaviours of young adult Latino and African American male gang members in Los Angeles, California. Data were collected from 249 gang members aged 18-26 years. The majority (59%) of gang members reported unprotected vaginal intercourse (UVI) in the past 12 months. Only one-third (33.2%) of gang members had ever been tested for HIV. In our multivariate analysis, gang members who reported UVI were more likely to have engaged in the following behaviours: had sex with someone they just met (adjusted odds ratio [AOR] = 4.51), had sex with someone they think or know had a sexually transmitted infection (STI; AOR = 4.67) or had sex while incarcerated (AOR = 8.92). In addition, gang members with a higher perceived vulnerability to HIV were less likely to report UVI in the previous 12 months (AOR = 0.75). These findings offer implications for development of an HIV prevention intervention for young Latino and African American male gang members.     

北京市部分男男性行为人群HIV感染情况及影响因素

目的了解北京市男男性行为人群（MSM）艾滋病病毒（HIV）感染情况及其影响因素。方法于2011年9-12月,在北京市通过同伴推动抽样法（RDS）招募500名MSM,进行问卷调查,内容包括社会人口学、性行为学及一般自我效能量表,并采集血样检测HIV抗体。用RDSAT软件对研究对象的社会网络进行调整,导出相关数据权重,并用SAS 9.1进行统计分析。结果 MSM的HIV感染粗率为7.2%（36/500）,经RDS调整,HIV感染率为6.1%。多因素Logistic回归分析显示,MSM感染HIV的保护性因素有：一般自我效能得分高（AOR=0.4,95%CI：0.2～0.9）,近1年做过HIV检测（AOR=0.5,95%CI：0.2～0.9）;危险因素为近6个月发生过被动肛交（AOR=2.2,95%CI：1.1～4.4）。MSM一般自我效能量表内部一致性检验克朗巴赫系数（Cronbach’s Alpha）为0.92,不同的自我效能得分组同HIV感染有剂量关系。结论北京市MSM中HIV感染率较高,需采取适当的心理干预措施,提高MSM的自我效能,同时促进MSM定期做HIV检测,减少MSM被动无保护性行为的发生,有助于控制HIV在该人群的传播。     

Choice of Rapid HIV testing and entrance into care in Baltimore City sexually transmitted infections clinics

Point-of-service (POS) HIV testing in sexually transmitted infection (STI) clinics is one public health strategy to increase knowledge of serostatus and to facilitate entry into care. Variation has been reported in clients' views of test reliability and rates of test acceptance. Our objective was to characterize STI clinic patients' choice of POS versus conventional testing (enzyme-linked immunosorbant assay [ELISA] followed by Western blot, with results in 1 week) in Baltimore, Maryland (a high-prevalence city) when both were offered (May through August 2008), then to compare rates of engaging in care. Odds ratios (OR) with 95% confidence intervals (CI) described factors associated with test type choice, as well as HIV test type with entrance into care. The overall prevalence of HIV among testers was 1.1% (60/5101). Those reporting receptive anal sex (OR 1.4; 95% CI 1.1-1.7), illicit drug use (OR 1.3; 95% CI 1.0-1.6), or an HIV-positive sexual contact (OR 1.5; 95% CI 1.0-2.2) were more likely to choose POS testing, as were those who had been tested for HIV previously (OR 1.3; 95% CI 1.1-1.5). Hispanics were less likely to choose POS testing (OR 0.6; 95% CI 0.4- 0.7). Entry into care was low in both categories of test takers (52% in POS testers versus 42% in conventional testers, p?=?0.58). Patients at the highest risk for HIV preferred POS testing in STI clinics. Strengthening linkage to care is important for optimizing outcomes of HIV-positive patients presenting to STI clinics.     

苏州市男男性行为人群HIV感染的配比病例对照研究

目的探讨苏州市男男性行为人群（MSM）艾滋病病毒（HIV）感染的危险因素。方法采用时间序列病例对照的研究方法,病例来源于2008年5月至2009年7月间苏州MSM人群调查中新发现的HIV感染者,对照为按入组时间进行1∶4匹配的HIV抗体阴性者;问卷调查收集人口学、行为学信息等信息。数据分析运用条件Logistic回归模型。结果共获得病例58人,对照232人。单因素结果显示,与HIV感染相关的因素有大专及以上文化程度（OR=0.40,95%CI：0.20,0.78）、外地户籍（OR=2.19,95%CI：1.05,4.55）、最近6月内有5个及以上同性性伴（OR=2.29,95%CI：1.15,4.56）、最近6月内与同性发生被插入性肛交（OR=2.30,95%CI：1.16,4.59）、最近6月内与同性肛交从不/偶尔使用安全套（OR=4.20,95%CI：1.95,9.08）、感染梅毒（OR=2.28,95%CI：1.17,4.41）;多因素分析表明,大专及以上文化程度（OR=0.45,95%CI：0.21,0.98）是MSM人群HIV感染的保护因素,而肛交从不/偶尔使用安全套（OR=3.76,95%CI：1.60,8.84）是MSM人群HIV感染的危险因素。结论文化程度高是MSM HIV感染的保护因素,而肛交不用安全套是MSM HIV感染的危险因素;需要针对MSM人群开展强化安全套使用的干预。     

Factors associated with sexually transmitted infection testing among men who utilize an internet-based men who have sex with men community

Public health messaging encourages men who have sex with men (MSM) to be tested for sexually transmitted infections (STI) and HIV at least yearly, and more frequently depending on sexual behaviors. However, despite engaging in a range of sexual behaviors, many MSM do not participate in regular STI testing. The objective of this study was to understand factors associated with STI testing among a nonclinic-based population of men accessing an Internet-based social and sexual networking site. We asked 25,736 men to complete a comprehensive behavioral and health assessment after being recruited from an Internet site popular among men seeking social or sexual interactions with other men. Analyses were performed using multivariate logistic regression with effects significant at p?相似文献   

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.     

Ethnicity and HIV vulnerabilities among men who have sex with men in China

Ethnic affiliation can define sociocultural boundaries and contribute to the HIV vulnerabilities faced by men who have sex with men (MSM). This study investigated the influence of ethnic affiliation on HIV vulnerabilities among MSM in North China. Our study analyzed a cross-sectional survey of MSM (n?=?398) in two major North China cities. We examined associations between ethnic affiliation and (a) HIV status, (b) sexual behaviors and experiences, and (c) substance use. Compared to ethnic majority Han MSM: MSM belonging to ethnic minority groups of South China had significantly greater odds of HIV infection (AOR: 7.40; 95% CI: 2.33–23.47) and experience of forced sex (AOR: 3.27; 95% CI: 1.12–9.52). Compared to ethnic majority Han MSM, Ethnic Hui MSM had significantly lower odds of condomless anal sex (AOR: 0.41; 95% CI: 0.21–0.82) and significantly greater odds of circumcision (AOR: 2.62; 95% CI: 1.24–5.51). HIV prevalence and riskier sexual behaviors among MSM in China appear to vary significantly by ethnic affiliation. Current epidemiological practices of aggregating all ethnic minority groups in China into a single category may be masking important interethnic differences in HIV risk, and precluding opportunities for more culturally appropriate interventions.     

Engagement in HIV care and sexual transmission risk behavior among men who have sex with men using online social/sexual networking in Latin America

HIV/AIDS in Latin America is concentrated among men who have sex with men (MSM). However, accurate estimates of engagement in HIV care in this population can be difficult to ascertain because many do not self-identify as MSM. Given evidence of decreased HIV transmissibility in the context of antiretroviral therapy (ART) adherence, identifying individuals not in care who are engaging in HIV transmission risk behavior is crucial for secondary prevention. Primary aims of this study were to examine engagement in care from testing to ART adherence among MSM using online social/sexual networking across Latin America, and whether individuals not in care at each step reported greater sexual transmission risk behavior than those in care. In the overall sample (n = 28,779), approximately 75% reported ever being tested for HIV, and 9% reported having received an HIV diagnosis. Among known HIV-infected individuals, 20% reported not being in care, 30% reported not taking ART, and 55% reported less than 100% ART adherence. Over one-third of HIV-infected individuals reported sexual HIV transmission risk behavior, defined as unprotected anal intercourse (UAI) with a male partner of different/unknown HIV serostatus in the past three months. HIV-infected individuals not engaged in care more often reported UAI compared to those in care (OR = 1.29; 95% CI = 1.01–1.66). Although not statistically significant, HIV-infected individuals not on ART more often reported UAI compared to those on ART (OR = 1.18; 95% CI = 0.94–1.47). Individuals who reported less than 100% ART adherence more often reported UAI compared to individuals with 100% adherence (OR = 1.55; 95% CI = 1.26–1.90). Findings demonstrate that a substantial portion of HIV-infected MSM in Latin America who are likely not virologically suppressed from lack of ART use or adherence report sexual HIV transmission risk. Tailoring secondary HIV prevention for MSM in Latin America who are not in HIV care or adherent to ART may be warranted.     

The influence of male circumcision for HIV prevention on sexual behaviour among traditionally circumcised men in Cape Town, South Africa

We examined the relationship between HIV prevention beliefs related to male circumcision and sexual behaviour/sexually transmitted infection (STI) acquisition among traditionally circumcised men in Cape Town, South Africa. HIV-negative men (n = 304), circumcised for cultural/religious reasons, attending a health clinic in Cape Town, South Africa, completed cross-sectional surveys. Generalized linear models were used to analyse the relationships between unprotected vaginal sex acts, number of female sexual partners, STI diagnoses and male circumcision-related beliefs and risk perceptions. Men who were aware that circumcision offers protection against HIV (relative risk [RR] = 1.19, 95% confidence interval [CI] = 1.06-1.32, P < 0.01), endorsed risk compensation related to male circumcision (RR = 1.15, 95% CI = 1.11-1.12, P < 0.01) and perceived lower risk of HIV infection when circumcised (RR = 1.08, 95% CI = 1.04-1.12, P < 0.01) were more likely to report unprotected vaginal sex acts. Similar patterns were also identified when predicting number of female sexual partners. Men who were more likely to endorse risk compensation related to male circumcision were also more likely to be diagnosed with a chronic STI (odds ratio [OR] = 1.64, 95% CI = 1.06-2.53, P < 0.05). Our findings suggest that we must not overlook the effects of beliefs towards male circumcision for HIV prevention among men traditionally circumcised; doing so may undermine current efforts to reduce HIV transmission through male circumcision.     

Diagnosing HIV in men who have sex with men: an emergency department's experience

In the United States, men who have sex with men (MSM) constitute the risk group in which the prevalence of new HIV infection is increasing. The percentage of undiagnosed HIV infection and HIV risk behaviors in MSM and non-MSM participating in an emergency department-based rapid HIV screening program were compared. Medical records of all male patients participating in the program from May 2008 to October 2010 were reviewed. MSM were identified as male or male-to-female patients reporting oral and/or anal sex with a male. Males eligible for testing were aged 18 or older, English-speaking, not known to be HIV infected, and able to decline testing. A total of 6672 males were approached for testing; 5610 (84.1%) accepted, 366 (6.5%) were MSM, and 5244 (93.5%) were non-MSM. A total of 90.7% were black. Median age was 41. Fifty-nine MSM (16.1%) were diagnosed with HIV compared to 81 (1.5%) non-MSM. MSM were 10 times more likely than non-MSM to have undiagnosed HIV infection (odds ratio [OR] 10.4, 95% confidence interval [CI] 7.3, 14.0). HIV-infected MSM (median age, 26) were younger than non-MSM (median age, 41). HIV-infected non-MSM were 2 times more likely than MSM to have CD4 counts less than 200 cells per microliter. MSM were more likely to report previous HIV testing (OR 1.9, 95% CI 1.4, 2.5) and risk behaviors, including sex without a condom (OR 2.0, 95% CI 1.5, 2.6), sex with an HIV-infected partner (OR 14.6, 95% CI 8.3, 25.6) and sex with a known injection drug user (OR 4.1, 95% CI 2.0, 8.4). Further investigation of emergency department-based HIV testing and risk reduction programs targeting MSM is warranted.     

Migration/mobility and risk factors for HIV among female sex workers in Andhra Pradesh, India: implications for HIV prevention

We examined the relation between high mobility/migration (sex work in three or more villages/towns within the past year) and HIV risk factors among a sample of female sex workers (FSWs) in Andhra Pradesh, India. We recruited FSWs aged ≥18 years (n = 673) through respondent-driven sampling for a survey on HIV risk. Adjusted logistic and linear regression models assessed high mobility in relation to sexual and physical victimization, sexually transmitted infection (STI) symptoms and treatment, condom use and negotiation, number and/or types of sex trades, number of clients and number of days worked. Twelve percent (n = 82) of FSWs were highly mobile; those with high mobility were more likely to report recent HIV risk factors: sexual violence (adjusted odds ratio [AOR] = 5.2; 95% confidence interval [CI]: 3.0-8.9), physical violence (AOR = 1.7; 95% CI: 1.1-2.7), unprotected sex for more money (AOR = 1.7; 95% CI: 1.1-3.0), at least one STI symptom (AOR = 1.9; 95% CI: 1.1-3.1), a greater number of vaginal sex trades (β = 3.9, P = 0.003), a greater number of clients (β = 2.5, P = 0.02) and anal sex with clients (AOR = 2.4; 95% CI: 1.4-4.1). Findings from this study underscore the violence and HIV-related vulnerability faced by mobile/migrant FSWs and highlight the need to inform and tailor related prevention strategies.     

Factors associated with intention to be tested for HIV among men who have sex with men in a country with a very low HIV prevalence

This study examined factors associated with the intention to take an HIV test among men who have sex with men (MSM) in South Korea. An internet website-based survey was conducted among users of the only and largest online MSM website between 20 July 2016, and 20 August 2016. A total of 2915 participants completed the survey and answered questions related to sociodemographic information, health behaviors, sexual behaviors, and HIV testing history. Of these, 2587 (88.7%) participants responded as having an intention to take an HIV test. A multivariable logistic regression analysis revealed the following as having reduced the intention to undergo HIV testing: very good subjective health status and no sexual interactions during the last 6 months (Adjusted odds ratios [AOR] 0.45 and 0.54, respectively). In contrast, increased intention to take an HIV test was associated with being 20–29 years old, 30–39 years old, not paying or receiving money for sex, having a history of HIV testing, and taking an HIV test once per 12 months (AOR 2.64, 2.13, 1.54, 1.81, and 2.17, respectively). In conclusion, HIV testing among MSM in this study was associated with age, subjective health status, sex(es) of one’s sexual partner(s) during the last 6 months, sexual risk behaviors, HIV testing history, and undergoing regular HIV testing.     

Perceived HIV risk,actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto,Canada

Pre-exposure prophylaxis (PrEP) reduces HIV acquisition. Our goal was to determine the willingness of men who have sex with men (MSM) to take PrEP given perceived and actual HIV risk. HIV-negative MSM were recruited from September 2010 to June 2012 and asked about PrEP willingness and perceived HIV risk. Actual sexual HIV risk was measured by three condom-use components generated through principal components analysis. General HIV risk was measured using the HIV Incidence Risk Index for MSM (HIRI-MSM). Model 1 measured PrEP willingness given perceived and actual sexual HIV risk. Model 2 included actual HIV sexual risk, perceived HIV risk and general HIV risk. Model 3 removed actual sexual HIV risk. We recruited 150 HIV-negative MSM. About 55% were willing to take PrEP. Reasons for PrEP unwillingness were: low perceived risk (64%), side-effect concerns (44%), daily pill burden (16%) and efficacy concerns (4%). Model 1: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 27.11, 95% CI 1.33–554.43) after adjusting for perceived risk, which was not significantly associated with PrEP willingness (OR 4.79, 95% CI 0.72–31.96). Model 2: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 29.85, 95% CI 1.39–640.53) after adjusting for perceived and general HIV risk, neither of which was significantly associated with PrEP willingness (OR 5.07, 95% CI 0.73–35.09) and (OR 1.58, 95% CI 0.37–6.79), respectively. Model 3: After removing actual sexual HIV risk, MSM with high compared to low perceived risk were more willing to use PrEP (OR 6.85, 95% CI 1.23–38.05), and the HIRI-MSM general risk index was not associated with PrEP willingness (OR 1.87, 95% CI 0.54–6.54). Therefore, actual sexual HIV risk was the best predictor of PrEP willingness and general HIV risk did not inform PrEP willingness.     

HIV risk among men who have sex with men who have experienced childhood sexual abuse: systematic review and meta-analysis

Previous research has indicated a high prevalence of childhood sexual abuse (CSA) among men who have sex with men (MSM) in the United States, and has suggested that CSA history is a risk factor for HIV infection in MSM. We conducted a systematic review to identify, synthesize, meta-analyze, and critique the current state of relevant literature. Systematic review methodology was utilized to identify 12 studies that compared MSM with a history of CSA to MSM without a history of CSA on HIV risk indicators including HIV serostatus, sexually transmitted infections (STIs), sexual behaviors, and illicit drug use. Overall, 27.3% (n = 4,263) of the MSM in all included studies (n = 15,622) reported a CSA history. Across the studies that used probabilistic sampling (n = 8,240), the estimated prevalence of CSA was 21.8% (n = 1,800). Meta-analysis indicated that MSM with CSA history were more likely to be HIV positive [odds ratio (OR) = 1.54; 95% confidence interval (CI) = 1.22-1.95)] and to engage in recent unprotected anal intercourse (OR = 1.85, 95% CI = 1.36-2.51). Studies also indicated that MSM with a history of CSA were more likely to report frequent casual male partners, substance use, and sex while under the influence of alcohol or other drugs. Trends across studies indicated a need for interventions to assess CSA history and address effects of CSA on sexual risk behavior of MSM. Inconsistencies across studies indicated a need to reach consensus among researchers and providers in defining CSA.     

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.     

Increasing hepatitis B vaccination among young African-American men who have sex with men: simple answers and difficult solutions

Using a bar-based sample, we identified factors associated with hepatitis B virus (HBV) vaccination among young African American men who have sex with men (MSM). The mean (+/- standard deviation [SD]) age of the 170 participants was 26 +/- 6.5 years. Nearly 40% reported at least one dose of vaccine; the remainder were completely unvaccinated. Approximately 22% (37) reported having never heard of HBV. Less than 7% of participants reported using condoms the majority of the time during oral intercourse within the past 3 months, and approximately 50% reported using condoms the majority of the time during anal intercourse within the past 3 months. In multivariable analysis, variables associated with vaccination were younger age (odds ratio [OR], 0.44 per 10-year increase in age; 95% confidence interval [CI]: 0.21-0.93, p = 0.032), higher educational attainment (OR, 4.6; 95% CI: 1.17-12.59, p = 0.003), homosexual as opposed to bisexual behavior (OR, 0.15; 95% CI: 0.06-0.41, p = 0.0001), and recent visits to a health care provider (OR, 4.31; 95% CI: 2.08-8.94, p = 0.0001). Our findings underscore the need to reach MSM for HBV vaccination. Innovative approaches are necessary to ensure the prevention of infection, transmission and disease among individuals with limited education, bisexual MSM, and men who have limited access to health care.