四座城市MSM人群同性恋与非同性恋者HIV和梅毒感染状况及相关因素

目的 了解我国四城市男男同性恋人群(men who have sex with man,MSM)中,同性性取向者(同性恋)和性取向为异性或双性或未确定者(非同性恋)艾滋病病毒(human immunodeficiency virus,HIV)和梅毒感染状况,探讨MSM同性恋和非同性恋者感染HIV和梅毒的相关因素.方法 采用横断面调查的方法,以北京、哈尔滨、郑州和成都市为调查现场,通过“滚雪球”的方法在MSM人群中招募调查对象,调查内容包括社会人口学特征、性伴和性行为、HIV和梅毒抗体血清学检测.运用Epi Data 3.0软件建立数据库,使用SPSS 13.0软件进行统计分析.结果 共1 693名符合条件的MSM,其中同性恋和非同性恋者所占的比例分别为67.5％和32.5％.同性恋和非同性恋者HIV感染检出率分别为6.8％、7.1％,梅毒检出率分别为11.6％、13.3％.在同性恋者中,年龄在18 ～24岁及无收入者所占的比例为41.6％和22.1％,均高于非同性恋者(均有P＜0.001).同性恋者感染HIV和梅毒的多因素分析结果显示,居住在成都市、在浴池等洗浴场所寻找性伴、男男肛交性角色仅做被插入方者或既做插入方又做被插入方者及感染梅毒者感染HIV的危险性增加,居住在哈尔滨市、在公园公厕寻找性伴、男男肛交性角色为仅做被插入方者或既做插入方又做被插入方者、男男肛交时未坚持使用安全套、HIV感染者和近6个月性伴数≥6个者感染梅毒的危险性增加;非同性恋者感染HIV和梅毒的多因素分析结果显示,居住在成都及感染梅毒者感染HIV的危险性增加,通过互联网寻找性伴者感染HIV的危险性降低,男男肛交时未坚持使用安全套及HIV感染者感染梅毒的危险性增加.结论 MSM人群同性恋和非同性恋亚群中HIV和梅毒均呈现高流行状态,两者的社会人口学构成及其HIV及梅毒感染的相关因素不尽相同,提示,在MSM人群中控制HIV和梅毒流行需要区别不同亚群的特点开展针对性干预策略和措施.     

Sexual identities and sexual health within the Celtic nations: An exploratory study of men who have sex with men recruited through social media

ABSTRACT

Associations of sexual identity with a range of sexual and sexual health behaviours were investigated amongst men who have sex with men (MSM). Data from 1816 MSM recruited from 4 Celtic nations (Scotland, Wales, Northern Ireland and the Republic of Ireland) were collected via a cross-sectional online survey advertised via social media. About 18.3% were non-gay identified MSM (NGI-MSM). In the last year, 30% of NGI-MSM reported high-risk unprotected anal intercourse and 45% reported never having had an sexually transmitted infection (STI) test. When compared to MSM who were gay identified (GI-MSM), NGI-MSM were more likely to be older, have a female partner, fewer sex partners, fewer anal sex partners, STI diagnoses and less likely to be HIV positive, more likely to never use the gay scene and be geographically further from a gay venue. NGI-MSM were also less likely to report STI and HIV testing behaviours. The findings highlight variations in risk by sexual identities, and unmet sexual health needs amongst NGI-MSM across Celtic nations. Innovative research is required regarding the utility of social media for reaching populations of MSM and developing interventions which target the heterogeneity of MSM and their specific sexual health needs.     

Love and HIV serodiscordance in gay men's accounts of life with their regular partners

This paper examines discourse on serodiscordant relationships in interviews with 16 HIV-positive and 3 HIV-negative gay men living in Scotland. Drawing on critiques concerning love, reason and HIV serostatus normativity, this paper supplies a much-needed insight into how gay men in serodiscordant relationships negotiate HIV prevention. Among other matters, some HIV-negative men were said to knowingly request risky sex with their HIV-positive partners as an expression of love. In some situations, the person without HIV claimed a normative serostatus that implied they could ‘invest’ more in the relationship by offering to have sexual intercourse that may expose them to HIV. Such dynamics expressed devotion on the part of the HIV-negative man, but implied obligation for the HIV-positive man. Based on these and other perspectives we argue for closer attention to gay men's subjectivity in the present circumstances of proliferating biomedical forms of HIV prevention; more thoroughly reflexive public health engagements with gay men's sexual cultures; and a research agenda for gay men that challenges HIV-serostatus normativity.     

亚文化特征对男男性接触者高危性行为的影响

目的：了解男男性接触者（Menwhohavesexwithmen，MSM）亚文化特征及高危性行为状况，为开展HIV／STIs预防干预活动提供依据。方法：对进入同性恋酒吧中活动的MSM进行问卷调查，调查内容包括社会人口特征，高危性行为状况和性伴特征等。结果：MSM中多性伴现象普遍，安全套使用率较低；在最近6个月中，与同性发生高危性行为的报告率为69．5％，与异性发生高危性行为的报告率为43．7％，有30．5％的人报告既有同性又有异性高危性行为。经多因素分析表明，年龄大是同性高危性行为的影响因素，既有同性又有异性高危性行为的影响因素为年龄大和最近2个月中有过4个及以上同性肛交性伴，女性高危性行为的影响因素为年龄大、非同性性取向、一生中拥有4个及以上异性性伴和在最近2个月中有2个及以上同性偶然性伴。结论：促使HIV／STIs在MSM人群中传播的危险因素广泛存在，为了达到有效的行为干预效果，在进行干预时，要充分考虑他们的亚文化特征。     

Intensive sex partying amongst gay men in Sydney

Intensive sex partying is a framework developed to analyse specific frequent behaviours amongst a small minority of gay men in Sydney, Australia. The behaviours included a higher frequency of dance party attendance, more frequent sex, more anal sex, multiple sex partners, more unprotected anal intercourse with casual partners and more frequent drug taking. These occur at a contextual intersection between a sub-group of sexually adventurous gay men and ‘party boys’. The men appear to be involved in both high-risk, adventurous sex practices and a specific form of partying distinguishable from dance partying and ‘clubbing’. Sex partying occurs on multiple sites (domestic spaces; within dance parties; sex parties; sex-on-premises venues) and appears to be geared to the maximisation of sexual pleasure. Intensive sex partying describes this coincidence of factors and locates them in relation to the multiple pleasures offered by sex partying. It emphasises the importance of ‘intensity’ in order to understand better the relations between sex, drug use, pleasure, care and risk in some gay men's lives.     

男男性行为人群抑郁症状危险因素Logistic回归分析

目的了解男男性行为者(MSM)人群抑郁症状况及相关危险因素。方法应用流调中心用抑郁自评量表(CES-D)及相应的评价标准,采用应答者趋动招募抽样法(RDS)对MSM人群进行招募和自填式匿名调查和评价,用非条件Logistic回归分析进行抑郁症状的危险因素分析。结果抑郁症状检出为37.8%,单因素分析影响抑郁症状的危险因素有:近6个月经常和MSM朋友到迪斯科/夜总会、MSM活动公厕、MSM活动公园,自认因同性恋伤害家庭、家庭拒绝接纳、朋友断交、失去住处、歧视压力感受大,有性病史、419性伴多、有无保护性性行为共11个(P0.05);多因素分析,主要危险因素是近6个月419性伴多、近1次性行为无保护性、因同性恋感到羞耻、因同性恋失去住处(P0.05)。结论 MSM人群抑郁症状检出率高,受多种因素影响,其中不乏艾滋病的高危险因素,提示应高度关注MSM人群的心理健康及对艾滋病防治的影响,结合开展心理干预。     

Globalization,Women, and Health in the 21st Century

Sexual partner mixing among men who have sex with men (MSM), based on both gender and partnership status, is an understudied theme in India. Using data from Round 2 of the Integrated Bio-behavioral Survey, this paper reports on gender and partnership status-based sexual mixing and levels of consistent condom use (CCU) among MSM in Maharashtra. A total of 689 MSM were sampled using probability-based sampling. Bivariate and regression analyses were carried out on condom use and partnership mixing. Over half (52%) of all MSM reported having only male partners while about one-third (34.5%) reported having partners of both gender. Over 70% of MSM engaged in sex with a mix of casual, regular, commercial and non-commercial partners. MSM with only male partners reported lower CCU as compared to MSM with partners of both genders (47.3% and 62%, respectively, p = 0.11). CCU levels differed significantly by status of sex partner. Overall, MSM having ‘men only’ as partners and those with partners of mixed status have greater risk behaviour in terms of low CCU. HIV prevention interventions need to focus attention on men in ‘exclusively male’ sex partnerships as well as MSM with a mix of casual, regular and commercial partners.     

Risk Reduction for HIV-Positive African American and Latino Men with Histories of Childhood Sexual Abuse

While the HIV epidemic has disproportionately affected African American and Latino men who have sex with men (MSM), few HIV prevention interventions have focused on African American and Latino men who have sex with both men and women (MSMW). Even fewer interventions target HIV-positive African American and Latino MSM and MSMW with histories of childhood sexual abuse (CSA), a population that may be vulnerable to high-risk sexual behaviors, having multiple sexual partners, and depression. The Men's Health Project, a small randomized clinical trial, compared the effects of two 6-session interventions, the Sexual Health Intervention for Men (S-HIM), guided by social learning theory and aimed at decreasing high-risk sexual behaviors, number of sexual partners, and depressive symptoms, and a standard health promotion control (SHP). A community sample of 137 HIV-positive gay and non-gay identifying African American and Latino MSM and MSMW with histories of CSA was recruited. Results were based on an "intent to treat" analyses of baseline to post, 3 and 6 month follow-ups. The sample as a whole reported reductions in sexual risk behaviors and number of sexual partners from baseline to post-test, and from the 3 to 6 month follow-ups, although the decrease in sexual risk behavior from baseline to post-test was significant only for S-HIM participants. No significant differences between conditions were reported for depressive symptoms, but the total sample reported a significant decrease at 6 months. These findings highlight the importance of addressing sexual decision-making and psychological adjustment for ethnic men, while being sensitive to CSA histories and sexual minority status, and suggest the need to develop additional strategies to heighten HIV risk reduction over time.     

HIV test uptake among MSM in China: Implications for enhanced HIV test promotion campaigns among key populations

Despite global efforts to increase HIV test uptake among men who have sex with men (MSM), social stigma and negative attitudes toward homosexuality hinder the effectiveness of traditional test promotion campaigns. Increasing HIV test uptake requires greater understanding of the conditions that facilitate decisions to get tested. We conducted an online survey hosted by two of the most highly frequented MSM web portals in China. A generalised ordered logistic regression analysis was conducted to determine factors associated with HIV testing behaviour. Compared to men who had never tested for HIV, men who had tested in the past year were more likely to have never engaged in sex with women, have multiple male sex partners in the past 3 months and have disclosed their sexual orientation to others. MSM found testing at local Chinese Centers for Disease Control and Prevention (80.7%), gay men's community-based organisations (80.2%) and public hospitals (70.9%) to be acceptable, while saunas (50.5%) and gay bars (41.8%) were found to be unacceptable testing venues. Our study shows that MSM in China prefer to test at venues that guarantee confidentiality, quality and quick results. Our study also suggests that self-testing may be a feasible approach to increase test uptake.     

Geosocial Networking Smartphone App Use and High-Risk Sexual Behaviors Among Men Who Have Sex With Men Attending University in China: Cross-sectional Study

BackgroundGay apps are smartphone-based geosocial networking apps where many men who have sex with men (MSM) socialize and seek sex partners. Existing studies showed that gay app use is associated with greater odds of high-risk sexual behaviors and potentially more HIV infections. However, little is known about this behavior among young MSM.ObjectiveWe conducted this study to understand gay app use and its influencing factors among MSM attending university in China.MethodsFrom January to March 2019, participants were recruited from 4 regions with large populations of college students in China: Chongqing, Guangdong, Shandong, and Tianjin. The eligibility criteria were MSM aged 16 years or older, self-identified as a university student, and being HIV negative. A self-administered online structured questionnaire was used to collect data on sociodemographic information, sexual behaviors, gay app use, substance use, and HIV testing history. We performed multivariable log-binomial regression to assess correlates of seeking sex partners via gay apps.ResultsA total of 447 MSM attending university with an average age of 20.4 (SD 1.5) years were recruited. Almost all participants (439/447, 98.2%) reported gay app use at some point in their life, and 240/439 (53.7%) reported ever seeking sex partners via gay apps. Blued (428/439, 97.5%) was the most popular gay app. Higher proportions of sexual risk behaviors (including seeking sex partners via apps [P<.001], engaging in group sex [P<.001], having multiple sex partners [P<.001], unawareness of sex partners’ HIV status [P<.001], and using recreational drugs during sex [P<.02]) were positively associated with the increase in the frequency of gay app use. In multivariable analysis, participants who used gay apps to seek sex partners might be more likely to have multiple sex partners in the past 3 months (adjusted prevalence ratio [APR] 1.53, 95% CI 1.33-1.76; P<.001), engage in group sex in the past 3 months (APR 1.55, 95% CI 1.35-1.78; P<.001), and have sex partners with unknown or positive HIV status (APR 1.72, 95% CI 1.46-2.01; P<.001).ConclusionsSeeking sex partners via gay apps may associate with the increased high-risk sexual behaviors among MSM attending university. The causality between seeking sex partners via gay apps and increased high-risk sexual behaviors should be further investigated so as to inform potential policies for HIV prevention.Trial RegistrationChinese Clinical Trial Registry ChiCTR1900020645; http://www.chictr.org.cn/showprojen.aspx?proj=34741     

Perceptions Towards Condom Use, Sexual Activity, and HIV Disclosure among HIV-Positive African American Men Who Have Sex with Men: Implications for Heterosexual Transmission

Disproportionately high HIV/AIDS rates and frequent non-gay identification (NGI) among African American men who have sex with men or with both men and women (MSM/W) highlight the importance of understanding how HIV-positive African American MSM/W perceive safer sex, experience living with HIV, and decide to disclose their HIV status. Thirty predominately seropositive and non-gay identifying African American MSM/W in Los Angeles participated in three semi-structured focus group interviews, and a constant comparison method was used to analyze responses regarding condom use, sexual activity after an HIV diagnosis, and HIV serostatus disclosure. Condom use themes included its protective role against disease and pregnancy, acceptability concerns pertaining to aesthetic factors and effectiveness, and situational influences such as exchange sex, substance use, and suspicions from female partners. Themes regarding the impact of HIV on sexual activity included rejection, decreased partner seeking, and isolation. Serostatus disclosure themes included disclosure to selective partners and personal responsibility. Comprehensive HIV risk-reduction strategies that build social support networks, condom self-efficacy, communication skills, and a sense of collective responsibility among NGI African American MSM/W while addressing HIV stigma in the African American community as a whole are suggested.Harawa is with the Charles B. Drew University of Medicine and Sciences, University of California, Los Angeles, CA, USA. Williams is with the Semel Institute of Neuroscience & Human Behavior, Suite C8-871C, 760 Westwood Plaza, Los Angeles, CA 90024-1759, USA. Williams and Ramamurthi are with the Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, USA; Bingham is with the Los Angeles Department of Health Services, HIV Epidemiology Program, Los Angeles, CA, USA.     

‘Top,bottom, versatile’: narratives of sexual practices in gay relationships in the Cape Metropole,South Africa

Abstract

Sexual practices among gay and other men who have sex with men are evolving in South Africa and heteronormative stereotypes are being contested. This paper draws from a larger qualitative study on how men construct a gay identity and negotiate their relationships within contemporary South African contexts, following constitutional and legal changes, in this respect. A feminist, social constructionist approach was used to collect and analyse data from in-depth interviews with 15 self-identified gay men, aged 20 to 46 years, drawn from a university in the larger Cape Metropole, South Africa. Interviews were audio-recorded, transcribed verbatim and analysed using thematic and narrative analysis. ‘Bottoms’ revealed being powerful in receptive sex. Other men deconstructed the binaries of masculine/feminine and resisted heteronormativity by engaging in fluid constructions in their relationships, whereby participants ‘switched’ or ‘flipped’ or did not recognise stereotypical roles when practising sex. There may be value in making these flexible and reciprocal sexual practices better known about and promoted as non-normative African models of sexual practice.     

HIV vulnerability and the erasure of sexual and gender diversity in Abidjan,Côte d'Ivoire

ABSTRACT

In the fight against concentrated HIV epidemics, men who have sex with men (MSM) are often framed as a homogeneous population, with little attention paid to sexual and gender diversity and its impact on HIV vulnerability. This article draws on ethnographic research conducted in Abidjan, Côte d'Ivoire among les branchés – a local term encompassing several categories of same-sex desire and practice. In the context of increased HIV prevention programming targeting Ivoirian sexual and gender minorities, such diversity is effectively erased. This obfuscation of difference has particularly negative impacts for travestis, who may be at higher risk for HIV infection, though research and prevention efforts in which they are grouped with ‘MSM’ render them underrepresented and make their vulnerability difficult to quantify. Branchés whose class and/or ethnic backgrounds compound their stigmatised status as sexual and gender minorities also bear the burden of this exclusion. Furthermore, some branchés deploy ‘MSM’ as a form of self-identification, further complicating who such categories represent. By highlighting the ways in which constructions of gender and sexuality within HIV/AIDS programming obscure complex social realities, I aim to reorient thinking around the development of purposeful HIV programming that engages the complexity of sexual and gender minority experience.     

Les effets de la dépression sur l’activité sexuelle et la prise de risques parmi les gays français utilisateurs de sites de rencontre sur Internet

ObjectivesThe objective of this study was to analyse how depression influences sexual desires and activities of gay men to understand the co-occurrence of depressed mood, high sex drive and unprotected anal intercourse with casual partners (UAIC) among some individuals.MethodsIn 2004, French gay men visiting a major gay Internet site participated in an online survey assessing serological status, numbers of casual partners, sex drive and control over sex drive, UAIC, depression and its impact on sexual desire.ResultsOne thousand nine hundred (and) thirty-two men who had casual partners in the previous year were included in the analysis. HIV-negative men on average had 22 casual partners per annum, and 28% reported UAIC. Insertive UAIC was practised with 4.5 partners, and receptive UAIC with 4 partners. Sexual activity and risk-taking were substantially higher for HIV-positive men (M = 46 partners, 58% UAIC), and HIV+ men had UAIC with more partners (insertive M = 20, receptive M = 22). Whereas depression lowered sexual desire among most gay men, a minority of men (22%) experienced the reverse effect. HIV+ men more often reported that depression strongly increased their sexual desires. These depressive sexual urges were found to increase sexual activity and reduce men's control over their sex drive. The combined effects of depressed sexual urges, high level of sex-drive, and low control over sex drive, explained 34% of the variance in risk behaviour in HIV-negative men and 56% of the variance in risk behaviour in HIV-positive men.DiscussionIn some gay men, especially those who are HIV-positive, sexual activity seems to be seems to be used to cope with depressive moods. Sexual coping however significantly increases exposures to risk because it may result in sexual compulsivity and reduces the amount of control individuals have over their sex drive. Tackling the issue of mental health amongst gay men is therefore an important challenge for the prevention of HIV.     

Seeking sexual partners on the internet: a marker for risky sexual behaviour in men who have sex with men

OBJECTIVE: In order to generate a generalizable estimate regarding risk for STI and HIV acquisition in men who have sex with men (MSM) who seek partners on the internet, we examined the sexual practices of MSM who seek partners on the internet compared to MSM who do not, using a community-based sample of MSM from British Columbia. METHODS: 'Sex Now', a questionnaire that was developed to examine trends in sexual behaviour in gay men, was offered to men attending Gay Pride events throughout the province of British Columbia, Canada between May and August 2004. Logistic regression analysis was used to model the association between seeking sexual partners online and other variables of interest, using odds ratio as the measure of association. RESULTS: Of the 2,312 MSM who completed the survey, 766 (33.1%) had used the internet to find a partner in the past year. In logistic regression analyses, MSM who found partners on the internet were more likely to have had more than 10 sexual partners in the past year (overall, insertive and receptive), and to engage in sexual activities in public venues. They were also more likely to agree with the statement "I think most guys in relationships have condom-free sex." MSM who sought partners on the net were more likely to be from specific geographic regions, including non-urban regions. Demographic characteristics, HIV status, and use of drugs were not significantly different between men who found partners on the internet and those who did not in multivariable modeling. DISCUSSION: MSM who sought to meet partners online had significantly more sexual partners, were more likely to be from specific geographic regions of the province and to have participated in seeking sexual partners in venues known to be associated with HIV and STI acquisition. This study confirms from a community-based sample of MSM that programming for prevention and treatment of HIV and STI need to be available and offered in the cyber setting, to ensure effective messaging and interventions reach this population.     

Sexual Risk Behavior of Men Who have Sex with Men: Comparison of Behavior at Home and at a Gay Resort

This study compared sexual behavior of gay and bisexual men (N = 551) while at their primary residence to their behavior while vacationing at a gay resort community. Participants reported behavior for the days they spent in the resort and for their last 60 days in their home residences. Overall, 11 times more non-main partners were reported for unprotected anal intercourse (UAI) per day while in the resort as for the “at home” period. Regression analysis identified negative attitudes toward condoms, less concern about AIDS, and daily number of non-main, male partners at home with whom UAI occurred as significant predictors of the daily number of non-main male partners with whom holidaymakers engaged in UAI while in the resort area. The results suggest that sexual risk taking by men who have sex with men (MSM) while on holiday may be elevated over that at home and that prevention efforts need to be promoted in gay resorts. Behavioral surveillance research would be helpful in better characterizing the current social contexts of sexual risk taking by MSM. Theory-based studies of the nature of risk-taking and sexual decision-making on “gay holiday” could inform the development of empirically proven and conceptually grounded interventions.     

HIV-negative gay men's accounts of using context-dependent sero-adaptive strategies

We enrolled 166 gay and bisexual men who tested HIV-negative at a community sexual health clinic in Vancouver, British Columbia, into a year-long mixed-methods study. A subsample of participants who reported recent condomless anal sex (n = 33) were purposively recruited into an embedded qualitative study and completed two in-depth qualitative interviews. Analysis of baseline interviews elicited three narratives relevant to men's use of context- or relationally-dependent HIV-risk management strategies: (1) seroadaptive behaviours such as partner testing and negotiated safety agreements used with primary sexual partners, (2) serosorting and seroguessing when having sex with new partners and first-time hookups and (3) seroadaptive behaviours, including one or more of seropositioning/strategic positioning, condom serosorting and viral load sorting, used by participants who knowingly had sex with a serodiscordant partner. Within men's talk about sex, we found complex and frequently biomedically-informed rationale for seroadaptation in men's decisions to have what they understood to be various forms of safe or protected condomless anal sex. Our findings support the need for gay men's research and health promotion to meaningfully account for the multiple rationalities and seroadaptive strategies used for having condomless sex in order to be relevant to gay men's everyday sexual decision-making.     

Sexual Behaviors of Non-gay Identified Non-disclosing Men Who Have Sex with Men and Women

The sexual behaviors of non-gay identified men who have sex with men and women (MSMW) who do not disclose their same-sex behavior to their female partners (referred to by some as men "on the down low") were examined, including the potential for these men to serve as a "bisexual bridge" for HIV and STD acquisition and transmission. Self-reported sexual behavior data were collected as part of an exploratory study of an ethnically diverse (41% African American, 35% Latino, 22% White, and 2% Asian) sample of 46 non-gay identified, non-disclosing MSMW in New York City. Men reported significantly more male than female sexual partners, but more frequent sex with females. The prevalence and frequency of unprotected sex did not differ significantly between male and female partners in the past 3 months. Men reported risk behavior more often with steady female and steady male partners (e.g., wives, girlfriends, boyfriends) than with more casual male and female partners (regular uncommitted partners, one-night stands). Men, especially African American/Black men, were significantly less likely to report receptive sexual behaviors with men than insertive behaviors. Unprotected sex was common with male and female partners in the past 3 months (e.g., 35% of anal sex with men; 50% of vaginal sex). Indeed, 22% of the sample (38% of those who had both recent males and female partners) reported both unprotected vaginal sex and unprotected anal sex with a male partner during the past 3 months. Although the study was limited by a small convenience sample, the findings suggest that non-gay identified non-disclosing MSMW are at risk for the acquisition and transmission of HIV and STDs, and may serve as a potential bridge, suggesting the need for further research and intervention targeting this unique population.