Drug-using men who have sex with men: Sexual behaviours and sexual identities

Men who have sex with men (MSM) and use drugs are at high risk for H V. This study assessed drug and sex-related risk behaviours and sexual identities for MSM^Idrug injectors and crack smokers. One hundred and forty four MSM drug injectors and crack smokers from five USA cities were interviewed. One-third of the men were current injectors, twice as many reported lifetime injection. Most (56%) reported sex with women in the prior year; sex trading was reported by 32% with males and 53% with females. There were significant differences between private and public sexual identities. For example, while 31% reported being behaviourally bisexual, only 17% identified themselves to others as bisexual. Drug using MSM are clearly a heterogenous group and prevention messages addressing this diversity are needed.     

重庆地区男男性行为人群多性伴行为特征及影响因素

目的  了解重庆地区艾滋病病毒(human immunodeficiency virus, HIV)阴性多性伴肛交(≥5人)男男性行为者(men who have sex with men, MSM)的人口学和性行为特征及其影响因素。 方法  从2018年6月至2019年6月, 招募重庆地区319名HIV阴性MSM, 收集其人口学特征、近半年内安全套使用率、是否感染性病、性角色、药物滥用史、是否服用过暴露后预防(post-exposure prophylaxis, PEP)药物、是否关注HIV知识和是否服用过暴露前预防(pre-exposure prophylaxis, PrEP)药物等信息。采用单因素和多因素Logistic回归分析模型分析MSM人群多性伴肛交的影响因素。 结果  319名HIV阴性MSM中, 34.5%(110/319)近6个月内性伴人数≥5人; 110名多性伴MSM中, 63.6%(70/110)年龄≤28岁, 75.4%(83/110)学历为大学本科或大专; 50名报告情感状况的MSM中, 72.0%(36/50)为单身。多因素Logistic回归分析模型分析显示, 服用过PEP药物和经常关注HIV知识是MSM多性伴肛交的主要影响因素。 结论  重庆地区HIV阴性MSM人群普遍存在多性伴肛交现象。应加大对MSM人群, 尤其是低龄MSM人群, HIV防治知识的宣教力度。在推广PrEP和PEP在MSM人群中的使用时, 应警惕其相关风险补偿。     

Negotiating homosexual identities: the experiences of men who have sex with men in Guangzhou

This paper reports on an ethnographic study of male homosexuality in contemporary Chinese society. The study focused on how men negotiated with the mainstream Chinese heterosexual society and in so doing constructed their sexual identities. The factors found to inform sexual identity were: the cultural imperative of heterosexual marriage, normative family obligations, desired gender roles, emotional experiences and a need for social belonging. The four types of sexual identities constructed included: establishing a deliberate non-homosexual identity, accumulating an individual homosexual identity, forming a collective homosexual identity and adopting a flexible sexual identity. For the men interviewed, sexual identity was both fluid and fragmented, derived from highly personalised negotiations between individualised needs and social and cultural constructs. The analysis is set against the background of China's rapid and recent economic development, shifting national and international social environments and improved access to the Internet.     

Men who have sex with men who do not access sexual health clinics nor disclose sexual orientation are unlikely to receive the HPV vaccine in the UK

BackgroundMen who have sex with men (MSM) are recommended the Human Papillomavirus (HPV) vaccination due to their higher risk of genital warts and anal cancer.PurposeTo examine HPV vaccine acceptability amongst MSM in the UK.MethodsUsing advertisements via Facebook, MSM were recruited to an online survey measuring motivations for HPV vaccination. Logistic regression was performed to identify predictors of HPV vaccine acceptability.ResultsOut of 1508 MSM (median age = 22, range: 14–63 years) only 19% knew about HPV. Overall, 55% of MSM were willing to ask for the HPV vaccine and 89% would accept it if offered by a healthcare professional (HCP). Access to sexual health clinics (SHCs) [OR = 1.82, 95% CI 1.29–2.89], the disclosure of sexual orientation to a HCP [OR = 2.02, CI 1.39–3.14] and HIV-positive status [OR = 1.96, CI 1.09–3.53] positively predicted HPV vaccine acceptability. After receiving information about HPV, perceptions of HPV risk [OR = 1.31, CI 1.05–1.63], HPV infection severity [OR = 1.89, CI 1.16–3.01), HPV vaccination benefits [OR = 1.61, CI 1.14–3.01], HPV vaccine effectiveness [OR = 1.54, CI 1.14–2.08], and the lack of perceived barriers to HPV vaccination [OR = 4.46, CI 2.95–6.73] were also associated with acceptability.ConclusionsAlthough nearly half of MSM would not actively pursue HPV vaccination, the vast majority would accept the vaccine if recommended by HCPs. In order to achieve optimal uptake, vaccine promotion campaigns should focus on MSM who do not access SHCs and those unwilling to disclose their sexual orientation.     

The Internet profiles of men who have sex with men within bareback websites

The Internet has become a venue for men who have sex with men to search for sexual partners. Some of these men intentionally seek unprotected anal intercourse with other men (‘bareback’ sex). This paper focuses on the creation, use, and content of Internet personal profiles of men who have sex with men in the greater New York City metropolitan area who use bareback sites for sexual networking. We used a mixed-methods approach to examine data from a cybercartography of Internet sites conducted during the first phase of the research (199 personal profiles) and from in-depth interviews conducted during its second phase (120 men who have sex with men who sought partners online for bareback sex). Results indicate that men generally followed offline stereotypical patterns in their online profiles. However, men who disclosed being HIV-positive were more likely to include face and head pictures. Overall, the images they used were heavily sexualised in accordance with group norms perceived and reinforced by the websites' design and imagery. Bottom-identified men tended to be more explicit in the exposition of their sexual and drug use interests online. This paper highlights how certain virtual and social performances play upon and reinforce other, in the flesh, performances.     

昆明市男男性接触者不同场所活动人群危险性行为状况分析

目的评估不同活动场所中男男性接触人群安全性行为状况、干预工作的成效及确定干预工作的重点。方法以面对面访问的方式对昆明市经常到公园、酒吧、浴室以及通过志愿者网络对较少到公共场所活动的男男性接触者进行艾滋病相关行为监测调查。结果4类被调查人群中6个月内肛交性伴情况为：浴室人群的性伴人数最多,2005年中位数是4.33,2006年是3.95;其次为公园人群,2005年是2.74,2006年是3.55。酒吧人群的性伴人数最少,2005年是2.52,2006年是1.70。男男性接触人群6个月内安全套使用率2005年为44.9%,2006年为51.1%。结论经常到浴室、公园以及较少到公共场所活动的男男性接触者具有较多的性伴和较高的性行为频度,是值得关注的人群。安全套使用虽有逐年上升的趋势,但仍较低,应分人群对安全套使用影响因素进行研究,以制定更加有效的干预策略。     

男男同性恋HIV感染者自我管理效果评价研究

目的  评估自我管理模式在感染艾滋病病毒(human immunodeficiency virus,HIV)的男男同性恋人群中的实践效果,为制定该人群HIV/艾滋病(acquired immune deficiency syndrome,AIDS)综合管理策略提供依据。 方法  依托男男同性恋非政府组织(non-governmental organizations,NGOs)采用同伴推动抽样方法(respondent-driven sampling,RDS)招募研究对象,并随机分为干预组和对照组。干预组实行自我管理模式,建立自我管理小组,在慢性病自我管理(chronic disease self-management,CDSM)的理论基础上以小组为单位开展健康教育课程和同伴教育;对照组实行常规随访管理模式,即以疾控中心为主体开展的医学随访等相关活动;1年后开展效果评估。 结果  自我管理小组在健康感受、角色功能、生活质量、健康转换、心理健康5个指标的得分上有不同程度的提高。自我管理小组有焦虑症状的比例从38.6%下降到22.6%,经常使用安全套的比例从43.3%提高到47.3%,坚持服药的比例从68.2%提升到78.8%。 结论  自我管理模式可有效突破目前男男同性恋人群艾滋病管理的瓶颈,可以改善该人群的生存质量。     

男男性接触者性伴网络特征与HIV传播

目的了解男男性接触者（MSM）性伴网络特征,探讨人类免疫缺陷病毒/性传播疾病（HIV/STDs）从该人群向普通人群传播的途径,为开展HIV/STDs的预防与控制提供依据.方法以同性恋酒吧为研究现场,以其中男男性接触者为对象进行匿名问卷调查.调查内容包括社会人口学特征、HIV/STDs感染状况、性伴类型及数量等.结果某市酒吧中MSM的HIV和STDs感染报告率分别为3.4%和10.3%;多性伴现象在MSM中普遍存在,且性伴类型广泛.在最近2个月中,50.0%的MSM有同性偶然性伴,17.8%有同性商业性伴,63.8%目前有同性固定性伴.曾有过异性性伴者为55.7%.拥有3种类型性伴者为19.5%,4种类型性伴者为12.6%.拥有不同类型性伴的MSM亚群之间相互关联,核心亚群为拥有异性性伴和拥有同性商业性伴亚群.结论 MSM以多维的性伴网络相互连接,不仅在MSM人群内部具有HIV/STDs的多向传播通道,而且已经形成了向普通人群传播的桥梁.     

Perceptions of sexual violence among men who have sex with men and individuals on the trans-feminine spectrum in Mongolia

With the growing realisation that sexual violence poses pressing health and human rights concerns for men who have sex with men (MSM) and individuals on the trans-feminine spectrum, research has focused on the context in which sexual violence takes place. Rape myths and other perceptions of sexual violence affect the prevalence of perpetration and the availability of services and support for survivors. Little research has been conducted on rape myths among sexual and gender minority groups, especially in low- and middle-income countries. Two focus groups and 30 in-depth interviews were conducted with MSM and individuals on the trans-feminine spectrum in Ulaanbaatar, Mongolia. A number of rape myths previously noted to be prevalent among Western, heterosexual men, and women were expressed by participants, including the myth that males are never raped, rape as a cause of homosexuality or transgenderism, conceptualisations of prototypical rape as requiring overwhelming force, and victim blaming. However, many of these perceptions appeared to have different origins and effects in these populations. This study illustrates interesting similarities and differences compared to rape myths explored in Western, heterosexual male samples, and draws attention to the need to address community perceptions of sexual violence in sexual health and violence intervention programming.     

不同招募场所的男男性行为者性网络特征研究

目的 了解哈尔滨市男男性行为者(men who have sex with men,MSM)性网络特征及艾滋病病毒(HIV)感染危险行为,探索MSM人群中HIV传播以及向一般人群传播的可能性.方法 选择黑龙江省哈尔滨市作为研究现场,招募场所分为酒吧或夜总会、浴室或桑拿、公园或公厕三类,同时安排志愿者通过社会网络招募MSM.从个人为中心的网络角度对性网络特征进行调查与分析.分析指标有个人网络的大小、密度、网络成员交往的相似程度(年龄和婚姻状况).结果 本次调查获得有效问卷647份,其中酒吧或夜总会229人、浴室或桑拿291人、公园或公厕36人,社会关系网络招募91人.调查对象过去6个月平均性伴网络大小为14人,最小网络密度为0.14;过去1年中,性伴关系维系比例为30.5%(647/2123);不同招募场所MSM性伴关系继续维持比例酒吧为22.8%(159/699),浴池35.9%(329/917),公园26.4%(28/106),社会网络招募32.7%(131/401),不同招募场所的MSM的性伴关系维系比较,差异有统计学意义(X~2=34.07,P<0.01),浴池的MSM平均性伴网络较大,为18人,过去1年性伴关系维系比例为35.9%(329/917).MSM与性伴之间在年龄和婚姻状况上的交往相似性Q值分别为0.03和0.41;过去6个月安全套坚持使用比例低,为40.9%(822/2012).结论 不同场所MSM人群性网络特征差别大.MSM与性伴之间的交往模式相似性较低,同时存在传播HIV的潜在危险.     

Going beyond the clinic: confronting stigma and discrimination among men who have sex with men in Mysore through community-based participatory research

Community-based participatory research (CBPR) has gained considerable popularity in recent decades given its ability to address social inequities, improve health outcomes and enhance community participation and ownership with respect to various health-related interventions. This paper describes the engagements of a community of self-identified men who have sex with men, most of whom also identified as male sex workers, in a long-term iterative and systematic process of knowledge production, reflection, and action. The project took place in 2006 in Mysore, South India, under the larger umbrella of an HIV intervention formed by the University of Manitoba and the sex workers collective known as Ashodaya Samithi, funded by the Bill & Melinda Gates Foundation (Avahan). CBPR is revealed as uniquely suited for tackling stigma and discrimination as subjects of scientific inquiry and as key methodological obstacles. As the community cultivated their own analysis around stigma, the concept became a key rallying point for increasing equity with respect to access to health services for this community. CBPR proved highly effective in mobilizing community participation and increasing access to sexual health services, over the long-term, because it was supported by and was able to feed community insights into a much larger infrastructure that sought to mobilize sexual minorities. More broadly, by highlighting various positive effects arising from CBPR, we have sought to further emphasize the greater possibilities of public health practitioners working more democratically with disenfranchised and highly stigmatized communities.     

Going social: Success in online recruitment of men who have sex with men for prevention HIV vaccine research

ObjectiveTo compare the use of four different social media sites to recruit men who have sex with men (MSM) and transgender women to a phase 2b HIV prevention vaccine trial, HVTN 505.DesignRetrospective, observational study.MethodsThe University of Pennsylvania HIV Vaccine Trials Unit (Penn HVTU) employed street outreach and online recruitment methods to recruit participants for HVTN 505 using a combination of national recruitment images/messages with Philadelphia-specific language and imagery. We compared the efficiency (number of enrolled participants per number of completed phone screens) and effectiveness (number of enrolled participants per time interval employed) of each strategy, as well as the demographics and risk behaviors of the populations.ResultsOnline recruitment strategies populated 37% (71/191) of trial participants at our site. Among the four social media strategies employed, 45.1% (32/71) were enrolled through Facebook, 16.9% (12/71) through Craigslist, 15.5% (11/71) through a web-based marketing company (WBMC), and 22.5% (16/71) via GRINDR. The number of participants enrolled per month of strategy and the months the strategy was employed were Facebook - 32(33 months), Craigslist - 12(33 months), WBMC - 11(6 months), and GRINDR - 16(0.56 months). In-person and online recruitment strategies yielded participants of similar demographics and levels of risk behavior.ConclusionUse of several social media recruitment modalities produced large numbers of MSM engaging in high risk behavior and willing to participate in an HIV prevention vaccine trial. In comparison to other social media and online strategies, recruitment via GRINDR was the most effective.     

中国内地2016—2022年浴池男男性行为者HIV感染率Meta分析

目的 对2016—2022年中国内地浴池男男性行为者（MSM）HIV感染率进行系统的评价。方法 检索中国知网数据库（CNKI）、万方数据库、中国生物医学文献数据库（CBM）、维普数据库、PubMed、Web of Science和Embase数据库中从2016年1月—2022年1月发表的所有相关研究并进行筛选,使用Stata 17.0软件对纳入的文献进行meta分析。结果 研究共纳入12篇文献,浴池型MSM的合并HIV感染率为8.7%（95%CI:7.3%～10.1%）。亚组分析显示:30岁以下浴池MSM的合并HIV感染率为6.8%,略高于30岁以上的6.1%;随着调查样本量增大,合并HIV感染率从13.6%降低至7.2%;通过场所招募检测得到的合并HIV感染率为8.3%,低于其他抽样方式检测得到的合并HIV感染率（9.7%）;2016年1月之前开展的人群横断面调查合并HIV感染率为9.9%,高于2016年1月之后的合并HIV感染率（8.1%）;西南地区的合并HIV感染率最高,为12.0%;一线城市的合并HIV感染率为9.8%,高于非一线城市合并HIV感染率（7.5%）。研究未发现明显发表偏倚。结论 近六年,我国内地浴池MSM的合并HIV感染率虽有下降,但仍显著高于我国2001—2018年MSM的合并HIV感染率,应继续加强浴池MSM的艾滋病干预。     

HIV阳性结果告知对男男性行为者高危性行为的影响

目的了解HIV阳性结果告知对男男性行为者(MSM)行为改变的影响。方法 2011年1月-2012年12月,对1 365名MSM进行问卷调查和梅毒快速血浆反应素环状卡片试验(RPR)、梅毒螺旋体血球凝集试验(TPPA)、艾滋病病毒(HIV)抗体初筛检测及确认,对121名HIV确认阳性者进行规范面对面告知,6个月后对纳入研究的HIV阳性者进行随访,比较阳性结果告知前后艾滋病(AIDS)知识知晓、高危性行为特征及性病感染情况。结果 79名MSM完成随访,阳性结果告知后51.9%的感染者减少了肛交行为,49.4%的减少了性伴数,55.7%的在性行为时安全套使用率提高,告知前后肛交行为、多性伴、不使用安全套等高危性行为发生率,差异均有统计学意义(P0.05)。结论阳性结果告知能有效降低MSM人群高危性行为发生率,应加强告知的规范性,确保告知的效果。     

男男性行为人群包皮环切术预防HIV意愿调查

目的 了解男男性行为人群进行包皮环切手术以预防艾滋病感染的意愿情况及其影响因素。方法 于2009年2月-3月,在北京市招募男男性行为者进行问卷调查,了解其对艾滋病及包皮环切术预防艾滋病感染的认知情况。结果 在参加调查的200名男男性行为者中,13人已经接受了包皮环切,3人不清楚是否做过包皮环切;在参加者184人未做过包皮环切的中,36.4%表示愿意参加今后的包皮环切预防男男性行为感染艾滋病的科学研究。多因素Logistic回归分析显示,其影响因素包括包皮过长(OR=2.82,95%CI=1.45～5.49)和认为包皮环切能增加自己/同伴性伴的同性性乐趣或性快感(OR=4.50,95%CI=1.77～11.49)。结论 应在该人群中加大包皮环切及艾滋病知识的普及力度,消除人们对包皮环切手术及相关预防艾滋病感染研究的担心和歧视。     

男男性接触者同性性行为特征及安全性行为影响因素研究

目的了解男男性接触者(men who have sex with men,MSM)同性性行为特征及安全性行为的影响因素,为开展MSM人群艾滋病综合防治提供建议。方法通过滚雪球的方式招募MSM进行面对面的调查,采用逐步后退法的logistic回归分析确定影响安全性行为的因素。数据采用SPSS12.0软件作统计学处理,率的比较用χ2检验,P0.05为差异有统计学意义。结果本研究共调查MSM951人,过去一年接受咨询检测服务的比例占44.5%,最近一次与最近6个月同男性发生肛交时安全套使用率分别为69.6%与38.3%。多因素logistic回归分析结果显示:月收入(AOR=0.86,95%CI:0.77~0.96)、最近一年是否做过艾滋病病毒(HIV)检测(AOR=0.65,95%CI:0.48~0.87)、过去一年是否接受过干预服务(AOR=0.64,95%CI:0.43~0.97)、第一次与男性发生性行为时的性角色(AOR=0.75,95%CI:0.62~0.92)、最近6个月发生性行为的男性性伴数(AOR=1.33,95%CI:1.04~1.71)是影响安全性行为的独立影响因素。结论 MSM人群安全套使用率低,接受咨询检测服务的比例低,仍存在艾滋病在该人群快速传播的风险,应切实加大对该人群的行为干预。     

年轻MSM性行为及HIV、梅毒感染分析

目的了解中国城市年轻男男性行为人群(MSM)人类免疫缺陷病毒(HIV)和梅毒感染状况、艾滋病知识水平及安全套使用频率,为探索针对MSM人群有效的性病艾滋病预防干预措施提供依据。方法采用滚雪球的方法在北京、哈尔滨、郑州和成都市各招募150名年轻MSM进行问卷调查,采集静脉血进行HIV和梅毒抗体血清学检测。结果在所调查的600名年轻MSM中,HIV和梅毒感染率分别为6.7%,8.3%,HIV和梅毒合并感染率为1.5%;肛交时为插入者,被插入者和双重角色的调查对象HIV感染率分别为4.5%,6.3%和8.1%,梅毒感染率分别为11.2%,10.2%和7.8%;不同肛交行为对象艾滋病知识水平、安全套使用、HIV和梅毒感染率差异均无统计学意义(P>0.05);HIV阳性调查对象近6个月无保护插入性肛交、被插入性肛交、口交和阴道性交的报告率分别为52.5%,45.0%,87.5%和22.5%,HIV阴性调查对象的报告率分别为31.1%,37.7%,72.9%和14.3%。结论年轻MSM人群HIV和梅毒感染水平较高,感染HIV和梅毒的危险在不同肛交行为中普遍存在。     

性感觉寻求与青少年男男性行为人群危险性行为的关系

目的 研究25岁及以下青少年男男性行为人群(YMSM)性感觉寻求与其艾滋病相关危险性行为的关系。方法 于2013年5-11月通过互联网宣传、外展活动以及例行的艾滋病自愿咨询检测服务招募403名YMSM, 采用匿名问卷调查, 回收375份(93.05%)有效问卷。结果 YMSM中有37.9%首次同性性行为未使用安全套, 最近6个月有55.7%发生多性伴行为, 51.7%有“419”(一夜情)行为, 5.6%有群交行为。性感觉寻求与首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为呈正相关(偏相关系数分别为0.247、0.218、0.296、0.252)。分别以首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为作为因变量进行logistic回归分析, 结果显示性感觉寻求高者更有可能发生以上危险性行为。结论 青少年性感觉寻求水平对危险性行为有影响, 应加强基于人群性感觉寻求分析的艾滋病相关知识及行为教育, 强化艾滋病相关危险性行为的风险意识, 从而更有效开展YMSM艾滋病干预。     

Characteristics of recently arrived Asian men who have sex with men diagnosed with HIV through sexual health services in Melbourne and Sydney

Objectives: Asian men who have sex with men (MSM) who have recently arrived in Australia are an emergent risk group for HIV; however, little is known about how they compare to Australian MSM diagnosed with HIV. This study compared the characteristics of these two groups. Methods: A retrospective, cross‐sectional study of MSM diagnosed with HIV between January 2014 and October 2017 in Melbourne and Sydney public sexual health clinics. Asian MSM were those who had arrived in Australia within 4 years of diagnosis. Results: Among 111 Asian men, 75% spoke a language other than English, 88% did not have Medicare and 61% were international students. Compared with Australian men (n=209), Asian men reported fewer male sexual partners within 12 months (median 4 versus 10, p<0.001), were less likely to have tested for HIV previously (71% versus 89%, p<0.001) and had a lower median CD4 count (326 versus 520, p<0.001). Among Asian men, HIV subtype CRF01‐AE was more common (55% versus 16%, p<0.001) and subtype B less common (29% versus 73%, p<0.001). Conclusions: Asian MSM diagnosed with HIV reported lower risk and had more advanced HIV. Implications for public health: HIV testing and preventative interventions supporting international students are required.     

Mental health and suicidal ideation among Chinese women who have sex with men who have sex with men (MSM)

ABSTRACT

In China, men who have sex with men (MSM) are the fastest growing population at risk for HIV. They face social stigma due to both MSM behavior and HIV. In addition, concern has been raised about the mental health of wives of MSM. In this cross-sectional study, the authors examine the mental health status of a sample of 135 of these women. Participants completed an Internet-administered questionnaire in Xi’an from April to June, 2012. Most were unaware at the time of marriage that their husbands were MSM. Physical abuse was frequently reported; depressive symptom and mental health (Symptom Checklist, SCL–90) scores were significantly higher than those of the general Chinese adult female population. A majority (59.8%) of women reported suicidal thoughts after discovering their husbands’ MSM behavior; about 10% had attempted suicide. Multiple logistic regression revealed that women’s experience with anal sex was associated with 7.8 times (95% CI: 1.3–65.9) greater odds of suicidal ideation. Also, women who demonstrated mental symptoms on the SCL–90 had 2.3 times (95% CI: 1.04–5.2) the odds of suicidal ideation. These results suggest that wives of MSM have a significant need for mental health care, suicide prevention, HIV education, and social support.