The relation between nitrite inhalants, unprotected receptive anal intercourse, and the risk of human immunodeficiency virus infection.

The role of nitrite was evaluated between 1985 and 1988 in a study of sexual transmission of the human immunodeficiency virus (HIV) among homosexual male couples in Boston, Massachusetts. Initial enrollment data suggested that a history of unprotected receptive anal intercourse (odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.4-3.6) and a history of nitrite use (OR = 1.7, 95% CI 1.1-2.5) were independent risk factors for HIV infection. In addition, interaction between nitrite use and unprotected receptive anal intercourse was observed (OR = 5.5, 95% CI 2.8-11.1) after controlling for number of unprotected receptive anal sex partners and history of sexually transmitted diseases. Since it was felt that nitrite use might be a marker for unprotected receptive anal sexual activity, a supplemental questionnaire was administered to obtain information on simultaneous nitrite use and unprotected receptive anal intercourse. The supplemental data suggested a strong interaction between nitrite use and unprotected receptive anal intercourse in increasing the risk of HIV infection. In the adjusted analyses, the odds ratio for HIV infection was considerably greater among men who always used nitrites during unprotected receptive anal intercourse (OR = 31.8, 95% CI 12.9-76.7) compared with men who sometimes (OR = 7.1, 95% CI 2.1-23.6) or never (OR = 9.0, 95% CI 2.5-32.1) used them. These findings have preventive public health implications and may add insight into our understanding of the mechanism by which HIV infection spread rapidly among homosexual men in the early 1980s.     

Anal condyloma prevalence among HIV infected patients

BACKGROUND: In the general HIV-infected population, there are few data on the prevalence and risk factors for anal condyloma, precursor lesions for anal cancer. METHODS: Screening for perianal and endoanal condyloma with an anoscopy was systematically proposed to 516 consecutive outpatients, followed in a university hospital in Paris. For each point, HIV characteristics and sexual behaviors assessed through semi-directive questionnaire were collected. FINDINGS: The 473 (92%) examined patients, consisted of 200 homosexual men, 123 heterosexual men, 150 women; 76% were receiving HAART, HIV-RNA was<50 copies/ml in 60%, mean (+/-SD) CD4 cell count were 484 (+/-274)/mm(3). Overall, 108 (23%) pts had histologically-confirmed anal condyloma (36, 15 and 11% of the respective populations), including 51 (47%) pts with only endoanal localisation. Intraepithelial neoplasia of grade I was noted in 59 patients, of grade II in 10 and of grade III in 2 and an invasive endoanal cancer in 1. In multivariate regression analysis, condyloma independent risk factor were history of gonococcia or syphilis (OR=0.54 (0.29-0.99)), and history of previous anal condyloma (OR=2.05 (1.07-3.92) in homosexual men, history of previous penis condyloma (OR=26.8 (2.3-309.6), and unprotected sexual intercourse (OR=7.5 (2.1-26.3)) in heterosexual men and CD4 cell count below 200/mm(3), (OR=8.9 (1.5-51.6)), receptive anal intercourse (OR=6.7 (1.7-25.8)) and history of previous anal condyloma (OR=25.4 (3.4-188.2)) in women. INTERPRETATION: In the HAART era, systematic screening revealed a high rate of anal condyloma in all HIV positive pts (not only in homosexual men). Anal examination should be proposed systematically to all HIV-infected patients.     

Time of exposure and risk of HIV infection in homosexual partners of men with AIDS.

We interviewed, and tested for HIV antibody, 117 homosexual men who had been regular sexual partners of men who developed acquired immunodeficiency syndrome (AIDS); 85 tested seropositive. Receptive anal intercourse with the index AIDS case and number of different sexual partners with whom subjects were anally receptive were both risk factors. Controlling for the number of partners with whom subjects were anally receptive, we found that the odds ratio of receptive anal intercourse with the case was infinite (95% confidence intervals, 3.3-infinity) if sexual contact continued up to or beyond the time of diagnosis, while the odds ratio was 1.0 (95% CI 0.3-3.2) if contact ceased before the case's AIDS diagnosis. Risk was not associated with the duration or frequency of contact. Our data suggest that the potential for sexual transmission from an HIV-infected person may be greater close to or after the onset of disease.     

HIV seroconversion in two homosexual men after receptive oral intercourse with ejaculation: implications for counseling concerning safe sexual practices.

Seroconversion for HIV antibody occurred in two homosexual men who reported no anal intercourse for greater than or equal to 5 years and multiple episodes of receptive oral intercourse with ejaculation. Neither man reported intravenous drug use or receipt of blood products. The last antibody-negative specimen was also negative by the polymerase chain reaction and p24 antigen assays. All sexually active persons should be clearly counselled that receptive oral intercourse with ejaculation carries a potential risk of HIV transmission.     

Reaching homosexual men for HIV surveillance through a gay magazine

HIV surveillance in homosexual men is poor in most countries, as this risk group is difficult to sample. The aim of this study is to test the feasibility of reaching homosexual men for national HIV surveillance using gay community media. In 1989, a questionnaire on general gay issues, with a section on AIDS, was included in a widely sold gay magazine in the Netherlands. Among 17,700 sold copies, 1134 responses were obtained from males (6%). Of these, 669 men (59%) gave their address, of which in turn 84% responded to a questionnaire on risk behaviour in 1990. In 1991/1992, the 669 men were asked to participate in an HIV serosurvey, in which eventually 308 participated with a blood test (46%) and 147 without (total 68%). Participation in the serosurvey with blood test was associated with reporting multiple partners in 1989. Twenty participants were infected (6.5%). In logistic regression analysis, risk factors for infection were recent unprotected receptive anal intercourse with multiple partners (odds ratio (OR):10.7; 95% confidence interval (CI): (2.18–52.2); one partner 1.17 (0.31–4.48); none 1) and living in Amsterdam (OR: 3.92; 95% CI: (0.99–15.5); urbanised western Netherlands 2.15 (0.57–8.03); elsewhere 1), while a high educational level was protective (OR: 0.29 (0.08–0.96); middle 0.41 (0.11–1.54); low 1). Among those who participated in 1991/1992, risk behaviour increased between 1989 and 1991/1992 (reporting multiple casual partners rose from 55% to 64%; reporting inconsistent condom use with receptive anal sex from 58% to 71%). Using a predictive model which included self-reported serostatus in 1989, the HIV prevalence rate in 1991/1992 among all male responders to the 1989 questionnaire was estimated to be 5.3% (95% CI: 3.1–7.7%). In conclusion, unless initial response is improved, recruitment through a gay magazine may not allow reliable estimates of HIV prevalence in homosexual men. However, it can be useful at the national level for monitoring changes in prevalence and risk behaviour over time, geographical differences and risk factors for infection.     

HIV infection in homosexual and bisexual men 18 to 29 years of age: the San Francisco Young Men's Health Study.

OBJECTIVES. Recent studies suggest very high human immunodeficiency virus (HIV) infection rates in some populations of younger homosexual men, but these studies may represent only particularly high-risk populations. The current study obtained population-based data on the HIV epidemic in young homosexual/bisexual men. METHODS. A household survey of unmarried men 18 through 29 years of age involved a multistage probability sample of addresses in San Francisco. A follow-up interview and HIV test for men who were HIV negative at baseline were completed; the median follow-up was 8.9 months. RESULTS. Sixty-eight of 380 homosexual/bisexual men (17.9%) tested HIV seropositive. Sixty-three percent of men reported one or more receptive anal intercourse partners in the previous 12 months, and 41% of those men did not use condoms consistently. The HIV seroincidence rate among those seronegative at first study was 2.6% per year. CONCLUSIONS. HIV infection rates in young homosexual men in San Francisco are lower than those in the early 1980s; however, the rate of infection in these men, most of whom became sexually active after awareness of AIDS had become widespread, threatens to continue the epidemic in the younger generation at a level not far below that of a decade ago.     

Risk factors for human immunodeficiency virus (HIV) infections in homosexual men.

To clarify risk factors for infection with the human immunodeficiency virus (HIV) we selected at random 785 homosexual men who had participated in studies of hepatitis B in San Francisco in 1978-80 for a follow-up study of the acquired immunodeficiency syndrome. Although most had not been contacted in over five years, 492 (63 per cent) were located and enrolled. The 240 (67 per cent) who had developed antibodies to HIV, as measured by an enzyme-linked immunosorbent assay (ELISA), were compared with 119 who had remained seronegative. In multivariate analyses, receptive anal intercourse with ejaculation by nonsteady sexual partners, many sexual partners per month, and other indicators of high levels of sexual activity were highly associated with seroconversions. None of the sexual practices that we studied appeared to offer protection against HIV infection.     

Factors associated with prevalent human immunodeficiency virus (HIV) infection in the Multicenter AIDS Cohort Study

Interviews regarding medical history, life-style, specific drug taking and sexual activities, and physical examinations were administered to 4,955 homosexual men who volunteered for the Multicenter AIDS Cohort Study in Baltimore, Chicago, Los Angeles, and Pittsburgh. Overall, the prevalence of antibodies to human immunodeficiency virus (HIV) in these men was 38.0%. The factor most strongly associated with prevalent HIV infection according to a multiple logistic regression model was rectal trauma, a composite variable which included receptive anal fisting, enemas before sex, reporting of blood around the rectum, and the observation of scarring, fissures or fistulas on rectal examination. Receptive anal intercourse also was strongly associated with HIV infection in the model. The multivariate relative odds for HIV antibody positivity was 7.72 for the highest level of rectal trauma and 3.04 for receptive anal intercourse. Symptoms reported to occur in some persons who subsequently develop acquired immunodeficiency syndrome (AIDS) were frequent among HIV seropositive men (12.9%) but were reported in 8.4% of seronegative men as well. Generalized lymphadenopathy was observed significantly more often in seropositive men (48.8%) compared with seronegative men (11.4%). The prevalence of HIV antibodies was inversely related to the number of T-helper cells and directly related (to a lesser extent) to the number of T-suppressor cells. The results suggest that disruption of the rectal mucosa provides access by HIV to the blood stream and to specific immunologic cells. Since symptoms and generalized lymphadenopathy were often reported among seronegative men, they probably also occur among some seropositive men not currently progressing to AIDS.     

Post-exposure prophylaxis for HIV infection in gay and bisexual men: Implications for the future of HIV prevention

Objective: To assess the psychological and behavioral characteristics of gay and bisexual men who intend to use antiretroviral post-exposure prophylaxis (PEP) to prevent HIV infection.Methods: Gay and bisexual men who had not tested HIV seropositive and were not in long-term exclusive sexual relationships (n = 327) completed anonymous surveys consisting of demographic characteristics, gay community acculturation, experience with and attitudes toward PEP, substance use, and sexual behavior in the past 6 months.Setting: A large annual Gay Pride festival in Atlanta, Georgia.Results: There were 8 (3%) men who had already used PEP and 85 (26%) who planned to use PEP to prevent themselves from becoming HIV infected. Compared to the 242 (74%) men who did not indicate plans to use PEP, those planning to use PEP were younger, less well educated, more likely to have used illicit substances in the past 6 months, and were more likely to have a history of injection drug use. Men intending to use PEP were also more likely to have practiced unprotected anal and oral intercourse as the receptive partner and were more likely to have multiple anal intercourse partners with whom they were receptive.Conclusions: Gay and bisexual men are generally supportive of the immediate use of PEP and a significant number of men are planning to use PEP, particularly less educated men who use multiple substances and practice the highest-risk sexual behaviors. Concurrent behavioral interventions must, therefore, be considered critical in the advancement of PEP.     

The Multicenter AIDS Cohort Study: rationale, organization, and selected characteristics of the participants

The Multicenter AIDS Cohort Study was designed to elucidate the natural history of the infection causing acquired immunodeficiency syndrome (AIDS), identify risk factors for occurrence and clinical expression of the infection, and establish a repository of biologic specimens for future study. A variety of recruitment techniques, including special assurance of confidentiality, were used to enroll participants. Nearly 5,000 homosexual men volunteered for semiannual interview, physical examination, and laboratory testing in four metropolitan areas. A significant majority of these men in each center (69-83%) reported having 50 or more lifetime sexual partners, and over 80% had engaged in receptive anal intercourse with at least some of their partners in the previous two years. By the time of the participants' initial evaluation (April 1984-April 1985), infection with the human immunodeficiency virus (HIV) had occurred in higher proportions of men in Los Angeles (51%) and Chicago (43%) than in Baltimore/Washington, DC (31%) and Pittsburgh (21%), presumably as a result of the higher number of partners and proportion with whom these men had engaged in high-risk practices (e.g., receptive anal intercourse). Follow-up evaluations are underway in this comprehensive longitudinal investigation of HIV infection.     

Behavioral, health and psychosocial factors and risk for HIV infection among sexually active homosexual men: the Multicenter AIDS Cohort Study.

We examined whether 644 homosexual men who engaged in receptive anal intercourse were at particularly elevated risk for seroconversion if they also possessed specific behavioral, health or psychosocial vulnerability characteristics. Of 11 potential factors examined, heavy drinking, moderate to heavy drug use, and younger age were significantly related to seroconversion. These variables were also associated with an increased number of sexual partners, anonymous sex, and failure to use condoms.     

High-risk sexual behavior by HIV-positive men who have sex with men--16 sites, United States, 2000-2002

The majority of persons living with human immunodeficiency virus (HIV) in the United States are men who have sex with men (MSM). High-risk sexual behavior by HIV-positive MSM exposes sex partners to HIV. The risk for transmitting HIV from an infected partner to an uninfected partner through unprotected insertive anal intercourse (UIAI) is greater than the risk for transmission through receptive anal intercourse or oral sex. Differences in sexual risk behavior might be associated with the perceived HIV serostatus of the partner (i.e., HIV positive, HIV negative, or unknown serostatus), as well as with the sex partner type (i.e., steady or nonsteady). During May 2000-December 2002, HIV-positive MSM were interviewed in a behavioral surveillance survey at surveillance sites in 16 states. This report describes insertive anal intercourse practices reported by these MSM; findings indicated that a large percentage of HIV-positive MSM were sexually abstinent, practiced safer sexual behavior by having protected insertive anal intercourse, or had UIAI with an HIV-positive partner. However, a small percentage of HIV-positive MSM reported UIAI with partners who were HIV negative or whose serostatus was unknown; for this group, more intensive and comprehensive HIV-prevention efforts are needed to eliminate this risk behavior.     

Exploring Contextual Differences for Sexual Role Strain Among Transgender Women and Men Who Have Sex with Men in Lima,Peru

Sexual and gender politics inform relational expectations surrounding sexual experiences of Peruvian transgender women (TW) and men who have sex with men (MSM). We used the framework of sexual role strain, or incongruence between preferred sexual role and actual sexual practices, to explore potential conflicts between personally articulated identities and externally defined norms of gender and sexuality and its potential to increase HIV/STI risk. Cross-sectional individual- and dyad-level data from 766 TW and MSM in Lima, Peru were used to assess the partnership contexts within which insertive anal intercourse was practiced despite receptive role preference (receptive role strain), and receptive anal intercourse practiced despite insertive role preference (insertive role strain). Sexual role strain for TW was more common with non-primary partners, while for MSM it occurred more frequently in the context of a primary partnership. Receptive role strain was more prevalent for TW with unknown HIV status (reference: without HIV) or pre-sex drug use (reference: no pre-sex drug use). For homosexual MSM, receptive role strain was more prevalent during condomless anal intercourse (reference: condom-protected) and with receptive or versatile partners (reference: insertive). Among heterosexual or bisexual MSM, insertive role strain was more prevalent with insertive or versatile partners (reference: receptive), and less prevalent with casual partners (reference: primary). Our findings suggest TW and MSM experience different vulnerabilities during sexual role negotiation with different partner-types. Future studies should explore the impact of sexual role strain on condom use agency, HIV/STI risk, and discordances between public and private presentations of gender and sexual orientation.

     

中国六省（区）性病门诊男性就诊者艾滋病相关行为特征及HIV感染状况 影响因素研究

目的 了解中国6省(区)15～90岁性病门诊男性就诊者的艾滋病知识知晓、艾滋病相关行为及HIV感染等状况,分析其HIV感染的影响因素.方法 根据全国艾滋病哨点监测实施方案(试行)操作手册的要求,汇总广西、广东、河南、四川、云南和江西6省(区)2009-2010年国家级性病门诊男性就诊者哨点监测数据.对上报数据进行“清洗”,剔除不合格数据后用SPSS18.0软件进行统计分析.结果 6省(区)共汇总性病门诊男性就诊者资料64 003份,15～49岁组55 220人,≥50岁组8783人(13.7％).两组人群的艾滋病知识总知晓率(69.6％vs.80.1％)、近3个月发生过商业性行为的比例(34.1％vs.36.6％)、近3个月发生过临时性行为的比例(18.7％vs.28.4％)、发生同性肛交性行为的比例(0.7％vs.1.4％)、最近一年做过HIV抗体检测的比例(14.3％vs.17.1％)均为≥50岁组低于15 ～ 49岁组.而≥50岁组HIV抗体阳性检出率高于15 ～49岁组(1.1％vs.0.7％).对≥50岁组多因素logistic回归分析结果显示,有固定性伴(OR=0.588,P=0.034)、发生过同性肛交性行为(OR=5.226,P=0.006)与HIV抗体阳性有关.结论 发生高危性行为(包括同性肛交性行为)是≥50岁性病门诊男性就诊者感染HIV的主要危险因素.     

北京市大学在校生男男性行为者HIV感染状况及其相关危险陛行为调查

目的 了解北京市大学在校生男男性行为者的HIV感染状况及其相关危险性行为.方法 研究对象主要通过网络招募,采用自填式问卷调查.问卷内容包括人口学信息与艾滋病相关危险行为等.问卷完成后采集血液样本进行HIV血清学检测.单因素分析采用X2检验,多因素分析采用logistic同归.结果 研究成功招募157人.平均年龄为(22.7±2.8)岁,少数民族占12.1%,77.7%自我认同为同性恋.98.1%曾有肛交行为,73.9%报告肛交是常采用的性行为方式.157人中近6个月有58.6%发生过无保护肛交,有58.0%口交时从不使用安全套,其中59.2%存在多性伴(性伴数≥2)行为.近50.0%认为自己不可能感染HIV或者风险很小,检测发现HIV阳性率为2.5%.logistic回归分析结果 显示,曾与陌生人发生性行为(OR=13.10)、了解"肛交时做主动方比做被动方感染HIV风险小"(OR=3.37)以及曾去同性恋酒吧(OR=2.49)是近6个月发生多性伴行为的独立危险因素.结论 大学在校生男男性行为者无保护肛交和多性伴行为较普遍.亟需开展有针对性的干预活动,预防HIV在该人群中传播.

Abstract：

Objective To assess the prevalence of HIV and risky sexual behaviors among university students who have sex with men(MSM)in Beijing.Methods MSM students in the universities were mainly recruited via internet.Questionnaires were self-administered to collect social demographic information and AIDS-related risky sexual behaviors.After completing the questionnaire,blood sample was collected to determine HIV infection through serological testing.X2 test and logistic regression were employed for univariate and multivariate analysis,respectively.Results A total of 157 students were recruited with mean age of 22.7±2.8 years old,12.1%of them were minorities and 77.7% were self-identified as homosexual.98.1% had engaged in anal intercourse(AI)in their lifetime and 73.9%reported that AI was common sexual behavior they often practised.In the past 6 months,58.6% had ever had unprotected anal intercourse(UAI),58.0% never used condoms during oral intercourse,and 59.2% had multiple sex partners(≥2).Nearly half of them believed that they were at low or no risk of contracting HIV and the prevalence of HIV infection was 2.5%.Data from logistic regression analysis showed that ever having had sex with a casual partner in a lifetime (OR=13.10).understanding that serving an insertive role had less risk than being receptive during the AI (OR=3.37),and ever having been to a gay bar(OR=2.49)was independently related to having multiple sex partners in the past 6 months.Conclusion Despite the extensive programs on education,behaviors regarding UAI and ever having had multiple sex partners were silll commonly seen among university MSM students.Interventions were needed to prevent HIV transmission in this population.     

北京市男男性行为者HIV和梅毒螺旋体血清抗体阳转率及影响因素

目的 了解北京市男男性行为者(MSM)的HIV和梅毒螺旋体血清抗体阳转情况及其影响因素. 方法 在北京市以社区为基础招募HIV阴性的MSM共525名,以一对一的方式进行问卷调查,收集人口学和行为学情况资料,在第6、12个月进行随访,并采集血样进行HIV和梅毒螺旋体抗体检测,初筛均采用ELISA法,确证分别采用蛋白印迹(WB)和凝集法. 结果 基线共调查550名,HIV和梅毒螺旋体血清抗体阳性率分别为4.5%(25/550)和29.3%(161/550),HIV血清抗体阴性队列525名,随访12个月,队列保持率为87.0%(457/525),HIV和梅毒螺旋体血清抗体阳转率分别为3.37/100人年和9.32/100人年.近3个月同性性行为后冲洗直肠者阳转率为7.11/100人年,未冲洗者为0.76/100人年,冲洗与HIV血清抗体阳转相关(HR=9.23,95%CI=2.08～40.88).近3个月在公园、公厕或浴池寻找男性性伴者阳转率为41.77/100人年,无该行为者阳转率为7.97/100人年;近3个月同性性行为后冲洗直肠者阳转率为16.17/100人年,无该行为者阳转率为4.92/100人年;近3个月在公园、公厕或浴池寻找男性性伴(HR=4.67,95%CI=1.77～12.34)和近3个月同性性行为后冲洗直肠(HR=3.09,95%CI=1.40～6.83)与梅毒螺旋体血清抗体阳转相关. 结论 北京市MSM的HIV和梅毒螺旋体血清抗体阳转情况十分严重,主要影响因素为同性性行为后冲洗直肠、到公园等场所寻找男性性伴.

Abstract：

Objective To study the incidence and risk factors of HIV and syphilis seroconversion among men who have sex with men(MSM) in Beijing. Methods A total of 550 MSM were recruited on the basis of community and followed up after 6 and 12 months in Beijing.Each subject was investigated by only one investigator at one time to collect information on demographics and behaviors.Blood samples were collected to test HIV and syphilis seroconversion.ELISA was used for screening test,west blotting(WB) and Particle agglutination were used for confirmatory test. Results A total of 550 MSM investigated,among which 4.5% (25/550) were HIV-positive and 29.3% (161/550) were syphilis-positive.For 525 HIVnegative MSM,87.0% (457/525) retained during the 12-month investigation.Seroincidences for HIV and syphilis were 3.37/100 person-years (95% CI = 1.66-5.08) and 9.32/100 person-years (95% CI =5.87-12.77) respectively.HIV seroconversions for those who performed and did not perform rectal douching after homosexual anal intercourse in the past 3 months were 7.11/100 and 0.76/100 person-years respectively.Multivariate Cox regression analysis revealed that rectal douching after homosexual anal intercourse in the past 3 months(HR=9.23,95%CI =2.08-40.88) was significantly associated with HIV seroconversion.Syphilis seroconversions for those who met male sex partners in parks,public washrooms or bathhouses in the past 3 months were 41.77/100 and 7.97/100 person-years respectively.Syphilis seroconversions for those who performed and did not perform rectal douching after homosexual anal intercourse in the past 3 months were 16.17/100 and 4.92/100 person-years respectively.In the past 3 months,meeting male sex partners in parks,public washrooms or bathhouses (HR=4.67,95% CI = 1.77-12.34) and performing rectal douching after homosexual anal intercourse (HR = 3.09,95% CI=1.40-6.83) were significantly associated with syphilis seroconversion. Conclusion The seroconversions of HIV and syphilis during the follow-up visits in this MSM cohort study in Beijing were very serious,and that the associated factors for seroconversions were rectal douching after homosexual anal intercourse and meeting male sex partners in parks,public washrooms or bathhouses.     

男男性行为人群直肠冲洗行为状况及相关因素

目的  了解男男性行为人群(men who have sex with men, MSM)直肠冲洗行为状况及相关因素,为制定针对性干预措施提供依据。方法  2020年5月1日―2020年7月10日,在江苏省无锡市采用滚雪球抽样的方法,选取KTV、浴室、公园、酒吧等场所招募400名MSM研究对象,开展横断面调查。通过调查问卷收集研究对象的社会人口学信息、行为学信息、物质滥用史、性病史和直肠冲洗行为等内容,并采集调查对象静脉血进行HIV抗体检测。采用χ²检验和多因素Logistic回归分析模型分析MSM直肠冲洗行为的相关因素。结果  共调查MSM400人,最近6个月发生性行为时进行直肠冲洗的占比51.3%,其中只在性行为前进行直肠冲洗的占比57.6%,只在性行为后进行直肠冲洗的占比14.6%,性行为前后均进行直肠冲洗的占比27.8%。多因素分析结果显示,月均收入>5 000元(OR=2.18, 95% CI: 1.36~3.51, P=0.001)、同性恋(OR=19.35, 95% CI: 4.01~93.38, P＜0.001)、双性恋(OR=10.31, 95% CI: 2.12~50.14, P=0.004)、最近6个月肛交时为被插入方(OR=8.96, 95% CI: 4.14~19.40, P＜0.001)、最近6个月肛交时为插入方和被插入方均有(OR=10.71, 95% CI: 4.80~23.89, P＜0.001)、物质滥用史(OR=3.20, 95% CI: 1.60~6.42, P=0.001)、性病史(OR=2.17, 95% CI: 1.30~3.63, P=0.003)、HIV检测阳性(OR=3.60, 95% CI: 1.14~11.36, P=0.029)是影响MSM直肠冲洗的相关因素。结论  MSM发生性行为时进行直肠冲洗较普遍,且与HIV感染有关,迫切需要加强对该人群的健康教育和行为干预,以降低该人群感染HIV的风险。     

淮南市男男性行为者艾滋病相关高危行为及影响因素分析

目的了解男男性行为者(MSM)高危行为特征及其影响因素,为制定艾滋病防治措施提供参考依据。方法采用"滚雪球"方法在淮南市招募279名MSM为研究对象,通过问卷收集人口学、艾滋病知识、高危行为及干预服务接受情况等,对数据进行单因素及多因素logistic回归分析。结果 279名调查对象绝大部分为青壮年,平均年龄28岁,未婚居多、文化程度以高中及以上为主,AIDS知识知晓率为89.90%。最近6个月,应答者中100%的调查对象发生过同性肛交,7.72%发生过同性商业性行为,31.05%MSM曾经和异性发生性接触;过去6个月同性非商业性无保护肛交的发生率为62.36%,同性无保护商业性性行为发生率为38.10%,与异性发生无保护性行为发生率为83.53%。多因素logistic回归分析发现,来自县城的招募对象、最近一周同性肛交多于1次、最近六个月有异性性行为、最近一年患过性病、高艾滋病知识得分、最近一年检测过HIV与MSM最近6个月同性肛交安全套坚持使用率的关系有统计学意义。结论淮南市MSM人群艾滋病相关的高危行为普遍存在,亟需采取针对性的干预措施。     

What’s In an Identity Label? Correlates of Sociodemographics,Psychosocial Characteristics,and Sexual Behavior Among African American Men Who Have Sex With Men

African American men who have sex with men (AAMSM) are vastly overrepresented among people with HIV/AIDS. Using data from 595 AAMSM in Philadelphia, we explored differences in sociodemographics, psychosocial characteristics related to beliefs about ethnicity, sexuality and masculinity, and sexual behavior with men and women by self-reported sexual identity (gay, bisexual, down low, straight). Roughly equivalent numbers identified as gay (40.6 %) and bisexual (41.3 %), while fewer identified as straight (7.6 %) or down low (10.5 %), with significant differences in age, income, history of incarceration, HIV status, alcohol and drug problems, childhood sexual abuse, and connection to the gay community evident among these groups. Analysis of psychosocial characteristics theorized to be related to identity and sexual behavior indicated significant differences in masculinity, homophobia, and outness as MSM. Gay and straight men appeared to be poles on a continuum of frequency of sexual behavior, with bisexual and down low men being sometimes more similar to gay men and sometimes more similar to straight men. The percentage of men having total intercourse of any kind was highest among down low and lowest among gay men. Gay men had less intercourse with women, but more receptive anal intercourse with men than the other identities. There were no significant differences by identity in frequency of condomless insertive anal intercourse with men, but gay men had significantly more condomless receptive anal intercourse. There were significant differences by identity for condomless vaginal and anal intercourse with women. This study demonstrates the importance of exploring differences in types of sex behavior for AAMSM by considering sexual identity.     

AIDS and heterosexual anal intercourse

Heterosexual anal intercourse is rarely discussed in the scientific literature. Review of the literature suggests the silence is linked to ethnocentric discomfort about it among researchers and health care providers, coupled with the misconception that anal sex is a homosexual male practice, not heterosexual. Review of surveys of sexual practices suggest that heterosexual anal intercourse is far more common than generally realized, more than 10% of American women and their male consorts engaging in the act with some regularity. Sexually transmitted disease (STD) data, especially where only the rectum is infected with gonorrhea or other STD agents, buttresses survey data. Considerably more heterosexuals engage in the act than do homosexual and bisexual men, not all of whom participate in anal coitus. Anal intercourse carries an AIDS risk for women greater than that for vaginal coitus, just as receptive anal intercourse carries a very high risk for males. Infection with the AIDS virus is increasingly documented in women engaging in anal coitus with infected males, in America, Europe, and Latin America. Women in Western countries are less likely to continue HIV infectivity chains than are males engaging in same-gender anal intercourse.