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Self-reported sexual behaviour and HIV risk taking among men who have sex with men in Fortaleza, Brazil.

OBJECTIVES: To describe and identify sociodemographic and behavioural characteristics and other factors related to high-risk behaviour for HIV infection of men who have sex with men (MSM) living in Fortaleza, Brazil. METHODS: A survey was carried out among 400 MSM aged 14-65 years and recruited through the snowball technique or in gay-identified venues. A semi-structured questionnaire was conducted among them. Logistic regression analysis was used to model the dichotomous outcome (high risk or low risk). RESULTS: Forty-four per cent of the participants reported engaging in high-risk sexual behaviour in the previous year. MSM less informed about AIDS, reporting more sexual partners, reporting at least one female partner in the previous year, having anal sex as the favourite way to have sex, and having great enjoyment of unprotected anal sex were more likely to be engaged in risky behaviour. Twenty-three per cent of participants reported at least one sexual contact with women during the previous year. Two-thirds of men who had unprotected sex with their female partners also had unprotected anal sex with their male partners. CONCLUSIONS: A large proportion of MSM in Fortaleza still remain at elevated risk for contracting HIV infection. The factors predictive of high-risk sexual behaviour are significant in spreading HIV infection among the MSM population and also among their female partners. The lifestyles of these men are different to those of men from other parts of Brazil or outside the country. Preventive interventions need to be culturally and socially specific in order to be effective.

Adolescent↗

Risk factors for human immunodeficiency virus infection and unprotected anal intercourse among young men who have sex with men.

BACKGROUND AND OBJECTIVES: Few studies concerning human immunodeficiency virus (HIV) and its risk behaviors have been conducted among young men who have sex with men (YMSM). These are important because YMSM will have profound influence on the HIV/acquired immunodeficiency syndrome epidemic. GOALS: To estimate the prevalence of and risk factors associated with HIV infection and recent unprotected anal intercourse (UAI) among YMSM in California. METHODS: Between March and October, 1994, 836 men, 17 to 25 years of age, were surveyed at four California sites. The survey consisted of an interview from a standardized questionnaire and a blood draw for HIV antibody testing. RESULTS: Almost 9.0% tested positive for HIV antibodies, whereas about 36.0% reported recent UAI. Several factors were associated both univariately and multivariately with HIV infection, as well as for recent UAI. CONCLUSIONS: Young men who have sex with men in California continue to engage in behaviors risky for HIV infection. Efforts helping YMSM reduce them should target subgroups having a high HIV seroprevalence or recent UAI prevalence.

Adolescent↗

Screening for Neisseria gonorrhoeae and Chlamydia trachomatis at entertainment venues among men who have sex with men.

BACKGROUND: To assess the prevalence and increase awareness of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men who have sex with men, a screening program was conducted at three inner-city homosexual entertainment venues and one community function. STUDY DESIGN: Each venue was accessed twice over a 3-month period between March and June 2000. First-catch urine specimens were collected for analysis by polymerase chain reaction (PCR), and throat swabs were collected for culture and PCR. RESULTS: A total of 202 men were tested during the 7 screening nights, including 16 who were tested more than once. From the 186 men tested for the first time, 184 urine specimens were collected, of which 8 (4.3%; 95% CI, 1.9-7.8%) were PCR-positive for C trachomatis and 1 (0.5%; 95% CI, 0-2.1%) was PCR-positive for N gonorrhoeae. Of the 161 throat swabs collected, none were positive for C trachomatis or N gonorrhoeae. CONCLUSIONS: C trachomatis is a potentially significant pathogen in this population of urban homosexual men. Screening programs such as these are valuable as health-promotion exercises.

Adult↗

Influence of a partner's HIV serostatus, use of highly active antiretroviral therapy, and viral load on perceptions of sexual risk behavior in a community sample of men who have sex with men.

OBJECTIVE: To assess the perceptions of gay and bisexual men concerning the risk of HIV transmission through various sexual practices with a new sex partner depending on that partner's disclosed HIV status, antiretroviral treatment status, and viral load. METHODS: Study participants read four different scenarios describing sexual situations with a new partner and rated each scenario for risk of HIV transmission. HIV status and antiretroviral treatment status disclosed by the new sex partner were varied across four scenarios: unknown HIV status; HIV-negative; HIV-positive and not taking highly active antiretroviral therapy (HAART); and HIV-positive and taking HAART with an undetectable viral load. RESULTS: Study participants were 472 men attending a gay pride festival who reported that they were HIV-negative. Eighty-nine percent of the men were white, and the mean age of the study participants was 35.8 years. Of the four scenarios, sex with an HIV-positive partner not taking HAART was rated as posing the greatest risk. Sex with an HIV-positive partner taking HAART who had an undetectable viral load was not consistently viewed as riskier than sex with an HIV-negative partner or a man with an unknown HIV status. CONCLUSIONS: The current study provides preliminary evidence for the effect of disclosure of HIV serostatus, use of HAART, and the presence of an undetectable viral load on the perceptions of sexual risk for HIV-negative men. The findings suggest that some gay and bisexual men judge risk based on the perceived HIV status of their sex partners and not on the general assumption that all sex partners entail equal risk, as many prevention campaigns have emphasized.

Adult↗

Substance use among men who have sex with men: comparison with a national household survey.

OBJECTIVE: Compare substance use among men who have sex with men (MSM) at high risk for HIV infection to a nationally representative sample of heterosexual men. METHODS: Compare data from surveys of 3,212 MSM recruited for participation in a Vaccine Preparedness Study (VPS) with an age-standardized group of 2481 single, urban-dwelling men from the 1995 National Household Survey on Drug Abuse (NHSDA). RESULTS: Except for alcohol, relative risk (RR [95% confidence interval (CI)]) for use of any substance was higher in the VPS than the National Household Survey on Drug Abuse (NHSDA) (3.64 [3.01-4.42]). Drugs with the highest relative risks were "poppers" (21.6 [15.2-30.8]), sedatives (6.98 [2.46-19.8]), hallucinogens (6.14 [4.61-8.17]), tranquilizers (4.99 [2.96-8.42]), and stimulants (4.47 [3.58-5.58]). RR was higher for weekly use of poppers (33.5 [12.5-89.6]), stimulants (2.75 [1.79-4.22]), marijuana (2.37 [1.93-2.92]), and cocaine (2.24 [1.32-3.79]); and for daily use of marijuana (1.49 [1.08-2.05]). CONCLUSIONS: Participants in the VPS used more substances than a group of age-standardized, single, urban-dwelling men from the NHSDA. In view of previous data showing that substance use can be associated with unprotected sex, assessing substance use among MSM at high risk for HIV infection is an important component of risk reduction efforts.

Adolescent↗

The association of socioeconomic status and use of crack/cocaine with unprotected anal sex in a cohort of men who have sex with men in Rio de Janeiro, Brazil.

To evaluate the relation between illicit drug use, sexual practices, and socioeconomic status, we analyzed data from the baseline interview of a cohort of 675 men who have sex with men conducted from 1994 to 1999 in Rio de Janeiro, Brazil. Bivariate analyses of factors associated with crack/cocaine use with sex revealed that men who reported crack/cocaine use were significantly ( p <.05) more likely than men who did not report drug use to be unemployed (42.7% vs. 29.1%), to have an income of <$250 per month (70.7% vs. 60.9%), to have <8 years of education (69.5% vs. 50.9%), to report bisexual activity (81.7% vs. 41.7%), and to engage in commercial sex (72.0% vs. 37.9%). Multivariate analysis of factors associated with unprotected anal sex with casual male partners in the last 6 months demonstrated that the following variables were associated with this outcome: an income <$250 per month (adjusted odds ratio [AOR] = 1.73, 95% confidence interval [CI]: 1.04-2.87), less than 8 years of education (AOR = 2.21, CI: 1.38-3.53), a greater sense of vulnerability (AOR = 2.58, CI: 1.54-4.33), a willingness to participate in vaccine trials (AOR = 1.91, CI: 1.20-3.05), and use of crack/cocaine (AOR = 1.91, CI: 1.05-3.46). Our findings suggest that HIV prevention programs for these men need to address drug use and how drug use may influence sexual behaviors.

Adolescent↗

Trends in AIDS incidence and survival among racial/ethnic minority men who have sex with men, United States, 1990-1999.

OBJECTIVES: We describe trends in AIDS incidence, survival, and deaths among racial/ethnic minority men who have sex with men (MSM). METHODS: We examined AIDS surveillance data for men diagnosed with AIDS from 1990 through 1999, survival trends from 1993 through 1997, and trends in AIDS incidence and deaths from 1996 to 1999, when highly active antiretroviral therapy (HAART) was introduced. RESULTS: The percentage of racial/ethnic minority MSM with AIDS increased from 33% of 26,930 men in 1990 to 54% of 17,162 men in 1999. From 1996 through 1998, declines in AIDS incidence were smallest among black MSM (25%, from 66.2 to 49.5 per 100,000) and Hispanic MSM (29%, from 39.3 to 27.8), compared with white MSM (41%, from 17.9 to 10.5). Declines in deaths of MSM with AIDS were also smallest among black MSM (53%, from 39.7 to 18.6 deaths per 100,000) and Hispanic MSM (61%, 21.6 to 8.4), compared with white MSM (63%, 12.3 to 4.5). Survival improved each year for all racial/ethnic groups but was poorest for black MSM in all years. CONCLUSIONS: Since the introduction of HAART, a combination of factors that include relatively higher infection rates in more recent years and differences in survival following AIDS diagnosis contribute to observed differences in trends in AIDS incidence and deaths among racial/ethnic minority MSM. Increased development of culturally sensitive HIV prevention services, and improved access to testing and care early in the course of disease are needed to further reduce HIV-related morbidity in racial/ethnic minority MSM.

AIDS Serodiagnosis↗

HIV infection and human herpesvirus-8 oral shedding among men who have sex with men.

Human herpesvirus-8 (HHV-8) is frequently detected in oropharyngeal secretions from HIV-infected men who have sex with men (MSM), and contact with saliva may be an important mode of HHV-8 transmission. A total of 196 MSM were followed over 2 years to determine the correlates of HHV-8 oropharyngeal shedding. A total of 134 (68%) of 196 participants were HHV-8 seropositive upon enrollment, and 9 (15%) of 62 participants seroconverted to HHV-8 during follow-up. HHV-8 DNA was detected in 43 (22%) of 196 participants: 39 (27%) of 134 HHV-8 seropositive, 4 (8%) of 53 HHV-8 seronegative, and 5 (56%) of 9 seroconverters to HHV-8. HHV-8 was detected in 101 (15%) of 696 total oral specimens: 84 (17%) of 481 samples from HHV-8-seropositive men, 6 (3%) of 180 samples from HHV-8-seronegative men, and 11 (31%) of 35 samples from seroconverters. Using adjusted marginal structural models, HHV-8 shedding was higher in men not receiving highly active antiretroviral therapy (odds ratio 2.4, 95% CI 1.0-6.0, P = 0.06), with CD4 counts > 200 cells/mm (odds ratio 4.8, 95% CI 1.0-22.8, P = 0.05), or with detectable oral leukocyte esterase (odds ratio 5.0, 95% CI 2.0-12.5, P < 0.01). CD4 count, antiretroviral therapy, and oral inflammation may influence HHV-8 oropharyngeal shedding.

Adult↗

Sex behaviour of men who have sex with men and risk of HIV in Andhra Pradesh, India.

OBJECTIVE: To obtain information on sex behaviour of a large sample of men who have sex with men (MSM) in India that would assist in planning HIV prevention. METHODS: Homosexual/bisexual behaviour of 6661 MSM at 62 urban-rural locations of various sizes in the Indian state of Andhra Pradesh was assessed through detailed interview. Multivariate analyses were performed to understand the associations with unprotected penetrative sex and barriers to condom use assessed. RESULTS: The average number of different male sex partners in past 4 weeks was six. In last three sex encounters with men, totalling 19 640, anal sex occurred in 16 769, at least once by 6121 (91.9%) MSM of which 3423 [55.9%; 95% confidence interval (CI), 51.7-60.1%] did not use condom at least once. A total of 2785 (41.8%) were currently married to women and 3354 (50.4%) had had vaginal/anal sex with women in the past 3 months, of which 2818 (84%; 95% CI, 81.1-86.9%) did not use a condom. Furthermore, 1585 (25.9%; 95% CI, 22.7-29.1%) had anal sex without a condom with men and also vaginal/anal sex without a condom with women. This was prevalent across urban-rural locations and its strongest association was with currently married MSM (odds ratio 15.1; 95% CI, 12.5-18.2). The predominant reason for not using a condom with women was 'do not use with regular partner' (68.4%). CONCLUSION: This high rate of unprotected penetrative sex by MSM with both men and women suggests that HIV prevention efforts in India should include a focus on MSM as well as their wives across many urban-rural locations and not only in large cities.

Adolescent↗

Prevention with gay and bisexual men living with HIV: rationale and methods of the Seropositive Urban Men's Intervention Trial (SUMIT).

OBJECTIVES: To provide a public health rationale for prevention with HIV-seropositive gay and bisexual men and to describe the methods of the Seropositive Urban Men's Intervention Trial (SUMIT). DESIGN: A randomized intervention trial. METHODS: Self-identified HIV-positive gay and bisexual men were recruited from community-based venues in New York City and San Francisco. Eligible participants completed an A-CASI baseline assessment, were asked to provide samples for sexually transmitted infection (STI) testing, and were randomly assigned to either a single-session intervention or a six-session enhanced intervention designed to reduce HIV transmission risk and promote serostatus disclosure. Participants who attended the first intervention session were assessed 3 and 6 months post-intervention. STI testing was offered at the 6-month assessment. RESULTS: A total of 1168 self-identified HIV-seropositive gay and bisexual men completed the baseline assessment, and 1110 of these (95%) opted for STI testing. A total of 811 attended the first intervention session, of which 85% were assessed at 3 months and 90% were assessed at 6 months. Of those assessed at 6 months, 92% (670/729) provided a blood or urine sample for STI testing. CONCLUSION: SUMIT demonstrates the feasibility and acceptability of prevention research with HIV-seropositive gay and bisexual men. The study provides new information about the sexual behavior, serostatus disclosure practices, and the efficacy of an intervention to reduce HIV transmission risk.

Adolescent↗

HIV infection and sexually transmitted infections among men who have sex with men in Senegal.

BACKGROUND: No epidemiological study has been conducted on HIV and vulnerability to sexually transmitted diseases (STI) among men who have sex with men (MSM) in sub-Saharan Africa. METHOD: A survey including questionnaire, physical examination and detection of HIV and STI was carried out among 463 MSM, aged 18-52 years, recruited through the snowball technique in five urban sites throughout Senegal. RESULTS: A total of 21.5% of men were found to be infected with HIV [95% confidence interval (CI), 17.8-25.6]. Active syphilis, positive serology for herpes simplex virus (HSV)-2, and polymerase chain reaction detection in urine of Chlamydia and gonorrhea infections were recorded in 4.8, 22.3, 4.1 and 5.4% of participants, respectively. Most respondents reported sex with women (94.1%). In the month preceding the interview, 24% reported at least one unprotected insertive anal intercourse with a male partner, 20% at least one unprotected receptive anal intercourse, and 18% at least one unprotected intercourse with a female partner. Genital examination showed that 5% of participants had at least one clinical sign of STI. Factors associated with HIV infection were age group, the reporting of more than nine lifetime male partners [odds ratio (OR), 3.76; 95% CI, 1.61-8.79], being a waiter or bartender (OR, 3.33; 95% CI, 1.41-7.84), and living in Dakar (OR, 3.33; 95% CI, 1.07-3.43). CONCLUSION: Men who have sex with men in Senegal are highly infected with HIV and other STI. Intervention programs targeting this population are urgently needed, given their particular vulnerability and because infections are likely to disseminate into the general population given the high proportion of bisexual activity in this community.

Adolescent↗

Risk factors for HIV infection among men who have sex with men.

OBJECTIVES: Risk factors for HIV acquisition were examined in a recent cohort of men who have sex with men (MSM). DESIGN: A longitudinal analysis of 4295 HIV-negative MSM enrolled in a randomized behavioral intervention trial conducted in six US cities. METHODS: MSM were enrolled and assessed for HIV infection and risk behaviors semi-annually, up to 48 months. RESULTS: In multivariate analysis, men reporting four or more male sex partners, unprotected receptive anal intercourse with any HIV serostatus partners and unprotected insertive anal intercourse with HIV-positive partners were at increased risk of HIV infection, as were those reporting amphetamine or heavy alcohol use and alcohol or drug use before sex. Some depression symptoms and occurrence of gonorrhea also were independently associated with HIV infection. The attributable fractions of high number of male partners, use of alcohol or drugs before sex, and unprotected receptive anal intercourse with unknown status partners and the same with presumed negative partners accounted for 32.3, 29.0, 28.4 and 21.6% of infections, respectively. CONCLUSIONS: The challenge is to develop strategies to identify men in need. Interventions are needed to help men reduce their number of sexual partners, occurrences of unprotected anal intercourse, alcohol or drug use before sex and address other mental health issues.

Adult↗

Understanding recent increases in the incidence of sexually transmitted infections in men having sex with men: changes in risk behavior from risk avoidance to risk reduction.

OBJECTIVE: The objective of this study was to explore risk behavior and routes of transmission in men having sex with men (MSM) with newly diagnosed sexually transmitted infections (STIs). METHODS: A questionnaire on clinical diagnosis and manifestation site for acute STIs was completed by physicians participating in a sentinel study. Patients contributed information on sexual risk behavior and the likely route of STI transmission. RESULTS: Three hundred fifty-six diagnosis forms and 169 matching patient questionnaires could be analyzed. The most frequent diagnosis was syphilis (n = 147; 33% primary syphilis with ulcer localization 71% genital, 22% anorectal, and 8% oral; 67% secondary syphilis), followed by gonorrhea (n = 136; 59% genital, 34% rectal, 7% pharyngeal) and Chlamydia trachomatis infection (n = 51; 48% genital, 48% rectal, 4% pharyngeal). In 12 patients, more than one infection was diagnosed, and 2 or 3 sites were affected in 11 patients. Approximately 60% of infections were acquired by genital-oral and oral-anal practices. Unprotected anal intercourse (UAI) was reported more often by HIV-positive men (mostly receptive) and men with high partner numbers. CONCLUSION: High partner numbers, an important role of genital-oral sexual practices for the transmission of STIs, and relatively high frequencies of mostly receptive UAI in HIV-positive men are all contributing to increasing STI incidences among MSM.

Adolescent↗

High prevalence of sexually transmitted diseases among men who have sex with men in Jiangsu Province, China.

OBJECTIVE: : The objective of this study was to investigate the prevalence of sexually transmitted diseases (STDs), including HIV infection, and sexual risk behaviors among men who have sex with men (MSM) in Jiangsu Province, China. DESIGN: : The authors conducted a cross-sectional study. METHODS: : From February to July 2003, men who attended 10 participating gay bars in five cities in Jiangsu Province were asked to complete a self-administered questionnaire, including measures of alcohol use and sexual risk behaviors. Blood samples and urethral swabs were taken to examine the presence of STDs, including HIV infection. RESULTS: : A total of 144 men were recruited in the study. Forty-six percent of men reported unprotected anal intercourse with their male sexual partners in the past 3 months. No one was found to be HIV-infected, but the prevalence of STDs was high: gonorrhea 2.7%, chlamydial infection 8.0%, nonchlamydial nongonococcal urethritis 27.7%, active syphilis 6.9%, hepatitis B virus infection 9.1%, herpes simplex virus-2 infection 7.8%, and genital warts 13.2%. CONCLUSIONS: : Given that HIV prevalence among MSM in some other parts of China has been as high as 3%, STDs facilitate the transmission of HIV, and high prevalence of STDs and sexual risk behaviors among MSM exist in Jiangsu Province, the potential for the future spread of HIV is of concern, and it is urgent to provide MSMs with STD healthcare services and HIV/AIDS/STD prevention education and intervention.

Adolescent↗

Exploring HIV prevention needs for nongay-identified black and African American men who have sex with men: a qualitative exploration.

OBJECTIVES: The objectives of this study were to describe ways in which black men who have sex with men (MSM) identify their sexual identities, explore their views of HIV prevention interventions, and assess barriers to recruiting men for future study participation. STUDY DESIGN: Focus groups were conducted with 25 black MSM who have sex with women. Thematic analyses were conducted. RESULTS: Factors influencing HIV/AIDS prevention perceptions included men's responses and reactions to homosexual labels and vies, sexual behaviors, contextual factors, and self-worth. Men also expressed a need to discuss ambivalent feelings about same-sex sexual encounters. CONCLUSION: The qualitative study provided insights into the significance of sexual identity and sexual labeling for black MSMs' HIV prevention needs.

Adult↗

The effect of venue sampling on estimates of HIV prevalence and sexual risk behaviors in men who have sex with men.

OBJECTIVE: The objective of this study was to investigate differences in HIV prevalence and sexual risk behaviors among men who have sex with men (MSM) according to their gay venue visit patterns. METHODS: In a cross-sectional survey, a population-based sample of men aged 18 to 64 years who self-identified as gay or bisexual were interviewed by telephone regarding their sexual behaviors, HIV serostatus, and gay venue visit patterns. RESULTS: A total of 398 men were recruited for the study. The results showed that frequent gay venue visitors were more likely to engage in high-risk sexual behaviors. Among gay venue attendees who visited different types of gay venues, men who visited sex clubs/bathhouses reported the highest rates of 5 or more male sexual partners and unprotected anal intercourse (UAI) with secondary partners (62.6% and 34.6%, respectively), gay bar/club attendees and cruisers reported higher rates of having sex with women (8.5% and 14.8%, respectively), and circuit party attendees reported the highest HIV prevalence (40.4%) and serodiscordant UAI (30.2%). CONCLUSIONS: MSM who visited different types of gay venues and with varied visit frequency showed marked differences in sexual risk behaviors, and the differences suggest the importance of weighting procedure to obtain unbiased estimates in venue-based studies.

Adolescent↗

What do gay men know about human papillomavirus? Australian gay men's knowledge and experience of anal cancer screening and human papillomavirus.

OBJECTIVE: The objective of this study was to determine levels of experience and knowledge concerning anal dysplasia, anal Pap smear tests, and human papillomavirus (HPV) among gay and other homosexually active men. STUDY DESIGN: Three hundred eighty-four men attending a large gay community event in Melbourne completed a short survey. RESULTS: Ninety-two percent identified as gay and 4.8% as bisexual. A total of 6.4% were HIV-positive and a further 3.5% did not know their HIV status. On a range of measures, it was clear that the men knew very little about anal cancer (19% scored zero on a 12-point knowledge scale) and virtually nothing about HPV (47% scored zero on an 8-point knowledge scale). A total of 55.1% had never heard of an anal Pap smear and 44.8% had ever heard of HPV; 56.4% did not know whether it affected men and/or women. CONCLUSIONS: The test for anal dysplasia is still largely unknown among Australian gay men and they currently have poor sense of personal susceptibility to the disease. Health education strategies are suggested to improve this situation.

Adolescent↗

Demographic and behavioral contextual risk groups among men who have sex with men participating in a phase 3 HIV vaccine efficacy trial: implications for HIV prevention and behavioral/biomedical intervention trials.

Recent outbreaks of syphilis and gonorrhea coupled with reported increases in HIV-risk behavior among men who have sex with men (MSM) have raised concerns about a potential resurgence of HIV among MSM. These concerns have led some to suggest the need for a paradigm shift in how HIV-prevention programs are designed and implemented. In this analysis, baseline demographic, sexual partnership, and substance use information was used to identify contextual-risk groups among 5,095 HIV-seronegative MSM enrolled in a 36-month phase 3 HIV vaccine efficacy trial across 61 sites primarily in North America. Eight demographic and behavioral contextual risk groups were identified, with annualized HIV seroincidence ranging from 1.8% to 6.3% across groups. Men in primary HIV-serodiscordant relationships had the lowest HIV seroincidence (1.8%), while an older group of men with many sex partners had the highest (6.3%). Visit-schedule compliance and study retention were lowest among younger non-White men and highest among older popper users, with annualized HIV seroincidence of 2.9% and 3.5%, respectively. Differences in HIV incidence, study compliance, and retention observed among contextual-risk groups suggest that responsiveness to heterogeneity within risk group (eg, MSM) could benefit screening, enrollment, and retention of HIV-prevention programs and intervention trials, reducing the time and cost related to their design, implementation, and conclusion.

AIDS Vaccines↗