Abstract
BackgroundThe increasing burden of sexually transmitted infections (STIs) including HIV and syphilis among male sex workers (MSWs) is a major global concern. The aim of our study was to evaluate the difference between MSWs and non-commercial MSMs in China.MethodsDuring 2008-09, in a cross-sectional study, 2618 adult MSM were recruited through respondent-driven and snowball sampling from seven cities of China. Information regarding socio-demographics, risk behaviors, HIV-related knowledge and STI-related symptoms were collected and participants were tested for HIV and syphilis.ResultsAmong 2618 participating MSM, 9.97% sold sex to males. HIV prevalence was 7.45% (6.13% among MSWs and 7.59% among non-MSW MSM) and syphilis prevalence was 14.32% (10.73% for MSWs and 14.72% for non-MSW MSM). Compared to non-MSW MSM, MSWs were more likely to be younger (adjusted odds ratio: aOR = 0.91, 95% confidence interval: 95%CI=0.88-0.93), never married (aOR = 4.38, 95% CI = 2.38-6.80), less educated, heterosexual (aOR = 13.04, 95% CI = 6.08-27.95), less knowledgeable regarding HIV (aOR = 0.70, 95% CI=0.51-0.96), experiencing symptoms of STI (aOR = 2.16, 95% CI = 1.47-3.19), engaging in condomless vaginal intercourse (aOR = 2.16, 95% CI = 1.47-3.19) and less likely to engage in condomless anal intercourse (aOR = 0.62, 95% CI = 0.46-0.85).ConclusionsHigh HIV and syphilis prevalence warranted urgent intervention targeting MSWs as a separate sentinel group for efficient surveillance owing to their different distribution from non-MSW MSM. Although male sex workers and non-commercial homosexuals have similar rates of HIV and syphilis, MSWs have different characteristics which should be considered in designing intervention programs targeting them.
Highlights
The high burden of HIV and syphilis among men who have sex with men (MSM) are major public health concerns worldwide and China is no exception [1,2,3]
Compared to non-male sex workers (MSWs) MSM, MSWs were more likely to be younger, never married, less educated, heterosexual, less knowledgeable regarding HIV, experiencing symptoms of sexually transmitted infections (STIs), engaging in condomless vaginal intercourse and less likely to engage in condomless anal intercourse
High HIV and syphilis prevalence warranted urgent intervention targeting MSWs as a separate sentinel group for efficient surveillance owing to their different distribution from nonMSW MSM
Summary
The high burden of HIV and syphilis among men who have sex with men (MSM) are major public health concerns worldwide and China is no exception [1,2,3]. Higher risk behaviors like having multiple sexual partners, frequent condom-less anal intercourse (CAI) and alcohol/drug abuse seemed to be the potential reasons [5, 6]. Owing to this increased vulnerability to STIs including HIV, compared to other MSM (non-MSW) who never sold sex to male for money or goods [6], some researchers argued that this subgroup should be considered as a separate sentinel population for HIV surveillance. The increasing burden of sexually transmitted infections (STIs) including HIV and syphilis among male sex workers (MSWs) is a major global concern.
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