Community-based HIV and STI screening in men who have sex with men in Hong Kong

Abstract

Background: Men who have sex with men (MSM) with sexually transmitted infections (STI) are at increased risk for HIV. Recently, the upsurge of acute hepatitis C virus (HCV) in HIV-positive MSM has raised concern of sexually acquired HCV infection within the local MSM communities with shared high-risk sexual behaviors. Current practice of STI screening and management based on sexual history and symptoms may not be sufficient for HIV/STI control for our local at-risk MSM population. This underscores the need for MSM-oriented sexual health services for appropriate HIV/STI screening, support and management. This study aimed to examine the prevalence of HIV and STI in MSM and assess whether the MSM-focused community health services reached the at-risk MSM in Hong Kong. Methods & Materials: A cross sectional study was conducted in 2016/2017 and MSM attending the community-based VCT site were included to participate regardless of symptoms. Information on sociodemographic, sexual behavioral characteristics, and HIV/STI testing history were collected by self-administered questionnaire. Screening for C. trachomatis/N. gonorrhoeae, HCV, HIV, and syphilis infections were offered free of charge. Results: Of 368 MSM, 4.5% and 6.1% were diagnosed with HIV and syphilis, respectively. Sexually transmitted HCV infection in MSM was low (1.1%). The positivity for urethral chlamydial and gonococcal infection was 5.0% and 1.1%, respectively; whereas pharyngeal C. trachomatis and N. gonorrhoeae was 2.7% and 7.3%, respectively. There were 56 (16.9%) MSM infected with rectal chlamydial infection, while 26 (7.9%) had rectal gonorrhea. Conclusion: Asymptomatic STI were common in MSM and remain undiagnosed and untreated. This study reveals a relatively high prevalence of STI, particularly rectal chlamydial and gonorrhea infections. Community sexual health services can reach the local at-risk MSM and provide new opportunities for HIV/STI prevention and counselling. Offering comprehensive community-based preventive and testing services for HIV with expanded STI screening including syphilis, HCV, chlamydia and gonorrhea for MSM would facilitate early diagnosis and treatment of STI and improve the control of HIV infection.