MSM Prevalence Research Articles

Progress in research of strategies of expanding HIV testing in men who have sex with men

In recent years, HIV infection prevalence in MSM has been in increase in China. HIV testing is the only way to identify HIV-infection, effectively curb the spread of HIV and reduce AIDS-related death risks. At present, the situation of HIV testing in MSM is not satisfactory, and expanding HIV testing is the one of the key measures for AIDS prevention and control in this population. This paper summarizes the role and strategies of expanding HIV testing in MSM in order to provide a reference for the improvement of HIV testing in this population.

Pre-exposure prophylaxis in France: How many MSM are eligible and how much will it cost?

Pre-exposure prophylaxis (PrEP) was definitively authorized in France in 2017 after a two-year probationary period. The fact that the estimated number of MSM eligible for PrEP is still unknown is a barrier to this prevention tool's roll-out at the national level. This study aimed to estimate the number of MSM eligible for PrEP in France, and to evaluate the direct cost of its roll-out. We used data from several sources including the Enquête Rapport au Sexe 2019-ERAS 2019 survey, the 2019 French population census from National Institute of Statistics and Economic Studies (INSEE), and the National Public Health Agency's (Santé Publique France) 2016 health barometer survey. We also used data from previous studies which estimated the proportion of MSM who were sexually active in the 12 months prior to the studies, and HIV prevalence in MSM in France. Furthermore, we used data on PrEP drug costs from the French public drug database and data on medical examinations costs from the IPERGAY study. For 2019, the number of HIV seronegative MSM in France who were sexually active in the previous 12 months was estimated at 398,015. Of these, 142,379 (95%CI: 139,893-145,241) and 104,645 (95%IC: 102311-106979) were eligible for PrEP, based on the Menza score and on official French criteria, respectively. The overall estimated cost of PrEP roll-out in eligible MSM varied between € 317,685,216 and € 545,903,216 for official French criteria, which was higher than the estimated €432,240,851 and €742,753,074 according to the Menza score. Our estimations will enable policy makers to make evidence-based decisions about PrEP roll-out to MSM in France. To accelerate the process, it is important to decentralize PrEP delivery, authorize general practitioners to write prescriptions, and promote this prevention tool through information campaigns.

HIV prevalence among men who have sex with men, transgender women and cisgender male sex workers in sub-Saharan Africa: a systematic review and meta-analysis.

Developing effective targets, policies and services for key populations requires estimations of population sizes and HIV prevalence across countries and regions. We estimated the relative and absolute HIV prevalence among men who have sex with men (MSM), transgender women and men, and male and transgender sex workers (MSW and TGSW) in sub-Saharan African countries using peer-reviewed literature. We performed a systematic review of peer-reviewed studies assessing HIV prevalence in MSM, transgender women and men, MSW and TGSW in sub-Saharan Africa between 2010 and 2021, following PRISMA guidelines. We searched Embase, Medline Epub, Africa Index Medicus, Africa Journal Online, Web of Science and Google Scholar. We calculated HIV prevalence ratios (PRs) between the study prevalence, and the geospatial-, sex, time and age-matched general population prevalence. We extrapolated results for MSM and transgender women to estimate HIV prevalence and the number living with HIV for each country in sub-Saharan Africa using pooled review results, and regression approximations for countries with no peer-reviewed data. We found 44 articles assessing HIV prevalence in MSM, 10 in transgender women, five in MSW and zero in transgender men and TGSW. Prevalence among MSM and transgender women was significantly higher compared to the general population: PRs of 11.3 [CI: 9.9-12.9] for MSM and 8.1 [CI: 6.9-9.6] for transgender women in Western and Central Africa, and, respectively, 1.9 [CI: 1.7-2.0] and 2.1 [CI: 1.9-2.4] in Eastern and Southern Africa. Prevalence among MSW was significantly higher in both Nigeria (PR: 12.4 [CI: 7.3-21.0]) and Kenya (PR: 8.6 [CI: 4.6-15.6]). Extrapolating our findings for MSM and transgender women resulted in an estimated HIV prevalence of 15% or higher for about 60% of all sub-Saharan African countries for MSM, and for all but two countries for transgender women. HIV prevalence among MSM and transgender women throughout sub-Saharan Africa is alarmingly high. This high prevalence, coupled with the specific risks and vulnerabilities faced by these populations, highlights the urgent need for risk-group-tailored prevention and treatment interventions across the sub-continent. There is a clear gap in knowledge on HIV prevalence among transgender men, MSW and TGSW in sub-Saharan Africa.

Abstract IA-15: Serum testosterone and estradiol modify risk of anal HPV16/18 infections but only estradiol and Estrogen Receptor 1-alpha influences risk for histological high-grade squamous intraepithelial lesions (HSIL)

Abstract Background: We reported higher serum free testosterone (FT) and anal-HPV16/18 infection prevalence in MSM. Associations between serum-FT and -estradiol, anal-HPV16/18 infections, and Estrogen Receptor 1α (ESR1) and histological HSIL (hHSIL) are unclear. Methods: Three serial cross-sectional analyses were performed using data for 489 HIV-infected/HIV-uninfected adult males enrolled in the Multicenter AIDS Cohort Study. For 340, anal cytology residuals were evaluated for 37 HPVs (PCR). For 214 men, 336 HRA/biopsies were evaluated for hHSIL; among them, <3 biopsy specimens for 47% (102) were assessed for ESR1 using immunohistochemistry. Serum specimen collection preceded HPV and HRA/biopsy visits by 24(+9) months. Each specimen was tested for Sex Hormone Binding Globulin (radioimmunoassay), and total testosterone and estradiol (TE2) (Liquid chromatography/mass spectrometry); serum-FT (pg/mL) was estimated. HPVs were classified: HPV16/18+, other Group-1 and -2 high-risk HPVs+ (hrHPVs); low-risk HPVs+ (lrHPVs), and none. Biopsies were evaluated as hHSIL vs. <hHSIL. Formalin-fixed paraffin-embedded anal biopsy (~4μm) were prepared and stained using a standard ESR1 immunohistochemistry protocol and were scored for immunofluorescence (0-3+) and percent affected (0-100%) by two pathologists. Multivariable-adjusted GEE logistic regression models assessed relationships between loge-transformed FT, TE2 and ESR1 (%), and HPV16/18+ and hHSIL separately. Self-reported sociodemographic/behavioral covariates were included. Results: Adjusted estimates showed higher FT increased odds of HPV16/18-infection (OR=1.87 (1.2-2.92)), but odds were inversely associated with TE2 (OR=0.68(0.49-0.94)). White race and other Group-1-hrHPVs+ increased odds for HPV16/18 infection (OR=2.61(1.16-5.87) and (OR=1.65(1.11-2.46)), but neither HIV-infection/CD4+count, receptive anal intercourse partnerships; exogenous-testosterone use, nor smoking increased HPV16/18-infection odds. Serum-TE2 and hHSIL were inversely associated (OR=0.51(0.3-0.89)) Serum-FT was not associated with odds of hHSIL (OR=1.09(0.78-1.74)), but. men testing HPV16/18+ showed higher odds of hHSIL than hrHPV-negative men (OR=4.27(1.71-10.66)). Median IHC ER1α-expression intensity was lower among hHSIL affected men: 10% (hHSIL) vs. 40% (<hHSIL). The percent of immunofluorescence intensity (%) was inversely associated with odds of hHSIL (OR=0.96(0.93-0.99). Conclusions: Higher serum-FT increased odds of anal HPV16/18-infection but not hHSIL. Higher serum-TE2 was inversely associated with the odds of both HPV16/18+ and hHSIL, and ESR1 expression in tissue is lower in hHSIL- than <hHSIL-affected epithelium. More research evaluating sex hormones and ERα expression in stroma and epithelial cells of HPV-associated HSIL/<HSIL-affected tissue is needed. Citation Format: Dorothy J. Wiley. Serum testosterone and estradiol modify risk of anal HPV16/18 infections but only estradiol and Estrogen Receptor 1-alpha influences risk for histological high-grade squamous intraepithelial lesions (HSIL) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-15.

HIV seroprevalence in five key populations in Europe: a systematic literature review, 2009 to 2019.

BackgroundIn Europe, HIV disproportionately affects men who have sex with men (MSM), people who inject drugs (PWID), prisoners, sex workers, and transgender people. Epidemiological data are primarily available from national HIV case surveillance systems that rarely capture information on sex work, gender identity or imprisonment. Surveillance of HIV prevalence in key populations often occurs as independent studies with no established mechanism for collating such information at the European level.AimWe assessed HIV prevalence in MSM, PWID, prisoners, sex workers, and transgender people in the 30 European Union/European Economic Area countries and the United Kingdom.MethodsWe conducted a systematic literature review of peer-reviewed studies published during 2009–19, by searching PubMed, Embase and the Cochrane Library. Data are presented in forest plots by country, as simple prevalence or pooled across multiple studies.ResultsEighty-seven country- and population-specific studies were identified from 23 countries. The highest number of studies, and the largest variation in HIV prevalence, were identified for MSM, ranging from 2.4–29.0% (19 countries) and PWID, from 0.0–59.5% (13 countries). Prevalence ranged from 0.0–15.6% in prisoners (nine countries), 1.1–8.5% in sex workers (five countries) and was 10.9% in transgender people (one country). Individuals belonging to several key population groups had higher prevalence.ConclusionThis review demonstrates that HIV prevalence is highly diverse across population groups and countries. People belonging to multiple key population groups are particularly vulnerable; however, more studies are needed, particularly for sex workers, transgender people and people with multiple risks.

The HIV Burden Among Men Who Have Sex with Men, Transgender People, and Male and Transgender Sex Workers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Background: Sub-Saharan Africa (SSA) bears the highest HIV burden worldwide with regional disparities between west and central Africa (WCA) and eastern and southern Africa (ESA). The HIV burden among men who have sex with men (MSM), transgender-women and -men, and male and transgender sex workers (SW) in SSA is largely unknown. We estimated the relative HIV risk and absolute HIV burden for these groups in SSA. Methods: We performed a systematic review of peer-reviewed literature, published between 2010 and 2020 that assessed HIV prevalence in MSM, transgender-women and -men, and male and transgender SW in SSA, following the PRISMA guidelines. The databases Embase, Medline Epub, Web of Science and Google Scholar were searched. Risk of bias was assessed using JBI critical appraisal checklist. We calculated HIV risk ratios (RRs) based on HIV prevalences from each study population and the geospatially matched HIV prevalence among the general population. We extrapolated results for MSM and transgender women to estimate HIV prevalence and number of HIV positives for each country in SSA. Findings: We found 44 articles assessing HIV prevalence in MSM, four in transgender women, five in male SW, and zero in transgender men and transgender SW. Prevalence among MSM, transgender women and male SW was significantly higher compared to the general population in both WCA (RRs: 9·3, 7·1, and 12·4 respectively) and ESA (RRs: 1·8, 1·4, and 8·6 respectively). Estimated HIV prevalence for MSM was 15% and 27% for transgender women, translating in into about 400,000-1,600,000 MSM and between 300,000-600,000 transgender women living with HIV in SSA. For male SW insufficient data was available for such extrapolation. Interpretation: HIV burden among MSM, transgender women and male SW throughout SSA are alarmingly high. Our findings further highlight the urgent need for scaling-up tailored HIV prevention and treatment interventions for these populations. Funding: Aidsfonds Netherlands. Declaration of Interest: None to declare.

Prostate cancer and sexual consequences among men who have sex with men.

Prostate cancer and its treatment frequently lead to sexual side effects that negatively impact personal identity, sexual function, and intimate relationships. The sexual consequences of prostate cancer treatment on men who have sex with men (MSM) differ in some ways from what is observed in heterosexual men. This review summarizes literature from the past two decades exploring how MSM are affected by, and adapt to, prostate cancer treatment. The evidence on whether prostate cancer has a lower prevalence in MSM is unclear but lower screening rates are well-documented within this population. Prostate cancer treatment affects urinary, bowel, and sexual function in both MSM and heterosexual men. These changes may have different sexual and psychological ramifications in MSM when compared to heterosexual men. A common concern among MSM treated for prostate cancer is absence of support, both from the medical profession and in some cases from their own communities. Many MSM with prostate cancer have developed coping strategies and altered sexual practices to accommodate side effects. Lessons learned from this population may have relevance to sexual wellness in non-MSM prostate cancer survivors. Concise recommendations for caring for MSM with prostate cancer are provided.

Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis

WHO has set targets for hepatitis C virus (HCV) elimination by 2030. We did a global systematic review of HCV prevalence and incidence in men who have sex with men (MSM) to provide updated estimates that can guide community education and public health policy. We did a systematic review and meta-analysis of studies published and listed on MEDLINE or Embase between Jan 1, 2000, and Oct 31, 2019, including conference proceedings. Studies were eligible if they reported measures of HCV prevalence or HCV incidence (or both) among MSM. Studies that relied on participants' self-reported HCV status with no laboratory confirmation were excluded. Pooled HCV estimates in MSM were stratified by HIV status and by injecting drug use, then by WHO region and by income level. Random-effects meta-analysis was done to account for between-study heterogeneity and examined using the I2 statistic. Pooled HCV prevalence was also compared with HCV estimates in the general population and presented as prevalence ratios (PRs). In HIV-negative MSM, incidence estimates were stratified by use of HIV pre-exposure prophylaxis (PrEP). The systematic review was registered with PROSPERO, number CRD42020156262. Of 1221 publications identified, 194 were deemed to be eligible and included in the systematic review and meta-analysis. Overall, the pooled HCV prevalence in MSM was 3·4% (95% CI 2·8-4·0; I2=98·0%) and was highest in Africa (5·8%, 2·5-10·4) and South-East Asia (5·0%, 0·0-16·6). Globally, HCV prevalence was 1·5% (1·0-2·1) in HIV-negative MSM and 6·3% (5·3-7·5) in HIV-positive MSM. Compared with the general population, HCV prevalence was slightly higher in HIV-negative MSM (PR 1·58, 95% CI 1·14-2·01) and markedly higher (6·22, 5·14-7·29) in HIV-positive MSM. Pooled HCV prevalence was substantially higher in MSM who had ever injected drugs (30·2%, 22·0-39·0) or currently injected drugs (45·6%, 21·6-70·7) than in those who never injected drugs (2·7%, 2·0-3·6). In HIV-negative MSM, the pooled HCV incidence was 0·12 per 1000 person-years (95% CI 0·00-0·72) in individuals not on PrEP and 14·80 per 1000 person-years (9·65-20·95) in individuals on PrEP. HCV incidence in HIV-positive MSM was 8·46 per 1000 person-years (6·78-10·32). HIV-positive MSM are at substantially increased risk of HCV. Overall, HIV-negative MSM had a slightly higher prevalence of HCV than the general population but had a lower prevalence than HIV-positive MSM. High HCV incidence in more recent PrEP studies suggests that as PrEP use increases, greater HCV transmission might occur. HCV burden in MSM varies considerably by region, which is likely to be associated with variation in the prevalence of injecting drug use and HIV. World Health Organization.

Screening is not associated with reduced incidence of gonorrhoea or chlamydia in men who have sex with men (MSM); an ecological study of 23 European countries.

Background: Increasing rates of antimicrobial resistance has motivated a reassessment of if intensive screening for gonorrhoea and chlamydia is associated with a reduction in the prevalence of these infections in men who have sex with men (MSM). Methods: Spearman's correlation was used to evaluate the country-level correlation between the intensity of self-reported sexual transmitted infection (STI) screening in MSM (both anal and urethral screening, taken from a large internet survey of MSM) and the incidence (taken from ECDC surveillance figures) and prevalence (taken from a literature review of studies estimating prevalence in MSM attending STI clinics) of gonorrhoea and chlamydia. Results: The intensity of both anal and genital screening was found to be positively associated with country level gonorrhoea incidence rates (rho 0.74; p=0.0004; rho=0.73; p=0.0004, respectively) and Ct incidence rates (rho 0.71; p=0.001; rho=0.78; p=0.0001, respectively). No associations were found between anal or genital screening intensity and Ng prevalence in clinic populations (Table 2). Conclusions: We found no evidence of a negative association between screening intensity and the prevalence of gonorrhoea or chlamydia in MSM. Randomized controlled trials are urgently required to evaluate if the high antimicrobial exposure resulting from intensive screening programmes is justified.

Self-Reported Extragenital Chlamydia and Gonorrhea Testing in the Past 12 Months Among Men Who Have Sex with Men in the United States-American Men's Internet Survey, 2017.

Current guidelines recommend that sexually active men who have sex with men (MSM) be screened at least annually for bacterial sexually transmitted infections (STIs) at sites of sexual contact regardless of condom use. Extragenital (rectal and pharyngeal) STI are common in MSM and associated with an increased risk of human immunodeficiency virus. We describe the prevalence of MSM who reported any STI test and an extragenital STI test in the past 12 months (p12m) in the United States. Data were obtained from the 2017 American Men's Internet Survey, an annual cross-sectional behavioral internet survey of MSM in the United States. We examined the prevalence of MSM who reported any STI test and an extragenital STI test in the p12m and compared the prevalence across demographic, clinical, and behavioral factors. Of 10,049 sexually active MSM who participated in American Men's Internet Survey 2017, 42% reported any STI test in the p12m and 16% reported an extragenital (rectal or pharyngeal) STI test in the p12m. Among those who reported getting an extragenital STI test in the p12m, 19% reported providing a throat swab only, 14% reported providing a rectal swab only, and 68% reported providing both a rectal and throat swab for STI testing. In a large sample of internet-using MSM in the United States, levels of STI screening were suboptimal, with fewer than half (42%) of MSM reporting any STI test and even fewer reporting an extragenital STI test in the p12m. Increased efforts are needed to ensure annual STI screening guidelines among MSM are implemented.

Screening is not associated with reduced incidence of gonorrhoea or chlamydia in men who have sex with men (MSM); an ecological study of 23 European countries

Background: Increasing rates of antimicrobial resistance has motivated a reassessment of if intensive screening for gonorrhoea and chlamydia is associated with a reduction in the prevalence of these infections in men who have sex with men (MSM). Methods: Spearman’s correlation was used to evaluate the country-level correlation between the intensity of self-reported sexual transmitted infection (STI) screening in MSM (both anal and urethral screening, taken from a large internet survey of MSM) and the incidence (taken from ECDC surveillance figures) and prevalence (taken from a literature review of studies estimating prevalence in MSM attending STI clinics) of gonorrhoea and chlamydia. Results: The intensity of both anal and genital screening was found to be positively associated with country level gonorrhoea incidence rates (rho 0.74; p=0.0004; rho=0.73; p=0.0004, respectively) and Ct incidence rates (rho 0.71; p=0.001; rho=0.78; p=0.0001, respectively). No associations were found between anal or genital screening intensity and Ng prevalence in clinic populations (Table 2). Conclusions: We found no evidence of a negative association between screening intensity and the prevalence of gonorrhoea or chlamydia in MSM. Randomized controlled trials are urgently required to evaluate if the high antimicrobial exposure resulting from intensive screening programmes is justified.

Assessment of HIV prevalence among MSM in Tokyo using self-collected dried blood spots delivered through the postal service

BackgroundMen who have sex with men (MSM) are at high risk of HIV infection. However, there are only few data on HIV prevalence in MSM in Japan. The objective of this study was to explore the HIV prevalence in MSM at Shinjuku 2-chome, a well known gay quarter in Tokyo.MethodsMSM directly collected the dried blood spot (DBS) self-collection HIV test kit from a drop-in center in Shinjuku 2-chome between August 2015 and December 2016. The participants collected their own blood by finger-prick and anonymously posted the kit to the laboratory. The participants accessed the study website and checked the results of their tests using unique ID and password. DBS was soaked in phosphate buffered saline overnight and the eluted sample was examined by the fourth generation HIV Ag/Ab test of LUMIPULSE (FUJIREBIO INC.), and followed by HISCL (Sysmex Corp.) when the first assay was positive. The result was defined provisionally positive if both were positive.ResultsA total of 1702 HIV test kits were distributed and 1403 DBS were returned (return rate: 82.4%). Since 20.2% of participants collected the test kit more than once, the estimated number of actual test kit users was 1120. Based on the results of the test kit, 34 cases were provisionally diagnosed with HIV. The estimated prevalence was 3.04% (95% confidence interval: 2.03–4.04). Of these 34, 24 (70.6%) were later confirmed to be HIV-positive in the hospital, while the remaining 10 were lost to follow-up. Among the participants, 34.5% received HIV test for the first time. Especially in those aged 20–29, 46.0% were first time HIV testers.ConclusionsThe prevalence of HIV infection in the study population was 3.04%. The high collection suggested a demand for this type of testing in MSM. The test should be expanded further to difficult-to-reach or hidden populations.Trial registrationThis study was registered with the University Hospital Medical Information Network Clinical Trial Registry in August 20th, 2015 (Registry number: UMIN000018699).

1286. Evaluating Strategies to Reduce Risk of HIV Infection in the US Blood Supply

BackgroundDue to risk of HIV transmission, the FDA recommends a ban on blood donation from men who have sex with men (MSM). Revised in 2015, the current restriction applies to men who have had sex with a man in the year before donation. Given advances in HIV testing and the option of risk-based screening, the current approach may not represent the optimal strategy for ensuring a safe blood supply.MethodsUsing a decision tree, we compared three strategies: (1) the current standard: a deferral for MSM followed by fourth-generation HIV antibody/antigen (Ab/Ag) and viral load (VL) testing of all donated units; (2) test-only: no deferral, with Ab/Ag and VL testing; (3) risk-based: deferral for all male donors who report condomless anal intercourse in the past 6 weeks, followed by Ab/Ag and VL testing. The primary outcome was the expected number of accepted HIV+ donations per million units of donated blood. Key input parameters include MSM prevalence (3.6%), HIV testing sensitivity for chronic (99.96%) and acute (75%) infection, and false negative rate of the current MSM deferral question and the risk-based screening question (2.6% for each). In sensitivity analyses, we assessed the impact of variation in these parameters.ResultsIn the base case, the current strategy resulted in 5.39 HIV+ accepted blood donations per million; the testing only strategy resulted in 7.10 HIV+ accepted blood donations per million; and the risk-based strategy resulted in 2.54 HIV+ accepted blood donations per million. In sensitivity analyses, the risk-based strategy was superior across plausible ranges of HIV test sensitivity and MSM prevalence. The risk-based strategy was superior when the false negative rate generated by the risk-based screening question was <10.4%; at higher rates, the current strategy was superior. The current strategy was superior when the MSM deferral question yielded <0.8% false negative rate; at higher rates, the risk-based strategy is superior. Compared with the current standard, a risk-based strategy could add 5 million low-risk MSM to the potential donor supply.ConclusionA risk-based screening question, combined with Ab/Ag and VL testing, may be more effective than the current strategy. The quality and ability of screening questions to accurately assess risk is key to any pre-donation screening strategy.Disclosures All authors: No reported disclosures.

34 - Serum testosterone and estradiol modify risk of anal HPV16/18 infections but only estradiol influences risk for histological high-grade squamous intraepithelial lesions (HSIL)

Background We reported higher serum free testosterone (FT) and increased anal-HPV16/18 infection prevalence in MSM. Associations between serum-FT and -estradiol and anal-HPV16/18 infections and histological HSIL (hHSIL) are unclear. Methods Two cross-sectional analyses were performed. 340 HIV-infected/HIV-uninfected Multicenter AIDS Cohort MSM were tested for anal HPVs; another 214 men were evaluated using HRA/biopsy with multiple assessments for some totaling 336 HRAs. Serum specimens collection preceded HPV and HRA visits by 24( + 9) months and were tested for albumin, SHBG (radioimmunoassay), and total testosterone and estradiol (TE2) (LC/MS); serum-FT (pg/mL) was estimated. Anal swabs were tested for 37 HPVs (PCR) and classified: HPV16/18+, other Group-1 and -2 high-risk HPVs+ (hrHPVs); low-risk HPVs+ (lrHPVs), vs. none. Biopsies were evaluated as hHSIL vs. Results Adjusted estimates showed higher FT increased odds of HPV16/18-infection (OR=1.9 (1.2–2.9)), but odds were inversely associated with TE2 (OR=0.68 (0.49–0.94)). White race and other Group-1-hrHPVs+ increased odds for HPV16/18 infection (OR=2.6 (1.2–5.9) and (OR=1.7 (1.1–2.5)), but neither HIV-infection/CD4+count, receptive anal intercourse partnerships; exogenous-testosterone nor tobacco use increased HPV16/18-infection odds. Serum-FT was not associated with odds of hHSIL (OR=1.1 (0.7, 1.8)), but serum-TE2 and hHSIL was: OR=0.5 (0.3, 0.9). Men testing HPV16/18+ alone showed higher odds of hHSIL than hrHPV-negative men (OR=4.3 (1.7, 10.7)). Conclusions Higher serum-FT increased odds of anal HPV16/18-infection but not hHSIL. Consistent across both analyses, and unexpectely, higher serum-TE2 lowered odds of both HPV16/18+ and hHSIL in these MSM.

Sexualised drug use in the United Kingdom (UK): A review of the literature

BackgroundSexualised drug use (SDU) refers to the use of drugs in a sexual context. This includes ‘Chemsex’- the use of drugs (specifically crystal methamphetamine, GHB/GBL and mephedrone) before or during planned sexual activity to sustain, enhance, disinhibit or facilitate the experience. Here we aimed to synthesise available UK prevalence data for Chemsex, SDU and the use of Chemsex drugs in an undefined context (CDU) in men who have sex with men (MSM). MethodsPapers published between January 2007 and August 2017 reporting Chemsex, SDU and/or Chemsex drug use (CDU) prevalence in MSM were identified through PubMed. Citations were searched for further eligible publications. We also conducted a review of national surveillance data, extracting prevalence data for Chemsex, SDU or CDU. Synthesized data were then assessed to determine the time at which these drugs were taken, in this case just prior to or during sexual activity (event-level). ResultsOur search identified 136 publications, of which 28 were included in the final data synthesis. Three of the four surveillance systems assessed provided SDU or CDU data in MSM. Few publications included event-level data for Chemsex (n = 4), with prevalence estimates ranging from 17% among MSM attending sexual health clinics (SHC) to 31% in HIV-positive MSM inpatients. Prevalence estimates for SDU (n = 7 publications) also varied considerably between 4% in MSM receiving HIV care to 41% among MSM attending SHC for HIV post-exposure prophylaxis (PEP). Eighteen publications provided data for CDU. ConclusionPrevalence estimates varied considerably due to differences in the definition used and population assessed. Standardised definitions and studies with representative national samples of MSM are required to improve our understanding of the extent of Chemsex and its associated risks. Longitudinal event-level data for SDU and Chemsex are needed to monitor impact of interventions.

New thinking on gonorrhoea control in MSM: are antiseptic mouthwashes the answer?

The rate of gonorrhoea is rising and is much higher in men who have sex with men (MSM) than heterosexuals. The purpose of this review was to describe research supporting a new paradigm of transmission of gonorrhoea in MSM and interventions that may result from this. Evidence is accumulating that gonorrhoea in MSM is transmitted differently than previously thought and that asymptomatic sites of infection may play a major role in the persistent of gonorrhoea at a population level. Saliva commonly contains gonorrhoea, and saliva is commonly used during sexual acts. Both in-vitro, in-vivo studies have suggested that antibacterial mouthwash may reduce gonorrhoea at the oropharynx. A recently published mathematical model also suggests that if mouthwash were effective, it would result in considerable declines in the community prevalence in MSM. A newly suggested paradigm for the transmission of gonorrhoea in MSM could potentially offer a simple condom-free control strategy. But considerable more research is required before it could be recommended even if it were shown to be effective in a clinical trial.

Partnerships Between a University-Affiliated Clinic and Community-Based Organizations to Reach Black Men Who Have Sex With Men for PrEP Care.

Partnerships Between a University-Affiliated Clinic and Community-Based Organizations to Reach Black Men Who Have Sex With Men for PrEP Care.

WITHDRAWN: The prevalence of HIV among MSM in China: a large-scale systematic review and meta-analysis

// Meng-Jie Dong 1 , Bin Peng 2 , Zhen-Feng Liu 1 , Cai-Qin Wang 3 , Hao Liu 1 , Xi-Li Lu 1 , Bo Zhang 1 , Yangjun Zhu 1 and Jia-Jia Chen 4 1 The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China 2 Department of Medical Statistics, Chongqing Medical University, Chongqing, People's Republic of China 3 Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education Women&rsquo;s Reproductive Health Key Laboratory of Zhejiang Province, Hangzhou, People&rsquo;s Republic of China 4 Infectious Disease Department, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China Correspondence to: Meng-Jie Dong, email: dmjlzf2016@zju.edu.cn Keywords: prevalence; MSM; HIV; meta-analysis; China Received: November 22, 2017&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Accepted: January 03, 2018&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Published: January 09, 2018 ABSTRACT The prevalence of HIV among men who have sex with men (MSM) has become a major public health challenge in China. However, our understanding of the nationwide epidemiology is far from complete. We performed a large-scale systematic review and meta-analysis to comprehensively evaluate HIV epidemiology among MSM in China based on studies published up to March 2016. In total, 325 studies met our eligibility criteria. The results showed that the overall national prevalence of HIV among MSM was 6.32% (95% CI: 6.05&ndash;6.60%) and that the HIV prevalence dramatically increased over the past 14 years from 1.31% to 11.44%, with the highest HIV prevalence in those aged 50 years and older (19.31%). HIV prevalence was greater in the illiterate population (16.76%) than those who had received an education. MSM who sought partners at bathhouses/saunas had the highest associated prevalence of HIV (14.58%). Additionally, an extraordinarily high HIV prevalence of MSM was found in the southwest compared to other regions. Finally, participants who had never used a condom during the past 6 months had an increased risk of HIV infection. Our analysis provides valuable information for HIV prevention among MSM in China.

Surveillance for HIV infection in MSM selected through respondent driven sampling in Beijing, 2005-2012

Objective: To understand the HIV prevalence among men who have sex with men (MSM) and discuss the feasibility of respondent driven sampling (RDS) as a tool to conduct long term HIV surveillance in MSM in Beijing. Methods: From 2005 to 2012 RDS was used to recruit MSM for face-to-face interview with structured questionnaire to collect their demographic characteristics and HIV risk-related behavior. Blood samples were collected from them for HIV test. Results: A total of 427, 540, 607, 614, 616, 602, 579 and 600 MSM were surveyed, respectively, from 2005 to 2012. The HIV infection prevalence increased from 4.2%(95%CI: 1.9-7.0) in 2005 to 10.1% (95%CI: 7.2-13.2) in 2012 (P=0.02). Meanwhile, HIV prevalence substantially increased among MSM aged >25 years, in floating population and with lower education level (≤high school), from 6.4%(95%CI: 2.2-9.5), 3.3%(95%CI: 1.8-5.4) and 5.5% (95%CI: 2.2-8.9) in 2005 to 7.6% (95%CI: 5.4-10.3, P=0.04), 10.7% (95% CI: 7.8-14.6, P=0.04) and 10.4% (95% CI:7.2-14.3, P=0.04) in 2012, respectively. Moreover, the HIV infection prevalence in MSM aged ≤25 years old and with higher education level (>high school) increased from 1.7%(95%CI: 0.4-3.1) in 2009 and 1.1%(95%CI: 0.2-1.7) in 2007 to 13.7%(95%CI: 7.2-20.4) and 9.1%(95%CI: 4.7-13.8) in 2012, respectively, the differences were not significant. Furthermore, the HIV infection prevalence in MSM who had 2-9 male sex partners in the last six months increased from 4.0% (95% CI: 1.0-8.0) in 2005 to 12.6% (95% CI: 8.7-16.7) in 2012 (P=0.02). Conclusions: Studies have shown that RDS is an effective and feasible sampling method for long term HIV surveillance in MSM. The HIV infection prevalence in MSM in Beijing increased from 2005 to 2012, especially among those with older age, in floating population and with lower educational level. More attention should be paid to MSM with younger age and with higher educational level.

Consistently high HIV prevalence among men who have sex with men in Chengdu city from 2009 to 2014.

To describe the trends of the HIV epidemic among men who have sex with men (MSM) in Chengdu city, China, consecutive cross-sectional surveys were conducted by the Chengdu Center for Disease Control and Prevention. These surveys were carried out between 2009 and 2014 according to the protocol of the national HIV Sentinel Surveillance System. For the 2422 MSM who participated in the survey, the overall HIV prevalence was 15.5% (375/2422, 95% CI 14.0-16.9%). Between 2009 and 2014, the HIV prevalence of MSM remained high, with HIV-positivity rates of 15.0%, 15.1%, 16.3%, 13.9%, 17.8% and 14.0% each year respectively (χ2 for trend = 0.008, P = 0.931). However, the majority (89.8%) of participants had had anal sex in the six months prior to the interview, and the percentage always using condoms during anal sex increased over the study period (36.7% in 2009, 39.8% in 2010, 36.9% in 2011, 46.2% in 2012, 65.1% in 2013, 49.0% in 2014; Chi-square for trend = 49.883, P < 0.001). HIV prevalence among MSM in Chengdu city has remained high. Given the continuing high levels of unprotected anal intercourse and high HIV prevalence among MSM, more effective intervention strategies are required to increase the coverage of MSM by risk-reduction interventions and to promote HIV testing among this population.