Rates Of Unprotected Anal Intercourse Research Articles

High rates of unprotected anal sex and use of generic direct-acting antivirals in a cohort of MSM with acute HCV infection.

The role of condomless anal intercourse (CAI) as a driver for the epidemic of hepatitis C in MSM is still debated. Timely access to direct-acting antivirals (DAA) could represent an essential strategy to tackle this. Case notes of MSM diagnosed with acute hepatitis C (AHC) between July 2016 and June 2017 in a sexual health clinic in London were included. Behavioural data on sexual practices and STI monitoring in the 6months prior to AHC diagnosis were collected. DAA routes of access and timing from AHC diagnosis to start of treatment were analysed. A total of 60 individuals were enrolled (median age 39years, IQR=33-46, 62% HIV co-infected, 72% genotype 1a). CAI was reported by 97%, drug use prior to or during sex by 73%; 46% was diagnosed with a rectal STI and 29% with syphilis. About 37% did not report any HCV risk factors other than condomless anal sex. About 36% had a new rectal STI in the 6months following AHC. About 82% accessed DAA treatment and median time from AHC to DAA start was 278days for those following the NHS standard of care route, 132days for those accessing DAA via participation in trials and 114 for those who had self-sourced DAA online (P<0.0011). SVR12 was achieved in 100% of the patients who received DAA treatment.In conclusion, CAI is a significant risk factor for HCV acquisition in MSM, irrespective of their HIV status. Rapid and wider access to treatment with DAA could represent a powerful strategy to reduce onward transmission and risk of reinfection in MSM.

A randomised controlled trial to evaluate the impact of sexual health clinic based automated text message reminders on testing of HIV and other sexually transmitted infections in men who have sex with men in China: protocol for the T2T Study

IntroductionThe frequency of screening for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) is still low in China.Methods and analysisA sexual health clinic...

Sexual identity and behavior in an online sample of Indian men who have sex with men

ABSTRACTIndian men who have sex with men are disproportionately impacted by HIV. While prevention efforts to date have focused on men who visit drop-in centers or physical cruising sites, little is known about men who are meeting sexual partners on virtual platforms. This paper explores issues related to sexual identity and sexual behaviors in an online sample of men who identified as gay (n = 279) or bisexual (n = 123). There were significant differences in outedness between the two groups, with 48% of bisexually identified men reporting that they were out to “no one” and 82% stating that they present themselves as heterosexual to family and friends. Corresponding rates for gay-identified men were 15% and 41%, respectively (both p < .001). Twenty-nine percent of bisexually identified men reported being married, compared to only 3% of the gay-identified men (p < .001). Bisexually identified men were also more likely to report having exclusively insertive anal sex (49% vs 30% p < .001), while gay-identified men were more likely to report exclusively receptive anal sex (41% vs 13% p < .0001). Rates of unprotected anal sex (UAS) in the two groups were similar; however, married men were significantly more likely to report unprotected vaginal sex (76% vs 35%, p < .012). Positive attitudes toward UAS and lower self-efficacy were associated with sexual risk in both groups; however, substance use was associated with sexual risk only among bisexually identified men. These findings show that a large proportion of Indian bisexually identified men lead closeted lives, especially in their interactions with friends and family, with the vast majority presenting as heterosexual. The lower condom use with wives may be due to societal pressures to have children. The results suggest that bisexually identified men may benefit from targeted programs and non-directive, non-judgmental individual or couples counseling which emphasizes condom use with both male and female partners.

O19.5 Does treatment as prevention jeopardise condom use amongst gay men? an analysis of gay men’s attitudes in nsw over two years

<h3>Introduction</h3> Ending HIV (EH) is the first large scale campaign to embody the NSW HIV Strategy, leveraging the treatment as prevention approach (TasP) in order to mobilise gay men to end HIV transmission by 2020. Since the inception of the campaign, ACON has been monitoring gay men’s knowledge and attitudes on HIV prevention in the context of TasP. One of the objectives was to assess whether condom use could be affected by an increased awareness about TasP. <h3>Methods</h3> Across five online evaluation surveys run by an independent consultant after each phase of the EH campaign, responses of gay men to seven statements have been tracked over two years. These statements covered testing and treatment and one was specific about the importance of condoms: ‘Condoms continue to be the most effective way of preventing HIV transmission.’ Each online evaluation recruited more than 500 gay men living in NSW. All samples were consistent across the four surveys in terms of age groups, HIV status and locations. <h3>Results</h3> While all respondents demonstrate significant positive shifts in knowledge, intent and attitudes towards testing and treatment, an overwhelmingly majority of survey respondents (across all ages, HIV statuses and locations) continue to strongly agree or agree that condoms remain the most effective way of preventing HIV transmission. This is confirmed by the 2014 Sydney Gay Community Periodic Survey, which shows that the rate of unprotected anal intercourse has been relatively stable between 2010 and 2014. <h3>Conclusion</h3> TasP has been widely discussed among HIV scientists, clinicians and the community sectors for several years. Many have expressed their concern that promoting TasP could jeopardise condom use. The EH campaign evaluation over two years demonstrates that TasP and condom reinforcement can go together, even if gay men now understand the preventative benefits of treatment.

Combination HIV prevention among MSM in South Africa: results from agent-based modeling.

HIV prevention trials have demonstrated the effectiveness of a number of behavioral and biomedical interventions. HIV prevention packages are combinations of interventions and offer potential to significantly increase the effectiveness of any single intervention. Estimates of the effectiveness of prevention packages are important for guiding the development of prevention strategies and for characterizing effect sizes before embarking on large scale trials. Unfortunately, most research to date has focused on testing single interventions rather than HIV prevention packages. Here we report the results from agent-based modeling of the effectiveness of HIV prevention packages for men who have sex with men (MSM) in South Africa. We consider packages consisting of four components: antiretroviral therapy for HIV infected persons with CD4 count <350; PrEP for high risk uninfected persons; behavioral interventions to reduce rates of unprotected anal intercourse (UAI); and campaigns to increase HIV testing. We considered 163 HIV prevention packages corresponding to different intensity levels of the four components. We performed 2252 simulation runs of our agent-based model to evaluate those packages. We found that a four component package consisting of a 15% reduction in the rate of UAI, 50% PrEP coverage of high risk uninfected persons, 50% reduction in persons who never test for HIV, and 50% ART coverage over and above persons already receiving ART at baseline, could prevent 33.9% of infections over 5 years (95% confidence interval, 31.5, 36.3). The package components with the largest incremental prevention effects were UAI reduction and PrEP coverage. The impact of increased HIV testing was magnified in the presence of PrEP. We find that HIV prevention packages that include both behavioral and biomedical components can in combination prevent significant numbers of infections with levels of coverage, acceptance and adherence that are potentially achievable among MSM in South Africa.

Tensions Between the Epidemiology and Psychology of HIV Risk: Implications for Pre-exposure Prophylaxis

This study focuses on psychological differences in risk-taking patterns and their association with risk compensation motivations in the context of pre-exposure prophylaxis (PrEP). Participants were 257 HIV-negative MSM and transgender women recruited in New York City. The majority of participants (89.5%, n=230), could be classified as either: Intimates (40%), who report unprotected anal intercourse (UAI) only with a main partner believed to be HIV-negative; Trusters (34%), who engaged in UAI only with casual partners believed to be HIV-negative; and Gamblers (26%) who report UAI with partners of unknown serostatus. Partner-based classifications were better predictors of HIV risk perception and other traditional correlates of risk-taking (e.g. impulsivity, sexual compulsivity) than rates of UAI. The three groups differed significantly in PrEP-related risk compensation motivations: sexual pleasure (Gamblers), intimacy (Trusters) and partner pressure (Intimates). These data underscore the importance of focusing the psychological dynamics of risk perception and sexual decision-making.

An Episodic Analysis of Substance Use and Risky Sexual Behavior in a Racially Diverse Sample of Young Men Who Have Sex with Men

Many studies have examined the relations between drug use and sexual behaviors; however, few have utilized episodic data to examine the co-occurrence of both behaviors within the same episode. This study surveyed 403 racially and ethnically diverse gay, bisexual, and other young men who have sex with men (YMSM; ages 18–29) in New York City. Men were surveyed about their sexual behavior and concurrent use of illicit substances and alcohol during their most recent sexual encounter with their main and/or casual partner(s). Logistic regression models were built to analyze predictors of unprotected oral and anal intercourse with main and casual partners. Results suggest that use of inhalant nitrates and alcohol increased the odds of men engaging in unprotected receptive anal intercourse (URAI) and men who identified as middle or high socioeconomic status (SES) were at lower odds of engaging in URAI with their main partner. Use of other illicit substances was not associated with unprotected sexual intercourse. These findings indicate a need to further consider the role of licit substances used by YMSM as a means of further reducing the incidence of HIV infection in this population. In addition, the high rates of unprotected anal intercourse among men reporting a main partner has the potential to be a significant source of HIV risk, and should be further explored among YMSM.

Early Male Partnership Patterns, Social Support, and Sexual Risk Behavior Among Young Men Who Have Sex with Men

Few data exist on the early sexual behavior patterns of contemporary young men who have sex with men (YMSM), the social context of these patterns, and which of these factors influence risk for HIV and other sexually transmitted infections (STI). We enrolled 94 YMSM (age 16-30) into a 1-year cohort study with serial online retrospective surveys and HIV/STI testing. The first three partnerships of YMSM were characterized by relatively high rates of unprotected anal sex and a rapidly expanding sexual repertoire, but also increasing rates of HIV status disclosure. During follow-up, 17 % of YMSM reported any nonconcordant unprotected anal intercourse (NCUAI) and 15 % were newly diagnosed with HIV/STI. Sex education in high school and current maternal support were protective against HIV/STI, while isolation from family and friends was associated with recent NCUAI. Social support-including from parents, peers, and school-based sex education-may help mitigate HIV/STI risk in this population.

Risks for HIV and other sexually transmitted infections among Asian men who have sex with men in Vancouver, British Columbia: a cross-sectional survey.

BackgroundIndividuals of Asian heritage represent the largest ethnic minority in Canada. Approximately 10% of the new HIV diagnoses in men in British Columbia occur among Asian-Canadians. However, the HIV risk patterns of Asian men who have sex with men (MSM) have not been extensively studied.MethodsParticipants aged ≥ 19 years were enrolled in a venue-based HIV serobehavioural survey of MSM in Vancouver, Canada. We compared the demographic characteristics, risk behaviours, and prevalence of HIV and other sexual and blood borne infections between Asian and non-Asian MSM using bivariate analysis and logistic regression confounder modelling.ResultsAmongst 1132 participants, 110 (9.7%) self-identified as Asian. Asian participants were younger than non-Asian participants (median age 29 vs. 32 years; p < 0.001), but otherwise did not differ from other study participants. HIV prevalence was lower among Asian MSM compared to Non-Asian MSM (3.7% vs 19.0%, p <0.001). Among men who self-reported as HIV negative or unknown we found no differences in unprotected anal intercourse (UAI) with a discordant or unknown serostatus partner in the previous six months (11 vs. 13%; p = 0.503). However, Asian MSM were less likely to report ever using injection drugs (10.8% vs. 19.2%; p = 0.043) or using alcohol before having sex (52% vs. 64.4%; p = 0.017).ConclusionsAsian MSM in our study reported similar rates of UAI as non-Asian MSM, but had a lower prevalence of HIV infection. Other factors, such as the use of drugs and alcohol, in relation to sex, may partly explain these differences. However this requires further investigation.

High rates of unprotected anal intercourse with regular and casual partners and associated risk factors in a sample of ethnic Malay men who have sex with men (MSM) in Penang, Malaysia

ObjectiveTo assess the prevalence of unprotected anal intercourse (UAI) and its correlates among ethnic Malay men who have sex with men (MSM).MethodsIn 2010, a convenience sample of 350 MSM in...

Prevalence of HIV/STIs and Associated Factors Among Men Who Have Sex With Men in An Giang, Vietnam

The prevalence of HIV and sexually transmitted infections among men who have sex with men (MSM) has increased substantially in Vietnam. This study aimed to estimate the prevalence of HIV, syphilis, urethral gonorrhoea, and urethral chlamydia, and determined correlates of HIV infection among MSM in An Giang, Vietnam. A group of 381 MSM were recruited in a community-based cross-sectional survey between August and December 2009. Face-to-face interviews were conducted for collecting data on sociodemographics, behaviors, and access to HIV prevention programs. Serological tests for HIV and syphilis and polymerase chain reaction for gonorrhoea/chlamydia were performed. Multivariate regression analyses were used to investigate the correlates of HIV infection. The prevalence of HIV, syphilis, gonorrhoea, chlamydia, and gonorrhoea/chlamydia were 6.3%, 1.3%, 1.8%, 3.2%, and 4.7%, respectively. HIV prevalence among 63 injecting MSM was significantly higher than that of 318 noninjectors (20.6% vs. 3.5%, P < 0.001). Approximately 40.4% identified as heterosexual and 42.8% had ever had sex with females. The rate of unprotected anal intercourse with another male in the last month was substantially high (75.3%). Injecting drugs (adjusted prevalence ratio [aPR] = 2.88, 95% confidence interval [CI]: 1.12-7.42), being transgender (aPR = 4.27, 95% CI, 1.17-15.57), and unprotected sex with a female sex worker (aPR = 4.88, 95% CI: 1.91-12.50) were significantly associated with HIV infection. The infection risk increased with age to a peak of 25 years and then decreased. Although prevalence levels are lower in An Giang, Vietnam than in some other comparable locations, HIV/sexually transmitted infections prevention, and sexual health promotion targeting MSM are highly important in this location.

Contextual Correlates of Per Partner Unprotected Anal Intercourse Rates Among MSM in Soweto, South Africa

Men who have sex with men (MSM) throughout the world are at high-risk of HIV acquisition and transmission. Although individual behavior remains a central feature of HIV prevention efforts in sub-Saharan Africa and beyond, contextual factors likely influence behavioral risk. We identify contextual factors at the individual, dyadic (within the partnership), and extra-dyadic (relationships external to the focal dyad) levels that are associated with increased rates of unprotected anal intercourse with a given male partner among MSM in Soweto, South Africa. Drawing on data from The Soweto Men's Study, multilevel models were applied to 758 partnerships nested within 377 MSM respondents. Independent of overall sexual engagement, dyadic (e.g. description of partner as 'regular'), psychosocial (e.g. experiences of homonegativity), and sociocultural (e.g. income) contextual factors were significant predictors of differential 6-month rates of UAI with a given partner. By contrast, sexual partnerships outside of the focal sexual pair were not significantly related to UAI rates within the focal pair. Our findings support the need for continuing to understand and intervene on partner-level, psychosocial, and sociocultural dimensions of sexual behavior and sexual risk among MSM in Soweto.

Increasing sexual risk behaviour among Dutch men who have sex with men

Changes in risk behaviour among men who have sex with men (MSM) in the Netherlands were estimated by fitting a mathematical model to annual HIV and AIDS diagnoses in the period 1980-2009 and, independently, from rates of unprotected anal intercourse in a prospective cohort study in Amsterdam. The agreement between the two approaches was very good, confirming that in terms of incidence, increasing risk behaviour between MSM is offsetting benefits offered by enhanced testing and treatment.

Sexual Transmission Behaviors and Serodiscordant Partnerships Among HIV-Positive Men Who Have Sex With Men in Asia

We described sexual transmission behaviors and serodiscordant partnerships among an online sample of HIV-positive men who have sex with men (N = 416) in Asia. High rates of unprotected anal intercourse (74.8%), serodiscordant partnerships (68.5%), and unprotected sex within serodiscordant partnerships (∼60.0%) were reported. Increased number of partners, meeting partners on the Internet, drug use before sex, and not knowing one's viral load were associated with unprotected anal intercourse. Efforts to develop and scale up biomedical and behavioral interventions for HIV-positive men who have sex with men in Asia are needed.

The prevalence of HIV infection and sexual behaviors among men who have sex with men and women in Chengdu and Guangzhou, China

To understand the status of HIV infection and sexual behaviors with men and women among men who have sex with men and women (MSMW) and documented for HIV epidemic among men who have sex with men to the general population. 300 participants were recruited by using "snowballing" sampling in Chengdu and Guangzhou, respectively. Participants completed the questionnaire and HIV test. The questionnaire included social demographic characteristics, number of male sexual partners, sexual behaviors and condom use in the past 6 months. Relations with female sexual partners, vaginal intercourse and condom use in the past 12 months were also studied. Of the 600 participants, the overall prevalence of HIV infection was 26.2% and the detection rate of HIV-positives in this survey was 8.5%. In the past 6 months 28.0% of the participants had 5 or more male sexual partners and the percentage of MSMW who had used condoms consistently during anal sex intercourse with men, was 44.2%. Of the participants, 52.3% had used condoms in the last three anal sex events and 63.0% in the last event. In the past 12 months, 86.0% of the participants who had vaginal sex with female partners and the proportions of MSMW who had wife, girlfriend, lover, female casual partner and female commercial partner were 65.0%, 27.2%, 1.5%, 12.7%, 4.5%, respectively. About a third of the MSMW had always used condoms when having vaginal sex in the past 12 month. In the last three vaginal sex events, the proportion of participants who had never used condoms was 36.5%. In the past 6 months, 55.7% of the MSMWs had used condoms consistently during anal sex with men in Chengdu, which was higher than those MSMW in Guangzhou (32.7%). In the past 12 months, the proportion of MSMW who had used condoms consistently during vaginal sex was 38.3%, which was higher than MSMW of Guangzhou (25.3%). Among those HIV-positive MSMWs, 91.1% had anal sex with men in the past 6 months and 49.7% HIV-positive MSMW had used condoms consistently during anal sex with men. The number of HIV-positive MSMW who had used condoms in the last or last three anal sex events with men, accounted for 60.5% and 69.4%, respectively. In the past 12 months, 82.8% of the HIV-positive participants had vaginal sex with women. Of the HIV-positive participants, 42.0% used condoms consistently and the percentage of HIV-positive MSMWs who used condom during last three vaginal sexes was 47.8%. In the past 6 months, the percentage (4.3%) of MSMW who were HIV-positive prior to the survey and never used condoms during anal sex with men was lower than the percentage (22.0%) of MSMW who were HIV-positive found in this survey. In the past 12 months 12.9% of the MSMW who were HIV positive prior to the survey never used condoms when having vaginal sex event, which was lower than MSMW (46.3%) who were HIV positive in this survey. The prevalence of HIV infection had reached a quite high level and with high rates of unprotected anal sex with men and vaginal sex with women among MSMWs, indicating that the inherent bridging aspect of MSMW might accelerate the spreading of HIV infection to the general population.

Sexual Behavior and HIV Testing Among Bisexual Men: A Nationwide Comparison of Australian Bisexual-Identifying and Gay-Identifying Men

Men who have sex with men (MSM) are typically studied as though they were a homogeneous population. This has resulted in a lack of knowledge about the sexual health and behavior of bisexual men as distinct from gay men. In this study, patterns of sexual behavior and rates of HIV testing were compared between 854 gay-identifying and 164 bisexual-identifying men who participated in an Australian nationwide online survey. Approximately half of both groups engaged in unprotected anal intercourse (UAI) at their most recent sexual encounter, but bisexual-identifying men were more likely to have had sex with a partner who was either serodiscordant or with whom their seroconcordance was unknown. Despite these patterns, only 62% of bisexual-identifying men had ever been tested for HIV compared to 84% of gay-identifying men. Multivariate logistic regression focused on rates of UAI and HIV testing among bisexual-identifying men. Patterns were similar across all age groups and educational backgrounds. However, bisexual-identifying men were less likely to engage in UAI with a casual partner and were more likely to have been tested for HIV if they had multiple partners or had disclosed their sexual orientation to their social networks. In all, these data reveal important differences between gay- and bisexual-identifying men, particularly with regard to HIV testing, and highlight a need for HIV prevention strategies to focus more strategically on finding ways of promoting safer sex and HIV testing among all MSM.

Increasing prevalence of HIV and syphilis but decreasing rate of self-reported unprotected anal intercourse among men who had sex with men in Harbin, China: results of five consecutive surveys from 2006 to 2010

To monitor the prevalence of HIV and syphilis as well as behaviours, a sentinel site for men who have sex with men was established in Harbin in 2002. With additional funding, the sentinel surveillance evolved into annual cross-sectional surveys since 2006. Behavioural and serological data collected in five consecutive cross-sectional surveys were analysed. SPSS 13.0 was applied to compare prevalence of HIV and syphilis as well as behavioural variables over time by demographic variables, bivariate and multivariate analysis. The prevalence of HIV and syphilis increased from 1.0% in 2006 to 7.5% in 2010 and from 9.2% in 2006 to 22.4% in 2009, respectively, whereas the rate of unprotected anal intercourse decreased from 61.3% in 2006 to 47.1% in 2010. Syphilis positivity and HIV infection are independently associated with each other across years. The rate of unprotected anal sex remains high although it has decreased over the years. Findings support an increasing prevalence of HIV and syphilis among men who have sex with men in Harbin. Targeted behavioural intervention and syphilis treatment are urgently needed to prevent the epidemic from growing.

Heterosexual anal intercourse and HIV infection risks in the context of alcohol serving venues, Cape Town, South Africa

BackgroundThe most efficient sexual behavior for HIV transmission is unprotected receptive anal intercourse. However, it is unclear what role heterosexual unprotected anal sex is playing in the world's worst HIV epidemics of southern Africa. The objective is to examine the prevalence of heterosexual unprotected anal intercourse among men and women who drink at informal alcohol serving establishments (shebeens) in South Africa.MethodsCross-sectional surveys were collected from a convenience sample of 5037 patrons of 10 shebeens in a peri-urban township of Cape Town, South Africa. Analyses concentrated on establishing the rates of unprotected anal intercourse practiced by men and women as well as the factors associated with practicing anal intercourse.ResultsWe found that 15% of men and 11% of women reported anal intercourse in the previous month, with 8% of men and 7% of women practicing any unprotected anal intercourse. Multiple logistic regression showed that younger age, having primary and casual sex partners, and meeting sex partners at shebeens were independently associated with engaging in anal intercourse. Mathematical modeling showed that individual risks are significantly impacted by anal intercourse but probably not to the degree needed to drive a generalized HIV epidemic.ConclusionsAnal intercourse likely plays a significant role in HIV infections among a small minority of South Africans who patronize alcohol serving establishments. Heterosexual anal intercourse, the most risky sexual behavior for HIV transmission, should not be ignored in HIV prevention for South African heterosexuals. However, this relatively infrequent behavior should not become the focus of prevention efforts.

HIV Risk and Perceptions of Masculinity Among Young Black Men Who Have Sex With Men

Young black men who have sex with men (YBMSM) are known to have the highest rates of HIV infection in the United States. Although reported rates of unprotected anal intercourse are similar to the rates of men who have sex with men of other racial/ethnic backgrounds, YBMSM aged 15-22 years are five times more likely to be HIV-infected than the comparably aged white men who have sex with men. We explored contextual social-environmental factors that may influence how YBMSM assess risk, choose partners, and make decisions about condom use. We analyzed semi-structured interviews with 35 YBMSM (age: 18-24 years) in New York City, Upstate New York, and Atlanta. We used structured analytic coding based on a theoretical scheme that emerged from the data. Perception of masculinity was the primary contextual factor influencing partner selection, risk assessment, and decision-making with regard to condom usage. Four primary themes emerged: (1) greater preference for partners perceived as masculine; (2) discomfort with allowing men perceived as feminine to be the insertive partner in anal intercourse; (3) a power dynamic such that partners perceived as more masculine made condom-use decisions within the dyad; and (4) use of potential partners' perceived masculinity to assess HIV risk. Perceived masculinity may play a significant role in HIV risk for YBMSM and may be an important concept to consider in prevention strategies directed toward this population.

Results from Two Online Surveys Comparing Sexual Risk Behaviors in Hispanic, Black, and White Men Who Have Sex with Men

Many men who have sex with men (MSM) are among those who increasingly use the internet to find sexual partners. Few studies have compared behavior by race/ethnicity in internet-based samples of MSM. We examined the association of race/ethnicity with HIV risk-related behavior among 10,979 Hispanic, black, and white MSM recruited online. Significant variations by race/ethnicity were found in: age, income level, sexual orientation, number of lifetime male and female sexual partners, and rates of unprotected anal intercourse (UAI). Black and Hispanic men were more likely to report anal intercourse during the last sexual encounter, but white men were more likely to report UAI. In multivariate analysis, UAI was associated with HIV infection and sex with a main partner. Significant risk behavior variations by race/ethnicity were found. Research is needed to better target online interventions to MSM who engage in UAI or have other risk factors for transmitting or acquiring HIV.