Respondent-driven Sampling Survey Research Articles

Social and structural drivers of HIV vulnerability among a respondent-driven sample of feminine and non-feminine presenting transgender women who have sex with men in Zimbabwe.

We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore differences in vulnerability by feminine presentation. A secondary analysis was conducted with a sub-sample of participants recruited from a 2019 respondent-driven sampling survey that comprised men who have sex with men, TGW and genderqueer individuals assigned male sex at birth, from two cities in Zimbabwe. Survey questionnaires captured information related to socio-demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi-square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation. Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20-26). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non-injection drug use (38.3% vs. 20.2%) than non-feminine presenting TGW (all p-value <0.05). Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. Interventions aimed at addressing inequities, including trans competency training for providers and gender-affirming, psychosocial and legal support services for TGW, might mitigate risk.

Association between in-country migration and HIV infection among transgender women from northeastern Brazil: a respondent-driven sampling survey

BackgroundMigration is common among transgender women (TGW), often driven by the desire to escape stigma, find acceptance, establish new connections, access body modifications, or enter new avenues of sex work. Given the heightened mobility of TGW, they are mostly vulnerable to human immunodeficiency virus (HIV) due to migration. This study aimed to evaluate the association between in-country migration and HIV infection among TGW in Northeast Brazil.MethodsThe DIVAS was a cross-sectional, multicity study investigating risk behaviors and sexually transmitted infections (STI) among TGW in 2016–2017. A total of 864 TGW were recruited through respondent-driven sampling from three capital cities in Northeast Brazil. Logistic regression estimating odds ratios (OR) and 95% confidence intervals (CI) was used to assess the relationship between in-country migration and HIV infection.ResultsThe prevalence of HIV among TGW was 24.5%, 21.4% among those aged 18–34 and 36.1% among those ≥ 35 years old. In-country migration increased the odds of HIV infection among TGW aged 18–34 years (OR = 1.84; 95%CI:1.04–3.27) and even higher among those aged ≥ 35y old (OR = 3.08; 95%CI:1.18–8.04).ConclusionsThese data reinforce the pressing need for public health policies that provide comprehensive access and strategies for demand creation for HIV/AIDS prevention and care for TGW who are already highly vulnerable to infection.

High Interest in the Use of mHealth Platform for HIV Prevention among Men Who Have Sex with Men in Nepal.

Mobile technology growth in Nepal offers promising opportunities for using mobile health (mHealth) interventions to facilitate HIV prevention efforts. However, little is known about access and utilization of communication technology and their willingness to use mHealth for HIV prevention services in Nepal. We conducted a cross-sectional respondent-driven sampling survey of 250 MSM in Kathmandu Valley of Nepal from October to December 2022. We collected information on participant characteristics, HIV risk-related behaviors, ownership, or access to and frequency of use of communication technology (phones, tablets, laptops, and computers), and willingness to use mHealth to access HIV prevention services. Descriptive, bivariate, and multivariate linear regression analyses were performed. Almost all participants had smartphones with the internet (231/250, 92.4%) and accessed the internet daily (219/250, 87.6%) on the smartphone (236/250, 94.4%). The median score for willingness to use mHealth for HIV prevention was 10 (IQR: 3 to 17). Willingness to use mHealth was higher among those participants with a high school or above education (β = 0.223, p = < 0.001), had experienced violence (β = 0.231, p = 0.006), and had moderate to severe depressive symptoms (β = 0.223, p = < 0.001). However, monthly income above NPR 20,000 (USD 150) (β= -0.153, p = 0.008), disclosure of their sexual orientation to anyone (β= -0.159, p = < 0.007), and worry about being negatively judged by health care workers (β= -0.136, p = 0.023) were less willing to use mHealth strategies. The findings from this study suggest that there is a high willingness for utilizing mHealth interventions for HIV prevention in MSM population who are at higher risk of HIV acquisition.

Prevalence of internet addiction and anxiety, and factors associated with the high level of anxiety among adolescents in Hanoi, Vietnam during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic and the resulting isolation measures created an increase in the usage of smart devices and internet among adolescents. This study aims to estimate the prevalence of internet addiction, the prevalence of high level of anxiety as well as to examine factors associated with the high level of anxiety among adolescents in Hanoi, Vietnam during the COVID-19 pandemic.MethodData was collected using respondent-driven sampling and Google online survey forms from a sample of 5,325 school students aged 11–17 in Hanoi between October and December 2021. A short scale consisting of 5 items was used to measure internet addiction and the GAD-7 was used to measure adolescent anxiety level.ResultsThe findings revealed that 22.8% and 7.32% of adolescents experienced moderate and severe anxiety. About 32.7% of the study sample exhibited at least three internet addiction indicators. Logistic regression analysis identified significant predictors for high levels of adolescent anxiety. Being female, family experiencing economic difficulties, and exposure to domestic violence were associated with higher risk of anxiety disorder (OR 1.78, 1.45, and 2.89, respectively). Both average daily online time and internet addiction demonstrated gradient association with high level of anxiety.ConclusionThe prevalence of internet addiction and high level of anxiety were high among adolescents in Hanoi, Vietnam during the COVID-19 pandemic. The study highlights the importance of implementing measures at the family and school levels to promote a balanced and healthy approach to smart device use among adolescents.

Estimating prevalence and modelling correlates of HIV test positivity among female sex workers, men who have sex with men, people who inject drugs, transgender people and prison inmates in Sierra Leone, 2021

Key populations (KPs) are particularly vulnerable to HIV infection and efforts to prevent HIV infections among KPs have been less successful, largely due to existing laws and legislation that classify the groups as illegal. Understanding the HIV infection pathway and the burden of HIV infection among Female Sex Workers (FSWs), Transgender people (TG), Men who have sex with Men (MSM), People who Inject Drugs (PWID), and Prison Inmates (PIs) is critical to combatting the HIV epidemic globally. This study aims to estimate HIV prevalence and model the risk factors of HIV positivity rate among the aforementioned KPs in Sierra Leone. This study used Time Location Sampling, Respondent Driven Sampling (RDS), and Conventional cluster Sampling designs to generate a representative sample of FSWs, MSM, TG, PI, and PWID. HIV prevalence and the corresponding 95% confidence intervals among each KP were estimated by adjusting for sampling weight using the logit-transformed confidence intervals. To determine correlates of HIV test positivity among KPs, a multivariable modified Poisson regression model that adjusts for RDS survey weights was used and sensitivity analysis was conducted using a multivariable logistic regression model with cluster robust standard errors. The prevalence of HIV among FSWs in the six regional headquarter towns was estimated to be 11.8% (95% CI: 7.9–17.1); MSM was 3.4% [95% CI: 1.9–5.8]; TGs was 4.2% (95% CI: 2.9–6.1); PWIDs was 4.2% (95% CI: 2.7–6.4) and PI was 3.7% (95% CI: 1.4–9.6). The correlates of HIV test positivity among KPs and PIs include HIV-related knowledge, marital status, district, income, age and sex of KP, level of education, alcohol intake, injecting drugs, and use of lubricants. HIV prevalence is relatively high among FSWs, MSMs, PWID, and TGs as compared to the previous estimate of the general population. There is a need to scale up and strengthen evidence-based HIV prevention interventions such Pre-Exposure Prophylaxis and needle and syringe exchange programmes targeting KPs, including prison inmates. Government must scale up both non-clinical and clinical routine HIV and STI testing and counseling services at the correctional center and drop-in centers for KPs screening/testing, and ensure that services are responsive to the needs of KP.

HIV testing and its associated factors among female sex workers in Iran in 2020: Finding from a respondent-driven sampling survey.

HIV testing uptake was around 70% among female sex workers (FSWs) in Iran in 2015. Due to the recognized importance of HIV testing in prevention, care, and treatment among FSWs, this study aimed to provide an update and also an improvement as it uses respondent-driven sampling (RDS) for the frequency and the correlates of HIV testing among FSWs in Iran. A total of 1,515 FSWs were recruited from eight cities in Iran between 2019-2020 using RDS. Data were collected using face-to-face interviews. Also, rapid diagnostic tests (RDT) were used to determine HIV and syphilis status as per national guidelines. We used multivariable logistic regression to explore correlates of HIV testing in the last 12 months. Of 1,399 FSWs who had data for HIV testing, 44.7% (95% Confidence Intervals (CI): 40.7; 48.7) reported HIV testing in the last 12 months. The odds of HIV testing in the last 12 months was higher among FSWs who used a condom at last sex with a non-paying partner (Adjusted OR = 1.78; 95% CI: 1.39; 2.27), never used alcohol (Adjusted OR = 1.72; 95% CI: 1.33; 2.23), ever used drug (Adjusted OR = 1.60; 95% CI: 1.22; 2.08). HIV testing among FSWs in Iran is considerably low. It is necessary to know the barriers to HIV testing to improve the cascade of HIV treatment in the country.

A Web-Based, Respondent-Driven Sampling Survey Among Men Who Have Sex With Men (Kai Noi): Description of Methods and Characteristics.

Thailand's HIV epidemic is heavily concentrated among men who have sex with men (MSM), and surveillance efforts are mostly based on case surveillance and local biobehavioral surveys. We piloted Kai Noi, a web-based respondent-driven sampling (RDS) survey among MSM. We developed an application coded in PHP that facilitated all procedures and events typically used in an RDS office for use on the web, including e-coupon validation, eligibility screening, consent, interview, peer recruitment, e-coupon issuance, and compensation. All procedures were automated and e-coupon ID numbers were randomly generated. Participants' phone numbers were the principal means to detect and prevent duplicate enrollment. Sampling took place across Thailand; residents of Bangkok were also invited to attend 1 of 10 clinics for an HIV-related blood draw with additional compensation. Sampling took place from February to June 2022; seeds (21 at the start, 14 added later) were identified through banner ads, micromessaging, and in online chat rooms. Sampling reached all 6 regions and almost all provinces. Fraudulent (duplicate) enrollment using "borrowed" phone numbers was identified and led to the detection and invalidation of 318 survey records. A further 106 participants did not pass an attention filter question (asking recruits to select a specific categorical response) and were excluded from data analysis, leading to a final data set of 1643 valid participants. Only one record showed signs of straightlining (identical adjacent responses). None of the Bangkok respondents presented for a blood draw. We successfully developed an application to implement web-based RDS among MSM across Thailand. Measures to minimize, detect, and eliminate fraudulent survey enrollment are imperative in web-based surveys offering compensation. Efforts to improve biomarker uptake are needed to fully tap the potential of web-based sampling and data collection.

Estimating the Size of Clustered Hidden Populations

Abstract Successive sampling population size estimation (SS-PSE) is a method used by government agencies, aid organizations, and researchers around the world to estimate the size of hidden populations using data from respondent-driven sampling surveys. SS-PSE addresses a specific need in estimation, since many countries rely on having accurate size estimates to plan and allocate finite resources to address the needs of hidden populations. However, SS-PSE relies on several assumptions, one of which requires the underlying social network of the hidden population to be fully connected. We propose two modifications to SS-PSE for estimating the size of hidden populations whose underlying social network is composed of disjoint clusters. The first method is a theoretically straightforward extension of SS-PSE, but it relies on prior information that may be difficult to obtain in practice. The second method extends the Bayesian SS-PSE model by introducing a new set of parameters that allow for clustered estimation without requiring the additional prior information. After providing theoretical justification for both novel methods, we then assess their performance using simulations and apply the Clustered SS-PSE method to a population of internally displaced persons in Bamako, Mali.

HIV Testing and HIV Positivity Among People Who Inject Drugs (PWIDs) With and Without History of High-Risk Behaviors: Findings From a Respondent-Driven Sampling (RDS) Survey in Southern Thailand

People who inject drugs (PWIDs) may engage in other behaviors with high risk of HIV transmission to various extents. However, data are scarce regarding differences in HIV testing and HIV positivity among PWIDs with and without high-risk behaviors. Such data can help inform stakeholders with regard to program prioritization. The objective of this study was to assess the extent that lifetime and past-year histories of HIV tests and HIV positivity varied by history of high-risk behaviors among PWIDs. We conducted a cross-sectional study with respondent-driven sampling (RDS) in the deep south provinces of Thailand during late 2019 thru early 2020. Data collection was done using structured questionnaire with face-to-face interviews. We analyzed data using descriptive statistics and multivariate logistic regression analyses. A total of 283 PWIDs gave verbal informed consent, and 282 PWIDs participated in the interview ( n = 282 PWIDs). Approximately 44.6% of the participants never had an HIV test. Participants with history of high-risk behaviors had significantly higher odds of lifetime HIV testing than participants with no history of high-risk behaviors (Adjusted OR = 2.94; 95% CI [1.11, 7.78]). Among participants with lifetime history of HIV tests, those with history of high-risk behaviors had significantly higher odds of being HIV-positive than those with no history of high-risk behaviors (Adjusted OR = 2.44; 95% CI [0.73, 8.17]). Stakeholders should consider encouraging those without history of high-risk behaviors not to be complacent about HIV testing, and ensure that those with high-risk behaviors have full access to HIV care when they test positive.

Community-based respondent-driven sampling as a strategy for drug use surveillance in a large French urban area

BackgroundUnderstanding drug use and behavior within the PWUD population is crucial to adapt harm reduction and prevention strategies, and provide improved addiction and medical treatment. However, in most countries such as France, the knowledge of drug use behaviors is likely biased as it originates from addiction centers which are attended by only an unknown proportion of PWUD. The objectives of this study were to describe drug use behavior in a population of active PWUD in the urban area of Montpellier, South of France.MethodsWe implemented a community-based respondent-driven sampling survey (RDSS), a validated strategy to obtain a representative sample of a population, to recruit PWUD in the city. Adult individuals reporting frequent psychoactive drug use other than cannabis, with confirmation by urine test, were eligible. Beside HCV and HIV testing, trained peers interviewed participants on their drug consumption and behavior using standardized questionnaires. Fifteen seeds launched the RDSS.ResultsDuring the 11 weeks of the RDSS, 554 actives PWUD were consecutively included. They were mostly men (78.8%), had a median age of 39 years, and only 25.6% had a stable living place. On average, participants consumed 4.7 (± 3.1) different drugs, and 42.6% smoked free-base cocaine. Unexpectedly, heroin and methamphetamine were consumed by 46.8% and 21.5% of participants, respectively. Among the 194 participants injecting drugs, 33% declared sharing their equipment.ConclusionThis RDSS highlighted a high consumption of heroin, crack and methamphetamine in this PWUD population. These unexpected results can be explained by low attendance to addiction centers, the source of drug use reports. Despite free care and risk reduction equipment in the city, sharing was very frequent among injectors, challenging the current program of harm reduction.

Accumulation of Biological and Behavioral Data of Female Sex Workers Using Respondent-Driven Sampling: Protocol for a Systematic Review.

Respondent-driven sampling (RDS) is a nonprobability sampling technique that allows the extrapolation of its outcome to the target population. This approach is typically used to overcome the difficulties in studying hidden or difficult-to-reach groups. The purpose of this protocol is to generate a systematic review on the accumulation of biological and behavioral data of female sex workers (FSWs) through different surveys that use the RDS method from around the world in the near future. The future systematic review will discuss the initiation, actualization, and problems of RDS during the accumulation of biological and behavioral data of FSWs through surveys from around the world. The behavior and biological data of FSWs will be extracted from peer-reviewed studies published between 2010 and 2022 and that are acquired through RDS. Using PubMed, Google Scholar, the Cochrane database, Scopus, Science Direct, and the Global Health network, all papers that are available will be obtained using the search phrases "respondent-driven" and "Female Sex Workers" OR "FSW" OR "sex workers" OR "SW." According to STROBE-RDS (Strengthening the Reporting of Observational Studies in Epidemiology for Respondent-Driven Sampling) criteria, the data will be retrieved through a data extraction form and will be organized using World Health Organization classifications of areas. The Newcastle-Ottawa Quality Assessment Scale will be used to measure bias risk and overall study quality. The future systematic review that will be generated from this protocol will offer evidence for or against the claim that using the RDS technique to recruit participants from "hidden" or "hard-to-reach" populations is the best strategy. The results will be disseminated through a peer-reviewed publication. Data collection started on April 1, 2023, and the systematic review is expected to be published by December 15, 2023. A minimum set of parameters for specific methodological, analytical, and testing procedures, including RDS methods to evaluate the overall quality of any RDS survey, will be provided by the future systematic review, in accordance with this protocol, to assist researchers, policy makers, and service providers in improving RDS methods for the surveillance of any key population. PROSPERO CRD42022346470; https://tinyurl.com/54xe2s3k. DERR1-10.2196/43722.

A community-based strategy to eliminate hepatitis C among people who inject drugs in Vietnam

Towards hepatitis C elimination among people who inject drugs (PWID), we assessed the effectiveness of a strategy consisting of a community-based respondent-driven sampling (RDS) as wide screening, a simplified and integrated hospital-based care, and prevention of reinfection supported by community-based organisations (CBO), in Hai Phong, Vietnam. Adults who injected heroin were enrolled in a RDS survey implemented in two CBO premises. Rapid HIV and HCV tests were done on site, and blood was taken for HCV RNA testing. Those with detectable HCV RNA were referred with CBO support to three public hospitals for 12-week sofosbuvir/daclatasvir, plus ribavirin for patients with cirrhosis. Participants were followed-up 12 weeks post-treatment (SVR12) and 48 weeks after enrolment. The primary endpoint was the rate of undetectable HCV RNA participants at 48 weeks. Among the 1444 RDS survey participants, 875 had hepatitis C. Their median age was 41 years (IQR 36-47), 96% were males, 36% were HIV-coinfected. Overall, 686 (78.4%) started sofosbuvir/daclatasvirs, and 629 of the 647 (97.2%) patients tested at SVR12 were cured. At week 48 (581/608) 95.6% had undetectable HCV RNA, representing 66.4% of all PWID identified with hepatitis C. The reinfection rate after SVR12 was 4/100 person-years (95% CI: 2-7). Our strategy, involving CBO and addressing all steps from wide HCV screening to prevention of reinfection, stands as a promising approach to eliminate HCV among PWID in low and middle-income countries. France ANRS|MIE (#ANRS12380). The RDS survey was implemented with grants from the NIDA (#R01DA041978) and ANRS|MIE (#ANRS12353).

Population Size Estimation of Men Who Have Sex With Men in Rwanda: Three-Source Capture-Recapture Method.

Globally, men who have sex with men (MSM) continue to bear a disproportionately high burden of HIV infection. Rwanda experiences a mixed HIV epidemic, which is generalized in the adult population, with aspects of a concentrated epidemic among certain key populations at higher risk of HIV infection, including MSM. Limited data exist to estimate the population size of MSM at a national scale; hence, an important piece is missing in determining the denominators to use in estimates for policy makers, program managers, and planners to effectively monitor HIV epidemic control. The aims of this study were to provide the first national population size estimate (PSE) and geographic distribution of MSM in Rwanda. Between October and December 2021, a three-source capture-recapture method was used to estimate the MSM population size in Rwanda. Unique objects were distributed to MSM through their networks (first capture), who were then tagged according to MSM-friendly service provision (second capture), and a respondent-driven sampling survey was used as the third capture. Capture histories were aggregated in a 2k-1 contingency table, where k indicates the number of capture occasions and "1" and "0" indicate captured and not captured, respectively. Statistical analysis was performed in R (version 4.0.5) and the Bayesian nonparametric latent-class capture-recapture package was used to produce the final PSE with 95% credibility sets (CS). We sampled 2465, 1314, and 2211 MSM in capture one, two, and three, respectively. There were 721 recaptures between captures one and two, 415 recaptures between captures two and three, and 422 recaptures between captures one and three. There were 210 MSM captured in all three captures. The total estimated population size of MSM above 18 years old in Rwanda was 18,100 (95% CS 11,300-29,700), corresponding to 0.70% (95% CI 0.4%-1.1%) of total adult males. Most MSM reside in the city of Kigali (7842, 95% CS 4587-13,153), followed by the Western province (2469, 95% CS 1994-3518), Northern province (2375, 95% CS 842-4239), Eastern province (2287, 95% CS 1927-3014), and Southern province (2109, 95% CS 1681-3418). Our study provides, for the first time, a PSE of MSM aged 18 years or older in Rwanda. MSM are concentrated in the city of Kigali and are almost evenly distributed across the other 4 provinces. The national proportion estimate bounds of MSM out of the total adult males includes the World Health Organization's minimum recommended proportion (at least 1.0%) based on 2012 census population projections for 2021. These results will inform denominators to be used for estimating service coverage and fill existing information gaps to enable policy makers and planners to monitor the HIV epidemic among MSM nationally. There is an opportunity for conducting small-area MSM PSEs for subnational-level HIV treatment and prevention interventions.

Hidden population size estimation and diagnostics using two respondent-driven samples with applications in Armenia.

Estimating the size of hidden populations is essential to understand the magnitude of social and healthcare needs, risk behaviors, and disease burden. However, due to the hidden nature of these populations, they are difficult to survey, and there are no gold standard size estimation methods. Many different methods and variations exist, and diagnostic tools are needed to help researchers assess method-specific assumptions as well as compare between methods. Further, because many necessary mathematical assumptions are unrealistic for real survey implementation, assessment of how robust methods are to deviations from the stated assumptions is essential. We describe diagnostics and assess the performance of a new population size estimation method, capture-recapture with successive sampling population size estimation (CR-SS-PSE), which we apply to data from 3 years of studies from three cities and three hidden populations in Armenia. CR-SS-PSE relies on data from two sequential respondent-driven sampling surveys and extends the successive sampling population size estimation (SS-PSE) framework by using the number of individuals in the overlap between the two surveys and a model for the successive sampling process to estimate population size. We demonstrate that CR-SS-PSE is more robust to violations of successive sampling assumptions than SS-PSE. Further, we compare the CR-SS-PSE estimates to population size estimations using other common methods, including unique object and service multipliers, wisdom of the crowd, and two-source capture-recapture to illustrate volatility across estimationmethods.

HIV prevalence and associated risk factors among young tertiary student men who have sex with men (MSM) in Nairobi, Kenya: a respondent-driven sampling survey

BackgroundYoung men who have sex with men (MSM), are a key population at higher risk of HIV infection yet they are underrepresented in research. We conducted a bio-behavioral survey to estimate HIV prevalence and associated risk factors among tertiary student MSM (TSMSM) in Nairobi, Kenya.MethodsBetween February and March 2021, 248 TSMSM aged ≥ 18 years who reported sex with another man in the past year participated in a respondent-driven sampling (RDS) based cross-sectional survey. Participants completed an electronically self-administered behavioral survey and provided a blood sample for HIV antibody testing, alongside urine, anorectal and oropharyngeal swabs for pooled testing of sexually transmitted infections using a multiplex nucleic acid amplification test. RDS-Analyst v.0.72 and Stata v.15 software were used for data analysis. Differences in proportions were examined using chi-square (χ2) test, and unweighted multivariate logistic regression was used to assess factors associated with HIV infection.ResultsHIV prevalence among study participants was 8.3%, whereas the weighted prevalence was 3.6% (95% CI: 1.3–6.0%). Median ages of participants, and at self-reported first anal sex with a man were 21(interquartile range [IQR] 20-22) and 18 (IQR 17-19) years, respectively. A majority (89.3%) of TSMSM owned a smart phone, 46.5% had ever used a geosocial networking app for MSM such as Grindr ® to find a sex partner, and a third (33.6%) met their last sex partner online. Almost three-quarters (71.3%) had > 1 male sex partner in the year before the survey. A third (34.3%) did not use condoms with their last sex partner, 21.2% received money from their last sex partner and 40.9% had taken alcohol/another drug during their last sexual encounter. HIV infection was associated with studying in private institutions (adjusted odds ratio[AOR] = 6.0; 95% confidence intervals [CI] : 1.2–30.0, p = 0.027), preferring a sex partner of any age—younger, same or older (AOR = 5.2; 95 CI: 1.1–25.2, p = 0.041), last sex partner being > 25 years (AOR = 6.4; 95% CI: 1.2–34.6, p = 0.030), meeting the last sex partner online (AOR = 4.2; 95% CI; 1.1–17.0, p = 0.043) and testing positive for Neisseria gonorrhea (AOR = 7.8; 95% CI: 2.0–29.9, p = 0.003).ConclusionsHIV prevalence among TSMSM in Nairobi is alarmingly high, demonstrating a need for tailored prevention and control interventions for this young key population.

Associations between punitive policies and legal barriers to consensual same-sex sexual acts and HIV among gay men and other men who have sex with men in sub-Saharan Africa: a multicountry, respondent-driven sampling survey

Few assessments of associations between structural-level factors and HIV among gay men and other men who have sex with men (MSM) have been conducted, especially in sub-Saharan Africa. Our objective was to examine HIV testing history, HIV status, and stigmas among MSM living in ten countries with heterogeneous legal environments. This study used pooled data from ten country-specific, cross-sectional studies done in 25 sites in Burkina Faso, Cameroon, Côte d'Ivoire, The Gambia, Guinea-Bissau, Nigeria, Senegal, Eswatini, Rwanda, and Togo. MSM were recruited by respondent-driven sampling and were eligible if they met country-specific requirements for age, area of residence, and self reported being assigned male sex at birth and having anal sex with a man in the past 12 months. Policy related to same-sex sexual behaviour for each country was categorised as not criminalised or criminalised. Countries were also categorised on the basis of recent reports of prosecutions related to same-sex sexual acts. Legal barriers were defined as those that legally prevented registration or operation of sexual orientation related civil society organisations (CSOs). Individual data on HIV testing history, HIV status, and stigma were collected via interviewer-administered sociobehavioural questionnaires and HIV testing. Multilevel logistic regression with random intercepts was used to assess the association between policies, recent prosecutions, legal barriers to CSOs, and HIV-related factors with adjusted odds ratios (aORs) and 95% CIs. Between Aug 3, 2011, and May 27, 2020, we recruited 8047 MSM with a median age of 23 years (IQR 21-27). 4886 (60·7%) lived in countries that criminalise same-sex sexual acts. HIV prevalence among MSM was higher in criminalised settings than non-criminalised settings (aOR 5·15, 95% CI 1·12-23·57); higher in settings with recent prosecutions than in settings without prosecutions (12·06, 7·19-20·25); and higher in settings with barriers to CSOs than without barriers to CSOs (9·83, 2·00-48·30). HIV testing or status awareness was not associated with punitive policies or practices. Stigma was associated with HIV status but did not consistently vary across legal environments. Disparities in HIV prevalence between MSM and other adult men were highest in punitive settings. Structural risks including discriminatory country-level policies, prosecutions, and legal barriers might contribute to higher HIV prevalence among MSM. Taken together, these data highlight the importance of decriminalisation and decreasing enforcement, alongside stigma reduction, as central to effective control for HIV. National Institutes of Health. For the French translation of the abstract see Supplementary Materials section.

Prevalence of five curable sexually transmitted infections and associated risk factors among tertiary student men who have sex with men in Nairobi, Kenya: a respondent-driven sampling survey†.

Young men who have sex with men (MSM) are a key population at high risk of sexually transmitted infections (STIs). We conducted a respondent-driven sampling (RDS) bio-behavioural survey to estimate the prevalence of five curable STIs: chlamydia, gonorrhoea, syphilis, trichomoniasis and Mycoplasma genitalium infection, and associated risk factors among tertiary student MSM (TSMSM) in Nairobi, Kenya. Between February and March 2021, we recruited 248 TSMSM aged ≥18years who self-reported engaging in anal and/or oral sex with another man in the past year. Samples collected included urine, anorectal and oropharyngeal swabs for pooled Chlamydia trachomatis , Mycoplasma genitalium , Neisseria gonorrhoeae and Trichomonas vaginalis testing using multiplex nucleic acid amplification tests, and venous blood for serological Treponema pallidum screening and confirmation of current infection. Participants self-completed a behavioural survey on a REDCap digital platform. Data analysis was done using RDS-Analyst (v0.72) and Stata (v15). Differences in proportions were examined using the chi-squared (χ 2 ) test, and unweighted multivariate logistic regression was used to assess factors associated with STI prevalence. RDS-adjusted prevalence rates of at least one of the five STIs, chlamydia, gonorrhoea, Mycoplasma genitalium infection, trichomoniasis and latent syphilis were 58.8%, 51.0%, 11.3%, 6.0%, 1.5% and 0.7%, respectively. Factors independently associated with STI prevalence were inconsistent condom use (adjusted odds ratio (AOR)=1.89, 95% confidence interval (CI): 1.03-3.47, P =0.038) and the last sex partner being a regular partner (AOR=2.35, 95% CI: 1.12-4.92, P =0.023). STI prevalence among TSMSM in Nairobi, Kenya, is disturbingly high, demonstrating urgent need for tailored testing, treatment and prevention interventions for this population.

Optimizing Respondent-Driven Sampling Survey to Identify Factors Associated With HIV Risk Behaviors Among Student MSM Aged 15 to 19.

Male homosexual behavior dominates the mode of HIV infection among students in China. This study aims to identify factors associated with HIV risk behaviors among male students who have sex with men (student MSM) aged 15 to 19 in China. The online sampling used the standard respondent-driven sampling (RDS) method, with recruitment support from community-based organizations (CBOs) in Tianjin and Guangzhou. Multivariate logistic regression models were performed to identify factors associated with multiple HIV risk behaviors. A total of 449 subjects were recruited in this study, including 206 in Tianjin and 243 in Guangzhou. The presence of multiple HIV risk behaviors among student MSM, in many cases, was found to positively correlate with parental or friends' awareness of their same-sex sexual behavior or sexual orientation, with some geographical differences. The prevalence of HIV risk behaviors among student MSM aged 15 to 19 was high and associated with the disclosure of their sexual orientation or their sex with males to parents and friends. These findings highlight the importance of addressing social support in HIV prevention among student MSM when delivering HIV-related education or services.

Estimating the Quasi-Underground: Oregon’s Informal Marijuana Economy

This study estimates the size of Oregon’s informal marijuana economy, drawing upon Respondent-Driven Sampling (RDS) procedures and survey methods to investigate this quasi-underground activity. The results suggest that average marijuana users consume approximately 4.5 ounces per year and pay approximately $177 per ounce. Most users purchase the drug from friends and nearly one third of respondents indicate that they sell marijuana in small quantities. Growers tend to sell inauspicious quantities to friends and relatives, and rarely earn more than $10,000 annually from their sales. The composition of distribution networks suggests that the informal marijuana economy is a “robust network,” particularly in states that allow personal medical production. This finding also suggests that legalization will likely produce a net increase in economic inequality, particularly affecting parts of Oregon associated with the State of Jefferson, by shutting out smaller producers. Several taxation schemes are presented to offer estimates of revenue if the drug were legalized; these findings suggest that marijuana could contribute modestly to the state’s total revenue, but the most economically beneficial aspect of legalization could be from criminal justice savings.

The adverse impact of excessive internet use during the COVID-19 pandemic on adolescents' coping skills: A case study in Hanoi, Vietnam 2021.

IntroductionThe COVID-19 pandemic has created significant stressors in Vietnamese adolescents' lives. Coping skills play important roles in helping adolescents contend with stress. This study aimed to evaluate adolescents' coping skills during the COVID-19 pandemic and examine how those skills are impacted by excessive internet use during this pandemic.MethodsThe study used respondent-driven sampling and Google online survey forms to collect data. The study sample included 5,315 high school students aged 11- 17 years in Hanoi's rural and urban areas. The Kid Coping Scale was applied to examine adolescents' coping, and the coping score was compared among adolescents with different levels of internet use.ResultsThe average coping score measured by Kid Coping Scale was 20.40 (std = 2.13). About half of adolescents often “avoid the problem or the area where it happened” when experiencing a hard time. One-third of adolescents often stopped thinking about the problem they faced. More than one-fourth of respondents stayed online for at least 8 h per day. The online time for learning/other activities showed a reverse dose-response relationship with the coping score; the longer the internet use duration, the lower the coping score.ConclusionThe mean score of coping of Hanoi adolescents was moderate. Internet use has an adverse impact on their coping skills.