Self-identified MSM Research Articles

Prevalence of HTLV-1 and Hepatitis B Surface Antigen (HBsAg) Positivity among MSM Attending a Large HIV Treatment Centre in Trinidad.

HIV-1, Hepatitis B and HTLV-1 have similar risk factors and shared routes of transmission and MSM are disproportionately affected by HIV. The aim of the study was to determine the prevalence of HTLV-1 and HBsAg positivity at initial enrolment among MSM attending a large HIV Clinic in Trinidad. Chart reviews were conducted between 2 and 15 January 2024, among self-identified MSM and a comparative group of randomly selected self-identified heterosexual males where sociodemographic, clinical and laboratory data were collected and analysed using SPSS Version 25. During the period April 2002-31 October 2023, in total there were 10,424 patients registered at the clinic, of whom 1255 (12.0%) were self-identified MSM, with an age range of 19-85 years and a median age of 40 years. There were 1822 randomly selected heterosexual males, with an age range of 18-94 years old and a median age of 52 years. Among the MSM, there were 21 (1.67%) patients who were HIV-1/HTLV-1-coinfected, 64 (5.10%) who were HIV-1/HBsAg-coinfected and two (0.16%) who were coinfected with all three viruses (HIV-1/HTLV-1/HBsAg) as compared to 47 ((2.58%) HIV-1/HTLV-1-coinfected (p = 0.12), 69 (3.79%) HIV-1/HBsAg-coinfected (p = 0.10) and three (0.16%) patients coinfected with all three viruses among the heterosexual males. There were no patients with HTLV-1-related diseases among the HIV-1/HTLV-1-coinfected patients and there were no deaths from chronic liver disease in patients coinfected with HIV-1/HBsAg. Despite the availability of an efficacious vaccine, there is a prevalence of hepatitis B of 5.1% among MSM attending the HIV Clinic in Trinidad; therefore, programmes to increase health literacy, screening and immunization are urgently needed.

Supernatural beliefs, religious affiliations, and HIV testing among recently arrived Asian-born men who have sex with men in Australia

ABSTRACT HIV testing rates among recently arrived (≤5 years) Asian-born men who have sex with men (MSM) in Australia remain suboptimal. Research indicates that belief in supernatural determinants of health (supernatural beliefs) may be an important barrier to greater HIV test uptake. We examined potential associations between supernatural beliefs and HIV testing among recently arrived Asian-born MSM in Australia. In 2019, an online survey was completed by 186 self-identified MSM born in Asia, and who arrived in Australia within the past five years and were never diagnosed with HIV. Supernatural belief was measured as the extent to which one felt that health was influenced by supernatural forces. Measures of association were estimated with multiple logistic regression. Participants with supernatural beliefs were significantly less likely to have tested for HIV in the past year. The adjusted predicted probability of not testing for HIV in the past year was 44.8% among those who held supernatural beliefs (95% CI: 30.5–59.2%), but only 5.2% among those who did not hold supernatural beliefs (95% CI: 1.9–8.6%). Religious affiliation was not significantly associated with testing for HIV. Supernatural beliefs may be an important but underappreciated barrier to HIV testing among recently arrived Asian-born MSM in Australia.

Human Papillomavirus associated prevention: knowledge, attitudes, and perceived risks among men who have sex with men and transgender women in Pakistan: a qualitative study

ObjectivesMen who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women’s perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan.DesignA qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan.MethodsParticipants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis.ResultsThree themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant’s recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one’s sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients’ integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding.ConclusionsThe findings from this study can help public health policy and researchers to understand this minority’s perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.

The lived experiences of men who have sex with men when accessing HIV care services in Zimbabwe.

BackgroundKey populations such as men who have sex with men are disproportionately affected by human immunodeficiency virus (HIV), yet they are underserved. This vulnerable group also faces stigma and discrimination when utilising the healthcare services. However, to achieve the HIV epidemic control, it is important for them to have access to HIV care services.AimThe aim of this study was to explore and describe the experiences of men who have sex with men (MSM) as they accessed HIV care services in healthcare settings in Bulawayo, Zimbabwe.SettingThe study setting was healthcare facilities (state and private owned) in Bulawayo, Zimbabwe, that offer HIV care services.MethodsThe study used a descriptive phenomenological design targeting self-identified MSM living with HIV. Data were gathered by using in-depth individual interviews that were audio recorded. Data saturation determined sample size. Data were transcribed verbatim and later analysed thematically.ResultsThe study revealed that counselling given to MSM was generalised and not individualised. Some clients faced stigma and discrimination after disclosure. Peer and family support were important in the journey to access HIV care services.ConclusionAn enabling environment was not provided for MSM clients to access HIV care services in the majority of health facilities. This calls for sensitisation and competency clinical training of service providers so that the diverse needs of MSM are met. Peer and family support for MSM needs to be strengthened.

Top, Versatile, and Bottom Identities and Sexual Behaviors in Self-Identified Bisexual MSM

There is a lack of research concerning self-identified bisexual men who have sex with men (BMSM), specifically regarding their self-identification as top, versatile, or bottom and their sexual behaviors. As a result, this study seeks to examine the use of top, versatile, and bottom identity labels among a group of self-identified BMSM and to describe their sexual behaviors, examining any possible associations between sexual positions and condomless anal sex. This study recruited 278 BMSM, who ranged in age from 21 to 69 years old (Mage=44.92, SDage=10.74). This study recruited participants via websites, e-mail, and social media. All participants self-identified as bisexual men who have sex with other men. The majority of sample participants were married to a woman (32.7%) or single (30.7%), held a university degree, and lived in urban areas. Participants indicated relatively high bisexual identity acceptance levels (8.03 on a scale from 1 to 10). The survey included three categories of questions, encompassing sociodemographic information, sex role self-identifications, and (un)protected anal sex behaviors. Regarding typical anal sex behaviors, 41.4% of BMSM self-identified as bottoms, 30.3% as tops, and 28.3% as versatiles. The study found significant differences among BMSM for all types of anal sex practices based on sex role identities. Versatile men more frequently reported condomless receptive anal sex, whereas tops were the most likely to report partaking in condomless insertive anal sex. Finally, self-identified bottom BMSM perceived themselves as having shorter penises and being younger in age than BMSM self-identifying as tops, versatiles, or as older in age. This study shows that sexual position self-labeling among BMSM is complex, as well as the need for further research.

Prevalence of Syphilitic Hepatitis Among HIV-Infected Patients in Istanbul, Turkey, a Region with an Increasing Incidence of Syphilis and HIV Infection

Background: Syphilis is a global health issue, which continues to occur at high rates worldwide, particularly in HIV-infected men, who have sex with men (MSM). Hepatitis can present as an uncommon manifestation of syphilis, and the diagnosis may be overlooked in favor of more common causes of liver injury in this group. Objectives: This study aimed to determine the prevalence and risk factors of syphilitic hepatitis among HIV-infected individuals diagnosed with acute syphilis. Methods: This cross-sectional study was conducted on HIV-infected individuals who regularly attended a tertiary clinic in Istanbul. The data were collected and analyzed between 2016 and 2019. Cases of syphilitic hepatitis were included according to the following criteria: (I) VDRL-confirmed Treponema pallidum infection after or simultaneously diagnosed with HIV infection; (II) elevated liver enzymes, including ALT, AST, and ALP, that resolved after penicillin treatment; and (III) exclusion of other causes of hepatitis. Sociodemographic characteristics of the participants, clinical and laboratory findings were evaluated using medical records. Results: Among 1,057 HIV-infected patients, 141 (13.3%) were diagnosed to have an early stage of syphilis, 138 of them were male. Nine (6.4 %) out of 141 patients had syphilitic hepatitis, and all of them were self-identified MSM. Moreover, 5 out of these 9 patients were simultaneously diagnosed with syphilis and HIV infection. Up to 10-fold increase in ALT/AST was noted in all of them, and a 3.5-fold increase in bilirubin was observed in two cases. The most prominent laboratory abnormalities in syphilitic hepatitis patients were the detection of a considerable increase in ALP and HIV RNA levels. Conclusions: Syphilitic hepatitis is not encountered rarely in HIV-infected individuals, predominantly MSM populations. Since HIV/syphilis coinfected patients are more infective as a result of higher HIV RNA levels, early diagnosis, and treatment are crucial.

Supernatural Explanatory Models of Health and Illness and HIV Antiretroviral Therapy Use Among Young Men Who Have Sex with Men in China.

In China, men who have sex with men (MSM) shoulder a disproportionate HIV burden. Early initiation and adherence to HIV antiretroviral therapy (ART) will be critical to reversing the HIV epidemic in China, but ART usage remains suboptimal among MSM diagnosed with HIV. One understudied but potentially important factor underpinning suboptimal ART usage is personal belief in supernatural explanatory models of health and illness (supernatural explanatory models). This study examines associations between beliefs in supernatural explanatory models and ART usage among MSM in China. In 2017, an online survey was distributed nationwide throughout China by gay community-based organizations. Eligible study participants were self-identified MSM between 16 and 30years old who had tested positive for HIV and who had seen a doctor in the last 2years. Beliefs in supernatural explanatory models were measured using a three-item scale developed specifically for the Chinese population (range, 3-15). Of 73 participants, the majority were currently using ART (83.6%) and 42.5% expressed some endorsement of belief in supernatural explanatory models. However, among 21 participants with the strongest belief in supernatural explanatory models, prevalence of current ART usage was 61.9%. Stronger belief in supernatural explanatory models was significantly associated with lower likelihood of current ART usage (adjusted odds ratio = 0.52; 95% confidence interval = 0.13-0.75). Belief in supernatural explanatory models may be a powerful predictor of ART usage among MSM living with HIV in China. Further studies are needed to corroborate these findings and elucidate mechanisms of association.

Anogenital Human Papillomavirus and HIV Infection in Rwandan Men Who Have Sex With Men

Background:Men who have sex with men (MSM) have a high prevalence of anal and penile human papillomavirus (HPV) infections with MSM living with HIV (MSMLH) bearing the highest rates. Data on anogenital high-risk HPV (hrHPV) among MSM in Rwanda and the associated risk factors are scant.Methods:We recruited 350 self-identified MSM aged 18 years living in Kigali, Rwanda, with 300 recruited from the community and 50 from partner clinics. Anal and penile specimens from all participants were analyzed for hrHPV using the AmpFire platform. Logistic regression was used to calculate crude odds ratios (ORs) and adjusted ORs (aORs) with 95% confidence intervals (95% CIs) as a measure of association between various factors and anal and penile hrHPV infection prevalence.Results:Anal hrHPV prevalence was 20.1%, was positively associated with having receptive anal sex with more partners (aOR: 9.21, 95% CI: 3.66 to 23.14), and was negatively associated with having insertive anal sex with more partners (aOR: 0.28, 95% CI: 0.12 to 0.66). Penile hrHPV prevalence was 35.0%, was negatively associated with having receptive anal sex with more partners (aOR: 0.29, 95% CI: 0.13 to 0.66), and differed significantly by HIV status, with 55.2% and 29.7% for MSMLH and HIV-negative MSM, respectively (P < 0.01).Conclusion:Penile hrHPV prevalence was higher than that of anal hrHPV and it was significantly higher in Rwandan MSMLH than in HIV-negative MSM. The prevalence of anal and penile HPV infections is likely variable at different locations in Africa, according to a number of factors including HIV status and sexual practices.

Internalized Homophobia, HIV Knowledge, and HIV/AIDS Personal Responsibility Beliefs: Correlates of HIV/AIDS Discrimination among MSM in the Context of Institutionalized Stigma

ABSTRACTThere exists a paucity of research on the psychosocial risk factors of HIV/AIDS among men who have sex with men (MSM) in settings where they are stigmatized or face prosecution. The present study investigates discrimination against people living with HIV (PLHIV), internalized homophobia, HIV/AIDS personal responsibility beliefs and HIV knowledge in a purposive sample of 106 self-identified MSM obtained through a web-based survey disseminated by two voluntary welfare organizations. Results indicate that internalized homophobia is positively associated with discrimination against PLHIV. Internalized homophobia also substantially mediates the effect of HIV/AIDS personal responsibility beliefs on discrimination against PLHIV, highlighting the confounded nature of HIV/AIDS and homosexual stigma in a setting where stigma is deep-rooted and institutionalized. Internalized homophobia may thus serve as a barrier to the effectiveness of HIV prevention efforts among MSM in Singapore.

Risk Behaviors and Perceptions Among Self-identified Men Who Have Sex with Men (MSM), Bisexuals, Transvestites, and Transgender Women in Western Guatemala

Guatemala has a concentrated HIV epidemic disproportionately affecting men who have sex with men (MSM) and transgender women. We recruited 205 self-identified MSM, bisexuals, transvestites, and transgender women in western Guatemala using long-chain peer referral, wherein "seed" participants were asked to invite as many as three acquaintances to participate in the study. Self-reported sexual or gender identity was MSM, 46%; bisexual, 28%; transvestite, 21%, and transgender woman, 5%. Median age of the participants was 23years, and 36% self-identified as being indigenous. Indigenous persons were more likely to self-identity as transvestite (32.9% vs 13.8%, P = 0.04), strongly perceive themselves at risk for HIV (87.7% vs 51.5%, P = 0.001), have had an HIV test in the last 12months and know the result (97.3% vs 85.4%, P = 0.008), and experience barriers to testing and treatment (86.3% vs 67.7%, P = 0.004). HIV prevention services for indigenous MSM should especially target transvestites and how to overcome stigmatization and barriers to care.

Willingness and influencing factors of using pre-exposure prophylaxis among 301 men have sex with men in Wuhan city, 2015

Objective: To understand willingness and influencing factors of using pre-exposure prophylaxis (Pr-EP) among men who have sex with men (MSM). Methods: Snow ball sampling was employed to recruit MSM in the social spaces (like bars and bathrooms) with focused activities by MSM and internet (QQ and Wechat) in Wuhan between August and November, 2015. 304 MSM were considered eligible when they were self-identified MSM and has had sex with men in the previous 12 months, over the age of 18 and have full civil liability. On-site and online questionnaire surveys were conducted by self-designed questionnaires to collect information including demographic characteristics, sexual risks and practices, awareness of PrEP, and willingness to use PrEP. A total of 301 qualified questionnaires were obtained. Multivariate logistic regression models were constructed to identify factors associated with willingness to use Pr-EP. Results: The mean age of surveyed MSM were (27.51±8.31) years, between18-61. 149 on-site survey, online were152; 131 MSM have regular homosexual partners, 170 MSM have not regular homosexual partners. Only 17.28% (52/301) had heard of Pr-EP before this survey, 18.32% (24/130) had heard of Pr-EP among those who had regular homosexual partners and those who had not accounted for 16.47% (28/170). 74.42% (224/301) had willingness to use Pr-EP after they knew Pr-EP was safe and effective through the survey. The proportion among those who had regular homosexual partners was 74.05%(74), and the proportion among those who had not was 74.71% (127); Among those who had regular homosexual partners, results suggested that those who were married/cohabiting were more likely to report a willingness to use PrEP compared to unmarried/divorced or widowed (OR=5.60), compared with homosexual, heterosexuality was associated with decreased odds of willingness to use Pr-EP (OR= 0.22), compared with HIV status of sexual partner was negative or uncertain, positive infection status was associated with increased odds of willingness to use (OR=7.52). Compared with MSM who have not regular homosexual partners, those who were married/cohabiting were more likely to report a willingness to use PrEP compared to unmarried/divorced or widowed (OR=9.09), compared with those who think they have risk of infection, those who do not think they have risk of infection was associated with decreased odds of willingness to use Pr-EP (OR= 0.30), compared with those with a high frequency to seek sexual partners, those not often to seek was associated with decreased odds of willingness to use Pr-EP (OR= 0.27). All above P values were<0.05. Conclusion: The awareness rate of Pr-EP among MSM in Wuhan is low in 2015, but the willingness to use Pr-EP could get a considerable increase after introduction. It is considered that promotion of Pr-EP is feasible in China, and there are different influencing factors for the willingness between two MSM subgroups (having regular homosexual partners and having no regular homosexual partners).

Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China.

Pre-exposure prophylaxis (PrEP) is a biomedical approach for preventing the acquisition of HIV in populations at substantial risk for HIV. However, its uptake among men who have sex with men (MSM) is low in China. The study aimed to identify factors that might influence MSM's uptake and use of PrEP. In-depth interviews were conducted with 32 self-identified MSM from a PrEP intervention study evaluating daily oral tenofovir disoproxil fumarate (TDF) to prevent HIV infection. Of these men, 11 were presently using the 'TDF' group; 8 from the 'change-over' group (i.e. initially used PrEP but subsequently quitted); and 13 from the non-user group. Data were analysed using thematic approach. Perception of low HIV risk, mistrust of the national PrEP program, and concerns of side effects were the main reasons for not wanting to use PrEP. Also, lack of main sexual partner's support, difficulties in adhering to the daily TDF regimen, and the inconvenient schedules in securing the medicine were the major reasons for not wanting to use or quitting the use of PrEP. On the other hand, perceived high HIV risk, beliefs in efficacy of PrEP, and worries of transmitting HIV to families were the major motives for PrEP uptake. Findings suggest that PrEP implementation strategies should first address issues including but not limited to accurate self-assessment of HIV risk, mistrust and limited knowledge about medical trials and PrEP, and ease of accessing PrEP.

The beliefs and willingness of men who have sex with men to comply with a one-year blood donation deferral policy: a cross-sectional study.

In 2016, the US Food and Drug Administration ended the lifetime blood donation deferral for men who have sex with men (MSM) and replaced it with a 1-year deferral period. It is currently unknown how many MSM may meet the new deferral policy and how many are willing to comply with it. An anonymous survey was shared on MSM-focused social media sites between May and July 2016 and enrolled self-identified American MSM who were at least 18 years old. The survey assessed the willingness of MSM to donate blood, donation history, and knowledge regarding current blood donation needs and testing limitations. A total of 764 men met criteria to be included in the final data set. Only 8.9% (95% confidence interval [CI], 6.9%-10.9%) met the current 12-month deferral criteria, yet 90.6% (95% CI, 88.5%-92.7%) were interested in donating. Among men interested in donating blood, 57.9% (95% CI, 54.3%-61.4%) would consider donating blood without meeting the 12-month deferral criteria. Overall, 26.7% (95% CI, 23.6%-29.8%) admitted to donating blood at least once in the past despite not meeting deferral criteria. Few MSM met the current deferral criteria, yet many were interested in donating, even without meeting deferral criteria. Possible motivations to donate without meeting deferral criteria may include a perceived shortage of donated blood and infallibility of current blood testing technology to detect human immunodeficiency virus. If the current 1-year deferral is maintained, it is essential that there is outreach to the MSM community to explain and educate why this policy exists.

Perceptions of HPV and attitudes towards HPV vaccination among men who have sex with men: a qualitative analysis

BackgroundMen who have sex with men (MSM) are at risk of genital warts and anal cancer due to human papillomavirus (HPV) infection. From 2016, MSM are being targeted for HPV vaccination in the UK through sexual health settings. This study explored perceptions of HPV and HPV vaccination among MSM. MethodsFocus groups and one-to-one interviews with self-identified MSM from Brighton, UK, were conducted between Nov 20, 2014, and March 15, 2015. Participants were recruited from community-based lesbian–gay–bisexual–transgender venues and organisations. Discussions were recorded, transcribed verbatim, and analysed with framework analysis. Ethics approval was granted from Brighton and Sussex Medical School. Findings33 men took part (median age 25 years, IQR 21–27), most of whom did not know about HPV (n=25), anal cancer (31), or HPV vaccination (26). Whereas genital warts and anal cancer were perceived as severe, men did not perceive themselves at risk for HPV. All MSM would accept the HPV vaccine if offered by a health-care professional. The inability to self-identify as gay or bisexual, access to sexual health services, and discussing sexuality with health-care professionals were barriers to HPV vaccination. Two MSM were concerned that selective HPV vaccination would increase stigma and prejudice comparable to the AIDS epidemic. Ten MSM were unsure about the effectiveness of HPV vaccination for sexually active men and were in favour of vaccinating all adolescent boys at school. InterpretationMost MSM have poor knowledge about HPV and associated anal cancer. Despite the lack of concern about HPV-related diseases, MSM would be willing to receive the HPV vaccine. There is a need for health education about the risk of HPV and HPV-related diseases so that MSM can appraise the benefits of the HPV vaccine for their health. Concerns about HPV vaccine effectiveness in sexually active men and possible stigmatisation need to be addressed to increase HPV vaccine acceptability. FundingThis work was funded through a competitive PhD scholarship from the University of Brighton.

"If You Tell People That You Had Sex with a Fellow Man, It Is Hard to Be Helped and Treated": Barriers and Opportunities for Increasing Access to HIV Services among Men Who Have Sex with Men in Uganda.

BackgroundDespite the high HIV prevalence among men who have sex with men (MSM) in sub-Saharan Africa, little is known about their access to HIV services. This study assessed barriers and opportunities for expanding access to HIV services among MSM in Uganda.MethodsIn October-December 2013, a cross-sectional qualitative study was conducted in 12 districts of Uganda. Semi-structured in-depth interviews were conducted with 85 self-identified MSM by snowball sampling and 61 key informants including HIV service providers and policy makers. Data were analysed using manifest content analysis and Atlas.ti software.ResultsThree quarters of the MSM (n = 62, 72.9%) were not comfortable disclosing their sexual orientation to providers and 69 (81.1%) felt providers did not respect MSM. Half (n = 44, 51.8%) experienced difficulties in accessing health services. Nine major barriers to access were identified, including: (i) unwelcoming provider behaviours; (ii) limited provider skills and knowledge; (iii) negative community perceptions towards MSM; (iv) fear of being exposed as MSM; (v) limited access to MSM-specific services; (vi) high mobility of MSM, (vii) lack of guidelines on MSM health services; viii) a harsh legal environment; and ix) HIV related stigma. Two-thirds (n = 56, 66%) participated in MSM social networks and 86% of these (48) received support from the networks to overcome barriers to accessing services.ConclusionsNegative perceptions among providers and the community present barriers to service access among MSM. Guidelines, provider skills building and use of social networks for mobilization and service delivery could expand access to HIV services among MSM in Uganda.

Delay in disclosure about sexual orientation to health-care professionals among men who have sex with men in Brighton, UK: a qualitative analysis

BackgroundMen who have sex with men (MSM) are at risk of poor sexual health and can benefit from preventive health interventions, such as vaccination and screening. For these interventions to be most effective, it is crucial that men can openly discuss same-sex sexual behaviours with health-care professionals at the beginning of their sexual activity. This study aimed to explore the barriers and facilitators to disclosure of sexual orientation among MSM. MethodsThe study involved four focus groups (five participants each) and 13 one-to-one interviews with self-identified MSM from Brighton, UK, between Nov 20, 2014, and March 15, 2015. Participants were recruited from community-based lesbian–gay–bisexual–transgender venues and organisations. Discussions were recorded, transcribed verbatim, and analysed with framework analysis. Ethics approval was granted from Brighton and Sussex Medical School. Findings33 men (mean age 25 years, SD 5, range 18–40) took part. Eight themes were identified. MSM reported that the attributes of a doctor and the characteristics of a clinic or surgery were important when judging the relevance of sexual orientation in their health care. Men who had negative experiences talking about their sexuality or did not associate themselves with the gay culture were less likely to reveal same-sex practices. Some men acknowledged that having a support network and feeling confident as a gay man enabled them to be open about sexual orientation. Questionnaires and direct face-to-face questions were perceived as acceptable ways to reveal sexual orientation. Almost all men admitted that they had waited until they felt it was important, safe, or worthwhile to discuss sexual orientation. InterpretationMost participants had delayed disclosure of sexual orientation until they perceived it to be relevant to health care and felt certain about confidentiality. To encourage MSM to discuss their health and wellbeing with health-care professionals, services need to inform MSM about the benefits and acceptance of disclosing sexual behaviours. Future studies should explore strategies to remove barriers and to communicate a welcoming approach to stigmatised sexual minorities. FundingThis work was funded through a competitive PhD scholarship from the University of Brighton.

Sexually transmitted infections among transgender people and men who have sex with men in Port Vila, Vanuatu.

Despite high sexually transmitted infection (STI) prevalence in the Pacific, there are limited data on STIs and risk among men who have sex with men (MSM) and transgender people (TG). In 2011, an Integrated Bio-Behavioural Survey recruited self-identified MSM and TG in Port Vila, Vanuatu. Descriptive findings were stratified by sexuality. Among 28 (55%) MSM and 23 (45%) TG, recent anal sex with male partners was more common among MSM (94% vs 71%; P<0.1), including with casual (47% vs 35%), regular (59% vs 29%) and paying partners (28% vs 12%). MSM more commonly reported lifetime (P<0.01) and recent sex with female partners (P<0.01). Reported condom use with any partner type was low. More MSM (35%) than TG (24%) were diagnosed with an STI; previous treatment-seeking behaviour when symptomatic was lower among TG (P<0.1). Tailored strategies acknowledging differences between MSM and TG are required to reduce STI vulnerability in Vanuatu.

Substance Use among a National Sample of Asian/Pacific Islander Men Who Have Sex with Men in the U.S.

The objectives of this study were to describe drug use among Asian/Pacific Islander (API) men who have sex with men (MSM) and to examine how nativity (and acculturation as a secondary correlate) predicted such use. A total of 445 self-identified API MSM from seven metropolitan cities participated in a national HIV serological testing and psychosocial and behavioral assessment study. Results indicate clubbing was significantly associated with higher levels of substance use. Additionally, participants who were U.S.-born were more likely to have reported marijuana use and those with higher levels of acculturation reported less marijuana use. Our bivariate findings suggest that foreign-born status and acculturation experience may provide a protective effect against marijuana use among API MSM. These associations largely did not hold in our multivariate models. Future research should more fully examine the role of acculturation and nativity in substance use behaviors.

Sexual Behavior and HIV Testing Practices among Men who have Sex with Men in Portugal

The objective of the study was to explore sexual behavior and HIV-testing practices among men who have sex with men (MSM) in Portugal, in light of current international health guidelines that recommend frequent HIV testing for MSM who engage in high-risk behavior. Participants were 304 mostly young, gay or bisexual self-identified MSM. They provided information regarding their HIV status (67% negative, 7% positive, 26% didn’t know), 24% had never been tested for HIV, and 15.5% had been tested only once; main reasons for never having tested previously were: always using condoms, and not feeling at risk. Thus, HIV testing was infrequent and insufficient for early detection of infection, entry into treatment, and protection of sexual partners, since many unprotected sexual practices still occur. Those who tested more were older, self-identified as gay, living in major urban areas and employed. Linear regression predicted that the number of times MSM had penetrative sex without a condom was associated with the number of times they got tested, indicating that they might be using the test itself as a means to gain control of their unprotected sexual practices. Testing campaigns should aim to help MSM become more aware of their risk behavior, decrease fear of testing by explaining available treatment resources and decreasing the stigma associated with HIV, and by publicizing information about free and confidential testing locations.

Population size, HIV, and behavior among MSM in Luanda, Angola: challenges and findings in the first ever HIV and syphilis biological and behavioral survey.

To conduct the first population size estimation and biological and behavioral surveillance survey among men who have sex with men (MSM) in Angola. Population size estimation with multiplier method and a cross-sectional study using respondent-driven sampling. Luanda Province, Angola. Study was conducted in a large hospital. Seven hundred ninety-two self-identified MSM accepted a unique object for population size estimation. Three hundred fifty-one MSM were recruited with respondent-driven sampling for biological and behavioral surveillance survey. Interviews and testing for HIV and syphilis were conducted on-site. Analysis used Respondent-Driven Sampling Analysis Tool and STATA 11.0. Univariate, bivariate, and multivariate analyses examined factors associated with HIV and unprotected sex. Six imputation strategies were used for missing data for those refusing to test for HIV. A population size of 6236 MSM was estimated. Twenty-seven of 351 individuals were tested positive. Adjusted HIV prevalence was 3.7% (8.7% crude). With imputation, HIV seroprevalence was estimated between 3.8% [95% confidence interval (CI): 1.6 to 6.5] and 10.5% (95% CI: 5.6 to 15.3). Being older than 25 (odds ratio = 10.8, 95% CI: 3.5 to 32.8) and having suffered episodes of homophobia (odds ratio = 12.7, 95% CI: 3.2 to 49.6) significantly increased the chance of HIV seropositivity. Risk behaviors are widely reported, but HIV seroprevalence is lower than expected. The difference between crude and adjusted values was mostly due to treatment of missing values in Respondent-Driven Sampling Analysis Tool. Solutions are proposed in this article. Although concerns were raised about feasibility and adverse outcomes for MSM, the study was successfully and rapidly completed with no adverse effects.