The association of intimate partner violence, recreational drug use with HIV seroprevalence among MSM

Global Prevalence and Factors Related to Intimate Partner Violence Amongst People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression

Reviews of intimate partner violence (IPV) have primarily focused on women and same-sex relationships, but little is known about the global epidemiology of IPV among people living with HIV/AIDS (PLWHA). This review employed meta-analytic approaches to determine the worldwide prevalence and factors related to different forms of IPV among PLWHA. Databases including PubMed, Cochrane review, EMBASE, Scopus, PsycINFO, CINAHL, ProQuest, and registers, were systematically reviewed until November 5, 2021. The meta-analysis was conducted using the metafor package in R software. The Newcastle Ottawa Scale and Cochrane Risk of Bias Tool version 1 were used to assess the study quality and risk of bias, respectively. A total of 49 published articles and 42,280 participants, were included in the meta-analysis. Over their lifetime, four in ten PLWHA have experienced some type of IPV. Over a quarter have experienced physical, emotional, or psychological IPV. One in five PLWHA experienced at least one form of IPV during the recall period of last year, with emotional IPV being the most prevalent. Rates of physical and any types of IPV differed substantially between IPV measurements. IPV rates also varied significantly by the study design, with physical (29%) and sexual (18%) IPV rates being more prevalent in cross-sectional studies. Public health measures are critical for preventing and combating IPV among PLWHA. Additional cross-national research using robust sampling methods is required to obtain more representative samples and thus a more reliable prevalence estimate of IPV prevalence.

Intimate Partner Violence and the Sexual Health of Sexual Minority Men

Purpose: This qualitative study explores the pathways by which various forms of intimate partner violence (IPV) impact the sexual health behaviors of cisgender identified sexual minority men (SMM). Methods: Semi-structured interviews were conducted with 23 racially and ethnically diverse SMM who recently experienced IPV and 10 clinical and social service providers focused on how experiences of IPV directly or indirectly influences sexual risk as well as engagement in HIV prevention behaviors (e.g., pre-exposure prophylaxis [PrEP] use). Applied thematic analysis, including cycles of analytic memo writing and coding, aided the identification of patterns across the data. Results: Analyses yielded three overarching themes: use of condoms, use of PrEP, and HIV and sexually transmitted infections (STIs). Participants described different ways condom use or nonuse was a mechanism by which power and/or control might be asserted by one partner over the other partner. A range of responses to questions about PrEP were identified, including partners encouraging PrEP use, as well as avoidance of conversations about PrEP or actual PrEP use, to prevent experiencing aggression or IPV from partners. Responses regarding HIV/STIs included those ranging from a new diagnosis being a potential trigger for violence to the exploitation of status to control partners. Conclusion: These findings suggest that in relationships with IPV, HIV prevention strategies can be sources of relationship control and trigger abuse. Addressing IPV may help to prevent HIV/STI transmission and promote the health of SMM. In addition, long-acting formulations of PrEP may be a promising strategy for SMM experiencing IPV when oral PrEP medications may be a risk factor for violence.

Prevalence of and Factors Associated With Intimate Partner Violence Victimhood Among Men Who Have Sex With Men in Guangzhou, China

BACKGROUND

Intimate partner violence (IPV) has been a concern among men who have sex with men (MSM), but less attention has been paid to the factors associated with this population in China.

AIMS

We investigated the prevalence of and factors associated with IPV victimhood among MSM in Guangzhou, China.

METHODS

Men who have sex with men were recruited from May to November 2017, and data were collected using an anonymous electronic questionnaire. χ2 Tests and nonconditional logistic regressions were used to explore the factors associated with IPV victimhood.

RESULTS

A total of 129 in 976 MSM (13.22%) reported experiencing IPV victimhood. Multivariable logistic regression analysis showed that individuals who had condomless anal intercourse (CAI; adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.00-2.17) or had sex with a female partner (aOR, 1.81; 95% CI, 1.15-2.83) in the past 6 months were at a higher risk of IPV victimhood. Participants who had ever experienced child sexual abuse (CSA) were more likely to experience IPV (aOR, 1.97; 95% CI, 1.32-2.94). Individuals who used rush poppers before sex had a higher risk of IPV (aOR, 1.79; 95% CI, 1.21-2.63). In addition, ever having sex with a female sex partner (aOR, 1.65; 95% CI, 1.04-2.60), ever having used rush poppers before sex (aOR, 1.79; 95% CI, 1.22-2.64) in the past 6 months, and ever having experienced CSA (aOR, 2.01; 95% CI, 1.35-3.01) were associated with experiencing more types of IPV.

CONCLUSIONS

Intimate partner violence victimhood was relatively common among MSM in Guangzhou, particularly among those who had CAI, experienced CSA, had sex with a female partner, used rush poppers before sex, and with less education.

Intimate Partner Violence and HIV Prevention Among Sexual Minority Men: Protocol for a Prospective Mixed Methods Cohort Study

BACKGROUND

Sexual minority men experience intimate partner violence (IPV) at rates similar to those reported by heterosexual women in the United States. Previous studies linked both IPV victimization and perpetration to HIV risk and seroconversion; however, less is known about the impact of IPV on HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among sexual minority men experiencing IPV. Although prior work suggests that IPV may influence HIV prevention behavior, experiences of IPV are so highly varied among sexual minority men (eg, forms, frequency, and severity; steady vs casual partnerships; perpetration vs receipt; and sexual vs physical vs psychological violence) that additional research is needed to better understand the impact that IPV has on HIV risk and protective behaviors to develop more effective interventions for sexual minority men.

OBJECTIVE

This study aims to contribute to our understanding of the antecedents of IPV and the direct and indirect pathways between perpetration and receipt of IPV and HIV or STI risk behavior, STIs, and use of PrEP among sexual minority men experiencing IPV.

METHODS

This mixed methods study has 2 phases: phase 1 involved formative qualitative interviews with 23 sexual minority men experiencing IPV and 10 key stakeholders or providers of services to sexual minority men experiencing IPV to inform the content of a subsequent web-based cohort study, and phase 2 involves the recruitment of a web-based cohort study of 500 currently partnered HIV-negative sexual minority men who reside in Centers for Disease Control and Prevention-identified Ending the HIV Epidemic priority jurisdictions across the United States. Participants will be followed for 24 months. They will be assessed through a full survey and asked to self-collect and return biospecimen kits assessing HIV, STIs, and PrEP use at 0, 6, 12, 18, and 24 months. They will also be asked to complete abbreviated surveys to assess for self-reported changes in key study variables at 3, 9, 15, and 21 months.

RESULTS

Phase 1 was launched in May 2021, and the phase 1 qualitative interviews began in December 2021 and were concluded in March 2022 after a diversity of experiences and perceptions were gathered and no new ideas emerged in the interviews. Rapid analysis of the qualitative interviews took place between March 2022 and June 2022. Phase 2 recruitment of the full cohort began in August 2022 and is planned to continue through February 2024.

CONCLUSIONS

This mixed methods study will contribute valuable insights into the association that IPV has with HIV risk and protective behaviors among sexual minority men. The findings from this study will be used to inform the development or adaptation of HIV and IPV prevention interventions for sexual minority men experiencing IPV.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41453.

Intimate Partner Violence and Preferences for Pre-exposure Prophylaxis (PrEP) Modes of Delivery Among A Sample of Gay, Bisexual, and Other Men Who Have Sex with Men

While there is strong evidence that the experience of intimate partner violence (IPV) shapes PrEP use among heterosexual women, evidence for similar relationships among gay, bisexual and other men who have sex with men (GBMSM) is scant. In this paper we analyze baseline data from a large randomized controlled trial (RCT) of an HIV prevention intervention for GBMSM recruited from three cities (Atlanta, Detroit and New York City) to examine how the recent experience of IPV shapes their rankings of PrEP delivery options. Men were asked to rank from 1 to 8 PrEP taken by daily pill, event-based pill, injection, anal suppository (before sex), suppository (after sex), gel (penile or rectal) (before sex), and gel (after sex) and condoms. The analysis sample is 694 HIV-negative, sexually active GBMSM. Analysis considers an ordinal outcome measuring participant's ranked preferences for their future use of eight HIV prevention options. Men who experienced physical IPV preferred PrEP in pill form, while men who experienced partners monitoring their behaviors (monitoring IPV) preferred PrEP by injection. Men who experienced emotional IPV ranked PrEP by pill lower than other methods. Sexual and controlling IPV were not significantly associated with PrEP modality ranking. As more modes of PrEP delivery become available, providers should be encouraged to screen GBMSM seeking PrEP for IPV, and to provide men with the necessary information to facilitate an informed choice when deciding on a PrEP modality that will work for them and their relationship context.

Experiencing Intimate Partner Violence (IPV) Is Associated with Psychosocial Health Problems Among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Nigeria, Africa

Previous research has shown high rates of intimate partner violence (IPV) among gay, bisexual, and other men who have sex with men (GBMSM). Experiencing IPV may predispose GBMSM to psychosocial health problems. A vast majority of the research on IPV among GBMSM have been conducted in North America and Europe. To date, no published studies that we are aware of have investigated the prevalence and correlates of IPV among GBMSM in West Africa. To fill this gap in research, the present study investigated the prevalence of IPV and its' association with psychosocial health problems in a large multicity sample of community-recruited GBMSM in Nigeria. Bivariate and multivariable logistic regression analyses were utilized to examine associations between sociodemographic characteristics, psychosocial health problems, sexual risk, and experiences of IPV (N = 389). The prevalence of experiencing emotional, physical, sexual, monitoring behaviors, and controlling behavior were 45%, 31%, 20%, 55%, and 22% respectively. Experiencing all types of IPV, except physical violence, was significantly associated with increased odds of having depressive symptoms (Adjusted OR [AOR] 1.79-2.63; 95% confidence interval [CI]: 1.08-4.60) and anxiety (AOR 1.63-2.63; 95% CI: 1.01-4.18). Experiencing emotional violence (standardized beta [β] = 0.21; standard error [SE] SE = 0.44), physical violence (β = 0.14; SE = 0.48), and controlling behaviors (β = 0.11; SE = 0.54) was associated with increased odds of loneliness. Experiencing all types of IPV was associated with history of suicide thoughts (AOR 2.20-3.68; 95% CI: 1.28-6.32) and suicide attempt (AOR 2.36-3.42; 95% CI: 1.20-6.75). Additionally, we observed a dose-response relationship, whereby increasing number of IPV was associated with a higher likelihood of reporting psychosocial health problems. Lastly, after adjusting for other psychosocial health problems and demographic characteristics, there remained a significant association between experiencing IPV and reporting a history of suicide thoughts and suicide attempt. Consequently, it is imperative that health interventions aimed at improving psychosocial health of GBMSM explore experience and perpetration of IPV.

Prevalence of Intimate Partner Violence and Associated Factors Among Men Who Have Sex with Men in China

Intimate partner violence (IPV) in the heterosexual population has gained increasing public concern in China, but little is known about it among men who have sex with men (MSM).¹ This study aimed to investigate the prevalence of IPV and associated factors among MSM in Chengdu, China. Participants were recruited from a local MSM-friendly health consulting center. This study used the adjusted Intimate Partner Violence Scale among Gay and Bisexual Men (IPV-GBM scale) to capture lifetime IPV experiences including physical, sexual and emotional violence, monitoring, and controlling behaviors. Among 431 participants, 153 (35.5%) reported any IPV experiences, and 119 (27.6%) reported themselves as being the perpetrator. Adjusted logistic regression models revealed that having been engaged in transactional sex was positively associated with victimization through monitoring behaviors (adjusted odds ratio [ORa] = 2.7, 95% confidence interval CI = [1.7, 7.4]) and perpetration of monitoring behaviors (ORa = 3.9, 95% CI = [1.5, 13.3]); drug use was positively associated with victimization through controlling behaviors (unadjusted odds ratio [ORu] = 2.5, 95% CI = [1.2, 5.0]) and emotional violence (ORa = 1.9, 95% CI = [1.0, 3.5]); older age (≥18 years) of first homosexual intercourse was negatively associated with perpetration of physical violence (ORu = 0.3, 95% CI = [0.2, 0.7]) and sexual violence (ORu = 0.4, 95% CI = [0.2, 1.0]); higher self-esteem was negatively associated with both victimization and perpetration of sexual and emotional violence. We found that victimization and perpetration experiences were correlated in all dimensions of IPV. Violence was prevalent among MSM and merits public attention. This study provides more evidence about IPV among Chinese MSM and identifies two significant factors contributing to IPV (self-esteem and age of first homosexual intercourse), which have been overlooked in previous studies. Researchers should take these factors into consideration for interventions developments.

Prevalence of Intimate Partner Violence Among Men Who Have Sex With Men: An Updated Systematic Review and Meta-Analysis

Introduction

Intimate partner violence (IPV) among men who have sex with men (MSM) has become a serious and widespread public health issue, which might result in low quality of life and increase the global burden of diseases.

Aim

To quantitatively estimate the pooled prevalence of IPV and its specific forms (physical violence, sexual violence and emotional violence) among MSM.

Methods

Databases of PubMed, Cochrane Library, CINAHL, MEDLINE, PsycINFO, CNKI, WANFANG Data, and Weipu (CQVIP) Data were searched for identified studies published between January 1990 and August 2020. Random effect meta-analyses were used to synthesize the pooled prevalence and 95% CIs of IPV.

Main Outcome Measures

The pooled prevalence of IPV in victimization and in perpetration among MSM.

Results

A total of 52 studies with 32,048 participants were included for final analysis. The pooled prevalence of IPV was 33% (6,342 of 19,873; 95%CI, 28–39%) in victimization and 29% (1,491 of 5,983; 95%CI, 17 –40%) in perpetration across all recall periods among MSM population. Furthermore, the pooled prevalence of physical violence was 17% (3,979 of 22,928; 95%CI, 14 –20%) and 12% (942 of 9,236; 95%CI, 10 –15%), of sexual violence was 9% (1,527 of 19,511; 95%CI, 8 –11%) and 4% (324 of 8,044; 95%CI, 3 –5%), of emotional violence was 33% (5,147 of 17,994; 95%CI, 25 –40%) and 41% (1,317 of 3,811; 95%CI, 17 –65%) in victimization and perpetration, respectively. Out of all the IPV identified, emotional violence was estimated at the highest level.

Conclusion

This study demonstrated a high prevalence of IPV both in victimization and perpetration among MSM, and emotional violence was estimated at the highest level out of all IPV forms. Efforts are needed to develop corresponding prevention programs for victims with an intent to increase the accessible availability of health services, and ultimately improve their life quality.

Liu M., Cai X., Hao G. et al., Prevalence of Intimate Partner Violence Among Men Who Have Sex With Men: An Updated Systematic Review and Meta-Analysis. Sex Med 2021;9:100433.

Sexual Partnership-Level Correlates of Intimate Partner Violence Among Men Who Have Sex with Men and Transgender Women in Lima, Peru

To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p < .01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79-8.04), partner concurrency (4.42, 1.19-16.40), and participant alcohol (4.71, 1.82-12.17) or drug use (5.38, 2.22-13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01-7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use.

Multilevel factors associated with perpetration of five types of intimate partner violence among men who have sex with men in China: an ecological model-informed study

In China, intimate partner violence (IPV) among men who have sex with men remains poorly investigated. Informed by the ecological model, this study explored multilevel factors associated with perpetration of IPV among men who have sex with men. The participants were recruited from 15 cities in mainland China. Univariate and multivariate regression analyses showed that the prevalence of committing physical, sexual, monitoring, controlling and emotional IPV was 8.6%, 7.1%, 15.2%, 7.6% and 17.1%, respectively. Committing physical IPV showed a positive association with perceived public discrimination and self-stigma towards homosexuality. Committing sexual IPV showed a positive association with involvement with a homosexual support agency and more sex partners. Monitoring IPV was positively associated with higher education and perceived stress, but negatively associated with instrumental and emotional support. Committing controlling IPV showed a positive association with drug use during sex and self-stigma but a negative association with self-esteem, self-efficacy and older age at first homosexual sex. Committing emotional IPV showed a positive association with commercial sex behaviour and perceived stress, but a negative association with resilience. Committing IPV was prevalent in this population. It is necessary to distinguish the various types of IPV in future studies, given their differences in associated factors.

The health impacts of violence perpetrated by police, military and other public security forces on gay, bisexual and other men who have sex with men in El Salvador

Gay, bisexual and other men who have sex with men face both high levels of violence and a disproportionate burden of poor health outcomes. We explored violence perpetrated against Salvadoran gay, bisexual and other men who have sex with men by public security forces; perceived motivations of violence; and impacts on health. We conducted structured qualitative interviews with 20 participants and used systematic coding and narrative analysis to identify emergent themes. Nearly all participants described the physical, emotional, sexual and/or economic violence by public security forces. Most attributed being targeted to their gender expression and/or perceived sexual orientation. The most common impact was emotional distress, including humiliation, fear and depression; lasting physical injuries were also widely reported. Study participants felt unable to report these incidents for fear of retribution or inaction. Men reported feelings of helplessness and distrust, avoidance of authorities and altering when, where or how often they appeared in public spaces. Programmes and interventions should focus on providing mental health services for LGBTI (lesbian, gay, bisexual, transgender and intersex) victims of violence, educating public security forces on the legal rights of Salvadorans and expanding current LGBTI-inclusive policies to all public security forces.

Prevalence of poppers use and its sexual risks among men who have sex with men in southwestern China: a cross-sectional study

Background

To investigate the prevalence of poppers use and its relationship with sexual risk behaviors among men who have sex with men (MSM) in southwestern China.

Methods

This cross-sectional study was conducted in three cities of southwestern China between July and September 2016. Anonymous questionnaire survey was administered to collect data on demographics, drug use, sexual behaviors, history of STIs and HIV infection. Logistic regression analysis was performed to explore factors correlated with sexual risk behaviors including group sex and unprotected anal intercourse (UAI).

Results

Of the 1122 participants included in the study, 24.1% reported a history of poppers use. 11.6% MSM reported ever engaging in group sex and 36.2% participants reported UAI with non-regular male partners in the past 12 months. Multivariate logistic analysis showed that age > 25 (OR = 2.96, 95% CI 1.87–4.68), seeking sex partners through the internet (OR = 3.16, 95% CI 1.59–6.29), preferring receptive anal intercourse (OR = 1.91, 95% CI 1.12–3.26) and ever using poppers (OR = 1.88, 95% CI 1.25–2.83) were positively associated with engaging in group sex. Lower levels of education (OR = 1.93, 95% CI 1.33–2.80) and ever using poppers (OR = 1.44, 95% CI 1.01–2.05) were significantly correlated with UAI with non-regular partners.

Conclusions

The study suggested poppers was prevalent among MSM and its use was significantly associated with sexual risk behaviors. Given high prevalence of HIV among this subpopulation, comprehensive measures are needed to decrease poppers use and its potential risk for HIV transmission in southwestern China.

Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US

Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N = 532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs > 6), multiple sex partnerships (AORs > 1.8), and condomless sex in the context of substance use (AORs > 3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release.

A Study of Intimate Partner Violence, Substance Abuse, and Sexual Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex With Men in a Sample of Geosocial-Networking Smartphone Application Users

Geosocial-networking smartphone applications ("apps") are widely used by gay, bisexual, and other men who have sex with men (MSM) and facilitate connections between users based on proximity and attraction. MSM have sexual encounters and relationships of varying degrees of emotional and physical intimacy with app-met individuals, potentially placing them at risk for intimate partner violence (IPV). The purpose of the current study was to utilize a geosocial-networking application to investigate relationships between experiences of IPV victimization as it relates to substance use and sexual risk behaviors in a sample of MSM. Participants ( n = 175) were recruited by means of broadcast advertisements on an application widely used by MSM (Grindr) to seek sexual partners. Multivariable regression models were fit to examine associations between IPV, substance abuse, and sexual risk behaviors. Lifetime experiences of IPV victimization were common, where 37.7% of respondents reported having experienced at least one form of IPV. While a marginally significant positive association between IPV and substance abuse was detected in multivariable models ( p = .095), individual forms of IPV were strongly associated with substance abuse. For example, sexual IPV victimization was associated with an increase in substance abuse in the preceding month ( p = .004). Experiences of IPV victimization were associated with higher numbers of partners for both condomless receptive and insertive anal intercourse ( p < .05). Given the relatively high prevalence of IPV victimization and its associations with substance abuse and sexual risk behaviors, these findings suggest that IPV screening and prevention programs may reduce substance abuse and sexual risk behaviors in this population.

Intimate Partner Violence Correlates With A Higher HIV Incidence Among MSM: A 12-Month Prospective Cohort Study in Shenyang, China

Intimate partner violence (IPV) and HIV are highly prevalent worldwide among MSM. However, the association between IPV and HIV seroconversion is virtually unknown. This 12-month prospective cohort study was conducted among MSM in Shenyang, China to explore the causality between IPV and the incidence of HIV. Adjusted Hazard Ratios (aHRs) of HIV acquisition were derived from a multivariate time-dependent Cox model and applied to calculate population attributable fractions (PAFs). Among 476 HIV-negative MSM subjects, 89(18.7%) reported being victims of IPV in the past 3 months (P3M). IPV was significantly correlated with lower education, having more condomless anal intercourse (CAI) and being depressed (each P < 0.05). The incidence of HIV among IPV victims was 11.3/100 PY compared to 3.8/100 PY in non-IPV-victims. Furthermore, IPV victimization was independently associated with HIV seroconversion (aHR = 4.1, PAF = 37.9%). Other predictors for seroconversion included non-local residence in Liaoning province (aHR = 3.9, PAF = 45.2%), engaging in condomless receptive anal intercourse (CRAI)(aHR = 3.1, PAF = 24.2%) or CAI with casual male partners (aHR = 3.8, PAF = 26.3%) in the P3M and syphilis infection (aHR = 4.7, PAF = 33.7%) (each P < 0.05). IPV increased the HIV seroconversion risk of MSM, with a high PAF. HIV prevention programs should integrate IPV screening and intervention, and MSM affected by IPV need to be preferentially enrolled in pre-exposure prophylaxis.

Recreational Drug Use among Chinese MSM and Transgender Individuals: Results from a National Online Cross-Sectional Study

Background

Recreational drug use has increased considerably among Chinese men who have sex with men (MSM). The phenomenon has the potentially to increase HIV transmission among Chinese MSM. The aims of this study were: 1) to investigate the prevalence of recreational drug use among Chinese MSM, and 2) to explore the correlation between gay smartphone based sex-seeking applications (gay apps), HIV/STIs testing, group sex, commercial sex, sexual roles and poppers use among Chinese MSM.

Methods

MSM who were born biologically male, were at least 16 years of age and had engaged in anal sex with a man at least once were recruited through a nation-wide online survey in 2014. Information regarding socio-demographics, risk behaviors, recreational drug use, HIV and other STIs testing history and gay app use were collected. Univariate and multivariate analysis were used to determine factors associated with recreational drug use among Chinese MSM.

Results

Among 1424 participating MSM, 1100 (77.3%) reported ever using recreational drugs in their lifetime. In the last 12 months, 303 (21.3%) used poppers, 34 (2.4%) used crystal meth and 15 (1.0%) used ecstasy. The mean age of respondents was 25.6±6.8 years, 72.9% identified as gay, 41.3% were students, and 83.8% had never been married. Multiple logistic regression models revealed that compared with non-popper users, popper users were more likely to have been tested for HIV (adjusted OR (aOR) = 1.50, 95% CI: 1.15–1.96) and other STIs (aOR = 1.65, 95% CI: 1.26–2.17). In addition, popper users were more likely to engage in group sex (aOR = 2.63, 95% CI:1.80–3.86), commercial sex (aOR = 1.86, 95% CI:1.13–3.06) and used gay mobile apps to seek sexual partners (aOR = 2.10, 95% CI:1.58–2.80).

Conclusion

Chinese MSM has a high rate of recreational drug use, including poppers. Public health programs serving MSM may consider integrating intervention programs to decrease recreational drug use related harms.

INTIMATE PARTNER VIOLENCE IS ASSOCIATED WITH INCREASED CD4+ T-CELL ACTIVATION AMONG HIV-NEGATIVE HIGH-RISK WOMEN

Background:

Biological pathways mediating the link between intimate partner violence (IPV) and increased HIV risk remain unexplored. We hypothesized that IPV-induced stress negatively affects HIV systemic immune defenses and aimed to evaluate whether IPV was associated with immune profiles linked to HIV susceptibility: CD4 activation and diminished regulatory T-cell (Treg) frequency.

Methods:

Seventy-five HIV-negative high-risk women were surveyed regarding their IPV experience. They provided blood, urine, and (if present) genital ulcer samples for cortisol, immune assays, and STI testing. Using flow cytometry, we assessed activated CD4⁺ T-cell (%HLA-DR⁺/ CD38⁺) and Treg (%CD4⁺CD25⁺FoxP3⁺) frequencies and phenotyping. Nonparametric tests evaluated the association between IPV and immune outcomes. Multivariate regression explored confounding and moderation of the IPV-CD4 activation pathway.

Results:

Lifetime IPV was associated with increased CD4⁺ activation (r = 0.331, P = 0.004), a shift in CD4⁺ phenotype from naïve to effector memory (r = 0.343, P = 0.003), and a decrease in naive (%HLA-DR⁺/CD45RA^-) Treg frequency (r = -0.337, P = 0.003). Experiencing IPV over the past year had similar trends. After controlling for sexual IPV, lifetime physical and psychological abuse remained significantly associated with CD4⁺ activation (P = 0.004 and P = 0.033, respectively). After controlling for race (the only covariate linked to activation), the lifetime IPV-CD4 activation association remained significant (P = 0.012). Alcohol use and depression were identified as potential pathway moderators.

Conclusion:

Our data is the first to suggest an immune link between IPV and HIV, and may help explain differences at the individual level in HIV susceptibility and response to biological HIV prevention strategies. The association of psychological and physical abuse with CD4 activation independent of sexual abuse further supports the existence of a stress-induced immune pathway.

Occurrence and impact of domestic violence and abuse in gay and bisexual men: A cross sectional survey

This cross-sectional survey measured adult experience and perpetration of negative and potentially abusive behaviours with partners and its associations with mental and sexual health problems, drug and alcohol abuse in gay and bisexual men attending a UK sexual health service. Of 532 men, 33.9% (95% CI: 29.4-37.9) experienced and 16.3% (95% CI: 13.0-19.8) reported carrying out negative behaviour. Ever being frightened of a partner (aOR 2.5; 95% CI: 2.0-3.1) and having to ask a partner's permission (aOR 2.7; 95% CI: 1.6-4.7) were associated with increased odds of being anxious. There were increased odds of cannabis use in the last 12 months amongst men who reported ever being physically hurt (aOR 2.4; 95% CI: 1.7-3.6). Being frightened (aOR 2.2; 95% CI: 1.5-3.2), being physically hurt (aOR 2.3; 95% CI: 1.4-3.8), being forced to have sex (aOR 2.5; 95% CI: 1.3-4.9) and experiencing negative behaviour in the last 12 months (aOR 1.7; 95% CI: 1.2-2.5) were associated with increased odds of using a Class A drugs in the last 12 months. Sexual health practitioners should be trained with regards to the risk indicators associated with domestic violence and abuse, how to ask about domestic violence and abuse and refer to support.

What are the risk factors for HIV in men who have sex with men in Ho Chi Minh City, Vietnam?- A cross-sectional study

BACKGROUND

The number of people living with HIV (PLWH) in Vietnam was estimated to rise from 156,802 in 2009 to 256,000 in 2014. Although the number of new HIV reported cases has decreased by roughly 14,000 cases per year from 2010 to 2013 a concerning increase in HIV prevalence has been identified among men who have sex with men (MSM) from 1.7 % in 2005 to 2.4 % in 2013. There are signs of increased HIV (+) prevalence among MSM in a number of cities/provinces, especially in the two largest cities, Ho Chi Minh City (HCMC) and Hanoi. HCMC is the country's major "hot spot" for HIV/AIDS, with over a third of the total national AIDS patients. This paper is based on a secondary analysis of Integrated Biological and Behavioural Surveillance (IBBS) data collected in Vietnam in 2009 to examine the research question "Do behavioural risk factors contribute to HIV infection among the MSM population in HCMC?".

METHODS

A cross-sectional design was employed to sample males aged over 15 from communities in HCMC, who reported having any types of sex with another man at least once during the last 12 months. Participants (399) were recruited using the respondent driven sampling (RDS) method and provided both biological data (specimens) and behavioural data collected through a questionnaire survey.

RESULTS

The study found high HIV prevalence (14.8 %) among the MSM sample from HCMC. Multivariate analysis found age and level of formal education completed, to be significantly associated with HIV infection. MSM aged over 25 were more likely to be HIV (+) than the younger group (OR = 7.82, 95 %CI = 3.37-18.16, p < 0.001); as were participants who had low educational (OR = 2.74, p < 0.05) and medium educational levels (OR = 2.68, p < 0.05). In addition, those participants who had anal sex with male partners (OR = 2.7, p < 0.05) and whose sexual partners injected drugs (OR = 2.24, p < 0.05) and who felt at risk of HIV infection (OR = 2.42, p < 0.01) had a higher risk of HIV infection.

CONCLUSIONS

The high proportion of HIV (+) MSM in our sample from HCMC indicates that we need a better understanding of MSM behaviour patterns, risk practices and social networks as well as improved HIV prevention and control measures. More targeted and relevant HIV prevention programs for older and less educated MSM are urgently needed to address the key risk factors we have identified. MSM engaging in drug-related risk behaviours require multi-strategy HIV interventions relating to both sex and drug behaviour among MSM and their partners who engage in drug use. Further work is needed to identify locations and strategies where these high-risk individuals can be accessed as well as to reduce barriers related to social discrimination and stigma. Targeting high risk individuals and groups should supplement existing efforts aimed at the MSM population in HCMC.

Poppers use and risky sexual behaviors among men who have sex with men in Beijing, China

BACKGROUND

Although poppers are increasingly popular among MSM in China, little is known about the patterns of poppers use. The objectives of this study were to describe the patterns of poppers use and examine its association with sexual behaviors and HIV infection among MSM in Beijing, China.

METHODS

As part of a multi-component HIV intervention trial, 3588 MSM were surveyed between March 2013 and March 2014 in Beijing, China. Blood samples were collected and tested for HIV and syphilis. The questionnaire collected information about socio-demographic and behavioral characteristics. Univariate and multivariable logistic regression analyses were performed to evaluate the correlates of poppers use.

RESULTS

Over a quarter of men (27.5%) reported having used at least one type of drugs in the past three months. Poppers were the most popular one (26.8%). Poppers use was correlated with a higher HIV prevalence [odds ratio (OR): 1.38, 95% confidence interval (CI): 1.11-1.70]. Demographic and sexual behavioral factors associated with poppers use included: younger age [adjusted OR (AOR): 1.56, 95% CI: 1.25-1.94], higher education (AOR: 1.61, 95% CI: 1.33-1.96), alcohol use (AOR: 1.32, 95% CI: 1.10-1.60), seeking male partners mainly via the internet (AOR: 1.60, 95% CI: 1.28-2.00), multiple male sex partnership (AOR: 2.22, 95% CI: 1.90-2.60), and unprotected receptive anal intercourse (AOR: 1.52, 95% CI: 1.28-1.81).

CONCLUSIONS

In this study, poppers use was positively associated with HIV infection and unprotected anal intercourse. Intervention efforts should be devoted to promote safer sex and HIV testing and counseling among MSM who use poppers.

Experiences of Intimate Partner Violence and Subsequent Police Reporting Among Lesbian, Gay, Bisexual, Transgender, and Queer Adults in Colorado: Comparing Rates of Cisgender and Transgender Victimization

Research indicates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at high risk of victimization by others and that transgender individuals may be at even higher risk than their cisgender LGBQ peers. In examining partner violence in particular, extant literature suggests that LGBTQ individuals are at equal or higher risk of partner violence victimization compared with their heterosexual peers. As opposed to sexual orientation, there is little research on gender identity and partner violence within the LGBTQ literature. In the current study, the authors investigated intimate partner violence (IPV) in a large sample of LGBTQ adults (N = 1,139) to determine lifetime prevalence and police reporting in both cisgender and transgender individuals. Results show that more than one fifth of all participants ever experienced partner violence, with transgender participants demonstrating significantly higher rates than their cisgender peers. Implications focus on the use of inclusive language as well as future research and practice with LGBTQ IPV victims.

Intimate Partner Violence and Sex Among Young Men Who Have Sex With Men

PURPOSE

Among young men who have sex with men (YMSM) few studies have examined the relationship between intimate partner violence (IPV) perpetration versus victimization and sexual behaviors.

METHODS

Using data from n = 528 urban YMSM, multinomial logistic regression models were built to examine the distinct relationships between any IPV, victimization, and perpetration with condomless sex in the previous 30 days, controlling for key sociodemographic characteristics.

RESULTS

In this sample of YMSM, lifetime experience of any IPV was associated with increased odds of recent condomless oral (adjusted odds ratio [AOR] = 1.81, 95% confidence interval [CI] = 1.21-2.72) and anal receptive sex (AOR= 2.29, 95% CI = 1.22-4.31). IPV victimization was associated with a greater likelihood of condomless receptive anal sex (AOR= 2.12, 95% CI = 1.15-3.93) whereas IPV perpetration was associated with increased odds of condomless receptive (AOR= 2.11, 95% CI = 1.14-3.91) and insertive (AOR= 2.21, 95% CI = 1.06-4.59) anal sex.

CONCLUSIONS

Among YMSM, reports of both IPV perpetration and victimization were associated with increased odds of recent condomless sex. These findings indicate that the need for IPV prevention and intervention programs for this new generation of YMSM is highly warranted.

Intimate partner violence and substance use risk among young men who have sex with men: The P18 cohort study

OBJECTIVES

Substance use is prevalent among young men who have sex with men (YMSM) and may be associated with intimate partner violence (IPV). Experiences of IPV are associated with several adverse health conditions among adult MSM, but there is a gap in knowledge about this relationship among YMSM, which warrants further investigation.

METHODS

This study employs baseline data from a prospective cohort study to examine lifetime experiences of IPV in relation to substance use in the previous 30 days among n=528 YMSM in New York City from 2009 to 2011. To examine the extent to which IPV (any experiences, victimization, and perpetration) are related to substance use (alcohol, marijuana, stimulant, and other drugs) in the last 30 days, distinct 2-step multinomial logistic regression models, controlling for sociodemographic differences, were constructed.

RESULTS

44.3% reported lifetime IPV experience, with 39.2% of reporting victimization and 30.5% reporting perpetration. IPV is associated with a 1.6 increased odds of 2 or more instances of alcohol use, a 1.6-1.8 increased odds of 2 or more instances of marijuana use, a 1.8-2.5 increased odds of 2 or more instances of stimulant use, and a 4.1-6.1 increased odds of 2 or more instances of other substance use.

CONCLUSION

Findings highlight the strong association between IPV and increased frequency of substance use among YMSM and provide support that violence may exist as part of a syndemic facing YMSM. Prevention and intervention strategies may be improved by addressing substance use in the context of IPV and other related health challenges.

Club Drugs and HIV/STD Infection: An Exploratory Analysis among Men Who Have Sex with Men in Changsha, China

OBJECTIVE

To evaluate current club drug use and its potential association with the transmission of HIV/STD among Changsha men who have sex with men (MSM).

METHOD

A cross-sectional survey was conducted by using self-administered questionnaires including information regarding socio-demographics, club drug use, high-risk behaviors, and HIV/STD infections. Multiple methods including venue-based, peer referral using "snowball" techniques, and internet advertisements were used to recruit study participants.

RESULTS

Of the 826 participants, 177 (21.4%) reported that they had used club drugs at some time before or during sex in the past six months. MSM with young age, low education level, and seeking partners through the internet or bars were the main population who used drugs. Poppers were the most common drug used among Changsha MSM. The prevalence of HIV, syphilis, and herpes simplex virus-2 were higher among drug users. There were no significant differences in unprotected sexual intercourse and condom use between drug users and non-users. Compared with non-users, risk behaviors such as group sex, multiple sex partners, and sex with foreigners were more frequent among drug users.

CONCLUSION

Club drug use is common among Changsha MSM, and is related to unsafe sex activities and HIV/STD infection. It is necessary to build novel targeted HIV prevention strategies to monitor and reduce club drug use among MSM.

Complex drug use patterns and associated HIV transmission risk behaviors in an Internet sample of U.S. men who have sex with men

Although the relationship between drug use and HIV risk among men who have sex with men (MSM) is well described, relatively few studies have employed empirical methods to assess underlying classes of drug use that may better predict the risk of HIV or sexually transmitted infections (STIs) among MSM. The aim of this study was to determine whether latent class analysis (LCA) would identify underlying drug classes reported prior to sex, as well as predict unprotected anal intercourse (UAI) in the last sexual encounter among MSM. From 2004 to 2005, an anonymous online survey was conducted among 8,717 sexually active MSM recruited from gay-affiliated U.S. websites. LCA clustered participants into six distinct drug use classes based on the specific types and number of drugs used: (1) low/no drug use, (2) recreational drug use, (3) poppers with prescription erectile dysfunction (ED) drug use, (4) poppers with both prescription and non-prescription ED drug use, (5) recreational, club, and ED drug use, and (6) high polydrug use. Compared with men in Class 1, men in the highest drug use class were 4.84 times more likely to report UAI in their last sexual encounter and 3.78 times more likely to report an STI in the past year (both ps < .001). Younger MSM aged 18-29 were significantly more likely to report an STI than men aged 50 and above (p < .001). There is a need to better understand the complex relationship between a diverse set of drugs used among MSM and how polydrug use impacts sexual negotiation over time.

Amphetamine-type stimulants and HIV infection among men who have sex with men: implications on HIV research and prevention from a systematic review and meta-analysis

Introduction

HIV infections and the use of amphetamine-type stimulants (ATS) among men who have sex with men (MSM) have been increasing internationally, but the role of ATS use as a co-factor for HIV infection remains unclear. We aimed to summarize the association between ATS use and HIV infection among MSM.

Methods

We conducted a systematic search of MEDLINE, EMBASE, GLOBAL HEALTH and PsycINFO for relevant English, peer-reviewed articles of quantitative studies published between 1980 and 25 April 2013. Pooled estimates of the association – prevalence rate ratios (PRR, cross-sectional studies), odds ratio (OR, case-control studies) and hazard ratio (HR, longitudinal studies), with 95% Confidence Intervals (CI) – were calculated using random-effects models stratified by study design and ATS group (meth/amphetamines vs. ecstasy). We assessed the existence of publication bias in funnel plots and checked for sources of heterogeneity using meta-regression and subgroup analysis.

Results

We identified 6710 article titles, screened 1716 abstracts and reviewed 267 full text articles. A total of 35 publications were eligible for data abstraction and meta-analysis, resulting in 56 records of ATS use. Most studies (31/35) were conducted in high-income countries. Published studies used different research designs, samples and measures of ATS use. The pooled association between meth/amphetamine use and HIV infection was statistically significant in all three designs (PRR=1.86; 95% CI: 1.57–2.17; OR=2.73; 95% CI: 2.16–3.46 and HR=3.43; 95% CI: 2.98–3.95, respectively, for cross-sectional, case-control and longitudinal studies). Ecstasy use was not associated with HIV infection in cross-sectional studies (PRR=1.15; 95% CI: 0.88–1.49; OR=3.04; 95% CI: 1.29–7.18 and HR=2.48; 95% CI: 1.42–4.35, respectively, for cross-sectional, case-control and longitudinal studies). Results in cross-sectional studies were highly heterogeneous due to issues with ATS measurement and different sampling frames.

Conclusions

While meth/amphetamine use was significantly associated with HIV infection among MSM in high-income countries in all study designs, evidence of the role of ecstasy in HIV infection was lacking in cross-sectional studies. Cross-sectional study design, measurement approaches and source populations may also be important modifiers of the strength and the direction of associations. Event-specific measure of individual drug is required to establish temporal relationship between ATS use and HIV infection. HIV prevention programmes targeting MSM should consider including interventions designed to address meth/amphetamine use.

Childhood sexual abuse and HIV-related risks among men who have sex with men in Washington, DC

Childhood sexual abuse (CSA) has been reported to be disproportionately higher among men who have sex with men (MSM) than among heterosexual men; it has also been found to be significantly positively associated with HIV status and HIV risk factors, including unprotected anal intercourse. The purpose of this study was to assess the correlates of CSA in a sample of community-recruited MSM, investigate race as a potential effect modifier, and describe the independent association between CSA and HIV infection in Washington, DC. A total of 500 MSM were recruited by venue-based sampling in 2008 as part of the National HIV Behavioral Surveillance. More than one-half of MSM identified as White, while one-third identified as Black. CSA was reported by 17.5 % of the 451 MSM, with the first instance of abuse occurring at a median age of 8.3 (interquartile range = 5.0, 11.0). In multivariable analysis, HIV-positive men were significantly more likely to report a history of CSA compared to HIV-negative men after adjusting for intimate partner violence in the last 12 months, having been arrested in the last 12 months, and depressive symptoms. HIV-positive MSM had more than four times the odds of reporting CSA after controlling for other correlates (aOR = 4.19; 95 % CI 2.26, 7.75). Despite hypothesizing that race modified the effect of CSA on HIV infection we found this was not the case in this sample. More research is needed to investigate the potential pathway between a history of CSA and HIV infection, and how this contributes to driving the HIV epidemic among MSM in Washington, DC.

Recreational drug use among Chinese men who have sex with men: a risky combination with unprotected sex for acquiring HIV infection

Objective. To investigate the prevalence of recreational drug use and its relationship with HIV infection among Chinese MSM. Methods. A cross-sectional study of 625 MSM was conducted in Shenyang, China. Questionnaires were administered to collect information on recreational drug use and sexual behaviors. Blood specimens were collected to test for HIV and syphilis antibodies. Results. Nearly a quarter (23.2%, 145/625) of participants reported ever using recreational drugs, among which alkyl nitrites (poppers) was the most frequently used drug (19.2%), followed by methylmorphine phosphate (5.1%), methamphetamine (4.0%), and ketamine (0.8%). The overall prevalence of HIV and syphilis was 9.6% and 10.4%, respectively. Multivariate logistic analysis showed that recreational drug use was significantly correlated with age ≤25 year (adjusted odds ratio [aOR] = 1.6, 95% CI, 1.1–2.9), single marital status (aOR = 2.1, 95% CI, 1.2–3.6), and seeking male sexual partners mainly through Internet (aOR = 1.8, 95% CI, 1.8–2.8). Recreational drug use was independently associated with an increased risk of HIV infection (aOR = 3.5, 95% CI, 2.0–6.2). Conclusions. Our study suggests that recreational drug use is popular among Chinese MSM and is associated with significantly increased HIV infection risk. HIV prevention intervention programs should reduce both drug use and risky sexual behaviors in this population.

Associations between intimate partner violence and health among men who have sex with men: a systematic review and meta-analysis

BACKGROUND

Intimate partner violence (IPV) among men who have sex with men (MSM) is a significant problem. Little is known about the association between IPV and health for MSM. We aimed to estimate the association between experience and perpetration of IPV, and various health conditions and sexual risk behaviours among MSM.

METHODS AND FINDINGS

We searched 13 electronic databases up to 23 October 2013 to identify research studies reporting the odds of health conditions or sexual risk behaviours for MSM experiencing or perpetrating IPV. Nineteen studies with 13,797 participants were included in the review. Random effects meta-analyses were performed to estimate pooled odds ratios (ORs). Exposure to IPV as a victim was associated with increased odds of substance use (OR = 1.88, 95% CI(OR) 1.59-2.22, I² = 46.9%, 95% CI(I)² 0%-78%), being HIV positive (OR = 1.46, 95% CI(OR) 1.26-1.69, I² = 0.0%, 95% CI(I)² 0%-62%), reporting depressive symptoms (OR = 1.52, 95% CI(OR) 1.24-1.86, I² = 9.9%, 95% CI(I)² 0%-91%), and engagement in unprotected anal sex (OR = 1.72, 95% CI(OR) 1.44-2.05, I² = 0.0%, 95% CI(I)² 0%-68%). Perpetration of IPV was associated with increased odds of substance use (OR = 1.99, 95% CI(OR) 1.33-2.99, I² = 73.1%). These results should be interpreted with caution because of methodological weaknesses such as the lack of validated tools to measure IPV in this population and the diversity of recall periods and key outcomes in the identified studies.

CONCLUSIONS

MSM who are victims of IPV are more likely to engage in substance use, suffer from depressive symptoms, be HIV positive, and engage in unprotected anal sex. MSM who perpetrate IPV are more likely to engage in substance use. Our results highlight the need for research into effective interventions to prevent IPV in MSM, as well as the importance of providing health care professionals with training in how to address issues of IPV among MSM and the need to raise awareness of local and national support services.

A systematic review of the frequency and correlates of partner abuse in HIV-infected women and men who partner with men

Partner abuse (PA) is a highly prevalent and devastating social phenomenon, extracting an economic toll of more than $8 billion annually in the United States due to lost productivity alone. Many of the risk factors for PA increase vulnerability to acquiring HIV as well, yet little research has explored these overlapping epidemics. In this systematic review, we examine the frequency of PA victimization from male partners among persons living with HIV-both men who have sex with men (MSM) and women. We located 31 manuscripts reporting data from 24 unique samples, indicating a high lifetime frequency (but large range) of estimates for women/MSM, respectively, for physical (26-62%/15-39%), sexual (22-44%/8-33%), and psychological abuse (55%/22-73%). Data indicate strong and consistent associations of PA with poor mental health, engagement in health risk behaviors, and nonadherence to HIV medication for both groups. We discuss implications for clinical practice as well as future research directions.