Factors Associated with Condom Use among a Sample of Men Who Have Sex with Men (MSM) Residing in Rural Oklahoma

Sexual (Risk) Behavior and Risk-Reduction Strategies of Home-Based Male Sex Workers Who Have Sex with Men (MSW-MSM) in The Netherlands: A Qualitative Study

An understanding of sexual (risk) behavior is necessary to successfully develop prevention and care strategies for the sexually transmitted infections (STI) high-risk group of male sex workers who have sex with men (MSW-MSM). However, limited scientific knowledge is available on sexual (risk) behavior of (home-based) MSW-MSM. This study aimed to gain an understanding of sexual (risk) behavior, factors influencing sexual (risk) behavior, and applied risk-reduction strategies of home-based MSW-MSM. For this qualitative study, semi-structured individual interviews were conducted with 20 home-based MSW-MSM in the Netherlands. The interviews' recordings were transcribed verbatim and thematically analyzed with Atlas.ti 8. Condom use was reported to be high during anal sex, but low during oral sex and mostly determined by STI risk perception, trust in clients, and sexual pleasure. Many experienced condom failure, while few knew what to do after condom failure and were aware of post-exposure prophylaxis (PEP). Many MSW-MSM had chemsex in the past 6 months in order to loosen up and enhance sexual pleasure. Some were not vaccinated against hepatitis B virus (HBV), mainly due to the lack of information and awareness of HBV vaccination and low risk perception of HBV. The results of this study can be used to tailor future STI/HIV risk-reduction strategies for home-based MSW-MSM and to increase awareness and uptake of available STI/HIV prevention strategies such as P(r)EP and HBV vaccination.

The Potential Risk Compensation after Receiving HPV Vaccination among Men Who Have Sex with Men in Southwest China: A HAPA-Based Analysis

Background: men who have sex with men (MSM) are a high-risk group for human papillomavirus (HPV) infection, and the HPV vaccine is effective in preventing it. However, according to risk compensation theory, people may increase sexual risk behaviors after receiving HPV vaccination. Based on the Health Action Process Approach (HAPA), this study investigated the influencing factors to predict intention to reduce condom use (risk compensation intention) among MSM after taking HPV vaccination in southwest China. Methods: we conducted a cross-sectional study among 948 MSM in southwest China using a non-probability sampling method and an electronic questionnaire including sociodemographic characteristics, sexual risk behavior characteristics, HPV-related prevention behavior, and the HAPA scale. Confirmatory factor analysis was performed using a structural equation model. Results: among 948 MSM, the incidence rate of reducing the frequency of condom use was 14.1%. The structural equation model showed that self-efficacy (β = -0.378, p = 0.020) and positive outcome expectancy (β = 0.366, p < 0.05) had greater effects on behavioral intention, followed by negative outcome expectancy (β = -0.296, p < 0.05) and risk perception (β = -0.232, p < 0.05). Conclusions: risk compensation may not be a major barrier to receiving HPV vaccination among MSM. Nevertheless, the recognition of possible risk compensation is necessary to implement appropriate interventions to reduce the occurrence of risk compensation.

Condom Use Among Male Sex Workers With Their Male Clients in Mombasa, Kenya: Results of a Sub-analysis of a Pilot, Multilevel, Structural, HIV Risk-Reduction Intervention

ABSTRACT

Despite the advent of preexposure prophylaxis, consistent condom use continues to be recommended because preexposure prophylaxis does not prevent sexually transmitted infections. This is important for high-risk populations (e.g., male sex workers; MSW) in low-resource, high-HIV/sexually transmitted infection prevalence settings, such as the Mombasa region in Kenya. This study aimed to examine the relationship between MSW's condom use, and their knowledge, beliefs, and attitudes about condoms. MSW (N = 158) completed surveys on their sexual behaviors/practices/attitudes. We used multiple regressions to identify associations between condom use, HIV knowledge/attitudes, and self-efficacy. Three quarters of participants reported always using condoms in the past week, and 64.3% reported always using condoms in the past month with male clients. Mean scores for knowledge and attitudes/self-efficacy toward condoms/safer sex were positively associated with condom use. Interventions to build self-efficacy, such as condom negotiation, and/or bringing up condom use with clients may be useful for Kenyan MSW.

HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey

OBJECTIVES

To estimate HIV prevalence and associated risk factors among men who have sex with men (MSM) in Dar es Salaam, Tanzania following the implementation of the national comprehensive package of HIV interventions for key population (CHIP).

DESIGN

A cross-sectional survey using respondent-driven sampling.

SETTING

Dar es Salaam, Tanzania's largest city.

PARTICIPANTS

Men who occasionally or regularly have sex with another man, aged 18 years and above and living in Dar es Salaam city at least 6 months preceding the study.

PRIMARY OUTCOME MEASURE

HIV prevalence was the primary outcome. Independent risk factors for HIV infection were examined using weighted logistics regression modelling.

RESULTS

A total of 777 MSM with a mean age of 26 years took part in the study. The weighted HIV prevalence was 8.3% (95% CI: 6.3%-10.9%) as compared with 22.3% (95% CI: 18.7%-26.4%) observed in a similar survey in 2014. Half of the participants had had sex with more than two partners in the month preceding the survey. Among those who had engaged in transactional sex, 80% had used a condom during last anal sex with a paying partner. Participants aged 25 and above had four times higher odds of being infected than those aged 15-19 years. HIV infection was associated with multiple sexual partnerships (adjusted OR/AOR, 3.0; 95% CI: 1.8-12.0), not having used condom during last sex with non-paying partner (AOR, 4.1; 95% CI: 1.4-7.8) and ever having engaged in group sex (AOR, 3.4; 95% CI: 1.7-3.6).

CONCLUSION

HIV prevalence among MSM in Dar es Salaam has decreased by more than a half over the past 5 years, coinciding with implementation of the CHIP. It is nonetheless two times as high as that of men in the general population. To achieve the 2030 goal, behavioural change interventions and roll out of new intervention measures such as pre-exposure prophylaxis are urgently needed.

Consistent condom use among men who pay for sex in sub-Saharan Africa: Empirical evidence from Demographic and Health Surveys

BACKGROUND

Paying for sex has often been associated with risky sexual behavior among heterosexual men, and men who pay for sex are considered as a bridging population for sexually transmitted infections. Consistent condom use during paid sex is essential for reducing sexually transmitted infections, including HIV/AIDS. In this study, we assessed the prevalence and predictors of consistent condom use among men who pay for sex in sub-Saharan Africa.

MATERIALS AND METHODS

We pooled data from 29 sub-Saharan African countries' Demographic and Health Surveys. A total of 3,353 men in sub-Saharan Africa who had paid for sex in the last 12 months preceding the surveys and had complete information on all the variables of interest were used in this study. The outcome variable for the study was consistent condom use for every paid sex in the last 12 months. Both bivariate and multivariable logistic regression analyses were carried out. Results were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Statistical significance was declared at p< 0.05.

RESULTS

Overall, the prevalence of consistent condom use during paid sex in sub-Saharan Africa was 83.96% (CI = 80.35-87.56), ranging from 48.70% in Benin to 98% in Burkina Faso. Men aged 35-44 [AOR, 1.39 CI = 1.04-1.49], men in the richest wealth quintile [AOR, 1.96 CI = 1.30-3.00], men with secondary level of education [AOR, 1.69 CI = 1.17-2.44], and men in Burkina Faso [AOR = 67.59, CI = 8.72-523.9] had higher odds of consistent condom use during paid sex, compared to men aged 15-19, those in the poorest wealth quintile, those with no formal education, and men in Benin respectively. Conversely, Muslim men had lower odds [AOR = 0.71, CI = 0.53-0.95] of using condom consistently during paid sex, compared to Christian men.

CONCLUSION

Empirical evidence from this study suggests that consistent condom use during paid sex encompasses complex social and demographic characteristics. The study also revealed that demographic characteristics such as age, wealth quintile, education, and religion were independently related to consistent condom use for paid sex among men. With sub-Saharan Africa having the highest sexual and reproductive health burden in the world, continuous application of evidence-based interventions (e.g., educational and entrepreneurial training) that account for behavioural and social vulnerabilities are required.