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Gao Y, Zhan Y, Sun Y, Zheng W, Zhang W, Fu L, Guo Z, Lin YF, Li Y, Zheng L, Zhan Y, Zhu Z, Duan J, Zhang G, Huang T, Su B, Yu M, Wu G, Ouyang L, Zhao J, Wang G, Zhou Y, Qian HZ, Fitzpatrick T, Vermund SH, Zou H. Efficacy of Voluntary Medical Male Circumcision to Prevent HIV Infection Among Men Who Have Sex With Men : A Randomized Controlled Trial. Ann Intern Med 2024; 177:719-728. [PMID: 38801778 DOI: 10.7326/m23-3317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Observational studies suggest that voluntary medical male circumcision (VMMC) may lower HIV risk among men who have sex with men (MSM). A randomized controlled trial (RCT) is needed to confirm this. OBJECTIVE To assess the efficacy of VMMC in preventing incident HIV infection among MSM. DESIGN An RCT with up to 12 months of follow-up. (Chinese Clinical Trial Registry: ChiCTR2000039436). SETTING 8 cities in China. PARTICIPANTS Uncircumcised, HIV-seronegative men aged 18 to 49 years who self-reported predominantly practicing insertive anal intercourse and had 2 or more male sex partners in the past 6 months. INTERVENTION VMMC. MEASUREMENTS Rapid testing for HIV was done at baseline and at 3, 6, 9, and 12 months. Behavioral questionnaires and other tests for sexually transmitted infections were done at baseline, 6 months, and 12 months. The primary outcome was HIV seroconversion using an intention-to-treat analysis. RESULTS The study enrolled 124 men in the intervention group and 123 in the control group, who contributed 120.7 and 123.1 person-years of observation, respectively. There were 0 seroconversions in the intervention group (0 infections [95% CI, 0.0 to 3.1 infections] per 100 person-years) and 5 seroconversions in the control group (4.1 infections [CI, 1.3 to 9.5 infections] per 100 person-years). The HIV hazard ratio was 0.09 (CI, 0.00 to 0.81; P = 0.029), and the HIV incidence was lower in the intervention group (log-rank P = 0.025). The incidence rates of syphilis, herpes simplex virus type 2, and penile human papillomavirus were not statistically significantly different between the 2 groups. There was no evidence of HIV risk compensation. LIMITATION Few HIV seroconversions and limited follow-up period. CONCLUSION Among MSM who predominantly practice insertive anal intercourse, VMMC is efficacious in preventing incident HIV infection; MSM should be included in VMMC guidelines. PRIMARY FUNDING SOURCE The National Science and Technology Major Project of China.
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Affiliation(s)
- Yanxiao Gao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, and School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (Y.G.)
| | - Yuewei Zhan
- Discipline Development Office, Shenzhen People's Hospital, Shenzhen, China (YueweiZhan)
| | - Yinghui Sun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Y.S.)
| | - Weiran Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Weijie Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Zhihui Guo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Yi-Fan Lin
- Department of Spine Surgery/Orthopaedics, the First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China (Y.-F.L.)
| | - Yuwei Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Lingling Zheng
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China (L.Z.)
| | - Yiqiang Zhan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Zhiqiang Zhu
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Junyi Duan
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Guanghui Zhang
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Tao Huang
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Bin Su
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Maohe Yu
- Tianjin Center for Disease Control and Prevention, Tianjin, China (M.Y.)
| | - Guohui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, China (G.Wu, L.O.)
| | - Lin Ouyang
- Chongqing Center for Disease Control and Prevention, Chongqing, China (G.Wu, L.O.)
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China (J.Z.)
| | - Guanghui Wang
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao, China (G.Wang)
| | - Yepeng Zhou
- Foshan Friend Care Center for AIDS/HIV Control, Foshan, China (Y.Zhou)
| | - Han-Zhu Qian
- Departments of Biostatistics and Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut (H.-Z.Q.)
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, Washington (T.F.)
| | - Sten H Vermund
- Departments of Biostatistics and Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, and Global Virus Network, Baltimore, Maryland (S.H.V.)
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China, and Shenzhen Campus, Sun Yat-sen University, Shenzhen, China (H.Z.)
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2
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Gao Y, Zheng W, Sun Y, Yang L, Guo Z, Li Y, Lin YF, Lu Z, Yuan T, Zhan Y, Qian HZ, Su B, Zhu Z, Duan J, Wang G, Cui X, Ouyang L, Sheng G, Zhou Y, Long A, Yao Y, Fitzpatrick T, Yu M, Wu G, Zou H. Voluntary Medical Male Circumcision and Incident HIV Infection Among Men Who Have Sex With Men in China (The CoM Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47160. [PMID: 37247211 PMCID: PMC10262017 DOI: 10.2196/47160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Systematic reviews and meta-analyses based on observational studies have shown voluntary medical male circumcision (VMMC) may reduce HIV risk among men who have sex with men (MSM). There is a lack of randomized controlled trial (RCT) data assessing the efficacy of VMMC. OBJECTIVE The primary objective of this study was to assess the efficacy of VMMC for preventing HIV acquisition among MSM who primarily engage in insertive anal sex. METHODS A multicenter RCT will be conducted among MSM in 8 cities in China. Eligible participants are men aged 18-49 years who self-report ≥2 male sex partners in the past 6 months, predominantly practice insertive anal sex, and are willing to undergo circumcision. Interested men who satisfy inclusion criteria will be tested for HIV 1 month before enrollment and at enrollment, and only those who are HIV negative will be enrolled. At baseline, all enrolled participants will be asked to report sociodemographic characteristics and sexual behaviors; provide a blood sample for HIV, syphilis, and herpes simplex virus type 2 testing; and provide a penile swab for human papillomavirus testing. Participants will be randomly assigned to the intervention or control group. Those in the intervention group will receive VMMC and undergo a web-based weekly follow-up assessment of postsurgery healing for 6 consecutive weeks. All participants will be tested for HIV at 3-, 6-, 9-, and 12-month follow-ups. All participants will also be asked to report sexual behaviors and undergo repeat herpes simplex virus type 2 and human papillomavirus testing at 6- and 12-month follow-ups. The primary end point is HIV seroconversion. Secondary end points are the safety and satisfaction with VMMC and the changes in sexual behaviors after VMMC. The grouped censored data will be analyzed by intention-to-treat approach. RESULTS Recruitment for the RCT began in August 2020 and continued through July 2022. Data collection is expected to be completed by July 2023, and full data analysis is going to be completed by September 2023. CONCLUSIONS This study will be the first RCT to assess the efficacy of VMMC in preventing HIV infection among MSM. Results from this trial will provide preliminary evidence for the potential efficacy of VMMC to reduce incident HIV infection among MSM. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000039436; https://www.chictr.org.cn/showproj.html?proj=63369. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47160.
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Affiliation(s)
- Yanxiao Gao
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Weiran Zheng
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yinghui Sun
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Luoyao Yang
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Zhihui Guo
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yuwei Li
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yi-Fan Lin
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Zhen Lu
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Tanwei Yuan
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yuewei Zhan
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Han-Zhu Qian
- GlaxoSmithKline plc, Rockville, MD, United States
| | - Bin Su
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhiqiang Zhu
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Junyi Duan
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Guanghui Wang
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao, China
| | - Xin Cui
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao, China
| | - Lin Ouyang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Genshen Sheng
- Shenzhen Rainbow 258 Centre for Men, Shenzhen, China
| | - Yepeng Zhou
- Foshan Pengyou Care and Rescue Center for AIDS Prevention, Foshan, China
| | - Ao Long
- Luzhou Red Ribbon Heart Association, Luzhou, China
| | - Yuming Yao
- Zhitong LGBT Service Center, Guangzhou, China
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Maohe Yu
- Tianjin Municipal Center for Disease Control and Prevention, Tianjin, China
| | - Guohui Wu
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Huachun Zou
- School of Public Health, Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Liu S, Xia D, Wang Y, Xu H, Xu L, Yuan D, Liang A, Chang R, Wang R, Liu Y, Chen H, Hu F, Cai Y, Wang Y. Predicting the risk of HIV infection among internal migrant MSM in China: An optimal model based on three variable selection methods. Front Public Health 2022; 10:1015699. [PMID: 36388367 PMCID: PMC9641070 DOI: 10.3389/fpubh.2022.1015699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Internal migrant Men who have sex with men (IMMSM), which has the dual identity of MSM and floating population, should be more concerned among the vulnerable groups for HIV in society. Establishing appropriate prediction models to assess the risk of HIV infection among IMMSM is of great significance to against HIV infection and transmission. Methods HIV and syphilis infection were detected using rapid test kits, and other 30 variables were collected among IMMSM through questionnaire. Taking HIV infection status as the dependent variable, three methods were used to screen predictors and three prediction models were developed respectively. The Hosmer-Lemeshow test was performed to verify the fit of the models, and the net classification improvement and integrated discrimination improvement were used to compare these models to determine the optimal model. Based on the optimal model, a prediction nomogram was developed as an instrument to assess the risk of HIV infection among IMMSM. To quantify the predictive ability of the nomogram, the C-index measurement was performed, and internal validation was performed using bootstrap method. The receiver operating characteristic (ROC) curve, calibration plot and dynamic component analysis (DCA) were respectively performed to assess the efficacy, accuracy and clinical utility of the prediction nomogram. Results In this study, 12.52% IMMSMs were tested HIV-positive and 8.0% IMMSMs were tested syphilis-positive. Model A, model B, and model C fitted well, and model B was the optimal model. A nomogram was developed based on the model B. The C-index of the nomogram was 0.757 (95% CI: 0.701-0.812), and the C-index of internal verification was 0.705. Conclusions The model established by stepwise selection methods incorporating 11 risk factors (age, education, marriage, monthly income, verbal violence, syphilis, score of CUSS, score of RSES, score of ULS, score of ES and score of DS) was the optimal model that achieved the best predictive power. The risk nomogram based on the optimal model had relatively good efficacy, accuracy and clinical utility in identifying internal migrant MSM at high-risk for HIV infection, which is helpful for developing targeted intervention for them.
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Affiliation(s)
- Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danni Xia
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuxuan Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huifang Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lulu Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Yuan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ajuan Liang
- Renji Hospital, Affiliated With the School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Ruijie Chang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Hu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Fan Hu
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Yong Cai
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Ying Wang
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Jing F, Ye Y, Zhou Y, Zhou H, Xu Z, Lu Y, Tao X, Yang S, Cheng W, Tian J, Tang W, Wu D. Modelling the geographical spread of HIV among MSM in Guangdong, China: a metapopulation model considering the impact of pre-exposure prophylaxis. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2022; 380:20210126. [PMID: 34802265 PMCID: PMC8607146 DOI: 10.1098/rsta.2021.0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Men who have sex with men (MSM) make up the majority of new human immunodeficiency virus (HIV) diagnoses among young people in China. Understanding HIV transmission dynamics among the MSM population is, therefore, crucial for the control and prevention of HIV infections, especially for some newly reported genotypes of HIV. This study presents a metapopulation model considering the impact of pre-exposure prophylaxis (PrEP) to investigate the geographical spread of a hypothetically new genotype of HIV among MSM in Guangdong, China. We use multiple data sources to construct this model to characterize the behavioural dynamics underlying the spread of HIV within and between 21 prefecture-level cities (i.e. Guangzhou, Shenzhen, Foshan, etc.) in Guangdong province: the online social network via a gay social networking app, the offline human mobility network via the Baidu mobility website, and self-reported sexual behaviours among MSM. Results show that PrEP initiation exponentially delays the occurrence of the virus for the rest of the cities transmitted from the initial outbreak city; hubs on the movement network, such as Guangzhou, Shenzhen, and Foshan are at a higher risk of 'earliest' exposure to the new HIV genotype; most cities acquire the virus directly from the initial outbreak city while others acquire the virus from cities that are not initial outbreak locations and have relatively high betweenness centralities, such as Guangzhou, Shenzhen and Shantou. This study provides insights in predicting the geographical spread of a new genotype of HIV among an MSM population from different regions and assessing the importance of prefecture-level cities in the control and prevention of HIV in Guangdong province. This article is part of the theme issue 'Data science approach to infectious disease surveillance'.
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Affiliation(s)
- Fengshi Jing
- Institute for Healthcare Artificial Intelligence, Guangdong Second Provincial General Hospital, Guangzhou 510317, People’s Republic of China
- University of North Carolina Project-China, Guangzhou 510085, People’s Republic of China
- School of Data Science, City University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Yang Ye
- School of Data Science, City University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Yi Zhou
- Faculty of Medicine, Macau University of Science and Technology, Macau SAR, People’s Republic of China
- Zhuhai Center for Diseases Control and Prevention, Zhuhai 519060, People’s Republic of China
| | - Hanchu Zhou
- School of Data Science, City University of Hong Kong, Hong Kong SAR, People’s Republic of China
- School of Traffic and Transportation Engineering, Central South University, Changsha 410075, People’s Republic of China
| | - Zhongzhi Xu
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Ying Lu
- University of North Carolina Project-China, Guangzhou 510085, People’s Republic of China
| | - Xiaoyu Tao
- Faculty of Medicine, Macau University of Science and Technology, Macau SAR, People’s Republic of China
| | - Shujuan Yang
- West China School of Public Health, Sichuan University, Chengdu 610041, People’s Republic of China
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence, Guangdong Second Provincial General Hospital, Guangzhou 510317, People’s Republic of China
- School of Data Science, City University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - Junzhang Tian
- Institute for Healthcare Artificial Intelligence, Guangdong Second Provincial General Hospital, Guangzhou 510317, People’s Republic of China
| | - Weiming Tang
- Institute for Healthcare Artificial Intelligence, Guangdong Second Provincial General Hospital, Guangzhou 510317, People’s Republic of China
- University of North Carolina Project-China, Guangzhou 510085, People’s Republic of China
| | - Dan Wu
- University of North Carolina Project-China, Guangzhou 510085, People’s Republic of China
- West China School of Public Health, Sichuan University, Chengdu 610041, People’s Republic of China
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Mi GD, Zhang BB, Yu F, Ren XL, Ong JJ, Fan YQ, Guo FH, Li CJ, Zhang MZ, Zhang MY. HIV incidence among men who have sex with men using geosocial networking smartphone application in Beijing, China: an open cohort study. Infect Dis Poverty 2021; 10:27. [PMID: 33795011 PMCID: PMC8017803 DOI: 10.1186/s40249-021-00814-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sexual transmission among men who have sex with men (MSM) is the dominant route of HIV transmission in China. Extensive use of geosocial networking (GSN) smartphone application (app) has dramatically changed the pattern of sexual behaviors and HIV risk among MSM, but data on HIV incidence and the changing risk behaviors of GSN app-using MSM are limited. We aims to assess the HIV incidence and its correlates among gay GSN app-using MSM in China. Methods We constructed an open cohort which was initiated and maintained using a GSN app to assess the HIV incidence among app-using MSM, recruited from June 2017 to December 2018. MSM completed an online questionnaire on their sociodemographic characteristics, sexual behaviors, recreational drug use and sexually transmitted infections status. Then each man had an HIV test, and those tested negatives were enrolled into the cohort. Participants completed follow-ups with additional HIV tests though the app during the study period, and were censored at HIV seroconversion or study end date. HIV incidence was calculated by dividing the sum of observed HIV seroconversions by the observed person-time. Univariate (Chi-square test and Fisher’s exact test) and multivariate (proportional hazards regression) analyses were used to examine correlates of HIV incidence. Results A total of 6957 HIV negative MSM were enrolled in the open cohort, 37 seroconversions occurred among 1937 men contributing 1065 observed person-years: HIV incidence was 3.47 per 100 person-years [95% confidence interval (CI): 2.37–4.57]. More than five sexual partners [hazard ratio (HR) = 2.65, 95% CI: 1.04–6.67], and sex with HIV positive partners (HR = 3.82, 95% CI: 1.16–12.64) in the preceding six months were positively associated with HIV seroconversion. Consistent condom use for anal sex (HR = 0.27, 95% CI: 0.07–0.96), and reporting insertive anal sex only (HR = 0.23, 95% CI: 0.08–0.62) in the preceding six months were protective factors for HIV seroconversion. Conclusions Tailored interventions targeting app-using MSM are urgently needed given their high risk of HIV. As a new tool for accessing MSM at higher HIV risk, GSN smartphone app could play an important role in HIV research among MSM. ![]()
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Affiliation(s)
- Guo-Dong Mi
- Danlan Beijing Media Limited, Beijing, China
| | - Bin-Bin Zhang
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China
| | - Fei Yu
- Danlan Beijing Media Limited, Beijing, China
| | - Xian-Long Ren
- Beijing Center for Diseases Control and Prevention, Beijing, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ya-Qi Fan
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China
| | - Feng-Hua Guo
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China
| | | | - Mian-Zhi Zhang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Min-Ying Zhang
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China.
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6
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Tang W, Wang Y, Huang W, Wu D, Yang F, Xu Y, Ong JJ, Fu H, Yang B, Wang C, Ma W, Wei C, Tucker JD. Adolescent and non-consensual anal sexual debut among Chinese men who have sex with men: a cross-sectional study. BMC Infect Dis 2020; 20:732. [PMID: 33028241 PMCID: PMC7541224 DOI: 10.1186/s12879-020-05466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adolescent sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection in adulthood among men who have sex with men (MSM) in high-income countries. This study aimed to examine adolescent and non-consensual anal sexual debut among Chinese MSM and to evaluate factors associated with adolescent sexual debut and non-consensual anal sex. METHODS A cross-sectional study was conducted recently among Chinese men assigned male sex at birth, ≥18 years old, and who had ever engaged in anal sex with a man. Participants answered questions regarding socio-demographics, condomless sex, age at anal sexual debut with a man, and whether the first anal sex was consensual. Factors associated with an adolescent sexual debut (< 18 years old) and non-consensual sex at sexual debut were evaluated. We defined adolescent sexual debut as having anal sex with another man at 17 years old or younger, and the participants were asked whether their first male-to-male anal sex was non-consensual. RESULTS Overall, 2031 eligible men completed the survey. The mean age of sexual debut was 20.7 (SD = 4.3) years old. 17.6% (358/2031) of men reported adolescent sexual debut, and 5.0% (101/2031) reported a non-consensual sexual debut. The adolescent sexual debut was associated with having more male sexual partners (adjusted OR 1.10, 95% CI 1.06-1.15) and condomless anal sex in the last three months (AOR = 1.71, 95% CI 1.34-2.18). MSM whose sexual debut was non-consensual were more likely to have condomless anal sex (AOR = 1.76, 95% CI 1.17-2.66), and to have reported an adolescent sexual debut (AOR = 2.72, 95% CI 1.75-4.21). CONCLUSIONS Many Chinese MSM reported adolescent sexual debut and non-consensual sex, both of which are associated with sexual risk behaviors and drive STI transmission. These findings highlight the need for designing tailored interventions for MSM who experienced adolescent sexual debut and non-consensual sex at debut.
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Affiliation(s)
- Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, 510095, China.
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China.
| | - Yehua Wang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Wenting Huang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Dan Wu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Fan Yang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Yongshi Xu
- Dermatology Hospital of Southern Medical University, Guangzhou, 510095, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Melbourne, Australia
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, 510095, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, 510095, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
| | | | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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