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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:678-707. [PMID: 35984608 DOI: 10.1007/s10461-022-03803-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.
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Jiao K, Wei R, Lin Y, Li C, Wang L, Ma W. Alcohol consumption and utilization of HIV prevention services among men who have casual sex with women in China. AIDS Care 2022; 35:564-571. [PMID: 36369927 DOI: 10.1080/09540121.2022.2142928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Men who have casual sex with women (MCSW) have played an important role in HIV new infections in China. Research studies have shown that heavy alcohol consumption can increase the risk of HIV infection. The cross-sectional study was conducted in two cities in China from December 2018 to May 2019 to examine the association between alcohol consumption and utilization of HIV prevention services among MCSW. Convenience sampling was used to recruit participants and 400 MCSW were recruited in this study. There were 238 (59.6%), 213 (53.4%) and 129 (32.4%) participants having utilized HIV prevention services, condom promotion and distribution or HIV counseling and testing (CPD/HCT) services, and peer education services in the past 12 months, respectively. MCSW who were identified as heavy drinkers were less likely to utilize HIV prevention services and CPD/HCT services compared with non-drinkers. For youngsters, those who are in the local household and those who are married/cohabitating, heavy drinkers was less likely to utilize HIV prevention services. This study highlights the significance of intensive education on heavy drinkers of MCSW, particularly for high-risk subgroups. Targeting resources for integrated HIV prevention efforts with alcohol-using MCSW should be considered by public health policymakers.
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Affiliation(s)
- Kedi Jiao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, PR People’s Republic of China
| | - Ran Wei
- Shandong Provincial Chest Hospital, Jinan, PR People’s Republic of China
| | - Yuxi Lin
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, PR People’s Republic of China
| | - Chuanxi Li
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, PR People’s Republic of China
| | - Lin Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, PR People’s Republic of China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, PR People’s Republic of China
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Jude O, Nelson O, Katagwa I. Socio-economic and demographic factors associated with never having tested for HIV among sexually active men across the four administrative regions of Uganda. BMC Public Health 2021; 21:2301. [PMID: 34923979 PMCID: PMC8684685 DOI: 10.1186/s12889-021-12384-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV testing among men is paramount in the prevention, diagnosis, and treatment of HIV. There is limited literature in understanding the socio-economic and demographic factors associated with never having tested for HIV among sexually active men aged 15 - 54 across the four administrative regions of Uganda. The purpose of this study is to investigate the socio-economic and demographic factors associated with never having tested for HIV among sexually active men aged 15 - 54 across the four administrative regions in the country. METHODS The study used a cross-sectional research design to examine factors associated with never having tested for HIV among 4,168 sexually active men (15 - 54 years) across four administrative regions of Uganda using data from 2016 Uganda Demographic and Health Survey (UDHS). Frequency distributions, Pearson chi-square tests, and multivariable logistic regression were used to establish the association between never having tested for HIV among sexually active men (15 - 54 years) and selected independent variables across regions. RESULTS About 20% of sexually active men (15 - 54 years) never tested for HIV across regions of the country. The major correlates amidst variability of never testing for HIV among sexually active men across regions were; educational level and marital status. Age, religious status, wealth quintile, worked in the last 12 months, circumcised, and one sexual partner in the last 12 months were only correlates of never having tested for HIV among respondents in particular regions of the country. CONCLUSION Findings in the study suggest promotion of male education, and suggest further investigation into the relationship between HIV non-testing among sexually active men (15 - 54 years) and being married across regions of the country. The study also proposes appreciation of regional differences in the outcome of HIV non-testing and suggests that efforts be focused on addressing regional differences in order to attain high HIV testing among sexually active men (15 - 54 years) across regions of Uganda, and thus reduce HIV related morbidity and mortality.
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Affiliation(s)
- Otim Jude
- Kyambogo University, Kampala, Uganda
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Ma Y, Zhong X, Lin B, He W. Factors Influencing the Intention of MSM to Use the PrEP Intelligent Reminder System. Risk Manag Healthc Policy 2021; 14:4739-4748. [PMID: 34866946 PMCID: PMC8633711 DOI: 10.2147/rmhp.s337287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/11/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Low adherence to medication is an important reason why pre-exposure prophylaxis (PrEP) is not effective at reducing the rate of new human immunodeficiency virus (HIV) infections among men who have sex with men (MSM). The intelligent reminder system (IRS) has been designed to improve user compliance, but the intention of MSM to use the IRS remains unclear. This study establishes a theoretical model to analyze the factors influencing their intention to use the IRS. PATIENTS AND METHODS Non-probability sampling was used to recruit MSM volunteers in Chongqing and Sichuan, China, and the data were collected from MSM who had used the IRS. A model based on the unified theory of acceptance and use of technology (UTAUT) was established for the data through a structural equation model, and the perceived privacy risk was considered to explore the subjects' behavior intention. RESULTS A total of 111 volunteers who had used the IRS filled out a questionnaire. Social influence had the greatest impact on behavior intention (β = 0.360, P < 0.001), followed by performance expectancy (β = 0.331, P < 0.001), and perceived privacy risk had a negative impact on behavior intention (β = -0.151, P = 0.040). In addition, social influence had an indirect effect on behavior intention (β = 0.182, P = 0.003) and performance expectancy played a mediating role in this indirect effect. CONCLUSION Developments in the IRS are required to improve its usefulness and adequately explain its role when recommending it to MSM. It is also important to improve the system's ability to protect user privacy. Clinical evidence for the effectiveness of the IRS is conducive to its widespread use.
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Affiliation(s)
- Yingjie Ma
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiaoni Zhong
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Bing Lin
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wei He
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China
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Septarini NW, Hendriks J, Maycock B, Burns S. Methodologies of Stigma-Related Research Amongst Men Who Have Sex With Men (MSM) and Transgender People in Asia and the Pacific Low/Middle Income Countries (LMICs): A Scoping Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:688568. [PMID: 36304052 PMCID: PMC9580832 DOI: 10.3389/frph.2021.688568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022] Open
Abstract
Much stigma-related research focuses on marginalized populations, including men who have sex with men (MSM) and transgender people. The importance of research in this area is widely recognized, however methodologies and measures vary between studies. This scoping review will collate existing information about how stigma-related research has been conducted in low/middle income countries (LMICs) within the Asia Pacific region, and will compare research designs, sampling frameworks, and measures. Strengths and limitations of these studies will inform recommendations for future stigma-related health research. A methodological framework for scoping studies was applied. Searches of Psych INFO, Scopus, ProQuest, Global Health and PubMed were used to identify articles. Stigma-related research amongst MSM and transgender communities, published between 2010 and 2019 in LMICs within the Asia Pacific region were included. A total of 129 articles based on 123 different studies were included. Of the 129 articles 51.19% (n = 66) were quantitative; 44.96% (n = 57) were qualitative and 3.88% (n = 5) were mixed methods studies. The majority of studies (n = 57; 86.36%) implemented a cross sectional survey. In-depth interviews (n = 20, 34.48%) were also common. Only 3.88% of studies utilized mixed-methods design. Non-probabilistic and probabilistic sampling methods were employed in 99.22 and 0.78% of studies respectively. The most common measures used in quantitative studies were the Center for Epidemiological Study on Depression (CES-D) (n = 18) and the Self Stigma Scale (SSS) (n = 6). Strengths and limitations proposed by researchers included in this review are summarized as lesson learnt and best practices in stigma-related research.
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Affiliation(s)
- Ni Wayan Septarini
- School of Population Health, Curtin University, Perth, WA, Australia
- Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- *Correspondence: Ni Wayan Septarini ;
| | - Jacqueline Hendriks
- School of Population Health, Curtin University, Perth, WA, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, WA, Australia
| | - Bruce Maycock
- European Center for Environmental and Human Health, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth, WA, Australia
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Hall CDX, Luu M, Nehl EJ, He N, Zheng T, Haardörfer R, Wong FY. Do the same socio-demographic variables predict testing uptake and sero-status? HIV and syphilis among an observational sample of Chinese men who have sex with men in Shanghai, China. Int J STD AIDS 2021; 31:939-949. [PMID: 32772687 DOI: 10.1177/0956462420909733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV and syphilis are pronounced among men who have sex with men (MSM) in China and often occur as co-infections, while testing remains low. Few studies examine common predictors across these outcomes. This observational venue-based sample of 546 MSM in Shanghai, China used a common set of psychosocial predictors to construct logistic models for the outcomes (HIV non-testing, syphilis non-testing, HIV sero-status, and syphilis sero-status). Fifty-seven (10.7%) participants tested positive for HIV, 126 (23.5%) for syphilis, and 33% of HIV-positive participants had a co-infection. Non-sex working MSM had consistently higher odds of HIV and syphilis non-testing (OR= 2.2, 95% CI 1.4-3.5, p < 0.001; OR = 2.4, 95, 95% CI 1.5-3.8, p < 0.001, respectively) compared to 'money boy' sex workers. Participants with a 0 score on HIV knowledge had 4.1 times (95% CI 1.4-12.5, p = 0.01) the odds of reporting HIV non-testing, 6.0 (95% CI 1.96-18.5, p < 0.01) times the odds of reporting non-testing for syphilis, and 8.44 times (95% CI 1.19-59.7, p = 0.03) the odds of testing positive for HIV, compared to a score of 8. The results highlighted the importance of integrating HIV/syphilis education and promoting testing for both HIV and syphilis among all sub-groups of MSM in China.
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Affiliation(s)
- Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Minh Luu
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Tony Zheng
- Shanghai Piaoxue Multicultural Medua, Ltd, Shanghai, China
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA.,Center for Indigenous Nursing Research for Health Equity, Florida State University, Tallahassee, FL, USA.,Department of Psychology, University of Hawai'i, Mānoa, Honolulu, HI, USA
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7
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Stephens JH, Surjan A. Barriers Preventing Access by Men who have Sex with Men to HIV-related health services in Southeast Asia: A Scoping Review. Glob Public Health 2020; 17:235-253. [PMID: 33317394 DOI: 10.1080/17441692.2020.1858922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of this scoping review was to identify and describe barriers experienced by men who have sex with men (MSM) when accessing HIV-related health care in Southeast Asia. A systematic search identified thirteen papers, which were full text reviewed and data extracted. An intersection of stigma and discrimination, fear and shame, cultural norms and societal expectations coalesce to influence the ability, either physically through lack of service provision or emotionally through personal restraint, of MSM to access HIV-related health services. Many of the factors continuing to drive the ongoing HIV epidemic across the Southeast Asia region have humanitarian origin - access to safe and non-discriminatory healthcare, education on sexual health, and not being persecuted for having a health condition. These must be addressed with an interdisciplinary response at local, government and regional level.
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Affiliation(s)
- Jacqueline H Stephens
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Akhilesh Surjan
- Emergency & Disaster Management, College of Indigenous Futures, Arts and Society, Charles Darwin University, Darwin, Australia
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Yan F, Shi CX, Zhang Y, Chen J, Williams AB, Li X. "I'll Change His Sexual Orientation, I Don't Think About HIV": A Qualitative Study to Explore Attitudes, Behaviors, and Experiences Among Wives of Men Who Have Sex With Men in Mainland China. J Assoc Nurses AIDS Care 2020; 31:428-438. [PMID: 32205501 PMCID: PMC7478852 DOI: 10.1097/jnc.0000000000000168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In mainland China, HIV prevalence among men who have sex with men (MSM) has risen sharply in the past decade. However, few HIV studies have directly addressed the female spouses' (tongqi) experiences, a population estimated at 14 million [Cheng, F. K. (2016). I want to come forward: Voices from Chinese tongqi. Cogent Social Sciences, 2(1), 1158343. doi:10.1080/23311886.2016.1158343; Zhu, J. (2018). "Unqueer" kinship? Critical reflections on "marriage fraud" in mainland China. Sexualities, 21(7), 1075-1091. doi:10.1177/1363460717719240]. We conducted this exploratory qualitative study to understand tongqi's attitudes toward same-sex sexuality and HIV risk as well as their sexual history. Semistructured interviews were conducted with 24 tongqi between October 2015 and September 2016. Data were coded and analyzed using thematic analysis. We identified four primary themes: (a) surprise, initial disbelief, and negative attitudes toward their husbands' same-sex sexuality; (b) maintenance of regular sexual contact, particularly before pregnancy; (c) unprotected sex with marital and extramarital partners; and (d) low perception of HIV risk. Strategies to increase HIV knowledge and testing uptake are urgently needed among these vulnerable women but must be implemented with caution to avoid exacerbating high levels of homophobia.
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Affiliation(s)
- Fang Yan
- Xiangya Nursing School, Central South University, Changsha, Hunan, Mainland China
| | - Cynthia X. Shi
- Department of Epidemiology of Microbial Diseases, Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Ye Zhang
- Zhuhai Maternal and Child Health Hospital, Zhuhai, Guangzhou, Mainland China
| | - Jia Chen
- Xiangya Nursing School, Central South University, Changsha, Hunan, China, Mainland China
| | - Ann Bartley Williams
- Rory Meyers College of Nursing, New York University, New York City, New York, USA
| | - Xianhong Li
- Xiangya Nursing School, Central South University, Changsha, Hunan, Mainland China
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He L, Pan X, Yang J, Ma Q, Jiang J, Wang W, Qiu J, Zou Y, Wang P, Zhao D, Wang H, Jiang T. HIV risk behavior and HIV testing among rural and urban men who have sex with men in Zhejiang Province, China: A respondent-driven sampling study. PLoS One 2020; 15:e0231026. [PMID: 32240244 PMCID: PMC7117739 DOI: 10.1371/journal.pone.0231026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Currently, human immunodeficiency virus (HIV) sentinel surveillance among men who have sex with men (MSM) in China conducted in large and medium-sized cities, and no HIV sentinel surveillance conducted in rural areas. HIV testing and intervention is predominantly conducted in urban areas, there have been a limited number of studies in rural areas MSM, it is necessary to conduct the investigation of HIV risk sexual behavior, HIV testing among rural and urban MSM. METHOD Between December 2013 and August 2015, a cross-sectional study was conducted in rural and urban areas in Zhejiang Province using respondent-driven sampling (RDS). Participants completed face-to-face interviewer-administered questionnaire surveys and were tested for HIV. RESULTS A total of 710 MSM participants were recruited, of whom 36.1% were from rural areas. The overall HIV prevalence was 16.6%, and was considerably lower among MSM living in rural areas (3.9%) than those living in urban areas (24.2%). 61.1% participants had not condom use with male sexual behavior in the past 6 months (86.7% in rural areas and 46.7% in urban areas). The social demographic and behavioral characteristics had significance difference among rural and urban MSM. Multivariate logistic regression revealed that, compared to men living in urban areas, MSM living in rural areas MSM were more likely to use dating apps to find sexual partners, were more likely to engage in bisexual behavior, and had lower condom use. 43.0% participants had been tested for HIV in the past year (41.8% in rural areas and 43.6% in urban areas). Multivariate logistic regression also revealed that among participants living in rural areas, having rural health insurance and not accepting HIV intervention were associated with lower HIV testing rates, while a higher monthly income and through use of internet to find sexual partner were associated with higher rates of HIV testing. CONCLUSION High risk behavior was prevalent, and HIV testing rates were low among MSM living in rural areas compare to urban areas in Zhejiang Province, therefore, preventative intervention measures should be immediately among rural MSM urgently to reduce HIV transmission and to promote HIV testing.
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Affiliation(s)
- Lin He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- * E-mail: (XP); (QM)
| | - Jiezhe Yang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- * E-mail: (XP); (QM)
| | - Jun Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Wei Wang
- Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Jiaquan Qiu
- Kaihua county Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Yazhou Zou
- Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Ping Wang
- Jiangshan Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Dongshe Zhao
- Lucheng district Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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HIV Testing and Risks of Sexual Behavior among HIV-Negative Men Who Have Sex with Men in Ningbo, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041322. [PMID: 32092851 PMCID: PMC7068381 DOI: 10.3390/ijerph17041322] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
Abstract
Human immunodeficiency virus (HIV) testing is confirmed as a preventive strategy for HIV control. However, the testing rate and risk behaviors of HIV-negative men who have sex with men (MSM) remain unclear. We aimed to examine factors associated with HIV testing and high-risk behaviors among HIV-negative MSM. From July 2016 to June 2017, participants were recruited by snowball sampling from WeChat groups, bars, and other venues. HIV testing was performed to exclude HIV-positive MSM. Face-to-face questionnaires regarding HIV testing and high-risk behaviors were conducted; 988 MSM were included, and 57.1% of participants underwent HIV testing in the past year. The proportion of high-risk behaviors was 49.9%. Factors associated with HIV testing were bisexual orientation, substance use to adjust psychiatric disorders, and receiving acquired immune deficiency syndrome (AIDS) interventions. Being married, bisexual orientation, and receiving AIDS interventions were risk factors for high-risk sexual behaviors, while college or higher degree was a protective factor. We determined that HIV transmission factors are widespread, and the rate of HIV testing is relatively low. Attention should be given to marital status, using substances to adjust psychiatric disorders, or bisexual HIV-negative MSM, and AIDS interventions should be strengthened to promote HIV testing and reduce high-risk behaviors.
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11
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Yang J, Xu H, Li S, Cheng W, Gu Y, Xu P, Yu Q, Lv F. The characteristics of mixing patterns of sexual dyads and factors correlated with condomless anal intercourse among men who have sex with men in Guangzhou, China. BMC Public Health 2019; 19:722. [PMID: 31182070 PMCID: PMC6558892 DOI: 10.1186/s12889-019-7082-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/31/2019] [Indexed: 11/19/2022] Open
Abstract
Background The HIV prevalence among men who have sex with men (MSM) in China has increased yearly. This study aimed to explore the association between the characteristics of social communication and condomless anal intercourse (CAI) among MSM and the implications for prevention and control of HIV among MSM in China using an egocentric network framework. Methods The data were collected in Guangzhou between November 2016 and May 2017 through standardized face-to-face interviews. The participants were recruited among MSM who received voluntary counselling and testing services (VCT) provided by nongovernmental organizations (NGOs) and the local Centers for Disease Control and Prevention (CDC). We used the framework of the egocentric network analysis, the odd ratios of CAI were analyzed using generalized estimating equations (GEE). Results In total, 1073 MSM who nominated 2667 sexual partners were sampled. MSM who were approximately 30 years old and chose sexual partners of different age category were more likely to engage in CAI. Participants with high level education who were in partnerships with individuals with lower education levels had a higher risk of CAI. Participants who reported having a strong relationship with their sexual partners(AOR = 1.31) were associated with a higher probability of experiencing CAI during sex; while having sexual partners who were unmarried (OR = 0.56), and participants who reported meeting sexual partners online (AOR = 0.74) or, having sex with an occasional partner (AOR = 0.44)were less likely to engage in CAI. Conclusion Our study indicates that the strength of sexual dyadic relational ties and different social communication mixing patterns across ages, educational categories, and marital status were associated with CAI. Electronic supplementary material The online version of this article (10.1186/s12889-019-7082-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juan Yang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155th Changbai Road, Changping District, Beijing, China
| | - Huifang Xu
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, China
| | - Shuo Li
- United Nations Entity for Gender Equality and the Empowerment of Woman, China Office, Beijing, China
| | - Weibin Cheng
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, China
| | - Yuzhou Gu
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, China
| | - Peng Xu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155th Changbai Road, Changping District, Beijing, China
| | - Qiuyan Yu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155th Changbai Road, Changping District, Beijing, China
| | - Fan Lv
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155th Changbai Road, Changping District, Beijing, China.
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12
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Pan SW, Durvasula M, Ong JJ, Liu C, Tang W, Fu H, Wei C, Wang C, Terris-Prestholt F, Tucker JD. No Place Like Home? Disentangling Preferences for HIV Testing Locations and Services Among Men Who Have Sex with Men in China. AIDS Behav 2019; 23:847-859. [PMID: 30565095 PMCID: PMC6458980 DOI: 10.1007/s10461-018-2366-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In China, some health departments and gay community-based organizations have begun to offer home-based HIV testing kits in order to augment test uptake among men who have sex with men (MSM). However, HIV test preferences and motivations for home-testing among MSM in China are not well understood. The HIV testing preferences of 803 MSM throughout China were evaluated using single-item assessment and a discrete choice experiment (DCE). In both the single-item assessment and DCE, participants expressed strong preference for free and anonymous testing by health professionals. Both approaches also indicated that naïve testers most prefer home testing. However, among previous testers, the single-item assessment indicated that "home" was the most preferred testing location (vs. hospital or clinic), while the DCE indicated that "home" was the least preferred testing location after controlling for anonymity. HIV home-testing may have limited appeal to previously tested Chinese MSM if anonymity is not maintained.
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Affiliation(s)
- Stephen W Pan
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, 111 Ren'ai Road, Suzhou Dushu Lake Higher Education Town, Suzhou, 215123, Jiangsu Province, China.
- UNC-Project China, Guangzhou, China.
| | - Maya Durvasula
- Department of Economics, Duke University, Durham, NC, USA
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Chuncheng Liu
- UNC-Project China, Guangzhou, China
- Department of Sociology, University of California at San Diego, San Diego, CA, USA
| | - Weiming Tang
- UNC-Project China, Guangzhou, China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Chongyi Wei
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Fern Terris-Prestholt
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D Tucker
- UNC-Project China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Smith MK, Stein G, Cheng W, Miller WC, Tucker JD. Identifying high risk subgroups of MSM: a latent class analysis using two samples. BMC Infect Dis 2019; 19:213. [PMID: 30832592 PMCID: PMC6399860 DOI: 10.1186/s12879-019-3700-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/09/2019] [Indexed: 01/08/2023] Open
Abstract
Background Latent class analyses (LCA) are increasingly being used to target specialized HIV interventions, but generalizability of emergent population structures across settings has yet to be considered. We compare LCA performed on two online samples of HIV negative Chinese men who have sex with men (MSM) to detect more generalizable latent class structures and to assess the extent to which sampling considerations impact the validity of LCA results. Methods LCAs were performed on an 1) nationwide online survey which involved no in-person contact with study staff and a 2) sentinel surveillance survey in which participants underwent HIV and syphilis testing in the city of Guangzhou, both conducted in 2014. Models for each sample were informed by risk factors for HIV acquisition in MSM that were common to both datasets. Results An LCA of the Guangzhou sentinel surveillance data indicated the presence of two relatively similar classes, differing only by the greater tendency of one to report group sex. In contrast an LCA of the nationwide survey identified three classes, two of which shared many of the same features as those identified in the Guangzhou survey, including the fact that they were mainly distinguished by group sex behaviors. The final latent class in the nationwide survey was composed of members with notably few risk behaviors. Conclusions Comparisons of the latent class structures of each sample lead us to conclude that the nationwide online sample captured a larger, possibly more representative group of Chinese MSM comprised of a larger, higher risk group and a small yet distinct lower group with few reported behaviors. The absence of a lower risk group in the Guangzhou sentinel surveillance dataset suggests that MSM recruited into studies involving free HIV/STI testing may oversample MSM with higher risk behaviors and therefore greater risk perception. Lastly, two types of higher risk MSM were emergent across both samples distinguished largely by their recent group sex behaviors. Higher odds not only of self-reported HIV infection but also of closeted tendencies and gender fluid identities in this highest risk group suggest that interacting factors drive individual and structural facets of HIV risk.
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Affiliation(s)
- M Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota Twin Cities, 1300 South 2nd Street, Minneapolis, MN, 55454, USA.
| | - Gabriella Stein
- Department of Biostatistics, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC, 27599, USA
| | - Weibin Cheng
- Guangzhou Center for Disease Control and Prevention, Department of AIDS/STD Control and Prevention, 1 Jiaochang E Rd, Guangzhou Shi, 510000, Guangdong Sheng, China
| | - William C Miller
- Division of Epidemiology, The Ohio State University, College of Public Health, 1841 Neal Ave., 302 Cunz Hall, Columbus, OH, 43210, USA
| | - Joseph D Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC, 27599, USA
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14
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Zhu Z, Yan H, Wu S, Xu Y, Xu W, Liu L, Li X, Xu F, Detels R. Trends in HIV prevalence and risk behaviours among men who have sex with men from 2013 to 2017 in Nanjing, China: a consecutive cross-sectional survey. BMJ Open 2019; 9:e021955. [PMID: 30705234 PMCID: PMC6359734 DOI: 10.1136/bmjopen-2018-021955] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the trends of HIV prevalence, risk behaviours and HIV testing among men who have sex with men (MSM) in Nanjing. DESIGN Five consecutive cross-sectional surveys. SETTING Nanjing, China. PRIMARY AND SECONDARY OUTCOME MEASURES HIV and syphilis prevalence, HIV testing rate and factors associated with HIV infection; demographic characteristics and behaviours. RESULTS 649, 669, 577, 633, 503 MSM were recruited from 2013 to 2017. HIV prevalence was 9.9%, 12.3%, 12.5%, 9.8% and 10.1%, respectively. Syphilis prevalence decreased with a range from 10.6% to 5.6%. Risk behaviours like unprotected anal intercourse (UAI) and unprotected virginal sex in the past 6 months decreased, but multiple sex partners and ever used rush popper rose significantly. MSM tested for HIV in the previous year remained stable from 57.0% to 64.1% (P=0.633). Multivariate analysis showed that tested for HIV in the past year was protective factor against HIV infection. MSM who had UAI in the past 6 months, sex role as receptive and dual, diagnosed with sexually transmitted diseases (STDs) in the past year and currently syphilis infected were risk factors for HIV infection. CONCLUSIONS We observed stable high HIV prevalence, a steady HIV testing rate, decreasing syphilis prevalence and UAI among MSM in Nanjing. However, rush popper use rose dramatically. The HIV preventive strategies for MSM including condom promotion, HIV testing expansion and reduction of rush popper use, STDs screening and standardised treatment should be strengthened.
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Affiliation(s)
- Zhengping Zhu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Hongjing Yan
- Section of AIDS Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, China
| | - Sushu Wu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Yuanyuan Xu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Wenjiong Xu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Li Liu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Xin Li
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Fei Xu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Roger Detels
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, California, USA
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15
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ZHOU J, CHEN J, Goldsamt L, WANG H, ZHANG C, LI X. HIV Testing and Associated Factors Among Men Who Have Sex with Men in Changsha, China. J Assoc Nurses AIDS Care 2018; 29:932-941. [PMID: 29861317 PMCID: PMC6204106 DOI: 10.1016/j.jana.2018.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/14/2018] [Indexed: 11/26/2022]
Abstract
Promoting HIV testing is an important strategy to end the HIV epidemic. HIV incidence among men who have sex with men (MSM) has increased rapidly in China in recent years, but HIV testing rates are still low. Our cross-sectional study investigated HIV testing rates and analyzed associated factors in 565 MSM in Changsha between April and December 2014. In the previous year, 37.7% of participants had not been tested, 38.2% had had one test, and 24.1% had had two or more tests. Those who initiated sexual debut at an older age, had known someone infected with HIV, or had been diagnosed with a sexually transmitted illness (STI) were more likely to have had an HIV test. HIV intervention programs in China should focus on sexually active young MSM, integrate HIV testing and counseling services in STI clinics, and describe real experiences of living with HIV to improve HIV testing in MSM.
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Affiliation(s)
- Jing ZHOU
- Graduate Student, Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Jia CHEN
- Professor, Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Lloyd Goldsamt
- Adjunct Professor, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Honghong WANG
- Professor, Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Ci ZHANG
- Graduate Student, Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Xianhong LI
- Associate Professor, Xiangya Nursing School of Central South University, Changsha, Hunan, China
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16
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Jiang Z, Xiu C, Yang J, Zhang X, Liu M, Chen X, Liu D. HIV test uptake and related factors amongst heterosexual drug users in Shandong province, China. PLoS One 2018; 13:e0204489. [PMID: 30335766 PMCID: PMC6193625 DOI: 10.1371/journal.pone.0204489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/17/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In China, the mode of HIV transmission and the types and routes of drug use have changed in the past decade. HIV testing amongst drug users needs further improvement. METHODS Interviewer-administered questionnaires were used for data collection amongst 600 heterosexual drug users from the community and a municipal detention centre, where criminal suspects are supervised. Descriptive statistics, univariate analysis and multilevel logistic regression analysis were used to identify the factors associated with HIV testing amongst heterosexual drug users. All participants were screened HIV and sexually transmitted infections. RESULTS Amongst 600 participants, 554 (92.3%) were methamphetamine users, and 155 (25.8%) underwent HIV testing in the past year. Multivariate analysis results revealed that drug users who were single (adjusted odds ratio(AOR) = 1.923, 95% confidence interval(CI) = 1.189-3.109), had less knowledge of HIV (AOR = 1.706, 95% CI = 1.074-2.711), used only one kind of drug (AOR = 2.649, 95% CI = 1.155-6.077), used drug via a non-injection route (AOR = 2.121, 95% CI = 1.103-4.078), did not receive free condoms (AOR = 2.307, 95% CI = 1.129-4.715) and who did not receive free publicity material from health workers in the past year (AOR = 2.828, 95% CI = 1.757-4.552) were less likely to undergo HIV testing. A total of 594 participants underwent HIV and syphilis screening in this survey. Amongst these participants, 2 (0.3%) were HIV antibody positive, and 88 (14.8%) showed positive results in both non-treponemal test (rapid plasma regain test) and treponemal test (Treponema pallidum particle agglutination test) for the first time. CONCLUSIONS The rate of HIV test uptake amongst heterosexual drug users in China remains low. Thus, more specific interventions are urgently needed to improve the utilisation of HIV testing amongst heterosexual drug users, particularly amongst non-injection drug users in China.
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Affiliation(s)
- Zhenxia Jiang
- Department of HIV/STI Prevention and Control, Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Cuizhen Xiu
- Department of HIV/STI Prevention and Control, Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Jun Yang
- Department of STI and Leprosy Prevention and Control, Jining Hospital for Skin Disease Control and Prevention, Jining, Shandong, China
| | - Xijiang Zhang
- Department of HIV/STI Prevention and Control, Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Minghua Liu
- Department of HIV/STI Prevention and Control, Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Xinlong Chen
- Department of STI and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Jinan, Shandong, China
| | - Dianchang Liu
- Department of STI and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Jinan, Shandong, China
- * E-mail:
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17
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Xu W, Zheng Y, Kaufman MR. Predictors of Recent HIV Testing Among Chinese Men Who Have Sex with Men: A Barrier Perspective. AIDS Patient Care STDS 2018; 32:408-417. [PMID: 30234365 DOI: 10.1089/apc.2018.0061] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In China, men who have sex with men (MSM) account for an increasing proportion of new HIV infections. We aim to assess recent HIV testing (in the past 6 months) among Chinese MSM and to identify barriers to testing. A nationwide sample of MSM (n = 1100) from mainland China was recruited. Data on sociodemographics, HIV-related risks, perceived barriers to testing, and testing behaviors were collected. Approximately 30% of MSM had recently undergone HIV testing. With regard to testing, almost half endorsed each of three barriers: did not believe themselves to be at HIV risk, had a fear of being diagnosed HIV positive, and feared their privacy would be violated during testing. Five distinct classes of barriers were identified from the responses. The adjusted multivariable logistic regression model demonstrated that the participants in both the "uncertainty concerning testing sites" and "low risk and privacy violation" classes were less likely to undergo testing than those in the "minimal barrier" class. Men who were unsure of their HIV status were less likely to undergo testing. Furthermore, participants who had multiple male sexual partners and who engaged in substance use over the preceding 6 months were more likely to undergo testing. Distinct subgroups of testing and HIV status varied within the different barrier classifications. Recent HIV testing rates remain low among MSM in China. Barrier factors associated with testing point to the necessity for preventing and controlling HIV, including increasing the privacy of sites or educating MSM on the importance of testing regularly.
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Affiliation(s)
- Wenjian Xu
- Faculty of Psychology, Southwest University, Chongqing, China
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yong Zheng
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Michelle R. Kaufman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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18
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Pham MD, Aung PP, Paing AK, Pasricha N, Agius PA, Tun W, Bajracharya A, Luchters S. Factors associated with HIV testing among young men who have sex with men in Myanmar: a cross-sectional study. J Int AIDS Soc 2018; 20. [PMID: 29105323 PMCID: PMC5810319 DOI: 10.1002/jia2.25026] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/12/2017] [Indexed: 01/10/2023] Open
Abstract
Introduction In Myanmar, men who have sex with men (MSM) experience high risk of HIV infection. However, access to HIV testing and prevention services remains a challenge among this marginalized population. The objective of this study was to estimate population prevalence and correlates of prior HIV testing among young MSM (YMSM) and informs the development of HIV testing and intervention programmes that respond to the specific needs of this population. Methods Five hundred and eighty‐five YMSM aged 18 to 24 years were recruited using respondent‐driven sampling (RDS) in a cross‐sectional survey conducted in six townships of Myanmar. RDS‐adjusted population estimates were calculated to estimate prevalence of HIV testing; RDS‐weighted logistic regression was used to examine correlates of HIV testing in the past 6 months and in a lifetime. Results There were 12 participants who reported receiving a HIV‐positive test; of those, five were tested in the past 6 months. The RDS‐weighted prevalence estimates of lifetime (any prior) HIV testing was 60.6% (95% CI: 53.3% to 66.4%) and of recent (≤ 6 months) HIV testing was 50.1% (95% CI: 44.1% to 55.5%). In multivariable analysis, sexual identity was associated with lifetime but not recent HIV testing. Lifetime and recent HIV testing were associated with having three or more male sexual partners in the past 12 months (adjusted ORs (aORs) = 2.28, 95% CIs: 1.21 to 4.32 and 2.69, 95% CI: 1.59 to 4.56), having good HIV‐related knowledge (aORs = 1.96, 95% CIs: 1.11 to 3.44 and 1.77, 95% CI: 1.08 to 2.89), reporting high HIV testing self‐efficacy (aORs = 13.5, 95% CIs: 6.0 to 30.1 and 9.81, 95% CI: 4.27 to 22.6) and having access to and use of non‐HIV health‐related services in the past 12 months (aORs = 13.2, 95% CIs: 6.85 to 25.6 and 7.15, 95% CI: 4.08 to 12.5) respectively. Conclusions HIV testing coverage among YMSM aged 18 to 24 years old in Myanmar is still suboptimal. Integrated HIV testing and prevention services in existing health service provision systems with tailored HIV information and education programmes targeting YMSM to improve HIV‐related knowledge and self‐efficacy may help to promote regular HIV testing behaviour and contribute to sustainable control of the HIV epidemic among this marginalized population in Myanmar.
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Affiliation(s)
- Minh D Pham
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Poe Poe Aung
- Institute for Global Health, Yangon, Myanmar.,University of Maryland, Baltimore, MD, USA.,Burnet Institute, Yangon, Myanmar
| | | | | | | | | | | | - Stanley Luchters
- Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.,International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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19
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Frequent HIV Testing: Impact on HIV Risk Among Chinese Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 72:452-61. [PMID: 27003496 DOI: 10.1097/qai.0000000000001001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The HIV epidemic continues to expand among men who have sex with men (MSM) in China. The NIMH Project Accept/HPTN 043 trial suggested a borderline significant trend toward HIV incidence reduction among persons with higher testing rates. METHODS We assessed HIV testing histories and infection status among a community-based Beijing MSM. HIV serostatus was lab confirmed. We ascertained demographic/behavioral factors through questionnaire-based interviews. Associations of previous HIV testing with odds of current HIV infection were assessed, seeking improved like-with-like risk comparisons through multivariable logistic regression analysis with propensity score adjustment and restricted cubic spline modeling. RESULTS Among 3588 participants, 12.7% were HIV infected; 70.8% reported having ever tested for HIV. Compared with MSM who never tested, those ever testing had a 41% reduction in the odds of being HIV positive [adjusted odds ratio (aOR): 0.59; 95% confidence interval (CI): 0.48 to 0.74. Higher HIV testing frequencies were associated with a decreasing trend in the odds of being infected with HIV vs. a referent group with no previous testing [>6 tests (aOR: 0.27; 95% CI: 0.18 to 0.41); 4-6 (aOR: 0.55; 95% CI: 0.39 to 0.78); 2-3 (aOR: 0.61; 95% CI: 0.45 to 0.82); P for trend <0.001]. The multivariable-adjusted model with restricted cubic spline of HIV testing frequency showed a higher frequency of previous HIV testing associated with lower odds of HIV infection, particularly among men with ≥10 lifetime male sexual partners. CONCLUSIONS Using risk probability adjustments to enable less biased comparisons, frequent HIV testing was associated with a lower HIV odds among Chinese MSM.
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20
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Wong NS, Tang W, Han L, Best J, Zhang Y, Huang S, Zheng H, Yang B, Wei C, Pan SW, Tucker JD. MSM HIV testing following an online testing intervention in China. BMC Infect Dis 2017; 17:437. [PMID: 28629439 PMCID: PMC5477382 DOI: 10.1186/s12879-017-2546-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/13/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Scaling up HIV testing is the first step in the HIV treatment continuum which is important for controlling the HIV epidemic among men who have sex with men (MSM). Following an online HIV testing intervention among MSM, we aim to examine sociodemographic and spatial factors associated with HIV testing. METHODS We conducted a secondary analysis on data from an online HIV testing intervention among MSM who had never-tested for HIV. The survey was distributed through online networks connected to all provinces and regions of China. Univariate and multivariable analyses were performed to examine factors associated with testing three weeks post-intervention. RESULTS At three weeks after the intervention, 36% of 624 followed-up MSM underwent HIV testing, 69 men reported positive HIV test results. Having money for sex, ever tested for sexually transmitted infections and intimate partner violence experience were significant factors of post-intervention HIV testing. Students were less likely to undergo HIV testing at follow-up compared to others (adjusted odds ratio=0.69, 95% C.I.=0.47-0.99), adjusted by age and type of intervention. Moderate provincial spatial variation of testing was observed. CONCLUSIONS While high risk men generally had higher HIV testing rates, some MSM like students had lower testing rates, suggesting the need for further ways to enhance HIV testing in specific MSM communities.
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Affiliation(s)
- Ngai Sze Wong
- University of North Carolina Project-China, Guangzhou, Guangdong China
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, Guangdong China
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- SESH Global, Guangzhou, Guangdong China
| | - Larry Han
- University of North Carolina Project-China, Guangzhou, Guangdong China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, Guangdong China
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - John Best
- University of North Carolina Project-China, Guangzhou, Guangdong China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, Guangdong China
- School of Medicine, University of California, San Francisco, CA USA
| | - Ye Zhang
- University of North Carolina Project-China, Guangzhou, Guangdong China
- SESH Global, Guangzhou, Guangdong China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, Guangdong China
| | - Shujie Huang
- SESH Global, Guangzhou, Guangdong China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, Guangdong China
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong China
| | - Heping Zheng
- SESH Global, Guangzhou, Guangdong China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, Guangdong China
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong China
| | - Bin Yang
- SESH Global, Guangzhou, Guangdong China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, Guangdong China
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong China
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
| | - Stephen W. Pan
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, Guangdong China
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- SESH Global, Guangzhou, Guangdong China
- Guangdong Provincial Centres for Skin Diseases and STI Control, Guangzhou, Guangdong China
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21
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Prevalence of condomless anal intercourse and recent HIV testing and their associated factors among men who have sex with men in Hangzhou, China: A respondent-driven sampling survey. PLoS One 2017; 12:e0167730. [PMID: 28273077 PMCID: PMC5342181 DOI: 10.1371/journal.pone.0167730] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022] Open
Abstract
Men who have sex with men (MSM) are a large high-risk population for HIV infection in recent years in China. A cross-sectional survey was conducted in Hangzhou, China, to determine rates of condomless anal intercourse (CAI), recent HIV testing (in the recent year) and associated factors using respondent-driven sampling. Questionnaires using face-to-face interviews were employed to collect data on sexual risk behaviors and HIV testing. Five hundred eleven MSM were recruited, of which 459 (89.8%) had anal intercourse in the past 6 months. Of these 459 participants, 457 (99.6%) answered whether they had taken an HIV test in the recent year, so only their data were analyzed. Weighted data were analyzed using bivariate and multivariate logistic regression analysis. The CAI rate with male partners in the past 6 months was 43.7% (95% confidence interval [CI], 34.0-51.5%), while the rate of condomless vaginal intercourse (CVI) was 21.6% (95% CI, 15.6-32.3%). The prevalence of recent HIV testing was 56.8% (95% CI, 48.7-66.5%), while the prevalence of HIV and syphilis were 8.8% and 6.5%, respectively. Multivariate analysis indicated that CAI was associated with earlier homosexual debut, suicidal inclinations, childhood sexual abuse, HIV testing in the recent year, and lower estimate of HIV prevalence. Recent HIV testing was associated with homosexual debut age, engaging in CAI with male partners in the past 6 months, having oral sex in the past 6 months, self-perceived higher likelihood of HIV infection, knowing about antiretroviral therapy for HIV/AIDS, receiving AIDS/sexually transmitted infection (STI) interventions in the past year, and syphilis infection. Given high prevalence of HIV and syphilis, high levels of CAI and CVI, and low HIV testing rate, the results indicated high risk of HIV infection and transmission among MSM. HIV prevention interventions should target MSM with early homosexual debut and psychosocial health problems, while HIV/AIDS education among MSM should focus on increasing knowledge of HIV risk, estimated HIV prevalence and antiretroviral therapy, and improving risk perception of HIV acquisition.
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He H, Lv F, Zhang NN, Wu Z, Liao Q, Chang Z, Li Y, Xu H, OuYang L, Huan X, Yang J. Look into the HIV Epidemic of Gay Community with a Socio-Cultural Perspective: A Qualitative Study in China, 2015-2016. PLoS One 2017; 12:e0170457. [PMID: 28107523 PMCID: PMC5249147 DOI: 10.1371/journal.pone.0170457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current Chinese studies continue to view male homosexuality through a disease focused lens which pays limited attention to socio-cultural aspects of sexual behavior and HIV transmission. This qualitative study aimed to investigate how socio-cultural factors influence gay men's sexual beliefs and behaviors in contemporary China, and their implications for HIV epidemic. METHODS AND FINDINGS Qualitative methodology was used in this study. During 2015-2016, in-depth interviews were conducted with 61 self identified gay men in Jiangxi, Henan, Heilongjiang, Guangdong, Jiangsu provinces and Chongqing municipality of China. Our study revealed that: 1) influenced by Chinese traditional culture, gay men have conflicts on self-identity, which led to low self-acceptance and negative attitude on sex, and huge socio-psychological stress; 2) a generational differences within gay community was observed, reflected in varied sexual attitudes and practices as well as way for approaching new friends, both of which have implications and challenges on HIV control and prevention; 3) socio-cultural barriers, including open minds towards casual sex and nonmonogamous relationship, and low priority of health demands were widely observed and led to negative coping with AIDS among gay community. CONCLUSIONS It is essential to take a holistic view into gay men's HIV epidemic in China. Socio-cultural barriers for HIV control and prevention found in this study call for serious and imperative consideration on integrated measures, including targeted efforts towards effective sex education and further inclusion of socio-cultural perspectives in HIV/AIDS interventions for gay men.
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Affiliation(s)
- Huijing He
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Lv
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| | - Nanci Nanyi Zhang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qinghua Liao
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Zhanjun Chang
- Zhengzhou Center for Disease Control and Prevention, Zhengzhou, Henan Province, China
| | - Yi Li
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, Heilongjiang Province, China
| | - Huifang Xu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China
| | - Lin OuYang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Juan Yang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Lim RBT, Tham DKT, Cheung ONY, Tai BC, Chan R, Wong ML. What are the factors associated with human immunodeficiency virus/sexually transmitted infection screening behaviour among heterosexual men patronising entertainment establishments who engaged in casual or paid sex? - Results from a cross-sectional survey in an Asian urban setting. BMC Infect Dis 2016; 16:763. [PMID: 27993135 PMCID: PMC5168707 DOI: 10.1186/s12879-016-2088-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 12/03/2016] [Indexed: 11/16/2022] Open
Abstract
Background Late presentation of human immunodeficiency virus (HIV) is associated with heterosexual transmission, particularly among heterosexual men in Asia. Although data on HIV/sexually transmitted infection (STI) testing behaviour is increasing, information is still lacking among heterosexual men who receive far lesser attention and are generally invisible in HIV/ STI prevention, particularly in the Asian urban setting. The aim of this study was to assess the prevalence of HIV/STI testing among heterosexual men patronising entertainment establishments (EEs) who engaged in casual or paid sex in Singapore, and the factors associated with this behaviour. Methods This was a cross-sectional survey involving 604 participants using time location sampling between March and May 2015. For multivariable analysis, we used a mixed effects Poisson regression model with backward stepwise approach to account for clustering by venue and to obtain the adjusted prevalence ratio (aPR) for the association of various factors with HIV/STI testing. Results Among 604 at-risk participants, only 163 (27.0%) had gone for HIV or STI testing in the past 6 months. Of this, 83.4% of them specifically underwent HIV testing. In multivariable analysis, HIV/STI testing increased with being non-Chinese (aPR 1.50; 95% CI: 1.08–2.06), having engaged in anal sex with casual or paid partner in the past 6 months (aPR 1.80; 95% CI: 1.27–2.57), number of partners in the past 6 months (aPR 1.03; 95% CI: 1.01–1.05) and HIV knowledge score (aPR 1.11; 95% CI: 1.05–1.16). Among those who reported non-consistent condom use with casual or paid partner, almost half of them (47.9%) perceived that they were at low risk for HIV/STI. Sigmatisation and discrimination was another common barrier for non-testing. Conclusions Despite being at risk of HIV/STI, the low prevalence of testing coupled with a high prevalence of risky sexual behaviour among this group of heterosexual men in Singapore calls for a need for HIV/STI prevention interventions in the EE setting. Other than promoting testing and safer sex, the interventions should address the discordance between perceived risk and actual sexual behaviour, in addition to the stigma and discrimination associated with testing for this group. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2088-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Dede Kam Tyng Tham
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Olive N Y Cheung
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Roy Chan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.,Department of Sexually Transmitted Infections Control, National Skin Centre, 31 Kelantan Lane, #01-16, Singapore, 200031, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
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24
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Zhang C, Qian HZ, Yin L, Liu Y, Strauss SM, Ruan Y, Shao Y, Lu H, Vermund SH. Sexual Behaviors Linked to Drug and Alcohol Use Among Men Who Have Sex With Men in China. Subst Use Misuse 2016; 51:1821-30. [PMID: 27608264 PMCID: PMC5423713 DOI: 10.1080/10826084.2016.1197264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND High-risk sexual behaviors drive the HIV epidemic among men who have sex with men (MSM). Alcohol consumption and use of club drugs may increase sexual risk behaviors. We evaluated effects of drug and alcohol use on sexual behaviors with both their male and female partners as well as on HIV and syphilis infections among MSM in China. METHODS As the part of a community randomized clinical trial that conducted among MSM in Beijing from 2013 to 2015, we recruited a total of 3,680 participants cross-sectionally. A self-administered questionnaire was employed to collect information regarding demographics, sexual behaviors, and a history of alcohol and drug use. Blood sample was collected for HIV and syphilis testing. RESULTS A total of 3,588 MSM completed the survey and were included in the data analysis. The mean age was 29.9 with 97.3% of Han-ethnicity and 85.0% unmarried. The HIV and syphilis prevalence was 12.7% and 7.4%, respectively. Drug use was significantly associated with higher odds of HIV infection (aOR = 1.3, 95% Confidence Interval [CI] = 1.0,1.6), but not associated with syphilis. A higher level of alcohol consumption was similarly associated with higher odds of HIV risks with both male (e.g., condomless sex acts) and female partners (e.g., numbers of sexual partners). CONCLUSION The association between drug and alcohol use and high-risk behaviors is notable among MSM in China. Integrated HIV interventions that target substance use among MSM may be more effective than programs that only target HIV alone.
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Affiliation(s)
- Chen Zhang
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Han-Zhu Qian
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,b Division of Epidemiology , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Lu Yin
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Yu Liu
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Shiela M Strauss
- c College of Nursing , New York University , New York , New York , USA
| | - Yuhua Ruan
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Yiming Shao
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Hongyan Lu
- e Beijing Center for Disease Control and Prevention , Beijing , China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,f Department of Pediatrics , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
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25
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MacCarthy S, Hoffmann M, Nunn A, da Silva LAV, Dourado I. Barriers to HIV testing, linkage to care, and treatment adherence: a cross-sectional study from a large urban center of Brazil. Rev Panam Salud Publica 2016; 40:418-426. [PMID: 28718490 PMCID: PMC9897025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/29/2016] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Early, continued engagement with the HIV treatment continuum can help achieve viral suppression, though few studies have explored how risk factors for delays differ across the continuum. The objective of this study was to identify predictors of delayed diagnosis, delayed linkage to care, and nonadherence to treatment in the city of Salvador, Bahia, Brazil. METHODS Data were collected during 2010 in a cross-sectional study with a sample (n = 1 970) of HIV-infected individuals enrolled in care. Multiple logistic regression analyses identified sociodemographic variables, behaviors, and measures of health service quality that were associated with delayed diagnosis, delayed linkage to care, and treatment nonadherence. RESULTS For delayed diagnosis, male gender (adjusted odds ratio (AOR), 3.02; 95% confidence interval (CI), 2.0-4.6); age 45 years and older (AOR, 1.67; 95% CI, 1.1-2.5); and provider-initiated testing (AOR, 3.00; 95% CI, 2.1-4.4) increased odds, while drug use (AOR, 0.29; 95% CI, 0.2-0.5) and receiving results in a private space (AOR, 0.37; 95% CI, 0.2-0.8) decreased odds. For delayed linkage to care, unemployment (AOR, 1.42; 95% CI, 1.07-1.9) and difficulty understanding or speaking with a health care worker (AOR, 1.61; 95% CI, 1.2-2.1) increased odds, while posttest counseling (AOR, 0.49; 95% CI, 0.3-0.7) decreased odds. For nonadherence, experiencing verbal or physical discrimination related to HIV (AOR, 1.94; 95% CI, 1.3-3.0) and feeling mistreated or not properly attended to at HIV care (AOR, 1.60; 95% CI, 1.0-2.5) increased odds, while posttest counseling (AOR, 0.34; 95% CI, 0.2-0.6) decreased odds. CONCLUSIONS More attention is needed on how policies, programs, and research can provide tailored support across the treatment continuum.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Santa Monica, California, United States of America
| | - Michael Hoffmann
- Brown University, Providence, Rhode Island, United States of America
| | - Amy Nunn
- Brown University, Providence, Rhode Island, United States of America
| | | | - Ines Dourado
- Instituto de Saúde Coletiva/Universidade Federal da Bahia, Salvador, Bahia, Brazil
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26
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Li R, Pan X, Ma Q, Wang H, He L, Jiang T, Wang D, Zhang Y, Zhang X, Xia S. Prevalence of prior HIV testing and associated factors among MSM in Zhejiang Province, China: a cross-sectional study. BMC Public Health 2016; 16:1152. [PMID: 27832761 PMCID: PMC5103478 DOI: 10.1186/s12889-016-3806-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 10/27/2016] [Indexed: 11/30/2022] Open
Abstract
Background Men who have sex with men (MSM) have become one of high-risk population for human immunodeficiency virus (HIV) infection, due to their multiple sex partners and unprotected anal intercourse. Promoting HIV testing is an effective strategy for the prevention and control of HIV infection. We assessed the factors associated with a prior HIV testing history, which could provide guidance for implementation of future HIV intervention programs. Methods A cross-sectional study was conducted in three cities of Zhejiang Province, namely, Hangzhou, Ningbo and Wenzhou, using respondent-driven sampling, between December 2013 and June 2014. A face-to-face questionnaire survey was employed to collect relevant information about HIV testing. Univariate and multivariate logistic regression analyses were used to identify the factors associated with a prior HIV testing history. Results The adjusted rate of prior HIV testing among MSM in Zhejiang Province was 55.9 %. The adjusted rates of HIV and syphilis infections among MSM in Zhejiang Province were 14.0 % and 11.4 %, respectively. A weighted multivariate analysis showed that MSM of older age were more likely to be tested, as were MSM with higher level of education, self-reported homosexuality and a higher frequency of receiving AIDS/sexually transmitted infections educational intervention in the past year. MSM with suicidal inclination and self-perceived lower possibility of HIV infection were less likely to report ever having undergone an HIV test. Conclusions The prevalence of prior HIV testing among MSM in Zhejiang Province, China is low. Effective and more frequent interventional measures should be adopted to improve risk awareness and psychosocial support for younger, less educated MSM, and to encourage more MSM to undergo HIV testing.
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Affiliation(s)
- Runhua Li
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China.,Department of Epidemiology and Health Statistics, School of Medicine, Ningbo University, Ningbo, Zhejiang Province, People's Republic of China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Lin He
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China
| | - Dayong Wang
- Wenzhou Center for Disease Control and Prevention, Wenzhou, Zhejiang Province, People's Republic of China
| | - Yan Zhang
- Ningbo Center for Disease Control and Prevention, Ningbo, Zhejiang Province, People's Republic of China
| | - Xingliang Zhang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shichang Xia
- Zhejiang Provincial Center for Disease Control and Prevention, No.3399, Binsheng Road, Hangzhou, Zhejiang Province, 310051, People's Republic of China.
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Liu Y, Li D, Vermund SH, Zhang C, Ruan Y, Yin L, Liu H, Amico KR, Shao Y, Qian HZ. Associations of current marital status and living arrangements with HIV and syphilis risk: findings from a community-based sample of men who have sex with men in China. AIDS Care 2016; 28:1461-6. [PMID: 27236988 DOI: 10.1080/09540121.2016.1189502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chinese men who have sex with men (MSM) are disproportionally affected by HIV and sexually transmitted infections (STIs), but little is known about the role of current marital status and living arrangements in shaping their HIV/syphilis risk. A cross-sectional study was conducted among MSM in Beijing, China to assess their sociodemographic/behavioral characteristics between married and single MSM, and test the hypothesis that currently married MSM have a lower odds of being HIV- and/or syphilis-infected. Participants were recruited via short message services, peer referral, internet, and community outreach. Data collection was based on a questionnaire survey and self-report. Infection status was lab-confirmed. Multivariable logistic regression modeling was used to assess the association of marital status and living arrangement with HIV/syphilis risk. Of the 3588 MSM, infection prevalence was high (HIV = 12.7%; syphilis = 7.5%). Compared to single MSM living with their boyfriends or male sex partners, single/alone MSM and married MSM living with wives were less likely to practice condomless insertive (CIAI) or receptive (CRAI) anal intercourse with men; while married MSM living with boyfriends or male sex partner were more likely to practice CIAI and CRAI, and married MSM were more likely to practice condomless vaginal sex. Compared to men living with boyfriends/sexual partners, significantly reduced odds of being HIV-positive were seen among married MSM who were living alone (aOR: 0.52; 95%CI: 0.28, 0.94) or living with their wives (aOR: 0.53; 95%CI: 0.31, 0.89). Similarly, single MSM living alone (aOR: 0.67; 95%CI: 0.48, 0.95) and married MSM living with their wives were comparatively less likely to be syphilis-infected (aOR: 0.43; 95%CI: 0.23, 0.79). Future efforts should consider characteristics of marital status and living arrangements for designing subgroup-specific risk reduction strategies among Chinese MSM.
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Affiliation(s)
- Yu Liu
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Dongliang Li
- b Chaoyang Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA.,c Division of Epidemiology, Department of Medicine , Vanderbilt University School of Medicine , Nashville , TN , USA.,d Department of Pediatrics , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Chen Zhang
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Yuhua Ruan
- e State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Lu Yin
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Hongjie Liu
- f Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - K Rivet Amico
- g Department of Health Behavior and Health Education , University of Michigan , Ann Arbor , MI , USA
| | - Yiming Shao
- e State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Han-Zhu Qian
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA.,c Division of Epidemiology, Department of Medicine , Vanderbilt University School of Medicine , Nashville , TN , USA
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Yan H, Li J, Raymond HF, Huan X, Guan W, Hu H, Yang H, McFarland W, Wei C. Increased HIV Testing among Men Who Have Sex with Men from 2008 to 2012, Nanjing, China. PLoS One 2016; 11:e0154466. [PMID: 27111540 PMCID: PMC4844110 DOI: 10.1371/journal.pone.0154466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 04/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV testing is the first point of HIV treatment entry for HIV-infected individuals and an avenue to engage persons at risk in prevention. In China, where the prevalence of HIV among men who have sex with men (MSM) has been rising over the last decade, uptake of HIV testing has been low. METHODS We examined changes in HIV testing in the preceding 12 months through two cross-sectional surveys conducted among MSM in Nanjing, Jiangsu province, China in 2008 and 2012. Respondent-driven sampling (RDS) was used to recruit participants. Questionnaire interviews and venous blood were collected to measure HIV testing, risk behaviors, and prevalence of HIV, syphilis, and HSV-2. RESULTS A total of 430 and 589 MSM were surveyed in 2008 and 2012, respectively, with comparable samples in each round with respect to demographic characteristics. HIV testing in the past 12 months increased significantly from 20.1% (95% CI 13.3-26.8) in 2008 to 46.0% (95% CI 39.3-51.4, p < 0.001) in 2012. HIV prevalence was stable, at 6.6% (95% CI 2.5-11.3) in 2008 and 10.1% (95% CI 6.6-13.9, p = 0.240) in 2012, as was syphilis (14.3% in 2008 vs. 9.9% in 2012, p = 0.240). HSV-2 prevalence (18.6% in 2008 vs. 10.2% in 2012, p = 0.040) and self-reported STI in the last year (24.3% in 2008 vs. 14.3% in 2012, p = 0.020) significantly decreased. Changes in reported sexual behaviors were mixed and the profiles of who did and did not test varied between 2008 and 2012. CONCLUSIONS HIV testing uptake more than doubled among MSM in Nanjing from 2008 to 2012 -a period of massive promotion and scale up of testing programs for MSM. However, additional efforts are still needed to further increase the proportion of men being not only tested but also undergoing repeat testing if they engage in continued risk taking behavior.
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Affiliation(s)
- Hongjing Yan
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Jianjun Li
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - H. Fisher Raymond
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Xiping Huan
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Wenhui Guan
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Haiyang Hu
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Haitao Yang
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
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Zhang N, Bussell S, Wang G, Zhu X, Yang X, Huang T, Qian Y, Tao X, Kang D, Wang N. Disparities in HIV Care Along the Path From Infection to Viral Suppression: A Cross-sectional Study of HIV/AIDS Patient Records in 2013, Shandong Province, China. Clin Infect Dis 2016; 63:115-21. [PMID: 27025832 DOI: 10.1093/cid/ciw190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 03/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The 90-90-90 targets recommended by the Joint United Nations Programme on HIV/AIDS require strengthening human immunodeficiency virus (HIV) care, which includes diagnosis, linkage to and retention in care, assessment for treatment suitability, and optimization of HIV treatment. We sought to quantify patient engagement along the continuum, 10 years after introduction of Chinese HIV care policies. METHODS We included patients from Shandong, China, who were diagnosed with HIV from 1992 to 2013. Records were obtained from the HIV/AIDS Comprehensive Response Information Management System to populate a 7-step HIV care continuum. Pearson χ(2) test and multivariate logistic regression were used for analysis. RESULTS Of 6500 estimated HIV-infected persons, 60.1% were diagnosed, of whom 41.9% received highly active antiretroviral therapy (HAART). Only 59.6% of patients on HAART and 15% of all infected persons achieved viral suppression. Children infected by mother-to-child transmission (MTCT) and persons infected by intravenous drug use were less likely to be linked to and retained in care (odds ratio [OR], 0.33 [95% confidence interval {CI}, .14-.80] and OR, 0.58 [95% CI, .40-.90], respectively). Persons tested in custodial institutions were substantially less likely to be on HAART (OR, 0.22 [95% CI, .09-.59]) compared with those tested in medical facilities. Patients on HAART infected by homosexual or heterosexual transmission and those infected by MTCT were less likely to achieve viral suppression (OR, 0.18 [95% CI, .09-.34]; OR, 0.12 [95% CI, .06-.22]; OR, 0.07 [95% CI, .02-.20], respectively). CONCLUSIONS Our report suggests, at the current rate, Shandong Province has to accelerate HIV care efforts to close disparities in HIV care and achieve the 90-90-90 goals equitably.
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Affiliation(s)
- Na Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Scottie Bussell
- Vanderbilt Institute for Global Health, Nashville, Tennessee
| | - Guoyong Wang
- Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xiaoyan Zhu
- Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xingguang Yang
- Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Tao Huang
- Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Yuesheng Qian
- Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xiaorun Tao
- Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Dianmin Kang
- Institute for AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
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Grover E, Grosso A, Ketende S, Kennedy C, Fonner V, Adams D, Sithole B, Mnisi Z, Maziya SL, Baral S. Social cohesion, social participation and HIV testing among men who have sex with men in Swaziland. AIDS Care 2016; 28:795-804. [PMID: 26824888 DOI: 10.1080/09540121.2015.1131971] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Social cohesion and social participation are social factors that may help reduce HIV risks and optimize health-seeking behaviors. We examined the association between these factors and HIV testing in the last 12 months among men who have sex with men (MSM) in Swaziland using a cross-sectional survey conducted with 326 men, 18 years of age or older reporting having sex with another man in the last 12 months. Social capital analyses included measures of social cohesion and social participation. The social cohesion measurement scale was created through exploratory factor analysis using polychoric correlations to determine unidimensionality and Cronbach's Alpha to assess internal consistency. The measurement scale was divided at the 25th and 75th percentiles using "high," "medium" and "low" levels of social cohesion for between-group comparisons. The social participation index included four questions regarding participation, resulting in a participation index ranging from 0 to 4. In the final multivariate logistic regression model, an increase in the level of social participation was found to be significantly associated with HIV testing in the last 12 months, adjusting for age, income, reporting a casual partner, family exclusion and rejection by other MSM due to sexual orientation (adjusted odds ratio [aOR]: 1.3, 95% confidence interval [CI] 1.1-1.7, p < .01). MSM with high social cohesion had almost twice the odds of HIV testing in the last 12 months (aOR: 1.8, 95% CI 1.1-3.3, p < .05) as MSM with medium social cohesion, though the overall social cohesion variable was not found to be significant using a Wald test in either the adjusted or unadjusted logistic regression models. These data suggest that building solidarity and trust within and between groups may be a strategy to improve uptake of HIV testing.
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Affiliation(s)
- Elise Grover
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ashley Grosso
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sosthenes Ketende
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Caitlin Kennedy
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Virginia Fonner
- c Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Darrin Adams
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | - Zandile Mnisi
- e Swaziland National AIDS Program , Mbabane , Swaziland
| | | | - Stefan Baral
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Accessibility to, Acceptability of, and Adherence to HIV/AIDS Prevention Services by Men Who Have Sex with Men: Challenges Encountered at Facility Level. ADVANCES IN PUBLIC HEALTH 2016. [DOI: 10.1155/2016/5157984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The prevalence of HIV/AIDS among men who have sex with men (MSM) in Nairobi has been reported to be 16.4% which is a public health concern. The aim of this study was to determine factors that affected accessibility to, acceptability of, and adherence to HIV/AIDS prevention services by men who have sex with men in Nairobi County, Kenya.Methods. The study used a mixed methods design, applying both quantitative and qualitative methods.Results. Over 70% of MSM reported that TB drugs, antiretroviral drugs, lubricants, condoms, and other STI treatment services were accessible. However, 31.6% of MSM reported that discrimination at the health facility level was a hindrance to accessing HIV/AIDS prevention services while 26.3% reported encountering stigma. 48.4% of MSM consumed alcohol while taking of drugs was reported, at 36.1%.Conclusion. Discrimination and stigma adversely affected MSM seeking HIV/AIDS prevention services in health facilities. MSM engaged in alcohol and substance abuse that likely affected their health seeking behavior. Although most prevention services are reported as accessible, uptake of the same needs to be considered.
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Risky sexual networks and concentrated HIV epidemics among men who have sex with men in Wenzhou, China: a respondent-driven sampling study. BMC Public Health 2015; 15:1246. [PMID: 26673429 PMCID: PMC4682249 DOI: 10.1186/s12889-015-2591-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 12/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background The high and continually increasing prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases among men who have sex with men (MSM) in China underscores the critical importance of examining the exact sexual networks that result in HIV transmission, as well as HIV infection, using powerful sampling methods, such as respondent-driven sampling (RDS), to improve the sexual health of this population. Methods Using RDS, a cross-sectional study was conducted among MSM in Wenzhou, Zhejiang province, China from December 2013 to June 2014. The type of sex, numbers of anal sex partners, male oral sex partners and vaginal sex partners, condom use during each type of sex over the previous 6 months, prevention behaviors, risk perception, and the burdens of HIV and syphilis were investigated and analyzed. Results Of 424 MSM, a great number of them did anal sex, male oral sex, and vaginal sex during the previous 6 months, and weighted estimates for the prevalence that MSM did not conduct these sexual behaviors were 11.2 % (95 % confidence interval [CI] =6.7–16.50 %), 20.3 % (95 % CI = 15.2–27.1 %), and 58.9 % (95 % CI = 52.1–65.8 %), respectively. Multiple sexual partners, engaging in regular, casual and commercial sex, and lack of condom use during all types of sex were common among MSM. The estimated HIV and syphilis prevalences were 22.8 % (95 % CI = 16.9–28.5 %) and 9.7 % (95 % CI = 6.4–13.6 %), respectively. Of the participants, 53.5 % (95 % CI = 45.3–60.2 %) received HIV-related interventions during the previous year, 48.1 % (95 % CI = 39.7–55.1 %) had never been tested for HIV, and only 14.1 % (95 % CI =10.1–19.2 %) perceived a risk of contracting HIV. Multiple logistic regression analysis revealed that age over 44 years (adjusted odds ratio [AOR] = 3.60, 95 % CI = 1.34–9.64), a monthly income of 3001–4000 yuan (approximately 470–630 US$) (AOR = 1.96, 95 % CI = 1.67–3.60), multiple anal sex partners (AOR = 1.93, 95 % CI = 1.15–3.24), awareness of the possibility of contracting HIV (AOR = 3.18, 95 % CI = 1.56–6.48), and current syphilis infection (AOR = 3.01, 95 % CI = 1.44–6.29) were predictors of HIV infection. Conclusions HIV transmission has become highly prevalent and will likely become more prevalent among MSM and their female partners if these risky sexual networks persist. Our findings call for urgent and effective interventions to prevent the rapid transmission of HIV among MSM in Wenzhou. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2591-7) contains supplementary material, which is available to authorized users.
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Yi S, Tuot S, Chhoun P, Brody C, Pal K, Oum S. Factors associated with recent HIV testing among high-risk men who have sex with men: a cross-sectional study in Cambodia. BMC Public Health 2015; 15:743. [PMID: 26231524 PMCID: PMC4522123 DOI: 10.1186/s12889-015-2096-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/24/2015] [Indexed: 12/02/2022] Open
Abstract
Background Despite remarkable success in the fight against HIV, HIV prevalence in many countries remains high among key populations including men who have sex with men (MSM), and HIV testing rates is relatively low among this hard-to-reach population. This cross-sectional study explores factors associated with recent HIV testing among MSM in Cambodia. Methods This study was conducted in 2014 and included 384 MSM randomly selected from two provinces of Battembang and Siem Reap, using a two-stage cluster sampling method. A structured questionnaire was used for face-to-face interviews to collect data on socio-demographic characteristics, HIV testing history, sexual behaviors, HIV testing attitudes, and HIV knowledge. Multivariate logistic regression analysis was performed to identify factors independently associated with recent HIV testing. Results Mean age of the participants was 23.4 (SD = 5.2). Of total, 83.6 % had been tested for HIV at least once in their lifetime, and 65.1 % had been tested for HIV in the past six months. After controlling for other covariates, MSM who had been tested for HIV in the past six months were significantly more likely to regard themselves as female (AOR = 2.29, 95 % CI = 1.06-5.37), have received some form of HIV education in the past six months (AOR = 3.97, 95 % CI = 1.91-8.26), perceive that they were at higher HIV risk compared to the general population (AOR = 2.48, 95 % CI = 1.14-4.86), have been diagnosed with an STI in the past six months (AOR = 3.19, 95 % CI = 1.02-9.24), report using a condom at last sexual intercourse with a man or woman (AOR = 2.24, 95 % CI = 1.06-3.13), and report using a condom at last sexual intercourse with a boyfriend (AOR = 2.17, 95 % CI = 1.04-5.31). Conclusions This study highlights the common practices of risky sexual behaviors and relatively low rate of recent HIV testing among MSM in Cambodia. HIV education and social marketing should be expanded and tailored for MSM, specifically addressing the risk of unprotected anal intercourse and the importance of regular HIV testing for early enrolment in the care and treatment cascade.
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Affiliation(s)
- Siyan Yi
- Research Center, KHANA, No. 33, Street 71, P.O Box 2311-PP3, Phnom Penh, Cambodia. .,Center for Global Health Research, Public Health Program, Touro University California, 1310 Club Drive, Vallejo, CA, 94594, USA.
| | - Sovannary Tuot
- Research Center, KHANA, No. 33, Street 71, P.O Box 2311-PP3, Phnom Penh, Cambodia.
| | - Pheak Chhoun
- Research Center, KHANA, No. 33, Street 71, P.O Box 2311-PP3, Phnom Penh, Cambodia.
| | - Carinne Brody
- Center for Global Health Research, Public Health Program, Touro University California, 1310 Club Drive, Vallejo, CA, 94594, USA.
| | - Khuondyla Pal
- Research Center, KHANA, No. 33, Street 71, P.O Box 2311-PP3, Phnom Penh, Cambodia.
| | - Sopheap Oum
- Research Center, KHANA, No. 33, Street 71, P.O Box 2311-PP3, Phnom Penh, Cambodia.
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