Habitual condom use across partner type and sexual position among younger gay and bisexual men: findings from New Zealand HIV behavioural surveillance 2006-2011

Rate and Predictors of Ineffective HIV Protection in African Men Who Have Sex with Men Taking Pre-Exposure Prophylaxis

We investigated the rate and predictors of ineffective HIV protection in men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) in a prospective cohort study from November 2017 to November 2020 in Mali, Côte d'Ivoire, Burkina Faso, and Togo. MSM had to be 18 years or older and at high risk of HIV infection to participate. They also received a comprehensive sexual health prevention package, including PrEP, in community-based clinics as part of the cohort study. Using socio-behavioral/clinical data, HIV protection during their most recent anal intercourse with a male partner was categorized as effective or ineffective (i.e., incorrect PrEP adherence and no condom use). Seventeen percent (500/2839) of intercourses were ineffectively protected for the 520 study participants. Predictors of ineffective HIV protection included being an event-driven user with financial difficulties, having a high alcohol misuse score, and not being a member of a community association. PrEP programs in West Africa must be tailored to socially vulnerable MSM who struggle to adopt PrEP.

Health Beliefs Linked to HIV Pre-Exposure Prophylaxis Use Intention Among Young Men Who Have Sex with Men in Taiwan

Pre-exposure prophylaxis (PrEP) is an effective tool to prevent HIV and has recently been approved in Taiwan. However, more research regarding PrEP acceptability and effective PrEP implementation is needed in Taiwan. Little is known about the intention to use PrEP and salient psychosocial factors among men who have sex with men (MSM). The purpose of this study was to examine health beliefs linked to PrEP use intention among young MSM (YMSM) in Taiwan. Using the Health Belief Model (HBM) as a guiding framework, an anonymous online survey was used to collect data from participants who were recruited using multiple channels to ensure diversity. Multivariate logistic regression was performed to examine the health beliefs linked to high PrEP use intention. Data from 1329 HIV-negative YMSM were analyzed; 488 (36.7%) were classified as having high PrEP use intention, which was found to be associated with having high perceived susceptibility to HIV infection [adjusted odds ratio (AOR) = 2.11], high perceived benefits of PrEP use (AOR = 2.14), high self-efficacy in PrEP use (AOR = 4.19), and many cues to action concerning PrEP use (AOR = 1.49). YMSM with high perceived barriers to PrEP use (AOR = 0.64) had lower PrEP use intention. In addition, the effects of HBM constructs and specific health beliefs on PrEP use intention varied by preferred penile-anal sexual role. The study findings may inform efforts aimed at improving PrEP acceptability and optimizing PrEP implementation programs tailored for YMSM of different sexual roles.

Longitudinal Event-Level Sexual Risk and Substance Use among Gay, Bisexual, and Other Men Who Have Sex with Men

(1) Background: Condomless anal sex and substance use are associated with STI risk among gay, bisexual, and other men who have sex with men (gbMSM). Our first study objective was to describe event-level sexual risk and substance use trends among gbMSM. Our second study objective was to describe substances associated with event-level sexual risk. (2) Methods: Data come from the Momentum Health Study in Vancouver, British Columbia and participants were recruited from 2012-2015, with follow-up until 2018. Stratified by self-reported HIV status, we used generalized estimating equations to assess trends of sexual event-level substance use and assessed interactions between substance use and time period on event-level higher risk sex defined as condomless anal sex with an HIV serodifferent or unknown status partner. (3) Results: Event-level higher risk anal sex increased across the study period among HIV-negative/unknown (baseline prevalence: 13% vs. study end prevalence: 29%) and HIV-positive gbMSM (baseline prevalence: 16% vs. study end prevalence: 38%). Among HIV-negative/unknown gbMSM, event-level erectile drug use increased, while alcohol use decreased over the study period. Overall, interactions between substance use and time on higher risk anal sex were not statistically significant, regardless of serostatus. However, we found a number of time-specific significant interactions for erectile drugs, poppers, Gamma-hydroxybutyrate (GHB), crystal methamphetamine and ecstasy/MDMA use among HIV-negative/unknown gbMSM. (4) Conclusion: Significant differences in substance use trends and associated risks exist and are varied among gbMSM by serostatus. These findings provide a more comprehensive understanding of the effects of event-level substance use on sexual risk through longitudinal follow-up of nearly six years.

National trends in sexual health indicators among gay and bisexual men disaggregated by ethnicity: repeated cross-sectional behavioural surveillance in New Zealand

OBJECTIVES

To assess trends in sexual health outcomes among men who have sex with men (MSM) disaggregated by ethnicity.

DESIGN

Repeated cross-sectional.

SETTING

Behavioural surveillance data from 2006, 2008, 2011 and 2014 were collected in-person and online across Aotearoa New Zealand.

PARTICIPANTS

Eligible participants were self-identified men aged 16 years or older who reported sex with another man in the past 5 years. We classified 10 525 participants' ethnicities: Asian (n=1003, 9.8%), Māori (Indigenous people of Aotearoa New Zealand, n=1058, 10.3%), Pacific (n=424, 4.1%) and European (n=7867, 76.8%).

OUTCOME MEASURES

The sexual health outcomes examined were >20 recent (past 6 months) male sexual partners, past-year sexually transmitted infection (STI) testing, past-year STI diagnosis, lifetime and past-year HIV testing, lifetime HIV-positive diagnosis and any recent (past 6 months) condomless anal intercourse with casual or regular partners.

RESULTS

When disaggregated, Indigenous and ethnic minority groups reported sexual health trends that diverged from the European MSM and each other. For example, Asian MSM increased lifetime HIV testing (adjusted OR, AOR=1.31 per survey cycle, 95% CI 1.17 to 1.47) and recent HIV testing (AOR=1.14, 95% CI 1.02 to 1.28) with no changes among Māori MSM or Pacific MSM. Condomless anal intercourse with casual partners increased among Māori MSM (AOR=1.13, 95% CI 1.01 to 1.28) with no changes for Asian or Pacific MSM. Condomless anal intercourse with regular partners decreased among Pacific MSM (AOR=0.83, 95% CI 0.69 to 0.99) with no changes for Asian or Māori MSM.

CONCLUSIONS

Population-level trends were driven by European MSM, masking important differences for Indigenous and ethnic minority sub-groups. Surveillance data disaggregated by ethnicity highlight inequities in sexual health service access and prevention uptake. Future research should collect, analyse and report disaggregated data by ethnicity to advance health equity.

Psychosocial Barriers to Pre-exposure Prophylaxis (PrEP) Uptake: The Roles of Heterosexual Self-Presentation, Sexual Risk, and Perceived Peer PrEP Use

Several challenges have emerged in ensuring uptake of preexposure prophylaxis (PrEP) for HIV prevention. By applying the health belief model, the present study assessed associations between novel psychosocial variables and PrEP use among gay and bisexual men. Logistic regression analyses indicated that heterosexual self-presentation, sexual risk, PrEP conspiracy beliefs, and perceived peer PrEP use were positively associated with PrEP use. Greater understanding of the psychosocial barriers to PrEP use for unique at-risk populations can facilitate the development of socially informed prevention strategies.

HIV Seroconversion and Types of Relationships Among Men Who Have Sex With Men: A Cohort Study in China

BACKGROUND

The role of partner types in modifying HIV seroconversion risk among men who have sex with men (MSM) is complex. We sought to understand the role of regular sexual partners and risky sexual behavior in contributing to incident HIV infection among MSM.

METHODS

From July 2011 to August 2017, we recruited HIV-negative men who reported having anal or oral homosexual encounters in the past 6 months and they were followed up every 3 months for 2 visits. We collected sociodemographic and behavioral characteristics by a self-administrated questionnaire. HIV status was confirmed by a sequential rapid test and confirmatory test. We used multivariable Cox regression to identify risk factors and interaction models to evaluate the relative excess risk between relevant variables.

RESULTS

Among 1218 participants, the HIV seroconversion rate was 3.66/100 person-years. HIV seroconversion was associated with lower educational attainment [adjusted hazards ratio (aHR)] = 1.73, 95% CI: 1.06 to 2.81), having had penetrative sex with male before age of 18 years (aHR = 2.44, 95% CI: 1.20 to 4.99), not using condoms in the last sexual encounter (aHR = 2.19, 95% CI: 1.29 to 3.71), and having regular but not committed partners (aHR = 3.33, 95% CI: 1.77 to 6.93). Among 890 (73%) of men reported having regular partners, HIV seroconversion was more frequent in men whose stable partners were not committed as boyfriends (aHR = 3.31, 95% CI: 1.73 to 6.36) and in men having unprotected anal sex (aHR = 2.61, 95% CI: 1.42 to 4.80). Interaction between these 2 factors was observed (relative excess risk of interaction = 4.53).

CONCLUSIONS

Incidence among MSM in China was high; unprotected sex with steady but not committed partners was associated with increased seroconversion risk. It is imperative to expand safer sex education and training for MSM to reduce unsafe sexual behaviors, including awareness that casual partners are not the only source of infection.

Evaluation of a Stepped-Care eHealth HIV Prevention Program for Diverse Adolescent Men Who Have Sex With Men: Protocol for a Hybrid Type 1 Effectiveness Implementation Trial of SMART

BACKGROUND

Adolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (eg, community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART program, represent an excellent modality for delivering AMSM-specific intervention material where youth are.

OBJECTIVE

This randomized trial aimed to test the effectiveness of the SMART program in reducing condom-less anal sex and increasing condom self-efficacy, condom use intentions, and HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important subgroups of AMSM based on race and ethnicity, urban versus rural residence, age, socioeconomic status, and participation in an English versus a Spanish version of SMART.

METHODS

Using a sequential multiple assignment randomized trial design, we will evaluate the impact of a stepped-care package of increasingly intensive eHealth interventions (ie, the universal, information-based SMART Sex Ed; the more intensive, selective SMART Squad; and a higher cost, indicated SMART Sessions). All intervention content is available in English and Spanish. Participants are recruited primarily from social media sources using paid and unpaid advertisements.

RESULTS

The trial has enrolled 1285 AMSM aged 13 to 18 years, with a target enrollment of 1878. Recruitment concluded in June 2020. Participants were recruited from 49 US states as well as Puerto Rico and the District of Columbia. Assessments of intervention outcomes at 3, 6, 9, and 12 months are ongoing.

CONCLUSIONS

SMART is the first web-based program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design indicates that SMART delivers resources to all adolescents, but more costly treatments (eg, video chat counseling in SMART Sessions) are conserved for individuals who need them the most. SMART has the potential to reach AMSM to provide them with a sex-positive curriculum that empowers them with the information, motivation, and skills to make better health choices.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT03511131; https://clinicaltrials.gov/ct2/show/NCT03511131.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19701.

Condom-Associated Erectile Function, But Not Other Domains of Sexual Functioning, Predicts Condomless Insertive Anal Sex Among Young Men Who Have Sex with Men

Condoms effectively prevent against HIV, especially when used in conjunction with biomedical strategies such as PrEP and viral suppression. However, consistent use of condoms in the real world has been a continual health promotion challenge, even among populations at highest risk, such as young men who have sex with men (YMSM). Inconsistent condom use may be related to poor sexual functioning, but limited research exists. The analytic sample comprised 688 racially diverse YMSM aged 16-29 (M = 22.9 years) living in Chicago, IL (19.2% living with HIV). Using multivariable logistic regression, we examined longitudinal associations between condom-associated sexual functioning (erectile function, orgasm satisfaction, global satisfaction, and anal discomfort) and condomless insertive anal sex (CIAS) and condomless receptive anal sex (CRAS) 6 months later. CIAS at Time 2 was associated with condom-associated erectile function at the bivariate and multivariable levels, even after controlling for CIAS at Time 1 (p < .05). Condom-associated erectile function, orgasm satisfaction, and global satisfaction predicted Time 2 CRAS in bivariate models, but none remained significant in the multivariable models. Age, having had a serious partner in the past 6 months, and HIV/PrEP status at Time 2 were significant predictors of CIAS/CRAS in some but not all models. Future interventions to improve consistent condom use should specifically highlight information and skills on how to use condoms within real-world contexts rather than from a clinical perspective. Our results also support the importance of biomedical strategies for those who have continued problems with sexual functioning when using condoms.

Psychosociobehavioral characteristics associated with high condomless anal intercourse intention: a comparison of receptive, versatile, and insertive MSM in Taiwan

In Taiwan, men who have sex with men (MSM) continue to be disproportionately affected by HIV, and the main route of HIV transmission is condomless anal intercourse (CAI). This study examined the associations between psychosociobehavioral characteristics and CAI intention among MSM in Taiwan who had ever engaged in anal intercourse with men, and compared the differences across three sexual roles (receptive, versatile, and insertive) using online survey data (N = 563). For all MSM, those that were in a relationship (AOR = 2.55; 95% CI: 1.61-4.03), had three or more steady partners (AOR = 2.58; 95% CI: 1.19-5.58), did not use a condom during last anal intercourse (AOR = 6.81; 95% CI: 4.36-10.63), perceived high HIV risk (AOR = 2.13; 95% CI: 1.26-3.60), and had high sexual sensation seeking (AOR = 2.80; 95% CI: 1.82-4.30) were more likely to have high CAI intention. After stratification, the significant characteristics differed depending on sexual role, except for no condom use during last anal intercourse remaining significant in all models (AOR = 5.09-20.30; 95% CI: 2.49-66.69, depending on sexual role). Tailoring the programs for MSM of different sexual roles may improve the effectiveness of future prevention efforts.

Intimate relationship characteristics as determinants of HIV risk among men who have sex with regular male sex partners: a cross-sectional study in Guangzhou, China

Background

China faces a serious HIV epidemic among men who have sex with men (MSM), and a large proportion of new infections are attributed to their regular male sex partners (RP). The objective of this study was to investigate the association between intimate relationship characteristics and HIV-related behaviors among MSM with RP in Guangzhou, China.

Methods

A convenience-sampling method was used in data collection. A total of 608 MSM were screened, of whom 406 HIV negative MSM with at least one RP in the past six months were used for data analysis. Three-step logistic regressions were used to analyze the data.

Results

The prevalence of unprotected anal intercourse (UAI) with regular male sex partners, non-regular male sex partners, and concurrent UAI in the past six months was 53.9%, 23.6%, 20.7%, respectively. Variables associated with UAI with regular male sex partners included expectations for this relationship (adjusted odds ratio in multiple forward stepwise logistic regression, OR_m = 1.66) and open communication about the sexual relationship (OR_m = 1.79), while expectations for the relationship (OR_m = 0.46 to 0.54) and conflicts of interest (OR_m = 5.46 to 5.97) were associated with concurrent UAI and UAI with non-regular male sex partners.

Conclusion

Intimate relationship characteristics were related to HIV-related risk behaviors. Future HIV prevention interventions should take MSM couples into consideration, include a focus on the quality of their intimate relationships, and encourage open communication about their sexual relationships.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3044-6) contains supplementary material, which is available to authorized users.

An Event-Level Analysis of Condom Use During Anal Intercourse Among Self-Reported Human Immunodeficiency Virus-Negative Gay and Bisexual Men in a Treatment as Prevention Environment

BACKGROUND

We sought to identify factors associated with condom use during anal intercourse among self-identified human immunodeficiency virus-negative gay, bisexual, and other men who have sex with men (GBM) in Vancouver, Canada following "treatment as prevention" (TasP) scale-up in 2010.

METHODS

Sexually active GBM were recruited using respondent-driven sampling from 2012 to 2014. We analyzed participants' most recent sexual encounter with up to their last 5 sexual partners within the past 6 months. In addition to individual- and event-level explanatory factors, we assessed potential associations with TasP awareness, TasP-related prevention practice (viral load sorting), and TasP-related attitudes (human immunodeficiency virus treatment optimism). Accounting for clustering at the respondent-driven sampling chain-level and participant-level, factors associated with event-level condom use versus nonuse were determined using a multivariable generalized linear mixed model built using backward selection and AIC minimization.

RESULTS

Of 513 participants, 436 GBM (85%) reported a total of 1196 anal sex events with 56% condom use. The proportion of condom-protected sexual events decreased monthly over the study period (odds ratio [OR], 0.95 per month, 95% confidence interval [CI], 0.92-0.98). The TasP practices and attitudes were significantly associated with lower odds of condom use at the univariate level, but were no longer significant at multivariate level. In the multivariable model, event-level partner methamphetamine use (adjusted OR [aOR], 0.18; 95% CI, 0.06-0.58), frequency of recent anal intercourse with that partner (aOR, 0.97 per act; 95% CI, 0.95-0.98) and time since first sex with that partner (aOR, 0.97 per 6 months; 95% CI, 0.95-0.99) were associated with lower odds of condom use, whereas event-level participant alcohol use (aOR, 1.41; 95% CI, 1.01-1.98) and no planned future sex with that partner (aOR, 1.56; 95% CI, 1.08-2.27) were associated with greater odds of condom use. Event-level receptive-only (aOR, 2.10; 95% CI, 1.38-3.20) or insertive-only (aOR, 2.53; 95% CI, 1.64-3.90) sexual positions were associated with greater odds of condom use compared with reporting both positions.

CONCLUSIONS

The TasP-related factors were not the most salient predictors of GBM's condom use. Health promotion must consider associations between condomless anal sex and substance use and relational factors.

A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men

Initial research into seroadaptive strategies suggests that, individually, they are potentially effective behavioral methods to reduce risk of HIV transmission. Combining strategies, therefore, has the potential to increase risk reduction. The aim of this study was to determine how gay and bisexual men (GBM) combine strategies. To this end, a total of 774 sexually active GBM, aged ≥16 years, in Metro Vancouver, Canada, were recruited. Grouped by self-reported HIV status, latent class analysis of self-reported condom use, strategic positioning, anal sex avoidance, serosorting, viral-load sorting, and withdrawal were conducted. Multinomial logistical regression identified explanatory variables of class membership (i.e., sensation seeking, treatment optimism, sexual altruism, relationship status, number of partners, anal sex preference). Four latent classes were identified: Condom Users, Multiple Prevention Users, Viral-Load Sorters, and Serosorters. The majority of HIV-negative/unknown men (72 %) and a large proportion of HIV-positive men (42 %) belonged to the Condom Users class. Class membership was associated with age, relationship status, treatment optimism, sexual altruism, sensation seeking, number of recent male anal sex partners, and recent condomless anal sex with a serodiscordant or unknown-status partner. Understanding these distinct patterns allows for tailored interventions addressing GBM's sexual health needs.

Fuckbuddy partnerships among men who have sex with men - a marker of sexually transmitted infection risk

'Fuckbuddies' are a type of regular sexual partner with whom men have ongoing sexual contact, generally in the absence of romantic attachment. We surveyed 989 men who have sex with men (MSM) at the Melbourne Sexual Health Centre, Australia, with the aim of determining the frequency of 'fuckbuddy' partnerships among sexual health clinic attendees and assessing their sexual risk. The majority (60%) of 1139 regular partnerships were described as 'fuckbuddies'. Most MSM (63%) with a 'fuckbuddy' had multiple 'fuckbuddies'. MSM with 'fuckbuddies' were more likely to also have casual sexual partners (odds ratio [OR] 5.7; 95% confidence interval 3.6-8.9) and had more casual sexual partners (median of 4 versus 1, p < 0.001) and more rectal chlamydia (12.4% versus 5.7%; adjusted OR 2.3; p < 0.05) than MSM without 'fuckbuddies', and this risk persisted after adjusting for total numbers of sexual partners. Our findings suggest that patients with 'fuckbuddies' are at particular risk of sexually transmitted infections. We argue that clinicians should specifically ask about 'fuckbuddy' partnerships as part of their risk assessment during patient interviews, as these patients may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP).

An Event-Level Analysis of the Interpersonal Factors Associated With Condomless Anal Sex Among Gay, Bisexual, and Other Men Who Have Sex With Men (MSM) With Online-Met Partners

The interpersonal determinants of condomless anal sex (CAS) within online-initiated sexual relationships remain poorly understood. Therefore, respondent-driven sampling was used to recruit a prospective cohort of sexually active gay, bisexual, and other men who have sex with men (MSM), aged ≥ 16 years in Vancouver, Canada. Follow-up occurred every 6 months, up to seven visits; at each visit participants reported their last sexual encounter with their five most recent partners. Stratified by self-reported HIV status, individual-level, interpersonal, and situational covariates of event-level CAS with partners met online were modeled using generalized estimating equations (GEE). CAS was reported during 32.4% (n = 1,015/3,133) of HIV-negative/unknown men's events, and 62.1% (n = 576/928) of HIV-positive men's events. Social (i.e., collective identity, altruism, network size social embeddedness) and situational (i.e., number of encounters, location, comparative age, seroconcordance, substance use) factors were identified as important correlates of CAS. Implications include the need for HIV prevention addressing social contexts associated with CAS.