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Sun HT, Fan XR, Gu YZ, Lu YH, Qiu JL, Yang QL, Li JH, Gu J, Hao C. WeChat-based HIV E-report, A New Manner for HIV Serostatus Request and Disclosure and Their Associated Factors Among Men Who Have Sex with Men: Prospective Subgroup Analysis of Randomized Controlled Trails (Preprint). JMIR Mhealth Uhealth 2022; 11:e44513. [PMID: 37155223 DOI: 10.2196/44513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Requesting and disclosing HIV serostatus is associated with a reduction in HIV transmission among men who have sex with men (MSM). However, the reliability of common methods for HIV serostatus requests and disclosure is unsatisfactory. Validated approaches for requesting and disclosing HIV serostatus are necessary. OBJECTIVE The objective of this study was to investigate the use of the HIV e-report as authentic evidence of HIV serostatus among the MSM community in Guangzhou, China. Additionally, the study aimed to explore its correlates with HIV serostatus requesting and disclosure receiving behavior. METHODS This study is a subgroup analysis of a cluster randomized controlled trial (RCT) that enrolled 357 participants during the first year. Participants in this RCT were recruited from the WeChat-based HIV testing service miniprogram developed by Guangzhou Center for Disease Control and Prevention, China. Participants completed web-based questionnaires at baseline and at the month 3 follow-up, which covered sociodemographic characteristics, HIV-related information, HIV serostatus requests, HIV serostatus disclosure receiving, and HIV e-report usage. Univariate and multivariate logistic regressions were used for data analysis. RESULTS The WeChat-based HIV e-report was available in Guangzhou when the RCT project started. At the month 3 follow-up, 32.2% (115/357) of participants had their own HIV e-reports, and 37.8% (135/357) of them had received others' HIV e-reports. For HIV serostatus requests, 13.1% (27/205) and 10.5% (16/153) of participants started to use HIV e-reports to ask the HIV serostatus of regular and casual male sex partners, respectively. Of the regular and casual male sex partners, 27.3% (42/154) and 16.5% (18/109), respectively, chose HIV e-reports to disclose HIV serostatus. Compared to MSM who did not have HIV e-reports, those who said, "I had had my own HIV e-report(s) but hadn't sent to others" (multivariate odds ratio 2.71, 95% CI 1.19-6.86; P=.02) and "I had had my own HIV e-reports and had sent to others" (multivariate odds ratio 2.67, 95% CI 1.07-7.73; P=.048) were more likely to request HIV serostatus from their partners. Whereas no factor was associated with HIV serostatus disclosure received from partners. CONCLUSIONS The HIV e-report has been accepted by the MSM community in Guangzhou and could be applied as a new optional way for HIV serostatus request and disclosure. This innovative intervention could be effective in promoting infectious disease serostatus disclosure among the related high-risk population. TRIAL REGISTRATION ClinicalTrials.gov NCT03984136; https://clinicaltrials.gov/show/NCT03984136. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12879-021-06484-y.
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Affiliation(s)
- Hai-Tong Sun
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Ru Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Yu-Zhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yong-Heng Lu
- Lingnan Community Support Center, Guangzhou, China
| | - Jia-Ling Qiu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Qing-Ling Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Jing-Hua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
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Biello KB, Goedel WC, Edeza A, Safren SA, Mayer KH, Marshall BD, Latkin C, Mimiaga MJ. Network-Level Correlates of Sexual Risk Among Male Sex Workers in the United States: A Dyadic Analysis. J Acquir Immune Defic Syndr 2020; 83:111-118. [PMID: 31929400 PMCID: PMC7262793 DOI: 10.1097/qai.0000000000002230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Male sex workers (MSWs) are at increased risk of HIV infection in the United States. Research is limited on sexual and drug use network characteristics of MSWs. SETTING Community-based organization and health center in 2 US Northeast cities. METHODS One hundred MSWs completed a behavioral assessment and sexual and drug network inventory. Using dyadic analyses, we assessed whether network characteristics, including sex worker-male client age, race, and HIV status homophily and risk multiplexity (ie, overlap in drug-use and sex networks), were associated with condom use. RESULTS MSW participants' mean age was 33.6. Two-thirds identified as Black or Latino, 12% identified as heterosexual, and 90% reported recent drug use. Participants reported an average of 5.3 male clients in the past month (SD = 3.4), and having anal sex with 74% of these clients, at a rate of 2.2 times per month (SD = 4.6). Participants reported inconsistent condom use during anal sex with 53% of clients. In multivariable models, inconsistent condom use was more common in relationships with presumed HIV status homophily [odds ratio (OR): 1.25; 95% confidence interval (CI): 1.07 to 1.46] and sexual and drug network multiplexity (OR: 1.19; 95% CI: 1.09 to 1.30); and less common within relationships where the client is older than the MSW participant (OR: 0.83; 95% CI: 0.74 to 0.93). Number of multiplex relationships was positively associated with number of condomless anal sex acts with male clients (incidence rate ratio: 1.35; 95% CI: 1.19 to 1.54). CONCLUSIONS Network characteristics may contribute to disproportionate HIV risk among MSWs. Modeling studies should include network characteristics when simulating HIV transmission, and future HIV interventions should address the role of networks.
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Affiliation(s)
- Katie B. Biello
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
- Fenway Institute, Fenway Health, Boston, MA
| | - William C. Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Steven A. Safren
- Fenway Institute, Fenway Health, Boston, MA
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, Florida
| | - Kenneth H. Mayer
- Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Global Health and Population, T.H. Chan School of Public Health, Harvard University, Cambridge, MA
| | - Brandon D.L. Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Matthew J. Mimiaga
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
- Fenway Institute, Fenway Health, Boston, MA
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Tang W, Liu C, Cao B, Pan SW, Zhang Y, Ong J, Fu H, Ma B, Fu R, Yang B, Ma W, Wei C, Tucker JD. Receiving HIV Serostatus Disclosure from Partners Before Sex: Results from an Online Survey of Chinese Men Who Have Sex with Men. AIDS Behav 2018; 22:3826-3835. [PMID: 29470809 PMCID: PMC6105569 DOI: 10.1007/s10461-018-2062-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV serostatus disclosure before sex can facilitate serosorting, condom use and potentially decrease the risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men (MSM) in China. An online cross-sectional study was conducted among MSM in eight Chinese cities in July 2016. Participants completed questions covering sociodemographic information, sexual behaviors, HIV testing (including HIV self-testing) history, self-reported HIV status, and post-test violence. In addition, participants were asked whether they received HIV serostatus disclosure from their most recent partners before sex. Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. A minority (20.6%, 346/1678; 17.8%, 287/1608) of men received HIV serostatus disclosure from their most recent regular and casual male partners, respectively. Multivariate analysis indicated that participants who ever self-tested for HIV were more likely to have received HIV status disclosure from regular [adjusted OR (aOR) = 1.92, 95% CI 1.50-2.44] and casual (aOR = 2.34, 95% CI 1.80-3.04) male partners compared to never self-tested participants. Compared to participants who had not received HIV status disclosure from regular partners, participants who received disclosure from regular male partners had higher likelihood in experiencing post-test violence (aOR = 5.18, 95% CI 1.53-17.58). Similar results were also found for receiving HIV serostatus disclosure from casual partners. This study showed that HIV serostatus disclosure from partners was uncommon among Chinese MSM. Interventions and further implementation research to facilitate safe disclosure are urgently needed for MSM.
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Affiliation(s)
- Weiming Tang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China.
- SESH Study Group, Guangzhou, China.
- Dermatology Hospital of Southern Medical University (Guangdong Dermatology Hospital), Guangzhou, China.
- School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Chuncheng Liu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
- Department of Sociology, University of California, San Diego, La Jolla, USA
| | - Bolin Cao
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
- College of Mass Communication, Shenzhen University, Shenzhen, China
| | - Stephen W Pan
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
| | - Ye Zhang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
- Dermatology Hospital of Southern Medical University (Guangdong Dermatology Hospital), Guangzhou, China
| | - Jason Ong
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Rong Fu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University (Guangdong Dermatology Hospital), Guangzhou, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
| | - Chongyi Wei
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
- School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA
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Wang C, Tucker JD, Liu C, Zheng H, Tang W, Ling L. Condom use social norms and self-efficacy with different kinds of male partners among Chinese men who have sex with men: results from an online survey. BMC Public Health 2018; 18:1175. [PMID: 30326880 PMCID: PMC6192108 DOI: 10.1186/s12889-018-6090-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/04/2018] [Indexed: 01/09/2023] Open
Abstract
Background Social norms and self-efficacy play important roles in promoting consistent condom use among men who have sex with men (MSM). Few studies have investigated the association between social norms, self-efficacy and consistent condom use with different kinds of male partners among MSM. We conducted an online survey of MSM to evaluate this in China. Methods A cross-sectional online survey was conducted in 2015. Participants completed a validated questionnaire covering socio-demographic information, consistent condom use, condom use social norms and self-efficacy. Eligible participants were 16 or older, born biologically as a male, engaged in anal sex with a man at least once during their lifetime, engaged in condomless anal or vaginal sex in the last three months. In this study, we further restricted to people who had sex with male partners in the last three months. Participants were classified into three groups: engaged in sex only with regular partners, engaged in sex only with casual partners and engaged in sex with both regular partners and casual partners. Results Participants were recruited from 32 provinces in China. Among 1057 participants, 451(42.7%), 217(20.5%), and 389(36.8%) engaged in sex with regular partners only, casual partners only and both types in the last three months, respectively. Men engaged in sex only with regular partners in the last three months had a higher condom use self-efficacy than with other two types of partners (P < 0.01). Both social norms (regular partners: adjusted OR:1.59, 95% CI: 0.97–2.60; casual partners: adjusted OR: 1.58, 95% CI: 1.19–2.09; both types: adjusted OR: 1.48, 95% CI: 1.13–1.95) and self-efficacy (regular partners: adjusted OR: 2.88, 95% CI: 1.59–5.22; casual partners: adjusted OR: 2.35, 95% CI: 1.69–3.26; both types: adjusted OR: 2.45, 95% CI: 1.81–3.32) were positively associated with consistent condom use. No interaction effect was detected between condom social norms and self-efficacy on consistent condom use among Chinese MSM (p > 0.05). Conclusions Both social norms and self-efficacy were positively correlated with consistent condom use with any types of partners among Chinese MSM. Tailored interventions that aimed to improve social norms and self-efficacy has the potential to improve overall condom use among Chinese MSM. Trial registration ClinicalTrials.gov: NCT02516930. August 6, 2015. Electronic supplementary material The online version of this article (10.1186/s12889-018-6090-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China.,SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China.,School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Chuncheng Liu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China.,SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China. .,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China. .,University of North Carolina at Chapel Hill Project-China, Guangzhou, China. .,SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China. .,School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Rivierez I, Quatremere G, Spire B, Ghosn J, Rojas Castro D. Lessons learned from the experiences of informal PrEP users in France: results from the ANRS-PrEPage study. AIDS Care 2018; 30:48-53. [PMID: 29848005 DOI: 10.1080/09540121.2018.1468014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Before January 2016, Pre-Exposure Prophylaxis (PrEP), a new biomedical HIV-prevention tool, was only available in France via ANRS-Ipergay clinical study but informal use was reported outside this setting. PrEPage qualitative study reports profiles and experiences of participants who used PrEP outside of a biomedical trial before this prevention method was authorized. Between March 2015 and February 2016, a cross-section of twenty-four informal PrEP users, mostly MSM, was recruited to complete in-depth semi-structured interviews. While ANRS-Ipergay was still ongoing (2012-2016), participants described their initiation to PrEP, the way they used it and the difficulties they faced to acquire antiretroviral drugs in an environment where PrEP was still not widely known and often criticized . Through the testimonies, different user profiles and motivation toward informal PrEP use emerged: (a) participants who have increasing difficulties using condoms, (b) "opportunists" who tried PrEP without the intention of using it regularly and (c) participants with a risk aversion who sought additional protection against HIV. Participants chose to use PrEP and/or their usual prevention strategies depending on available supplies, type of partners and individual attitudes toward risk. The feeling of living a safer sex life helped participants to outweigh the fear of possible toxicity and drug resistance. Participants' needs and expectations about PrEP implementation in France were also presented.
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Affiliation(s)
- I Rivierez
- a AIDES, Community Based Research Department , Pantin , France.,b Paris Descartes University, UMR 8070, CERLIS , Paris , France
| | - G Quatremere
- a AIDES, Community Based Research Department , Pantin , France
| | - B Spire
- c Aix Marseille University, INSERM, IRD, SESSTIM , Marseille , France
| | - J Ghosn
- d APHP, Department of Infectious Diseases , Bichat University Hospital , Paris , France.,e IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité , Paris , France
| | - D Rojas Castro
- c Aix Marseille University, INSERM, IRD, SESSTIM , Marseille , France.,f Coalition PLUS, Research Department , Pantin , France.,g Lyon 2 University, GRePS EA 4163 , Lyon , France
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Marcus U, Schink SB, Sherriff N, Jones AM, Gios L, Folch C, Berglund T, Nöstlinger C, Niedźwiedzka-Stadnik M, Dias SF, Gama AF, Naseva E, Alexiev I, Staneková D, Toskin I, Pitigoi D, Rafila A, Klavs I, Mirandola M. HIV serostatus knowledge and serostatus disclosure with the most recent anal intercourse partner in a European MSM sample recruited in 13 cities: results from the Sialon-II study. BMC Infect Dis 2017; 17:730. [PMID: 29178847 PMCID: PMC5702243 DOI: 10.1186/s12879-017-2814-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022] Open
Abstract
Background Knowledge of HIV status can be important in reducing the risk of HIV exposure. In a European sample of men-who-have-sex-with-men (MSM), we aimed to identify factors associated with HIV serostatus disclosure to the most recent anal intercourse (AI) partner. We also aimed to describe the impact of HIV serostatus disclosure on HIV exposure risks. Methods During 2013 and 2014, 4901 participants were recruited for the bio-behavioural Sialon-II study in 13 European cities. Behavioural data were collected with a self-administered paper questionnaire. Biological specimens were tested for HIV antibodies. Factors associated with HIV serostatus disclosure with the most recent AI partner were examined using bivariate and multilevel multivariate logistic regression analysis. We also describe the role of serostatus disclosure for HIV exposure of the most recent AI partner. Results Thirty-five percent (n = 1450) of the study participants reported mutual serostatus disclosure with their most recent AI partner or disclosed having HIV to their partner. Most of these disclosures occurred between steady partners (74%, n = 1077). In addition to the type of partner and HIV diagnosis status, other factors positively associated with HIV serostatus disclosure in the multilevel multivariate logistic regression model were recent testing, no condom use, and outness regarding sexual orientation. Disclosure rates were lowest in three south-eastern European cities. Following condom use (51%, n = 2099), HIV serostatus disclosure (20%, n = 807) was the second most common prevention approach with the most recent AI partner, usually resulting in serosorting. A potential HIV exposure risk for the partner was reported by 26% (111/432) of HIV antibody positive study participants. In 18% (20/111) of exposure episodes, an incorrect HIV serostatus was unknowingly communicated. Partner exposures were equally distributed between steady and non-steady partners. Conclusions The probability of HIV exposure through condomless AI is substantially lower after serostatus disclosure compared to non-disclosure. Incorrect knowledge of one’s HIV status contributes to a large proportion of HIV exposures amongst European MSM. Maintaining or improving condom use for anal intercourse with non-steady partners, frequent testing to update HIV serostatus awareness, and increased serostatus disclosure particularly between steady partners are confirmed as key aspects for reducing HIV exposures amongst European MSM. Electronic supplementary material The online version of this article (10.1186/s12879-017-2814-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrich Marcus
- Department of Infectious Diseases Epidemiology, Robert Koch-Institute, Berlin, Germany.
| | | | | | - Anna-Marie Jones
- University of Brighton, Health Sciences, Brighton, UK.,Mill View Hospital, Sussex Education Centre, Research & Development, Brighton, UK
| | - Lorenzo Gios
- Department of Health, Verona University Hospital, CReMPE - Regional Coordination Centre for European Project Management, Verona, Veneto Region, Italy
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Badalona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Torsten Berglund
- Department of Monitoring & Evaluation, Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Sonia F Dias
- Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Lisbon, Portugal
| | - Ana F Gama
- Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Lisbon, Portugal
| | - Emilia Naseva
- Ministry of Health, Program "Prevention and Control of HIV/AIDS", Sofia, Bulgaria
| | - Ivailo Alexiev
- National Centre of Infectious and Parasitic Diseases, National Reference Laboratory of HIV, Sofia, Bulgaria
| | - Danica Staneková
- Slovak Medical University, National Reference Centre for HIV/AIDS, Bratislava, Slovakia
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Daniela Pitigoi
- University of Medicine and Pharmacy Carol Davila, Department Clinic 2, Epidemiology, Bucharest, Romania.,National Institute for Infectious Diseases "Prof Dr Matei Bals", Bucharest, Romania
| | - Alexandru Rafila
- Department of Microbiology, National Institute of Infectious Diseases "Prof Dr Matei Bals", Bucharest, Romania
| | - Irena Klavs
- National Institute of Public Health, Communicable Diseases Centre, Ljubljana, Slovenia
| | - Massimo Mirandola
- Department of Health, Infectious Disease Section, Verona University Hospital, CReMPE - Regional Coordination Centre for European Project Management, Verona, Veneto Region, Italy
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Khosropour CM, Dombrowski JC, Hughes JP, Manhart LE, Simoni JM, Golden MR. Operationalizing the Measurement of Seroadaptive Behaviors: A Comparison of Reported Sexual Behaviors and Purposely-Adopted Behaviors Among Men who have Sex with Men (MSM) in Seattle. AIDS Behav 2017; 21:2935-2944. [PMID: 28097616 DOI: 10.1007/s10461-017-1682-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Seroadaptive behaviors are traditionally defined by self-reported sexual behavior history, regardless of whether they reflect purposely-adopted risk-mitigation strategies. Among MSM attending an STD clinic in Seattle, Washington 2013-2015 (N = 3751 visits), we used two seroadaptive behavior measures: (1) sexual behavior history reported via clinical computer-assisted self-interview (CASI) (behavioral definition); (2) purposely-adopted risk-reduction behaviors reported via research CASI (purposely-adopted definition). Pure serosorting (i.e. only HIV-concordant partners) was the most common behavior, reported (behavioral and purposely-adopted definition) by HIV-negative respondents at 43% and 60% of visits, respectively (kappa = 0.24; fair agreement) and by HIV-positive MSM at 30 and 34% (kappa = 0.25; fair agreement). Agreement of the two definitions was highest for consistent condom use [HIV-negative men (kappa = 0.72), HIV-positive men (kappa = 0.57)]. Overall HIV test positivity was 1.4 but 0.9% for pure serosorters. The two methods of operationalizing behaviors result in different estimates, thus the choice of which to employ should depend on the motivation for ascertaining behavioral information.
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Changes in Condomless Sex and Serosorting Among Men Who Have Sex With Men After HIV Diagnosis. J Acquir Immune Defic Syndr 2017; 73:475-481. [PMID: 27792685 DOI: 10.1097/qai.0000000000001128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Among men who have sex with men (MSM) diagnosed with HIV, high-risk sexual behaviors may decline in the year after diagnosis. The sustainability of these changes is unknown. METHODS We created a retrospective cohort (Seroconversion Cohort) of MSM attending an STD clinic in Seattle, Washington who tested HIV positive between 2001 and 2013 and had a negative HIV test <2 years before diagnosis. We randomly selected 1000 HIV-negative controls (men who always tested HIV negative) who were frequency-matched to the Seroconversion Cohort based on HIV diagnosis year. 12-month sexual behavior data were collected at each clinic visit. We examined condomless anal intercourse (CAI) with HIV-negative, HIV-positive, and HIV unknown-status partners before diagnosis and up to 4 years thereafter. RESULTS Of the 26,144 clinic visits where MSM tested for HIV, there were 655 (2.5%) new HIV diagnoses. Of these, 186 (28%) men had previously tested HIV negative and were included in the Seroconversion Cohort. The proportion (of the 186) reporting CAI with HIV-negative partners declined from 73% at diagnosis to 12% after diagnosis (P < 0.001), whereas CAI with HIV-positive partners increased (11%-67%; P < 0.001). The proportion who serosorted (ie, CAI only with HIV-concordant partners) did not change before or after diagnosis (34%-40%; P = 0.65). These 3 behaviors remained stable for up to 4 years after diagnosis. Among HIV-negative controls, serosorting and CAI with HIV-positive and HIV-negative partners was constant. CONCLUSIONS MSM substantially modify their sexual behavior after HIV diagnosis. These changes are sustained for several years and may reduce HIV transmission to HIV-uninfected men.
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Jansen K, Schmidt AJ, Drewes J, Bremer V, Marcus U. Increased incidence of syphilis in men who have sex with men and risk management strategies, Germany, 2015. ACTA ACUST UNITED AC 2016; 21:30382. [PMID: 27813472 PMCID: PMC5114722 DOI: 10.2807/1560-7917.es.2016.21.43.30382] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/15/2016] [Indexed: 01/05/2023]
Abstract
In Germany, the number of reported syphilis cases increased between 11% and 22% per year between 2010 and 2014. We analysed syphilis surveillance data and data of four behavioural surveys on men who have sex with men (MSM) in Germany (2003, 2007, 2010, 2013) to assess if this rise is ongoing and to find possible explanations for it. Syphilis notifications increased in 2015 by 19% to a total of 6,834. This was mainly due to increasing notifications in MSM of all age groups in larger German cities. Data from the behavioural surveys on MSM in Germany showed a simultaneous increase of selective condom use as HIV-status-bases risk management strategy and the number of syphilis cases. MSM diagnosed with HIV reported condomless anal intercourse with non-steady partners more frequent than MSM not diagnosed with HIV or untested for HIV, but the latter also reported higher frequencies of this behaviour in the more recent surveys. Transmission in HIV-positive MSM probably plays an important, but not exclusive role, for the syphilis dynamics in Germany. A risk adapted routine screening for sexually active MSM and potentially innovative approaches to increase early screening and treatment of syphilis such as internet counselling, home sampling, home testing and broadening venue-based (rapid) testing, should be critically evaluated to effectively reduce syphilis infections.
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Affiliation(s)
- Klaus Jansen
- Robert Koch Institute, Unit for HIV/AIDS, STI and blood-borne infections, Berlin, Germany
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10
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Otis J, McFadyen A, Haig T, Blais M, Cox J, Brenner B, Rousseau R, Émond G, Roger M, Wainberg M. Beyond Condoms: Risk Reduction Strategies Among Gay, Bisexual, and Other Men Who Have Sex With Men Receiving Rapid HIV Testing in Montreal, Canada. AIDS Behav 2016; 20:2812-2826. [PMID: 26961381 PMCID: PMC5108827 DOI: 10.1007/s10461-016-1344-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) have adapted their sexual practices over the course of the HIV/AIDS epidemic based on available data and knowledge about HIV. This study sought to identify and compare patterns in condom use among gay, bisexual, and other MSM who were tested for HIV at a community-based testing site in Montreal, Canada. Results showed that while study participants use condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also make use of various other strategies such as adjusting to a partner's presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.
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Affiliation(s)
- Joanne Otis
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
- CIHR Canadian HIV Trials Network, Vancouver, Canada.
| | - Amélie McFadyen
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Thomas Haig
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
- CIHR Canadian HIV Trials Network, Vancouver, Canada
- COCQ-SIDA, Montreal, QC, Canada
| | - Martin Blais
- Department of Sexology, Université du Québec à Montréal, Case postale 8888, succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Joseph Cox
- Direction de santé publique du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Bluma Brenner
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Gilbert Émond
- Applied Human Sciences, Concordia University, Montreal, QC, Canada
| | - Michel Roger
- Laboratoire de Biologie Moléculaire, Centre hospitalier de l'université de Montréal, Montreal, QC, Canada
| | - Mark Wainberg
- Faculty of Medicine, McGill University, Montreal, QC, Canada
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11
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Abstract
Serosorting (i.e., choosing partners of the same HIV serostatus to reduce the risk of transmission with unprotected sex) and other forms of seroadaptation (i.e., engaging in diverse behaviors according to a hierarchy of risk by type of sex and partner serostatus) are phenomena widely described for men who have sex with men (MSM) in the developed world. We assessed seroadaptive behaviors among MSM surveyed in Yangon, Myanmar in 2013-2014. Among HIV-negative MSM, 43.1 % engaged in some form seroadaptation including serosorting (21.8 %), using condoms with potentially serodiscordant anal sex (19.3 %), and seropositioning (1.7 %). Among HIV-positive MSM, 3.5 % engaged in serosorting, 36.0 % in using condoms with potentially serodiscordant anal sex, 7.0 % in seropositioning, and 46.5 % in any form of seroadaptation. For HIV-negative and HIV-positive MSM, seroadaptation was more common than consistent condom use (38.0 and 26.7 %, respectively). MSM in Myanmar are engaging in seroadaptive behaviors in magnitude and ways similar to MSM in industrialized countries.
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Affiliation(s)
- Tin Aung
- Population Services International-Myanmar, Yangon, Myanmar
| | - Si Thu Thein
- Population Services International-Myanmar, Yangon, Myanmar
| | - Willi McFarland
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6033, USA.
- University of California, San Francisco, San Francisco, CA, USA.
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12
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Salazar‐Vizcaya L, Kouyos RD, Zahnd C, Wandeler G, Battegay M, Darling KEA, Bernasconi E, Calmy A, Vernazza P, Furrer H, Egger M, Keiser O, Rauch A. Hepatitis C virus transmission among human immunodeficiency virus-infected men who have sex with men: Modeling the effect of behavioral and treatment interventions. Hepatology 2016; 64:1856-1869. [PMID: 27531615 PMCID: PMC5132019 DOI: 10.1002/hep.28769] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 07/04/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED The incidence of hepatitis C virus (HCV) infections among human immunodeficiency virus (HIV)-infected men who have sex with men has increased in recent years and is associated with high-risk sexual behavior. Behavioral interventions that target high-risk behavior associated with HCV transmission and treatment with direct-acting antivirals may prevent further HCV infections. We predicted the effect of behavioral and treatment interventions on HCV incidence and prevalence among HIV-infected men who have sex with men up to 2030 using a HCV transmission model parameterized with data from the Swiss HIV Cohort Study. We assessed behavioral interventions associated with further increase, stabilization, and decrease in the size of the population with high-risk behavior. Treatment interventions included increase in treatment uptake and use of direct-acting antivirals. If we assumed that without behavioral interventions high-risk behavior spread further according to the trends observed over the last decade and that the treatment practice did not change, HCV incidence converged to 10.7/100 person-years. All assessed behavioral interventions alone resulted in reduced HCV transmissions. Stabilization of high-risk behavior combined with increased treatment uptake and the use of direct-acting antivirals reduced incidence by 77% (from 2.2 in 2015 to 0.5/100 person-years) and prevalence by 81% (from 4.8% in 2015 to 0.9%) over the next 15 years. Increasing treatment uptake was more effective than increasing treatment efficacy to reduce HCV incidence and prevalence. A decrease in high-risk behavior led to a rapid decline in HCV incidence, independent of treatment interventions. CONCLUSION Treatment interventions to curb the HCV epidemic among HIV-infected men who have sex with men are effective if high-risk behavior does not increase as it has during the last decade; reducing high-risk behavior associated with HCV transmission would be the most effective intervention for controlling the HCV epidemic, even if this was not accompanied by an increase in treatment uptake or efficacy. (Hepatology 2016;64:1856-1869).
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Affiliation(s)
- Luisa Salazar‐Vizcaya
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Department of Infectious DiseasesInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Roger D. Kouyos
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital ZurichZurichSwitzerland,Institute of Medical VirologyUniversity of ZurichZurichSwitzerland
| | - Cindy Zahnd
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Gilles Wandeler
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Department of Infectious DiseasesInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
| | | | - Enos Bernasconi
- Division of Infectious DiseasesLugano Regional HospitalLuganoSwitzerland
| | - Alexandra Calmy
- Division of Infectious DiseasesUniversity Hospital GenevaGenevaSwitzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St. GallenSt. GallenSwitzerland
| | - Hansjakob Furrer
- Department of Infectious DiseasesInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Centre for Infectious Disease Epidemiology & ResearchUniversity of Cape TownCape TownSouth Africa
| | - Olivia Keiser
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Andri Rauch
- Department of Infectious DiseasesInselspital, Bern University Hospital, University of BernBernSwitzerland
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13
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Khosropour CM, Dombrowski JC, Swanson F, Kerani RP, Katz DA, Barbee LA, Hughes JP, Manhart LE, Golden MR. Trends in Serosorting and the Association With HIV/STI Risk Over Time Among Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2016; 72:189-97. [PMID: 26885806 PMCID: PMC4866874 DOI: 10.1097/qai.0000000000000947] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/26/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Serosorting among men who have sex with men (MSM) is common, but recent data to describe trends in serosorting are limited. How serosorting affects population-level trends in HIV and other sexually transmitted infection (STI) risk is largely unknown. METHODS We collected data as part of routine care from MSM attending a sexually transmitted disease clinic (2002-2013) and a community-based HIV/sexually transmitted disease testing center (2004-2013) in Seattle, WA. MSM were asked about condom use with HIV-positive, HIV-negative, and unknown-status partners in the prior 12 months. We classified behaviors into 4 mutually exclusive categories: no anal intercourse (AI); consistent condom use (always used condoms for AI); serosorting [condom-less anal intercourse (CAI) only with HIV-concordant partners]; and nonconcordant CAI (CAI with HIV-discordant/unknown-status partners; NCCAI). RESULTS Behavioral data were complete for 49,912 clinic visits. Serosorting increased significantly among both HIV-positive and HIV-negative men over the study period. This increase in serosorting was concurrent with a decrease in NCCAI among HIV-negative MSM, but a decrease in consistent condom use among HIV-positive MSM. Adjusting for time since last negative HIV test, the risk of testing HIV positive during the study period decreased among MSM who reported NCCAI (7.1%-2.8%; P= 0.02), serosorting (2.4%-1.3%; P = 0.17), and no CAI (1.5%-0.7%; P = 0.01). Serosorting was associated with a 47% lower risk of testing HIV positive compared with NCCAI (adjusted prevalence ratio = 0.53; 95% confidence interval: 0.45 to 0.62). CONCLUSIONS Between 2002 and 2013, serosorting increased and NCCAI decreased among Seattle MSM. These changes paralleled a decline in HIV test positivity among MSM.
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Affiliation(s)
| | - Julia C. Dombrowski
- Medicine
- Public Health—Seattle and King County HIV/STD Program, Seattle, WA; and
| | | | - Roxanne P. Kerani
- Departments of Epidemiology
- Medicine
- Public Health—Seattle and King County HIV/STD Program, Seattle, WA; and
| | - David A. Katz
- Medicine
- Public Health—Seattle and King County HIV/STD Program, Seattle, WA; and
| | - Lindley A. Barbee
- Medicine
- Public Health—Seattle and King County HIV/STD Program, Seattle, WA; and
| | | | - Lisa E. Manhart
- Departments of Epidemiology
- Global Health, University of Washington, Seattle, WA
| | - Matthew R. Golden
- Departments of Epidemiology
- Medicine
- Global Health, University of Washington, Seattle, WA
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