Barriers and facilitators to utilisation of public sexual healthcare services for male sex workers who have sex with men (MSW-MSM) in The Netherlands: a qualitative study

Use of patient portals to disclose STI test histories to sex partners among U.S. men who have sex with men: A call for research and guidance

BACKGROUND

This study investigates the use of patient portals for disclosing sexually transmitted infection (STI) test result histories to sexual partners among men who have sex with men (MSM) in the United States.

METHODS

Using data from the 2022-2023 American Men's Internet Survey, this cross-sectional analysis examined demographic, behavioral, and healthcare-related factors associated with MSM's utilization of patient portals for sharing STI test results. Participants (N = 2601) were surveyed on portal use, STI testing frequency, and partner disclosure practices.

RESULTS

18% of survey participants used portals to disclose a STI test result to parrtners, with higher prevalences among individuals aged 16-37 years old versus 56 years and older, black non-Hispanic (26.4%) versus white non-Hispanic (16.8%), and those reporting nine or more times being tested for STIs (30.1%) versus 1 to 3 times (7.5%). Participants reporting sex work (33.3% vs 17.7%) and HIV pre-exposure prophylaxis (PrEP) use (24.2% vs 13.0%) also had a higher prevalence of portal use for disclosure. Multivariable Poisson regression analysis with robust error variance showed that sexual behavioral stigma from family and friends [adjusted prevalence ratio (aPR) = 1.11; p = .04] also, being tested for STIs four to 8 (aPR = 2.21; p < .001) and nine or more times aPR = 3.42; p < .001) were significantly associated with prevalence of portal-based disclosure.

CONCLUSION

Findings suggest patient portals may be viable tools for STI prevention in MSM communities, especially among individuals with increased vulnerability to STI acquisition. Addressing disparities in portal access and explaining patient portal capabilities may enhance the role of digital health in reducing STI transmission among MSM communities.

Identifying High-Risk Populations for Sexually Transmitted Infections in Chinese Men Who Have Sex With Men: A Cluster Analysis

Background

This study aimed to identify subpopulations of Chinese men who have sex with men (MSM) with distinct sexual behavioral patterns and explore their correlations with sexually transmitted infections (STIs).

Methods

We recruited 892 eligible MSM in Xi'an, China, collecting sociodemographic, sexual behavior, and STI data. Cluster analysis identified distinct sexual behavioral patterns, allowing us to examine STI differences across clusters.

Results

Among the 892 MSM analyzed, 3 clusters were identified. Cluster 1 (n = 157) exhibited high-risk sexual behavioral patterns, including the highest median number of sexual partners (5 vs 1 in cluster 2 vs 3 in cluster 3, P < .001), lowest consistent condom use for insertive anal sex (0% vs 64.12% vs 99.76%, P = .004) and receptive anal sex (9.22% vs 67.71% vs 98.91%, P = .006), highest uncertainty of partners' STIs (77.07% vs 57.89% vs 64.5%, P < .001), all recent partners being casual, longest length of sequential sexual acts (6 vs 5 vs 5, P = .045), and highest rates of gonorrhea (20.38% vs 10.09% vs 14.99%, P = .019) and chlamydia (16.56% vs 8.33% vs 13.21%, P = .045). Cluster 2 (n = 228) showed the lowest engagement in high-risk behaviors and STIs, characterized by the fewest sexual partners, highest certainty of partner's STIs, and all recent partners being regular. Cluster 3 (n = 507) showed moderate levels of high-risk behaviors and STIs, with the highest consistent condom use during anal sex.

Conclusions

This study identified 3 subpopulations of Chinese MSM with distinct sexual behavioral patterns. Targeted public health interventions to the most at-risk subpopulations of MSM are essential for STI prevention.

HIV Incidence and Transactional Sex Among Men Who Have Sex With Men in Ningbo, China: Prospective Cohort Study Using a WeChat-Based Platform

Background

Sexual transmission among men who have sex with men (MSM) has become the major HIV transmission route. However, limited research has been conducted to investigate the association between transactional sex (TS) and HIV incidence in China.

Objective

This study aims to investigate HIV incidence and distinguish sociodemographic and sexual behavioral risk factors associated with HIV incidence among MSM who engage in TS (MSM-TS) in China.

Methods

We conducted a prospective cohort study using a WeChat-based platform to evaluate HIV incidence among Chinese MSM, including MSM-TS in Ningbo, recruited from July 2019 until June 2022. At each visit, participants completed a questionnaire and scheduled an appointment for HIV counseling and testing on the WeChat-based platform before undergoing offline HIV tests. HIV incidence density was calculated as the number of HIV seroconversions divided by person-years (PYs) of follow-up, and univariate and multivariate Cox proportional hazards regression was conducted to identify factors associated with HIV incidence.

Results

A total of 932 participants contributed 630.9 PYs of follow-up, and 25 HIV seroconversions were observed during the study period, resulting in an estimated HIV incidence of 4.0 (95% CI 2.7-5.8) per 100 PYs. The HIV incidence among MSM-TS was 18.4 (95% CI 8.7-34.7) per 100 PYs, which was significantly higher than the incidence of 3.2 (95% CI 2.1-5.0) per 100 PYs among MSM who do not engage in TS. After adjusting for sociodemographic characteristics, factors associated with HIV acquisition were MSM-TS (adjusted hazard ratio [aHR] 3.93, 95% CI 1.29-11.93), having unprotected sex with men (aHR 10.35, 95% CI 2.25-47.69), and having multiple male sex partners (aHR 3.43, 95% CI 1.22-9.64) in the past 6 months.

Conclusions

This study found a high incidence of HIV among MSM-TS in Ningbo, China. The risk factors associated with HIV incidence include TS, having unprotected sex with men, and having multiple male sex partners. These findings emphasize the need for developing targeted interventions and providing comprehensive medical care, HIV testing, and preexposure prophylaxis for MSM, particularly those who engage in TS.

Differences in STI/HIV Burden and Sexual Health Care-Seeking Behavior Among First- and Second-Generation Migrant and Western-Born Male Sex Workers Who Have Sex With Men in the Netherlands: A Retrospective Cohort Study

BACKGROUND

Globally, migrant sex workers have a higher burden of sexually transmitted infections (STI)/human immunodeficiency virus (HIV). This large study aimed to assess demographics, STI/HIV burden, and sexual health care-seeking behavior of first-generation migrant and second-generation migrant male sex workers who have sex with men (MSW-MSM) versus Western-born MSW-MSM.

METHODS

Coded STI clinic consultations (n = 6970) from 3116 individual MSW-MSM attending any Dutch STI clinic between 2016 and 2021 were included. First-generation migrant: born outside of northern/central/southern/western Europe/North America/Oceania. Second-generation migrant: ≥1parent born outside of northern/central/southern/western Europe/North America/Oceania. Multivariable logistic regression analysis assessed associations between MSW-MSM groups and STI in first consultation in the data. A Cox proportional hazard regression compared the incidence of a first repeat consultation between migration groups, stratified by STI in first consultation. All analyses were adjusted for age and urbanity of STI clinic region.

RESULTS

First-generation migrant MSW-MSM (n = 1085) were mostly born in Latin America (50%), whereas second-generation migrant MSW-MSM (n = 368) mostly originated from North Africa (30.4%). The proportion of STI diagnoses differed (33.2%, 29.3%, 23.3%; P < 0.001) between the first-generation migrant, second-generation migrant, and Western-born MSW-MSM. First-generation migrant MSW-MSM versus Western-born had an adjusted odds ratio of 1.6 (95% confidence interval, 1.3-1.9) of STI diagnosis in the first consultation. First-generation migrant MSW-MSM versus Western-born had an adjusted hazard ratio of 1.5 (95% confidence interval, 1.3-1.8) of having a first repeat consultation at any time, when stratified for no STI in the first consultation.

CONCLUSIONS

The STI/HIV burden is high among all 3 MSW-MSM groups. First-generation migrants have higher odds of STI, but retention in care seems similar. Results highlight the importance of low-threshold STI testing and care for (migrant) MSW-MSM.

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

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