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Hong H, Shi X, Liu Y, Feng W, Fang T, Tang C, Xu G. HIV Incidence and Transactional Sex Among Men Who Have Sex With Men in Ningbo, China: Prospective Cohort Study Using a WeChat-Based Platform. JMIR Public Health Surveill 2024; 10:e52366. [PMID: 39045869 PMCID: PMC11287094 DOI: 10.2196/52366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 07/25/2024] Open
Abstract
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.
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Affiliation(s)
- Hang Hong
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
| | - Xiaojun Shi
- Beilun Center for Disease Control and Prevention, Ningbo, China
| | - Yuhui Liu
- Ningbo Center for Disease Control and Prevention, Ningbo, China
| | - Wei Feng
- Fenghua Center for Disease Control and Prevention, Ningbo, China
| | - Ting Fang
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
| | - Chunlan Tang
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
| | - Guozhang Xu
- School of Public Health, Health Science Center, Ningbo University, Ningbo, China
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Kanagasabai U, Thorsen V, Zhu L, Annor FB, Chiang L, McOwen J, Augusto A, Manuel P, Kambona C, Coomer R, Kamagate F, Ramphalla P, Denhard L, Cain M, Hegle J, de Barros RB, Saenz S, Kamami M, Patel P. Adverse childhood experiences, HIV and sexual risk behaviors - Five sub-Saharan countries, 2018-2020. CHILD ABUSE & NEGLECT 2024; 150:106541. [PMID: 38114359 DOI: 10.1016/j.chiabu.2023.106541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been shown to have negative, lasting effects on health including increasing the likelihood of engaging in sexual risk behaviors. OBJECTIVE This study aimed to identify associations between exposures to ACEs and sexual risk behaviors and HIV service utilization among young people. PARTICIPANTS AND SETTING A sample of 8023 sexually active young people (19-24 year olds) from five sub-Saharan African countries participated Violence Against Children and Youth Surveys (VACS). METHODS Descriptive analysis of demographic variables, individual ACEs, cumulative ACEs, sexual risk behaviors, HIV testing, antiretroviral treatment (ART) and Antenatal Care (ANC) attendance were completed. Bivariate and multivariable logistic regression analyses were conducted to assess the associations between both individual and cumulative ACEs, sexual HIV risk behaviors, and service utilization while controlling for important covariates such as demographic, having ever been pregnant, had an STI, and used contraception. RESULTS Exposure to three or more ACEs was higher among males (26.1 %) compared to females (21.3 %); p = 0.003. The most prominent sexual risk behavior for females was having sexual partners who were at least 5 years older (45.7 % compared to males 3.7 %; p < 0.0001) whereas in males it was no or infrequent condom use (45.3 % compared to females 30.1 %; p < 0.0001). Males and females exposed to childhood sexual violence had seven and four times the odds of engaging in transactional sex (aOR = 7.34, 95 % CI: [3.5-15.0]) and (aOR =3.75, 95 % CI: [2.3-6.2], respectively. Females exposed to three or more ACEs were four times more likely to engage in transactional sex (aOR = 4.85, 95 %, CI: [1.6-14.4]) compared to those who did not experience any ACEs. Males exposed to three or more ACEs were two times more likely to engage in early sexual debut (aOR = 2.2, 95 % CI: [1.3-3.4]),]) compared to those who did not experience any ACEs. Females who had witnessed IPV or violence in the community had significantly higher odds of getting tested for HIV (aOR = 2.16, 95 % CI: [1.63-2.87]) and (aOR = 1.36, 95 % CI: [1.03-1.81]), respectively. CONCLUSIONS This study demonstrated that experiencing ACEs during childhood is associated with higher HIV risk behaviors in sub-Saharan Africa (SSA) with unique differences between males and females.
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Affiliation(s)
| | - Viva Thorsen
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Liping Zhu
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Francis B Annor
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Laura Chiang
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jordan McOwen
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Mozambique
| | | | - Pedro Manuel
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Mozambique
| | - Caroline Kambona
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Kenya
| | - Rachel Coomer
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Namibia
| | - Fathim Kamagate
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Cote d'Ivoire
| | - Puleng Ramphalla
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lesotho
| | - Langan Denhard
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Meagan Cain
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jennifer Hegle
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Shantal Saenz
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Mwikali Kamami
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Pragna Patel
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, USA
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3
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Kisaakye P, Bukuluki P, Nabulya A, Nakijoba B, Kasirye R, Mutaawe R. Substance use and watching pornography are drivers of transactional sex: evidence from young women receiving care from Uganda Youth Development Link. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2183907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Peter Kisaakye
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Anna Nabulya
- Department of Programmes and Research, Uganda Youth Development Link, Kampala, Uganda
| | - Barbara Nakijoba
- Department of Programmes and Research, Uganda Youth Development Link, Kampala, Uganda
| | - Rogers Kasirye
- Department of Programmes and Research, Uganda Youth Development Link, Kampala, Uganda
| | - Rogers Mutaawe
- Department of Programmes and Research, Uganda Youth Development Link, Kampala, Uganda
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4
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Meinhart M, Seff I, Villaveces A, Roa AH, Stark L. Violence Exposure Among Adolescent Boys and Young Men in Colombia With a Lifetime History of Transactional Sex. J Adolesc Health 2022; 71:696-704. [PMID: 36088231 PMCID: PMC9891716 DOI: 10.1016/j.jadohealth.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE There is a paucity of research examining the contextual factors that shape the violence experienced by those engaged in transactional sex, particularly among adolescent boys and young men. Recognizing the acute vulnerability among youth engaged in transactional sex, this analysis examined the associations between lifetime transactional sex and experience of violence among 13- to 24-year-old males. METHODS Using data from two strata of the 2018 Violence Against Children and Youth Survey from Colombia, logistic regressions were used to estimate the association between engagement in transactional sex and violence exposure. Three groups of violence outcomes were examined: violence victimization, violence perpetration, and witnessing violence. RESULTS Violence victimization and witnessing violence were widespread. Adolescent boys and young men with a lifetime history of transactional sex were significantly more likely to experience violence victimization than those without a lifetime history of transactional sex, particularly intimate partner violence (adjusted odds ratio [aOR]: 5.23 and 5.41) and caregiver emotional violence (aOR: 7.23 and 8.74). In the national and priority samples respectively, those with a lifetime history of transactional sex were also significantly more likely to witness violence within the home (aOR: 4.42 and 4.99) and outside of the home (aOR: 7.24 and 28.32). DISCUSSION Although research is needed to determine causal pathways, our findings highlight the ubiquity of violence and the criticality of supporting this group of adolescent boys and young men. Interventions for those with a history of transactional sex should address factors that may contribute to drivers of violence and transactional sex.
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Affiliation(s)
- Melissa Meinhart
- National Coalition of Independent Scholars, Brattleboro, Vermont
| | - Ilana Seff
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Andrés Villaveces
- Division of Violence Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri.
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Phyllys K, Ziro OW, Kissinger G, Ngari M, Budambula NLM, Budambula V. Poly-drug use among female and male commercial sex workers visiting a drop in centre in Mombasa County, Kenya. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001247. [PMID: 36962634 PMCID: PMC10045590 DOI: 10.1371/journal.pgph.0001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022]
Abstract
The relationship between commercial sex work and drug use is complex and the two exacerbate each other. In Kenya, Mombasa County has one of the highest populations of drug users and commercial sex workers. Despite documentation of drug use among sex workers, most of the studies are based on self-reported history which is prone to social desirability and memory recall biases. It is in this context that we sought to establish actual drug use is this sub-population. A cross-sectional study was conducted to determine self-reported and confirmed drug use among 224 commercial sex workers accessing services at Mvita Drop-in. Actual drug use was determined qualitatively using 6 panel plus alcohol Saliva Test kit. The overall prevalence of self-reported and confirmed current use for at least one drug was 98% and 99% respectively. Regardless of the technique used, alcohol and tobacco products were the most consumed substances. Alcohol use increased significantly with age (P = 0.03). Risk of cigarette use and testing positive for cotinine was higher among those age 18 to 35 years compared to >35years at P = 0.001 and P = 0.002 respectively. Poly-drug use was common with 98% testing positive for more than one drug. The reason for drug use was sex work related pressure (88%) with 60% of the respondents reporting they cannot transact this business without drugs. Almost every commercial sex worker is a poly-drug user. We recommend targeted interventions for commercial sex workers.
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Affiliation(s)
- Kemunto Phyllys
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Onesmus Wanje Ziro
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - George Kissinger
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Moses Ngari
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
| | | | - Valentine Budambula
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
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6
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Ogunbajo A, Abubakari GM, Edeza A, Iwuagwu S, Williams R, Biello K, Mimiaga MJ. Transactional Sex Is Associated with Income Level and Psychosocial Health Problems among Gay and Bisexual Men (GBM) in Nigeria, Africa. JOURNAL OF SEX RESEARCH 2021; 58:706-712. [PMID: 33284044 PMCID: PMC8180523 DOI: 10.1080/00224499.2020.1854649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Gay and bisexual men (GBM) who report engagement in transactional sex are at increased risk for HIV acquisition. The current study aimed to assess the prevalence of transactional sex and its association with demographic characteristics, social marginalization, HIV sexual risk behaviors, psychosocial health problems, and access to healthcare services among a multi-site sample of GBM in Nigeria. Bivariate and multivariable logistic regression were used to examine factors associated with engagement in transactional sex in the previous 3 months. More than a third (39.6%) of the participants reported engagement in transactional sex in the previous 3 months. In the multivariable model, factors associated with engagement in transactional sex included: reporting a monthly income of 30,000 Naira [adjusted odds ratio (aOR) 1.98; 95% CI: 1.12 to 3.35], compared to 30,000 or more Naira monthly income, reporting 4 or more receptive anal sex acts in the previous 30 days (aOR 2.45; 95% CI: 1.31 to 4.57) compared to reporting none, and having depressive symptoms (aOR 1.82; 95% CI: 1.06 to 3.14). There is an urgent need for interventions that address the economic disenfranchisement and psychosocial problems experienced by GBM in Nigeria, which has implications for sexual health.
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Affiliation(s)
- Adedotun Ogunbajo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Corresponding Author: Adedotun Ogunbajo, PhD, MPH, MHS, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115,
| | - Gamji M’Rabiu Abubakari
- Yale AIDS Prevention Training Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, CT, United States of America
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | | | - Rashidi Williams
- Equality Triangle for Health and Peoples Development Initiative, Warri, Delta, Nigeria
| | - Katie Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Fenway Institute, Fenway Health, Boston, MA, United States of America
| | - Matthew J. Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
- The Fenway Institute, Fenway Health, Boston, MA, United States of America
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, United States of America
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7
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Saiyed FK, Segura ER, Tan D, Clark JL, Lake JE, Holloway IW. Social networks and condomless intercourse with female partners among male sex workers in the Dominican Republic. Int J STD AIDS 2020; 32:176-183. [PMID: 33334269 PMCID: PMC10387283 DOI: 10.1177/0956462420920406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Male sex workers (MSW) in the Dominican Republic (DR) have multiple sexual partners, including personal and client-relationships, and are disproportionately affected by human immunodeficiency virus (HIV). We examined the prevalence of condomless anal and/or vaginal intercourse (CI) among MSW in the DR as a function of social network factors. Self-report surveys and social network interviews were administered to MSW recruited through venue-based sampling (N = 220). A generalized linear model was used to complete a Poisson Regression model and identify variables significantly associated with the outcome of interest. CI was more common with female (28.3%) than with male partners (4.9%). Factors associated with CI with the last female partner included older age of MSW, CI with the last male partner, having a stable female partner (a consistent or main partner), and having ≥1 family member in the participants' social network. Partner and social network characteristics associated with CI among MSW suggest the utility of dyadic and network interventions to reduce HIV risk.
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Affiliation(s)
- Faiez K Saiyed
- McGovern Medical School at UTHealth, Houston, TX, USA.,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Eddy R Segura
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Diane Tan
- Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, UCLA, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, UCLA, Los Angeles, CA, USA
| | - Jordan E Lake
- McGovern Medical School at UTHealth, Houston, TX, USA.,South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ian W Holloway
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, UCLA, Los Angeles, CA, USA.,Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
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8
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Application of the "syndemics" theory to explain unprotected sex and transactional sex: A crosssectional study in men who have sex with men (MSM), transgender women, and non-MSM in Colombia. ACTA ACUST UNITED AC 2020; 40:391-403. [PMID: 32673465 PMCID: PMC7505518 DOI: 10.7705/biomedica.5082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Indexed: 01/28/2023]
Abstract
Introduction: Men who have sex with men (MSM) and transgender women (TW) in Colombia are highly affected by HIV. To improve understanding of the role of HIV risk behaviors in HIV acquisition, we used the syndemic framework, a useful concept to inform prevention efforts. Objective: To examine the effect of four psychosocial conditions, namely, forced sex, history of childhood sexual abuse, frequent alcohol use, and illicit drug use on unprotected sex and the synergistic effects (“syndemic” effects) of these conditions on HIV risk behavior. Materials and methods: We enrolled a total of 812 males (54.7% men who have sex with men, MSM; 7.3% transgender women, and 38% non-MSM). The participants were recruited from neighborhoods of low socioeconomic status through free HIV-counseling and-testing campaigns. We performed Poisson regression analysis to test the associations and interactions between the four psychosocial conditions and unprotected sex with regular, occasional, and transactional partners. To test the “syndemic” model, we assessed additive and multiplicative interactions. Results: The prevalence of any psychosocial condition was 94.9% in transgender women, 60.1% in MSM, and 72.2% in non-MSM. A higher likelihood of transactional sex was associated in MSM (prevalence ratio (PR)=7.41, p<0.001) and non-MSM (PR=2.18, p< 0.001) with three or all four conditions compared to those with one condition. Additive interactions were present for all combinations of psychosocial problems on transactional sex in MSM. No cumulative effect or additive interaction was observed in transgender women. Conclusions: Our study highlights the need for bundled mental health programs addressing childhood sexual abuse, illicit drug use, and frequent alcohol use with other HIV prevention programs.
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9
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Kounta CH, Sagaon-Teyssier L, Coulaud PJ, Mora M, Maradan G, Bourrelly M, Keita AA, Yoro SAB, Anoma C, Coulibaly C, Dah ETT, Agbomadji S, Mensah E, Bernier A, Couderc C, Dembélé Keita B, Laurent C, Spire B. Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa. PLoS One 2019; 14:e0217115. [PMID: 31693669 PMCID: PMC6834336 DOI: 10.1371/journal.pone.0217115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/21/2019] [Indexed: 01/22/2023] Open
Abstract
Although the HIV epidemic is generalized in West Africa, some population groups such as men who have sex with men (MSM), especially those engaged in transactional sex (TS), are thought to be particularly more vulnerable to HIV than others. However, few data are available to help identify their health-related needs with a view to implementing targeted prevention interventions. To fill this knowledge gap, we aimed to characterize MSM reporting TS (MSM-TS) and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM, which was conducted in Burkina Faso, Côte d’Ivoire, Mali and Togo. Three stigmatization sub-scores were constructed (experienced, perceived and internalized). The generalized estimating equation method was used for data analysis. Of the total 630 HIV-negative MSM recruited in CohMSM, 463, 410 and 244 had a follow-up visit at 6, 12 and 18 months, respectively. In a total of 1747 follow-up visits, 478 TS encounters were reported by 289 MSM-TS (45.9%). Of the latter, 91 regularly reported TS (31.5%), 55 (19.0%) stopped reporting TS after baseline, and 53 (18.3%) reported TS after baseline and 90 (31.1%) occasionally reported TS. The following variables, regarding the previous 6 months, were positively associated with TS: being younger (aOR[95%CI]:1.86[1.39–2.50]), less educated (aOR[95%CI]:1.49[1.09–2.03]), unmarried status (aOR[95%CI]:1.79[1.10–2.93]), satisfaction with current sex life (aOR[95%CI]:1.41[1.06–1.88]), group sex with men (aOR[95%CI]:2.07[1.46–2.94]), multiple male sexual partners (aOR[95%CI]:1.85[1.40–2.44]), receptive or versatile anal sex with male partners (aOR [95%CI]:1.48[1.12–1.96]), giving benefits in exchange for sex with a man (aOR[95%CI]:2.80[1.97–3.98]), alcohol consumption (aOR[95%CI]:1.44[1.08–1.93]) and drug use (aOR[95%CI]:1.82[1.24–2.68]) during sex, and finally experiencing stigmatization (aOR [95%CI]:1.15[1.07–1.25]). Condom use during anal sex (aOR[95%CI]:0.73[0.53–0.99]) was negatively associated with TS.
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Affiliation(s)
- Cheick Haïballa Kounta
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Pierre-Julien Coulaud
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaelle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | | | | | - Elias Ter Tiero Dah
- Association Africaine Solidarité, Ouagadougou, Burkina Faso.,Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | | | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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10
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Bond KT, Yoon IS, Houang ST, Downing MJ, Grov C, Hirshfield S. Transactional Sex, Substance Use, and Sexual Risk: Comparing Pay Direction for an Internet-Based U.S. Sample of Men Who Have Sex with Men. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2019; 16:255-267. [PMID: 31814855 PMCID: PMC6897531 DOI: 10.1007/s13178-018-0366-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Demographic, behavioral, and structural factors among four mutually exclusive transactional sex categories were assessed in an online sample of 7217 sexually active US men who have sex with men (MSM): (1) No Trade Sex group (87%); (2) Sellers, accepting money or drugs for sex (5%); (3) Buyers, giving money or drugs for sex (6%); and (4) Sellers and Buyers, accepting and giving money or drugs for sex (2%). Separate multivariable logistic regressions compared men who did not report past 60-day transactional sex with men in the three transactional sex groups. Sellers were more likely to report being black or Asian (versus white), low income, a recent STI diagnosis, six or more recent male anal sex partners, and polydrug use. Buyers were more likely to report being older, higher income, urban residence, incarceration history, a recent STI diagnosis, and having non-main sex partners. Sellers and Buyers were more likely to report a higher income, incarceration history, six or more recent male anal sex partners, and polydrug use. Findings suggest that public health policy and HIV prevention harm reduction strategies should address the distinct sexual and behavioral risk patterns among MSM who engage in transactional sex based on payment direction.
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Affiliation(s)
- Keosha T. Bond
- Department of Public Health, New York Medical College, Valhalla, NY, USA
| | - Irene S. Yoon
- L2 Gartner, Research and Strategy Team, New York, NY, USA
| | - Steven T. Houang
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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11
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Reisner SL, Perez-Brumer A, Oldenburg CE, Gamarel KE, Malone J, Leung K, Mimiaga MJ, Rosenberger JG, Biello KB. Characterizing HIV risk among cisgender men in Latin America who report transgender women as sexual partners: HIV risk in Latin America men. Int J STD AIDS 2019; 30:378-385. [PMID: 30537903 PMCID: PMC9897015 DOI: 10.1177/0956462418802687] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cisgender men (CM) who report transgender women (TW) as sexual partners are an understudied population in the HIV epidemic in Latin America. The current study sought to characterize this group in a 2012 cross-sectional online survey of Latin American CM who were members of a sexual networking website for men who have sex with men (N = 11,847). Multivariable logistic regression models were fit to estimate demographic, behavioral, and psychosocial correlates of having a TW sexual partner and engaging in condomless sex. Overall, 0.9% (n = 106) reported a TW sexual partner in the last 12 months; of these, 76.4% (n = 81) reported condomless sex in the last three months. Identifying as bisexual or heterosexual compared to gay, and specifying a versatile sexual role preference compared to insertive were associated with reporting a recent TW sex partner (all p < 0.05). HIV-negative serostatus, lifetime STI history, and alcohol dependence were associated with recent condomless sex (all p < 0.05). CM with TW sexual partners have distinct HIV-related vulnerabilities. Future research is needed to understand CM who report TW sexual partners, including their sexual preferences and practices, sexual networks, exposure to stigma, biomedical prevention interest and uptake, and acceptability of integrating alcohol abuse screening into sexual health services.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Kingsley Leung
- Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Center for Health Equity Research, Brown University, Providence, RI
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12
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Logie CH, Lacombe-Duncan A, Kenny KS, Levermore K, Jones N, Baral SD, Wang Y, Marshall A, Newman PA. Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey. Glob Health Action 2018; 11:1424614. [PMID: 29338660 PMCID: PMC5774420 DOI: 10.1080/16549716.2018.1424614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Globally, men who have sex with men (MSM) experience social marginalization and criminalization that increase HIV vulnerability by constraining access to HIV prevention and care. People who sell sex also experience criminalization, rights violations, and violence, which elevate HIV exposure. MSM who sell sex may experience intersectional stigma and intensified social marginalization, yet have largely been overlooked in epidemiological and social HIV research. In Jamaica, where same sex practices and sex work are criminalized, scant research has investigated sex selling among MSM, including associations with HIV vulnerability. OBJECTIVE We aimed to examine social ecological factors associated with selling sex among MSM in Jamaica, including exchanging sex for money, shelter, food, transportation, or drugs/alcohol (past 12 months). METHODS We conducted a cross-sectional survey with a peer-driven sample of MSM in Kingston, Ocho Rios, and Montego Bay. Multivariable logistic regression analyses were conducted to estimate intrapersonal/individual, interpersonal/social, and structural factors associated with selling sex. RESULTS Among 556 MSM, one-third (n = 182; 32.7%) reported selling sex. In the final multivariable model, correlates of selling sex included: individual/intrapersonal (lower safer sex self-efficacy [AOR: 0.85, 95% CI: 0.77, 0.94]), interpersonal/social (concurrent partnerships [AOR: 5.52, 95% CI: 1.56, 19.53], a higher need for social support [AOR: 1.08, 95% CI: 1.03, 1.12], lifetime forced sex [AOR: 2.74, 95% 1.65, 4.55]) and structural-level factors (sexual stigma [AOR: 1.09, 95% CI: 1.04, 1.15], food insecurity [AOR: 2.38, 95% CI: 1.41, 4.02], housing insecurity [AOR: 1.94, 95% CI: 1.16, 3.26], no regular healthcare provider [AOR: 2.72, 95% CI: 1.60, 4.64]). CONCLUSIONS This study highlights social ecological correlates of selling sex among MSM in Jamaica, in particular elevated stigma and economic insecurity. Findings suggest that MSM in Jamaica who sell sex experience intensified social and structural HIV vulnerabilities that should be addressed in multi-level interventions to promote health and human rights.
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Affiliation(s)
- Carmen H Logie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada.,b Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Ashley Lacombe-Duncan
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Kathleen S Kenny
- c Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | | | - Stefan D Baral
- e Johns Hopkins Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
| | - Ying Wang
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Annecka Marshall
- f Institute for Gender and Development Studies , Mona Campus, University of the West Indies , Kingston , Jamaica
| | - Peter A Newman
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
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13
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Transactional Sex between Men and Its Implications on HIV and Sexually Transmitted Infections in Nigeria. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2017; 2017:1810346. [PMID: 28845320 PMCID: PMC5563421 DOI: 10.1155/2017/1810346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/22/2017] [Accepted: 06/13/2017] [Indexed: 11/26/2022]
Abstract
Introduction Men who have transactional sex with men (MTSM) are known to be at higher risk for HIV and sexually transmitted infections (STIs). This study explored the risk factors associated with STI symptoms and HIV prevalence among men who have transactional sex with men in Nigeria. Methods In 2014, a cross-sectional study, using respondent driven sampling technique, was carried out to recruit 3,172 MSM across eight states in Nigeria. Relevant information on sociodemographic characteristics, sexual behaviors, and self-reported symptoms of STI was obtained. Bivariate and multivariate analysis was performed to identify risk factors for STI symptoms and HIV. Results 38.2% of the MSM were involved in transactional sex. Prevalence of self-reported STI symptoms was higher among MTSM than other MSM, while HIV prevalence was higher among other MSM than MTSM. Identified factors associated with STI symptoms and HIV among MSTM were being single, alcohol consumption, oral sex, and history of rape by a male partner. Conclusion Sexually transmitted infections are a significant challenge to men who have transactional sex with men. Adolescents and single men are more at risk of these infections. Youth empowerment needs to be invested on to avoid increased risk among these groups of people.
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14
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Oldenburg CE, Biello KB, Perez-Brumer AG, Rosenberger J, Novak DS, Mayer KH, Mimiaga MJ. HIV testing practices and the potential role of HIV self-testing among men who have sex with men in Mexico. Int J STD AIDS 2017; 28:242-249. [PMID: 27020081 PMCID: PMC5039047 DOI: 10.1177/0956462416641556] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The objective of this study was to characterize HIV testing practices among men who have sex with men in Mexico and intention to use HIV self-testing. In 2012, members of one of the largest social/sexual networking websites for men who have sex with men in Latin America completed an anonymous online survey. This analysis was restricted to HIV-uninfected men who have sex with men residing in Mexico. Multivariable logistic regression models were fit to assess factors associated with HIV testing and intention to use a HIV self-test. Of 4537 respondents, 70.9% reported ever having a HIV test, of whom 75.5% reported testing at least yearly. The majority (94.3%) indicated that they would use a HIV home self-test if it were available. Participants identifying as bisexual less often reported ever HIV testing compared to those identifying as gay/homosexual (adjusted odds ratio = 0.52, 95% confidence interval: 0.44-0.62). Having a physical exam in the past year was associated with increased ever HIV testing (adjusted odds ratio = 4.35, 95% confidence interval: 3.73-5.07), but associated with decreased interest in HIV self-testing (adjusted odds ratio = 0.66, 95% confidence interval: 0.48-0.89). The high intention to use HIV home self-testing supports the use of this method as an acceptable alternative to clinic- or hospital-based HIV testing.
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Affiliation(s)
| | - Katie B. Biello
- The Fenway Institute, Fenway Community Health, Boston, MA
- Departments of Behavioral & Social Health Sciences and Epidemiology and the Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI
| | - Amaya G. Perez-Brumer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Joshua Rosenberger
- Department of Biobehavioral Health, Penn State University, University Park, PA
| | - David S. Novak
- Online Buddies, Inc, OLB Research Institute, Cambridge, MA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Community Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Matthew J. Mimiaga
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- The Fenway Institute, Fenway Community Health, Boston, MA
- Departments of Behavioral & Social Health Sciences and Epidemiology and the Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI
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15
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Biello KB, Oldenburg CE, Mitty JA, Closson EF, Mayer KH, Safren SA, Mimiaga MJ. The "Safe Sex" Conundrum: Anticipated Stigma From Sexual Partners as a Barrier to PrEP Use Among Substance Using MSM Engaging in Transactional Sex. AIDS Behav 2017; 21:300-306. [PMID: 27351194 DOI: 10.1007/s10461-016-1466-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is efficacious for HIV prevention when taken consistently; however, barriers to PrEP use are poorly understood among individuals who could benefit from PrEP, including men who have sex with men (MSM) who engage in transactional sex (i.e., sex exchanged for money or drugs). Two hundred and thirty-seven HIV-uninfected, PrEP-naive MSM reporting concurrent substance dependence and sexual risk completed a questionnaire on PrEP use barriers. Barriers to PrEP use for MSM who engaged in recent transactional sex (22 %) versus those who had not were compared using an ecological framework. Individual (e.g., HIV stigma, substance use) and structural (e.g., economic, healthcare) barriers did not differ (p > 0.05). MSM who recently engaged in transactional sex were more likely to report that anticipated stigma from primary and casual partners would be barriers to PrEP use. Assessing recent transactional sex may help identify men who may need additional counseling to avoid anticipated stigma so they can integrate PrEP into their lives.
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Affiliation(s)
- Katie B Biello
- Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.
- Institute for Community Health Promotion, Brown University, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Catherine E Oldenburg
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer A Mitty
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elizabeth F Closson
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Social and Environmental Health Research, The London School of Hygiene & Tropical Medicine, London, UK
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Matthew J Mimiaga
- Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
- Institute for Community Health Promotion, Brown University, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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16
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Klingelschmidt J, Parriault MC, Van Melle A, Basurko C, Gontier B, Cabié A, Hoen B, Sow MT, Nacher M. Transactional sex among men who have sex with men in the French Antilles and French Guiana: frequency and associated factors. AIDS Care 2016; 29:689-695. [PMID: 27690562 DOI: 10.1080/09540121.2016.1234680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The French Antilles (Martinique, Saint Martin and Guadeloupe) and French Guiana are the French territories most affected by the HIV epidemic. Some population groups such as men who have sex with men (MSM), especially those involved in transactional sex, are thought to be particularly vulnerable to HIV but few data exist to help characterize their health-related needs and thus implement relevant prevention interventions. To fill this knowledge gap, we used data collected from an HIV/AIDS Knowledge, Attitudes, Behaviours and Practices survey conducted in 2012 among MSM living in the French Antilles and French Guiana and recruited through snowball sampling. Our objectives were to compare social and demographic characteristics and sexual behaviours between MSM engaging in transactional sex and MSM not engaging in transactional sex and to identify factors associated with transactional sex involvement using a logistic regression model. A total of 733 MSM were interviewed, 21% of whom reported to undergo transactional sex. Their behaviour and social and demographic characteristics were different from other MSMs' and they were more exposed to factors that are recognized to potentiate HIV vulnerability, at the individual, community, network and structural levels. The variables positively associated with sex trade involvement were having ever consumed drug (OR = 2.84 [1.23-6.52]; p = .002), having a greater number of sex partners than the median (OR = 8.31 [4.84-14.30]; p < .001), having experienced intimate partner violence (OR = 1.72 [0.99-3.00]; p = .053) and having undergone physical aggression because of sexual orientation (OR = 2.84 [1.23-6.52]; p = .014). Variables negatively associated with sex trade involvement were being older (OR = 0.93 [0.90-0.97] per year; p = .001), having a stable administrative situation (OR = 0.10 [0.06-0.19]; p < .001), having a stable housing (OR = 0.29 [0.15-0.55]; p < .001) and being employed full-time (OR = 0.29 [1.23-6.52]; p = .002).
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Affiliation(s)
- Justine Klingelschmidt
- a Centre d'Investigation Clinique Antilles-Guyane INSERM CIC 1424 , CH de Cayenne , French Guiana , France
| | - Marie-Claire Parriault
- a Centre d'Investigation Clinique Antilles-Guyane INSERM CIC 1424 , CH de Cayenne , French Guiana , France
| | - Astrid Van Melle
- a Centre d'Investigation Clinique Antilles-Guyane INSERM CIC 1424 , CH de Cayenne , French Guiana , France
| | - Célia Basurko
- a Centre d'Investigation Clinique Antilles-Guyane INSERM CIC 1424 , CH de Cayenne , French Guiana , France
| | - Barbara Gontier
- a Centre d'Investigation Clinique Antilles-Guyane INSERM CIC 1424 , CH de Cayenne , French Guiana , France
| | - André Cabié
- c Centre d'Investigation Clinique Antilles-Guyane INSERM CIC 1424 , CHU de Fort-de-France , Martinique , France.,d Service des Maladies Infectieuses et Tropicales , CHU de Fort-de-France , Martinique , France
| | - Bruno Hoen
- e Centre d'Investigation Clinique Antilles-Guyane INSERM CIC 1424 , CHU de Pointe-à-Pitre , Guadeloupe , France.,f Service des Maladies Infectieuses et Tropicales , CHU de Pointe-à-Pitre , Guadeloupe , France
| | - Marie-Thérèse Sow
- f Service des Maladies Infectieuses et Tropicales , CHU de Pointe-à-Pitre , Guadeloupe , France
| | - Mathieu Nacher
- a Centre d'Investigation Clinique Antilles-Guyane INSERM CIC 1424 , CH de Cayenne , French Guiana , France.,b COREVIH Guyane , CH de Cayenne , French Guiana , France
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17
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Tomori C, McFall AM, Srikrishnan AK, Mehta SH, Nimmagadda N, Anand S, Vasudevan CK, Solomon S, Solomon SS, Celentano DD. The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India. BMC Public Health 2016; 16:784. [PMID: 27520978 PMCID: PMC4983056 DOI: 10.1186/s12889-016-3446-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/25/2016] [Indexed: 12/22/2022] Open
Abstract
Background Childhood sexual abuse (CSA) is a significant global public health problem, which is associated with negative psychosocial outcomes and high-risk sexual behaviors in adults. Men who have sex with men (MSM) often report higher prevalence of CSA history than the general population, and CSA may play a key role in MSM’s greater vulnerability to HIV. Methods This study examined the prevalence of CSA history and its impact on the number of recent HIV-related risk behaviors (unprotected anal intercourse, high number of male and female sexual partners, alcohol use, drug use, and sex work in prior 6 months) and lifetime risk behaviors and experiences (high number of lifetime male and female sexual partners, early sexual debut, injection drug use, sex work, and intimate partner violence) among 11,788 adult MSM recruited via respondent driven sampling across 12 sites in India, with additional insights from thematic analysis of qualitative research with 363 MSM from 15 sites. Results Nearly a quarter (22.4 %) of participants experienced CSA, with substantially higher prevalence of CSA in the South and among kothis (feminine sexual identity). Qualitative findings revealed that older, trusted men may target young and, especially, gender nonconforming boys, and perpetrators’ social position facilitates nondisclosure. CSA may also initiate further same-sex encounters, including sex work. In multivariable analysis, MSM who experienced CSA had 21 % higher rate of recent (adjusted rate ratio [aRR = 1.21], 95 % confidence interval [CI]: 1.14–1.28), and 2.0 times higher lifetime (aRR = 2.04, 95 % CI: 1.75–2.38) HIV-related behaviors/experiences compared with those who did not. Conclusion This large, mixed-methods study found high overall prevalence of CSA among MSM (22.4 %), with substantially higher prevalence among MSM residing in the South and among more feminine sexual identities. Qualitative findings highlighted boys’ vulnerabilities to CSA, especially gender nonconformity, and CSA’s role in further sexual encounters, including sex work. Additionally, CSA was associated with an elevated rate of recent, and an even higher rate of lifetime HIV-related risk factors. Our results suggest an acute need for the development of CSA prevention interventions and the integration of mental health services for MSM with histories of CSA as part of HIV-prevention efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3446-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilia Tomori
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | | | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - Suniti Solomon
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.,YR Gaitonde Centre for AIDS Research and Education, Chennai, India.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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18
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Biello KB, Thomas BE, Johnson BE, Closson EF, Navakodi P, Dhanalakshmi A, Menon S, Mayer KH, Safren SA, Mimiaga MJ. Transactional sex and the challenges to safer sexual behaviors: a study among male sex workers in Chennai, India. AIDS Care 2016; 29:231-238. [PMID: 27397549 DOI: 10.1080/09540121.2016.1204421] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Male sex workers (MSW) are a significant but invisible population in India who are at risk for HIV/sexually transmitted infections (STIs). Few studies from India have documented HIV risk factors and motivations for sex work in this population. Between 2013 and 2014, a community-based convenience sample of 100 MSW in Chennai (south India) completed a baseline risk assessment as part of a behavioral intervention. Participants were ≥18 years, and reported current sex work. We report medians and proportions, and Wilcoxon-Mann-Whitney and chi-square tests are used to examine differences between sex work and sexual behavior measures by income source. Participants were engaged in sex work for 5.0 years (IQR = 2.3-10.0), and earned 3000 (IQR = 2000-8000) Rupees (<50 USD) per month from sex work. Sixty-four percent reported ever testing for HIV and 20.2% for any STI. The most common reasons for starting sex work were money (83.0%) and pleasure (56.0%). Compared to participants with an additional source of income, those whose only source of income was sex work reported more male clients in the past month (10.0 vs. 6.0, p = .017), as well as more condomless anal sex acts with male clients (8.0 vs. 5.0, p = .008). Nearly 70.0% were offered more money not to use a condom during sex with a client, and 74.2% reported accepting more money not to use a condom. Three-quarters reported having experienced difficulty using condoms with clients. MSW in India engage in high levels of sexual risk for HIV/STIs. Money appears to be a driving factor for engaging in sex work and condomless sex with clients. HIV prevention interventions with MSW should focus on facilitating skills that will support their ability to negotiate sexual safety in the context of monetary disincentives.
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Affiliation(s)
- Katie B Biello
- a Institute for Community Health Promotion, Brown University , Providence , RI , USA.,b Departments of Behavioral & Social Sciences and Epidemiology , Brown University School of Public Health , Providence , RI , USA.,c The Fenway Institute, Fenway Health , Boston , MA , USA
| | - Beena E Thomas
- d National Institute for Research in Tuberculosis (NIRT) , Chennai , India
| | - Blake E Johnson
- c The Fenway Institute, Fenway Health , Boston , MA , USA.,e Department of Epidemiology , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | | | | | - A Dhanalakshmi
- d National Institute for Research in Tuberculosis (NIRT) , Chennai , India
| | | | - Kenneth H Mayer
- c The Fenway Institute, Fenway Health , Boston , MA , USA.,g Division of Infectious Diseases , Harvard Medical School/Beth Israel Deaconess Medical Center , Boston , MA , USA.,h Department of Global Health and Population , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Steven A Safren
- c The Fenway Institute, Fenway Health , Boston , MA , USA.,h Department of Global Health and Population , Harvard T. H. Chan School of Public Health , Boston , MA , USA.,i Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Matthew J Mimiaga
- a Institute for Community Health Promotion, Brown University , Providence , RI , USA.,b Departments of Behavioral & Social Sciences and Epidemiology , Brown University School of Public Health , Providence , RI , USA.,c The Fenway Institute, Fenway Health , Boston , MA , USA
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19
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Biello KB, Oldenburg CE, Rosenberger J, Mayer KH, Novak D, Mimiaga MJ. Is Involvement in Sex Work Associated with Engagement in HIV-Related Medical Care in Latin American Men Who Have Sex with Men? Results of a Large, Multinational Internet Survey. LGBT Health 2015; 3:233-7. [PMID: 26789395 DOI: 10.1089/lgbt.2015.0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Men who have sex with men (MSM) who engage in transactional sex are at increased HIV risk, and face complex barriers to care seeking. Among 2,035 men recruited through an MSM social/sexual networking website in Latin America and who reported being HIV-infected, 186 (9.1%) reported being paid for sex with another man in the past year. Engagement in transactional sex was associated with decreased odds of receiving medical care for HIV (AOR=0.57, 95% CI=0.37-0.85). No significant differences were seen in being on antiretroviral therapy (ART) or ART adherence once in care. Interventions in this population should focus on reducing barriers to engagement in care.
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Affiliation(s)
- Katie B Biello
- 1 Department of Epidemiology, Harvard School of Public Health , Boston, Massachusetts.,2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Catherine E Oldenburg
- 1 Department of Epidemiology, Harvard School of Public Health , Boston, Massachusetts
| | - Joshua Rosenberger
- 3 Department of Global and Community Health, George Mason University , Fairfax, Virginia
| | - Kenneth H Mayer
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts.,4 Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston, Massachusetts.,5 Department of Global Health and Population, Harvard School of Public Health , Boston, Massachusetts
| | - David Novak
- 6 OLB Research Institute , Online Buddies, Inc., Cambridge, Massachusetts
| | - Matthew J Mimiaga
- 1 Department of Epidemiology, Harvard School of Public Health , Boston, Massachusetts.,2 The Fenway Institute , Fenway Health, Boston, Massachusetts.,7 Department of Psychiatry, Harvard Medical School , Boston, Massachusetts.,8 Department of Psychiatry, Massachusetts General Hospital , Boston, Massachusetts
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