The use of inappropriate anal douching tool associates with increased HIV infection among men who have sex with men: a cross-sectional study in Shenyang, China
Zhenxing ChuGuangquan ShenQinghai HuHongyi WangJing ZhangWilla DongYongjun JiangWenqing GengHong ShangJunjie Xu
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Abstract Background: Rectal douching (RD) is widely practiced by men who have sex with men (MSM), and is associated with increased risk of HIV infection. However, the mechanism of how RD increases the risk of HIV infection is not well understood, and there is limited data on RD behavior in MSM practicing anal sex in China. We examine the purpose of RD, its timing in relation to anal sex, the types of RD products used, and risky sexual behaviors among MSM reporting anal sex. Methods: Between August 2017 and December 2018, a cross-sectional study was conducted among adult MSM in Shenyang, China. Data were collected on demographics, sexual behaviors, and RD for the most recent sexual intercourse by means of interviewer-administered face-to-face questionnaires. Blood samples were collected to test for antibodies to HIV and syphilis. Multivariable logistic regression models were used to assess the risk factors associated with HIV infection. Results: A total of 515 eligible MSM participated in this survey (median age: 31 years). During the most recent anal intercourse, 28.3% (146/515) had condomless receptive anal intercourse (CRAI), 21.4% (110/515) practiced serosorting, and more than half (61.6%, 317/515) reported RD before or after anal sex. Of those practicing RD, 96.8% (307/317) conducted RD before sex, while 62.5% (198/317) conducted RD after sex. The douching devices used were primarily shower hoses (85.3%, 262/307), and relatively few MSM used commercial RD products (8.1%, 25/307) before sex. The prevalence of HIV-1 and syphilis was 11.7% and 13.2%, respectively. HIV infection was positively associated with RD (adjusted odds ratio (AOR), 2.8; 95% confidence interval (CI), 1.4-5.5), practicing RD before sex (AOR, 2.3; 95% CI, 1.2–4.3), practicing RD after sex (AOR, 1.8; 95% CI, 1.0–3.1), using a shower hose for RD (AOR, 3.5; 95% CI, 1.1–13.0), CRAI (AOR, 2.9; 95% CI, 1.6–5.5), and an interaction effect of RD and CRAI (AOR = 4.2; 95 % CI, 2.2- 8.1) in the most recent anal intercourse. Conclusions: RD is popular among Chinese MSM. Improper noncommercial RD tools use (such as shower hose), the interaction effect between RD and CRAI associated with HIV infection. Public health workers and the MSM community should publicize scientific knowledge and prevention approaches relating to RD and HIV transmission to MSM. We recommend that further studies should be conducted to understand the detailed mechanism between RD and increased HIV prevalence.Keywords:
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Sexual behavior of HIV-positive men who have sex with men (MSM) are different from the general MSM. HIV-positive men who know their HIV status are more likely to have sex with positive partner and to engage in receptive anal intercourse as a self harm reduction approach than the general MSM. It is important to strengthen behavioral interventions so as to practice safe sexual behavior to prevent HIV transmission and maintain high life quality among HIV-positive MSM.
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OBJECTIVE: This behavioral surveillance survey in Sichuan province was aimed to gain an insight into the behavioral features related to HIV prevalence among men who have sex with men (MSM). METHODS: The pilot survey was initiated in the year from September to December, 2003. Two cities, Chengdu and Nanchong, were selected as the surveillance sites. All behavioral data were collected by a special questionnaire. Convenience sampling and snowball sampling techniques were applied to recruit participants in 5 types of places where MSM appeared more often. RESULTS: Most of the participants sexed only with male partners, and the most common ways of intercourse for MSM were anal sex, mouth sex and masturbation. The cases of multiple sex partners existed generally in MSM. The median partner numbers for anal sex and mouth sex were 4.4 and 4.2 respectively. There were 491 MSM (84.7%) who had sexed with male partners 6 months before, in which 68.6% of them sexed with non-commercial regular male partners, 66.2% with non-commercial non-regular male partners, and 20.4% with commercial male partners. Condom use with different male partners varied significantly. The proportions of consistent condom use with non-commercial regular, non-commercial non-regular, and commercial male partners were 15.8%, 16.3% and 32.3% respectively. 1.9% of participants reported they had had the experience of injecting drug and 18.3% of participants reported they had been tested for HIV antibody 12 months before. CONCLUSION: High risk behaviors such as multiple sex partners, unprotected anal sex, commercial sex, and injecting drug use among the MSM population in the two cities were unveiled broadly.
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Objective
To identify risk factors for rectal lymphogranuloma venereum (rLGV) in men who have sex with men (MSM).Design
A case-control study at 6 UK hospitals compared MSM with rLGV (cases) with rLGV-negative controls: MSM without potential rLGV symptoms (CGa) and separately, MSM with such symptoms (CGs).Methods
Between 2008 and 2010, there were 90 rLGV cases, 74 CGa and 69 CGs recruited. Lifestyles and sexual behaviours in the previous 3 months were reported using internet-based computer-assisted self-interviews. Logistic regression was used to investigate factors associated with rLGV.Results
Cases were significantly more likely to be HIV-positive (89%) compared with CGa (46%) and CGs (64%). Independent behavioural risks for rLGV were: unprotected receptive anal intercourse (adjusted OR (AOR)10.7, 95% CI 3.5 to 32.8), fisting another (AOR=6.7, CI 1.8 to 25.3), sex under the influence of gamma-hydroxybutyrate (AOR=3.1, CI 1.3 to 7.4) and anonymous sexual contacts (AOR=2.7, CI 1.2 to 6.3), compared with CGa; unprotected insertive anal intercourse (AOR=4.7, CI 2.0 to 10.9) and rectal douching (AOR=2.9 CI 1.3 to 6.6), compared with CGs. An incubation period from exposure to symptoms of 30 days was indicated.Conclusions
Unprotected receptive anal intercourse is a key risk factor for rectal LGV with the likelihood that rectal-to-rectal transmission is facilitated where insertive anal sex also occurs. The association between HIV and rLGV appears linked to HIV-positive men seeking unprotected sex with others with the same HIV status, sexual and drug interests. Such men should be targeted for frequent STI screening and interventions to minimise associated risks.Lymphogranuloma venereum
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Summary The role of condomless anal intercourse ( CAI ) as a driver for the epidemic of hepatitis C in MSM is still debated. Timely access to direct‐acting antivirals ( DAA ) could represent an essential strategy to tackle this. Case notes of MSM diagnosed with acute hepatitis C ( AHC ) between July 2016 and June 2017 in a sexual health clinic in London were included. Behavioural data on sexual practices and STI monitoring in the 6 months prior to AHC diagnosis were collected. DAA routes of access and timing from AHC diagnosis to start of treatment were analysed. A total of 60 individuals were enrolled (median age 39 years, IQR = 33‐46, 62% HIV co‐infected, 72% genotype 1a). CAI was reported by 97%, drug use prior to or during sex by 73%; 46% was diagnosed with a rectal STI and 29% with syphilis. About 37% did not report any HCV risk factors other than condomless anal sex. About 36% had a new rectal STI in the 6 months following AHC . About 82% accessed DAA treatment and median time from AHC to DAA start was 278 days for those following the NHS standard of care route, 132 days for those accessing DAA via participation in trials and 114 for those who had self‐sourced DAA online ( P < 0.0011 ) . SVR 12 was achieved in 100% of the patients who received DAA treatment.In conclusion, CAI is a significant risk factor for HCV acquisition in MSM , irrespective of their HIV status. Rapid and wider access to treatment with DAA could represent a powerful strategy to reduce onward transmission and risk of reinfection in MSM .
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To investigate the AIDS-related high risk behaviors of men who have sex with men (MSM) who ever exchanged money for the same sex.Target sampling for cross-sectional study and valid anonymous questionnaires were adopted to compare the differences of AIDS-related high risk behaviors between MSM with the experience of exchanging money for the same sex and those without that experience. 1959 rstadied samples were recruited in nine cities. SPSS 13.0 was used and t, χ(2) and Mann-Whitney tests were taken for statistical analysis.Compared to corresponding ones without "buying" the same sex experience, MSM who ever engaged in "buying" sex had the characteristics of being prone to in marriage and living in larger cities with older age and higher income (P < 0.01). They also had a significant larger number in the following events: total sexual partners, anal sex and oral sex episodes with same sex, number of sexual partners, anal sex and oral sex in the previous six months, with the figure of median 50.0, 20.0, 20.0, 5.0, 4.0, 5.0 respectively. 31.5% had ever participated in 'group sex', 48.0% had sex with male partners away from his own region in the previous year, 70.5% had sexual intercourse with strangers at MSM avenues in the last six months. The OR (95%CI) values were 2.288 (1.702 - 3.077), 3.231 (2.462 - 4.241), 2.840 (2.140 - 3.770). All the above mentioned figures were higher than those without the experience, with significant differences. They had a significant lower rate of 45.7% of condom use while having sex with female partners (P < 0.05).MSM with the experience of exchanging money for the same sex would have more AIDS-related high risk behaviors, AIDS preventative measures should be taken to target different subgroups.
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Objective To investigate the prevalence of AIDS-related high risk behaviors among men who have sex with men(MSM)ever infected by sexually transmitted disease(STI)within previous one year.Methods Snowball sampling and an anonymous questionnaire survey were adopted for a cross-sectional study to compare the differences in high risk behaviors related to AIDS between MSM with STI and without STI experience in nine cities.SPSS 13.0 statistical software was used in data analysis.Results Among the 2 134 MSM,compared to the MSM without STI experience,the MSM with STI had a significant higher number of total sexual partners of anal sex with same sex and the number of anal sex in the previous six months,with the medians of 20.0 and 3.0,respectively.In the previous year,28.8%(95/330)of MSM with STI participated in group sex,24.7%(81/328)had commercial homosex,44.1%(146/331)reported bleeding while having sexual intercourse,with significant differences compared to those of MSM without STI.The MSM with STI had a significant lower rate of condom use(67.3%[181/269]) in the latest anal sex.Moreover,STI group had a higher HIV infection rate(4.03%[14/347]).Conclusion The MSM with STI experience have a high prevalence of high risk AIDS-related behaviors and urgent health intervention targeting MSM with STI experience should be conducted.
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Abstract Background Sexualized drug use (SDU, use of any psychoactive substance before/during sexual intercourse) is prevalent among men who have sex with men (MSM). This study investigated uptake and willingness to use pre-exposure prophylaxis (PrEP) among MSM with experience of SDU. Methods A total of 580 Hong Kong Chinese speaking MSM self-reported to be HIV negative/unknown sero-status completed a cross-sectional anonymous telephone interview. Results Of the participants, 107 (18.4%) and 56 (9.7%) had experience of SDU and chemsex in their lifetime. The prevalence of PrEP use was 4.0% among all participants and 12.1% among those with experience of SDU. Among MSM with experience of SDU who were not on PrEP (n=94), 59.6% were willing to use daily oral PrEP in the next six months. After adjustment for significant background variables (age group, HIV testing in the past year, and anal intercourse with non-regular male sex partners), having ≥3 episodes of SDU per month (adjusted odds ratios (AOR): 3.87, 95%CI: 1.01, 15.28), presence of condomless anal intercourse during SDU (AOR: 2.96, 95%CI: 1.03, 9.55), positive attitudes toward PrEP (AOR: 2.01, 95%CI: 1.37, 2.95), perceived support from significant others to use PrEP (AOR: 11.63, 95%CI: 3.93, 34.37)), and perceived behavioral control of using PrEP (AOR: 20.82, 95%CI: 6.51, 66.64) were significantly associated with higher willingness to use PrEP. Conclusion MSM with experience of SDU are potential good candidates of PrEP implementation. Effective strategies to increase PrEP coverage are needed even if affordable PrEP became available, future health promotion may make use of HIV testing and counseling settings and modify perception related to PrEP.
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Abstract Background: Rectal douching (RD) is widely practiced by men who have sex with men (MSM), and is correlated with increased risk of HIV infection. However, the mechanism of how RD increases the risk of HIV infection is not well understood, and there is limited data on RD behavior in MSM practicing anal sex in China. We examine the purpose of RD, its timing in relation to anal sex, the types of RD products used, and risky sexual behaviors among MSM reporting anal sex. Methods: Between August 2017 and December 2018, a cross-sectional study was conducted among adult MSM in Shenyang, China. Data were collected on demographics, sexual behaviors, and RD for the most recent sexual intercourse by means of interviewer-administered face-to-face questionnaires. Blood samples were collected to test for antibodies to HIV and syphilis. Multivariable logistic regression models were used to assess the risk factors associated with HIV infection. Results: A total of 515 eligible MSM participated in this survey (median age: 31 years). During the most recent anal intercourse, 28.3% (146/515) had condomless receptive anal intercourse (CRAI), 21.4% (110/515) practiced serosorting, and more than half (61.6%, 317/515) reported RD before or after anal sex. Of those practicing RD, 96.8% (307/317) conducted RD before sex, while 62.5% (198/317) conducted RD after sex. The douching devices used were primarily shower hoses (85.3%, 262/307), and relatively few MSM used commercial RD products (8.1%, 25/307) before sex. The prevalence of HIV-1 and syphilis was 11.7% and 13.2%, respectively. HIV infection was positively associated with RD (adjusted odds ratio (AOR), 2.8; 95% confidence interval (CI), 1.4-5.5), practicing RD before sex (AOR, 2.3; 95% CI, 1.2–4.3), practicing RD after sex (AOR, 1.8; 95% CI, 1.0–3.1), using a shower hose for RD (AOR, 3.5; 95% CI, 1.1–13.0), CRAI (AOR, 2.9; 95% CI, 1.6–5.5), and an interaction effect of RD and CRAI (AOR = 4.2; 95 % CI, 2.2- 8.1) in the most recent anal intercourse. Conclusions: RD is popular among Chinese MSM. Improper noncommercial RD tools use (such as shower hose), the interaction effect between RD and CRAI associated with HIV infection. Public health workers and the MSM community should publicize scientific knowledge and prevention approaches relating to RD and HIV transmission to MSM. We recommend that cohort studies should be conducted to confirm the causal relationship between RD and acquiring HIV.
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Background Geosocial-networking smartphone applications (apps) have been used increasingly by men who have sex with men (MSM) to meet new sexual partners. The purpose of this study was to examine associations between contexts of app use (e.g. using apps when drinking) and condomless anal intercourse among a sample of MSM who use these apps. Methods: MSM (n = 174) in New York City were recruited through Grindr, a geosocial-networking app popular among MSM, using broadcast advertisements asking MSM to complete an Internet-based survey about their app use and sexual behaviours. Log-binomial regression models were fit to assess the association between each of the six app-use contexts (e.g. using apps when lonely, when drinking) and engagement in condomless insertive and receptive anal intercourse with one or more partners in the past 3 months. Results: Engagement in condomless receptive and insertive anal intercourse with one or more partners in the preceding 3 months was common (39.7% and 43.1% respectively) and was associated with several app-use contexts. For example, significant associations (P < 0.05) were observed between alcohol and other drug use when using these apps and engagement in condomless receptive and insertive anal intercourse. Conclusion: Given that 57.5% of respondents had engaged in condomless anal intercourse in the preceding 3 months and the associations of app-use contexts with condomless sexual behaviours, these findings suggest that reductions in substance use may lead to safer sexual practices among MSM who use apps to meet sexual partners.
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Objectives
To assess changes in seroadaptive behaviours among men who have sex with men (MSM) in San Francisco over the past 4 years.Methods
461 MSM were recruited in 2008 as the second wave of the US National HIV Behavioural Surveillance (NHBS) survey in San Francisco. Participants were classified into patterns of seroadaptive behaviours based on reported sexual practices (ie, episodes of insertive and receptive anal sex), condom use, HIV serostatus and partners9 serostatus for up to five partners in the preceding 6 months. The prevalence of seroadaptive behaviours was compared with the first wave of NHBS, which used identical methods in 2004.Results
In 2008, 33.7% of HIV-negative and 18.9% of HIV-positive MSM used condoms 100% of the time; nearly half (48.0%) of HIV-negative MSM and two-thirds (66.7%) of HIV-positive MSM had unprotected anal intercourse (UAI). Collectively, seroadaptive behaviours comprised the most common form of risk management; 40.5% of HIV-negative MSM and 51.1% of HIV-positive MSM engaged in some form of seroadaptation, the most common being 'pure serosorting' (all UAI with same serostatus partners) reported by 27.5% of HIV-negative MSM and 22.2% of HIV-positive MSM. None of these behaviours were significantly different from their corresponding measures in 2004.Conclusions
Seroadaptation continues to describe the prevailing form of sexual risk management for MSM in San Francisco, suggesting that these behaviours are not novel and require careful measurement to gauge the true potential for the spread of HIV, and nuanced prevention messages to reduce risk.Serostatus
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