Henry F. Raymond

Prevalence of seroadaptive behaviours of men who have sex with men, San Francisco, 2004

Objectives: To define and measure the prevalence of HIV seroadaptive behaviours among men who have sex with men (MSM). Methods: A community-based, cross-sectional sample of 1211 HIV negative and 251 HIV positive MSM was recruited in San Francisco in 2004 by time-location sampling. Seroadaptive behaviours were defined by enumerating and characterising all episodes of anal intercourse by partner type, partner HIV serostatus, sexual position and condom use for up to five partners in the preceding 6 months. Results: Among HIV negative MSM, 37.6% engaged in some form of apparent seroadaptive behaviour, predominantly pure serosorting (24.7%), followed by seropositioning (5.9%), condom serosorting (3.9%) and negotiated safety (3.1%). Among HIV positive men, 43.4% engaged in some form of seroadaptation, including pure serosorting (19.5%), seropositioning (14.3%) and condom serosorting (9.6%). Consistent condom use was reported by 37.1% of HIV negative and 20.7% of HIV positive MSM. Conclusions: In aggregate, seroadaptive behaviours appear to be the most common HIV prevention strategy adopted by MSM in San Francisco as of 2004. Surveillance and epidemiological studies need to precisely measure seroadaptive behaviours in order to gauge and track the true level of HIV risk in populations. Rigorous prevention research is needed to assess the efficacy of seroadaptive behaviours on individuals’ risk and on the epidemic.

HIV prevalence and related risk factors among male sex workers in Shenzhen, China: results from a time-location sampling survey.

Background HIV transmission among men who have sex with men has recently become a major concern in China. Little is known, however, about HIV transmission among male sex workers (MSW). This study aimed to investigate HIV infection prevalence and risk factors among MSW in Shenzhen, China. Materials and methods Following formative research, a cross-sectional study was conducted using time–location sampling among MSW in Shenzhen, from April to July 2008. Behavioural and serological data on HIV and syphilis were collected. The risk factors for HIV infection were analysed using a logistic regression model. Results In total, 394 MSW were recruited for the survey. The prevalence of HIV and syphilis among these workers was 5.3% and 14.3%, respectively. Only a quarter of the MSW self-identified as homosexual. More than 70% had sex with both men and women. HIV-related knowledge levels were high regardless of HIV serostatus. Consistent condom use was low (37.1%) and varied by type of sexual partner. Factors including more non-commercial male partners, working in small home-based family clubs, being drunk before sexual intercourse, having a history of HIV tests, syphilis infection and a short period of residence in Shenzhen were associated with an increased risk of HIV infection. Conclusions High-risk sexual practices were common among MSW regardless of their high level of HIV awareness. The working venues were associated with HIV infection and a recent test for HIV was a potential predictor of HIV infection. The time–location sampling method was found to be an appropriate way of recruiting MSW for this study, especially those without fixed working places.

Accessing HIV testing and treatment among men who have sex with men in China: A qualitative study

Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, seven focus group (FG) discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, nondisclosure to families, misconceptions of domestically produced antiretroviral drugs (ARVs) and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed.

Concurrent sexual partnerships and racial disparities in HIV infection among men who have sex with men

Objectives: To measure the level of sexual partner concurrency and assess its potential role in explaining disparities in HIV prevalence by race/ethnicity among men who have sex with men (MSM). Methods: A cross-sectional, community-based survey of MSM in San Francisco was conducted in 2008 using time-location sampling. Four different measures of sexual partner concurrency were assessed and compared across race/ethnicity groups: overlap in time with the most recent sexual partners, knowledge of the most recent sexual partner having other partners, any overlap with up to the last five partners and complete overlap with up to the last five partners. Results: A total of 521 MSM was recruited; 10% self-described their race/ethnicity as black, 62% as white, 25% as Latino and 9% as Asian (not mutually exclusive). Black MSM had fewer sexual partners overall, yet had three times the odds that all their partnerships were concurrent compared with non-black MSM (39% vs 17%, respectively, p = 0.034). None of the other measures of concurrency showed racial/ethnic differences. MSM whose partnerships were completely concurrent had a higher number of sexual episodes and unprotected sexual episodes per partnership compared with those whose partners were not completely concurrent. Conclusions: Findings support the hypothesis that the sexual networks of black MSM rather than individual behaviours account for their higher prevalence of HIV compared with non-black MSM. There remains the need specifically to validate different concurrency measures in larger samples and directly assess them as risk factors for acquiring HIV infection.

High prevalence of risk behaviour concurrent with links to other high-risk populations: a potentially explosive HIV epidemic among men who have sex with men in Guangzhou, China.

Objectives: HIV disproportionately affects men who have sex with men (MSM), but HIV prevalence among MSM in Guangzhou has not shown the rapid increasing trend as it has elsewhere in China. The aim of this study is to detect the epidemic and to determine the characteristics of MSM in Guangzhou susceptible to HIV. Methods: A cross-sectional survey with serological testing for HIV, syphilis, HBV and HCV through long-chain referral sampling strategy to help control the bias generated from non-statistic sampling. Results: The most important features of MSM in Guangzhou are being young and mobile, and of comparable education and income level to that of the general population. The HIV prevalence was 1.3% (95% CI 0.3 to 2.7%) in 2006. Many HIV risk factors were identified: low awareness of HIV risk perception and prevention, high prevalence of diverse, multiple partners and versatile sexual role, more than half of them actively having sex with women, low persistent condom use with both male and female partners, commercial sex and one out of 27 practising needle or syringe sharing during illicit drug use. Conclusion: HIV has been introduced into MSM in Guangzhou. Demographic and behavioural risk factors and overlapping risk populations contribute to a potentially rapidly rising epidemic among MSM and the potential for a bridge to female partners in Guangzhou if timely and effective interventions are not implemented.

Untested and undiagnosed: barriers to HIV testing among men who have sex with men Beijing China.

Objectives Undiagnosed HIV presents great potential for the spread of infection. The authors identify the prevalence and correlates of never testing and being unaware of HIV infection in Beijing men who have sex with men (MSM). Methods Cross-sectional biological and behavioural survey using respondent-driven sampling; 500 MSM were included. Results HIV prevalence was 7.2% with 86.1% unaware of their infection; 33.2% had never tested. Never testing was associated with lower educational (adjusted odds ratio (AOR) 1.6, 95% CI (CI) 1.1 to 2.5), living in Beijing for ≤3 years (AOR 1.5, 95% CI 1.0 to 2.3), unprotected anal intercourse with most recent male partner (AOR 1.6, 95% CI 1.0 to 2.4), being unaware of the most recent male partners HIV status (AOR 3.6, 95% CI 2.1 to 6.1) and holding stigmatised attitudes towards persons with HIV (AOR 1.1 per scale point, 95% CI 1.0 to 1.1). Predictors of having undiagnosed HIV infection were being married (AOR 2.4, 95% CI 1.0 to 5.4), living in Beijing for ≤3 years (AOR 3.6, 95% CI 1.5 to 8.4), being unaware of the most recent male partners HIV status (AOR 6.8, 95% CI 0.9 to 51.6) and holding negative attitudes towards safe sex (AOR 1.1 per scale point, 95% CI 1.0 to 1.1). Conclusions Recent attention has focused on HIV prevention interventions that depend upon knowing ones serostatus, including viral load suppression, prevention with positives, pre-exposure prophylaxis and seroadaptation. Until the low level of testing and resulting high level of undiagnosed HIV infection are addressed, these tools are not likely to be effective for MSM in China.

Incorporating the service multiplier method in respondent-driven sampling surveys to estimate the size of hidden and hard-to-reach populations: case studies from around the world.

Background Estimating the sizes of populations at highest risk for HIV is essential for developing and monitoring effective HIV prevention and treatment programs. We provide several country examples of how service multiplier methods have been used in respondent-driven sampling surveys and provide guidance on how to maximize this method’s use. Methods Population size estimates were conducted in 4 countries (Mauritius— intravenous drug users [IDU] and female sex workers [FSW]; Papua New Guinea—FSW and men who have sex with men [MSM]; Thailand—IDU; United States—IDU) using adjusted proportions of population members reporting attending a service, project or study listed in a respondent-driven sampling survey, and the estimated total number of population members who visited one of the listed services, projects, or studies collected from the providers. Results The median population size estimates were 8866 for IDU and 667 for FSW in Mauritius. Median point estimates for FSW were 4190 in Port Moresby and 8712 in Goroka, Papua New Guinea, and 2,126 for MSM in Port Moresby and 4200 for IDU in Bangkok, Thailand. Median estimates for IDU were 1050 in Chiang Mai, Thailand, and 15,789 in 2005 and 15,554 in 2009 in San Francisco. Conclusion Our estimates for almost all groups in each country fall within the range of other regional and national estimates, indicating that the service multiplier method, assuming all assumptions are met, can produce informative estimates. We suggest using multiple multipliers whenever possible, garnering program data from the widest possible range of services, projects, and studies. A median of several estimates is likely more robust to potential biases than a single estimate.

HIV/AIDS-Related Stigmatizing and Discriminatory Attitudes and Recent HIV Testing Among Men Who Have Sex With Men in Beijing

This study assessed the correlates of recent HIV testing and HIV/AIDS-related stigmatizing and discriminatory attitudes among men who have sex with men (MSM) in Beijing, China. A cross-sectional study probed demographics, sexual and drug use behaviors, HIV testing, and prevention services. Of 500 participants, 39.3% recently received a test for HIV. Recent testing was independently associated with expressing lower levels of HIV/AIDS-related stigmatizing and discriminatory attitudes, more male sex partners, no female sexual partners and knowing HIV status of their last male partner. Expressing lower levels of HIV/AIDS-related stigmatizing and discriminatory attitudes was independently associated with recent testing, younger age, and knowing HIV status of their last male partner. This study revealed that HIV/AIDS-related stigmatizing and discriminatory attitudes were common and inversely associated with recent HIV testing. Low levels of testing highlighted the urgent needs to reduce HIV/AIDS-related stigma and discrimination and expand HIV testing among MSM in Beijing.ResumenEl estudio fue evaluar la correlación de los últimos la prueba del VIH y el VIH/SIDA relacionados con las actitudes estigmatizantes y discriminatorias entre hombres que tienen sexo con hombres (HSH) en Beijing, China. Un estudio transversal investigado los datos demográficos, las conductas sexuales y de uso de drogas, pruebas de VIH y servicios de prevención. De 500 participantes, el 39,3% ha recibido recientemente una prueba de VIH. Pruebas recientes se asoció independientemente con la expresión de los niveles más bajos de VIH/SIDA relacionados con las actitudes estigmatizantes y discriminatorias, más parejas sexuales masculinas, no las parejas sexuales femeninas y conocer el estado de VIH de su pareja masculina pasado. Expresar niveles más bajos de VIH/SIDA actitudes estigmatizantes y discriminatorias se asoció independientemente con las pruebas recientes, una edad más joven, y conocer el estado de VIH de su pareja masculina pasado. Este estudio reveló que el VIH/SIDA relacionados con las actitudes estigmatizantes y discriminatorias eran comunes e inversamente asociada con las recientes pruebas de VIH. Los bajos niveles de las pruebas destacó la necesidad urgente de reducir el VIH/SIDA, el estigma y la discriminación y ampliar las pruebas del VIH entre los HSH Beijing.

Behavioral and Serologic Survey of Men Who Have Sex with Men in Beijing, China: Implication for HIV Intervention

We assessed HIV prevalence and associated behaviors and risk factors among men who have sex with men (MSM) in Beijing, China. Five hundred MSM were recruited for a biological and behavioral survey using respondent-driven sampling (RDS) in 2009. Serologic specimens were tested for markers of HIV and syphilis infection. A computer-assisted personal interview (CAPI) administered questionnaire gathered information including demographic characteristics, sexual behaviors, HIV testing, and social norms concerning condom use. The adjusted HIV prevalence was 8.0%, syphilis 22.0%. HIV testing and disclosure was low; only 39.3% had HIV tested in the past 12 months, 49.7% knew their own HIV status and 22.8% knew their last male partners HIV status. HIV infection was associated with syphilis, ever having sex with a woman, not knowing the HIV status of the most recent male partner, and never buying condoms in the past 12 months. Stronger endorsement of positive social norms around condom use strongly and predicted lower prevalence of HIV infection. Compared to surveys of similar design in the recent past, HIV continues to spread rapidly among Beijings MSM. Our results identify points of intervention that, if addressed in time, may still alter the course of the epidemic including the promotion of HIV testing and partner disclosure, syphilis control and particularly changing social norms around condom use.

Trends in condom use among MSM in the United States: the role of antiretroviral therapy and seroadaptive strategies.

Objective:Evaluate changes in condomless anal sex at last sex among men who have sex with men (MSM) and assess if these changes are associated with the adoption of serosorting and biomedical prevention. Design:The National HIV Behavioral Surveillance is a crosssectional survey done in up to 21 cities in 2005, 2008, 2011 and 2014. Methods:MSM were recruited through venue-based sampling. Among men reporting at least one male partner, we evaluated changes in condomless anal sex at last sex with a partner with (1) HIV-concordant (proxy for serosorting) or (2) HIV-discordant (discordant/unknown) status. We hypothesized that if concordant condomless sex was increasing while discordant was stable/declining, the increases could be driven by more men attempting to serosort. We used generalized estimating equations assuming a Poisson distribution and robust variance estimator to explore whether temporal changes in the outcomes varied by selected characteristics. We also assessed changes in condomless anal sex by antiretroviral therapy (ART) use among HIV-positive MSM. Results:Among 5371 HIV-positive MSM, there were increases in concordant (19% in 2005 to 25% in 2014, P < 0.001) and discordant condomless sex (15 to 19%, P < 0.001). The increases were not different by ART use. Among 30 547 HIV-negative MSM, concordant (21 to 27%, P < 0.001) and discordant condomless sex (8 to 13%, P < 0.001) increased. Conclusion:Our data suggest that condom use decreased among MSM and that the trends are not explained by serosorting or ART. Promotion of condoms and increased access to preexposure prophylaxis are vital to ensure that the benefits of ART in reducing transmission of HIV are not undermined.