A survey of condom use behaviors and HIV/STI prevalence among venue-based money boys in Shenzhen, China

Prevalence of HIV and syphilis and their co-infection among men having sex with men in Asia: A systematic review and meta-analysis

Background

Studies found that the group of men who have sex with men (MSM) is at a very high level of risk of HIV and sexually transmitted infections (STIs) in Asian regions due to multiple reasons. Although the prevalence of HIV among general people in Asia is considered low, the prevalence of HIV and Syphilis among MSM in this region was found very high and usually, it goes unnoticed. This study aimed to inspect the prevalence of and trends in HIV, Syphilis, and their co-infection among MSM in Asia.

Methods

A systematic search was performed on January 5, 2021, in PubMed, Web of Science, and Google Scholar databases. To evaluate the heterogeneity, Q-tests, and I ² were used. To explore the publication bias, Eggers' test and funnel plot were used. The random-effect model and subgroup analysis were performed due to the significant heterogeneity.

Results

A total of 2872 articles were identified, and 66 articles were included in the final analysis. The overall prevalence of HIV and Syphilis among MSM was estimated considering 69 estimates from 66 studies whereas 19 estimates of co-infection were found in 17 studies. The pooled HIV prevalence was 8.48% (CI: 7.01-9.95) and the pooled Syphilis prevalence was 9.86% (CI: 8.30-11.41) with significant heterogeneity and publication bias. The pooled prevalence of HIV and Syphilis co-infection was 2.99% (CI: 1.70-4.27) with significant heterogeneity and no publication bias. The HIV, Syphilis, and HIV-Syphilis co-infection prevalence estimates exhibited an upward trend during 2002-2017.

Conclusions

HIV, Syphilis, and their co-infection are quite prevalent among MSM in the Asia-Pacific region. Integrated and intensified intervention strategies, HIV testing, and improved access to antiretroviral treatment as well as increased awareness are needed to reduce HIV, Syphilis, and their co-infection among the discussed vulnerable group.

The Prevalence of HIV Infection in Minority Indigenous Populations of the South-East Asia and Western Pacific Regions: A Systematic Review and Meta-analysis

A random effects meta-analysis was used to estimate the pooled prevalence of HIV infection within minority indigenous populations of the South-East Asia (SEAR) and Western Pacific Regions (WPR). Sub-group analyses were conducted, and the sources of heterogeneity explored through meta-regression. The majority of studies were undertaken in high HIV risk subpopulations. There was a paucity of data for many countries with data from China representing 70% of the comparative studies. Within minority indigenous populations the pooled prevalence of HIV infection was 13.7% (95% CI 8.9, 19) and 8.4% (95% CI 6.3, 10.7) among other populations. The prevalence differential between populations was significant in the WPR (adjusted odds ratio 1.1, 95% CI 1.0, 1.2). Across both regions, in contrast to other populations, minority indigenous did not experience any significant reduction in HIV prevalence over the years of data collection. There was large heterogeneity in the prevalence of HIV across studies.

Women Who Trade Sexual Services from Men: A Systematic Mapping Review

Most research on transactional sex frame men as buyers and females as sellers of sex. We conducted a systematic mapping review of the empirical research on transactional sex where women form the demand (buyer) and men the supply (seller). We included 46 studies, of which 25 explicitly researched women as buyers of sex from male sellers, and 21 studies where this topic was a subset of larger topics. The majority of research on women who trade sexual services from men is published in the last 15 years, by female researchers, using cross-sectional or qualitative/ethnographic design, and from the perspective of males as sellers. While the women appear to be mature and financially independent, the men are young and socioeconomically vulnerable. Men's main motivation for the sexual-economic exchanges with women is financial, whereas women's motivations are largely satisfaction of sexual needs and a stereotyped erotic fantasy of black male hypersexuality. Condoms are often not used. Our review shows that there is a - possibly growing and diversifying - female consumer demand for male sexual services, and transactional sex where women trade sex from men is a complex social phenomenon firmly grounded in social, economic, political, and sexual relations.

The prevalence of HIV among MSM in China: a large-scale systematic analysis

BACKGROUND

The prevalence of HIV among men who have sex with men (MSM) has become a significant public health challenge. The aim was to comprehensively estimate the national prevalence of HIV among MSM and its time trends through a large-scale systematic analysis.

METHODS

Systematic search of Cochrane Library, PubMed, EMBASE, CNKI, VIP, and Wanfang Data databases without language restriction for studies on the prevalence of HIV among MSM published before Dec.31, 2018. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used validated assessment methods to assess the prevalence of HIV among MSM. Estimates were pooled using random-effects analysis.

RESULTS

Data were extracted from 355 cross-sectional studies (571,328 individuals) covered 59 cities from 30 provinces and municipalities of China. The overall national prevalence of HIV among MSM from 2001 to 2018 was estimated to be 5.7% (95% CI: 5.4-6.1%), with high between-study heterogeneity (I² = 98.0%, P <  0.001). Our study showed an increased tendency in the HIV prevalence as time progressed by meta-regression analysis (I² = 95.9%, P <  0.0001). HIV prevalence was the highest in those aged 50 years and older with HIV prevalence of 19.3% (95%CI: 13.1-27.4%, N = 13). HIV was more prevalent in the illiterate population (16.8%), than in those who had received an education. Although the internet was a major venue for Chinese MSM seeking male sex partners (35.6, 95%CI: 32.3-39.9%, N = 101), seeking MSM in bathhouses/saunas had the highest associated prevalence of HIV (13.4, 95%CI: 10.3-17.1%, N = 22). The HIV prevalence among MSM varied by location: compared with other regions in China, HIV was highly prevalent among MSM in the southwest (10.7, 95%CI: 9.3-12.2%, N = 91). Compared to participants who sometimes or always used condoms, participants who had never used a condom in the past 6 months had a higher risk of HIV infection, with odds ratios of 0.1 (95%CI: 0.08-0.14).

CONCLUSIONS

Our analysis provided reliable estimates of China's HIV burden among MSM, which appears to present an increasing national public health challenge. Effective government responses are needed to address this challenge and include the implementation of HIV prevention.

Inequities in consistent condom use among sexually experienced undergraduates in mainland China: implications for planning interventions

BACKGROUND

Since pre-exposure prophylaxis (PrEP) is mainly prescribed to high-risk uninfected individuals, consistent condom use (CCU) continues to be recommended as an inexpensive, feasible, practical and acceptable way to prevent the general population from acquiring and transmitting HIV through sexual intercourse. The objective of this cross-sectional study was to compare the relative importance of various determinants of CCU among sexually experienced undergraduates in mainland China so as to assess and subsequently to suggest ways to eliminate inequities in its use.

METHOD

From September 10, 2018, to January 9, 2019, an anonymous self-administered online questionnaire was voluntarily completed by 12,750 participants distributed across 30 provinces in mainland China (except for Tibet). The present analysis was restricted to 2054 sexually experienced undergraduates. Pearson's chi-square test and Logistic regression models were chosen to analyze the factors associated with CCU.

RESULTS

The overall rate of CCU was 61.3% [95% confidence interval (CI) = 59.2-63.4%]. CCU was inequitably distributed since enabling factors exerted greater effects than predisposing and need variables. Compared with heterosexual men, heterosexual women [adjusted odds ratio (AOR) = 0.78, 95% confidence interval (CI):0.64-0.96)], non-heterosexuals men (AOR = 0.64, 95% CI:0.45-0.92) and women (AOR = 0.68, 95% CI:0.47-0.99) were less prone to using condoms consistently. Those with more resources [i.e., higher levels of self- efficacy for condom use (AOR = 2.86, 95% CI:2.35-3.49) and being knowledgeable of the national AIDS policy (AOR = 1.50, 95% CI:1.23-1.82)], and those with lower need for condoms [i.e., late initiation of sexual activity (AOR = 1.34, 95% CI:1.09-1.64) and single sexual partner (AOR = 1.68,95% CI:1.21-2.33)] were more likely to be consistent condom users.

CONCLUSIONS

In order to increase consistency of condom use and simultaneously reduce the remaining inequities, a comprehensive intervention measure should be taken to target heterosexual women, non-heterosexual men and women, and those with higher need for condoms, improve their condom use self- efficacy and raise their awareness of the national AIDS policy.

Life satisfaction and its associated factors among money boys in China

OBJECTIVES

Money Boy (MB) is a unique term used in China referring to a specialized population of men who sell sex to other men. Life satisfaction can influence one's health-related behaviors. The aim of our study was to find out the situation of MBs' life satisfaction and its associated factors.

STUDY DESIGN

A cross-sectional study among MBs was conducted between July and December 2013 in Hunan province, China.

METHODS

Respondent-driven sampling method was used for recruitment, with the initial seven 'seeds' found from a gay dating website, and 234 participants were enrolled into the study. They were asked to complete a questionnaire about their demographic characteristics, work experience as MB, family environment, health-related behaviors, status of self-esteem, self-stigma, and perceived life satisfaction. Descriptive statistics and multiple linear regression analysis were applied.

RESULTS

There were 205 valid questionnaires collected. The results showed that MBs' life satisfaction score was 17.9 ± 6.3. The multiple linear regression model identified five factors correlated with MBs' life satisfaction. Three factors were found to be positively correlated with life satisfaction, consistent condom use with clients (β = 3.093, P = 0.010), interpersonal relationship (β = 1.027, P = 0.017), and self-esteem (β = 0.253, P = 0.005). And two factors were found to be negatively correlated with life satisfaction, seeking for clients through mommy's arrangement (β = -2.091, P = 0.019) and had ever gotten at least one kind of sexually transmitted disease (STDs) (β = -1.971, P = 0.034).

CONCLUSIONS

The present study contributed to a better understanding of MBs' life satisfaction and behavioral and other psychosocial features. It is suggested that comprehensive interventions involving behavioral and psychosocial health promotion approaches are needed for this population. Those programs will be more acceptable among this group and tend to be sustainable.

Recreational drug use and risk of HIV infection among men who have sex with men: A cross-sectional study in Shenzhen, China

BACKGROUND

Recreational drug use has increased in recent years, especially among MSM, and has been found to be associated with higher risk of HIV infection. However, there is limited information about current recreational drug use among MSM in Shenzhen which is an international gateway city to China with a rapidly expanding MSM population.

METHODS

A cross-sectional survey among MSM in Shenzhen was conducted and was used to collected information on demographics, sexual behavior and drug use via questionnaires. Serologic results on HIV and syphilis were obtained from laboratory assays. We performed logistic regression analysis to evaluate correlates with drug use.

RESULTS

Among the 1935 MSM surveyed, 12.7% reported use of recreational drugs in the past six months. Rush poppers had become the most frequently used drug (10.6%). Risk factors associated with the use of recreational drugs included being unmarried, non-Han ethnicity, having high education level, seeking male sex partners via the internet, having multiple male sex partners, performing receptive role during anal sex, and having unprotected anal intercourse. Recreational drug use was significantly associated with higher risk of both HIV and syphilis infections (aOR:1.89, 95% CI:1.28-2.79; aOR:1.79, 95% CI:1.25-2.60, respectively).

CONCLUSIONS

Recreational drug use is associated with increased risk of HIV and syphilis infections among MSM in Shenzhen. Rush poppers were the most popular recreational drug. This finding suggests the need for targeted prevention and behavioral intervention programs to control the recreational drug use, and to reduce HIV and other sexually transmitted diseases among MSM in Shenzhen and internationally.

Male Sex Workers in Spain: What has Changed in the Last Lustrum? A Comparison of Sociodemographic Data and HIV Sexual Risk Behaviors (2010-2015)

The purpose of this study is to compare the evolution of risky factors related to HIV infection among Male Sex Workers (MSW) in Spain between 2010 and 2015. Participants were 180 MSW: 100 in 2010 and 80 in 2015. Socio-demographic characteristics, condom use with clients and personal partners, and other aspects about HIV infection were explored (serostatus, HIV information, perceived risk and fear, and drug use). The proportion of Spanish MSW (nonimmigrants) (5.5 vs. 62.5 %), educational level (19.8 vs. 40.5 % reported university degree), and the percentage of self-identified as bisexual (20.2 vs. 55.8 %) increased in 2015, whereas the percentage of MSW who self-identified as sex workers (62 vs. 25.8 %) decreased. The percentage of condom use has decreased during oral sex (76.8 vs. 35.5 %), vaginal sex (97.6 vs. 50.7 %) and insertive (99.6 vs. 92.2 %) and receptive (99.7 vs. 93 %) anal sex. The proportion of MSW living with HIV climbed from 1.1 to 13.6 %. The possible influence of economic crisis over MSW's profile changes in the 5-year period, and the necessity of more efficient health strategies based on culture and sexual orientation are discussed. The evolution observed indicates that this population is still at high risk for HIV and STI, therefore governmental resources have to be increased due the consequences among MSW and general society.

Prevalence of HIV and syphilis co-infection and associated factors among non-commercial men who have sex with men attending a sexually transmitted disease clinic in Shenzhen, China

BACKGROUND

Although HIV and syphilis co-infection has been frequently observed in men who have sex with men (MSM), only few studies have focused on it. Different subgroups of MSM might exhibit heterogeneous HIV and syphilis risk profiles, indicating that interventions for HIV and HIV-related co-infections may vary with different subgroups of MSM. However, no previous study has investigated HIV and syphilis co-infection among non-commercial MSM (ncMSM) attending a sexually transmitted disease (STD) clinic. Therefore, this study aimed to explore the prevalence of HIV and syphilis co-infection and associated factors among ncMSM attending an STD clinic in Shenzhen, China.

METHODS

NcMSM attending the STD clinic of Shenzhen Center for Chronic Disease Control were recruited in this cross-sectional study every Monday between March 2013 and August 2015 using a site based convenience sampling method. An anonymous questionnaire was used to collect data regarding socio-demographic characteristics, risky sexual behaviors and HIV-related knowledge. Blood samples were collected to perform HIV and syphilis tests.

RESULTS

Totally 533 participants were enrolled in this study and the prevalence of HIV and syphilis co-infection among them was 13.13%. Multivariable analyses indicated that having lived in Shenzhen for less than one year (aOR = 2.80, 95% CI = 1.30-6.05), having first anal sexual intercourse before the age of 18 (aOR = 2.78, 95% CI = 1.29-5.89), having 3 to 5 anal sexual partners in the past six months (aOR = 2.54, 95% CI = 1.19-5.40), playing exclusively receptive (aOR = 6.87, 95% CI = 3.02-15.61) or both insertive and receptive (aOR = 3.65, 95% CI = 1.64-8.09) roles in anal sexual intercourse and not always using condom in anal sexual intercourse (aOR = 2.13, 95% CI = 1.08-4.19) were associated risk factors for HIV and syphilis co-infection, relative to the non-infected ncMSM. Compared with the mono-infected ncMSM, associated risk factors for the co-infection were being unmarried (aOR = 2.47, 95% CI = 1.03-5.89) and playing exclusively receptive role (aOR = 2.44, 95% CI = 1.04-5.73) in anal sexual intercourse.

CONCLUSIONS

HIV and syphilis co-infection is quite prevalent among the study participants in Shenzhen. Integrated and intensified intervention strategies, specifically targeting at the non-infected and mono-infected ncMSM attending the STD clinic, are needed to reduce HIV and syphilis co-infection. Most importantly, non-infected and mono-infected ncMSM attending the STD clinic with the aforementioned associated risk factors should be given special concern.

Human Trafficking and Emerging Sex Risk Environments in Vietnam: A Preliminary Profile of a Sex Work "Shared House"

Young male sex workers (YMSW) in Vietnam have high rates of HIV and STIs, yet have poor access to healthcare due low knowledge, stigma, and economic constraints. In the process of implementing a Sexual Health Promotion intervention to engage YMSW in Ho Chi Minh City in healthcare, we identified a unique sex work venue, known as a "Shared House," in which YMSW provide sex under the direction of a manager who negotiates the terms of the transaction directly with the client. Survey data reveal that compared with YMSW recruited in other locations, those interviewed in Shared Houses reported lower levels of substance use, less contact with the police, and fewer nights spent sleeping in pubic places. However, observational data and informal interviews with YMSW in Shared Houses revealed that the majority were trafficked through third-party brokers who connect youth with Shared House managers for the explicit purpose of sex work. These YMSW had little or no control over their sex work transactions and very low levels of knowledge regarding transmission of HIV and STIs. Further research is needed in these and other venues in which young men are trafficked for sex work.

Early Sexual Debut and HIV Infection among Men Who Have Sex with Men in Shenzhen, China

Studies investigating the association between early sexual debut and human immunodeficiency virus (HIV) infection have mainly focused on Africans or females but rarely on men who have sex with men (MSM) in China. This study, therefore, mainly aimed at exploring the association between early sexual debut and HIV infection among MSM in Shenzhen, China. A total of 533 MSM were enrolled in this study using a convenience sampling method. Information about sociodemographic characteristics and risky sexual behaviors was collected. It was found that the prevalence of HIV infection was 24.2% among this study population and 66.4% of the MSM reported having had vaginal sexual intercourse with females. The mean ages at first vaginal sexual intercourse, first anal sexual intercourse, and first sexual intercourse were 21.38, 22.43, and 19.87 years, respectively. Multivariable logistic regression analyses showed that the MSM who experienced early anal sexual debut were more likely to be infected with HIV than those who did not. The results indicate that HIV infection is quite prevalent among MSM in Shenzhen. Early and efficient intervention strategies should be taken, and the MSM experiencing early anal sexual debut should be given special attention.

Suboptimal HIV Testing Uptake Among Men Who Engage in Commercial Sex Work with Men in Asia

PURPOSE

Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia.

METHODS

The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred and seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included in this analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year.

RESULTS

About half (48.6%) of the participants had been tested for HIV at least once within the past year, and 30.5% had never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested.

CONCLUSION

While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed.

Changes in Prevalence of HIV or Syphilis among Male Sex Workers and Non-Commercial Men Who Have Sex with Men in Shenzhen, China: Results of a Second Survey

BACKGROUND

A previous time-location sampling survey (TLS) was performed in 2008 to evaluate the HIV or syphilis infection rate among male sex workers (MSWs) and non-commercial men who have sex with men (ncMSM) in Shenzhen, China. This is a second TLS performed in 2014. This article describes the findings and changes in the prevalence of HIV and syphilis.

METHODS

TLS was used to collect information as a second cross-sectional survey to an earlier TLS assessment. Data on behavior (e.g., sexual history and sexual behavior) were analyzed. Blood specimens were drawn for HIV and syphilis testing. To determine the changes in the prevalence of HIV and syphilis, we analyzed these results and compared them to the results of our first survey.

RESULTS

A total of 965 participants were recruited, including 489 MSWs and 476 ncMSM. Overall, the prevalence of HIV was 9.7%: 2.9% for MSWs and 16.8% for ncMSM (P<0.001). 10.9% of the 965 participants tested positive for syphilis: 4.5% among MSWs and 17.4% among ncMSM (P<0.001). The HIV prevalence in MSWs decreased from 4.5% in 2008 to 2.9% in 2014 (P = 0.143) but increased in ncMSM (7.0% in 2008 vs 16.8% in 2014, P<0.001). Decreased syphilis rates were observed in both MSWs (12.9% in 2008 vs 4.5% in 2014, P<0.001) and ncMSM (20.2% in 2008 vs 17.4% in 2014, P = 0.221).

CONCLUSIONS

Overall, there was a decline in the prevalence of HIV and syphilis in MSWs but not in ncMSM. The study indicated the need for continued efforts to improve public health, particularly to counter the rising rate of HIV in ncMSM.

Sexual Risk Behaviors and HIV Infection among Men Who Have Sex with Men and Women in China: Evidence from a Systematic Review and Meta-Analysis

OBJECTIVES

To understand the current risk of HIV infection and transmission and further elucidate the underlying risk factors among men who have sex with men and women (MSMW) in China.

METHODS

Following PRISMA guidelines, we conducted a systematic review and meta-analysis of searching through Chinese and English available literature databases between January 2000 and June 2014 to identify articles.

RESULTS

Thirty-six articles (including 19,730 MSMW and 53,536 MSMO) met the selection criteria and the aggregated results found that MSMW have significantly higher HIV prevalence than MSMO (6.6% versus 5.4%, OR = 1.27, 95% CI = 1.01-1.58). A higher proportion of MSMW had commercial male partners in the past 6 months (18.3% versus 12.2%, OR = 1.56, 95% CI = 1.01-2.42). Additionally, substance use in the past 6 months was significantly more frequent among MSMW than MSMO (alcohol use: 27.1% versus 13.1%, OR = 2.53, 95% CI = 2.14-2.99; illicit drug use: 5.3% versus 2.5%, OR = 2.09, 95% CI = 1.48-2.95).

CONCLUSION

A higher proportion of commercial sex and substance use among MSMW may be a potentially indicative factor for significantly higher HIV prevalence compared to MSMO. Targeted interventions should aim at increasing the frequency of HIV/STIs screening and preventing high risk commercial sex and substance use among MSMW to decrease their HIV transmission to the general population.

Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission

Male sex workers who sell or exchange sex for money or goods encompass a very diverse population across and within countries worldwide. Information characterising their practices, contexts where they live, and their needs is limited, because these individuals are generally included as a subset of larger studies focused on gay men and other men who have sex with men (MSM) or even female sex workers. Male sex workers, irrespective of their sexual orientation, mostly offer sex to men and rarely identify as sex workers, using local or international terms instead. Growing evidence indicates a sustained or increasing burden of HIV among some male sex workers within the context of the slowing global HIV pandemic. Several synergistic facilitators could be potentiating HIV acquisition and transmission among male sex workers, including biological, behavioural, and structural determinants. Criminalisation and intersectional stigmas of same-sex practices, commercial sex, and HIV all augment risk for HIV and sexually transmitted infections among male sex workers and reduce the likelihood of these people accessing essential services. These contexts, taken together with complex sexual networks among male sex workers, define this group as a key population underserved by current HIV prevention, treatment, and care services. Dedicated efforts are needed to make those services available for the sake of both public health and human rights. Evidence-based and human rights-affirming services dedicated specifically to male sex workers are needed to improve health outcomes for these men and the people within their sexual networks.

HIV prevention interventions for young male commercial sex workers

The sex industry, where men sell sexual services to other men or women, has grown in recent years. These men who offer sexual services are particularly vulnerable to HIV infection due to such factors as: frequency of risky sexual practices, number of sex partners, drug-taking, prevalence of sexually-transmitted infections (STI) and their specific situation of social exclusion which may hinder access to health services. These multi-faceted realities faced by sex workers explain the burgeoning interest in new avenues of scientific research. There are too few preventive programs however aimed at this population group and the studies that evaluate their effectiveness are fewer still. In this article we survey more recent studies on the difficulties of implementing programs for HIV prevention in male sex workers (MSW), as well as the studies that have gauged the impact of preventive programs in this group.

Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis

BACKGROUND

Men who engage in transactional sex, the exchange of sex for money, goods, or other items of value, are thought to be at increased risk of HIV, but there have been no systematic attempts to characterize HIV burden in this population. We undertook a systematic review and meta-analysis to quantify the burden in this population compared with that of men in the general population to better inform future HIV prevention efforts.

METHODS

We searched seven electronic databases, national surveillance reports, and conference abstracts for studies of men who engage in transactional sex published between 2004-2013. Random effects meta-analysis was used to determine pooled HIV prevalence and prevalence ratios (PR) for the difference in HIV prevalence among men who engage in transactional sex as compared to general population men.

FINDINGS

Of 66 studies included representing 31,924 men who had engaged in transactional sex in 28 countries, pooled biological assay-confirmed HIV prevalence was 10.5% (95% CI = 9.4 to 11.5%). The highest pooled HIV prevalence was in Sub-Saharan Africa (31.5%, 95% CI = 21.6 to 41.5%), followed by Latin America (19.3%, 95% CI = 15.5 to 23.1%), North America (16.6%, 95% CI = 3.7 to 29.5%), and Europe (12.2%, 95% CI = 6.0 to 17.2%). Men who engaged in transactional sex had an elevated burden of HIV compared to the general male population (PR = 20.7, 95% CI = 16.8 to 25.5).

CONCLUSIONS

The global burden of HIV is disproportionately high among men who engage in transactional sex compared with the general male population. There is an urgent need to include this population in systematic surveillance as well as to scale-up access to quality HIV prevention programs.

HIV prevalence and high-risk sexual behaviours among MSM repeat and first-time testers in China: implications for HIV prevention

Introduction

Little is known about HIV testing, HIV infection and sexual behaviour among bathhouse patrons in China. This study aims to assess differences in HIV prevalence and high-risk sexual behaviours between repeat and first-time testers among men who have sex with men (MSM) attending bathhouse in Tianjin, China.

Methods

Between March 2011 and September 2012, a HIV voluntary counselling and testing station was established in a gay bathhouse, which provided HIV testing and conducted a survey among participants recruited through snowball sampling. Differences in demographic and high-risk sexual behaviours between repeat and first-time testers were assessed using the chi-square test. Univariate and multivariate logistic regression analyses were conducted to identify predictors for HIV infection.

Results

Of the 1642 respondents, 699 (42.6%) were repeat testers and 943 (57.4%) were first-time testers. Among repeat testers, a higher proportion were men aged 18 to 25, single, better educated, had a history of STIs and worked as male sex workers or “money boys” (MBs). Repeat testers were less likely to report having unprotected anal intercourse in the past six months. The overall HIV prevalence was 12.4% (203/1642). There was no difference in HIV prevalence between repeat (11.2%, 78/699) and first-time (13.3%, 125/943) testers. The HIV prevalence increased with age among first-time testers (χtrend2=9.816, p=0.002). First-time MB testers had the highest HIV prevalence of 34.5%.

Conclusions

MSM attending bathhouse had an alarmingly high HIV infection rate, particularly in MB. Targeted interventions are urgently needed especially focusing on older MSM and MBs.

Disparities and risks of sexually transmissible infections among men who have sex with men in China: a meta-analysis and data synthesis

Background

Sexually transmitted infections (STIs), including Hepatitis B and C virus, are emerging public health risks in China, especially among men who have sex with men (MSM). This study aims to assess the magnitude and risks of STIs among Chinese MSM.

Methods

Chinese and English peer-reviewed articles were searched in five electronic databases from January 2000 to February 2013. Pooled prevalence estimates for each STI infection were calculated using meta-analysis. Infection risks of STIs in MSM, HIV-positive MSM and male sex workers (MSW) were obtained. This review followed the PRISMA guidelines and was registered in PROSPERO.

Results

Eighty-eight articles (11 in English and 77 in Chinese) investigating 35,203 MSM in 28 provinces were included in this review. The prevalence levels of STIs among MSM were 6.3% (95% CI: 3.5–11.0%) for chlamydia, 1.5% (0.7–2.9%) for genital wart, 1.9% (1.3–2.7%) for gonorrhoea, 8.9% (7.8–10.2%) for hepatitis B (HBV), 1.2% (1.0–1.6%) for hepatitis C (HCV), 66.3% (57.4–74.1%) for human papillomavirus (HPV), 10.6% (6.2–17.6%) for herpes simplex virus (HSV-2) and 4.3% (3.2–5.8%) for Ureaplasma urealyticum. HIV-positive MSM have consistently higher odds of all these infections than the broader MSM population. As a subgroup of MSM, MSW were 2.5 (1.4–4.7), 5.7 (2.7–12.3), and 2.2 (1.4–3.7) times more likely to be infected with chlamydia, gonorrhoea and HCV than the broader MSM population, respectively.

Conclusion

Prevalence levels of STIs among MSW were significantly higher than the broader MSM population. Co-infection of HIV and STIs were prevalent among Chinese MSM. Integration of HIV and STIs healthcare and surveillance systems is essential in providing effective HIV/STIs preventive measures and treatments.

Trial Registration

PROSPERO No: CRD42013003721

Assessing prescription stimulant use, misuse, and diversion among youth 10-18 years of age

PURPOSE OF REVIEW

Assessing the medical and nonmedical use (NMU) of stimulants and diversion is a challenge, especially among youth, with different methods for recruitment and definitions of NMU. The field needs inexpensive, yet effective and reliable, methods of data collection to understand the prescription drug use problem. Most studies of youth are school or web-based, and conducted with teens.

RECENT FINDINGS

The National Monitoring of Adolescent Prescription Stimulants Study recruited 11,048 youth 10-18 years of age from urban, rural, and suburban areas in 10 US cities using an entertainment venue intercept study. This review discusses the effectiveness of the method and results from four cross-sections as well as the representativeness of the sample. Lifetime prevalence of any stimulant use was 14.8%, with rates highest among rural 16-18 year olds. The rate of last 30-day use was 7.3%, with over half (3.9%) NMU. Nearly 12% of all youth (whether a user or not) reported lifetime incoming/outgoing diversion of prescription stimulants.

SUMMARY

Because no study has focused on stimulant use among youth as young as 10 and 11, this study is a landmark for future comparisons and offers a unique strategy for sampling and data collection.

HIV and sexually transmissible infections among money boys in China: a data synthesis and meta-analysis

BACKGROUND

Commercial sex workers within the population of men who have sex with men (MSM) in China, known as 'money boys' (MBs), are perceived to be at higher risk for HIV and other sexually-transmissible infections (STIs).

METHODS

We conducted a systematic review and meta-analyses from peer-reviewed literature accessed in two English (PubMed and Embase) and three Chinese databases (CNKI, CQVIP, Wanfang data). A data synthesis exercise was carried out to determine the extent and patterns of behaviours and HIV/STI epidemics. Pooled estimates, with 95% confidence intervals, for each study variable were calculated.

RESULTS

Thirty-two eligible articles (9 in English and 23 in Chinese) were identified. Our analysis indicated that Chinese MBs are generally young, currently employed, at low literacy levels and highly mobile. The prevalence of HIV, syphilis and co-infection among MBs were estimated to be 6.0% (4.2-8.5%), 12.4% (9.9-15.3%) and 2.2% (1.1-4.1%) over the period of 2004-2011. Level of condom use among MBs is generally higher than the broader MSM population (69.2% at last act, and 48.5% consistently over the past 6 months). One-third of the Chinese MBs identified themselves as bisexual and 8.7% (5.6-13.5%) are currently married to a female. Further, 40.9% (34.5-47.7%) of MBs participated in group sex in the past 12 months and 14.8% (10.6-20.3%) concurrently use illicit drugs.

CONCLUSIONS

HIV/STI epidemics have affected Chinese MBs but the evidence suggests that the extent of infections is not greater than among other MSM in China.

Recreational drug use: an emerging concern among venue-based male sex workers in China

A 2009 survey of 418 venue-based male commercial sex workers in Shenzhen, China revealed that 19.9% used recreational drugs. Consistent condom use by drug users was lower than that by nonusers. HIV, syphilis, and herpes simplex virus 2 prevalences were higher among drug users. Prevention programs need to address drug use among male commercial sex workers in China.

Condom use with various types of sex partners by money boys in China

Money boys (MBs) who typically sell sex to males have not yet been extensively studied in China. In this 2009 study, 28 venue-based MBs were interviewed. We analyzed their condom use behaviors with various partners, including male and female clients, male and female casual partners, other MBs and female sex workers, and boyfriends and girlfriends. All participants were aware of the need for using condoms; however, usage with different partner types varied. The longer a relationship with a partner, the less frequent was condom use. A major reason for not using condoms was that they or their partners did not like the loss of sensation due to condom use. Other factors included sexual orientation, age, duration in commercial sex, concerns about HIV/AIDS, attractiveness of partners, and support of "mommies" (brothel supervisors). Both individual- and venue-level interventions are needed to promote condom use, and mommies need to be included in intervention strategies.