Perceptions of HPV, genital warts, and penile/anal cancer and high-risk sexual behaviors among men who have sex with men in Hong Kong

Self-reported changes in sexual behaviors and HIV prevention services utilization among gay, bisexual and other men who have sex with men after entering the post-pandemic era: tales of two Chinese cities with different pathways of "resume normal"

BACKGROUND

Relaxing Coronavirus Disease 2019 (COVID-19) control measures and "resume normal" might have direct impacts on sexual behaviors and utilization of HIV prevention and sexual health services among gay, bisexual and other men who have sex with men (GBMSM). To address the knowledge gaps, this study aimed to compare self-reported changes in sexual risk behaviors and HIV service utilization among GBMSM in the post-pandemic era between Beijing and Hong Kong. In addition, the determinants of self-reported increase in condomless anal sex (CAS) were investigated among GBMSM in Beijing or Hong Kong.

METHODS

This cross-sectional study was conducted between November 2023 and March 2024. Participants were Chinese males aged ≥ 18 years who had anal sex with at least one man in the past six months recruited through multiple sources. Eligible GBMSM completed a telephone interview. A multiple logistic regression model was then fitted.

RESULTS

A total of 524 GBMSM in Beijing and 613 in Hong Kong completed the telephone interview. After adjusting for background characteristics with between-city differences, more GBMSM in Beijing self-reported an increase in the frequency of CAS with men (23.7% versus 7.8%, p < 0.001), anal sex with regular male sex partners (30.5% versus 15.5%, p < 0.001) and non-regular male sex partners (27.5% versus 16.0%, p < 0.001), seeking male partners online (28.8% versus 18.9%, p < 0.001), sexualized drug use (SDU) (9.4% versus 2.3%, p < 0.001), and using HIV testing (31.5% versus 11.7%, p < 0.001), pre-exposure prophylaxis (PrEP) (18.9% versus 3.6%, p < 0.001) and other HIV prevention services (20.2% versus 10.1%, p < 0.001). GBMSM in both cities who self-reported increases in the frequency of anal sex with regular and non-regular male sex partners, having sex with men coming from other cities, seeking male partners online, utilization of SDU, HIV testing, PrEP and other HIV prevention services were more likely to report an increase in CAS.

CONCLUSIONS

More GBMSM in Beijing than their counterparts in Hong Kong reported increases in the frequency of sexual risk behaviors and HIV prevention services utilization when comparing their current situation with the time during COVID-19. Our findings highlighted the importance of strengthening HIV prevention in GBMSM in the post-pandemic era.

Culpability Framing Influences on Community Support for Those Managing Illness: A Multi-Malady Comparison of Mediated Health Stigma

Prior research demonstrates an influence of culpability framing on news consumers' perceptions about, and willingness to provide support for, those managing illness. Framing research of this sort has typically focused on the effect of frames on a particular health context (e.g. cancer). It is necessary to examine how three health frames which are overwhelmingly represented in health news could be uniquely influencing perceptions about those managing illness in a number of disparate health contexts. Specifically, we explore the nature of health frame influence as it relates to news reports regarding alcoholism, morbid obesity, and cancer. These illnesses represent the three of the most prominent health concerns for Americans that also vary in terms of how they relate to four chief cues for stigma communication. Experimental findings reveal unique ways in which culpability framing influences social support dispositions for those managing illness, as a function of intergroup anxiety perceptions.

Human papillomavirus prevalence and genotype distribution in Liaocheng men between 2016 and 2022

Human papillomavirus (HPV) infection can lead to HPV-related cancer in men, including the anus, penile, and oropharyngeal cancers and precancerous lesions. This study retrospectively investigated HPV prevalence and genotype distribution in Liaocheng men between 2016 and 2022. The total HPV positive rate was 64.87% (2388/3681, 95% confidence interval [CI]: 63.32%-66.40%), where high risk (HR)-HPV and low risk (LR)-HPV accounted for 42.49% (1564/3681, 95% CI: 40.90%-44.09%) and 69.71% (2566/3681, 95% CI: 68.20%-71.17%), respectively. The mixed HPV infection rate of two and more genotypes was 35.72%. The infection rate of HR-HPV increased with the number of positive cases annually from 2016 (16.91%) to 2022 (46.59%). The most common HR-HPV genotypes were HPV16 (11.60%), HPV52 (6.95%), and HPV59 (6.28%), whereas the least common HR-HPV was HPV26. The most common LR-HPV genotypes were HPV6 (56.99%), HPV11 (23.79%), and HPV43 (6.37%). The 9 v HPV vaccine preventable for LR-HPV and HR-HPV accounted for 80.78% and 30.40%, respectively, in this study. Most HPV-positive patients aged 1-86 were in the 30-39 age group. This study confirmed that HPV prevalence in Liaocheng men was common and diverse. HPV16, HPV52, and HPV59 are widely distributed in Liaocheng men, and the male HR-HPV infection rate remained high in this region. Regarding public health and cancer prevention, it is recommended and effective to include the HPV vaccination in the national vaccination program for men.

Patterns and Factors of the Sexual Agreement for Extra-Dyadic Sex Among Men Who Have Sex with Men in Hong Kong, China: A Cross-Sectional Survey

This study investigated patterns of sexual agreement for extra-dyadic sex and their associations with sexual risk behaviors among men who have sex with men (MSM) having a regular male sex partner (RP) in China. A cross-sectional telephone survey was conducted among 530 MSM recruited through multiple sources in Hong Kong, China, between April and December 2020. This study was based on a subsample of 368 participants who had an RP in the past 6 months. Logistic regression models were fitted. Among the participants, 27.2%, 13.0%, and 3.0% had a closed agreement, an in-between agreement, and an open agreement, respectively. Compared to no agreement, a closed agreement was associated with fewer extra-dyadic partners and fewer instances of condomless sex with extra-dyadic partners. Those who had more positive attitudes toward a closed agreement, perceived more support from significant others to create a closed agreement, and perceived higher behavioral control of refraining from sex with extra-dyadic partners were more likely to have a closed agreement with RP. Those who were concerned that a closed agreement would impair freedom and sexual desire were less likely to have such an agreement. A closed agreement is a potentially useful risk reduction strategy for Chinese MSM with an RP.

Promoting HPV vaccination among Latinx: an application of the extended parallel processing model

Vaccine hesitancy is a substantial barrier to increasing HPV vaccination rates among Latinx in the US who experience disproportional rates of HPV-related cancers. The current research tests the effectiveness of culturally-targeted, fear-appeal messages designed using the Extended Parallel Processing Model (EPPM). We compared differences among Latinx young adults and parents of adolescents of the effectiveness of messages that highlight HPV-related cancers, genital warts, or a control condition to promote online information seeking about the HPV vaccine-a known precursor to vaccination intention. Results found messages containing EPPM messaging elements produced significantly higher self-reported intention to seek information about HPV vaccines in comparison to a control message group. However, participants who received control messages had the highest percentage of hyperlink clicks to more information about HPV (a novel measure of information seeking). Findings suggest that fear appeals may be effective for promoting information seeking about HPV vaccination, which in turn could increase vaccine utilization, among Latinx participants. Clinical trial registration number (NCT05206669) retrospectively registered January 25, 2022.

Predicting human papillomavirus vaccine uptake in men who have sex with men the influence of vaccine price and receiving an HPV diagnosis

BACKGROUND

To understand how human papillomavirus (HPV) screening results, HPV-related knowledge and attitudes are related to vaccination intention in three cost ranges and the actual vaccination behavior in a community sample of men who have sex with men (MSM).

METHODS

MSM aged 20 years of age or older were recruited between October 2015 and May 2016 from community health centers that provide HIV testing and consultation services in Southern Taiwan and on social media. MSM were seen at baseline and again at 6 months after baseline in a cohort study. The baseline study included 253 individuals; 182 of them returned for the 6th-month follow-up. At each visit, MSM were asked to receive HPV screening and filled out a questionnaire. Structural equation modeling was used to test whether attitudinal factors and HPV screening results from the baseline affect their self-reported actual vaccine uptake at the in 6^th-month follow-up.

RESULTS

Our research included 171 participants from the cohort because they had full information of the study variables (mean ± SD age = 29.21 ± 6.18). Our model showed good model fit using indices such as the comparative fit index (value = 0.998) and root mean square error of approximation (value = 0.013). HPV knowledge can predict those who have intention to take up HPV vaccine no matter what the price (p = .02), and then predict vaccine uptake at the follow-up (p < .001). A positive HPV screening result can predict vaccine uptake at the follow-up (p = .004).

CONCLUSION

Our findings highlight the impact of vaccine price and HPV screening results on the intention and uptake of HPV vaccine. It is important to raise awareness of HPV in male populations. Clinicians and health educators should establish a safe and private environment for male patients for inquiring about HPV vaccine and HPV-related cancers.

Testing Messages on Facebook to Promote Use of an HPV Educational Web-Intervention

In the US, the human papillomavirus (HPV) vaccine remains underutilized leading to disparities in HPV-related diseases. Latinx have some of the highest rates of cancer caused by HPV. In a previous study, we developed a tailored-messaging based online educational intervention (CHICOS) that was found to increase HPV vaccination intention among Latinx participants. The current research uses Facebook Advertising to test the comparative effectiveness of messages designed using the Extended Parallel Processing Model (EPPM) to promote the use of CHICOS among Latinx young adults and parents of adolescents. We also looked at differences in the effectiveness of messages that highlighted HPV-related cancers, genital warts, or a control condition as well as differences in Spanish vs. English messages. Results found Latinx young adults and parents, were more likely to click on Facebook Advertisements containing messages in Spanish and those that mention cancer risks pertinent to this population compared to those in English or messages that discuss genital warts. Thus, findings suggest that Facebook Advertising has the potential to be a useful tool for motivating information seeking online about HPV vaccination.

High Prevalence of Inconsistent Condom Use With Regular Female Sex Partners Among Heterosexual Male Sexually Transmitted Disease Patients in Southern China

This study was to investigate the prevalence of and factors associated with inconsistent condom use with regular female sex partners (RPs) among heterosexual male STD patients (MSTDPs) in China. We interviewed 413 MSTDPs who had had sex with at least one RP and had received a diagnosis within the past week to six months. The prevalence of inconsistent condom use with RPs was 42.9% since STD diagnosis. Associated factors included perceptions related to condom use, regret about the decision of having unprotected sex with RP, and perceived personal partners' responsibility of using condoms.

Prevalence and Factors of Concurrent Multiple Male Sex Partnership Among Men Who Have Sex With Men With Regular Sex Partners in Beijing, China

This study was to test whether the cognitive factors of the theory of planned behavior were associated with concurrent multiple male sex partnership (CMMSP) status (past three months) and intention to have CMMSP (next six months) among 251 men who have male regular sex partners in Beijing, China. The prevalence of having had CMMSP and intention to do so was 48.2% and 28.7%, respectively. Positive attitudes toward CMMSP, injunctive norm for not having CMMSP, and behavioral control for not having CMMSP were significantly associated with behavioral intention. Descriptive norm and perceived behavioral control were significant factors for CMMSP status.

Contemporary perceptions of human papillomavirus and penile cancer: Perspectives from a national survey

INTRODUCTION

We aimed to assess the contemporary knowledge of human papillomavirus (HPV) and its association with penile cancer in a nationwide cohort from the U.S.

METHODS

We used the Health Information National Trends Survey (HINTS), a cross-sectional telephone survey performed in the U.S. initiated by the National Cancer Institute. The most recent iteration, HINTS 4 Cycle 4, was conducted in mail format between August 19 and November 17, 2014. Primary endpoints included knowledge of HPV and its causal relationship to penile cancer. Baseline characteristics included sex, age, education, race and ethnicity, income, residency, personal or family history of cancer, health insurance status, and internet use. Multivariable logistic regression assessed predictors of HPV and penile cancer knowledge.

RESULTS

An unweighted sample of 3376 respondents was extracted from the HINTS 4, Cycle 4. Whereas 64.4% of respondents had heard of HPV, only 29.5% of these were aware that it could cause penile cancer. Men were significantly less likely to have heard of HPV than women (odds ratio [OR] 0.32; 95% confidence interval [CI] 0.24-0.43). Older age; African-American, Asian, and "other race"; being married; from a lower education bracket; having a personal cancer history; and those without internet access were significantly less likely to have heard of HPV. None of our examined variables were independent predictors for the knowledge of the association of penile cancer and HPV.

CONCLUSIONS

Our analysis of a large, nationally representative survey demonstrates that the majority of the American public is familiar with HPV, but lack a meaningful understanding between this virus and penile cancer. Primary care providers and specialists should be encouraged to intensify counselling about this significant association as a primary preventive measure of this potentially fatal disease.

Prevalence of actual uptake and willingness to use pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Hong Kong, China

OBJECTIVES

This study was to investigate the prevalence of actual uptake of pre-exposure prophylaxis (PrEP), willingness to use daily oral PrEP under two cost scenarios, and potential issues related to PrEP use among men who have sex with men (MSM) with HIV negative/unknown sero-status in Hong Kong, China. Factors associated with the two measures of willingness were also investigated.

METHODS

403 eligible MSM completed the anonymous venue-based face-to-face interview/telephone interview.

RESULTS

Only 1% had ever used PrEP. After being briefed about some facts of PrEP, the prevalence of willingness to use daily oral PrEP was 7.7% if they could purchase PrEP at private hospitals/clinics at HK$8,000 (US$1,032)/month (market rate) and 45.2% if free PrEP was provided by public hospitals/clinics in Hong Kong (free PrEP). After adjusted for significant background variables, significant factors of these two measures of willingness included: (1) number of correct responses to knowledge on PrEP, (2) perceived risk of HIV infection in the next six months, and (3) constructs of the Theory of Planned Behavior: positive and negative attitudes toward PrEP, perceived their significant others would support them take PrEP (perceived subjective norm), perceived number of local MSM who were willing to take PrEP (perceived descriptive norm), and confidence in using PrEP under the two scenarios (perceived behavioral control). Among all participants, 9.7% and 25.1% would start and discontinue using PrEP without consulting doctors; 26.0% would not take PrEP daily if it was provided for free, and 42.4% would not take up HIV testing every 3 months after using PrEP.

CONCLUSION

Different strategies should be considered for promoting PrEP at market rate and if free PrEP is made available. Future promotion should increase their knowledge about PrEP, modify their perceptions related to HIV and PrEP, and address some potential issues related to PrEP use.

A Randomized Controlled Trial Evaluating Efficacy of Promoting a Home-Based HIV Self-Testing with Online Counseling on Increasing HIV Testing Among Men Who Have Sex with Men

We developed an innovative home-based HIV self-testing (HIVST) service that included mailing of a free HIVST kit, and providing online real-time instructions and pre-test/post-test counseling (HIVST-OIC). The present parallel-group and non-blinded randomized controlled trial was conducted to evaluate the efficacy of promoting HIVST-OIC in increasing HIV testing rate among 430 men who have sex with men (MSM), with access to online live-chat applications in Hong Kong. At month 6, as compared to the control group, the intervention group reported significantly higher prevalence of HIV testing of any type (89.8 vs. 50.7%; relative risk (RR): 1.77; p < 0.001). Among those who have taken up any HIV testing in the last six months, significant between-group difference was found in multiple male sex partnerships (34.2 vs. 47.7%, RR: 0.72; p = 0.021). HIVST-OIC has a strong potential in increasing prevalence of HIV testing and reducing sexual risk behaviors. Implementation research is warranted.

Experience and psychological impact of anal cancer screening in gay, bisexual and other men who have sex with men: a qualitative study

OBJECTIVE

Human papillomavirus-related anal cancer rates are increasing and are particularly high in gay, bisexual and other men who have sex with men (GBM/MSM), especially HIV-positive individuals. Although screening programs for high-risk populations have been advocated, concerns about possible adverse psychological consequences exist. This study aimed to investigate GBM/MSM's experience, understanding and emotional response to screening techniques for anal cancer to determine how best to minimise psychological distress in future programs.

METHODS

In-depth qualitative face-to-face interviews were conducted with 21 GBM/MSM participating in the "Study of the Prevention of Anal Cancer" in Sydney, Australia, between June 2013 and June 2014. Nonrandom, purposive sampling was used to ensure heterogeneity with respect to HIV status and screening test results. Framework analysis method was used to organise the data and identify emerging themes.

RESULTS

Knowledge about anal cancer, human papillomavirus and the link between them was limited. Abnormal screening results affected participants' sense of well-being and were associated with anxiety and concern about developing anal cancer. HIV-negative men receiving abnormal results showed higher levels of distress compared to their HIV-positive counterparts. Consultations with general practitioners about abnormal results had an important role in increasing participants' understanding and in moderating their anxiety.

CONCLUSION

Anal cancer screening should be accompanied by health education around anal cancer, its aetiology and the meaning of associated test results. Simple and effective communication strategies should be encouraged. Collaboration with general practitioners could assist the process of education and reporting test results.

Prevalence of and factors associated with unprotected anal intercourse with regular and nonregular male sexual partners among newly diagnosed HIV-positive men who have sex with men in China

OBJECTIVES

This study investigated the prevalence of, and multi-dimensional factors associated with, unprotected anal intercourse (UAI) with regular male sexual partners ('regular partners') and nonregular male sexual partners ('nonregular partners') among newly diagnosed HIV-positive men who have sex with men (MSM) in Chengdu, China.

METHODS

A total of 225 newly diagnosed HIV-positive MSM were interviewed using a combined interviewer-computer-assisted method in Chengdu, China.

RESULTS

The prevalence of UAI with regular and nonregular partners since diagnosis was 27.7% and 33.8% among participants reporting having sex with regular and nonregular partners (n = 159 and 133), respectively. Adjusted analysis showed that: (1) cognitive variables based on the Health Belief Model (perceived susceptibility to HIV transmission and perceived severity of the consequences of HIV transmission, perceived barriers and perceived self-efficacy related to consistent condom use), (2) emotion-related variables (worry about transmitting HIV to others), (3) psychological factors (post-traumatic growth) and (4) socio-structural factors (perceived partners' responsibility for condom use) were significantly associated with UAI with regular and/or nonregular partners.

CONCLUSIONS

Interventions are warranted, and should be designed with consideration of multi-dimensional factors and be partner type-specific.

A Randomized Control Trial for Evaluating Efficacies of Two Online Cognitive Interventions With and Without Fear-Appeal Imagery Approaches in Preventing Unprotected Anal Sex Among Chinese Men Who Have Sex with Men

Fear appeal approach has been used in health promotion, but its effectiveness has been mixed. It has not been well applied to HIV prevention among men who have sex with men (MSM). The present study developed and evaluated the relative efficacy of three online interventions (SC: STD-related cognitive approach, SCFI: STD-related cognitive plus fear appeal imagery approach, Control: HIV-related information based approach) in reducing prevalence of unprotected anal intercourse (UAI) among 396 MSM using a randomized controlled trial design. Participants' levels of fear-related emotions immediately after watching the assigned intervention materials were also assessed. Participants were evaluated at baseline and 3 months after the intervention. Results showed that participants in the SCFI scored significantly higher in the instrument assessing fear after the watching the intervention materials. However, no statistically significant differences were found across the three groups in terms of UAI at Month 3. Some significant within-group reductions in some measures of UAI were found in three groups. Further studies are warranted to test the role of fear appeal in HIV prevention.

Prevalence and associated factors of condomless receptive anal intercourse with male clients among transgender women sex workers in Shenyang, China

Introduction

Globally, transgender women sex workers have a high prevalence of HIV and condomless receptive anal intercourse with male clients (CRAIMC). We investigated the prevalence of CRAIMC and factors associated with CRAIMC among transgender women sex workers in China.

Methods

In 2014, we anonymously interviewed 220 transgender women sex workers face to face in Shenyang, China. Those who self-reported as HIV negative or as having unknown HIV serostatus were invited to take up free, anonymous HIV rapid testing (n=183); 90 did so. Using CRAIMC in the last month as the dependent variable, three types of associated factors were investigated, in addition to background factors: feminizing medical interventions, sex work and perceptions related to condom use. Univariate and multiple logistic regression models were fitted.

Results

Of the participants, 16.8% self-reported as HIV positive and 9.1% were detected to be HIV positive through free HIV testing; 26.8% had had CRAIMC in the last month, 45.5% had performed sex work in other Chinese cities (last year), and 23.2% had had condomless anal intercourse with men who were non-clients. In the adjusted analysis, significant factors associated with CRAIMC (last month) included the following: 1) any feminizing medical intervention performed (adjusted odds ratio, AOR: 2.22); 2) sex-work-related factors, including recruitment of male clients most often at hotels (AOR: 5.02) and charge per episode of transactional sex (201 to 400 RMB, AOR: 0.27; reference group: ≤100 RMB); and 3) perceptions related to condom use, including perceived transgender identity's impact on condomless sex such as wearing feminine attire, concern about exposing their status as a transgender woman to male clients (AOR: 1.20) and perceived self-efficacy of consistent condom use with male clients (AOR: 0.56). Perceived self-efficacy of consistent condom use with male clients fully mediated the association between perceived transgender identity's impact on condomless sex and CRAIMC.

Conclusions

HIV prevalence among transgender women sex workers was high but probably underestimated. The high prevalence of condomless anal intercourse with male non-clients and high mobility in sex work among this population in China are causes for concern. Risk factors for CRAIMC were multidimensional and should be considered when designing interventions targeting transgender women sex workers. Such interventions are urgently needed.

Acceptability of Voluntary Medical Male Circumcision (VMMC) among Male Sexually Transmitted Diseases Patients (MSTDP) in China

Voluntary Medical Male circumcision (VMMC) is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP) who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42) of them were circumcised at the time of survey. When the uncircumcised participants (n = 308) were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1) emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06–1.18), 2) cognitive variables derived from Health Belief Model (HBM): perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15–5.33) (perceived susceptibility), perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02–1.10), perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16–1.42) and sexual performance (AOR = 1.45, 95%CI: 1.26–1.71), perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81–0.95), and perceived cue to action (AOR = 1.41, 95%CI: 1.23–1.61) and self-efficacy (AOR = 1.38, 95%CI: 1.26–1.35) related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the important findings of this study into account.

Awareness and acceptance of human papillomavirus (HPV) vaccination among males attending a major sexual health clinic in Wuxi, China: A cross-sectional study

OBJECTIVE

To study the awareness and acceptance of human papillomavirus (HPV) vaccination among sexually active men having sex with men (MSM) and men not having sex with men (MNSM) attending the largest sexual health clinic in Wuxi, China.

METHODS

A questionnaire about participants' socio-demographic characteristics and view on HPV vaccination was collected.

RESULTS

A total of 186 MSM and 182 MNSM were recruited. Among MSM, 12.4% were under 20 years old, 64.5% never married and 56.5% from Jiangsu Province (where Wuxi City is located); 64.0% had resided in Wuxi for over 2 years, 64.5% had high school education or more, and 83.9% had an income of 5000 RMB or less per month compared to figures of 5.5%, 50.6%, 73.6%, 54.9%, 86.8% and 64.8% among MNSM, respectively (All P values < 0.05). Among these 2 groups of men, 18.4% and 23.1% had heard of HPV; 10.2% and 15.4% had heard of HPV vaccine; and 26.2% and 20.2% would take HPV vaccine before sexual debut, respectively. MNSM were significantly more willing to take HPV vaccine than MSM (70.9 vs 34.9%, p < 0.001). Factors associated with HPV vaccine acceptance among MSM included engaging mostly in receptive anal sex (Odds ratio (OR)=3.9, 95% Confidence interval (CI): 1.8-13.5), never using a condom in anal sex in the past 6 months (3.5, 1.5-20.2), ever diagnosed with a sexually transmitted infection (STI) (3.4, 1.3-8.4) and ever receiving HIV related services (1.6, 1.1-4.4). Among MNSM these Factors included commercial sex with women (1.7, 1.2-8.6), never using a condom in commercial sex (1.6, 1.4-7.6) and STI diagnosis (2.0, 1.6-7.3).

CONCLUSIONS

Sexually active MSM and MNSM in Wuxi lacked knowledge of HPV and HPV vaccination. The majority of these at-risk men would not benefit from HPV vaccination as their age at first sex proceeded perceived age of vaccine uptake. Aggressive education aimed at increasing knowledge of HPV and HPV vaccination among these men is warranted.

High Prevalence and Genotype Diversity of Anal HPV Infection among MSM in Northern Thailand

BACKGROUND

HPV infection is common and may cause cancer among men who have sex with men (MSM). Anal HPV infection (HPV+) was found in 85% of HIV-positive (HIV+) and 59% of HIV-negative (HIV-) MSM in Bangkok, central Thailand. As little is known about HPV in this group in northern Thailand, we studied MSM subgroups comprised of gay men (GM), bisexual men (BM), and transgender women (TGW).

METHODS

From July 2012 through January 2013, 85 (42.5% of 200) GM, 30 (15%) BM, and 85 (42.5%) TGW who practiced receptive anal intercourse were recruited after informed consent, followed by self-assisted computer interview, HIV testing, and anal swabs for HPV genotyping.

RESULTS

Of 197 adequate specimens, the overall prevalence of any HPV was 157 (80%). Prevalence was 89% (76/85) in GM, 48% (14/29) in BM, and 81% (67/83) in TGW. The most common high-risk types were HPV16 (27% of 197), HPV58 (23%), and HPV51 (18%). Prevalence of high-risk types was 74% in 85 GM, 35% in 29 BM, and 71% in 83 TGW. Prevalence of any HPV type, or high-risk type, was 100% and 94%, respectively, among 48 HIV+ MSM, 70% and 54% among 120 HIV- MSM. Of the 197 specimens, 36% (70) had HPV types 16 and/or 18 in the bivalent vaccine, compared to 48% (95) with ≥1 of types 16/18/06/11 in the quadrivalent, 56% (111) for 16/18/31/33/45/52/58 in the 7-valent, and 64% (126) for 16/18/31/33/45/52/58/06/11 in the 9-valent. HIV+, GM, and TGW were independently associated with HPV infection.

CONCLUSIONS

We found higher rates of both any HPV and high-risk types than previous studies. Among the heretofore unstudied TGW, their equivalent HPV rates were comparable to GM. Current and investigational HPV vaccines could substantially protect GM, BM, and TGW from the serious consequences of HPV infection especially among HIV + MSM.

Prevalence and associated factors of inhaled nitrites use among men who have sex with men in Beijing, China

BACKGROUND

Inhaled nitrites are commonly used by men who have sex with men (MSM) in western countries. As such compounds are not illicit, they are widely available in China. Recent studies have documented a high prevalence of inhaled nitrites use in this population.

METHODS

Snowball sampling was used to recruit 576 MSM in Beijing, China, who completed an anonymous face-to-face interview.

RESULTS

Of the participants, 49.8% had heard of "Rush" or "inhaled nitrites". The prevalence of use in the last three months was 28.3% among all participants and 56.8% among those with awareness about the compounds. A stepwise model found that age group (26-35 years old, ORm= 3.91; ≤ 25 years old, ORm = 3.05; reference group: >35 years old, P < 0.01) and multiple male sex partnerships (ORm = 2.29, P < 0.01) were associated with inhaled nitrites use. Adjusted for these two variables, constructs based on the Health Belief Model (HBM) were significantly associated with inhaled nitrites use in the last three months: Perceived Severity Scale [Adjusted Odds Ratios (AOR) = 0.72, P < 0.001], the Perceived Benefit Scale (AOR = 1.20, P < 0.001), the Perceived Barrier Scale (AOR = 0.81, P < 0.01), the Cue to Action Scale (AOR = 1.45, P < 0.001), and the Perceived Self-efficacy Scale (AOR = 0.71, P < 0.001).

CONCLUSIONS

The prevalence of inhaled nitrites use was high. It may further increase sharply among MSM in China when awareness becomes more common. Cognitive variables derived from the HBM provided a useful framework for designing interventions at structural, inter-personal and individual levels. Policy changes should also be considered.

Perceived empathy of service providers mediates the association between perceived discrimination and behavioral intention to take up HIV antibody testing again among men who have sex with men

HIV antibody testing is a key measure of HIV prevention for men who have sex with men (MSM). The World Health Organization recommends sexually active and at-risk MSM to take up HIV antibody testing regularly. This study aimed to investigate the prevalence of behavioral intention to take up HIV antibody testing in the next six months among Hong Kong MSM who were ever-testers. An anonymous cross-sectional survey recruited 326 MSM who had taken up HIV antibody testing from gay-friendly venues and internet in Hong Kong. Of the participants, 40.8% had had unprotected anal intercourse with regular or non-regular male sex partners in the last six months; they were at risk of HIV transmission despite experience in HIV antibody testing. Only 37.2% showed a strong intention to take up HIV antibody testing again in the next six months. Adjusted analysis showed that both perceived discrimination toward Hong Kong MSM (AOR = .60, 95% CI: .36–.98) and the CARE Measure assessing perceived empathy of service providers (AOR = 1.05, 95% CI: 1.02–1.08) were significantly associated with intention for retesting. Perceived discrimination, however, became statistically non-significant (AOR = .68, 95% CI: .41–1.14), when both CARE Measure and perceived discrimination entered into the adjusted model. It is warranted to increase HIV retesting rate by removing perceived discrimination and reducing the negative effect of perceived discrimination through enhancement of empathy of service providers.

Associations between cognitive, sociocontextual, and affective variables and unprotected anal intercourse among men who have sex with men--a comparative study conducted in two Chinese cities

Few studies compared HIV-related risk behaviors between cities with different sociocultural environments among men who have sex with men (MSM). This study investigated the prevalence of unprotected anal intercourse (UAI) and associated individual and socio-cultural factors among Chinese MSM in Hong Kong and Shenzhen in Mainland China, which were proximal to each other but experienced different socioeconomic developments. Amongst all the 535 participants, 40.2% had had UAI. Significant factors of UAI among Shenzhen MSM included being able to find someone to share one's sexual orientation, disclosure of sexual orientation to family members, HIV risk perception, and use of alcohol or substances (adjusted OR ranged from 2.37 to 4.91), whilst disclosure of sexual orientation to family members was the only significant factor among Hong Kong MSM (adjusted OR = 1.64). Geographic variations in factors associated with UAI were observed. Future research and interventions need to take this into account.