Incidence and correlates of HIV and syphilis in a prospective cohort of men who have sex with men in Mianyang, China, over a 36-month period

Incidence of HIV infection and associated factors among men who have sex with men in Zhejiang, China: a cohort study

Aim

Men who have sex with men (MSM) contribute increasingly to the burden of HIV infection due to their high-risk sexual behaviors; however, studies focusing on the sexual behaviors among student MSM population remain limited. This study aims to investigate the incidence of HIV infection among MSM, while exploring high-risk sexual behavior in student MSM in Zhejiang province, China.

Method

Prospective cohort study was conducted among MSM population in four cities in Zhejiang province. Information including socio-demographic characteristics as well as sexual behaviors were collected at baseline. Follow-up surveys and testing for HIV infection were conducted every 3 months. Univariable and multivariable logistic regression were performed to assess risk factors for HIV infection, investigate the sexual behavior differences between student and non-student MSM groups. Cox regression analyses were employed to discover potential association among various risk factors.

Result

2081 HIV-negative MSM were enrolled in our cohort and 36 participants were infected with HIV. The incidence density of HIV infection was 2.15 per 100 person-years among this population. Student MSM are more likely to take sexual role of versatile (OR: 1.56, 95% CI: 1.05-2.32, p = 0.029) and receptive only (OR: 2.65, 95% CI: 1.62-4.08, p < 0.001) during anal intercourse, with a lower rate of previous HIV testing (OR: 0.45, 95% CI: 0.31-0.66, p < 0.001). Cox regression discovered that MSM who had more than 6 partners in anal sexual intercourse were more likely to obtain HIV-seroconversion than who had one fixed partner (HR: 5.14, 95% CI: 1.67-10.59, p < 0.001), participants who sometimes use condoms (HR: 4.11, 95% CI: 1.28-13.16, p = 0.017) and never use condoms (HR: 2.57, 95% CI: 1.16-5.66, p = 0.020) were more vulnerable to be infected by HIV compared to those use condoms constantly. Versatile (HR: 5.30, 95% CI: 1.65-17.06, p = 0.005) and receptive only role (HR: 3.23, 95% CI: 1.05-9.96, p = 0.042) in anal intercourse were more likely to be infected by HIV than insertive only.

Conclusion

High-risk behaviors, particularly inconsistent condom uses during anal sex, significantly increase the risk of HIV infection. Student MSM exhibited persistent high-risk behaviors and low HIV testing rates. Greater attention and tailored interventions are needed to promote safer sexual practices and reduce HIV transmission in this population.

HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

The goal to effectively prevent new HIV infections among gay, bisexual, and other men who have sex with men (MSM) is more challenging now than ever before. Despite declines in the late 1990s and early 2000s, HIV incidence among MSM is now increasing in many low- and high-income settings including the US, with young, adolescent, and racial/ethnic minority MSM being among those at highest risk. Potentiating HIV risks across all settings are individual-, network-, and structural-level factors such as stigma and lack of access to pre-exposure prophylaxis (PrEP) and antiretroviral treatment as prevention. To make a sustained impact on the epidemic, a concerted effort must integrate all evidence-based interventions that will most proximally decrease HIV acquisition and transmission risks, together with structural interventions that will support improved coverage and retention in care. Universal HIV treatment, increased access to HIV testing, and daily oral PrEP have emerged as integral to the prevention of HIV transmission, and such efforts should be immediately expanded for MSM and other populations disproportionately affected by HIV. Respect for human rights and efforts to combat stigma and improve access to prevention services are needed to change the trajectory of the HIV pandemic among MSM.

Relationship between self-efficacy and HIV testing uptake among young men who have sex with men in Myanmar: a cross-sectional analysis

Men who have sex with men (MSM) are disproportionally affected by the HIV epidemic. Self-efficacy is an important individual psychosocial factor associated with access to and use of health and HIV-related services. We estimated HIV testing prevalence and examined the relationship between HIV testing self-efficacy and self-reported HIV testing behavior among young MSM (YMSM) in Myanmar. We enrolled 585 MSM aged 18–24 years from six urban areas using respondent-driven sampling (RDS) technique. RDS analyses were performed to provide estimates for the key outcome of interest. More than a third (34.5%) had never been tested for HIV, whereas 27.5% and 38.0% had their most recent HIV test more than three months and within the past three months from the time of interview, respectively. Young MSM who reported high self-efficacy (adjusted relative risk ratio [ARR]=7.35, 95%CI = 2.29–23.5) and moderate self-efficacy (ARR = 8.61, 95%CI = 3.09–24.0) were more likely to report having tested for HIV in the past three months compared to their counterparts who reported low self-efficacy. Findings highlight a positive association between self-efficacy and HIV testing uptake, indicating a potential causal relationship. Further research is needed to examine the direction of this association and inform future public health interventions targeting YMSM in Myanmar.

The global response to HIV in men who have sex with men

Gay, bisexual, and other men who have sex with men (MSM) continue to have disproportionately high burdens of HIV infection in countries of low, middle, and high income in 2016. 4 years after publication of a Lancet Series on MSM and HIV, progress on reducing HIV incidence, expanding sustained access to treatment, and realising human rights gains for MSM remains markedly uneven and fraught with challenges. Incidence densities in MSM are unacceptably high in countries as diverse as China, Kenya, Thailand, the UK, and the USA, with substantial disparities observed in specific communities of MSM including young and minority populations. Although some settings have achieved sufficient coverage of treatment, pre-exposure prophylaxis (PrEP), and human rights protections for sexual and gender minorities to change the trajectory of the HIV epidemic in MSM, these are exceptions. The roll-out of PrEP has been notably slow and coverage nowhere near what will be required for full use of this new preventive approach. Despite progress on issues such as marriage equality and decriminalisation of same-sex behaviour in some countries, there has been a marked increase in anti-gay legislation in many countries, including Nigeria, Russia, and The Gambia. The global epidemic of HIV in MSM is ongoing, and global efforts to address it remain insufficient. This must change if we are ever to truly achieve an AIDS-free generation.