Risk Factors for HIV/Syphilis Infection and Male Circumcision Practices and Preferences among Men Who Have Sex with Men in China

Risk Factors for HIV/Syphilis Infection and Male Circumcision Practices and Preferences among Men Who Have Sex with Men in China

Infection with Kaposi sarcoma-associated herpesvirus (KSHV; also called human herpesvirus-8) is common among men who have sex with men (MSM). This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 5.Rectal gonorrhoea culture test and chlamydia PRC in men who has anal sex. Along with HIV status, these results were compared with K8.1 and ORF73 ELISA, PCR virus detection, and additional LIPS testing. Methods. Preventive interventions should focus on increasing HIV and syphilis testing, and increasing promotion of condom awareness and use. Sille on luonteenomaista tulehdus ja nivelten rustojen tuhoutuminen, ja se aiheuttaa usein epämuodostumista sormissa.

In this study, combined rates of bacterial STI in MSM were high; a regular assessment of sexual health would allow those at risk of STI to be offered testing, treatment and partner management. Men who have sex with men (MSM) continue to comprise the greatest number of HIV infections in the U.S. The findings are presented in a narrative format. We herein report a HIV-negative MSM with KS who does not match with these 4 clinical subgroups. Nearly a fifth (18.0%) of participants were circumcised. More than half of uncircumcised participants expressed willingness to be circumcised. Human herpes virus 8 (HHV-8) was first described in 1994 [1], and subsequently identified as the underlying infectious cause of Kaposi sarcoma (KS) [2-5], therefore also called Kaposi sarcoma-associated herpes virus (KSHV).

Prior research with this sample of Indian MSM found high rates of alcohol use and unsafe sexual behaviours.24 As a follow-up to this research, the present paper examines the correlates of alcohol use and concomitant sexual risk among that MSM sample, filling an important gap in current research with Indian MSM. The frequency of unprotected receptive anal intercourse and multiple male sexual partnerships highlight the urgency for an effective comprehensive HIV prevention strategy. These partnerships were identified through contact tracing of individuals newly diagnosed with HIV infection. Since reports of the HIV virus began to emerge in the United States in the 1980s, the HIV epidemic has frequently been linked to men who have sex with men (MSM) [1]. Sexual transmission among MSM accounts for the majority of prevalent AIDS cases in Western Europe, United States, Canada, Australia, and New Zealand. In Africa, Asia, and Latin America, the prevalence of HIV infection has increased rapidly in recent years [2]. measure of preference for connections to one’s own group) were computed using RDSAT ver.

61/257,751 filed Nov. A large national survey of 47,231 MSM in China indicated HIV and syphilis prevalence rates of 4.9% and 11.8% in 2008, respectively [6]. Data consistently indicated unprotected male-to-male sexual contact has become one of the major transmission routes for HIV in China [7]. Chengdu is one of the large metropolitan cities in Southwest China. There are estimated 71,000 MSM among its 4.5 million residents in 2007, among whom at least 10,000 are active members of the homosexual social network [8]. HIV/AIDS surveillance indicates that HIV prevalence increased rapidly from 1.06% (2/189) in 2004 [9] to 11.2% (51/456) in 2008 [10], a rate that is twice as high as the national average HIV prevalence among MSM [6]. Antiretroviral treatment and treatment of sexually transmitted infections (STIs) have been approved as effective prevention approaches for HIV, and increasingly promoted as a means of reducing HIV transmission among MSM [11–15].

There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men. Three randomized clinical trials demonstrated that male circumcision (MC) reduced HIV acquisition risk among heterosexual men by approximately 60% [16–18]. The World Health Organization (WHO) and UNAIDS recommend male circumcision as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men. Several studies of MSM who predominantly practice insertive anal intercourse (IAI) suggest some protective effect of male circumcision, as reported in Peru [19] South Africa [20], and Australia [21]. The small sample size of some subgroups/categories of MSWs may affect the statistical power of estimates and hence there is a need to interpret the data with caution. In addition, African data may not be readily generalizable to MSM [22] and the potential efficacy of circumcision in reducing HIV infection among MSM is still unclear [23, 24]. In China, MC is not commonly practiced; while the prevalence of MC worldwide is almost 30%, it is only 5% among Chinese males [25].

1–4 years) in HIV positive subjects who later seroconvert to HHV-8.11, 20, 22 Alternatively, these subjects could have had false negative HHV-8 serology results reflecting a low sensitivity of the IFA or a poor antibody response in immunocompromised patients (CD4 count ranged from 1 to 1341 cells/μl, median 63 cells/μl). There is no data available on MSM male circumcision in Sichuan. Risk factors for KSHV acquisitionwere assessed by univariate and multivariate logistic regression. A cross-sectional survey was conducted in Chengdu from June to September 2009. MSM eligible for the study included men 18–69 years of age who reported engaging in sex with men in the previous year. Stratified-snowball sampling was used to recruit participants from the Chengdu MSM community [6]. A formative assessment was conducted to determine the sizes of the MSM populations who most often seek sex partners at social venues including bars, tea houses, dance halls, public bathhouses/saunas, parks, public restrooms, and internet sites.

Each venue represented a stratum of MSM to be surveyed. Studies were considered to be of high validity if they met the following criteria: (1) reported both HIV and syphilis infection; (2) used two or more recruitment methods; (3) sample size larger than 500; (4) published in English. Our study recruited 18 seeds and each one was given an unlimited number of referral coupons to recruit other subgroup members. These individuals in turn were asked to provide information on other subgroup members. Recruitment ceased when the required sample size was reached [26]. Participants who tested HBsAg positive and anti-HBc negative were considered HBV infected. HTLV-1 on retrovirus, josta on keskusteltu yllämainitussa kirjassa sivulla 262.

Study clinicians assessed 698 patients for eligibility (). The study included 8 steps, namely, participant identification, obtaining informed consent, pretest counseling, blood collection, questionnaire administration, genital exam, HIV and Syphilis rapid testing, and posttest counseling. The scale consists of 11 items. All participants completed the written questionnaire via a face-to-face interview. The information collected in the questionnaire included demographic characteristics; HIV knowledge and attitudes; sexual history with other men and women, including unprotected anal intercourse, commercial sex; self-reported STD infection history, circumcision history, and history of receipt of HIV prevention services. A blood sample (approximately 8 mL) was collected from each individual and tested immediately on-site for HIV and current, active syphilis infection (not lifetime exposure). The primary objective is to describe the prevalence of HHV-8 in children and adults stratified by geographical region, age, gender, ethnicity, HIV status, sexual orientation, and calendar year.

First, as a cross-sectional study, inferences about causality cannot be made. Counseling was conducted in an individual setting to assure client’s privacy and confidentiality. Alternatively, the correlation might be due to a factor which increases both CMV shedding and HIV viral load. Pretest counseling lasted about 10 minutes. During the postcounseling, consultants provided test results, counseled on HIV prevention and HIV/STD risk reduction and provided appropriate referrals and take home information. Participants who tested positive were referred to the peer support project. Posttest counseling also gave participants sufficient time to react and to obtain emotional support, so it took about 15 minutes on average.

[0025] Further disclosed are methods of inhibiting microbial activity. A genital examination was conducted as well. HIV prevalence was calculated by dividing the sum of all confirmed cases by all participants. In addition, the prevalence of circumcision, willingness to be circumcised, and the relationship between MC and HIV infection were analyzed. Univariate and multivariate logistic regressions analyses were used to assess the association between risk factors and HIV infection. Variables significant at a level of 0.2 in univariate logistic regression analyses were fitted into multivariate models. Multivariate logistic regression models were constructed to identify independent risk factors for HIV infection, while controlling for potential confounding factors.

Risk Factors for HIV/Syphilis Infection and Male Circumcision Practices and Preferences among Men Who Have Sex with Men in China
Missing values were treated as separate categories for clarity but otherwise received no special treatment. All regression models were run using complete cases. All statistical analyses were performed using SAS v9.2 for Windows (SAS Institute, Cary, NC). This study was reviewed and approved by the Institutional Review Board of the National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention. Subjects provided signed informed consent and were assigned unique identification numbers so that anonymity could be maintained yet double testing prevented. A total of 570 eligible participants completed the survey. Two participants declined to participate in the study.

The age of participants ranged from 18 to 69 years with median age of 26.5 years. Approximately 40% of participants were under 25 years of age. Although the KSHV incidence rate in this cohort was similar to that reported from other cohorts of MSM [8, 9], the absolute number of seroconverters was small. Approximately 46% were registered as Chengdu residents and nearly two-thirds (65.3%) self-identified as homosexual. Less than 30% (161/570) of respondents self-identified as bisexual, 5% did not state their sexual orientation or “did not know”, and 1% self-identified as heterosexual. The most common venues to find male sexual partners included the internet (59.1%), bars (18.2%), public bathhouses (10.5%), peer referral (6.7%), and parks or public restrooms (5.4%). The age of sexual debut with a man ranged from 11 to 63 years with a median of 20 years.

In terms of MSM anal sex, 34.2% of participants exclusively engaged in insertive anal intercourse (IAI), 25.3% predominantly (>50%) engaged in insertive anal intercourse, 20.7% exclusively engaged in receptive anal intercourse (RAI), and 19.4% predominantly engaged in receptive anal intercourse. Several limitations of our analyses must be kept in mind. The rate of consistent condom use (always used condoms when having sex) varied by type of sexual partners; 50.0% condom use while selling sex to male partners and 34.4% while having sex with a female partner. About two-thirds of respondents used a condom in the last anal sex whereas 223 participants (43.0%) admitted to engaging in unprotect RAI. HIV prevalence in the study population was 13.3% and syphilis prevalence was 15.9%. Syphilis-positive MSM had the highest HIV prevalence (37.8%) (Table 1). Mahdollisesti biomarker mittasi jotakin, joka liittyi HTLV-1-virukseen, joka on yhä läsnä, mutta ei myötävaikuttavana tulehdukseen.

Opinions about the role of the STI clinic in offering regular STI testing differed between groups, however. Multivariable logistic regression analysis suggested that a positive syphilis result, (AOR = 6.9; 95%CI: 3.5–13.5), having more male sex partners (AOR = 6.2; 95%CI = 2.0–19.1), predominantly engaging in receptive anal intercourse (AOR = 2.9; 95%CI: 1.2–6.9), and exclusively engaging in receptive male sex (AOR = 3.9; 95%CI: 1.6–9.3), was independently associated with HIV infection. Two reviews on hepatitis B and C viruses (HBV and HCV) in Europe presented disaggregated data for MSM [30, 31]. In the entire group of MSM, circumcision was not associated with HIV, but the prevalence of syphilis was significantly lower among men who were circumcised than those who were uncircumcised (7.6% versus 17.5% resp., ). These findings stayed the same after stratifying by participants’ sexual role (IAI or RAI) in the past six months (Table 4). Nearly a fifth of respondents (18.2%) reported having been circumcised, which was confirmed by clinical examination. For the primary objective (prevalence of HHV-8) we aim to pool data on HHV-8 prevalence using a fully bayesian approach for meta-analysis with random effects at the study level [48].

Reasons provided by circumcised MSM for the circumcision included a redundant foreskin (58.7%); 13.2% prevention of HIV and STIs (13.2%); personal hygiene (8.8%); to enhance sexual pleasure (5.9%) and cosmetic reasons to improve one’s physical appearance (4.4%). The clinical examination indicated that more than half (53.2%) of individuals had foreskin problems, such as phimosis (1.1%), redundant foreskin (28.8%), and paraphimosis (11.6%). Among 504 uncircumcised men, 56.9% reported that they were willing to be circumcised; 30.4% were absolutely not willing to undergo circumcision, and 12.7% were not sure. For those participants who would accept male circumcision, the main reasons included prevention of HIV and STDs (49.0%), redundant foreskin (48.3%), enhance sexual pleasure (20.3%), getting free male circumcision medical services (16.8%), penile hygiene (9.8%), cosmetic reasons (7.7%), and peer influence (2.8%). The reasons of not accepting MC included no redundant foreskin problem (55.3%), inconvenient (12.1%), useless (8.8%), surgical complication (7.4%), and doubts about the effectiveness of MC as a HIV/STI prevention method (7.0%). This study revealed an alarming prevalence of HIV among MSM in Chengdu, substantially higher than that among other vulnerable groups, for example, injection drug users (3.9%) and female sex workers (0.8%) in Chengdu [27] and higher than the overall prevalence among MSM in a large national survey across 61 cities [6]. The HIV prevalence in this study is similar to that reported from South and Southeast Asia (range: 14% to 18%) [28].

coli, enteroinvasive E. A significant epidemiological change is that unprotected male-to-male sex replaced IDU as the predominant mode of transmission for HIV in this large metropolitan city. Our finding underscores the urgent need to strategically target intervention prevention efforts toward MSMs. STIs have been associated with biological risk for HIV infection in MSM, notably syphilis and infection with herpes simplex virus type 2, and more recently anal infection with human papillomavirus [30]. High rates of undiagnosed and untreated syphilis are associated with the substantially higher rates of HIV infection [31]. In our study, syphilis prevalence is 15.9%, which was higher than that of the national survey [6]. After controlling for other risk factors, participants who were infected with syphilis were six times more likely to be infected by HIV.

The finding of this study highlighted the needs for the treatment of STIs as one of the components of a comprehensive HIV prevention strategy. The disproportionate HIV disease burden in MSM is explained largely by the high per-act and per-partner transmission probability of HIV transmission in receptive anal sex [28]. This study also shows that multiple male sex partners and receptive anal intercourse are associated with HIV infection. The participants in this study had an average of two male partners in the preceding 6 months. Of great concern, more than 5% of respondents reported having had at least ten male partners in the same time period. Besides, about two-thirds of participants engaged in IAI and 65.4% did not use condoms consistently. The finding of common unprotected receptive anal intercourse and multiple sex partners portend the high risk of continuous rapid expansion of the HIV epidemic among the MSM community in Chengdu.

In our study, the coverage of a single intervention was about 28% to 58%, which were much less than 60–80% needed to have an effect on the HIV epidemic [32]. Multiple logistic regression result showed that those who received the peer education in the last year had lower chances to infect HIV. The significant relationship between peer education and HIV intervention may be contributed to the relative high coverage of peer education service. This finding underscored the need for scaling up the intervention effort. The study was the first in Sichuan to assess the frequency of male circumcision and its association with HIV infection among MSM. One-fifth of participants reported having been circumcised, which was similar to the finding in Beijing, China [33] and much lower than the male circumcision prevalence (79%) in US [34]. When comparing self-reported and genital examination, the study found that participant can accurately report their circumcision status, which was consistent with an Australia’s study [35].

Over half uncircumcised respondents in our study indicated that they would be willing to be circumcised, which was similar to the reports in Beijing, China [33] and other countries [36]. The relative low prevalence of male circumcision and a high willingness to be circumcised could be the evidence of the feasibility to promote MC as an intervention component of the multifaceted intervention strategy among MSM in Chengdu. This study did not demonstrate an independent association of male circumcision with HIV infection whether we restricted the sample to men who engage in RAI or IAI. This finding is consistent with the findings from a clinical trial among MSM [37]. In contrast, in this study, being circumcised was associated with a lower frequency of syphilis among MSM (especially among those who engaged in IAI), which is consistent with a prospective study to assess circumcision status and a broad range of STIs among MSM [21]. Circumcision is unlikely to reduce URAI risk but could partially protect against HIV for MSM practicing unprotected insertive anal intercourse (UIAI) [22]. Consistent with previous research, our study found an association between male circumcision and lower frequency of syphilis among MSM (especially among those who engaged in IAI).

There are no randomised controlled trials of the effects on HIV transmission of diagnosing and treating STI in HIV-positive MSM but a large impact is unlikely because most new HIV infections in MSM are thought to be acquired from people who are unaware that they are HIV-infected (van Sighem et al., 2012). This study has limitations. We found four systematic reviews on the prevalence of violence in SGM, including 1 global, 1 regional (North America and Europe) and 2 national-level reviews (USA) [37–40]. Participants in the study may not be representative because of the biases associated with snowball sampling. However, compared with our previous study [10], the present study started from more seeds (eighteen) and had more diversity in demographic characteristics, especially with regard to age and education. With the exception of the clinical examination and HIV, syphilis serological testing, this study relied on self-reported data. Risk behaviors could be over- or underestimated due to social desirability regarding reporting.

Additionally, the nature of the cross sectional design precluded the ascertainment of causality. This study did not find an independent association of circumcision with HIV infection, which may be caused by our use of prevalent cases. In summary, this study demonstrated an alarming prevalence of HIV and syphilis among MSM in Chengdu. The common practice of unprotected receptive anal intercourse and multiple male sexual partnerships in our study population highlight the urgency for an effective comprehensive HIV prevention strategy, including the promotion of safer sex practices, treatment for STIs, the promotion of correct and consistent condom use, and the provision of HIV testing and antiretroviral therapy. Further research will shed more light on optimal ways and desirability of integrating male circumcision into a comprehensive prevention package to restrain the rapid expansion of the HIV epidemic among MSM in Chengdu, China. The authors thank Chengdu Gay Community Organization for helping in community mobilization, participant recruitment, and pre and posttest counseling; and Guodong Mi and Zhi Dou for their technical assistance. This study was supported by the Chinese Government AIDS Program (Grant no.

To determine if culture conditions permit product production, the microorganism can be cultured for 2, 4, 6, 8, 12, 24, 36, 48 or 72 hours and a sample can be obtained and analyzed.

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