Study On Sexual Behaviors Of HIV Infected Youth Male Students Who Have Sex With Men

BackgroundYouth people are the main sufferers of HIV epidemic.The infection and the consequent disease cause a heavy burden on society and themselves.In the past ten years,the reported number of HIV-infected youth students has been rising in China.The main route of infection was homosexual behavior.Youth students are easily to have unprotected sex thus resulting to HIV infection due to immaturity of ideology and social experience,along with the fact that they are at a sexually active age with inadequate understanding of sexually transmitted diseases such as AIDS.Therefore,the prevention and treatment of HIV transmission among the youth group of men who have sex with men(MSM),especially the MSM students,play a very important role in the general control of AIDS epidemic.Objective1.To characterize the sexual behaviors of the HIV infected MSM youth students;2.To reveal the characteristics of the HIV infected MSM youth students’sexual network and partners,by analyzing the personal sexual network with molecular biology methods.Methods1.Retrospective data analysis of HIV/AIDS case reports.Data of newly reported cases of HIV infected persons at the age of 15 to 24 were collected from both Case Reporting Cards and Follow-up Cards since 1st January 2013 till 31st December 2017.Information about demographic characteristics,high-risk behaviors and sexual partners was analyzed.2.Cross-sectional study.The reported HIV infected MSM students in Beijing,Chongqing and Nanjing,during the period since 1st January,2015 till 31st July,2017 were selected.The method of egocentric network analysis was used to characterize the respondents-centered sexual relationship network,and,by the varied characteristics of their sex partners,to analyze,stratified,the age similarity.Finally,the blood samples were collected for sequence determination and subtype analysis,while constructing the phylogenetic tree,and combining the results of molecular biology and epidemiological findings,thus to draw a sexual network map.3.Indepth interviews.Information about the students’ sexual behaviors,HIV testing status,and school education regarding HIV/AIDS prevention and control was collected by face to face surveys with the staff of social organizations,CDC and HIV/AIDS prevention and treatment agencies.And meanwhile,indepth interviews were carried out for the typical cases identified during the cross-sectional study.RestultsBy analyzing the past data of reported cases all over the country since 2013 till 2017,we found that there were totally 12037 youth students infected by HIV.Among them,as reported,7839(65.1%)were at the age of 19 to 22,with 11760 males(97.7%),9897 infected by homosexual intercourse(82.2%),and 5646(46.9%)cases diagnosed at the voluntary counseling and testing locations(VCT).The proportion of MSM youth students aged 20 or below has increased yearly.The older or higher education he had received,the higher proportion of sexual occurrence rate 3 months before the time of being diagnosed.Among the 3342 HIV infected MSM youth students who had had sexual behaviors 3 months before diagnosis.2087(62.4%)didn’t use condom and 937(44.9%)had more than 2 sexual partners.256 MSM youth students were surveyed by the cross-sectional study,who were aware of their sexual preference at a median age of 16.Among the 244 infected students who had their first intercourse at the median age of 18,with their first partners of the same gender,149(67.4%)were on the passive side(being inserted.marked as"0"),126(56.0%)didn’t use condoms.241 MSM students reported the information of sexual behaviors by which it was probable to be infected with HIV.176(73.9%)students judged themselves being infected with HIV,at the median age of 19 and during the period from the 3rd grade in senior high school to junior year in university.235(97.5%)once experienced anal sex,among whom 166(70.6%)were on the passive side,and only 34(14.5%)students used condoms.The main reasons for not using condoms for the first sexual intercourse were”I have never thought about the possibility of infection",”I think that my sexual partner was not infected"and"I don’t think I will be infected".Beside these reasons,there was"partners rejecting",drinking and substance abuse.Youth MSM students were more likely to have sex with casual male partners most of whom acquainted with each other by dating software or through the internet;most of them surveyed were on the passive side,with more than 50%using no condoms.Compared with those having casual sex partners,the ones who had fixed sex partners were more likely to have intercourse without condoms,and with an even higher rate of infection.The students who had sex with non-student partners or the ones older than 30 years old were more likely to be infected than those who had student partners or the ones younger than 20 years old.Of the 256 MSM young students,104(40.6%)used RUSH which was mainly obtained from sexual partners(65.4%).225(87.9%)young MSM students were aware of the HIV infection risk of unprotect anal intercourse.The knowledge was mainly obtained through websites,bulletin boards,newspapers and pernodicals,etc.,and the proportion of such knowledge obtained from school courses and school publicity activity was lower.141 MSM students out of 256 were detected HIV positive for the first time being tested,taking a percentage of 55.1%.The median of sexual network size(number of sex mates)was 3(2-6),among the 251 MSM students who had reported their sexual partners.The younger when they had their first intercourse,the larger their sexual network size was.Among the networks,their sex mates tended to be older than the students when they had their first intercourse(Q=0.03)or the one most likely to be infected(Q=0.09).Age similarity between casual mates(Q=0.10)was higher than that of between fixed mates(Q=-0.03).The highest age similarity was between the mates who acquainted each other at school(Q=0.32);second highest(Q=0.12)was between those getting to know each other at a party or through a friend;and the pares who got acquainted with each other by websites,chatting rooms(Q=-0.03),or mobile dating apps(Q=0.09)then had the lowest age similarity249 blood samples were collected on spot from MSM students.150 specimens were successfully amplified and the HIV virus gene was sequenced.Most of the subtypes of HIV virus were CRF01_AE(56,37.3%)and CRF07 BC(53,35.3%).Distribution of subtypes was not significantly related with the year of case report or the first CD4+T lymphocyte(CD4)test results.However,there were differences in the distribution of subtypes in different sites.Most of the subtypes were CRFI-AE in Beijing(51.7%,31)and Nanjing(57.6%,19),and most were CRF07 BC in Chongqing(63.2%,36)According to the information obtained from the comprehensive epidemiological survey and molecular biology analysis,we found that the transmission relationship between the three groups of MSM students and their partners was verified,and the genetic distance between them was less than or equal to 0.001ConlusionThe MSM youth students had their first intercourse at the median age of 18.Judged by themselves,the students were,at the median age of 19,and mainly during the period from the 3rd grade in high school to junior year in university,most likely to be infected.The MSM youth students were mostly on the passive side during intercourse,with a high proportion of unprotected anal sex.The reason why they didn’t use condoms was probably that they kept the luck mind that it’s impossible for them to be infected with HIV.The virus was most likely to be from their fixed sex partners or the partners older than 30HIV infected MSM youth students*median of sexual network size(number of sex mates)was 3(2-6),The younger when they had their first intercourse,the larger their sexual network size was.Most of them got acquainted with each other by dating apps or through the internet.The pairs getting to know each other by websites,chatting rooms,or mobile dating apps,had a more significant difference in age than the ones who got acquainted with each other at school,parties,or by introduction of their friends.Subtype distribution of HIV viruses showed neither significant differences among the cases reported in different years nor significant correlation with the varied first CD4 test results.Most of the subtypes were CRF01_AE in Beijing and Nanjing,and most were CRF07 BC in Chongqing.