The Epidemiological Study Of HIV/STDS Among Men Who Have Sex With Men In Beijing

BackgroundIt is estimated that cumulative reported number of HIV infections, AIDS patients and HIV-related deaths still sustain at a higher level. 2009 Estimates for the HIV/AIDS Epidemic in China indicates that sexual transmission has gradually become main route of HIV spread. Infection rate of HIV among MSM accelerates year after year, accounting for 32 percent of total HIV infections. Measures for HIV/AIDS available currently including behavioral interventions, such as HIV testing regularly and use of male condom, have slowed down the HIV epidemic in high-risk population to some extent. But, current intervention measures are not suitable or available for all individuals with high-risk behavior, and behavioral intervention alone can not contain HIV/AIDS epidemic effectively. Both observational and randomized clinical trials (RCTs) have shown that circumcision (MC) can lower the risk of HIV acquisition in heterosexual men, but the results among MSM are still inconclusive.ObjectiveTo understand the demographic characteristics, HIV/AIDS-related knowledge level, sexual characteristics, history of drug use, and circumcision status and other background data of MSM in Beijing; to study the rate and predictors of recent HIV testing among MSM; to study the prevalence and predictors of HIV, syphilis and herpes simplex type 2 virus (HSV-2) among MSM, exploring the association between male circumcision and HIV/STDS and the acceptability of circumcision.MethodsA cross-sectional study was conducted in a skin hospital in Beijing, and MSM were recruited through peer referring and internet advertising. Interviewer-administered interviews were conducted to collect information on demographics, HIV related knowledge, sexual characteristics, history of drug use, etc. Blood samples were collected to test for HIV, syphilis and HSV-2. EpiData version 3.1 software was used for data input and management and SAS version 9.1 software was used for data analysis.ResultsA total of 962 eligible MSM completed questionnaires and blooding. 83.68% (805/962) of participants were not local residents, of which 72.56%(698/962) lived in Beijing for more than 2 years. The age of the MSM ranged from 18 to 71 years,with a median age of 27 years, 62.89%(605/962) reported unmarried and 22.14%(213/962)married, 48.96%(471/962) with tertiary level above, 66.73%(642/962) self-identified as homosexual. 53.53%(515/962)of MSM understood the 8 HIV-related knowledge correctly, and 84.62%(814/962) accepted the prevention services of HIV/AIDS.91.27% (878/962) of MSM had anal sex with men in the last 6 months, with a median number of 3 (range from 1 to 413) sex partners, of which only 49.66%(436/878) always used condoms2.91% (28/962) and 4.88% (47/962) of MSM bought or sold sex services, respectively. 17.88% (172/962) of MSM had sex with female in the 6 months, of which 68.02% (117/172) had sex without condoms. 1.14% (11/962) of MSM used drug, of which only 1 was patient in-jecting drug user. 8.11% (78/962) of MSM reported having been circumcised. In the past 1 year, 17.15% (165/962) of MSM had symptoms of STDS. 11.95% (115/962) of MSM were found signs of STDS by physical examination.Of the 962 MSM surveyed, 51.4% had tested for HIV in the last 12 months. Multivariate logistic regression analysis showed that self-identification as homosexual (OR=1.41,95% CI:1.04-1.90), understanding the 8 HIV-related knowledge correctly (OR=2.22,95% CI: 1.67-2.95), receiving HIV prevention services recently (OR=10.01, 95% CI:6.22-16.11), looking for partners from parks or bathhouses(OR=1.60,95% CI:1.16-2.20 ) and reporting unprotected sex in the last 6 months (OR=1.65,95% CI:1.24-2.18)were associated with recent HIV testing.Of the 962 MSM surveyed, the prevalence of HIV, syphilis and HSV-2 was 6.3%(61/962), 17.7%(170/962) and 5.3%(51/962), respectively. Multivariate logistic regression analysis showed that non-Beijing residence (OR=1.88, 95%CI: 1.04-3.39), the first sex partner being female (OR=1.86, 95%CI: 1.09-3.17), having more than 3 sex partners in the last 6 months (OR=2.03, 95%CI: 1.19-3.45) and recent syphilis infection (OR=3.46, 95%CI: 1.85=6.48) were associated with HIV infection. Multivariate logistic regression analysis showed that tertiary level below (OR=1.84, 95%CI: 1.11-3.04), looking for partners from parks or bathhouses (OR=1.63, 95%CI: 1.01-2.65), HIV infection (OR=3.32, 95%CI: 1.76-6.23) and HSV-2 positive (OR=2.23, 95%CI: 1.08-4.63) were associated with recent syphilis infection. Multivariate logistic regression analysis showed that more than 25 years old (OR=3.6, 95%CI: 1.72-7.52), having more than 3 sex partners in the last 6 months (OR=1.81, 95%CI: 1.01-3.22), prepuce or phimosis (OR=1.98, 95%CI: 1.06-3.72), recent syphilis infection (OR=2.51, 95%CI: 1.22-5.16) were associated with HSV-2 positive.ConclusionMultiple sex partners and other high risk behaviors when have sex with men or women among MSM represents a unique risk group within the population of MSM that may bridged the HIV transmission between HIV high risk group and common people. Unprotected anal sex, multiple sex partners and bisexual behaviors were common among MSM, coupled with a low HIV testing rate, suggesting that MSM already has been met the condition for rapid spread of AIDS in Beijing, so targeted interventions for various sub-groups were needed urgently to reduce the risk of HIV infection, such as advocating gay culture, regular counseling and testing, safe sex and partner loyalty, etc. The prevalence of HIV and STDS among MSM in Beijing has reached a high level, and synergistic relationship existed between HIV and ulcerative STDS, so the prevention and control of HIV and STDS should be carried out simultaneously. The study explored the association between circumcision and infection of HIV/STDS for the first time, but results did not show an association. After considering the length of the foreskin, multivariate analysis showed that prepuce or phimosis was the independent factor of HSV-2 infection. Future studies without the methodological limitations are needed to elucidate further the relationship between circumcision status and HIV or STDS among MSM.