Infection And Factors Of HIV And Syphilis And Regular Sexual Partner Interference Among Men Who Have Sex With In Beijing

Background: AIDS(Acquired immunodeficiency syndrome) is an important problem of public health around the world. People lived with HIV(PLHIV) has been increased from 650,000 in 2005 to 780,000 in 2011 according to the report of Health Department, AIDS Department of UN and WHO in China. It is estimated that the PLHIV we have known only contribute half of the real number of it. With the fast increasing number of PLHIV, the proportion of homosexual transmission is higher and higher, from 14.7% in 2009 to 17.4 in 2011, while the homosexual transmission contribute to as high as 65% in newly infection. Homosexuality is still not widely accepted in China. Therefore marriage between MSM and women remains common to hide the nature of sexual orientation, which cause MSM may act as a bridge for transmission of HIV and other sexual transmitted diseases to other MSM and general population. 31.2% of MSM in China had the experience of bisexual according to a survey.Health education, peer education, interference in amusement place, promotion of condom use, health education through internet and Voluntary HIV Counseling and Testing(VCT) are the most common ways to HIV prevention so far. However, those ways can only decrease the number of newly HIV-infected people. But for the MSM, which are extremely concealed and full-feeling of stigma, the effects were limited. As the regular sexual partners of MSM ware put in to an important position, there are more studies about them. According to American Centre of Disease Control and Prevention, regular sexual partners contribute to 68% of newly infection among MSM.Objectives:1 To explore the prevalence and predictors of HIV and syphilis infection among MSM in Beijing;2 To understand the incidence and predictors of HIV and syphilis infection among MSM in Beijing;3 To explore the retention rate and factors associated with the follow-up among the cohort of MSM in Beijing;4 To evaluate the effects of HIV testing of regular sexual partners and to explore the possibility to undertake the regular sexual partner interference in China;5 To understand the factors associated with MSM`s willing to accept the interference of regular sexual partners HIV testing.Methods: Basement recruitment and follow-up were carried out during Match 2013 and April 2014. Respondents were recruited by connecting with the MSM who joined the last cohort, sending message through gay website and respondent driven sampling(RDS). Follow-ups were carried out 3 month and 6 month after the recruitment. Regular sexual partners interference was introduced to MSM who have regular sexual partners and ask them to join the interference activity if they agreed. For these who accepted the regular sexual partner interference, the staff of our group will offer Rapid HIV Testing Kit to them, ask them to test for their regular sexual partners, and follow the track of testing results via QQ until we obtained it, and also provide counseling for both respondent and their sexual partners. Electronic questionnaire were used both at the baseline and follow-ups, which contains the demographic HIV testing in a year, sex characteristic in recent 3 month and experience of sexual transmitted diseases. Rapid HIV Testing Kit was used to test HIV and syphilis. SAS 9.2 is used to analyze the data.Results:1 602 respondents were recruited, along with the 295 MSM form the last cohort. The prevalence of HIV and syphilis is 4.5%(27/602) and 25.7(155/602), respectively. In single variable analysis, factors below were associated with HIV prevalence: HIV testing in a recent year, whether to know the testing results or not, the possibility of infection the think of themselves, whether infected with syphilis; factors below were associated with syphilis prevalence: education level, place they mostly went for sexual partners, age of sex debut, gender of sex debut, the number of anal and oral intercourse in recent 3 month, whether had regular sexual partners or not and whether infected with HIV. In multivariable analysis, factors below associated with HIV prevalence: HIV testing in a recent year(OR=3.10, 95%CI 1.38 6.97), the possibility of infection the think of themselves(OR=3.11, 95 CI 1.39 6.99), whether infected with syphilis(OR=2.27, 95%CI 1.01 5.17); factors below were associated with syphilis prevalence: education level(OR=3.48, 95%CI 2.35 5.17), age of sex debut(OR=1.74, 95%CI 1.11 2.74), whether infected with HIV(OR=2.44, 95%CI 1.07 2.57) and he number of anal and oral intercourse in recent 3 month(OR=0.60, 95%CI 0.36 0.99).2 575 HIV-negative respondents were recruited in our cohort, and the retention rate of 3 month follow-up and 6 month follow-up are 83.7(481/575) and 76.3(439/575) respectively. In single variable analysis, factors below were associated with retention rate of 6 month follow-up: age, how long they have lived in Beijing, HIV testing in a recent year and whether to have unprotected anal intercourse in recent 3 month. In multivariable analysis, factor below associated with 6 month follow-up: HIV testing in a recent year(OR=2.22, 95%CI 1.38 3.58).3 8 HIV antibody was converted into positive among the 575 HIV-negative respondents during the follow-up. Total observation time is 237.3 person-year and the incidence of HIV is 3.4/100 person-year(95%CI 1.9 4.9). In multivariable analysis, factors below associated with HIV incidence: HIV testing in a recent year(OR=2.57, 95%CI 1.10 6.02), the possibility of infection the think of themselves(OR=3.62, 95 CI 1.54 8.51). 25 respondents were tested for TPPA positive among 420 TPPA-negative MSM. Total observation time is 192.6 person-year and the incidence of syphilis is 13.0/100 person-year. In multivariable analysis, factor associated with HIV incidence is the education level(OR=0.09, 95%CI 0.01 0.78).4 Since the regular sexual partner interference was carried in 2012, 785 respondents with regular sexual partners was introduced this interference and 321 MSM accepted it with 467 times. 384 results were collected by tracking with a rate of 82.2%(384/467). Among all the results, 340 were negative, 27 were of no avail, 16 were positive and 1 was uncertain. Partner was asked for further HIV testing at VCT if his result was positive or uncertain. 5 of them came to VCT for further HIV testing and 3 of which were negative, 2 of which were positive. After the interference was carried out, the proportion of HIV testing of regular sexual partners increased from 70.2%(225/321) to 88.7%(240/271), with statistically significant. The chi-square analysis shows that the factors associated with willingness to accept the interference are: nation, place to seek their sexual partners, gender of sex debut, number of anal and oral intercourse in a recent month, whether to have temporary sexual partners. In multivariable analysis, factors below associated with willingness to accept the interference: nation(OR=0.45, 95%CI 0.23 0.88), place to seek their sexual partners(OR=0.26. 95%CI 0.16 0.56), number of anal and oral intercourse in a recent month(OR=2.07, 95%CI 1.44 2.97), whether to have temporary sexual partners(OR=2.07, 95%CI 1.44 2.97), whether infected with HIV(OR=2.62, 95%CI 1.06, 6.48).Conclusions:1 The prevalence of HIV and syphilis among MSM in Beijing are still high compare to others. Effective measurements should be conducted to decrease the prevalence.2 The incidence if HIV is still high compared to other area though it is quite low compared to the incidence of the cohort in 2011 and 2012 cohort. In multivariable analysis, factors below were associated with the HIV incidence: HIV testing in a recent year(OR=2.57, 95%CI 1.10 6.02), the possibility of infection the think of themselves(OR=3.62, 95 CI 1.54 8.51); factor associated with HIV incidence is the education level(OR=0.09, 95%CI 0.01 0.78).3 The proportion of HIV testing of regular sexual partners increased from 70.2%(225/321) to 88.7%(240/271) after the regular sexual partner interference was carried out with statistically significant. We can see that the interference works well in promotion of HIV testing rate in partners.4 The results show that factors below associated with willingness to accept the interference: nation(OR=0.45, 95%CI 0.23 0.88), place to seek their sexual partners(OR=0.26. 95%CI 0.16 0.56), number of anal and oral intercourse in a recent month(OR=2.07, 95%CI 1.44 2.97), whether to have temporary sexual partners(OR=2.07, 95%CI 1.44 2.97), whether infected with HIV(OR=2.62, 95%CI 1.06, 6.48).