Predictors Of HIV And Syphilis Infections Among Men Who Have Sex With Men (MSM) In Chongqing Municipality China

Objective:To examine the prevalence and predictors of HIV and Syphilis infections among men who have sex with men(MSM)in Chongqing municipality, China; To examine the prevalence and risk factors for HIV infection and prevalence of syphilis infection among men who have sex exclusively with men (MSM/M) or with men and women(MSM/W)in Chongqing Municipality, China.Methods: Based on the mapping and population size estimation, two cross-sectional survey was conducted among MSM using snowball sampling method by different MSM clusters cross 3 districts in 2006,2007. Face to face interview was conducted by the well trained investigators with informed consent , Demographic characteristic,sexual behavior and self reported STI were included in the questionnaire . 3-5ml blood was extracted for HIV/Syphilis tested. Univariate and multivariate stepwise logistic regression model was constructed using SPSS13.0 software.Results:Of the 1,691 participants, the age of the MSM ranged from 18-68 years, with a mean age of 27.7(SD:±8.7) years, 76.9% reported unmarried, 77.7% were local residents, 86.5% received high school or higher education,98.0% belonged to the Han ethnic group, and 64.9% self-identified as homosexual. Of the participants, 71.3% recruitedfrom Bars/night clubs/tea bars, 19.3% from Internet/clinics/grassroots, and 9.4% recruited from Bath house/saunas.Of the participants, 10.9% were HIV-infeced, 8.6% were syphilis-infected and 15.3% self-reported having STI-related symptoms in the past 12 months. Both HIV and syphilis infected were 30 MSM, and both HIV and self-reported STI symptoms were 43 MSM. 81.6% MSM reported having had sex with a male in the past 6 months, with 65.2% reporting more than two sex partners(median:2) and only 36.6% consistent condom use during anal sex with men. 5.0% reported paying for sex with men in the part 6 months, with 71.0% reporting have more than two sex partners and the rate of consistent condom use was 60.0%. 6.3% reported receiving money from male sex partners, 85.1% reported more than two sex partners and the the rate of consistent condom use was 68.5%. HIV infection among MSM was independently associated with older age (AOR=1.6,95%CI:1.1-2.5, 25-34 years of age vs. younger; AOR=2.3, 95%CI: 1.4-3.7,≥35 vs.<25 years of age), less education (AOR=2.2; 95%CI:1.5-3.3),being recruited from bathhouses or saunas (AOR=2.1, 95%CI: 1.0-4.4), more than two male sex partners in the past 6 months (AOR=1.8; 95%CI: 1.2-2.7), sex with a woman in the past 6 months (AOR=1.4; 95%CI: 1.0-2.5), self-reported STI-related symptoms in the past 12 months (AOR=1.7, 95%CI: 1.1-2.7) and syphilis infection (AOR=1.7; 95% CI:1.1-2.9). Syphilis infection was independently associated with older age (AOR=1.9; 95%CI: 1.1-3.4;≥35 vs.<25years of age), less education (AOR=1.7; 95% CI:1.1-2.6), inconsistent condom use during anal sex with a male (AOR=1.5, 95% CI:1.1-2.3, sometimes vs. always), self-reported STI-related symptoms (AOR=1.6; 95%CI: 1.0-2.4), and HIV infection (AOR=1.7; 95% CI:1.1-2.8) . Of the participants, 21.6% reported having had sex with women in the past 6 months, 70.8% reported only one female sex partners and only 23.9% MSM always use condom. Contrast with MSM/M, the MSM/W with old mean age(31.5 years old vs. 26.6 years old, P<0.001), more in the state of married/cohabitting(47.8% vs. 8.7%, P<0.001), more less-education (23.0% vs. 10.9%, P<0.001), most with lower HIV-related knowledge(84.4% vs. 93.9%, P<0.001), most of them self-identified as bisexual/ uncertain(70.8% vs. 25.4%, P<0.001). And a lot more MSM/W recruited from bath house/saunas(20.0% vs. 6.4%, P<0.001). Heterosexual behaviors independently associated with married/cohabiting AOR=6.5,95%CI:4.4-9.8), self- identified as bisexual/ undetermined (AOR=3.9,95% CI:2.8- 5.5), being recruited from bars/night clubs/tea bars(AOR=1.6,95%CI:1.0- 2.6), lack of HIV related knowledge (AOR=1.9,95%CI:1.1-3.2), first lifetime female sexpartners (AOR=2.2,95%CI:1.5-3.0), HIV infection(AOR=1.7,95%CI:1.1-2.7), older age at sex debut (AOR=0.6,95%CI:0.4-0.8),and did not offer sex for money for anal intercourses in the past six months (AOR=0.5,95% CI:0.3-1.0).Conclusion:High prevalence rates of HIV and syphilis infections found among Chongqing's MSM suggest an emerging public health emergency for the world's most populous nation. Unprotected anal sex, multiple sex partners, and bisexual behaviors were common in this group. Multiple sex partners and other high risk behaviors when have sex with men or women among MSM/W represents a unique risk group within the population of MSM that may bridged the HIV transmission between HIV high risk group and common people . We need to pay specifically attention to MSM/W, exploit effective intervention urgently to prevent HIV transmit from HIV high risk group to common.In-depth, better targeted intervention, including education, copying skill training, condom promotion and distribution, HIV and syphilis screening and treatment, are urgently needed.