Prevalence Of HIV And Sexuai Behaviors Among Men Who Have Sex With Men And Women

Objectives To determine the status of HIV infection, the characteristics of male andfemale partners, and to know the same-sex and opposite-sex behaviors among men whohave sex with men and women (MSMW) and to explore the factors associated withunprotected sex among MSMW, and to discuss the role of MSMW in the HIV spreadfrom men who have sex with men (MSM) to the general population.Methods The survey was conducted in Chengdu and Guangzhou from July2010toFebruary2011and600participants were recruited using snowball sampling (300participants of each city). Eligibility criteria were men who were18years or older; whohad anal sex with man and had vaginal sex with woman in the past12month or whowere currently married to a woman. After confirming their eligibility and getting theirinformed consent, participants were asked to complete behavioral surveys which wereadministered by face-to-face survey in a private room. The questionnaire for the surveyincluded social demographic characteristics, the male sexual partners and sexualbehaviors and condom use in the past6months, as well as the female sexual partners,vaginal intercourse and condom use in the past12months. After behavioral surveys, theparticipants received HIV antibody testing.EpiData3.0software and SPSS10.0were used to establish a data-base and analyze data.The statistical analysis technique included frequency distribution, Chi-Square test andLogistic Regression Analysis. Results The average age of participants was34.3years (SD=9.5), with38.5%ofparticipants being26-35years of age. Approximately two-thirds (62.5%) were currentlymarried. The percentages of participants who had got education of junior high school orless, high school or vocational school and college or higher were20.5%,36.0%and43.5%, respectively. Half of the participants (50%) identified themselves as bisexual,42.3%identified themselves as homosexual, and7.7%identified themselves asheterosexual or unsure. The majority (58.3%) did not have a residence card in the city.Overall,26.2%(157/600) of the sample were HIV positive which included41newlydiagnosed positive and116previously tested positive. The prevalence of new HIVdiagnosis was8.5%(41/484). Among participants in Guangzhou and Chengdu, the HIVprevalence were13.0%(39/300) and39.3%(118/300) and the prevalence of new HIVdiagnosis were3.0%(8/269) and15.3%(33/215), respectively. Among gay and non-gayidentified MSMW, the HIV prevalence was31.5%and22.3%, respectively.In the past6months,28.0%participants had5or more male sexual partners and44.2%of them had used condoms consistently in the anal sex with men. Of the participants,52.3%had used condoms in the last three anal sexes and63.0%in the last anal sex. Inthe past12months, there are86.0%participants who had vaginal sex with femalepartners and the proportions of MSMW who had wife, girlfriend, lover, female casualpartner and female commercial partner are65.0%,27.2%,1.5%,12.7%,4.5%,respectively. About a third of participants had always used condoms in vaginal sexes inthe past12month. In the last three vaginal sexes,36.5%of participants had never usedcondoms. In the past6months,55.7%participants had used condoms consistently in the anal sex with men in Chengdu, which is higher than participants in Guangzhou (32.7%).In the past12months, the proportion of participants who had used condomsconsistently in the vaginal sexes is38.3%, which is also higher than MSMW ofGuangzhou (25.3%).Among HIV-positive participants,91.1%had anal sex with men in the past6monthsand49.7%HIV-positive participants had used condoms consistently in anal sex withmen. The number of HIV-positive participants who had used condoms in the last or lastthree anal sex with men account for60.5%and69.4%, respectively. In the past12months there are82.8%HIV-positive participants who had vaginal sex with women. OfHIV-positive participants,42.0%used condoms consistently and the percentage of themwho used condom in the last three vaginal sexes is47.8%. In the past6months, thepercentage (4.3%) of HIV-positive participants diagnosed before the survey never usedcondoms in the anal sexes with men is lower than the percentage (22.0%) ofHIV-positive participants diagnosed in this survey. In the past12months12.9%participants who were HIV positive prior to the survey never used condoms in thevaginal sexes, which is lower than participants (46.3%) who were found HIV positive inthe survey.Logistic Regression Analysis demonstrated that the risk for unprotected anal sex ofparticipants who were older age (26-35vs.18-25years, OR=1.796,95%CI=1.019-3.165;>45vs.18-25years, OR=3.572,95%CI=1.624-7.858), residing inGuangzhou (VS. living in Chengdu, OR=2.557,95%CI=1.676-3.903), having multiplemale partners (5or over, OR=2.114,95%CI=1.175-3.802), not having commercialmale sexual partners (OR=2.460,95%CI=1.244-4.861), during past12months never or sometimes using condom in vaginal intercourse (never, OR=3.747,95%CI=2.307-6.086; sometimes, OR=1.867,95%CI=1.115-3.125), HIV-positive found in thesurvey (OR=4.107,95%CI=1.642-10.272).The results from multivariate Logistic Regression of unprotected vaginal sex amongparticipants showed that：the risk factors were having multiple male partners (5or over,OR=2.387,95%CI=1.370-4.157), non-homosexual orientation(bisexual, OR=2.591,95%CI=1.746-3.845; heterosexual orientation or undecided, OR=3.484,95%CI=1.618-7.501), during past6months never or sometimes using condom in analintercourse (never, OR=3.315,95%CI=1.633-6.730; sometimes, OR=2.603,95%CI=1.740-3.895), HIV-positive found in the survey (OR=2.383,95%CI=1.014-5.601) and HIV negative (OR=2.466,95%CI=1.511-4.027).The results from multivariate analysis of unprotected anal sex among MSMW inGuangzhou showed that：the independently and significantly associated factors includedhaving multiple male partners, lower monthly income, during past12months neverusing condom in vaginal intercourse, having casual male partner during past6months.The factors independently and significantly associated with unprotected vaginal sexduring past12months among MSMW in Guangzhou were non-homosexual orientation,being insertive and being both insertive and receptive in anal sex, having wife duringpast12months.The factors independently and significantly associated with unprotected anal sex duringpast6months among MSMW in Chengdu were as follows, older age, having boyfriendduring past6months, not having commercial male sexual partners, during past12months never or sometimes using condom in vaginal intercourse, HIV-positive found inthe survey and HIV negative. The factors independently and significantly associated with unprotected vaginal sex during past12months among MSMW in Chengdu wereheterosexual or undecided orientation, having casual male partner during past6months,HIV-positive found in the survey and HIV negative.Conclusions The prevalence of HIV infection had reached a quite high level and thehigh rates of unprotected anal sex with men and vaginal sex with women amongMSMW, so the inherent bridging aspect of MSMW may accelerate the spreading ofHIV infection in the general population. Therefore, in order to develop effectiveinterventions and strategies to control the spreading of HIV among MSMW even fromMSMW to the general population, we should take these related factors with unprotectedsex found in our study into consideration.