The Research Of Sexual Transmission Behaviors And Related Intervention Among HIV-positive MSM Who Engaged In Unprotected Sex

Objectives To know sexual behaviors and sexual partners among HIV-positive MSM who engaged in unprotected sexual behaviors and to investigate the sexual transmission behaviors as well as to examine the risk factors of sexual transmission behaviors among those HIV-positive MSM.Methods This survey was conducted in Shanghai and Chengdu of China. Eligibility of subjects were men who were 18 years or older, had unprotected anal sex with another men in the past 6 months, and lived in Shanghai or Chengdu. A total of 308 subjects were recruited by “snowballing” sampling. The subjects participated in the survey after providing informed consent, and completed questionnaire on face-to-face anonymously in a private room. The content of questionnaire included demographic characteristics, sexual behaviors and condom use with different kind of sexual partners in the past six months, the number of sexual partners(primary and casual male sexual partners and female partners) and HIV disclosure. Epi Data and SPSS13.0 were used for establishing a database and data analysis respectively.Results In cross-sectional surveys, the average age of participants was 35.37±10.13 years old, and the proportion of 26~35 age group was 41.9%(129/308). Of participants, 66.3%(204/308) were unmarried, Over half(50.3%) had college or higher education and 79.5% identified themselves as homosexual. Participants diagnosed HIV infection during one year account for nearly one third(31.8%), 51.7% of participants had more than 350/mm3 CD4 count and 65.6%(202/308) were on antiviral therapy. Among 308 participants, 48.1%(148/308) found their sexual partner mostly through internet. A total of respondents who engaged anal sex with HIV-positive, HIV-negative and HIV-unknown partners accounted for 51.6%(159/308), 37.7%(116/308), 57.1%(176/308) respectively, and the proportions of participants who reported condom use consistently with HIV-negative and HIV-unknown partners were 4.9% and 3.9%. In addition, respondents who reported having group sexual accounted for 8.4%(26/308). In the past six month, prevalence of alkyl nitrite or other illicit drug use during unprotected anal sex was 28.9%. Of participants, the proportion of having sexual transmission behaviors during past 6 months was 70.1%(216/308). Participants who had primary sexual partners and casual sexual partners post-HIV infection diagnosed accounted for 89.0%(274/308) and 68.2%(210/308) respectively. Of them, 59.1%(162/274) and 94.3%(198/210) respectively had not disclosed their HIV infection to primary and casual sexual partners. The percentage of sexual transmission behaviors was 91.9%(149/162) and 89.9%(178/198) in participants who did not disclosed their HIV infection to primary and casual sexual partners.Multivariable logistic regression models were conducted to examine associations of sexual transmission behaviors with risk factors, having sexual transmission behaviors in the past six months assign as 1, no sexual transmission behaviors assign as 0, and independent variables included demographics characteristics, casual sexual partner disclosure, the time of HIV diagnosed, the time of receiving antiviral therapy, having anal sex with male primary sexual partners in the past six months, alkyl nitrite use during high risk sexual behaviors in the past six months. The results showed that compared with respondents who have no male primary partners, respondents who have male primary partners less likely to engage in sexual transmission behaviors(OR=0.208, 95% CI: 0.048-0.912); Those with interval after diagnosed HIV-positive less than 2 year and more than or equal to 1 year less likely than those diagnosed in half a year to report sexual transmission behaviors(OR=0.056, 95% CI:0.004-0.860); participants who were receiving antiviral therapy were less likely than those with no antiviral therapy to report sexual transmission behaviors(OR=0.056, 95% CI: 0.004-0.860). HIV-positive MSM who had not disclosure their own HIV-infection to any or some male casual sexual partners were 34 and 44 times more likely to have sexual transmission behaviors, when compared with those with all male casual sexual partners disclosure(OR=34.157, 95% CI: 6.904-68.987; OR=44.042, 95% CI: 7.155-71.081). Compared to no alkyl nitrite use during high risk sexualbehaviors, those with alkyl nitrite use were 2 times more likely to report sexual transmission behaviors(OR=2.108, 95% CI: 1.216-4.572).Among participants, those who reported condom use insistently with HIV-positive sexual partners, while they never used condom with HIV-negative or HIV-unknown sexual partners, such people have high degree of intentional transmission, and accorded for 1.0%(3/308), those who reported condom use insistently with HIV-positive sexual partners, while they sometimes used condom with HIV-negative or HIV-unknown sexual partners, such people have relatively low degree of intentional transmission, and accorded for 2.9%(9/308).Conclusion More than two-third HIV-positive MSM with unprotected sexual behaviors reported sexual transmission behavior, in addition, substance use and group sex can increase risk of sexual transmission behavior, indicating that strategy targeting HIV spread rapidly is urgently needed.Objectives To analysis the reasons of sexual trans- mission behaviors, to describe the “intentional sexual transmission behaviors” and related reasons, through individual interview. We organized targeted population and other related staff who engaged in high risk sexual behavior interventions to discuss, and to develop intervention targeted high risk sexual behaviors of HIV-positive MSM through focus group discussion.Methods We chose 10 participants who reported unprotected anal sexual with HIVnegative or HIV-unknown partners in the past six months, 4 participants who have been diagnosed STIs in the past year, 3 participants who reported group sex in the past six months, 3 participants who reported sexual behaviors with female partners in each city to participated in the individual interview. After informed consent, participants were interviewed according to the same interview outlines and the interview were recorded. The contents of interview were the sexual transmission behavior, intentional sexual transmission behavior and related reasons. With assistance of NGOs in the two cities, to recruit the participants to participated in the focus group discussion. After informed consent, participants were discussed according to the interview outlines and The contents of focus group discussion were developing intervention of high risk sexual behaviors.Results The results of individual interview showed that though most HIV-infected MSM, use the stratrey of reduce the sexual partner numbers and increasing condom use to protect themselves, to avoid superinfection and cross infection until their HIV diagnosed. There are still have unprotected sex which accorded for 10%-15%, and 5%-10% of them still had unprotected sex with HIV-negative or HIV-unknown sexual partners, this situation would accelerate the secondary spread of HIV. Methamphetamine use and group sexual behaviors is largely accelerated the spread of HIV, also caused the unprotectedintercourse among HIV-positive MSM in recent years. The proportion of group sexual behaviors was 15%-20%. Interview participants consider there were a small number of “intentional sexual transmission behaviors” in HIV-positive MSM community, it is esitimated the proportion was 5%. The qualitative results show that, HIV-positive MSM with “intentional sexual transmission” would had male and female sexual partners, they also engaged unprotected sexual behaviors when not disclosure their HIV-infection to any or some of their primary or casual sexual partners, thus has strong concealment. Such kind of HIV-positive MSM had strong self-preservation, and mostly chose bath room as intentional sexual transmission behaviors place.Conclusion Among MSM in our country, the prevalence and incidence of HIV to keep rising in nearly decade. HIV-positive MSM as source of infection still have multiple sexual partners and unprotected sexual behaviors, these situation may accelerate the spread of HIV in MSM. Meanwhile, HIV-positive MSM who engaged in unprotected sexual behaviors reported sexual transmission behaviors. In addition, it is worth noting that there are a small number of “intentional sexual transmission behaviors” among HIVpositive MSM, they had strong self-preservation, while had no consciousness to protected others, they also had multiple sexual partners, included male and female partners. Although the number of HIV-infected MSM engaged "intentional sexual transmission behaviors" is not much, plays a huge role in promoting the HIV epidemic. Therefore, we need to combined with the national policy, community groups and the health service institutions, establish a comprehensive intervention strategy HIV secondary spread among MSM, according to the characteristics of the HIV-infected MSM with sexual transmission.