'Men at Risk': Sex Work, Tourism & STI/HIV Risk in Jamaica

Female sex tourism has become an accepted income generator for many underemployed men in Jamaica who seek to reap economic benefits from relationships with visiting tourist women. 

This issue provides contexts to explore the numerous ways in which health intersects with issues of masculinity, sexuality and marginality. Based on ethnographic fieldwork in a popular Jamaican resort town, this paper examines the health implications of female sex tourism for the local population and tourist visitors. 

Data from this project indicate the need for improved sexually transmitted infection education and HIV outreach work towards men who are involved in transactional sex with tourist women. Due to prevalent perceptions of masculinity and gendered notions of sexuality, men who engage in sex tourism constitute a population that rarely receives the attention of local and national health authorities. 

Data from this qualitative study suggest that engaging this particular vulnerable population could potentially decrease the risk of STI and HIV infection in the country's most popular resort areas. 

Research of this kind is urgently needed to better understand the risk factors and challenges for Caribbean populations, as well as to inform future prevention efforts in the region.

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By:  Johnson LC^1,2.

¹ Department of Anthropology , University of South Florida , Tampa , USA.

² College of Education , University of North Georgia , Dahlonega , USA.

Cult Health Sex. 2016 Mar 22:1-14

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Suboptimal HIV Testing Uptake among Men Who Engage in Commercial Sex Work with Men in Asia

PURPOSE:

Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia.

METHODS:

The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included for analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year.

RESULTS:

About half (48.6%) of the participants have been tested for HIV at least once within the past year, and 30.5% have never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested.

CONCLUSION:

While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed.

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By:  Jin H1, Friedman MR2, Lim SH3, Guadamuz TE4, Wei C5.

• 1 Center for Public Health Research , San Francisco Department of Public Health, San Francisco, California.
• 2 Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health , Pittsburgh, Pennsylvania.
• 3 Center of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur, Malaysia .
• 4 Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University , Nakorn Pathom, Thailand .
• 5 Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California. 
• LGBT Health. 2016 Mar 16.

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Is Intimate Partner and Client Violence Associated with Condomless Anal Intercourse and HIV among Male Sex Workers in Lima, Peru?

Violence experience can increase HIV risk behaviors; however, literature is scarce on violence among male sex workers (MSWs) globally. 

In 2014, 210 Peruvian MSWs (median age 24.9) were interviewed about their experience of physical, emotional, and sexual violence and condom use with non-paying intimate partners and clients and were tested for HIV. 

Multivariable models examined relationships between violence in the past 6 months, condomless anal intercourse (CLAI) in the past 3 months and HIV infection. HIV infection (24 %), CLAI (43 %), being a violence victim (42 %) and perpetrator (39 %) were common. 

In separate multivariable models, being a violence victim and perpetrator were associated with CLAI. Further, being a victim was associated with HIV infection. 

Violence, which was significantly associated with CLAI and HIV infection, is common among Peruvian MSWs, reinforcing the importance of violence awareness and prevention as HIV risk-reduction strategies.

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By:  George PE1,2, Bayer AM3,4, Garcia PJ4,5, Perez-Lu JE4, Burke JG6, Coates TJ3, Gorbach PM3,7.

• 1Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA. george.paul.e@gmail.com.
• 2Washington University in St. Louis School of Medicine, St. Louis, MO, USA. george.paul.e@gmail.com.
• 3Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA.
• 4Epidemiology, STD, and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
• 5Department of Global Health, University of Washington, Seattle, WA, USA.
• 6Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
• 7Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA. 
• AIDS Behav. 2016 Feb 15.

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Male Clients of Male Sex Workers in China: An Ignored High-Risk Population

BACKGROUND:

There is a high prevalence of HIV/syphilis among male sex workers, but no formal study has ever been conducted focusing on male clients of male sex workers (MCM). A detailed investigation was thus called for, to determine the burden and sociobehavioral determinants of HIV and syphilis among these MCM in China.

METHODS:

As part of a multicenter cross-sectional study, using respondent-driven and snowball sampling, 2958 consenting adult men who have sex with men (MSM) were recruited, interviewed, and tested for HIV and syphilis between 2008 and 2009. The distributions of sociodemographic characteristics, risk behaviors, and HIV/syphilis prevalence were determined and compared between MCM and other MSM.

RESULTS:

Among recruited MSM, 5.0% (n = 148) were MCM. HIV prevalences for MCM and other MSM were 7.4% and 7.7%, whereas 18.9% and 14.0% were positive for syphilis, respectively. Condomless anal intercourse (CAI) was reported by 59.5% of MCM and 48.2% of MSM. Multiple logistic regression revealed that compared with other MSM, MCM were more likely to have less education, higher income (for >500 US Dollars per month), more often found partners at parks/restrooms, reported CAI, reported a larger sexual network, and higher odds of syphilis.

CONCLUSIONS:

The greater frequency of risk behaviors and high prevalence of HIV and syphilis indicated that HIV/syphilis prevention programs in China need to pay special attention to MCM as a distinct subgroup, which was completely ignored until date.

  

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By:  Chen L¹, Mahapatra T, Fu G, Huang S, Zheng H, Tucker JD, Yang B, Zhao J, Detels R, Tang W.

¹*Department of STI control, Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, China;†Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA;‡Department of HIV and STI Prevention and Control, Jiangsu Provincial Central for Disease Prevention and Control, Nanjing, China;§University of North Carolina, Project-China, Guangzhou, China; and Monitoring and Evaluation Unit, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.

J Acquir Immune Defic Syndr. 2016 Mar 1;71(3):316-322.

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Young Male Sex Workers Are at High Risk for Sexually Transmitted Infections, A Cross-Sectional Study from Dutch STI Clinics, The Netherlands, 2006-2012

BACKGROUND:

Male sex workers (MSW) are particularly exposed to sexually transmitted infections (STI) including HIV. In the Netherlands, data about STI among MSW are scarce. We estimated chlamydia, gonorrhoea, syphilis and HIV diagnoses among MSW attending STI clinics and determined associated factors to guide prevention policies.

METHODS:

Using 2006-2012 cross-sectional national surveillance data from Dutch STI clinics, we calculated the proportion of consultations with a positive test for any of three bacterial STI or HIV among MSW. Associated factors were determined by using Poisson logistic regression with robust variance.

RESULTS:

We identified 3,053 consultations involving MSW, of which 18.1 % included at least one positive bacterial STI test and 2.5 % a positive HIV test. Factors associated with bacterial STI and/or HIV diagnoses were respectively age groups < 35 y.o. and self-reporting homo- or bisexual preferences (aRR = 1.6; 95 % CI: 1.3-2.1), and age group 25-34 y.o. (aRR = 2.7; 95 % CI: 1.2-6.5) and self-reporting homo- or bisexual preferences (aRR = 24.4; 95 % CI: 3.4-176.9). Newly diagnosed and pre-existing HIV infection were associated with an increased risk for bacterial STI (aRR = 2.7, 95 % CI: 1.7-2.6 and aRR = 2.1, 95 % CI: 2.2-3.4 respectively). MSW with no history of HIV screening were more likely to be tested positive for HIV compared to those with a previous HIV-negative test (aRR = 2.6, 95 % CI: 1.6-4.3).

CONCLUSION:

Health promotion activities should target MSW who are young, homo- or bisexual, those who are HIV-infected or who have never been tested for HIV, to increase early diagnosis, prevention and treatment.

Below:  Percentage of consultations with a positive bacterial STI test or positive HIV test among MSW at STI clinics in the Netherlands, 2006–2012

Full article at:   http://goo.gl/OQJ9ab

By:  Fournet N1,2, Koedijk FD3,4, van Leeuwen AP5, van Rooijen MS6, van der Sande MA7,8, van Veen MG9.

• 1Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. nellyfournet@yahoo.fr.
• 2European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. nellyfournet@yahoo.fr.
• 3Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. f.koedijk@ggdtwente.nl.
• 4Public Health Service Twente, Enschede, The Netherlands. f.koedijk@ggdtwente.nl.
• 5Public Health Service Amsterdam, Amsterdam, The Netherlands. petravanleeuwenap@gmail.com.
• 6Public Health Service Amsterdam, Amsterdam, The Netherlands. mvrooijen@ggd.amsterdam.nl.
• 7Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. marianne.van.der.sande@rivm.nl.
• 8Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. marianne.van.der.sande@rivm.nl.
• 9Public Health Service Amsterdam, Amsterdam, The Netherlands. MvVeen@ggd.amsterdam.nl. 
• BMC Infect Dis. 2016 Feb 4;16(1):63. doi: 10.1186/s12879-016-1388-3.

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Sexual Initiation and Complex Recent Polydrug Use Patterns among Male Sex Workers in Vietnam: A Preliminary Epidemiological Trajectory

Little is known about the age of onset of sexual and drug risk and their association with complex patterns of recent drug use among male sex workers (MSW) in a developing country, such as Vietnam. 

The aim of this study was to determine whether latent class analysis (LCA) would aid in the detection of current individual and polydrug use combinations to predict how different trajectories of sexual and drug initiation contribute to different patterns of current illicit drug use. Data were collected from a cross-sectional survey administered to young MSWs between 2010 and 2011 in Vietnam (N = 710). LCA clustered participants into recent drug use groups, incorporating both the specific types and overall count of different drugs used. Men reported drug use within a 1 month period from an 11-item drug use list. LCA identified three distinct drug use classes: (1) alcohol use, (2) alcohol and tobacco use, and (3) high polydrug use. 

The current drug use classes are associated with sex worker status, housing stability, income level, educational attainment, marital status, sexual identity, and sexual preferences. High levels of drug use are strongly associated with being a recent sex worker, not having recent stable housing, higher than median income, more than a high school education, less likely to be currently in school and more likely to have non-homosexual preferences and heterosexual partners. An event history analysis approach (time-event displays) examined the timing of the age of onset of drug and sexual risks. Early ages of drug and sexual initiation are seen for all three classes. High current drug users show earlier onset of these risks, which are significantly delayed for moderate and low current drug users. LCA incorporating an overall count of different drugs detected three distinct current drug use classes. 

The data illustrates that the complexity of drug factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of drug use and the use of drug and sexual risk initiation data to predict current drug use subtypes among high-risk populations.

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By:  Yu G1, Goldsamt LA2, Clatts MC3, Giang LM4.

• 1New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. gy9@nyu.edu.
• 2New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA.
• 3School of Public Health, University of Puerto Rico Medical Science Center, San Juan, PR, USA.
• 4Center for Research and Training on HIV/AIDS, Hanoi Medical University, 1 Tôn Thất Tùng Street, Room 601, Building A1, Hanoi, Vietnam.

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Prevalence and Behavioral Correlates of Depression and Anxiety among Male Sex Workers in Vietnam

OBJECTIVES:

This study assessed depression and anxiety symptoms, and their association with high-risk sexual and drug behaviors, among male sex workers in three Vietnamese cities.

METHODS:

Male sex workers ages 16 to 35 completed an interview that included the CES-D to assess depressive symptoms and the BAI to assess anxiety symptoms, as well as questions assessing drug and sexual risk practices.

RESULTS:

A majority of participants reported depressive symptomatology although fewer report symptoms of anxiety. Risky sexual and drug use practices predicted both types of symptoms.

CONCLUSIONS:

Mental distress is associated with drug and sexual risk among male sex workers.

Table 3

Sexual attraction, sexual identity and sexual behaviors by city

	Hanoi	Nha Trang	HCMC	Overall	Significance
Sexual attraction
Exclusively/mostly men	15.7%	22.1%	30.5%	23.4%	x2=38.6, p<.001
Both men and women	49.8%	60.4%	35.7%	46.0%
Exclusively women	34.5%	17.5%	33.8%	30.5%
Sexual identity
Think of myself as a man	68.4%	55.8%	60.3%	62.2%	x2=101.1, p<.001
Think of myself as a woman	5.2%	2.6%	8.9%	6.2%
Think of myself as a transgender person	4.8%	14.9%	3.0%	6.2%
Other	1.2%	1.3%	16.7%	7.9%
Not sure	20.4%	25.3%	11.1%	17.5%
Years since first sex work	1.97	2.50	2.82	2.45	F=6.32, p=.002
Elective male partners
Lifetime	30.8%	52.6%	47.1%	42.5%	x2=23.0, p<.001
Current (past 30 days)	18.0%	35.1%	30.7%	27.2%	x2=17.4, p<.001
Elective female partners
Lifetime	83.2%	81.8%	65.0%	75.1%	x2=29.1, p<.001
Recent (past 90 days)	64.8%	61.0%	43.5%	54.8%	x2=28.4, p<.001
UAI last sex work	28.2%	54.5%	24.8%	32.7%	x2=43.7, p<.001

Table 4

Drug use by city

	Hanoi	Nha Trang	HCMC	Overall	Significance
Current drug use (past 30 days)
Alcohol	82.4%	93.5%	80.4%	83.9%	x2=13.75, p=.001
Tobacco	74.4%	73.4%	70.9%	72.7%	n.s.
Marijuana	12.0%	13.0%	6.9%	10.0%	n.s.
Ecstasy	8.0%	12.3%	15.7%	12.3%	x2=7.56, p=.023
Amphetamines	3.6%	8.4%	32.0%	16.9%	x2=89.18, p<.001
Any illicit drug
Lifetime use	52.0%	59.1%	66.0%	59.6%	x2=11.24, p=.004
Current use (past 30 days)	29.2%	28.6%	40.8%	34.1%	x2=10.97, p=.004

Full article at:   http://goo.gl/3VAZQs

By:   Goldsamt LA1, Clatts MC2, Giang LM3, Yu G1.

• 1New York University College of Nursing, New York, NY.
• 2School of Public Health, University of Puerto Rico, San Juan, PR.
• 3Hanoi Medical University, Hanoi, Vietnam. 

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