Is Involvement in Sex Work Associated with Engagement in HIV-Related Medical Care in Latin American Men Who Have Sex with Men? Results of a Large, Multinational Internet Survey

Men who have sex with men (MSM) who engage in transactional sex are at increased HIV risk, and face complex barriers to care seeking. Among 2,035 men recruited through an MSM social/sexual networking website in Latin America and who reported being HIV-infected, 186 (9.1%) reported being paid for sex with another man in the past year. Engagement in transactional sex was associated with decreased odds of receiving medical care for HIV (AOR=0.57, 95% CI=0.37–0.85). No significant differences were seen in being on antiretroviral therapy (ART) or ART adherence once in care. Interventions in this population should focus on reducing barriers to engagement in care.

...Results of this analysis suggest that there are disparities in receipt of HIV medical care associated with recent engagement in transactional sex among HIV-infected MSM in Latin America. The ability to access HIV-related medical care is related not only to availability of care facilities, but also barriers and facilitators to engagement and retention in care, and these factors may be compounded for MSM who engage in transactional sex. For example, stigma and discrimination may limit care seeking to a greater extent among men who engage in transactional sex, given multiple sources of stigma. Previous research suggests that MSM may face sexual stigma from multiple dimensions. Stigma from healthcare providers may limit disclosure of sexual orientation or sexual behaviors among MSM, if they anticipate discrimination following disclosure.¹⁶Among people living with HIV, HIV and healthcare stigma has been associated with decreased care-seeking behavior.^9,12 MSM who engage in transactional sex may experience additional stigma due to being involved in sex work, which is illegal and/or socially unacceptable across most of Latin America, and which has been described as a barrier to care seeking among female sex workers.^17,18 Although experienced and/or perceived stigma could act as a mechanism through which MSM who engage in transactional sex in Latin America have decreased engagement in HIV care, we were unable to quantify experiences of stigma in this study. Future work should consider the role of experienced and/or perceived stigma specifically as a barrier to engaging in care in this population.

...Interestingly, although participants who engaged in transactional sex were less likely to be engaged in HIV-related medical care, prior research by this team¹⁵ and by others in other regions²¹ indicates that MSM who engage in transactional sex are more likely to have a history of HIV testing and of HIV diagnosis.^22,23 This may indicate that men who engage in transactional sex are aware of their increased risk and thus are more likely to test for HIV, but that there are structural, interpersonal, and individual factors—including differential power dynamics due to social or economic position, physical or sexual violence, substance use, and/or psychological distress⁷—which are major barriers to linkage and continued engagement in care if diagnosed...

  

Full article at:  http://goo.gl/5RWUOC

By: Katie B. Biello, PhD, MPH, ^1,,2 Catherine E. Oldenburg, MPH,¹ Joshua Rosenberger, PhD,³ Kenneth H. Mayer, MD,^2,,4,,5 David Novak, MSW,⁶ and Matthew J. Mimiaga, ScD, MPH^1,,2,,7,,8

¹Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.

²The Fenway Institute, Fenway Health, Boston, Massachusetts.

³Department of Global and Community Health, George Mason University, Fairfax, Virginia.

⁴Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

⁵Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.

⁶OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts.

⁷Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.

⁸Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.

¹Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.

²The Fenway Institute, Fenway Health, Boston, Massachusetts.

³Department of Global and Community Health, George Mason University, Fairfax, Virginia.

⁴Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

⁵Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.

⁶OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts.

⁷Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.

⁸Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.

LGBT Health. 2016 Jun 1; 3(3): 233–237. doi:  10.1089/lgbt.2015.0006

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Risk Factors Associated with HIV among Men Who Have Sex With Men (MSM) in Ecuador

The Joint United Nations Program on HIV/AIDS estimates that between 0.3% and 0.7% of adults aged 15 to 49 years were living with HIV in Ecuador in 2013. However, very little is known about the HIV prevalence rate among men who have sex with men (MSM) in that country. 

A cross-sectional survey was conducted to investigate the knowledge, attitudes, and practices regarding HIV/AIDS as well as to estimate the prevalence of HIV among MSM in one of the cities with high HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 307 adult MSM. 

An HIV prevalence of 10% was observed. Knowledge about HIV was high; 91% of participants could identify how HIV is transmitted. Although consistent condom use for anal sex was relatively high (89%) among participants who reported having pay-for-service clients, only 64% reported using a condom during oral sex with a client. Participants who had multiple male sexual partners (i.e., their stable male partners plus other partner[s]) had 3.7 times higher odds of testing positive for HIV compared with those who did not. They also had reduced odds of condom use. Participants who were forced to have anal receptive sex had 3 times higher odds of testing positive for HIV. 

Despite the finding that participants exhibited high knowledge about HIV/AIDS, a high prevalence rate of HIV was observed, which warrants targeted behavioral interventions. These data are consistent with MSM being one of the highest at-risk population groups for HIV in this region of Ecuador.

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By:  Hernandez I1, Reina-Ortiz M2, Johnson A3, Rosas C4, Sharma V3, Teran S4, Naik E3, Salihu HM5, Teran E6, Izurieta R3.

• 1Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
• 2University of South Florida, Tampa, FL, USA Fundación Raíces, Esmeraldas, Ecuador.
• 3University of South Florida, Tampa, FL, USA.
• 4Universidad San Francisco de Quito, Quito, Ecuador.
• 5Baylor College of Medicine, Houston, TX, USA.
• 6Universidad San Francisco de Quito, Quito, Ecuador eteran@usfq.edu.ec.
• Am J Mens Health. 2016 May 8. pii: 1557988316646757 

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Sexual Positioning among Men Who Have Sex with Men: A Narrative Review

Sexual positioning practices among men who have sex with men (MSM) have not received a thorough discussion in the MSM and HIV literature, given that risks for acquiring or transmitting HIV and STIs via condomless anal sex vary according to sexual positioning. MSM bear a disproportionate burden of HIV compared to the general population in the United States; surveillance efforts suggest that HIV and STIs are increasing among domestic and international populations of MSM. 

We conducted a narrative review, using a targeted literature search strategy, as an initial effort to explore processes through which sexual positioning practices may contribute to HIV/STI transmission. Peer-reviewed articles were eligible for inclusion if they contained a measure of sexual positioning identity and/or behavior (i.e., "top", "bottom," etc.) or sexual positioning behavior (receptive anal intercourse or insertive anal intercourse), or assessed the relationship between sexual positioning identity withHIV risk, anal sex practice, masculinity, power, partner type, or HIV status. 

A total of 23 articles met our inclusion criteria. This review highlights dynamic psychosocial processes likely underlying sexual decision making related to sexual positioning identity and practices among MSM and MSM who have sex with women (MSMW), and ways these contexts may influence HIV/STI risk. 

Despite limited focus in the extant literature, this review notes the important role the contextual factors (masculinity stereotypes, power, partner type, and HIV status) likely to play in influencing sexual positioning identity and practices. Through this review we offer an initial synthesis of the literature describing sexual positioning identities and practices and conceptual model to provide insight into important areas of study through future research.

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By:  Dangerfield DT 2nd1, Smith LR2, Williams J3, Unger J3, Bluthenthal R3.

• 1Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA. ddangerf@usc.edu.
• 2Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA.
• 3Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA.
• Arch Sex Behav. 2016 May 13. 

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Correlates of Sexual Violence among Men Who Have Sex with Men in Tijuana, Mexico

Sexual violence among men who have sex with men (MSM) is prevalent in developing countries and is associated with increased HIV/STI risk. Despite high HIV prevalence (20 %) among MSM in Tijuana, Mexico, little attention has been paid to the occurrence of sexual violence in this high-risk group. 

The present study used a syndemic conditions framework to examine correlates of sexual violence victimization in a sample of 201 MSM surveyed in Tijuana, Mexico during 2012 and 2013. Participants were recruited through respondent-driven sampling and underwent a 2-h baseline interview and testing for HIV and syphilis. Sexual violence was defined as any incident during the past year in which the participant had been raped, sexually molested, or sexually harassed. 

The majority of participants self-identified as gay or bisexual, had never married, were employed, and had a high school education or greater. The average age was 29.7 years. Thirty-nine percent reported sexual violence in the past year. A hierarchical multiple linear regression model predicting more experiences of sexual violence was tested. In a final model, a higher number of experiences of sexual violence was associated with a history of childhood sexual abuse, more adult experiences of homophobia, more depression and hostility symptoms, and not living with a spouse or steady partner. 

The findings from this study support a model of co-occurring psychosocial factors that increase the likelihood of sexual violence experiences among MSM. Multi-level approaches to the prevention of childhood and adult experiences of sexual violence and homophobia are needed to avert the development of adverse mental and physical health outcomes associated with sexual violence victimization.

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By:  Semple SJ1, Stockman JK2, Goodman-Meza D3, Pitpitan EV2, Strathdee SA2, Chavarin CV1, Rangel G4, Torres K5, Patterson TL6.

• 1Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
• 2Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
• 3Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
• 4US-Mexico Border Health Commission, Tijuana, Mexico.
• 5Agencia Familiar Binacional, A.C., Tijuana, Mexico.
• 6Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA. tpatterson@ucsd.edu. 
• Arch Sex Behav. 2016 May 13. 

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Availability and Quality of Size Estimations of Female Sex Workers, Men Who Have Sex with Men, People Who Inject Drugs and Transgender Women in Low- and Middle-Income Countries

Objective

To assess the availability and quality of population size estimations of female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women.

Methods

Size estimation data since 2010 were retrieved from global reporting databases, Global Fund grant application documents, and the peer-reviewed and grey literature. Overall quality and availability were assessed against a defined set of criteria, including estimation methods, geographic coverage, and extrapolation approaches. Estimates were compositely categorized into ‘nationally adequate’, ‘nationally inadequate but locally adequate’, ‘documented but inadequate methods’, ‘undocumented or untimely’ and ‘no data.’

Findings

Of 140 countries assessed, 41 did not report any estimates since 2010. Among 99 countries with at least one estimate, 38 were categorized as having nationally adequate estimates and 30 as having nationally inadequate but locally adequate estimates. Multiplier, capture-recapture, census and enumeration, and programmatic mapping were the most commonly used methods. Most countries relied on only one estimate for a given population while about half of all reports included national estimates. A variety of approaches were applied to extrapolate from sites-level numbers to national estimates in two-thirds of countries.

Conclusions

Size estimates for FSW, MSM, PWID and transgender women are increasingly available but quality varies widely. The different approaches present challenges for data use in design, implementation and evaluation of programs for these populations in half of the countries assessed. Guidance should be further developed to recommend: a) applying multiple estimation methods; b) estimating size for a minimum number of sites; and, c) documenting extrapolation approaches.

Below:  Categorization of population size estimates of female sex workers, men who have sex with men, people who inject drugs, and transgender women in low- and middle-income countries, 2010–2014

Full article at:   http://goo.gl/wG4uNP

By:  

Keith Sabin, Sonia Arias Garcia 
Strategic Information and Evaluation Department, the Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland

Jinkou Zhao, Yaou Sheng, Annette Reinisch 

Technical Advice and Partnerships Department, The Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

Jinkou Zhao

Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China

Jesus Maria Garcia Calleja 

Department of HIV/AIDS, World Health Organization, Geneva, Switzerland

Ryuichi Komatsu 

Technical Evaluation Reference Group Support Team, The Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

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Risk behaviours of an interrelated syphilis-infected sexual network of men who have sex with men

AIMS AND OBJECTIVES:

We examined the risk behaviours in an interrelated sexual network of 33 syphilis-infected men who have sex with men on the use of condoms, substances and websites to meet sexual partners. Our study used a descriptive exploratory design to investigate co-occurring high-risk behaviours in this interrelated sexual network to inform future health interventions and research directions.

BACKGROUND:

Although the risk behaviours for human immunodeficiency virus transmission in men who have sex with men have been studied, few have studied the high-risk population of men who already have syphilis, and even fewer have studied the risk behaviours in sexual networks of syphilis-infected men who have sex with men who were identified using contact tracing.

DESIGN/METHODS:

The data were collected from semi-structured, individual interviews at a not-for-profit lesbian, gay, bisexual and transgender health centre in a large city in the Midwestern USA.

RESULTS:

Inconsistent condom use was substantial during both insertive (92%) and receptive (88%) anal intercourse. Most participants (97%) reported using one or more substances prior to or during anal intercourse, and Internet websites were the most common place to meet sexual partners (88%).

CONCLUSIONS:

High-risk behaviours were significant within this syphilis-infected sexual network of men who have sex with men. The majority of our 33 participants were non-Hispanic Whites (n = 27, 82%), possessed a baccalaureate degree or higher (n = 23, 70%), and actively sought out unprotected anal intercourse [21 participants (64%) used BareBackRT.com, a website to seek out unprotected anal intercourse].

RELEVANCE TO CLINICAL PRACTICE:

Nurses should be more informed about the risk factors of a high-risk sexual network of syphilis-infected men who have sex with men. Interrelated sexual networks have high levels of similarity among participants' high-risk behaviours; contact tracing may be used to identify individual participants for relevant risk-reduction interventions.

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By:  Diesterheft R¹, Brady JP², Shattell M^1,3.

¹School of Nursing, DePaul University, Chicago, IL, USA.

²Department of Psychology, DePaul University, Chicago, IL, USA.

³Department of Community, Systems, and Mental Health Nursing, Rush University, DePaul University, Chicago, IL, USA.

J Clin Nurs. 2016 Apr 22. doi: 10.1111/jocn.13209. [Epub ahead of print]

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Duration of Gonorrhoea & Chlamydia Infection at the Pharynx & Rectum among Men Who Have Sex with Men: A Systematic Review

Background:

Chlamydia and gonorrhoea are the two most common sexually transmissible infections (STI) among men who have sex with men (MSM) worldwide. Infections at the pharynx and rectum are usually asymptomatic; however, the natural history of these infections remains unknown. The aim of this study is to estimate the duration of both infections at the extragenital sites from published epidemiological cohort studies.

Methods:

English peer-reviewed articles were searched from 1 January 2000 to 12 March 2015 in three electronic databases (MEDLINE, EMBASE and Cochrane Central). The prevalence-to-incidence ratio from each study was calculated to reflect the duration of each infection. This review followed the PRISMA guidelines and was registered in PROSPERO (CRD42014007087).

Results:

There were 2585 records identified, with 1721 abstracts and 52 full-text articles screened, resulting in four studies fulfilling the inclusion criteria. Pharyngeal gonorrhoea (114-138 days) had a shorter duration of infection than rectal gonorrhoea (346 days). In addition, chlamydia had a longer duration of infection at the pharynx (667 days) and rectum (579 days) compared with gonorrhoea infection.

Conclusions:

Gonorrhoea has a shorter duration of infection than chlamydia, suggesting that annual STI screening will be more effective at diagnosing chlamydia than gonorrhoea. The current STI guidelines recommend screening gonorrhoea and chlamydia at least once a year in MSM; it would only detect ~30% of incident pharyngeal gonorrhoea cases, with a mean duration of 4 months.

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By:  Eric P. F. Chow A B C, Shayne Camilleri A, Christopher Ward A, Sarah 

Huffam A,Marcus Y. Chen A B, Catriona S. Bradshaw A B and Christopher K. Fairley A B 

A Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, Vic. 3053, Australia. B Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic. 3004, Australia. C Corresponding author. Email: echow@mshc.org.au 

Sex Health. 2016 Feb 18. doi: 10.1071/SH15175. 

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Providing HIV-Related Services in China for Men Who Have Sex with Men

Problem

In China, human immunodeficiency virus (HIV) care provided by community-based organizations and the public sector are not well integrated.

Approach

A community-based organization and experts from the Guangzhou Center for Disease Control and Prevention developed internet-based services for men who have sex with men, in Guangzhou, China. The internet services were linked to clinical services offering HIV testing and care.

Local setting

The expanding HIV epidemic among men who have sex with men is a public health problem in China. HIV control and prevention measures are implemented primarily through the public system. Only a limited number of community organizations are involved in providing HIV services.

Relevant changes

The programme integrated community and public sector HIV services including health education, online HIV risk assessment, on-site HIV counselling and testing, partner notification, psychosocial care and support, counting of CD4+ T-lymphocytes and treatment guidance.

Lessons learnt

The internet can facilitate HIV prevention among a subset of men who have sex with men by enhancing awareness, service uptake, retention in care and adherence to treatment. Collaboration between the public sector and the community group promoted acceptance by the target population. Task sharing by community groups can increase access of this high-risk group to available HIV-related services.

Below:  HIV testing of men who have sex with men through a project linking internet-based HIV services to testing, in Guangzhou, China, 2008–2013

Full article at:  http://goo.gl/K7wbD6

By:  Weibin Cheng,^a Yanshan Cai,^a Weiming Tang,^b Fei Zhong,^a Gang Meng,^c Jing Gu,^d Chun Hao,^d Zhigang Han,^a Jingyan Li,^c Aritra Das,^e Jinkou Zhao,^f Huifang Xu,^a Joseph D Tucker,^b and Ming Wang^a

^aDepartment of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Jiahe, Guangzhou, Guangdong,510440, China.

^bUniversity of North Carolina Project-China, Guangzhou, China.

^cLingnan Partners Community Support Center (GZTZ.ORG), Guangzhou, China.

^dSchool of Public Health, Sun Yat-sen University, Guangzhou, China.

^eFielding School of Public Health, University of California Los Angeles, Los Angeles, United States of America.

^fGlobal Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.

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Depression & HIV Risk among Men Who Have Sex with Men in Tanzania

Studies have shown high rates of depression among men who have sex with men (MSM) in developed countries. Studies have also shown association between depression and HIV risk among MSM. However, very little research has been done on depression among African MSM. 

We assessed depression and HIV risk among a sample of MSM in Tanzania. We reviewed data on 205 MSM who were recruited from two Tanzanian cities using the respondent driven sampling method. Demographic and behavioral data were collected using a structured questionnaire. HIV and sexually transmitted infections data were determined from biological tests. Depression scores were assessed using the Patient Health Questionnaire (PHQ-9). For the analysis, depression scores were dichotomized as depressed (PHQ > 4) and not depressed (PHQ ≤ 4). Bivariate and multivariable Poisson regression analyses were conducted to assess factors associated with depression. 

The prevalence of depression in the sample was 46.3%. The mean (±SD) age of the sample was 25 (±5) years. In bivariate analysis, depression was associated with self-identifying as gay (p = .001), being HIV positive (p < .001: <8% of MSM knew they were HIV infected) and having a high number of sexual partners in the last 6 months (p = .001). 

Depression was also associated with sexual (p = .007), physical (p = .003) and verbal (p < .001) abuse. In the Poisson regression analysis, depression was associated with verbal abuse (APR = 1.91, CI = 1.30-2.81). Depression rates were high among MSM in Tanzania. It is also associated with abuse, HIV and HIV risk behaviors. Thus, reducing the risk of depression may be helpful in reducing the risk of HIV among MSM in Africa. 

We recommend the colocation of mental health and HIV preventive services as a cost-effective means of addressing both depression and HIV risk among MSM in Africa.

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By:  Ahaneku H1, Ross MW2, Nyoni JE3, Selwyn B1, Troisi C4, Mbwambo J5, Adeboye A6, McCurdy S6.

• 1 Department of Epidemiology, Human Genetics and Environmental Sciences , The University of Texas School of Public Health , Houston , TX , USA.
• 2 Department of Family Medicine and Community Health , University of Minnesota , Minneapolis , MN , USA.
• 3 Department of Sociology and Anthropology , University of Dar es Salaam , Dar es Salaam , Tanzania.
• 4 Department of Management, Policy and Community Health , The University of Texas School of Public Health , Houston , TX , USA.
• 5 Department of Psychiatry , Muhimbili University of Health Sciences , Dar es Salaam , Tanzania.
• 6 Department of Health Promotion and Behavioral Sciences , The University of Texas School of Public Health , Houston , TX , USA
• AIDS Care. 2016 Mar;28 Suppl 1:140-7. doi: 10.1080/09540121.2016.1146207. 

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