Correlates of Anal Sex Roles among Malay and Chinese MSM in Kuala Lumpur, Malaysia

Identifying roles for anal sex is an important issue for populations of MSM. We describe the prevalence of identifying as being 'top', 'bottom', 'versatile', or 'don't know/not applicable' among Malay and Chinese MSM in Kuala Lumpur, Malaysia, and behavioural outcomes according to these labels for sexual role identity. 

Data analysis was conducted on a survey administered during weekly outreach throughout Kuala Lumpur in 2012. Pearson's Chi square tests were used to compare demographic and behavioural characteristics of MSM who reported roles for anal sex. Binary logistic regression was used to explore the odds of behavioural outcomes among MSM who identified as 'bottom', 'versatile,' and 'don't know' compared to MSM who reported that 'top' was their sexual role. 

Labels for anal sex roles were significantly associated with condom use for last anal sex. Among MSM who used labels for anal sex roles, MSM who identified as 'bottom' had highest level of not using condoms for last anal sex (24.1%). In binary logistic regression model, identifying as 'top' was significantly associated with reporting using a condom during last anal sex and reported consistent condom use for anal sex in the past six months. With regard to sexual role identity, some MSM may be a part of a special subgroup of at-risk men to be targeted. 

Future research should evaluate the origins, meanings, and perceptions of these labels, and the developmental process of how these MSM identify with any of these categories. Research should also uncover condom use decision making with regard to these labels for sexual positioning.

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By:  Dangerfield DT 2nd1, Gravitt P2, Rompalo AM3, Tai R4, Lim SH5.

• 1University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA ddangerf@usc.edu.
• 2University of New Mexico, Department of Pathology, Albuquerque, NM, USA.
• 3Johns Hopkins School of Medicine, Division of Infectious Disease, Baltimore, MD, USA.
• 4PT Foundation, Kuala Lumpur, Malaysia.
• 5Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• Int J STD AIDS. 2016 Mar;27(4):313-20. doi: 10.1177/0956462415581125. Epub 2015 Apr 16. 

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Pain, Instability & Familial Discord: A Qualitative Study into Women Who Use Drugs in Malaysia

Out of 20,887 persons who use drugs that came into contact with the National Anti-Drugs Agency (NADA) officials in the year 2013, 3.2 % were women. Because women who use drugs (WWUD) are often a hidden population, this may be an underestimate. International literature shows that women who use drugs face increased risk of HIV, intimate partner violence, and mental health issues. Similar literature in Malaysia is lacking, and thus, the objective of our study was exploratory in nature.

Thirty-eight women who use drugs were interviewed using a semi-structured topic guide in Kelantan, Penang, Johor, Kuala Lumpur, and Selangor. Locations were chosen purposively. Nineteen women were interviewed individually and the remaining 19 were in focus group discussions (FGDs). All interviews were transcribed verbatim, translated to English, and analyzed with NVivo.

Median age of respondents was 35.5 years old, 89.5 % ethnic Malays, majority having married below the age of 20, and were of low socioeconomic backgrounds. Youngest age of initiation into drug use was 9 years old. Most reported is inhalation of amphetamine-type substances. Seven reported ever injecting. Three themes emerged: (a) repeating patterns of fluid family structures and instability; (b) “pain” and “difficulty” as features of home life; and (c) seeking marriage as a source of stabilization and practices of power within those marriages. Respondents often came from very fluid family environments and married to find stability, only to be drawn into a similar cycle. None of the women who had been separated from their children either institutionally, by family members, or by third parties, had accessed legal recourse for the loss of their parental rights.

Unstable familial relationships or environments contributed to earlier initiation of drug use which raised questions about support services for WWUD and children who use drugs. Respondents were drawn into unstable and/or abusive relationships, perpetuating social inequalities that marked their own familial environments during childhood. These findings support the need for additional services to support the unique needs of WWUD, including domestic violence services, financial and life skills, parental rights assistance, and empowerment programs.

Full article at: http://goo.gl/ZWPVAw

By: Fifa Rahman^1*, Priya Lall², Sarah Iqbal¹ and B. Vicknasingam³

¹Malaysian AIDS Council, No. 12, Jalan 13/48A, Sentul Raya Boulevard, Kuala Lumpur, 51000, Malaysia

²University of Malaya, Medical Faculty, Kuala Lumpur, 50603, Malaysia

³Centre for Drug Research, Universiti Sains Malaysia, Penang, 11800, Malaysia

  

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The Syndemic of HIV, HIV-Related Risk & Multiple Co-Morbidities among Women Who Use Drugs in Malaysia: Important Targets for Intervention

Substance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders.

To explore HIV risk behaviors, substance use, and social factors associated with poor health outcomes among women who use drugs in Malaysia.

A cross-sectional survey of 103 drug-using women in Kuala Lumpur, Malaysia were recruited to assess their medical, psychiatric and social comorbidity as well as their engagement in nationally recommended HIV testing and monitoring activities.

One-third reported having ever injected drugs, with most (68.2%) having recently shared injection paraphernalia. Sex work (44.7%) and infrequent condom use (42.4%) were common as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women (62.1%) had unstable living situations and suffered from an unmet need for social support and health services. HIV prevalence was high (20%) with only two thirds of women eligible for antiretroviral therapy having received it. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence and negatively associated with drug injection.

Women who use drugs in Malaysia demonstrate considerable medical, psychiatric and social co-morbidity, which negatively contributes to optimal and crucial engagement in HIV treatment-as-prevention strategies. Mental health and social support may be key targets for future public health interventions aimed at drug-using women in Malaysia.

Purchase full article at: http://goo.gl/LdzjVf

By: Loeliger KB1, Marcus R2, Wickersham JA3, Pillai V4, Kamarulzaman A3, Altice FL5.

• 1Yale University School of Medicine, New Haven, CT, USA; Yale University School of Public Health, New Haven, CT, USA.
• 2Yale University School of Medicine, New Haven, CT, USA.
• 3Yale University School of Medicine, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• 4Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• 5Yale University School of Medicine, New Haven, CT, USA; Yale University School of Public Health, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: frederick.altice@yale.edu. 

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The Syndemic of HIV, HIV-Related Risk & Multiple Co-Morbidities among Women Who Use Drugs in Malaysia: Important Targets for Intervention

Substance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders.

To explore HIV risk behaviors, substance use, and social factors associated with poor health outcomes among women who use drugs in Malaysia.

A cross-sectional survey of 103 drug-using women in Kuala Lumpur, Malaysia were recruited to assess their medical, psychiatric and social comorbidity as well as their engagement in nationally recommended HIV testing and monitoring activities.

One-third reported having ever injected drugs, with most (68.2%) having recently shared injection paraphernalia. Sex work (44.7%) and infrequent condom use (42.4%) were common as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women (62.1%) had unstable living situations and suffered from an unmet need for social support and health services. HIV prevalence was high (20%) with only two thirds of women eligible for antiretroviral therapy having received it. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence and negatively associated with drug injection.

Women who use drugs in Malaysia demonstrate considerable medical, psychiatric and social co-morbidity, which negatively contributes to optimal and crucial engagement in HIV treatment-as-prevention strategies. Mental health and social support may be key targets for future public health interventions aimed at drug-using women in Malaysia.

Purchase full article at: http://goo.gl/p3QKKW

By: Loeliger KB1, Marcus R2, Wickersham JA3, Pillai V4, Kamarulzaman A3, Altice FL5.

• 1Yale University School of Medicine, New Haven, CT, USA; Yale University School of Public Health, New Haven, CT, USA.
• 2Yale University School of Medicine, New Haven, CT, USA.
• 3Yale University School of Medicine, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• 4Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• 5Yale University School of Medicine, New Haven, CT, USA; Yale University School of Public Health, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 

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HIV Prevalence among People Who Inject Drugs in Greater Kuala Lumpur

The HIV epidemic in Malaysia is concentrated among people who inject drugs (PWID). Accurate estimates of HIV prevalence are critical for developing appropriate treatment and prevention interventions for PWID in Malaysia. 

In 2010, 461 PWID were recruited using respondent-driven sampling in Greater Kuala Lumpur, Malaysia. Participants completed rapid HIV testing and behavioral assessments. Estimates of HIV prevalence were computed for each of the three recruitment sites and the overall sample. 

HIV prevalence was 15.8% overall but varied widely by location: 37.0% in Kampung Baru, 10.3% in Kajang, and 6.3 % in Shah Alam. 

Recruitment extended to locations far from initial interview sites but was concentrated around discrete geographic regions. We document the high prevalence of HIV among PWID in Greater Kuala Lumpur. 

Sustained support for community surveillance and HIV prevention interventions is needed to stem the HIV epidemic among PWID in Malaysia.

Via: http://ht.ly/SpjV1 

By: Bazazi AR1,2,3, Crawford F4, Zelenev A5, Heimer R6, Kamarulzaman A7,5,8, Altice FL6,7,5.

• 1Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
• 2Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. alexander.bazazi@yale.edu.
• 3Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT, 06510, USA.
• 4Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
• 5Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT, 06510, USA.
• 6Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
• 7Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• 8Infectious Diseases Unit, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.

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HIV Prevalence among People Who Inject Drugs in Greater Kuala Lumpur Recruited Using Respondent-Driven Sampling

The HIV epidemic in Malaysia is concentrated among people who inject drugs (PWID). Accurate estimates of HIV prevalence are critical for developing appropriate treatment and prevention interventions for PWID in Malaysia. 

In 2010, 461 PWID were recruited using respondent-driven sampling in Greater Kuala Lumpur, Malaysia. Participants completed rapid HIV testing and behavioral assessments. Estimates of HIV prevalence were computed for each of the three recruitment sites and the overall sample. 

HIV prevalence was 15.8% overall but varied widely by location: 37.0% in Kampung Baru, 10.3% in Kajang, and 6.3% in Shah Alam. Recruitment extended to locations far from initial interview sites but was concentrated around discrete geographic regions. 

We document the high prevalence of HIV among PWID in Greater Kuala Lumpur. Sustained support for community surveillance and HIV prevention interventions is needed to stem the HIV epidemic among PWID in Malaysia.

Via: http://ht.ly/S9Sq8 

By: Bazazi AR1,2,3, Crawford F4, Zelenev A5, Heimer R6, Kamarulzaman A7,5,8, Altice FL6,7,5.

• 1Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. alexander.bazazi@yale.edu.
• 2Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. alexander.bazazi@yale.edu.
• 3Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT, 06510, USA. alexander.bazazi@yale.edu.
• 4Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
• 5Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT, 06510, USA.
• 6Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
• 7Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• 8Infectious Diseases Unit, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.