Effects Of A Syndemic On Risk Sexual Behaviors Among Men Who Have Sex With Men In Guangzhou,China

Objective:This stuy was designed to understand the prevalence of high-risky sexual behaviors,such as unprotected anal intercourse（UAI）and multiple sexual partners（MSPs）,in Guangzhou MSM and identify the influencing factors of high-risky sexual behaviors.To explore the interaction between coexisting society psychological behavioral factors on MSM high-risk sexual behavior based on the syndemic theory.Methods:From June 2017 to April 2018,with the assistance of the Guangzhou Center for Disease Control and Prevention,a cross-sectional survey was conducted relying on the Zhitong Charity’s Youtong Voluntary Counseling and Testing（VCT）Clinic.An anonymous electronic questionnaire survey was conducted by Guangzhou MSM,which recruited from the Youtong VCT Clinic using a convenient sampling method,to collect imformation on social-demographic,sexual behaviors,society psychosocial behavior（including:Childhood sexual abuse（CSA）,Intimate partner violence（IPV）,depressive symptoms,Internalized homophobia（IH）,higer level of Sexual sensation seeking（SSS）and the alcohol/rush popper use before sex）characteristics and the prevalence of high-risk sexual behaviors.Logistic regression model was used to analyze the influencing factors of high-risk sexual behaviors.The contingency table?² test and logistic regression model were used to verify the dose-response relationship between the number of society psychosocial behavior factors and high-risk sexual behaviors.Multi-order latent variable syndemic structural equation model（SEM）was used to explore the syndemic effect of society psychosocial behavior factors on high-risk sexual behavior.Statistical analysis was performed using SAS 9.4.Results:1.Basic characteristic:Among the 568 participants,ages range from18 to 51 years old,the median age（IQR）was 26（23,30）years old.Most of the participants were non-Guangzhou residents（72.01%）but local residence time more than 1 year（87.32%）,colleges and above degree（78.70%）,unmarried（87.68%）,with 17.73%were student MSM.Majority of the participants identified themselves as homosexual（72.18%）,while 22.54%as bisexual,and 86.09%of MSM searched for sexual partners through the Internet.The median first same-sex anal intercourse age was（21.90±4.44）years old,and 28.17%of participants no/unsure used condom at their first same-sex anal intercourse.The mean SSS score among all participants was 25.92±6.54 points.The prevalence of depressive symptoms and IH was 45.60%and 58.63%,respectively.The proportion of MSM had experience CSA,IPV,had use alcohol and rush popper before sex last 6 months was 23.59%,13.20%,33.80%and33.40%,respectively.Among the 568 participants,500 MSM had sex with male partners in the last 6 months.Individuals with self-reported any UAI in last 6 month accounted for 44.40%,MSPs（two or more sexual partners）for 60.40%.2.Correlation analysis:MSM with the domicile is other city of Guangdong province,married,employed/part-time,unemployed,not used or unsure whether the use of condoms at first same-sex anal intercourse,higher level of SSS were more likely to have UAI,with the OR（95%CI）of 1.60（1.03².48）,2.44（1.41⁴.21）,1.70（1.02².86）,2.04（1.10³.78）,1.78（1.15².75）,2.93（1.41⁶.07）and 1.50（1.05².15）,respectively,and the higher the education level the risk of unprotected anal sex was lower（P<0.05）.MSM with higher level of SSS,had CSA experience and had use rush popper before sex were more likely to have MSPs,with the OR（95%CI）of 1.94（1.35².79）,1.86（1.19².91）and2.41（1.60³.61）,respectively.MSM with older age group（OR=0.55,95%CI:0.32⁰.95）,age of first same-sex anal intercourse≥18 years old（OR=0.53,95%CI:0.28¹.00）the risk of MSPs was reduced.2.Syndemic analysis:94.80%of MSM had at least one society psychosocial behavior problem,while 76.00%had two or more kinds of society psychosocial behavior problems at the same time.The larger number of social psychological behavior problems existed,the higher risk of UAI（aOR=1.23,95%CI:1.05¹.45）and MSPs（aOR=1.33,95%CI:1.13¹.56）.The second-order latent variable syndemic SEM is better than the first-order latent variable syndemic SEM,and the ability to explain high-risk behavioral variation is also significantly increased(R²_{second order}=91%,R²_{first order}=66%).There is a strong linear relationship between the syndemic burden and the high-risk sexual behavior formed by the potential interaction of violent incidents,mental health,and substance use behaviors（Standard regression coefficient=0.96）.Among them,mental health contributes the most to the syndemic burden(R²_{mental health}=96%,R²_{violent incidents}=58%,R²_{substance use}=34%).Conclusions:1.The prevalence of UAI among Guangzhou MSM is still high level,common to have MSPs,which still have a high risk of transmission and HIV infection.2.There are many factors associated with high-risk sexual behavior:the domicile is other city of Guangdong province,married,the low education level,off-campus social staff,not or unsure whether the use of condoms at first same-sex anal intercourse,higher level of SSS were more likely to have UAI;lower age,age of first same-sex anal intercourse was younger,higher level of SSS,had CSA experience,had use rush popper before sex are associated with MSPs.More attention should be focus on key populations,and appropriate intervention strategies should be developed.3.Guangzhou MSM experienced a variety of concurrent society psychosocial behavior problems,and the interaction of these problems forms a syndemic burden and is closely related to the occurrence of high-risk sexual behavior:The larger number of social psychological behavior problems existed,the higher risk of UAI and MSPs.The second-order latent variable syndemic SEM is better than the first-order latent variable syndemic SEM.There is a strong linear relationship between the syndemic burden and the high-risk sexual behavior formed by the potential interaction of violent incidents,mental health,and substance use behaviors.Among them,mental health contributes the most to the syndemic burden.Therefore,we should fully consider the multiple social psychological behavior problems and their internal interactions in MSM when formulating targeted interventions and health care policies to improve the intervention effect.Mental health screening and psychological counseling are could be prioritized under limited health resources.