| BackgroundHomosexual behavior among men has become the main route of HIV infection which ranks next to heterosexual transmission in China currently. HIV epidemic among men who have sex with men (MSM) is now growing swiftly and its risk factors are widely existing and inter-related complicatedly. Therefore, further research of HIV epidemic risk factors and exploitation of the effective measures to promote HIV testing and antiretroviral therapy (ART) are urgently needed among this population.Object1. To understand unprotected anal intercourse (UAI) of different anal sex role and HIV testing and preventive services accessibility among MSM.2. To understand drug use and the interaction effects of alcohol use before sex and poppers use on HIV related high risk behaviors among MSM.3. To compare the different effects of the control group and intervention group on ART enrollment and viral suppression through randomized field trial.Method1. To understand how anal sex role may modify UAI and the effects of UAI correlates, and the related factors of HIV testing and preventive services accessibility among MSM in Beijing through the survey data of previous three cross-sectional study.2. To analyze drug use and related factors among MSM in Beijing through a cross-sectional study.3. To compare the different effects of the control group and intervention group on ART enrollment and viral suppression through a randomized field trial, in which the intervention group was given a intervention of interactive short message (SMS) and peer counseling/referral combined with standard HIV care whereas the control group was given the standard HIV care only.ResultsA total of 500,385 and 427 eligible participants were recruited through three cross-sectional studies from 2009-2011 respectively, in which 475(95%),352(91.4%) and 403(85.4%) self-reported having anal intercourse behavior in the last 6 months, and the proportion of unprotected anal intercourse was 46.9% (577/1230). Compared with "receptive" anal sex role and "versatile" anal sex role, the proportion of UAI was relatively lower among "insertive" anal sex role, and the proportions were 53%,51% and 39%, respectively. Regardless of sexual position, UAI was associated with cohabiting with a male or female partner and perceiving great or moderate risk of HIV infection from male contact at the individual level, and steady (vs. casual) partnership at the dyad level. However, early MSM anal sex debut, high number of male partners, alcohol use, receiving free condoms/lubricant, HIV testing, and MSM sex-seeking venues were found to be only statistically significantly correlated with UAI among some but not all sexual positions.In three cross-sectional survey of MSM in Beijing, the proportion of ever having HIV testing was 69.0% (905/1312); receiving free condoms/lubricant last year:78.7% (1033/1312); the proportion of HIV testing:56.2% (737/1312); the proportion of STD diagnosis/treatment: 46.1% (605/1312); the proportion of comprehensive preventive services 39.6%(520/1312). MSM with larger social networks and who knew someone infected with HIV were more likely to receive HIV testing and preventive services; lower degrees of stigma and discriminatory attitudes toward HIV/AIDS were positively associated with having an HIV test, whereas unprotected anal intercourse in the past 6 months (P6M) was associated with less preventive services participation. The mostly reported barriers to HIV testing were fear of testing HIV positive (79.3%) and perceiving no risk for HIV (75.4%). Almost all participants felt that ensuring confidentiality would encourage more MSM to have a HIV testing. The two main reasons for not seeking HIV test were not knowing where to go for a test (63.2%) and perceiving low risk of HIV infection (55.1%).In the cross-sectional survey of 2013-2014,3588 participants were recruited. The HIV and syphilis infection rates were 12.7% (455/3588) and 7.5% (269/3588), respectively. The most popular new drugs were poppers in the past 3 month, the proportion of using them at least once was 26.8% (961/3588). Risk factors of poppers use were:having a bachelors degree or higher (AOR=1.46,95%CI:,1.09-1.95), monthly income of 5000 yuan (AOR=1.69, 95%CI:,1.42-2.02), more than 5 years of homosexual behavior (AOR=1.40,95%CI:, 1.15-1.70), seeking partners through the Internet (AOR= 1.44,95%CI:1.15-1.80), the previous cumulative number of male sexual partners was 6-10(AOR= 1.77,95%CI:,1.42-2.20) or more than 11 (AOR=2.23,95%CI:or 1.78-2.80), perceiving low risk of HIV infection (AOR=2.10,95%CI:,1.37-3.22), median risk (AOR=1.97,95%CI:,1.27-3.05 in risk) and high risk (AOR=2.53,95%CI:,1.56-4.09), using alcohol before sexual intercourse (AOR=1.57,95%CI:,1.26-1.95), using two typs of drugs or more (AOR=6.42,95%CI:, 3.63-11.33), having more than 2 male sexual partners(AOR=1.64,95% CI:1.38-1.95) and UAI in the past 3 months(AOR=1.56,95%CI:1.30-1.86).A total of 367 newly diagnosed HIV positive MSM were recruited into the randomized field trial, in which they were randomly divided into the control group of 183 participants, and the intervention group of 184 participants. The proportion of ART initiation among newly diagnosed HIV positive MSM in 24 months of follow-up was 65.7% (241/367), the intervention group was significantly higher than the control group, and the proportions were 71.7%(132/184) and 59.6%(109/183), respectively. Multivariate logistic regression analysis showed that statistically significant correlates of ART initiation among newly diagnosed HIV positive MSM in 24 months of follow-up were:poppers use (AOR=9.23,95%CI:1.18-71.92), and having a score of 15 or higher in anxiety and depression scale (AOR=4.12,95%CI: 1.29-13.14) (when CD4<350 cells/?L); intervention group (AOR=1.74,95%CI:1.01-3.00), and without a permanent Beijng residence certificate (AOR=0.53,95%CI:0.26-1.09) (when CD4>350 cells/?L). Among 241 MSM receiving ART, viral load tests proportion was 91.7% (221/241). Viral suppression (viral load<20 copies/mL) proportion was 71.5%(158/221)and 91.9% (203/221) after 12 months and 24 months of ART initiation, respectively.Conclusion:Risk factors of HTV infection existed widely and interrelated among MSM in Beijing, such as unprotected sexual behavior, multiple sexual partners, the new drugs use, alcohol use before sex intercourse, never receiving HIV testing or not testing HIV regularly. The impact of high-risk behavior and substance use on HIV infection and transmission should be comprehensively considered in implementing preventive intervention in the future. Further exploration of effective comprehensive intervention measures for high-risk behavior and substance use, and the provision of substance abuse treatment and improved HIV testing and prevention services accessibility for MSM are needed.For newly diagnosed HIV infected MSM, standard HIV care combined with interactive SMS and peer counseling/referral can promote early infected MSM to begin ART in time, and those with ART also showed effective viral suppression. In the future, we should further expand the the coverage of HIV testing among MSM population and take effective care and interventions to promote newly diagnosed HIV infected MSM to initiate ART as soon as possible. |
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