Investigation On HIV Testing And Informed Partner Status Of Male Male Sex Workers In Beijing

BackgroundHIV continues to spread among men who have sex with men (MSM) on a global level. MSM in low and middle income countries have19.3times higher odds of having HIV compared with general population. MSM contributed to about half of new HIV infections in many Western countries. In China, MSM contributed to a third (33%) of recent estimated new HIV infections in2009, which was near tripled the estimated number (12%) in2007, and which was29.4%in2011. MSM are not only at high risk for HIV, but also the people that spread HIV to the general population. On the one hand, HIV testing remains an important part and entry point of HIV prevention and care, on the other hand, HIV status disclosure is also an important strategy for HIV prevention and care. Current effective tools for HIV prevention depend upon knowing one’s serostatus, including viral load suppression, prevention with positive, pre-exposure prophylaxis, and seroadaptation. Only by expanding HIV testing, reducing the levels of undiagnosed HIV infection and encouraging disclosure of HIV status these tools can be effective. We therefore conducted a behavioral and serological survey of MSM in Beijing in order to assess the prevalence and correlates of HIV testing and being unaware of HIV infection among MSM and HIV status disclosure among HIV-negative MSM, so as to provide valuable basis for establishing HIV intervention measures.Objective1To understanding the prevalence of and factors associated with HIV testing and being unaware of HIV infection among MSM in Beijing.2To determine the prevalence of and factors associated with HIV testing in the past year among MSM in Beijing.3To assess the prevalence and correlates of HIV status disclosure among Beijing MSM MethodsCross sectional biological and behavioral surveys using respondent-driven sampling (RDS) were conducted among Beijing MSM in2009and2010. After eligibility screening and obtaining informed consent, each participant received a20minute computer-assisted interview (The questionnaire gathered information including demographic characteristics, behaviors and psychology). Blood was drawn for HIV and syphilis screening. We conducted descriptive statistical analysis, logistic regression analysis and generalized estimating equations (GEE) analysis using SAS9.1software.Results500eligible MSM were recruited between September-and October in2009. HIV prevalence was7.2%with86.1%(31/36) unaware of their infection;33.2%had never tested. Never testing was associated with lower educational (adjusted odds ratio [AOR]1.6,95%confidence interval [CI]1.1-2.5), living in Beijing three years or fewer (AOR1.5,95%CI1.0-2.3), unprotected anal intercourse with most recent male partner (AOR1.6,95%CI1.0-2.4), being unaware of the most recent male partner’s HIV status (AOR3.6,95%CI2.1-6.1), and holding higher levels of stigmatized attitudes towards persons with HIV (AOR1.1per scale point,95%C I1.0-1.1). Predictors of having undiagnosed HIV infection were being married (AOR2.4,95%CI1.0-5.4), living in Beijing three years or fewer (AOR3.6,95%CI1.5-8.4), being unaware of the most recent male partner’s HIV status (AOR6.8,95%CI0.9-51.6), and holding negative attitudes towards safe-sex (AOR1.1per scale point,95%CI1.0-1.1).500eligible MSM were recruited between October in2010and January in2011. Of the participants,60.2%received a HIV test in the past12months. HIV prevalence was7.8%with97.4%(38/39) of them unaware of their infection. Multivariable logistic regression analysis indicated that HIV testing in the past year was associated with living in Beijing more than three years (AOR1.6,95%CI1.0-2.5), knowing ten or more local MSM (AOR1.6,95%CI1.0-2.5), disclosing HIV status to most recent male partner (AOR4.4,95%CI2.8-6.8), unprotected sex with most recent female partner (AOR0.4,95%CI0.2-0.8), receiving free condom/lubricant in the past12months (AOR5.5,95%CI3.3-9.2).Of these500MSM,479(95.8%) had at least one male partner in the past six months. Of these479men,332MSM had a previous HIV-negative test result thus considered themselves HIV-negative and were included in our analysis of disclosure, but seven tested HIV positive in this study. On the individual level, MSM who disclosed were more likely to be living with a main partner (χ212.45, P=0.0004). On the partnership level, using GEE analysis to characterize individuals from their partnership data we found having at least one main partnership (AOR1.0,95%CI1.0-1.0,χ27.91, P=0.005) and knowing people who were infected with HIV (AOR1.4,95%CI1.1-1.7, χ27.48, P=0.006) to be associated with a participant being a discloser.ConclusionThe study revealed that the level of HIV testing was low and undiagnosed HIV infection was high among Beijing MSM, stigmatizing and discriminatory attitudes wards people living with HIV/AIDS inversely associated with HIV testing. The findings of this study highlighted the urgent needs to reduce HIV/AIDS related stigma and discrimination, expand HIV testing and reduce the levels of undiagnosed HIV infection among this group.The high level of HIV infection, low level of HIV testing in the past12months suggest an urgent need to adopt feasible measures of prevention. We can make full use of the internal social networking among MSM as platform for propaganda, reduce risky sexual behavior with female partner, promote HIV disclosure, popularize AIDS knowledge, eliminate fear and discrimination psychology, not only promote HIV testing, but also encourage MSM to take HIV testing regularly, thus effectively control the spread of HIV in this population.While disclosure apparently occurs in main partnerships interventions may need to prioritize increasing disclosure among casual partnerships as well. Not knowing others who are infected with HIV may reinforce men’s perception that they are at low risk for HIV infection and thus act against having conversations about HIV with sexual partners. Campaigns that work to create healthy dialog between HTV-negative and HIV-positive men may serve to reduce risk for new infections.