Hiv Incidence And Influential Factors Of Unprotected Anal Sexual Intercourse Among Men Who Have Sex With Men In Kunming

ObjectivesTo investigate the HIV incidence rate among men who have sex with men in Kunming and observe the correlation between unprotected anal sexual intercourse and HIV seroconversion during the research period. At the same time, to provide the theoretical basis for the implementation of HIV related intervention, the influential factors of unprotected anal sexual behavior was analyzed.MethodThrough this study, the methods included cohort study, cross-sectional study, and qualitative study. The cohort study was started from March2013, and we dated back the survey information from July2012. At the beginning of the study, we had finished the recruitment of participants, the baseline study, and the follow-up of some participants. Based on the survey data we had got, the participants who had been recruited would attend a12months prospective follow-up with a frequency of six month per visit. In the cohort study, The HIV incidence rate was calculated. According to whether having unprotected anal sexual intercourse, the participants were divided into exposure group and non-exposure group. We compared the disparity of HIV incidence rate between these two groups, and the correlation between unprotected anal sexual intercourse and HIV seroconversion was observed. Based on the cohort study, cross-sectional study was carried out to investigate the MSM (men who have sex with men) who took part in the HIV voluntary counseling and testing in the Yunnan provincial rainbow sky group between March2013and August2013. And combined with qualitative study information among HIV infections, we analyzed the related factors of having unprotected anal sexual intercourse.Results1HIV incidence rate among men who have sex with men during research periodAt the baseline survey,191cases of men who have sex with men were recruited into the cohort study, and160cases and132cases took part in the6months and12months follow-up survey respectively. The retention rate was83.77%and69.11%. During the research period, the total observational time is157.37PY (person year). Eight MSM had HIV seroconversion. The HIV incidence rate was5.08/100PY(person year)(95%CI=0.66～9.50/100PY).2the analysis of correlation between unprotected anal sexual intercourse and HIV seroconversionAccording to the baseline survey and follow-up information,80participants reported having unprotected anal sexual intercourse at the baseline survey and/or follow-up survey, so they were included into the exposure group.111participants reported using condoms consistently at the baseline survey and follow-up survey, so they were included into the non-exposure group. We found no significant difference between exposure group and non-exposure group in social demographic characteristics (age, marital status, ethnicity, educational level, occupation, and income), sexual orientation, and the participation of follow-up. There were a good balance and comparability between exposure group and non-exposure group.In the exposure group, the total observation time was65.73PY (person year), there were7cases of HIV seroconversion during12months follow-up, and HIV seroconversion rate was10.65/100PY(person year)(95%CI=4.25～17.05/100PY). In the non-exposure group, the total observation time was91.64PY (person year), there was1case HIV seroconversion during12months follow-up, HIV seroconversion rate was1.09/100PY(95%CI=0.05～2.13/100PY). The results of univariate Cox regression indicated that unprotected anal sexual intercourse had correlation with HIV seroconversion(p<0.05, RR=9.85).3The analysis of influential factors on unprotected anal sexual intercourseWhether having unprotected anal sexual intercourse was regarded as the dependent variable. We used univariate Logistic regression model to analyze the information of404participants, and the results indicated that age, ethnicity, whether using condoms in the first sexual anal intercourse, whether knowing about the information that sexual anal intercourse have the potential risk to transmit HIV in the first anal sexual intercourse, whether knowing about the information that using condoms consistently could reduce the HIV infection risk in the first anal sexual intercourse, sexual role in the last six months, whether having drunk sex in the last six months, STD history, whether having HIV testing and in the last year were correlated with the unprotected anal sexual intercourse(p<0.05).The variables of p<0.05were included into the multivariate Logistic regression model. And the results indicated that not taking part in the HIV testing(OR=3.32,95%CI=2.16～5.19), not using condoms in the first anal sexual intercourse(OR=3.36,95%CI=2.16～5.23) were the risky factors of having unprotected anal sexual intercourse in the last six months. The insertive sexual role(OR=0.44,95%CI=0.25～0.78) no STD history(OR=0.23,95%CI=0.09～0.60) were the protective factors of having unprotected anal sexual intercourse.4qualitative studies of HIV infections11cases of HIV positive MSM participated in the qualitative study. The majority of the participants had undergone a long process to recognize their own sexual orientation. Some participants reported that with the growth of age, homosexual orientation was developed naturally. But some participants reported that the formation of homosexual orientation or their sexual desire for men was affected by the social environment or their own experience. The interviewees generally reported that their awareness on HIV prevention was a little late. When they entered the gay community and experienced a long period of time after the first sexual act, they were unaware of the knowledge on HIV prevention. And what is more, some participants reported that they just learned the knowledge about HIV prevention from doctors of CDC (center for disease control and prevention) or volunteers of gay community organization when they had been tested with HIV positive. Participants reported that there were so many reasons to have unprotected anal sexual intercourse, such as unawareness of HIV preventive knowledge, feeling uncomfortable when they used condoms, sexual dynamic, having permanent sexual partners and so on. For the high rates of HIV infection among men who have sex with men, the participants also come up with their suggestions. Some participants hold a view that although CDC made en effort to prevent and control HIV epidemic, self-constraint was more important. Some participants reported that because of the double identity, eliminating or reducing the social discrimination was an important part.ConclusionIn the practical work, the more targeted interventional measures should be provided to the MSM who plays the receptive sexual role. The early intervention should be carried out among men who have sex with men to increase the condom use rate at the first homosexual intercourse and the awareness rate of HIV related knowledge at an early stage. To control the HIV epidemic among men who have sex with men, the implementation of HIV related intervention measures, the expansion of the coverage of HIV detection and the provision the standardized STD clinic service for MSM were very crucial.