The Risk Of HIV Transmission Via Sex And Its Correlates Among HIV-positive Men Who Have Sex With Men

Objective To understand the risk of HIV transmission to different types of partners among HIV-positive MSM who engaged in unprotected sex and to determine the related factors.And the result of research,will be documented for development of effective HIV interventions on HIV transmission among HIV-positive MSM who engaged in unprotected sex.Methods Participants were recruited by NGO of MSM community with “snowball” sampling in Shanghai and Chengdu,China.We collaborated with non-government organizations(NGO),Beautiful Life Health Promotion Center of Shanghai and Tongle Health Consulting Service Center of Chengdu,China.Data were collected of this study via a cross-sectional questionnaire survey among HIV positive MSM who were 18 years of age and older,and infected HIV through male same sex transmission and resided in Shanghai and Chengdu during research period.The survey was conducted on face-to-face by well trained staff of NGOs in a confidential room.The questionnaire was comprised of five parts:(1)Demographic characteristics included age,marital status,residence card,educational level,monthly income and sexual orientation;(2)Sexual behavior was made up of type of sexual partners(such as main partners,casual or commercial partners,and heterosexual partners),sexual insertive or receptive position,numbers of sexual partners,condom use,etc;(3)Substance use included alcohol,alkyl nitrite use,methamphetamine,heroin use;(4)Health status included time of diagnosed HIV,CD4 count,plasma HIV RNA,ART use and depression.(5)Disclosure of HIV status to their family and sexual partners.The prevalence of HIV transmission risk was distributed on demographic characteristics.The Chi-square test was use to assess the association of sociodemographic,sexual behaviors and health-related factors with HIV transmission risk,and finally multiple logistic regression models were used to determine the risk factors of sexual transmission risk among HIV-positive MSM who engaged in unprotected sex...Results A total of 308 participants were enrolled in this study.The average age was 35.4 years(SD=10.1)with 41.9%(129/308)of participants between 26 to 35 years old.The majority(58.8%)of participants had a residence card in Chengdu of Shanghai.Two-thirds(66.3%)of participants were unmarried and more than half(88.0%)had at least high school degree.79.5%(245/308)of participants identified themselves as homosexual.Of 308 participants,51.6%(159/308)had HIV-positive partners,37.7%(116/308)had HIV-negative partners and 57.1%(176/308)had unknown serostatus partners in the past six months.There were 8.4%(26/308)of participants reported that they erer had group sex.Among the 308 participants,84.7%(261/308)engaged in unprotected sexual behaviors with main partners in the last six months.The proportion of participants who had main partners of HIV positive or negative was 40.6%(106/261)and 20.3%(53/261),respectively.The proportion of participants who used condoms with main partners in the last sex was 52.1%(136/261).Of 308 participants,61.7%(190/308)had casual or commercial sex partners in the last six months and of whom,4.7%(9/190)had HIV-positive casual or commercial sexual partners and 14.2%(27/190)had HIV-negative casual or commercial sexual partners.The results of the survey showed that the proportion of participants who used condoms with casual or commercial partners constantly was only 9.5%(18/190).The survey presented that the proportion of participants who disclosed their status of HIV infection to all,some or none of main partners was 40.9%,23.1% and 33.2%,respectively and accordingly,the proportion of participants who disclosed their status of HIV infection to their all,some of and none of casual or commercial partners was 5.7%,23.8% and 70.5%,respectively.Participants who disclosure their status of HIV infection to family or neighbors accounted for 40.9% and 31.2%,respectively.Of 83 participants who had a wife,accounting for 26.9% of participants,14.6% reported that they disclosed their status of HIV infection to their wife.This survey showed that 35.4%(109/308)of participant reported that they had the risk of HIV transmission to their main sexual partners.The results from multivariate Logistic Regression revealed that the participants who dignosed HIV-positve in one years were more likely to have the risk of HIV transmission to their sexual partners.The risk of HIV transmission to their sexual partners increased with CD4 cell counts(compared with CD4 cell counts under 350/mL,OR=2.69 for CD4 cell counts were 350~500/mL,95%CI: 1.23~5.85 and OR=2.44 for CD4 cell counts?500/mL,95%CI:2.44~15.73)and decreased with disclosure to family(OR=0.41,95%CI: 0.19~0.87).Compared with disclosure to all main partners,participants who disclosed their HIV status to some or none of main partners were more likely to have the risk of HIV transmission to their sexual partners(OR=5.68,95%CI: 2.16~14.95 and OR=7.22,95%CI:2.91~17.96).The risk of HIV transmission to sexual partner also were associated with seeking partners through Internet(OR=2.53,95%CI: 1.19~5.34)and had casual or commercial partners in the past six months(OR=4.84,95%CI: 2.19~10.69).This survey found that participants who had the risk of HIV transmission to their main sexual partners accounted for 26.9%(83/308).The multivariate Logistic Regression presented that the risk of HIV transmission to main partners among participants diagnosed to be infected HIV in one year was 10 times that of ones who were diagnosed over three years.Participants seeking seual partners on internet were 3 times more likely to have the risk of HIV transmission to main sexual partners than others.The risk of HIV transmission to main partner would reduce 25% when participants disclosed their status of HIV infection to families.The participants who only disclosed their status of HIV infection to some or none of male main partners were more likely to have the risk of HIV transmission to main sexual partners,ORs are 23.4(95%CI: 6.04-90.37)and 31.7(95%CI: 8.79-114.57),respectively.The survey found that the proportion of participants who reported risk of HIV transmission to their casual or commercial sexual partner was 29.5%(91/308).Multivariate logistic analysis showed that the risk of HIV transmission to casual or commercial partners of participants who diagnosed HIV infection within 1 year was 7.6 times of those diagnosed HIV infection in 1-3 years.Participants who had HIV negative or unknown status male regular partners were more likely to have risk of HIV transmission to their casual or commercial partners(OR=7.8).Comparing with those had 350-500/mL or more CD4 cell counts,participants whose CD4 cell counts under the 350 /mL were less likely to have risk of HIV transmission to their casual or commercial partners.Conclusions In summary,this study demonstrated that one thirds of HIV-positive MSM who engaged unprotected sex has the risk of HIV transmission to sexual partners,25% of them has the risk to main partners and 30% to casual or commercial partners in China.Therefore,finding HIV infection earlier and taking ART in time are very important to control HIV spread in the MSM population.Meanwhile,promoting HIV-infected MSM to disclose their HIV status to sexual partners and their family members as well as to be receptive sexual role could reduce the risk of HIV transmission.