The Association Between Intimate Partner Violence Experience And High-risk Behaviors Among Men Who Have Sex With Men In Shandong Province

BackgroundAcquired immunodeficiency syndrome(AIDS)has become one of the biggest public health problems in the 21st century.According to the data from the Joint United Nations Program on HIV/AIDS in 2020,about 38 million people were living with HIV worldwide by the end of 2019,the number of new HIV infections has decreased from 2.7 million in 2000 to 1.7 million in 2019,and the number of AIDS-related deaths has decreased from 1.4 million in 2000 to 690,000 in 2019.The global AIDS prevention and control action has achieved some success,but the overall AIDS situation is still not optimistic.The social network of the men who have sex with men(MSM)is complex,with the characteristics of multiple sexual roles and partners.In addition,they also engaged in high-risk sexual behaviors such as unprotected anal intercourse,group sex,and new-type drugs abuse.Therefore,MSM have a high risk of HIV transmission and infection.The HIV/AIDS epidemic among MSM in Shandong province is relatively serious,and MSM has become the largest group of people living with HIV/AIDS patients in Shandong province in recent years.By October 31,2020,the number of people living with HIV/AIDS patients in Shandong province was 19157,of which 67.5 percent were transmitted through male homosexual behaviors.In recent years,new-type drugs are more prevalent among MSM,and new-type drug abuse will promote MSM to have high-risk sexual behaviors,thus aggravating the transmission and infection of HIV.Unprotected anal intercourse is the direct cause of HIV infection through the sexual route in MSM.The proportion of unprotected anal intercourse with any type of male sexual partners,fixed male sexual partners,non-regular male sexual partners,temporary male sexual partners,and commercial male sexual partners in the Chinese MSM was 53%,45%,34%,33%,and 12%,respectively.Group sex is also one of the high-risk sexual behaviors among MSM and is an independent risk factor for HIV infection.Intimate partner violence(IPV)describes physical,sexual,and psychological violence by a past or current intimate sexual partners or spouses.It can occur not only among heterosexual couples but also in homosexual relationships.More and more studies have suggested that IPV is a key factor in HIV transmission,and may be associated with higher levels of risk behaviors.IPV experience among the MSM population may lead to the increase of unprotected anal intercourse,group sex,and new-type drug abuse.ObjectivesThe purposes of this study are to investigate the basic information,IPV experience,and high-risk behavior characteristics among the MSM in Shandong province,to explore the associations between IPV experience and new-type drug abuse,unprotected anal intercourse,and group sex behavior,respectively,and to provide a scientific basis for the intervention of high-risk behaviors and the development of targeted AIDS prevention and control measures.MethodsA cross-sectional study was conducted from April to July 2019.Survey sites were set up in 11 cities in Shandong province.With the assistance of MSM social organizations,MSM were recruited by using four non-probabilistic sampling methods.SPSS 24.0 software was used for statistical analysis.Chi-square tests were used to compare the differences between participants who had IPV experience in the past year and those who did not.Univariate logistic regressions were used to analyze the differences between the new-type drug abusers and non-abusers,participants who had unprotected anal intercourse in the past 6 months and those who did not,participants who had group sex in the past 6 months and those who did not.Using new-type drug abuse,unprotected anal intercourse in the past 6 months and group sex in the past 6 months as the dependent variable,and IPV experience in the past year as the independent variable,variables with P-value<0.1 in univariate logistic regression analysis as the adjusted variables,multivariate logistic regression models were conducted to analyze the association between IPV experience and high-risk behaviors.Results1.The total number of participants in this study was 3977,and all the participants participated in the questionnaire survey and HIV antibody testing.The age of participants ranged from 18 to 74 years,with an average age of(31.40±8.87)years.Among these participants,54.6%were unmarried,93.2%were registered in Shandong province,90.1%have lived in the local area for more than 2 years,47.8%had an education level of college or above.About three fourths(75.0%)of the participants reported their sexual orientation as homosexual.The main place/way to seek male sexual partners was the Internet/dating software,accounting for 84.1%.The overall awareness rate of AIDS prevention knowledge was 88.9%.Over 90 percent(92.4%)had received an AIDS intervention service in the past year,7.4%reported having been infected with Sexually Transmitted Diseases(STD)in the past year,and 67.4%had been tested for HIV in the past year.The HIV antibody positive rate in this survey was 3.6%.2.About five percent(4.6%)of the participants had IPV experience in the past year,among these,42.3%had been forced to have sex by a partner,and 73.1%had physical or mental violence.Chi-square test results showed that MSM who were younger than 25 years and 25-34 years old,self-reported homosexual orientation,had an education level of college or above,found sexual partners in bar/bathroom/park,had received AIDS intervention services in the past year had a higher proportion of IPV experience in the last year(P<0.05).3.About one fourth(24.5%)of the participants ever used new-type drugs,and the main drug types were Rush(89.3%),Capsule Zero/G-spot liquid(24.2%),and Methamphetamine(8.9%).Univariate logistic regression results showed that MSM who were unmarried/divorced/widowed,registered in other provinces,had an education level of college or above,found sexual partners on Internet/dating software,had received AIDS intervention services in the past year,ever infected with STD in the past year,had HIV testing in the past year,had IPV experience in the last year had a higher proportion of new-type drug abuse(P<0.05).4.About forty percent(43.4%)of the participants had unprotected sex behaviors and 10.4%had group sex behaviors in the past six months,respectively.Univariate logistic regression results showed that MSM who infected with STD in the past year,had HIV testing in the past year,were HIV positive,and had IPV experience in the past year had a higher proportion of unprotected anal intercourse in the past 6 months(P<0.05);MSM who registered in other provinces,had an education level of college or above,found sexual partners in bar/bathroom/park,knew about AIDS knowledge,ever infected with STD in the past year,had received AIDS intervention services in the past year,ever infected with STD in the past year,had HIV testing in the past year,and had IPV experience in the past year had a higher proportion of group sex in the past 6 months(P<0.05).5.The results of multivariate logistic regression showed that the IPV experience was associated with new drug abuse(P=0.002).MSM who experienced IPV in the past year had a 1.70(95%CI.21-2.38)times higher risk of new drug abuse than those without IPV experience.The IPV experience was associated with unprotected anal intercourse(P=0.007).MSM who experienced IPV in the past year had a 1.52(95%CI:1.12-2.05)times higher risk of unprotected anal intercourse in the past 6 months than those without IPV experience.The IPV experience was also associated with group sex(P<0.001).MSM who experienced IPV in the past year had a 4.15(95%CI:2.94-5.85)times higher risk of group sex in the past 6 months than those without IPV experience.Conclusions1.MSM in Shandong province are generally young,unmarried,with homosexual orientation,seeking sexual partners through the Internet/dating software,and having a low proportion of HIV testing in the past year.It is necessary to make use of the advantages of the network to carry out diversified AIDS knowledge education,HIV health intervention,and HIV testing services among the MSM population,to improve the awareness rate of AIDS knowledge and the HIV testing rate.2.The proportion of new-type drugs abuse among MSM in Shandong province is high.It is necessary to strengthen the publicity and education of the harm of new-type drugs among the MSM population,and to strengthen the monitoring and intervention of new drug abuse behavior.The proportion of unprotected anal intercourse and group sex among MSM in Shandong province are also high.We should continue to promote the publicity of the importance of consistent condom use and the harm of high-risk sexual behavior,to increase the proportion of condom use and reduce the proportion of high-risk sex behaviors among the MSM population.3.IPV exists in the MSM in Shandong province,and IPV experience is associated with new-type drugs abuse,unprotected anal intercourse,and group sex behavior.The MSM who had experienced IPV in the past year are more likely to abuse new-type drugs and engage in unprotected anal intercourse and group sex.We should pay attention to MSM with IPV experience,and formulate corresponding comprehensive intervention measures to reduce the occurrence of IPV,to reduce the occurrence of high-risk behaviors and reduce the risk of HIV infection among the MSM population.