Incidence and correlates of HIV and syphilis in a prospective cohort of men who have sex with men in Mianyang, China, over a 36-month period.

UNLABELLED: Background Estimates for the HIV/AIDS epidemic from the China Ministry of Health show that the epidemic is spreading rapidly among men who have sex with men (MSM). METHODS: Respondent-driven sampling (RDS) was adapted in 2009 and snowball sampling was adapted to supplement the number of participants in 2010 and 2011. Interviewer-administered questionnaires and blood tests were conducted to confirm enrolment eligibility of participants. RESULTS: A total of 725 HIV-negative participants were included into the cohort study. The cohort had a HIV incidence density of 5.6 (95% CI: 3.9-7.3)/100 person-years (PY) and a syphilis incidence density of 5.6 (95% CI:3.7-7.6)/100 PY. Age ≤20 years (21-25 years, hazard ratio (HR)=0.32, 95%CI: 0.11-0.95/≥26 years, HR=0.17, 95%CI: 0.05-0.66), having not participated in peer education in the past year (HR=2.96, 95%CI: 1.19-7.35), seeking male sexual partners in a public washroom/park (HR=3.61, 95%CI: 1.03-12.47), being currently infected with syphilis (HR=3.21, 95%CI: 1.31-7.91), having sex partners aged ≥30 years (HR=3.40, 95%CI: 1.11-10.39) and having more than four male sexual partners within the past 6 months (HR=3.34, 95%CI: 1.24-9.04) were found to be risk factors for HIV seroconversion (each P<0.05). Being married (HR=2.38, 95%CI: 1.04-5.46), having not participated in peer education in the past year (HR=2.28, 95%CI: 1.08-4.82), having limited HIV/AIDS knowledge (HR=4.28, 95%CI: 1.94-9.43) and having a sexually transmitted disease infection in the past 6 months (HR=4.74, 95%CI: 1.83-12.30) were identified as factors for syphilis infection (each P<0.05). CONCLUSION: The incidence rates of HIV and syphilis in Mianyang City reamained high in the cohort of MSM for 36 months. Increased attention should be given to this serious epidemic, and appropriate interventions should be implemented to address MSM-specific issues in order to prevent HIV and syphilis infection in China.

[Relations between self-discrimination of MSM and sexual behavior and psychological factors].

OBJECTIVE: To understand the self-discrimination experience of MSM and its relationship with sexual behavior and psychological factors. METHODS: By respondent-driven sampling (RDS) method, a call-for action and anonymous self-administration questionnaire investigation was carried out in Mianyang city on experience of self-discriminations, sexual partners and behaviors and depression symptom, etc. The first 12 qualified people were designated as the "root" in the whole investigation from different MSM subgroups. Every "root" would get 3 recruit cards after their own investigation, then cards could be promoted to another 3 qualified people who were willing to accept questionnaires. And this process would go on till the sample size was accomplished. χ(2) test, rank correlation and contingency coefficient would be applied for the statistical analysis. RESULTS: In total, 201 persons were investigated. Within the past 6 months, 59.2% (119/201) persons felt they did harm to their family or made the family down as gays, 79.6% (160/201) had to disguise their real sexual orientation in avoidance of being discriminated, 39.3% (79/201) were humiliated for having gay sex. It showed correlation between humiliation or harm to family and frequency to disco balls/night clubs (r = 0.196, χ(2) = 7.95, P < 0.05), concerts or theaters (r = 0.201, χ(2) = 8.423, P < 0.05) with MSM friends, HIV health consultancy (r = 0.231, χ(2) = 11.329, P < 0.05), experiences of one night stands (r(s) = 0.183, µ = 2.588, P < 0.05), detection of depression (r(s) = 0.241, µ = 15.717, P < 0.05) and stress-related perception (r(s) = -0.310, µ = 23.112, P < 0.05), the corresponding behavior report rates of who experienced 3-4 times were 66.7% (11/33), 52.9% (18/34), 41.2% (14/34), 17.6% (6/34), 44.1% (15/34), 44.7% (10/24). Statistical significance was found between the relations of humiliation for gay sex and frequency into concerts or theaters (r = 0.195, χ(2) = 7.933, P < 0.05) with MSM friends, experiences of one night stands (r(s) = 0.145, µ = 2.051, P < 0.05), man-man anal sex (r = 0.165, χ(2) = 10.823, P < 0.05), numbers of female sexual partners (r = 0.265, χ(2) = 11.422, P < 0.05), protectiveness of female sexual behavior in the past 6 months (r = 0.513, χ(2) = 7.442, P < 0.05), detection of depression (r(s) = 0.152, µ = 13.034, P < 0.05) and stress-related perception (r(s) = -0.259, µ = 21.190, P < 0.05), the corresponding behavior report rates of who experienced 3-4 times were 22.7% (5/22), 9.1% (2/22), 13.6% (3/22), 91.6% (2/22), 66.7% (2/3), 57.1% (4/7), 33.3% (19/57). It has statistical significance between the relations of disguising their real sexual orientation in avoidance of being discriminated and the frequency of show up in the cybercafé (r = 0.272, χ(2) = 15.932, P < 0.05), involvement of HIV test (r = 0.232, χ(2) = 11.446, P < 0.05), and stress-related perception (r(s) = -0.373, µ = 28.868, P < 0.05). It was found that increasing of discrimination was connected to entrance into gay-welcome places, acceptance of HIV consultancy and tests, posting gay information among MSM friends and hold of many sexual partners. Meanwhile, the pressure was rising when depression was checked out. CONCLUSION: Self-discrimination was prevalent among MSM, which had brought critical influence on the individual behavior, MSM psychological health and prevalence of AIDS.