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Although recreational drug use is associated with risky sexual behaviors and HIV infection among men who have sex with men (MSM), it is unclear to what extent these behaviors and outcomes differ between single-drug users and polydrug users in China. This is a cross-sectional study conducted from July to September 2016 among MSM in three cities of Sichuan Province, China. Multinomial logistic regression was performed to examine factors correlated with single-drug and polydrug use. A total of 1,122 participants were included in the study. Overall, 28% of MSM have ever used recreational drugs, of whom 64.0% were single-drug users, and 36.0% were polydrug users. Factors associated with both single-drug and polydrug use included: receptive sexual role (single-drug use: AOR = 1.79, 95% CI: 1.05-3.07; polydrug use: AOR = 6.00, 95% CI: 2.54-14.17), engaging in group sex (AOR = 2.23, 95% CI: 1.28-3.87; AOR = 4.68, 95% CI: 2.41-9.08), frequent alcohol use (AOR = 3.11, 95% CI: 1.75-5.52; AOR = 6.41, 95% CI: 2.50-16.47), seeking partners mainly by Internet (AOR = 4.87, 95% CI: 3.31-7.17; AOR = 4.58, 95% CI: 2.58-8.14), history of STIs (AOR = 1.86, 95% CI: 1.08-3.21; AOR = 3.32, 95% CI: 1.77-6.26) and HIV infection (AOR = 1.76, 95% CI: 1.02-3.02; AOR = 3.19, 95% CI: 1.62-6.26). Our findings suggest the urgent need for HIV and STIs prevention programs among MSM in China to integrate strategies that mitigate recreational drug use.

Background: Many young migrant workers move across the border to Chiang Mai, a major city in Northern Thailand, in search of work opportunities. This study describes their sexual behavior, lifestyles, relationships and experiences with youth-friendly sexual and reproductive health (SRH) services., Methods: This is the qualitative arm of a mixed methods study using focus group discussions (FGDs) among young MWs aged 15-24 years in urban Chiang Mai. We conducted 6 FGDs with 84 participants (43 males, 41 females) organized in groups of 10-15 people, including 3 groups of males, 2 groups of females, and 1 group of both males and females., Results: We found that the lack of parental control, pressure to assimilate into Thai society, access to social media and modern communication technologies, and limited knowledge and access to sexual and reproductive health (SRH) services interplayed to shape lifestyle and sexual behaviors, including low condom use among young migrants., Conclusion: The present study helped discern the vulnerability of young migrants to adverse SRH outcomes. This particular group of youth needs urgent intervention to improve their knowledge on SRH and access to a youth-friendly clinic to help them personalize risk of HIV and other adverse SRH outcomes.

Social networking sites (SNSs) have been suggested to facilitate risky sexual activities. However, it is unknown and of concern how SNSs such as Facebook shape risky sexual activities in developing settings such as Swaziland, the country hardest hit by HIV and AIDS. We conducted an online cross-sectional study in 2012 to explore the prevalence of multiple sexual partnerships (MSPs) and their correlates among Facebook users in Swaziland. The response rate was 44.1% (N = 882); relatively, an equal proportion of men 82.7% (341/414) and 82.9% (388/468) women had ever had sex. Of those sexually active, 44.9% of men and 30.7% of women reported having sex with someone they met on Facebook. Approximately half of the participants (61.6% men, 41.0% women and 50.6% total) reported MSPs over the past 12 months. Multiple logistic regression analysis revealed that time spent on Facebook, "finding it easier to initiate a romantic conversation on Facebook" and having had sex with someone met on Facebook were significantly associated with having MSPs (adjusted odds ratio = 1.6-3.8). The potential impact of risky sexual behaviour among Facebook users should be appropriately addressed particularly in high HIV-prevalent settings like Swaziland.

Thailand has undergone rapid modernization with implications for changes in sexual norms. We investigated sexual behavior and attitudes across generations and gender among a probability sample of the general population of Nonthaburi province located near Bangkok in 2012. A tablet-based survey was performed among 2,138 men and women aged 15-59 years identified through a three-stage, stratified, probability proportional to size, clustered sampling. Descriptive statistical analysis was carried out accounting for the effects of multistage sampling. Relationship of age and gender to sexual behavior and attitudes was analyzed by bivariate analysis followed by multivariate logistic regression analysis to adjust for possible confounding. Patterns of sexual behavior and attitudes varied substantially across generations and gender. We found strong evidence for a decline in the age of sexual initiation, a shift in the type of the first sexual partner, and a greater rate of acceptance of adolescent premarital sex among younger generations. The study highlighted profound changes among young women as evidenced by a higher number of lifetime sexual partners as compared to older women. In contrast to the significant gender gap in older generations, sexual profiles of Thai young women have evolved to resemble those of young men with attitudes gradually converging to similar sexual standards. Our data suggest that higher education, being never-married, and an urban lifestyle may have been associated with these changes. Our study found that Thai sexual norms are changing dramatically. It is vital to continue monitoring such changes, considering the potential impact on the HIV/STIs epidemic and unintended pregnancies.

Background: The characteristics of heterosexual attendees who visit sexually transmitted disease (STD) clinics and practice oral sex have not been revealed in China. This information is important for the development of targeted STD prevention programmes for this population., Study Design: A self-administered questionnaire survey with a cross-sectional design was administered to consecutive attendees at four STD clinics in Zhejiang Province, China, between October and December in 2007. Demographic, psychosocial, and behavioural factors associated with oral sex over a lifetime were identified using univariate and multivariate analyses., Results: Of the 872 attendees, 6.9% engaged in oral sex over their lifetimes. Of the oral-sex group, 96.6% also engaged in vaginal sex. The correlates for oral sex over a lifetime as determined by the multivariate analysis were high income (odds ratio [OR] = 2.53, 95% confidence interval [CI] 1.39-4.59), high human immunodeficiency virus (HIV)-related knowledge (OR = 2.71, 95% CI 1.26-5.81), early sex initiation (OR = 2.42, 95% CI 1.37-4.27), multiple sexual partners (OR = 3.09, 95% CI 1.58-6.06), and sexually active in the previous 6 months (OR = 7.73, 95% CI 1.04-57.39)., Conclusions: Though the prevalence of oral sex is low, the heterosexual STD clinic attendees practicing oral sex was found to have higher risks associated with STD/HIV transmission than those not. Behavioural and medical interventions conducted by clinicians in Chinese STD clinics should take into account the characteristics and related risks of those who practice oral sex.

Background: Iran faced an HIV epidemic among injecting-drug users (IDUs) and has responded to this threat. Meanwhile, there is growing concern over the possibility of bridging HIV infection from IDUs to other populations, including men who have sex with men (MSM)., Methods: Cross-sectional biobehavioral surveys were conducted among 370 injecting-drug users recruited from drug treatment centers, a drop-in center, as well as streets in drug-populated areas in Tehran, Iran, between 2003 and 2004., Results: Data from these surveys showed that about 12% of male, sexually experienced IDUs have had same-gender sex, and HIV prevalence is high (19%), but condom use during the last sexual encounter was low (20%). A multivariate analysis showed that IDUs who had sex with men (MSM IDUs), compared to other sexually experienced IDUs, are younger (AOR, 0.89; 95% CI, 0.81-0.98), more likely to have used a shared needle/syringe for drug injection (AOR, 4.29; 95% CI, 1.82-10.12), and have had more than 5 sexual partners in their lifetime (AOR, 2.71; 95% CI, 1.14-6.44)., Conclusions: These results show that MSM IDUs exhibit more drug-related and sexual risk behaviors that may serve as a bridge for sexual transmission of HIV to other populations, including the broader MSM community, in Tehran. This report intends to encourage health authorities in Iran to take serious action to prevent sexual transmission of HIV from MSM IDUs to their sexual networks.

Background: Although number of sexually transmitted infections (STIs) reported in STI surveillance increased rapidly for women in Japan during the 1990s, the sexual behavior of women potentially at risk of STI infection remains unknown., Methods: In order to determine the demographic and behavioral characteristics of non-sex worker (SW) females attending STI clinics, female attendees (n = 145), excluding SW, from nine clinics across Japan and female controls from the general population (n = 956), both aged 18-50 years, were compared using two data sets of nationwide sexual behavior surveys conducted in 1999., Results: Although the occupation-type and education level were unrelated to STI clinic attendance in multivariate analysis, non-SW females attending STI clinics were younger (adjusted odds ratios [AOR] = 0.94, 95%CI: 0.89, 0.99), and more likely to be unmarried (AOR = 4.11, 95% CI: 1.73, 9.77) than the controls from the general population. In the previous year, STI clinic attendees were more likely to have had multiple partnerships (AOR = 3.09, 95% CI: 1.42, 6.71) and unprotected vaginal sex with regular partners (AOR = 3.59, 95% CI: 1.49, 8.64), and tended to have had their first sexual intercourse at a younger age (AOR = 1.77, 95%CI: 0.89, 3.54) and more unprotected vaginal and/or oral sex with casual partners (AOR = 2.08, 95%CI: 0.75, 5.71). Identical sexual behavior patterns were observed between the female attendees with a current diagnosis of STI (n = 72) and those before diagnosis (n = 73) and between those with a past history of STI (n = 66) and those without (n = 79)., Conclusion: These results indicate that not only multiple partnerships or unprotected sex with casual partners, but also unprotected vaginal sex within a regular partnership is prevalent among non-SW female STI clinic attendees. The identical sexual behavior patterns observed between female attendees with a current STI diagnosis and those without, and between those attendees with a past history of STI diagnosis and those without, indicate that the result are unlikely confounded with the cases of non-STI infection. This sexual behavior pattern may be predictive of STI infection among young Japanese women and could have contributed to the STI epidemic in women in Japan during the 1990s.

Background: To explore any association between the timing of the initiation of sexual activity and sexual behaviors and risks among university students in China., Methods: Data were derived from a cross-sectional study on sexual behavior among university students conducted in Ningbo municipality, China, at the end of 2003. Students completed a self-administered, structured questionnaire. Of 1981 sexually active male students, 1908 (96.3%) completed the item for timing of the initiation of sexual activity and were included in bivariate trend analyses and multiple logistic regression analyses to compare the association between this timing and sexual behavior and risks., Results: Male early sexual initiators had a significantly higher risk profile, including a significantly higher proportion reporting non-regular partners (i.e., casual or commercial partners), multiple partners, diagnosis with a sexually transmitted disease (STD), partner history of pregnancy, partner history of induced abortion, and less condom and oral contraceptive use, compared with late initiators. Multivariate analyses confirmed the increased likelihood of these risks in early initiators versus late initiators, other than partner type during the last year., Conclusion: Our results showed that, compared to late initiators, people who initiated sexual activity early engaged in more risky behaviors that could lead to elevated risks of unwanted pregnancies and STDs or human immunodeficiency virus infection. Sex-education strategies should be focused on an earlier age, should include advice on delaying the age of first sexual activity, and should target young people who continue to take sexual risks.

Background: National HIV serological and behavioural surveillance of Bangladesh repeatedly demonstrated a very high proportion of rickshaw pullers in Dhaka city, having sex with female sex workers (FSWs) and using illicit substances. However, no study has been conducted to identify the correlates of having sex with FSWs among this population. This study aimed to describe behavioural profile of rickshaw pullers in Dhaka city using probability samples and to identify the correlates for having sex with FSWs in order to focus HIV prevention intervention., Methods: Six hundred rickshaw pullers were randomly selected from rickshaw garages in the Kamrangirchar area, the single largest slum cluster of Dhaka, Bangladesh, during March-April 2008 using the Proportion Probability to Size method. Participants were interviewed, with a response rate of 99.2% (n = 595), using a structured questionnaire and asked about illicit substance use, sexual behaviour and risk perception for HIV and sexually transmitted diseases. Independent predictors of having sex with FSWs were analysed by multivariate analysis. A qualitative study was subsequently conducted with 30 rickshaw pullers to supplement the findings of the initial survey., Results: The proportion of survey respondents who had sex with FSWs and those who used illicit substances in the previous 12 months period were 7.9% and 24.9%, respectively, much lower than the results achieved in the 2003-04 behavioural surveillance (72.8% and 89.9%, respectively). Multivariate analysis revealed the characteristics of younger age, being never married, living alone with family remaining in other districts and using illicit substances in the previous 12 months were significantly associated with having sex with FSWs., Conclusion: HIV-related risk behaviour of our study population of the rickshaw pullers was lower than what has been suggested by the results of behavioural surveillance. While this discrepancy should be addressed in further studies, our study emphasizes the importance of focused HIV prevention programs for rickshaw pullers as high-risk behaviour is displayed at an unacceptable level and concentrated in identifiable sub-populations.

In China the HIV epidemic has started to infiltrate into a broader population through heterosexual contact and particularly to impact young people. The purpose of this study was to identify behavioral and psychosocial correlates of condom use among Chinese university students. A self-administered questionnaire survey with cross-sectional design was conducted among all classes of undergraduate students at two universities in one municipality of Eastern China, 2003. Data obtained from 1850 sexually active students who answered the question on condom use during the previous year were used for analysis. Frequent (always/often) condom use during the previous year was reported by only about 40% of both men and women. Multivariate analysis revealed that condom use during the first sexual experience, oral contraceptive use in the previous year and higher condom self-efficacy score in both genders were potent predictors of frequent condom use, while frequent condom use was less likely practiced by men who ever had non-vaginal sex, by those with higher risk-awareness for pregnancy/HIV/sexually transmitted diseases and by women with lower scores for perceived condom benefits. Safe sex education for Chinese students should be urgently introduced and should not be limited to knowledge provision but should also address psychosocial factors, such as condom self-efficacy and gender differences adequately to effectively encourage safer behavior.

Background: Sexually transmitted infections (STIs) increased rapidly in Japan during the 1990s., Methods: To determine the epidemiologic characteristics of STI patients, male cases (n = 765) from 21 clinics across Japan and controls from the general population (n = 1,167), both aged 18 to 59 years, were compared using two datasets of nationwide sexual behavior surveys conducted in 1999., Results: Male STI patients were more likely to be <40 years of age (OR = 3.94, 95% CI: 2.17, 7.15), unmarried (OR = 2.65, 95% CI: 1.80, 3.91), and at least college/university educated (OR = 2.03, 95% CI: 1.45, 2.83). They were also more likely to have had multiple partnerships in the previous year (OR = 3.33, 95% CI: 2.20, 5.05 for 2-3 partners, OR = 6.29, 95% CI: 3.81, 10.37 for >or=4 partners), unprotected vaginal sex with regular partners (OR = 2.70, 95% CI: 1.75, 4.17), unprotected vaginal and/or oral sex with casual partners (OR = 2.14, 95% CI: 1.40, 3.26), and unprotected vaginal (OR = 2.64, 95% CI: 1.46, 4.80) and oral sex with paid partners (OR = 4.72, 95% CI: 3.04, 7.32) in the previous year., Conclusions: These results suggest that male STI patients in Japan are highly educated and have a diverse occupational background, and that STI risks exist universally for various types of sex and sexual partnerships.

Background: The risks for Chinese male university students who have sex with other men (MSM) have not been compared with those for non-MSM students. This information is important for the development of targeted HIV prevention programmes for this population., Methods: Sexually active MSM and non-MSM students were compared for demographic characteristics, sexual behaviour, and related psychosocial variables using bivariate analyses. The data were a subset drawn from a large-scale cross-sectional questionnaire survey of sexually active male students conducted at two universities in a large city in Zhejiang Province, China, in 2003., Results: Of 1824 sexually active male students, 68 (3.7%) reported having had sex with a man at least once; 33.8% of these 68 men had also had female partners. Compared with non-MSM students, MSM students were 3-6.5 times more likely to have had sexual encounters with casual or commercial sex partners and were three times less likely to have protected sex in the past year or during their lifetime. They were three to five times more likely to have had multiple partners and 15 times more likely to have had a sexually transmitted disease (STD). In addition, the MSM students knew half as much about HIV and had less condom-decision than did non-MSM students and were two times more accepting of commercial sex. However, the MSM students were twice as aware of the risks for HIV infection., Conclusion: MSM composed 3-4% of the male sexually active university student population studied and was found to be at greater risk than non-MSM students for STD/HIV infection. There is an urgent need for STD/HIV programmes in university health services that take into consideration the sexuality and psychosocial issues of MSM students.

Background: The study was conducted to determine the prevalence of unintended pregnancy, induced abortion and contraceptive use, and factors associated with unintended pregnancy among Chinese university students., Study Design: A self-administered questionnaire survey with cross-sectional design was administered among students in two universities in Ningbo, China, in November-December 2003. Sociodemographic and behavioral factors associated with unintended pregnancy were identified in both genders using univariate and multivariate analyses., Results: Of sexually active students, 10.6% of male and 11.6% of female students reported their partner or they had a history of pregnancy; 10.0% of male and 11.3% of female students reported their partner or they had a history of induced abortion. The risk factors for unintended pregnancy identified among males by multivariate analysis were older age [odds ratio (OR), 2.12; 95% confidence interval (CI), 1.15-3.88], initiation of sexual activity before high school (OR, 2.45; 95% CI, 1.36-4.44), reported lack of condom use in first sexual activity (OR, 1.71; 95% CI, 1.10-2.64), multiple sexual partners (OR, 1.54; 95% CI, 1.06-2.23), and often used condoms during their lifetime (OR, 1.97; 95% CI, 1.01-3.81). The identified risk factors among females were initiation of sexual activity before high school (OR, 5.12; 95% CI, 1.49-17.68), non-consensual sexual intercourse as first sex (OR, 1.77; 95% CI, 1.08-2.90), multiple partners (OR, 2.75; 95% CI, 1.61-4.71), and sometimes/never (OR, 3.02; 95% CI, 1.16-7.87) or often (OR, 3.92; 95% CI, 1.43-10.73) used condoms during their lifetime., Conclusion: The high prevalence of unintended pregnancies and induced abortions in this population indicates a need for better and targeted sex education and family planning services.

A cross-sectional survey was conducted in two mountainous villages of the Karen, a major ethnic minority in Thailand. The participants were 566 villagers aged 15-54 years (371 in Village A, 195 in Village B; response rate=81.9%). Premarital/extramarital sex was experienced by 10-20% of the sexually active respondents and sex with a female sex worker (FSW) by 12.6% of males. Premarital sex was independently associated with being a Christian and occupational experience in town; extramarital sex was associated with Village A and drug use; sex with a FSW was associated with being unmarried, a nonfarmer, and occupational experience in town. Approximately 80% of the married participants never used a condom with their spouse, and nearly one-third never did so with a boy/girlfriend or a FSW. A history of sexually transmitted infections (STIs) was associated with sex with a FSW. These findings suggest that nontraditional sexual practices are prevalent and could potentially threaten Karen communities with the spread of HIV.