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The emergence of gay communities in Asia may predispose men who have sex with men (MSM) to drug use. We describe patterns and levels of illicit drug use, and characteristics of stimulant drug users among MSM in Asia.A cross-sectional Internet-based survey was conducted among 10,861 participants recruited through online methods. Pearson's chi-square tests were used to compare patterns of drug use by participants' HIV status. Multivariable logistic regression analysis was conducted to identify significant correlates of stimulant drug use.Overall, 16.7% of participants reported recreational drug use in the past 6 months. Ecstasy (8.1%) and Viagra (7.9%) were the most prevalent drugs being used. HIV-positive MSM reported significantly higher levels of individual drug use and polydrug use compared to HIV-negative/unknown MSM. Being gay (AOR=1.62, 95% CI: 1.28, 2.05), having casual male partners only or having both casual and regular partners (AOR=2.05, 95% CI: 1.66, 2.53; AOR=2.97, 95% CI: 2.39, 3.69), HIV-positive status (AOR=4.54, 95% CI: 3.63, 5.69), sex work (AOR=1.52, 95% CI: 1.19, 1.93), and having more gay friends ("Some" vs. "A few/None" AOR=1.98, 95% CI: 1.62, 2.43; "Most/All" vs. "A few/None" AOR=4.59, 95% CI: 3.77, 5.59) were independently associated with stimulant drug use.Our findings point to the urgency of incorporating substance use prevention and treatment into current HIV prevention activities in Asia, which must use a harm reduction approach and galvanize dignity.

BACKGROUND: The spread of healthy behaviors through social networks may be accelerated by influential individuals. Previous studies have used lay health influencers to prevent sexually transmitted infections (STIs) among internet-using men who have sex with men (MSM). However, there is a lack of understanding of the characteristics of this key subset of MSM. OBJECTIVE: This study aimed to examine sociodemographic characteristics, HIV and syphilis testing, and sexual behaviors of Web-based MSM sexual health influencers (SHIs) in China, defined as individuals with relatively stronger influence on spreading HIV and STI information online. METHODS: A Web-based survey of MSM was conducted in August 2017 as a final follow-up of a randomized controlled trial promoting HIV testing in 8 Chinese cities. Men were recruited through a gay social networking mobile phone app and were included if they were born biologically male, aged 16 years and above, ever had sex with another man, and HIV negative or with unknown HIV status. Information regarding sociodemographic characteristics, sexual behaviors, and HIV and syphilis testing was obtained. We assessed men's Web-based sexual health influence using a standardized 6-item opinion leadership scale focused on HIV and STI information. Influencers were defined as those whose mean score ranked within the top 13% (a higher score means greater influence). We used multivariable linear and logistic regression models to measure Web-based sexual health influence's association with HIV and syphilis testing, controlling for intervention trial effects, age, education, income, and marital status. RESULTS: Overall, 1031 men completed the survey. Most men were younger than 30 years (819/1031, 79.43%) and had at least college education (667/1031, 64.69%). Influencers were more likely to get tested for HIV (73/132, 55.3% vs 337/899, 37.5%; P

The source and generated mechanisms of DS-size inclusions in bearing steel were studied by sampling systematically and using ASPEX, SEM and EDS to analyse the morphology, composition and amount of non-metallic inclusions larger than 13 µm. Two kinds of typical DS-size inclusions were found in the refining process: type I is CaO-MgO-Al2O3-SiO2 distributed evenly and wrapped by CaS; type II is composite inclusion with MgO-Al2O3 as the core, CaO-Al2O3 and CaO-SiO2 as the inner layer, covered by CaS. Based on the FactSage and thermodynamic calculations, the DS inclusions formation mechanisms were drawn. There are two formation mechanisms of the type II inclusions: one is the solid phases will precipitate from the matrix of type I inclusions as the temperature drops; another is that when the reaction time is not sufficient, the MgO∙Al2O3 spinel core will not be transformed completely, and the evolution can be summarized as: Al2O3 → MgO-Al2O3 → CaO-MgO-Al2O3 → surrounded by CaO-Al2O3(SiO2) → covered by CaS.

We describe the behavioral characteristics and sexually transmitted disease (STD) prevalence of Chinese men who have sex with men (MSM) (n = 41) from a national probability sample of men (n = 1861). Most MSM were partnered with females (97%) and had a low rate of consistent condom use (7%). More MSM than heterosexual men self-reported a prior STD and risky sexual behaviors. MSM may act as a bridge for HIV transmission to female partners. Targeted interventions may help prevent a generalized HIV epidemic in China.

Background The increasing population of marriage-based migrant women is disproportionally affected by AIDS/STDs in China, and social support plays a critical role. This study aims to describe the social support level received by married migrant women in rural areas in Shandong province in comparison to non-migrant local women, identifies the relevant factors of this social support condition among married migrant women, and observes the correlation between social support level and infection status of AIDS and STDs among this group. Methods A probability-based sample of 1,076 migrant and 1,195 local women were included in the study. A pre-tested field questionnaire was administered to participants through a direct face-to-face interview. Questionnaire contained questions on socio-demographic information, AIDS and STDs prevalence information and Social Support Rating Scale (SSRS) which measures objective support, subjective support, and utilization of social support. Results Compared to local women, married migrant women had lower levels of social support in most dimensions. Multi-variable analysis revealed that relationship with spouse, family average income, number of children, education, engagement and claimed reasons of moving have various correlations with one or all dimensions of social support scores. Higher social support is also related to awareness of infection status of HIV and STDs among this group. Conclusion Our findings provide further evidence that married migrant women have lower levels of social support which may be related to some social characteristics and their awareness status of AIDS and STDs infection status and that targeted interventions need to be developed for this population.

Sexual health campaigns are often designed "top-down" by public health experts, failing to engage key populations. Using the power of crowdsourcing to shape a "bottom-up" approach, this note describes 2 creative contributory contests to enhance sexual health campaigns. We provide guidance for designing creative contributory contests to improve HIV and other sexually transmitted disease testing.

Objective Transgender individuals are at increased risk for HIV infection around the world, yet few studies have focused on transgender individuals in China. We conducted an online cross-sectional survey of men who have sex with men (MSM) and transgender individuals to examine sociodemographics, intimate partner violence (IPV) and sexual behaviours in China. Methods We recruited participants (born biologically male, ≥16 years old, ever engaged in anal sex with men and agreed to provide cell phone number) from three web platforms in 2014. Data on sociodemographics, IPV and sexual behaviours were collected. Logistic regressions were performed to compare the differences between transgender individuals and non-transgender MSM. Results Overall, 1424 eligible participants completed our online survey. Of these participants, 61 (4.3%) were transgender individuals, including 28 (2.0%) identifying as women and 33 (2.3%) identifying as transgender. Compared with MSM, transgender individuals were more likely to have experienced IPV and sexual violence (economic abuse, physical abuse, threat to harm loved ones, threat to ‘out’, forced sex). In addition, transgender individuals were more likely to have engaged in commercial sex (21.3% vs 5.1%, aOR 4.80, 95% CI 2.43 to 9.51) and group sex (26.2% vs 9.2%, aOR 3.47, 95% CI 1.58 to 6.48) in the last 12 months. Conclusions Our study is consistent with the emerging literature demonstrating increased sexual risk behaviours and high levels of IPV among transgender individuals. Future research should further investigate transgender individuals9 experiences of IPV and explore ways to promote disclosure of gender identity to healthcare providers. Furthermore, transgender research in China should be expanded independently of MSM research.

Anti-gay stigma and harsh local environments in many low and middle-income countries (LMIC) encourage men who have sex with men (MSM) partner-seeking mobile application (gay app) use. To investigate the sexual risk profiles of gay app users and guide future HIV prevention programs, we conducted a cross-sectional online survey among 1,342 MSM in China examining associations between gay app use and sexual behaviors, including HIV and sexually transmitted disease (STD) testing. Compared to non-app users, app users were more likely to be younger, better educated, “out” about their sexual orientation, and single. They were also more likely to report multiple recent sex partners and HIV testing, but there was no difference in condomless sex between the two groups. Future research among MSM in LMIC is needed to characterize gay app use and explore its potential for future public health interventions.

BACKGROUND: HIV and syphilis are disproportionately common among transgender individuals globally yet few studies have investigated transgender HIV/syphilis risk and testing in low- and middle-income nations. We conducted an online survey of men who have sex with men (MSM) and transgender individuals to examine sexual behaviors and HIV/syphilis testing in China. METHODS: We recruited MSM and transgender individuals from 2 major Chinese lesbian gay bisexual and transgender Web platforms. chi Test and logistic regression were used to compare risk behaviors HIV and syphilis testing history and prevalence between transgender individuals and other MSM. RESULTS: Among the 1320 participants 52 (3.9%) self-identified as transgender. Demographics including education employment and marital status were similar between both groups whereas transgender individuals were older. Condomless anal intercourse rate was comparable between the groups. Transgender individuals were less likely to report ever testing for HIV (34.6% vs. 62.0%) and syphilis (15.7% vs. 31.2%) with adjusted odds ratios of 0.36 (95% confidence interval 0.20-0.65) and 0.42 (95% confidence interval 0.20-0.91) respectively. We found a trend toward a higher HIV prevalence among transgender individuals (11.1% vs. 5.7% P = 0.12). CONCLUSIONS: Transgender individuals have suboptimal HIV and syphilis testing rates in China. Given the substantial risk behaviors and burden of HIV/STI in the general Chinese MSM population and a lack of knowledge about transgender individuals enhanced HIV/syphilis testing programs for transgender individuals in China are needed.

Differences in risk behaviours between men who have sex with men (MSM) and men who have sex with both men and women (MSMW) have important implications for HIV and sexually transmitted infection (STI) transmission. We examined differences in risk behaviours, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to HIV care between MSM and MSMW across China. Participants were recruited through three MSM-focused websites in China. An online survey containing items on socio-demographics, risk behaviours, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September to October 2014. Chi square tests and logistic regression analyses were conducted. MSMW were less likely to use a condom during last anal sex ( p ≤ 0.01) and more likely to engage in group sex ( p ≤ 0.01) and transactional sex ( p ≤ 0.01) compared to MSM. Self-reported HIV/STI testing and positivity rates between MSM and MSMW were similar. Among HIV-infected MSM, there was no difference in rates of linkage to or retention in antiretroviral therapy when comparing MSM and MSMW. Chinese MSM and MSMW may benefit from different HIV and STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese MSM and MSMW will depend on the ability of targeted and culturally congruent HIV/STI control programmes to facilitate a reduction in risk behaviours.

Background Poor HIV testing uptake by MSM may be attributable to unique challenges that are localized in Southeast Asia. Objective To characterize MSM who never tested for HIV, to identify correlates of never testing, and to elucidate the perceived barriers to HIV testing. Methods The present study used data from the Asian Internet MSM Sex Survey (AIMSS) and restricted the analysis to 4,310 MSM from the ten member countries of the Association of South East Asian Nations (ASEAN). Results Among MSM participants from ASEAN in our sample, 1290 (29.9%) reported having never been tested for HIV, 471 (10.9%) tested for HIV more than 2 years ago, and 2186 (50.7%) reported their last test date was between 6 months and two years ago, with only 363 (8.4%) of these men having been tested in the past 6 months. In multivariable logistic regression, younger MSM (age 15–22 years old [AOR: 4.60, 95% CI: 3.04–6.96]), MSM with lower education (secondary school or lower [AOR: 1.37, 95% CI: 1.03–1.83]), MSM who identify as bisexual or heterosexual (compared to gay-identified) (AOR: 1.94, 95% CI: 1.60–2.35), and MSM who had never used a condom with male partners (AOR: 1.61, 95% CI: 1.32–1.97) had higher odds of never been HIV tested. Main reason for not being tested was a low risk perception of HIV exposure (n = 390, 30.2%). Conclusion Current HIV prevention response must not leave MSM “in the dark,” but instead meet them where they are by utilizing the Internet creatively through social media and smart phones. As ASEAN Economic Community (AEC) is quickly becoming a reality, so must there be an equally fast and united response to slowing down the HIV epidemics among MSM in ASEAN.

BACKGROUND: Intimate partner violence (IPV) research has primarily focused on heterosexual couples but has largely ignored IPV among men who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. METHODS: Men who have sex with men older than 16 years were recruited through 3 MSM-focused Web sites in China. An online survey containing items on sociodemographics risk behaviors IPV and self-reported HIV or sexually transmitted infection diagnosis was completed. Multivariate regression was used to examine associations between IPV and risk behaviors and an HIV or sexually transmitted infection diagnosis. RESULTS: Among 610 participants 182 (29.8%) reported experiencing at least 1 type of IPV. Men who have sex with both men and women were at significantly greater risk for IPV (adjusted odds ratio [AOR] 1.65; 95% confidence interval [CI] 1.08-2.53) compared with MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR 1.86; 95% CI 1.08-3.21) to have had sex in exchange for gifts or money (AOR 5.06; 95% CI 2.47-10.35) and to report a positive HIV diagnosis (AOR 2.59; 95% CI 1.22-5.51). CONCLUSIONS: There is a hidden epidemic of IPV among MSM in China especially among MSMW. The hidden nature of MSM and MSMW suggests the need for a clinical environment more conducive to disclosure. Research is needed to understand the pathways linking IPV and HIV risk among MSM to optimize the design of effective interventions.

Background Increased HIV testing is an effective strategy for HIV control among key populations, including men who have sex with men (MSM). We aimed to examine the interaction between social norms related to HIV testing and self-efficacy of HIV testing among Chinese MSM. Methods A cross-sectional online survey was conducted in eight Chinese cities in Shandong and Guangdong provinces in July 28–31, 2016. The inclusion criteria included: born as a male, age at least 16 years old, ever engaged in anal sex with men, and currently living in one of the designated cities. Information regarding sociodemographics, risk behaviours, and testing history for HIV and other sexually transmitted infections were collected. Social norm was operationalised by six items asking participants about the social norms of HIV testing. HIV testing self-efficacy was measured with a six-item scale. Higher mean scores indicated higher self-reported strength of social norms and self-efficacy for HIV testing. Univariate and multivariate logistic regressions were used to evaluate the interaction between self-efficacy and social norm on HIV testing. Findings 2105 men completed the survey. The mean age of the participants was 25·97 years (SD 6·42). More than four-fifths (1809 [86%]) of participants were unmarried, 477 (23%) were students, and 1359 (65%) had at least a college degree. Overall, 1315 (62%) participants had been ever tested for HIV, and 687 (33%) had been tested in the past 3 months. 685 (33%) had ever HIV self-tested in their lifetime. The main effect estimate on HIV testing in the past 3 months was 1·01 (95% CI 0·96–1·06) for social norm and 1·09 (95% CI 1·05–1·14) for self-efficacy, with an interaction effect of 1·02 (95% CI 1·01–1·03). Interpretation Our survey demonstrated the interaction between self-efficacy and social norm on HIV testing among Chinese MSM. Further research and interventions to increase self-efficacy and social norm on HIV testing are needed. Funding National Institutes of Health (National Institute of Allergy and Infectious Diseases 1R01AI114310; National Center for Advancing Translational Sciences grant number UL1TR001111), UNC-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532), UNC Center for AIDS Research (National Institute of Allergy and Infectious Diseases 5P30AI050410), University of California San Francisco Center for AIDS Research (National Institute of Allergy and Infectious Diseases P30 AI027763), and the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138).

Background HIV-related stigma has been positively associated with low health-care utilisation and risky sexual behaviours in people living with HIV. However, the relationship between HIV-related stigma and the use of new technologies such as gay mobile applications and HIV self-testing is still not clear. We aimed to examine factors associated with HIV-anticipated stigma among men who have sex with men (MSM) and transgender individuals in China. Methods During July 28–31, 2016, MSM and transgender individuals aged 16 years or older who self-reported as HIV negative were recruited for an online cross-sectional survey on China's biggest MSM mobile application BlueD. Information regarding sociodemographics, sexual behaviours, sexual health service use, and anticipated HIV stigma (measured by a seven-item Likert scale, ranging from one to four) were collected. The mean values of the seven items were calculated to create an overall score, with a higher score indicating a higher level of anticipated HIV stigma. Univariate and multivariable linear regressions were conducted to examine the factors associated with anticipated HIV stigma, while age, education, income, sexual orientation, and marital status were adjusted in the multivariable models. Findings 2006 participants were recruited; most were MSM (1904 of 2006, 95%). The mean score for anticipated HIV stigma was 2·98 (SD 0·64). Having used social media platforms to seek sexual partners within in the past 3 months (adjusted β 0·11, 95% CI 0·05–0·17) was associated with increased anticipated HIV stigma, whereas having self-tested for HIV (adjusted β −0·07, 95% CI −0·13 to −0·01), and having disclosed one's sexuality to one's health-care provider (adjusted β −0·16, 95% CI −0·22 to −0·96) were associated with decreased anticipated HIV stigma. Interpretation Campaigns to combat HIV-related stigma are needed on gay mobile applications. Promotion of HIV self-testing and disclosure might be an effective method to reduce HIV-related stigma among MSM and transgender individuals in China. Funding National Institutes of Health (National Institute of Allergy and Infectious Diseases [NIAID] 1R01AI114310; National Center for Advancing Translational Sciences [UL1TR001111]), University of North Carolina–South China STD Research Training Centre (Fogarty International Centre 1D43TW009532), University of North Carolina Center for AIDS Research (NIAID 5P30AI050410), University of California San Francisco Center for AIDS Research (NIAID P30 AI027763), and the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138).

Background HIV serostatus disclosure before sex can facilitate serosorting, condom use, and potentially decreased risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men (MSM) in China. Methods An online cross-sectional study was conducted among MSM in eight Chinese cities in July 28–31, 2016. Participants completed questions covering sociodemographic information, sexual behaviours, HIV testing history (including HIV self-testing), self-reported HIV status, and post-test violence (ie, violence after HIV test). Additionally, participants were asked whether they received HIV serostatus disclosure from different kinds of most recent partners before sex. Findings 2105 men completed the survey. 1809 (86%) were never married, and 746 (35%) had high school or less education. Overall, 1678 (80%) participants reported that they ever had regular male partners, and 1608 (76%) ever had casual male partners. 346 (21%) of 1678 men who ever had regular partners received HIV serostatus disclosure from their most recent regular male partners, while 704 (42%) of 1678 provided HIV status disclosure to their regular partners. Multivariable analysis indicated that participants who ever self-tested for HIV were more likely to have received HIV status disclosure from regular male partners (adjusted odds ratio [aOR] 1·92, 95% CI 1·50–2·44), compared with participants who had never self-tested. Compared with participants who had not received HIV status disclosure from regular partners, men who received disclosure from regular male partners had higher likelihood of experiencing post-test violence (aOR 5·18, 95% CI 1·53–17·58). Similar results were found for receiving HIV serostatus disclosure from casual partners. Interpretation HIV serostatus disclosure from partners was uncommon among Chinese MSM. Interventions and further implementation research to facilitate safe disclosure are urgently needed. Funding National Institutes of Health (National Institute of Allergy and Infectious Diseases 1R01AI114310, National Center for Advancing Translational Sciences grant number UL1TR001111)), UNC-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532), UNC Center for AIDS Research (National Institute of Allergy and Infectious Diseases 5P30AI050410), University of California San Francisco Center for AIDS Research (National Institute of Allergy and Infectious Diseases P30 AI027763), and the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138).

Background The wide range of interventions to promote HIV testing might inadvertently contribute to coerced testing. There has been concern about coerced HIV self-testing in non-research settings where there is minimal supervision. The aim of this study was to examine the prevalence and correlates of coerced HIV testing among men who have sex with men (MSM) in China. Methods In July 2016, we recruited MSM from eight cities through BlueD, a gay social network mobile application. Data on sociodemographics, HIV self-testing, HIV facility testing, test coercion, condomless sex in the past 3 months, and transactional sex were collected. Coerced testing was defined as someone (partner, friend, employer, or others) forcing the participant to take an HIV test. Multivariable logistic regression was used to examine correlates of coerced testing among MSM who had ever received HIV testing. Findings 1312 men were included, most of whom were young (mean age 26·9 years [SD 6·3]). 1002 (76%) men were identified as gay, and 685 (52%) men had used HIV self-testing. 64 (15%) men reported coerced testing, and 39 of these men were forced to have a self-test. Adjusting for age, education, income, and residence, men who reported coerced testing were more likely to have ever self-tested for HIV (adjusted odds ratio 4·25; 95% CI 2·23–8·09). Coerced testing was more common among men who had sex with casual partners in exchange for gifts or money (3·34; 1·90–5·86) than among men who did not report transactional sex. Coerced testing was also more common among MSM who reported condomless anal sex in the preceding 3 months (2·38; 1·43–3·98) than among men who did not report condomless anal sex. Interpretation HIV test coercion is uncommon among MSM in China, but is more likely in men who used HIV self-tests. As HIV self-testing is scaled up worldwide, research and enhanced post-test surveillance are needed. Funding National Institute of Allergy and Infectious Diseases (1R01AI114310-01) and the Australian National Health Medical Research Council (APP1104781). The funders had no role in the design of the study, the collection, analysis, and interpretation of data, or in the writing of the Abstract.

Objectives To examine trends in HIV testing, late HIV diagnosis and associated factors among men who have sex with men (MSM) in Jiangsu province, China. Methods Four consecutive community-based cross-sectional surveys were conducted among MSM from 2011 to 2014 in eight cities in the province. Participants were recruited from MSM venues and via the internet. HIV bio-behavioral surveys were conducted to collect demographic and behavioral data and measure HIV infection. HIV-infected participants with CD4 counts less than 350 cells/uL were defined as having a late HIV diagnosis. Chi-square trend tests were used to compare temporal changes over the years and multivariable logistic regression analyses were used to identify factors associated with late diagnosis. Results A total of 2,441, 2,677, 2,591 and 2,610 participants were enrolled in 2011, 2012, 2013 and 2014, respectively. Testing for HIV in the last 12 months decreased over the time period, from 59.9% to 52.5% (p

Objectives To compare the rates of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in HIV-seropositive sexual relationships with that among men in HIV-seronegative and serodiscordant relationships in the context of an emerging hepatitis C virus (HCV) epidemic among HIV-positive MSM. Methods Time-location sampling was used to obtain a cross-sectional sample of MSM who attended public venues in San Francisco between November 2007 and October 2008 (N=1199). Behavioural measures of sexual risk-taking at the level of the sexual dyad were administered to the sample. Results Men in HIV-positive/positive sexual relationships are significantly more likely to have UAI and combine sex and drugs than men in negative/negative sexual relationships. Conclusions If it is possible to spread HCV infection between HIV-positive men via UAI, very high levels of behavioural risk among positive MSM should exist to facilitate HCV transmission. Identifying the precise behavioural risk factors for HCV among HIV-positive MSM has become an important public health priority.

With the help of a community-based survey, we assess the potential effect of circumcision on the HIV epidemic among men who have sex with men (MSM) in San Francisco. Only a small minority of MSM would both derive benefit from circumcision (i.e., were uncircumcised, HIV-negative, predominantly insertive, and reported unprotected insertive anal sex) and be willing to participate in circumcision trials (0.7%) or be circumcised if proven effective as a prevention strategy (0.9%). Circumcision would have limited public health significance for MSM in San Francisco.

Background High prevalence of substance use among men who have sex with men (MSM) may drive the HIV epidemic in Malaysia but patterns of substance use among Malaysian MSM have not been examined. Our study investigated specific Malaysian MSM risk groups to determine the association between their substance use and sexual risk behaviors. Methods Data from Malaysian respondents ( n = 1235) in a large, multinational online survey of Asian MSM in 2010 were used to identify latent classes of substance use. Subsequent covariates were included in a joint model to predict class membership. Results The 3-class model was identified as the best fitting model, which included: (1) ‘negligible substance use’ for those reporting none or using any substance sparingly; (2) ‘soft substance use’ for those using poppers, ecstasy and drinking before sex; and (3) ‘amphetamine-type stimulant (ATS) use’ for those using stimulants (methamphetamine, ecstasy), erectile dysfunction drugs and recreational drug use before sex. Men in the ‘ATS use’ category were significantly less likely to not know their HIV status (AOR: 0.30, 95%CI: 0.14,0.66), more likely to have had more than 6 male sex partners (AOR: 4.83, 95% CI: 1.92–12.2), to have group sex (AOR:4.07, 95% CI: 2.31–7.15), to report inconsistent condom use (AOR:2.01, 95% CI: 1.12–3.60), to be HIV-infected (AOR:3.92, 95% CI: 1.63–8.42) and to have had any sexually transmitted infections (AOR:3.92, 95% CI:1.70, 9.08), compared to men in the ‘negligible substance use’ category. Conclusions Our study identified subgroups of Malaysian MSM with distinct substance use patterns and HIV-related risk profiles, which provides implication for targeting HIV prevention in this subpopulation.

Studies of heterosexual populations across the globe and men who have sex with men (MSM) in a few developed countries showed that earlier sexual debut (sexarche) was associated with higher levels of co-occurring and subsequent HIV risk behaviors. We examined the relationships between earlier anal sexarche, unprotected earlier anal sexarche and current HIV risks among MSM from Asia. A cross-sectional online survey was conducted among MSM (N = 10,826) in Asia in 2010. Bivariate and multivariable logistic regressions were used to identify co-occurring (i.e., sexual experiences during sexarche) and current HIV-related risk factors (i.e., past six months) associated with earlier anal sexarche (before the age of 18) and unprotected earlier anal sexarche, respectively. Earlier anal sexarche was significantly associated with lack of condom use, being anal receptive or both receptive and insertive, and having a partner who were older during sexarche. It was also associated with current HIV-related risk behaviors including having multiple male sexual partners, having been paid for sex, and increased frequencies of recreational drug use. Unprotected earlier anal sexarche was significantly associated with inconsistent condom use in the past the six months. Improved and culturally sensitive sex education at schools should be included in national and regional HIV/AIDS prevention programming and policies in Asia. Such sex education programs should incorporate curriculum that address sexuality, sexual orientation, and sexual behaviors beyond those related to reproductive health.

We postulated that the growing popularity of circuit parties may play a role in the escalating HIV prevalence among men who have sex with men (MSM) in Asia. The present study is the first to characterize the sociodemographic and HIV-related behavioral factors of circuit party attendees living in Asia. We analyzed a subset of data from the Asia Internet MSM Sex Survey conducted from January 1 to February 28, 2010. Inclusion criteria included: being biologically male, aged 18 years or above, self-reported sex with another man, and reported international travel in the past 6 months (N = 6,094). From our multivariable logistic regression model, participants’ resident country with low HIV prevalence (among MSM) (AOR: 1.59, 95% CI: 1.27–2.00) and country of destination with high HIV prevalence were independently associated with higher odds of circuit party attendance (AOR: 1.32, 95% CI: 1.14–1.53) during international travel. Statistical interaction indicated circuit party attendees were likely to have traveled from low HIV prevalence (among MSM) countries to high HIV prevalence countries (AOR: 1.40, 95% CI: 1.20–1.64). Other independent correlates included unprotected anal sex with a male casual sex partner and recreational drug use during travel. HIV and STI prevention focusing on circuit party attendees may have a pivotal role on the spread of the HIV epidemics among MSM in Asia.

To examine outcomes of a peer-led, community-based intervention providing rapid HIV testing and case management for linkage to care for untested men who have sex with men (MSM) in China.Rapid HIV testing was performed by trained peer volunteers of a community-based organisation (CBO) in three cities of Jiangsu province at MSM-oriented venues. MSM screened positive were referred and accompanied to local government health agencies (Centres for Disease Control and Prevention (CDC)) for confirmatory HIV testing and provided social support for up to 1 month. Data for the programme were compared with sentinel surveillance surveys of MSM conducted by the national and provincial CDC in the province during the same year to assess differences in the populations reached, in HIV positivity, and linkage to HIV care.A total of 512 previously untested MSM were tested by the CBO programme in 6 months. Compared with those in the surveillance surveys, MSM tested by the CBO were significantly more likely to be younger, single, non-resident of the province, more educated and used condoms less frequently. Higher proportions of HIV-positive MSM screened by the CBO received their confirmatory test results (98.1% vs 72.6%, p0.001) and linked to care (90.4% vs 42.0%, p0.001).Trained peers providing rapid HIV testing with social support and case management through the early period following diagnosis can efficiently expand HIV testing and improve linkage to care among MSM in China.

Objectives To estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses. Results We estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples. Conclusions This represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population’s HIV burden.

Increasing use of the Internet to seek sex partners is accompanied by rising HIV infections among men who have sex with men (MSM) in East and South-East Asia. We examined whether the Internet facilitates greater HIV risk taking among MSM in the region. A cross-sectional sample of 9,367 MSM was recruited via the Internet in 2010. We compared socio-demographic and HIV-related behavioral characteristics among MSM who met sex partners on the Internet only, who met sex partners offline only, and who met sex partners through both. Multinomial logistic regression was used to identify independent correlates that were associated with differences in where participants met their male sex partners. Compared to MSM who met partners offline only, those who met partners online only were less likely to have multiple male sex partners, have paid for sex, have consumed recreational drugs, and have used alcohol before sex. MSM who met partners both online and offline appeared to be the riskiest group that they were more likely to have multiple male sex partners, have engaged in UIAI, and have consumed alcohol before sex. These findings suggest that social networking websites alone do not facilitate greater HIV risk taking among MSM. Rather, they provide additional venues for MSM who already engage in HIV-related high risk behaviors to seek sex partners. The Internet offers incredible opportunities to reach large numbers of MSM in East and South-East Asia for HIV prevention and research. Web-based outreach and prevention activities are needed to reach these men. In addition, mobile and application-based interventions should also be developed and disseminated.

Background : Many men who have sex with men (MSM) in China are “ in the closet. ” The low rate of disclosure may impact sexual behaviours, testing for HIV and other sexually transmitted infections (STIs), and diseases transmission. This study examines factors associated with overall sexual orientation disclosure and disclosure to healthcare professionals. Methods : A nationwide cross-sectional online survey was conducted from September 2014 to October 2014 in China. Participants completed questions covering socio-demographic information, sexual behaviours, HIV/STI testing history, and self-reported HIV status. We defined healthcare professional disclosure as disclosing to a doctor or other medical provider. Results : A total of 1819 men started the survey and 1424 (78.3%) completed it. Among the 1424 participants, 62.2% (886/ 1424) reported overall disclosure, and 16.3% (232/1424) disclosed to healthcare professionals. In multivariate analyses, the odds of sexual orientation disclosure were 56% higher among MSM who used smartphone-based, sex-seeking applications [adjusted odds ratio (aOR) = 1.56, 95% CI: 1.25 – 2.95], but were lower among MSM reporting sex while drunk or recreational drug use. The odds of disclosure to a healthcare professional were greater among MSM who had ever tested for HIV or STIs (aOR = 3.36, 95% CI: 2.50 – 4.51 for HIV, and aOR = 4.92, 95% CI: 3.47 – 6.96 for STIs, respectively) or self-reported as living with HIV (aOR = 1.59, 95% CI: 0.93 – 2.72). Conclusion : Over 80% of MSM had not disclosed their sexual orientation to health professionals. This low level of disclosure likely represents a major obstacle to serving the unique needs of MSM in clinical settings. Further research and interventions to facilitate MSM sexual orientation disclosure, especially to health professionals, are urgently needed. Keywords: China; disclosure; healthcare professional; men who have sex with men (MSM); sexual behaviours; sexual orientation (Published: 6 February 2017) Tang W et al. Journal of the International AIDS Society 2017, 20: 21416 http://www.jiasociety.org/index.php/jias/article/view/21416 | http://dx.doi.org/10.7448/IAS.20.1.21416

Background The Chinese government now encourages innovation, and more specifically, crowdsourcing. Crowdsourcing, the process of shifting individual tasks to a large group, might reimagine health communication, making it more people-centred. We aimed to compare the effectiveness of a crowdsourced versus social marketing condom promotion video to promote condom use. Methods A non-inferiority randomised controlled trial was conducted in November 2015 in China. Men who have sex with men (MSM) aged 16 years or older who reported having had sexual contact without use of a condom in the preceding 3 months were recruited through a nationwide MSM website. Men were randomly allocated to one of the two arms in a 1:1 ratio using a computer algorithm and then watched one of two videos. The crowdsourced video was developed through an open contest and the social marketing video was designed by a company. Participants completed a baseline survey and follow-up surveys at 3 weeks and 3 months post-intervention. The primary outcome was incidence of sexual contact without a condom. Intention-to-treat analysis was used, with a non-inferiority margin of 10%. The trial is registered with ClinicalTrials.gov, number NCT02516930. All participants gave informed consent and the protocol was approved by Chinese (Guangdong Provincial Centre for Skin Diseases and STI Control) and American (University of North Carolina at Chapel Hill and the University of California San Francisco) institutional review boards. Findings 1173 participants were recruited to the study; 907 (77%) completed the 3-week follow up and 791 (67%) the three-month follow up. At three weeks, 146/434 (33·6%) participants in the crowdsourced group and 153/473 (32·3%) in the social marketing group reported having sexual contact without a condom. The crowdsourced intervention achieved our pre-specified non-inferiority criterion (estimated difference: +1·3% [95%CI: 4·8–7·4]). At 3 months, 196/376 (52·1%) men in the crowdsourced group and 206/415 (49·6%) in the social-marketing group reported having sexual contact without a condom (estimated difference: +2·5% [95%CI −4·5–9·5%]). The two groups reported similar HIV testing rates and other condom-related secondary outcomes. The cost of the crowdsourcing intervention was substantially lower than the social marketing intervention (16 686 vs 26 845 USD). No adverse outcomes were reported. Interpretation Crowdsourcing could be a useful tool in China, which has a large population and government support. Crowdsourcing provides a structured system for multi-sectoral input into health policy in China. Funding US National Institute of Allergy and Infectious Diseases (NIAID; 1R01AI114310); University of North Carolina (UNC)-South China Sexually Transmitted Disease Research Training Centre (Fogarty International Centre; 1D43TW009532); UNC Center for AIDS Research (NIAID; 5P30AI050410); University of California San Francisco Centre for AIDS Research (NIAID; P30 AI027763); US National Institute of Mental Health (R00MH093201 to CW); UNC Chapel Hill, Johns Hopkins University, Morehead School of Medicine and Tulane University (UJMT) Fogarty Fellowship (FIC R25TW0093); Doris Duke International Clinical Research Fellowship; US National Center for Advancing Translational Sciences (UL1TR001111).

Background HIV self-testing holds great promise for reaching high-risk key populations who do not access facility-based services, but it has rarely been evaluated outside of structured research settings. HIV self-testing is a process by which a person takes and interprets a test. We aimed to characterise implementation of unsupervised HIV self-testing among men who have sex with men (MSM) in China. Methods We undertook a nationwide online survey of MSM in November, 2015, in China. Men were invited to participate by clicking through banner adverts on social network sites. Eligible men were at least 16 years of age, had ever had anal sex with a man, and had had sex without use of a condom in the past 3 months. Among MSM who ever self-tested for HIV, we assessed benefits (eg, first-time HIV test, increased testing frequency, confirmatory testing) and adverse outcomes, (eg, coercion, violence, suicidality). First-time HIV test was defined by what an individual reported was their first ever test for HIV (a self-test or a facility test). Among MSM who reported ever testing for HIV, we identified correlates of HIV self-testing as first-time HIV test with use of multivariable logistic regression. The institutional review boards of the Guangdong Provincial Center for Skin Diseases and STI Control, the University of North Carolina at Chapel Hill, and the University of California San Francisco approved this study. Findings Of 1610 eligible men, 1189 (73·9%) completed the survey. 28·7% (341/1189) reported ever self-testing for HIV. The HIV prevalence among self-testers was 7·0% (24/341) and among non-self-testers was 4·9% (15/306). Among self-testers, 58·7% (200/341) reported HIV self-testing as a first-time HIV test and 22·6% (77/341) had increased testing frequency. 77·5% (31/40) of those with a positive HIV self-test received confirmatory facility-based testing. Minimal adverse outcomes were noted. Multivariable analysis showed that self-testing as first-time HIV test was associated with younger age (odds ratio 0·95, 95% CI 0·91–0·99), not telling health-care providers about having sex with men (2·22, 1·56–3·17), not using the internet to meet sex partners (2·53, 1·45–4·43), and having group sex (1·76, 1·03–2·98). Interpretation HIV self-testing increases first-time HIV testing and testing frequency among those with previous testing. This tool could be useful to scale up HIV testing among high-risk men in China and other settings. Funding National Institutes of Health (NIAID 1R01AI114310-01), UNC-South China STD Research Training Center (FIC 1D43TW009532-01), UNC Center for AIDS Research (NIAID 5P30AI050410-13), UCSF Center for AIDS Research (NIAID P30 AI027763), NIMH (R00MH093201), Fulbright-Fogarty Fellowship (FIC R25TW0093), and SESH Global.

Background Sex tourism among men who have sex with men (MSM) provides a risk for spread of HIV and other sexually transmitted infections. Sex tourism is defined as travelling outside of one's home town and purchasing sex with gifts or money. Our objective was to characterise the frequency, sociodemographic characteristics, and sexual risk behaviours among Chinese MSM sex tourists. Methods We undertook an online, cross-sectional survey of high-risk MSM throughout China in November, 2015. Men were invited to participate by clicking through banner adverts on social network sites. Eligible men were at least 16 years of age, had ever had anal sex with a man, and had had sex without use of a condom in the past 3 months. Questions covered sociodemographic characteristics and sexual risk behaviours. Univariate and multivariable logistic regressions were done to identify correlates of sex tourism. We also compared the mean MSM HIV prevalence in each sex tourist's origin and destination locations. Ethics approval was obtained from the ethics review boards of the Guangdong Provincial Center for Skin Diseases and STI control, the University of North Carolina at Chapel Hill, and the University of California at San Francisco. Findings Among 1610 eligible men, 1189 (74%) completed the survey and 62 (5%) were identified as sex tourists. 20 (32%) of these men travelled primarily to purchase sex and the remainder purchased sex while travelling for another purpose. We noted little difference in sociodemographics and sexual risk behaviours between the two groups. 45 (73%) of sex tourists used a mobile app or website to find sex partners. In multivariable analyses, adjusting for age and income, sex tourism was correlated with high-risk sexual behaviours (adjusted odds ratio 1·83, 95% CI 1·06–3·17), higher income (4·44, 1·77–11·18), and living with HIV (2·79, 1·03–7·55). Sex tourism was more often from a location with a lower MSM HIV prevalence (mean prevalence 4·47, SD 2·01) to a location with a higher MSM HIV prevalence (6·86, 5·24; p Interpretation MSM sex tourists were more likely to have risky sexual behaviours and travel from locations with low to high HIV prevalence rather than high to low HIV prevalence. MSM sex tourists might be part of core groups that disproportionately contribute to MSM HIV transmission. Enhanced surveillance and interventions tailored to MSM sex tourists should be considered. Funding National Institutes of Health, Doris Duke Charitable Foundation.

Background Most men who have sex with men (MSM) in China do not publicly disclose their sexual orientation. This low rate of disclosure may affect sexual behaviours, testing for HIV or other sexually transmitted infections (STIs), and disease transmission. This study examined factors associated with overall sexual orientation disclosure and disclosure to a healthcare professional. Methods We did a cross-sectional online survey of MSM in China from September 23, 2014, to October 8, 2014, through three national websites. Participants completed questions covering sociodemographic information, sexual behaviors, HIV and syphilis test history, and self-reported HIV status. We defined overall disclosure as having ever disclosed sexual orientation to anyone other than a sexual partner, and healthcare professional disclosure as disclosing to a doctor or other medical provider. Eligible participants gave informed consent electronically before beginning the survey. Findings A total of 1819 men started the survey and 1424 (78%) completed it. Of 1424 participants, 62% (886/1424) reported overall disclosure, and 16% (232/1424) had disclosed to healthcare providers. In multivariate analyses, the odds of overall sexual orientation disclosure were 56% higher among MSM who used smartphone-based sex-seeking applications (adjusted OR 1·56 [95% CI 1·25–2·95]), but were lower among MSM reporting high-risk sexual risk behaviors such as sex while drunk (0·55 [0·37–0·81]) and sex while using drugs (0·66 [0·50–0·87]). The odds of disclosure to a healthcare professional were greater among MSM who had ever been tested for HIV (3·36 [2·50–4·51]) or STIs 4·92 [3·47–6·96]) or self-reported as HIV positive (1·59 [0·93–2·72]). Interpretation More than 80% of MSM surveyed had not disclosed their sexual orientation to health professionals. This low level of disclosure probably represents a major obstacle to serving the unique needs of MSM in clinical settings. Further research and action to facilitate disclosure of sexual orientation by MSM, especially to healthcare professionals, is urgently needed. Funding US National Institute of Allergy and Infectious Diseases (NIAID; 1R01AI114310); University of North Carolina (UNC)-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532); UNC Center for AIDS Research (NIAID; 5P30AI050410); University of California San Francisco Centre for AIDS Research (NIAID; P30 AI027763]; US National Institute of Mental Health (R00MH093201); UNC Chapel Hill, Johns Hopkins University, Morehead School of Medicine and Tulane University (UJMT) Fogarty Fellowship (FIC R25TW0093); Doris Duke International Clinical Research Fellowship; US National Center for Advancing Translational Sciences (UL1TR001111).

Background In the past decade, recreational drug use has considerably increased among Chinese men who have sex with men (MSM). This increase has a great potential to worsen the scenario of the heavy burden of HIV among Chinese MSM. This study aimed to investigate the prevalence of recreational drug use, and to explore the association between poppers use and testing history for HIV or STIs, gay app use, and other sexual behaviours. Methods We recruited MSM who were born male and were aged 16 years or older through a nation-wide online survey in 2014. We collected information regarding socio-demographics, risk behaviours, recreational drug use, sexual orientation, testing history for HIV and other STIs, and gay app use. We did univariate and multivariate analyses to determine factors associated with recreational drug use among Chinese MSM. Written informed consent was gained from each participants, and the ethical approval was obtained from institution review committees in China and the United States. Findings Among 1424 participating MSM, 1100 (77%) had used any recreational drugs in their life-time. In the past 12 months, 303 (21%) had used poppers, 34 (2%) had used crystal meth, and 15 (1%) had used ecstasy. The mean age of all participants was 25·6 years (SD 6·8), 1038 (73%) were self-identified as gay, 588 (41%) were students, and 1194 (84%) had never been married. Multiple logistic regression revealed that compared with non-poppers users, poppers users were more likely to have been tested for HIV (adjusted odds ratio [aOR]=1·50, 95% CI 1·15–1·96) and for other STIs except HIV (1·65, 1·26–2·17). Additionally, poppers users were more likely to engage in group sex (2·63, 1·80–3·86) or in commercial sex (1·86, 1·13–3·06), and to use gay apps for partner seeking (2·10, 1·58–2·80). Interpretation High-risk MSM in China have a high rate of recreational drug use. Public health programmes serving MSM may consider integration of interventions to decrease harms associated with recreational drug use. Funding This work was supported by National Institutes of Health (National Institute of Allergy and Infectious Diseases 1R01AI114310 to JT and CW); UNC-South China STD Research Training Centre (Fogarty International Centre 1D43TW009532 to JT); UNC Center for AIDS Research (National Institute of Allergy and Infectious Diseases 5P30AI050410 to JT); University of California San Francisco Centre for AIDS Research (National Institute of Allergy and Infectious Diseases P30 AI027763 to CW); National Institute of Mental Health (R00MH093201 to CW); the UNC Chapel Hill, Johns Hopkins University, Morehead School of Medicine and Tulane University (UJMT) Fogarty Fellowship (FIC R25TW0093 to WT). This publication was also supported by Grant Number UL1TR001111 from the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health. These funders played no role in any step of this study.

HIV was first discovered in the United States 30 years ago. Since then, one characteristic of the epidemic has remained constant: gay men (or men who have sex with men (MSM) have been among the most severely impacted of any social group in the nation. While MSM account for less than 5% of all men in most behavioral surveys, they currently account for nearly 60% of all new HIV infections in the United States [1]. A recent CDC analysis calculated that MSM are 60 and 61 times more likely to be infected with HIV and syphilis, respectively, than heterosexual men and are 54 and 93 times more likely to be infected with HIV and syphilis, respectively, than women [2].

Background Social marketing interventions have been shown to both promote and change many health-related behaviours and issues. As the HIV epidemic continues to disproportionately affect MSM and transgender women around the world, social marketing interventions have the potential to increase HIV/STI testing uptake among these populations. Objectives To assess the impact of social marketing interventions on HIV/STI testing uptake among men who have sex with men and transgender women compared to pre-intervention or control group testing uptake in the same population. Search methods We searched the following electronic databasesfor results from 01 January 1980 to the search date, 14 July 2010: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, LILACS (Latin America and Brazil), PsycINFO, PubMed, Web of Science/Web of Social Science, Chinese National Knowledge Infrastructure (CNKI), and CQ VIP (China). We also searched for conference abstracts in the Aegis archive of HIV/AIDS conference abstracts and the CROI and International AIDS Society websites. In addition to searching electronic databases, we searched the following sources of grey literature: Australasian Digital Theses Program, Canadian Evaluation Society, Eastview: China Conference Proceedings, ProQuest Dissertations and Theses, and World Health Organization Library Information System (WHOLIS). We contacted individual researchers, experts working in the field, and authors of major trials for suggestions of any relevant manuscripts that were in preparation or in press. References of published articles from the databases above were searched for additional, pertinent materials. All languages were included in this search. Selection criteria Randomized controlled trials and controlled clinical trials that compared social marketing interventions with a control were included. Interrupted time series and pretest-posttest design studies (controlled or uncontrolled) that compared social marketing interventions with no intervention or a control were also included. Posttest-only studies and studies that combined pre-post data were excluded. Interventions that targeted at general public but did not include MSM or transgender women as a segment or did not have outcome data for an MSM or transgender segment were excluded. Data collection and analysis Two authors independently extracted data from each included study and assessed study quality. Meta-analyses were conducted to compare pre- and post-intervention and intervention and control group outcomes of HIV and STI testing uptake. Quality of evidence was assessed using the GRADE approach. Main results Three serial, cross-sectional pretest-posttest study designs (one with a control group and two without) were included in the final analysis. Statistical pooling was conducted for two studies and compared to pre-intervention level testing uptake, which showed that multi-media social marketing campaigns had a significant impact on HIV testing uptake (OR=1.58, 95%CI = 1.40 - 1.77). However, the campaigns were not found to be effective in increasing STI testing uptake (OR=0.94, 95%CI = 0.68 - 1.28). Overall, risk of bias was high and quality of evidence was low. None of the studies were conducted in developing countries or included male-to-female transgender women. Authors' conclusions This review provided limited evidence that multi-media social marketing campaigns can promote HIV testing among MSM in developed countries. Future evaluations of social marketing interventions for MSM should employ more rigorous study designs. Long-term impact evaluations (changes in HIV or STI incidence over time) are also needed. Implementation research, including detailed process evaluation, is needed to identify elements of social marketing interventions that are most effective in reaching the target population and changing behaviours.

Objectives. We compared the likelihood of childhood sexual abuse (under age 18), parental physical abuse, and peer victimization based on sexual orientation. Methods. We conducted a meta-analysis of adolescent school-based studies that compared the likelihood of childhood abuse among sexual minorities vs sexual nonminorities. Results. Sexual minority individuals were on average 3.8, 1.2, 1.7, and 2.4 times more likely to experience sexual abuse, parental physical abuse, or assault at school or to miss school through fear, respectively. Moderation analysis showed that disparities between sexual minority and sexual nonminority individuals were larger for (1) males than females for sexual abuse, (2) females than males for assault at school, and (3) bisexual than gay and lesbian for both parental physical abuse and missing school through fear. Disparities did not change between the 1990s and the 2000s. Conclusions. The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanisms underlying higher rates of mental health problems, substance use, risky sexual behavior, and HIV reported by sexual minority adults.

Men who have sex with men experience high rates of psychosocial health problems such as depression, substance use, and victimization that may be in part the result of adverse life experiences related to cultural marginalization and homophobia. These psychosocial health conditions interact to form a syndemic which may be driving HIV risk within this population. However, MSM also evidence great resilience to both the effects of adversity and the effects of syndemics. Investigating and harnessing these natural strengths and resiliencies may enhance HIV prevention and intervention programs thereby providing the additional effectiveness needed to reverse the trends in HIV infection among MSM.

Objectives To describe socio-demographic, behavioural and other characteristics associated with HIV testing behaviour among men who have sex with men (MSM) in Jinan, China. Methods A cross-sectional survey was conducted among MSM (N=500) in Jinan in 2008 using respondent-driven sampling—a method used worldwide to reach hidden high-risk populations. Bivariate and multivariate analyses, adjusted for the sampling method, were conducted to identify correlates of not having an HIV test. Results Overall, 80.7% (95% CI 75.0% to 85.0%) of MSM in Jinan have not had an HIV test in the past 12 months. In the multivariate analyses, having not visited the local Centers for Disease Control and Prevention9s website (AOR 5.59, 95% CI 2.62 to 11.95), being over the age of 35 years (AOR 3.77, 95% CI 1.19 to 11.93) and self-identified as bisexual or unsure (AOR 3.85, 95% CI 2.16 to 6.85) are significantly associated with having not had an HIV test. In addition, married men are slightly less likely to have not been tested compared to single men (AOR 0.38, 95% CI 0.17 to 0.85). Those who report meeting their sex partners at high-risk venues are two times more likely to have not had an HIV test (AOR 2.02, 95% CI 0.97 to 4.21). Conclusions Targeted, culturally appropriate and innovative interventions to increase HIV testing uptake should be a top priority for HIV prevention among MSM in China.

We conducted a critical literature review for possible reasons that may explain the lower HIV prevalence observed among API MSM compared to MSM of other races/ethnicities. Trends emerging from the literature suggest that traditional individual-level factors-unprotected anal intercourse, substance use, STD prevalence, rates and frequency of HIV testing, and utilization of HIV prevention services-do not appear to be related to the lower HIV prevalence among API MSM. Some evidence suggests that socio-cultural and structural factors might be the more critical forces in determining racial/ethnic disparities of HIV among MSM. For API MSM, these factors include structures of sexual networks, access to and reception of medical care and treatment among HIV-positive MSM, and influences of different levels and types of acculturation. Moreover, emerging risk reduction strategies, such as seroadaptive behaviors, could play a role. Future research should address these factors in intervention design. In addition, better theories of resilience and measurement of strengths and protective factors are needed to enhance the efficacy of HIV interventions.

This study aims to describe and compare the gender-specific prevalence of chlamydia and gonorrhoea, sexual behaviours and experiences, and risk factors associated with sexually transmitted infections (STIs) among migrants versus rural and urban non-migrants in China. Data were abstracted from the Chinese Health and Family Life Survey conducted from 1999 to 2000, which provided a nationally representative adult (ages 20–64 years) sample. STI results were determined using a urine-based nucleic acid amplification assay. The prevalence of chlamydia for migrant women was triple that of rural non-migrant women. Migrants were more likely to engage in STI-associated risk behaviours than non-migrants (e.g. receiving money for sex). Among migrants, women were more likely than men to have STIs. The high STI prevalence among migrants highlights an urgent need to implement comprehensive prevention and intervention programmes targeting the cultural, social and structural needs of migrants in the city, especially migrant women.

This paper reports demographic characteristics, HIV prevalence, and correlates among male sex workers (MSW) in Chiangmai, Thailand. A behavioral assessment survey was included as part of the Thailand Ministry of Public Health HIV sentinel surveillance conducted during June 2003. A sample of 181 MSW from 14 sex establishments around Chiangmai who self-identified as sex workers were interviewed. Non-Thai MSW made up half of the sample (48.6%), with the majority being of Shan ethnicity (64.7%). Thai MSW were significantly more likely to report having had receptive anal intercourse (38.0% vs. 11.8%, p0.001) and to have higher HIV prevalence than non-Thai MSW(11.8% vs. 3.4%, p0.001). In multivariate analysis, having one or more than one steady male partner in the past month (Odds Ratio: 5.56, 95% Confidence Intervals: 1.13-27.27 and 8.29, 2.01-34.20, respectively), and being older than 21 years (2.26, 1.04-4.90) were significantly and independently associated with prevalent HIV infection. While Thai MSW had higher HIV prevalence and engage in riskier activities, culturally appropriate education and outreach activities are still needed for the large number of ethnic minority MSW, particularly Shan MSW.

We examined racial/ethnic differences in reported seroadaptive and serodisclosure behaviors among the partnerships of MSM recruited for a cross-sectional survey using time-location sampling (TLS) in San Francisco during 2007–2008. The sample (N = 1,199) consisted of 12.2% Asian/Pacific Islander (API), 52.4% White, 6.8% Black, 20.2% Latino, and 8.5% of “other” race/ethnicity. Pure serosorting was most common (about 20%) among HIV-negative men while seropositioning was most used (about 15%) by HIV-positive men. Reported seroadaptive behaviors did not differ significantly across races/ethnicities among both HIV-negative and HIV-positive men. However, HIV-positive Black and Latino men were significantly more likely to report no preventive, seroadaptive behavioral strategy (i.e., unprotected insertive anal intercourse with unknown status or serodiscordant partners). Among men who reported engaging in seroadaptive behaviors, they reported not discussing HIV status with a third of their partners—a major concern in that lack of disclosure undermines the effectiveness and means to practice serosorting. Partnerships of API and Black men were least likely to involve serodisclosure behaviors. Our study confirms that seroadaptive behaviors are common preventive strategies reported by MSM of all races/ethnicities, and does not find strong evidence that racial/ethnic differences in seroadaptive behaviors are enhancing disparities in HIV prevalence. The implications are that condom promotion and safe sex messages are not the only prevention measures adopted by MSM and that public health professionals should be well aware of current trends within the MSM community in order to better assist HIV prevention efforts.

Self-labeling of, and preference for, anal sex roles is an important aspect of identities and cultures among men who have sex with men (MSM) populations. In this article, we examined sociodemographic and behavioral correlates of preference for and maintenance of anal sex roles, and risk for HIV infection. Using time-location sampling, we conducted a cross-sectional survey of racially diverse MSM in San Francisco. Of the 386 men who reported an anal sex role preference, 41% preferred being “versatile” while 21 and 37% preferred being “bottom” and “top” only. Lower educated men, Asian/Pacific Islander men, and men born in Asia/Philippines were more likely to prefer being “bottom.” Among all racial/ethnic groups, men in general did not maintain their preferences 100% of the time in their reported sexual behavior, and none of the racial/ethnic groups maintained their preference at greater or lesser levels than any other group. There were no significant differences in all the behavioral risks between men who maintained their preferences and those who did not. Yet, prevalence of HIV infection was two times higher among men who were strictly “bottom.” Linguistically and/or culturally appropriate HIV prevention information/interventions at an appropriate educational level should be provided to those from the developing world and those of lower socioeconomic status, who may lack the knowledge of differential risks associated with anal sex activities.

Controlling hypertension is important to protect renal function and prevent cardiovascular disease in chronic kidney disease (CKD) patients. However, data on hypertension awareness, treatment and control among CKD patients are limited. Two nationwide surveys were conducted in China in 1999–2000 and 2004–2005 among, respectively, 1328 and 1244 adult, non-dialysis, hypertensive CKD patients, to assess the status of hypertension awareness, treatment and control and associated factors. A standard questionnaire was adopted, and blood pressure (BP) was measured by trained staff according to a standard protocol in both surveys. Compared with the data from 1999–2000, the data from 2004–2005 showed increased awareness (87.2 vs. 75.7%, P