Abstract
Background: HIV infection is prevalent among men who have sex with men (MSM), and sexual roles may be important factors related to it. This study aims to describe the sexual roles, risky sexual behaviors and HIV prevalence among MSM, and to determine associated factors for HIV prevalence.
Methods: A convenient sampling method was used to recruit participants in a non-government organization in Changsha, China. The participants were asked to complete a 38-item self-administered questionnaire regarding demographic characteristics and risky sexual behaviours before collecting blood samples for HIV testing. Chi-square tests and logistic regression analysis were conducted with the Statistical Package for the Social Sciences Version 18.0 and other indexes were statistically described.
Results: A total of 601 MSMs who came to a local non-government organization for voluntary counseling and testing completed a pencil-and-paper survey and were tested for HIV. The overall HIV prevalence of this sample was 13.3%, and that of the bottoms (16.3%) was similar to the versatiles (15.9%) but higher than the tops (6.1%). Bivariate analyses showed that there were significant differences in age, marital status, monthly income, sexual orientation, age at first sex, sex of the first sex partner, sex with a woman in the last 6 months, oral sex with a man in the last 6 months and role of oral sex among 3 subgroups of MSM (p < 0.05). Multivariate analyses indicated that MSMs who played the role of either the bottoms or the versatiles were more likely to be HIV positive than the tops. While MSMs who used condoms in anal sex in the last 6 months, had sex with a woman in the last 6 months or had oral sex with a man in the last 6 months were less likely to be HIV positive.
Conclusion: Different sexual roles are associated with high-risk sexual behaviors among MSMs and their HIV infection status. Further research should target preventive interventions, and improve the effectiveness of the intervention according to the characteristics of the subgroups to reduce the HIV transmission among Chinese MSM.
Keywords: Men who have sex with men, sexual roles, risky sexual behaviors, HIV, China, epidemic.
Graphical Abstract
[1]
Wang QQ, Chen XS, Yin YP, et al. HIV prevalence, incidence and risk behaviors among men who have sex with men inYangzhou and Guangzhou, China: a cohort study. J Int AIDS Soc 2014; 17(4): 18849.
[2]
Li L, Lu X, Li H, et al. High genetic diversity of HIV-1 was found in men who have sex with men in Shijiazhuang, China. Infect Genet Evol 2011; 11(6): 1487-92.
[4]
NCAIDS, NCSTD, China CDC. Update on the AIDS/STD epidemic
in China in December 2017. Chinese J AIDS STD 2018;
24(2): 111.
[5]
NCAIDS, NCSTD,China CDC. Update on the AIDS/STD epidemic
in China in December 2016. Chinese J AIDS STD 2017;
23(2): 93.
[6]
National Health and Family Planning Commission of the People’s
Republic of China. 2015 China AIDS Response Progress Report.
UNAIDS 2015. Available from: http://www.unaids.org/sites/ default/files/country/documents/CHN_narrative_report_2015.pdf [cited: 6th Apr 2017].
[8]
Lu H, Han Y, He X, et al. Alcohol use and HIV risk taking among Chinese MSM in Beijing. Drug Alcohol Depend 2013; 133(2): 317-23.
[9]
Xu J, Han DL, Liu Z, et al. The prevalence of HIV infection and the risk factors among MSM in 4 cities, China. Chin J Prev Med 2010; 44(11): 975-80.
[10]
Feng Y, Wu Z, Detels R, et al. HIV/STD prevalence among MSM in Chengdu, China and associated risk factors for HIV infection. J Acquir Immune Defic Syndr 2010; 53(Suppl. 1): S74.
[11]
Xue B, Xu J, Yang J, et al. HIV prevalence and high-risk sexual behaviors among MSM repeat and first-time testers in China: implications for HIV prevention. J Int AIDS Soc 2014; 17(1): 18848.
[12]
Zeng X, Zhong X, Peng B, et al. Prevalence and Associated Risk Characteristics of HIV Infection Based on Anal Sexual Role among Men Who Have Sex with Men: A Multi-city Cross-sectional Study in Western China. Int J Infect Dis 2016; 49(C): 111-8.
[13]
Daily Ps. Fight against AIDS, we are together: People's Daily;
2016. Available from: http://www.gov.cn/xinwen/2016-12/02/content_5141656.htm [cited: 2nd Dec 2016].
[14]
Yao D. Effectiveness of control measures against human immunodeficiency
virus (HIV) infection among men who have sex with
men (MSM) in China: a systematic review. Postgraduate Thesis
2013.
[15]
Liu G, Lu H, Wang J, et al. Incidence of HIV and Syphilis among Men Who Have Sex with Men (MSM) in Beijing: An Open Cohort Study. PLoS One 2015; 10(10): e0138232.
[16]
Hong VT, Xin L, Donnell D, et al. Anal Sex Role Segregation and Versatility among Men Who Have Sex with Men: EXPLORE Study. J Acquir Immune Defic Syndr 2013; 64(1): 121.
[17]
Hart TA, Wolitski RJ, Purcell DW, Gómez C, Halkitis P. Sexual behavior among HIV‐positive men who have sex with men: What’s in a label? J Sex Res 2003; 40(2): 179.
[18]
Wei C, Raymond H. Preference for and maintenance of anal sex roles among men who have sex with men: sociodemographic and behavioral correlates. Arch Sex Behav 2011; 40(4): 829-34.
[19]
Lou J, Wu J, Chen L, Ruan Y, Shao Y. A sex-role-preference model for HIV transmission among men who have sex with men in China. BMC Public Health 2009; 9(Suppl. 1): S10.
[20]
Zheng L, Hart T, Zheng Y. Top/Bottom Sexual Self-labels and Empathizing-Systemizing Cognitive Styles Among Gay Men in China. Arch Sex Behav 2015; 44(5): 1431-8.
[21]
Moskowitz D, Rieger G, Roloff M. Tops, bottoms and versatiles. Sex Relationship Ther 2008; 23(3): 191-202.
[22]
Zheng LJ. Y Z. Role distinguish and Demand in Partners’ Role in Homosexual. Chin Ment Health J 2009; 23(3): 192-5.
[23]
Zhang JY, Li QQ, Han DL, et al. The sexual role status and its relationship with condom use and HIV-testing in men who have sex with men. Chinese J Dis Cont Prevent 2013; 17(5): 400-3.
[24]
Meng X, Zou H, Fan S, et al. Relative Risk for HIV Infection Among Men Who Have Sex with Men Engaging in Different Roles in Anal Sex: A Systematic Review and Meta-analysis on Global Data. AIDS Behav 2015; 19(5): 882-9.
[25]
Wegesin DJ. Top/Bottom Self-Label, Anal Sex Practices, HIV Risk and Gender Role Identity in Gay Men in New York City. J Psychol Human Sex 2000; 12(3): 43-62.
[26]
Zhang H, Zhao J. WAu W, Liu S, Wu Y, Zhang X. Characteristics
of sexual behavior and related factors among MSM with different
sexual roles in Shenzhen. China Trop Med 2016; 16(5): 470-4.
[27]
Jeffries WL. A Comparative Analysis of Homosexual Behaviors, Sex Role Preferences, and Anal Sex Proclivities in Latino and Non-Latino Men. Arch Sex Behav 2009; 38(5): 765-78.
[28]
Moskowitz DA, Hart TA. The influence of physical body traits and masculinity on anal sex roles in gay and bisexual men. Arch Sex Behav 2011; 40(4): 835-41.
[29]
Lick DJ, Johnson KL. Intersecting Race and Gender Cues are Associated with Perceptions of Gay Men’s Preferred Sexual Roles. Arch Sex Behav 2015; 44(5): 1471-81.
[30]
Zheng L, Hart TA, Zheng Y. The relationship between intercourse preference positions and personality traits among gay men in China. Arch Sex Behav 2012; 41(3): 683.
[31]
Fields EL, Bogart LM, Smith KC, Malebranche DJ, Ellen J, Schuster MA. HIV Risk and Perceptions of Masculinity Among Young Black Men Who Have Sex With Men. J Adolesc Health 2012; 50(3): 296-303.
[32]
Chen C, Wang M, Wang T, et al. Analysis of the sex roles in the relationship with the HIV/syphilis infection and the related behavior among men who have sex with men in Zhongshan City. J Prev Med Public Health 2016; 27(1): 53-6.
[33]
Wang Y, Li L, Zhang G, et al. Anal sex roles and related behaviors among men who have sex with men (MSM) and the HIV/syphilis infection in Mianyang city of China. Chinese J Viral Dis 2014; (1): 43-8.
[34]
Hladik W, Barker J, Ssenkusu JM, et al. HIV Infection among Men Who Have Sex with Men in Kampala, Uganda–A Respondent Driven Sampling Survey. PLoS One 2012; 7(5): e38143.
[35]
Lyons A, Pitts M, Grierson J. Versatility and HIV Vulnerability: Patterns of Insertive and Receptive Anal Sex in a National Sample of Older Australian Gay Men. Aids Beha 2013; 17(4): 1370-7.
[36]
Zhou C, Raymond HF, Ding X, et al. Anal Sex Role, Circumcision Status, and HIV Infection Among Men Who Have Sex with Men in Chongqing, China. Arch of Sex Behav 2013; 42(7): 1275.
[37]
Park JN, Papworth E, Kassegne S, et al. HIV prevalence and factors associated with HIV infection among men who have sex with men in Cameroon. J Intern Aids Society 2013; 16(4)(Suppl. 3): 18752.
[38]
Zhang W, Xu JJ, Zou H, Zhang J, Wang N, Shang H. HIV incidence and associated risk factors in men who have sex with men in Mainland China: an updated systematic review and meta-analysis. Sex Health 2016; 13(4): 373-82.
[39]
Subramanian T, Ramakrishnan L, Aridoss S, et al. Increasing condom use and declining STI prevalence in high-risk MSM and TGs: evaluation of a large-scale prevention program in Tamil Nadu, India. BMC Public Health 2013; 13(1): 1-14.
[40]
García MC, Meyer SB, Ward P. Elevated HIV prevalence and risk behaviours among men who have sex with men (MSM) in Vietnam: a systematic review. BMJ Open 2012; 2(5): e001511.
[41]
Ruan S, Yang H, Zhu Y, et al. Rising HIV prevalence among married and unmarried among men who have sex with men: Jinan, China. AIDS Behav 2009; 13(4): 671-6.
[42]
Kelley CF, Kraft CS, Man TJD, et al. The rectal mucosa and condomless receptive anal intercourse in HIV-negative MSM: implications for HIV transmission and prevention. Mucosal Immunol 2017; 10(4): 996-1007.
[43]
Wang J, Xu J, Dou Z, et al. HIV, syphilis and HSV-2 prevalence in relation to receptive,insertive and both sex roles among MSM in eight cities of China. Chinese J AIDS STD 2012; 18(5): 306-9.
[44]
Prudden H, Mitchell K, Phillips A, et al. Do men who have sex
with men (MSM) in southern India change their identity or sexual
role behaviour over time? Implications for the HIV epidemic. Proceedings
of the 19th International AIDS Conference; 2012 Jul 22-
27; Washington, DC, USA 2012.
[45]
Johns MM, Pingel E, Eisenberg A, Santana ML, Bauermeister J. Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. Am J Men Health 2012; 6(6): 505.
[46]
Dai LP, Lin YX, Liu Q. Characteristics of sexual behavior and HIV infection among 1472 MSM with different gender role in Guangzhou city. Chin J Publ Health 2013; 29(2): 256-8.
[47]
Zhang H, Lu H, Pan SW, et al. Correlates of Unprotected Anal Intercourse: The Influence of Anal Sex Position Among Men Who Have Sex with Men in Beijing, China. Arch of Sex Behav 2015; 44(2): 375-87.
[48]
Warren JC, Fernández MI, Harper GW, Hidalgo MA, Jamil OB, Torres RS. Predictors of unprotected sex among young sexually active African American, Hispanic, and White MSM: the importance of ethnicity and culture. AIDS Behav 2008; 12(3): 459-68.
[49]
Erausquin JT, Duan N, Grusky O, Swanson AN, Kerrone D, Rudy ET. Increasing the reach of HIV testing to young Latino MSM: results of a pilot study integrating outreach and services. Journal of Health Care for the Poor and Underserved 2009; 20(20): 756-65.
[50]
Young LS, Sullivan P. The Perfect Man: How Do Desired Partner
Characteristics Shape Condom Use in Young MSM Relationships?
Proceedings of the 2013 Annual meeting of Population Association
of America; 2013 Apr 11-13; New Orleans, USA 2013.
[51]
Chemnasiri T, Varangrat A, Chaikummao S, Chitwarakorn A, Holtz TH. Why Young MSM Do Not Use Condoms Consistently:
A Qualitative Exploration. Aids Research & Human Retroviruses
2014; 30 Suppl 1(S1): A199.
[52]
Clark J, Salvatierra J, Segura E, et al. Moderno Love: Sexual Role-Based Identities and HIV/STI Prevention Among Men Who Have Sex with Men in Lima, Peru. AIDS Behav 2013; 17(4): 1313-28.
[53]
Xu J, Ding XB, Feng LG, et al. Prevalence of HIV and syphilis and its influential factors among 192 MSM in Chongqing City. China Trop Med 2009; 9(11): 2096-137.
[54]
Lau JT, Wang M, Wong HN, et al. Prevalence of bisexual behaviors among men who have sex with men (MSM) in China and associations between condom use in MSM and heterosexual behaviors. Sex Transm Dis 2008; 35(4): 406-13.
[55]
Zhou Q, Wu Y, Hong YA, et al. Association between perceived social norm and condom use among people living with HIV/AIDS in Guangzhou, China. AIDS Care 2016; 29(1): 91.
[56]
Li D, Peng L, He QY, Zhang JY. Associated Factors of Condom Use in Oral Sex Among Men Who Have Sex With Men. J Prev Med Inf 2014; 30(11): 945-8.
[57]
Gutiérrez JP, Molinayepez D, Morrison K, Samuels F, Bertozzi SM. Correlates of condom use in a sample of MSM in Ecuador. BMC Public Health 2006; 6(1): 1-8.
[58]
Adam PC, de Wit JB, Toskin I, et al. Estimating levels of HIV
testing, HIV prevention coverage, HIV knowledge, and condom
use among men who have sex with men (MSM) in low-income and
middle-income countries. J Acquir Immune Defic Syndr 2009; 52
Suppl 2(2): S143.
[59]
Yi S, Tuot S, Chhoun P, Pal K, Tith K, Brody C. Factors Associated with Inconsistent Condom Use among Men Who Have Sex with Men in Cambodia. PLoS One 2015; 10(8): e0136114.
[60]
Semple SJ, Pitpitan EV, Goodmanmeza D, et al. Correlates of condomless anal sex among men who have sex with men (MSM) in Tijuana, Mexico: The role of public sex venues. PLoS One 2017; 12(10): e0186814.
[61]
Berry M, Wirtz AL, Janayeva A, et al. Risk Factors for HIV and Unprotected Anal Intercourse among Men Who Have Sex with Men (MSM) in Almaty, Kazakhstan. PLoS One 2012; 7(8): e43071.
[62]
Lachowsky NJ. Going Down Under: HIV Testing and Condom Use
by Ethnicity in all MSM and Among Young MSM in Aotearoa
New Zealand. PhD dissertation. Guelph (ON): University of
Guelph 2014.
[63]
Malta M, Magnanini MM, Mello MB, Pascom AR, Linhares Y, Bastos FI. HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A Systematic Review and Meta-analysis. BMC Public Health 2010; 10(1): 317.
[64]
Feng Y, Wu Z, Detels R, et al. HIV/STD prevalence among men who have sex with men in Chengdu, China and associated risk factors for HIV infection. J Acquir Immune Defic Syndr 2010; 53(Suppl. 1): S74-80.
[65]
Dong T, Xiong HY, Peng L, et al. Factors associated with condom use by sex roles among MSM in Chengdu. Mod Prev Med 2015; 42(18): 3346-50.
[66]
Morineau G, Nugrahini N, Riono P, et al. Sexual Risk Taking, STI and HIV Prevalence Among Men Who Have Sex with Men in Six Indonesian Cities. AIDS Behav 2011; 15(5): 1033-44.
[67]
Carlos JA, Bingham TA, Stueve A, et al. The role of peer support on condom use among Black and Latino MSM in three urban areas. AIDS Educ Prev 2010; 22(5): 430-44.
[68]
Liu Y, Li X, Zhang L, Li S, Jiang S, Stanton B. Correlates of consistent condom use among young migrant men who have sex with men (MSM) in Beijing, China. Eur J Contracep Repr 2012; 17(3): 219-28.
[69]
Pageshafer K, Shiboski CH, Osmond DH, et al. Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men. AIDS 2002; 16(17): 2350.
[70]
Gilbart VL, Evans BG, Dougan S. HIV transmission among men who have sex with men through oral sex. Sex Transm Infect 2004; 80(4): 324.
[71]
Underhill K. Intimacy, Condom Use, and Pre-Exposure Prophylaxis (PrEP) Acceptability among Men Who Have Sex with Men (MSM) in Primary Partnerships: A Comment on Gamarel and Golub. Ann Behav Med 2015; 49(2): 151-3.
[72]
Yeo TE, Fung TH. Between ‘0’ and ‘1’: safer sex and condom use among young gay men in Hong Kong. Cult Health Sex 2016; 18(3): 294.
[73]
Neville S, Adams J, Moorley C, Jackson D. The condom imperative in anal sex – one size may not fit all: a qualitative descriptive study of men who have sex with men. J Clin Nurs 2016; 25(23-24)
[74]
Van GF, Jw DLVW. A review of the epidemiology of HIV infection
and prevention responses among MSM in Asia. Aids 2010; 24
Suppl 3(3): S30.
[75]
Oster AM, Wiegand RE, Sionean C, et al. Understanding disparities in HIV infection between black and white MSM in the United States. AIDS 2011; 25(8): 1103-12.
Related Books
Frontiers in Clinical Drug Research: Anti-Infectives
Frontiers in Anti-Infective Drug Discovery
Coronaviruses
Moving From COVID-19 Mathematical Models to Vaccine Design: Theory, Practice and Experiences
COVID-19: Effects in Comorbidities and Special Populations
An Update on SARS-CoV-2: Damage-response Framework, Potential Therapeutic Avenues and the Impact of Nanotechnology on COVID-19 Therapy
An Epidemiological Update on COVID -19
Frontiers in Clinical Drug Research: Anti-Infectives
Frontiers in Anti-infective Agents
Coronavirus Disease-19 (COVID-19): A Perspective of New Scenario
Article Metrics
27
5