To avert a widespread epidemic, HIV prevention interventions for Russian MSM are critically needed. Factors predicting risk were consistent with those found among MSM in other countries early in the HIV epidemic. However, unique cultural factors, including frequent bisexual behavior, the 'newness' of openly gay communities in Russia and lack of community experience in dealing with AIDS, require HIV prevention program tailoring.
A new and understudied HIV epidemic is quickly unfolding in the Central and Eastern European countries of the former Soviet Union. Men who have sex with men (MSM) in Russia constitute a population highly vulnerable to sexually-transmitted HIV infection. In a community sample of 434 Russian MSM accessed in gay venues in St. Petersburg, 126 had had both male and female partners in the past three months. In this paper, we report on their risk characteristics. Forty-five per cent of men reported recently engaging in unprotected anal intercourse with their male partners. Respondents had a mean of 3.3 male and 3.4 female partners in the past three months, and most had multiple male and female partners in this time period. There were serious and significant gaps in the AIDS risk knowledge levels of these men, and most believed they had no personal contact with HIV-positive people. Bisexual men were more likely than exclusively gay men to have engaged in commercial sex and tended to have lower AIDS risk knowledge. Although they did not differ in average age, bisexual compared to gay men more recently had their first sex with a man. Multivariate logistic and linear regression analyses showed that condom and safer sex attitudes, perceived norms, AIDS risk knowledge and age at first sex with a man were independent predictors of high-risk behaviour among bisexual men. HIV prevention interventions for bisexual men should address their sexual practices with both male and female partners, correct misconceptions about risk, address behaviour practices rather than gay identity, and recognize risk issues faced by the female partners of bisexual men.
One of the world's newest HIV epidemics is emerging now in Russia and other countries of Central and Eastern Europe. We report on the HIV risk characteristics of young Russian men who exchange sex for money or valuables, a group that constitutes almost one-fourth of men surveyed recently in gay-identified venues in St. Petersburg. Among 96 MSM who have sex for economic gain, most reported multiple male and female partners, 45% had unprotected anal intercourse with their male partners in the past three months, and many not only received but also gave money or valuables themselves to their male partners. Relative to men who did not give sex for economic gain (n = 326), those who did were younger (n = .0001), less well-educated (p = .0001), and more often unemployed (p = .02). They also were less knowledgeable concerning even basic HIV risk reduction steps (p = .02) and held many misconceptions about safer sex. Men who exchanged sex for economic gain had more male (p = .001) and female partners (p = .01) in the past three months than men who did not, and one-third had been treated for STDs. In the context of Russia's rapid cultural and social changes, economic turmoil, and gay communities not yet experienced in AIDS, HIV prevention programs must be tailored to risk patterns and dynamics different than those found in the gay communities of many western countries.
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