Bisexual Behavior and Infection with HIV and Syphilis Among Men Who Have Sex with Men Along the East Coast of China

Abstract

This study examined the correlates of bisexual behavior and infection with HIV/syphilis among men who have sex with men only (MSM-only) and those who have sex with both men and women (MSMW) in Shandong, China. Cross-sectional surveys probed sociodemographic information, sexual and drug use behaviors, knowledge, and use of prevention services; blood samples were tested for HIV/syphilis status. Of 2996 participants, 39.5% acknowledged being MSMW; 60.5% being MSM-only; 2.5% were HIV-infected with similar rates for MSMW (2.5%) and MSM-only (2.6%); 5.5% syphilis-infected with comparable rates for MSMW (5.6%) and MSMonly (5.5%). In multivariable models, MSMW were more likely than MSM-only to be older, local residents, recruited from outdoor cruising area, drug users, and less likely to have used a condom during last anal sex with a male partner. HIV-infected MSMW were more likely to have syphilis and other sexually transmitted diseases (STDs) and less likely to have received peer education. HIV-infected MSM-only were more likely to be older, nonlocal residents, and have syphilis and other STDs. MSMW with syphilis were more likely to be recruited from Jinan, Qingdao, and Zibo (versus Yantai), infected with HIV, and less likely to have received lubricant promotion. MSM-only with syphilis were more likely to be recruited from Jinan and Qingdao (versus Yantai), drug users, infected with HIV, and have had sex with male partners in the past 6 months. High prevalence of bisexual behavior and HIV/other STDs with common unprotected sex and multiple sexual partners among Shandong's gay community revealed in this study highlighted the importance of bisexuals as a potential epidemiologic bridge. Further research is needed to investigate the impact of bisexual behaviors on population transmission.

HIV/AIDS-Related Stigmatizing and Discriminatory Attitudes and Recent HIV Testing Among Men Who Have Sex With Men in Beijing

“…Our other study among Shandong MSM found that bisexual men are more likely to be older and have lower levels of HIV-related knowledge than men who have sex with men-only. (Liao, Kang, & Jia, 2011) The common bisexual practice showed in the present study were consistent with our previous study and other reports in China (Choi, Gibson, Han, & Guo, 2004; Gu, Qu, Lu, Luo, Wang, & Gu, 2004; Jiang, Cao, Zhang, Xia, Gong, Xue et al, 2006; Liao et al, 2011; X. Ma et al, 2007b; Ruan, Yang, Zhu, Ma, Li, Zhao et al, 2008), it is more common than a corresponding figure obtained in the West (Hightow, Leone, Macdonald, McCoy, Sampson, & Kaplan, 2006).…”

Highly Active Antiretroviral Therapy is Associated with Decreased Incidence of Sexually Transmitted Diseases in a Taiwanese HIV-Positive Population

“…In addition, enrolled subjects may visit other clinics for STD treatments, lowering the estimated STD incidence. Nevertheless, the STD rate reported here is similar to that reported in previous studies, 12,14,15,21,24,25,42,43 and represents the current scenario in Taiwan.…”

“…Fan and associates 24 reported that HIV infection was associated with syphilis among MSM in Beijing, China, and that syphilis control strategies such as changing social norms about condom use may have an impact on HIV prevention. 24 Liao and colleagues 25 noted that targeting the highly prevalent bisexual behavior with multiple sexual partners and unprotected sex in Shandong's gay community may have an influence on HIV transmission. 25 Ko and associates 21 also highlighted that 1 year after enrollment into the CM program in Tainan, Taiwan, 80% of the HIVpositive patients practiced safe sex.…”

“…24 Liao and colleagues 25 noted that targeting the highly prevalent bisexual behavior with multiple sexual partners and unprotected sex in Shandong's gay community may have an influence on HIV transmission. 25 Ko and associates 21 also highlighted that 1 year after enrollment into the CM program in Tainan, Taiwan, 80% of the HIVpositive patients practiced safe sex. 21 Unfortunately, the above efforts only moderately affect HIV prevention.…”

Syphilis infection, sexual practices and bisexual behaviour among men who have sex with men and transgender women: a cross-sectional study

“…MSM/TW play a bridging role in the transmission of HIV and other STIs to sexual networks in which the majority is heterosexual 10 11. Several studies have shown significantly higher rates of sexual risk behaviours and syphilis infection among MSM 12–14…”