High Levels of Unprotected Sex With Men and Women among Men Who Have Sex With Men: A Potential Bridge of HIV Transmission in Beijing, China

Abstract

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). We investigated sexual risk, risk perception, HIV and condom knowledge, and utilization of prevention services in the first large sample of MSM recruited in Beijing. Four hundred eighty-two MSM were sampled from September 2001 to January 2002. Forty-nine percent of participants reported unprotected anal intercourse with men during the previous 6 months. However, only 15% perceived they are at risk for HIV and many had misconceptions about HIV transmission routes and limited knowledge about condoms. Less than one quarter obtained free condoms (24%) and condom lubricants (19%) in the past 2 years. Multiple logistic regression analysis showed that unprotected insertive anal intercourse was associated with not having a Beijing residence card, having six or more male sexual partners, not having sex with women, having a lifetime history of sexually transmitted diseases (STDs), and having never tested for HIV. Unprotected receptive anal intercourse was independently associated with having six or more male sexual partners, not having sex with women, having a lifetime history of STDs, having never tested for HIV, and having less exposure to HIV prevention services. In addition, 28% reported having sex with both men and women during the previous 6 months, and 11% had unprotected intercourse with both men and women. This finding suggests that MSM are a potential bridge of HIV transmission to heterosexual women (or vice versa) and that addressing the HIV prevention needs of MSM may benefit the wider population.

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

“…However, the alarming and rapid rise in both HIV and syphilis prevalence among MSM in recent years in China has primarily been reported in some urban areas. [8][9][10]12,13 The prevalence of bisexual behaviors among MSM varies according to a country's culture and its social acceptance of homosexuality.…”

“…15 These bisexual and marital relationships could have a strong impact on the HIV epidemic, as across different countries the rate of unprotected sexual behaviors between spouses and/or regular heterosexual partners tends to be very high. 13,16,17 This potential route of HIV transmission may explain the HIV epidemic in certain settings. 17 The traditional Chinese culture does not openly endorse MSM behaviors.…”

“…12 Under social pressure, many MSM conceal their sexual orientation and do not inform their female sex partners about their homosexual behaviors; nearly one third of MSM are married in China, and an even higher proportion reported having had sex with women. 13,18 Therefore, bisexually active men in China could play a critical bridging role in spreading HIV and other sexually transmitted diseases (STDs) from their high-risk male-to-male sexual partners to low-risk female partners, e.g., their wives. 19,20 The prevalent bisexual behaviors among Chinese MSM has not been fully investigated.…”

Correlates of Incident Infections for HIV, Syphilis, and Hepatitis B Virus in A Cohort of Men Who Have Sex with Men in Beijing

“…Approximately one third are married and an even higher proportion of Chinese MSM have had sex with women. 23,29 Whereas previous research provides only cross-sectional data on the incidence rates of HIV, syphilis and hepatitis B virus (HBV) infections, 9,13,30-32 a limited number of cohort studies with small sample sizes and/or poor retention rates among MSM were conducted recently in China. 33,34 This is the first cohort study among MSM in China to assess the correlates of HIV, syphilis, and HBV seroconversions among this group in Beijing.…”

Determinantes do risco e implicações para a saúde nas práticas sexuais de homens que têm sexo com homens

“…Por exemplo, Choi et al (2004) verificaram que na sua amostra de HSH, 49% tinham práticas de sexo anal sem preservativo e que apenas 15% deles percepcionavam o risco de se infectarem com o HIV. De entre os HSH, cerca de 30% deles têm múltiplos parceiros (Lau et al, 2002) com os quais têm sexo anal, muitas vezes desprotegido, bem como com profissionais do sexo (Girault et al, 2004).…”