Background. Community sampling of men having sex with men (MSM) for human immunodeficiency virus (HIV) and sexually transmitted infections prevalence studies poses challenges in view of problems in logistics and the hidden nature of MSM population. Methods. MSM in Hong Kong were recruited through social venues and the Internet. All participants were invited to complete a behavioural questionnaire and submit a urine specimen for HIV, Chlamydia, and gonorrhoea testing. Results. Totally, 994 MSM were recruited. No differences between venue and online-recruited respondents were identified regarding their demographics and infection status. The prevalence of HIV, Chlamydia, and gonorrhoea was 3.6% (95% CI: 2.6–5.0%), 4.7% (95% CI: 3.6–6.2%), and 0.2% (95% CI: 0.1–0.7%), respectively. Of all HIV cases, only 8.3% were aware of the infection; reflecting newly infected MSM were probably overrepresented. Some 58.3% had had HIV test within the past year, and 11.1% had CT/NG coinfection. HIV infection was associated with group sex [aOR: 2.67 (1.03–6.92)], receiving money for anal sex [aOR: 4.63 (1.12–19.18)], and unprotected anal sex with nonregular partners [aOR: 3.047 (1.16–8.01)]. Conclusion. Difference between venue- and online-recruited MSM was observed. A combination of sampling methods is complementary for epidemiology purpose. Overall, risk behaviours practised by undiagnosed HIV-positive MSM remains a cause for concern. 1. Introduction Unprotected sexual contacts have remained one of the major routes of acquiring HIV and other sexually transmitted infections (STI) in the men who have sex with men (MSM) population globally [1–4]. In Hong Kong, despite the low HIV prevalence in the general population [5], a rising trend of new HIV reports in MSM has been observed over the last decade [3, 4]. Since 2006, HIV prevalence in MSM in the territory has been hovering around 4%, and there is concern for a continued increase with time [3, 4]. The research on risk factors is important to better inform future prevention strategies. Behavioural factors aside, effects of bacterial STI on HIV transmission have been reported in various studies [6–8]. It has been suggested that the STI could enhance HIV’s infectivity by disrupting hosts’ epithelial surface and by recruitment and activation of HIV target cells during inflammatory response [7]. Of all STI, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are among the commonest pathogens that afflict MSM [2, 9, 10]. Infection caused by these organisms may increase HIV viral load in semen by up to 8-folds [10]. In Hong
References
[1]
P. S. Sullivan, O. Hamouda, V. Delpech et al., “Reemergence of the HIV epidemic among men who have sex with men in north America, Western Europe, and Australia, 1996–2005,” Annals of Epidemiology, vol. 19, no. 6, pp. 423–431, 2009.
[2]
WHO and Department of HIV/AIDS, Eds., “Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people: Recommendations for a public health approach,” 2011.
[3]
Department of Health, “HIV surveillance report 2010,” Tech. Rep., Hong Kong, December 2011.
[4]
F. Van Griensven, J. W. D. L. Van Wijngaarden, S. Baral, and A. Grulich, “The global epidemic of HIV infection among men who have sex with men,” Current Opinion in HIV and AIDS, vol. 4, no. 4, pp. 300–307, 2009.
[5]
M. K. T. Chan and S. S. Lee, “Can the low HIV prevalence in Hong Kong be maintained?” AIDS Education and Prevention, vol. 16, no. 3, supplement A, pp. 18–26, 2004.
[6]
J. A. R？ttingen, W. D. Cameron, and G. P. Garnett, “A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known?” Sexually Transmitted Diseases, vol. 28, no. 10, pp. 579–597, 2001.
[7]
S. R. Galvin and M. S. Cohen, “The role of sexually transmitted diseases in HIV transmission,” Nature Reviews Microbiology, vol. 2, no. 1, pp. 33–42, 2004.
[8]
M. S. Cohen, I. F. Hoffman, R. A. Royce et al., “Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1,” Lancet, vol. 349, no. 9069, pp. 1868–1873, 1996.
[9]
P. D. Benn, G. Rooney, C. Carder et al., “Chlamydia trachomatis and Neisseria gonorrhoeae infection and the sexual behaviour of men who have sex with men,” Sexually Transmitted Infections, vol. 83, no. 2, pp. 106–112, 2007.
[10]
C. K. Kent, J. K. Chaw, W. Wong et al., “Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003,” Clinical Infectious Diseases, vol. 41, no. 1, pp. 67–74, 2005.
[11]
“Department of Health,” Hong Kong STD/AIDS Updates, vol. 18, no. 2, 2012.
[12]
D. A. MacKellar, K. M. Gallagher, T. Finlayson, T. Sanchez, A. Lansky, and P. S. Sullivan, “Surveillance of HIV risk and prevention behaviors of men who have sex with men—a national application of venue-based, time-space sampling,” Public Health Reports, vol. 122, no. 1, pp. 39–47, 2007.
[13]
I. H. Meyer, “Prejudice, social stress, and mental health in lesbian, gay and bisexual populations: concptual issues and research evidence,” Psychological Bulletin, vol. 129, no. 5, pp. 674–697, 2003.
[14]
N. S. Koch and J. A. Emrey, “The internet and opinion measurement: surveying marginalized populations,” Social Science Quarterly, vol. 82, no. 1, pp. 131–138, 2001.
[15]
R. A. Respess, M. A. Rayfield, and T. J. Dondero, “Laboratory testing and rapid hiv assays: applications for HIV surveillance in hard-to-reach populations,” AIDS, vol. 15, supplement 3, pp. S49–S59, 2001.
[16]
R. M. S. Mota, L. R. F. S. Kerr, C. Kendall et al., “Reliability of self-report of HIV status among men who have sex with men in Brazil,” Journal of Acquired Immune Deficiency Syndromes, vol. 57, supplement 3, pp. S153–S156, 2011.
[17]
U. Marcus, F. Hickson, P. Weatherburn, and A. J. Schmidt, “Prevalence of HIV among MSM in Europe: comparison of self-reported diagnoses from a large scale internet survey and existing national estimates,” BMC Public Health, vol. 12, no. 1, article 978, 2012.
[18]
M. A. Chernesky, D. H. Martin, E. W. Hook et al., “Ability of new APTIMA CT and APTIMA GC assays to detect Chlamydia trachomatis and Neisseria gonorrhoeae in male urine and urethral swabs,” Journal of Clinical Microbiology, vol. 43, no. 1, pp. 127–131, 2005.
[19]
S. M. Jenness, A. Neaigus, C. S. Murrill, C. Gelpi-Acosta, T. Wendel, and H. Hagan, “Recruitment-adjusted estimates of HIV prevalence and risk among men who have sex with men: effects of weighting venue-based sampling data,” Public Health Reports, vol. 126, no. 5, pp. 635–642, 2011.
[20]
Y. Zhang, P. Chen, R. Lu et al., “Prevalence of HIV among men who have sex with men in chongqing, China, 2006–2009: Cross-sectional biological and behavioural surveys,” Sexually Transmitted Infections, vol. 88, no. 6, pp. 444–450, 2012.
[21]
K. E. Nelson, D. D. Celentano, S. Eiumtrakol et al., “Changes in sexual behavior and a decline in HIV infection among young men in Thailand,” The New England Journal of Medicine, vol. 335, no. 5, pp. 297–303, 1996.
[22]
UNAIDS, “Sex work and HIV/AIDS,” June 2002.
[23]
W. D. Cai, J. Zhao, J. K. Zhao et al., “HIV prevalence and related risk factors among male sex workers in Shenzhen, China: results from a time-location sampling survey,” Sexually Transmitted Infections, vol. 86, no. 1, pp. 15–20, 2010.
[24]
W. B. Cheng, F. Zhong, F. Wen et al., “Investigation of HIV and syphilis infection and AIDS-related behaviors among money boys, in Guangzhou, China,” Chinese Journal of Preventive Medicine, vol. 44, no. 11, pp. 1027–1031, 2010.
[25]
J. T. F. Lau, W. D. Cai, H. Y. Tsui, L. Chen, and J. Q. Cheng, “Psychosocial factors in association with condom use during commercial sex among migrant male sex workers living in shenzhen, Mainland China who serve cross-border Hong Kong male clients,” AIDS and Behavior, vol. 13, no. 5, pp. 939–948, 2009.
[26]
M. W. Ross, R. Tikkanen, and S. A. M？nsson, “Differences between Internet samples and conventional samples of men who have sex with men: implications for research and HIV interventions,” Social Science and Medicine, vol. 51, no. 5, pp. 749–758, 2000.
[27]
A. Bowling, “Mode of questionnaire administration can have serious effects on data quality,” Journal of Public Health, vol. 27, no. 3, pp. 281–291, 2005.
[28]
M. J. Visser, J. D. Makin, and K. Lehobye, “Stigmatizing attitudes of the community towards people living with HIV/AIDS,” Journal of Community and Applied Social Psychology, vol. 16, no. 1, pp. 42–58, 2006.
[29]
W. W. Mak, P. K. Mo, R. Y. Cheung, J. Woo, F. M. Cheung, and D. Lee, “Comparative stigma of HIV/AIDS, SARS, and Tuberculosis in Hong Kong,” Social Science & Medicine, vol. 63, no. 7, pp. 1912–1922, 2006.
[30]
R. L. Cook, K. S. George, A. J. Silvestre, S. A. Riddler, M. Lassak, and C. R. Rinaldo, “Prevalence of chlamydia and gonorrhoea among a population of men who have sex with men,” Sexually Transmitted Infections, vol. 78, no. 3, pp. 190–193, 2002.
[31]
M. J. Mimiaga, D. J. Helms, S. L. Reisner et al., “Gonococcal, chlamydia, and syphilis infection positivity among MSM attending a large primary care clinic, Boston, 2003 to 2004,” Sexually Transmitted Diseases, vol. 36, no. 8, pp. 507–511, 2009.
[32]
N. A. Lister, A. Smith, T. Read, and C. K. Fairley, “Testing men who have sex with men for Neisseria gonorrhoeae and Chlamydia trachomatis prior to the introduction of guidelines at an STD clinic in Melbourne,” Sexual Health, vol. 1, no. 1, pp. 47–50, 2004.
[33]
N. A. Lister, A. Smith, S. Tabrizi et al., “Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men at male-only saunas,” Sexually Transmitted Diseases, vol. 30, no. 12, pp. 886–889, 2003.
[34]
J. Debattista, C. Clementson, D. Mason et al., “Screening for Neisseria gonorrhoeae and Chlamydia trachomatis at entertainment venues among men who have sex with men,” Sexually Transmitted Diseases, vol. 29, no. 4, pp. 216–221, 2002.
[35]
J. Sherrard and D. Barlow, “Gonorrhoea in men: clinical and diagnostic aspects,” Genitourinary Medicine, vol. 72, no. 6, pp. 422–426, 1996.
