Bridging the serodivide.: Attitudes of PrEP users towards sex partners living with HIV

The introduction of biomedical HIV prevention methods, such as pre-exposure prophylaxis (PrEP), holds the potential to overcome the serodivide. We investigated the attitudes of PrEP users towards having sex with partners living with HIV. PrEP users in the Netherlands were recruited online and completed three questionnaires over a period of six months. We investigated changes over time in feelings of fear of HIV, comfort, and attitudes towards condom use when having sex with men living with HIV (MLHIV). A majority of PrEP users in our sample (up to 71.6%) had sex with MLHIV. Feeling comfortable to have sex with MLHIV did not change over time, but was already at a high level at T1. Most importantly, feeling safe not to use condoms with HIV-positive partners significantly increased, and did so in a rather short period of time after the onset of PrEP use (3-6 months). Taken together, the findings suggest that that PrEP may contribute to decreasing the serodivide between MSM rather quickly after the onset of PrEP use

Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis

BACKGROUND: The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV. METHODS: We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches. RESULTS: We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence. CONCLUSIONS: Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly

Hi-fun among men who have sex with men in Bangkok: A scoping study exploring key informants' perspectives on hi-fun contexts, harms and support strategies.

The use of specific drugs (e.g. methamphetamine, GHB/GBL and other stimulants) to enhance sex among men who have sex with men (MSM), is the focus of global public health concern because of links to social harms, poor mental and sexual health. Often called 'chemsex' in Western settings or 'hi-fun' in Southeast Asia, this type of sexualised drug use is increasingly visible in Thailand where the unique sociocultural and legislative environments shape sexual cultures and harms. This study aimed to develop an understanding of key informants' perspectives on hi-fun contexts, harms and current responses in Bangkok. In-depth interviews were conducted with thirteen key informants from clinical, community, policy and development organisations. Four key informants had personal experience of hi-fun. Interviews covered hi-fun contexts, harms and support, were transcribed verbatim, translated to English (where necessary) and analysed using a thematic framework. MSM hi-fun 'influencers' shape norms and provide support online, primarily through Twitter. Hi-fun was linked to Westernisation and wealth; complex hierarchies emerged from asymmetries in social/financial capital. Police coercion towards MSM engaged in hi-fun was a concern. Given the nature of their funding, HIV/HCV/STI transmission was the most pressing focus for many organisations, however key informants were concerned especially about drug overdoses and mental health/well-being impacts. The political and economic context means funding for MSM health in Thailand focuses primarily on HIV prevention/treatment; restrictions on development aid constrain holistic hi-fun focused service development. Most hi-fun support was informally developed; successful strategies relied on partnership working and peer developed/delivered services, some of which were adapted from high-income settings. Despite substantial barriers, organisations developed services responding to the needs of MSM engaged in hi-fun. Given that many were informally developed or adapted from high-income settings, establishing a theoretical basis for further interventions that is grounded in this unique context is a priority

Sexual orientation disclosure and depression among Thai gay, bisexual, and other men who have sex with men: The roles of social support and intimate partner violence.

BackgroundAmong gay, bisexual, and other men who have sex with men (GBM), sexual orientation disclosure to social groups can act as a significant risk for depression. The primary goal of this research is to understand the association between disclosure and depression, the association of social support and intimate partner violence (IPV) experiences, depression, and disclosure.MethodsThis project uses a secondary dataset of Thailand from a larger cross-sectional study distributed in the Greater Mekong Sub-Region. This study utilized web-based answers from 1468 Thai GBM respondents between the ages of 15-24 years.ResultsPrevalence of depression was over 50%. Across the social groups of interest, those who disclosed to everyone had the lowest depression prevalence. This association was statistically significant for all groups (pDiscussionThis study provides strengthened evidence of the impact that differences in supportive networks can have on mental health outcomes. In addition, they provided a wider consideration for how people may have different IPV experiences, either as a perpetrator, victim, or both, and how those shapes health outcomes of depression. GBM communities still face adversity and challenges that affect their long-term health outcomes, even if they do live in what is considered an accepting country

Youth Perceptions on Cyberbullying (การรับรู้ของเยาวชนต่อการรังแกในพื้นที่ไซเบอร์ )

This qualitative study focused on the perceptions youth have about cyberbullying – its definition, types, causes, impact and ways of managing it. The data were collected from 15-24 year old youth in Central Thailand through 22 focus groups with 4-6 participants each, as well as 26 in-depth interviews, totaling 136 participants. Findings indicated that youth view cyberbullying as harming others through mobile phones and the Internet.  The actions must cause real harm and annoyance to the person they are done to, and be done with intention to harm, to count as cyberbullying. The relationship between the parties involved is a further consideration. Types of cyberbullying perceived by youth include verbal abuse and attacks over the Internet or mobile phone, online sexual harassment, impersonation of others to harm them, and online hate groups. The youth studied viewed that the anonymity of cyberspace is a key cause of cyberbullying; they also considered cyberbullying to be a continuation of previous offline violence incidents. In their view, cyberbullying impacts both on the individual and on their social interactions. They thought they would manage the problem by themselves or perhaps consult their friends, but not their parents. A cause for concern is that they viewed cyberbullying as       an ordinary matter.  Keywords: cyberbullying, perception, youth violenceบทคัดย่อ การวิจัยเชิงคุณภาพครั้งนี้มีวัตถุประสงค์ศึกษาเกี่ยวกับการรับรู้ของเยาวชนต่อการรังแกในพื้นที่ไซเบอร์ ในแง่ของความหมาย รูปแบบ สาเหตุ ผลกระทบ และวิธีการจัดการกับปัญหาการรังแกในพื้นที่ไซเบอร์ เก็บรวบรวมข้อมูลจากกลุ่มเยาวชนที่อยู่ในช่วงอายุระหว่าง 15-24 ปี ในภาคกลาง โดยใช้วิธีการสนทนากลุ่มๆ ละ 4-6 คนจำนวน 22 กลุ่ม และสัมภาษณ์เชิงลึกจำนวน 26 คน รวมทั้งสิ้น 136 คน ผลการศึกษาพบว่า เยาวชนให้ความหมายต่อการรังแกในพื้นที่ไซเบอร์ว่าหมายถึง การใช้โทรศัพท์มือถือหรืออินเทอร์เน็ตในการทำร้ายกัน ซึ่งการรังแกในพื้นที่ไซเบอร์มีมิติที่สำคัญคือต้องสร้างความเสียหาย และสร้างความรำคาญต่อผู้ถูกกระทำ ทั้งนี้ขึ้นอยู่กับเจตนาของผู้กระทำ และความสัมพันธ์ระหว่างผู้กระทำกับผู้ถูกกระทำ รูปแบบของการรังแกที่รับรู้ประกอบด้วย การโจมตีหรือใช้วาจาหยาบคายผ่านอินเทอร์เน็ตและโทรศัพท์มือถือ การคุกคามทางเพศออนไลน์ การแอบอ้างชื่อหรือตัวตนของผู้อื่นเพื่อให้ร้าย รวมไปถึงการสร้างกลุ่มขึ้นมาเพื่อโจมตีบุคคลอื่น ส่วนสาเหตุของการรังแกในพื้นที่ไซเบอร์นั้นเยาวชนรับรู้ว่าเกิดจากความเป็นนิรนามของพื้นที่ไซเบอร์ ความง่ายและสะดวกในการรังแกกัน และเป็นผลที่ต่อเนื่องมาจากการเกิดความรุนแรงในพื้นที่จริง ผลกระทบจากการรังแกในพื้นที่ไซเบอร์ก็จะส่งผลกระทบทั้งในระดับบุคคล และระดับปฏิสัมพันธ์ทางสังคม ในแง่ของการจัดการปัญหาดังกล่าวพบว่าเยาวชนมีการรับรู้ว่าจะจัดการปัญหานี้ด้วยตัวของตัวเอง หรืออาจมีการปรึกษาเพื่อนๆ บ้าง แต่จะไม่ปรึกษาผู้ปกครอง และประเด็นที่ต้องตระหนักคือปัญหาเกี่ยวกับการรังแกในพื้นที่ไซเบอร์ถูกมองว่าเป็นเรื่องปกติธรรมดาในสายตาของเยาวชน   คำสำคัญ: การรังแกในพื้นที่ไซเบอร์, การรับรู้, ความรุนแรงในเยาวชน

‘Hu Hong’ (bad thing): parental perceptions of teenagers’ sexuality in urban Vietnam

Abstract Background Teenagers under 18 years old in Vietnam are considered as minors who usually lack the autonomy to make decisions. They are also sometimes viewed as contributors to social evils including crime, violence and substance use. Moreover, most Vietnamese teenagers have unsafe sex before marriage. The objective of this study is to explore the parental perceptions relating to their teenagers’ sexuality, particularly the social and cultural forces, that may hinder access to sexuality information. Methods Guided by a Community Advisory Board (CAB), this qualitative study uses four focus group discussions (FGDs) consisting of 12 mothers and 12 fathers, as well as twelve individual in-depth interviews (IDIs) with a diverse sample of parents of teens in Ho Chi Minh City (HCMC), Vietnam. Content and discourse analysis were conducted, based on Foucauldian concepts. Results Four themes emerged: 1) Meanings of sexuality and sexuality education, 2) Early sexual intercourse destroys teenagers’ future, 3) Teenagers are not hu hong (spoil/bad thing), are innocent and virgin, and 4) Policing and controlling of sexual intercourse among teens. Parents did not view their teenage children as sexual beings; those who are sexual are considered hu hong. Parents believed that teens need to be policed and controlled to prevent them from becoming hu hong, particularly girls. Controlling of sexuality information by parents was therefore common in HCMC, but differed by gender and educational levels of parents. For example, fathers more than mothers were not comfortable teaching their teenage children about sex and sexuality. Parents with higher education police their teenage children’s usage of the Internet and social media, while parents with lower education control who can be friends with their teenage children. Conclusions Vietnamese parents in general have negative views of sex and sexuality education for their teenage children. Recognizing that many Vietnamese teenagers have unsafe sex before marriage, parents need to change their perceptions and understand the importance of comprehensive sexuality education (CSE), which are included in UNESCO, UNFPA and UNICEF-developed CSE tools

Bridging the serodivide: Attitudes of PrEP users towards sex partners living with HIV

The introduction of biomedical HIV prevention methods, such as pre-exposure prophylaxis (PrEP), holds the potential to overcome the serodivide. We investigated the attitudes of PrEP users towards having sex with partners living with HIV. PrEP users in the Netherlands were recruited online and completed three questionnaires over a period of six months. We investigated changes over time in feelings of fear of HIV, comfort, and attitudes towards condom use when having sex with men living with HIV. A majority of PrEP users in our sample (up to 71.6%) had sex with men living with HIV. Feeling comfortable to have sex with men living with HIV did not change over time, but was already at a high level at T1. Most importantly, feeling safe not to use condoms with HIV positive partners significantly increased, and did so in a rather short period of time after the onset of PrEP use (3-6 months). Taken together, the findings suggest that that PrEP may contribute to decreasing the serodivide between MSM rather quickly after the onset of PrEP use

Slow Uptake of PrEP: Behavioral Predictors and the Influence of Price on PrEP Uptake Among MSM with a High Interest in PrEP

Despite the improved availability and affordability of PrEP in the Netherlands, PrEP uptake is low among men who have sex with men (MSM). To optimize uptake, it is important to identify facilitators and barriers of PrEP use. During our study period, the price of PrEP dropped significantly after generic PrEP was introduced. We investigated whether the price drop predicts PrEP uptake, alongside behavioral and demographic characteristics. Participants (N = 349) were recruited online and completed three questionnaires over a period of 6 months, between February 2017 and March 2019. After 6 months, 159 (45.6%) participants were using PrEP. PrEP uptake was greater among MSM who ever had postexposure prophylaxis (PEP) treatment, among MSM with a better perceived financial situation, and when the price of PrEP dropped. MSM in a tighter perceived financial situation may use PrEP more when it would be free or fully reimbursed