Young, Online and in the Dark: Scaling Up HIV Testing among MSM in ASEAN

<div><p>Background</p><p>Poor HIV testing uptake by MSM may be attributable to unique challenges that are localized in Southeast Asia.</p><p>Objective</p><p>To characterize MSM who never tested for HIV, to identify correlates of never testing, and to elucidate the perceived barriers to HIV testing.</p><p>Methods</p><p>The present study used data from the Asian Internet MSM Sex Survey (AIMSS) and restricted the analysis to 4,310 MSM from the ten member countries of the Association of South East Asian Nations (ASEAN).</p><p>Results</p><p>Among MSM participants from ASEAN in our sample, 1290 (29.9%) reported having never been tested for HIV, 471 (10.9%) tested for HIV more than 2 years ago, and 2186 (50.7%) reported their last test date was between 6 months and two years ago, with only 363 (8.4%) of these men having been tested in the past 6 months. In multivariable logistic regression, younger MSM (age 15–22 years old [AOR: 4.60, 95% CI: 3.04–6.96]), MSM with lower education (secondary school or lower [AOR: 1.37, 95% CI: 1.03–1.83]), MSM who identify as bisexual or heterosexual (compared to gay-identified) (AOR: 1.94, 95% CI: 1.60–2.35), and MSM who had never used a condom with male partners (AOR: 1.61, 95% CI: 1.32–1.97) had higher odds of never been HIV tested. Main reason for not being tested was a low risk perception of HIV exposure (n = 390, 30.2%).</p><p>Conclusion</p><p>Current HIV prevention response must not leave MSM “in the dark,” but instead meet them where they are by utilizing the Internet creatively through social media and smart phones. As ASEAN Economic Community (AEC) is quickly becoming a reality, so must there be an equally fast and united response to slowing down the HIV epidemics among MSM in ASEAN.</p></div

Factors associated with never tested for HIV among an online sample of 4,310 men who have sex with men (MSM) from ASEAN countries.

<p>^aCollapsed with bisexual identity for subsequent analysis</p><p>^bSum not equal to total sample size due to missing responses</p><p>Factors associated with never tested for HIV among an online sample of 4,310 men who have sex with men (MSM) from ASEAN countries.</p

Independent correlates of never tested for HIV among an online sample of men who have sex with men (MSM) from ASEAN countries (N = 3632)^a.

<p>^aThe model also adjusted for educational status and no. of male sexual partners in the past 6 moths.</p><p>Likelihood Ratio test: X² = 510.1, df = 23, p<0.001</p><p>Max-rescaled (pseudo) R-Square = 0.188</p><p>Goodness-of-fit test: X² = 5.65, df = 8, p = 0.687</p><p>Independent correlates of never tested for HIV among an online sample of men who have sex with men (MSM) from ASEAN countries (N = 3632)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0126658#t002fn001" target="_blank">^a</a>.</p

Reasons for never tested for HIV among an online sample of men who have sex with men (MSM) who never tested for HIV (N = 1290).

<p>Reasons for never tested for HIV among an online sample of men who have sex with men (MSM) who never tested for HIV (N = 1290).</p

Sexual transmission behaviors and serodiscordant partnerships among HIV-positive men who have sex with men in Asia

We described sexual transmission behaviors and serodiscordant partnerships among an online sample of HIV-positive men who have sex with men (N = 416) in Asia. High rates of unprotected anal intercourse (74.8%), serodiscordant partnerships (68.5%), and unprotected sex within serodiscordant partnerships (∼60.0%) were reported. Increased number of partners, meeting partners on the Internet, drug use before sex, and not knowing ones viral load were associated with unprotected anal intercourse. Efforts to develop and scale up biomedical and behavioral interventions for HIV-positive men who have sex with men in Asia are needed. © 2012 Public Health Agency of Canada and Government of Canada All rights reserved

Patterns and levels of illicit drug use among men who have sex with men in Asia

Background: The emergence of gay communities in Asia may predispose men who have sex with men (MSM) to drug use. We describe patterns and levels of illicit drug use, and characteristics of stimulant drug users among MSM in Asia. Methods: A cross-sectional Internet-based survey was conducted among 10,861 participants recruited through online methods. Pearson's chi-square tests were used to compare patterns of drug use by participants' HIV status. Multivariable logistic regression analysis was conducted to identify significant correlates of stimulant drug use. Results: Overall, 16.7% of participants reported recreational drug use in the past 6 months. Ecstasy (8.1%) and Viagra (7.9%) were the most prevalent drugs being used. HIV-positive MSM reported significantly higher levels of individual drug use and polydrug use compared to HIV-negative/unknown MSM. Being gay (AOR = 1.62, 95% CI: 1.28, 2.05), having casual male partners only or having both casual and regular partners (AOR = 2.05, 95% CI: 1.66, 2.53; AOR = 2.97, 95% CI: 2.39, 3.69), HIV-positive status (AOR = 4.54, 95% CI: 3.63, 5.69), sex work (AOR = 1.52, 95% CI: 1.19, 1.93), and having more gay friends (" Some" vs. "A few/None" AOR = 1.98, 95% CI: 1.62, 2.43; "Most/All" vs. "A few/None" AOR = 4.59, 95% CI: 3.77, 5.59) were independently associated with stimulant drug use. Conclusions: Our findings point to the urgency of incorporating substance use prevention and treatment into current HIV prevention activities in Asia, which must use a harm reduction approach and galvanize dignity. © 2011 Elsevier Ireland Ltd

Factors associated with unprotected receptive anal intercourse with internal ejaculation among men who have sex with men in a large internet sample from asia

We examined socio-demographic and behavioral characteristics of men who have sex with men (MSM) residing in Asia and correlates of unprotected receptive intercourse with Internet ejaculation (URAIE). Asia Internet MSM Sex Survey, a behavioral survey of MSM in Asia was conducted from 1 January to 28 February 2010. Data analysis was limited to participants aged 18 or above, biological male, and had one regular or casual sex partner in the past 6 months (n = 10,413). Pearson's Chi-square test, t test and logistic regression were used to examine the correlates of URAIE in the past 6 months, the highest risk sexual behavior sampled. Of 7311 participants who had receptive anal intercourse, 47.5 % had URAIE, which was associated with the following attributes: less than high-school education and pre-college education compared to university (AOR = 1.53, 95 % CI: 1.28, 1.83; AOR = 1.22, CI: 1.08, 1.37), being in the heterosexual marriage (AOR = 1.35, CI: 1.18, 1.56), having regular partners or both regular and casual partners compared to having casual partners (AOR = 2.85, CI: 2.48, 3.27; AOR = 2.32, CI: 2.06, 2.62), HIV-positive compared to HIV-negative status (AOR = 1.39, 95 % CI: 1.08, 1.81), higher perception of HIV risk (AOR = 1.62, CI: 1.34, 1.95), use of recreational drug before sex (AOR = 1.30, CI: 1.14, 1.49), and use of the Internet as the main way to seek sex partners (AOR = 1.21, CI: 1.08, 1.36). MSM from certain Asian countries reported alarming rates of URAIE. The internet can be used as a platform for HIV surveillance and intervention. © Springer Science+Business Media, LLC 2012