Top PDF Seroadaptive practices: association with HIV acquisition among HIV-negative men who have sex with men.

Seroadaptive practices: association with HIV acquisition among HIV-negative men who have sex with men.

Seroadaptive practices: association with HIV acquisition among HIV-negative men who have sex with men.

We pooled data from four longitudinal HIV prevention studies of HIV-uninfected MSM conducted from 1995–2007. The HIVNET Vaccine Preparedness Study (VPS) (1995–1998), was an observational study of HIV risk behaviors and seroincidence [16]. VAX004 (1998–2001; ClinicalTrials.gov/NCT00002441), was a randomized controlled trial (RCT) of an HIV vaccine, which showed no efficacy at preventing HIV infection [17]. EXPLORE (1999–2003; ClinicalTrials.gov/NCT00000931), was an RCT of a behavioral intervention, which showed modest reductions in self-reported risk behavior, but no statistically significant reduction in HIV acquisition [18]. Finally, STEP (2004–2007; ClinicalTrials.gov/NCT00095576), an RCT of another HIV vaccine, was stopped early when an interim analysis met pre-specified futility boundaries [19]. Although there was some variability in specific enrollment criteria, all of the studies sought to enroll men who reported, at the very least, anal sex with one or more men in the past 12 months, VPS, VAX004 and STEP also enrolled participants from other continents or risk groups, however in this analysis, we include only North American MSM. All four studies followed participants every six months for 18–48 months. Sexual behavior over the last six months was assessed at each visit. VPS, VAX004, and STEP used face-to-face interviews, while EXPLORE used audio-computer-assisted self interview (ACASI). Sexual history obtained at each visit included total number of sex partners, perceived serostatus of each partner, and occurrence of specific sexual practices (insertive/receptive anal sex and protected/unprotected anal sex) with partners of each serostatus. Information on any methamphetamine or amyl nitrite (popper) use was also obtained. Questions regarding sexual behavior were asked in a similar format in these studies, enabling us to categorize each participant visit into one of the six seroadaptive behavior categories described below. Finally, HIV- antibody testing was conducted at the time of each interview.
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Prevalence and associated factors of unprotected anal intercourse with regular male sex partners among HIV negative men who have sex with men in China: a cross-sectional survey.

Prevalence and associated factors of unprotected anal intercourse with regular male sex partners among HIV negative men who have sex with men in China: a cross-sectional survey.

A number of qualitative studies explored the significance of inter-personal factors in ex- plaining risk behaviors among MSMRP. It was found that the duration of regular partnership and familiarity with the RP were positively associated with perception of low possibility of being harmed by the RP, which was in turn associated with UAI with the RP among MSM [29]. Trust may also lead to risky sex behaviors among MSMRP [28,29,30], as MSMRP assume that their trusted RP would be frank about their sexual experiences and become convinced that the RP is risk-free [31]. Similarly, MSMRP would perceive a low level of risk associated with UAI with their RP, even if MSMRP don’t have complete knowledge about their RP’s HIV sero- status [32]. Furthermore, MSM commonly believed that condom use with a trusted RP is un- necessary, and the belief was associated with lower intention and negative attitudes regarding condom use during anal intercourse [33]. UAI may also be seen as an expression of trust among MSM [23,40]. There is a dearth of studies that explore the relationship between dyadic trust within MSM couples and their condom use. Furthermore, affectionate feeling toward a sex partner was associated with UAI among MSM [34–36]. Some MSM might express their deep emotional involvement [37], love, intimacy, and mutual commitment [30] to their RP through UAI, and believe that condom use would reduce intimacy [29]. There is a dearth of quantitative studies investigating the relationship between intimacy and UAI within MSM cou- ples [32,33]. One study found that deeper emotional involvement was associated with per- ceived low risk for having UAI with RP [32].
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Association between childhood physical abuse, unprotected receptive anal intercourse and HIV infection among young men who have sex with men in Vancouver, Canada.

Association between childhood physical abuse, unprotected receptive anal intercourse and HIV infection among young men who have sex with men in Vancouver, Canada.

novel in that they highlight the importance of childhood physical violence, over sexual abuse, as a predictor of HIV seroconversion. Heuristic models describing the potential pathways between CSA and HIV risk behaviours among MSM have identified five inter- related mediators: personal motivations, coping responses, sexual scripts, risk appraisal and interpersonal factors [16,19,61]. A recent mediation model has identified salient pathways linking CSA and unprotected anal intercourse in a large sample of MSM [61]. While mediation analyses were outside the scope of this study, evaluation of our results in conjunction with this empiri- cally-derived heuristic model suggests that CPA may have placed YMSM in this cohort at increased risk of URAI and HIV- seroconversion by sequentially affecting their: i) motivation (i.e. decreasing self-esteem, increasing depressive mood) ii) cognitive and behavioural coping strategies (i.e. increased substance use); iii) risk appraisal (i.e. reducing concern with contraction of HIV); and ultimately iv) HIV risk behaviour (i.e. increasing transactional sex, URAI). Additional studies are needed to examine the pathways through which childhood maltreatment predisposes to risk behaviours and HIV infection.
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HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana.

HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana.

Overall, HIV rates were substantial, and risks for HIV infection from sex with both were men and women were common. The participants were generally young, though there was a significant association between HIV and age. Excluding the few men above the age of 49, overall more than one-third (35.7%, 95%CI 26.3– 46.4) of MSM between the ages of 30–49 were HIV infected. These data suggest that this is not a new epidemic of HIV among African MSM which is spreading more rapidly among younger MSM, as has been seen observed among MSM in other settings such as Russia [16]. Because younger men were much less likely to be HIV infected, prevention programs targeting younger MSM in these populations could have marked potential for avoiding future infections. All possible combinations of biomedical and behav- ioural interventions need to be evaluated including those directed at MSM who are already HIV seropositive[17]. While very little is known about the benefit of targeted HIV prevention programming among MSM in Africa, in other contexts these approaches are known to be very effective in decreasing unprotected anal intercourse (UAI) [18,19]. Prevention research and optimization of existing prevention tools for MSM are a clear public health priority for Southern Africa.
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Prevalence of Sexually Transmitted Viral and Bacterial Infections in HIV-Positive and HIV-Negative Men Who Have Sex with Men in Toronto.

Prevalence of Sexually Transmitted Viral and Bacterial Infections in HIV-Positive and HIV-Negative Men Who Have Sex with Men in Toronto.

Our study recruitment was clinic-based, and so it not clear to what extent these results can be extrapolated to MSM from Toronto who are not in medical care. The Maple Leaf Medical Clinic provides care for over 10,000 MSM, and as such is the largest provider of MSM care in Toronto. However, it is likely that men in regular care at this site differ in several ways to those not in care, or in care at less community-focused clinics. Further selection bias may also apply to participant uptake within the clinic, such that men who participated may have differed from non-participants in unknown ways. We do not believe that these potential biases would lead to an over-estimation of STI prevalence among participants, since testing and treatment for most study STIs is already available free of charge within the clinic (exceptions being screening for asymptomatic HSV1/2 and HPV); if anything, we suspect that the STI prevalence among sexu- ally active MSM from the community who are not in care would be higher than those that we observed. Formal data regarding participation rates were not collected, but clinic staff infor- mally estimated participation to have been approximately 95% among HIV+ men and 70% among HIV-uninfected men [Loutfy M, personal communication]. This differential participa- tion was due in part to greater familiarity of infected men with research, as the clinic partici- pates in numerous HIV clinical trials.
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Burden of HIV and Syphilis: A Comparative Evaluation between Male Sex Workers and Non-Sex-Worker Men Who Have Sex with Men in Urban China.

Burden of HIV and Syphilis: A Comparative Evaluation between Male Sex Workers and Non-Sex-Worker Men Who Have Sex with Men in Urban China.

In this survey involving a multicentre population of urban MSM of China the prevalence of HIV and syphilis were found to be slightly lower among MSWs compared to their non-MSW counterparts although the difference was not statistically significant for HIV. Our study further confirmed the results of one meta-analysis that focused on Chinese MSM[16]. Similar observa- tions were also reported by one study conducted at Sydney, where significantly lower preva- lence of HIV was revealed among MSWs than the non-MSW MSM [6]. A few factors could lead to this seemingly contradictory result. First, although our study indicated that proportion of MSWs having CAI in the last six months were similar to that among non-MSW MSM, MSWs had significantly lower proportions for CAI during their last anal intercourse. The lower burden of this important risk behavior might well have reduced the risk of acquisition of HIV and syphilis infection among MSWs, compared to non-MSW MSM despite the fact that MSWs had relatively much higher number of sexual partners (22.49±6.59 VS 4.00 ±3.35 in the last six months). Second: very few MSWs in China might have identified themselves as sex workers. They probably belonged to a group of younger men with lower socio-economic status (SES) who offered sex to other male in exchange for money, gifts or other economic support, and were often not even gay or bisexual. They might also have worked as MSWs for only a short period of time to earn some quick money [7]. Data collected from our study also sup- ported these explanations, as the MSWs in our study were more likely to be younger, less edu- cated, migrants and heterosexual. Third: as a cross-sectional study, our study might have suffered from some selection bias, particularly if the response rate among different sub-groups remained different and was influenced by their commercial sexual behavior The participating MSWs might be belonging to a more aware proportion of the population they were represent- ing, who could have relatively better health-seeking and less risk behavior compared to those who did not participate.
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Incidence of HIV and Syphilis among Men Who Have Sex with Men (MSM) in Beijing: An Open Cohort Study.

Incidence of HIV and Syphilis among Men Who Have Sex with Men (MSM) in Beijing: An Open Cohort Study.

Among the 699 participants included in analysis, only 8.9% (62/699) reported drinking alcohol prior to engaging in sexual intercourse in the last 4 months. This was much lower com- pared to other studies conducted among MSM in Beijing (e.g. reported sex after alcohol use within a three-month period of 42.1% [16], or reported sex after alcohol use within a one-year time span of 57.9% [17]). This inconsistency may be due to different instruments and research designs. Nonetheless, our study and former studies identified a significant association between HIV infection and alcohol intake prior to sexual activity. The finding may point to more strate- gic intervention approaches needed to reduce HIV transmission among Chinese MSM, a sig- nificant target population which has typically seen little public health attention. In addition, having STIs is another risk factor for HIV infection due to biological and behavioral links between STIs and HIV, as confirmed by former studies [18–20]. However, according to a sur- vey carried out among young MSM in colleges in Beijing, less than two-thirds (63.1%) knew that STIs could facilitate HIV infection [21]. Therefore, it is also recommended that future HIV prevention interventions should address this awareness gap.
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HIV prevalence, incidence and risk behaviours among men who have sex with men in Yangzhou and Guangzhou, China: a cohort study

HIV prevalence, incidence and risk behaviours among men who have sex with men in Yangzhou and Guangzhou, China: a cohort study

Sera separated from the venous blood of each participant were tested for HIV and syphilis antibodies. The screening test algorithm for the HIV antibody was tested using the enzyme- linked immunosorbent assay (ELISA; Wansheng Biotech Inc., Beijing, China), and positive tests were confirmed by the Western blot assay (HIV Blot 2.2, Genelabs Diagnostics, Singapore). The toluidine red unheated serum test (TRUST; Rongsheng Biotech Inc., Shanghai, China) was used for syphilis screening and quantitative analysis. The Treponema pallidum particle agglutination test (TPPA; Fujirebio Inc., Tokyo, Japan) or Treponema pallidumELISA (TP-ELISA, Wansheng Biotech Inc., Beijing, China) was used for syphilis test confirmation. Subjects with plasma positive for both TPPA and TRUST were defined as being currently infected with syphilis. In addition, baseline TRUST-negative cases that turned positive for both TPPA and TRUST were defined as syphilis seroconversion during the follow-up period. Baseline TPPA-negative cases that turned TPPA positive (regardless of TRUST status) at follow-up were also considered as syphilis seroconversion. Likewise, baseline HIV-negative cases that turned positive, as confirmed by the Western blot assay, were defined as HIV seroconversion during the follow-up period.
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Bio-behavioural HIV and STI surveillance among men who have sex with men in Europe: the Sialon II protocols

Bio-behavioural HIV and STI surveillance among men who have sex with men in Europe: the Sialon II protocols

Prior to biological sample collection in both TLS and RDS study arms, informed consent was collected for each participant. A self-administered pen-and-paper questionnaire was then administered to all participants to obtain data on: the social and cultural context of respondents; behavioural data on sex practices; risk- reduction strategies such as not having anal intercourse with non-steady partners, condom use, and HIV serosta- tus disclosure; STI history; self-reported serostatus, and number and type of sexual partners. The questionnaire was designed by the Sialon II network in line with the GARPR indicators. A preliminary version of the ques- tionnaire was piloted in each country with the collab- oration of local gay and/or HIV NGOs. Subsequently, a ‘final’ English version of the questionnaire was trans- lated into each of the languages of the participating countries and then back-translated into English for quality control. The same questionnaire was used in both surveys (TLS and RDS): in the TLS version add- itional items were included focusing on the venues in the given city (for weight calculations), whilst in the RDS survey extra items were used in order to assess the network size of the participants.
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The potential impact of pre-exposure prophylaxis for HIV prevention among men who have sex with men and transwomen in Lima, Peru: a mathematical modelling study.

The potential impact of pre-exposure prophylaxis for HIV prevention among men who have sex with men and transwomen in Lima, Peru: a mathematical modelling study.

The use of antiretroviral (ARV) medicines for prevention of acquisition or transmission of HIV is currently a focus of policy discussions. The use of ARV drugs in HIV-uninfected individuals to prevent HIV acquisition—pre-exposure prophylaxis (PrEP)—is one of the alternatives being considered as a potential tool in the HIV prevention arsenal [1]. In 2010, the results of the first phase III clinical trial of PrEP were published: the Pre-Exposure Prophylaxis Initiative (iPrEx) study was a multinational trial of daily oral tenofovir/emtricitabine to prevent acquisition of HIV among high-risk men who have sex with men (MSM) [2]. It showed that this regime was safe and reduced the risk of HIV acquisition by 44% [2]. Consequently, the World Health Organization, the US Centers for Disease Control and Prevention, the British Association for Sexual Health and HIV, and the South African HIV Clinicians Society have published interim guidance on PrEP [3–6] recommending its use as part of a programme of comprehensive HIV prevention. Recently the US Food and Drug Administration approved the use of ARV drugs (tenofovir/ emtricitabine, brand name Truvada) for use as PrEP among men and women [7]. Consultations are taking place to inform public health policy-makers in the development of clinical and service guidelines regarding PrEP. Additionally, adding momen- tum to this fast-moving field, PrEP was also found to be effective in preventing acquisition of HIV among heterosexual men and women in sub-Saharan Africa in some studies [8,9]. However, FEM-PrEP, a trial recruiting heterosexual women in South Africa, Tanzania, and Kenya was closed prematurely last year when the data review committee stated that it would not be able to demonstrate an effect of PrEP [10]. Two further trials have tested the efficacy of 1% tenofovir gel, with somewhat inconsistent results. The CAPRISA 004 trial found a reduction in women’s risk by 39% [11], while the VOICE trial’s gel arm was stopped early after finding the product safe but not effective [12]. There is, therefore, a need to understand if and how PrEP could cost- effectively prevent HIV infection in specific populations within the current context of expanding access to treatment.
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Molecular Epidemiology of HIV-1 Infection among Men who Have Sex with Men in Taiwan in 2012.

Molecular Epidemiology of HIV-1 Infection among Men who Have Sex with Men in Taiwan in 2012.

The inappropriate use of lubricants among MSM is not a new phenomenon, as it was ob- served in high-income settings nearly two decades ago [64]. Surprisingly, we found a very high percentage of oil- or petroleum-based solution misuse as lubricants in this study (47.2% in HIV-1-infected MSM vs. 25.9% HIV-1 sero-negative MSM). Oil-based lubricants misused in- cluded Vaseline (14%), baby oil (6%), soap (4%) and other types of lotion (6%). Multivariate analysis showed that participants using such lubricants were more likely to be infected with HIV than those using saliva or water-based lubricants (OR = 4.23; p <0.001). In addition, data analysis combined with in-depth interview at post-test counseling showed that among 53 HIV- 1 seroconverters, 12 (22.6%) MSM used condoms consistently but misused oil-based solution as lubricants. Since most of them played a receptive role (bottom) during anal intercourse, they were not aware of the breakage of condoms during or after sexual intercourse. This is a very important risk factor that has been neglected in AIDS education for a long time. Similar phe- nomena may exist among MSM in other countries and this should be taught in AIDS education campaign. The Taiwan’s Centers for Disease Control has produced a video to correct this mis- conception (www.youtube.com/watch?v=BinExvvOTMM&feature = iv&src_vid=
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Anal HPV infection in HIV-positive men who have sex with men from China.

Anal HPV infection in HIV-positive men who have sex with men from China.

complete sample collection and 2 Vietnamese living in Beijing), leading to a final study population of 602 (302 from Beijing and 300 from Tianjin). As shown in Table 1, major characteristics of the study population were evaluated by site, No significant difference was found for any character (p.0.05). Therefore, subjects from the two sites were pooled together for further association analyses. The majority of participants were younger than 30 years (69.7%), Han nationality (95.0%), self-reported homosexual tendency (72.6%), and had the first homosexual act at 18 years old or later (88%). Minority nationalities were distributed in the study participants as: Hui (1.5%), Manchu (1.5%), MongoljEn (0.5%), Miao (0.3%), Uyghur (0.3%), Korean (0.3%), Chuang (0.2%), Tujia (0.2%) and Sui (0.2%). There were 23.3% participants reported a history of STDs other than HIV. Laboratory data suggested a prevalence of 8.5% of HIV seropositivity among the study population.
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Heterogeneous Evolution of HIV-1 CRF01_AE in Men Who Have Sex with Men (MSM) and Other Populations in China.

Heterogeneous Evolution of HIV-1 CRF01_AE in Men Who Have Sex with Men (MSM) and Other Populations in China.

The HIV epidemic in men who have sex with men (MSM) continues to grow in most countries [1]. More than half of new HIV infections occur among MSM in both the United States of America and the United Kingdom [2, 3]. In China, the proportion of MSM among those newly diagnosed with HIV increased to 29.4% in 2011 [4]. The drivers of the HIV epidemic in MSM are complex; they include increased high-risk behaviors, high risk of transmission through receptive anal intercourse, and a high prevalence within the network of possible sexual contacts [5]. There is an unmet need for studies focusing on the phylodynamics and virology of HIV transmission and acquisition risks for MSM and transmission dynamics within the MSM networks.
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Associations between intimate partner violence and health among men who have sex with men: a systematic review and meta-analysis.

Associations between intimate partner violence and health among men who have sex with men: a systematic review and meta-analysis.

themselves as gay had a higher prevalence of IPV compared to men who disclosed same-sex sexual behaviour, but did not identify themselves as gay or bisexual [18]. The term ‘‘partner’’ was not clearly operationalised in many of the studies. Studies measuring IPV often define ‘‘partner’’ as someone with whom the respondent has had sex. Therefore, some studies may have captured violence and abuse experienced in the context of casual encounters. This may have diluted the association between health outcomes and IPV because it is less likely that these relationships are characterised by a pattern of abuse and coercive, controlling behaviour that escalates over time [68,69]. Moreover, the role of sexual agreements, which can be monogamous or non-monoga- mous [70] and are common among gay couples [70,71], was missing from the studies identified. Lastly, there was a dearth of research relating to MSM in low- and middle-income countries [72], where MSM are at elevated risk of HIV infection and in some countries might face serious discrimination and multiple barriers to accessing health care [73].
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Daily oral emtricitabine/tenofovir preexposure prophylaxis and herpes simplex virus type 2 among men who have sex with men.

Daily oral emtricitabine/tenofovir preexposure prophylaxis and herpes simplex virus type 2 among men who have sex with men.

physical examination, adverse event (AE) assessment, study drug dispensation, HIV testing, risk-reduction counseling, and adher- ence assessment. Serologic testing for HSV-2 and physical examinations for signs of sexually transmitted infections (STI) were performed by clinicians at screening (baseline), every six months during follow-up, and when the study drug was suspended, or when prompted by symptoms reported during the monthly medical examination. HIV infection status was determined using two rapid antibody tests and confirmed by Western blot or RNA testing. Sexual practices during the previous three months were assessed by interviewer-administered questionnaires at screening and quarterly visits during follow-up. The primary analysis of iPrEx data included visits through the pre-specified cutoff date of May 1, 2010, while the current analyses include follow-up visits through September 30, 2010, the last visit at which participants would have been expected to have had exposure to study drug.
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Factors Associated with Low Levels of HIV Testing among Men Who Have Sex with Men (MSM) in Brazil.

Factors Associated with Low Levels of HIV Testing among Men Who Have Sex with Men (MSM) in Brazil.

least once may indicate a low refusal rate for voluntary testing when the HIV test is provided in the circumstances of a special study. Some studies have shown that not knowing where to test and fear of the consequences of testing positive are two of the main reasons cited for not testing [16, 20, 23, 25]. On the other hand, it is likely that people who have recently tested—especially if they are seropositive—may not wish to repeat the experience. In terms of sexual behavior, an association was found between “feeling sexually attracted towards men and women” and never having taken an HIV test. These individuals are more than twice as likely not to have been tested as compared to those who are attracted only to men. This may be related to a higher level of internalization of negative views regarding homosexuality among bisexuals, which, as shown by other studies is associated with lower access to STD services and HIV testing [53]. Inversely, the finding that there is an association between sexual violence and testing may sug- gest that sexual violence induces individuals to seek HIV testing.
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Frontline Health Service Providers' Perspectives on HIV Vaccine Trials among Female Sex Workers and Men Who Have Sex with Men in Karnataka, South India.

Frontline Health Service Providers' Perspectives on HIV Vaccine Trials among Female Sex Workers and Men Who Have Sex with Men in Karnataka, South India.

This study contributes to the scant literature exploring FHSPs’ knowledge of and views on clin- ical trials and their potential willingness to play a role in the operation of future HIV vaccine trials. The perspectives presented by FHSPs in this study raise important implications for future planning of HIV vaccine trials among FSWs and MSM in India. Because of their on- going interactions with “high risk” communities in the context of HIV prevention services, FHSPs could be highly influential in clinical trial design, pre-study preparatory work, partici- pant recruitment, trial implementation, and knowledge translation to community members throughout the life cycle of a vaccine trial. Importantly, and in contrast to previous findings [6,10], participants in our study—particularly those who self-identified with FSW and MSM communities—expressed great willingness to participate in future HIV vaccine trials, noting that their participation would be an extension of their duties as FHSPs. Given their rapport with community members, FHSPs could prove instrumental in effectively communicating the precise reasons why a trial to needs to shut down at an early stage, due to positive or adverse events. In other words, they can help to mitigate the circulation of misinformation that can feed negative media portrayals of clinical trials. From a communications perspective, FHSPs can also facilitate “two-way communication” by not only helping to understanding community concerns, needs, and experiences that emerge before, during and after trials, but they can also “clearly describe the research being proposed, related benefits and risks, and other practical implications” [41].
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Factors associated with loss-to-follow-up during behavioral interventions and HIV testing cohort among men who have sex with men in Nanjing, China.

Factors associated with loss-to-follow-up during behavioral interventions and HIV testing cohort among men who have sex with men in Nanjing, China.

conducted using an interviewer administered structured questionnaire by trained professionals in a separate and private room. At the end of the interview, specific risk reduction counseling was provided to each participant on HIV and other STIs (like increase in condom use/reducing number of sexual partner/avoiding high risk sexual practices like UVI/UAI/risk of alcohol/drug use during sex etc.) by an experienced counselor. Blood sample was collected next from each consenting participant for HIV and syphilis testing. Post-test counseling was provided to each subject when they returned to the clinic to collect HIV test results. Participants were asked to come back to the designated clinic for the follow-up assessment every 6 months. Any participant who was found to be HIV sero-positive at baseline or during any follow-up visits were excluded from the cohort and were linked to national free anti-retroviral treatment center.
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Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities.

Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities.

The HPTN 061 study has been described previously.[42, 43] Briefly, HPTN 061 tested the feasibility and acceptability of a multi-component intervention to prevent HIV infection for Black MSM in Los Angeles and San Francisco, CA; Atlanta, GA; Boston, MA; New York, NY; and Washington, DC. Between 2009–2010, Black MSM were recruited directly from the com- munity or as sex partners referred into the study by community-recruited participants. Meth- ods for recruitment of the community-recruited men were developed by and varied at each site, including community outreach, engagement of key informants and local community- based groups, and print and online advertising. Because the study had a particular interest in enrolling men who were HIV-positive but unaware of their status and men who were HIV-pos- itive but not in care and reported unprotected sex with uninfected partners or partners of unknown status, enrollment caps were created for specific categories of participants. Overall, the enrollment target for each site was 250 community-recruited participants who agreed to HIV testing with a limit of 200 HIV-negative participants. An enrollment cap of 10 was applied to community-recruited participants with a prior HIV diagnosis who were already in care, or reported only having unprotected anal sex with HIV-positive partners. No more than 83 par- ticipants per site who refused HIV testing could be enrolled.
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Factors related to condomless anal intercourse between men who have sex with men

Factors related to condomless anal intercourse between men who have sex with men

In this study, the venues or settings for data collection included social and/or commercial venues and cruising settings pre- liminarily identi fied through formative research and which were then selected randomly for data collection sampling calendars. 18 RDS was used in Bratislava, Bucharest, Verona, and Vilnius (n = 1305). RDS is similar to snowball sampling in that it requires the target population to be socially net- worked so participants can invite their peers to participate. However, RDS is different in that it incorporates numerous theoretical assumptions to reduce the numerous biases found in standard snowball sampling methods (see 19 ). Enrolment for RDS in Sialon II was based on the indivi- duals ’ social network and for the data collection, locally accredited healthcare facilities (e.g. a hospital) were used. In TLS cities, participants were recruited during 2013, whilst in RDS cities recruitment started in 2013 and finished in 2014. Prior to the survey we estimated a 50% response rate as part of the sample size calculations. A data collection pro- cedure to record refusals was therefore developed for TLS only. However, not all sites collected this data (with excep- tion of the Brighton site with a 59% response rate). Thus an
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