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Using data from the National HIV Behavioral Surveillance of men who have sex with men (MSM), we estimated the prevalence of sexual behaviors among HIV-negative San Francisco MSM between 2004 and 2017. We estimate a recent increase in the 1-year prevalence of pre-exposure prophylaxis (PrEP) use, from 9.8% in 2014 to 44.9% in 2017. Over that same period, we estimate a decrease in the prevalence of consistent condom use, from 18.5 to 9.4%, and an increase in the percent of individuals with multiple condomless anal intercourse partners. We conclude that while risks for HIV infection may be decreasing among San Francisco MSM due, in part, to increases in PrEP use, the population faces increased risks for other sexually transmitted infections (STIs). Because PrEP alone does not protect against other STIs, we strongly recommend that PrEP users use condoms when possible, routinely screen for STIs, and disclose infections with sexual partners.

HIV/STI risk varies by sexual positioning practices; however, limited data have characterized the behavioral profiles of men who have sex with men (MSM) in France. This study used latent class analysis (LCA) to explore sexual risk profiles among MSM in Paris, France. LCA was used to classify sexual positioning and serosorting profiles among MSM in Paris (n = 496). Age, HIV status, relationship status, substance use, group sex, and PrEP history were used in a multinomial regression model predicting class membership. Three latent classes were identified: majority top/serosorters, versatile/low partners, and majority bottom/some serosorters. Majority top/serosorters had the highest probability of condomless serosorting; majority bottom/some serosorters had the highest mean number of partners (~ 12 partners) for condomless receptive anal intercourse. HIV-positive MSM were more likely to be classified as majority bottom/some serosorters than versatile/low partners (AOR 7.61; 95% CI 2.28, 25.3). Findings support the need for tailored and targeted interventions for highest-risk individuals.

This study examined the associations between minority stressors, poor mental health, and sexual risk behaviors, and whether there were interactive effects of minority stress and mental health factors in their associations with sexual risk behaviors in a sample of Chinese transgender women sex workers (TGSW). A cross-sectional study was conducted in 204 TGSW in Shenyang, China (mean age 33.4 years and 18.1% self-reported as HIV positive). We found a high prevalence of condomless anal intercourse (CAI) with male clients (27.9%) and CAI with male regular partners (49.5%) in the past three months among TGSW. Multivariate logistic regression analysis showed that discrimination, victimization, and life dissatisfaction were significantly associated with higher odds of CAI with male clients (AOR range: 1.05–1.42, all p < 0.05). Likewise, CAI with male regular partners was more frequently reported by participants who experienced higher levels of victimization, rejection, and anxiety (AOR range: 1.37–2.88, all p < 0.05). No significant interaction effects of gender minority stress and mental health on sexual behaviors were observed. Interventions addressing the multiple psychosocial risks are warranted to prevent behavioral risks of TGSW.

Limited data exists on intimate partner violence (IPV) among transgender women (TW), though global trends suggest IPV is associated with HIV risk in this population. We describe the prevalence of verbal, physical, and/or sexual violence as well as participant- and partner-level correlates of IPV among TW in Lima, Peru. Among 389 respondents, 15.2% reported IPV with one or more of their last three sexual partners: 9.2% verbal, 8.2% physical, and 2.3% sexual violence. Physical and verbal violence were more common with stable partners (aPR 3.46, 95% CI 1.17–10.25, aPR 2.46, 95% CI 1.14–5.28, respectively). Physical violence was associated with condomless receptive anal intercourse (cRAI) (aPR 2.22, 95% CI 1.19–4.13) and partner alcohol use (aPR 4.38, 95% CI 1.56–12.33) while verbal violence correlated with participant inebriation (aPR 4.86, 95% CI 1.63–14.46). Our results link IPV with stable partnerships, alcohol use, and cRAI, suggesting TW in Peru may benefit from multidimensional IPV prevention strategies to foster supportive relationships and reduce HIV transmission.

Background Men who have sex with men (MSM) bear a disproportionately high burden of new HIV infections while lagging behind other populations with respect to engagement across the HIV care continuum. General risk factors for condomless anal intercourse (CAI) among MSM are well studied but there is a paucity of partner-level data, where emerging evidence suggests that much of the variation in condom use occurs. Methods MSM were recruited across 10 cities in India using respondent-driven sampling (RDS) from 2016–17. Among the individuals who reported sexual intercourse in the prior 6 months, condom use and partner characteristics of the last 4 partners were captured. Correlates of CAI at the individual and partner level were determined using Poisson regression models using generalized estimating equations and incorporating RDS-II weights, which weights estimates for the participant’s network size. Results Among the 8,086 individuals, 21,723 sexual partnerships were analyzed. The prevalence of CAI was 46.9% and most partners were casual or one-time (70.7%) with partner HIV status reported as unknown in 42.6% of the sexual encounters. In multivariable analyses, partner-level characteristics associated with higher likelihood of CAI included unknown partner HIV status (aPR vs. known HIV negative partner: 1.34; 95% confidence interval (CI): 1.27–1.43) and use of alcohol/ drugs prior to intercourse either sometimes (aPR 1.42; 95% CI: 1.33–1.51) or always (aPR 1.31; 95% CI: 1.23–1.41). At an individual level, any HIV treatment literacy was associated with a lower likelihood of CAI (aPR 0.80; 95% CI: 0.74–0.86). Conclusions To reduce HIV transmission among this population of MSM across India, combination interventions are likely needed. Interventions targeting substance use and education as well as initiatives to increase self-testing are urgently needed among MSM in India and have the potential to reduce HIV transmission in this high-risk population. Trial registration ClinicalTrials.gov Identifier: NCT01686750. Date of Registration: September 18, 2012.

Background The impact of receiving HIV serostatus disclosure from partners before sex on number of sexual partners and condomless anal intercourse (CAI) among men who have sex with men (MSM) remains unclear. We aimed to determine the association between receiving this disclosure and engaging in risky sexual behaviors and its impact on HIV incidence rates. Methods HIV-negative MSM were followed with questionnaires every 3months for 12months. Generalized estimation equations models were used to assessed the factors associated with receiving serostatus disclosure and its impact on multiple sexual partners and CAI. Results Of the 363 participants, those tested for HIV in the past 3months were more likely to receive serostatus disclosure than those who had not (adjusted odds ratio (aOR)=3.145, 95% confidence interval (CI): 2.109-4.691, P P P =0.351). Subgroup analysis revealed that MSM with casual partners who received serostatus disclosure were more likely to engage in CAI (aOR=1.646, 95% CI: 1.06-2.556, P =0.027). Conclusions HIV testing promotes serostatus disclosure and disclosure of HIV serostatus correlated with fewer sexual partners. However, among MSM with casual partners, disclosure was associated with a higher likelihood of CAI. These findings encourage regular HIV testing and HIV serostatus disclosure.

Transgender women (TGW) worldwide report disproportionate violence victimization, depression and condomless anal intercourse (CAI), but the mechanism of the coexistence remains unclear. Using snowball sampling, we recruited 198 self-identified TGW in Shenyang, China between April 2017 and July 2017, and conducted confidential questionnaire survey among them. Positive HIV status was reported by 49 (24.7%) participants. 117 (59.1%) reported at least one type of lifetime violence victimization, with transactional sexual partners being the main violence perpetrators. 108 (54.5%) reported mild to severe depression. 105 (53.0%) reported having CAI with their sexual partners during the last 6 months. Path analysis showed that the association between participants’ violence victimization and CAI was fully mediated by their depression (indirect effect: 0.083, p = 0.014; direct effect: 0.137, p = 0.121). We suggest to incorporate violence screening and prevention and mental health services into intervention strategies to prevent CAI among Chinese TGW.

This study used qualitative methods to assess why women engage in heterosexual anal (receptive) intercourse (AI) with a male partner. Four focus groups which comprised women from diverse ethnicities were conducted. All groups were digitally recorded for transcription; transcripts were analyzed using the methods of grounded theory to determine themes. Women’s reasons for engaging in anal intercourse with a male partner can be described in broad categories including that the women wanted to have anal intercourse, either because of their own desire, to please a male partner, or they were responding to a quid pro quo situation. The riskiness of AI was assessed within relationship contexts. Past experience with AI including emotional and physical reactions was identified. Among the negative physical experiences of AI were pain and disliking the sensation, and uncomfortable side effects, such as bleeding of the rectum. Negative emotional experiences of AI included feelings of shame, disgust, and being offended by something her male partner did, such as spitting on his penis for lubrication. Positive physical experiences included liking the sensation. Many of the women also endorsed positive emotional experiences of AI, including that it was more intimate than vaginal sex, and that it was something they reserved only for special partners. The majority of AI episodes were unplanned and not discussed prior to initiation. Pain during AI was mitigated by the use of lubricants or illicit drugs. Even those women who found pleasure in AI expressed a preference for vaginal intercourse.

Heterosexual anal intercourse (HAI) is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. We examined data from heterosexuals recruited in 20 US cities for the 2013 National HIV Behavioral Surveillance system. We assessed correlates of reporting HAI in the previous year. Then, among people reporting HAI in the past year, we assessed what event-level factors are associated with having HAI at last sex. Thirty percent of women and 35 % of men reported HAI in the past year. Among people who had HAI in the past year, those who had HAI at last sex were more likely to have a partner who was HIV-positive or of unknown status or to have exchanged money or drugs for sex at last sex. Information that highlights the risk of HIV transmission associated with HAI would complement existing HIV prevention messages focused on heterosexuals in the U.S.

Background Unprotected anal intercourse (UAI) within the context of concurrent sexual relationship are prevalent among men who have sex with men (MSM) who have regular male sex partners and it aggravates the risk of HIV infection among this community. The aim of this study was to assess the effect of intimate relationship characteristics on UAI among MSM couples at the dyadic level. Methods Two hundred four MSM couples were recruited from a HIV testing clinic from April 2017 to April 2018 in Guangzhou, China. The actor-partner interdependence model (APIM) was applied for dyadic analysis. Each MSM couple was divided into the insertive role and the receptive role according to their regular anal sex role. In this context, actor effect is the impact of an MSM’s intimate relationship characteristics on his own UAI, and partner effect is the impact of his partner’s intimate relationship characteristics on his UAI. Results Of the 408 participants, 58.82% had UAI with regular male sex partner (UAI-RP) and 8.09% had concurrent UAI. Intimate relationship characteristics were associated with concurrent UAI, but not associated with UAI-RP. For the receptive role, his relationship investment exerted significant actor and partner effects on concurrent UAI ( AOR actor  = 1.31, P  < 0.001; AOR partner  = 1.17, P  < 0.001). Meanwhile, receptive role’s violence experience within relationship exerted significant actor effects on his own concurrent UAI ( AOR actor  = 6.43, P  = 0.044). Conclusions Relationship investment and violence experience influenced concurrent UAI among MSM couples and it varied in different sex roles. Additional assistance on empowerment, relationship therapy and sexual agreement is urgently needed to reduce their high possibility on engagement of HIV-related risk behaviors.