Yếu tố ảnh hưởng đến việc không thống nhất dùng bao cao su ở những người có quan hệ tình dục đồng giới nam_Factors associated with inconsistent condom use among men who have sex with men in cambodia

Yếu tố ảnh hưởng đến việc không thống nhất dùng bao cao su ở những người có quan hệ tình dục đồng giới nam_Factors associated with inconsistent condom use among men who have sex with men in cambodia Đồng tính nam (Men sex men) và HIVLess progress in reducing HIV prevalence and incidence among men who have sex with men (MSM)(Beyrer et al 2012 CDC 2012)MSM are at greater risk for HIV acquisition and transmission due to their more hidden and stigmatized nature, compounded by limited access to basic prevention materials such as condoms and lubricant HIV prevalence in MSM ranged from 3.0% in the Middle East and north Africa region to 25.4% in the CaribbeanHIV prevalence and sexual behaviours among MSM remain of great concerns despite encouraging declines in new HIV infections in the general populationPrevalence of HIV among MSM: 2.2%Prevalence of sexually transmitted infections (STIs) among MSM: 51.5% MSM had sold sex to men in the past 12 months: 26.9% Rates of consistent condom and lubricant use with male clients in the past months: 35.7% and 49.5% Rationales and ObjectivesRationalesGreater risk for HIVLess understood due to their hidden and stigmatized natureDiscrepancy in findings in the literatureObjectives: to explore factors associated with inconsistent condom use among highrisk MSM in Cambodia

Factors Associated with Inconsistent Condom Use among Men Who Have Sex with Men in

Cambodia

7 th ICPH, Hue City, Vietnam | 26-27 September 2015

Presented by: Pheak Chhoun, MPH Research Fellow, Center for Population Health Research

Investigators:

KHANA (Cambodia): Siyan Yi, Sovannary Tuot, Pheak Chhoun, Khuondyla Pal, Khimuy Tith

Touro University California (USA): Siyan Yi, Carinne Brody

MSM and HIV

• Less progress in reducing HIV prevalence and incidence

among men who have sex with men (MSM)

(Beyrer et al 2012 & CDC 2012)

• MSM are at greater risk for HIV acquisition and transmission due to their more hidden and stigmatized nature,

compounded by limited access to basic prevention materials such as condoms and lubricant

(Altman et al 2012 & Trapence et al 2012)

• HIV prevalence in MSM ranged from 3.0% in the Middle East and north Africa region to 25.4% in the Caribbean

(Beyrer et al 2012)

MSM and HIV in Cambodia

• HIV prevalence and sexual behaviours among MSM remain of great concerns despite encouraging declines in new HIV

infections in the general population

(Vun et al 2014 & Liu 2010)

• Prevalence of HIV among MSM: 2.2%

• Prevalence of sexually transmitted infections (STIs) among

MSM: 51.5%

(Liu 2010)

• MSM had sold sex to men in the past 12 months: 26.9%

• Rates of consistent condom and lubricant use with male

clients in the past months: 35.7% and 49.5%

(NCHADS 2013)

Rationales and Objectives

• Rationales

– Greater risk for HIV

– Less understood due to their hidden and

stigmatized nature

– Discrepancy in findings in the literature

inconsistent condom use among high-risk MSM in

Cambodia

Study design

• Cross-sectional study

• Two-stage cluster sampling method:

– Communes (third-level administrative divisions) in each province used as the smallest unit for the

sampling process

– Probability proportional-to-size sampling method was used to select the required number of MSM from each commune

Study population and Sample size

• Sample size: 367 MSM

• Study period: April and May 2014

• Inclusion Criteria:

– 18 years or older

– self-reported as an MSM

– sexually active in the past three months

– able to provide consent to participate in the study – available for a face-to-face interview on the day of the data collection

Map of the Study Sites

• Sociodemographic characteristics

• HIV testing history

• Self-perception of HIV risk

• Substance use

• Sexual behaviors

• Mental disorders

• HIV knowledge

Data Analyses

• Double data entry: EpiData

• Bivariate analyses:

– Chi-square or Fisher’s Exact test for categorical

variables

– Student’s t-test for continuous variables

• Multivariable logistic regression model

– Controlling potential confounders – Including all variables associated with condom use in

bivariate analyses at the level of p< 0.05

– Soft wares: SPSS version 22

Ethical Considerations

• Ethical approval:

– National Ethics Committee for Health Research

(NECHR)

• Written informed consent: All participants

• Confidentiality & privacy protection:

– No personal identifier collected

– Interviews at private places

Comparisons of characteristics of MSM who reported always using condoms

and MSM who reported not always using condoms

Socio-demographic

Total (n = 367)

Always (n = 230)

Not always (n = 137)

p-value*

Comparisons of characteristics of MSM who reported always using condoms and

MSM who reported not always using condoms (Con.)

Condom use in the past 3 months Total

(n = 367) (n = 230)Always Not always (n = 137) p-value*

Self-perception of HIV risk compared

Comparisons of substance use of MSM who reported always using condoms

and MSM who reported not always using condoms

Condom use in the past 3 months Total

(n = 367) (n = 230)Always Not always (n = 137) p-value*

Drunk at least a full glass of

Mean number of days getting

Self-perception of level of

Comparisons of sexual behaviours of MSM who reported always using

condoms and MSM who reported not always using condoms

Comparisons of substance use of MSM who reported always using condoms and MSM who reported not always using

condoms

Socio-demographic characteristics

Condom use in the past 3 months

Total (n = 367) (n = 230)Always Not always (n = 137) value*

Always used lubricant when

Factors associated with inconsistent condom use among MSM in

multivariable logistic regression model

Age group

Self-rated overall quality of life

Perception of HIV risks compared to

general population

Factors associated with inconsistent condom use among MSM in

multivariable logistic regression model

Illicit drug use in the past 3 months

Lubricant use when selling anal sex to

men in the past 3 months

• Having multiple commercial and non-commercial partners

combined with inconsistent condom use may result in high risk of HIV and STI acquisition and transmission

• Condom use rates across all types of relationship remained considerably low

• Illicit drug users were significantly more likely to report

inconsistent condom use compared to non-users

• MSM in the age group of 25 or older were significantly more likely to report inconsistent condom use compared to younger MSM in the age group of 24 or younger

Limitations of the study

• Limited sample size

• MSM in this study include TG (may have different characteristics and sexual behavior)

• Representativeness of the study population

• Cross-sectional design precludes interpretation

of the finding

over-reporting

• Risky sexual behaviours was considerably high among MSM, especially those who used illicit drugs or were older than 25

• HIV education and social marketing should be expanded and specifically designed for MSM

to better educate on:

– the increased risk of HIV with unprotected anal sex and illicit drug use as risk factors

– the importance of the use of both condoms and lubricant during anal intercourse

Acknowledgement

members