Consistent condom use and correlates among men who have sex with men recruited by internet based sampling in hanoi

Internet-based sampling in Hanoi.Objective: This study was conducted to examine the consistent condom use CCU with different types of partners and correlates among MSM recruited by inter

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MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH

HANOI MEDICAL UNIVERSITY

PHAM THU VAN

CONSISTENT CONDOM USE AND CORRELATES AMONG MEN WHO HAVE SEX WITH MEN RECRUITED BY

INTERNET-BASED SAMPLING IN HANOI

THESIS OE GRADUATION MEDICAL DOCTOR

COURSE 2015-2021

HANOI - 2021

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH

HANOI MEDICAL UNIVERSITY

_

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CONSISTENT CONDOM USE AND CORRELATES AMONG MEN WHO HAVE SEX WITH MEN RECRUITED BY

INTERNET-BASED SAMPLING IN HANOI

Major : Doctor of Preventive Medicine

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I would like to express my special thanks of my gratitude to my supervisor Mrs HoangThi Hai Van MD Ph D for Iter enthusiastic guidance, great patient, and strong support sincethe beginning 1 came to know about so many new things and I am really thankful to them

1 am very grateful to all the study participants who agreed to spend their timecompleting the questionnaire and all staff members at SUP clinic Hanoi Medical Universitywho contributed Their contribution plays a crucial role in the success of this thesis

Besides, many thanks to Nguyen Thi Hoang Ha Tran Thi Thao Allh Nguyen HuyHoang Tran Hoan and all my classmates, who were always ready to share their knowledgeand skills, and helped me a lot throughout the process 1 would like to thank my close friends.Trinh Thuv Duong Bui Thu Hien Quach Linh Giang, who always support me and give me ahand whenever I need

Last but not least I also would like to express my deepest gratitude towards my family,who always stay by my side and encourage me to finalize this study

Hanoi, May 2021

Pham Thu Van

Hanoi, May 2021

Pham Thu Van

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1.2 The situation of HIV/STls among MSM 6

I 3 Researches on consistent condom use among MSM 71.4 Researches on factors associated with consistent condom use among MSM 8

1.5 Researches on using the internet-based sampling to recruit MSM 9

I 6 Information about MSM in Hanoi 10

CHAPTER 2 METHODOLOGY 12

2 I Subjects

2.3 Study Design 132.4 Sampling 132.5 Variables 13

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LIST OF ABBREVIATION

HSS+ HIV Sentinel Surveillance plus behaviors

IBBS Integrated Biological and Behavioral Surveillance

USAID United State Agency for International Development

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Table 3.1 Socio-demographic characteristics of participants 18

Table 3.2 Self-reported HIV/STIs status 19

Table 3.3 Drug use to enhance sexual performance 20

Table 3 4 Having sexual intercourse with male partners met online 23

Table 3.5 Sexual behaviors among MSM with noncommercial male partner 25

Table 3.6 Sexual behaviors among MSM with noncommercial female partner 26

Table 3.7 Consistent condom use with different types of male partners 26

Table 3.8 Consistent condom use With different types of female partners 27

Table 3.9 Factors associated with consistent condom use among MSM in Hanoi recruited by IBS 31

Table 3.10 Factors associated with consistent condom use among MSM recruited by IBS in Hanoi 34

Internet-based sampling in Hanoi.

Objective: This study was conducted to examine the consistent condom use (CCU) with

different types of partners and correlates among MSM recruited by internetbased sampling(IBS) in Hanoi

Methods: Data for this analysis were from a cohort study IÍIM-Ỉ lanoi conducted from 2017 IO

2019 in Hanoi MSM aged from 16 years were recruited for the survey using IBS Univariateand multivariate logistic regression were used to assess the association of ecu with selectedsocio-demographic characteristics and other factors

Results: Among 802 MSN interviewed, ecu with non-commercial male partner, male client,

male sex worker, and female transgender was 39.8% 41.5% 40.0% and 20.0% respectively.Meanwhile, ecu with non-commcrcial female partner, female client and female sex worker was43.1% 72.7% and 80.0% respectively Characteristics associated with increased odds for ecuwith noncommercial male partner were being aged from 25 years or older (OR: 1.27, 95%CI:0.82 - I 96) having tertiary education level (OR: 1.63, 95%CI: 1.01 2.64) never getting married(OR: 2.22 95%C1: 1.01 - 4 88) and using the Internet to seek male partners (OR:2.05,95%C1: 117 3.60) Factors associated with decreased odds of ecu w ith noncommercialmale partner was spending the night at hotel guesthouse frequently (OR: 0 49 95%CI: 0 25 -0.97) never being tested HIV (OR: 0.43 95%CI 0 19-0 96) and using ATS to enhance sexual

performance (OR: 0.44 95%CI: 0.21 - 0.90) Conclusion: ecu with different types of partners

among Hanoi MSM sun eyed remains low HIV interventions for MSM should take associatedfactors found in the study into consideration to increase ecu among MSM thereby contributing

to the reduction of HIV and STI infections

Keywords: Men who have sex with men MSM Consistent condom use Sexual partners.

Internet-based sampling Hanoi

TÓM TẢT

Tên đề tài' Sử dung bao cao su thưởng xuyên vã các yều tồ liên quan ớ nhóm nam quan hệ

tinh dục đòng giới thu tháp bởi phương pháp chọn mầu trực tuyển tai Há Nội Mục liêu: Nghiên

cửu được thưc hiện nhím niuc tiêu xác đinh ti lệ sử dung bao cao su thưởng xuycn và cãc yếu

tố liên quan ơ nhóm MSM được thu thập bởi phương pháp chọn mầu trực tuyền tai Hà Nội (IBS)

Phươngpháp: Nghiên cữu sư dụng số liệu tứ nghiên cứu IIIM-tlà Nội với đối tượng MSM tũ 16

tuỏi trớ lẽn được thu thập bảng phương pháp IBS Phương pháp phân tích hồi quy logisticđược dùng đề dành giá mói liên quan giừa việc sử dung bao cao su thưởng xuyên (CCƯ) vớicác yếu tồ liên quan

Kct quà: Trong số 802 MSM ti lô CCƯ với ban tinh nam tư nguyện, bạn tinh nam khách hãng,

ban tinh nam bán dâm vã nừ chuyền giới lằn lưọt lã 39 8% 41 5% 40.0% và 20.0% Ti lệ ecuvới bạn tinh nừ tự nguyện, ban lình nừ khách hàng vá bạn tinh nừ băn dâm lần lượt là 43.1%,72.7% và 80.0% Cãc vcu tơ lãm tăng khá năng ccu khi quan hộ tinh dục (QIITD) với ban tinhnam tự nguyện gồm; tuồi tú 25 trở len (OR: 1.27.95%CI: 0 82 1.96) trinh độ hoe vần lữ đai hoetrờ lẽn (OR: 1.63.95%CI: 1.01 - 2.64) chưa từng kềt hòn (OR: 2.22 95%C1: 1.01 4 88)

vả có sữ dung

Internet đê tim kiếm ban tinh nam (OR: 2.05 95%CI: 1.17 - 3.60) Cãc yếu tố lãm giam khanàng ecu khi ỌHTD với ban tinh nam tư nguyên gôm thướng xuyên qua dẽm tai khách sannhã nghi (OR 0.49 95%CI: 0.25 0.97) chưa từng xét nghiêm HIV (OR 0.43 95%CI: 0.19 -0.96) vã sử dụng ATS đè tảng khoái cám tinh dục (OR: 0.44 95%CI: 0.21 - 0.90)

Két luận: Ti lệ ecu với các loai ban tinh khác nhau trong nhõm MSM tạt Hã Nội còn thấp Cãc

biện pháp can thiệp dư phóng HIV cần chủ trọng đèn các yếu tó liên quan được xác định trongnghiên cứu để làm tâng ti lê ecu trong công đồng MSM tử đõ góp phần giam lây nhiễm HIV vàcác bênh lây truyền qua đường tinh due

Từ khỏa: Nam quan hê tinh due đồng giói MSM sứ dung bao cao su thường xuyên, ban tinh,

chon mầu trực tuyến 1 lã Nội

of the most at-risk populations for the national HIV pandemic 1

Condoms are one of the main tools for HIV prevention, with a high level ofeffectiveness at preventing the transmission of HIV and STIs when used correctly andconsistently 6 Many studies also have shown that consistent condom use reduces the incidence

of STIs significantly in comparison with the non-use of condoms ' However, in Vietnam, the rate

of consistent condom use among MSM remains low HIV Sentinel Surveillance Survey Plus(HSS-) in 2011 indicated that only 43.3% of MSN used condoms consistently last month and 713% of MSM reported using a condom with their male partners at their last anal intercourse InHanoi, although MSM who reported always using condoms in the past month with their malepartners (including both commercial and noil-commercial partners) rose remarkably during the2005-2013 period, this figure remained low (below 45%)1

In recent years Vietnam has witnessed a tremendous development of technology thatleads to significant growth in the number of Internet users It IS estimated that about 65 millionVietnamese people use social networking sites, accounting for 67% of the population? 87% ofthe MSM population have smartphones and almost all of them (98%) use at least one socialnetworking sitex

This virtual environment creates a favorable condition for MSM to expand their social circlesHence, more and more MSM have started to find then sexual partners via the Internet In a

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report of the Vietnam Administration of HIV/AIDS Control (VAAC), 74%of MSM users seekpartners through online websites by mobile phones 8 Hanoi saw a rapid increase in socialmedia use among the MSN community in the last decade, with more than 75%of MSM usingsocial media to find a male sexual partner compared to only 35% reported in 2008/' AlthoughHanoi is the second-largest city in the MSM population with an estimate of 34 000 MSM”andhas high rates of MSM using the Internet,” little is known about the sexual behaviors of thispopulation Apart from this, many studies examined condom use among the MSN! population inHanoi.1* 11 but the study that examined indicators of consistent condom use among thispopulation was limited Hence, It is important to understand the factors in order to informeffective HIV prevention interventions targeted towards M$M in Hanoi To fill this gap we haveconducted a study title “Consistent condom use and correlates among men who have sex withmen recruited by internet-based sampling in Hanoi” with the aim:

1 To describe consistent condom use with different types of partners among men whohave sex with men recruited by internet-based sampling in Hanoi

2 To describe correlates of consistent condom use among men who have sex with menrecruited by internet-based sampling in Hanoi

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CHAPTER 1 LITERATI RE REVIEW

1.1 Definitions

1.1.1 Terms related to men who have sex with men

• Sex: The term “sex” refers to biologically determined differences that are used to labelindividuals as males or females The bases for this classification are reproductiveorgans and functions.1*

- Gender: The term “gender” refers to (he social attributes and opportunities associatedwith being male and female and the relationships between women and men and girlsand boys, as well as the relations between women and those between men Genderdetermines what is expected, allowed, and valued in a woman or a man in a givencontext 14

- Gender identity: Gender identity has been defined as a person’s internal, deeply feltsense of being male or female or something other, or in betw een A person’s genderidentity may or may not correspond with their biological sex (Human Right Council.2011)”

- Sexual orientation: The term sexual orientation refers to each person's capacity forprofound emotional, affectional, and sexual attraction to (and intimate and sexualrelations with) individuals of any sex 14 Terms include homosexual, heterosexual,bisexual, etc Sexual orientation does not equal sexual behaviour.10

+ Heterosexual The term heterosexual is used to refer to people who have sex with and/

or are attracted to people of the opposite sex.14

+ Homosexual People who have sex with and or sexual attraction to people of the samesex This should not be confused with the Latin word homo, meaning a man 14

+ Bisexual: A bisexual person IS defined as a person who IS attracted to and/or has sexwith both men and women, and who identifies with this as a cultural identity Theterms men who have sex with both men and women or women

- Condomless sexA'nprotceted sex: the sex act is not protected by male or femalecondoms Previously known, as unprotected sex this is now increasingly referred to ascondom less sex.14

- Insertive anal sex: the sex act which inserting the penis into the anus, also known astopping '

- Receptive anal sex: the sex act which receiving the penis into the anus, also known asbottoming 17

1.1.2 Definition of men who have sex with men

According to UNAIDS Terminology Guidelines 2015 the term “men who have sex withmen" (MSM) describes males who have sex with males, regardless of whether or not they alsohave sex with women or have a personal or social gay or bisexual identity.14

+ Gay - The term gay can refer to same-sex sexual attraction, same-sex sexualbehavior, and same-sex cultural identity Unless individuals or groups sclf- ldentify

as gay the expression of men w ho have sex w ith men should be used

+ Transgender - Transgender is an umbrella term to describe people whose genderidentity and expression do not conform to the norms and expectations traditionallyassociated with their sex at birth Someone who dresses or/and acts as and wishes

to be (or is) recognized as a member of the opposite sex from which they were born.+ Bóng kin (hidden gay/shadow) - A man who is discreet about his sexual identity, whomaintain a masculine gender performance and who publically present asheterosexual18

+ Bóng lộ (conspicuous shadow) - A man who IS open about his sexual identity Bóng lộrefers to MSM whose presentation is more effeminate, and who do not hide their

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sexual preference for men18

1.1.3 Definition of sexual partners

In this study, we mentioned 7 ty pes of partners:

+ Non-commercial male partners - Males who they have sex with but there was noexchange of money or goods

+ Male sex workers - Males arc those they have sex with and pay money

♦ Male clients - who they pay for sex includes payment by money or goods

+ Non-commercial female partners - Females with who they have sex but there was Itoexchange of money or goods

+ Female transgenders - a trans-gender person who was a male at birth but whosecunent gender identity is a female

+ Female clients - Females who pay for sex include pay ment by money or goods.+ Female sex workers - Females are (hose they have sex with and pay money

1.1.3 Definition of consistent condom use

Consistent condom use definition was varied in previous studies It depended on thescales they used to examine the frequency of condom use In a study conducted in Tokyo.Japan, condom use frequency was recorded as ‘never*, ‘rarely’, most of the time’, and ‘always’Inconsistent condom use was defined as ‘never use condoms’ or ‘rarely use condoms', whileconsistent condom use was defined as ‘always use condoms’ and use condoms most of thetime.19 However, according to another study conducted in lluzhou China, consistent condomusers are MSM who reported using a condom every time with both stable and casual partners,while inconsistent condom users did not?"

In this study, condom use frequency was recorded as '‘always”, “occasionally”, and

“never” Consistent condom use was defined as “always use condom" and inconsistent condomuse was defined as "occasionally", “never” or “do not remember"

1.2 The situation of HIV/STIs among MSN

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1.2.1 The situation of HIV/STIs among VISM in the world

Analysis of data available of UNAIDS suggested that gay men and other men who havesex With men accounted for an estimated 17% of new HIV infections globally in 2018." MSMhad the highest new infections among key populations in most continents Especially, in Asiaand the Pacific and Latin America, MSM made up lip to 30% and 40% of new HIV infectionsrespectively.21

Along with HIV STIs prevalence was also high among the MSM population In a report

of the US CDC the incidence of many STIs in gay bisexual, and other men who have sex withmen (MSM)—including primary and secondary syphilis and antimicrobial-resistant gonorrhea—

is greater than that reported in women and men who have sex with women only." MSMaccounted for nearly two-thirds (64.3%) of reported syphilis cases among women or men withinformation about sex of sex partners in 2018." Among men exclusively MSM accounted for77.6% of reported cases with information on sex of sex partners.22 Research conducted inAmsterdam also indicated that the infection rate of rectal gonorrhea and early syphilisincreased among homosexual men when compared with bisexual male.2'

1.2.2 The situation of HIV/STIs among MSM in Vietnam

In Vietnam HIV prevalence among MSM tends to be increasing, from 2.3% in 2012to6.7%in 2014 and 7.4% in 2016.' HSS+ in 2016 also showed that the HIV prevalence amongMSN rose from 5.1% in 2015 to 7.36% in 2016.24 The I BBS 2013

1.3 Researches on consistent condom use among MSM

1.3.1 In the world

Condoms are one of the main tools for HIV prevention, with a high level ofeffectiveness at preventing the transmission of HIV and SI Is when used correctly andconsistently.6 Many studies have shown that consistent condom use reduced the incidence ofSTIs significantly when compared with the non-use of condoms.7 However, the prevalence ofusing condoms when having sex still remains high, especially in unprotected anal intercourse.Hence, unprotected anal intercourse is considered as the highest risk in 1IIV and STIstransmission in the MSM population 26

A study conducted in Tamil Nadu India shows that among 1618 MSM interview ed,consistent condom use during anal sex with regular, paying, and a casual male partner was 453% 50 8% and 57 9% respectively Consistent condom use with all three types of partnerscombined was 52.6%.27

Another study conducted in Nigeria showed similar results, approximately more thanhalf (53%) of participants reported always using condoms with male partners in the past 6months and 43% reported always using condoms with female partners in the past 6 months.28

A cross-sectional study used survey data from 1,230 MSM in Beijing China reportedthat nearly half of the participants engaged in unprotected anal intercourse with at least one of

up to three partners in the past 6 months.2*

1.3.2 In Vietnam

2013 gave more information about using condoms with different types of partners To bespecific, consistent condom use with noncommercial male partners in the last month rangedfrom 40% to 78.6% among MSM in four surveyed cities Consistent condom use with maleclients among male sex workers ranged from 55 8% to IOƠ%.,:

Another study conducted 111 An (hang showed that condom use was considerably low

in both heterosexual and homosexual sex The overall rate of consistent condom use was only24.7%?'

1.4 Researches on factors associated with consistent condom use among MSM

1.4.1 In the world

In the world, many studies examined the assocation between consistent condom useand factors A study conducted in Tamil Nadu India with L618 MSM recruited by time-locationcluster sampling examined factors associated with consistent condom use with three types ofmale partners including regular, paying and casual male partners This study revealed thatfactors associated with increased odds for ecu with MSM having all three types of partnerscombined were frequent receptive anal sex acts with regular partners, fewer number of casualpartners, and being a member 111 a community-based organization, meanwhile, factorsassociated with decreased odds of ecu were using alcohol and using drug in the past month Interms of ecu with paving male partners MSM who perceived higher risk of acquiring HIV weremore likely to use condom consistently Besides, those who accessing to any HIV preventionintervention was associated with increased odds of ecu w ith casual male partners?'

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A cross-sectional study in lluzhou China using the Internet-based sampling to recruite

410 MSM showed that factors associated with consistent condom use was having acomprehensive know ledge of Hl V using alcohol before sex and ever having sex with malesex workers?

1.4.2 In Vietnam

In Vietnam, little is known about factors associated with consistent condom use amongMSM Only a cross-sectional study conducted by Garcia Ct al in 2011 using Internet-basedsurvey examined the factors associated with inconsistent condom use during anal sexintercourse with male partners This study revealed that MSM who consumed alcohol before orduring sex in the last 6 months were more likely to use condom inconsistently In addition,those who reported having received free lubricants in the last 12 months and those whoperceived themselves as being at medium or high risk of HIV infection were more likely toengage in inconsistent condom use with male partners.3*

1.5 Researches on using the internet-based sampling to recruit MSM

1.5.1 In the world

With the increasing number of MSM who are connected through web-based socialmedia and phone-based social apps MSM have more opportunities to expand their socialrelationships and seek partners The advances in technology provide a potential platform toidentify and recruit at-risk MSM for HIV/ST1 interventions Thanks to that, many researchers inthe world used this method to reach hidden MSM population A study conducted in 2007 ill theUSA used banner advertisements to recruit persons who accessed MSM-related websites (e

g Gay.com Manhunt.net Dlist) and social networking websites (c.g., MySpace andFnendster) from 2003 to 2005 and total 7.978 were eligible for participation32 Many studiesalso succeeded in using social media to recruit a large number of MSM.W-M Therefore, theInternet provides a perfect channel to access sensitive information and recruit a large number

of participants

1.5.2 In Vietnam

In Vietnam, the first internet-based sampling (IBS) study among MSN was implemented

web-1.6 Information about MSM in Hanoi

1.6.1 The number of MSM in Hanoi

According to the report ’’Estimates and projections of HIV/AỈDS 111 Vietnam 2007 2012” the high estimate is used to estimate the size of the population group, assuming 3% ofmen over 15 years old in Hanoi A specific number is estimated at 35.436 people

-1.6.2 rhe HIV/STls prevalence among MSM in Hanoi

In terms of HIV prevalence, the report IBBS I II Ill 111 2005 2009 and 2013 showedthat the HIV prevalence among MSM in Hanoi was 9.4% 14% and 4% respectively 1237 •’* Inthe IBBS 2009 for MSM who had sold sex the HIV prevalence was 14% For those who hadnot sold sex the prevalence was 20% in 2009

When It comes to STIs prevalence, the proportion of Rectal Chlamydia infection andRectal Neisseria Gonorrhea in Hanoi was the highest among sun eyed provinces, at 10% and3.4% respectively.'* Genital Chlamydia prevalence was 4.4% among MSN in Hanoi in 2013.'*

In a 2017 study conducted by Hanoi Medical University among MSM in Hanoi, nearly 19% ofparticipants tested positive for syphilis?

1.6.3 The situation of condom use among MSM in Hanoi

The I BBS 2013 used respondent-driven sampling to examine the consistent condomuse rate with 6 types of partners in the last month in four cities To be specific, rhe consistentcondom use rate among MSM in Hanoi with noncommercial male partners, male clients, and

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male sex workers in the past month was 59.1%, 76.4% and 98.7% respectively; meanwhile, allparticipants reported using condom consistently with their female partners, includingnoncommercial female partners, female clients, and female sex workers in the pastmonth Although trends in consistent condom use with male partners in the past month amongMSM in Hanoi increased in the 2005-2013 period, the figure remained low at roughly 40%.12

+ At least 16 years of age.

+ Living in Hanoi continuously for the past 3 months and not having an immediate plan

to move in the next two years

+ Have had oral or anal sex with another man or transgender woman in the past 12months

+ Willing and able to provide written informed consent

- Exclusion criteria

+ Foreign national

+ Female at birth

+ Not residing in Hanoi

+ Younger than 16 years of age

+ Neither oral nor anal sex with another man or a transgender wo-man in the past 12months

+ Not able or willing to provide written informed consent

2.2 Location and time

This study was conducted in Hanoi

• Participants were identified and recruited from July 2017 to September 2019

- Students accessed data and analyze it from March 2021 to May 2021

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2.3 Study Design

This is a cross-sectional study, using data from the baseline survey of the "HIV

incidence and the dynamics of behavioral change among men who have sex with men in Hanoi Vietnam: the Hanoi MSM cohort study” (HLM-Hanoi)

womanHave never been married

to a woman

Qualitative

Employment Have a job to support their life Qualitative

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14

support from their family

Unit: million Vietnam Dong

Quantitative

The venue where they spent the night most frequently

In the last 30 days, where have you slept (spent the night) most frequently

Qualitative

Sexual orientation Types of people that

participants are sexually attracted to

In the past, have they ever been diagnosed with STIs at ahealth clinic

Lists of social apps that participants used to find male sex partners

Qualitative

Having sexual intercourse with male partners met online

The frequency of having sexual intercourse with male partners met through wcbsites/social apps

Qualitative

Types of partners

in the last 6 months

- Non-commercial male partners

- Male sex workers

Qualitative

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- Male clients

- Non-commercial femalepartners

- Female sex workersFemale transgendersNumber of sexual

partners

Number of sexual partners during the last month

Quantitative

sex during the last 6 months

Consistent condom use was defined as "always’' using condom during sexual intercourse with their partners)

Qualitative

Main reasons for not using condom consistently

- Condom use reduces thepleasure

- Condom is not available

- My partners look healthy

- Condoms are too expensive

• My partner didn’t want to

- 1 trust my partners

- I feel embarrassed to buycondoms

Qualitative

2.6.1 Data collection tool

The self-answered questionnaire included 3 parts: (I) Socio-dcmographic characteristics(2) Internet usage and other factors (3) Sexual history with different types of partners

2.6.2 Data collection process

- Step 1: Recruiting potential participants through the Internet.

St udy promotion materials and study contacts were posted on commercial andcommunity-operated websites/Facebook pages used by MSM in Hanoi such as xomcauvong.gtown lovcboyhanoi and social apps such as Zalo Jack’d, and Blue d Promotional materialshad SHP clinic contact information (telephone and street address) so that interested participantsmight contact SHP staff if they were interested in the study Those who were interested in thestudy would be asked to contact study staff (via email, phone, other social media means, orshow up at SUP clinic) for screening

- Step 2: Screening and invitation

Once outreach workers or field researchers made contact with potential participants,they used the Field Scrccner to establish eligibility of the participants through an internet-basedquestionnaire Those who were eligible were briefed on survey objectives and given invitationcoupons with information about the address of the survey center where the data were collected,and the appointment date Each recruitment method was screened by study staff Then theindividual came to the clinic for the first visit, the study would be further described and informedconsent obtained If the selected individual did not visit the survey center witlun four weeks

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after the appointment date, another selection was made until the required sample size was met

- Step 3: Dam collection

Data collection took place at the Sexual Health Promotion (SUP) Clinic located on thecampus of Hanoi Medical University The eligible participants selfanswered in the form of acomputer-administered structured questionnaire A research assistant trained in interviewingwith MSM assisted participants in completing the self-interviewing process

2.7 Statistical analysis

Analysis tests used

- Descriptive statistics: Mean and standard deviation were used to describe quantitativevariables Frequency and percentage were used to describe qualitative variables

• Univariate and multivariate logistic regression model were used to determine theassociation between consistent condom use and participants’ socio-demographic characteristicsand other related factors

Stata version 14.0 was used for data analysis

Venues where they spent the night most frequently

8

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The average age of the subjects was 24.8 ± 6.1 years with more than half of participants(63.5%) at the age of 16 to 24 years old, 23.3% of participants from 25 to 29 years old, and13.2%over 30 The age ranged fiom 16 to moie than 55 years old In terms of education 19.4%

of surveyed people just finished grade under 12 34.7% were studying in vocationaltraining/college/university and nearly a half completed tertiary education (45.9%) While themajority of respondents neser got married to women, only 7.4% of participants reported that theyused to many to a female

Nearly all of the respondents had a occupation to support their life (93.9%) and had anincome of more than 3 million per month (84.4%),

Venues, where MSM spent the night most frequently, were their own home (78.8%) andtheir family/relative's home (11.7%) Besides 6.1% of participants usually spent the night at hotelguest house/othcr temporary room and just a small proportion of participants (1.9%) overnighted

at their sex partner's home

A large percentage of MSM in this study seif-identified as being attracted to men(51.6%) However, die percentage of MSM attracted to both men and women was also high,accounted for 47.9% Very few MSN were attracted to women only (0 4%)

3.1.2. Self-reported HIV/S I ls status

Table 3.2 Self-reported mv/sris status

(n)

Percentage(%)HIV status (Self-report)

The table above shows the result of using drug (ATS) among MSM to enhance theirsexual performance 6 5% of MSM interviewed reported they had ever used drug to help themboost their sexual performance.

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3.1.4 Internet usage to seek partners

■ Yes No

Figure ĩ I The percentage of using the Internet to seek male partners

A majority of men sun eyed stated seeking male partners online, accounted for 88.7%.Meanwhile, only 11.3% of participants did not find the information or did not have smartphone

to access the Internet

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Figure 3.2 Percentage of social apps and websites used to seek male partners

Of those who used the Internet to seek sexual male partners, the percentage of usingBlueD was the highest figure, at 64.4% I acebook and Zalo accounted for 61.3% and 48 1%,respectively It is followed by Jack’d and Grindr with 30.9% and 21.9% of MSM using to findtheir partners, respectively Just a fraction of MSM surveyed used other social apps

Percentage(%)Ever had sex with male partner through

websites (N-802)

Ever had sex with male partner through

social apps (N“8O2)

More than half of MSM sun eyed reported they had ever had sexual act with male partner met through social apps This proportion was more than fourth times as higher as the proportion of MSM who reported ever having sex with male partner met through websites (51.5% compared to 12 3%)

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3.1.5 Sexual behaviors

Mate client Female transgender 0.7

Non-commercial female partner

Female client 1

h

Female sex worker 0.7

Figure 3.3 Distribution types of sexual partners during the last 6 months

Among 7 types of sex partners, noncommercial male partner held the vast majority ofMSM's sexual partners The percentage of MSN reported having sexual encounter withnoncommercial male partners during the last 6 months was approximately 13 times higher thanthat of those having sexual intercourse with the second popular sex partners - noncommercialfemale partners (98.7% compared to 7.7%) Just a fraction of MSM surveyed having sexualintercourse with other types of partners 111 the Iasi 6 months period

Non-cornmerclal mate partner

Male tex workers I 40

Percentage(%)Number of sexual partners during the last

Sexual role when having anal sex during

the last 6 months (N=743)

Table 3.6 Sexual behaviors among MSM with non-commercia! female partner

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Characteristics

Frequencyin)

Percentage(%)Number of sexual partners during the last month

3.2 Consistent condom use with different types of partners

Table 3.7 Consistent condom use with different types of male parrners

during the last 6 months

Consistent condom use % (n)

Table 3 fl Consistent condom use with different types of female partners

during the last 6 months

Consistent condom use