Psychosocial and Behavioral Characteristics of High-Risk Men Who Have Sex with Men (MSM) of Unknown HIV Positive Serostatus in Bangkok, Thailand

Abstract

HIV prevalence remains high in men who have sex with men (MSM) in Bangkok. Even though resources for HIV testing and treatment are available for all, a large proportion of MSM still do not get HIV tested. We studied high risk MSM who are unaware of their HIV status to help maximize effectiveness of our resources. Convenience sampling was conducted among MSM who came for HIV testing at the Thai Red Cross Anonymous Clinic and two popular drop-in centers in Bangkok. Inclusion criteria were MSM aged >18 years, have not been tested positive for HIV, who reported ≥1 of the following in the previous 6 months: condomless sex with a male, being a sex worker, or having a sexual transmitted infection diagnosis. Audio-Computer-Assisted Self-Interview was used to assess psychosocial profile, sexual risks, and HIV testing patterns prior to being informed of their HIV positive status. Among 499 high-risk MSM enrolled, the median age was 24.8 years and 112 (22 %) tested HIV-positive. Among the HIV-positive participants, 92 % self-identified as gay (versus bisexual), 39 % attained a bachelors degree or higher, 65 % had monthly income 10,000-29,999 baht ($280-830 USD), 10 % had vaginal or anal sex with a woman in the past 12 months, 39 % had condomless receptive sex with men and 21 % went to Lat Phrao to find a sexual partner. Compared to HIV negative MSM, HIV-positive MSM had less HIV testing: 31 % had ever been tested for HIV, 12 % had been tested in the past 6 months; but were more likely to guess correctly their positive status (31 %). Regarding psychosocial variables among HIV-positive MSM, 7 % had regular methamphetamine use in the past 3 months, 10 % had >2 sources of discrimination, and 8 % had >2 sources of discrimination due to being MSM. In multivariable model, age<30 year old, self-identified as gay, had monthly income <50,000 baht ($1400 USD), had anal sex with men in past 12 months, had >2 sources of discrimination because of being MSM, did not get HIV test in past 6 months, and guess of positive HIV were significantly associated with HIV positive status. Young MSM with lower socioeconomic status (SES) should be prioritized for innovative approaches to promoting awareness and uptake of HIV testing. Societal stigmatization of MSM should be addressed as a potential barrier to uptake of voluntary HIV testing. Resilience factors among these marginalized MSM who still test frequently and remain HIV-negative despite residing in a context with community viral loads and discrimination should also be studied in order to curb the HIV epidemic in Bangkok.

Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross‐sectional online survey

“…We found that roughly half of MSM in our sample had ever tested for HIV in their lifetime. This figure is similar to MSM data from China, higher than those from Thailand [38], and lower than those from Cambodia [39], South Africa [40], Peru [41], Australia [42], and the US [43]. We also found that only 23% of men tested for HIV at least once every six months, which is much lower than recommendations by US CDC guidelines [36].…”

High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems

“…A sizeable portion of HIV-infected persons (~ 15%) are unaware of their HIV serostatus in the US and Spain [1,2]. Men who have sex with men and persons who inject drugs are at greater risk for unknown HIV serostatus [1], which is associated with high-risk behaviors in Latinos and other ethnic groups [3][4][5]. Undetected HIV infection undermines HIV prevention and treatment goals to curb the epidemic and improve treatment outcomes [6].…”

The interaction between HIV testing social norms and self-efficacy on HIV testing among Chinese men who have sex with men: results from an online cross-sectional study

“…In our study, the prevalence of HIV testing among MSM remained low with 32.6% of participants having been tested for HIV in the last 3 months and 62.5% of participants having been tested for HIV in their lifetime. These testing proportions are higher than those from Thailand in 2014 [ 25 ] and Zhejiang, China in 2014 [ 1 ], but lower than those from Cambodia in 2015 [ 26 ]. The HIV testing proportion is still far behind the UNAIDS target for 90% testing among infected individuals in 2014 [ 27 ].…”