A total of 600 MSM were recruited. No refusals were reported by the interviewers, perhaps reflecting that the study was anonymous and the participants were provided with $10 US compensation for their time. For the social mapping phase, the MSM population was divided into four distinct groups: transvestites (who dress like women, known as “bong lo”) (75 men), “non-transvestites (wear male attire, known as “bong kin”) (460 men), bisexuals who had both male and female partners (known as “da he”) (55 men), and sex workers (heterosexuals selling sex to men to earn money) (10 men), based on the responses of the interviewees.
The participants had a mean age of 27 years (range, 15–69 years). The mean education level was secondary school attendance (46.5%). Very few had studied at the college or university level (5.6%). Some of the participants were illiterate (4.9%). The majority of participants were not married and did not live with a woman (94.7%) ().
Social-demographic characteristics (n = 600)
The mean age of first oral sex (18 years old; range, 8–43 years) was significantly lower than the mean age of first anal sex (20 years old; range, 8–43 years) (P < 0.05). About one-third of participants had ever bought sex from other men (28.9%). A higher proportion of participants had ever sold sex (37%). The mean age of first selling sex (19 years; range, 10–32 years) was significantly less than the mean age of first buying sex (21 years, range, 10–43 years) (P < 0.05).
Most participants (84.0%) reported having oral sex with another man in the past month, with an average of 4.1 sex partners (range, 0–50). More than half (54.3%) of participants reported having anal sex with a man in the past month; the mean number of anal sex partners among them was 2.7 (range 0–60). Among those who had anal sex in the past month, the proportions having one, two–three, or more than three sexual partners were 20.4%, 36.1%, and 43.5%, respectively.
The sex workers had lived for a shorter duration in HCMC (18.4 years) than the other groups (22.2 years) (P < 0.0005), had a lower mean age of first anal sex (19.4 years) than those who did not sell sex (20.5 years) (P < 0.02), and had a higher mean number (4.0) of anal sex partners in the past month than those not selling sex (1.9 partners) (P < 0.00001).
presents the proportion in each group engaging in either insertive or receptive anal intercourse during the past month and the use of condoms consistently. A higher proportion of transvestites and MSM were receptive than insertive. The proportion was lower for receptive than for insertive among sex workers.
Anal sex with male partners and condom use in the past month
About one-third (30.3%) of the participants (excluding bisexuals and heterosexual sex workers) reported ever having had sex with a female. The mean age of having first sex with a female partner among them was 18 years (range 8–32 years). A “general woman” was defined as wife, lover, or girlfriend. The proportions having sex with general women or CSWs in the last 6 months were 16.6% and 1.5%, respectively. The mean numbers of general women sex partners and CSWs in the last 6 months were 1.5 (range 0–6) and 0.8 (range 0–18), respectively.
Lubricant and Condom Use
The proportion using lubricants for anal sex was 78.6% (). The most frequently used lubricants were saliva (53%), antibiotic ointment (26.5%), lubricant not dissolving in water (21.5%), skin lotion (21.5%), and lubricants dissolving in water (20.5%). Less than half (44%) had always used lubricant during anal sex in the last 6 months. The main reasons for not using lubricants during last anal sex were “did not like to use” (34.9%) and “could not find lubricant” (26%). Those who knew where to get lubricant mainly bought it at pharmacies (82.5%).
The proportion of MSM using condoms when having sex ranged from 0% to 80%, but was generally lower than 65% among the four types of MSM studied, even among men selling sex (). The proportion of condom use during last sex act with a general woman (40%) was much lower than that with a CSW (84.4%). The proportion of consistent condom use during the last 6 months with general women (26.3%) was much lower than with CSWs (68.8%).
The proportion of men ever having used drugs was 6.0%: 1.4% of transvestites, 4.9% of non-transvestites, 20.8% of bisexuals, and 11.1% of heterosexual men selling sex. Amongst the 6% who admitted to drug use, 66% had used heroin, 4% had used opium, 4% had used amphetamines, and 25% had used tranquilizers. About 11% of the MSM selling sex reported drug use, but 100% of those using drugs injected. The proportion of all participants injecting drugs in the last 12 months was 1.5%.
Voluntary Counseling and Testing
Among all the men interviewed, about one-fifth (19.5%) had ever been tested for HIV. The proportions receiving voluntary testing, pre-test counseling, and post-test counseling were 15.1%, 6.8%, and 5.8%, respectively. Only a total of 5.2% of all participants had received complete pre- and post-test counseling and results.
Knowledge and Beliefs about HIV/AIDS
Almost all of the participants had heard about HIV/AIDS (98.0%). Many knew a person living with HIV/AIDS (PLWHA) or someone who had died from AIDS (76.0%). A high proportion of participants (95%) believed that HIV infection could be prevented, but only 74.0% of those believed that HIV transmission could be prevented by abstaining from anal sex. The proportion of persons who believed HIV transmission could be prevented if they always use condom for every anal sex encounter was 78%. The proportion believing that HIV can be transmitted through mosquito bites was 30%. Almost all (93%) of the MSM knew that HIV infection could be transmitted through sharing syringes and needles.
HIV Prevalence and Risk Factors for HIV Infection
All of the men were tested for HIV, regardless of whether they had been tested previously. The HIV prevalence was 8% (47/599). There was one person who underwent the first test, which was positive, but did not take the confirmatory test. HIV prevalence was 6.8% among transvestites, 7.0% among non-transvestites, 13.5% among bisexuals, and 33.3% among sex workers. Only 15.6% of them had been previously tested, of whom only 71% knew their HIV status.
Results of univariate and multivariate logistic regression analyses are presented in and , respectively. The following factors were associated with HIV infection by univariate analysis: being 20–40 years old (OR = 4.72; 95% CI, 1.67–13.4), less than 6 years of education (OR = 2.98; 95% CI, 1.60–5.53), only selling sex (OR = 6.12; 95% CI, 1.48–25.33), injecting drugs in the past 12 months (OR = 33.52; 95% CI, 8.33–134.85), and having more than five male anal sex partners in the past month (OR = 2.55; 95% CI, 1.31–4.98).
Univariate analysis for risks of HIV infection among MSM
Multivariate analysis of logistic regression on the risk factors of HIV infection among MSM in HCMC
To determine the independent correlates of HIV infection, a multiple logistic regression stepwise analysis was conducted (). The results indicated that injecting drugs in the last 12 months (OR = 30.35; 95% CI, 6.49–141.90), selling sex (OR = 8.61; 95% CI, 1.20–61.69), being 20–40 years old (OR = 4.43, 95% CI, 1.45–13.59), having less than 6 years of education (OR = 2.60; 95% CI, 1.32–5.13), and having more than five male anal sex partners in the past month (OR = 2.43; 95% CI, 1.14–5.17) were independently associated with HIV infection.