HIV infection is a major ongoing public health problem disproportionately affecting men who have sex with men (MSM) in many countries. In Taiwan, the majority of new HIV infections occur in young MSM. According to the Taiwan Centers for Disease Control, in recent years, MSM have accounted for over 80 percent of all new HIV cases in Taiwan, and more than 70 percent of new cases have occurred in those aged 15–34 years. Condomless anal intercourse (CAI) has been identified as the main route of HIV transmission among MSM. To systematically examine CAI intention and associated factors among young MSM, researchers at National Taiwan University undertook an anonymous survey of 694 MSM ages 15–39 in Taiwan.
Conducted by Dr. Jiun-Hau Huang, associate professor in the Institute of Health Behaviors and Community Sciences at National Taiwan University College of Public Health, and his graduate student, Mr. Jen-Hao Chu, this study has been published in the October 2018 issue of Archives of Sexual Behavior.
“The prevalence of CAI among MSM varied across studies, but in general, a sizeable proportion of MSM reported CAI. Moreover, the risk of HIV transmission differs by sexual role. The transmission risk is approximately two to seven times higher in receptive MSM, compared with insertive MSM. However, while numerous studies have examined demographic characteristics associated with CAI, few have used a guiding framework to systematically examine CAI or CAI intention. Therefore, we used a theory-driven approach to conduct an anonymous online survey based on the Theory of Planned Behavior (TPB), and stratified the data analysis by sexual role,” said Dr. Huang, the study’s corresponding and co-first author.
Of the 694 surveyed young MSM in Taiwan, 45.5 percent were classified as having high CAI intention. Multivariate logistic regression also found the significant factors and strengths of associations with CAI intention varied by their sexual role. For example, in receptive, versatile, and insertive MSM, those holding relatively positive attitudes toward positive CAI outcomes had 6.85 (95 percent CI 3.19–14.74), 3.80 (95 percent CI 1.38–10.46), and 15.93 (95 percent CI 3.60–70.51) times the odds of having high CAI intention, respectively.
Furthermore, relatively positive attitudes toward negative CAI outcomes were significantly associated with greater odds of having high CAI intention (AOR 3.99, 95 percent CI 1.79–8.85) only among receptive MSM. By contrast, versatile and insertive MSM perceiving others to be relatively supportive of their CAI had 4.55 (95 percent CI 1.42–14.60) and 5.86 (95 percent CI 1.62–21.21) times the odds of having high CAI intention, respectively. Lastly, only among versatile MSM was perceived high control over their CAI under facilitating conditions linked to increased odds of having high CAI intention (AOR 6.77, 95 percent CI 2.30–19.91).
In conclusion, Dr. Huang said, “To our knowledge, this study was the first to employ the TPB as a theoretical foundation to systematically examine CAI intention among young MSM in Taiwan. Regardless of their sexual role, positive attitudes toward positive CAI outcomes remained most strongly associated with high CAI intention. Importantly, because the TPB factors examined in this study are modifiable, the findings can inform future research and HIV prevention efforts tailored for young MSM of different sexual roles to optimize the program effectiveness.”