Abstract
Men who have sex with men (MSM) in China face a rapidly expanding HIV epidemic. Anal sex role plays a significant role in HIV infection. Research has already begun in China investigating the potential for circumcision-based interventions to slow the rise of HIV among Chinese MSM. Using peer referral recruitment, we sampled 491 men who reported anal sex role preference. We analyzed preferred anal sex role, enacted sex role during recent sexual behavior, and circumcision status and HIV infection among MSM in one Chinese city. Men reported on their anal sex role preference and reported on up to three male sexual partners. Men were asked to report on whether they were “top” or “bottom” with each of the partners. Those that preferred being bottom and versatile were significantly younger than those who preferred being top. Men who preferred bottoming and those that preferred the versatile role were significantly more likely to be HIV-infected than those who preferred to be tops. There was no significant association between circumcision and HIV infection among men who maintained their preferred top role. In terms of anal sex role behavior, prevalence was not statistically different across anal sex roles. Circumcision conferred no additional protection to men who preferred and who engaged the top role during anal sex. HIV interventions will need to address anal sex roles in more sophisticated ways than perhaps originally thought. Simplistic assumptions that anal sex role is a fixed behavior undermines interventions such as circumcision among MSM.
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Baral, S., Sifakis, F., Cleghorn, F., & Beyrer, C. (2007). Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: A systematic review. PLoS Medicine, 4(12), e339.
China Ministry of Health. (2009). 2009 estimates for the HIV/AIDS epidemic in China. Retrieved from http://www.unaids.org.cn/download/2009%20China%20Estimation%20Report-En.pdf.
Feng, L., Ding, X., Lu, R., Liu, J., Sy, A., Ouyang, L.,… Zhao, J. (2009). High HIV prevalence detected in 2006 and 2007 among men who have sex with men in China’s largest municipality: An alarming epidemic in Chongqing, China. Journal of Acquired Immune Deficiency Syndromes, 52, 79–85.
Fleming, D. T., & Wasserheit, J. N. (1999). From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually Transmitted Infections, 75, 3–17.
Han, M., Feng, L. G., Jiang, Y., Shen, S., Ling, H., Ding, X. B.,…Zhang, M. (2009). Surveillance on HIV-1 incidence among men who have sex with men in Chongqing, China, 2006–2008. Chinese Journal of Epidemiology, 30, 873–881.
Heckathorn, D. D. (1997). Respondent-driven sampling: A new approach to the study of hidden populations. Social Problems, 44, 174–199.
Jameson, D. R., Celum, C. L., Manhart, L., Menza, T. W., & Golden, M. R. (2010). The association between lack of circumcision and HIV, HSV-2, and other sexually transmitted infections among men who have sex with men. Sexually Transmitted Diseases, 37, 147–152.
Lau, J. T., Yan, H., Lin, C., Zhang, J., Choi, K. C., Wang, Z.,… Yang, H. (2010). How willing are men who have sex with men in China to be circumcised for the sake of protecting his female sex partner? Journal of Sexual Medicine. doi:10.1111/j.1743-6109.2010.02050.x.
Lau, J. T., Zhang, J., Yan, H., Lin, C., Choi, K. C., Wang, Z.,…Yang, H. (2011). Acceptability of circumcision as a means of HIV prevention among men who have sex with men in China. AIDS Care, 23, 1472–1482.
Lou, J., Wu, J., Chen, L., Ruan, Y., & Shao, Y. (2009). A sex-role-preference model for HIV transmission among men who have sex with men in China. BMC Public Health, 9, S1–S10.
Lyons, A., Pitts, M., Smith, G., Grierson, J., Smith, A., McNally, S., & Couch, M. (2011). Versatility and HIV vulnerability: Investigating the proportion of Australian gay men having both insertive and receptive anal intercourse. Journal of Sexual Medicine, 8, 2164–2171.
Magnani, R., Sabin, K., Saidel, T., & Heckathorn, D. (2005). Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS, 19(Suppl. 2), S67–S72.
Malekinejad, M., Johnston, L. G., Kendall, C., Kerr, L. R., Rifkin, M. R., & Rutherford, G. W. (2008). Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS and Behavior, 12(4 Suppl.), S105–S130.
Millett, G. A., Ding, H., Lauby, J., Flores, S., Stueve, A., Bingham, T.,… Marks, G. (2007). Circumcision status and HIV infection among Black and Latino men who have sex with men in 3 US cities. Journal of Acquired Immune Deficiency Syndromes, 46, 643–650.
Millett, G. A., Flores, S. A., Marks, G., Reed, J. B., & Herbst, J. H. (2008). Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men: A meta-analysis. Journal of the American Medical Association, 300, 1674–1684.
Moskowitz, D. A., Rieger, G., & Roloff, M. E. (2008). Tops, bottoms and versatiles. Sexual and Relationship Therapy, 23, 191–202.
Ruan, Y., Qian, H. Z., Li, D., Shi, W., Li, Q., Liang, H.,…Shao, Y. (2009a). Willingness to be circumcised for preventing HIV among Chinese men who have sex with men. AIDS Patient Care and STDS, 23, 315–321.
Ruan, S., Yang, H., Zhu, Y., Wang, M., Ma, Y., Zhao, J..,…Raymond, H. F. (2009b). Rising HIV prevalence among married and unmarried men who have sex with men: Jinan, China. AIDS and Behavior, 13, 671–676.
Service, S., & Blower, S. M. (1995). HIV transmission in sexual networks: An empirical analysis. Proceedings of the Royal Society B: Biological Sciences, 260, 237–244.
Tebit, D. M., Ndembi, N., Weinberg, A., & Quiñones-Mateu, M. E. (2012). Mucosal transmission of human immunodeficiency virus. Current HIV Research, 10(1), 3–8.
Templeton, D. J., Millett, G. A., & Grulich, A. E. (2010). Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men. Current Opinion in Infectious Disease, 23, 45–52.
Vittinghoff, E., Douglas, J., Judson, F., McKirnan, D., MacQueen, K., & Buchbinder, S. P. (1999). Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology, 150, 306–311.
Wei, C., & Raymond, H. F. (2011). Preference for and maintenance of anal sex roles among men who have sex with men: Sociodemographic and behavioral correlates. Archives of Sexual Behavior, 40, 829–834.
Wei, C., Raymond, H. F., McFarland, W., Buchbinder, S., & Fuchs, J. D. (2011). What is the potential impact of adult circumcision on the HIV epidemic among men who have sex with men in San Francisco? Sexually Transmitted Diseases, 38, 353–355.
Wiysonge, C. S., Kongnyuy, E. J., Shey, M., Muula, A. S., Navti, O. B., Akl, E. A., & Lo, Y. R. (2001). Male circumcision for prevention of homosexual acquisition of HIV in men. Cochrane Database of Systematic Reviews, 6, CD007496.
Wolitski, R. J., & Branson, B. M. (2002). Gray area behaviors and partner selection strategies. In A. O’Leary (Ed.), Beyond condoms: Alternative approaches to HIV prevention (pp. 173–198). New York: Kluwer Academic/Plenum Publishers.
Xiao, Y., Ding, X., Li, C., Liu, J., Sun, J., & Jia, Y. (2009). Prevalence and correlates of HIV and syphilis infections among men who have sex with men in Chongqing Municipality, China. Sexually Transmitted Diseases, 36, 647–656.
Zetola, N. M., & Klausner, J. D. (2007). Syphilis and HIV infection: An update. Clinical Infectious Diseases, 44, 1222–1228.
Zhang, Y., Chen, P., Lu, R., Liu, L., Wu, Y., Liu, X.,…Yi, D. (2012). Prevalence of HIV among men who have sex with men in Chongqing, China, 2006–2009: Cross-sectional biological and behavioural surveys. Sexually Transmitted Infections. doi:10.1136/sextrans-2011-050295.
Zheng, L., Hart, T. A., & Zheng, Y. (2011). The relationship between intercourse preference positions and personality traits among gay men in China. Archives of Sexual Behavior, 41, 683–689.
Acknowledgments
The first two authors contributed equally to this article. This study was funded by grant R01AI078933 from the National Institutes of Health of the USA, by the Ministry of Science and Technology of China (2008ZX10001-004, 2008ZX10001-010, and 2009DFB30420) and Chinese State Key Laboratory for Infectious Disease Develop Grant (2011SKLID102).
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Zhou, C., Raymond, H.F., Ding, X. et al. Anal Sex Role, Circumcision Status, and HIV Infection Among Men Who Have Sex with Men in Chongqing, China. Arch Sex Behav 42, 1275–1283 (2013). https://doi.org/10.1007/s10508-012-0008-6
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DOI: https://doi.org/10.1007/s10508-012-0008-6