Sexual mixing patterns in men who have sex with men: network approaches for smart resource allocation
M. Kumi Smith
A * , Matthew Graham B , Katherine Harripersaud A , Qiuying Zhu C , Guanghua Lan C , Zhiyong Shen C and Shuai Tang C *
+ Author Affiliations
- Author Affiliations
A Division of Epidemiology & Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA.
B Li Ka Shing Centre for Health Information and Discovery, Oxford, UK.
C Guangxi Center for Disease Control and Prevention, Nanning, China.
Sexual Health 20(2) 126-133 https://doi.org/10.1071/SH22163
Submitted: 29 September 2022 Accepted: 8 February 2023 Published: 27 February 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Age-based sexual mixing patterns in men who have sex with men (MSM) can greatly inform strategic allocation of intervention resources to subsets of the population for the purpose of preventing the greatest number of new HIV infections.
Methods: Egocentric network data collected from MSM participating in annual HIV sentinel surveillance surveys were used to assess age-dependent mixing and to explore its epidemiological implications on the risk of HIV transmission risk (among those HIV-infected) and HIV acquisition risk (among those not infected).
Results: Mixing in this sample of 1605 Chinese MSM is relatively age assortative (the average of values expressing the degree of preferential mixing were 2.01 in diagonal cells vs 0.87 in off-diagonal cells). Expected numbers of HIV acquisition were highest in the 20–24 years age group; those for HIV transmissions were highest among 25–29 year olds. The risk of both acquisition and transmission was highest in age groups that immediately follow the most commonly reported ages of sexual debut in this population (i.e. age 20).
Conclusions: These findings suggest that combination prevention resources should be targeted at younger MSM who are at higher risk of both transmission and acquisition. Programs may also do well to target even younger age groups who have not yet debuted in order to establish prevention effects before risky sexual behaviours begin. More research on optimal strategies to access these harder-to-reach subsets of the MSM population is needed. Findings also support ongoing efforts for public health practitioners to collect network data in key populations to support more empirically driven strategies to target prevention resources.
Keywords: age mixing, combination prevention, contact matrices, HIV, men who have sex with men (MSM), network analysis, resource allocation, sexual mixing.
References
[1] Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365 493–505.| Prevention of HIV-1 infection with early antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[2] Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363 2587–2599.
| Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[3] Joint United Nations Programme on HIV/AIDS (UNAIDS). End Inequalities. End AIDS. Global AIDS Strategy 2021–2026. Geneva: UNAIDS; 2021. Available at https://www.unaids.org/sites/default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf
[4] Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN. Combination HIV prevention: significance, challenges, and opportunities. Curr HIV/AIDS Rep 2011; 8 62–72.
| Combination HIV prevention: significance, challenges, and opportunities.Crossref | GoogleScholarGoogle Scholar |
[5] Vermund SH, Hayes RJ. Combination prevention: New hope for stopping the epidemic. Curr HIV/AIDS Rep 2013; 10 169–186.
| Combination prevention: New hope for stopping the epidemic.Crossref | GoogleScholarGoogle Scholar |
[6] Kippax SC, Holt M, Friedman SR. Bridging the social and the biomedical: engaging the social and political sciences in HIV research. J Int AIDS Soc 2011; 14 S1
| Bridging the social and the biomedical: engaging the social and political sciences in HIV research.Crossref | GoogleScholarGoogle Scholar |
[7] Kessler J, Braithwaite RS. Modeling the cost-effectiveness of HIV treatment: how to buy the most “health” when resources are limited. Curr Opin HIV AIDS 2013; 8 544–549.
| Modeling the cost-effectiveness of HIV treatment: how to buy the most “health” when resources are limited.Crossref | GoogleScholarGoogle Scholar |
[8] McNairy ML, El-Sadr WM. Antiretroviral therapy for the prevention of HIV transmission: What will it take? Clin Infect Dis 2014; 58 1003–1011.
| Antiretroviral therapy for the prevention of HIV transmission: What will it take?Crossref | GoogleScholarGoogle Scholar |
[9] Menza TW, Hughes JP, Celum CL, Golden MR. Prediction of HIV acquisition among men who have sex with men. Sex Transm Dis 2009; 36 547–555.
| Prediction of HIV acquisition among men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[10] Hoenigl M, Weibel N, Mehta SR, et al. Development and validation of the San Diego Early Test Score to predict acute and early HIV infection risk in men who have sex with men. Clin Infect Dis 2015; 61 468–475.
| Development and validation of the San Diego Early Test Score to predict acute and early HIV infection risk in men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[11] Smith DK, Pals SL, Herbst JH, Shinde S, Carey JW. Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr 2012; 60 421–427.
| Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States.Crossref | GoogleScholarGoogle Scholar |
[12] Jones J, Hoenigl M, Siegler AJ, Sullivan PS, Little S, Rosenberg E. Assessing the performance of three HIV incidence risk scores in a cohort of black and white MSM in the south. Sex Transm Dis 2017; 44 297–302.
| Assessing the performance of three HIV incidence risk scores in a cohort of black and white MSM in the south.Crossref | GoogleScholarGoogle Scholar |
[13] Dou Z, Zhang F, Zhao Y, et al. Progress on China’ s national free antiretroviral therapy strategy in 2002–2014. Zhonghua Liu Xing Bing Xue Za Zhi 2015; 36 1345–1350.
[14] Baggaley RF, White RG, Boily M-C. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol 2010; 39 1048–1063.
| HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention.Crossref | GoogleScholarGoogle Scholar |
[15] Liu C, Fu R, Tang W, et al. Transplantation or rurality? Migration and HIV risk among Chinese men who have sex with men in the urban areas. J Int AIDS Soc 2018; 21 e25039
| Transplantation or rurality? Migration and HIV risk among Chinese men who have sex with men in the urban areas.Crossref | GoogleScholarGoogle Scholar |
[16] Fisher JD, Smith L. Secondary prevention of HIV infection: the current state of prevention for positives. Curr Opin HIV AIDS 2009; 4 279–287.
| Secondary prevention of HIV infection: the current state of prevention for positives.Crossref | GoogleScholarGoogle Scholar |
[17] Lu Z, Wang L, Wang LP, et al. A mathematical model for HIV prevention and control among men who have sex with men in China. Epidemiol Infect 2020; 148 e224
| A mathematical model for HIV prevention and control among men who have sex with men in China.Crossref | GoogleScholarGoogle Scholar |
[18] Li J, Peng L, Gilmour S, et al. A mathematical model of biomedical interventions for HIV prevention among men who have sex with men in China. BMC Infect Dis 2018; 18 600
| A mathematical model of biomedical interventions for HIV prevention among men who have sex with men in China.Crossref | GoogleScholarGoogle Scholar |
[19] Lou J, Blevins M, Ruan Y, et al. Modeling the impact on HIV incidence of combination prevention strategies among men who have sex with men in Beijing, China. PLoS One 2014; 9 e90985
| Modeling the impact on HIV incidence of combination prevention strategies among men who have sex with men in Beijing, China.Crossref | GoogleScholarGoogle Scholar |
[20] Weiss KM, Goodreau SM, Morris M, et al. Egocentric sexual networks of men who have sex with men in the United States: results from the ARTnet study. Epidemics 2020; 30 100386
| Egocentric sexual networks of men who have sex with men in the United States: results from the ARTnet study.Crossref | GoogleScholarGoogle Scholar |
[21] Schneider JA, Cornwell B, Ostrow D, et al. Network mixing and network influences most linked to HIV infection and risk behavior in the HIV epidemic among black men who have sex with men. Am J Public Health 2013; 103 e28–e36.
| Network mixing and network influences most linked to HIV infection and risk behavior in the HIV epidemic among black men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[22] Leung KK, Wong HTH, Naftalin CM, Lee SS. A new perspective on sexual mixing among men who have sex with men by body image. PLoS One 2014; 9 e113791
| A new perspective on sexual mixing among men who have sex with men by body image.Crossref | GoogleScholarGoogle Scholar |
[23] Armbruster B, Roy S, Kapur A, Schneider JA. Sex role segregation and mixing among men who have sex with men: implications for biomedical HIV prevention interventions. PLoS One 2013; 8 e70043
| Sex role segregation and mixing among men who have sex with men: implications for biomedical HIV prevention interventions.Crossref | GoogleScholarGoogle Scholar |
[24] Hurt CB, Matthews DD, Calabria MS, et al. Sex with older partners is associated with primary HIV infection among men who have sex with men in North Carolina. J Acquir Immune Defic Syndr 2010; 54 185–190.
| Sex with older partners is associated with primary HIV infection among men who have sex with men in North Carolina.Crossref | GoogleScholarGoogle Scholar |
[25] Jin F, Grulich AE, Mao L, et al. Sexual partner’s age as a risk factor for HIV seroconversion in a cohort of HIV-negative homosexual men in Sydney. AIDS Behav 2013; 17 2426–2429.
| Sexual partner’s age as a risk factor for HIV seroconversion in a cohort of HIV-negative homosexual men in Sydney.Crossref | GoogleScholarGoogle Scholar |
[26] Liu Y, Qian H-Z, Amico KR, et al. Subsequent sexual risks among men who have sex with men may differ by sex of first partner and age at sexual debut: a cross-sectional study in Beijing, China. AIDS Behav 2017; 21 2913–2923.
| Subsequent sexual risks among men who have sex with men may differ by sex of first partner and age at sexual debut: a cross-sectional study in Beijing, China.Crossref | GoogleScholarGoogle Scholar |
[27] Huai P, Li F, Li Z, et al. Prevalence, risk factors, and medical costs of Chlamydia trachomatis infections in Shandong Province, China: a population-based, cross-sectional study. BMC Infect Dis 2018; 18 534
| Prevalence, risk factors, and medical costs of Chlamydia trachomatis infections in Shandong Province, China: a population-based, cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
[28] Xu R, Dai W, Zhao G, et al. Early sexual debut and HIV infection among men who have sex with men in Shenzhen, China. Biomed Res Int 2016; 2016 2987472
| Early sexual debut and HIV infection among men who have sex with men in Shenzhen, China.Crossref | GoogleScholarGoogle Scholar |
[29] Wang N, Wu G, Lu R, et al. Investigating HIV among Chinese men who have sex with men with recent sexual debut, Chongqing, China, 2011. AIDS Behav 2016; 20 2976–2982.
| Investigating HIV among Chinese men who have sex with men with recent sexual debut, Chongqing, China, 2011.Crossref | GoogleScholarGoogle Scholar |
[30] Huai P, Li F, Chu T, Liu D, Liu J, Zhang F. Prevalence of genital Chlamydia trachomatis infection in the general population: a meta-analysis. BMC Infect Dis 2020; 20 589
| Prevalence of genital Chlamydia trachomatis infection in the general population: a meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[31] Cao B, Gupta S, Wang J, et al. Social media interventions to promote HIV testing, linkage, adherence, and retention: systematic review and meta-analysis. J Med Internet Res 2017; 19 e394
| Social media interventions to promote HIV testing, linkage, adherence, and retention: systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[32] Jin X, Xu J, Smith MK, et al. An internet-based self-testing model (easy test): Cross-sectional survey targeting men who have sex with men who never tested for HIV in 14 provinces of China. J Med Internet Res 2019; 21 e11854
| An internet-based self-testing model (easy test): Cross-sectional survey targeting men who have sex with men who never tested for HIV in 14 provinces of China.Crossref | GoogleScholarGoogle Scholar |
[33] Choi K-H, Ning Z, Gregorich SE, Pan Q-C. The influence of social and sexual networks in the spread of HIV and syphilis among men who have sex with men in Shanghai, China. J Acquir Immune Defic Syndr 2007; 45 77–84.
| The influence of social and sexual networks in the spread of HIV and syphilis among men who have sex with men in Shanghai, China.Crossref | GoogleScholarGoogle Scholar |
[34] Liu H, Feng T, Liu H, et al. Egocentric networks of chinese men who have sex with men: network components, condom use norms, and safer sex. AIDS Patient Care STDS 2009; 23 885–893.
| Egocentric networks of chinese men who have sex with men: network components, condom use norms, and safer sex.Crossref | GoogleScholarGoogle Scholar |
[35] Zhao YJ, Lu Y. Mapping determinants of rural poverty in Guangxi — a less developed region of China. J Mt Sci 2020; 17 1749–1762.
| Mapping determinants of rural poverty in Guangxi — a less developed region of China.Crossref | GoogleScholarGoogle Scholar |
[36] Guangxi Zhuang Autonomous Region Bureau of Statistics. Guangxi Statistical Yearbook 2019. Nanning: Guangxi Zhuang Autonomous Region Bureau of Statistics; 2020. Available at http://tjj.gxzf.gov.cn/tjsj/tjnj/material/tjnj20200415/2019/zk/indexch.htm
