Assessment of HIV and STI and risk behaviours among men who have sex with men (MSM) in Lao PDR

1. Assessment of HIV and STI and risk behaviours among men who have sex with men (MSM) in Lao PDR Venue Day Time Sampling (VDTS) Dr Sisavath Manivong, Center for HIV/AIDS and STI (CHAS) – Vientiane – Lao PDR

2. Background • HIV prevalence among adults 15-49 years in Lao PDR is estimated to be 0.2% • HIV prevalence among service women ranges from 1.1% to 3.9% (2004) • Most Lao men who have sex with men are not openly gay and are difficult to identify for HIV prevention and surveillance

3. Findings of former study of young male sexual behaviour, Vientiane, Burnet Institute Aug-Nov 2004 • Sample size = 800 • 18.5% of men 15-30 years old reported ever having sex with a man • Of those men reporting ever having sex with another man: • 67% had ever had oral sex • 52% had ever had anal sex (= 9% of all men in the sample) • Around 10% of men reported having sex with a man in the first six months of 2004, of whom 4.4% had more than one male partner • During the same 6 months, 7.6% of men had at least one female and one male sex partner

4. Goals of study MSM 2008 • To assess HIV and STI prevalence, risk behavior and associated factors among men who have sex with men in Lao PDR • To set a baseline for monitoring epidemiologic trends in HIV/STI prevalence among men who have sex with men in Lao PDR • To develop capacity and human resources of the Lao MOH, CHAS, and the PCCAs to conduct HIV and STI surveillance among men who have sex with men

5. Basic principles of study • Respect confidentiality and informed consent • Ensure that participants can access their test results at a mobile clinic, CHAS, or Sethathirat Hospital within one week • Ensure that participants can access their results at CHAS or Setthatirat Hospital for up to three months • To provide confirmatory testing and counseling to those participants testing positive for HIV • To provide free treatment to those participants testing positive for STIs

6. Planned sample size = 540 • Adequate to estimate HIV prevalence with a 95% confidence interval of +/- 3%

7. Criteria for entry into the study • Aged at least 15 years • Lao citizen • Has had oral or anal sex with a man within the previous six months • Currently residing in Vientiane Capital

8. Method of choosing the sample • Men who have sex with men in Lao PDR are not organised and so cannot be sampled directly • We used VDTS = venue, day, time sampling

9. VDTS • VDTS uses four distinct stages: • Identification, mapping and description of venues • Enumeration and characterisation of venue attendees • Determination of eligibility and willingness to participate (4)Selection of venues and recruitment of participants

10. ♣ ♣ ♣

11. Beer shops and restaurants- 12 Venues where participants recruited Discos, night clubs, and bars – 11 Saunas and massage parlours - 4

12. Training of study team • Data collectors4 days • Counsellors2 days • lab technicians2 days • Supervisors1 day Data Collectors: • CHAS 3 • Burnet Institute 7 • PSI 1 • LYAP 1

13. Study methods(1) • Data collectors introduced themselves to potential participants, explained the study, and asked them to participate 2. If they met the study criteria they were given a consent form to read and provided verbal consent • Participants were usually recruited in the motorbike parking lots of venues • Participants filled in the questionnaire on a hand-held computer

14. 5. Saliva samples were taken using Orasure kits 6. Urine samples were taken for testing for gonorrhoea and Chlamydia • Used bar codes rather than names to identify samples and questionnaires 8. Data from hand-held computers were downloaded to a notebook computer by the IT staff

15. Sample size achieved: 540 Venue where sampled Beer shop/bar - 50% Disco/night club - 45.6% Sauna or massage parlour - 4.4% External characteristics and mannerisms of participants Effeminate gay - 18.5% Masculine gay – 19.3% Transgender - 12.2% Masculine or “straight” acting - 50% Findings

16. Age – mean 22.3 years 15-24 years – 74.8% 25-29 years – 18.3% >30 years – 6.9% Education Primary school or less – 7.4% Secondary – 63.3% Vocational or higher – 29.3% Marital status Never married – 96.5% Ever married – 3.5% Characteristics of participants

17. 30 out of 540 men (5.6%) tested positive for HIV; of whom 43% were men who had a female sex partner in the previous 3 months 86 men (15%) returned to receive their results at the mobile clinic, CHAS, or Setthatirat Hospital, of whom four were HIV positive Men who ever sold sex and reported not using a condom consistently with a non-regular partner had an HIV prevalence of 12.5% HIV prevalence

18. STI Prevalence Total of sample size 514 • STI prevalence : 1. Chlamydia (CT) 7,58% 2. Gonorrhea (GN) 0,97% 3. CT & GN 0,38%

19. Primary sexual attraction Men – 39.6% Women – 44.6% More than one sex – 15.8% Age when first had sex Median 17 years (range 7-26) Median age of first anal sex 18 years (range 7–32) Sex of first partner Male – 46.5% Female – 50.4% Transgender man – 3.2% Sexual behaviour

20. Anal sex with men Ever – 83.7%, of whom: Insertive – 42.2% Receptive – 43.8% Both – 13.9% 74.1% of effeminate gay men reported preferring the receptive role 88.5% of transgender reported preferring the receptive role 68.7% of combined masculine gay and “straight-acting” men preferred the insertive role 85% of all men knew that HIV can be transmitted through having unprotected anal sex

21. Venue-based study; men who do not attend venues are not included – we do not know if this biased the findings Cross-sectional study so we cannot explain the causal direction of any association between behaviours and HIV prevalence Behaviours are self-reported so some men may exaggerate and others under-report certain behaviours Limitations of study

22. THANK YOU