Advanced Search

Preplanned Studies: Oral Sexual Behavior Among HIV-Infected Men Who Have Sex with Men — China, February 2021

View author affiliations
  • Summary

    What is already known about this topic?

    Unprotected oral sex carries a risk of the transmission of sexually transmitted infections (STIs), especially if the individual has poor oral health.

    What is added by this report?

    Most human immunodeficiency virus (HIV) infected men who have sex with men (MSM) had never used a condom when giving oral sex (89.30%, 718/804) or receiving oral sex (90.32%, 709/785). Among MSM with detectable viral loads who had ever received oral sex without a condom, 40.00% reported ejaculation in their partner’s mouth.

    What are the implications for public health practice?

    Unprotected oral sex is very common among HIV-infected MSM in China. The public health sectors in China should recommend condom use during oral sex among HIV-infected MSM, especially when in-mouth ejaculation is involved.

  • loading...
  • Funding: Supported by the Natural Science Foundation of China Excellent Young Scientists Fund (82022064), Natural Science Foundation of China International/Regional Research Collaboration Project (72061137001), Natural Science Foundation of China Young Scientist Fund (81703278), the National Science and Technology Major Project of China (2018ZX10721102), the Sanming Project of Medicine in Shenzhen (SZSM201811071), the High Level Project of Medicine in Longhua, Shenzhen (HLPM201907020105), the National Key Research and Development Program of China (2020YFC0840900), the Shenzhen Science and Technology Innovation Commission Basic Research Program (JCYJ20190807155409373), Special Support Plan for High-Level Talents of Guangdong Province (2019TQ05Y230), and the Fundamental Research Funds for the Central Universities (58000-31620005)
  • [1] Centers for Disease Control and Prevention. STD risk and oral sex - CDC fact sheet. 2022. https://www.cdc.gov/std/healthcomm/STDFact-STDRiskAndOralSex.htm. [2022-3-22]https://www.cdc.gov/std/healthcomm/STDFact-STDRiskAndOralSex.htm
    [2] Robbins SJ, Dauda W, Kokogho A, Ndembi N, Mitchell A, Adebajo S, et al. Oral sex practices among men who have sex with men and transgender women at risk for and living with HIV in Nigeria. PLoS One 2020;15(9):e0238745. http://dx.doi.org/10.1371/journal.pone.0238745CrossRef
    [3] Bruce D, Harper GW, Fernández MI, Jamil OB. Age-concordant and age-discordant sexual behavior among gay and bisexual male adolescents. Arch Sex Behav 2012;41(2):441 − 8. http://dx.doi.org/10.1007/s10508-011-9730-8CrossRef
    [4] Weng RX, Hong FC, Yu WY, Cai YM. Compare HIV/syphilis infections between age groups and explore associated factors of HIV/syphilis co-infections among men who have sex with men in Shenzhen, China, from 2009 to 2017. PLoS One 2019;14(10):e0223377. http://dx.doi.org/10.1371/journal.pone.0223377CrossRef
    [5] Sirivongrangson P, Lolekha R, Charoenwatanachokchai A, Siangphoe U, Fox KK, Jirarojwattana N, et al. HIV risk behavior among HIV-infected men who have sex with men in Bangkok, Thailand. AIDS Behav 2012;16(3):618 − 25. http://dx.doi.org/10.1007/s10461-011-9884-3CrossRef
    [6] Zheng WR, Sun YH, Li H, Zhao HP, Zhan YW, Gao YS, et al. COVID-19 vaccine uptake and hesitancy among HIV-infected men who have sex with men in mainland China: a cross-sectional survey. Hum Vaccines Immunother 2021;17(12):4971 − 81. http://dx.doi.org/10.1080/21645515.2021.1996152CrossRef
    [7] Politch JA, Mayer KH, Welles SL, O’brien WX, Xu C, Bowman FP, et al. Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men. AIDS 2012;26(12):1535 − 43. http://dx.doi.org/10.1097/QAD.0b013e328353b11bCrossRef
    [8] van Kesteren NMC, Hospers HJ, van Empelen P, van Breukelen G, Kok G. Sexual decision-making in HIV-positive men who have sex with men: how moral concerns and sexual motives guide intended condom use with steady and casual sex partners. Arch Sex Behav 2007;36(3):437 − 49. http://dx.doi.org/10.1007/s10508-006-9125-4CrossRef
    [9] Semple SJ, Patterson TL, Grant I. HIV-positive gay and bisexual men: predictors of unsafe sex. AIDS Care 2003;15(1):3 − 15. http://dx.doi.org/10.1080/713990434CrossRef
    [10] Vanable PA, Carey MP, Brown JL, Littlewood RA, Bostwick R, Blair D. What HIV-positive MSM want from sexual risk reduction interventions: findings from a qualitative study. AIDS Behav 2012;16(3):554 − 63. http://dx.doi.org/10.1007/s10461-011-0047-3CrossRef
  • TABLE 1.  Basic characteristics of HIV-infected men who have sex with men in China who ever had oral sex in the past six months.

    Characteristicsn (%)
    Number of participants873 (100.00)
    Gender Identity
    Cisgender male787 (90.15)
    Transgender women86 (9.85)
    Age (years)
    ≤25276 (31.62)
    26–44570 (65.29)
    ≥4527 (3.09)
    Education
    High school or below181 (20.73)
    Bachelor or college611 (69.99)
    Master or doctor81 (9.28)
    Chinese geographical division*
    North China155 (17.75)
    Northeast China66 (7.56)
    East China256 (29.32)
    Central China114 (13.06)
    South China124 (14.20)
    Southwest China109 (12.49)
    Northwest China49 (5.61)
    Marital status
    Unmarried757 (86.71)
    Married75 (8.59)
    Other41 (4.70)
    Employment status
    Full-time employment523 (61.89)
    Freelancer167 (19.76)
    Student86 (10.18)
    Unemployed69 (8.17)
    Salary (CNY)
    0–1,999132 (15.12)
    2,000–4,999331 (37.92)
    5,000–9,999302 (34.59)
    ≥10,000108 (12.37)
    Sexual orientation
    Heterosexual10 (1.15)
    Homosexual691 (79.15)
    Other or not sure172 (19.70)
    Way to find sex partners
    Regular partner327 (37.46)
    Social app517 (59.22)
    Bar/party/bathhouse40 (4.58)
    Workmates19 (2.18)
    Friend recommendation31 (3.55)
    Gym20 (2.29)
    Gay community20 (2.29)
    HIV status of regular male partner
    Positive116 (35.47)
    Negative153 (46.79)
    Unknown58 (17.74)
    Time since HIV diagnosis (months)
    <12162 (18.56)
    13–35300 (34.36)
    ≥36411 (47.08)
    Viral load of HIV in the last year
    Detectable (at least once)126 (14.43)
    Undetectable613 (70.22)
    Not sure134 (15.35)
    Taking HIV medications
    Yes801 (91.75)
    No72 (8.25)
    Recreational drug use before or during sexual activities
    Yes525 (60.14)
    No348 (39.86)
    Alcohol use before or during sexual activities
    Yes316 (36.20)
    No557 (63.80)
    Circumcised
    Yes226 (25.89)
    No647 (74.11)
    Type of oral sex
    Ever giving oral sex804 (92.10)
    Receiving oral sex§785 (89.92)
    Frequency of oral sex
    ≥10 times per month55 (6.30)
    4–9 times per month106 (12.14)
    1–3 times per month296 (33.91)
    <1 time per month416 (47.65)
    Number of oral sex male partners
    ≥6 per month27 (3.09)
    2–5 per month177 (20.27)
    1 per month259 (29.67)
    <1 per month410 (46.96)
    Condom use when giving oral sex
    Sometime/often86 (10.70)
    Never718 (89.30)
    Condom use when receiving oral sex
    Sometime/often76 (9.68)
    Never709 (90.32)
    Ever ejaculated in partners’ mouth when receiving oral sex without a condom
    Yes250 (35.26)
    No459 (64.74)
    Mouthwash before/after oral sex
    Yes464 (53.15)
    No409 (46.85)
    Note: Numbers may vary due to missing data.
    Abbreviations: CNY=Chinese Yuan; PLAD=provincial-level administrative division; HIV=human immunodeficiency virus.
    * Chinese Geographical Divisions by PLADs: North China (Beijing, Tianjin, Hebei, Shanxi, Inner Mongolia); Northeast China (Heilongjiang, Jilin, Liaoning); East China (Shanghai, Jiangsu, Zhejiang, Anhui, Jiangxi, Shandong, Fujian, Taiwan); Central China (Henan, Hubei, Hunan); South China (Guangdong, Guangxi, Hainan, Hong Kong, Macao); Southwest China [Chongqing, Sichuan, Guizhou, Yunnan, Xizang (Tibet)]; Northwest China (Shaanxi, Gansu, Qinghai, Ningxia, Xinjiang).
    Giving oral sex: putting your mouth on your partner’s penis (Oral-Penis).
    § Receiving oral sex: putting your penis in your partner’s mouth (Penis-Oral).
    Download: CSV

    TABLE 2.  Characteristics of oral sex in MSM with different HIV viral loads in China.

    VariablesDetectable
    n (%)
    Undetectable
    n (%)
    Not sure
    n (%)
    P value
    Ever giving oral sex*0.924
    Yes115 (91.27)565 (92.17)124 (92.54)
    No11 (8.73)48 (7.83)10 (7.46)
    Ever receiving oral sex§<0.001
    Yes101 (80.16)563 (91.84)121 (90.30)
    No25 (19.84)50 (8.16)13 (9.70)
    Frequency of oral sex0.005
    ≥10 times per month16 (12.70)27 (4.40)12 (8.96)
    4–9 times per month20 (15.87)69 (11.26)17 (12.68)
    1–3 times per month40 (31.75)208 (33.93)48 (35.82)
    <1 time per month50 (39.68)309 (50.41)57 (42.54)
    Number of oral sex male partners0.001
    ≥6 per month5 (3.97)14 (2.28)8 (5.97)
    2–5 per month32 (25.40)107 (17.46)38 (28.36)
    1 per month43 (34.13)187 (30.51)29 (21.64)
    <1 per month46 (36.50)305 (49.75)59 (44.03)
    Condom use when giving oral sex<0.001
    Sometime/often22 (19.13)45 (7.96)19 (15.32)
    Never93 (80.87)520 (92.04)105 (84.68)
    Condom use when receiving oral sex0.042
    Sometime/often16 (15.84)46 (8.17)14 (11.57)
    Never85 (84.16)517 (91.83)107 (88.43)
    Ever ejaculated in partners’ mouth when
    receiving oral sex without a condom
    0.258
    Yes34 (40.00)173 (33.46)43 (40.19)
    No51 (60.00)344 (66.54)64 (59.81)
    Mouthwash before/after oral sex0.050
    Yes79 (62.70)320 (52.20)65 (48.51)
    No47 (37.30)293 (47.80)69 (51.49)
    Total126613134
    Detectable: HIV viral load can be detected at least once in the past six months.
    Abbreviations: MSM=men who have sex with men; HIV=human immunodeficiency virus.
    *Giving oral sex: putting your mouth on your partner’s penis (Oral-Penis).
    § Receiving oral sex: putting your penis in your partner’s mouth (Penis-Oral).
    Download: CSV

    TABLE 3.  Factors associated with unprotected oral sex among HIV-infected MSM in China.

    CharacteristicsUnadjusted OR
    (95% CI)
    P valueAdjusted OR
    (95% CI)
    P value
    Gender Identity
    Cisgender maleRef
    Transgender women0.7 (0.4–1.1)0.1070.8 (0.5–1.3)0.371
    Age (year)
    ≤25Ref
    26–441.2 (0.9–1.7)0.270
    ≥451.6 (0.6–4.4)0.353
    Education
    High school or belowRef
    Bachelor or college0.8 (0.6–1.3)0.407
    Master or doctor1.4 (0.7–2.7)0.326
    Marital status
    UnmarriedRef
    Married0.8 (0.5–1.3)0.311
    Other1.3 (0.6–2.9)0.508
    Have a regular partner
    Yes0.7 (0.5–0.9)0.0401.1 (0.8–1.7)0.541
    NoRef
    Find sexual partner through social apps
    Yes2.4 (1.8–3.3)<0.0012.5 (1.7–3.7)<0.001
    NoRef
    Time since HIV diagnosis
    <12 monthsRef
    13–35 months1.0 (0.7–1.6)0.970
    ≥36 months1.4 (0.9–2.1)0.132
    Viral load of HIV in the last year
    DetectableRef
    Undetectable2.4 (1.6–3.6)<0.0012.1 (1.3–3.3)0.001
    Not sure1.8 (1.1–3.0)0.0291.3 (0.7–2.3)0.384
    Taking HIV medications
    YesRef
    No0.5 (0.3–1.0)0.0670.5 (0.3–1.1)0.072
    Recreational drug use before or during sexual activities
    YesRef
    No0.8 (0.6–1.2)0.294
    Alcohol use before or during sexual activities
    Yes2.2 (1.6–3.0)<0.0011.7 (1.2–2.4)0.001
    NoRef
    Circumcised
    Yes0.4 (0.3–0.6)<0.0010.6 (0.4–0.8)0.002
    NoRef
    Abbreviations: OR=odds ratio; CI=confidence interval; Ref=reference; HIV=human immunodeficiency virus; MSM=men who have sex with men.
    Download: CSV

Citation:

通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索
Turn off MathJax
Article Contents

Article Metrics

Article views(618) PDF downloads(10) Cited by()

Share

Related

Oral Sexual Behavior Among HIV-Infected Men Who Have Sex with Men — China, February 2021

View author affiliations

Summary

What is already known about this topic?

Unprotected oral sex carries a risk of the transmission of sexually transmitted infections (STIs), especially if the individual has poor oral health.

What is added by this report?

Most human immunodeficiency virus (HIV) infected men who have sex with men (MSM) had never used a condom when giving oral sex (89.30%, 718/804) or receiving oral sex (90.32%, 709/785). Among MSM with detectable viral loads who had ever received oral sex without a condom, 40.00% reported ejaculation in their partner’s mouth.

What are the implications for public health practice?

Unprotected oral sex is very common among HIV-infected MSM in China. The public health sectors in China should recommend condom use during oral sex among HIV-infected MSM, especially when in-mouth ejaculation is involved.

  • 1. School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China
  • 2. Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
  • 3. Center for Disease Control and Prevention, Shizhong District, Jinan, Shandong Province, China
  • Corresponding author:

    Huachun Zou, zouhuachun@mail.sysu.edu.cn

  • Funding: Supported by the Natural Science Foundation of China Excellent Young Scientists Fund (82022064), Natural Science Foundation of China International/Regional Research Collaboration Project (72061137001), Natural Science Foundation of China Young Scientist Fund (81703278), the National Science and Technology Major Project of China (2018ZX10721102), the Sanming Project of Medicine in Shenzhen (SZSM201811071), the High Level Project of Medicine in Longhua, Shenzhen (HLPM201907020105), the National Key Research and Development Program of China (2020YFC0840900), the Shenzhen Science and Technology Innovation Commission Basic Research Program (JCYJ20190807155409373), Special Support Plan for High-Level Talents of Guangdong Province (2019TQ05Y230), and the Fundamental Research Funds for the Central Universities (58000-31620005)
  • Online Date: June 24 2022
    doi: 10.46234/ccdcw2022.117
  • Oral sex is one of the most common sexual activities. Although evidence supports that unprotected oral sex carries a risk of the transmission of sexually transmitted infections (STIs), especially if the individual has a poor oral health, the risk of human immunodeficiency virus (HIV) transmission through oral sex is much lower than that through anal sex (1). Many people, including people living with HIV (PLWH), may think that oral sex carries little or no risk for the transmission of HIV and other STIs. After knowing their HIV status, they may increase the frequency of oral sex and decrease that of anal sex in order to minimize HIV transmission to others. As a result, PLWH may be more likely to have regular oral sex than the uninfected population (2). Unprotected oral sex is common among men who have sex with men (MSM) (3). A cross-sectional study from China showed that only 6.87% of 5,181 MSM reported condom use in their last oral sex (4). Sarah et al. found that a higher proportion of HIV-infected MSM (75.00%) reported having oral sex than uninfected MSM (59.00%) (2). Another study from Thailand showed that 85.00% of HIV-infected MSM had reported unprotected oral sex, significantly higher than the proportion of unprotected anal sex (32.00%) (5). The purpose of the current study was to investigate oral sexual behavior and factors associated with the use of condoms in oral sex among HIV-infected MSM in China. Most participants in this study never used a condom when giving oral sex (89.30%, 718/804) or receiving oral sex (90.32%, 709/785). Among the 85 participants with a detectable viral load who received oral sex without a condom, 40.00% reported that they had ever ejaculated in their partner’s mouth. It is necessary for clinicians and public health practitioners to develop targeted education and interventions for HIV-infected MSM to minimize the risk from unprotected oral sex.

    We conducted a nationwide cross-sectional online survey in February 2021 in China. Convenience sampling was applied in this study. A total of 873 eligible participants were recruited through Li Hui Shi Kong, a WeChat official account with more than 76,000 HIV-infected followers. Details of the description of Li Hui Shi Kong are available in a previously published literature (6). Eligibility criteria included self-identified MSM, having oral sex with at least one man in the past six months, and having a known diagnosis of HIV. The following measures were taken to ensure the quality of the questionnaire results: 1) each mobile phone or computer could only be used once; 2) a pre-investigation of 12 HIV-infected MSM was conducted to modify questionnaires before the formal launch of the survey; 3) invalid questionnaires were identified by the logic checks built into the back-end system; 4) quality-controlled questions were designed to exclude participants filling in wrong answers (e.g., “How many seasons are there?”); 5) participants who finished questionnaires within a short answer time (less than 5 minutes), and those who chose the same option in all choice questions were also excluded. Every eligible participant received a reimbursement of 4.6 USD to 15.4 USD as an incentive through an online random lottery. Oral sexual behaviors included the following questions: in the past six months, 1) type of oral sex (given, received, or both); 2) frequency of oral sex; 3) number of oral sex male partners; 4) condom use when giving or receiving oral sex; 5) ever ejaculated in partners’ mouth; 6) mouthwash use before or after performing oral sex. To ensure that all participants were using the same definition of oral sex, a short statement was given on the survey, defining giving oral sex as “putting your mouth on your partner’s penis (Oral-Penis)” and receiving oral sex as “putting your penis in your partner’s mouth (Penis-Oral).” Unprotected oral sex in this study was defined as the absence of condom use during oral sex.

    The chi-squared test was used to compare the oral sexual behavior between different viral loads of HIV in the last six months of HIV-infected MSM. Univariate logistic regressions were performed to identify factors potentially associated with unprotected oral sex. Odds ratios (OR) and 95% confidence intervals (CI) were calculated in univariate analysis. Variables with P<0.2 in univariate analysis were included in multivariable modeling, which was performed using multiple logistic regression. All analyses were conducted using IBM SPSS (version 20.0, SPSS, Inc. Chicago, USA), and P<0.05 was considered significant.

    The proportion of transgender women was 9.85% (86/873). The age of participants ranged from 16 to 63 years (median=29, interquartile range: 25–34). In all participants, 59.22% (517/873) used social apps to find sexual partners, and 37.46% (327/873) had regular male partners (Table 1). In the past 6 months, the proportions of participants who reported ever giving oral sex and receiving oral sex were 92.10% (804/873) and 89.92% (785/873). Most participants never used a condom when giving oral sex (89.30%, 718/804) or receiving oral sex (90.32%, 709/785). Overall, 35.26% (250/709) of the participants reported ejaculation in their partner’s mouth when receiving oral sex without a condom, and 53.15% (464/873) used mouthwash before or after performing oral sex. Among the 126 participants with a detectable viral load in the past 6 months, 67.46% (85/126) reported receiving oral sex without a condom.

    Characteristicsn (%)
    Number of participants873 (100.00)
    Gender Identity
    Cisgender male787 (90.15)
    Transgender women86 (9.85)
    Age (years)
    ≤25276 (31.62)
    26–44570 (65.29)
    ≥4527 (3.09)
    Education
    High school or below181 (20.73)
    Bachelor or college611 (69.99)
    Master or doctor81 (9.28)
    Chinese geographical division*
    North China155 (17.75)
    Northeast China66 (7.56)
    East China256 (29.32)
    Central China114 (13.06)
    South China124 (14.20)
    Southwest China109 (12.49)
    Northwest China49 (5.61)
    Marital status
    Unmarried757 (86.71)
    Married75 (8.59)
    Other41 (4.70)
    Employment status
    Full-time employment523 (61.89)
    Freelancer167 (19.76)
    Student86 (10.18)
    Unemployed69 (8.17)
    Salary (CNY)
    0–1,999132 (15.12)
    2,000–4,999331 (37.92)
    5,000–9,999302 (34.59)
    ≥10,000108 (12.37)
    Sexual orientation
    Heterosexual10 (1.15)
    Homosexual691 (79.15)
    Other or not sure172 (19.70)
    Way to find sex partners
    Regular partner327 (37.46)
    Social app517 (59.22)
    Bar/party/bathhouse40 (4.58)
    Workmates19 (2.18)
    Friend recommendation31 (3.55)
    Gym20 (2.29)
    Gay community20 (2.29)
    HIV status of regular male partner
    Positive116 (35.47)
    Negative153 (46.79)
    Unknown58 (17.74)
    Time since HIV diagnosis (months)
    <12162 (18.56)
    13–35300 (34.36)
    ≥36411 (47.08)
    Viral load of HIV in the last year
    Detectable (at least once)126 (14.43)
    Undetectable613 (70.22)
    Not sure134 (15.35)
    Taking HIV medications
    Yes801 (91.75)
    No72 (8.25)
    Recreational drug use before or during sexual activities
    Yes525 (60.14)
    No348 (39.86)
    Alcohol use before or during sexual activities
    Yes316 (36.20)
    No557 (63.80)
    Circumcised
    Yes226 (25.89)
    No647 (74.11)
    Type of oral sex
    Ever giving oral sex804 (92.10)
    Receiving oral sex§785 (89.92)
    Frequency of oral sex
    ≥10 times per month55 (6.30)
    4–9 times per month106 (12.14)
    1–3 times per month296 (33.91)
    <1 time per month416 (47.65)
    Number of oral sex male partners
    ≥6 per month27 (3.09)
    2–5 per month177 (20.27)
    1 per month259 (29.67)
    <1 per month410 (46.96)
    Condom use when giving oral sex
    Sometime/often86 (10.70)
    Never718 (89.30)
    Condom use when receiving oral sex
    Sometime/often76 (9.68)
    Never709 (90.32)
    Ever ejaculated in partners’ mouth when receiving oral sex without a condom
    Yes250 (35.26)
    No459 (64.74)
    Mouthwash before/after oral sex
    Yes464 (53.15)
    No409 (46.85)
    Note: Numbers may vary due to missing data.
    Abbreviations: CNY=Chinese Yuan; PLAD=provincial-level administrative division; HIV=human immunodeficiency virus.
    * Chinese Geographical Divisions by PLADs: North China (Beijing, Tianjin, Hebei, Shanxi, Inner Mongolia); Northeast China (Heilongjiang, Jilin, Liaoning); East China (Shanghai, Jiangsu, Zhejiang, Anhui, Jiangxi, Shandong, Fujian, Taiwan); Central China (Henan, Hubei, Hunan); South China (Guangdong, Guangxi, Hainan, Hong Kong, Macao); Southwest China [Chongqing, Sichuan, Guizhou, Yunnan, Xizang (Tibet)]; Northwest China (Shaanxi, Gansu, Qinghai, Ningxia, Xinjiang).
    Giving oral sex: putting your mouth on your partner’s penis (Oral-Penis).
    § Receiving oral sex: putting your penis in your partner’s mouth (Penis-Oral).

    Table 1.  Basic characteristics of HIV-infected men who have sex with men in China who ever had oral sex in the past six months.

    HIV-infected MSM with an undetectable viral load were more likely to receive oral sex in the past 6 months (P<0.001), and those with a detectable viral load were on a more frequent basis (P=0.005) (Table 2). A higher proportion of HIV-infected MSM with detectable viral load reported condom use when giving oral sex (19.13% vs. 7.96%, P<0.001) and receiving oral sex (15.84% vs. 8.17%, P=0.042) in the past 6 months compared to those with undetectable viral load. Among the 85 participants with detectable viral load who had ever received oral sex without a condom, 40.00% (34/85) reported ejaculation in their partner’s mouth.

    VariablesDetectable
    n (%)
    Undetectable
    n (%)
    Not sure
    n (%)
    P value
    Ever giving oral sex*0.924
    Yes115 (91.27)565 (92.17)124 (92.54)
    No11 (8.73)48 (7.83)10 (7.46)
    Ever receiving oral sex§<0.001
    Yes101 (80.16)563 (91.84)121 (90.30)
    No25 (19.84)50 (8.16)13 (9.70)
    Frequency of oral sex0.005
    ≥10 times per month16 (12.70)27 (4.40)12 (8.96)
    4–9 times per month20 (15.87)69 (11.26)17 (12.68)
    1–3 times per month40 (31.75)208 (33.93)48 (35.82)
    <1 time per month50 (39.68)309 (50.41)57 (42.54)
    Number of oral sex male partners0.001
    ≥6 per month5 (3.97)14 (2.28)8 (5.97)
    2–5 per month32 (25.40)107 (17.46)38 (28.36)
    1 per month43 (34.13)187 (30.51)29 (21.64)
    <1 per month46 (36.50)305 (49.75)59 (44.03)
    Condom use when giving oral sex<0.001
    Sometime/often22 (19.13)45 (7.96)19 (15.32)
    Never93 (80.87)520 (92.04)105 (84.68)
    Condom use when receiving oral sex0.042
    Sometime/often16 (15.84)46 (8.17)14 (11.57)
    Never85 (84.16)517 (91.83)107 (88.43)
    Ever ejaculated in partners’ mouth when
    receiving oral sex without a condom
    0.258
    Yes34 (40.00)173 (33.46)43 (40.19)
    No51 (60.00)344 (66.54)64 (59.81)
    Mouthwash before/after oral sex0.050
    Yes79 (62.70)320 (52.20)65 (48.51)
    No47 (37.30)293 (47.80)69 (51.49)
    Total126613134
    Detectable: HIV viral load can be detected at least once in the past six months.
    Abbreviations: MSM=men who have sex with men; HIV=human immunodeficiency virus.
    *Giving oral sex: putting your mouth on your partner’s penis (Oral-Penis).
    § Receiving oral sex: putting your penis in your partner’s mouth (Penis-Oral).

    Table 2.  Characteristics of oral sex in MSM with different HIV viral loads in China.

    In multivariable logistic regression analysis, HIV-infected MSM who were circumcised [adjusted odds ratio (aOR)=0.6, 95% CI: 0.4–0.8] were less likely to have unprotected oral sex. HIV-infected MSM who found sexual partners via social apps (aOR=2.5, 95% CI: 1.7–3.7), used alcohol before or during sexual activities (aOR=1.7, 95% CI: 1.2–2.4), and with an undetectable viral load in the past 6 months (aOR=2.1, 95% CI: 1.3–3.3) were more likely to engage in oral sex without a condom. (Table 3)

    CharacteristicsUnadjusted OR
    (95% CI)
    P valueAdjusted OR
    (95% CI)
    P value
    Gender Identity
    Cisgender maleRef
    Transgender women0.7 (0.4–1.1)0.1070.8 (0.5–1.3)0.371
    Age (year)
    ≤25Ref
    26–441.2 (0.9–1.7)0.270
    ≥451.6 (0.6–4.4)0.353
    Education
    High school or belowRef
    Bachelor or college0.8 (0.6–1.3)0.407
    Master or doctor1.4 (0.7–2.7)0.326
    Marital status
    UnmarriedRef
    Married0.8 (0.5–1.3)0.311
    Other1.3 (0.6–2.9)0.508
    Have a regular partner
    Yes0.7 (0.5–0.9)0.0401.1 (0.8–1.7)0.541
    NoRef
    Find sexual partner through social apps
    Yes2.4 (1.8–3.3)<0.0012.5 (1.7–3.7)<0.001
    NoRef
    Time since HIV diagnosis
    <12 monthsRef
    13–35 months1.0 (0.7–1.6)0.970
    ≥36 months1.4 (0.9–2.1)0.132
    Viral load of HIV in the last year
    DetectableRef
    Undetectable2.4 (1.6–3.6)<0.0012.1 (1.3–3.3)0.001
    Not sure1.8 (1.1–3.0)0.0291.3 (0.7–2.3)0.384
    Taking HIV medications
    YesRef
    No0.5 (0.3–1.0)0.0670.5 (0.3–1.1)0.072
    Recreational drug use before or during sexual activities
    YesRef
    No0.8 (0.6–1.2)0.294
    Alcohol use before or during sexual activities
    Yes2.2 (1.6–3.0)<0.0011.7 (1.2–2.4)0.001
    NoRef
    Circumcised
    Yes0.4 (0.3–0.6)<0.0010.6 (0.4–0.8)0.002
    NoRef
    Abbreviations: OR=odds ratio; CI=confidence interval; Ref=reference; HIV=human immunodeficiency virus; MSM=men who have sex with men.

    Table 3.  Factors associated with unprotected oral sex among HIV-infected MSM in China.

    • The study found a high proportion of HIV-infected MSM engaged in oral sex without a condom. Since the risk of HIV transmission through oral sex is much lower than that during anal sex, people might mistakenly believe that unprotected oral sex is not a risky sexual behavior. Our findings showed that among the 85 participants with detectable viral loads who had ever received oral sex without a condom, 40.00% had ever ejaculated in the partner’s mouth. Being exposed to semen and having sores in the mouth or on the genital may increase a person’s chance of getting HIV or other STIs during oral sex, even when the infected partner has an undetectable viral load (7). The results of this study indicated that it was possible for HIV-infected MSM to transmit HIV to their sexual partners, who were also at the risk of STIs and infection of HIV of a different genotype. Therefore, condom use is necessary in oral sex among HIV-infected individuals, especially when they receive oral sex and ejaculate in their partner’s mouth.

      The findings suggested that HIV-infected MSM who found sexual partners through social apps were more likely to engage in oral sex without a condom. A previous study showed that HIV-positive MSM were more likely to engage in high-risk sexual behaviors in the context of casual sex encounters than in steady sexual relationships (8). A possible explanation is that casual partners who meet through social apps, will not be informed of the HIV status of participants during oral sex, so they are more likely to engage in oral sex without a condom due to their negligence of the risk of this sexual practice. This study supported the integration of social apps commonly used by MSM into sexual health education. In addition, the results of this study also showed that alcohol drinking before or during sexual activity was significantly related to the use of condoms in oral sex of HIV-infected MSM. People under the influence of alcohol may become disinhibited and are more likely to engage in risky sexual behaviors (9). This study emphasized the need to implement alcohol risk reduction programs in HIV-infected MSM.

      A previous study showed that 85% of HIV-infected MSM reported having oral sex without a condom, which was similar to the finding of this study (5). A qualitative study among HIV-infected MSM showed that in the absence of information about whether oral sex posed a significant risk of HIV transmission, HIV-infected MSM would give up condom use during oral sex but were usually accompanied by anxiety (10).

      The study was subject to at least four limitations. First, the convenience sampling might produce selection bias and might not represent the entire HIV-infected MSM in China. Second, the partner’s serostatus was not mentioned in the questionnaire. Third, the cross-sectional data in this study may be subject to potential recall bias and could not establish a causal relationship. Fourth, information on STIs history were not collected, so the connection between oral sex and STIs were unable to be evaluated.

      HIV-infected MSM should be informed of the potential risk of unprotected oral sex. Targeted educational strategies and interventions are needed for HIV-infected MSM to minimize the risk of unprotected oral sex. The public health sectors in China should recommend condom use during oral sex among HIV-infected MSM, especially when in-mouth ejaculation is involved.

    • No conflicts of Interest declared.

Reference (10)

Citation:

Catalog

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return