www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

A Bio Behavioural and Prevalence study of HIV, syphilis and Hepatitis B in high risk men who have

sex with men (MSM) in Kuala Lumpur, Malaysia

I. Azwa 1, E. Celaya 2, I. Yee 3, K. Baker 4, S.H. Lim 3, A. Ashraf 5, F.T. Tai 2, M. Choo Kok Keong 3, D. Dangerfield 1

1 University Malaya, Department of Medicine, Kuala Lumpur, Malaysia, 2

PT Foundation, Kuala Lumpur, Malaysia, 3 CERIA, Kuala Lumpur, Malaysia, 4 London School of Hygiene and Tropical Medicine, London, United Kingdom, 5 Terrence Higgins Trust, London, United Kingdom

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Objective and Methods• The MSM community is a heterogeneous and hidden population in Malaysia due

to stigma, cultural and religious influences. • Previous studies looking at the HIV prevalence within the MSM population in Kuala

Lumpur such as the venue day time sampling ( Kanter et al, 2011) recorded surprisingly low levels of HIV. (VDTS -3.9%)

• The Objective of the study was to describe the risk behaviours and estimate the prevalence and risk factors of HIV, syphilis and hepatitis B in high risk MSM attending a voluntary counselling and testing (VCT) centre in Kuala Lumpur.

• High risk behaviour was defined as MSM who engaged in unprotected anal intercourse (UAI) in the previous 6 months

• Clients completed a self- administered questionnaire on sexual behaviour, alcohol and substance use and HIV/STI testing and knowledge

• Each client was tested for HIV using a rapid test kit (Intec, Korea) and venous blood was tested for syphilis (RPR and TPPA) and Hepatitis B (hepatitis B surface Antigen and surface antibody)

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Results

Sociodemographics• 229 men fulfilled inclusion

criteria• Mean age – 29 years • 55% Chinese, 35% Malays• 94% single, 4% married• 72% university graduates• 85% identified as

homosexual

Prevalence (N=229)

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Results

Sexual Behaviour Recreational Drug Use

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Predictors of HIV and syphilis infectionBivariate analysis

Variable HIV Negative HIV Positive P value

EthnicityChineseMalaysIndians/Others

105 (83.3%)65 (80.2%)19 (86.4%)

21 (16.7%)16 (19.8%)3 (16.4%)

0.751

Education< Form 5Form 5 and higher

8 (53.3%)181 (84.6%)

7 (46.7%)33 (15.4%)

0.002

UAI during last sex with casual partnersNoYes

169 (85.4%)20 (64.5%)

29 (14.7%)11 (35.5%)

0.005

Used drugs during group sexNoYes

172 (83.9%)17 (70.8%)

33 (16.1%)7 (29.2%)

0.110

SyphilisPositiveNegative – previously infectedNegative – never infected

29 (78.4%)8 (57.1%)152 (85.4%)

8 (21.6%)6 (42.9%)26 (14.6%)

0.021

Variable Syphilis Negative Syphilis Positive P value

Education< Form 5Form 5 or higher

8 (53.3%)184 (86%)

7 (46.7%)9 (14%)

0.001

STI symptoms in past 12 monthsNoYes

138 (89.1%)5454 (72.9%)

17 (10.9%)20 (27.1%)

0.002

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Conclusion

• Highest rates of HIV prevalence reported to date within high risk MSM in Kuala Lumpur

• Syphilis prevalence very similar to that of HIV and may be fuelling the HIV epidemic within the MSM population

• High levels of UAI and recreational drug use particularly for the purposes of sex are prevalent within this population

• There is an urgent need to provide more effective and targeted HIV prevention education and strategies to combat the spread of HIV infection within the MSM community in Malaysia

• Future studies need to look at HIV incidence within established MSM cohorts, the role of cultural and religious norms and perceived stigma on risk behaviour, the impact of newer HIV prevention strategies on HIV incidence and include online recruitment given the high numbers that use the internet to solicit partners for sex