HIV and STI testing among East and Southeast Asian men who have sex with men in Toronto.
Immigrants (Demographic aspects)
HIV testing (Methods)
Gay men (Health aspects)
Gay men (Demographic aspects)
Sexually transmitted diseases (Prevention)
Sexually transmitted diseases (Methods)
Poon, Maurice Kwong-Lai
Wong, Josephine Pui-Hing
Ho, Peter Trung-Thu
|Publication:||Name: The Canadian Journal of Human Sexuality Publisher: SIECCAN, The Sex Information and Education Council of Canada Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2011 SIECCAN, The Sex Information and Education Council of Canada ISSN: 1188-4517|
|Issue:||Date: Winter, 2011 Source Volume: 20 Source Issue: 4|
|Product:||Product Code: E198450 Immigrants; 8000147 Venereal Disease Prevention NAICS Code: 621999 All Other Miscellaneous Ambulatory Health Care Services|
|Geographic:||Geographic Scope: Canada Geographic Code: 1CANA Canada|
Abstract: This study explored the patterns of HIV and STI testing,
and factors associated with HIV testing in a convenience sample of 222
East and Southeast Asian men in Toronto recruited through a gay
bathhouse and a gay website. Approximately 75% of the respondents had
sex with a casual partner in the previous six months (with an average of
16.7 partners). Over 25% of the respondents did not know their current
HIV status and 19.8% of the total sample reported at least one incident
of unprotected anal sex with a casual partner in the past six months.
Half of those who had not previously been tested for HIV or STIs cited
"I am at low risk for HIV and STI and don't need to be
tested" as the main reason for not testing. Factors such as STI
testing, history of seeking sex via bathhouses and the internet, having
a casual partner or partners, and having higher numbers of casual
partners in the past six months, were found to be associated with HIV
testing. HIV prevention strategies need to continue to promote regular
testing for HIV and STIs among Asian MSM. To increase testing,
prevention efforts need to be focused on developing culturally and
linguistically appropriate testing strategies that directly target
altering risk perception and continue to emphasize the benefit of early
testing. Testing strategies should aim to increase awareness of and
access to testing and offer different methods of testing (such as finger
prick HIV tests).
Since the 1970s, there has been a substantial growth in the number of East and Southeast Asian immigrants in Canada. Today they are the largest ethno-racial minority group in this country. In Toronto, over 16% of the 2.5 million residents are of East and Southeast Asian backgrounds (Statistics Canada, 2008). In the changing landscape of HIV and AIDS, reported HIV cases among people of East and Southeast Asian backgrounds in Toronto have also increased significantly, from 2.4% between 1980 and 2000 to 6.3% between 2001 and 2005. Men accounted for over 90% of these cases and the primary route of transmission was sexual contact between men. The recent Laboratory Enhancement Program data in the province of Ontario also confirmed that, from January 2009 to September 2010, approximately three quarters of the HIV infections among men of East and Southeast Asian backgrounds were via sexual contact between men (Remis & Liu, 2011).
Evidence from Canada and the U.S. suggests that H1V risk among Asian men is associated with high rates of unprotected anal intercourse among men who have sex with men (MSM). For instance, a study in Toronto found that only 53% of East and Southeast Asian MSM used condoms every time they engaged in sexual activity (Poon, Ho, & Wong, 2001). A similar study conducted in Vancouver reported that 24% of East and Southeast Asian MSM had unprotected receptive anal sex with ejaculation into their rectum with their primary sexual partners (Bhat, Yee, & Koo, 1994). U.S. studies also found comparable rates of unprotected anal sex among Asian and Pacific Islander MSM. For example, a recent study in San Francisco found that 18% of this population had engaged in unprotected anal intercourse during the past six months (Raymond & McFarland, 2009). Other U.S. studies have documented even higher rates of unprotected anal intercourse among Asian and Pacific Islander MSM, ranging from 27% to 38% during the previous three months (Choi, Coates, Catania, Lew, & Chow, 1995; Choi, Han, Hudes, & Kegeles, 2002; Choi et al., 1996; Do, Hudes, Proctor, Han, & Choi, 2006; Flores, Bakeman, Millett, & Peterson, 2009; Lai, 1999).
At the same time, research data show low rates of HIV testing among Asian MSM. A recent study, conducted in Toronto and Ottawa, reported that South and Southeast Asian MSM had the lowest rate of HIV testing (78%) among all ethnic groups (Myers et al., 2011). Prior Canadian studies have also recorded even lower rates of HIV testing (65%-69%) among East and Southeast Asian MSM (Bhat et al., 1994; Poon et al., 2001). Studies conducted in Australia and the United States showed similar rates of HIV testing in this population, ranging from 62% to 81% (Boldero, Sanitioso, & Brain, 1999; Choi, Salazar, Lew, & Coates, 1995; Do et al., 2005, 2006; Mayne, Weatherburn, Hickson, & Hartley, 1999; Multicultural HIV/AIDS Education and Support Services, 1996).
Despite comparatively lower rates of reported HIV cases among Asian MSM, there is evidence to suggest that HIV is a significant issue of concern in this population. Previous studies in the United States have shown high rates of opportunistic infection at the time of HIV diagnosis among Asians and Pacific Islanders (Adih, Campsmith, Williams, Hardnett, & Hughes, 2011; New York City Department of Health, 2000; Wong, Campsmith, Nakamura, Crepaz, & Begley, 2004). A recent study, based on surveillance data from 33 states and 4 independent areas during 2001-2008, found that 33% of HIV diagnoses among Asians and Pacific Islanders progressed to AIDS within 12 months (Adih et al., 2011). In another study, 44% of Asian and Pacific Islanders were already infected with AIDS-related disease at the time of diagnosis (New York City Department of Health, 2000). These findings suggest that many Asians and Pacific Islanders do not seek early testing, which leads to delayed diagnosis and treatment, and subsequently poor prognosis. Early testing is thus essential not only for HIV prevention but also for optimal health outcomes in persons living with HIV. However, little is known about HIV testing behaviours among East and Southeast Asian MSM in Canada. The purpose of this study was to explore HIV and sexually transmitted infection (STI) testing behaviours, reasons for not testing, and correlates of HIV testing in a sample of East and Southeast Asian MSM in Toronto.
From 2006 to 2007 a convenience sample of respondents (n = 222) was recruited via a gay bathhouse and a gay website (gay.com) frequented by East and Southeast Asian MSM in Toronto. In Phase One of the study, we hired six East and Southeast Asian peer research assistants to help recruit participants in the bathhouse. They approached each potential participant individually, explained the purpose and methodology of the study, and invited him to participate in the study (see Poon, Wong, Sutdhibhasilp, Ho & Wong  for further information regarding the recruitment). In Phase Two of the study, we posted an advertisement in gay.com with a brief explanation of the purpose and methodology of the study, and contact information. When we were contacted, we further explained our study, answered questions regarding the research and arranged an interview in our office. Inclusion criteria for participants were: male, 18 years of age or older, of East or Southeast Asian background, and MSM. Ethics approval for the study was obtained from the Institutional Review Board at McMaster University. Each participant provided informed consent, completed a face-to-face interview using a questionnaire, and received a $20 honorarium.
The survey consisted of four demographic questions on ethnicity, age, sexual orientation, and education. In addition, we asked questions regarding sexual partnerships, sexual behaviours, and HIV and STI testing history. For sexual partnerships, we asked participants whether they currently had a regular partner (defined as a sex partner, a boyfriend or a lover) and whether they had a casual partner or casual partners (defined as a one-night stand) in the past six months. For sexual behaviours, we asked whether they had sought sex via bathhouses and/or the internet, the number of casual partners they had, and whether they had engaged in unprotected oral sex and/or anal intercourse with a casual partner in the past six months.
For HIV testing history, we asked each participant if he had ever been tested for HIV. If the answer was yes, we followed up by asking the time of his last HIV test, and the test result. If the answer was no, we asked each participant to select from a list of concerns he had about HIV testing. For STI testing history, we asked each participant if he had ever been tested for STIs, whether he had any previous diagnosis of STIs and if so, how many and what types of STIs he had. We also asked each participant to select from a list of seven reasons for not getting tested.
In addition to descriptive analysis, bivariate associations between HIV testing and ten variables were assessed via chi-square employing p-values. They included ethnicity, age, sexual orientation, education, history of STI testing, currently having a regular partner, history of seeking men for sex via bathhouses and/or the internet in the last six months, having engaged in casual sex in the past six months, numbers of casual partners in the previous six months, and unprotected anal sex with a casual partner in the past six months. However, chi-square tests were not suitable when the number of observations was smaller than five. In this case Fisher's exact tests were performed (Witte & Witte, 2000).
Table 1 presents the demographic characteristics of the participants. As shown, most of the 222 respondents self-identified as either Chinese (61.3%) or Filipino (21.2%). The remaining 17.6% included MSM of Indonesian, Japanese, Korean, Malaysian, Taiwanese, Thai and Vietnamese backgrounds. The youngest respondent was 18 years of age and the oldest 53 with a mean age of 30.9. Approximately 65% of the respondents were under the age of 35, with 9.1% under the age of 21 and 41.2% between the ages of 21 and 30. Approximately, 10% were 41 years old or above. Most respondents (85.1%) identified themselves as gay or homosexual while the remaining respondents self-identified as bisexual (13.1%) or others (1.8%) such as MSM and queer. The majority of the respondents (78.4%) had some post-secondary education or above.
Forty (18%) of the participants reported currently having a regular male sex partner or partners but having no casual partners in the last six months; in contrast, 41.9% of the participants reported having only casual partners in the last six months. Approximately one third of the participants (32.9%) indicated that they had both. Among participants who reported having casual partners, the average number of casual partners in the last six months was 16.7 ranging from 1 to 180. In terms of condom use during oral sex with casual partners, 72.9% of the participants reported no condom use in the past six months while 13.2% reported occasional use of condoms. Furthermore, 44 participants (19.8% of the total study sample) reported having engaged in at least one incident of unprotected anal sex with a casual partner in the past six months.
Of the 222 respondents, 75.2% (n = 167) indicated that they had been tested for HIV (Table 2). Among those who had previously been tested, the majority (83.9%) were tested two years prior to our survey. Only five respondents reported being HIV positive. Sixty-one (27.5%) indicated that they had never been tested for HIV or did not know their current HIV status. This is particularly concerning since 13 of these men reported unprotected anal sex with casual partners in the past six months and 14 indicated they had had an STI. Of these 61 participants, close to two-thirds (65.6%) also reported that they had engaged in sex with casual partners in the last six months; their number of casual partners ranged from 1 to 48 with an average of 8.1 partners.
Among those who had never been tested for HIV, the most frequently cited reason for not getting tested were "I am at low risk and don't need to be tested" (49.1%), followed by "Don't want to know the results" (16.4%), "don't know where to get tested" (12.7%) and "fear of stigma or discrimination" (12.7%).
As indicated in Table 3, only 57.2% (n = 127) of the 222 respondents had previously been tested for STI. Approximately 15% (n = 33) reported previous diagnoses with STI. Of these men, 12.1% reported having been infected twice, while another 12.1% reported having been infected four times. Chlamydia (45.5%) was the most common infection, followed by Gonorrhea (33.3%) and Syphilis (18.2%). Three of these men were HIV positive.
Similar to HIV testing, when participants were asked of their reasons for not testing, over half of those who had never been tested for STIs cited: "I am at low risk and don't need to be tested" as the key reason. This finding was surprising because a majority of this group (64.2%) had had casual sex in the previous six months, with an average of 14.4 partners (ranging from 1 to 48). In addition, the majority of them reported that they never (73.8%) or only occasionally (13.1%) used condoms during oral sex with their casual partners in the last six months. The second most commonly cited reasons were: "don't want to know the results" (15.8%) and "don't know where to get tested" (15.8%), followed by "fear of stigma or discrimination" (10.5%).
Bivariate associations of different variables with HIV testing
Four of the ten variables tested were found to be associated with HIV testing: history of STI testing, seeking men for sex via bathhouse and/or internet, casual sex with a male partner, and greater numbers of casual partners in the previous six months (see Table 4). As shown, those who had previously been tested for STIs were also more likely to have been tested for HIV than those never tested for STIs ([x.sup.2] = 64.0183, df = 1, p = <0.0001). In addition, those who sought men for sex via bathhouse and/or internet ([x.sup.2] = 7.5150, df = 1, p = <0.05) and those who had engaged in casual sex in the last six months ([x.sup.2] = 6.5071, df = 1, p = <0.05) were more likely to have had a prior HIV test. Those with greater numbers of casual partners in the previous six months were more likely to have been tested for HIV than those with fewer numbers of casual partners (p = <0.0001). However, unprotected anal sex with a casual male partner in the past six months was not found to be independently associated with prior HIV testing.
The present research is the first and largest study ever conducted in Canada to explore issues and behaviours regarding HIV and STI testing among East and Southeast Asian MSM. In particular, it sought to document HIV and STI testing history, reasons for not testing, and correlates of HIV testing in a sample of East and Southeast Asian MSM living in Toronto. Approximately 75% of East and Southeast Asian MSM who participated in our study have previously been tested for HIV, with a relatively small infection rate of 2.5%. However, one in four of the participants did not know or were unsure of their current HIV status. Yet, many of these men had multiple casual sexual partners (with an average of 8.1 partners in the past six months) and a sizeable number of them had a history of STIs and unprotected anal sex in the past six months. These findings suggested that these men, who were not aware of their current HIV status, were at high risk for HIV infection.
In this study, only 57% of East and Southeast Asian MSM had previously been tested for STIs. The diagnosis rate for STIs (14.9%) was slightly lower than the diagnosis rate in Asian and Pacific Islander MSM in San Francisco (16.8%) (Do et al., 2005). However, many of the East and Southeast Asian MSM (74.8%) who participated in this study had casual sex, with an average of 16.7 partners in the past six months. Few reported using condoms for oral sex which suggests that STI transmission through oral sex was not a common concern for these men. A San Francisco study reported that rectal gonorrhea continues to rise among Asian and Pacific Islander MSM--from below 400 per 100,000 in 1999 to approximately 1,600 per 100,000 in 2005 (Raymond et al., 2007). Given that STI facilitates HIV transmission and increases the risk of HIV infection (D'Adesky, 1999; Wasserheit, 1992) it is important to provide information about STI transmission and prevention to encourage regular STI testing as part of an overall prevention program for East and Southeast Asian MSM. The Public Health Agency of Canada suggests that sexually active MSM should test for STIs and HIV regularly (Public Health Agency of Canada, 2008). Similarly, the Centers for Disease Control and Prevention in the U.S., urges sexually active MSM to test for STIs and HIV annually, and every 3-6 months if they report multiple risk factors (such as multiple sexual partners and unprotected anal and oral sex) for infection (Centers for Disease Control and Prevention, 2010).
In our study, the most commonly cited reasons for not testing previously for both HIV and STIs were perception of low risk, fear of HIV or STI diagnosis, and concerns of stigma and discrimination. Consistent with previous studies (Do et al., 2006; Huang, Wong, De Leon, & Park, 2008; Poon et al., 2001; Yoshikawa et al., 2003), these findings reflected the major barriers for not testing among East and Southeast Asian MSM. In Canada and the U.S., Asian people are often defined by others as the model minorities. This stereotype may have led many East and Southeast Asian MSM to deny their risk for HIV infection or STI transmission and reinforced their fear of stigma and discrimination. However, as previously argued, early testing and diagnosis is critical in this population. Thus, HIV/STI prevention efforts must consider the socio-cultural contexts of the sexual practices of Asian MSM in order to develop culturally inclusive and linguistically appropriate programs that alter their risk perceptions. It is also important to highlight the health benefits of routine and regular testing, including the benefits of early diagnosis and treatment of HIV in terms of prognosis and health outcomes (Adih et al., 2011).
Another reason given by the participants for not being tested for HIV and STI was that they did not know where to get tested. This findings is consistent with previous research indicating that knowing a comfortable place to undergo HIV testing increases the likelihood of testing (Do et al., 2006) while stigma decreases both the likelihood of STI testing and perception of STI risk (Fortenberry, 2004). Prevention programs need to include increasing the awareness of testing sites (Poon et al., 2001) and the availability of inclusive services that reduce social stigma and increase social support (Do et al., 2005). Culturally and linguistically appropriate counseling and information about testing may further facilitate the increase of HIV and STI testing among East and Southeast Asian MSM (Poon et al., 2011). Furthermore, it is important to offer different testing methods such as urine tests for chlamydia and oral swab HIV tests for those with a fear of needles (Do et al., 2006). Given that there is a strong association between HIV testing and STI testing, as found both in previous research (Do et al., 2005; Huang et al., 2008) and in the present study, it appears to be beneficial to develop specific campaigns that promote HIV and STI testing simultaneously.
Consistent with previous research (Do et al., 2005, 2006; Huang et al., 2008), ethnicity, age and education were not found to be associated with HIV testing. Gay identification was also found to be an insignificant factor in our study. This finding, however, is contrary to other studies of HIV testing (Do et al., 2005, 2006) and may be due to the large proportion of the participants (over 85%) self-identifying as gay in this study. Similarly, a recent study found an association between having had sex with a primary male partner and recent testing, suggesting that some men entering primary relationships might undergo testing as part of a discussion of HIV risk with their partner (Do et al., 2006). Our findings did not confirm such an association. The difference may be explained by our definition of a regular partner as a sex partner, a boyfriend or a lover, which some participants may not necessarily consider a primary relationship.
The relationship between sexual risk behaviours and HIV testing was also assessed through four variables in this study. Having sought men for sex via bathhouse and/or the internet, having had casual sex, and greater number of casual partners in the past six months were all found to be associated with previous HIV testing. Consistent with previous studies (Do et al., 2005, 2006) this finding suggested that East and Southeast Asian MSM who engaged in these sexual behaviours were aware of the potential risk of having multiple casual partners and therefore sought testing. However, our study did not find an association between testing and unprotected anal intercourse with a casual partner in the past six months. There were several possible explanations for this lack of association. As shown elsewhere (Do et al., 2005)and in the present study, among East and Southeast Asian MSM, fear of testing results was cited as one of the major reasons for not ever getting tested. Those who had engaged in unprotected anal sex with a casual partner might find it difficult to face the potential positive test result. In addition, using prior (lifetime) testing to assess the association, there was a relatively high proportion of testing in both groups. Regardless of the reasons, it is important to urge sexually active East and Southeast Asian MSM who engage in unprotected sex with causal partners to have routine and periodic testing for HIV.
Limitations and concluding observations
This study has several limitations. The study sample of East and Southeast Asian men primarily drew from two gay-identified venues within one Canadian city. The sample size is relatively small. Participants in this study also tended to be well educated and younger than 40 years-old. These factors may limit the generalizability of our findings for all East and Southeast Asian MSM. Furthermore, we relied on the participants to self-report testing and sexual behaviours. As sex is considered a sensitive subject in many Asian communities, participants may have been hesitant to fully disclose their sexual behaviour for fear of stigmatization or in order to be perceived as having socially acceptable behaviours (Poon & Ho 2002; Poon, Ho, Wong, Wong, & Lee, 2005). Further studies are needed to validate these findings in other Canadian cities and to examine potential differences between sub-populations based on different ethnicities, age, class and education levels.
At the end of 2008, it was estimated that 65,000 people were living with HIV or AIDS in Canada. Furthermore, approximately 16,900 (26%) of these people were not aware of their infection (Public Health Agency of Canada, 2010). Research evidence shows that early and regular testing, particularly among populations at increased risk of HIV and STI transmission, is an important public health measure because it reduces transmission among people unaware of their HIV and STI status (Do et al., 2006). Research also shows that people diagnosed with HIV are more likely to reduce risk behaviour that transmits the virus (Adih et al., 2011). Furthermore, early and regular testing also facilitates early HIV treatment and care critical to the prognosis and health outcomes of people living with HIV.
Early and regular testing is an important HIV prevention strategy in the Asian MSM communities. Our study showed that a substantial number of participants engaged in unprotected sex with casual partners and were, therefore, at increased risk of STIs and HIV infection. Furthermore, previous studies in the U.S. found high rates of opportunistic infection at the time of HIV diagnosis, and high rates of progression to AIDS within 12 months of an HIV diagnosis among Asian and Pacific Islander MSM. These findings indicate that HIV and STI prevention efforts in the Asian MSM communities must emphasize the benefits of early and regular testing, address stigma and discrimination, and promote access to inclusive HIV prevention, testing, treatment and care. In addition, prevention efforts that increase awareness of testing sites, and access to different testing methods (such as rapid finger prick HIV tests) may further encourage Asian MSM to regularly test for HIV and STIs.
Acknowledgements: This project is funded by the Community-Linked Evaluation AIDS Resource Unit at McMaster University. The authors would also like to thank Gina Browne, Rose Sokolowski, and Maria Wong for their assistance in conducting this project. An earlier version of this article was presented at the International Conference on Global Health and Public Health Education, Hong Kong, October 25-27, 2011.
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Maurice Kwong-Lai Poon (1,3), Josephine Pui-Hing Wong (2,3), Noulmook Sutdhibhasilp (3), Peter Trung-Thu Ho (3,4), and Bernard Wong (5)
(1) School of Social Work, York University, Toronto, ON
(2) Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
(3) Asian Community AIDS Services, Toronto, ON
(4) Regent Park Community Health Centre, Toronto, ON
(5) Department of Mathematics, University of Toronto, Toronto. ON
Correspondence concerning this article should be addressed to Maurice Kwong-Lai Poon, School of Social Work, York University, 4700 Keele St., Toronto, ON M3J 1P3. E-mail: email@example.com
Table 1 Demographic characteristics of survey participants (n = 222) Ethnicity Chinese 136 (61.3%) Filipino 47 (21.2%) Vietnamese 18 (8.1%) Others (Indonesian, 21 (9.5%) Japanese, Korean, Thai) Sexual identity Heterosexual 0 Homosexual 189 (85.1%) Bisexual 29 (13.1%) Others 4 (1.8%) Age 18-20 20 (9%) 21-30 91 (41%) 31-40 88 (39.6%) 41 and up 22 (9.9%) Not Stated 1 (0.5%) Education High school 48 (21.6%) Some college/university 39 (17.6%) College graduate 34 (15.3%) University graduate 95 (42.8%) Post graduate education 6 (2.7%) Relationship status Currently having a regular 40 (18%) male partner but no casual partner in the past 6 months Having only casual 93 (41.9%) partners in the last 6 months Both 73 (32.9%) Neither 16 (7.2%) Table 2 Participants' HIV testing status * Ever had an HIV test (n = 222) Yes 167 (75.2%) No 55 (24.8%) Last HIV test (n = 167) Less than 6 months ago 62 (37.1%) 7-12 months ago 42 (25.2%) 1-2 years ago 36 (21.6%) 2-4 years ago 19 (11.4%) More than 4 years ago 8 (4.8%) HIV status (n = 167) Positive 5 (3%) Negative 156 (93.4%) Unknown 6 (3.6%) Reasons for not getting tested (n = 55) (+) I am at low risk and don't need to 27 (49.1%) be tested Don't want to know the results 9 (16.4%) Don't know where to get tested 7 (12.7%) Fear of stigma or discrimination 7 (12.7%) Don't want government to know 5 (9.1%) Fear of needle 4 (7.3%) Cost 1 (1.8%) * Due to rounding, proportions may not sum to 100 per cent. (+) Respondents were asked to check all that apply Table 3 Participants' STI testing status * Ever had a STI test (n = 222) Yes 127 (57.2%) No 95 (42.8%) Prior STI diagnosis (n = 222) Yes 33 (14.9%) No 189 (85.1%) Numbers of STI infection (n = 33) One 25 (75.8%) Two 4 (12.1%) Three 0 Four 4 (12.1%) Type of STI (n = 33) Chlamydia 15 (45.5%) Gonorrhoea 11 (33.3%) Syphilis 6 (18.2%) Genital herpes 3 (9.1%) Others 14 (42.4%) Reasons for not getting tested (n = 95) (+) I am at low risk and don't need to be tested 52 (54.7%) Don't want to know the results 15 (15.8%) Don't know where to get tested 15 (15.8%) Fear of stigma or discrimination 10 (10.5%) Fear of needle 8 (8.4%) Don't want government to know 6 (6.3%) Cost 2 (2.1%) * Due to rounding, proportions may not sum to 100 per cent. (+) Respondents were asked to check all that apply Table 4: Demographic characteristics and sexual risk behaviours by HIV testing * HIV Testing Yes No (p-value) Ethnicity (n = 222) ns Chinese 100 (73.5%) 36 (26.5%) Filipino 35 (74.5%) 12 (25.5%) Others 32 (82.1%) 7 (18%) Age (n = 221) ns Under 35 104 (72.2%) 40 (27.8%) 35 and above 63 (81.8%) 14 (18.2%) Sexuality orientation (n = 222) Gay/homosexuality 142 (75.1%) 47 (24.9%) ns Bisexuality and others 25 (75.8%) 8 (24.2%) Education (n = 222) ns High School 34 (70.8%) 14 (29.2%) Some post-secondary 133 (76.4%) 41 (23.6%) or above History of STI testing <0.0001 (n = 222) Yes 121 (95.3%) 6 (4.7%) No 46 (48.4%) 49 (51.6%) Currently has a regular ns partner (n = 222) Yes 88 (77.9%) 25 (22.1%) No 79 (72.5%) 30 (27.5%) History of seeking men for sex via bathhouses and/or the internet in the past 6 months <0.05 (n = 222) Yes 143 (79%) 38 (21%) No 24 (58.5%) 17 (41.5%) Casual sex in the past 6 <0.05 months (n = 222) Yes 132 (79.5%) 34 (20.5%) No 35 (62.5%) 21 (37.5%) Numbers of casual partners in the last 6 months (n = 198) <0.0001 0 to 5 86 (67.2%) 42 (32.8%) 6 to 25 36 (83.7%) 7 (16.3%) 26 or above 25 (92.6%) 2 (7.4%) Unprotected anal sex with a casual partner in the past 6 months (n = 222) ns Yes 35 (79.6%) 9 (20.5%) No 132 (74.2%) 46 (25.8%) * Due to rounding, proportions may not sum to 100 per cent.
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