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Human immunodeficiency virus infection in Mexico City. Rectal bleeding and anal warts as risk factors among men reporting sex with men.

Abstract：

:The objectives of this study were to evaluate the frequency and determinants of rectal bleeding and the association between rectal bleeding and risk of human immunodeficiency virus (HIV) infection among homosexual/ bisexual men in Mexico City. Men who requested anonymous HIV testing at a public clinic in Mexico City and who reported engaging in any homosexual behavior were eligible to participate in this study. Trained staff collected information on demographic factors, sexual behavior, psychological states, and HIV serostatus from all consenting, eligible clients. Logistic regression modeling was used to investigate the independent effect of risk factors among 2,758 men who were tested between June 1991 and December 1992. Bleeding during anal intercourse was a common occurrence: More than one third of the men in the study reported some bleeding, and 8% reported bleeding in half or more of their intercourse episodes. The prevalence of HIV infection among bleeders was 42% as compared with 28% in nonbleeders (p < 0.0001), and the adjusted odds ratio was 1.8 (95% confidence interval (CI) 1.1-2.8) for men who bled in more than half of their anal intercourse episodes relative to nonbleeders. There was a trend of increasing HIV seroprevalence with increasing frequency of rectal bleeding (p = 0.001). Nine percent of all HIV infections and 42% of infections among frequent bleeders were attributable to rectal bleeding. Men who reported both rectal bleeding and anal warts were 3.5 (95% CI 2.1-5.8) times more likely to be HIV-infected in multivariate analysis than men reporting neither rectal bleeding nor anal warts. Determinants of rectal bleeding included older age, more education, more receptive anal intercourse than insertive intercourse, receptive digital-anal contact, anal warts, and genital ulcers. Among men reporting sex with men in Mexico City, rectal bleeding is common. It is an independent risk factor for HIV infection, and warrants attention in acquired immunodeficiency syndrome prevention efforts. Rectal bleeding that results from rupture of anal warts may be an especially effective portal of HIV transmission. :During June 1991 to December 1992, 68.8% of all men who gave informed consent for HIV testing at a public health clinic in Mexico City and for participation in this study had ever had sexual intercourse with men. The final sample size was 2758 men. The study examined the reported frequency of rectal bleeding, the determinants of rectal bleeding, and the interactions between rectal bleeding and other risk factors with HIV infection among homosexual/bisexual men. It also aimed to determine whether rectal bleeding is an independent risk factor for HIV transmission. 32.8% had HIV infection. 39% reported some rectal bleeding during anal intercourse. 8% experienced rectal bleeding during at least 50% of intercourse episodes. Overall, bleeders were more likely to be HIV infected than nonbleeders (42% vs. 28%; p 0.0001; adjusted odds ratio [AOR] = 1.8 for men who bled in more than 50% of anal intercourse episodes; AOR = 1.3 for men who sometimes bled). The odds ratios increased as the frequency of reported rectal bleeding increased (p = 0.001). Condom use during receptive anal intercourse did not affect the association between rectal bleeding and HIV infection. 9% of all HIV infections were attributable to rectal bleeding. 42% of HIV infections among bleeders were attributable to rectal bleeding. In the multivariate analysis, men with both rectal bleeding and anal warts were more likely to have HIV infection than men who had neither (67.9% vs. 27.2%; AOR = 3.5). Significant predictors of rectal bleeding were older age (i.e., =or 30) (AOR = 1.5), more education (AOR = 1.4-1.5), more receptive anal intercourse than insertive intercourse (AOR = 5.3-16.1), receptive digital-anal contact (AOR = 1.6), anal warts (AOR = 1.9), and genital ulcers (AOR = 2). These findings show that rectal bleeding is an independent risk factor for HIV infection. Rupture of anal warts is an especially effective portal of HIV transmission.

journal_name

Am J Epidemiol

journal_title

American journal of epidemiology

authors

Coplan PM,Gortmaker S,Hernandez-Avila M,Spiegelman D,Uribe-Zuñiga P,Mueller NE

doi

10.1093/oxfordjournals.aje.a009016

subject

Has Abstract

pub_date

1996-11-01 00:00:00

pages

817-27

issue

eissn

0002-9262

issn

1476-6256

journal_volume

144

pub_type

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Human immunodeficiency virus infection in Mexico City. Rectal bleeding and anal warts as risk factors among men reporting sex with men.