title: Risk factors for HIV and unprotected anal intercourse among men who have sex with men (MSM) in Almaty, Kazakhstan.
abstract: BACKGROUND
  Men who have sex with men (MSM) are at high risk for HIV infection. MSM in Central Asia, however, are not adequately studied to assess their risk of HIV transmission.
  
  
  METHODS
  This study used respondent driven sampling methods to recruit 400 MSM in Almaty, the largest city in Kazakhstan, into a cross-sectional study. Participation involved a one-time interviewer-administered questionnaire and rapid HIV screening test. Prevalence data were adjusted for respondent network size and recruitment patterns. Multivariate logistic regression was used to investigate the association between HIV and selected risk factors, and unprotected anal intercourse (UAI) and selected risk factors.
  
  
  RESULTS
  After respondent driven sampling (RDS) weighted analysis, 20.2% of MSM were HIV-positive, and 69.0% had unprotected sex with at least one male partner in the last 12 months. Regression analysis showed that HIV infection was associated with unprotected receptive anal sex (AOR: 2.00; 95% CI: 1.04-3.84). Having unprotected anal intercourse with male partners, a measure of HIV risk behaviors, was associated with being single (AOR: 0.38; 95% CI: 0.23-0.64); very difficult access to lubricants (AOR: 11.08; 95% CI: 4.93-24.91); STI symptoms (AOR: 3.45; 95% CI: 1.42-8.40); transactional sex (AOR: 3.21; 95% CI: 1.66-6.22); and non-injection drug use (AOR: 3.10; 95% CI: 1.51-6.36).
  
  
  CONCLUSIONS
  This study found a high HIV prevalence among MSM in Almaty, and a population of MSM engaging in multiple high-risk behavior in Almaty. Greater access to HIV education and prevention interventions is needed to limit the HIV epidemic among MSM in Almaty.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States of America. mberry@jhsph.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Berry
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wirtz
authors.forename: Assel
authors.initials: A
authors.lastname: Janayeva
authors.forename: Valentina
authors.initials: V
authors.lastname: Ragoza
authors.forename: Assel
authors.initials: A
authors.lastname: Terlikbayeva
authors.forename: Bauyrzhan
authors.initials: B
authors.lastname: Amirov
authors.forename: Stefan
authors.initials: S
authors.lastname: Baral
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D007623:Kazakhstan / Q000453:epidemiology; D008297:Male; D012307:Risk Factors