title: High rates of unprotected anal intercourse with regular and casual partners and associated risk factors in a sample of ethnic Malay men who have sex with men (MSM) in Penang, Malaysia.
abstract: OBJECTIVE
  To assess the prevalence of unprotected anal intercourse (UAI) and its correlates among ethnic Malay men who have sex with men (MSM).
  
  
  METHODS
  In 2010, a convenience sample of 350 MSM in Penang were recruited to participate in an anonymous, computerised survey with rapid HIV testing. Participants who were not of Malay ethnicity (n=44) or who did not report sex with another man in the previous 12 months (n=22) were excluded, resulting in 284 participants in the final analysis. Correlates of UAI were examined separately for regular and casual partnerships using bivariate and multivariate logistic regression.
  
  
  RESULTS
  Four men (1.9%) tested HIV positive. In the past 12 months, 64.7% of participants had regular sexual partners, 77.1% had casual sexual partners and 41.9% had both. Most participants (83.1%) reported UAI, which was more common in regular partnerships. Over two-thirds of participants had never been tested for HIV. In multivariate analysis, agreement about sexual risk reduction practices was associated with a reduction in UAI with regular partners (adjusted OR (AOR)=0.14, 95% CI 0.05 to 0.40). Reporting difficulty in using condoms was associated with an increase in UAI with casual partners (AOR=9.07, 95% CI 3.35 to 24.5), and any exposure to HIV prevention was associated with a decrease in UAI with casual partners (AOR=0.22, 95% CI 0.09 to 0.54).
  
  
  CONCLUSIONS
  Despite highly prevalent HIV risk behaviours, HIV seropositivity and prior HIV testing were low. Increasing sexual negotiation skills and access to HIV testing and other prevention services may improve future prevention efforts.
authors.affiliation: Center of Excellence for Research in AIDS (CERiA), , Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Sin How
authors.initials: SH
authors.lastname: Lim
authors.forename: Alexander Reza
authors.initials: AR
authors.lastname: Bazazi
authors.forename: Clarence
authors.initials: C
authors.lastname: Sim
authors.forename: Martin
authors.initials: M
authors.lastname: Choo
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D017008:Negotiating / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners; D047568:Unsafe Sex / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*
keywords: HIV; Homosexuality; Prevention; Sexual Behaviour