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  1. Lim SH, Guadamuz TE, Wei C, Chan R, Koe S
    AIDS Behav, 2012 Oct;16(7):1979-87.
    PMID: 22714116
    We examined socio-demographic and behavioral characteristics of men who have sex with men (MSM) residing in Asia and correlates of unprotected receptive intercourse with Internet ejaculation (URAIE). Asia Internet MSM Sex Survey, a behavioral survey of MSM in Asia was conducted from 1 January to 28 February 2010. Data analysis was limited to participants aged 18 or above, biological male, and had one regular or casual sex partner in the past 6 months (n = 10,413). Pearson's Chi-square test, t test and logistic regression were used to examine the correlates of URAIE in the past 6 months, the highest risk sexual behavior sampled. Of 7311 participants who had receptive anal intercourse, 47.5 % had URAIE, which was associated with the following attributes: less than high-school education and pre-college education compared to university (AOR = 1.53, 95 % CI: 1.28, 1.83; AOR = 1.22, CI: 1.08, 1.37), being in the heterosexual marriage (AOR = 1.35, CI: 1.18, 1.56), having regular partners or both regular and casual partners compared to having casual partners (AOR = 2.85, CI: 2.48, 3.27; AOR = 2.32, CI: 2.06, 2.62), HIV-positive compared to HIV-negative status (AOR = 1.39, 95 % CI: 1.08, 1.81), higher perception of HIV risk (AOR = 1.62, CI: 1.34, 1.95), use of recreational drug before sex (AOR = 1.30, CI: 1.14, 1.49), and use of the Internet as the main way to seek sex partners (AOR = 1.21, CI: 1.08, 1.36). MSM from certain Asian countries reported alarming rates of URAIE. The internet can be used as a platform for HIV surveillance and intervention.
    Matched MeSH terms: Unsafe Sex/psychology; Unsafe Sex/statistics & numerical data*
  2. Lim SH, Bazazi AR, Sim C, Choo M, Altice FL, Kamarulzaman A
    Sex Transm Infect, 2013 Dec;89(8):642-9.
    PMID: 23787168 DOI: 10.1136/sextrans-2012-050995
    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.
    KEYWORDS: HIV; Homosexuality; Prevention; Sexual Behaviour
    Matched MeSH terms: Unsafe Sex/prevention & control; Unsafe Sex/psychology; Unsafe Sex/statistics & numerical data*
  3. Tan RKJ, Wong CM, Chen MI, Chan YY, Bin Ibrahim MA, Lim OZ, et al.
    Int J Drug Policy, 2018 11;61:31-37.
    PMID: 30388567 DOI: 10.1016/j.drugpo.2018.10.002
    BACKGROUND: Sexualised substance use, or 'chemsex' has been shown to be a major factor driving the syndemic of HIV/AIDS in communities of gay, bisexual, and other men who have sex with men (GBMSM) around the world. However, there is a paucity of research on chemsex among GBMSM in Singapore due to punitive drug laws and the criminalisation of sexual behaviour between men. This qualitative descriptive study is the first to explore perceptions towards, motivators to engaging in, and the barriers to addressing the harms associated with chemsex among GBMSM in Singapore.

    METHODS: We conducted 30 semi-structured in-depth interviews with self-identifying GBMSM between the ages of 18-39 in Singapore following a purposive sampling strategy. Interview topics included participants' perceptions of drug use among GBMSM in Singapore, perceptions towards chemsex, reasons for drug use and chemsex, and recommendations to address the harms associated with chemsex in Singapore. Interviews were audio-recorded, transcribed, coded, and analysed using thematic analysis.

    RESULTS: Participants reported that it was common to encounter chemsex among GBMSM in Singapore as it could be easily accessed or initiated using social networking phone apps. Enhancement and prolongation of sexual experiences, fear of rejection from sexual partners and peers, and its use as a means of coping with societal rejection were three main reasons cited for engaging in chemsex. The impact of punitive drug laws on disclosure and stigmatisation of GBMSM who use drugs were reported to be key barriers towards addressing chemsex. Participants suggested using gay-specific commercial venues as avenues for awareness and educational campaigns, and social media to reach out to younger GBMSM.

    CONCLUSIONS: This study highlights the complexities behind chemsex use among GBMSM in Singapore, and the range of individual to institutional factors to be addressed. We recommend that community-based organisations and policy-makers find ways to destigmatise discussion of chemsex and provide safe spaces to seek help for drug use.

    Matched MeSH terms: Unsafe Sex/drug effects; Unsafe Sex/psychology; Unsafe Sex/statistics & numerical data
  4. Wang M, Lim SH, Gibson BA, Azwa I, Guadamuz TE, Altice FL, et al.
    Int J STD AIDS, 2021 06;32(7):609-619.
    PMID: 33752518 DOI: 10.1177/0956462420970417
    Globally, cisgender women sex workers (CWSWs) and transgender women sex workers (TWSWs) experience increased vulnerabilities to HIV infection. Unfortunately, there is limited data on the drivers of HIV infection in these two understudied populations, particularly in Southeast Asia. To better understand factors associated with HIV infection, we evaluated correlates of newly diagnosed HIV infection in these two populations in Greater Kuala Lumpur, Malaysia. A total of 469 women (CWSW: n = 283; TWSW: n = 186) were included in this study. Most participants who tested HIV+ were unaware of their infection (59.6%; n = 34/57). Separate binary and multivariable logistic regressions were conducted to identify correlates of newly diagnosed HIV in CWSWs and TWSWs. Among CWSWs, Chlamydia trachomatis (aOR = 5.66; p = 0.007) and lifetime use of ecstasy/MDMA (aOR = 5.34; p = 0.03) were associated with newly diagnosed HIV, while condomless vaginal sex with clients was associated with lower likelihood of HIV infection (aOR = 0.98; p = 0.01). Among TWSWs, being single (aOR = 6.76; p = 0.03), using mobile application to solicit clients (aOR = 25.33; p = 0.006), and having C. trachomatis infection (aOR = 88.22, p = 0.02) were associated with newly diagnosed HIV. Expansion of HIV/sexually transmitted infection screening is needed to increase detection of HIV and linkage to care for sex workers. Interventions to reduce HIV infection among CWSWs and TWSWs should be tailored to these populations' unique vulnerabilities.
    Matched MeSH terms: Unsafe Sex
  5. Najwa Afiqa R, Aizan Sofia A, Haikal Anuar A
    The HIV positive cases in Malaysia and the world are increasing from day to day among individuals of all races and ages. However, the issue of social support for HIV positive patients still needs to be discussed in detail as this issue will have an impact on the lives of HIV positive patients in Malaysia. The focus of this study is to examine social support among HIV positive people in Malaysia. This study used a full qualitative method to collect and analyze data. Five male informants with HIV positive were involved in this study. All informants were interviewed separately using semi structured interview methods. Among the topics discussed in this study were family acceptance, the type of social support they received and the social support resources. The findings showed that, four out of five informants were infected with the HIV viruses from sharing needle and one informant was infected from unprotected sex. The results showed that they received adequate social support in terms of emotions, information, instrumental and networking from various sources. Nevertheless, social support for HIV positive people in Malaysia still needs to be discussed and promoted to ensure their psychological well-being.
    Matched MeSH terms: Unsafe Sex
  6. Lee LK, Chen PC, Lee KK, Kaur J
    Singapore Med J, 2006 Jun;47(6):476-81.
    PMID: 16752015
    INTRODUCTION: Sexual intercourse among Malaysian adolescents is a major concern, especially with the worry of HIV/AIDS. This study was done to determine the prevalence of sexual intercourse among secondary school students aged 12 to 19 years in Negeri Sembilan, Malaysia.
    METHODS: This is a cross-sectional school survey conducted on 4,500 adolescent students based on a structured questionnaire. Data were collected using the self-administered questionnaire (translated version of the Youth Risk Behaviour Surveillance in Bahasa Malaysia).
    RESULTS: The study showed that 5.4 percent of the total sample were reported to have had sexual intercourse. The proportion among male students who had had sex was higher (8.3 percent) compared with female students (2.9 percent). The mean age at first sexual intercourse was 15 years. One percent of students reported that they had been pregnant or had made someone else pregnant. Adolescent sexual intercourse was significantly associated with (1) socio-demographical factors (age, gender); (2) environmental factors (staying with parents); and (3) substance use (alcohol use, cigarette smoking, drug use), even after adjustment for demographical factors. The survey showed that 20.8 percent of respondents had taken alcohol, 14.0 percent had smoked cigarettes, 2.5 percent had tried marijuana, 1.2 percent had tried ecstasy pills, 2.6 percent had tried glue sniffing, 0.7 percent had tried heroin, and 0.7 percent had intravenous drugs.
    CONCLUSION: Prevalence of sexual intercourse among Malaysian adolescents was relatively low compared to developed countries. However, certain groups of adolescents tend to be at higher risk of engaging in sexual intercourse. This problem should be addressed early by targeting these groups of high-risk adolescents.
    Matched MeSH terms: Unsafe Sex/ethnology; Unsafe Sex/psychology; Unsafe Sex/statistics & numerical data*
  7. Jin H, Friedman MR, Lim SH, Guadamuz TE, Wei C
    LGBT Health, 2016 Dec;3(6):465-471.
    PMID: 26982598
    PURPOSE: Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia.

    METHODS: The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred and seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included in this analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year.

    RESULTS: About half (48.6%) of the participants had been tested for HIV at least once within the past year, and 30.5% had never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested.

    CONCLUSION: While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed.

    Matched MeSH terms: Unsafe Sex/ethnology
  8. Vicknasingam B, Narayanan S, Navaratnam V
    AIDS Care, 2009 Aug;21(8):984-91.
    PMID: 20024754 DOI: 10.1080/09540120802657530
    Despite the growing HIV threat among injecting drug users (IDUs) in Malaysia, there is a dearth of information on their HIV risk behaviour. This study focused on identifying specific risk behaviours that distinguished HIV positive IDUs from those who were not. For the first time, data on IDUs not in treatment were obtained through a cross-sectional survey of 526 subjects recruited from five selected cities across peninsular Malaysia. A structured questionnaire and face-to-face interviews were utilised to collect detailed information on their drug use practices and sexual behaviours. On-site serological testing determined their HIV and hepatitis C status. The findings indicated that ethnic Malays, who are also Muslims, form the majority of IDUs not in treatment. Bivariate analysis identified six risk factors associated with HIV seropositivity: being 44 years or younger; not holding a regular job; initiating drug use at age 23 or younger; being a morphine user; sharing injecting equipment and having multiple-sex partners. However, only the last two remained significant in multivariate analysis. That sharing contaminated injecting equipment is a significant risk factor strongly justifies the widening of the pilot needle and syringe exchange programme initiated hesitantly in late 2005 as a reaction to the worsening HIV/AIDS situation. Condom use, though not independently significant, remains important because consistent and wider use could neutralise the second risk factor--having multiple-sex partners. The finding that injecting drug use is increasingly occurring in groups underscores the need for outreach programmes that emphasise safe injecting practices in group settings. In addition, counsellors should endeavour to convince drug users to enter treatment since being in treatment appears to reduce risk behaviours. Finally, conservative Muslim unease about harm reduction must be assuaged quickly since Malay Muslims form the majority of IDUs not in treatment.
    Matched MeSH terms: Unsafe Sex/psychology; Unsafe Sex/statistics & numerical data
  9. Stephen N, Gusen NJ, Kumzhi PR, Gaknung B, Auta DA, Bulndi LB, et al.
    Indian J Sex Transm Dis AIDS, 2018 03 26;41(1):73-82.
    PMID: 33062987 DOI: 10.4103/ijstd.IJSTD_102_17
    Background: Adolescence is a critical stage in human development. Most young people become sexually active during adolescence and are more likely to have multipartner and unprotected sex with high-risk behavior that predisposes them to sexually transmitted infections such as human immunodeficiency virus (HIV).

    Objectives: The objective of the study was to evaluate the effectiveness of a structured teaching programme on transmission and prevention of HIV/acquired immune deficiency syndrome (HIV/AIDS) among adolescent girls.

    Methods: An evaluative research approach was adopted, in which a preexperimental, one group pre- and post-test research design was used to evaluate the effectiveness of the structured teaching programme on transmission and prevention of HIV/AIDS among adolescent girls studying at Lowry Memorial High School, Bengaluru. A self-administered structured questionnaire was used for data collection. Data were presented in frequency tables and statistical graphs (bar charts) and analyzed using descriptive statistics (mean, standard deviation) and inferential statistical methods (Chi-square and paired "t"-tests) using SPSS version 21.

    Results: The findings of the study revealed that the mean percentage difference in the pre- and post-test knowledge scores was statistically significant at 5% level (P < 0.05). The overall mean post-test knowledge score of adolescent girls on transmission and prevention of HIV/AIDS was 88.83%. It is apparently higher compared to the pretest knowledge score, which was 67.67% with enhancement of 21.16%. This implies that the structured teaching programme was effective in gaining knowledge of adolescent girls regarding transmission and prevention of HIV/AIDS.

    Conclusion: Our study suggests that structured teaching programme enhanced the knowledge of the adolescent girls on transmission and prevention of HIV/AIDS. We, therefore, recommend that structured teaching programmes on transmission and prevention of HIV/AIDS should be encouraged among adolescents and youths to reduce the spread of HIV infection.

    Matched MeSH terms: Unsafe Sex
  10. Ng RX, Guadamuz TE, Akbar M, Kamarulzaman A, Lim SH
    Int J STD AIDS, 2020 05;31(6):568-578.
    PMID: 32299293 DOI: 10.1177/0956462420913444
    Matched MeSH terms: Unsafe Sex/psychology*
  11. Bachireddy C, Bazazi AR, Kavasery R, Govindasamy S, Kamarulzaman A, Altice FL
    Drug Alcohol Depend, 2011 Jul 1;116(1-3):151-7.
    PMID: 21232882 DOI: 10.1016/j.drugalcdep.2010.12.001
    Pre-incarceration HIV transmission behaviors and current attitudes toward opioid substitution therapy (OST) among HIV-infected male prisoners in Malaysia have important implications for secondary HIV prevention efforts.
    Matched MeSH terms: Unsafe Sex/prevention & control; Unsafe Sex/psychology
  12. Wickersham JA, Gibson BA, Bazazi AR, Pillai V, Pedersen CJ, Meyer JP, et al.
    Sex Transm Dis, 2017 11;44(11):663-670.
    PMID: 28708696 DOI: 10.1097/OLQ.0000000000000662
    BACKGROUND: Sex workers face a disproportionate burden of human immunodeficiency virus (HIV) and sexually transmitted infections (STI) worldwide. For cisgender women sex workers (CWSW), global HIV prevalence is over 10%, whereas transgender women sex workers (TWSW) face an HIV burden of 19% to 27%.

    METHODS: We used respondent-driven sampling to recruit 492 sex workers, including CWSW (n = 299) and TWSW (n = 193) in Greater Kuala Lumpur, Malaysia. Participants completed an in-depth survey and were screened for HIV, syphilis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Sample characteristics stratified by gender identity and interview site are presented. Bivariate analyses comparing CWSW and TWSW were conducted using independent samples t tests for continuous variables and χ tests for categorical variables.

    RESULTS: Pooled HIV prevalence was high (11.7%; 95% confidence interval [CI], 8.8-14.5), and was similar for CWSW (11.1%) and TWSW (12.4%). Rates of syphilis 25.5% (95% CI, 21.6-29.5), C. trachomatis (14.8%; 95% CI, 11.6-18.0) and N. gonorrhoeae (5.8%; 95% CI, 3.7-7.9) were also concerning. Both groups reported lifetime HIV testing (62.4%), but CWSW were less likely to have ever been HIV tested (54.5%) than TWSW (74.6%). Median time since last HIV test was 24 months. Previous screening for STI was low. Inconsistent condom use and drug use during sex work were not uncommon.

    CONCLUSIONS: High HIV and STI prevalence, coupled with infrequent HIV and STI screening, inconsistent condom use, and occupational drug use, underscore the need for expanded HIV and STI prevention, screening, and treatment efforts among CWSW and TWSW in Malaysia.
    Matched MeSH terms: Unsafe Sex/statistics & numerical data
  13. Kimmitt PT, Kirby A, Perera N, Nicholson KG, Schober PC, Rajakumar K, et al.
    J Travel Med, 2008;15(5):369-71.
    PMID: 19006515 DOI: 10.1111/j.1708-8305.2008.00240.x
    Sexually transmitted infections (STIs) are an increasingly common and important cause of a fever in a returning traveler. Systemic complications of STIs, human immunodeficiency virus seroconversion illness, and secondary syphilis are diagnoses that can easily be missed. We present a case of culture-negative disseminated gonococcal infection presenting with fever, malaise, polyarthralgia, arthritis, and a rash that developed following orogenital contact and was diagnosed using real-time polymerase chain reaction. This technology has major potential to improve the speed and sensitivity of diagnosis and consequent management of patients with this syndrome.
    Study site: United Kingdom (patient had recent travel to Thailand and Malaysia)
    Matched MeSH terms: Unsafe Sex
  14. Zain NM, Low WY, Othman S
    PMID: 26521527
    Pregnancy among unmarried women may have negative social and health implications in Malaysia. The number of pregnancies among unmarried women has increased in Malaysia, but the socio-demographic profile of these women is unclear. This study aims to evaluate the characteristics of unmarried pregnant women and the factors associated with unmarried pregnancies among young women in Malaysia. We conducted a cross sectional study at six hospitals and six women's shelters in Peninsular Malaysia during 2011-2012. Unmarried pregnant women were compared with married pregnant women. Participants were interviewed using a structured questionnaire asking for socio-demographic data, family background, risky sexual behavior, social support and pregnancy details. A total of 484 women (239 unmarried and 245 married) were included in the study. Most unmarried subjects were adolescents, from urban areas, from a low socioeconomic group, and lived with parents prior to pregnancy. Age (OR=0.67; 95% CI: 0.61-0.74), studying status (OR=17.33; 95% CI: 2.65-113.19), alcohol use (OR=40.46; 95% CI: 2.51-652.38) exposure to pornographic material (OR=13.48; 95% CI: 3.24-56.01), contraceptive use (OR=0.20; 95% CI: 0.08-0.51), and social support (OR=0.90; 95% CI: 0.86-0.94) were all associated with unmarried pregnancy. These factors need to be considered when.designing an intervention program.
    Matched MeSH terms: Unsafe Sex/statistics & numerical data
  15. Wong LP, Syuhada AR
    PMID: 22299438
    Globally, HIV/AIDS-related stigma and discriminatory attitudes deter the effectiveness of HIV prevention and care programs. This study investigated the general public's perceptions about HIV/AIDS-related stigma and discrimination towards people living with or affected by HIV/AIDS in order to understand the root of HIV/AIDS-related stigma and discriminatory attitudes. Study was carried out using qualitative focus group discussions (FGD). An interview guide with semi-structured questions was used. Participants were members of the public in Malaysia. Purposive sampling was adopted for recruitment of participants. A total 14 focus group discussions (n = 74) was carried out between March and July 2008. HIV/AIDS-related stigma and discrimination towards people living with HIV/AIDS (PLWHA) was profound. Key factors affecting discriminatory attitudes included high-risk taking behavior, individuals related to stigmatized identities, sources of HIV infection, stage of the disease, and relationship with an infected person. Other factors that influence attitudes toward PLWHA include ethnicity and urban-rural locality. Malay participants were less likely than other ethnic groups to perceive no stigmatization if their spouses were HIV positive. HIV/AIDS-related stigma and discrimination were stronger among participants in rural settings. The differences indicate attitudes toward PLWHA are influenced by cultural differences.
    Matched MeSH terms: Unsafe Sex
  16. Bórquez A, Rich K, Farrell M, Degenhardt L, McKetin R, Tran LT, et al.
    J Int AIDS Soc, 2020 Jun;23 Suppl 1(Suppl 1):e25495.
    PMID: 32562365 DOI: 10.1002/jia2.25495
    INTRODUCTION: Among men who have sex with men (MSM) and transgender women (TW), stimulant use is high and has been associated with an increased risk of HIV infection, suicide and cardiovascular disease (CVD) mortality. We used epidemic modelling to investigate these intersecting health harms among MSM/TW in Lima, Peru and assess whether they could be mitigated by prioritizing HIV pre-exposure prophylaxis (PrEP) and harm reduction interventions among MSM/TW who use stimulants.

    METHODS: We adapted a dynamic model of HIV transmission among MSM/TW in Lima to incorporate stimulant use and increased HIV risk, suicide and CVD mortality. Among 6% to 24% of MSM/TW using stimulants (mostly cocaine), we modelled an increased risk of unprotected anal sex (RR = 1.35 [95%CI: 1.17 to 1.57]) obtained from local data, and increased risk of suicide (SMR = 6.26 [95%CI: 2.84 to 13.80]) and CVD (SMR = 1.83 [95%CI: 0.39 to 8.57]) mortality associated with cocaine use based on a global systematic review. We estimated the proportion of health harms occurring among MSM/TW who use stimulants in the next year (01-2020/01-2021). We also investigated the 10-year impact (01-2020/01-2030) of: (1) PrEP prioritization for stimulant-using MSM/TW compared to random allocation, and (2) integrating PrEP with a theoretical intervention halving stimulant-associated risk.

    RESULTS: MSM/TW in Lima will experience high HIV incidence, suicide mortality and CVD mortality (1.6/100 py, and 0.018/100 py, 0.13/100 py respectively) in 2020. Despite stimulant using MSM/TW comprising an estimated 9.5% (95%CI: 7.8 to 11.5) of all MSM/TW, in the next year, 11% 95%CI (i.e. 2.5% to 97.5% percentile) 10% to 13%) of new HIV infections, 39% (95%CI: 18% to 60%) of suicides and 15% (95%CI: 3% to 44%) of CVD deaths could occur among this group. Scaling up PrEP among all stimulant using MSM/TW could prevent 19% (95%CI: 11% to 31%) more HIV infections over 10 years compared to random allocation. Integrating PrEP and an intervention to halve stimulant-associated risks could reduce new HIV infections by 20% (95%CI: 10% to 37%), suicide deaths by 14% (95%CI: 5% to 27%) and CVD deaths by 3% (95%CI: 0% to 16%) over a decade.

    CONCLUSIONS: MSM/TW who use stimulants experience a disproportionate burden of health harms. Prioritizing PrEP based on stimulant use, in addition to sexual behaviour/gender identity criteria, could increase its impact. Integrated substance use, harm reduction, mental health and HIV care among MSM/TW is needed.

    Matched MeSH terms: Unsafe Sex
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