HIV-Syphilis Co-infection Among MSM in Malaysia

Elizabeth DiDomizio, Yale School of Public Health


Background: Globally, nearly 6 million people are diagnosed with syphilis each year. Because syphilis can facilitate acquisition and transmission of HIV, the study of syphilis and HIV co-infections has been a focus of renewed interest, particularly among high-risk populations such as MSM. In Malaysia, data are limited for both syphilis and syphilis-HIV co-infection among MSM. Objective: The objective of the current study is to determine the prevalence of syphilis and HIV co-infection among MSM in Kuala Lumpur, Malaysia, and to examine the correlates that contribute to coinfection such as drug use, history of STIs, and sexual behaviors. Methods: Biological testing for HIV was performed on participants using rapid HIV Antigen/Antibody testing as well as a blood test for syphilis. A cross-sectional survey was also administered to assess lifetime and active substance abuse history, sexually transmitted infection history, sexual behaviors and practices, along with an assessment for depressive symptoms and history of physical/sexual abuse. Descriptive statistics characterized demographics and bivariate logistic regressions to examine potential correlates of co-infection. Between June-August 2018, a total of 220 MSM from Kuala Lumpur were recruited and consented to receive rapid HIV Antigen/Antibody testing and syphilis serology, as well as to undergo a structured, self-administered questionnaire about their socio-demographics, sexual and drug use risk behaviors, and previous HIV and STI testing history. Results: The study recruited and enrolled 250 participants. Syphilis prevalence in the sample population was 19.2% and HIV prevalence was 17.6%. The co-infection of HIV and syphilis was 7.6%. Lack of condom use increased the odds of HIV by 4.4 times compared to those who reported always using condoms. Rate of chem sex was 20% in this sample and among those with HIV it was 52.3%, with 6 times the odds of HIV when having engaged in chem sex.