Prevalence and correlates of alcohol tobacco and substances use among men who have sex with men in hanoi vietnam

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEA LTH HANOI MEDICAL VNB ERSITY NGUYEN THI HOANG HA PREVALENCE AND C ORRELATES OF ALCOHOL, TOBACCO, AND SUBSTANCE USE AMONG MEN WHO HAVE SEX WITH MEN IN HANOI, VIETNAM Major : Doctor of Preventive Medicine Code : D720302 THESIS OF GRADUATI ON MEDICAL DOCTOR COURSE 2015-2021 Supervisor: MD PhD Hoang ThiHai Van r-u -ÍM Qỉ ugc V Hl HANOI 2021 ACKNO WEED G EM ENT Throughout the writing of this graduation thesis I have received a great deal of support and assistance I would first like to express my gratitude and appreciation for my supervisor MD Ph D Hoang Thi Hai Van, who has given me dedicated support and insightful comments on my work I am extremely grateful for being under her guidance in this research, as well as other projects and for my career development I would like to acknowledge the Department of Global Health and Training Scientific management, and International Cooperation Department for their support throughout various stages of my thesis I would like to thank the School of Preventive Medicine and Public Health for giving me the chance to meet inspiring teachers and friends, and all the opportunities to comprehend the priceless value of my major Preventive medicine I would like to thank my friends who have been with me for the past years, gone through lots of ups and downs together, argued a lot vet still maintained our precious friendship They unexpectedly made my university life enjoyable and unforgettable Last but not least I for amdefinitely would like to express sincere thank support toWithout my family them for I their unconditional would notrole love bemy the and person I am today Thank mom being my greatest model r-u -ÍM Qỉ ugc V Hl ii CONFIRMATION To: - Management Board of Hanoi Medical University - Training Scientific management, and International Cooperation Department • School of Preventive Medicine and Public Health Hanoi Medical University • Department of Global Health Hanoi Medical University - Examination Committee for Graduation Thesis 2020-2021 I hereby declare that this research was originally done by myself The data handling and analysis were objectively completed with honesty The results of this study have not been published in any document Hanoi June 2021 Student Nguyen Thi Hoang Ha r-u -ÍM Qỉ ugc V Hl ãii TABLE OF CONTE NT ABBRE VI ATI ONLIST OF TABLES i _ iii LIST OF FIGURES 1.1.3 HIV 1.1.1 1.1 HIV situation in MSM worldwide and in Vietnam _4 1.2 2.1 1.3 iv 1.4 1.5 1.6 REFERE NCE 1.7 APPEND IX 1.8 1.10 OR 1.12 TS 1.14 a 1.16 V 1.18 BS 1.20 S 1.22 SM 1.24 HI SW 1.26 R 1.28 LHIV 1.9 ABBRE MATION A 1.11 1.13 Adjusted odds ratio Amphetamine-type stimulants CI 1.15 Confidence interval IB IB 1.17 1.19 Surveillance Human immunodeficiency virus Integrated Biologcial and Behavioral M 1.21 1.23 Internet Based Sampling Men who have sex with men M 1.25 Male sex workers O 1.27 Odds ratio 1.29 People living with HIX’ P 1.30 DS 1.32 TI 1.34 LS 1.36 HO R 1.31 Respondent Driven Sampling S 1.33 Sexual transmitted infections T 1.35 Time-Location (or time-space) sampling 1.37 World Health Organization W 1.38 LIST OF TABLES 1.39 1.40 r-u -ÍM Qỉ ugc V Hl 1.41 ãii 1.42 LIST OF FIGURES 1.43 1.44 r-u -ÍM Qỉ ugc V Hl 1.45 1.46 ABSTRACT Title: Prevalence and correlates of alcohol, tobacco, and substances use among men who have sex with men in Hanoi Vietnam 1.47 Objectives: The aim of this study was to describe the prevalence and correlates of tobacco, alcohol and ATS use among MSM in Hanoi Vietnam and relates issues to their use of substances 1.48 Methods: We used the baseline survey data collected by internet-based sampling method of the HIM Hanoi study to estimate prevalence and conelates of substances use among MSM in Hanoi The WHO ASSIST questionnaire was used to collect substance use data Descriptive statistics and logistics regression techniques were used for analysis 1.49 Results: The prevalence of lifetime tobacco, alcohol and ATS use was 19.08% S3.54%, 6.98% The prevalence of tobacco, alcohol and ATS use in the past months was 15.21%, 77 18% 11% Lifetime prevalence of other drug use ranged from 1.00% to 85% Age monthly income sexual orientation, group sex and drug use to enhance sex performance were correlated with the use of tobacco, alcohol ATS and other drugs in their life and in the past months 1.50 Conclusions: Substance use was prevalent in MSM in Hanoi Socio-demographic and sex-related characteristics were correlated with the consumption of substances These findings highlight that substance use harm reduction programs should be considered in MSM sexual health services 1.51 Keywords: alcohol, ATS, drug, substance, MSM,tobacco, H anoi, Vietnam r-u -ÍM Qỉ ugc V Hl 1.52 Tiêu đề: Tý lệ liên quan cua việc sư đụng rượu bia thuốc vã cãc chất gãy nghiện nhóm nam quan hộ tinh dục dồng giói Hã Nội Việt Nam 1.53 Mục tiêu: Nghiên cứu dược thực đẽ mò ta ty lộ vã liên quan cua việc sư dụng rượu bia thuốc IỊ vả cãc chắt gãy nghiện ỡ nhõm MSM Hà Nội Việt Nam vã vấn đề lién quan tới việc sứ dụng chất 1.54 Phương pháp nghiên cứu: Nghiên cữu sư dụng số liệu diều tra ban đầu bang phương pháp chọn mẫu trực tuyển cứa nghiên cứu IIIM Hanoi de ước tinh tý lệ sư dụng yếu tồ liên quan tới chất gảy nghiện nhóm MSM Há Nội Bộ càu hoi WHO ASSIST dưục Sừ dụng de thu thỹp thòng tin sư dụng chất gảy nghiện Phản tích kết qua thống kẻ mỏ tá vã hồi quy logistic 1.55 Ket nghiên cứu: Tỳ lộ sư dưng thuồc nrợu bia ATS đời lã 19.08% 83.54% 6.98% Tỳ lộ sư dụng thuốc nrợu bia vã ATS tháng gan dãy lã 15.21% 77.18% 5.11% Ty lộ dụng chắt gãy nghiện khác đời từ 1.00% tói 8.85% Tuỏi thu nhập hàng tháng, xu hướng tính dục quan hệ tinh dục tập thê sư dụng chất kich thích quan hệ tinh dục liên quan tội việc sư dựng chầt ỡ nhõm MSM Hà Nội 1.56 Kvt luận: Chất gảy nghiện dược sữ dụng phố biến nhõm MSM Hã Nội Các yếu tố nhãn khâu học vã yếu tố liên quan tới tinh đục lối sống liên quan vói việc sư dụng chất Những kết qua cho thấy chương tành giam thiều tãc hại cua sir dụng chầt gây nghiện cần dược cân nhấc dưa vào dịch vụ châm sõc sức khoé cho nhõm MSM 1.57 Tử MSM, khoa:Há thuốc rirọu nghiện, Nội,lá Việt Nam bia, ATS, chất gày 1.58 INTRODUCTION 1.59 HIX’ is now an epidemic that mainly targets on kev populations, one of which is men who have sex with men Severad studies have indicated the association of alcohol, tobacco and other substance use towards the risk of HIV infections in this population Problematic use of alcohol was associated with having a history of sexual coercion (OR=1 95%CI: 1.2-2.6)/ sexual violence (aOR=3.39 95%CI: 69-6 81)? receptive condomless sex (aOR = 1.07, 95%CI: 1-1.13) and insertive condomless sex (aOR=l.ll 95%CI: 1.04-1 IS) MSM that had alcohol use disorder were 2.14 times more likely to being unaware of their HIX' status (aOR=2 14 95%CI: 1.01-4.54)? A study conducted in Chinese MSM indicated that life time sexual risk behaviors were significantly correlated with drinking (Coef.=l 16) and smoking (Coef.=0.23) in the past months, and lifetime drug use (Coef.=l 04)? Another research in -ÍM Qỉ ugc V Hl China found similar results that -the use of alcohol and drug is associated with increasing HIX' risk by encouraging drinking before sex having unprotected sex with other men and having more sex partners A systematic review in Africa found that MSM who injected drugs were more likely to have inconsistent condom use have two and above sex partners, participate in group sex and acquire sexually transmitted infection 1.60 World Health Organization (WHO) reported an increase in alcohol consumption in Vietnam in the period of 2010 and 2016 and 25.1% of Vietnamese adult males were heavy episodic drinker in 2016 ■ 45.3% of adult males were cunent smokers, and 38.7% smoked daily?0 The presence of illicit drug use in Vietnamese MSM was 12.0%? ■ A study conducted in male sex workers indicated that prevalence of lifetime alcohol, tobacco, and cannabis use was 98.0% 797.7% and 28.0%, respectively 12 which was alarmingly higher than that of rhe general male population A qualitative study in 2011 revealed that some MSM used illicit drugs alone other MSM shared with friends during group sex or traded sex for drugs?' Among illicit drug used in MSM in Asia amphetamine-type stimulants (ATS) is becoming one of the most common used drug classes? In Vietnam UNODC reported high prevalence of different types of ATS in MSM (10.7- 81.5%).15 1.61 In Vietnam the prevalence of HIV among MSM has been increasing rapidly from 1.7% in 2005 to 2.4% in 2013 w and to 10.8% in 2018.l: MSM is among three key populations of HIV infections in Vietnam, and a primary target of the country's HIX’ response to end AIDS in 2030? Hanoi is the second largest city of MSM population in the country :s Therefore, in order to achieve this national goal, it is needed to better understand the situation of and factors related to tobacco, alcohol ATS and other drug use in this specific population in Hanoi Vietnam For that aim this study was conducted with two following objectives 1.62 To describe the prevalence of tobacco, alcohol ATS and other drug use among MSM in Hanoi Vietnam and related issues to theữ substance use 1.63 alcohoL ATS To describe and other the drug correlates use among ofMSM tobacco in Hanoi Vietnam 1.64 CHAPTER LITERATURE REVIEW 1.1 Concepts and definitions 1.65 1.1.1.Sex and gender 1.66 Sex refers to a person's biological status and is typically categorized as male, female or intersex There are a number of indicators of biological sex including sex -ÍM Qỉ ugc V Hl Cessation Among Men Who Have Sex with Men: New Orleans 2011 AIDS Behov 2O14:1S(3) 324-332 doi:10.1007/sl0461-013-0585-y 78 Lim SH Daghar L Bullen c et al Tobacco Use and Cessation Among a National Online Sample of Men Who Have Sex With Men in Malaysia Asia Pac J Public Health 2Q20.32(,S).4\4-4\1 doi.10.1 177 1010539520965370 79 Bitty-Anderson AM Gbeasor-Komlanvi FA Johnson p et al Prevalence and correlates of alcohol and tobacco use among key populations in Togo in 2017: a cross-sectional study B.VƯ Open 2019:9(11) doi:10.1136 bmjopen-2019- 028934 1.2598 soTobacco World Health Organization II7/O Report on the Global Epidemic, 200S.\ 2018 .Tin -u ■' JZ ECOND DRUG ETC)? 1.2812.1.2816 ■5 1.2818.1.2822 • 1.2813 zc Ỉ5 1.2810.1.2814.1.2817.1.2819.Jj 8Qc z 1.2823 1.2825 a Tobacco products (cigarettes, chewing 1.2826.1.2827.1.2828.1.2829 1.2830 tobacco, cigars, etc.) 1.2831 b Alcoholic beverages (beer wine, spirits, etc.) 1.2837 c Cannabis (marijuana, pot, grass, hash, etc.) 1.2843 d Cocaine (coke, crack, etc.) r-u -ÍM CỊỈ ugc V Hl 1.2832 1.2833 1.2838 1.2839 1.2844 1.2845 •> 1.2834.1.2835 1.2840.1.2841 1.2847.1.2848 1.2836 1.2842 1.2849 1.2850 e Amphetamine-type stimulants (speed, diet pills, ecstasy, etc.) 1.2856 f Inhalants (nitrous, glue, petrol, paint thinner, etc.) 1.2862 g Sedatives or Sleeping Pills (Valium, Serepax Rohypnol etc.) 1.2868 h Hallucinogens (LSD acid, mushroom, PC Special K etc.) 1.2874 i Opioids (heroin morphine, methadone codeine, etc.) 1.2880 j Other specify: 1.2886 1.2851.1.2852.1.2853.1.2854 1.2855 1.2857 1.2858 1.2859.1.2860 1.2861 1.2863 1.2864 1.2865.1.2866 1.2867 1.2869 1.2870 1.2871.1.2872 1.2873 1.2875 1.2876 1.2877.1.2878 1.2879 1.2881 1.2882 1.2883.1.2884 1.2885 1.2887 If “Never" to all items in Question 2, skip to Question 1.2888 If any substances in Question were used in the previous three months, continue with Question 3, & for each substance used 1.2889 Question 1.2890 During the past three months, how often have 1.2892 1.2900 v! o E 1.2901 < you had a strong desừe or urge to use (FIRST DRUG, s 1.2893 1.2902 k ECOND DRUG ETC)? 1.2897 1.2894 s 1.2891 1.2898.1.2899 * z 1.2895 1.2903 a Tobacco products (cigarettes, chewing 1.2904.1.2905.1.2906.1.2907 1.2908 tobacco, cigars, etc.) 1.2909 b Alcoholic beverages (beer wine, spirits, etc.) 1.2915 c Cannabis (marijuana, pot, grass, hash, etc.) 1.2921 d Cocaine (coke, crack, etc.) 1.2927 e Amphetamine-type stimulants (speed, diet pills, ecstasy, etc.) 1.2933 f Inhalants (nitrous, glue, petrol, paint thinner, etc.) r-u -ÍM CỊỈ ugc V Hl 1.2910.1.2911.1.2912.1.2913 1.2916.1.2917.1.2918 1.2919 1.2922.1.2923.1.2924 1.2925 1.2928.1.2929.1.2930.1.2931 1.2914 1.2920 1.2926 1.2932 1.2934 1.2935.1.2936.1.2937 1.2938 1.2947 Special KL etc.) 1.2953 i Opioids (heroin, morphine, methadone, codeine, etc.) 1.2959 j Other specify 1.2960. 1.2967 During the past three months, how often have your use of (FIRST DRUG SECOND DRUG ETC) led to health, social, legal or financial problems? 1.2975 a Tobacco products (cigarettes, chewing tobacco, cigars, etc.) 1.2981 b Alcoholic beverages (beer wine, spirits, etc.) 1.2987 c Cannabis (marijuana, pot grass, hash, etc.) 1.2993 d Cocaine (coke, crack, etc.) 1.2999 e Amphetamine-type stimulants (speed, diet pills, ecstasy, etc.) 1.3005 f Inhalants (nitrous, glue, petrol, paint thinner, etc.) 1.3011 g Sedatives or Sleepily Pills (Valium, Serepax Rohypnol, etc.) 1.3017 h Hallucinogens (LSD acid, mushroom, PC 1.3023 Special K etc.) 1.3029 i Opioids (heroin, morphine, methadone, codeine, etc.) 1.3035 j Other specify: 1.3041 1.2948.1.2949.1.2950.1.2951 1.2952 1.2954.1.2955.1.2956.1.2957 1.2958 1.2961.1.2963.1.2964.1.2965 1.2966 1.2973 • 1.2972 Weekly 1.2946 h Hallucinogens (LSD acid, mushroom, PC, 1.2971 Monthly 1.2940 Rohypnol, etc.) 1.2941.1.2942.1.2943.1.2944 1.2945 1.2970 Once or Tw ICC 1.2939 g Sedatives or Sleepily Pills (Valium Serepax, ugc V Hl 1.2968 b i 1.2969 5z 1.2976 1.2977.1.2978.1.2979.1.2980 s 1.2982.1.2983 1.2984.1.2985.1.2986 1.2988.1.2989 1.2990.1.2991.1.2992 1.2994.1.2995 1.2996.1.2997.1.2998 1.3000.1.3001 1.3002.1.3003.1.3004 1.3006.1.3007 1.3008.1.3009.1.3010 1.3012 1.3013.1.3014.1.3015 1.3016 1.3018.1.3019 1.3020.1.3021.1.3022 1.3024 1.3025 1.3026 1.3027 61.3028 1.3030.1.3031 1.3032.1.3033.1.3034 1.3036 1.3037.1.3038.1.3039 _L _1_ r-u -ÍM CỊỈ 1.2974 1.3040 61 DRUG ETC)? 1.3050 a Tobacco products (cigarettes, chewing tobacco, cigars, etc.) 1.3056 b Alcoholic beverages (beer wine, spirits, etc.) 1.3062 c Cannabis (marijuana, pot grass, hash, etc.) 1.3068 d Cocaine (coke, crack, etc.) 1.3074 e Amphetamine-type stimulants (speed, diet pills, ecstasy, etc.) 1.3080 f Inhalants (nitrous, glue, petrol, paint thinner, etc.) 1.3086 g Sedatives or Sleepily Pills (Valium, Serepax Rohypnol etc.) 1.3092 h Hallucinogens (LSD acid, mushroom, PC 1.3098 Special K etc.) 1.3104 i Opioids (heroin, morphine, methadone, codeine, etc.) 1.3110 j Other specify: • 1.3047 Weekly because of your use of (FIRST DRUG SECOND 1.3048 1.3046 Monthly you failed to what was normally expected of you 1.3045 Once or Tw ICC 1.3042 During the past three months, how often have ugc V Hl 1.3043 b i 1.3044 5z 1.3051 1.3052.1.3053.1.3054.1.3055 s 1.3057.1.3058 1.3059.1.3060.1.3061 1.3063.1.3064 1.3065.1.3066.1.3067 1.3069.1.3070 1.3071.1.3072.1.3073 1.3075.1.3076 1.3077.1.3078.1.3079 1.3081.1.3082 1.3083.1.3084.1.3085 1.3087 1.3088.1.3089.1.3090 1.3091 1.3093.1.3094 1.3095.1.3096.1.3097 1.3099 1.3100 1.3101 1.3102 61.3103 1.3105.1.3106 1.3107.1.3108.1.3109 s 1.3111 1.3112.1.3113.1.3114 _L _1_ r-u -ÍM CỊỈ 1.3049 1.3115 61 1.3116 Ask Question & for all substances ever used (i.e those endorsed in Question 1) 1.3117 Question 1.3118 Has a friend or relative or anyone else ever 1.3120 wr—— 1.3121 expressed concern about your use of (FIRST DRUG 1.3126 — 55 ~v SECOND DRUG, E TO? 1.3130 a Tobacco products (cigarettes, chewing tobacco, cigars, etc.) 1.3134 b Alcoholic beverages (beer wine, spirits, etc.) 1.3138 c Cannabis (marijuana, pot grass, hash, etc.) 1.3142 d Cocaine (coke, crack etc.) 1.3146 e Amphetamine-type stimulants (speed diet pills, ecstasy, etc.) 1.3150 f Inhalants (nitrous, glue, petrol, paint thinner, etc.) 1.3154 g Sedatives or Sleeping Pills (Valium Serepax Rohvpnol.etc.) 1.3158 h Hallucinogens (LSD acid, mushroom PC, special 1.3159 K, etc.) 1.3163 i Opioids (heroin, morphine, methadone, codeine, etc.) 1.3167 j Other specify: 1.3171 Has you ever tried and failed to control, cut down 1.3122 1.3119 Q1.3127 J b s z 1.3123 O y đz o 1.3128 1.3131 1.3132 1.3133 1.3135 1.3139 1.3143 1.3147 1.3136 1.3140 1.3144 1.3148 1.3137 1.3141 1.3145 1.3149 1.3151 1.3155 1.3152 1.3156 1.3153 1.3157 1.3160 1.3161 1.3162 1.3164 1.3165 1.3166 1.3168 ± or stop using (FIRST DRUG SECOND DRUG ETC)? 1.3182 a Tobacco products (cigarettes, chewing tobacco, cigars, etc.) 1.3186 b Alcoholic beverages (beer wine, spirits, etc) r-u -ÍM Qỉ ugc V Hl 1.3169 1.3170 1.3174. -“W - 1.3179 ĩ 1.3175 1.3172 ssz 1.3173 cz 1.3183 1.3187 Ì s Ĩ- 1.3176 cc ềs £ 1.3180 i I 1.3181 ■ zr i ỊL 1.3177 1.3184 1.3185 1.3188 1.3189 1.3190 c Cannabis (marijuana, pot, grass, hash etc.) 1.3194 d Cocaine (coke, crack, etc.) 1.3198 e Amphetamine-type stimulants (speed diet pills ecstasy, etc.) 1.3202 f Inhalants (nitrous, glue, petrol, paint thinner, etc.) 1.3206 g Sedatives or Sleeping Pills (Valium, Serepax Rohypnol etc.) 1.3210 h Hallucinogens (LSD acid, mushroom, PC Special K.etc.) 1.3214 i Opioids (heroin, morphine, methadone codeine etc.) 1.3218 1.3222 j Other specify: 1.3191 1.3195 1.3199 1.3192 1.3196 1.3200 1.3193 1.3197 1.3201 1.3203 1.3207 1.3204 1.3208 Ố 1.3205 1.3209 1.3211 1.3212 1.3213 1.3215 1.3216 1.3217 1.3219.1.3220 1.3221 1.3223 1.3224 1.3225 r-u -ÍM Qỉ ugc V Hl 1.3226 c SE XL AL HISTORY AND p RACTI CES 1.3227 Cl How often in the last six months have vou done any of these activities I am about to Tead out with (any of) your regular male partners)? (Since now when we mention about a regular male partner, we want to talk about your boyfriend; or a sex partner, who are in a relationship with you in a long time) - Never - Occasionally = Often = V.4 Vớ regular partners 1.3228 s - Refusal 1.3229 = Don't know 1.3230 1.3231 1.3238.1.3239 Group sex with your regular partners that J included women 1.3246.1.3247 Group sex with other men only (including K your regular partner s) 1.3254.1.3255 Use drugs to enhance sexual performance L (Popper and Erectile dysfunction medications, such as Viagra) 1.3262.1.3263 Use amphetamine type stimulant (ATS) to M enhance sexual performance 1.3270 1.3271 I used lubricant while having anal sex with my male partner 1.3278 1.3232 1.3233 1.3234 1.3235 1.3236 1.3237 1.3240 1.3241 1.3242 1.3243 1.3244 1.3245 1.3248 1.3249 1.3250 1.3251 1.3252 1.3253 1.3256 1.3257 1.3258 1.3259 1.3260 1.3261 *> 1.3264 1.3265 1.3266 1.3267 1.3268 1.3269 1.3272 1.3273 1.3274 1.3275 1.3276 1.3277 1.3279 C2 How often in the last six months have you done any of these activities I am about to read out with (any of) your non-regular male partner(s)? = Never = Occasionally = Often -■c -ÍM Qỉ ugc V Hl = A’zl - Vớ regular partners = Refusal = Don't know 1.3280 1.3281 1.3288.1.3289 Group sex with your non-regular partner's J that included women 1.3297.1.3298 Group sex with other men only (including K your non-regular partner s) 1.3305.1.3306 Use drugs to enhance sexual performance L (Popper and Erectile dysfunction medications, such as Viagra) 1.3313.1.3314 Use amphetamine type stimulant (ATS) to M enhance sexual performance 1.3321.1.3322 Group sex while using party drugs Ư 1.3329.1.3330 Have sex with someone you met online on a V website (e g daugau.com taoxanh.net etc.) 1.3337.1.3338 Have sex with someone you met through z mobile app (Grindr Blue Jack’d Facebook, etc.) 1.3345.1.3346 I used lubricant while having anal sex with Y my maLe partner -■c -ÍM Qỉ ugc V Hl 1.3282 1.3283 1.3284 1.3285 1.3286 1.3287 1.3291 1.3290.2 1.3293 1.3294 1.3295 1.3296 1.3292.3 *• 1.3300 1.3299 1.3301 1.3302 1.3303.1.3304 1.3307 1.3308 1.3309 1.3310 1.3311 1.3312 1.3315 1.3316 1.3317.1.3318 1.3319 1.3320 1.3323 1.3324 1.3325 1.3326 1.3327.1.3328 1.3331 1.3332 1.3333.1.3334 1.3335 1.3336 1.3339 1.3340 1.3341.1.3342 1.3343.1.3344 1.3347 1.3348 1.3349.1.3350 1.3351 1.3352 ... Title: Prevalence and correlates of alcohol, tobacco, and substances use among men who have sex with men in Hanoi Vietnam 1.47 Objectives: The aim of this study was to describe the prevalence and correlates. .. Alcohol use 1.90 1.4.2.1 Prevalence of alcohol use in MSM 1.91 Alcoholic beverages use was highly prevalent among MSM in many setting Prevalence of frequent alcohol use in India was 27.5%?* In. .. 1.70 1.1.2 Men who have sex frith men 1.71 Sexual intercourse is the act of having sex typically involving the insertion of the penis into the vagina, thus mainly refers to opposite -sex partners