Acceptability of circumcision among clients of female sex worker in Hong Kong

The Potential Risk Compensation after Receiving HPV Vaccination among Men Who Have Sex with Men in Southwest China: A HAPA-Based Analysis

Background: men who have sex with men (MSM) are a high-risk group for human papillomavirus (HPV) infection, and the HPV vaccine is effective in preventing it. However, according to risk compensation theory, people may increase sexual risk behaviors after receiving HPV vaccination. Based on the Health Action Process Approach (HAPA), this study investigated the influencing factors to predict intention to reduce condom use (risk compensation intention) among MSM after taking HPV vaccination in southwest China. Methods: we conducted a cross-sectional study among 948 MSM in southwest China using a non-probability sampling method and an electronic questionnaire including sociodemographic characteristics, sexual risk behavior characteristics, HPV-related prevention behavior, and the HAPA scale. Confirmatory factor analysis was performed using a structural equation model. Results: among 948 MSM, the incidence rate of reducing the frequency of condom use was 14.1%. The structural equation model showed that self-efficacy (β = -0.378, p = 0.020) and positive outcome expectancy (β = 0.366, p < 0.05) had greater effects on behavioral intention, followed by negative outcome expectancy (β = -0.296, p < 0.05) and risk perception (β = -0.232, p < 0.05). Conclusions: risk compensation may not be a major barrier to receiving HPV vaccination among MSM. Nevertheless, the recognition of possible risk compensation is necessary to implement appropriate interventions to reduce the occurrence of risk compensation.

Behavioral intention to perform risk compensation behaviors after receiving HPV vaccination among men who have sex with men in China

Men who have sex with men (MSM) are recommended to take up human papillomavirus (HPV) vaccination. There are concerns that MSM would increase sexual risk behaviors after taking up HPV vaccination, a phenomenon known as risk compensation. This study investigated the prevalence of and factors associated with behavioral intention to reduce the frequency of condom use with men after receiving the HPV vaccination. The study was based on the baseline sample of an ongoing randomized controlled trial promoting HPV vaccination among MSM in Hong Kong. Hong Kong Chinese-speaking MSM who have never vaccinated against HPV were recruited from multiple sources. A total of 624 participants completed the baseline survey during July to December 2017. The prevalence of behavior intention to reduce the frequency of condom use with regular and non-regular male sex partners after receiving HPV vaccination was 6.9% and 4.0%; 8.0% of them intended to reduce condom use with either type of male partners after receiving the HPV vaccination. Adjusting for significant background variables (education level and condomless anal intercourse with men in the last six months), two constructs of the pre-intentional phase of Health Action Process Approach model were significantly associated with the dependent variable in the expected direction. They were (1) positive outcome expectancies of condomless anal intercourse after receiving HPV vaccination (adjusted odds ratios [AOR]: 1.29, 95% confidence interval [CI]: 1.12, 1.48, p < 0.001) and (2) perceived self-efficacy of consistent condom use after receiving HPV vaccination (AOR: 0.83, 95% CI: 0.70, 0.92, p = 0.001). Risk compensation may not be a major concern when promoting HPV vaccination among MSM. The results should be assuring health-care providers and policymakers.

Prevalence of and Factors Associated With Inconsistent Condom Use With HIV-Discordant Male Regular Sex Partners Among HIV-Infected Women in China

This study was to investigate the prevalence and associated factors of inconsistent condom use with HIV-discordant regular male sex partners (RP: defined as their husband or steady boyfriends) in the last six months among HIV-infected women in China. We interviewed 256 HIV-infected women who currently had at least one HIV-discordant RP and had had sexual intercourse with such RP since diagnosis. The prevalence of inconsistent condom use with HIV-discordant RP was 48.4%. Associated factors included perceptions related to condom use and perceived competence in communicating with HIV-discordant RP regarding condom use.

Low uptake of HIV testing among male clients of female sex workers in China

Male client of female sex workers (MCFSW) is a sizable population transmitting HIV from high-risk population to female general population in China. This study was to investigate the prevalence of taking up any forms of HIV testing in lifetime and in the past year among MCFSW in Hong Kong. Factors associated with uptake of any forms HIV testing in the past year were also investigated. A cross-sectional survey was conducted. Participants were Hong Kong Chinese males aged ≥18 years, and self-reported had patronized at least one female sex workers (FSW) in the last six months. A total of 303 MCFSW recruited online (n = 160) or from venues (n = 143) completed the self-administered questionnaire. Logistic regression was used for data analysis. The prevalence of taking up any forms of HIV testing in lifetime and last year was 49.2% and 23.8%, respectively. Adjusting for these background variables, scale scores representing perceived severity of HIV infection (AOR: 1.17), perceived benefits of HIV testing (AOR: 1.18) and perceived self-efficacy in taking up HIV testing (AOR: 1.36) were significantly and positively associated with uptake of any forms of HIV testing in the last year, while negative associations were found for the Perceived Psychological Barrier Scale (AOR= 0.88) and the Perceived Logistical Barrier Scale (AOR: 0.78). MCFSW in Hong Kong reported low uptake of HIV testing. Health promotion is urgently needed. Modifying perceptions related to the Health Belief Model are potential useful strategies. The potential of using HIV self-testing to increase HIV testing coverage among MCFSW should also be considered.

Prevalence of and factors associated with unprotected anal intercourse with regular and nonregular male sexual partners among newly diagnosed HIV-positive men who have sex with men in China

OBJECTIVES

This study investigated the prevalence of, and multi-dimensional factors associated with, unprotected anal intercourse (UAI) with regular male sexual partners ('regular partners') and nonregular male sexual partners ('nonregular partners') among newly diagnosed HIV-positive men who have sex with men (MSM) in Chengdu, China.

METHODS

A total of 225 newly diagnosed HIV-positive MSM were interviewed using a combined interviewer-computer-assisted method in Chengdu, China.

RESULTS

The prevalence of UAI with regular and nonregular partners since diagnosis was 27.7% and 33.8% among participants reporting having sex with regular and nonregular partners (n = 159 and 133), respectively. Adjusted analysis showed that: (1) cognitive variables based on the Health Belief Model (perceived susceptibility to HIV transmission and perceived severity of the consequences of HIV transmission, perceived barriers and perceived self-efficacy related to consistent condom use), (2) emotion-related variables (worry about transmitting HIV to others), (3) psychological factors (post-traumatic growth) and (4) socio-structural factors (perceived partners' responsibility for condom use) were significantly associated with UAI with regular and/or nonregular partners.

CONCLUSIONS

Interventions are warranted, and should be designed with consideration of multi-dimensional factors and be partner type-specific.

Prevalence and associated factors of behavioral intention for risk compensation following voluntary medical male circumcision among male sexually transmitted diseases patients in China

Risk compensation was an important concern of voluntary medical male circumcision (VMMC) promotion campaigns. No study investigated risk compensation following VMMC among male sexually transmitted diseases patients (MSTDP). A cross-sectional survey interviewed 308 uncircumcised MSTDP in Shenzhen, China. 26.9% of them intended to perform at least one of the five types of risk compensation behaviors following VMMC. In the summary stepwise model, provision of incorrect response to HIV/sexually transmitted diseases knowledge items (multivariate odds ratios (ORm) = 2.30), genital herpes infection (ORm = 3.19), Risk Reduction Score for Unprotected Sex, and Negative Condom Attitudes Scale (ORm = 1.13) were significantly associated with behavioral intention to perform at least one type of risk compensation behavior following VMMC. The results provided a framework for developing related interventions. Prevention of risk compensation should be an essential component of VMMC promotion for all MSTDP, irrespective of their intention for VMMC.

Estimation of country-specific and global prevalence of male circumcision

BACKGROUND

Male circumcision (MC) status and genital infection risk are interlinked and MC is now part of HIV prevention programs worldwide. Current MC prevalence is not known for all countries globally. Our aim was to provide estimates for country-specific and global MC prevalence.

METHODS

MC prevalence data were obtained by searches in PubMed, Demographic and Health Surveys, AIDS Indicator Surveys, and Behavioural Surveillance Surveys. Male age was ≥15 years in most surveys. Where no data were available, the population proportion whose religious faith or culture requires MC was used. The total number of circumcised males in each country and territory was calculated using figures for total males from (i) 2015 US Central Intelligence Agency (CIA) data for sex ratio and total population in all 237 countries and territories globally and (ii) 2015 United Nations (UN) figures for males aged 15-64 years.

RESULTS

The estimated percentage of circumcised males in each country and territory varies considerably. Based on (i) and (ii) above, global MC prevalence was 38.7 % (95 % confidence interval [CI]: 33.4, 43.9) and 36.7 % (95 % CI: 31.4, 42.0). Approximately half of circumcisions were for religious and cultural reasons. For countries lacking data we assumed 99.9 % of Muslims and Jews were circumcised. If actual prevalence in religious groups was lower, then MC prevalence in those countries would be lower. On the other hand, we assumed a minimum prevalence of 0.1 % related to MC for medical reasons. This may be too low, thereby underestimating MC prevalence in some countries.

CONCLUSIONS

The present study provides the most accurate estimate to date of MC prevalence in each country and territory in the world. We estimate that 37-39 % of men globally are circumcised. Considering the health benefits of MC, these data may help guide efforts aimed at the use of voluntary, safe medical MC in disease prevention programs in various countries.

Acceptability of Voluntary Medical Male Circumcision (VMMC) among Male Sexually Transmitted Diseases Patients (MSTDP) in China

Voluntary Medical Male circumcision (VMMC) is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP) who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42) of them were circumcised at the time of survey. When the uncircumcised participants (n = 308) were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1) emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06–1.18), 2) cognitive variables derived from Health Belief Model (HBM): perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15–5.33) (perceived susceptibility), perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02–1.10), perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16–1.42) and sexual performance (AOR = 1.45, 95%CI: 1.26–1.71), perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81–0.95), and perceived cue to action (AOR = 1.41, 95%CI: 1.23–1.61) and self-efficacy (AOR = 1.38, 95%CI: 1.26–1.35) related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the important findings of this study into account.

Perceptions of HPV, genital warts, and penile/anal cancer and high-risk sexual behaviors among men who have sex with men in Hong Kong

The prevalence of HIV and HPV is high among men who have sex with men (MSM) in China. It is unclear whether cognitive and affective responses related to HPV and HPV-related diseases are negatively associated with HIV-related risk behaviors among MSM. This cross-sectional study interviewed 449 adult Chinese MSM in Hong Kong. The prevalence of unprotected anal intercourse (UAI) and having had anal sex with more than one man in the last 6 months (multiple male sex partnerships) was 39.0 and 71.3 %, respectively. After adjusting for four significant background variables (education level, cohabitation with a man, exposure to HIV prevention materials, and HIV voluntary counseling and testing), variables negatively associated with UAI and/or multiple male sex partnerships included (1) correct HPV-related knowledge (AOR = 0.48-0.66), (2) perceived susceptibility (AOR = 0.32-0.55) and perceived severity (AOR = 0.12-0.60) related to HPV and HPV-related diseases, and (3) fear towards contracting genital warts and penile/anal cancer (AOR = 0.40-0.55). Perceived high chance of contracting HPV was positively associated with multiple partnerships (AOR = 4.74). It is possible to reduce HIV-related risk behaviors by increasing levels of knowledge, cognitions, and fear related to HPV and related diseases. It is important to integrate prevention of HIV with prevention of sexually transmitted infections. Such interventions are warranted.

Prevalence and associated factors of intention to participate in HIV voluntary counseling and testing for the first time among men who have sex with men in Hong Kong, China

OBJECTIVE

We investigated the prevalence and associated factors of men who have sex with men (MSM) and had never participated in Human Immunodeficiency Virus (HIV) voluntary counseling and testing (VCT) but intended to do so in the next six months.

METHOD

An anonymous cross-sectional survey interviewed 577 MSM in Hong Kong, China, face-to-face or through an electronic questionnaire.

RESULTS

We identified 245 MSM who had never participated in VCT (never-testers), among whom 12.7% intended to do so in the next six months. Factors associated positively with high behavioral intention were: 1) perceived necessity to participate in HIV test regularly (multivariate odds ratios (ORm)=4.54, 95% confidence interval (CI): 1.30-15.83), 2) perception that >20% of the local MSM had participated in VCT (ORm=17.86, 95% CI: 1.89-169.08) and 3) perceived higher chance to have sex with people living with HIV (PLWH) in the next six months (ORm=2.92, 95% CI: 1.08-7.93). Negatively associated factors were: local residency (ORm=0.06, 95% CI: 0.01-0.34) and perceived higher chance of having unprotected anal intercourse (UAI) in the next six months (ORm=0.27, 95% CI: 0.09-0.84). In addition, no interaction term between the independent variable and UAI status was found to be statistically significant.

CONCLUSION

Many sampled never-testers had low intention to take up VCT and were in the pre-contemplation stage of the Transtheoretical Model. Stage-matched promotions are warranted.

Awareness and acceptability of female condoms among monogamous Hong Kong Chinese female sexually transmitted infection patients

Female condom is an effective means of HIV prevention. Monogamous female sexually transmitted infection (STI) patients are exposed indirectly to high risk of contracting HIV/STI via their sole male sex partners. There are few interventions to protect such women whilst female condom use is a potential means of self-protection. With informed consent, this cross-sectional study investigated the prevalence of awareness and acceptability of female condoms among 335 Chinese monogamous female STI patients attending a government STI clinic in Hong Kong. Among those who were aware of female condoms (66.9 % of the sample), 68.3 % were willing to use free female condoms. Awareness was associated with having the sex partner being a boyfriend (OR = 3.76, P < 0.001), knowledge about asymptomatic property of HIV (OR = 2.14, P = 0.006) and no immunity for STI (OR = 2.14, P = 0.011), experience of HIV antibody testing (OR = 2.21, P = 0.004) and unemployment (OR = 0.50, P = 0.011). Among those who had heard of female condoms, acceptability was associated with knowledge about possibility to contracting two STI concomitantly (OR = 2.26, P = 0.03) and perceived chance of contracting STI from the sex partner in the coming 6 months (OR = 2.27, P = 0.04). Awareness is relatively low but the prevalence of acceptability is encouraging. Female condoms have been underused and should be promoted among monogamous female STI patients as a means of empowerment as an option for sex protection.