Population-based sexual behavior surveys in China: Liuzhou compared with other prefectural cities

The Longitudinal Relationships among Casual Sex and Psychological Well-Being in Chinese College Student

This study integrates the important psychological well-being indicators (i.e., life satisfaction, psychological distress, and self-esteem) into a model framework. We used a cross-lagged panel design (CLPD) to examine the bidirectional relationship between casual sex and psychological well-being among Chinese college students. Chinese college students (N = 833) completed self-report measures (i.e., hookup behavior, life satisfaction, psychological distress, and self-esteem) at six-month intervals. The results show that the ratio of college students who reported engaging in at least one hookup experience in the past year or half a year was lower than that of Western college students. We find that college students with hookup behavior had poorer psychological well-being in later six months than those who did not engage in hookup behavior. However, previous psychological well-being did not predict subsequent hookup behavior. We discuss these findings in terms of China's unique sexual culture to provide useful information for preventing and interfering with risky sexual behaviors and their negative consequences among Chinese college students. Specifically, this study could provide students with a more in-depth understanding of associated risks, assisting those engaged in or intending to engage in hookups to evaluate the advantages and drawbacks of such behavior. Furthermore, it underscores the importance of implementing targeted educational programs in China that address the psychological consequences of casual sex.

Prevalence and Patterns of Extramarital Sex among Chinese Men and Women: 2000-2015

Despite growing concern about the "sexual revolution" in China in the past decades, empirical evidence regarding the national trends in prevalence and patterns of extramarital sex (EMS) remains sparse. This study aimed to fill this gap, using data from a population-based, repeated cross-sectional survey administered at four time points during the period 2000-2015. EMS was assessed by asking whether a person in marriage had engaged in sexual activity with someone else during the relationship with his/her current partner. Our findings showed that among married adults aged 20-59, the occurrence rate of EMS nearly tripled over the period 2000-2015, increasing from 12.9% to 33.4% for men, and from 4.7% to 11.4% for women. Moreover, in the early years of this century, EMS was negatively associated with older age (50-59 years), lower educational level (elementary and below) and rural residence for men, and negatively associated with older age and positively associated with higher educational level (college and above) for women. All these differences, however, disappeared in more recent years. Overall, this study indicates a marked increase in EMS, a widening gender gap in EMS, and for each gender, a convergence of EMS across various sociodemographic groups.

A Short-Term Longitudinal Investigation of the Perceived Hookup Attitude of Gender-Specific Close Friends and Hookup Behavior

Research suggests that peer injunctive norms (i.e., perceived attitudes) have an indirect effect on youth’s behavior. Few studies have explored the underlying mechanism of the relationship between the perceived attitude of gender-specific close friends and hookup behavior. Following the social norm approach and the social learning theory, a person’s own hookup attitude and their emotional reaction after a hookup would influence this relationship as mediators. We therefore examined the association between perceived hookup attitudes of students’ same-sex/opposite-sex close friends and the number of hookup partners via mediated variables (i.e., own hookup attitude and affect following a recent hookup) in Chinese college students (N = 314) who completed self-report measures at 6-month intervals. The results of a path analysis showed that students’ own attitudes toward hookups and negative affect following a hookup significantly mediated the association between perceived hookup attitudes of same-sex close friends and the number of hookup partners over 6 months. These findings indicate that same-sex close friends’ injunctive norms were more strongly associated with future hookup behavior, as compared to opposite-sex friends’ injunctive norms. To better understand the relationship between peer norms and hookup behavior, both students’ hookup attitudes and negative emotional responses should be considered.

Population-based study of chlamydial and gonococcal infections among women in Shenzhen, China: Implications for programme planning

This study was aimed to estimate the prevalences of chlamydia (CT) and gonococcal (NG) infections and explore risk factors associated with the CT infection among women in Shenzhen, China. We collected socio-demographic and clinical data from women (aged 20–60) and determined positivity of CT or NG by nucleic acid amplification test (NAAT) with self-collected urine specimens. We estimated prevalence of CT and NG and determined risk factors associated with CT infection. Among 9,207 participants, 4.12% (95% confidence interval [CI], 3.71%-4.53%) tested positive for CT and 0.17% (95% CIs, 0.09%-0.25%) for NG. Factors significantly associated with CT infection included being an ethnic minority (ethnicity other than Han China) (Adjusted odds ratio [AOR], 1.9; 95% CI, 1.2–3.0), using methods other than condom for contraception (AOR, 1.5; 95% CI, 1.2–1.8), having a history of adverse pregnancy outcomes (AOR, 1.4; 95% CI, 1.1–1.8), and experiencing reproductive tract symptoms in the past three months (AOR, 1.3; 95% CI, 1.0–1.7). we found that CT infection is prevalent among women in Shenzhen, China and associated with both demographic and behavioral factors. A comprehensive CT screening, surveillance and treatment programme targeting this population is warranted.

Recognizing the impact of endemic hepatitis D virus on hepatitis B virus eradication

BACKGROUND

Hepatitis delta virus (HDV) in conjunction with hepatitis B virus (HBV) increases adult morbidity and mortality. A number of studies have performed cost-benefit analyses for HBV interventions, but they have ignored the impact of HDV on these outcomes.

METHODS

Using a mathematical model of HBV-HDV epidemiology, we compare health benefits and cost outcomes of four interventions: testing with HBV adult vaccination (diagnosis), diagnosis with antiviral treatment for HBV infections (mono-infections), diagnosis with antiviral treatment for HBV-HDV infections (dual-infections), and awareness programs. The relationship between optimal levels and outcomes of each of these interventions and HDV prevalence in HBV infected individuals ranging from 0 to 50% is determined.

RESULTS

Over a 50 year period under no intervention, HBV prevalence, per capita total cost and death toll increase by 2.25%, -$11 and 2.6-fold respectively in moderate HDV endemic regions compared to mono-infected regions; the corresponding values for high HDV endemic regions are 4.2%, -$21 and 3.9-fold. Optimal interventions can be strategized similarly in mono and dually endemic regions. Only implementation of all four interventions achieves a very low HBV prevalence of around 1.5% in a moderate HDV endemic region such as China, with 2.8 million fewer deaths compared to no intervention. Although the policy of implementation of all four interventions costs additional $382 billion compared to no intervention, it still remains cost-effective with an incremental cost-effectiveness ratio of $1400/QALY. Very high efficacy awareness programs achieve less prevalence with fewer deaths at a lower cost compared to treatment and/or vaccination programs.

CONCLUSION

HDV substantially affects the performance of any HBV-related intervention. Its exclusion results in over-estimation of the effectiveness of HBV interventions.

Spatial distribution and cluster analysis of risky sexual behaviours and STDs reported by Chinese adults in Guangzhou, China: a representative population-based study

OBJECTIVES

To assess associations between residences location, risky sexual behaviours and sexually transmitted diseases (STDs) among adults living in Guangzhou, China.

METHODS

Data were obtained from 751 Chinese adults aged 18-59 years in Guangzhou, China, using stratified random sampling by using spatial epidemiological methods. Face-to-face household interviews were conducted to collect self-report data on risky sexual behaviours and diagnosed STDs. Kulldorff's spatial scan statistic was implemented to identify and detect spatial distribution and clusters of risky sexual behaviours and STDs. The presence and location of statistically significant clusters were mapped in the study areas using ArcGIS software.

RESULTS

The prevalence of self-reported risky sexual behaviours was between 5.1% and 50.0%. The self-reported lifetime prevalence of diagnosed STDs was 7.06%. Anal intercourse clustered in an area located along the border within the rural-urban continuum (p=0.001). High rate clusters for alcohol or other drugs using before sex (p=0.008) and migrants who lived in Guangzhou <1 year (p=0.007) overlapped this cluster. Excess cases for unprotected sex (p=0.031) overlapped the cluster for college students (p<0.001). Five of nine (55.6%) students who had sexual experience during the last 12 months located in the cluster of unprotected sex.

CONCLUSIONS

Short-term migrants and college students reported greater risky sexual behaviours. Programmes to increase safer sex within these communities to reduce the risk of STDs are warranted in Guangzhou. Spatial analysis identified geographical clusters of risky sexual behaviours, which is critical for optimising surveillance and targeting control measures for these locations in the future.

A Comparison of the Number of Men Who Have Sex with Men among Rural-To-Urban Migrants with Non-Migrant Rural and Urban Residents in Wuhan, China: A GIS/GPS-Assisted Random Sample Survey Study

Background

Mobile populations and men who have sex with men (MSM) play an increasing role in the current HIV epidemic in China and across the globe. While considerable research has addressed both of these at-risk populations, more effective HIV control requires accurate data on the number of MSM at the population level, particularly MSM among migrant populations.

Methods

Survey data from a random sample of male rural-to-urban migrants (aged 18-45, n=572) in Wuhan, China were analyzed and compared with those of randomly selected non-migrant urban (n=566) and rural counterparts (580). The GIS/GPS technologies were used for sampling and the survey estimation method was used for data analysis.

Results

HIV-related risk behaviors among rural-to-urban migrants were similar to those among the two comparison groups. The estimated proportion of MSM among migrants [95% CI] was 5.8% [4.7, 6.8], higher than 2.8% [1.2, 4.5] for rural residents and 1.0% [0.0, 2.4] for urban residents, respectively. Among these migrants, the MSM were more likely than non-MSM to be older in age, married, and migrated to more cities. They were also more likely to co-habit with others in rental properties located in new town and neighborhoods with fewer old acquaintances and more entertainment establishments. In addition, they were more likely to engage in commercial sex and less likely to consistently use condoms.

Conclusion

Findings of this study indicate that compared to rural and urban populations, the migrant population in Wuhan consists of a higher proportion of MSM who also exhibit higher levels of HIV-related risk behaviors. More effective interventions should target this population with a focus on neighborhood factors, social capital and collective efficacy for risk reduction.

Social contexts of heterosexual transmission of HIV/STI in Liuzhou City, China

In this special issue of AIDS and Behavior, we focus on the social contexts of sexual transmission of HIV/STI in one South China city. Our multiple projects grew from partnerships across the social and biomedical sciences, and with public health experts in Liuzhou City, to address critical gaps in knowledge about how social factors drive heterosexual transmission. The eleven articles that comprise this special issue feature multidisciplinary and mixed method approaches, collecting data in Liuzhou from different populations, environments, and social venues where individuals often find sexual partners. They document heterosexual behaviors and their meanings. They investigate the experiences and behaviors of women and men in social venues, exploring the networks of people within these venues, how they relate to one another, share information, and influence each other. The articles also examine the experiences of people living with HIV, again collecting data from multiple levels and sources, and revealing the ongoing power of stigma to shape these lives. Taken together, the articles demonstrate the critical role of social contexts in shaping behaviors and meanings, which are linked to heterosexual transmission of HIV/STI, and which must be taken into account for the development of appropriate and effective public health interventions.

Brief non-commercial sexual encounters among patrons of entertainment venues in Liuzhou, China

Brief non-commercial sexual encounters among patrons of social venues are increasing in China, but whether these encounters increase syphilis risk is unknown. We surveyed and tested 797 men and women at randomly selected social venues in urban Liuzhou and three surrounding counties. The percent reporting recent non-commercial one-time sex ranged from 14.5% of county women to 24.8% of urban men. 2.4% of men and 3.7% of women had a positive rapid syphilis test. Men reporting non-commercial one-time sex were significantly more likely to have a positive rapid syphilis test than other men (7.4 vs. 0.9%). Among women, commercial sex was more strongly associated with syphilis than non-commercial one-time sex (6.0 vs. 0.7%). Recent one-time sex was common and associated with syphilis among men. Venue-based HIV/STI prevention methods may be warranted among persons who do not engage in commercial sex, but frequently engage in one-time sex.

Advancing the prevention agenda for HIV and other sexually transmitted infections in south China: social science research to inform effective public health interventions

Despite widespread biomedical advances in treatment and prevention, HIV and other sexually transmitted infections (STI) continue to affect a large portion of the world's population. The profoundly social nature of behaviorally driven epidemics and disparities across socioeconomic divides in the distribution of HIV/STI and care outcomes emphasize the need for innovative, multilevel interventions. Interdisciplinary approaches to HIV/STI control are needed to combine insights from the social and biological sciences and public health fields. In this concluding essay to a Special Issue on HIV/STI in south China, we describe the evolution of the region's HIV/STI epidemics and the government response, then synthesize findings from the 11 studies presented in this issue to extend seven recommendations for future HIV/STI prevention and care research in China. We discuss lessons learned from forging international collaborations between the social and biological sciences and public health to inform a shared research agenda to better meet the needs of those most affected by HIV and other STI.

Coping strategies for HIV-related stigma in Liuzhou, China

This study explores the feelings, experiences, and coping strategies of people living with HIV (PLHIV) in Liuzhou, China. In a southwestern Chinese city with high HIV prevalence, we conducted semi-structured in-depth interviews with 47 PLHIV selected to represent individuals who had acquired HIV via different acquisition routes. Many participants felt severely stigmatized; they commonly reported having very low self-esteem and feelings of despair. Based on style of coping and whether it occurred at the interpersonal or intrapersonal level, four types of coping that participants used to deal with HIV-associated stigma were identified: (1) Compassion (Passive/Avoidant-Interpersonal); (2) Hiding HIV status (Passive/Avoidant-Intrapersonal); (3) Social support (Active/Problem-focused-Interpersonal; and (4) Self-care (Active/Problem-focused-Intrapersonal). Educational and stigma-reduction interventions targeting potential social support networks for PLHIV (e.g., family, close friends, and peers) could strengthen active interpersonal PLHIV coping strategies. Interventions teaching self-care to PLHIV would encourage active intrapersonal coping, both of which may enhance PLHIV quality of life in Liuzhou, China.