Adapting and applying a multiple domain model of condom use to Chinese college students

The influence of type of sexual partnership on male condom use: empirical evidence from the South African construction industry

There are indications that gender has an effect on individual risk factors and pathways to HIV diagnoses and treatment. Furthermore, there is growing recognition that to improve HIV-related health outcomes for men, it is important to understand their experiences and perspectives. Perhaps because of the physical nature of construction work, the South African construction industry is dominated by men. Given that employed men are a hard-to-reach community population group, the construction workplace offers an ideal environment for data collection and delivery of non-health-facility-based HIV prevention and treatment interventions. Furthermore, workers in the construction industry have been identified as being at a heightened risk of acquiring HIV and AIDS because of work-related travel, the ubiquity of transactional sex around worker hostels and having an increased likelihood of multiple and concurrent sex partnerships. As a consequence, this study examines the association between condom use and sexual partnerships among men working in the construction industry. A purposive cross-sectional survey was used to collect data from 450 workers across 18 construction sites in the Western Cape province of South Africa. The types of sexual partnership had three categories: regular sex partnerships, casual sex partnerships and sex worker partnerships. Frequency of condom use was determined to be highest with casual sex partners (51.2%), followed by sex workers (40.6%) and regular sex partners (25.6%). Hierarchical multiple linear regression analysis was used to examine the demographic, experiential, behavioural and cognitive predictors of condom use across the three categories of sexual partnership. The results indicate that an individual's perception of control over condom use, and the perceived threat posed by HIV and AIDS are significantly associated with consistent condom use, even after accounting for differences in partner type. Implications of the findings are discussed, and directions for future research on the association between sexual partnerships and condom use are offered.

Demographic Characteristics and Hot-Spot Areas of Recent Infections Among New HIV Diagnoses in Sichuan, China, Between 2018 and 2020

Background

Sichuan Province is severely affected by the HIV epidemic in China. Little is known about the characteristics of recent infections among new HIV diagnoses, which is critical to prevention strategies, evaluation of the HIV epidemic and health resource allocation. Meanwhile, individuals at primary stages of infection are related to the hot-spot areas of ongoing transmission in new HIV diagnoses, which is also rarely known.

Objective

This article aimed to report the proportion of recent infections among new HIV diagnoses, and to reveal demographic characteristics associated with HIV recent infections, and finally, to indicate the hot-spot areas of ongoing transmission in Sichuan province between 2018 and 2020.

Methods

Limiting Antigen (LAg)-Avidity assay was performed to detect recent infection within new HIV diagnoses reported in odd months between 2018 and 2020. Results were reclassified according to the data on CD4 cell count, antiretroviral treatment and the existence of an AIDS-defining illness. Logistic regression was used to determine characteristics associated with HIV recent infections. The spatial analysis was conducted with ArcGIS 10.7 to figure hot-spot areas of HIV recent infections.

Results

42,089 newly diagnosed HIV-1 cases were tested using the LAg-Avidity EIA. In total, 5848 (13.89%) of those were classified as HIV recent infections. Female, age between 18-25 years and men who had sex with men were related to higher proportion of HIV recent infections. Logistic regression revealed that MSM aged between 18-25 years were more likely to be classified as recent infection. Spatial analysis demonstrated significant clustering in Chengdu, Yibin, Luzhou city between 2018 and 2020. Hot spots were mainly clustered in the center of Sichuan in 2018, but gradually spread to southwest and northwest between 2019 and 2020.

Conclusion

Enhanced preventive measures among relevant risk groups and areas where the potential HIV-1 transmission is ongoing is urgently needed to curb further spread.

A spatial analysis of the epidemiology of HIV-infected students in Zhejiang province, China

BACKGROUND

The upsurge in HIV infections among students is a matter of particular concern. However, few studies have explored the epidemiological characteristics including the risky sexual networking of HIV-infected students in Zhejiang province, China.

METHODS

Using the provincial surveillance data of HIV-infected students, we conducted a retrospective epidemiology study to describe the epidemiological characteristics of 628 newly diagnosed cases from 2011 to 2016 and detailed information of 124 cases from 2015 to 2016. Spatial analyses were conducted using ArcGIS software, and statistical analyses were performed using SPSS software.

RESULTS

A total of 628 cases of HIV/AIDS were diagnosed among students in Zhejiang Province, China between 2011 and 2016. The cases showed an overall increasing trend over time, while the proportions of students with HIV disease status, cases diagnosed by HIV voluntary counseling and testing (VCT), and cases of homosexual transmission remained stable over time. Significant spatial heterogeneity in the cases was seen at the county level. Detailed data on 124 HIV-positive individuals collected from the local Center for Disease Control and Prevention (CDC) from 2015 and 2016, showed that the majority of them (85.5%,) engaged in homosexual behavior, and 93.4% had sex with casual partners. These partners included not only social members, but also other students. Online dating applications represented the most common means of seeking and communicating with homosexual partners. The level of awareness regarding the risk of HIV infection, and the amount coverage of face-to-face education towards students were both low.

CONCLUSIONS

HIV infections among students were characterized by increasing trend and spatial clustering in Zhejiang Province between 2011 and 2016, with homosexual sexual activity being the main mode of infection. Interventions are urgently required to prevent HIV infection in this population by increasing awareness of the disease. HIV testing programs and information regarding disease prevention specifically through online dating applications are needed.

Patterns of condom use in a university student population residing in a high-risk area for HIV infection

OBJECTIVE

The study objective was to investigate factors associated with condom use among university students.

METHODS

During the 2013-2014 academic year, 1017 first and fourth year students from the University of Pristina temporarily seated in Kosovska Mitrovica, northern Kosovo, completed a questionnaire on sociodemographic data, HIV-related knowledge, attitudes and risky behaviours.

RESULTS

Condom use during the most recent sexual encounter and with casual partners was reported by just over half of participants. Factors associated with condom use during the most recent sexual encounter were: being male (35.1%), using medical sources of information about HIV (35.7%), having a positive approach to HIV testing (40.1%) and a positive attitude towards sex workers (17.7%), as well as not having had a sexually transmitted infection in the past year (54.2%). Factors associated with more frequent condom use with casual partners were: being single (28.9%), not living in a rented apartment or own home (32.1%), frequenting night clubs at the weekend (35.3%), not using drugs/opioids (54.1%), not being sure whether to keep a contact after learning of their HIV-positive status (10.1%), and having stronger opinions (either positive or negative) on homosexual individuals (15.5% and 32.1%, respectively), sex workers (18.7% and 23.9%, respectively) and drug users (13.2% and 36.5%, respectively).

CONCLUSION

Condom use among students in northern Kosovo was low. Strategies for HIV prevention should be focussed on promoting healthy behaviours, especially among female students and students who live alone while at university. Moreover, sexuality education should be carried out in schools and primary health care centres to provide support and enable young people to negotiate safe sex.

Spatiotemporal analysis and epidemiological characterization of the human immunodeficiency virus (HIV) in Libya within a twenty five year period: 1993-2017

Background

Infection with the human immunodeficiency virus (HIV) is an alarming problem in North African countries, but few studies have analyzed the geographical distribution of the epidemic. Libya, the second largest country in Africa and with the longest coast on the Mediterranean basin facing Europe, has experienced major outbreaks of HIV infection. Since then, no studies have followed up on the burden of HIV infections. To plan interventions and allocate resources, spatial analysis of HIV/AIDS clusters are required in order to identify epidemic foci and trends in the country. The objective of this study was to assess HIV infection clustering and trends in Libya.

Methods

Information on all recorded HIV/AIDS cases during 1993–2017 were extracted from the National Reporting System. A total of 8015 newly diagnosed HIV cases with address information were included. Spatial autocorrelation and spatial–temporal analysis were used to identify HIV clusters. Spatial correlations between cases and socio-demographic factors were determined using spatial regression.

Results

HIV cases steadily increased within the Libyan population, particularly among those aged < 27 years. Spatiotemporal analysis showed marked geographic and temporal variation of HIV infection, particularly during 2005–2012. The risk factors varied from one region to another, and the contribution of injection drug use to infection increased with time. Four clusters in three time periods were identified, three on the Mediterranean coast and one in the south.

Conclusion

HIV is an emerging problem in Libya, particularly among young adults. The infection rate varies greatly among the regions and districts, particularly within certain definable geographical areas. Effective intervention strategies are needed to contain HIV infections, especially within the endemic areas.

Electronic supplementary material

The online version of this article (10.1186/s12981-019-0228-0) contains supplementary material, which is available to authorized users.

The Variable Characteristics of Human Papillomavirus in Squamous Cell Carcinoma and Adenocarcinoma of Cervix in China

OBJECTIVE

A hospital-based multicenter, retrospective study was conducted to compare the distribution of human papillomavirus (HPV) in squamous cell carcinoma (SCC) and cervical adenocarcinoma (CADC) in China.

METHODS

Paraffin-embedded tissue blocks diagnosed as SCC and CADC across China were collected, as well as the total number of diagnosed invasive cervical cancer of the 9 selected centers. DNA enzyme immunoassay, reverse hybridization, and multiplex type-specific polymerase chain reaction were used for HPV genotyping.

RESULTS

The ratios of CADC to SCC were increasing from 2005 to 2010, in parallel with HPV prevalence in CADC. In 630 patients with SCC (mean ± SD age, 45.40 ± 10.30) and 718 patients with CADC (mean ± SD age, 46.09 ± 10.59) recruited, HPV prevalence rates were 97.6% and 74.5%, respectively. Human papillomavirus viral load for SCC is significantly higher than that for CADC. Most common HPV types distributed in SCC and CADC were HPV-16 (78.5%, 75.1%-81.6%; 47.1%, 42.9%-51.3%), HPV-18 (8.0%, 6.1%-10.4%; 41.1%, 37.0%-45.3%), HPV-52 (2.3%, 1.4%-3.8%; 5.6%, 4.0%-7.9%), and HPV-45 (1.1%, 0.6%-2.3%; 3.9%, 2.6%-5.9%). Different diagnostic mean ± SD age for HPV-16/HPV-18 versus other high-risk HPV types were observed: SCC (44.5 ± 9.94 vs 51.0 ± 10.83, p < .05) and CADC (44.1 ± 9.44 vs 47.4 ± 10.41, p = .006). For HPV-negative cases, mean ± SD age was 46.1 ± 10.73 in SCC and 50.3 ± 11.85 in CADC, which were older than the positive (45.4 ± 10.31, 44.5 ± 9.64). HPV-16 and HPV-18 were the most frequent HPV types in both histological types, and HPV-18 was more frequent in CADC than in SCC.

CONCLUSIONS

Human papillomavirus infection was identified more often in SCC than in CADC. Women with HPV-associated cancers, especially HPV-16/HPV-18, were of a younger age at diagnosis when compared with non-HPV-associated cancers.

Structural Equation Modeling Test of an Integrated Model of Spanish Youth's Condom Use

Heterosexual transmission represents 26 % of newly diagnosed infection in Spanish youth. Behavioral change models have emphasized the influence of multiple variables to predict condom use behavior. The aim of this study is to examine how those variables are organized and which theory explains the condom use behavior better. A sample of 424 young heterosexuals (M _age  = 20.62; SD = 2.16) filled out a battery of self-report questionnaires for assessing AIDS-related variables, personality traits and clinical variables (general, sexuality-related and health-related). A structural model was specified that included perceived pleasure and condom use self-efficacy as predictive variables. Depression and sexual compulsivity indirectly influence behavior. The final model accounted for 65.9 % of the variance in behavior. These results highlight the importance of cognitive and emotional variables as predictors of behavior (ex. expectations of pleasure and self-efficacy beliefs). This is important information for designing effective psychological interventions.

The HIV/AIDS epidemic among young people in China between 2005 and 2012: results of a spatial temporal analysis

OBJECTIVES

Despite a recent increase in the HIV/AIDS epidemic among young people in China, youth-specific HIV data are limited.

METHODS

In total, 56 621 individuals with HIV/AIDS, aged 15-24 years, registered in the Case Reporting System of China between 2005 and 2012 and having complete spatial information were included in the present analysis. Spatial autocorrelation (general and local) and space-time scanning were performed using the ArcGIS 10.2 and SaTScan 9.3 software, respectively.

RESULTS

During 2005-2012, the number of reported HIV/AIDS cases and the proportion of HIV cases increased while the proportion of AIDS cases decreased. Sexual contact became the predominant route of transmission in later years. Spatial analysis showed marked geographical variations in HIV infection among young people throughout China during 2005-2012. The number of new hotspots increased over time. They were mainly localized to southeastern coastal areas, southwestern frontier provinces or autonomous regions (of Guangxi, Yunnan and Sichuan) and Beijing municipality. Later these hotspots disappeared and new hotspots were found in the northeast of the country. Significant clusters of HIV-positive cases were identified in three different time periods, which indicated high HIV transmission among young Chinese people in the recent past. The risk of HIV infection was highest in the first cluster (2009-2012; this cluster was the largest in size) covering the provinces of Guizhou and Yunnan, the Chongqing municipality, Guangxi, and the province of Sichuan. The second cluster (2010-2012) was mostly located in Shanghai, South Jiangsu, Zhejiang and South Anhui, while the third cluster (2010-2012) was located in Beijing and Tianjin.

CONCLUSIONS

Target-specific comprehensive behavioural interventions are urgently needed to contain the HIV epidemic among young people.

Determinants of consistent condom use among college students in China: application of the information-motivation-behavior skills (IMB) model

Background

Due to the increase incidents of premarital sex and the lack of reproductive health services, college students are at high risk of HIV/AIDS infections in China. This study was designed to examine the predictors of consistency of condom use among college students based on the Information-Motivation-Behavioral Skills (IMB) model and to describe the relationships between the model constructs.

Methods

A cross-sectional study was conducted to assess HIV/AIDS related information, motivation, behavioral skills and preventive behavior among college students in five colleges and universities in Nanjing, China. An anonymous questionnaire survey was conducted for data collection, and the structural equation model (SEM) was used to assess the IMB model.

Results

A total of 3183 participants completed this study. The average age was 19.90 years (SD = 1.43, range 16 to 25). 342 (10.7%) participants of them reported having had premarital sex, among whom 30.7% reported having had a consistent condom use, 13.7% with the experience of abortion (including the participants whose sex partner has the same experience), 32.7% of participants had experience of multiple sex partners. The final IMB model provided acceptable fit to the data (CFI = 0.992, RMSEA = 0.028). Preventive behavior was significantly predicted by behavioral skills (β = 0.754, P<0.001). Information (β = 0.138, P<0.001) and motivation (β = 0.363, P<0.001) were indirectly affected preventive behavior, and was mediated through behavioral skills.

Conclusions

The results of the study demonstrate the utility of the IMB model for consistent condom use among college students in China. The main influencing factor of preventive behavior among college students is behavioral skills. Both information and motivation could affect preventive behavior through behavioral skills. Further research could develop preventive interventions based on the IMB model to promote consistent condom use among college students in China.

Health behavior change models for HIV prevention and AIDS care: practical recommendations for a multi-level approach

Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social–structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the individual–structural spectrum, (2) to map out and compare the characteristics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly context-specific mechanisms, overall producing greater intricacies. We conclude with recommendations on how best to respond to this complexity, which include: using formative research and interdisciplinary collaboration to select the most appropriate levels and variables in a given context; measuring social and institutional variables at the appropriate level to ensure meaningful assessments of multiple levels are made; and conceptualizing intervention and research with reference to theoretical models and mechanisms to facilitate transferability, sustainability, and scalability.

Response inhibition moderates the association between drug use and risky sexual behavior

BACKGROUND

HIV infection is problematic among all drug users, not only injection drug users. Drug users are at risk for contracting HIV by engaging in risky sexual behaviors.

OBJECTIVE

The present study sought to determine whether inhibitory processes moderate the relationship between problematic drug use and HIV-risk behaviors (unprotected sex and multiple sex partners).

METHODS

One hundred ninety-six drug offenders enrolled in drug education programs were administered a battery of computer-based assessments. Measures included a cued go/no-go assessment of inhibitory processes, the Drug Abuse Screening Test (DAST) assessment of problematic drug use, and self-report assessment of condom use and multiple sex partners.

RESULTS

Findings revealed that response inhibition assessed by the proportion of false alarms on the cued go/no-go moderated the relationship between problematic drug use and an important measure of HIV risk (condom nonuse) among drug offenders. However, response inhibition did not moderate the relationship between problematic drug use and another measure of HIV risk: multiple sex partners.

CONCLUSIONS

Among this sample of drug offenders, we have found a relationship between problematic drug use and condom nonuse, which is exacerbated by poor control of inhibition. These findings have implications for the development of HIV intervention components among high-risk populations.

Mediation effect of perceived behavioural control on intended condom use: applicability of the theory of planned behaviour to money boys in China

BACKGROUND

Money boys (MBs) are male sex workers who sell sex to men who have sex with men. The objectives of this study were to assess (a) the sexual HIV risk of MBs; (b) the ability of the theory of planned behaviour (TPB) to predict MBs' intentions to use condoms; and (c) the manner in which TPB constructs (attitudes towards condom use, subjective norms and perceived behavioural control) combine to influence condom use intentions.

METHODS

Participants came from 10 MB-frequented clubs in two cities in China. Multiple regression and path analytic models were used to test inter-relationships among the TPB constructs.

RESULTS

Seventy-eight percent of the 122 MB participants reported having used condoms for every anal sex act. About one-third reported having had female sexual partners in the past 2 months; of these MBs, half (53%) used condoms for every sex act. A revised model using TPB constructs accounted for 52% of the variance of condom use intentions and revealed that perceived behavioural control was a mediator in pathways beginning with attitudes and ending with condom use intentions, and beginning with subjective norms and ending with intentions.

CONCLUSIONS

The findings suggest that a revised model of TPB applies to condom use intentions among Chinese MBs. It may be appropriate to adapt HIV interventions that are grounded in TPB and that have been shown to be effective elsewhere for use with Chinese MBs. HIV interventions for this population should give perceived behavioural control and its predictors special consideration.

Systematic review of HIV prevention interventions in China: a health communication perspective

OBJECTIVES

To examine whether communication strategies and principles have been utilized in the HIV prevention intervention programs conducted in China.

METHODS

Comprehensive literature searches were conducted using PsycINFO, Medline, and Academic Search Complete with combinations of a number of keywords. Studies were included if they (1) were conducted in China and published prior to October 2011; (2) tested interventions promoting HIV/sexual risk reduction; and (3) reported empirical outcome evaluations on HIV knowledge, condom use and other condom-related variables. Data on 11 dimensions were extracted and analyzed, including formative research, theory, message targeting, messenger and channels, process evaluation, evaluation design, outcome measures.

RESULTS

The majority of the 45 intervention studies were not theory-based, did not report conducting formative research or process evaluation, used pretest-posttest control group designs, combined nonmedia channels, printed and visual materials, and employed HIV knowledge and condom use as outcome measures.

CONCLUSIONS

Many HIV prevention interventions in China have been successful in reducing HIV risk-related outcomes. This literature has its weaknesses; however, the current review illuminates gaps in the literature and points to important future directions for research.

Correlates of condom use among chinese college students in hunan province

A cross-sectional survey was conducted to test an integrated model of condom use with a sample of 490 sexually active Chinese college students. A number of variables in the integrated model were predictors of condom use, explaining 33.4% of the variance in use. Partner communication was the strongest predictors (β = .317, SE = .038, p < .001). Self-efficacy (β = .252, SE = .076, p < .001), positive attitudes (β = .150, SE = .060, p < .001), and social norms (β = .207, SE = .080, p < .001) were also significant predictors of condom use. Additionally, peer communication marginally significantly predicted condom use (β = .089, SE = .039, p = .055). This study provides evidence of the utility of the theories of reasoned action and planned behavior as an effective underlying theoretical framework for HIV prevention and safe sex intervention programs in a non-Western culture. The study also provides evidence that communication with sexual partners about condom use should be one of the most important factors to be considered in the development of HIV prevention and safer sex education programs for Chinese youth.

Sexual behaviors, decisional balance, and self-efficacy among a sample of Chinese college students in the United States

OBJECTIVES

To assess sexual behaviors and condom use including perceived benefits, barriers, and self-efficacy among Chinese college students in the United States.

PARTICIPANTS

One hundred thirty-three Chinese undergraduate and graduate students studying at 3 US universities.

METHODS

Self-report Internet questionnaire grounded in the Transtheoretical Model (TTM) framework analyzed with multivariate linear regression.

RESULTS

More than half (57.9%) have initiated sex. Only 27.3% used condoms every time. Frequent reasons for not using condoms were trust in partner, reduced pleasure, and partner dislike for condoms. Participants in the earlier TTM stages (precontemplation, contemplation, preparation) reported more worry about making partners angry if condoms were used and lower self-efficacy in situations involving alcohol or drug use and perceived low-risk scenarios.

CONCLUSIONS

Interventions should increase condom availability to students and should also make condom use more acceptable, more often expected, and easier to discuss.

A test of an adapted multiple domain model in predicting sexual behaviors among unmarried young adults in India

Theory-based, scientific research examining sexual behaviors of young adults is sparse in India, even though pre-marital sex among unmarried young people has been rising in recent years. At the same time, young people aged 15 to 24 are disproportionately affected by HIV/AIDS. This has been attributed in part to rising pre-marital sexual behaviors, coupled with a lack of sex education. The objective of this study was to advance an understanding of the determinants of sexual behavior among unmarried young adults in northern India. An adaptation of a comprehensive model of health behavior, the Multiple Domain Model, was employed to study the effects of environmental/cultural influences (parental and media), structural determinants (sex, socioeconomic status, age, caste, and place of residence), personality factors (sensation-seeking and impulsive decision making), gender role identity, psychosocial variables (attitudes, norms, and self-efficacy), contextual influences (relationship status and alcohol/drug use) and preparatory behaviors (frequency of being in sexual situations) on adolescents' sexual behaviors. Results of path analysis indicated that key predictors of ever having had vaginal sex included preparatory behaviors, masculine gender role identity, attitudes toward having sex and peer norms regarding sex. Implications of these findings for future research and intervention are discussed.