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Yang X, Yu Y, Song X, He L, Fu Y, Zhang J, Wang X, Zhang H. Prevalence of unprotected anal intercourse and associated factors among male students who have sex with men in Qingdao, China: A cross-sectional study. Medicine (Baltimore) 2023; 102:e33180. [PMID: 36862866 PMCID: PMC9981382 DOI: 10.1097/md.0000000000033180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
The significant rise of human immunodeficiency virus (HIV) epidemic among young students has become a new feature of acquired immune deficiency syndrome in China, and unprotected anal intercourse (UAI) among male students who have sex with men (SMSM) played a central role in this process. The aim of this study was to investigate the prevalence of UAI, as well as analyze the factors associated with UAI among SMSM in Qingdao, China. From May 2021 to April 2022, men who aged 15 to 30, studied in a high school or college in Qingdao and had anal sex with men in the past 6 months were recruited through snowball method relying on the nongovernmental organization. An anonymous electronic questionnaire was administrated to collect information on socio-demographic characteristics, sexual behaviors, substance use before sex, HIV prevention services and self-esteem. Univariate and multivariate logistic regressions were used to assess factors related to UAI. Among the 341 SMSM included in the study, 40.5% engaged in UAI in the past 6 months. Being migrants from other provinces [odds ratios (OR) = 2.04, 95% confidence intervals (CI): 1.10-3.78], failing to use condoms for the first anal intercourse (OR = 3.38, 95% CI: 1.85-6.18), drinking alcohol before sex (OR = 2.31, 95% CI: 1.25-4.28) and being low level self-esteem (OR = 1.77, 95% CI: 1.09-2.87) were positively associated with UAI. SMSM who had homosexual intercourse more than once a week (OR = 1.76, 95% CI: 1.03-3.00) or had multiple male sex partners (OR = 1.99, 95% CI: 1.20-3.30) were more likely to engage in UAI. Received peer education in the past 12 months (OR = 0.48, 95% CI: 0.27-0.86) was associated with lower odds of UAI. The situation of UAI among SMSM in Qingdao was a public health issue of concern. It is necessary to take targeted measures, such as focusing on first-time sex, advancing sexual health education, expanding peer education, implementing alcohol use screening and maintaining the self-esteem of SMSM, so as to reduce the occurrence of high-risk behaviors among SMSM and curb the spread of HIV on campus.
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Affiliation(s)
- Xuebin Yang
- School of Public Health, Qingdao University, Qingdao, China
| | - Yingying Yu
- School of Public Health, Qingdao University, Qingdao, China
| | - Xin Song
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Lili He
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Yong Fu
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Jianwen Zhang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Xiaojun Wang
- School of Public Health, Shandong First Medical University, Tai An, China
| | - Huaqiang Zhang
- School of Public Health, Qingdao University, Qingdao, China
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
- * Correspondence: Huaqiang Zhang, School of Public Health, Qingdao University, Qingdao 266071, China (e-mail: )
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Valente PK, Edeza A, Klasko-Foster L, Mimiaga MJ, Mayer KH, Safren SA, Biello KB. Sexual orientation and social network size moderate associations between stigma and problematic alcohol use among male sex workers in the US Northeast: an observational study. Sex Health 2020; 17:429-436. [PMID: 33176902 DOI: 10.1071/sh20137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023]
Abstract
Background Stigma is associated with poor health among sexual minority individuals. However, no studies have examined the relationship between stigma and problematic drinking among male sex workers (MSWs). This study examined the relationship between sex work stigma and problematic alcohol use among MSWs. METHODS Using baseline data from a cohort of 98 MSWs in the US Northeast enrolled between 2015 and 2016, we used logistic regression to examine associations between sex work stigma and hazardous drinking (Alcohol Use Disorders Identification Test (AUDIT) score ≥8) and sex work while drunk, and tested whether sexual orientation (gay vs non-gay identified) and social network size moderated these associations. RESULTS Almost half the sample (n = 46; 44%) reported hazardous drinking and 56 MSWs (57%) reported engaging in sex work while drunk. Sex work stigma was associated with hazardous drinking (adjusted odds ratio (aOR) 1.2, 95% confidence interval (CI) 1.05-1.36). Sexual orientation marginally moderated this relationship (P = 0.07), such that it was only significant among gay-identified MSWs (aOR 1.91, 95% CI 1.11-3.28), not among non-gay MSW. Similarly, sexual orientation moderated the effect of sex work stigma on sex work while drunk (P = 0.02), which was only significant among gay-identified MSWs (aOR 1.65, 95% CI 1.05-1.60). Social network size also moderated the effect of sex work stigma on sex work while drunk (P = 0.02), which was only significant among MSWs with small networks (aOR 1.26, 95% CI 1.00-1.58), suggesting large networks can be protective. CONCLUSIONS Gay MSWs may be particularly vulnerable to alcohol-related effects of stigma. Future interventions should consider engaging social networks to curb problematic drinking among MSWs.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA; and Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; and Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, 700 Butler Drive, Box G-BH, Providence, RI 02906, USA; and The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; and Harvard University Medical School, 25 Shattuck Street, Boston, MA 02115, USA; and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA; and Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; and The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; and Corresponding author.
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Yang GL, Zhang AD, Yu Y, Liu H, Long FY, Yan J. Drug use and its associated factors among money boys in Hunan Province, China. Public Health 2016; 140:213-220. [PMID: 27381058 DOI: 10.1016/j.puhe.2016.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/24/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe drug use, types of drugs and related factors among money boys in Hunan Province, China. STUDY DESIGN A cross-sectional study was conducted between July 2012 and January 2013. METHODS Based on respondent-driven sampling, researchers located seven 'seeds' via a gay-dating website: http://www.ixxqy.org. After three waves of recruitment, 234 money boys were enrolled. They were asked to complete a 23-item questionnaire regarding demographic characteristics, drug use, a history of human immunodeficiency virus infection and family environment. Descriptive statistics and logistic regression analysis were conducted using Statistical Package for the Social Sciences Version 20.0. RESULTS In total, 205 valid questionnaires were collected. Based on the data collected, 80 (39.0%) money boys had used drugs within the last 3 months. Rush popper (36.6%) and methamphetamine (12.7%) were used most commonly, and other drugs used were ecstasy (7.8%), ketamine (5.9%), marijuana (2.4%), morphine (1.5%), heroin (1.0%) and cocaine (0.5%). Factors included in the logistic regression were length of service (odds ratio [OR] 0.395, 95% confidence interval [CI] 0.175-0.896), being an only child (OR 2.272, 95% CI 1.108-4.659), relationship between parents (OR 0.428, 95% CI 0.213-0.858) and social network (OR 2.387, 95% CI 1.144-4.970). A shorter length of service and a good relationship between parents were protective factors against drug use, while being an only child and having a wide social network were risk factors. CONCLUSION Drug use is common among money boys. This study found that length of service, being an only child, relationship between parents and social network are associated with drug use.
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Affiliation(s)
- G L Yang
- Third Xiangya Hospital, Central South University, Changsha, China
| | - A D Zhang
- Third Xiangya Hospital, Central South University, Changsha, China
| | - Y Yu
- School of Humanities and Management, Southern Medical University, Guangzhou, China
| | - H Liu
- Third Xiangya Hospital, Central South University, Changsha, China
| | - F Y Long
- Third Xiangya Hospital, Central South University, Changsha, China
| | - J Yan
- Third Xiangya Hospital, Central South University, Changsha, China.
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Ibragimov U, Harnisch JA, Nehl EJ, He N, Zheng T, Ding Y, Wong FY. Estimating self-reported sex practices, drug use, depression, and intimate partner violence among MSM in China: a comparison of three recruitment methods. AIDS Care 2016; 29:125-131. [PMID: 27367038 DOI: 10.1080/09540121.2016.1201191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Men who have sex with men (MSM) are the group at highest risk for HIV in China. Researchers have used various recruitment methods to reach this population hidden from the hetero-normative culture. To inform future recruitment strategies, we compared estimates of socio-demographic characteristics, HIV risk behaviors, depression, and intimate partner violence (IPV) across three samples of MSM and money boys in Shanghai, China. Data were collected from three community-based samples of MSM and money boys (n = 1352) recruited via respondent-driven sampling (RDS) (n = 404), community popular opinion leaders (CPOL) (n = 385), and Internet and venue-based sampling (VBS) (n = 546). Different recruitment methods generated samples with statistically significant differences among a number of socio-demographic characteristics, sexual behaviors, drug use, depression scores, and exposure to IPV. Specifically, RDS participants had lower education (p = .002), income levels (p < .001), and were more likely to report condomless sex with a woman (p < .001). CPOL participants were younger (p < .001), more likely to report lifetime condomless anal sex (p = .009), more than 10 male partners in the past 30 days (p < .001), and were less likely to experience violence by a male intimate partner (p = .001). VBS participants had lowest depression score (p = .005) and were more likely to report lifetime drug use (p = .003). Our findings reinforce that each recruitment method may reach a sub-group of MSM with a specific risk profile, so multiple methods may be needed to obtain a representative sample of MSM. Interventions may use specific recruitment methods to target certain segments of the MSM population.
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Affiliation(s)
- Umedjon Ibragimov
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Jessica A Harnisch
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Eric J Nehl
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Na He
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA.,b Department of Epidemiology , Fudan University School of Public Health , Shanghai , China
| | - Tony Zheng
- c Shanghai Piaoxue Cultural Media, Ltd ., Shanghai , China
| | - Yingying Ding
- b Department of Epidemiology , Fudan University School of Public Health , Shanghai , China
| | - Frank Y Wong
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA.,d Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA.,e Department of Epidemiology , Emory University Rollins School of Public Health , Atlanta , GA , USA.,f Department of Sociology , Emory College, Emory University , Atlanta , GA , USA
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Validity of the CAGE questionnaire for men who have sex with men (MSM) in China. Drug Alcohol Depend 2016; 160:151-6. [PMID: 26850511 PMCID: PMC4767580 DOI: 10.1016/j.drugalcdep.2015.12.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/03/2015] [Accepted: 12/31/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Detection of heavy drinking among men who have sex with men (MSM) is crucial for both intervention and treatment. The CAGE questionnaire is a popular screening instrument for alcohol use problems. However, the validity of CAGE for Chinese MSM is unknown. METHOD Data were from three waves of cross-sectional assessments among general MSM (n=523) and men who sell sex to other men ("money boys" or MBs, n=486) in Shanghai, China. Specifically, participants were recruited using respondent-driven, community popular opinion leader, and venue-based sampling methods. The validity of the CAGE was examined for different cutoff scores and individual CAGE items using self-reported heavy drinking (≥14 drinks in the past week) as a criterion. RESULTS In the full sample, 75 (7.4%) of participants were classified as heavy drinkers. 32 (6.1%) of general MSM and 43 (8.9%) of MBs were heavy drinkers. The area under curve statistics for overall sample was 0.7 (95% CI: 0.36-0.77). Overall, the sensitivities (ranging from 18.7 to 66.7%), specificities (ranging from 67.5 to 95.8%), and positive predictive values (ranging from 14.1 to 26.4%) for different cutoff scores were inadequate using past week heavy drinking as the criterion. The ability of CAGE to discriminate heavy drinkers from non-heavy drinkers was limited. CONCLUSIONS Our findings showed the inadequate validity of CAGE as a screening instrument for current heavy drinking in Chinese MSM. Further research using a combination of validity criteria is needed to determine the applicability of CAGE for this population.
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Fan W, Lu R, Wu G, Yousuf MA, Feng L, Li X, Xiao Y, Shao Y, Ruan Y. Alcohol drinking and HIV-related risk among men who have sex with men in Chongqing, China. Alcohol 2016; 50:1-7. [PMID: 26632032 DOI: 10.1016/j.alcohol.2015.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 09/23/2015] [Accepted: 09/23/2015] [Indexed: 12/28/2022]
Abstract
To estimate the prevalence of any alcohol use and heavy alcohol drinking using the Alcohol Use Disorders Identification Test (AUDIT) and its correlates among men who have sex with men (MSM), a cross-sectional study was conducted among 391 MSM in Chongqing, China to collect data about sociodemographic characteristics, alcohol use, sexual behaviors, and other related factors through a computer-assisted self-administered questionnaire. Heavy alcohol drinking in the past 12 months was defined as an AUDIT-C score ≥ 4. Blood was collected from each potential participant to test for HIV and syphilis status. Twenty three percent of MSM had consumed a drink containing alcohol in the previous year. 7.2% had an AUDIT-C score ≥ 4, defined as heavy alcohol drinkers. 23.5% were unmarried, but planning to marry, who were more likely to report any alcohol drinking (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 1.40-4.06) and to have AUDIT-C scores ≥ 4 (AOR, 3.58; 95% CI, 1.60-8.00). MSM who had used any alcohol in the previous year, and MSM who were heavy alcohol drinkers, were more likely to have had anal sex with male casual partners in the previous 6 months, to have been tested for HIV, and to have decreased scores on the scales of general self-efficacy, increased scores on the scales of stigma and discrimination. Our findings provided further evidence of the associations of any alcohol use and heavy alcohol consumption with HIV-risky behaviors, lowered sense of general self-efficacy, and higher sense of HIV/AIDS-related stigma and discrimination among MSM in the city with the highest HIV epidemic among MSM in China.
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Affiliation(s)
- Wensheng Fan
- Department of Public Health, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Rongrong Lu
- Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Guohui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Mohammed Adnan Yousuf
- Department of Public Health, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Liangui Feng
- Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Xuefeng Li
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China; Karamay Center for Disease Control and Prevention, Karamay, PR China
| | - Yan Xiao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China.
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Liu G, Lu H, Wang J, Xia D, Sun Y, Mi G, Wang L. Incidence of HIV and Syphilis among Men Who Have Sex with Men (MSM) in Beijing: An Open Cohort Study. PLoS One 2015; 10:e0138232. [PMID: 26426271 PMCID: PMC4591335 DOI: 10.1371/journal.pone.0138232] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/26/2015] [Indexed: 12/31/2022] Open
Abstract
Background This study investigated HIV and syphilis incidence among men who have sex with men (MSM) in Beijing, China. Methods An open cohort was established from September 2009 to April 2012. Participants were followed up with every three to four months after recruitment and for thirty-one months in total. Chi-square tests were used to compare demographic and behavioral characteristics between participants who were followed up with and those lost to follow up. Univariate and multivariate Cox proportional hazards regression analyses were used to examine demographic and behavioral associations with HIV and syphilis incidence. Results 69.7% (699/1,003) of the participants finished at least two follow-up surveys during the study period. Variables which corresponded to increased loss to follow-up included younger age, less education, non-identification of homosexual identity, and migrant status. A total of 1,045 person-years (PYs) and 1,016.4 PYs were followed up for HIV and syphilis incidence estimation, respectively. The HIV incidence was 5.9 per 100 PYs and 7.8 per 100 PYs for syphilis. The predictors for the high HIV incidence included unsafe anal sex, sex after drinking alcohol and STI infection. Conclusion HIV incidence increased rapidly within the cohort, but syphilis incidence remained stable and decreased. More research is needed to provide multi-pronged HIV prevention interventions among MSM in order to reduce the increasing burden of HIV and sexually transmitted infections (STIs) in China.
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Affiliation(s)
- Guowu Liu
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Hongyan Lu
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Juan Wang
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Dongyan Xia
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Yanming Sun
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Guodong Mi
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (GDM); (LMW)
| | - Liming Wang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- * E-mail: (GDM); (LMW)
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Chen X, Yu B, Zhou D, Zhou W, Gong J, Li S, Stanton B. 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. PLoS One 2015; 10:e0134712. [PMID: 26241900 PMCID: PMC4524597 DOI: 10.1371/journal.pone.0134712] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
- School of Public Health, Wuhan University, Wuhan, China
- Pediatric Prevention Research Center, Wayne State University, Detroit, Michigan, United States of America
- * E-mail:
| | - Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
| | - Dunjin Zhou
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Wang Zhou
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Jie Gong
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Shiyue Li
- School of Public Health, Wuhan University, Wuhan, China
| | - Bonita Stanton
- Pediatric Prevention Research Center, Wayne State University, Detroit, Michigan, United States of America
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Yang C, Guadamuz TE, Lim SH, Koe S, Wei C. Factors Associated with Alcohol Use Before or During Sex Among Men Who Have Sex with Men in a Large Internet Sample from Asia. LGBT Health 2015; 3:168-74. [PMID: 26789393 DOI: 10.1089/lgbt.2014.0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We explored factors associated with alcohol use before or during sex among a sample of 10,861 men who have sex with men (MSM) in Asia who were recruited online for the study. Multinomial logistic regression analysis indicated that having sex under the influence of alcohol was associated with having multiple male partners, seeking partners primarily through gay bar/gym/dance party/friends, selling sex and using multiple drugs during the past 6 months, and unprotected anal sex. More efforts are needed to better assess alcohol use and misuse among MSM in Asia and understand contextual influences on alcohol use and HIV-related behaviors in order to implement culturally-specific interventions.
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Affiliation(s)
- Cui Yang
- 1 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Thomas E Guadamuz
- 2 Department of Society and Health, Center for Health Policy Studies, Faculty of Social Sciences and Humanities Mahidol University , Bangkok, Thailand
| | - Sin How Lim
- 3 Center of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur, Malaysia
| | | | - Chongyi Wei
- 5 Department of Epidemiology and Biostatistics & Global Health Sciences, University of California-San Francisco , San Francisco, California
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Abstract
BACKGROUND This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka "money boys") in China. OBJECTIVES Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs. METHODS The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM. RESULTS MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex. CONCLUSIONS It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.
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Affiliation(s)
- Eric J Nehl
- 1Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
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Alcohol use among Chinese men who have sex with men: an epidemiological survey and meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:414381. [PMID: 24711993 PMCID: PMC3966324 DOI: 10.1155/2014/414381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/12/2014] [Indexed: 12/26/2022]
Abstract
The HIV/AIDS epidemic among Chinese men who have sex with men (MSM) has become a significant public health concern. Knowledge of alcohol consumption in this population is limited. In this study, 1,155 Chinese MSM were surveyed to assess alcohol use and its correlates. A meta-analysis was also performed to aggregate pooled prevalence of current alcohol use. MSM who were unmarried (aOR: 1.87; 95% CI: 1.29-2.71) or unemployed/retired (aOR: 2.77; 95% CI: 1.73-4.45) were more likely to drink alcohol more than once per week. MSM who consumed alcohol more than once per week were more likely to use drug (P < 0.01), have sex with women (P < 0.01), have unprotected insertive (P = 0.04) or receptive (P = 0.03) anal sex with men, have more than 10 lifetime male sex partners (P < 0.01), predominantly practice insertive anal sex (P < 0.01), and trade sex for money (P < 0.01). Pooled overall alcohol use prevalence was 32%. Pooled prevalence for MSM who drank alcohol more than once per week and who drank alcohol before sex with male partners was 23%. Our findings provide the basis for further exploring the alcohol-HIV association and developing risk reduction interventions.
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Yan H, Wong FY, Zheng T, Ning Z, Ding Y, Nehl EJ, Lin L, He N. Social support and depressive symptoms among 'money' boys and general men who have sex with men in Shanghai, China. Sex Health 2014; 11:285-7. [PMID: 24919661 DOI: 10.1071/sh14017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/27/2014] [Indexed: 12/18/2022]
Abstract
The primary objective was to examine prevalence and correlates of social support and depressive symptoms among male sex workers (known as 'money boys' (MBs)) and general men who have sex with men (MSM) in Shanghai. The Social Provision Scale (SPS), which consists of 24 items, scored out of 4 for social provision, was used to evaluate the functions of social relationships. The score for each item ranges from 1 to 4, with a higher score indicating more social provision. The overall mean SPS score was 68.1 (s.d.=6.53) for MBs and 69.3 (s.d.=6.99) for general MSM. Depression was measured with a 12-item version of the Center for Epidemiological Studies Depression Scale (CES-D), where a score of 9 has been recommended as the cutoff score to indicate possible depressive symptoms. The prevalence of depressive symptoms was 57.9%, with MBs having a higher level of depressive symptoms than general MSM (70.0% v. 46.1%) (odds ratio=1.86, 95% confidence interval=1.07-3.24). Social support was a protective factor for depressive symptoms (odds ratio=0.92, 95% confidence interval=0.89-0.96). MSM in China, particularly MBs, are vulnerable to low social support and high depressive symptoms, highlighting the need for tailored psychological programs targeting this population.
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Affiliation(s)
- Huamei Yan
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Tony Zheng
- Shanghai Piaoxue Cultural Media Limited, Shanghai 200023, China
| | - Zhen Ning
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Lavinia Lin
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China
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Lu H, Han Y, He X, Sun Y, Li G, Li X, McFarland W, Xiao Y, Shao Y, Ruan Y, Raymond HF. Alcohol use and HIV risk taking among Chinese MSM in Beijing. Drug Alcohol Depend 2013; 133:317-23. [PMID: 23876859 DOI: 10.1016/j.drugalcdep.2013.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/04/2013] [Accepted: 06/05/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few studies have used standardized alcohol use measures among men who have sex with men in China. METHODS A cross-sectional study was conducted among MSM in Beijing. A computer-assisted self-administered questionnaire was used to collect demographics, risk behaviors the Alcohol Use Disorders Identification Test (AUDIT). AUDIT uses a cutoff score of ≥ 8 while AUDIT C uses a score of ≥ 4 to classify respondents as problem drinkers. Both include a binge drinking measure. RESULTS A total of 500 participants were recruited using respondent-driven sampling. HIV and prevalence is estimated to be 6.1% (95% CI 3.7, 9.2). Almost half of MSM (42.1%, 95% CI 35.8, 49.0) never had a drink containing alcohol in the past year. 5.0% (95% CI 3.1, 7.0) and 8.8% (95% CI 6.1, 11.6) had AUDIT score ≥ 8 and AUDIT-C score ≥ 4, respectively. Binge drinking was at 11.8% (95% CI 7.9, 16.0). In multivariate models all measures were associated with alcohol during sex, while AUDIT was associated with high level of attitudes and perceptions on safe sex (AOR 0.9, 95% CI 0.9,1.0), AUDIT-C with being older (AOR 3.5, 95%CI 1.4, 8.8), and HIV status (AOR 2.2, 95% CI 1.4, 10.9), and binge drinking with number of male partners (AOR 2.0, 95% CI 1.0, 3.9) and ever having had an HIV test (AOR 1.0, 95%CI 0.9, 1.0). Compared to AUDIT ≥ 8, AUDIT-C ≥ 4 and binge drinking were more suitable in identifying HIV risks related to problem drinking. CONCLUSIONS Findings suggest AUDIT is appropriate for use among MSM in China and reinforces the need for incorporating problem drinking as part of approaches to prevent HIV infection among Chinese MSM.
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Affiliation(s)
- Hongyan Lu
- Beijing Center for Disease Prevention and Control, 16 Hepinglizhongjie, Beijing 100013, China
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Luo X, Duan S, Duan Q, Pu Y, Yang Y, Ding Y, Gao M, He N. Alcohol use and subsequent sex among HIV-infected patients in an ethnic minority area of Yunnan Province, China. PLoS One 2013; 8:e61660. [PMID: 23626712 PMCID: PMC3633954 DOI: 10.1371/journal.pone.0061660] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/12/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To examine alcohol use and subsequent HIV risky behaviors among a sample of predominately ethnic minority people living with HIV/AIDS (PLWHA) in a rural community in Yunnan Province, China. Method A cross-sectional study with a face-to-face questionnaire interview was conducted among eligible participants. Results In total, 455 (94.4%) out of 482 eligible HIV patients participated in the study. Of them, 82.6% were ethnic minorities; 15.4% were never married; 96.5% were sexually experienced; 55.4% had used drugs, 67% were receiving antiretroviral therapy (ART). Over 65% were ever drinkers; of whom 61.5% were current drinkers. Among current drinkers, 32.4% drank daily and 41.2% were hazardous drinkers. Chinese white wine was the preferred choice. Higher level of alcohol use among drinkers in the preceding month was positively associated with being males (OR = 2.76, 95%CI: 1.03–7.43), ethnic minorities (OR Jingpo = 2.21, 95%CI: 1.06–4.59; OR other minorities = 3.20, 95%CI: 1.34–7.62), higher education (OR1–6 = 1.98, 95%CI: 0.99–3.96; OR≥7 = 2.35, 95%CI: 1.09–5.06) and being ART-naive (OR = 2.69, 95%CI: 1.67–4.32). About 39% of ever drinkers reported having engaged in sex after drinking since HIV diagnosis. Those who were younger than 46 years (OR16–25 = 7.77, 95%CI: 1.22–49.60, OR26–35 = 2.79, 95%CI: 1.06–7.35, OR36–45 = 2.96, 95%CI: 1.57–7.58), hazardous drinkers (OR = 1.99, 95%CI: 1.00–3.97) and drug users (OR = 3.01, 95%CI: 1.19–7.58) were more likely to have had sex after drinking. Approximately 56% of drug users had used drugs after drinking. Conclusions High prevalence of alcohol use and subsequent risky behaviors including sexual engagement and drug use among HIV patients in rural Yunnan require tremendous and integrated efforts for prevention and control of alcohol and drug abuse and HIV spreading.
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Affiliation(s)
- Xiaofeng Luo
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
| | - Song Duan
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Qixiang Duan
- Longchuan County Center for Disease Control and Prevention, Dehong Prefecture, Longchuan, Yunnan Province, China
| | - Yongcheng Pu
- Longchuan County Center for Disease Control and Prevention, Dehong Prefecture, Longchuan, Yunnan Province, China
| | - Yuecheng Yang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
- * E-mail:
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Nehl EJ, Nakayama KK, He N, Huang ZJ, Zheng T, Wong FY. Substance Use and Sexual Risks Among General MSM and Money Boys in Shanghai, China. JOURNAL OF DRUG ISSUES 2012. [DOI: 10.1177/0022042612456016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In China, men who have sex with men (MSM) are at high risk for substance use, HIV, and other sexually transmitted infections (STIs). However, there has been little research into their drug use and the sexual behaviors they engage in after drug and alcohol use. Using respondent-driven sampling methodology, this cross-sectional study of 404 MSM described drug use and examined sexual behaviors after drug and alcohol use among general MSM and money boys (those who engage in same-sex commercial sex) in Shanghai, China. Money boys reported using more drugs in the last week, 3 months and ever, and having sex after drinking and sex after using drugs more frequently than general MSM. It is vital to continue research and begin science-based interventions in these high-risk and underserved populations.
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Affiliation(s)
- Eric J. Nehl
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Na He
- Emory University Rollins School of Public Health, Atlanta, GA, USA
- Fudan University School of Public Health, Shanghai, China
| | | | - Tony Zheng
- Shanghai Piaoxue Cultural Media Limited, Shanghai, China
| | - Frank Y. Wong
- Emory University Rollins School of Public Health, Atlanta, GA, USA
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