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Yang Y, Deng H, He H, Fan SF, Li Y, Wu X, Li N, Xi J, Xu J, Xiao J, Liao RP, Xiao W. Lifetime commercial heterosexual behavior among HIV negative elderly men from rural Chengdu, China: a modified knowledge-attitude-practice perspective. BMC Public Health 2021; 21:2095. [PMID: 34781900 PMCID: PMC8594087 DOI: 10.1186/s12889-021-12139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background China is facing big challenges to achieve the “90–90-90 targets”. The HIV prevalence of elderly (≥50 years) men have been steadily increasing in China, mainly through the sexual transmission route, but sexual behaviors of them are far from well-studied. In 2019, elderly men accounted for 59.2% of HIV/AIDS cases in Sichuan, China. Methods The research design is a cross-sectional study. Face-to-face interviews were conducted among 795 HIV negative elderly men from rural Chengdu, capital City of Sichuan. Bivariate and multivariate logistic regression models were applied to examine factors associated with commercial heterosexual behavior from a modified Knowledge-Attitude-Practice (KAP) perspective. Results 129 (16.23%) respondents admitted high-risk sexual behaviors, including 11.07% commercial heterosexual behavior, 6.16% extramarital, 2.89% casual and 0.25% homosexual behavior, and no one used condom consistently. 427(68.43%) had ever gotten HIV-related Health Education (HRHE), mainly through mass media (70.49%). The HIV-related knowledge awareness rate was only 31.41%. Migration history (AOR =2.46,95% CI = 1.02–5.91), age(≥60 vs. 50–59, OR = 0.41, 95% CI = 0.19–0.91), receiving HRHE from mass media (OR = 0.37, 95%CI = 0.16–0.85), marital status (married vs. never married, OR = 0.04, 95%CI = 0–0.52), and undecided (AOR =0.02, 95%CI = 0.01–0.09) and objection (AOR =0.04, 95%CI = 0.01–0.1) attitude toward commercial sex were related to lifetime commercial heterosexual behavior. Conclusions High-risk sexual behaviors are common among elderly men from rural areas in Chengdu. Receiving HRHE from mass media and undecided and objection attitude toward commercial sex prevent elderly from being involving in commercial heterosexual behavior. According to the results, health facilities should continue to conduct systematic interventions, paying more attention to 50–59 years old group. Sex and condom use need to be talked in public. Working with mass media, health facilities give elderly men education not only focusing on HIV/AIDS, but also on knowledge and skills of condom use.
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Affiliation(s)
- Yi Yang
- Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China.
| | - Hua Deng
- Department of Urology, Chengdu Second Peoples' Hospital, 10 Qingyunnan Road, Chengdu, 610017, China
| | - Huan He
- School of Public Administration, Southwestern University of Finance and Economics, 555 Liutai Avenue, Wenjiang District, Chengdu, China
| | - Shuang Feng Fan
- Department of HIV/AIDS prevention, Chengdu Center for Disease Control and Prevention, No.4, Longxiang Road, Wuhou District, Chengdu, 610000, China
| | - Yuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China
| | - Xia Wu
- Department of HIV/AIDS prevention, Pengzhou Center for Disease Control and Prevention, 331 Longta Road, Pengzhou District, Chengdu, 610000, China
| | - Na Li
- Department of HIV/AIDS prevention, Pengzhou Center for Disease Control and Prevention, 331 Longta Road, Pengzhou District, Chengdu, 610000, China
| | - Jing Xi
- Department of HIV/AIDS prevention, Chengdu Center for Disease Control and Prevention, No.4, Longxiang Road, Wuhou District, Chengdu, 610000, China
| | - Jing Xu
- Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China
| | - Jie Xiao
- Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China
| | - Rui Ping Liao
- Department of HIV/AIDS prevention, Pengzhou Center for Disease Control and Prevention, 331 Longta Road, Pengzhou District, Chengdu, 610000, China
| | - Wei Xiao
- Department of HIV/AIDS prevention, Pengzhou Center for Disease Control and Prevention, 331 Longta Road, Pengzhou District, Chengdu, 610000, China
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Sun S, Whiteley L, Brown LK. HIV Testing Among Chinese Men Who Have Sex with Men: The Roles of HIV Knowledge, Online Social Life, and Sexual Identity Concerns. AIDS Behav 2020; 24:437-449. [PMID: 30924064 PMCID: PMC6765462 DOI: 10.1007/s10461-019-02471-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
HIV testing is critical for timely care and controlling the HIV epidemic among men who have sex with men (MSM), particularly for regions with increasing infection rates such as China. This study investigated HIV testing and associated demographic, psychosocial, and risk behavior factors among internet-using Chinese MSM (n = 332). Most participants received HIV testing before (74.1%), which was associated with more HIV knowledge, online social life, and more frequent condomless anal sex. Among MSM who tested previously (n = 246), 48.4% reported regular HIV testing, which was associated with a greater online social life and less sexual identity concerns (internalized homonegativity and concealment motivation). Findings suggest a two-step approach to engage MSM who never tested for HIV and who do not undergo regular testing. Strategies to promote testing should enhance HIV knowledge, sex education, and online MSM community building. Interventions to increase acceptance and positivity of sexual identity are crucial to regular testing.
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Affiliation(s)
- Shufang Sun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 167 Point Street, Providence, RI, 02901, USA.
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 167 Point Street, Providence, RI, 02901, USA
| | - Larry K Brown
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 167 Point Street, Providence, RI, 02901, USA
- Division of Child and Adolescent Psychiatry, Bradley and Hasbro Children's Hospital, Providence, RI, USA
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Purnomo J, Coote K, Mao L, Fan L, Gold J, Ahmad R, Zhang L. Using eHealth to engage and retain priority populations in the HIV treatment and care cascade in the Asia-Pacific region: a systematic review of literature. BMC Infect Dis 2018; 18:82. [PMID: 29454322 PMCID: PMC5816561 DOI: 10.1186/s12879-018-2972-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 01/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The exponential growth in the reach and development of new technologies over the past decade means that mobile technologies and social media play an increasingly important role in service delivery models to maximise HIV testing and access to treatment and care. This systematic review examines the impact of electronic and mobile technologies in medical care (eHealth) in the linkage to and retention of priority populations in the HIV treatment and care cascade, focussing on the Asia-Pacific region. METHODS The review was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement from the Cochrane Collaboration guidelines. Both grey and published scientific literature from five different databases were searched for all original articles in English published from 2010 to 2017. Studies conducted outside the Asia-Pacific region or not including HIV priority populations were excluded. The methodological quality of studies included in the review was assessed using the Quality Assessment Tool for Quantitative Studies. RESULTS The database search identified 7309 records. Of the 224 peer-reviewed articles identified for full text review, 16 studies from seven countries met inclusion criteria. Six cross sectional studies found evidence to support the use of eHealth, via text messages, instant messaging, social media and health promotion websites, to increase rates of HIV testing and re-testing among men who have sex with men (MSM). Evidence regarding the efficacy of eHealth interventions to improve antiretroviral treatment (ART) adherence was mixed, where one randomised controlled trial (RCT) showed significant benefit of weekly phone call reminders on improving ART adherence. Three further RCTs found that biofeedback eHealth interventions that provided estimated ART plasma concentration levels, showed promising results for ART adherence. CONCLUSIONS This review found encouraging evidence about how eHealth can be used across the HIV treatment and care cascade in the Asia-Pacific region, including increasing HIV testing and re-testing in priority populations as well as ART adherence. eHealth interventions have an important role to play in the movement towards the end of AIDS, particularly to target harder-to-reach HIV priority populations, such as MSM.
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Affiliation(s)
- Julianita Purnomo
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia.
| | - Katherine Coote
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
| | - Ling Fan
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia
| | - Julian Gold
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia.,Centre for Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, UK
| | - Raghib Ahmad
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia
| | - Lei Zhang
- Research Center for Public Health, Tsinghua University, Beijing, 100084, China. .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. .,Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia. .,School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia.
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Liu Y, Wang J, Qian HZ, Liu H, Yin L, Lu H, Zhang C, Ruan Y, Shao Y, Vermund SH. Seeking Male Sexual Partners via Internet and Traditional Venues among Chinese Men Who Have Sex with Men: Implications for HIV Risk Reduction Interventions. AIDS Behav 2016; 20:2222-2230. [PMID: 27000143 DOI: 10.1007/s10461-016-1371-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The dynamic nature of finding male sexual partners (sex-finding) among Chinese men who have sex with men (MSM) may play a substantial role in the HIV epidemic. We compared characteristics and behaviors of MSM who mostly sought sex via the Internet versus traditional venues in a cross-sectional survey among 3588 Chinese MSM. We assessed the sociodemographic predictors and compared high-risk behaviors of using Internet versus traditional venues for sex-finding. Compared to non-Internet MSM, Internet-user MSM were more likely to have been: younger, currently single, better educated, health-insured, with higher income, with Beijing residency ('Hukou'), living longer in the city, HIV-positive, ever using drug and engaging in condomless receptive anal sex. Internet sex-finding users were less likely to be sexually active for longer duration, drink alcohol, drink alcohol before sex, or ever have sex with women. Knowledge of differential characteristics of various sex-finding MSM can help design targeted interventions.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Juan Wang
- Beijing Municipal Center for Disease Control and Prevention, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Hongyan Lu
- Beijing Municipal Center for Disease Control and Prevention, Beijing, China
| | - Chen Zhang
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA.
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Souleymanov R, Huang YT. 'Men who use the Internet to seek sex with men': Rethinking sexuality in the transnational context of HIV prevention. Glob Public Health 2016; 11:888-901. [PMID: 27142110 DOI: 10.1080/17441692.2016.1180701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
MISM (i.e. men who use the Internet to seek sex with men) has emerged in public health literature as a population in need of HIV prevention. In this paper, we argue for the importance of rethinking the dominant notions of the MISM category to uncover its ethnocentric and heteronormative bias. To accomplish this, we conducted a historical, epistemological and transnational analysis of social sciences and health research literature (n = 146) published on MISM between 2000 and 2014. We critically unravel the normative underpinnings of 'westernised' knowledge upon which the MISM category is based. We argue that the essentialist approach of Western scholarship can homogenise MISM by narrowly referring to behavioural aspects of sexuality, thereby rendering multiple sexualities/desires invisible. Furthermore, we argue that a Eurocentric bias, which underlies the MISM category, may hinder our awareness of the transnational dynamics of sexual minority communities, identities, histories and cultures. We propose the conceptualisation of MISM as hybrid cultural subjects that go beyond transnational and social boundaries, and generate conclusions about the future of the MISM category for HIV prevention and health promotion.
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Affiliation(s)
- R Souleymanov
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - Y-T Huang
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
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Shi LE, Wei C, McFarland W, Yan H, Li J, Raymond HF. Comparing Samples of Men Who Have Sex with Men Recruited Online and in Venues, Jiangsu Province, China, 2013. LGBT Health 2015; 3:238-42. [PMID: 26651841 DOI: 10.1089/lgbt.2014.0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Two common methods to sample men who have sex with men (MSM) for HIV research are venue- and internet-based approaches. However, it is unclear which is best to sample Chinese MSM. METHODS We conducted side-by-side comparisons of time-location sampling (TLS) and an online sample of MSM in Nanjing, China. RESULTS TLS-recruited MSM tended to be older and of lower socio-economic status compared to online-recruited MSM, whereas online-recruited MSM reported higher risk behavior and lower frequency of HIV testing. CONCLUSION Significant differences were observed between the two separate samples. Without a gold standard, the choice of sampling method or recruitment approach should be guided by the segment of the population targeted to be reached.
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Affiliation(s)
- Ling-En Shi
- 1 Jiangsu Provincial Centers for Disease Control and Prevention , Nanjing, Jiangsu, China
| | - Chongyi Wei
- 2 Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California
| | - Willi McFarland
- 2 Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California.,3 San Francisco Department of Public Health , San Francisco, California
| | - Hongjing Yan
- 1 Jiangsu Provincial Centers for Disease Control and Prevention , Nanjing, Jiangsu, China
| | - Jianjun Li
- 1 Jiangsu Provincial Centers for Disease Control and Prevention , Nanjing, Jiangsu, China
| | - H Fisher Raymond
- 2 Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California.,3 San Francisco Department of Public Health , San Francisco, California
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Muessig KE, Bien CH, Wei C, Lo EJ, Yang M, Tucker JD, Yang L, Meng G, Hightow-Weidman LB. A mixed-methods study on the acceptability of using eHealth for HIV prevention and sexual health care among men who have sex with men in China. J Med Internet Res 2015; 17:e100. [PMID: 25900881 PMCID: PMC4420841 DOI: 10.2196/jmir.3370] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 12/19/2014] [Accepted: 02/05/2015] [Indexed: 01/16/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) infection disproportionately affects men who have sex with men (MSM). Over half of all HIV-positive MSM in China may not know their HIV status. Mobile phones and Web interventions (eHealth) are underutilized resources that show promise for supporting HIV education, testing, and linkage to care. Objective This mixed-methods study among MSM in China assessed technology utilization and eHealth acceptability for sexual health care. Methods We conducted in-depth interviews and an online survey. Qualitative analyses informed the development of the Internet survey, which was administered through two popular MSM websites. Bivariate and multivariate analysis assessed characteristics of MSM interested in eHealth for sexual health care. Results The qualitative sample included MSM across a range of ages, education, marital status, sexuality, and HIV testing experience. Qualitative findings included the importance of the Internet as the primary source of information about sexual health, HIV and other sexually transmitted diseases (STDs), use of the Internet to enable HIV testing opportunities by facilitating connections with both the gay community and health care providers, and mixed perceptions regarding the confidentiality of eHealth tools for sexual health. Among the Internet sample (N=1342), the average age was 30.6 years old, 82.81% (1098/1342) were single, and 53.42% (711/1331) had completed college. In the past 3 months, 38.66% (382/988) had condomless sex and 60.53% (805/1330) self-reported having ever tested for HIV. The majority of men owned computers (94.14%, 1220/1296) and mobile phones (92.32%, 1239/1342), which many had used to search for HIV/STD information and testing sites. In multivariate analysis, interest in using computers or mobile phones to support their sexual health care was associated with being a student, prior use of computers or mobile phones to search for general health information, prior use of computers or mobile phones to search for HIV/STD information, and confidentiality concerns. Conclusions MSM in this sample had high utilization of technology and interest in eHealth despite confidentiality concerns. Future eHealth interventions can thoughtfully and creatively address these concerns as a priority for successful implementation.
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Affiliation(s)
- Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Liu YY, Tao HD, Liu J, Fan YG, Zhang C, Li P, Li LJ, Huang Q, Zhao W, Ye DQ. Prevalence and associated factors of HIV infection among men who have sex with men in Hefei, China, 2013-2014: a cross-sectional study. Int J STD AIDS 2015; 27:305-12. [PMID: 25887062 DOI: 10.1177/0956462415580886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/16/2015] [Indexed: 11/16/2022]
Abstract
The objective of this study was to investigate the prevalence and influencing factors of HIV infection among men who have sex with men (MSM) in Hefei, China. A total of 578 MSM were recruited, with a mean age of 28.13 ± 6.91; 70.7% were under 30. The awareness rate was 95.4% (560/587) in the cross-sectional study. Of all the respondents, 73 (12.44%) were seropositive for HIV and 56 (9.54%) for syphilis. Multivariate analysis showed that self-reported sexually transmitted infections (STIs) (AOR = 8.02, 95% CI: 2.58-24.98, P < 0.001), received HIV testing in the past year (AOR = 0.33, 95% CI: 0.19-0.60, P < 0.001) and syphilis (AOR = 3.40, 95% CI: 1.69- 6.85, P = 0.001) were independently associated with HIV infection. It is necessary for post-test counselling to address risk among those who engage in sexual risk behaviours. More efforts are needed to enhance HIV/STI testing and treatment services in China.
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Affiliation(s)
- Yan-Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Hai-Dong Tao
- Department of AIDS Control and Prevention, Luyang District Center for Disease Control and Prevention, Heifei, Anhui, PR China
| | - Juan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Yin-Guang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Chao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Peng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Lian-Ju Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Qing Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Wei Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Anhui, PR China
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