Sexual risk behaviors in the internet age: the case of Chinese men who have sex with men

Gay community involvement and the sexual health behaviours of sexual minority men: a systematic review and directions for future research

Considerable research has examined how involvement in gay-affiliated communities is associated with sexual health behaviours in sexual minority men (i.e., gay, bisexual, and other men who have sex with men), yet findings in this domain are often contradictory and inconclusive. This systematic review aimed to (a) synthesise the related empirical literature, and (b) identify potential factors driving inconsistent findings. Peer-reviewed publications were included if they contained quantitative data and at least one measure of the statistical association between gay community involvement and sexual health behaviour. The search strategy was implemented in six databases and returned 6,409 articles, of which 86 met the inclusion criteria. There was considerable heterogeneity in how gay community involvement was assessed across studies. Although gay community involvement was consistently associated with greater engagement in protective behaviours across studies, the association between gay community involvement and risk behaviours appeared to depend on how gay community involvement was conceptualised and measured (e.g., nightlife involvement vs. political activism). Findings emphasise a need for studies that employ validated measures that reflect the multidimensional nature of gay community involvement, as well as research designs better suited to address the causal effects of community involvement on HIV/STI transmission and prevention.

Using Self-Reported Sexual Positioning as an Indicator for Rectal Chlamydia and Gonorrhea Screening Among Men Who Have Sex With Men in China: A Missed Opportunity

BACKGROUND

Rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) are escalating public health concerns. This study aimed to explore (1) the reliability of self-reported sexual positioning as an indicator for rectal CT and NG screening, and (2) factors associated with rectal CT and NG infections in Shenzhen, China.

METHODS

A cross-sectional study was conducted in 2 settings in Shenzhen, China, from April 1, 2021, to March 31, 2022. Data on sociodemographic characteristics, sexual behaviors, and basic CT knowledge were collected. Urine and self-collected rectal swabs were collected for CT and NG testing.

RESULTS

In total, 195 MSM participated in the study, and 5.1% tested positive for urogenital CT, 29.2% for rectal CT, 1.0% for urogenital NG, and 8.2% for rectal NG. Among those who reported exclusively insertive anal sex, 69.2% of CT infections and 85.7% of NG infections would have remained undetected with urine testing alone. Risk factors for rectal CT infection included engaging in both insertive and receptive anal sex, with a significant association found for coinfection with rectal NG.

CONCLUSIONS

Self-reported sexual positioning was found to be an unreliable indicator for CT and NG screening, as a substantial proportion of infections would have remained undetected. The findings suggest that CT and NG screening in China should be offered to all MSM regardless of self-reported sexual positioning, and that the dual CT/NG testing is recommended.

Safe on Blued? A Qualitative Exploration of Sex, Risk, and Stigma on a Gay Social Application in China

Introduction

Mobile dating apps emerged with the development of technology, for example, Blued in China, becoming a new risk field for gay men in the AIDS era. Users use social apps to chat online and date offline to achieve the satisfaction of lust or sexual practice, but the risk of AID looms over the whole process of using apps.

Methods

Nineteen interviewees were invited to participate in this study, which included gay men who were using or had used Blued. The content of the semi-structured interviews focused on the relationship between gay social apps and HIV risk.

Results

The study finds Blued interweaved with sex, risk, and stigma. Blued is sexualized due to sexual intentions and practices. There is also a sexual stratification of risk with Blued and its users based on socioeconomic factors. Users experience a dilemma between pursuing sex while being concerned about latent risk within a context of stigmatization.

Conclusions

Blued is sexualized in terms of the process of stimulating sexual gratification and facilitating sexual practices. The experience of Blued is an example of sexual stratification, and a structure of desire based on app users and app uses. Furthermore, the social stigma against men who have sex with men is transferred to Blued, which bears the stigma of "AIDS-Blued" with a dual stigma-HIV-related and homosexual stigma. However, with the authorized approval of Blued in public health, Blued could play an essential role in HIV/AIDS prevention and control.

Emotion Analysis and Opinion Monitoring of Social Network Users Under Deep Convolutional Neural Network

With the development of the internet, the user behavior and emotional characteristics behind social networks have attracted scholars' attention. Meanwhile, identifying user emotion can promote the development of mobile communication technology and network intelligence industrialization. Based on this, this work explores the emotions of social network users and discusses the public comments on the speeches through the speeches of social network users. After 100 times of training, F1 of the BiLSTM algorithm can reach 97.32%, and after 100 times of training, its function loss can be reduced to 1.33%, which can reduce the impact of function loss on emotion recognition. The exploration is of great significance for analyzing the emotional behavior of social network users and provides a reference for the intelligent and systematic development of internet social model as well as the information management.

Gay Dating Apps in China: Do They Alleviate or Exacerbate Loneliness? The Serial Mediation Effect of Perceived and Internalized Sexuality Stigma

Gay dating apps have become increasingly popular and been intensively used. However, studies that closely examine the effects of gay dating app usage on mental health outcomes are few. This study tackles an unsolved question on whether gay dating apps alleviate or exacerbate loneliness through perceptions of sexuality stigma. A cross-sectional online survey from 371 Chinese gay or bisexual men found that the intensity of gay dating app usage is positively associated with loneliness. The association between gay dating app usage intensity and loneliness is sequentially mediated by perceived sexuality stigma and internalized sexuality stigma. That is, increased intensity of gay dating app usage strengthens perceived sexuality stigma, which in turn reinforces internalized sexuality stigma, further exacerbating loneliness. This study echoes the "alone together" phenomena and uncovers the feasibility of using stigma perceptions as a mechanism to understand the mental health of gay dating app users.

Metrics of sexual behavior stigma among cisgender men who have sex with men in Mexico: exploratory and confirmatory factor analyses

Cisgender gay, bisexual, and other men who have sex with men (MSM) in Mexico experience disparities in sexual health outcomes, perhaps most notably in HIV prevalence, HIV testing and status awareness, and condom use. Sexual behavior stigma, underpinned by socio-structural factors specific to Mexico (e.g., machismo), uniquely shapes these sexual health disparities. However, few reliable, valid measures are available to document, track, and ultimately mitigate sexual behavior stigma in this context. Exploratory and confirmatory factor analyses were performed on responses to a 13-item sexual behavior stigma scale from 15,681 MSM recruited online across Mexico. Associations with extracted factors were tested to assess construct validity. Three subscales were identified in exploratory factor analysis and validated in confirmatory factor analysis: "stigma from family and friends" (α = 0.65), "anticipated healthcare stigma" (α = 0.84), and "general social stigma" (α = 0.70). External construct validity was indicated through each subscale's strong association (all p < 0.001) with perceived community intolerance of MSM and perceived community discrimination toward people living with HIV. These subscales show promise as reliable, valid measures for assessing sexual behavior stigma among MSM in Mexico, and as tools for documenting and tracking sexual behavior stigma trends, comparing regional burdens of sexual behavior stigma, and tracking the progress of stigma-mitigation interventions among MSM in Mexico. Future research is needed to understand the extent to which each subscale is differentially associated with sexual (and other) health outcomes, which can inform the development and implementation of uniquely tailored stigma-mitigation, HIV-prevention, HIV-care, and other needed interventions for MSM in Mexico.

Chained multimediator model of sexual orientation disclosure, sexual minority stigma, sexual minority identity, social support, and resilience among ymsms

Introduction

This study aimed to investigate sexual orientation disclosure and mental health among young men who have sex with men (YMSMs). To this end, we constructed a chained multimediator model of sexual minority stigma, sexual minority identity, social support, and resilience, with the moderator of sexual orientation disclosure.

Methods

We conducted a cross-sectional survey of 345 YMSMs in Nanning, China. Bivariate analysis was used to evaluate factors associated with sexual orientation disclosure. Sexual minority stigma was used to predict identity, with social support as the step 1 mediator and resilience as the step 2 mediator. Sexual minority identity was analyzed using a chained moderated mediation model; sexual orientation disclosure was included as a moderator in all models to control its confounding effect.

Results

The average age of YMSMs was 20.0 ± 1.3 years. Bivariate analysis indicated that YMSMs who disclosed sexual orientation may have experienced less stigma (15.49 ± 3.02 vs 16.21 ± 2.74), obtained more social support (65.98 ± 11.18 vs 63.19 ± 11.13), had strong psychological resilience (37.40 ± 8.57 vs 35.39 ± 7.73), and had a more positive self-identity (104.12 ± 21.10 vs 95.35 ± 16.67); differences between subgroups were statistically significant (p < 0.05). Sexual minority stigma, perceived stigma, and enacted stigma were significantly associated with social support and resilience. The association between sexual minority stigma and sexual minority identity was significantly mediated by social support (indirect effect [95% CI] =  − 3.307 [− 4.782, − 1.907]). Resilience significantly mediated the same association for identity (− 2.544 [− 4.052, − 1.114]). The chained relationship from sexual minority stigma to social support, resilience, and identity was also significant, with an indirect effect of − 0.404 [− 0.621, − 0.249].

Conclusion

Among YMSMs in China, sexual minority stigma affects sexual minority identity through social support and resilience. Given the psychological effects of stigma, social support and resilience must be considered to better promote positive self-identity and mental health among YMSMs.

An adapted cognitive behavioral stress and self-management (CBSM) intervention for sexual minority men living with HIV and cancer using the SmartManage eHealth platform: Study design and protocol. (Preprint)

Background

Objective

Methods

Results

Conclusions

International Registered Report Identifier (IRRID)

PrEP Willingness and Adherence Self-Efficacy Among Men Who have Sex with Men with Recent Condomless Anal Sex in Urban China

This study investigates PrEP willingness, adherence self-efficacy and potential impact of PrEP among HIV-negative, Chinese men who have sex with men (MSM; n = 622) with recent condomless anal sex. Facilitative factors of PrEP willingness included migrant status, sexual risk, and prior PrEP use, whereas barriers included concerns over being treated as an HIV/AIDS patient, recent HIV testing, identity concealment, and HIV prevention service usage. Adherence self-efficacy was associated with PrEP knowledge and confidence in PrEP efficacy of HIV prevention. A total of 39.3% anticipated increase in sex partners, 25.6% anticipated decrease in condom use, and 38.0% anticipated increased HIV testing following PrEP uptake. Results suggest a two-step approach to (1) promote PrEP acceptance among Chinese MSM and (2) enhance adherence and risk monitoring among PrEP-willing MSM. Efforts to reduce stigma, incorporate PrEP in the HIV prevention continuum, and increase PrEP knowledge will be crucial to optimize PrEP implementation.

Internalized Sexual Minority Stigma is Associated With HIV Testing Behavior Among Chinese Men Who Have Sex With Men: A Cross-Sectional Study

ABSTRACT

Although studies have examined the relationship between HIV-related stigma and HIV testing among men who have sex with men (MSM) in China, there is still a lack of knowledge regarding whether sexual minority stigma and HIV testing are associated. The purpose of this study was to identify the association between sexual minority- and HIV-related stigmas with HIV-testing behavior. A cross-sectional study was conducted in the Hunan Province of China. After controlling for covariates, the multivariate analyses showed that high internalized sexual minority stigma was negatively associated with HIV testing behavior in the previous year. However, anticipated sexual minority- and HIV-related stigmas were not associated with HIV-testing behavior. Findings suggest that internalized sexual minority stigma should be addressed in health care settings to encourage MSM to seek HIV testing services, especially considering the continuing HIV epidemic among MSM in China.

Modelling the impact of an HIV testing intervention on HIV transmission among men who have sex with men in China

OBJECTIVES

An intervention developed through participatory crowdsourcing methods increased HIV self-testing among men who have sex with men [MSM; relative risk (RR) = 1.89]. We estimated the long-term impact of this intervention on HIV transmission among MSM in four cities (Guangzhou, Shenzhen, Jinan and Qingdao).

METHODS

A mathematical model of HIV transmission, testing and treatment among MSM in China was parameterized using city-level demographic and sexual behaviour data and calibrated to HIV prevalence, diagnosis and antiretroviral therapy (ART) coverage data. The model was used to project the HIV infections averted over 20 years (2016-2036) from the intervention to increase self-testing, compared with current testing rates.

RESULTS

Running the intervention once would avert < 2.2% infections over 20 years. Repeating the intervention (RR = 1.89) annually would avert 6.4-10.7% of new infections, while further increases in the self-testing rate (hypothetical RR = 3) would avert 11.7-20.7% of new infections.

CONCLUSIONS

Repeated annual interventions would give a three- to seven-fold increase in long-term impact compared with a one-off intervention. Other interventions will be needed to more effectively reduce the HIV burden in this population.

Minority stress and health: A grounded theory exploration among men who have sex with men in China and implications for health research and interventions

RATIONALE

Men who have sex with men (MSM) in China are disproportionately affected by HIV and mental health issues. Although predominately western-based research suggests a minority stress perspective to explain health disparities, how Chinese MSM experience stress related to being a sexual minority and how such experiences affect their health have not been carefully examined.

OBJECTIVE

This study was a qualitative investigation of how stress related to sexuality (e.g., stigma, discrimination, and oppression) are experienced among MSM in China and how these experiences affect their psychological and behavioral health.

METHOD

In-depth, semi-structured interviews were conducted with 24 MSM in China. Grounded theory was employed to guide data analysis.

RESULTS

Six categories emerged, which included: A Family-Oriented, Heteronormative Culture, Interpersonal Rejections and Marginalization, Internalization of Stigma, the Psychological Impact of Minority Stress, Impact on HIV-related Behavioral Health, and Coping. A conceptual model was developed, which illustrated relationships among categories and described sources, processes, and impact of minority stress among MSM in China. Cultural, social, and internalized sources of minority stress were shown to have detrimental effects on participants' psychological health and HIV-related behavioral health. Various coping strategies shared the purpose of navigating well-being in one's direct environment and in the larger culture.

CONCLUSIONS

Findings demonstrate the relevance of minority stress in behavioral health among Chinese MSM as well as the need to conceptualize minority stress within MSM's sociocultural context. HIV prevention efforts may benefit from a contextualized understanding of minority stress and addressing minority stress in a culturally congruent, community-centered fashion.

Addressing Minority Stress and Mental Health among Men Who Have Sex with Men (MSM) in China

PURPOSE OF REVIEW

Men who have sex with men (MSM) in China experience elevated risks of mental health issues in comparison to the general population in China, which contribute to vulnerability to HIV/STI risks and can comprise the effectiveness of HIV prevention efforts. A conceptual framework for understanding this mental health disparity is minority stress theory, which posits that experiences of external prejudice events (i.e., distal stressors) and internal stress processes such as internalized homophobia and concealment (i.e., proximal stressors) contribute to sexual minorities' elevated risk of psychological distress. To deepen the understanding of mental health among Chinese MSM and explore the potential utility of minority stress theory in this population, this paper synthesizes research evidence regarding prevalent mental health issues as well as how minority stress may be linked to psychological health in Chinese MSM.

RECENT FINDINGS

Results indicate that Chinese MSM experience a high prevalence of several mental health issues including depression, anxiety, suicidal behaviors, and alcohol dependence. This review further reveals minority stress to be an important determinant of psychological distress among Chinese MSM, though evidence is mixed regarding the relationship between proximal minority stress and psychological health. Nonetheless, there is a lack of mental health services and interventions focusing on MSM in China. Culturally relevant, competent, and LGBT-affirmative mental health interventions are needed for Chinese MSM. To guide future intervention research, we provide considerations for reducing minority stress and promoting psychological health among Chinese MSM.