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Cheung DH, Chen S, Fang Y, Sun F, Zhang Q, Yu FY, Mo PKH, Wang Z. Influences of mpox disease perceptions, sources and contents of information exposure on mpox vaccine uptake among gay, bisexual, and other men who have sex with men in Hong Kong, China. Vaccine 2024; 42:2337-2346. [PMID: 38480102 DOI: 10.1016/j.vaccine.2024.02.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Following the global mpox outbreak in 2022, multiple regions in Asia have been reporting ongoing mpox cases within high-risk groups, including gay, bisexual, and other men who have sex with men (GBMSM). An optimal level of vaccination rate is essential to prevent further mpox outbreaks. However, no existing studies have examined mpox vaccine uptake among GBMSM in East Asia. METHODS A cross-sectional survey was conducted among a sample of 531 GBMSM in Hong Kong, China, between March and October 2023. The study used multivariable logistic regression models to investigate the associations between mpox-related disease perceptions, exposures to sources and contents of mpox-related information, and mpox vaccine uptake. RESULTS The prevalence of mpox vaccine uptake among GBMSM in Hong Kong was 21.7%, with 7.7% completing one dose and 13.9% completing two doses. GBMSM who were younger or earning less monthly income were less likely to have been vaccinated. After adjusting for confounding variables, participants who perceived more negative impacts on their lives if they were to contract mpox, more severe symptoms, and a more coherent understanding of mpox were positively associated with mpox vaccine uptake. In addition, more frequent exposure to information through the following sources: TV, newspaper, radio and posters, government websites, news websites or apps, other people's social media, and communication over the phone or face-to-face was positively associated with mpox vaccine uptake. Finally, more frequent exposure to the following information contents: mpox statistics from other countries, the Hong Kong government's responses to mpox cases, negative information about patients with mpox, and information on prevention and treatment of mpox were positively associated with mpox vaccine uptake. CONCLUSIONS This study provides timely and evidence-based implications to address health communication and messaging needs in promoting mpox vaccination among GBMSM in Hong Kong, relevant to regions with similar sociocultural contexts.
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Affiliation(s)
- Doug H Cheung
- Center of Population Sciences for Health Equity, Florida State University, Tallahassee, FL, USA
| | - Siyu Chen
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong Special Administrative Region.
| | - Fenghua Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong Special Administrative Region
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Fuk-Yuen Yu
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Saadat M, Keramat A, Nazari AM, Ranjbar H, Jahanfar S, Motaghi Z. Transgender women sex workers' experiences accessing sexual health care in Iran: a qualitative study. Sex Health 2024; 21:NULL. [PMID: 38109743 DOI: 10.1071/sh23113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND This study aimed to examine the experiences of transgender women who work in the sex industry regarding their access to health care facilities for sexual health. Transgender women sex workers are recognised worldwide as a high-risk group for HIV and sexually transmitted infections (STIs). METHODS In Iran, between January and May 2022, we employed a snowball sampling technique to recruit a diverse group of 22 transgender women sex workers aged 19-42 years. Semi-structured interviews were conducted with these participants to provide insights into their experiences with accessing sexual health care. RESULTS The data was analysed using thematic analysis, revealing four overarching themes: experiences of violence, contextual barriers to health, socioeconomic challenges and HIV/STI risk practices, and 11 sub-themes. The results demonstrate that many participants experienced difficulties in accessing sexual health services due to violence, discrimination, financial difficulties and lack of awareness about STIs. CONCLUSION Sex workers face extraordinarily challenging occupational risks, including sexual and physical abuse, mental health issues, and HIV and STIs. Targeted public intervention programs and research for this group are urgently needed. Outreach programs engaging with underserved transgender women sex workers have the potential to enhance access to healthcare services, and contribute to the reduction of HIV transmission rates.
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Affiliation(s)
- Mina Saadat
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ali Mohammad Nazari
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Shayesteh Jahanfar
- Tufts School of Medicine, Department of Public Health and Community Medicine, Boston, MA, USA
| | - Zahra Motaghi
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Martín-Romo L, Sanmartín FJ, Velasco J. Invisible and stigmatized: A systematic review of mental health and risk factors among sex workers. Acta Psychiatr Scand 2023; 148:255-264. [PMID: 37105542 DOI: 10.1111/acps.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Sex work is a common phenomenon, but socially invisible and stigmatized. Due to exposure to work-related risks, sex workers (SWs) are vulnerable to developing health problems. However, little attention has been paid to their mental health. The purpose of this systematic review was to synthesize the existing literature on mental health and to explore risk factors related to psychopathology in sex workers. METHODS A systematic review (CRD42021268990) was conducted on the Web of Science, PubMed, Scopus, and PsycInfo for peer reviewer papers published between 2010 and 2022. The Newcastle-Ottawa Scale (NOS) was used to examine the quality of the studies. Of the 527 studies identified, 30 met the inclusion criteria. RESULTS Mental health problems were prevalent among sex workers. Depression was the most common mental health problem; however, other psychological problems were also high, including anxiety, substance abuse, and suicidal ideation. Sex workers are exposed to numerous work-related risks, including violence and high-risk sexual behaviors. Despite the high prevalence of mental health problems, SWs often encounter significant barriers to accessing healthcare services. CONCLUSION These results suggest the need to focus on preventive measures to promote psychological well-being among sex workers.
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Affiliation(s)
| | - Francisco J Sanmartín
- Department of Psychology, University of Córdoba, Spain
- The Maimonides Institute for Biomedical Research of Cordoba, Córdoba, Spain
- Reina Sofía Hospital, Córdoba, Spain
| | - Judith Velasco
- Department of Psychology, University of Córdoba, Spain
- The Maimonides Institute for Biomedical Research of Cordoba, Córdoba, Spain
- Reina Sofía Hospital, Córdoba, Spain
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Cao Q, Zhang Q, Chen Y, He Z, Xiang Z, Guan H, Yan N, Qiang Y, Li M. The relationship between non-suicidal self-injury and childhood abuse in transgender people: a cross-sectional cohort study. Front Psychol 2023; 14:1062601. [PMID: 37621935 PMCID: PMC10445944 DOI: 10.3389/fpsyg.2023.1062601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Objective To explore the relationship between non-suicidal self-injury (NSSI) and childhood abuse in transgender people and the mediating effect of emotional dysregulation traits in the association between childhood abuse and non-suicidal self-injury. Patients and methods From May to October 2021, 296 female-to-male (FTM) and 675 male-to-females (MTF), with age of 24.5 ± 6.4 years, were recruited using peer-driven sampling and anonymous questionnaires in Guangdong Province. The Childhood Abuse Questionnaire (CTQ-SF), the Personality Diagnostic Questionnaire (PDQ-4+) emotion regulation ability scale and the DSM-5 Clinical Examination of Stereotypic Disorders were used to measure childhood abuse experiences, emotional dysregulation traits and self-injurious behaviour, respectively. Results Childhood abuse scores were positively correlated with both emotional dysregulation traits scores and non-suicidal self-injury (NSSI) behaviours (p < 0.01), and emotional dysregulation traits scores were positively correlated with NSSI behaviours (p < 0.01); emotional dysregulation traits partially mediated the association between childhood abuse and NSSI behaviours, with the mediating effect accounting for 23.23% of the total effect. In addition, among the factors of childhood abuse, emotional dysregulation traits mediated the association between emotional abuse, emotional neglect, sexual abuse, physical abuse, physical neglect and NSSI behaviour significantly, with the mediating effect accounting for 22.48%-32.58% of the total effect. Conclusion Transgender NSSI behaviours are associated with childhood abuse and emotional dysregulation traits, and emotional dysregulation traits partially mediates the association between childhood abuse and NSSI behaviours, and screening for emotional dysregulation traits in transgender people and timely interventions are needed to improve the current situation of discrimination against transgender people.
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Affiliation(s)
- Qiang Cao
- Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China
- School of Medicine, Macau University of Science and Technology, Macau, Macao SAR, China
| | - Qi Zhang
- Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China
- Undergraduate Department, Taishan University, Taian, China
| | - Yuquan Chen
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zixu He
- Undergraduate Department, University of New South Wales, Sydney, NSW, Australia
| | - Zhibiao Xiang
- Xiangya School of Medicine Central South University, Changsha, China
| | - Haoran Guan
- School of Medicine, Macau University of Science and Technology, Macau, Macao SAR, China
| | - Na Yan
- School of Medicine, Macau University of Science and Technology, Macau, Macao SAR, China
| | - Yi Qiang
- Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China
| | - Mantao Li
- Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China
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Wang Z, Chan PSF, Xin M, Fang Y, Chidgey A, Yu FY, Ip M, Chen S, Mo PKH. An Online Intervention Promoting HIV Testing Service Utilization Among Chinese men who have sex with men During the COVID-19 Pandemic: A quasi-experimental Study. AIDS Behav 2023:10.1007/s10461-023-04100-5. [PMID: 37284925 DOI: 10.1007/s10461-023-04100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
The COVID-19 pandemic created disruptions in HIV testing service utilization among men who have sex with men (MSM). The present study was to evaluate the effectiveness of an online health promotion program implemented by a community-based organization (CBO) in increasing the uptake of any type of HIV testing and home-based HIV self-testing (HIVST) over a six-month follow-up period. Participants of an observational prospective cohort study conducted during the same period served as the comparison group. This study was conducted between September 2020 and December 2021. Participants were Chinese-speaking adult MSM who were HIV-negative/unknown sero-status recruited through multiple sources in Hong Kong, China. Participants in the intervention group were exposed to the following health promotion components: (1) viewing an online video promoting HIVST, (2) visiting the project webpage, and (3) having access to a chargeable HIVST service implemented by the CBO. Among 400 and 412 participants in the intervention group and the comparison group, 349 (87.3%) and 298 (72.3%) completed follow-up evaluation at Month 6. Multiple imputation was used to replace missing values. At Month 6, participants in the intervention group reported significantly higher uptake of any type of HIV testing (57.0% versus 49.0%, adjusted odds ratios [AOR]: 1.43, p = .03) and HIVST (25.8% versus 14.8%, AOR: 2.04, p = .001), as compared to those in the comparison group. Process evaluation of the health promotion components for the intervention group was positive. Promoting HIVST is a potentially useful strategy to increase HIV testing service utilization among Chinese MSM during the pandemic.
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Affiliation(s)
- Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | - Paul Shing-Fong Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Meiqi Xin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, the Hong Kong Polytechnic University, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, the Education University of Hong Kong, Hong Kong, China
| | | | - Fuk-Yuen Yu
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Mary Ip
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Siyu Chen
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix K H Mo
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
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Wang H, Jonas KJ, Guadamuz TE. Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis. Drug Alcohol Depend 2023; 243:109741. [PMID: 36630807 PMCID: PMC10435892 DOI: 10.1016/j.drugalcdep.2022.109741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV. METHODS We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches. RESULTS We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence. CONCLUSIONS Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Thomas E Guadamuz
- Faculty of Social Sciences and Humanities, Mahidol University, Nakorn Pathom, Thailand; John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA.
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High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031704. [PMID: 35162728 PMCID: PMC8835457 DOI: 10.3390/ijerph19031704] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: We aimed to estimate sexualized drug use (SDU) prevalence and its predictors among sexual and gender minorities. (2) Methods: We used an online and on-site survey to enroll sexual/gender minorities people between October-December/2020, and multivariate logistic regression to obtain SDU correlates. (3) Results: We enrolled 3924 individuals (280 transgender women [TGW], 3553 men who have sex with men [MSM], and 91 non-binary), 29.0% currently on pre-exposure prophylaxis (PrEP). SDU prevalence was 28.8% (95% confidence interval [CI] 27.4-30.2). TGW had 2.44-times increased odds (95%CI 1.75-3.39) of engaging in SDU compared to MSM, regardless of PrEP use. PrEP use (aOR 1.19, 95%CI 1.00-1.41), South/Southeast region (aOR 1.26, 95%CI 1.04-1.53), younger age (18-24 years: aOR 1.41, 95%CI 1.10-1.81; 25-35 years: aOR 1.24, 95%CI 1.04-1.53), white race/color (aOR 1.21, 95%CI 1.02-1.42), high income (aOR 1.32, 95%CI 1.05-1.67), binge drinking (aOR 2.66, 95%CI 2.25-3.14), >5 sexual partners (aOR 1.88, 95%CI 1.61-2.21), condomless anal sex (aOR 1.49, 95%CI 1.25-1.79), self-reported sexually transmitted infection (aOR 1.40, 95%CI 1.14-1.71), and higher perceived HIV-risk (aOR 1.37, 95%CI 1.14-1.64) were associated with SDU. (4) Conclusions: TGW had the highest SDU odds. SDU may impact HIV vulnerability among key populations and should be addressed in HIV prevention approaches.
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Chakrapani V, Lakshmi PVM, Newman PA, Kaur J, Tsai AC, Vijin PP, Singh B, Kumar P, Rajan S, Kumar R. Syndemic violence victimization, alcohol and drug use, and HIV transmission risk behavior among HIV-negative transgender women in India: A cross-sectional, population-based study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000437. [PMID: 36962491 PMCID: PMC10021466 DOI: 10.1371/journal.pgph.0000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/29/2022] [Indexed: 03/26/2023]
Abstract
Transgender women globally are disproportionately burdened by HIV. Co-occurring epidemics of adverse psychosocial exposures accelerate HIV sexual risk, including among transgender women; however, studies using additive models fail to examine synergies among psychosocial conditions that define a syndemic. We examined the impact of synergistic interactions among 4 psychosocial exposures on condomless anal sex (CAS) among transgender women in India. A national probability-based sample of 4,607 HIV-negative transgender women completed the Indian Integrated Biological and Behavioural Surveillance survey, 2014-2015. We used linear probability regression and logistic regression to assess 2-, 3-, and 4-way interactions among 4 psychosocial exposures (physical violence, sexual violence, drug use, and alcohol use) on CAS. Overall, 27.3% reported physical and 22.3% sexual violence victimization (39.2% either physical or sexual violence), one-third (33.9%) reported frequent alcohol use and 11.5% illicit drug use. Physical violence was associated with twofold higher odds of CAS in the main effects model. Statistically significant two- and three-way interactions were identified, on both the multiplicative and the additive scales, between physical violence and drug use; physical and sexual violence; physical violence, sexual violence, and alcohol use; and physical violence, alcohol use and drug use. Physical and sexual violence victimization, and alcohol and drug use are highly prevalent and synergistically interact to increase CAS among HIV-negative transgender women in India. Targeted and integrated multilevel initiatives to improve the assessment of psychosocial comorbidities, to combat systemic transphobic violence, and to provide tailored, trauma-informed alcohol and substance use treatment services may reduce HIV risk among transgender women.
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Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - Peter A Newman
- University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Canada
| | - Jasvir Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - Alexander C Tsai
- Massachusetts General Hospital and Harvard Medical School, Boston, United States of America
| | - P P Vijin
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - Bhawani Singh
- National AIDS Control Organisation, New Delhi, India
| | - Pradeep Kumar
- National AIDS Control Organisation, New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organisation, New Delhi, India
| | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
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The mental health of transgender and gender non-conforming people in China: a systematic review. Lancet Public Health 2021; 6:e954-e969. [DOI: 10.1016/s2468-2667(21)00236-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
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