1
|
Xie L, Mo PKH, Wang Z, Tian X, Lau JTF. Men who have sex with men were more depressed than their counterparts because of lower social support and higher loneliness: A comparative survey among Chinese university students. J Affect Disord 2024; 353:11-18. [PMID: 38373515 DOI: 10.1016/j.jad.2024.02.011] [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: 03/27/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Poor mental health is prevalent among men who have sex with men (MSM), including MSM university students (MSMUS), causing a significant burden on their health and society. The study aimed to compare the difference in levels of depressive symptoms between Chinese MSMUS and non-MSMUS and test the mediating roles of social support and loneliness in the relationship between MSM status and depressive symptoms among male university students. METHODS From June to October 2018, a total of 305 MSMUS and 2447 non-MSMUS from two cities in Sichuan province (China) were investigated using questionnaires. RESULTS The proportion of depression in the MSMUS and non-MSMUS groups was 54.1 % and 36.4 %, respectively. MSM status, social support, and loneliness were all significantly associated with depressive symptoms among Chinese university students. Structural equation modelling showed that the association between MSM status and depressive symptoms was partially mediated by three indirect paths, including 1) via social support (mediated proportion = 19.4 %), 2) via loneliness (mediated proportion = 19.3 %), and 3) via social support and then loneliness (mediated proportion = 16.1 %). CONCLUSIONS Depression was prevalent among university students in China, especially MSMUS. The findings increased our understanding of the mediating roles of social support and loneliness in the link between MSM status and depressive symptoms among Chinese male university students, which have great implications for designing interventions to improve their mental health. LIMITATION The cross-sectional study design limited causal inferences.
Collapse
Affiliation(s)
- Luyao Xie
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - 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, China.
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Xiaobing Tian
- Department of Epidemiology and Biostatistics, School of Public Health, North Sichuan Medical University, Nanchong, China
| | - Joseph T F Lau
- Public Mental Health Center, School of Mental Health, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
2
|
Yang L, Sun Z. Are All Gay Men at Risk of Developing HIV/AIDS? Why China's Mass HIV Testing Has Majorly Targeted Gay Men in the Era of Biomedicalization. Am J Mens Health 2024; 18:15579883241230165. [PMID: 38321807 PMCID: PMC10851740 DOI: 10.1177/15579883241230165] [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: 10/26/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Global HIV/AIDS responses have been increasingly biomedically dominated over the past years. In line with this shifting paradigm, China has prioritized mass HIV testing as a practical approach to controlling its HIV/AIDS epidemics among at-risk populations, especially gay men and other men who have sex with men (MSM). This study analyzed why China's mass HIV testing mainly targeted gay men by understanding the perspectives of public health professionals, community-based organization (CBO) workers, and gay men. In addition, this study revealed the tensions and unintended consequences of HIV/AIDS prevention and the representation of gay men in China. The study involved fieldwork conducted in a major city in Eastern China from 2015 to 2019. Semi-structured interviews were held with participants from the three abovementioned groups (N = 25). The study identified four processes concerning why gay men are mainly targeted for HIV testing. Some public health professionals believe that being a gay man is equivalent to having HIV/AIDS risks. In addition, this study particularly noted tensions between public health professionals and gay men, including gay men-identified CBO workers, over whether mass HIV testing should target gay men or anyone who engaged in sexual risk behaviors. This study argued that a particular focus on gay men due to pursuing biomedical advances in HIV/AIDS prevention seems to have unintendedly stereotyped gay men based on the presumptions that they are at risk of developing HIV/AIDS. In addition, this study corresponded to the broader social scientific discussion concerning whether HIV/AIDS intervention should target specific sexual risk practices or sexual identity/population.
Collapse
Affiliation(s)
- Lei Yang
- School of Public Administration, Beihang University, Beijing, P.R. China
| | - Zhipeng Sun
- Shanghai Technician School; Higher Vocational and Technical College, Shanghai University of Engineering Science, Shanghai, P.R. China
| |
Collapse
|
3
|
Ribeiro L, Pinho AA, Carneiro RL. Narrative review of studies on HIV pre-exposure prophylaxis in Brazil and its implementation in the public health network. Glob Public Health 2022; 17:3721-3734. [PMID: 36065619 DOI: 10.1080/17441692.2022.2116749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To discuss studies conducted in Brazil relating to PrEP, from 2012 to 2022, based on a narrative review. METHODOLOGY The databases of the Virtual Health Library/PAHO, portals from Scielo, Scopus, and PubMed, and the descriptors in English and Portuguese 'Pre-exposure to HIV' and 'Brazil' were used, as well as a list of planned/in-progress demonstrative studies. Inclusion criteria consists of articles with fieldwork in Brazil coupled with PrEP in the Brazilian scenario; and articles in English or Portuguese. Articles in which PrEP was not the central theme and the participating Brazilian population did not reside in Brazil were excluded. RESULTS 107 papers have been reviewed, 80 articles met the inclusion criteria. The majority participating population was men who have sex with men. 61 studies preceded the implementation of PrEP in Brazil. Studies carried out after implementation (n = 19) deal primarily with the impact of the COVID-19 pandemic. CONCLUSIONS There was an incipient number of studies on the injectable form of PrEP. Fewer studies included segments with greater difficulties in access, use, and adherence. Despite the issues that circumscribe this prevention technology, literature is consensual on the importance of Brazilian leadership for implementing PrEP.
Collapse
Affiliation(s)
- Laura Ribeiro
- Medical interns at the Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana A Pinho
- Department of Infectious and Parasitic Diseases at the Faculty of Medicine and at the Institute of Collective Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodolfo L Carneiro
- Medical interns at the Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Murray LR, Brigeiro M, Monteiro S. A retreat from human rights? A reflection on sex work's place in contemporary HIV prevention. Glob Public Health 2022; 17:3160-3174. [PMID: 33736567 DOI: 10.1080/17441692.2021.1896762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In 2012, the World Health Organization guidelines for HIV prevention recommended the decriminalisation of sex work as their number one good practice. Although human rights language played a key role in the international scientific and activist endorsement of the WHO policies, since then there have been few initiatives in terms of advancing the kinds of structural and political changes endorsed. In this Commentary, we reflect on sex work's place in the broader field of the biomedicalization of responses to HIV. The analysis is based on literature reviews and our research trajectories, including preliminary results from a qualitative study on the implementation of PrEP in Rio de Janeiro, Brazil. We argue that sex workers occupy an ambiguous and less visible role in current AIDS policies, and that such policies are increasingly characterised by their prioritisation of biomedical approaches over structural factors. These shifts should be understood as part of a broader, global hegemony of clinical responses to HIV prevention and the continuation of a neoliberal discourse around human rights, without adequate investment in the material conditions necessary to guarantee these rights.
Collapse
Affiliation(s)
- Laura R Murray
- Centre on Public Policy and Human Rights, Federal University of Rio de Janeiro (NEPP-DH/UFRJ), Rio de Janeiro, Brazil
| | - Mauro Brigeiro
- Laboratory of Environmental and Health Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Simone Monteiro
- Laboratory of Environmental and Health Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
5
|
Brigeiro M, Monteiro S. Pre-exposure prophylaxis for HIV in Brazil: hopes and moral panic in the social construction of a biomedical technology. CULTURE, HEALTH & SEXUALITY 2022:1-15. [PMID: 36153738 DOI: 10.1080/13691058.2022.2121423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
This paper addresses the role emotions play in the social assemblage of medicines and technical processes in the response to the HIV called pre-exposure prophylaxis (PrEP) for HIV. We describe a series of stages and processes in the social construction of PrEP in Brazil from the run-up to the launch of the initiative by the Ministry of Health to the subsequent implementation of the strategy by public health services. To understand the meanings and symbolism assigned to this biomedical technology, we examined the hopes underpinning scientific, government and non-governmental narratives, clinical processes and health policy. The social trajectory of PrEP was influenced not only by these hopes but also by fears and concerns about the impact of this approach to HIV prevention on lifestyles and modes of sexual governance. The evidence used in this study comes from interviews with health professionals and AIDS activists, anthropological fieldwork, scientific articles and documentary analysis. Our findings provide important insights into how emotions have shaped the meanings assigned to PrEP and shed light on the complex game of negotiation involved in defining responses to the HIV epidemic.
Collapse
Affiliation(s)
- Mauro Brigeiro
- Laboratory of Health and Environmental Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Simone Monteiro
- Laboratory of Health and Environmental Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| |
Collapse
|
6
|
Thomann M, Kombo B, Musyoki H, Masinya K, Kuria S, Kyana M, Musimbi J, Lazarus L, Blanchard J, Bhattacharjee P, Lorway R. Remaking the Technosubject: Kenyan Men Contextualizing HIV Self-Testing Technologies. Med Anthropol 2022; 41:272-286. [PMID: 35129411 DOI: 10.1080/01459740.2022.2027405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Kenyan government offers free HIV self-testing kits to men who have sex with men. The value of self-testing is based on the imaginary of an autonomous technosubject empowered to independently control testing services, thereby "freed," through technology, from the social conditions that might inhibit health services utilization. Following a community-centered collaborative approach, community researchers interviewed their peers who examined and reacted to the technology. Participants reframed the technosubject as intertwined with the social world and the testing kit itself as an object that exerts agency and possesses affective potential. Attending to these socio-material relationalities offers insights into program planning.
Collapse
Affiliation(s)
| | | | | | | | - Samuel Kuria
- Minority Person's Empowerment Program, Thika, Kenya
| | - Martin Kyana
- HIV & AIDS People's Alliance of Kenya, Mombasa, Kenya
| | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | | | - Parinita Bhattacharjee
- University of Manitoba, Winnipeg, Canada.,Partners for Health and Development in Africa, Nairobi, Kenya
| | | |
Collapse
|
7
|
Ferraz D, Couto MT, Zucchi EM, Calazans GJ, dos Santos LA, Mathias A, Grangeiro A. AIDS- and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study. Sex Reprod Health Matters 2019; 27:1650587. [PMID: 31533555 PMCID: PMC7888039 DOI: 10.1080/26410397.2019.1650587] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIDS-related stigma is a major hurdle to care and it hinders people from accessing HIV prevention methods, such as post-exposure prophylaxis. This study was designed to explore how AIDS-related stigma impacts the experience of using non-occupational post-exposure prophylaxis (nPEP) for HIV after sexual contact. Data were gathered in in-depth interviews with 59 people who voluntarily sought out nPEP in five public healthcare facilities in Brazil between 2015 and 2016. Data were analysed into three thematic categories: fear of being mistaken for a person living with HIV and AIDS (PLWHA); desire to hide particular features of one's sexual life; and experiences of stigmatising behaviour due to nPEP use. Based on the Health Stigma and Discrimination Framework, predominant manifestations of AIDS-related stigma in each category were analysed, as well as their intersections with gender- and sexuality-related stigmas. Results show that experiences of using nPEP are permeated by AIDS-related stigma, intersecting with sexuality- and gender-related stigmas. Stigma experiences are mainly perceived, anticipated and internalised; stigma practices include prejudice and stigmatising behaviours. Taking antiretrovirals (ARVs) led participants to the fear of being discriminated against as a PLWHA and having particular features of their sexual identities disclosed. Thus, hiding nPEP was strategic to protect from stigmatising behaviour. As ARV-based prevention technologies are scaled-up, interventions designed to tackle AIDS- and sexuality-related stigmas must be expanded in Brazil. Required interventions include public campaigns about nPEP, educational programmes in healthcare settings to offer adequate support to nPEP users and investments in stigma research and monitoring.
Collapse
Affiliation(s)
- Dulce Ferraz
- Public Health Analyst, Escola de Governo em Saúde, Fundação Oswaldo Cruz, Brasília, Brazil
- PhD Candidate, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Eliana Miura Zucchi
- Assistant Professor at Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brazil
| | | | | | - Augusto Mathias
- PhD Candidate, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Grangeiro
- Researcher, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|