"I'll Change His Sexual Orientation, I Don't Think About HIV": A Qualitative Study to Explore Attitudes, Behaviors, and Experiences Among Wives of Men Who Have Sex With Men in Mainland China

New sexually transmitted HIV infections from 2016 to 2050 in Guangdong Province, China: a study based on a dynamic compartmental model

BACKGROUND

In Guangdong Province, China, there is lack of information on the HIV epidemic among high-risk groups and the general population, particularly in relation to sexual transmission, which is a predominant route. The new HIV infections each year is also uncertain owing to HIV transmission from men who have sex with men (MSM) to women, as a substantial proportion of MSM also have female sexual partnerships to comply with social demands in China.

METHODS

A deterministic compartmental model was developed to predict new HIV infections in four risk groups, including heterosexual men and women and low- and high-risk MSM, in Guangdong Province from 2016 to 2050, considering HIV transmission from MSM to women. The new HIV infections and its 95% credible interval (CrI) were predicted. An adaptive sequential Monte Carlo method for approximate Bayesian computation (ABC-SMC) was used to estimate the unknown parameter, a mixing index. We calibrated our results based on new HIV diagnoses and proportions of late diagnoses. The Morris and Sobol methods were applied in the sensitivity analysis.

RESULTS

New HIV infections increased during and 2 years after the COVID-19 pandemic, then declined until 2050. New infections rose from 8,828 [95% credible interval (CrI): 6,435-10,451] in 2016 to 9,652 (95% CrI: 7,027-11,434) in 2019, peaking at 11,152 (95% CrI: 8,337-13,062) in 2024 before declining to 7,084 (95% CrI: 5,165-8,385) in 2035 and 4,849 (95% CrI: 3,524-5,747) in 2050. Women accounted for approximately 25.0% of new HIV infections, MSM accounted for 40.0% (approximately 55.0% of men), and high-risk MSM accounted for approximately 25.0% of the total. The ABC-SMC mixing index was 0.504 (95% CrI: 0.239-0.894).

CONCLUSIONS

Given that new HIV infections and the proportion of women were relatively high in our calibrated model, to some extent, the HIV epidemic in Guangdong Province remains serious, and services for HIV prevention and control are urgently needed to return to the levels before the COVID-19 epidemic, especially in promoting condom-based safe sex and increasing awareness of HIV prevention to general population.

Factors Influencing Intention on Condom Use During Sexual Intercourse With Regular Female Partners Among Men Who Have Sex With Men in Western China: A Structural Equation Modeling Analysis

BACKGROUND

Given the rapid rise in HIV infection among men who have sex with men (MSM) in China, they may be a potential bridge for HIV transmission to the general female population, and increasing condom use is an important protective measure. This study aimed to explore factors that influence the intention of condom use during sexual intercourse with regular female partners among MSM in Western China, based on the Health Action Process Approach model.

METHODS

This study used a baseline sample from a cohort study of the National Science and Technology Major Project. A nonprobability sampling method was adopted to recruit MSM from western China. Information on sociodemographic characteristics, HIV-related characteristics, sexual behavior, and constructs of the Health Action Process Approach model was collected through structured questionnaires, and the data were analyzed using a structural equation model.

RESULTS

Among 232 participants, 62.9% (146 of 232) intended to use condoms every time they had sex with their regular female partners during the following 3 months. The results of the structural equation model showed that self-efficacy had the greatest influence on behavioral intention (β = 0.398, P < 0.001), followed by negative outcome expectancy (β = -0.303, P < 0.05). In addition, risk perception (β = 0.206, P < 0.05) and positive outcome expectancy (β = 0.270, P < 0.01) had indirect effects on intention, whereas self-efficacy played a mediating role in these indirect influencing factors.

CONCLUSIONS

Risk perception, outcome expectancy, and self-efficacy are predictors of condom use intention, with self-efficacy in particular serving as a significant medium for future interventions. These findings could provide a reference for future targeted interventions to reduce the likelihood of HIV transmission from MSM to the female population.

Social capital, perceived stress, and mental health of men who have sex with men in China: A cross-sectional study

Background

Mental health problems are prevalent among men who have sex with men (MSM). Social capital and perceived stress may affect the mental health of MSM. The purpose of this study was to understand the current status of mental health, social capital, and perceived stress among MSM and to explore which variables are influential factors of mental health.

Methods

This study adopted a convenience sampling method and posted recruitment information through online social platforms (Blued, QQ, and WeChat) from January 2022 to June 2022 to recruit participants. The questionnaire included a demographic questionnaire, Social Capital Questionnaire (SCQ), Perceived Stress Scale (PSS), and Self-Reporting Questionnaire 20 (SRQ-20). Descriptive analyses of demographic characteristics, social capital, perceived stress, and mental health were conducted using percentages, median, interquartile range, means, and standard deviations. One-way ANOVA and independent-samples t-test were used to test the relationship between demographic characteristics and mental health, and multiple linear regression was used to analyze which variables were influencing factors of mental health. SPSS 24.0 was used for data analysis, and significant differences were found at p &lt; 0.05.

Results

A total of 546 MSM participated in this study. Total social capital score was 18.59 ± 2.62, cognitive social capital, social participation, and social network scores were 6.53 ± 1.05, 4.15 ± 0.97, and 7.91 ± 1.57. PSS score was 26.91 ± 6.44, and SRQ-20 score was 7.5 (3, 11). Education level, relationship status, employed information, monthly income, sexual orientation, perceived stress, and three dimensions of social capital were included in the multiple linear regression based on the results of One-way ANOVA, t-test, and correlation analysis. Multiple linear regression analysis showed that relationship status (in a relationship), sexual orientation (heterosexual, bisexual, other), perceived stress, social participation, and social network had a significant effect on mental health.

Conclusion

Sex with men have poorer mental health. Relationship status, sexual orientation, perceived stress, social networks, and social participation are important factors influencing mental health. The general public should be called upon to treat them with a more tolerant attitude, improve the social environment, and promote their identification with their sexual orientation, thereby reducing perceived stress and promoting the mental health of this population. In addition, from the perspective of social capital, promoting MSM social participation and expanding social networks may also be an important way to promote MSM mental health.

Sex life and sexuality among tongqi: doing gender and heterosexuality

The term tongqi refers to cisgender, heterosexual women who unwittingly marry non-straight men. In mainland China, their adverse social position and health have been the subject of concern. This study aims to broaden and diversify perceptions of the lived experiences of tongqi by focusing on sex and sexualities in mixed-orientation marriages. Four themes (lack of sexuality-related exploration before marriage, the unsatisfactory nature of marital sex life, the exercise of sexual agency, and increased self-awakening) were developed from observations of a tongqi online support group and 12 semi-structured interviews with members. Using inductive thematic analysis, findings reveal how heteronormativity oppresses and punishes both tongqi and their non-straight husbands. In most cases, husbands not 'doing heterosexuality' as expected were still found to be 'doing gender' in patriarchal ways, with wives' subordinate status thereby being reinforced, making them more vulnerable. However, despite women's sexual autonomy and agency being constrained by normative forces, some were able to navigate their conjugal relationships by practising sexual autonomy and agency within and outside their marriage.

The association between HIV disclosure, spousal testing and unprotected vaginal intercourse within marriage among HIV positive married MSM in China

Disclosure of HIV status can encourage spouses of people diagnosed with HIV to prioritize HIV prevention. However, few studies have reported the HIV disclosure status of married men who have sex with men (MSM) and their female spouses. The purpose of this study was to describe the prevalence of HIV disclosure, and whether it was associated with spouses' HIV testing uptake and unprotected vaginal intercourse within marriage for MSM living with HIV (HIV + MSM) in China. A cross-sectional study was conducted in three Chinese cities. Of 309 participants, only 31.1% of men had disclosed their HIV status to spouses. About 80% of participants reported that their spouses had been tested for HIV. A small proportion of men (9.1%) had unprotected sex with their spouse after HIV diagnosis. Multivariate analyses indicated HIV disclosure was positively associated with HIV testing uptake of spouses, but there was no significant association between HIV disclosure and unprotected marital sexual behaviors for HIV + MSM. The findings indicated that HIV disclosure to spouses is uncommon among married HIV + MSM in China, and HIV disclosure is associated with increased uptake of HIV testing among spouses of MSM, but it does not decrease the unprotected sexual behaviors in marriage.

HIV prevalence among 338,432 infertile individuals in Hunan, China, 2012-2018: A cross-sectional study

BACKGROUND

The prevalence of human immunodeficiency virus (HIV) varies markedly among different risk groups in China, spreading fromhigh-risk populations to the general population. Indeed, China is in a critical period of HIV/acquired immunodeficiency syndrome (AIDS) prevention and control; however, data regarding HIV testing, infection and coinfection among infertile couples are lacking. This study aimed to estimate the HIV/AIDS prevalence to identify risk factors among infertile couples in Hunan, China.

METHODS

A cross-sectional hospital-based study was conducted to evaluate the prevalence of HIV/other infections (hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium (MG) infections) among 338,432 infertile individuals in Hunan, China, from 2012 to 2018. We calculated linear trends in prevalence using bivariate linear regression.

RESULTS

The overall prevalence rates of HIV, chlamydia, gonorrhea, MG, syphilis, and HBV and HCV antibody positivity in this study were 0.04%, 1.73%, 0.05%, 2.60%, 2.15%, 12.01% and 0.56%, respectively. The predominant infection was HBV, followed by MG, syphilis, and chlamydia. Only 1.13% of the participants (382/338432) reported sexually transmitted disease (STD) signs and symptoms suggesting genital tract infection. However, from 2012-2018, the variation in HIV prevalence was not significant (β = 0.000, PTREND = 0.907). The characteristics of the HIV-infected infertile population have not shifted dramatically, with women accounting for 32.56% of HIV cases in China. Overall, 87.60% of HIV-infected individuals have a relatively low education. In total, 37.98% of HIV-positive patients engage in high-risk behaviors.

CONCLUSIONS

This study expands upon existing knowledge of HIV prevalence in the infertile Chinese population. However, much work is needed to achieve popularization of prevention knowledge and change concept. Routine HIV screening is urgently needed for all adults with high-risk behaviors.