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Chen W, Ma Q, Pan X, Chen L, Wang H, Zhou X, Jiang T, Chen W. Characteristics of men who have casual sex with men among Chinese university students: A cross-sectional study. PLoS One 2024; 19:e0301817. [PMID: 38603659 PMCID: PMC11008886 DOI: 10.1371/journal.pone.0301817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/24/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES The characteristics of men who have sex with men (either exclusively or with both men and women; MSM) who engaged in casual sex among Chinese male university students have not been compared with the characteristics of men who have sex with only women (MSW). This information is important for tailoring targeted behavioral interventions to prevent human immunodeficiency virus (HIV)/sexually transmitted infection (STI) transmission in this subgroup of MSM. METHODS Data were derived from a large cross-sectional electronic questionnaire survey conducted at 13 universities in Zhejiang Province, China, in 2018. Bivariate analyses were used to compare demographic, HIV-related psychosocial, and behavioral characteristics between MSM and MSW students who engaged in casual sex during the previous year. Proportion differences between the two groups and their 95% confidence intervals were analyzed. RESULTS Among the 583 sexually active male students who engaged in casual sex during the previous year, 128 and 455 were MSM and MSW, respectively. Compared with MSW students, larger proportions of MSM students reported knowing that male-to-male sexual behavior was the main mode of HIV transmission among Chinese students (62.5% vs. 45.5%), consenting to commercial sex (67.2% vs. 53.4%), wanting to know the HIV serostatus of partners before casual sex (65.8% vs. 51.3%), feeling at risk of HIV infection (40.5% vs. 11.8%), high condom-decision scale scores (55.3% vs. 42.6%), engaging in sex with ≥ 5 casual sex partners (44.6% vs. 25.9%), searching for casual partners online (89.2% vs. 51.3%), consuming alcohol before casual sex (64.8% vs. 45.0%), engaging in sex with regular partners (83.1% vs. 67.0%), engaging in commercial sex (54.2% vs. 26.4%), and visiting a clinic for voluntary counselling and testing (VCT) (16.4% vs. 8.4%). However, compared with MSW students, smaller proportions of MSM students reported knowing that consistent condom use could prevent HIV transmission (80.5% vs. 95.2%) and that VCT should be actively sought after risky sexual behavior (78.9% vs. 93.8%), using condoms sometimes/often (26.4% vs. 44.3%), and consistently using condoms (28.9% vs. 40.1%) while engaging in sex with casual partners. CONCLUSIONS MSM students who engaged in casual sex were at a greater risk of HIV/STI transmission, compared with MSW students. Comprehensive interventions to address the risks of unprotected male-to-male sex, searching for casual sex partners online, and non-use of HIV testing services are needed to reduce the burden of HIV/STI transmission among this subgroup of MSM.
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Affiliation(s)
- Weiyong Chen
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Qiaoqin Ma
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Xiaohong Pan
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Lin Chen
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Hui Wang
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Xin Zhou
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Tingting Jiang
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
| | - Wanjun Chen
- Department of HIV/STI Control and Prevention, Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, Zhejiang Province, China
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Sun S, Pachankis JE, Li X, Operario D. Addressing Minority Stress and Mental Health among Men Who Have Sex with Men (MSM) in China. Curr HIV/AIDS Rep 2020; 17:35-62. [PMID: 31950336 PMCID: PMC7050812 DOI: 10.1007/s11904-019-00479-w] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Shufang Sun
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, 167 Point St, Providence, RI, 02906, USA.
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, SC, 29208, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
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Yin L, Zhao Y, Peratikos MB, Song L, Zhang X, Xin R, Sun Z, Xu Y, Zhang L, Hu Y, Hao C, Ruan Y, Shao Y, Vermund SH, Qian HZ. Risk Prediction Score for HIV Infection: Development and Internal Validation with Cross-Sectional Data from Men Who Have Sex with Men in China. AIDS Behav 2018; 22:2267-2276. [PMID: 29786768 DOI: 10.1007/s10461-018-2129-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Receptive anal intercourse, multiple partners, condomless sex, sexually transmitted infections (STIs), and drug/alcohol addiction are familiar factors that correlate with increased human immunodeficiency virus (HIV) risk among men who have sex with men (MSM). To improve estimation to HIV acquisition, we created a composite score using questions from routine survey of 3588 MSM in Beijing, China. The HIV prevalence was 13.4%. A risk scoring tool using penalized maximum likelihood multivariable logistic regression modeling was developed, deploying backward step-down variable selection to obtain a reduced-form model. The full penalized model included 19 sexual predictors, while the reduced-form model had 12 predictors. Both models calibrated well; bootstrap-corrected c-indices were 0.70 (full model) and 0.71 (reduced-form model). Non-Beijing residence, short-term living in Beijing, illegal drug use, multiple male sexual partners, receptive anal sex, inconsistent condom use, alcohol consumption before sex, and syphilis infection were the strongest predictors of HIV infection. Discriminating higher-risk MSM for targeted HIV prevention programming using a validated risk score could improve the efficiency of resource deployment for educational and risk reduction programs. A valid risk score can also identify higher risk persons into prevention and vaccine clinical trials, which would improve trial cost-efficiency.
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Affiliation(s)
- Lu Yin
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuejuan Zhao
- Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China
| | | | - Liang Song
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Xiangjun Zhang
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Ruolei Xin
- Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China
| | - Zheya Sun
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunan Xu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Li Zhang
- Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China
| | - Yifei Hu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Child, Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, 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, 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 Medical Center, Nashville, TN, USA.
- Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
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Zhang C, Li X, Liu Y, Zhou Y, Shen Z, Chen Y. Impacts of HIV Stigma on Psychosocial Well-Being and Substance Use Behaviors Among People Living With HIV/AIDS In China: Across the Life Span. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:108-119. [PMID: 29688775 PMCID: PMC6056313 DOI: 10.1521/aeap.2018.30.2.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To date, existing studies have indicated that stigma against people living with HIV/AIDS (PLWHA) negatively affects their psychosocial well-being, and the impact may differ by age. In the current study, we aim to assess the impact of various types of stigma on PLWHA's psychological status and concomitant substance use. We explored different types of HIV stigma with psychosocial well-being and substance use employing mixed effect models among 2,987 Chinese PLWHA. Multivariate analyses revealed that each type of HIV stigma is positively associated with psychosocial distress, but negatively related to resilience and self-esteem across all age groups of PLWHA, with enacted stigma showing the strongest impact. Stigmatized PLWHA are more likely to smoke and use drugs, especially among the < 35 and 35-49-year-old groups. Age-specific interventions should be implemented to enhance PLWHA's stigma coping skill for improving their psychological health and reducing substance use in China and worldwide.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester, Rochester, New York
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Yu Liu
- Division of Public Health Science, School of Medicine and Dentistry, University of Rochester
| | - Yuejiao Zhou
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Zhiyong Shen
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
| | - Yi Chen
- Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China
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Zhang C, Qian HZ, Yin L, Liu Y, Strauss SM, Ruan Y, Shao Y, Lu H, Vermund SH. Sexual Behaviors Linked to Drug and Alcohol Use Among Men Who Have Sex With Men in China. Subst Use Misuse 2016; 51:1821-30. [PMID: 27608264 PMCID: PMC5423713 DOI: 10.1080/10826084.2016.1197264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND High-risk sexual behaviors drive the HIV epidemic among men who have sex with men (MSM). Alcohol consumption and use of club drugs may increase sexual risk behaviors. We evaluated effects of drug and alcohol use on sexual behaviors with both their male and female partners as well as on HIV and syphilis infections among MSM in China. METHODS As the part of a community randomized clinical trial that conducted among MSM in Beijing from 2013 to 2015, we recruited a total of 3,680 participants cross-sectionally. A self-administered questionnaire was employed to collect information regarding demographics, sexual behaviors, and a history of alcohol and drug use. Blood sample was collected for HIV and syphilis testing. RESULTS A total of 3,588 MSM completed the survey and were included in the data analysis. The mean age was 29.9 with 97.3% of Han-ethnicity and 85.0% unmarried. The HIV and syphilis prevalence was 12.7% and 7.4%, respectively. Drug use was significantly associated with higher odds of HIV infection (aOR = 1.3, 95% Confidence Interval [CI] = 1.0,1.6), but not associated with syphilis. A higher level of alcohol consumption was similarly associated with higher odds of HIV risks with both male (e.g., condomless sex acts) and female partners (e.g., numbers of sexual partners). CONCLUSION The association between drug and alcohol use and high-risk behaviors is notable among MSM in China. Integrated HIV interventions that target substance use among MSM may be more effective than programs that only target HIV alone.
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Affiliation(s)
- Chen Zhang
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Han-Zhu Qian
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,b Division of Epidemiology , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Lu Yin
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Yu Liu
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Shiela M Strauss
- c College of Nursing , New York University , New York , New York , USA
| | - Yuhua Ruan
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Yiming Shao
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Hongyan Lu
- e Beijing Center for Disease Control and Prevention , Beijing , China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,f Department of Pediatrics , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
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Zhang C, Liu Y, Sun X, Wang J, Lu HY, He X, Zhang H, Ruan YH, Shao Y, Vermund SH, Qian HZ. Substance use and HIV-risk behaviors among HIV-positive men who have sex with men in China: repeated measures in a cohort study design. AIDS Care 2016; 29:644-653. [PMID: 27832699 DOI: 10.1080/09540121.2016.1255709] [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: 10/20/2022]
Abstract
Global literature revealed that seropositive men who have sex with men (MSM) posed an even higher risk compared to their seronegative counterparts. Identifying risk factors that contribute to HIV-risk behaviors will help to curb the rapid HIV transmission among this group. Our hypothesis was that MSM with substance use were more likely to conduct HIV-risk behaviors, even after accounting for repeated measures. In the current study, we employed a cohort study design by following a group of 367 HIV-positive MSM up to four visits for one year to collect information regarding their sexual behaviors and history of substance use in the past three months. We used Generalized Estimating Equations (GEE) models to account both within- and between-subject variation when assessing associations between substance use and HIV-risk behaviors. A total of 367 MSM were included at the baseline with a mean age of 29.6 years. After accounting for potential confounders and time-varying effects, our models indicated that drug and alcohol use increase HIV risks at the population level by increasing risks of drinking alcohol before sex, having unprotected sex with men and seropositive partners, having more lifetime female sex partners and having a higher number of male sexual partners in the past three months. The current study is one of the first studies with repeated measures to evaluate the association between substance use and sexual risk behaviors among MSM in China. Findings in the current study have several implications for future research. We call for more rigorous study design for future research to better capture changes of risky behaviors among this at-risk population.
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Affiliation(s)
- Chen Zhang
- a Vanderbilt Institute for Global Health, Vanderbilt University , Nashville , TN , USA
| | - Yu Liu
- a Vanderbilt Institute for Global Health, Vanderbilt University , Nashville , TN , USA
| | - Xiaoyun Sun
- b Xicheng Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Juan Wang
- c Chaoyang Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Hong-Yan Lu
- d Beijing Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Xiong He
- d Beijing Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Heng Zhang
- e State Key Laboratory for Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , People's Republic of China
| | - Yu-Hua Ruan
- f Chinese Center for Disease Control and Prevention (China CDC), National Center for AIDS/STD Control and Prevention (NCAIDS) , Beijing , People's Republic of China
| | - Yiming Shao
- g Chinese Center for Disease Control and Prevention (China CDC), Beijing , People's Republic of China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health, Vanderbilt University , Nashville , TN , USA
| | - Han-Zhu Qian
- h Center for Disease Control and Prevention , Atlanta , USA
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Liu Y, Ruan Y, Strauss SM, Yin L, Liu H, Amico KR, Zhang C, Shao Y, Qian HZ, Vermund SH. Alcohol misuse, risky sexual behaviors, and HIV or syphilis infections among Chinese men who have sex with men. Drug Alcohol Depend 2016; 168:239-246. [PMID: 27723554 PMCID: PMC5523945 DOI: 10.1016/j.drugalcdep.2016.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/21/2016] [Accepted: 09/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few studies have employed standardized alcohol misuse measures to assess relationships with sexual risk and HIV/syphilis infections among Chinese men who have sex with men (MSM). METHODS We conducted a cross-sectional study among MSM in Beijing during 2013-2014. An interviewer-administered survey was conducted to collect data on sociodemographics, high-risk behaviors, and alcohol use/misuse patterns (hazardous/binge drinking and risk of alcohol dependence) in the past 3 months using Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). We defined AUDIT-C score ≥4 as recent hazardous drinkers, and drinking ≥6 standard drinks on one occasion as recent binge drinkers. RESULTS Of 3588 participants, 14.4% reported hazardous drinking, 16.8% reported binge drinking. Hazardous and binge drinking are both associated with these factors (p<0.05): older age, being migrants, living longer in Beijing, township/village origin, being employed, higher income, self-perceived low/no HIV risk, and sex-finding via non-Internet venues. Hazardous (vs non-hazardous) or binge (vs. non-binge) drinkers were more likely to use illicit drugs, use alcohol before sex, have multiple partnerships, pay for sex, and have condomless insertive anal intercourse. MSM who reported binge (AOR, 1.34, 95% CI, 1.02-1.77) or hazardous (AOR, 1.36, 95% CI, 1.02-1.82) drinking were more likely to be HIV-infected. MSM at high risk of current alcohol dependence (AUDIT-C ≥8) were more likely to be HIV- (AOR, 2.37, 95% CI, 1.39-4.04) or syphilis-infected (AOR, 1.96, 95% CI, 1.01-3.86). CONCLUSIONS Recent alcohol misuse was associated with increased sexual and HIV/syphilis risks among Chinese MSM, emphasizing the needs of implementing alcohol risk reduction programs in this population.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee 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
| | - Shiela M. Strauss
- The Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA
| | - Hongjie Liu
- The Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Chen Zhang
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA
| | - 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
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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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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9
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Liu Y, Li D, Vermund SH, Zhang C, Ruan Y, Yin L, Liu H, Amico KR, Shao Y, Qian HZ. Associations of current marital status and living arrangements with HIV and syphilis risk: findings from a community-based sample of men who have sex with men in China. AIDS Care 2016; 28:1461-6. [PMID: 27236988 DOI: 10.1080/09540121.2016.1189502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chinese men who have sex with men (MSM) are disproportionally affected by HIV and sexually transmitted infections (STIs), but little is known about the role of current marital status and living arrangements in shaping their HIV/syphilis risk. A cross-sectional study was conducted among MSM in Beijing, China to assess their sociodemographic/behavioral characteristics between married and single MSM, and test the hypothesis that currently married MSM have a lower odds of being HIV- and/or syphilis-infected. Participants were recruited via short message services, peer referral, internet, and community outreach. Data collection was based on a questionnaire survey and self-report. Infection status was lab-confirmed. Multivariable logistic regression modeling was used to assess the association of marital status and living arrangement with HIV/syphilis risk. Of the 3588 MSM, infection prevalence was high (HIV = 12.7%; syphilis = 7.5%). Compared to single MSM living with their boyfriends or male sex partners, single/alone MSM and married MSM living with wives were less likely to practice condomless insertive (CIAI) or receptive (CRAI) anal intercourse with men; while married MSM living with boyfriends or male sex partner were more likely to practice CIAI and CRAI, and married MSM were more likely to practice condomless vaginal sex. Compared to men living with boyfriends/sexual partners, significantly reduced odds of being HIV-positive were seen among married MSM who were living alone (aOR: 0.52; 95%CI: 0.28, 0.94) or living with their wives (aOR: 0.53; 95%CI: 0.31, 0.89). Similarly, single MSM living alone (aOR: 0.67; 95%CI: 0.48, 0.95) and married MSM living with their wives were comparatively less likely to be syphilis-infected (aOR: 0.43; 95%CI: 0.23, 0.79). Future efforts should consider characteristics of marital status and living arrangements for designing subgroup-specific risk reduction strategies among Chinese MSM.
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Affiliation(s)
- Yu Liu
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Dongliang Li
- b Chaoyang Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA.,c Division of Epidemiology, Department of Medicine , Vanderbilt University School of Medicine , Nashville , TN , USA.,d Department of Pediatrics , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Chen Zhang
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Yuhua Ruan
- e 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 , People's Republic of China
| | - Lu Yin
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Hongjie Liu
- f Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - K Rivet Amico
- g Department of Health Behavior and Health Education , University of Michigan , Ann Arbor , MI , USA
| | - Yiming Shao
- e 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 , People's Republic of China
| | - Han-Zhu Qian
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA.,c Division of Epidemiology, Department of Medicine , Vanderbilt University School of Medicine , Nashville , TN , USA
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10
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Lee JGL, Ylioja T, Lackey M. Identifying Lesbian, Gay, Bisexual, and Transgender Search Terminology: A Systematic Review of Health Systematic Reviews. PLoS One 2016; 11:e0156210. [PMID: 27219460 PMCID: PMC4878791 DOI: 10.1371/journal.pone.0156210] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/04/2016] [Indexed: 11/18/2022] Open
Abstract
Research on the health of lesbian, gay, bisexual, and transgender (LGBT) populations can provide important information to address existing health inequalities. Finding existing research in LGBT health can prove challenging due to the plethora of terminology used. We sought to describe existing search strategies and to identify more comprehensive LGBT search terminology. We iteratively created a search string to identify systematic reviews and meta-analyses about LGBT health and implemented it in Embase, PubMed/MEDLINE, and PsycINFO databases on May 28–29, 2015. We hand-searched the journal LGBT Health. Inclusion criteria were: systematic reviews and meta-analyses that addressed LGBT health, used systematic searching, and used independent coders for inclusion. The published search terminology in each record and search strings provided by authors on request were cross-referenced with our original search to identify additional terminology. Our search process identified 19 systematic reviews meeting inclusion criteria. The number of search terms used to identify LGBT-related records ranged from 1 to 31. From the included studies, we identified 46 new search terms related to LGBT health. We removed five search terms as inappropriate and added five search terms used in the field. The resulting search string included 82 terms. There is room to improve the quality of searching and reporting in LGBT health systematic reviews. Future work should attempt to enhance the positive predictive value of LGBT health searches. Our findings can assist LGBT health reviewers in capturing the diversity of LGBT terminology when searching.
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Affiliation(s)
- Joseph G. L. Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, United States of America
- * E-mail:
| | - Thomas Ylioja
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mellanye Lackey
- Eccles Health Sciences Library, University of Utah, Salt Lake City, Utah, United States of America
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11
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Liu Y, Ruan Y, Vermund SH, Osborn CY, Wu P, Jia Y, Shao Y, Qian HZ. Predictors of antiretroviral therapy initiation: a cross-sectional study among Chinese HIV-infected men who have sex with men. BMC Infect Dis 2015; 15:570. [PMID: 26714889 PMCID: PMC4696158 DOI: 10.1186/s12879-015-1309-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 12/03/2015] [Indexed: 11/16/2022] Open
Abstract
Background Early antiretroviral therapy (ART) initiation is crucial to achieve HIV viral suppression and reduce transmission. HIV-infected Chinese men who have sex with men (MSM) were less likely to initiate ART than other HIV-infected individuals. We assessed predictors of ART initiation among Chinese MSM. Methods In 2010–2011, a cross-sectional study was conducted among MSM in Beijing, China. We examined ART initiation within the subgroup who were diagnosed with HIV infection prior to participation in the survey. Logistic regression models were fitted to evaluate socio-demographic and behavioral factors associated with ART initiation. The eligibility criterion in the 2010/2011 national HIV treatment guidelines was CD4 cell count <350 cells/μL or World Health Organization (WHO) clinical stage III/IV. Results Of 238 eligible HIV-infected participants, the median duration of HIV infection was 15 months (range: 31 days-12 years); 62 (26.1 %) had initiated ART. Among 103 men with CD4 counts <350 cells/μL, 38 (36.9 %) initiated ART. Being married to a woman (adjusted odd ratios [aOR]: 2.50; 95 % confidence interval [CI]: 1.07-5.87), longer duration of HIV infection (aOR: 10.71; 95 % CI: 3.66-31.32), and syphilis co-infection (aOR: 2.58; 95 % CI: 1.04-6.37) were associated with a higher likelihood of ART initiation. Of 135 men with CD4 count ≥350 cells/μL, 24 (18 %) initiated ART. Being married to a woman (aOR: 4.21; 95 % CI: 1.60-11.06), longer duration of HIV infection (aOR: 22.4; 95 % CI: 2.79-180), older age (aOR: 1.26; 95 % CI: 1.1-1.44), Beijing Hukou (aOR: 4.93; 95 % CI: 1.25-19.33), presence of AIDS-like clinical symptoms (aOR: 3.97; 95 % CI: 1.32-14.0), and history of sexually transmitted infections (aOR: 4.93; 95 % CI: 1.25-19.43) were associated with ART initiation. Compared with men who did not initiated ART, those with ART were more likely to receive counseling on benefits of ART (96.8 % vs. 66.4 %, P = 0 < 0.01), HIV stigma coping strategy (75.8 % vs. 65.9 %, P = 0.04), mental health (66.1 % vs. 52.9 %, P = 0.02), and substance use (46.7 % vs. 36.6 %, P = 0.04). Conclusions We documented low rates of ART initiation among Chinese MSM. Policy changes for expanding ART eligibility and interventions to improve the continuum of HIV care are in progress in China. Impact evaluations can help assess continuing barriers to ART initiation among MSM.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, 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 (China CDC), Beijing, China.
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Chandra Y Osborn
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Pingsheng Wu
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Yujiang Jia
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - 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 (China CDC), Beijing, China.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Liu Y, Sun X, Qian HZ, Yin L, Yan Z, Wang L, Jiang S, Lu H, Ruan Y, Shao Y, Vermund SH, Amico KR. Qualitative Assessment of Barriers and Facilitators of Access to HIV Testing Among Men Who Have Sex with Men in China. AIDS Patient Care STDS 2015; 29:481-9. [PMID: 26186029 DOI: 10.1089/apc.2015.0083] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Diagnosis of HIV is the entry point into the continuum of HIV care; a well-recognized necessary condition for the ultimate prevention of onward transmission. In China, HIV testing rates among men who have sex with men (MSM) are low compared to other high risk subgroups, yet experiences with HIV testing among MSM in China are not well understood. To address this gap and prepare for intervention development to promote HIV testing and rapid linkage to treatment, six focus groups (FGs) were conducted with MSM in Beijing (40 HIV-positive MSM participated in one of four FGs and 20 HIV-negative or status unknown MSM participated in one of two FGs). Major themes reported as challenges to HIV testing included stigma and discrimination related to HIV and homosexuality, limited HIV knowledge, inconvenient clinic times, not knowing where to get a free test, fear of positive diagnosis or nosocomial infection, perceived low service quality, and concerns/doubts about HIV services. Key facilitators included compensation, peer support, professionalism, comfortable testing locations, rapid testing, referral and support after diagnosis, heightened sense of risk through engagement in high-risk behaviors, sense of responsibility to protect self, family and partner support, and publicity via social media. Themes and recommendations were generally consistent across HIV-positive and negative/status unknown groups, although examples of enacted stigma were more prevalent in the HIV-positive groups. Findings from our study provide policy suggestions for how to bolster current HIV prevention intervention efforts to enhance 'test-and-treat' strategies for Chinese MSM.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Xiaoyun Sun
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine (Division of Epidemiology), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Zheng Yan
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Lijuan Wang
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Shulin Jiang
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Hongyan Lu
- Beijing City Center for Disease Control and Prevention, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics (Division of Infectious Diseases), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
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