Social contexts of risk behaviors for HIV among male, unskilled, unregistered laborers in urban Vietnam

Comparing the Efficacy of 2 WeChat Mini Programs in Reducing Nonmarital Heterosexual Contact by Male Factory Workers: Randomized Controlled Trial

BACKGROUND

Male factory workers in China are vulnerable to HIV transmission. Commercial and nonmarital noncommercial contacts are the driving forces of heterosexual HIV transmission among male factory workers in China. There is a lack of effective HIV interventions for male factory workers in China.

OBJECTIVE

The primary objective of this randomized controlled trial was to compare the efficacy of an enhanced versus the standard version of a WeChat mini program in reducing sexual intercourse with nonregular female sex partners and female sex workers among male factory workers in Shenzhen, China.

METHODS

A nonblinded 2-arm parallel randomized controlled trial was conducted between December 2021 and April 2023. Participants were adult male factory workers in Shenzhen who had access to a smartphone and WeChat. Those who had oral or anal sex with a man or self-reported as HIV positive were excluded. A total of 247 participants were randomly assigned to the intervention group (n=125, 50.6%) or the control group (n=122, 49.4%); 221 (89.5%) and 220 (89.1%) completed follow-up surveys at T1 (6 months after completion of the interventions) and T2 (6 months after T1). Participants in the control group had access to the standard WeChat mini program that provided basic HIV-related knowledge and information about local free HIV testing services. Participants in the intervention group had access to the enhanced WeChat mini program. The enhanced mini program covered all the information in the standard mini program. In addition, the enhanced mini program assessed users' behaviors and invited users to watch different web-based videos on reducing nonmarital sexual contacts and promoting HIV testing based on their behavioral characteristics at months 0 and 1. The videos were developed based on in-depth interviews with male factory workers. Intention-to-treat analysis was used for outcome analyses. Multiple imputation was used to replace missing outcome values at T1 and T2.

RESULTS

At T1, fewer participants in the intervention group reported sexual intercourse with a nonregular female sex partner in the past 6 months compared with the control group (1/125, 0.8% vs 8/122, 6.6%; relative risk=0.12, 95% CI 0.02-0.96; P=.02). However, there were no between-group differences in sexual intercourse with a nonregular female sex partner at T2 (10/125, 8% vs 14/122, 11.5%; P=.36) or sexual intercourse with a female sex worker at T1 (2/125, 1.6% vs 2/122, 1.6%; P=.98) or T2 (8/125, 6.4% vs 8/122, 6.6%; P=.96).

CONCLUSIONS

The enhanced WeChat mini program was more effective than the standard WeChat mini program in reducing sexual intercourse with nonregular female sex partners among male factory workers in the short term but not in the longer term. Improvements should be made to the WeChat mini program before implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05811611; https://clinicaltrials.gov/study/NCT05811611.

Multifaceted Determinants of Sexual Intercourse with Non-Regular Female Sex Partners and Female Sex Workers among Male Factory Workers in China-A Cross-Sectional Survey

With a stratified multi-stage sampling approach, 1361 male factory workers in the Longhua district of the Shenzhen Municipality of China were selected to investigate the multifaceted determinants of sexual intercourse with non-regular female sex partners (NRP) and female sex workers (FSW) among them. The results showed that 24.5% and 21.2% of participants had sexual intercourse with NRP and FSW in the past 6 months, respectively. More specifically, at the individual level, perceived higher job stress and maladaptive coping styles were linked with a higher likelihood of having sexual intercourse with NRP and FSW (adjusted odds ratios [AOR] ranged from 1.06 to 1.17). At the interpersonal level, those who had higher exposure to information related to sexual intercourse with NRP or FSW were more likely to have sex with these female sex partners (AOR: 1.08 & 1.11). At the social structural level, perceived social norms supporting multiple sex partnerships were linked with a higher likelihood of having sexual intercourse with NRP and FSW (AOR: 1.10 & 1.11). No interaction effects were found between the variables at different levels. Providing pre-employment training to clarify roles and job duties, introducing adaptive coping strategies, and addressing misconceptions of social norms are useful strategies to reduce sexual intercourse with NRP or FSW.

Gaps of Knowledge about HIV and Sexually Transmitted Infections Among Industrial Workers in Northern Vietnam

Industrial workers are a vulnerable population for HIV and sexually transmitted infections (STIs). This cross-sectional study assessed the general knowledge about sexually transmitted infections (STIs) and HIV transmission risk among 289 industrial workers in Northern Vietnam. Results indicated that most workers could identify common routes of HIV transmissions and were aware of common STIs. However, insufficient knowledge about HIV transmission via anal sex practices, as well as common signs and symptoms of STIs were observed. Gender, marital status, education, locality status and health information sources were associated with the knowledge. This study reveals a gap of knowledge about HIV and other STIs, and suggested further tailored education interventions to improve the knowledge and promote sexual health-seeking behaviors in industrial workers.

A Systematic Review on Sexual Boredom

BACKGROUND

Empirical data on sexual boredom are scarce and unsystematized, contrasting with the literature on general boredom.

AIM

The aim of this review of literature is to verify how sexual boredom is defined in previous research and which relationships were found with sexual functioning, relationship dynamics, or gender.

METHODS

A systematic search was conducted in EBSCO, Scopus, Web of Science, and PubMed databases for papers published until August 2020. Search terms used were "sexual boredom" or "sexual tedium" or "sexual indifference" or "sexual monotony" or a combination of "boredom" and "sexual activity" or "intercourse". This systematic review followed PRISMA guidelines.

OUTCOMES

Articles were grouped in general boredom and sexuality research and in sexual boredom research.

RESULTS

This review consists of 43 articles, of which 31 are quantitative studies, 8 are qualitative studies, and 4 are mixed-method studies. Studies concerning general boredom and sexuality include research on diverse aspects of sexual behavior, namely solitary sexual behavior, extra-dyadic sex, compulsive sexual behavior, and risky sexual behavior. Sexual boredom research included papers regarding personality, sexual response, and varied aspects of sexual behavior.

CLINICAL IMPLICATIONS

Findings suggest sexual boredom is related with sexual response, sexual satisfaction, and hypersexuality, which renders clinical relevance. Sexual boredom impacts well-being, and further research should focus on exploring potential mechanisms underpinning this sexual problem.

STRENGTHS AND LIMITATIONS

To the authors' knowledge, this is the only existing systematic review of sexual boredom and allowed identifying key features of sexual boredom and related aspects. However, because most studies are correlational, and several do not use comprehensive measures of sexual boredom, no causal relationships were identified.

CONCLUSION

This review indicates the construct of sexual boredom includes individual, relationship, and societal aspects. However, no definition of sexual boredom includes these, and current knowledge does not allow formulating a model or a theory of sexual boredom. de Oliveira L, Carvalho J, Nobre P. A Systematic Review on Sexual Boredom. J Sex Med 2021;18:565-581.

Characterizing Unsafe Sexual Behavior among Factory Workers in the Context of Rapid Industrialization in Northern Vietnam

Industrial workers or factory workers, especially migrant workers, have been found to be vulnerable populations at risk of sexually transmitted infections (STIs). However, there has been a gap in literature regarding health behaviors of migrant factory workers. We conducted a cross-sectional study among 230 factory workers in Hanoi and Bac Ninh cities in Northern Vietnam from July to September 2018 to identify sexual risk practices and related factors among migrant and nonmigrant factory workers. Information collected regarding sexual behavior included the number of sexual partners in the previous 12 months and whether they used condoms in their last sexual intercourse. Two-thirds of participants reported having no sexual activity in the last 12 months, and there was a low percentage of participants using condoms in their last sexual intercourse. Being female, living with spouses/partners, and being a nonimmigrant had a negative association with the lack of using condoms in the last sexual intercourse with casual partners/sex workers, as opposed to having mobility and self-care problems and identifying as a binge drinker. Therefore, workplace-based prevention programs focusing on providing tailored sexual health education and promoting condom use among industrial workers, especially those who are immigrant or migrant workers, in Vietnam should be emphasized.

Predictors of condom use behaviour among male street labourers in urban Vietnam using a modified Information-Motivation-Behavioral Skills (IMB) model

HIV risk in vulnerable groups such as itinerant male street labourers is often examined via a focus on individual determinants. This study provides a test of a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behaviour among male street workers in urban Vietnam. In a cross-sectional survey using a social mapping technique, 450 male street labourers from 13 districts of Hanoi, Vietnam were recruited and interviewed. Collected data were first examined for completeness; structural equation modelling was then employed to test the model fit. Condoms were used inconsistently by many of these men, and usage varied in relation to a number of factors. A modified IMB model had a better fit than the original IMB model in predicting condom use behaviour. This modified model accounted for 49% of the variance, versus 10% by the original version. In the modified model, the influence of psychosocial factors was moderately high, whilst the influence of HIV prevention information, motivation and perceived behavioural skills was moderately low, explaining in part the limited level of condom use behaviour. This study provides insights into social factors that should be taken into account in public health planning to promote safer sexual behaviour among Asian male street labourers.

Factors Associated with Depression Among Male Casual Laborers in Urban Vietnam

This study examined the level, the prevalence of and the factors associated with depression among male casual laborers in Hanoi. Social mapping was done to recruit and interview 450 men aged over 18 years, mostly unskilled and unregistered laborers from 135 street venues across 13 districts of the city using a structured questionnaire . Most were from rural and mountainous provinces and did manual works such as motorbike taxi drivers, porters, construction workers, small traders and others in the current city. The prevalence of self-reported depressive symptoms (25 %) was high. Structural equation modeling showed that marriage, family separation and living with peers or partners were three significant distal risk factors, while illicit drug use and low social connectedness were proximal predictors of depression. Of all factors, social connectedness appeared to be the most important because it plays a mediating role. Drug use was an independent risk factor. This study provides a model to understand the mental health of male casual laborers and to develop culturally appropriate intervention programs for these men.

Factors associated with drug use among male motorbike taxi drivers in urban Vietnam

A cross-sectional study was conducted on a sample of 291 male motorbike taxi drivers (MMTDs) recruited through social mapping technique in Hanoi, Vietnam, for face-to-face interviews to examine factors associated with drug use among MMTDs using Information-Motivation-Behavioral skills (IMB) model. Among 291 MMTDs, 17.18% reported drug use sometime in their lives, 96% of whom were drug injectors. Being depressed, being originally borne in urban cities, currently residing in rural areas, having a longer time living apart from their wives/lovers, using alcohol, following Buddhism, and reporting lower motivation of HIV prevention predict significantly higher odds of uptaking drugs.

Risks for HIV infection among male street laborers in urban Vietnam

Risks for HIV infection remain unknown in male street laborers. This research investigates patterns of self-reported risk behaviors among these men in urban Vietnam. In a cross-sectional survey using a social mapping technique, 450 men, mostly low-skilled and unregistered migrant laborers across 13 districts in Hanoi were approached for interviews. The study revealed that male street laborers were at high risk of acquiring and transmitting HIV. One in every 12 men reported homosexual or bisexual behavior. These men on average had three sexual partners within the preceding year, and condom use was inconsistent. Close to 95 % of the men had reported sexual encounters with regular partners. One-third with commercial sex workers (CSW) and 24.2 % with casual partners, but just under one-third had ever used condoms with regular partners and CSWs and very few (17.6 %) with casual partners at their last sexual encounter. 17.11 % used illicit drugs sometimes, with 66.7 % of them frequently sharing injecting equipment with peers. These men had limited HIV knowledge; 51.4 % incorrectly believed that, once you trust your partner, you no longer need to use condoms and 42.4 % believed that you can tell by looking at someone if they have HIV. Access to HIV prevention was also limited; only 19.8 % of men had been tested for HIV during the previous 12 months, almost 10 % of whom neither returned for the result nor knew their HIV status. The study provides interesting directions for future research and suggests ways to effectively design prevention strategies for these men.

Predictors of recent HIV testing among male street laborers in urban Vietnam

This study assessed the prevalence of and factors associated with HIV testing among male street laborers. In a cross-sectional survey, social mapping was done to recruit and interview 450 men aged 18-59 years in Hanoi. Although many of these men engaged in multiple risk behaviors for HIV, only 19.8 percent had been tested for HIV. A modified theoretical model provided better fit than the conventional Information-Motivation-Behavioral Skills model, as it explained much more variance in HIV testing. This model included three Information-Motivation-Behavioral components and four additional factors, namely, the origin of residence, sexual orientation, the number of sexual partners, and the status of condom use.

Modeling predictors of risky drug use behavior among male street laborers in urban Vietnam

BACKGROUND

The application of theoretical frameworks for modeling predictors of drug risk among male street laborers remains limited. The objective of this study was to test a modified version of the IMB (Information-Motivation-Behavioral Skills Model), which includes psychosocial stress, and compare this modified version with the original IMB model in terms of goodness-of-fit to predict risky drug use behavior among this population.

METHODS

In a cross-sectional study, social mapping technique was conducted to recruit 450 male street laborers from 135 street venues across 13 districts of Hanoi city, Vietnam, for face-to-face interviews. Structural equation modeling (SEM) was used to analyze data from interviews.

RESULTS

Overall measures of fit via SEM indicated that the original IMB model provided a better fit to the data than the modified version. Although the former model was able to predict a lesser variance than the latter (55% vs. 62%), it was of better fit. The findings suggest that men who are better informed and motivated for HIV prevention are more likely to report higher behavioral skills, which, in turn, are less likely to be engaged in risky drug use behavior.

CONCLUSIONS

This was the first application of the modified IMB model for drug use in men who were unskilled, unregistered laborers in urban settings. An AIDS prevention program for these men should not only distribute information and enhance motivations for HIV prevention, but consider interventions that could improve self-efficacy for preventing HIV infection. Future public health research and action may also consider broader factors such as structural social capital and social policy to alter the conditions that drive risky drug use among these men.

Male migrants' non-spousal sexual partnerships in the place of origin: an in-depth investigation in two rural settings of India

Male migrants in India are at disproportionately high risk for HIV, not only because of their sexual behaviours in destination areas but also due to their risk behaviours in their place of origin. While studies have documented male migrants' risky behaviours in the home setting, few have attempted to understand the underlying socio-cultural context in which they engage in such behaviours. This paper examines the patterns and context of male migrants' non-spousal sexual partnerships in two high-out-migration districts of India. Data, drawn from a cross-sectional behavioural mixed-methods study conducted in 2008, included a structured survey with 1272 migrants, followed by in-depth interviews with 33 male migrants. Results suggest that sexual activity was common in the place of origin: around 50% of migrants had sex with a non-spousal female partner and two-fifths had initiated sex in this setting. Migrants' non-spousal sexual behaviours in the home village were influenced by the prevailing socio-cultural context, including migrants' enhanced socio-economic status, attitudes to non-spousal sex and accessibility of sexual partners. Male migrants' non-spousal sexual partnerships in source areas are influenced by socio-cultural factors, which must be considered when designing HIV programmes in India and elsewhere.

Prevalence and correlates of alcohol use disorders during antiretroviral treatment in injection-driven HIV epidemics in Vietnam

BACKGROUND

Alcohol use disorders (AUD) negatively affects adherence to and outcomes of antiretroviral treatment (ART) for HIV/AIDS patients. This study determined the prevalence of AUD and identified correlates of alcohol consumption and drinking problems during ART in large injection-driven HIV epidemics in Vietnam.

METHODS

We conducted a cross-sectional study of 1016 patients (36.2% women, mean age=35.4) in 7 hospitals in Hanoi, Hai Phong, and Ho Chi Minh City. Alcohol use problems were assessed using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C). Step-wise multivariate regression analyses determined the correlates of alcohol consumption, hazardous drinking, and binge drinking in HIV/AIDS patients.

RESULTS

There were 55.0% patients reported ever drinking, 30.1% had positive hazardous drinking and 22.3% had binge drinking. Patients who were male, drug users, working as free-lancers, asymptomatic stage, and poorer immune status were more likely to have severe alcohol consumption, hazardous drinking and binge drinking. Drug users taking both ART and Methadone Maintenance Treatment (MMT), were less likely to report AUD. In non-drug users, the longer duration of ART was also associated with lower alcohol consumption and likelihood of drinking problems. In drug users, those in the 1st year ART were more likely to be at-risk drinking than other patient groups.

CONCLUSION

AUD is highly prevalent in HIV/AIDS patients taking ART in large injection-driven HIV epidemics. ART guidelines should include AUD screening and interventions. Expanding the coverage of current services for drug users, including MMT and ART, might contribute to the reduction of AUD.

The effect of participatory community communication on HIV preventive behaviors among ethnic minority youth in central Vietnam

Background

In Vietnam, socially marginalized groups such as ethnic minorities in mountainous areas are often difficult to engage in HIV research and prevention programs. This intervention study aimed to estimate the effect of participatory community communication (PCC) on changing HIV preventive ideation and behavior among ethnic minority youth in a rural district from central Vietnam.

Methods

In a cross-sectional survey after the PCC intervention, using a structured questionnaire, 800 ethnic minority youth were approached for face-to-face interviews. Propensity score matching (PSM) technique was then utilized to match these participants into two groups-intervention and control-for estimating the effect of the PCC.

Results

HIV preventive knowledge and ideation tended to increase as the level of recall changed accordingly. The campaign had a significant indirect effect on condom use through its effect on ideation or perceptions. When intervention and control group statistically equivalently reached in terms of individual and social characteristics by PSM, proportions of displaying HIV preventive knowledge, ideation and condom use were significantly higher in intervention group than in matched control counterparts, accounting for net differences of 7.4%, 12.7% and 5%, respectively, and can be translated into the number of 210; 361 and 142 ethnic minority youth in the population.

Conclusions

The study informs public health implications both theoretically and practically to guide effective HIV control programs for marginalized communities in resources-constrained settings like rural Vietnam and similar contexts of developing countries.