Relationship between quality of life and unprotected anal intercourse among Chinese men who have sex with men: a cross-sectional study

Positive Coping as a Mediator of Mobile Health Intervention Effects on Quality of Life Among People Living With HIV: Secondary Analysis of the Randomized Controlled Trial Run4Love

BACKGROUND

The effectiveness of psychosocial interventions on quality of life (QOL) among people living with HIV has been validated, including mobile health (mHealth) interventions. However, it is unclear which components of such interventions account for these effects.

OBJECTIVE

This study aims to examine positive coping as a potential mediator of the effects of an mHealth intervention on QOL among people living with HIV.

METHODS

For this secondary analysis, we used data from an mHealth-based randomized controlled trial, Run4Love, which was conducted to improve QOL and mental health outcomes of people living with HIV. A total of 300 participants were randomly assigned to the intervention group to receive the adapted cognitive-behavioral stress management courses and regular physical activity promotion or the waitlist control group in a 1:1 ratio. Our analysis focused on positive coping and QOL, which were repeatedly measured at baseline and at 3-, 6-, and 9-month follow-ups. Latent growth curve models were constructed to explore the mediating role of positive coping in the effects of the mHealth intervention on QOL.

RESULTS

Positive coping served as a mediator in the effect of the mHealth intervention on QOL for up to 9 months. The mHealth intervention had a significant and positive indirect effect on the slope of QOL via the slope of positive coping (b=2.592×1.620=4.198, 95% CI 1.189-7.207, P=.006). The direct effect of the intervention was not significant (b=0.552, 95% CI -2.154 to 3.258, P=.69) when controlling for the mediator.

CONCLUSIONS

The longitudinal findings suggest that positive coping could be a crucial mediator of the mHealth intervention in enhancing QOL among people living with HIV. These findings underscore the importance of improving positive coping skills in mHealth interventions to improve QOL among people living with HIV.

Assessing the Determinants of Quality of Life and the Impact on HIV Prevention Measures among HIV-Negative and Status-Unknown Young Men Who Have Sex with Men: A Study in Two U.S. Metropolitan Areas

Young men who have sex with men (YMSM) in the United States (U.S.) are disproportionally burdened by HIV and experience adverse social determinants of health. Minimal research has examined quality of life (QoL) and psychosocial/behavioral determinants among HIV-negative or status-unknown YMSM. We conducted a study with YMSM from two U.S. cities to assess their QoL scores, and whether specific QoL domains (e.g., physical, psychological, social, and environment) were associated with their demographics, psychosocial determinants, behavioral risk factors, and HIV prevention measures. Black YMSM, YMSM of low socioeconomic status (below high school education, income < $20,000, and lack of health insurance), and YMSM who did not disclose their sexual orientation had the lowest QoL scores across all domains. Substance use and unprotected anal intercourse were negatively associated with men’s physical/psychosocial health. Housing/food instability and perceived stress were among the strongest predictors of lower QoL in all domains. Higher physical/psychological and environment QoL scores were associated with a higher likelihood of HIV testing and PrEP use. The identification of YMSM within these demographic, behavioral, and psychosocial sub-groups is important for targeted intervention to enhance their well-being and engagement with HIV prevention.

The Holistic Health Status of Chinese Homosexual and Bisexual Adults: A Scoping Review

Background: Same-sex marriage is currently not legalized in China, despite the considerably large number of homosexual and bisexual Chinese populations. At the same time, their holistic health status remains unclear. This is the first scoping review conducted to comprehensively examine all the available literature and map existing evidence on the holistic health of homosexual and bisexual Chinese. Methods: This scoping review used the framework of Arksey and O'Malley and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR). A comprehensive search strategy was carried out across 20 English (EN) and Chinese (both traditional and simplified) electronic databases from January 1, 2001, to May 31, 2020. Two reviewers conducted the reference screening and study selection independently and consulted a third senior reviewer whenever a consensus must be achieved. Data extraction was conducted using a structured data form based on the Cochrane template, after which a narrative synthesis of the findings was performed. Results: A total of 2,879 references were included in the final analysis, with 2,478 research articles, 167 reviews, and 234 theses. Regarding the study populations, the vast majority of studies centered on men only (96.46%), especially men who have sex with men (MSM). Only 1.32% of the studies targeted female sexual minorities. The geographical distribution of all research sites was uneven, with most of them being conducted in mainland China (95.96%), followed by Hong Kong (2.05%), Taiwan (2.02%), and Macau (0.06%). Regarding the specific study focus in terms of the health domain, around half of the studies (45.93%) focused on sexual health only, and an additional quarter of the studies (24.15%) investigated both sexual health and social well-being. Meanwhile, the studies focusing on mental health only accounted for approximately 15% of the total. Conclusions: This scoping review revealed that previous research focused more on male than female sexual minorities, on disease-centered surveys than person-centered interventions, and investigations on negative health conditions than positive health promotion. Therefore, investigations centered on the female sexual minorities and corresponding person-centered interventions are highly needed. Review Registration: The protocol of this review has been registered within Open Science Framework (https://osf.io/82r7z) on April 27, 2020.

Chemsex Practices and Health-Related Quality of Life in Spanish Men with HIV Who Have Sex with Men

Chemsex, a new risky sexual behavior involving participation in sexual relations under the influence of drugs, has shown a significantly increased prevalence in recent years. This fact entails a serious public health issue, especially when Chemsex is practiced by individuals with an HIV (Human Immunodeficiency Virus) diagnosis. Hence, analyzing the characteristics of Chemsex practices, associated sexual practices and the health outcomes of individuals who participate in Chemsex, is extremely important. The main aim of the present study is to analyze the prevalence and characteristics of the practice of Chemsex in a sample of 101 men with HIV who have sex with men who attended the Department of Infectious Diseases of the General University Hospital of Alicante (Spain). Furthermore, the association between Chemsex and Health-Related Quality of Life (HRQoL) was also assessed. Chemsex and sexual practices were evaluated by employing a questionnaire applied on an ad hoc basis. HRQoL was assessed by employing the Medical Outcomes Study HIV Health Survey (MOS-HIV). In total, 40.6% of the participants had practiced Chemsex during the last year. When sexual practices were compared between those individuals who practiced Chemsex and those who did not, the former presented a higher level of risky sexual behaviors, especially with occasional and multiple sexual partners. Regarding HRQoL, those individuals who practiced Chemsex exhibited a poorer HRQoL in the majority of domains, especially those participants who practiced it with a higher intensity. The present study points out the high prevalence of Chemsex practice between men with HIV who have sex with men in Spain. Moreover, this study highlights the negative effects of Chemsex on HRQoL, probably due to the mixed effects of higher levels of risky sexual practices and the consequences of drug consumption.

Identification of Self-Management Behavior Clusters Among People Living with HIV in China: A Latent Class Profile Analysis

BACKGROUND

Self-management directly affects the health outcomes and quality of life among people living with HIV (PLWH). A better understanding of self-management level will provide evidence for researchers to develop effective interventions.

PURPOSE

This study aims to identify the latent classes among PLWH in their levels of self-management behavior, and to explore the sociodemographic and disease-related predictors within these classes.

MATERIALS AND METHODS

A total of 868 PLWH were recruited from August 2017 to January 2019 in Sichuan Province, China. A latent class profile analysis was used to identify participants' self-management behavior, and multinomial logistic regression was used to explore the sociodemographic and disease-related predictors of the different latent classes.

RESULTS

Model fit indices supported a three-class model. The mean self-management scores in the three classes were 23.56 (SD=6.02), 37.91 (SD=3.80), and 47.95 (SD=4.18), respectively. The latent classes were Class 1 (a poor level of self-management behavior, 12.1%, n=104), Class 2 (a moderate level of self-management behavior, 56.1%, n=491) and Class 3 (a good level of self-management behavior, 31.7%, n=273). Antiretroviral trerapy (ART) status, infection route, and educational level were the main predictors of self-management behavior.

CONCLUSION

The findings indicated that the level of self-management behaviors among PLWH in China is inadequate. Those with a lower educational level, who were infected through blood/injecting drugs, and who were not receiving ART, showed a significantly lower level of self-management behavior. These results could help healthcare professionals to quickly recognize PLWH who are at a high risk of low-level self-management, using individual characteristics and could provide a scientific basis for the development of effective and targeted programs to improve self-management level in PLWH.

The Influence of Internalized Homophobia on Health-Related Quality of Life and Life Satisfaction Among Gay and Bisexual Men in China

The aim of this study was to examine the influences of internalized homophobia on Chinese gay and bisexual men's quality of life and life satisfaction. Four hundred and eighty-three participants completed the Internalized Homophobia Scale, Chinese SF-12 Health Survey Version 2, and Satisfaction With Life Scale via the Internet. Scores for quality of life in several domains and life satisfaction were significantly lower than the heterosexuals' norm scores. The present study revealed that internalized homophobia significantly negatively correlated with the mental component summary score and life satisfaction. The mental component summary score mediated the relationship between internalized homophobia and life satisfaction. Sexual orientation moderated the relationship between internalized homophobia and mental component score. Gay and bisexual men in China experience poorer quality of life and less satisfaction with life compared to heterosexuals, and internalized homophobia contributes to both.

HIV-related stigma and quality of life in people living with HIV and depressive symptoms: indirect effects of positive coping and perceived stress

Despite a strong evidence on the negative association between HIV-related stigma and quality of life (QoL), few studies have examined the indirect effects of this relationship. This study aimed to examine the association between HIV-related stigma and QoL and the indirect effects of positive coping and perceived stress in people living with HIV and depressive symptoms (PLWHD). This study used baseline date from a randomized controlled trial. Structural equation model was used to examine the association between HIV-related stigma and QoL as well as the indirect effects of positive coping and perceived stress. Perceived and internalized stigma had negative direct (β = -0.14, p < 0.05) effect on QoL. Moreover, perceived and internalized stigma had indirect effects on QoL through decreased positive coping and increased perceived stress (β = -0.23, p < 0.001). Multilevel interventions to reduce perceived and internalized stigma and perceived stress as well as programs to enhance positive coping may improve QoL of PLWHD. Integrated interventions that both enhance positive coping and reduce perceived stress and stigma are potentially more effective in improving QoL than programs that focus on only one aspect of stigma reduction among PLWHD.

Psychosociobehavioral characteristics associated with high condomless anal intercourse intention: a comparison of receptive, versatile, and insertive MSM in Taiwan

In Taiwan, men who have sex with men (MSM) continue to be disproportionately affected by HIV, and the main route of HIV transmission is condomless anal intercourse (CAI). This study examined the associations between psychosociobehavioral characteristics and CAI intention among MSM in Taiwan who had ever engaged in anal intercourse with men, and compared the differences across three sexual roles (receptive, versatile, and insertive) using online survey data (N = 563). For all MSM, those that were in a relationship (AOR = 2.55; 95% CI: 1.61-4.03), had three or more steady partners (AOR = 2.58; 95% CI: 1.19-5.58), did not use a condom during last anal intercourse (AOR = 6.81; 95% CI: 4.36-10.63), perceived high HIV risk (AOR = 2.13; 95% CI: 1.26-3.60), and had high sexual sensation seeking (AOR = 2.80; 95% CI: 1.82-4.30) were more likely to have high CAI intention. After stratification, the significant characteristics differed depending on sexual role, except for no condom use during last anal intercourse remaining significant in all models (AOR = 5.09-20.30; 95% CI: 2.49-66.69, depending on sexual role). Tailoring the programs for MSM of different sexual roles may improve the effectiveness of future prevention efforts.

Effect of chronic disease self-management program on the quality of life of HIV-infected men who have sex with men: An empirical study in Shanghai, China

OBJECTIVES

The HIV/AIDS epidemic rages on in China, particularly among men who have sex with men (MSM). MSM with HIV/AIDS also tend to have poorer quality of life than other members of the population. A major contributor to these issues is the huge gap between the increasing demand of MSM for medical services and the availability of such services; their current needs cannot be met only with the services of the Chinese Center for Disease Control and Prevention. The aim of the present study was to examine the quality of life of MSM with HIV/AIDS in Shanghai, as well as determine whether it is influenced by chronic disease self-management (CDSM).

METHODS

We conducted a pre-post study to evaluate the effect of CDSM on participants' quality of life. Four hundred twenty participants were assigned to either the CDSM group (n = 210) or the control group (n = 210). We collected data on quality of life (using the Medical Outcomes Study HIV Health Survey [MOS-HIV]) and various psychological and behavioral variables via interviewer-administered questionnaires.

RESULTS

The physical and mental health summary scores of the MOS-HIV were 53.7 and 49.9, respectively. The CDSM group showed a significant improvement in quality of life and a significant decrease in the proportion of participants with anxiety symptoms (from 38.6% to 22.6%). Furthermore, the frequency of condom use increased from 43.3% to 47.3%.

CONCLUSION

MSM with HIV generally had low quality of life in Shanghai. The CDSM program might help promote the quality of life of MSM while helping them practice healthy behaviors.

Psychosocial Factors Associated with Quality of Life in Young Men Who Have Sex with Men Living with HIV/AIDS in Zhejiang, China

OBJECTIVES

To explore the quality of life (QOL) status and related factors in young human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) aged 16 to 24 years in Zhejiang province.

METHODS

A cross-sectional study was conducted in 22 counties of Zhejiang province, and 395 subjects took part in our research. A t-test, one-way Analysis of variance (ANOVA), and multivariate stepwise linear regression analysis were used to investigate the factors associated with QOL in young HIV-infected MSM.

RESULTS

The total score on the QOL was 86.86 ± 14.01. The multivariate stepwise linear regression analysis revealed that self-efficacy and discrimination were associated with all domains on the QOL assessment, monthly income was associated with QOL for all domains except spirituality and consistent condom use during oral sex with men in the past three months was associated with QOL for all domains except the relationship domain. Those individuals within the group of young HIV-infected MSM who have higher self-efficacy, a higher monthly income, greater social support, safer sexual behaviors, a higher level of education, and a higher cluster of differentiation 4 (CD4) count have a better QOL.

CONCLUSIONS

These findings suggest that to improve the QOL of this population, greater emphasis should be placed on improving social support, self-efficacy, and antiviral therapy adherence and on reducing discrimination, disease progression, and high-risk behaviors.

Quality of life of gay and bisexual men during emerging adulthood in Taiwan: Roles of traditional and cyber harassment victimization

This study examined factors related to the quality of life (QOL) of gay and bisexual men during emerging adulthood in Taiwan. The factors included traditional harassment (e.g., verbal ridicule, relational exclusion, physical aggression, and theft of belongings), cyber harassment, sex- and gender-related factors (e.g., sexual orientation, age at initial identification of sexual orientation, self-reported level of gender nonconformity, and perceived social acceptance toward homosexuality and bisexuality), and demographic characteristics. In total, 305 Taiwanese gay and bisexual men, aged 20-25 years, were recruited. Their QOL, traditional harassment, and cyber harassment data were collected using the World Health Organization Questionnaire on Quality of Life: Short Form, School Bullying Experience Questionnaire, and Cyberbullying Experiences Questionnaire, respectively. In total, 60.3%, 34.4%, 28.2%, and 29.5% of the participants reported experiencing traditional harassment, cyber harassment, traditional harassment across multiple contexts, and harassment in multiple forms, respectively. Both traditional and cyber harassment were significantly associated with lower QOL. Individuals who experienced traditional harassment across multiple contexts and harassment in multiple forms had lower QOL in nearly all domains than did individuals who had experienced traditional harassment in a single context and harassment of a single form. However, the QOL did not significantly differ between individuals who had experienced traditional harassment in a single context and nonvictims nor between individuals who had experienced harassment of a single form and nonvictims. Lower education level, older age at initial identification of sexual orientation, higher perception of gender nonconformity, and lower perceived social acceptance toward homosexuality and bisexuality were significantly associated with lower QOL. Clinical and public health professionals should consider these factors when developing programs to enhance the QOL of gay and bisexual men.

Individual and family level factors associated with physical and mental health-related quality of life among people living with HIV in rural China

Background

One of the major challenges faced by people living with HIV (PLH) is the compromised quality of life due to the negative impact of HIV on their health. HIV/AIDS control effort should go beyond laboratory and lay more emphasis on improving the health-related quality of life (HRQoL) for PLH. The objective of this study is to evaluate the physical and mental HRQoL of PLH in rural China, and explore the relationship between HRQoL and individual- and family-level factors.

Methods

A cross-sectional study was conducted among 522 PLH in Anhui, China. Participant’s sociodemographic characteristics, family status, and HIV-related factors were collected. Physical health summary score (PHS) and mental health summary score (MHS) of quality of life were measured. Multiple linear regressions were conducted to estimate the association of the individual- and family-level factors with MHS and PHS.

Results

Male were more likely to report a higher level of PHS and MHS than female (β = 0.123, P = 0.009; β = 0.150, P = 0.002). Age was significantly negatively associated with the PHS (β = − 0.232, P<0.001) when other variables were controlled. Family size remained negatively correlated with PHS (β = − 0.105, P = 0.021). Family annual income was significantly positively associated with PHS and MHS (β = 0.126, P = 0.003; β = 0.135, P = 0.002).

Conclusions

Future intervention should be carefully tailored to the specific needs of sub-populations (such as female and older PLH) considering their physical and mental HRQoL conditions. More attention and care should be provided to PLH with left-behind children in the family.

Condomless Anal Intercourse by Partner Type Among Chinese Men Who Have Sex With Men in Tianjin

HIV prevalence and incidence is high among men who have sex with men (MSM) in China, underscoring the need to support and optimize HIV risk reduction strategies for this population. We sought to estimate the prevalence of condomless anal sex among MSM living in Tianjin, China. We recruited 595 HIV-negative MSM living in Tianjin to participate in a HIV study between 2013 and 2014. Data were collected after a voluntary counseling and testing session through a face-to-face survey. We used multivariable logistic regressions to examine the association between sociodemographic characteristics and HIV risk correlates and MSM's likelihood of engaging in condomless anal intercourse with main and casual partners in the prior 6 months. Results are presented. HIV risk reduction efforts should be developed to be sensitive and responsive to the unique experiences of Chinese MSM. We discuss opportunities for future work, including the development HIV risk reduction interventions.

Prevalence of condomless anal intercourse and recent HIV testing and their associated factors among men who have sex with men in Hangzhou, China: A respondent-driven sampling survey

Men who have sex with men (MSM) are a large high-risk population for HIV infection in recent years in China. A cross-sectional survey was conducted in Hangzhou, China, to determine rates of condomless anal intercourse (CAI), recent HIV testing (in the recent year) and associated factors using respondent-driven sampling. Questionnaires using face-to-face interviews were employed to collect data on sexual risk behaviors and HIV testing. Five hundred eleven MSM were recruited, of which 459 (89.8%) had anal intercourse in the past 6 months. Of these 459 participants, 457 (99.6%) answered whether they had taken an HIV test in the recent year, so only their data were analyzed. Weighted data were analyzed using bivariate and multivariate logistic regression analysis. The CAI rate with male partners in the past 6 months was 43.7% (95% confidence interval [CI], 34.0-51.5%), while the rate of condomless vaginal intercourse (CVI) was 21.6% (95% CI, 15.6-32.3%). The prevalence of recent HIV testing was 56.8% (95% CI, 48.7-66.5%), while the prevalence of HIV and syphilis were 8.8% and 6.5%, respectively. Multivariate analysis indicated that CAI was associated with earlier homosexual debut, suicidal inclinations, childhood sexual abuse, HIV testing in the recent year, and lower estimate of HIV prevalence. Recent HIV testing was associated with homosexual debut age, engaging in CAI with male partners in the past 6 months, having oral sex in the past 6 months, self-perceived higher likelihood of HIV infection, knowing about antiretroviral therapy for HIV/AIDS, receiving AIDS/sexually transmitted infection (STI) interventions in the past year, and syphilis infection. Given high prevalence of HIV and syphilis, high levels of CAI and CVI, and low HIV testing rate, the results indicated high risk of HIV infection and transmission among MSM. HIV prevention interventions should target MSM with early homosexual debut and psychosocial health problems, while HIV/AIDS education among MSM should focus on increasing knowledge of HIV risk, estimated HIV prevalence and antiretroviral therapy, and improving risk perception of HIV acquisition.