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Shen Y, Zhang C, Goldsamt LA, Peng W, Wang R, Li X. Condom-Related Stigma Scale among Men Who Have Sex with Men in China: Development and Psychometric Tests. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4779. [PMID: 36981688 PMCID: PMC10048750 DOI: 10.3390/ijerph20064779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Condom-related stigma is a frequently mentioned barrier to consistent condom use among men who have sex with men (MSM). Based on the concept and operational definition of condom-related stigma recently defined by our team, we developed the 20-item condom-related stigma scale (CRSS) and examined its psychometric properties among 433 MSM in China, following DeVellis's scale development guidelines. The content validity, convergent validity, empirical validity, factorial validity, scale score reliability, split-half reliability, and test-retest reliability for the CRSS were all assessed. The scale consists of four domains: perceived distrust, perceived potential HIV/STI risk, perceived embarrassment, and perceived violation of the traditional understanding of sexual intercourse. The CRSS has good validity (the scale-level content validity index was 0.99; the empirical validity was greater than 0.70) and high reliability (the Cronbach's alpha coefficient overall was 0.926; the split-half reliability overall was 0.795; the test-retest reliability overall was 0.950). This scale is recommended for assessing the level of condom-related stigma among Chinese MSM, which can serve as an evaluating indicator for safer-sex interventions to prevent HIV infection among the MSM population in a Chinese cultural context.
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Affiliation(s)
- Yan Shen
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Ci Zhang
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Lloyd A. Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA
| | - Wenwen Peng
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Run Wang
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Y.S.)
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Yang X, Yu Y, Song X, He L, Fu Y, Zhang J, Wang X, Zhang H. Prevalence of unprotected anal intercourse and associated factors among male students who have sex with men in Qingdao, China: A cross-sectional study. Medicine (Baltimore) 2023; 102:e33180. [PMID: 36862866 PMCID: PMC9981382 DOI: 10.1097/md.0000000000033180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
The significant rise of human immunodeficiency virus (HIV) epidemic among young students has become a new feature of acquired immune deficiency syndrome in China, and unprotected anal intercourse (UAI) among male students who have sex with men (SMSM) played a central role in this process. The aim of this study was to investigate the prevalence of UAI, as well as analyze the factors associated with UAI among SMSM in Qingdao, China. From May 2021 to April 2022, men who aged 15 to 30, studied in a high school or college in Qingdao and had anal sex with men in the past 6 months were recruited through snowball method relying on the nongovernmental organization. An anonymous electronic questionnaire was administrated to collect information on socio-demographic characteristics, sexual behaviors, substance use before sex, HIV prevention services and self-esteem. Univariate and multivariate logistic regressions were used to assess factors related to UAI. Among the 341 SMSM included in the study, 40.5% engaged in UAI in the past 6 months. Being migrants from other provinces [odds ratios (OR) = 2.04, 95% confidence intervals (CI): 1.10-3.78], failing to use condoms for the first anal intercourse (OR = 3.38, 95% CI: 1.85-6.18), drinking alcohol before sex (OR = 2.31, 95% CI: 1.25-4.28) and being low level self-esteem (OR = 1.77, 95% CI: 1.09-2.87) were positively associated with UAI. SMSM who had homosexual intercourse more than once a week (OR = 1.76, 95% CI: 1.03-3.00) or had multiple male sex partners (OR = 1.99, 95% CI: 1.20-3.30) were more likely to engage in UAI. Received peer education in the past 12 months (OR = 0.48, 95% CI: 0.27-0.86) was associated with lower odds of UAI. The situation of UAI among SMSM in Qingdao was a public health issue of concern. It is necessary to take targeted measures, such as focusing on first-time sex, advancing sexual health education, expanding peer education, implementing alcohol use screening and maintaining the self-esteem of SMSM, so as to reduce the occurrence of high-risk behaviors among SMSM and curb the spread of HIV on campus.
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Affiliation(s)
- Xuebin Yang
- School of Public Health, Qingdao University, Qingdao, China
| | - Yingying Yu
- School of Public Health, Qingdao University, Qingdao, China
| | - Xin Song
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Lili He
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Yong Fu
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Jianwen Zhang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Xiaojun Wang
- School of Public Health, Shandong First Medical University, Tai An, China
| | - Huaqiang Zhang
- School of Public Health, Qingdao University, Qingdao, China
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
- * Correspondence: Huaqiang Zhang, School of Public Health, Qingdao University, Qingdao 266071, China (e-mail: )
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Huang H, Xu Z, Ge Q, Zhou X, Zou M, Qin G, Cao Y, Duan X, Chu M, Zhuang X. The Impact of Customized Short Message Service on High-Risk Behaviors Among MSM in China, a Randomized Controlled Trial Study. AIDS Behav 2023:10.1007/s10461-023-03995-4. [PMID: 36705771 PMCID: PMC9880942 DOI: 10.1007/s10461-023-03995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
An individual based randomized controlled trial (RCT) was designed to evaluate the impact of a customized short message service (SMS) intervention on HIV-related high-risk behaviors among Men who have sex with men (MSM). In total, 631 HIV-negative MSM were enrolled at baseline and divided into intervention and control groups randomly. Nine months later, the intervention group who received additional customized SMS intervention reported significantly lower rates of multiple partners, unclear partner infection status and condomless anal intercourse compared to the control group who received the routine intervention only. Six months post stopping the SMS intervention, the rates of unclear partner infection status and condomless anal intercourse still remained lower report in the intervention group. Our study shown that the customized SMS interventions can significantly reduce the HIV-related high-risk behaviors among MSM and with sustained effects over a period of time.
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Affiliation(s)
- Hao Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Zhengcheng Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Qiwei Ge
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Xiaoyi Zhou
- Nantong Center for Disease Control and Prevention, Nantong, Jiangsu China
| | - Meiyin Zou
- Department of Infectious Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu China
| | - Gang Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Yuxin Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Xiaoyang Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Minjie Chu
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Xun Zhuang
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
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Shen Y, Zhang C, Valimaki MA, Qian H, Mohammadi L, Chi Y, Li X. Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis. BMC Infect Dis 2022; 22:850. [PMCID: PMC9661788 DOI: 10.1186/s12879-022-07843-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Despite a large amount of behavioral interventions to reduce human immunodeficiency virus (HIV)-related high-risk sexual behaviors, consistent condom use remains suboptimal among men who have sex with men (MSM). However, current databases are lack of synthesized evidence to explain why MSM practiced condomless sex.
Objective
Our study aims to conduct a systematic review and meta-synthesis of 39 eligible qualitative studies to explore the barriers to condom use among MSM.
Methods
A systematic review and meta-synthesis of qualitative studies (1994–2021). On March 4, 2021, a comprehensive search was conducted in 14 electronic databases. The study was conducted based on the Joanna Briggs Institute’s recommendations.
Results
Thematic analysis produced six synthesized themes, which were classified into three levels according to the Social-ecology Model. Individual level barriers to condom use included physical discomfort, lack of HIV/STI-related knowledge and substance use; interpersonal-level barrier was mainly the condom stigma, namely regarding using condom as symbols of distrust or HIV/sexually transmitted infections (STIs) prevention, or as violating traditional cognition of sex, or as an embarrassing topic; environmental/structural-level barriers included situational unavailability, unaffordability of condoms and power imbalance in the sexual relationship.
Conclusion
This meta-synthesis offered in-depth understanding of condom use barriers for MSM and could guide the development of multifactorial interventions according to the identified barriers, especially targeting to reduce condom stigma, which has not been focused and intervened previously.
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Yu Y, Ling RHY, Ip TKM, Luo S, Lau JTF. Factors of COVID-19 Vaccination among Hong Kong Chinese Men Who Have Sex with Men during Months 5–8 since the Vaccine Rollout—General Factors and Factors Specific to This Population. Vaccines (Basel) 2022; 10:vaccines10101763. [PMID: 36298627 PMCID: PMC9609851 DOI: 10.3390/vaccines10101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
This study investigated an under-researched topic regarding the prevalence of COVID-19 vaccination behavior among Chinese men who have sex with men (MSM) and the associations of this with general and MSM-specific perceptions grounded in the health belief model (HBM) and the theory of planned behaviors (TPB). A total of 400 Chinese MSM were recruited from multiple sources (site recruitment, online recruitment, and peer referral) in Hong Kong from July to October 2021, who then participated in a structured telephone interview. Of all the participants, the prevalence of COVID-19 vaccination (i.e., taking at least one dose of COVID-19 vaccination) was 78.3%. Multivariable logistic regression analyses showed that, after adjusting for background factors, (1) the general and MSM-specific HBM variables of perceived benefits and self-efficacy were positively associated with COVID-19 vaccination behavior; (2) the items or scale of general/MSM-specific perceived barriers and social norms were negatively associated with COVID-19 vaccination behavior; (3) the general perceived severity and MSM-specific perceived susceptibility, perceived severity, and cue to action were not significantly associated with COVID-19 vaccination behavior. The findings suggest that the HBM and social norm construct of the TPB only partially explained the participant’s COVID-19 vaccination behavior. Health promotion may need to focus more on modifying perceptions related to COVID-19 vaccination rather than COVID-19.
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Affiliation(s)
- Yanqiu Yu
- Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Shanghai 200032, China
| | - Rachel Hau Yin Ling
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tsun Kwan Mary Ip
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sitong Luo
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Joseph T. F. Lau
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, China
- School of Mental Health, Wenzhou Medical University, Wenzhou 325000, China
- School of Public Health, Zhejiang University, Hangzhou 310058, China
- Correspondence:
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Chen S, Yang Q, He J, Fan X, Liu Z, Qiu J, Zheng Z, Gu J, Cheng W, Hao Y, Li J, Hao C. The effects of intimate relationship characteristics on unprotected anal intercourse among same-sex male couples in China: a dyadic analysis using the actor-partner interdependence model. BMC Infect Dis 2021; 21:593. [PMID: 34157968 PMCID: PMC8218385 DOI: 10.1186/s12879-021-06317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unprotected anal intercourse (UAI) within the context of concurrent sexual relationship are prevalent among men who have sex with men (MSM) who have regular male sex partners and it aggravates the risk of HIV infection among this community. The aim of this study was to assess the effect of intimate relationship characteristics on UAI among MSM couples at the dyadic level. METHODS Two hundred four MSM couples were recruited from a HIV testing clinic from April 2017 to April 2018 in Guangzhou, China. The actor-partner interdependence model (APIM) was applied for dyadic analysis. Each MSM couple was divided into the insertive role and the receptive role according to their regular anal sex role. In this context, actor effect is the impact of an MSM's intimate relationship characteristics on his own UAI, and partner effect is the impact of his partner's intimate relationship characteristics on his UAI. RESULTS Of the 408 participants, 58.82% had UAI with regular male sex partner (UAI-RP) and 8.09% had concurrent UAI. Intimate relationship characteristics were associated with concurrent UAI, but not associated with UAI-RP. For the receptive role, his relationship investment exerted significant actor and partner effects on concurrent UAI (AOR actor = 1.31, P < 0.001; AOR partner = 1.17, P < 0.001). Meanwhile, receptive role's violence experience within relationship exerted significant actor effects on his own concurrent UAI (AOR actor = 6.43, P = 0.044). CONCLUSIONS Relationship investment and violence experience influenced concurrent UAI among MSM couples and it varied in different sex roles. Additional assistance on empowerment, relationship therapy and sexual agreement is urgently needed to reduce their high possibility on engagement of HIV-related risk behaviors.
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Affiliation(s)
- Sha Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qingling Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Juan He
- Institution of Drug Clinical Trial, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
| | - Xiongzhi Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhongqi Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jialing Qiu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhiwei Zheng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China.
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
- Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China.
- Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Association between Psychological Factors and Condom Use with Regular and Nonregular Male Sexual Partners among Chinese MSM: A Quantitative Study Based on the Health Belief Model. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5807162. [PMID: 33062685 PMCID: PMC7539081 DOI: 10.1155/2020/5807162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/04/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022]
Abstract
Objective The Chinese men who have sex with men (MSM) population is suffering from a high HIV infection rate owing to unprotected anal sex. The Health Belief Model (HBM) has been proven to be an effective frame associated with behavior maintenance. Based on HBM, we analyzed the beliefs associated with consistent condom use behavior with regular and nonregular partners among MSM to better provide targeted interventions and services. Methods A study was conducted in Sichuan Province, China, from November 2018 to April 2019, and 801 eligible participants were recruited by snowball sampling. Sociodemographic characteristics, AIDS-related characteristics, sexual behaviors, condom use behavior, and dimensions of HBM were investigated. Univariate, single multivariate, and summary multivariate models were employed to analyze the factors associated with consistent condom use. Results Of all participants, 39.1% and 53.6% had had anal sex with regular and nonregular partners in the last six months, respectively. Only 56.5% of them had used condoms consistently with regular partners, and only 60% of them had used condoms consistently with nonregular partners. When taking consistent condoms use with regular partners as the dependent variable, the dimensions of perceived threats (ORM = 1.28, 95% CI: 1.10, 1.49), perceived barriers (ORM = 0.70, 95% CI: 0.60, 0.82), self-efficacy (ORM = 1.23, 95% CI: 1.14, 1.32), and cues to action (ORM = 1.21, 95% CI: 1.02, 1.43) showed significant associations with the dependent variable. When taking consistent condoms use with nonregular partners as the dependent variable, the dimensions of perceived barriers (ORM = 0.77, 95% CI: 0.67, 0.89), self-efficacy (ORM = 1.22, 95% CI: 1.13, 1.32), and cues to action (ORM = 1.53, 95% CI: 1.30, 1.80) showed significant associations with the dependent variable. Conclusions More attention should be focused on how to decrease the obstructive factors of condom use, how to improve the confidence of condom use, and how to layout more cues to action to promote consistent condom use behavior with regular and nonregular partners during anal sex among Chinese MSM.
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HIV Seroconversion and Types of Relationships Among Men Who Have Sex With Men: A Cohort Study in China. J Acquir Immune Defic Syndr 2020; 83:365-372. [PMID: 31913999 DOI: 10.1097/qai.0000000000002264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of partner types in modifying HIV seroconversion risk among men who have sex with men (MSM) is complex. We sought to understand the role of regular sexual partners and risky sexual behavior in contributing to incident HIV infection among MSM. METHODS From July 2011 to August 2017, we recruited HIV-negative men who reported having anal or oral homosexual encounters in the past 6 months and they were followed up every 3 months for 2 visits. We collected sociodemographic and behavioral characteristics by a self-administrated questionnaire. HIV status was confirmed by a sequential rapid test and confirmatory test. We used multivariable Cox regression to identify risk factors and interaction models to evaluate the relative excess risk between relevant variables. RESULTS Among 1218 participants, the HIV seroconversion rate was 3.66/100 person-years. HIV seroconversion was associated with lower educational attainment [adjusted hazards ratio (aHR)] = 1.73, 95% CI: 1.06 to 2.81), having had penetrative sex with male before age of 18 years (aHR = 2.44, 95% CI: 1.20 to 4.99), not using condoms in the last sexual encounter (aHR = 2.19, 95% CI: 1.29 to 3.71), and having regular but not committed partners (aHR = 3.33, 95% CI: 1.77 to 6.93). Among 890 (73%) of men reported having regular partners, HIV seroconversion was more frequent in men whose stable partners were not committed as boyfriends (aHR = 3.31, 95% CI: 1.73 to 6.36) and in men having unprotected anal sex (aHR = 2.61, 95% CI: 1.42 to 4.80). Interaction between these 2 factors was observed (relative excess risk of interaction = 4.53). CONCLUSIONS Incidence among MSM in China was high; unprotected sex with steady but not committed partners was associated with increased seroconversion risk. It is imperative to expand safer sex education and training for MSM to reduce unsafe sexual behaviors, including awareness that casual partners are not the only source of infection.
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Li H, Tucker JD, Ma W, Kim ES, Marley G, Kang D, Liao M, Tang W, Jiang B. Growth Trajectories of Peer Norms, Self-efficacy and Condom Use Behavior Among Sexually Active Chinese Men Who Have Sex with Men: Latent Class Analysis and Growth Mixture Modeling. AIDS Behav 2020; 24:854-865. [PMID: 31016503 DOI: 10.1007/s10461-019-02515-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Data from a randomized controlled trial in 2015 were used to estimate the growth trajectories of peer norms, self-efficacy, and condom use behavior, and to identify associated sociodemographic and behavioral factors among a sample of 804 Chinese men who have sex with men (MSM). Latent class analysis and growth mixture modeling were conducted using Mplus. Two growth trajectories were estimated for each outcome variable with good model fit. The growth trajectories of peer norms were related to age (β = - 0.066, p < 0.05). The growth trajectories of self-efficacy were related to age (β = 0.057, p < 0.01) and using a condom during first sexual encounter with another man (β = 0.777, p < 0.001). The growth trajectories of condom use behavior were related to income (β = 0.366, p < 0.01) and having casual male partners (β = - 1.016, p < 0.001). Predictors for the growth factors within each latent class were also estimated. For subsets of MSM who are older, richer, used a condom during their first sexual encounter with another man, and do not have a casual male partner, condom videos may not have sufficient efficacy and other interventions may be necessary.
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Li H, Tucker JD, Ma W, Kim ES, Marley G, Wang J, Kang D, Liao M, Tang W, Jiang B. Mediation Analysis of Peer Norms, Self-Efficacy, and Condom Use Among Chinese Men Who Have Sex with Men: A Parallel Process Latent Growth Curve Model. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:287-297. [PMID: 31535244 PMCID: PMC8187081 DOI: 10.1007/s10508-019-1459-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 03/30/2019] [Accepted: 04/17/2019] [Indexed: 06/10/2023]
Abstract
The objective of this study was to examine direct and indirect relationships among peer norms, self-efficacy, and condom use among Chinese men who have sex with men (MSM). A longitudinal study determined the effectiveness of a condom use video promotion among Chinese MSM in 2015. In this analysis, 804 Chinese MSM were recruited at baseline and then followed at 3 weeks and 3 months after the intervention. Parallel process latent growth curve modeling (LGM) with multiple indicators and bootstrapping was conducted using Mplus 7.4. The LGM model fit indexes were good with RMSEA = 0.046, 90% CI (0.044, 0.048), CFI = 0.956, TLI = 0.955. Our results showed that the initial measure of peer norms affected the initial measure of condom use indirectly through the initial measure of self-efficacy (αβ = 0.414, 95% CI 0.260-0.759). The rate of change in peer norms over time also significantly affected the rate of change in condom use through the rate of change in self-efficacy (αβ = 0.101, 95% CI 0.014-0.262). Self-efficacy mediated the association between peer norms and condom use, indicating a strong potential of causal relationship between peer norms and self-efficacy among Chinese MSM.
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Affiliation(s)
- Haochu Li
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, 250012, Shandong Province, China.
| | - Joseph D Tucker
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- SESH Global, Guangzhou, China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Eun Sook Kim
- Department of Educational and Psychological Studies, University of South Florida, Tampa, FL, USA
| | - Gifty Marley
- Department of Epidemiology and Health Statistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jichuan Wang
- Children's National Health System, The George Washington University, Washington, DC, USA
| | - Dianmin Kang
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Meizhen Liao
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Weiming Tang
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- SESH Global, Guangzhou, China
- Guangdong Provincial Center for Skin Diseases and STI Control, Guangzhou, China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, 250012, Shandong Province, China
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Ritchwood TD, He J, Smith MK, Tang W, Ong JJ, Oduro A, Ntlapo N, Tucker JD. "Getting to Zero" Among Men Who Have Sex with Men in China: a Review of the HIV Care Continuum. Curr HIV/AIDS Rep 2019; 16:431-438. [PMID: 31792704 PMCID: PMC7163396 DOI: 10.1007/s11904-019-00472-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW To review the literature on progress towards UNAIDS 90-90-90 targets for HIV prevention and treatment among men who have sex with men (MSM) in China. RECENT FINDINGS China has made progress towards UNAIDS 90-90-90 targets among MSM. However, socio-structural barriers, including HIV-related stigma and homophobia, persist at each stage of the HIV care continuum, leading to substantial levels of attrition and high risk of forward HIV transmission. Moreover, access to key prevention tools, such as pre-exposure prophylaxis, is still limited. Multilevel interventions, many using digital intervention, have been shown effective in pragmatic randomized controlled trials in China. Multilevel interventions incorporating digital health have led to significant improvement in engagement of Chinese MSM in the HIV care continuum. However, interventions that address socio-structural determinants, including HIV-related stigma and discrimination, towards Chinese MSM are needed.
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Affiliation(s)
- Tiarney D Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W Main St, Durham, NC, USA.
| | - Jiayu He
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Weiming Tang
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Asantewa Oduro
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Noluthando Ntlapo
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Joseph D Tucker
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Wu ZL, Guan GY, Zhao JH, Ma XM, Wang XM, Yang DZ, Cao M, Rawle DJ. Dynamic Characteristics and HIV Infection of Men who have Sex with Men from 2011 to 2017 in Yinchuan, Ningxia, China. Curr HIV Res 2019; 16:364-373. [PMID: 30659545 PMCID: PMC6446446 DOI: 10.2174/1570162x17666190119094035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Ningxia Hui Autonomous Region, an important area for ethnic Hui settlement in Northwest China, is a low HIV prevalence region. However, HIV infection rates among men who have sex with men (MSM) in Ningxia have increased to an alarming level, despite scale-up of control measures in recent years. This study aimed to understand the demographical and sexual behavior dynamics of MSM and to explore the factors associated with HIV infection. METHODS Annual cross-sectional surveys were carried out among MSM during 2011~2017 in Yinchuan, the capital city of Ningxia. Information regarding social demographics, sexual behavior and HIV prevention knowledge was collected. Blood samples were taken for HIV, HCV serological and genetic analysis, and syphilis serological analysis. The dynamic trend was analyzed with trend χ2 test and factors associated with HIV infection were identified by multivariate logistic regression analysis. RESULTS The study found a decreasing trend for mean age of the MSM population over the study period. MSMs with a college education or higher increased significantly, while the proportions that were in a marriage significantly decreased over the study period. The rate of HIV positive among MSM increased during the study period (p<0.05), however, the rate of recently diagnosed infections decreased from 2012 (p<0.05). Overall, a very high proportion (98%) of MSM had basic knowledge of HIV prevention, however, only approximately 40% of them used condoms consistently during anal sex with male partners. Unprotected anal sex was identified as a risk factor associated with HIV infection, as was syphilis infection. Local residency status and MSM who received intervention and detection services were the factors that decreased HIV infection risk. Sequence analysis identified the HIV-1 CRF55_01B subtype from MSM for the first time in Yinchuan. CONCLUSION The reduction of recent HIV diagnoses is an encouraging sign of successful HIV control measures in MSM in Ningxia. The finding that a high proportion of MSM had knowledge of HIV prevention but still conducted unprotected sex highlights the need for further control measures to change unsafe sexual practices among MSM.
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Affiliation(s)
- Zhong-Lan Wu
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Guang-Yu Guan
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Jian-Hua Zhao
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Xue-Min Ma
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Xue-Min Wang
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Dong-Zhi Yang
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Min Cao
- Ningxia Center for Disease Control and Prevention, 470 Shengli St. Yinchuan, Ningxia 750001, China
| | - Daniel J Rawle
- Department of Cell and Molecular Biology, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
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13
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Jiang H, Chen X, Li J, Tan Z, Cheng W, Yang Y. Predictors of condom use behavior among men who have sex with men in China using a modified information-motivation-behavioral skills (IMB) model. BMC Public Health 2019; 19:261. [PMID: 30832640 PMCID: PMC6399930 DOI: 10.1186/s12889-019-6593-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/25/2019] [Indexed: 01/11/2023] Open
Abstract
Background Men who have sex with men (MSM) are at high risk for human immunodeficiency virus (HIV) infection in China. Correct and consistent condom use is one of the most effective strategies for preventing the spread of HIV. This study developed a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behavior among Chinese MSM. Methods A cross-sectional study was conducted to collect data using self-administered electronic questionnaire. Participants were recruited from HIV Voluntary Counseling and Testing clinics in six district Centers for Disease Control and Prevention in Guangzhou and two community-based HIV service centers (Lingnan Partners and Zhitong Charity) from May to September 2017. Structural equation modeling was performed to develop the modified IMB model with extended multilevel factors. Results Among the 976 MSM included, 52.05% had engaged in anal intercourse with a condom every time. The final modified IMB model fitted the data more ideally than the conventional model. The final modified IMB model revealed that behavioral skills positively contributed directly to condom use (β = 0.385, p < 0.001) and partially mediated the associations between information (β = 0.106, p = 0.005) and motivation (β = 0.390, p < 0.001) and condom use. Regarding the extended multilevel factors, education, income, receiving HIV prevention services, sexual partner seeking behavior, depression, intimate partner violence, and child sexual abuse had indirect impacts on condom use that were mediated by information, motivation, and/or behavioral skills (p < 0.05). All paths from the latent variable to the corresponding observed variables were statistically significant (p < 0.001). Conclusion The modified IMB model with extended multilevel factors could serve as a theoretical framework for behavioral interventions for condom use among Chinese MSM. Further prospective studies are needed to examine the predictive power of the modified IMB model. Electronic supplementary material The online version of this article (10.1186/s12889-019-6593-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Xiaobin Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Baiyun District, Guangzhou, China.
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
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14
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Wang X, Wang Z, Jiang X, Li R, Wang Y, Xu G, Zou H, Cai Y. A cross-sectional study of the relationship between sexual compulsivity and unprotected anal intercourse among men who have sex with men in shanghai, China. BMC Infect Dis 2018; 18:465. [PMID: 30219033 PMCID: PMC6139151 DOI: 10.1186/s12879-018-3360-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background HIV prevalence among men who have sex with men (MSM) in China is rising rapidly, and unprotected anal intercourse (UAI) is associated with HIV transmission. Recent research has shown that associations between UAI and other factors can differ according to the type of sex partners, including regular partners and casual partners. This study aimed to explore the relationship between sexual compulsivity and UAI according to partner type among MSM in Shanghai, China. Methods A cross-sectional study was conducted among 547 MSM from four districts in Shanghai, China. All participants were recruited using snowball sampling. The Sexual Compulsivity Scale was used to evaluate participants’ sexual compulsivity. Multivariable logistic regression was used to identify factors associated with sexual compulsivity and UAI. The mediation effects of substance use before sex on the relationship between sexual compulsivity and UAI were tested through mediation analyses. Results After adjusting for sociodemographic variables, sexual compulsivity was associated with overall UAI (adjusted odds ratios [AOR] = 1.039, 95% confidence intervals [CI] = 1.004–1.075), UAI with non-regular sex partners (AOR = 1.089, 95% CI = 1.033–1.148) and UAI with commercial sex partners (AOR = 1.185, 95% CI = 1.042–1.349). No significant association was found between sexual compulsivity and UAI with regular sex partners (AOR = 1.029, 95% CI = 0.984–1.077). Mediation analyses indicated that the relationship between sexual compulsivity and UAI was not mediated by either alcohol use before sex or drug use before sex. Conclusions The association between sexual compulsivity and UAI varies depending on the type of UAI partner. Therefore, individuals may engage in different types of UAI for different reasons, and tailored HIV cognitive–behavioral intervention programs are needed.
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Affiliation(s)
- Xin Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Zezhou Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Xueqin Jiang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Rui Li
- Department of Public Health Science, School of Medicine and Dentistry, University of Rochester, New York, USA
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Gang Xu
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China. .,School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China. .,Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China.
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15
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Du M, Zhao J, Zhang J, Lau JTF, Mo PKH, Li J. Depression and social support mediate the effect of HIV self-stigma on condom use intentions among Chinese HIV-infected men who have sex with men. AIDS Care 2018; 30:1197-1206. [PMID: 29911428 DOI: 10.1080/09540121.2018.1487916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
HIV self-stigma in HIV positive men who have sex with men (HIVMSM) has been identified as one of the largest challenges of HIV prevention, and associates with numerous negative outcomes, including depression, decreased social support, and less condom use intentions. In the present study, 321 HIVMSM in Chengdu, China were recruited to examine the prevalence of condom use in the past months and intentions to use condoms in next six months; we also identify pathways between HIV self-stigma and intentions to use condoms by the structural equation modeling approach. Results showed that Chinese HIVMSM had the suboptimal prevalence of consistent condom use and low intentions to use condoms consistently. Additionally, depression and decreased social support were significant mediators between HIV self-stigma and condom use intentions. The complex pathways between HIV self-stigma and intentions to use condoms should be taken into account in the HIV prevention and intervention programs.
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Affiliation(s)
- Mengran Du
- a Department of Health and Social Behaviors, West China School of Public Health , Sichuan University , Chengdu , People's Republic of China
| | - Jian Zhao
- b Department of Epidemiology and Biostatistics, School of Public Health , Curtin University , Perth , Australia
| | - Jianxin Zhang
- a Department of Health and Social Behaviors, West China School of Public Health , Sichuan University , Chengdu , People's Republic of China
| | - Joseph T F Lau
- c School of Public Health , Zhejiang University School of Medicine , Hangzhou , Zhejiang , People's Republic of China.,d The Jockey Club School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong, Shatin , Hong Kong , People's Republic of China
| | - Phoenix K H Mo
- e Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , People's Republic of China.,f Department of Social Science and Health Management, School of Public Health , Sun Yat-sen University , Guangzhou , People's Republic of China
| | - Jinghua Li
- g School of Public Health , Sun Yat-sen University , Guangzhou , People's Republic of China.,h Sun Yat-sen Global Health Institute , Sun Yat-sen University , Guangzhou , People's Republic of China
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16
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He J, Xu HF, Cheng WB, Zhang SJ, Gu J, Hao YT, Hao C. Intimate relationship characteristics as determinants of HIV risk among men who have sex with regular male sex partners: a cross-sectional study in Guangzhou, China. BMC Infect Dis 2018; 18:150. [PMID: 29606100 PMCID: PMC5879993 DOI: 10.1186/s12879-018-3044-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background China faces a serious HIV epidemic among men who have sex with men (MSM), and a large proportion of new infections are attributed to their regular male sex partners (RP). The objective of this study was to investigate the association between intimate relationship characteristics and HIV-related behaviors among MSM with RP in Guangzhou, China. Methods A convenience-sampling method was used in data collection. A total of 608 MSM were screened, of whom 406 HIV negative MSM with at least one RP in the past six months were used for data analysis. Three-step logistic regressions were used to analyze the data. Results The prevalence of unprotected anal intercourse (UAI) with regular male sex partners, non-regular male sex partners, and concurrent UAI in the past six months was 53.9%, 23.6%, 20.7%, respectively. Variables associated with UAI with regular male sex partners included expectations for this relationship (adjusted odds ratio in multiple forward stepwise logistic regression, ORm = 1.66) and open communication about the sexual relationship (ORm = 1.79), while expectations for the relationship (ORm = 0.46 to 0.54) and conflicts of interest (ORm = 5.46 to 5.97) were associated with concurrent UAI and UAI with non-regular male sex partners. Conclusion Intimate relationship characteristics were related to HIV-related risk behaviors. Future HIV prevention interventions should take MSM couples into consideration, include a focus on the quality of their intimate relationships, and encourage open communication about their sexual relationships. Electronic supplementary material The online version of this article (10.1186/s12879-018-3044-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juan He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Hui-Fang Xu
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, 510440, People's Republic of China
| | - Wei-Bin Cheng
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, 510440, People's Republic of China
| | - Sheng-Jie Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, Guangdong, 510080, People's Republic of China.,Current address: Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Chinese Academy of Medical Science & Peking Union Medical College, A105, Xishan Institute of Fuwai Hospital, Fengcunxili, Mentougou Dist, Beijing, 102300, China
| | - Jing Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, Guangdong, 510080, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, Guangdong, 510080, People's Republic of China.,Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Yuan-Tao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, Guangdong, 510080, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, Guangdong, 510080, People's Republic of China.,Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Chun Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, Guangdong, 510080, People's Republic of China. .,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, Guangdong, 510080, People's Republic of China. .,Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, People's Republic of China.
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17
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The relation between mental health, homosexual stigma, childhood abuse, community engagement, and unprotected anal intercourse among MSM in China. Sci Rep 2018; 8:3984. [PMID: 29507341 PMCID: PMC5838107 DOI: 10.1038/s41598-018-22403-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/22/2018] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to explore the relation of various factors with unprotected anal intercourse (UAI) and provide some insight for HIV intervention on Chinese men who have sex with men (MSM). The current cross-sectional study recruited 365 MSM in Dalian, China. More than half of the respondents (117 respondents, 51.8% of the sample) had engaged in UAI. The multivariable logistic regression model suggested that poorer mental health (AOR: 7.16; 95% CI: 3.14–16.31), self-stigma (AOR: 1.53; 95% CI: 1.00–2.34), and experience(s) of physical abuse in childhood (AOR: 5.85; 95% CI: 1.77–19.30) were significantly and positively related to UAI. Community engagement was negatively associated with UAI (p < 0.05). It appears it is necessary to incorporate mental health services, eliminate the stigma against homosexuality, and facilitate MSM-related community engagement into intervention strategies to prevent UAI among Chinese MSM. Targeted UAI interventions in the subgroup with a history of childhood physical abuse should also be of great concern.
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18
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Zhou N, Bauermeister J, Guo W, Yu M, Yang J, Zheng M, Guo Y, Gong H, Gao Y, Jiang G. Condomless Anal Intercourse by Partner Type Among Chinese Men Who Have Sex With Men in Tianjin. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:63-71. [PMID: 29481303 DOI: 10.1521/aeap.2018.30.1.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Ning Zhou
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | | | - Wei Guo
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Maohe Yu
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jie Yang
- Tianjin Dark Blue Working Group, Tianjin, China
| | - Minna Zheng
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Yan Guo
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Hui Gong
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Yongjun Gao
- Tianjin Hongqiao District Center for Disease Control and Prevention, Tianjin, China
| | - Gueohong Jiang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
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19
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Xu Y, Zheng Y. The Influence of Power and Intimacy Sexual Motives on Sexual Position Preference Among Men Who Have Sex with Men in China. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:245-258. [PMID: 27844315 DOI: 10.1007/s10508-016-0858-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 06/06/2023]
Abstract
We examined the sexual motives underlying sexual self-labels among Chinese men who have sex with men. A total of 60 bottoms, 120 versatiles, and 48 tops participated in a Web-based survey. Our results showed that tops were more likely to desire exerting power over their partners during sex, while bottoms were more likely to desire being overpowered by their partners. There were no significant sexual self-label differences in the sexual motives of wanting intimacy and the desire for pleasure. The intimacy and power ratings differed across sexual activities and sex positions. There was a tendency for sexual positions in which the performer was facing the receiver to be rated as more intimate than those in which the performer was facing away from the receiver, and for individuals who preferred to be insertive to feel more powerful in sexual positions in which their partner was kneeling down or standing than those in which their partner was sitting or lying down. Tops were significantly more likely than bottoms to engage in insertive sexual positions, while bottoms were significantly more likely to engage in receptive sexual positions. Both tops and bottoms were more likely to engage in the corresponding insertive/receptive position when the insertive position was rated as more powerful than the receptive position. Our results suggest that the concordance between sexual self-labels and sexual position preferences may rely on the power difference between the insertive and receptive positions in addition to body characteristics.
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Affiliation(s)
- Yin Xu
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Yong Zheng
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China.
- Faculty of Psychology, Southwest University, No. 2 Tiansheng, Beibei, Chongqing, 400715, China.
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20
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Luo Z, Feng T, Fu H, Yang T. Lifetime prevalence of suicidal ideation among men who have sex with men: a meta-analysis. BMC Psychiatry 2017; 17:406. [PMID: 29268723 PMCID: PMC5740861 DOI: 10.1186/s12888-017-1575-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a leading cause of death among men who have sex with men (MSM) and suicidal ideation may put individuals at higher risk of suicide. A great disparity of lifetime prevalence of suicidal ideation among MSM was observed across studies, indicating the importance of a reliable estimation of the pooled lifetime prevalence. However, the only one published meta-analysis estimating the pooled lifetime prevalence of suicidal ideation among MSM was conducted in 2008 with only 2 eligible studies. Subsequently, there was a rapid increase of publications about lifetime suicidal ideation among MSM, suggesting that an update on the pooled lifetime prevalence of suicidal ideation among MSM was necessary. Therefore, this study aimed to update the estimation of the pooled lifetime prevalence of suicidal ideation among MSM. METHODS Electronic databases of PubMed, CINAHL, Scopus (social science), Embase and PsycInfo were searched until September 2017 to identify relevant studies. Cross-sectional studies exploring the lifetime prevalence of suicidal ideation among MSM were enrolled. Heterogeneity was evaluated using the Cochran Q test and quantified using the I 2 statistic. The possibility of publication bias was assessed using both Begg's rank test and Egger's linear test, and an Egger's funnel plot for asymmetry was presented. Subgroup analyses were performed according to the geographic area, sample source and HIV status. RESULTS Nineteen studies with a total of 26,667 MSM were included, of which 9374 were identified with suicidal ideation. A high degree of heterogeneity (P ≤ 0.001, I 2 =99.2%) was observed among the eligible studies, with the reported prevalence ranging from 13.18 to 55.80%. The pooled lifetime prevalence of suicidal ideation among MSM by a random effects model was 34.97% (95% confidence interval: 28.35%-41.90%). Both the Begg's rank test and Egger's linear test indicated low possibility of publication bias. Subgroup analyses showed that the lifetime prevalence of suicidal ideation among MSM differed significantly by geographic area, sample source and HIV status (P < 0.05). CONCLUSIONS The high pooled lifetime prevalence of suicidal ideation among MSM found in this meta-analysis significantly underscores the importance of early assessment of suicidal ideation among MSM, as well as the need for strengthening the psychological interventions.
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Affiliation(s)
- Zhenzhou Luo
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China ,Shenzhen Nanshan Center for Chronic Disease Control, Guangdong, China
| | - Tiejian Feng
- Shenzhen Center for Chronic Disease Control, Guangdong, China
| | - Hanlin Fu
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China.
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21
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Lau JTF, Wang Z, Kim Y, Li J, Gu J, Mo PKH, Wang X. Low sustainability, poor governance, and other challenges encountered by grassroots non-governmental organizations targeting HIV prevention for men who have sex with men in China - a nation-wide study. AIDS Care 2017; 29:1480-1490. [PMID: 28271717 DOI: 10.1080/09540121.2017.1300630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Grassroots non-governmental organizations (NGOs) played pivotal roles in HIV prevention among men who have sex with men (MSM) in China. Their governance and sustainability issues were under-studied. This nation-wide study surveyed leaders of 202 of the HIV related NGOs in China.58.4% of the leaders believed that their NGO would last for ≤5 years; which was negatively associated with perceived good relationship with CDC. 65.3% mentioned ≥3 non-sustainability issues; associated factors included perceived inadequacies in prevention skills, management skills, policy support, technical support, operational support, and CDC's support; a reverse association was found for frequent collaboration with organizations in China. 30.6% of the leaders mentioned ≥7 governance issues; a stepwise model found a positive association with having no office and negative associations with number of full-time staff and core volunteers. These problems would severely limit the effectiveness of HIV prevention among MSM. Related improvements and support are warranted.
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Affiliation(s)
- Joseph T F Lau
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China.,b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China.,c Centre for Medical Anthropology and Behavioral Health , Sun Yat-sen University , Guangzhou , China
| | - Zixin Wang
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China.,b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China
| | - Yoona Kim
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Jinghua Li
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Jing Gu
- d School of Public Health , Sun Yat-sen University , Guangzhou , China
| | - Phoenix K H Mo
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Xiaodong Wang
- e Chengdu Tongle Health Consulting Service Center , Chengdu , China
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Xu Y, Zheng Y, Rahman Q. The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China. J Sex Med 2017; 14:357-365. [PMID: 28130018 DOI: 10.1016/j.jsxm.2017.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Previous studies have indicated that viewing sexually explicit media (SEM) might be associated with sexual risk behaviors in men who have sex with men (MSM). However, most prior research has not explored this association cross-culturally or the potential influence that important covariates might have on the association. AIM To explore the association between self-reports of viewing SEM depicting various sexual risk behaviors and engagement in sexual risk behaviors after controlling for relevant covariates in MSM in China. METHODS Three hundred fourteen Chinese MSM participated in a web-based survey. MAIN OUTCOME MEASURES SEM consumption, sexual risk behavior, and measurements of covariates. RESULTS SEM consumption was frequent in MSM in China. Viewing a larger proportion of SEM depicting sexual risk behaviors was associated with a larger number of regular partners with whom MSM reported engaging in sexual risk behaviors, but not with the number of casual partners, after controlling for covariates. HIV-related knowledge and seeking male sex partners were associated with the number of regular partners with whom MSM had engaged in sexual risk behaviors. Seeking sexual sensation, HIV-related knowledge, and seeking male sex partners were associated with the number of casual partners with whom MSM had engaged in sexual risk behaviors. CONCLUSION Future research exploring the relation between SEM use and sexual health risk behaviors should consider theoretically important psychological and behavioral covariates. Xu Y, Zheng Y, Rahman Q. The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China. J Sex Med 2017;14:357-365.
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Affiliation(s)
- Yin Xu
- Faculty of Psychology, Southwest University, Chongqing, China; Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
| | - Yong Zheng
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
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Wang Y, Wang Z, Jia M, Liang A, Yuan D, Sun Z, Gan F, Wang Y, Cai Y, Zhang Z. Association between a syndemic of psychosocial problems and unprotected anal intercourse among men who have sex with men in Shanghai, China. BMC Infect Dis 2017; 17:46. [PMID: 28061819 PMCID: PMC5219803 DOI: 10.1186/s12879-016-2132-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 12/15/2016] [Indexed: 11/12/2022] Open
Abstract
Background Previous studies have discussed the overlapping and reinforcing effects (defined as a syndemic) of psychosocial problems on high-risk sexual behaviors among men who have sex with men (MSM). The present study aimed to apply the syndemic theory to verify the reinforcing effects of psychosocial problems on unprotected anal intercourse (UAI) among MSM in Shanghai, and determine if other important psychosocial factors fit into the syndemic theory. Methods Data were collected from 547 MSM in Shanghai, China, through face-to-face interviews. The measures for psychosocial problems included the Rosenberg Self-Esteem Scale; the Generalized Anxiety Disorder-7; the Center for Epidemiological Studies Depression Scale; the University of California, Los Angeles Loneliness Scale; and the Sexual Compulsivity Scale. We used multivariate analysis and binary logistic regression to investigate the associations between psychosocial problems and high-risk sexual behaviors. Results The prevalence of UAI among MSM in the past 6 months was 54.5%. Education (graduate from college vs. high school) served as a protective factor against UAI (OR 0.59, 95% CI: 0.38–0.94). There was a high prevalence of psychosocial problems, and at least one-third of participants reported experiencing more than two psychosocial symptoms. Of these psychosocial factors that we investigated, lower self-esteem was associated with UAI in both univariate and multivariate regression model (P = 0.009). Result suggests that overlapping and reinforcing effects of psychosocial problems may increase high risk sexual behaviors among MSM in Shanghai, China (OR 1.65, 95% CI: 1.09–2.50; P = 0.018). Conclusions We found further evidence for a syndemic of psychosocial problems among MSM in Shanghai, China. This syndemic may also increase high risk sexual behaviors among MSM. Most HIV prevention interventions are focused on behavior change and only have moderate effects; our findings suggest that a shift from behavior-focused interventions to a more comprehensive strategy that addresses psychosocial factors may be necessary.
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Affiliation(s)
- Ying Wang
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Zezhou Wang
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Mengmeng Jia
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Ajuan Liang
- Renji Hospital, affiliated with School of Medicine Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Dong Yuan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Zhe Sun
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Feng Gan
- School of Continuing Education, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yichen Wang
- Ruijin Hospital, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Yong Cai
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
| | - Zhiruo Zhang
- School of Public Health, affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
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Hu QH, Xu JJ, Chu ZX, Zhang J, Yu YQ, Yu H, Ding HB, Jiang YJ, Geng WQ, Wang N, Shang H. Prevalence and Determinants of Herpes Simplex Virus Type 2 (HSV-2)/Syphilis Co-Infection and HSV-2 Mono-Infection among Human Immunodeficiency Virus Positive Men Who Have Sex with Men: a Cross-Sectional Study in Northeast China. Jpn J Infect Dis 2016; 70:284-289. [PMID: 27795468 DOI: 10.7883/yoken.jjid.2016.177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assessed the prevalence and determinants of herpes simplex virus type 2 (HSV-2)/syphilis co-infection and HSV-2 mono-infection in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) in China. A cross-sectional study was conducted of 545 HIV-positive MSM in Shenyang between February 2009 and October 2014. Participants underwent physical examinations and serological tests for HSV-2 and syphilis. A multinomial logistic regression was used to identify the risk factors associated with HSV-2/syphilis co-infection and HSV-2 mono-infection. The prevalence of HSV-2 mono-infection, syphilis mono-infection, and HSV-2/syphilis co-infection (95% confidence interval) was 48.6% (44.4-52.8%), 34.3% (30.3-38.3%), and 22.9% (19.4-26.5%), respectively. After controlling within HSV-2/syphilis-seropositive cases, regression analysis revealed that the related factors for HSV-2/syphilis co-infection included age (25-50 vs. ≤ 24 years: adjusted odds ratio [aOR], 4.55; > 50 vs. ≤ 24 years: aOR, 43.02), having regular female sexual partner(s) in the past 6 months (aOR, 0.43), and age at first MSM experience (≤ 18 vs. > 18 years: aOR, 2.59) (all P < 0.05). The high prevalence of HSV-2 mono infection and HSV-2/syphilis co-infection in HIV-positive MSM indicates a high secondary HIV transmission risk. A campaign for detection and treatment of HSV-2 and syphilis is urgently required for HIV-positive MSM in China.
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Affiliation(s)
- Qing-Hai Hu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Jun-Jie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Zhen-Xing Chu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Jing Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Yan-Qiu Yu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Huan Yu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Hai-Bo Ding
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Yong-Jun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Wen-Qing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Ning Wang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
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HIV epidemiology and responses among men who have sex with men and transgender individuals in China: a scoping review. BMC Infect Dis 2016; 16:588. [PMID: 27765021 PMCID: PMC5073436 DOI: 10.1186/s12879-016-1904-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite global efforts to control HIV among key populations, new infections among men who have sex with men (MSM) and transgender (TG) individuals are still increasing. The increasing HIV epidemic among MSM/TG in China indicates that more effective services are urgently needed. However, policymakers and program managers must have a clear understanding of MSM/TG sexual health in China to improve service delivery. To meet this need, we undertook a scoping review to summarize HIV epidemiology and responses among MSM and TG individuals in China. METHODS We searched MEDLINE, EMBASE and the Cochrane Library for recent studies on MSM/TG HIV epidemiology and responses. We also included supplemental articles, grey literature, government reports, policy documents, and best practice guidelines. RESULTS Overall, HIV prevalence among Chinese MSM was approximately 8 % in 2015 with a higher prevalence observed in Southwest China. TG are not captured in national HIV, STD, or other sexual health surveillance systems. There is limited data sharing between the public health authorities and community-based organizations (CBOs). Like other low and middle income countries, China is challenged by low rates of HIV testing, linkage, and retention. Several pilot interventions have been shown to be effective to increase HIV testing among MSM and TG individuals, but have not been widely scaled up. Data from two randomized controlled trials suggests that crowdsourcing contests can increase HIV testing, creating demand for services while engaging communities. CONCLUSION Improving HIV surveillance and expanding HIV interventions for Chinese MSM and TG individuals are essential. Further implementation research is needed to ensure high-quality HIV services for MSM and TG individuals in China.
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Zhang W, Xu JJ, Zou H, Zhang J, Wang N, Shang H. HIV incidence and associated risk factors in men who have sex with men in Mainland China: an updated systematic review and meta-analysis. Sex Health 2016; 13:SH16001. [PMID: 27294689 DOI: 10.1071/sh16001] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/15/2016] [Indexed: 12/15/2022]
Abstract
Background: The national annually reported proportion of men who have sex with men (MSM) among people living with HIV (PLWH) is growing in China. To better inform the public health sector how to improve HIV prevention strategies, it is necessary to understand the current level of HIV incidence and its correlates. Methods: Google Scholar, PubMed, Web of Science and three major Chinese electronic publication databases (http://qikan.cqvip.com/, http://g.wanfangdata.com.cn/, http://www.cnki.net/, respectively) were searched for studies reporting HIV incidence. Comprehensive Meta-Analysis (CMA) 2.0 statistical software (Biostat, Inc. Englewood, NJ, USA) was used to calculate the pooled HIV incidence and perform subgroup-analysis to find correlates for HIV seroconversion in Chinese MSM. Random effects modelling was then conducted. Results: Twenty-five eligible studies were included in this meta-analysis. The calculated pooled HIV incidence was 5.61/100 person years (PY), with an increasing trend over time (3.24/100PY, 5.29/100PY, 5.50/100PY in 2005-2008, 2009-2011, 2012-2014 respectively, χ2 test for trend P = 0.04). Subgroup analyses indicated that age <25 years (rate ratio (RR) = 1.85), junior college education and below (RR = 1.87), having ≥ 2 male sexual partners in past 6 months (RR = 2.50), baseline syphilis infection (RR = 2.99), homosexual orientation (RR = 1.91), preferred bottom/versatile roles in anal sexual intercourse (RR = 2.33), and having unprotected anal intercourse in the past 6 months (RR = 2.16) significantly increased the risk for HIV seroconversion (each P < 0.05). Uncircumcised MSM had a marginal statistically significant higher HIV incidence (RR = 3.35, P = 0.051). Conclusion: HIV incidence is still alarmingly high among Chinese MSM. Stronger HIV intervention strategies should be implemented, in particular targeting young, less educated and syphilis-infected MSM.
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Zhu Y, Liu J, Qu B, Hu B, Zhang Y. Relationship between quality of life and unprotected anal intercourse among Chinese men who have sex with men: a cross-sectional study. BMC Public Health 2016; 16:382. [PMID: 27165001 PMCID: PMC4862160 DOI: 10.1186/s12889-016-3076-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 05/04/2016] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of unprotected anal intercourse (UAI) is high among Chinese men who have sex with men (MSM). As important aspects of quality of life (QOL), psychological health and social relationships have been found to be associated with UAI among MSM, which was of great concern for intervening on UAI. Methods We conducted a cross-sectional study in Zhengzhou, Henan province, and in Huludao, Liaoning province, China, to measure quality of life (QOL) using the brief version of the World Health Organization Quality of Life (WHOQOL-BREF). Cronbach's α coefficient was used to test the internal consistency of the questionnaire items, and construction validity was assessed by exploratory factor analysis. T-test, chi-square test and multivariate logistic analysis were carried out to test the relationship between quality of life and unprotected anal intercourse. Results The questionnaires of 320 of the 373 men who have sex with men that were surveyed met our validity criteria (response rate: 85.8 %). A total of 161 subjects (50.3 %) reported having unprotected anal sex in the last 6 months. The results of univariate analysis indicated that having unprotected anal sex was significantly associated with psychological health (PSYCH), social relationships (SOCIL), age, and marital status (P-value <0.05). The 3 items (“Negative feelings”, “Hopeness on your life”, and “Be able to concentrate”) in the PSYCH subscale were associated with UAI significantly (P-value <0.05). Multivariate analysis showed that psychological health (adjusted odd ratio (AOR) 0.979, 95 % confidence interval (CI) 0.961-0.998) was independent factor affecting the likelihood of having UAI in the population of Chinese MSM, and participants who aged 45 or more had higher odds of UAI (AOR 3.986, 95 % CI 1.199-13.255). Conclusions WHOQOL-BREF was acceptable for evaluating the quality of life of MSM. Psychological health, as one important aspect of quality of life, was negatively associated with unprotected anal intercourse. The finding underscored the needs to incorporate the strategies on improving psychological health into the UAI intervention to reduce the HIV transmission among MSM.
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Affiliation(s)
- Yaxin Zhu
- Department of Health Statistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Jie Liu
- Department of Health Statistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Bo Qu
- Department of Health Statistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China.
| | - Bingxue Hu
- Department of Health Statistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Yang Zhang
- Department of Health Statistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
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28
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Liao M, Wang M, Shen X, Huang P, Yang X, Hao L, Cox C, Wu P, Tao X, Kang D, Jia Y. Bisexual Behaviors, HIV Knowledge, and Stigmatizing/Discriminatory Attitudes among Men Who Have Sex with Men. PLoS One 2015; 10:e0130866. [PMID: 26121250 PMCID: PMC4485898 DOI: 10.1371/journal.pone.0130866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/26/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the correlates for bisexual behaviors, HIV knowledge, and HIV/AIDS-related stigmatizing/discriminatory attitudes among men who have sex with men (MSM). METHODS A cross-sectional survey among MSM was conducted in 2011 to provide demographics, sexual behaviors, HIV knowledge, HIV/AIDS-related stigmatizing/discriminatory attitudes, and services in Jinan, Qingdao, and Yantai of Shandong Province of China. RESULTS Of 1230 participants, 82.8% were single, 85.7% aged <35 years, and 47.2% received college or higher education. There were 28.6% MSM who reported to be married or cohabitating or ever had sex with woman in the past 6 months (P6M). 74.5% had ≥6 HIV-related knowledge score. The average total score of stigmatizing/discriminatory attitude was 37.4±4.4(standard deviation). Bisexual behavior was independently associated with higher levels of HIV/AIDS-related stigma/discrimination(AOR = 1.1, 95% CI:1.0-1.1), older age(AOR = 1.2, 95%CI:1.1-1.2), and lower HIV-related knowledge score(AOR = 1.6, 95%CI:1.2-2.2). HIV knowledge score ≥6 was independently associated with lower levels of HIV/AIDS-related stigma/discrimination(AOR = 1.3, 95%CI:1.2-1.3), less bisexual behaviors(AOR = 0.6, 95%CI:0.5-0.9), ever received a test for HIV in the past 12 months (P12M)(AOR = 3.2, 95%CI:2.3-4.5), college or higher level education(AOR = 1.9, 95%CI:1.4-2.6), consistent condom use with men in P6M(AOR=6.9, 95%CI:4.6-10.6), recruited from internet or HIV testing sites(AOR = 11.2, 95%CI:8.0-16.1) and bars, night clubs, or tea houses(AOR = 2.5, 95%CI:1.7-4.8). Expressing higher levels of HIV/AIDS-related stigmatizing/discriminatory attitudes was independently associated with bisexual behaviors(Aβ = 0.9, 95%CI:0.4-1.4), lower HIV-related knowledge score(Aβ = 3.6, 95%CI:3.0-4.1), the number of male sex partners in the past week ≥2(Aβ = 1.4, 95%CI:1.0-1.9), unprotected male anal sex in P6M(Aβ = 1.0, 95%CI:0.5-1.6), and inversely associated with ever received HIV test(Aβ = 1.4, 95%CI:0.8-2.0) and peer education in P12M(Aβ = 1.4, 95%CI:0.9-1.9). CONCLUSION HIV/AIDS-related stigmatizing/discriminatory attitudes were associated with bisexual behaviors, low HIV testing rate, lower HIV-related knowledge and risk behaviors. This study called for innovative programs that would reduce HIV/AIDS-related stigmatizing/discriminatory attitudes and bisexual behaviors and improve the uptake of prevention service among MSM.
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Affiliation(s)
- Meizhen Liao
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Mei Wang
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Xingjie Shen
- Jinan Central Hospital Affiliated Shandong University, Jinan, Shandong Province 250014, P. R. China
| | - Pengxiang Huang
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Xingguang Yang
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Lianzheng Hao
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Catherine Cox
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD 20742, United States of America
| | - Pingsheng Wu
- Department of Biostatistics, Vanderbilt University, Nashville, TN 37232, United States of America
| | - Xiaorun Tao
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Dianmin Kang
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Yujiang Jia
- Department of Health Policy, Vanderbilt University, Nashville, TN 37232, United States of America
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Liu J, Qu B, Zhu Y, Hu B. The influence of social support on quality of life of men who have sex with men in China: a preliminary study. PLoS One 2015; 10:e0127644. [PMID: 26010133 PMCID: PMC4444086 DOI: 10.1371/journal.pone.0127644] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/17/2015] [Indexed: 11/19/2022] Open
Abstract
The quality of life (QOL) of men who have sex with men (MSM) has received increasing attention in recent years. Our study surveyed the QOL and explored the influence of social support on QOL in Chinese MSM. A cross-sectional survey was conducted from September 2013 to March 2014 of 438 MSM in Huludao and Zhengzhou City, China. The results of univariate analysis showed that higher QOL scores were associated with receiving psychosocial counseling, higher health education, younger age and marital status of being single or unmarried p < 0.05). The structural equation model fitted well, with χ2 = 2083.47 (p < 0.05), RMSEA = 0.07, and GFI = 0.88. Among the latent factors, social support, with a factor load of 0.47, had greater impact on QOL than demographic characteristics. Within social support, the item loads for psychosocial counseling and health education were 0.17 and 0.29, respectively. Basic demographic characteristics also influenced social support, with a factor load of -0.65. For demographic characteristics, the greatest item loads were for marital status and age (0.77 and 0.71, respectively). These findings suggest that strengthening social support, especially for older and married individuals, would improve QOL in MSM in China.
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Affiliation(s)
- Jie Liu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
| | - Bo Qu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
- * E-mail:
| | - Yaxin Zhu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
| | - Bingxue Hu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
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30
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Zhang SH, Liu SJ, Hu LL, Li JF, Liu LH, Wei N. The prevalence and correlates of syphilis and HIV among homosexual and bisexual men in Shijiazhuang, China. Int J STD AIDS 2015; 27:127-32. [PMID: 25725492 DOI: 10.1177/0956462415575619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 02/01/2015] [Indexed: 11/17/2022]
Abstract
Bisexual men (men who have sex with men and women) are potential epidemiological bridges responsible for the spread of HIV and other sexually transmitted infections from men who have sex with men only to the heterosexual population. We aimed to estimate the prevalence of syphilis and HIV and the factors associated with syphilis infection among men who have sex with men and women and men who have sex with men only from Shijiazhuang, China. In 2011-2013, a cross-sectional cohort of 427 men who have sex with men was recruited by a snowball sampling method and tested for syphilis and HIV. Chi square and logistic regression were performed to identify syphilis risk factors. Among the 427 men who have sex with men, 71 (16.6%) cases were syphilis-positive and 16 cases (3.7%) were HIV-positive. The proportions of men who have sex with men and women and men who have sex with men only in the total sample were 31.4% and 68.6%, respectively. Men who have sex with men and women exhibited double the syphilis prevalence of men who have sex with men only and were more likely to practice insertive anal sex. Higher education level, being married, having more male partners, and both receptive and insertive anal sex roles were associated with syphilis among men who have sex with men and women. Residing in suburban areas, being married, being HIV positive, and an absence of desire to change sexual orientation were associated with syphilis among men who have sex with men only. Therefore, men who have sex with men and women represent an important sub-group in the syphilis epidemic and further interventions should be developed to reduce risk among different sub-sets of men who have sex with men.
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Affiliation(s)
- Shao-Hui Zhang
- Experiment Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shu-Jun Liu
- Department of STD and AIDS Prevention and Control, Shijiazhuang Central for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Ling-Ling Hu
- Experiment Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jie-Fang Li
- Department of STD and AIDS Prevention and Control, Shijiazhuang Central for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Li-Hua Liu
- Department of STD and AIDS Prevention and Control, Shijiazhuang Central for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Ning Wei
- Experiment Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Zhang H, Lu H, Pan SW, Xia D, Zhao Y, Xiao Y, He X, Yue H, Sun Z, Xu Y, Ruan Y, Shao Y. Correlates of unprotected anal intercourse: the influence of anal sex position among men who have sex with men in Beijing, china. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:375-387. [PMID: 25548064 DOI: 10.1007/s10508-014-0396-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 06/04/2023]
Abstract
Understanding barriers to consistent condom use among men who have sex with men (MSM) requires consideration of the context in which risk behaviors occur. Anal sex position is one such context. This pooled cross-sectional study used survey data from 1,230 MSM and their 2,618 reported male sexual partnerships. Overall, nearly half of the participants engaged in unprotected anal intercourse (UAI) with at least one of upto three partners in the past 6 months. "Insertive" men engaged in less UAI (39 %) than "receptive" (53 %) or "versatile" (51 %) men. Regardless of sexual position, UAI was associated with cohabiting with a male or female partner and perceiving great or moderate risk of HIV from male contact at the individual level, and steady (vs. casual) partnership at the dyad level. However, early MSM anal sex debut, high number of male partners, alcohol use, receiving and buying condoms, HIV testing, and MSM sex-seeking venues were found to be only statistically significantly correlated with UAI among some but not all sexual positions, implying that interventions to increase condom use should take into account how anal sex position may influence willingness and ability to engage in safer sex. Dyad level data appear to provide additional insight into the influence of sexual positions, and should be used to complement individual data for future intervention designs.
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Affiliation(s)
- Heng Zhang
- Epidemiology and Biostatistics Branch of Division of Virology and Immunology, State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
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Cheng W, Tang W, Zhong F, Babu GR, Han Z, Qin F, Gao K, Mai H, Zhao Y, Liang C, Fan L, Wu H, Xu H, Wang M. Consistently high unprotected anal intercourse (UAI) and factors correlated with UAI among men who have sex with men: implication of a serial cross-sectional study in Guangzhou, China. BMC Infect Dis 2014; 14:696. [PMID: 25519034 PMCID: PMC4279965 DOI: 10.1186/s12879-014-0696-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/11/2014] [Indexed: 12/22/2022] Open
Abstract
Background China experiencing an increasing HIV epidemic among men who have sex with men (MSM), and unprotected anal intercourse (UAI) has played a key role in this process. The aims of this study were to examine the trend of UAI and to explore the factors correlated with UAI among MSM in Guangzhou, China. Methods Data from 2008 to 2013 were retrieved from the annual serological and behavioral surveys system. We collected information on demographic, HIV related sexual behavior with men and women, access to HIV prevention services, and symptoms of sexually transmitted infections. Chi-square test was used to examine the similarity of the participants during the study period. Univariate and multivariate logistic regression were conducted to test the factors associated with UAI. Trend test was used to check the change of UAI in different characteristic stratums during the study period. Results In total, 58.4% (range from 54.5% to 62.0%) of the participants reported that they engaged in UAI in the past six months. Participants who aged less than 20 [Adjusted Odds Ratio (AOR): 2.22, 95% Confidential Interval (CI): 1.07-4.61], only attended elementary school (or less) (AOR: 1.41, 95% CI: 1.04-1.90), cohabiting with male partner (AOR: 2.15, 95% CI: 1.66-2.79), divorced or widowed (AOR: 2.80, 95% CI: 1.54-5.07), did not test for HIV in the past year (AOR: 1.36, 95% CI: 1.12-1.65), and had 10 or more partners in the past six months (AOR: 1.85, 95% CI: 1.18-2.91) had higher odds of UAI. However, the proportions of UAI were stable in different stratums during the study period. Conclusions The proportion of MSM engaged in UAI was consistently high during the study period. Effective intervention strategies, which include but not limit to risk reduction counseling and testing services, are urgently needed to bring down the risk behaviors of the MSM in Guangzhou, in order to control HIV/STIs epidemic in this specific population.
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Affiliation(s)
- Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Weiming Tang
- University of North Carolina Project-China, No.2 Lujing Road, Yuexiu District, Guangzhou, Guangdong Province, 510095, China.
| | - Fei Zhong
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China. .,School of Public Health, Sun Yat-Sen University, No.74 2nd Yat-Sen Road, Yuexiu District, Guangzhou, Guangdong, Province, 510080, China.
| | - Giridhar R Babu
- Department of Epidemiology, Public Health Foundation of India, IIPH H, Bangalore Campus, SIHFW Premises, 1st cross, Magadi road, Bangalore, Karnataka, 560023, India.
| | - Zhigang Han
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Faju Qin
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Kai Gao
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Huixia Mai
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Yuteng Zhao
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Caiyun Liang
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Lirui Fan
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Hao Wu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Huifang Xu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Ming Wang
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
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