The influence of social support on quality of life of men who have sex with men in China: a preliminary study

A Study of the Relationship between Men Who Have Sex with Men Stigma and Depression: A Moderated Mediation Model

(1) Background: Men who have sex with men (MSM) have a high prevalence of depression due to stigma. However, whether resilience and social support play a moderating role in the effects of stigma on depression remains to be tested. This study constructed a moderated mediation model to explore the mediating role of perceived stigma in the relationship between enacted stigma and depression and whether this relationship is moderated by social support. (2) Methods: MSM were recruited during November-December 2022 using a non-probability sampling method, and a total of 1091 participants were included. Enacted stigma, perceived stigma, resilience, social support, and depressive symptoms were measured. Mediation and moderated mediation models were used to analyze the relationships between these variables. (3) Results: Moderated mediation analyses show that enacted stigma indirectly affects depression through perceived stigma (β = 0.315, 95% confidence interval = 0.221 to 0.421). Social support had a positive moderating effect between enacted stigma and depressive symptoms (β = 0.194, p < 0.001) and a negative moderating effect between perceived stigma and depressive symptoms (β = -0.188, p < 0.001). (4) Resilience and perceived stigma mediated the relationship between enacted stigma and depression, and the relationship between enacted stigma, perceived stigma, and depression was moderated by social support. Reducing stigma while increasing social support has the potential to alleviate depressive symptoms among Chinese MSM.

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

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

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

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

Allocating treatment resources for hepatitis C in the UK: a constrained optimization modelling approach

Background and objective: Although the treatment of chronic hepatitis C (CHC) has significantly evolved with the introduction of direct-acting antivirals, the treatment uptake rates have been low especially among marginalized groups in the UK, such as people who inject drug (PWID) and men who have sex with men (MSM). Cutting health inequality is a major focus of healthcare agencies. This study aims to identify the optimal allocation of treatment budget for chronic hepatitis CHC among populations and treatments in the UK so that liver-related mortality in patients with CHC is minimized, given the constraint of treatment budget and equity issue. Methods: A constrained optimization modelling of resource allocation for the treatment of CHC was developed in Excel from the perspective of the UK National Health System over a lifetime horizon. The model was designated with the objective function of minimizing liver-related deaths by varying the decision variables, representing the number of patients receiving each treatment (elbasvir-grazoprevir, ombitasvir-paritaprevir-ritonavir-dasabuvir, sofosbuvir-ledipasvir, and pegylated interferon-ribavirin) in each population (the general population, PWID, and MSM). Two main constraints were formulated including treatment budget and the issue of equity. The model was populated with UK local data applying linear programming and underwent internal and external validation. Scenario analyses were performed to assess the robustness of model results. Results: Within the constraints of no additional funding over original spending in status quo and the consideration of the issue of equity among populations, the optimal allocation from the constrained optimization modelling (treating 13,122 PWID, 160 MSM, and 904 general patients with ombitasvir-paritaprevir-ritonavir-dasabuvir) was found to treat 2,430 more patients (relative change: 20.7%) and avert 78 liver-related deaths (relative change: 0.3%) compared with the current allocation. The number of patients receiving treatment increased 4,928 (relative change: 60.1%) among PWID and 42 (relative change: 35.8%) among MSM. Conclusion: The current allocation of treatment budget for CHC is not optimal in the UK. More patients would be treated, and more liver-related deaths would be avoided using a new allocation from a constrained optimization modelling without incurring additional spending and considering the issue of equity.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Assessment of Surgery Resident Competency Provided by Patients

The objective of this study was to assess the competency of surgery residents from the patient perspective in the current healthcare environment in China. The authors performed an assessment of 508 surgery residents in Liaoning province. Seven patients were as a group to complete the self-administered questionnaires on the survey for each individual corresponding resident. A 5-point rating scale with an unable-to-evaluate category was used to assess surgery resident competency by patients. Reliability and validity were assessed by Cronbach alpha (α) and exploratory factor analysis, respectively. Statistical analysis was performed using SPSS 13.0. The surveys on 421 residents were valid, and the valid response rate was 82.8%. A total of 2947 questionnaires from patients were analyzed in this study. The Cronbach α coefficient was 0.92. The 4 factors emerging in the exploratory factor analysis reached a cumulative contribution rate of 66.98%. The items of "promotes health maintenance (talks about preventive care)" (206/7.0%), "tells me about any side effects of the medicine" (177/6.0%), "spends enough time with me" (189/6.4%), and "answers my questions thoroughly" (168/5.7%) were scored <4 by higher percentage of patients. The instrument provided an acceptable means for patients to evaluate the competency of Chinese surgery residents. Surgery residents should improve their competencies on preventive care, patient safety, and communication skills.

Associated factors of self-reported psychopathology and health related quality of life among men who have sex with men (MSM) with HIV/AIDS in Dalian, China: a pilot study

Background

Despite the availability of Anti-Retroviral Therapy (ART), the health-related quality of life (HRQoL) among HIV-positive men who have sex with men (HIVMSM) in China remains poor. This study aimed to explore the relationship between self-reported psychopathology and HRQoL among HIVMSM in Dalian, China.

Methods

A cross-sectional study was conducted in 112 HIVMSM. Symptom check list 90 (SCL 90): a measure of psychopathology and World Health Organization quality of life in HIV infection (WHOQOL-HIV-Bref): a measure of HRQoL were used. Correlation and multiple regression analysis were employed to explore the association between self-reported psychopathology and HRQoL in HIVMSM.

Results

Out of the total 112 HIVMSM cases, 9 (8 %) cases were homosexuals and 103 (92 %) ones were bisexuals. The participants who had low family income (P = 0.001), perceived discrimination (P = 0.001) and lack of regular attendance in medical follow-ups (P = 0.014) reported poorer HRQoL than their counterparts. Somatization, obsession, depression, phobia and overall SCL 90 scores in self-reported psycholpathology had a negative impact on the domains of HRQoL among HIVMSM.

Conclusions

Total quality of life was predicted by family income, perceived discrimination, and medical follow-up attendance. Self-reported psychopathology was negatively correlated with HRQoL in HIVMSM. The Strategies that target MSM focusing on linking and engaging HIV-positive patients in medical care is the key step to improve their HRQoL. More emphasis is needed on the newly diagnosed HIVMSM in Dalian in order to develop a more targeted intervention to prevent perceived discrimination and lack of proper medical follow-up services.

Trial registration

The trial registration number does not require for this manuscript. The study is cross-sectional design that do not involve intervention at all, it is not a clinical trial.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-016-0204-z) contains supplementary material, which is available to authorized users.