Anticipated HIV Stigma Among HIV Negative Men who have Sex with Men in China: A Cross-Sectional Study
Transplantation or Rurality? Migration and HIV Risk among Chinese Men who have Sex with Men in the Urban Areas. Journal of International AIDS Society. 21(1):e25039. highlight
Receiving HIV Serostatus Disclosure from Partners Before Sex: Results from an Online Survey of Chinese Men Who Have Sex with Men and Transgender Individuals. AIDS & Behavior. (online first) abstract
This study showed that HIV serostatus disclosure from partners was uncommon among Chinese MSM. Interventions and further implementation research to facilitate safe disclosure are urgently needed for MSM.
Sex tourism among Chinese Men who have Sex with Men: A Cross-Sectional Observational Study. BMC Public Health. 18:306. abstract
Background: Sex tourism among men who have sex with men (MSM) may exacerbate transmission of HIV and other sexually transmitted infections (STIs). Sex tourism is defined as purchasing sex with gifts or money outside of one’s hometown. Our objective was to characterize the frequency, socio-demographic characteristics, and sexual risk behaviors among Chinese MSM sex tourists.
Methods: An online, cross-sectional survey for high-risk MSM throughout China was conducted in November 2015 covering sociodemographic characteristics, sexual risk behaviors, and sex tourism. Univariate and multivariable logistic regressions were performed to identify correlates of sex tourism. The mean MSM HIV prevalence of sex tourism journey origins and destinations were compared.
Results: Of 1189 MSM who completed the survey, 62 (5%) men identified as sex tourists; among these sex tourists, twenty (32%) traveled primarily to purchase sex and the remainder purchased sex while traveling for another purpose. There was minimal socio-demographic and behavioral difference between the two groups. In multivariable analyses, adjusting for age and income, sex tourism was correlated with high-risk sexual behaviors, higher income (aOR 4.44, 95%CI 1.77–11.18) and living with HIV (aOR 2.79, 95%CI 1.03–7.55). Sex tourism was more often from locations with lower to higher MSM HIV prevalence (mean = 4.47, SD = 2.01 versus mean = 6.86, SD = 5.24).
Conclusion: MSM sex tourists were more likely to have risky sexual behaviors and travel to locations with a higher HIV prevalence. MSM sex tourists may be part of core groups that are disproportionately responsible for MSM HIV transmission. Enhanced surveillance and interventions tailored to MSM sex tourists should be considered.
Condom Use Social Norms and Self-efficacy with Different Kinds of Male Partners among Chinese Men who have Sex with Men: Results from an Online Survey. BMC Public Health. 18:1175. abstract
Background: Social norms and self-efficacy play important roles in promoting consistent condom use among men who have sex with men (MSM). Few studies have investigated the association between social norms, self-efficacy and consistent condom use with different kinds of male partners among MSM. We conducted an online survey of MSM to evaluate this in China.
Method: A cross-sectional online survey was conducted in 2015. Participants completed a validated questionnaire covering socio-demographic information, consistent condom use, condom use social norms and self-efficacy. Eligible participants were 16 or older, born biologically as a male, engaged in anal sex with a man at least once during their lifetime, engaged in condomless anal or vaginal sex in the last three months. In this study, we further restricted to people who had sex with male partners in the last three months. Participants were classified into three groups: engaged in sex only with regular partners, engaged in sex only with casual partners and engaged in sex with both regular partners and casual partners.
Result: Participants were recruited from 32 provinces in China. Among 1057 participants, 451(42.7%), 217(20.5%), and 389(36.8%) engaged in sex with regular partners only, casual partners only and both types in the last three months, respectively. Men engaged in sex only with regular partners in the last three months had a higher condom use self-efficacy than with other two types of partners (P < 0.01). Both social norms (regular partners: adjusted OR:1.59, 95% CI: 0.97–2.60; casual partners: adjusted OR: 1.58, 95% CI: 1.19–2.09; both types: adjusted OR: 1.48, 95% CI: 1.13–1.95) and self-efficacy (regular partners: adjusted OR: 2.88, 95% CI: 1.59–5.22; casual partners: adjusted OR: 2.35, 95% CI: 1.69–3.26; both types: adjusted OR: 2.45, 95% CI: 1.81–3.32) were positively associated with consistent condom use. No interaction effect was detected between condom social norms and self-efficacy on consistent condom use among Chinese MSM (p > 0.05).
Conclusion:Both social norms and self-efficacy were positively correlated with consistent condom use with any types of partners among Chinese MSM. Tailored interventions that aimed to improve social norms and self-efficacy has the potential to improve overall condom use among Chinese MSM.
Out of the Closet, Into the Clinic: Opportunities for Expanding MSM-Competent Services in China. Sexual Transmitted Diseases. 45(8): 527–533. abstract
Background: Despite the high human immunodeficiency virus (HIV) burden among men who have sex with men (MSM), there is little research on health services provided to MSM in China and other low- and middle-income countries. Discrimination and inadequate services may discourage MSM from seeking health care services. This study examined essential services provided to MSM and health care discrimination among MSM in China.
Method: A nationwide cross-sectional online survey was conducted among MSM who saw a physician in the last 24 months in China. The survey included items on sociodemographic information, HIV testing, experiences from the last physician encounter, and history of perceived health care discrimination. We defined MSM-competent physicians as physicians who asked their patient about having sex with other men, asked about anal sex, and either asked about or recommended HIV testing at the most recent visit.
Finding: Among the 503 participants, 35.0% (176/503) saw an MSM-competent physician. In multivariate analyses, respondents who saw an MSM-competent physician were more likely to be younger (adjusted odds ratio (AOR), 0.87; 95% confidence interval (CI), 0.81–0.94), have a primary care physician (AOR, 3.24; 95% CI, 1.85–5.67), and be living with HIV (AOR, 2.01; 95% CI, 1.13–3.56). 61.2% (308/503) of MSM had ever experienced health care discrimination.
Conclusion: Our data suggest that there is variability in the extent to which physicians are meeting the needs of MSM in China. There is an urgent need to evaluate and expand MSM-competent services in China.
The Interaction between HIV Testing Social Norms and Self-efficacy on HIV Testing among Chinese Men who Have Sex with Men: Results from an Online Cross-Sectional Study. BMC Infectious Diseases. 18(1): 541. abstract
BACKGROUND: Increasing human immunodeficiency virus (HIV) testing is critical for HIV control. This study aimed to evaluate the interaction between social norms and self-efficacy on HIV testing among Chinese men who have sex with men (MSM).
METHODS: We conducted an online survey in eight Chinese cities in Shandong and Guangdong Provinces in July 2016. We included participants who were born as a male, at least 16 years old, currently living in one of the designated cities, and had ever engaged in anal sex with a man. We collected information regarding socio-demographics, high-risk behaviors, and history of HIV and other STI testing. We coded sensitivity to social norms using six items asking participants about their perceived social norm regarding HIV testing. We coded HIV testing self-efficacy using a separate six-item scale. We interpreted higher mean scores as higher sensitivity to social norms and higher self-efficacy, respectively. We conducted logistic regressions to evaluate the interaction between self-efficacy and social norms on HIV testing.
RESULTS: A total of 2105 men completed the survey. The mean age of the participants was 25.97 ± 6.42 years. Over four-fifths (85.9%) of participants were unmarried, 22.7% were students, and 64.6% at least had a college degree. 62.5 and 32.6% of participants ever and tested HIV in the last three months, respectively. With respect to uptake of HIV testing in the last three months, the adjusted odds ratio was 1.01(95% CI: 0.96-1.06) for higher sensitivity to social norms and 1.09 (95% CI: 1.05-1.14) for higher self-efficacy, with an interaction effect of 1.02 (95% CI: 1.01-1.03), respectively. With respect to uptake of lifetime HIV testing, the adjusted odds ratio was 1.03(95% CI: 0.99-1.07) for higher sensitivity to social norms and 1.15 (95% CI: 1.11-1.19) for higher self-efficacy, with an interaction effect of 1.02 (95% CI: 1.01-1.04), respectively.
CONCLUSIONS: Our survey demonstrated that there is a significant association between the uptake of HIV testing with sensitivity to the social norm, higher self-efficacy, as well as the interaction between them. Tailored studies for improving HIV testing among MSM in China can combine these two interventions together.
Community Engagement in Sexual Health and Uptake of HIV Testing and Syphilis Testing among MSM in China: A Cross-sectional Online Survey. Journal of the International AIDS Society. 20(1):21372. abstract
Traditional, Complementary and Alternative Medical Cures for HIV: Rationale and Implications for HIV Cure Research. Global Public Health. 2017. abstract
Disclosure of Sexual Orientation to Health Professionals in China: Results from an Online Cross-Sectional Study. Journal of the International AIDS Society, 20(1), 21416. abstract
Physician Perceptions of HIV Cure in China: A Mixed Methods Review and Implications for HIV Cure Research. Asian Pacific Journal of Tropical Disease, 5(9), 687-690. abstract