Money Boys, HIV Risks, and the Associations between Norms and Safer Sex: A Respondent-Driven Sampling Study in Shenzhen, China

Department of Epidemiology and Community Health, Virginia Commonwealth University School of Medicine, 1000 East Clay Street, P.O. Box 980212, Richmond, VA 23298, USA.
AIDS and Behavior (Impact Factor: 3.49). 11/2008; 13(4):652-62. DOI: 10.1007/s10461-008-9475-0
Source: PubMed


Money boys (MBs) are male sex workers who sell sex to men who have sex with men (MSM). This study estimates the proportion of MBs in the Chinese MSM, compares HIV risks between MBs and non-MB MSM, and examines the associations between practicing safer sex and peer norms of condom use. Respondent-driven sampling (RDS) was used to sample 351 MSM in the city of Shenzhen in 2007. The RDS-adjusted proportion of MBs among MSM was 9%. Compared to non-MB MSM, more MBs reported having had multiple male and female sexual partners. Half of MBs and non-MB MSM had consistently used condoms. Both descriptive and subjective norms were positively associated with condom use. The MB proportion of 9% in MSM implies a relatively large population of MBs in China. The association between peer norms and consistent condom use can assist with the development of culturally competent HIV interventions that promote safer sex.

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    • "MSM are highly vulnerable to HIV infection due to unprotected anal intercourse and multiple sexual partners. [19], [20] Self-discrimination, or discrimination and censure from society that makes a group feel shameful, guilty or inferior, is remarkably prevalent among MSM because of traditional Chinese culture, which has had a critical impact on their individual behavior, psychological health status and prevalence of AIDS. [21], [22] MSM tend to disguise their sexual orientation by marrying to female spouses, which makes them hard-to-reach population [23] and potentially increases the rate of HIV infection in the general population. "
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    ABSTRACT: The study was to investigate the incidence of HIV-1 and related factors, as well as predictors associated with retention in a cohort study among men who have sex with men (MSM) in Yangzhou, Jiangsu Province, China. A carefully designed 12-month prospective cohort study was conducted. A total of 278 sero-negative MSM were recruited and followed up for 12 months starting from May, 2008. Participants were tested for HIV-1 at baseline, 6-month, and 12-month follow-up visits. Questionnaire interviews were conducted to collect information. The retention rate and HIV incidence were analyzed as functions of demographic and behavioral variables. Risk factors were identified by estimating the relative risks (RR) and respective 95% confidence intervals (CI) using a Poisson regression model, univariate and multivariate analyses and risk factors analyses. 71 (25.5%) and 45 (16.2%) of the 278 participants were retained at the 6-month and 12-month follow-up visits respectively. The incidence rates of HIV-1 were 5.65 and 6.67 per 100 person years (PY) respectively. Both having received condoms and having received lubricant were negatively associated with HIV sero-conversion at the 12 months' follow-up. Predictors associated with 12-month retention rate include Yangzhou residency (RR = 0.471, 95%CI: 0.275∼0.807, P = 0.006), having received condoms (RR = 0.065, 95%CI: 0.007∼0.572, P = 0.014), and having received VCTs (RR = 0.093, 95%CI: 0.010∼0.818, P = 0.032). The incidence of HIV-1 among MSM in Yangzhou is relatively high and effective interventions are needed urgently. More attention should be focused on maintaining a higher retention rate.
    PLoS ONE 12/2012; 7(12):e52731. DOI:10.1371/journal.pone.0052731 · 3.23 Impact Factor
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    • "The detailed procedures of the recruitment of study subjects have been previously described [9]. Briefly, a cross-sectional study of social network factors associated with HIV/STI-related risks was conducted among MSM in Shenzhen, China. "
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    ABSTRACT: Little research has assessed the degree of severity and ordering of different types of sexual behaviors for HIV/STI infection in a measurement scale. The purpose of this study was to apply the Rasch model on psychometric assessment of an HIV/STI sexual risk scale among men who have sex with men (MSM). A cross-sectional study using respondent driven sampling was conducted among 351 MSM in Shenzhen, China. The Rasch model was used to examine the psychometric properties of an HIV/STI sexual risk scale including nine types of sexual behaviors. The Rasch analysis of the nine items met the unidimensionality and local independence assumption. Although the person reliability was low at 0.35, the item reliability was high at 0.99. The fit statistics provided acceptable infit and outfit values. Item difficulty invariance analysis showed that the item estimates of the risk behavior items were invariant (within error). The findings suggest that the Rasch model can be utilized for measuring the level of sexual risk for HIV/STI infection as a single latent construct and for establishing the relative degree of severity of each type of sexual behavior in HIV/STI transmission and acquisition among MSM. The measurement scale provides a useful measurement tool to inform, design and evaluate behavioral interventions for HIV/STI infection among MSM.
    BMC Public Health 10/2011; 11(1):763. DOI:10.1186/1471-2458-11-763 · 2.26 Impact Factor
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    • "However, very few epidemiological and socio-behavioural studies have focused on this population to date. Limited studies indicated that Chinese 'money boys' are usually younger than the overall MSM population and unmarried [38,45-47]. An estimated 71% of Chinese money boys had 1-3 male clients and 11% had more than 10 clients per week [38]. "
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    ABSTRACT: HIV prevalence among men who have sex with men (MSM) in China has rapidly increased in recent years. It is suggested that MSM could be a potential bridge of HIV transmission to the general female population. We investigated the bisexual behaviour of MSM in China through systematic review and meta-analysis. We conducted a systematic review and meta-analyses on published peer-reviewed Chinese and English literature during 2001-2010 according to the PRISMA guidelines. Marital status and sexual behavioural indicators of MSM were presented graphically using forest plots. The pooled effect rates with 95% confidence intervals were also calculated. Meta-regression analyses were performed to examine the factors associated with high heterogeneities across the studies. Forty-three eligible articles (11 in English and 32 in Chinese) were identified. Our results showed that 17.0% (95% CI: 15.1-19.1%) of MSM in China are currently married to a woman and 26.3% (95% CI: 23.6-29.1%) of MSM had female sexual partners in the last six months. The pooled estimates for condom use rate between MSM and female sex partners was 41.4% (95% CI: 35.5-47.5%) at the last sex act; and 25.6% (95% CI: 23.0-28.4%) in the last six months. The consistent condom use rates with regular, non-commercial, casual and commercial female sex partners in the last six months were 23.3% (95% CI: 11.25-42.1%), 39.0% (95% CI: 28.8-50.3%) and 55.8% (95% CI: 41.4-69.4%), respectively. A substantial proportion of Chinese MSM is currently married or had sexual relations with a female in the past six months. In addition, low condom usage was common between married MSM and their wives, hence posing a higher risk of transmitting HIV. Harm-reduction programs targeting married MSM and their female partners are necessary to curb the further spread of HIV infection to the general female population.
    BMC Infectious Diseases 09/2011; 11(1):242. DOI:10.1186/1471-2334-11-242 · 2.61 Impact Factor
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