Unprotected anal intercourse behavior and intention among male sex workers in Shenzhen serving cross-boundary male clients coming from Hong Kong, China – prevalence and associated factors

Abstract

The HIV epidemic among men who have sex with men (MSM) in China is becoming very serious. Unprotected anal intercourse (UAI) among MSM during cross-boundary commercial sex spread HIV across geographic areas. This study interviewed 186 Chinese male sex workers (MSW) in Shenzhen, China, serving cross-boundary Hong Kong male clients; 49.5% had had UAI with their Hong Kong male clients (last six months) and 24.2% intended to do so (future six months). Multivariate analyses showed that perceived efficacy of condom use for HIV prevention, perceived prevalence of HIV among Hong Kong MSM (>4%), and perceived ability to convince Hong Kong male clients to use condoms during anal sex were associated with lower likelihoods of UAI with such clients (OR = 0.04-0.09); the reverse was true for those who left the decision of condom use to their Hong Kong male clients (OR = 6.44). Perceived condom efficacy, self-efficacy in protection against HIV infection, and perceived control over condom use were associated with an intention for UAI (OR = 0.06-80.44). Adjusting for background variables, the scales representing contextual (Clients Characteristics, Substance Use, or Environmental Influences) and affective factors (Fear of Diseases) were associated with UAI (adjusted OR = 0.44-32.61). Except the Fear of Diseases scale, other scales were associated with an intention for UAI (adjusted OR = 4.59-43.32). MSW are at high risk of HIV transmission. Various factors are associated with UAI with male cross-boundary clients; these factors and the context of sex work need to be considered when designing HIV prevention programs.

Prevalence of Unprotected Anal Intercourse among Men Who Have Sex with Men in China: An Updated Meta-Analysis

“…Among the 82 studies, 23 were conducted from 2001 to 2007, 56 from 2008 to 2012, and another three across from 2007 to 2008 [49], [95]. The participants were recruited from MSM venue-based methods, either in conjunction with or exclusive of other methods, in about half of the studies (42/82).…”

Sexual Motivation, Sexual Transactions and Sexual Risk Behaviors in Men who have Sex with Men in Dar es Salaam, Tanzania

“…It was found in another bisexual MSM population that when condom use was inconsistent in sex with male partners, it tended to be inconsistent also in sex with female partners. (17) In the behavioral surveillance survey of MSM in Zanzibar, Tanzania, about 87% of respondents did not consistently use a condom with female sexual partner(s) (paid or non-paid) in the past month. (22) STIs/HIV prevention for this group of MSM, besides condom use promotion, may want to address financial sexual motivation in order to reduce unnecessary or unwanted engagement in anal sex with men.…”

“…(16) Presumably due to these risk factors, engaging in sex work among MSM has been shown to result in elevated risk for HIV infection in many settings. (6, 8, 10, 11, 17-19)…”

Correlates of Perceived HIV Prevalence and Associations With HIV Testing Behavior Among Men Who Have Sex With Men in the United States

“…Prior research has pointed to the influence of constructs such as self-efficacy, perceived behavioral control, perceived benefit from testing, and perceived severity of HIV infection (Albarracín et al, 2001;Floyd et al, 2000;Janz & Becker, 1984;Lau et al, 2012), which were not assessed in this study. Many subjective factors also influence perceptions of the risk posed by specific partners, including physical attractiveness and the level of intimacy and trust (Agocha & Cooper, 1999;Kowalewski et al, 1997;Lorenc et al, 2011;Mitchell & Horvath, 2013;Schmälzle, Renner, & Schupp, 2012).…”