Sexual health status of women who have regular sexual relations with men who have sex with men in mainland China.

BACKGROUND: Men who have sex with men (MSM) are a high-risk group for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection. In China, the vast majority of MSM feel forced to marry or plan to marry women, according to traditional Chinese culture. Women who have regular sexual relations with MSM, called tongqi in mainland China, live with a high risk of STDs or HIV infection, but these risks are often ignored. Our investigation of this group of the women is a preliminary study that aims to understand the sexual health problems of tongqi and related factors. METHODS: This study relied on website mobilization and was funded by tongqi. Participants were limited to women who had sex with MSM to whom they were married (in-GWs), whom they had divorced (ex-GWs), or with whom they were friends (GGFs). The data were collected using questionnaire software. RESULTS: A total 144 valid surveys were returned from 100 in-GWs, 33 ex-GWs, and 11 GGFs. Average respondent age was 32.8 ± 6.4 years (range 22 to 58 years). Among in-GWs and ex-GWs, over 95% learned that their husbands were MSM after marriage. More than half of respondents had had sex before marriage, and one-third of those women had sex partners other than their husbands. In addition, 35.3% of tongqi had STDs symptoms. About 50% participants had had oral sex with sex partners of MSM and 10% had had passive anal sex, with low condom use during both oral (9.7%) and anal sex (23.1%). Most tongqi had misunderstandings about STDs and HIV and less than 30% had undergone HIV screening. Among participants tested, 5.6% were HIV positive. A total 93.5% of respondents believed that laws should be established to protect the sexual rights of women. CONCLUSIONS: Women who have regular sexual relations with MSM face adverse sexual health issues and are susceptible to STDs and HIV infection. Measures must be taken to protect the rights and interests of tongqi in mainland China.

Mental health and suicidal ideation among Chinese women who have sex with men who have sex with men (MSM).

In China, men who have sex with men (MSM) are the fastest growing population at risk for HIV. They face social stigma due to both MSM behavior and HIV. In addition, concern has been raised about the mental health of wives of MSM. In this cross-sectional study, the authors examine the mental health status of a sample of 135 of these women. Participants completed an Internet-administered questionnaire in Xi'an from April to June, 2012. Most were unaware at the time of marriage that their husbands were MSM. Physical abuse was frequently reported; depressive symptom and mental health (Symptom Checklist, SCL-90) scores were significantly higher than those of the general Chinese adult female population. A majority (59.8%) of women reported suicidal thoughts after discovering their husbands' MSM behavior; about 10% had attempted suicide. Multiple logistic regression revealed that women's experience with anal sex was associated with 7.8 times (95% CI: 1.3-65.9) greater odds of suicidal ideation. Also, women who demonstrated mental symptoms on the SCL-90 had 2.3 times (95% CI: 1.04-5.2) the odds of suicidal ideation. These results suggest that wives of MSM have a significant need for mental health care, suicide prevention, HIV education, and social support.

Causes of suicidal behaviors in men who have sex with men in China: a national questionnaire survey.

BACKGROUND: Men who have sex with men (MSM) have become a high-risk group of HIV infection in China. To date, little is known regarding the psychological characteristics in Chinese MSM, especially the prevalence of suicidal ideation and attempts. METHODS: A questionnaire survey was conducted on 2,250 MSM recruited from gay bars in 9 large cities in mainland China. Data on the prevalence of suicidal ideation and attempts as well as the underlying causes in the respondents were analyzed. RESULTS: A total of 1530 MSM responded to the question regarding previous suicidal ideation and attempts. Of these respondents, 26.01% had ever considered suicide and 12.55% actually attempted suicide at least once. Romantic gay relationship breakup was the number one cause of suicide behaviors, followed by self-objection to homosexuality, difficulties in finding gay partners or in getting used to heterosexual marriage life, sudden emotional hurts from unexpected events, illegal status of gay marriage in China and disclosure of homosexuality. CONCLUSIONS: The survey study has led to a better understanding of the factors contributing to suicide behaviors of MSM in China, which may have significant implications in developing preventive strategies against suicide behaviors in this unique group of individuals.

Psychological characteristics in high-risk MSM in China.

BACKGROUND: Men who have sex with men (MSM) have become a high-risk group of HIV infection in China. To date, little is known regarding the behavioral, social and psychological characteristics in Chinese MSM, which makes the implementation of preventive and therapeutic strategies for this high-risk subpopulation of people extremely difficult. METHODS: A total of 714 questionnaires were retrieved from the database of a Chinese government-sponsored National Key Research Project titled "Risk Analysis and Strategic Prevention of HIV Transmission from MSM to the General Population in China". The respondents were categorized into a high-risk group and a control group. Their behavioral, social and psychological characteristics were comparatively analyzed. RESULTS: Of the 714 MSM analyzed, 59 (8.26%) had high-risk homosexual behaviors. This sub-group of MSM had a higher in-marriage rate, a higher monthly income, heavier alcohol consumption and more serious problems with sexual abuse in childhood, intentional suicide attempts and mistaken assumption on condom's role in protecting HIV infection, as compared with the control group (P < 0.05). In contrast, the two groups did not differ significantly the sexual orientation, level of education, types of profession, drug use, condom use and experience of social stigma and discrimination (P > 0.05). A vast majority of the individuals in both behavior categories expressed support of legally protected gay clubs as well as gay marriage legislation in China. There was a strong correlation between high-risk behaviors and sexual abuse in childhood, alcohol drinking, income level and a mistaken belief in perfect HIV protection through the use of condoms. CONCLUSIONS: MSM with and without high-risk homosexual behaviors have different social and psychological characteristics, which should be taken into account when implementing behavioral and therapeutic interventions aimed at preventing HIV/AIDS transmission among MSM as well as from MSM to the general population in China.

[Study on high-risk behaviour and suicide associated risk factors related to HIV/AIDS among gay or bisexual men].

OBJECTIVE: Characteristics on AIDS high-risk behaviors in gay or bisexual men with suicide ideas were explored and analyzed. METHODS: A cross-sectional survey was conducted with the snowball sampling method adopted. Subjects with suicide ideas were collected from responses to the valid questionnaires and subjects with no suicide ideas were collected from the age comparable men. RESULTS: The overall rate of gays or bisexuals with suicide ideas was 20.2% in this survey. The attitude for homogeneity and marital status among the unmarried was more than that among the comparable group (P < 0.05). The rate of AIDS high-risk behaviors as same-sex sexual harassment, bleeding during sexual intercourse in the last year, coitus with unfamiliar same-sex partners in cities, suffering from adult same-sex sexual abuse before the age of 16, having had sexual abuse and abusive behavior, having had active or passive anal kiss, having had active or passive coitus with fingers, alcohol consumption weekly at least once or more, hurt by gays because of attitude and/or same-sex sexual activity and hurt by heterosexual men because of attitude and/or same-sex sexual activity were significantly higher in gays and bisexual men with suicide ideas than those without (P < 0.05). Data from multivariate logistic regression models suggested that harm from gays (Waldχ(2) = 6.637, P = 0.010) and heterosexual men (Waldχ(2) = 5.835, P = 0.016) due to attitude on homosexual activity appear to be the risk factors causing the suicide ideas. CONCLUSION: Reducing the social discrimination and harm towards gays and bisexual men could reduce the occurrence of the suicide ideas and have a positive effect on curbing the prevalence of AIDS.

[Study on the AIDS-related high risk behaviors of men who have sex with men under the experience of exchanging money for the same sex].

OBJECTIVE: To investigate the AIDS-related high risk behaviors of men who have sex with men (MSM) who ever exchanged money for the same sex. METHODS: Target sampling for cross-sectional study and valid anonymous questionnaires were adopted to compare the differences of AIDS-related high risk behaviors between MSM with the experience of exchanging money for the same sex and those without that experience. 1959 rstadied samples were recruited in nine cities. SPSS 13.0 was used and t, χ(2) and Mann-Whitney tests were taken for statistical analysis. RESULTS: Compared to corresponding ones without "buying" the same sex experience, MSM who ever engaged in "buying" sex had the characteristics of being prone to in marriage and living in larger cities with older age and higher income (P < 0.01). They also had a significant larger number in the following events: total sexual partners, anal sex and oral sex episodes with same sex, number of sexual partners, anal sex and oral sex in the previous six months, with the figure of median 50.0, 20.0, 20.0, 5.0, 4.0, 5.0 respectively. 31.5% had ever participated in 'group sex', 48.0% had sex with male partners away from his own region in the previous year, 70.5% had sexual intercourse with strangers at MSM avenues in the last six months. The OR (95%CI) values were 2.288 (1.702 - 3.077), 3.231 (2.462 - 4.241), 2.840 (2.140 - 3.770). All the above mentioned figures were higher than those without the experience, with significant differences. They had a significant lower rate of 45.7% of condom use while having sex with female partners (P < 0.05). CONCLUSION: MSM with the experience of exchanging money for the same sex would have more AIDS-related high risk behaviors, AIDS preventative measures should be taken to target different subgroups.

[Study on the association of partner-seeking and high risk behaviors related to AIDS among men who have sex with men in the different sites].

OBJECTIVE: To explore the situation of AIDS-related high risk behaviors among men who have sex with men (MSM) ever experienced partner-seeking in different sites. METHODS: Target sampling for cross-sectional study ("snowball") and valid anonymous questionnaires were adopted to compare the differences of high risk behaviors related to AIDS. 1834 MSM were studied in nine cities who sought sex partners through internet, bars or bath ponds. RESULTS: Compared to the other corresponding groups, those MSM from the bath pond group had a significant larger number of total sexual partners, chances of having anal and oral sex with same sex, and ones of anal sex in the previous six months with the median number as 40, 16, 20 and 4 respectively. Internet group had a higher rate of bleeding (36.4%) when having sexual intercourse in the previous year and a lower proportion of 8.7% exchanged sex for money, and 14.9% and 13.3% in both bar and bath pond groups respectively. Bar group had significant lower rates of condom use with 79.6% while having sex with men and 45.3% with women, but higher rates (28.9%) ever participated in group sex in the last year and 4.2% with HIV infection. CONCLUSION: MSM had high risk behaviors related to AIDS appeared in different sites when seeking partners. Intervention strategy should be taken, according to the characteristics of different subpopulations, especially on the bath pond group.

[Behavioral characteristics of men who have sex with men with sadomasochism associated with bleeding].

OBJECTIVE: To investigate the behavioral characteristics of men who have sex with men (MSM)with sadomasochism associated bleeding and to analyze the relationship with HIV/AIDS high risk behavior. METHODS: Using modified snowball sampling methods (target sampling methods) to carry out a cross-sectional study on persons with behavior of sadomasochism that associated with bleeding in MSM, using a valid questionnaire. Another control group without the related behavior was set up. SPSS 13.0 was used. RESULTS: People practicing sadomasochism associated with bleeding had higher percentage in the following indicators: number of accumulated same gender sexual partners (median = 20), anal intercourse (median = 10), oral intercourse (median = 10), hand intercourse (median = 15) with same gender sexual partners, number of same gender sexual partners in the previous six months (median = 4), numbers of anal intercourse (median = 3), hand intercourse (median = 3), were more than in the control group. People with sadomasochism associated bleeding had higher rates in the following behaviors: condom was ever broken or slipped in the previous six months (22.6%), suffering from disease of sexual transmitted infections (28.0%), involving in group-sex intercourse (34.8%), having sex with same sex strangers at the place for MSM in the previous six months (62.2%), ever having initiative or passive behavior of oral-anal sex (64.0%), fist-sex (18.9%), finger-sex (66.7%), bleeding during sexual intercourse(58.3%), first coition object was pupil (33.8%), having strong suicide attempts (33.3%) and suicide attempt (23.6%) etc. were more than in the control group. CONCLUSION: MSM who had the behavior of sadomasochism which associated with bleeding had the higher percentage of HIV/AIDS high risk behaviors than the persons without those behaviors. The latter group called for special concern on interventions.

[Study on the high risk behaviors related to AIDS among men who having sex with men in the floating population].

OBJECTIVE: To explore the risks on sexual behaviors related to AIDS among men who having sex with men (MSM) in floating population and to develop relevant interventions. METHODS: Study objectives were recruited through target sampling and anonymous questionnaires were adopted. Male sexual behaviors were compared between floating population and permanent registered residents. RESULTS: Among those MSM, the average numbers of same-gender partners, oral sex, anal sex and sex with females during the past 6 months among floating population were 9.61, 8.61, 7.52 and 1.17 respectively. Numbers of partners on oral sex and anal sex during the past month were 2.89 and 3.69 respectively. Both figures were higher than those of the permanent registered residents (P<0.05 or P< 0.01). The rates of condom use among floating population when having anal sex with men or with non-marital female partners were 37.15% and 23.28% respectively. The figures were all higher than those of permanent registered residents' (P<0.05 or P<0.01). Among floating population, the percentages of men who had sex with male sex workers or who had sex with men acquainted through inter-net or with stable female sex partners were 17.89%, 12.56%, and 31.86% respectively. The rates of men who had group sex among gay men, who bled when having sex with men or who had sex with men from other areas during the past year were 22.13%, 31.38% and 32.36% respectively. The figures were all higher than those of permanent registered residents' (P<0.05 or P<0.01). CONCLUSION: Sex-related high risk behaviors were more ubiquitous among floating population than those of permanent registered residents because they were more likely to transmit HIV to people from/to other areas. More attention should be paid to the floating population with MSM in particular, when health interventions are carried out.

[Study on HIV/AIDS related high risk behaviors among unmarried men who have sex with women].

OBJECTIVE: To explore the risk of sexual behaviors related to AIDS among unmarried men who often have sex with women. METHODS: Study objectives were recruited through target sampling and anonymous questionnaires were adopted. Men' s sexual behaviors were compared with each other between the group of men who always had sex with women (group A) and who never had sex with women (group B) in the past 6 months. RESULTS: The average numbers of same-gender partners among group A who acted as the male role in the past 6 months and who had anal intercourse in the last month were 5.64 and 3.09 respectively, which were both higher than those of group B's (P < 0.05). The rate of condom use among men in group A when having sex with men was 81.94%. The percentages of condom use among men in group A who having had oral or anal sex with male sex buyers last time were 15.38% and 70.27% respectively. They were all higher than those of group B' s (P < 0.05 or 0.01). The rates of men in group A who were male sex workers and who having had sex with unknown men in gay places during the past 6 months were 27.59% and 61.70% respectively. Among group A, the percentages of men who had had sex with unknown men during the last time and who had had sex with nonlocal male partners during the past year were 43.06% and 40.28% respectively. They were all higher than those of group B's (P < 0.01). The percentage of condom use among men in group A when having had sex with women during the past 6 months was 68.94%, but only 25.96% of the men used condom regularly. The rate of condom use in men from group A when having sex with women during the last sexual intercourse was 65.45%. CONCLUSION: HIV high-risk sex behaviors were more ubiquitous among unmarried MSM who always had sex with women, suggesting that different interventions be developed to prevent them from transmitting HIV from MSM to women or other men.

[The impact of childhood sexual abuse on the development of AIDS related high risk behaviors and psychological appearances among men who have sex with men].

OBJECTIVE: To study the AIDS related high risk behaviors and psychological appearances among men who have sex with men (MSM) who ever experienced childhood sexual abuse (CSA). METHODS: Target sampling for a cross-sectional study was developed and valid anonymous questionnaires were adopted to compare the differences of high risk behaviors related to AIDS and psychological appearances between those with or without CSA experiences among 2147 MSM from nine cities. RESULTS: Compared to corresponding ones without CSA experience, CSA group had a significant larger numbers in the following events: total sexual partners, anal sex episodes with same sex, female sexual partners and anal sex in the previous six months, with the figures of median as 20.0, 10.0, 3.0, 3.0 respectively. In the previous year, 30.8% of them had ever participated in 'group sex', 19.2% ever exchanged money for sex, 36.7% bled while having sexual intercourse, 37.3% had sex with male partners away from his own region. All the above said figures were higher than non-CSA group, with significant differences. It also appeared that CSA experience had an impact on significant lower rate of condom use (67.3%) in the last anal sex. Those with CSA experience had more psychological problems which appeared as: 75.6% considered they would suffer from serious discrimination if their sexual orientation ever disclosed, 34.7% had a strong intention of suicide and 24.3% ever having had suicidal attempts. The differences of the two groups showed statistical significance. CONCLUSION: CSA experience not only increased the number of AIDS related high risk behaviors in adulthood, but also had negative impact on their psychological appearances. It is of urgent need to carry out psychological intervention approaches to target on MSM with CSA experiences while childhood sexual education and rights assurance towards juvenile population should also not be neglected.

[Associations between partner-seeking activities through Internet and sexual risk behaviours related to HIV/AIDS among men who have sex with men in China].

OBJECTIVE: To explore the associations between partner-seeking activities through internet and HIV/AIDS related risk behaviours among men who have sex with men (MSM). METHODS: Target sampling, anonymous questionnaires were adopted and analyzed with SPSS 11.0. RESULTS: Data from 45.6% of the 2178 valid questionnaires showed that most partner-seeking activities was through internet. 73.1% of them landed on gay website, in which 83.0% looked for sexual partners and 91.7% of them had intercourse with other men met through internet when compared with MSM who did not seek sex activities through internet. The internet group obviously had fewer numbers of partners (5.73 vs. 10.3), oral sex partners (5.13 vs. 8.71), passive anus sex partners (4.67 vs. 8.26) and active anus sex partners (3.51 vs. 6.06) in the past 6 months (P < 0.01 respectively) and obviously had fewer group sex (16.7% vs. 20.5%) activities in the past one year but had more activities on oral sex (94.7% vs. 89.6%), anus sex (95.1% vs. 86.5%), regular sexual partner (52.6% vs. 46.7%) in the past 6 months (83.4% vs. 75.5%) (P < 0.01 respectively) and more likely to have finger intercourse (52.2% vs. 38.5%), hemorrhage sexual intercourse (36.4% vs. 21.9%, OR = 2.04), non-local sexual intercourse (28.1% vs. 22.7%) (P < 0.01 respectively). CONCLUSION: Seeking sexual partners through internet had positive and double effects on MSM's risk behaviours, suggesting that it is of urgent need to take the advance of internet and gay website to disseminate HIV/AIDS prevention message.

[Study on the comparison of high risk behaviors related to AIDS among different status of income in men who have had sex with men].

OBJECTIVE: To explore the risk sexual behaviors related to AIDS among different status of income among men who have had sex with men and to provide relevant interventions for AIDS control and prevention. METHODS: Study objectives were recruited through target sampling and anonymous questionnaires were adopted. Men's sexual behaviors were reported under the categories as high, mid or low-income. RESULTS: The total number of same-gender partners with high and mid-income was 110.17 with an average of 71.97. Among high and mid-income men, the number of partners for oral sex was 62.45, with an average of 46.6 respectively. The number of partners having anal intercourse was 52.21, with an average of 32.3, obviously more than in the low-income group (P < 0.01). The rates of condom use among high-income and mid-income men were 79.03% and 77.29% respectively and were higher than that those among low-income men (P < 0.01). The percentage of high-income men who recently had had sex with male sex workers was 3.81%, higher than that of the mid-income and the low-income men (P < 0.01). The rates of high-income and mid-income men who had paid for sex from men were 24.27% and 14.7% respectively and were all higher than that of the low-income men with the highest in the high-income group (P < 0.01). The rates of high-income and mid-income men who were male sex workers were 6.72% and 11.05% respectively, which were all lower than that from the low-income group (P < 0.01). CONCLUSION: The characteristics of sexual behaviors related to AIDS were different in the three groups. In high-income group, risk sexual behaviors also existed, suggesting that different interventions for different people should be developed.

[Study on 1389 men who have sex with men regarding their HIV high-risk behaviors and associated factors in mainland China in 2004].

OBJECTIVE: To study the HIV related high-risk behaviors and associated factors on the spread of HIV among men having sex with men(MSM) who lived in mainland China and to provide evidence for developing related policies and intervention measures. METHODS: Questionnaires were distributed at gay bars and volunteer activity venues in six big cities of China. Data on 1389 valid cases was collected and urine HIV screening test was provided. Data was analyzed with SPSS 11.0. RESULTS: The respondents were 27.62 year olds on average with an average age for first intercourse at 19.18. The most commonly available way of finding a sex partner was through internet(43.07%), followed by gay bar and public bathrooms(35.29 % ). 6 months prior to the study, the average number of their male sex partners was 5.69 including 4.37 unfamiliar sex partners and the average number of anal-intercourse was 4.33 with 11.61 per cent of them had experienced group sex. 13 cases of them showed positive results for preliminary urine HIV screening test. In the prior 6 months, 32.46 per cent of those who had experienced intercourse using condom every time while 76.37 per cent of them during the last sex episode. In the previous 6 months, 47.18 per cent of those who had experienced intercourse with women never used condoms. CONCLUSION: HIV high-risk behaviors are ubiquitous among MSM and AIDS intervention measures should be significantly strengthened in reaching MSM via a wide variety of conduits, especially internet. Meanwhile, a gay-friendly environment for prevention and control of AIDS is vital.

Survey on HIV/AIDS-related high risk behaviors among male sex workers in two cities in China.

OBJECTIVE: To investigate HIV/AIDS-related high-risk behaviors and condom use among male sex workers (MSW). DESIGN AND METHODS: A cross-sectional survey in which 'snow-ball' sampling was used to recruit 85 male sex workers in Beijing and Qingdao City. Face-to-face interviews were conducted to obtain quantitative information on HIV related high-risk behaviors and condom use. RESULTS: The rate of receptive anal intercourse, insertive anal intercourse, receptive oral sex and insertive oral sex with clients was 57.6, 48.2, 65.8 and 65.8%, respectively. The rate of condom use while having above sex with clients was 53.1, 70.7, 23.2 and 19.6%, respectively. Multivariate analysis showed that consistent condom use with commercial receptive anal intercourse was associated with having regular partners, regretting their involvement in the sex trade, serving both male and female clients, and being required to use a condom by clients. Factors associated with condom use in commercial insertive sex included: age older than 20 years, knowing the protective effect of condom use, and being required to use a condom by clients. CONCLUSION: HIV-related high-risk behaviors were common among male sex workers. HIV prevention activities should be delivered through websites and in the sites where male sex workers and their clients usually meet, such as bars, bathhouses or saunas, and parks. Preventive measures targeting this population are urgently needed, given their particular vulnerability, and infections are likely to disseminate into the general population given the high proportion of bisexual activity and marriage.

[Study on the comparison of high risk behaviors related to AIDS between heterosexual and homosexual men among men who have had sex with men].

OBJECTIVE: To study the risk sexual behaviors related to AIDS between heterosexual and homosexual men who have had sex with men. METHODS: Target sampling, anonymous questionnaires were adopted to compare sexual behaviors between the two groups. RESULTS: The total amount of sex partners with same-sex was 13.8 on average among heterosexual men including 3.8 with male partners in the past 6 months. Numbers of male partners who had oral sex with was 10.5 and anal sex was 12.4 which were both less than with same sex. Among heterosexual men, the total number of female partners was 4.9 on average but number of female partners in the past 6 months was 1.7 which were both more than that among the homosexuals who were all in marriage status. The rate of condom use was 68.8% (lower than that among homosexual men), among heterosexual men when having sex with men. The rate of condom use among heterosexual men during last anal intercourse was 91.3% with male partners or 63.7% with females. Both figures were higher than that among the homosexuals. The rates of condom use among the two groups were 91.3% and 71.0% respectively during the last anal intercourse with men which were higher than the corresponding rate of condom use during the last oral sex. The rate of heterosexual men who ever had engaged in group sex was 9.9% in the previous year and the incidence of bleeding was 16.7% during sexual intercourse. 11.4% of them reported ever having had sex with partners from other areas in the last year and 4.2% had experienced same-sex harassment before 16 years of age. 4.6% had paid for male-male sex. All these figures were lower than that of the homosexuals. CONCLUSION: The characteristics of high risk sexual behaviors related to AIDS showed much difference in the two groups which called for attention among these groups of MSM.