The dynamics of the HIV epidemic among men who have sex with men (MSM) from 2005 to 2012 in Shenzhen, China.

HIV-1 epidemics among MSM are a major public health concern in China, especially in large cities. This study sought to better understand the dynamics of HIV molecular epidemiology among MSM in Shenzhen, a rapidly developing city with over 13.8 million people. HIV-1 pol sequences were obtained from 996 (53.5%) of 1862 HIV-infected MSM and 403(9.0%) of 4498 heterosexuals and injection drug users in Shenzhen, China from 2005-2012. Eight HIV-1 subtypes and some inter-subtype recombinants were identified among sampled MSM with CRF07_BC (39.1%) and CRF01_AE (35.1%) being the most predominant. From 2006 to 2012, the prevalence of CRF07_BC and CRF55_01B rapidly increased, while the prevalence of subtypes B and CRF01_AE gradually decreased. The genetic distances within CRF07_BC and CRF55_01B groups were significantly lower than within CRF01_AE and B groups. The vast majority (90.3%) of HIV-1 infected MSM in Shenzhen were migrants who came from 31 of the 34 provinces of China, and these migrants had significantly different HIV-1 subtype distributions from the local MSM. This study highlighted the importance of CRF07_BC and migrants in the changing HIV epidemic among MSM in China, and provides a molecular epidemiology framework for understanding how HIV-1 epidemics can change in large cities with diverse risk groups.

Determinants of recent HIV testing among male sex workers and other men who have sex with men in Shenzhen, China: a cross-sectional study.

We recruited 510 male sex workers (also referred as 'money boys' (MBs) and 533 other men who have sex with men (MSM) to investigate determinants of recent (last year) HIV testing in Shenzhen, China. Overall, 43% of MBs and 48% of other MSM reported having been tested for HIV in the last year. The most important determinant of testing among MBs was having multiple anal sex partners; among other MSM, the most important determinants were having a homosexual orientation and having a history of sexually transmissible infection. For MBs, education programs are needed to increase their awareness of actual HIV risk. For other MSM, destigmatising programs are needed.

A comparison between respondent-driven sampling and time-location sampling among men who have sex with men in Shenzhen, China.

Men who have sex with men (MSM) are a key population for HIV control and prevention in China. It is difficult to acquire representative samples of this hidden population. Respondent-driven sampling (RDS), based on peer referral, and time-location sampling (TLS) based on random selection of venue-day-time periods, are among the most commonly used sampling methods. However, differences in HIV-related characteristics of MSM recruited by these two methods have not been fully evaluated. We compared sociodemographics, risk behaviors, utilization of HIV-related intervention services, and HIV/syphilis infection rates between samples of 621 RDS MSM and 533 TLS MSM in Shenzhen, China in 2010. We found that the HIV prevalence was comparable in RDS and TLS MSM. TLS recruited larger proportions of more marginalized MSM than RDS: MSM recruited by TLS were older, less educated and more likely to be migrants (without Shenzhen hukou registration), to be non-gay identified and to engage in risky sexual behaviors. On the other hand, MSM recruited by TLS were more likely to have been covered by HIV-related intervention services. To conclude, in Shenzhen, TLS is more effective to reach the marginalized population of MSM. But because TLS can only reach MSM who physically attend venues and HIV-related intervention services are already commonly available at gay venues in Shenzhen, RDS is more informative for allocating prevention efforts than TLS. Furthermore, researchers and public health authorities should take into account the different sample compositions of RDS and TLS and apply sampling methods consistently when evaluating trends over time.

HIV risk and prevention behaviors in men who have sex with men and women: a respondent-driven sampling study in Shenzhen, China.

Men who have sex with men and women (MSMW) may expand the HIV epidemic from men who have sex with men to the female population. From a respondent-driven sampling survey in Shenzhen, China, we quantified the burden of HIV/syphilis and studied patterns of risk and prevention behaviors in 107 MSMW, and compared these with those of 542 men who have sex with men only (MSM-only). HIV prevention behaviors and consistent condom use with male partners did not differ between the two groups. However, HIV risk behaviors were more common among MSMW than MSM-only. Moreover, among MSMW, the HIV prevalence was as high as 6 % and consistent condom use was extremely low with female partners in MSMW. We conclude that there is risk of HIV transmission from MSMW to the female population. Special efforts are needed to convince MSMW they should refrain from HIV risk behaviors.

HIV infection and sexual behaviors among non-commercial men who have sex with men at different venues.

The prevalence of HIV infection among men who have sex with men (MSM) has increased rapidly in China. Previous studies suggested that some venue-specific characteristics could significantly affect MSM's sexual behaviors that were related to HIV transmission. Thus, to compare the HIV infection rates and related risky sexual behaviors among MSM at different venues, we conducted a cross-sectional study with time-location sampling in Shenzhen, China. Among the 801 MSM recruited in the study, 7.0 % (n = 56) were found to be HIV positive, with 0.9 % of MSM at bars (BMSM), 3.5 % of MSM at suburban recreational centers (RMSM), 8.1 % of MSM at saunas (SMSM), 9.3 % of MSM at parks (PMSM), and 10.1 % of MSM at dorm-based venues (DMSM). HIV infection was significantly more prevalent in MSM in dorm-based venues, parks, and saunas than in other venues. Compared to MSM in other venues, BMSM were more likely to be single, drug and alcohol users, but less likely to be HIV and syphilis positive. More PMSM reported having unprotected anal intercourse with other men while more SMSM reported having multiple male sex partners and more RMSM had a low level of HIV-related knowledge. The results indicated that MSM frequenting different venues were inconsistent with regards to demographic characteristics, HIV and syphilis infection rates, and risky sexual behaviors. Greater efforts are needed to develop intervention strategies that target specific venues and risky behaviors.

Prevalence and correlates of unprotected anal intercourse among Hong Kong men who have sex with men traveling to Shenzhen, China.

In China, the HIV prevalence among men who have sex with men (MSM) has been increasing sharply. A total of 195 Hong Kong MSM having had sex with men in Shenzhen, a mainland China city separated from Hong Kong by a border, were recruited from some randomly selected gay venues in Shenzhen. Participants were face-to-face and anonymously interviewed. The results showed that in the last six months, respectively 62.1, 84.6, and 31.3 % of the participants from Hong Kong had had sex with commercial sex partners (CSP), non-regular partners (NRP) and regular partners (RP) in Shenzhen. The prevalence of unprotected anal intercourse (UAI) with these three types of sex partners was respectively 29.8, 27.9, and 78.7 %. Factors associated with UAI with any MSM in Shenzhen in the last six months included perceived chances of contracting HIV, perceived non-availability of condoms, giving money/gifts to Shenzhen MSM sex partners, and perception that MSM partners in Shenzhen would not always insist on condom use (multivariate OR = 2.9-13.90, p < 0.05), whilst factors of inverse associations included university education, having had sex with NRP but not with CSP and RP in Shenzhen and self-efficacy of insisting on condom use (multivariate OR = 0.04-0.22, p < 0.05). In sum, the prevalence of having multiple types of male sex partners and UAI was high. This was especially true when anal sex with RP was involved. Cross-border HIV prevention is greatly warranted. It should ensure condom availability and modify perceptions toward UAI.

A comparison of HIV infection and related risk factors between money boys and noncommercial men who have sex with men in Shenzhen, China.

BACKGROUND: HIV transmission among men who have sex with men (MSM) has become an increasing concern in China. Money boys (MBs) are a subgroup of MSM who sell sex to men. Direct comparison of HIV prevalence and related risk factors between MB and noncommercial MSM (ncMSM) has rarely been done. This study was conducted to make the comparison. METHODS: Eight hundred fifty MBs and 801 ncMSM were parallel recruited in Shenzhen by time-location sampling. Their behavioral and serologic data on HIV and syphilis were collected and compared. Multiple logistic regression analysis was performed to evaluate the determinants for HIV risk in MBs and ncMSM, respectively. RESULTS: The prevalence of HIV was 4.5% in MBs and 7.0% in ncMSM. Although MBs tended to have more male partners than ncMSM, they were more likely to report a consistent condom use in male anal intercourse, especially in commercial sex. Noncommercial MSM were more likely to visit parks and saunas instead of bars, massage centers, recreational centers, and home-based venues. Syphilis infection and recruitment venue were associated with HIV infection in both MBs and ncMSM. Being from a hometown with a high HIV prevalence and without a male partner from Hong Kong were found to be risk factors for HIV infection in MBs, and early sexual debut was a risk factor in ncMSM. CONCLUSION: Money boys differed from ncMSM in the rate of HIV infection and some sexual characteristics and behaviors. Formatting separate interventions specifically targeting the 2 subgroups may be necessary.

Condom use with various types of sex partners by money boys in China.

Money boys (MBs) who typically sell sex to males have not yet been extensively studied in China. In this 2009 study, 28 venue-based MBs were interviewed. We analyzed their condom use behaviors with various partners, including male and female clients, male and female casual partners, other MBs and female sex workers, and boyfriends and girlfriends. All participants were aware of the need for using condoms; however, usage with different partner types varied. The longer a relationship with a partner, the less frequent was condom use. A major reason for not using condoms was that they or their partners did not like the loss of sensation due to condom use. Other factors included sexual orientation, age, duration in commercial sex, concerns about HIV/AIDS, attractiveness of partners, and support of "mommies" (brothel supervisors). Both individual- and venue-level interventions are needed to promote condom use, and mommies need to be included in intervention strategies.

A survey of condom use behaviors and HIV/STI prevalence among venue-based money boys in Shenzhen, China.

We examined an at-risk population in China, money boys (MBs), to evaluate their potential role for transmitting HIV and sexually transmitted infections (STIs). Data were collected from 418 MBs selected by time-location cluster sampling, using a self-administered computerized questionnaire and testing a small blood sample for HIV/STIs. One-third (32.1%) of participants self-identified as homosexual, 25.4% heterosexual, 33.5% bisexual, and 9.1% uncertain. Consistent condom use by participants was 70-80% with commercial sex partners, 43.9% with girlfriends, and 60-70% with other non-commercial partners. HIV prevalence was 3.3%; syphilis, 10.5%; and HSV-2, 11.0%; overall prevalence for any was 20.3%. Factors significantly associated with HIV/STIs included being minority (OR = 4.82), having only male partners (OR = 1.92), having more male casual partners in the last 6 months (OR = 1.28), being younger at sexual debut (OR = 1.14), and being older (OR = 1.11). This study emphasizes the importance of developing targeted interventions for MBs, particularly those who are homosexual or minority.

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.

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.

A comparison of HIV infection and related risks among male sex workers in different venues in Shenzhen, China.

Different risks of HIV infection have been reported among different types of male sex workers (MSW). In order to compare the prevalence of HIV infection and related risk behaviors of MSW in different venues in Shenzhen, China, a time-location sampling survey was conducted in 2008. 5.1% of the 394 MSWs were tested positive for HIV, with 6.9% in those working in parks (PMSW), 11.3% in small family clubs (FMSW) and 1.7% in entertainment venues. PMSWs and FMSWs reported a higher proportion of self-identified homosexual/gay. Moreover, FMSWs reported a lower coverage of HIV-related education and services and were more likely to self-report coming from provinces with higher HIV prevalence. The results indicated that MSWs in small venues and parks were comparatively at higher risk of being infected and suggested that current HIV preventive intervention needs to be expanded to the small venues in Shenzhen.

HIV prevalence and related risk factors among male sex workers in Shenzhen, China: results from a time-location sampling survey.

BACKGROUND: HIV transmission among men who have sex with men has recently become a major concern in China. Little is known, however, about HIV transmission among male sex workers (MSW). This study aimed to investigate HIV infection prevalence and risk factors among MSW in Shenzhen, China. MATERIALS AND METHODS: Following formative research, a cross-sectional study was conducted using time-location sampling among MSW in Shenzhen, from April to July 2008. Behavioural and serological data on HIV and syphilis were collected. The risk factors for HIV infection were analysed using a logistic regression model. RESULTS: In total, 394 MSW were recruited for the survey. The prevalence of HIV and syphilis among these workers was 5.3% and 14.3%, respectively. Only a quarter of the MSW self-identified as homosexual. More than 70% had sex with both men and women. HIV-related knowledge levels were high regardless of HIV serostatus. Consistent condom use was low (37.1%) and varied by type of sexual partner. Factors including more non-commercial male partners, working in small home-based family clubs, being drunk before sexual intercourse, having a history of HIV tests, syphilis infection and a short period of residence in Shenzhen were associated with an increased risk of HIV infection. CONCLUSIONS: High-risk sexual practices were common among MSW regardless of their high level of HIV awareness. The working venues were associated with HIV infection and a recent test for HIV was a potential predictor of HIV infection. The time-location sampling method was found to be an appropriate way of recruiting MSW for this study, especially those without fixed working places.

Psychosocial factors in association with condom use during commercial sex among migrant male sex workers living in Shenzhen, mainland China who serve cross-border Hong Kong male clients.

Male sex workers serving Hong Kong male clients in Shenzhen were surveyed (n = 199); 98.9% had been in Shenzhen for < or =3 years; 83.4% served local male clients; 82.8% had no family members/relatives in Shenzhen; 58.3% depended exclusively on sex work; 73% were bothered by one's sex work; and 81.7% found financial support unavailable when needed. About 29.1% had had unprotected anal intercourse (UAI) with Hong Kong male clients in the last month. UAI behavior was associated with exposure to HIV prevention services (OR = 0.08) and poor social support, being bothered by the sex work, substance use, and type of sex work venue (OR = 2.92-5.96).