Rong Mao

Rural-to-Urban Migrants and the HIV Epidemic in China

China is the next probable frontier for the global HIV epidemic. Central to this anticipated growth of the epidemic is the nations new and growing population of rural-to-urban migrants. Although there are an estimated 120 million migrants, little information is available about their social and cultural context of their lives in urban areas and their HIV-related perceptions and behaviors. On the basis of the in-depth individual interviews conducted among 90 rural-to-urban migrants in 2 major Chinese cities, Beijing and Nanjing, this qualitative study was designed to explore these issues with a particular focus on their relevance to sexual transmission of HIV. The findings suggest an urgent need for HIV/STI prevention programs that address the cultural, social, and economic constraints facing the migrant population in China.

HIV-Related Risk Factors Associated with Commercial Sex Among Female Migrants in China

Abstract Data from 633 sexually experienced female migrants were analyzed to examine the sociodemographic and psychosocial factors and human immunodeficiency virus (HIV)-related behaviors associated with involvement in commercial sex. Six percent (40/633) of the participants reported having had sex for money. Compared with women who had not engaged in commercial sex, women who had sold sex were younger, less educated, and more likely to be unmarried. They were more likely to have engaged in HIV-related risk behaviors, such as becoming intoxicated with alcohol and using drugs. Among women who engaged in commercial sex, only 28% of them consistently used condoms during the last three episodes of sexual intercourse. Women who had ever engaged in commercial sex demonstrated greater depressive symptoms than those without such a history (p < .01). Female migrants, especially those engaging in commercial sex, were vulnerable to HIV/sexually transmitted diseases (STDs). Sexual risk reduction and condom promotion are urgently needed among this population. Further studies are needed to examine the causal relationship between depression and HIV risk behaviors.

HIV-related risk behaviors and history of sexually transmitted diseases among male migrants who patronize commercial sex in China.

Background and Objective: Men who pay for sexual services are at increased risk for HIV/sexually transmitted disease. Data on the sociodemographic and behavioral characteristics of such men in China are limited. Study Design: Two cross-sectional surveys, using similar instruments, were completed among Chinese migrants in Beijing, Shanghai, and Nanjing in 2002. A total of 1304 rural-to-urban migrant men from community settings (“community sample”) and 465 migrant men attending sexually transmitted disease clinics (“STD clinic sample”) were included in the current study. Results: Ten percent of men in the community sample and 32.7% of men in the STD clinic sample reported having ever paid for sex. Nearly 20% of clients from the community sample and 60% of clients from the STD clinic sample reported a history of STDs. For both the community and STD clinic samples, working at industrial or construction sectors, multiple sexual partners, regular sex partner having sex with others, and a history of drug use were associated with being a male client. In addition, perceived peer sexual risk and perceived vulnerability to STD were associated with being a male client in the community sample, and a history of STD and being tested for STD/HIV were associated with being a male client in the STD sample. Conclusion: Male migrants who paid for sex in China were vulnerable to HIV/STDs. HIV prevention efforts should target young migrant men who work at factory and construction sectors. STD clinics may be important sites for outreach and intervention efforts among male clients.

Workplace and HIV-related sexual behaviours and perceptions among female migrant workers

Abstract Data from 1,543 female migrants working in eight occupational clusters in Beijing and Nanjing, China were analysed to examine the association of workplace with HIV-related behaviours and perceptions. For sexually experienced women (n = 666, 43.2%), those working in entertainment establishments or personal service (e.g., nightclubs, dancing halls, barbershops, beauty salons, massage parlours, etc.) engaged in risky sexual practices twice as frequently as those working in non-entertainment establishments (e.g. restaurants, stalls, domestic service, factories, etc.). About 10% of women in the entertainment establishments reported having sold sex, 30% having multiple sexual partners and 40% having sex with men with multiple sexual partners. The rate of consistent condom use was less than 15%. They also tended to have a higher level of perceptions of both peer risk involvement and positive expectancy of risk behaviours, and lower perceptions of severity of STDs and HIV. For women who were not sexually experienced, those working in ‘stalls’ or ‘domestic service’ tended to perceive higher peer risk involvement, less severity of HIV infection, and less effectiveness of protective behaviour. The occupational pattern of sexual risk behaviours and perceptions observed in the current study indicates employment conditions are associated with HIV risk. Intervention strategies should be tailored to address occupational-related factors.

Perceptions and Attitudes Regarding Sex and Condom Use Among Chinese College Students: A Qualitative Study

Perceptions regarding sex and condom use among Chinese college students were examined within a framework provided by protection motivation theory. Data from semistructured individual interviews indicate that Chinese students generally perceive a low level of vulnerability to HIV and sexually transmitted disease (STD) infection and a minimum exposure from family to drugs and risky sexual behaviors. While only a small proportion of students reported being sexually experienced, the majority of them expressed tolerance toward premarital sex and a high level of perceived intrinsic rewards from sexual experience. Students view condoms to be efficacious in preventing pregnancy or HIV/STD, but they also perceive a high level of response cost for use of condoms. The findings suggest that efforts to adapt HIV/STD prevention programs targeting Chinese adolescents and young adults need to consider cultural aspects of perceptions regarding sex and condoms among Chinese students and to address the conflict between traditional Chinese cultural values and modern influences.

Psychosocial correlates of cigarette smoking among college students in China

The objectives are to examine the smoking practice and intention among Chinese college students and to explore the association between cigarette smoking and individual and psychosocial factors. Cross-sectional data were collected from 1874 students from 19 college campuses in Jiangsu province, China. Both bivariate and multivariate analyses were performed to assess the associations of smoking practice and smoking intention with various individual and psychosocial factors. There was a significant gender difference in both smoking practice and smoking intention. Overall, 53% of the participants (70% male and 31% female) reported ever having smoked in their lifetime and 29% of the sample (49% male and 5% female) reported having smoked in the past 30 days. About one-fourth of the sample (44% male and 6% female) thought they were likely to smoke in the next 6 months. Male gender, low family socioeconomic status, perception of more peer smoking, more perceived benefits of smoking, higher level of pro-smoking attitude, higher level of perceived cost of non-smoking and more involvement in other health risk were positively associated with being a past or current smoker. Likewise, male gender, older age, more friends smoking, greater perceived benefits of smoking, higher pro-smoking attitudes and more health risk involvement were associated with the likelihood to smoke in the next 6 months. The data suggest a substantial smoking experimentation among college students in China, which presents both a challenge and an opportunity to prevent a large proportion of experimenters from progressing to regular smokers. The findings in the current study can be used to inform the development of effective smoking intervention prevention programs among college students in China.

Effect of social cognitive theory-based HIV education prevention program among high school students in Nanjing, China

This study was designed to evaluate potential preventive effects of a cultural adaption of the Focus on Kids (FOK) program among Chinese adolescents through a quasi-experimental intervention trial in Nanjing, China. High school students were assigned to either experimental groups (n = 140) or control groups (n = 164) by schools (with three schools in each condition). The participants completed a confidential questionnaire at baseline and 6-month post-intervention with a follow-up rate of 94.4% (287 of 304). The outcome measures included HIV knowledge, HIV-related perceptions based on the protection motivation theory, stigmatizing attitude toward people living with HIV/AIDS (PLWHA), intentions of health-related risk behaviors and sexual intercourse in the previous 6 months. Results showed a significant intervention effect at 6-month post-intervention in increasing HIV knowledge, decreasing perceptions of response cost associated with abstinence and reducing stigmatizing attitudes toward PLWHA, after controlling for key demographic characteristics and relevant baseline measures. Further mediation analysis suggested that HIV knowledge mediated the effect of intervention on stigma reduction. Findings from this study support the feasibility and initial efficacy of the cultural adaptation of FOK HIV prevention program among high school students in China.

Relation of sexual risks and prevention practices with individuals' stigmatising beliefs towards HIV infected individuals: an exploratory study

Objective: To investigate how an individual’s stigmatising beliefs towards people living with HIV are related to his or her own sexual risk and protective behaviours. Methods: A cross sectional survey was conducted to assess HIV related stigmatising beliefs, risk sexual behaviours, and preventive practices among sexually experienced rural to urban migrants aged 18–30 years in 2002 in Beijing and Nanjing, two large Chinese cities. Results: Among 2153 migrants, 7.2% reported having had more than one sexual partner in the previous month, 9.9% had commercial sex partners, and 12.5% had an episode of a sexually transmitted disease (STD). Only 18% reported frequently or always using condoms, with 20% sometimes or occasionally using them. 57% of the Chinese migrants were willing to take a voluntary HIV test, and 65% had HIV related stigmatising beliefs towards people living with HIV. Multiple logistic regression analysis depicts that individual’s stigmatising beliefs towards people with HIV were positively associated with having had an episode of an STD, having multiple sex partners, or having had commercial sex partners, and were negatively associated with condom use and the willingness to accept an HIV test. Conclusion: The finding that one’s own stigmatising belief is a potential barrier to HIV related preventive practices highlights the difficulties and challenges in implementing behavioural interventions.

Cultural Adaptation of the Focus on Kids Program for College Students in China

This pilot study was designed to evaluate the efficacy of cultural adaptation of a social cognitive theory-based HIV risk reduction program delivered among college students in China. Three hundred eighty students from four universities in Nanjing, China, were assigned by classroom to either an intervention group receiving the culturally adapted HIV risk reduction curriculum or a control group. Data were collected at baseline and 6 months postintervention. Outcome measures included HIV-related knowledge and perceptions, intention of risk behaviors, and self-reported risk behaviors. The participation in the intervention was significantly associated with increased HIV-related knowledge (including knowledge of condom use) and protective perceptions (e.g., self-efficacy), and associated with decreased intention of engaging in sexual intercourse in the next 6 months. There was no intervention effect on sexual behaviors because of the relatively low rates of sexual activities. The results suggest that a social cognitive theory based HIV risk reduction program for young adults can be effective in changing HIV-related perceptions and intentions in China.

Stigmatizing attitudes towards people living with HIV/AIDS among college students in China: Implications for HIV/AIDS education and prevention

Purpose – The purpose of this paper is to show that HIV/AIDS‐related stigma has persisted world‐wide for decades. However, studies on the linkage between stigmatizing attitudes towards people living with HIV/AIDS (PLWHA) and misconceptions about HIV transmission routes in the general population, especially among youth in China, are sparse – a gap this study is intended to fill.Design/methodology/approach – Cross‐sectional data from 1,839 students from 19 colleges were collected by trained interviewers using a structured questionnaire in Jiangsu province of China.Findings – This study reveals that there is a high proportion of college students having both stigmatizing attitudes toward PLWHA and misconceptions about HIV/AIDS transmission routes. Multilevel logistic regression analysis results show that having stigmatizing attitudes towards PLWHA is positively associated with having misconceptions about HIV transmission routes. Participants with high misconception scores were more likely to possess stigmatiz...