Xiuyun Lin

HIV-testing behavior among young migrant men who have sex with men (MSM) in Beijing, China

Abstract Previous studies suggested a rapid increase of HIV prevalence among men who have sex with men (MSM) in China in recent years, from 0.4% in 2004 to 5.8% in 2006. However, some MSM had never been tested for HIV. In order to expand the accessibility to HIV testing, understanding HIV-testing behavior and barriers among MSM is important. Using data collected from 307 young migrant MSM (aged 18–29 years) in 2009 in Beijing, we aimed to identify psychological and structural barriers to HIV testing. MSM were recruited through peer outreach, informal social networks, Internet outreach, and venue-based outreach. Participants completed a confidential self-administered questionnaire. Results show that about 72% of MSM ever had an HIV test. Logistic regression analysis indicated that the HIV-testing behavior was associated with sexual risk behaviors (e.g., multiple sexual partners and inconsistent condom use for anal sex) and history of sexually transmitted diseases. Eighty four MSM (28%) who never had an HIV test reported that the psychological barriers mainly were perceived low risk of HIV infection and fears of being stigmatized. The structural barriers reported inconvenience of doing test and lack of confidentiality. Future HIV prevention programs should be strengthened among MSM to increase their awareness of HIV risk. Efforts are needed to increase access to quality and confidential HIV testing among MSM and reduce stigma against MSM.

Parental HIV/AIDS and Psychosocial Adjustment among Rural Chinese Children

OBJECTIVE To assess the relationship between parental HIV/AIDS and psychosocial adjustment of children in rural central China. METHODS Participants included 296 double AIDS orphans (children who had lost both their parents to AIDS), 459 single orphans (children who had lost one parent to AIDS), 466 vulnerable children who lived with HIV-infected parents, and 404 comparison children who did not experience HIV/AIDS-related illness and death in their families. The measures included depressive symptoms, loneliness, self-esteem, future expectations, hopefulness about the future, and perceived control over the future. RESULTS AIDS orphans and vulnerable children consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. The level of psychosocial adjustment was similar between single orphans and double orphans, but differed by care arrangement among double orphans. CONCLUSION The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the psychosocial wellbeing of these children.

HIV Testing Behaviors Among Female Sex Workers in Southwest China

Despite the recognized importance of HIV testing in prevention, care and treatment, HIV testing remains low in China. Millions of female sex workers (FSW) play a critical role in China’s escalating HIV epidemic. Limited data are available regarding HIV testing behavior among this at-risk population. This study, based on a cross-sectional survey of 1,022 FSW recruited from communities in Southwest China, attempted to address the literature gap. Our data revealed that 48% of FSW ever took HIV testing; older age, less education, working in higher-income commercial sex venues and better HIV knowledge were associated with HIV testing. Those who never took HIV testing were more likely to engage in high-risk behaviors including inconsistent condom use with clients and stable partners. A number of psychological and structural barriers to testing were also reported. We call for culturally appropriate interventions to reduce HIV risks and promote HIV testing for vulnerable FSW in China.

Psychometric evaluation of the Trauma Symptoms Checklist for Children (TSCC) among children affected by HIV/AIDS in China

Abstract The current study, utilizing the baseline data from a longitudinal assessment of psychosocial needs of children orphaned by HIV/AIDS or living with HIV-infected parents in China, was designed to assess the psychometric properties of the Trauma Symptoms Checklist for Children (TSCC) among children affected by HIV/AIDS in China. The psychometric properties assessed in this study include internal consistency, convergent and discriminant validity, and construct validity. The sample in the current study include 296 double orphans, 459 single orphans, and 466 children living with HIV-infected parents in central China where many residents had been infected with HIV through unhygienic blood collection. The results demonstrate adequate reliability and validity of the TSCC among study population. Children who experienced more traumatic events scored significantly higher on all TSCC clinical scales and subscales than those children who experienced less such events. The Chinese version of the TSCC should provide mental health researchers and practitioners with a reliable and valid assessment instrument in studying posttraumatic distress and related psychological symptomology among children affected by HIV/AIDS in China.

Lifetime Incidences of Traumatic Events and Mental Health Among Children Affected by HIV/AIDS in Rural China

Cross-sectional data were gathered from 1,625 children (M age = 12.85, SD = 2.21) which included 755 AIDS orphans, 466 vulnerable children, and 404 comparison children. Participants completed self-report measures of exposure to traumatic events, and psychosocial adjustment including behavior problems, depression, self-esteem, and future orientation. AIDS orphans and vulnerable children reported experiencing a higher total occurrence, density, duration, initial impact and lasting impact of traumatic events compared to comparison children. Scores reflecting adjustment were lower among orphans and vulnerable children than among comparison children. Both orphan status and traumatic events contributed unique variance in the expected direction to the prediction of psychosocial adjustment. The data in the current study suggested that children affected by HIV/AIDS in China are exposed to more trauma and suffer more adjustment problems than children who do not experience HIV/AIDS in their families.

Functions and sources of perceived social support among children affected by HIV/AIDS in China.

Abstract While the relationship between perceived social support (PSS) and psychosocial well-being has been well documented in the global literature, existing studies also suggest the existence of multiple domains in definition and measurement of PSS. The current study, utilizing data from 1299 rural children affected by HIV/AIDS in central China, examines the relative importance of PSS functional measures (informational/emotional, material/tangible, affectionate, and social interaction) and PSS structural measures (family/relatives, teachers, friends, and significant others) in predicting psychosocial outcomes including internalizing problems, externalizing problems, and educational resilience. Both functional and structural measures of PSS provided reliable measures of related but unique aspects of PSS. The findings of the current study confirmed the previous results that PSS is highly correlated with childrens psychosocial well-being and such correlations vary by functions and sources of the PSS as well as different psychosocial outcomes. The findings in the current study suggested the roles of specific social support functions or resources may need to be assessed in relation to specific psychosocial outcome and the context of childrens lives. The strong association between PSS and psychosocial outcomes underscores the importance of adequate social support to alleviate stressful life events and improve psychosocial well-being of children affected by HIV/AIDS. Meanwhile, the study findings call for gender and developmentally appropriate and situation-specific social support for children and families affected by HIV/AIDS.

A comparison of four sampling methods among men having sex with men in China: implications for HIV/STD surveillance and prevention

Abstract Sample representativeness remains one of the challenges in effective HIV/STD surveillance and prevention targeting men who have sex with men (MSM) worldwide. Although convenience samples are widely used in studies of MSM, previous studies suggested that these samples might not be representative of the broader MSM population. This issue becomes even more critical in many developing countries where needed resources for conducting probability sampling are limited. We examined variations in HIV and Syphilis infections and sociodemographic and behavioral factors among 307 young migrant MSM recruited using four different convenience sampling methods (peer outreach, informal social network, Internet, and venue-based) in Beijing, China in 2009. The participants completed a self-administered survey and provided blood specimens for HIV/STD testing. Among the four MSM samples using different recruitment methods, rates of HIV infections were 5.1%, 5.8%, 7.8%, and 3.4%; rates of Syphilis infection were 21.8%, 36.2%, 11.8%, and 13.8%; and rates of inconsistent condom use were 57%, 52%, 58%, and 38%. Significant differences were found in various sociodemographic characteristics (e.g., age, migration history, education, income, and places of employment) and risk behaviors (e.g., age at first sex, number of sex partners, involvement in commercial sex, and substance use) among samples recruited by different sampling methods. The results confirmed the challenges of obtaining representative MSM samples and underscored the importance of using multiple sampling methods to reach MSM from diverse backgrounds and in different social segments and to improve the representativeness of the MSM samples when the use of probability sampling approach is not feasible.

Perceived HIV stigma among children in a high HIV-prevalence area in central China: beyond the parental HIV-related illness and death

Abstract Objectives. (1) Examine the psychometric properties of two parallel measures of HIV-related stigma (i.e., perceived public stigma and childrens personal stigma against people living with HIV/AIDS [PLWHA]) among children affected by HIV/AIDS. (2) Examine whether expressions of stigma measures differ by childs sex, developmental stage, family socioeconomic status (SES), or orphanhood status (i.e., AIDS orphans, vulnerable children, and comparison children). (3) Examine the association between HIV-related stigma and childrens psychosocial adjustments among these children. Methods. Cross-sectional data were collected from 755 AIDS orphans (children who had lost one or both their parents to AIDS), 466 vulnerable children who lived with HIV-infected parents, and 404 comparison children who did not experience HIV-related illness and death in their families. The measures included perceived public stigma, personal stigma, depressive symptoms, loneliness, self-esteem, future expectations, hopefulness about the future, and perceived control over the future. Results. Both stigma scales were positively associated with psychopathological symptoms (e.g., depression, loneliness) and negatively associated with psychosocial well-being (e.g., self-esteem, positive future expectation, hopefulness about future, and perceived control over the future). Both stigma measures contribute to childrens psychosocial problems independent of their orphanhood status and other key demographic factors. Conclusion. Community-wide stigma reduction and psychological support should be part of the care efforts for children affected by AIDS. Stigma reduction efforts should not only target the stigma against PLWHA but also possible stigma against the entire community (e.g., villages) with a high prevalence of HIV/AIDS. The stigma reduction efforts also needs to be appropriate for childrens age, gender, family SES, and AIDS experience in the family. Future research should explore individual and contextual factors such as social support, coping, and attachment in mitigating the negative effect of stigma among these children.

Psychosocial consequences for children experiencing parental loss due to HIV/AIDS in central China.

Abstract Individual in-depth interviews were conducted with 47 children (ages 8–17 years) experiencing the loss of one or both parents due to HIV/AIDS in two rural counties of central China. Findings in this study reveal that the families of the children orphaned by AIDS had experienced financial burdens because of treatment costs for sick parents and loss of labor in the household. The majority of the participants reported some level of stigmatization because of their parents’ HIV status. The participants described feelings of sadness, fear, anxiety, anger, loneliness, low self-esteem, social withdrawal, and sleep problems. Implications for intervention programs include the need for psychological support and special counseling services, more public education with accurate knowledge about HIV/AIDS to decrease stigma and discrimination, and financial programs to decrease economic and caregiving burdens for these children.

Internet Use Among Female Sex Workers in China: Implications for HIV/STI Prevention

Based on a cross-sectional survey with 1,022 female sex workers (FSWs) recruited from different types of commercial sex venues in Southwest China, we examined their Internet-using behaviors and explored the feasibility of Internet-based HIV/STI intervention in this population. About 75% of FSWs were Internet users; among them 57% were frequent users, and 40% had searched HIV/STI information online. Internet use was significantly associated with younger age, more schooling, higher income, and engagement in a social network of Internet users. Frequent use of the Internet was associated only with factors of the social environment, such as peers’ Internet use. Two thirds of Internet-using FSWs were willing to participate in an online HIV/STI prevention program. Multivariate analyses showed that willingness to participate in an online HIV/STI prevention intervention was significantly associated with higher Internet use and younger age. Our data suggest that Internet may offer a promising strategy to deliver low-cost HIV/STI prevention programs for FSWs in China.