Z. Jennifer Huang

Social Network and Other Correlates of HIV Testing: Findings from Male Sex Workers and Other MSM in Shanghai, China

Although the Chinese government provides free-of-charge voluntary HIV counseling and testing, HIV testing rates among men who have sex with men (MSM) are reported to be extremely low. This study examines the association of structural and psychosocial factors and social network characteristics with HIV testing behaviors among “money boys” and general MSM in Shanghai. Overall, 28.5% of “money boys” and 50.5% of general MSM had never tested for HIV despite high rates of reported HIV risk behaviors. Factors associated with not testing for HIV included: not knowing of a testing site, limited HIV knowledge, low perceived HIV risk, concern about HIV testing confidentiality, being a closeted gay, not using the Internet, and having a small social network or network with few members who had tested for HIV. Future efforts to promote HIV testing should focus on outreach to general MSM, confidentiality protection, decreasing the stigma of homosexuality, and encouraging peer education and support through the Internet and social networks.

Gender Differences in Intimate Partner Violence on Substance Abuse, Sexual Risks, and Depression among a Sample of South Africans in Cape Town, South Africa

Because men account for nearly half of the HIV cases in South Africa, it is critical to understand the contexts in which they live and the behaviors in which they engage. The purpose of this study was to describe and examine gender differences in intimate partner violence on substance abuse, sexual risks, and depression among a sample of South Africans in Cape Town. We found that recent exposure to intimate partner violence among men was associated with all forms of drug use, whereas women who were recently abused were more likely to suffer from depression and problem drinking. We also found high levels of problem drinking among both men (58%) and women (42%). Men were more likely to use drugs. Exposure to community violence increased sexual risk behaviors among men. Overall, these gender differences have important implications for alcohol and drug prevention strategies as they relate to HIV transmission risk.

Prevalence and Correlates of Tobacco Use Among a Sample of MSM in Shanghai, China

INTRODUCTION Men who have sex with men (MSM) have higher smoking rates than the general population in the United States, but less is known about smoking among MSM in developing countries. Thus, we examined the prevalence and correlates of smoking among MSM in China. METHODS We conducted a cross-sectional study of 404 MSM in Shanghai, China (half of whom were male sex workers), recruited through respondent-driven sampling. Assessments included sociodemographics; tobacco, alcohol, and drug use; the Center for Epidemiological Studies Depression Scale (CES-D); the Social Provisions Scale (SPS); and the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). RESULTS Smoking prevalence was 65.9% in this sample. Recent smoking (i.e., in the past 3 months) was significantly associated with lower education, greater alcohol use, and higher LGBIS scores, after controlling for important sociodemographics. Among smokers, smoking ≥10 cigarettes per day (CPD), in comparison with <10 CPD, was related to older age and lower LGBIS scores and marginally related to heavy alcohol use. Although bivariate analyses indicated a relationship of CES-D and SPS scores to recent smoking, these factors did not contribute to the regression models. CONCLUSIONS Smoking rates among MSM in China are higher than MSM in the United States and men in China. Less comfort with ones sexual orientation was related to smoking, particularly light smoking. Heavier alcohol consumption, lower education, and older age were also associated with smoking. Future research should confirm these findings and examine mediators and moderators of these relationships in order to inform cessation interventions and tobacco control policy.

HIV Infection, Sexual Behaviors, Sexual Networks, and Drug Use Among Rural Residents in Yunnan Province, China

This cross-sectional study examined HIV prevalence, sexual behaviors, sexual networks, and drug use among 591 participants from a rural community in Yunnan Province, China. Face-to-face interviews were conducted to collect information about sexual behavior, drug use, and sexual networks. Blood samples were collected and tested for HIV. Of the participants, 52.6% were male and 62.6% were Jingpo minority. The HIV prevalence was 5.5% overall and highest among the Jingpo minority (7.7%). Most participants were sexually experienced and 32.5% had had multiple sex partners. About 18.8% had used drugs, with the highest proportion among the Jingpo minority. HIV infection was independently correlated with drug use among males and with multiple sexual partnerships among females. A total of 336 independent sexual network components (mostly small, linear, and acyclic) were constructed. Eighty-percent were dyads involving two members and 20% involved three to 71 members. Coupled with the promotion of condom use, gender- and network-specific efforts are needed for HIV prevention targeting ethnic minorities in Yunnan.

Intimate Partner Violence, Depression, and Alcohol Use Among a Sample of Foreign-Born Southeast Asian Women in an Urban Setting in the United States

Intimate partner violence (IPV) is a serious global public health issue. At least one in three women worldwide has been beaten, coerced into sex, or otherwise abused during her lifetime. According to the Bureau of Justice Statistics, more than three women in the United States die every day from physical abuse suffered at the hands of an intimate partner. IPV is defined as violence that occurs within the private sphere, generally between individuals who are related through intimacy, blood, or law. When perpetrated against women, IPV is generally understood to include physical, sexual, and psychological abuse by intimate male partners.

HIV testing and management: findings from a national sample of Asian/Pacific islander men who have sex with men.

Objectives. We examined reasons for and barriers to participating in HIV voluntary counseling and testing for Asian/Pacific Islander (A/PI) men who have sex with men (MSM) in the U.S. Methods. We collected data between June 2007 and September 2009 in a study known as Men of Asia Testing for HIV, using a cross-sectional community-based participatory design. This national study was conducted in seven U.S. metropolitan cities through a coalition of seven community-based organizations. Results. Participants included 445 self-identified A/PI MSM aged ≥18 years. Perception of being at risk was the number one reason for testing behaviors. For first-time testers, structural barriers (e.g., language barriers with health professionals) and fear of disclosure (e.g., sexual orientation not known to parents) were deterrents for nontesting in the past. Among previously known HIV-positive men, 22% were not seeing a doctor and 19% were not taking any HIV medications. Conclusions. HIV testing, care, and treatment policies would be less than optimal without addressing barriers to testing, including stigma related to sexual orientation, among A/PI MSM.

Beyond Medical Insurance: Delayed or Forgone Care among Children in Chinese Immigrant Families

While Asian Americans are less likely than most Americans to use health services, little is known about their barriers to pediatric care. This study seeks to describe the prevalence of delayed/forgone pediatric care and its association with parental acculturation status in recent-immigrant Chinese families. Survey data were obtained from 76 families across two community services sites. Half of the surveyed families reported delayed/forgone pediatric care in the previous 12 months. Low-income families in suburban areas reported greater financial burdens, linguistic barriers, and a higher prevalence of delayed/forgone care than low-income families living in downtown area. Middle class immigrant families reported cultural barriers as a reason for delayed/forgone care. Traditional beliefs and not medical insurance were significant predictors of delayed/forgone care. Culturally and linguistically appropriate studies on risk reduction interventions will be needed to address the linguistic and cultural barriers to health care access.

The Impact of Social Factors on Human Immunodeficiency Virus and Hepatitis C Virus Co-Infection in a Minority Region of Si-Chuan, the People's Republic of China: A Population-Based Survey and Testing Study

Background While many human immunodeficiency virus (HIV) studies have been performed in Liangshan, most were focused only on HIV infection and based on a sampling survey. In order to fully understand HIV and hepatitis C virus (HCV) prevalence and related risk factors in this region, this study implemented in 2009, included a survey, physical examination, HIV and HCV test in two towns. Methods All residents in two towns of the Butuo county were provided a physical examination and blood tests for HIV and HCV, and then followed by an interview for questionnaire. Results In total, 10,104 residents (92.4%) were enrolled and 9,179 blood samples were collected for HIV and HCV testing, 6,072 were from individuals >14 years old. The rates of HIV, HCV, and HIV/HCV co-infection were 11.4%, 14.0%, and 7.7%, respectively for >14-year-old residents. The 25–34 yr age group had the highest prevalence of HIV, HCV, and HIV/HCV co-infections, reaching 24.4%, 26.2% and 16.0%, respectively. Overall, males had a much higher prevalence of all infections than females (HIV: 16.3% vs. 6.8%, HCV: 24.6% vs. 3.9%, HIV/HCV co-infected: 14.7% vs. 1.1%, respectively; P = 0.000). Approximately half of intravenous drug users tested positive for HIV (48.7%) and 68.4% tested positive for HCV. Logistic regression analysis showed that five factors were significantly associated with HIV and HCV infection: gender (odds ratio [OR]  = 5.8), education (OR = 2.29); occupation (student as reference; farmer: OR = 5.02, migrant worker: OR = 6.12); drug abuse (OR = 18.0); and multiple sexual partners (OR = 2.92). Knowledge of HIV was not associated with infection. Conclusion HIV and HCV prevalence in the Liangshan region is very serious and drug use, multiple sexual partners, and low education levels were the three main risk factors. The government should focus on improving education and personal health awareness while enhancing drug control programs.

Development and Implementation of a Collaborative, Multistakeholder Research and Practice Model on HIV Prevention Targeting Asian/Pacific Islander Men in the United States Who Have Sex With Men

We describe lessons learned from a national HIV prevention research program grounded in community-based participatory research, the Men of Asia Testing for HIV (MATH) Study, which targeted self-identified Asian/Pacific Islander men in the United States who have sex with men. We discuss the genesis of and impetus for the study and then describe its various facets, including accomplishments, challenges, and unanticipated consequences. We conclude with a discussion about the real-world practice of community-based participatory research with respect to the MATH Study in particular and similar research in general.

Substance Use and Sexual Risks Among General MSM and Money Boys in Shanghai, China

In China, men who have sex with men (MSM) are at high risk for substance use, HIV, and other sexually transmitted infections (STIs). However, there has been little research into their drug use and the sexual behaviors they engage in after drug and alcohol use. Using respondent-driven sampling methodology, this cross-sectional study of 404 MSM described drug use and examined sexual behaviors after drug and alcohol use among general MSM and money boys (those who engage in same-sex commercial sex) in Shanghai, China. Money boys reported using more drugs in the last week, 3 months and ever, and having sex after drinking and sex after using drugs more frequently than general MSM. It is vital to continue research and begin science-based interventions in these high-risk and underserved populations.