Participation of HIV prevention programs among men who have sex with men in two cities of China—a mixed method study

BMC Public Health

Yan Xiao⁶  Yuhua Ruan⁶  Yiming Shao⁶  Yujiang Jia⁴  Jiangping Sun⁶  Xuefeng Li⁶  Song Fan⁶  Liangui Feng³  Xiong He²  Jing Xu³  Dongyan Xia²  Xiaoyan Ma²  Rongrong Lu³  Xianbin Ding³  Hongyan Lu²  Willi McFarland¹  Erin C Wilson¹  H Fisher Raymond¹  Wei Ma⁵ 

[1] San Francisco Department of Public Health, San Francisco, CA, USA;Beijing Municipal Centre for Disease Control and Prevention, Beijing, China;Chongqing Municipal Centre for Disease Control and Prevention, Chongqing, China;Institute for Global Health and Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA;Shandong University School of Public Health, Jinan, China;State Key Laboratory for Infectious Disease Prevention and Control, and National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China

关键词: China;    Participation;    Utilization;    HIV prevention programs;    MSM;   

Others  :  1163016
DOI  :  10.1186/1471-2458-12-847

 received in 2012-05-23, accepted in 2012-10-04,  发布年份 2012

【 摘 要 】

Background

Although various HIV prevention programs targeting men who have sex with men (MSM) are operating in China, whether and how these programs are being utilized is unclear. This study explores participation of HIV prevention programs and influencing factors among MSM in two cities in China.

Methods

This is a mixed-method study conducted in Beijing and Chongqing. A qualitative study consisting of in-depth interviews with 54 MSM, 11 key informants, and 8 focus group discussions, a cross-sectional survey using respondent-driven sampling among 998 MSM were conducted in 2009 and 2010 respectively to elicit information on MSM’s perception and utilization of HIV prevention programs. Qualitative findings were integrated with quantitative multivariate factors to explain the quantitative findings.

Results

Fifty-six percent of MSM in Chongqing and 75.1% in Beijing ever participated in at least one type of HIV prevention program (P=0.001). Factors related to participation in HIV prevention programs included age, ethnicity, income, HIV risk perception, living with boyfriend, living in urban area, size of MSM social network, having talked about HIV status with partners, and knowing someone who is HIV positive. Reasons why MSM did not participate in HIV prevention programs included logistical concerns like limited time for participation and distance to services; program content and delivery issues such as perceived low quality services and distrust of providers; and, cultural issues like HIV-related stigma and low risk perception.

Conclusions

The study shows that there is much room for improvement in reaching MSM in China. HIV prevention programs targeting MSM in China may need to be more comprehensive and incorporate the cultural, logistic and HIV-related needs of the population in order to effectively reach and affect this population’s risk for HIV.

【 授权许可】

   
2012 Ma et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Van Griensven F, van Wijngaarden JW DL, Baral S, Grulich A: The global epidemic of HIV infection among men who have sex with men. Curr Opin HIV AIDS 2009, 4(4):300-307.
• [2]Grulich AE, Kaldor JM: Trends in HIV incidence in homosexual men in developed countries. Sex Health 2008, 5:113-118.
• [3]van Wijngaarden JW DL, Brown T, Girault P, Sarkar S, van Griensven F: The epidemiology of human immunodeficiency virus infection, sexually transmitted infections, and associated risk behaviours among men who have sex with men in the Mekong Subregion and China: implications for policy and programming. Sex Transm Dis 2009, 36(5):319-324.
• [4]Beyrer C: Hidden yet happening: the epidemics of sexually transmitted infections and HIV among men who have sex with men in developing countries. Sex Transm Infect 2008, 84(6):410-412.
• [5]State Council AIDS Working Committee Office, UN Theme Group on AIDS in China: A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007). Beijing; 2007.
• [6]The 22th World AIDS Day, 2009. Accessed December 2010, at: http://www.phic.org.cn/hangyexinxi/quanguoweisheng/200912/t20091214_32639.htm webcite
• [7]Ma X, Zhang Q, He X, Sun W, Yue H, Chen S, Raymond HF, Li Y, Xu M, Du H, McFarland W: Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behaviour among men who have sex with men. results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006. J Acquir Immune Defic Syndr 2007, 45(5):581-587.
• [8]Ruan Y, Luo F, Jia Y, Li X, Li Q, Liang H, Zhang X, Li D, Shi W, Freeman JM, Vermund SH, Shao Y: Risk factors for syphilis and prevalence of HIV, hepatitis B and C among men who have sex with men in Beijing, China: implications for HIV prevention. AIDS Behav 2009, 13(4):663-670.
• [9]Xiao Y, Ding X, Li C, Liu J, Sun J, Jia Y: Prevalence and correlates of HIV and syphilis infections among men who have sex with men in Chongqing Municipality, China. Sex Transm Dis 2009, 36(10):647-656.
• [10]Wu ZY: China’s assessment and responses to HIV epidemic in MSM. Geneva: WHO meeting on MSM; 2009.
• [11]Feng L, Ding X, Lu R, Liu J, Sy A, Ouyang L, Pan C, Yi H, Liu H, Xu J, Zhao J: High HIV prevalence detected in 2006 and 2007 among men who have sex with men in China’s largest municipality: an alarming epidemic in Chongqing, China. J Acquir Immune Defic Syndr 2009, 52(1):79-85.
• [12]Chinese State Council: Chinese national medium- and long-term strategic plan for HIV/AIDS prevention and control (1998–2010). Beijing; 1998.
• [13]China Ministry of Health, Joint United Nations Programme on HIV/AIDS, World Health Organization: 2005 Update on the HIV/AIDS Epidemic and Response in China. Beijing; 2006.
• [14]State Council AIDS Working Committee Office, U.N. Theme Group on HIV/AIDS in China: A Joint Assessment of HIV/AIDS Prevention Treatment and Care in China. Beijing; 2004.
• [15]Wong FY, Huang ZJ, Wang W, He N, Marzzurco J, Frangos S, Buchholz ME, Young D, Smith BD: STIs and HIV among men having sex with men in China: a ticking time bomb? AIDS Educ Prev 2009, 21(5):430-446.
• [16]Herbst JH, Sherba RT, Crepaz N, Deluca JB, Zohrabyan L, Stall RD, Lyles CM: A meta-analytic review of HIV behavioural interventions for reducing sexual risk behaviour of men who have sex with men. J Acquir Immune Defic Syndr 2005, 39(2):228-241.
• [17]Johnson WD, Hedges LV, Ramirez G, Semaan S, Norman LR, Sogolow E, Sweat MD, Diaz RM: HIV prevention research for men who have sex with men: a systematic review and meta-analysis. J Acquir Immune Defic Syndr 2002, 30(Suppl 1):S118-S129.
• [18]Hong Y, Li X: HIV/AIDS behavioural interventions in China: a literature review and recommendation for future research. AIDS Behav 2009, 13(3):603-613.
• [19]Beyrer C: Global prevention of HIV infection for neglected populations: men who have sex with men. Clin Infect Dis 2010, 50(Suppl 3):S108-S113.
• [20]Van Griensven F, van Wijngaarden JW DL: A review of the epidemiology of HIV infection and prevention responses among MSM in Asia. AIDS 2010, 24(Suppl 3):S30-S40.
• [21]Zhang H, Wu Z, Xu J, Zhu J, Zheng Y, Wang J, Xu J: Models of interventions for HIV/AIDS among MSM in China. Chin J AIDS STD 2009, 15(1):29-32.
• [22]Steward WT, Charlebois ED, Johnson MO, Remien RH, Goldstein RB, Wong FL, Morin SF: Receipt of prevention services among HIV-infected men who have sex with men. Am J Public Health 2008, 98(6):1011-1014.
• [23]Thomas B, Mimiaga MJ, Mayer KH, Johnson CV, Menon S, Chandrasekaran V, Murugesan P, Swaminathan S, Safren SA: HIV prevention interventions in Chennai, India: are men who have sex with men being reached? AIDS Patient Care STDS 2009, 23(11):981-986.
• [24]Greene JC, Caracelli VJ, Graham WD: Toward a conceptual framework for mixed-method evaluation designs. Educ Eval Policy Ana 1989, 11(3):255-274.
• [25]National Cancer Institute: Theory at a Glance-A Guide For Health Promotion Practice. Bethesda; 2005.
• [26]Choi KH, Lui H, Guo Y, Han L, Mandel JS: Lack of HIV testing and awareness of HIV infection among men who have sex with men, Beijing, China. AIDS Educ Prev 2006, 18(1):33-43.
• [27]China Global Fund AIDS Program Round 5: China Global Fund AIDS Program Round 5 Progress Report(July 2006 - June 2007). Beijing; 2007.
• [28]Introduction of China Global Fund AIDS Program Round 5http://www.chinaaids.cn/n16/n1238/n1579/260902.html webcite. Accessed in July, 2011
• [29]Li G, Zhang W, Shi W, Li S, Yang T, Xu Y, Qiu H, Wang L: Current situation analysis on the utilization and demand of VCT service among MSM group. Modern Preventive Medicine 2009, 36(18):3555-3556,3559.
• [30]Behel SK, MacKellar DA, Valleroy LA, Secura GM, Bingham T, Celentano DD, Koblin BA, Lalota M, Shehan D, Torian LV: HIV prevention services received at health care and HIV test providers by young men who have sex with men: an examination of racial disparities. J Urban Health 2008, 85(5):727-743.
• [31]Miller RL: Adapting an evidence-based intervention: tales of the Hustler Project. AIDS Educ Prev 2003, 15(1 Suppl A):127-138.
• [32]Seal DW, Kelly JA, Bloom FR, Stevenson LY, Coley BI, Broyles LA: HIV prevention with young men who have sex with men: what young men themselves say is needed. Medical College of Wisconsin CITY Project Research Team. AIDS Care 2000, 12(1):5-26.
• [33]Courtenay-Quirk C, Wolitski RJ, Hoff C, Parsons JT: Interests in HIV prevention topics of HIV-seropositive men who have sex with men. AIDS Educ Prev 2003, 15(5):401-412.
• [34]Bowen AM, Williams ML, Daniel CM, Clayton S: Internet based HIV prevention research targeting rural MSM: feasibility, acceptability, and preliminary efficacy. J Behav Med 2008, 31(6):463-477.
• [35]Kegeles SM, Hays RB, Pollack LM, Coates TJ: Mobilizing young gay and bisexual men for HIV prevention: a two-community study. AIDS 1999, 13(13):1753-1762.
• [36]Sumartojo E, Doll L, Holtgrave D, Gayle H, Merson M: Enriching the mix: incorporating structural factors into HIV prevention. AIDS 2000, 14(Suppl 1):S1-S2.
• [37]Peterson JL, Jones KT: HIV prevention for black men who have sex with men in the United States. Am J Public Health 2009, 99(6):976-980.