Cognitive, affective, and contextual factors in association with unprotected anal intercourse among Chinese male sex workers

Published: July 22, 2010

Cognitive, affective, and contextual factors in association with unprotected anal intercourse among Chinese male sex workers

J.T.F. Lau1, W. Cai2, H.Y. Tsui1, L. Chen2, J.Q. Cheng2, J. Gu3

1The Chinese University of Hong Kong, Hong Kong, China, 2Center for Disease Control and Prevention, Shenzhen, China, 3Sun Yat-sen University, Guangzhou, China

Background: Worldwide, the prevalence of HIV has been increasing among men who have sex with men (MSM). Male sex workers (Money Boys or MBs) serving men are at particularly high risk for HIV infection. However, relatively few studies have been conducted among this vulnerable group.
Methods: A cross-sectional anonymous survey was conducted. In total, 186 MBs in Shenzhen, China serving cross-border Hong Kong male clients were interviewed by peer workers.
Results: Of all respondents, 49.5% had engaged in unprotected anal intercourse (UAI) with Hong Kong male clients in the last 6 months and 24.2% anticipated they would do so in the next 6 months. Stepwise logistic regression analyses found that perceived efficacy of condom use for HIV prevention, perceived ability to convince Hong Kong male clients to use condoms during anal sex, and perceived prevalence of HIV among Hong Kong MSM were associated with lower likelihoods of UAI with Hong Kong male clients (OR=0.02 to 0.09); the reverse was found for those who always left decisions of condom use to Hong Kong male clients (OR=6.44). Perceived condom efficacy, self-efficacy in protecting oneself from contracting HIV and perceived control over condom use were associated with intention for UAI (OR=0.06 to 80.44). Adjusted for background variables, the four scales assessing impact of contextual factors onto decisions on UAI with male clients (Clients Characteristics, Fear of Diseases, Substance Use or Environmental Influences) were significantly associated with UAI (adjusted OR=0.44 to 32.61). All but one (Fear of Diseases) scales were associated with intention of UAI (adjusted OR=4.59 to 43.32).
Conclusion: MBs are at high risk of HIV acquisition and transmission. A wide range of cognitive, affective, and contextual factors are associated with UAI with clients and need to be taken into account for HIV prevention.
 

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