Correlates of HIV risk behaviors among MSM in China: the association of alcohol with sexual risks
E.J. Nehl1, F.Y. Wong1, N. He2, Z.J. Huang3, J. Ramirez-Valles4, T. Zheng5
1Emory University, Rollins School of Public Health, Decatur, United States, 2Fudan University, School of Public Health, Shanghai, China, 3Georgetown University, Department of International Health, Washington DC, United States, 4University of Illinois at Chicago, School of Public Health, Chicago, United States, 5Shanghai Leyi, Shanghai, China
Background: The international literature concerning HIV risk behaviors indicates that men who have sex with men (MSM) engage in riskier sex practices than the general population. Studies also show a strong link between increased alcohol consumption and risky sex. However, little research has been conducted exploring these issues in China, where MSM account for over 11% of HIV/AIDS cases. Thus, the aim of this study was to explore alcohol and other potential correlates of risky sexual behaviors among Chinese MSM.
Methods: MSM participants (n = 404) were recruited through respondent-driven sampling in Shanghai and completed self-administered questionnaires. The current analyses examined demographics, alcohol use and dependence, psychosocial scales, and HIV sexual risk behaviors. A sexual risk index was created from sixteen behaviors found in the literature as being markers for increased HIV risk. Examples of these items include protected and unprotected anal sex, oral sex, and casual sex partners. Additionally, sex with male/female prostitutes was specifically explored.
Results: Over 50% of participants reported a score of 8 or more unsafe behaviors. Higher risk scores were associated with greater amounts of drinking (β =.65, p < .01), increased income (β = .64, p < .001), lower identification with being gay (β = -.81, p < .001), and greater attitudes of sexual permissiveness (β = -.02, p < .01). Sex with prostitutes was associated with higher drinking (OR = 1.78; 95% CI 1.12-2.81), lower education (OR = 0.57; 95% CI 0.40-0.80), and higher income (OR = 1.56; 95% CI 1.12-2.17).
Conclusions: The high rate of risky sexual behaviors and its association with alcohol use among MSM in China is cause for alarm. Future research and prevention efforts should focus on this relationship and consider specific aspects of gay identification and sexual attitudes that may influence HIV risk among MSM in China.