Violence from sexual partners as a driver of HIV risk among money boys and other MSM in Shanghai, China
K. Dunkle1, N. He2, E.J. Nehl1, F.Y. Wong1,3, Z.J. Huang4, J. Ramirez-Valles5, T. Zheng4
1Emory University/Rollins School of Public Health, Department of Behavioral Sciences and Health Education and Center for AIDS Research, Atlanta, United States, 2Fudan University School of Public Health, Department of Epidemiology, Shanghai, China, 3Emory University/Rollins School of Public Health, Hubert Department of Global Health, Atlanta, United States, 4Georgetown University, Department of International Health, Washington, United States, 5University of Illinois at Chicago School of Public Health, Department of Community Health, Chicago, United States
Background: China is experiencing increasing rates of HIV infection, with MSM particularly at risk. Violence from sexual partners has been conclusively linked to HIV among women in a range of settings, but the prevalence of violence and its role in HIV risk among MSM internationally, while likely important, is underexplored.
Method: We used respondent driven sampling techniques to recruit 404 MSM from Shanghai, including 204 money boys (sex workers) and 200 general MSM. Respondents completed pencil-and-paper surveys including questions on sexual behavior and experience of abuse from male sexual partners.
Results: 57.4% of money boys versus 44.8% of other MSM (p=.01) reported at least one type of abuse from a male sexual partner, with money boys more like to report financial abuse (14.1% vs 7.8%, p=.04), destruction of property (17.7% vs 9.8%, p=.02), and threats to others (29.3% vs 20.7%, p=.05). There was no difference between money boys and other in threats of harm (25.7%), threats of being outed (9.0%), being hit (14.7%), or being forced into unwanted sex (5.7%). After adjusting for being a money boy, education, income, marriage to a woman, and out vs closeted, men who had experienced more than one type of abuse scored a mean 1.36 points higher on 16 point scale of sexual risk, and were more likely to report any unprotected sex with a man [OR=2.76 (1.26, 6.07)], unprotected anal sex [OR=1.85 (1.03, 3.32)], sex while drunk or high [OR=1.81 (1.10, 2.98)], or sex with a prostitute [OR=1.97 (1.13, 3.46)].
Conclusion: Chinese MSM experience high levels of violence from male partners, with money boys more vulnerable to threats and financial abuse than other MSM. This experience of violence is linked to increased HIV risk behavior. HIV prevention efforts in China should include a focus on preventing violence against MSM and within MSM relationships.