title: Unprotected anal intercourse behavior and intention among male sex workers in Shenzhen serving cross-boundary male clients coming from Hong Kong, China - prevalence and associated factors.
abstract: The HIV epidemic among men who have sex with men (MSM) in China is becoming very serious. Unprotected anal intercourse (UAI) among MSM during cross-boundary commercial sex spread HIV across geographic areas. This study interviewed 186 Chinese male sex workers (MSW) in Shenzhen, China, serving cross-boundary Hong Kong male clients; 49.5% had had UAI with their Hong Kong male clients (last six months) and 24.2% intended to do so (future six months). Multivariate analyses showed that perceived efficacy of condom use for HIV prevention, perceived prevalence of HIV among Hong Kong MSM (>4%), and perceived ability to convince Hong Kong male clients to use condoms during anal sex were associated with lower likelihoods of UAI with such clients (OR = 0.04-0.09); the reverse was true for those who left the decision of condom use to their Hong Kong male clients (OR = 6.44). Perceived condom efficacy, self-efficacy in protection against HIV infection, and perceived control over condom use were associated with an intention for UAI (OR = 0.06-80.44). Adjusting for background variables, the scales representing contextual (Clients Characteristics, Substance Use, or Environmental Influences) and affective factors (Fear of Diseases) were associated with UAI (adjusted OR = 0.44-32.61). Except the Fear of Diseases scale, other scales were associated with an intention for UAI (adjusted OR = 4.59-43.32). MSW are at high risk of HIV transmission. Various factors are associated with UAI with male cross-boundary clients; these factors and the context of sex work need to be considered when designing HIV prevention programs.
authors: Centre for Health Behaviors Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China. jlau@cuhk.edu.hk
authors: Joseph T F
authors: JT
authors: Lau
authors: Wende
authors: W
authors: Cai
authors: Hi Yi
authors: HY
authors: Tsui
authors: Lin
authors: L
authors: Chen
authors: Jinquan
authors: J
authors: Cheng
authors: Chunqing
authors: C
authors: Lin
authors: Jing
authors: J
authors: Gu
authors: Chun
authors: C
authors: Hao
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006723:Hong Kong / Q000208:ethnology; D006801:Humans; D033182:Intention; D008297:Male; D015995:Prevalence; D012309:Risk-Taking; D011477:Sex Work / Q000523:psychology* / Q000706:statistics & numerical data; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012725:Sexual Behavior; D047568:Unsafe Sex / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult