title: Bisexual Behaviors, HIV Knowledge, and Stigmatizing/Discriminatory Attitudes among Men Who Have Sex with Men.
abstract: OBJECTIVE
  To assess the correlates for bisexual behaviors, HIV knowledge, and HIV/AIDS-related stigmatizing/discriminatory attitudes among men who have sex with men (MSM).
  
  
  METHODS
  A cross-sectional survey among MSM was conducted in 2011 to provide demographics, sexual behaviors, HIV knowledge, HIV/AIDS-related stigmatizing/discriminatory attitudes, and services in Jinan, Qingdao, and Yantai of Shandong Province of China.
  
  
  RESULTS
  Of 1230 participants, 82.8% were single, 85.7% aged <35 years, and 47.2% received college or higher education. There were 28.6% MSM who reported to be married or cohabitating or ever had sex with woman in the past 6 months (P6M). 74.5% had ≥6 HIV-related knowledge score. The average total score of stigmatizing/discriminatory attitude was 37.4±4.4(standard deviation). Bisexual behavior was independently associated with higher levels of HIV/AIDS-related stigma/discrimination(AOR = 1.1, 95% CI:1.0-1.1), older age(AOR = 1.2, 95%CI:1.1-1.2), and lower HIV-related knowledge score(AOR = 1.6, 95%CI:1.2-2.2). HIV knowledge score ≥6 was independently associated with lower levels of HIV/AIDS-related stigma/discrimination(AOR = 1.3, 95%CI:1.2-1.3), less bisexual behaviors(AOR = 0.6, 95%CI:0.5-0.9), ever received a test for HIV in the past 12 months (P12M)(AOR = 3.2, 95%CI:2.3-4.5), college or higher level education(AOR = 1.9, 95%CI:1.4-2.6), consistent condom use with men in P6M(AOR=6.9, 95%CI:4.6-10.6), recruited from internet or HIV testing sites(AOR = 11.2, 95%CI:8.0-16.1) and bars, night clubs, or tea houses(AOR = 2.5, 95%CI:1.7-4.8). Expressing higher levels of HIV/AIDS-related stigmatizing/discriminatory attitudes was independently associated with bisexual behaviors(Aβ = 0.9, 95%CI:0.4-1.4), lower HIV-related knowledge score(Aβ = 3.6, 95%CI:3.0-4.1), the number of male sex partners in the past week ≥2(Aβ = 1.4, 95%CI:1.0-1.9), unprotected male anal sex in P6M(Aβ = 1.0, 95%CI:0.5-1.6), and inversely associated with ever received HIV test(Aβ = 1.4, 95%CI:0.8-2.0) and peer education in P12M(Aβ = 1.4, 95%CI:0.9-1.9).
  
  
  CONCLUSIONS
  HIV/AIDS-related stigmatizing/discriminatory attitudes were associated with bisexual behaviors, low HIV testing rate, lower HIV-related knowledge and risk behaviors. This study called for innovative programs that would reduce HIV/AIDS-related stigmatizing/discriminatory attitudes and bisexual behaviors and improve the uptake of prevention service among MSM.
authors.affiliation: Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China.
authors.forename: Meizhen
authors.initials: M
authors.lastname: Liao
authors.affiliation: Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China.
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.affiliation: Jinan Central Hospital Affiliated Shandong University, Jinan, Shandong Province 250014, P. R. China.
authors.forename: Xingjie
authors.initials: X
authors.lastname: Shen
authors.affiliation: Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China.
authors.forename: Pengxiang
authors.initials: P
authors.lastname: Huang
authors.affiliation: Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China.
authors.forename: Xingguang
authors.initials: X
authors.lastname: Yang
authors.affiliation: Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China.
authors.forename: Lianzheng
authors.initials: L
authors.lastname: Hao
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD 20742, United States of America.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cox
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, TN 37232, United States of America.
authors.forename: Pingsheng
authors.initials: P
authors.lastname: Wu
authors.affiliation: Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China.
authors.forename: Xiaorun
authors.initials: X
authors.lastname: Tao
authors.affiliation: Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China.
authors.forename: Dianmin
authors.initials: D
authors.lastname: Kang
authors.affiliation: Department of Health Policy, Vanderbilt University, Nashville, TN 37232, United States of America.
authors.forename: Yujiang
authors.initials: Y
authors.lastname: Jia
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D003710:Demography; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D013240:Stereotyping; D019966:Substance-Related Disorders / Q000453:epidemiology; D013587:Syphilis / Q000453:epidemiology