title: Exploring Unprotected Anal Intercourse among Newly Diagnosed HIV Positive Men Who Have Sex with Men in China: An Ethnographic Study.
abstract: BACKGROUND
  Unprotected anal intercourse (UAI) is a major pathway towards secondary HIV transmission among men who have sex with men (MSM). We explored the socio-cultural environment and individual beliefs and experiences conducive to UAI in the context of Southern China.
  
  
  METHODS
  We employed an ethnographic approach utilizing a socio-ecological framework to conduct repeated in-depth interviews with thirty one newly diagnosed HIV positive MSM as well as participant observations in Shenzhen based healthcare settings, MSM venues and NGO offices.
  
  
  RESULTS
  Some men (6/31) reported continuing to practice UAI after an initial diagnosis of being HIV positive. For MSM who had existing lovers or stable partners, the fear of losing partners in a context of non-serostatus disclosure was testified to be a major concern. MSM with casual partners reported that anonymous sexual encounters and moral judgments played a significant role in their sexual risk behaviors. Simultaneously, self-reported negative emotional and psychological status, perception and idiosyncratic risk interpretation, as well as substance abuse informed the intrapersonal context for UAI.
  
  
  CONCLUSIONS
  UAI among these HIV positive MSM was embedded in an intrapersonal context, related to partner type, shaped by anonymous sexual encounters, psychological status, and moral judgments. It is important that prevention and intervention for secondary HIV transmission among newly diagnosed HIV positive MSM in China take into account these contextual factors.
authors.affiliation: School of Public Health, Shandong University, Jinan, China; UNC Project-China, Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Haochu
authors.initials: H
authors.lastname: Li
authors.affiliation: School of Health Sciences, RMIT University, Melbourne, Australia; Centre for Women's Health, Gender & Society, The University of Melbourne, Melbourne, Australia.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Holroyd
authors.affiliation: Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lau
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology*; D000884:Anthropology, Cultural; D002681:China / Q000453:epidemiology; D003075:Coitus / Q000502:physiology*; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D047568:Unsafe Sex / Q000502:physiology*; D055815:Young Adult