title: Male Clients of Male Sex Workers in China: An Ignored High-Risk Population.
abstract: BACKGROUND
  There is a high prevalence of HIV/syphilis among male sex workers, but no formal study has ever been conducted focusing on male clients of male sex workers (MCM). A detailed investigation was thus called for, to determine the burden and sociobehavioral determinants of HIV and syphilis among these MCM in China.
  
  
  METHODS
  As part of a multicenter cross-sectional study, using respondent-driven and snowball sampling, 2958 consenting adult men who have sex with men (MSM) were recruited, interviewed, and tested for HIV and syphilis between 2008 and 2009. The distributions of sociodemographic characteristics, risk behaviors, and HIV/syphilis prevalence were determined and compared between MCM and other MSM.
  
  
  RESULTS
  Among recruited MSM, 5.0% (n = 148) were MCM. HIV prevalences for MCM and other MSM were 7.4% and 7.7%, whereas 18.9% and 14.0% were positive for syphilis, respectively. Condomless anal intercourse (CAI) was reported by 59.5% of MCM and 48.2% of MSM. Multiple logistic regression revealed that compared with other MSM, MCM were more likely to have less education [for ≤ elementary level, adjusted odds ratio (aOR) = 3.13, 95% confidence interval (95% CI): 1.42 to 6.90], higher income (for >500 US Dollars per month, aOR = 2.97, 95% CI: 1.53 to 5.77), more often found partners at parks/restrooms (aOR = 4.01, 95% CI: 2.34 to 6.85), reported CAI (aOR = 1.49, 95% CI: 1.05 to 2.10), reported a larger sexual network (for ≥ 10, aOR = 2.70, 95% CI: 1.44 to 5.07), and higher odds of syphilis (aOR = 1.54, 95% CI: 1.00 to 2.38).
  
  
  CONCLUSIONS
  The greater frequency of risk behaviors and high prevalence of HIV and syphilis indicated that HIV/syphilis prevention programs in China need to pay special attention to MCM as a distinct subgroup, which was completely ignored until date.
authors.affiliation: *Department of STI control, Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, China;†Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA;‡Department of HIV and STI Prevention and Control, Jiangsu Provincial Central for Disease Prevention and Control, Nanjing, China;§University of North Carolina, Project-China, Guangzhou, China; and‖Monitoring and Evaluation Unit, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Tanmay
authors.initials: T
authors.lastname: Mahapatra
authors.forename: Gengfeng
authors.initials: G
authors.lastname: Fu
authors.forename: Shujie
authors.initials: S
authors.lastname: Huang
authors.forename: Heping
authors.initials: H
authors.lastname: Zheng
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.forename: Jinkou
authors.initials: J
authors.lastname: Zhao
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.forename: Weiming
authors.initials: W
authors.lastname: Tang
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008310:Malocclusion; D021841:Safe Sex; D060386:Sex Workers; D013587:Syphilis / Q000150:complications / Q000453:epidemiology; D055815:Young Adult