Skip to main content
SpringerLink
Log in

Social Network and Other Correlates of HIV Testing: Findings from Male Sex Workers and Other MSM in Shanghai, China

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Although the Chinese government provides free-of-charge voluntary HIV counseling and testing, HIV testing rates among men who have sex with men (MSM) are reported to be extremely low. This study examines the association of structural and psychosocial factors and social network characteristics with HIV testing behaviors among “money boys” and general MSM in Shanghai. Overall, 28.5% of “money boys” and 50.5% of general MSM had never tested for HIV despite high rates of reported HIV risk behaviors. Factors associated with not testing for HIV included: not knowing of a testing site, limited HIV knowledge, low perceived HIV risk, concern about HIV testing confidentiality, being a closeted gay, not using the Internet, and having a small social network or network with few members who had tested for HIV. Future efforts to promote HIV testing should focus on outreach to general MSM, confidentiality protection, decreasing the stigma of homosexuality, and encouraging peer education and support through the Internet and social networks.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wu Z, Wang Y. Introduction: China meets new AIDS challenges. J Acquir Immune Defic Syndr. 2010;53(Suppl 1):S1–3.

    PubMed  Google Scholar 

  2. He Q, Wang Y, Lin P, Raymond HF, Li Y, Yang F, et al. High prevalence of risk behaviour concurrent with links to other high-risk populations: a potentially explosive HIV epidemic among men who have sex with men in Guangzhou, China. Sex Transm Infect. 2009;85(5):383–90.

    Article  PubMed  CAS  Google Scholar 

  3. Juan S. China to have 1.2 million HIV-positive people by 2015 [Internet]. China Daily. 2010. http://www.chinadaily.com.cn/china/2010-12/04/content_11652055.htm.

  4. Guo Y, Li X, Stanton B. HIV-related behavioral studies of men who have sex with men in China: a systematic review and recommendations for future research. AIDS Behav. 2011;15(3):521–34.

    Article  PubMed  Google Scholar 

  5. Wang L. HIV prevalence among populations at risk, using sentinel surveillance data from 1995 to 2009 in China. Chung-Hua Liu Hsing Ping Hsueh Tsa Chih. 2011;32(1):20.

    PubMed  Google Scholar 

  6. USAID. Health policy initiative. The value of investing in MSM programs in the Asia-Pacific region [Internet]. 2007. http://www.msmasia.org/The_Value_of_Investing_in_MSM_Programs_in_the_Asia-Pacific_Region.pdf.

  7. USAID. The value of investing in MSM programs in the Asia-Pacific region [Internet]. 2006. http://www.msmasia.org/The_Value_of_Investing_in_MSM_Programs_in_the_Asia-Pacific_Region.pdf.

  8. State Council AIDS Working Committee Office and UN Theme Group on HIV/AIDS in China. A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China [Internet]. 2004. www.chinaaids.cn/worknet/download/2004/report2004en.pdf. Accessed 30 Dec 2011.

  9. China Ministry of Health. China estimation report-en.pdf [Internet]. 2011. http://www.unaids.org.cn/download/2009%20China%20Estimation%20Report-En.pdf. Accessed 3 Aug 2011.

  10. Lau JT, Lin C, Hao C, Wu X, Gu J. Public health challenges of the emerging HIV epidemic among men who have sex with men in China. Public Health. 2011;125(5):260–5.

    Article  PubMed  CAS  Google Scholar 

  11. Ma X, Zhang Q, He X, Sun W, Yue H, Chen S, et al. Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006. J Acquir Immune Defic Syndr. 2007;45(5):581–7.

    Article  PubMed  Google Scholar 

  12. Han M, Feng LG, Jiang Y, Shen S, Ling H, Ding XB, et al. Surveillance on HIV-1 incidence among men who have sex with men in Chongqing, China, 2006–2008. Zhonghua Liu Xing Bing Xue Za Zhi. 2009;30(9):878–81.

    PubMed  Google Scholar 

  13. Ouyang L, Feng LG, Ding XB, Zhao JK, Xu J, Han M, et al. A respondent-driven sampling survey on HIV and risk factors among men who have sex with men in Chongqing. Zhonghua Liu Xing Bing Xue Za Zhi. 2009;30(10):1001–4.

    PubMed  Google Scholar 

  14. Feng Y, Wu Z, Detels R, Qin G, Liu L, Wang X, et al. HIV/STD prevalence among men who have sex with men in Chengdu, China and associated risk factors for HIV infection. J Acquir Immune Defic Syndr. 2010;53(Suppl 1):S74–80.

    PubMed  Google Scholar 

  15. Yang H, Hao C, Huan X, Yan H, Guan W, Xu X, et al. HIV incidence and associated factors in a cohort of men who have sex with men in Nanjing, China. Sex Transm Dis. 2010;37(4):208–13.

    Google Scholar 

  16. Xu JJ, Zhang M, Brown K, Reilly K, Wang H, Hu Q, et al. Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang, China. Sex Transm Dis. 2010;37(7):432–9.

    PubMed  Google Scholar 

  17. Hong FC, Zhou H, Cai YM, Pan P, Feng TJ, Liu XL, et al. Prevalence of syphilis and HIV infections among men who have sex with men from different settings in Shenzhen, China: implications for HIV/STD surveillance. Sex Transm Infect. 2009;85(1):42–4.

    Article  PubMed  Google Scholar 

  18. Liu H, Liu H, Cai Y, Rhodes AG, Hong F. Money boys, HIV risks, and the associations between norms and safer sex: a respondent-driven sampling study in Shenzhen, China. AIDS Behav. 2009;13(4):652–62.

    Article  PubMed  Google Scholar 

  19. Ruan S, Yang H, Zhu Y, Wang M, Ma Y, Zhao J, et al. Rising HIV prevalence among married and unmarried among men who have sex with men: Jinan, China. AIDS Behav. 2009;13(4):671–6.

    Article  PubMed  Google Scholar 

  20. Guo H, Wei J-F, Yang H, Huan X, Tsui SK-W, Zhang C. Rapidly increasing prevalence of HIV and syphilis and HIV-1 subtype characterization among men who have sex with men in Jiangsu, China. Am Sex Transm Dis Assoc. 2009;36(2):120–5.

    Article  Google Scholar 

  21. Choi KH, Ning Z, Gregorich SE, Pan QC. The influence of social and sexual networks in the spread of HIV and syphilis among men who have sex with men in Shanghai, China. J Acquir Immune Defic Syndr. 2007;45(1):77–84.

    Article  PubMed  Google Scholar 

  22. Choi KH, Diehl E, Guo Y, Qu S, Mandel J. High HIV risk but inadequate prevention services for men in China who have sex with men: an ethnographic study. AIDS Behav. 2002;6(3):255–66.

    Article  Google Scholar 

  23. Choi KH, Gibson DR, Han L, Guo Y. High levels of unprotected sex with men and women among men who have sex with men: a potential bridge of HIV transmission in Beijing, China. AIDS Educ Prev. 2004;16(1):19–30.

    Article  PubMed  Google Scholar 

  24. Choi KH, Liu H, Guo Y, Han L, Mandel JS, Rutherford GW. Emerging HIV-1 epidemic in China in men who have sex with men. Lancet. 2003;361(9375):2125–6.

    Article  PubMed  Google Scholar 

  25. He N, Wong FY, Huang ZJ, Thompson EE, Fu C. Substance use and HIV risks among male heterosexual and “money boy” migrants in Shanghai, China. AIDS Care. 2007;19(1):109–15.

    Article  PubMed  CAS  Google Scholar 

  26. Liu S, Wang K, Yao S, Guo X, Liu Y, Wang B. Knowledge and risk behaviors related to HIV/AIDS, and their association with information resource among men who have sex with men in Heilongjiang province, China. BMC Public Health. 2010;10:250.

    Article  PubMed  Google Scholar 

  27. Cai WD, Zhao J, Zhao JK, Raymond HF, Feng YJ, Liu J, et al. HIV prevalence and related risk factors among male sex workers in Shenzhen, China: results from a time-location sampling survey. Sex Transm Infect. 2010;86(1):15–20.

    Article  PubMed  Google Scholar 

  28. Wong FY, Huang ZJ, Wang W, He N, Marzzurco J, Frangos S, et al. STIs and HIV among men having sex with men in China: a ticking time bomb? AIDS Educ Prev. 2009;21(5):430–46.

    Article  PubMed  Google Scholar 

  29. Wei C, Ruan S, Zhao J, Yang H, Zhu Y, Raymond HF. Which Chinese men who have sex with men miss out on HIV testing? Sex Transm Infect. 2011;87(3):225–8.

    Article  PubMed  Google Scholar 

  30. Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.

    Article  PubMed  Google Scholar 

  31. Marseille E, Hofmann PB, Kahn JG. HIV prevention before HAART in sub-Saharan Africa. Lancet. 2002;359(9320):1851–6.

    Article  PubMed  Google Scholar 

  32. Shen J, Yu DB. Governmental policies on HIV infection in China. Cell Res. 2005;15(11–12):903–7.

    Article  PubMed  Google Scholar 

  33. Choi KH, Lui H, Guo Y, Han L, Mandel JS. Lack of HIV testing and awareness of HIV infection among men who have sex with men, Beijing, China. AIDS Educ Prev. 2006;18(1):33–43.

    Article  PubMed  Google Scholar 

  34. Wong FY, Huang ZJ, He N, Smith BD, Ding Y, Fu C, et al. HIV risks among gay- and non-gay-identified migrant money boys in Shanghai, China. AIDS Care. 2008;20(2):170–80.

    Article  PubMed  CAS  Google Scholar 

  35. Wong FY, Huang ZJ, He N, Young D, O’Conor CA, Ding Y, et al. Migration and illicit drug use among two types of male migrants in Shanghai, China. J Psychoactive Drugs. 2010;42(1):1–9.

    Article  PubMed  Google Scholar 

  36. RDS Inc. RDS analysis tool, V.5.6, user manual. Ithaca: RDS Inc.; 2006.

    Google Scholar 

  37. Ramirez-Valles J, Heckathorn DD, Vazquez R, Diaz RM, Campbell RT. From networks to populations: the development and application of respondent-driven sampling among IDUs and Latino gay men. AIDS Behav. 2005;9(4):387–402.

    Article  PubMed  Google Scholar 

  38. Malekinejad M, Johnston LG, Kendall C, Kerr LR, Rifkin MR, Rutherford GW. Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS Behav. 2008;12(4 Suppl):S105–30.

    Article  PubMed  Google Scholar 

  39. He N, Wong FY, Huang ZJ, Ding Y, Fu C, Smith BD, et al. HIV risks among two types of male migrants in Shanghai, China: money boys vs. general male migrants. AIDS. 2007;21(Suppl 8):S73–9.

    Article  PubMed  Google Scholar 

  40. Huang ZJ, Wong FY, De Leon JM, Park RJ. Self-reported HIV testing behaviors among a sample of southeast Asians in an urban setting in the United States. AIDS Educ Prev. 2008;20(1):65–77.

    Article  PubMed  Google Scholar 

  41. Do TD, Hudes ES, Proctor K, Han CS, Choi KH. HIV testing trends and correlates among young Asian and Pacific Islander men who have sex with men in two U.S. cities. AIDS Educ Prev. 2006;18(1):44–55.

    Article  PubMed  Google Scholar 

  42. Radloff LS. The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  43. Hendrick S, Hendrick C. Multidimensionality of sexual attitudes. J Sex Res. 1987;23:502–26.

    Article  Google Scholar 

  44. Zane N, Yeh M. The use of culturally-based variables in assessment: studies on loss of face. In: Asian American mental health: assessment theories and methods. New York, NY: Kluwer Academic/Plenum Publishers; 2002. p. 123–38.

  45. Mohr J, Fassinger R. Measuring dimensions of lesbian and gay male experience. Meas Eval Couns Dev. 2000;33:66–90.

    Google Scholar 

  46. Russell D, Cutrona CE, Rose J, Yurko K. Social and emotional loneliness: an examination of Weiss’s typology of loneliness. J Pers Soc Psychol. 1984;46(6):1313–21.

    Article  PubMed  CAS  Google Scholar 

  47. Iguchi MY, Ober AJ, Berry SH, Fain T, Heckathorn DD, Gorbach PM, et al. Simultaneous recruitment of drug users and men who have sex with men in the United States and Russia using respondent-driven sampling: sampling methods and implications. J Urban Health. 2009;86(Suppl 1):5–31.

    Article  PubMed  Google Scholar 

  48. Heckathorn D. Deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002;49:11–34.

    Article  Google Scholar 

  49. SAS Institute Inc. SAS/STAT 9.2 user’s guide. Cary: SAS Institute Inc.; 2010.

    Google Scholar 

  50. Borgatti S. A brief guide to using NETDRAW [Internet]. 2009. http://www.analytictech.com/Netdraw/netdraw.htm.

  51. Heckathorn D. Respondent driven sampling [Internet]. 2011. http://www.respondentdrivensampling.org/. Accessed 14 Dec 2011.

  52. Liu H, Liu H, Cai Y, Rhodes AG, Hong F. Money boys, HIV risks, and the associations between norms and safer sex: a respondent-driven sampling study in Shenzhen, China. AIDS Behav. 2009;13:652–62.

    Article  PubMed  Google Scholar 

  53. Sheridan S, Phimphachanh C, Chanlivong N, et al. HIV prevalence and risk behaviour among men who have sex with men in Vientane Capital, Lao People’s Democratic Republic. AIDS. 2009;23(3):409–14.

    Article  PubMed  Google Scholar 

  54. 呂麗萍反同志 央視批「要反省」 | 港陸傳真 | 娛樂追星 | 聯合新聞網 [Internet]. World News. 2011. http://udn.com/NEWS/ENTERTAINMENT/ENT8/6444368.shtml. Accessed 3 Aug 2011.

  55. Zou H, Wu Z, Yu J, Li M, Ablimit M, Li F, et al. Sexual risk behaviors and HIV infection among men who have sex with men who use the internet in Beijing and Urumqi, China. J Acquir Immune Defic Syndr. 2010;53(Suppl 1):S81–7.

    PubMed  Google Scholar 

  56. Rosser BR, Oakes JM, Konstan J, Hooper S, Horvath KJ, Danilenko GP, et al. Reducing HIV risk behavior of men who have sex with men through persuasive computing: results of the Men’s INTernet Study-II. AIDS. 2010;24(13):2099–107.

    Article  PubMed  Google Scholar 

  57. Coleman E, Horvath KJ, Miner M, Ross MW, Oakes M, Rosser BR. Compulsive sexual behavior and risk for unsafe sex among internet using men who have sex with men. Arch Sex Behav. 2010;39(5):1045–53.

    Article  PubMed  Google Scholar 

  58. Mansergh G, Koblin BA, McKirnan DJ, Hudson SM, Flores SA, Wiegand RE, et al. An intervention to reduce HIV risk behavior of substance-using men who have sex with men: a two-group randomized trial with a nonrandomized third group. PLoS Med. 2010;7(8):e1000329.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Preparation of this article was supported in part by grants from the National Institutes of Health (R01HD046354; PI: Wong) and the Emory Center for AIDS Research (P30 AI050409; Nehl and Wong).

Author information

Authors and Affiliations

  1. Department of International Health, Georgetown University School of Nursing and Health Studies, 3700 Reservoir Road NW, St. Mary’s Hall 224, Box 571107, Washington DC, WA, 20057, USA

    Z. Jennifer Huang, Brian D. Smith, Jin Zhang & Sarah McNabb

  2. Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China

    Na He

  3. Emory University’s Rollins School of Public Health, Atlanta, GA, USA

    Na He, Eric J. Nehl & Frank Y. Wong

  4. Shanghai Piaoxue, Shanghai, China

    Tony Zheng

Authors
  1. Z. Jennifer Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Na He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric J. Nehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tony Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brian D. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sarah McNabb
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Frank Y. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Z. Jennifer Huang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huang, Z.J., He, N., Nehl, E.J. et al. Social Network and Other Correlates of HIV Testing: Findings from Male Sex Workers and Other MSM in Shanghai, China. AIDS Behav 16, 858–871 (2012). https://doi.org/10.1007/s10461-011-0119-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-011-0119-4

Keywords

Search

Navigation