Behavioural surveillance of sexually-related risk behaviours for the cross-border traveller population in Hong Kong: the evaluation of the overall effectiveness of relevant prevention programmes by comparing the results of two surveillance surveys

The present study reports the results of 2 surveys of the first behavioural surveillance system (BSS) set up to monitor sexually-related risk behaviours practised by Hong Kong-China cross-border travellers. The 2 studies interviewed 1263 and 1448 male adult Hong Kong residents in 1997 and 1998 respectively. About one-third of the respondents had had sexual intercourse with a commercial sex worker (CSW) in the past 6 months; about 20% had had sexual intercourse with a CSW or a non-regular sex partner in a single trip; about 35-40% of the CSW clients had not used a condom during the intercourse and about 20% of the respondents reported that they had contracted STD. When the results of the 2 surveys were compared, no significant changes in the outcomes of the surveillance indicators were detected; instead, some unfavourable changes in terms of condom use were observed. The effectiveness of the relevant prevention programmes in Hong Kong is not evident.     

Behavioural surveillance of sexually-related risk behaviours of the Chinese male general population in Hong Kong: a benchmark study

The objective of the study was to establish a behavioural surveillance system (BSS) for sexually-related risk behaviours of the Hong Kong adult male general population. Benchmark data were obtained by interviewing 1,020 male respondents, age 18 to 60. The results showed that: (1) 14% of the respondents had engaged in commercial sex in the past six months, (2) 27% of the male commercial sex clients did not always use condoms when having sexual intercourse with commercial sex workers (CSWs), (3) 1.5% of the respondents had contracted sexually transmitted diseases (STDs) in the past six months, (4) 6.1% of respondents had only ever had sex with a man, (5) 0.8% of the respondents had practised unprotected anal intercourse with a man in a six-month period, (6) 4.4% of respondents practised sexually-related high risk behaviours, defined as unprotected sex with a CSW or unprotected anal intercourse with a man, and (7) 36.4% of those who engaged in commercial sex had not used condoms with their regular sex partners. Commercial sex was often practised outside Hong Kong, very commonly in Mainland China or Macau, and was often practised at multiple locations by the same client. Effective programmes have to be able to reduce the size of the at-risk population. This study together with future ones, will form the first BSS in Hong Kong for the general male population and will provide a relevant yardstick for programme evaluation.     

HIV infection dynamics in rural Andhra Pradesh south India: a sexual-network analysis exploratory study

The southern state of Andhra Pradesh (AP) has one of the highest rates of HIV-1 infection in India. Estimates of HIV infection in rural areas have begun to approximate the urban. Methods of HIV transmission in rural India are poorly understood. We examined risk factors for HIV transmission in a group of rural villages in AP through the use of a sexual-network analysis survey - the Indian Health and Family Life Survey (IHFLS). The study sample included 20 HIV-positive and 40 HIV-negative matched controls randomly selected from a population-based, voluntary counselling and testing program in rural AP. HIV-1 status was confirmed by Western Blot. The 405-item IHFLS is based upon the National Health and Life Survey which has been validated in the US and China. The sample mean age was 37 years and 22% were of a tribal caste. Among female respondents, none were commercial sex workers (CSWs) and there were no significant social or behavioral associations with HIV infection. Among male respondents, ever having bought sex and having more than one lifetime partner were found to be significantly associated with HIV infection (p=0.002 and p=0.017). Amongst sub-populations, all men who had sex with men (MSM) were married. Tribals were more likely to report a concurrent sexual relationship (p=0.04). All high-risk men, including MSM, men who buy sex and men with multiple lifetime female partners did not use condoms. Public health interventions aimed at reducing HIV transmission in rural AP should consider targeting sub-populations of men who engage in covert MSM or CSW, high-risk tribal caste members and at-risk wives.     

Narrowing sexual behavioural differences between Chinese and non-Chinese populations in Hong Kong: implications for sexually transmitted infection (STI) transmission

Information on sexual networking between different ethnic groups, in particular between Chinese and non-Chinese, is scarce. This study compared patterns of sexual behaviour and determinants of unsafe sexual behaviours amongst the Chinese and non-Chinese residents of Hong Kong. Of the 2,060 respondents (2060/4157; 50% response rate), 73% identified themselves as being ethnic Chinese. Overall, having a non-regular partner was more common amongst the non-Chinese (36%) than the Chinese (17%) respondents. Chinese people who were at increased risk of having had sex with a non-regular partner included social hygiene clinic attendees and airport travellers, males and ever smokers. For non-Chinese this was inconsistent condom use and being aged 18-45. Predictors of inconsistent condom use for Chinese included being aged 18-45, never having been married, and having had sex with non-regular partners; for non-Chinese the predictors were being aged 18-45, having had sex with non-regular partners and being unafraid of AIDS. We conclude that there are similarities and differences in sexual risk-taking behaviours between Chinese and non-Chinese residents in Hong Kong. To maximize potential public health benefits, behavioural interventions should be designed to address the different risk profiles of Chinese and non-Chinese populations separately.     

The intent and practice of condom use among HIV-positive men who have sex with men in Japan

To evaluate the intent and practice of condom use among Japanese HIV-positive men who have sex with men (MSM), a survey using anonymous questionnaires was carried out and 117 respondents were investigated. For anal sex and oral sex, respectively, 58.1% and 15.2% intended to use condoms and 47.2% and 12.4% used condoms all of the time. The intent of condom use decisively affected the practice of condom use and was closely related to the perceived risk level of HIV/sexually transmitted (STI) transmission. In anal sex, willingness to protect sexual partners from HIV infection was strongly related not only to the intent but also to the practice. Enhancement of willingness to protect oneself from STI was suggested to enhance willingness to protect his/her sexual partners from HIV infection with secondary enhancement of the intent or the practice of condom use. Specific support of MSM with HIV for improving the intent and practice of condom use is urgently needed.     

Evidence of changes in sexual behaviours among male factory workers in Ethiopia

OBJECTIVE: To assess changes in sexual behaviours among male factory workers in Ethiopia. DESIGN: Open cohort studies in two factories near Addis Ababa. DATA AND METHODS: At intake and biannual follow-up visits, data were collected on sexual behaviours including casual sex, sex with commercial sex workers (CSW), condom use, and history of sexually transmitted diseases (STDs) as indicated by genital discharge and genital ulcer. Health education, HIV testing, and counselling were offered to all participants. RESULTS: Between February 1997 and December 1999, 1124 males were enrolled in the two cohort studies. At intake, the prevalence of casual sex in the past year, sex with CSWs, condom use with the last casual partner, history of genital discharge in the past 5 years, and history of genital ulcer in the past 5 years were 9.7, 43.4, 38.8 (Akaki site only), 10.6 and 2.1%, respectively. At the Wonji site, the intake prevalence of casual sex, sex with CSW, and history of genital discharge decreased significantly by calendar year between 1997 and 1999. At both sites combined, between the first and the fourth follow-up visits, there was a decline in the proportion of males reporting recent casual sex (from 17.5 to 3.5%, < 0.001), sex with CSWs (from 11.2 to 0.75%, < 0.001), and genital discharge (from 2.1 to 0.6%, = 0.004). CONCLUSION: There was a decline over time in risky sexual behaviours reported by cohort participants. Part of this decline occurred independently of cohort interventions.     

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

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.     

Risk Behaviors of Homeless Men in India: A Potential Bridge Population for HIV Infection

This study investigated whether homeless men are a bridge group for transmission of HIV to the general population in India. A cross-sectional study design was used to measure subjects' past and current sexual activities. We surveyed 493 of 606 homeless men aged 18-49 years who live in public places in Kolkata, India, who were invited to take part in a structured interview, using a CD player and earphones. Almost two-thirds of respondents had never attended school. Sex with commercial sex worker (CSWs), multiple sex partners, and inconsistent condom use were common. About 90% of married homeless men visited CSWs, but only 3.3% consistently used condoms. AIDS awareness and risk perception were very low. Less education and being married but not currently living with wife were associated with high-risk sexual behaviors. Homeless men should be considered a potential bridge for HIV transmission from CSWs to the general population. Appropriate non-written communication strategies targeted to homeless people are urgently needed. Community intervention programs targeting the homeless, such as the 'Popular Opinion Leader' model, should be designed and evaluated.     

Predictors of visits to commercial sex workers by male attendees at sexually transmitted disease clinics in southern Vietnam.

OBJECTIVES: To determine the HIV/sexually transmitted disease (STD) status of male patients at STD clinics and factors associated with frequent visits to commercial sex workers (CSW) in southern Vietnam. DESIGN: Cross-sectional survey. METHODS: Confidential interviews and physical and laboratory evaluation of 804 male patients at STD clinics in two semi-rural provinces in the Mekong delta. RESULTS: HIV seroprevalence was 0.5%. The prevalence of urethritis syndrome was 19.3%, gonorrhea 10.2% (Gram-stain positive) and syphilis 2% (reactive rapid plasma reagin test). All the men had visited CSW in the past and 58% had their first sexual experience with a CSW; 73% had visited a CSW in the last 3 years. Married men were equally as likely as single men to have casual partners or to have visited a CSW. The men recruited CSW more from the streets (45%) than from brothels (38%). Factors independently associated with visiting a CSW in the last 3 years included being single [odds ratio (OR), 2.2], age under 20 years (OR, 1.9), having first sexual intercourse with a CSW (OR, 2.1), not having a current girlfriend (OR, 2.1), using alcohol before sex (OR, 2.7) and drug use (OR, 1.8). Only 7% of men used condoms consistently; 70% had never used them. Only 37% had used a condom last time they had intercourse with a CSW. CONCLUSIONS: Prevention programs for men in Vietnam, particularly those who are young or single, need to focus on reducing drug and alcohol consumption and improving condom use with CSWs.     

739名暗娼STD/AIDS危险行为监测分析

目的掌握曲靖市暗娼的性传播疾病/艾滋病(STD/AIDS)危险行为特征和影响因素。方法绘制娱乐场所分布图,采用三阶段随机抽样法抽取调查对象,进行一对一匿名调查。结果调查739名暗娼,平均年龄23.66岁,AIDS知识平均知晓率为57.36%。首次性行为年龄18.51岁,每周平均客人数3.19人。最近一次与客人使用安全套的占53.86%,与客人每次都用安全套的占10.42%。39.64%的人在半年内有过生殖器的异常,27.30%的人到正规医院就诊,44.71%的人自己买药,22.53%的人到私立诊所就医。自愿做过艾滋病病毒(HIV)检查的占2.84%,认为自己有感染HIV可能性的有9.47%,HIV感染率为1.23%。结论暗娼对AIDS知识认识少,且未充分认识AIDS的危害。暗娼感染和传播HIV的危险行为有多性伴,性交频次多,首次性交年龄较小,无保护性行为多,性病患病率高,吸毒兼卖淫。     

The relationship between condom use,sexually transmitted diseases,and location of commercial sex transaction among male Hong Kong clients

OBJECTIVE: This study investigated the consistency of condom use and the prevalence of self-reported sexually transmitted diseases (STD) among male Hong Kong commercial sex clients with respect to the geographical location of these transactions. DESIGN AND METHODS: Male clients were identified via three independent, population-based surveys conducted in 1998, 1999, and 2001. A unique confidential telephone system was used to collect sensitive information. RESULTS: Respondents patronizing female sex workers (FSW) in 'mainland China only' or in 'mainland China and other places' were more likely to be inconsistent condom users (28 and 34%) than those patronizing FSW in 'Hong Kong only' (9.1%). A similar pattern was found for self-reported STD in the past 6 months (10.1, 8.1 and 1.0%, respectively). Patronizing FSW in mainland China was associated with a higher prevalence of self-reported STD (adjusted OR 4.16), independent of consistent condom use and other potential confounding factors, including calendar year of survey, age, educational attainment, HIV-related knowledge, perceived efficacy of condom use for HIV/AIDS prevention, number of female sex partners, and the presence of a regular female sex partner in the past 6 months. Clients who had commercial sex both in mainland China and Hong Kong were more likely to use condoms in Hong Kong than in mainland China (paired OR 4.67, < 0.05). CONCLUSION: The geographical location of commercial sexual activity is related to the consistency of condom use, irrespective of the clients engaged in such activity. Prevention programmes need to be aware of how risk behaviour is dependent on local contexts.     

Relationship between network operators and risky sex behaviors among female versus transgender commercial sex workers in Pakistan

Unprotected sex among commercial sex workers (CSWs) remains a leading cause of HIV transmission internationally. Previous research on condom use among CSWs has focused on females, with limited research among transgenders or on the role of network operators who mediate paid sexual transactions. We test whether network operators increase the likelihood of condom use among female and transgender CSWs in four Pakistan provinces using the 2011 Integrated Behavioral and Biological Survey. We find that transgender CSWs recruiting clients through network operators had higher odds of consistently using condoms compared with female CSWs recruiting clients through another source (relative OR: 2·80, 95% CI: 1·67, 4·70). While transgender CSWs in Pakistan using network operators have higher rates of condom use, however, this protective effect does not hold among females. This suggests that network operators may be a valuable group to target for HIV prevention efforts.     

Determinants of HIV antibody testing among selected groups of Chinese residents in Hong Kong

HIV testing is promoted to the public as a tool for HIV prevention in many countries. However, the patterns and determinants of HIV antibody testing among the Chinese people are unknown. To describe the prevalence and determinants of HIV antibody testing amongst the Hong Kong Chinese a cross-sectional anonymous survey was carried out among 1,027 subjects from different population groups (airport travellers, business sector workers, service sector workers, university staff, and STD clinic attendees). Subjects were categorized into either 'STD population' (respondents from STD clinics) versus 'all others' (respondents from other settings) groups. Forty-five percent of the respondents reported ever having had a test for HIV antibody. 'STD population' group members were almost three times more likely to have had an HIV test than were 'all others' group members (77% vs 20%). After adjustments, 'STD population' group members who reported having tested for HIV were more often aged 45 years or older, alcohol drinkers, with high self-efficacy scores, and inconsistent condom users; members in the 'all others' group, more often had had sex with strangers, drank alcohol, and favoured having multiple sex partners. Awareness among the public about the risk behaviours for HIV should be enhanced and efforts should be made to reduce high-risk behaviours among those tested by emphasizing the importance of maintaining safer sex behaviour and having follow-up tests during post-test counselling.     

Identifying the psychosocial correlates of condom use by female sex workers in Hong Kong

This study examined factors affecting condom use by Hong Kong female sex workers when they have sex with their clients and steady partners. Our respondents consisted of 109 active female sex workers, mainly streetwalkers or sex workers who worked in villas. During a 30-minute interview, respondents were interviewed individually and were asked questions regarding their condom use practice. These questions were designed to measure various factors affecting their condom use practice, including attitudes toward condom use, normative pressure, perceived behavioural control, perceived AIDS risks, past condom use behaviour, and future condom use intentions with respect to the two types of partners. Multiple regression analyses reveal that perceived behavioural control is the most important factor associated with these respondents' future condom use across the two types of partners. Perceived AIDS risk is the additional predictor for condom use with clients, while normative pressure is the additional predictor for condom use with steady partners. Past condom use behaviour also provided significant additional prediction for both types of partners, implying the habitual nature of condom use among our respondents. These results have significant implications for designing intervention programmes targeting at increasing condom use by female sex workers in Hong Kong.     

Social development of commercial sex workers in India: an essential step in HIV/AIDS prevention

India has the highest number of HIV/AIDS cases in the world. Current HIV/AIDS prevention strategies are based on regular and appropriate condom use. However, most commercial sex workers (CSWs), who form the core/high-risk groups toward whom the prevention strategy is directed, are disempowered and socioeconomically marginalized. This does not allow them to insist on condom use by the client, especially in absence of governmental structural support. This paper discusses HIV/AIDS prevention issues that relate to CSWs in India; issues that play a vital role in initiation, perpetuation, and expansion of economic activity of CSWs; and those factors that influence the HIV/AIDS preventive practices of CSWs. This paper argues that CSWs can be empowered and emancipated; that HIV/AIDS control and prevention efforts in India must recognize that ad hoc promotion of condom use or similar such programs will not be effective to control HIV/AIDS; and that more extensive developmental work aimed at betterment of living conditions of CSWs is required for effective HIV/AIDS prevention.     

2010—2013年攀枝花市商业性性工作者安全套使用分析

目的 了解四川省攀枝花市商业性性工作者（CSW）安全套使用变化趋势及相关影响因素,为制定本地的艾滋病预防干预措施提供科学依据。方法 依据《国家级HIV综合监测点监测方案》,2010-2013每年在全市分层整群抽样和方便抽样,对CSW进行重复横断面问卷调查,了解该人群的社会人口学特征、艾滋病知识知晓、安全套使用情况及干预服务接受情况等,采用SPSS19.0统计软件分析。结果 2010-2013年共调查CSW 3 200人,CSW人群最近1次商业性行为安全套使用率,分别为64.3%、89.8%、93.9%、93.5%。最近1个月每次商业性行为坚持每次使用安全套的比例,分别为43.3%、61.8%、69%、70.8%,差异均有统计学意义（χ2=386.04,P〈0.01;χ2=225.42,P〈0.01）;促进安全套使用的因素主要是：文化程度、接受宣传检测干预、知识知晓。结论 2010-2013年攀枝花市CSW使用安全套比例逐年提高,但坚持每次使用安全套比例需进一步提高,今后还需加强推广安全套及发放宣传材料,并注重艾滋病防治知识宣传。     

High-risk behaviours in men from Bogotá, Colombia and the spread of HIV

Our objective was to identify sexual behaviours related to risk of HIV infection. A cluster survey of sexually experienced men from diverse sociodemographic settings in Bogotá, Colombia was carried out using a standardized self-administered questionnaire. A high response rate (96%) resulted in the enrollment of 553 men. Most participants 129/442 reported having intercourse with women and 51/111 reported having sex with other men. Most respondents (90%) engaged in high-risk sexual practices; only 2% knew their HIV-1 serostatus. Consistent condom use was reported by 20% of those who practised anal sex, and was even lower (5%) among men who had sex with women during menses. Heterosexuals exhibited a higher degree of risky sexual patterns than homosexual/bisexuals (P=0.01). In conclusion, high-risk sexual practices are prevalent among men in Bogotá, particularly heterosexuals, attesting to the urgent need for effective and specific interventions to prevent HIV transmission.     

Correlates of HIV Risk and Preventive Behaviors in Armenian Female Sex Workers

This study describes HIV risk and preventive behaviors and their correlates among Armenian female commercial sex workers (CSWs) as a prerequisite to developing gender and culturally appropriate interventions. Ninety-eight CSWs from three Armenian cities were interviewed using a structured questionnaire. Quantitative findings were further elaborated by focus group discussions (N = 25) and key informant interviews (N = 8). Inconsistent condom use with all types of sexual partners was reported, as were condom tear/slippage, alcohol and drug use, and sex with drug injecting clients. Prominent misconceptions regarding HIV transmission, prevention and disease manifestations were noted. Correlates of condom use intentions included history of substance use, attitudes regarding condom use, risk perception, and comfort negotiating condom use. Intentions to use condoms were strongly associated with recent frequency of condom use. Understanding the relationship between condom use and its determinants is critical in the design and implementation of effective prevention programs tailored for Armenian CSWs.     

Rapid Assessment of HIV Risk Behavior in Drug Using Sex Workers in Three Cities in South Africa

A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate practices putting them at risk for contracting HIV. It included key informant (KI) (N = 67) and focus group (N = 10) interviews in locations with a high prevalence of drug use in Cape Town, Durban and Pretoria, South Africa. HIV testing of KIs was conducted. Cocaine, Ecstasy, heroin and methaqualone are used by CSWs prior to, during and after sex. Drugs enhance the sexual experience and prolong sex sessions. Interviews revealed inconsistent condom use among CSWs together with other risky sexual practices such as needle sharing. Among CSWs who agreed to HIV testing, 34% tested positive. Barriers to accessing drug treatment and HIV treatment and preventive services were identified. Interventions recognizing the role of drug abuse in HIV transmission should be prioritized, and issues of access to services, stigma and power relations must be considered.     

河南省基于农村社区的艾滋病综合防治模式探讨

目的探索河南省以社区为依托的艾滋病（AIDS）综合防治（艾防）模式,为制定艾防工作提供科学依据。方法依据并完善现有的县-乡-村医疗卫生体系,科学地开展艾滋病病毒（HIV）感染者管理、患者追踪、实验室检测、母婴阻断、高危干预、健康教育和医疗救治。结果截至2008年底,河南省艾滋病病死率下降至4.57%,母婴传播率降为4.16%,单阳性配偶阳转率为1.13/100人年,病人治疗12个月后仍坚持治疗的比例达到85.2%,大众人群艾滋病防治知识知晓率为82.3%,暗娼中艾滋病预防服务覆盖率为96.98%,娱乐场所暗娼在最近一次商业性性行为时使用安全套的比例为89.54%,暗娼中能够正确识别艾滋病经性传播的途径并摒弃艾滋病传播主要错误观点的比例达81.17%,HIV感染者和AIDS病人（HIV/AIDS病人）安全套坚持使用率达92.57%。结论河南省基于农村社区的艾滋病综合防治模式效果显著,建议在HIV/AIDS病人相对较为集中的地区推广应用。