Risk behaviours of Hong Kong male residents travelling to mainland China: a potential bridge population for HIV infection

The objective was to assess levels of high-risk sexual behaviour, condom use, sexually transmitted disease (STD) history and AIDS-related perceptions among Hong Kong men returning from China by land; 1,254 systematically sampled subjects were interviewed. Of respondents, 32.5% had sexual intercourse with a commercial sex worker (CSW) in China in the past six months; 11.2% have done so on this trip. A third of those who reported having sex with CSWs did so without a condom. A fifth had a history of STDs: seventy per cent of respondents who did not use a condom with a CSW would not use a condom with their regular sexual partner. Less educated respondents, 31-40-year-olds and non-business and frequent travellers were more likely to have sex with a CSW. Those who practice high-risk sex fear AIDS more, are aware that their own risk of HIV infection is not negligible, but think that chances of HIV infection from CSWs in China are small. Although Hong Kong's estimated HIV prevalence among adults is low (0.06%), the huge volume of cross-border travel between Hong Kong and China and the common practice of high-risk sex by Hong Kong male travellers provide a bridge for emerging epidemics to spread.     

学生中122名男男性行为者HIV/STD高危行为及其感染状况分析

目的了解男男性接触者(MSM)的学生亚群中艾滋病病毒/性传播疾病(HIV/STD)感染高危性行为及其感染状况。方法采用应答者驱动、关键知情人介绍、网上公告等方法在安徽省合肥市招募,共有122名符合条件的MSM完成了面对面问卷调查,其中121人参加了HIV和梅毒检测。调查内容主要包括社会人口学特征、艾滋病知识和感染意识、主要社会活动场所、性伴和性行为特征。结果79.5%的调查对象为大学生及研究生,20.5%为高中生。HIV检测阳性率为1.7%,梅毒现感染率7.4%。82.0%调查对象近6个月有同性肛交性伴,24.6%有2个以上固定性伴,39.3%有偶然性伴;性伴平均年龄大于调查对象的平均年龄(P<0.001)。63.1%的调查对象近6个月内有过无保护同性肛交行为,与固定性伴发生无保护肛交(插入或被插入)均高于同偶然性伴(P<0.05)。大多数MSM艾滋病知识缺乏,他们获得艾滋病知识的主要途径是因特网、报纸、电视等媒体。结论要加强在校学生性病艾滋病健康教育,倡导单一固定性伴关系和安全性行为观念,并推广安全套使用。     

STD-related knowledge, beliefs and attitudes of Xhosa-speaking patients attending STD primary health-care clinics in South Africa.

The primary aim of this study was to describe patients at sexually transmitted disease (STD) clinics in Cape Town, South Africa, in terms of gender, education and age differences relative to their STD knowledge and beliefs, their condom use, as well as their attitudes towards condom use and their condom-use behaviour. The information was collected with a view to developing a health education intervention. Structured interviews were conducted with 2978 randomly sampled Xhosa-speaking STD clinic attenders about their knowledge, beliefs and practices regarding STDs and related behaviours. More males (75%) than females (25%) presented for STD treatment. The majority of patients (92%) were younger than 35 years. Female patients were found to be more aware than male patients of the sexual nature of STD transmission, valued personal autonomy in sexual behaviour and expressed a greater need to use condoms. Males perceived STD symptoms to be more serious, had more misconceptions about the cause of STDs and also more negative beliefs and attitudes towards condom use. Only 34.9% of the patients reported using condoms in the last 6 months while only 24.5% reported regular use. Those who reported condom use were more knowledgeable about the sexual transmission of STDs and the effects of STDs on the neonate. They also had fewer misconceptions about the causes of STDs and perceived STD symptoms to be more serious, attached greater value to personal autonomy in sexual behaviour and condom use and had more positive outcome expectancies of refusing sex than those who never used condoms. The data suggest that targeted interventions directed at males will have to address their inadequate knowledge regarding STDs in terms of transmission, causes, consequences, prevention and cure. Their negative beliefs and attitudes towards condoms will need special attention, especially in view of their multiple partner behaviour. Interventions directed at females will need to improve their knowledge regarding STD consequences, causes, recognition of symptoms as well as improve their knowledge of aspects of prevention and cure. All interventions must facilitate personal autonomy in decision making about sexual behaviour and condom use for both men and women, through skills development programmes that promote self-efficacy in the individual and instil a culture of mutual respect of such in the community.     

Sexual risk behaviors and HIV/AIDS awareness among males in a rural community in Goa

To study the heterosexual risk behaviors and to study the level of HIV/ AIDS awareness among males in a rural community in Goa. Survey was cross-sectional and community based. A sample of 300 males aged 15-49 years selected by stratified random sampling. An "UNAIDS protocol for measurement of HIV/STD prevention indicators" was used. SPSS software package was used for statistical analysis. One hundred and ninety eight (66%) males reported ever having sexual intercourse, of these 17% were single. Fifty three (17.7%) males reported intercourse with a non-regular partner in the past 12 months, of these 90.6% had intercourse with strangers, 92.5% had paid for sex and only 43.4% had used a condom for the last sexual encounter with a non-regular partner. Less educated males (<10th class), single and those employed have higher sexual indulgence with non-regular sexual partners. The level of knowledge about HIV/ AIDS was very high in all areas of causation and prevention. Although the awareness about sexual risk behavior was high, condom use was very low resulting in high risk behavior related to HIV/ AIDS and STDs among males. The study highlights the need for more effective behaviour change communication (BCC) strategies in the community as well as innovative methods like village level peer education.     

Gender differences in HIV-related perceptions, sexual risk behaviors, and history of sexually transmitted diseases among Chinese migrants visiting public sexually transmitted disease clinics

The goal of this study was to explore gender difference in HIV-related perceptions according to a social cognitive theory and sexual risk behaviors and to examine associations between mobility, sexual risk, and history of sexually transmitted diseases (STDs) among male and female migrants visiting STD clinics. A cross-sectional study among migrants visiting STD clinics in three large cities in China assessed HIV-related perceptions, sexual activity, condom use, and history of STDs was used. Among participants, 20% of women had ever sold sex and 33% of men had paid for sex. Women and men were similar in multiple partnerships in the last month (23% versus 22%), consistent condom use during last three sexual encounters (14% versus 15%), and a history of STDs (57% versus 53%). However, more women who reported a history of STDs had contracted at least two STDs than men (55% versus 36%, p < 0.001). Increased sexual risk was associated with increased perception of extrinsic rewards for both genders, but was associated with increased perceptions of intrinsic rewards and response cost in women only, and with decreased perceptions of vulnerability and response efficacy in men only. High mobility was associated with increased sexual risk in women. Self-reported history of STDs was associated with a high rate of past multiple partnership and low education among both genders, but was associated with high mobility and commercial sex in women only. Fifty-four percent of women with a history of STDs informed their partners about their infections, compared to 36% of men (p < 0.001). Married women, both women and men who did not engage in commercial sex, and women and men who used condoms were more likely to inform their partners about their STD infections. Gender differences in HIV-related perceptions and sexual behaviors underscore the importance of gender-specific intervention efforts to prevent the spread of HIV/STD in China.     

云南某市矿工STD/AIDS危险因素调查

目的了解云南省某市矿工性病/艾滋病(STD/AIDS)相关知识、性行为特征和感染率。方法在矿区暗娼相对集中的两个镇,采用方便样本抽样法共抽取427名矿工,进行面对面访谈式问卷调查,采集静脉血和首段尿,检测HIV、淋球菌、衣原体。结果有性经历的矿工中发现HIV、淋球菌、衣原体感染率分别为0.3%(1/352)、0.5%(1/182)、9.3%(17/182),衣原体阳性与文化程度(P=0.027)、婚姻状况(P=0.007)有统计学意义。矿工中认为经性、血液、共用注射器、母婴传播可以传播HIV的分别占50.4%、43.5%、45.7%和39.3%。有27.9%的矿工没有听说过安全套,52.5%不知道安全套作用。报告嫖娼比例为14.2%,嫖娼中从未使用安全套的占40.0%。结论矿工中存在高危性行为,STD/AIDS防治知识缺乏,安全套使用率低,极易造成STD/HIV的传播,对他们进行干预是至关重要的。     

男男性行为性工作者的性安全行为调查

目的分析研究男男性行为性工作者（MB）的性行为安全状况。方法在成都、沈阳和南京3个中心城市,对有明确的性交易经历或准备从事性交易的MB进行问卷调查分析。结果共调查577人,回收有效问卷484份。乎均年龄21．56岁,认同自己是同性恋的占72．5％。性病艾滋病知识知晓率低于75％,安全套正确使用技巧知晓率仅达63％。插入性性行为发生率均超过60％,还有少量性虐行为,性虐中有半数发生出血现象。每次坚持使用安全套与男性发生性行为的已达到72％,而与女性则仅达到59％。报告曾感染性病的占18．2％,但只有一半多一点的人愿意去公立医院看病。结论他们是流动人口,缺乏性病艾滋病预防基本知识和意识,存在健康服务的认识误区,需要加强对这个群体的健康干预。     

HIV Risk Among Patients Attending Sexually Transmitted Disease Clinics in China

HIV and other sexually transmitted diseases (STDs) are spreading rapidly in China. However, little is known about HIV risk among STD patients. In October–November 1997, we recruited a consecutive sample of 1,371 STD clinic patients from 16 different provinces and municipalities across the country and examined their sexual practices and condom use. We found that the median age for sexual initiation was 22 years for men and 21 years for women, and only a small proportion of men (12%) and women (15%) had used a condom during this first sexual intercourse. Eighty-one percent of men and 53% of women had two or more sexual partners in the past year. During the same period, 78% of men and 44% of women had both steady and nonsteady partners; of those with both types of partners, only 1% of men and 7% of women always used a condom with these partners. Multiple sexual partnerships in the past year were more common among men, older men (over 35 years), and those who had initiated sex at an earlier age. More frequent condom use was associated with being younger, having nonsteady partners, and having used a condom during a first sexual encounter. Our findings underline a need for patient education and condom promotion among STD clinic patients as a part of efforts to prevent the spread of HIV in China.     

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。     

Correlates of human immunodeficiency virus infection risk behavior in male attendees of a clinic for sexually transmitted disease.

Human immunodeficiency virus (HIV) infection risk behavior was evaluated in a cross-sectional survey of 400 male active-duty US Army personnel who presented at a sexually transmitted disease (STD) clinic with symptoms of acute urethritis. High-risk partners were common, and nearly one-quarter of the sample had previously had STDs. Logistic regression models examined correlates of HIV exposure risk, of inconsistent condom use, and of having partners with increased risk of HIV infection. Frequent partner turnover, sex "binging," negative attitudes toward condom use, and engaging in sex during military leaves were important correlates of risk. Individuals with HIV infection risk behavior generally were cognizant of their risk for HIV infection. Implications for intervention are discussed.     

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.

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). We investigated sexual risk, risk perception, HIV and condom knowledge, and utilization of prevention services in the first large sample of MSM recruited in Beijing. Four hundred eighty-two MSM were sampled from September 2001 to January 2002. Forty-nine percent of participants reported unprotected anal intercourse with men during the previous 6 months. However, only 15% perceived they are at risk for HIV and many had misconceptions about HIV transmission routes and limited knowledge about condoms. Less than one quarter obtained free condoms (24%) and condom lubricants (19%) in the past 2 years. Multiple logistic regression analysis showed that unprotected insertive anal intercourse was associated with not having a Beijing residence card, having six or more male sexual partners, not having sex with women, having a lifetime history of sexually transmitted diseases (STDs), and having never tested for HIV. Unprotected receptive anal intercourse was independently associated with having six or more male sexual partners, not having sex with women, having a lifetime history of STDs, having never tested for HIV, and having less exposure to HIV prevention services. In addition, 28% reported having sex with both men and women during the previous 6 months, and 11% had unprotected intercourse with both men and women. This finding suggests that MSM are a potential bridge of HIV transmission to heterosexual women (or vice versa) and that addressing the HIV prevention needs of MSM may benefit the wider population.     

对北京部分男男性接触者HIV/AIDS的KABP调查

目的对北京部分男男性接触者(men have sex with men,MSM)进行HIV/AIDS的KABP调查,为今后在MSM中开展干预工作奠定基础.方法培训MSM中的志愿者,由他们到MSM活动场所酒吧、公园、浴池等地,对MSM进行自愿匿名的问卷调查,发放宣传品及安全套并提供自愿匿名的抗-HIV检测.结果MSM中固定性伴比例较低(36.9%),多性伴现象较普遍,一半以上的MSM(53.8%)与女性有过性接触;安全套使用率低;每次都用的进行口交者为6.2%,接受口交者为6.5%,进行肛交者为30.9%,接受肛交者为40.4%.有40.5%的人认为自己不可能感染HIV.有23.8%的人自诉曾出现过性病病症.MSM对艾滋病传播途径认识正确率较高(78.6%以上),但对性病/艾滋病相关知识的认识较差,正确率为36.9%～65.5%.MSM主动进行抗-HIV检测的较少,本次仅为11人(13.84%).其中1人为抗-HIV阳性.结论MSM的不安全的性行为使他们成为感染STD、HIV的高危人群,并将这一危险扩散到一般人群.     

中国大陆男同性性接触者的艾滋病高危行为及影响因素研究(一)

目的本文描述了中国大陆男同性性接触者(MSM)与HIV/AIDS/STD相关的高危行为、认识和某些影响因素.方法通过自我填写问卷和当面访谈填写问卷两种形式,对426位男性进行了调查.结果本组主要生活在大中城市、接受过较好教育、较为年轻的MSM,平均约18岁开始与同性性交.4/5以上有口-生殖器性交,半数以上有肛门性交行为.累计性伴中位数9人.2/5以上在近一年内有偶遇性性伴.约半数人在调查时有固定性伴,但仅少数人与性伴保持闭合性性关系.约1/3已婚,近半数人与女性性交过.1/4曾患性传播疾病,近一年患病率为6.81%.仅1/10进行过HIV抗体检测,1人阳性.约1/3使用过安全套,通常在少数情况下使用,只有2人坚持使用.不用安全套的原因主要是认为安全套能降低快感、自己无感染HIV的可能和性伴健康,虽然他们已普遍具有关于HIV传播的一般知识.结论中国大陆部分MSM在性方面相当活跃,存在HIV在MSM中高水平流行的可能性.HIV在中国MSM中的流行速度高于90年代初中期在西方国家MSM中的流行速度,而且流行还会直接蔓延到妇女人群.由于社会文化等因素的阻力,对中国MSM的AIDS干预面临重大困难.     

Low and stable HIV infection rates in Senegal: natural course of the epidemic or evidence for success of prevention?

OBJECTIVES: To document the level of HIV infection in Senegal and also to review evidence of the impact of efforts in prevention, developed by the National AIDS Control Programme and the Civil Society, on the level of the HIV epidemic. METHODS: Research, compilation and critical review of all relevant data on HIV and sexually transmission diseases (STDs) epidemiology, sexual behaviour, and the efforts in prevention developed in Senegal. RESULTS: From 1989 to 1996, the levels of HIV infection estimated in four sentinel urban regions remained stable at around 1.2% in the population of pregnant women, and at 3% in male STD patients. It had increased to 19% in female sex workers. A strong political and community commitment led to an early response to the HIV/AIDS epidemic that has been extended since 1986. Blood transfusion safety was established at the start of the HIV epidemic. The level of knowledge of preventive practices relating to HIV/AIDS among the general population exceeded 90% in the early 1990s. From 1991 to 1996, a 30% to 66% decrease of the STD prevalence rates was observed in pregnant women and sex workers in Dakar. In 1997, 33% of men aged 15-49 years in Dakar reported having had sex with non-regular partners. Among them 67% reported condom use. CONCLUSIONS: It is not possible to know what the course of the HIV epidemic in Senegal would have taken in the absence of efforts at prevention. Certainly, several factors that pre-dated the occurrence of AIDS in Senegal laid the groundwork for a positive response. However, data from a number of sources do reveal the successfulness of efforts in prevention. From available data, Senegal can rightfully claim to have contained the spread of HIV by intervening early and comprehensively to increase knowledge and awareness of HIV/AIDS and to promote safe sexual behaviour.     

AIDS and STD knowledge, condom use and HIV/STD infection among female sex workers in Bali, Indonesia

The objectives of this paper were to examine changes in AIDS/STD knowledge and behaviour from 1992-1998, current levels of STD infection and psychosocial and demographic determinants of condom use and STD infection among female sex workers. Data for the study were drawn from cross-sectional surveys of female sex workers conducted in 1992, 1994 and 1997-8. For each survey, women participated in a face-to-face interview in the brothel complexes. Survey questions included information on AIDS/STD knowledge, demographics, sexual history and psychosocial factors related to condom use. After the last survey, women were offered a vaginal exam for STD diagnosis and treatment. Sera were tested for HIV infection (anonymous, Elisa/Western blot) and syphilis (TYPHA, RPR). Cervical mucous was tested for chlamydia (LcX), gonorrhea (LCx), herpes (pcr) and HPV (pcr). Knowledge of AIDS and awareness of STDs has increased tremendously in this population since 1992. Reported condom use has also increased substantially (69.9%). Perceived susceptibility toward HIV infection remains low. Ineffective preventive strategies such as medication use continue to be common. HIV infection remains very low in this population (0.2%), although the prevalence of other STDs such as gonorrhea (60.5%), chlamydia (41.3%) and HPV (37.7%) were very high. STD knowledge and self-efficacy were significantly related to condom use as were the sex workers' perceived susceptibility to STD and HIV infection. Women with a larger number of partners were more likely to be infected with gonorrhea, chlamydia and HIV. Women who had come to Bali recently were more likely to be infected with HIV and gonorrhea.     

性病门诊就诊者行为及艾滋病性病知识调查

目的 了解性病门诊就诊者的求医行为、出现性病相关症状后的性行为状况及其艾滋病性病相关知识态度水平。方法 2003年8月中旬连续2周时间，对前来北京市性病防治所就诊的325名性病门诊就诊者进行了问卷调查，调查采用不记名、面对面逐项询问的方式。结果 调查对象出现性病相关症状后3天内就诊者占24．7％。出现性病相关症状后继续有性生活者占43．2％，其中多性伴侣者占12.8％，平均性伴侣数为6．1，但无再与商业性伴侣发生性关系者。出现性病相关症状后与临时性伴侣的性生活平均为6．4次，坚持使用安全套者占22．2％，发生性关系时临时性伴侣知情者占15．0％。艾滋病传播知识全部回答正确者占27．3％。结论 调查对象的性病求医行为需要引导和促进。出现性病相关症状后仍具有较多的无保护性行为，且对方多不知情，存在着传播性病艾滋病的潜在危险。艾滋病性病传播、预防知识的知晓率水平均较低，应在该人群中加强宣传教育干预，开展自愿咨询检测，以降低危险性行为，遏制艾滋病性病的流行和传播。     

204例MSM人群HIV／梅毒感染状况及行为学特征分析

目的了解天津市部分男男同性性行为人群（MSM）艾滋病相关危险行为,以及艾滋病病毒（HIV）、梅毒（SP）感染状况,为预防性病、艾滋病传播提供依据。方法采用横断面调查,对进入酒吧的男同性恋者进行问卷调查,同时抽取血样进行梅毒和HIV的实验室检测。结果调查的204人中,HIV感染率为5．9％,梅毒感染率为18．7％。艾滋病知识知晓率为81．4％,近6个月每次性行为均使用安全套的比例为47．9％,HIv感染者安全套使用率低,仅为11．1％,71．4％的HIV感染者最近6个月存在多性伴现象。结论天津市MSM人群危险性行为普遍存在,安全套使用率低,HIV、梅毒感染率较高,应加强对该人群艾滋病性病相关的宣传教育及干预工作,控制HIv的传播。     

广西边贸地区卖淫妇女健康风险减少干预效果评价

目的探索在边境地区卖淫妇女中开展预防性病艾滋病和生殖健康知识、信息的传播,提高她们防病意识,减少由于提供卖淫引起的健康风险.方法建立妇女健康中心,通过出访到服务场所对卖淫妇女进行多种形式的健康教育、咨询服务和促进避孕套的使用,定性访谈和问卷调查以评估干预效果.结果通过项目干预活动的开展,卖淫妇女性病艾滋病知识水平、患病意识及正确的求医行为逐年有了不同程度的提高.读过项目提供资料的卖淫妇女知识水平、患病意识及行为改变上明显高于未读过资料的卖淫妇女.结论经过干预项目活动的开展,卖淫妇女的知识水平、患病意识和行为可发生不同程度的改变,表明在服务场所进行健康风险干预是可行的、有效的.     

Difference in Risk Behaviors and STD Prevalence Between Street-Based and Establishment-Based FSWs in Guangdong Province,China

The major mode of HIV/AIDS transmission in China is now heterosexual activities, but risk for HIV and sexually transmitted diseases (STDs) may differ among different strata of female sex workers (FSWs). Respondent-driven sampling was used to recruit 320 FSWs in Guangdong Province, China. The respondents were interviewed using a structured questionnaire, and tested for HIV, syphilis, gonorrhea, and Chlamydia. The street-based FSWs had lower education levels, a higher proportion supporting their families, charged less for their services, and had engaged in commercial sex for a longer period of time than establishment-based FSWs. The proportion consistently using condoms with clients and with regular non-paying partners was also lower. The prevalence of syphilis, gonorrhea, and Chlamydia was higher among street-based sex workers. Being a street-based sex worker, having regular non-paying sex partners, and having non-regular non-paying partners were independent risk factors for inconsistent condom. Street-based FSWs had more risk behaviors than establishment-based FSWs, and should therefore be specifically targeted for HIV as well as STD intervention programs.