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China's HIV/AIDS epidemic continues to grow in rural and less developed areas. This consecutive cross-sectional study examines demographic and behavioral factors associated with HIV/STI infection, Hepatitis C (HCV) and other sexually transmitted infections (STIs) among Vietnamese female sex workers (FSW), a vulnerable population who cross into Guangxi, China. This study is a secondary data analysis of 303 Vietnamese and 4,348 Chinese FSWs recruited over seven years from two Chinese counties that border Vietnam. Logistic regression models compared demographics, HIV/STI status, HIV/AIDS-related knowledge, attitudes, and risk behaviors between Vietnamese FSWs and Chinese FSWs. Compared with Chinese FSWs, Vietnamese FSWs were younger, had attained lower education levels, were highly mobile, more likely to report using drugs, and were more vulnerable to HIV/STIs. Younger age, less educational attainment, shorter time in their current working location, no voluntary HIV testing in the last year, greater drug use, and not using condoms for all commercial sex in the last month were associated with higher HIV/STIs. In conclusion, several factors were associated with HIV/STI risk in Vietnamese cross-border FSWs. There is a pressing need to improve support systems for Vietnamese cross-border FSW and health system cooperation across the Chinese/Vietnamese border. [ABSTRACT FROM AUTHOR]

Objectives: Parental HIV infection presents unique psychosocial challenges for families. Affected children are vulnerable to stigma-related distress from a parent's HIV status and are more likely to experience symptoms of depression and low self-esteem than unaffected peers. This study examined whether HIV-related stigma predicted poorer mental health among children affected by parental HIV and whether psychosocial assets mediated this relationship. Methods: A sample of 790 children (ages 6-17) affected by parental HIV in Henan, China reported on HIV-related stigma, social support, emotional regulation, future outlook, and mental health symptoms. Structural equation modeling was used to examine the direct and indirect effects of stigma on mental health. Results: Results indicated that stigma was associated with psychosocial resources, which in turn were associated with mental health symptoms. The indirect pathways from stigma to mental health symptoms through psychosocial resources were consistent across age and gender. Conclusion: The experience of HIV-related stigma was associated with poorer overall mental health among children affected by parental HIV in China. Children's psychosocial resources, including social support, emotional regulation, and future outlook, mediated the relationship between HIV-related stigma and mental health symptoms. Future interventions may wish to target these modifiable aspects of wellbeing to improve social and behavioral outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). Minority stress theory posits that marginalized populations experience additional stress, which influences experiences of psychological distress and health outcomes. This study aimed to understand psychological distress of MSM relative to men who have sex with women (MSW) in an urban Chinese setting. Cross-sectional survey data were collected from 162 HIV-positive Chinese men receiving HIV treatment at Beijing's Ditan Hospital. Multiple linear regression with imputation was used to identify correlates of psychological distress. Relative to MSW, MSM were younger, more educated, and less likely to be in a relationship or have children. While both groups reported clinically elevated levels of depression and anxiety, sexual behavior was not associated with either outcome. Higher endorsement of depression symptomology was associated with worse reported physical health (β = −1.37, p <.05) and greater endorsement of maladaptive coping (β = 2.39, p <.05), whereas higher endorsement of anxiety symptomology was associated with greater endorsement of adaptive coping (β = 0.78, p <.05), diminished physical health (β = −0.86, p <.05), and a high school or greater level of education (β = 4.13, p <.05). These findings suggest that interventions targeting coping strategies may address psychological distress among HIV-positive Chinese men. [ABSTRACT FROM AUTHOR]

We examined the prevalence of sex with older male partner (SWOMP) and its association with condomless anal intercourse (CAI) with male partners and unrecognized HIV infection among young men who have sex with men (MSM) in Shanghai, China. The analytic sample included 243 MSM who were 18-45 years and HIV negative or of unknown HIV serostatus. Older male partner refers to male sex partner who was at least 10 years older than themselves. Overall, 99 (43.0%) and 50 (20.7%) reported having SWOMP in lifetime and in the last 3 months, respectively. Having any CAI with male partners in the last 3 months was independently associated with SWOMP and sex with stable male partners in the last 3 months. Unrecognized HIV infection was independently associated with being HSV-2 positive and having any CAI with male partners as well as SWOMP in last 3 months. Sex with stable male partner in the last 3 months was also marginally significantly associated with unrecognized infection (p = 0.084). Older partner selection is common among young MSM in China. Prevention programs should incorporate education messages about the HIV risk associated with SWOMP. MSM should be informed that having condomless sex with stable partners may place them at HIV risk. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) are the group at highest risk for HIV in China. Researchers have used various recruitment methods to reach this population hidden from the hetero-normative culture. To inform future recruitment strategies, we compared estimates of socio-demographic characteristics, HIV risk behaviors, depression, and intimate partner violence (IPV) across three samples of MSM and money boys in Shanghai, China. Data were collected from three community-based samples of MSM and money boys (n = 1352) recruited via respondent-driven sampling (RDS) (n = 404), community popular opinion leaders (CPOL) (n = 385), and Internet and venue-based sampling (VBS) (n = 546). Different recruitment methods generated samples with statistically significant differences among a number of socio-demographic characteristics, sexual behaviors, drug use, depression scores, and exposure to IPV. Specifically, RDS participants had lower education (p = .002), income levels (p < .001), and were more likely to report condomless sex with a woman (p < .001). CPOL participants were younger (p < .001), more likely to report lifetime condomless anal sex (p = .009), more than 10 male partners in the past 30 days (p < .001), and were less likely to experience violence by a male intimate partner (p = .001). VBS participants had lowest depression score (p = .005) and were more likely to report lifetime drug use (p = .003). Our findings reinforce that each recruitment method may reach a sub-group of MSM with a specific risk profile, so multiple methods may be needed to obtain a representative sample of MSM. Interventions may use specific recruitment methods to target certain segments of the MSM population. [ABSTRACT FROM PUBLISHER]

This study aims to investigate health care providers' empathy levels and its association with avoidance in providing service to patients living with HIV/AIDS (PLWHA) in China. A total of 1760 health service providers were randomly sampled from 40 county hospitals in two provinces of China. Using a self-administered questionnaire, participants' demographic characteristics, work history, empathy level, and avoidance attitudes toward PLWHA were collected in a cross-sectional survey. Empathy was higher among participants aged 31–40 years, those who had an associated medical degree, and those who had served in the medical profession for less than 20 years. Nurses, younger providers, and providers with lower education tended to avoid contact with PLWHA. Multiple linear regression model showed that a higher level of empathic attitude toward patients was significantly negatively associated with avoidance attitude toward PLWHA. Service providers' empathy level plays an important role in providing quality care to HIV-infected patients. Future stigma reduction interventions should cultivate empathy as a platform for understanding, effective communication, and trusting provider–patient relationships. PLWHA could potentially benefit from attitudinal change in medical settings. [ABSTRACT FROM PUBLISHER]

The sexual transmission of HIV and STI is becoming a major public health concern in China. However, studies on sexuality in China remain scant, particularly those that analyze female sexuality. This study is to investigate the prevalence of multiple sexual partnerships (MSP) among adult women, and to examine trends and correlates for having more than one lifetime sexual partner. MSP, coded as having one or none vs. two or more lifetime sexual partners, was the key binary outcome measure. The data were from two national probability surveys on sexual behaviors in China carried out in 2000 and 2006. The sample size of adult women was 1899 in 2000 (total sample n=3812), and 2626 in 2006 (n=5404). Overall prevalence of MSP increased from 8.1% in 2000 to 29.6% in 2006 (chi-square test, significance = 0.000). The most rapid changes took place among women with less education, those who worked in blue-collar jobs and lower social-status positions, and those living in rural areas or small towns. Women who were better educated, lived in big cities, and held management-level occupations exhibited less change but had a higher baselines prevalence of MSP, suggesting that changes in MSP behavior may occur initially among women of higher socioeconomic status. Based on the 2006 data-set, significant positive correlates of MSP included more years of education, being in a long-term relationship, being middle aged, having a lower-status job, going out dancing at entertainments venues, and being a state of overall health in the past 12 months. The significant recent increase in MSP among women reinforces the need to examine China's sexual revolution in the context of a rapidly transitioning society. Findings regarding female sexuality also raise new questions to be explored in further sexuality studies, in order to better understand population sexual behaviors and to inform future HIV-prevention efforts. [ABSTRACT FROM AUTHOR]

The sexual transmission of HIV and STI is becoming a major public health concern in China. However, studies on sexuality in China remain scant, particularly those that analyze female sexuality. This study is to investigate the prevalence of multiple sexual partnerships (MSP) among adult women, and to examine trends and correlates for having more than one lifetime sexual partner. MSP, coded as having one or none vs. two or more lifetime sexual partners, was the key binary outcome measure. The data were from two national probability surveys on sexual behaviors in China carried out in 2000 and 2006. The sample size of adult women was 1899 in 2000 (total sample n=3812), and 2626 in 2006 (n=5404). Overall prevalence of MSP increased from 8.1% in 2000 to 29.6% in 2006 (chi-square test, significance = 0.000). The most rapid changes took place among women with less education, those who worked in blue-collar jobs and lower social-status positions, and those living in rural areas or small towns. Women who were better educated, lived in big cities, and held management-level occupations exhibited less change but had a higher baselines prevalence of MSP, suggesting that changes in MSP behavior may occur initially among women of higher socioeconomic status. Based on the 2006 data-set, significant positive correlates of MSP included more years of education, being in a long-term relationship, being middle aged, having a lower-status job, going out dancing at entertainments venues, and being a state of overall health in the past 12 months. The significant recent increase in MSP among women reinforces the need to examine China's sexual revolution in the context of a rapidly transitioning society. Findings regarding female sexuality also raise new questions to be explored in further sexuality studies, in order to better understand population sexual behaviors and to inform future HIV-prevention efforts. [ABSTRACT FROM AUTHOR]