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

Abstract

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.

Keywords:

• Chinese male sex workers
• HIV/STD
• cognitive factors
• unprotected anal intercourse
• intention
• perceptions

Acknowledgements

The authors would like to thank all respondents for their participation in the study. Thanks are extended to fieldworkers and volunteers who had helped in the data collection of the project. The study was supported by the Hong Kong Council for the AIDS Trust Fund (SPF#020).

Additional information

Notes on contributors

Wende Cai

Co-first authors; Both authors are contributed equally to the study