Co-Occurring Psychosocial Problems and Multiple Sexual Partners among Men Who Have Sex with Men in Shanghai, China: A Syndemic Approach

Abstract

We aimed to apply syndemic theory to verify the association and reinforcing effects between psychosocial problems and multiple sexual partners (MSP) of men who have sex with men (MSM) in Shanghai, China. A cross-sectional study was conducted among 547 MSM in Shanghai, China using a face-to-face survey. Sociodemographic and psychosocial data were collected, as well as information on MSP and condomless anal sex. In the 6 months prior to the survey, 54.3% of the MSM sample had had MSP. Univariate analysis showed that self-esteem, depression, loneliness, sexual compulsivity, and involuntary subordination (IS) were associated with MSP. Sexual compulsivity (multivariate odds ratio [ORm] = 2.94, 95% CI = 1.76–4.91) and IS (ORm = 1.79, 95% CI = 1.14–2.81) remained significant in multivariate analysis. MSM with five or more psychosocial problems had greater odds of (adjusted odds ratios = 3.06, 95% CI = 1.49–6.25) having MSP in the previous 6 months than the non-syndemic group. Our findings provide preliminary confirmation of the additive relationship of syndemic psychosocial health conditions and MSP among MSM in Shanghai, China. An integrated intervention with special focus on sexual compulsivity and IS is needed.

Acknowledgments

We acknowledge the contribution of the investigators and staff from the Shanghai Center for Disease Control and Prevention, the Shanghai Dermatology Hospital, and the Shanghai Youth AIDS Health Promotion Centre who participated in the study. We thank Anita Harman for linguistic advice.

Funding

This study was sponsored by the Shanghai Municipal Education Commission (14YS022), the Shanghai Jiao Tong University School of Medicine (14XJ10007), the Cross-study Research Foundation about Medicine and Engineering of Shanghai Jiao Tong University (YG2014QN23), the National Natural Science Funds of China (71603166, 71673187), the Shanghai Pujiang Program (14PJC076), and the Social Cognitive and Behavioral Sciences program of Shanghai Jiao Tong University (14JCRY03). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Declaration of interest

The authors declare that they have no competing interests.