Substance use and HIV risks among male heterosexual and ‘money boy’ migrants in Shanghai, China

Abstract

There is a growing awareness that internal migration in China might shift the HIV epidemic by broadening the social and sexual mixing of its population. However, little is known about how drug use/abuse might contribute to the spread of HIV. This qualitative study aims to elucidate factors for preventing substance abuse and HIV among two types of male migrants living in the Shanghai metropolitan area; the general migrant population and so-called ‘money boys’ (those who engaged in same-sex activities for money). Compared to most male migrants, the ‘money boys’ had a slightly better economic situation; rarely visited their hometowns; used alcohol less but drugs more; had more knowledge about HIV and sexually transmitted diseases; higher HIV/ STD testing rates and fewer HIV risk behaviors. The general male migrants had more misconceptions about HIV (e.g. the need to pay for HIV testing) than the ‘money boys’. However, it was noted that ‘money boys’ who were new to the enterprise and men who have sex with men but did not engage in commercial sex often lacked HIV knowledge and protective skills. Given the needs of various sub-types of ‘migrants’, differential approaches to HIV prevention are needed.

Acknowledgments

The study was supported by a grant from the National Institute on Drug Abuse (R01DA15623-04S1) to the second author. All opinions expressed are those of the authors.

Notes

1. These groups are (1) injection drug users (IDUs), (2) former blood plasma donors/recipients, and (3) commercial sex workers.

2. The term ‘Tongzhi’ or comrade is often used to refer to the gay or men having sex with men (MSM) community. It is noted that MB may or may not self-identify as gay.

3. The Choi et al. (2003) and Choi et al. (2004) are from the same parent study.

4. Two of the MB self-identified as heterosexual; their MSM activities are purely business transactions.

5. A copy can be obtained from the first author.

6. Occupations include hairdressers, construction workers, small factory workers and commercial service workers.

7. One GMM had been in Shanghai for over ten years.

8. Participants singled out migrants from Xinjiang (a predominantly Uygur province in western China) in particular.

9. For example, some MB stated that a small amount of heroin benefits the health of those who are physically weak.

10. Moreover, the MB noted that MSM who are not MB tend to believe erroneously that they are not at risk simply because they do not'sell sex'.

11. For example, many GMM believed that HIV testing costs money, when in fact it is free.

12. Chou finds that the decision to marry is due largely to strong social pressures.