Condom use social norms and self-efficacy with different kinds of male partners among Chinese men who have sex with men: results from an online survey

Cheng Wang, Joseph D Tucker, Chuncheng Liu, Heping Zheng, Weiming Tang, Li Ling, Cheng Wang, Joseph D Tucker, Chuncheng Liu, Heping Zheng, Weiming Tang, Li Ling

Abstract

Background: Social norms and self-efficacy play important roles in promoting consistent condom use among men who have sex with men (MSM). Few studies have investigated the association between social norms, self-efficacy and consistent condom use with different kinds of male partners among MSM. We conducted an online survey of MSM to evaluate this in China.

Methods: A cross-sectional online survey was conducted in 2015. Participants completed a validated questionnaire covering socio-demographic information, consistent condom use, condom use social norms and self-efficacy. Eligible participants were 16 or older, born biologically as a male, engaged in anal sex with a man at least once during their lifetime, engaged in condomless anal or vaginal sex in the last three months. In this study, we further restricted to people who had sex with male partners in the last three months. Participants were classified into three groups: engaged in sex only with regular partners, engaged in sex only with casual partners and engaged in sex with both regular partners and casual partners.

Results: Participants were recruited from 32 provinces in China. Among 1057 participants, 451(42.7%), 217(20.5%), and 389(36.8%) engaged in sex with regular partners only, casual partners only and both types in the last three months, respectively. Men engaged in sex only with regular partners in the last three months had a higher condom use self-efficacy than with other two types of partners (P < 0.01). Both social norms (regular partners: adjusted OR:1.59, 95% CI: 0.97-2.60; casual partners: adjusted OR: 1.58, 95% CI: 1.19-2.09; both types: adjusted OR: 1.48, 95% CI: 1.13-1.95) and self-efficacy (regular partners: adjusted OR: 2.88, 95% CI: 1.59-5.22; casual partners: adjusted OR: 2.35, 95% CI: 1.69-3.26; both types: adjusted OR: 2.45, 95% CI: 1.81-3.32) were positively associated with consistent condom use. No interaction effect was detected between condom social norms and self-efficacy on consistent condom use among Chinese MSM (p > 0.05).

Conclusions: Both social norms and self-efficacy were positively correlated with consistent condom use with any types of partners among Chinese MSM. Tailored interventions that aimed to improve social norms and self-efficacy has the potential to improve overall condom use among Chinese MSM.

Trial registration: ClinicalTrials.gov: NCT02516930 . August 6, 2015.

Keywords: Self-efficacy; Social norms; casual partners; consistent condom use; men who have sex with men; regular partners.

Conflict of interest statement

Ethics approval and consent to participate

Ethics review committees in China(Guangdong provincial center for Skin diseases and STI Control)and the United States(the University of North Carolina at Chapel Hill and the University of California, San Francisco) provided study approval, and participants completed an online informed consent process.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Musinguzi Geofrey, Bastiaens Hilde, Matovu Joseph K. B., Nuwaha Fred, Mujisha Geoffrey, Kiguli Juliet, Arinaitwe Jim, Van Geertruyden Jean-Pierre, Wanyenze Rhoda K. Barriers to Condom Use among High Risk Men Who Have Sex with Men in Uganda: A Qualitative Study. PLOS ONE. 2015;10(7):e0132297. doi: 10.1371/journal.pone.0132297.
    1. Guo Y, Li X, Song Y, Liu Y. Bisexual behavior among Chinese young migrant men who have sex with men: implications for HIV prevention and intervention. AIDS Care. 2012;24(4):451–458. doi: 10.1080/09540121.2011.613914.
    1. Wei C, Guadamuz TE, Stall R, Wong FY. STD prevalence, risky sexual behaviors, and sex with women in a national sample of Chinese men who have sex with men. Am J Public Health. 2009;99(11):1978–1981. doi: 10.2105/AJPH.2008.150037.
    1. Kong TS, Laidler KJ, Pang H. Relationship type, condom use and HIV/AIDS risks among men who have sex with men in six Chinese cities. AIDS Care. 2012;24(4):517–528. doi: 10.1080/09540121.2011.617411.
    1. Tang S, Tang W, Meyers K, Chan P, Chen Z, Tucker JD. HIV epidemiology and responses among men who have sex with men and transgender individuals in China: a scoping review. BMC Infect Dis. 2016;16(1):588. doi: 10.1186/s12879-016-1904-5.
    1. Zhongdan C, Schilling RF, Shanbo W, Caiyan C, Wang Z, Jianguo S. The 100% Condom Use Program: A demonstration in Wuhan, China. Eval Program Plann. 2008;31(1):10–21. doi: 10.1016/j.evalprogplan.2007.09.001.
    1. Qin Q, Tang W, Ge L, Li D, Mahapatra T, Wang L, Guo W, Cui Y, Sun J. Changing trend of HIV, Syphilis and Hepatitis C among Men Who Have Sex with Men in China. Sci Rep. 2016;6:31081.
    1. Lau JT, Cai W, Tsui HY, Chen L, Cheng J, Lin C, Gu J, Hao C. 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. AIDS Care. 2012;24(1):59–70. doi: 10.1080/09540121.2011.592813.
    1. Cai Y, Lau JT. Multi-dimensional factors associated with unprotected anal intercourse with regular partners among Chinese men who have sex with men in Hong Kong: a respondent-driven sampling survey. BMC infectious diseases. 2014;14:205.
    1. Latkin CA, Forman V, Knowlton A, Sherman S. Norms, social networks, and HIV-related risk behaviors among urban disadvantaged drug users. Soc Sci Med. 2003;56(3):465–476. doi: 10.1016/S0277-9536(02)00047-3.
    1. Thorpe L, Ford K, Fajans P, Wirawan DN. Correlates of condom use among female prostitutes and tourist clients in Bali, Indonesia. AIDS Care. 1997;9(2):181–198. doi: 10.1080/09540129750125208.
    1. Semple SJ, Patterson TL, Grant I. Partner type and sexual risk behavior among HIV positive gay and bisexual men: social cognitive correlates. AIDS Educ Prev. 2000;12(4):340.
    1. Miner MH, Peterson JL, Welles SL, Jacoby SM, Simon Rosser B. How do social norms impact HIV sexual risk behavior in HIV-positive men who have sex with men? Multiple mediator effects. J Health Psychol. 2009;14(6):761–770. doi: 10.1177/1359105309338976.
    1. Wagner GJ, Hoover M, Green H, Tohme J, Mokhbat J. Social, relational and network determinants of unprotected anal sex and HIV testing among men who have sex with men in Beirut, Lebanon. Int J Sexual Health. 2015;27(3):264–275. doi: 10.1080/19317611.2014.969467.
    1. Sohn A, Cho B. Knowledge, attitudes, and sexual behaviors in HIV/AIDS and predictors affecting condom use among men who have sex with men in South Korea. Osong Public Health and Research Perspectives. 2012;3(3):156–164. doi: 10.1016/j.phrp.2012.07.001.
    1. Janssen M, De Wit J, Stroebe W, Griensven F. Educational Status and Risk of HIV in Young Gay Men. J Health Psychol. 2000;5(4):487–499. doi: 10.1177/135910530000500407.
    1. Wei C, Cheung DH, Yan H, Li J, Shi L-e, Raymond HF. The Impact of Homophobia and HIV Stigma on HIV Testing Uptake among Chinese Men Who Have Sex with Men: A Mediation Analysis. Journal of acquired immune deficiency syndromes (1999) 2016;71(1):87–93.
    1. Zhou N, Bauermeister J, Guo W, Yu M, Yang J, Zheng M, Guo Y, Gong H, Gao Y, Jiang G. Condomless Anal Intercourse by Partner Type Among Chinese Men Who Have Sex With Men in Tianjin. AIDS Educ Prevent. 2018;30(1):63–71. doi: 10.1521/aeap.2018.30.1.63.
    1. Tang Weiming, Mao Jessica, Liu Chuncheng, Mollan Katie, Li Haochu, Wong Terrence, Zhang Ye, Tang Songyuan, Hudgens Michael, Qin Yilu, Ma Baoli, Liao Meizhen, Yang Bin, Ma Wei, Kang Dianmin, Wei Chongyi, Tucker Joseph D. Crowdsourcing health communication about condom use in men who have sex with men in China: a randomised controlled trial. The Lancet. 2016;388:S73. doi: 10.1016/S0140-6736(16)32000-1.
    1. Tang W, Han L, Best J, Zhang Y, Mollan K, Kim J, Liu F, Hudgens M, Bayus B, Terris-Prestholt F, et al. Crowdsourcing HIV Test Promotion Videos: A Noninferiority Randomized Controlled Trial in China. Clin Infect Dis. 2016;62(11):1436–1442. doi: 10.1093/cid/ciw171.
    1. Tang W, Wei C, Cao B, Wu D, Li KT, Lu H, Ma W, Kang D, Li H, Liao M, et al. Crowdsourcing to expand HIV testing among men who have sex with men in China: A closed cohort stepped wedge cluster randomized controlled trial. PLoS Med. 2018;15(8):e1002645. doi: 10.1371/journal.pmed.1002645.
    1. Ramanathan S, Chakrapani V, Ramakrishnan L, Goswami P, Yadav D, Subramanian T, George B, Paranjape R. Consistent condom use with regular, paying, and casual male partners and associated factors among men who have sex with men in Tamil Nadu, India: findings from an assessment of a large-scale HIV prevention program. BMC Public Health. 2013;13(1):827. doi: 10.1186/1471-2458-13-827.
    1. Lociciro S, Jeannin A, Dubois-Arber F. Men having sex with men serosorting with casual partners: who, how much, and what risk factors in Switzerland, 2007-2009. BMC Public Health. 2013;13(1):839. doi: 10.1186/1471-2458-13-839.
    1. DeHart DD, Birkimer JC. Trying to practice safer sex: Development of the sexual risks scale. J Sex Res. 1997;34(1):11–25. doi: 10.1080/00224499709551860.
    1. Coleman CL, Jemmott L, Jemmott JB, Strumpf N, Ratcliffe S. Development of an HIV risk reduction intervention for older seropositive African American men. AIDS Patient Care STDs. 2009;23(8):647–655. doi: 10.1089/apc.2008.0276.
    1. Frye V, Nandi V, Egan JE, Cerda M, Rundle A, Quinn JW, Sheehan D, Ompad DC, Van Tieu H, Greene E. Associations among neighborhood characteristics and sexual risk behavior among black and white MSM living in a major urban area. AIDS Behav. 2017;21(3):870–890. doi: 10.1007/s10461-016-1596-2.
    1. Li H, Xue L, Tucker JD, Wei C, Durvasula M, Hu W, Kang D, Liao M, Tang W, Ma W. Condom use peer norms and self-efficacy as mediators between community engagement and condom use among Chinese men who have sex with men. BMC Public Health. 2017;17(1):641.
    1. Brafford LJ, Beck KH. Development and validation of a condom self-efficacy scale for college students. J Am Coll Heal. 1991;39(5):219–225. doi: 10.1080/07448481.1991.9936238.
    1. Reisner SL, Hughto JMW, Pardee DJ, Kuhns L, Garofalo R, Mimiaga MJ. LifeSkills for Men (LS4M): Pilot Evaluation of a Gender-Affirmative HIV and STI Prevention Intervention for Young Adult Transgender Men Who Have Sex with Men. J Urban Health. 2016;93(1):189–205. doi: 10.1007/s11524-015-0011-z.
    1. Frye V, Nandi V, Egan J, Cerda M, Greene E, Van Tieu H, Ompad DC, Hoover DR, Lucy D, Baez E, et al. Sexual Orientation- and Race-Based Discrimination and Sexual HIV Risk Behavior Among Urban MSM. AIDS Behav. 2015;19(2):257–269. doi: 10.1007/s10461-014-0937-2.
    1. Theall KP, Sterk CE, Elifson KW, Kidder D. Factors Associated with Positive HIV Serostatus among Women Who Use Drugs: Continued Evidence for Expanding Factors of Influence. Public Health Rep. 2003;118(5):415–424. doi: 10.1016/S0033-3549(04)50273-X.
    1. Lau J, Lin C, Hao C, Wu X, Gu J. Public health challenges of the emerging HIV epidemic among men who have sex with men in China. Public Health. 2011;125(5):260–265. doi: 10.1016/j.puhe.2011.01.007.
    1. Hu Y, Lu H, Raymond HF, Sun Y, Sun J, Jia Y, He X, Fan S, Xiao Y, McFarland W, et al. Measures of condom and safer sex social norms and stigma towards HIV/AIDS among Beijing MSM. AIDS Behav. 2014;18(6):1068–1074. doi: 10.1007/s10461-013-0609-7.
    1. Amirkhanian YA, Kelly JA, Kirsanova AV, DiFranceisco W, Khoursine RA, Semenov AV, Rozmanova VN. HIV risk behaviour patterns, predictors, and sexually transmitted disease prevalence in the social networks of young men who have sex with men in St Petersburg, Russia. Int J STD AIDS. 2006;17(1):50–56. doi: 10.1258/095646206775220504.
    1. Fishbein M, Hennessy M, Kamb M, Bolan GA, Hoxworth T, Iatesta M, Rhodes F, Zenilman JM. Using intervention theory to model factors influencing behavior change: Project RESPECT. Eval Health Prof. 2001;24(4):363–384. doi: 10.1177/01632780122034966.
    1. Liu H, Liu H, Cai Y, Rhodes AG, Hong F. Money boys, HIV risks, and the associations between norms and safer sex: a respondent-driven sampling study in Shenzhen, China. AIDS Behav. 2009;13(4):652–662. doi: 10.1007/s10461-008-9475-0.
    1. Hart TA, Heimberg RG. Social anxiety as a risk factor for unprotected intercourse among gay and bisexual male youth. AIDS Behav. 2005;9(4):505–512. doi: 10.1007/s10461-005-9021-2.
    1. Safren SA, Blashill AJ, Lee JS, O'Cleirigh C, Tomassili J, Biello KB, Mimiaga MJ, Mayer KH. Condom-use self-efficacy as a mediator between syndemics and condomless sex in men who have sex with men (MSM) Health Psychol. 2018;37(9):820–827. doi: 10.1037/hea0000617.
    1. Chamratrithirong A, Kaiser P. The dynamics of condom use with regular and casual partners: analysis of the 2006 national sexual behavior survey of Thailand. PLoS One. 2012;7(7):e42009. doi: 10.1371/journal.pone.0042009.
    1. Newcomb ME, Mustanski B. Cognitive influences on sexual risk and risk appraisals in men who have sex with men. Health Psychol. 2014;33(7):690–698. doi: 10.1037/hea0000010.
    1. Jemmott Iii JB, Jemmott LS, O’Leary A, Icard LD, Rutledge SE, Stevens R, Hsu J, Stephens AJ. On the Efficacy and Mediation of a One-on-One HIV Risk-Reduction Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial. AIDS Behav. 2015;19(7):1247–1262. doi: 10.1007/s10461-014-0961-2.
    1. Chow EPF, Wilson DP, Zhang L. Patterns of Condom Use Among Men Who Have Sex with Men in China: A Systematic Review and Meta-Analysis. AIDS Behav. 2012;16(3):653–663. doi: 10.1007/s10461-011-9935-9.
    1. Elford J, Bolding G, Maguire M, Sherr L. Sexual risk behaviour among gay men in a relationship. AIDS. 1999;13(11):1407–1411. doi: 10.1097/00002030-199907300-00019.
    1. Lau JTF, Cai W, Tsui HY, Cheng J, Chen L, Choi KC, Lin C. Prevalence and Correlates of Unprotected Anal Intercourse Among Hong Kong Men Who Have Sex with Men Traveling to Shenzhen, China. AIDS Behav. 2013;17(4):1395–1405. doi: 10.1007/s10461-012-0244-8.
    1. Kumar GA, Dandona R, Poluru R, Chandran SA, Alary M, Dandona L. Patterns of condom use by men who have sex with men before and after the Avahan intervention in Andhra Pradesh state of India. BMC Public Health. 2014;14(1):64. doi: 10.1186/1471-2458-14-64.
    1. Zhang L, Chow EPF, Wilson DP. Distributions and trends in sexual behaviors and HIV incidence among men who have sex with men in China. BMC Public Health. 2012;12(1):546. doi: 10.1186/1471-2458-12-546.
    1. Hao C, Lau JTF, Zhao X, Yang H, Huan X, Yan H, Gu J. Associations Between Perceived Characteristics of the Peer Social Network Involving Significant Others and Risk of HIV Transmission Among Men Who Have Sex with Men in China. AIDS Behav. 2014;18(1):99–110. doi: 10.1007/s10461-013-0492-2.
    1. Chow EP, Jing J, Feng Y, Min D, Zhang J, Wilson DP, Zhang X, Zhang L. Pattern of HIV testing and multiple sexual partnerships among men who have sex with men in China. BMC Infect Dis. 2013;13(1):549. doi: 10.1186/1471-2334-13-549.
    1. Mitchell JW, Petroll AE. Factors Associated with Men in HIV-Negative Gay Couples Who Practiced UAI Within and Outside of Their Relationship. AIDS Behav. 2013;17(4):1329–1337. doi: 10.1007/s10461-012-0255-5.
    1. Wang Cheng, Mollan Katie R, Hudgens Michael G, Tucker Joseph D, Zheng Heping, Tang Weiming, Ling Li. Generalisability of an online randomised controlled trial: an empirical analysis. Journal of Epidemiology and Community Health. 2017;72(2):173–178. doi: 10.1136/jech-2017-209976.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren