Prevalence and correlates of tobacco use among a sample of MSM in Shanghai, China

An Integrative Psychological Model of Risk Factors for Suicidal Ideation and Behavior Among Israeli LGBT Individuals

Lesbians, gays, bisexuals, and transgender individuals (LGBT) are at high risk for suicide. This study aimed to examine an integrative psychological model of risk factors among LGBT individuals and explore the psychological pathways connecting social stigma, mental pain, and interpersonal characteristics to suicidal ideation and behavior (SIB) in this population. LGBT adults (N = 473) responded to an online questionnaire about stigma, mental pain, interpersonal characteristics, as well as suicidal ideation and behaviors. We found group differences between LGBT respondents in the study variables: Transgender people reported the highest levels of SIB and depression, closely followed by bisexuals. The association between stigma-related variables and SIB was mediated by depression, entrapment, and perceived burdensomeness. These results highlight the role of entrapment and burdensomeness in facilitating suicide risk among LGBT adults, as they may increase the damaging effect of negative societal stigma against LGBTs and thus, elevate the suicide risk in this population.

Internalized Homonegativity is Indirectly Associated with Smoking Status through Somatic Anxiety

Objective

In this study, we examined how internalized homonegativity (IH), a non-adaptive cognitive response to lesbian, gay, and bisexual (LGB) minority stressors, related to the manifestation of somatic anxiety symptoms and reduced the likelihood of being a former smoker.

Methods

Participants (N = 77) smoked ≥ 100 cigarettes in their lifetime, some of whom successfully quit their use (N = 23 former smokers). The Lesbian, Gay, and Bisexual Identity Scale and the State-Trait Inventory for Cognitive and Somatic Anxiety were used to assess IH and somatic anxiety.

Results

Current smokers experienced higher IH rates than former smokers (former = 0, current = 1; b = .65, p < .05). IH was positively associated with somatic anxiety (b = .17, p < .001), and the association between IH and smoking status was mediated through somatic anxiety (b = .17; CI = [.0002, .6539]).

Conclusion

One's experience with IH may be a risk factor for psychological distress and continued smoking. Current findings can aid in the development of future longitudinal or experimental studies to examine the causality between IH and somatic anxiety and include confounding variables.

Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service-Delivered Smoking Cessation Intervention for People with HIV in China: A Qualitative Study (Preprint)

Background

China, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population.

Objective

This study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages.

Methods

We recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups.

Results

A total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level.

Conclusions

We identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China.

Minority stress, depression, and cigarette smoking among Chinese gay versus bisexual men: a two-group structural equation model analyses

Background

Literature in the West suggested that bisexual men have a higher smoking rate compared to gay men. Data on patterns of smoking among gay and bisexual men are limited in Eastern Asian countries like China. This study examined the cigarette smoking prevalence for gay versus bisexual men in China and their unique minority stress - smoking pathways.

Methods

Between September 2017 and November 2018, we surveyed a convenience sample of 538 gay men and 138 bisexual men recruited from local sexual minority organizations in four metropolitan cities in China (i.e., Beijing, Wuhan, Nanchang, and Changsha). Measures included sexual orientation, sociodemographics, theory-based minority stressors, depressive symptoms, and past 30-day cigarette smoking. Two-group (gay men vs. bisexual men) structural equation modeling (SEM) was used to test possible distinct mechanisms between theory-based stressors, depressive symptoms, and cigarette smoking among gay men and bisexual men, respectively.

Results

The mean age of participants was 26.51 (SD = 8.41) years old and 76.3% of them had at least a college degree. Bisexual men reported a higher rate of cigarette smoking compared to gay men (39.9% vs. 27.3%). Two-group SEM indicated that the pathways for cigarette smoking were not different between gay and bisexual men. Higher rejection anticipation was associated with greater depressive symptoms (standardized β = 0.32, p < .001), and depressive symptoms were not associated with cigarette smoking.

Conclusions

Minority stress, specifically rejection anticipation, may be critical considerations in addressing depressive symptoms, but not smoking, among both gay and bisexual men in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10888-5.

A three-arm randomised controlled trial to evaluate the efficacy of a positive psychology and social networking intervention in promoting mental health among HIV-infected men who have sex with men in China

AIMS

There is a lack of mental health promotion and treatment services targeting HIV-positive men who have sex with men (HIVMSM) in China. The aim of this study was to evaluate the mental health promotion efficacy of an online intervention that combined Three Good Things (TGT) with electronic social networking (TGT-SN) and an intervention that used TGT only (TGT-only), compared with a control group.

METHODS

We conducted a randomised controlled trial among HIVMSM in Chengdu, China. The participants were randomly assigned to the TGT-SN, TGT-only, and control groups. The participants in the TGT-SN group were divided into five social network groups and asked to post brief messages to the group about three good things that they had experienced and for which they felt grateful. The participants in the TGT-only group were only required to write down their three good things daily without sharing them with others. The control group received information about mental health promotion once a week for a month. The primary outcome was probable depression. Secondary outcomes were anxiety, positive and negative affect, gratitude, happiness and social support. These outcomes were assessed at baseline, 1, 3, 6 and 12 months after the intervention. Repeated-measures analyses were conducted using generalised estimation equations. The study was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC-13003252).

RESULTS

Between June 2013 and May 2015, 404 participants were enrolled and randomly assigned to either the TGT-SN (n = 129), TGT-only (n = 139) or control group (n = 136). The main effects of TGT-SN (adjusted odds ratio (aOR) = 0.75, 95% CI 0.52-1.09; p = 0.131) and TGT-only (aOR = 0.83, 95% CI 0.57-1.21; p = 0.332) in reducing depression were statistically non-significant. The participants of the TGT-SN group showed significantly lower anxiety symptoms (aOR = 0.62, 95% CI 0.43-0.89; p = 0.009) and negative affect (β = -1.62, 95% CI 2.98 to -0.26; p = 0.019) over time compared with those of the control group. No significant main effect was found for any secondary outcomes for the TGT-only group.

CONCLUSIONS

The novel intervention combining the TGT exercise with electronic social networking was found effective in reducing anxiety and negative affect among HIVMSM.

Cigarette Smoking and Its Associations with Substance Use and HIV-Related Sexual Risks among Chinese Men Who Have Sex with Men

China has the largest population of male smokers globally. Men who have sex with men (MSM) are at greater risk of cigarette smoking compared to the general population. Limited data are available regarding cigarette smoking and its associations with other health issues among Chinese MSM. Eligible MSM (n = 1100) were recruited from mainland China using an online national cross-sectional survey conducted in 2014-2015. Socio-demographic characteristics, smoking behavior, substance use, homosexual stigma and outness, HIV-related risk behavior, and HIV status were obtained. Logistic regression analyses were performed to evaluate predictors of current cigarette smoking frequency and the co-occurrence of smoking and drug use. Nearly 41% (n = 446) of participants had ever smoked cigarettes; 25% (n = 278) were current frequent smokers; and 13% (n = 138) were current infrequent smokers. Factors associated with a history of smoking included age, employment status, and monthly salary. Risk factors associated with current frequent smoking included self-identification as gay, having female sexual partners, binge drinking, drug use, higher levels of homosexual stigma, and being partially or fully "out" as gay. Adjusted multinomial analysis showed that human immunodeficiency virus (HIV) related risks, including risky sexual behaviors, lack of condom use, and a reported history of sexually transmitted infections (STIs), were associated with co-occurrence of current smoking and drug use. Cigarette smoking rates remain high among MSM in China. Cigarette smoking is associated with binge drinking, drug use, and HIV-related risks in this community. There is a clear opportunity for smoking cessation interventions to be linked with HIV and substance use prevention interventions, thereby addressing multiple health issues simultaneously for the MSM community in China.

Tobacco, Alcohol, Drug Use, and Intimate Partner Violence Among MSM Living With HIV

Men who have sex with men (MSM) and are living with HIV have reported high rates of intimate partner violence (IPV) and substance use. We examined relationships between accumulative IPV, incidents of IPV, and numbers of substances used. One hundred twenty Taiwanese MSM living with HIV completed a cross-sectional survey. Accumulative IPV was assessed by summing the number of 15 types of IPV experienced in the previous year; substance use was measured by any use of alcohol, tobacco, or other drugs during the previous week. In multivariate analysis, IPV was not associated with tobacco use but was positively associated with alcohol and other drug use and significantly associated with the probability of using multiple substances. MSM living with HIV who experienced greater IPV were more likely to use alcohol and other drugs and were more likely to use more than one substance. Health care providers screening for IPV should also screen for substance use.

Tobacco use and HIV symptom severity in Chinese people living with HIV

Exposure to nicotine among people living with HIV (PLWH) may impact physical health as indicated by experienced symptoms. Yet, the empirical evidence documenting the relations between tobacco use and symptom experiences among PLWH remains limited. This study aims to assess the relationships between tobacco use and HIV symptoms through a cross-sectional survey conducted in Beijing and Shanghai. The WHO ASSIST screening test was used for frequency of tobacco use. Sixty-four items from the revised signs and symptoms checklist for persons with HIV disease (SSC-HIVrev) were used. "Total number of symptoms" was created by summing all the binary coded and "Maximal symptom severity" was created by taking the maximal severity level across all symptoms for each participant. After controlling for confounding variables, tobacco use was not associated with the total number of symptom, yet was associated with the maximal symptom severity. This study documents the link between tobacco use and experienced symptoms among PLWH by demonstrating that higher frequency of tobacco use is associated with greater odds of reporting more severe symptoms. Smoking cessation strategies should be integrated into symptom management interventions for PLWH to optimize their effectiveness.

Changing Epidemic of HIV and Syphilis Among Resident and Migrant Men Who Have Sex with Men in Jiangsu, China

Men who have sex with men (MSM) in China face high rates of HIV and syphilis infection exacerbated by internal migration. Studies on the differences of HIV and syphilis epidemics changing trends in high-risk behaviors and geographic distribution between resident and migrant MSM in Jiangsu, China were conducted. MSM were recruited from 14 surveillance sites in the serial cross-sectional study. Data on demographics, sexual behaviors, HIV and syphilis prevalence were collected. Participants were classified as residents or migrants based on household registration. During 2010–2014, 19,750 MSM were investigated. Engaged in anal sex (76.3% to 80.2%, P < 0.01) as well as received HIV-related services (72.1% to 79.2%, P < 0.01) were increasing. In contrast, engaged in commercial anal sex with males (7.4% to 5.0%, P < 0.01) and drug use (1.6% to 0.8%, P < 0.01) were decreasing. HIV prevalence ranged between 8.6% to 9.6%, while syphilis prevalence decreased over time (13.4–6.8%, P < 0.01). Further, we found that migrant MSM were more likely to engage in condomless anal sex, also had a higher HIV and syphilis prevalence than resident. During the study period, while syphilis prevalence decreased, higher rates of risk behaviors among migrant MSM called for targeted intervention strategies to reduce the HIV transmission.

Roles of Self-Stigma, Social Support, and Positive and Negative Affects as Determinants of Depressive Symptoms Among HIV Infected Men who have Sex with Men in China

Poor mental health was prevalent among HIV positive men who have sex with men (HIVMSM), and a tremendous burden extents on their families and society. The present study investigated the prevalence of depression and its relationship with social support, HIV self-stigma, positive affect and negative affect among 321 HIVMSM in Chengdu, China. The study was conducted during July 2013 through October 2013. Findings showed that 55.8 % of the participants had mild to severe depression. The results of structural equation modeling showed that social support and positive affect were negatively associated with depression, while HIV self-stigma and negative affect were positively associated with depression. Social support, positive affect, and negative affect mediated the association between HIV self-stigma and depression. The hypothesized model had a satisfactory fit. Interventions improving mental health among this population are warranted.

HIV/STIs risks between migrant MSM and local MSM: a cross-sectional comparison study in China

Background. Internal migration plays a significant role in China’s HIV epidemic. However, few studies have directly compared migrant men who have sex with men (MSM) with local MSM with regard to HIV/sexually transmitted infections (STIs) risks.

Methods. We conducted a study in Guangzhou, China, with the aim of understanding the differences in HIV/STIs risks between migrant MSM and local MSM. A cross-sectional study was conducted among 273 migrant MSM and 249 local MSM in Guangzhou, China. Their behavioral and serologic data on HIV/syphilis were collected and compared between the two groups. A multivariate logistic regression was used to estimate the associations between HIV/STIs risks and migratory status.

Results. Migrant MSM, compared to local MSM, have higher odds of reporting unprotected anal intercourse (UAI) (OR = 1.4; 95% CI [0.9–2.0]) and having multiple homosexual partners (OR = 1.2; 95% CI [0.8–1.8]). A lower rate of condom use at homosexual debut was reported in migrant MSM than in local MSM (OR = 0.7; 95% CI [0.5–0.9]). Migrant MSM have less odds of reporting HIV/STIs testing in the previous 6 months relative to local MSM (OR = 0.5; 95% CI [0.4–0.8]). In addition, migrant MSM demonstrated a lower level of HIV knowledge than local MSM (OR = 0.4; 95% CI [0.2–0.8]).

Conclusion. Migrant MSM are more likely to engage in sexual risk behaviors, report a lower level of HIV knowledge and have less access to HIV/STIs testing. Further comprehensive interventions targeting migrant MSM are urged.

Smoking Prevalence and Associated Factors as well as Attitudes and Perceptions towards Tobacco Control in Northeast China

Objectives: The present study aimed to investigate the prevalence of smoking and environmental tobacco smoke (ETS), the associated factors of current smoking among adults, and their attitudes and perceptions towards tobacco control. Methods: A population-based cross-sectional survey was conducted in 2012 using a self-reported questionnaire. A representative sample of adults aged 18–79 years was collected in the Jilin Province of Northeast China by a multistage stratified random cluster sampling design. Descriptive data analysis was conducted, and 95% confidence intervals (CI) of prevalence/frequency were calculated to enable comparisons between the alleged differences and similarities. Multivariable logistic regressions were used to examine the risk factors associated with current smoking. Results: 21,435 adults responded to the survey (response rate: 84.9%). The overall prevalence of ever smoking, current smoking, and former smoking or smoking cessation was 39.1% (95% CI: 38.3–39.9), 31.8% (95% CI 31.1–32.6), and 7.3% (95% CI: 6.9–7.7), respectively. The proportion of ETS exposure among adult non-smokers in Jilin Province was 61.1% (95% CI: 60.1–62.1), and 23.1% (95% CI: 22.3–24.0) of the non-smokers reported daily ETS exposure. The proportion of ETS exposure at home was 33.4% (95% CI: 32.5–34.4), but the proportion of ETS exposure at restaurants was lower (6.5%) (95% CI: 6.0–7.1). More than 90% of the participants had positive attitudes and perceptions towards tobacco control, but 23.2% (95% CI: 22.5–24.0) of them did not agree with the perception of “smoking is fully quit in public places”, and almost half of the adults (49.5%) (95% CI: 48.7–50.3) did not agree with the perception of “hazards of low-tar cigarettes are equal to general cigarettes”. Conclusions: Smoking and exposure to ETS are prevalent among adults from the Jilin Province of Northeast China. Our findings suggest that tobacco control should be advocated in Northeast China. Anti-smoking campaigns and legislation should be built into the public health curriculum and government policy.

Drug use and sexual behaviors among MSM in China

BACKGROUND

This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka "money boys") in China.

OBJECTIVES

Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs.

METHODS

The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM.

RESULTS

MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex.

CONCLUSIONS

It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.

High incidence of HIV and syphilis among migrant men who have sex with men in Beijing, China: a prospective cohort study

OBJECTIVES

The purpose of the study was to investigate the incidence of HIV and syphilis and their related factors, as well as to examine the predictors associated with seroconversion among migrant men who have sex with men (MSM) in Beijing, China.

DESIGN

Prospective cohort study.

SETTING

Beijing, China.

PARTICIPANTS

511 HIV-negative migrant MSM.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sociodemographic and behavioural information of participants, HIV and syphilis incidence rates, and factors associated with HIV/syphilis seroconversion and cohort retention.

RESULTS

Of the 511 participants, 60.3% (308) and 52.4% (273) were retained at the 4- and 8-month follow-up visits, respectively. The HIV and syphilis incidence rates were 7.83 (95% CI 4.48 to 12.72) and 11.11 (95% CI 6.47 to 17.80) per 100 person-years, respectively. HIV seroconversion was significantly associated with 'had first anal intercourse at age 15 or younger' (adjusted HR (aHR) 9.20, 95% CI 1.94 to 43.56) and 'ever had group sex' (aHR 4.30, 95% CI 1.40 to 13.18). Bisexual orientation (aHR 5.09, 95% CI 1.02 to 25.57) was significantly associated with syphilis seroconversion. Predictors associated with both 4- and 8-month retention rates included age ≥25 years old and living in Beijing for more than 1 year.

CONCLUSIONS

The high incidence of HIV and syphilis among migrant MSM is a cause for concern. A comprehensive strategy should be implemented to maintain a higher retention rate among migrant MSM.

Association between alcohol use and HIV-related sexual risk behaviors among men who have sex with men (MSM): findings from a multi-site bio-behavioral survey in India

This paper examines the association between alcohol use and HIV-related sexual risk behaviors among men who have sex with men (MSM). A cross-sectional bio-behavioral survey was conducted among 3,880 MSM, recruited using time-location cluster sampling from cruising sites in three Indian states. Nearly three-fifths of the participants reported alcohol use. Among frequent users (40 % of the sample), defined as those who consumed alcohol daily or at least once a week, 66 % were aged 25 years and above, 53 % self-identified as kothi (feminine/receptive), and 63 % consistently used condoms with male paying partners. Multivariate logistic regression demonstrated that frequent users were more likely to be aged 25 years and above, less likely to self-identify as kothi, and less likely to consistently use condoms with male paying (AOR = 0.7; 95 % CI 0.5–0.9) and male regular (AOR = 0.7; 95 % CI 0.6–0.9) partners. HIV prevention interventions for MSM need to provide tailored information on alcohol use-related sexual risk, especially for MSM in sex work and MSM with male regular partners.

Utilization of cessation resources among HIV-positive and HIV-negative men who smoke and who have sex with men in Chengdu, China

INTRODUCTION

Given the implications for smoking among individuals living with HIV and the high rates of smoking and HIV among men who have sex with men (MSM) in China, we examined differences in prior use of and future interest in various cessation resources among MSM smokers with or without HIV.

METHODS

We conducted a cross-sectional survey of 381 MSM; HIV status was provided by 350 MSM, and complete data was provided by a total of 344 (188 HIV-positive and 156 HIV-negative) current smokers (past 30 days) recruited by a nongovernmental organization in Chengdu in 2012-2013. Participants reported tobacco and alcohol use; psychosocial factors; past-year quit attempts; health care provider interactions on smoking; and prior use of and interest in cessation resources.

RESULTS

Smokers living with HIV were more likely to have used behavioral interventions (p < .001) and pharmacotherapy (p = .033). Those who were HIV-positive were also more interested in behavioral interventions (p = .002) and pharmacotherapy (p = .008). Correlates of interest in behavioral interventions in the regression model included lower cigarette consumption (p = .011), higher confidence in quitting (p = .035), greater likelihood of attempting to quit in the past year (p = .026), and being HIV-positive (p = .008). Correlates of interest in pharmacotherapy included greater depressive symptoms (p = .047) and being HIV-positive (p = .015).

CONCLUSIONS

Smokers living with HIV were more likely to have ever attempted to quit smoking, to have used cessation resources, and to be interested in using cessation aids. These findings indicate the promise of greater dissemination of cessation resources, particularly if Chinese clinical practices are strengthened to offer cessation support.

Alcohol use among Chinese men who have sex with men: an epidemiological survey and meta-analysis

The HIV/AIDS epidemic among Chinese men who have sex with men (MSM) has become a significant public health concern. Knowledge of alcohol consumption in this population is limited. In this study, 1,155 Chinese MSM were surveyed to assess alcohol use and its correlates. A meta-analysis was also performed to aggregate pooled prevalence of current alcohol use. MSM who were unmarried (aOR: 1.87; 95% CI: 1.29-2.71) or unemployed/retired (aOR: 2.77; 95% CI: 1.73-4.45) were more likely to drink alcohol more than once per week. MSM who consumed alcohol more than once per week were more likely to use drug (P < 0.01), have sex with women (P < 0.01), have unprotected insertive (P = 0.04) or receptive (P = 0.03) anal sex with men, have more than 10 lifetime male sex partners (P < 0.01), predominantly practice insertive anal sex (P < 0.01), and trade sex for money (P < 0.01). Pooled overall alcohol use prevalence was 32%. Pooled prevalence for MSM who drank alcohol more than once per week and who drank alcohol before sex with male partners was 23%. Our findings provide the basis for further exploring the alcohol-HIV association and developing risk reduction interventions.

Healthcare provider intervention on smoking and quit attempts among HIV-positive versus HIV-negative MSM smokers in Chengdu, China

Given the implications for smoking among HIV-positive individuals and high smoking and HIV rates among men who have sex with men (MSM) in China, we examined sociodemographic, smoking-related, psychosocial, and substance use factors in relation to HIV status; receiving some sort of healthcare provider intervention regarding smoking; and having made a quit attempt in the past year in a sample of MSM smokers in Chengdu. We conducted a cross-sectional survey of 381 MSM smokers recruited by a nongovernmental organization in Chengdu in 2012-2013. Of these, 350 disclosed their HIV status and 344 (188 HIV-positive and 156 HIV-negative) provided completed data. Half (50.0%) reported at least one quit attempt in their lifetime; 30.5% reported a quit attempt in the past year. The majority (59.4%) reported that a healthcare provider had intervened in some way (assessed smoking, advised quitting, provided assistance), most commonly by assessing smoking status (50.0%). HIV-positive individuals were more likely to report a healthcare provider intervening on their smoking (p < .001). Those who received provider intervention were more likely to have attempted to quit ever (p = .009) and in the past year (p < .001). Those HIV-positive were more likely to have attempted to quit since diagnosis if a provider had intervened (p = .001). Multivariate regression documented that being HIV-positive (p < .001), greater cigarette consumption (p = .02), less frequent drinking (p = .03), and greater depressive symptoms (p = .003) were significant correlates of healthcare provider intervention. Multivariate regression also found that healthcare provider intervention (p = .003), older age (p = .01), and higher autonomous motivation (p = .007) were significant correlates of attempting to quit in the past year. Given the impact of healthcare provider intervention regarding smoking on quit attempts among MSM, greater training and support is needed to promote consistent intervention on smoking in the clinical setting among HIV-positive and HIV-negative MSM smokers.

Tobacco use among HIV-infected individuals in a rural community in Yunnan Province, China

OBJECTIVE

To examine the prevalence and correlates of smoking versus tobacco chewing, and potential gender differences in tobacco use among HIV-infected individuals in a rural community in Yunnan Province, China.

METHOD

A cross-sectional design using face-to-face interviews.

RESULTS

Among the participants, 301 (66.2%) were male; 79 (17.4%) were ethnic Han, 310 (68.1%) were Jingpo minority, 62 (13.6%) were Dai minority; 17.8% had no formal education and 55.6% had only primary school education; 15.4% were never married; 40% reported drinking in the past 30 days; 55.4% had ever used drugs; and 67% were currently receiving antiretroviral therapy (ART). The mean age of the study participants was 38.1 years (SD=8.8). About 62% were current cigarette smokers. Current cigarette smoking was positively associated with being male (OR=142.43, 95% CI: 35.61-569.72) and current drinking (OR=7.64, 95% CI: 2.68-21.81), as well as having ever used drugs (OR=4.03, 95% CI: 1.31-12.35). Among current smokers, 67.6% were heavy smokers (smoked at least 20 cigarettes per day). Those who were older than 46 years of age (OR=9.68, 95% CI: 1.41-66.59) and current drinkers (OR=2.75, 95% CI: 1.56-4.83) were more likely to be heavy smokers. Approximately 9% were currently used chewing tobacco. Those who were female (OR=41.29, 95% CI: 8.53-199.93) and current drinkers (OR=3.22, 95% CI: 1.02-10.16) were more likely to use chewing tobacco. All who used chewing tobacco were ethnic minorities.

CONCLUSIONS

Cigarette smoking and use of chewing tobacco were highly prevalent among HIV-infected individuals in rural Yunnan, underscoring the urgent need for tobacco prevention and intervention programs tailored for this population.

Addressing Health Disparities among Men: Demographic, Behavioral and Clinical Characteristics of Men who have Sex with Men Living in Puerto Rico

The objective of this study was to compare sociodemographic, behavioral and clinical characteristics associated with HIV among Men who have sex with Men (MSM) and men who have sex with women (MSW) in Puerto Rico. Data from a population-based cross-sectional study in PR (2005-2008) was analyzed. Descriptive statistics were used to describe the study sample and bivariate analyses were performed to identify differences of sociodemographic, behavioral and clinical characteristics between MSM and MSW. Exact logistic regression models adjusting for age were constructed for each risk behavior associated to MSM in bivariate analysis. Of the 674 men interviewed, 6.1% (n=41) reported ever having sex with men. Age-adjusted logistic regression models indicated that MSM were significantly more likely than MSW to have first sexual intercourse before the age of 15 (POR=2.6; 95%CI= 1.3, 5.3) and have at least 10 lifetime sex partners (POR=2.8; 95%CI= 1.4,5.9). Also, MSM were significantly more likely to report lifetime use of marihuana (POR=2.7; 95%CI= 1.3,5.8), cocaine (POR=2.5; 95%CI= 1.2,5.0), amphetamines (POR=3.8; 95%CI= 1.4,9.2) and sedatives or tranquilizers (POR=3.3; 95%CI= 1.4,7.2). Also, MSM were 13 times more likely to be HIV seropositive as compared to MSW (POR=13.3; 95%CI=1.7,102.0). In this population-based sample of men living in Puerto Rico, self-reported same-sex behavior is strongly associated with HIV, and other behavioral factors associated with HIV. Future targeted research is still necessary for the development of intervention programs among MSM in Puerto Rico.

A syndemic including cigarette smoking and sexual risk behaviors among a sample of MSM in Shanghai, China

OBJECTIVES

We explored possible correlates of cigarette smoking and their associations with levels of smoking among a sample of Chinese men who have sex with men (MSM). We also explored the syndemic associations of substance use and psychosocial problems on sexual risk behaviors.

METHODS

Cross-sectional data collection from 404 MSM in Shanghai, China.

RESULTS

MSM exhibit a high prevalence of smoking (66.3%). Both light and heavy smoking were associated with alcohol and drug use, depression, intimate partner violence, sexual attitudes, and gay identity (though the associations for light smokers were moderate compared to those for heavy smokers).

CONCLUSIONS

Our findings indicate the presence of a health syndemic among MSM, and suggest that smoking prevention and cessation and other substance abuse interventions should be integrated into efforts preventing sexual risk behaviors among MSM.

Substance Use and Sexual Risks Among General MSM and Money Boys in Shanghai, China

In China, men who have sex with men (MSM) are at high risk for substance use, HIV, and other sexually transmitted infections (STIs). However, there has been little research into their drug use and the sexual behaviors they engage in after drug and alcohol use. Using respondent-driven sampling methodology, this cross-sectional study of 404 MSM described drug use and examined sexual behaviors after drug and alcohol use among general MSM and money boys (those who engage in same-sex commercial sex) in Shanghai, China. Money boys reported using more drugs in the last week, 3 months and ever, and having sex after drinking and sex after using drugs more frequently than general MSM. It is vital to continue research and begin science-based interventions in these high-risk and underserved populations.

Comprehensive clinical care for men who have sex with men: an integrated approach

Men who have sex with men (MSM) have unique health-care needs, not only because of biological factors such as an increased susceptibility to infection with HIV and sexually transmitted infections associated with their sexual behaviour, but also because of internalisation of societal stigma related to homosexuality and gender non-conformity, resulting in depression, anxiety, substance use, and other adverse outcomes. Successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive clinical care programmes for MSM that address these health disparities and root causes of maladaptive behaviour (eg, societal homophobia). Health-care providers need to become familiar with local outreach agencies, hotlines, and media that can connect MSM with positive role models and social opportunities. Research is needed to understand how many MSM lead resilient and productive lives in the face of discrimination to develop assets-based interventions that build on community support. Optimum clinical care for sexual and gender minorities is a fundamental human right. MSM deserve to be treated with respect, and health-care providers need to interact with them in ways that promote disclosure of actionable health information.

A systematic review of the aetiology of tobacco disparities for sexual minorities

OBJECTIVE

To conduct a systematic review of the literature examining risk factors/correlates of cigarette smoking among lesbian, gay and bisexual (ie, sexual minority) populations.

METHODS

Sets of terms relevant to sexual minority populations and cigarette smoking were used in a simultaneous search of 10 databases through EBSCOhost. The search was limited to the peer-reviewed literature up to January 2011, using no geographic or language limits. For inclusion, the paper was required to: (1) have been written in English, (2) have sexual minorities (defined by either attraction, behaviour, or identity) included in the study population and (3) have examined some form of magnitude of association for risk factors/correlates of any definition of cigarette smoking. A total of 386 abstracts were reviewed independently, with 26 papers meeting all inclusion criteria. Abstracts were reviewed and coded independently by authors JB and JGLL using nine codes derived from the inclusion/exclusion criteria.

RESULTS

Studies used various measures of sexual orientation and of smoking. Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. Some studies also indicated common smoking risk factors experienced at higher rates among sexual minorities, including stress, depression, alcohol use and victimisation.

CONCLUSIONS

This review identified risks that were associated with sexual minority status and common to the general population but experienced at potentially higher rates by sexual minorities. Government and foundation funds should be directed towards research on the origins of this disparity.