1
|
Ruiz-Robledillo N, Clement-Carbonell V, Ferrer-Cascales R, Portilla-Tamarit I, Alcocer-Bruno C, Gabaldón-Bravo E. Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life. Psychol Res Behav Manag 2021; 14:2103-2114. [PMID: 34938135 PMCID: PMC8687686 DOI: 10.2147/prbm.s332494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction The human immunodeficiency virus (HIV) stills remains a serious public health problem. HIV acquisition has several negative health consequences, such as a cognitive deterioration or health-related quality of life (HRQoL) impairment. Although these negative consequences could be directly related to a significant increase in self-stigma in this population, few previous studies have analysed the possible associations between these variables. This is especially the case in specific groups of people living with HIV, such as men who have sex with men who could be at a greater risk of stigmatisation. The main aim of the present study was to evaluate the association between cognitive functioning, HRQoL and self-stigma in a group of men with HIV who have sex with men. Methods The present study was conducted in the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). The final sample was composed of 70 participants who passed the inclusion and exclusion criteria. All were men with HIV who had sex with men and the sample’s mean age was 45 years. Each participant completed questionnaires on HRQoL and HIV self-stigma. Moreover, they completed an online cognitive assessment through the previously validated platform for cognitive evaluation CogniFit, Inc. Results The obtained results showed a significant association between memory functioning impairment, lower levels of HRQoL and higher HIV self-stigma scores. Hence, HRQoL, in the mental summary domain, was shown to be a significant mediator in the relationship between low memory performance and higher HIV self-stigma. Discussion Neurocognitive impairment could decrease HRQoL in men with HIV who have sex with men, and hence, reinforce the idea widespread in society that having HIV holds serious consequences. This fact, together with the reduced cognitive abilities to fight against their own self-stigma could represent plausible explanations of the obtained results. In this sense, intervention strategies, oriented towards reducing cognitive impairment, such as those based on cognitive training, and other psychological interventions to promote HRQoL could be effective approaches to prevent the negative effects of HIV self-stigma in this population.
Collapse
Affiliation(s)
- Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | | | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Irene Portilla-Tamarit
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Cristian Alcocer-Bruno
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Eva Gabaldón-Bravo
- Department of Nursing, Faculty of Health Science, University of Alicante, Alicante, Spain
| |
Collapse
|
2
|
Sun, sea and sex: a review of the sex tourism literature. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2020; 6:24. [PMID: 33292661 PMCID: PMC7691961 DOI: 10.1186/s40794-020-00124-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/16/2020] [Indexed: 01/24/2023]
Abstract
Background Sex tourism is defined as travel planned specifically for the purpose of sex, generally to a country where prostitution is legal. While much of the literature on sex tourism relates to the commercial sex worker industry, sex tourism also finds expression in non-transactional sexual encounters. This narrative review explores current concepts related to travel and sex, with a focus on trans-national sex tourism. Methods The PubMed database was accessed to source relevant literature, using combinations of pertinent search terms. Only articles published in the English language were selected. Reference lists of published articles were also examined for relevant articles. Results With regard to preferred destinations, South/Central America and the Caribbean were more likely to receive tourists looking for casual sex. Longer duration of travel, travelling alone or with friends, alcohol or drug use, being younger and being single were factors associated with higher levels of casual sex overseas. The majority of literature retrieved on sex workers focused on risk behaviours, sexually transmitted infections (STI), mobility of sex workers and how these factors affected their lives. Sex tourists require better access to effective methods of preventing HIV, such as pre-exposure prophylaxis, and better education on HIV prevention. Drugs and alcohol play a major role as risk factors for and cofactors in casual sexual behaviour while abroad. Conclusions Travellers need to be informed of the increased risks of STI before travel. They should be aware of the local prevalence of STIs and the risks associated with their sexual practices when they travel, including engaging with commercial sex workers, having unprotected sexual intercourse and becoming victims of sexual violence.
Collapse
|
3
|
Li J, Lau JTF, Ma YL, Lau MMC. Trend and Factors Associated with Condom Use Among Male Clients of Female Sex Workers in Hong Kong: Findings of 13 Serial Behavioural Surveillance Surveys. AIDS Behav 2018; 22:2235-2247. [PMID: 29946808 DOI: 10.1007/s10461-018-2148-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study investigated the trend and associated factors of condom use among male clients of female sex workers (CFSW) in Hong Kong. A total of 25,443 males of the general population were screened to identify 2,330 CFSW via 13 rounds of population-based serial cross-sectional telephone surveys during 1998 through 2015. Over time, there were no significant changes in condom use with various types of female sex partners (p ranged 0. 219-0.837) and prevalence of self-reported STI (p = 0.975) in the past 6 months. Decrease in the prevalence of non-regular sex partners (p < 0.001) and increase in perceived efficacy of condom use for HIV prevention (p = 0.028) were observed. Perceived efficacy of condom use for HIV prevention and self-reported STI experience were significantly associated with condom use with various types of female sex partners in the past 6 months. No evident improvement for condom use was found. Tailored intervention programs are warranted.
Collapse
Affiliation(s)
- Jinghua Li
- The School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Joseph T F Lau
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Yee Ling Ma
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Mason M C Lau
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| |
Collapse
|
4
|
Svensson P, Sundbeck M, Persson KI, Stafström M, Östergren PO, Mannheimer L, Agardh A. A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel. Travel Med Infect Dis 2018; 24:65-88. [PMID: 29567294 DOI: 10.1016/j.tmaid.2018.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/23/2018] [Accepted: 03/12/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND International travel facilitates global spread of sexually transmitted infections (STI). Travellers could contribute to onward transmission of pathogens rarely encountered at home and export new strains to the destination. The aim was to systematically examine evidence regarding determinants of travel-related sexual risk-taking and identify knowledge gaps and areas for targeted interventions. METHOD Articles published in peer-reviewed journals from 2000 to 2017 were screened in 6 databases and assessed for relevance against criteria. Data was extracted for factors associated with travel-related STI or proxies. Meta-analyses estimated pooled prevalence of casual sex and non-condom use. Adjusted odds ratios of predictors were pooled to generate a combined estimate. RESULT Forty-nine articles qualified for inclusion. A heterogeneity test indicated variation across studies. The pooled prevalence of casual travel sex was 35% and prevalence of non-condom use 17%. Expectations of casual sex strongly predicted sex with a new partner when travelling abroad. Planning to have sex indicated condom use. CONCLUSION The studies largely represented sub-groups of risk-taking populations from a European context, indicating substantial knowledge gaps. Studies investigating migrants travelling to visit friends and relatives, older travellers, and female travelers are needed. Post-travel harm reduction activities may serve as a focus for future interventions.
Collapse
Affiliation(s)
- Pia Svensson
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - Mats Sundbeck
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Kristina Ingemarsdotter Persson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Public Health Agency, Health and Sexuality, Stockholm, Sweden
| | - Martin Stafström
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Louise Mannheimer
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Public Health Agency, Health and Sexuality, Stockholm, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| |
Collapse
|
5
|
Abstract
Travel has historically been an important risk factor for acquisition of sexually transmitted infections (STIs). Travel is often associated with a sense of adventure, periods of loneliness, and exploration away from one's home environment-which often form a milieu in which sexual activity can occur with new partners. Survey data clearly demonstrate that out-of-country travel is associated with recruitment of new sex partners and increased STI risk. Pretravel counseling to prevent STI risk is variable, and there is little evidence that it modifies risk behavior. Some travel occurs specifically for sexual purposes, such as the sexual tourism junkets to Southeast Asian destinations which became popular during the 1980s or the more recent rise in the popularity of circuit parties for men who have sex with men. Some travel situations pose particularly high risks. For example, military deployments and assignments to work camps such as those for oil extraction occur in the context of large groups of individuals of reproductive age, often predominantly males, exposed to high levels of stress in unfamiliar environments. Additionally, over the past decade, the Internet has dramatically changed the ability to identify sexual partners while traveling.
Collapse
|
6
|
Liao W, Lau JTF, Tsui HY, Gu J, Wang Z. Relationship between sexual compulsivity and sexual risk behaviors among Chinese sexually active males. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:791-8. [PMID: 25030121 DOI: 10.1007/s10508-014-0317-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 03/03/2012] [Accepted: 03/09/2013] [Indexed: 05/25/2023]
Abstract
Compulsivity is defined as "an insistent, repetitive, intrusive, and unwanted urge to perform specific acts often in ritualized or routinized fashions." Sexual compulsivity has been shown to be associated with some high risk sexual behaviors related to HIV and sexually transmitted infection (STI). In some Western countries, the 10-item Sexual Compulsivity Scale (SCS) has been developed to assess people's sexual compulsivity but no Chinese version has been validated. This study validated the Chinese version of the SCS and investigated its associations with specific sexual behaviors. In 2008, a random telephone survey was conducted in the sexually active male general population in Hong Kong, interviewing 1,048 participants. The Chinese version of the SCS was found to be internally consistent (Cronbach's α = 0.88 for the overall scale), with a mean total score of 20.7 (SD = 4.7). An exploratory factor analysis procedure extracted two factors that were named Controllability and Functional Consequences. Higher SCS scores were associated with multiple female sexual partnerships in the last 6 months, having had sex with either non-regular partner(s) or female sex worker(s) in the last 6 months, having contracted STI in the last 6 months, and inconsistent condom use with either non-regular partner(s) or female sex worker(s) in the last 6 months. The scale can be used to assess sexual compulsivity among sexually active Chinese men in Hong Kong. It can potentially be used in other Chinese communities. Further confirmatory studies are warranted.
Collapse
Affiliation(s)
- Wei Liao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | | | | | | | | |
Collapse
|
7
|
Lau JTF, Zhou H, Su XY, Feng TJ, Hong FC, Tsui HY, Ma YL, Wang Z, Walden D. Condoms used but sex not well protected. AIDS Behav 2014; 18:1934-44. [PMID: 24452496 DOI: 10.1007/s10461-013-0690-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Condom use is often equated to safer sex. The prevalence of condom use during sex work among female sex workers (FSW) in China is high. Condom use, however, co-exists with condom failure and improper use and hence risk of HIV transmission. In a cross-sectional study, we interviewed 195 FSW in Shenzhen, China. The prevalence of condom use in the last episode of sex work was 97.4 %, However, respectively 53.8 and 86.2 % had experienced at least one condition of condom failure that may lead to genital contact (wearing condoms after penetration, condom breakage/slippage, condoms removed by clients) and at least one condition of improper condom use (not removing air from the tip of the condom, not pulling it down to the root of penis and not choosing good quality condoms). Factors of individual level (e.g. never choosing high quality condoms for sex work), inter-personal level (e.g. agreement to have unprotected sex if fond of clients or paid more) and environmental/structural level (e.g. non-availability of condoms) were associated with various types of condom failure and improper use. Although HIV prevention interventions have increased prevalence of condom use among FSW, the risk of HIV transmission may still be high as "unsafe" sex due to condom failure and improper use is prevalent. Interventions promoting safer sex need to address such issues and take socio-ecological factors into account. Condom use during sex work is not equivalent to well protected sex as the protective effects could be compromised by frequent condom failure and improper use.
Collapse
|
8
|
Yang X, Li S, Attané I, Feldman MW. Commercial sex behaviours among involuntary male bachelors: findings from a survey of migrants in Xi'an, China. J Public Health (Oxf) 2014; 37:305-12. [PMID: 25104838 DOI: 10.1093/pubmed/fdu047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The highly male-biased sex ratio at birth has produced a severe male 'marriage squeeze' in China. However, with an imbalanced sex ratio, the marriage-squeezed or involuntary bachelors can meet their sexual needs only through ways other than marriage. METHODS To investigate the commercial sex behaviours of involuntary bachelors, we conducted a survey on reproductive health and family living among male migrant bachelors in Xi'an City, the capital of Shaanxi Province, from December 2009 to January 2010. RESULTS The prevalence of commercial sex use was 37.2% among unmarried men, 30.1% among married but separated men and 17.2% among married and cohabitating men (χ(2) = 31.33; P = 0.000; df = 2). Marital status, knowledge about acquired immunodeficiency syndrome (AIDS), age and income were associated with the prevalence and frequency of commercial sex behaviours. Condom use was less frequent among involuntary bachelors and was significantly associated with knowledge about AIDS and other sexually transmitted diseases, the frequency of commercial sex behaviours, marital status and age. CONCLUSIONS The higher prevalence of commercial sex behaviours and the lower frequency of condom use indicate a higher risk of disease from commercial sex among involuntary bachelors, implicating both individual and public health.
Collapse
Affiliation(s)
- Xueyan Yang
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an 710049, Shaanxi Province, P. R. China
| | - Shuzhuo Li
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an 710049, Shaanxi Province, P. R. China
| | - Isabelle Attané
- French National Institute for Demographic Studies, INED, Paris 75020, France
| | - Marcus W Feldman
- Morrison Institute for Population and Resource Studies, Stanford University, Stanford, CA 94305, USA
| |
Collapse
|
9
|
Yang X, Attané I, Li S. Commercial sex and condom use among involuntary bachelors: an exploratory survey in rural China. Am J Mens Health 2013; 8:205-16. [PMID: 24128671 DOI: 10.1177/1557988313505762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the present context of the Chinese male marriage squeeze, commercial sex is becoming an important way for bachelors to meet their sexual needs. Using data from a survey conducted in a rural district of Anhui province, China, this study analyzes commercial sex experiences and condom use among involuntary bachelors and compares usage in this population to that observed in married men in the same age groups. Our findings indicate that, for both first and most recent sexual intercourse, the prevalence of commercial sex among unmarried men is significantly higher than that reported among married men; indeed, marital status was the only variable that was consistently related to rates of commercial sex for both first and most recent sexual intercourse. The vast majority of sexual intercourse was still unprotected, and the rate of condom use was not only lower among unmarried men than among married men, but was also significantly related to knowledge of sexually transmitted diseases, as well as age, education, and income. Because of their lower condom use, unmarried men face much higher risks of contracting and spreading sexually transmitted diseases than married men do. This situation poses a severe threat to public health.
Collapse
Affiliation(s)
- Xueyan Yang
- 1Xi'an Jiaotong University, Xi'an, People's Republic of China
| | | | | |
Collapse
|
10
|
Haseen F, Chawdhury FAH, Hossain ME, Huq M, Bhuiyan MU, Imam H, Rahman DMM, Gazi R, Khan SI, Kelly R, Ahmed J, Rahman M. Sexually transmitted infections and sexual behaviour among youth clients of hotel-based female sex workers in Dhaka, Bangladesh. Int J STD AIDS 2012; 23:553-9. [PMID: 22930291 DOI: 10.1258/ijsa.2012.011373] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A cross-sectional study was conducted among youth clients of hotel-based female sex workers (YCHBFSWs) in nine randomly selected hotels in Bangladesh to examine sexual-risk behaviour, condom use and determinants of condom use in last sex, knowledge of HIV, sexually transmitted infection (STI) prevalence and STI care-seeking behaviour. A prestructured questionnaire was used to collect sociodemographic, behavioural, clinical information; urine specimens (before sex) and blood were collected for diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, syphilis and herpes simplex virus 2 (HSV2) infection. One thousand and thirteen participants were enroled in the study. Approximately half of them reported visiting female sex workers (FSWs) at least once a month and 25% visited FSWs at least once a week. Only 12% of participants reported regular condom use. The prevalence of N. gonorrhoeae, C. trachomatis, T. vaginalis, syphilis and HSV2 was 2.2%, 3.9%, 7.2%, 2.6% and 12.9%, respectively. Only 15.3% of the YCHBFSW sought STI care in the past year. Negotiation of condom use with FSWs was the main determinant (odds ratio = 17.95) for condom use at last sex. Male clients of FSWs, including YCHBFSW, are an important bridge population for HIV transmission in Bangladesh and HIV interventions should be designed and implemented for them.
Collapse
Affiliation(s)
- F Haseen
- International Centre for Diarrhoeal Disease Research, Bangladesh GPO Box 128, Dhaka 1000, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Shi Y, Guo S, Bo F, Zhang X, Cao W, Wang P. Impact evaluation of a sexually transmitted disease preventive intervention among female sex workers in Hohhot, China. Int J Infect Dis 2012; 17:e59-64. [PMID: 23154177 DOI: 10.1016/j.ijid.2012.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/24/2012] [Accepted: 09/03/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of HIV and sexually transmitted disease (STD) prevention interventions among female sex workers (FSWs) in the city of Hohhot in northern China. METHODS Three serial cross-sectional surveys were conducted in 2006, 2007, and 2008 among FSWs. A questionnaire was administered to the FSWs, and HIV and syphilis tests were performed for all participants. Intervention activities including condom promotion and provision, increased condom availability and accessibility, and voluntary HIV counseling and testing (VCT) were carried out among FSWs. RESULTS There were 624 participants in the 2006 survey, 444 in the 2007 survey, and 451 in the 2008 survey. The United Nations General Assembly Special Session (UNGASS) indicators for FSWs increased from 13.9% in 2006 to 37.7% in 2008 (p<0.001). The average rate of consistent condom use with commercial clients in the month preceding the interview increased significantly from 39.8% in 2006 to 59.6% in 2008 (p<0.001). Not a single HIV-positive case was found among the FSWs over these 3 years, and the prevalence of syphilis decreased remarkably from 9.5% in 2006 to 1.3% in 2008. Logistic regression analysis showed that sauna or hair salon work venues, receiving services from intervention programs, and accepting HIV tests were factors associated with consistent condom use. CONCLUSIONS The findings suggest that consistent condom use and awareness of HIV/AIDS prevention-related knowledge among FSWs have been improved by the intervention. Further prioritized and combined prevention programs aimed at FSWs are needed in order to prevent the HIV/AIDS epidemic spreading in the general population in China.
Collapse
Affiliation(s)
- Yuhui Shi
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China
| | | | | | | | | | | |
Collapse
|
12
|
Yan J, Lau JTF, Tsui HY, Gu J, Wang Z. Prevalence and factors associated with condom use among Chinese monogamous female patients with sexually transmitted infection in Hong Kong. J Sex Med 2012; 9:3009-17. [PMID: 23035945 DOI: 10.1111/j.1743-6109.2012.02945.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Monogamous female sexually transmitted infection (STI) patients are at high risk of recurrent STI, but there is no study investigating their risk behaviors. AIM We investigated the prevalence of male condom use and associated factors among monogamous STI female patients. MAIN OUTCOME MEASURES Independent variables included socio-demographic characteristics, STI history, nature of relationship, and cognitions (Health Belief Model). Dependent variables included the use of male condoms in the past two months and intention to use male condoms consistently in the future 6 months. METHODS A cross-sectional survey using a structured questionnaire was conducted among STI female patients with only one male sex partner in the last 12 months and attended a major government STI clinic in Hong Kong. RESULTS Among the 538 participants, 25.1% used condoms consistently (every time) during sex in the past 2 months, while 35.2% intended to do so in the next 6 months. A multiple stepwise logistic regression model identified three statistically significant factors associated with lower likelihoods of consistent condom use in the past 2 months: type of sole sex partner (cohabitant vs. husband: OR = 0.29, 95% CI = 0.12 to 0.70; regular boyfriend vs. husband: OR = 0.52, 95% CI = 0.30 to 0.91), being financially dependent (OR = 0.45, 95% CI = 0.27 to 0.75), and partner's dislike of condom use (OR = 0.23, 95% CI = 0.15 to 0.39). In a similar model, the same three factors were found to be significantly associated with the intention to use condoms consistently in the next 6 months. The low prevalence of intention to use condoms consistently in the future suggested that our study population might be victimized again. The impact of financially dependent relationships and men's dislike of using condoms on condom use may operate through imbalanced gender power. CONCLUSIONS Interventions are greatly warranted and should increase risk awareness and empower this vulnerable population.
Collapse
Affiliation(s)
- Jin Yan
- The Third Xiangya Hospital, Central South University, Changsha, China
| | | | | | | | | |
Collapse
|
13
|
Wang Z, Lau JTF, Gu J. Acceptability of circumcision among clients of female sex worker in Hong Kong. AIDS Behav 2012; 16:1836-45. [PMID: 22080385 DOI: 10.1007/s10461-011-0088-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Clients of female sex workers (CFSW) are at high risk of HIV transmission. Circumcision reduces the risk of heterosexual transmission of HIV. A total of 353 CFSW were interviewed using a combined interviewer-computer-assisted method. Amongst the participants, 28.0% were circumcised, whilst 63.8% of the uncircumcised participants were willing to take up circumcision (conditioned on being briefed about a 50% potential risk reduction effect). In a stepwise logistic regression model, frequency of patronizing female sex workers and factors related to the Health Belief Model were significantly associated with conditional willingness. Amongst uncircumcised participants, 20.9% anticipated risk compensation (i.e. would use condoms less frequently after being circumcised). Adjusting for background variables, inconsistent condom use during commercial sex and self-reported STD history in the last 6 months were significantly associated with anticipated risk compensation. It is feasible to promote circumcision among CFSW but such programs also need to promote condom use.
Collapse
Affiliation(s)
- Zixin Wang
- Division of Health Improvement, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | | | | |
Collapse
|
14
|
Lau JTF, Tsui HY, Kim JH, Chan PKS, Griffiths S. Monitoring of perceptions, anticipated behavioral, and psychological responses related to H5N1 influenza. Infection 2010; 38:275-83. [PMID: 20582562 PMCID: PMC7100839 DOI: 10.1007/s15010-010-0034-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 05/25/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to monitor changes in behavioral and emotional responses to human H5N1 in the community over a 28-month period (from November 2005 to February 2008). METHODS A total of 3,527 Hong Kong Chinese adults were interviewed by telephone within the framework of six identical cross-sectional surveys carried out during the 28-month study period. Given a hypothetical scenario that two to three new human-to-human H5N1 cases had been reported in Hong Kong, the trends of the respondents in various H5N1-related risk perceptions, anticipated personal psychological responses, and anticipated personal preventive behaviors were investigated. RESULTS Over time, a decreased proportion of the respondents (1) felt susceptible to contracting H5N1, (2) expected a large outbreak would eventually occur, (3) believed that the impacts of H5N1 were worse than those of severe acute respiratory syndrome (SARS), and (4) anticipated adopting more types of preventive measures and experiencing mental distress in the case of a small-scale outbreak in Hong Kong (AOR from 0.27 to 0.43, p < 0.001), but the public remained vigilant on public health behaviors, such as hand-washing. The prevalence of misconceptions on the mode of transmission declined, but remained high; perceptions on the fatality of H5N1 remained largely underestimated. The SARS experience and unconfirmed beliefs about the transmission modes were associated with variables on anticipated preventive behaviors and emotional distress. CONCLUSION Starting in 2005 through to 2008, respondents perceived a decreasing level of susceptibility, severity, and anticipated stress towards a hypothetical human-to-human H5N1 outbreak, possibly due to the low efficiency of transmission. The public's general preparedness was still relatively good and rational, even though individual preventive behaviors were less common. However, misconceptions were prevalent among the respondents. Based on these results, public education is warranted to rectify these misconceptions.
Collapse
Affiliation(s)
- J T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F, Prince of Wales Hospital, Shatin, NT, Hong Kong.
| | | | | | | | | |
Collapse
|
15
|
Lau JT, Tsui HY, Cheng S, Pang M. A randomized controlled trial to evaluate the relative efficacy of adding voluntary counseling and testing (VCT) to information dissemination in reducing HIV-related risk behaviors among Hong Kong male cross-border truck drivers. AIDS Care 2009; 22:17-28. [DOI: 10.1080/09540120903012619] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Joseph T.F. Lau
- a Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
| | - Hi Yi Tsui
- a Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
| | | | | |
Collapse
|
16
|
Lau JTF, Tsui HY, Ho SPY. Variations in condom use by locale: a comparison of mobile Chinese female sex workers in Hong Kong and mainland China. ARCHIVES OF SEXUAL BEHAVIOR 2007; 36:849-59. [PMID: 17674181 DOI: 10.1007/s10508-007-9203-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 01/08/2007] [Accepted: 01/08/2007] [Indexed: 05/16/2023]
Abstract
The present study investigated the prevalence of HIV and HIV-related behaviors and perceptions among 336 female sex workers (FSW) traveling from mainland China to work in Hong Kong. None of the participants tested HIV positive. Of the participants, 13.2% and 26.8%, respectively, would have unprotected sex with a client in Hong Kong or in mainland China if they liked the client; 16.7% and 21.7%, respectively, would have unprotected sex with a client in Hong Kong and in mainland China if he paid more. Of the participants, 98.5% used condoms in the last episode of sex work in Hong Kong and 78.1% were consistent condom users in Hong Kong in the last month. Yet, among those who previously worked as FSW in mainland China (n = 141), only 28.6% used condoms consistently in mainland China in the last year; 60% of those who used condoms inconsistently while in mainland China became consistent condom users in Hong Kong. Among those who did not use condoms in mainland China, willingness to have unprotected sex with a client who was liked by the FSW was a strong predictor for consistent condom use in Hong Kong (OR = 18.67, p < .001). Among those who were consistent condom users in Hong Kong, the same variable predicted inconsistent condom use while in mainland China (OR = 14.02, p < .05). Condom use behaviors change when FSW are working in different social contexts and behavioral changes are possible. Education programs should take socio-contextual factors into account.
Collapse
Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | | | | |
Collapse
|
17
|
Abstract
OBJECTIVE To analyze the extent by which Chinese female sex workers (FSWs) serve as vectors of HIV/AIDS to an otherwise spared general population and to describe the implications of centering efforts solely on this high-risk group. GOAL By using the example of FSWs in China, we intend to demonstrate the role that structural factors can have on HIV transmission above and beyond individual high-risk behaviors. STUDY DESIGN Literature review of years 1980-2006. RESULTS Analysis of the literature suggests that major determinants of HIV transmission amongst FSWs in China include sociopolitical context, gender, work environment and finally, risky sexual behaviors. CONCLUSIONS Chinese FSWs live in a specific sociopolitical context that shapes their capacities to engage in safe-sex practices. Focusing on FSWs as vectors of HIV/AIDS epidemic in China neglects the larger context that endangers all members of society and blames an already vulnerable population.
Collapse
Affiliation(s)
- Catherine Pirkle
- Unité de Santé Internationale, Université de Montréal, Montreal, Quebec, Canada.
| | | | | |
Collapse
|
18
|
Abstract
The study documents the characteristics of Hong Kong residents who used substances in mainland China. Characteristics of such users were compared with those using substances elsewhere. A cross-sectional survey was used. Data analyses were stratified by gender, and multivariate analyses were performed. Respondents, Hong Kong adults aged 18-30 (n = 6,528), were interviewed using a mixed interviewer and computerized mobile phone method, at the Hong Kong-mainland China boundary. Cross-border substance users and other types of substance users had characteristics that were quite different (e.g., education level, perceived harmfulness of substance use in general, having friends who frequently used substances in mainland China). Cross-boundary substance users also found it easier to obtain substances in mainland China than in Hong Kong (males: 60.5%, females: 39.6%) and perceived no chance of being arrested in mainland China because of substance use (men: 28.8%, women: 24.5%). They tended to use substances in discos/rave parties together with friends (men: 77%, women: 81%), and substances were often obtained for free (men: 63.2%, women: 78%). Ecstasy and ketamine were often used (men: 86.5% & 79.4%, women: 81% & 70.2%), and multiple uses of different substances were common (men: 81.3%, women: 68.6%). Lower price, peer influence, and better availability were reasons behind cross-boundary substance use behaviors. Cross-boundary substance users have specific characteristics. Prevention policies should take these characteristics into account. Regional collaborations are highly warranted.
Collapse
Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong.
| | | | | | | |
Collapse
|
19
|
Lau JTF, Yang X, Tsui HY. Health services-seeking behaviors of people traveling from developed areas--a case of Hong Kong residents visiting mainland China. J Travel Med 2007; 14:215-25. [PMID: 17617843 DOI: 10.1111/j.1708-8305.2007.00121.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The study investigated risk perceptions and inclination to defer seeking of medical services among Hong Kong residents if they become sick in mainland China, and prevalence and factors associated with purchase of travel medical insurance. METHOD A random, population-based telephone survey was conducted on 406 Hong Kong Chinese aged 18 to 60. RESULT Of all respondents, 70.9, 62.9, and 57.2%, respectively, would defer seeking medical consultation until back to Hong Kong for mild conditions of influenza, injury, and acute disease; 55.6, 36.7, and 37.3%, respectively, would do so even for the three severe medical conditions. Concern for inferior medical standards in mainland China is the main reason for inclination to defer seeking medical services when traveling in mainland China. Multivariately, fear for nosocomial infection, lack of family/social support, and lack of knowledge about medical services in mainland China were significant factors associated with the inclination. Travel medical insurance was purchased by 20.0% of the respondents. Other difficulties for using medical services in mainland China and demands for relevant services were reported. CONCLUSIONS A dilemma exists between deferring seeking medical services and exposure to risk due to suboptimal medical services when people are traveling from developed areas to developing areas.
Collapse
Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| | | | | |
Collapse
|
20
|
Lau JTF, Ho SPY, Yang X, Wong E, Tsui HY, Ho KM. Prevalence of HIV and factors associated with risk behaviours among Chinese female sex workers in Hong Kong. AIDS Care 2007; 19:721-32. [PMID: 17573591 DOI: 10.1080/09540120601084373] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The study examined the HIV prevalence and factors associated with risk behaviours among Chinese female sex workers (FSW) in Hong Kong. Unlinked anonymous HIV antibody testing and interviews, using structured questionnaires, were conducted for 293 FSW. None was tested HIV positive. In the last 6 months, 13.7% self-reported having contracted STD, 50.7% were not using condoms with their male clients consistently; 73.3% and 22.6% respectively had had unprotected sex with boyfriends and one-night-stand partners. Believing that condom use with a boyfriend is a mistrust and the perception that one did not have full control over condom use decisions, would agree not to use condoms if being paid more, and could not refuse to have unprotected sex with clients were significantly associated with condom use with various types of sex partners (OR =1.95 to 4.83). FSW has low HIV prevalence but high prevalence of risk behaviours. Bridging effects exist. Empowerment of FSW is warranted.
Collapse
Affiliation(s)
- J T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT Hong Kong.
| | | | | | | | | | | |
Collapse
|
21
|
Wong ML, Chan RKW, Koh D. HIV prevention among travelers: why do men not use condoms when they engage in commercial sex overseas? Sex Transm Dis 2007; 34:237-44. [PMID: 16878052 DOI: 10.1097/01.olq.0000233644.66090.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated factors associated with condom use among men patronizing female sex workers abroad and locally. STUDY DESIGN We conducted a survey on 372 local men attending the only public sexually transmitted infections clinic in Singapore between 2001 and 2003. RESULTS Condom use was higher among clients patronizing sex workers in Singapore than those patronizing sex workers abroad (87.5% vs. 54.4%, P<0.001). Condom use in both groups was associated with initiation of condom use by the sex workers (adjusted prevalence ratios: 1.67, 95% confidence interval: 1.11-2.49; 1.87, 1.21-2.90) but was not associated with clients' knowledge of disease, self-perceived risk, confidence in condom use, and dislike of condoms. Less sex workers abroad than in Singapore (32.7% vs. 75.6%, P<0.001) initiated condom use. CONCLUSION Lower condom use among Singaporean travelers abroad was determined by extrinsic factors, whereby sex workers abroad were less likely to initiate condom use rather than by clients' factors.
Collapse
Affiliation(s)
- Mee-Lian Wong
- Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, Faculty of Medicine, National University of Singapore.
| | | | | |
Collapse
|
22
|
Holroyd EA, Wong WCW, Ann Gray S, Ling DC. Environmental health and safety of Chinese sex workers: a cross-sectional study. Int J Nurs Stud 2007; 45:932-41. [PMID: 17475266 DOI: 10.1016/j.ijnurstu.2006.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 04/21/2006] [Accepted: 04/26/2006] [Indexed: 10/23/2022]
Abstract
AIM This paper presents a Hong Kong (HK) data on the effect that sex work has on women's environmental health and safety. An outreach role that highlights safety and human rights is suggested for nurses working with female sex workers (FSWs) as clients. BACKGROUND In HK it was estimated that there were at least 200,000 FSWs in 2002 and the total population involved as workers, support staff, clients and partners of the clients exceeded half a million in a city of 6.8 million people. Despite these numbers, both locally and internationally there are very limited outreach nursing services that address the FSW's occupational health needs. METHOD A cross-sectional survey, was undertaken over a 5 month period commencing in October 2003. A validated Chinese version of the World Health Organisation Quality of Life Measure was administered to a convenience sample of 89 female street sex workers. A focus group interview was later conducted to gain contextual information. RESULTS The predominantly mainland Chinese FSWs had a mean age of 36.1 years. These women tended to be less educated and older than the general population of FSWs. They worked long hours with most of their income sent back home to China. Many lived in sub-optimal conditions and risked being abused while at work. The women scored significantly lower in the environmental domains when compared to the general female population. CONCLUSION Highlighted is the critical importance of developing a new role, both international and within the Asian region, for community nurses working in an outreach capacity. This role should be visible, affordable and accessible, for at risk populations such as FSWs. The primary focus of the new role would be to establish a close working relationship between sex workers, sex industry owner/operators, health agencies and local authorities. Risk awareness programs developed and conducted by community nurses should embrace the complexity of occupational health issues. Such programs would also have the benefit of affirming the health rights of sex workers and public health.
Collapse
Affiliation(s)
- Eleanor A Holroyd
- Asian and Gender Nursing, Division of Nursing and Midwifery, RMIT University, Melbourne, Australia.
| | | | | | | |
Collapse
|
23
|
Lau JTF, Tsui HY, Lam LT. Alcohol consumption, sex, and use of psychotropic substances among male Hong Kong-mainland China cross-border substance users. Addict Behav 2007; 32:686-99. [PMID: 16839694 DOI: 10.1016/j.addbeh.2006.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 05/30/2006] [Accepted: 06/06/2006] [Indexed: 11/25/2022]
Abstract
The study investigated the prevalence and associated factors for co-occurrence of psychotropic substance use, alcohol consumption and sexual activities among substance users. Totally, 1167 Hong Kong Chinese males aged 18-30 having used substances in mainland China in the last year were identified. Of them, 72.5% and 42.7% respectively reported having consumed alcohol and engaged in sexual activities in conjunction with the last episode of substance use. Among those using substances exclusively in mainland China, multivariate analyses showed that having friends who frequently used substances in China (OR=3.18) and being accompanied by friends in the last episode of substance use (OR=2.31) were associated with alcohol consumption; older age (OR=2.01), higher education level (OR=2.31), alcohol consumption (OR=2.72), belief that substance use increased sexual potency (OR=2.81) and use of multiple types of psychotropic substances in China (OR=2.94) were significantly associated with having sex in conjunction with the last episode of using psychotropic substances. Cross-border psychoactive substance use often co-occurs with alcohol and sex. High levels of risk are involved. Different types of preventive programs need to be integrated.
Collapse
Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, 5/F., School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong.
| | | | | |
Collapse
|
24
|
Mak WWS, Cheung RYM, Law RW, Woo J, Li PCK, Chung RWY. Examining attribution model of self-stigma on social support and psychological well-being among people with HIV+/AIDS. Soc Sci Med 2007; 64:1549-59. [PMID: 17223239 DOI: 10.1016/j.socscimed.2006.12.003] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Indexed: 10/23/2022]
Abstract
Among various infectious diseases, HIV/AIDS is considered to be one of the most stigmatizing conditions. Using a prospective design, the present study attempted to test the attributional pathway from perceived control to responsibility to self-blame and finally to self-stigmatization, and to examine the social and psychological sequelae of stigma among a sample of 119 people with HIV/AIDS (PWHA) in Hong Kong. Structural equation modeling findings showed that the model had good fit to the data. Although the linkage between the attributions of control, responsibility, and blame was confirmed, the relationship of blame to self-stigma was not significant. Self-stigma was found to dampen social support and lead to psychological distress half a year later. The present study challenged the adequacy of attributional factors in understanding self-stigmatization and demonstrated the impact of stigma on psychological adjustment among PWHA.
Collapse
|
25
|
You JHS, Wong WCW, Sin CW, Woo J. The cost-effectiveness of an outreach clinical model in the management and prevention of gonorrhea and chlamydia among Chinese female sex workers in Hong Kong. Sex Transm Dis 2006; 33:220-7. [PMID: 16434885 DOI: 10.1097/01.olq.0000187300.58733.a6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Social marginalization and stigmatization in usual medical care setting may refrain female sex workers (FSWs) from seeking usual medical care for sexually transmitted infections in Hong Kong. GOAL To evaluate the cost-effectiveness of using an outreach approach for treatment and prevention of gonorrhea and chlamydia among FSWs. STUDY DESIGN A decision tree was designed to simulate the outcomes of 2 alternatives: (1) outreach service providing treatment of gonorrhea and chlamydia and counseling to FSWs (outreach arm) and (2) no outreach service (control arm). Five tiers of outcomes were estimated for each study arm: (1) total direct medical cost, (2) number of FSWs infected with gonorrhea, (3) number of new cases of gonorrhea in clients transmitted by FSWs, (4) number of FSWs infected with chlamydia, and (5) number of new cases of chlamydia in clients transmitted by FSWs. Clinical inputs were estimated from literature, and cost analysis was conducted from the perspective of a public health organization. RESULTS Compared to the control group, the marginal savings per new case of infection averted (marginal cost divided by marginal cases of infection) of the outreach group were $10,988 (US dollars) per case of gonorrhea averted in FSWs, $685 per case of gonorrhea averted in clients, $9643 per case of chlamydia averted in FSWs, and $220 per case of chlamydia averted in clients ($1=7.8 Hong Kong dollars). CONCLUSIONS An outreach clinic is potentially less costly and more effective in preventing transmission of gonorrhea and chlamydia between FSWs and their clients in Hong Kong.
Collapse
Affiliation(s)
- Joyce H S You
- Centre for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | | | | | | |
Collapse
|
26
|
Lau JTF, Yang X, Tsui HY, Pang E, Wing YK. Positive mental health-related impacts of the SARS epidemic on the general public in Hong Kong and their associations with other negative impacts. J Infect 2005; 53:114-24. [PMID: 16343636 PMCID: PMC7132442 DOI: 10.1016/j.jinf.2005.10.019] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2004] [Revised: 10/20/2005] [Accepted: 10/21/2005] [Indexed: 12/19/2022]
Abstract
Objectives To investigate 2 positive impacts (better family/social support and lifestyle changes) and their associations with other negative impacts. Study design and participants A telephone survey using random telephone numbers and a structured questionnaire was conducted in Hong Kong general population. Eight hundred and eighteen Hong Kong residents of age 18–60 years completed the interview (response rate: 65%) at around end of June 2003, the early ending phase of the epidemic. Results Over 60% of the respondents stated that they cared more about the family members' feelings; about 30%–40% stated that they found their friends, their family members more supportive or having more sharing with others when not feeling happy; only a few percent felt the opposite. Further, about 2/3 of the respondents paid more attention to their mental health. About 35%–40% took more time to rest, for relaxation or doing exercise. These items were, in general, negatively associated with post-traumatic stress, perception of stress and other perceptions that were related to SARS. Conclusions SARS have brought some positive impacts on social/family support, mental health awareness and lifestyle changes. These positive impacts were associated with other relevant negative impacts and might be important cushions of the negative impact.
Collapse
Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | | | | | | | | |
Collapse
|
27
|
Lau JTF, Yang X, Tsui HY, Kim JH. Impacts of SARS on health-seeking behaviors in general population in Hong Kong. Prev Med 2005; 41:454-62. [PMID: 15917041 PMCID: PMC7119319 DOI: 10.1016/j.ypmed.2004.11.023] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Revised: 07/23/2004] [Accepted: 11/24/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND The severe acute respiratory syndrome (SARS) epidemic that occurred in Hong Kong in 2003 caused serious public health consequences. Its impacts on health-seeking behaviors of the general public have not been assessed. METHODS Two cross-sectional, random telephone surveys interviewed 1603 Hong Kong adult residents in the post-SARS epidemic period, June and September 2003 to investigate changes in the post-SARS period. RESULTS Noteworthy percentages of the respondents self-reported increased frequencies of practicing favorable health-seeking behaviors in June 2003, as compared with the pre-SARS period. Few respondents reported the opposite. This was observed in different dimensions: health services seeking, adoption of healthier lifestyle, spending more resources on health, adoption of good personal hygiene, mask use when ill with influenza, and avoidance of risk behaviors. The frequencies of practicing most of these health-seeking behaviors, as measured in June and September 2003, were comparable. Further increases in healthy diet and weight control, etc., were observed during that period. Those who worried about contracting SARS were more likely to have improved health-seeking behaviors. CONCLUSIONS The community in Hong Kong responded to the SARS epidemic by practicing more favorable health-seeking behaviors. Public health workers should utilize these opportunities to foster favorable changes.
Collapse
Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, China.
| | | | | | | |
Collapse
|
28
|
Wong ML, Chan RKW, Koh D, Barrett ME, Chew SK, Wee SSH. A Comparative Study of Condom Use and Self-Reported Sexually Transmitted Infections Between Foreign Asian and Local Clients of Sex Workers in Singapore. Sex Transm Dis 2005; 32:439-45. [PMID: 15976602 DOI: 10.1097/01.olq.0000168279.05452.ad] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We conducted a survey to compare condom use and its associated factors between foreign Asian and local clients of female sex workers in Singapore. STUDY A survey was conducted between 2001 and 2002 on a random sample of 810 clients (677 foreign Asian workers and 133 locals) recruited from the streets and outside the brothels in Singapore. RESULTS Foreign clients were more likely than locals to be inconsistent condom users with sex workers. Clients from China reported the highest percentage of inconsistent condom use (29.2%) and sexually transmitted infections (16.7%) compared with 8.3% (P < 0.003) and 2.3% (P < 0.005), respectively, among locals. On multivariate analysis, inconsistent condom use among foreign clients increased significantly with the number of freelance sex workers. The reverse trend was found for local clients. CONCLUSION There is a need to design separate condom-promotion programs for foreign Asian and local clients of sex workers in Singapore.
Collapse
Affiliation(s)
- Mee Lian Wong
- Department of Community, Occupational and Family Medicine Faculty of Medicine, National University of Singapore.
| | | | | | | | | | | |
Collapse
|
29
|
Lau JTF, Yang X, Pang E, Tsui HY, Wong E, Wing YK. SARS-related perceptions in Hong Kong. Emerg Infect Dis 2005; 11:417-24. [PMID: 15757557 PMCID: PMC3298267 DOI: 10.3201/eid1103.040675] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To understand different aspects of community responses related to severe acute respiratory syndrome (SARS), 2 population-based, random telephone surveys were conducted in June 2003 and January 2004 in Hong Kong. More than 70% of respondents would avoid visiting hospitals or mainland China to avoid contracting SARS. Most respondents believed that SARS could be transmitted through droplets, fomites, sewage, and animals. More than 90% believed that public health measures were efficacious means of prevention; 40.4% believed that SARS would resurge in Hong Kong; and ≈70% would then wear masks in public places. High percentages of respondents felt helpless, horrified, and apprehensive because of SARS. Approximately 16% showed signs of posttraumatic symptoms, and ≈40% perceived increased stress in family or work settings. The general public in Hong Kong has been very vigilant about SARS but needs to be more psychologically prepared to face a resurgence of the epidemic.
Collapse
Affiliation(s)
- Joseph T F Lau
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | | | | | | | | | | |
Collapse
|
30
|
Lau JTF, Kim JH, Lau M, Tsui HY. Prevalence and Risk Behaviors of Hong Kong Males Who Seek Cross-Border Same-Sex Partners in Mainland China. Sex Transm Dis 2004; 31:568-74. [PMID: 15480120 DOI: 10.1097/01.olq.0000137905.94154.0a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about cross-border sex-networking behaviors among men who have sex with men (MSM) GOAL: The goal of this study was to determine the prevalence of cross-border sex-networking in mainland China among MSM in Hong Kong and the associated risk behaviors STUDY A telephone survey was conducted. A total of 15,230 Hong Kong Chinese men aged 18 to 60 participated in the study. RESULTS Of the 283 MSM engaged in some MSM behaviors in the last 6 months, 15.2% had engaged in sexual activity with a man in mainland China in the 6 months before the survey. These "cross-border MSM" were more likely than others to have practiced risk behaviors such as having patronized male commercial sex workers, having contracted a sexually transmitted disease (STD), having had > or = 3 MSM partners, and having higher prevalence of HIV testing in the last 6 months (adjusted odds ratio, 3.32-43.83). CONCLUSIONS There is an urgent need for a regional approach to HIV/STD prevention for MSM in southern China.
Collapse
Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology & Biostatistics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | | | | | | |
Collapse
|
31
|
Lau JTF, Kim JH, Lau M, Tsui HY. Prevalence and risk behaviors of Chinese men who seek same-sex partners via the internet in Hong Kong. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2003; 15:516-528. [PMID: 14711165 DOI: 10.1521/aeap.15.7.516.24046] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
To examine the prevalence of Internet sex networking among men who have sex with men (MSM) in Hong Kong and risk behaviors associated with the behavior, a telephone survey of 15,230 Hong Kong Chinese men aged 18-60 was conducted. Of the 283 active MSM (having engaged in some MSM behaviors in the last 6 months) identified, 17.7% had networked for MSM partners via the Internet in the last 6 months. Younger age (odds ratio [OR] for age < or = 25 vs. age >25 = 4.67, 95% confidence interval [CI] = 2.35-9.28) and being an anal-sex MSM (OR = 4.72, 95% CI=2.36-9.44) were independent predictors of Internet sex networking. Being an Internet sex networker was associated with some risk behaviors such as having contracted a sexually transmitted disease (adjusted OR = 4.79, 95% CI = 1.34-17.11), having had > or = 3 MSM partners (adjusted OR = 4.74, 95% CI = 2.20-10.23), and having engaged in anal sex (adjusted OR = 3.95, 95% CI = 1.89-8.23). HIV prevention programs for MSM should thereby include Internet-based interventions.
Collapse
Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
| | | | | | | |
Collapse
|
32
|
Lau JTF, Tsui HY. HIV/AIDS Behavioral Surveillance Surveys of the Cross-Border Sex-Networker Population in Hong Kong From 1997 to 2001. Sex Transm Dis 2003; 30:827-34. [PMID: 14603090 DOI: 10.1097/01.olq.0000086605.65963.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Mobility is an important risk factor in the spread of HIV. GOAL The goal was to conduct behavioral surveillance surveys on Hong Kong males crossing the border to mainland China to have sex with female sex workers (FSW) or nonregular female sex partners who were not FSW (NRP). STUDY DESIGN Four surveys (1997-2001), using a special data collection method, were conducted at the Hong Kong-mainland China border checkpoint (n=5294). RESULTS Consistently, a notable proportion of the travelers had patronized FSW or had had sex with NRP in the preceding trip to mainland China. Inconsistent condom use was high (> or =40%) and HIV antibody testing was low (<12%). Self-perceived susceptibility of contracting HIV also was low. CONCLUSION No remarkable improvement on the level of risk behaviors was observed over the study period. Sustained efforts to promote safer sex and awareness of the risk associated with sex-networking are required.
Collapse
Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, Faculty of Medicine, The Chinese University of Hong Kong.
| | | |
Collapse
|
33
|
Lau JTF, Tsui HY, Wang QS. Effects of two telephone survey methods on the level of reported risk behaviours. Sex Transm Infect 2003; 79:325-31. [PMID: 12902587 PMCID: PMC1744728 DOI: 10.1136/sti.79.4.325] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Reporting bias due to social desirability is an important consideration in carrying out surveys on sensitive issues. The study compared the frequency of self reported sensitive behaviours and response rates between the conventional "telephone interviewer method" (TIM) and a combined interviewer and computerised data capturing method (telephone interviewer and computerised questionnaire method, or TICQM). METHODS A total of 580 males and 582 females were recruited and randomly assigned to either of the two methods in a cross sectional study. The overall response rate was about 51.6%. RESULTS While the two methods both had high completion and low item non-response rates, the TICQM respondents reported higher frequencies of sensitive risk behaviours. Sexually active female respondents interviewed by the TICQM were more likely to report that their sex partners were their steady boyfriend, instead of their husband; and were also more likely to admit that they had had "one night stand" experiences or had undergone an HIV antibody test, when compared with their counterparts in the TIM group. Similar contrasts were observed for sexually active male respondents, that the TICQM group were more likely to report that they had had sexual intercourse with female sex workers or non-regular sex partners. Sex differences in the strength of association were observed between some studied behaviours (for example, HIV testing and substance abuse) and modes of data collection. CONCLUSION The choice of data collection method has a significant impact on the results of sensitive studies; special attention should be given to designing the study and interpreting the results.
Collapse
Affiliation(s)
- J T F Lau
- Community Research Program on AIDS, Centre for Epidemiology and Biostatistics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT.
| | | | | |
Collapse
|