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author:("LIU, shengjie")
1.  Typology of older female sex workers and sexual risks for HIV infection in China: a qualitative study 
Culture, health & sexuality  2013;16(1):47-60.
The HIV epidemic continues to develop among older adults in China, including older female sex workers. Yet, few studies have been conducted among this relatively hidden population. The objectives of this study were to investigate the reasons for women's entry into sex work during their thirties and to develop typology of older women sex workers. Semi-structured in-depth interviews with sixty-three older women sex workers and six focus groups interviews with stakeholders were conducted in three cities in China in 2012. Data were analysed inductively using constant comparative method. The mean age of participants was 43 years old and the mean age of entry into sex work was 39 years old. The primary reasons for entry into sex work include heavy economic burdens, limited employment opportunities, and the appealing nature of sex work. Street-based and venue-based older sex workers were identified based on where they solicited clients. Street-based older sex workers were more likely to engage in unsafe commercial sex due to financial incentives, whereas those in entertainment venues were unlikely to use condoms with regular clients. The development of effective HIV interventions needs to consider older women sex workers unique characteristics and target factors that impede safer sex practices.
doi:10.1080/13691058.2013.826820
PMCID: PMC4010200  PMID: 23998493
older women; sex work; sexual risk; China
2.  Identification of a novel EXT1 mutation in patients with hereditary multiple exostosis by exome sequencing 
Oncology Reports  2014;33(2):547-552.
Hereditary multiple exostosis (HME) is an autosomal inherited skeletal disease whose etiology is not fully understood. To further understand the genetic spectrum of the disease, we analyzed a five-generation Chinese family with HME that have observable inheritance. Exome sequencing was performed on three HME individuals and three unaffected individuals from the family. A downstream study confirmed a new C deletion at codon 442 on exon 5 of the exostosin-1 (EXT1) gene as the only pathogenic site which generated a stop codon and caused the truncation of the protein. We rediscovered the deletion in other affected individuals but not in the unaffected individuals from the family. Upon immunohistochemistry assay, we found that the EXT1 protein level of the patients with the novel mutation in our study was less than the level in the patients without the EXT1 mutation from another unrelated family. For a deeper understanding, we analyzed the mutation spectrum of the EXT1 gene. The present study should facilitate a further understanding of HME.
doi:10.3892/or.2014.3610
PMCID: PMC4306274  PMID: 25421355
hereditary multiple exostosis; Ext1; exome sequencing; immunohistochemistry; truncated protein
3.  Psychological Impacts among Older and Younger People Living with HIV/AIDS in Nanning, China 
Journal of Aging Research  2014;2014:576592.
Objectives. The HIV epidemic has drastically increased among older adults in China, yet little research has examined the psychological impacts among older and younger people living with HIV/AIDS (PLWHAs). This study examined and compared self-efficacy, depression, well-being, and quality of life among older and younger PLWHAs in China. Method. A two-stage sampling procedure was used to recruit a final sample of 148 participants. Older adults were defined as age 50 and older. Result. Compared to younger PLWHAs aged 18–49 years old, older PLWHAs reported lower levels of well-being (7.6 versus 11.4), higher levels of depression (18.6 versus 15.8), and poorer quality of life. Self-efficacy was similar among older (23.9) and younger (24.6) PLWHAs. A higher level of depression among older PLWHAs was associated with much lower levels of subjective well-being and quality of life (physical health and psychological health). Conclusion. The findings suggest that older PLWHAs face psychological problems and mental health challenges beyond those experienced by younger PLWHAs. Intervention programs dedicated to improving mental health and quality of life are greatly needed for HIV infected older adults.
doi:10.1155/2014/576592
PMCID: PMC4123477  PMID: 25132993
4.  Fracture Property of Y-Shaped Cracks of Brittle Materials under Compression 
The Scientific World Journal  2014;2014:192978.
In order to investigate the properties of Y-shaped cracks of brittle materials under compression, compression tests by using square cement mortar specimens with Y-shaped crack were conducted. A true triaxial loading device was applied in the tests, and the major principle stresses or the critical stresses were measured. The results show that as the branch angle θ between the branch crack and the stem crack is 75°, the cracked specimen has the lowest strength. In order to explain the test results, numerical models of Y-shaped cracks by using ABAQUS code were established, and the J-integral method was applied in calculating crack tip stress intensity factor (SIF). The results show that when the branch angle θ increases, the SIF KI of the branch crack increases from negative to positive and the absolute value KII of the branch crack first increases, and as θ is 50°, it is the maximum, and then it decreases. Finally, in order to further investigate the stress distribution around Y-shaped cracks, photoelastic tests were conducted, and the test results generally agree with the compressive test results.
doi:10.1155/2014/192978
PMCID: PMC4072035  PMID: 25013846
5.  Measuring HIV Stigma at the Family Level: Psychometric Assessment of the Chinese Courtesy Stigma Scales (CCSSs) 
PLoS ONE  2014;9(3):e92855.
Courtesy stigma is the stigmatization a person perceives or experiences due to their association with a stigmatized individual or group. Most HIV-related stigma scales have been developed for people living with HIV/AIDS (PLWHAs), but not for their HIV-uninfected family members. To date, few measurement scales have been designed to measure the degree of stigma among both PLWHAs and their HIV-uninfected family members at the family level. We developed a set of courtesy stigma scales and estimated their reliability and validity from 256 PLWHAs and 256 of their HIV-uninfected family members. Exploratory and confirmatory factor analyses were performed in two independent samples: a development sample (N = 216) and a validation sample (N = 296), respectively. Two factors (“public stigma” and “self-perceived stigma”) had high internal consistency reliability (Cronbach's alpha coefficient between 0.83–0.90) and good construct validity (standardized factor loading range: 0.37–0.95) in both samples. These findings document that the newly developed brief instrument is a psychometrically sound measure of HIV-related stigma among both PLWHAs and their HIV-uninfected family members.
doi:10.1371/journal.pone.0092855
PMCID: PMC3962465  PMID: 24658364
6.  Meta-Analysis of Interventions for Reducing Number of Sexual Partners and Drug and Alcohol Abuse among People Living with HIV/AIDS 
Objective
To perform a systematic review and meta-analysis of the efficacy of risk reduction interventions on HIV-related risk behaviors among people living with HIV/AIDS (PLWHA)
Methods
Studies included in the meta-analysis were randomized clinical trials (RCTs) of risk reduction interventions, which targeted PLWHA aged 18 year or older and assessed the changes of number of sexual partners, drug use, needle sharing, and/or alcohol abuse between pre- and post-intervention. The standardized mean differences (SMD) between study arms as well as between baseline and post-intervention, defined as the effect sizes (ES), were calculated in random effects models. Heterogeneity of studies was estimated by the I2 statistic.
Results
Twelve RCTs involving 3993 PLWHA were included in our analysis: seven reported impacts on the number of sexual partners, and three reported impacts on drug use, needle sharing, and alcohol abuse, respectively. There were no statistically significant impacts of risk reduction interventions on the number of total sexual partners (mean ES, -0.10; 95% confidence interval [CI], -0.26, 0.06; P=0.22) or on the subset of HIV-negative or unknown-status sexual partners (mean ES, 0.003; 95% CI, -0.54, 0.54; P=0.99). Overall, risk reduction intervention studies documented a reduction of drug abuse (mean ES: -0.26; 95% CI: -0.51, -0.01; P=0.04) among HIV-infected drug users, but this impact was mainly attributable to one study. Risk reduction interventions did not show a reduction of needle sharing (mean ES, -0.15; 95% CI, -0.43, 0.13; P=0.29) or of alcohol abuse (mean ES, -0.10; 95% CI, -0.36, 0.17; P=0.47). No heterogeneity or publication bias was found across individual studies.
Conclusions
Our meta-analysis did not find a positive impacts of risk reduction interventions on number of sexual partners, drug use, needle sharing, or alcohol abuse among PLWHA, but the small number of studies meeting our review criteria limits these findings.
doi:10.4172/2155-6113.1000213
PMCID: PMC3819193  PMID: 24224118
People living with HIV/AIDS (PLWHA); Randomized clinical trial (RCT); Sexual partners; Positive prevention; Drug use; Alcohol abuse; Meta-analysis
7.  Emerging HIV Epidemic Among Older Adults in Nanning, China 
AIDS Patient Care and STDs  2012;26(10):565-567.
Abstract
The HIV/AIDS surveillance data indicates that the proportion of people living with HIV/AIDS (PLWHAs) who were 50 years old or older increased to 42.7% in 2011 from 16.5% in 2007 in Nanning, the capital city of Guangxi Province. A greater number of newly diagnosed HIV cases compared to clinical AIDS cases were identified from older adults. The dominant HIV transmission mode among older PLWHAs was heterosexual although approximately 30% of all PLWHAs acquired HIV through heterosexual contacts.
doi:10.1089/apc.2012.0227
PMCID: PMC3462385  PMID: 22984779
8.  Correction: Associations between Perceived HIV Stigma and Quality of Life at the Dyadic Level: The Actor-Partner Interdependence Model 
PLoS ONE  2013;8(6):10.1371/annotation/2eff8045-349d-4b70-b786-7b85288ffe01.
doi:10.1371/annotation/2eff8045-349d-4b70-b786-7b85288ffe01
PMCID: PMC3724951
9.  Associations between Perceived HIV Stigma and Quality of Life at the Dyadic Lvel: The Actor-Partner Interdependence Model 
PLoS ONE  2013;8(2):e55680.
Background
Few studies have investigated the relationship between HIV-related stigma and quality life at the dyadic level. The objective of this study was to examine the actor and partner effects of stigma that was perceived by people living with HIV/AIDS (PLWHAs) and caregivers on quality of life at the dyadic level.
Method
A survey was conducted among 148 dyads consisting of one PLWHA and one caregiver (296 participants) in Nanning, China. The interdependent relationship between a pair of dyadic members that influences the associations between stigma and quality of life was analyzed, using an innovative dyadic analysis technique: the Actor-Partner Interdependence Model (APIM).
Results
We found in this dyadic analysis that (1) PLWHAs compared to their caregivers exhibited a higher level of perceived HIV stigma and lower level of quality of life measured in four domains; (2) both PLWHAs' and caregivers' perceived HIV stigma influenced their own quality of life; (3) The quality of life was not substantially influenced by their partners' perceived stigma; and (4) Both actor and partner effects of stigma on quality of life were similar among PLWHAs and their caregivers.
Conclusion
As HIV stigma and quality of life are complex phenomena rooted in cultures, intervention programs should be carefully planned based on social or cognitive theories and should be culturally adopted.
doi:10.1371/journal.pone.0055680
PMCID: PMC3562178  PMID: 23383343
10.  Psychometric assessment of scales measuring HIV public stigma, drug-use public stigma and fear of HIV infection among young adolescents and their parents 
AIDS Care  2011;24(1):39-45.
The objective of this study was to design and assess measurement instruments that accurately measure the levels of stigma among individuals with a primarily collectivist culture. A cross-sectional study was conducted among middle school students and their parents or guardians in a rural area of China. Exploratory and confirmatory factor analyses were used to examine and determine the latent factors of the sub-scales of stigma respectively among students and their parents. Factor analyses identified three sub-scales: HIV public stigma (7 items), drug-use public stigma (9 items), and fear of HIV infection (7 items). There were no items with cross-loading onto multiple factors, supporting the distinctness of the constructs that these scales were meant to measure. Goodness of fit indices indicated that a three-factor solution fit the data at an acceptable level in the student sample (χ2/degree ratio = 1.98, CFI = 0.92, RMSEA = 0.055, SRMR = 0.057) and in the parent sample (χ2/degree ratio = 1.95, CFI = 0.91, RMSEA = 0.06, SRMR = 0.059). Reliability of the three scales was excellent (Cronbach’s alpha: 0.78–0.92 for students; 0.80–0.94 for parents or guardians) and stable across split samples and for the data as a whole. The scales are brief and suitable for use in developing countries where the collectivist culture prevails.
doi:10.1080/09540121.2011.592820
PMCID: PMC3206131  PMID: 21756072
HIV public stigma; drug-use public stigma; measurement scale; psychometric assessment; Chinese
11.  Role of sexual transmission of HIV among young non-injection and injection opiate users: A respondent driven sampling study 
Sexually transmitted diseases  2011;38(12):1161-1166.
Background
Little research has investigated sexual transmissibility of HIV among young drug users in China. The objective of this study was to examine the role of sexual transmission on HIV infection among injection drug users (IDUs) and non-injection drug users (NIDUs).
Methods
Respondent-driven sampling (RDS) was used to recruit 426 young heroin/opium drug users in Yunnan, China. Logistic regression modeling was performed to examine interrelationships among risky sexual behaviors, drug-use modes, and drug-use practices.
Results
Substantial proportions of NIDUs and IDUs reported engagement in risky sexual behaviors including: (1) multiple sexual partners (42% of NIDUs vs. 37% of IDUs); (2) concurrent sexual partnerships (48% vs. 46%); (3) commercial sex partners (23% vs. 24%) and sex partners who were NIDUs (14% vs. 17 %). Both NIDUs and IDUs reported low levels of condom use with non-regular partners (48% vs. 42%) and regular partner (24% vs. 27%), and having a history of recent methamphetamine use (21% vs. 18%). Compared to IDUs, NIDUs reported having had fewer sex partners who were IDUs, fewer IDU network peers, more NIDU network peers, and having lower levels of HIV knowledge and self-perceived HIV risk.
Conclusions
Generalization of the HIV epidemic from high-risk groups to the general population may be driven by risky sexual behavior among drug users. Reducing sexual transmission of HIV among both IDUs and NIDUs is the next major challenge for HIV intervention among drug users in China.
doi:10.1097/OLQ.0b013e3182315772
PMCID: PMC3229029  PMID: 22082729
HIV; Injection drug use; Non-Injection drug use; Sexual behavior; China
12.  Psychometric assessment of HIV/STI sexual risk scale among MSM: A Rasch model approach 
BMC Public Health  2011;11:763.
Background
Little research has assessed the degree of severity and ordering of different types of sexual behaviors for HIV/STI infection in a measurement scale. The purpose of this study was to apply the Rasch model on psychometric assessment of an HIV/STI sexual risk scale among men who have sex with men (MSM).
Methods
A cross-sectional study using respondent driven sampling was conducted among 351 MSM in Shenzhen, China. The Rasch model was used to examine the psychometric properties of an HIV/STI sexual risk scale including nine types of sexual behaviors.
Results
The Rasch analysis of the nine items met the unidimensionality and local independence assumption. Although the person reliability was low at 0.35, the item reliability was high at 0.99. The fit statistics provided acceptable infit and outfit values. Item difficulty invariance analysis showed that the item estimates of the risk behavior items were invariant (within error).
Conclusions
The findings suggest that the Rasch model can be utilized for measuring the level of sexual risk for HIV/STI infection as a single latent construct and for establishing the relative degree of severity of each type of sexual behavior in HIV/STI transmission and acquisition among MSM. The measurement scale provides a useful measurement tool to inform, design and evaluate behavioral interventions for HIV/STI infection among MSM.
doi:10.1186/1471-2458-11-763
PMCID: PMC3213074  PMID: 21970669
13.  Sexual transmissibility of HIV among opiates users with concurrent sexual partnerships: An egocentric network study in Yunnan, China 
Addiction (Abingdon, England)  2011;106(10):1780-1787.
Aims
To investigate the patterns of concurrent sexual partnerships among young opiate users and sexual transmissibility of HIV in concurrent sexual partnerships in drug-use and sexual networks.
Design
Cross-sectional design.
Participants
426 young opiate users in Yunnan, China.
Measurement
Respondent-driven sampling (RDS) was used to recruit participants. Multiple logistic regressions were performed to analyze the relationships of concurrent sexual partnerships with egocentric social network components, risky sexual behavior for HIV, and drug-use practices.
Findings
The RDS-adjusted prevalence of concurrent sexual partners was 42.9% among opiate users. Opiate users with concurrent sexual partnerships were more likely to engage in risky HIV-related sexual behavior, compared to those without. Specifically, they were more likely to report having had four or more sexual partners (26.3% vs. 2.0%), having had a spouse or boy/girl friends who also had concurrent sexual partnerships (28.1% vs. 8.2%), having exchanged drug for sex (12.4% vs. 3.8%), having had sexual partners who were non-injection drug users (22.6% vs. 10.1%), having had sexual partners who were injection drug users (25.3% vs. 13.5%), and having used club drugs (26.3% vs. 13.5%). There were no significant differences in consistent condom use between opiate users with sexual concurrency and those without. The same proportion (25.8%) of opiate users in the two groups reported having consistently used condoms when having sex with regular partners, and 46.3% of opiate users with sexual concurrency and 36.4% of those without such concurrency consistently used condoms with non-regular partners.
Conclusion
The expansion of the HIV epidemic from high risk populations to the general population in China may be driven by concurrent sexual partnerships. Behavioral interventions targeting safer sex should be integrated into harm reduction programmes.
doi:10.1111/j.1360-0443.2011.03459.x
PMCID: PMC3142291  PMID: 21457169
opiate use; concurrent sexual partnership; HIV; China
14.  Role of Social Network Dimensions in the Transition to Injection Drug Use: Actions Speak Louder than Words 
AIDS and behavior  2011;15(7):1579-1588.
The objective of this study was to examine the influences of social network factors, particularly social support and norms, in the transition from non-injection heroin and/or opiate use to heroin-injection, which is one of the leading causes of the spread of HIV/AIDS in China. Respondent-driven sampling was used to recruit young heroin and/or opiate users in an egocentric network study in Yunnan, China. Multivariate logistic regression using hierarchical combinations of candidate variables was used to analyze network factors for the injection transition. A total of 3,121 social network alters were reported by 403 egos with an average network size of eight. Fifty-eight percent of egos transitioned to heroin-injection from non-injection. This transition was associated with having a larger sex network size, a larger number of heroin injectors in one’s network, and a higher network density. The findings enhance our understanding of the influence of social network dimensions on the transition to injection drug use. Accordingly, the development of interventions for heroin and/or opiate users in China should consider social network characteristics.
doi:10.1007/s10461-011-9930-1
PMCID: PMC3145823  PMID: 21431412
Social networks; Heroin; Transition; HIV/AIDS; China
15.  Chinese Culture, Homosexuality Stigma, Social Support and Condom Use: A Path Analytic Model 
Stigma research and action  2011;1(1):27-35.
Purpose
The objective of this study was to examine the interrelationships among individualism, collectivism, homosexuality-related stigma, social support, and condom use among Chinese homosexual men.
Methods
A cross-sectional study using the respondent-driven sampling approach was conducted among 351 participants in Shenzhen, China. Path analytic modeling was used to analyze the interrelationships.
Results
The results of path analytic modeling document the following statistically significant associations with regard to homosexuality: (1) higher levels of vertical collectivism were associated with higher levels of public stigma [β (standardized coefficient) = 0.12] and self stigma (β = 0.12); (2) higher levels of vertical individualism were associated with higher levels self stigma (β = 0.18); (3) higher levels of horizontal individualism were associated with higher levels of public stigma (β = 0.12); (4) higher levels of self stigma were associated with higher levels of social support from sexual partners (β = 0.12); and (5) lower levels of public stigma were associated with consistent condom use (β = −0.19).
Conclusions
The findings enhance our understanding of how individualist and collectivist cultures influence the development of homosexuality-related stigma, which in turn may affect individuals’ decisions to engage in HIV-protective practices and seek social support. Accordingly, the development of HIV interventions for homosexual men in China should take the characteristics of Chinese culture into consideration.
doi:10.5463/sra.v1i1.16
PMCID: PMC3124705  PMID: 21731850
collectivism; HIV/AIDS; homosexuality; individualism
16.  Does Chinese culture influence psychosocial factors for heroin use among young adolescents in China? A cross-sectional study 
BMC Public Health  2010;10:563.
Background
Little empirical research has examined how cultural factors influence psychosocial factors for heroin drug use. The objectives of the study were to investigate the levels of individualism and collectivism among young adolescents and how cultural differences were associated with the constructs of the Theory of Planned Behavior and other psychosocial factors for heroin drug use.
Methods
A cross-sectional study was conducted among young adolescents in an HIV and heroin-stricken area in China. The Individualism-Collectivism Interpersonal Assessment Inventory (ICIAI) was used to measure cultural norms and values in the context of three social groups: family members, close friends, and classmates.
Results
A total of 220 boys and 241 girls were recruited and participated in an interview. Compared to boys, girls reported higher levels of the three specific-relationship ICIAIs, as well as higher levels of perceived behavioral control for heroin use, perceived peer control, and communication with parent about heroin use, but a lower level of favorable attitude towards heroin use. The levels of descriptive and subjective norms of heroin use were low in both girls and boys. Among boys, family ICIAI was positively associated with perceived behavioral control, and friend ICIAI was positively associated with perceived peer control and communication with parent. Among girls, family ICIAI was positively associated with perceived behavioral control and communication with parents about heroin use, but negatively with favorable attitudes to heroin use; friend ICIAI was positively associated with perceived peer control, and classmate ICIAI was negatively associated with favorable attitudes toward heroin use.
Conclusions
This study documents that collectivistic aspects of Chinese culture may influence psychosocial factors for heroin use, although the patterns are varied by gender. Findings provide an empirical basis for the development of culturally competent intervention programs for heroin use intervention and prevention.
doi:10.1186/1471-2458-10-563
PMCID: PMC2955002  PMID: 20858259
17.  The Chinese government's response to drug use and HIV/AIDS: A review of policies and programs 
Illicit drug use has become popular in China. Acknowledging the challenge of illicit drug use, China has adopted several new policies on the management of illicit drug use in recent years. This study reviews the current policies on drug use and assesses the harm reduction interventions among drug users in China. The review documents that the new policies on drug use provide a variety of choices of detoxification treatment for drug users. The methadone maintenance treatment and needle exchange programs have been adopted as harm reduction models in China. Most of the reviewed harm reduction programs have been successfully implemented and yielded positive effects in reducing drug related risk behaviors among drug users. Although there remain barriers to the effective implementation of policies on drug use and harm reduction programs, Chinese government has shown their commitment to support the expansion of harm reduction interventions for drug users throughout the country.
doi:10.1186/1477-7517-7-4
PMCID: PMC2847555  PMID: 20205729
18.  Gender-Based Model Comparisons of Maternal Values, Monitoring, Communication and Early Adolescent Risk Behavior 
Purpose:
To examine the relationships among maternal values, monitoring knowledge, parent-adolescent communication, and adolescent risk involvement based on adolescent gender.
Methods:
Parent reports of their personal values, monitoring knowledge, and communication with their children were compared to adolescent reports of risk involvement using information gathered from 647 Bahamian mother-adolescent (9−13 years) dyads.
Results:
Parent values of conservation (e.g., conformity) were positively associated with greater parent-adolescent communication and communication was significantly associated with greater monitoring knowledge for both genders. Among mother-son dyads only, group-based parent values of self-transcendence (e.g., universalism) were significantly associated with greater perceived parental monitoring knowledge; individualized self-enhancement values (e.g., hedonism) were negatively associated with open and supportive parent-adolescent communication.
Conclusions:
Parent values influence other parenting processes such as monitoring and communication. Parental monitoring, in turn, inversely influences adolescent risk involvement. These influences appear to differ based on the adolescent's gender as many of the relationships were stronger among mother-son dyads. These findings highlight a need to better understand the nature of the relationship between maternal values, parent-adolescent interactions, and adolescent's risk decisions.
doi:10.1016/j.jadohealth.2007.05.006
PMCID: PMC2082061  PMID: 17875463
Maternal values; maternal monitoring knowledge; communication; risk behavior
19.  HIV-Related Risk Factors Associated with Commercial Sex Among Female Migrants in China 
Data from 633 sexually experienced female migrants were analyzed to examine the sociodemographic and psychosocial factors and human immunodeficiency virus (HIV)-related behaviors associated with involvement in commercial sex. Six percent (40/633) of the participants reported having had sex for money. Compared with women who had not engaged in commercialsex, women who had sold sex were younger, less educated, and more likely to be unmarried. They were more likely to have engaged in HIV-related risk behaviors, such as becoming intoxicated with alcohol and using drugs. Among women who engaged in commercialsex, only 28% of them consistently used condoms during the last three episodes of sexualintercourse. Women who had ever engaged in commercialsex demonstrated greater depressive symptoms than those without such a history (p<.01). Female migrants, especially those engaging in commercial sex, were vulnerable to HIV/sexually transmitted diseases (STDs). Sexualrisk reduction and condom promotion are urgently needed among this population. Further studies are needed to examine the causal relationship between depression and HIV risk behaviors.
doi:10.1080/07399330590905585
PMCID: PMC1791013  PMID: 15804913
20.  Heterosexual Transmission of HIV in China 
Sexually transmitted diseases  2005;32(5):270-280.
Objective:
The objective of this study was to address the role of heterosexual transmission of HIV in China.
Goal:
The goal of this study was to explore the prevalence of unsafe sex and the likelihood of HIV spread heterosexually from core populations to others.
Study:
The authors conducted a review of behavioral studies.
Results:
Drug users were more likely to be involved in higher-risk sexual behaviors than were those who abstained from using drugs. Most female drug users (52-98%) reported having engaged in commercial sex. Most female sex workers (FSWs) and individuals with sexually transmitted diseases (STDs) had concurrent sexual partners. Many continued to have unprotected sex after noticing STD symptoms in themselves or their sexual partners. From 5% to 26% of rural-to-urban migrants had multiple sexual partners and 10% of males patronized FSWs during migration.
Conclusions:
Factors such as high rates of FSW patronage, low rates of condom use during commercial sex, having sex with both commercial and noncommercial sexual partners, and high rates of STD infection may promote a heterosexual epidemic in China.
PMCID: PMC1791011  PMID: 15849527
21.  Men Who Have Sex with Men and Human Immunodeficiency Virus/Sexually Transmitted Disease Control in China 
Cell research  2005;15(11-12):858-864.
Objectives:
To address the role of men who have sex with men (MSM) in the human immunodeficiency virus (HIV)/sexually transmitted disease (STD) epidemic in China.
Goal:
To explore the prevalence of risky sexual behaviors and the existing prevention efforts among men who have sex with men (MSM) in China.
Study Design:
Review of behavioral and STD/HIV prevention studies addressing MSM in China.
Results:
Sexual risk behaviors including unprotected group sex, anal sex, casual sex, and commercial sex were prevalent among Chinese MSM. Many Chinese MSM also engaged in unprotected sex with both men and women. Most MSM either did not perceive that they were at risk of HIV/AIDS or underestimated their risk of infection. Surveillance and intervention research among these men are still in the preliminary stages.
Conclusions:
Chinese MSM are at risk for HIV/STD infection and potential transmission of HIV to the general population. In addition to sexual risk reduction among MSM, reduction of homosexualityrelated stigma should be part of effective intervention efforts. Volunteers from the MSM community and health care workers in primary health care system may serve as valuable resources for HIV/STD prevention and control among MSM.
doi:10.1038/sj.cr.7290359
PMCID: PMC1791010  PMID: 16354560
22.  WILLINGNESS TO PARTICIPATE IN HIV/STD PREVENTION ACTIVITIES AMONG CHINESE RURAL–TO–URBAN MIGRANTS 
Data from 4,208 migrants aged 18–30 years old in Beijing and Nanjing, China, were analyzed to examine the correlates of willingness to participate (WTP) in HIV/STD prevention intervention activities among Chinese rural–to–urban migrants. Overall, 83.3% of the respondents would be willing to participate. Increased WTP was associated with employment in the industrial sector (OR = 1.59, 95% CI: 1.11–2.29), migrating to cities to learn more about the outside world (OR = 1.31, 95% CI: 1.08–1.59), prior experience with health maintenance (OR = 1.36, 95% CI: 1.11–1.66), higher level of HIV/AIDS awareness (OR = 1.16, 95% CI: 1.02–1.31), and perceived severity of risk behaviors (OR = 1.32, 95% CI: 1.04–1.68). Decreased WTP was associated with increased involvement in health risk behaviors (OR = 0.50, 95% CI: 0.35–0.73), increased perceptions of peer risk involvement (OR = 0.81, 95% CI: 0.68–0.98), perceived intrinsic rewards for risk behaviors (OR = 0.81, 95% CI: 0.68–0.96) and perceptions of HIV–related stigma (OR = 0.68, 95% CI: 0.53–0.89). The high level of WTP suggests that HIV/STD prevention activities are acceptable among rural–to–urban migrants. Their awareness of HIV/AIDS should be increased and HIV–related stigma should be reduced to increase the level of WTP. Recruitment and retention of individuals with high-risk behavior in prevention activities will be critical and challenging.
doi:10.1521/aeap.16.6.557.53792
PMCID: PMC1965499  PMID: 15585431
23.  Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China 
Drug and alcohol dependence  2005;79(1):103-112.
Background
The migrant population in China is at high risk for sexual risk behavior and alcohol intoxication. Information about the prevalence of alcohol intoxication and its association with sexual risk behavior among migrants is needed for designing effective intervention prevention programs for reduction in alcohol abuse and HIV infection.
Methods
Cross-sectional data were collected from 2153 sexually experienced young rural-to-urban migrants in Beijing and Nanjing, China, in 2002.
Results
Approximately one-third of the participants had been intoxicated with alcohol at least once during the previous month, with more males than females reporting intoxication (40.2% versus 23.7%, p < 0.001). Compared to non-intoxicated participants, respondents with alcohol intoxication in previous 30 days reported more psychological problems, including higher depression scores, lower levels of satisfaction with life and work, and higher perception of peer involvement in risk behavior. Intoxicated respondents were more likely to engage in premarital sex than non-intoxicated respondents (76% versus 60.2%, p < 0.001), have multiple sexual partners (13.4% versus 5.2%, p < 0.001), purchase sex (12.6% versus 4.9%, p < 0.001), and sell sex (10.1% versus 3.7%, p < 0.001). However, there was no association between alcohol intoxication and inconsistent/non-use of condoms. Multivariate analysis controlling for depression, peer risk involvement, age, gender, and other socio-demographic variables indicated that alcohol intoxication was independently correlated with premarital sex, multiple sexual partners, and buying and selling sex.
Conclusions
Compared to the general Chinese population, levels of intoxication were elevated among Chinese rural-to-urban migrants. Alcohol intoxication was associated with sexual risk behaviors. HIV/AIDS prevention and intervention efforts should include components of alcohol use/abuse prevention for an effective reduction of sexual risk among young rural-to-urban migrants in China.
doi:10.1016/j.drugalcdep.2005.01.003
PMCID: PMC1965498  PMID: 15943949
Alcohol intoxication; China; rural-to-urban migrants; Sexual risk behavior
24.  Risk Factors for Sexually Transmitted Disease Among Rural-to-Urban Migrants in China: Implications for HIV/Sexually Transmitted Disease Prevention 
AIDS patient care and STDs  2005;19(1):49-57.
The objective of the study was to identify risk factors associated with sexually transmitted diseases (STDs) among rural-to-urban migrants in Beijing in 2002. Migrants with STDs consisted of 432 migrants who sought STD care in two public STD clinics. Migrants without STDs included 892 migrants recruited from 10 occupational clusters. Multiple logistic regression was used for data analysis. Compared to migrants without STDs, migrants with STDs were more likely to report having engaged in commercial sex (selling or buying sex) (odds ratio [OR] = 2.70, 95% confidence interval [CI]: 1.71–4.25), multiple sex partners in the previous month (OR = 6.50, 95% CI: 3.73–11.32) and higher perceived HIV-related stigma (OR = 1.89, 95% CI: 1.30–2.75). Being a migrant with an STD was also associated with female gender (OR = 4.10, 95% CI: 2.89–5.82), higher education (OR = 2.92, 95% CI: 1.40–6.06), and higher monthly salary (OR = 1.68. 95% CI: 1.23–2.29). Migrants with STDs visited their hometowns more frequently and had more stable jobs than migrants without STDs. Approximately 10% of the migrants with STDs and 7.7% of the migrants without STDs always used condoms. This study suggests that among migrants, acquisition of an STD is associated with higher participation in risk behaviors as would be expected, but also with higher perceived stigma, education, stable jobs, salary, and with female gender. Appropriate behavioral intervention programs are advocated to reduce the risk and stigma among the special population.
doi:10.1089/apc.2005.19.49
PMCID: PMC1935434  PMID: 15665635
25.  Personal values and involvement in problem behaviors among Bahamian early adolescents: a cross-sectional study 
BMC Public Health  2007;7:135.
Background
Few studies, particularly in developing countries, have explored the relationship between adolescents and parental values with adolescent problem behaviors. The objectives of the study are to (1) describe adolescents' personal values, their problem behaviors, and the relationships thereof according to gender and (2) examine the relationship between parental values, adolescent values, and adolescents' problem behaviors among sixth-grade students and one of their parents.
Methods
The data used in these analyses were from the baseline assessment of a school-based HIV risk reduction intervention being conducted and evaluated among sixth grade students and one of their parents across 9 elementary schools in The Bahamas. Personal values were measured by the Portrait Values Questionnaire (PVQ). Seven reported problem behaviors were queried from the students, which included physical fight with a friend, drank alcohol, beer, or wine, smoked a cigarette, pushed or carried any drugs, carried a gun, knife, screwdriver or cutlass to use as a weapon, had sex and used marijuana or other illicit drugs over the past 6 months. Multilevel modeling for binary data was performed to estimate the associations between adolescent and parental values and adolescent problem behaviors.
Results
Among 785 students, 47% of the students reported at least one problem behavior. More boys (54%) reported having one or more problem behaviors than girls (41%, p < 0.01). Boys compared to girls expressed a higher level of self-enhancement (means score: 36.5 vs. 35.1; p = 0.03), while girls expressed a higher level of self-transcendence (42.3 vs. 40.7; p = 0.03). The results of multilevel modeling indicates that boys with a higher level of self-enhancement and girls with a higher level of openness to change and a lower level of conservation were more likely to report engagement in problem behaviors. Only two parental values (self-transcendence and conservation) were low or modestly correlated with youth' values (openness to change and self-enhancement). Parental-reported values documented limited association on adolescents' reported values and behaviors.
Conclusion
In designing interventions for reducing adolescents' problem behaviors, it may be important to understand the values associated with specific problem behaviors. Further exploration regarding lack of association between adolescent and parental values and problem behaviors is needed.
doi:10.1186/1471-2458-7-135
PMCID: PMC1924852  PMID: 17605792

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