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Title page for ETD etd-11302013-075429

Type of Document Dissertation
Author Zhang, Lan
URN etd-11302013-075429
Title HIV Risk among Men Who Have Sex with Men in a Large Chinese City
Degree PhD
Department Epidemiology
Advisory Committee
Advisor Name Title
Sten H. Vermund Committee Chair
Bryan E. Shepherd Committee Member
Han-Zhu Qian Committee Member
Kenneth A. Wallston Committee Member
Yuhua Ruan Committee Member
  • China
  • Chongqing City
  • systematic review
  • online
  • Internet
  • behavioral intervention
  • syphilis
  • men who have sex with men
  • homosexual men
  • respondent driving sampling
  • HIV testing
  • sexual behavior
  • college student
Date of Defense 2013-06-21
Availability unrestricted
In this dissertation, I conducted epidemiological secondary data analysis of two serial cross-sectional surveys to explore prevalence and risk factors for HIV and syphilis among men who have sex with men (MSM) in Chongqing City in southwestern China.

I first looked into the predictors, barriers, and facilitators of HIV testing. Among 492 MSM surveyed in 2010, 58% had ever been tested for HIV. Prior HIV testing was associated with having a college degree (adjusted odds ratio [aOR]: 1.7, 95% confidence interval [CI]: 1.2-2.6), having used condoms with the most recent male partner (aOR: 2.9, 95% CI: 1.3-6.6), and preferring receptive anal sex roles (aOR: 0.6, 95% CI: 0.4-0.9). Fear of knowing a positive result was the major barrier.

I then assessed predictors for HIV infection itself among 975 MSM in 2009 and 2010, excluding duplicate participants in 2010. The HIV prevalence was 15.1% and syphilis prevalence was 5.7%. HIV infection was associated with non-Han minorities (aOR: 0.2, 95% CI: 0.1-0.6), non-student MSM who attained (aOR: 2.7, 95% CI: 1.2-5.9) or who did not attain a college degree (aOR: 6.9, 95% CI: 3.2-15.2), and syphilis infection (aOR: 5.8, 95% CI: 3.0-11.4).

I further examined HIV risks among student MSM. Among 503 MSM surveyed in 2009, 36% were registered students with an HIV prevalence of 5.5%. Both non-student college graduates (aOR: 3.5; 95% CI: 1.3-9.5) and non-college graduates (aOR: 5.7; 95% CI: 1.8-18.4) had higher risk of HIV infection than but similar risky sexual behaviors with student MSM

Finally, I did a systematic review of Internet-based behavioral interventions for HIV prevention among MSM, anticipating new interventions to be considered . Among MSM aged 18 years or older, 5128 were enrolled in six eligible randomized controlled trials and one quasi-experimental study. Intervention effectiveness was inconsistent. A pooled effect estimate was unable to be calculated due to significant heterogeneity of the interventions and the outcomes.

In summary, MSM in Chongqing, China, are at very high risk for HIV and syphilis infections, including risk among college students. These analyses provide an evidence-base for planning focused interventions in key sub-populations to maximize testing, prevention, and therapy.

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