Zhang H, Wu Z, Zheng Y, Wang J, Zhu J, Xu J. A pilot intervention to increase condom use and HIV testing and counseling among men who have sex with men in Anhui, China. J Acquir Immune Defic Syndr. 2010; 53:S88-S92.
The Chinese Ministry of Health estimated in 2007 that approximately 11% of all HIV infections in China are in men who have sex with men (MSM) and that 12.2% of recent infections were in this group.(1) Prevalence of HIV among Chinese MSM has been found to be increasing to 5.8% in Beijing in 2006 and 16.9% in southwestern China in 2007.(2) MSM in China are a high-risk group with low rates of condom use and low rates of HIV testing. A national study found the rate of condom use at last anal intercourse was 54.8%,(3) and a 2005 survey in Hefei found that 24.5% of MSM had been tested for HIV.(4)
To evaluate the efficacy of a peer-driven sexual network-based group intervention for MSM to increase condom use, increase HIV testing and reduce numbers of sexual partners.
MSM in cities of Hefei, Wuhu and Fuyang in Anhui Province, China.
This is an uncontrolled intervention study. Participants were recruited using a modified respondent-driven sampling method with 12 initial seeds and 3 referrals per participant. Inclusion criteria were age >18 years, sex with another man in the past 12 months and residence in Hefei, Wuhu or Fuyang during the study year. The intervention was directed to each seed and his sexual network. Peers led 4 1.5-hour sessions on HIV risk reduction based on the AIDS Risk Reduction Model.(5) The intervention was evaluated by comparing pretest and posttest self-reports of sexual behavior, HIV-related knowledge, condom use in the last 3 episodes of anal intercourse with a man and HIV testing the past 2 months. Posttest data were collected 3 months after the end of the intervention program.
A total of 218 MSM participated. Their median age was 24.0 years; 64% reported their sexual orientation as homosexual and 22% as bisexual. Of the 218 participants, all attended the first two sessions, 164 (75%) attended the third and fourth sessions, and 170 (78%) completed the posttest assessment. Seven seeds reached 5 waves of recruitment, and 3 reached 4 waves. Compared to pretest reports, HIV testing in the prior 2 months increased from 15% to 52%, never-use of condoms decreased from 25% to 9%, and consistent condom use in the 3 most recent episodes of anal intercourse with a man increased from 50% to 60%. There were no changes in the number of male sexual partners but a significant decrease in the proportion with female sexual partners in the prior 2 months from 18% to 11%.
A peer-driven network-based behavioral intervention program is feasible and likely effective in promoting condom use and HIV testing in MSM in China. This method of recruitment for MSM interventions may
obviate some of the discrimination that MSM face in China(6) and make MSM more easily identifiable for public health interventions.(7) The authors suggest that the model should now be incorporated into a larger national efficacy trial.
There is no formal method for evaluating the quality of pretest-posttest uncontrolled intervention studies, but uncontrolled studies would be considered low-quality evidence under the GRADE system of evaluating literature. Additionally, the study relied on self reported behaviors, which introduces the possibility of social desirability bias influencing reported outcomes, and 22% of participants did not complete the final assessment, which introduces the potential for differential loss to follow-up (i.e., those less likely to change behavior were more likely to drop out, leading to an overestimation of the effect of the intervention).
This should be considered a preliminary study, but its results and methods are intriguing and seemingly well-suited for settings where MSM populations are largely hidden. A formal evaluation using a more robust design is the next step.
- State Council AIDS Working Committee Office, UN Theme Group on AIDS in China. Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007). Beijing, China: State Council AIDS Working Committee Office, December 1, 2007.
- Ma XY, Zhang QY, He X, et al. Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men. J Acquir Immune Defic Syndr. 2007; 45: 581-587.
- Wu SW, Zhang BC, Li SF, et al. AIDS high risk behaviors surveillance and comparison of homosexual men in China. Chin J AIDS/STD. 2004; 10: 332-334.
- Xu J, Zhang HB, Zheng YJ, et al. Demand and use of VCT service among MSM. Chin J Public Health. 2007; 23:1040-1042.
- UNAIDS. AIDS Risk Reduction Model. Sexual Behavioral Change for HIV: Where Have Theories Taken Us? Geneva, Switzerland: UNAIDS, 1999.
- Liu JX, Choi K. Experiences of social discrimination among men who have sex with men in Shanghai, China. AIDS Behav. 2006; 10:S25-S33.
- Xu J. Zhang HB, Zheng YJ. The characteristics of MSM and venues. Chin J Public Health Med 2007; 23:389-391.