published_or_final_version / Education / Doctoral / Doctor of Philosophy

published_or_final_version / Architecture / Master / Master of Architecture

人類免疫缺陷病毒 (HIV) 是人獲得性免疫缺陷綜合征 (愛滋病，AIDS) 的致病原，2010年全球有180萬人死於愛滋病，HIV/AIDS已成為全球健康的嚴重挑戰。人類免疫缺陷病毒與乙型肝炎病毒 (HBV) ，丙型肝炎病毒 (HCV) 的合併感染非常普遍，已演變成具有嚴重臨床後果的新健康問題。儘管對於人類免疫缺陷病毒的研究已有很大的進展，但由於受研究模型的限制，人體免疫系統對人類免疫缺陷病毒感染的應答，特別是對乙型肝炎病毒，丙型肝炎病毒與人類免疫缺陷病毒合併感染的免疫應答，仍值得進一步的闡明。 / 在本研究中，我們首先對深圳人類免疫缺陷病毒，乙型肝炎病毒，丙型肝炎病毒合併感染的流行情況進行研究。共選取914份人類免疫缺陷病毒感染者的血漿，經過對乙型肝炎病毒表面抗原 (HBsAg) 和抗丙型肝炎病毒抗體 (anti-HCV) 的檢測，發現10.9% (100/914) 的被檢測者是人類免疫缺陷病毒/乙型肝炎病毒合併感染，14.6% (133/914) 為人類免疫缺陷病毒/丙型肝炎病毒合併感染，3.7% (34/914) 為人類免疫缺陷病毒/乙型肝炎病毒/丙型肝炎病毒三重感染。多元邏輯回歸分析證明人類免疫缺陷病毒傳染的危險行為與合併感染顯著相關聯。大多數的人類免疫缺陷病毒/乙型肝炎病毒合併感染者都是通過性接觸感染人類免疫缺陷病毒，包括異性傳播與同性傳播 (95/100, 95%); 大多數的人類免疫缺陷病毒/丙型肝炎病毒合併感染者是靜脈注射吸毒者 (89/133, 66.9%); 人類免疫缺陷病毒/乙型肝炎病毒/丙型肝炎病毒三重感染者中，大多數是靜脈注射吸毒者 (28/34, 82.4%)。靜脈注射吸毒人群中，大部分是男性 (108/122, 88.5%)，約半數人的年齡介乎27至32歲 (56/122, 45.9%) 。有接近一半的經過血液和血液製品傳播人類免疫缺陷病毒的人是人類免疫缺陷病毒/丙型肝炎病毒合併感染者 (10/23, 43.5%) 。性別與人類免疫缺陷病毒感染的危險行為有顯著關係，大部份的靜脈注射吸毒者是男性。 / 進一步，我們利用酶聯免疫吸附測定法 (ELISA) 檢測深圳愛滋病陽性樣本血漿中白細胞介素27 (IL-27) 的濃度。結果顯示，對比健康參照者，人類免疫缺陷病毒單獨感染者，人類免疫缺陷病毒/乙型肝炎病毒合併感染者，人類免疫缺陷病毒/丙型肝炎病毒合併感染者的血漿IL-27濃度顯著升高。隨後我們進一步發現，人類免疫缺陷病毒單獨感染組，人類免疫缺陷病毒/乙型肝炎病毒，人類免疫缺陷病毒/乙型肝炎病毒/丙型肝炎病毒合併感染組之間的血漿IL-27濃度沒有顯著差異，而人類免疫缺陷病毒/丙型肝炎病毒合併感染組與人類免疫缺陷病毒/乙型肝炎病毒/丙型肝炎病毒三重感染組的血漿IL-27濃度差異顯著。我們還發現人類免疫缺陷病毒單獨感染組中，血漿IL-27濃度與CD4⁺ T 淋巴細胞數量顯著正相關 (r = 0.177, P = 0.034)。 / 我們進一步分析了人類免疫缺陷病毒和丙型肝炎病毒的病毒載量對血漿IL-27濃度的影響，發現HIV單獨感染組中人類免疫缺陷病毒載量與血漿IL-27濃度沒有顯著相關 (r = - 0.063, P = 0.679)，而人類免疫缺陷病毒/丙型肝炎病毒合併感染組中，人類免疫缺陷病毒載量與血漿IL-27濃度顯著正相關 (r = 0.362, P = 0.049)。人類免疫缺陷病毒/丙型肝炎病毒合併感染組中，人類免疫缺陷病毒載量與丙型肝炎病毒載量缺少顯著線性關聯 (r = - 0.072, P = 0.704)，而人類免疫缺陷病毒/丙型肝炎病毒合併感染組可根據人類免疫缺陷病毒與丙型肝炎病毒的病毒載量再細分成血漿IL-27濃度差異顯著的三組 (P = 0.014) ， 丙型肝炎病毒載量與血漿IL-27濃度缺少顯著關聯 (r = - 0.119, P = 0.530) 。 / 我們利用TaqMan®等位基因分型技術測定深圳男同性戀人群中IL-27 p28基因的單核苷酸多態性 (SNP)。結果顯示，人類免疫缺陷病毒感染組IL-27 p28 -964A/G 和4603G/A的基因型與健康男同性戀參照組的基因型沒有顯著差異， IL-27 p28 -964A/G 和4603G/A的等位基因比率也沒有顯著差異。結果也顯示，IL-27 p28 2905T/G的TG基因型可減少2.77倍的人類免疫缺陷病毒感染風險，等位基因G可減少2.72倍的人類免疫缺陷病毒感染風險。連鎖不平衡在IL-27 p28 -964A/G 和2905T/G 中存在 ( / 綜上所述， 在本研究中，我們首次調查了深圳人類免疫缺陷病毒，乙型肝炎病毒，丙型肝炎病毒合併感染的流行情況，並分析了合併感染的風險因素。 發現人類免疫缺陷病毒單獨感染者，人類免疫缺陷病毒/乙型肝炎病毒合併感染者， 及人類免疫缺陷病毒/丙型肝炎病毒合併感染者的血漿IL-27濃度比健康參照組顯著地升高；人類免疫缺陷病毒單獨感染組中，血漿IL-27濃度與CD4⁺ T淋巴細胞數量顯著正相關。人類免疫缺陷病毒/丙型肝炎病毒合併感染組中，人類免疫缺陷病毒載量與血漿IL-27濃度顯著正相關 (r = 0.362, P = 0.049)。分析深圳男同性戀人群IL-27 p28基因的單核苷酸多態性，發現IL-27 p28 2905T/G 與人類免疫缺陷病毒感染相關，GGG單型可降低男同性戀人群人類免疫缺陷病毒感染的風險。 / Human Immunodeficiency Virus (HIV) is the causative agent of Acquired Immunodeficiency Syndrome (AIDS); HIV/AIDS caused 1.8 million deaths world-widely in 2010 and became a major global health challenge. HIV co-infections with Hepatitis B virus (HBV), Hepatitis C virus (HCV) are common and have emerged into new health problems with severe clinical consequences. Since the discovery of HIV, massive progress in understanding of the pathogen has been achieved. Due to the restriction of research model, how human immune system responds to HIV infection, particularly, to HBV or HCV co-infections is still worthy further elucidation. / A cohort study was first conducted in Shenzhen regarding the seroprevalence of HBV, HCV infections among HIV-infected population. Totally 914 HIV positive individuals were recruited in the study and tested for HBsAg and anti-HCV antibodies. The results showed a 10.9% (100/914) HIV/HBV co-infection rate, 14.6% (133/914) HIV/HCV co-infection prevalence and 3.7% (34/914) HIV/HBV/HCV triple-infection prevalence. Multivariate logistic regression revealed that HIV transmission risk behavior was significantly associated with HIV, HBV, HCV co-infections. Most HIV/HBV co-infection cases got HIV through sexual contact including heterosexual and homosexual behaviors (95/100, 95%); while most HIV/HCV co-infection subjects were injection drug users (IDUs) (89/133, 66.9%). In the case of HIV/HBV/HCV triple-infection, IDUs accounted for a large ratio (28/34, 82.4%). Among IDUs, most of them were male (108/122, 88.5%) and nearly half were aged 27 to 32 years old (56/122, 45.9%). Near half people who got HIV through blood and blood products were HIV/HCV co-infected (10/23, 43.5%). Gender has a significant correlation with HIV risk behavior and most IDUs were male. / Next, we applied ELISA to test HIV positive clinical samples and proved that plasma interleukin-27 (IL-27) level was significantly elevated in HIV mono-infected, HIV/HBV co-infected and HIV/HCV co-infected subjects when compared with healthy controls. Later, we further revealed that plasma IL-27 titer was not significantly varied among HIV, HBV and HCV co-infections except between HIV/HCV co-infections and HIV/HBV/HCV triple-infections. We also observed a significant positive correlation between CD4⁺ T cell counts and plasma IL-27 titer within HIV mono-infected group (r = 0.177, P = 0.034). / We further analyzed the impact HIV and HCV viral loads on plasma IL-27 titer. We found there was no significant correlation between HIV viral load and IL-27 titer among HIV mono-infected individuals (r = - 0.063, P = 0.679); while a significant positive correlation was observed between HIV viral load and IL-27 titer in HIV/HCV co-infected individuals (r = 0.362, P = 0.049). In the case of HIV/HCV co-infection, there was no significant linear correlation between HIV and HCV viral loads (r = - 0.072, P = 0.704) but exist obvious subdivision of samples in terms of HIV and HCV viral loads with significant IL-27 titer variance (P = 0.014). No correlation was observed between HCV viral load and IL-27 titer (r = - 0.119, P = 0.530). / IL-27 p28 polymorphisms were genotyped with TaqMan® Allelic Discrimination Assay in Chinese men who have sex with men (MSM) population in Shenzhen and the results revealed that proportions of IL-27 p28 -964A/G and 4603G/A genotypes were not significantly different from the healthy controls; IL-27 p28 -964A/G and 4603G/A allele frequencies were similar between HIV positive MSM group and healthy control MSM group. Results also showed that for IL-27 p28 2905T/G polymorphism, TG genotype has a 2.77-fold decreased risk of HIV susceptibility and subjects with G allele has a 2.72-fold decreased risk of HIV susceptibility. Linkage disequilibrium (LD) coefficients were observed between IL-27 p28 -964A/G and 2905T/G ( / In conclusion, the seroprevalences of HBV and HCV infection among HIV positive population in Shenzhen were surveyed and risk factors associated with co-infections were analyzed. Plasma IL-27 titer was significantly elevated in HIV mono-infected, HIV/HBV co-infected and HIV/HCV co-infected individuals. IL-27 level was correlated with CD4⁺ T cell counts within HIV mono-infected people. A significant positive correlation was found between HIV viral load and IL-27 titer in HIV/HCV co-infected individuals (r = 0.362, P = 0.049). IL-27 p28 2905T/G was associated with individual susceptibility to HIV infection and haplotype GGG showed a protective role in restricting HIV infection in MSM population. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / He, Lai. / "October 2012." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 135-155). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract (English) --- p.iii / Abstract (Chinese) --- p.vi / Acknowledgements --- p.ix / Contents --- p.x / List of Tables --- p.xv / List of Figures --- p.xvi / Abbreviations --- p.xvii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Human Immunodeficiency Virus --- p.1 / Chapter 1.1.1 --- HIV virology --- p.1 / Chapter 1.1.1.1 --- HIV structure and genome organization --- p.1 / Chapter 1.1.1.2 --- HIV life cycle --- p.3 / Chapter 1.1.1.3 --- HIV genotypes --- p.5 / Chapter 1.1.2 --- HIV epidemiology --- p.6 / Chapter 1.1.2.1 --- Global HIV epidemiology --- p.6 / Chapter 1.1.2.2 --- HIV epidemiology in China --- p.9 / Chapter 1.1.3 --- HIV pathogenesis --- p.13 / Chapter 1.1.3.1 --- Natural history of HIV infection --- p.13 / Chapter 1.1.3.2 --- HIV transmission --- p.15 / Chapter 1.1.3.3 --- HIV tropism --- p.17 / Chapter 1.1.4 --- Immune responses to HIV infection --- p.19 / Chapter 1.1.4.1 --- Innate immune response --- p.19 / Chapter 1.1.4.2 --- Adaptive immune response --- p.21 / Chapter 1.1.5 --- Diagnosis --- p.24 / Chapter 1.1.6 --- HIV prevention --- p.25 / Chapter 1.1.7 --- Anti-HIV therapy --- p.25 / Chapter 1.1.8 --- Hepatitis B virus, Hepatitis C virus infection --- p.26 / Chapter 1.1.8.1 --- HBV infection natural history, diagnosis, disease progression and epidemiology --- p.26 / Chapter 1.1.8.2 --- HCV infection natural history, diagnosis, disease progression and epidemiology --- p.30 / Chapter 1.1.9 --- HIV, HBV, HCV co-infections --- p.32 / Chapter 1.2 --- Interleukin-27 --- p.36 / Chapter 1.2.1 --- Biology of IL-27 --- p.36 / Chapter 1.2.2 --- IL-27 on immune system --- p.37 / Chapter 1.2.3 --- IL-27 anti-tumor properties --- p.38 / Chapter 1.2.4 --- IL-27 antiviral features --- p.40 / Chapter 1.2.5 --- IL-27 with hepatitis --- p.41 / Chapter 1.3 --- Single-nucleotide polymorphisms (SNPs) --- p.42 / Chapter 1.3.1 --- Types of SNPs --- p.43 / Chapter 1.3.2 --- Functions of SNPs --- p.43 / Chapter 1.4 --- Objectives of the study --- p.45 / Chapter Chapter 2 --- Seroprevalence of HBV, HCV infection among HIV positive individuals in Shenzhen --- p.52 / Chapter 2.1 --- Introduction --- p.52 / Chapter 2.2 --- Materials and methods --- p.54 / Chapter 2.2.1 --- Study participants --- p.54 / Chapter 2.2.2 --- Measure of HBV, HCV seroprevalence --- p.55 / Chapter 2.2.3 --- Statistical analysis --- p.60 / Chapter 2.3 --- Results --- p.61 / Chapter 2.3.1 --- HIV infection in Shenzhen --- p.61 / Chapter 2.3.2 --- Seroprevalence of HBV, HCV infection among HIV positive individuals in Shenzhen --- p.61 / Chapter 2.4 --- Discussion --- p.65 / Chapter 2.4.1 --- HIV infection in Shenzhen --- p.65 / Chapter 2.4.2 --- HIV, HBV, HCV co-infections in Shenzhen --- p.68 / Chapter 2.4.3 --- Limitations of the study --- p.71 / Chapter Chapter 3 --- Upregulation of Interleukin-27 titer in HIV infected persons --- p.78 / Chapter 3.1 --- Introduction --- p.78 / Chapter 3.2 --- Materials and methods --- p.80 / Chapter 3.2.1 --- Study participants --- p.80 / Chapter 3.2.2 --- Measure of HIV, HBV, HCV infection --- p.80 / Chapter 3.2.3 --- Detection of IL-27 in plasma --- p.81 / Chapter 3.2.4 --- CD4 counting --- p.84 / Chapter 3.2.5 --- Statistical analysis --- p.84 / Chapter 3.3 --- Results --- p.84 / Chapter 3.3.1 --- Demographics of study participants --- p.84 / Chapter 3.3.2 --- Upregulation of IL-27 levels in HIV infected persons --- p.85 / Chapter 3.3.3 --- Correlation of plasma IL-27 titer with CD4⁺ T cell count --- p.86 / Chapter 3.4 --- Discussion --- p.86 / Chapter Chapter 4 --- Impact of HIV, HCV viral loads on Interleukin-27 titer among Antiretroviral Therapy- Naïve HIV positive Chinese --- p.95 / Chapter 4.1 --- Introduction --- p.95 / Chapter 4.2 --- Materials and methods --- p.96 / Chapter 4.2.1 --- Study participants --- p.97 / Chapter 4.2.2 --- HIV, HBV and HCV Serological assays --- p.97 / Chapter 4.2.3 --- CD4 counting --- p.97 / Chapter 4.2.4 --- Detection of plasma IL-27 --- p.98 / Chapter 4.2.5 --- Quantification of HIV, HCV viral loads --- p.98 / Chapter 4.2.6 --- Statistical analysis --- p.102 / Chapter 4.3 --- Results --- p.102 / Chapter 4.3.1 --- Demographics of study participants --- p.102 / Chapter 4.3.2 --- Plasma IL-27 was elevated in HIV-positive persons --- p.103 / Chapter 4.3.3 --- Correlation of IL-27 titer and CD4⁺ T cell count --- p.103 / Chapter 4.3.4 --- Correlation of HIV viral load and IL-27 titer --- p.104 / Chapter 4.3.5 --- Correlation of HCV viral load and IL-27 titer --- p.104 / Chapter 4.4 --- Discussion --- p.105 / Chapter Chapter 5 --- Association of Interleukin-27 polymorphisms with the susceptibility to HIV infection in a Chinese men who have sex with men population --- p.116 / Chapter 5.1 --- Introduction --- p.116 / Chapter 5.2 --- Materials and methods --- p.118 / Chapter 5.2.1 --- Study participants --- p.118 / Chapter 5.2.2 --- HIV screening --- p.118 / Chapter 5.2.3 --- Genomic DNA extraction --- p.119 / Chapter 5.2.4 --- IL-27 p28 -964A/G, 2905T/G and 4603G/A genotyping --- p.120 / Chapter 5.2.5 --- Statistical analysis --- p.121 / Chapter 5.3 --- Results --- p.122 / Chapter 5.3.1 --- Demographics of study participants --- p.122 / Chapter 5.3.2 --- IL-27 genotypes and allele frequencies in HIV MSM and healthy MSM controls --- p.122 / Chapter 5.3.3 --- LD analysis and haplotype analysis --- p.123 / Chapter 5.4 --- Discussion --- p.124 / Chapter Chapter 6 --- Summary and perspectives --- p.130 / Chapter 6.1 --- Summary --- p.130 / Chapter 6.2 --- Perspectives --- p.132 / Bibliography --- p.135

介紹.與確診多年的HIV陽性男男性接觸者（MSM）相比，新確診的HIV陽性男男性接觸者（N-MSM）傳播HIV的危險性更高，承受更多的心理健康問題，但愛滋病相關知識相對缺乏。目前的研究已經描述了N-MSM的心理健康和危險行為情況，但關於二者影響因素的調查卻甚少，且暫無關於N-MSM獨特相關因素，如疾病認知，安全套使用認知，安全使用的社會道德等的研究报告。目前，中國只有少量關於HIV陽性MSM的研究，無關於N-MSM的研究。 / 目的.本研究的目的包括： 1）描述中國N-MSM的心理健康和危險行為情況；2）驗證疾病認知量表在N-MSM人群的適應性；3）探討N-MSM疾病認知與心理健康（自殺意念，抑鬱，自我歧視和創傷後成長）的關係，並進一步研究在認知表徵與心理健康結果關係中，情感表徵的仲介作用與交互作用； 4）探索疾病認知與心理因素（抑鬱、自我歧視和創傷後成長）對自殺意念的獨立作用與交互作用；和5）研究愛滋病傳播相關危險行為的多方面因素。 / 對象與方法：本研究採用橫斷面研究設計，對中國成都共225名N-MSM進行了面對面訪談和電腦輔助移動電話訪談。根據Moss-Morris的方法，驗證疾病認知問卷的信度及效度； 使用單變量、多變量及分層的logistic和線性回歸等方法進行資料分析。 / 結果.在225名研究對象中，48%有自殺意念和抑鬱表現，35%自我歧視得分較高，17%有積極的創傷後成長。N-MSM的危險行為普遍存在：31%在確診感染後發生過非保護肛交性行為，40%認為在未來6個月意願與HIV陰性男性發生非保護肛交性行為，20%在感染後想過故意將HIV傳染給別人。經驗證，疾病認知問卷在N-MSM中具有良好的心理測量特徵。疾病認知的多個維度，如情感反應和治療控制等，與心理健康結果顯著相關。在認知表徵與心理健康結果的關係中，情感表徵表現出強烈的仲介作用。兩個疾病認知維度（情感反應與治療控制）和兩個心理因素（抑鬱和創傷後成長）對自殺意念有獨立作用，但無交互作用。影響N-MSM危險行為的多方面因素包括安全套相關認知，情感因素，心理健康和社會道德。 / 結論.本研究結果顯示中國N-MSM心理健康問題和危險行為是普遍存在的。疾病認知與心理健康結果的顯著聯繫，提示了可以通過改善N-MSM的疾病認知從而減少該人群的心理健康問題；在HIV領域中，這是一個新的研究方向。在對N-MSM危險行為的幹預研究中，需考慮影響N-MSM的獨特因素，如安全套相關認知，情感反應和社會責任等。 / Introduction.Newly diagnosed HIV positive men who have sex with men (N-MSM) comprise a special subgroup of HIV positive MSM, as they have higher risks of transmission via anal sex, suffer from more mental health problems, and possess less knowledge of HIV/AIDS than those who have been diagnosed for many years. Previous studies have investigated the prevalence of mental health and risk behaviours among N-MSMs, while few studies have explored the risk factors associated with these health-related outcomes, particularly the factors unique to N-MSMs, like illness perception, cognitions regarding condom use, social morality of condom use, etc. China provides only limited data about HIV positive MSM, and no such data is about N-MSMs. / Objectives.The aims of the study were to 1) investigate the characteristics of mental health and risk behaviours among N-MSMs in China; 2) validate the revised illness perception questionnaire (IPQ-R) modified for N-MSMs; 3) examine the effects of patients’ illness perception on their mental health outcomes and determine the mediating or moderating effects of emotional representation on the associations between cognitive representation and mental health outcomes; 4) examine the main effects and interaction effects of illness perception and psychological variables on suicidal ideation; and 5) investigate the multidimensional factors associated with risk behaviours related to HIV transmission. / Subjects and Methods.A cross-sectional study was conducted in Chengdu, China. A total of 225 N-MSMs participated in this study. Both face-to-face and computer-assisted mobile phone interviews were applied. The methodology by Moss-Morris was used to validate IPQ-R among N-MSMs. Univariate, multivariate, hierarchical logistic, and linear regression methods were used for data analysis. / Results.Of all participants, 48% had suicidal ideation and depression, and 36% reported self-stigma, but only 17% experienced posttraumatic growth (PTG). Risk behaviours were prevalent: 32% had had unprotected anal intercourse (UAI) since HIV diagnosis, 40% had the intention to have UAI with HIV negative men in the coming 6 months, and 20% had had thoughts of transmitting HIV to others purposely since HIV diagnosis. The modified IPQ-R for N-MSMs was validated and found to have acceptable psychometric properties. Most dimensions of illness perception (such as emotional response, treatment control and consequences) were significantly associated with mental health outcomes. Emotional representation had strong mediation effects rather than moderator effects on the associations between cognitive representation and mental health outcomes. Two illness perception dimensions (emotional response and treatment control) and two psychological variables (depression and PTG) showed independent effects on suicidal ideation, but not interaction effects on suicidal ideation. Multidimensional factors, such as variables related to cognitions of condom use, emotional affect (feelings of guilt regarding HIV transmission to others), mental health, and social morality (perceptions regarding responsibility for condom use), were associated with risk behaviours among N-MSMs. / Conclusions.The results show that mental health problems and risk behaviours are prevalent among Chinese N-MSM. Illness perception has a strong influence on mental health outcomes, indicating a new direction for the reduction of mental health problems via the modification of patients’ illness perception. Multidimensional factors are associated with risk behaviours related to HIV transmission, such as cognitions of condom use, emotional affection and social morality, which are unique to HIV infectors and should be considered in the development of intervention programs among N-MSMs. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wu, Xiaobing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 257-276). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract (English) --- p.i / Abstract (Chinese) --- p.i / Acknowledgements --- p.iii / List of Contents --- p.v / List of Tables --- p.xi / List of Figures --- p.xv / Abbreviations --- p.xvii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.2.1 --- The importance of HIV positive men who have sex with men as a source of HIV transmission --- p.1 / Chapter 1.2.2 --- The importance of newly diagnosed HIV positive MSM (N-MSM) --- p.3 / Chapter 1.2.3 --- Knowledge gaps about N-MSM --- p.4 / Chapter 1.2.4 --- Illness perception as a relative new perceptive in HIV research --- p.5 / Chapter 1.2 --- Aims --- p.7 / Chapter 1.3 --- Structure of the thesis --- p.10 / Chapter 1.4 --- Summary --- p.15 / Chapter Chapter 2 --- Literature review --- p.16 / Chapter 2.1 --- HIV epidemic --- p.16 / Chapter 2.1.1 --- Global HIV/AIDS epidemic --- p.16 / Chapter 2.1.2 --- HIV/AIDS in China --- p.17 / Chapter 2.2 --- MSM and HIV --- p.22 / Chapter 2.2.1 --- HIV epidemic among MSM worldwide --- p.22 / Chapter 2.2.2 --- HIV prevalence and incidence among MSM in China --- p.24 / Chapter 2.2.3 --- Risk sexual behavior among HIV positive MSM and its determinants --- p.25 / Chapter 2.2.4 --- Mental health problems faced by HIV positive MSM --- p.31 / Chapter 2.2.5 --- Studies of PLWH in China --- p.38 / Chapter 2.3 --- Newly diagnosed HIV positive MSM (N-MSM) --- p.43 / Chapter 2.3.1 --- HIV transmission risk varies at different stages of HIV infection --- p.43 / Chapter 2.3.2 --- More risky sexual behavior among N-MSM --- p.45 / Chapter 2.3.3 --- More stress and lack of knowledge among N-MSM --- p.46 / Chapter 2.3.4 --- Definition of N-MSM --- p.47 / Chapter 2.3.5 --- Studies about N-MSM --- p.47 / Chapter 2.4 --- Self-regulation model and illness representation --- p.51 / Chapter 2.4.1 --- Self-regulation model --- p.51 / Chapter 2.4.2 --- Illness representation --- p.52 / Chapter 2.4.3 --- Application of illness representation in HIV research --- p.60 / Chapter 2.5 --- Audio computer-assisted self-interviewing (ACASI) --- p.61 / Chapter 2.5.1 --- Types of questionnaire deliver modes --- p.61 / Chapter 2.5.2 --- Comparisons of sexual behavior reporting between ACASI and other delivery modes --- p.63 / Chapter 2.5.3 --- Limitations of ACASI --- p.65 / Chapter Chapter 3 --- Subjects and Methods --- p.67 / Chapter 3.1 --- The study site --- p.67 / Chapter 3.2 --- Study population --- p.68 / Chapter 3.3 --- Recruitment of study participants --- p.68 / Chapter 3.4 --- Data collection procedure --- p.69 / Chapter 3.4.1 --- Face-to-face interview --- p.70 / Chapter 3.4.2 --- Computer-assisted mobile phone interview --- p.70 / Chapter 3.4.3 --- Service provision and incentives --- p.71 / Chapter 3.4.4 --- Sample size and the representativeness --- p.71 / Chapter 3.5 --- Quality control --- p.71 / Chapter 3.6 --- Establishment of the CAMP system --- p.72 / Chapter 3.7 --- Collaborator --- p.73 / Chapter 3.8 --- Measurements --- p.74 / Chapter 3.9 --- Statistical analysis --- p.83 / Chapter 3.10 --- Ethical approval --- p.85 / Chapter Chapter 4 --- Participant profiles --- p.86 / Chapter 4.1 --- Background --- p.86 / Chapter 4.2 --- Objectives --- p.87 / Chapter 4.3 --- Statistical analysis --- p.87 / Chapter 4.4 --- Results --- p.87 / Chapter 4.4.1 --- Background information --- p.87 / Chapter 4.4.2 --- Mental health outcomes --- p.88 / Chapter 4.4.3 --- HIV secondary transmission related behaviours --- p.90 / Chapter 4.4.4 --- Service utilization and quality of life --- p.94 / Chapter 4.5 --- Discussion --- p.95 / Chapter Chapter 5 --- Validation of the revised illness perception questionnaire among newly diagnosed HIV positive MSMs --- p.111 / Chapter 5.1 --- Background --- p.111 / Chapter 5.2 --- Objectives --- p.112 / Chapter 5.3 --- Modification and translation --- p.113 / Chapter 5.4 --- Statistical analysis --- p.114 / Chapter 5.5 --- Results --- p.116 / Chapter 5.5.1 --- Items of the main cognitive representation subscales --- p.116 / Chapter 5.5.2 --- Items of the emotional response subscale --- p.117 / Chapter 5.5.3 --- Items of the causal attribution subscale --- p.118 / Chapter 5.5.4 --- Examination of the identity subscale --- p.118 / Chapter 5.5.5 --- Descriptions of the derived subscales --- p.119 / Chapter 5.5.6 --- Inter-correlations among subscales --- p.119 / Chapter 5.5.7 --- External validity --- p.120 / Chapter 5.5.8 --- Associations between background variables and illness perception --- p.120 / Chapter 5.6 --- Discussion --- p.121 / Chapter Chapter 6 --- Relationships between illness perception and mental health outcomes among N-MSM --- p.132 / Chapter 6.1 --- Background --- p.132 / Chapter 6.2 --- Objectives --- p.134 / Chapter 6.3 --- Statistical analysis --- p.136 / Chapter 6.3.1 --- Analysis of the associations between illness perception and mental health outcomes --- p.136 / Chapter 6.3.2 --- Analysis of the mediation effects of emotional response on the associations between cognitive representation and health related outcomes --- p.137 / Chapter 6.3.3 --- Analysis of moderating effects of emotional response on the associations between cognitive representation and mental health outcomes --- p.139 / Chapter 6.4 --- Results --- p.140 / Chapter 6.4.1 --- Suicidal ideation --- p.140 / Chapter 6.4.2 --- Depression --- p.142 / Chapter 6.4.3 --- Self-stigma --- p.145 / Chapter 6.4.4 --- Posttraumatic growth --- p.147 / Chapter 6.5 --- Summary --- p.149 / Chapter 6.5.1 --- Associations between illness perception and health related outcomes --- p.149 / Chapter 6.5.2 --- Summary of the mediation effects of emotional response on the association between cognitive representation and health related outcomes --- p.150 / Chapter 6.5.3 --- Summary of the moderating effects of emotional response on the association between cognitive representation and health related outcomes --- p.150 / Chapter 6.6 --- Discussion --- p.151 / Chapter Chapter 7 --- The main and interaction effects of illness perception and other psychological variables on suicidal ideation among N-MSM --- p.177 / Chapter 7.1 --- Background --- p.177 / Chapter 7.2 --- Objectives and hypothesis --- p.179 / Chapter 7.3 --- Data analysis and results --- p.180 / Chapter 7.3.1 --- Associated factors of suicidal ideation in univariate analysis --- p.180 / Chapter 7.3.2 --- The associations between illness perception / psychological variables and suicidal ideation --- p.180 / Chapter 7.3.3 --- The independent effects of emotional response/treatment control and psychological variables on suicidal ideation --- p.182 / Chapter 7.3.4 --- Analysis of the interaction effects between illness perception and psychological variables onto suicidal ideation --- p.184 / Chapter 7.4 --- Discussion --- p.184 / Chapter Chapter 8 --- Risk behaviours related to HIV transmission and associated factors --- p.197 / Chapter 8.1 --- Background --- p.197 / Chapter 8.2 --- Objectives --- p.199 / Chapter 8.3 --- Statistical analysis --- p.202 / Chapter 8.4 --- Results --- p.203 / Chapter 8.4.1 --- Factors associated with having had UAI with men since HIV diagnosis --- p.203 / Chapter 8.4.2 --- Factors associated with intention to have UAI with HIV negative men in the coming 6 months --- p.205 / Chapter 8.4.3 --- Factors associated with having the thoughts of transmitting HIV to others purposively since HIV diagnosis --- p.206 / Chapter 8.5 --- Discussion --- p.207 / Chapter Chapter 9 --- Conclusions --- p.225 / Chapter 9.1 --- Summaries and interpretations of findings related to mental health --- p.225 / Chapter 9.1.1 --- Poor mental health status --- p.225 / Chapter 9.1.2 --- A validated revised illness perception questionnaire (IPQ-R) among N-MSM --- p.226 / Chapter 9.1.3 --- Strong associations between illness perception and mental health outcomes --- p.226 / Chapter 9.1.4 --- Significant associations between illness perception / other psychological variables and suicidal ideation --- p.227 / Chapter 9.2 --- Summaries and interpretations of findings related to risk behaviours --- p.228 / Chapter 9.2.1 --- Prevalent risk behaviours --- p.228 / Chapter 9.2.2 --- Factors affecting the risk behaviours related to HIV transmission and implications --- p.229 / Chapter 9.3 --- Service implications --- p.231 / Chapter 9.3.1 --- Intervention programs for reducing mental health problems --- p.231 / Chapter 9.3.2 --- Intervention programs for reducing risk behaviours related to HIV transmission --- p.233 / Chapter 9.3.3 --- Policy support in HIV prevention --- p.236 / Chapter 9.4 --- Study limitations --- p.238 / Chapter 9.5 --- Recommendations for future research --- p.239 / Chapter 9.5.1 --- Longitudinal studies --- p.239 / Chapter 9.5.2 --- Behavioural studies --- p.240 / Chapter 9.5.3 --- Intervention studies --- p.240 / Chapter 9.6 --- Conclusions --- p.241 / Chapter Appendix I --- Questionnaire for face-to-face interview --- p.243 / Chapter Appendix II --- Questionnaire for computer-assisted mobile phone interview --- p.254 / Reference --- p.257

Conclusions The results showed that depression is prevalent among Chinese PLWH and perceived discrimination is a source of stress. Perceived stress, social support and coping strategies had independent effects on mental health outcomes but there were no interaction effects. The Brief COPE was validated and had a structure different from the original, again supporting the importance of cultural variations. Our results hence provided useful instrumentations (PSSHIV and Brief COPE) as well as a good foundation for the development of theories and interventions specific to the needs of the PLWH in China. / Introduction Mental health issues are prevalent among People Living with HIV (PLWH). Instrumentation, conceptualization and theoretical models of stress-coping-mental health relationships among PLWH are important but theoretical and practical differences exist in the context of different cultures and quality of care services. / Objectives The aims of the study were 1) to develop a new Perceived Stress Scale for People Living with HIV (PSSHIV); 2) to validate the Brief COPE inventory among Chinese PLWH; 3) to investigate determinants of perceived stress and psychological well-being. / Results The newly developed PSSHIV and the rearranged version of the Brief COPE were validated and found to have acceptable psychometric properties. Of all participants, 63.3% showed moderate/severe depressive symptoms. 'Problem-solving and Acceptance' and 'Self-blame and Denial' were commonly used coping strategies. Socioeconomic status (SES), perceived discrimination, and optimism were significantly associated with overall stress and some of the subscales of PSSHIV. Perceived stress appeared to mediate the relationship between perceived discrimination and psychological well-being. In addition to perceived stress, social support and some particular coping strategies were associated with depression. Similar though not identical results were found using quality of life as the outcome. / Subject and Methods To achieve Aim 1, PLWH in two Chinese cities were interviewed for item generation and validation. Aims 2 to 4 were achieved through another survey conducted in the same cities. Participants were recruited from the registry of the Centers for Disease Control and Prevention and from users of hospital services and Methadone Maintenance Treatment clinics. Standard statistical methods were used for validation studies. / Su, Xiaoyou. / Adviser: Tak Fai Joseph Lau. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 181-206). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.