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.
| Identifer | oai:union.ndltd.org:VANDERBILT/oai:VANDERBILTETD:etd-11302013-075429 |
| Date | 05 December 2013 |
| Creators | Zhang, Lan |
| Contributors | Sten H. Vermund, Bryan E. Shepherd, Kenneth A. Wallston, Han-Zhu Qian, Yuhua Ruan |
| Publisher | VANDERBILT |
| Source Sets | Vanderbilt University Theses |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.vanderbilt.edu/available/etd-11302013-075429/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to Vanderbilt University or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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