Skip to main content
Top
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Relationship between quality of life and unprotected anal intercourse among Chinese men who have sex with men: a cross-sectional study

Authors: Yaxin Zhu, Jie Liu, Bo Qu, Bingxue Hu, Yang Zhang

Published in: BMC Public Health | Issue 1/2016

Login to get access

Abstract

Background

The prevalence of unprotected anal intercourse (UAI) is high among Chinese men who have sex with men (MSM). As important aspects of quality of life (QOL), psychological health and social relationships have been found to be associated with UAI among MSM, which was of great concern for intervening on UAI.

Methods

We conducted a cross-sectional study in Zhengzhou, Henan province, and in Huludao, Liaoning province, China, to measure quality of life (QOL) using the brief version of the World Health Organization Quality of Life (WHOQOL-BREF). Cronbach's α coefficient was used to test the internal consistency of the questionnaire items, and construction validity was assessed by exploratory factor analysis. T-test, chi-square test and multivariate logistic analysis were carried out to test the relationship between quality of life and unprotected anal intercourse.

Results

The questionnaires of 320 of the 373 men who have sex with men that were surveyed met our validity criteria (response rate: 85.8 %). A total of 161 subjects (50.3 %) reported having unprotected anal sex in the last 6 months. The results of univariate analysis indicated that having unprotected anal sex was significantly associated with psychological health (PSYCH), social relationships (SOCIL), age, and marital status (P-value <0.05). The 3 items (“Negative feelings”, “Hopeness on your life”, and “Be able to concentrate”) in the PSYCH subscale were associated with UAI significantly (P-value <0.05). Multivariate analysis showed that psychological health (adjusted odd ratio (AOR) 0.979, 95 % confidence interval (CI) 0.961-0.998) was independent factor affecting the likelihood of having UAI in the population of Chinese MSM, and participants who aged 45 or more had higher odds of UAI (AOR 3.986, 95 % CI 1.199-13.255).

Conclusions

WHOQOL-BREF was acceptable for evaluating the quality of life of MSM. Psychological health, as one important aspect of quality of life, was negatively associated with unprotected anal intercourse. The finding underscored the needs to incorporate the strategies on improving psychological health into the UAI intervention to reduce the HIV transmission among MSM.
Literature
1.
go back to reference Wirtz AL, Kirey A, Peryskina A, Houdart F, Beyrer C. Uncovering the epidemic of HIV among men who have sex with men in Central Asia. Drug Alcohol Depend. 2013;132 Suppl 1:S17–24.CrossRefPubMed Wirtz AL, Kirey A, Peryskina A, Houdart F, Beyrer C. Uncovering the epidemic of HIV among men who have sex with men in Central Asia. Drug Alcohol Depend. 2013;132 Suppl 1:S17–24.CrossRefPubMed
2.
go back to reference Zhang L, Zhang D, Yu B, Wang S, Liu Y, Wang J, et al. Prevalence of HIV Infection and Associated Risk Factors among Men Who Have Sex with Men (MSM) in Harbin, P.R. China. PLoS One. 2013;8:e58440.CrossRefPubMedPubMedCentral Zhang L, Zhang D, Yu B, Wang S, Liu Y, Wang J, et al. Prevalence of HIV Infection and Associated Risk Factors among Men Who Have Sex with Men (MSM) in Harbin, P.R. China. PLoS One. 2013;8:e58440.CrossRefPubMedPubMedCentral
3.
go back to reference Beyrer C, Sullivan P, Sanchez J, Baral SD, Collins C, Wirtz AL, et al. The increase in global HIV epidemics in MSM. AIDS. 2013;27:2665–78.CrossRefPubMed Beyrer C, Sullivan P, Sanchez J, Baral SD, Collins C, Wirtz AL, et al. The increase in global HIV epidemics in MSM. AIDS. 2013;27:2665–78.CrossRefPubMed
5.
go back to reference Li J, Lau JT, Gu J, Hao C, Lai CH. Event-Specific Risk Factors Predicting Episodes of Unprotected Anal Intercourse with Male Nonregular Partners among Men Who Have Sex with Men Using Case-Crossover Study Design. Biomed Res Int. 2014;2014:475195.PubMedPubMedCentral Li J, Lau JT, Gu J, Hao C, Lai CH. Event-Specific Risk Factors Predicting Episodes of Unprotected Anal Intercourse with Male Nonregular Partners among Men Who Have Sex with Men Using Case-Crossover Study Design. Biomed Res Int. 2014;2014:475195.PubMedPubMedCentral
6.
go back to reference Wang K, Yan H, Liu Y, Leng Z, Wang B, Zhao J. Increasing prevalence of HIV and syphilis but decreasing rate of self-reported unprotected anal intercourse among men who had sex with men in Harbin, China: results of five consecutive surveys from 2006 to 2010. Int J Epidemiol. 2012;41:423–32.CrossRefPubMed Wang K, Yan H, Liu Y, Leng Z, Wang B, Zhao J. Increasing prevalence of HIV and syphilis but decreasing rate of self-reported unprotected anal intercourse among men who had sex with men in Harbin, China: results of five consecutive surveys from 2006 to 2010. Int J Epidemiol. 2012;41:423–32.CrossRefPubMed
7.
go back to reference McDaid LM, Hart GJ. Sexual risk behavior for transmission of HIV in men who have sex with men: recent findings and potential interventions. Curr Opin HIV AIDS. 2010;5:311–5.CrossRefPubMed McDaid LM, Hart GJ. Sexual risk behavior for transmission of HIV in men who have sex with men: recent findings and potential interventions. Curr Opin HIV AIDS. 2010;5:311–5.CrossRefPubMed
8.
go back to reference Hart GJ, Elford J. Sexual risk behaviour of men who have sex with men: emerging patterns and new challenges. Curr Opin Infect Dis. 2010;23:39–44.CrossRefPubMed Hart GJ, Elford J. Sexual risk behaviour of men who have sex with men: emerging patterns and new challenges. Curr Opin Infect Dis. 2010;23:39–44.CrossRefPubMed
9.
go back to reference Mayer KH, Bekker LG, Stall R, Grulich AE, Colfax G, Lama JR. Comprehensive clinical care for men who have sex with men: an integrated approach. Lancet. 2012;380:378–87.CrossRefPubMed Mayer KH, Bekker LG, Stall R, Grulich AE, Colfax G, Lama JR. Comprehensive clinical care for men who have sex with men: an integrated approach. Lancet. 2012;380:378–87.CrossRefPubMed
10.
go back to reference Wu J, Hu Y, Jia Y, Su Y, Cui H, Liu H, et al. Prevalence of Unprotected Anal Intercourse among Men Who Have Sex with Men in China: An Updated Meta-Analysis. PLoS One. 2014;9:e98366.CrossRefPubMedPubMedCentral Wu J, Hu Y, Jia Y, Su Y, Cui H, Liu H, et al. Prevalence of Unprotected Anal Intercourse among Men Who Have Sex with Men in China: An Updated Meta-Analysis. PLoS One. 2014;9:e98366.CrossRefPubMedPubMedCentral
11.
go back to reference Prestage G, Mao L, Fogarty A, Van de Ven P, Kippax S, Crawford J, et al. How has the sexual behavior of gay men changed since the onset of AIDS: 1986–2003. Aust N Z J Public Health. 2005;29:530–5.CrossRefPubMed Prestage G, Mao L, Fogarty A, Van de Ven P, Kippax S, Crawford J, et al. How has the sexual behavior of gay men changed since the onset of AIDS: 1986–2003. Aust N Z J Public Health. 2005;29:530–5.CrossRefPubMed
12.
go back to reference Jin F, Crawford J, Prestage GP, Zablotska I, Imrie J, Kippax SC, et al. HIV risk reduction behaviors in gay men: Unprotected anal intercourse, risk reduction behaviors, and subsequent HIV infection in a cohort of homosexual men. AIDS. 2009;23:243–52.CrossRefPubMedPubMedCentral Jin F, Crawford J, Prestage GP, Zablotska I, Imrie J, Kippax SC, et al. HIV risk reduction behaviors in gay men: Unprotected anal intercourse, risk reduction behaviors, and subsequent HIV infection in a cohort of homosexual men. AIDS. 2009;23:243–52.CrossRefPubMedPubMedCentral
13.
go back to reference Wim VB, Christiana N, Marie L. Syndemic and other risk factors for unprotected anal intercourse among an online sample of Belgian HIV negative men who have sex with men. AIDS Behav. 2014;18:50–8.CrossRefPubMed Wim VB, Christiana N, Marie L. Syndemic and other risk factors for unprotected anal intercourse among an online sample of Belgian HIV negative men who have sex with men. AIDS Behav. 2014;18:50–8.CrossRefPubMed
14.
go back to reference Dolezal C, Carballo-Diéguez A, Nieves-Rosa L, Díaz FC. Substance use and sexual risk behavior: understanding their association among four ethnic groups of Latino men who have sex with men. J Subst Abuse. 2000;11:323–36.CrossRefPubMed Dolezal C, Carballo-Diéguez A, Nieves-Rosa L, Díaz FC. Substance use and sexual risk behavior: understanding their association among four ethnic groups of Latino men who have sex with men. J Subst Abuse. 2000;11:323–36.CrossRefPubMed
15.
go back to reference Ruan S, Yang H, Zhu Y, Ma Y, Li J, Zhao J, et al. HIV prevalence and correlates of unprotected anal intercourse among men who have sex with men, Jinan, China. AIDS Behav. 2008;12:469–75.CrossRefPubMed Ruan S, Yang H, Zhu Y, Ma Y, Li J, Zhao J, et al. HIV prevalence and correlates of unprotected anal intercourse among men who have sex with men, Jinan, China. AIDS Behav. 2008;12:469–75.CrossRefPubMed
16.
17.
go back to reference Mimiaga MJ, Noonan E, Donnell D, Safren SA, Koenen KC, Gortmaker S, et al. Childhood Sexual Abuse Is Highly Associated With HIV Risk–Taking Behavior and Infection Among MSM in the EXPLORE Study. J Acquir Immune Defic Syndr. 2009;51:340–8.CrossRefPubMedPubMedCentral Mimiaga MJ, Noonan E, Donnell D, Safren SA, Koenen KC, Gortmaker S, et al. Childhood Sexual Abuse Is Highly Associated With HIV Risk–Taking Behavior and Infection Among MSM in the EXPLORE Study. J Acquir Immune Defic Syndr. 2009;51:340–8.CrossRefPubMedPubMedCentral
18.
go back to reference Lau JT, Feng TJ, Liu XL, Gu J, Tsui HY, Hong FC, et al. Associations between Cognitive, Sociocontextual, and Affective Variables and Unprotected Anal Intercourse among Men Who Have Sex with Men—A Comparative Study Conducted in Two Chinese Cities. Biomed Res Int. 2014;2014:970975.PubMedPubMedCentral Lau JT, Feng TJ, Liu XL, Gu J, Tsui HY, Hong FC, et al. Associations between Cognitive, Sociocontextual, and Affective Variables and Unprotected Anal Intercourse among Men Who Have Sex with Men—A Comparative Study Conducted in Two Chinese Cities. Biomed Res Int. 2014;2014:970975.PubMedPubMedCentral
19.
20.
go back to reference Chen JP, Han MM, Liao ZJ, Dai ZZ, Liu L, Chen H, et al. HIV-related behaviors, social support and health-related quality of life among men who have sex with men and women (MSMW): a cross-sectional study in Chongqing, China. PLoS One. 2015;10:e0118651.CrossRefPubMedPubMedCentral Chen JP, Han MM, Liao ZJ, Dai ZZ, Liu L, Chen H, et al. HIV-related behaviors, social support and health-related quality of life among men who have sex with men and women (MSMW): a cross-sectional study in Chongqing, China. PLoS One. 2015;10:e0118651.CrossRefPubMedPubMedCentral
21.
go back to reference Croog SH, Levine S. Quality of life and health care interventions. In: Freeman HE, Levine S, editors. Handbook of Medical Sociology. 4th ed. New Jersey: Prentice Hall; 1989. p. 508–28. Croog SH, Levine S. Quality of life and health care interventions. In: Freeman HE, Levine S, editors. Handbook of Medical Sociology. 4th ed. New Jersey: Prentice Hall; 1989. p. 508–28.
22.
go back to reference Liu J, Qu B, Hu B, Jiang N, Wang D. The Quality of Life of Men Who Have Sex with Men in China: Reliability and Validity Testing of the SF-36 Questionnaire. PLoS One. 2013;8:e83362.CrossRefPubMedPubMedCentral Liu J, Qu B, Hu B, Jiang N, Wang D. The Quality of Life of Men Who Have Sex with Men in China: Reliability and Validity Testing of the SF-36 Questionnaire. PLoS One. 2013;8:e83362.CrossRefPubMedPubMedCentral
23.
go back to reference Bouhnik AD, Préau M, Schiltz MA, Peretti-Watel P, Obadia Y, Lert F, et al. Unsafe sex with casual partners and quality of life among HIV-infected gay men: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA). J Acquir Immune Defic Syndr. 2006;42:597–603.CrossRefPubMed Bouhnik AD, Préau M, Schiltz MA, Peretti-Watel P, Obadia Y, Lert F, et al. Unsafe sex with casual partners and quality of life among HIV-infected gay men: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA). J Acquir Immune Defic Syndr. 2006;42:597–603.CrossRefPubMed
24.
go back to reference Kelly-Campbell RJ, Atcherson SR. Perception of quality of life for adults with hearing impairment in the LGBT community. J Commun Disord. 2012;45:367–77.CrossRefPubMed Kelly-Campbell RJ, Atcherson SR. Perception of quality of life for adults with hearing impairment in the LGBT community. J Commun Disord. 2012;45:367–77.CrossRefPubMed
25.
go back to reference Dey M, Gmel G, Studer J, Mohler-Kuo M. Health-risk behaviors and quality of life among young men. Qual Life Res. 2014;23:1009–17.CrossRefPubMed Dey M, Gmel G, Studer J, Mohler-Kuo M. Health-risk behaviors and quality of life among young men. Qual Life Res. 2014;23:1009–17.CrossRefPubMed
26.
go back to reference The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28:551–8.CrossRef The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28:551–8.CrossRef
27.
go back to reference Chen JP, Wang H, Liu L. Quality of life and related social support for men who have sex with men among university students in Chongqing, China. Zhonghua Liu Xing Bing Xue Za Zhi. 2013;34:888–92 [Article in Chinese].PubMed Chen JP, Wang H, Liu L. Quality of life and related social support for men who have sex with men among university students in Chongqing, China. Zhonghua Liu Xing Bing Xue Za Zhi. 2013;34:888–92 [Article in Chinese].PubMed
28.
go back to reference Ghorayeb DB, Dalgalarrondo P. Homosexuality: mental health and quality of life in a Brazilian socio-cultural context. Int J Soc Psychiatry. 2011;57:496–500.CrossRefPubMed Ghorayeb DB, Dalgalarrondo P. Homosexuality: mental health and quality of life in a Brazilian socio-cultural context. Int J Soc Psychiatry. 2011;57:496–500.CrossRefPubMed
29.
30.
go back to reference Xia P, Li N, Hau KT, Liu C, Lu Y. Quality of life of Chinese urban community residents: a psychometric study of the mainland Chinese version of the WHOQOL-BREF. BMC Med Res Methodol. 2012;27:37.CrossRef Xia P, Li N, Hau KT, Liu C, Lu Y. Quality of life of Chinese urban community residents: a psychometric study of the mainland Chinese version of the WHOQOL-BREF. BMC Med Res Methodol. 2012;27:37.CrossRef
31.
go back to reference Finlayson TJ, Le B, Smith A, Bowles K, Cribbin M, Miles I, et al. HIV risk, prevention, and testing behaviors among men who have sex with men—National HIV Behavioral Surveillance System, 21 US cities, United States, 2008. MMWR. 2011;60:1–34.PubMed Finlayson TJ, Le B, Smith A, Bowles K, Cribbin M, Miles I, et al. HIV risk, prevention, and testing behaviors among men who have sex with men—National HIV Behavioral Surveillance System, 21 US cities, United States, 2008. MMWR. 2011;60:1–34.PubMed
32.
go back to reference Feng Y, Wu Z, Detels R, Qin G, Liu L, Wang X, et al. HIV/STD prevalence among men who have sex with men in Chengdu, China and associated risk factors for HIV infection. J Acquir Immune Defic Syndr. 2010;53 Suppl 1:S74–80.CrossRefPubMedPubMedCentral Feng Y, Wu Z, Detels R, Qin G, Liu L, Wang X, et al. HIV/STD prevalence among men who have sex with men in Chengdu, China and associated risk factors for HIV infection. J Acquir Immune Defic Syndr. 2010;53 Suppl 1:S74–80.CrossRefPubMedPubMedCentral
33.
go back to reference Liu JX, Choi K. Experiences of social discrimination among men who have sex with men in Shanghai, China. AIDS Behav. 2006;10 Suppl 4:S25–33.CrossRefPubMed Liu JX, Choi K. Experiences of social discrimination among men who have sex with men in Shanghai, China. AIDS Behav. 2006;10 Suppl 4:S25–33.CrossRefPubMed
34.
35.
go back to reference van Heeringen C, Vincke J. Suicidal acts and ideation in homosexual and bisexual young people: A study of prevalence and risk factors. Soc Psychiatry Psychiatr Epidemiol. 2000;35:494–9.CrossRefPubMed van Heeringen C, Vincke J. Suicidal acts and ideation in homosexual and bisexual young people: A study of prevalence and risk factors. Soc Psychiatry Psychiatr Epidemiol. 2000;35:494–9.CrossRefPubMed
36.
go back to reference Walls NE, Freedenthal S, Wisneski H. Suicidal ideation and attempts among sexual minority youths receiving social services. Soc Work. 2008;53:21–9.CrossRefPubMed Walls NE, Freedenthal S, Wisneski H. Suicidal ideation and attempts among sexual minority youths receiving social services. Soc Work. 2008;53:21–9.CrossRefPubMed
37.
go back to reference Safren SA, Blashill AJ, O'Cleirigh CM. Promoting the sexual health of MSM in the context of comorbid mental health problems. AIDS Behav. 2011;15 Suppl 1:S30–4.CrossRefPubMedPubMedCentral Safren SA, Blashill AJ, O'Cleirigh CM. Promoting the sexual health of MSM in the context of comorbid mental health problems. AIDS Behav. 2011;15 Suppl 1:S30–4.CrossRefPubMedPubMedCentral
38.
go back to reference Crepaz N, Lyles CM, Wolitski RJ, Passin WF, Rama SM, Herbst JH, et al. Do prevention interventions reduce HIV risk behaviors among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006;20:143–57.CrossRefPubMed Crepaz N, Lyles CM, Wolitski RJ, Passin WF, Rama SM, Herbst JH, et al. Do prevention interventions reduce HIV risk behaviors among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006;20:143–57.CrossRefPubMed
39.
go back to reference Sikkema KJ, Watt MH, Drabkin AS, Meade CS, Hansen NB, Pence BW. Mental health treatment to reduce HIV transmission risk behavior: a positive prevention model. AIDS Behav. 2010;14:252–62.CrossRefPubMedPubMedCentral Sikkema KJ, Watt MH, Drabkin AS, Meade CS, Hansen NB, Pence BW. Mental health treatment to reduce HIV transmission risk behavior: a positive prevention model. AIDS Behav. 2010;14:252–62.CrossRefPubMedPubMedCentral
40.
go back to reference Liu J, Qu B, Ezeakile MC, Zhang Y. Factors Associated with Unprotected Anal Intercourse among Men Who Have Sex with Men in Liaoning Province, China. PLoS One. 2012;7:e50493.CrossRefPubMedPubMedCentral Liu J, Qu B, Ezeakile MC, Zhang Y. Factors Associated with Unprotected Anal Intercourse among Men Who Have Sex with Men in Liaoning Province, China. PLoS One. 2012;7:e50493.CrossRefPubMedPubMedCentral
41.
go back to reference Liu H, Yang H, Li X, Wang N, Liu H, Wang B, et al. Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China. Sex Transm Dis. 2006;33:68–76.CrossRefPubMed Liu H, Yang H, Li X, Wang N, Liu H, Wang B, et al. Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China. Sex Transm Dis. 2006;33:68–76.CrossRefPubMed
42.
go back to reference Tsui HY, Lau JT, Feng T, Hong F, Cai Y, Zhou H, et al. Sexual Dysfunction and Unprotected Anal Intercourse Among Men Who Have Sex With Men in Two Chinese Cities. J Sex Marital Ther. 2014;40:139–48.CrossRefPubMed Tsui HY, Lau JT, Feng T, Hong F, Cai Y, Zhou H, et al. Sexual Dysfunction and Unprotected Anal Intercourse Among Men Who Have Sex With Men in Two Chinese Cities. J Sex Marital Ther. 2014;40:139–48.CrossRefPubMed
43.
go back to reference Satinsky S, Rosenberger JG, Schick V, Novak DS, Reece M. USA study of sex toy use by HIV-positive men who have sex with other men: implications for sexual health. Int J STD AIDS. 2011;22:442–8.CrossRefPubMed Satinsky S, Rosenberger JG, Schick V, Novak DS, Reece M. USA study of sex toy use by HIV-positive men who have sex with other men: implications for sexual health. Int J STD AIDS. 2011;22:442–8.CrossRefPubMed
44.
go back to reference Tang W, Huan X, Mahapatra T, Tang S, Li J, Yan H, et al. Factors Associated with Unprotected Anal Intercourse Among Men Who Have Sex with Men: Results from a Respondent Driven Sampling Survey in Nanjing, China, 2008. AIDS Behav. 2013;17:1415–22.CrossRefPubMed Tang W, Huan X, Mahapatra T, Tang S, Li J, Yan H, et al. Factors Associated with Unprotected Anal Intercourse Among Men Who Have Sex with Men: Results from a Respondent Driven Sampling Survey in Nanjing, China, 2008. AIDS Behav. 2013;17:1415–22.CrossRefPubMed
45.
go back to reference Li YZ, Xu JJ, Qian HZ, You BX, Zhang J, Zhang JM, et al. High prevalence of HIV infection and unprotected anal intercourse among older men who have sex with men in China: a systematic review and meta-analysis. BMC Infect Dis. 2014;14:531.CrossRefPubMedPubMedCentral Li YZ, Xu JJ, Qian HZ, You BX, Zhang J, Zhang JM, et al. High prevalence of HIV infection and unprotected anal intercourse among older men who have sex with men in China: a systematic review and meta-analysis. BMC Infect Dis. 2014;14:531.CrossRefPubMedPubMedCentral
47.
go back to reference Shang H, Xu J, Han X, Spero Li J, Arledge KC, Zhang L. HIV prevention: Bring safe sex to China. Nature. 2012;485:576–7.CrossRefPubMed Shang H, Xu J, Han X, Spero Li J, Arledge KC, Zhang L. HIV prevention: Bring safe sex to China. Nature. 2012;485:576–7.CrossRefPubMed
48.
go back to reference Emlet CA, Brennan DJ, Brennenstuhl S, Rueda S, Hart TA, Rourke SB. The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter? AIDS Care. 2014;14:1–9. Emlet CA, Brennan DJ, Brennenstuhl S, Rueda S, Hart TA, Rourke SB. The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter? AIDS Care. 2014;14:1–9.
Metadata
Title
Relationship between quality of life and unprotected anal intercourse among Chinese men who have sex with men: a cross-sectional study
Authors
Yaxin Zhu
Jie Liu
Bo Qu
Bingxue Hu
Yang Zhang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3076-z

Other articles of this Issue 1/2016

BMC Public Health 1/2016 Go to the issue