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Unprotected anal intercourse behavior and intention among male sex workers in Shenzhen serving cross-boundary male clients coming from Hong Kong, China – prevalence and associated factors

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The HIV epidemic among men who have sex with men (MSM) in China is becoming very serious. Unprotected anal intercourse (UAI) among MSM during cross-boundary commercial sex spread HIV across geographic areas. This study interviewed 186 Chinese male sex workers (MSW) in Shenzhen, China, serving cross-boundary Hong Kong male clients; 49.5% had had UAI with their Hong Kong male clients (last six months) and 24.2% intended to do so (future six months). Multivariate analyses showed that perceived efficacy of condom use for HIV prevention, perceived prevalence of HIV among Hong Kong MSM (>4%), and perceived ability to convince Hong Kong male clients to use condoms during anal sex were associated with lower likelihoods of UAI with such clients (OR = 0.04–0.09); the reverse was true for those who left the decision of condom use to their Hong Kong male clients (OR = 6.44). Perceived condom efficacy, self-efficacy in protection against HIV infection, and perceived control over condom use were associated with an intention for UAI (OR = 0.06–80.44). Adjusting for background variables, the scales representing contextual (Clients Characteristics, Substance Use, or Environmental Influences) and affective factors (Fear of Diseases) were associated with UAI (adjusted OR = 0.44–32.61). Except the Fear of Diseases scale, other scales were associated with an intention for UAI (adjusted OR = 4.59–43.32). MSW are at high risk of HIV transmission. Various factors are associated with UAI with male cross-boundary clients; these factors and the context of sex work need to be considered when designing HIV prevention programs.

Keywords: Chinese male sex workers; HIV/STD; cognitive factors; intention; perceptions; unprotected anal intercourse

Document Type: Research Article


Affiliations: 1: Centre for Health Behaviors Research, School of Public Health and Primary Care,The Chinese University of Hong Kong, Hong Kong, China 2: Shenzhen Center for Disease Control and Prevention, Guangdong, China 3: Department of Medical Statistics and Epidemiology, School of Public Health,Sun Yat-sen University, Guangzhou, China

Publication date: January 1, 2012

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