Abstract
Syndemic factors tend to co-occur and increase the risks of condomless anal intercourse (CAI), multiple sexual partners (MSP) and HIV vulnerability among men who have sex with men (MSM). This study aimed to test the synergistic effects of syndemic factors on HIV risk and to further explore the moderators between syndemics and HIV risk among Chinese MSM. A cross-sectional study was conducted to recruit MSM in Guangzhou to collect data on syndemic factors (depression, intimate partner violence, childhood sexual abuse [CSA], alcohol, and rush popper use before anal sex). The relative excess risk due to interactions (RERIs) was calculated to test the synergy in adjusted regression models. A moderated analysis was conducted to test the buffer effects of potential resilience factors (education and income). Among the 976 included MSM, individuals experiencing more syndemic factors were more likely to have CAI (odds ratio [OR]= 1.26, 95% confidence interval [CI] 1.11–1.44), MSP (OR= 1.33, 95% CI 1.16–1.52), and HIV infection (OR= 1.46, 95% CI 1.12–1.90). RERIs showed a synergy of depression and rush popper use prior to sex for MSP (1.17, 95% CI 0.03–2.03) and CSA and rush popper use prior to sex for HIV infection (1.72, 95% CI 0.05–3.43). However, no significant association was found for the interaction between the number of syndemic factors and education or income. Our findings support the synergy approach in syndemic studies and highlight the need for comprehensive and multifactorial intervention strategies on sexual health of MSM. Future studies are needed to identify potential resilience factors among Chinese MSM.
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Acknowledgements
The authors would like to thank the staff in the voluntary counseling and testing clinics of Baiyun, Conghua, Panyu, Huadu, Huangpu, Zengcheng District CDC, Lingnan Partners, and Zhitong Charity to help collect the data in this study.
Funding
This study was funded by the Young Scientists Fund (81703282) from the National Natural Science Foundation of China (http://www.nsfc.gov.cn/), the “13th Five-Year” plan for the development of philosophy and social sciences in Guangzhou (2018GZGJ67) from the Guangzhou Association of Social Science Societies (http://www.gzsk.org.cn/), Special Funds for Provincial Health and Family Planning Development of Guangdong in China in 2016 (AIDS prevention Project: 2100409) from the Department of Finance of Guangdong Province (http://www.gdczt.gov.cn/) and the Medical Scientific Research Foundation of Guangdong Province, China (A2017036), from the Health and Family Planning Commission of Guangdong Province (http://www.gdwst.gov.cn/).
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Jiang, H., Li, J., Tan, Z. et al. Syndemic Factors and HIV Risk Among Men Who Have Sex with Men in Guangzhou, China: Evidence from Synergy and Moderated Analyses. Arch Sex Behav 49, 311–320 (2020). https://doi.org/10.1007/s10508-019-01488-x
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DOI: https://doi.org/10.1007/s10508-019-01488-x