Assessing consistent condom use among migrant men who have sex with men in Shanghai, China: validation of an information\u2013motivation\u2013behavioural skills model

Ying Wang,Mengyun Luo,Zezhou Wang,Zhiruo Zhang,Ajuan Liang,Xueqin Jiang,Yong Cai,Yi Chen,Mengmeng Jia,Dong Yuan,Huiyao Zhu

doi:10.1186/s12879-019-4090-4

Abstract

BackgroundIn China, high prevalence of risky sexual behaviours and inequity in health services lead to situations in which migrant men who have sex with men face higher risk of contracting the human immunodeficiency virus. Consistent condom use is a primary means of preventing HIV infection during anal sex among MSM. This study aimed to apply the information–motivation–behavioural skills model to examine the predictors of consistent condom use among migrant MSM in Shanghai, and tested the associations between model constructs.MethodsA cross-sectional study was conducted among 412 migrant MSM in Shanghai. Data on HIV-related information, motivation, behavioural skills, and behaviours were collected via structured questionnaires. A structural equation model was used to assess the IMB model.ResultsOf the 412 participants, 4.4% reported HIV-positive status, and prevalence of consistent condom use in the previous 6 months was 44.9%. A restricted IMB model provided an acceptable fit to the data. Behavioural skills were found to directly predict consistent condom use (β = 0.629, P < 0.01). Neither information nor motivation could directly predict consistent condom use (P > 0.05), but motivation predicted it indirectly and was mediated by behavioural skills.ConclusionThe prevalence of consistent condom use was found to be relatively low among migrant MSM in Shanghai. The restricted IMB model was found to be a good predictor of consistent condom use among them. The results of this study indicate that intervention strategies for safer sexual behaviour should not only include information dissemination, but also emphasize motivation and behavioural skills among this population.

Highlights

In China, high prevalence of risky sexual behaviours and inequity in health services lead to situations in which migrant men who have sex with men face higher risk of contracting the human immunodeficiency virus
Migrants are typically excluded from the general health care system in host cities, and researchers have found migrants are more likely to engage in risky sexual behaviours, which makes them more vulnerable to human immunodeficiency virus (HIV) infection as compared with residents [1, 4, 6, 7]
It has been reported that migrant Men who have sex with men (MSM) in China have greater likelihood of being infected with HIV compared to resident MSM [4, 7, 22,23,24,25]

Summary

Introduction

In China, high prevalence of risky sexual behaviours and inequity in health services lead to situations in which migrant men who have sex with men face higher risk of contracting the human immunodeficiency virus. While they are part of the migrant population in search of better employment opportunities, MSM in China might have additional motivations to migrate, so they could hide their sexual orientation from mainstream heterosexual society in their home towns [12,13,14,15,16] This strong discrimination against homosexuality and internalized MSM related stigma might further limit their ability to access HIV prevention and care in their host cities [15, 17,18,19,20]. It is important to focus on interventions for promoting condom use among migrant MSM [7, 13, 27]

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Discussion

Conclusion