Condoms used but sex not well protected.

Condom use is often equated to safer sex. The prevalence of condom use during sex work among female sex workers (FSW) in China is high. Condom use, however, co-exists with condom failure and improper use and hence risk of HIV transmission. In a cross-sectional study, we interviewed 195 FSW in Shenzhen, China. The prevalence of condom use in the last episode of sex work was 97.4 %, However, respectively 53.8 and 86.2 % had experienced at least one condition of condom failure that may lead to genital contact (wearing condoms after penetration, condom breakage/slippage, condoms removed by clients) and at least one condition of improper condom use (not removing air from the tip of the condom, not pulling it down to the root of penis and not choosing good quality condoms). Factors of individual level (e.g. never choosing high quality condoms for sex work), inter-personal level (e.g. agreement to have unprotected sex if fond of clients or paid more) and environmental/structural level (e.g. non-availability of condoms) were associated with various types of condom failure and improper use. Although HIV prevention interventions have increased prevalence of condom use among FSW, the risk of HIV transmission may still be high as "unsafe" sex due to condom failure and improper use is prevalent. Interventions promoting safer sex need to address such issues and take socio-ecological factors into account. Condom use during sex work is not equivalent to well protected sex as the protective effects could be compromised by frequent condom failure and improper use.

Prevalence of seasonal influenza vaccination and associated factors in people with chronic diseases in Hong Kong.

Chronic disease patients are at high risk of developing serious influenza-related complications. This study investigated the prevalence of seasonal influenza vaccination (IV) and associated factors in such patients. A random sample of 704 Chinese adults with chronic disease was anonymously interviewed by telephone; 35·8% of them had ever taken up IV and 22·7% did so during the last flu season. The most frequently mentioned facilitator was recommendation made by a healthcare worker (HCW). Knowledge that IV is required annually, perceived severe health impacts of influenza, and recommendation made by a HCW were positively associated with previous IV and intention to take up IV in the next year, while perceived side-effects was inversely associated with previous IV and intention to take up IV. The coverage of IV in this study population was low. HCWs should clarify IV-related health beliefs in chronic disease patients and actively advise them to take up IV.

Monitoring of perceptions, anticipated behavioral, and psychological responses related to H5N1 influenza.

BACKGROUND: The aim of this study was to monitor changes in behavioral and emotional responses to human H5N1 in the community over a 28-month period (from November 2005 to February 2008). METHODS: A total of 3,527 Hong Kong Chinese adults were interviewed by telephone within the framework of six identical cross-sectional surveys carried out during the 28-month study period. Given a hypothetical scenario that two to three new human-to-human H5N1 cases had been reported in Hong Kong, the trends of the respondents in various H5N1-related risk perceptions, anticipated personal psychological responses, and anticipated personal preventive behaviors were investigated. RESULTS: Over time, a decreased proportion of the respondents (1) felt susceptible to contracting H5N1, (2) expected a large outbreak would eventually occur, (3) believed that the impacts of H5N1 were worse than those of severe acute respiratory syndrome (SARS), and (4) anticipated adopting more types of preventive measures and experiencing mental distress in the case of a small-scale outbreak in Hong Kong (AOR from 0.27 to 0.43, p < 0.001), but the public remained vigilant on public health behaviors, such as hand-washing. The prevalence of misconceptions on the mode of transmission declined, but remained high; perceptions on the fatality of H5N1 remained largely underestimated. The SARS experience and unconfirmed beliefs about the transmission modes were associated with variables on anticipated preventive behaviors and emotional distress. CONCLUSION: Starting in 2005 through to 2008, respondents perceived a decreasing level of susceptibility, severity, and anticipated stress towards a hypothetical human-to-human H5N1 outbreak, possibly due to the low efficiency of transmission. The public's general preparedness was still relatively good and rational, even though individual preventive behaviors were less common. However, misconceptions were prevalent among the respondents. Based on these results, public education is warranted to rectify these misconceptions.

Prevalence of psychological problems and relationships with condom use and HIV prevention behaviors among Chinese female sex workers in Hong Kong.

The present study investigated the prevalence of psychological problems and their relationships with relevant HIV prevention behaviors among female sex workers (FSWs). An anonymous cross-sectional survey was conducted. With a mapping exercise, 293 Chinese FSWs were recruited from a red-light district in Hong Kong. Results showed high prevalence of psychological problems among FSWs: substance use (40.4%), probable depression (53.9%), self-harm tendencies (34-38%), poor self-esteem (48-52%), and pessimistic future outlook (46-47%). Inconsistent condom use was common (51% with clients, 23% with one-night-stand sex partner, and 73% with boyfriends). Over 70% had not used HIV-related prevention services in the last 6 months. Multivariate analyses indicated that psychological problems were significantly associated with inconsistent condom use and non-use of prevention services. The poor psychological well-beings of FSWs have important public health implications. Relevant professional services should be provided and integrated with HIV prevention efforts.

Changes in HIV-related behaviours over time and associations with rates of HIV-related services coverage among female sex workers in Sichuan, China.

OBJECTIVES: To investigate changes in HIV-related behaviours among female sex workers (FSW) and associations with services coverage rates. METHODS: Behavioural surveillance data from Sichuan, China, were analysed. A mapping exercise was conducted; FSW were recruited from randomly selected sex-work establishments in 19 sites in Sichuan, China, from 2003 (n = 7068), 2004 (n = 6875) and 2005 (n = 6833). RESULTS: Site variations were substantial. The random effect pooled AOR comparing the prevalence of condom use with regular sex partners, possession of condoms, HIV-related knowledge, HIV antibody testing and services coverage rates in 2005 versus 2003 ranged from 1.42 to 20.35. The 95% CI of these pooled AOR all excluded 1.0; hence rejecting the null hypothesis that such OR were not different from 1.0. Most of the AOR of these evaluative parameters (indicator of improvement) for the 19 individual sites in 2004 and 2005 (vs 2003) were significantly associated with coverage rates (Spearmen correlation coefficients = 0.35 to 0.67, p<0.05). CONCLUSIONS: Improvements were observed in relevant behaviours and coverage rates and the two were associated with each other.

A randomized controlled study to evaluate the efficacy of an Internet-based intervention in reducing HIV risk behaviors among men who have sex with men in Hong Kong.

A randomized controlled study evaluated an Internet-based HIV behavioral intervention for men who have sex with men (MSM). Hong Kong Chinese men aged >or=18 having engaged in oral or anal MSM behaviors in the last six months were randomly allocated into the intervention (n=140) and the control groups (n=140). Participants were interviewed anonymously at the baseline and after six months. Interventions included periodic HIV information dissemination, monitoring of risk behaviors and interactive feedback, online peer counseling and provision of a hotline. The control group only received some educational materials. Efficacy of the intervention was not supported as no statistically significant between-group differences in background characteristics, HIV risk behaviors and perceptions were observed both at the baseline and after the 6-month period. Effectiveness of online interventions should not be taken for granted and evidence-based approach is warranted.

Prevalence and factors of sexual problems in Chinese males and females having sex with the same-sex partner in Hong Kong: a population-based study.

A cross-sectional, anonymous telephone survey was conducted to examine sexual problem (SP) among sexually active, Chinese homosexual adults in Hong Kong. Of the homosexual respondents, 49.1% of males and 75.6% of females reported at least one SP, of whom 36.0 and 65.7% of the males and females, respectively, felt very bothered by the SP. The prevalence of SP ranged from 3.6% (pain) to 21.8% (premature orgasm) for men and from 16.9% (anxiety) to 39.3% (lubrication problems) for females. Female homosexuals were less likely to be satisfied with their sex life and more bothered by an SP than heterosexual females and homosexual males. There were few significant differences between homosexual and heterosexual males. Female homosexuals were also more likely than male homosexuals to experience lack of orgasm and pain during intercourse. Being bothered by SP was associated with erectile dysfunction among homosexual men and lubrication problems and lack of pleasure among the homosexual women.

Prevalence of male and female sexual problems, perceptions related to sex and association with quality of life in a Chinese population: a population-based study.

The prevalence of sexual problems (SP) and sexual satisfaction and their associations with sex-related perceptions and quality of life (QOL) were investigated by interviewing 3257 and 1568 Chinese adults in Hong Kong by a specially designed computerized telephone-interviewing method. SP was prevalent among male (50.9%) and female (54%) respondents; approximately 50% were dissatisfied with their sexual life. Of respondents, 23.9% of men and 5.9% of women perceived sex as important and 52.5% for men and 33.8% of women reported adequate sexual knowledge. The prevalence of SP ranged from 3.4% (pain) to 29.7% (premature orgasm) for men and 6.9% (anxiety) to 24.7% (lack of interest) for women. Prevalence of erectile and lubrication problems were 9.6 and 23.6%, respectively. Sex-related knowledge, perceived importance of sex, perceived physical health status, sexual satisfaction were predictors of SP. Gender differences and strong cultural influences appear to exist. Moreover, SP and sexual satisfaction were associated with mental health and vitality QOL and overall life satisfaction.

The relationship between condom use, sexually transmitted diseases, and location of commercial sex transaction among male Hong Kong clients.

OBJECTIVE: This study investigated the consistency of condom use and the prevalence of self-reported sexually transmitted diseases (STD) among male Hong Kong commercial sex clients with respect to the geographical location of these transactions. DESIGN AND METHODS: Male clients were identified via three independent, population-based surveys conducted in 1998, 1999, and 2001. A unique confidential telephone system was used to collect sensitive information. RESULTS: Respondents patronizing female sex workers (FSW) in 'mainland China only' or in 'mainland China and other places' were more likely to be inconsistent condom users (28 and 34%) than those patronizing FSW in 'Hong Kong only' (9.1%). A similar pattern was found for self-reported STD in the past 6 months (10.1, 8.1 and 1.0%, respectively). Patronizing FSW in mainland China was associated with a higher prevalence of self-reported STD (adjusted OR 4.16), independent of consistent condom use and other potential confounding factors, including calendar year of survey, age, educational attainment, HIV-related knowledge, perceived efficacy of condom use for HIV/AIDS prevention, number of female sex partners, and the presence of a regular female sex partner in the past 6 months. Clients who had commercial sex both in mainland China and Hong Kong were more likely to use condoms in Hong Kong than in mainland China (paired OR 4.67, < 0.05). CONCLUSION: The geographical location of commercial sexual activity is related to the consistency of condom use, irrespective of the clients engaged in such activity. Prevention programmes need to be aware of how risk behaviour is dependent on local contexts.

SARS related preventive and risk behaviours practised by Hong Kong-mainland China cross border travellers during the outbreak of the SARS epidemic in Hong Kong.

OBJECTIVES: To investigate patterns of behaviours and attitudes related to SARS prevention in the Hong Kong cross border traveller population. SETTINGS: A survey was carried out at the Hong Kong-China cross border checkpoint in the middle of the epidemic. PARTICIPANTS: A total of 839 Hong Kong adult residents returning to Hong Kong from mainland China were surveyed. MAIN OUTCOME MEASURES: Practice of preventive measures and relevant behaviours and attitudes. RESULTS: Around 40% of the respondents were using masks all or most of the time in public places or washing their hands frequently (>10 times per day) and about one third avoided visiting crowded places in mainland China. Such figures were however lower than those practised by the general public in Hong Kong. SARS related perceptions, such as perceived risk of transmission and efficacy, etc, were associated with mask use and not visiting crowded places, but not with hand washing, which was associated with duration of stay. Gender differences were also observed. Around 70% of the travellers would have delayed medical consultation for influenza-like illness in China; 12.7% would not wear masks during such episodes of illness. Furthermore, about 30% of the respondents used to wear masks in Hong Kong but not in mainland China. CONCLUSIONS: The findings have implications on cross border prevention of SARS. It seems that those travelling during the SARS epidemic were a "self selected" group, and they were using less preventive measures. Special attention and intervention need to be provided to travellers to prevent a second wave cross border transmission of the disease.

Surveillance of HIV/AIDS-related attitudes and perceptions among the general public in Hong Kong from 1994 to 2000.

The present study monitored the trends of HIV/AIDS-related attitudes and perceptions including awareness, knowledge, self-perceived risk of HIV infection, and program evaluation among the general public in Hong Kong over a period of 7 years. Six cross-sectional telephone surveys were conducted. A total of 6,795 respondents aged 18-50 randomly selected from the general population participated in the study. Over the study period, the level of HIV/AIDS-related knowledge has improved slightly for most of the studied items. Condom use has been more widely accepted as an efficacious means of HIV prevention. However, the public seemed to be losing interest in HIV/AIDS-related issues and were not satisfied with the efficacy and adequacy of HIV/AIDS programs in Hong Kong. Sustaining efforts to remove misconceptions and to raise the public's interest, formulation of more effective programs, and ongoing evaluation are necessary.

Behavioral surveillance and factors associated with condom use and std incidences among the male commercial sex client population in Hong Kong--results of two surveys.

The present study compared the results of behavioral surveillance data obtained on the male clients of female sex workers (FSWs) population in Hong Kong. Two surveys, using an identical method, were completed in 1998 and 2000. Respectively, 1,020 and 2,074 respondents aged 18-60 who were randomly selected from the general population participated in the study. About 12% of the respondents had patronized FSWs in the past 6 months in 2000 as compared with 14% in 1998 (p = .143). Crossing the border for sex and purchasing sex in multiple geographic areas was very common and a higher percentage of respondents reported having patronized FSWs in mainland China in 2000 than in 1998 (p = .003). About 25% of the respondents in both surveys had not always been using condoms (i.e., not used condoms every time) when having sexual intercourse with FSWs. Those who practiced commercial sex in mainland China were less likely to have always been using condoms with FSWs (p < .01) and were more likely to have ever contracted STD in the past 6 months (p < .05), when compared with those who had purchased sex only in Hong Kong or in other places.

Prevalence and risk behaviors of Chinese men who seek same-sex partners via the internet in Hong Kong.

To examine the prevalence of Internet sex networking among men who have sex with men (MSM) in Hong Kong and risk behaviors associated with the behavior, a telephone survey of 15,230 Hong Kong Chinese men aged 18-60 was conducted. Of the 283 active MSM (having engaged in some MSM behaviors in the last 6 months) identified, 17.7% had networked for MSM partners via the Internet in the last 6 months. Younger age (odds ratio [OR] for age < or = 25 vs. age >25 = 4.67, 95% confidence interval [CI] = 2.35-9.28) and being an anal-sex MSM (OR = 4.72, 95% CI=2.36-9.44) were independent predictors of Internet sex networking. Being an Internet sex networker was associated with some risk behaviors such as having contracted a sexually transmitted disease (adjusted OR = 4.79, 95% CI = 1.34-17.11), having had > or = 3 MSM partners (adjusted OR = 4.74, 95% CI = 2.20-10.23), and having engaged in anal sex (adjusted OR = 3.95, 95% CI = 1.89-8.23). HIV prevention programs for MSM should thereby include Internet-based interventions.

Surveillance of discriminatory attitudes toward people living with HIV/AIDS among the general public in Hong Kong from 1994 to 2000.

PURPOSE: This study monitored the level of discriminatory attitudes toward people living with HIV/AIDS (PLWHA) exhibited by the general public in Hong Kong from 1994 to 2000. METHODS: A series of six cross-sectional telephone surveys using an identical method and a structured questionnaire were conducted. A total of 6,795 respondents aged 18 - 50 randomly selected from the general population participated in the study. RESULTS: Over the study period, the level of discriminatory attitudes toward PLWHA exhibited by the public has been improved slightly. For instance, fewer respondents in 2000 (10.6%) than in 1994 (21.8%) agreed that an HIV infected person should move out of the household (chi(2) test for trend, p < 0.001). However, there remained about one third who would avoid a friend infected with HIV (chi(2) test for trend, p < 0.05). Logistic regression analysis demonstrated that misconceptions about HIV transmission routes remained strongly associated with the discriminatory attitudes toward PLWHA; other significant factors included exposure to TV Announcement of Public Interest on HIV/AIDS-related issues and perceived chance of HIV infection as a result of having homosexual behaviours. CONCLUSIONS: Though some improvement has been observed, the level of discriminatory attitudes is still high. Sustained education to remove misconceptions about HIV infection is much required.

Plesiomonas shigelloides infection in Hong Kong: retrospective study of 167 laboratory-confirmed cases.

OBJECTIVE: To study the epidemiological, clinical, and microbiological features of Plesiomonas shigelloides infection in Hong Kong. DESIGN: Retrospective study. SETTING: Infectious Disease Unit of a district hospital, Hong Kong. PATIENTS: Patients with laboratory-confirmed cases of Plesiomonas shigelloides infection between 1 January 1995 and 31 December 1998. MAIN OUTCOME MEASURES: Epidemiological and clinical data, antibiotic sensitivity, and clinical outcome. RESULTS: There was an increasing trend in the number of isolates of Plesiomonas shigelloides obtained and the prevalence of the bacterium. A total of 197 isolates were obtained from 188 patients, and most isolates (172; 87.3%) were obtained during the summer. Clinical and epidemiological data were available for 167 patients (85 males, 82 females). Patient age ranged from 1 month to 95 years; the mean and median ages of the patients older than 15 years were 51.0 and 40.5 years, respectively (n=132). Only 35 (21.0%) of the 167 patients had a history of travel outside Hong Kong, whereas 21 (12.6%) had a history of consuming seafood or uncooked food; 39 (23.4%) had underlying medical conditions. Most patients (165; 98.8%) had symptoms of Plesiomonas shigelloides infection. Nine (5.4%) patients had had chronic diarrhoea for more than 2 weeks; watery and bloody diarrhoea was discharged by 122 (73.1%) and 42 (25.1%) of the patients, respectively. All 197 Plesiomonas shigelloides isolates were sensitive to ofloxacin, or levofloxacin and ceftriaxone. Resistance or partial resistance was recorded for ampicillin (72%), tetracycline (67%), co-trimoxazole (12%), and chloramphenicol (5%). The majority of patients (142/167; 85.0%) had self-limiting cases of infection, but 25 patients were given antibiotics for more severe symptoms at the time of presentation; there were two deaths. CONCLUSIONS: The occurrence of Plesiomonas shigelloides infection in Hong Kong is increasing, although most cases of are self-limiting.

Predicting traditional Chinese medicine's use and the marginalization of medical care in Hong Kong.

The study examined the importance of socio-demographic factors, health conditions, health beliefs and health seeking behaviors in predicting the use of Traditional Chinese Medicine (TCM) in Hong Kong. A sample of 4,339 respondents was randomly selected and interviewed. Among the 1,651 respondents who had consulted a doctor in the three months prior to the survey, 8.6% consulted a TCM doctor. Besides, 13.5% of the entire sample reported that they had been using TCM drugs frequently or occasionally. Socio-demographic factors, health conditions, health beliefs and health seeking behaviors were all found predictive of the use of TCM. In particular, those who were older, female, new immigrants, unemployed, retired, had chronic disease such as rheumatism, bronchitis, asthma, and those taking non-prescribed medication and not seeking treatment when falling ill were more likely to use TCM. Perceived difficulty in obtaining medical services and high medical cost also predicted TCM use. In sum, the findings suggest that TCM users are likely to be those who have been marginalized in obtaining medical care.

Prevalence and determinants of influenza vaccination in the Hong Kong Chinese adult population.

BACKGROUND: The study examined the prevalence and associated factors of influenza vaccination (IV) among the general adult population in Hong Kong. METHODS: A population-based, random telephone survey interviewed 1,102 Hong Kong Chinese adults aged 18-64 years old in 2006. RESULTS: Of all study participants, 95.5% had heard of IV, and only 28.1% had ever received IV. Associated factors included knowledge that IV is required annually, variables related to the Health Belief Model (HBM) (eg, perceived adverse effects, perceived efficacy), and advices given by health care professionals. CONCLUSIONS: The prevalence of IV was moderately low and factors related to the HBM were found predictive of IV.