Money boys in Chengdu, China: migration, entrepreneurial precarity and health service access.

This qualitative study highlights the complex interplay between the social and structural conditions in Chengdu, China that shape the possibilities and vulnerabilities of money boys' sexual health. Within the context of China's liberalised market economy, we explore (1) how money boys' enter the sex trade market and navigate their sexual networks; (2) how their lives are enmeshed in fields of sexual desire, stigma and coercion; and (3) how the illicit and stigmatising nature of their work poses barriers to health service access. Findings reveal how the sex trade market and clinic are precarious spaces in which entrepreneurial ethics of the self and stigma-related coercive relations simultaneously enable and constrain money boys' sexual freedom and safer sex practices. By understanding this entrepreneurial precarity through the co-articulation of clinical and organisational work spaces, public health and social service providers can have a stronger sense of how various vulnerabilities configure to affect safer sex practices.

The characteristics of internet-based venue sex-seeking and mobility among money boys in Tianjin, China.

OBJECTIVES: Internet-based venue sex-seeking is prevalent among money boys (MBs), as is a high degree of mobility, which is crucial for HIV transmission in key populations with high risks of HIV infection. However, correlation studies in MBs are scarce because of the secretive nature of this hard-to-reach subpopulation. We conducted this project to explore the characteristics of MBs. METHODS: This survey was conducted from December 2014 to June 2015 in Tianjin; a total of 330 MBs were recruited by convenience sampling. Demographic and behavioural data were collected for analysis. RESULTS: Among the investigated MBs, 38 (11.52%) were HIV positive, 147 (44.55%) reported using internet-based venues to seek sexual partners and 257 (77.88%) had travelled to two or more destinations in the past 6 months. Compared with non-internet-based venue-using MBs, internet-based venue-using MBs were more likely to have part-time employment as MBs, to have a longer duration of working in the sex trade, to engage in finger intercourse and to present a history of substance abuse and sexually transmitted infections. However, internet-based venue-using MBs were less likely to exhibit consistent condom usage and undergo HIV testing. Origin of residence data showed that most MBs were from northern China, with Tianjin, Beijing and Shanghai as the main travel destinations. Mobile MBs were characterized as a group who were fully engaged in the sex trade and frequently took part in sexual activities but had a weak sense of self-protection. CONCLUSIONS: Internet-based venue sex-seeking and mobility are prevalent in MBs. Renewed efforts in internet-based health promotion and school-based primary health examination programmes may benefit more mobile and/or internet-based venue sex-seeking MBs.

Using latent class analysis to identify money boys at highest risk of HIV infection.

OBJECTIVES: Limited research has been conducted to investigate the characteristics of money boys (MBs) in China. This study was aimed to identify the subgroups of MBs based on sexual behaviors, Net-based venue sex-seeking, and substance abuse. STUDY DESIGN: Cross-sectional study. METHODS: Convenience sampling was used to recruit MBs from December 2014 to June 2015 in Tianjin, China. Face-to-face interviews were conducted for 330 MBs, and trained interviewers collected data. RESULTS: The laboratory-confirmed human immunodeficiency virus (HIV)-positive rate was 11.52% among 330 MBs. Four classes were identified through latent class analysis (LCA) method: 'relatively safe behavior' group, 'higher sexual risk' group, 'multiple sexual-partners' group, and 'unprotected sex and substance abuse' group, and there is a significant difference based on the HIV status. Significant differences were found in original residence, monthly income, duration in sex trade, employment, history of sexually transmitted infection (STI), HIV testing, knowledge of free antiviral treatment policy, and awareness of free AIDS testing between the four latent classes (P < 0.05). MBs who used Net-based venues to seek sexual partners; who have inconsistent condom use, substance abuse, a longer duration in sex trade, multiple sexual clients, and multiple anal sex; and who were full-time employed had the highest risk of HIV infection. CONCLUSIONS: The utility of LCA to identify subgroups based on risky behaviors attributes to formulating targeted intervention strategy.

Life satisfaction and its associated factors among money boys in China.

OBJECTIVES: Money Boy (MB) is a unique term used in China referring to a specialized population of men who sell sex to other men. Life satisfaction can influence one's health-related behaviors. The aim of our study was to find out the situation of MBs' life satisfaction and its associated factors. STUDY DESIGN: A cross-sectional study among MBs was conducted between July and December 2013 in Hunan province, China. METHODS: Respondent-driven sampling method was used for recruitment, with the initial seven 'seeds' found from a gay dating website, and 234 participants were enrolled into the study. They were asked to complete a questionnaire about their demographic characteristics, work experience as MB, family environment, health-related behaviors, status of self-esteem, self-stigma, and perceived life satisfaction. Descriptive statistics and multiple linear regression analysis were applied. RESULTS: There were 205 valid questionnaires collected. The results showed that MBs' life satisfaction score was 17.9 ± 6.3. The multiple linear regression model identified five factors correlated with MBs' life satisfaction. Three factors were found to be positively correlated with life satisfaction, consistent condom use with clients (ß = 3.093, P = 0.010), interpersonal relationship (ß = 1.027, P = 0.017), and self-esteem (ß = 0.253, P = 0.005). And two factors were found to be negatively correlated with life satisfaction, seeking for clients through mommy's arrangement (ß = -2.091, P = 0.019) and had ever gotten at least one kind of sexually transmitted disease (STDs) (ß = -1.971, P = 0.034). CONCLUSIONS: The present study contributed to a better understanding of MBs' life satisfaction and behavioral and other psychosocial features. It is suggested that comprehensive interventions involving behavioral and psychosocial health promotion approaches are needed for this population. Those programs will be more acceptable among this group and tend to be sustainable.

Drug use and its associated factors among money boys in Hunan Province, China.

OBJECTIVES: To describe drug use, types of drugs and related factors among money boys in Hunan Province, China. STUDY DESIGN: A cross-sectional study was conducted between July 2012 and January 2013. METHODS: Based on respondent-driven sampling, researchers located seven 'seeds' via a gay-dating website: http://www.ixxqy.org. After three waves of recruitment, 234 money boys were enrolled. They were asked to complete a 23-item questionnaire regarding demographic characteristics, drug use, a history of human immunodeficiency virus infection and family environment. Descriptive statistics and logistic regression analysis were conducted using Statistical Package for the Social Sciences Version 20.0. RESULTS: In total, 205 valid questionnaires were collected. Based on the data collected, 80 (39.0%) money boys had used drugs within the last 3 months. Rush popper (36.6%) and methamphetamine (12.7%) were used most commonly, and other drugs used were ecstasy (7.8%), ketamine (5.9%), marijuana (2.4%), morphine (1.5%), heroin (1.0%) and cocaine (0.5%). Factors included in the logistic regression were length of service (odds ratio [OR] 0.395, 95% confidence interval [CI] 0.175-0.896), being an only child (OR 2.272, 95% CI 1.108-4.659), relationship between parents (OR 0.428, 95% CI 0.213-0.858) and social network (OR 2.387, 95% CI 1.144-4.970). A shorter length of service and a good relationship between parents were protective factors against drug use, while being an only child and having a wide social network were risk factors. CONCLUSION: Drug use is common among money boys. This study found that length of service, being an only child, relationship between parents and social network are associated with drug use.

Prevalence of consistent condom use with various types of sex partners and associated factors among money boys in Changsha, China.

INTRODUCTION: Money boys with inconsistent condom use (less than 100% of the time) are at high risk of infection by human immunodeficiency virus (HIV) or sexually transmitted infection (STI), but relatively little research has examined their risk behaviors. AIM: We investigated the prevalence of consistent condom use (100% of the time) and associated factors among money boys. METHODS: A cross-sectional study using a structured questionnaire was conducted among money boys in Changsha, China, between July 2012 and January 2013. MAIN OUTCOME MEASURE: Independent variables included socio-demographic data, substance abuse history, work characteristics, and self-reported HIV and STI history. Dependent variables included the consistent condom use with different types of sex partners. RESULTS: Among the participants, 82.4% used condoms consistently with male clients, 80.2% with male sex partners, and 77.1% with female sex partners in the past 3 months. A multiple stepwise logistic regression model identified four statistically significant factors associated with lower likelihoods of consistent condom use with male clients: age group, substance abuse, lack of an "employment" arrangement, and having no HIV test within the prior 6 months. In a similar model, only one factor associated significantly with lower likelihoods of consistent condom use with male sex partners was identified in multiple stepwise logistic regression analyses: having no HIV test within the prior six months. As for female sex partners, two significant variables were statistically significant in the multiple stepwise logistic regression analysis: having no HIV test within the prior 6 months and having STI history. CONCLUSIONS: Interventions which are linked with more realistic and acceptable HIV prevention methods are greatly warranted and should increase risk awareness and the behavior of consistent condom use in both commercial and personal relationship.

Drug use and sexual behaviors among MSM in China.

BACKGROUND: This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka "money boys") in China. OBJECTIVES: Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs. METHODS: The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM. RESULTS: MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex. CONCLUSIONS: It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.

Epidemiological and molecular characteristics of HIV infection among money boys and general men who have sex with men in Shanghai, China.

To examine and compare the epidemiological and molecular characteristics of HIV infection between money boys (MBs) and general men who have sex with men (MSM) in Shanghai, China. Using a venue-based sampling strategy, a total of 535 MSM including 226 MBs and 309 general MSM were recruited to participate in a cross-sectional survey including a face-to-face questionnaire interview and HIV testing. Genotyping of HIV-1 pol gene was performed for HIV-positive participants. Compared with general MSM, MBs reported more sexual partners, more alcohol and drug use and more sex after alcohol or drug use. HIV prevalence was 10.7% overall, 14.6% for MBs and 7.8% for general MSM (p=0.011). Two independent multiple logistic regression analyses indicated that HIV infection was positively associated with non-Han ethnicity (Odds Ratio [OR]=4.79, 95% Confidence Interval [CI]: 1.08-21.28) and sex after drug use in the past 6months (OR=3.59, 95% CI: 1.50-8.61) among MBs, and with sex after drug use in the past 6months (OR=3.38, 95% CI: 1.10-10.34) among general MSM as well. HIV-1 pol gene was successfully amplified and sequenced for 52 (91.2%) of HIV-positive participants. Of them, 53.8% were genotyped as CRF01_AE, 36.5% as CRF07_BC and 9.6% as subtype B. Two CRF01_AE subtype-infected participants (3.8%), a 50years old MB and a 24years old general MSM, harbored viruses with a M46L mutation conferring resistance to protease inhibitors (PI). MSM particularly MBs in Shanghai, China were at high risk of HIV infection, underscoring an urgent need for joint intervention efforts for drug use and sexual behaviors. HIV drug resistance surveillance is also warranted although the relatively low prevalence of HIV drug resistance implies the effectiveness of current antiretroviral treatment regimen.