A Study of AIDS/STIs-Related Knowledge, Attitudes, Beliefs, & Practices among Establishment-based Money Boys in Shenzhen, China

Background: Sexual activities have become the primary transmission mode in China recently. Money boys (MBs) as a new bridging population of HIV/STI epidemic need to be studied to evaluate their potential role in spreading HIV/STI infections both within the high risk populations and to the general population.;Methods: Two brothels, two gay bars, and two massage centers were selected for naturalistic observation, and 28 MBs were interviewed in-depth and audio-taped. A computer-assisted self-interview (CASI) survey was then conducted among 418 MBs. Blood samples were collected for HIV, syphilis, HCV, and HSV-2 antibody testing.;Results: A basic description about MBs and the establishments where they worked were observed, and strategies to conduct health education programs were discussed in-depth with MBs in our study. MBs' awareness of HIV/AIDS was not good, many having misconceptions about HIV transmission. One fifth (20.8%) reported ever use of drugs, such as ketamine and methamphetamine. MBs self-identified as either homosexual, heterosexual, or bisexual. They have many types of sex partners, commercial and non-commercial, both male and female. The longer a relationship with a partner, the less frequent was their condom use: male clients 82.4%, paid MBs 77.2%, female sex workers 70.5%, male casual partners 69.6%, female clients 69.1%, boyfriends 63.4%, female casual partners 58.6%, and girlfriends 43.9%. The HIV/STI prevalence rates were: HIV 3.3%, syphilis 10.5%, HSV-2 11.0%, and HCV 1.4%. The prevalence of any HIV/STI was 21.8%. MBs whose sexual partners were males only had a higher likelihood of HIV infection, OR=8.01 (95% CI: 1.77, 36.26). Older age (OR=1.11), not Han (the largest ethnic group in China) (OR=6.48), younger age at first sex (OR=1.15), whose sexual partners were males only (OR=1.79), and larger number of male casual partners in the last 6 months (OR=1.26) were factors significantly associated with an HIV/STI infection.;Conclusion: MBs are at high risk of HIV/STI infections and have a potential to spread infections to others. Appropriate, targeted intervention activities need to be conducted in order to reduce unprotected sexual activities with all types of partners.