Chronicling the relationships, attitudes, and sexual encounters of men who have sex with men in Shanghai, China: A web-administered sexual events diary

Background: Unprotected anal intercourse (UAI) remains the primary mode of HIV infection among MSM in China. As no sexual events studies have been conducted to date, little is known about how characteristics of a sexual event influence sexual behaviour.;Objectives: Utilizing a conceptual framework to situate the quantitative analyses within the community, cultural, and social structures that affect the lives of MSM, this dissertation describes attitudes towards homophobia and masculinity; characterizes community involvement and social support; describes egocentric sexual networks; and investigates individual- and event level variables associated with UAI during sexual events (UAIevents).;Methods: Data were collected using a cross-sectional questionnaire and a 28-day event-based, web-administered diary. Bivariable and multivariable logistic regression models with GEE were used to investigate associations between individual- and event- level variables and UAIevents.;Results: During 4,172 days of follow-up, 149 diary participants reported 854 sexual events with 389 unique partners. Individual-level variables associated with UAIevents included the end of a close relationship; number of social contacts; uncertain filial intentions; masculinity (selfreliance); internalized homophobia (failings and heteronormativity); perceived community homophobia (acceptance), sexual history; and attachment to the Tongzhi circle. Event-level variables associated with UAIevents included: the discussion of personal matters during the sexual event; partner dynamics (confidence), partnership duration; and participant intoxication.;Conclusions: The novel diary method allowed an in-depth exploration of partners and partnerships which revealed that the duration of the partnership and the discussion of personal matters (but not partner type) were associated with UAIevents. This suggests that the former two should be considered as alternatives to the traditional measure of partner type. Childrearing is important to many Shanghainese MSM. Uncertainty about one's filial intentions increases the odds of UAIevents. Failure to acknowledge the socio-cultural and political context in which men live can affect the collection, interpretation and utility of epidemiologic findings.