The roles and training of primary care doctors: China, India, Brazil and South Africa

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Patient–physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study

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Standard of care: how can we safeguard it?

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A qualitative study on HIV risk behaviors and medical needs of sex workers in a China/Myanmar border town

Ruili is a small border town between China and Myanmar where drugs and commercial sex are common, and rates of sexually transmitted diseases (STDs) including HIV, are high. A qualitative study was carried out on 89 commercial sex workers there in 2001 to understand more about their HIV awareness, medical-seeking behaviors and needs. We found that the sex workers were young and the turnover rates were high. Contrary to common belief, many came from nearby villages or cities, but were probably reluctant to participate in organized activities. Their medical knowledge was very limited, often acquired from peers and self-medication was common. The contraception they used was inappropriate and screening for cervical cancer was nonexistent. They were very stigma conscious. Condoms were purchased in small quantities when required and used only if the clients were agreeable. These findings have strong implications for the future planning of services and HIV/STD prevention.published_or_final_versio

The health of female sex workers in Hong Kong: Do we care?

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A Peer-Led, Social Media-Delivered, Safer Sex Intervention for Chinese College Students: Randomized Controlled Trial

Background: The peer-led, social media-delivered intervention is an emerging method in sexual health promotion. However, no research has yet investigated its effectiveness as compared with other online channels or in an Asian population. Objective: The objective of this study is to compare a peer-led, social media-delivered, safer sex intervention with a sexual health website. Both conditions target Chinese college students in Hong Kong. Methods: A randomized controlled trial was conducted with a peer-led, safer sex Facebook group as the intervention and an existing online sexual health website as the control. The intervention materials were developed with peer input and followed the information-motivation-behavioral skills model; the intervention was moderated by peer educators. The participants filled out the online questionnaires before and after the 6-week intervention period. Outcome evaluations included safer sex attitudes, behavioral skills, and behaviors, while process evaluation focused on online experience, online-visiting frequency, and online engagement. The effect of online-visiting frequency and online engagement on outcome variables was investigated. Results: Of 196 eligible participants—100 in the control group and 96 in the intervention group—who joined the study, 2 (1.0%) control participants joined the Facebook group and 24 of the remaining 194 participants (12.4%) were lost to follow-up. For the process evaluation, participants in the intervention group reported more satisfying online experiences (P<.001) and a higher level of online-visiting frequency (P<.001). They also had more positive comments when compared with the control group. For outcome evaluation, within-group analysis showed significant improvement in condom use attitude (P=.02) and behavioral skills (P<.001) in the intervention group, but not in the control group. No significant between-group difference was found. After adjusting for demographic data, increased online-visiting frequency was associated with better contraceptive use behavioral intention (P=.05), better behavioral skills (P=.02), and more frequent condom use (P=.04). Conclusions: A peer-led, social media-delivered, safer sex intervention was found to be feasible and effective in improving attitudes toward condom use and behavioral skills, but was not significantly more effective than a website. Future research may focus on the long-term effectiveness and cost-effectiveness of this popular method, as well as the potential cultural differences of using social media between different countries.published_or_final_versio

Correlates of sexual behaviors with health status and health perception in Chinese adolescents: A cross-sectional survey in schools

Sexual intercourse remains taboo among adolescents in a Chinese society such as Hong Kong. It is not openly discussed and little research has been done on its impact on health, although it carries serious risks of contracting sexually transmitted diseases (STDs)/HIV. In 1999, a cross-sectional, self-report survey on youth risk behaviors was carried out on 8382 students 15-18 years of age from 48 schools in Hong Kong. Three hundred seventy-seven (4.69%) reported that they had had sexual intercourse. Among them, forced sex (16.94%) was common, most often happening to boys (52.38%). They were more likely to have consulted doctors in the last month (odds ration [OR] 1.41 in boys 95% confidence interval [CI] 1.03, 1.94; OR 2.46 in girls 95% CI 1.81, 3.30) and 6 months (OR 1.33 in boys 95% CI 0.98, 1.78; OR 2.66 in girls 95% CI 1.80, 3.91). They also perceived poorer and deteriorating health. The sexually active female students were 6.70 times (95% CI 4.65, 9.66) more likely to attempt suicide than the other group and were more likely to take sick leaves (OR 3.56 in girls 95% CI 2.35, 5.41). Parental education and occupation, place of birth, and type of housing did not correlate in the initiation of sexual intercourse. The sexually experienced group reported worse physical and psychological health as well as health perception. Some of the characteristics and patterns identified in our study were quite different from the findings in the West but further studies are required to determine the reason for this.published_or_final_versio

Strengthening Evidence-based Family Medicine in Hong Kong

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Primary care of patients with sexually transmitted diseases or genitourinary symptoms in Hong Kong

Objectives. To determine the adequacy of care received from general practitioners by patients with sexually transmitted diseases or genitourinary symptoms. Design. Prospective study. Setting. Hong Kong. Participants. Diagnoses and drug data obtained from logbooks submitted by doctors studying for the Diploma in Family Medicine and candidates for Fellowship examinations between 1999 and 2002. Main outcome measures. Diagnosis or symptom of a sexually transmitted disease and prescribed treatment. Results. Sexually transmitted diseases and genitourinary symptoms accounted for 1.1% of the workload of these community doctors in Hong Kong. The majority of patients were young adult males. The overall standard of treatment was inadequate: both multi-pharmacy and inappropriate treatment was common; in up to 30% of cases, doctors ignored local or international guidelines. Conclusion. Primary care doctors play an important role in the diagnosis and management of sexually transmitted diseases or genitourinary symptoms in Hong Kong. A high index of suspicion should be maintained and continuing education made available if doctors are to provide an equally high standard of care.published_or_final_versio

HIV and sexual risk behaviours amongst intravenous drug users at rehabilitation centre in rural China

The study is aimed at investigating the sexual and HIV risk behaviours of intravenous drug users (IDUs) in rural Southwest China and the relationships between the demographics of the population, needle sharing and condom use. 993 IDUs at a drug rehabilitation centre in Dali, Yunnan Province completed an anonymous structured questionnaire between November and December 2006. IDUs were involved in multiple HIV risk behaviours. 37.5% admitted to sharing needles in the past and very few sterilised their needles using the correct technique. A third had engaged in multiple partnerships and 17.9% had a sexual partner who was also an IDU. Only 12.6% always used condoms during vaginal sex- this figure was even lower for oral (7.5 - 7.9%) and anal sex (14.3 - 16.1%). Males were less likely to use condoms compared to females (p < 0.001). 60.8% of the population had never had a HIV test. In the regression model, occupational status, marital status and daily dose of heroin were significant independent predictors of condom non-use. Sex, ethnicity, months and frequency of injecting were significant independent predictors of sharing needles in the past. A worrying number of IDUs in rural China are engaged in HIV risk behaviours despite recent government prevention programmes. Further educational interventions are required to target these behaviours.published_or_final_versio