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Growth Trajectories of Peer Norms, Self-efficacy and Condom Use Behavior Among Sexually Active Chinese Men Who Have Sex with Men: Latent Class Analysis and Growth Mixture Modeling


Data from a randomized controlled trial in 2015 were used to estimate the growth trajectories of peer norms, self-efficacy, and condom use behavior, and to identify associated sociodemographic and behavioral factors among a sample of 804 Chinese men who have sex with men (MSM). Latent class analysis and growth mixture modeling were conducted using Mplus. Two growth trajectories were estimated for each outcome variable with good model fit. The growth trajectories of peer norms were related to age (β = − 0.066, p < 0.05). The growth trajectories of self-efficacy were related to age (β = 0.057, p < 0.01) and using a condom during first sexual encounter with another man (β = 0.777, p < 0.001). The growth trajectories of condom use behavior were related to income (β = 0.366, p < 0.01) and having casual male partners (β = − 1.016, p < 0.001). Predictors for the growth factors within each latent class were also estimated. For subsets of MSM who are older, richer, used a condom during their first sexual encounter with another man, and do not have a casual male partner, condom videos may not have sufficient efficacy and other interventions may be necessary.

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  1. 1.

    Joint United Nations Program on HIV/AIDS. Report on the Global AIDS Epidemic. Geneva, Switzerland: Joint United Nations Program on HIV/AIDS. Available at: www.unaids.org/sites/default/files/media_asset/jc1510_2008globalreport_en_0.pdf. Accessed April 25 2018.

  2. 2.

    National Health and Family Planning Commission of the People’s Republic of China. 2015 China AIDS Response Progress Report. Joint United Nations Program on HIV/AIDS. http://www.unaids.org/sites/default/files/country/documents/CHN_narrative_report_2015.pdf. Accessed May 25 2018.

  3. 3.

    Ministry of Health People’s Republic of China, Joint United Nations Programme on HIV/AIDS, World Health Organization. 2005 Update on the HIV/AIDS Epidemic and Response in China. National Center for AIDS/STD Control and Prevention, China CDC. http://data.unaids.org/publications/external-documents/rp_2005chinaestimation_25jan06_en.pdf. Accessed May 25 2018.

  4. 4.

    Shang H, Zhang L. MSM and HIV-1 infection in China. Natl Sci Rev. 2015;2(4):388–91.

  5. 5.

    Zou H, Wu Z, Yu J, et al. Sexual risk behaviors and HIV infection among men who have sex with men who use the internet in Beijing and Urumqi, China. J Acquir Immune Defic Syndr. 2010;53:S81–7.

  6. 6.

    Feng Y, Wu Z, Detels R, et al. HIV/STD prevalence among MSM in Chengdu, China and associated risk factors for HIV infection. J Acquir Immune Defic Syndr. 2010;53(1):S74–80.

  7. 7.

    Zheng Y, Xu J, Zhang H. Characteristics of sexual network and HIV transmission among men who have sex with men. Chin J Public Health. 2006;22:531–3.

  8. 8.

    Chow EP, Wilson DP, Zhang L. Patterns of condom use among men who have sex with men in China: a systematic review and meta-analysis. AIDS Behav. 2012;16(3):653–63.

  9. 9.

    Wu J, Hu Y, Jia Y, et al. Prevalence of unprotected anal intercourse among men who have sex with men in China: an updated meta-analysis. PLoS ONE. 2014;9(5):e98366.

  10. 10.

    Qin Q, Tang W, Ge L, et al. Changing trend of HIV, syphilis and hepatitis C among men who have sex with men in China. Sci Rep. 2016;6:31081.

  11. 11.

    Lux KM, Petosa R. Using the health belief model to predict safer sex intentions of incarcerated youth. Health Educ Q. 1994;21(4):487–97.

  12. 12.

    Madden TJ, Ellen PS, Ajzen I. A comparison of the theory of planned behavior and the theory of reasoned action. Pers Soc Psychol Bull. 1992;18(1):3–9.

  13. 13.

    Brafford LJ, Beck KH. Development and validation of a condom self-efficacy scale for college students. J Am Coll Health. 1991;39(5):219–25.

  14. 14.

    DeHart DD, Birkimer JC. Trying to practice safer sex: development of the sexual risks scale. J Sex Res. 1997;34(1):11–25.

  15. 15.

    Tang W, Han L, Best J, et al. Crowdsourcing HIV test promotion videos: a noninferiority randomized controlled trial in China. Clin Infect Dis. 2016;16(11):1436–42.

  16. 16.

    Boone TL, Lefkowitz ES. Safer sex and the health belief model. J Psychol Human Sex. 2004;16(1):51–68.

  17. 17.

    Johnson WD, Diaz R, Flanders WD, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev. 2008;3:CD001230.

  18. 18.

    Li H, Lau JT, Holroyd E, Yi H. Sociocultural facilitators and barriers to condom use during anal sex among men who have sex with men in Guangzhou, China: an ethnographic study. AIDS Care. 2010;22(12):1481–6.

  19. 19.

    Zhang H, Wu Z, Zheng Y, Wang J, Zhu J, Xu J. A pilot intervention to increase condom use and HIV testing and counseling among men who have sex with men in Anhui, China. J Acquir Immune Defic Syndr. 2010;53:S88–92.

  20. 20.

    Holliday CS. Risky Sexual Behavior among African-American men who have sex with men: the effects of peer norms for condom use on risky sexual behavior as moderated by socio-demographic, socio-contextual, and health-related variables [unpublished dissertation]. Atlanta (GA): Georgia State University; 2006.

  21. 21.

    Pingel ES, Bauermeister JA, Elkington KS, Fergus S, Caldwell CH, Zimmerman MA. Condom use trajectories in adolescence and the transition to adulthood: the role of mother and father support. J Res Adolesc. 2012;22(2):350–66.

  22. 22.

    Lim SH, Christen CL, Marshal MP, et al. Middle-aged and older men who have sex with men exhibit multiple trajectories with respect to the number of sexual partners. AIDS Behav. 2012;16(3):590–8.

  23. 23.

    Pines HA, Gorbach PM, Weiss RE, et al. Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery. J Acquir Immune Defic Syndr. 2014;65(5):579–86.

  24. 24.

    Frankfurt S, Frazier P, Syed M, Jung KR. Using group-based trajectory and growth mixture modeling to identify classes of change trajectories. Couns Psychol. 2016;44(5):622–60.

  25. 25.

    Tang W, Mao J, Liu C, et al. Reimagining health communication: a non-inferiority randomized controlled trial of crowdsourced intervention in China. Sex Transm Dis. 2019;46(3):172–8.

  26. 26.

    Tang W, Mao J, Liu C, et al. Crowdsourcing health communication about condom use in men who have sex with men in China: a randomised controlled trial. Lancet. 2016;388:73.

  27. 27.

    Liu C, Mao J, Wong T, et al. Comparing the effectiveness of a crowdsourced video and a social marketing video in promoting condom use among Chinese men who have sex with men: a study protocol. BMC Open. 2016;6:e010755.

  28. 28.

    Best J, Tang W, Zhang Y, et al. Sexual behaviors and HIV/syphilis testing among transgender individuals in China: implications for expanding HIV testing services. Sex Transm Dis. 2015;42(5):281–5.

  29. 29.

    Xiao Z. Correlates of condom use among chinese college students in Hunan Province. AIDS Educ Prev. 2012;24(5):469–82.

  30. 30.

    Walsh JL, Senn TE, Scott-Sheldon LAJ, Vanable PA, Carey MP. Using growth mixture modeling to identify heterosexual men who reduce their frequency of unprotected sex following a behavioral intervention. AIDS Behav. 2012;16(6):1501–10.

  31. 31.

    Newson JT. Longitudinal structural equation modeling: a comprehensive introduction. New York, NY: Routledge; 2015.

  32. 32.

    Kline RB. Principles and practice of structural equation modeling. 4th ed. New York, NY: The Guilford Press; 2016.

  33. 33.

    Wickrama KK, Lee TK, O’Neal CW, Lorenz FO. Higher order growth curves and mixture modeling with Mplus: a practical guide. New York: Routledge; 2016.

  34. 34.

    George D, Mallery P. SPSS for Windows step by step : a simple guide and reference (17.0 update). Boston, MA: Allyn & Bacon; 2010.

  35. 35.

    Arrington-Sanders R, Morgan A, Oidtman J, et al. Context of first same-sex condom use and nonuse in young black gay and bisexual males. J Res Adolesc. 2016;26(4):1009–21.

  36. 36.

    Bauermeister JA, Hickok AM, Meadowbrooke C, Veinot T, Loveluck J. Self-efficacy among young men who have sex with men: an exploratory analysis of HIV/AIDS risk behaviors across partner types. AIDS Behav. 2014;18(1):69–77.

  37. 37.

    Kramer SC, Schmidt AJ, Berg RC, et al. Factors associated with unprotected anal sex with multiple non-steady partners in the past 12 months: results from the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS 2010). BMC Public Health. 2016;16:47.

  38. 38.

    Maksut JL, Eaton LA, Siembida EJ, Driffin DD, Baldwin R. An evaluation of factors associated with sexual risk taking among Black men who have sex with men: a comparison of younger and older populations. J Behav Med. 2016;39(4):665–74.

  39. 39.

    Khumsaen N, Stephenson R. Beliefs and perception about HIV/AIDS, self-efficacy, and HIV sexual risk behaviors among young thai men who have sex with men. AIDS Educ Prev. 2017;29(2):175–90.

  40. 40.

    Muthén LK, Muthén BO. Mplus user’s guide. 7th ed. Los Angeles, CA: Muthén & Muthén; 2015.

  41. 41.

    Albarracin D, Kumkale GT, Johnson BT. Influences of social power and normative support on condom use decisions: a research synthesis. AIDS Care. 2004;16(6):700–23.

  42. 42.

    Crosby R, Shrier C, Sanders SA, Graham CA, Milhausen RR, Yarber WL. Negative perceptions about condom use in a clinic population: comparisons by gender, race and age. Int J STD AIDS. 2013;24:100–5.

  43. 43.

    Oidtman J, Sherman SG, Morgan A, German D, Arrington-Sanders R. Satisfaction and condomless anal sex at sexual debut and sexual risk among young black same-sex attracted men. Arch Sex Behav. 2017;46(4):947–59.

  44. 44.

    Li H. Homosexuality in contemporary Chinese society: implications for HIV/AIDS prevention [unpublished dissertation]. Bangkok (Thailand): Mahidol University; 2006.

  45. 45.

    Gillespie S, Kadiyala S, Greener R. Is poverty or wealth driving HIV transmission? AIDS. 2007;21:s5–16.

  46. 46.

    Piot P, Greener R, Russell S. Squaring the circle: AIDS, poverty, and human development. PLoS Med. 2007;4(10):1571–5.

  47. 47.

    Tsui HY, Lau JT. Comparison of risk behaviors and socio-cultural profile of men who have sex with men survey respondents recruited via venues and the internet. BMC Public Health. 2010;10:232.

  48. 48.

    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

  49. 49.

    Operario D, Nemoto T, Iwamoto M, Moore T. Unprotected sexual behavior and HIV risk in the context of primary partnerships for transgender women. AIDS Behav. 2011;15(3):674–82.

  50. 50.

    Kim J, Pronyk P, Barnett T, Watts C. Exploring the role of economic empowerment in HIV prevention. AIDS. 2008;22:S57–71.

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This work was supported by the National Institutes of Health [National Institute of Allergy and Infectious Diseases 1R01AI114310]; UNC-South China STD Research Training Centre [Fogarty International Centre 1D43TW009532 to JT]; UNC Center for AIDS Research [National Institute of Allergy and Infectious Diseases 5P30AI050410]; the UNC Chapel Hill, Johns Hopkins University, Morehead School of Medicine and Tulane University (UJMT) Fogarty Fellowship [FIC R25TW0093]; and American Psychological Association’s Cyber Mentors Program [National Institute of Mental Health R25-MH083635]. The listed grant funders played no role in any step of this study. We appreciate the men who participated in this study. We also thank Dr. Angela Jacques Tiura for careful edit and Prof. Eleanor Holroyd for proofreading. The content of the article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

HL contributed to the conception and design of the study and drafted the paper. JT provided oversight for data collection, and WM, DK, ML, WT, and BJ assisted in the data collection. HL and GM searched the literature. HL and ESK analyzed the data. All authors revised the manuscript and approved the final version to be published.

Correspondence to Haochu Li.

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This study was reviewed and approved by institutional review boards at the Guangdong Provincial Center for Skin Diseases and STI Control, University of North Carolina at Chapel Hill, and University of California San Francisco.

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Li, H., Tucker, J.D., Ma, W. et al. Growth Trajectories of Peer Norms, Self-efficacy and Condom Use Behavior Among Sexually Active Chinese Men Who Have Sex with Men: Latent Class Analysis and Growth Mixture Modeling. AIDS Behav 24, 854–865 (2020). https://doi.org/10.1007/s10461-019-02515-7

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  • Condom use
  • Growth trajectory
  • Latent class analysis
  • Growth mixture modeling
  • Chinese MSM