Archives of Sexual Behavior

, Volume 43, Issue 4, pp 789–800 | Cite as

Perceptions of HPV, Genital Warts, and Penile/Anal Cancer and High-Risk Sexual Behaviors Among Men Who Have Sex with Men in Hong Kong

  • Joseph T. F. LauEmail author
  • Zixin Wang
  • Mason Lau
  • Coco H. Y. Lai
Original Paper


The prevalence of HIV and HPV is high among men who have sex with men (MSM) in China. It is unclear whether cognitive and affective responses related to HPV and HPV-related diseases are negatively associated with HIV-related risk behaviors among MSM. This cross-sectional study interviewed 449 adult Chinese MSM in Hong Kong. The prevalence of unprotected anal intercourse (UAI) and having had anal sex with more than one man in the last 6 months (multiple male sex partnerships) was 39.0 and 71.3 %, respectively. After adjusting for four significant background variables (education level, cohabitation with a man, exposure to HIV prevention materials, and HIV voluntary counseling and testing), variables negatively associated with UAI and/or multiple male sex partnerships included (1) correct HPV-related knowledge (AOR = 0.48–0.66), (2) perceived susceptibility (AOR = 0.32–0.55) and perceived severity (AOR = 0.12–0.60) related to HPV and HPV-related diseases, and (3) fear towards contracting genital warts and penile/anal cancer (AOR = 0.40–0.55). Perceived high chance of contracting HPV was positively associated with multiple partnerships (AOR = 4.74). It is possible to reduce HIV-related risk behaviors by increasing levels of knowledge, cognitions, and fear related to HPV and related diseases. It is important to integrate prevention of HIV with prevention of sexually transmitted infections. Such interventions are warranted.


Men who have sex with men Unprotected anal intercourse HPV HIV AIDS 



This study was funded by Merck Sharp & Dohme (Asia) Ltd. (MSD ref: IISP 37671).


  1. Ajzen, I. (1991). The theory of planned behavior. Organization Behavior and Human Decision Process, 50, 179–211.CrossRefGoogle Scholar
  2. Akin, A. (2012). The relationships between Internet addiction, subjective vitality, and subjective happiness. Cyberpsychology Behavior and Social Networking, 15, 404–410.CrossRefGoogle Scholar
  3. Barr, E., & Sings, H. L. (2008). Prophylactic HPV vaccines: New interventions for cancer control. Vaccine, 26, 6244–6257.CrossRefPubMedGoogle Scholar
  4. Belcher, L., Sternberg, M. R., Wolitski, R. J., Halkitis, P., & Hoff, C. (2005). Condom use and perceived risk of HIV transmission among sexually active HIV-positive men who have sex with men. AIDS Education and Prevention, 17, 79–89.CrossRefPubMedGoogle Scholar
  5. Berg, R. C. (2008). Barebacking among MSM Internet users. AIDS and Behavior, 12, 822–833.CrossRefPubMedGoogle Scholar
  6. Davis, R. A., Flett, G. L., & Besser, A. (2002). Validation of a new scale for measuring problematic internet use: Implications for pre-employment screening. Cyberpsychology & Behavior, 5, 331–345.CrossRefGoogle Scholar
  7. Dietz, C. A., & Nyberg, C. R. (2011). Genital, oral, and anal human papillomavirus infection in men who have sex with men. Journal of American Osteopathic Association, 111(3 Suppl. 2), S19–S25.Google Scholar
  8. Feng, L., Ding, X., Lu, R., Liu, J., Sy, A., Ouyang, L., … Zhao, J. (2009). High HIV prevalence detected in 2006 and 2007 among men who have sex with men in China’s largest municipality: An alarming epidemic in Chongqing, China. Journal of Acquired Immune Deficiency Syndrome, 52, 79–85.Google Scholar
  9. Feng, Y., Wu, Z., Detels, R., Qin, G., Liu, L., Wang, X., … Zhang, L. (2010). HIV/STD prevalence among men who have sex with men in Chengdu, China and associated risk factors for HIV infection. Journal of Acquired Immune Deficiency Syndrome, 53(Suppl. 1), S74–S80.Google Scholar
  10. Fennema, J. S., van Ameijden, E. J., Coutinho, R. A., & van den Hoek, A. A. (1995). HIV, sexually transmitted diseases and gynaecologic disorders in women: Increased risk for genital herpes and warts among HIV-infected prostitutes in Amsterdam. AIDS, 9, 1071–1078.CrossRefPubMedGoogle Scholar
  11. Galvin, S. R., & Cohen, M. S. (2004). The role of sexually transmitted diseases in HIV transmission. Nature Review Microbiology, 2, 33–42.CrossRefGoogle Scholar
  12. Guo, H., Wei, J. F., Yang, H., Huan, X., Tsui, S. K., & Zhang, C. (2009). Rapidly increasing prevalence of HIV and syphilis and HIV-1 subtype characterization among men who have sex with men in Jiangsu, China. Sexually Transmitted Diseases, 36, 120–125.CrossRefPubMedGoogle Scholar
  13. Hershey, J. H., & Velez, L. F. (2009). Public health issues related to HPV vaccination. Jounal of Public Health Management and Practice, 15, 384–392.CrossRefGoogle Scholar
  14. Hong Kong Special Administrative Region of China. (2008). PRiSM-HIV prevalence and risk behavioural survey of men who have sex with men in Hong Kong 2006. Retrieved from
  15. Hong, F. C., Zhou, H., Cai, Y. M., Pan, P., Feng, T. J., Liu, X. L., et al. (2009). Prevalence of syphilis and HIV infections among men who have sex with men from different settings in Shenzhen, China: Implications for HIV/STD surveillance. Sexually Transmitted Infections, 85, 42–44.CrossRefPubMedGoogle Scholar
  16. Huebner, D. M., Neilands, T. B., Rebchook, G. M., & Kegeles, S. M. (2011). Sorting through chickens and eggs: A longitudinal examination of the associations between attitudes, norms, and sexual risk behavior. Health Psychology, 30, 110–118.PubMedCentralCrossRefPubMedGoogle Scholar
  17. Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education Quarterly, 11, 1–47.CrossRefPubMedGoogle Scholar
  18. Jiang, J., Cao, N., Zhang, J., Xia, Q., Gong, X., Xue, H., … Shao, C. (2006). High prevalence of sexually transmitted diseases among men who have sex with men in Jiangsu Province, China. Sexually Transmitted Diseases, 33, 118–123.Google Scholar
  19. Lau, J. T., Cai, W., Tsui, H. Y., Chen, L., Cheng, J., Lin, C., … Hao, C. (2012). Unprotected anal intercourse behavior and intention among male sex workers in Shenzhen serving cross-boundary male clients coming from Hong Kong, China: Prevalence and associated factors. AIDS Care, 24, 59–70.Google Scholar
  20. Lau, J. T., Lau, M., Cheung, A., & Tsui, H. Y. (2008). A randomized controlled study to evaluate the efficacy of an Internet-based intervention in reducing HIV risk behaviors among men who have sex with men in Hong Kong. AIDS Care, 20, 820–828.CrossRefPubMedGoogle Scholar
  21. Lau, J. T., Siah, P. C., & Tsui, H. Y. (2002). A study of the STD/AIDS related attitudes and behaviors of men who have sex with men in Hong Kong. Archives of Sexual Behavior, 31, 367–373.CrossRefPubMedGoogle Scholar
  22. Leventhal, H. (1971). Fear appeals and persuasion: The differentiation of a motivational construct. American Journal of Public Health, 61, 1208–1224.PubMedCentralCrossRefPubMedGoogle Scholar
  23. Levina, M., Dantas, G., Fishbein, M., von Haeften, I., & Montano, D. (2001). Factors influencing MSMs’ intentions to always use condoms for vaginal, anal and oral sex with their regular partners. Psychology, Health & Medicine, 6, 191–206.CrossRefGoogle Scholar
  24. Lin, C., Lau, J. T., Ho, K. M., Lau, M. C., Tsui, H. Y., & Lo, K. K. (2010). Incidence of genital warts among the Hong Kong general adult population. BMC Infectious Diseases, 10, 272.PubMedCentralCrossRefPubMedGoogle Scholar
  25. Liu, H., Wang, N., Zhang, Q., Shao, Y., Wu, T., Liu, Y., et al. (2007). Study of HIV and syphilis infection situation and sexual behavioral characteristics among 416 MSM. Chinese Journal of AIDS & HIV, 13, 230–234.Google Scholar
  26. Ma, X., Zhang, Q., He, X., Sun, W., Yue, H., Chen, S., … McFarland, W. (2007). Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men: Results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006. Journal of Acquired Immune Deficiency Syndrome, 45, 581–587.Google Scholar
  27. MacKellar, D. A., Valleroy, L. A., Secura, G. M., Behel, S., Bingham, T., Celentano, D. D., … Torian, L. V. (2007). Perceptions of lifetime risk and actual risk for acquiring HIV among young men who have sex with men. AIDS and Behavior, 11, 263–270.Google Scholar
  28. Mahoney, M. C. (2006). Protecting our patients from HPV and HPV-related diseases: The role of vaccines (pp. 10–17). Suppl: Journal of Family Practice.Google Scholar
  29. Manhart, L. E., & Koutsky, L. A. (2002). Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sexually Transmitted Diseases, 29, 725–735.CrossRefPubMedGoogle Scholar
  30. Reiter, P. L., Brewer, N. T., McRee, A. L., Gilbert, P., & Smith, J. S. (2010). Acceptability of HPV vaccine among a national sample of gay and bisexual men. Sexually Transmitted Diseases, 37, 197–203.PubMedCentralCrossRefPubMedGoogle Scholar
  31. Ruan, Y., Jia, Y., Zhang, X., Liang, H., Li, Q., Yang, Y., … Shao, Y. (2009b). Incidence of HIV-1, syphilis, hepatitis B, and hepatitis C virus infections and predictors associated with retention in a 12-month follow-up study among men who have sex with men in Beijing, China. Journal of Acquired Immune Deficiency Syndrome, 52, 604–610.Google Scholar
  32. Ruan, Y., Li, D., Li, X., Qian, H. Z., Shi, W., Zhang, X., … Shao, Y. (2007). Relationship between syphilis and HIV infections among men who have sex with men in Beijing, China. Sexually Transmitted Diseases, 34, 592–597.Google Scholar
  33. Ruan, S., Yang, H., Zhu, Y., Wang, M., Ma, Y., Zhao, J., … Raymond, H. F. (2009a). Rising HIV prevalence among married and unmarried among men who have sex with men: Jinan, China. AIDS and Behavior, 13, 671–676.Google Scholar
  34. Ruiter, R., Verplanken, B., De Cremer, D., & Kok, G. (2004). Danger and fear control in response to fear appeals: The role of need for cognition. Basic and Applied Social Psychology, 24, 13–24.CrossRefGoogle Scholar
  35. Schutz, M., Godin, G., Kok, G., Vezina-Im, L. A., Naccache, H., & Otis, J. (2011). Determinants of condom use among HIV-positive men who have sex with men. International Journal of STD and AIDS, 22, 391–397.CrossRefPubMedGoogle Scholar
  36. Simatherai, D., Bradshaw, C. S., Fairley, C. K., Bush, M., Heley, S., & Chen, M. Y. (2009). What men who have sex with men think about the human papillomavirus vaccine. Sexually Transmitted Infections, 85, 148–149.CrossRefPubMedGoogle Scholar
  37. Smerecnik, C. M., & Ruiter, R. A. (2010). Fear appeals in HIV prevention: The role of anticipated regret. Psychology, Health & Medicine, 15, 550–559.CrossRefGoogle Scholar
  38. Tsui, H., Lau, J. T., Xiang, W., Gu, J., & Wang, Z. (2012). Should associations between HIV-related risk perceptions and behaviors or intentions be positive or negative? PLoS ONE, 7, e52124.PubMedCentralCrossRefPubMedGoogle Scholar
  39. Wang, Z., Lau, J. T., & Gu, J. (2012a). Acceptability of circumcision among clients of female sex workers in Hong Kong. AIDS and Behavior, 16, 1836–1845.CrossRefPubMedGoogle Scholar
  40. Wang, Z., Lau, J. T., Hao, C., Yang, H., Huan, X., Yan, H., et al. (2012b). Syphilis-related perceptions not associated with risk behaviors among men who have sex with men having regular male sex partner(s) in Nanjing, China. AIDS Care. doi: 10.1080/09540121.2012.748166.Google Scholar
  41. Wheldon, C. W., Daley, E. M., Buhi, E. R., Nyitray, A. G., & Giuliano, A. R. (2011). Health beliefs and attitudes associated with HPV vaccine intention among young gay and bisexual men in the southeastern United States. Vaccine, 29, 8060–8065.CrossRefPubMedGoogle Scholar
  42. World Health Organization. (2011). Retrieved from
  43. Xinhuanet. (2009). HIV incidence among gays increase fast in China. Retrieved from
  44. Xu, J. J., Zhang, M., Brown, K., Reilly, K., Wang, H., Hu, Q., … Shang, H. (2010). Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang, China. Sexually Transmitted Diseases, 37, 432–439.Google Scholar
  45. Yang, H., Hao, C., Huan, X., Yan, H., Guan, W., Xu, X., … Lau, J. T. (2010). HIV incidence and associated factors in a cohort of men who have sex with men in Nanjing, China. Sexually Transmitted Diseases, 37, 208–213.Google Scholar
  46. Zhang, X., Yu, J., Li, M., Sun, X., Han, Q., Zhou, F., … Gao, L. (2011). Prevalence and related risk behaviors of HIV, syphilis, and anal HPV infection among men who have sex with men from Beijing, China. AIDS and Behavior, 17, 1129–1136.Google Scholar
  47. Zhong, F., Lin, P., Xu, H., Wang, Y., Wang, M., He, Q., … Zhao, J. (2011). Possible increase in HIV and syphilis prevalence among men who have sex with men in Guangzhou, China: Results from a respondent-driven sampling survey. AIDS and Behavior, 15, 1058–1066.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Joseph T. F. Lau
    • 1
    • 2
    Email author
  • Zixin Wang
    • 1
  • Mason Lau
    • 1
  • Coco H. Y. Lai
    • 1
  1. 1.Centre for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of MedicineThe Chinese University of Hong KongHong KongHong Kong
  2. 2.Centre for Medical Anthropology and Behavioral HealthSun Yat-sen UniversityGuangzhouChina

Personalised recommendations