Perceived social norm predicts HIV behaviors in China

HIV, the virus that causes AIDS, is a major public health issue around the world. One of the most effective methods of reducing its spread is consistent condom use, particularly by people who are living with HIV. Therefore, it is important to understand how best to encourage people to engage in safer sex practices, and Texas A&M researchers recently published work that attempted to do just that in an understudied area of the world: China. They found that social norms, defined as the opinions and attitudes of peer groups, affect condom use rates.

In the United States, this effect is well-established: If one’s friends talk about condom use and consider it to be important, people are more likely to use them consistently. This is a phenomenon often found in other areas of life and health promoting behaviors. “If we believe most of our friends exercise regularly, we are more likely to do so,” said Yan Alicia Hong, PhD, associate professor of health promotion and community health sciences at the Texas A&M School of Public Health.

Little research on how social norms affect condom use in people with HIV has been done in China, However, with more than 500,000 people living with HIV in China, this sort of work is crucial. Hong and colleagues from the United States and China conducted a study of more than 400 HIV patients in Guangzhou, China’s third-largest city, to see whether social norms had a similar effect there as they do in the United States and what other characteristics might affect condom use rates. The study was published in the journal AIDS Care.

The researchers sent surveys to 450 HIV patients, of whom 412 responded. Of these 412, the researchers focused on the 301 who were sexually active. A little more than half of those sexually active subjects reported talking to friends about condom use, with half of those patients stating that their friends considered condom use necessary. Patients whose peers had positive views of condom use were more likely to use condoms consistently than either those whose friends had neutral or negative views or patients who did not talk about condom use at all. This points to a correlation between peer group attitudes and safer sex practices similar to that found in the United States.

The study also examined factors such as the patient’s age and sex, whether they lived with family, with friends or alone and if family members were aware of the patient’s HIV status. The researchers found that those living with family members were less likely to consistently use condoms than subjects who lived alone or with friends. Family awareness of HIV infection also seems to matter, as patients whose family knew that they had HIV were more likely to engage in safer sex practices.

The study also found a significant difference in consistent condom use rates among men and women, with women far less likely to use condoms consistently. “This is possibly due to women’s lower social economic status, which means that they have less negotiation power in condom use,” said Hong. “These findings point to a need for future efforts to put additional focus on women and try to include family members as stakeholders.”

The study’s results show that social norms influence safer sex practices in China, meaning that HIV prevention efforts should encourage people to talk openly and positively about condom use. However, stigma surrounding HIV could make this difficult, Hong said. “This stigma can lead people with HIV to hide their identities in daily life, choosing to interact with fellow HIV patients online,” she added. “Because of this, my colleagues at China’s Sun Yet-sen University and I are working to develop a new social media approach to promote positive social norms, allowing people with HIV to discuss condom use and other issues with less fear of being stigmatized to better promote HIV prevention behaviors in this vulnerable population.”