Measures

Participants reported their age, highest level of education, monthly income, and current relationship status.

One question assessed for the experience of UAI (yes vs. no). UAI was defined as having had at least one episode of anal intercourse with any male sex partner without a condom in the past 6 months.

Participants were asked to report their anal sex role. It was measured with one question “what’s your usual anal sex role with male partners in your life?” Response categories were “exclusively receptive”, “mostly receptive, sometimes insertive”, “versatile”, “mostly insertive, sometimes receptive”, and “exclusively insertive”. Those responding “exclusively receptive” or “mostly receptive sometimes insertive” were coded as receptive. Those responding “exclusively insertive” or “mostly insertive sometimes receptive” were coded as insertive and the rest as “versatile”.

A short version of the General Health Questionnaire (GHQ-12)⁴¹ was used in this study. It is a psychometric screening tool used to identify mental health problems experienced by an individual in the past few weeks. It contains 12 items rated on a 4 point scale, and we used a bi-modal scoring method. The responses of “less than usual” and “no more than usual” were scored equally at 0 point, and “rather more than usual” and “much more than usual” were both scored as 1 point⁴¹. All item scores were totalled to determine the final GHQ-12 score. A score of 4 or greater was considered indicative of a psychological problem⁴¹. The Cronbach’s alpha for the scale among MSM in this study was 0.93, which was satisfactory.

The Self-Stigma Scale–Short Form (SSS-S)⁴² was adopted in this study to measure the internalized stigma that participants may have towards themselves as a result of their sexual minority status. Respondents were asked to rate the extent to which they agreed with the statements on a 4-point Likert-type scale, from 1 (strongly disagree) to 4 (strongly agree). The scale consists of 9 items assessing affective, behavioural, and cognitive dimensions of self-stigma. The scale score and each dimension’s scores were based on averaging the item scores, with a higher score indicating a stronger sense of self-stigma. The scores ranged from 1 to 4. The reliability of this instrument in our study was satisfactory, with alpha equal to 0.96.

We measured two aspects of childhood abuse, physical abuse and psychological abuse. We measured these with 2 questions developed from previous research on childhood abuse^27,29,39. The two questions assessed whether an individual had ever experienced physical abuse and/or verbal abuse before 17 years of age (yes vs. no). Physical abuse was defined as the intentional use of physical force against an individual that results in harm to his/her health, survival, development or dignity. This definition includes hitting, kicking, shaking, biting, burning, poisoning or any other physical behaviour meant to hurt or injure an individual. Psychological abuse was defined as experiencing mistreatment, such as intimidation, threats, humiliation, belittling, ridiculing or verbal abuse, that makes an individual feel serious emotional harm. The Cronbach’s alpha was 0.74 suggesting acceptable internal consistency.

HIV-related knowledge was measured with an 8-item set of questions commonly used for measuring HIV knowledge⁴³, which covers HIV transmission routes and modes of prevention. Respondents were given the option to state whether each statement was true or false. The total number of correct answers was computed as the HIV-related knowledge score. A higher score indicated higher levels of knowledge. The reliability of this measure in our study was acceptable, with alpha equal to 0.78.

Two items assessed the level of community engagement in the past year. One item was “How often have you engaged in community activities in the past year?” The three possible answers to this item were never, occasionally, and always. The other item was “How many CBOs have you engaged with during the past year?” The possible answers were grouped into three categories: 0, 1–2, and more than 2. The Cronbach’s alpha of this measure was 0.61 suggesting the moderate reliability.