Prevalence of high-risky behaviors in transmission of HIV among high school and college student MSM in China: a meta-analysis

HIV knowledge, sexual attitudes, and PrEP-Eligible behaviors among college students in Southwest China: a cross-sectional study

BACKGROUND

There is an increasing number of human immunodeficiency virus (HIV) reported cases among students in Southwest China. However, the data on HIV/sex-related knowledge, attitude toward sex, sexual behaviors, and correlates of pre-exposure prophylaxis (PrEP)-eligible behaviors among college students in this area is still limited. This study aimed to assess the prevalence of HIV/sex-related knowledge, sexual attitudes, sexual behaviors, and factors associated with PrEP-eligible behaviors among college students.

METHOD

An online survey from 2020 to 2021 based on a multistage stratified and cluster sampling method was conducted among college students in Southwest China, and a well-designed questionnaire collected data. Propensity score matching (PSM), logistic, and log-binomial regression were used to identify the determinants of PrEP-eligible behaviors.

RESULT

A total of 108,987 students participated in the survey, and 92,946 provided valid responses. 91.6% (85,145/92,946) had good HIV-related knowledge, while only 26.0% (24,137/92,946) reported awareness of sex-related knowledge. Furthermore, more than half of the participants (64.5%) held negative stances towards engaging in "one-night stand", and 58.9% (617/1,047) reported PrEP-eligible behaviors. Log-binomial regression analysis indicated that unaware of HIV-related knowledge (aPR = 1.66, 95% CI:1.22-2.26, P = 0.001), not discussing about sex with their parent(s) (aPR = 1.16, 95% CI:1.01-1.33, P = 0.021), not receiving sex-related education in school(aPR = 1.24, 95% CI: 1.07-1.45, P = 0.005), not participating in HIV/AIDS prevention activities in the past year (aPR = 1.32, 95%CI:1.09-1.60, P = 0.004), experiencing forced sex (aPR = 2.08, 95% CI: 1.19-3.63, P = 0.010), and having the drug abuse (aPR = 22.21, 95% CI:5.59-88.31, P < 0.001) were significantly associated with increased odds of PrEP-eligible behaviors.

CONCLUSION

College students in Southwest China exhibited suboptimal HIV/sex-related knowledge, received limited sex education, reported conservative attitudes towards casual sex, and significant PrEP-eligible behaviors. These findings suggest that sexually experienced college students who were unaware of HIV-related knowledge, lacked sex education, experienced forced sex, and reported drug abuse were the key individuals for evaluating eligibility for PrEP initiation, and interventions aimed at increasing awareness of HIV/sex-related knowledge, promoting participation in sex education, addressing issues related to forced sex and tackling drug abuse could contribute to reducing the incidence of PrEP-eligible behaviors among college students.

Cascade analysis of awareness, willingness, uptake and adherence with regard to PrEP among young men who have sex with men (YMSM) in China: A comparison between students and non-students

INTRODUCTION

In China, young men who have sex with men (YMSM) are one of the groups most at risk of HIV/AIDS. The uptake of pre-exposure prophylaxis (PrEP) among YMSM has not been well documented. A cascade analysis of awareness, willingness, use and adherence with regard to PrEP was conducted separately among YMSM students and non-students.

METHODS

From 20 October to 30 December 2021, all adolescents aged 16-24 years were selected for the study from among MSM recruited from 31 provincial administrative regions in mainland China. Participants were included in a cross-sectional study of awareness, willingness, use and adherence with regard to PrEP among YMSM. Logistic regression modelling was used to identify factors associated with the four outcomes.

RESULTS

Among 1014 student and 866 non-student YMSMs, respectively, 88.07% and 81.64% had heard of PrEP; 58.16% and 50.35% were willing to use PrEP; 7.59% and 7.62% had used PrEP; and 3.16% and 3.58% had adhered to PrEP. Among students, those living in high-risk areas and pilot cities and those who had engaged in commercial sex and group sex had a positive effect on PrEP use, and the same trends were found among non-students living in high-risk areas and pilot cities and those who had engaged in group sex. 'Daily oral' and 'flexible' PrEP use positively influenced adherence among both groups.

CONCLUSIONS

A differentiation strategy of PrEP promotion should be implemented among YMSM. Material support for students, such as financial resources, should increase, while non-students should increase their level of perception of HIV risk.

Men who have sex with men were more depressed than their counterparts because of lower social support and higher loneliness: A comparative survey among Chinese university students

BACKGROUND

Poor mental health is prevalent among men who have sex with men (MSM), including MSM university students (MSMUS), causing a significant burden on their health and society. The study aimed to compare the difference in levels of depressive symptoms between Chinese MSMUS and non-MSMUS and test the mediating roles of social support and loneliness in the relationship between MSM status and depressive symptoms among male university students.

METHODS

From June to October 2018, a total of 305 MSMUS and 2447 non-MSMUS from two cities in Sichuan province (China) were investigated using questionnaires.

RESULTS

The proportion of depression in the MSMUS and non-MSMUS groups was 54.1 % and 36.4 %, respectively. MSM status, social support, and loneliness were all significantly associated with depressive symptoms among Chinese university students. Structural equation modelling showed that the association between MSM status and depressive symptoms was partially mediated by three indirect paths, including 1) via social support (mediated proportion = 19.4 %), 2) via loneliness (mediated proportion = 19.3 %), and 3) via social support and then loneliness (mediated proportion = 16.1 %).

CONCLUSIONS

Depression was prevalent among university students in China, especially MSMUS. The findings increased our understanding of the mediating roles of social support and loneliness in the link between MSM status and depressive symptoms among Chinese male university students, which have great implications for designing interventions to improve their mental health.

LIMITATION

The cross-sectional study design limited causal inferences.

A Systematic Review of Interventions for Young Men Who Have Sex With Men and Young Transgender Women Living with HIV

Young men who have sex with men (YMSM) and young transgender women (YTGW) have unique challenges to HIV care. We conducted a systematic review to summarize behavioral and structural interventions exclusively targeting YMSM and YTGW living with HIV. We screened 6546 records published through August 19th, 2022 from six databases. For eligibility, studies needed to involve structural or behavioral interventions exclusively targeting YMSM and/or YTGW living with HIV or presenting disaggregated data in this group. Quality assessment was performed using the ICROMS checklist. Twenty studies from 18 interventions were included in the review. There was considerable heterogeneity in intervention characteristics, including population, location, content and format of the interventions and targeted outcomes. Half of the interventions were described as pilot studies, and all but one study was conducted in the United States. The most common outcomes included the HIV care continuum, followed by HIV knowledge and self-efficacy, HIV-risk behaviors and mental health. The evidence base remained sparse, and the results on effectiveness were inconsistent, with some interventions reporting improved outcomes among participants after receiving treatment and others not reporting any meaningful changes. Although there has been some progress in the development of interventions targeting this group, we highlighted several directions for future research. Interventions expanding to low-resource settings, addressing structural barriers, and targeting different aspects of health among participants are warranted. Rigorous studies with larger sample sizes that follow participants over longer periods are necessary to increase the strength of the evidence.

Characteristics of men who have casual sex with men among Chinese university students: A cross-sectional study

OBJECTIVES

The characteristics of men who have sex with men (either exclusively or with both men and women; MSM) who engaged in casual sex among Chinese male university students have not been compared with the characteristics of men who have sex with only women (MSW). This information is important for tailoring targeted behavioral interventions to prevent human immunodeficiency virus (HIV)/sexually transmitted infection (STI) transmission in this subgroup of MSM.

METHODS

Data were derived from a large cross-sectional electronic questionnaire survey conducted at 13 universities in Zhejiang Province, China, in 2018. Bivariate analyses were used to compare demographic, HIV-related psychosocial, and behavioral characteristics between MSM and MSW students who engaged in casual sex during the previous year. Proportion differences between the two groups and their 95% confidence intervals were analyzed.

RESULTS

Among the 583 sexually active male students who engaged in casual sex during the previous year, 128 and 455 were MSM and MSW, respectively. Compared with MSW students, larger proportions of MSM students reported knowing that male-to-male sexual behavior was the main mode of HIV transmission among Chinese students (62.5% vs. 45.5%), consenting to commercial sex (67.2% vs. 53.4%), wanting to know the HIV serostatus of partners before casual sex (65.8% vs. 51.3%), feeling at risk of HIV infection (40.5% vs. 11.8%), high condom-decision scale scores (55.3% vs. 42.6%), engaging in sex with ≥ 5 casual sex partners (44.6% vs. 25.9%), searching for casual partners online (89.2% vs. 51.3%), consuming alcohol before casual sex (64.8% vs. 45.0%), engaging in sex with regular partners (83.1% vs. 67.0%), engaging in commercial sex (54.2% vs. 26.4%), and visiting a clinic for voluntary counselling and testing (VCT) (16.4% vs. 8.4%). However, compared with MSW students, smaller proportions of MSM students reported knowing that consistent condom use could prevent HIV transmission (80.5% vs. 95.2%) and that VCT should be actively sought after risky sexual behavior (78.9% vs. 93.8%), using condoms sometimes/often (26.4% vs. 44.3%), and consistently using condoms (28.9% vs. 40.1%) while engaging in sex with casual partners.

CONCLUSIONS

MSM students who engaged in casual sex were at a greater risk of HIV/STI transmission, compared with MSW students. Comprehensive interventions to address the risks of unprotected male-to-male sex, searching for casual sex partners online, and non-use of HIV testing services are needed to reduce the burden of HIV/STI transmission among this subgroup of MSM.

HIV Infection and Associated Factors Among Out-of-School MSM Aged 16-24 Years - 6 Cities and Tianjin Municipality, China, 2022-2023

What is already known about this topic?

Approximately 80% of newly diagnosed human immunodeficiency virus (HIV) cases among individuals aged 15-24 years in China are attributed to out-of-school youth.

What is added by this report?

This study presents findings on HIV prevalence and comprehensive insights into HIV service utilization, risky behaviors, and prevention knowledge among young out-of-school men who have sex with men (MSM) aged 16-24 years in China. This population exhibits a disproportionately high burden of HIV, with only 51.6% of HIV cases previously diagnosed.

What are the implications for public health practice?

HIV services should be expanded to include these key populations. Tailored interventions are needed to remove barriers to regular HIV services faced by young key populations.

Outreach strategies to promote HIV testing and linkage-to-care focusing on a young sexual and gender-diverse population in Bangkok, Thailand

INTRODUCTION

Human Immunodeficiency Virus (HIV) prevalence among young gender-diverse (a wide range of gender identities for people whose gender identity is different from the sex that they were assigned at birth) individuals is high but testing coverage among this key population remains low. We aim to evaluate strategies for outreach, HIV testing, and linkage to proper management in young men-who-have-had-sex-with-men (MSM, homosexual male) and transgender women (TGW) in Bangkok, Thailand.

METHODS

The "YM2M outreach program" consisted of two strategies: 1) online platforms (OP) and 2) physical outreach activities (POA). Participant questionnaires were completed on a voluntary basis during outreach activities during 2018-2021. Demographic and behavioral characteristics were assessed for association with HIV positivity.

RESULTS

A total of 3,972 homosexual male and TGW participated in the YM2M program: 2,973 by OP and 999 by POA. Of 2,230 participants who reported gender identity, 603/1,392 (43.3%) of OP and 252/985 (25.6%) of POA were gender diverse. Of 631 (21.2%) participants in OP and 970 (97.1%) in POA who underwent testing, 286 (45.3%) in OP and 41 (4.2%) in POA were HIV-positive. The venue reporting highest HIV yield was the Mor-Lam (11.5%). Among those with an HIV-positive test, 175 (61.2%) from OP and 23 (51.1%) from POA were successfully linked to HIV care. The independent factors associated with HIV positive in OP were being youth (adjusted odd ratio (aOR), 0.37; 95%CI 0.16-0.81; P = 0.01) and suspected or confirmed STI (aOR 15.39; 95%CI 7.17-33.03, P<0.01); while those in in POA at Mor-Lam were being gender diverse (aOR, 8.43; 95%CI 1.94-36.62; P<0.01) and reactive syphilis test (aOR, 5.40;95%CI 2.45-11.88; P<0.01). Linkage to pre-exposure prophylaxis (PrEP) among HIV-negative participants was low, 4.9% and 2.6% in OP and POA participants, respectively.

CONCLUSIONS

While uptake of HIV testing was higher in POA while OP was more effective in identifying undiagnosed people living with HIV/AIDS and linking them to care. Neither strategy was considered effective in linkage to PrEP.

Disparity of HIV-1 Pretreatment Drug Resistance in Men Who Have Sex With Men and the Heterosexual Population in Guangxi, China

Background

The prevalence of human immunodeficiency type 1 (HIV-1) pretreatment drug resistance (PDR) in men who have sex with men (MSM) in Guangxi remains unclear, and its effect on antiretroviral therapy (ART) needs to be further studied.

Methods

Individuals newly diagnosed with HIV in Guangxi from 2016 to 2020, which mainly included MSM and the heterosexual (HES) population, were recruited in this study. Pol sequences were sequenced to analyze PDR and construct a genetic network. The risk factors for PDR and the effect on ART were respectively analyzed.

Results

The PDR of MSM in Guangxi was 4.7% (34/716), consisting of nonnucleoside reverse transcriptase inhibitors (3.5%), protease inhibitors (0.8%), integrase strand transfer inhibitors (0.7%), and nucleoside reverse transcriptase inhibitors (0.4%), and lower than that of HES (9.3% [77/827]). The subtype was associated with PDR, and MSM was lower than HES (CRF01_AE: 3.0% vs 8.0%; CRF07_BC: 4.1% vs 7.2%). CRF55_01B (adjusted odds ratio [aOR], 3.35) was a risk factor for PDR in MSM, while CRF08_BC (aOR, 2.34) and older (aOR, 2.75) were risk factors for PDR in HES. Six of 18 (33.3%) PDR of MSM in the network connected to each other, lower than that of HES (61.1% [22/36]). CRF55_01B (aOR, 5.69) was a risk factor for PDR transmission in MSM, while CRF08_BC (aOR, 4.08) was a risk factor in HES. Pretreatment CD4⁺ T-cell count, age, infection route, and subtype were associated with recovery of CD4⁺ count and suppression of viral load.

Conclusions

The prevalence of PDR was different between MSM and HES, which may be associated with subtype. Thus, the monitoring of subtype and PDR should be strengthened.

HIV Prevalence and Risk Factors Among Young Men Who Have Sex With Men in Southwest China: Cross-sectional Questionnaire Study

BACKGROUND

Previous studies showed an increase in HIV prevalence among young men who have sex with men aged 25 years or younger in China.

OBJECTIVE

This study aimed to assess HIV prevalence and associated factors among young men who have sex with men in the Guangxi Zhuang Autonomous Region.

METHODS

This study was conducted in 4 cities (Guilin, Liuzhou, Beihai, and Nanning) in the Guangxi Zhuang Autonomous Region between June 2014 and May 2016. Participants were reached through web-based and site recruitment approaches. Laboratory tests were performed to detect HIV and syphilis infections. A self-administered questionnaire was used to collect data from 632 eligible young men who have sex with men.

RESULTS

The prevalence of HIV and syphilis was 9.3% (59/632) and 11.4% (72/632), respectively. Multivariable logistic analysis showed that ethnic minority (adjusted odds ratio [AOR] for Han Chinese vs other minorities 0.28, 95% CI 0.11-0.71, P=.007), receptive sexual positioning in the past 6 months (AOR 2.94, 95% CI 1.32-6.53, P=.008), current syphilis infection (AOR for individuals without vs those with infection 0.38, 95% CI 0.19-0.75, P=.005), inconsistent condom use in the past 6 months (AOR 1.91, 95% CI 1.06-3.45, P=.03), and psychotropic drug use before last anal intercourse (AOR 16.70, 95% CI 2.34-119.18, P=.005) were independently associated with HIV infection.

CONCLUSIONS

There is an urgent need to scale up HIV and syphilis interventions in young men who have sex with men. Some subgroups might need specific attention for HIV prevention, including ethnic minority men, individuals with a history of sexually transmitted infections, and individuals who have been engaging in receptive anal sex.

Predicting the risk of HIV infection among internal migrant MSM in China: An optimal model based on three variable selection methods

Introduction

Internal migrant Men who have sex with men (IMMSM), which has the dual identity of MSM and floating population, should be more concerned among the vulnerable groups for HIV in society. Establishing appropriate prediction models to assess the risk of HIV infection among IMMSM is of great significance to against HIV infection and transmission.

Methods

HIV and syphilis infection were detected using rapid test kits, and other 30 variables were collected among IMMSM through questionnaire. Taking HIV infection status as the dependent variable, three methods were used to screen predictors and three prediction models were developed respectively. The Hosmer-Lemeshow test was performed to verify the fit of the models, and the net classification improvement and integrated discrimination improvement were used to compare these models to determine the optimal model. Based on the optimal model, a prediction nomogram was developed as an instrument to assess the risk of HIV infection among IMMSM. To quantify the predictive ability of the nomogram, the C-index measurement was performed, and internal validation was performed using bootstrap method. The receiver operating characteristic (ROC) curve, calibration plot and dynamic component analysis (DCA) were respectively performed to assess the efficacy, accuracy and clinical utility of the prediction nomogram.

Results

In this study, 12.52% IMMSMs were tested HIV-positive and 8.0% IMMSMs were tested syphilis-positive. Model A, model B, and model C fitted well, and model B was the optimal model. A nomogram was developed based on the model B. The C-index of the nomogram was 0.757 (95% CI: 0.701-0.812), and the C-index of internal verification was 0.705.

Conclusions

The model established by stepwise selection methods incorporating 11 risk factors (age, education, marriage, monthly income, verbal violence, syphilis, score of CUSS, score of RSES, score of ULS, score of ES and score of DS) was the optimal model that achieved the best predictive power. The risk nomogram based on the optimal model had relatively good efficacy, accuracy and clinical utility in identifying internal migrant MSM at high-risk for HIV infection, which is helpful for developing targeted intervention for them.

The relationship between acceptance of illness and quality of life among men who have sex with men living with human immunodeficiency virus: A cross-sectional study

Objectives

To explore the relationship between acceptance of illness and quality of life (QOL), and factors associated with acceptance of illness among men who have sex with men (MSM) living with human immunodeficiency virus (HIV).

Methods

Three hundred and one MSM were recruited from an HIV clinic between August and December 2018. The battery of measurements consisted of the Acceptance of Illness Scale, World Health Organization Quality of Life Questionnaire for HIV brief version, HIV Cognitive Appraisal Scale and a self-designed questionnaire used to collect general information. Pearson correlation test was used to examine the relationship between acceptance of illness and QOL. Univariate and multivariate ordinal logistic regression analyses were used to examine whether the general data (demographic and HIV-related clinical data) and HIV cognitive appraisal were associated with acceptance of illness levels.

Results

Descriptive analysis showed the acceptance level among MSM living with HIV was moderate (Mean = 26.29, SD = 5.28). Those with a better acceptance of illness had a better QOL (r = 0.69, P < 0.01). In the multivariate ordinal logistic regression model, education level, threat appraisals (OR:1.09; 95%CI [1.06–1.13]), and controllability appraisals (OR: 0.82; 95%CI [0.71–0.94]) were significantly associated with acceptance of illness.

Conclusions

Results showed acceptance level was moderate and had a positive correlation with QOL. High level of education, low threat appraisals and high controllability appraisals were related to high illness acceptance. This finding highlights the importance of focusing on HIV-infected MSM with low education and on their perceptions of threat and controllability about HIV-related issues when designing interventions to promote illness acceptance in this vulnerable population.

Geosocial Networking Smartphone App Use and High-Risk Sexual Behaviors Among Men Who Have Sex With Men Attending University in China: Cross-sectional Study

BACKGROUND

Gay apps are smartphone-based geosocial networking apps where many men who have sex with men (MSM) socialize and seek sex partners. Existing studies showed that gay app use is associated with greater odds of high-risk sexual behaviors and potentially more HIV infections. However, little is known about this behavior among young MSM.

OBJECTIVE

We conducted this study to understand gay app use and its influencing factors among MSM attending university in China.

METHODS

From January to March 2019, participants were recruited from 4 regions with large populations of college students in China: Chongqing, Guangdong, Shandong, and Tianjin. The eligibility criteria were MSM aged 16 years or older, self-identified as a university student, and being HIV negative. A self-administered online structured questionnaire was used to collect data on sociodemographic information, sexual behaviors, gay app use, substance use, and HIV testing history. We performed multivariable log-binomial regression to assess correlates of seeking sex partners via gay apps.

RESULTS

A total of 447 MSM attending university with an average age of 20.4 (SD 1.5) years were recruited. Almost all participants (439/447, 98.2%) reported gay app use at some point in their life, and 240/439 (53.7%) reported ever seeking sex partners via gay apps. Blued (428/439, 97.5%) was the most popular gay app. Higher proportions of sexual risk behaviors (including seeking sex partners via apps [P<.001], engaging in group sex [P<.001], having multiple sex partners [P<.001], unawareness of sex partners' HIV status [P<.001], and using recreational drugs during sex [P<.02]) were positively associated with the increase in the frequency of gay app use. In multivariable analysis, participants who used gay apps to seek sex partners might be more likely to have multiple sex partners in the past 3 months (adjusted prevalence ratio [APR] 1.53, 95% CI 1.33-1.76; P<.001), engage in group sex in the past 3 months (APR 1.55, 95% CI 1.35-1.78; P<.001), and have sex partners with unknown or positive HIV status (APR 1.72, 95% CI 1.46-2.01; P<.001).

CONCLUSIONS

Seeking sex partners via gay apps may associate with the increased high-risk sexual behaviors among MSM attending university. The causality between seeking sex partners via gay apps and increased high-risk sexual behaviors should be further investigated so as to inform potential policies for HIV prevention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900020645; http://www.chictr.org.cn/showprojen.aspx?proj=34741.

Prediction Model for the Risk of HIV Infection among MSM in China: Validation and Stability

The impact of psychosocial factors on increasing the risk of HIV infection among men who have sex with men (MSM) has attracted increasing attention. We aimed to develop and validate an integrated prediction model, especially incorporating emerging psychosocial variables, for predicting the risk of HIV infection among MSM. We surveyed and collected sociodemographic, psychosocial, and behavioral information from 547 MSM in China. The participants were split into a training set and a testing set in a 3:1 theoretical ratio. The prediction model was constructed by introducing the important variables selected with the least absolute shrinkage and selection operator (LASSO) regression, applying multivariate logistic regression, and visually assessing the risk of HIV infection through the nomogram. Receiver operating characteristic curves (ROC), Kolmogorov–Smirnov test, calibration plots, Hosmer–Lemeshow test and population stability index (PSI) were performed to test validity and stability of the model. Four of the 15 selected variables—unprotected anal intercourse, multiple sexual partners, involuntary subordination and drug use before sex—were included in the prediction model. The results indicated that the comprehensive prediction model we developed had relatively good predictive performance and stability in identifying MSM at high-risk for HIV infection, thus providing targeted interventions for high-risk MSM.

Blocking and being blocked on gay dating apps among MSM attending a sexual health clinic: an observational study

Background

There are limited studies on blocking and men who have sex with men (MSM) health outcomes. We need such data in China, to better understand the relationship between Chinese MSM gay app use and health outcomes, thus providing insight on risky sexual behaviors and HIV transmission among Chinese MSM - one of the world’s largest MSM communities. Blocking someone is when users select a function on an app to prevent another user from contacting them and being blocked is when someone is prevented from contacting another user. We studied the correlates of blocking on the world’s largest gay dating app among Chinese MSM (N = 208).

Methods

We conducted a cross-sectional survey as part of an HIV testing intervention in Guangzhou, China, May–December 2019. Using logistic regression models, we estimated the correlates of blocking (e.g. sociodemographic characteristics, sexual behavior, HIV testing history, social network data).

Results

MSM had a mean age of 27.9 years (SD = 7.1) and median of one sexual partner in the last 3 months. About 62% had blocked someone in their lifetime and 46% had been blocked in their lifetime. Each additional male partner was associated with an 87% (aOR = 1.87, 95%CI = 1.03, 3.40) increased chance of being blocked. Reporting a versatile sexual role was related with a 90% (aOR = 0.10, 95%CI = 0.02, 0.45) decreased likelihood of blocking behavior and an 86% (aOR = 0.14, 95%CI = 0.04, 0.46) reduced chance of being blocked.

Conclusions

Number of male partners may be associated with blocking behavior, with implications for the design of online sexual health interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12182-w.

Project BESPOKE (Integrated Bio-Behavioral Assessment of HIV and STI Among Young Tertiary Student Men Who Have Sex With Men in Nairobi, Kenya): A Respondent-Driven Sampling Survey Protocol

Introduction: Globally, men who have sex with men (MSM) are a key population for the human immunodeficiency virus (HIV) epidemic. Among MSM, young men who have sex with men (YMSM) are disproportionately affected by HIV and other sexually transmitted infections (STI). However, there is a dearth of research and interventions targeting HIV/STI prevention among YMSM. In Kenya, there is paucity of knowledge on the burden of HIV/STI and related factors among YMSM, including tertiary student men who have sex with men (TSMSM). The barriers TSMSM experience in accessing and utilizing health services in their learning institutions have seldom been explored. In the context of healthcare providers (HCP) working in tertiary institutions, little is known about their knowledge, attitudes, and practices toward providing services to TSMSM. Methods: The aims of the study are to: estimate prevalence and correlates of HIV/STI among TSMSM; estimate population size of TSMSM; explore experiences of TSMSM with access and utilization of health services; and assess HCP knowledge of, attitudes toward, and practices in provision of services to TSMSM. A mixed-methods approach will be used in three phases: Phase I-formative qualitative research will be conducted to understand TSMSM social networks, select "seeds", and explore strategies for implementing a respondent-driven sampling (RDS) survey. Interviews will be conducted with at least three staff who work in community based/non-governmental organizations (CBO/NGO) that serve MSM and at least 10 TSMSM. Phase II-an integrated bio-behavioral assessment (IBBA) will be conducted, where 200 TSMSM recruited by RDS will be offered HIV/STI testing, complete a behavioral survey, and provide information for population size estimation (PSE). Phase III-in-depth interviews will be held with 20 TSMSM selected from 200 TSMSM in phase II, to explore their experiences with access and utilization of healthcare services. Focus group discussions (FGD) will be conducted with HCP working in tertiary institutions to assess their knowledge of, attitudes toward, and practices in providing services to TSMSM. Data collection started in September 2020 and is expected to end by September 2021. Discussion: Findings from this study will be useful in informing HIV/STI prevention programming for TSMSM, by policy makers such the Kenyan ministries of health and education, tertiary education institutions, service providers, advocacy groups, and other interested stakeholders.

Analysis of homosexual behavior characteristics and influencing factors of male college students in Zhejiang Province

The purpose of this study was to understand the homosexual behavior characteristics and influencing factors of male college students and to provide scientific evidence for the prevention of HIV infection in college students.A self-made online questionnaire was used to collect information on demographic characteristics, sexual attitudes, sexual behaviors, and interventions of the respondents. The χ2 test was performed on the constituent ratios of different groups, and whether homosexual behavior occurred was the dependent variable. Logistic regression was subsequently used to analyze the influencing factors of male homosexual behavior.A total of 2665 students were surveyed, including 219 men who have sex with men, accounting for 8.22% of the sample population. Multivariate analysis revealed the following independent influencing factors of homosexual behavior among male college students: the student's household registration was Zhejiang Province, the hometown was in the city, accepted male homosexual sex, had temporary sex in the last year, and awareness that the correct use of condoms can reduce the spread and risk of acquired immunodeficiency syndrome.Various measures should be enacted to promote human immunodeficiency virus/acquired immunodeficiency syndrome education and intervention among college students, especially emphasizing making friends and advocating safe sex to prevent the spread of the disease.

Service acceptance of HIV non-occupational post-exposure prophylaxis(nPEP) among college students: a cross-sectional study in China

Background

College students were the key group we should pay more attention for acquired immune deficiency syndrome (AIDS) prevention and control in recent years in China. Few studies of HIV non-occupational post-exposure prophylaxis (nPEP) knowledge and service acceptance had been conducted among them in China. This study conducted a cross-sectional survey to understand the service acceptance of nPEP and its influencing factors among college students in the three cities of China.

Methods

A questionnaire survey was conducted to collect information on socio-demographic, behavioral characteristic, HIV/AIDS knowledge, nPEP knowledge, acceptance of nPEP services among the college students in Beijing, Shenzhen, and Kunming of China from March to April of 2019. Each participant completed an anonymous questionnaire on line by computer-assisted or mobile phone-assisted self-interview with informed consent. Multivariable logistic regression analyses identified predictors for service acceptance of nPEP.

Results

A total of 4698 students were surveyed with the average age of 20 years old. 98.0% (4605/4698) of them were undergraduates, 21.8%(1022/4698) had sexual intercourse; 48.6% (2282/4698) heard of nPEP, among which 4.95%(113/2282) received nPEP services. The awareness rate of HIV/AIDS knowledge was 85.6% (5495/4698) with the differences statistically significant between the three cities. The awareness rate of nPEP knowledge was 16.5% (774/4698). There were significant differences in receiving nPEP services among students of different ages, genders, sexual behaviors, and knowledge of HIV/AIDS by univariate analysis. Multivariable analyses indicated that age group of 18 and under (OR = 2.551, 95% CI = 1.153–5.646), male (OR = 3.131, 95% CI = 1.866–5.253), homosexual behavior (OR = 4.661,95%CI = 2.658–8.172), heterosexual behavior (OR = 1.676, 95% CI = 1.040–2.947), no awareness of AIDS knowledge (OR = 3.882, 95% CI = 2.371–6.356) and nPEP (OR = 4.788, 95% CI = 2.50–9.169) knowledge, were associated with the service acceptance of nPEP among the college students.

Conclusion

The low acceptance of nPEP services was mainly affected by low level of nPEP knowledge among the college students. Further publicity and education of nPEP knowledge were necessary, as well as promotion of knowledge of HIV/AIDS prevention and treatment. More attention should be paid to the factors associated with acceptance of nPEP services.

Condom Use Consistency and Associated Factors Among College Student Men Who Have Sex with Men from Seven Colleges in Changsha City: A Cross-Sectional Survey

Background

College student men who have sex with men (MSM) are at high risk for HIV infection due to multiple social and behavioral factors. Consistent condom use is nationally advocated for HIV prevention. This study explored the sexual behaviors and factors associated with condom use consistency in the past six months among college student MSM from seven colleges in Hunan Province, China.

Methods

A cross-sectional survey was conducted from September 2017 to March 2018. Condom use consistency, sexual behaviors, HIV testing performance, substance use, and alcohol consumption were examined using researcher-created questionnaires. Condom use self-efficacy and HIV-related knowledge were assessed using the Condom Use Self-Efficacy Scale and the unified National AIDS Sentinel Surveillance Questionnaire. Univariate and multivariate logistic regressions were used. P <0.05 was considered significant.

Results

In the 214 respondents, the rate of consistent condom use was 56% (n = 119) during the past six months. Participants who were studying at first-tier universities (odds ratio [OR]: 2.522, 95% confidence interval [CI]: 1.255–5.067) and had higher scores for condom use self-efficacy (OR: 2.617, 95% CI: 1.462–4.685) were more likely to report consistent condom use than the others. The risk factor was having suspicious symptoms of sexually transmitted diseases (OR: 0.357, 95% CI: 0.163–0.780).

Conclusion

Numerous students were at high risk of HIV infection with inconsistent condom use. Comprehensive and specific topics about safe sex education from parents and peers should be offered on campuses in China.

Factors associated with past HIV testing among men who have sex with men attending university in China: a cross-sectional study

Background HIV prevalence has been rapidly increasing among men who have sex with men (MSM) attending university in China, but HIV testing rates remain suboptimal. The factors associated with past HIV testing in this population in Beijing, China, were investigated.

METHODS

This study used data from the baseline survey of an HIV intervention clinical trial among MSM who did not have a history of a positive HIV diagnosis. This analysis focused on the HIV testing experience in a subgroup of university student MSM participants. Log-binomial models were used to evaluate factors associated with past HIV testing.

RESULTS

Of 375 university student MSM, the median age was 22 years; 89.3% were Han ethnic. Approximately half (50.4%, n = 189) had ever taken an HIV test before the survey. In a multivariable log-binomial model, older age (adjusted prevalence ratio (APR), 1.04; 95% confidence interval (CI), 1.02-1.06), had first sexual intercourse at age <18 years (APR, 1.35; 95% CI, 1.08-1.45) and knew someone living with HIV (APR, 1.33; 95% CI, 1.07-1.61) were associated with a higher likelihood of past testing. Self-reported barriers to taking a test included perceived low HIV risk, fear of a positive diagnosis, did not know where to get tested and fear of discrimination. Facilitators included anonymity in taking a test, confidentiality of testing results and availability of home-based and rapid testing.

CONCLUSIONS

The HIV testing rate among university student MSM was low. Interventions should be implemented to address structural, institutional and individual barriers to HIV testing in this vulnerable population.

A pilot cultural adaptation of LGB-affirmative CBT for young Chinese sexual minority men's mental and sexual health

Young men who have sex with men (YMSM) represent one of the most at-risk groups for HIV infection and experience sexual minority stress especially in high-stigma settings, which affects their psychological health and increases likelihood of HIV-risk behaviors. The HIV epidemic in China is increasing rapidly among YMSM. However, no evidence-based intervention has specifically targeted Chinese YMSM's minority stress to improve their mental and sexual health. Adaptation of evidence-based interventions to promote the mental and sexual health of YMSM is one promising way to achieve the global target of HIV epidemic control. The current adaptation study followed the Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing model. YMSM (n = 41) and key stakeholders (n = 16) in China provided feedback into the selected intervention, a cognitive-behavioral therapy called Effective Skills to Empower Effective Men, originally developed with efficacy in the United States. An open pilot (n = 8) was also then conducted. Qualitative and quantitative data collected from each adaptation phase were analyzed to form the adapted intervention: "Yi Si Tang ()." Adaptations addressed a cultural context prioritizing family needs, limited support from the health system, as well as YMSM delivery preferences. YMSM and key stakeholders deemed the intervention acceptable and preliminarily feasible for the Chinese context. The pre-post comparison of mental and sexual health outcomes indicated improvement in mental health and sexual health of Chinese YMSM. Outcomes of the small initial pilot suggest future promise for this first-of-its-kind intervention for Chinese YMSM. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Risk assessment and identification of HIV infection among men who have sex with men: a cross-sectional study in Southwest China

OBJECTIVES

The HIV epidemic is around 7%-20% among men who have sex with men (MSM) in Southwest China. The low HIV-testing rate highlights the need for tools to identify high-risk MSM in resource-limited regions. Our aim was, therefore, to evaluate the HIV RISK Assessment Tool for HIV prediction and to characterise the primary infection among MSM in Southwest China.

DESIGN

A cross-sectional survey was conducted in Guizhou province between January and December 2018. Participants were recruited from gay communities, among whom the HIV RISK Assessment Tool was evaluated. Logistic regression was used to analyse items associated with HIV and the area under the curve (AUC) of the receiver operating curve was calculated to quantify discrimination performance.

PARTICIPANTS

1330 MSM participants, of which 83 (6.2%) tested as HIV positive.

RESULTS

A higher composite score of the tool (adjusted OR (aOR) 9.33, 95% CI 4.57 to 19.05) was independently associated with HIV infection. Items positively associated with HIV infection included having 2-5 same sex partners (aOR 2.43, 95% CI 1.28 to 4.64), always (aOR 5.93, 95% CI 1.59 to 22.13) or sometimes (aOR 4.25, 95% CI 2.09 to 8.64) having unprotected anal intercourse, taking both insertive and receptive sex roles (aOR 4.95, 95% CI 2.57 to 9.53) or only the receptive sex role (aOR 2.26, 95% CI 1.21 to 4.24). The tool showed an optimal discrimination ability (AUC=0.827), with a specificity of 0.747 and sensitivity of 0.785. Five MSM were identified with primary infection and had similar sexual risk behaviors as HIV-positive participants.

CONCLUSIONS

The HIV RISK Assessment Tool showed an overall good performance in predicting HIV risk among MSM in Guizhou province where the prevalence is still severe. This tool also demonstrated a potential to identify primary infection and is worth being promoted in resource-limited regions.

HIV and syphilis and sexual risk behaviours among men who have sex with men attending university in China: a systematic review and meta-analysis

Background This study was conducted to summarise the HIV epidemic, sexual behaviours and HIV testing among men who have sex with men (MSM) attending university in China.

METHODS

Five databases were searched for student MSM information in English and Chinese language publications. Meta-analyses were performed to calculate the pooled prevalence of HIV and syphilis, pooled mean age at first anal intercourse (AFAI) and the rate of other HIV-related behaviours among MSM attending university in China. Univariate meta-regression and subgroup analysis were conducted to explore potential sources of heterogeneity. Publication bias was measured using Egger's test.

RESULTS

Thirty-three articles representing 31 studies were included in the analysis. The pooled HIV prevalence was 4.1% (95% CI 3.1-5.0%). The estimated AFAI was 18.7 years, but 37.5% of students had their first anal intercourse before 18 years of age. Most (88.2%) had their first sexual intercourse with a male partner. Of the MSM attending university, 4.2% of MSM engaged in commercial sex (either selling or buying sex), 10.3% had ever engaged in group sex, 13.1% had had sex with a female partner in the past month and 10.1% had ever used drugs. Most (77.7%) sought sex partners via geosocial networking gay apps or the Internet, and 42.9% had ever tested for HIV. There was a tendency for an increase in lifetime HIV testing rate from 32% in 2005-07 to 53% in 2014-16.

CONCLUSIONS

This review found high HIV prevalence, early AFAI and a high prevalence of sexual risk behaviours among MSM attending university in China. Interventions aimed at increasing HIV testing and reducing sexual risk behaviours are urgently needed among this young population.

Effect of availability of HIV self-testing on HIV testing frequency among men who have sex with men attending university in China (UniTest): protocol of a stepped-wedge randomized controlled trial

Background

HIV testing plays a central role in the combat against HIV. We aimed to determine if the availability of HIV self-testing (HIVST) would increase the frequency of testing among men who have sex with men (MSM) attending university in China.

Methods

A stepped wedge randomized controlled trial will be conducted in 4 provinces in China: Chongqing, Guangdong, Shandong, and Tianjin. Eligibility assessment will include (1) male, aged 16 years or older, (2) university student (technical diploma and undergraduate students), (3) MSM (sexual behaviors including mutual masturbation, oral sex, and anal sex), (4) HIV negative, and (5) willing to provide informed consent.

Participants will be randomly allocated to HIV self-testing intervention with free HIVST kits in every 30 days according to the intervention waiting lists with a computer-generated randomized sequence. All participants will complete a self-administrated online questionnaire onsite at baseline and 12-month follow-up and complete an online questionnaire at 4- and 8-month.

The primary outcome is the effect of HIVST on HIV testing frequency. Secondary outcomes include the change in sexual behaviors and HIV incidence.

Discussion

No previous study had measured the effect of social media based HIVST intervention on the change in HIV testing behaviors, sexual behaviors and incident HIV infection among MSM attending university in China. Findings from this study will provide evidence for further interventional practice promotions and prevention strategies scale-up, including HIV testing, pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), and sexual partner serosorting.

Trial registration

Chinese Clinical Trial Registry: ChiCTR1900020645. Registered 11 January 2019.

Current risk factors for HIV infection among blood donors in seven Chinese regions

BACKGROUND

In China, there is a rising concern on the increasing trends of HIV infections in high-risk groups, who make blood donations that might potentially challenge the blood safety. Analyses on current risk factors for HIV infection among Chinese blood donors are urgently needed for developing effective strategies to defer high-risk donors and to warrant the safety of the blood supply.

STUDY DESIGN AND METHODS

We recruited 313 HIV-positive and 762 HIV-negative donors from seven study sites in China and evaluated donor demographic characteristics, current medical and behavioral risk factors associated with HIV infection in a case-control survey. Univariable analyses examined the relationship between HIV infection and donor and donation characteristics, medical and behavioral risks, living conditions, and lifestyles. Multivariable logistic regression analyses evaluated the association between selected individual risks and HIV infection. Regression tree analysis was used to select covariates correlated with both HIV infection and individual risks and thus need to be controlled for in logistic regression models.

RESULTS

Being a man who has sex with men was associated with the highest odds of HIV infection. Not using a condom, having sex with HIV-infected individuals, having sex partners with sexually transmitted diseases (STDs), having more than two concurrent sex partners, or having an STD were all associated with more than five times higher odds of having HIV. Having remunerated sex was associated with a 2.4 increased odds of having HIV infection.

CONCLUSION

High-risk sexual behaviors were among the major risks for HIV infection among Chinese blood donors.

The prevalence of HIV among MSM in China: a large-scale systematic analysis

BACKGROUND

The prevalence of HIV among men who have sex with men (MSM) has become a significant public health challenge. The aim was to comprehensively estimate the national prevalence of HIV among MSM and its time trends through a large-scale systematic analysis.

METHODS

Systematic search of Cochrane Library, PubMed, EMBASE, CNKI, VIP, and Wanfang Data databases without language restriction for studies on the prevalence of HIV among MSM published before Dec.31, 2018. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used validated assessment methods to assess the prevalence of HIV among MSM. Estimates were pooled using random-effects analysis.

RESULTS

Data were extracted from 355 cross-sectional studies (571,328 individuals) covered 59 cities from 30 provinces and municipalities of China. The overall national prevalence of HIV among MSM from 2001 to 2018 was estimated to be 5.7% (95% CI: 5.4-6.1%), with high between-study heterogeneity (I2 = 98.0%, P <  0.001). Our study showed an increased tendency in the HIV prevalence as time progressed by meta-regression analysis (I2 = 95.9%, P <  0.0001). HIV prevalence was the highest in those aged 50 years and older with HIV prevalence of 19.3% (95%CI: 13.1-27.4%, N = 13). HIV was more prevalent in the illiterate population (16.8%), than in those who had received an education. Although the internet was a major venue for Chinese MSM seeking male sex partners (35.6, 95%CI: 32.3-39.9%, N = 101), seeking MSM in bathhouses/saunas had the highest associated prevalence of HIV (13.4, 95%CI: 10.3-17.1%, N = 22). The HIV prevalence among MSM varied by location: compared with other regions in China, HIV was highly prevalent among MSM in the southwest (10.7, 95%CI: 9.3-12.2%, N = 91). Compared to participants who sometimes or always used condoms, participants who had never used a condom in the past 6 months had a higher risk of HIV infection, with odds ratios of 0.1 (95%CI: 0.08-0.14).

CONCLUSIONS

Our analysis provided reliable estimates of China's HIV burden among MSM, which appears to present an increasing national public health challenge. Effective government responses are needed to address this challenge and include the implementation of HIV prevention.

Psychosocial Factors Associated with Quality of Life in Young Men Who Have Sex with Men Living with HIV/AIDS in Zhejiang, China

OBJECTIVES

To explore the quality of life (QOL) status and related factors in young human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) aged 16 to 24 years in Zhejiang province.

METHODS

A cross-sectional study was conducted in 22 counties of Zhejiang province, and 395 subjects took part in our research. A t-test, one-way Analysis of variance (ANOVA), and multivariate stepwise linear regression analysis were used to investigate the factors associated with QOL in young HIV-infected MSM.

RESULTS

The total score on the QOL was 86.86 ± 14.01. The multivariate stepwise linear regression analysis revealed that self-efficacy and discrimination were associated with all domains on the QOL assessment, monthly income was associated with QOL for all domains except spirituality and consistent condom use during oral sex with men in the past three months was associated with QOL for all domains except the relationship domain. Those individuals within the group of young HIV-infected MSM who have higher self-efficacy, a higher monthly income, greater social support, safer sexual behaviors, a higher level of education, and a higher cluster of differentiation 4 (CD4) count have a better QOL.

CONCLUSIONS

These findings suggest that to improve the QOL of this population, greater emphasis should be placed on improving social support, self-efficacy, and antiviral therapy adherence and on reducing discrimination, disease progression, and high-risk behaviors.

The characteristics of mixing patterns of sexual dyads and factors correlated with condomless anal intercourse among men who have sex with men in Guangzhou, China

Background

The HIV prevalence among men who have sex with men (MSM) in China has increased yearly. This study aimed to explore the association between the characteristics of social communication and condomless anal intercourse (CAI) among MSM and the implications for prevention and control of HIV among MSM in China using an egocentric network framework.

Methods

The data were collected in Guangzhou between November 2016 and May 2017 through standardized face-to-face interviews. The participants were recruited among MSM who received voluntary counselling and testing services (VCT) provided by nongovernmental organizations (NGOs) and the local Centers for Disease Control and Prevention (CDC). We used the framework of the egocentric network analysis, the odd ratios of CAI were analyzed using generalized estimating equations (GEE).

Results

In total, 1073 MSM who nominated 2667 sexual partners were sampled. MSM who were approximately 30 years old and chose sexual partners of different age category were more likely to engage in CAI. Participants with high level education who were in partnerships with individuals with lower education levels had a higher risk of CAI. Participants who reported having a strong relationship with their sexual partners(AOR = 1.31) were associated with a higher probability of experiencing CAI during sex; while having sexual partners who were unmarried (OR = 0.56), and participants who reported meeting sexual partners online (AOR = 0.74) or, having sex with an occasional partner (AOR = 0.44)were less likely to engage in CAI.

Conclusion

Our study indicates that the strength of sexual dyadic relational ties and different social communication mixing patterns across ages, educational categories, and marital status were associated with CAI.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7082-9) contains supplementary material, which is available to authorized users.

A spatiotemporal meta-analysis of HIV/syphilis epidemic among men who have sex with men living in mainland China

Background

Geographic differences in HIV, syphilis and condomless sex among men who have sex with men in China remained unknown. We aimed to elucidate these spatiotemporal changing patterns in China.

Methods

We conducted a spatiotemporal meta-analysis. We searched four databases for studies conducted between 2001 and 2015. We included studies that reported original data of HIV/syphilis prevalence in China, the study’s area/province, and period of data collection. We grouped studies into six regions and four time periods. We examined the changing patterns of national and regional prevalence of HIV, syphilis and condomless sex.

Results

Search results yielded 2119 papers, and 272 were included in the meta-analysis. The sample sizes of the studies ranged from 19 to 47,231. National HIV prevalence increased from 3.8% (95% CI 3.0–4.8) in 2001–07 to 6.6% (5.6–7.7) in 2013–15. In most regions, the rise occurred before 2010 and the HIV prevalence remained relatively stable afterwards, except for the Northwest which showed a considerable increase since 2008. National syphilis prevalence decreased from 12.3% (10.2–14.9) in 2001–07 to 7.1% (5.6–8.9) in 2013–15.

Conclusions

The trends of HIV and syphilis infections have been effectively curbed in MSM in most regions of China. Continuous efforts, particularly promotion of condom use, are needed to further reduce these infections.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3532-8) contains supplementary material, which is available to authorized users.