Epidemiological Profile of Men Who Have Sex with Men: First Data about Male Sex Workers in Central African Republic (CAR)

Objectives: Sex work is not well documented among African men. The aim of this study was to describe the epidemiological profile of men who have sex with men (MSM) and eventually to determine the proportion of sex workers (SW) among them, as well as the proportion of MSM who have been victims of gender-based violence (GBV). Material and Methods: A cross-sectional study coordinated by the Direction de la Médecine du Travail was carried out at the headquarters of the association ALTERNATIVES in Bangui Bangui from July 1 to October 31, 2021. Consenting MSM present during the study period were systematically included. Sociodemographic variables, those relating to the future vision of the activity and to GBV were collected and analyzed using Epi-Info version 7 software. Results: Forty MSM with an average age of 23 years and mainly secondary education (75.0%) were included. The vast majority of MSM were unemployed (85.0%). 45.0% had been victims of GBV and wanted to stop working as an MSM (47.5%), and almost 2/3 (65.0%) would accept another income-generating activity in exchange for the MSM. Violence was sexual (32.5%), economic (22.5%), physical (20.0%), verbal (12.5%) and psychological (12.5%). Conclusion: The MSM were mainly young, poorly educated, unemployed, and almost half were victims of GBV. The desire to change MSM activity to another income-generating activity alongside that of MSM shows that many of them are SW, workers in the informal sector. This must be taken into account in prevention activities, even if the data needs to be confirmed on a much larger sample.

Factors influencing HIV infection in men who have sex with men in China

To identify risk factors for HIV infection among men who have sex with men （MSM） and to provide a theoretical basis for prevention interventions. Between December 2011 and August 2012, a case-control study was conducted among MSM who underwent voluntary counselling and testing for HIV. Confirmed HIV-positive MSM were included in the case group, and HIV-negative MSM were included in the control group. Information on possible risk factors was collected by a survey questionnaire and a qualitative interview. The results of a conditional logistic regression showed that the following were influencing factors for HIV infection： average monthly income between 2001 and 3000 Yuan （odds ratio （0R）=6.341, 95% Ch 1.714-12.544）, only sometimes using condoms when having anal sex with men in the last 6 months （0R=7.601, 95% Ch 1.359-23.083）, having HIV-positive sex partners （0R=5.273, 95% Ch 1.572- 17.691）, rectal trauma with bleeding in the last 6 months （0R=2.947, 95% Ch 1.308-6.638）, not using condoms at last sexual encounter （OR-- 1.278, 95% Ch 1.012-5.595）, engaging in commercial sex （0R=5.925, 95% Ch 1.923-13.890） and having more than 16 sex partners in the last 6 months （0R=1.175, 95% Ch 1.021-1.353）. These seven factors were the risk factors of HIV infection （OR〉l）. However, having anal sex less than 10 times in the previous 1 month （OR=O.O02, 95% CI： 0.000-0.287） was a protective factor against HIV infection among MSM （OR〈l）, and insertive （0R=0.116, 95% Ch 0.000-0.236） （OR〈l） anal intercourse influenced HIV infection. Interventions should be targeted at MSM whose average monthly income is between 2001 and 3000 Yuan, and who engage in commercial sex. In addition, the importance of using condoms at every sexual encounter should be emphasised in health education, as should the treatment of rectal trauma with bleeding. Finally, MSM should decrease the number of sex partners and frequency of anal sex to decrease the rate of HIV infection.

Uptake of HIV Self-testing among Men Who have Sex with Men in Beijing, China： a Cross-sectional Study

Objective To examine HIV self-testing uptake and its determinates among men who have sex with men （MSM） in Beijing, China. Methods A cross-sectional online survey was conducted in Beijing, China in 2016. Participants were users of a popular Chinese gay networking application and had an unknown or negative HIV status. Univariate and multivariate logistic regression analyses were conducted to examine factors associated with HIV self-testing based on adjusted odds ratio （AOR） and 95% confidence interval （CI）. Results Among the 5,996 MSM included in the study, 2,383 （39.7%） reported to have used HIV self-testing kits. Willingness to use an HIV self-test kit in the future was expressed by 92% of the participants. High monthly income （AOR = 1.49; CI = 1.10-2.02; P = 0.010）, large number of male sex partners （≥2： AOR = 1.24; CI = 2.09-1.43; P = 0.002）, sexual activity with commercial male sex partners （〉 2： AOR = 1.94; CI = 1.34 -2.82; P = 0.001）, long-term drug use （AOR = 1.42; CI = 1.23-1.62; P 〈 0.001）, and long-term HIV voluntary counseling and testing （VCT） attendance （AOR = 3.62; CI = 3.11-4.22; P 〈 0.001） were all associated with increased odds of HIV self-testing uptake. Conclusion The nearly 40% rate of HIV self-testing uptake among MSM in our sample was high. In addition, an over 90% willingness to use kits in the future was encouraging. HIV self-testing could be an important solution to help China achieve the global target of having 90% of all people living with HIV diagnosed by 2020.

A survey of HIV infection and related high-risk factors among men who have sex with men in Suzhou,Jiangsu,China

A cross-sectional study using the snowball sampling method was conducted in May 2008 to investigate human immunodeficiency virus （HIV） infection status and related high risk factors among men who have sex with men （MSM） in Suzhou city of Jiangsu province. The researchers carried out a face-to-face questionnaire interview among MSM, and collected their blood samples to test for HIV and other sexually transmitted diseases （STDs）. Among the 280 respondents, 91.1% had homosexual acts in the past 6 months and 87.5% had multiple homosex- ual partners; 46.4% had heterosexual sex in the past 6 months and 33.1% had multiple heterosexual partners. The rate of continued condom use was 44.3% in homosexual sex in the past 6 months, while the rate in heterosexual sex was 33.9%. Laboratory test results showed that the prevalences of HIV and syphilis were 7.1% （20/280） and 15.0% （42/280）, respectively, but no HCV-positive person was found. In the multivariate logistic regression model, subjects with a monthly income of more than RMB $ 1,000 （OR=4.83,95% CI=1.44-16.22）, subjects who often went to bars for sexual partners （OR=2.25, 95%CI=1.21-4.20）, and subjects who had more than one sexual partner in the past 6 months （OR=0.49, 95%CI=0.25-0.97） and had sex with fixed sexual partners in the past 6 months （OR=0.42, 95%CI=0.25-0.75） were significantly associated with the rate of continued condom use in homosexual sex in the past 6 months. Unprotected sex and multiple sexual partners were more common among MSM in Suzhou city; furthermore, the prevalences of HIV infection and syphilis were relatively high. HIV preventive measures should be designed to address these risk factors and control the spread of HIV among MSM.

Prevalence and risk factors of HIV and syphilis,and knowledge and risk behaviors related to HIV/AIDS among men who have sex with men in Chongqing,China

High HIV prevalence and incidence burdens have been reported in men who have sex with men（MSM）in Chongqing,China.We aimed to estimate the prevalence of HIV and other sexually transmitted infections（STIs）,to appraise the knowledge and risk behaviors related to HIV/AIDS among MSM,and to analyze the possible causes of deviation between behavior and knowledge to make better strategies.We recruited 617 MSM from February to July in 2008 by using a respondent-driven sampling（RDS） method in Chongqing,China.Through the collection of questionnaire-based data and biological testing results from all objects,we launched a crosssectional survey.STATA/SE was used for data analysis by frequency,ANOVA,rank sum test and logistic regression models.MSM with syphilis（OR=4.16,95%CI：2.35-7.33,P〈0.0001） were more likely to be HIV infected.Being a company employee（OR=3.64,95%CI：1.22-10.08,P〈0.0001） and having bought male for sex（OR=3.52,95%CI：1.10-11.32,P〈0.034） were associated with a higher probability of syphilis.MSM with younger age,higher education and greater monthly income had a higher mean knowledge score.MSM who had HIV testing had a higher mean knowledge score than those who never had.Students,venues for finding sex partners by Internet and homosexuals in MSM had a higher mean knowledge score compared to other occupations,venues for finding sex partners and sexual orientation.There is an urgent need for delivery of barrier and biomedical interventions with coordinated behavioral and structural strategies to improve the effect of HIV interventions among MSM.

Chemsex and its risk factors associated with human immunodeficiency virus among men who have sex with men in Hong Kong

We were intrigued by Hanum et al,who published a study on the prevalence of human immunodeficiency virus(HIV)in homosexual,bisexual,and other men who have sex with men at sexual health clinics in England and the relationship between baseline variables and future HIV occurrence.Chemically-enhanced sexual experience(chemsex)is becoming a global phenomenon.There are increasing medical and academic concerns about chemsex,where substances are used to boost sexual satisfaction,which is prevalent in groups,especially among homosexuals.Lesbians,gays,bisexuals,transgenders,and queers have become increasingly visible,valued,and committed community.However,chemsex requires urgent attention.

Barriers and facilitators in Pre-exposure Prophylaxis(PrEP)use intention among Chinese homosexual men

Background:Despite strengthened efforts on human immunodeficiency virus(HIV)prevention and control,new HIV infections continue to increase among men who have sex with men(MSM)in China.Pre-exposure prophylaxis(PrEP),a highly effective HIV-prevention tool,has recently been included in China’s Action Plan of HIV Prevention and Control.To promote future PrEP implementation,this study aims to identify the barriers and facilitators in PrEP use intention among MSM in China.Methods:In 2018,a cross-sectional survey was conducted among 300 MSM in Nanjing,Jiangsu Province.Questions on demographics,sexual behavior(including a seven-item high-risk behavior index),PrEP use intention,PrEP-related awareness and accessibility,and a seven-item public HIV stigma scale were included in the questionnaire.Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with PrEP use intention.Results:Overall,44.67%of the participants had more than two male sexual partners and 5.56%had HIV-positive sexual partners.Only 57.00%had heard of PrEP and only four(1.33%)participants had used PrEP.However,75.34%expressed the willingness to use oral PrEP if its efficacy was assured.The beliefs that“PrEP can prevent HIV if taken as prescribed”(adjusted odds ratio(AOR)=4.84,P<0.001)and“PrEP can be scaled up in the community”(AOR=3.24,P<0.001)were positively associated with oral PrEP use intention.Concerns of side effects were negatively associated with oral PrEP use intention(AOR=0.32,P=0.006).Further,77.00%of the participants would choose injectable or implanted PrEP instead of oral PrEP.One of the PrEP stigma items,“Not certain if doctors can prescribe PrEP if I go to the clinic”was positively associated with the intention to use injectable or implanted PrEP(AOR=3.03).The items“Heard of PrEP”(AOR=2.74)and“PrEP can prevent HIV if taken as prescribed”(AOR=2.65)were also positively related to the intention to use injectable or implanted PrEP.The most common concerns regarding PrEP use were efficacy(44.67%)and side effects(38.67%).The most common reasons for using injectable and implanted PrEP were adherence(81.94%and 77.86%,respectively)and privacy concerns(56.48%and 55.00%,respectively).Affordable price and coverage by health insurance were the driving factors for PrEP use.Conclusion:Given the low level of awareness of PrEP-related information in China,it’s necessary to provide interventions for high-risk individuals and communities,in order to increase their awareness and knowledge of PrEP.Furthermore,additional alternatives to HIV prevention,such as long-acting injectable or implanted PrEP,should be investigated to reduce the risk of HIV infection in at-risk MSM.Even if this programme could be approved by the National Medical Products Administration of China and implemented,a supportive social environment for MSM is essential during its implementing.

Sexual Risk Behavior and Satisfaction Among Men Who Have Sex With Men Living With Detectable HIV Viral Loads:A Nationwide Online Survey in China

Little is known about sexual behavior and satisfaction among men who have sex with men(MSM)with detectable HIV viral loads(VL)in China.This study aims to investigate sexual risk behavior and sexual satisfaction among MSM living with HIV in China,as well as poten-tial predictors.This cross-sectional study was conducted in February 2021 using an anonymous online survey based on WeChat.Data were collected on sociodemographics,sexual behavior,HIV clinical information,sexual satisfaction and mental health.Descriptive sta-tistics,logistic regression and multivariable logistic regression were performed.MSM with detectable HIV VL(VL+)or VL not sure were more likely to report inconsistent condom use,even with HIV-negative/unknown-status regular male partners.Having an HIV-positive regular partner and recreational drug use were positively associated with inconsistent condom use during anal sex among MSM with undetectable VL(VL-).Alcohol use before or during sexual activities was positively associated with inconsistent condom use during anal sex among VL+or VL not sure MSM.A total of 58.3%of participants reported being sexually satisfied.MSM living with HIV who were currently employed,had experienced anal sex in the prior 6 months,had VL-HIV status,or had more frequent ejaculation during sex/masturbation were more likely to report sexual satisfaction.The development of targeted education and interventions to minimize sexual risk behavior among MSM living with HIV is in dire need.Treating sexual dysfunction and developing a reasonable antiretroviral therapy regimen to achieve viral suppression can help promote sexual satisfaction in MSM living with HIV.

Exploring the Perspectives of Healthcare Providers on Providing HIV Prevention and Treatment Services for Key Populations in Rwanda: A Qualitative Study

Background: The overall HIV prevalence and incidence in Rwanda have decreased significantly in the past decade. However, opposite trends are seen among key populations (KP). The HIV prevalence among sex workers is as high as 51% and continues to rise. While the HIV prevalence among KP remains high, their adherence to treatment is low. Healthcare providers play a vital role in KP’s access and adherence to HIV treatment. This study aimed to explore the perspectives of healthcare providers on providing HIV services to key populations in Rwanda. Methods: An exploratory qualitative study was conducted with nurses, doctors, social workers, and psychologists who provide HIV services to KP in public health facilities in Rwanda. In-depth interviews were conducted using a semi-structured interview guide. All data were analyzed thematically using Dedoose. Results: Interviews were conducted with 18 healthcare providers. Three overarching themes emerged from the interviews: healthcare providers’ intrinsic feelings affect the ways they provide HIV services to key populations, key populations face a multitude of challenges related to accessing treatment and preventing the spread of HIV, and a more comprehensive and sensitive approach should be used to improve HIV services for key populations. Conclusion: Healthcare providers expressed difficulties in providing services to key populations and identified a lack of adherence to treatment and prevention guidelines, structural barriers, KP’s lack of trust in the healthcare system, and the discrimination and abuse KP face as challenges to effective HIV prevention and treatment. More comprehensive services including clinical, financial, and psychosocial support from trusted sources are needed. Some important policy changes are essential to facilitate access to HIV services for KP.

Near obstructing painful anorectal mass and facial rash in a man with monkeypox: A case report

BACKGROUND Monkeypox(MPX)is a zoonotic infection that is endemic in Western and Central Africa along the Congo River basin.It has a high case fatality rate especially in younger age groups.It belongs to the virus family orthopoxvirus like smallpox.It is transmitted from wild animals to humans but human to human transmission has been established.It is often a self-limited infection in endemic regions.Recently,attention has been given to MPX with the spread of infection to Europe and the United States of America(USA).There is currently sporadic infection of MPX in the USA especially amongst men who have sex with men(MSM).It is a serious life-threatening infection in human immunodeficiency virus/acquired immunodeficiency syndrome co-infected individuals especially those who are treatment naïve with severe immunosuppression.CASE SUMMARY We report a 38-year old man who presented with rectal pain,and anal,torso,and facial rash.Abdominal computed tomography scan showed a near obstructive rectal mass with peri-anal fistula.MPX was positive.He was started on tecovirimat(TPOXX)and HAART therapy.Additional treatment provided included vaccinia immunoglobulin following his clinical deterioration.CONCLUSION This case highlights a rare presentation of MPX with peri-anal fistula and near obstructive rectal mass,and the significance of MPX as a differential diagnosis in proctitis in MSM in addition to other sexually transmitted infection like gonorrhea and chlamydia.

Monkeypox claims new victims: the outbreak in men who have sex with men

Monkeypox has a very prominent regional epidemic.It has been confined to Western and Central African countries.Sporadic cases found in countries outside Africa generally have a history of sojourn in endemic areas.However,the recent multinational outbreak of monkeypox cases in Europe in early May 2022 has revealed a changing epidemiological trend,those confirmed cases had no sojourn history in endemic areas and with a high proportion of cases involving men who have sex with men(MSM).Among the MSM cases,many of them presented atypical clinical manifestations of monkeypox and with other sexually transmitted diseases co-infection.Combined with the high social interactivity in this community,there is likely a higher risk of monkeypox transmission in this population.Establishing an infectious disease surveillance system,maintaining highly vigilant regarding the transmission of monkeypox in MSM,and responding promptly are necessary and effective measures to contain the outbreak.

Modelling Key Population Attrition in the HIV and AIDS Programme in Kenya Using Random Survival Forests with Synthetic Minority Oversampling Technique-Nominal Continuous

HIV and AIDS has continued to be a major public health concern, and hence one of the epidemics that the world resolved to end by 2030 as highlighted in sustainable development goals (SDGs). A colossal amount of effort has been taken to reduce new HIV infections, but there are still a significant number of new infections reported. HIV prevalence is more skewed towards the key population who include female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID). The study design was retrospective and focused on key population enrolled in a comprehensive HIV and AIDS programme by the Kenya Red Cross Society from July 2019 to June 2021. Individuals who were either lost to follow up, defaulted (dropped out, transferred out, or relocated) or died were classified as attrition;while those who were active and alive by the end of the study were classified as retention. The study used density analysis to determine the spatial differences of key population attrition in the 19 targeted counties, and used Kilifi county as an example to map attrition cases in smaller administrative areas (sub-county level). The study used synthetic minority oversampling technique-nominal continuous (SMOTE-NC) to balance the datasets since the cases of attrition were much less than retention. The random survival forests model was then fitted to the balanced dataset. The model correctly identified attrition cases using the predicted ensemble mortality and their survival time using the estimated Kaplan-Meier survival function. The predictive performance of the model was strong and way better than random chance with concordance indices greater than 0.75.

Detection of recent HIV-1 infections among men who have sex with men in Beijing during 2005-2006

Background Men who have sex with men （MSM） have become one of the most risky populations for HIV infection in China. Though several cross-sectional sero-prevalence studies have been conducted, the annual HIV incidence remains unknown in this population.Methods We applied IgG-capture BED-enzyme immunoassay （BED-CEIA） to define the recent HIV-1 infections among MSM in Beijing in the years 2005 and 2006 and the annual HIV incidence was estimated.Results Overall, 1067 MSM samples were collected, including 526 samples in the year 2005 and 541 in 2006. In 2005, of 17 HIV seropositive samples, 7 were identified as recent HIV-1 infections and the estimated HIV infection incidence was 2.9% per year （95% CI, 0.8%-5.0%）. In 2006, of 26 HIV seropositive samples, 9 were identified as recent HIV-1 infections and the estimated annual incidence was 3.6% （95% CI, 1.3%-5.9%）, which was 0.7% higher than that in 2005. Individuals engaging in male group sexual intercourse （5.17% vs 0.87%, P=0.019） and having receptive anal sexual intercourse more than five times （2.79% vs 0.33%, P=0.047） in the past 6 months significantly increase the risk of being infected by HIV-1.Conclusions A high level of annual HIV-1 infection incidence was observed among MSM in Beijing for the consecutive years 2005 and 2006 with a continuous increasing trend. The rising incidence and related high risk behavior among MSM alarmed the health authorities and calls for more effective intervention strategies among this population.

High HIV incidence epidemic among men who have sex with men in china: results from a multi-site cross-sectional study

Background:Recent upsurge of new HIV infections among men who have sex with men(MSM)is a major concern in China.Paucity of national-level information regarding the burden and predictors of this progressive epidemic of new infections called for a multi-centric,timely and comprehensive investigation.Methods:Mixed methods were used to recruit MSM from seven cities in China between 2012 and 2013.Recent and established HIV infections were estimated by Western Blot and BED HIV-1 capture enzyme immunoassay.Syphilis and herpes simplex virus-2(HSV-2)were also tested.Results:A total of 4496 eligible MSM were recruited.The majority was aged≤35 years(77.5%),migrants(60.3%),never married(69.8%),and played receptive role in anal sex(70.5%).The HIV prevalence was 9.9%,and 41.9%were recently infected,with sensitivity/specificity adjusted HIV incidence of 8.9(95%CI:7.6-10.2)/100 Person-Years.The prevalence of history HSV-2 and syphilis were 12.5%and 8.5%,respectively.Recent HIV infection was associated with having multiple male partners(aOR=1.4,95%CI 1.1-1.9),recreational drug use(aOR=2.2,95%CI 1.6-3.0),anal bleeding(aOR=2.1,95%CI 1.4-3.0),syphilis infection(aOR=2.8,95%CI 1.9-4.3)and history HSV-2 infection(aOR=2.3,95%CI 1.5-3.3).Conclusion:High rate of recent HIV infection is potentially resulting in progressive deterioration of the overall HIV epidemic among MSM in China.Targeted interventions to address high-risk MSM including those having multiple partners,history of recreational drug use and syphilis or HSV-2 infection seemed to be the need of the hour.

Treatment-seeking behaviour and barriers to service access for sexually transmitted diseases among men who have sex with men in China:a multicentre cross-sectional survey

Background:Delayed or inappropriate treatment for sexually transmitted diseases(STDs)increases the risk of HIV acquisition and may cause other harmful outcomes.However,studies on STD treatment-seeking behaviour and correlated factors in men who have sex with men(MSM)are scarce.This information is crucial for the promotion of STD treatment-seeking behaviour and reduction of HIV transmission among Chinese MSM.Methods:During 2012-2013,a multicentre cross-sectional study was conducted in 7 Chinese cities.Participants completed an interview-questionnaire and gave venous blood samples,which were then tested for antibodies to HIV,syphilis,and herpes simplex virus-2(HSV-2).MSM who tested positive for syphilis/HSV-2 or had obvious STD-related symptoms within the last 12 months were defined as suspected STD-infected MSM.Results:Of the 4496 eligible MSM who completed this survey,24.4%(1096/4496)were categorized as suspected STD-infected MSM.35.7%(391/1096)of these MSM with suspected STD infections sought STD treatment in clinics within the last 12 months.Among MSM who did not attend STD clinics for treatment,the prevalence of syphilis and HSV-2 was significantly higher;the HIV prevalence and incidence within this subpopulation reached as high as 14.5%and 12.2/100 person-years,respectively.Multivariate logistic regression analysis indicated that having 7-12 years of education(vs.≤6 years;aOR,2.5;95%CI,1.0-6.1),≥13 years of education(vs.≤6 years:aOR,2.8;95%CI,1.2-7.0),monthly income>500 USD(vs.≤500 USD:aOR,1.5;95%CI,1.1-2.1),obvious STD-related symptoms within last 12 months(aOR,5.3;95%CI,3.7-7.5),being HIV infected(aOR,1.7;95%CI,1.1-2.6),currently syphilis infected(aOR,0.6;95%CI,0.4-0.9)and HSV-2 infected(aOR,0.6;95%CI,0.5-0.9)were independent correlates with seeking STD treatment in clinics among Chinese MSM.Conclusions:The high prevalence of STD infection coupled with a low proportion of individuals who exhibit appropriate treatment-seeking behaviour create a high risk of a growing HIV epidemic among Chinese MSM.Models that prioritize better screening for and education about STDs should be urgently implemented,especially among low-income MSM.

Associated factors of self-reported psychopathology and health related quality of life among men who have sex with men (MSM) with HIV/AIDS in Dalian, China: a pilot study

Background:Despite the availability of Anti-Retroviral Therapy(ART),the health-related quality of life(HRQoL)among HIV-positive men who have sex with men(HIVMSM)in China remains poor.This study aimed to explore the relationship between self-reported psychopathology and HRQoL among HIVMSM in Dalian,China.Methods:A cross-sectional study was conducted in 112 HIVMSM.Symptom check list 90(SCL 90):a measure of psychopathology and World Health Organization quality of life in HIV infection(WHOQOL-HIV-Bref):a measure of HRQoL were used.Correlation and multiple regression analysis were employed to explore the association between self-reported psychopathology and HRQoL in HIVMSM.Results:Out of the total 112 HIVMSM cases,9(8%)cases were homosexuals and 103(92%)ones were bisexuals.The participants who had low family income(P=0.001),perceived discrimination(P=0.001)and lack of regular attendance in medical follow-ups(P=0.014)reported poorer HRQoL than their counterparts.Somatization,obsession,depression,phobia and overall SCL 90 scores in self-reported psycholpathology had a negative impact on the domains of HRQoL among HIVMSM.Conclusions:Total quality of life was predicted by family income,perceived discrimination,and medical follow-up attendance.Self-reported psychopathology was negatively correlated with HRQoL in HIVMSM.The Strategies that target MSM focusing on linking and engaging HIV-positive patients in medical care is the key step to improve their HRQoL.More emphasis is needed on the newly diagnosed HIVMSM in Dalian in order to develop a more targeted intervention to prevent perceived discrimination and lack of proper medical follow-up services.Trial registration:The trial registration number does not require for this manuscript.The study is cross-sectional design that do not involve intervention at all,it is not a clinical trial.

HIV incidence among men who have sex with men using geosocial networking smartphone application in Beijing, China: an open cohort study

Background:Sexual transmission among men who have sex with men(MSM)is the dominant route of HIV transmission in China.Extensive use of geosocial networking(GSN)smartphone application(app)has dramatically changed the pattern of sexual behaviors and HIV risk among MSM;but data on HIV incidence and the changing risk behaviors of GSN app-using MSM are limited.We aims to assess the HIV incidence and its correlates among gay GSN app-using MSM in China.Methods:We constructed an open cohort which was initiated and maintained using a GSN app to assess the HIV incidence among app-using MSM,recruited from June 2017 to December 2018.MSM completed an online questionnaire on their sociodemographic characteristics,sexual behaviors,recreational drug use and sexually transmitted infections status.Then each man had an HIV test,and those tested negatives were enrolled into the cohort.Participants completed follow-ups with additional HIV tests though the app during the study period,and were censored at HIV seroconversion or study end date.HIV incidence was calculated by dividing the sum of observed HIV seroconversions by the observed person-time.Univariate(Chi-square test and Fisher's exact test)and multivariate(proportional hazards regression)analyses were used to examine correlates of HIV incidence.Results:A total of 6957 HIV negative MSM were enrolled in the open cohort,37 seroconversions occurred among 1937 men contributing 1065 observed person-years:HIV incidence was 3.47 per 100 person-years[95%confidence interval(Cl):2.37-4.57].More than five sexual partners[hazard ratio(HR)=2.65,95%Cl:1.04-6.67],and sex with HIV positive partners(HR=3.82,95%Cl:1.16-12.64)in the preceding six months were positively associated with HIV seroconversion.Consistent condom use for anal sex(HR=0.27,95%Cl:0.07-0.96),and reporting insertive anal sex only(HR=0.23,95%Cl:0.08-0.62)in the preceding six months were protective factors for HIV seroconversion.Conclusions:Tailored interventions targeting app-using MSM are urgently needed given their high risk of HIV.As a new tool for accessing MSM at higher HIV risk,GSN smartphone app could play an important role in HIV research among MSM.

Disparity of human immunodeficiency virus incidence and drug resistance in college student,non-student youth and older men who have sex with men:a cross-sectional study from seven major cities of China

Background:Human immunodeficiency virus(HIV)prevalence among student men who have sex with men(MSM)in college is more than 5.0%and keeps on increasing in China.This study aims to clarify the proportion of HIV recent infection,its propeller and the source among college student MSM.Methods:We conducted a multicenter cross-sectional study in seven major Chinese cities during 2012-2013.HIV recent infections(≤168 days)and incidence was measured and estimated by BED HIV-1 capture enzyme immunoassay(BED-CEIA)testing strategy.HIV-related behaviors and transmitted drug resistance(TDR)were investigated and compared between the college student MSM,<25-year-old non-student youth MSM(NSYM),and≥25-year-old non-student non-youth MSM(NSNYM),using structured survey,and analyses of drug resistance.Results:Overall,4496(4496/4526,99.3%)were eligible for enrollment,comprising 565 college student MSM,1094 NSYM,and 2837 NSNYM.The proportion of HIV recent infection were 70.3%(26/37),50.8%(65/128)and 35.1%(95/271),the HIV incidence rate were 10.0(95%CI:6.2-13.9)/100 person-year(PY),12.9(95%CI:9.8-16.1)/100PY,6.8(95%CI:5.4-8.2)/100 PY,and TDR prevalences were 7.4%(2/27),2.0%,(2/98)and 4.9%(11/226),among student MSM,NSYM,and NSNYM,respectively.Among HIV positive student MSM with age<21 years,the proportion of HIV recent infection is 90.9%(10/11).Factors independently associated with HIV recent infection in student MSM was usage of recreational drug in the past 6 months(adjusted odds ratio[aOR]:2.5;95%CI:1.0-5.8).Conclusions:College student MSM had higher proportion of HIV recent infection and TDR than the youth and older MSM in China during 2012-2013.The HIV infections were more likely to happen during the early year of college life among student MSM.

HIV care-seeking behaviour after HIV selftesting among men who have sex with men in Beijing,China:a cross-sectional study

Background:Men who have sex with men(MSM)has become the group with the fastest growing HIV epidemic in China.Since many Chinese MSM are conducting HIV self-testing,we aimed to determine the rate of HIV care seeking after self-testing,examine characteristics of“seekers”compared to“non-seekers,”and explore factors associated with HIV care-seeking behaviour.Methods:A cross-sectional study design was used and an online survey was conducted in Beijing,China in 2016,among users of a popular Chinese gay networking smart phone application.Chi-square test was used to compare characteristics of those who sought HIV care(“seekers”)and those who did not(“non-seekers”).Univariate and multivariate logistic regression analyses were conducted to assess factors associated with HIV care seeking.Results:Among 21,785 screened,2383 participants(10.9%)were included in the study.A total of 380 participants(15.9%)reported seeking HIV care after HIV self-testing while 2003(84.1%)did not.Lack of knowledge of the“window period”(adjusted odds ratio[AOR]=0.68,95%confidence interval[95%CI]=0.47-0.97,P=0.04)was associated with reduced odds of seeking HIV care,while lower monthly income(AOR=1.29,95%CI=1.03-1.62,P=0.03)and obtaining HIV self-testing kits from health facilities(AOR=2.40,95%CI=1.81-3.17,P<0.001),and non-governmental organizations(AOR=2.44,95%CI=1.79-3.34,P<0.001)was associated with increased odds of seeking HIV care.Among those who sought HIV care,a large majority(92.4%)had non-reactive HIV self-testing results.Only 29 out of 265 with reactive,uncertain,or unknown results sought HIV care.Conclusions:We found a very low rate of HIV care seeking among our sample of urban Chinese MSM.The observation that most with reactive,uncertain,or unknown results did not seek HIV care is a cause for concern.These people should be paid more attention and helped to enter the care cascade.Our findings highlight that interventions aimed at improving linkage to care after HIV self-testing are urgently needed.However,further study is required to inform the design and implementation of future interventions aiming to encourage HIV care-seeking behaviour.

Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men in China:a study protocol for a three-arm cluster randomized controlled trial

Background:Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men(MSM).A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing among MSM.Pay-it-forward offers an individual a gift(e.g.,a free test)and then asks the same person if they would like to give a gift to another person.This article reports the protocol of a randomized controlled trial to evaluate dual gonorrhea/chlamydia test uptake and other outcomes among MSM in three arms-a pay-it-forward arm,a pay-what-you-want arm,and a standard of care arm.Methods:Three hundred MSM will be recruited at three HIV testing sites in Guangzhou and Beijing.Testing sites include two hospital-based MSM sexually transmitted diseases clinics and one MSM community-based organization.Eligible participants will be born biologically male,aged 16 years or older,reporting previous anal sex with another man,having never participated in the pay-it-forward program,without previous gonorrhea and chlamydia testing in the past 12 months,and residing in China.Following a cluster randomized design,every cluster of ten participants will be randomly allocated into one of three arms:(1)a pay-it-forward arm in which men are offered free gonorrhea and chlamydia testing and then asked whether they would like to donate("pay it forward")toward testing for future testers;(2)a pay-what-you-want arm in which men are offered free testing and told to decide how much to pay after receiving the test;(3)a standard of care arm in which men can pay the full price for dual gonorrhoea and chlamydia testing.The primary outcome is dual gonorrhoea/chlamydia testing as verified by administrative records.Secondary outcomes include incremental cost per test,incremental cost per diagnosis,community connectedness,and social cohesion.Primary outcome will be calculated for each arm using intention-to-treat and compared using one-sided 95%confidence intervals with a margin of 20%increase defined as superiority.Discussion:This study will examine the pay-it-forward strategy in comparison to the standard of care in improving test uptake for gonorrhea and chlamydia.We will leverage the cluster randomized controlled trial to provide scientific evidence on the potential effect of pay-it-forward.Findings from this study will shed light on novel intervention methods for increasing preventive health service utilization and innovate ways to finance it among communities.Trial registration:ClinicalTrials.gov,NCT03741725.Registered on 12 November 2018.