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Pre-exposure prophylaxis (PrEP) is a biomedical prevention approach that significantly reduces HIV acquisition. Our study aimed to explore factors associated with PrEP willingness and intention to adhere to PrEP among MSM through a cross-sectional survey in Nanjing, Jiangsu province, China. Location sampling (TLS) and online recruitment were used to recruit participants to gauge their PrEP willingness and intention to adhere. Of 309 HIV-negative/unknown serostatus MSM, 75.7% were willing to use PrEP and 55.3% had high intention to take PrEP daily. Willingness to use PrEP was positively associated with having a college degree or higher (AOR = 1.90, 95%CI: 1.11–3.26) and higher anticipated HIV stigma (AOR = 2.74, 95%CI: 1.13–6.61). Facilitators of intention to adhere included higher education levels (AOR = 2.12, 95%CI: 1.33–3.39) and higher anticipated HIV stigma (AOR = 3.65, 95%CI: 1.36–9.80), whereas a primary barrier was community homophobia (AOR = 0.43, 95%CI: 0.20–0.92). This study documented high willingness to use PrEP, yet lower intention to adhere to PrEP in a sample of MSM in China. Public interventions and programs to promote adherence of PrEP for MSM is urgently needed in China. Psychosocial factors should be addressed and taken into consideration for PrEP implementation and adherence programs. [ABSTRACT FROM AUTHOR]

Despite abundant evidence on its safety, tolerability and cost-effectiveness, post-exposure prophylaxis (PEP) has not been officially approved for non-occupational use in China. This study aims to assess awareness of, willingness to use, and actual experience with PEP in gay, bisexual and other men who have sex with men (GBM) in China and to explore potential associations between demographic, behavioral, and psychosocial factors and PEP-related outcomes. We recruited a convenience sample through community venue-based strategies, peer referrals, and online advertisement in four cities of China in 2018. We used bivariable and multivariable logistic regression to test associations between potential predictors and PEP outcomes. Over 60% of men reported having heard of PEP prior to the survey, 70% would be willing to use it if exposed to HIV, and 6% reported having used PEP. Awareness of PEP was associated with higher education, more frequent HIV testing, knowing someone who seroconverted in the past two years, having sex with only men in the past six months, and lower perceived risk of HIV infection. PEP willingness was associated with more frequent HIV testing, being worried about becoming HIV infected, prior awareness and favorable attitudes towards PEP among friends. Findings suggest PEP is an underutilized diomedical HIV prevention intervention among GBM in China. Clinical guidance on non-occupational PEP use, as well as communication campaigns targeting social networks of GBM are needed to address barriers to PEP awareness and uptake. [ABSTRACT FROM AUTHOR]

We examined the prevalence of sex with older male partner (SWOMP) and its association with condomless anal intercourse (CAI) with male partners and unrecognized HIV infection among young men who have sex with men (MSM) in Shanghai, China. The analytic sample included 243 MSM who were 18-45 years and HIV negative or of unknown HIV serostatus. Older male partner refers to male sex partner who was at least 10 years older than themselves. Overall, 99 (43.0%) and 50 (20.7%) reported having SWOMP in lifetime and in the last 3 months, respectively. Having any CAI with male partners in the last 3 months was independently associated with SWOMP and sex with stable male partners in the last 3 months. Unrecognized HIV infection was independently associated with being HSV-2 positive and having any CAI with male partners as well as SWOMP in last 3 months. Sex with stable male partner in the last 3 months was also marginally significantly associated with unrecognized infection (p = 0.084). Older partner selection is common among young MSM in China. Prevention programs should incorporate education messages about the HIV risk associated with SWOMP. MSM should be informed that having condomless sex with stable partners may place them at HIV risk. [ABSTRACT FROM AUTHOR]

Chinese men who have sex with men (MSM) are disproportionally affected by HIV and sexually transmitted infections (STIs), but little is known about the role of current marital status and living arrangements in shaping their HIV/syphilis risk. A cross-sectional study was conducted among MSM in Beijing, China to assess their sociodemographic/behavioral characteristics between married and single MSM, and test the hypothesis that currently married MSM have a lower odds of being HIV- and/or syphilis-infected. Participants were recruited via short message services, peer referral, internet, and community outreach. Data collection was based on a questionnaire survey and self-report. Infection status was lab-confirmed. Multivariable logistic regression modeling was used to assess the association of marital status and living arrangement with HIV/syphilis risk. Of the 3588 MSM, infection prevalence was high (HIV = 12.7%; syphilis = 7.5%). Compared to single MSM living with their boyfriends or male sex partners, single/alone MSM and married MSM living with wives were less likely to practice condomless insertive (CIAI) or receptive (CRAI) anal intercourse with men; while married MSM living with boyfriends or male sex partner were more likely to practice CIAI and CRAI, and married MSM were more likely to practice condomless vaginal sex. Compared to men living with boyfriends/sexual partners, significantly reduced odds of being HIV-positive were seen among married MSM who were living alone (aOR: 0.52; 95%CI: 0.28, 0.94) or living with their wives (aOR: 0.53; 95%CI: 0.31, 0.89). Similarly, single MSM living alone (aOR: 0.67; 95%CI: 0.48, 0.95) and married MSM living with their wives were comparatively less likely to be syphilis-infected (aOR: 0.43; 95%CI: 0.23, 0.79). Future efforts should consider characteristics of marital status and living arrangements for designing subgroup-specific risk reduction strategies among Chinese MSM. [ABSTRACT FROM AUTHOR]

HIV-positive men who have sex with men (HIVMSM) face severe stigma and high levels of stressors, and have high prevalence of mental health problems (e.g., depression and anxiety). Very few studies explored the role of positive psychological factors on mental health problems among HIVMSM. The present study investigated the prevalence of two mental health problems (anxiety and depression), and their associated protective (gratitude) and risk (enacted HIV-related stigma, and perceived stress) factors among HIVMSM in China. A cross-sectional survey was conducted among 321 HIVMSM in Chengdu, China, by using a structured questionnaire. Over half (55.8%) of the participants showed probable mild to severe depression (as assessed by the Center of Epidemiologic Studies Depression scale); 53.3% showed probable anxiety (as assessed by the General Anxiety Disorder scale). Adjusted logistic regression models revealed that gratitude (adjusted odds ratio (ORa = 0.90, 95% confidence intervals (95% CI) = 0.86–0.94) was found to be protective, whilst perceived stress (ORa = 1.17, 95% CI = 1.12–1.22) and enacted stigma (ORa = 7.72, 95% CI = 2.27–26.25) were risk factors of depression. Gratitude (ORa = 0.95, 95% CI = 0.91–0.99) was also found to be protective whilst perceived stress (ORa = 1.19, 95% CI = 1.14–1.24) was a risk factor of anxiety. Gratitude did not moderate the associations found between related factors and poor mental health. It is warranted to promote mental health among HIVMSM, as depression/anxiety was highly prevalent. Such interventions should consider enhancement of gratitude, reduction of stress, and removal of enacted stigma as potential strategies, as such factors were significantly associated with depression/anxiety among HIVMSM. [ABSTRACT FROM PUBLISHER]

Men who have sex with men (MSM) in China are highly susceptible to HIV infection and HIV prevalence among Chinese MSM is rapidly increasing in recent years. Unprotected anal intercourse (UAI) is a major contributing factor of HIV transmission. This study aims to identify factors associated with UAI among MSM in Changsha city, China. A cross-sectional survey was conducted among 642 MSM in Changsha city from July 2009 to June 2011 via a venue-based sampling method. Data on socio-demographic characteristics, sexual behaviours and utilisation of HIV/AIDS services were collected to determine the associates of UAI in MSM. Among the 642 MSM, 184 (28.7%) reported having UAI with male partners at the last sexual episode. UAI was associated with the venues where MSM met other MSM, and having unprotected sex with female partners at last the sexual episode and in the past six months. In addition, UAI was significant associated with not being exposed to HIV interventions, including free condom, lubricant, HIV testing and counselling, and peer education. MSM who have UAI practice are more likely to have unprotected sex with female; hence, potentially bridging HIV to the general female population. Specific harm-reduction programmes are shown to have significant impacts in reducing UAI and should be scaled up among MSM in China. [ABSTRACT FROM AUTHOR]

Given the implications for smoking among HIV-positive individuals and high smoking and HIV rates among men who have sex with men (MSM) in China, we examined sociodemographic, smoking-related, psychosocial, and substance use factors in relation to HIV status; receiving some sort of healthcare provider intervention regarding smoking; and having made a quit attempt in the past year in a sample of MSM smokers in Chengdu. We conducted a cross-sectional survey of 381 MSM smokers recruited by a nongovernmental organization in Chengdu in 2012–2013. Of these, 350 disclosed their HIV status and 344 (188 HIV-positive and 156 HIV-negative) provided completed data. Half (50.0%) reported at least one quit attempt in their lifetime; 30.5% reported a quit attempt in the past year. The majority (59.4%) reported that a healthcare provider had intervened in some way (assessed smoking, advised quitting, provided assistance), most commonly by assessing smoking status (50.0%). HIV-positive individuals were more likely to report a healthcare provider intervening on their smoking (p< .001). Those who received provider intervention were more likely to have attempted to quit ever (p= .009) and in the past year (p< .001). Those HIV-positive were more likely to have attempted to quit since diagnosis if a provider had intervened (p= .001). Multivariate regression documented that being HIV-positive (p< .001), greater cigarette consumption (p= .02), less frequent drinking (p= .03), and greater depressive symptoms (p= .003) were significant correlates of healthcare provider intervention. Multivariate regression also found that healthcare provider intervention (p= .003), older age (p= .01), and higher autonomous motivation (p= .007) were significant correlates of attempting to quit in the past year. Given the impact of healthcare provider intervention regarding smoking on quit attempts among MSM, greater training and support is needed to promote consistent intervention on smoking in the clinical setting among HIV-positive and HIV-negative MSM smokers. [ABSTRACT FROM AUTHOR]