Differences in risk behaviors, intimate partner violence, and HIV & STI prevalence among men who have sex with men and men who have sex with men and women in China

Introduction: Intimate partner violence (IPV) research has primarily focused on heterosexual couples, but has been largely ignored among men who have sex with men. Differences in risk behaviors and IPV prevalence between men who have sex exclusively with men (MSM) and men who have sex with both men and women (MSMW) have important implications for HIV and sexually transmitted infections (STI) transmission. We examined differences in IPV prevalence, risk behaviors, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to and retention in HIV care between MSM and MSMW across China.;Methods: Men who have sex with men over the age of 16 were recruited through three MSM-focused websites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September-October 2014. Chi-square tests and logistic regression analyses were conducted.;Results: Among 610 participants, 182 (29.8%) reported experiencing at least one type of IPV. MSMW were at significantly greater risk for IPV (adjusted odds ratio (AOR) 1.65, 95% CI [1.08-2.53]) compared to MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR 1.86, 95% CI [1.08-3.21]), to have had sex in exchange for gifts or money (AOR 5.06, 95% CI [2.47-10.35]), and to report a positive HIV diagnosis (AOR 2.59, 95% CI [1.22-5.51]). Among 1,363 participants, MSMW were less likely to use a condom during last anal sex (p≤0.01) and more likely to engage in group sex (p≤0.01) and transactional sex (p≤0.01) compared to MSM. HIV/STI testing rates and self-reported STI and HIV serostatus between MSM and MSMW were similar.;Conclusion: There is a hidden epidemic of IPV among MSM and MSMW in China. Given their different prevalences of risk behaviors, Chinese MSM and MSMW may benefit from different HIV/STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese men who have sex with men and avoiding potential HIV/STI outbreaks across numerous populations, including Chinese women, will depend on the ability of targeted and culturally-congruent HIV/STI control programs to facilitate a reduction in risk behaviors.