Analysis Of HIV Prevalence,HIV Testing Characteristics And Its Related Factors Among MSM Of 10 Cities In Shandong Province

BackgroundAIDS is a serious infectious disease caused by the human immunodeficiency virus(HIV).It is top one in the reported deaths in 2018 among all notifiable infectious diseases in China.UNAIDS has set the "90-90-90" target to help end the AIDS epidemic.The first 90%target is:By 2020,90%of all people living with HIV will know their HIV status.But by the end of 2015,only 68%of HIV-infected people in China had been tested,which was far from the 90%target.Men who have sex with men(MSM)are a high-risk group of HIV infection and one of the key populations to control AIDS epidemic.As of October 31,2019,MSM accounted for 23.0%of newly reported HIV/AIDS cases in China,whereas the proportion was only 13.2%in 2010.MSM are one of the sensitive populations who have their own special characteristics like having multiple sexual partners,changing their sexual partners frequently,engaging in unprotected sex and having complex social networks,etc.According to the sentinel surveillance data,the number of newly diagnosed HIV-positive MSM has increased by 22600,the HIV positive rate has risen from 5.73%in 2010 to 7.98%in-2015.Another study shows that some MSM chose to get married with females,thus,MSM who do not know their own infectious state of HIV can transmit HIV to female partners through heterosexual behavior.Though the HIV prevalence is high among MSM in China,the HIV testing rate remains low,the proportion of HIV testing in the past one year among MSM in Shandong Province was only 50.6%in 2018.Therefore,it is important for AIDS control and prevention to understand the prevalence and testing rate of HIV and explore the related factors to provide information and a scientific basis for decreasing HIV prevalence and increasing HIV testing rate among MSM.ObjectivesBaseline survey data of a cluster randomized controlled trial were used in this study.Our aim is to explore the HIV prevalence and testing rate and then find the related factors among MSM of 10 cities in Shandong Province.We expected that this study can provide theoretical support for understanding the characteristics and reducing the risk of HIV transmission among MSM.MethodsMSM of 10 cities in Shandong Province were recruited from the Internet and Community-based Organizations(CBOs)of MSM.A self-administered online questionnaire was used to collect data,including socio-demographic information,sexual behaviors,HIV testing behaviors,syphilis testing behaviors,social networking,access to HIV prevention services,HIV testing self-efficacy and anticipated HIV stigma scale.The basic information of MSM was analyzed using descriptive statistics.The influencing factors of HIV infection and HIV testing were analyzed using generalized linear mixed model(GLMM).HIV infection status and HIV testing behavior were used as dependent variable respectively.Socio-demographic factors,sexual behavioral factors,HIV and syphilis testing behaviors,social networking behaviors,HIV testing self-efficacy and anticipated HIV stigma scores were used as independent variables.Variables with P<0.1 in univariate regression and those were considered to be biologically significant were included in the final GLMM model.Results1.A total of 978 valid questionnaires were obtained in this survey.The average age of respondents was 28.57±8.00 years old.Among them,72.3%were unmarried,66.8%were college or beyond,46.2%had monthly income between 3,001-5,000 RMB.There were 84.8%respondents who ever had stable male sex partners,37.4%could use condoms consistently with their stable male sex partners in the past three months.76.0%respondents had casual male sex partners,36.3%could use condoms consistently with their casual male sex partners in the past three months.There were 84.8%respondents who had ever tested for HIV,76.5%had facility-based HIV testing,56.5%had self-testing.The syphilis positive rate was 6.5%.There were 89.2%respondents who had ever searched information about HIV testing online,75.3%had ever seen messages related to HIV testing on social software.In terms of receiving HIV prevention services,the proportion of receiving condom distribution is the highest,accounting for 57.1%.HIV testing self-efficacy score was 16.00±2.48,and anticipated HIV stigma was 18.58±4.13.2.The HIV positive rate was 6.2%among MSM.Aged above 25(OR:2.06,95%CI:1.03-4.14),syphilis positive(OR:4.56,95%CI:2.07-10.04),having sex partners living with HIV-positive(OR:6.52,95%CI:2.69-15.80),not knowing HIV infection status of sex partners(OR:2.16,95%CI:1.10-4.25),looking for sex partner in pub/disco/tearoom/club(OR:3.75,95%CI:1.70-8.27),ever seen messages related to HIV testing on social software(OR:2.64,95%CI:1.05-6.66)were positively correlated with HIV infection.3.The HIV testing rate was 84.7%among MSM,HIV testing rate in the past one year was 72.9%.Aged above 25(OR:1.85,95%CI:1.09-3.12),homosexual(OR:1.91,95%CI:1.24-2.94),having ever searched information about HIV testing online(OR:3.50,95%CI:2.04-5.99),having ever received condom distribution(OR:2.33,95%CI:1.40-3.87),having ever received STDs examination or treatment(OR:4.08,95%CI:1.62-10.29)and HIV testing self-efficacy(IR:1.17,95%CI:1.08-1.27)were positively correlated with HIV testing,the occupation of unemployed/self-employed(OR:0.45 95%CI:0.21-0.99)was negatively correlated with HIV testing.4.The facility-based HIV testing rate was 76.5%among MSM,the facility-based HIV testing rate in the past one year was 64.3%.Aged above 25(OR:2.18,95%CI:1.37-3.45),having ever had HIV self-testing(OR:2.75,95%CI:1.91-3.96),having ever searched information about HIV testing online(OR:2.03,95%CI:1.18-3.47),having ever received condom distribution(OR:2.07,95%CI:1.33-3.23),having ever received STDs examination or treatment(OR:3.04,95%CI:1.48-6.21)and HIV testing self-efficacy(OR:1.22,95%CI:1.13-1.32)were positively correlated with facility-based HIV testing,looking for sex partners on social software(OR:0.53,95%CI:0.29-0.99)was negatively correlated with facility-based HIV testing.5.The HIV self-testing rate was 56.5%,the HIV self-testing rate in the past one year was 46.4%.Monthly income above 5,000 RMB(OR:2.06,95%CI:1.24-3.42),the number of male sex partners was 2 or more than 2(OR:2.08,95%CI:1.25-3.44),having sex partners living with HIV-positive(OR:232,95%CI:1.18-4.57),having facility-based HIV testing(OR:2.98,95%CI:2.07-4.29),having seen messages related to HIV testing on social software(OR:1.43,95%CI:1.01-2.02)and HIV testing self-efficacy(OR:1.07,95%CI:1.01-1.14)were positively correlated with HIV self-testing.Having condomless sex(OR:0.70,95%CI:0.50-0.97)and anticipated HIV stigma(OR:0.96,95%CI:0.93-0.99)were negatively correlated with HIV self-testing.Conclusions1.MSM who have not tested for HIV in the past three months are mostly young,well educated,unmarried and homosexual.2.The HIV positive rate is high among MSM.Aged above 25,syphilis positive,having sex partners living with HIV-positive,not knowing HIV infection status of sex partners,looking for sex partner in pub/disco/tearoom/club,ever seen messages related to HIV testing on social software were positively correlated with HIV infection.It is recommended to strengthen the intervention of HIV prevention in MSM gathering places,popularize relevant knowledge of HIV testing through official accounts and various user-operated media,encourage MSM to tell their HIV infection status to sex partners and carry out joint detection of HIV and Treponema pallidum.3.Though the HIV testing rate is high among MSM,it is still far from China’s first 90%target.Aged above 25,homosexual,having ever searched information about HIV testing online,having ever received condom distribution,having ever received STDs examination or treatment and HIV testing self-efficacy were positively correlated with HIV testing,the occupation of unemployed/self-employed was negatively correlated with HIV testing.Thus,while doing well in traditional HIV prevention(such as condom distribution,STD testing and treatment),we should actively explore the online intervention approaches,popularize HIV testing knowledge through the Internet and social software,expand the coverage of HIV intervention,develop the cooperation with CBOs and MSM dating software,and improve HIV testing self-efficacy through encouragement and education to increase HIV testing rate among MSM.