Sexual Behaviors And Networks Among College Students Men Who Have Sex With Men Of Gansu Province

Aims:In order to understand sexual networks and risk behaviors among college students men who have sex men（MSM）and provide tailored interventions for them.Methods:From November 2020 to July 2021,we conducted a cross-sectional study of college students MSM in Gansu province.Participants were recruited through 15 colleges/universities from5 cities of Gansu province（Lanzhou,Qingyang,Gannan,Tianshui,and Zhangye cities,as well as Zang Autonomous Prefecture）.And participants were eligible if they:（1）were born biologically as a male and self-identified as a male,（2）were currently studying at colleges or universities which located in Gansu province,（3）had sex with a man in last year（oral sex,anal intercourse,or both）,and（4）were aged 16 or older.Participants were recruited into this study via a broadcast advertisement placed on“Blued”,and Human Immunodeficiency Virus（HIV）voluntary counseling and testing（VCT）.Every participant was given a unique survey link to complete anonymously with the support of investigators using the"Wenjuanxing".All of the study participants were informed of the purpose of this study,and information about socio-demographics,HIV-related knowledge,HIV-test,sexual behaviors and networks were collected.Logistic regression models were used to assess relations between variables and sexual risk behaviors and sexual network size.To further assess sexual networks differences between different partner type,Chi square tests were conducted.Software Cytoscape was used to depict sexual networks.Results:A total of 502 participants are included,68.13%aged less than 21,90.24%were Han nationality,22.91%majored in engineering,50.60%not registered residence in Gansu,62.15%lived in urban,73.11%self-identified as homosexual,39.44%were self-aware of sexual attraction to the same sex during their junior high school years,34.46%were versatile position,and 83.27%answered at least 6 correctly on the MSM questionnaire,90.23%answered at least 6 appropriate responses of the young student questionnaire,71.31%learned about HIV-related knowledge in fewer than five paths,46.81%ever tested for HIV.And participants indicated that their first sexual intercourse was at 18.19±3.09 years old,9.76%engaged in group sex,62.95%used condom during last anal sex.Among 502 study participants,27.29%sexual debuted before age of 18.And among those who engaged in group sex,40.82%sexual debuted before age of 18.As the results shown,men who aged less than 21 were more likely to report sexual debut before age of 18（a OR=2.34,95%CI:1.39-3.93）;majored in arts were more likely to report sexual debut before age of 18（a OR=2.00,95%CI:0.96-4.19）;self-identified as heterosexual were more likely to report sexual debut before age of 18（a OR=5.30,95%CI:1.42-19.76）;self-awareness of sexual attraction to the same sex during undergraduate and above were less likely to sexual debut before age of 18（a OR=0.20,95%CI:0.06-0.66）;sexual debut with a woman were more likely to report sexual debut before age of 18（a OR=2.93,95%CI:1.17-7.37）;never engaged in casual sex were less likely to report sexual debut before age of 18（a OR=0.61,95%CI:0.38-0.97）;engaged in group sex were more likely to report sexual debut before age of 18（a OR=1.96,95%CI:0.99-3.88）.Among 502 study participants,45.82%engaged in casual sex.And among those who engaged in group sex,88.76%engaged in casual sex.Men who were non-Han nationality were more likely to engage in casual sex（a OR=2.18,95%CI:1.09-4.37）;compared to oral sex,both receptive position,insertive and versatile position were more likely to engage in casual sex(a OR₀=4.14,95%CI:1.80-9.52;a OR₁=2.12,95%CI:1.02-4.44;a OR_0.5=4.08,95%CI:1.99-8.36);test for HIV were more likely to engage in casual sex（a OR=1.94,95%CI:1.28-2.95）;ever engaged in group sex were more likely to engage in casual sex（a OR=6.49,95%CI:2.08-20.25）.Among 502 study participants,79.48%engaged in anal sex.And among those who ever tested for HIV,90.64%engaged in anal sex.Men who higher than age of 21 were more likely to engage in anal sex（a OR=2.03,95%CI:1.07-3.86）;test for HIV were more likely to engage in anal sex（a OR=4.05,95%CI:2.32-7.08）;sexual debut with a woman were less likely to engage in anal sex（a OR=0.25,95%CI:0.10-0.63）;never engaged in casual sex were less likely to engage in anal sex（a OR=0.25,95%CI:0.13-0.47）.Among 291 study participants,36.08%used Rush.And among those who engaged in group sex,66.67%used Rush.Men who majored in arts were more likely to report Rush use（a OR=3.08,95%CI:1.14-8.35）;not registration in Gansu were less likely to report Rush use（a OR=0.53,95%CI:0.30-0.94）;self-identified as heterosexual were more likely to report Rush use（a OR=10.20,95%CI:1.33-78.10）;insertive and versatile position were more likely to report Rush use(a OR₁=2.43,95%CI:1.01-5.87;a OR_0.5=2.34,95%CI:1.03-5.29);sexual debut after age of 18 were less likely to report Rush use（a OR=0.42,95%CI:0.22-79）;never engaged in casual sex were less likely to report Rush use（a OR=0.41,95%CI:0.23-0.76）;ever engaged in group sex were more likely to report Rush use（a OR=3.28,95%CI:1.39-7.73）.Among 291 study participants,40.21%engaged in UAI.And among those who learned about HIV-related knowledge in less than five paths,87.62%engaged in UAI.Men who majored in arts were more likely to engaged in UAI（a OR=3.53,95%CI:1.28-9.69）;not registration in Gansu were more likely to engaged in UAI（a OR=1.97,95%CI:1.14-3.43）;had an increasing way of acquired HIV-related knowledge were less likely to engaged in UAI（a OR=0.47,95%CI:0.26-0.87）;sexual debut with a woman were less likely to engaged in UAI（a OR=0.06,95%CI:0.01-0.63）;sexual debut after age of 18 were less likely to engaged in UAI（a OR=0.42,95%CI:0.22-0.79）.A total of 1936 sexual partner were reported by 339 study participants,and the median sexual network size was 3（IQR:1-6）.There were no significant differences in condom use among different partner type（X~2=1.79,P=0.41）;significant differences were found in knowledge with serostatus among different partner type（X~2=81.04,P<0.001）;significant differences were found in Rush use among different partner type（X~2=53.49,P<0.001）;significant differences were found in the composition of sexual partners among different partner type（X~2=7.43,P<0.02）.Among 339 study participants,57.23%had a sexual network size≥3.And among those who sexual debut before 18 years old,74.72%had a sexual network size≥3.As the results shown,men who majored in science or engineering or agriculture or medicine were more likely to have a bigger sexual network size（a OR=1.85,95%CI:1.05-3.28）;engaged in anal sex were more likely to have a bigger sexual network size(a OR₀=2.46,95%CI:0.97-6.25;a OR₁=2.90,95%CI:1.24-6.76;a OR_0.5=2.68,95%CI:1.18-6.09);had an increasing way of acquired HIV-related knowledge were less likely to have bigger a sexual network size（a OR=0.45,95%CI:0.26-0.77）;never test for HIV were less likely to have a bigger sexual network size（a OR=0.58,95%CI:0.34-0.99）;sexual debut after age of 18 were less likely to have a bigger sexual network size（a OR=0.38,95%CI:0.20-0.70）;ever had group sex were more likely to have bigger a sexual network size（a OR=12.82,95%CI:2.79-58.86）.Conclusions:⑴Sex education among college students MSM in Gansu province should be enhanced,and we should take effective measures to help them transform health knowledge into healthy behaviors.⑵Sexual risk behaviors,such as Rush use,sexual debut before 18 years old,casual sex,UAI were extremely common among college students MSM.In addition,we found sexual debut before age of 18 was associated with later sexual risk behaviors,it suggests that sex education should be taken as soon as possible in primary school and middle school,so that school-based sex education can play an important role in reducing sexual risk behaviors and reducing HIV transmission.⑶Most of study participants with a large number of sexual partners and multiple sexual partner types.Carry out peer education for college students MSM who with a large number of sexual partners,which can help HIV-related educations transmitted to MSM who are hard to reach through sexual network,and reducing sexual risk behaviors.