The Association Between HIV Infection Risk Perception Bias And HIV Prevention Services Among Men Who Have Sex With Men In Shandong Province

BackgroundAcquired Immune Deficiency Syndrome(AIDS)is a serious infectious disease caused by human immunodeficiency virus(HIV)attacking the human immune system.By the end of 2021,it is estimated that there are 38.4 million people living with HIV in the world.Although the number of new HIV infections has declined in recent years,it has not met expectations.In addition,during the prevalence of coronavirus infection(Corona Virus Disease 2019,COVID19),the delayed response of the medical and health systems to HIV may lead to the interruption of HIV prevention or treatment services,which may lead to an increase in the number of HIV infections.Despite the low prevalence trend of AIDS in China,the number of HI V/AIDS related deaths is still the first among all notifiable infectious diseases.The death rate caused by HIV/AIDS combined with other chronic diseases is still on the rise,and HIV/AIDS is still an important problem in China.Men who have sex with men(MSM)are playing an increasingly important role in the HIV epidemic and they are the key population for HIV infection and transmission.The UN AIDS report showed that MSM accounted for 21%of new HIV infections worldwide in 2021,and its risk of HIV infection was 28 times higher than that of ordinary adult men.China’s HIV sentinel surveillance system estimated that the HIV infection rate of MSM has increased from 1%in 2003 to 8%in 2014.By the end of 2021,the epidemic situation in Shandong Province continued to maintain a low prevalence level,but sexual transmission accounted for 98.93%among the newly reported HIV infected people,of which homosexual transmission accounted for 74.37%.Studies in several regions have shown that there is a difference between HIV perceived risk and actual risk in MSM which also known as HIV risk perception bias.A study based on six cities in the United States showed that most MSM(74%)thought they were less likely to be infected with HIV,but most of them reported having high-risk behaviors.The proportion of inconsistency between perceived and actual risk of HIV infection among China young MSM was 36.49%.Risk perception bias is common in MSM.Accurate risk perception is essential for MSM to reduce risk behaviors and promote preventive measures.However,few studies have explored the reasons for the inconsistency between self-perceived risk of HIV infection and actual risk in MSM.In order to prevent the spread of HIV/AIDS,different countries have adopted various prevention strategies and measures according to the actual situation,including condom use,HIV counseling and testing,pre-exposure prophylaxis(PrEP),post-exposure prophylaxis(PEP),etc.China have advocated some free and out-of-pocket HIV prevention services to control the spread of HIV.However,the coverage of various prevention services in China’s MSM varies greatly and most of the services are applied at a low level.More and more studies have shown that there is a link between risk perception bias and HIV related prevention services.MSM with risk perception bias may not accept HIV-related prevention services,and those who have not received prevention services may also have risk perception bias.ObjectivesThere is little analysis of the relationship between HIV risk perception bias of MSM and HIV prevention services in China.This study was a cross-sectional survey.The purposes of this study were to understand the general demographic characteristics,sexual behavior,health service utilization and other characteristics of MSM in Shandong Province,and understand the situation of risk perception bias and its influencing factors.Besides,the study also aimed to explore the relationship between risk perception bias and the acceptance of free and out-ofpocket HIV prevention services in MSM in Shandong Province,so as to provide theoretical basis for promoting the use of HIV prevention services from the perspective of risk perception.MethodsThis study was a cross-sectional survey conducted in 16 cities in Shandong Province by online recruitment of participants.From June to July 2021,the participants filled in the electronic questionnaire by clicking the questionnaire link in the WeChat official account or the questionnaire link distributed by the community-based organizations(CBOs)volunteers.The questionnaire had two parts:a screening questionnaire and a formal questionnaire.Those who met the inclusion criteria of the screening questionnaire were directed to the complete the formal questionnaire.Each city in Shandong Province established a WeChat account for administration.After the staffs added the participants as WeChat friends,they would conduct the questionnaire review,participant management and reward distribution of the participant in the city.According to the cross-sectional study formula,at least 968 MSMs should be recruited in this study.In this study,Sojump was used for questionnaire collection,Excel 2021 was used for data collation after data was exported in the Sojump.SPSS 24.0 and R 4.1.0 software were used for statistical analysis.The median M(P25,P75)or frequency(n)and constituent ratio(%)were used to describe the basic characteristics of MSM.χ2 test or Fisher’s exact were used to compare the differences of MSM with self-perception HIV infection risks and actual HIV infection risks in general demographic characteristics,sexual behavior characteristics,knowledge of HIV prevention and control,health service utilization and other characteristics.Least Absolute Contraction and Selection Operator(LASSO)regression and multivariate logistic regression were used to explore the relevant factors of risk perception bias of MSM and the forest plot was used to visualize the results.Stepwise variable input was used to control multiple confounding factors,and multivariate logistic regression analysis was used to explore the relationship between risk perception bias and the acceptance of free and out-of-pocket services in the past six months.Results1.A total of 1256 participants were included in this study.The age range of the participants was 18-63 years old,and the median age was 27(23,33)years old.About forty percent(39.5%)of the participants informed the medical staff of their sexual orientation.About three quarters(74.7%)of MSM had received HIV prevention services.More than 90%of MSM met fixed or casual sexual partners through social software or other new media channels,94.4%of them reported using gay social software 88.9%said they had received HIV/AIDS related information in Weibo,WeChat,Blued or other software,and 87.3%said that they had actively searched for HIV-related information online.Over eighty percent(83.3%)of the participants knew the severity of HIV infection in MSM population in China.2.In this study,97.7%of MSM self-perceived that the risk of HIV infection was low or unclear,84.8%had a low actual risk of being infected with HIV,and 15.2%were at high risk.Among 1,227 participants with low self-perception risk,14.7%of them had risk perception bias.The results of multivariate analysis showed that MSM with gender identity of female/other,casual sexual partners,participation in activities organized by local community-based organizations,and use of social software had a positive correlation with risk perception bias(P<0.05).MSM who had received HIV prevention services in the past six months and knew that the number of people infected with HIV in China’s MSM is average or relatively large had a negative correlation with risk perception bias(P<0.05).3.Among the 1227 MSM with low self-perceived risk in this study,74.4%of MSM had received HIV prevention services in the past six months,of which 74.3%had received free services and 25.7%had received out-of-pocket services.4.After adjusting for potential confounding factors,the risk perception bias in MSM was associated with receiving HIV prevention service in the past six months(P=0.014).Compared with those without risk perception bias,MSM with risk perception bias was less likely to take HIV prevention service(AOR=0.587,95%CI:0.383-0.898).Besides,the risk perception bias in MSM was associated with receiving free HIV prevention service in the past six months(P=0.015).Compared with those without risk perception bias,MSM with risk perception bias was less likely to take free service(AOR=0.591,95%CI:0.387-0.905).There was no correlation between risk perception bias and out-of-pocket HIV prevention services in the past six months(AOR=1.342,95%CI:0.902-1.997).Conclusions1.The proportion of MSM in Shandong Province who inform their sexual orientation to medical staff was relatively small.The proportion of MSM who met fixed and casual sexual partners through QQ,WeChat or other social software or who received HIV-related information in Weibo,Blued and other new media was relatively high.We should create a good supportive social environment to promote MSM to disclose their sexual orientation to medical staff,so as to obtain personalized prevention services.Social media and networks should be better used to carry out health education for MSM and promote HIV related services.2.MSM in Shandong Province generally had low self-perception risk of HIV infection,and there was a bias in HIV risk perception.We should strengthen publicity and education on HIV infection risk in MSM to improve awareness accuracy.The MSM in Shandong Province had a low coverage of HIV prevention,especially out-of-pocket services.We should continue to explore new interventions to promote the promotion and utilization of HIV prevention services.3.HIV risk perception bias was related to free HIV prevention services in the past six months.MSM with risk perception bias was unlikely to take free services.There was no correlation between risk perception bias and out-of-pocket HIV prevention services.Attention should be paid to individuals with risk perception bias,and education on correct risk perception among MSM should be carried out to improve the accuracy of self-perception risk.We should increase the use of HIV prevention services,and reduce the risk of HIV infection among MSM population.