HIV and syphilis prevalences among MSM in China are high and the 2 epidemics are largely separate geographically. Three segments of the Chinese MSM population each have different demographic and sexual risk "profiles" that suggest high potential for bridging infection across geographies, generations, and sexes.

The study demonstrated that the first phase MMT contributed to a reduction in drug use, drug injecting behaviours, drug-related criminal behaviours, HIV infections, and improved relationships within families among heroin users who participated in the MMT programme. MMT needs to be scaled up nationwide rapidly with improved services.

Background Many evidence-based preventive services are unaffordable. Pay-it-forward offers an individual a gift (e.g. a test for sexually transmitted diseases) and then asks whether they would like to give a gift (e.g. a future test) to another person. This study examined the effectiveness of a pay-it-forward program to increase gonorrhea and chlamydia testing among men who have sex with men (MSM) in China. Methods We conducted a randomized controlled superiority trial at three HIV testing sites run by MSM community-based organizations between November 2018 to January 2019. We included MSM aged 16 and older seeking HIV testing who met indications for gonorrhea and chlamydia testing. Restricted randomization was employed using computer-generated permuted blocks. Thirty groups were 1:1:1 randomized into three arms: a pay-it-forward arm where men were offered free gonorrhea and chlamydia testing and then asked whether they would like to donate others' tests; a pay-what-you-want arm where men were offered free testing and given the option to pay any desired amount for the test; and a standard-of-care arm where testing was offered at 150RMB (US$22). There was no masking to arm assignment. The primary outcome was gonorrhea and chlamydia test uptake ascertained by administrative records. We used generalized estimating equations to estimate intervention effect with one-sided 95% confidence intervals and a pre-specified superiority margin, 20%. The trial was registered (NCT03741725). Findings Three hundred and one men were recruited and included in the analysis: 101 were randomized to pay-it-forward, 100 to pay-what-you-want, and 100 to standard-of-care. Test Interpretation Pay-it-forward strategy can increase gonorrhea and chlamydia testing among Chinese MSM and may be a useful tool for scaling up preventive services that carry a mandatory fee.

Introduction HIV incidence among men who have sex with men (MSM) is high in China. Pre‐exposure prophylaxis (PrEP) is a promising mean to prevent HIV transmission but it is not widely available in China. We conducted a large Internet‐based online survey to assess the willingness of Chinese MSM to take PrEP and associated factors to their uptake preferences.MethodsBetween 19 January and 6 February, 2017, 4581 MSM aged over 15 years were recruited via a social networking app to take an online PrEP survey. HIV status at the time of the survey being conducted was not one of recruitment criteria. Participants were asked if they had heard of PrEP, if they had concerns about PrEP, and if they would be ready to uptake PrEP should it be provided. When asked if participants were willing to take PrEP, they were asked to select from the following responses: “definitely not,” “probably not,” “not sure,” “probably yes,” and “definitely yes.” In the final analysis, we grouped these five‐level Likert scale responses into three‐level responses as “definitely yes,” “probably yes,” and “no (definitely not/probably not/not sure).” Descriptive analysis and multinomial logistic regressions were conducted to assess the associations of PrEP adoption readiness and uptake concerns with HIV risk behaviours and demographic characteristics.Results MSM from 33 geographical regions of China participated in the survey. The majority were younger than 25 (65.2%) and had attended college (68.6%). HIV prevalence was high (6.8%) and 43.3% reported a history of unprotected anal sex. Only 22.4% of participants had heard of PrEP. When asked if they would uptake PrEP, 26.0% said “definitely yes,” 49.6% were “probably yes,” and 24.4% said “no.” PrEP adoption readiness was associated with having previously heard of PrEP and expressing concerns about accessibility and cost. Worries about side effects, low perceived HIV risk, preference for condoms, and never having received HIV testing were negatively associated with PrEP uptake willingness.ConclusionYoung and well‐educated Chinese MSM reported a low willingness to uptake PrEP despite being high‐risk for HIV. Effective education, especially through online mediums, will be critical to optimize this group's PrEP uptake.

HIV-related high-risk behaviors were common among male sex workers. HIV prevention activities should be delivered through websites and in the sites where male sex workers and their clients usually meet, such as bars, bathhouses or saunas, and parks. Preventive measures targeting this population are urgently needed, given their particular vulnerability, and infections are likely to disseminate into the general population given the high proportion of bisexual activity and marriage.