Internet-Based Sex-Seeking Behavior Promotes HIV Infection Risk: A 6-Year Serial Cross-Sectional Survey to MSM in Shenyang, China

Abstract

HIV prevalence is still rapidly increasing among Chinese men who have sex with men (MSM). The Internet also makes it easier for MSM to have casual partners. This study aims to evaluate the trend of Internet-based sex-seeking behavior of MSM and its impact on HIV prevalence, the distribution of HIV subtype strains, and transmitted drug resistance rates. A serial cross-sectional study was conducted from 2009 to 2014. Of the 1,981 MSM, 50.5% (1,000/1,981) mainly sought homosexual partners through the Internet (Internet-based MSM, IBM). The proportion of IBM among total MSM subjects increased from 43.3% to 61.5% (p < 0.001). HIV prevalence of IBM increased from 5.7% to 20.7%, while that of non-Internet-based MSM (NIBM) increased from 7.0% to 14.7%. A relative higher proportion of NIBM were infected with HIV CRF01_AE subtype than IBM (79.5% versus 72.2%, p = 0.52). Multivariable analysis found IBM had a significantly higher HIV prevalence than NIBM (13.2% versus 10.5%, aOR = 1.4, 95% CI [1.0–1.9]). Being a migrant non-Shenyang resident MSM (aOR = 1.9, 95% CI [1.3–2.9]) and occasionally/never using condoms with casual homosexual partners (aOR = 1.7, 95% CI [1.1–2.6]) were two distinct risk factors for HIV infection in IBM. More efforts should be targeted towards developing interventions aimed at IBM, particularly migrant MSM and who engage in UAI with casual homosexual partners.

An Internet-Based Self-Testing Model (Easy Test): Cross-Sectional Survey Targeting Men Who Have Sex With Men Who Never Tested for HIV in 14 Provinces of China

“…Participants in this study reported more sexual risk behaviors than in comparable Web-based samples of MSM in China, including more multiple sexual partnerships, infrequent or incorrect condom use, more frequent receptive anal sex, and less awareness of sexual partners’ HIV status [6,21]. The overall HIV prevalence (98/683, 14.3%) was also far higher than in a similar sample (24/341, 7.0%) [21].…”

“…Facility-based HIV testing is defined as HIV testing conducted in health care facilities, including the Centers for Disease Control and Prevention (CDC), hospitals and clinics, and community-based organizations (CBOs) that conduct HIV antibody screening (often using rapid tests) with linkage services to health care facilities for those who screen positive. The public health utility of internet-based interventions is of growing interest in China owing to the expansion of internet access—internet and mobile internet users currently exceed 800 million people [5]—and the growing use of social networking apps for socializing and sexual partner seeking [6-9]. To date, internet-based interventions have been used to promote HIV testing in young MSM, promote HIV/hepatitis C virus testing among people who inject drugs, reduce HIV transmission among male sex workers, reduce pretreatment loss to follow-up in HIV-diagnosed individuals, and improve the adherence of antiretroviral therapy in people living with HIV/AIDS [10-14].…”

“…The Chinese Center for Disease Control and Prevention (China CDC) has also cited self-testing as a priority area. However, public health concerns about self-testing, including the risk of the clients misinterpreting results and missed opportunities for safe sex counseling and linkage to care, have slowed its implementation beyond small-scale studies in urban areas [6,18]. To address these shortcomings, the AIDS Healthcare Foundation (AHF) China developed an internet-based self-testing model, Easy Test, in which clients were invited to place Web-based orders for home delivery of free HIV self-test kits.…”

Intimate Partner Violence Correlates With A Higher HIV Incidence Among MSM: A 12-Month Prospective Cohort Study in Shenyang, China

“…We also found that IPV victims seemed more likely to find their sexual partners over the internet. MSM who were recruited via the internet are more likely to encourage high-risk sexual behaviors 44 – 46 . These risky behaviors could increase the risk of acquiring HIV among IPV victims.…”

The Effect of Using Geosocial Networking Apps on the HIV Incidence Rate Among Men Who Have Sex With Men: Eighteen-Month Prospective Cohort Study in Shenyang, China

“…Men who have sex with men (MSM) are disproportionately affected by HIV [1-3]. The percentage of MSM with HIV and AIDS in China increased from 13.7% in 2011 to 28.3% in 2015 [4,5]. Understanding the driving forces of this epidemic is essential to provide tailored interventions to MSM.…”