HIV risk behavior and HIV testing among rural and urban men who have sex with men in Zhejiang Province, China: A respondent-driven sampling study

PLoS One. 2020 Apr 2;15(4):e0231026. doi: 10.1371/journal.pone.0231026. eCollection 2020.

Abstract

Background: Currently, human immunodeficiency virus (HIV) sentinel surveillance among men who have sex with men (MSM) in China conducted in large and medium-sized cities, and no HIV sentinel surveillance conducted in rural areas. HIV testing and intervention is predominantly conducted in urban areas, there have been a limited number of studies in rural areas MSM, it is necessary to conduct the investigation of HIV risk sexual behavior, HIV testing among rural and urban MSM.

Method: Between December 2013 and August 2015, a cross-sectional study was conducted in rural and urban areas in Zhejiang Province using respondent-driven sampling (RDS). Participants completed face-to-face interviewer-administered questionnaire surveys and were tested for HIV.

Results: A total of 710 MSM participants were recruited, of whom 36.1% were from rural areas. The overall HIV prevalence was 16.6%, and was considerably lower among MSM living in rural areas (3.9%) than those living in urban areas (24.2%). 61.1% participants had not condom use with male sexual behavior in the past 6 months (86.7% in rural areas and 46.7% in urban areas). The social demographic and behavioral characteristics had significance difference among rural and urban MSM. Multivariate logistic regression revealed that, compared to men living in urban areas, MSM living in rural areas MSM were more likely to use dating apps to find sexual partners, were more likely to engage in bisexual behavior, and had lower condom use. 43.0% participants had been tested for HIV in the past year (41.8% in rural areas and 43.6% in urban areas). Multivariate logistic regression also revealed that among participants living in rural areas, having rural health insurance and not accepting HIV intervention were associated with lower HIV testing rates, while a higher monthly income and through use of internet to find sexual partner were associated with higher rates of HIV testing.

Conclusion: High risk behavior was prevalent, and HIV testing rates were low among MSM living in rural areas compare to urban areas in Zhejiang Province, therefore, preventative intervention measures should be immediately among rural MSM urgently to reduce HIV transmission and to promote HIV testing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Bisexuality / statistics & numerical data
  • China
  • Cross-Sectional Studies
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / etiology*
  • Homosexuality, Male / statistics & numerical data*
  • Humans
  • Male
  • Mass Screening / methods
  • Risk-Taking
  • Rural Population / statistics & numerical data*
  • Safe Sex / statistics & numerical data
  • Sampling Studies
  • Sexual Behavior / statistics & numerical data
  • Sexual Partners
  • Sexual and Gender Minorities / statistics & numerical data
  • Young Adult

Grants and funding

The study was funded by a grant from ‘National S & T Major Project Foundation of China’ (2012ZX10001-001) to XP and (2017ZX10201101002) to XP, Zhejiang Provincial Medicine Science and Technology Plan (2015PYA004) to XP and Social Development Project of Public Welfare Technology Research in Zhejiang Province (LGF18H260006) to LH. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.