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

BackgroundCurrently, 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.MethodBetween 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.ResultsA 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.ConclusionHigh 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.

背景：当前，中国针对男男性行为者（MSM）的人类免疫缺陷病毒（HIV）哨点监测仅在大中型城市开展，农村地区尚未建立相关HIV哨点监测体系。目前HIV检测与干预工作主要集中于城市地区，针对农村男男性行为者的研究较为有限，因此有必要对城乡男男性行为者的HIV高危性行为、HIV检测情况开展调查。
方法：本研究于2013年12月至2015年8月期间，在浙江省城乡地区采用应答者驱动抽样法（RDS）开展横断面研究。研究对象接受面对面访谈式问卷调查，并进行HIV抗体检测。
结果：本研究共纳入710名男男性行为者研究对象，其中36.1%来自农村地区。总体HIV感染率为16.6%，农村地区男男性行为者的HIV感染率（3.9%）显著低于城市地区男男性行为者（24.2%）。61.1%的研究对象在过去6个月内与男性性伴发生性行为时未使用安全套，其中农村地区占比86.7%，城市地区占比46.7%。城乡男男性行为者的社会人口学与行为特征存在显著差异。多因素logistic回归分析显示，与城市地区男男性行为者相比，农村地区男男性行为者更倾向于通过交友应用寻找性伴、更易发生双性性行为，且安全套使用率更低。43.0%的研究对象在过去1年内接受过HIV检测，其中农村地区占比41.8%，城市地区占比43.6%。多因素logistic回归分析还显示，在农村地区男男性行为者中，参加农村医保且未接受HIV干预者的HIV检测率更低，而月收入较高、通过互联网寻找性伴者的HIV检测率更高。
结论：浙江省农村地区男男性行为者的高危性行为流行率较高，且HIV检测率低于城市地区男男性行为者，因此亟需针对农村男男性行为者立即实施预防性干预措施，以降低HIV传播风险并提升HIV检测覆盖率。