Incidence of HIV infection and associated factors among men who have sex with men in Zhejiang, China: a cohort study

Hui Wang ^1* Wenkai Zhou ² XIAOHONG PAN ¹ Qiaoqin Ma ¹ Lin He ¹ Xin Zhou ¹ Tingting Jiang ¹ Wanjun Chen ¹

• ¹ Zhejiang Center for Disease Control and Prevention (Zhejiang CDC), Hangzhou, China
• ² Zhejiang University, Hangzhou, Zhejiang Province, China

Aim: Men who have sex with men (MSM) contribute increasingly to the burden of HIV infection due to their high-risk sexual behaviors; however, studies focusing on the sexual behaviors among student MSM population remain limited. This study aims to investigate the incidence of HIV infection among MSM, while exploring high-risk sexual behavior in student MSM in Zhejiang province, China.Method: Prospective cohort study was conducted among MSM population in four cities in Zhejiang province. Information including socio-demographic characteristics as well as sexual behaviors were collected at baseline. Follow-up surveys and testing for HIV infection were conducted every three months. Univariable and multivariable logistic regression were performed to assess risk factors for HIV infection, investigate the sexual behavior differences between student and non-student MSM groups. Cox regression analyses were employed to discover potential association among various risk factors.Result: 2081 HIV-negative MSM were enrolled in our cohort and 36 participants were infected with HIV. The incidence density of HIV infection was 2.15 per 100 person-years among this population. Student MSM are more likely to take sexual role of versatile (OR:1.56, 95%CI: 1.05-2.32, P=0.029) and receptive only (OR: 2.65, 95% CI: 1.62-4.08, P<0.001) during anal intercourse, with a lower rate of previous HIV testing (OR: 0.45, 95% CI: 0.31-0.66, P<0.001). Cox regression discovered that MSM who had more than 6 partners in anal sexual intercourse were more likely to obtain HIV-seroconversion than who had one fixed partner (HR:5.14, 95%CI: 1.67-10.59, P<0.001), participants who sometimes use condoms (HR:4.11, 95%CI: 1.28-13.16, P=0.017) and never use condoms (HR:2.57, 95%CI:1.16-5.66, P=0.020) were more vulnerable to be infected by HIV compared to those use condoms constantly. Versatile (HR:5.30, 95%CI: 1.65-17.06, P=0.005) and receptive only role (HR:3.23 ,95%CI: 1.05-9.96, P=0.042) in anal intercourse were more likely to be infected by HIV than insertive only.: High-risk behaviors, particularly inconsistent condom uses during anal sex, significantly increase the risk of HIV infection. Student MSM exhibited persistent high-risk behaviors and low HIV testing rates. Greater attention and tailored interventions are needed to promote safer sexual practices and reduce HIV transmission in this population.