Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Sep 1, 2023
Date Accepted: Jun 5, 2024
HIV incidence and transactional sex among men who have sex with men in Ningbo, China: a prospective cohort study using WeChat-based platform
ABSTRACT
Background:
Sexual transmission among men who have sex with men(MSM) has become the major HIV transmission route. However, little is known about the association between transactional sex(TS) and HIV incidence in China.
Objective:
This study aimed to investigate HIV incidence and distinguish sociodemographic and sexual behavioral risk factors associated with HIV incidence among MSM who engage in TS (MSM-TS) in China.
Methods:
We conducted a prospective cohort study using a WeChat-based platform to assess the HIV incidence among Chinese MSM, including MSM-TS in Ningbo, recruited from July 2019 until June 2022. At each visit, participants completed an online questionnaire and made an appointment for HIV counseling and testing on the Wechat-based platform before they had HIV tests offline. HIV incidence density was calculated as the number of HIV seroconversions divided by person-years(PYs) over the observed time, and univariate and multivariate Cox proportional hazards regression was conducted to identify factors associated with HIV incidence.
Results:
932 participants contributed 630.9 PYs of follow-up, and 25 HIV seroconversions occurred during the follow-up period, yielding an estimated HIV incidence of 4.0/100 PYs(95%CI:2.7~5.8). HIV incidence among MSM-TS was 18.4/100 PYs(95%CI:8.7~34.7), which was significantly higher than that of 3.2/100 PYs(95%CI:2.1~5.0) among MSM who do not engage in TS (MSM-NTS). After adjusting for sociodemographic characteristics, factors associated with HIV acquisition were being MSM-TS (aHR=3.93,95% CI:1.29~11.93), having unprotected sex with men(aHR=10.35, 95%CI:2.25~47.69) and multiple male sex partners (aHR=3.43, 95%CI:1.22~9.64) in the past six months.
Conclusions:
This study found that the incidence of HIV among MSM-TS in Ningbo was high. The risk factors associated with HIV incidence include TS, having unprotected sex with men and multiple male sex partners, emphasizing the need for developing new interventions and providing medical care, HIV testing, and pre-exposure prophylaxis for MSM, particularly MSM-TS.
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