JMIR Publications

ABSTRACT

Background:

Recently, China has implemented a strategy to promote and facilitate community organization involvement in HIV prevention among men who have sex with men (MSM). Although community-based strategies have been shown to increase HIV testing uptake, the relative effectiveness of online social media promotion compared to volunteer-driven recruitment remains underexplored. Limited research has examined how these strategies differentially affect MSM who have not undergone prior HIV testing.

Objective:

This study aimed to compare the differences between an online social media promotion strategy and a volunteer-driven strategy for community organizations to recruit MSM for HIV testing.

Methods:

A cross-sectional study was conducted from July to December 2023 among MSM in Zhejiang Province, China. Participants aged  16 years and HIV-negative or had an unknown HIV status were recruited either through an online social media promotion strategy or through a volunteer-driven strategy by a community organization. They completed a questionnaire that collected information on demographics, sexual behavior, and HIV testing history. All participants were tested for HIV after completing the questionnaire. A multivariate logistic regression model was used to identify factors associated with recruitment through online social media promotion.

Results:

The study included 4,600 MSM, of whom 3,035 (66.0%) were recruited through the online social media strategy. Overall, 1.4% of participants tested positive for HIV, and 18.8% underwent HIV testing for the first time. Recruitment via the online social media promotion strategy was significantly associated with several factors: having only gay sexual partners (adjusted odds ratio [aOR] = 1.47, 95% confidence interval [CI]: 1.21–1.79), having more than two sexual partners in the past three months (aOR = 1.67, 95% CI: 1.40–2.05), frequent use of rush poppers during sex (aOR =1.47, 95% CI: 1.21–1.79), a history of sexually transmitted infections (STIs) (aOR = 1.70, 95% CI: 1.11–2.61), awareness of pre-exposure prophylaxis (PrEP) (aOR = 1.43, 95% CI: 1.19–1.72), awareness of post-exposure prophylaxis (PEP) (aOR = 1.47, 95% CI: 1.22–1.78), use of mail-in self-testing kits (aOR = 2.00, 95% CI: 91.75–2.27), testing HIV-positive (aOR = 2.48, 95% CI: 1.34–4.59), and first-time HIV testing (aOR = 1.39, 95% CI: 1.18–1.64).

Conclusions:

Community organizations play a critical role in expanding HIV testing and identifying undiagnosed HIV-infected individuals. Compared to volunteer-driven outreach, online social media promotion strategies resulted in a higher proportion of first-time testers and a higher rate of HIV positivity. We recommend prioritizing online social media strategies in regions with limited gay community organizations or HIV health services to increase HIV testing coverage and interventions among MSM.