Objective: To study the awareness and acceptance of human papillomavirus (HPV) vaccination among sexually active men having sex with men (MSM) and men not having sex with men (MNSM) attending the largest sexual health clinic in Wuxi, China. Methods: A questionnaire about participants' sociodemographic characteristics and view on HPV vaccination was collected. Results: A total of 186 MSM and 182 MNSM were recruited. Among MSM, 12.4% were under 20 years old, 64.5% never married and 56.5% from Jiangsu Province (where Wuxi City is located); 64.0% had resided in Wuxi for over 2 years, 64.5% had high school education or more, and 83.9% had an income of 5000 RMB or less per month compared to figures of 5.5%, 50.6%, 73.6%, 54.9%, 86.8% and 64.8% among MNSM, respectively (All P values < 0.05). Among these 2 groups of men, 18.4% and 23.1% had heard of HPV; 10.2% and 15.4% had heard of HPV vaccine; and 26.2% and 20.2% would take HPV vaccine before sexual debut, respectively. MNSM were significantly more willing to take HPV vaccine than MSM (70.9 vs 34.9%, p < 0.001). Factors associated with HPV vaccine acceptance among MSM included engaging mostly in receptive anal sex (Odds ratio (OR)D3.9, 95% Confidence interval (CI): 1.8-13.5), never using a condom in anal sex in the past 6 months (3.5, 1.5-20.2), ever diagnosed with a sexually transmitted infection (STI) (3.4, 1.3-8.4) and ever receiving HIV related services (1.6, 1.1-4.4). Among MNSM these Factors included commercial sex with women (1.7, 1.2-8.6), never using a condom in commercial sex (1.6, 1.4-7.6) and STI diagnosis (2.0, 1.6-7.3). Conclusions: Sexually active MSM and MNSM in Wuxi lacked knowledge of HPV and HPV vaccination. The majority of these at-risk men would not benefit from HPV vaccination as their age at first sex proceeded perceived age of vaccine uptake. Aggressive education aimed at increasing knowledge of HPV and HPV vaccination among these men is warranted. KEYWORDS acceptance; awareness; China; HPV vaccine; men having sex with men; men not having sex with men

This study is aimed at investigating the awareness of and preferences for oral and long-acting injectable HIV preexposure prophylaxis (PrEP) and their associated factors among men who have sex with men (MSM) at high risk of HIV infection in southern China. A cross-sectional survey was conducted among 603 MSM who were recruited through a cohort study called the T2T Study at three sexual health clinics in Guangzhou, Shenzhen, and Wuxi, China, from 2017 to 2018. We collected information on HIV-negative participants’ awareness of and willingness to use PrEP and its potential correlations. Univariate and multivariate logistic regressions were used for data analyses. A total of 550 HIV-negative MSM were enrolled in the study. Less than half of at-risk MSM (43.1%) had heard of PrEP before, and the rate of overall willingness to use PrEP was 65.8%, while MSM were more willing to use daily oral PrEP than long-acting injectable- (LAI-) PrEP (62.2% vs. 38.5%). MSM who had university degrees or above ( aOR = 1.55 , 95% CI: 1.01-2.37), used condoms during last anal sex (1.52, 1.01-2.29), and tested 3 times or more for HIV (2.45, 1.10-5.47) were more likely to be aware of PrEP. MSM who had use of gay dating apps (1.51, 1.02-2.23), ever participated in HIV- or sexually transmitted disease (STD-) related studies (1.91, 1.24-2.94), and had heard of PrEP (3.06, 2.06-4.54) were more willing to use any regimen of PrEP. MSM at high risk of HIV infection had low awareness of PrEP and moderate willingness to use PrEP. Further studies of the implementation and promotion of PrEP targeting at-risk MSM should be performed.

IntroductionThe frequency of screening for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) is still low in China.Methods and analysisA sexual health clinic based randomised controlled trial will be conducted in Guangzhou, Wuxi and Shenzhen, China, enrolling 600 MSM. Eligibility will be judged by the pre-programed iPad based questionnaire: (1) age ≥18 years and (2) have had two or more male anal sex partners, or condomless anal sex with a casual male sex partner, or an STI history, in the past 6 months, and (3) provides a valid mobile phone number. Eligible men will be randomly allocated 1:1 to the intervention arm (with monthly text messages reminding them to test for HIV/STIs) or to the control arm (with no reminders). Men in both arms will complete a questionnaire onsite at enrolment and after 12 months, and another questionnaire online at 6 months. Men in both arms will be tested for HIV, syphilis, anal gonorrhoea/chlamydia and penile gonorrhoea/chlamydia at enrolment and at 12 months. The primary outcome is the rate and frequency of HIV testing within the 12 months after enrolment. The secondary outcome is the rate of unprotected anal intercourse. An assessment of the cost effectiveness of this intervention is also planned.Ethics and disseminationThe study has been approved by the ethical review committees of the University of New South Wales, Australia (HC16803), the Guangdong Provincial Centre for Skin Disease and STI Control (GDDHLS-20160926) and the Wuxi Centre for Disease Control and Prevention (WXCDC2016009), China. Study findings will be submitted to academic journals and disseminated to local health authorities.Trial registration numberChinese Clinical Trial Registry at: http://www.chictr.org.cn/showprojen.aspx?proj=15752 and WHO International Clinical Trials Registry Platform at: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=ChiCTR-IOR-16009304.