China's HIV epidemic may be shifting towards predominantly sexual transmission and emerging data point to potential increases in HIV prevalence among men who have sex with men (MSM). There is particular need to assess the extent of risk behavior among MSM outside of China's most cosmopolitan cities. We conducted a respondent-driven sampling survey (N = 428) to measure HIV seroprevalence and risk behavior among MSM in Jinan, China, the provincial capital of Shandong. HIV prevalence was 0.5% (95% confidence interval [CI] 0.1-1.0). Unprotected anal intercourse (UAI) in the last 6 months (reported by 61.4%) was associated with buying or selling sex to a man in the last 6 months, syphilis infection, multiple partners in the last month, low HIV knowledge and migrant status. No participant had previously tested for HIV. Risk for HIV transmission is widespread among MSM throughout China; basic prevention programs are urgently needed.

We report on two waves of bio-behavioral surveillance of MSM in Jinan, Shandong Province, China. HIV prevalence rose from 0.05% in 2007 to 3.1% in 2008. Differences in the two waves of surveys were noted, particularly with respect to marital status, requiring stratified analysis. In multivariable analysis, unmarried, homosexually identified MSM who do not have female sex partners have a greater than sixfold greater chance of being infected with HIV compared to married, non-homosexually identified MSM who do have female partners. Carefully targeted and population-specific messages will be needed for homosexually identified and non-identified MSM in China.

Targeted, culturally appropriate and innovative interventions to increase HIV testing uptake should be a top priority for HIV prevention among MSM in China.