HIV-Related Behavioral Studies of Men Who Have Sex with Men in China: A Systematic Review and Recommendations for Future Research

Abstract

HIV prevalence among men who have sex with men (MSM) has increased significantly in China since early 2000, with MSM accounting for 32.5% of the newly infected HIV cases in China in 2009. This study reviews a total of 33 studies published in English literature on MSM in China from 2000 to 2009. Existing studies indicated that frequently MSM in China were married (especially older MSM); a majority were migrants and self-identified as gay. A large and increasing proportion of MSM sought sexual partners online. Sexual risk behaviors among MSM were prevalent, including high rates of unprotected sex, concurrent sexual relationships with both men and women, and commercial sex. Illicit drug use, however, was relatively low among general Chinese MSM, but higher among those engaged in commercial sex with men. The existing literature suggests a lack of socio-behavioral studies, lack of intervention studies specifically targeting MSM, and lack of studies in smaller cities, towns, and rural areas. Future studies need to employ more rigorous research methodology, including longitudinal study design, multiple sampling methods, and common measurements of HIV-related risk behaviors.

Earlier Anal Sexarche and Co-occurring Sexual Risk are Associated with Current HIV-Related Risk Behaviors Among an Online Sample of Men Who Have Sex with Men in Asia

“…Consistent with trends in sexarche in the general population and MSM in developed countries [9, 10, 14], we found that younger age was associated with earlier anal sexarche, which could be explained by the changing social and cultural norms toward sex in general [15, 16], and easier access for Asian MSM to meet sex partners at younger age (e.g., Internet and emerging gay venues) [17, 18]. Although younger Asian MSM tended to have sexarche at an earlier age, we also found that they were less likely to have unprotected sex during their anal sexarche compared to older participants.…”

Social Network and Other Correlates of HIV Testing: Findings from Male Sex Workers and Other MSM in Shanghai, China

“…Thus, the development of effective interventions in China is essential. China's HIV epidemic is increasingly transmitted through sex and will grow from the current 740,000 cases [1,2] to an estimated 1.2 million cases by 2015 [3], while the annual HIV infection rate has been rising steadily since the 1990s: increases of 30% between 1995 and 2000, 58% during 2001, 122% during 2003, and 45% during 2007 [4,5]. As in many other Asian countries, men who have sex with men (MSM) represent an increasing proportion of new infections in China: 0.2% in 2001, 7.3% in 2005, 12.2% in 2007, and 32.5% in 2009 [5][6][7][8].…”

“…Other regional and sentinel surveys reveal high HIV prevalence rates among MSM in many large metropolitan areas: 5.2% in Beijing in 2006 [11], 7-8% in Chongqing [12,13], and 10.6% in Chengdu [14], while rising HIV prevalence rates among MSM were also reported in Nanjing [15], Shenyang [16], Shenzhen [17,18], Jinan [19], and Jiangsu Province [20]. The increased number of reported cases among MSM may result from a combination of factors, including a higher disclosure rate that can be attributed to increasing cultural acceptance of homosexuality and the expanding size of sexual networks [4,21] and increased presence of risk behaviors [2,16,[22][23][24][25][26] with persistently high rates of unprotected anal intercourse (UAI) among MSM [10,14,27] in China. It is undeniable that China, like other Asian countries, is facing an expanding HIV epidemic among its 10 to 20 million MSM [6].…”

“…Recent articles [4,10,28] based on research projects in China have summarized the demographic and sexual risk profiles of MSM, emphasizing the unique cultural and demographic characteristics of MSM and the high prevalence of risky behaviors such as unprotected anal intercourse and multiple sex partners among the population. It is still unknown whether unrecognized infections among MSM are a driving force behind the high rate of HIV transmission [29].…”

The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex with Men in China

“…Further research suggests that unprotected anal intercourse (UAI) is a major risk factor for HIV infection among MSM and that the prevalence of UAI among MSM is high in China (e.g., the estimated prevalence of UAI was 50% in 2008-2012) 6,7,8,9 . Further studies are needed to explore the factors associated with UAI, and other sexual risk behaviours, among MSM in China, in order to better target behavioral prevention strategies.…”