Mental Health and HIV-related Risky Sexual Behaviors Among Cisgender, Transgender, and Gender Non- Conforming MSM in China

Abstract

Background The new recognition of sub-groups among gender minorities (i.e transgender and gender non-conforming) who also identify as men who have sex with men (MSM) play a considerable role in new HIV infections in China. However, while research focuses on the prevalence of MSM, it ignores the diversity of gender minorities within the MSM population. Furthermore, information on the mental health and HIV-related risky sexual behavior also requires consideration to understand the prevalence and new rates of infection both of MSM and within these gender minority sub-groups. Methods From September 2017 to December 2017, MSM were recruited in Wuhan, Nanchang, and Changsha cities in China. Participants were asked to fill out a structured self-designed questionnaire to assess depression, perceived social support, resilience, identify concealment, and HIV-related risky sexual behaviors. Results A total of 715 MSM completed the structured questionnaire, the number of gender minorities identifying as MSM were 63 and accounted for 8.8% of the population. Compared with the cisgender MSM population, transgender MSM had a significantly lower likelihood of identity concealment (P = 0.016, 95%CI = 0.16, 5.79), were more likely to have one-night stand/occasional partner in the past six months (AOR = 3.90, 95% CI = 1.17–13.03), have sex after drug use (AOR = 2.84, 95%CI = 1.18–6.79), and engage in commercial sexual behavior in the past six months (AOR = 6.09, 95%CI = 1.003–36.94). In terms of gender non-conforming MSM, the differences were not significant for mental health and HIV-related risky sexual behaviors in comparison to the cisgender MSM population. Conclusions It is critical to create targeted interventions tailored towards the different gender minority identities among the MSM population. Further research is necessary to understand the relationship between gender identity, mental health, and HIV-related risky sexual behaviors.