In our study, 49.2% of the respondents self-identified as bisexual, about 46.6% of MSM respondents were married, and the prevalence of married MSM increased to 71.4% or greater among those MSM who were over 30 years old. In China, MSM are a hidden subgroup in mainstream society. Due to stigma, discrimination, denial and ignorance, it is a challenge to identify MSM. They may use marriage as a means to disguise their homosexual behaviors or sexual orientations. High-risk behaviors were common in this population. Only 66.4% of the respondents used a condom during their last sexual intercourse. Consistent condom use was low even with male sexual partners (35.4%). Moreover, the rate of consistent condom use with women was lower than with men. 49.2% of the respondents reported having had sex with women in the past 6 months, and 61.8% did not use a condom in their last sexual intercourse with a female. During sexual intercourse with a female in the past 6 months, most of the respondents sometimes used a condom, and 30.4% of the respondents had never used a condom. The high portion of men who have sex with both men and women could serve as a potential “bridge” for the spread of HIV and other STDs from the high-risk population to their female partners and to the general Chinese population.
Our study suggested that for respondents who were residents of other provinces, the risk of HIV infection was 5.53 times higher. Zhengzhou, the capital city of Henan province, is one of the major cities in middle China. Therefore, it has a much greater nonlocal population. It is difficult to get information to the nonlocal MSM population regarding social support. Our study found that the rates of HIV prevalence was higher than those reported in other districts in China [2, 14, 17, 18]. Therefore, more effective strategies need to be implemented to control the HIV spread in nonlocal populations.
Studies have suggested a positive association between condom use in male-to-male anal intercourse and access to HIV preventives actions [19–26]. Our study also found that condom use in the last sexual intercourse were independently associated with HIV infection. In addition, we found accepting condoms significantly decreased the risk for HIV infection, which indicated that risky sexual behaviors associated with HIV infection could be constrained, in part, by increasing condom distributions. However, based on the results of our study, services utilization was still low in Zhengzhou. Only 30.4% of respondents reported having had an HIV test, and about 50% of respondents received condoms and peer education. Intervention programs for MSM, such as condom promotion and distribution and AIDS advisory and testing, and the distribution of materials on AIDS information need to be made more available and accessible to the MSM population.
Studies have demonstrated the connection between HIV and syphilis infections [27–30]. Our data also indicated a possible correlation between HIV and syphilis infections. After controlling for other risk factors, respondents who had been infected with syphilis were 4 times more likely to be infected with HIV. The high prevalence of syphilis suggested that MSM in Zhengzhou are at a greater risk for HIV infection. Widespread screening for syphilis infections in this risk group should be considered as a measure for control.
Unlike some other countries where drug use was considered as a major risk for HIV spread in the MSM population, only 2 participants in our study used illicit drugs in the past 6 months. It seems that there is little overlap of between the two populations of drug users and MSM in Zhengzhou.
The study has a number of limitations. First, the questionnaire data relying on retrospective self-reports was subject to recall bias. The findings should be interpreted carefully when generalizing the larger MSM population or comparing results from other studies. Second, our study was conducted in a limited area in Zhengzhou, China. Further work that focuses on extending the research into the broader areas in China would be valuable.