Background: Men who have sex with men (MSM) constitute a significant population of patients infected with HIV. In recent years, several efforts have been made to promote HIV testing among MSM in China. Objective: This study aimed to assess HIV testing coverage and factors associated with first-time HIV testing among MSM to provide a scientific basis for achieving the goal of diagnosing 95% of patients infected with HIV by 2030. Methods: This cross-sectional study was conducted between July 2023 and December 2023. MSM were recruited from the “Sunshine Test,” an internet platform that uses location-based services to offer free HIV testing services to MSM by visiting the WeChat official account in Zhejiang Province, China. Participants were required to complete a questionnaire on their demographic characteristics, sexual behaviors, substance use, and HIV testing history. A logistic regression model was used to analyze first-time HIV testing and its associated factors. Results: A total of 7629 MSM participated in the study, with 87.1% (6647) having undergone HIV testing before and 12.9% (982) undergoing HIV testing for the first time. Multivariate logistic regression analysis revealed that first-time HIV testing was associated with younger age (adjusted odds ratio [aOR] 2.55, 95% CI 1.91-3.42), lower education (aOR 1.39, 95% CI 1.03-1.88), student status (aOR 1.35, 95% CI 1.04-1.75), low income (aOR 1.55, 95% CI 1.16-2.08), insertive anal sex role (aOR 1.28, 95% CI 1.05-1.56), bisexuality (aOR 1.69, 95% CI 1.40-2.03), fewer sex partners (aOR 1.44, 95% CI 1.13-1.83), use of rush poppers (aOR 2.06, 95% CI 1.70-2.49), unknown HIV status of sex partners (aOR 1.40, 95% CI 1.17-1.69), lack of awareness of HIV pre-exposure prophylaxis (aOR 1.39, 95% CI 1.03-1.88), and offline HIV testing uptake (aOR 2.08, 95% CI 1.80-2.41). Conclusions: A notable 12.9% (982/7629) of MSM had never undergone HIV testing before this large internet survey. We recommend enhancing HIV intervention and testing through internet-based platforms and gay apps to promote testing among MSM and achieve the target of diagnosing 95% of patients infected with HIV by 2030.

Previous studies have shown that the increased coverage of antiretroviral therapy (ART) could reduce the community viral load (CVL) and reduce the occurrence of new HIV infections. However, the impact on the reduction of HIV transmission among men who have sex with men (MSM) is much less certain. The frequency of HIV infections in MSM have been rapidly increasing in recent years in Hangzhou, China. The “Treatment as Prevention” strategy was implemented at a population-level for HIV-infected MSM from January 2014 to June 2016 in Hangzhou; it aimed to increase the ART coverage, reduce the CVL, and reduce HIV transmission. We investigated a subset of MSM diagnosed with HIV pre- and post-implementation of the strategy, using random sampling methods. Viral load (VL) testing was performed for all enrolled individuals; the lower limits of detection were 20 and 50 copies/mL. The data on infections were collected from the national epidemiology database of Hangzhou. Logistic regression analyses were conducted to identify factors associated with the differences in social demographic characteristics and available VL data. The ART coverage increased from 60.7% (839/1383) during the pre-implementation period to 92.3% (2183/2365) during the post-implementation period in Hangzhou. A total of 940 HIV-infected MSM were selected for inclusion in this study: 490 (52.1%) and 450 (47.9%) MSM in the pre- and post-implementation periods, respectively. In total, 89.5% (841/940) of patients had data available on VL rates. The mean CVL was 579 copies/mL pre-implementation and this decreased to 33 copies/mL post-implementation (Kruskal-Wallis < 0.001). The mean CVL decreased for all variables investigated post-implementation of the treatment strategy (P < 0.05). The undetectable VL (≤400 copies/mL) rate pre-implementation period was 50.0% which increased to 84.7% post-implementation (P < 0.001). The mean CVL at the county level significantly decreased in each county post-implementation (Kruskal-Wallis < 0.05). Our study confirmed a population-level association between increased ART coverage and decreased mean CVL; overall 84.7% of HIV infected MSM had an undetectable VL and were no longer infectious.

The objective of this study was to determine the rate of acquired immune deficiency syndrome (AIDS) in Zhejiang province and to identify specific factors associated with progression of this disease. This study utilized a retrospective cohort to identify the specific factors involved in the progression of human immunodeficiency virus (HIV) to AIDS. We collected data of patients existing in care between 2008 and 2012 from the national surveillance system databases. We performed our analyses using a multivariate Cox proportional hazards model. This study included 9216 HIV-positive patients (75.6 % male), which yielded 12,452 person-years (py) of follow-up-data. The AIDS progression rates were 33.9 % (2008), 33.6 % (2009), 38.1 % (2010), 30.6 % (2011) and 25.9 % (2012). We observed a significant reduction in the rate of progression Of HIV to AIDS post-2010 (Pearson χ2 = 4341.9, P < 0.001). The cumulative AIDS progression incidence rates were 33.4, 35.4, 36.4, 37.0 and 37.04 per 100 py in 1 each of the 5 years of follow-up. This study found that age was an independent risk factor for the progression of HIV to AIDS. Compared with patients infected with HIV by homosexual transmission, patients infected with HIV by heterosexuals transmission or blood transfusion had a reduced hazard ratio (HR) for progression to AIDS (heterosexual transmission: HR = 0.695, 0.524, P = 0.007; blood transfusion: HR = 0.524, P = 0.015). Diagnosed with HIV from 2011 to 2012 and having a higher CD4+ cell count (350–500 cells/mm3; or >500 cells/mm3) at baseline were independently associated with lower rates of HIV progression to AIDS [HR = 0.382, 0.380, 0.187, P < 0.001]. Patients with a CD+ T-cell count of 200–350 cells/mm3 or greater than 350 cells/mm3 were less likely to develop AIDS following HIV diagnosis than were those patients without HAART treatment. This study found a high progression rate from HIV to AIDS in HIV patients residing within Zhejiang province from 2008 to 2010. This rate decreased after 2010, which coincided with the new criteria for HAART treatment, which likely contributed to the observed reduction in the rate of progression. Initiation of HAART with higher CD4+ T-cell count may reduce rate of AIDS progression. Based on our results, we conclude that efficient strategies for HIV screening, as well as early diagnosis and treatment are necessary to reduce the progression of HIV to AIDS.

Background: Men who have sex with men (MSM) constitute a significant proportion of individuals living with human immunodeficiency virus. Over the past few years, China has implemented various strategies aimed at increasing the rate of HIV testing and reducing HIV transmission among MSM. Among these, the disclosure of HIV serostatus is an effective prevention strategy. Objective: This study aimed to assess HIV serostatus disclosure and identify factors associated with awareness of sexual partners’ HIV status among MSM to provide a scientific basis for promoting HIV testing and reducing HIV transmission. Methods: A cross-sectional study based on a large-scale web-based survey was conducted among MSM in Zhejiang province, China, between July and December 2023. MSM who were HIV-negative or had an unknown HIV status were recruited from the Sunshine Test, a web-based platform that uses location-based services to provide HIV prevention services. Participants were required to complete a questionnaire on demographic characteristics, sexual behavior, rush popper use, awareness of sexual partners’ HIV status, and knowledge of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). A multinomial regression model was used to identify the factors associated with awareness of sexual partners’ HIV status. Results: A total of 7629 MSM participated in the study, with 45.2% (n=3451) being aware, 35.4% (n=2701) being partially aware, and 19.4% (n=1477) being unaware of their sexual partner’s HIV status. The multinomial logistic regression analysis revealed the following results. Compared to those who were unaware of their sexual partner’s HIV status, participants who were students (adjusted odds ratio [aOR] 1.43, 95% CI 1.09‐1.86), had a monthly income of more than US $1400 (aOR 1.36, 95% CI 1.03‐1.80), had insertive anal sex (aOR 1.35, 95% CI 1.12‐1.63), had only male sexual partners (aOR 1.53, 95% CI 1.28‐1.82), had 1 sexual partner in the past 3 months (aOR 2.36, 95% CI 2.01‐2.77), had used condoms for the past 3 months (aOR 1.72, 95% CI 1.33‐2.22), had frequently used rush poppers in the past 3 months (aOR 2.27, 95% CI 1.81‐2.86), were aware of HIV PrEP (aOR 2.04, 95% CI 1.68‐2.48), were aware of HIV PEP (aOR 1.69, 95% CI 1.39‐2.06), used mail reagent self-testing (aOR 1.19, 95% CI 1.04‐1.36), and had previously undergone HIV testing (aOR 1.40, 95% CI 1.16‐1.69) were associated with increased odds of being aware of their sexual partner’s HIV status. Conclusions: Overall, 45.2% of MSM who were HIV-negative or had an unknown status were aware of their sexual partners’ HIV status in China. We suggest strengthening targeted interventions through web-based platforms and gay apps to promote the disclosure of HIV serostatus and reduce HIV transmission among MSM.

Background: China has recently implemented a strategy to promote and facilitate community organization involvement in HIV prevention among men who have sex with men (MSM). Although community-based strategies have been shown to increase HIV testing uptake, the relative effectiveness of mobile social media promotion compared with volunteer-driven recruitment remains underexplored. Limited research has investigated how these strategies differentially affect MSM who have not undergone previous HIV testing. Objective: This study aimed to compare the differences between a mobile social media promotion strategy and a volunteer-driven strategy for community organizations to recruit MSM for HIV testing. Methods: A cross-sectional study was conducted from July to December 2023 among MSM in Zhejiang Province, China. Participants aged 16 years with an HIV-negative or unknown status were recruited either through a mobile social media promotion strategy or through a volunteer-driven strategy by a community organization. They completed a questionnaire that collected information on demographics, sexual behavior, and HIV testing history. All participants were tested for HIV after completing the questionnaire. A multivariate logistic regression model was used to identify factors associated with recruitment through mobile social media promotion. Results: The study included 4600 MSM, of whom 3035 (66%) were recruited through the mobile social media strategy. Overall, 1.4% (66/4600) of participants tested positive for HIV, and 18.8% (865/4600) underwent HIV testing for the first time. Recruitment via the mobile social media promotion strategy was significantly associated with several factors: having only gay sexual partners (adjusted OR [aOR] 1.23, 95% CI 1.05-1.45), having more than 2 sexual partners in the past 3 months (aOR 1.74, 95% CI 1.42-2.11), frequently using rush poppers during sex (aOR 1.39, 95% CI 1.14-1.99), having a history of sexually transmitted infections (aOR 1.56, 95% CI 1.02-2.39), having awareness of pre-exposure prophylaxis (aOR 1.42, 95% CI 1.19-1.71), having awareness of postexposure prophylaxis (PEP; aOR 1.49, 95% CI 1.24-1.79), using mail-in HIV self-testing kits (aOR 2.02, 95% CI 1.77-2.31), testing HIV-positive (aOR 2.02, 95% CI 1.10-3.72), and first-time HIV testing (aOR 1.28, 95% CI 1.09-1.52). Conclusions: Community organizations play a critical role in expanding HIV testing and identifying undiagnosed individuals infected with HIV. Compared to the volunteer-driven outreach, mobile social media promotion strategies had a higher proportion of first-time testers and a higher rate of HIV positivity. We recommend prioritizing mobile social media strategies in regions with limited LGBTQ+ organizations or HIV health services to increase HIV testing coverage and interventions among MSM.

Few large studies evaluated the effects of time trends on virologic suppression in people living with HIV/AIDS (PLWHA) in China. To address this, An retrospective observational longitudinal study was conducted. We examined annual trends in the rate of virologic suppression, the viral load at the time of virologic suppression, and other determinants of virologic suppression in Zhejiang Province, China in PLWHA between January 2013 and July 2018. Patients who received a treatment regimen for at least 24 weeks were included. Virologic suppression was defined as VL ≤50 copies/mL. Generalized estimating equation logistic regression models were used to adjust for covariates. We included 16,265 patients with 45023 tests. The proportion of patients who experienced an unsuccessful virologic outcome decreased continuously throughout the observation period (18.14% to 6.64%). Time was significantly negatively associated with detectable VL (all ORs <1). Other factors were positively associated with detectable VL, including patients <30 years of age, single, non-adherent to treatment, and with a follow-up CD4 count <200 cells/µL. Patients infected through homosexual transmission and those with a longer ART duration were more likely to reach virologic suppression. We demonstrated outstanding time trend improvements in the virological outcomes of PLWHA in China.