Sexually Transmitted Infection Testing and Associated Factors Among Men Who Have Sex with Men in China

Abstract

OBJECTIVE: Sexually transmitted infection (STI) testing allows timely diagnosis and treatment and is therefore an effective STI prevention strategy. Yet, little is known about sexually transmitted infection (STI) testing rates and behaviors among men who have sex with men (MSM) in China. This study sought to examine the prevalence of recent STI testing and associated factors among HIV-negative/unknown Chinese MSM and compare recent STI and HIV testing. METHODS: An online cross-sectional survey was conducted among users of a gay geosocial networking app in April 2018 in 4 Chinese provinces. For this analysis, we included cis-gender men who were 18 years and older without a prior HIV diagnosis who reported anal sex with a man in the past 6 months. We used log-binomial regression models to identify sociodemographic and behavioral correlates of STI testing in the last 6 months (recent STI testing) and McNemar’s test to compare recent STI vs. HIV testing. RESULTS: Of 2,872 HIV-negative/unknown cis-MSM, 962 (33.5%) reported recent STI testing, of whom 13% reported being diagnosed with an STI, including 6.4% with syphilis, 1.5% gonorrhea, 0.5% chlamydia, 5.4% HPV/genital warts, and 1.1% other STIs. In multivariate analysis, recent STI testing was associated with being older (>45 years old vs. 18-24), being employed, more frequent condom use during anal sex, being in an ongoing sexual relationship with an HIV-positive partner or a monogamous relationship with an recently tested HIV-negative partner, and substance use in the past 6 months (p<0.05 for all). Men were more likely to have tested recently for HIV than for STIs (50% vs 34%) with only 57% of those testing recently for HIV also testing for STIs and 84% of those testing recently for HIV also testing for HIV (p<0.0001). CONCLUSION: Only a third of geosocial network app-using Chinese MSM reported testing for any STI in the last 6 months, with even lower testing reported by young MSM and students, and significant missed opportunities for concurrent HIV and STI testing. Integrating HIV and STI testing has potential to increase STI testing among Chinese MSM, and additional efforts are needed to reach young MSM with STI services.