TY  - JOUR
AU  - Hong, Hang
AU  - Shi, Xiaojun
AU  - Liu, Yuhui
AU  - Feng, Wei
AU  - Fang, Ting
AU  - Tang, Chunlan
AU  - Xu, Guozhang
PY  - 2024
DA  - 2024/7/23
TI  - HIV Incidence and Transactional Sex Among Men Who Have Sex With Men in Ningbo, China: Prospective Cohort Study Using a WeChat-Based Platform
JO  - JMIR Public Health Surveill
SP  - e52366
VL  - 10
KW  - HIV/AIDS
KW  - incidence
KW  - men who have sex with men
KW  - MSM
KW  - transactional sex
KW  - WeChat
KW  - HIV
KW  - STI
KW  - STD
KW  - sexual
KW  - behavior
KW  - behavioral
KW  - risk
KW  - risky
KW  - risks
KW  - China
KW  - Chinese
KW  - testing
KW  - mHealth
KW  - mobile health
KW  - app
KW  - apps
KW  - applications
KW  - text message
KW  - text messages
KW  - messaging
KW  - social media
KW  - regression
KW  - sexually transmitted infection
KW  - sexually transmitted disease
AB  - Background: Sexual transmission among men who have sex with men (MSM) has become the major HIV transmission route. However, limited research has been conducted to investigate the association between transactional sex (TS) and HIV incidence in China. Objective: This study aims to investigate HIV incidence and distinguish sociodemographic and sexual behavioral risk factors associated with HIV incidence among MSM who engage in TS (MSM-TS) in China. Methods: We conducted a prospective cohort study using a WeChat-based platform to evaluate HIV incidence among Chinese MSM, including MSM-TS in Ningbo, recruited from July 2019 until June 2022. At each visit, participants completed a questionnaire and scheduled an appointment for HIV counseling and testing on the WeChat-based platform before undergoing offline HIV tests. HIV incidence density was calculated as the number of HIV seroconversions divided by person-years (PYs) of follow-up, and univariate and multivariate Cox proportional hazards regression was conducted to identify factors associated with HIV incidence. Results: A total of 932 participants contributed 630.9 PYs of follow-up, and 25 HIV seroconversions were observed during the study period, resulting in an estimated HIV incidence of 4.0 (95% CI 2.7-5.8) per 100 PYs. The HIV incidence among MSM-TS was 18.4 (95% CI 8.7-34.7) per 100 PYs, which was significantly higher than the incidence of 3.2 (95% CI 2.1-5.0) per 100 PYs among MSM who do not engage in TS. After adjusting for sociodemographic characteristics, factors associated with HIV acquisition were MSM-TS (adjusted hazard ratio [aHR] 3.93, 95% CI 1.29-11.93), having unprotected sex with men (aHR 10.35, 95% CI 2.25-47.69), and having multiple male sex partners (aHR 3.43, 95% CI 1.22-9.64) in the past 6 months. Conclusions: This study found a high incidence of HIV among MSM-TS in Ningbo, China. The risk factors associated with HIV incidence include TS, having unprotected sex with men, and having multiple male sex partners. These findings emphasize the need for developing targeted interventions and providing comprehensive medical care, HIV testing, and preexposure prophylaxis for MSM, particularly those who engage in TS. 
SN  - 2369-2960
UR  - https://publichealth.jmir.org/2024/1/e52366
UR  - https://doi.org/10.2196/52366
DO  - 10.2196/52366
ID  - info:doi/10.2196/52366
ER  -