Disparity of Human Immunodeficiency Virus Incidence and Drug Resistance in College Student, Non-Student Youth and Older Men Who Have Sex with Men: A Cross-Sectional Study from Seven Major Cities of China
Introduction
The Human Immunodeficiency Virus (HIV) epidemic has disproportionately affected men who have sex with men (MSM) globally. In China, the prevalence of HIV among college student MSM has surpassed 5.0% and continues to rise. This study aims to elucidate the proportion of recent HIV infections, its drivers, and sources among college student MSM in China. The findings are crucial for understanding the dynamics of HIV transmission and for formulating targeted prevention strategies.
Methods
A multicenter cross-sectional study was conducted in seven major Chinese cities (Shenyang, Nanjing, Shanghai, Ji’nan, Changsha, Zhengzhou, and Kunming) from June 2012 to June 2013. The study enrolled 4496 MSM, including 565 college student MSM, 1094 non-student youth MSM (NSYM), and 2837 non-student non-youth MSM (NSNYM). Participants were recruited through various methods, including online platforms, venue-based recruitment, and peer referrals.
HIV recent infections (≤168 days) and incidence were estimated using the BED HIV-1 capture enzyme immunoassay (BED-CEIA). HIV-related behaviors and transmitted drug resistance (TDR) were investigated using structured surveys and drug resistance analyses. The study also collected data on demographics, sexual behaviors, and recreational drug use.
Results
The study found that the proportion of recent HIV infections was highest among college student MSM (70.3%), followed by NSYM (50.8%) and NSNYM (35.1%). The HIV incidence rates were 10.0, 12.9, and 6.8 per 100 person-years (PY) for college student MSM, NSYM, and NSNYM, respectively. The prevalence of TDR was 7.4% among college student MSM, 2.0% among NSYM, and 4.9% among NSNYM.
College student MSM were more likely to use the internet as the main venue for seeking male partners (80.5%) compared to NSYM (71.4%) and NSNYM (64.1%). They were also more likely to have had their first anal intercourse before the age of 18 (44.6%) and to have experienced anal bleeding in the past 12 months (22.3%). The prevalence of condomless anal intercourse (CAI) was similar across all groups (29.6% for college student MSM, 28.2% for NSYM, and 27.4% for NSNYM).
HIV prevalence was 6.5% among college student MSM, 11.7% among NSYM, and 9.8% among NSNYM. Syphilis prevalence was 4.1% among college student MSM, 8.7% among NSYM, and 9.3% among NSNYM.
The proportion of recent HIV infections decreased with age among college student MSM, with 91.0% of those aged <21 years having recent infections, compared to 71.4% of those aged 21-23 years and 50.0% of those aged 24-30 years.
Factors associated with recent HIV infection included recreational drug use in the past six months among college student MSM (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.0–5.8), self-reported STI symptoms in the past year among NSYM (aOR: 2.3; 95% CI: 1.1–5.2), and having more than two male sexual partners in the past six months among NSNYM (aOR: 1.7; 95% CI: 1.1–2.5).
Discussion
The study highlights a higher proportion of recent HIV infections and TDR among college student MSM compared to other MSM groups in China. The findings suggest that HIV sero-conversion is more likely to occur during the early years of college life, emphasizing the need for early sexual health education and HIV prevention measures.
The high proportion of recent HIV infections among college student MSM is consistent with the increasing HIV prevalence and newly reported cases among this population in China. The HIV incidence rate among college student MSM (10.0/100 PY) is higher than that reported for young MSM in the U.S. and the general MSM population in China.
Recreational drug use, particularly rush poppers, was identified as a significant factor associated with recent HIV infection among college student MSM. Syphilis infection was also correlated with recent HIV infection across all groups, underscoring the importance of STI testing and treatment in HIV control.
The higher rate of TDR among college student MSM indicates potential challenges in ART effectiveness for this group. The study recommends TDR testing before ART initiation for HIV-diagnosed college student MSM to ensure appropriate treatment regimens.
Conclusion
This study provides valuable insights into the HIV epidemic among college student MSM in China. The high proportion of recent HIV infections and TDR in this population calls for targeted prevention strategies, including early sexual health education, promotion of HIV and STI testing, and interventions addressing recreational drug use. The findings also highlight the need for TDR testing before ART initiation to improve treatment outcomes for HIV-diagnosed college student MSM.
doi.org/10.1097/CM9.0000000000001161
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