Risky behaviour and HIV transmission rates are on the rise among men who have sex with men (MSM) in China according to surveys carried out in 2004, 2005 and 2006. The survey authors say MSM-friendly HIV testing, STI services and education is urgently needed to stem the rise.
The three annual surveys of MSM were carried out at the HIV voluntary counselling and testing clinic at the Beijing Centers for Disease Control and Prevention. Participants were men who had ever reported having sex with another man. The lower age limit for participants was set at 18 in 2004 but lowered to 16 in 2005 and 2006 and 325 men were surveyed in 2004, 427 in 2005 and 540 in 2006. There was no significant increase in consistent condom use over the three years.
But the numbers of men reporting multiple partners increased dramatically. In 2004 2.4% of men reported having ten or more partners in the past six months but this had risen to 17.4% in 2006. In 2004 36.6% of men said they had just one partner in the past six months but this had dropped to 17.4% by 2006.
The proportion of men who had ever had an STI rose from 15.1% to 27.9% in the three years – including a doubling in syphilis infection rates, from 4.5% to 9.9%.
In 2004 just 0.4% of the men were HIV-positive in 2004 but this shot up to 4.6% in 2005 and 5.8% in 2006. Hepatitis C infection rates also rose sharply from 0.4% in 2004 to 5.2% in 2006. These rises are being fuelled by a low rate of condom use and an increasingly number of sexual partners, say the researchers.
More than half of men reported having unprotected insertive anal sex in the past six months and two fifths having unprotected receptive anal sex.
The findings are particularly worrying, they say, in light of recent reports documenting rapidly increasing HIV rates in other Asian countries like Thailand, and high HIV prevalence in MSM observed in Phnom Penh, Cambodia (8.9%), Chiang Mai, Thailand (15%) and Andhra Pradesh, India (18%).
But they add that the data need careful scrutiny as such a huge rise from a small baseline level of HIV prevalence could mean the 2004 figure was an underestimate. There were also far more “unofficial” Beijing residents in the later years and a particularly large rise in HIV status among them. Education status was also significantly lower in later years.
These factors mean a more detailed analysis of HIV risk behaviour, internal migration and education level among MSM in China is needed.
Men surveyed said the HIV healthcare resource they would most like to see would be MSM-friendly HIV testing sites followed by HIV/STI counselling services.
The authors say provision of these services need to be addressed as a matter or urgency.
Ma X. Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B and sexual risk behaviour among ,men who have sex with men- results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006. J Acquir Immune Defic Syndrome 2007, 45: 581-587.