Abstract
In recent years, the prevalence of human immunodeficiency virus (HIV) infection among Chinese university students has increased significantly, and HIV transmission among men who have sex with men (MSM) comprises more than half of the new cases. There is still a lack of research investigating the incidence of male-to-male sex, the attitudes towards MSM, and the awareness of HIV/AIDS among university students in Guangxi, one of the HIV high-risk areas in China. Therefore, we performed a cross-sectional investigation among 578 male students, recruited by stratified sampling, in universities in Nanning, Guangxi, between January 2016 and March 2017. Researcher-administered anonymous questionnaires were completed. Self-recognition as MSM was found in 8.48% of the subjects. Compared with non-MSM, university student MSM included more people over the age of 20 (OR = 4.95), had less migration from other districts of Guangxi (OR = 0.26), and the majority were nonmedical students (OR = 8.99). In total, 63.25% of the male student participants reported a lack of acceptance of MSM, while 35.47% acknowledged barriers between themselves and acquaintances who were MSM. Overall, 67.30% of the subjects correctly answered questions related to AIDS knowledge. The proportion of MSM subjects who answered the AIDS-related questions completely correctly was significantly lower than that of non-MSM subjects (42.86% vs. 69. 57%, respectively, OR: 0.33), but the self-recognition risk of MSM was significantly higher than that of non-MSM (OR = 2.59). Risky behaviors associated with HIV infections, including smoking, alcohol consumption, drug abuse, and inconsistent condom use, were significantly higher among the MSM participants. The percentages of student's willingness to accept MC and PrEP were 70.93% and 77.51%, respectively. These results raise the alarm that university student MSM in Guangxi, China, require urgent public attention and more effective health education, including the education on MC and PrEP.
Highlights
Acquired Immune Deficiency Syndrome (AIDS) has been an epidemic worldwide since the 1980s
Our study suggests that effective interventions such as male circumcision (MC) and pre-exposure prophylaxis (PrEP) could be implemented for the prevention and control of human immunodeficiency virus (HIV)/AIDS among the student men who have sex with men (MSM) population, which is an emerging high-risk population for HIV transmission currently in China
Our study reported that 77.5% of male university students (MUSs) participants were willing to accept PrEP, which is higher than those previously reported in different places in the world, such as 39% among Australian gay and bisexual men in 2015 [36], 64% among HIV-negative MSM in Western China in 2010, 48% in Washington DC in 2014, 60% in Miami in 2014, 48% in Baltimore in 2011, 55.4% in
Summary
Acquired Immune Deficiency Syndrome (AIDS) has been an epidemic worldwide since the 1980s. The reported number of HIV infections in China was 861042 by the end of 2018 [2]. High risky behaviors including unprotected anal intercourse (UAI) and multiple sexual partners made MSM at high risk of HIV infection. As sexual transmission has become the main mode of HIV transmission, the proportion of MSM in new HIV cases has been increasing each year. The proportion of estimated new HIV cases among MSM increased from 2.5% in 2006 to 21.4% in 2013, according to the 2014 China AIDS Response Progress Report [4]. Among the reported cases of HIV infection in China in 2015, 28.4% were transmitted through male-to-male intercourse [5]. The percentage of HIV infection transmitted through maleto-male sex is much higher than that in China. MSM accounted for 71.5% of the total estimated newly diagnosed HIV positives in Japan, 67% in the US, and approximately 54% in Canada in 2014 [6,7,8]
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