Abstract
BackgroundCondom use remains consistently low among Chinese men who have sex with men (MSM). This study aims to identify factors associated with condom use after online video intervention.MethodsThis is a secondary data analysis of data collected from an online non-inferiority trial comparing the effectiveness of two condom use promotion video interventions among Chinese MSM. Participants from the two groups were combined since the effectiveness of two video interventions were shown to be non-inferior. Univariable and multivariable logistic regression were used to identify factors associated with condomless sex after the intervention during the follow-up interval.ResultsOverall, 1173 participants were recruited at baseline and 791 (67.4%) completed the three-month follow-up survey. 57.3% (453/791) of the participants reported condomless sex after intervention in the three-month follow-up interval. MSM who have had sex under the influence of alcohol in the last 3 months (Odds Ratio(OR) = 1.90; 95% CI: 1.22, 2.97; Adjusted OR(AOR) = 1.79; 95% CI: 1.13, 2.83) and ever have had sex tourism (OR = 2.75; 95% CI: 1.34, 5.63; AOR = 2.40; 95% CI: 1.15, 5.07) at baseline were more likely to have condomless sex after intervention in the three-month follow-up period. MSM who had a higher level of community engagement in sexual health (OR = 0.54; 95% CI: 0.35, 0.82; AOR = 0.49; 95% CI: 0.32, 0.75 with substantial engagement) and who viewed additional condom promotion videos during the follow-up period by themselves (OR = 0.67; 95% CI = 0.50, 0.89; AOR = 0.67; 95% CI: 0.50, 0.91). were less likely to have condomless sex during the follow-up period.ConclusionThe intervention appeared to be effective among MSM who reported viewing additional condom promotion videos by themselves and more community engagement after the intervention. In MSM who reported risky sexual behaviors at baseline, the intervention appeared less effective. Tailored intervention videos that target particular subgroups, active in-person community engagement, and optimized intervention frequency should be considered in future sexual health interventions.
Highlights
Condom use remains consistently low among Chinese men who have sex with men (MSM)
This study aimed to identify the factors that may impact the effectiveness of the online intervention in reducing condomless sex among Chinese MSM
The results showed that condomless sex after intervention was associated with following sexual risky behaviors at baseline: having had sex under the influence of alcohol in the last 3 months (AOR = 1.79, 95% Confidence interval (CI): 1.13, 2.83) and ever having had sex tourism (AOR = 2.40, 95% CI: 1.15, 5.07)
Summary
Condom use remains consistently low among Chinese men who have sex with men (MSM). The national HIV prevalence has remained low (< 0.1%) in China, this prevalence has been increasing among men who have sex with men (MSM) [1]. HIV prevalence among MSM increased from 1.5% in 2005 to 8.0% in 2015 [2, 3]. If the current HIV epidemic in MSM were not contained, the overall HIV prevalence would increase from 9.2% in 2016 to 12.6% in 2020 and 16.2% in 2025, [1]. The rate of condom use remains consistently low among Chinese MSM. One study found that condomless sex practices with female partners were common in bisexual MSM [5], which could act as a bridge in HIV transmission between male and female partners
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