HIV Serostatus Disclosure Among Men Who Have Sex with Men in China in the Era of U=U and PrEP

Wangnan Cao,Shengzhi Sun,Jing Gu,Carla Sturm,Chun Hao,Fengsu Hou,Liping Peng,Dannuo Wei,Yang Deng,Jinghua Li,Xinyi You,Anna Mia Ekström

doi:10.1007/s10461-021-03502-7

Abstract

Given the recent evidence on “Undetectable = Untransmittable” (U=U) and pre-exposure prophylaxis (PrEP), the present study aimed to investigate HIV disclosure behaviors and their associations with sexual risk behaviors and U=U and PrEP awareness among men who have sex with men (MSM) in China. A cross-sectional survey was conducted among 689 MSM recruited through a gay-friendly non-governmental organization located in Chengdu, China in 2018–2019. Information was collected by a structured self-administrated questionnaire. The enrolled sample included 554 (80.4%) participants who were HIV-negative and 135 (19.6%) participants with an unknown HIV status. In terms of disclosure, 41.4% of participants informed all partners about their HIV status all the time (informing behavior), while 30.4% asked all partners about their HIV status all the time (asking behavior). Only one-fifth knew about U=U, but this was not statistically associated with either informing or asking behavior. Half (50.5%) had heard of PrEP but this was not statistically associated with either informing or asking behavior. Common barriers to informing and asking behaviors were lower risk perception of HIV infection, a history of sexually transmitted infections, engagement in receptive sex, and a history of sex with casual partners. We found that both U=U and PrEP awareness and HIV serostatus disclosure were infrequent and not associated in this study of Chinese MSM. These data indicate huge information gaps among MSM in China.

Highlights

Disclosure of HIV serostatus may bring both advantages and disadvantages
This study aimed to investigate the prevalence and emerging factors associated with HIV serostatus disclosure among men who have sex with men (MSM) living in Chengdu, China in the era of U=U and Pre-exposure prophylaxis (PrEP)
We found that younger MSM and those with a higher education were more likely than their counterparts to engage in both asking and informing behaviors related to HIV disclosure [40]

Summary

Introduction

Disclosure of HIV serostatus may bring both advantages and disadvantages. Potential advantages include improved adherence to antiretroviral therapy (ART), psychological relief, and shared decision-making with partners in terms of sex and condom use. Due to the small sample size of MSM known to be living with HIV in the present study, we are unable to perform a subgroup analysis by HIV status in terms of predictors of disclosure. Half (54.0%) of the participants were single, 13.4% were married to woman, and 26.0% were in a stable relationship with a boyfriend. More than half of the participants (54.9%) reported having had their first homosexual intercourse before age 21 years (Table 1). Homosexual Heterosexual Bisexual Other Age of first homosexual intercourse (years) < 21 ≥ 21 HIV serostatus disclosure status. Never Occasionally Half of the time Most of the time Always I informed all partners in the past month of my HIV status.

Objectives

Discussion

Conclusion