HIV testing and the PrEP care continuum among Chinese sexual minority men: A comparison by relationship status and sexual agreement

BackgroundSexual minority men (SMM) in China continue to face a disproportionately high burden of HIV. Yet, little is known about the differences in HIV prevention service utilization including HIV testing and pre-exposure prophylaxis (PrEP) by relationship status and sexual agreements among this population. The study aimed to explore the associations between relationship status and sexual agreements and HIV testing behaviors, PrEP willingness, and PrEP uptake among sexually active SMM in China.MethodsWe surveyed 1,379 sexually active SMM in China on a geosocial networking app and conducted multivariable regression to examine differences in HIV testing and PrEP-related outcomes.ResultsOver one-third of Chinese SMM (36%) were in a relationship (e.g., having a boyfriend or partner) and among these, 44% had a monogamous sexual agreement and 24.6% were having an open relationship agreement. In adjusted models, partnered Chinese SMM were more likely to have received a recent HIV test (AOR = 1.47, 95%CI: 1.14-1.91). Bisexual men were less likely to have tested for HIV (AOR = 0.71, 95% CI: 0.53-0.96) or ever used PrEP compared to gay men (AOR = 0.56, 95% CI: 0.30-0.98). Among partnered SMM, those with an open relationship agreement were less likely to have tested for HIV in the past 6 months (AOR = 0.51, 95% CI: 0.28-0.94) and more willing to use PrEP for HIV prevention (AOR = 1.96, 95% CI: 1.19-3.22), compared to SMM in monogamous relationships.ConclusionsThese findings provided quantitative evidence and insights into the differences in HIV prevention service utilizations among SMM in China and suggest the need for tailored interventions for targeted sub-groups to address the unique sexual health needs of Chinese SMM.