Association of demographics and psychological barriers with late presentation of HIV among men who have sex with men in Chengdu, China

In China, despite the improved availability of diagnostic services, men who have sex with men (MSM) still face high HIV risk and barriers to timely diagnosis due to internalized homophobia, self-stigma, and other potential factors. This study aimed to explore these factors and how they associated to late presentation (LP) of HIV among MSM in Chengdu, China. Characteristics of participants were collected by face-to-face interviews, including demographics, sexual behaviors, mental health, HIV knowledge, self-stigma, and internalized homophobia. Baseline CD4 at first presentation was obtained from the national integrated AIDS prevention and control information system. Logistic regression analysis was applied to analyze factors associated with LP (defined as a baseline CD4 count < 350 cells/µL). A total of 285 HIV-positive MSM participants were included, 56.5% were classified as late presenters (LPs). Multivariate regression analyses suggested that higher levels of internalized homophobia and self-stigma are positively associated with LP of HIV (both p < 0.001). Other linked factors included lower educational attainment (p = 0.039) and inadequate HIV-related knowledge (p < 0.001). Additionally, using severe anxiety as the reference group, individuals without anxiety symptoms showed an 86% lower likelihood of LP (p = 0.045, 95% CI: 0.02-0.96). Psychological barriers and a lack of related education are the potential barriers for LP of HIV among MSM in Chengdu, China. Interventions should focus on reducing homophobia and stigma while enhancing mental health support and HIV education to promote timely HIV testing in MSM.