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HIV-1 epidemics among MSM are a major public health concern in China, especially in large cities. This study sought to better understand the dynamics of HIV molecular epidemiology among MSM in Shenzhen, a rapidly developing city with over 13.8 million people. HIV-1 pol sequences were obtained from 996 (53.5%) of 1862 HIV-infected MSM and 403(9.0%) of 4498 heterosexuals and injection drug users in Shenzhen, China from 2005-2012. Eight HIV-1 subtypes and some inter-subtype recombinants were identified among sampled MSM with CRF07_BC (39.1%) and CRF01_AE (35.1%) being the most predominant. From 2006 to 2012, the prevalence of CRF07_BC and CRF55_01B rapidly increased, while the prevalence of subtypes B and CRF01_AE gradually decreased. The genetic distances within CRF07_BC and CRF55_01B groups were significantly lower than within CRF01_AE and B groups. The vast majority (90.3%) of HIV-1 infected MSM in Shenzhen were migrants who came from 31 of the 34 provinces of China, and these migrants had significantly different HIV-1 subtype distributions from the local MSM. This study highlighted the importance of CRF07_BC and migrants in the changing HIV epidemic among MSM in China, and provides a molecular epidemiology framework for understanding how HIV-1 epidemics can change in large cities with diverse risk groups.

The HIV epidemic among men who have sex with men (MSM) in China is becoming very serious. Unprotected anal intercourse (UAI) among MSM during cross-boundary commercial sex spread HIV across geographic areas. This study interviewed 186 Chinese male sex workers (MSW) in Shenzhen, China, serving cross-boundary Hong Kong male clients; 49.5% had had UAI with their Hong Kong male clients (last six months) and 24.2% intended to do so (future six months). Multivariate analyses showed that perceived efficacy of condom use for HIV prevention, perceived prevalence of HIV among Hong Kong MSM (>4%), and perceived ability to convince Hong Kong male clients to use condoms during anal sex were associated with lower likelihoods of UAI with such clients (OR = 0.04–0.09); the reverse was true for those who left the decision of condom use to their Hong Kong male clients (OR = 6.44). Perceived condom efficacy, self-efficacy in protection against HIV infection, and perceived control over condom use were associated with an intention for UAI (OR = 0.06–80.44). Adjusting for background variables, the scales representing contextual (Clients Characteristics, Substance Use, or Environmental Influences) and affective factors (Fear of Diseases) were associated with UAI (adjusted OR = 0.44–32.61). Except the Fear of Diseases scale, other scales were associated with an intention for UAI (adjusted OR = 4.59–43.32). MSW are at high risk of HIV transmission. Various factors are associated with UAI with male cross-boundary clients; these factors and the context of sex work need to be considered when designing HIV prevention programs. [ABSTRACT FROM AUTHOR]

We recruited 510 male sex workers (also referred as 'money boys' (MBs) and 533 other men who have sex with men (MSM) to investigate determinants of recent (last year) HIV testing in Shenzhen, China. Overall, 43% of MBs and 48% of other MSM reported having been tested for HIV in the last year. The most important determinant of testing among MBs was having multiple anal sex partners; among other MSM, the most important determinants were having a homosexual orientation and having a history of sexually transmissible infection. For MBs, education programs are needed to increase their awareness of actual HIV risk. For other MSM, destigmatising programs are needed. [ABSTRACT FROM AUTHOR]