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Many countries worldwide have implemented dedicated measures, such as shelter at home, to contain the spread of the COVID-19 virus. However, those mitigation measures may have major implications for individuals living with someone abusive or controlling. Domestic violence (DV) may be one of the unintended consequences of public health measures due to increased various stressors and reduced access to support and services. There has been a lack of empirical research on DV victimization among gender and sexual minorities, a population vulnerable to interpersonal violence and its associated adverse health outcomes. This study investigates the prevalence of DV victimization among men who have sex with men (MSM) in Jiangsu Province, China, during the COVID-19 lockdown and its correlates with COVID-19–related psychosocial and health stressors. A total of 413 MSM were recruited via snowball sampling, venue-based, and internet-based sampling from four cities in Jiangsu Province. After providing informed consent, all participants completed study questionnaires, followed by HIV testing. Over a quarter of the participants (27.4%) reported DV victimization during the COVID-19 lockdown, including experience of verbal, physical, or sexual abuse. After adjusting sociodemographic factors, DV victimization was associated with various adverse experiences during the COVID-19 lockdown, including increased stress or anxiety level, increased alcohol use, and housing instability. Study findings underscore the prevalence of DV victimization among MSM during the COVID-19 pandemic in China. The results can inform public health efforts to raise awareness and address DV victimization among MSM in the low- and middle-income country context during the COVID-19 pandemic. Adequate health and social services and economic resources are also critical to address the needs of MSM experiencing DV victimization.

Background: Studies have been conducted to assess the prevalence of undiagnosed HIV infections however, at present, there is no study that compares and evaluates the association of perceived HIV stigma, gay related enacted stigma, and undiagnosed HIV infections among MSM by geographic region in the United States (U.S). This ecological study identifies clusters of cities with similar stigma measures in the U.S. Methods: We conducted the analysis using data from National HIV Behavioral Surveillance (NHBS) collected during the 2017 MSM cycle. We used unsupervised machine learning procedure known as k-means clustering to identify clusters of cities with similar stigma measures. We also examined correlations between percentages of undiagnosed HIV infections both with perceived HIV stigma and gay related enacted stigma. In addition, we used American Community Survey (ACS), 2013-2017, data to characterize each city in terms of key population level characteristics. Results: Cities were grouped in two distinct clusters after the implementation of the clustering technique; each cluster was different in terms of their racial makeup. There was a moderate correlation (0.50) between percentage of perceived HIV stigma and undiagnosed HIV infections and a low correlation (0.23) between percentage of gay related enacted stigma and undiagnosed HIV infections among MSM. Conclusion: Stigma reduction interventions should be tailored by city to address the underlying HIV burden among MSM communities. This will not only improve the health of the MSM communities but the larger community as a whole. Future studies should include more cities from the Southern U.S and examine how stigma affects MSM populations, especially of color.

In light of recent advances in HIV prevention and treatment, we reviewed the literature to understand how different types of stigma impact HIV risk; access to HIV prevention, care, and treatment services; and related health outcomes among men who have sex with men (MSM) in the US. We conducted a scoping literature review of observational and qualitative studies that examined stigma and HIV-related outcomes among MSM. Our search identified 5794 studies, of which 47 met the eligibility criteria and were included in the final analysis. The review suggests that stigma remains a formidable barrier to engaging in HIV prevention and treatment among both HIV-negative and HIV-positive MSM. Among the studies of HIV-positive MSM, internalized stigma was related to lower levels of treatment engagement. HIV-positive MSM in the Southern part of the US were also more likely to engage in risky sexual behavior. Perceived health care discrimination was negatively associated with PrEP awareness, particularly among HIV-negative Black MSM. Among young MSM of color, intersectional stigma compounded the social structural barriers to PrEP adherence. Findings indicate that stigma reduction interventions should be implemented in diverse MSM communities to address the disproportionate burden of HIV along with critical gap in the care continuum. Further research should examine how individual types of stigma, including intersectional stigma, affect viral suppression and PrEP uptake and adherence, especially among MSM of color. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-021-03262-4.

Background HIV self-testing (HIVST) is a promising approach to expand HIV testing. HIVST is a process in which a person performs an HIV test and interprets the result. Negative HIVST results may encourage men who have sex with men (MSM) to use HIV prevention services. The objective of this study was to examine behaviors (e.g., facility-based HIV testing, condom use) after a negative HIVST test result among Chinese MSM. Methods We collected data from MSM in eight Chinese cities over a 12-month period. This is a secondary analysis of longitudinal cohort data collected as part of an intervention trial to increase HIV testing. Men completed a survey that described sociodemographic information, sexual behaviors, HIV self-testing, and facility-based HIV testing. Men who completed at least one follow-up survey were included in this analysis. Generalized linear mixed models were used to evaluate whether HIVST increased subsequent facility-based HIV testing and consistent condom use. Results We included 1219 men. Most men (78.7%) were under 30 years old and had never been married (87.0%). 755 (61.9%) men tested for HIV and 593 (49.3%) men self-tested during the study period. At baseline, among men who had never been tested for HIV, 44.9% (314/699) initiated HIVST during the study period. HIVST was associated with subsequent facility-based testing (aOR of 1.87, 95% CI: 1.47–2.37). HIVST was also associated with subsequent consistent condom use (aOR = 1.53, 95% CI: 1.13–2.06). Conclusion HIVST was associated with subsequent facility-based HIV testing and consistent condom use. HIVST may enhance uptake of related HIV prevention services at facilities, suggesting the need for more implementation research.

BACKGROUND: Although periodic chlamydia and gonorrhea testing is recommended for men who have sex with men (MSM), little is known about testing rates in China. This study examines chlamydia and gonorrhea testing rates and testing correlates among Chinese MSM. METHODS: An online survey of MSM was conducted in August 2017. Men aged 16 years or above who had ever had sex with a man were enrolled through a gay social networking mobile application. We asked men about their sexual behaviors, community engagement in sexual health, and previous testing for chlamydia, gonorrhea and HIV. Multivariable logistic regressions were used to examine the association of testing with community engagement and recent HIV testing. RESULTS: Of 1031 men, 819 (79.5%) were under 30 years of age, and 263 (25.5%) reported condomless sex in past three months. In total, 294 (28.5%) men tested for chlamydia, 315 (30.6%) men tested for gonorrhea, and 817(79.2%) men tested for HIV. One hundred and twenty-five (42.5%) men who received chlamydia testing and 134 (42.5%) men who received gonorrhea testing had substantial community engagement. Compared to men with no/minimal community engagement, men with substantial community engagement had greater odds of chlamydia testing (adjusted odds ratio [AOR] =2.8, 95%CI: 1.9–4.3) and gonorrhea testing (AOR=2.9, 95%CI: 2.0–4.4). Men with recent HIV testing were more likely to have received chlamydia testing (AOR=1.5, 95%CI: 1.1–2.0) and gonorrhea testing (AOR=1.6, 95%CI: 1.2–2.1). CONCLUSIONS: Chlamydia and gonorrhea testing levels are low among Chinese MSM. Integrating chlamydia and gonorrhea test promotion strategies into HIV prevention programs that engage MSM communities may help bridge the gap. SUMMARY: We found low chlamydia and gonorrhea lifetime testing rates among MSM in China and integrated STI/HIV testing programs that engage MSM may improve lifetime chlamydia and gonorrhea test uptake.

Background Adolescent sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection in adulthood among men who have sex with men (MSM) in high-income countries. This study aimed to examine adolescent and non-consensual anal sexual debut among Chinese MSM and to evaluate factors associated with adolescent sexual debut and non-consensual anal sex. Methods A cross-sectional study was conducted recently among Chinese men assigned male sex at birth, ≥18 years old, and who had ever engaged in anal sex with a man. Participants answered questions regarding socio-demographics, condomless sex, age at anal sexual debut with a man, and whether the first anal sex was consensual. Factors associated with an adolescent sexual debut ( Results Overall, 2031 eligible men completed the survey. The mean age of sexual debut was 20.7 (SD = 4.3) years old. 17.6% (358/2031) of men reported adolescent sexual debut, and 5.0% (101/2031) reported a non-consensual sexual debut. The adolescent sexual debut was associated with having more male sexual partners (adjusted OR 1.10, 95% CI 1.06–1.15) and condomless anal sex in the last three months (AOR = 1.71, 95% CI 1.34–2.18). MSM whose sexual debut was non-consensual were more likely to have condomless anal sex (AOR = 1.76, 95% CI 1.17–2.66), and to have reported an adolescent sexual debut (AOR = 2.72, 95% CI 1.75–4.21). Conclusions Many Chinese MSM reported adolescent sexual debut and non-consensual sex, both of which are associated with sexual risk behaviors and drive STI transmission. These findings highlight the need for designing tailored interventions for MSM who experienced adolescent sexual debut and non-consensual sex at debut.

Author(s): Smith, M Kumi; Xu, Richie H; Hunt, Shanda L; Wei, Chongyi; Tucker, Joseph D; Tang, Weiming; Luo, Danyang; Xue, Hao; Wang, Cheng; Yang, Ligang; Yang, Bin; Li, Li; Joyner, Benny L; Sylvia, Sean Y | Abstract: IntroductionNearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research.MethodsWe conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews.Results and discussionOur search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings.ConclusionsCombating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.

Background: Early sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection in adulthood among men who have sex with men (MSM) in high-income countries. This study aimed to examine early and non-consensual sexual debut among Chinese MSM and to evaluate factors associated with early sexual debut and non-consensual sex. Methods: A cross-sectional study was conducted in 2016 among Chinese men assigned male sex at birth, ≥18 years old, and who had ever engaged in anal sex with a man. Participants answered questions regarding socio-demographics, condomless sex, age at anal sexual debut with a man, and whether the first anal sex was consensual. Factors associated with an early sexual debut (Results: Overall, 2031 eligible men completed the survey. The mean age of sexual debut was 20.7 (SD=4.3) years old. 17.6% (358/2031) of men reported early sexual debut, and 5.0% (101/2031) reported a non-consensual sexual debut. The early sexual debut was associated with having more male sexual partners (adjusted OR 1.10, 95% CI 1.06–1.15) and condomless anal sex in the last three months (AOR=1.71, 95% CI 1.34-2.18). MSM whose sexual debut was non-consensual were more likely to have condomless anal sex (AOR=1.76, 95% CI 1.17-2.66), and to have reported an early sexual debut (AOR=2.72, 95% CI 1.75-4.21). Conclusions: Many Chinese MSM reported early sexual debut and non-consensual sex, both of which are associated with sexual risk behaviors and drive STI transmission. These findings highlight the need for designing tailored interventions for MSM who experienced early sexual debut and non-consensual sex at debut.

Social media interventions may enhance HIV services among key populations, including men who have sex with men (MSM). This longitudinal analysis examined the effect of recalling, sharing, and participating in different components of a social media intervention on HIV testing among MSM. The social media intervention included six images/texts and information about an online local community contest to promote testing. Of the 1033 men, they recalled a mean of 2.7 out of six images and shared an average of one image online. 34.5% of men recalled information on the online local community contest and engaged in a mean of 1.3 contest. Recalling images/texts (aOR = 1.13, 95% CI: 1.02–1.25) and recalling a local contest (aOR = 1.59, 95% CI: 1.13–1.24) were associated with facility-based HIV testing. This study has implications for the development and evaluation of social media interventions to promote HIV testing.

Background The World Health Organization recommends HIV self-testing (HIVST) as an additional approach to HIV testing services. We aimed to assess to what extent HIVST was conducted correctly by Chinese men who have sex with men (MSM) and to identify user errors during the HIVST process in order to inform strategies to optimize its use and thus reduce the number of undiagnosed HIV infections. Methods Between February and March 2017, participant observations were conducted with 27 MSM in an east coastal city in China. In the presence, but without the assistance or orientation, of a trained HIV testing counselor, participants conducted HIVST (either finger prick or oral fluid) according to manufacturers’ instructions. Errors were recorded on checklists during direct observation and double checked afterwards by reviewing video files of the observations. Results Overall, 12 participants (44.4%) had invalid test results due to user errors. Just five (18.5%) did not make any errors during the entire HIVST process. Failure to follow all the steps based on manufactures’ instructions was a common problem for both finger prick and oral fluid self-testers. For finger prick users, most errors occurred during the stage of collecting the specimen. In contrast, oral fluid users made most errors during the stage of testing the collected specimen. Conclusions Although we found that user errors were common among MSM administering HIVST, this should not deter or discourage routine implementation and scale-up of HIVST as strategies can be implemented to facilitate the correct use of HIVST. Trial registration This study was a part of a clinical trial: ClinicalTrials.gov (#NCT02999243); Registration date: December 20, 2016. Electronic supplementary material The online version of this article (10.1186/s12889-018-6007-3) contains supplementary material, which is available to authorized users.

Public health programmes are frequently developed by experts with limited feedback from communities.1 Crowdsourcing, allowing a group to solve a problem and then sharing the solution with the public, may help to improve public health programmes. Crowdsourcing can often take the form of participatory contests.2 Previous crowdsourcing contests have focused on producing individual components of communication programmes, such as videos,3 4 images5 6 or logos.7 However, crowdsourcing contests have not focused on designing the final programme and plan for implementation. The purpose of this project was to crowdsource the development of an HIV testing programme using a designathon. The concept of a crowdsourcing designathon is related to, but distinct from, a hackathon. Hackathons are intensive, approximately 72-hour contests that bring together young people to complete a task.8 9 For example, hackathons organised by a university have brought together students and others interested in technology to create a mobile application.10 Medical hackathons have challenged participants to create devices that help people with dementia, disability and other illnesses.9 11 12 We propose the concept of a crowdsourcing designathon, drawing on the principles of crowdsourcing in order to design a public health programme with strong community input. The purpose of this article is to describe a crowdsourcing designathon, summarise designathon outputs and discuss designathon implications for public health. The purpose of our crowdsourcing designathon was to develop a community-based HIV testing programme to be implemented in eight Chinese cities. This concept was influenced by theories of crowdsourcing13 and community-based participatory research.14 Our designathon was implemented in the following steps: forming a local steering committee; open call for participants; prepare for the event; 72-hour implementation; sustaining engagement and evaluation (table 1). View this table: Table 1 Stages of a designathon Our SESH (Social Entrepreneurship to Spur Health) group …

BACKGROUND: While research conducted among men who have sex with men (MSM) in high-income countries has demonstrated that negative mental health is one of the significant drivers of HIV infection, few studies have examined the status of mental health among MSM in China. We sought to describe depression and loneliness and identify their correlates among Chinese MSM. METHODS: A cross-sectional study was conducted among HIV-negative or unknown status MSM in 2014. Time-location sampling and online convenience sampling methods were employed. Depression was measured via a short version of CES-D (CES-D 10). Loneliness was measured from a single item in CES-D 10. Multivariable logistic regressions were conducted to identify independent correlates of depression and loneliness. RESULTS: A total of 507 individuals participated in the study. Of them, 26.8% and 35.5% reported moderate-to-severe symptoms of depression and feeling lonely, respectively. Depressed participants were more likely to have a sense of hopelessness for the future (AOR = 3.2, 95% CI: 1.9, 5.2) and report higher levels of internalized homophobia (AOR = 2.3, 95% CI: 1.47, 3.67). Participants who reported feeling lonely were more likely to have had condomless receptive anal intercourse in the past six months (AOR = 1.7, 95% CI: 1.1, 2.6) and feel hopeless for the future (AOR = 2.4, 95% CI: 1.6, 3.7). CONCLUSIONS: MSM in China have significant rates of depression and loneliness. HIV-prevention efforts should address the mental health needs of Chinese MSM such as providing safe environments for social support and role models.

BackgroundDespite strengthened efforts on HIV prevention and control, new HIV infections continue to increase among men who have sex with men (MSM) in China. Pre-exposure prophylaxis (PrEP), a highly effective HIV prevention tool, has recently been included in China’s Action Plan of HIV Prevention and Control. To inform future PrEP implementation, this study aims to identify the barriers and facilitators of PrEP intention among MSM in China. MethodsIn 2018, a cross-sectional survey was conducted among 300 MSM in Nanjing, Jiangsu Province. Questions on demographics, sexual behavior (including a 7-item high-risk behavior index), PrEP use intention, PrEP-related awareness and accessibility, and a 7-item public HIV stigma scale were included in the questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with PrEP intention. ResultsOverall, 44.67% had more than 2 male sexual partners and 5.56% had HIV-positive sexual partners. Just 57.00% had heard of PrEP and only 4 (1.33%) participants had used PrEP. However, 75.34% expressed a willingness to use oral PrEP if its efficacy was assured. Beliefs that ‘PrEP can prevent HIV if taken as prescribed’ (aOR=4.84, p p p =0.006). Respectively 77.00% of the participants would choose injectable or implanted PrEP instead of oral PrEP. One of the PrEP stigma items, ‘Not certain if doctors can prescribe PrEP if I go to the clinic’ was positively associated with the intention to use injectable or implanted PrEP (aOR=3.03). Individuals who had heard of PrEP (aOR=2.74) and believed ‘PrEP can prevent HIV if taken as prescribed’ (aOR=2.65) were also positively related to the intention to use injectable or implanted PrEP. The most common concerns regarding PrEP use were efficacy (44.67%) and side effects (38.67%). The most common reasons for using injectable and implanted PrEP were adherence (81.94% and 77.86%, respectively) and privacy concerns (56.48% and 55.00%, respectively). Affordable price and coverage of health insurance are the driving factors for using PrEP. ConclusionsGiven the relatively low awareness of PrEP-related information in China, interventions on awareness and knowledge targeting high risk individuals and communities are needed. Furthermore, additional alternatives to prevent HIV, such as long-acting injectable or implanted PrEP, should be investigated to reduce the risk of HIV infection in at-risk MSM. Particularly, it is necessary to develop a more supportive social environment for MSM when implementing PrEP programs that are approved by China’s FDA.

BackgroundAnticipated HIV stigma, i.e., the expectation of adverse experiences from one’s seroconversion, is associated with both negative psychological and behavioral outcomes. We know little about anticipated HIV stigma’s relationship with emerging technologies, such as HIV self-testing (HIVST) and online sex-seeking platforms, that have become popular among populations that are disproportionately affected by HIV/AIDS. This study examined correlates of anticipated HIV stigma among Chinese men who have sex with men (MSM).MethodsIn July 2016, MSM, who were ≥ 16 years old and self-reported as HIV negative or unknown, were recruited from a gay mobile phone application in China. Information regarding socio-demographics, sexual behaviors, sexual health service utilization, and anticipated HIV stigma were collected. Anticipated HIV stigma (i.e., negative attitude toward future stigmatization of HIV seroconversion by others) was measured as the mean score from a 7-item Likert-scale ranging from 1 (low) to 4 (high). Generalized linear models were conducted to examine the factors associated with the anticipated HIV stigma scores.ResultsOverall, 2006 men completed the survey. Most men completed high school (1308/2006, 65.2%) and had an annual personal income of ≤9200 USD (1431/2006, 71.3%). The mean anticipated HIV stigma score for the participants was 2.98 ± 0.64. Using social media to seek sexual partners was associated with higher anticipated HIV stigma (Adjusted β = 0.11, 95% confidence interval (CI): 0.05 to 0.17,p = 0.001). HIV self-testing (Adjusted β = − 0.07, 95%CI: − 0.13 to − 0.01,p = 0.02) and having disclosed one’s sexual orientation to a healthcare provider (Adjusted β = − 0.16, 95%CI: − 0.22 to − 0.96,p ConclusionOur data suggested that anticipated HIV stigma is still common among Chinese MSM not living with HIV. Tailored anti-HIV stigma campaigns on social media are especially needed, and the promotion of HIVST may be a promising approach.

BACKGROUND: Men who have sex with men (MSM) are a diverse population yet are often treated as a monolithic risk group. In China, MSM have long been characterized as a “bridge population” of closeted men who are married to (or will marry) women due to sociocultural expectations. Latent class models can inform a more nuanced yet empirical characterization of this population. METHODS: 1424 eligible respondents recruited online provided self-reported behavioral data. Nine items related to constructs including sexual behaviors, sexual orientation, and gender identity informed the latent class model. Logistic regression was used to measure associations between latent class membership and HIV-related sexual and health-seeking behaviors. RESULTS: Model fit indicated a population structure made up of four classes that we characterized as “Gender nonconforming” (4.3%), “Closeted-unmarried” (29.9%), “Closeted-married” (24.6%), and “Out” (41.2%). Members of the “gender nonconforming” class were more likely to report HIV-related risk behaviors, and “Closeted-unmarried” class members were less likely to report health-seeking behaviors, both relative to “Out” members. DISCUSSION: The largest latent class was made up of members of the “Out” class, an enlightening revision of a population traditionally viewed as largely closeted men. Two types of “closeted” classes emerged, distinguished by divergent tendencies regarding marriage and health seeking. Findings suggest that current understandings of Chinese MSM are simplistic (regarding closeted behaviors) and too narrow (in its definition of MSM as cisgender men). A more nuanced understanding of MSM subgroups and their heterogeneous risk behaviors will be critical for provision of more meaningful prevention services.

BACKGROUND Mobile health (mHeath)–based HIV and sexual health promotion among men who have sex with men (MSM) is feasible in low- and middle-income settings. However, many currently available mHealth tools on the market were developed by the private sector for profit and have limited input from MSM communities. OBJECTIVE A health hackathon is an intensive contest that brings together participants from multidisciplinary backgrounds to develop a proposed solution for a specific health issue within a short period. The purpose of this paper was to describe a hackathon event that aimed to develop an mHealth tool to enhance health care (specifically HIV prevention) utilization among Chinese MSM, summarize characteristics of the final prototypes, and discuss implications for future mHealth intervention development. METHODS The hackathon took place in Guangzhou, China. An open call for hackathon participants was advertised on 3 Chinese social media platforms, including Blued, a popular social networking app among MSM. All applicants completed a Web-based survey and were then scored. The top scoring applicants were grouped into teams based on their skills and content area expertise. Each team was allowed 1 month to prepare for the hackathon. The teams then came together in person with on-site expert mentorship for a 72-hour hackathon contest to develop and present mHealth prototype solutions. The judging panel included experts in psychology, public health, computer science, social media, clinical medicine, and MSM advocacy. The final prototypes were evaluated based on innovation, usability, and feasibility. RESULTS We received 92 applicants, and 38 of them were selected to attend the April 2019 hackathon. A total of 8 teams were formed, including expertise in computer science, user interface design, business or marketing, clinical medicine, and public health. Moreover, 24 participants self-identified as gay, and 3 participants self-identified as bisexual. All teams successfully developed a prototype tool. A total of 4 prototypes were designed as a mini program that could be embedded within a popular Chinese social networking app, and 3 prototypes were designed as stand-alone apps. Common prototype functions included Web-based physician searching based on one’s location (8 prototypes), health education (4 prototypes), Web-based health counseling with providers or lay health volunteers (6 prototypes), appointment scheduling (8 prototypes), and between-user communication (2 prototypes). All prototypes included strategies to ensure privacy protection for MSM users, and some prototypes offered strategies to ensure privacy of physicians. The selected prototypes are undergoing pilot testing. CONCLUSIONS This study demonstrated the feasibility and acceptability of using a hackathon to create mHealth intervention tools. This suggests a different pathway to developing mHealth interventions and could be relevant in other settings.

Background Mobile health (mHeath)–based HIV and sexual health promotion among men who have sex with men (MSM) is feasible in low- and middle-income settings. However, many currently available mHealth tools on the market were developed by the private sector for profit and have limited input from MSM communities. Objective A health hackathon is an intensive contest that brings together participants from multidisciplinary backgrounds to develop a proposed solution for a specific health issue within a short period. The purpose of this paper was to describe a hackathon event that aimed to develop an mHealth tool to enhance health care (specifically HIV prevention) utilization among Chinese MSM, summarize characteristics of the final prototypes, and discuss implications for future mHealth intervention development. Methods The hackathon took place in Guangzhou, China. An open call for hackathon participants was advertised on 3 Chinese social media platforms, including Blued, a popular social networking app among MSM. All applicants completed a Web-based survey and were then scored. The top scoring applicants were grouped into teams based on their skills and content area expertise. Each team was allowed 1 month to prepare for the hackathon. The teams then came together in person with on-site expert mentorship for a 72-hour hackathon contest to develop and present mHealth prototype solutions. The judging panel included experts in psychology, public health, computer science, social media, clinical medicine, and MSM advocacy. The final prototypes were evaluated based on innovation, usability, and feasibility. Results We received 92 applicants, and 38 of them were selected to attend the April 2019 hackathon. A total of 8 teams were formed, including expertise in computer science, user interface design, business or marketing, clinical medicine, and public health. Moreover, 24 participants self-identified as gay, and 3 participants self-identified as bisexual. All teams successfully developed a prototype tool. A total of 4 prototypes were designed as a mini program that could be embedded within a popular Chinese social networking app, and 3 prototypes were designed as stand-alone apps. Common prototype functions included Web-based physician searching based on one’s location (8 prototypes), health education (4 prototypes), Web-based health counseling with providers or lay health volunteers (6 prototypes), appointment scheduling (8 prototypes), and between-user communication (2 prototypes). All prototypes included strategies to ensure privacy protection for MSM users, and some prototypes offered strategies to ensure privacy of physicians. The selected prototypes are undergoing pilot testing. Conclusions This study demonstrated the feasibility and acceptability of using a hackathon to create mHealth intervention tools. This suggests a different pathway to developing mHealth interventions and could be relevant in other settings.

BackgroundThe World Health Organization has recommended HIV self-testing (HIVST) as an alternative testing strategy given the limitations of facility-based testing. While the benefits of HIV self-testing have been demonstrated at the individual level among men who have sex with men (MSM), limited data exist on if this testing approach can be effectively diffused through individuals' social or sexual networks. The objectives of this study were to examine patterns and correlates of HIVST distribution within Chinese MSM's sexual networks.MethodsData used for this analysis was a part of the process evaluation of an HIVST intervention trial among MSM in Nanjing, China. Between May and October 2017, we enrolled 400 men into the trial. Participants assigned to the intervention group (N = 200) were given three HIVST kits at baseline and could request more during the follow-up periods. We incorporated measures for process evaluation in the self-administered online follow-up surveys. This analysis reported findings from the three-month follow-up survey in the intervention group. Frequencies and percentages were used to describe characteristics of participants who distributed kits to their sexual partners as well as patterns of distribution. Multivariable logistic regression was conducted to identify independent correlates of participants who distributed the kits.ResultsOf the 177 participants retained (88.5%) at the three-month follow-up, 72 (40.7%) distributed one or more kits to either primary or casual partners. About half of distributors (51.4%) gave one HIVST kit to their sexual partners while 15.3% distributed 3 or more. Over half gave these kits (58.3%) to primary sexual partners while 27.8% reported giving the kits to both primary and casual partners. About half (54.2%) of distributors used the kits together with their partners. Compared to participants who had an HIV test in the past six months, those who tested over six months ago or never tested had significantly lower odds of distributing the kits (AOR = 0.484, 95% CI: 0.250-0.983, p = 0.032). Compared to those who had not used the kits themselves, participants who did had significantly higher odds of distributing the kits (AOR = 3.345, 95% CI: 1.488-7.517, p = 0.003). Participants who reported higher HIV testing efficacy had 2.051 fold greater odds (95% CI: 1.062-3.961, p = 0.033) of distributing the kits compared to those who had lower efficacy.ConclusionOur study demonstrated that a sexual network-based approach to distributing HIVST among Chinese MSM is feasible and can be a promising strategy to improve the effectiveness of HIVST programs including its reach to untested men. Such approach should be complimented by intervention components that enhance HIV testing efficacy and improve experiences of HIVST.

Background Early sexual debut and non-consensual sex among men who have sex with men (MSM) may contribute to adult high-risk behaviors and STI transmission. Most knowledge about early MSM sex comes from high-income countries. This study examined the prevalence and factors associated with the early sexual debut and non-consensual sex at sexual debut among Chinese MSM. Methods An online cross-sectional study was conducted among MSM who were born as a male, ≥16 years-old, and ever engaged in anal sex with a man in China in 2016. Participants answered questions regarding sociodemographics, condomless sex, and HIV testing history. Early sexual debut was defined as having anal sex before 18. Non-consensual sex was defined as “where a person do sexual things to you that you did not want them to do.” Multivariable logistic regression was used to identify factors associated with the early sexual debut and non-consensual sex. Results Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. The mean age of sexual debut was 20.82 (SD=5.30) years. About one-fifth (20.1%, 424/2105) of men experienced early sexual debut, and 4.9% (104/2105) experience non-consensual sex at sexual debut. Results from multivariable logistic regression models showed that early sexual debut was associated with having more male partners in the last three months (adjusted OR 1.08 [95% CI 1.04–1.13]) and condomless sex in the last three months (1.49 [1.18–1.89]). MSM whose sexual debut was non-consensual were more likely to have tested for HIV (1.56 [1.01–2.42]), have had recent condomless sex (1.70 [1.13–2.56]), and to experience early sexual debut (2.54 [1.65–3.89]). Conclusion Many Chinese MSM experience early sexual debut and non-consensual sex at sexual debut. Given the limited coverage of sexual health education in China, this has implications for expanding education and research about sexuality among youth. Disclosure No significant relationships.

Background Crowdsourcing method is an excellent tool for developing tailored interventions to improve sexual health. We evaluated the implementation of an innovation contest for sexual health promotion in China. Methods We organized an innovation contest over three months in 2014 for Chinese individuals Results We received 96 image submissions from 76 participants in 10 Chinese provinces. Most participants were youth ( Conclusion Innovation contests may useful for soliciting images as a part of comprehensive sexual health campaigns in low- and middle-income countries. Future sexual health campaigns should incorporate face-to-face interactions where participants can ask questions and solicit feedback about their submission ideas. Disclosure No significant relationships.

PURPOSE OF REVIEW: This review synthesizes evidence on the use of crowdsourcing to improve HIV/sexual health outcomes. RECENT FINDINGS: We identified 15 studies, including four completed randomized controlled trials (RCTs), one planned RCT, nine completed observational studies, and one planned observational study. Three of the four RCTs suggested that crowdsourcing is an effective, low-cost approach for improving HIV testing and condom use among key populations. Results from the observational studies revealed diverse applications of crowdsourcing to inform policy, research, and intervention development related to HIV/sexual health services. SUMMARY: Crowdsourcing can be an effective tool for informing the design and implementation of HIV/sexual health interventions, spurring innovation in sexual health research, and increasing community engagement in sexual health campaigns. More research is needed to examine the feasibility, acceptability, and effectiveness of crowdsourcing interventions, particularly in low- and middle-income countries.