The HIV Incidence And Risk Facts Among Student Men Who Have Sex With Men:a Prospective Cohort Study

Background: The HIV prevalence of men students who have sex with men(MSM)is increasing year by year.At present,domestic studies on HIV infection-related risk factors in MSM students are not in-depth enough,and most studies are cross-sectional studies,which can not obtain HIV incidence among students MSM.Objective: Cross-sectional studies were conducted to understand sexual characteristics,mental health status,HIV testing history and obstacles,sources of HIV health knowledge,levels of social software use,levels of HIV and syphilis infection and related risk factors among student MSM.A prospective cohort study was conducted to obtain HIV incidence among student MSM,and to master the risk factors for HIV incidence.Method: From June 2017 to December 2018,respondents were recruited through snowball and We Chat public accounts.The inclusion criteria of the respondents were MSM students aged 16 or above who reported having had anal/oral sex with males in the past six months,and who had no HIV test was positive and informed consent was given.HIV and syphilis status of the participants were tested by offline VCT laboratory testing and the online HIV/Syphilis self-test reagent.The questionnaire was collected through the self-filling electronic questionnaire collection software ‘gold data’,and the content of the questionnaire included social demography,sexual behavior,recreational drug use,HIV testing history,mental health status,HIV health knowledge source and other information.Open prospective cohort follow-up was conducted every 3 months among baseline HIV negative MSM students.Frequency and percentage were used to describe the behavioral characteristics of students MSM,and the distribution differences of social demography and sexual characteristics between HIV/syphilis positive and negative students MSM were analyzed by chisquare comparison.Multivariate logistic regression model was used to analyze the statistical correlation between behavioral characteristics and HIV infection.Multivariate COX regression model was used to analyze the correlation between the variables and new HIV infection.Results: A total of 672 MSM students were recruited in the baseline survey,with an average age of(21.1±2.4)years,84.8%(570/672)with bachelor’s degree or above,the average age of first same-sex was(18.7±2.3),and 38.4%(258/672)of first same-sex partner was non-student.In the past six months,87.4%(587/672)of students MSM mainly used social software to find same-sex sexual partners,81.3%(546/672)used Blued to find same-sex sexual partners,42.6%(286/672)had unprotected anal sex,6.0%(40/672)had group sex,9.4%(58/672)had drunk sex,37.8%(207/672)had anal bleeding,and 30.8%(207/672)had used recreational drugs.Among the MSM students,11.9%(80/672)had STD related symptoms and 7.9%(53/672)had STD diagnosed.In the past six months,41.8%(281/672)of MSM students had depression due to sexual orientation,15.0%(101/672)had been ridiculed and discriminated against by classmates,friends,relatives and others due to sexual orientation,and 22.6%(124/548)had suicidal thoughts due to sexual orientation.Among the MSM students,65.3%(439/672)had been tested for HIV,and the main reason(51.9%,121/233)for not having been tested for HIV was that they did not consider themselves at risk of HIV infection.Among the MSM students,30.7%(206/672)have the homosexual sex health education in their school,and the main(90.9%,611/672)source of HIV health knowledge received by the MSM students is the Internet.The prevalence of HIV among baseline MSM students was 3.7%(25/668),and that of syphilis was 3.6%(24/659).After adjusting for education,age,and place of residence,unprotected anal sex(AOR=5.0,95%CI=1.8-13.8),group-sex(AOR=4.7,95%CI=1.6-13.5),recreational drugs use(AOR=2.5,95%CI=1.1-5.7),existence of HIV-positive sexual partners(AOR=7.4,95%CI=1.1-48.7),and diagnosis of sexually transmitted diseases(AOR=2.9,95%CI=1.0-8.2)was an independent risk factor for HIV infection among MSM students.The first same-sex sexual partner was a non-student(vs.student)(AOR=3.1,95%CI=1.3-7.2);have multiple partner in the last half year(AOR=5.0,95%CI=1.5-17.0);used new drugs(AOR=2.7,95%CI=1.2-6.1);had STD symptoms(AOR=4.2,95%CI=1.7-10.3);had diagnosed STD(AOR=14.7,95%CI=6.2-35.3)was an independent risk factor for syphilis infection among MSM students.After excluding the MSM of baseline HIV antibody positive students,a total of 250(38.6%)participated in at least one prospective cohort follow-up,with a total follow-up time of 172.3 years and an average follow-up time of 0.7 years.There were 10 HIVpositive patients,and the new HIV incidence was 5.8/100 PY.Multivariate COX regression model analysis found that the first occupation with same-sex sexual partners was non-student(vs student)(AHR=7.1,95%CI=1.4-34.8).Unprotected anal sex(AHR=10.7,95%CI=1.3-86.7),drunk sex(AHR=14.7,95%CI=3.4-63.6),STD related symptoms(AHR=4.8,95%CI=1.4-16.6),depression(AHR=5.2,95%CI=1.2-21.3)are independent risk factors for HIV positive conversion in MSM students.Conclusion: Students MSM are young in the age of first homosexual sex,and have high-risk behaviors such as multiple sexual partners,anal bleeding,and use of new drugs,the rate of HIV testing is low,and there are different degrees of mental health problems.The prevalence of HIV and syphilis in students MSM was significantly higher than that in general students,and the risk factors for HIV and syphilis infection were non-condom sex,anal bleeding,group sex,and the use of recreational drugs.The incidence of HIV epidemic situation of MSM students is severe.The first homosexual partner is a non-student,who has unprotected sex,drunk sex and STD related symptoms,mental inferiority,depression are risk factors for HIV positive conversion.In the future,it is necessary to carry out a comprehensive homosexual sex health education on students’ MSM dangerous behaviors,strengthen the prevention and control measures of HIV/AIDS in students’ MSM,so as to curb the spread of HIV in students’ MSM.