HIV Serostatus Disclosure Among Men Who Have Sex with Men in China in the Era of U=U and PrEP

Abstract

Given the recent evidence on "Undetectable = Untransmittable" (U=U) and pre-exposure prophylaxis (PrEP), the present study aimed to investigate HIV disclosure behaviors and their associations with sexual risk behaviors and U=U and PrEP awareness among men who have sex with men (MSM) in China. A cross-sectional survey was conducted among 689 MSM recruited through a gay-friendly non-governmental organization located in Chengdu, China in 2018-2019. Information was collected by a structured self-administrated questionnaire. The enrolled sample included 554 (80.4%) participants who were HIV-negative and 135 (19.6%) participants with an unknown HIV status. In terms of disclosure, 41.4% of participants informed all partners about their HIV status all the time (informing behavior), while 30.4% asked all partners about their HIV status all the time (asking behavior). Only one-fifth knew about U=U, but this was not statistically associated with either informing or asking behavior. Half (50.5%) had heard of PrEP but this was not statistically associated with either informing or asking behavior. Common barriers to informing and asking behaviors were lower risk perception of HIV infection, a history of sexually transmitted infections, engagement in receptive sex, and a history of sex with casual partners. We found that both U=U and PrEP awareness and HIV serostatus disclosure were infrequent and not associated in this study of Chinese MSM. These data indicate huge information gaps among MSM in China.

Keywords: Antiretroviral therapy; China; HIV; Men who have sex with men (MSM); Pre-exposure prophylaxis (PrEP); Serostatus disclosure; Treatment as prevention (TasP); Undetectable = Untransmittable (U=U).

Fig. 1

Significant variables for HIV serostatus disclosure among men who have sex with men in Chengdu, China. Variables presented in the figure were statistically significant at the 5% level in multivariate models (Table 3), those underlined variables were significant variables for both informing and asking behaviors.