High HIV Incidence Among Men Who Have Sex with Men in Eight Chinese Cities: Results from a Randomized Control Study Cohort

Wenting Huang1,2, Yehua Wang1,2, Haidong Lu3, Joseph D. Tucker1,2,4,5, Weiming Tang 1,2,6

1. University of North Carolina at Chapel Hill Project-China, Guangzhou, China;

2. SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China;

3. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA;

4. Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK;

5. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA;

6. Dermatology Hospital of Southern Medical University, Guangzhou, China


  • Globally, HIV epidemic is under well control among at-risk populations, except the men who have  sex with men (MSM).

  • In China, MSM is currently the only group that has a rapid increasing HIV infection (from 5.73% to 7.75% between 2010-2014).

  • Previous studies have observed the geographic regional disproportion of HIV prevalence in China.

  • This study aims to assess the HIV incidence rate among MSM in a large cohort study in eight cities in Guangdong and Shandong province.



  • This study is a secondary analysis of a stepped-wedged randomized controlled trial focusing on promoting HIV testing among Chinese MSM.

  • MSM from eight cities in Guangdong and Shandong Province were recruited and followed from July 2016 to August 2017.

  • Sexual behaviors and HIV testing activity were measured at baseline and during follow-up survey every three months. Participants who reported to have tested HIV at least twice during different follow-up periods were included in this analysis.

  • We defined HIV seroconversion as having an initial negative HIV testing result in any follow-up period and followed by a positive testing result at any subsequent tests during the study.

  • Cox regression were used to examine correlates with HIV seroconversion.



  • Overall, 1381 participants were enrolled into the stepped-wedged randomized controlled trial, among which 1219 participants have attended at least one follow-up survey and 755 reported had at least one HIV test during the study period. In this analysis, we included 347 participants whose first HIV testing was negative and at least tested twice during the study period.

  • We observed 25 HIV seroconversions among those 347 eligible participants, corresponding to a proportion of incidence of 7.2% and an incidence of 15.56 per 100 person-years (PY) among MSM. The observed incidence rate was 18.52 per 100 PY in Guangdong and 12.56 per 100 PY in Shandong, respectively.

  • Both having multiple female partners and having bisexual behaviors were associated with a increased risk of HIV infection.



  • The HIV incidence rates are high in both Guangdong and Shandong provinces, suggesting that the epidemic of HIV among MSM is growing in China.

  • This situation calls for more understands and better approaches to reach these men to promote HIV testing and safe sex practices.